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Biomedical subjects

I M Marks

Publications and source records attributed to I M Marks.

At least 91 records · Page 5Linked to original sources
PubMed1984

Alcohol and sedative drug use in neurotic outpatients.

One hundred and six adult neurotic patients attending a behavioural psychotherapy unit were asked about their use of alcohol and other drugs and the perceived anxiolytic effect of these substances. Their drinking behaviour was not significantly different from that of the general population. Alcohol and other drugs were not perceived as reliable anxiolytics and not regularly used as such. Where alcohol or drug abuse coexist with anxiety-related problems, it is helpful to ask the patient to withdraw from these substances prior to starting behavioural therapy of the latter. We ask patients having behavioural therapy to refrain from alcohol or drug use prior to therapy or homework tasks.

Alcohol Drinking↗
PubMed1983

Imipramine and brief therapists-aided exposure in agoraphobics having self-exposure homework.

Forty-five chronic agoraphobics were randomly assigned to treatment by placebo or imipramine in doses up to 200 mg/day for 28 weeks. All patients also had systematic self-exposure homework with an instruction manual. In addition, half of each drug group had therapist-aided exposure and half had therapist-aided relaxation, each totalling three hours. Patients in both drug groups improved substantially and maintained their gains for one year of follow-up. Imipramine had no significant therapeutic effect despite satisfactory plasma levels and significant drug side effects. Patients' low initial Hamilton depression scores might explain the absence of any drug effect. Antidepressants may be ineffective for agoraphobics who have normal mood. Brief therapist-aided exposure improved phobias and panics to a significant but limited extent, and is a useful adjuvant to self-exposure homework, which can be a powerful therapeutic agency by itself.

Adult↗
PubMed1982

Clomipramine and exposure for chronic obsessive-compulsive rituals: III. Two year follow-up and further findings.

Forty chronic ritualizers were given clomipramine or placebo from weeks 0 to 36; also all had exposure in vivo, half from weeks 4 to 10 (30 hours) and half from weeks 7 to 10 (15 hours). In the 37 patients available at week 114 there were substantial and maintained improvements in rituals, mood and social adjustment compared to week 0. Reduction of rituals was even greater in those who had 30 hours of exposure. There was no drug effect on rituals at two year follow-up. Greater initial anxiety or depression predicted the superiority of clomipramine over placebo from weeks 10 to 36 and more prescription of tricyclics in follow-up. However, two years outcome was not predicted by initial anxiety or depression, nor by sex, age, age of onset nor duration of rituals.

Anxiety↗
PubMed1982

Anxiety management training for anxiety states: positive compared with negative self-statements.

Twelve patients complaining of chronic free-floating anxiety, usually also with panic attacks, were assigned at random to treatment by six hour-long sessions of anxiety-management training, either with positive or with negative self-statements, given over six weeks. Patients in both treatment conditions improved, with a small trend favouring positive over negative self-instruction, especially at follow-up. It is unclear how much self-instruction, rather than therapeutic attention or mere passage of time, accounted for the bulk of the modest improvement obtained.

Adolescent↗
PubMed1981

Review of behavioral psychotherapy, I: Obsessive-compulsive disorders.

Obsessive-compulsive ritualizers have maintained their improvement after exposure in vivo for up to 3 years' follow-up in the United States, Britain, Greece, and Australia. Unlike exposure in vivo, relaxation is of little value. Early gains in treatment predict long-term outcome. Exposure therapy is usually on an outpatient basis and takes 1-30 sessions. Self-exposure homework is critical. Sessions at home are also required, together with relatives cooperating as exposure cotherapists. Some patients can treat themselves almost unaided, while others need extensive assistance. Clomipramine is helpful for ritualizers with coexisting depression, but depression tends to recur when clomipramine therapy is stopped.

Behavior Therapy↗
PubMed1981

Review of behavioral psychotherapy, II: sexual disorders.

Sexual dysfunction has been shown to respond to a "behavioral Masters and Johnson" approach. Several controlled studies have found this approach to be superior to other methods, with one follow-up showing improvement up to 18 months later. Good results have usually been obtained using one rather than two therapists per couple. This brings into question whether the doubling of expense by use of two therapists is justified by the marginal gains in outcome. Results of early group treatment experiments with couples with sexual dysfunction have been encouraging. Behavioral methods are also useful in reducing a variety of sexual deviations (paraphilias); recent emphasis has moved away from the patient being passively averted by the therapist toward devising his own self-management program, including self-administered aversion when necessary.

Aversive Therapy↗
PubMed1981

Guided mourning for morbid grief: a controlled study.

During 2 weeks on a waiting list 12 patients with morbid grief did not improve significantly. They were then randomly allocated either to guided mourning treatment, in which they were encouraged to face cues concerning their bereavement, or to control treatment in which they were asked to avoid such cues. Each treatment comprised six 1 1/2 hour sessions over 2 weeks. At week 4 guided mourning patients had improved significantly more than had controls on 3 measures, with a supportive trend on 4 measures. Improvement, though modest, was maintained to 10-28 weeks follow-up. Control patients did not improve significantly or show any trend to do so.

Adult↗
PubMed1980

Clomipramine and exposure for obsessive-compulsive rituals: i.

