Anxiety Disorders: Jones C

Jones C. · No affiliation provided · Acta Anaesthesiol Scand. · Pubmed #17567265 No free full text.

This publication has no abstract.

Jones C, Griffiths RD. · Critical Care Unit, Whiston Hospital, Prescot, Liverpool, UK. · Curr Opin Crit Care. · Pubmed #17762226 No free full text.

Abstract: PURPOSE OF REVIEW: To examine current research on the psychological needs of both patients and their families following critical illness, and discuss how these may be met in a cost-effective manner. RECENT FINDINGS: Patients and their families have significant psychological problems following critical illness. To date, very few intensive care units have specialist psychological services to help with the aftermath of the illness experience. There are promising simple therapeutic interventions, such as intensive care unit diaries, that may be beneficial, but which require further research at present. SUMMARY: Currently, there is an awareness of the psychological sequelae of critical illness for patients and their family caregivers, and with this a responsibility to assess and appropriately help those who are unable to manage their distress. The development and application of specialist psychological services after an episode of critical illness, possibly using a stepped care model, is in its infancy. There are a few centres of excellence that are currently employing these resources, but the vast majority of patients and their families are left to cope on their own. This lack of psychological support has important implications for long-term recovery and quality of life following the episode of critical illness.

Griffiths RD, Jones C. · Division of Metabolic and Cellular Medicine, School of Clinical Science, University of Liverpool, Liverpool, UK. · Curr Opin Anaesthesiol. · Pubmed #17413395 No free full text.

Abstract: PURPOSE OF REVIEW: In the critically ill patient, disease and the therapies we use impact on brain function. Simple tools are now available to recognise such problems. This review highlights neuropsychiatric and cognitive observations that have direct relevance to patient care and outcome. RECENT FINDINGS: Delirium is a common event, especially the hypoactive forms in the elderly. The recognition of significant cognitive dysfunction is worrying since it has profound implications for how we treat and manage patients within intensive care and beyond. The most important message is that the 'awake' intensive care unit patient is not necessarily free of significant brain dysfunction. There is also the added complication of psychological disturbances related to real or imagined delusional experiences underlying the importance of memory and recall. Longer-term implications, particularly debilitating conditions such as posttraumatic stress disorder, mean that there is a need for improved post-intensive care unit rehabilitation care. SUMMARY: Health professionals working with the critically ill must routinely include the assessment of brain cognitive function. While some of the consequences may be unavoidable, we need to reassess our sedation and care practices to ensure we are not confounding the problem. Practical options to improve outcome are being developed and emphasise that the recovery from critical illness is psychological as well as physical.

Harvey AG, Brewin CR, Jones C, Kopelman MD. · Department of Experimental Psychology, University of Oxford, Oxford, UK. · J Int Neuropsychol Soc. · Pubmed #12755178 No free full text.

Abstract: The coexistence of posttraumatic stress disorder (PTSD) and traumatic head or brain injury (TBI) in the same individual has been proposed to be paradoxical. It has been argued that individuals who sustain a TBI and have no conscious memory of their trauma will not experience fear, helplessness and horror during the trauma, nor will they develop reexperiencing symptoms or establish the negative associations that underlie avoidance symptoms. However, single case reports and incidence studies suggest that PTSD can be diagnosed following TBI. We highlight critical issues in assessment, definitions, and research methods, and propose two possible resolutions of the paradox. One resolution focuses on ambiguity in the criteria for diagnosing PTSD. The other involves accepting that TBI patients do experience similar symptoms to other PTSD patients, but that there are crucial differences in symptom content.

Harvey AG, Jones C, Schmidt DA. · Department of Experimental Psychology, University of Oxford, OX1 3UD, UK. · Clin Psychol Rev. · Pubmed #12729678 No free full text.

