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Chakraborty S, Roy PK. Interpersonal Therapy in Primary Infertility, Life-Cycle Transitions, and Dysthymia: A Single Case Study. Clin Case Stud 2021. [DOI: 10.1177/15346501211038275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Interpersonal psychotherapy (IPT) is an evidence-based therapy, originally developed to treat major depression. IPT conceptualizes depression from a bio-psychosocial perspective where signs of depression are understood in the context of an individual’s current social and interpersonal stressors, defined in terms of role transitions, disputes, bereavements, and sensitivities. In this single case study, IPT was used to treat a woman undergoing primary infertility with multiple failed pregnancies and unsuccessful adoption procedures along with specific grief reactions and depressive symptoms for 2 years. The therapy was formulated over 12 weekly sessions in the outpatient set-up in a general hospital in Kolkata in 2017. Hamilton Depression Rating Scale (HDRS) was used to assess the efficacy of the therapy and its outcomes. The therapy was found to be effective in the patient and justifies the rationale of choosing the said therapy for the specific case from an interpersonal viewpoint. The case study may help suggest how and why to use interpersonal psychotherapy in infertility conditions with psychological ramifications.
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Affiliation(s)
- Sampurna Chakraborty
- Mount Carmel College, Banglore, India
- Department of Clinical Psychology, Central Institute of Psychiatry, Ranchi, India
| | - Prasanta K. Roy
- Department of Clinical Psychology, Institute of Psychiatry, Kolkata, India
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Suicidality in Chronic Illness: An Overview of Cognitive–Affective and Interpersonal Factors. J Clin Psychol Med Settings 2020; 28:137-148. [DOI: 10.1007/s10880-020-09749-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/18/2022]
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Bausch P, Fangmeier T, Meister R, Elsaeßer M, Kriston L, Klein JP, Zobel I, Hautzinger M, Härter M, Schramm E. The Impact of Childhood Maltreatment on Long-Term Outcomes in Disorder-Specific vs. Nonspecific Psychotherapy for Chronic Depression. J Affect Disord 2020; 272:152-157. [PMID: 32379608 DOI: 10.1016/j.jad.2020.03.164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/23/2020] [Accepted: 03/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childhood maltreatment (CM) predicted poorer outcomes in acute depression treatment with CBT, IPT and Supportive Psychotherapy (SP). The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) fared well in patients with chronic depression and CM during acute treatment, yet there is a considerable lack of empirical evidence for long-term outcomes. METHODS We analyzed one and two-year follow-up data of 268 patients randomized to 24 sessions (20 weeks) of acute and 8 sessions (28 weeks) of extended treatment with CBASP or SP. Primary outcome was the number of well weeks as measured by the Longitudinal Interval Follow-Up Evaluation Interview (LIFE). Secondary outcomes included self- and clinician-rated depression symptoms. We investigated this moderating effect for any CM and for specific subtypes of CM. RESULTS Intent-to-treat analyses revealed that the presence of CM did not significantly moderate long-term effects of CBASP compared to SP. The analysis of trauma subtypes revealed that patients with childhood emotional abuse had statistically significant worse outcomes than patients without (main effect, p=.015) and that the advantage of CBASP over SP was larger in patients with childhood emotional abuse than in patients without (interaction effect, p=.045) after 1 year. No significant effects were found for other trauma subtypes. LIMITATIONS The measurement of CM was limited to retrospective self-assessment. CONCLUSIONS The presence of CM did not significantly moderate long-term treatment effects of CBASP compared to SP. When trauma subtypes were considered, CBASP was more effective than SP after one year in patients who retrospectively reported emotional abuse.
