Anxiety Disorders: Bryant B

Bryant B, Mayou R, Wiggs L, Ehlers A, Stores G. · Department of Psychiatry, University of Oxford. · Psychol Med. · Pubmed #14982139 No free full text.

Abstract: BACKGROUND: Little is known about the psychological and behavioural consequences of road traffic accidents for children. The study aimed to determine the outcome of road traffic accidents on children and their mothers. METHOD: A 1-year cohort study of consecutive child attenders aged 5-16 years at an Accident and Emergency Department. Data were extracted from medical notes and from interview and self-report at baseline, 3 months and 6 months. RESULTS: The children had an excellent physical outcome. Fifteen per cent suffered acute stress disorder; 25% suffered post-traumatic stress disorder at 3 months and 18% at 6 months. Travel anxiety was frequent. Post-traumatic consequences for mothers were common. CONCLUSION: Psychological outcome was poor for a minority of children and associated with disability, especially for travel. There were significant family consequences. There is a need for changes in clinical care to prevent, identify and treat distressing and disabling problems.

Dalgleish T, Meiser-Stedman R, Kassam-Adams N, Ehlers A, Winston F, Smith P, Bryant B, Mayou RA, Yule W. · Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK. · Br J Psychiatry. · Pubmed #18450669 links to  free full text

Abstract: Adult research suggests that the dissociation criterion of acute stress disorder has limited validity in predicting post-traumatic stress disorder (PTSD). We addressed this issue in child and adolescent survivors (n=367) of road accidents. Dissociation accounted for no significant unique variance in later PTSD, over and above other acute stress disorder criteria. Furthermore, thresholds of either three or more re-experiencing symptoms, or six or more re-experiencing/hyperarousal symptoms, were as effective at predicting PTSD as the full acute stress disorder diagnosis.

Meiser-Stedman R, Dalgleish T, Smith P, Yule W, Bryant B, Ehlers A, Mayou RA, Kassam-Adams N, Winston F. · Department of Psychology, Institute of Psychiatry, London, · J Trauma Stress. · Pubmed #17597127 No free full text.

Abstract: Acute stress disorder (ASD) is a good predictor of posttraumatic stress disorder in adult populations, although the emphasis on dissociation symptoms within the diagnosis has been questioned. Recent studies suggest that ASD may also have application to children and adolescents. The present study examined properties of ASD within youth. A large (N = 367) multisite sample of 6- to 17-year-old children and adolescents exposed to motor vehicle accidents completed interviews or self-report questionnaires regarding their acute stress symptoms. The study found evidence supporting the suggestion that the dissociative criterion of ASD is excessively strict in youth, and that there is less overlap between dissociative symptoms than in adults. The implications of these findings for how ASD is applied to youth are discussed.

Mayou R, Bryant B. · Department of Psychiatry, Warneford Hospital, Oxford University, OX37JX, Oxford, UK. · Injury. · Pubmed #12623250 No free full text.

Abstract: The study aimed to describe the immediate and later physical, social and psychological consequences of a road traffic accident for vehicle occupants, motorcyclists, cyclists and pedestrians amongst consecutive hospital attenders at an Accident and Emergency Department. Physical and accident details were collated from hospital records. Subjects completed questionnaires at hospital attendance, 3 months, 1 and 3 years.There were 1148 respondents from 1441 consecutive attenders over a 1-year period. The main outcome measures were self-report physical status, standard measures of post-traumatic stress disorder, mood, travel anxiety and health status at 3 months, 1 and 3 years. There were marked differences in injury pattern and immediate reaction between road user groups. Pedestrians and motorcyclists suffer the most severe injuries and report more continuing medical problems and greater resource use, especially in the first 3 months. There were few differences in psychological or social outcomes at any stage of follow-up. Despite differences between the road user groups in their injuries, immediate reactions and treatment, there were few longer-term differences. A third of all groups described chronic adverse consequences which were principally psychological, social and legal.

Ehlers A, Mayou RA, Bryant B. · Department of Psychology, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. · Behav Res Ther. · Pubmed #12488116 No free full text.

Abstract: The present study explored whether cognitive factors specified in the Ehlers and Clark model (Behav. Res. Ther. 38 (2000) 319) of posttraumatic stress disorder (PTSD) predict chronic PTSD in children who had experienced a road traffic accident. Children were assessed at 2 weeks, 3 months, and 6 months after the accident. Data-driven processing during the accident, negative interpretation of intrusive memories, alienation from other people, anger, rumination, thought suppression and persistent dissociation at initial assessment predicted PTSD symptom severity at 3 and 6 months. On the basis of sex and stressor severity variables, 14% of the variance of PTSD symptoms at 6 months could be explained. The accuracy of the prediction increased to 49% or 53% when the cognitive variables measured at initial assessment or 3 months, respectively, were taken into account.

Mayou R, Bryant B. · Department of Psychiatry, University of Oxford, Warneford Hospital. · Psychol Med. · Pubmed #12102381 No free full text.

