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Biomedical subjects

D Kingdon

Publications and source records attributed to D Kingdon.

At least 19 recordsLinked to original sources
PubMed2002

Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes.

BACKGROUND: Cognitive-behavioural therapy (CBT) improves persistent psychotic symptoms. AIMS: To test the effectiveness of added CBT in accelerating remission from acute psychotic symptoms in early schizophrenia. METHOD: A 5-week CBT programme plus routine care was compared with supportive counselling plus routine care and routine care alone in a multi-centre trial randomising 315 people with DSM-IV schizophrenia and related disorders in their first (83%) or second acute admission. Outcome assessments were blinded. RESULTS: Linear regression over 70 days showed predicted trends towards faster improvement in the CBT group. Uncorrected univariate comparisons showed significant benefits at 4 but not 6 weeks for CBT v. routine care alone on Positive and Negative Syndrome Scale total and positive sub-scale scores and delusion score and benefits v. supportive counselling for auditory hallucinations score. CONCLUSIONS: CBT shows transient advantages over routine care alone or supportive counselling in speeding remission from acute symptoms in early schizophrenia.

Adult↗
PubMed2000

A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication.

BACKGROUND: Research evidence supports the efficacy of cognitive-behavioral therapy in the treatment of drug-refractory positive symptoms of schizophrenia. Although the cumulative evidence is strong, early controlled trials showed methodological limitations. METHODS: A randomized controlled design was used to compare the efficacy of manualized cognitive-behavioral therapy developed particularly for schizophrenia with that of a nonspecific befriending control intervention. Both interventions were delivered by 2 experienced nurses who received regular supervision. Patients were assessed by blind raters at baseline, after treatment (lasting up to 9 months), and at a 9-month follow-up evaluation. Patients continued to receive routine care throughout the study. An assessor blind to the patients' treatment groups rated the technical quality of audiotaped sessions chosen at random. Analysis was by intention to treat. RESULTS: Ninety patients received a mean of 19 individual treatment sessions over 9 months, with no significant between-group differences in treatment duration. Both interventions resulted in significant reductions in positive and negative symptoms and depression. At the 9-month follow-up evaluation, patients who had received cognitive therapy continued to improve, while those in the befriending group did not. These results were not attributable to changes in prescribed medication. CONCLUSION: Cognitive-behavioral therapy is effective in treating negative as well as positive symptoms in schizophrenia resistant to standard antipsychotic drugs, with its efficacy sustained over 9 months of follow-up.

Adult↗
PubMed2000

Cognitive-behavioural techniques for general psychiatrists in the management of patients with psychoses.

BACKGROUND: Recent research progress showing the benefits of cognitive therapy in schizophrenia leaves the general psychiatrist unsure whether to attempt to use such techniques. AIMS: To test whether cognitive-behavioural techniques are beneficial in the management of patients with schizophrenia in general psychiatric practice. METHOD: A randomised controlled study comparing the use of cognitive-behavioural techniques and befriending in schizophrenia. RESULTS: Significant improvement in symptoms occurred in the group treated with cognitive-behavioural techniques but not in the befriending group. During the 6-month follow-up period the cognitive-behavioural group tended to have shorter periods in hospital. CONCLUSIONS: General psychiatrists could help their patients with schizophrenia by using cognitive-behavioural techniques. Such techniques are well within the capability of general psychiatrists, but their application would involve more of the consultant's time spent in direct contact with patients with psychoses.

Adolescent↗
PubMed2000

The management of schizophrenia: cognitive behavioural therapy.

Over the past decade advances in the management of schizophrenia in the community have involved increasing emphasis on the psychosocial dynamics of care, coordinated through a care programme approach, and the introduction of new medication. In particular, the use of cognitive behavioural therapy (CBT) has been shown to be an effective means of tackling symptoms associated with schizophrenia (Jones et al, 1998). While some of the techniques used in CBT may be too advanced for untrained therapists to use, the approach described in this article may be used by registered mental health nurses and community professionals. This approach includes medication adherence, coping strategies, questioning style, the prevention of patient relapse and dealing with relatives.