Forty chronic obsessive-compulsive ritualizers were randomly assigned to treatment with oral clomipramine or placebo for 8 months. During weeks 4 to 7 these two groups were each randomly split into treatment by relaxation or by exposure in vivo, and during weeks 7 to 10 all patients had exposure in vivo. Double blind assessments were made at weeks 4, 7, 10, 18, 36, 62 and 114. Results are reported to one year. Clomipramine produced significant improvement in rituals, mood and social adjustment, but only in those patients who initially had depressed mood. The clomipramine effect was maximum from weeks 10 to 18 and diminished thereafter. On stopping clomipramine patients often relapsed and improved again on restarting the drug. Relaxation produced little change. Exposure produced significant lasting improvement in rituals, but less change in mood; improvement generalized to social adjustment at follow-up. Clomipramine plus exposure had a slight additive but not interactional effect. Clomipramine enhanced compliance both with exposure and with relaxation. Clomipramine is useful for compulsive ritualizers with depressed mood, but may need continuation for over a year and combination with exposure in vivo. Exposure in vivo remains the treatment of choice for rituals without depressed mood.

Adolescent↗
PubMed1980

Clomipramine and exposure for compulsive rituals: II. Plasma levels, side effects and outcome.

Forty obsessive-compulsive ritualizers received nightly placebo or clomipramine up to 225 mgs nocte for 8 months, and received behavioural treatment (exposure to vivo) from weeks 4 to 10. Plasma concentrations of clomipramine and its primary metabolite N-desmethylclomipramine steadily increased over the first 4 weeks of treatment after which they remained relatively steady. Plasma levels correlated significantly with dose and with outcome but not with side effects. Patients with plasma clomipramine levels in the range 100-250 ng/ml and N-desmethylclomipramine levels between 230-550 ng/ml were found to improve significantly more than patients outside these ranges, thus suggesting a therapeutic window for clomipramine and its primary metabolite.

Clomipramine↗
PubMed1980

Clomipramine: plasma levels, side effects and outcome in obsessive-compulsive neurosis.

The relationship between plasma levels of clomipramine and desmethylclomipramine and clinical response was studied in a group of patients with obsessive-compulsive neurosis. In general the response was best in the middle range of plasma concentrations, showing the inverted U curve well recognized with nortriptyline. However, the results of this study suggest that the response of compulsive rituals correlates with levels of plasma clomipramine, while depression appears to correlate with plasma levels of desmethylclomipramine. The former relationship may be the stronger. There may also be some relationship between side effects and relative plasma levels of clomipramine and desmethylclomipramine.

Adolescent↗
PubMed1980

Plasma concentrations of clomipramine and desmethylclomipramine in obsessive-compulsive neurosis.

Patients suffering from chronic obsessive-compulsive states were treated with clomipramine up to 200 mg/day according to tolerance for periods up to 8 months and their plasma clomipramine and desmethylclomipramine concentrations determined weekly by a double radioisotope derivative technique. Plasma concentrations of both the parent compound and its metabolite rose with dose and within 7-14 days of constant dosage reached steady states. A strong positive correlation was found between clomipramine, and to a lesser extent desmethylclomipramine, and the daily dose of clomipramine. In almost all patients plasma desmethylclomipramine concentrations exceeded those of unchanged drug by a factor of two or three.

Adolescent↗
PubMed1979

Cure and care of neurosis. I. Cure.

Behavioural psychotherapy has long historical roots. Recently it has led to effective treatment for selected neuroses, including phobic, obsessive-compulsive and sexual disorders. Potent therapy has become a tool of experimental psychopathology which advances theory and practice. A pervasive principle is exposure of the patient to those stimuli which evoke his discomfort until this subsides. Level of arousal during exposure does not affect outcome. Theoretical issues are reviewed which decide when exposure will be sensitizing or habituating. Both psychoanalytical and conditioning models of neurosis are out of date, and models derived more directly from clinical experiment are becoming possible. The aetiology of phobias and rituals can be seen as failed extinction rather than enhanced acquisition. Relevant phylogenetic and biological factors are discussed. At the other extreme, well-documented faith-healing indicates huge gaps in our knowledge of psychotherapy.

Antidepressive Agents, Tricyclic↗
PubMed1979

Morbid jealousy featuring as obsessive-compulsive neurosis: treatment by behavioral psychotherapy.

Morbid jealousy can occasionally be indistinguishable from obsessive-compulsive neurosis and then be partially amenable to broad-spectrum behavioural treatment. This can involve the partner and includes (a) methods to reduce jealousy and (b) other methods where appropriate, such as social skills training, and sex and marital therapy. This pilot study describes such treatment of four jealous out-patients. Rituals improved in three patients but ruminations in only one. Of three patients who were depressed at the start of treatment, two improved in rituals and in mood. The patient who failed was poorly motivated and did not comply with treatment.

Adult↗
PubMed1979

Nurse therapists in psychiatry: developments, controversies and implications.

This paper concerns a new clinical role for psychiatric nurses--as case managers for selected adult neurotics with behaviour problems. The role involves unusual autonomy. The selection and training procedures are unusually rigorous and focus on general case-management as much as behavioural skills. The number of service posts offered these therapists is rising. These developments have wide implications for other personnel, particularly in respect of authority and responsibility boundaries, selection and training procedures, and team structure.

Adult↗
PubMed1977

Social skills training of out-patient groups. A controlled study of rehearsal and homework.

Fifty-one out-patients with social skills deficits (two-thirds men) completed ten weekly sessions of 75-minute group treatment; 44 were followed up for a mean of 16 months. Random assignment was to one of three conditions: (I) Cohesive group discussion; (2) Modelling and role-rehearsal; or (3) Modelling and role-rehearsal + daily social homework. All three treatment conditions produced significant but incomplete improvement at the end of treatment and follow-up. The two role-rehearsal conditions were significantly superior to group discussion on several measures. Patients who completed daily social homework assignments did significantly better than patients who completed control homework. Alcohol and drug abuse patients usually dropped out. Schizophrenic patients in remission had lost their improvement at follow-up. Patients with other diagnoses retained their gains to 16-month follow-up.

Ambulatory Care↗