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Affiliation(s)
- Paul Bausch
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Thomas Fangmeier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Moritz Elsaeßer
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Ingo Zobel
- Psychology School at the Fresenius University of Applied Sciences Berlin, Berlin, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology, and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Elisabeth Schramm
- Department of Psychology, Clinical Psychology, and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
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Psychological Treatment for Depressive Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1180:233-265. [PMID: 31784967 DOI: 10.1007/978-981-32-9271-0_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Depression is highly prevalent and causes unnecessary human suffering and economic loss. Therefore, its treatment and prevention are of utmost importance. There are several advantages of using psychotherapy either by itself or combined with pharmacological treatment methods in the treatment of depression. First, it is well known that combining biological treatment with psychosocial methods increases the chances of recovery. Second, in some individuals, psychotherapy continues to be the only solution. Third, the use of antidepressants contains some safety risks and side effects, but psychotherapy does not. Fourth, clinically, depressive patients prefer psychotherapy to drug therapy. Use of a depression-focused psychotherapy alone is recommended as an initial treatment choice for patients with mild to moderate depression, with clinical evidence supporting the use of cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), psychodynamic psychotherapy (PDP), and problem-solving therapy (PST) in individual and group formats. Important developments took place within the past 20 years in the psychotherapy of depression. In the present chapter, we introduced several key issues, such as, Are all psychotherapies equally effective? Who benefits from psychotherapies? Is telepsychotherapy effective? Finally, we introduce the psychotherapy for special populations.
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C A D, N S C, W J C, M S, M R, M B. A double-edged sword? Sub-types of psychological flexibility are associated with distinct psychiatric disorders. JOURNAL OF RESEARCH IN PERSONALITY 2018; 77:119-125. [PMID: 31105357 PMCID: PMC6516491 DOI: 10.1016/j.jrp.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Psychological flexibility is associated with both better and worse health outcomes. The objective of this study was to differentiate two types of psychological flexibility - affective instability and interpersonal flexibility - and to estimate associations with psychiatric disorders. METHOD Study participants were drawn from a large outpatient psychiatric sample that completed standard assessment batteries at an academic hospital (N = 1,358, 55.5% males, mean age=43.87, SD=16.57). RESULTS Less interpersonal flexibility was associated with depressive diagnoses. Greater affective instability was associated with bipolar disorder and was negatively associated with psychotic disorders, but showed no association with depressive disorders. CONCLUSION Differing degrees of flexibility and instability in emotional and interpersonal domains may be uniquely associated with specific classes of psychological disorders.
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Affiliation(s)
- Denckla C A
- Harvard T. H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
| | - Consedine N S
- University of Auckland, School of Medicine, New Zealand
| | - Chung W J
- Psychological Assessment and Research Laboratory, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, Boston, MA, 02114 USA
| | - Stein M
- Psychological Assessment and Research Laboratory, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, Boston, MA, 02114 USA
| | - Roche M
- Department of Psychology, Penn State Altoona, 3000 Ivyside Park, Altoona, PA 16601, USA
| | - Blais M
- Psychological Assessment and Research Laboratory, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, Boston, MA, 02114 USA
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Abstract
SummaryInterpersonal psychotherapy is an evidence-based therapy, originally developed to treat major depression. It is cited in numerous good practice guidelines. The biopsychosocial signs of depression are understood in the context of current social and interpersonal stressors, defined in terms of role transitions, disputes, bereavements and sensitivities. In therapy, the patient learns to understand the interactions between symptoms and interpersonal difficulties and the ways in which they are mutually reinforcing. Patients are helped to break this pattern and achieve a reduction in depressive symptoms and improvement in interpersonal functioning through improved communication, expression of affect and proactive engagement with the current interpersonal network. The therapeutic relationship is used as a tool for exploring and modelling external relationships. This article outlines the background to interpersonal psychotherapy, the process of therapy and the expansion of the evidence base.
