Academic and clinical psychiatrist for 40 years, professor at University of London and Imperial College, published over 400 professional articles and 13 books.
The basic principle of treatment of phobias and obsessions is exposure of the patient to the evok... more The basic principle of treatment of phobias and obsessions is exposure of the patient to the evoking stimulus. Utilizing this principle, exposure in vivo seems an effective treatment for many, but not all, obsessional patients. The role of tricyclic drugs is at present being investigated. Nurse therapists have been found to be very competent in delivering treatment. Similar results, using an exposure in vivo model, have been obtained in the managment of phobias. Some reasons why patients do not comply with, or adhere to, treatment recommendations are put foward. Finally, the vexed question of the cost-effectiveness of treatment is considered.
Background The concept of fixed, unshakeable (delusional) beliefs within the context of obsessive... more Background The concept of fixed, unshakeable (delusional) beliefs within the context of obsessive–compulsive disorder (OCD) is one that has received varying amounts of attention in the literature, and has not yet received universal acknowledgement. There are good grounds for including these cases within the diagnostic concepts of OCD, with significant implications for clinical management. Aims To present cases with unusual OCD, in order to re-evaluate the issue of delusions and OCD. Method The cases of five subjects with delusions in the course of obsessive–compulsive disorder are presented to illustrate ‘delusional’ OCD. The management and outcome of these cases are discussed. Results Fixity and bizarreness of beliefs in OCD occur on a continuum from ‘none’ to ‘delusional intensity’ and may fluctuate within subjects. Conclusions The idea that these cases may represent a form of OCD has implications for management, as, if this is correct, they should be able to respond to appropriat...
BACKGROUND General psychiatrists have recently been encouraged to provide treatment to heroin add... more BACKGROUND General psychiatrists have recently been encouraged to provide treatment to heroin addicts, including in-patient detoxification. No comparison has previously been made of specialist versus general psychiatric in-patient care. METHOD During a randomised study of cue exposure, 186 opiate addicts were also randomised to either specialist in-patient (DDU; n = 115) or general psychiatric (GEN; n = 71) wards in the same hospital. RESULTS From pre-treatment (post-randomisation) onwards, patient outcomes differed across the two in-patient settings. Of the original randomised sample, significantly more DDU than GEN subjects accepted their randomisation (100 v. 77%), were subsequently admitted (60 v. 42%), and completed in-patient detoxification (45 v. 18%). Of patients admitted, more DDU than GEN patients completed detoxification (75 v. 43%). During seven-month follow-up, of those 43 patients who reached the end of treatment, significantly more ex-DDU than ex-GEN subjects were opi...
A controlled study of community care in serious mental illness (SMI) was carried out. Patients wi... more A controlled study of community care in serious mental illness (SMI) was carried out. Patients with SMI were randomised to have hospital care or be looked after by a community psychiatric care team in a Daily Living Programme (DIP). The day-to-day work of a clinical team with the difficulties encountered in delivering community psychiatric care in an inner city is described. There were seven deaths from self-harm during the 45-month study. One DIP patient committed homicide. An ordeal by media following this and the suicides are described. Lessons learnt include the need for the community care team to be responsible for discharge from any in-patient phases and for attention to team morale, especially during adversity, and to time spent working under pressure.
Objective: To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to th... more Objective: To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome. Design: Randomised controlled trial with final assessment ...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2010
To understand what predicts good outcome in psychiatric treatments, thus creating a pathway to im... more To understand what predicts good outcome in psychiatric treatments, thus creating a pathway to improving efficacy. Our study investigated relations between predictor variables and outcome (on the Clinician Administered Posttraumatic Stress Disorder [PTSD] Scale [CAPS]) at posttreatment for 77 treatment completers in a randomized controlled trial of exposure therapy and (or) cognitive restructuring, compared with relaxation, for chronic PTSD in adults. More social support on the Significant Others Scale significantly predicted better outcome on the CAPS, even after controlling for the effects of treatment group and of pretreatment severity. Importantly, social support was only a significant predictor of outcome for participants receiving cognitive restructuring and (or) exposure therapy and not for participants in the relaxation condition. Better social support is associated with significantly greater gain following cognitive restructuring and (or) exposure therapy for PTSD. Future i...
In health care training, professional examinations of competence test trainees' knowledge rat... more In health care training, professional examinations of competence test trainees' knowledge rather than their actual contribution to the improvement of patients' health. Clinical training programmes have the ultimate aim of improving patients' health, but rarely measure their success in attaining it. This paper provides an analysis of the results of clinical outcome for 2,032 patients treated during eight consecutive English National Board 650 courses, in which 68 nurse behaviour therapist trainees were trained at the Maudsley Hospital from 1978-91. The outcome of 668 patients treated in three recent courses (1987-91) is compared with that of 1,384 patients treated in five earlier courses (1978-86). Measures and diagnostic categories were similar over the whole study period. The trainees in 1987-91 achieved a similar health gain for most of their patients as did their counterparts in 1979-86, but this was achieved over a shorter time spent with each patient, and with great...
