The '2005 National Framework for Service Change in the National Health Service (NHS) in Scotland' promoted the need for NHS service delivery in local communities rather than in hospitals, and to develop a systematic approach for the most vulnerable (especially older people) with long term conditions with a view to managing their conditions at home or in the community and reducing the chance of hospitalization. This combined with the recognition of an aging population encouraged service redesign in a Scottish health region with the focus on community assessment of older people with mental health needs.

To establish and assess the functioning of a joint Health and Social Services enhanced assessment and support team (EAST) for community-dwelling elders with significant mental health needs living in a Scottish health region, and to determine the impact of this team on mental health hospital services.

Prospective three-year data collection of local service activity involving EAST, and both inpatient and day hospital facilities for older adults with mental health problems.

EAST assessed 111 patients during the study, 83% with a diagnosis of dementia. The mean duration of assessment was 6 weeks with 9% of patients receiving an overnight home assessment and 6% requiring hospital admission. Overall there was a substantial reduction in utilization of both acute admission beds and day hospital placements.

Multi-agency community assessment of older adults with mental health problems can be addressed effectively without recourse to hospital admission, which may allow resource release for further service developments.

A number of definitions for 'psychiatric intensive care' exist but generally they detail care in a multidisciplinary, highly staffed, and often secure, unit for persons with mental disorder and associated behavioural disturbance. The role of psychiatric intensive care units (PICU) is well established for the general adult psychiatric population, but these units are often less suitable for older adults. A dedicated PICU for older adults in a Scottish Health Region serving a population of 350,000 was established in 2001 to deal primarily with an increase of behaviourally challenging demented male patients in the psychogeriatric admission wards of that region.

To detail patient characteristics and outcomes of admission to the PICU for older adults in a Scottish Health Region.

Prospective survey of admissions to the PICU from January 2006 until August 2007, using routinely collected data.

25 male patients, mean age 74 years, were admitted during the survey, with 52% detained under Mental Health legislation. The main transfer reasons were resistive behaviours and persistent physical aggression. The majority (32%) of patients had a primary diagnosis of Alzheimer's dementia, 20% with vascular dementia. The average mini-mental state score was 15/30, and the mean duration of patient stay in the PICU was 54 days, with 84% of admissions discharged from the unit during the evaluation period.

A regional psychogeriatric intensive care unit can serve a useful function in the management of disturbed elders who are otherwise difficult to manage within existing psychogeriatric acute admission wards.

The aim of the study was to determine the effects of volunteering on the physical and mental health of older adults, including the effect of type of volunteer work.

Data were collected from 120 subjects above the age of 60, of whom half were volunteers: 30 subjects provided care to terminally ill in hospices and 30 subjects collected funds in a single charity event during the 14th Finale of the Great Orchestra of Christmas Charity. The control group comprised 60 subjects not engaged in any kind of social activity. The following questionnaire methods were used: The Geriatric Depression Scale, Instrumental Activities of Daily Living, Norbeck Social Support Questionnaire and the originally developed inventory of health behaviors as recommended for this group of age.

The analysis of variance revealed that volunteering had protective effect on functional dependency, depression and level of health behaviors. The type of volunteer work was found as a moderator of the level of depression, subjective health status over last year and physical activity. The multiple regression analysis revealed the importance of social support variable for daily activities, albeit only in the control group. Curiously, the obtain results indicated that the stronger the support network perceived by these subjects, the lowest the ability to functional independence.

The findings suggest that a need exists for the development of social programs and policies aimed at maximizing the engagement of older adults in volunteer roles, independently of the type of volunteer work.

Physical activity (PA) is recognized to be an efficient therapy for depression but few patients are practicing it.

This study investigates whether motivational interviewing stimulates hospitalized depressed patients to participate to PA therapeutic programs.

