The couples life story approach: a dyadic intervention for dementia.

This article describes an approach for working with individuals who have dementia, along with their spouses or partners. The 5-week intervention focuses on helping couples communicate, reminisce about the story of their relationship, find photographs and mementoes from their past, and develop a book that incorporates these mementoes. This clinical approach highlights the strengths and the resilience of couples and adds to the limited repertoire of dyadic interventions for dementia care which are currently available. Preliminary findings from 24 couples are presented, including the intervention's feasibility and acceptability.

Identifying the gap between need and intervention for alcohol use disorders in Europe.

AIMS: A literature review of existing research on the prevalence of alcohol use disorders (AUDs) and availability of alcohol interventions in Europe was conducted. The review also explored what is known about the gap between need and provision of alcohol interventions in Europe. METHODS: The review search strategy included: (i) descriptive studies of alcohol intervention systems in Europe; (ii) studies of alcohol service provision in Europe; and (iii) studies of prevalence of AUD and alcohol needs assessment in Europe. RESULTS: Europe has a relatively high level of alcohol consumption and the resulting disabilities are the highest in the world. Most research on implementation of alcohol interventions in Europe has been restricted to screening and brief interventions. Alcohol needs assessment methodology has been developed but has not been applied in comparative studies across countries in Europe. CONCLUSIONS: This review points to key gaps in knowledge related to alcohol interventions in Europe. There is a lack of comparative data on variations in alcohol treatment systems across European countries and there is also a lack of comparative data on the prevalence of alcohol use disorders across European countries and the relative gap between need and access to treatment. The forthcoming Alcohol Measures for Public Health Research Alliance (AMPHORA) research project work package on 'Early identification and treatment' aims to address these gaps.

Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne): implementation of an early intervention programme for psychosis in Switzerland.

AIM: In a survey conducted in the Lausanne catchment area in 2000, we could estimate on the basis of file assessment that first-episode psychosis (FEP) patients had psychotic symptoms for more than 2 years before treatment and that 50% did not attend any outpatient appointment after discharge from hospital. In this paper, we describe the implementation of a specialized programme aimed at improving engagement and quality of treatment for early psychosis patients in the Lausanne catchment area in Switzerland. METHOD: The Treatment and Early Intervention in Psychosis Program-Lausanne is a comprehensive 3-year programme composed of (i) an outpatient clinic based on assertive case management; (ii) a specialized inpatient unit; and (iii) an intensive mobile team, connected for research to the Center for Psychiatric Neuroscience. RESULTS: Eight years after implementation, the programme has included 350 patients with a disengagement rate of 9% over 3 years of treatment. All patients have been assessed prospectively and 90 participated in neurobiological research. Based on this experience, the Health Department funded the implementation of similar programmes in other parts of the state, covering a total population of 540 000 people. CONCLUSION: Programmes for early intervention in psychosis have a major impact on patients' engagement into treatment. While development of mobile teams and assertive case management with specific training are crucial, they do not necessitate massive financial support to be started. Inclusion of a research component is important as well, in terms of service planning and improvement of both quality of care and impact of early intervention strategies.

Psychological needs of adolescents in the early phase of bipolar disorder: implications for early intervention.

Aim: This paper will describe the rationale for, and importance of, psychological interventions for young people early in the course of bipolar disorder. Methods: Emerging literature in this field will be discussed in addition to describing specific clinical challenges and opportunities with this population. Results: In order to be more developmentally appropriate for young people with bipolar disorder, eight aspects of clinical work which may require modification were identified. Conclusions: The evidence base for the effectiveness of psychological interventions for people diagnosed with bipolar disorder is growing. However, some aspects relating to working with adults with bipolar disorder require modification to be effective in working with young people early in the course of the disorder.

Anticipatory pleasure skills training: a new intervention to reduce anhedonia in schizophrenia.

