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Biomedical subjects

N Tarrier

Publications and source records attributed to N Tarrier.

At least 73 records · Page 4Linked to original sources
PubMed1992

Prodromal symptoms in manic depressive psychosis.

Twenty patients suffering from manic depressive psychosis were interviewed about the prodromes to both manic and depressive episodes. These prodromal periods were compared with a recent control period during which the patient was in remission. It was possible for 85% of patients to identify a depressive prodrome and 75% a manic prodrome. Prodromal periods were characterised by a significant increase in the number and magnitude of symptoms compared with those present during remission. The mean duration of manic prodromes was slightly longer than that of depressive prodromes (28.9 days and 18.8 days respectively). The majority of patients could identify a time sequence to the retainment of insight during their prodromes and could also identify idiosyncratic symptoms.

Adult↗
PubMed1992

The relationship between relative's Expressed Emotion and schizophrenic relapse: an Australian replication.

We report a predictive study, carried out in Sydney Australia, investigating the association between the Expressed Emotion (EE) status of the household to which the patient is discharged and schizophrenic relapse. Expressed Emotion was not related to illness severity either at admission or discharge, but was related to variables reflecting chronicity and employment history. There was a significant association between returning to a high EE household and both re-hospitalisation and relapse. The significant association between EE and relapse held only for: patients not on medication, males, and those patients in high contact with their relatives. A discriminant function analysis found that decline in occupational status and the number of critical comments expressed by the relative were the strongest predictors of relapse. The results presented here are consistent with the majority of published reports on EE and relapse and contradict the negative findings of a recently published but smaller study also carried out in Sydney.

Adult↗
PubMed1992

The Sydney intervention trial: a controlled trial of relatives' counselling to reduce schizophrenic relapse.

The result of a psychosocial intervention which aimed to reduce schizophrenic relapse through relatives' counselling is presented. Thirty-six schizophrenic patients living in high Expressed Emotion (EE) parental households were randomly allocated to an intervention or control group. The parents of patients allocated to the intervention were offered ten weekly sessions of counselling. The patient was not included in these sessions. Patients in both groups received standard after-care of medication and support. Relapses in the intervention group, although fewer, were not significantly different from the control group. Given the impressive evidence in favour of family interventions in reducing relapse rates in schizophrenic patients possible reasons for this result are discussed. Aspects of the intervention described here, exclusion of the patient, no control over the patients' medication or involvement with their management, short duration of intervention and lack of individual assessment, could explain this finding. This negative result is important in indicating what factors should be included in an effective psychosocial intervention.

Adult↗
PubMed1992

Training community psychiatric nurses for psychosocial intervention. Report of a pilot study.

Community psychiatric nurses were trained to deliver psychosocial intervention to clients with a diagnosis of schizophrenia living at home with relatives. The training package consisted of family assessment, health education, and family stress management strategies. In a 'quasi-experimental' design, a sample of families (n = 54) were recruited to either a control or experimental condition and followed up for 12 months. A number of favourable outcomes were observed in the experimental group, including improvements in the client's target symptoms, personal functioning, and social adjustment. Relatives' satisfaction with services increased and reports of their own minor psychiatric morbidity improved.

Adolescent↗
PubMed1992

The use of image habituation training with post-traumatic stress disorders.

An exposure treatment for patients suffering from post-traumatic stress disorder (PTSD) is described. Image habituation training (IHT) involves the patient in generating verbal descriptions of the traumatic event and recording these onto an audiotape. After the initial training session with the therapist, homework sessions of self-directed exposure in which the patient visualised the described event in response to listening to the audiotape were carried out. Of ten consecutive patients who received this treatment, six improved considerably after ten homework sessions, two showed moderate improvements, and two showed minimal improvement on a range of outcome measures. There were significant decreases in anxiety between and within homework sessions, suggesting that habituation did occur and was responsible for improvement. Treatment gains were maintained at six-month follow-up.

Adaptation, Psychological↗
PubMed1991

Prodromal signs of relapse in schizophrenia.

Fifty-six patients who were hospitalised for a schizophrenic episode were followed up for nine months after discharge. The Psychiatric Assessment Scale (PAS, Krawiecka et al., 1977) was administered at monthly intervals during this period. Twenty-three patients relapsed of which data were available for sixteen. In these sixteen patients who relapsed comparisons were made of the PAS symptoms between the month prior to relapse and the month preceding this. Sixteen patients who did not relapse were randomly matched with the relapsing patients and an index point comparable in time to relapse onset in the matched relapsed patient was identified. Comparisons were made on the PAS symptoms using a repeated measures ANOVA to compare relapsers and non relapsers on the month prior to relapse and the month which preceded this. Discriminant function analysis was used to predict relapse by analysis of those PAS symptoms which showed an increase in the month before relapse. This suggested that the measures of depression and hallucinations significantly increased in the month prior to relapse compared to the preceding month in relapsers but not non-relapsers. The results of this study closely agree with previous published results even though there were some differences between studies in the patient samples.