Abstract: Research seeking to establish the relationship between sleep and posttraumatic stress disorder (PTSD) is in its infancy. An empirically supported theory of the relationship is yet to emerge. The aims of the present paper are threefold: to summarise the literature on the prevalence and treatment of sleep disturbance characteristic of acute stress disorder (ASD) and PTSD, to critically review this literature, and to draw together the disparate theoretical perspectives that have been proposed to account for the empirical findings. After a brief overview of normal human sleep, the literature specifying the relation between sleep disturbance and PTSD is summarized. This includes studies of the prevalence of sleep disturbance and nightmares, content of nightmares, abnormalities in rapid eye movement (REM) sleep, arousal threshold during sleep, body movement during sleep, and breathing-related sleep disorders. In addition, studies of the treatment of sleep disturbance in individuals with PTSD are reviewed. We conclude that the role of sleep in PTSD is complex, but that it is an important area for further elucidating the nature and treatment of PTSD. Areas for future research are specified. In particular, a priority is to improve the methodology of the research conducted.

Jones C, Skirrow P, Griffiths RD, Humphris G, Ingleby S, Eddleston J, Waldmann C, Gager M. · Department of Medicine, Intensive Care Research Group, University of Liverpool, Liverpool, Merseyside L69 3GA, UK. · Intensive Care Med. · Pubmed #14767589 No free full text.

Abstract: OBJECTIVE: To evaluate the effectiveness of the provision of information in the form of a rehabilitation program following critical illness in reducing psychological distress in the patients' close family. DESIGN: Randomised controlled trial, blind at follow-up with final assessment at 6 months. SETTING: Two district general hospitals and one teaching hospital. PATIENTS AND PARTICIPANTS: The closest family member of 104 recovering intensive care unit (ICU) patients. INTERVENTIONS: Ward visits, ICU clinic appointments at 2 and 6 months. Relatives and patients received the rehabilitation program at 1 week after ICU discharge. The program comprised a 6-week self-help manual containing information about recovery from ICU, psychological information and practical advice. MEASUREMENTS AND RESULTS: Psychological recovery of relatives was assessed by examining the rate of depression, anxiety, and post-traumatic stress disorder (PTSD)-related symptoms by 6 months after ICU. The proportion of relatives scoring in the range >19 on the Impact of Events Scale (cause for concern) was high in both groups at 49% at 6 months. No difference was shown in the rate of depression, anxiety, or PTSD-related symptoms between the study groups. CONCLUSION: A high incidence of psychological distress was evident in relatives. Written information concerning recovery from ICU provided to the patient and their close family did not reduce this. High levels of psychological distress in patients were found to be correlated with high levels in relatives.

Jones C, Skirrow P, Griffiths RD, Humphris GH, Ingleby S, Eddleston J, Waldmann C, Gager M. · Department of Medicine, University of Liverpool, and the Intensive Care Unit, Whiston Hospital, Prescot, UK. · Crit Care Med. · Pubmed #14530751 No free full text.

Abstract: OBJECTIVE: To evaluate the effectiveness of a rehabilitation program following critical illness to aid physical and psychological recovery. DESIGN: Randomized controlled trial, blind at follow-up with final assessment at 6 months. SETTING: Two district general hospitals and one teaching hospital. PATIENTS: Patients were 126 consecutively admitted intensive care patients meeting the inclusion criteria. INTERVENTIONS: Control patients received ward visits, three telephone calls at home, and clinic appointments at 8 wks and 6 months. Intervention patients received the same plus a 6-wk self-help rehabilitation manual. MEASUREMENTS AND MAIN RESULTS: We measured levels of depression and anxiety (Hospital Anxiety and Depression Scale), phobic symptoms (Fear Index), posttraumatic stress disorder (PTSD)-related symptoms (Impact of Events Scale), and scores on the Short-Form Health Survey physical dimension 8 wks and 6 months after intensive care unit (ICU) treatment. Memory for ICU was assessed at 2 wks post-ICU discharge using the ICU Memory Tool.The intervention group improved, compared with the control patients, on the Short-Form Health Survey physical function scores at 8 wks and 6 months (p =.006), and there was a trend to a lower rate of depression at 8 wks (12% vs. 25%). However, there were no differences in levels of anxiety and PTSD-related symptoms between the groups. The presence of delusional memories was correlated significantly with both anxiety and Impact of Events Scale scores. CONCLUSIONS: A self-help rehabilitation manual is effective in aiding physical recovery and reducing depression. However, in those patients recalling delusional memories from the ICU, further psychological care may be needed to reduce the incidence of anxiety and PTSD-related symptoms.