70 depressed patients, hospitalized in a psychiatric unit were followed regarding their participation to indoor bike training sessions. The first 39 ones (controls = C) were informed that this training possibility was at their disposal without further comment. The 31 next ones (the participants = P) received one session per week of motivational interviewing. Frequency, time, and intensity of the indoor bike training were compared between groups. Demographical variables, BDI and STAI were recorded. There were no significant differences between groups regarding these variables. Participation frequency was recorded as the total number of sessions of physical training by each patient divided by the number of his hospitalization days.

The frequency of participation to AP for the P group is 0.45 participations per day [SD=0.14] versus 0.16 for the C group[SD=0.14](p<0.0001). The mean energy spent at each participation is equivalent in both groups, 41.9 Kcal [SD=21.8] for the P group versus 44.2 Kcal [SD=32.7] for the C group.

Motivational interviewing is able to raise significantly the frequency of participation to physical activity programs in depressed inpatients.

CBT is proved to be very efficient in treatment of depression with or without pharmacotherapy. In this paper case study of a patient with clinical manifested severe depressive episode will be presented. This patient was treated only with CBT without pharmacotherapy.

Is to demonstrate efficiency of CBT in treatment of depression based on case study.

History of the problem: Patient J., 41 years old female was referred for CBT treatment on recommendation of a friend. When she started treatment she was diagnosed as Severe Depressive episode without psychotic symptoms. Before she was referred for CBT treatment, her symptoms lasted about 4 months and she was treated with pharmacotherapy without improvement. On initial assessment she showed high scores on BDI (33) and BAI (21) scales.

She was complaining on depressive mood, anhedonia, loss of interest, social isolation and frequent anger outbursts.

CBT treatment for this patient lasted 14 sessions. CBT techniques used were: behavior activation, self monitoring of activities and level of achieved satisfaction, cognitive restructuring and problem solving. Patient was motivated to accept her part of work according CBT principles. Rapid improvement of her condition that patient subjectively recognized contributed to final therapy outcome. Objectively on BDI her depressiveness had tendency to decrease from BDI 33 on BDI 7 and level of her anxiety decreased from BAI 21 on BAI 5. General functioning of the patient significantly increased.

This case study suggests that CBT can be effective in the treatment of depression without applied pharmacotherapy.

Anxiety disorder in adolescents is a common mental disorder seen in the clinics. It can impair the psychosocial wellbeing of adolescents, influence their academic achievement and increase the family burden. Now cognitive-behavior therapy (CBT) may be the best provided psychotherapy for the treatment of it with a comparable effect with pharmacological treatment. And evidence based medicine had recommended the combining usage of the two treatments.

The aim of the present study was to examine the effectiveness of manual-guided cognitive-behaviour therapy (CBT) for adolescents with anxiety disorder.

With the help of foreign manual and consideration of characteristics of Chinese anxiety disorder adolescents, a treatment manual for the treatment of adolescent anxiety disorder in China is established.Clinical control test is formed to test the effect of manual. A cases analyze of the adolescent patients who received the CBT treatment.

A multimodular and several stage treatment manual for the treatment of Chinese anxious adolescents is established with objectives as oriented.63.7% of the adolescent anxiety disorder patients who received the CBT treatment is recovered. Analyze of patients who receive CBT result three models of requirements.

The treatment manual in this research is fitted with the characteristics of the adolescent anxiety disorder in China, and it is proved useful in the clinical work.In the CBT treatment of adolescent anxiety disorder, the patients can be classified to three requirement models which should be treated with different focus.

Asperger's disorder is characterized by marked difficulties in social interactions, which might be the result of a specific deficit in theory of mind and lack of social skills. Treatment programs based on cognitive-behavioral therapy (CBT) principles have shown effectiveness in improving the theory of mind and social skills for children and adolescents with Asperger's disorder. This study intends to examine the efficacy of a cognitive-behavioral group therapy (CBGT) program designed to promote the theory of mind and social skills for Taiwanese school-age children with Asperger's disorder.

Eight Taiwanese children aged 7-10 years with average intelligence participated in this program which included 10 weekly sessions with 80 minutes each. The behaviors of these participants were evaluated and compared before and after the training. Outcome measures consisted of (1) Australian Scale for Asperger's syndrome; (2) behavior observation; (3) theory of mind task; and (4) Vineland Adaptive Behavior Scales.

