Biomedical subjects
Publications and source records attributed to P Tyrer.
A patient presenting with mixed affective symptoms was found to have active neurosyphilis after intermittent cognitive impairment suggested an organic cause. Most of these symptoms resolved after treatment with penicillin.
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The personality characteristics of 77 patients seen in general practice with a Catego diagnosis of anxiety state (including phobic state) or depressive neurosis derived from the Present State Examination were compared with those in 77 normal subjects chosen at random from the list of the same general practitioner. Each patient was matched with a normal subject of the same age and sex. The personality characteristics were rated using the Personality Assessment Schedule, an interview schedule designed to elicit the premorbid personality of the subject. The neurotic patients had significantly higher scores for the personality charcteristics of anxiousness, vulnerability, resourcelessness, hypochondriasis and other features commonly described as oral and hysterical. Schizoid features were absent in the neurotic group. The results suggest that there are common personality attributes in neurotic disorder and that these have clinical significance.
Eighty children from the North West and North East Thames Regional Health Authorities who had been identified as having congenital hypothyroidism either by neonatal screening (76 cases) or by clinical symptoms (four) were seen for psychological assessments at 1 (60 cases), 3 (58), and/or 5 (20) years of age. Almost all the children's scores were in the normal range, and comparisons with matched controls suggested that they were doing only slightly less well than normal children in overall development. They were significantly slower, however, on a motor skills task. Moreover, a low initial serum thyroxine and triiodothyronine value, considerable delay in initial bone age, and an absence of thyroid tissue on isotope scan seemed to be associated with a somewhat poorer prognosis.
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Psychiatrist services are currently in a state of flux because of a change in philosophy towards care in the community. There is much disquiet among psychiatrists about the lack of resources needed to effect this change. However, the most appropriate focus of community care already exists in the form of the general practitioner's surgery, but at present it is rarely used to its full potential because liaison between general practitioners and psychiatrists is poor. Ways of improving the liaison between psychiatric and primary care teams are outlined that if implemented would enable community psychiatry to flourish.
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Fifty patients who had previously been treated with both a monoamine oxidase inhibitor and a tricyclic antidepressant at different times were rated using an interview schedule to assess abnormal personality. Thirty-four per cent of the sample were found to have an abnormal personality with anankastic (obsessional) personality being the most frequent. Those who failed to respond to either treatment were significantly more likely to have an abnormal personality than those who did respond. There was some evidence to support the view that patients who improved on monoamine oxidase inhibitors showed fewer abnormal personality traits, particularly for sensitivity, pessimism and hypochrondriasis, than those who improved on tricyclic antidepressants.
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Thirty-six patients with generalised anxiety disorder, panic disorder or agoraphobia with panic attacks, diagnosed by DSM-III criteria, were treated with a new non-benzodiazepine anti-anxiety drug, buspirone, and with diazepam and placebo, in a cross-over design. Each patient took buspirone, diazepam and placebo for one week each in flexible dosage and balanced order. Ratings of symptomatology using the Comprehensive Psychopathological Rating Scale were made after each week's treatment and a sub-scale used for measuring anxiety change alone was used separately. There was no overall difference in efficacy between the drugs, but when the scores for individual symptoms were analysed, diazepam was significantly superior to the other treatments for the symptom of muscle tension only. The results suggest that the common practice of giving short-term therapy with tranquilising drugs for anxiety in primary care is pharmacologically suspect.
51 psychiatric outpatients with depressive, anxiety and phobic neuroses were withdrawn from their maintenance treatment with tricyclic antidepressant drugs or the monoamine oxidase inhibitor, phenelzine, at a time mutually agreed between patient and doctor. Self-ratings of anxiety and depression were recorded at the time of withdrawal and at weekly intervals thereafter for 4 weeks. An increase in symptoms after withdrawal was found to be more likely after longer duration of maintenance treatment and in patients taking phenelzine.
The relationship between the dose and anxiolytic effects of diazepam and the serum concentrations of diazepam and nordiazepam were examined in groups of acutely and chronically anxious patients. The results showed a significant correlation between dose and serum nordiazepam concentrations after short-term (14-day) administration, but no significant association between clinical symptoms of anxiety and serum diazepam and nordiazepam. We conclude that the main value of serum benzodiazepine measurements in anxious patients in assessing compliance, particularly in patients suspected of taking more than the recommended dose. Serum nordiazepam is a more consistent index of dosage after chronic therapy than serum diazepam because it has a longer elimination half-time.
The inter-rater reliability of a schedule used to assess personality disorders was examined. The Personality Assessment Schedule (PAS) involves an interview with both the patient and a close informant and the ratings for the informant are given most weight in the final scoring. Videotaped interviews with 23 psychiatric patients, most of whom had a clinical diagnosis of personality disorder, and a close informant were scored by seven raters, four in the United Kingdom and three in the United States. Overall inter-rater reliabilities (using the intraclass correlation coefficient, RI) were generally good to excellent for each of the 24 personality variables tested, ranging between .66 and .94 for informants and between .51 and .91 for subjects. Corresponding reliability coefficients for overall mean PAS scores were .82 and .75, respectively. Consistent with these findings, there was little bias between the scores of American and British raters, although there was some tendency for American raters to score higher for the trait of eccentricity and lower for the trait of conscientiousness than was true for British raters. There was less bias for informants' ratings than for those of subjects. In a second set of analyses, it was shown that inter-rater reliability levels (using the Kappa statistic) were also good to excellent (.6 to .8) for the categorical diagnosis of personality disorder. These results, taken together, demonstrate that abnormal personality can be reliably assessed by both British and American raters.