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Background: The aim of our study was to evaluate how sociodemographic factors, psychosocial adaptation to pregnancy and well-being levels are associated with the onset of preterm uterine contractions allowing symptomatic preterm labor. Methods: In a prospective case-control design, 51 consecutive women admitted for threatened preterm labor were enrolled. The patients received standard care. The day before discharge, once contractions had been stopped, the patients were administered 2 questionnaires: the Prenatal Self-Evaluation Questionnaire of Lederman and the Psychological Well-Being Scales. Controls were enrolled among asymptomatic, healthy women attending routine prenatal care. They were matched for parity and gestational age. Results: Gestational age at inclusion ranged from 25 to 34 weeks. Fourteen cases and 4 controls delivered preterm. Cases were less educated than controls, showed a lower acceptance of pregnancy and worse relationship with others, namely with the husband, compared to controls. They also displayed a reduced environmental mastery. Conclusion: Having a low education, poor relationship with others, including the husband, and impaired coping skills appeared to be independent risk factors for the development of symptomatic preterm labor in urbanized women.

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There is insufficient research on rating psychological well-being and distress in clinical populations. The aim of this study was to evaluate the differential characteristics of instruments assessing well-being and distress in 20 remitted patients with affective (mood and anxiety) disorders and 20 healthy control subjects matched for sociodemographical variables. Remitted patients displayed significantly higher levels of psychological distress - as measured by Paykel's Clinical Interview for Depression (CID), Van Pragg's Scale for Personality Disturbances and Kellner's Symptom Questionnaire (SQ) - and significantly less well-being - as measured by Ryff's Scales of Psychological Well-Being (PWB) and the SQ - than control subjects. The correlations between scales of psychological distress and well-being were found to be complex in both patients and controls. Psychotherapeutic treatment of residual symptomatology in patients disclosed a differential sensitivity of the scales to change. The results thus suggest that well-being cannot be equated to lack of distress (as implicitly endorsed by current psychiatric paradigms), and the need for a multidimensional assessment in stress medicine

Behavioural lifestyle interventions focused on diet and physical activity are a cornerstone for the treatment of obesity. However, their effects vary substantially across individuals in terms of magnitude and durability. Personalized approaches that target psychological well-being may be promising to facilitate healthy behaviours and sustained weight loss. This preliminary study aimed to explore whether the sequential combination of behavioural lifestyle intervention (BLI) and well-being therapy (WBT) may result in more favourable outcomes than BLI alone in promoting weight loss (primary outcome) and improving psychological well-being, distress, dietary behaviours and physical activity (secondary outcomes). A total of 83 patients with obesity were randomly assigned to BLI/WBT (N = 38) or BLI group (N = 45). The BLI group received a 12-week behavioural weight loss programme, whereas the BLI/WBT group received the same programme followed by an additional 4-week WBT, adapted for group interventions. Data were collected at pretreatment (baseline, T1), at the end of BLI/WBT (T2), at 6-month (T3) and 12-month (T4) follow-ups. There was a significant weight loss in both treatment groups at T2, T3 and T4. The BLI/WBT group showed greater improvements in depressive symptoms at T3 and T4, in autonomy at T2, in personal growth at T4 and in global well-being at T4 compared with BLI group. WBT yielded no additional effect on weight loss. However, the secondary outcomes indicate that WBT may have enduring effects that reduce vulnerability to psychological distress in patients with obesity. In order to confirm these preliminary findings and explore whether a more intensive and individualized WBT can foster sustained weight loss, future studies are needed.

