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PubMedDate not supplied

A comparison of two intensities of psychosocial intervention for alcohol dependent patients treated with acamprosate.

AIMS: To compare two levels of psychosocial intervention in combination with acamprosate medication for the treatment of alcohol dependence. METHODS: Patients (n = 70) were prescribed acamprosate and randomized to Minimal Psychosocial Intervention (MPI) or Extended Psychosocial Intervention (EPI). MPI patients met a psychiatrist for 20-30 min sessions on four occasions during a 6 month period. EPI patients were offered 10-15 sessions with a psychiatric nurse in addition to the visits to the psychiatrist. EPI patients were trained to use behavioural and cognitive coping skills to deal with high-risk situations in line with a manual developed for relapse prevention. Patients were assessed four times during the 24-week study by self-report and laboratory tests. RESULTS: Patients on average reported a decline in days with heavy drinking and in cumulative number of drinking days. No significant differences between patients in MPI and EPI were found with respect to heavy drinking, cumulative number of drinking days, number of days to first drink, or biomarkers of alcohol consumption. Higher age and lower level of education were significant predictors of treatment success. CONCLUSIONS: Adding more intensive individual treatments appears to add no extra improvement beyond that obtained by prescribing acamprosate and offering an infrequent consultation with a physician.

Acamprosate↗
PubMed1996

Evaluation of an HIV risk reduction intervention among African-American homosexual and bisexual men.

OBJECTIVE: To provide the first data which evaluates an HIV risk reduction intervention designed to reduce HIV high-risk sexual behavior in African-American homosexual and bisexual men. SUBJECTS: Participants (n = 318) were recruited from bars, bathhouses, and erotic bookstores, and through homosexual African-American organizations, street out-reach, media advertisements, and personal referrals of individuals aware of the study. METHODS: Participants were randomized into a single or triple session experimental group or a wait-list control group. Both experimental interventions included AIDS risk education, cognitive-behavioral self-management training, assertion training, and attempts to develop self-identity and social support. Data collection involved assessments of self-reported changes in sexual behavior at 12- and 18-month follow-up. RESULTS: Participants in the triple session intervention greatly reduced their frequency of unprotected anal intercourse (from 46 to 20%) at the 12-month follow-up evaluation and (from 45% to 20%) at the 18-month follow-up evaluation. However, levels of risky behavior for the control group remained constant (from 26 to 23% and from 24 to 18%) at 12- and 18-month follow-up evaluations, respectively. In addition, levels of risky behavior for the single session intervention decreased only slightly (from 47 to 38% and from 50 to 38%) at the 12- and 18-month follow-up evaluations, respectively. CONCLUSIONS: Results were interpreted to demonstrate the superiority of a triple session over a single session intervention in reducing risky sexual behavior in this cohort.

Adult↗
PubMed2003

Effects of a general practice-based intervention on diet, body mass index and blood lipids in patients at cardiovascular risk.

BACKGROUND: General practice-based health-promotion programmes implemented by nurse-counsellors may reduce cardiovascular risk factors, particularly in patients at increased risk. DESIGN: In a randomized controlled trial, trained nurse-counsellors delivered cognitive behavioural programmes aiming to reduce cardiovascular risk in patients with hypertension, Type 2 diabetes mellitus or coronary heart disease. Of 591 eligible patients from seven general practices in Perth, Western Australia, 212 agreed to participate and were randomized to one of three groups. In the 'Low' intervention (n = 69), monthly telephone contacts for 1 year followed one face-to-face individual counselling session; in the 'High' intervention (n = 74) individual face-to-face counselling continued over 1 year, taking place monthly, for up to 1 h; Controls (n = 69) received usual care only. Participants were assessed at baseline with follow-up 12 and 18 months later. RESULTS: Follow-up assessments were attended by 77, 71 and 65% of the Control, 'Low' and 'High' groups, respectively. Total fat intake fell by 9, 12 and 5% in the 'High', 'Low' and Control groups, respectively, at 12 months and by 2, 10 and 5% at 18 months. Total serum cholesterol fell by 3, 3 and 2% in the 'High', 'Low' and 'Control' groups, respectively, at 12 months and by 7, 5 and 8% at 18 months. Neither change in fat intake nor serum cholesterol differed significantly between groups. Body mass index increased in all groups with no significant changes related to the programme. CONCLUSIONS: Programmes using nurse-counsellors were not significantly more successful than usual care from general practitioners, consistent with reported benefits of lifestyle advice from primary-care physicians.

