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Liira H, Garner P, Malmivaara A, Kanerva M, Kvarnström K, Sainio M, Varonen M, Venäläinen M, Vuokko A, Arokoski J. Prognosis of patients with post-Covid-19 condition: Prospective cohort cluster analysis at one year. J Psychosom Res 2024; 182:111808. [PMID: 38781803 DOI: 10.1016/j.jpsychores.2024.111808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE We aimed to identify clinically relevant clusters among patients with post-Covid-19 condition (PCC) and assess prognosis overall and within clusters. METHODS Prospective cohort study of patients with PCC attending a rehabilitation clinic. We monitored patient reported outcome measures (PROMs): EuroHIS quality of life and symptoms. Unsupervised hierarchical cluster analyses were performed to identify clusters of patients with different quantity of symptoms, and symptoms presenting together. Preliminary findings on symptom prevalence and quality of life at 12 months are reported. RESULTS Among 409 patients, 70.4% were women, with an average baseline of 20.3 (SD 6.8) symptoms. Three clusters emerged based on symptom quantity, labelled by the average number of symptoms at baseline: Cluster-11 (17% of all patients), Cluster-17 (35%), and Cluster-25 (48%). Multinomial logistic regression showed female sex, multiple comorbidities predicting more symptoms. Four symptom-based clusters were defined: fatigue and cognitive complaints; pain, trouble sleeping, palpitations and other symptoms; gastrointestinal symptoms; and emotion-related symptoms. Linear regression models showed that female sex, multiple comorbidities, anxiety, use of antidepressants, BMI and smoking were among the determinants of symptom clusters. In 12-month follow-up, symptom count decreased, and quality of life improved across all clusters, with 9% having good quality of life at baseline and 33% at 12 months. CONCLUSION Four patient clusters based on symptoms were identified in the PCC cohort. Prognosis was favorable across all clusters, with symptom reduction and improved quality of life observed. Female sex, comorbidities, BMI, and mental-health related variables predicted higher symptom burden, suggesting multifactorial origins of PCC.
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Affiliation(s)
- Helena Liira
- Clinic for Persistent Somatic Symptoms, Helsinki University Hospital, Helsinki, Finland.
| | - Paul Garner
- Clinic for Persistent Somatic Symptoms, Helsinki University Hospital, Helsinki, Finland
| | - Antti Malmivaara
- Clinic for Persistent Somatic Symptoms, Helsinki University Hospital, Helsinki, Finland
| | - Mari Kanerva
- Clinic for Persistent Somatic Symptoms, Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Kvarnström
- Clinic for Persistent Somatic Symptoms, Helsinki University Hospital, Helsinki, Finland
| | - Markku Sainio
- Clinic for Persistent Somatic Symptoms, Helsinki University Hospital, Helsinki, Finland
| | - Mikko Varonen
- Clinic for Persistent Somatic Symptoms, Helsinki University Hospital, Helsinki, Finland
| | - Mikko Venäläinen
- Clinic for Persistent Somatic Symptoms, Helsinki University Hospital, Helsinki, Finland
| | - Aki Vuokko
- Clinic for Persistent Somatic Symptoms, Helsinki University Hospital, Helsinki, Finland
| | - Jari Arokoski
- Clinic for Persistent Somatic Symptoms, Helsinki University Hospital, Helsinki, Finland
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Wilhelmsen-Langeland A, Børtveit T, Jürgensen M, Søfteland E, Hystad SW, Kvale G. Concentrated transdiagnostic and cross-disciplinary micro-choice based group treatment for patients with depression and with anxiety leads to lasting improvements after 12 months: a pilot study. BMC Psychiatry 2024; 24:361. [PMID: 38745158 PMCID: PMC11094865 DOI: 10.1186/s12888-024-05786-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND A concentrated transdiagnostic and micro choice-based group treatment for patients with depression and anxiety has previously shown to yield significant reduction in symptoms and increased level of functioning from pre to 3-month follow-up. In the present study, we report the results after 12 months follow-up. METHODS This was a non-randomized clinical intervention pilot study, conducted in line with a published protocol. Sixty-seven consecutively referred patients, aged 19-47 (mean age 32.5, SD = 8.0) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age at onset of symptoms was 17.6 (SD = 7.9) years. Mean number of prior treatment courses was 3.5 (SD = 3.3; range 0-20). The main objective was