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Biomedical subjects

P Tyrer

Publications and source records attributed to P Tyrer.

At least 109 records · Page 6Linked to original sources
PubMed1992

The general neurotic syndrome: a coaxial diagnosis of anxiety, depression and personality disorder.

The validity of the general neurotic syndrome, a combination of anxiety, depression and dependent personality disorder, was examined in a 2-year study of outpatients with dysthymic, panic and generalized anxiety disorder diagnosed using a structured interview schedule. The general neurotic syndrome, found in a third of the patients, was associated with greater mental disorder and a significantly worse outcome than patients without the syndrome. It did not, however, predict response to treatment. Further analysis revealed that the general neurotic syndrome was a better predictor of short- and long-term outcome than any other variable apart from initial psychopathology score. It is argued that the syndrome may represent a personality diathesis that makes the individual more vulnerable to both anxiety and depressive symptoms.

Adjustment Disorders↗
PubMed1992

The clinical evaluation of a new community psychiatric service based on general practice psychiatric clinics.

A new community psychiatric service in Nottingham based on general practice clinics was compared with a conventional hospital-orientated model. Despite providing treatment for an inner-city population of significantly greater social disadvantage, the community service was associated with similar levels of symptom morbidity as assessed by the CRPS and the SFS. It also involved greater use of day-hospital facilities, more extensive multidisciplinary care, and a commitment to longer-term follow-up of chronically ill patients. Such a model is offered as a basis for future developments of urban community psychiatric services.

Adolescent↗
PubMed1991

Does division of the left renal vein during aortic surgery adversely affect renal function?

Between July 1980 and July 1988, 478 consecutive patients underwent aortic aneurysm operations at Royal Prince Alfred Hospital. Renal function was assessed by measurement of serum creatinine levels. The left renal vein was divided in 28 (8%) of the 355 patients undergoing elective aneurysm resection. The mean immediate postoperative creatinine values were significantly higher after left renal vein division, 193 +/- 174 mumol/L, compared to 133 +/- 93 mumol/l for those whose left renal vein remained intact (p less than 0.05 by Mann-Whitney U test). After one month, serum creatinine levels had decreased but were still significantly higher in those patients in whom the left renal vein had been divided, 170 +/- 166 mumol/l, compared to those in whom it was left intact 109 +/- 49 mumol/l (p less than 0.05 by Mann-Whitney U test). The suprarenal aorta was cross-clamped in seven (25%) of the 28 patients in whom the left renal vein was divided, compared to 21 (6%) of the 327 with the left renal vein intact. A rise in creatinine level was observed after suprarenal aortic cross-clamping. The left renal vein was divided in 17 (14%) of the 123 patients having emergency surgery for ruptured aortic aneurysm, 61 (49%) of whom survived more than 30 days. The mean immediate postoperative creatinine values were significantly higher after left renal vein division, 426 +/- 277 mumol/l, compared to those in whom the vein was left intact, 178 +/- 136 mumol/l (p less than 0.05 by Mann-Whitney U test). After one month, serum creatinine levels were still significantly higher in those patients in whom the left renal vein had been divided. Although division of the left renal vein is a useful way to improve exposure of the juxtarenal aorta, the maneuver is associated with an adverse effect on renal function.

Aged↗
PubMed1991

A three-year follow-up of psychiatric morbidity in urban and rural primary care.

Follow-up by examination of medical and psychiatric records was carried out on 357 patients with conspicuous psychiatric morbidity in two general practices three years after clinical and personality assessment using structured interview schedules. One practice was an inner-city urban one and the other was rural. Full follow-up data over the 3-year period was available for 301 patients (84.3%). After three years patients with personality disorder and those in the urban practice had greater morbidity, more contacts with all levels of the psychiatric service and more psychotropic drugs, particularly benzodiazepines. Despite this increased morbidity, the number of consultations with the general practitioner for psychiatric illness was no higher in the urban group and those for medical illness were significantly higher in the rural one. The implications of the findings are discussed with particular reference to developments in community psychiatric care.

Adult↗
PubMed1991

A double-blind comparison of the effects of gradual withdrawal of lorazepam, diazepam and bromazepam in benzodiazepine dependence.

Using a double-blind procedure, 68 patients with putative benzodiazepine dependence were randomly allocated to one of three groups given lorazepam (n = 22), diazepam (n = 23) or bromazepam (n = 23) in doses equivalent to those of the patients' original benzodiazepine. After four weeks the dosage was reduced in 25% quantities until no further benzodiazepines were taken. A total of 23 patients dropped out during the study, ten on lorazepam (one of whom committed suicide), seven on diazepam and six on bromazepam. There were few differences in withdrawal symptoms between the three groups but, despite the higher dropout rate, these symptoms were somewhat less marked in the lorazepam group. Withdrawal symptoms were greater in patients who had taken a benzodiazepine for greater than 5 years and were most marked in those with personality disorders, predominantly dependent ones.

