ABSTRACT
The aim of this study was to explore differential psychological profiles among patients with chronic pain with and without fibromyalgia, and to determine the results of the cognitive behavioral therapy (CBT) for pain. Thirty patients with chronic pain and 60 patients with fibromyalgia were referred to 10 weekly sessions of CBT in a general hospital and were evaluated in pain-related variables, psychopathological symptoms, coping strategies, resilience, and quality of life. The program was implemented in specific groups for patients with fibromyalgia and nonfibromyalgia chronic pain. After the intervention, patients with fibromyalgia showed higher levels of psychopathology, rated their health status as poorer, and presented larger amplification of symptoms, higher levels of somatization, a more ruminating style of thinking and greater distress. Patients without fibromyalgia achieved better therapeutic results in both pain intensity (d = 0.39 vs. d = 0.12) and psychopathological distress (d = 0.77 vs. d = 0.11) compared to patients with fibromyalgia. Therefore, differential profiles and limited therapeutic results in fibromyalgia patients suggest the need to outline differentiated treatments and include other therapeutic strategies.
Subject(s)
Chronic Pain , Cognitive Behavioral Therapy , Fibromyalgia , Humans , Fibromyalgia/therapy , Fibromyalgia/psychology , Chronic Pain/therapy , Quality of Life , Treatment Outcome , Cognitive Behavioral Therapy/methodsABSTRACT
Objective: This paper describes the results of testing a multi-component psychological therapy that includes integrated psychological therapy (IPT), together with an adaptation of emotional management therapy (EMT), versus treatment as usual (TAU), delivered in a community mental health setting for individual with chronic schizophrenia. We investigated the effectiveness of a psychological intervention on clinical symptoms, cognitive and social functioning, as well as the feasibility of treatment and its acceptance. Method: 77 outpatients were recruited, 42 in the experimental group, who were treated with IPT + EMT, and 35 participants in control condition (TAU), both during 8 months. The subjects of both groups were assessed pre and postreatment. Results: Treatment attendance was 98% in experimental group and none of patients required hospital admission during therapy, meanwhile 11 patients from the TAU group withdrew and 3 were hospitalized during therapy. After therapy, patients in the experimental group compared to TAU, reduced clinical symptoms and improved cognitive functioning and quality of life. Conclusion: Psychological therapy seems to be a feasible intervention even in the chronic stages of the disease.
Subject(s)
Emotions , Quality of Life , Schizophrenia/therapy , Schizophrenic Psychology , Adult , Aged , Cognition , Female , Humans , Male , Middle Aged , OutpatientsABSTRACT
The chronic phase of schizophrenia is characterized by illness progression and patients encountering difficulties to return to premorbid level of functioning. The objective of this study was to describe the characteristics of a sample of patients with chronic schizophrenia, as well to assess differences between patients under and over 45 years of age. In a clinical sample of 77 chronic schizophrenia patients, we assessed basic symptoms, cognitive performance, social functioning and quality of life. All participants obtained very high scores in residual symptoms, and no differences in sociodemographic or clinical characteristics between the age groups were found. Younger patients had better cognitive performance and older patients obtained better scores for social functioning and quality of life. Number of psychotropic drugs, verbal learning delayed of SCIP, errors in WCST, Similarities and Digit Symbol Coding of WAIS were the most important variables to predict global functioning of patients over 45 years old. Increasing our understanding of differences in characteristics of the chronic phase of the illness and the profile of functioning at different ages, may help us design intervention strategies to improve adaptation in young and middle-aged patients with chronic schizophrenia
La fase crónica de la esquizofrenia se caracteriza por la progresión de la enfermedad y por las dificultades que presentan los pacientes para volver al nivel de funcionamiento premórbido. El objetivo de este estudio fue describir las características de una muestra de pacientes con esquizofrenia crónica, y conocer las diferencias entre los pacientes menores y mayores de 45 años. En una muestra clínica de 77 pacientes con esquizofrenia crónica, se han evaluado síntomas básicos, el rendimiento cognitivo, el funcionamiento social y la calidad de vida. Todos los participantes obtuvieron puntuaciones muy altas en los síntomas residuales, y no se encontraron diferencias en las características sociodemográficas o clínicas entre los grupos de edad. Los resultados señalan que los pacientes más jóvenes tienen mejor rendimiento cognitivo, y los mayores, mejor funcionamiento social y calidad de vida. El número de fármacos utilizados, los valores en la escala de aprendizaje verbal diferido del SCIP, los errores en WCST, los subtests de Semejanzas y Dígitos del WAIS fueron las variables que mejor pronostican el funcionamiento global de los pacientes mayores de 45 años. Por lo tanto, aumentar nuestra comprensión de las características de la fase crónica de la enfermedad y el perfil de funcionamiento en función de la edad, puede ayudarnos a diseñar estrategias de intervención para mejorar la adaptación en pacientes jóvenes y de mediana edad con esquizofrenia crónica
