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Biomedical subjects

P Tyrer

Publications and source records attributed to P Tyrer.

At least 73 records · Page 4Linked to original sources
PubMed1998

Prediction of outcome in neurotic disorder: a 5-year prospective study.

BACKGROUND: There have been no previous studies of the outcome of different neurotic disorders in which a prospective group with original randomization to treatment have been followed up over a long period. Such studies are important in identifying the factors associated with good and poor outcome. METHODS: A 5-year follow-up assessment was made of a cohort of 210 psychiatric out-patients seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74) or dysthymic disorder (65) and randomized to drug treatment, cognitive and behaviour therapy, and self-help. A total of 182 of the patients (87%) were assessed after 5 years by examination of hospital and GP records using a standardized procedure and outcome determined with a four-point outcome scale. RESULTS: One hundred and seven (60%) of the patients had a favourable outcome but the remainder continued to be handicapped either intermittently or continuously throughout the 5-year period. Analysis of the value of initial data in predicting outcome using polychotomous step-wise logistic regression revealed that five variables were significant predictors of poor prognosis: older age; recurrent episodes; the presence of personality disorder at entry; general neurotic syndrome at entry; and symptom severity after 10 weeks. The initial DSM diagnosis and original treatment given, together with ten other variables, were of no predictive value. CONCLUSIONS: The long-term outcome of neurotic disorder is better predicted by age, personality and recency of onset than by other clinical variables with the exception of initial response to treatment.

Adult↗
PubMed1998

Recovery of positive future thinking within a high-risk parasuicide group: results from a pilot randomized controlled trial.

OBJECTIVES: The research examined: (i) whether high risk parasuicide patients showed a deficit in positive future thinking but no increase in negative future thinking; and (ii) whether such a deficit could be remedied by a brief, manual-assisted psychological intervention (manual assisted cognitive-behaviour therapy; MACT). DESIGN: A cross-sectional, mixed model design was used to assess differences between a sample of high risk parasuicide patients and matched controls on future thinking. A longitudinal mixed model design was used to assess changes in future thinking in the different groups over time. METHODS: Parasuicide patients with a history of previous suicidal behaviour and personality disturbance were compared with a matched group of community controls on an adapted fluency measure of future thinking, which measured both quantitative and qualitative aspects of anticipated experiences. Patients were then randomly allocated to either the specific intervention (MACT) or treatment as usual (TAU) and assessed again at 6 month follow-up. RESULTS: Parasuicide patients showed reduced positive future thinking but no increased negative future thinking. Patients who received MACT showed a significant improvement in positive future thinking over the follow-up period whereas the TAU group showed no such improvement. However, interpretation of this finding was made more difficult by the control group also showing a significant improvement in positive future thinking. CONCLUSION: The results confirm that parasuicide patients exhibit a relative deficit in positive future thinking and suggest that this lack of positive future thinking may be remedied, at least partly, by a brief intervention.

Adolescent↗
PubMed1998

Whither community care?

Explore the source record for details and available documents.

Community Mental Health Services↗
PubMed1998

Systematic review of the outcome of anxiety and depressive disorders.

BACKGROUND: Although there have been many changes in the diagnosis of anxiety and depressive disorders in the past 20 years there have been few comparative enquiries into the clinical outcome of greater diagnostic categories. We therefore compared the outcome of all studies which compared the outcome of specific anxiety and depressive disorders using the standard procedures of systematic review. METHOD: A Medline search was carried out of all studies comparing the outcome of anxiety and depressive disorders or mixed anxiety--depressive disorders in which information was available separately for each disorder. RESULTS: Eight studies satisfied the search criteria (all involving a period of observation of two years or greater); only one of these included randomisation of treatment and comparison between specific anxiety disorder outcome. There was a somewhat better outcome in patients with depressive disorders compared with anxiety ones, and strong evidence that both anxiety and depressive disorders singly had better outcomes than comorbid mixed disorders. CONCLUSION: Comorbid anxiety--depressive disorders have a poor outcome compared with single anxiety and depressive disorders, and there is some evidence that anxiety disorders have a worse outcome than depressive ones.

Anxiety Disorders↗
PubMed1997

Extent of comorbidity between mental state and personality disorders.

