Memory deficits are widely reported in patients with schizophrenia, but uncertainties remain abou... more Memory deficits are widely reported in patients with schizophrenia, but uncertainties remain about the extent and the longitudinal course of these deficits. Twenty-eight patients with a DSM-IV diagnosis of schizophrenia were tested on multiple aspects of memory at baseline, 9-and 18-month follow-up
The diagnosis, classification, and course of psychotic major depression (PMD) is considered with ... more The diagnosis, classification, and course of psychotic major depression (PMD) is considered with regard to its status as a distinct syndrome. Several factors, especially biological markers, suggest, although as yet do not confirm, that PMD is distinct from nonpsychotic major depression (NPMD), particularly for the purposes of treatment. This article provides a critical review of somatic treatments for PMD, with attention to problems of inadequate treatment, as well as underused and more recently introduced treatments. The somatic treatment options reviewed include (1) combined antidepressant (AD) and antipsychotic (AP) therapy with tricyclic antidepressants (TCAs) and typical APs; (2) electroconvulsive therapy (ECT); (3) amoxapine; (4) selective serotonin reuptake inhibitors (SSRIs), alone and in combination; (5) several atypical APs, alone and in combination; (6) mood stabilizers and anticonvulsants; and (7) some experimental treatments and surgery. A comprehensive treatment algorithm (heuristic) is presented, which draws on some previous guidelines and the critical review. This heuristic is conservative in its aims, but forward-looking in its recommendations. The status of the TCA plus typical AP regime is challenged as the default first-line treatment, and preferable alternatives are discussed. ECT has been shown to be at least as effective in short-term treatment and should be considered more frequently, especially in severe presentations and as a maintenance treatment. Some single compounds should be considered as first-line monotherapies in less severe cases. For cases in which combined AD+AP regimes are instituted, SSRIs and atypical APs should be used before older classes of drugs are considered. These recommendations aim to minimize the number of treatments used and unwanted effects experienced.
In a Hull and Holderness Community NHS Trust audit of prescribing in unipolar depression, 55 pati... more In a Hull and Holderness Community NHS Trust audit of prescribing in unipolar depression, 55 patients were identified as taking a redundant conventional antipsychotic with no apparent diagnostic indication. Concerns regarding these patients' polypharmacy, duration of treatment, and risk of long-term or undetected side effects led to their being contacted with a view to the discontinuation of conventional antipsychotic treatment. All case notes were scrutinized to validate, as far as possible, the diagnosis of unipolar depression without psychotic features. Patients were invited for a review of their medication. Ratings of symptoms (Brief Psychiatric Rating Scale), depression (Hamilton Rating Scale for Depression), motor side effects (Abnormal Involuntary Movement Scale), and personal function (Independent Living Skills Survey) were made before and after conventional antipsychotic discontinuation. The study was conducted Autumn 1999-Spring 2000. None of the 55 patients were deemed to present comorbid depression secondary to any other diagnosis. One patient could not be contacted; 14 patients, who tended to be older, refused the review. Of the remaining 40 who were seen, 25 had already discontinued antipsychotic treatment; their chronicity of illness was half that of the 15 patients continuing antipsychotic treatment. However, only 11 of these 25 patients had their medications discontinued under consultant psychiatrist supervision following the audit; 14 patients had stopped medication of their own volition, or for unclear reasons. Of the remaining 15 patients, 13 had their conventional antipsychotic discontinued by us. There were clinically and statistically significant improvements in symptoms and side effects after antipsychotic treatment was discontinued, and a statistically significant improvement in personal health care function. In this small sample, discontinuation of nonindicated conventional antipsychotic treatment was associated with clear benefits. Conventional antipsychotics should be used with caution in nonpsychotic depressed patients, particularly in the long term. Reluctance to discontinue medication in more chronic patients may be misplaced.
