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PubMed1976

[Technique of submucous sclerosing in patients with bleeding esophageal varices -- therapeutic results (author's transl)].

Acute hemorrhage from esophageal varices is becoming more and more frequent, implying a poor prognosis for the patient and necessitating dramatic therapeutic procedures by the physician or the surgeon. Regular endoscopic controls of patients with liver cirrhosis and portal hypertension are necessary before the first bleeding occurs in spite of negative X-ray findings of the esophagus, since long-term therapeutic results may be inproved by such controls. Sclerosing the esophageal wall does not occlude the esophageal veins, which do remain open consequently; they are just "displaced" deeper into the mucosa. There are no risks or complications of this procedure especially when esophageal varices are just beginning to form and when the esophageal mucosa is still being intact. Therapeutic results are encouraging, and they are better as compared to the results of emergency shunt or elective shunt surgery. Until short time ago sclerosing the esophageal wall was sort of a preliminary preoperative therapeutic procedure. Today it is a well established therapy in its own right, although it is, as is shunt surgery, symptomatic therapy. It does seem to be superior however to all other forms of therapy aimed at preventing or treating esophageal bleeding, since primary mortality seems to be lower and longterm results seem to be better.

Adult↗
PubMed1999

[Anatomic-therapeutic-chemical classification of drugs].

European Research Association for Pharmaceutical Market and an international group have developed the ADC Drug Classification system, which is recommended by the World Health Organization (WHO). It has been in use since 1987. According to this classification, drugs are grouped into fourteen basic groups according to the organic system of the organism where they work. These fourteen anatomical groups represent the first anatomical level and is labeled with one capital letter, as follows: A Alimentary tract and metabolism B Blood and blood forming organs C Cardiovascular system D Dermatologicals G Genito urinary system and sex hormones H Systemic hormonal preparations, excl. sex hormones J General antiinfectives for systemic use L Antineoplastic and immunomodulating agents M Muscle-skeletal system N Nervous system P Antiparasitic products, insecticides and repellents R Respiratory system S Sensory organs V Various. Drugs are further divided into therapeutic groups and subgroups (2nd and 3rd level), the 4th level is the chemical-therapeutic subgroup. The 5th level is the generic drug name. Each drug is represented by 7 numeric-character bytes code. These seven bytes are determining the group (1st anatomical classification level marked by a capital letter) with the corresponding therapeutic subgroups on the 2nd and 3rd classification level, 4th level labels the chemical-therapeutic subgroup, while the 5th level is signified by the individual chemical compounds (generic name) and is marked by an Arabic number. The importance of the ATC classification is the possibility of the international comparability, monitoring of the use and consumption from various aspects. The standardized monitoring methodology incorporates too the daily doze determining methodology (DDD). Defined Daily Dose (DDD) is the drug amount used for the most common indication, and is, therefore, the basic statistical unit of drug use monitoring. It represents not only the recommended doze, but is also the only means of acquiring the number of patients receiving that particular drug (DDD per 1000 inhabitants). This makes the basis for the comparability of drug use in various places (country, region, institution, etc.).

Europe↗
PubMed1976

[Immunosuppressive treatment of rheumatic diseases. Experimental bases of a rational concept of therapeutic approach (author's transl)].