Pre-post comparison showed significant decreases in parental ratings in symptom severity (t=-5.59, p<.01), with a significant improvement in their children's social-emotional ability (t=-4.69, p<.01) and communication skills (t=-2.98, p<.01). Behavior observation also indicated improvement in theory of mind ability. However, there were neither significant difference in participants' performance on the theory of mind task nor in teachers' ratings of symptom severity and social skills.

Findings of this study partially support the immediate effect of this CBGT program for Taiwanese children with Asperger's disorder, but with limited generalization effect across situations.

to examine short and middle-term effectiveness of a group cognitive-behavioral intervention (CBT) in pathological gambling (PG) and to analyze predictors of therapy outcome.

Two hundred and ninety PG patients consecutively admitted to our Unit participated in the current study. All participants were diagnosed according to DSM-IV-criteria. Manualized outpatient group CBT [16 weekly sessions] was given. Specific assessment before and after the therapy and at 1, 3 and 6 months follow-up was conducted. Logistic regression analyses and survival analysis were applied.

outpatient group CBT was effective with abstinence rates by the end of therapy of 76.1%, and 81.5% at 6 months follow-up. The dropout rate during treatment decreased significantly after the fifth treatment session. Psychopathological distress (p = 0.040) and obsessive-compulsive symptoms were identified as factors predicting relapses and drop-outs respectively.

our findings suggest that group CBT is effective for treating PG individuals. Several psychopathological and personality traits were identified as outcome predictors.

Overweight, obesity and binge eating disorder are commonly reported in persons with severe mental disorders. Particularly, antipsychotic drugs (AP) induce weight gain in up to half of the patients.

The aim of the present study is to confirm a previous study results on a larger sample of patients, to assess the impact of the interventions on other relevant dimensions of eating and weight related cognitions as well as to assess potential clinical indicators of outcomes such as AP drug, concomitant treatment with lithium or carbamazepine, psychiatric diagnostic, binge eating and severity of cognitive distortions.

A controlled study (12-week CBT vs. B N E) was carried out on 99 patients treated with an AP and who have gained weight following this treatment. Binge eating symptomatology, eating and weight-related cognitions, as well as weight and body mass index were assessed before treatment, at 12 weeks and at 24 weeks.

The findings confirms usefulness and effectiveness of the proposed CBT program on the treatment of binge symptomatology, cognitive distortions and obesity in patients treated with AP. Reduction of binge symptoms and maladapted cognitions appeared early, whereas the effect on weight appeared later during the follow up observation. No differences on outcomes were found across pharmacotherapy characteristics, diagnostic categories, binge eating nor severity of cognitive distortions.

The proposed CBT treatment is useful for patients suffering from weight gain associated with AP treatments indeed when a concomitant treatment with lithium or valproate was given.

Mental Health Advance Directives (ADs) are potentially useful for bipolar patients due to the episodic characteristic of their disease. An advanced directives based cognitive therapy (ADCBT) involving the self-determination model for adherence, the cognitive representation of illness model, and the concordance model is studied on this article.

The aim of the study is to evaluate ADBCT's impact on the number and duration of hospitalization as well as commitment and seclusion procedures.

Charts of all patients who have written their ADs following an ADBCT intervention since at least 24 months were included in the study. Number and duration of psychiatric hospitalization for a mood or a psychotic episode as well as commitment and seclusion procedures were recorded for each patient two years before ADBCT and during a follow up of at least 24 months.

Number of hospitalizations, number of commitment procedures and number of days spent in psychiatric hospital reduced significantly after ADCBT in comparison of the two years who preceded the intervention.

ADBCT seems to be effective in patients with compliance and coercion problems in this retrospective study. Its effect remains however to be confirmed in large prospective studies.

