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Biomedical subjects

A Tylee

Publications and source records attributed to A Tylee.

33 records · Page 2Linked to original sources
PubMed1997

Measuring general practitioner psychology: the personal construct perspective.

BACKGROUND: According to personal construct theory (PCT), psychological processes are determined by the way in which individuals perceive differences and similarities between aspects of their environment and by the way this information is used to assist in the prediction of events. The important discriminations made by individuals are called "constructs'. OBJECTIVE: This article seeks to introduce PCT as a psychological measurement procedure to complement traditional standardized scales in research in general practice. METHOD: The repertory grid technique is a method of eliciting the content of the individual's constructs and determining their structure and inter-relationships. PCT and traditional measurement procedures are compared and contrasted, and the relevance of PCT to general practice psychology is discussed.

Attitude of Health Personnel↗
PubMed1997

The Defeat Depression Campaign: psychiatry in the public arena.

OBJECTIVE: The adequate recognition and treatment of depression are inhibited by negative public attitudes and gaps in professional expertise. This paper describes the activities and efforts of the Defeat Depression Campaign, a joint activity of the Royal College of Psychiatrists and the Royal College of General Practitioners, in the United Kingdom. METHOD: A 5-year campaign was undertaken from 1992 to 1996, aimed at enhancing public awareness and attitudes and providing professional education. RESULTS: An informational media campaign directed toward the general public was successfully undertaken. Leaflets, books, and audiotapes were also prepared and distributed to the public. Multiprofessional conferences on specific aspects of depression were organized. An extensive program of general practice education included consensus conferences and statements, recognition and management guidelines, training videotapes, and other publications. Public attitudes were found to be relatively favorable, except attitudes toward antidepressants, which were viewed as addictive. A general consequence of the campaign was the development of much additional public material and professional education not directly originating from the campaign. Aspects of the campaign are being evaluated, including public attitude change, impact of educational materials on general practitioners, and prescription of antidepressants. CONCLUSIONS: A campaign of this kind serves a useful function in enhancing public education and awareness and improving professional recognition and management of depression.

Antidepressive Agents↗
PubMed1997

Depression in the community: the first pan-European study DEPRES (Depression Research in European Society).

DEPRESS (Depression Research in European Society) is the first large pan-European survey of depression in the community. A total of 13359 of the 78463 adults who participated in screening interviews across six countries were identified as suffering from depression, a 6-month prevalence of 17%. Major depression accounted for 6.9% of the cases of depression and minor depression for 1.8%. Depressed subjects in both these categories perceived that their working or social lives were substantially impaired by depressive symptoms. The remaining 8.3% of depressed subjects considered that their functional impairment was not substantial. A significant proportion of sufferers from depression (43%) failed to seek treatment for their depressive symptoms. Of those who did seek help (57%), most consulted a primary care physician, the frequency of consultation increasing with the severity of depression. Sufferers from major depression imposed the greatest demand on healthcare resources, making almost three times as many visits to their GP or family doctor as non-sufferers (4.4 vs 1.5 visits over 6 months). More than two-thirds of depressed subjects (69%) were not prescribed any treatment and when drug therapy was prescribed (31%), only 25% of these subjects were given antidepressant drugs. The number of days of work lost due to illness increased with the severity of depression. Major depression had most impact on productive work, with sufferers losing four times as many working days over 6 months as non-sufferers. The results of the DEPRES survey confirm the high prevalence of depression in the community and the burden imposed on the individual sufferer in terms of impaired quality of life and on society in terms of healthcare utilization and lost productivity.

Adult↗
PubMed1996

Lay people's attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch.

OBJECTIVE: To investigate the attitudes of the general public towards depression before the Defeat Depression Campaign of the Royal Colleges of Psychiatrists and General Practitioners; these results form the baseline to assess the change in attitudes brought about by the campaign. DESIGN: Group discussions generated data for initial qualitative research. The quantitative survey comprised a doorstep survey of 2003 people in 143 places around the United Kingdom. RESULTS: The lay public in general seemed to be sympathetic to those with depression but reluctant to consult. Most (1704 (85%)) believed counselling to be effective but were against antidepressants. Many subjects (1563 (78%)) regarded antidepressants as addictive. CONCLUSIONS: Although people are sympathetic towards those with depression, they may project their prejudices about depression on to the medical profession. Doctors have an important role in educating the public about depression and the rationale for antidepressant treatment. In particular, patients should know that dependence is not a problem with antidepressants.

