Olfactory bulb volume predicts therapeutic outcome in major depression disorder

The volume of the olfactory bulb (OB) is strongly reduced in patients with major depressive disorder (MDD) and this group exhibits markedly decreased olfactory function. It has been suggested that olfactory input is important for maintaining balance in limbic neurocircuits. The aim of our study was to investigate whether reduced OB volume is associated with response to therapy in MDD. Twenty-four inpatients (all women, age 21-49 years, mean 38 ± 10 years SD) with MDD and 36 healthy controls (all women, age 20-52 years, mean 36 ± 10 years SD) underwent structural MRI. OB volume was compared between responders (N = 13) and non-responders (N = 11) to psychotherapy. Retest of OB volume was performed about 6 months after the end of therapy in nine of the patients. Therapy responders exhibited no significant difference in OB volume compared to healthy controls. However, average OB volume of non-responders was 23 % smaller compared to responders (p = .0011). Furthermore, OB volume was correlated with the change of depression severity (r = .46, p = .024). Volume of the OB did not change in the course of therapy. OB volume may be a biological vulnerability factor for the occurrence and/or maintenance of depression, at least in women.

Transiente Globale Amnesie versus Transiente Ischämische Attacke – Klinik und Schlaganfallrisiko

Transient global amnesia versus transient ischaemic attack: clinical presentation and cerebral vascular accident risk Transient global amnesia is an acute, benign, isolated and temporarily limited disturbance of memory, that can occur repeatedly but shows no increased risk of cardiovascular events or stroke in particular. Therefore, patients with the typical clinical presentation and a normal brain magnetic resonance-scan require neither further diagnostic nor therapeutic interventions. Since the differential diagnosis of transient global amnesia is wide, and transient ischaemic attacks can present similarly, a careful clinical evaluation and neuroimaging is recommended. In any case of doubt further diagnostic steps according to stroke workup should be initiated. In contrast, a transient ischaemic attack represents a neurological emergency where clinical and diagnostic evaluation must be introduced fast. The rapid establishment of therapeutic and secondary preventive measures decreases the clearly elevated stroke risk and prevents disability.

The shorter the better? A follow-up analysis of 10-session psychiatric treatment including the motive-oriented therapeutic relationship for borderline personality disorder

OBJECTIVE: There is little research on short-term treatments for borderline personality disorder (BPD). While the core changes may occur only in long-term treatments, short-term treatments may enable the study of early generic processes of engagement in therapy and thus inform about effective treatment components. It was shown that a 10-session version of a psychiatric treatment was effective in reducing borderline symptoms at the end of this treatment [Kramer, U., Kolly, S., Berthoud, L., Keller, S., Preisig, M., Caspar, F., … Despland, J.-N. (2014). Effects of motive-oriented therapeutic relationship in a ten-session general psychiatric treatment for borderline personality disorder: A randomized controlled trial. Psychotherapy and Psychosomatics, 83, 176-186.]. Also, it was demonstrated in a randomized design that adding the motive-oriented therapeutic relationship (MOTR), following an individualized case formulation based on Plan Analysis, further increased general outcome after session 10 and had a positive effect on the early changes in self-esteem and alliance. METHOD: The present study focuses on the follow-up period after this initial treatment, examining treatment density and outcomes after 6 months and service utilization after 12 months. Outcome was measured using the OQ-45. RESULTS: Results on a sub-sample of N = 40 patients with available OQ-45 data at follow-up (n = 21 for MOTR-treatment, n = 19 for comparison treatment) showed maintenance of gains over the follow-up period, which did not differ between both conditions. It appeared for this sample that MOTR treatments, while using the same number of sessions, lasted more weeks (i.e., lower treatment density, defined as the number of sessions per week), when compared to the treatments without MOTR. Density marginally predicted symptom reduction at follow-up. Patients in MOTR treatments had a greater likelihood of entering structured psychotherapy after the initial sessions than patients in the comparison group. CONCLUSIONS: These results are overall consistent with earlier studies on short-term treatments for BPD and underline the importance of individualizing interventions, by using case formulations that rely on idiographic methods and integrative concepts.