Patients with psychotic illness are frequently dissatisfied with psychiatric services although it... more Patients with psychotic illness are frequently dissatisfied with psychiatric services although it is unclear whether this can be explained as being due to the mental disorder itself, or to the lower quality of care received by this group of patients. We explored this issue by comparing service satisfaction from different user perspectives: patients and key relatives. The satisfaction and needs of 52 patients with schizophrenia and 66 of their relatives were assessed using the Verona Service Satisfaction Scale (VSSS). Patients were generally more satisfied with services than relatives, but there was a high degree of consistency between the groups regarding the aspects of the service which they were most, and least, satisfied with. Patient satisfaction surveys can be used as reliable indicators of service quality and can highlight specific strengths and shortcomings in mental health service provision. Such surveys can be very useful to help improve the quality of care for patients and their relatives.
In a Hull and Holderness Community NHS Trust audit of prescribing in unipolar depression, 55 pati... more In a Hull and Holderness Community NHS Trust audit of prescribing in unipolar depression, 55 patients were identified as taking a redundant conventional antipsychotic with no apparent diagnostic indication. Concerns regarding these patients' polypharmacy, duration of treatment, and risk of long-term or undetected side effects led to their being contacted with a view to the discontinuation of conventional antipsychotic treatment. All case notes were scrutinized to validate, as far as possible, the diagnosis of unipolar depression without psychotic features. Patients were invited for a review of their medication. Ratings of symptoms (Brief Psychiatric Rating Scale), depression (Hamilton Rating Scale for Depression), motor side effects (Abnormal Involuntary Movement Scale), and personal function (Independent Living Skills Survey) were made before and after conventional antipsychotic discontinuation. The study was conducted Autumn 1999-Spring 2000. None of the 55 patients were deemed to present comorbid depression secondary to any other diagnosis. One patient could not be contacted; 14 patients, who tended to be older, refused the review. Of the remaining 40 who were seen, 25 had already discontinued antipsychotic treatment; their chronicity of illness was half that of the 15 patients continuing antipsychotic treatment. However, only 11 of these 25 patients had their medications discontinued under consultant psychiatrist supervision following the audit; 14 patients had stopped medication of their own volition, or for unclear reasons. Of the remaining 15 patients, 13 had their conventional antipsychotic discontinued by us. There were clinically and statistically significant improvements in symptoms and side effects after antipsychotic treatment was discontinued, and a statistically significant improvement in personal health care function. In this small sample, discontinuation of nonindicated conventional antipsychotic treatment was associated with clear benefits. Conventional antipsychotics should be used with caution in nonpsychotic depressed patients, particularly in the long term. Reluctance to discontinue medication in more chronic patients may be misplaced.
OBJECTIVE The aim of this study was to find out whether clinical symptoms, such as positive and n... more OBJECTIVE The aim of this study was to find out whether clinical symptoms, such as positive and negative symptoms, or cognitive problems, such as impairment in memory, are predictive of social outcome among patients with schizophrenia and treated with clozapine in the long-term. METHODS Twelve subjects with a DSM-III-R diagnosis of schizophrenia treated with clozapine were recruited from an inpatient rehabilitation psychiatry unit. Subjects were assessed at baseline, and 6, 12 and 24 months, using symptoms measures, the Social Behaviour Scale (SBS) and the Rivermead Behavioural Memory Test (RBMT), which tests episodic memory. Three multivariate stepwise regression models were created with SBS at 6, 12 and 24 months score as dependent variable, and the other measures at baseline as independent variables. RESULTS The only significant contribution on social functioning in each model was made by the RBMT, which was therefore the only significant predictor of social functioning in all models. CONCLUSIONS The authors discuss the importance of episodic memory in the prediction of social functioning.
"Psychology in Question explores controversial aspects of psychological practice and res... more "Psychology in Question explores controversial aspects of psychological practice and research. It examines the key figures and issues that have raised concerns within the discipline, and considers the contribution that psychology has made to society and ...
Psychology in Social Context is a book that should be compulsory reading for all psychology unde... more Psychology in Social Context is a book that should be compulsory reading for all psychology undergraduates. However you define psychology, it is a discipline that is rooted in a social context with traditional underlying philosophical assumptions about how behaviour should be ...
"Psychology in Question explores controversial aspects of psychological practice and res... more "Psychology in Question explores controversial aspects of psychological practice and research. It examines the key figures and issues that have raised concerns within the discipline, and considers the contribution that psychology has made to society and ...