Placebo effects are often attributed to clinical interactions and contextual factors that affect expectations of the patient about the treatment and result in symptom changes. The prevailing conceptualization consists of an undifferentiated placebo response that needs to be minimized in controlled investigations and maximized in clinical practice. However, treatment outcome is the cumulative result of the interaction of several classes of variables with a selected treatment: living conditions (housing, nutrition, work environment, social support), patient characteristics (age, sex, genetics, general health conditions, personality, well-being), illness features and previous therapeutic experience, self-management, and treatment setting (physician's attitude and attention, illness behavior). Such variables may be therapeutic or countertherapeutic, and are unlikely to be simply additive. In certain patients their interactive combination may lead to clinical improvement, whereas in other cases it may produce no effect, and, in a third group, it may lead to worsening of the condition. Maximizing patients' expectations does not necessarily result in sustained effects and, in due course, may actually lead to worsening of the condition (violation of expectations). In this paper, we outline a multifactorial conceptual model that may have implications for the design of clinical trials as well as for clinical practice, with special reference to psychopharmacology and psychotherapy. The effects of drug treatment may be potentiated by specific nonpharmacological treatment strategies, and this synergism may disclose significant differences against placebo. Medical outcomes may be unsatisfactory not because technical interventions are missing, but because our conceptual models and thinking are inadequate.

OBJECTIVE: number of randomized controlled trials in major depressive disorder have employed a sequential model, which consists of the use of pharmacotherapy in the acute phase and of psychotherapy in its residual phase. The aim of this review was to provide an updated meta-analysis of the efficacy of this approach in reducing the risk of relapse in major depressive disorder and to place these findings in the larger context of treatment selection. METHODS: Keyword searches were conducted in MEDLINE, EMBASE, PsycINFO, and Cochrane Library from inception of each database through October 2014. Randomized controlled trials examining the efficacy of the administration of psychotherapy after successful response to acute-phase pharmacotherapy in the treatment of adults with major depressive disorder were considered for inclusion in the meta-analysis. RESULTS: Thirteen high-quality studies with 728 patients in a sequential treatment arm and 682 in a control treatment arm were included. All studies involved cognitive-behavioral therapy (CBT). The pooled risk ratio for relapse/recurrence was 0.781 (95% confidence interval [CI]=0.671-0.909; number needed to treat=8), according to the random-effects model, suggesting a relative advantage in preventing relapse/recurrence compared with control conditions. A significant effect of CBT during continuation of antidepressant drugs compared with antidepressants alone or treatment as usual (risk ratio: 0.811; 95% CI=0.685-0.961; number needed to treat=10) was found. Patients randomly assigned to CBT who had antidepressants tapered and discontinued were significantly less likely to experience relapse/recurrence compared with those assigned to either clinical management or continuation of antidepressant medication (risk ratio: 0.674; 95% CI=0.482-0.943; number needed to treat=5). CONCLUSIONS:The sequential integration of CBT and pharmacotherapy is a viable strategy for preventing relapse in major depressive disorder. The current indications for the application of psychotherapy in major depressive disorder are discussed, with special reference to its integration with pharmacotherapy.

Background: Selective serotonin reuptake inhibitors (SSRI) are widely used in medical practice. They have been associated with a broad range of symptoms, whose clinical meaning has not been fully appreciated. Methods: The PRISMA guidelines were followed to conduct a systematic review of the literature. Titles, abstracts, and topics were searched using the following terms: ‘withdrawal symptoms' OR ‘withdrawal syndrome' OR ‘discontinuation syndrome' OR ‘discontinuation symptoms', AND ‘SSRI' OR ‘serotonin' OR ‘antidepressant' OR ‘paroxetine' OR ‘fluoxetine' OR ‘sertraline' OR ‘fluvoxamine' OR ‘citalopram' OR ‘escitalopram'. The electronic research literature databases included CINAHL, the Cochrane Library, PubMed and Web-of-Science from inception of each database to July 2014. Results: There were 15 randomized controlled studies, 4 open trials, 4 retrospective investigations, and 38 case reports. The prevalence of the syndrome was variable, and its estimation was hindered by a lack of case identification in many studies. Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse. Conclusions: Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs. The term ‘discontinuation syndrome' that is currently used minimizes the potential vulnerabilities induced by SSRI and should be replaced by ‘withdrawal syndrome'.

