RESUMEN
This paper reports the main findings of a large-scale study of subsidized psychoanalysis and long-term psychotherapy. More than 400 people in various phases, before, during and after subsidized psychoanalysis or long-term psychodynamic psychotherapy, were followed up for a period of three years with personal interviews, questionnaires and official statistics. Our analyses revealed progressive improvement the longer patients were in treatment--impressively strong among patients in psychoanalysis--on self-rating measures of symptom distress and morale. Improvement, however, was equally weak in both groups on a self-rating measure of social relations. Dosage factors (treatment duration and session frequency in combination) partly accounted for the outcome differences between those referred to psychoanalysis and those referred to long-term psychotherapy. Attitudes and ideals among therapists and analysts concerning the goals and means of psychotherapy were also associated with patient outcome, although in rather complex ways. A significant part of the outcome differences between patients in psychoanalysis and in psychotherapy could be explained by the adoption, in a large group of therapists, of orthodox psychoanalytic attitudes that seemed to be counterproductive in the practice of psychotherapy but not in psychoanalysis. It is suggested that this effect may be a negative transfer of the psychoanalytic stance into psychotherapeutic practice and that this may be especially pronounced when the attitudes are not backed up by psychoanalytic training.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastornos Mentales/terapia , Terapia Psicoanalítica/métodos , Adulto , Humanos , Persona de Mediana Edad , Encuestas y Cuestionarios , Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: To assess the ability of the five-region biopsy technique compared with the traditional sextant biopsy technique to detect high-grade prostatic intraepithelial neoplasia (PIN) in patients with an abnormal digital rectal examination or elevated prostate-specific antigen, or both, by a retrospective study. METHODS: We conducted a retrospective review of 50 consecutive patients diagnosed with PIN at our institution from January 1 990 to May 1998. Of the 50 patients, 26 patients were diagnosed with high-grade PIN. The reasons for the initial prostate biopsy were elevated prostate-specific antigen in 15 patients, abnormal digital rectal examination in 1 patient, and combined abnormalities in 10 patients. These patients underwent transrectal ultrasound-guided needle biopsy of the prostate using the five-region biopsy technique. Biopsy findings from regions 1, 3, and 5 (additional five-region biopsies) were compared with those of regions 2 and 4 (traditional sextant biopsies). RESULTS: Of the 26 patients, PIN was detected in the sextant regions in only 14 patients (53%). However, by using the five-region biopsy technique, an additional 1 2 patients (47%) were diagnosed with PIN (P <0.05). Twenty-four patients underwent repeated five-region biopsies. Eight (33%) of the 24 patients were found to have prostate cancer. Of the eight patients with cancer, 5 of the cancers were found with the five-region biopsy technique. CONCLUSIONS: In this study, the five-region method of prostate biopsy significantly increased the diagnosis of PIN compared with the traditional sextant method of biopsy. Furthermore, 33% of patients diagnosed with high-grade PIN on the initial biopsies were found to have prostate cancer on subsequent five-region biopsies.