Biomedical subjects

A Winston

Publications and source records attributed to A Winston.

At least 37 records · Page 2Linked to original sources

PubMed1998

Early identification of treatment failures in short-term psychotherapy. An assessment of therapeutic alliance and interpersonal behavior.

Early sessions of patients categorized as dropouts (n = 25), good outcome (n = 28), and poor outcome (n = 20) completers of a 40-session protocol of short-term psychotherapy were compared to determine predictive validity of in-session measures of therapeutic alliance and interpersonal behavior (Working Alliance Inventory, Session Evaluation Questionnaire, and Interpersonal Adjective Scale). A number of significant differences were found among the three groups: both patients and therapists in the dropout group rated the relationship as more problematic than those in the good outcome group, and patients in the dropout group also rated the relationship as more problematic than those in the poor outcome group, while therapists' ratings did not distinguish dropouts from poor outcome. Differences between good and poor outcome groups were nonsignificant. These findings have clinical significance, particularly in early identification of patients at risk for treatment failure.

Adult↗

PubMed1998

A randomized prospective study comparing supportive and dynamic therapies. Outcome and alliance.

The authors report preliminary results of Brief Supportive Psychotherapy (BSP) in the Beth Israel Brief Psychotherapy Program for a sample with primarily Cluster C Axis II disorders. This study compares 24 patients treated with BSP with 25 patients treated with Short-Term Dynamic Psychotherapy (STDP). STDP was chosen because its confrontational methods contrast dramatically to BSP, which emphasizes building self-esteem, reducing anxiety, and enhancing coping mechanisms. Videotaped therapies were based on manualized 40-session protocols. Similar degrees of improvement were seen in BSP and STDP at termination and at 6-month follow-up. A study of therapeutic alliance in BSP showed stable and high levels of alliance in good-outcome cases and more variability in poor-outcome cases. These preliminary findings are consistent with other studies and suggest supportive psychotherapy may be effective for many patients, leading to significant and lasting change.

Adult↗

PubMed1997

Development of a suboutcome strategy to measure interpersonal process in psychotherapy from an observer perspective.

Based on increasing recognition that the therapeutic relationship is critical in psychotherapy, the goal of this study was to establish the psychometric properties of a suboutcome strategy that could identify important in-session events involving patient-therapist interactions. Ten third-party observers were calibrated on a circumplex measure of suboutcome, a shortened version of the Wiggins' Interpersonal Adjective Scale-Revised. These observers rated four sessions from each of 28 cases of short-term psychotherapy. Each session was rated by thirds and selected to represent each quartile of a 40-session treatment protocol. The major findings indicated adequate interrater reliability and evidence for criterion validity that suggested a predictive relationship of patient and therapist affiliation to ultimate outcome, especially as observed early in treatment.

Adult↗

PubMed1997

An examination of the accident and emergency management of deliberate self harm.

OBJECTIVE: To examine the adequacy of assessment and management of deliberate self harm (DSH) undertaken by accident and emergency (A&E) medical staff. METHODS: The records for attendances to the Leicester Royal Infirmary A&E department with a diagnosis of "self inflicted" injury for the 12 month period April 1994 to March 1995 were scrutinised. If the episode was identified as DSH, then assessment and management were examined, using an instrument based on the Royal College of Psychiatrists' standards of service for the general hospital management of adult DSH. RESULTS: There were 934 episodes of DSH involving 854 patients. The mean age was 32 (SD 14.2), with an even sex distribution. Overdose was by far the most common method of DSH (91.5%). Information concerning suicide intent was documented in 70% of cases, and psychiatric history in 67%. Less information was recorded for medical history (50%), mental state (51%), recent stress (55%), or previous DSH (47%), and only 23% had an assessment of risk of further DSH. Very little was recorded concerning alcohol or substance misuse. In 291 cases (31%), the patient was discharged directly home by A&E medical staff, and 50 of these were referred for psychiatric outpatient follow up; 210 (23%) were referred for specialist assessment in the department and 423 (45.5%) were admitted to medical/surgical wards. The frequency with which information was recorded varied significantly between outcome groups. At night A&E staff were far more likely to discharge a patient home themselves than refer for specialist assessment (P << 0.001). CONCLUSIONS: With over half the sample not admitted, the responsibility for the initial risk assessment lies with A&E medical staff. The study reveals a need for improved planning and delivery of services.