Abstract: BACKGROUND: Road traffic accidents are known to have significant consequences for mental state and quality of life in the ensuing year that are largely unrelated to the nature of the injuries. Little is known of longer-term outcome in a representative population. METHODS: Questionnaires covering mental state and social adjustment were sent to 770 subjects who had previously participated in a prospective study of consecutive attenders at an emergency department following a road traffic accident and who had completed questionnaires at baseline, 3 months and 1 year. Outcomes were not predicted by measures related to injury type or severity but were predicted by baseline and later non-injury variables. RESULTS: Replies were received from 507 (66%) subjects. Although 76% of injuries were medically minor bruises and lacerations, 132 (26%) reported symptoms of psychiatric disorder and 104 (21 %) moderate or severe pain at 3 years. There was little evidence of improvement in prevalence between 1 and 3 years, with continuing physical symptoms, psychiatric disorder and reported consequences for everyday life. There was a significant reduction in the number of cases of post-traumatic stress disorder (PTSD) despite there being 21 late onset cases. Psychiatric outcomes and pain were unrelated to the severity of injury and were largely predicted by post-accident variables. CONCLUSIONS: Road traffic accidents have much greater consequences than would be expected from the largely minor nature of the physical injuries. There is a need for changes in medical care and in socio-legal procedures.

Mayou RA, Ehlers A, Bryant B. · Department of Psychiatry, University of Oxford, UK. · Behav Res Ther. · Pubmed #12051485 No free full text.

Abstract: The paper presents a 3-year follow-up of a prospective longitudinal study of posttraumatic stress disorder (PTSD) after motor vehicle accidents (J. Abnormal Psychol., 107 (1998) 508). Participants were 546 patients who had been assessed when attending an emergency clinic shortly after a motor vehicle accident, and at 3 months and 1 year afterwards. The prevalence of posttraumatic stress disorder PTSD at 3 years was 11%. Maintaining psychological factors, i.e. negative interpretation of intrusions, rumination, thought suppression and anger cognitions, were important in predicting the persistence of PTSD at 3 years, as were persistent health and financial problems after the accident. Other predictors were female sex, hospital admission for injuries, perceived threat and dissociation during the accident, and litigation.

Mayou R, Bryant B. · Oxford University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. · Br J Psychiatry. · Pubmed #11983642 links to  free full text

Abstract: BACKGROUND: The psychiatric outcome of whiplash neck injury is controversial. AIMS: To describe outcomes and predictors as compared with other types of road accident injury. METHOD: Consecutive emergency department attenders (n=1148; whiplash 278) assessed by self-report at baseline, 3 months, 1 year and 3 years. RESULTS: Moderate to severe pain was reported by 27% of whiplash sufferers at 1 year and by 30% at 3 years. Psychiatric consequences were common and persistent. Whiplash victims and those with bony injury were more likely to seek compensation. Accident and early post-accident psychosocial variables predicted the pain at 1 year. Claiming compensation at 3 months predicted the pain at 1 year for those with whiplash or bony injury. CONCLUSIONS: There is no special psychiatry of whiplash neck injury. Psychological variables and consequences are important following whiplash in a similar manner to other types of injury.

Mayou R, Bryant B, Ehlers A. · University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK · Am J Psychiatry. · Pubmed #11481156 links to  free full text

Abstract: OBJECTIVE: The authors' goal was to identify predictors of 1-year outcomes for consecutive patients in a hospital emergency department following motor vehicle accidents and to describe the prevalence and course of four types of psychiatric outcomes after such accidents. METHOD: Consecutive patients aged 17-69 years who attended a general hospital emergency department following a motor vehicle accident were identified. Medical information for these patients was extracted from case notes, and the patients completed self-report questionnaires at baseline (soon after the accident), 3 months after the accident, and 1 year after the accident. Measures included a self-report scale for posttraumatic stress disorder (PTSD), the Hospital Anxiety and Depression Scale, and questions about phobic travel anxiety. Logistic regression was used to examine predictors of outcome. RESULTS: Different frequencies and courses of PTSD, phobic travel anxiety, general anxiety, and depression were reported by a third of the subjects at both 3-month and 1-year follow-up. Many of the subjects reported improvements between 3 and 12 months, but others described late onset of psychiatric outcomes after the accident. There were differences in baseline and 3-month predictors of each type of 1-year outcome. CONCLUSIONS: The four types of psychiatric outcomes after a motor vehicle accident that were noted overlap, are persistent, and have different early predictors. These findings have implications for the early recognition of psychiatric consequences of motor vehicle accidents that would enable early intervention.

Mayou RA, Black J, Bryant B. · Department of Psychiatry, University of Oxford. · Br J Psychiatry. · Pubmed #11102330 links to  free full text

Abstract: BACKGROUND: Although road traffic accident injury is the most common cause of traumatic brain injury, little is known of the prevalence of psychiatric complications or the significance of unconsciousness and amnesia. AIMS: To describe amnesia and unconsciousness following a road traffic accident and to determine whether they are associated with later psychological symptoms. METHOD: Information was obtained from medical and ambulance records for 1441 consecutive attenders at an emergency department aged 17-69 who had been involved in a road traffic accident. A total of 1148 (80%) subjects completed a self-report questionnaire at baseline and were followed up at 3 months and 1 year. RESULTS: Altogether, 1.5% suffered major head (and traumatic brain) injury and 21% suffered minor head injury. Post-traumatic stress disorder (PTSD) and anxiety and depression were more common at 3 months in those who had definitely been unconscious than in those who had not, but there were no differences at 1 year. CONCLUSIONS: PTSD and other psychiatric complications are as common in those who were briefly unconscious as in those who were not.