Using technology to enhance decision making

We focus here on decision making in the everyday clinical situation and do not address decision making in politics and administration, although obviously it affects clinical practice and vice versa. For example, decisions against providing sufficient face-to-face psychotherapy is one factor that may increase the demand for Internet therapy, and vice versa—that is, the use of technology for therapy, as in Internet therapy, might influence to what extent face-to-face therapy needs to be provided. It is obvious that the aggregation of information for political and administrative decisions can take advantage of technology. If technology is used professionally, this should contribute to better informed decisions and less dependency on information provided by lobbyists who might not work in the interest of high-quality service for those who need it. An optimistic view is thus that technology works in favor of patients on this level as well. In the interest of keeping the focus of this chapter manageable, we also do not address treatments fully delivered over the Internet or computers, as for the example described in Comer and Barlow (2014), although such treatments, as they unfold, of course also include decision making.

Therapists under influence – Patient strategies and therapist reactions

Therapists having a positive influence on patients is a common view of psychotherapy. There is, however, an influence of patients on therapists too, which has received less attention. The more restricted and rigid patients are, the more limited the interpersonal behavior of others with which the get along well. In line with social psychological, interpersonal and clinical models they try to bring the therapist into an interpersonal position which suits them well. With 60 patients, common strategies have been rated: Good mood, Positive feedback, Negative feedback, Agenda setting, Provoking a response from the therapist, Negative reports about third persons, Fait accompli, Supplication, Self-promotion, Avoidance of contents, und Emotional avoidance. The rating procedure, frequencies, and therapist reactions upon these patient strategies will be reported

Multifaceted responsiveness

The idea of responsiveness is closely related to therapist style and therapeutic relationship. While this may be the most important aspect of the therapeutic process from a responsiveness perspective, responsiveness is also crucial when it comes to deciding for themes and goals, and particular methods or interventions. Findings related to this notion that have been accumulated in our research group will be presented along with conceptual considerations. This will be complemented by some reflections from a basic psychology perspective.

Effects of a Transdiagnostic Internet Intervention («velibra») for Anxiety Disorders in Primary Care: Results of a Randomized Controlled Trial

Internet-based cognitive behavioral self-help treatment (ICBT) for anxiety disorders has shown promising results in several trials, but there is yet a lack of studies of ICBT in „real world” primary care settings. In this randomized controlled trial we recruited participants through general practitioners. The aim of the study was to examine whether treatment-as-usual (TAU) in primary care settings plus ICBT is superior to TAU alone in reducing anxiety symptoms and other outcome measures among individuals meeting diagnostic criteria of a least one of three anxiety disorders (social anxiety disorder, panic disorder with or without agoraphobia, generalized anxiety disorder). 150 adults fulfilling diagnostic criteria for a least one of the anxiety disorders according to a diagnostic interview are randomly assigned to one of the two conditions: TAU plus ICBT versus TAU. Randomization is stratified by primary disorder, medication (yes/no) and concurrent psychotherapy. ICBT consists of a transdiagnostic and tailored Internet-based self-help program for several anxiety disorders which also includes cognitive bias modification for interpretation (CBM-I). Primary outcomes are symptoms of disorder-specific anxiety measures and diagnostic status after the intervention (9 weeks). Secondary outcomes include primary outcomes at 3-month follow-up and secondary measures such as general symptomatology, depression, quality of life, adherence to ICBT and satisfaction with ICBT. The study is currently being completed. Primary results along with results for specific subgroups (e.g. primary diagnosis, concurrent medication and/or psychotherapy) will be presented and discussed.

Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis.

