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Biomedical subjects

G Andrews

Publications and source records attributed to G Andrews.

At least 19 recordsLinked to original sources
PubMed1992

Personality as a cause of adverse life events.

The element of chance and the role of the individual in causing negative life events was explored by examining the relationship between measures of personality, symptoms, and a number of demographic variables in a nonclinical population (n = 892). The results indicated that Eysenck's neuroticism was the best predictor of negative interpersonal life events. Symptoms added a negligible amount to the variance explained in the occurrence of life events. The well-established relationships between neuroticism and symptoms and life events and symptoms are discussed in the light of these findings.

Adaptation, Psychological↗
PubMed1992

Drop-out rate as a performance indicator in psychotherapy.

Many large studies of psychotherapy show that the median patient drops out by the 5th session and most before the 10th session. Data from an effective behavior therapy clinic for the anxiety disorders showed that only 17% of patients failed to complete a median of 60 h of therapy. Patient characteristics were not associated with attrition. We examined 5 meta-analytic treatment reviews and found the median drop-out rate was 8% after 20 h of therapy. We suggest that low attrition is associated with effective, standardized treatment and as such, drop-out rate may be a proxy variable that can indicate effective service delivery.

Adult↗
PubMed1991

The cost of schizophrenia revisited.

This article discusses two approaches to costing disease and summarizes an incidence-based costing of schizophrenia using 1975 data. Because the presentation of schizophrenia may have changed in the last 16 years, the effects of three possible changes--a reduction in incidence, a transfer to treatment in the community, and an improvement in prognosis--are all entered into the 1975 model and the changes in costs are noted. The decrease in costs is greatest presuming a reduction in incidence, moderate given an improvement in prognosis, and relatively minor given the economies in direct treatment costs likely to follow a transfer to community treatment. Nevertheless, because community treatment might also be associated with an improvement in prognosis, the social issues for medicine implicit in the transfer from hospital to community treatment are discussed.

Adolescent↗
PubMed1991

The Parental Bonding Instrument: a measure of perceived or actual parental behavior?

In the investigation of the relationship between childhood adversity and adult psychopathology, scales that require retrospective reports of parental style are often employed. Controversy exists as to whether these scales reflect the actual behavior of the parents concerned or reflect the perceptions of the child. One such scale, the Parental Bonding Instrument, was completed by a volunteer sample of 672 twins. For females, agreement between twins was generally high and a shared environment model fitted all scales except maternal care. This is consistent with the view that the ratings reflect the behavior of the parents. Agreement between male twins was substantially lower and well-fitting models did not include a shared environment component. It is argued that the scales may be affected by competition between twins or comparisons made by the respondent with his or her co-twin.

Adult↗
PubMed1991

The changing nature of psychiatry.

The traditional role of psychiatrist as the central figure in the delivery of mental health services is changing. First, the advent of structured diagnostic interviews means that the diagnosis of mental disorders is no longer the exclusive preserve of psychiatrists; second, the growth of community mental health services staffed by non-psychiatrists means that psychiatrists now treat a minority of the patients with mental disorders; and third, the psychiatrists' continued endorsement of dynamic psychotherapy means they are becoming identified with an unproven and very expensive treatment. These changes should be seen against the broader background of a profession that is well-trained, active in evaluating performance, supported by a burgeoning research base in cognitive science and neuroscience, and delivering services efficiently and inexpensively.

Australia↗
PubMed1990

The diagnosis and management of pathological anxiety.

The anxiety disorders are common reasons for patients approaching their doctors for help. While benzodiazepines used to be the treatments most commonly used, increasing concern about the wisdom of prescribing these drugs means that other treatments have to be considered. A differential diagnostic schema for patients who complain of anxiety is presented and an outline for counselling these patients is described. Treatment of the four major anxiety disorders is evaluated, and the efficacy of drug treatment compared to various levels of behaviour therapy. Cognitive behaviour therapy is recommended for all four disorders on the grounds of a short-term effectiveness comparable to drug therapy and evidence for stability of improvement after treatment has concluded, evidence that is lacking for the drug therapies.

Anxiety Disorders↗
PubMed1990

The genetics of six neurotic disorders: a twin study.

Persons who had met criteria for specific anxiety or depressive neuroses during their lifetime were identified from a sample of 446 pairs of adult twins. Although there was a genetic contribution to neuroticism and to symptoms, there was no inheritance of specific disorders. This concurs with previous work in a sample from the same Australian Twin Registry and with those from a Norwegian sample. It is concluded that while there is a genetic contribution to the predisposing trait, and therefore to the intermittent appearance of symptoms, this contribution is obscured by the grouping of symptoms into diagnoses and by the help seeking which is a prerequisite to clinical diagnosis.

Adolescent↗
PubMed1990

Tyrosine hydroxylase messenger RNA in the hypothalamus, substantia nigra and adrenal medulla of old female rats.

