Biomedical subjects

N Tarrier

Publications and source records attributed to N Tarrier.

At least 19 recordsLinked to original sources

PubMed2004

The evolution of insight, paranoia and depression during early schizophrenia.

BACKGROUND: How insight, paranoia and depression evolve in relation to each other during and after the first episode of schizophrenia is poorly understood but of clinical importance. METHOD: Serial assessments over 18 months were made using multiple instruments in a consecutive sample of 257 patients with first episode DSM-IV non-affective psychosis. Repeated measures of paranoia, insight, depression and self-esteem were analysed using structural equation modelling, to examine the direction of relationships over time after controlling for confounds. RESULTS: Depression was predicted directly by greater insight, particularly at baseline, and by greater paranoia at every stage of follow-up. Neither relationship was mediated by self-esteem, although there was a weak association of lower self-esteem with greater depression and better insight. Paranoia was not strongly associated with insight. Duration of untreated psychosis and substance use at baseline predicted depression at 18 months. CONCLUSIONS: In first-episode psychosis, good insight predicts depression. Subsequently, paranoia is the strongest predictor. Neither effect is mediated by low self-esteem. Effective treatment of positive symptoms is important in preventing and treating low mood in early schizophrenia.

Adult↗

PubMed2003

The family and compliance in schizophrenia: the influence of clinical variables, relatives' knowledge and expressed emotion.

BACKGROUND: . A variety of factors are related to compliance with medication in schizophrenia, but little attention has been paid to the role of families. Carers' knowledge or expressed emotion (EE) may be related to compliance. The aim of the present study was to evaluate the relevance of these two factors, as well as their relationships with other variables for the prediction of compliance. METHOD: A sample of patient-carer pairs (N = 79) involved in a family intervention for schizophrenia trial was recruited. Compliance, symptoms, social functioning and attitudes to their carers were assessed in patients. Carers' EE, knowledge and psychopathology were also evaluated. RESULTS: A number of factors were related to compliance, including carers' EE and patients' psychotic symptoms, which contributed independently to not taking medication. Carers' knowledge about schizophrenia and other groups of symptoms was not related to compliance. CONCLUSIONS: EE may be an important factor to account for in the understanding of patients' compliance and the direction of the relationship between EE and compliance should be the subject of further study.

Adolescent↗

PubMed2003

The Family Questionnaire (FQ): a scale for measuring symptom appraisal in relatives of schizophrenic patients.

OBJECTIVE: This study examined the psychometric properties of the Family Questionnaire (FQ): a self-report measure of relatives' perceptions of the behaviours and symptoms of schizophrenic patients in terms of three dimensions: the frequency of symptoms, the relatives' concern (primary appraisal) and their ability to cope (secondary appraisal) with the symptoms. METHOD: Factor analysis of the FQ, test-retest and inter-rater reliability, and measures of validity were examined. RESULTS: Factor analysis supported the validity of five subscales labelled negative symptoms, antisocial behaviours, interpersonal problems, affective symptoms and psychotic symptoms. Test-retest reliability for all scales was good and the prediction that there would be limited correspondence between two different relatives' scores was supported for the subscales of negative symptoms and affective symptoms. Concurrent measures of relatives' distress, burden and patients' symptomatology indicated that the FQ showed acceptable validity. In particular, the study showed that high expressed emotion relatives have higher scores on the appraisal dimensions of some subscales. CONCLUSION: The study provides evidence that the FQ is a useful tool for measuring relatives' perceptions of schizophrenic illness, particularly within the context of family interventions where it may be utilized to help to understand the factors mediating relatives' burden and distress.

Adaptation, Psychological↗

PubMed2002

The nature and timing of seasonal affective symptoms and the influence of self-esteem and social support: a longitudinal prospective study.

BACKGROUND: Seasonal affective disorder (SAD) is characterized by recurrent episodes of depression occurring regularly with the onset of winter. METHOD: The study was a prospective naturalistic follow-up of the emergence of symptoms of seasonal depression with the passage of time and change in seasons. Participants were screened during summer for SAD. Participants were excluded if they were depressed (BDI > 14) during the summer reruitment. Eligible participants prospectively monitored their mood and anxiety by completing the BDI and BAI every 2 weeks from 1 September through to the 31 March. RESULTS: Forty-five participants met criterion for SAD were included in the final data analyses. Depression scores rose gradually over the 30 week period reaching a peak median score around weeks 22 to 24 (January-February). The 'hallmark' physiological symptoms (changes in sleep, appetite and fatigue) emerged earlier in the winter period than cognitive symptoms. The emergence of anxiety symptoms was highly correlated with depressive symptoms, although the median anxiety scores did not reach a clinically significant level. Low self-esteem and poor perceived social support were significantly related to an earlier onset in the emergence of depressive symptoms. Both these factors together resulted in the speediest onset of depression. Poor perceived social support, but not low self-esteem, was associated with earlier emergence of anxiety symptoms. CONCLUSIONS: Physiological symptoms may activate negative cognitions in individuals with risk factors of low self-esteem and poor social support so that the disorder is precipitated earlier and is of longer duration.