Adult↗
PubMedDate not supplied

Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow.

OBJECTIVE: We evaluated heart rate variability biofeedback as a method for increasing vagal baroreflex gain and improving pulmonary function among 54 healthy adults. METHODS: We compared 10 sessions of biofeedback training with an uninstructed control. Cognitive and physiological effects were measured in four of the sessions. RESULTS: We found acute increases in low-frequency and total spectrum heart rate variability, and in vagal baroreflex gain, correlated with slow breathing during biofeedback periods. Increased baseline baroreflex gain also occurred across sessions in the biofeedback group, independent of respiratory changes, and peak expiratory flow increased in this group, independently of cardiovascular changes. Biofeedback was accompanied by fewer adverse relaxation side effects than the control condition. CONCLUSIONS: Heart rate variability biofeedback had strong long-term influences on resting baroreflex gain and pulmonary function. It should be examined as a method for treating cardiovascular and pulmonary diseases. Also, this study demonstrates neuroplasticity of the baroreflex.

Adult↗
PubMed2006

Reducing young driver road trauma: guidance and optimism for the future.

This paper highlights lessons from each of the Expert Panel papers in the present supplement that provide guidance for future research and initiatives. Although some shortfalls still remain in our understanding, it is argued that much has been learned and we are ready for more translation, implementation, and evaluation of multilevel interventions to help reduce young driver road trauma. Non-use of restraints, speeding, driving at night and with passengers, and fatigue are highlighted as key risk factors to address. "Best practice" intervention is proposed as implementing and strengthening graduated driver licensing systems and complementary candidate programs and research, such as hazard perception training programs. A schematic cognitive-perceptual model to explain the crash sequence process is explored. There is optimism that meaningful impacts can be made, especially coupled with the advances in vehicle technologies, but caution is necessary in the absence of targeted "real world" evaluations and broader implementation and diffusion strategies.

Accident Prevention↗
PubMed1998

Therapy concept in enuretic children.

More than 700 children aged between 5 and 15 years were treated at the University of Vienna Department of Urology during the last 10 years. The therapeutic approach was based on a complex diagnostic scheme to define the individual problem of each enuretic child. Generally speaking the enuresis problem turned out to be a symptom of delayed maturation of fine motor control [1] or sleep and hormone secretion rhythm during day and night hours. In a high percentage of enuretic children, no major physical problem or disease could be found, but the possibility of a physical problem, especially a neurourological problem, should not be ignored. Nonneurogenic discoordinated voiding in children can be treated by cognitive flow-triggered feedback training [2, 3] while overproduction of urine during sleep is reduced by antidiuretic hormone therapy with desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), a synthetic analogue of antidiuretic hormone.

Adolescent↗
PubMedDate not supplied

Anxiety is a good indicator for somatic symptom reduction through behavioral medicine intervention in a mind/body medicine clinic.

BACKGROUND: This study examined the effect of anxiety on symptom reduction through a behavioral medicine intervention in a Mind/Body Medicine Clinic. METHOD: Participants were 1,312 outpatients attending a 10-week behavioral medicine intervention which included training in the relaxation response, cognitive restructuring, exercise and nutrition. All of the patients had physical symptoms and were referred to the clinic by their physician. The Medical Symptom Checklist (12 major symptoms), Symptom Checklist 90 Revised (SCL-90R), Stress Perception Scale and the Health-Promoting Lifestyle Profile were administered before and after the program. RESULTS: Of the sample, 1,012 patients completed the program, and 911 completed the posttreatment assessment. Self-reported frequency of medical symptoms, degree of discomfort and interference with daily activities were significantly reduced as a result of the program. Anxiety and other psychological distress as measured by the SCL-90R and stress perception scales also showed significant reductions. Furthermore, health-promoting lifestyle functioning significantly improved. High levels of pretreatment anxiety predicted a decrease in the total number of medical symptoms endorsed. CONCLUSIONS: Behavioral medicine interventions are effective in reducing medical symptoms coinciding with improvement in anxiety. High anxiety at program entry may predict better outcome.