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Schizophrenia/therapy , Schizophrenic Psychology , Psychometrics/methods , Memory, Short-Term/classification , Comprehension , Executive Function , Treatment Outcome , Self Report/statistics & numerical data , Disease Progression , 50293 , Chronic Disease/trendsABSTRACT
Background:effective group psychological therapies in the chronic phases of schizophrenia are rare. This paper describes the results of testing a group therapy that includes integrated psychological therapy (IPT) together with an adaptation of emotional management therapy (EMT), delivered in a sample of outpatients with chronic schizophrenia. Method: 42 patients received the psychological intervention during eight months and they were assessed at baseline, posttreatment and 1, 3, 6 and 12 months follow-up. Results: The program was well accepted, and there was only one dropped out during the therapy and 2 hospital admissions during the 20 months of contact with patients along the study. Improvements were observed in cognition, social functioning, and quality of life after the treatment, and these results were maintained to the long-term follow-up. To summarize, patients were better 12 months after the treatment than in baseline. Conclusion: the integrative psychological program applied was effective and it was well accepted and could be used in public mental health services as a protective factor, reducing hospitalizations, preventing cognitive decline, helping patients to manage their daily worries and making them feel more supported
Antecedentes: los programas de tratamiento psicológico grupal eficaces para las fases crónicas de la esquizofrenia son escasos. Este artículo describe los resultados obtenidos tras la aplicación de un programa grupal, que incluye la terapia psicológica integrada (IPT) junto con una adaptación de la terapia de manejo emocional (EMT), en una muestra de pacientes ambulatorios con esquizofrenia crónica. Método: 42 pacientes recibieron el programa durante ocho meses y se evaluaron al inicio, en el post-tratamiento y en los seguimientos de 1, 3, 6 y 12 meses. Resultados: el programa fue bien aceptado ya que únicamente hubo un abandono durante los 8 meses de tratamiento y 2 ingresos hospitalarios durante los 20 meses de duración del estudio. Se obtuvieron mejorías en la cognición, el funcionamiento social y la calidad de vida tras recibir el tratamiento, y éstas se mantuvieron en el seguimiento a largo plazo. En resumen, los pacientes estaban mejor 12 meses después de recibir el tratamiento que en la evaluación inicial. Conclusión: el tratamiento resulta efectivo, ha sido bien aceptado y podría ser útil en los servicios de salud para reducir las hospitalizaciones, prevenir el deterioro cognitivo y ayudar a los pacientes a manejar sus preocupaciones diarias
Subject(s)
Humans , Male , Female , Adult , Cognitive Dysfunction/prevention & control , Cognitive Dysfunction/psychology , Emotional Adjustment , Psychotherapy, Group , Chronic Disease , Cognitive Dysfunction/etiology , Schizophrenia/complications , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Effective group psychological therapies in the chronic phases of schizophrenia are rare. This paper describes the results of testing a group therapy that includes integrated psychological therapy (IPT) together with an adaptation of emotional management therapy (EMT), delivered in a sample of outpatients with chronic schizophrenia. METHOD: 42 patients received the psychological intervention during eight months and they were assessed at baseline, posttreatment and 1, 3, 6 and 12 months follow-up. RESULTS: The program was well accepted, and there was only one dropped out during the therapy and 2 hospital admissions during the 20 months of contact with patients along the study. Improvements were observed in cognition, social functioning, and quality of life after the treatment, and these results were maintained to the long-term follow-up. To summarize, patients were better 12 months after the treatment than in baseline. CONCLUSION: the integrative psychological program applied was effective and it was well accepted and could be used in public mental health services as a protective factor, reducing hospitalizations, preventing cognitive decline, helping patients to manage their daily worries and making them feel more supported.