to assess the treatment effectiveness by questionnaires measuring relevant symptoms at pre-treatment, 7 days-, 3 months-, 6 months- and at 12-months follow-up. RESULTS Validated measures of functional impairment (WSAS), depression (PHQ9), anxiety (GAD7), worry (PSWQ), fatigue (CFQ), insomnia (BIS) and illness perception (BIPQ) improved significantly (p < .0005) from before treatment to 12 months follow-up, yielding mostly large to extremely large effect sizes (0.89-3.68), whereas some moderate (0.60-0.76). After 12 months, 74% report an overall improvement in problems related to anxiety and depression. Utilization of specialist, public and private mental health care was reported as nonexistent or had decreased for 70% of the patients at 12-month follow up. CONCLUSIONS The concentrated, micro-choice based group treatment approach yielded a highly clinically significant reduction in a wide range of symptoms already one week after treatment, and the positive results persisted at 12-month follow-up. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05234281, first posted date 10/02/2022.
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Affiliation(s)
- Ane Wilhelmsen-Langeland
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
- Helse i Hardanger, Øystese, Norway.
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Tore Børtveit
- Helse i Hardanger, Øystese, Norway
- Division of Mental Health and Addiction, Vestfold Hospital, Vestfold, Norway
| | - Marte Jürgensen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Helse i Hardanger, Øystese, Norway
| | - Eirik Søfteland
- Helse i Hardanger, Øystese, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Gerd Kvale
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Helse i Hardanger, Øystese, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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Kvale G, Søfteland E, Jürgensen M, Wilhelmsen-Langeland A, Haugstvedt A, Hystad SW, Ødegaard-Olsen ØT, Aarli BB, Rykken S, Frisk B. First trans-diagnostic experiences with a novel micro-choice based concentrated group rehabilitation for patients with low back pain, long COVID, and type 2 diabetes: a pilot study. BMC Med 2024; 22:12. [PMID: 38200486 PMCID: PMC10782659 DOI: 10.1186/s12916-023-03237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The health care is likely to break down unless we are able to increase the level of functioning for the growing number of patients with complex, chronic illnesses. Hence, novel high-capacity and cost-effective treatments with trans-diagnostic effects are warranted. In accordance with the protocol paper, we aimed to examine the acceptability, satisfaction, and effectiveness of an interdisciplinary micro-choice based concentrated group rehabilitation for patients with chronic low back pain, long COVID, and type 2 diabetes. METHODS Patients with low back pain > 4 months sick-leave, long COVID, or type 2 diabetes were included in this clinical trial with pre-post design and 3-month follow-up. The treatment consisted of three phases: (1) preparing for change, (2) the concentrated intervention for 3-4 days, and (3) integrating change into everyday life. Patients were taught and practiced how to monitor and target seemingly insignificant everyday micro-choices, in order to break the patterns where symptoms or habits contributed to decreased levels of functioning or increased health problems. The treatment was delivered to groups (max 10 people) with similar illnesses. Client Satisfaction Questionnaire (CSQ-8)) (1 week), Work and Social Adjustment Scale (WSAS), Brief Illness Perception Questionnaire (BIPQ), and self-rated health status (EQ-5D-5L) were registered at baseline and 3-month follow-up. RESULTS Of the 241 included participants (57% women, mean age 48 years, range 19-84), 99% completed the concentrated treatment. Treatment satisfaction was high with a 28.9 (3.2) mean CSQ-8-score. WSAS improved significantly from baseline to follow-up across diagnoses 20.59 (0.56) to 15.76 (0.56). BIPQ improved from: 22.30 (0.43) to 14.88 (0.47) and EQ-5D-5L: 0.715 (0.01) to 0.779 (0.01)), all P<0.001. CONCLUSIONS Across disorders, the novel approach was associated with high acceptability and clinically important improvements in functional levels, illness perception, and health status. As the concentrated micro-choice based treatment format might have the potential to change the way we deliver rehabilitation across diagnoses, we suggest to proceed with a controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT05234281.
