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Biomedical subjects

I M Marks

Publications and source records attributed to I M Marks.

At least 19 recordsLinked to original sources
PubMed1992

A prospective study of panic and anxiety in agoraphobia with panic disorder.

The features of panic and anxiety in the natural environment were studied by prospective self-monitoring in 39 patients with chronic agoraphobia and panic disorder. Panics overlapped greatly with anxiety episodes but were more intense. Panics occurred more often in public places than did anxiety episodes, but had otherwise similar symptom profile, time of occurrence, and antecedents. Most panics surged out of a pre-existing plateau of tonic anxiety which lasted most of the day. Spontaneous panics were less frequent than situational panics and occurred more often at home but were otherwise similar. These findings do not support the sharp distinction between panic and anxiety in DSM-III-R, not its emphasis on spontaneous panic in classifying anxiety disorders. Thoughts of dying and 'going crazy'/losing control accompanied only a minority of panic/anxiety episodes and seemed to be a product of intense panic rather than a cause.

Adult↗
PubMed1992

The daily living programme. Preliminary comparison of community versus hospital-based treatment for the seriously mentally ill facing emergency admission.

Patients with a serious mental illness requiring admission were randomised to home care or standard hospital care. Over the initial 18 months, 60 patients entered each group and were studied for a mean of 10 months. Home care reduced hospital use by 80%, with patients being admitted for a mean of 14 days, compared with 72 days for the standard group, but this bed-saving made no difference in direct treatment costs. Home care offers individualised treatment, and many patients require continuing support with the emphasis on areas such as finances and housing.

Activities of Daily Living↗
PubMed1991

Gender-divergent aetiological factors in obsessive-compulsive disorder.

Among 307 adults with OCD, early onset (age 5-15 years) was more common in men and later onset (age 26-35 years) in women. Early onset was associated with more checking, and late onset with more washing. More women than men had a history of treated depression; 12% of the women but none of the men had a history of anorexia. More women than men were married. Gender-divergent features may reflect differential aetiological factors. Our sample resembled others in the literature in its slight overall female preponderance, low rate of marriage and low fertility, onset mainly before age 35 years, chronicity, and common present and past depression.

Adolescent↗
PubMed1991

Obsessive slowness revisited.

Of 665 patients referred between 1969 and 1984 for behavioural treatment of obsessive-compulsive disorder, 22 had marked slowness not due to washing, which was secondary to mental or overt rituals or ruminations. Over 90% of the slowness cases were male, and over a quarter had pre-natal or delivery problems.

Adult↗
PubMed1990

Obsessive-compulsive disorder: case study and discussion of treatment.

A patient's own account of her obsessive-compulsive disorder is presented. She describes her distressing experiences, the impact of the disturbance on her and her family's life and her subsequent improvement using the technique of exposure and response prevention. The treatments available are discussed and the benefits of self-directed behavioural psychotherapy are reviewed. A comment from a general practitioner is appended.

Adult↗
PubMed1989

Exposure plus prevention of bingeing vs. exposure plus prevention of vomiting in bulimia nervosa. A crossover study.

In a crossover study, 11 bulimic patients divided into two groups of six and five patients underwent six sessions of exposure and response prevention of bingeing (ERPB) or exposure and response prevention of vomiting (ERPV) over 3 weeks. After a buffer period of 3 weeks, they were crossed over to six sessions of the other treatment. High drop-out rates, particularly during the ERPB phases, precluded full use of the crossover design. The two treatments yielded similar reduction in binge-vomit frequencies and in other between-session measures. Within-session measures, however, showed significant differences between the two treatments. ERPB was less time-consuming and led to greater reductions of urges to binge, anxiety, and liking of food. Overall improvement of patients in both groups was reasonable and further supports the usefulness of exposure techniques in the treatment of bulimic patients.

Adolescent↗
PubMed1988

Writer's cramp: not associated with anxiety.

