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Biomedical subjects

E Guthrie

Publications and source records attributed to E Guthrie.

At least 19 recordsLinked to original sources
PubMed2001

Randomised controlled trial of brief psychological intervention after deliberate self poisoning.

OBJECTIVES: To determine the effects of a brief psychological intervention (brief psychodynamic interpersonal therapy) for patients after deliberate self poisoning compared with usual treatment. To compare the impact of the active intervention and usual treatment on patients' satisfaction with care. DESIGN: Randomised controlled trial. PARTICIPANTS: 119 adults who had deliberately poisoned themselves and presented to the emergency department of a teaching hospital. SETTING: Community based study. INTERVENTION: Four sessions of therapy delivered in the patient's home. Control patients received "treatment as usual," which in most cases consisted of referral back to their general practitioner. OUTCOME MEASURES: Severity of suicidal ideation six months after treatment as assessed by the Beck scale for suicidal ideation. Secondary outcome measures at six month follow up included depressive symptoms as measured by the Beck depression inventory, patient satisfaction with treatment, and self reported subsequent attempts at self harm. RESULTS: Participants randomised to the intervention had a significantly greater reduction in suicidal ideation at six month follow up compared with those in the control group (reduction in the mean (SD) Beck scale 8.0 v 1.5). They were more satisfied with their treatment and were less likely to report repeated attempts to harm themselves at follow up (proportion repeating 9% v 28% in control group; difference 19%, 95% confidence interval 9% to 30 %, P=0.009). CONCLUSION: Brief psychodynamic interpersonal therapy may be a valuable treatment after people have deliberately tried to poison themselves.

Adolescent↗
PubMed2001

Health-related quality of life and health care costs in severe, refractory irritable bowel syndrome.

BACKGROUND: The irritable bowel syndrome (IBS) may lead to considerable impairment of health-related quality of life and high health care costs. It is not clear whether these poor outcomes directly result from severe bowel symptoms or reflect a coexisting psychiatric disorder. OBJECTIVE: To determine whether bowel symptom severity and psychological symptoms directly influence health-related quality of life and health care costs. DESIGN: Cross-sectional survey. SETTING: Secondary and tertiary gastroenterology clinics. PATIENTS: 257 patients with severe IBS who did not respond to usual treatments and were recruited for a trial of psychological treatment. MEASUREMENTS: Predictors were abdominal pain, entries in a diary of 10 IBS symptoms, and measures of psychological symptoms. Outcomes were inability to work, health-related quality of life (measured by Medical Outcomes Survey 36-item short-form questionnaire [SF-36] physical component summary scores), and health care and productivity costs. Predictor and outcome measures were compared by using multiple regression and logistic regression analyses. RESULTS: Abdominal pain occurred on average 24 days per month and activities were restricted on 145 days of the previous 12 months. The mean (+/-SD) Hamilton depression score was 11.3 +/- 6.1. The SF-36 physical component summary score was low (37.7 +/- 10.6), and the patients had incurred high health care costs ($1743 +/- $2263) over the previous year. Global severity and somatization scores on the Symptom Checklist 90 Revised, abdominal pain, and Hamilton depression scores independently contributed to the physical component score of the SF-36 (adjusted R(2) = 35.2%), but only psychological scores were associated with disability due to ill health. These variables did not accurately predict health care or other costs (adjusted R(2) = 9.3%). History of sexual abuse was not an independent predictor of outcome. CONCLUSIONS: Both abdominal and psychological symptoms are independently associated with impaired health-related quality of life in patients with severe IBS. Optimal treatment is likely to require a holistic approach. Since health care and loss of productivity costs are not clearly associated with these symptoms, alleviation of them will not necessarily lead to reduced costs.

Abdominal Pain↗
PubMed2001

Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: a comparison with routine attenders.

Seventy-seven frequent attenders at an emergency department (ED) in an inner-city hospital in the UK (defined as seven or more visits in the previous 12 months) were compared with 182 patients who were attending the same department on a routine basis. Patients completed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Short Form (SF)-36. Information was obtained on 64% of the frequent attenders and 45% underwent a detailed psychiatric assessment. Of the frequent attenders, 45% had psychiatric disorder and 49% had some form of an alcohol-related disorder. Compared with routine attenders, frequent attenders reported lower health status, had more psychiatric disorder (odds ratio: OR=8.2, 95% confidence interval: CI=3.8--18.1), had more general hospital admissions (OR=19.9, 95% CI=8.3--47.8), more psychiatric admissions (OR=167.5, 95% CI=9.5--2959.0), and more GP visits (95% CI for difference=-10.2 to -5.7). There was no evidence that frequent attenders had more somatisation than routine attenders. Specific treatment and management strategies need to be developed for this group of patients, although a substantial proportion may be difficult to engage in the treatment process.