Kubzansky LD, Koenen KC, Jones C, Eaton WW. · Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02115, USA. · Health Psychol. · Pubmed #19210026 No free full text.

Abstract: OBJECTIVE: Posttraumatic stress disorder (PTSD) reflects a prolonged stress reaction and dysregulation of the stress response system and is hypothesized to increase risk of developing coronary heart disease (CHD). No study has tested this hypothesis in women even though PTSD is more prevalent among women than men. This study aims to examine whether higher levels of PTSD symptoms are associated with increased risk of incident CHD among women. DESIGN: A prospective study using data from women participating in the Baltimore cohort of the Epidemiologic Catchment Area study (n = 1059). Past year trauma and associated PTSD symptoms were assessed using the NIMH Diagnostic Interview Schedule. MAIN OUTCOME MEASURES: Incident CHD occurring during the 14-year follow-up through 1996. RESULTS: Women with five or more symptoms were at over three times the risk of incident CHD compared with those with no symptoms (age-adjusted OR = 3.21, 95% CI: 1.29-7.98). Findings were maintained after controlling for standard coronary risk factors as well as depression or trait anxiety. CONCLUSION: PTSD symptoms may have damaging effects on physical health for civilian community-dwelling women, with high levels of PTSD symptoms associated with increased risk of CHD-related morbidity and mortality.

Granja C, Gomes E, Amaro A, Ribeiro O, Jones C, Carneiro A, Costa-Pereira A, Anonymous00046. · Medical Intensive Care Unit, Hospital Pedro Hispano, Matosinhos, Portugal. · Crit Care Med. · Pubmed #18766108 No free full text.

Abstract: OBJECTIVE: To assess the factual and delusional memories reported by intensive care unit survivors and its relationship with the development of Posttraumatic Stress Syndrome (PTSS). DESIGN: Multicenter observational cohort study. SETTING: Nine Portuguese intensive care units, as part of a multicenter study. METHODS AND PATIENTS: Between January and June 2005, 1,174 patients were admitted across the nine intensive care units. Two hundred thirty-nine patients were excluded, 14 with < 18 yrs old and 225 with a length of intensive care stay < or = 48 hrs. Thus a total of 935 patients were included in the study. One hundred ninety (20%) patients died in the intensive care unit, 90 (12%) patients died on the ward (30% in-hospital mortality rate), and another 56 (9%) died in the next 6 months after intensive care unit discharge. RESULTS: From the 599 survivors at 6 months, 313 patients answered the questionnaires (52% response rate). From the 313 respondents, 58% (n = 183) were men, median age was 59. The median Simplified Acute Physiology Score II was 37, median intensive care unit length of stay was 8 days, 57% (n = 177) of the patients were admitted for medical reasons. Forty percent (n = 116) of the respondents did not remember their admission to hospital, 48% (n = 142) did not remember the time in the hospital before intensive care unit admission, 73% (n = 220) had factual memories and 39% (n = 118) had delusional memories. Twenty-three percent (n = 66) stated that they had had intrusive memories. A higher number of "adverse" experiences were significantly associated with a higher PTSS-14 score. Eighteen percent (n = 54) of patients had a PTSS-14 score > 49, indicating a higher risk of developing posttraumatic stress disorder. A PTSS-14 score > 49 was significantly associated with not remembering the hospital stay before intensive care unit admission. CONCLUSION: Amnesia for the early period of critical illness (early amnesia) was positively associated with the level of posttraumatic stress disorder-related symptoms, which may be a proxy for severity of disease at the time of intensive care unit admission.

Capuzzo M, Bertacchini S, Jones C, Griffiths R, Ambrosio MR, Bondanelli M, Alvisi R. · No affiliation provided · Acta Anaesthesiol Scand. · Pubmed #18201316 No free full text.

This publication has no abstract.

Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. · Psychological Services (Paediatrics), Royal Liverpool Children's Hospital, Liverpool, UK. · Acta Anaesthesiol Scand. · Pubmed #18005373 No free full text.