For treatment of diseases such as rheumatoid arthritis or systemic lupus erythematodes, which are initiated or sustained by immune-pathological mechanisms, various "immunosuppressive" drugs are used. There are conflicting data as to the benefit of this type of therapy. In this paper it is attempted to define a base for a more differentiated application of available drugs, since the present therapeutic approach seems rather empiric or is deducted from analogy to selected animal experiments. The investigations presented focus primarily on the behaviour of the small and medium lymphocytes of the organism, the adopted carriers of immunological (as well as autoimmune) reactivity, under conventional conditions (and under the influence of suitable drugs) as a biological supposition for the activity of "immunosuppressives". In rabbits, and mice, number and rate of proliferation of lymphoid cells is determined in untreated controls and animals treated with 6-mercaptopurine (6-MP) and cyclophosphamide (Cy), two immunosuppressive agents representing different types of pharmacological action. The elucidation why in rabbits both substances are equally immunosuppressive, whereas in mice only Cy has significant immunosuppressive activity, yields the base for a therapeutic concept of clinical immunosuppression. This species dependent activity of 6-MP can be explained by different proliferation kinetics of lymphoid cells in mouse and rabbit. Lymphocytes of the rabbit, compared to those of mice, are short-lived and have a distinctly higher proliferation rate. Thus, 6-MP, as an antiproliferative agent, leads, in the rabbit (under long-term as well as single-dose therapy) to a significant reduction of the number of small lymphocytes, whereas it reduces the long-lived lymphocytes of the mouse only marginally, thus explaining the good immunosuppressive potency in the rabbit and failure in the mouse. Cy leads, in both species, to a marked reduction of small lymphocytes and affects the long-lived cells of the mouse as well, resulting in high immunosuppressive potency in both species. In the NZB mouse, a well-fitting model of human lupus erythomatodes, Cy is successful in prophylaxis and therapy. A similar therapeutic effect cannot be obtained with 6-MP. Neither of the two groups of substances revealed selective activity on circulating T- or B-cells. According to the literature available, lymphocytes in humans are predominantly long-lived, too. Accordingly, Cy possesses a good immunosuppressive potency in man, too. Its therapeutic success is paralleled by a reduction of small lymphocytes. In conclusion, a true basic immunosuppressive therapy of autoimmune diseases in humans will primarily be possible by aid of substances which act through a cytotoxic mechanism and are thus able to affect even the long-lived human lymphocytes. In contrast, a substance acting purely through interference with certain steps of cell proliferation will predominantly remain restricted to an antiphlogistic use.

Animals↗
PubMed2000

Evidence-based implementation of free phenytoin therapeutic drug monitoring.

BACKGROUND: The majority of laboratories measure total phenytoin concentration for therapeutic drug monitoring. However, there are substantial interindividual variations in free phenytoin concentrations, the pharmacologically active component. METHODS: We describe the process and data used to implement monitoring of free phenytoin only in an urban medical center. Over a 6-week period, total and free phenytoin concentrations were measured, clinical charts reviewed, and indications for alterations in the percentage of free phenytoin fraction were determined. RESULTS: Of the 189 phenytoin requests from 139 patients, 136 data points were analyzed. Free phenytoin concentrations were 6.8-35.3%, with 50% outside the expected range of 8-12%. Clinical indications likely responsible for variations were hypoalbuminemia, drug interactions, uremia, pregnancy, and age. Overall, 30% of patients demonstrated a discrepancy between therapeutic, subtherapeutic, or supratherapeutic concentrations between free and total phenytoin concentrations. The largest discordance (53%) occurred in the patient group with free phenytoin <8% or >12%. CONCLUSIONS: This study supports previous clinical findings that monitoring total phenytoin is not as reliable as free phenytoin as a clinical indicator for therapeutic and nontherapeutic concentrations. Thus, we recommend that therapeutic monitoring should use free phenytoin concentrations only.

Adolescent↗
PubMedDate not supplied

Preclinical evidence for therapeutic efficacy of selective estrogen receptor modulators for uterine leiomyoma.

OBJECTIVE: Uterine leiomyoma are the most common gynecologic neoplasm and a primary cause of hysterectomy in premenopausal women. Preclinical studies were conducted in the Eker rat model to investigate the potential efficacy of selective estrogen receptor modulators (SERMs) as therapeutic agents for this tumor. METHODS: Twelve-month-old Eker rats were randomized into five treatment arms including tamoxifen, placebo, LY 326315, vehicle, and no treatment. Additional animals received ovariectomy or sham surgery at 4 months of age to determine the effect of ovarian ablation on tumor development. The study was terminated after 2 to 4 months of treatment, and tumor incidence, size, proliferative and apoptotic indices were determined. Size and incidence data were subjected to chi-square analysis. One-way analysis of variance and Fisher's least significant difference tests were used to compare proliferative and apoptotic indices. RESULTS: Ovariectomy virtually ablated leiomyoma development, indicating that these tumors were dependent on ovarian hormones for growth and development. Treatment with tamoxifen or raloxifene analog LY 326315 reduced leiomyoma incidence by 40-60% and reduced the size of remaining tumors. The effect of SERMs on leiomyomas was mediated by a decrease in cell proliferation without a decrease in apoptotic index. CONCLUSION: SERMs have been shown to be therapeutically efficacious against breast cancer and to reduce tumor incidence in women at increased risk for this disease. The present data indicate that therapeutic efficacy may also be extended to uterine leiomyoma and demonstrate the utility of this animal model for preclinical studies to identify new therapeutic modalities.

