• Fregoli syndrome after cerebral infarction

      De Pauw, Karel W. (1987)
      A case of a rare form of delusional misidentification, the Fregoli syndrome, is described. Although usually occurring in the setting of primary or secondary schizophrenic psychoses, delusional misidentification has been reported in affective, neurological, and toxic-metabolic disorders. In this instance a diagnosis of paranoia (delusional disorder) secondary to predominantly right hemisphere pathology, rather than schizophrenia, seemed more appropriate.
    • Motor disorder in severe mental handicap

      Jones, Jo (1991)
      In response to the D. Rogers et al (see record 1991-21389-001) finding that motor disorder is significantly associated with more severe mental handicap, the present author discusses the appropriateness of using the Dyskinesia Identification System: Condensed User Scale (R. L. Sprague and K. M. Shaw, 1989) with patients with mental handicaps. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Tardive dyskinesia: Risk disclosure and informed consent in the Netherlands

      Bouman, Walter P. (1997)
      A questionnaire was sent to 200 consultant psychiatrists enquiring about their current practice towards informing their patients on neuroleptic medication about the long-term risks of tardive dyskinesia. It was agreed by 75% of Ss that most psychotic patients receiving ongoing treatment with neuroleptic drugs are capable of informed decisions regarding their medication. This study was similar to one conducted in the UK (Chaplin and Potter, 1996) and results are compared. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Sleep studies of adults with severe or profound mental retardation and epilepsy

      Hamilton, David S. (1998)
      Sleep patterns of people with mental retardation have received little research attention. This is an important gap in knowledge because understanding the relation between sleep and wakefulness may be critical to care provision. Descriptive sleep information on 28 people with severe or profound mental retardation and epilepsy was presented here. Sleep EEG data, studied both conventionally and by means of a neural network-based sleep analysis system suggest atypical sleep stages with significant depletion of REM sleep and a predominance of 'indiscriminate' non-REM sleep. Sleep diaries completed by caregivers reveal lengthy sleep period times, especially among those with profound mental retardation. Possible explanations for these results and their implications were discussed.
    • Cognitive functioning in people with epilepsy plus severe learning disabilities: A systematic analysis of predictors of daytime arousal and attention

      Hamilton, David S. (1999)
      In spite of the high prevalence of epilepsy and the importance of preserving cognitive function in people with learning disabilities, this population has received relatively little research attention. This study sets out systematically to investigate possible predictive factors of inter-ictal states of arousal and attention. The daytime function of 28 people with epilepsy and severe learning disabilities was assessed by performance on a two-choice reaction time vigilance task, behavioural analysis of time-sampled video recordings taken in naturalistic settings, and carer ratings on visual analogue scales. This methodology yielded eight discrete functional measures, from which two further index measures were derived after principal components analysis. A range of clinical and psychosocial assessments was completed and subjects had 36 hour ambulatory EEG and sleep EEG monitoring. Regression models identified significant predictors of cognitive function from a range of potential explanatory variables i.e. demographic, clinical, pharmacological, background EEG rhythms and sleep parameters. Results indicated that greater severity of learning disability, longer bedtime periods, poor sleep efficiency, frequent seizures and antiepileptic drug polytherapy were significant predictor variables. Explained variance (adjusted R<sup>2</sup>) was greater than 50% for six of 10 outcome variables (range up to 85%). Furthermore, significant regression equations (P < 0.05) were obtained for all but one variable. Thus, these results appear reasonably robust. Results support an interactional model of daytime arousal and attention in people with epilepsy plus severe learning disabilities. Inter-ictal cognitive function appears to be mediated by a combination of organic, circadian (sleep wake), clinical and pharmacological factors.
    • Coping with the challenge of transition in older adolescents with epilepsy

