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Biomedical subjects

P de Silva

Publications and source records attributed to P de Silva.

At least 19 recordsLinked to original sources
PubMed1999

Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy.

Despite the major advances in the development of treatments for bulimia nervosa, drop-outs and a lack of engagement in treatment, continue to be problems. Recent studies suggest that the transtheoretical model of change may be applicable to bulimia nervosa. The aim of this study was to examine the roles of readiness to change and therapeutic alliance in determining engagement and outcome in the first phase of treatment. One hundred and twenty five consecutive female patients meeting DSM-IV criteria for bulimia nervosa took part in a randomised controlled treatment trial. The first phase of the sequential treatment compared four sessions of either cognitive behavioural therapy (CBT) or motivational enhancement therapy (MET) in engaging patients in treatment and reducing symptoms. Patients in the action stage showed greater improvement in symptoms of binge eating than did patients in the contemplation stage. Higher pretreatment scores on action were also related to the development of a better therapeutic alliance (as perceived by patients) after four weeks. However, pretreatment stage of change did not predict who dropped out of treatment. There were no differences between MET and CBT in terms of reducing bulimic symptoms or in terms of developing a therapeutic alliance or increasing readiness to change. The results suggest that the transtheoretical model of change may have some validity in the treatment of bulimia nervosa although current measures of readiness to change may require modification. Overall, readiness to change is more strongly related to improvement and the development of a therapeutic alliance than the specific type of treatment.

Adult↗
PubMed1999

The role of traumatic experiences in the genesis of obsessive-compulsive disorder.

This paper discusses the role of traumatic stress in the genesis of obsessive-compulsive disorder. While the early classical conditioning theory of the onset of obsessive-compulsive disorder has only limited empirical support, authorities have always recognised the role of stress in precipitating this disorder, and in triggering relapse in those who have been successfully treated. Here, clinical cases are cited that show a causal link between severe trauma and the onset of obsessive-compulsive disorder. The nature of the traumatic reaction and the possible mechanisms by which it leads to frank obsessive-compulsive disorder are discussed. The apparent links between this and posttraumatic stress disorder are also explored. Finally, implications for therapy are considered.

Adolescent↗
PubMed1999

Thought-starting: a review of new developments.

This paper discusses the work on thought-starting, a clinical technique developed by Durac, over many years. Much clinical work has taken place in using and further developing this approach, and some research has also been carried out. This paper attempts a review of these developments. A selective account of some of the major developments is given. The implications of these developments are also briefly discussed.

Anxiety Disorders↗
PubMed1995

Post-traumatic stress disorder in airplane cabin crew attendants.

Six cabin crew attendants who survived an airplane crash in which 47 passengers were killed were assessed for post-traumatic stress disorder and other psychological problems. Each was interviewed 8 months after the crash and completed questionnaires measuring intrusive thoughts, avoidance, depressed mood, anxiety, and fear. Questionnaires were repeated 10 months later. All six met DSM-III-R criteria for post-traumatic stress disorder, reported a wide range of symptoms, and developed a fear of flying 8 months after the crash. Depression scores were normal 18 months after the crash, but all other measures remained unchanged, showing a continued high level of traumatic stress. Results point to the potential for crash survivors to develop chronic psychological problems. The highest levels of distress were reported by the three most senior members of staff with the most responsibility on board, who had also suffered the most severe physical injury. Clinical implications of the results are discussed, and the need for predisaster training of cabin crew and postdisaster treatment is emphasized.

Accidents, Aviation↗
PubMed1994

The 'match/mismatch' model of fear: empirical status and clinical implications.

This paper reviews empirical evidence for the 'match/mismatch' model of fear and defines what is currently known about the prediction of fear. It also outlines several gaps in the literature on this topic and problems with the methodology used to study this phenomenon. Some of these gaps are filled by studies on the prediction of pain and where relevant these are discussed. Important areas for future research are identified, the clinical implications of the model are outlined and specific suggestions for treatment are made.

Fear↗
PubMed1993

Is the selective information processing of food and body words specific to patients with eating disorders?

The selective processing of food- and body size-related information was investigated using a modified version of the Stroop task. Anorexic and bulimic patients and matched female controls were compared on the basis of categorical (diagnosis), dimensional (restraint and drive for thinness) criteria, or both. The findings suggest that the phenomenon assessed by the Stroop paradigm is not exclusive to patients with a clinical eating disorder, but patients and those control subjects who are restrained eaters with a high drive for thinness share a selective processing of information related to shape and eating. The discussion focuses on the implications of these findings.

