Shared Reflection to Maximize Resources and Minimize Costs: The Reflecting Team Applied to a Hospital Environment.

Severe mental illness entails multiple hospital admissions and a large use of public resources. The Reflecting Team (RT), together with other dialogue strategies, place in a single therapeutic space, the patient, his family and a team of professionals to find together a solution to a situation of stagnation. The aim of this study was to evaluate feasibility and cost-effectiveness of a RT intervention in psychiatric inpatients in a public hospital. Six RT were performed, and clinical variables were collected retrospectively for six months pre-RT and post-RT. Both number of hospital admissions and total time spent in the psychiatric acute unit show a significant decrease. All computed cost showed statistically significant reduction. The results suggest RT might be a good strategy to introduce a positive change in the treatment of those psychiatric cases in which the patient and family find themselves caught in a system that seems to offer stale and ineffective help to problems that have become chronic.

[Group psychotherapy with young alcoholics: specialization or integration?]. / Grupos de terapia para alcohólicos jóvenes: especialización o integración?

INTRODUCTION: Group therapy (GT) is widely used in the treatment of alcoholism. Nevertheless, few data are available on the inclusion criteria for specific individual, as well as on specific group, techniques for the management of some types or groups of patients with homogeneous characteristics. METHOD: Compliance with group therapy has been analyzed in a sample of 459 alcoholics under 36 years of age, 303 of whom were placed in specific GT for young people (Y groups) and 156 were allocated in standard GT (NY) groups. RESULTS: Similar rates of discharge (16.8% vs 18.6%), withdrawals and drop-outs (63.4% vs 61.5%) of patients have been found in both groups. No differences were found in the survival function of time of compliance adjusted for gender and age (Y: 27.2%, and NY: 33.3% at one year, and Y: 18.4%, and NY: 21% at 2 years). CONCLUSIONS: There is no scientific evidence to support the use of Y groups in the treatment of young alcoholics. On the other hand, the possibility still exists that the use of groups with composition, techniques and specific objectives may provide improvement in compliance and in the therapeutic results as long as they adequately identify the characteristics of the patients who may benefit from a homogeneous treatment.

Grupos de terapia para alcohólicos jóvenes: ¿especialización o integración? / Group psychotherapy with young alcoholics: specialization or integration?

Introducción. A pesar de la amplia utilización de la terapia grupal (TG) para tratar el alcoholismo no existen criterios para su indicación individualizada a los distintos pacientes ni para el diseño de tipos o técnicas específicas de TG para algunas clases o grupos de enfermos con características homogéneas.Método. Se ha comparado la adherencia a la TG de 459 pacientes alcohólicos menores de 36 años, de los cuales 303 fueron asignados a grupos de TG específicos para jóvenes (grupos J) y 156 a grupos de TG convencionales (grupos NJ).Resultados. Los resultados del estudio han revelado similares porcentajes de altas (16,8 frente a 18,6 %), bajas y abandonos (63,4 frente a 61,5 %), así como similar supervivencia una vez ajustada la edad y el sexo, en ambos tipos de grupos de TG (J: 27,2 % y NJ: 33,3% al año; J: 18,4 % y NJ: 21 % a los 2 años).Conclusiones. Se concluye que no hay evidencias científicas que apoyen el uso de grupos de TG especializados para pacientes jóvenes. En cambio sigue abierta la posibilidad de que el empleo de grupos con composición, técnicas y objetivos específicos puede proporcionar una mejora en la adherencia y en los resultados terapéuticos siempre que se identifiquen convenientemente las características de los enfermos que pueden beneficiarse de un tratamiento homogéneo

Introduction. Group therapy (GT) is widely used in the treatment of alcoholism. Nevertheless, few data are available on the inclusion criteria for specific individual, as well as on specific group, techniques for the management of some types or groups of patients with homogeneous characteristics.Method. Compliance with group therapy has been analyzed in a sample of 459 alcoholics under 36 years of age, 303 of whom were placed in specific GT for young people (Y groups) and 156 were allocated in standard GT (NY) groups.Results. Similar rates of discharge (16.8 % vs 18.6 %), withdrawals and drop-outs (63.4 % vs 61.5 %) of patients have been found in both groups. No differences were found in the survival function of time of compliance adjusted for gender and age (Y: 27.2 %, and NY: 33.3 % at one year, and Y: 18.4 %, and NY: 21 % at 2 years).Conclusions. There is no scientific evidence to support the use of Y groups in the treatment of young alcoholics. On the other hand, the possibility still exists that the use of groups with composition, techniques and specific objectives may provide improvement in compliance and in the therapeutic results as long as they adequately identify the characteristics of the patients who may benefit from a homogeneous treatment

[Efficacy of group therapy of alcoholics. Results of a controlled clinical trial]. / Eficacia de la terapia de grupo para alcohólicos. Resultados de un ensayo clínico controlado.

BACKGROUND: Group therapy is widely used in psychiatry and psychology, specially in the treatment of alcoholism. Nevertheless, scientific evidence of its efficacy is scarce, and professionals tend very often to doubt about its usefulness. METHODS: Clinical trial to test the efficacy of group therapy to improve abstinence and compliance of alcoholics (CIE-10 criteria) randomly assigned to standard treatment plus group therapy (TG+, n = 45) versus standard treatment alone (TG-, n = 43) during 12 months. RESULTS: At 6 months follow up, the percentage of alcohol consumers (26 vs 20%) and dropouts (49 vs 36%), was slightly higher among the TG- group; while Cumulated Abstinence Duration (131 days [SD 57] versus 135 days [SD 64]) tended to be higher in the TG+ group. Differences increase at the one year follow up, reaching a significant level when measuring time to first relapse (233 vs 382 days; p = 0.04). Also, the probability to remain abstinent is clearly lower in the TG- (31 vs 76%). CONCLUSIONS: These results clearly show the efficacy of group therapy. Its effect appears from the 3rd month and increases from 6th to 12th months. Some patients, specially those who will have worse clinical evolution, refuse to attend group sessions. Also, some others who don't accept an abstinence oriented treatment, may interfere in group dynamics. In order to maximize group efficacy, extreme care should be taken in selection of patients, group composition, setting and leadership style.