      Reeve, Dawn K.; Lincoln, Nadina B. (2002)
      Chronic illnesses, such as epilepsy, have been shown to have detrimental effects on both psychological adjustment and coping behaviour. Using the process model of coping, these effects were investigated in a patient group of 36, 16-21 year olds with epilepsy and a control group of 31 of their peers. Participants completed a postal questionnaire containing measures of psychological adjustment (self-esteem, affect, self-efficacy) and an adolescent coping questionnaire. Comparison of the two groups showed that the patient group exhibited significantly more non-productive coping than the control group. The control group exhibited significantly more problem solving coping and displayed significantly more problem solving bias than the patient group. No significant differences were found between the patient and control group on measures of psychological adjustment. However, psychological adjustment was found to be associated with coping response in the patient but not the control group.; Copyright 2002 BEA Trading Ltd.
    • Assessing mood in patients with multiple sclerosis

      Groom, Madeleine J.; Lincoln, Nadina B.; Francis, Valerie M.; Stephan, Talal F. (2003)
      Objective: To assess the validity and reliability of mood measures for use with people with multiple sclerosis (MS).; Design: Four mood measures designed for use with people with communication and cognitive problems were completed; two were completed with the patient at interview and two by hospital staff or carers of the patients. This procedure was repeated two weeks later to assess test-retest reliability.; Subjects: People with MS at a rehabilitation unit (n = 22) and living in the community (n = 27).; Main Outcome Measures: The Stroke Aphasic Depression Questionnaire (SADQ) and Signs of Depression Scale (SODS) were completed by rehabilitation unit staff or by carers of the patients. An assistant psychologist completed the Visual Analogue Self-Esteem Scale (VASES) and the Visual Analogue Mood Scales (VAMS) with each patient. The Guy's Neurological Disability Scale (GNDS) was administered to assess physical disability. Nonprofessional carers were asked to complete the General Health Questionnaire 12 (GHQ-12) about themselves.; Results: In both samples there were significant correlations between scores on the two self-report measures (VASES and VAMS) (r(s) = 0.51-0.79) and between scores on the two observational measures (SADQ and SODS) (r(s) = 0.62-0.81) but not between the observational and self-report measures. There was a significant correlation between the SODS and the carer GHQ (r(s) = 0.68, p < 0.01), indicating that carer mood influenced reporting of patients' mood. There was no significant influence of profession on the observational measures, indicating good inter-rater reliability. Test-retest reliability was high for patients in the community but not for patients in hospital.; Conclusions: In both the inpatient and community samples, the self-report and observational mood measures appeared to be measuring different aspects of patients' mood. Further investigation is needed to determine which of these is providing the most accurate information.;
    • Predicting longer-term outcomes following psychological treatment for hypnotic-dependent chronic insomnia

      Mathers, Nigel (2003)
      Objectives: To identify predictors of treatment adherence, patient dropout, and treatment response among long-term hypnotic users recruited into a randomized controlled trial of psychological treatment for insomnia. Methods: Of 108 treatment and 101 control patients initially recruited, 37 treatment group patients (34.3%) failed to complete all 6 sessions (i.e., were nonadherent), while across both groups 61 (29.2%) patients failed to return postal assessments at 3-month follow-up (i.e., dropped out). Relationships between baseline characteristics and adherence (adherent vs. nonadherent) and attrition (dropout vs. nondropout) were examined in discriminant models. Relationships between baseline characteristics and treatment response (sleep quality, sleep latency, sleep efficiency, and hypnotic drug use) were examined in a series of multiple regression models. Results: Adherent patients showed a significantly greater severity of pretreatment sleep disturbance, as measured by the Pittsburgh Sleep Quality Index (PSQI). Dropout at 3 months was associated with significantly lower perceived health status at baseline. In the regression models, lower Cure/Control subscale scores from the Illness Perception Questionnaire (IPQ) predicted greater posttreatment improvements in sleep efficiency and PSQI scores, while lower baseline anxiety scores predicted a posttreatment increase in hypnotic-free nights/week. Conclusion: In routine clinical practice settings, higher anxiety and a less positive attitude towards symptom control were associated with poorer treatment response. Adherence and attrition show a different pattern of associations, with greater need (as indexed by insomnia severity) predicting higher levels of service uptake and poorer general health predicting a higher likelihood of dropout. (C) 2003 Elsevier Science Inc. All rights reserved.
    • Psychological treatment for insomnia in the management of long-term hypnotic drug use: A pragmatic randomised controlled trial

