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rkharsh

Effect of CBT/PSYCHOTHERAPY ON COMPLIANCE

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dear friends,

i would appreciate if u could help me in search for Evidence Based Medicine ...PICO

Question: The effect of Psychotherapy on compliance for the depressed clients who are on antidepressants?

How would i go for search for EBM?

Thanks ::)

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Not sure if the KA24 example might help (Knowledge Access 24 hours a day; a collection of bibliographic databases with links to some full text journal articles)?

http://www.londonlinks.ac.uk/working_groups/clist_trainers_toolkit.htm >> Training guides: >> Introduction to KA24 >> Download and open file clist_ka24_introduction_dialog_datastar.doc or clist_ka24_introduction_dialog_datastar.pdf >> 2. Planning your search and constructing a search strategy >>page 11 >>

Step Two

> Focusing your search question

Being focused about what you are looking for is important because of the potential volume of information you could retrieve; because it makes your search more precise, and because it helps you assess the relevance of your search results.

a) It is often helpful to think about what you are looking for in terms of a question.  It is also important that the question clearly specifies the particular problem you are concerned with.

For example:

1. Is psychotherapy an effective treatment for eating disorders?

2. Is psychotherapy effective in treating adults with anorexia?

3. Is psychotherapy effective in treating adults with anorexia in the outpatient setting?

Notice how the question has become more specific.  The first question was very general.  The second narrows the search to anorexia nervosa and specifies adults, and the third also brings a particular care setting into the equation.

B) To help you think about all the elements of your search there is a tool which you may find helpful called PICO, particularly if you are looking at therapeutic interventions.  PICO stands for

Patient or Population or Problem

Intervention

Comparison

Outcome

Patient/population/problem

This covers:

  • Details about the disease or condition – what is it?; how advanced is it?
  • Information about the population group, eg their age or gender or race
  • The care setting – are the patients at home, in- or out-patients?

    What is happening to the patient, when, how and how often?
    • The type of intervention – eg a test, drug therapy or surgical procedure
    • Frequency (eg daily) or level of the intervention (eg dosage)
    • Stage of intervention – is it a preventative technique or treatment at an advanced stage of disease?
    • Delivery of intervention – where does it happen?; is anyone else involved?

    Comparison

    This is only applicable if two or more interventions are being compared, for example as part of a controlled trial.  Alternative interventions would be a placebo, current standard practice or another specific intervention.

    Outcome

    What is being measured?

  • Clinical outcomes might be a reduction in mortality or adverse effects
  • A health care provider might be measuring cost-effectiveness
  • The outcomes might be patient–centred, eg quality of life or satisfaction

    PICO can be a helpful guide when planning a search but should not dictate it.



    Step Three

    ...

    B)

    ...

    In the example 'Is psychotherapy effective in treating teenagers with anorexia in the outpatient setting?' the search terms and limits would be:

    Search terms[TAB][TAB][TAB][TAB]Limits

    Anorexia[TAB][TAB][TAB][TAB][TAB]Adolescents
    Psychotherapy
    Outpatient department

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BMC Psychiatry. 2007; 7: 18. (Published online 2007 May 14. doi: 10.1186/1471-244X-7-18).

Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1894782

BACKGROUND

... Nevertheless, the use of benzodiazepines has been associated with sedation, reduced coordination, cognitive impairments, increased accident proneness and development of dependence, and it has been reported that a rebound of panic attacks can occur during taper.

CONCLUSION

... Based on this limited evidence, exposure therapy may be recommended for patients with agoraphobia who have access to appropriate resources. Benzodiazepine alone is not to be recommended for those in such a situation. It seems possible that combined therapy is superior to exposure therapy alone in the acute treatment, but after the acute treatment is terminated, this trend may be reversed.

Norio Watanabe, Rachel Churchill, and Toshi A Furukawa [COMPETING INTERESTS - TAF has received several research grants and fees for speaking from a pharmaceutical company, which markets a benzodiazepine (ethyl loflazepate). RC and NW have no conflict of interest to declare].

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Arch Gen Psychiatry. Author manuscript; available in PMC 2006 June 9. (Published in final edited form as: Arch Gen Psychiatry. 2000 November; 57(11): 1084).

Treatment of Atypical Depression With Cognitive Therapy or Phenelzine

A Double-blind, Placebo-Controlled Trial

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1475805

ADVERSE EFFECTS

... Weakness or fatigue, drowsiness or sedation, insomnia, dry mouth, dizziness, and increased appetite were significantly more likely to be reported by patients treated with phenelzine than those treated with placebo ([ch967]21 test; P<.01, Bonferroni correction). More patients treated with phenelzine reported marked side effects (33/36 [92%]) than did patients treated with placebo (19/36 [53%]).

COMMENT

... In conclusion, the results of this randomized controlled clinical trial suggest that cognitive therapy, when provided twice weekly by experienced and competent therapists, reduces symptoms more than placebo and as much as phenelzine in outpatients diagnosed as having MDD and atypical features. Acute-phase cognitive therapy appears to be a safe and effective alternative to standard acute-phase treatment with MAOIs for outpatients with atypical depression.

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BMC Psychiatry. 2007; 7: 18. (Published online 2007 May 14. doi: 10.1186/1471-244X-7-18).

Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review

...

Norio Watanabe, Rachel Churchill, and Toshi A Furukawa [COMPETING INTERESTS - TAF has received several research grants and fees for speaking from a pharmaceutical company, which markets a benzodiazepine (ethyl loflazepate). RC and NW have no conflict of interest to declare].

A bit of further information on benzodiazepine addiction can be found at this link:

http://www.soterianetwork.org/index.php?option=com_joomlaboard&Itemid=32&func=view&id=32&catid=3

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dear friends,

i would appreciate if u could help me in search for Evidence Based Medicine ...PICO

Question: The effect of Psychotherapy on compliance for the depressed clients who are on antidepressants?

How would i go for search for EBM?

Thanks ::)

surely the PICO format (Population Intervention Comparison Outcome) question would be more like...

For people with depression who are prescribed antidepressants, is (insert specific type of) psychotherapy when compared to treatment as usual associated with better adherence to treatment?

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