RESUMEN
Predictors of compliance with psychosocial treatment were examined in a clinical sample of 150 patients seeking outpatient treatment for alcohol problems. Predictor variables were as follows: a) patient characteristics at the beginning of treatment and b) treatment characteristics of a matching model developed from the Conceptual System Theory. This model was based on the conceptual level of patients and therapists, and on the structure of the treatment. Using logistic regression analysis, we identified predictors of compliance in the motivation phase (first four consultations) and the active treatment phase (the remainder of the agreed treatment period of 12 months). Predictors of compliance in the motivation phase were a) therapists with a high conceptual level, characterized by an attitude toward the patients of empathetic and reflective listening; b) disulfiram; and c) psychopharmacological treatment. The only patient-related predictors of compliance in the active treatment phase were a) age below 40 and b) the presence of family and social problems, both factors predicting noncompliance. The only treatment-related predictor variables were a) the matching of patients with the structure of treatment and b) disulfiram during the first month of treatment, both factors predicting compliance. Two years after the beginning of treatment, those patients who completed the motivation phase as well as the active treatment phase had a significantly better psychosocial function than the noncompliant patients.
Asunto(s)
Alcoholismo/terapia , Atención Ambulatoria , Cooperación del Paciente , Adulto , Factores de Edad , Disuasivos de Alcohol/uso terapéutico , Alcoholismo/tratamiento farmacológico , Alcoholismo/psicología , Actitud del Personal de Salud , Actitud Frente a la Salud , Estudios de Casos y Controles , Disulfiram/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Modelos Teóricos , Motivación , Oportunidad Relativa , Cooperación del Paciente/estadística & datos numéricos , Probabilidad , Relaciones Profesional-Paciente , Psicoterapia , Análisis de Regresión , Ajuste Social , Resultado del TratamientoRESUMEN
In chronic medical disorders, patient compliance is very poor and often less than 50%. The purpose of this investigation was to determine whether the proper matching of patient, treatment, and therapist would improve patient compliance in the outpatient treatment of alcoholics. We randomly placed 119 alcoholics who had commenced protracted outpatient treatment for alcoholism in either low or high structured treatments. These 119 patients were offered 12 months of individual treatment. Interruption of this treatment was recorded as noncompliance. The treatment courses were expressed in survival curves. The consequence of compliance for long-term prognosis was described by means of the Addiction Severity Index. The form of treatment in itself had no importance for compliance. However, correct matching of a patient and a treatment structure resulted in a compliance rate of 63% as opposed to 38% compliance among mismatched patients. Twenty-four months after the initiation of treatment, patients in the compliance group had a significantly higher level of function than those in the noncompliance group. Our investigation of alcoholics involved in outpatient treatment shows that the correct matching of patients and treatment structure improves compliance and long-term prognosis. It is hoped that the present investigation will generate interest in future research on correct matching to gain improved compliance in patients with a chronic medical disorder.
Asunto(s)
Alcoholismo/terapia , Atención Ambulatoria , Protocolos Clínicos , Cooperación del Paciente , Selección de Paciente , Adaptación Psicológica , Adulto , Alcoholismo/diagnóstico , Terapia Conductista , Protocolos Clínicos/normas , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Masculino , Pacientes Desistentes del Tratamiento , Relaciones Profesional-Paciente , Pronóstico , Terapia Psicoanalítica , Índice de Severidad de la Enfermedad , Ajuste Social , Resultado del TratamientoRESUMEN
The present study covers 130 consecutive patients referred to the two outpatient clinics for alcoholism in Odense over a ten-month period from January to October 1993. The aim of the study was to describe the process of treatment over 12 months and assess the condition of the patients 12 months after the admission for treatment. All patients were assessed by means of the Addiction Severity Index at admission and after 12 months. While female alcoholics typically had psychiatric complaints, the drinking pattern was, however, alike for both sexes. Patients who themselves terminated their treatment had a significantly worse drinking pattern than those who completed treatment. Twelve months after the admission there was a significant decrease in the alcohol abuse and an improvement in psycho-social function for both sexes.
Asunto(s)
Alcoholismo/terapia , Adulto , Alcoholismo/diagnóstico , Alcoholismo/psicología , Atención Ambulatoria , Estudios de Cohortes , Dinamarca , Femenino , Humanos , Masculino , Estudios Prospectivos , Factores SocioeconómicosAsunto(s)
Trastorno Depresivo/tratamiento farmacológico , Imipramina/uso terapéutico , Isoquinolinas/uso terapéutico , Nomifensina/uso terapéutico , Adolescente , Adulto , Ensayos Clínicos como Asunto , Método Doble Ciego , Femenino , Humanos , Imipramina/efectos adversos , Masculino , Persona de Mediana Edad , Nomifensina/efectos adversos , Escalas de Valoración PsiquiátricaRESUMEN
1 Addition of lithium carbonate (55 mmol/kg dry wt.) to the diet of rats for 4 days resulted in ratios between lithium in the brain and serum and between the cerebrospinal fluid (CSF) and serum of approx. 1 and 0.4, respectively. The relationships between the concentrations were linear. 2 After single intraperitoneal injections of lithium chloride (5 mmol/kg body wt.) the concentration of lithium in the CSF was greater than that of the brain for 2 h. 3 Repeated subcutaneous injections of lithium chloride (0.9 mmol/kg body wt.) resulted in steady state ratios corresponding to those observed when lithium was given in the diet. The rate of elimination from the CSF was intermediate between that of the serum and cerebral tissue until a new equilibrium was reached after approx. 24 h. At that time the ratios between lithium in the brain and serum, and in the CSF and serum were increased to approx. 5 and 0.8, respectively. 4 These results are consistent with passive transfer kinetics of lithium in the CSF and elimination of lithium from the cerebral tissue via the CSF. 5 The results may explain some of the phenomena observed in patients during intoxication with lithium.