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Biomedical subjects

P Tyrer

Publications and source records attributed to P Tyrer.

At least 91 records · Page 5Linked to original sources
PubMed1996

The Nottingham Study of Neurotic Disorder: influence of cognitive therapists on outcome.

BACKGROUND: In previously published papers from the Nottingham Study of Neurotic Disorder a short treatment package of cognitive-behaviour therapy was no more effective than placebo drug treatment after 10 weeks' assessment in a cohort of 210 patients with neurotic disorders. This paper examines the outcome over two years of the patients treated by cognitive-behaviour therapy separated into two therapist groups, those who were competent in administering treatment and those of uncertain competence. METHOD: The therapists (mainly community psychiatric nurses) of 70 patients with an original DSM-III diagnosis of either dysthymic, panic or generalised anxiety disorder were separated into two groups on the basis of their perceived competence by their supervisor (DK). Ratings of psychopathology were made at regular intervals over two years by assessors blind to knowledge of treatment or therapist. RESULTS: The patients treated by competent therapists (n = 30) generally showed greater improvement than those allocated to therapists of uncertain competence (n = 40), mainly with respect to depressive symptoms, and the difference persisted over two years, long after the cognitive-behaviour therapy had been completed. CONCLUSIONS: Cognitive-behaviour therapy given by competent therapists over a 10 week period is of lasting benefit in neurotic disorder.

Adult↗
PubMed1995

A randomised controlled study of close monitoring of vulnerable psychiatric patients.

The care programme approach was introduced in mental health services in the UK in 1991. It was intended to improve the quality of care and prevent patients losing contact with care services and, by implication, to reduce psychiatric admissions. We did a study to find out if the approach worked. 400 patients from a London inner-city area who had been identified as psychiatrically vulnerable and included on a case register of patients with special needs were randomised into two groups of 200 each. One group received close supervision by nominated key-workers (as recommended in the care programme approach of the UK Department of Health), and the other received standard follow-up from psychiatric and social services. Outcome was recorded after eighteen months. Data on 393 patients was available for analysis. Of 197 patients allocated to standard care, 64 (32.5%) were lost to follow-up compared with 40 (20.4%) of 196 patients receiving close supervision (p = < 0.005). However, patients under close supervision had significantly more admissions (30% vs 18%, chi 2 = 7.61, p < 0.01) and spent 68% more days in hospital than the standard group. The findings of greater hospital-bed use, which differ from those of studies with community-based psychiatric teams, suggest that close supervision by a single key worker, as recommended in the care programme approach, will lead to greater success in maintaining contact with vulnerable patients, but is likely to lead to more psychiatric admissions.

Adult↗
PubMed1994

The effect of personality disorder on clinical outcome, social networks and adjustment: a controlled clinical trial of psychiatric emergencies.

One hundred psychiatric emergencies presenting to an inner London teaching hospital had formal assessments of psychopathology, personality disorder (using both ICD-10 and the Personality Assessment Schedule), social networks and social functioning before being randomly assigned to a multidisciplinary community-based team (Early Intervention Service (N = 48) or conventional hospital-based psychiatric services (N = 52) and treated for a period of 12 weeks. The ICD-10 classification yielded a higher proportion (50%) of personality disordered patients than the Personality Assessment Schedule (34%) and those from ethnic minorities (mainly Afro-Caribbean) and upper social classes had a lower incidence of personality disorder. Social networks were smaller in personality disordered patients and there were fewer attachment figures. Improvement in social function, and to a lesser extent with depressive symptomatology, was better in patients with no differences were found between the numbers and duration of social contacts in the two services and it is concluded that the better outcome in the community-treated patients was independent of changes in social networks.

Community Mental Health Services↗
PubMed1994

What are the borders of borderline personality disorder?

It is argued that the usefulness of borderline personality disorder in clinical and research practice is largely because the borders of the diagnosis are so flexible. The diagnosis overlaps with other personality disorders, disturbances of mood and intermittent abnormal behavior. As almost all behavior likely to lead to consultation with mental health professionals is included among the elements of personality disorder, it is not surprising that it is almost the most common condition seen by specialists in the field. An attempt is made to define the borders of the condition in this review. It is concluded that these are so far-reaching that they negate the notion that borderline conditions are personality disorders. It is argued that the borderline state is a coaxial diagnosis of personality and mental state disorder and to continue to describe the concept as a personality disorder is wrong and misleading.

Adjustment Disorders↗
PubMed1993

The consequences of an open referral system to a community mental health service.

The first 590 patients referred to a community mental health service (the Early Intervention Service) in an inner-city district were separated into groups based on their referral source. The service has an open referral system allowing any agency (including patients) to contact the service by letter or by telephone, and priority is given to patients with serious mental illness. The results of open referral showed that the number of referrals was adequate for the service to process, the proportion of inappropriate referrals was similar in all referral agencies, and milder cases of mental illness were referred more often from doctors than from other agencies. It is concluded that an open referral system is likely to be more sensitive to need and has some advantage over closed referral arrangements in inner-city areas.

Adolescent↗
PubMed1993

The Nottingham study of neurotic disorder. Effect of personality status on response to drug treatment, cognitive therapy and self-help over two years.

