Psychological Mindedness, Personality Structure, and Outcomes in Short-Term Group Analytic Psychotherapy.

The present study investigated the treatment effects of focused short-term group analytic psychotherapy and examined whether outcomes were predicted by the client's psychological mindedness and personality structure as measured by the Operationalized Psychodynamic Diagnosis (OPD). Treatment foci were formulated according to the OPD for 66 student counseling clients across nine groups. Two observers independently rated client psychological mindedness and personality structure. The pre-post Cohen's d effect sizes were large on the Global Severity Index (GSI) and the Inventory of Interpersonal Problems (IIP-64) and moderate on the Social Adjustment Scale Self Report, including all 66 clients starting treatment. Psychological mindedness significantly predicted two outcomes (GSI, IIP), and personality structure predicted one outcome (GSI). These measures could be helpful when selecting clients for short-term group analytic psychotherapy. We discuss study limitations and implications for future research and practice.

Five-year follow-up of supportive psychodynamic psychotherapy in first-episode psychosis: long-term outcome in social functioning.

OBJECTIVES: The long-term outcomes of several approaches to intervention targeting social functioning in schizophrenia are not well documented. Contemporary supportive psychodynamic psychotherapy (SPP) aims to improve social functioning. The aim of the present study was to investigate the long-term outcome of SPP in a prospective, longitudinal, comparative, multicenter investigation of successively referred patients diagnosed with first-episode schizophrenia spectrum disorder. METHOD: Manualized SPP for up to 3 years as a supplement to standard treatment (ST) were compared to ST alone and followed up for 5 years (N = 269). The SPP targeted interpersonal relationships, emotion regulation, social cognition, and self-coherence. RESULTS: Significant between-group effects in favor of SPP+ST on social functioning, overall symptoms, and positive psychotic symptoms were found during the period of active SPP intervention. These differential effects, however, were not sustained after end of additional SPP at 5-year follow-up. CONCLUSION: The findings are in line with results from other approaches targeting social functioning in schizophrenia and support SPP as a valuable treatment. Further research into the curative elements of SPP is needed.

Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis: two-year outcome.

During recent decades, the field of treatment of schizophrenia has lacked empirical, systematic outcome studies that support psychodynamic psychotherapy as an evidence-based intervention for patients with schizophrenia. The Danish schizophrenia project (DNS) compared psychodynamic psychotherapy for psychosis with standard treatment in patients with a first-episode schizophrenia spectrum disorder. The study was designed as a prospective, comparative, longitudinal multi-site investigation of consecutively referred patients who were included during two years. The patients were treated with either manualized individual supportive psychodynamic psychotherapy (SPP) in addition to treatment as usual or with treatment as usual alone (TaU). Symptoms and functional outcomes were measured using the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning scale (GAF). The study included 269 consecutively admitted patients, age 18-35, of whom 79% remained in the study after two years. The intervention group improved significantly on measures of both PANSS and GAF scores, with large effect sizes at two years follow-up after inclusion. Further, improvement on GAF(function) (p = 0.000) and GAF(symptom) (p = 0.010) significantly favored SPP in combination with TaU over TaU alone. In spite of limitations, this study speaks in favor of including supportive psychodynamic psychotherapy in the treatment for patients with schizophrenic first-episode psychoses.

Outcome of a psychotherapeutic programme for patients with severe personality disorders.

A specialized psychotherapeutic day treatment programme was established in a Danish clinical setting on the basis of recent research and advances in treatment for severe personality disorders. This study analyses treatment effectiveness by comparing the day treatment programme with a treatment as usual (TAU) situation as given to personality-disordered patients on a waiting list. The sample consisted of 66 personality-disordered patients consecutively referred and diagnosed according to standardized criteria. The intervention group comprised 38 patients. There was no selection made for the intervention group: when the programme capacity was reached, a waiting list of 28 consecutive patients formed the comparison group; none of these patients figured in the intervention group. Intervention included psychodynamic and cognitive-based therapy in a group/individual setting and lasted 5 months. Outcome measures were self-rated and observer-rated multidimensional evaluation of functioning relevant to personality-disordered patients. The day treatment programme did significantly better in reducing acute and prolonged hospitalizations and suicide attempts, in stabilizing the psychosocial functioning and in reducing complaints that lead to treatment. The intensive day treatment programme stabilized patient functioning but did not lead to changes on personality traits for which more extended treatment might be necessary.