Adult↗
PubMed1995

Treatment and outcome of adolescent anorexia nervosa.

Treatment of adolescent anorectic patients includes a comprehensive assessment of the patient's condition, measures leading to effective weight restoration and the choice of the optimal treatment setting. The main psychotherapeutic approaches include supportive individual psychotherapy, behavioural, and family therapy. Individual psychotherapy is provided by a supportive relationship with treatment staff and the therapeutic environment of the ward. Behavioural therapy uses operant conditioning to promote weight gain and may include cognitive methods and social skills training. Family therapy may also be beneficial for some adolescent patients. There is no evidence that pharmacotherapy, besides treating depressive symptoms, has any beneficial effect in anorectic patients. The outcome and prognosis of an individual patient is unpredictable.

Adolescent↗
PubMed2006

Thinking, feeling and moving: drama and movement therapy as an adjunct to a multidisciplinary rehabilitation approach for chronic pain in two adolescent girls.

Chronic Pain without an identifiable organic basis represents a substantial element of referrals to both medical and mental health professionals. Chronic pain can compromise independence, school attendance, physical and social activities. The tendency to label 'nonorganic' pain as having a psychological origin is usually strongly resisted by parents and young people with treatment creating a significant challenge for health care professionals. Collaborative, multidisciplinary treatment programmes encourage families to find ways of getting on with their lives by taking a proactive approach to challenging pain. The family is invited to join with the team in the task of challenging the pain through the use of physiotherapy to increase strength, stamina and suppleness alongside a range of individual and group activities that can include relaxation training, hypnotherapy, systemic and cognitive-behavioural approaches. This article describes how drama and movement therapy was introduced as an additional component of the treatment programme of two adolescents who had been long-term inpatients on a medical adolescent ward. The experiences of adding a complementary therapy to the programme are described to illustrate a creative way of contributing to established treatment programmes through the use of sound, movement and gesture in order to provide a space to explore new ways of being and expanding abilities.

Adolescent↗
PubMed2006

Effectiveness and cost-effectiveness of a minimal psychological intervention to reduce non-severe depression in chronically ill elderly patients: the design of a randomised controlled trial [ISRCTN92331982].

BACKGROUND: Depression is a prevalent disorder in chronically ill elderly persons. It may decrease quality of life, and increase functional disability, medical costs, and healthcare utilisation. Because patients may slip into a downward spiral, early recognition and treatment of depression is important. Depression can be treated with antidepressants or psychological interventions; the latter can also be applied by trained paraprofessionals. In this paper, we describe the design of the DELTA study (Depression in Elderly with Long-Term Afflictions). The first objective of the DELTA study is to evaluate the effectiveness and cost-effectiveness of a minimal psychological intervention (MPI) to reduce depression in chronically ill elderly patients. The second objective is to evaluate whether a potential effect of the MPI may differ between types of chronic illnesses. The tailor-made intervention is administered by nurses, who are trained in the principles of cognitive behavioural therapy and self-management. METHODS/DESIGN: DELTA is a two-armed randomised controlled trial, comparing MPI to usual care. A total number of 180 patients with diabetes mellitus type II (DM) and 180 patients with chronic obstructive pulmonary disease (COPD), who in addition suffer from non-severe depression, will be included in the study. In our study, non-severe depression is defined as having minor depression, mild major depression or moderate major depression. The primary outcome measure is depression using the Beck Depression Inventory. Secondary outcome measures include quality of life, daily functioning, self-efficacy, autonomy, and participation. In the economic evaluation, cost-effectiveness and cost-utility ratios will be calculated. Furthermore, a process evaluation will be carried out. Analyses will include both univariate and multivariate techniques and according to the intention to treat principle. The economic evaluation will be done from a societal perspective and data of the process evaluation will be analysed using descriptive techniques. DISCUSSION: A total number of 361 patients has been included in the study. All interventions have been administered and follow-up data will be complete in September 2006. Preliminary results from the process evaluation indicate that patients' satisfaction with the intervention is high. If this intervention proves to be effective, implementation of the DELTA intervention is considered and anticipated.