The online treatment program Deprexis simulates evidence-based psychotherapy and can be used by psychiatrists for patients on waiting lists, as an adjunct to traditional treatment, or as a stand-alone intervention. The program includes modules such as behavioural activation, cognitive restructuring, mindfulness/acceptance exercises, social skills training, and positive psychology interventions.

In this randomised trial, 60 adults with mild to moderate depression were assigned to 9 weeks of either online-treatment (N = 34) or treatment-as-usual (N = 26).

Taking the program was associated with significant reductions in depression severity and improvements in social functioning, which were maintained over nine weeks of follow-up. In the treatment group, 41% experienced clinically significant improvement, whereas this was true in only 3.8% of the control participants. This corresponds to an odds-ratio of 17.50, indicating that participants in the treatment group were more than 17 times as likely to experience clinically significant improvement, compared to those in the control group. The effect size achieved by Deprexis resembles those achieved in routine community treatments, including medication or psychotherapy (Grawe, 2006; Westbrook & Kirk, 2005). The Deprexis program was also well received by the users: 88% felt that the program had helped them and 97% would recommend it to others suffering from mild depression.

These encouraging preliminary data suggests that Deprexis is an effective, online, self-help intervention for adults suffering from mild to moderate depression.

Combination of individual and group psychotherapy increases global functions rate regardless of significantly lesser improvement of depressiveness in comparison with isolated group psychotherapy.

In our prospective study we compared 30 of patients with major depressive disorder, treated with cognitive- behavioral psychotherapy(CBT) and psycho pharmacotherapy (Group I) with 30 patients, with only psycho pharmacotherapy (group II) mean age 37,6 ± 10,8.

For 18 months there have been used Beck Depression inventory II (BDI-II), and Global Assessment of Functioning Scale, (GAF) on the beginning, at the end of treatment (after 12 months), and 6 months after treatment.

At the beginning of treatment in first group (patients under psychotherapy and psychopharmacotherapy) GAF shoved negative correlation in comparison with BDI (-0,62). In second group (patients cured with only psycho pharmacotherapy) GAF shoved negative correlation in comparison with, BDI (-0,66),. After one year of CBT and psycho pharmacotherapy mean value of improvements in first group were: BDI 37,4 ± 7,5, GAF 23,9, and GAF still highly correlated with BDI (-62). In second group mean value of improvements were: BDI 31,7 ± 10,8, GAF 13,2 ± 5,4 (significantly lower than in first group; p< 0,0001), but GAF still highly correlated with BDI (-69). Six months after psychotherapy all parameters in first group were significantly worsen:

In patients treated with combined cognitive-behavioral psychotherapy and pharmacotherapy there is a significant improvement of depression and functioning in relation to patients treated only with pharmacotherapy. Keywords: cogntive-behavioural psychotherapy, psychopharmacotherapy, anxiety, depression, hopelessness.

Patients with dual diagnosis, major depressive disorders and cluster B personality disorders, must be carefully monitored because of the refractory cases high incidence to either psychotherapeutic or pharmacologic therapy, when applied alone. In histrionic patients the the emphasis during psychotherapy must be on the collaborative therapeutic relationship and on the goals operationalizing process.

We prospectively evaluated 12 patients, female, mean age 35.5 years, diagnosed with major depressive disorder and histrionic personality disorder (according to DSM IV TR criteria) treated with antidepressants (fluoxetine 30 mg/day, n=5, paroxetine 30 mg/day, n=4, mirtazapine 45 mg/day, n=3) and weekly sessions of cognitive-behavioural therapy, for 6 months. We used Beck Depression Inventory (BDI)- 21 items form initially and every two weeks until the endpoint. The Global Assessment of Functioning (GAF) was used also, with the same frequency. The specific schemas of histrionic personality disorder had been addressed simultaneously with depressive specific dysfunctional beliefs.

There were 4 cases of discontinuation after a mean duration of 10.6 weeks. These patients presented at 6 months a higher score on BDI (+6.5) and a lower degree of social and professional level of functioning (-15 on GAF); a follow-up evaluation (after one year from baseline) observed more residual symptoms or recurrence of depression than patients that participated in all study sessions (mean BDI score 15.6vs.9.5, GAF 78vs.89, 2vs.0.5 depression episodes incidence).

