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Biomedical subjects

I M Marks

Publications and source records attributed to I M Marks.

At least 109 records · Page 6Linked to original sources
PubMed1977

Pharmacokinetic studies in obsessional patients.

As part of a larger controlled study, 9 patients with chronic obsessive-compulsive rituals received oral clomipramine (Anafranil, Geigy Pharmaceuticals) and behavioural treatment. Dosage was 20 mg clomipramine during the first three days of treatment, increasing gradually over the next few weeks to a maximum daily dose of 200 mg clomipramine unless side-effects dictated a lower dose. Blood was sampled at weekly intervals and the plasma fraction analyzed simultaneously for clomipramine and its primary metabolic breakdown product, N-desmethylclomipramine, using a double radioisotope derivative technique. Plasma concentrations of clomipramine and desmethylclomipramine were observed to rise as the administered dose was increased during the first few weeks of treatment. However, within seven to fourteen days of constant daily dosing steady-state levels were reached in the plasma of clomipramine and its metabolite. Higher plasma levels were found with higher doses. Steady plasma clomipramine levels appeared to be related to dosage, the mean steady-state plasma concentrations between weeks 5 and 11 of treatment being 99 ng/ml, 145 ng/ml and 180 ng/ml, in patients receiving daily doses of 100, 150 and 200 mg clomipramine, respectively. In contrast, plasma metabolite levels did not show any apparent relationship to dosage. In most patients, the concentration of desmethylchlomipramine in the plasma was approximately twice that of the parent compound.

Adolescent↗
PubMed1976

Feedback of true heart rate during exposure in vivo. Partial replication with methodological improvement.

Ten specific phobics improved during a mean of two sessions of experimental treatment by exposure in vivo in a balanced design. Short-term results replicated those of a previous study that self-control of heart rate with the aid of biofeedback significantly reduced heart rate during treatment, but this did not hasten reduction of subjective anxiety, nor of respiratory rate or skin conductance responses. An hour's pretreatment training in self-control of heart rate with the aid of feedback did not enhance the effect. Mere instructions to lower heart rate without feedback had a significant effect during treatment, but the addition of heart rate feedback to instructions significantly augmented the decline in heart rate.

Adolescent↗
PubMed1976

The current status of behavioral psychotherapy: theory and practice.

Behavioral psychotherapy has become one of the definitive treatments available for the relief of psychiatric suffering. Although hardly a panacea for all ills, the behavioral approach is the treatment of choice for certain selected problems. Behavioral methods make their contribution in the context of general psychiatric management and often must be used in conjunction with other treatment. The theoretical and practical aspects of behavioral psychotherapy have changed a great deal over the past few years and continue to evolve rapidly. Although useful molecular theories are emerging to guide the discipline, no global theory is likely to be satisfactory in the foreseeable future.

Anxiety↗
PubMed1975

Nurse therapists in behavioural psychotherapy.

Five registered mental nurses (R.M.N.s) were trained over two years to become behavioural psychotherapists for adult neurotic disorders. They achieved results comparable to those obtained with similar patients and methods by psychologists and psychiatrists. Similar results were maintained when over a third year the therapists were seconded to work in four hospitals and a general practice. Patients were satisfied at being treated by nurses. After initial teething difficulties nurse therapists became valuable members of treatment teams during both training and secondment, becoming accepted by most nurses, psychologists, and psychiatrists with whom they came into contact. The training of further nurse therapists would facilitate treatment of many disabled neurotics who would otherwise go without effective treatment. Training nurse therapists takes less time and money than training psychologists and psychiatrists because less of their education is redundant to the skills involved. The pool of R.M.N.s suitable for training is much larger than that of psychiatrists and psychologists. The nurse therapists can be integrated relatively easily into treatment teams. The present nursing structure imposes restrictions on the advancement of clinical nurse specialists and a clinical tree is badly needed parallel with present administrative and teaching hierarchies. An 18-month course in adult behavioural psychotherapy has been recognized by the Joint Board of Clinical Nursing Studies for England and Wales so that nurse therapists seem destined to be a lasting feature of future treatment teams.

Adult↗
PubMed1975

Feedback of true heart rate during exposure in vivo.

Ten women with specific chronic animal phobias were treated by graded exposure in vivo in two to four two-hour treatment sessions. Sessions were divided into four balanced half-hour epochs, half with visual feedback of true heart rate plus instructions to lower heart rate during approach to phobic stimulus. All patients improved significantly from the start to end of sessions on heart rate and on subjective anxiety. Feedback of heart rate plus instructions to lower it substantially reduced heart rate during epochs of feedback, compared to non-feedback epochs without instructions, but this effect did not generalize to skin conductance or to subjective anxiety in our short-term experiment.

Adult↗
PubMed1975

Treatment of chronic obsessive-compulsive neurosis by in-vivo exposure. A two-year follow-up and issues in treatment.

Twenty patients with chronic obsessive-compulsive rituals were treated in a partially controlled design by in-vivo (real life) exposure with self-imposed response prevention. Treatment included 4-12 weeks as in-patients, and lasted a mean of 23 sessions. All patients were followed-up for at least two years. No patients dropped out during the trial, though one refused domiciliary treatment after discharge. Significant improvement in compulsions was found after three weeks of real-life exposure, and continued during follow-up. At two years follow-up 14 patients were much improved, one improved and 5 unchanged; in a third year of follow-up the improved patient became symptom-free after further exposure treatment. Improvement after three weeks exposure predicted good outcome at 6 and 12 months follow-up. Muscular relaxation treatment had no significant effect on rituals. Modelling of exposure conferred no advantage over exposure alone for the group as a whole, though it may help selected patients. The role of response prevention is unknown. Patients' commitment to treatment facilitates exposure. Domiciliary treatment with involvement of family members in therapy seems crucial in some cases. Pilot group treatment of patients and families together suggests that this may be a useful adjuvant to individual treatment by increasing motivation and aiding follow-up. Compulsive slowness presents special treatment problems but can be improved by a prompting and pacing approach. The course of rituals was often independent of that of agoraphobia, marital problems and depression where these had initially coexisted with rituals. Depressive episodes were common before, during and after treatment, and required tricyclic medication. The trial sample was predominantly female but was otherwise typical of patients with compulsive rituals. Of the 125 obsessive-compulsives seen in the first author's unit over four years 96 per cent were offered behavioural or anti-depressant treatment. One quarter refused behavioural treatment after it was offered. Real-life exposure with self-imposed response prevention is usually an effective procedure for lasting reduction of chronic compulsive rituals in well motivated patients.

Adult↗
PubMed1973

Psychiatric nurse as therapist.

Under supervision five nurse-therapists have treated phobic patients as successfully as have psychiatrists and psychologists using similar psychological treatments in comparable psychiatric populations. Nurses have also had good results in other neurotic disorders. Intensive training is required. Nurse-therapists find their work rewarding, but the present Salmon gradings make no provision for their advancement should they retain their clinical function. Results suggest that the use of selected psychiatric nurses as skilled therapists can ease the current critical shortage of treatment personnel in psychiatry.

Abreaction↗