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Biomedical subjects

P Tata

Publications and source records attributed to P Tata.

14 recordsLinked to original sources
PubMed2004

Therapist competence and clinical outcome in the Prevention of Parasuicide by Manual Assisted Cognitive Behaviour Therapy trial: the POPMACT study.

BACKGROUND: Therapist competence may be an important factor in determining clinical outcome in psychological therapies. However, there are few published studies of therapist competence v. patient outcome from randomized controlled trials. We tested the hypothesis that higher levels of therapist competence would lead to better clinical outcomes in both patient- and observer-rated measures at 6- and 12-month follow-up. METHOD: A random sample of 49 audiotapes of manual assisted cognitive therapy sessions delivered by 21 therapists involved in the Prevention of Parasuicide by Manual Assisted Cognitive Behaviour Therapy trial was rated to assess the level of therapist competence. Patient outcome was assessed using self and observer ratings of depressive and anxiety symptoms, social functioning, global functioning and number of episodes of deliberate self-harm. RESULTS: At 6-month follow-up, there was a statistically significant association between therapist level of competence and observer-rated depression only. At 12-month follow-up, significant associations were noted between therapist competence and all observer-rated clinical outcomes but not for self-rated outcome measures. However, there was no association between therapist competence and the number of self-harm episodes during follow-up. CONCLUSIONS: When treated by therapists rated as more competent than other therapists who received equivalent brief training, patients with recurrent self-harm show significant clinical improvements. However, this benefit is not identified across all outcome measures and is not fully apparent until 12-month follow-up.

Adult↗
PubMed2003

Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study.

BACKGROUND: We carried out a large randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behaviour therapy (MACT) versus treatment as usual (TAU) for deliberate self-harm. METHOD: Patients presenting with recurrent deliberate self-harm in five centres were randomized to either MACT or (TAU) and followed up over 1 year. MACT patients received a booklet based on cognitive behaviour therapy (CBT) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study. Ratings of parasuicide risk, anxiety, depression, social functioning and global function, positive and negative thinking, and quality of life were measured at baseline and after 6 and 12 months. RESULTS: Four hundred and eighty patients were randomized. Sixty per cent of the MACT group had both the booklet and CBT sessions. There were seven suicides, five in the TAU group. The main outcome measure, the proportion of those repeating deliberate self-harm in the 12 months of the study, showed no significant difference between those treated with MACT (39%) and treatment as usual (46%) (OR 0.78, 95% CI 0.53 to 1.14, P=0.20). CONCLUSION: Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition, but the findings taken in conjunctin with the economic evaluation (Byford et al. 2003) indicate superiority of MACT over TAU in terms of cost and effectiveness combined.

Adult↗
PubMed2002

Psychiatric morbidity among patients with recurrent miscarriage.

In this study 81 women with recurrent miscarriages completed questionnaires designed to assess depression, anxiety and general health. This data was matched with data from their medical notes to ascertain demographic and reproductive variables. The results indicated that 33% of patients could be classified as depressed with 9.9% of women being moderately depressed and 7.4% suffering from severe depression. Twenty-one percent of patients had levels of anxiety that were equal or higher to a typical psychiatric outpatient population. Neither age, cigarette consumption, alcohol intake, previous live birth, number of miscarriages, lateness of miscarriage nor length of time since last miscarriage were found to affect the degree of psychiatric morbidity. These findings add to our understanding of the degree to which recurrent miscarriage can affect mental health.

Abortion, Habitual↗
PubMed1999

Manual-assisted cognitive-behaviour therapy (MACT): a randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm.

BACKGROUND: The treatment of deliberate self-harm (parasuicide) remains limited in efficacy. Despite a range of psychosocial, educational and pharmacological interventions only one approach, dialectical behaviour therapy, a form of cognitive-behaviour therapy (CBT), has been shown to reduce repeat episodes, but this is lengthy and intensive and difficult to extrapolate to busy clinical practice. We investigated the effectiveness of a new manual-based treatment varying from bibliotherapy (six self-help booklets) alone to six sessions of cognitive therapy linked to the booklets, which contained elements of dialectical behaviour therapy. METHODS: Thirty-four patients, aged between 16 and 50, seen after an episode of deliberate self-harm, with personality disturbance within the flamboyant cluster and a previous parasuicide episode within the past 12 months, were randomly assigned to treatment with manual-assisted cognitive-behaviour therapy (MACT N = 18) or treatment as usual (TAU N = 16). Assessment of clinical symptoms and social function were made at baseline and repeated by an independent assessor masked to treatment allocation at 6 months. The number and rate of all parasuicide attempts, time to next episode and costs of care were also determined. RESULTS: Thirty-two patients (18 MACT; 14 TAU) were seen at follow-up and 10 patients in each group (56% MACT and 71% TAU) had a suicidal act during the 6 months. The rate of suicidal acts per month was lower with MACT (median 0.17/month MACT; 0.37/month TAU; P = 0.11) and self-rated depressive symptoms also improved (P = 0.03). The treatment involved a mean of 2.7 sessions and the observed average cost of care was 46% less with MACT (P = 0.22). CONCLUSIONS: Although limited by the small sample, the results of this pilot study suggest that this new form of cognitive-behaviour therapy is promising in its efficacy and feasible in clinical practice.