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Picardi A, Gaetano P. Psychotherapy of mood disorders. Clin Pract Epidemiol Ment Health 2014; 10:140-58. [PMID: 25493093 PMCID: PMC4258697 DOI: 10.2174/1745017901410010140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 09/22/2014] [Accepted: 09/28/2014] [Indexed: 11/22/2022]
Abstract
In the last decades, psychotherapy has gained increasing acceptance as a major treatment option for mood disorders. Empirically supported treatments for major depression include cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT), behavioural therapy and, to a lesser extent, short-term psychodynamic psychotherapy. Meta-analytic evidence suggests that psychotherapy has a significant and clinically relevant, though not large, effect on chronic forms of depression. Psychotherapy with chronic patients should take into account several important differences between patients with chronic and acute depression (identification with their depressive illness, more severe social skill deficits, persistent sense of hopelessness, need of more time to adapt to better circumstances). Regarding adolescent depression, the effectiveness of IPT and CBT is empirically supported. Adolescents require appropriate modifications of treatment (developmental approach to psychotherapy, involvement of parents in therapy). The combination of psychotherapy and medication has recently attracted substantial interest; the available evidence suggests that combined treatment has small but significant advantages over each treatment modality alone, and may have a protective effect against depression relapse or recurrence. Psychobiological models overcoming a rigid brain-mind dichotomy may help the clinician give patients a clear rationale for the combination of psychological and pharmacological treatment. In recent years, evidence has accumulated regarding the effectiveness of psychological therapies (CBT, family-focused therapy, interpersonal and social rhythm therapy, psychoeducation) as an adjunct to medication in bipolar disorder. These therapies share several common elements and there is considerable overlap in their actual targets. Psychological interventions were found to be useful not only in the treatment of bipolar depressive episodes, but in all phases of the disorder.
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Affiliation(s)
- Angelo Picardi
- Mental Health Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Paola Gaetano
- Italian Society for Behavioural and Cognitive Therapy (SITCC), Rome, Italy
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Wischkaemper KC, Coop Gordon K. Integration of Cognitive-Behavioral and Interpersonal Therapies in Treating Depression With Concurrent Relational Distress and Chronic Pain. Clin Case Stud 2014. [DOI: 10.1177/1534650114559939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is a single-case study of a middle-aged man presenting with relationship distress and simultaneous major depressive disorder with chronic back pain and a physical tic. Treatment was informed by cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), and psychodynamic principles. Over the course of treatment, a variety of techniques were utilized, including progressive muscle relaxation training, behavioral monitoring, cognitive restructuring, and interpersonal principles to address somatic complaints and underlying feelings of helplessness and inadequacy. Symptoms including general distress, frustration, back pain, worry about his wife’s mental illness, and amount of negative thinking were tracked on a daily basis over three assessment periods. In addition, clinically significant change was assessed using a comparison of baseline and follow-up results from the patient’s Outcome Questionnaire–45 (OQ-45.2). Evidence for symptomatic and characterological change is outlined, and treatment implications are discussed.
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Bauer M, Pfennig A, Severus E, Whybrow PC, Angst J, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry 2013; 14:334-85. [PMID: 23879318 DOI: 10.3109/15622975.2013.804195] [Citation(s) in RCA: 382] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This 2013 update of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal has been to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. The guidelines are intended for use by all physicians seeing and treating patients with these conditions. METHODS The 2013 update was conducted by a systematic update literature search and appraisal. All recommendations were approved by the Guidelines Task Force. RESULTS This first part of the guidelines (Part 1) covers disease definition, classification, epidemiology, and course of unipolar depressive disorders, as well as the management of the acute and continuation phase treatment. It is primarily concerned with the biological treatment (including antidepressants, other psychopharmacological medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic strategies) of adults. CONCLUSIONS To date, there is a variety of evidence-based antidepressant treatment options available. Nevertheless there is still a substantial proportion of patients not achieving full remission. In addition, somatic and psychiatric comorbidities and other special circumstances need to be more thoroughly investigated. Therefore, further high-quality informative randomized controlled trials are urgently needed.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