Memory deficits are widely reported in patients with schizophrenia, but uncertainties remain abou... more Memory deficits are widely reported in patients with schizophrenia, but uncertainties remain about the extent and the longitudinal course of these deficits. Twenty-eight patients with a DSM-IV diagnosis of schizophrenia were tested on multiple aspects of memory at baseline, 9-and 18-month follow-up
The diagnosis, classification, and course of psychotic major depression (PMD) is considered with ... more The diagnosis, classification, and course of psychotic major depression (PMD) is considered with regard to its status as a distinct syndrome. Several factors, especially biological markers, suggest, although as yet do not confirm, that PMD is distinct from nonpsychotic major depression (NPMD), particularly for the purposes of treatment. This article provides a critical review of somatic treatments for PMD, with attention to problems of inadequate treatment, as well as underused and more recently introduced treatments. The somatic treatment options reviewed include (1) combined antidepressant (AD) and antipsychotic (AP) therapy with tricyclic antidepressants (TCAs) and typical APs; (2) electroconvulsive therapy (ECT); (3) amoxapine; (4) selective serotonin reuptake inhibitors (SSRIs), alone and in combination; (5) several atypical APs, alone and in combination; (6) mood stabilizers and anticonvulsants; and (7) some experimental treatments and surgery. A comprehensive treatment algorithm (heuristic) is presented, which draws on some previous guidelines and the critical review. This heuristic is conservative in its aims, but forward-looking in its recommendations. The status of the TCA plus typical AP regime is challenged as the default first-line treatment, and preferable alternatives are discussed. ECT has been shown to be at least as effective in short-term treatment and should be considered more frequently, especially in severe presentations and as a maintenance treatment. Some single compounds should be considered as first-line monotherapies in less severe cases. For cases in which combined AD+AP regimes are instituted, SSRIs and atypical APs should be used before older classes of drugs are considered. These recommendations aim to minimize the number of treatments used and unwanted effects experienced.
In a Hull and Holderness Community NHS Trust audit of prescribing in unipolar depression, 55 pati... more In a Hull and Holderness Community NHS Trust audit of prescribing in unipolar depression, 55 patients were identified as taking a redundant conventional antipsychotic with no apparent diagnostic indication. Concerns regarding these patients' polypharmacy, duration of treatment, and risk of long-term or undetected side effects led to their being contacted with a view to the discontinuation of conventional antipsychotic treatment. All case notes were scrutinized to validate, as far as possible, the diagnosis of unipolar depression without psychotic features. Patients were invited for a review of their medication. Ratings of symptoms (Brief Psychiatric Rating Scale), depression (Hamilton Rating Scale for Depression), motor side effects (Abnormal Involuntary Movement Scale), and personal function (Independent Living Skills Survey) were made before and after conventional antipsychotic discontinuation. The study was conducted Autumn 1999-Spring 2000. None of the 55 patients were deemed to present comorbid depression secondary to any other diagnosis. One patient could not be contacted; 14 patients, who tended to be older, refused the review. Of the remaining 40 who were seen, 25 had already discontinued antipsychotic treatment; their chronicity of illness was half that of the 15 patients continuing antipsychotic treatment. However, only 11 of these 25 patients had their medications discontinued under consultant psychiatrist supervision following the audit; 14 patients had stopped medication of their own volition, or for unclear reasons. Of the remaining 15 patients, 13 had their conventional antipsychotic discontinued by us. There were clinically and statistically significant improvements in symptoms and side effects after antipsychotic treatment was discontinued, and a statistically significant improvement in personal health care function. In this small sample, discontinuation of nonindicated conventional antipsychotic treatment was associated with clear benefits. Conventional antipsychotics should be used with caution in nonpsychotic depressed patients, particularly in the long term. Reluctance to discontinue medication in more chronic patients may be misplaced.
