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Biomedical subjects

K P O'Connor

Publications and source records attributed to K P O'Connor.

At least 19 recordsLinked to original sources
PubMed2006

Cognitive behaviour therapy and medication in the treatment of obsessive-compulsive disorder.

OBJECTIVE: To compare cognitive behaviour therapy (CBT) with CBT plus medication; medication alone; and placebo in the treatment of adult obsessive-compulsive disorder (OCD). METHOD: Forty-eight participants (43 completers) were recruited into two protocols. In the first protocol, 21 people with OCD were randomly allocated to either a standard medication (fluvoxamine) or standard placebo condition for a 5-month period. Both these groups subsequently received CBT for a further 5 months. In the second protocol, 22 people with OCD received CBT, one group was already stabilized on an antidepressant of choice; the second group was drug naïve. RESULTS: All active treatments, but not the placebo, showed clinical improvement. There was no difference in treatment response to CBT regardless of whether participants had previously received medication or placebo. CONCLUSION: CBT has a more specific antiobsessional effect than medication but CBT plus medication shows greatest overall clinical improvement in mood.

Adult↗
PubMed2005

Evaluation of an inference-based approach to treating obsessive-compulsive disorder.

This study evaluated an inference-based approach (IBA) to the treatment of obsessive-compulsive disorder (OCD) by comparing its efficacy with a treatment based on the cognitive appraisal model (CAM) and exposure and response prevention (ERP). IBA considers initial intrusions in OCD (e.g. "Maybe the door is open", "My hands could be dirty") as idiosyncratic inferences about possible states of affairs arrived at through inductive reasoning. In IBA such primary inferences represent the starting point of obsessional doubt, and the reasoning maintaining the doubt forms the focus for therapy. This is unlike CAM, which regards appraisals of intrusions as the maintaining factors in OCD. Fifty-four OCD participants, of whom 44 completed, were randomly allocated to CAM, ERP or IBA. After 20 weeks of treatment all groups showed a significant reduction in scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Padua Inventory. Participants with high levels of obsessional conviction showed greater benefit from IBA than CAM. Appraisals of intrusions changed in all treatment conditions. Strength of primary inference was not correlated with symptom measures except in the case of strong obsessional conviction. Strength of primary inference correlated significantly with the Y-BOCS insight item. Treatment matching for high and low conviction levels to IBA and CAM, respectively, may optimize therapy outcome.

Adult↗
PubMed2002

Recollections of parent-child relationships in patients with obsessive-compulsive disorder and panic disorder with agoraphobia.

OBJECTIVE: In previous studies, patients with different psychiatric conditions, as compared with matched controls, have reported that their parents were more protective and less caring towards them when they were children. However, studies investigating associations between parental behaviours and anxiety disorders have yielded inconsistent results. The aim of this study was to compare recalled parental behaviours in out-patients with obsessive-compulsive disorder (OCD), in out-patients with panic disorder with agoraphobia (PDA), and in non-anxious controls. METHOD: The sample included 43 out-patients with OCD, 38 with PDA, and 120 controls. Participants completed the Parental Bonding Instrument and the Egna Minnen Beträffande Uppfostran or Own Memories of Parental Rearing Experiences in Childhood. RESULTS: No differences were found between the two anxious groups. However, compared with the control group, anxious patients recalled their parents as more protective. CONCLUSION: Our findings suggest that child rearing practices such as overprotection may be a risk factor in the development of anxiety disorders.

Adult↗
PubMed2002

A dialogical approach to obsessions.

Cognitive conceptualizations of obsessions based on the information-processing metaphor are contrasted with a dialogical approach to understanding obsessive compulsive disorder (OCD). The dialogical approach views obsessions as one-sided conversations. The unit of analysis is the narrative or 'voice', which engages the person in the neutralizing behaviour. The dialogical approach accommodates well the apparent paradox that obsessions are both self and other generated, and that people can be positioned differently regarding the senselessness of their obsessions at different times. Also, people themselves characterize their obsessions in dialogical terms as: voice, conversation, or argument. The focus of therapy is the language and power of the narrative rather than discrete cognitive biases or representations, and dialogical therapy emphasizes role-play and narrative techniques. Cognitive therapy has already shown signs of adopting a narrative turn, and cognitive and dialogical conceptualizations of OCD are alternative perspectives rather than competing explanations.

Cognitive Behavioral Therapy↗
PubMed2001

Evaluation of a cognitive-behavioural program for the management of chronic tic and habit disorders.

