A controlled randomized study on the efficacy of short-term dinamic psychotherapy in borderline personality disorders (BPD). Preliminary results [Meeting Abstract]
Introduction: Four psychotherapies have been recognized as effective with scientific evidence for the treatment of BPD, but are long term techniques. It is necessary to explore new time limited psychotherapies in order to be more accessible. We have developed a specific manualized psychotherapy for BPD named Psychic Representation focused Psychotherapy (PRFP) Objectives: To assess the efficacy of the PRFP in BPD in an outpatient care setting compared to a control group receiving psychiatric treatment as usual in several specific symptoms and in diminishing the disability due to the illness. Methods: 60 subjects with BPD were randomized to one of the two treatment groups. The study group has received PRFP with 20 sessions on a weekly basis; the control group has received treatment as usual. Both groups may receive psychopharmacological treatment. The assessment is done in four time-points: at baseline, after the psychotherapy or conventional treatment (six months), and at a six and twelve month's follow-up period. Results: Preliminary results of the first 30 patients (control group 17, experimental group 13, without significant differences, Age 18-35 years; 70% women) assessed at the baseline and at the end of the intervention (six months). Experimental group reached a statistically significant clinical improvement over the controls in all measured variables: Scales: SCL-90; Zanarini ; MDRS; Barrat; STAI anxiety state; Rosemberg self-esteem and SASS social adaptation. Conclusion: The preliminary results are encouraging and reveal that this method could be effective. This study state the interest in develop more studies about time limited psychotherapy for BPD
Brain SPECT Imaging in Complex Psychiatric Cases: An Evidence-Based, Underutilized Tool
Over the past 20 years brain Single Photon Emission Computed Tomography (SPECT) imaging has developed a substantial, evidence-based foundation and is now recommended by professional societies for numerous indications relevant to psychiatric practice. Unfortunately, SPECT in clinical practice is utilized by only a handful of clinicians. This article presents a rationale for a more widespread use of SPECT in clinical practice for complex cases, and includes seven clinical applications where it may help optimize patient care.
Emergency psychiatry in the twenty-first century
Emergency psychiatry was once deemed a necessary component of psychiatric care but not a preferred specialty interest. The practice of psychotherapy with or without psychopharmacotherapy was the usual career choice. Today with decreasing hospital stays, rising acuity of patients presenting for crisis care and the increasing comorbidity occurring with a particular disorder demands that all primary care providers and mental health professionals have some emergency psychiatric skill.
Multicultural aspects of mental health
Health disparities, defined as population-specific differences in the prevalence, onset, severity of disease, and differential access to health care, is a rising issue in the mental healthcare debate. The populations most seriously affected by adverse health disparities include protected minorities who often seek and receive care through language and cultural barriers. This article discusses a body of knowledge, skills, and attitudes which can help clinicians bridge the care gaps created by such barriers. The article highlights means to overcome these barriers while performing diagnostic interviews, completing mental status examinations, and selecting and implementing pharmacologic and psychosocial treatments.
Assessment of spirituality and its relevance to addiction treatment
The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders. We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers. This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs. Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery. Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities
Intensive dynamic psychotherapy of anxiety and depression
Though considerable progress has been made in the treatment of anxiety and depressive disorders over the last 2 decades, many patients either fail to achieve remission or struggle with burdensome residual symptoms and personal conflicts. This article describes the application of short-term, psychoanalytically based, dynamic psychotherapy for the treatment of these prevalent psychiatric disorders. The article describes the psychodynamic views of anxiety and depression, the criteria for the selection of patients for these treatments, and the delineation of the spectrum psychotherapeutic techniques that are used to foster the resolution of the unconscious dynamic conflicts which generate, or maintain, anxiety or depressive experiences. In addition, recent meta-analysis of the application of short-term dynamic psychotherapies for the treatment of anxiety and depressive disorders have demonstrated efficacy comparable to psychopharmacology and cognitive-behavioral trials. Case examples and descriptions of the clinical process of therapy are provided. (journal abstract)
Psychotherapy and the suicidal patient
Considerable advances have been made since the mid-20th century in understanding and treating the suicidal patient. Self-inflicted death is the fourth leading cause of death in adults 18-65 years of age. Approximately 25,000-30,000 individuals kill themselves annually. The most outstanding advances in care of suicidal patients are due to both the better understanding of the neurochemistry of impulsive violence and to the development of psychopharmacotherapy and psychotherapies that target disorders associated with increased risk. (journal abstract)
Philadelphia, PA, US: Lippincott Williams & Wilkins Publishers, 2006
Evaluation of a model for the treatment of combined mental illness and substance abuse: the Bellevue model for peer-led treatment in systems change
The present study evaluated a model program at Bellevue Hospital Center incorporating a peer-led self-help (PLSH) approach which can be applied to bring about systems-level change in a variety of settings where persons with dual diagnosis are encountered. A total of 461 consecutive MICA inpatient admissions were evaluated to compare the PLSH unit with two standard psychiatric units. The PLSH program was associated with a higher rate of acceptance of aftercare referral (93% vs. 74%) and aftercare attendance (52% vs. 30%) among patients with no prior psychiatric hospitalizations (N = 111). In addition, the PLSH program appeared to benefit chronically impaired MICA patients (N = 350) or those with a history of prior psychiatric hospitalizations, as they were more likely to accept referral to aftercare treatment than were chronic patients discharged from the standard psychiatric units (96% vs. 81%). Such a program, when more widely applied, could yield decreased recidivism and considerably lower medical, psychiatric, and economic cost
Network therapy for cocaine abuse: use of family and peer supports
Cocaine-dependent subjects were treated by psychiatric residents in a 24-week sequence of Network Therapy. This approach, developed for practitioners in solo practice, employs a cognitive-behavioral orientation in sessions with family and peers as well as in individual sessions. Of 47 subjects, 73% of all observed weekly urines were negative for cocaine, and 20 (45%) of the subjects had negative toxicologies in the last 3 scheduled samples. A positive outcome was associated with the number of network (but not individual) sessions attended and completion of the full treatment sequence. Results suggest the utility of Network Therapy, even in the hands of relatively naive therapists