PURPOSE: Anhedonia is a challenging symptom of schizophrenia and remains largely recalcitrant to current pharmacological treatments. The goal of this exploratory pilot study was to assess if a cognitive-sensory intervention could improve anticipatory pleasure. DESIGN AND METHODS: Five participants meeting the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) criteria for schizophrenia, presenting severe anhedonia and stabilized on atypical antipsychotic medication, received between 10 hours and 25 hours of training. FINDINGS: Results show that the patients improved on the anticipatory scale of the Temporal Experience of Pleasure Scale. Daily activities of the patients were also increased. PRACTICE IMPLICATIONS: These preliminary data need to be interpreted with caution given the small sample of the study, but they offer promising paths to develop new interventions to alleviate anhedonia in schizophrenia.

Comparison of clinical and angiographic prognostic risk scores in elderly patients presenting with acute coronary syndrome and referred for percutaneous coronary intervention.

BACKGROUND: Multiple risk prediction models have been validated in all-age patients presenting with acute coronary syndrome (ACS) and treated with percutaneous coronary intervention (PCI); however, they have not been validated specifically in the elderly. METHODS: We calculated the GRACE (Global Registry of Acute Coronary Events) score, the logistic EuroSCORE, the AMIS (Acute Myocardial Infarction Swiss registry) score, and the SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score in a consecutive series of 114 patients ≥75 years presenting with ACS and treated with PCI within 24 hours of hospital admission. Patients were stratified according to score tertiles and analysed retrospectively by comparing the lower/mid tertiles as an aggregate group with the higher tertile group. The primary endpoint was 30-day mortality. Secondary endpoints were the composite of death and major adverse cardiovascular events (MACE) at 30 days, and 1-year MACE-free survival. Model discrimination ability was assessed using the area under receiver operating characteristic curve (AUC). RESULTS: Thirty-day mortality was higher in the upper tertile compared with the aggregate lower/mid tertiles according to the logistic EuroSCORE (42% vs 5%; odds ratio [OR] = 14, 95% confidence interval [CI] = 4-48; p <0.001; AUC = 0.79), the GRACE score (40% vs 4%; OR = 17, 95% CI = 4-64; p <0.001; AUC = 0.80), the AMIS score (40% vs 4%; OR = 16, 95% CI = 4-63; p <0.001; AUC = 0.80), and the SYNTAX score (37% vs 5%; OR = 11, 95% CI = 3-37; p <0.001; AUC = 0.77). CONCLUSIONS: In elderly patients presenting with ACS and referred to PCI within 24 hours of admission, the GRACE score, the EuroSCORE, the AMIS score, and the SYNTAX score predicted 30 day mortality. The predictive value of clinical scores was improved by using them in combination.

L'« Intervention systémique brève » : un manuel thérapeutique

Evaluer l'efficacité d'une thérapie ne devrait pas se limiter à en étudier l'impact sur différentes dimensions pertinentes. En effet, la recherche en psychothérapie insiste sur l'importance de développer des manuels thérapeutiques, afin de décrire ce que les thérapeutes font et donc comprendre ce qui est efficace, ainsi que des protocoles d'adhérence à ces manuels, afin de pouvoir évaluer si les intervenants font effectivement ce qu'ils prétendent faire. Cet article présente le manuel thérapeutique de l'Intervention systémique brève (ISB), un modèle d'intervention en six séances, utilisé dans une consultation pour couples et familles au Département de psychiatrie du CHUV à Lausanne. Ce modèle fait l'objet d'une recherche visant à évaluer son efficacité à court et moyen termes, au moyen de questionnaires remplis par les patients, évaluant différents niveaux : 1) les symptômes individuels, 2) la satisfaction conjugale, 3) la qualité des relations parentales, 4) la qualité des relations coparentales et 5) les relations familiales. L'ISB est un modèle intégratif des principales écoles de thérapie familiale systémique. Pour élaborer le manuel de l'ISB, nous nous sommes basés sur certains principes généraux communs aux différentes approches systémiques. La difficulté d'élaborer un tel manuel thérapeutique intégratif systémique sera discutée.