Anorexia Nervosa↗
PubMed1993

A multicenter comparative trial of triphasic and monophasic, low-dose combined oral contraceptives.

A comparative multicenter clinical trial of two combined oral contraceptives (OCs) was conducted at clinics located in the Sudan, Sri Lanka, Chile, the Dominican Republic and Ecuador. The trial was designed to determine if there were differences in efficacy, safety and acceptability between a triphasic and a low-dose monophasic OC. This report includes analysis of 1088 women. At each center, subjects were randomly allocated to one of the two OCs. Follow-up visits were scheduled at 1, 4, 8 and 12 months after admission. There were two accidental pregnancies attributed to user failure reported during the study period; one in the triphasic group and one in the monophasic group. Adverse experiences were mainly minor with headaches and dizziness being the most common complaints; frequency of reports was similar in both groups. Cycle control was good in both groups with women in the triphasic group reporting fewer complaints of intermenstrual bleeding. Both OCs were safe and effective.

Adolescent↗
PubMed1992

Worry and obsessional symptoms: a correlational analysis.

Several studies have suggested that worry and obsessional symptoms are systematically associated. In the present study, the relationship between worry and obsessional symptoms was confirmed. Measures included a worry content measure, a worry visual analogue scale, a modification of the everyday checking behaviours scale, and the MOCI. Worry was found to be more consistently associated with checking and doubting, than washing and slowness. It is suggested that worry and obsessional symptoms both occur in response to stress. In addition, it is suggested that worry and checking are functionally similar, and Generalised Anxiety Disorder may represent a 'cognitive' variant of obsessional checking.

Adult↗
PubMed1990

Is filariasis a trigger for bronchial asthma?

Many Sri Lankan children with cough and wheeze and peripheral blood eosinophilia are treated with diethyl carbamazine (D.E.C.) on the assumption that filaria is the cause. We tried to establish whether filaria can trigger asthma and whether D.E.C. improves bronchial reactivity. In 35 symptomatic and 22 asymptomatic children peripheral blood eosinophil counts, filarial antibody test, stool examination, chest radiography, allergy skin tests and histamine inhalation tests were performed before and after treatment with D.E.C. Most of the symptomatic children were atopic; 1/3 of all children had helminthiasis, positive filarial antibodies and total eosinophil counts of greater than 2,000. Ten children had chest radiographs suggestive of tropical pulmonary eosinophilia. Only in those with intermittent symptoms was there a marked improvement in bronchial reactivity after D.E.C., but baseline peak expiratory flow (P.E.F.) improved in all symptomatic groups. We conclude that 1/3 of the children had filariasis which in an atopic individual may trigger asthma. Both the anti-inflammatory and the anti-filarial action of D.E.C. probably contribute to improvement of bronchial reactivity.

Asthma↗
PubMed1989

A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa.

This study was undertaken to investigate whether a cognitive-behavioural treatment procedure was superior to a standard behavioural treatment, in the outpatient therapy of patients with anorexia nervosa. The two treatments were also compared with a control treatment procedure consisting of routine outpatient management. Each group consisted of eight subjects. All the groups showed some improvement, but the findings did not provide support for the prediction that cognitive-behavioural treatment, designed specifically to manipulate both attitudes and behaviour, was superior to the other types of treatment. The implications of the findings are considered.

Adult↗
PubMed1988

The modification of human food aversions: a preliminary study.

Food aversions in normal adult humans are quite common, but they rarely present a clinical problem. The present report describes the modification of food aversions in a series of adults. The strategy used was simple in vivo graded exposure, with modelling and verbal reinforcement. The success of the strategy suggests that human food aversions are modifiable with relatively simple techniques.

Adult↗
PubMed1988

Selective processing of food words in anorexia nervosa.

The selective processing of food- and body size-related information was investigated using a modified version of the Stroop task. Anorexic subjects were generally slower than controls in colour-naming all words, and particularly slow with food-related words. This interference effect appeared to operate maximally amongst subjects who fell into the higher end of the anorexic weight range. The findings appeared to be a reflection of current concerns with food and eating.

Anorexia Nervosa↗