The potential growth of clinical psychology lie in its capacity to progress in emerging lines of research that have been developed. The first line is concerned with psychological assessment. A second line of research is concerned with psychobiologic exploration of clinical states. A third line of research is concerned with psychotherapy. These emerging trends of clinical psychology provide important opportunities for development.

The precipitating role of emotional stress in the development of congestive heart failure (CHF) is a long-standing clinical observation. We employed new clinimetric criteria for the assessment of allostatic overload (AO) in a sample of CHF patients, with regard to its associations with psychological distress and health status. Allostatic overload was assessed by a semi-structured interview based on clinimetric criteria in 70 consecutive outpatients with CHF. One observer-rated scale and two self-rating questionnaires for psychological distress were administered. Cardiac variables were also collected at intake. Twenty-three patients (32.9%) were classified as having AO according to clinimetric criteria. Significant differences were found with regard to gender, with women being more likely to report AO than men (23.5% versus 57.9%). Patients with AO presented significantly higher levels of psychological distress (based on scales administered) compared with those who did not. Among cardiac risk factors, hyperglycaemia was found to be significantly associated with the presence of AO. The use of the clinimetric criteria provides a global index for identifying distress that might adversely influence the course and progression of CHF. It may be of use in clinical practice, leading to therapeutic suggestions such as lifestyle modifications and psychotherapy to help patients deal with their difficulties.

and Paul McCartney in music. The book was so much ahead of its time when it was published that, when I was consulting it for my clinical activities in the early 1980s, it did not really seem as if it had been written a decade earlier. When I browse through it today, I realize it is still ahead of its time, forty years later. How is it possible? Was it science fiction or has psychiatry failed to make substantial progress?

Background: The staging method, whereby a disorder is characterized according to its seriousness, extension, development and features, is attracting increasing attention in clinical psychology and psychiatry. The aim of this systematic review was to critically summarize the tools that are available for reproducing and standardizing the clinical intuitions that are involved in a staging formulation. Methods: A comprehensive research was conducted on the MEDLINE, PsycINFO, EMBASE and Cochrane databases from inception to May 2012. The following search terms were used: ‘stage/staging’ AND ‘psychiatric disorder/mental disorder/schizophrenia/mood disorder/anxiety disorder/substance use disorder/eating disorder’. Results: A total of 78 studies were identified for inclusion in the review. We discussed studies addressing or related to the issue of staging in a number of mental disorders (schizophrenia, unipolar depression, bipolar disorder, panic disorder, substance use disorders, anorexia and bulimia nervosa). The literature indicates that disorders have a longitudinal development or a treatment history that can be categorized according to stages. We proposed staging formulations for the above-mentioned psychiatric disorders. Conclusion: Staging models offer innovative assessment tools for clinical psychologists and psychiatrists. Characterizing each stage of an illness demarcates major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis. A stage 0 to denote an at-risk condition does not appear to be warranted at the current state of research.

There have been major transformations in health-care needs in the past decades. Chronic disease is now the principal cause of disability, and the use of health services for patients with chronic diseases consumes almost 80 % of health expenditures. The exponential spending on preventive medication justified by the potential long-term benefits to a small segment of the population is now being challenged, whereas the benefits of modifying lifestyle by population-based measures are increasingly demonstrated and are in keeping with the biopsychosocial model. Medically unexplained symptoms occur in up to 30–40 % of medical patients and increase medical utilization and costs. The traditional medical specialties, based mostly on organ systems (e.g., cardiology, gastroenterology), appear to be more and more inadequate in dealing with symptoms and problems which cut across organ system subdivisions. The need for a holistic approach is underscored by the implementation of interdisciplinary services. The need to include consideration of functioning in daily life, productivity, performance of social roles, intellectual capacity, emotional stability, and well-being, has emerged as a crucial part of clinical investigation and patient care. These aspects have become particularly important in chronic diseases, where cure cannot take place and also extend over family caregivers of chronically ill patients and health providers.