BACKGROUND Panic disorder is characterised by the presence of recurrent unexpected panic attacks, discrete periods of fear or anxiety that have a rapid onset and include symptoms such as racing heart, chest pain, sweating and shaking. Panic disorder is common in the general population, with a lifetime prevalence of 1% to 4%. A previous Cochrane meta-analysis suggested that psychological therapy (either alone or combined with pharmacotherapy) can be chosen as a first-line treatment for panic disorder with or without agoraphobia. However, it is not yet clear whether certain psychological therapies can be considered superior to others. In order to answer this question, in this review we performed a network meta-analysis (NMA), in which we compared eight different forms of psychological therapy and three forms of a control condition. OBJECTIVES To assess the comparative efficacy and acceptability of different psychological therapies and different control conditions for panic disorder, with or without agoraphobia, in adults. SEARCH METHODS We conducted the main searches in the CCDANCTR electronic databases (studies and references registers), all years to 16 March 2015. We conducted complementary searches in PubMed and trials registries. Supplementary searches included reference lists of included studies, citation indexes, personal communication to the authors of all included studies and grey literature searches in OpenSIGLE. We applied no restrictions on date, language or publication status. SELECTION CRITERIA We included all relevant randomised controlled trials (RCTs) focusing on adults with a formal diagnosis of panic disorder with or without agoraphobia. We considered the following psychological therapies: psychoeducation (PE), supportive psychotherapy (SP), physiological therapies (PT), behaviour therapy (BT), cognitive therapy (CT), cognitive behaviour therapy (CBT), third-wave CBT (3W) and psychodynamic therapies (PD). We included both individual and group formats. Therapies had to be administered face-to-face. The comparator interventions considered for this review were: no treatment (NT), wait list (WL) and attention/psychological placebo (APP). For this review we considered four short-term (ST) outcomes (ST-remission, ST-response, ST-dropouts, ST-improvement on a continuous scale) and one long-term (LT) outcome (LT-remission/response). DATA COLLECTION AND ANALYSIS As a first step, we conducted a systematic search of all relevant papers according to the inclusion criteria. For each outcome, we then constructed a treatment network in order to clarify the extent to which each type of therapy and each comparison had been investigated in the available literature. Then, for each available comparison, we conducted a random-effects meta-analysis. Subsequently, we performed a network meta-analysis in order to synthesise the available direct evidence with indirect evidence, and to obtain an overall effect size estimate for each possible pair of therapies in the network. Finally, we calculated a probabilistic ranking of the different psychological therapies and control conditions for each outcome. MAIN RESULTS We identified 1432 references; after screening, we included 60 studies in the final qualitative analyses. Among these, 54 (including 3021 patients) were also included in the quantitative analyses. With respect to the analyses for the first of our primary outcomes, (short-term remission), the most studied of the included psychological therapies was CBT (32 studies), followed by BT (12 studies), PT (10 studies), CT (three studies), SP (three studies) and PD (two studies).The quality of the evidence for the entire network was found to be low for all outcomes. The quality of the evidence for CBT vs NT, CBT vs SP and CBT vs PD was low to very low, depending on the outcome. The majority of the included studies were at unclear risk of bias with regard to the randomisation process. We found almost half of the included studies to be at high risk of attrition bias and detection bias. We also found selective outcome reporting bias to be present and we strongly suspected publication bias. Finally, we found almost half of the included studies to be at high risk of researcher allegiance bias.Overall the networks appeared to be well connected, but were generally underpowered to detect any important disagreement between direct and indirect evidence. The results showed the superiority of psychological therapies over the WL condition, although this finding was amplified by evident small study effects (SSE). The NMAs for ST-remission, ST-response and ST-improvement on a continuous scale showed well-replicated evidence in favour of CBT, as well as some sparse but relevant evidence in favour of PD and SP, over other therapies. In terms of ST-dropouts, PD and 3W showed better tolerability over other psychological therapies in the short term. In the long term, CBT and PD showed the highest level of remission/response, suggesting that the effects of these two treatments may be more stable with respect to other psychological therapies. However, all the mentioned differences among active treatments must be interpreted while taking into account that in most cases the effect sizes were small and/or results were imprecise. AUTHORS' CONCLUSIONS There is no high-quality, unequivocal evidence to support one psychological therapy over the others for the treatment of panic disorder with or without agoraphobia in adults. However, the results show that CBT - the most extensively studied among the included psychological therapies - was often superior to other therapies, although the effect size was small and the level of precision was often insufficient or clinically irrelevant. In the only two studies available that explored PD, this treatment showed promising results, although further research is needed in order to better explore the relative efficacy of PD with respect to CBT. Furthermore, PD appeared to be the best tolerated (in terms of ST-dropouts) among psychological treatments. Unexpectedly, we found some evidence in support of the possible viability of non-specific supportive psychotherapy for the treatment of panic disorder; however, the results concerning SP should be interpreted cautiously because of the sparsity of evidence regarding this treatment and, as in the case of PD, further research is needed to explore this issue. Behaviour therapy did not appear to be a valid alternative to CBT as a first-line treatment for patients with panic disorder with or without agoraphobia.

