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Biomedical subjects

D M Clark

Publications and source records attributed to D M Clark.

At least 55 records · Page 3Linked to original sources
PubMed1994

A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder.

Recent studies have shown that cognitive therapy is an effective treatment for panic disorder. However, little is known about how cognitive therapy compares with other psychological and pharmacological treatments. To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy, applied relaxation, imipramine (mean 233 mg/day), or a 3-month wait followed by allocation to treatment. During treatment patients had up to 12 sessions in the first 3 months and up to three booster sessions in the next 3 months. Imipramine was gradually withdrawn after 6 months. Each treatment included self-exposure homework assignments. Cognitive therapy and applied relaxation sessions lasted one hour. Imipramine sessions lasted 25 minutes. Assessments were before treatment/wait and at 3, 6, and 15 months. Comparisons with waiting-list showed all three treatments were effective. Comparisons between treatments showed that at 3 months cognitive therapy was superior to both applied relaxation and imipramine on most measures. At 6 months cognitive therapy did not differ from imipramine and both were superior to applied relaxation on several measures. Between 6 and 15 months a number of imipramine patients relapsed. At 15 months cognitive therapy was again superior to both applied relaxation and imipramine but on fewer measures than at 3 months. Cognitive measures taken at the end of treatment were significant predictors of outcome at follow-up.

Adolescent↗
PubMed1993

An experimental study of the relationship between thoughts and eating behaviour in bulimia nervosa.

This study tested the hypothesis that cognitive disturbance has a causal role in the maintenance of disturbed eating in bulimia nervosa. Thoughts about eating, weight and shape were activated in one group of patients with bulimia nervosa (the experimental group) but not in another (the control group). There was an increase in negative self-statements in the experimental group following the experimental manipulation. Food consumption was then measured in a taste test. As predicted, the experimental group ate less in the short term than the control group. Contrary to expectations, they did not subsequently report more objective bulimic episodes as a consequence of this decreased food intake. They did, however, report significantly fewer subjective bulimic episodes.

Adult↗
PubMed1993

Cognitive processes in social phobia.

Social phobics, anxious controls and non-patient controls took part in a brief videotaped conversation with a stooge in order to investigate the cognitive model of social phobia. Thoughts, behaviour, and attention during the conversation were assessed. Compared to the control groups, social phobics had more negative self-evaluative thoughts, performed less well, and systematically underestimated their performance. There were no differences in attention between the three groups. Content analysis of thought sampling data from the conversation, and from three hypothetical situations, revealed that few of the negative thoughts reported by social phobics explicitly mentioned evaluation by other people. This suggests that social phobics may not closely monitor other people's responses in social situations and hence that their thoughts are not data driven. The results are discussed in relation to the cognitive model of social phobia and suggestions are made for improvements in the treatment of social phobia.

Attention↗
PubMed1993

Psychological treatment of panic: work in progress on outcome, active ingredients, and follow-up.

Initial interest in the causes and treatment of panic disorder was triggered by biological theories and investigators. More recently, however, research on newly developed psychological approaches for panic has advanced our understanding of the disorder and has led to the development of specific treatment programs. Typically, these programs consist of a range of treatment components that more or less directly target panic attacks and the fears and behaviors associated with them. The paper reviews four studies evaluating these programs that have recently been completed or are close to completion in different centers in the United States (Albany, New York; Austin, Texas) and Europe (Oxford, England; Marburg, Germany). Conforming to strict methodological standards, these studies report consistently high success rates and temporal stability of the treatment gains. About 80% or more of the patients receiving combined cognitive-behavioral treatments achieved panic free status as well as strong and clinically significant improvement in general anxiety, panic-related cognitions, depression, and phobic avoidance. Furthermore, these gains were maintained at follow-ups of up to 2 years. The success of these psychological treatments compares favorably with the outcome for the established pharmacological treatments. In addition, the studies provide new insights into the active ingredients that may operate in cognitive-behavioral treatments for panic disorder and show the feasibility of group treatments. Together, these studies underscore the fact that cognitive-behavioral treatments rest on firm experimental evidence that justifies their application in everyday practice as well as continued research into their mechanisms of action.

Arousal↗
PubMed1993

A further experimental investigation of thought suppression.

