Impact of Psychotherapy in Psychosis: A Retrospective Case Control Study

Background: The need for psychological therapies for psychosis has become apparent since long-term antipsychotic drug treatment has a range of adverse side effects, with moderate therapeutic effects at best.Aims: To investigate whether the psychotherapeutic approach, dialogue therapy (DT) is associated with improvements of symptoms and functioning beyond standard psychiatric treatment (ST) in both schizophrenia and other psychosis.Methods: A retrospective case-control design, comparing 54 patients with different psychoses who received DT with 54 patients in a control group receiving ST was carried out. The groups were matched on diagnosis, age, sex, and treatment start. Outcome measures were Global assessment of functioning (GAF) scores, medications at follow up, and hospital stays after completed outpatient treatment.Results: Mean time in treatment from inclusion to follow-up was 3 years and 5 months. At follow-up, GAF functioning (GAF-F) and GAF symptom (GAF-S) scores both were significantly higher in the DT group than the ST group. Effect sizes (Cohen's d) were large; 1.8 for GAF-S and 2.1 for GAF-F. At follow-up, the use of psychoactive drugs was significantly reduced despite a shorter time in psychotherapy in the DT group compared to the ST group. Days of hospitalizations after end of treatment in the study period were significantly reduced in both groups compared to the period before start of treatment.Conclusions: The findings from this exploratory study are consistent with the possibility that dialogue therapy may lead to improvements in symptoms and functioning compared to standard treatment in psychosis

Effectiveness of Internet-Based Cognitive Behavioral Therapy with Telephone Support for Noncardiac Chest Pain: Randomized Controlled Trial

Background: Noncardiac chest pain has a high prevalence and is associated with reduced quality of life, anxiety, avoidance of physical activity, and high societal costs. There is a lack of an effective, low-cost, easy to distribute intervention to assist patients with noncardiac chest pain. Objective:In this study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy with telephone support for noncardiac chest pain. Methods: We conducted a randomized controlled trial, with a 12-month follow-up period, to compare internet-based cognitive behavioral therapy to a control condition (treatment as usual). A total of 162 participants aged 18 to 70 years with a diagnosis of noncardiac chest pain were randomized to either internet-based cognitive behavioral therapy (n=81) or treatment as usual (n=81). The participants in the experimental condition received 6 weekly sessions of internet-based cognitive behavioral therapy. The sessions covered different topics related to coping with noncardiac chest pain (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, and maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to internet-based cognitive behavioral therapy sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence, and provide access to the next session. Participants in the treatment-as-usual group received standard care for their noncardiac chest pain without any restrictions. Primary outcomes were cardiac anxiety, measured with the Cardiac Anxiety Questionnaire, and fear of bodily sensations, measured with the Body Sensations Questionnaire. Secondary outcomes were depression, measured using the Patient Health Questionnaire; health-related quality of life, measured using the EuroQol visual analog scale; and level of physical activity, assessed with self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 score ≥5) was conducted. Assessments were conducted at baseline, posttreatment, and at 3- and 12-month follow-ups. Linear mixed models were used to evaluate treatment effects. Cohen d was used to calculate effect sizes. Results: In the main intention-to-treat analysis at the 12-month follow-up time point, participants in the internet-based cognitive behavioral therapy group had significant improvements in cardiac anxiety (–3.4 points, 95% CI –5.7 to –1.1; P=.004, d=0.38) and a nonsignificant improvement in fear of bodily sensations (–2.7 points, 95% CI –5.6 to 0.3; P=.07) compared with the treatment-as-usual group. Health-related quality of life at the 12-month follow-up improved with statistical and clinical significance in the internet-based cognitive behavioral therapy group (8.8 points, 95% CI 2.8 to 14.8; P=.004, d=0.48) compared with the treatment-as-usual group. Physical activity had significantly (P<.001) increased during the 6-week intervention period for the internet-based cognitive behavioral therapy group. Depression significantly improved posttreatment (P=.003) and at the 3-month follow-up (P=.03), but not at the 12-month follow-up (P=.35). Participants with depressive symptoms at baseline seemed to have increased effect of the intervention on cardiac anxiety (d=0.55) and health-related quality of life (d=0.71) at the 12-month follow-up. In the internet-based cognitive behavioral therapy group, 84% of the participants (68/81) completed at least 5 of the 6 sessions. Conclusions: This study provides evidence that internet-based cognitive behavioral therapy with minimal therapist contact and a focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with noncardiac chest pain.publishedVersio