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Affiliation(s)
- Gerd Kvale
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Eirik Søfteland
- Helse i Hardanger, Kvam, Norway.
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Marte Jürgensen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Helse i Hardanger, Kvam, Norway
| | - Ane Wilhelmsen-Langeland
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Helse i Hardanger, Kvam, Norway
| | - Anne Haugstvedt
- Helse i Hardanger, Kvam, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | | | - Bernt Bøgvald Aarli
- Helse i Hardanger, Kvam, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Bente Frisk
- Helse i Hardanger, Kvam, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Njøten KL, Espehaug B, Magnussen LH, Jürgensen M, Kvale G, Søfteland E, Aarli BB, Frisk B. Relationship between exercise capacity and fatigue, dyspnea, and lung function in non-hospitalized patients with long COVID. Physiol Rep 2023; 11:e15850. [PMID: 37984816 PMCID: PMC10659919 DOI: 10.14814/phy2.15850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
Long COVID is a global health problem that impairs patients' functional status. More than 200 reported symptoms have been identified where fatigue, dyspnea, and exercise impairment are most common. This study aimed to describe exercise capacity, fatigue, dyspnea, and lung function in previously non-hospitalized patients with long COVID, and examine the relationship between exercise capacity and fatigue, dyspnea, and lung function. Sixty-five patients, 54 women (83%), mean age of 39 standard deviation (12) years, were included and completed spirometry, cardiopulmonary exercise test, stair climbing test (SCT), 30 second sit-to-stand test (30STST), and questionnaires regarding fatigue and dyspnea. Fatigue was reported by 95% of the participants, whereas 65% reported severe fatigue, and 66% reported dyspnea. Mean exercise capacity measured with peak oxygen uptake (V̇O2peak % pred.) was ≥85% in 65% of the participants. Mean forced expiratory volume in 1 s. and forced vital capacity were 96.6 (10.7)% and 100.8 (10.9)%, respectively, while reduced diffusion capacity for carbon monoxide (DLCO ) was found in eight participants (13%). Reduced V̇O2peak kg-1 and increased time on SCT were significantly associated with increased dyspnea and reduced DLCO but not with fatigue, while 30STST was associated with increased fatigue and dyspnea in previously non-hospitalized patients with long COVID.
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Affiliation(s)
- Kiri Lovise Njøten
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
- Helse i HardangerØysteseNorway
| | - Birgitte Espehaug
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
| | - Liv Heide Magnussen
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
| | - Marte Jürgensen
- Helse i HardangerØysteseNorway
- Division of PsychiatryHaukeland University HospitalBergenNorway
| | - Gerd Kvale
- Helse i HardangerØysteseNorway
- Division of PsychiatryHaukeland University HospitalBergenNorway
- Department of Clinical PsychologyUniversity of BergenBergenNorway
| | - Eirik Søfteland
- Helse i HardangerØysteseNorway
- Department of MedicineHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Bernt Bøgvald Aarli
- Helse i HardangerØysteseNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Thoracic MedicineHaukeland University HospitalBergenNorway
| | - Bente Frisk
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
- Helse i HardangerØysteseNorway
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Frisk B, Jürgensen M, Espehaug B, Njøten KL, Søfteland E, Aarli BB, Kvale G. A safe and effective micro-choice based rehabilitation for patients with long COVID: results from a quasi-experimental study. Sci Rep 2023; 13:9423. [PMID: 37296140 PMCID: PMC10252160 DOI: 10.1038/s41598-023-35991-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
At least 65 million people suffer from long COVID. Treatment guidelines are unclear, especially pertaining to recommendations of increased activity. This longitudinal study evaluated safety, changes in functional level and sick leave following a concentrated rehabilitation program for patients with long COVID. Seventy-eight patients (19-67 years) participated in a 3-day micro-choice based rehabilitation program with 7-day and 3-month follow-up. Fatigue, functional levels, sick leave, dyspnea and exercise capacity were assessed. No adverse events were reported and 97.4% completed the rehabilitation. Fatigue measured with Chalder Fatigue Questionnaire decreased at 7-days [mean difference (MD = - 4.5, 95% CI - 5.5 to - 3.4) and 3-month (MD = - 5.5, 95% CI - 6.7 to - 4.3). Sick leave rates and dyspnea were reduced (p < 0.001) and exercise capacity and functional level increased (p < 0.001) at 3-month follow-up regardless of severity of fatigue at baseline. Micro-choice based concentrated rehabilitation for patients with long COVID was safe, highly acceptable and showed rapid improvements in fatigue and functional levels, sustaining over time. Even though this is a quasi-experimental study, the findings are of importance addressing the tremendous challenges of disability due to long COVID. Our results are also highly relevant for patients, as they provide the base for an optimistic outlook and evidence supported reason for hope.