      Tomeny, Maureen (2003)
      Objective: To evaluate the clinical and cost impact of providing cognitive behaviour therapy (CBT) for insomnia (comprising sleep hygiene, stimulus control, relaxation and cognitive therapy components) to long-term hypnotic drug users in general practice. Design: A pragmatic randomised controlled trial with two treatment arms (a CBT treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments commencing at 3 and 6 months. Setting. Twenty-three general practices in Sheffield, UK Participants. Two hundred and nine serially referred patients aged 31-92years with chronic sleep problems who had been using hypnotic drugs for at least I month (mean duration 13.4 years). Results. At 3- and 6-month follow-ups patients treated with CBT reported significant reductions in sleep latency, significant improvements in sleep efficiency, and significant reductions in the frequency of hypnotic drug use (all P<0.01). Among CBT treated patients SF-36 scores showed significant improvements in vitality at 3 months (P<0.01). older age presented no barrier to successful treatment outcomes. The total cost of service provision was pound154.40 per patient, with a mean incremental cost per quality-adjusted life-year of pound3416 (at 6 months). However there was evidence of longer term cost offsets owing to reductions in sleeping tablet use and reduced utilisation of primary care services. Conclusions: In routine general practice settings, psychological treatments for insomnia can improve sleep quality and reduce hypnotic consumption at a favourable cost among long-term hypnotic users with chronic sleep difficulties.
    • Informing patients about tardive dyskinesia: A survey of clinicians' attitudes in three countries

      Bouman, Walter P. (2004)
      There is a general increase in awareness amongst clinicians of the need to inform patients about the risks and benefits of treatments offered. Neuroleptic drugs have proven effectiveness in the treatment of schizophrenia, but side effects are common and potentially serious. These include tardive dyskinesia (TD) an involuntary movement disorder associated with the long-term administration of neuroleptics. TD has an overall prevalence of 20-25% in neuroleptic-treated patients, and is potentially irreversible. The introduction of "atypical" neuroleptics in recent years may have reduced the risk of TD, but evidence for this is currently limited. According to the Code of Practice of the United Kingdom Mental Health Act, consent is the "voluntary and continuing permission of the patient to receive a particular treatment, based on an adequate knowledge of the purpose, nature, likely effects, and risks of that treatment, including the likelihood of its success and any alternatives to it." Permission given under unfair undue pressure is not consent. Ensuring valid and informed consent amongst psychiatric patients, and particularly those with a psychotic illness can be problematic. We have investigated the attitudes of consultant psychiatrists in three countries to informing their patients about the long-term risks of neuroleptic medication, in particular TD. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    • Psychological treatment for insomnia in the regulation of long-term hypnotic drug use

