Jenny Rosendahl

Physical and mental health in patients and spouses after intensive care of severe sepsis: a dyadic perspective on long-term sequelae testing the Actor-Partner Interdependence Model.

Objective:To examine the physical and mental long-term consequences of intensive care treatment for severe sepsis in patients and their spouses under consideration of a dyadic perspective using the Actor–Partner Interdependence Model. Design:Prospective study. Setting:Patients and spouses who had requested advice from the German Sepsis Aid’s National Helpline were invited to participate. Subjects:We included 55 patients who survived severe sepsis and their spouses an average of 55 months after ICU discharge. Measurements and Main Results:The Hospital Anxiety and Depression Scale, the Short Form-12 Health Survey, the Posttraumatic Stress Scale-10, and the Giessen Subjective Complaints List-24 were used. The Actor–Partner Interdependence Model was tested using multilevel modeling with the actor effect representing the impact of a person’s posttraumatic stress symptoms on his or her own mental health-related quality of life and the partner effect characterized by the impact of a person’s posttraumatic stress symptoms on his or her partner’s mental health-related quality of life. A significant proportion of patients and spouses (26%–42%) showed clinically relevant scores of anxiety and depression; approximately two thirds of both, patients and spouses, reported posttraumatic stress symptoms defined as clinically relevant. Compared with normative samples, patients reported greater anxiety, poorer mental and physical health-related quality of life, and greater exhaustion; spouses had an impaired mental health-related quality of life and increased anxiety. Testing the Actor–Partner Interdependence Model revealed that posttraumatic stress symptoms were related to patients’ (&bgr; = −0.71, 95% confidence interval −0.88 to −0.54) and spouses’ (&bgr; = −0.62, 95% confidence interval −0.79 to −0.46) own mental health-related quality of life. Posttraumatic stress symptoms further influenced the mental health-related quality of life of the respective other (&bgr; = −0.18, 95% confidence interval −0.35 to −0.003 for patients; &bgr; = −0.15, 95% confidence interval −0.32 to 0.02 for spouses). Conclusions:Interventions to treat posttraumatic stress symptoms after critical illness to improve mental health-related quality of life should not only include patients, but also consider spouses.

Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of randomized-controlled trials.

Group psychotherapy for social anxiety disorder (SAD) is an established treatment supported by findings from primary studies and earlier meta-analyses. However, a comprehensive summary of the recent evidence is still pending. This meta-analysis investigates the efficacy of group psychotherapy for adult patients with SAD. A literature search identified 36 randomized-controlled trials examining 2171 patients. Available studies used mainly cognitive-behavioral group therapies (CBGT); therefore, quantitative analyses were done for CBGT. Medium to large positive effects emerged for wait list-controlled trials for specific symptomatology: g=0.84, 95% CI [0.72; 0.97] and general psychopathology: g=0.62, 95% CI [0.36; 0.89]. Group psychotherapy was also superior to common factor control conditions in alleviating symptoms of SAD, but not in improving general psychopathology. No differences appeared for direct comparisons of group psychotherapy and individual psychotherapy or pharmacotherapy. Hence, group psychotherapy for SAD is an efficacious treatment, equivalent to other treatment formats.

Stress disorders following prolonged critical illness in survivors of severe sepsis.

Objectives:To examine the frequency of acute stress disorder and posttraumatic stress disorder in chronically critically ill patients with a specific focus on severe sepsis, to classify different courses of stress disorders from 4 weeks to 6 months after transfer from acute care hospital to postacute rehabilitation, and to identify patients at risk by examining the relationship between clinical, demographic, and psychological variables and stress disorder symptoms. Design:Prospective longitudinal cohort study, three assessment times within 4 weeks, 3 months, and 6 months after transfer to postacute rehabilitation. Setting:Patients were consecutively enrolled in a large rehabilitation hospital (Clinic Bavaria, Kreischa, Germany) admitted for ventilator weaning from acute care hospitals. Patients:We included 90 patients with admission diagnosis critical illness polyneuropathy or critical illness myopathy with or without severe sepsis, age between 18 and 70 years with a length of ICU stay greater than 5 days. Interventions:None. Measurements and Main Results:Acute stress disorder and posttraumatic stress disorder were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria by a trained and experienced clinical psychologist using a semistructured clinical interview for Diagnostic and Statistical Manual of Mental Disorders. We further administered the Acute Stress Disorder Scale and the Posttraumatic Symptom Scale-10 to assess symptoms of acute stress disorder and posttraumatic stress disorder. Three percent of the patients had an acute stress disorder diagnosis 4 weeks after transfer to postacute rehabilitation. Posttraumatic stress disorder was found in 7% of the patients at 3-month follow-up and in 12% after 6 months, respectively. Eighteen percent of the patients showed a delayed onset of posttraumatic stress disorder. Sepsis turned out to be a significant predictor of posttraumatic stress disorder symptoms at 3-month follow-up. Conclusions:A regular screening of post-ICU patients after discharge from hospital should be an integral part of aftercare management. The underlying mechanisms of severe sepsis in the development of posttraumatic stress disorder need further examination.

