Evaluation of psychodynamic psychotherapy in a community mental health center.

This study describes an evaluation of the effectiveness of psychodynamic psychotherapy provided in an outpatient community mental health clinic. The study used a single group pretest-posttest design involving 78 clients. Clinical outcomes included overall psychosocial functioning and quality of life, level of subjective distress, interpersonal functioning and role functioning, measured by the Outcome Questionnaire (Lambert, Hansen, Umpress, Lunnen Okilshi, & Burlingame, 2000). Clients showed statistically significant improvement from pretest (first sessions) to completion of treatment in overall functioning, and quality of life, level of subjective distress, interpersonal functioning and role functioning. Eighty-five percent of clients made statistically and clinically significant change. Calculation of effect sizes for each outcome found moderate to strong change effects ranging from d = .4 to .9. The study illustrates a method of intervention research that therapists and agencies can use to integrate practical evaluation methods into their clinical services in order to improve mental health service to clients, to demonstrate the effectiveness of interventions, and to provide data to support coverage for needed services for clients.

An assessment of emotional pain among subjects with chronic dermatological problems in Lagos, Nigeria.

BACKGROUND: In dermatology, it is known that there is a significant co-morbidity between dermatological disorders and psychological complications, and it has been estimated that in at least one-third of patients with skin diseases, their effective management involves consideration of associated emotional factors. In Africa, particularly Nigeria, despite the prevalent dermatological disorders with their possible attendant mental health complications, little or no work has been done in the field of psycho-dermatology, hence the rationale for this study. METHODS: A prospective study was carried out in the dermatology/venerology clinic of Lagos University Teaching Hospital (LUTH). Ethical clearance and consent were obtained to conduct the study. The subjects were selected by simple random sampling from adult patients that have had their dermatological disorders for at least six months before presentation in the clinic. Those with other co-existing chronic medical illness such as hypertension, diabetes, or haemoglobinopathy were excluded from the study. Controls were obtained to match for age and sex from apparently healthy workers in a nearby general hospital. Each subject was evaluated with a questionnaire to obtain necessary socio-demographic data: Psychache scale (PAS), and subscales C, D, and J of Symptom Check List (SCL-90). The data generated was analyzed to obtain means, and t-test was used to compare the means; p = 0.05 was taken as being significant. The analyses were done using SPSS version 10. RESULTS: Eighty subjects with dermatological disorders, and of equal sex distribution, were evaluated, with mean age of 33 +/- 12.1 years. Equal number of controls matched for sex and mean age of 34.6 +/- 7.3 years were also evaluated. Among the subjects, 16.3% had Acne, followed by Urticaria (13.8%), Vitiligo (12.5%), Tinea (11.3%), Hansen's disease (5%), and others (41.1%). From assessment with PAS and SCL subscales, the mean scores by the subjects were much higher than those of the controls and in each group the males scored slightly higher than their female counterparts. On assessment with PAS, the subjects had much higher mean score of 28.94 +/- 12.61 and the controls: 18.92 +/- 7.1 with "t" of 6.19*; and the difference was statistically significant at p < 0.05 and critical "t" of 1.66. On SCL; subscale C, the mean scores for the subjects and controls were: 7.89 +/- 7.69 and 5.02 +/- 5.23 respectively and the difference was statistically significant with "t" of 2.75*. For subscale D, the mean score by the subjects was 11.09 +/- 10.56, and the controls had 4.84 +/- 6.08; and statistically significant difference with "t" of 4.59*. On subscale J, the subjects' mean score was 4.68 +/- 5.44, the controls: 1.98 +/- 3.19 with statistically significant "t" of 3.83*. CONCLUSIONS: The results showed that subjects with dermatological disorders suffered from significant emotional pain when compared to the healthy controls; the males had higher mean scores on PAS and SCL subscales, hence more likely to suffer emotional pain than their female counterparts. Finally, the need to have consultation-liaison psychiatry in the dermatology facilities in Nigeria was emphasized.