Adressing dysfunctional schemas of histrionic personality disorder improves the long term prognosis in depressed patients with dual diagnosis.

One of the main goals of psychotherapy should be increasing the patient's quality of life. This purpose is of extreme importance in patients diagnosed with cancer that have to fight with anxiety, depression, social and occupational adjustment difficulties.

We included in a 3 months weekly sessions program of cognitive psychotherapy a number of 12 patients, 8 female and 4 male, mean age 52.4, diagnosed with malignant tumors (lung cancer 2 cases, ovarian cancer 2 cases and stomach cancer one case). The assessment included Cancer Coping Questionnaire (CCQ)- 21 items version, Hamilton Rating Scale for Anxiety (HAM-A), Beck Depression Inventory-21 items (BDI), Global Assessment of Functioning (GAF) and the dysfunctional beliefs monitoring throughout all the 3 months of this trial. Therapy focused on working with “realistic” negative automatic thoughts, attention switch on resources instead of loses, stimulating emotional expression of frustration, anger or blaming, involving in planning activities and isolation prevention. Inclusion criteria: CCQ baseline value under 42, either anxiety or depressive symptoms, or both, that interfere with daily functioning (HAM-A score over 20, BDI over 15, GAF under 75).

All patients that reach the endpoint (two drop-outs recorded) improved their cognitive approach to cancer because their coping methods improved and dysfunctional beliefs decreased in frequency and strength. CCQ score improved with 34.5%, HAM-A decreased with 15+/-2.5%, BDI decreased with 18+/-1.5% and GAF increased with 10+/-1.1% at endpoint.

Cognitive therapy is an usefull approach in oncologic patients, helping them to focus on resources, activity and relational support.

The aim of this study is to determine prevalence of tobacco-smoking and nicotine dependence among psychiatric patients; peculiarities of tobacco smoking and addiction according to diagnosis.

A population of 198 psychiatric inpatients and 211 psychiatric outpatient were surveyed using a detailed smoking self-questionnaire for smoking habits, Fagerström Questionnaire, questionnaire for estimating type of smoking behavior and HAD (Hospital Anxiety and Depression) scale.

Smoking prevalence was higher among psychiatric patients than in general population. Correlations between level of nicotine dependence, types of smoking behavior and ICD-10 diagnoses were estimated. A significant proportion of psychiatric patients recognize that smoking is a problem, want to quit and would like attend smoking cessation therapy.

It was found that a majority of the patients wished to quit smoking, and that they would like to participate in a smoking cessation course.

There are many reasons why mentally ill persons may find it more difficult to quit smoking than mentally healthy smokers. Among the important reasons are: severe nicotine dependence, neurological vulnerability, self-medication with nicotine, lack of support from the surroundings, use of ineffective smoking cessation methods.

The aim of this study is to determine prevalence of tobacco-smoking and nicotine dependence among psychiatric patients; peculiarities of tobacco smoking and addiction according to diagnosis.

A population of 198 psychiatric inpatients were surveyed using a detailed smoking self-questionnaire for smoking habits, Fagerström Questionnaire, questionnaire for estimating type of smoking behavior and HAD (Hospital Anxiety and Depression) scale.

Smoking prevalence was higher among psychiatric patients than in general population. Correlations between level of nicotine dependence, types of smoking behavior and ICD-10 diagnoses were estimated. A significant proportion of psychiatric inpatients recognize that smoking is a problem, want to quit and would like attend smoking cessation therapy.

It was found that a majority of the patients wished to quit smoking, and that they would like to participate in a smoking cessation course.

There are many reasons why mentally ill persons may find it more difficult to quit smoking than mentally healthy smokers. Among the important reasons are: severe nicotine dependence, neurological vulnerability, self-medication with nicotine, lack of support from the surroundings, use of ineffective smoking cessation methods.