Subject(s)
Cognitive Dysfunction/prevention & control , Cognitive Dysfunction/psychology , Emotional Regulation , Psychotherapy, Group , Adult , Chronic Disease , Cognitive Dysfunction/etiology , Female , Humans , Male , Schizophrenia/complications , Time Factors , Treatment OutcomeABSTRACT
The present paper provides an overview of the recent contributions to the study of the course of schizophrenia. This is not a disorder as chronic and as acute at its start as traditionally thought. Beyond the positive and negative symptoms and different subtypes of illness, it is important to call attention to the development and course of schizophrenia. According to this approach, the aim of this paper is to review the most recent studies on schizophrenia according to clinical stages. With this aim, we review the research carried out by leading research teams and recently published clinical practice guidelines (Birmingham Group, Melbourne Group, GPCSNS, NICE) in relation to the course, the main features, and more adjusted treatment alternatives, aimed to improve the characteristic symptoms of each stage of the disease. Finally, we point out the necessity to integrate this approach with the proposed changes for the upcoming DSM-V. This review identifies effective treatment options for each of the phases of the disease defined by the clinical stage approach.
Subject(s)
Schizophrenia/diagnosis , Schizophrenia/therapy , Acute Disease , Chronic Disease , Humans , Severity of Illness IndexABSTRACT
En este texto se presenta una síntesis de las aportaciones recientes en el estudio del curso de la esquizofrenia. Este trastorno no es tan cronificante ni su inicio tan agudo como tradicionalmente se pensaba. Más allá de los síntomas positivos y negativos y de los diferentes subtipos, es importante prestar atención a la evolución y al curso de la esquizofrenia. En consonancia con este enfoque, el objetivo de este trabajo es realizar una revisión de las investigaciones más recientes sobre la esquizofrenia en función de los estadios clínicos. Para ello, se ha realizado un estudio de las aportaciones de los principales grupos de investigación y de las Guías de Práctica Clínica editadas recientemente (Grupo de Birmingham, Grupo de Melbourne, GPCSNS, NICE) en relación con el curso, las características principales y las alternativas de tratamiento más orientadas a mejorar la sintomatología propia de cada una de las fases de la enfermedad. En esta revisión se señalan las alternativas de tratamiento eficaces para cada una de las fases de la enfermedad definidas mediante el enfoque de los estadios clínicos. Por último, se señala la integración de esta perspectiva con los cambios propuestos para la próxima publicación del DSM-V(AU)
The present paper provides an overview of the recent contributions to the study of the course of schizophrenia. This is not a disorder as chronic and as acute at its start as traditionally thought. Beyond the positive and negative symptoms and different subtypes of illness, it is important to call attention to the development and course of schizophrenia. According to this approach, the aim of this paper is to review the most recent studies on schizophrenia according to clinical stages. With this aim, we review the research carried out by leading research teams and recently published clinical practice guidelines (Birmingham Group, Melbourne Group, GPCSNS, NICE) in relation to the course, the main features, and more adjusted treatment alternatives, aimed to improve the characteristic symptoms of each stage of the disease. Finally, we point out the necessity to integrate this approach with the proposed changes for the upcoming DSM-V. This review identifies effective treatment options for each of the phases of the disease defined by the clinical stage approach(AU)
Subject(s)
Humans , Male , Female , Schizophrenia/epidemiology , Schizophrenia/physiopathology , Schizophrenic Psychology , Psychotherapy/methods , Psychotherapy/statistics & numerical data , Psychotherapy/trends , Affective Disorders, Psychotic/epidemiology , Diagnostic and Statistical Manual of Mental Disorders , Longitudinal Studies/instrumentation , Longitudinal Studies/methodsABSTRACT
The Quality of Life (QoL) in psychiatric patients is currently of great relevance. This study aims to examine, through a multi-informant approach, the QoL perception in schizophrenic patients, analyzing differences between the informants, as well as the relationship between negative symptoms and QoL. Participants were 32 schizophrenic patients, their caregivers (relatives or psychosocial educators; 25 and 3, respectively), and a team of four professionals of Outpatient Centers of Mental Health in Guipuzcoa, Spain. The assessment of patients QoL was obtained with application of Satisfaction with Life Domains Scale and Karnofsky Performance Status Scale. Self-informant QoL was assessed with Seville Quality of Life Questionnaire and Social Adjustment Scale Self-reported. The negative symptoms were measured with the Brief Psychiatric Rating Scale and the Scale for Assessment of Negative Symptoms. Patients showed an average high life satisfaction. There were significant discrepancies among informants reports, with the lowest evaluation given by the professional team and the highest by the patients. Evaluations made by caregivers and patients yielded similar results. These findings suggest that patients and their caregivers present a more optimistic perception of their QoL (AU)
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