Adolescent↗

PubMed1996

Follow-up assessment of medication-treated dysthymia.

1. The objective was to assess long-term efficacy of antidepressant medications in dysthymia. 2. In a naturalistic study, patients with DSMIII-R dysthymia who had participated in previous antidepressant trials with fluoxetine and trazodone were evaluated at a mean of 40.0 weeks of follow-up to assess whether medication response persisted over time. A multivariate analysis was performed for patients on vs. off medication. Relapse rates (with relapse defined as HDRS score > 13) were also compared for these two groups. 3. Of 40 patients, the 24 still on medication showed significantly lower scores on most rating scales (HDRS, Cornell Dysthymia Rating Scale, and CGI, but not on the SCL-58) than the heterogeneous group of 16 patients not taking medication. Relapse was low (17.4%) among patients remaining on medication. 4. These preliminary findings suggest that dysthymia patients who remain on medication maintain improvement over time.

Adult↗

PubMed1996

Panic attacks with psychotic features.

BACKGROUND: Anxiety disorders are among the most frequently diagnosed group of psychiatric disorders in the general population. Although anxiety disorders are often comorbid with depression and personality disorders, they rarely culminate in psychosis. METHOD: Having observed psychosis in the course of a severe panic attack, the authors prospectively identified four patients who experienced panic attacks with co-occurring psychosis. All met the DSM-IV criteria for panic disorder. Distinctive features of their clinical presentation, pharmacotherapy, and follow-up were recorded. RESULTS: Three patients had a history of panic disorder, and one had a history of generalized anxiety disorder. In all cases, psychosis (auditory hallucinations or delusions) originated in the course of a severe panic attack. Psychotic symptoms occurred only during panic attacks; however, these could occur up to 10 to 15 times a day. In all four patients, psychotic symptoms resolved after a brief time either spontaneously or with benzodiazepine/SSRI treatment. None of the patients required neuroleptic treatment. CONCLUSION: The cases suggest that psychosis may develop in the course of a severe panic attack in patients with panic disorder, as was reported previously for patients with obsessive-compulsive disorder and posttraumatic stress disorder. Distinguishing panic attacks with psychotic features from other psychotic disorders is clinically important since antipsychotic medication treatment for these psychotic symptoms is not indicated. Further research on the prevalence of psychotic symptoms in the anxiety disorders and the pathophysiology of this phenomenon is required to clarify the relationship between the anxiety disorders and psychosis.

Adult↗

PubMed1995

Linking in-session change to overall outcome in short-term cognitive therapy.

To better understand the mechanisms of change in psychotherapy, it is important to validate suboutcome measures that represent intermediate links between more molecular in-session changes and ultimate outcome. The present study involved the collection of pre- and postsession ratings from 53 patients in a 20-session protocol of cognitive therapy, which yielded 5 suboutcome measures: Anxiety Shift, Depression Shift, Cognitive Shift, Optimism Shift, and Therapeutic Alliance. From a series of regression analyses of repeated measures with a generalized estimating equations approach, results regarding the predictive relationship of these variables to a number of patient and therapist-rated outcome criterion variables indicated that change in cognition and quality of the therapeutic alliance were the strongest predictors.

Adult↗

PubMed1995

Change in coordination across phases of psychotherapy and outcome: two mechanisms for the role played by patients' contribution to the alliance.

This article investigated the mechanisms underlying associations between patients' contribution to the alliance and outcome by examining relations between change in the alliance over the course of treatment and improvement in Short-Term Dynamic Psychotherapy (STDP) and Brief Adaptive Psychotherapy (BAP). Findings for STDP were consistent with 1 model about the role played by the alliance, according to which change in the alliance over the course of therapy is the vehicle for overall improvement. Results for BAP were consistent with the other main position proposed in the literature, which argues that a positive alliance provides the foundation for successful treatment. Discussion includes suggesting that it might prove useful in future research to group therapy approaches in terms of these 2 models and that this idea may explain 2 apparently contradictory sets of findings from previous studies on relations between change in the alliance and outcome.

Adult↗

PubMed1994

Long-term treatment of double depression: a preliminary study with serotonergic antidepressants.