Körperliche und psychische Langzeitfolgen nach intensivmedizinischer Behandlung einer schweren Sepsis bei Patienten und Angehörigen

This study aimed at investigating the physical and mental long-term sequelae in survivors of severe sepsis and in their relatives. Furthermore, the role of resilience as protective factor was examined. We contacted all persons who had requested free of charge advice from the German Sepsis Aids National Helpline and asked them to answer a questionnaire. We included 87 patients and 90 relatives of patients who survived a severe sepsis. About two thirds of the patients and relatives reported clinically relevant post-traumatic symptoms. There were strong dyadic relations between patient and spouses regarding physical and mental health and quality of life. Resilience was found to be a significant negative predictor of physical complaints, anxiety, depression and post-traumatic stress symptoms in patients and relatives. Diagnosis and therapy of mental disorders is of particular importance within primary care following sepsis.

Psychologische Interventionen im Rahmen chirurgischer Eingriffe: eine narrative Übersicht über vorliegende Meta-Analysen

Studies investigating the effects of adjunctive psychological interventions to surgical routine care are summarized as a narrative review of existing meta-analyses. Primary studies evaluate the effects of the provision of information, supportive approaches, coping skills training, behavioural instructions, cognitive-behavioural strategies, relaxation, and hypnosis. The meta-analyses include studies of different methodological quality, also considering non-randomized trials, and indicate small to large effects depending on the type of intervention and outcome measure. The greatest effects were achieved on patient satisfaction, recovery, and the reduction of postoperative pain, with a slight advantage of complex interventions. Since most of the meta-analyses reveal methodological limitations, an updated and methodologically improved quantitative research synthesis seems to be required.

Efficacy of group psychotherapy for panic disorder: Meta-analysis of randomized, controlled trials.

Among psychological treatments for panic disorder (PD) with or without agoraphobia, group therapy is an established and cost-effective treatment. The typical review assessing the effects of psychological treatments for PD merges findings from both individual and group formats. What is absent from the literature is a meta-analysis that separately summarizes the efficacy of group treatments. The present meta-analysis addresses this gap by estimating the efficacy of group psychotherapy for PD in adults using randomized, controlled trials (RCTs). More specifically, studies that directly compared the effects of group psychotherapy with control groups or alternative treatments were included. We identified 15 RCTs that yielded 19 comparisons with 864 patients. In most studies, group therapy was based on a cognitive–behavioral approach. Outcomes assessing panic, agoraphobia, depression, and general anxiety symptoms were extracted and between-groups effect sizes (Hedges’ g) calculated using a random-effects model. Results showed large effects for group therapy reducing symptoms of panic and agoraphobia when compared with no-treatment control groups (k = 9; g = 1.08; 95% confidence interval [CI] [0.82, 1.34]; p < .001). However, no significant differences were found when group therapy was compared with alternative treatments (k = 6; g = 0.18; 95% CI [−0.14, 0.49]; p = .264). This review adds support for group psychotherapy (primarily cognitive–behavioral therapy, CBT) being one of several treatment options for PD. Results are discussed with respect to the positive effects of group therapy and the limits of group therapy when compared with alternative treatments such as individual therapy or pharmacotherapy.

Bypass Surgery with Psychological and Spiritual Support (the BY.PASS Study): Results of a Pragmatic Trial Based on Patients’ Preference

Background: Some general hospitals within the German health system provide supportive interventions, psychological as well as spiritual, to their patients. It remains to be proven if these interventions are effective when used in routine clinical practice. Aim: To evaluate the effectiveness of psychological and spiritual interventions on improving recovery following bypass surgery. Methods: The BY.PASS study is a pragmatic, patient preference trial (ISRCTN 07297983). Adult patients scheduled for elective coronary bypass surgery were enrolled. Patients were assigned to study conditions according to their personal preference: preference for psychological interventions, for spiritual interventions or for no intervention. Patients who were open for any kind of intervention were randomly assigned either to psychological or spiritual interventions. During a control period, patients were asked about their preference, but did not receive any interventions. Primary outcomes of the study were in-hospital morbidity and early mortality. Psychological measures served as secondary outcomes. Results: A total of 847 patients were enrolled. Patients of the control (n = 260) and the intervention group (n = 269) who explicitly wanted to have interventions were compared. No significant treatment effects either for morbidity (d = 0.08, 95% CI –0.09 to 0.25), or for mortality (OR = 1.81; 95% CI 0.50–6.57) could be found. A reduction of negative mood resulted from both interventions. Conclusions: Although the effects observed were small, the study can serve as a basis to discuss methodological as well as theoretical aspects of a pragmatic trial, based upon patients’ preferences.

Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: Systematic review and meta-analysis

OBJECTIVES This meta-analysis investigates the efficacy of non-pharmacological interventions in adults undergoing dental procedures under regional or general anesthesia compared to standard care alone or an attention control group on the reduction of mental distress, pain, and analgesic use. DATA SOURCES To identify relevant papers a comprehensive literature search was carried out in MEDLINE, CENTRAL, Web of Science, and PsycINFO (last search August 2017). Additionally, lists of references of relevant articles and previous reviews were checked. ProQuest Dissertations and Theses Full Text Database was screened to identify any unpublished material. STUDY SELECTION A total of 29 eligible randomized controlled trials were included, comprising a total of 2.886 patients. Included trials investigated the effects of hypnosis, enhanced information, relaxation, music, or cognitive-behavioral approaches including distraction. RESULTS Random effects meta-analyses revealed significant positive treatment effects on the reduction of mental distress (g = 0.58, CI 95% [0.39; 0.76]). Effects on pain relief (g = 0.00, CI 95% [-0.28; 0.28]) and the reduction of analgesic use (g = 0.26, CI 95% [-0.22; 0.73]) were not significant. Because effects on mental distress were substantially heterogeneous, subgroup analyses were run yielding significantly larger effects for studies with low risk of bias compared to studies with high or unclear risk of selection and attrition bias. No significant differences appeared between various types of non-pharmacological interventions. CONCLUSIONS In summary, benefits of non-pharmacological interventions on reducing mental distress were demonstrated with largest effects being shown for hypnosis. However, further high quality trials are needed to strengthen the promising evidence. CLINICAL SIGNIFICANCE This systematic review and meta-analysis indicated that non-pharmacological interventions may be beneficial for reducing mental distress in patients undergoing dental procedures and could thus be considered as valuable adjunct to standard care.

Psychological interventions for acute pain after open heart surgery (Protocol)

The objectives are as follows: To assess the efficacy of psychological interventions as an adjunct to standard surgical care compared to standard surgical care or attention control in adults undergoing open heart surgery.

Adverse effects of psychotherapy: protocol for a systematic review and meta-analysis

BackgroundWhile it is well known that psychotherapy is efficacious in the treatment of mental disorders, much less is known about the adverse effects of psychotherapeutic interventions. The aim of this systematic review is to examine the definition, frequency, nature, and severity of adverse effects occurring parallel to or following psychotherapeutic treatment and to compare it against control groups.MethodsAll registered randomised controlled trials published since 2004 (publication year of harm-reporting extension of the CONSORT statement) with adult patients fulfilling clinical criteria of defined mental disorders, which compare individual or group psychotherapy against a control group, will be included. First, a search through international trial registers as well as a search in literature databases (e.g. MEDLINE) and in relevant journals (e.g. Trials) for study protocols will be conducted to identify eligible trials. In a second step, we will search for respective publications of the results of the eligible studies. Publications will be retrieved and screened for eligibility. Two previously trained, independent raters will extract the data in duplicate. Reporting of adverse effects will be descriptively analysed regarding frequency, heterogeneity, and longitudinal course. We will further compare the adverse effects of psychotherapeutic interventions against various control groups. For each categorical outcome, we will calculate relative risks (RR) together with 95% confidence intervals. For continuous outcomes, standardised mean differences (Hedges’ g) with a 95% confidence interval will be computed. Between-study heterogeneity will be tested with the Q statistic and quantified using I2.DiscussionPreselecting studies with regard to randomised controlled trials might induce bias due to dropout before the beginning of treatment or end of treatment. However, we will thoroughly assess the negative effects of randomisation, e.g. reasons for non-randomisation, if reported. Even if delayed adverse effects might be overlooked in randomised controlled trials, these are the only sources of causal evidence.Systematic review registrationPROSPERO International Prospective Register of Systematic Reviews 2017: CRD42017055507 (17 January 2017)