Controlled Evaluation of Intravenous Drugs in the Specific Desensitization of Phobias

1973 ◽  
Vol 18 (1) ◽  
pp. 47-53 ◽  
Author(s):  
J. Trevor Silverstone ◽  
M.R. Salkind
Keyword(s):  
Normal Saline ◽  
Rating Scales ◽  
Behaviour Therapy ◽  
Social Phobias ◽  
General Anxiety ◽  
Drug Of Choice ◽  
End Of Treatment ◽  
Specific Phobias ◽  
Controlled Evaluation

The present study was undertaken to compare intravenous methohexitone, given as an adjunct to the behaviour therapy of phobias, with another centrally-acting, rapidly metabolised intravenous agent, propanidid, and also with normal saline. Thirty-five patients were included in the trial, all of whom had had phobic symptoms of at least one year's duration which were seriously interfering with their lives — 15 had specific phobias, 9 had social phobias and 11 had agoraphobia. Treatment consisted of twelve weekly drug-assisted desensitization treatments, using either 1 per cent methohexitone, 2.5 per cent propanidid or normal saline. Within each diagnostic group the drugs were randomly allocated. All treatments were conducted by one of the authors and all assessments by the other (who did not know which of the three preparations the patient had received). In addition to monthly ratings of the phobic symptoms, assessments of anxiety and depression were made, using self-rating scales. Patients were followed up six months after the end of treatment. Patients with specific phobias fared best, 9 out of the 13 who completed being considered to be markedly improved. Although the numbers are small there was a suggestion that patients receiving the two active drugs did better than those on the placebo. While methohexitone and propanidid were similarly effective, recovery time was much more rapid with propanidid. No patient in the specific phobia group relapsed significantly during the six months follow-up period. Furthermore, as the phobia improved the general anxiety level fell. Few depressive symptoms arose during successful desensitization, and there was no evidence of symptom substitution. Patients with social phobias and agoraphobia did far less well. In neither case did the active drugs appear to possess any advantage over placebo. Furthermore, of the 7 patients with agoraphobia who had improved, 4 relapsed within six months. It was concluded that drug-assisted desensitization is likely to be of greatest benefit in the management of specific phobias, with propanidid being the drug of choice.

Symptomatic Treatment of Agoraphobia and Social Phobias: A Follow-up Study

1975 ◽  
Vol 127 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Peter Tyrer ◽  
Derek Steinberg
Keyword(s):  
Personality Disorder ◽  
Social Adjustment ◽  
Prolonged Treatment ◽  
Comparable Efficacy ◽  
List Type ◽  
Behaviour Therapy ◽  
Double Blind ◽  
Social Phobias ◽  
One Year

Summary1.Twenty-six out of 28 out-patients with agoraphobia and social phobias who had originally been treated with phenelzine or placebo in a double-blind clinical trial were followed up for a mean period of one year. During the follow-up period patients received further pharmacotherapy or behaviour therapy, except that those patients originally receiving placebo were not allowed therapy with monoamine oxidase inhibitors.2.Ratings of phobic and additional symptoms, social adjustment and degree of personality disorder were made after one year by one of the authors (D.S.) who had no prior knowledge of the treatment each patient had received.3.There were no significant differences in any of the ratings between the patients of the two groups, but those originally receiving placebo had more additional treatment in the follow-up period. Patients continuing to receive phenelzine frequently experienced a return of symptoms if the drug was withdrawn before six months treatment had elapsed.4.Degree of personality disorder showed a significant negative correlation (p = –0.6) with improvement in the phenelzine group but not in those receiving placebo originally.5.Improvement in social adjustment items was less than improvement in symptoms at follow-up. The implications of this are discussed.6.The results suggest that phenelzine is of comparable efficacy to other symptomatic treatments for agoraphobia and social phobias, but that it acts mainly by symptom suppression. Prolonged treatment in patients with personality disorders is not indicated, for improvement is less likely and the dangers of dependence are greater.

scholarly journals Centchroman versus Tamoxifen in the management of mastalgia: a randomized controlled clinical trial

2016 ◽  
Vol 18 (3) ◽  
pp. 60
Author(s):  
S Khadka ◽  
S Rajbanshi ◽  
S Khaniya ◽  
CS Agrawal ◽  
S Adhikary
Keyword(s):  
Cost Effective ◽  
Controlled Clinical Trial ◽  
Ongoing Debate ◽  
Randomized Controlled ◽  
Vas Score ◽  
Drug Of Choice ◽  
Tamoxifen Group ◽  
End Of Treatment ◽  
Number Of Patients