1. There is increasing evidence that many patients with major depression also have coexisting dysthymia, and that antidepressant treatment may alleviate both conditions. 2. Open-label study of fluoxetine and trazodone for 18 patients meeting DSM-III-R criteria for concurrent dysthymia and major depression. 3. Fourteen patients completed three-month medication trials, and seven (50%) of completers) responded to treatment. At five months, eight (57.1%) were in remission. Fluoxetine was significantly better tolerated than trazodone, with respective dropout rates of 7.7% and 80%. 4. Findings are consistent with efficacy of serotonergic agents in this condition.

Adult↗

PubMed1994

Short-term psychotherapy of personality disorders.

OBJECTIVE: The efficacy of short-term psychotherapy has become an area of increasing interest. The primary objective of this study was to assess the results of two forms of short-term psychotherapy in patients with personality disorders. METHOD: Eighty-one patients with personality disorders were randomly assigned to brief adaptive psychotherapy, short-term dynamic psychotherapy, or a waiting list for therapy. Outcome at termination of therapy for the treatment groups and at the end of the waiting period for the waiting list group was evaluated by means of ratings of target complaints and scores on the SCL-90 and the Social Adjustment Scale. In addition, for 38 of the treated patients, target complaints were reevaluated an average of 1.5 years after treatment ended. RESULTS: Patients in the two therapy conditions improved significantly on all measures in comparison with the patients on the waiting list. There was no significant difference between the results in the two therapy conditions. The waiting list period averaged approximately 15 weeks; treatment averaged 40 weeks. At follow-up, after an average of 1.5 years, target complaint ratings were not significantly different from those at the termination of therapy. CONCLUSIONS: These data indicate that brief adaptive psychotherapy and short-term dynamic psychotherapy are effective for patients with certain types of personality disorder and that the two therapy approaches do not differ in overall outcome.

Adult↗

PubMed1993

A randomized double-blind study of fluoxetine versus placebo in the treatment of dysthymia.

OBJECTIVE: The purpose of this study was to assess the efficacy of fluoxetine, a selective serotonergic antidepressant, in the treatment of dysthymia. METHOD: Thirty-five patients who met criteria for dysthymia, but not major depression, began randomized, double-blind 8-week trials of fluoxetine or placebo. RESULTS: Of 32 patients who completed the study, 10 (62.5%) of the 16 patients given fluoxetine and three (18.8%) of the 16 given placebo responded to treatment. Response was defined as 1) 50% or greater decrease in Hamilton Rating Scale for Depression score and 2) a score of 1 or 2 on the Clinical Global Impression (CGI) improvement subscale. Fluoxetine subjects showed significantly greater improvement at week 8 than placebo subjects on the Hamilton depression and CGI scales, but not on the Hopkins Symptom Check-list (58-item) or the Cornell Dysthymia Rating Scale. CONCLUSIONS: When compared to placebo, fluoxetine showed short-term effectiveness in treating dysthymic symptoms.

Adult↗

PubMed1993

Clinical and research implications of patient-therapist interaction in brief psychotherapy.

The study of immediate in-session processes and outcomes as possible change events as they vary across context has become an important research focus. In this paper we examined transference and nontransference interpretations, as well as clarifications (in-session processes) followed by patient affect or defensive behavior (in-session outcomes). Transference interpretations followed by affect are associated with a positive outcome, while interpretations and clarifications followed by patient defensive behavior are correlated with poor outcome. On a clinical level these patient responses can be thought of as sub-outcome markers. An affective response to a transference interpretation should serve as an indicator to the clinician that he/she is on the right track. Conversely, repeated defensive behavior by the patient should alert the therapist to consider a change in approach. Highly defensive patients generally have a lower level of object relations, less psychological flexibility, and diminished access to feelings. Careful exploration of the multiple factors operating simultaneously (and which are only slowly becoming evident to us), hopefully will yield data to guide future clinicians when clinical intuition is not able to make fine enough discriminations.

Adaptation, Psychological↗

PubMed1992

A preliminary study of serotonergic antidepressants in treatment of dysthymia.