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Affiliation(s)
- Bente Frisk
- Department of Health and Functioning, Western Norway University for Applied Sciences, Bergen, Norway
- Helse i Hardanger, Øystese, Norway
| | - Marte Jürgensen
- Helse i Hardanger, Øystese, Norway
- Divison of Psychiatry, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway
| | - Birgitte Espehaug
- Department of Health and Functioning, Western Norway University for Applied Sciences, Bergen, Norway
| | - Kiri Lovise Njøten
- Department of Health and Functioning, Western Norway University for Applied Sciences, Bergen, Norway
- Helse i Hardanger, Øystese, Norway
| | - Eirik Søfteland
- Helse i Hardanger, Øystese, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bernt Bøgvald Aarli
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Gerd Kvale
- Divison of Psychiatry, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway.
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.
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Pedersen H, Havnen A, Brattmyr M, Attkisson CC, Lara-Cabrera ML. A digital Norwegian version of the client satisfaction questionnaire 8: factor validity and internal reliability in outpatient mental health care. BMC Psychiatry 2022; 22:671. [PMID: 36316661 PMCID: PMC9623922 DOI: 10.1186/s12888-022-04281-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Validated measures of patient-reported experiences are essential for assessing and improving the quality of mental health services and interventions. In Norwegian mental healthcare settings, the Client Satisfaction Questionnaire (CSQ-8) is increasingly being used for this purpose, but the validity and reliability of the Norwegian translation have not been investigated. METHODS We examined the factor structure and internal consistency of a digitally administrated Norwegian translation of the CSQ-8 in a sample of 338 patients recruited from outpatient treatment. The relationship between satisfaction scores and the change in symptom severity during treatment, measured by the Patient Health Questionnaire-4, was also investigated. RESULTS The Norwegian CSQ-8 showed a clear unidimensional structure with one factor explaining 74% of the variance. Internal consistency was very high, with a Cronbach's alpha of 0.95. Satisfaction showed a small-to-moderate negative relationship with change in symptom severity. Satisfaction scores were negatively skewed, and the presence of ceiling effects is discussed. CONCLUSION Our results support the use of the Norwegian CSQ-8 as a valid and reliable measure of satisfaction with mental healthcare services. Further studies are needed to determine the test-retest reliability of the questionnaire, its sensitivity to change, and to assess its propensity to ceiling effects.