Introduction and Objective: Mastalgia is defined as painful nodularity for more than 1 week of menstrual cycle. The long list of drugs highlights the ongoing debate about the drug of choice for the management of mastalgia. So in this study, we compared the effectiveness and cost of Centchroman and Tamoxifen in the management of mastalgia.Materials and methods: A total of 106 female patients with the clinical diagnosis of mastalgia were enrolled in the study and randomized to 1:1 ratio into Centchroman and Tamoxifen group for a period of 1 year. The duration of therapy was 3 months. All patients completed the study and follow up. The response of therapy was assessed on 1, 2, 3 and 6 months by using a Visual Analogue Scale (VAS).Results: Baseline mean VAS score was 6.25 in Tamoxifen and 6.49 in Centchroman group.There was marked improvement in VAS score after the treatment in both the groups, which was statistically significant with greater reduction in Centchroman group(p= 0.001).The number of patients who achieved VAS less than 3 were 51(96.2%) in Centchroman and 49(92.5%) in Tamoxifen group at the end of treatment. Tamoxifen was found to be statistically significant and cost-effective (p <0.001) in comparison to Centchroman.Conclusion: We conclude that Centchroman is not inferior to Tamoxifen and both the drugs effectively reduced pain, however Centchroman reduced the pain more than Tamoxifen.

Cognitive Behaviour Therapy For Auditory Hallucinations Without Concurrent Medication: A Single Case

1994 ◽  
Vol 22 (3) ◽  
pp. 259-264 ◽  
Author(s):  
Anthony P. Morrison
Keyword(s):  
Single Case ◽  
Auditory Hallucinations ◽  
Behavioural Intervention ◽  
Behaviour Therapy ◽  
Cognitive Behavioural ◽  
End Of Treatment ◽  
Cognitive Behaviour ◽  
Cognitive Behavioural Intervention ◽  
Concurrent Medication

A 38 year old patient with auditory hallucinations was treated with a brief cognitive-behavioural intervention without concurrent medication. This intervention was based upon the theory of Bentall (1990a, b) and the methods of Haddock, Bentall and Slade (1993). The patient's ratings for frequency of hallucinations and distress caused were significantly reduced at end of treatment, and her belief in the reality of these voices was correspondingly diminished. These gains were maintained at one and three month follow-up.

scholarly journals Now and then: a ten-year comparison of young people in residential substance use disorder treatment receiving group dialectical behaviour therapy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ely M. Marceau ◽  
Gabriella Holmes ◽  
Jane Cutts ◽  
Lauren Mullaney ◽  
Denise Meuldijk ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Substance Use ◽  
Young People ◽  
Substance Use Disorder ◽  
Psychiatric Symptoms ◽  
Trial Registration ◽  
Behaviour Therapy ◽  
End Of Treatment

Abstract Background Reducing substance use in youth is a global health priority. We compared two cohorts from the same 12-week residential substance use disorder (SUD) facility over a 10 year period: Cohort A (2008–2009) and Cohort B (2018–2020). The essential components of the program remained the same with the primary treatment being dialectical behaviour therapy (DBT) plus residential milieu. Methods Young people in the current Cohort B (N = 100) versus historical Cohort A (N = 102) had a similar ratio of males (74 vs. 70%) but were slightly older (mean 20.6 vs. 19.5 years). Linear mixed models were used to model outcome measures (global psychiatric symptoms, substance use severity, and quality of life) longitudinally up to 12 months later. Results Baseline to end-of-treatment comparisons showed that the current Cohort B had overall higher levels of global psychiatric symptoms (d = 0.70), but both groups reduced psychiatric symptoms (Cohort A: d = 1.05; Cohort B: d = 0.61), and had comparable increases in confidence to resist substance use (d = 0.95). Longitudinal data from the current Cohort B showed significant decreases in substance use severity from baseline to 6-month follow-up (d = 1.83), which were sustained at 12-month follow-up (d = 0.94), and increases in quality of life from baseline to end-of-treatment (d = 0.83). Conclusions We demonstrate how DBT plus milieu residential care for young people continues to show positive effects in a 10-year comparison. However, youth seeking treatment today compared to 10 years ago evidenced higher acuity of psychiatric symptoms reinforcing the importance of continuous improvement of psychological treatments. Trial registration Australian New Zealand Clinical Trials Registry: trial IDACTRN12618000866202, retrospectively registered on 22/05/2018, .

Psychopathology 8½ Years Post Parasuicide

Crisis ◽  
1999 ◽  
Vol 20 (3) ◽  
pp. 115-120 ◽  
Author(s):  
Stephen Curran ◽  
Michael Fitzgerald ◽  
Vincent T Greene
Keyword(s):  
Rating Scales ◽  
Psychiatric Morbidity ◽  
Parental Bonding ◽  
Social Maladjustment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Face To Face ◽  
Long Term Follow Up

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

Cathartic Effect of Suicide Attempts Not Limited to Depression

Crisis ◽  
2003 ◽  
Vol 24 (2) ◽  
pp. 73-78 ◽  
Author(s):  
Yves Sarfati ◽  
Blandine Bouchaud ◽  
Marie-Christine Hardy-Baylé
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Personality Traits ◽  
Rating Scales ◽  
Suicide Attempts ◽  
World Health ◽  
Life Questionnaire ◽  
Short Term