Treatment of patients with first-episode psychosis: two-year outcome data from the Danish National Schizophrenia Project.

First episode psychosis interventions have been in focus in the last two decades in an attempt to improve the course and outcome of schizophrenic disorders. The Danish National Schizophrenia Project began in 1997 its intake of patients, aged 16-35, with a first psychotic episode of a schizophrenic spectrum disorder, diagnosed by ICD-10 (F20-29). The study was carried out as a prospective, longitudinal, multicentre investigation, encompassing 16 centres, spread all over the country. The sample consists of 562 patients consecutively diagnosed during two years. Patients were treated with "supportive psychodynamic psychotherapy as a supplement to treatment as usual", "integrated, assertive, psychosocial and educational treatment programme", or "treatment as usual". Data on symptoms and social function and sociodemographic data were obtained at inclusion, and at year 1 and 2. The three sub-cohorts did not differ at baseline. After one year, the total sample of patients improved significantly concerning symptoms and social function. The significance of the improvement remained after two years. After one year, patients in the two intervention groups improved more concerning symptoms and social function than patients in the treatment-as-usual group. Improvement in the intervention groups continued into the second year. Patients receiving integrated assertive treatment faired better than those being treated with the less intensive method of supportive psychodynamic psychotherapy, and the latter group improved more than the treatment-as-usual group.

The Danish National Schizophrenia Project: prospective, comparative longitudinal treatment study of first-episode psychosis.

BACKGROUND: First-episode psychosis intervention may improve the course and outcome of schizophrenic disorders. AIMS: To describe the Danish National Schizophrenia Project and to measure the outcome of two different forms of intervention after 1 year, compared with standard treatment. METHOD: A prospective, prospective, longitudinal, multicentre investigation included 562 patients, consecutively referred over a 2-year period, with a first episode of psychosis. Patients were allocated to supportive psychodynamic psychotherapy as a supplement to treatment as usual, an integrated, assertive, psychosocial and educational treatment programme or treatment as usual. RESULTS: There was a non-significant tendency towards greater improvement in social functioning in the integrated treatment group and the supportive psychodynamic psychotherapy group compared with the treatment as usual group. Significance was reached for some measures when the confounding effect of drug and alcohol misuse was included. CONCLUSIONS: Integrated treatment and supportive psychodynamic psychotherapy in addition to treatment as usual may improve outcome after 1 year of treatment for people with first-episode psychosis, compared with treatment as usual alone.

The Danish national multicenter schizophrenia project: assessment of psychotic patients for dynamic psychotherapy (APPP).

Clinicians need guidance in selecting schizophrenic patients for individual psychodynamic psychotherapy. The purpose of the present study was to investigate whether a 17-item questionnaire (APPP) for quantification of suitability for psychotherapy could predict continuance, adherence and outcome from individual dynamic psychotherapy with patients with schizophrenic psychoses. Therapists rated 72 first-episode patients with schizophrenic psychoses in the initial interview. The scores were then correlated to the course of therapy and change in symptoms. APPP was tested to have good psychometric characteristics and had a satisfactory interrater reliability ((ICC,2)=0.70), when four raters scored eight videotaped interviews with eight different patients. The scale scores were highly correlated to "therapeutic alliance" measured by the Working Alliance Inventory (WAI) and the Active Engagement Scale (AES). APPP suitability gave a good early prediction of adherence to therapy (continued in therapy at least 12 months and a satisfactory number of sessions), but had no predictive value of symptomatic improvement or improved social function after 1 year.