[Mental health locus of control in refugees with clinically established psychopathology]

The present study attempts to examine the mental health locus of control (LOC) of refugees with clinically diagnosed psychopathology and to examine the possible association of LOC with the presentation of the psychopathology. LOC refers to the degree to which a person attributes what happens in their life to themselves or to external factors. It draws its theoretical background from Rotter's theory of social learning. External LOC has been linked to psychopathology in anxiety disorders (AD), depression and post-traumatic stress disorder (PTSD), of which migrants are primarily at risk in comparison to the indigenous population. This is a descriptive cross-sectional study. The study involved 40 refugees who were referred to the psychiatric office, by the psychologists of a non-governmental organization, due to clinically established psychopathology. In the first session, the Patient Health Questionnaire-9 (PHQ-9) and the Harvard Trauma Questionnaire-5 (HTQ5) were administered, according to the score of which the psychologists' referral diagnoses were confirmed. To assess the LOC the Multidimensional Health Locus of Control Questionnaire (MHLC) was administered, which measures LOC in self, significant others, and luck. The questionnaires were administered in English, Farsi, and Lingala. We translated the MHLC questionnaire to Lingala for the needs of the present study and the validity of the translation was ensured using back-translation, from English to Lingala and from Lingala back to English by different translators to control the identification of the English texts. Refugees scored lower on self and higher on significant others and chance. Correlations between LOC and the presentation of psychopathology were sought. A negative correlation was found between the severity of depression and the score on self on the MHLC, a finding that has also been demonstrated in other studies. The intensity of depression was positively correlated with the score of MHLC on luck. There was also a positive correlation between the intensity of the symptoms of PTSD and the score of MHLC to luck, in our sample. The present study highlights the Multidimensional Health Locus of Control Questionnaire as a remarkable and useful tool in the assessment of refugees with psychopathology in Greece.

Cognitive changes in health locus of control attributions after behavioral analysis in patients with panic disorder and/or agoraphobia

Patients with Panic Disorder and / or Agoraphobia (PD +/- Ag) attribute their mental health more to external factors and less to internal, while after behavior treatment (BT) their external attributions decrease and internal attributions increase. We examined whether these cognitive changes observed at the end of BT, begin earlier. Forty patients with PD +/- Ag were assessed on the Multidimensional Health Locus of Control Scale, before and after the diagnostic and psychoeducational sessions that precede the clinical implementation of BT. Decreased health attributions to significant others (t = 4.22, p < 0.01), and an increase trend to self (t = -0.78, p = 0.43) were observed, which are compatible with the active role patients need to adopt in the clinical application of BT.

Differentiation of 2 Obsessive-Compulsive Disorder Subgroups with Regard to Demographic and Phenomenological Characteristics Combining Multiple Correspondence and Latent Class Analysis

INTRODUCTION

Classic factor analysis of obsessive-compulsive disorder (OCD) dimensions and attempts to identify valid subgroups have not yet produced definitive conclusions.

OBJECTIVE AND METHODS

This study aims to examine possible homogeneous subgrouping of demographic and phenomenological characteristics in 134 treatment-seeking OCD patients. A combination of multiple correspondence analysis (MCA) and latent class analysis (LCA) was used.

RESULTS

MCA showed 2 distinct subgroups of OCD patients and LCA confirmed this result by a two-class solution. Both analyses demonstrated (a) a clear subgroup of female patients with washing compulsions, obsessions related to contamination, and late age of onset and (b) a subgroup comprised mostly of male patients with earlier onset of OCD, checking rituals, and doubts or aggressive obsessions. Mental, ordering, hoarding compulsions, religious, or sexual obsessions and images appeared exclusively in this subgroup.

CONCLUSIONS

Using 2 different analytic methods, we confirmed at least 2 subgroups in a clinical sample of Greek OCD patients. Future research combining dimensional and latent approaches could facilitate our understanding of the heterogeneous phenotype of OCD.

Earthquake-related psychological distress and associated factors 4 years after the Parnitha earthquake in Greece

Exposure to earthquakes has been associated with psychological distress and in particular the development of post-traumatic stress disorder (PTSD). Earthquake-related psychological distress can be longstanding. The present study involved 157 Greek survivors of the 1999 Parnitha earthquake assessed approximately 4 years after the earthquake. Assessments were based on the Traumatic Stress Symptom Checklist (TSSC). Using stringent calibrations for the estimation of symptom presence 25% of the survivors endorsed at least 5 and 12% at least 10 TSSC symptoms. Approximately 22% of the survivors reported subjective distress and 15% impaired adjustment due to their symptoms. Intensity of fear during the earthquake and participation in rescue operations related to greater post-earthquake psychological distress. The results suggest that the psychological consequences of earthquakes can be serious and long-standing even when the magnitude of the earthquake is moderate. Psychological treatments that have been proven to reduce fear and PTSD symptoms need to be made available to the survivors. Such treatments may also increase the survivors' psychological preparedness and emotional resilience in view of future earthquakes.