There is increasing evidence that antidepressants may alleviate symptoms of dysthymia, but few prior studies on selective serotonergic agents. Twenty patients meeting criteria for dysthymia, but not meeting criteria for major depression, received open label trials of a serotonergic antidepressant, either fluoxetine or trazodone. Seventeen (85%) completed three-month medication trials, and of these, twelve (70.6% of completers) responded to treatment. Seven (41.2% of completers) were still in remission on follow-up at five months. Both fluoxetine and trazodone were well tolerated in dysthymics, and showed similar short-term effectiveness in treating dysthymic symptoms.

Adult↗

PubMed1992

Fluoxetine-induced psoriasis.

BACKGROUND: A number of medications have been reported to induce psoriasis. We report two cases of fluoxetine-related psoriasis and discuss similarities between lithium-, trazodone hydrochloride-, and fluoxetine-induced psoriasis. OBSERVATIONS: Two women being treated for depression with fluoxetine developed psoriasis after 6 and 12 months' exposure. This time frame is clinically similar to that observed with lithium-induced psoriasis. CONCLUSIONS: The occurrence of lithium- and fluoxetine-induced psoriasis may not be random. Both drugs modulate serotonergic function, a factor that may contribute to the pathophysiology of psoriasis. If a patient on acute or long-term fluoxetine therapy develops psoriasis, the drug should be considered as a possible etiologic agent.

Adult↗

PubMed1991

Brief psychotherapy of personality disorders.

Thirty-two patients with personality disorder diagnoses were randomly assigned to two treatment conditions that vary on several techniques of brief dynamic psychotherapy. Seventeen patients constituted a waiting list control group. The two brief psychotherapies showed significant improvement on target complaints, SCL-90, and Social Adjustment Scale-SR compared with the control subjects. The two therapy groups were similar in overall outcome but showed interesting differences on several subscale measures. Process measurements of videotaped sessions revealed significant variations in frequencies of therapist interventions across the two treatment conditions, which validated planned differences in the treatment techniques.

Cognitive Behavioral Therapy↗

PubMed1990

Change in patient affect/defense ratio from early to late sessions in brief psychotherapy.

The current study examined changes in the ratio of patients' affective and defensive behaviors during the course of brief psychodynamic psychotherapy. Treatments of 16 patients were videotaped. For each patient, four sessions were evaluated with a minute-by-minute coding system of process variables. When patients were grouped according to outcome scores, significant differences between the high outcome and the average-to-low outcome groups emerged. During the early phase of treatment, patients in both groups showed an average of one affective response per five defensive responses. By the late phase of treatment, the high outcome patients showed a marked shift to one affective response per two defensive responses, while the low outcome patients remained the same. An incidental finding was a negative correlation between good outcome and the ratio of defensive behavior to total patient activity.

Affect↗

PubMed1990

Efficacy of long-term fluoxetine treatment of obsessive-compulsive disorder.

Ten outpatients meeting DSM-III-R criteria for obsessive-compulsive disorder completed a 32-week, open-label study with fluoxetine, a selective serotonin reuptake blocker. The patients were evaluated every four weeks for obsessive-compulsive symptomatology, anxiety, and depression. Significant improvement of obsessive-compulsive and anxiety measures were observed after four weeks, with maximal improvement at eight weeks. Depressed and nondepressed patients showed similar rates of improvement in obsessive-compulsive symptomatology. Overall, fluoxetine was tolerated well by all patients, and no serious side effects were observed. This study suggests that fluoxetine is an effective and safe treatment for obsessive-compulsive disorder, both for short-term alleviation and for long-term maintenance.

Body Weight↗

PubMed1988

NMR water-proton spin-lattice relaxation time of human red blood cells and red blood cell suspensions.

NMR water-proton spin-lattice relaxation times were studied as probes of water structure in human red blood cells and red blood cell suspensions. Normal saline had a relaxation time of about 3000 ms while packed red blood cells had a relaxation time of about 500 ms. The relaxation time of a red cell suspension at 50% hematocrit was about 750 ms showing that surface charges and polar groups of the red cell membrane effectively structure extracellular water. Incubation of red cells in hypotonic saline increases relaxation time whereas hypertonic saline decreases relaxation time. Relaxation times varied independently of mean corpuscular volume and mean corpuscular hemoglobin concentration in a sample population. Studies with lysates and resealed membrane ghosts show that hemoglobin is very effective in lowering water-proton relaxation time whereas resealed membrane ghosts in the absence of hemoglobin are less effective than intact red cells.

Adult↗