It has often been suggested that attempts to suppress a thought will lead to an immediate and/or delayed increase in its occurrence. In a recent experiment (Clark, Ball & Pape, Behaviour Research and Therapy, 29, 253-257, 1991) we obtained a delayed (rebound) effect but failed to demonstrate an immediate enhancement effect. Lavey and van den Hout (Behavioural Psychotherapy, 18, 251-258, 1991) have suggested immediate enhancement might be observed only if subjects are instructed not to use distraction while suppressing. The present experiment tested this hypothesis. An immediate enhancement effect was not obtained but the delayed (rebound) effect was twice replicated and an artifactual explanation of this effect was discounted.

Adult↗
PubMed1993

Cognitive treatment for panic disorder.

Several kinds of evidence indicate that there are important psychological causes of panic disorder as well as the biological causes that have been demonstrated by others. These psychological causes are fears that physical symptoms of anxiety will be followed by an immediate medical emergency: for example, that palpitations will be followed by a heart attack. Evidence is presented to show (a) that such fears are more frequent among panic disorder patients than other anxious patients; (b) that activating the fears can produce panic; and (c) that reducing the fears can attenuate the effects of procedures that produce panic. For panic disorder, cognitive therapy, which reduces these specific fears, gives results comparable to those of imipramine and alprazolam. If further research confirms that these therapeutic effects of cognitive therapy are sustained well beyond the end of treatment, cognitive therapy could be the treatment of choice for panic disorder.

Alprazolam↗
PubMed1993

Prehospital cardiac arrest treated by urban first-responders: profile of patient response and prediction of outcome by ventricular fibrillation waveform.

STUDY OBJECTIVES: To determine the speed and characteristics of patient response to urban first-responder defibrillation and to determine whether amplitude of ventricular fibrillation (VF) can predict outcome in these patients. TYPE OF PARTICIPANTS: All adult patients in prehospital VF treated by fire department first-responders (265). DESIGN AND INTERVENTIONS: A prospective observational study occurring between February 1, 1989, and January 1, 1991. Patients were defibrillated according to advanced cardiac life support and first-responder protocols. ECG and time data were recorded digitally. MAIN RESULTS: Sixty-five percent of patients converted from VF to a more stable rhythm at least once during first-responder monitoring. Fifty-four percent of converted patients refibrillated at least once, and 42% of all stable conversions occurred after at least one episode of refibrillation. Seventy percent of all refibrillations occurred less than six minutes after the defibrillator was turned on, and 23% occurred after more than ten minutes. The proportion of stable conversions decreased from 30% on first conversion to 2% on fourth conversion. With each successive conversion the interval to refibrillation grew shorter, and development of a pulse or blood pressure became less likely. Presence of blood pressure or pulse after conversion had a sensitivity for hospital discharge of 54% and a specificity of 98%. Maximum VF amplitude before countershock was highly predictive of postshock rhythm, stable conversion in the field, time interval before refibrillation, inpatient admission, and hospital discharge. VF amplitude was unrelated to response interval or interval to defibrillation but was positively related to bystander CPR. Logistic regression identified VF amplitude as the most important predictor of hospital discharge; traditional variables such as response interval and bystander CPR were not predictive once amplitude had been accounted for. Changes in VF amplitude during the course of resuscitation efforts were frequent and also predictive of outcome. CONCLUSION: Patients in VF who were treated by early countershock refibrillated much more frequently than previously reported. Refibrillations occur both early and late. Initial VF maximum amplitude is strongly predictive of outcome. Future reports of VF cardiac arrest should control for this previously neglected variable. Increased amplitude of VF during repeated refibrillation episodes is associated with increased hospital discharge, so future studies of advanced cardiac life support interventions should explore changes in VF amplitude as an outcome variable.

Aged↗
PubMed1992

Use of the neodymium:yttrium-aluminum-garnet laser for treatment of squamous cell carcinoma of the nasal planum in a cat.