Animals↗
PubMedDate not supplied

[Effect of therapeutic drug monitoring of amitriptyline and genotyping on efficacy and safety of depression therapy].

Modern pharmacotherapy is based on precise adjustment of a dosage schedule to individual requirements of patient. Therapeutic drug monitoring is a method that allows for a more effective treatment approach, especially in the case of a narrow therapeutic index of a drug. Tricyclic antidepressant drugs are characterised by narrow therapeutic index as well as relationship between serum drug concentration and side effects. It was demonstrated that interindividual variability of blood concentrations of tricyclic antidepressant drugs is related to genetic polymorphism of oxidating enzymes participating in metabolism of these drugs. The aim of the study was to estimate the impact of therapeutic drug monitoring of tricyclic antidepressant drugs as well as genotyping on efficacy and safety of endogenous depression therapy. The study included 9 patients with established diagnosis of endogenous depression. Blood serum concentrations of amitryptyline was measured by fluorescence polarisation immune assay (FPIA, Abbott system). Genotype of cytochrome P450 isoenzyme CYP2D6 was determined using PCR-RFLP method. It was demonstrated that monitoring therapy of tricyclic antidepressant drugs in combination with determination of the genotype seems to be more safe and effective. Monitoring therapy and genotyping may be less expensive than the costs of prolonged hospitalisation and risk of side effects.

Adult↗
PubMed2000

A case-study of PTSD in infancy: diagnostic, neurophysiological, developmental and therapeutic aspects.

Post-traumatic Stress Disorder of Infancy has become accepted as a nosological entity. Assessment guidelines and diagnostic criteria have been defined, taking into account the impact of development on the expression of post-traumatic symptoms. Therapeutic reenactment has been considered the cornerstone of the therapeutic process. The issue of deciding what is the optimal time for therapist-induced reenactment of the trauma remains ill-defined. The less verbal and the more avoidant the traumatized infant is, the more directive the therapist needs to be, meaning he will not necessarily get clues from the infant of his readiness for reenactment. The therapist will need to introduce the trauma, at the risk of provoking a massive "flight or fight" reaction, as is illustrated by the case study of a two-and-a-half-year-old post-traumatic preverbal boy and his mother. Issues relating to conditions under which reenactment stops causing reactivation of the trauma and starts being a process of therapeutic desensitization are raised. We suggest that integration of psychodynamic and neurodevelopmental concepts might be useful in deepening the understanding of the impact of therapeutic reenactment in PTSD of Infancy.

Arousal↗
PubMed2001

Therapeutic doses of oral methylphenidate significantly increase extracellular dopamine in the human brain.

Methylphenidate (Ritalin) is the most commonly prescribed psychoactive drug in children for the treatment of attention deficit hyperactivity disorder (ADHD), yet the mechanisms responsible for its therapeutic effects are poorly understood. Whereas methylphenidate blocks the dopamine transporter (main mechanism for removal of extracellular dopamine), it is unclear whether at doses used therapeutically it significantly changes extracellular dopamine (DA) concentration. Here we used positron emission tomography and [(11)C]raclopride (D2 receptor radioligand that competes with endogenous DA for binding to the receptor) to evaluate whether oral methylphenidate changes extracellular DA in the human brain in 11 healthy controls. We showed that oral methylphenidate (average dose 0.8 +/- 0.11 mg/kg) significantly increased extracellular DA in brain, as evidenced by a significant reduction in B(max)/K(d) (measure of D2 receptor availability) in striatum (20 +/- 12%; p < 0.0005). These results provide direct evidence that oral methylphenidate at doses within the therapeutic range significantly increases extracellular DA in human brain. This result coupled with recent findings of increased dopamine transporters in ADHD patients (which is expected to result in reductions in extracellular DA) provides a mechanistic framework for the therapeutic efficacy of methylphenidate. The increase in DA caused by the blockade of dopamine transporters by methylphenidate predominantly reflects an amplification of spontaneously released DA, which in turn is responsive to environmental stimulation. Because DA decreases background firing rates and increases signal-to-noise in target neurons, we postulate that the amplification of weak DA signals in subjects with ADHD by methylphenidate would enhance task-specific signaling, improving attention and decreasing distractibility. Alternatively methylphenidate-induced increases in DA, a neurotransmitter involved with motivation and reward, could enhance the salience of the task facilitating the "interest that it elicits" and thus improving performance.