Adult↗

PubMed2002

2-COM: an instrument to facilitate patient-professional communication in routine clinical practice.

OBJECTIVE: A simple patient-completed self-report instrument may facilitate patient-professional carer communication. METHOD: A 19-item self-report needs schedule was used in a sample of 243 out-patients with non-affective psychosis. Patients and professional carers commented on the usefulness of the instrument. In a subgroup of 95 patient-carer dyads, the professional carer was asked to rate the needs in addition to the patient. RESULTS: Patients scored their needs reliably and lower than the professionals (OR = 0.9, 95% CI: 0.9, 0.97). Concordance between patients and professional carers on individual needs was very low. More than 50% of the professional carers and more than 80% of the patients found 2-COM useful. The higher the number of needs indicated by the patient, the greater the discrepancy between patients and professional carers with regard to the usefulness of the schedule. CONCLUSION: 2-COM is a useful instrument to expose, and subsequently bridge, patient-professional carer discordance on patient needs.

Adult↗

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↗

PubMed2001

Investigating the functional anatomy of empathy and forgiveness.

Previous functional brain imaging studies suggest that the ability to infer the intentions and mental states of others (social cognition) is mediated by medial prefrontal cortex. Little is known about the anatomy of empathy and forgiveness. We used functional MRI to detect brain regions engaged by judging others' emotional states and the forgivability of their crimes. Ten volunteers read and made judgements based on social scenarios and a high level baseline task (social reasoning). Both empathic and forgivability judgements activated left superior frontal gyrus, orbitofrontal gyrus and precuneus. Empathic judgements also activated left anterior middle temporal and left inferior frontal gyri, while forgivability judgements activated posterior cingulate gyrus. Empathic and forgivability judgements activate specific regions of the human brain, which we propose contribute to social cohesion.

Adult↗

PubMed2001

Personality and peritraumatic dissociation in the prediction of PTSD in victims of road traffic accidents.

OBJECTIVES: To investigate the contribution of personality and peritraumatic dissociation in the development of posttraumatic stress disorder (PTSD). METHOD: Victims of road traffic accidents (RTA) were assessed within 2-4 weeks (Time 1) of the accident and again between 4 and 6 months (Time 2). The Eysenck Personality Questionnaire (EPQ) and Peritraumatic Dissociation Experience Questionnaire (PDEQ) were administered at Time 1 and posttraumatic stress symptoms were assessed at Time 2. RESULTS: 265 subjects were assessed at both time points, although neuroticism, psychoticism, and peritraumatic dissociation were significantly correlated with posttraumatic symptoms, only the personality dimensions were independent and significant predictors of subsequent PTSD in a logistic regression. CONCLUSIONS: Consistent with the literature personality measures, especially neuroticism, is associated with the development of PTSD. However, peritraumatic dissociation was not found to be an independent predictor of PTSD.

Accidents, Traffic↗

PubMed2001

A survey of the need for psychological input in a follow-up service for adult burn-injured patients.

Increasingly, burns services are incorporating clinical psychologists as members of their acute care and rehabilitation teams. This study aimed to provide evidence for the necessity of psychological input in a follow-up service for victims of burn injuries in Manchester. Psychological morbidity and need of consecutive burn-injured patients (n=68) attending an outpatient clinic was surveyed in comparison to a sample of consecutive plastics and trauma patients attending the same clinic (n=44). Significantly more burn-injured patients reported emotional difficulties as measured by the hospital anxiety and depression scale and the impact of events scale due to their condition than the plastics and trauma patients. Burn-injured individuals reported a lack of psychological support and made suggestions for support services that may have been beneficial. The findings supported the need for a comprehensive follow-up service that would make specialist physical and psychological support more accessible to burn-injured patients post-hospitalisation. The accuracy of medical staff in identifying psychological difficulties during a routine follow-up consultation was examined in a sub-group of burns victims (n=21). Medical staff was able to correctly identify the presence of psychological difficulties in 58% of cases. Implications regarding referral routes to psychological services were highlighted.

Adaptation, Psychological↗

PubMed2001

Needs-based cognitive-behavioural family intervention for carers of patients suffering from schizophrenia: 12-month follow-up.