Adult↗
PubMed1991

Personality disorder in perspective.

Personality disorders have for many years been on the fringe of psychiatry, with considerable doubts expressed about the usefulness, implications and validity of the concept. It is argued here that developments in the past few years have brought personality disorders into the mainstream of psychiatric practice. In particular, the recognition that personality function can be separated usefully from clinical symptoms, and that both mental state and personality can be disordered simultaneously, has led to better assessment and understanding. Advances in the classification, epidemiology, treatment and prognosis of personality disorders show that these conditions are common, extensive in their pathology, and cause much suffering. They cannot be ignored or dismissed as peripheral to psychiatry for they are an essential part of good psychiatric practice.

Humans↗
PubMed1990

A plea for the diagnosis of hypochondriacal personality disorder.

Hypochondriacal personality disorder is identified as a separate condition by cluster analysis of data from a structured interview for assessing personality disorders, the Personality Assessment Schedule. Close examination of the patients identified as having hypochondriacal personality disorder suggests that they have common characteristics, including excessive preoccupation with the maintenance of health, distorted perception of minor symptoms so that they are elevated to the status of major disease, and frequent medical consultations and disciplines fringing on medicine. In a study of 1000 psychiatric patients 2.5% were found to have the disorder, most frequently among the affective psychoses.

Adjustment Disorders↗
PubMed1990

The Benzodiazepine Withdrawal Symptom Questionnaire.

A self-report questionnaire is described which records the main symptoms experienced during withdrawal from benzodiazepines in pharmacologically dependent patients. The questionnaire consists of 20 items; evidence is given that these are reasonably independent and are sensitive in detecting withdrawal symptoms from a study of 68 patients undergoing slow withdrawal from benzodiazepines.

Anti-Anxiety Agents↗
PubMed1990

The Nottingham Study of Neurotic Disorder: relationship between personality status and symptoms.

Two hundred and ten psychiatric patients with one of three DSM-III diagnoses, generalized anxiety disorder (N = 71), panic disorder (N = 74) or dysthymic disorder (N = 65), were included in a clinical trial in which diazepam, dothiepin or placebo tablets, cognitive and behaviour therapy, or a self-help package were given over ten weeks. Personality status was assessed independently using a structured interview, the Personality Assessment Schedule. One hundred and ninety-eight patients had personality assessments, 89% with a close informant. Thirty-six per cent had a personality disorder and these patients had more severe psychopathology than those with no personality disorder. Personality disorder was more common in patients with dysthymic disorder and this group responded less well to treatment. The category of personality disorder had no apparent influence on symptoms.

Anxiety Disorders↗
PubMed1990

Liaison psychiatry in general practice: the comprehensive collaborative model.

A model of liaison psychiatry in general practice is described and its impact assessed using data from the Nottingham psychiatric case register. The model incorporates a comprehensive network of general practice psychiatric clinics for both psychiatrists and other mental health professionals, associated with mainly informal liaison with general practitioners and others in the primary care team, and a reduction in psychiatric outpatient clinics. Following the introduction of this model, the proportion of new and referred patients seen in primary care settings rose from 1% to 18% in Nottingham over an 8-year period. Over this period admission rates significantly fell in Nottingham compared with the rest of England and evidence is given that the growth of primary care psychiatry contributed significantly to this reduction.

Adolescent↗
PubMed1990

Efficacy of combined antidepressant therapy in resistant neurotic disorder.

A 35-year-old woman with persistent affective and phobic symptoms responded dramatically to a combination of isocarboxazid and amitriptyline, and this improvement was maintained over the next three-and-a-half years. Isocarboxazid was replaced by placebo, using double-blind procedure. The change to placebo was accompanied by a marked increase in anxiety and depressive symptoms, which resolved when active isocarboxazid was reintroduced. It is suggested that combined antidepressant therapy still has a place in the treatment of resistant neurotic disorder.

Adult↗
PubMed1990

Personality disorder and psychiatric illness in general practice.

In a one-year prevalence study of conspicuous psychiatric morbidity in two group general practices, one urban and the other rural, personality disorder was diagnosed in 5.3% by the GP and in 5.6% by the psychiatrist, but this increased to 28% when personality disorder was assessed using a structured interview. The prevalence of personality disorder was higher in the urban practice than in the rural one but there was no consistent association between personality disorder and mental state disorder, with the exception of alcohol abuse and dependence. The high rate of personality disorder found using the interview schedule is likely to be a true finding, and failure to recognise this hidden morbidity is important in both general and psychiatric practice.

England↗
PubMed1990

Zopiclone.

Explore the source record for details and available documents.

Azabicyclo Compounds↗
PubMed1990

The role of the community psychiatric nurse.

The community psychiatric nurse is an essential element in a comprehensive mental health service. At present each nurse is expected to be a trained counsellor and psychotherapist, a skilled behaviour therapist and an expert assessor of clinical status. This superhuman role is unrealistic; a more appropriate one is outlined.

Behavior Therapy↗