Adaptation, Psychological↗
PubMed1998

Managing what you measure: creating outcome-driven systems of care for youth with serious emotional disturbances.

This article presents the California System of Care Model for youth with severe emotional disturbances as an illustration of how ongoing assessment of the costs and outcomes of service delivery can be an integral part of a service delivery model. The core of this model, developed initially in Ventura County, California, is a five-step planning process that guides care system development and implementation. The implications of each stage of the planning process for evaluation and feedback at the child, family, and system levels are highlighted. A set of principles for selecting outcome measures deriving from the planning process are also presented that, in conjunction with the planning model, serve as guidelines for establishing outcome measures within care systems. The resulting specific plan for measuring system- and client-level outcomes deriving from this process, along with challenges to the implementation of the outcome management plan, is described.

California↗
PubMed1996

Utility of the Pediatric Symptom Checklist as a psychosocial screen to meet the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) standards: a pilot study.

OBJECTIVE: To examine the usefulness of the Pediatric Symptom Checklist (PSC) as the psychosocial screening measure to meet federal Medicaid/Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) standards in a low-income Hispanic community. DESIGN AND SETTING: Three hundred seventy-nine children (aged 6 to 16 years) were screened with the PSC in a 10-month period during well child visits to three clinics in Ventura and San Mateo counties in California. The PSC was available in English and Spanish and was administered both in written (paper-and-pencil) and oral formats. Follow-up services were provided for children identified as needing evaluation. RESULTS: The Cronbach alpha was high (r = 0.91) for the PSC in the whole sample and virtually identical for English, Spanish, oral, and written formats. All the PSC items were significantly associated with total score on the PSC in English, Spanish, oral, and written formats. Overall, the PSC identified 10.6% of the sample as at risk for psychosocial problems. Thirty-six children (9.5% of sample) were referred for mental health follow-up. Public health data from Ventura County showed a statistically significant increase in referrals for psychologic problems during the study period in two locations using the PSC: from 0.5% to 2.9% of the school-aged children seen. CONCLUSION: The PSC provides a feasible, well-accepted method for screening for psychosocial problems during EPSDT examinations of school-aged children. Psychosocial screening using a validated instrument such as the PSC, as well as increased efforts to refer positive screening results, track outcomes, and assess cost benefits should be essential requirements in capitated Medicaid approaches to caring for poor children.

Adolescent↗
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↗
PubMed1991

Replacing the mental hospital. Community provision for a district's chronically psychiatrically disabled in domestic environments?

Eighteen long-stay patients from an old county asylum moved into hospital hostels. After 12-24 months, there were significant reductions in overall symptoms, as rated by the CPRS and the Krawiecka scale, as well as in deviant but not general behaviour, rated by the REHAB scale. Six later moved to live in supported accommodation. All relatives and patients who expressed an opinion to an independent assessor were satisfied with their present accommodation or wished to move to more independent living.

Activities of Daily Living↗
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↗
PubMed1988

The Nottingham study of neurotic disorder: comparison of drug and psychological treatments.

210 psychiatric outpatients with generalised anxiety disorder (71), or panic disorder (74), or dysthymic disorder (65) diagnosed by an interview schedule for DSM-III were allocated by constrained randomisation to one of five treatments: diazepam (28), dothiepin (28), placebo (28), cognitive and behaviour therapy (84), and a self-help treatment programme (42). All treatments were given for 6 weeks and then withdrawn by 10 weeks. Ratings of psychopathology were made by psychiatric assessors blind to both treatment and diagnosis before treatment and at 2, 4, 6, and 10 weeks after randomisation. 18 patients had insufficient data for analysis because of early drop-out. There were no important differences in treatment response between the diagnostic groups, but diazepam was less effective than dothiepin, cognitive and behaviour therapy, or self-help, these three treatments being of similar efficacy. Significantly more patients in the placebo group took additional psychotropic drugs in the 10 week period, and those allocated to dothiepin and cognitive and behaviour therapy took the least.

Adult↗