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Biomedical subjects

M A Oakley-Browne

Publications and source records attributed to M A Oakley-Browne.

At least 19 recordsLinked to original sources
PubMed2001

EBM in practice: psychiatry.

Psychiatry was one of the first medical specialties to use the tools of evidence-based medicine (EBM)--randomised controlled trials (RCTs), systematic reviews with meta-analyses--and as many treatment decisions in psychiatry are evidence-based as in general medicine. Psychiatrists have some reservations about the EBM approach because of perceived limitations in methodology of RCTs and systematic reviews; gaps in the evidence base; problems interpreting the available evidence; and neglect of individual patient uniqueness in quantitative research based on groups or populations. Research supports the value of psychotherapy and there are now a number of empirically validated efficacious psychotherapies for a range of disorders.

Evidence-Based Medicine↗
PubMed2000

Interventions for pathological gambling.

BACKGROUND: With the legalization of new forms of gambling there are increasing numbers of individuals who appear to have gambling related problems and who are seeking help. The individual and societal consequences are significant. Pathological gambling can result in the gambler jeopardizing or losing a significant relationship or job and committing criminal offences. Pathological gamblers may develop general medical conditions associated with stress. Increased rates have been reported for mood disorders, attention-deficit/hyperactivity disorder, substance abuse or dependence. There is a high risk of suicide and a high correlation with antisocial, narcissistic and borderline personality disorders and alcohol addiction. With increasing public awareness of gambling related problems health funders and practitioners are asking questions about the efficacy of treatments. Consequently quality research into gambling treatment is crucial. OBJECTIVES: The objective of this review was to complete a systematic review and meta-analysis of all randomised controlled trials (RCTs) of psychological and pharmacological treatments for pathological gambling, from both published and unpublished scientific reports. SEARCH STRATEGY: Published and unpublished RCTs of treatments of pathological gambling were identified by searches of electronic databases and hand searching journals likely to contain RCTs of gambling treatments. Researchers and gambling treatment centres were contacted by letter. Bibliographies of all identified research studies were scanned to identify other relevant references. SELECTION CRITERIA: All RCTs of treatments for pathological gambling were eligible for inclusion. DATA COLLECTION AND ANALYSIS: The data was entered into the Cochrane Review Manager software (REVMAN). The component RCTs were quality rated, with special emphasis on the concealment of treatment allocation and blinding. Relative risk analyses were conducted for the dichotomous outcome of controlled vs. uncontrolled gambling. The relative risks were aggregated using both fixed and random effects models. Tests for heterogeneity were undertaken. Both short-term (1 month or less) and long-term (6 months or longer) outcomes were considered. MAIN RESULTS: Only four RCTs of psychological treatments were identified. These RCTs were heterogeneous in terms of design, interventions, outcome measurement and follow-up periods. All had small numbers of participants. The studies had poor methodological quality features. The experimental interventions, behavioural or cognitive-behavioural therapy (BT/CBT), were more efficacious than the control interventions in the short-term (relative risk 0.44, 95% confidence interval (CI) 0.24-0. 81). There was a trend for long-term treatment with BT/CBT to be more efficacious than the control treatments, but the statistical significance of this was sensitive to the statistical model used for meta-analysis. With a fixed effect model the relative risk was 0.56 (95% CI 0.33-0.95); the relative risk with a random effects model was 0.61 (95% CI 0.25-1.47). REVIEWER'S CONCLUSIONS: This systematic review revealed a paucity of evidence for effective treatment of pathological gambling. As gambling is becoming more accessible in many countries and there is epidemiological evidence of increasing rates of pathological gambling, more rigorous RCTs are required.

Behavior Therapy↗
PubMed1997

The cross-national epidemiology of panic disorder.

BACKGROUND: Epidemiological data on panic disorder from community studies from 10 countries around the world are presented to determine the consistency of findings across diverse cultures. METHOD: Data from independently conducted community surveys from 10 countries (the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand), using the Diagnostic Interview Schedule and DSM-III criteria and including over 40,000 subjects, were analyzed with appropriate standardization for age and sex differences among subjects from different countries. RESULTS: The lifetime prevalence rates for panic disorder ranged from 1.4 per 100 in Edmonton, Alberta, to 2.9 per 100 in Florence, Italy, with the exception of that in Taiwan, 0.4 per 100, where rates for most psychiatric disorders are low. Mean age at first onset was usually in early to middle adulthood. The rates were higher in female than male subjects in all countries. Panic disorder was associated with an increased risk of agoraphobia and major depression in all countries. CONCLUSIONS: Panic disorder is relatively consistent, with a few exceptions, in rates and patterns across different countries. It is unclear why the rates of panic and other psychiatric disorders are lower in Taiwan.

