Applicabilité des thérapies comportementales et cognitives en psychiatrie de liaison (Applicability of behavioral and cognitive therapies by consultation-liaison psychiatry)


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Article: article from journal or magazin.
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Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Applicabilité des thérapies comportementales et cognitives en psychiatrie de liaison (Applicability of behavioral and cognitive therapies by consultation-liaison psychiatry)
Journal de thérapie comportementale et cognitive
Maccaferri Giorgio Enrico, Calamand Doris
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Objective. —Cognitive-behavioral therapy (CBT) is a psychotherapy proven to be effectivein the treatment of numerous psychological disorders. A specific psychiatric subspecialty,consultation—liaison (C-L) psychiatry, is used to detect and treat psychological comorbidities ingeneral hospitalized patients. The practice of psychotherapy by the psychiatric C-L team offerscertain advantages, but may also be faced with limitations. In this context, our research wasfocused on the current use of CBT by C-L psychiatry, and its effectiveness.
Method. — Articles were found through English databases, such as PubMed (Medline), Science-Direct, and PsychINFO. Moreover, they were selected based on precise criteria: recent date ofpublication, journal impact factor, written in English or French, good quality methodologicalcriteria and original subject matter.
Results. — Five articles were retained. The first one was a review of somatic symptoms in C-L psychiatry setting (Grover and Kate, 2013). It emphasized the role of C-L psychiatry in thediagnosis and management of medically unexplained symptoms (MUS), as well as teaching withan internist. The use of CBT reduced the severity of complaints, chronic pain, chronic fatiguesyndrome (CFS), and number of hospital visits. The second article assessed the treatment ofMUS with CBT (Ehlert et al., 1999), and observed a decrease in somatic complaints, depressivesymptoms (NS), and increased motivation for psychotherapy. Three research reports were alsoretained on the treatment of CFS, or human immunodeficiency virus (HIV)-infected patients.The use of CBT in CFS tended to lead to a reduction in the frequency of symptoms, a decreaseof functional and social damage, and a reduction in hospital visits (Akagi et al., 2001). Twoother studies revealed that the treatment of HIV-infected patients with CBT by C-L psychiatryimproved depressive and anxious symptoms (Blanch et al., 2002), and enhanced psychosocialadjustment to HIV infection (Rousaud et al., 2007).
Discussion. —There are few studies in scientific literature on the use of CBT with patientswith somatic disorders, but not specifically by the psychiatric C-L team. Due to the very lownumber of publications on this topic, interpretability of results must be considered as the mainlimitation of this review. Nevertheless, the exposed results are encouraging, in particular inthe treatment of some disorders. Indeed, use of CBT by C-L psychiatry in the cases of MUS,CFS, and with HIV-infected patients leads to a significant clinical improvement. Through thesestudies, particular advantages in CBT use by the psychiatric C-L team were observed. Thismanagement involves multidisciplinarity, which may lead to a more global comprehension ofpatients. The importance of therapeutic alliance is also emphasized and is particularly efficientwhen elaborated as early as possible. Fundamental tools seem to be psychoeducation, self-observation, and preparation of a therapeutic contract. Other authors explain the advantagesof CBT use in hospitals (Rangaraj and Pelissolo, 2007). Crisis situations can facilitate the requestfor assistance; regular exchanges in CBT make therapeutic alliance easier, and facilitate quickresults. The hospital setting enables better observation of the patient, and frequent and variedtasks of exposure. On the other hand, limitations must be considered, such as follow-up whenthe patient leaves the hospital, or acute mental or somatic disorders which are contraindicationsin CBT use. Finally, it is necessary to emphasize the particular interest of third wave techniques,which are currently being developed. For example, an original study observed the benefits ofa treatment of HIV-infected patients with mindfulness, against CD4+ T lymphocytes decrease(Creswell et al., 2009).
Conclusion. — Despite their low impact, the results of our review are positive and encouraging.Indeed, if CBT use by the psychiatric C-L team reveals positive effects in cases of MUS, CFSand with HIV-infected patients, development of this practice in patients suffering from otherdisorders with psychosomatic components can be envisaged.
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04/01/2017 12:58
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20/08/2019 15:25
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