Psychiatrists' referrals to self-help groups for people with mood disorders.

The study examined psychiatrists' referrals to and support for participation in self-help groups by people with mood disorders. Massachusetts and Michigan psychiatrists with a special interest in patients with mood disorders were surveyed; the 278 respondents represented a 78 percent response rate. About three-fourths of the psychiatrists reported that they made referrals to and felt knowledgeable about self-help groups. However, less than half had self-help literature available or discussed self-help groups with their patients. Beliefs that a patient would gain a better understanding of the illness and would receive support after an episode of illness were positively related to support for self-help. Beliefs that the program was inappropriate and that it lacked professional oversight were negatively related.

Self-help activities in cocaine dependent patients entering treatment: results from NIDA collaborative cocaine treatment study.

Although little is known about self-help attendance among cocaine dependent patients, clinicians frequently recommend this treatment. Cocaine dependent patients (519) entering a psychotherapy study were therefore surveyed regarding their recent self-help group attendance and participation. During the previous week, 34% had attended a self-help group. Of self-help attenders who actively participated 55% initiated abstinence within the next month, compared with 40% of non-attenders and 38% of non-participating attenders (P < 0.01). These findings support the potential short-term positive prognostic significance of self-help attendance and participation in cocaine dependent patients.

Patient-therapist codocumentation: implications of jointly authored progress notes for psychotherapy practice, research, training, supervision, and risk management.

This paper describes patient-therapist codocumentation, a method of creating and using jointly authored treatment-progress notes. Codocumentation has five basic elements: (1) Patient and therapist agree to share responsibility for documentation of treatment. (2) During the last several minutes of each session, the patient records, by dictation, his or her views about the important issues covered, while the therapist listens. (3) The therapist can then dictate his or her comments, in the presence of the patient. (4) The notes are transcribed from tape-recorded to written form between sessions. (5) The typed transcriptions are available for joint review by patient and therapist during subsequent sessions. Sharing responsibility for documentation of treatment using this method promotes bidirectional feedback between patient and therapist. Several examples illustrate how jointly authored progress notes can help in the management of countertransference, as well as transference components of common problems in psychotherapy. The implications of patient-therapist codocumentation for psychotherapy research, training and supervision, and risk management are potentially significant. Further experience is necessary to refine the indications for, and limitations of, patient-therapist codocumentation.

Withdrawal and detoxification from benzodiazepine dependence: a potential role for clonazepam.

Alprazolam and triazolam dependence and withdrawal may be uniquely problematic. This paper describes current clinical approaches to benzodiazepine withdrawal, with a focus on recent experience with alprazolam. The withdrawal characteristics of the triazolobenzodiazepines are discussed, and the epidemiology of benzodiazepine dependence is reviewed. Estimates of the incidence of alprazolam abuse are provided from Drug Abuse Warning Network data. The only two case reports in the literature of failure of cross tolerance between alprazolam and other benzodiazepines are noted to be open to alternative interpretations. A case is reported in which a patient was successfully detoxified with clonazepam from a very high dose of alprazolam. The author concludes that clonazepam may have a role in withdrawal from high-dose alprazolam dependence.