      Tomeny, Maureen (2004)
      Objectives: To evaluate the clinical and cost impact of providing, in routine general practice settings, a cognitive-behaviour therapy (CBT) package for insomnia to long-term hypnotic drug users with chronic sleep difficulties; and to identify factors associated with variations in clinical outcomes. Design: A pragmatic cluster randomised controlled trial with two treatment arms (a CBT-treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments starting at 3, 6 and 12 months. Setting: Twenty-three general practices in Sheffield, UK. Participants: In total, 209 patients (aged 31-92 years) with chronic sleep problems who had been receiving repeat hypnotic drug prescriptions for at least 1 month (mean = 13.4 years) were recruited into the trial. Interventions: The intervention consisted of six 50-minute sessions as follows: introduction and sleep assessment, basic sleep hygiene, stimulus control and sleep restriction procedures, progressive relaxation, cognitive treatments, and review and discharge. Main outcome measures: These included: global sleep quality [as measured by the Pittsburgh Sleep Quality Index (PSQI)], frequency of hypnotic drug use, mean dose of hypnotics consumed, health-related quality of life [ as measured by the Short-Form 36 (SF-36)], NHS service costs and overall cost utility. Results: At 3- and 6-month follow-ups, patients treated with CBT showed improved global PSQI scores as well as improvements in the SF-36 dimensions of vitality at 3 months and physical functioning and mental health at 6 months. CBT-treated patients also reported reductions in the frequency of hypnotic drug use compared with the control group, with many CBT-treated patients reporting zero drug use at the follow-up assessments. Clinical improvements were maintained within the CBT group at the 12-month follow-up, with PSQI scores and the frequency of hypnotic drug use continuing to show significant reductions relative to the control group. Multiple regression analyses of PSQI scores within the sleep clinic group alone indicated that the magnitude of pre- to post-treatment change in overall sleep quality was closely related to Hospital Anxiety and Depression Scale depression scores at 3-, 6- and 12-month follow-ups. In each model higher depression scores at baseline were associated with poorer treatment outcomes. No significant relationship was found between the patient's age and PSQI outcomes in any of these analyses. Within the sleep clinic group, reductions in drug use showed no significant association with the hypnotic product consumed. At the 3- month follow-up low-frequency drug use was reported by 22.9% (8/35) of temazepam users, 33.3% (5/15) of nitrazepam users and 38.9% (7/18) of zopiclone users. The total cost of service provision was pound154.40 per patient (1999/2000 prices). The mean incremental cost per quality-adjusted life-year (QALY) at 6 months was pound3418; this figure was insensitive to changes in costs. A simple model also showed that extending the evaluation period beyond 6 months may improve the cost-effectiveness of CBT. The incorporation of hidden costs associated with hypnotic drug treatment (e.g. accidents) also reduces the cost per QALY ratio, although to a much lesser degree. Conclusions: In routine general practice settings, psychological treatment for insomnia can improve sleep quality, reduce hypnotic drug use, and improve health-related quality of life at a favourable cost among long-term hypnotic users with chronic sleep difficulties. These positive outcomes appear robust over time, persisting for at least 1 year among the more treatment-adherent patients. While these benefits may be reduced among those patients presenting with higher levels of psychological distress, the present study clearly indicates that older age per se presents no barrier to successful treatment outcomes. Further research should assess the long-term clinical and cost-effectiveness of psychological treatments for insomnia among non-hypnotic-using patients, and establish the minimum psychological treatment input required.
    • Impact of cognitive behavior therapy on health-related quality of life among adult hypnotic users with chronic insomnia

      Dixon, Simon; Tomeny, Maureen (2006)
      Results were combined from representative surveys of health related quality of life (HRQoL; n=11,877; age range=16-104) with data from a randomized controlled trial of cognitive behavior therapy for chronic insomnia (n=209; age range=31-92). Secondary analyses of scores from the SF-36 measure of HRQoL were conducted in order: (a) to compare the health related quality of life profiles of adult hypnotic users with chronic insomnia with those of population norms, and (b) to assess the impact of cognitive behavior therapy (CBT) for insomnia on HRQoL outcomes over 6 months. Compared with the primary care reference values, HRQoL among the trial participants at baseline was generally poorer. The magnitude of these decrements reduced markedly with advancing age. In the evaluation of the CBT intervention, statistically significant differences in SF-36 scores in favor of the intervention were present for physical functioning, emotional role limitation, and mental health over 6 months. Overall, this study shows that the SF-36 can play an important role in describing HRQoL in this patient group, and in the evaluation of interventions within this group.;
    • Lithium treatment in cluster headache, review of literature

