ABSTRACT
This article describes Interpersonal and Social Rhythm Therapy (IPSRT) adapted for use in a group setting for patients with bipolar disorder. In a preliminary efficacy study, we studied the pre-post group treatment effect on affective symptoms. One-year pre-post findings in the IPSRT group indicated that this modality was effective in reducing depressive symptoms and might reduce the number of hospital admissions. Also, group IPSRT increased stability of the social rhythm, which is thought to be important in reducing recurrence of manic and depressive episodes. These findings suggest that group IPSRT could be an additional treatment option for patients with bipolar disorder who continue to have mood episodes despite adequate pharmacotherapy and psychoeducation.
Subject(s)
Bipolar Disorder/therapy , Circadian Rhythm/physiology , Interpersonal Relations , Psychiatric Status Rating Scales/standards , Psychotherapy, Group/methods , Adult , Female , Humans , Male , Middle Aged , Psychometrics/instrumentation , Secondary Prevention , Treatment OutcomeABSTRACT
BACKGROUND: This study aimed to determine the feasibility and the effectiveness of a Stepped Care Program (SCP) for preventing relapse of depression in older people. Stepped care consisted of (1) watchful waiting; (2) bibliotherapy; (3) individual cognitive behavioral therapy; and (4) indicated treatment. METHODS: In a randomized controlled trial, persons 55 years and older (n = 136) who had suffered at least one episode of major depression in the past received a SCP or Care As Usual (CAU). The primary outcome measure was incidence of a new depressive episode. RESULTS: Of 1725 previously depressed persons, 175 were willing to partake in the study, 136 of whom were eligible. Treatment satisfaction for stepped care was high. At 12-month follow-up, no difference in incidence of depression between SCP and CAU was found. Medical patient records showed that missing data were often related to relapse. CONCLUSIONS: In this study, SCP was not more effective in preventing relapse than CAU. Watchful waiting may harmfully delay actual preventive treatment. Prevention as an integral part of regular treatment might lead to higher participation rates.
Subject(s)
Cognitive Behavioral Therapy/methods , Depressive Disorder/prevention & control , Preventive Health Services/methods , Aged , Analysis of Variance , Bibliotherapy , Depressive Disorder/epidemiology , Feasibility Studies , Female , Humans , Incidence , Male , Middle Aged , Netherlands/epidemiology , Prospective Studies , Secondary Prevention , Watchful WaitingABSTRACT
This article presents the results of a large efficacy study comparing different forms of therapy for major depressive disorder (MDD), including interpersonal psychotherapy (IPT) and pharmacotherapy. Patients were randomized to either IPT, IPT in combination with anti-depressant medication, IPT in combination with pill-placebo or medication only. The primary outcome measure was the Hamilton Rating Scale for Depression (HAMD). Patients were treated for 12 to 16 weeks. Ratings were performed at baseline, after 6 weeks of treatment and at the end of treatment. Ethnic minority patients (EMP) had higher scores on the HAMD than non-EMP for every rating period. However, the rate of improvement was the same for EMP and non-EMP. The higher mean scores of EMP on the HAMD could not be explained as solely due to higher scores on somatic items of the rating scales. The attrition rate in EMP (45.9%) was significantly higher than in non-EMP (24.4%), even in the structured treatment format studied. The results suggest that standard antidepressant therapy, be it medication, psychotherapy or both, may be effective for depressed minority patients but therapists should focus on enhancing adherence to treatment.
Subject(s)
Antidepressive Agents, Second-Generation/therapeutic use , Cross-Cultural Comparison , Depressive Disorder, Major/ethnology , Depressive Disorder, Major/therapy , Psychotherapy , Triazoles/therapeutic use , Adult , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Morocco/ethnology , Netherlands , Piperazines , Suriname/ethnology , Turkey/ethnologyABSTRACT
BACKGROUND: Despite various studies, supportive evidence for the efficacy of exercise in treatment of mental illness is still weak. OBJECTIVE: The aim of this study was to compare two forms of exercise, namely running therapy (RT) and physiotraining therapy (PT), on stationary devices. METHODS: Patients in a day treatment programme for treatment of affective disorders were randomly allocated to one of the exercise groups or to a control group. Depression scores, self-efficacy, physical conditions and appreciations of the training programme were measured. RESULTS: After 6 weeks, no significant differences were found between both the training groups and the control group; however, after 12 weeks, the physiotraining group showed significant improvement on scores for blind-rated Hamilton Rating Scale for Depression and on scores for self-rated Beck Depression Inventory 21-item version. CONCLUSIONS: Our results suggest that PT has advantages over RT. We speculate that an improved feeling of self-efficacy may be a mediating factor.