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Ley P, Helbig-Lang S, Czilwik S, Lang T, Worlitz A, Brücher K, Petermann F. Phenomenological differences between acute and chronic forms of major depression in inpatients. Nord J Psychiatry 2011; 65:330-7. [PMID: 21271948 DOI: 10.3109/08039488.2011.552121] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chronic forms of depression are highly prevalent especially in inpatient settings. Defined only by episode duration greater than 2 years, heterogeneous diagnoses like dysthymic disorder, double depression, major depression and recurrent major depression are included. Chronic depression is considered difficult to treat, although its distinguishing characteristics remain unclear. AIMS The purpose of the present study was empirically to approach proposed differences between acute and chronic forms of depression. METHODS 80 psychiatric inpatients positively screened for depression and diagnosed with the Composite International Diagnostic Interview (CIDI), completed a set of questionnaires regarding symptom severity (a simplified version of the Beck Depression Inventory), dysfunctional attitudes (Dysfunctional Attitudes Scale), ruminative response style (Response Styles Questionnaire, Why Ruminate Scale) and interpersonal problems (Inventory of Interpersonal Problems; IIP). RESULTS 30 patients were diagnosed with chronic forms of depression; 34 patients with acute depression. Patients did not differ regarding symptom severity, ruminative response styles, all but one subscales of the IIP or presence of comorbid post-traumatic stress disorder. However, chronic depression did show higher dysfunctional attitudes than acute depression, and reported higher rates of socially avoidant behavior. CONCLUSIONS In line with previous findings, acute and chronic forms of depression differed in dysfunctional attitudes, which might actually reflect a distinguishing pattern of chronicity. Chronic depression patients also reported higher socially avoidant behavior, which might be crucial to focus in treatment. Surprisingly, other variables that are assumed to characterize chronic depression could not be confirmed as distinguishing features. Future research should take etiological aspects into account.
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Affiliation(s)
- Pia Ley
- Biological Psychology and Neuropsychology, University of Hamburg, Von-Melle-Park 11, D-20146 Hamburg, Germany.
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Schramm E, Hautzinger M, Zobel I, Kriston L, Berger M, Härter M. Comparative efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus supportive psychotherapy for early onset chronic depression: design and rationale of a multisite randomized controlled trial. BMC Psychiatry 2011; 11:134. [PMID: 21849054 PMCID: PMC3176185 DOI: 10.1186/1471-244x-11-134] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 08/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective treatment strategies for chronic depression are urgently needed since it is not only a common and particularly disabling disorder, but is also considered treatment resistant by most clinicians. There are only a few studies on chronic depression indicating that traditional psycho- and pharmacological interventions are not as effective as in acute, episodic depression. Current medications are no more effective than those introduced 50 years ago whereas the only psychotherapy developed specifically for the subgroup of chronic depression, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), faired well in one large trial. However, CBASP has never been directly compared to a non-specific control treatment. METHODS/DESIGN The present article describes the study protocol of a multisite parallel-group randomized controlled trial in Germany. The purpose of the study is to estimate the efficacy of CBASP compared to supportive psychotherapy in 268 non-medicated early-onset chronically depressed outpatients. The intervention includes 20 weeks of acute treatment with 24 individual sessions followed by 28 weeks of continuation treatment with another 8 sessions. Depressive symptoms are evaluated 20 weeks after randomisation by means of the 24-item Hamilton Rating Scale of Depression (HRSD). Secondary endpoints are depressive symptoms after 12 and 48 weeks, and remission after 12, 20, and 48 weeks. Primary outcome will be analysed using analysis of covariance (ANCOVA) controlled for pre-treatment scores and site. Analyses of continuous secondary variables will be performed using linear mixed models. For remission rates, chi-squared tests and logistic regression will be applied. DISCUSSION The study evaluates the comparative effects of a disorder-specific psychotherapy and a well designed non-specific psychological approach in the acute and continuation treatment phase in a large sample of early-onset chronically depressed patients. TRIAL REGISTRATION ClinicalTrials.gov (NCT00970437).