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Affiliation(s)
- Henrik Pedersen
- Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway. .,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Audun Havnen
- grid.52522.320000 0004 0627 3560Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Martin Brattmyr
- grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - C. Clifford Attkisson
- grid.266102.10000 0001 2297 6811Department of Psychiatry, University of California, San Francisco, United States ,Tamalpais Matrix Systems, LLC, San Fransisco, United States
| | - Mariela L. Lara-Cabrera
- grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway ,grid.52522.320000 0004 0627 3560Nidelv Community Mental Health Centre, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway , Trondheim, Norway
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Frisk B, Njøten KL, Aarli B, Hystad SW, Rykken S, Kjosås A, Søfteland E, Kvale G. A Novel Concentrated, Interdisciplinary Group Rehabilitation Program for Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Nonrandomized Clinical Intervention Study. JMIR Res Protoc 2022; 11:e40700. [PMID: 36287602 PMCID: PMC9647463 DOI: 10.2196/40700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Pulmonary rehabilitation has been demonstrated to be a highly effective treatment for people with chronic obstructive pulmonary disease (COPD). However, its availability is scarce worldwide, and new and innovative rehabilitation models are highly warranted. Recently, the group behind the present study published a protocol describing a novel concentrated, interdisciplinary group rehabilitation program for patients with chronic illnesses. The current paper describes an extension of this protocol to patients with COPD. Objective The objective of this study is to explore the acceptability of concentrated, interdisciplinary group pulmonary rehabilitation for patients with COPD. The intervention is expected to improve functional status and be highly acceptable to patients. Methods This study will include 50 patients aged over 40 years who fulfill the diagnostic criteria for COPD: a forced expiratory volume at the first second (FEV1) <80% of expected and a FEV1/forced vital capacity ratio below the lower limit of normal according to the Global Lung Function Initiative. An interdisciplinary team consisting of physicians, physiotherapists, psychologists, pharmacists, clinical nutritionists, and nurses will deliver the treatment to groups of 6 to 10 patients over 3 to 4 consecutive days with a 12-month follow-up. The intervention is divided into three distinct phases: (1) pretreatment preparation for change, (2) concentrated rehabilitation, where the patient is coached to focus on making health-promoting microchoices, and (3) integration of the changes into everyday living, aided by digital follow-up and 2 on-site clinical examinations. Statistical significance will be set at α=.05. Results The recruitment period will last from April 2022 until June 2023. Conclusions If successful, this highly novel rehabilitation format might change the way we deliver care for patients with COPD, leading to substantial societal and socioeconomic gains. The study will expand knowledge on the concentrated treatment format as a rehabilitation model for people with COPD. Trial Registration ClinicalTrials.gov NCT05234281; https://clinicaltrials.gov/ct2/show/NCT05234281 International Registered Report Identifier (IRRID) PRR1-10.2196/40700
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Affiliation(s)
- Bente Frisk
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
- Helse i Hardanger, Øystese, Norway
| | - Kiri Lovise Njøten
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
- Helse i Hardanger, Øystese, Norway
| | - Bernt Aarli
- Helse i Hardanger, Øystese, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | | | - Eirik Søfteland
- Helse i Hardanger, Øystese, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Gerd Kvale
- Helse i Hardanger, Øystese, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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Kvale G, Wilhelmsen-Langeland A, Jürgensen M, Hystad SW, Öst LG, Søfteland E, Børtveit T. Concentrated transdiagnostic and cross-disciplinary group treatment for patients with depression and with anxiety: a pilot study. BMC Psychiatry 2022; 22:587. [PMID: 36058925 PMCID: PMC9441319 DOI: 10.1186/s12888-022-04229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of treatment approaches have shown efficacy for depression and/or anxiety, yet there is a paucity of research on potentially cost-effective concentrated approaches. Based on our previous experience with concentrated treatment in disorders such as Obsessive-Compulsive Disorder and chronic fatigue, we proposed that this novel approach could be useful for other conditions, including depression and/or anxiety. As a pre-requisite for a future randomized controlled trial, the aim of this study was to investigate the acceptability, satisfaction and effectiveness of a transdiagnostic, interdisciplinary group treatment delivered during 5 consecutive days to groups of 6-10 patients with depression and/or anxiety. METHODS This was a non-randomized clinical intervention pilot study in line with a published protocol. Forty-two consecutively referred patients, aged 19-47 (mean age 31.7, SD = 8.12) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age when the symptoms became a problem was 20.9 years. Mean number of prior treatment courses was 2.77 (SD = 2.19; range 0-8). Acceptability was defined as the proportion of eligible patients who accepted and completed the treatment. Satisfaction was evaluated by Client Satisfaction Questionnaire-8. Secondary objectives were to assess the treatment effectiveness by questionnaires at pre-treatment, seven days post-treatment and three months follow-up. RESULTS The treatment was highly acceptable (91.3% accepted, all completed), and patients were highly satisfied with the treatment, including the amount. Functional impairment, as measured by Work and Social Adjustment Scale (WSAS) improved significantly (p < .0005) from "severe" (mean 25.4 SD = 6.59) to "less severe" (mean 13.37, SD = 9.43) at 3 months follow-up. Using the Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), the effect sizes at 3 months follow-up were 1.21 for anxiety and 1.3 for depression. More than 80% reported reduced utilization of mental health care, and 67% had not used, or had used the family doctor less, for anxiety or depression. 52% had not used, or had reduced, medication for their disorder. CONCLUSIONS The concentrated, interdisciplinary treatment approach yielded promising results. Long-term follow up is warranted. TRIAL REGISTRATION This study is registered in Clinical Trials, identifier NCT05234281 and approval date 09/02/2022.
