ABSTRACT
PURPOSE: We examined the efficacy of adding short-term psychodynamic psychotherapy (STPP) to antidepressants in the treatment of depression by means of a systematic review and meta-analysis of individual participant data, which is currently considered the most reliable method for evidence synthesis. RESULTS: A thorough systematic literature search resulted in 7 studies comparing combined treatment of antidepressants and STPP versus antidepressant mono-therapy (n = 3) or versus antidepressants and brief supportive psychotherapy (n = 4). Individual participant data were obtained for all these studies and totaled 482 participants. Across the total sample of studies, combined treatment of antidepressants and STPP was found significantly more efficacious in terms of depressive symptom levels at both post-treatment (Cohen's d = 0.26, SE = 0.10, p = .01) and follow-up (d = 0.50, SE = 0.10, p < .001). This effect was most apparent at follow-up and in studies examining STPP's specific treatment efficacy. Effects were still apparent in analyses that controlled for risk of bias and STPP quality in the primary studies. CONCLUSIONS: These findings support the evidence-base of adding STPP to antidepressants in the treatment of depression. However, further studies are needed, particularly assessing outcome measures other than depression and cost-effectiveness, as well as examining the relative merits of STPP versus other psychotherapies as added to antidepressants.
Subject(s)
Antidepressive Agents/therapeutic use , Depression/therapy , Psychotherapy, Psychodynamic/methods , Adult , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Treatment Outcome , Young AdultABSTRACT
Resumen Más de la mitad de los pacientes con trastorno de personalidad limítrofe (TPL) han realizado al menos un intento suicida durante su vida y el 70% ha tenido al menos una hospitalización psiquiátrica. La presente investigación tiene como objetivo evaluar la efectividad de la Terapia Conductual Dialéctica (TCD) en pacientes con trastorno de personalidad limítrofe. Método: A través de un diseño observacional retrospectivo se evaluó el número de intentos suicidas, el número de hospitalizaciones psiquiátricas y el impacto clínico previo al tratamiento con TCD y posterior a éste. Se analizó la información disponible de 144 pacientes de la Unidad de Terapia Conductual Dialéctica del Servicio de Psiquiatría del Hospital del Salvador, de Santiago de Chile, entre los años 2006-2012. Los datos fueron recolectados a través de registros electrónicos, análisis de ficha clínica, mediante el cuestionario OQ-45.2 y contacto telefónico. Resultados: En cuanto a los resultados, a través del método estadístico de Wilcoxon, se demostró una diferencia significativa (p = 0,000) en el número de hospitalizaciones psiquiátricas pre y post tratamiento, una disminución (p = 0,000) del número de intentos suicidas posterior al tratamiento y mejoría en los puntajes del cuestionario OQ-45.2. Conclusión: La TCD fue efectiva en disminuir las 3 variables estudiadas en la población escogida.
More than half of patients diagnosed with borderline personality disorder have made at least one suicide attempt during their lifetime and 70% have been admitted to an inpatient psychiatric unit. This research aims to assess the effectiveness of Dialectical Behavior Therapy (DBT) in patients with borderline personality disorder. Methods: Using a retrospective observational design, the number of suicide attempt and psychiatric hospitalizations was measured pre and post DBT treatment. Data from 144 patients from Dialectical Behavior Therapy Unit at Hospital Salvador in Santiago de Chile was analyzed during 2006 and 2012. The data were gathered from electronic files of clinical records, a OQ-45.2 questionnaire and telephone calls. Results: The Wilcoxon statistical test showed a significant difference (p = 0.000) in the number of psychiatric hospitalizations pre and post-treatment, as well as a reduction (p = 0.000) in the number of post-treatment suicide attempt. Conclusion: The Dialectical Behavior Therapy was effective in the 3 studied events in the selected population.
Subject(s)
Humans , Male , Female , Psychiatry , Suicide, Attempted , Borderline Personality Disorder , Dialectical Behavior Therapy , Chile , Observational StudyABSTRACT
OBJECTIVE: The study examined the effectiveness of a three-month structured outpatient intervention developed for women with severe depression and childhood trauma that used brief psychodynamic psychotherapy by comparing it to standard treatment recommended in clinical guidelines issued by the Chilean Ministry of Health. METHODS: Eighty-seven women who sought treatment from a public health service in Curicó, Chile, and who had severe depression and a history of childhood traumatic experiences were randomly assigned to receive either the intervention (N=44) or standard treatment (N=43). The participants were assessed at baseline and at three months (completion of the intervention) and six months with use of the Hamilton Depression Scale (Ham-D); Lambert's Outcome Questionnaire (OQ-45.2), which rates psychiatric symptoms, interpersonal relationships, and social role functioning; and the Post-traumatic Stress Treatment Outcome scale (PTO 8), which assesses symptoms of posttraumatic stress disorder. An intent-to-treat design was used with multiple analyses of variance. RESULTS: At three months significant differences were found in favor of the intervention group in Ham-D scores (p<.001) and OQ-45.2 scores (p<.05). At six months a significantly greater proportion of the intervention group had indicators of remission as measured by the OQ-45.2 (39% versus 14%, p<.05) and by the Ham-D (22% versus 5%, p<.05). Scores on the PTO 8 indicated significant improvements in posttraumatic stress disorder symptoms at six months, although there were no significant differences between the groups. CONCLUSIONS: An outpatient intervention that screened for and focused on childhood traumas and that helped patients understand current psychosocial difficulties as a repetition of past traumas was effective in reducing psychiatric symptoms and improving interpersonal relationships and social role functioning among women with severe depression and a history of childhood trauma.