      Abdel-Maksoud, Mohamed B. (2009)
      Background: The pain, which is involved in Cluster Headache (CH), is excruciating and is probably one of the most painful conditions known to humans. In the early 70es it was found out that lithium could be used in treating this rare condition. Ekbom produced his first report of using lithium successfully to treat five cases of CH and this was followed later by other studies, which showed the effectiveness of lithium in this condition. Objective: In this article we reviewed the evidence for using lithium in CH. We discuss some issues including the duration, the dosage of lithium required and the short and long-term side effects, which are likely to occur. We also included the mechanism of action of lithium in treating this condition. Methodology: We searched the Medline database from 1950 to date. We included all studies done in English, which were related to the use of lithium in cluster headache. We excluded all studies which were not in English and which included other types of headache. Results and conclusions: We concluded that lithium is effective in both chronic and episodic forms of cluster Headache.
    • Self-help CBT-I in the management of insomnia symptoms associated with chronic disease in older adults: A randomized controlled trial

      Tomeny, Maureen (2010)
      Objectives: The increasing prevalence of insomnia symptoms with age is closely associated with levels of chronic disease, presenting a challenge for sleep management. Manualised self-help CBT-I has been reported to be effective among younger patients with primary insomnia, but has not been used to address comorbid insomnia symptoms in older people. Methods: Participants were recruited from the community, aged 55+, diagnosed with chronic conditions (e.g. arthritis, asthma, diabetes, stroke, COPD), were not taking neuroleptic medication, and scored > 5 on the Pittsburgh Sleep Quality Index. Randomisation (treatment v control) followed an initial assessment. Treatment comprised 6 weekly -accessible' booklets covering: 1) insomnia and self-monitoring; 2) sleep hygiene; 3) sleep medications; 4) sleep restriction/stimulus control; 5) cognitive strategies; and 6) maintaining progress. Treatment group participants also had access to a telephone helpline for queries relating to the booklets. Control participants received sleep hygiene advice (as a printed sheet), in line with UK clinical guidelines. Treatment materials were sent by post. Assessments were conducted: prior to treatment (baseline); 1 week after the dispatch of booklet 6 to the treated group, or 7 weeks after baseline for the control group (post-treatment); and 3 months after post-treatment. Assessment materials, which included the PSQI (the principal outcome) and the Brief Pain Inventory (BPI), were sent and returned by post (using telephone prompts). Results: Of 192 participants (age 55-87) at baseline, 132 (70 treatment; 62 controls) completed post-treatment, and 122 (69 treatment; 53 controls) completed 3-month assessments. Analyses were conducted on an -intention to treat' basis. Adjusting for BDI scores and age, treated patients showed significantly improved PSQI scores relative to controls at post-treatment (F = 6.48, df = 1, 128, P = 0.01) and 3-months (F = 4.70, df = 1,118, P = 0.03), with moderate effect sizes (Cohen's d = 0.4 & 0.4 respectively). Conclusion: Self-help CBT-I, appropriately designed and supported, can provide practical and effective treatment for comorbid insomnia symptoms associated with chronic disease.
    • Self-help treatment for insomnia symptoms associated with chronic conditions in older adults: A randomized controlled trial

      Tomeny, Maureen (2012)
      Objectives To evaluate the effectiveness of a self-help cognitive behavioral intervention in improving sleep quality in older adults reporting insomnia symptoms associated with chronic disease. Design A pragmatic two-arm randomized controlled trial comparing supported self-help with treatment as usual ( TAU). Setting Primary care. Participants One hundred ninety-three self-referred individuals aged 55 to 87 with long-term conditions and chronic insomnia symptoms (as defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Intervention Self-help participants received six consecutive booklets, at weekly intervals, providing structured advice on important components of cognitive behavioral therapy for insomnia ( CBT-I, including self-monitoring, sleep restriction, stimulus control procedures, and cognitive strategies), plus access to a telephone helpline. Control group participants received a single sheet of advice detailing standard sleep hygiene measures. Measurements The primary outcome was sleep quality, measured by the Pittsburgh Sleep Quality Index ( PSQI). Secondary outcomes were the Insomnia Severity Index ( ISI), the subjective sleep efficiency index, and the Fatigue Severity Scale. Results In the self-help group, sleep outcomes showed significant improvements after treatment ( PSQI, P < .001; ISI, P < .001; sleep efficiency, P < .001) and at 3-month ( PSQI, P = .002; ISI, P = .006; sleep efficiency, P = .001) and 6-month ( PSQI, P = .003; ISI, P = .003; sleep efficiency, P = .001) follow-up. Effect sizes were moderate (range of adjusted Cohen d = 0.51-0.75). Treatment had no effect on levels of daytime fatigue. Most treated participants (73%) said they would recommend the self-help program to others. Conclusion Self-help CBT-I offers a practical first-line response to individual reporting insomnia symptoms associated with chronic disease in primary care settings. In these individuals, symptoms of daytime fatigue may be more closely associated with disease processes than with sleep quality.
    • Psychiatry beyond the current paradigm