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Affiliation(s)
- Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Martin Hautzinger
- Department of Psychology, University of Tuebingen, Christophstr. 2, 72072 Tuebingen, Germany
| | - Ingo Zobel
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Yapko MD. Hypnosis in the treatment of depression: an overdue approach for encouraging skillful mood management. Int J Clin Exp Hypn 2010; 58:137-46. [PMID: 20390687 DOI: 10.1080/00207140903523137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rieger E, Van Buren DJ, Bishop M, Tanofsky-Kraff M, Welch R, Wilfley DE. An eating disorder-specific model of interpersonal psychotherapy (IPT-ED): causal pathways and treatment implications. Clin Psychol Rev 2010; 30:400-10. [PMID: 20227151 DOI: 10.1016/j.cpr.2010.02.001] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 02/05/2010] [Accepted: 02/06/2010] [Indexed: 11/18/2022]
Abstract
Several studies support the efficacy of interpersonal psychotherapy (IPT) in the treatment of eating disorders. Treatment outcomes are likely to be augmented through a greater understanding, and hence treatment targeting, of the mechanisms whereby IPT induces therapeutic gains. To this end, the present paper seeks to develop a theoretical model of IPT in the context of eating disorders (IPT-ED). After providing a brief description of IPT, the IPT-ED model is presented and research supporting its theorized mechanisms is summarized. This model proposes that negative social evaluation plays a pivotal role as both a cause (via its detrimental impact on self evaluation and associated affect) and consequence of eating disorder symptoms. In the final section, key eating disorder constructs (namely, the developmental period of adolescence, clinical perfectionism, cognitive dysfunction, and affect regulation) are re-interpreted from the standpoint of negative social evaluation thereby further explicating IPT's efficacy as an intervention for individuals with an eating disorder.
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Affiliation(s)
- Elizabeth Rieger
- Department of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.
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Bellino S, Rinaldi C, Bogetto F. Adaptation of interpersonal psychotherapy to borderline personality disorder: a comparison of combined therapy and single pharmacotherapy. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:74-81. [PMID: 20181302 DOI: 10.1177/070674371005500203] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Combined treatment with interpersonal psychotherapy (IPT) and antidepressants (ADs) has been found more effective than single pharmacotherapy in patients with major depression and concomitant borderline personality disorder (BPD). The aim of our study is to investigate whether combined treatment with a modified version of IPT is still superior to ADs when treating patients with a single diagnosis of BPD. METHOD Fifty-five consecutive outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnosis of BPD were enrolled. They were randomly assigned to 2 treatment arms for 32 weeks: fluoxetine 20 to 40 mg per day plus clinical management; and fluoxetine 20 to 40 mg per day plus IPT adapted to BPD (IPT-BPD). Eleven patients (20%) discontinued treatment owing to noncompliance. Forty-four patients completed the treatment period. They were assessed at baseline, and at week 16 and 32 with: a semi-structured interview for demographic and clinical variables; Clinical Global Impression Scale (CGI-S); Hamilton Depression Rating Scale (HDRS); Hamilton Anxiety Rating Scale (HARS); Social and Occupational Functioning Assessment Scale (SOFAS); BPD Severity Index (BPD-SI); and a questionnaire for quality of life (Satisfaction Profile [SAT-P]). A univariate general linear model was performed with 2 factors: duration and type of treatment. P values of less than 0.05 were considered significant. RESULTS Remission rates did not differ significantly between subgroups. Duration, but not type of treatment, had a significant effect on CGI-S, HDRS, SOFAS, and total BPD-SI score changes. Combined therapy was more effective on the HARS; the items: interpersonal relationships, affective instability, and impulsivity of BPD-SI; and the factors: psychological functioning and social functioning of SAT-P. CONCLUSIONS Combined therapy with adapted IPT was superior to fluoxetine alone in BPD patients, concerning a few core symptoms of the disorder, anxiety, and quality of life.
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Affiliation(s)
- Silvio Bellino
- Service for Personality Disorders, Unit of Psychiatry 1, Department of Neurosciences, University of Turin, Via Cherasco 11, Turin, Italy.