Adolescent↗
PubMed1996

Family history of depression in clinic and community samples.

Because most published family studies of depression ascertained subjects from treatment settings, the reported familial aggregation of depression could be an artifact if a family history of depression increased the likelihood of seeking treatment. To investigate this possibility, we compared the family history of depression in three groups of probands aged 18-44; 54 women randomly selected from the community with depression in the prior year, 41 women who entered a clinical trial for depression and 37 women randomly selected from the community who had not been depressed in the prior year. The presence of depression in the parents and siblings of the probands was assessed by the family history method and quantified via family history scores which took the age, gender and number of relatives into account. Depressed probands ascertained from clinical sources had markedly higher family history scores of depression than other two groups (P < 0.00005 in each instance). In the absence of direct interviews with relatives, we cannot exclude the impact of differential reporting. A family history of depression might be associated with an increased probability of treatment or the differential reporting of family history. It is thus possible that the familial aggregation of depression observed in probands from treatment settings is an artifact.

Adolescent↗
PubMed1996

Intimate bonds in depression.

There is considerable interest in the relationship between interpersonal relationships and mood disorders. The Intimate Bond Measure (IBM) assesses the respondent's perception of their partner over recent times. IBM care scores have been reported to be independent of depression severity and personality, to distinguish between melancholic and non-melancholic depressives, and to predict treatment outcome. In a sample of 105 depressed patients, IBM care measures were independent of depression severity and personality measures, but they did not distinguish between melancholic and non-melancholic depressives, and did not predict treatment outcome. When the sample was restricted to individuals who had been previously treated, IBM care measures did distinguish between melancholic and non-melancholic depressives, although they still did not predict treatment outcome. Possible implications of these findings are discussed.

Adolescent↗
PubMed1996

Impulsivity in disordered eating, affective disorder and substance use disorder.

BACKGROUND: Failure to control impulsive behaviour has been postulated as an underlying mechanism common to substance use disorder, sociopathy and to a substantial subgroup of women with bulimia nervosa. METHOD: Three hundred and one women recruited to a general population study were selected either at random or because they had lifetime substance use disorder, affective disorder or symptoms of bulimia. A subsequent interview determined the existence of problems with impulsivity. Behaviour that is an integral part of a DSM-III axis 1 disorder was excluded from the impulsivity measure. RESULTS: Similar rates of impulsivity were found in all three of these types of disorder, and this was little different from the rate found in the women selected randomly from the general population. However, among those with comorbid disorder there was more impulsivity, and the more comorbid disorders found, the higher the proportion with problems of impulsivity. CONCLUSIONS: Because those in treatment facilities are more likely to have other comorbid disorders (Berkson's bias), findings derived from observations of women with bulimia who are in treatment may be compromised by selection bias and may have limited applicability to those with the disorder who are not in treatment.

Adolescent↗
PubMed1995

Adverse parenting and other childhood experience as risk factors for depression in women aged 18-44 years.

65 women who had experienced a recent major depressive disorder, and 81 women who had never been depressed, were recruited from a community probability sample. The two groups of women were compared with regard to a number of childhood experiences, including parenting style, which was assessed with the Parental Bonding Instrument (PBI). When all the childhood factors were considered simultaneously in a logistic regression analysis, only low maternal care was significantly associated with recent depressive episodes. Low maternal care increased the risk of recent major depression approximately 4-fold and the estimate of the population attributable risk was 35%. These findings give further weight to the contention that adverse parenting in childhood, particularly a maternal parenting style typified by low care, is a significant risk factor for adult depression.

Adolescent↗
PubMed1994

Perceived barriers to care in St. Louis (USA) and Christchurch (NZ): reasons for not seeking professional help for psychological distress.