Antidepressive Agents↗
PubMed1996

Familial breast cancer: a controlled study of risk perception, psychological morbidity and health beliefs in women attending for genetic counselling.

The present study set out to evaluate perceptions of risk, psychological morbidity and health behaviours in women with a family history of breast cancer who have attended genetic counselling and determine how these differ from general population risk women. Data were collected from 62 genetic counselees (cases) attending the Royal Marsden and Mayday University Hospital genetic counselling services and 62 matched GP attenders (controls). Levels of general psychological morbidity were found to be similar between cases and controls; however, cases reported significantly higher breast cancer-specific distress despite clinic attendance [mean (s.d.) total Impact of Event Scale score, 14.1 (14.3) cases; 2.4 (6.7) controls, P < 0.001]. Although cases perceived themselves to be more susceptible to breast cancer, many women failed correctly to recall risk figures provided by the clinic; 66% could not accurately recall their own lifetime chance. Clinics appeared to have a positive impact on preventive behaviours and cases tended to engage more regularly in breast self-examination (monthly, 66% of cases vs 47% of controls), although few differences were found between groups in terms of health beliefs. We conclude that counselees and GP controls showed considerable similarities on many of the outcome measures, and risk of breast cancer was not predictive of greater psychological morbidity; although cases were more vulnerable to cancer-specific distress. Despite genetic counselling, many cases continued to perceive their risk of breast cancer inaccurately.

Adult↗
PubMed1996

The treatment of depression: prescribing patterns of antidepressants in primary care in the UK.

BACKGROUND: Consensus has been achieved about how depression should be treated in primary care, and guidelines have been issued by the Royal Colleges of General Practitioners and Psychiatrists, and by the British Association for Psychopharmacology. One of the principal recommendations is to prescribe antidepressant medicine at effective doses. This study was established to investigate how current prescribing practices in primary care compared with these guidelines. METHOD: Information on prescribing of antidepressant medicines was obtained using three independent data sources: Prescribing Analysis and Cost (PACT) data; medical notes; and a large, computerised patient record database. RESULTS: Data were obtained on populations in excess of 1.5 million people, and over 80,000 prescriptions were reviewed. All three data sources showed very similar patterns of prescribing, in particular that as many as 88% of prescriptions for older tricyclic antidepressants are prescribed by GPs at doses below those recommended by the consensus guidelines. Newer antidepressants-lofepramine and the SSRIs-are prescribed comparatively well. CONCLUSIONS: Prescribing of antidepressants by GPs is not in line with the consensus recommendations on dosage. This may have major educational implications for GPs. A pragmatic approach to improve prescribing in the short term may be to advocate the use of lofepramine or the SSRIs as first line treatment for depression. This study validates the use of PACT data as a useful audit tool in this area of clinical practice.

Antidepressive Agents↗
PubMed1996

Continuing medical education in mental illness: a paradox for general practitioners.

BACKGROUND: In 1992, the Royal College of General Practitioners instituted its fellowship in mental health education, which aimed to provide general practitioner tutors with the skills they need to help general practitioners manage mental illness in general practice. However, the emphasis of the fellowship on pedagogic education may discourage educators wishing to introduce andragogic teaching, a paradox which general practitioners must resolve if the aims are to be realized. AIM: This study set out to follow the difficulties encountered by the regional fellows in managing the fellowship and to understand how the scheme has evolved. METHOD: Data collected for interim evaluation of the fellowship was studied and interviews undertaken with the senior fellow and the regional fellows participating in the scheme. RESULTS: From its beginnings, the project encountered difficulties involving acceptance among general practitioner tutors. In response to the objections raised, the project metamorphosed through three stages, from a (perceived) pedagogic approach to a much more overtly learner-centered one. CONCLUSION: Learner-centred education requires trust and belief in the ability of general practitioners to teach general practitioners; over-protection of the audience from 'non-expert' educators merely perpetuates the status quo. If education in mental health care is to become truly learner-centred, general practitioners must address this paradox.