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Taylor SF, Liberzon I. Neural correlates of emotion regulation in psychopathology. Trends Cogn Sci 2008; 11:413-8. [PMID: 17928261 DOI: 10.1016/j.tics.2007.08.006] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 07/20/2007] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
Abstract
What can psychopathology and its treatment tell us about cognitive emotional interactions? Standard approaches to interactions between emotion and cognition often adopt a variant of the idea that cognitive processes, subserved by dorsal and lateral cortical circuits, exert control and regulation of ventral, limbic brain areas associated with emotional expression and experience. However, it is becoming clear from studies on depression, post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD), that a binary, opponent theory of cognitive emotion interaction (CEI) and the dorsal-ventral model of neurocircuitry do not fully describe the data. We summarize recent research to suggest that networks of direct and indirect pathways exist by which cognition can regulate pathological emotion, and the inter-relationships of specific nodes within the networks need to be characterized.
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Affiliation(s)
- Stephan F Taylor
- University of Michigan Department of Psychiatry, 4250 Plymouth Rd, Ann Arbor, MI 48109-5765, USA.
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Bellino S, Zizza M, Rinaldi C, Bogetto F. Combined therapy of major depression with concomitant borderline personality disorder: comparison of interpersonal and cognitive psychotherapy. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:718-25. [PMID: 18399039 DOI: 10.1177/070674370705201106] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The combination of antidepressants and brief psychotherapies has been proven more efficacious in treating major depression and is particularly recommended in patients with concomitant personality disorders. We compare the effects of 2 combined therapies, fluoxetine and interpersonal therapy (IPT) or fluoxetine and cognitive therapy (CT), on major depression in patients with borderline personality disorder (BPD). METHOD Thirty-five consecutive outpatients with a diagnosis of BPD and a major depressive episode (not bipolar and not psychotic) were enrolled. They were randomly assigned to 1 of the 2 combined treatments and treated for 24 weeks. Assessment included a semistructured interview, Clinical Global Impression (CGI) scale, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Beck Depression Inventory-II (BDI-II), Social and Occupational Functioning Assessment Scale (SOFAS), Satisfaction Profile (SAT-P) for quality of life (QOL), and Inventory of Interpersonal Problems (IIP-64). Statistical analysis was performed using the univariate General Linear Model to calculate the effects of duration and type of treatment. RESULTS No significant differences between treatments were found at CGI, HDRS, BDI-II, and SOFAS score. Combined treatment with CT had greater effects on HARS score and on psychological functioning factor of SAT-P. Combined treatment with IPT was more effective on social functioning factor of SAT-P and on domains domineering or controlling and intrusive or needy of IIP-64. CONCLUSIONS Both combined therapies are efficacious in treating major depression in patients with BPD. Differences between CT and IPT concern specific features of subjective QOL and interpersonal problems. These findings lack reliable comparisons and need to be replicated.
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Affiliation(s)
- Silvio Bellino
- Department of Neurosciences, University of Turin, Torino, Italy.
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Bauer M, Bschor T, Pfennig A, Whybrow PC, Angst J, Versiani M, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders in Primary Care. World J Biol Psychiatry 2007; 8:67-104. [PMID: 17455102 DOI: 10.1080/15622970701227829] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These practical guidelines for the biological treatment of unipolar depressive disorders in primary care settings were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). They embody the results of a systematic review of all available clinical and scientific evidence pertaining to the treatment of unipolar depressive disorders and offer practical recommendations for general practitioners encountering patients with these conditions. The guidelines cover disease definition, classification, epidemiology and course of unipolar depressive disorders, and the principles of management in the acute, continuation and maintenance phase. They deal primarily with biological treatment (including antidepressants, other psychopharmacological and hormonal medications, electroconvulsive therapy, light therapy).