A mature castrated male domestic shorthair cat was referred for treatment of an excoriated, ulcerated area on the nasal planum. Undifferentiated squamous cell carcinoma was diagnosed. Surgical resection of the nasal planum was not an option, so the lesion was treated 4 times with neodymium:yttrium-aluminum-garnet laser. Laser surgery results in uniform photovaporization of large volumes of tissue. Although treatment with laser does not yield tissue specimens suitable for histologic evaluation, it can result in a cosmetically suitable appearance and can extend the predicted life span. A diagnosis of undifferentiated squamous cell carcinoma has a guarded prognosis: however, the cat of this report survived more than 18 months.

Animals↗
PubMed1992

Canine hip dysplasia: clinical signs and physical diagnosis.

Clinical signs of hip dysplasia include lameness, gait abnormalities, reluctance to exercise, and pelvic limb muscle atrophy with compensatory shoulder muscle hypertrophy. Because these clinical signs are not pathognomonic for CHD, a thorough orthopedic and neurologic examination is recommended for all patients with suspected CHD. Specific maneuvers, including the Barlow, Ortolani, and Barden's signs are useful to characterize the degree of coxofemoral laxity, both as screening tools in young puppies and as diagnostic aids in clinically lame dogs. None of the signs are definitive diagnostic tests for CHD, but they should be performed as sequential maneuvers in the veterinarian's workup for suspected CHD. Pelvic radiography is mandatory to definitively diagnose CHD but should not be the first step in the workup, because other diagnoses may be missed or concurrent conditions may coexist with dysplasia.

Animals↗
PubMed1992

Psychosocial adjustment in siblings of children with chronic life-threatening illness: a research note.

The psychosocial functioning of 10 siblings of children with chronic life-threatening illness and their parents was compared with 10 healthy matched controls. The main differences found were in family relationships, with the index siblings expressing more negative emotion in relation to their fathers than controls, index mothers being less involved in social activities and index fathers being less involved with the extended family. No significant differences were found in any of the measures of depression, anxiety and self concept. Index siblings expressed a number of other concerns such as a fear of the break up of their family after the sick child died. The need for increased awareness of the welfare of healthy siblings as well as closer involvement of the fathers is discussed.

Adolescent↗
PubMed1991

Expression of annexin VI (p68, 67 kDa-calelectrin) in normal human tissues: evidence for developmental regulation in B- and T-lymphocytes.

This paper describes the tissue distribution of annexin VI, a Ca(2+)-dependent phospholipid binding protein, and a member of the annexin super-gene family. In order to determine whether annexin VI expression correlated with a particular functional phenotype, an extensive series of non-pathological human tissues were examined, in which annexin VI was detected either immunohistochemically or by immunofluorescence, using a rabbit polyclonal anti(human annexin VI)-IgG of known specificity. Although most tissues investigated were found to express annexin VI, the protein was usually confined to highly specific cell types within each tissue, the staining generally appearing cytoplasmic and diffuse. There was particularly good correlation between annexin VI expression and hormone secreting cells, with positive staining in the islet cells of the pancreas, the Leydig cells of the testis and the cells of the adrenal cortex. A notable exception was the parathyroid gland, which lacked detectable annexin VI. Although the protein was absent in most epithelia, it was expressed strongly in certain secretory epithelia; e.g. the ductal epithelial cells of the salivary glands and non-lactating breast, and the sweat glands and their ducts. The observation that the epithelial cells of lactating breast failed to stain for annexin VI suggests functional regulation of protein expression in this tissue. However, the most interesting finding was that annexin VI expression appeared to be developmentally regulated in B- and T-lymphocyte differentiation, with negative staining in the proliferating B cells of the germinal centre of the lymph nodes, but strong staining in the mature small lymphocytes of the cortex, mantle zone and paracortex.

Adrenal Cortex↗
PubMed1991

Does anxiety lead to selective processing of threat-related information?