This paper examines perceived barriers to mental health care reported in two very similar community surveys in two cities that are not only on opposite sides of the world but that differ substantially in their health care systems, their size, and their mix of ethnic groups, namely, St. Louis in the United States and Christchurch in New Zealand. Respondents were asked about mental health care ever received, any failure to seek care when required, and symptoms of 14 psychiatric disorders according to DSM-III. The frequency with which respondents reported not seeking care and the popularity of specific reasons for not seeking care were almost identical in the two sites. A common reason offered for not seeking care was doubt about the need for professional help; this appeared to be particularly common for people with alcohol disorder. Respondents who said that they had failed to seek care when needed gave reasons that were mainly attitudinal, such as believing they should be strong enough to cope without professional help. Structural characteristics of services such as cost, times open, and travel distance were given less often. Sociodemographic factors had small or negligible effect on care seeking.

Adaptation, Psychological↗
PubMed1994

Bulimia comorbidity in the general population and in the clinic.

This study compares rates of comorbidity of lifetime psychiatric disorder in a clinical sample of women with bulimia, with general population base rates, and with rates of comorbidity among bulimic women in the general population. Eighty-four per cent of the clinical sample of bulimic women had a lifetime affective disorder, and 44% a lifetime alcohol or drug disorder. These rates of disorder were significantly higher than the base rates in the general population. Bulimic women in the general population also had more affective and substance-use disorders than the general population base rates, but the rates of these disorders were lower than found in the clinical sample. In the general population, quite similar rates of other disorders including generalized anxiety, panic, phobia and obsessive-compulsive disorder, are found among those with bulimia, substance-use disorder and depression. Furthermore, among those with depression and substance-use disorder in the general population, rates of eating disorder are comparable. Rather than suggesting a specific relationship between bulimia and either depression or substance-use disorder, the data from this study suggest that the presence of any disorder is associated with a non-specific increase in the likelihood of other psychiatric disorder.

Adolescent↗
PubMed1994

The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group.

Data on the epidemiology of psychiatric disorders from different parts of the world using similar methods and diagnostic criteria have previously not been available. This article presents data on lifetime and annual prevalence rates, age at onset, symptom profiles, and comorbidity of obsessive compulsive disorder (OCD), using DSM-III criteria, from community surveys in seven countries: the United States, Canada, Puerto Rico, Germany, Taiwan, Korea, and New Zealand. The OCD annual prevalence rates are remarkably consistent among these countries, ranging from 1.1/100 in Korea and New Zealand to 1.8/100 in Puerto Rico. The only exception is Taiwan (0.4/100), which has the lowest prevalence rates for all psychiatric disorders. The data for age at onset and comorbidity with major depression and the other anxiety disorders are also consistent among countries, but the predominance of obsessions or compulsions varies. These findings suggest the robustness of OCD as a disorder in diverse parts of the world.

Adolescent↗
PubMed1992

Long-term effects of intrafamilial sexual abuse in childhood.

This study reports results from follow-up interviews with 301 women aged 18-44 years who were first identified 2 years earlier in a cross-sectional study of 1498 adults in the general population of the city of Christchurch, New Zealand. The prevalence of intrafamilial sexual abuse was 13%. This incestuous sexual abuse in childhood was associated with an increase in many adult mental symptoms, particularly symptoms of depression, bulimia and generalized anxiety. In this community study the consequences associated with sexual abuse within the family appear to be widespread and not very specific, and show as additional comorbidity rather than as increased severity within a disorder. These results do not support the strong direct causal effects postulated in some theories derived from clinical studies.

Adolescent↗
PubMed1991

Preventing alcohol problems: the implications of a case-finding study in Christchurch, New Zealand.

In 1986 the Christchurch Psychiatric Epidemiology Study obtained 1498 interviews using the Diagnostic Interview Schedule. Respondents were from a probability sample of adults aged 18-64 years. This article reports results relevant to preventing alcohol problems. The symptoms most likely ever to be experienced were types of heavy drinking (7-22%) and their consequences such as blackouts (13%). Thirty-two percent of men and 6% of women had met criteria for alcohol disorder prior to interview. The predictors of alcohol disorder were gender, childhood conduct disorder symptoms, early drunkenness, family breakdown and age of leaving school. Cohort effects were clear for onset of drunkenness and alcohol problems. The median duration of alcohol problems was at least 10 years, indicating scope for secondary prevention. General practice and hospitals appeared to be the most suitable places for intervention.