Comorbidity between major psychiatric disorders (Axis I) and personality disorders (Axis II) is widespread, often extremely strong, and invariably confusing. The strongest associations are found between substance use and the cluster B (flamboyant) personality disorders, anxiety disorders and the anxious/fearful personality group (cluster C), and between somatisation and both cluster B and C disorders. The significance of these associations is far from clear, and almost certainly include more than one type of relationship. Empirical studies of patients with and without Axis I and II comorbidity show that the presence of a personality disorder can affect the outcome of treatment, both positively and negatively, in a way that currently appears unpredictable. One useful way of interpreting this comorbidity is by postulating personality dispositions that make some people prone to certain mental state disorders.

Comorbidity↗
PubMed1997

Heuristic models of comorbidity of axis I and axis II disorders.

The mechanisms responsible for the co-occurrence of personality disorders with Axis I disorders are not well understood. We propose a number of models that include various relationships at the etiological, pathophysiological, and observable clinical levels between personality disorders and Axis I disorders. It is recommended that such models be subjected to empirical tests to assess their validity.

Comorbidity↗
PubMed1996

L-733,060, a novel tachykinin NK1 receptor antagonist; effects in [Ca2+]i mobilisation, cardiovascular and dural extravasation assays.

This study investigated the properties of a novel piperidine ether-based tachykinin NK1 receptor antagonist L-733,060, ((2S,3S)-3-((3,5-bis(trifluoromethyl)phenyl)methyloxy)-2-phenyl piperidine and its 2R,3R-enantiomer L-733,061 on [Ca2+]i mobilisation in Chinese hamster ovary cells transfected with human tachykinin NK1 receptors, compared to their effects in rodent cardiovascular and neurogenic plasma extravasation assays. Using FURA-2-imaging techniques, L-733,060 inhibited substance P-induced [Ca2+]i mobilisation with an estimated affinity of 0.8 nM whereas L-733,061 (30-300 nM) did not. No significant effects of L-733,060 were observed on mean arterial blood pressure or heart rate in conscious or anaesthetised rats at doses of < 3000 micrograms kg-1 i.v. L-733,060 also stereoselectively inhibited neurogenic plasma extravasation in rat dura produced by electrical stimulation of trigeminal nerves with an ID50 of 212 +/- 19 micrograms kg-1 i.v. Thus, L-733,060 is a novel antagonist of human tachykinin NK1 receptors which stereoselectively inhibits neurogenic plasma extravasation at doses that do not cause adverse cardiovascular effects.

Animals↗
PubMed1996

The cost of treatment of psychiatric emergencies: a comparison of hospital and community services.

This study aimed to compare the costs of treatment by community-based and hospital-based psychiatric services. The design entailed random allocation of patients presenting with psychiatric emergencies over a subsequent 3-month period to one of two services, followed by retrospective quantification of service use and its cost for each group. One hundred patients with emergency presentations to the psychiatric service via the Accident and Emergency Department, liaison psychiatrist and approved social worker were included in the study. Their use of a range of terms of service was recorded and disaggregated costings of these items of service was calculated. The use of non-psychiatric services was similar for both groups, but the use of psychiatric services differed, with the hospital group making greater use of in-patient beds and the community group employing more frequent home-based interventions. The total cost of treatment for the community group (pound 56,000) was much lower than for the hospital group (pound 130,000), although the median patient cost was 50% higher in the community group (pound 938 v. pound 610), and a greater proportion of the community service expenditure (10% v. 2%) was due to failed contacts. Taken together with clinical outcome, which showed no advantages for the hospital-based service over the community-based service, our findings suggest that this form of community psychiatric service is a cost-efficient alternative to hospital-based care for this group of patients.

Adult↗
PubMed1996

Diagnostic anomalies in social phobia.