Four experiments investigating the detailed nature of the attentional bias in anxiety are reported. Previous research using the Stroop task has shown that, when compared with non-patient controls, anxious patients are relatively slower at colour naming threat-related words than non-threat words. Experiments One and Two investigated whether this apparent attentional bias is a function of anxiety per se and/or is related to patient/non-patient status. Experiment One compared colour-naming times for threat and non-threat words in low, medium and high trait anxiety normal subjects. High anxiety was not associated with slower colour-naming times for threat words. Experiment Two compared generalized anxiety disorder patients with equally anxious non-patients and found that the patients were significantly slower at colour-naming threat words. Read aloud and dwell tasks were also included in these experiments in order to identify the mechanism of Stroop interference. Experiments Three and Four investigated whether anxious patients' attentional bias is specific to threat-related material or also extends to certain positive, emotional material. In Experiment Three words used in previous Stroop studies were rated for emotionality. Threat words were more emotional, as well as more threatening, than control words, indicating that previous studies have confounded threat and emotionality. Experiment Four compared colour-naming times for threat words, equally emotional positive words, and neutral words. Consistent with the emotionality hypothesis, generalized anxiety disorder patients were slower than non-anxious controls at colour naming both threat words and positive words. The theoretical, methodological and clinical implications of these results are discussed.

Adult↗
PubMed1991

Treatment of panic attacks using cognitive therapy without exposure or breathing retraining.

Cognitive treatment of panic attacks is based on the hypothesis that panic results from the catastrophic misinterpretation of bodily sensations, and that changing such misinterpretations will block the occurrence of panic. The treatment normally involves an integrated set of cognitive and behavioural techniques. In a consecutive series of panic patients, a multiple baseline across subjects design was used to investigate whether a modified form of treatment involving only cognitive procedures could reduce panic attack frequency. The results provide preliminary evidence that cognitive procedures directed at changing misinterpretations of bodily sensations can reduce panic attack frequency, and also that cognitive procedures which do not target misinterpretations may not reduce panic.

Anxiety Disorders↗
PubMed1991

An experimental investigation of thought suppression.

An experiment investigating the hypothesis that trying to suppress a thought will lead to an immediate and/or delayed increase in its occurrence is reported. Normal subjects listened to a taped story and then verbalized their stream of consciousness during two consecutive time periods. During the first period, one group (suppression) were asked not to think about the tape while two other groups (controls) were asked to think about anything or think about anything including the tape. During the second period, all three groups were instructed to think about anything. Results from the first period failed to support the immediate enhancement hypothesis as the suppression group reported less thoughts about the tape than the controls. However, results from the second period supported the delayed (rebound) hypothesis as subjects who had previously suppressed reported more thoughts about the tape than subjects who had not. The theoretical, methodological, and clinical implications of these results are discussed.

Adult↗
PubMed1990

Affective responses to hyperventilation: a test of the cognitive model of panic.

A cognitive explanation of the association between acute hyperventilation and panic attacks has been proposed: the extent to which sensations produced by hyperventilation are interpreted in a negative and catastrophic way is said to be a major determinant of panic. Non-clinical subjects were provided with a negative or a positive interpretation of the sensations produced by equivalent amounts of voluntary hyperventilation. As predicted, there was a significant difference between positive and negative interpretation conditions on ratings of positive and negative affect. Subjects in the positive interpretation condition experienced hyperventilation as pleasant, and subjects in the negative interpretation condition experienced hyperventilation as unpleasant, even though both groups experienced similar bodily sensations and did not differ in their prior expectations of the affective consequences of hyperventilation. When the subjects were given a positive interpretation, the number of their sensations correlated with positive affect; when a negative interpretation was given, the number of bodily sensations correlated with negative affect. The results provide support for a cognitive model of panic and are inconsistent with the view that panic is simply a symptom of hyperventilation syndrome.

Adult↗
PubMed1990

Synchronous adenocarcinoma and primary malignant lymphoma of the stomach.

A synchronous presentation of an adenocarcinoma and a primary low grade B cell lymphoma of the stomach is reported in a 79 year old man. Both diagnoses were made on endoscopic biopsies and immunocytochemistry was essential in confirming the lymphoma. The true incidence, aetiology and spatial relations of these tumours are unknown since only few cases of such synchronous gastric tumours have been reported in the literature.

Adenocarcinoma↗
PubMed1989

Branchial cyst in a dog.

A 7-year-old spayed German Shorthaired Pointer was determined to have a branchial cyst in the subcutaneous tissues of the cervical/facial area. Treatment had been attempted by aspiration and placement of drains, but without success; the final diagnosis was made after microscopic examination of the wall of the excised cyst. The means by which fluctuant swellings in this region may be differentiated are anatomic location and examination of full-thickness biopsy specimens of cyst walls.

Animals↗