Adolescent↗
PubMed2001

Comparing two different methods of identifying alcohol related problems in the emergency department: a real chance to intervene?

OBJECTIVES: To examine the feasibility of screening for alcohol problems in a representative flow sample of patients attending a busy UK emergency department. To compare two methods of identifying alcohol related problems in the emergency department. METHODS: Brief interview administered by the same interviewer to a representative flow sample of 429 patients attending a single accident and emergency department over a six week period. Measures included a CAGE questionnaire and assessments by the patient and staff as to whether the attendance was alcohol related. RESULTS: 413 patients (96%) were successfully screened. Of these, 115 (28%) patients were considered to have an alcohol related attendance on the basis of the CAGE questionnaire or the staff assessment. Head injuries and psychiatric presentations were particularly likely to be associated with alcohol misuse. Compared with those identified by staff, patients scoring above threshold on the CAGE were more likely to attend during routine working hours and recognise they had an alcohol problem. CONCLUSIONS: Emergency departments may provide an opportunity for the early prevention of alcohol related difficulties. However, patients with alcohol problems who present to the emergency department are not a homogenous group. Different screening methods identify different groups of patients, who in turn may respond to different forms of intervention. Further research examining the efficacy and feasibility of different alcohol treatment approaches is needed to enable us to target specific interventions to those patients who might most benefit.

Adolescent↗
PubMed2001

What are GPs for?

Explore the source record for details and available documents.

Family Practice↗
PubMed2000

A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia.

BACKGROUND & AIMS: This study aimed to determine whether brief psychodynamic-interpersonal (PI) psychotherapy is more efficacious than a psychological control for patients with chronic, intractable functional dyspepsia (FD), and whether patients with abnormal gastric function respond differently than those with normal gastric function. METHODS: Ninety-five consecutive patients with chronic symptoms of FD who had failed to respond to conventional pharmacologic treatments were approached. Thirty-seven received PI psychotherapy, and 36 the control condition (supportive therapy). Patients completed self-report questionnaires before and after treatment and 12 months later. The patients' gastroenterologists, who were blind to the study groups, conducted independent ratings before and after treatment. Forty-nine patients also underwent a radioisotope gastric emptying study. An intention-to-treat analysis was used with baseline scores as covariates. RESULTS: At the end of treatment, there were significant advantages for PI psychotherapy compared with controls for the gastroenterologists' (P = 0.002) and patients' total symptom score (P = 0.015). One year after treatment, the symptomatic scores were similar. However, a subanalysis showed that PI therapy was superior to the control condition at 1 year, when patients with severe heartburn were excluded. There was no difference in outcome between patients with normal and abnormal gastric emptying. CONCLUSIONS: PI therapy may have both short- and long-term effects in patients with dyspepsia, but further evaluation is required. Its cost-effectiveness needs to be determined.

Adult↗
PubMed2000

Survival, morbidity, and quality of life after discharge from intensive care.

OBJECTIVE: To assess survival, morbidity (physical and psychological), quality of life (QOL), and employment status of intensive care survivors up to 12 months after discharge from the intensive care unit (ICU). DESIGN: Prospective study. SETTING: University hospital adult ICU. PATIENTS: Between August 1, 1995, and July 31, 1996, 370 patients were admitted. Of these patients, 29% died in the ICU. Three months after discharge from the ICU, 227 patients were alive, and 143 agreed to participate. Cumulative mortality was calculated using the original complete cohort. MEASUREMENTS AND MAIN RESULTS: Demographic data, severity of acute illness (Acute Physiology and Chronic Health Evaluation [APACHE] II), admitting specialty, primary diagnosis, and length of stay were recorded. Physical and ICU-related psychological morbidity (Hospital Anxiety and Depression scale score) were recorded. Health-related QOL was assessed using the Short-Form 36. All the questionnaires were completed in the clinic at 3 months. Assessment of physical morbidity and employment status at 6 and 12 months were conducted by telephone. The cumulative mortality was 39% at 3 months, 41% at 6 months, and 43% at 12 months. Deaths after 3 months occurred in the group who refused follow-up. The median age for the follow-up group was 51 yrs; the gender split was 68 women and 75 men; the mean admission APACHE II score was 18.79 (SD 6.15); and the median length of ICU stay was 3.8 days. At 3 months, approximately 80% of all patients interviewed were satisfied with their QOL. Older men (>65 yrs) and younger women (<65 yrs) demonstrated significantly better health with respect to some subdomains of the Short-Form 36 compared with their counterparts. The prevalence of psychological distress (Hospital Anxiety and Depression scale score, > or =8) was low: 11.9% had heightened anxiety, and 9.8% were depressed. There were high levels of fatigue, poor concentration, and sleep disturbance; the latter was more marked in women (p = .022). Improvement in all three symptoms occurred during the next 9 months. Significantly more women reported loss of hair (p < .0001). Men were slower to return to employment; 75% of women had returned by 6 months compared with only 65% of men at 1 yr. CONCLUSION: Assessment of outcome after ICU stay must include QOL measurements. Three months after discharge, there is a low incidence of ICU-related psychological or psychiatric illness and the majority of patients are satisfied. Differences in the incidence and nature of morbidity exist between the genders.