Repeated assessments of psychopathology, together with personality status, were made over two years on 181 psychiatric out-patients with generalised anxiety disorder (59), panic disorder (66), or dysthymic disorder (56) diagnosed using an interview schedule for DSM-III. Patients were randomly allocated to drug treatment, cognitive and behaviour therapy, or a self-help treatment programme. Although there were no overall differences in compliance rate and efficacy between the three modes of treatment, the psychological treatment methods, particularly self-help, were more effective in patients without personality disorder, and those with personality disorder responded better to drug treatment, primarily antidepressants. The findings suggest that assessment of personality status could be a valuable aid to selection of treatment in neurotic disorders and that self-help approaches are particularly valuable once personality disorder has been excluded.

Adult↗
PubMed1993

Benzodiazepine dependence. Avoidance and withdrawal.

Benzodiazepine dependence is a frequent complication of regular prescriptions for 4 weeks or longer, occurring in almost one-third of patients. Although it is also manifested by tolerance to drug effects and occasional drug seeking behaviour, particularly in those prone to drug abuse, most dependence is characterised by a withdrawal syndrome on stopping treatment. The withdrawal syndrome includes symptoms of anxiety and those of perceptual disturbance such as depersonalisation, hypersensitivity of all major senses, dysphoria and (rarely) epileptic seizures and psychotic episodes. Risk factors for dependence include high dosage, use of more potent and short acting benzodiazepines, long duration of therapy and dependent premorbid personality characteristics. If none of these apply, benzodiazepines can be prescribed with safety.

Anti-Anxiety Agents↗
PubMed1993

Benzodiazepine dependence: a shadowy diagnosis.

When benzodiazepines were introduced into clinical practice in the 1950s they were hailed as efficacious minor tranquillizers, largely devoid of unwanted side effects, in contrast to the barbiturates and similar drugs that they largely superseded. It was 30 years before the phenomenon of low-dose dependence on benzodiazepines was recognized. Benzodiazepine dependence differs from other psychotropic drug addictions because the benzodiazepines do not produce either euphoria or drug-seeking behaviour (except in those who are already addicted to other drugs). However, benzodiazepine use is associated in some individuals with a marked withdrawal (abstinence) syndrome that provides the best evidence of dependence. Just over half the people prescribed long-term benzodiazepines do not develop any sign of a withdrawal reaction (Fig. 1): this reflects factors including the type of benzodiazepine prescribed, the dosage and duration of treatment, as well as characteristics of the patient. Individuals with passive-dependent personalities appear to be more likely to experience withdrawal symptoms than other patients, although this remains a controversial issue. Therefore benzodiazepine use should follow certain guidelines, and if these are adhered to the benzodiazepines will continue to be valuable drugs in clinical practice.

Anti-Anxiety Agents↗
PubMed1992

Early intervention in psychiatric emergencies: a controlled clinical trial.

In the UK, psychiatric care of patients with acute and chronic disorders has increasingly moved from hospital to the community. We have evaluated in a controlled trial patients with severe mental illness, who were assigned to early intervention by community services or to standard hospital treatment. 100 patients aged 16 to 65 years presenting as psychiatric emergencies to an inner London teaching hospital were randomly allocated to a multidisciplinary community-based team (n = 48) or conventional hospital-based psychiatric services (n = 52) and assessed over a 3-month period. Ratings of psychopathology and social functioning were made before treatment and after 2, 4, and 12 weeks by independent assessors. 85 patients completed all assessments, and all patients had evaluable data beyond 2 weeks. 3 patients died during the study, 2 from natural causes and 1 from an accident. Patients referred to the community service showed greater improvement in symptoms and were more satisfied with services than those in the hospital-based service. Patients treated in the hospital-based service spent eight times as many days as psychiatric inpatients as those treated in the community-based service. Patients both prefer and seem to benefit from community-based psychiatric care, and our early-intervention community service might be a good model for such care.

Adolescent↗
PubMed1992

Factors predicting long-term outcome after chronic benzodiazepine therapy.

41 patients who took part in a withdrawal programme from long-term treatment with diazepam in a controlled clinical trial were followed up five years later. Assessments were made of outcome derived from clinical symptomatology, formal psychiatric diagnosis, psychotropic drug use and frequency of contact with both primary care and psychiatric services. Using discriminant function analysis it was found that better outcome was associated with younger patients, fewer symptoms at time of withdrawal and, more particularly, six months later, less personality disturbance, and longer duration of diazepam use before withdrawal. The implications are discussed with particular reference to policies for withdrawing benzodiazepines.

Adult↗
PubMed1992

Anxiolytics not acting at the benzodiazepine receptor: beta blockers.

1. Although there is clear evidence for many controlled trials in the past 25 years that beta blockers are effective in anxiety disorders clear indications for their use are lacking. 2. The balance of evidence suggests that the mechanism of action of beta-blocking drugs is through peripheral blockade of beta-mediated symptoms. 3. Most evidence to the efficacy of beta-blockers comes from study of their use in generalized anxiety and in acute stress. 4. Because beta-blockers carry no risks of pharmacological dependence they may be preferred to many other anti-anxiety drugs.

Adjustment Disorders↗