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Affiliation(s)
- Michael Bauer
- University Hospital Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
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Schulberg HC, Post EP, Raue PJ, Have TT, Miller M, Bruce ML. Treating late-life depression with interpersonal psychotherapy in the primary care sector. Int J Geriatr Psychiatry 2007; 22:106-14. [PMID: 17096458 DOI: 10.1002/gps.1700] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Interpersonal psychotherapy (IPT) is an empirically-validated intervention for treating late-life depression. OBJECTIVE To determine the manner in which IPT is utilized by primary care physicians in relation to antidepressant medications. METHODS The authors reviewed treatment logs prepared by care managers during the first 12 months of a patient's participation in the PROSPECT clinical trial to determine initial and longitudinal treatment patterns utilized by physicians, and clinical outcomes associated with initial treatment assignment. RESULTS Primary care physicians in practices randomized to PROSPECT's intervention arm initially prescribed an antidepressant medication for 58% of eligible patients and referred only 11% of them to IPT. Over time, however, 27% of patients participated in IPT as monotherapy or augmentation therapy. Initial treatment assignment was not associated with depressive status at 4 and 12 months nor with suicidal ideation at 4, 8, and 12 months. CONCLUSION IPT is an effective treatment for late-life depression whose greater use by primary care physicians should be encouraged.
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Parker G, Parker I, Brotchie H, Stuart S. Interpersonal psychotherapy for depression? The need to define its ecological niche. J Affect Disord 2006; 95:1-11. [PMID: 16712944 DOI: 10.1016/j.jad.2006.03.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 03/27/2006] [Accepted: 03/27/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Interpersonal psychotherapy (IPT) has long been viewed as an efficacious treatment for depression, with a large number of published studies allowing its efficacy and utility to be considered closely. METHODS We review original studies and the one published meta-analysis of controlled efficacy trials, examining acute-phase and prophylactic studies, comparison studies with cognitive behaviour therapy, and studies evaluating its efficacy in combination with pharmacotherapy. RESULTS We highlight difficulties in evaluating any psychotherapy, particularly when tested as having universal application for varying depressive conditions, but do identify circumstances where IPT may have specific salience. CONCLUSIONS As for other treatments, IPT is unlikely to be a universal therapy for depression. This review offers suggestions as to where its preferential utility may lie, and argues for modified research paradigms to assist definition of its therapeutic niche.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, Black Dog Institute, Australia.
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Bellino S, Zizza M, Rinaldi C, Bogetto F. Combined treatment of major depression in patients with borderline personality disorder: a comparison with pharmacotherapy. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2006; 51:453-60. [PMID: 16838827 DOI: 10.1177/070674370605100707] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Combined treatment with psychotherapy and antidepressants is more effective than monotherapies. Recent data show that combined therapy has better results in patients with depression and Axis II codiagnosis. The aim of this study was to compare combined treatment using interpersonal psychotherapy (IPT) with pharmacotherapy alone in patients with depression and borderline personality disorder (BPD). METHODS There were 39 consecutive outpatients diagnosed with BPD who presented with a major depressive episode enrolled in this study. They were randomly assigned to 1 of 2 treatment groups: fluoxetine 20 mg to 40 mg daily or fluoxetine 20 mg to 40 mg daily plus IPT 1 session weekly. Owing to noncompliance, 7 patients dropped out. We assessed the 32 patients who completed the 24 weeks of treatment at baseline, Week 12, and Week 24, using a semistructured interview for clinical characteristics, the Clinical Global Impression Scale (CGI), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS), and 2 self-report questionnaires, that is, the Satisfaction Profile (SAT-P) for quality of life and the 64-item Inventory for Interpersonal Problems (IIP-64). We performed statistical analysis, using univariate general linear models with 2 factors: duration and type of treatment. RESULTS Changes in remission rates, CGI, and HARS score did not differ between treatments. According to changes in the HDRS scores; changes in psychological functioning and social functioning scores on the SAT-P; and changes in vindictive or self-centred, cold or distant, intrusive or needy, and socially inhibited scores on the IIP-64, combined therapy was superior to fluoxetine alone. CONCLUSIONS Combined therapy with IPT is more effective than antidepressant therapy alone, both in treating symptoms of major depression and in improving dimensions of quality of life and interpersonal functioning.
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Affiliation(s)
- Silvio Bellino
- Unit of Psychiatry, Department of Neuroscience, University of Turin, Torino, Italy.