APACHE↗
PubMed2000

Psychotherapy for patients with complex disorders and chronic symptoms. The need for a new research paradigm.

BACKGROUND: A clear distinction has been made between efficacy and effectiveness in relation to the methods of evaluation of new psychological treatments in psychiatry. Efficacy trials target patients with relatively pure conditions, who may not be representative of the patients who are usually referred for psychological treatment in a clinical setting. Few studies have explored the benefits of psychotherapy in patients with complex disorders and enduring symptoms. AIMS: To explore the rationale for the distinction between efficacy and effectiveness, particularly in relation to outcome studies of patients with complex and enduring disorders. METHOD: A narrative review with examples drawn from the literature, and an illustration of a recent naturalistic outcome study which combines features of both efficacy and effectiveness. RESULTS: Studies of patients with complex and mixed disorders can be designed so that they retain internal validity, but also have external validity and are relevant to clinical practice. CONCLUSION: Studies which evaluate psychological interventions should be carried out in populations of patients clinically representative of those who are likely to receive the intervention, should it be shown to be of benefit.

Adult↗
PubMed1999

Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services.

BACKGROUND: It is known that a small number of patients with mental health problems have chronic disorders and account for a disproportionate amount of mental health costs. This randomized controlled trial evaluated the cost-effectiveness of psychodynamic-interpersonal therapy vs treatment as usual in patients with mental health problems who were unresponsive to usual treatment. METHOD: Subjects (N = 110) with nonpsychotic disorders unresponsive to 6 months of routine specialist mental health treatment were enrolled in a randomized controlled trial. Sixty-three percent were women, the mean age was 41.4 years, the median duration of illness was 5 years, 68% were unemployed or receiving state benefits because of illness, and 75.5% had a depressive illness. Intervention patients received 8 weekly sessions of psychodynamic-interpersonal psychotherapy. Control patients received usual care from their psychiatrist. Outcome measures included ratings of psychological distress and health status and a detailed economic evaluation. Analysis was conducted on an intent-to-treat basis. RESULTS: Subjects randomized to psychotherapy had a significantly greater improvement than controls in psychological distress and social functioning 6 months after the trial. Baseline treatment costs were similar for both groups. Subjects who received psychotherapy showed significant reductions in the cost of health care utilization in the 6 months after treatment compared with controls. The extra cost of psychotherapy was recouped within 6 months through reductions in health care use. CONCLUSION: These preliminary findings suggest that brief psychodynamic-interpersonal therapy may be cost-effective relative to usual care for patients with enduring nonpsychotic symptoms who are not helped by conventional psychiatric treatment.

Adult↗
PubMed1999

Best practice guidelines for the management of women with epilepsy. The Women with Epilepsy Guidelines Development Group.

Clinical guidelines for the treatment of epilepsy have been published. A statement on management issues for women with epilepsy has recently been produced by the American Academy of Neurology which has raised awareness of the issues facing women with epilepsy. The communication presented here aims to review current literature on specific issues relating to women with epilepsy, and proposes graded recommendations for its management within a UK health care framework.

Abnormalities, Drug-Induced↗
PubMed1999

Psychosocial outcome and patient satisfaction following breast reduction surgery.

There is an increasing awareness that psychosocial outcome and health status are important outcomes following breast reduction surgery. In this study, patients awaiting breast reduction surgery completed detailed and comprehensive psychosocial assessments before and after surgery. Of 33 patients who completed the preoperative assessment, 20 patients were operated on and 19 were reassessed 4 months post-surgery. Patients expressed high levels of satisfaction with specific and overall results of surgery. Scores for anxiety, depression, body image and body satisfaction improved significantly using specific questionnaires. Patients also reported significant improvements on five out of eight subscales on the Short Form 36 health status questionnaire. This study provides further evidence for overall improvement in health status and psychological functioning in patients undergoing breast reduction surgery and supports the provision of this service by the NHS.