Summary: The cathartic effect of suicide is traditionally defined as the existence of a rapid, significant, and spontaneous decrease in the depressive symptoms of suicide attempters after the act. This study was designed to investigate short-term variations, following a suicide attempt by self-poisoning, of a number of other variables identified as suicidal risk factors: hopelessness, impulsivity, personality traits, and quality of life. Patients hospitalized less than 24 hours after a deliberate (moderate) overdose were presented with the Montgomery-Asberg Depression and Impulsivity Rating Scales, Hopelessness scale, MMPI and World Health Organization's Quality of Life questionnaire (abbreviated versions). They were also asked to complete the same scales and questionnaires 8 days after discharge. The study involved 39 patients, the average interval between initial and follow-up assessment being 13.5 days. All the scores improved significantly, with the exception of quality of life and three out of the eight personality traits. This finding emphasizes the fact that improvement is not limited to depressive symptoms and enables us to identify the relative importance of each studied variable as a risk factor for attempted suicide. The limitations of the study are discussed as well as in particular the nongeneralizability of the sample and setting.

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Well Being ◽  
Major Depressive ◽  
Outpatient Mental Health ◽  
End Of Treatment

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

scholarly journals Expectancies as predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease

2021 ◽  
Author(s):  
Henriët van Middendorp ◽  
Anneleen Berende ◽  
Fidel J. Vos ◽  
Hadewych H. M. ter Hofstede ◽  
Bart Jan Kullberg ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Treatment Success ◽  
Symptomatic Improvement ◽  
Post Treatment ◽  
Symptom Improvement ◽  
Persistent Symptoms ◽  
Treatment Expectancies ◽  
End Of Treatment ◽  
Pre Treatment

Abstract Introduction/Objective Expectancies about symptom improvement or deterioration are reliable predictors of symptom progression and treatment outcomes (symptom resolution or symptomatic improvement) in many (non-)pharmacological studies and treatments. This study examined predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease, hypothesizing particularly pre-treatment expectancies regarding symptom improvement to be predictive. Methods A predictive study was performed on pre-treatment and post-treatment individual characteristics, including expectancies, and physical and mental health–related quality of life (HRQoL) from the PLEASE-trial comparing randomized 12-weeks of doxycycline, clarithromycin-hydroxychloroquine, or placebo following 2 weeks of intravenous ceftriaxone. At end-of-treatment (14 weeks after trial start) and follow-up (52 weeks), complete data of 231 and 170 (of initial 280) patients with persistent symptoms temporally related to a history of erythema migrans or otherwise confirmed symptomatic Lyme disease, or accompanied by B. burgdorferi IgG or IgM antibodies, were examined through hierarchical regression analyses. Results In addition to pre-treatment HRQoL, pre-treatment expectancies regarding symptom improvement were consistently associated with stronger physical and mental HRQoL improvements at both end-of-treatment and follow-up (95% CI range: .09;.54, p < .01 to .27;.92, p < .001). Post-treatment expectancies regarding having received antibiotics vs. placebo was associated with more HRQoL improvement at end-of-treatment, but not at follow-up (95% CI-range 1.00;4.75, p = .003 to −7.34; −2.22, p < .001). Conclusions The present study shows that, next to pre-treatment functioning, patients’ pre-treatment and post-treatment expectancies regarding improvement of persistent symptoms attributed to Lyme disease relate to a more beneficial symptom course. Expectancies of patients may be relevant to explain and potentially improve patient outcomes (e.g., by optimized communication about treatment success). Trial registration ClinicalTrials.gov, NCT01207739 (Registration date: 23–09-2010) Key Points• As there is currently no sufficient symptom resolution or symptomatic improvement for many patients with persistent symptoms attributed to Lyme disease, it is relevant to know which factors determine symptom progression and predict heterogeneity in treatment response.• Next to pre-treatment functioning, expectancies regarding symptom improvement and having received antimicrobial study medication are associated with a more beneficial symptom course after both shorter-term and longer-term antimicrobial treatment.• Expectancies are relevant to consider in treatment studies and may be useful in clinical settings to improve symptom course and treatment outcome (e.g., by optimized communication about treatment success).

Replacement of an Extruded Segment of Radius after Autoclaving and Sterilising with Gentamicin

2006 ◽  
Vol 31 (6) ◽  
pp. 616-618 ◽  
Author(s):  
P. KUMAR ◽  
D. SHRESTHA ◽  
S. BAJRACHARYA
Keyword(s):  
Distal Radius ◽  
Functional Recovery ◽  
Normal Saline ◽  
Iodine Solution

A 10 year-old boy had a traumatic extrusion of 10 cm of the distal radius. The segment of bone was replaced after washing it with providine iodine solution and normal saline, autoclaving and dipping in gentamicin solution for 2 hour. At four and half year’s follow-up, there was complete incorporation of the segment with almost full functional recovery. We report this case for its rarity and discuss the treatment.

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