Administration, Oral↗
PubMed2001

An analysis of therapeutic effect of drug acupoint application in 209 cases of allergic asthma.

Both therapies of traditional crude herb moxibustion and drug acupoint application were used in 209 cases of allergic asthma to compare their long-term and short-term therapeutic effects and to analyze the relationship between clinic therapeutic effects of both therapies and differential types of the disease. The results showed that the short-term total effective rate in the group of drug acupoint application was higher than that in the group of traditional crude herb moxibustion, the therapeutic effects of drug acupoint application being closely related to differential types. Analysis also shows the best short-term therapeutic effect was in the type of heat in the lung while the poorest effect in the type of deficiency of the kidney-yang.

Acupuncture Points↗
PubMed2001

[Plasma substitutes: strategies for use in intensive therapy to maintain a correct ratio between therapeutic efficacy and costs].

BACKGROUND: The coice of one product rather than another in clinical practice is based on two main criteria: therapeutic efficacy and the cost of the product in question. However, if therapeutic efficacy is equal, the choice of a less expensive product is not necessarily the right option. We compared the costs and therapeutic efficacy of two products used in plasma replacement therapy in order to identify which would be the most advantageous. METHODS: A total of 126 patients due to undergo major abdominal surgery were recruited and, having been duly informed, they were divided into two random groups. One group was treated with a solution of hydroxyethylamide 6% with an intermediate molecular weight (MW 200 kDa SD 0.5), and the other was treated with a solution of modified fluid gelatine (MFG) at 4% (MW 30 kDa). The solutions were administered to patients at the start of surgery until the morning of the first postoperative day in order to maintain mean arterial pressure (MAP) greater than 60 mmHg and central venous pressure (CVP) between 10 and 14 mmHg. Moreover, the costs of the two products and their additional charges were taken into consideration, taken from the supply lists provided by the pharmacy in the hospital where the study was carried out. RESULTS: No significant differences were found between the two groups in terms of therapeutic efficacy. In economic terms, the cost of the entire infusion treatment was comparable between the two groups in spite of the higher cost of hydroxyethylamide. CONCLUSIONS: The higher cost of hydroxyethylamide was compensated by the fact that a smaller amount of the solution is required to obtain the same hemodynamic parameters guaranteed by gelatine. Moreover, no adverse reactions were reported in this study to either compound. In the international literature, gelatine is associated with adverse reactions in a greater number of cases than hydroxyethylamide. This study shows that when proposing strategies of use, a simple cost analysis of the products used is not sufficient for a correct decision.

Adult↗
PubMed1998

[Ultrasonic angiography in therapeutic decision-making in peripheral occlusive vascular diseases].

OBJECTIVE: To study quickscan (QS) in different therapeutic decision-making in 55 patients with peripheral occlusive vascular diseases. METHODS: Based on QS results, 30 patients were treated conservatively. The disease progress and therapeutic effects were assessed by QS in every three months. Percutaneous transluminal angioplasty was performed successfully in 5 patients without prior diagnostic angiography. 20 patients were scheduled for surgery. Operation of eleven patients was guided by information obtained from QS findings only, which was confirmed during operation. Angiography was necessary in 9 patients except one to formulate a therapeutic strategy. RESULTS: The accuracy of QS was 92%(23/25). CONCLUSION: QS is of value in deciding the access route of angiography and PTA, and can replace preoperative angiography, Quickscan is time-saving, inexpensive, objective and accurate. It can be used in therapeutic decision making in peripheral occlusive vascular diseases and bypass grafting.

Adult↗
PubMed2001

[Therapeutic cloning in debate].

Human embryos can be conceived by cell nuclear transfer in order to isolate human embryonic stem cells (hES cells) for research into autologous cell therapy (therapeutic cloning). However, this technique broaches the major ethical problem concerning the instrumental use of human preimplantation embryos. From the viewpoint of subsidiarity, it is argued that various potential alternatives for therapeutic cloning should first be investigated further. The question as to whether therapeutic cloning should be allowed only becomes apparent when research with surplus embryos obtained in the course of in-vitro fertilization suggests that usable transplants can be obtained in vitro from hES cells, and when the potential alternatives for therapeutic cloning are either less promising or need more time for development than is currently expected.

