Medicina integradora: un puente entre la biomedicina y la medicina alternativa que se ajusta al espíritu de la época / Integrative Medicine: A Bridge between Biomedicine and Alternative Medicine Fitting the Spirit of the Age

Complementary and alternative medicine (CAM) are increasingly used by people in first world countries, almost always in combination with biomedicine. The combination of CAM and biomedicine is now commonly referred to as "integrative medicine" (IM). In Groningen, The Netherlands, we founded a center for integrative psychiatry, offering conventional and complementary mental health care. Like other centers for integrative (mental) health we have mostly received positive reactions although there have been negative and even hostile reactions as well, using phrases like "quackery" and "betrayal". We will try to illustrate that these polarising qualifications, in which "the good" is being positioned against "the bad" in an over-simplified manner, are unnecessary and not useful. Moreover, it is unlikely that this polarisation will stall the growth of IM. It seems that integration is not only a current tendency in medicine, but also a trend fitting the contemporary spirit of the age in which integration seems to be the most common focus. It can be observed in religion, philosophy, spirituality and psychotherapy as well. This article will discuss the difference between differentiation and integration and will show that the focus on differentiation or integration varies with time, mostly rising as a reaction to each other. The transition from one period to the next is often met with resistance and criticism. If the integrative movement is to survive, it cannot do without differentiation and must find a middle way in which appropriate attention is being paid to keeping the integrated parts sufficiently differentiated and allowing them to keep their own identity.

The Dutch complementary and alternative medicine (CAM) protocol: to ensure the safe and effective use of complementary and alternative medicine within Dutch mental health care.

BACKGROUND: Complementary and alternative medicine (CAM) is subject to heated debates and prejudices. Studies show that CAM is widely used by psychiatric patients, usually without the guidance of a therapist and without the use of a solid working method, leading to potential health risks. AIM: The purpose of this study is to facilitate the judicious use of CAM alongside conventional psychiatry in an outpatient psychiatric clinic. METHODS: A search was made through scientific and legal articles and discussion in focus groups. RESULTS: In the Centre for Integrative Psychiatry (CIP) of Lentis in The Netherlands, some carefully selected CAM are offered under strict conditions, alongside conventional treatments. Because of the controversy and the potential health risks, Lentis designed a protocol that is presented. CONCLUSIONS: The CIP hopes, by using this protocol, to better serve and respect the individual needs and preferences of the diversity of psychiatric patients in our Dutch multicultural society, and better protect them from harm.

Effectiveness of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality problems in a 'real-world' sample: moderation by diagnosis or severity?

BACKGROUND: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for borderline personality disorder (BPD). Two prior randomized controlled trials (RCTs) have shown the efficacy of this training. In both RCTs, patients with borderline features who did not meet the DSM-IV criteria for BPD were excluded, which were many. We investigated the effectiveness of STEPPS in a sample representative of routine clinical practice and examined whether DSM-IV diagnosis and/or baseline severity were related to differential effectiveness. METHODS: Patients whom their practicing clinician diagnosed with BPD were randomized to STEPPS plus adjunctive individual therapy (STEPPS, n = 84) or to treatment as usual (TAU, n = 84). RESULTS: STEPPS recipients showed more improvement on measures of general and BPD-specific psychopathology as well as quality of life than TAU recipients, both at the end of treatment and at a 6-month follow-up. Presence of DSM-IV-diagnosed BPD was not related to differential treatment effectiveness, but dimensional measures of symptom severity were; STEPPS was superior to TAU particularly in patients with higher baseline severity scores. CONCLUSIONS: The findings show the effectiveness of STEPPS in a 'real-world' sample, and underscore the importance of dimensional versus categorical measures of personality disturbance.

A randomized controlled trial of a Dutch version of systems training for emotional predictability and problem solving for borderline personality disorder.

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for persons with borderline personality disorder (BPD) that is relatively easy to implement. We investigated the efficacy of a Dutch version of this treatment (VERS). Seventy-nine DSM-IV BPD patients were randomly assigned to STEPPS plus an adjunctive individual therapy, or to treatment as usual. Assessments took place before and after the intervention, and at a 6-month follow-up. STEPPS recipients showed a significantly greater reduction in general psychiatric and BPD-specific symptomatology than subjects assigned to treatment as usual; these differences remained significant at follow-up. STEPPS also led to greater improvement in quality of life, especially at follow-up. No differences in impulsive or parasuicidal behavior were observed. Effect sizes for the differences between the treatments were moderate to large. The results suggest that the brief STEPPS program combined with limited individual therapy can improve BPD-treatment in a number of ways.

Learning (potential) and social functioning in schizophrenia.

Cognitive dysfunction in schizophrenia has well-known functional consequences. The ability to learn (learning potential) may be an important mediator. This study examines the relationship between learning and functional status in schizophrenia patients before and after participation in a rehabilitation program. We reasoned that learning is a broad construct, encompassing controlled, effortful as well as automatic (learning by doing) mechanisms, called explicit and implicit learning, respectively. Both types of learning ability are important in daily life. The study included 44 medicated schizophrenia patients and 79 healthy controls. We included measures of implicit and explicit learning as well as measures of the cognitive domains for which significant relationships with functional outcome have been established: immediate and secondary verbal memory, card sorting and vigilance. Learning potential and the patient's 'learner status' were also assessed. The results show that learning, as assessed by measures of explicit and implicit learning and learning potential, was not associated with social functioning or rehabilitation outcome. The highest correlations between cognitive functioning and social functioning were found for more or less 'static' performance measures when they were assessed for a second time with or without instructions on how to do the test. Optimized cognitive performance (i.e. performance after instruction or training) seems to be a better predictor of complex domains of functioning than naive or everyday performance.