Historically, mental health research has been dramatically weighted on the side of psychological dysfunction, and health has been equated with the absence of illness, rather than the presence of wellness. Ryff and Singer 1 suggested that the absence of well-being creates conditions of vulnerability to possible future adversities and that the route to enduring recovery lies not exclusively in alleviating the negative, but also in engendering the positive. Bringing the person out of negative functioning is one form of success, but facilitating progression toward the restoration of positive functioning is quite another. George Vaillant rightly points out to the relative contributions and cultural sensitivity of different models of positive mental health. However, the concept of mental health is inextricably linked to that of psychological well-being. A comprehensive model developed by C. Ryff 2 provides an integration of different viewpoints. It encompasses six inter-related psychological dimensions: positive evaluation of one’s self, a sense of continued growth and development, the belief that life is purposeful and meaningful, the possession of quality relations with others, the capacity to manage effectively one’s life, and a sense of self-determination. A number of clinical studies have yielded substantial support to this model. Assessment of psychological well-being using the Psychological Well-Being Scales 2 has disclosed that these dimensions are often impaired in patients with mood and anxiety disorders who remitted upon standard pharmacological or psychotherapeutic treatment 3. Lack of psychological well-being has been found to be a risk factor for depression 4. A specific psychotherapeutic strategy for increasing psychological well-being and resilience, the well-being therapy (WBT), based on Ryff’s conceptual model 2, has been developed and tested in a number of randomized controlled trials 3. The application of WBT, in addition to standard cognitive behavior therapy (CBT), to patients with recurrent depression who responded to drug treatment was found to yield a significantly lower relapse rate at a 6-year follow-up compared to clinical management (CM) 5. Further, the sequential combination of CBT and WBT has been found to induce a higher degree of remission, as shown by both distress and well-being scales, compared to CBT alone in generalized anxiety disorder, with advantages persisting at a 2-year follow-up 6. A recent randomized controlled trial in cyclothymia 7 has yielded additional insights. Sixty-two patients with DSM-IV cyclothymic disorder were randomly assigned to CBT/WBT or CM. At post-treatment, significant differences were found on all outcome measures, with greater improvements after treatment in the CBT/WBT group compared to the CM group. Therapeutic gains were maintained at 1- and 2-year follow-ups. These results imply that a sequential combination of CBT and WBT, addressing both polarities of mood swings and comorbid anxiety, yields significant and persistent benefits in cyclothymic disorder. This investigation suggests that it is the balance among the various psychological dimensions that matters the most. Ryff and Singer 1 emphasize Aristotle’s admonishment to seek “what is intermediate”, avoiding excess and extremes. The pursuit of well-being may in fact be so solipsistic and individualistic to leave no room for human connection and the social good; or it can be so focused on responsibilities and duties outside the self that personal talents and capacities are neither recognized nor developed. Ryff and Singer 1 thus value the concept of balance, both as a theoretical guide and as an empirical reality that scholars of well-being need to appreciate. The application of Ryff’s model 2, both in terms of assessment and treatment, thus suggests that optimally balanced well-being differs from person to person: there is no single right way to be well (people have differing combinations of strengths and vulnerabilities and one has to work with what is available). The cross-cultural implications of the model are thus considerable and should integrate Vaillant’s framework. Further, Ryff 2 emphasizes that personality assets should be combined with contextual variables (work, family life, social ties and socioeconomic conditions). The central message is that personality, well-being and distress come together in different ways for different people. G. Engel 8 defined etiological factors as “factors which either place a burden on or limit the capacity of systems concerned with growth, development or adaptation”. Positive mental health should aim to address these etiological factors. Assessment of well-being and pursuit of well-being enhancing strategies such as WBT should be incorporated in clinical evaluation and therapeutic plans 9.