Vol IX, No. 1, 2009 9

9.1

ADOLESCENT DOSE AND RATINGS OF AN INTERNET-BASED DEPRESSION PREVENTION PROGRAM: A RANDOMIZED TRIAL OF PRIMARY CARE PHYSICIAN BRIEF ADVICE VERSUS A MOTIVATIONAL INTERVIEW

Internet-based interventions for education and behavior change have proliferated, but most adolescents may not be sufficiently motivated to engage in Internet-based behavior change interventions. We sought to determine how two different forms of primary care physician engagement, brief advice (BA) versus motivational interview (MI), could enhance participation outcomes in an Internet-based depression prevention intervention.

Eighty-three adolescents at risk for developing major depression were recruited by screening in primary care and randomized to two groups: BA (1-2 minutes) + Internet program versus MI (10-15 minutes) + Internet program. We compared measures of participation and satisfaction for the two groups for a minimum of 12 months after enrollment.

Both groups engaged the site actively (MI: 90% versus BA: 78%, p=0.12). MI had significantly higher levels of engagement than BA for measures including total time on site (143.7 minutes versus 100.2 minutes, p=0.03), number of sessions (8.16 versus 6.00, p=0.04), longer duration of session activity on Internet site (46.2 days versus 29.34 days, p=0.04), and with more characters typed into exercises (3532 versus 2004, p=0.01). Adolescents in the MI group reported higher trust in their physician (4.18 versus 3.74, p=0.05) and greater satisfaction with the Internet-based component (7.92 versus 6.66, p=0.01).

Our results indicate that primary care engagement, particularly using motivational interviewing, may increase Internet use dose, and some elements enhance and intensify adolescent use of an Internet-based intervention over a one to two month period. Primary care engagement may be a useful method to facilitate adolescent involvement in preventive mental health interventions.

VERBAL, VISUOSPATIAL AND FACE WORKING MEMORY IMPAIRMENT IN MULTIPLE EPISODE SCHIZOPHRENIA PATIENTS

Memory impairment has been acknowledged as a core cognitive deficit in schizophrenia, and it is present irrespective of specific features related to the patient or the evolution of the disorder. It is suggested that distinct functional subsystems of memory are differently impaired in these patients, hence the broad range of levels of functioning affected in this specific population. The aim of this study was to assess working memory performance in multiple episode schizophrenia patients. A group of patients diagnosed with schizophrenia and a control group of healthy subjects were comparatively evaluated with 3 neurocognitive tests which require the use of working memory subsystems. Our results indicate significantly poorer performance in the case of patients suffering from schizophrenia, in all three working memory tests - they displayed impaired face recognition abilities and used a significantly higher number of non-list words when asked to repeat a list of words, which may be particularly relevant for their social functioning. The neurobiological and genetic background of the memory impairment in schizophrenia have been acknowledged due to increasing body of evidence, and the current study supports the current data which state that working memory deficits in schizophrenia are consistent, stable and comprehensive. This is particularly relevant for the personal management, and also for the academic, interpersonal and social rehabilitation of schizophrenia patients.

HEALTH-RELATED QUALITY OF LIFE IN CHILDREN AND ADOLESCENTS AND ASSOCIATED FACTORS

The main objective of this study was to propose a model, which includes personal and social factors associated to health-related quality of Life (HRQoL) in children and in adolescents.

A sample of 3195 children and adolescents was randomly selected from 5th and 7th graders, in Portuguese public schools. The Portuguese versions of KIDSCREEN-52, Harter’s SPPS, LOT-R, SSSS and HBSC (selected items) were used to evaluate personal and social factors and health behaviors.

Various structural equation models were developed in association with gender, age, socioeconomic status (SES) and using the global sample. The studied models presented good adjustment indexes, which suggest a good fit for the hypothesized model.

The psychosocial variables have a strong impact in the HRQoL. Consequently, health promotion programs for children and adolescents should include the psychosocial approach. Based on our results, we discuss and propose strategies to develop HRQoL in children and adolescents, in schools and in families.

The Receiver-Operating Characteristic (ROC) Analysis: fundamentals and applications in CLINICAL PSYCHOLOGY

The Receiver-Operating Characteristic (ROC) analysis has been long used in Signal Detection Theory to depict the tradeoff between hit rates and false alarm rates of classifiers. In the last years, ROC analysis has become largely used in the medical community for visualizing and analyzing the performance of diagnostic tests. Our article points out some fundamental aspects of ROC analysis underlying the importance of using ROC analysis in evaluating the diagnostic validity of tests commonly used in clinical psychology. The main statistical programs available for this type of analysis, with their advantages and deficiencies are also discussed. In order to illustrate how ROC analysis works in clinical research, we also describe an application of ROC analysis in evaluating scales generally related to depression.