The impact of traditional psychiatric services and case management services on the functioning of people with schizophrenia: A cross-national study in Nova Scotia and Texas

The purpose of this study was to determine the impact of traditional psychiatric services with case management services on the functioning of people with schizophrenia. Traditional services were defined as routine clinic services consisting of medication follow-along, psychotherapy, and support services. Case management consisted of activities involved in linking, planning, and monitoring services for the outpatient client who has schizophrenia. The target population was adult schizophrenics who had been receiving outpatient clinic services for a minimum of six months. Structured interviews were conducted using standardized scales (e.g., Quality of Life, Self-Efficacy, and Brief Symptom Inventory) with 78 outpatient client volunteers from two sites: Nova Scotia (Canada) and Texas (USA). The researcher tested for differences in psychiatric symptomatology, recidivism, and quality of life for persons with schizophrenia receiving traditional psychiatric services in Nova Scotia and traditional plus case management services in Texas. Data were collected from the structured interviews and medical records review forms. Types of services were blocked into low and high levels of Intensity (frequency x minutes) and compared to determine the relative contribution of each. Finally, the role of clients' self-efficacy was tested as an intervening variable. Although the findings did not support the hypotheses in the direction anticipated, there were some interesting and useful results. From the Nova Scotia site, clients who received low levels of services were hospitalized less compared to the Texas site. The more psychotic a patient was the higher their involvement in medication follow-along and the more monitoring they received. The more psychotherapy received, the lower the reported satisfaction with social relationships. Of particular interest is the role that self-efficacy played in improved client outcomes. Although self-efficacy scores were related to improved functioning, the mechanism for this still needs to be clarified through subsequent research. ^

La noción medieval de cogitativa y sus posibles proyecciones en psicología y psicoterapia

La doctrina de los sentidos internos -y, en particular, la de la cogitativa-, esbozada en la antigüedad, desarrollada en el Medioevo, y redescubierta parcialmente por la psicología contemporánea, constituye una elaboración conceptual originalísima con importantes consecuencias prácticas para la psicología. El presente estudio procura una primera aproximación en este sentido a la noción de cogitativa, examinando sus posibles proyecciones en los campos de la psicoterapia y de la comprensión etiológica de las enfermedades psíquicas, e indagando en las semejanzas que dicho concepto podría guardar con desarrollos psicológicos contemporáneos.

La enseñanza de la psicoterapia de la tercera fuerza en la UNLP

En este trabajo nos proponemos indagar los contenidos relacionados a la psicoterapia de la Tercera Fuerza, mediante el análisis de programas de asignaturas vinculadas a la práctica clínica y psicoterapéutica. A los fines de nuestra investigación, nos hemos centrado en la formación universitaria en carreras de psicología, en el particular analizaremos la carrera de psicologíaen la Universidad Nacional de La Plata (UNLP). Hemos considerado elcaso de la Universidad Nacional de La Plata, por la antigua tradición fenomenológica-existencial que existiera en los años iniciales de aquella carrera y por la influencia de personalidades relevantes para la universidad, vinculadas a la psicología existencial, tal es el caso de Luis María Ravagnan. En este estudio hemos realizado un recorte del material analizado, seleccionando los programas de aquellas materias que tenían vinculación directa con la psicoterapia o la clínica en diversos años, y se procedió al análisis de los contenidos, bibliografía, objetivos y fundamentos de cada uno de los programas

La enseñanza de la psicoterapia de la tercera fuerza en la UNLP

En este trabajo nos proponemos indagar los contenidos relacionados a la psicoterapia de la Tercera Fuerza, mediante el análisis de programas de asignaturas vinculadas a la práctica clínica y psicoterapéutica. A los fines de nuestra investigación, nos hemos centrado en la formación universitaria en carreras de psicología, en el particular analizaremos la carrera de psicologíaen la Universidad Nacional de La Plata (UNLP). Hemos considerado elcaso de la Universidad Nacional de La Plata, por la antigua tradición fenomenológica-existencial que existiera en los años iniciales de aquella carrera y por la influencia de personalidades relevantes para la universidad, vinculadas a la psicología existencial, tal es el caso de Luis María Ravagnan. En este estudio hemos realizado un recorte del material analizado, seleccionando los programas de aquellas materias que tenían vinculación directa con la psicoterapia o la clínica en diversos años, y se procedió al análisis de los contenidos, bibliografía, objetivos y fundamentos de cada uno de los programas