Adolescent↗
PubMed1999

Autobiographical memory processes and the course of depression.

The authors report a 6-month follow-up study of clinically depressed patients. At baseline, 2 indexes of autobiographical memory functioning were assessed: the presence of spontaneous intrusive memories of stressful life events and performance on the Autobiographical Memory Test (J. M. G. Williams & K. Broadbent, 1986), which measures overgeneral memory. The index of overgeneral memory was associated with greater levels of spontaneous intrusion of stressful memories. Overgeneral memory did not predict outcome, but depression at follow-up was predicted by the amount of intrusion and avoidance of stressful memories, even after controlling for initial severity of psychiatric symptoms.

Aged↗
PubMed1998

Recovery of positive future thinking within a high-risk parasuicide group: results from a pilot randomized controlled trial.

OBJECTIVES: The research examined: (i) whether high risk parasuicide patients showed a deficit in positive future thinking but no increase in negative future thinking; and (ii) whether such a deficit could be remedied by a brief, manual-assisted psychological intervention (manual assisted cognitive-behaviour therapy; MACT). DESIGN: A cross-sectional, mixed model design was used to assess differences between a sample of high risk parasuicide patients and matched controls on future thinking. A longitudinal mixed model design was used to assess changes in future thinking in the different groups over time. METHODS: Parasuicide patients with a history of previous suicidal behaviour and personality disturbance were compared with a matched group of community controls on an adapted fluency measure of future thinking, which measured both quantitative and qualitative aspects of anticipated experiences. Patients were then randomly allocated to either the specific intervention (MACT) or treatment as usual (TAU) and assessed again at 6 month follow-up. RESULTS: Parasuicide patients showed reduced positive future thinking but no increased negative future thinking. Patients who received MACT showed a significant improvement in positive future thinking over the follow-up period whereas the TAU group showed no such improvement. However, interpretation of this finding was made more difficult by the control group also showing a significant improvement in positive future thinking. CONCLUSION: The results confirm that parasuicide patients exhibit a relative deficit in positive future thinking and suggest that this lack of positive future thinking may be remedied, at least partly, by a brief intervention.

Adolescent↗
PubMed1996

An automated and portable low-flow pulsatile perfusion system for organ preservation.

While machine preservation reduces the incidence of delayed graft function in renal transplant recipients, it is only used in 10% of kidney transplantations. The performance of our portable, low-flow-pulsatile organ perfusion system was examined in a canine kidney autotransplantation model. Grafts were stored for 72 h by simple cold preservation in University of Wisconsin (UW) solution, or by high or low-flow machine preservation After preservation, the grafts were autotransplanted and the animals were followed for 15 days. Graft function was better in machine-preserved kidneys. Tissue biochemistry indicated that machine preservation resulted in higher levels of adenine nucleotides and better histological integrity than the cold storage. While histology and biochemistry of machine-preserved groups were similar, electromicroscopy of high-flow grafts showed mild accumulation of intravenous debris and endothelial swelling. This study shows that a simplified machine perfusion technique is effective for organ preservation.

Animals↗
PubMed1996

Mood, learned resourcefulness and perceptions of control in type 1 diabetes mellitus.

A cohort of 90 insulin-dependent diabetics was examined to explore the relationship between physiological measures of control, learned resourcefulness, and the patients' perceptions of their own and their doctor's control over the diabetes. The doctors' perceptions of control over diabetes were measured. The patient's perceptions of control over diabetes were also measured. The patient's perceptions of control are compared with their doctor's views about medical and patient responsibility for controlling the condition. Patients in this study, overall, have a low level of psychiatric morbidity, with only 7% depressed and with a lower anxiety level than those reported in other published studies. It was found that patients who view control of good outcomes to be in the hands of their doctors fare worse as far as physiological control is concerned. There was little congruence between the attitudes of doctor and patient pairs about responsibility for controlling the diabetes mellitus. The most important clinical implication of the study is that there appears to be a relationship between poor physiological control and a passive, dependent approach to the condition.

