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Biomedical subjects

N Tarrier

Publications and source records attributed to N Tarrier.

At least 55 records · Page 3Linked to original sources
PubMed1998

An investigation of the factors associated with an increased risk of psychological morbidity in burn injured patients.

Previous research aimed at identifying factors that increase the risk of major burns patients experiencing psychological problems post-burn has generally ignored the potential role of psychological factors. In a prospective study, patients with burn injuries ranging from < 1 per cent up to 40 per cent were interviewed within 2 weeks of sustaining the burn and followed up at ca 3 months post-burn in order to assess the effects of both non-psychological and psychological factors on their subsequent mental health. The factors investigated included burn related information, demographic information, previous psychiatric history, levels of psychological morbidity at 2 weeks post-burn, responsibility for the injury, previous life events, compensation claims and factors from the coping literature including appraisal, coping strategies and coping efficacy. Forward stepwise multiple regression analyses were used to investigate the relationships between these factors and subsequent mental health. Post-burn psychological morbidity was strongly associated with psychological factors including levels of psychological morbidity in the first 2 weeks of sustaining the injury and factors from the coping literature.

Adaptation, Psychological↗
PubMed1998

Intimacy as a determinant of expressed emotion in carers of people with Alzheimer's disease.

BACKGROUND: Although high expressed emotion (EE) has been found to be an important predictor of poor prognosis in a wide range of conditions such as schizophrenia, anorexia and depression no complete explanation exists for individual differences in EE responses. The aim of this paper is to investigate the role of intimacy in determining the level of EE in carers of people with dementia. METHODS: Ninety-nine carers of people with dementia who presented to Old Age Psychiatry Services in South and Central Manchester completed questionnaires to ascertain past and current levels of intimacy. Camberwell Family Interviews (CFIs) were carried out to ascertain levels of EE. RESULTS: Current intimacy was found to be strongly related to EE such that low current intimacy was associated with high EE and there was a significant difference between high and low intimacy groups on measures of criticism and hostility, though not warmth. CONCLUSIONS: The association found between intimacy and EE indicates that high EE may be a characteristic of low intimacy relationships between the carer and the cared-for-person. Since the assessment of EE is time intensive, perhaps a measure of intimacy will provide a short-hand screen for identifying critical and hostile caring environments.

Aged↗
PubMed1998

The clinical skills of community psychiatric nurses working with patients who have severe and enduring mental health problems: an empirical analysis.

This study describes the use of reliable scales to rate the clinical skills of mental health nurses when working with individuals and families with severe mental health problems. The Cognitive Therapy Scale and the Schizophrenia Family Work Scale were adapted for the study and were shown to have good inter-rater reliability when assessing audio-taped interviews carried out by mental health nurses during their usual course of work with patients with severe mental health problems and their families. The sample of mental health nurses studied were shown to have significantly better general therapy skills than specific cognitive therapy technical skills. The implications for training are discussed.

Clinical Competence↗
PubMed1998

Individual cognitive-behavioural interventions in early psychosis.

BACKGROUND: Cognitive-behavioural treatments have previously been explored in the treatment of chronic psychotic problems, but recently, the effectiveness of these treatments has been investigated with regard to recent onset and acute psychosis. METHOD: The literature relating to cognitive-behavioural treatments in psychosis is explored and the application of the approach to recent onset psychosis is described in detail. RESULTS: There appears to be a growing body of evidence that the advances made in the treatment of people with chronic treatment resistant psychosis can be similarly applied to people with recent onset and acute psychosis. CONCLUSIONS: Cognitive-behavioural treatments are feasible with recent onset psychotic patients although further evaluation of their effectiveness is necessary.

Antipsychotic Agents↗
PubMed1997

The impact of the symptoms of dementia on caregivers.

BACKGROUND: The symptoms of dementia are the most obvious stressors to which caregivers are exposed and many studies have investigated the association of such symptoms with the adverse consequences of caring. The present paper represents the only dedicated review of this literature. METHOD: Manual and computer (MEDLINE) literature searches were performed. RESULTS: Seventeen empirical studies were found. CONCLUSIONS: Variability in conceptual and methodological approaches and inconsistencies in the reported findings have prevented firm conclusions from being drawn. However, the literature provided support for a relationship between non-cognitive features in dementia and psychological problems in caregivers, and suggested possible associations between cognitive deficits and some negative care-giver outcomes. New methodological and conceptual approaches are required if decisive evidence is to be forthcoming. This information is a prerequisite for investigations into the causal mechanisms that sustain these relationships, and for rationally designed interventions.

Activities of Daily Living↗
PubMed1996

Distress, expressed emotion, and attributions in relatives of schizophrenia patients.