La enseñanza de la psicoterapia de la tercera fuerza en la UNLP

En este trabajo nos proponemos indagar los contenidos relacionados a la psicoterapia de la Tercera Fuerza, mediante el análisis de programas de asignaturas vinculadas a la práctica clínica y psicoterapéutica. A los fines de nuestra investigación, nos hemos centrado en la formación universitaria en carreras de psicología, en el particular analizaremos la carrera de psicologíaen la Universidad Nacional de La Plata (UNLP). Hemos considerado elcaso de la Universidad Nacional de La Plata, por la antigua tradición fenomenológica-existencial que existiera en los años iniciales de aquella carrera y por la influencia de personalidades relevantes para la universidad, vinculadas a la psicología existencial, tal es el caso de Luis María Ravagnan. En este estudio hemos realizado un recorte del material analizado, seleccionando los programas de aquellas materias que tenían vinculación directa con la psicoterapia o la clínica en diversos años, y se procedió al análisis de los contenidos, bibliografía, objetivos y fundamentos de cada uno de los programas

MANEJO TÉCNICO DO ATENDIMENTO PSICOLÓGICO EM AMBULATÓRIO DE REPRODUÇÃO HUMANA ASSISTIDA

O presente estudo teve por objetivos: descrever o manejo técnico do atendimento psicológico, ilustrado pelo caso de uma paciente infértil de um ambulatório de reprodução humana assistida; descrever as vicissitudes no campo analítico nestes atendimentos; e sistematizar esse manejo técnico em intervenções ambulatoriais em que se privilegia a compreensão das relações transferenciais. O instrumento utilizado para a coleta de dados foram os próprios atendimentos, ou entrevistas psicológicas, baseadas no método clínico de abordagem psicanalítica. A análise e a discussão dos resultados se basearam na apresentação de um único caso, que ilustrou a técnica que se objetivou sistematizar e descrever. É apresentado o caso da Sra. S., uma mulher de 41 anos, com parceiro em união estável há cinco anos, que realizava tratamento de infertilidade no ambulatório de reprodução humana. A paciente foi atendida pela psicóloga no próprio ambulatório durante o período da segunda tentativa de gravidez. Foram realizados efetivamente três (3) atendimentos e, no período de dois meses, a paciente não compareceu a três (3) sessões. Foram criadas cinco (5) categorias de análise: 1) Escuta; 2) Configuração de Queixa Psicológica; 3) Manejo dos Conflitos; 4) Manejo da Transferência; e 5) Enquadre. Estas categorias representaram elementos do atendimento. A divisão do atendimento em categorias teve propósito didático, no entanto, a sistematização do manejo deu-se a partir do desenvolvimento destas categorias, mas não numa ordem pré-estabelecida. A Escuta refere-se à capacidade do psicoterapeuta compreender a relação estabelecida com o paciente, assim como os elementos metapsicológicos depositados no campo, a partir de seu quadro de referência teórico-metodológico. A Configuração de Queixa Psicológica refere-se à aproximação do sofrimento psíquico e dos conflitos que subjazem à queixa orgânica ou manifesta. O Manejo dos Conflitos representa o modo como são interpretados e devolvidos a um paciente os conteúdos trazidos para a sessão. Ressalta-se, no manejo dos conflitos, a eleição de um foco de trabalho em que se privilegia a situação atual da vida do paciente relacionada especificamente à sua queixa. O Manejo da Transferência refere-se à forma como os aspectos transferenciais são compreendidos e devolvidos ao paciente. A neurose e psicose de transferência são evitadas e o trabalho é preferencialmente desenvolvido a partir da interpretação de situações extra-transferenciais. Por fim, o Enquadre engloba todos os aspectos formais e dinâmicos que constituem o campo emocional sobre o qual se trabalha. Este tipo de atendimento pode ser situado entre a entrevista psicológica e o atendimento em psicoterapia breve com objetivos e tempo limitados, variando de acordo com a qualidade adaptativa do paciente e sua motivação para o atendimento psicológico. Concluímos que este modelo de atendimento ambulatorial engloba aspectos tanto diagnósticos quanto de intervenção e que o papel do psicólogo neste contexto é auxiliar o paciente atendido a compreender sua queixa em seus aspectos latentes e manifestos, além de propiciar um espaço de escuta em que os conteúdos trazidos podem ser pensados e compreendidos