Many authors have commented on an association between writer's cramp and anxiety and some view it as a form of anxiety disorder. This study describes 22 patients with writer's cramp who were recruited from a neurology clinic. Clinical examination found little evidence of generalized anxiety or of anxiety specific to the writing situation. Additionally, the subjects' scores on the Crown-Crisp Experiential Index, which contains several anxiety subscales, did not differ significantly from those of a matched normal control group. Writer's cramp differs from the anxiety disorders in two other respects: it has a later onset (mean in the 30s) and the male preponderance is much greater than in any anxiety disorder, even social phobia.

Adolescent↗
PubMed1988

Clomipramine in obsessive-compulsive ritualisers treated with exposure therapy: relations between dose, plasma levels, outcome and side effects.

Forty-nine obsessive-compulsive ritualisers completed a double-blind controlled study of clomipramine and exposure therapy. More severely ill patients allowed higher doses of medication to be prescribed and had higher plasma levels of both clomipramine and desmethylclomipramine. Exposure instructions had a strong effect, whereas the clomipramine effect was small and short-lived. Plasma levels of desmethylclomipramine but not of clomipramine correlated with outcome at weeks 8 and 17. There was no evidence of a therapeutic window for either clomipramine or its metabolite. Patients' physical complaints before treatment correlated positively with depression and anxiety, especially sexual difficulties. Dry mouth, as a side effect, was most evidently related to clomipramine and its usefulness in monitoring drug compliance for patients on clomipramine is reaffirmed.

Adolescent↗
PubMed1988

Urinary cortisol during exposure in obsessive-compulsive ritualizers.

Nineteen obsessive-compulsive (OC) ritualizers were exposed to both brief and prolonged neutral and aversive stimuli (the latter evoked a significant urge to ritualize). Urinary cortisol and subjective anxiety were measured over 3 1/2 hours throughout the experiment, and cortisol secretion was compared to a control session the previous day. Both groups showed higher cortisol secretion after exposure compared to the control session. Only the group that received prolonged aversive stimuli, in addition to brief aversive and neutral stimuli, showed significantly higher urinary cortisol levels after the session. Cortisol response correlated with subjective anxiety reports during prolonged aversive stimulation only.

Adolescent↗
PubMed1988

Obsessive-compulsive beliefs and treatment outcome.

Of 49 compulsive ritualizers one-third perceived their obsessive thoughts as a rational and felt that their rituals warded off some unwanted or feared event (the content of their obsessions). The more bizarre the obsessive belief the more strongly it was defended and 12% of cases made no attempt to resist the urge to ritualize. Neither fixity of belief nor resistance to compulsive urges were related to duration of illness. Patients with bizarre and fixed obsessive beliefs responded as well to treatment (all but three received exposure), as did patients whose obsessions were less bizarre and recognized as senseless. There was no difference in outcome between patients who initially found it hard to control their obsessions or never resisted the urge to ritualize and those who initially could control obsessions or resist rituals. One year after starting treatment, patients whose obsessions and compulsions had improved with treatment recognized their irrationality more readily and controlled their compulsive urges more easily. Beliefs appeared to normalize as a function of habituation.

Adult↗
PubMed1988

Computer-supervised exposure treatment for phobias.

Twenty phobic outpatients were treated by 9 weekly "interviews" at the console of a desk computer. Using a conversational style and multiple choice questions, the computer assessed the symptoms and agreed a hierarchy of self-exposure tasks. Each week the patient was given a diary sheet of tasks to practise daily. At his next visit his progress and motivation were assessed, and if he was succeeding he was encouraged to accept progressively more difficult tasks. This group was compared with a group of 20 patients (matched for age, sex and type of phobia) treated conventionally by a therapist in the preceding year. Progress was measured on standardized scales (both self- and clinician-rated). The two groups showed significant improvement on all the scales, and 75-80% of each group were much improved (scores reduced by 50%). The therapist treated group tended to be more severely ill at entry and to show greater improvement during treatment. Improvement was maintained at 6 month follow-up in both groups.