OBJECTIVE: To examine longer-term effectiveness of a needs-based family intervention for carers and out-patients suffering from schizophrenia. METHOD: Seventy-nine unselected patient-carer pairs were recruited from a geographical area and allocated randomly to one of two conditions. One group received needs-based cognitive-behavioural family intervention in combination with general family support plus the standard care. The control group received the general family support and standard care only. RESULTS: Analysis was carried out on an intention-to-treat basis. There was a significant advantage for family intervention, in terms of relapse (37% relapsed compared to 72%, NNT=3) and on other clinical measures. Treatment group and medication compliance were significant and independent predictors of relapse. There was a significant reduction in carer needs in the intervention group. CONCLUSION: Family intervention directed at carers' needs within a standard mental health service can produce benefits for patients beyond the term of intervention.

Adult↗

PubMed2001

A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults.

The authors used a randomized trial to compare cognitive-behavioral therapy (CBT) and supportive counseling (SC) in the treatment of anxiety symptoms in older adults who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.: American Psychiatric Association, 1994) criteria for anxiety disorders. Both conditions had a 6-week baseline no-treatment phase. Treatment was delivered primarily in patients' own homes and in an individual format. Outcomes were assessed at posttreatment and at 3-, 6-, and 12-month follow-ups. There was no spontaneous improvement during the baseline phase. Both groups showed improvement on anxiety measures following treatment, with a better outcome for the CBT group on self-rating of anxiety and depression. Over the follow-up period, the CBT group maintained improvement and had significantly greater improvement than the SC group on anxiety and 1 depression measure. Treatment response for anxiety was also superior for the CBT group, although there was no difference between groups in endstate functioning.

Aged↗

PubMed2001

Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders.

OBJECTIVE: Comorbidity of substance abuse disorders with schizophrenia is associated with a greater risk for serious illness complications and poorer outcome. Methodologically sound studies investigating treatment approaches for patients with these disorders are rare, although recommendations for integrated and comprehensive treatment programs abound. This study investigates the relative benefit of adding an integrated psychological and psychosocial treatment program to routine psychiatric care for patients with schizophrenia and substance use disorders. METHOD: The authors conducted a randomized, single-blind controlled comparison of routine care with a program of routine care integrated with motivational interviewing, cognitive behavior therapy, and family or caregiver intervention. RESULTS: The integrated treatment program resulted in significantly greater improvement in patients' general functioning than routine care alone at the end of treatment and 12 months after the beginning of the study. Other benefits of the program included a reduction in positive symptoms and in symptom exacerbations and an increase in the percent of days of abstinence from drugs or alcohol over the 12-month period from baseline to follow-up. CONCLUSIONS: These findings demonstrate the effectiveness of a program of routine care integrated with motivational interviewing, cognitive behavior therapy, and family intervention over routine psychiatric care alone for patients with comorbid schizophrenia and alcohol or drug abuse or dependence.

Adolescent↗

PubMed2000

Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: clinical effectiveness.

OBJECTIVE: To compare the clinical effectiveness of general practitioner care and two general practice based psychological therapies for depressed patients. DESIGN: Prospective, controlled trial with randomised and patient preference allocation arms. SETTING: General practices in London and greater Manchester. PARTICIPANTS: 464 of 627 patients presenting with depression or mixed anxiety and depression were suitable for inclusion. INTERVENTIONS: Usual general practitioner care or up to 12 sessions of non-directive counselling or cognitive-behaviour therapy provided by therapists. MAIN OUTCOME MEASURES: Beck depression inventory scores, other psychiatric symptoms, social functioning, and satisfaction with treatment measured at baseline and at 4 and 12 months. RESULTS: 197 patients were randomly assigned to treatment, 137 chose their treatment, and 130 were randomised only between the two psychological therapies. All groups improved significantly over time. At four months, patients randomised to non-directive counselling or cognitive-behaviour therapy improved more in terms of the Beck depression inventory (mean (SD) scores 12.9 (9.3) and 14.3 (10.8) respectively) than those randomised to usual general practitioner care (18.3 (12.4)). However, there was no significant difference between the two therapies. There were no significant differences between the three treatment groups at 12 months (Beck depression scores 11.8 (9.6), 11.4 (10.8), and 12.1 (10.3) for non-directive counselling, cognitive-behaviour therapy, and general practitioner care). CONCLUSIONS: Psychological therapy was a more effective treatment for depression than usual general practitioner care in the short term, but after one year there was no difference in outcome.

Adult↗

PubMed2000

Factors associated with outcome of cognitive-behavioural treatment of chronic post-traumatic stress disorder.

The study examined factors that were associated with outcome in the treatment of PTSD. A trial of cognitive therapy compared to imaginal exposure of chronic PTSD showed that although clinical improvements were obtained after treatment and at 6 month follow-up one type of treatment was not significantly superior to the other. Characteristics of the patient, the trauma and treatment and of pretreatment clinical measures were investigated as predictors of PTSD outcome. Eleven variables were significantly associated with the pre- to post-treatment change in CAPS severity scores. Of these, three (duration of therapy, gender and suicide risk) were selected into a step-wise multiple regression equation to explain 36.5% of the outcome. Similarly, nine variables were significant associated with the pretreatment to follow-up change with three variables (number of missed therapy sessions, residential status and co-morbid GAD) being selected into the equation and explaining 36.9% of the outcome. The best predictor of outcome was inconsistent attendance at therapy.

