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Biomedical subjects

D Turkington

Publications and source records attributed to D Turkington.

18 recordsLinked to original sources
PubMed2001

The CBT of delusional disorder: the relationship between schema vulnerability and psychotic content.

This paper reports the process, interventions, and outcome of the cognitive-behavioural therapy of a patient who had a diagnosis of delusional disorder. The clinical features, process of therapy, and successful outcome are all discussed in relation to explanatory information processing models of delusion development and maintenance, and recent developments in formulation-driven CBT of delusions. The implications for therapy, service development, and training are discussed. Beliefs that mediate the relationship between core schemas and delusions may form a helpful focus for early therapeutic endeavour in psychosis.

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↗
PubMed1997

Florid psychopathology in patients receiving shocks from implanted cardioverter-defibrillators.

OBJECTIVES: To increase awareness of the potential for disabling anxiety and depression in patients receiving shocks from implanted cardioverter-defibrillators (ICDs). PATIENTS AND METHODS: ICDs are implanted in patients at this hospital for control of serious ventricular tachyarrhythmias inadequately controlled by drug treatment, who are unsuitable for map guided antiarrhythmic surgery. All are reviewed regularly at a dedicated ICD clinic and are advised to make contact between visits if they experience shocks. Symptoms of anxiety or depression were not actively sought, nor was a patient support group operating at the time of this data collection. When overt psychopathology was identified, patients were referred to a designated psychiatrist for management. RESULTS: Over a six year period, six (17%) of 35 patients with ICDs developed florid psychiatric problems after experiencing shocks. None had premorbid psychiatric predisposition. Of the six patients suffering severe psychiatric problems, four were men, their age range was 30-63 years, and left ventricular ejection fraction was 18-40%. All shocks were appropriate for clinical arrhythmias and ranged in frequency from two in six months to 111 in 24 hours. All six patients manifested severe anxiety, focused on fear of future shocks. Depression was also evident in three patients and two had become housebound. All responded within weeks to anxiolytic or antidepressant drugs, combined with relaxation and cognitive therapies. Ongoing psychiatric therapy was refused by one patient, and was required for between three and 18 months in the remainder. One patient died and one received a cardiac transplant during the follow up period (median 27.5 months, range 8-43). CONCLUSIONS: Because ICD implantation occurs against a complex medical background with inevitable psychological stress, all such patients should be considered at high risk for developing psychopathology.

Adult↗
PubMed1993

Fluoxetine in phantom limb pain.

Complete recovery of phantom limb pain of five years' duration occurred in a 71-year-old man following treatment with fluoxetine. There was no coexisting affective disorder. Further research is indicated in view of the postulated role of lowered central 5-hydroxytryptamine activity in the genesis and maintenance of chronic pain.

Aged↗
PubMed1991

The use of cognitive behavior therapy with a normalizing rationale in schizophrenia. Preliminary report.

Sixty-four consecutively referred patients with schizophrenia were treated with cognitive-behavioral psychotherapy as an adjunct to standard treatment. A destigmatizing rationale to explain symptom emergence was devised and supplemented these techniques. They proved safe to use and appeared acceptable to patients and their relatives. Members of the group are being maintained on low levels of or no medication and have required minimal hospitalization. The techniques used are described in detail.

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↗
PubMed1989

Chlordiazepoxide vs. methadone in opiate withdrawal: a preliminary double blind trial.

A double blind trial of chlordiazepoxide vs. methadone in the management of the opiate withdrawal syndrome was conducted in a group of 24 regular heroin takers. Subjective and objective measures including physiological parameters were recorded to compare the severity of opiate withdrawal between the two groups. No significant difference was found in terms of subjective withdrawal distress between the two treatment conditions, although there was a tendency to a return of withdrawal symptoms in the methadone group towards the end of treatment. A nurse rating scale demonstrated a significantly higher level of withdrawal signs in the chlordiazepoxide group on day 3. Physiological measures suggested that neither group experienced a severe withdrawal illness. A similar number in each group (37%) became completely drug free.

Adult↗
PubMed1989

How should opiate withdrawal be measured?

Comparison is made between subjective and objective measurements of opiate withdrawal severity in a group of 24 regular opiate takers undergoing inpatient detoxification. A lack of correlation is found between patients' subjective ratings, objective nurse ratings and physiological parameters of withdrawal severity. This indicates that in future research the subjective and objective dimensions of withdrawal should be considered and measured separately.

Arousal↗
PubMedDate not supplied

Mania induced by lorazepam withdrawal: a report of two cases.

Although depression is a well recognised component of the benzodiazepine withdrawal syndrome there have, as yet, been no convincing reports of mania. We report two cases of mania induced by abrupt discontinuation of lorazepam. Both cases were treated by reintroduction of the benzodiazepine followed by gradual dose reduction.

Adult↗