Adult↗
PubMed1988

Therapist contact and outcome of self-exposure treatment for phobias. A controlled study.

Eighty-four chronic phobic patients were randomly assigned to self-exposure in vivo instructed by either a psychiatrist, a computer or a book; mean therapy time per patient was respectively 3.1, 3.2 and 0 hours. Seventy-one patients completed treatment. All three groups improved substantially and similarly to 6 months follow-up, with no significant difference between them; self-exposure treatment was effective even without therapist contact. Among the three groups, initial expectation of help and positive attitude to the psychiatrist were equally high and related to subsequent rating of help received. All three groups rated the psychiatrist as more tolerant, reliable, and understanding than the computer or book, but these attitudes did not relate to outcome, were initially similar among all three groups, and changed minimally at 6 months follow-up.

Adolescent↗
PubMed1988

Clomipramine, self-exposure and therapist-aided exposure for obsessive-compulsive rituals.

A randomised treatment design for 49 chronically obsessive-compulsive ritualising patients was devised and three controlled comparisons were made. 1. During 7 weeks of self-exposure instructions, clomipramine treatment improved some measures of rituals and depression significantly more than did placebo medication; this effect was transient and disappeared as drug treatment and exposure were continued for a further 15 weeks. 2. During 11-16 weeks of clomipramine treatment, self-exposure instructions yielded highly significantly more patient improvement than did anti-exposure instructions on nearly all measures of rituals and some of social adjustment. 3. Adding therapist-aided exposure (1.3 hours) to self-exposure instructions (3 hours) after 8 weeks had a barely significant transient effect of dubious clinical value, which was lost by the end of exposure (at week 23) and during follow-up assessments to week 52. We conclude that of the three therapeutic factors tested, self-exposure was the most potent; clomipramine played a limited adjuvant role, and therapist-aided exposure a marginal one.

Adolescent↗
PubMed1987

Relationship of skin conductance activity to clinical features in obsessive-compulsive ritualizers.

Before treatment 49 obsessive-compulsive (o-c) ritualizers were presented with two series of brief stimuli--15,100db tones (brief neutral) and 15 presentations of a ritual-evoking object (brief aversive). Habituation of skin conductance (SC) responses to the tones was reduced compared with that previously found in normal subjects. Neither habituation rates to tones nor aversive stimuli were related to coexisting anxiety or depression or to the severity of o-c symptoms. The increased arousal induced by the aversive stimuli was sustained, that induced by the tones was short-lived and SC level and subjective anxiety had returned to resting levels by the end of the tone series. Concordance between SC activity and subjective anxiety was much greater during and after the presentations of ritual evoking stimuli than of tones. There were few correlations between SC and clinical measures, though patients who strongly resisted and were able to control their compulsive urges were more aroused.

Anxiety Disorders↗
PubMed1987

Agoraphobics 5 years after imipramine and exposure. Outcome and predictors.

Five years after treatment in a controlled trial, in which all had received self-exposure homework, a group of 40 agoraphobic outpatients retained marked improvement in agoraphobia, mood, and free-floating anxiety. Frequency of spontaneous panics decreased as much in those who had placebo and self-exposure as in those who received imipramine and self-exposure. Few patients, however, were completely well at 5 years and over half had received further treatment for agoraphobia during the follow-up. Patients who were still highly phobic at the end of the clinical trial were more often prescribed psychotropic medication during follow-up and remained phobic at 5 years. Phobic improvement had generalized more in those patients with very low than in those with moderate pretreatment Hamilton depression scores. Frequency of initial spontaneous panics did not predict outcome. Improvement in agoraphobia was associated with improved marital adjustment. Those who began with the best marital, work, and social adjustment were more improved in their phobias 5 years later.

Adult↗