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Biomedical subjects

D A Shapiro

Publications and source records attributed to D A Shapiro.

At least 73 records · Page 4Linked to original sources
PubMed1987

Comparison of enalapril and thiazide diuretics in the elderly hypertensive patient.

One hundred seventy-four patients, 65 years of age or older, entered a double-blind, seven-center, 16-week, controlled study to compare the effects of enalapril and hydrochlorothiazide (HCTZ) in an elderly hypertensive population. Sixty-eight percent of the patients were men, 32% were women. Thirty-two percent of the patients had isolated systolic hypertension. Approximately 80% of the patients were white. After a 4-week placebo run-in period, patients with sitting diastolic BP (DBP) of 90-120 mm Hg or systolic BP (SBP) greater than or equal to 160 mg Hg and DBP less than 90 mm Hg (isolated systolic hypertension) were randomized to receive 10 mg of enalapril or 12.5 mg of HCTZ once daily. If after 4 weeks their BPs were not controlled (i.e., DBP greater than 85 mm Hg or SBP greater than 140 mm Hg), the dose of the drug was doubled. If after successive 4-week intervals, their BPs were still not controlled, the other drug was added to their regimen and this was then doubled. The initial mean BPs were 167/94 mm Hg in both groups. By the end of the monotherapy phase at 8 weeks, the mean BPs had fallen significantly (p less than or equal to 0.01) to 148/85 mm Hg in both groups. By 16 weeks, the mean BPs had again fallen similarly: in the enalapril group to 144/83 mm Hg, and in the HCTZ group to 145/83 mm Hg. Seventy-nine percent of the enalapril group and 85% of the HCTZ group had controlled BPs at this time (DBP less than or equal to 85 or SBP less than or equal to 140 mm Hg). White and nonwhite patients in both drug groups had similar falls in SBP and DBP both at the end of the monotherapy period and the overall study. The white patients experienced more rapid falls in BP with enalapril, the nonwhite patients with HCTZ. Three serious adverse experiences occurred in the enalapril group, none of which were considered likely to be due to the drug therapy. Overall, 49% of the enalapril group and 61% of the HCTZ group reported an adverse effect during the study (not significant). Laboratory adverse effects occurred 10% more frequently in the HCTZ group: enalapril, 22%; HCTZ, 32% (not significant); none was serious. Both drugs therefore appeared to be equally efficacious antihypertensive agents in these elderly patients.

Aged↗
PubMed1987

Prescriptive v. exploratory psychotherapy. Outcomes of the Sheffield Psychotherapy Project.

Prior research suggests that psychotherapeutic techniques which differ in their contents are quite similar in their outcomes. Outcome data are reported from a study designed to maximise sensitivity to technique effects on outcome in a clinically realistic setting, and to permit detailed analysis of the relations between content, immediate impact, and outcome of therapy. Forty professional and managerial workers with depression or anxiety received eight sessions of Prescriptive (cognitive/behavioural) and eight sessions of Exploratory (relationship-oriented) therapy in a crossover design, with each client seeing the same therapist throughout. Outcome was assessed by standard interview and questionnaire methods. The results favoured Prescriptive therapy, although this difference was of moderate extent. The outcome was largely unaffected by the order in which the two methods were offered.

Anxiety Disorders↗
PubMed1986

Social support and life events in working class women. Stress buffering or independent effects?

Several authors have suggested that social support reduces the risk of psychiatric disorder by providing a "buffer" against the adverse effects of stressful events. Others have proposed, in contrast, that social support is beneficial irrespective of life stress. We addressed this issue in a community survey of 193 working class mothers by measuring social support, threatening life events, psychiatric symptomatology, and psychological well-being via a detailed assessment combining a standardized interview and case-identification procedure with self-report questionnaires yielding continuous measures of distress and well-being. Subject selection minimized confounding between support and events. The effects of life stress and social support were found to be largely independent of one another, although detailed analysis suggested that the conclusions drawn in such studies are affected by the measures and statistics used.

Adult↗
PubMed1986

The case of the anxious executive: a study from the research clinic.

Most psychotherapists are neither active researchers nor consumers of research findings. Research approaches are needed which build a bridge between clinical realism and independent evidence, but which are applicable in National Health Service settings by clinicians lacking substantial research resources. A new method of clinical inquiry is described which combines measurement techniques developed in psychotherapy research with the therapist's session notes and client perceptions of helpful events in therapy. The method is illustrated by a case study which examines the content of helpful and unhelpful therapy sessions.

Adult↗
PubMed1985

Therapist response modes in prescriptive vs. exploratory psychotherapy.

Therapists' use of verbal response modes was compared in two forms of psychotherapy offered to 27 clients in a crossover design, where each client saw the same therapist throughout both treatments. This design isolated effects due to treatment techniques, specified in manuals followed by therapists, from those due to therapist or client differences. As predicted, therapists used more interpretation and exploration in an exploratory, relationship-oriented therapy, and asked more closed and open questions, and gave more general advisements and information, during a prescriptive, cognitive/behavioural therapy. The magnitude of the differences obtained ranged from a twofold to a sixfold difference in the percentages of each response mode offered in the two treatments. Also as predicted, therapists were more verbally active in the prescriptive therapy. These findings confirm previous research showing large differences in therapist contributions to different types of psychotherapy, demonstrating that these are not attributable to personal characteristics of therapists or clients.

Adult↗
PubMed1985

Alzheimer's disease: an emerging affliction of the aging population.