The aim was to evaluate the efficacy of a manualized cognitive-behavioural program based on habit reversal for the management of chronic tic disorder (CTD) and habit disorder (HD). Forty-seven CTD and 43 HD received a 4-month treatment program. Thirty-eight (22 CTD, 16 HD) were placed on a waitlist control group, which subsequently received treatment. The treatment approach combined awareness training, relaxation (including modification of a tension-producing style of action), and habit-reversal training, with more general cognitive restructuring of anticipations linked to ticcing. Sixty-five percent of completers reported between 75 and 100% control over the tic. At 2-year follow-up, 52% rated 75-100% control. There were also significant changes post-treatment in measures of self-esteem, anxiety, depression and style of planning action. Successful tic/habit modification was associated in CTD and HD groups with successful change in style of planning action. There were no consistent differences in any outcome measures between CTD and HD groups.

Adolescent↗
PubMed2001

Clinical and psychological features distinguishing obsessive-compulsive and chronic tic disorders.

Medical and biogenetic research has suggested that obsessive-compulsive disorder and chronic (multiple) tic disorder may share a common etiology. This article reviews corresponding evidence for psychological similarities and differences between the two disorders. There are similarities in self-management strategies, psychological traits (both report high scores on different aspects of perfectionism) and in the ego-syntonic-ego-dystonic cycle of the impulsive-compulsive behavior. Situational cues likely to elicit or worsen the problem differ between the disorders as do associated emotions, comorbidity and background styles of action. In both disorders, cognitive factors, such as anticipations and appraisals of the problem, can play a role in onset and maintenance of the problem, and this raises the question as to whether cognitive or behavioral factors are best addressed in treatment. Psychological characteristics, such as lack of confidence, may contribute to apparent performance deficit. Psychological evaluation, particularly functional analysis, may aid in differential diagnosis between the two disorders, lead to improvement in treatment matching, and in understanding of the multidetermined etiology.

Adult↗
PubMed1995

Construing contexts: problems and prospects of George Kelly's personal construct psychology.

Kelly's concept of man is that of a scientist formulating hypotheses about the world and revising them in the light of their predictive utility. His position is one of subjective realism by which each of us interprets the world according to personal dimensions termed constructs. Establishing knowledge about how others construe the world is made possible in clinical situations by recourse to two Kellyan methods: the character sketch and the role construct repertory test. The former relies on clinical observation, the latter on statistical sophistication. This divergence in methods has led to an ideological split in the following that Kelly spawned, which need not, however, be a barrier to clinical research in this field. Although not all cognitive therapists are constructivists, they share with the latter the desire to look for core patterns underlying individual maladaptive thoughts and actions. Kelly's methods can be applied to the functional analysis favoured by cognitive behaviourists, with clinical gains resulting from the quicker access this provides to personal meaning. But cognitive psychology's schematic approach to organization is a challenge to Kelly's, which conceives of everyday experience solely in terms of the logical nature of construing. Some constraints and assumptions of Kelly's dialectical logic may be avoided by adopting a more phenomenological approach to construing.

Cognitive Behavioral Therapy↗
PubMed1994

Personal constructs associated with tics.

Thirteen subjects experiencing chronic tics kept diaries noting frequency, intensity and degree of control of their tic during their daily routines for one week. Three examples of high-, medium- and low-risk situations were chosen as elements and, using a modified form of Kelly's repertory grid, bipolar constructs were elicited by comparing the three types of situations. Principal dimensions extracted from INGRID analyses differed across individuals but related to three principal areas; self-image, degree of task involvement and type of task demand. Feelings of impatience and frustration frequently accompanied tic onset. Subjects' cognitive evaluations of their tic situations may be important in tic management.

Adult↗
PubMed1993

Acute scrotal swelling in Henoch-Schonlein syndrome: evaluation with testicular scanning.

Acute scrotal swelling may accompany Henoch-Schonlein syndrome and may be the presenting manifestation mimicking testicular torsion. Two patients with scrotal involvement were recently evaluated with nuclear imaging to assess testicular perfusion. One patient had normal perfusion, and the other had increased perfusion. Scan results allowed expectant management and avoided the need for exploratory surgery to rule out testicular torsion.

Acute Disease↗
PubMed1993

The diagnosis of acute pyelonephritis in the piglet using single photon emission computerized tomography dimercaptosuccinic acid scintigraphy: a pathological correlation.