Adolescent↗
PubMed1996

Intrusive memories in depression: an index of schema activation?

A sample of 31 male and female depressed patients was interviewed to investigate spontaneous, intrusive memories of immediate and past life events. Previous findings that depressed patients experience high frequency intrusive memories were confirmed, as was an association between intrusive memories of childhood abuse and severity of depression. Patients reported intrusive memories for a variety of other events, particularly involving illness and death. Limited support was obtained for the hypotheses that the course of depression would be related to the activation of negative memories, and that immediate life events would trigger the activation of memories of similar events from the past.

Adolescent↗
PubMed1996

Does providing more accessible primary care psychology services lower the clinical threshold for referrals?

BACKGROUND: The growing number of specialist services being provided within primary care has lead to the argument that this will reduce the clinical threshold for referrals to these clinics. AIM: The possibility that increasing the accessibility of primary care psychology services will reduce the threshold for referral was examined by comparing levels of psychological disturbance among patients seen by practice-based clinical psychologists with those attending outpatient clinics. METHOD: Psychological symptoms, distress, disruption in daily life and satisfaction with life were assessed using a questionnaire-based methodology. A consecutive series of 177 patients, assessed in a local general practice or an outpatient department across a wide range of urban locations, was studied over a fixed period. RESULTS: The study revealed equivalent levels of psychopathology within both specialist and primary care clinics. Of the overall sample, 79% were likely to merit a formal psychiatric diagnosis, relating primarily to mood disorder. Levels of subjective distress and life satisfaction were also equivalent at both service locations. CONCLUSION: The lack of evidence for a reduction in clinical threshold for referral within the primary care sample suggests that general practitioners' referral rates are similar regardless of whether practice-based clinical psychology services are available. This has implications for primary-care-led commissioning of mental health services.

Adult↗
PubMed1991

In-patient withdrawal from long-term benzodiazepine use.

Twenty-one patients completed an intensive in-patient and out-patient group-based programme, to achieve withdrawal from long-term benzodiazepine dependence. By 6-month follow-up (post-withdrawal), eight patients (38%) had achieved a 'good' outcome. Generally, patients demonstrated moderate levels of psychiatric morbidity and depression in the pre-withdrawal phase; a diagnosis of a depressive disorder being associated with either an 'intermediate' or 'poor' outcome in comparison to patients receiving a diagnosis of anxiety disorder, who showed a predominantly 'good' outcome. Two patients committed suicide some time after withdrawal. Additionally, older patients fared less well than their younger counterparts. We conclude that maintenance benzodiazepine prescription, rather than withdrawal, may be the preferred treatment for some dependent patients. Furthermore, more data are required regarding the association, and causality, between depression and benzodiazepine withdrawal in long-term users.

Adult↗
PubMed1987

Perception of emotionally valenced information in depression.

Bower's (1981) associative network model of mood and cognition predicts that depression will selectively facilitate the perception of negatively toned words. Recent studies by Clark et al. (1983) and by Powell & Hemsley (1984) have, however, produced apparently discrepant results. Alternative means of accommodating the discrepancy are considered, and the current experiment empirically distinguishes between these possibilities. The results are inconsistent with Bower's model.

Adult↗
PubMedDate not supplied

The directed forgetting task: application to emotionally valent material.

Three experiments are reported which investigate the application of the directed forgetting task to emotionally valent material and to different mood states. In this task, some subjects are told when halfway through an intentional or incidental learning task that the trials presented so far are to be forgotten because they were merely practice. However, at the end of the subsequent list, the subjects are then asked to recall all of the previous items including those that they were instructed to forget. The results typically show that significantly fewer directed forgetting items are recalled whether the task is an intentional or incidental learning one. In the first experiment, normal and 'depressed' students rated positive and negative material for pleasantness; although directed forgetting effects were obtained, there were no differential effects of mood state nor of valence of the material. In order to investigate this effect further, a variant of this task was used in Experiment 2 in which the positive and negative material had to be processed in relation to the self. The results showed that differential forgetting now occurred; healthy students recalled more positive than negative information, but this positive bias was not obtained for 'depressed' students who showed an even-handed level of recall. In Experiment 3, groups of clinically depressed, clinically anxious, and normal controls were presented with the directed forgetting task. The key finding showed that the depressed subjects showed a retrieval facilitation for to-be-forgotten negative adjectives, an effect that was not present for the other two groups. It is concluded therefore, that the directed forgetting task could be usefully extended to investigate cognition-emotion interactions in clinical populations.

Adult↗