Education, Medical, Continuing↗
PubMed1995

How does the content of consultations affect the recognition by general practitioners of major depression in women?

BACKGROUND: Major depression is a common and disabling condition. However, for many reasons, the condition is not recognized in about half of the patients with major depression. AIM: The aim of the study was to establish whether the content of general practice consultations affected general practitioners' recognition of major depressive illness in women patients. METHOD: The 30-item general health questionnaire was used as a first stage screening instrument for psychiatric morbidity. Patients newly recognized as depressed by their general practitioner and those not recognized as depressed who scored 11 or more on the questionnaire were interviewed, usually within three days of consulting their general practitioner, using the combined psychiatric interview. Videorecordings of the consultations for these two groups of women were analysed; analyses were based on mentions of physical, psychiatric and social symptoms and on whether the first mention of a psychiatric symptom was within the first four mentions of any symptoms (early in the consultation) or after four mentions of any symptoms (late) or if psychiatric symptoms were not mentioned. RESULTS: A paired sample of 72 women with major depression was obtained from patients consulting 36 general practitioners, each general practitioner providing one patient whom he or she had correctly recognized as being depressed and one patient whose depression had not been recognized. Women with major depression were about five times more likely to have their depression recognized if they mentioned their psychiatric symptoms early in the consultation compared with those who either left it later to mention such symptoms or never mentioned them. Major depression was more likely to be recognized if no physical illness was present. After adjusting for physical illness, depression was 10 times less likely to be recognized if the first psychiatric symptom was mentioned late in the consultation, or not mentioned at all, than if it was mentioned early in the consultation. CONCLUSION: General practitioners need to remember that patients who present with symptoms of physical illness may also have depression. They also need to remember to give equal importance diagnostically to mentions of symptoms at whatever point they occur in the consultation, regardless of the presence or absence of physical illness.

Adolescent↗
PubMed1993

A randomized, double-blind, multi-centre, parallel-group study comparing the tolerability and efficacy of moclobemide and dothiepin hydrochloride in depressed patients in general practice.

A randomized, double-blind, multi-centre, parallel-group study compared the tolerability and efficacy of 450 mg of moclobemide and 75-150 mg of dothiepin in the management of depressed patients in general practice. Patients who fulfilled the DSM-III-R criteria for major depressive disorder and who scored 13 or more on the Hamilton Depression Rating Scale were admitted. The trial lasted six weeks. The dose of moclobemide was 150 mg three times daily and that of dothiepin was 75 mg daily for the first two weeks and 150 mg thereafter. Assessments were made at baseline and after one, three and six weeks using the HDRS, the Zung SRS and the CGI. Adverse events and vital signs were monitored at each visit, and laboratory screening tests performed at the beginning and end of the study. Sixty-four general practitioners from four centres recruited 345 patients: 175 received dothiepin and 170 moclobemide; 265 completed six weeks of treatment. Thirty-eight dothiepin-treated patients (22%) and 42 who received moclobemide (25%) dropped out, most commonly because they experienced adverse events. More patients on dothiepin (24) than on moclobemide (16) dropped out for this reason; the incidence of adverse events was 10% higher in the dothiepin-treated group and of "side effects" more than 10% higher, the latter difference being statistically significant. Both treatments resulted in significant improvement; this was greater in the dothiepin-treated group and the difference was statistically significant, although clinically small.

Adolescent↗
PubMed1987

Consultation analysis by triggers and symptoms (CATS). A new objective technique for studying consultations.

Doctor-patient consultation is a field of study important to general practice. The emphasis has tended to be on modes of exchange and subjective judgement of task achievement. More recently, a need to establish relationships between the information transferred and its mode of transfer has become clear. This paper describes such an approach with a specially devised scale (the consultation and analysis by triggers and symptoms (CATS) scale). The inter-rater reliability of the scale was established using a standard videotape. The CATS scale seems relatively easy to learn and to have relatively high inter-rater reliability.

Humans↗