The effects of aging in the female rat were analyzed in terms of tyrosine hydroxylase (TH) gene expression and serum prolactin levels. The number of tuberoinfundibular dopaminergic (TIDA) neurons and the concentration of TH mRNA per cell was greater in 16- to 18-month-old rats than in 25-month-old rats. The amount of TH immunostaining was more intense in the median eminence of the 18-month-old rats compared to either younger or older rats. Plasma prolactin levels were moderately elevated in 18-month-old rats compared to 4-month-old rats, and extremely elevated in 25-month-old rats due to the occurrence of pituitary prolactinomas. There were no detectable changes in TH mRNA levels in the substantia nigra with age, whereas adrenal TH mRNA increased with age. We propose that prolactin initially exerts a stimulatory effect on the TIDA neurons as the rat ages, but eventually causes a loss in neuronal number and neuronal function as the pituitary prolactinoma secretes increased amounts of prolactin.

Adrenal Medulla↗
PubMed1990

Genetic and environmental determinants of the lability of trait neuroticism and the symptoms of anxiety and depression.

A genetic analysis was conducted on trait neuroticism and symptoms of anxiety and depression in a five-wave study of 462 twin pairs. Models that assessed the relative importance of genetic and environmental factors to the lability (within-individual variability over time) of these measures were fitted to the data. Previous results concerning the substantial genetic involvement in the level of neuroticism and symptoms were confirmed. However, it was found that neither genes nor the shared environment of the twins was a significant cause of lability of these measures. An attempt was therefore made to identify aspects of individuals' environments that might be responsible for lability of neuroticism and symptoms. Adverse life events were found to predict variability of symptoms, but not of neuroticism. The availability of close social ties or having affectionless control in childhood did not contribute to lability.

Adult↗
PubMed1990

Treatment of panic and agoraphobia. An integrative review.

There is now agreement about the clinical features of panic disorder and agoraphobia but less agreement about treatment because of controversy over whether the disorder is primarily biological or psychological. The authors were requested to produce an impartial review for continuing education and peer review. We chose to do this by using a quantitative review procedure, by providing a bibliography of studies, and by a literature review. We found that symptoms of panic and phobia did not change significantly while on wait-list control or while receiving placebo. The evidence for the efficacy of the low-potency benzodiazepines or of monoamine oxidase inhibitors was limited. It was also clear that only limited improvement can be expected from behavior therapies that do not involve exposure to the symptoms of panic or to the feared situation. Symptoms of panic, as well as the frequency of spontaneous panic, were shown to be substantially improved following imipramine, high-potency benzodiazepines such as alprazolam, exposure in vivo (especially if a cognitive anxiety management procedure was used), and the combination of imipramine and exposure in vivo. The effects on panic produced by the exposure therapies (with or without imipramine) were maintained over long follow-up periods. Imipramine, alprazolam, exposure therapy, and imipramine plus exposure each produced significant improvements in phobias. In the short term and in the long term, the larger improvements in phobias were associated with exposure therapy, particularly if used in combination with imipramine. We conclude that it would be unwise to theorize about the etiology of this disorder on the basis of response to a specific treatment because, both at the meta-analytic level and from the review of individual studies, it is clear that both drug and nondrug therapies can produce substantial and long-lasting changes in panic and in phobias.

Agoraphobia↗
PubMed1990

An examination of defense style in parents who abuse children.

The study aimed to determine the predominant defense style in parents who abuse their children, at least as determined by a new defense style questionnaire. The scores of 32 parents who had physically abused their young children and had been assessed after court proceedings were compared with a normal population sample and with patients with anxiety disorders who were equally symptomatic. Parents who had abused their children identified themselves as being particularly likely to use projection, displacement, passive-aggressiveness denial, and splitting to a degree greater than normal persons or patients with anxiety disorders. We would caution that, although the differences remained after statistical control of age and sex differences, a firm conclusion that such defenses are germane to child abuse will have to await replication of these findings with a study using a control group of young parents who do not abuse their children matched for social class and family structure.

Adult↗
PubMed1990

Twins: a test of the equal environments assumption.

We asked a sample of 343 adult same-sex twin pairs a number of questions about the similarity of their social environment during childhood and early adolescence. A factor analysis of their responses indicated that their common environment was derived from two sources, one being similar treatment "imposed" upon them by their parents, the other being "elicited" by the twins' similar interests and behavior. Monozygotic (MZ) twins reported experiencing more similar "imposed" and "elicited" environments than dizygotic (DZ) twins. The extent of imposed similar treatment received during childhood and early adolescence was unrelated to either MZ or DZ twins' current behavioral similarity, as indicated by absolute intrapair differences in their Neuroticism, Anxiety, and Depression scores. Similar treatment imposed upon MZ twins on the basis of their zygosity alone is therefore not a threat to the validity of the twin method.

Adolescent↗
PubMed1990

Follow-up of community placement of the chronic mentally ill in New South Wales.

A total of 208 long-stay hospital patients in New South Wales, Australia, who were discharged to supported community accommodations were studied to determine their adjustment in the community. For 172 patients, measurements were obtained of the patients' satisfaction with their accommodations, the caretakers' perceptions of the patients' impairment and management difficulty, and the restrictiveness of practices in the various accommodations. Most patients were considered to be functioning well, although 22 of the more impaired and difficult patients were rehospitalized at the time of the study. Seventy-eight percent of the patients preferred living in the community, and only 7 percent preferred a hospital. The patients benefited from the supported, subsidized, permanent housing available in the community and required low levels of mental health care.

Adult↗