Adolescent↗
PubMed1999

General hospital services for deliberate self-poisoning: an expensive road to nowhere?

This study was designed to investigate the clinical and economic aspects of deliberate self-poisoning services in four teaching hospitals in Leeds, Leicester, Manchester and Nottingham. We investigated the management of the current self-harm episode, including direct in-hospital costs, in 456 individuals who presented to hospital on a total of 477 occasions with deliberate self-poisoning during a 4-week period in 1996. Fewer than half of the patients received specialist psychosocial assessment or follow-up. Patients were more likely to receive an assessment if they were already in contact with psychiatric services, had a history of previous overdoses, if they presented during working hours, or if they lived near the hospital. Patients who were admitted were nearly twice as likely to receive specialist assessment, and those who received a specialist assessment were nearly three times as likely to be offered follow-up. In-patient days and days on the intensive care unit accounted for 47% and 8% of the total costs, respectively. This study suggests that general hospital services are disorganised, with evidence of inequitable access to specialist assessment and after-care. This state of affairs cannot be justified on financial or clinical grounds.

Analysis of Variance↗
PubMed1999

Diagnosing genetic anomalies by inspection.

Several readily identifiable syndromes that have a genetic basis consist of mental retardation, hyperactivity or other abnormal behaviors, and characteristic physical signs. These disorders are not only an opportunity for clinical diagnosis, but they reflect the neurologic underpinning of intellect and behavior. Moreover, the wide variations in their phenotypes suggests that genetic testing be considered in children with abnormal appearance and mental retardation.

Child↗
PubMed1999

Traumatic brain injury in children and adolescents.

Traumatic brain injury is an insult to the brain caused by an external force that results in an impairment (transient or permanent) of cognitive, behavioral, emotional, or physical function. Traumatic brain injury encompasses shearing injury, which might be seen in a shaken infant, as well as penetrating injury from a foreign body, such as a bullet. This article addresses the recovery phase and functional sequelae following traumatic brain injury. Research and clinical experience over the past decade have led to a better understanding of the pathophysiology of head injury and, in turn, improved management.

Adolescent↗
PubMed1999

Costs of antidepressant overdose: a preliminary study.

There is ongoing debate regarding the relative cost effectiveness of different classes of antidepressants. Although factors such as tolerability and discontinuation rates have been taken into account, there has been little consideration of the cost of overdose. In the current study we examined the cost of antidepressant overdose at four teaching hospitals over a four-week period and found that the cost of selective serotonin reuptake inhibitor overdose was less than half that of tricyclic anti-depressant overdose. The cost of overdose is often ignored and should be considered in future analyses of the cost effectiveness of different antidepressant prescribing policies in primary care.

Adult↗
PubMed1998

Psychosocial status of women requesting breast reduction surgery as compared with a control group of large-breasted women.

The breast has special significance for women but unlike women seeking breast augmentation little research has been carried out on those seeking breast reduction. The few studies to date have not used well-recognized instruments nor appropriate controls. The present study compared 33 patients on a waiting list with 22 large-breasted controls using a semistructured questionnaire and well-validated instruments. Patients experienced greater physical and psychological difficulties but similar social difficulties as compared with the control group. Patients were also more anxious and depressed and had poorer self-esteem, body image, interpersonal functioning, and health status. This study confirms the high psychological morbidity of patients seeking breast reduction.

Adult↗
PubMed1998

Psychological stress and burnout in medical students: a five-year prospective longitudinal study.

The aim of this study was to assess psychological morbidity and symptoms of burnout in medical students during their undergraduate training, and to identify baseline factors that predict psychological morbidity in students in the final year of the course. It was a 5-year prospective longitudinal cohort study. Students were assessed in years 1, 4 and 5 of their medical undergraduate training by means of the GHQ-12 and the Maslach Burnout Inventory. 172 (84.3%), 157 (77.0%) and 155 (75.9%) students out of an original group of 204 completed assessments in years 1, 4 and 5, respectively. 18 students were above threshold on the GHQ-12 on all three occasions, 25 on two occasions and 43 on one occasion; 69 students were never a 'case'. Students who were cases on two or more occasions were more likely to find the medical course stressful during the first year, but not subsequent years. There was no significant difference between the percentages of men and women who scored as cases on the GHQ-12 in any of the years. The best predictor of psychological morbidity in the final year of the course was the GHQ-12 score in year 1. This study suggests that a small group of students repeatedly experience psychological distress during their medical training.

Alcohol Drinking↗