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Biomedical subjects

I Marks

Publications and source records attributed to I Marks.

At least 91 records · Page 5Linked to original sources
PubMed1988

Drugs and psychological treatments for agoraphobia/panic and obsessive-compulsive disorders: a review.

In the short term, both antidepressants and exposure therapy usually improve agoraphobia/panic (AP) and obsessive-compulsive (OC) disorders and are accepted by most patients; psychological methods omitting exposure are not consistently helpful. Antidepressants have a broad-spectrum rather than specific anti-agoraphobia/panic or anti-obsessive-compulsive action. For long-term efficacy, there is good evidence for the value of exposure, but none for drugs. Because of relapse on ceasing drugs, and their side-effects, medication is less useful as the first line of treatment for chronic agoraphobia/panic or obsessive-compulsive disorder than is the lastingly helpful approach of exposure. Antidepressants are worth trying when patients refuse or fail with exposure therapy, or are dysphoric.

Agoraphobia↗
PubMed1987

Phobias and their management.

Disabling phobias and phobia like compulsive rituals are surprisingly common in the general population, though only a minority ask for help. Behavioural treatment (exposure) and antidepressants are the most helpful approaches. Most patients can help themselves if they use a self exposure approach systematically under the guidance of a clinician. The method seems well suited for use by general practitioners. Anti-depressants are a useful adjuvant, not a substitute, for exposure when there is evidence of depression complicating the phobias or rituals.

Behavior Therapy↗
PubMed1987

The development of normal fear: a review.

This review synthesizes literature on how human and other mammalian young develop fear. After an early attachment period there is a rise and fall of certain fears in an ontogenetic sequence. Observation and experiment show how experiential, maturational and genetic factors interact in fears of heights, novelty, strangers and separation.

Animals↗
PubMed1986

Behavioural and drug treatments of phobic and obsessive-compulsive disorders.

The two most-used treatments for phobic and obsessive-compulsive disorders are exposure and drugs. In exposure therapy, the patient is persuaded to re-enter the phobia- or ritual-evoking situation and to stay there despite the ensuing panic until it starts to subside, which may take 1 h or more. The patient does this repeatedly and systematically, noting outcome in an exposure-homework diary which the clinician reviews. Controlled studies show that such self-exposure treatment (requiring little time from the clinician) has lasting value. Only a minority of cases need additional therapist-aided exposure. Antidepressants are useful adjuvants to exposure in dysphoric phobics and ritualisers. No antidepressant is clearly superior to any other. Relapse on stopping medication is a problem. Neither beta-blockers nor benzodiazepines are yet of proven lasting value for these syndromes. It is too easy to forget that drugs have unpleasant side-effects which are not seen with exposure therapy.

Agoraphobia↗
PubMed1985

Controlled trial of psychiatric nurse therapists in primary care.

In a randomised controlled clinical trial neurotic patients (mainly phobic and obsessive-compulsive) did significantly better up to one year follow up after receiving behavioural psychotherapy from a nurse therapist rather than routine treatment from a general practitioner. At the end of the year control patients who had not improved had crossover behavioural treatment from the nurse and then improved. Those who dropped out or refused therapy did not show worthwhile gains. Patients preferred being treated in the primary care setting rather than in hospital. Placing nurse therapists in primary care is not only viable but may save more health care resources than it consumes.

Adult↗
PubMed1985

Behavioral psychotherapy for anxiety disorders.

Behavioral psychotherapy is probably the treatment of choice for most phobic and obsessive-compulsive disorders and plays a lesser role in the management of panic disorder without agoraphobia, generalized anxiety disorder, and posttraumatic stress disorder. This article discusses treatment goals and strategies for each disorder.

Abreaction↗
PubMed1984

Cost-benefit analysis of a controlled trial of nurse therapy for neuroses in primary care.

In a randomized, controlled trial neurotic patients (mainly phobics and obsessive-compulsives) in primary care were assigned to behavioural psychotherapy from a nurse therapist or to routine care from their general practitioner. At the end of one year clinical outcome was significantly better in patients cared for by the nurse therapist. Economic outcome to one year, compared with the year before entering the trial, showed a slight decrease in the use of resources by the nurse therapist group (N = 22), and an increase in resource usage in the GP-treated group (N = 28), mainly due to the latter's increased absence from work and more hospital treatment and drugs. On the reasonable assumptions that nurse therapists treat 46 patients a year and that such patients treated behaviourally maintain their gains for 2 years, the economic benefits to society from nurse therapists treating such patients may outweigh the costs. This excludes any monetary value on the substantial clinical gains such as reduction in fear and anxiety. However, the numbers are small, few economic differences were significant, and many patients either did not complete the trial or waiting-list periods or they failed to return economic data. Conclusions must thus be tempered with caution, even though pre-treatment demographic and clinical data of non-returners were comparable with those of returners, and though the few drop-outs who could be rated at one year had not improved. The findings cannot be extrapolated to other types of clinical problem and treatment.

Behavior Therapy↗
PubMed1983

Panic disorder.

Explore the source record for details and available documents.

Agoraphobia↗
PubMed1983

Are there anticompulsive or antiphobic drugs? Review of the evidence.

Review of 19 uncontrolled studies of antidepressants in phobic and in obsessive-compulsive disorders suggests that such drugs do not act reliably in the absence of symptoms of anxiety-depression (dysphoria). In dysphoric patients the drugs have a broad-spectrum effect, not only reducing phobias and rituals but also anxiety-depression, panic, anger, and hostility, all of which are highly intercorrelated, but none yet demonstrated to be the core disturbance. Phobics, but not obsessive-compulsives, have an unusually high dropout rate from treatment when drugs or placebo are given. When antidepressants are stopped, even after 6-8 months, relapse is likely. The drugs do not reduce the liability of many phobics and obsessive-compulsives to have dysphoric episodes over the years. Exposure treatments are not lastingly effective for phobias and for rituals, but do not reduce the liability to later dysphoric episodes.

Adult↗
PubMed1983

Comparative studies on benzodiazepines and psychotherapies.

BZD may have some temporary palliative value in reducing anxiety over the short-term, but have not yet been shown to be of lasting value for neuroses either on their own or with any form of psychotherapy. When the drug is withdrawn, at best the effects do not persist and at worst there are severe side effects after withdrawal. 3 controlled studies of diazepam have been completed in phobics having exposure. In two of these there was a slight temporary gain when diazepam was combined with exposure, but the only study to have followup found that this gain dissipated within a month. Uncontrolled evidence suggests that high doses of BZD might actually impede improvement during exposure treatment of phobics . In contrast, exposure treatment is enduringly effective and can often be self-administered with minimum guidance from the therapist.

Agoraphobia↗