Psychodynamic psychotherapy lasting for at least a year is effective and superior to shorter-term therapy for patients with complex mental disorders such as personality and chronic mental disorders, according to a meta-analysis published in the October 1 issue of JAMA.

Evidence indicates that short-term psychodynamic psychotherapy is insufficient for a considerable proportion of patients with complex mental disorders, i.e., patients with multiple or chronic mental disorders or personality disorders. Some studies suggest that long-term psychodynamic psychotherapy (LTPP) may be helpful for these patients, according to background information in the article. LTPP is therapy in which emphasis is placed on more interpretive or supportive interventions, depending on the patient's needs, and that involves careful attention to the therapist-patient interaction.

Falk Leichsenring, D.Sc., of the University of Giessen, Germany, and Sven Rabung, Ph.D., of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany, conducted a meta-analysis to examine the effectiveness of LTPP (lasting for at least a year, or 50 sessions) and whether it is superior to shorter psychotherapeutic treatments for complex mental disorders, including personality disorders, chronic mental disorders (defined as lasting at least a year) and multiple mental disorders. The researchers identified and included 23 studies for the meta-analysis (11 randomized controlled trials and 12 observational studies), involving a total of 1,053 patients receiving LTPP.

The authors found: "In this meta-analysis, LTPP was significantly superior to shorter-term methods of psychotherapy with regard to overall outcome, target problems, and personality functioning. Long-term psychodynamic psychotherapy yielded large and stable effect sizes in the treatment of patients with personality disorders, multiple mental disorders, and chronic mental disorders. The effect sizes for overall outcome increased significantly between end of therapy and follow-up."

With regard to overall effectiveness, analysis indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96 percent of the patients in the comparison groups. The authors add that further research should evaluate the cost-effectiveness of LTPP.

An analysis of news media coverage of medical studies indicates that news articles often fail to report pharmaceutical company funding and frequently refer to medications by their brand names, both potential sources of bias, according to a study in the October 1 issue of JAMA.

New articles represent an important source of medical information for many patients, and even some physicians. "An increasingly recognized source of commercial bias in medical research is the funding of studies by companies with a financial interest in the results," the authors write. Little is known about how frequently news articles report the funding sources of the medical research they report on, or how frequently news articles use brand medication names instead of generic names, which could create commercial bias.

Michael Hochman, M.D., of the Cambridge Health Alliance and Harvard Medical School, Cambridge, Mass., and colleagues reviewed U.S. news articles from newspaper and online sources about pharmaceutical-funded medication studies to determine how frequently and prominently they indicate the funding source and how often they refer to medications by their brand vs. generic names. The studies were published in five major general medical journals (JAMA, New England Journal of Medicine, Lancet, Archives of Internal Medicine and the Annals of Internal Medicine). The researchers also surveyed editors at the 100 most widely circulated newspapers in the U.S. about their publications' practices on the reporting of company funding and the use of generic medication names.

The authors identified 306 news articles, of which 175 were from newspapers and 131 were from online sources. Among the 306 news articles about company-funded medication studies, the funding source for the studies was not reported in 42 percent of the articles. There was no significant difference in nonreporting rates between articles obtained from newspaper and online sources. Of the 306 news articles, 277 concerned medications with both generic and brand names. Among these 277 articles, 38 percent used only brand names and 67 percent used brand names in at least half of the medication references.

The survey of newspaper editors found that 88 percent indicated that his/her publication often or always reported company funding in articles about medical research, and that 77 percent reported that they often or always referred to medications by the generic names in articles about medical research. Three percent of editors indicated that their publication had a written policy stating that company funding should be reported in articles about medical research, while the editor at two percent of newspapers responded that his/her publication had a written policy stating that medications should be referred to predominantly by their generic names.

However, the editors' perceptions diverged from their publications' actual performances. A total of 104 newspaper articles were analyzed from publications for which editors reported always identifying company funding. Of these articles, 45 percent failed to cite company funding. Additionally, a total of 75 newspaper articles were analyzed from publications for which the editors reported always using generic names. Of these articles, 76 percent used brand names in at least half of the medication references.

"Our findings raise several concerns. For patients and physicians to evaluate new research findings, it is important that they know how the research was funded so they can assess whether commercial biases may have affected the results. Additionally, the use of generic medication names by the news media is preferable so that physicians and patients learn to refer to medications by their generic names, a practice that is likely to reduce medication errors and may decrease unnecessary health care costs," the authors write.