Web-Based Training Program Using Cognitive Behavioral Therapy to Enhance Cognitive Flexibility and Alleviate Psychological Distress Among Schoolteachers: Pilot Randomized Controlled Trial.

BACKGROUND: Schoolteachers are known to be faced with various stresses in their work. A simple, less onerous, and effective intervention technique that can enhance the stress management skills, particularly, cognitive flexibility, of schoolteachers is needed. OBJECTIVE: This study aimed to determine whether stress management training using a Web-based cognitive behavioral therapy (CBT) program is effective for enhancing the cognitive flexibility of schoolteachers and alleviating their subjective distress. METHODS: This study was conducted in a random controlled design covering public elementary schoolteachers. Teachers allocated to the intervention group received 120 min of group education and completed homework using a Web-based CBT program that lasted for 3 months. The items of outcome evaluation were cognitive flexibility and subjective distress, and the efficacy of intervention was evaluated at 3 months after intervention. RESULTS: A total of 240 participants were randomly allocated to the intervention group (120 individuals) and the control group (120 individuals). On the basis of the principle of intention to treat, the intervention group and the control group were compared regarding the amount of change from before intervention to after intervention, using a general linear model. Scores of cognitive flexibility and subjective distress were significantly more improved in the intervention group than in the control group. CONCLUSIONS: The results of this study suggest that simple stress management training using a Web-based CBT program in elementary schoolteachers enhances cognitive flexibility and alleviates subjective distress.

The relationship between patient characteristics and psychiatric day care outcomes in schizophrenic patients.

AIM: A retrospective study was conducted to assess the relationship between patient characteristics and psychiatric day care outcomes in 430 Japanese schizophrenic patients. METHODS: The patients were divided into psychiatric day care completers and non-completers. Patients who could not be included in these groups were categorized as unclassifiable. The completers were subdivided into four outcome groups: (i) patients who obtained a part-time job, (ii) patients who began working at community workshops for mentally disabled persons, (iii) patients who obtained a full-time job or returned to their former positions, and (iv) patients who entered or returned to school. The non-completers were subdivided into two outcome groups: (i) patients who discontinued psychiatric day care because of worsened schizophrenia, and (ii) patients who were rehospitalized because of worsened schizophrenia. Age, sex, age of onset of schizophrenia, number and duration of previous psychiatric hospitalizations, number of persons living with the patient, educational background, previous employment type, marital status, chlorpromazine-equivalent doses of antipsychotic drugs used, and psychiatric day care outcomes were compared among the outcome groups with logistic regression analysis using the outcomes as target variables. RESULTS: A later onset of schizophrenia and fewer previous psychiatric hospitalizations were significantly related with better outcomes. A higher educational background was related with the outcomes without statistical significance. CONCLUSIONS: Our results suggest that the assessment of the relationship between patient characteristics and psychiatric day care outcomes is essential to enhance therapeutic effectiveness of psychiatric day care by beginning appropriate communication, support, and programs for individual patients at the initiation of the care.

Comparison of the risk of adverse events between risperidone and haloperidol in delirium patients.

The aim of this study was to determine the risk of adverse events for risperidone and haloperidol in delirium patients. The authors conducted a retrospective study with medical records of 266 Japanese delirium inpatients who were referred to them between July 2001 and May 2005. Information on gender, age, delirium, drug therapy, adverse events, death, and other relevant factors was collected and analyzed for each patient. As a primary antipsychotic drug for the treatment of delirium, risperidone was used in 93 patients; oral haloperidol was used in 95; and intravenous or intramuscular haloperidol was used in 61. The incidence of adverse events was 6.5% for risperidone, 31.4% for oral haloperidol, and 32.8% for haloperidol injection. The incidence of death during delirium was 3.2% for risperidone, 2.1% for oral haloperidol, and 13.1% for haloperidol injection. The incidence of death within 1 year after the onset of delirium was 30.1% for risperidone, 29.5% for oral haloperidol, and 45.9% for haloperidol injection. Between risperidone, oral haloperidol, and intravenous or intramuscular haloperidol the incidence of adverse events was significantly lowest for risperidone, and the incidence of death during delirium was significantly highest for intravenous or intramuscular haloperidol. The use of haloperidol as a first-line drug in delirium patients who can receive the drug orally will not contribute to the establishment of drug therapy for delirium based on risk-benefit assessment of the therapy.