This article investigates the level of distress in relatives at the time of an acute episode of illness in the schizophrenia sufferer. Guided by attributional literature on the prediction of distress and depression, the association between relatives' distress and their explanations and beliefs concerning the illness is examined in the context of the expressed emotion status of the relative. The study found that although distress levels were unrelated to the relatives' beliefs about the patient's role in negative events, beliefs that illness events were caused by factors internal to the relatives themselves ("self-blaming" beliefs) were associated with distress in the relatives. The authors argue that understanding the cognitive appraisal processes involved in how caregivers perceive schizophrenia is important to understanding their response to the illness and helping them to adapt to the problems.

Acute Disease↗
PubMed1996

Monitoring of intrusions in post-traumatic stress order: a report of single case studies.

The effect of monitoring on frequency and duration of intrusions, and on reported symptomatology in patients with a diagnosis of post-traumatic stress disorder (PTSD) was investigated. Six patients were asked to monitor their intrusions over a period of two months. The patients were reassessed after completing the monitoring and followed up after three months. Four patients recovered and no longer met criteria for PTSD, one patient was still experiencing some symptoms, and one still met criteria for a diagnosis of PTSD.

Adult↗
PubMed1995

The role of autonomic arousal in problem gambling.

The present study investigated the role of arousal in problem gambling. Three groups of subjects were recruited into the study corresponding to problem gamblers, high and low frequency social gamblers. For the two gambling groups, the preferred form of gambling was poker machine playing. Five different conditions were employed in order to determine under which conditions gambling related cues were related to increased autonomic arousal, as measured by skin conductance level (SCL), heart rate (HR) and frontalis electromyography (EMG). The five conditions were a neutral task, a videotaped poker machine gambling scenario presented with and without distraction, a personally relevant "win" situation and a videotaped horse race. Comparisons between responses for the videotaped poker machine gambling stimuli versus a horse-racing video task demonstrated differences only for the problem gambling group and only for SCL. No differences between these tasks emerged on the HR and EMG indices and no differences were evident for either of the social gambling groups. No changes were observed in any group when subject's cognitions were prevented by asking patients to count the number of wins made during the video play period while watching the same poker machine video. However, when personally relevant situations were presented and compared to a neutral task, differences were observed in all three groups. However, the nature of these differences varied between the groups and the different indices of arousal. For problem gamblers, increases were evident in all three measures. Increases were also observed for the control groups in comparison to the neutral task, but only in HR and SCL and not for EMG. For HR, the increases were equivalent across all three gambling groups. However, for SCL the problem gambling group became significantly more aroused than the control groups, but no differences were observed between the high and low frequency gamblers. Only the problem gambling groups evidenced significant increases in the personally relevant task compared to the neutral task for EMG. Theoretical and clinical implications of these results for the development, maintenance and treatment of problematic levels of gambling are discussed.

Adult↗
PubMed1995

Effect of emotional salience on thought disorder in patients with schizophrenia.

BACKGROUND: This study examined the effect of emotional salience on the severity of thought disorder in schizophrenic patients. METHOD: Ten thought disordered and ten non-thought disordered schizophrenic patients were interviewed under two conditions: a personal interview involving material which was emotionally salient and an impersonal interview involving material which was not emotionally salient. RESULTS: Both groups exhibited some thought disorder during both interviews. The thought disordered patients exhibited significantly more thought disorder during the emotionally salient interview. CONCLUSIONS: Thought disorder in schizophrenic patients is affected by the emotional salience of the material being discussed. Clinical implications are discussed.

Adult↗
PubMed1994

Demographic factors associated with extreme non-compliance in schizophrenia.

Having identified total non-compliance with neuroleptic medication as a major problem in a significant proportion of schizophrenic patients, an analysis of potentially important demographic factors associated with this problem was carried out. The in-patient records of 256 schizophrenic patients were examined with reference to ethnicity, gender, age, number of admissions and amount of time spent in hospital over a 3-year period. Non-compliant patients differed from those who were at least partially compliant in that they were more likely to be Afro-Caribbean and male, have shorter stays in hospital and have more admissions. There was no difference between these groups in terms of age, although certain subgroups exhibited some age differences. Logistic regression analyses revealed that gender and ethnicity were significant predictors of extreme non-compliance, to the extent that in male Afro-Caribbeans there was a 31% chance that prophylactic medication would be completely refused. The implications of these results and methodological issues are discussed.

Adolescent↗
PubMed1994

A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder.

Thirty-six patients with PTSD were randomly allocated to individual treatment with imaginal exposure (image habituation training -- IHT), or applied muscle relaxation (AMR) or eye movement desensitization (EMD). Assessment by a blind independent rater and self-report instruments applied pre and posttreatment and at 3-month follow-up indicated that all groups improved significantly compared with a waiting list and that treatment benefits were maintained at follow-up. Despite a failure to demonstrate differences among groups, there was some suggestion that immediately after treatment EMD was superior for intrusive memories.