Adolescent↗
PubMed1990

Christchurch psychiatric epidemiology study: use of mental health services.

Use of health and mental health services by the 1498 adults in the Christchurch psychiatric epidemiology study is reported. Fourteen percent of the sample had visited a health service for help with mental health problems over the preceding six months. Of those with identified psychiatric disorder during the last six months, only 29% had over that period visited a health service or professional for a mental health consultation though 75% had sought health care. Mental health consultations were more commonly with general practitioners than with mental health specialists, the latter seeing only one in seven of those with recent disorder. Those who at some point in their lives had not sought help, even though they or others had considered it necessary, reported the reasons to be attitudinal rather than to do with practical concerns such as finance, time or access to care.

Adolescent↗
PubMed1990

Birth cohort trends in major depression: increasing rates and earlier onset in New Zealand.

In a community sample of 1498 urban adults (18-64 years) interviewed in their homes with the Diagnostic Interview Schedule (DIS), the 6-month and lifetime prevalence of major depression was higher in females than males. However, in the most recent birth cohort young men had a higher 6-month prevalence of depression. Survival analysis of the cumulative lifetime risk for major depression demonstrated a significant trend in both sexes for depression to be increasing in prevalence, and for it to be occurring at an earlier age. Thus New Zealand, like other countries, may be entering an age of melancholy.

Adolescent↗
PubMed1990

Prevalence of three bulimia syndromes in the general population.

Prevalence of bulimia was estimated from a cross-sectional general population survey of 1498 adults, using the Diagnostic Interview Schedule (DIS) administered by trained lay interviewers. Lifetime prevalence of the DSM-III syndrome in adults aged 18-64 was 1.0% and this was concentrated in young women: in women aged 18-44 lifetime prevalence was 2.6%, and 1.0% currently had the disorder. Based on clinicians' reinterviews of random respondents and identified and marginal cases, the prevalence of current disorder using criteria for draft DSM-III-R bulimia was 0.5%, for DSM-III it was 0.2%, and for Russell's Criteria bulimia nervosa 0.0%. A strong cohort effect was found, with higher lifetime prevalence among younger women, which is consistent with a growing incidence of the disorder among young women in recent years. Although elements of the syndromes were so common as to suggest that dysfunctional attitudes to eating and disturbed behaviour surrounding eating are widespread, there was little evidence of the bulimia syndrome having become an epidemic on the scale suggested by early reports.

Adolescent↗
PubMed1989

Factors affecting the use of mental health services in people with alcohol disorders.

In a preliminary analysis of data from a community survey of psychiatric disorders in urban Christchurch, 157 of the 1018 adults interviewed met diagnostic criteria for alcohol abuse and/or dependence. The subjects who met the criteria for alcohol abuse and/or dependence were more likely to have used mental health services than the population at large, although 39% of those with an alcohol disorder had never used any form of mental health service. We examined the impact of severity of alcohol disorder, duration of disorder and gender on the use of services among those with an alcohol disorder. Duration of disorder was not related to use of mental health services. Women are more likely than men to use these services. However, the most important finding was that those with the most severe disorders were most likely to have used mental health services.

Adult↗
PubMed1989

Christchurch Psychiatric Epidemiology Study, Part I: Methodology and lifetime prevalence for specific psychiatric disorders.

In 1986 the Christchurch Psychiatric Epidemiology Study obtained interviews with a probability sample of 1498 adults aged 18 to 64 years. The Diagnostic Interview Schedule (DIS) was used to enable DSM-III diagnoses to be made. This paper describes the methodology of the study and reports the lifetime prevalence of specific psychiatric disorders. The highest lifetime prevalences found were for generalised anxiety (31%), alcohol abuse/dependence (19%) and major depressive episode (13%). Men had higher rates of substance abuse whereas women had higher rates of affective disorders and most anxiety disorders. Compared with results from the Epidemiologic Catchment Area Program, Puerto Rico and Edmonton, Christchurch has the highest rates for major depression and is among the highest for alcohol abuse/dependence.

Adolescent↗