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Affiliation(s)
- Gerd Kvale
- Haukeland University Hospital, Bergen Division of Mental Health, 5021, Bergen, Norway. .,Department of Clinical Psychology, University of Bergen, Bergen, Norway.
| | - Ane Wilhelmsen-Langeland
- grid.412008.f0000 0000 9753 1393Haukeland University Hospital, Bergen Division of Mental Health, 5021 Bergen, Norway ,Helse i Hardanger, Øystese, Norway
| | - Marte Jürgensen
- grid.412008.f0000 0000 9753 1393Haukeland University Hospital, Bergen Division of Mental Health, 5021 Bergen, Norway ,Helse i Hardanger, Øystese, Norway
| | - Sigurd William Hystad
- grid.7914.b0000 0004 1936 7443Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Lars-Göran Öst
- grid.10548.380000 0004 1936 9377Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Eirik Søfteland
- Helse i Hardanger, Øystese, Norway ,grid.412008.f0000 0000 9753 1393Department of Medicine, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Science, University of Bergen, Norway, Norway
| | - Tore Børtveit
- grid.412008.f0000 0000 9753 1393Haukeland University Hospital, Bergen Division of Mental Health, 5021 Bergen, Norway ,Helse i Hardanger, Øystese, Norway ,grid.417292.b0000 0004 0627 3659Division of Mental Health and Addiction, Vestfold Hospital, Vestfold, Norway
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Update of the Potential Treatments for Psychiatric and Neuropsychiatric Symptoms in the Context of the Post-COVID-19 Condition: Still a Lot of Suffering and Many More Things to Learn. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The World Health Organization (WHO) has defined a post-COVID-19 condition. Some of these symptoms can be categorized as psychiatric long COVID-19 if they appeared in the aftermath of COVID-19, including depression, anxiety, post-traumatic stress disorder, somatic symptoms disorders such as hyperventilation syndrome, fatigue, cognitive and sleep disorders. Psychiatric and neuropsychiatric post-COVID-19 present mental health specialists with difficult challenges because of its complexity and the multiple ways in which it integrates into a singular somatic context. Methods: We conducted a systematic research paradigm from SARS-CoV-2 using LitCOVID and Web of Science to search management strategies and potential treatments for psychiatric post-COVID-19 symptoms. Results: Management strategies must be based on a multidisciplinary approach to promote the global evaluation of psychiatric and physical symptoms, systematic detection and prevention. Selective serotonin reuptake inhibitors appear to be the best choice to treat post-COVID-19 depression and anxiety disorders, and tofisopam could be helpful for anxiety. Cognitive behavioral therapy techniques adjusted to post-COVID-19 fatigue, functional remediation, extracorporeal apheresis, transcutaneous auricular vagus nerve stimulation, monoclonal antibodies, flavonoids, oxytocin or L-carnitine all represent hypothetical therapeutic avenues that remain to be evaluated in clinical trials. Conclusions: Psychiatric and neuropsychiatric post-COVID-19 symptoms occur frequently and are debilitating. Attention should be paid to this condition and studies undertaken to specify the effective treatments.
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