Manualized single-session behavior treatment with self-help manual for panic disorder with or without agoraphobia

Objective: We examined the clinical feasibility and utility of a single behavior treatment session, with 11 patients with Panic Disorder with or without Agoraphobia (PD+/-AG). Patients used an individualized, exposure based, homework manual, derived from their behavioral analysis. Treatment was implemented in an outpatient behavior treatment unit. Method: Patients presented with moderate to severe anxiety, avoidance behavior, functional impairment and depressive symptoms. Treatment was evaluated with a double-baseline case series/pre-post design with four follow-ups. Results: There was a significant and steady improvement in all self-rated outcome measures and participants were satisfied with the services provided. Nine out of 11 patients (82%) were free of PD+/-AG at 3 months and all patients at 1-year follow-up. The absence of a control group, the small sample and lack of blind assessments, limit the validity of the study. Conclusions: These case studies provide empirical evidence in support of both the feasibility and utility of a single-session behavior treatment (SSBT) plus self-help implemented in a public mental health unit. Further research with a control group is needed to assess the efficacy of the intervention in routine clinical practice.

Treatment engagement in the early phase of cognitive-behavior therapy for panic disorder: A grounded theory analysis of patient experience

Exposure-based cognitive-behavior therapy (EBCBT) is the treatment of choice for panic disorder (PD). However, little is known about early treatment processes that facilitate retention in treatment and positive outcomes of PD treatment. We studied the development of early treatment process with semi-structured individual in-depth interviews with 12 patients with PD, conducted post session 3. Grounded theory was used to analyze the transcripts. The development of early treatment process was captured by four thematic categories: approaching the problem, easing in and opening up, building trust and bonding, and making sense of panic. The developmental scheme culminated to the core category: Jointly Engaging in PD Therapy versus Awaiting Relief, capturing early engagement or disengagement from PD therapy respectively. The emergent core category was cross-validated against distal treatment outcome. Emergent processes can be replicated and incorporated in early treatment procedures of EBCBT for PD. Clinical practice recommendations are discussed.

Postwithdrawal exposure treatment to prevent relapse in opiate addicts: a pilot study

A major problem in treating opiate addiction is relapse within a few months after withdrawal. Learning models of relapse offer some promise toward understanding this problem. The present pilot study examines whether cue-exposure treatment to drug-related cues, in hospital and real life, might reduce relapse. Fourteen opiate addicts were withdrawn on clonidine over 6 days, and 10 of those were exposed to drug-related cues in hospital for 1 week and in real life for another. There were then followed as outpatients up to 6 months. Craving was elicited in half of the 10 patients exposed to drug cues who showed within- and between-session habituation. Four cases were opiate-free at 6 months follow up and 1 at 3 months. Half of the cases had relapsed to heroin at various times up to 6 months. Habituation to craving responses was not obviously related to outcome whereas vocational factors were. The operational use of craving in research is discussed.

Gender-divergent aetiological factors in obsessive-compulsive disorder

Among 307 adults with OCD, early onset (age 5-15 years) was more common in men and later onset (age 26-35 years) in women. Early onset was associated with more checking, and late onset with more washing. More women than men had a history of treated depression; 12% of the women but none of the men had a history of anorexia. More women than men were married. Gender-divergent features may reflect differential aetiological factors. Our sample resembled others in the literature in its slight overall female preponderance, low rate of marriage and low fertility, onset mainly before age 35 years, chronicity, and common present and past depression.

Clonidine versus long- and short-term methadone-aided withdrawal from opiates. An uncontrolled comparison

Twelve heroin addicts and one methadone addicts began withdrawal from street opiates, under clonidine cover, in a general psychiatric ward. Ten (80%) of them completed it within 6 days. Clonidine doses used were lower than in similar studies and all patients were alert and mobile throughout withdrawal. Two other groups of opiate addicts, of similar age and sex, were withdrawn on standard methadone regimens. Clonidine and methadone withdrawal had similar acceptability and attrition rates. Self-reports of subjective discomfort were higher in the clonidine group without affecting compliance with treatment. Withdrawal under clonidine cover deserves further study, in view of the need for postwithdrawal treatment to prevent relapse to opiate use.

Clomipramine, self-exposure and therapist-aided exposure for obsessive-compulsive rituals

A randomised treatment design for 49 chronically obsessive-compulsive ritualising patients was devised and three controlled comparisons were made. 1. During 7 weeks of self-exposure instructions, clomipramine treatment improved some measures of rituals and depression significantly more than did placebo medication; this effect was transient and disappeared as drug treatment and exposure were continued for a further 15 weeks. 2. During 11-16 weeks of clomipramine treatment, self-exposure instructions yielded highly significantly more patient improvement than did anti-exposure instructions on nearly all measures of rituals and some of social adjustment. 3. Adding therapist-aided exposure (1.3 hours) to self-exposure instructions (3 hours) after 8 weeks had a barely significant transient effect of dubious clinical value, which was lost by the end of exposure (at week 23) and during follow-up assessments to week 52. We conclude that of the three therapeutic factors tested, self-exposure was the most potent; clomipramine played a limited adjuvant role, and therapist-aided exposure a marginal one.

Clomipramine in obsessive-compulsive ritualisers treated with exposure therapy: relations between dose, plasma levels, outcome and side effects

Forty-nine obsessive-compulsive ritualisers completed a double-blind controlled study of clomipramine and exposure therapy. More severely ill patients allowed higher doses of medication to be prescribed and had higher plasma levels of both clomipramine and desmethylclomipramine. Exposure instructions had a strong effect, whereas the clomipramine effect was small and short-lived. Plasma levels of desmethylclomipramine but not of clomipramine correlated with outcome at weeks 8 and 17. There was no evidence of a therapeutic window for either clomipramine or its metabolite. Patients' physical complaints before treatment correlated positively with depression and anxiety, especially sexual difficulties. Dry mouth, as a side effect, was most evidently related to clomipramine and its usefulness in monitoring drug compliance for patients on clomipramine is reaffirmed.