Factors influencing employment after minor stroke and NSTEMI

Aim: To study the effect of cognitive function, fatigue and emotional symptoms on employment after a minor ischemic stroke compared to non-ST-elevation myocardial infarction (NSTEMI). Material and methods: We included 217 patients with minor ischemic stroke and 133 NSTEMI patients employed at baseline aged 18–70 years. Minor stroke was defined as modified Rankin scale (mRS) 0–2 at day seven or at discharge if before. Included NSTEMI patients had the same functional mRS. We applied a selection of cognitive tests and the patients completed questionnaires measuring symptoms of anxiety, depression and fatigue at follow up. Stroke patients were tested at three and 12 months and NSTEMI at 12 months. Results: The patients still employed at 12 monthswere significantly younger than the unemployed patients and the NSTEMI patients employed were significantly older than the stroke patients (59 vs 55 years, p < .001). In total, 82 % of stroke patients and 90 % of the NSTEMI patients employed at baseline were still employed at 12 months (p = 06). Stroke patients at work after 12 months had higher education than unemployed patients. There were no difference between employed and unemployed patients in risk factors or location of cerebral ischemic lesions. Cognitive function did not change significantly in the stroke patients from three to 12 months. For stroke patients, we found a significant association between HADS-depression and unemployment at 12 months (p = 04), although this association was not present at three months. Lower age and higher educational level were associated with employment at 12 months for all patients. Discussion and conclusion: Age and education are the main factors influencing the ability to stay in work after a minor stroke. Employed stroke patients were younger than the NSTEMI patients, but there was no difference in the frequencies in remaining employed. The employment rate at 12 months was high despite the relatively high prevalence of cognitive impairment in both groups.publishedVersio

Chest Pain and Palpitations in a Cardiac Setting;Psychological Factors, Outcome and Treatment

Brystsmerter og hjertebank ved kardiologisk poliklinikk; psykologiske faktorer, forløp etter undersøkelsen og psykologisk behandling for plagene. Brystsmerter og hjertebank som kan være symptom på alvorlig hjertesykdom, er vanlige plager i befolkningen. Forløpet etter hjerteundersøkelsen for de som ikke får påvist hjertesykdom, er ofte dårlig. Mange fortsetter å bekymre seg for symptomene og har begrensninger i sine liv og nedsatt livskvalitet. Det er en utfordring å fange opp pasientene som trenger behandling og å utvikle gode behandlingsopplegg Formålet med studien var å beskrive hvor mange av pasientene henvist til kardiologisk poliklinikk som hadde hjertesykdom, hvor mange som hadde psykiatrisk lidelse, hvordan det gikk med pasientene uten hjertesykdom de kommende 6 månedene og til sist å gjøre en randomisert kontrollert behandlingsstudie av pasientene med vedvarende plager. Alle pasientene mellom 18 og 65 år som ble henvist fra allmennlege pga brystsmerter eller hjertebank til kardiologisk poliklinikk ved Molde sykehus og som ikke tidligere hadde fått diagnostisert hjertesjukdom, fikk tilbud om å delta. Av de 160 pasientene som ble inkludert, var det kun 4 % som fikk påvist behandlingstrengende hjertesjukdom, mens ca 40 % av pasientene uten hjertesjukdom hadde en psykiatrisk lidelse. De vanligste var; panikklidelse (14%), somatiseringslidelse (14%), spesifikke fobier (20%) og depresjon (5%). Seks måneder etter hjerteundersøkelsen hadde 43% av pasientene med normal hjerteundersøkelse betydelige plager relatert til brystsmerter og hjertebank, og 70% unngikk fysisk aktivitet en sjelden gang eller oftere fordi de var bekymret for hjertet. Pasientene hadde mer depressive symptomer og var mer redd for sine kroppslige symptomer seks måneder etter enn før hjerteundersøkelsen. Høy score på depresjonstest forut for hjerteundersøkelsen predikerte dårlig prognose. Omtrent 60% av pasientene, med betydelige plager relatert til brystsmerter og hjertebank seks måneder etter normal hjerteundersøkelse, ønsket psykologisk behandling for plagene. De som ønsket behandling var mer redd for kroppslige plager og var mer begrenset av plagene enn andre. De trudde også i større grad før hjerteundersøkelsen at deres plager skyldes hjertesjukdom. Som en del av studien utviklet vi en behandling som besto av tre sesjoner med kognitiv terapi der eksponering for fysisk aktivitet var et av elementene. Behandlingen ble prøvd ut i en randomisert kontrollert studie (RCT) til 40 pasienter med oppfølgingstid på ett år etter avsluttet behandling. Behandlingen hadde positiv effekt på frykt for kroppslige symptomer, på depressive symptomer, unngåelse av fysisk aktivitet og flere områder av helserelatert livskvalitet. Endringen i frykt for kroppslige symptomer syntes å være en viktig faktor for hele behandlingseffekten. Konklusjon: Få av pasientene med brystsmerter og hjertebank som henvises elektivt til kardiologisk poliklinikk har hjertesykdom, mange av pasientene uten hjertesykdom har vedvarende plager med funksjonsreduksjon i månedene etter hjerteundersøkelsen. Mange av disse har effekt av tre timer med kognitiv terapi der eksponering for fysisk belastning på ergometersykkel er inkludert