Adolescent↗
PubMed1991

Changes in the electrodermal activity of schizophrenic patients associated with changes in the expressed emotion status of their relatives.

Thirty-nine relatives of schizophrenic patients, who had been rated as high on Expressed Emotion (EE) during the patients' admission for an acute episode, were re-rated on EE 9 months after discharge from the index admission. Electrodermal activity was recorded from the patient during a 15-min period when the relative was absent and a similar period while the relative was present. Recording took place during the index admission and at a 9-month follow-up. A comparison was made between those patients whose relatives remained high EE at follow-up (Stables) and those whose relatives change to low EE (Decreasers). No differences were apparent between these two groups, however, differences were found within groups. At admission both groups showed an increase in electrodermal measures from the relative-absent period to the relative-present period. At 9-month follow-up, the Stables still exhibited this direction of change, whereas the Decreasers showed a decrease in electrodermal activity between these periods.

Adolescent↗
PubMed1991

Some aspects of family interventions in schizophrenia. I: Adherence to intervention programmes.

Although family intervention programmes to instruct relatives in management and coping skills are often effective in reducing schizophrenic relapse, many families either fail to be engaged or withdraw from treatment at an early stage. Some possible reasons for this are described and some suggestions for increasing adherence are made. Adherence with interventions may be viewed as a complex behaviour pattern, and factors increasing or decreasing the probability of such behaviour occurring and being maintained can and should be investigated to maximise the clinical potential of family intervention programmes.

Caregivers↗
PubMed1991

Some aspects of family interventions in schizophrenia. II: Financial considerations.

The direct costs to the mental health services for patients who participated in a trial of a behavioural family intervention to reduce schizophrenic relapse were estimated. Comparisons were made between two patient groups from households of high expressed emotion (HEE): one group received a nine-month family intervention (HEE Intervention) and the other group routine treatment (HEE Control). A third group consisted of patients from low-EE households (LEE Control). The significant decrease in relapse rates in the HEE Intervention group compared with the HEE Control group has previously been reported; the analysis of costs indicates that any increase in costs due to the family intervention is outweighed by a decrease in usage of the established mental health services. The intervention resulted in a decrease of 27% in mean cost per patient.

Adult↗
PubMed1990

Social functioning in schizophrenic patients. I. The effects of expressed emotion and family intervention.

The relationship between the social functioning of schizophrenic patients and the EE levels of their relatives is examined. Patients living with a high EE relative function significantly worse than those living with low EE relatives. This appeared to be due to a poorer social functioning in patients who lived with hostile relatives. Patients who participated in a nine month behavioural family intervention showed greater improvements in social functioning than control groups. The improvements could not be explained as being due to medication since high neuroleptic dosage over nine months was associated with poorer social functioning.

Adult↗
PubMed1990

Social functioning in schizophrenia. II. The effects of autonomic arousal.

The association between electrodermal arousal and social functioning was investigated. It was predicted that poor social functioning would be associated with higher levels of arousal. Patients were tested for a 15 minute period without their relative and for 15 minutes with their relative present. The prediction received some support from the results in that three subscales of the Social Adjustment Scale (SAS) showed a significant association between lower social functioning and higher arousal. This association showed a trend towards significance in the SAS Overall Score. When patients with high EE and low EE relatives were analysed separately, significant associations were only found for the high EE group. These results were interpreted as giving some support to the hypothesis that patients who are functioning poorly have relatively stable high levels of arousal.

Adult↗
PubMed1990

Family interventions for schizophrenia.

Studies that have attempted to reduce schizophrenic relapse by the use of family interventions are described. Results from studies that implemented behavioral family interventions with patients who were identified as high risk because of the expressed emotion status of their relatives have demonstrated that relapse rates can be significantly reduced over a 2-year postdischarge follow-up period. A number of ongoing studies, especially those that are investigating the interaction of family interventions and different medication regimes, are also discussed. Areas for further investigation are identified, for example: the use of multiple outcome measures, the use of single-case studies and the development of ideographic assessment measures, the interaction of biological and environmental influences, the alleviation of the burden of care, the involvement of the consumer in services, the development of behavioral formulations and analysis of family engagement and compliance, staff training in intervention methods, and the translation of research results into clinical practice.

Behavior Therapy↗
PubMed1989

Electrodermal activity as a predictor of schizophrenic relapse.

Electrodermal activity and self-report of affect were recorded from schizophrenic patients with their relative absent and present, at index admission and on two subsequent occasions after discharge. It was hypothesised that it would be possible to discriminate at index admission patients who relapsed in the subsequent 2-year period from those who remained well, and that these differences would be stable over time and independent of illness episode. The former hypothesis was supported in part, but not the second. The results did not support electrodermal hyperactivity as a stable, enduring vulnerability marker.

Adolescent↗