Patients with psychotic illness are frequently dissatisfied with psychiatric services although it... more Patients with psychotic illness are frequently dissatisfied with psychiatric services although it is unclear whether this can be explained as being due to the mental disorder itself, or to the lower quality of care received by this group of patients. We explored this issue by comparing service satisfaction from different user perspectives: patients and key relatives. The satisfaction and needs of 52 patients with schizophrenia and 66 of their relatives were assessed using the Verona Service Satisfaction Scale (VSSS). Patients were generally more satisfied with services than relatives, but there was a high degree of consistency between the groups regarding the aspects of the service which they were most, and least, satisfied with. Patient satisfaction surveys can be used as reliable indicators of service quality and can highlight specific strengths and shortcomings in mental health service provision. Such surveys can be very useful to help improve the quality of care for patients and their relatives.
In a Hull and Holderness Community NHS Trust audit of prescribing in unipolar depression, 55 pati... more In a Hull and Holderness Community NHS Trust audit of prescribing in unipolar depression, 55 patients were identified as taking a redundant conventional antipsychotic with no apparent diagnostic indication. Concerns regarding these patients' polypharmacy, duration of treatment, and risk of long-term or undetected side effects led to their being contacted with a view to the discontinuation of conventional antipsychotic treatment. All case notes were scrutinized to validate, as far as possible, the diagnosis of unipolar depression without psychotic features. Patients were invited for a review of their medication. Ratings of symptoms (Brief Psychiatric Rating Scale), depression (Hamilton Rating Scale for Depression), motor side effects (Abnormal Involuntary Movement Scale), and personal function (Independent Living Skills Survey) were made before and after conventional antipsychotic discontinuation. The study was conducted Autumn 1999-Spring 2000. None of the 55 patients were deemed to present comorbid depression secondary to any other diagnosis. One patient could not be contacted; 14 patients, who tended to be older, refused the review. Of the remaining 40 who were seen, 25 had already discontinued antipsychotic treatment; their chronicity of illness was half that of the 15 patients continuing antipsychotic treatment. However, only 11 of these 25 patients had their medications discontinued under consultant psychiatrist supervision following the audit; 14 patients had stopped medication of their own volition, or for unclear reasons. Of the remaining 15 patients, 13 had their conventional antipsychotic discontinued by us. There were clinically and statistically significant improvements in symptoms and side effects after antipsychotic treatment was discontinued, and a statistically significant improvement in personal health care function. In this small sample, discontinuation of nonindicated conventional antipsychotic treatment was associated with clear benefits. Conventional antipsychotics should be used with caution in nonpsychotic depressed patients, particularly in the long term. Reluctance to discontinue medication in more chronic patients may be misplaced.
OBJECTIVE The aim of this study was to find out whether clinical symptoms, such as positive and n... more OBJECTIVE The aim of this study was to find out whether clinical symptoms, such as positive and negative symptoms, or cognitive problems, such as impairment in memory, are predictive of social outcome among patients with schizophrenia and treated with clozapine in the long-term. METHODS Twelve subjects with a DSM-III-R diagnosis of schizophrenia treated with clozapine were recruited from an inpatient rehabilitation psychiatry unit. Subjects were assessed at baseline, and 6, 12 and 24 months, using symptoms measures, the Social Behaviour Scale (SBS) and the Rivermead Behavioural Memory Test (RBMT), which tests episodic memory. Three multivariate stepwise regression models were created with SBS at 6, 12 and 24 months score as dependent variable, and the other measures at baseline as independent variables. RESULTS The only significant contribution on social functioning in each model was made by the RBMT, which was therefore the only significant predictor of social functioning in all models. CONCLUSIONS The authors discuss the importance of episodic memory in the prediction of social functioning.
"Psychology in Question explores controversial aspects of psychological practice and res... more "Psychology in Question explores controversial aspects of psychological practice and research. It examines the key figures and issues that have raised concerns within the discipline, and considers the contribution that psychology has made to society and ...
Psychology in Social Context is a book that should be compulsory reading for all psychology unde... more Psychology in Social Context is a book that should be compulsory reading for all psychology undergraduates. However you define psychology, it is a discipline that is rooted in a social context with traditional underlying philosophical assumptions about how behaviour should be ...
"Psychology in Question explores controversial aspects of psychological practice and res... more "Psychology in Question explores controversial aspects of psychological practice and research. It examines the key figures and issues that have raised concerns within the discipline, and considers the contribution that psychology has made to society and ...
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