Social phobia has been recognized only recently as a clinical entity, and there is considerable overlap in diagnosis between agoraphobia, panic disorder, stress disorder and avoidant (anxious) personality disorder. In more severe cases there may also be some difficulty in differentiating the condition from schizophrenia. In reaching a correct diagnosis of social phobia it appears that the two essential elements of a phobic diagnosis, situational fear and avoidance, should be present prominently and that a distinction from agoraphobia can be made by paying close attention to the nature of the situations in which fear is shown. If this policy is followed, social phobia can be readily defined and is fairly easily distinguished from other neurotic disorders. There is considerable overlap with the anxious and fearful group of personality disorders, particularly avoidant (anxious) personality disorder and this is almost impossible to distinguish from chronic persisting social phobia. Data are presented on the incidence of primary and secondary social phobia occurring prospectively in patients with the most common neurotic disorders (dysthymia, panic and generalized anxiety disorder) seen over a 2-year period. Twelve per cent of the patients had secondary social phobia initially, but over the 2-year period 9% of the patients had social phobia as a primary or single psychiatric diagnosis on at least one occasion. This was most likely in those patients allocated to a benzodiazepine, diazepam, in the first phase of treatment (p < 0.05).

Adolescent↗
PubMed1996

General practitioners' views of an open referral system to a community mental health service.

The satisfaction of general practitioners with a community mental health service operating an open referral system was compared to that with two services both operating a closed referral system covering the same inner-city district. The open referral system allows any agency (including patients) to contact the service by letter or by telephone, and priority is given to patients with serious mental illness. General practitioners' satisfaction with all aspects of the open referral system was greater than that with either of the closed referral systems. In particular, speed of assessment of referrals was preferred in the open referral system.

Community Mental Health Services↗
PubMed1996

Cognitive therapy for antisocial and borderline personality disorders: single case study series.

Cognitive therapy for affective disorders has been recently adapted and developed for the treatment of personality disorders. In the present study, a specific and detailed cognitive therapy treatment manual for borderline and antisocial personality disorders was evaluated in a pilot study. The results of a single case series demonstrate that important clinical changes in dysfunctional behaviour and attitudes can be achieved with short-term cognitive therapy in patients with antisocial and borderline personality disorders, although these were not, on the whole, statistically significant.

Adult↗
PubMed1996

Establishing the severity of personality disorder.

OBJECTIVE: The authors developed a simplified method of rating the severity of personality disorder. METHOD: The new rating method is based on four levels of severity: no personality disorder, personality difficulty, simple personality disorder, and diffuse personality disorder. The new method was applied to different diagnostic systems and was then compared with an old rating system based on six severity levels. Data were derived from a longitudinal study in which 163 patients with anxiety and depressive disorders had initial assessments of personality status and were followed up over 2 years. Ratings of psychiatric symptoms were made by using the Comprehensive Psychopathological Rating Scale over this period. The results were analyzed with special attention to linear and quadratic trends. RESULTS: The new system was clinically useful in separating patients' initial assessments and outcomes. Patients with no personality disorder had the lowest initial symptom scores and the best outcomes, and those with diffuse personality disorder had the highest initial levels of symptoms and improved least over the 2 years. When the patients were separated by the old classification system, 72% of the variation between groups was accounted for by linear and quadratic trends; the comparable percentage was 97% when the patients were categorized by the new system. CONCLUSIONS: The new system of rating severity of personality disturbance is an improvement on existing methods and allows ratings to be made easily from DSM-IV and ICD-10.

Humans↗
PubMed1996

A controlled trial of dothiepin and placebo in treating benzodiazepine withdrawal symptoms.

BACKGROUND: The possibility that treatment with tricyclic antidepressants, in the form of dothiepin, might attenuate benzodiazepine withdrawal symptoms was investigated in a double-blind trial. METHOD: Eighty-seven non-depressed psychiatric out-patients with putative normal dose benzodiazepine dependence had their benzodiazepines reduced in stepwise amounts of 20% of the original dose for eight weeks. The patients were randomised to receive dothiepin (with dosage increasing to 150 mg/day) or placebo as an aid to withdrawal before benzodiazepine reduction and these drugs were taken for four further weeks before being stopped. RESULTS: Fewer patients entered and completed the study than expected and a Type II error was possible in the results. Although there was some evidence of withdrawal symptoms being less marked in those patients allocated to dothiepin this was independent of any antidepressant effect as depression scores were lower in the placebo group in the early phase of withdrawal (P < 0.01). Of those completing the study, greater satisfaction (P = 0.03) was recorded by those who had received dothiepin; no other differences reached statistical significance. CONCLUSIONS: Dothiepin (and by implication other tricyclic antidepressants) might have some value in reducing benzodiazepine withdrawal symptoms but does not aid drug withdrawal.

Ambulatory Care↗