Intervention with feedback using Outcome Questionnaire 45 (OQ-45) in a Swedish psychiatric outpatient population. A randomized controlled trial.

Aim: The objective of the study was to evaluate the efficacy of the Outcome Questionnaire 45 (OQ-45) with feedback in a Swedish psychiatric outpatient population using a randomized controlled design. Method: In all 1720 patients made at least one regular visit to the clinics in the period 12 February 2007 to 10 February 2008 and received information about the study. Of these, 374 patients (22%) agreed to participate. After written consent, 188 patients were randomized to the feedback group and 186 patients to the control group. Those constituted the intention-to-treat (ITT) group. Two hundred and sixty-two patients (70%) completed the OQ-45 questionnaire at least twice, and they were included in the per-protocol analysis. Those who improved less than expected and were at risk for treatment failure were called alerted patients. Results: There was a tendency that patients who received feedback improved more than the controls in OQ-45 total score. In the ITT analysis, the P-value was 0.061 and the effect size g = 0.21. In the per-protocol analysis the P-value was 0.076 and the effect size g = 0.24. In the intervention group, 27% of the patients were alerted because of risk of treatment failure vs. 28% in the control group (reaching level of alertness). The OQ-45 differences between the intervention and control groups did not significantly differ for patients who were alerted/reaching level of alertness and for non-alerted patients (g = 0.17 and g = 0.28, respectively). Conclusions: The feedback group had a tendency to improve more than the control group, possibly indicating that the method is effective, and the result (basically) supports previous findings

Being in want of control: Experiences of being on the road to, and making, a suicide attempt

Attempted suicide is a risk factor for future suicidal behaviour, but understanding suicidality from the perspective of people who have experienced attempted suicide is limited. The aim of the study was to explore the lived experience of being suicidal and having made a suicide attempt, in order to identify possible implications for health care professionals. Semi-structured individual interviews were held with 10 persons shortly after they attempted suicide and were analysed through qualitative content analysis. The participants’ experience of being suicidal and of having attempted suicide could be described as “Being on the road towards suicidal action”, which culminated in an experience of either chaos or turned off emotions, “Making sense of the suicide attempt”, and “Opening the door to possible life lines”. An overall theme, “Being in want of control”, captured their all-embracing lack of sense of control and was seen in relation to different aspects of oneself, overall life-situation, the immediate suicide attempt situation and in the outlook on the future. Being in want of control may be a relevant and general feature of being suicidal. People who have attempted suicide need more adequate help to break vicious circles before they reach a point of no return and enter an acute suicidal state of mind. Patients’ experience-based knowledge is highly important to listen to and use clinically as well as theoretically when constructing suicide prevention programs

Risky use of alcohol, drugs and cigarettes in a psychosis unit: a 1 1/2 year follow-up of stability and changes after initial screening

<p>Abstract</p> <p>Background</p> <p>Co-morbidity with substance use disorders negatively influences overall functioning in patients with psychosis. However, frequencies and courses of risky use of alcohol, drugs and cigarettes are rarely investigated in patients at psychosis units.</p> <p>The purpose of this study is to describe the use of alcohol, drugs and cigarettes in patients at a psychosis unit over a 1 1/2 year period after them having taken part in a screening investigation including a feed-back of the results to personnel. Relationships with sex and age are also described.</p> <p>Methods</p> <p>The patients' use of the substances was examined at baseline and at follow-up using three self-reporting instruments: Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT) and Fagerstrom Test for Nicotine Dependence (FTND).</p> <p>Results</p> <p>One hundred and eighty-six patients out of 238 at baseline (78 percent) took part in the follow-up. Total AUDIT score decreased in women. Older men more often developed a risky alcohol use. Older women tended to reduce their risky drug habits. On a group level the habits mostly were stable, but 11 percent changed their alcohol habits and 15 percent changed their smoking habits from risky to no/low risky use, or vice versa. Nine percent changed their drug habits, predominantly from risky to no/low risky use.</p> <p>Conclusion</p> <p>A more active approach towards alcohol, drug and smoking habits in psychosis units would probably be beneficial.</p

To keep the alcoholic in out-patient treatment. : A differentiated approach through treatment contracts