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Markowitz JC, Bleiberg KL, Christos P, Levitan E. Solving interpersonal problems correlates with symptom improvement in interpersonal psychotherapy: preliminary findings. J Nerv Ment Dis 2006; 194:15-20. [PMID: 16462550 DOI: 10.1097/01.nmd.0000195314.80210.41] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Interpersonal psychotherapy (IPT) research has addressed outcome more than mechanism. This study used the novel Interpersonal Psychotherapy Outcome Scale (IPOS) to test the theoretical axiom that symptomatic improvement in IPT reflects resolution of interpersonal problem areas. The IPOS rates change in focal interpersonal problem areas on a 5-point scale. Patients (N = 24) and therapists (N = 7) in a time-limited IPT outcome study of dysthymic disorder, and patients (N = 11) in an open trial for posttraumatic stress disorder, completed the IPOS at treatment termination. All responding dysthymic subjects (N = 24) and therapists (N = 21) reported interpersonal gains: dysthymic patients scored 4.39 (SD = 0.52) out of 5, therapists 4.27 (0.53). Posttraumatic stress disordered patients rated 4.75 (0.34). Patient and therapist IPOS ratings correlated with objectively measured symptomatic improvement with full or trend statistical significance. Despite methodological limitations, initial testing of the IPOS supports the theorized link between resolving interpersonal crises and improvement in IPT.
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Affiliation(s)
- John C Markowitz
- Department of Psychiatry, Weill Medical College of Cornell University, New York, New York 10032, USA
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Enns MW, Cox BJ. Psychosocial and clinical predictors of symptom persistence vs remission in major depressive disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:769-77. [PMID: 16408525 DOI: 10.1177/070674370505001206] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The present study evaluates the impact of a range of psychosocial factors on the outcome of major depression while controlling for the effect of clinical variables. METHOD Patients (n = 171) seen in consultation at a mood disorders clinic completed measures of neuroticism, rumination, coping style, sexual abuse history, and parental bonding experiences at Time 1 and completed measures of interpersonal and achievement life events and depression 12 months later. RESULTS In univariate analyses, neuroticism, rumination, interpersonal and achievement life events, and sexual abuse history were associated with nonremission, whereas avoidance coping was associated with remission at Time 2. Interpersonal and achievement life events and sexual abuse history were associated with nonimprovement, whereas avoidance coping was associated with improvement at Time 2. Significant predictors of both remission and improvement in logistic regression analyses controlling for clinical variables (depression and anxiety severity, duration of illness, and age) included avoidance, interpersonal life events, and the interaction between avoidance and interpersonal life events. CONCLUSIONS Interpersonal events and responses to depression (that is, coping) play an important role in the outcome of major depression. Further attention to coping style and interactions between psychological factors and life events is warranted in future research on depression persistence.
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Affiliation(s)
- Murray W Enns
- Department of Psychiatry, University of Manitoba, Winnipeg.
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McFarland BR, Klein DN. Mental health service use by patients with dysthymic disorder: treatment use and dropout in a 7 1/2-year naturalistic follow-up study. Compr Psychiatry 2005; 46:246-53. [PMID: 16175754 DOI: 10.1016/j.comppsych.2004.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Little is known about long-term treatment use among patients with dysthymia. This paper describes patterns of treatment use by 85 outpatients with dysthymic disorder and a comparison group of 36 outpatients with nonchronic (episodic) major depression in a naturalistic follow-up. Patients with dysthymia had higher rates of treatment use across 7 1/2 years compared with patients with episodic major depression. Baseline variables that predicted which patients with dysthymia dropped out of treatment before recovering from dysthymic disorder included age, ethnicity, Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition Axis II pathology as obtained from informant reports, higher self-reported autonomy, and receiving psychotherapy alone as compared to receiving a combination of psychotherapy and medication. Dysthymic disorder places a significant burden on the mental health services system, yet many outpatients with dysthymia may be receiving inadequate treatment. Younger patients, ethnic minority patients, and patients with personality disorders may be at increased risk of dropping out from treatment for depression. Combination treatments may increase treatment retention.
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Affiliation(s)
- Brian R McFarland
- Psychology Department, Stony Brook University, Stony Brook, NY 11794-2500, USA.
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