Aged↗
PubMedDate not supplied

[Interdisciplinary education for health: planning nurse undergraduate programs].

Interdisciplinary teaching as an educational alternative which allows for global education of individuals who are also professionals is shown in this article as an educational planning report organized by the undergraduate Nursing program from Regional University of Blumenau (FURB), located in the city of Blumenau, in the state of Santa Catarina, Brazil. We show this didactic-pedagogical perspective from a theoretical perspective that presents ethics as an alternative for an education process aimed at the global community. This is a didactic proceeding supported by the methodology of "culture circles", proposed by Paulo Freire. Through them one searches for the integration of relevant contents to a nurse training centered on essential principles, cognitive bases, and relevant themes.

Brazil↗
PubMed2000

A review of the epidemiology and approaches to the treatment of social anxiety disorder.

This review presents current literature on the epidemiology and treatment of social anxiety disorder (social phobia). This illness has been demonstrated to be the most common anxiety disorder with a 1-year prevalence of 7 to 8% and a lifetime prevalence of 13 to 14% in patients aged between 15 and 54 years. Social anxiety disorder can be classified into 2 subtypes, discrete and generalised. Morbidity is high with this disorder, and 70 to 80% of patients have co-morbid mental disorders. Although effective treatments are available, social anxiety disorder is under-recognised and under-treated. Treatments that have been systemically studied and have shown efficacy in patients with social anxiety disorder include pharmacotherapy (selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, reversible inhibitors of monoamine-A and benzodiazepines) and short term psychotherapies (cognitive behaviour therapy, social skills training and exposure in vivo therapy). Beta-blockers are useful in treating performance-related anxiety. Few published data are available on the treatment of social anxiety disorder with a combination of pharmacotherapy and psychotherapy. We conclude this review by discussing proposed algorithms for treating both subtypes of social anxiety disorder.

Adolescent↗
PubMed2003

Psychopathology and psychological problems in patients with burn scars: epidemiology and management.

Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce psychopathological responses. Depression and post-traumatic stress disorder (PTSD), which are prevalent in 13-23% and 13-45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in burn patients compared with the general population. Problems in the mental area are more troublesome than physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury. Few studies of psychological treatments in burn patients are available. From general trauma literature, it is concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization are successful. Psychological debriefing aiming to prevent chronic post-trauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area includes cognitive-behavioral therapy, social skills training, and community interventions. Sexual health promotion and counseling may decrease problems in sexual life.In conclusion, psychopathology and psychological problems are identified in a significant minority of burn patients. Symptoms of mood and anxiety disorders (of which PTSD is one) should be the subject of screening in the post-burn phase and treated if indicated. A profile of the patient at risk, based on pre-injury factors such as pre-morbid psychiatric disorder and personality characteristics, peri-traumatic factors and post-burn factors, is presented. Finally, objective characteristics of disfigurement appear to play a minor role, although other factors, such as proneness to shame, body image problems, and lack of self-esteem, may be of significance.

Burns↗
PubMed1986

Maximization of biofeedback following cognitive stress preselection in generalized anxiety.

53 subjects, who scored high on an anxiety check list, were evaluated for their responsiveness to relaxation exercises and biofeedback. Each subject was cognitively stressed prior to the training phase by imagining anxiety-provoking situations. Analysis was done on pertaining/posttraining anxiety scores and physiological parameters (galvanic skin response, differences in finger temperature, and frontalis muscle activity). Subjects given feedback corresponding to that physiological parameter which changed the most when stressed, maximized that feedback more than subjects receiving nonrelevant or no feedback. All groups reported significant reductions in anxiety symptoms. Follow-up analysis 15 mo. later showed 76% of the subjects were still symptom-free for anxiety regardless of type of feedback received.

Adult↗
PubMed1997

Anger management training in prison inmates.

Inflicting harm on others after a perceived wrong is called revenge and has been implicated in a wide range of criminal and antisocial behaviors. Revenge is defined as a retaliatory act and may be ruled out when antecedent to instrumental aggression if hurting someone is secondary to the primary goal of acquisition. Revenge is considered the impetus for reactive aggression, however, if the primary goal is to hurt someone. 26 male inmates were chosen for training in anger management using cognitive behavioral methods. Selection of inmates was based on their history of reactive aggression. As predicted, inmates showed a significant reduction in posttest scores on the Vengeance scale.

