Matteo Porcellana

Short-Term Psychodynamic Psychotherapy Versus Treatment as Usual for Depressive and Anxiety Disorders: A Randomized Clinical Trial of Efficacy

This randomized clinical trial aimed to evaluate the clinical efficacy of short-term psychodynamic psychotherapy (STPP) in the treatment of patients suffering from anxiety or depressive disorders, as compared with a control case sample composed of patients undergoing treatment as usual (TAU). Sixty patients with depressive or anxiety disorders according to DSM IV-TR were randomly assigned in a 1:1 ratio to an intervention group (STPP) or control group for 12 months (T1). Primary outcome measures were the Symptom Checklist 90-Revised (SCL-90-R), the Inventory of Interpersonal Problems (IIP), and the Clinical Global Impression Improvement Scale. Intention to treat analysis revealed that patients who received STPP showed significantly more improvements in comparison with those who were in the TAU group on Clinical Global Impression Improvement Scale and IIP measures. This study offers evidence that STPP is an effective treatment for patients with anxiety or depressive disorders, and it could be more effective than TAU in improving interpersonal problems as measured by IIP.

Systemic Family Therapy in Schizophrenia: A Randomized Clinical Trial of Effectiveness

Background: Although evidence suggests the effectiveness of cognitive and behaviorally oriented family therapies for schizophrenia, no specific randomized study has been carried out on Systemic Family Therapy (SFT). The purpose of this longitudinal prospective study was to evaluate the clinical effectiveness of SFT in the treatment of patients suffering from schizophrenia, as compared with a control case sample composed of patients undergoing routine psychiatric treatment. The study included a 2-year follow-up period and was conducted following the Milan School model. Methods: The case sample in the study was made up of 20 patients treated with SFT associated with routine psychiatric treatment, and 20 patients undergoing routine psychiatric treatment alone. Both groups of patients were re-evaluated at the end of treatment (T1) and 12 months after the end of treatment (T2) to assess the clinical course of the illness. Results: At the end of the follow-up period, we noticed an improved clinical course and a better pharmacological compliance in the group of patients treated with SFT. In the experimental case sample, 3 subjects (15%) had relapsed, compared to 13 patients (65%) in the control group (p = 0.03). No significant difference was found in the 2nd year of follow-up. Conclusions: Our study provides an innovative contribution with regard to the evaluation of the clinical effectiveness of SFT in the treatment of schizophrenic patients. The clinical results were significant, and we thus feel justified in continuing to use this type of therapy in integrated interventions involving schizophrenic patients.

Epilepsy and family expressed emotion: results of a prospective study

PURPOSE To verify the emotional components expressed by the relatives of adult patients with a diagnosis of epilepsy, and whether they are related to adjustment to the illness and the course of the illness over time. METHODS We studied a consecutive sample of 43 outpatients suffering from epilepsy and 43 key relatives using the Camberwell Family Interview (CFI), with the expressed emotion (EE) of the relatives being rated at baseline (T0). EE refers to a construct representing some key aspects of interpersonal relationships: the relatives were assigned to the high-EE group if they scored 3 or more on the emotional over involvement (EOI) scale, or showed hostility, or made 6 or more critical comments. The patients were clinically evaluated at baseline and for 1 year of appropriate treatment by an epileptologist who was blinded to the EE ratings. They also completed STAI XI, STAI X2 and Becks Depression Inventory at baseline. RESULTS Twenty-six relatives (60%) were rated as showing a high degree of EE. In the 12-month follow-up study, high EE and high EOI were found to be associated with a significantly higher seizure frequency than that recorded for the patients living in low-EE households (p<0.05). The patients from households assessed as reflecting a high degree of criticism showed poor drug compliance (p<0.01), whereas those with relatives assessed as having a high degree of warmth showed better clinical and pharmacological compliance (p<0.01). High family criticism scores also correlated with higher study entry levels of depression (p<0.05) and trait and state anxiety (p<0.05) among the patients. CONCLUSIONS The study findings highlight the impact of particular components of the family emotional climate on the clinical course and psychological adjustment of patients with epilepsy.

Is it possible to assess subjective well-being among bipolar inpatients? An 18-week follow-up study

OBJECTIVE The study evaluates the association between subjective well-being and psychopathology in bipolar inpatients at the time of hospitalization and during a follow-up period. METHOD One hundred twenty consecutive inpatients with a diagnosis of bipolar affective disorder were studied on admission (T0), at discharge (T1) and every 6 weeks for 18 weeks after hospitalization. The Youngs Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HAM-D) were used to determine affective symptoms, while subjective well-being was assessed by subjective well-being under neuroleptic (SWN). Associations between SWN and HAM-D or YMRS scores and between their changes were analyzed across the different time points by using Pearson correlation coefficients. Linear regression models were constructed using SWN as the dependent variable and demographic and clinical characteristics as possible predictors. RESULTS At baseline, depression explained 24% and mania explained an additional 16% of baseline SWN variance. Changes in SWN and HAM-D total score displayed an inverse correlation during hospitalization and follow-up. End point severity of depression was associated with the end point SWN total score explaining additional 26% of SWN total score variance, whereas severity of mania was inversely associated with SWN total score. CONCLUSION Data of this study provide further support for the need to consider the subjective well-being as a personal variable associated to psychopathological state in bipolar patients. However, results seem to be in line with authors who suggest to use other subjective quality of life scales in acute mania.