Adult↗
PubMed1994

Eye-movement desensitisation. Symptom change in post-traumatic stress disorder.

A novel approach is described for the treatment of post-traumatic stress disorder (PTSD). Eye-movement desensitisation (EMD) requires the patient to generate images of the trauma in the mind and define physiological and emotional arousal states. While concentrating on these states, lateral multisaccardic eye movements are induced. Ten consecutive cases are reported who presented with symptoms originating from a range of traumas. The effectiveness of EMD in reducing symptoms outlined by DSM-III-R is described. An independent rater indicated that eight of the ten cases showed considerable improvement in PTSD symptoms following EMD, which was maintained at follow-up. Particular reference is given to the 'specificity' of EMD in treating symptoms and the changing pattern of effect at follow-up.

Adolescent↗
PubMed1994

The Salford Family Intervention Project: relapse rates of schizophrenia at five and eight years.

BACKGROUND: This study assessed the long-term effects of family intervention on schizophrenic relapse. METHOD: Forty schizophrenic patients who had participated in a family intervention trial and who had not experienced relapse at two years after discharge from the index admission were traced through case notes and hospital records. The percentage of patients experiencing a relapse was estimated for patients in the family intervention group, the high-EE control group, and the low-EE control group, at five years and eight years after discharge. RESULTS: There were significantly fewer relapses in the family intervention group than in the high-EE control group at both five years and eight years. The number of relapses in the low-EE control group was lower than in the high-EE control group, but this just failed to reach significance. CONCLUSIONS: The benefit of family intervention and the predictive power of EE are sustained over eight years.

Adult↗
PubMed1993

A trial of two cognitive behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients. II. Treatment-specific changes in coping and problem-solving skills.

Changes in coping skills and problem-solving skills were examined in two groups of schizophrenic patients. The groups received either coping skills enhancement or problem-solving treatments to reduce their drug-resistant residual psychotic symptoms. The coping skills group showed significant increases both in the number of positive coping strategies used and in their efficacy, whereas the problem-solving group showed a decrease in these measures during treatment. Both groups showed significant improvements in problem-solving skills. Changes in coping but not problem solving were significantly related to decreases in psychotic symptoms during treatment. It was concluded that treatment involving the teaching of coping skills had a specific treatment effect.

Adaptation, Psychological↗
PubMed1993

Prevalence of anticipatory nausea and other side-effects in cancer patients receiving chemotherapy.

98 patients receiving chemotherapy for cancer were interviewed to determine the prevalence of anticipatory nausea and vomiting, anxiety and dietary changes. Among those who had received at least four treatments 41% reported at least mild anticipatory nausea (AN). For 24% this was a moderate to severe problem, which was significantly associated with a high level of anxiety about treatment. Prevalence at this level was independent of whether the subject was receiving treatment as an in- or an outpatient. Anticipatory vomiting (AV) was reported by only 12 patients, of whom 11 were women; this was the only effect of gender found in the sample. Independence between moderate AN and AV was also suggested by a difference in type of event triggering the effect: predominantly odours for AN and thoughts of the treatment for AV. Changes in diet after commencing chemotherapy were reported by 50% of patients who had received at least four treatments. These most commonly took the form of aversions to meat and then to coffee, and were attributed most frequently to changes in taste and then to loss of appetite.

Adolescent↗
PubMed1993

Towards a cognitive-behavioural theory of problem gambling.

A heuristic model to account for the development and maintenance of problem gambling is provided with the aim of directing clinical management and future research. Previous explanations of problem gambling have been limited in two main ways. Firstly, the models have been primarily descriptive, and secondly they have generally lacked clinical value. Most explanations have ignored the mechanisms through which this behaviour becomes problematic, and have not identified the relationships between different variables.

Adaptation, Psychological↗
PubMed1993

A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: I. Outcome.

Despite neuroleptic medication, many schizophrenic patients continue to experience residual positive psychotic symptoms. These residual symptoms cause distress and disability. We report a controlled trial of two cognitive-behavioural treatments to alleviate residual hallucinations and delusions. Forty-nine patients were recruited into the trial, of whom 27 entered the trial and completed post-treatment assessment, and 23 were reassessed at six-month follow-up. Patients were randomly allocated to either coping strategy enhancement (CSE) or problem solving (PS). Half the patients were allocated to a high-expectancy positive demand condition and half to a counter-demand condition to evaluate expectation of improvement. Patients receiving either cognitive-behavioural treatment showed significant reductions in psychotic symptoms compared with those in the waiting period, who showed no improvement. There was some evidence, although equivocal, that patients receiving CSE improved more than those receiving PS. There was no evidence that improvements generalised to negative symptoms or social functioning, nor was there evidence that expectancy of treatment benefit contributed to the treatment effect.

Activities of Daily Living↗