Adult↗
PubMed2007

Brain nitric oxide synthases and mitochondrial function.

Nitric oxide is a small signaling molecule, which may act as a neurotransmitter and neuromodulator, exerting a regulatory effect on neuronal function. It can diffuse from its site of synthesis to different intra and extracellular compartments, being therefore present in the pre-synaptic, synaptic and post-synaptic spaces. Recently, a NOS located in the mitochondria (mtNOS) has been observed in different brain regions, responsible for the production of NO in these organelles and identified as nNOS. A regulatory effect of NO on mitochondrial function was described in brain mitochondria, where NO acts mainly by inhibiting cytochrome oxidase activity. Hippocampal mitochondrial dysfunction and decreased mtNOS activity and expression were reported in association with ultrastructural damage in an experimental model of hepatic encephalopathy. Enriched environment exposure preserved the aged animals from spatial cognition impairment; also environment and training modulated neuronal plasticity in pre-pubertal rats through NO-dependent mechanisms. In addition, brain cortical mitochondrial respiration and mtNOS activity and expression were analyzed as function of age. Mitochondrial NO production showed a decreasing tendency as a function of age. These results are in accordance with the protein expression analyzed by Western Blot of mitochondrial fractions which was 6.5 times higher in 1 month aged rats as compared with 14 old animals. Concomitant with these results, a clear increasing oxygen uptake tendency in state 3 respiration was observed, meanwhile only a slight increase was observed in state 4. All these results seems to be clearly related with the reversible and concentration-dependent attenuation of the respiratory chain by NO.

Aging↗
PubMed2005

Attention-deficit/hyperactivity disorder: presentation and management in the Haitian American child.

A case study of a young Haitian American is presented that is illustrative of cultural issues that influence care of those with attention-deficit/hyperactivity disorder (ADHD). Medications are the preferred treatment for ADHD and can be combined with psychological intervention. However, many Haitians and Haitian Americans see psychoactive medications as leading to substance abuse or mental illness. Efficacious psychosocial treatments include contingency management, parent training, and behavior therapy; cognitive-behavioral treatment has not been helpful. Complementary and alternative medicine might have appeal; primary care physicians can help families to assess such treatments and not to be enticed by expensive ones of little benefit. A determinant of the treatment a family pursues is their perception of the cause of the ADHD behaviors. While there is no term for ADHD in the Haitian-Creole language, in the Haitian culture the behaviors consistent with the diagnosis might be interpreted as indicating a poorly raised child whose behavior could be modified by parental discipline, an intentionally bad child, or a psychically victimized child suffering from an "unnatural" condition. "Natural" ailments are attributed to natural forces (e.g., wind, temperature), while "unnatural" ones are attributed to bad spirits or punishment by God. Families may "lift their feet" (Leve pye nou: to see a Hougan or voodoo priest) to determine the unnatural cause. Haitian Americans often combine therapeutic foods that are considered cold in nature, natural sedatives and purgatives from herbal medicine, religious treatments, and Western medicine. Immigrants often lack support of extended families in an environment not supportive of their interpretation of child behaviors and traditionally accepted parental disciplinary style. Stigma, language, cultural conceptions, concerns about governmental agencies, and physician bias can all be barriers to care for immigrant families. Primary care and behavioral integration are useful in managing families from other cultures.

Journal Article↗
PubMed2001

Anxiety disorders. How to recognize and treat the medical symptoms of emotional illness.

Anxiety symptoms in older patients frequently coexist with depression, medical illness, and dementia, which complicate diagnosis and treatment. Most anxiety disorders do not begin in later life but are a recurrence or worsening of a pre-existing condition. Anxiety should be considered in any older patient with depressive symptoms or somatic complaints that are not explained by physical examination. Older patients may benefit from cognitive-behavioral therapy and relaxation training. Antidepresants, particularly selective serotonin reuptake inhibitors, are the preferred medical treatment.

Aged↗