Illness perception among patients with chest pain and palpitations before and after negative cardiac evaluation

Background Patients with chest pain or palpitations often have poor outcomes following a negative cardiac evaluation, with symptom persistence, limitations in everyday activities, and reduced health-related quality of life. The aims of this study were to evaluate illness perceptions before and after negative cardiac evaluations and measure the ability of a self-report questionnaire to predict outcomes. Methods Patients (N = 138) referred for chest pain or palpitations to a cardiac outpatient clinic were assessed before and six months after a negative cardiac evaluation. In addition to Brief Illness Perception Questionnaire (BIPQ), all patients completed the Beck Depression Inventory and SF-36 Health Survey. Results The emotional reactions to and understanding of symptoms had not improved six months after a negative cardiac evaluation. A stronger correlation between illness perceptions and health at follow-up than before the cardiac evaluation might explain the tendency for poor outcomes among these patients. Most of the eight BIPQ item scores before the negative cardiac evaluation were predictive of the outcome six months later. A single question asking about the perceived consequences of the complaints (BIPQ Item 1) rated before the cardiac evaluation was collapsed into a dichotomous variable with a cut-off at ≥4 which yields a sensitivity of 51%, a specificity of 85%, a positive predictive value of 71%, a negative predictive value of 69%, and an odds ratio of 5.7 (r = .38, p < .001) in predicting poor outcomes. Conclusions Assessing illness perceptions is important in patients with negative cardiac tests for understanding and predicting outcomes

Erfaringar med dialektisk åtferdsterapi i Molde

Det er ei stor utfordring å gi pasientar med kjenslemessig ustabilitet og sjølvdestruktiv åtferd eit godt behandlingstilbod. Dialektisk åtferdsterapi (DBT) er ein poliklinisk behandlingsmodell som har gitt gode resultat. DBT-poliklinikken i Molde er den første i sitt slag i Noreg. Vi ønskjer i dette arbeidet å evaluere våre pasientar i høve til komorbiditet, karakteristika for dei som deltok og dei som fall ut av behandlinga, endringar under behandling, samt å samanlikne pasientar med kort og lang behandlingstid. Pasientane blir evaluert i høve til alder, kjønn, diagnosar og psykometriske variablar. Av 128 pasientar evaluert for DBT, starta 60 opp i programmet. Pasientane vart diagnostisert med MINI og SCID-II, i tillegg til eigenvurderingar og terapeutvurderingar av psykometriske variablar. Det var høg grad av komorbiditet, og dei fleste hadde personlegdomsdiagnosar (80 %). Fråfallprosent var låg (20 %). Dei som fall frå skilte seg lite frå behandlingsgruppa ved oppstart av behandlinga. Behandlingsgruppa viste signifikant positiv endring for håpløyse, depresjon, livskvalitet, psykisk helse, skår for personlegdomsforstyrring og terapeutvurdert funksjons- og symptomskår. Dei med kort behandlingstid var yngre og hadde mindre eteforstyrringar. DBT-poliklinikk i Distrikts-Noreg synest å vere eit hensiktsmessig og godt behandlingstilbod for pasientar med kjenslemessig dysregulering og sjølvdestruktiv åtferd. Offering proper treatment to people with emotional instability and self-destructive behaviour is a challenge. Dialectical Behavior Therapy (DBT) is an outpatient treatment that has proven effective. The DBT-outpatient clinic in Molde is the first of its kind in Norway. In this study we want to evaluate patients according to comorbidity, characteristics of those who attended and those who dropped out of treatment, changes during treatment, and differences by length of treatment. Of 128 patients evaluated for DBT, 60 attended the programme. The patients were diagnosed by MINI and SCID II, in addition to self-evaluations and therapist assessments of psychiatric variables. The degree of comorbidity was high and most of the patients had personality disorders (80%). Dropout was low (20 %). The dropouts showed little difference at the beginning of treatment from those who completed the treatment. The treatment group showed significant positive changes in hopelessness, depression, mental health, quality of life, personality disorder scores and therapist-assessed scores for symptoms and function. The patients who attended for a short time were younger and had lower prevalence of eating disorder The DBT outpatient clinic seems to offer suitable and positive treatment for patients with emotional dysregulation and self-destructive behaviour in rural parts of Norway