Cloning, Organism↗
PubMed1975

Bioavailability of trivalent iron in oral iron preparations. Therapeutic efficacy and iron absorption from simple ferric compounds and high- or low-molecular weight ferric hydroxide-carbohydrate complexes.

All available results from critical hemoglobin regeneration tests, postabsorption serum iron concentration studies, 59Fe erythrocyte incorporation and 59Fe whole-body retention measurements demonstrate that humans do absorb ferrous iron between 4 and 10 times (in the average about 5 times) better than ferric iron from therapeutic oral 50--250 mg iron doses. Ferrous sulfate iron is 3 to 4 times better available than the iron from ferric ammonium citrate or sulfate. Whereas 100 mg of ferrous sulfate iron/day are sufficient for an optimal oral compensation iron therapy and to produce initial hemoglobin regeneration rates of about 0.26 g/100 ml/day, 400 to 1000 mg of ferric iron/day are necessary for the same therapeutic effect because of the poor bioavailability of ferric iron. The ratio of the dose-absorption relationships for ferric and ferrous 59Fe was shown to decrease from 0.43 for a diagnostic 0.56 mg Fe dose to 0.21 for the therapeutic 50 mg Fe dose in subjects with normal iron stores. Absorption ratios of 0.65 for the 0.56 mg Fe dose and 0.26 for the 50 mg Fe dose were measured in subjects with depleted iron stores. At all dose levels the superior bioavailability of ferrous iron was demonstrable. A high-molecular weight ferric hydroxide-carbohydrate complex (MW similar to 30 000) was palatable but so poorly absorbed that is was practically without effect on hemoglobin regeneration even at a daily 300 mg Fe dose. Following several warnings such a useless commerecial oral iron preparation was finally withdrawn from the market. The iron from any high-molecular weight carbohydrate complex of ferric hydroxide has to be suspected to be poorly absorbed and therefore therapeutical useless, unless the opposite has been demonstrated with a reliable bioassay (59Fe absorption whole-body retention and hemoglobin regeneration test). A low-molecular weight so-called ferric hydroxide-fructose complex was shown to contain iron of more or less the same poor bioavailability as contained in ferric chloride since the iron from ferrous sulfate was about 5 times better absorable. The good absorption of ferrous sulfate iron was not further augmented by even very large oral doses of fructose since this carbohydrate did not improve the ferrous iron absorption at a fructose: Fe molar ratio of 106:1. Trivalent iron in simple compounds like ferric ammonium citrate or in low- and high-molecular weight carbohydrate complexes of ferric hydroxide is so poorly available for intestinal iron absorption in man that it cannot be used for a fast and reliable oral iron therapy with reasonably low doses as it can be easily practised with quick-lease preparations of ferrous sulfate at a 100 mg Fe2

Anemia, Hypochromic↗
PubMed2000

[To probe into the practicability of using the jaw position of eliminating TMJ clicks as the therapeutic position of repositioning splint].

OBJECTIVE: To evaluate that it was practicable to use the jaw position of eliminating TMJ clicks as the therapeutic position of repositioning splint and to probe into the therapeutic mechanism of repositioning splint. METHODS: 25 patients with reducible disc displacement were treated with repositioning splint. The therapeutic jaw position was the position without TMJ clicking, then verified by Arthrography. The treatment effect was observed. RESULTS: Among 25 cases, 19 discs were completely recaptured, 5 incompletely recaptured, 1 not recaptured. Once the splints inserted, the movements of disc-condyle complex were smooth. After treatment finished, the opening types were improved, the clicks were lessened. CONCLUSIONS: It's practicable to use the jaw position of eliminating clicks as the treatment jaw position of repositioning splint. The therapeutic mechanism of repositioning splint may be that it altered the relationship of disc and condyle and improved their movement. That was favorable to fibrize the retrodiscal tissue and to strengthen the posterior band of disc.

Adolescent↗
PubMed1975

The effect of toxic and therapeutic doses of tricyclic antidepressant drugs on intracardiac conduction.

