ABSTRACT
This work aims is to evaluate the therapeutic efficacy of cognitive behavior therapy (CBT) in pediatric patients with obsessive-compulsive disorder (OCD) who had not previously been treated with either pharmacotherapy or psychotherapy and who remained medication-free during CBT. Sixteen OCD outpatients, 8-17 years of age, were treated in a 12-week open trial with manualized CBT. Target symptoms were rated at two-week intervals with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the National Institute of Mental Health Global Obsessive-Compulsive Scale (NIMH Global), the Clinical Global Impression Scale (CGI), and the Hamilton Anxiety Rating Scale (Ham-A). Statistical analyses showed a significant benefit for treatment. Ten patients experienced at least a 50% reduction in symptoms on the CY-BOCS; seven were asymptomatic on the NIMH Global. These results build on previous reports that CBT may be effective in the acute treatment of pediatric OCD. Further, the results of this study suggest that CBT can be efficacious in alleviating OCD symptoms in the absence of pharmacotherapy. These results must be considered preliminary, given the small sample size and open administration of treatment.
Subject(s)
Cognitive Behavioral Therapy/methods , Obsessive-Compulsive Disorder/therapy , Adolescent , Child , Female , Humans , Male , Obsessive-Compulsive Disorder/diagnosis , Severity of Illness Index , Treatment OutcomeABSTRACT
This study assessed psychological distress and psychiatric disorder in high-risk women enrolled in a hereditary breast and ovarian cancer registry, and it evaluated the concordance between self-report data and interview-based psychiatric diagnosis. A sample of 464 women completed the Hopkins Symptom Checklist-25 and were interviewed using modules of the Structured Clinical Interview for DSM-IV. Level of psychological distress and the prevalence of psychiatric disorder were low and in the range that would be expected for a sample of community-residing women. Screening proved inefficient: Less than 10% of distressed women met criteria for a clinical disorder. High-risk women seeking genetic testing in research settings may not require extensive psychological screening and diagnostic assessment. Caution is expressed about possible self-selection biases in women enrolled in hereditary cancer registries.
Subject(s)
Breast Neoplasms/psychology , Genetic Predisposition to Disease/psychology , Mental Disorders/epidemiology , Ovarian Neoplasms/psychology , Stress, Psychological/epidemiology , Adult , Female , Humans , Interview, Psychological , Mental Disorders/etiology , Pennsylvania/epidemiology , Prevalence , Psychiatric Status Rating Scales , Registries , Selection Bias , Stress, Psychological/etiologyABSTRACT
The utility of Coyne's (1976a) interactional model in predicting negative spousal attitudes toward depressed patients was examined. Eighty-nine couples with at least 1 member in treatment for depression were selected on the basis of semistructured diagnostic interviews. Overall, spouses living with a depressed patient reported significantly more distress than population norms. Consistent with prediction, patients' reassurance seeking and spouses' mood contributed to negative spousal attitudes. Additional analyses demonstrated that these effects persisted even after controlling for spouse marital adjustment, suggesting that negative spousal attitudes were more than a simple reflection of marital maladjustment.
Subject(s)
Attitude , Depressive Disorder, Major/psychology , Spouses/psychology , Adaptation, Psychological , Adult , Depressive Disorder, Major/diagnosis , Female , Humans , Male , Marriage/psychology , Middle AgedABSTRACT
BACKGROUND: Neurobiologic abnormalities in the thalamus have been implicated in the pathophysiology of obsessive-compulsive disorder. We recently reported increased thalamic volume in treatment-naive pediatric obsessive-compulsive disorder patients versus case-matched healthy comparison subjects that decreased to levels comparable to control subjects after effective paroxetine therapy. To our knowledge, no prior study has measured neuroanatomic changes in the thalamus of obsessive-compulsive disorder patients near illness onset before and after cognitive behavioral therapy. METHODS: Volumetric magnetic resonance imaging studies were conducted in 11 psychotropic drug-naive 8-17-year-old children with obsessive-compulsive disorder before and after 12 weeks of effective cognitive behavioral therapy monotherapy (> or =30% reduction in obsessive-compulsive disorder symptom severity). RESULTS: No significant change in thalamic volume was observed in obsessive-compulsive disorder patients before and after cognitive behavioral therapy. CONCLUSIONS: Our findings suggest that reduction in thalamic volume after paroxetine therapy may be specific to paroxetine treatment and not the result of a general treatment response or spontaneous improvement. These results are preliminary in view of the small sample studied.
Subject(s)
Cognitive Behavioral Therapy/methods , Obsessive-Compulsive Disorder/therapy , Thalamus/anatomy & histology , Adolescent , Child , Female , Humans , Magnetic Resonance Imaging , Male , Obsessive-Compulsive Disorder/physiopathology , Time Factors , Treatment OutcomeABSTRACT
The depressed mood and specific burdens experienced by spouses of patients in treatment for depression were examined. Forty-nine wife-depressed couples and 30 husband-depressed couples were administered the Structured Clinical Interview for DSM-IV (M. B. First, R. L. Spitzer, M. Gibbon, & J. B. W. Williams, 1995), and spouses completed measures of depressed mood and burden. Overall, spouses living with a depressed patient reported significantly more depressed mood than general population norms and numerous specific burdens. Regression analyses showed that these burdens as well as gender of the spouse accounted for the spouses' depressed mood that would otherwise be attributed to mood contagion. It is suggested that as an alternative to an exclusive therapeutic focus on patient outcomes, attention might profitably be directed to the distress and burden experienced by spouses.
Subject(s)
Depressive Disorder, Major/psychology , Dysthymic Disorder/psychology , Marriage/psychology , Spouses/psychology , Adult , Cost of Illness , Depressive Disorder, Major/diagnosis , Dysthymic Disorder/diagnosis , Female , Gender Identity , Humans , Male , Middle Aged , Personality Inventory/statistics & numerical data , PsychometricsABSTRACT
This study examines the discriminant validity of the Trauma Symptom Checklist (TSC-40) in a clinical sample. The TSC-40 was developed as a research instrument for assessing the impact of a history of sexual victimization. Previous validity studies used nonclinical samples of women (Elliott & Briere, 1992; Gold, Milan, Myall, & Johnson, 1994). In the present study, the TSC-40 was administered to 103 men and 79 women requesting services at two outpatient clinics. Information about sexual victimization was collected from the client during intake and from the therapist after the client had received 6 months of therapy. A history of CSA was associated both with high symptom levels across symptom dimensions, and, specifically, with elevation on the trauma subscale of the TSC-40. The findings support the view that, in a clinical setting, CSA is associated both with generalized distress and with PTSD symptoms.
Subject(s)
Child Abuse, Sexual/psychology , Personality Inventory/statistics & numerical data , Adult , Ambulatory Care , Child , Child Abuse/psychology , Discriminant Analysis , Female , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Personality Development , Psychometrics , Psychotherapy , Reproducibility of ResultsABSTRACT
A longitudinal study was designed to assess the effects of infertility as well as the influence of the subsequent medical investigation on marital functioning. During their initial visit at a fertility clinic, 165 couples underwent psychological assessment. Questionnaires were completed to assess stress, sexual satisfaction, and marital adjustment. Participants were categorized into those who became pregnant during the 12 months of the study (n = 48 couples) and those for whom treatment was not successful (n = 117 couples). Significant increases in stress and decreases in marital functioning were experienced by subjects as the treatment investigation progressed. Furthermore, greater levels of marital distress were observed in couples that did not conceive. Significant gender differences were observed.