Single photon emission computerized tomography (SPECT) scintigraphy has proved to be an extremely sensitive renal imaging modality in children with genitourinary pathology, including pyelonephritis, particularly when compared to 2-dimensional planar imaging. This study was undertaken to corroborate SPECT dimercaptosuccinic acid (DMSA) scintigraphic findings with specific histopathology in acute pyelonephritis. Unilateral vesicoureteral reflux was produced in 19 Yorkshire piglets 3 to 4 weeks old. The bladders of 12 animals were inoculated with Escherichia coli 2 weeks later, after baseline SPECT DMSA scans had been obtained. The animals were then re-imaged at 3 (4), 7 (4) or 14 (4) days after infection and sacrificed for histological evaluation. Seven purposefully uninfected piglets with unilateral reflux served as controls and were followed for up to 6 weeks before imaging and sacrifice. SPECT proved to be 97% sensitive and 93% specific in providing the diagnosis of acute pyelonephritis. The SPECT findings were manifest by a spectrum of abnormal findings (mottling, striations, inner cortical scalloping and focal cortical defects), which correlated precisely with the extent and severity of cortical involvement in the acute pyelonephritic process. We propose a new classification scheme for SPECT DMSA renal scintigraphic imaging, and believe that this modality is exquisitely sensitive in providing the diagnosis as well as in evaluating the extent of renal parenchymal involvement when acute pyelonephritis is induced in the animal model.

Acute Disease↗
PubMed1993

Changes in construals of tic-producing situations following cognitive and behavioral therapy.

12 clients suffering from chronic tics participated in one of two treatment programs, either a behavioral group using competing response therapy or a group using Beck-style cognitive restructuring. A repertory grid based upon the personal construct psychology of George Kelly was administered to all clients before and after treatment. The grid comprised a set of elements made up of situations with high, medium, and low risk of eliciting tics, and constructs were derived from comparisons between them. Clients' ratings of the elements on the constructs were subjected to a principal components analysis using an INGRID program. Following treatment the total variation around construct means decreased in both groups but significantly more in the cognitive group, indicating a narrowing of the difference in their perceptions of situations which formerly indicated high and low risk of inducing tics.

Adult↗
PubMed1989

Priapism: current concepts.

The treatment options for the management of the patient with priapism have changed markedly within the past several years. When possible, the underlying cause of the priapism should be identified. Therapy should be guided by the results of aspiration of the blood-filled corpora cavernosa of the erect penis. Early intervention through pharmacologic manipulation or surgical shunting should not be delayed while trying conservative measures.

Adrenergic alpha-Agonists↗
PubMed1989

Evaluation of a computer interview system for use with neuro-otology patients.

The effectiveness, feasibility and credibility of a computer assessment package was evaluated in a group of 60 neuro-otological outpatients. The computer system was compared with a standard questionnaire and used to elicit basic neuro-otological information prior to clinical interview. The majority of patients (81%) preferred computer assessment. There were no differences in attitude or difficulties between diagnostic groups. Older patients had more difficulties and took longer than younger patients. The computer system was also more efficient than the form from an information handling and administrative point of view.

Attitude to Computers↗
PubMed1988

Dizziness: behavioural, subjective and organic aspects.

The aim of the study was to investigate the relationship between medical and behavioural aspects of dizziness, and the subjective experiences before, during and after an 'attack'. Clinical and self-report data were collected on 60 patients who attended a neuro-otology clinic and whose main complaint was dizziness. The results indicated little direct correlation between subjective experience and organic severity, though there was some correlation between types of movement provocation and both subjective and organic factors. Correspondence analysis of self-reported dizzy sensations revealed four principal clusters. There was a clear distinction between attacks characterized by sensations of actual loss of balance and those preceded by autonomic sensations. Two types of mainly psychologically generated dizziness were proposed: one characterized by inhibition of sensory-motor processes and breathing problems; the other by a range of sympathetic signs. It is suggested that the reporting of sensations should be considered as an independent part of dizziness behaviour and not as a by-product of the physiological disturbance.

Adolescent↗
PubMed1984

Cognitive style, cortical function, and electroconvulsive therapy.

Performance on the rod and frame test (RFT) was measured over three separate occasions in three groups of 20 depressive patients and a nonpatient control group. Depressive patients were selected into three groups according to whether they had been prescribed one of three forms of treatment: bilateral electroconvulsive therapy (ECT), nondominant unilateral ECT, or a course of antidepressant drugs. The RFT was administered on three occasions: before treatment, 1 week after completion of treatment, and at 3 months follow-up. The control group received no treatment, but were tested at comparable periods. The RFT was scored as mean absolute error and also as separate frame-dependent, rod-dependent, and constant error components. All depressive groups showed improved error measures post-treatment. The two ECT groups showed less frame dependence post-treatment than the drug group. The group receiving bilateral ECT showed a greater decrease in the mean error of performance than the unilateral group. Right-sided unilateral ECT affected frame dependence in patients who were initially frame independent, rather than in those who were initially frame dependent. The results indicated that the effect of ECT may depend on a patient's initial pretreatment cognitive style.

Antidepressive Agents↗