Eighty-two alcoholics were offered a 2-year out-patient programme characterized by stressing the patients' own decisions both in joining the programme and in the choice of objectives and methods, by repeated feedbacks through treatment evaluations, and by relapse prevention. The 58 patients who accepted were more often married than the others. All but eight completed the programme. The most important treatment components were ranked by the patients. Individual counselling was ranked highest, followed by evaluations of contract with therapist, disulfiram and biofeedback by means of gamma-GT. Patients with alcohol dependence more often preferred instrumental components, such as disulfiram and gamma-GT, while the others more often preferred psychological components, such as individual counselling and contract evaluations. Preference of psychological components was not found to be related to degree of personality disturbances. It is suggested that to effectively keep the patients in treatment in the present programme depends on the combination of patients' active engagement, continuous feedback and individualized treatment objectives

Depression och självmord

Vi har systematiskt gått igenom befolkningsbaserade studier, som separat har analyserat frekvenserna för depression och självmord eller självmordsbeteende och deras samband med alkoholberoende, alkoholmissbruk eller riskfylld alkoholkonsumtion. Depressionssjukdomar visade en stark ökning vid alkoholberoende, men endast en marginell ökning vid alkoholmissbruk och riskfylld alkoholkonsumtion. Hela 48 procent av självmorden i Sverige har visat sig vara alkoholrelaterade. Självmordsfrekvensen var förhöjd vid alkoholberoende och hade ofta samband med samtidig depression. En mindre del av självmorden kan förklaras av akut berusningsdrickande oberoende av samtidig depressions- eller alkoholdiagnos

Acceptance, Attrition, and Outcome in an Outpatient Treatment Programme for Alcoholics : a Comparison Between a Randomized and a Non-Randomized Process-Outcome Study

Acceptance, attrition and outcome of the same outpatient treatment programme for alcoholics was studied first in a non-randomized and later in a randomized study. There was a lower (15%) rate of acceptance and a higher (19%) rate of attrition in the randomized study. Among treatment completers drinking outcome during the third year after commencement of treatment did not differ between the non-randomized and the randomized study. It is concluded that the characteristics of subjects accepting a randomly assigned study should always be clearly presented. The absence of a patient-therapist matching in a randomized design could negatively effect attrition and probably also acceptance of treatment, while it seems to be less influential on outcome in those completing therapy

Modern medicinsk behandling har förbättrat livssituationen för unga med juvenil idiopatisk artrit. Långtidsuppföljning av två patientkohorter.

Svensk sammanfattning utan rubrik: Två patientkohorter som vårdats för barnreumatism vid Lunds universitetssjukhus 1982 (grupp 1) respektive 1996 (grupp2) följdes upp efter drygt 10 år. Syftet var att kunna beskriva deras levnadsförhållande i olika avseenden i vuxen ålder. Patientgrupperna bedömdes jämförbara och följdes upp på samma sätt med intervjuer och självskattningar; HAQ, ISSI, SAS-SR, SCL-90-R. Grupp 2 hade haft tillgång till behandling med metotrexat tidigt i sjukdomsförloppet och senare även biologiska läkemedel. De hade vid uppföljningen en högre funktionsnivå, mindre hjälpbehov och en bättre social situation än den första gruppen, som inte haft tillgång till dessa mediciner. Båda grupperna hade få psykiska symtom (SCL-90) och ett välfungerande nätverk (ISSI).  Engelsk sammanfattning.  Modern pharmacological treatments improved life for young people with Juvenile Idiopathic Arthritis. Long-term follow up of two patient cohorts.Inpatients, similar age and sex, treated at an age &gt; 15, group 1 in 1982, group 2 in 1996, were followed up after &gt;10 years, with the same semi-structured telephone-interviews and self-ratings questionnaires; HAQ, ISSI, SAS-SR, SCL-90-R. Group 2 showed better functioning (HAQ), had more often fulltime work (53% vs 30%), and were more often married (55% vs 34%). Both groups had few psychiatric symptoms (SCL-90) and a satisfying network (ISSI). Group 1 patients were almost adult before methotrexate was used, while many in group 2 had got that treatment almost from disease onset. At follow up none in group 1 was treated with biological drugs versus 38% in group 2