Impact of psychotherapy in psychosis: A retrospective case control study

Background: The need for psychological therapies for psychosis has become apparent since long-term antipsychotic drug treatment has a range of adverse side effects, with moderate therapeutic effects at best. Aims: To investigate whether the psychotherapeutic approach, dialogue therapy (DT) is associated with improvements of symptoms and functioning beyond standard psychiatric treatment (ST) in both schizophrenia and other psychosis. Methods: A retrospective case-control design, comparing 54 patients with different psychoses who received DT with 54 patients in a control group receiving ST was carried out. The groups were matched on diagnosis, age, sex, and treatment start. Outcome measures were Global assessment of functioning (GAF) scores, medications at follow up, and hospital stays after completed outpatient treatment. Results: Mean time in treatment from inclusion to follow-up was 3 years and 5 months. At follow-up, GAF functioning (GAF-F) and GAF symptom (GAF-S) scores both were significantly higher in the DT group than the ST group. Effect sizes (Cohen's d) were large; 1.8 for GAF-S and 2.1 for GAF-F. At follow-up, the use of psychoactive drugs was significantly reduced despite a shorter time in psychotherapy in the DT group compared to the ST group. Days of hospitalizations after end of treatment in the study period were significantly reduced in both groups compared to the period before start of treatment. Conclusions: The findings from this exploratory study are consistent with the possibility that dialogue therapy may lead to improvements in symptoms and functioning compared to standard treatment in psychosis

Effectiveness of Internet-Based Cognitive Behavioral Therapy with Telephone Support for Noncardiac Chest Pain: Randomized Controlled Trial

Background: Noncardiac chest pain has a high prevalence and is associated with reduced quality of life, anxiety, avoidance of physical activity, and high societal costs. There is a lack of an effective, low-cost, easy to distribute intervention to assist patients with noncardiac chest pain. Objective:In this study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy with telephone support for noncardiac chest pain. Methods: We conducted a randomized controlled trial, with a 12-month follow-up period, to compare internet-based cognitive behavioral therapy to a control condition (treatment as usual). A total of 162 participants aged 18 to 70 years with a diagnosis of noncardiac chest pain were randomized to either internet-based cognitive behavioral therapy (n=81) or treatment as usual (n=81). The participants in the experimental condition received 6 weekly sessions of internet-based cognitive behavioral therapy. The sessions covered different topics related to coping with noncardiac chest pain (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, and maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to internet-based cognitive behavioral therapy sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence, and provide access to the next session. Participants in the treatment-as-usual group received standard care for their noncardiac chest pain without any restrictions. Primary outcomes were cardiac anxiety, measured with the Cardiac Anxiety Questionnaire, and fear of bodily sensations, measured with the Body Sensations Questionnaire. Secondary outcomes were depression, measured using the Patient Health Questionnaire; health-related quality of life, measured using the EuroQol visual analog scale; and level of physical activity, assessed with self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 score ≥5) was conducted. Assessments were conducted at baseline, posttreatment, and at 3- and 12-month follow-ups. Linear mixed models were used to evaluate treatment effects. Cohen d was used to calculate effect sizes. Results: In the main intention-to-treat analysis at the 12-month follow-up time point, participants in the internet-based cognitive behavioral therapy group had significant improvements in cardiac anxiety (–3.4 points, 95% CI –5.7 to –1.1; P=.004, d=0.38) and a nonsignificant improvement in fear of bodily sensations (–2.7 points, 95% CI –5.6 to 0.3; P=.07) compared with the treatment-as-usual group. Health-related quality of life at the 12-month follow-up improved with statistical and clinical significance in the internet-based cognitive behavioral therapy group (8.8 points, 95% CI 2.8 to 14.8; P=.004, d=0.48) compared with the treatment-as-usual group. Physical activity had significantly (P<.001) increased during the 6-week intervention period for the internet-based cognitive behavioral therapy group. Depression significantly improved posttreatment (P=.003) and at the 3-month follow-up (P=.03), but not at the 12-month follow-up (P=.35). Participants with depressive symptoms at baseline seemed to have increased effect of the intervention on cardiac anxiety (d=0.55) and health-related quality of life (d=0.71) at the 12-month follow-up. In the internet-based cognitive behavioral therapy group, 84% of the participants (68/81) completed at least 5 of the 6 sessions. Conclusions: This study provides evidence that internet-based cognitive behavioral therapy with minimal therapist contact and a focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with noncardiac chest pain