The basic principle of treatment of phobias and obsessions is exposure of the patient to the evok... more The basic principle of treatment of phobias and obsessions is exposure of the patient to the evoking stimulus. Utilizing this principle, exposure in vivo seems an effective treatment for many, but not all, obsessional patients. The role of tricyclic drugs is at present being investigated. Nurse therapists have been found to be very competent in delivering treatment. Similar results, using an exposure in vivo model, have been obtained in the managment of phobias. Some reasons why patients do not comply with, or adhere to, treatment recommendations are put foward. Finally, the vexed question of the cost-effectiveness of treatment is considered.
Background The concept of fixed, unshakeable (delusional) beliefs within the context of obsessive... more Background The concept of fixed, unshakeable (delusional) beliefs within the context of obsessive–compulsive disorder (OCD) is one that has received varying amounts of attention in the literature, and has not yet received universal acknowledgement. There are good grounds for including these cases within the diagnostic concepts of OCD, with significant implications for clinical management. Aims To present cases with unusual OCD, in order to re-evaluate the issue of delusions and OCD. Method The cases of five subjects with delusions in the course of obsessive–compulsive disorder are presented to illustrate ‘delusional’ OCD. The management and outcome of these cases are discussed. Results Fixity and bizarreness of beliefs in OCD occur on a continuum from ‘none’ to ‘delusional intensity’ and may fluctuate within subjects. Conclusions The idea that these cases may represent a form of OCD has implications for management, as, if this is correct, they should be able to respond to appropriat...
BACKGROUND General psychiatrists have recently been encouraged to provide treatment to heroin add... more BACKGROUND General psychiatrists have recently been encouraged to provide treatment to heroin addicts, including in-patient detoxification. No comparison has previously been made of specialist versus general psychiatric in-patient care. METHOD During a randomised study of cue exposure, 186 opiate addicts were also randomised to either specialist in-patient (DDU; n = 115) or general psychiatric (GEN; n = 71) wards in the same hospital. RESULTS From pre-treatment (post-randomisation) onwards, patient outcomes differed across the two in-patient settings. Of the original randomised sample, significantly more DDU than GEN subjects accepted their randomisation (100 v. 77%), were subsequently admitted (60 v. 42%), and completed in-patient detoxification (45 v. 18%). Of patients admitted, more DDU than GEN patients completed detoxification (75 v. 43%). During seven-month follow-up, of those 43 patients who reached the end of treatment, significantly more ex-DDU than ex-GEN subjects were opi...
A controlled study of community care in serious mental illness (SMI) was carried out. Patients wi... more A controlled study of community care in serious mental illness (SMI) was carried out. Patients with SMI were randomised to have hospital care or be looked after by a community psychiatric care team in a Daily Living Programme (DIP). The day-to-day work of a clinical team with the difficulties encountered in delivering community psychiatric care in an inner city is described. There were seven deaths from self-harm during the 45-month study. One DIP patient committed homicide. An ordeal by media following this and the suicides are described. Lessons learnt include the need for the community care team to be responsible for discharge from any in-patient phases and for attention to team morale, especially during adversity, and to time spent working under pressure.
Objective: To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to th... more Objective: To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome. Design: Randomised controlled trial with final assessment ...
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2010
To understand what predicts good outcome in psychiatric treatments, thus creating a pathway to im... more To understand what predicts good outcome in psychiatric treatments, thus creating a pathway to improving efficacy. Our study investigated relations between predictor variables and outcome (on the Clinician Administered Posttraumatic Stress Disorder [PTSD] Scale [CAPS]) at posttreatment for 77 treatment completers in a randomized controlled trial of exposure therapy and (or) cognitive restructuring, compared with relaxation, for chronic PTSD in adults. More social support on the Significant Others Scale significantly predicted better outcome on the CAPS, even after controlling for the effects of treatment group and of pretreatment severity. Importantly, social support was only a significant predictor of outcome for participants receiving cognitive restructuring and (or) exposure therapy and not for participants in the relaxation condition. Better social support is associated with significantly greater gain following cognitive restructuring and (or) exposure therapy for PTSD. Future i...
In health care training, professional examinations of competence test trainees' knowledge rat... more In health care training, professional examinations of competence test trainees' knowledge rather than their actual contribution to the improvement of patients' health. Clinical training programmes have the ultimate aim of improving patients' health, but rarely measure their success in attaining it. This paper provides an analysis of the results of clinical outcome for 2,032 patients treated during eight consecutive English National Board 650 courses, in which 68 nurse behaviour therapist trainees were trained at the Maudsley Hospital from 1978-91. The outcome of 668 patients treated in three recent courses (1987-91) is compared with that of 1,384 patients treated in five earlier courses (1978-86). Measures and diagnostic categories were similar over the whole study period. The trainees in 1987-91 achieved a similar health gain for most of their patients as did their counterparts in 1979-86, but this was achieved over a shorter time spent with each patient, and with great...
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