TREATING PRIMARY INSOMNIA: A COMPARATIVE STUDY OF SELF-HELP METHODS AND PROGRESSIVE MUSCLE RELAXATION

Insomnia is one of the most prevalent psychological disorders worldwide. Some of the deficiencies of the current treatments of insomnia are: side effects in the case of sleeping pills and high costs in the case of psychotherapeutic treatment. Some suggest that self-help treatments could be a viable alternative, with certain advantages such as low cost, and wide accessibility to a large number of people. In our study we used a modified Latin square experimental design for single subject research to verify the effect of multi-component treatment efficiency in primary insomnia. Another goal of our study was to compare the effects of the three treatment techniques (progressive muscle relaxation, sleep hygiene, binaural beats) included in the multi-component intervention package. Our results reflect the efficiency of the multi-component treatment. Significant differences were found only between muscle relaxation and binaural beat. Based on effects size measures we can say that muscle relaxation and sleep hygiene have a very similar effect. The effect of binaural beat treatment is lower than that of the other two types of intervention.

EMOTIONAL DISTRESS, PAIN CATASTROPHIZING AND EXPECTANCIES IN PATIENTS WITH LOW BACK PAIN

Low back pain (LBP) is an important aspect of vertebral pathology. Due to its medical, social and financial importance, acute and chronic LBP is an important concern of the medical world. Pain catastrophizing and response expectancies are among the most robust psychological predictors of pain outcomes. Pain experience has been studied in relationship with pain catastrophizing on one hand, and in relationship with emotional distress, and with response expectancies on the other hand. Fewer studies have looked at relationships with hope. The current study was designed to investigate all these variables in one research. We assessed 46 patients (aged 27 to 84, 17 men and 29 women) with LBP to see the relevance of and relations between pain catastrophizing (Pain Catastrophizing Scale), emotional distress (Hospital Anxiety and Depression Scale), pain outcomes (SF-McGill Pain Questionnaire) and expectancies and hopes for pain relief after treatment. Our results show that pain catastrophizing totally mediates the relationship between pain and emotional distress and is related to expectancies. Chronic pain patients have more negative expectancies and hopes for pain relief after treatment as compared to acute pain patients. Implications for research and treatment are discussed.

THE IMPACT OF RATIONAL EMOTIVE BEHAVIOUR EDUCATION ON ANXIETY IN TEENAGERS

The present study is based on the assumption that teenagers endorsing high levels of irrational cognitions are prone to higher levels of anxiety, which can be diminished by rational emotive education (REE). To test this assumption we developed a brief REE intervention that was offered to a group of 88 10th-12th grade students from a high school in Cluj-Napoca. ABS II (irrationality) scores and STAI and HADS scores (anxiety) were used to assess the dependent variables, whereas the independent variables were represented by the presence/absence of the rational emotive behavior intervention and by gender, respectively.

The intervention consisted of a one-hour REE lesson, followed by a 14-day period during which the students were required to read the Rationality vs. Irrationality Decalogue (David, 2007) daily. After two weeks, both groups (intervention/non-intervention) were assessed again.

Our results indicate a strong correlation between irrational thinking and anxiety among teenagers. Moreover, REE resulted in a significant reduction in anxiety levels, and a decrease in irrational thinking.

AUTHOR MOTIVATION: AN INTERVIEW EXAMINING PERSONALITY THEORY

Background: In late October, 2008, Dr. Mike Abrams presented a four hour lecture with questions on his text (written with Albert Ellis et al) at the Albert Ellis Institute in Manhattan. Dr. McMahon attended the lecture. At the conclusion of the lecture, Dr. McMahon asked Dr. Abrams if he would consent to answer questions (below). He accepted to do so without reservation. In turn, Dr. McMahon asked Prof. Dr. Daniel David, Editor of the Journal of Cognitive Psychotherapies if he would be interested in publishing the interview. He readily agreed. McMahon is a trustee of the AEI, as well as a life member and supervisor of the Institute. Abrams is a Fellow of the Institute, co-leader of a private practice in psychotherapy with his wife, Lidia Abrams PhD, and a faculty member at Montclair State University in New Jersey. McMahon is Professor of the University. State University of Oradea, Romania, and Visiting Professor of Pastoral Interventions in Theology at BBU, Cluj, Romania.

LIAISON PSYCHIATRY – A NEW CLINICAL SUBSPECIALTY?

The term “liaison psychiatry” expresses, on the one hand, the act of consultation, the psychiatric intervention intended for the patient and, on the other hand, it emphasizes the assistance given to the physicians and the therapeutic team treating the patients. Liaison psychiatry aims to become a new subspecialty of psychiatry whose purpose is to study and manage mental disorders in patients treated by other medical disciplines. The activities of liaison psychiatry involve: initial focus on the consultation of the admitted patient, extensive services with multidisciplinary personnel, offers for various hospital activities (e.g. emergency care) and specialties (e.g. obstetrics and oncology), services for specific medical problems requiring collaborative planning, training and the supervision of the medical team, liaison and consultation by the liaison team, an increased interest in the treatment of functional symptoms, activities for discharged patients, connections with primary care, training and supervision for clinical medical and surgical teams. Recent reviews of the literature suggest that liaison psychiatry will require determination and political abilities if it is to assume the role it plays in multidisciplinary medical care approaches.