      Evans, Chris; Middleton, Hugh; Moldavsky, Daniel (2012)
      A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially 'applied neuroscience'. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.
    • Conceptual issues in neurodevelopmental disorders: Lives out of synch

      Clegg, Jennifer; Gillott, Alinda; Jones, Jo (2013)
      Purpose of review Current revision of the two major psychiatric classification systems has elicited particular comment on neurodevelopmental disorders, which have seen increased provision of specialist clinical services, user group activity, fictional and biographical accounts, and research. Philosophical scrutiny of autism research and literature provides an additional perspective. Recent findings Neurodevelopmental disorders show considerable overlap neuropsychologically, physiologically and genetically. They overlap diagnostically with schizophrenia, personality disorders, anxiety and depression. Of the two main diagnostic groups, there is more evidence of change with maturation in autism spectrum disorder than attention-deficit hyperactivity disorder. Interventions should combine cognitive, affective and embodied aspects of these disorders, and encompass the individual and their social environment. There is considerable evidence of the toll that caring for people with neurodevelopmental disorders exerts on parents. Summary Neurodevelopmental disorders are multifaceted: research addressed to connection rather than further Balkanization is more likely to be fruitful. Clinicians should consider which facets are displayed symptomatically to enable people to grow through rather than surrender to their impairments. Social scaffolding optimizes functional well being. Future research should take into account the tensions in the relationship between research and user groups, and examine the experiences of adults and of the spouses and partners of those affected.
    • La psiquiatría más allá del paradigma actual

      Evans, Chris; Moldavsky, Daniel (2013)
      A series of editorials in this journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially "applied neuroscience". While not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service-user movement. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(journal abstract)
    • On the interaction between sad mood and cognitive control: The effect of induced sadness on electrophysiological modulations underlying Stroop conflict processing

      Nixon, Elena; Liddle, Peter F.; Nixon, Neil L. (2013)
      The present study employed high-density ERPs to examine the effect of induced sad mood on the spatiotemporal correlates of conflict monitoring and resolution in a colour-word Stroop interference task. Neuroimaging evidence and dipole modelling implicates the involvement of the anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) regions in conflict-laden interference control. On the basis that these structures have been found to mediate emotion-cognition interactions in negative mood states, it was predicted that Stroop-related cognitive control, which relies heavily on anterior neural sources, would be affected by effective sad mood provocation. Healthy participants (N=14) were induced into transient sadness via use of autobiographical sad scripts, a well-validated mood induction technique (Liotti et al., 2000a, 2002). In accord with previous research, interference effects were shown at both baseline and sad states while Stroop conflict was associated with early (N450) and late (Late Positive Component; LPC) electrophysiological modulations at both states. Sad mood induction attenuated the N450 effect in line with our expectation that it would be susceptible to modulation by mood, given its purported anterior limbic source. The LPC effect was displayed at the typical posterior lateral sites but, as predicted, was not affected by sad mood. However, frontocentral LPC activity-presumably generated from an additional anterior limbic source-was affected at sad state, hinting a role in conflict monitoring. Although the neurophysiological underpinnings of interference control are yet to be clarified, this study provided further insight into emotion-cognition interactions as indexed by Stroop conflict-laden processing.Copyright © 2012 Elsevier B.V. All rights reserved.