[Evaluation of therapeutic success by patients with anxiety disorders after inpatient psychotherapy]

OBJECTIVE

To identify factors influencing the subjective assessment of patients regarding the outcome of in-patient psychotherapy for anxiety disorders.

METHODS

A total of 231 patients were tested at admission, discharge and 1-year follow-up in a multi-center study. Subjective outcome assessment was measured with the revised German version of the Helping Alliance Questionnaire. The use of the term "outcome satisfaction" is discussed.

RESULTS

Patient outcome assessment did not correlate with age, sex, or education, or with duration or severity of illness or duration of treatment. Outcome assessment was closely connected with therapy success. Reaching a low symptom level ("clinical significance") had a higher impact than a high pre-post-difference ("statistical significance").

CONCLUSIONS

Anxiety patients give a generally positive assessment of their therapy outcome, which is most determined by symptom-related treatment success. The differentiation of "clinical" and "statistical significance" of success is of importance for the patient's subjective view of the therapy outcome.

High-density exposure therapy for obsessive-compulsive inpatients: a 1-year follow-up

BACKGROUND

This study evaluates the effects of individual high-density exposure (2-3 weeks, all day) plus response prevention therapy on 85 unselected inpatients suffering from obsessive-compulsive disorder (OCD).

METHODS

Twenty-eight therapist practitioners performed treatment.

RESULTS

At 1-year follow-up, self-ratings indicated that patients on average felt much improved. Impairment by both obsessions and compulsions was significantly reduced (p < 0.001 in each case), and OCD symptoms as assessed by two OCD questionnaires had also decreased significantly, as had depressiveness and overall symptomatology (all p < 0.001). Defining improvements as >30% successes, as done in other OCD treatment outcome studies, success rates were 68 and 69%, respectively, for the two OCD questionnaire scores, 75% for self-rated impairment by obsessions and 84.5% for compulsions, 85.6% for overall psychopathology (General Symptom Index), and 75% for depressiveness (Beck Depression Inventory). Effect sizes were >1 SD for all of the measures included.

CONCLUSIONS

We conclude that long-term effects for high-density treatment of unselected OCD patients bring about as good results as treatments with exposure and response prevention performed with selected patient samples in a research context.

Combination of behavioral smoking cessation with transdermal nicotine substitution

Effects of a transdermal nicotine substitution on psychological smoking cessation were investigated in a double-blind prospective study. 131 smokers were randomly assigned to three treatment conditions: All smokers underwent nine weeks of self-controlled smoking cessation. During six weeks one group was additionally treated with nicotine patches continuously releasing nicotine through the skin into the blood circuit. The second group received placebo patches; while the third group was treated with behavioral training alone. Treatment effects were measured by daily cigarette consumption. Nicotine-treated subjects reached significantly higher abstinence rates during and at the end of treatment than both placebo- and control-subjects: 69% in the nicotine condition, 51.2% and 44.4% under placebo and control conditions respectively. Effects are influenced by initial cigarette consumption, with the light smokers benefitting most from the nicotine patch. Self-assessments suggest an aversive effect of transdermal nicotine on cigarette taste. Our results, although not yet verified by long-term observations, demonstrate that transdermal nicotine substitution significantly enhances the effectiveness of behavioral smoking cessation methods.

[Long-term effects of a combination of transdermal nicotine administration with behavior therapy for smoking cessation]

Effects of a transdermal nicotine substitution on psychological smoking cessation were investigated in a double-blind prospective study. 131 smokers have been randomly assigned to three treatment conditions: All smokers underwent nine weeks of self-controlled smoking cessation. During 6 weeks one group was additionally treated with nicotine patches continuously releasing nicotine through the skin into the blood circuit. The second group received placebo patches; while the third group was treated with behavioral training alone. Treatment effects were measured by daily cigarette consumption. Follow-up investigations were performed 3, 6 and 12 months after therapy. Nicotine-treated subjects reached significantly higher abstinence rates during and at the end of treatment as well as during the follow-up period, than both placebo- and control-subjects. No severe side effects of plasters have been reported. The results thus indicate good therapeutic effectiveness of transdermal nicotine substitution.

Failure of high-dose sustained release luteinizing hormone releasing hormone agonist (buserelin) plus oral testosterone to suppress male fertility

Previously we have demonstrated that sperm counts of normal young men decreased during constant subcutaneous infusion of the LHRH agonist buserelin (118 or 230 micrograms/d). In order to test whether azoospermia can be achieved with higher doses, seven young men received 450 micrograms buserelin subcutaneously daily for 12 weeks via extracorporeal osmotic minipumps. To avoid symptoms of androgen deficiency, oral supplementation with 80 mg/d testosterone undecanoate (TU) was initiated in week 5 and was increased to 120 mg/d by week 8. Follow-up after treatment lasted for another 12 weeks. In order to evaluate possible psychotropic effects of treatment-related endocrine changes, continuous psychometric testing was performed focusing on personality, emotions and sexuality. After an initial rise, both serum LH and FSH returned to normal. FSH was below normal during the 3rd-5th week following treatment. LHRH stimulation tests performed at the end of treatment showed pituitary desensitization. Serum T (always measured between 0800 and 1300 h at least 12 h after last TU) tended to decrease by week 7 and remained slightly depressed until the end of treatment while libido, potency and emotional well-being remained unchanged. While testicular volumes showed a reduction from week 7 of treatment to week 10 post-treatment, sperm counts decreased only insignificantly from 65 +/- 10 to 44 +/- 14 million per ml in week 12 post-treatment. Severe oligo- or azoospermia was not observed in any of the seven men. It is concluded that full androgen substitution by TU can drastically delay if not abolish the antifertility effect of LHRH-induced pituitary desensitization.

Clinical trial of 19-nortestosterone-hexoxyphenylpropionate (Anadur) for male fertility regulation

To test the effectiveness of 19-nortestosterone (19NT) as an antifertility agent, 12 normal men (age, 24.0 +/- 2.2 years) received 19NT-hexoxyphenylpropionate (19NT-HPP), 200 mg/week intramuscularly for 7 weeks. After this initial phase, two groups were formed that received injections at different intervals. Except for the 19NT serum levels, there was no difference in treatment effects between both groups. 19NT-HPP administration in general suppressed gonadotropins below detection limits, accompanied by testosterone levels well in the castrate range. At the end of the treatment phase, azoospermia or severe oligozoospermia (total sperm count less than 5 X 10(6)) was present in ten volunteers. No loss of libido or potency was reported. Administration of 19NT-HPP did not affect liver enzymes, creatinine, uric acid, serum electrolytes, or serum lipids. The presented data demonstrate that 19NT-HPP as a single entity given every 3 weeks can suppress sperm output in a high proportion of men and simultaneously maintain virility.

Psychology of male infertility--a literature survey

Fifty-three articles on the psychology of male infertility published between 1948 and 1985 are reviewed with respect to theoretical backgrounds, methodological approaches and results suggesting an influence of psychological factors on male fertility. Although the data of most empirical studies are found to be incomplete and inconclusive because of conceptual deficiencies and insufficient methods, there is some evidence for stress responses negatively affecting male fertility. The variety of psychological factors presented in the literature indicates the heterogeneity of psychological involvement in male infertility. In conclusion, goals for future research on psychobiological aspects of male infertility are suggested and methodological criteria are outlined.