Psychological support for families of ICU patients: longitudinal documentation of the service

This study is the first systematic effort to investigate psychological services provided to relatives of ICU patients at Nicosia General Hospital. Documentation of psychological sessions provided to relatives of ICU patients for the years 2011–2014 was analyzed. To investigate possible differences in the total number of sessions for the referenced years, the records were analyzed using patients’ demographics, the outcome of hospitalization and the total number of sessions with relatives. A questionnaire was sent to the ICU staff aiming to identify their perception towards the need for psychological support. A total number of 863 psychological sessions were conducted with 640 relatives of 345 patients hospitalized in the ICU. Results indicate that more sessions are recorded when the outcome of younger patients’ condition worsens, whereas the number of sessions decreases for older patients’ families. When comparing the personnel’s beliefs, regarding the importance of providing psychological services to different age groups, significant difference was found suggesting that the older the patient the less sessions they believe are required indicating a possible ageism bias.     

Cognitive Processing Therapy Delivered in 5 Days via Telehealth to a Gay Latino Adolescent: A Clinical Case Study

Cognitive Processing Therapy (CPT) has been thoroughly investigated as an efficacious treatment for posttraumatic stress disorder (PTSD). However, for many, the barriers to receiving treatment in the traditional weekly, in-person format prevent engagement. Recent evidence suggests alternative modalities, such as telehealth, and condensed administration of treatment protocols may reduce barriers, increasing treatment completion. This case study reports the treatment of a gay-identifying adolescent Latino male who received 10 sessions of CPT over the course of 5 consecutive days (CPT-5). The patient experienced significant reduction in PTSD symptoms over the course of treatment, dropping below the clinical threshold for PTSD diagnosis by the 10th session. Treatment gains were maintained, and continued, 6 weeks posttreatment. Further, the patient reported marked reduction in suicidality and substance use. In conclusion, the administration of CPT-5 via telehealth holds promise as an effective evidence-based treatment for adolescents with PTSD, including those holding multiple historically marginalized identities, though further investigation through clinical trials is warranted.     

Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Comorbid Substance Abuse and Mental Health Disorders

Comorbid substance use disorders (SUDs) and mental health disorders are a pervasive problem among post-9/11 veterans and service members. Treatment of SUD and comorbid disorders has historically occurred separately and sequentially, and when treated concurrently has been primarily done in a weekly outpatient setting, which has high rates of dropout. The current study describes an integrated 2-week intensive outpatient treatment (IOP) using cognitive-behavioral therapy, including prolonged exposure for posttraumatic stress disorder (PTSD), unified protocol for anxiety and mood disorders, and relapse prevention for SUD. Forty-two patients completed the comorbid treatment program. Results indicated that self-reported substance use, PTSD, and depression symptoms significantly decreased following treatment, while satisfaction with participation in social roles increased. These preliminary effectiveness data indicate that comorbid SUD and mental health disorders can be effectively treated in a 2-week intensive outpatient program.     

The acute psychobiological impact of the intensive care experience on relatives

There is a growing awareness amongst critical care practitioners that the impact of intensive care medicine extends beyond the patient to include the psychological impact on close family members. Several studies have addressed the needs of relatives within the intensive care context but the psychobiological impact of the experience has largely been ignored. Such impact is important in respect to health and well-being of the relative, with potential to influence patient recovery. The current feasibility study aimed to examine the acute psychobiological impact of the intensive care experience on relatives. Using a mixed methods approach, quantitative and qualitative data were collected simultaneously. Six relatives of patients admitted to the intensive care unit (ICU) of a District General Hospital, were assessed within 48 h of admission. Qualitative data were provided from semi-structured interviews analysed using interpretative phenomenological analysis. Quantitative data were collected using a range of standardised self-report questionnaires measuring coping responses, emotion, trauma symptoms and social support, and through sampling of diurnal salivary cortisol as a biomarker of stress. Four themes were identified from interview: the ICU environment, emotional responses, family relationships and support. Questionnaires identified high levels of anxiety, depression and trauma symptoms; the most commonly utilised coping techniques were acceptance, seeking support through advice and information, and substance use. Social support emerged as a key factor with focused inner circle support relating to family and ICU staff. Depressed mood and avoidance were linked to greater mean cortisol levels across the day. Greater social network and coping via self-distraction were related to lower evening cortisol, indicating them as protective factors in the ICU context. The experience of ICU has a psychological and physiological impact on relatives, suggesting the importance of identifying cost-effective interventions with evaluations of health benefits to both relatives and patients.     

Intensive Outpatient Comprehensive Behavioral Intervention for Tics: A Clinical Replication Series

Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious behavioral treatment for Tourette’s disorder. In its standard format, CBIT is completed in 8 sessions over a 10-week period. Unfortunately, significant obstacles (e.g., not having a provider nearby; inability to attend weekly sessions) prevent many individuals from participating in standard outpatient CBIT. An intensive outpatient program that compresses CBIT into a week may help overcome many of these barriers. The present clinical replication series examines treatment outcomes in 5 individuals with Tourette’s disorder. Importantly, 4 out of the 5 participants reported clinically meaningful tic reductions on the Yale Global Tic Severity Scale (YGTSS) at the posttreatment assessment, with an average decrease of 11.5 points across those 4 participants. This represents a 28% decrease in the average posttreatment YGTSS score from the average baseline YGTSS score. Of the 3 participants who completed the 1-month follow-up assessment, 2 participants continued to endorse reductions in their baseline tic severity on the YGTSS and were rated as having a positive response on the Clinician Global Impressions–Improvement subscale. Clinical implications are discussed.     

两种麻醉方式在门诊隆胸手术中的应用比较

为了比较瑞芬太尼-丙泊酚静脉麻醉与利多卡因硬膜外神经阻滞在门诊隆胸手术中的应用效果,选取ASAⅠ级行门诊隆胸手术患者80例,随机等分为瑞芬太尼-丙泊酚静脉麻醉组(A组)和利多卡因硬膜外神经阻滞组(B组)。观察两组患者围手术期的麻醉效果和术后2h内不良反应发生情况。结果显示,A组麻醉效果显著优于B组,且术后2h内发生的不良反应明显少于B组。     

儿童内包量概念发展的实验研究

以2～5年级学生为被试．系统探讨了儿童速度、浓度内包量概念的发展。研究发现：(1)儿童的内包量概念发展要经历四个阶段;(2)儿童速度概念的形成早于其浓度概念的形成;(3)凋整任务在儿童解决速度内包量问题中优于比较任务;(4)儿童解决内包量概念问题的策略经历从单维向双维、从比差的加法法则向乘法法则的转变。