Adult↗

PubMed2000

Partners' expressed emotion and the control and management of type 1 diabetes in adults.

OBJECTIVE: "Expressed emotion" (EE) refers to a set of valid and reliable measures of family emotional attitudes, which are robust predictors of illness course in several psychiatric conditions and which have recently been studied in some medical conditions. We hypothesised that high EE in partners of diabetes patients would be associated with poorer glucose control, management of and adaptation to diabetes. METHODS: Sixty adult Type 1 diabetes patients, who were attending routine clinics at a specialist diabetes centre, and their partners were interviewed separately and completed various questionnaire measures. Partners' EE was rated from a modified Camberwell Family Interview; patients were interviewed to assess self-management practices. Glycated hemoglobin (HbA(1c)) was the measure of glucose control. RESULTS: Only 10/60 (17%) partners were classified as high EE. Patients with high-EE partners had significantly worse self-management scores, more negative appraisal of diabetes, and higher depression scores than those with low-EE partners, but there was no association between EE measures and HbA(1c). CONCLUSIONS: In contrast to findings from previous research on the families of patients with psychiatric illnesses, only a minority of partners of adult patients with Type 1 diabetes are classified as high-EE. We found no evidence that partners' EE was related to patients' blood glucose control.

Adolescent↗

PubMed2000

A review of expressed emotion research in health care.

Much research has been carried out on the impact of family relationships on the development and course of different illness. Research on Expressed Emotion (EE) developed out of studies of the impact of family members on patients with schizophrenia, and has provided us with a robust measure of relatives' emotional attitudes towards patients, which has now been applied in the study of numerous psychiatric and medical illnesses. This review outlines the history of EE research in schizophrenia, and discusses the evidence for the association between family EE and the course of schizophrenic illness. Some of the factors which might moderate the association between EE and illness course are outlined and the issues of the meaning and development of EE are discussed in the light of recent theoretical advances. The application of the EE methodology in other psychiatric and medical conditions is then reviewed and conclusions are drawn about the extent to which EE predicts illness course in conditions other than schizophrenia. Consideration is given to the ways in which the application of the paradigm to a variety of illnesses or conditions with different features can enhance our understanding of the EE construct.

Expressed Emotion↗

PubMed2000

The expressed emotion of case managers of the seriously mentally ill: the influence of expressed emotion on clinical outcomes.

BACKGROUND: Expressed emotion (EE) measured from relatives and informal carers has been consistently demonstrated to be associated with clinical outcome in schizophrenic patients. There have also been published studies that have investigated EE in professional carers that have suggested that the quality of the relationship between staff and patient may also be associated with patient outcomes. A large controlled trial of the effectiveness of different intensities of case management provided the opportunity to assess the association between the EE of case managers, including the quality of the relationship they had with patients under their care, and later clinical outcomes. METHOD: This was a prospective naturalistic study of EE present in a case manager patient dyad and subsequent patient outcomes. EE was assessed from the Five Minute Speech Sample (FMSS) at least 3 months after the case manager became responsible for the patient's care and a range of clinical outcomes were assessed 6 to 9 months later. Assessment of clinical outcomes was made independent and blind of the EE ratings. RESULTS: High EE ratings were significantly associated with individual case managers and not to symptom or illness factors. High EE was not associated with later clinical outcome, however, the positive relationship between case manager and patient was. The absence of a positive relationship was significantly associated with poorer outcomes. CONCLUSIONS: In spite of very low face-to-face contact between case managers and patients, compared with the amount of contact patients have with their informal carers and family, aspects of staff attitudes and behaviour did influence clinical outcome. There are potential implications of these results for staff training and clinical practice.

Adult↗

PubMed2000

Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease.

BACKGROUND: The majority of patients with Alzheimer's disease live outside institutions and there is considerable serious psychological morbidity among their carers. AIMS: To evaluate whether family intervention reduces the subjective burden of care in carers of patients with Alzheimer's disease and produces clinical benefits in the patients. METHOD: A prospective single-blind randomised controlled trial with three-month follow-up in which the experimental group received family intervention and was compared with two control groups. RESULTS: There were significant reductions in distress and depression in the intervention group compared with control groups at post-treatment and follow-up. There were significant reductions in behavioural disturbance at post-treatment and an increase in activities at three months in patients in the intervention group. Based on an improvement on the General Health Questionnaire resulting in a carer converting from a case to a non-case, the number to treat was three immediately post-treatment and two at follow-up. CONCLUSIONS: Family intervention can have significant benefits in carers of patients with Alzheimer's disease and has a positive impact on patient behaviour.

Adult↗