Alzheimer's disease is one of several brain disorders under the broad category of dementia. It is a gradually debilitating illness with no known cure. The first symptom is usually a slowly increasing memory loss, beginning between 40 and 65 years of age. As the disease progresses, the brain begins to deteriorate more rapidly, until it literally stops functioning. Of great concern is the projection that the number of people who will have Alzheimer's disease will double by the year 2030 because of the rising elderly population. Treating this population will escalate from the current estimate in excess of $2.5 billion to more than $6 billion. Speculation toward the increasing costs in money and workforce has led to an accelerated program in search of a cure or at least a symptomatic therapy for this condition. One of the most promising research leads is the striking connection between Alzheimer's disease and Down's syndrome and certain cancers: --Virtually 100% of patients with Down's syndrome who survive past age 35 show the same mental deterioration and identical brain changes seen in patients with Alzheimer's disease, including the presence of plaque and neurofibrillary tangles.--The presence of a high percentage of Down's syndrome among relatives of patients with Alzheimer's disease. --A high incidence of certain types of syndrome and among relatives of people who have Alzheimer's disease, such as leukemia, lymphomas, Hodgkin's disease, and immune system disorders. The key to the intercorrections between Alzheimer's disease and Down's syndrome seems to be a genetic component related to chromosome 21.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

The reliability of a modified helper behaviour rating system.

Response mode analysis seeks to classify the utterances of psychotherapists and others offering personal help, with respect to the interpersonal function of the utterance. It is applicable in diverse settings, and irrespective of the theoretical orientation of the helper or the researcher. The present study presents reliability data on a new such system of analysis, incorporating a novel mode, termed exploration. Intermediate between interpretation and reflection, this mode taps the theoretically important effort by the helper to construct a frame of reference shared with the client. Results indicated that the additional precision gained by the introduction of this new mode was not accompanied by any loss in reliability as compared with previous research. Overall, the system achieved acceptable reliability although the data cautioned against overinterpretation of the codings of individual response units.

Counseling↗
PubMed1983

Social and psychological determinants of recovery from industrial injuries.

Social and psychological determinants of the time taken to return to work were investigated in a sample of male manual workers referred to an accident clinic with mostly minor industrial injuries. Patients who showed a rapid recovery relative to the severity of their injuries were more often married, had greater job satisfaction, were less likely to be receiving an income supplement from their employers, and blamed themselves more for their accidents. The findings also indicated that a poor recovery rate could be expected when the accident was due to some environmental fault or failure, and the implications for studies of compensation are discussed.

Accidents, Occupational↗
PubMed1981

Comparative credibility of treatment rationales: three tests of expectancy theory.

Previous research has challenged the adequacy of conventional "placebo' controls, by demonstrating that active treatments, such as systematic desensitization, are more credible than supposedly inert control conditions. Such findings give support to the hypothesis that the arousal of positive expectancies is the key to therapeutic change. Three experiments are reported, in which Borkovec's credibility rating method was applied to treatment comparisons modelled upon the findings of outcome research. In the first experiment, systematic desensitization was more credible than rational-emotive and client-centered therapy (P less than 0.001), consistent with an expectancy-arousal explanation of Di Loreto's (1971) comparative outcome study. In the second experiment, Paul's (1966) attention placebo condition was less credible than three active treatments (P less than 0.001). In the third experiment, in vivo desensitization was in some respects more credible than imaginal desensitization, which was in turn more credible in some respects than relaxation alone (P less than 0.001). The results of the latter two experiments were broadly consistent with an expectancy-arousal interpretation of much outcome literature. These results emphasize the insufficiency of merely including a designated "placebo control condition' in outcome research (Kazdin & Wilcoxon, 1976). Credibility differences did not mirror precisely the results of the outcome research on which these studies were modelled, however. Methodological limitations are discussed, and further clinical research is advocated, in which the persuasiveness of treatment rationales is studied in its own right as contribution to treatment efficacy.

Arousal↗
PubMed1980

Science and psychotherapy: the state of the art.

Training and practice within British clinical psychology are profoundly influenced by the belief that behavioural psychotherapy has been shown as more effective than verbal psychotherapy in the treatment of disorders for which both claim utility. A review of the comparative outcome evidence shows that this belief is largely unfounded. Taken together with the growing theoretical convergence between verbal and behavioural approaches, this negative result from comparative outcome studies has important implications for the future development of psychotherapy research, training and practice. More precise and sophisticated research strategies are required to identify the therapeutic ingredients of the psychotherapies, whether these be common to many approaches or specific to particular treatment modes. Closer integration between clinical and research activities in all forms of psychotherapy is necessary. Clinical psychologists should be trained in a variety of behavioural and verbal methods, and in the research methodologies necessary to evaluate and develop these methods. If the challenge of the present state of evidence is not evaded, then we may eventually supersede crude global comparisons, with precise specification of interventions appropriate for given populations.

Behavior Therapy↗
PubMed1976

The effects of therapeutic conditions: positive results revisited.

This paper surveys evidence relating the 'therapeutic conditions' of Accurate Empathy, Non-Possessive Warmth and Genuineness to psychotherapeutic outcome. The studies reviewed include comparisons of 'good' therapy with no-treatment control groups, and correlational studies relating levels of 'conditions' to outcome. Even leaving aside the question of the validity of the outcome measures used, it is concluded that present evidence suggests no more than a weak relationship between these 'conditions' and patient improvement. It is suggested that a methodologically adequate, experimental, demonstration of their effectiveness has yet to be attempted.

Antisocial Personality Disorder↗