Primary Care, Health-Behavior Groups.

Due to the increased physical, emotional, and financial burden of chronic health conditions on patients and the larger medical community, efforts have intensified to provide health-behavior focused group therapy in primary care settings. The goal of these groups is to increase access for patients who may be hesitant to engage in more traditional mental health services due to stigma, and to reduce medical costs and improve overall emotional and physical health of patients with chronic conditions. Groups are focused on providing patients with the information and tools they need to understand and improve their conditions. Success is measured by increase in knowledge and behavioral action in group members. Interventions provided in primary care are brief, solution-focused, and contextually relevant. A skilled primary care clinician leading a health-behavior group will unify participants around common themes and foster focus on the health-related topic while adjusting to the their contextual needs.

Everyday problems with executive dysfunction and impulsivity in adults recovering from methamphetamine addiction.

OBJECTIVES: Compared with non-addicted controls (CTLs), adults in remission from methamphetamine addiction (MA-REM) evidence impairments on objective measures of executive functioning and impulsivity. METHODS: To evaluate the impact of these impairments in MA-REM adults, demographically matched groups (MA-REM, n=30; CTLs, n=24) completed objective and self-report measures of executive functioning and impulsivity. RESULTS: MA-REM adults demonstrated significantly (p < 0.050) greater objective and subjective problems with executive functioning and impulsivity. CONCLUSIONS: These results suggest that adults in MA-REM are aware of their deficits and that these deficits have significant impact in everyday life.

A longitudinal study evaluating the effects of interferon-alpha therapy on cognitive and psychiatric function in adults with chronic hepatitis C.

OBJECTIVE: To prospectively evaluate for changes in objective cognitive performance (attention, memory, and executive function) and psychiatric symptom severity (depression, anxiety, fatigue, and pain) in patients before, during and after interferon-alpha based therapy (IFN) for chronic hepatitis C virus infection (HCV). METHODS: 33 HCV+ adults were evaluated two months before IFN initiation (baseline), three months into IFN, and six months following IFN termination (IFN+ Group). 31 HCV+ adults who did not undergo IFN therapy were evaluated at baseline and six months later (IFN- Group). At each evaluation, participants completed the Neuropsychological Assessment Battery (NAB) Attention, Memory and Executive Functions Modules, the Beck Depression Inventory, Second Edition (BDI), Generalized Anxiety Disorder Inventory (GADI), Fatigue Severity Scale (FSS), and Brief Pain Inventory (BPI). RESULTS: Compared with the IFN- Group, the IFN+ Group experienced significantly (p<0.050) increased symptoms of depression, anxiety, fatigue and pain during IFN therapy relative to baseline. In the IFN+ Group, psychiatric symptoms generally returned to baseline levels following IFN termination. Sustained viral response was associated with significantly lower depression and fatigue. No significant changes in cognitive performance were observed. CONCLUSIONS: During IFN, patients with HCV evidence significantly increased psychiatric symptoms, including symptoms of depression, anxiety, fatigue and pain. These psychiatric symptoms are generally short-term and remit following IFN termination, with increased benefit if viral clearance is achieved. However, IFN is not associated with significant declines in objective cognitive performance during or following IFN.

The importance of group cohesion in inpatient treatment of combat-related PTSD.

Post-traumatic stress disorder (PTSD) is the most widespread mental illness resulting from exposure to combat, necessitating an increase in the provision of group therapy. This pilot study examined the efficacy of, and treatment outcome predictors associated with, group inpatient treatment of combat-related PTSD. Participants included 38 active duty military personnel deployed during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), diagnosed with PTSD, and consecutive admissions to an inpatient PTSD treatment facility. A paired samples t-test revealed significant change in symptom severity and global functioning between pre- and post-treatment. Multiple regression analyses supported the predictive utility of baseline symptomatology and group cohesion (> 50% of the variance in treatment outcome), highlighting the importance of group cohesion in the efficacy of group treatment for combat-related PTSD.