Intracardiac conduction studies using His bundle electrography (HBE) were performed in 14 patients admitted to hospital following an overdosage of one of the tricyclic antidepressant drugs and in another 12 patients before and during administration of therapeutic doses of nortriptylline. Amongst the former group, 7 of 8 patients showed impaired distal intracardiac conduction (H-V interval) following overdosages of nortriptyline, imipramine or amitriptyline but none of the 6 patients with doxepin overdosage. The prolonged H-V interval had returned to normal at a repeat study 7 days later. In the therapeutic dose study, 5 of 12 patients showed an increase in the H-V interval by more than 10 msec during treatment with nortriptyline. Four of these 5 patients had plasma nortriptyline levels of over 200 ng/ml. Tricyclic antidepressant drugs show a quinidine-like effect in toxic, and in some patients, in therapeutic doses. This finding may having a bearing on the treatment of cardiac arrhythmias in patients following overdosage with these drugs and may provide a clue to the reported increase in the incidence of sudden deaths in 'cardiac patients' following therapeutic doses of such agents.

Antidepressive Agents, Tricyclic↗
PubMed2000

[The clinical features and study on therapeutic effects of fungal keratitis].

OBJECTIVE: To review the clinical features and therapeutic effects of fungal keratitis (FK). METHODS: 110 cases (110 eyes) with the disease were divided into two types: hyphomycetic keratitis in 94 eyes and candida keratitis in 16 eyes. The clinical features and therapeutic effects of the two types were observed and compared. RESULTS: The hyphomycetic keratitis generally had a plant traumatic history. The border of corneal infiltration was not clear with feather edges, and had a tendency to penetrate into the deep stroma of cornea. There were endothelial plaques, hypopyon and bad therapeutic effects. The pathogenicity of cardida keratitis (CK) was related to the local long-term use of glucocorticoid, the fungus seldom expanded into the deep corneal layers and infiltrated into the inner eye. Its therapeutic effects were better. The border of CK was characterized with limitations, and was clear. CONCLUSIONS: The clinical features of the two types are different. The clinical features caused by different or the same pathogenic fungi show great variations. Early diagnoses, correct use of medicine and operation are the key points to increase the curative rate.

Adolescent↗
PubMedDate not supplied

Therapeutic play and the impact on anxiety in hospitalized children.

Zahr's (1998) study supported the use of puppet shows, as therapeutic play, to decrease anxiety in hospitalized preschoolers. The results of this study support our group's research utilization project to educate nurses on the effects of therapeutic play on anxiety levels in hospitalized children. Nurses could use this information to implement therapeutic play in hospitals throughout the world. Feasibility issues would include the cost of materials needed and the time involved to educate nurses. More research should be done on therapeutic play as a method to decrease anxiety in children. Future research could be conducted using other cultures or age groups.

Anxiety↗
PubMedDate not supplied

[Therapeutic alliance and analytic setting].

OBJECTIVE: The goal of this work is to study the relationship between the therapeutic alliance, the subjective perception of improvement, the frequency of sessions and the type of analytic interventions, in both psychoanalysts and non-psychoanalysts patients. METHODOLOGY: 39 subjects under psychoanalytic treatment lasting one to six years (mean 4.2 years) were interviewed. It was performed: a) a therapeutic alliance evaluation scale (HRQ); b) a subjetive improvement perception scale (PSM); c) a scale to evaluate the style of the psychoanalytic interventions (EI). The sample was divided in two groups: 1) 18 non-psychoanalysts under psychoanalytic treatment, who assited to a mean of 1.15 sessions per week (group 1) and b) 21 psychoanalysts receiving two kinds of psychoanalytic treatments: a) one following the international Psychoanalytc Associations rules (group 2A), b) the other with 1.65 mean sessions per week (group 2B). RESULTS: a) patients in groups 1 and 2A showed similar HRQ scores, and both were higher than that shown by group 2B (21.53 vs 21.51 vs 17.22) No differences were found neither in PSM scores (3.61 vs 3.85 vs 3.85 respectively) nor in the EI scores (3.61 vs 3.71 vs 3.71). It was observed a positive correlation between HRQ and PSM (group 1: r: 0.55 and gorup 2, r: 0.31) but no correlation was found neither with the number of sessions per week (group 1, r:0.13; group 2, r: 0.30) nor with EI score (group 1, r: -0.21; group 2, r: 0.08). DISCUSION AND CONCLUSIONS: a) intensity of perceived therapeutic alliance is correlated with improvement but b) is not correlated with sessions frequency or style of psychoanalytic interventions. It is also discussed which psychic changes are related with the therapeutic alliance with regards with different psychoanalytic theoretical frames.

Adult↗