Abstract: BACKGROUND: Although rates vary across studies, research in recent years shows that prevalence of post-traumatic stress disorder (PTSD) following intensive care unit (ICU) can be high. Presently no screening tool assessing all three PTSD symptom categories has been validated in ICU patients. The aim of the study was to conduct a preliminary validation of such a measure, the UK- Post-Traumatic Stress Syndrome 14-Questions Inventory (UK-PTSS-14). METHODS: A case series cohort study performed at two ICUs in two UK district general hospitals. The UK-PTSS-14 was administered at three time-points (4-14 days, 2 months and 3 months post-ICU discharge). At time-point three participants also completed the Post-traumatic Stress Diagnostic Scale (PDS) and the Impact of Events Scale (IES). RESULTS: Forty-four patients completed the 3-month follow up. The UK-PTSS-14 was internally reliable at all three time-points (Cronbach's alpha=0.89, 0.86 and 0.84, respectively). Test-retest reliability was highest between time-points two and three (ICC=0.90). Concurrent validity at time-point three was high against the PDS (r=0.86) and the IES (r=0.71). Predictive validity was highest at time-point two (r=0.85 with the PDS and r=0.71 with the IES). Receiver operator characteristic curve analysis suggested the highest levels of sensitivity (86%) and specificity (97%) for diagnosis of PTSD were at time-point two, with an optimum decision threshold of 45 points. CONCLUSION: This preliminary validation study suggests that the UK-PTSS-14 could be reliably used as a screening instrument at 2 months post-discharge from the ICU to identify those patients in need of referral to specialist psychological services.

Griffiths RD, Jones C. · Division of Metabolic and Cellular Medicine, School of Clinical Science, University of Liverpool, Liverpool, UK. · Curr Opin Crit Care. · Pubmed #17762227 No free full text.

Abstract: PURPOSE OF REVIEW: Through a personal narrative, the authors discuss the lessons they have learned from 20 years of intensive care follow-up and rehabilitation. RECENT FINDINGS: There is a greater understanding of the legacies of the physical, psychological and cognitive problems after critical illness, and new momentum toward developing and delivering practical care to both survivors of intensive care and their relatives. SUMMARY: The need and demand for care after critical illness is now firmly established.

Jones C, Bäckman C, Capuzzo M, Flaatten H, Rylander C, Griffiths RD. · University of Liverpool, Intensive Care Research Group, Division of Metabolic & Cellular Medicine, School of Clinical Sciences, Faculty of Medicine, L69 3GA Liverpool, UK. · Intensive Care Med. · Pubmed #17384929 No free full text.

Abstract: OBJECTIVE: This prospective observational study was designed to explore the relationships between post-traumatic stress disorder (PTSD), patients' memories of the intensive care unit (ICU) and sedation practices. DESIGN: Prospective multi-centre follow-up study out to 3 months after ICU discharge. SETTING: Two district general hospitals and three teaching hospitals across Europe. PATIENTS AND PARTICIPANTS: Two hundred and thirty-eight recovering, post-ventilated ICU patients. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Assessment of patients' memories of ICU was undertaken at 1-2 weeks post ICU discharge. Patients' psychological recovery was assessed by examining the level of PTSD-related symptoms and rate of PTSD by 3 months post ICU. The rate of defined PTSD was 9.2%, ranging from 3.2% to 14.8% in the different study ICUs. Independent of case mix and illness severity, the factors found to be related to the development of PTSD were recall of delusional memories, prolonged sedation, and physical restraint with no sedation. CONCLUSION: The development of PTSD following critical illness is associated with a number of different precipitating factors that are in part related to how patients are cared for within intensive care. This study raises the hypothesis that the impact of care within the ICU has an impact on subsequent psychological morbidity and therefore must be assessed in future studies looking at the way patients are sedated in the ICU and how physical restraint is used.

Bernard M, Jackson C, Jones C. · Birmingham Early Intervention Service, UK. · Br J Clin Psychol. · Pubmed #17147105 No free full text.

Abstract: OBJECTIVE: This paper examined whether written emotional disclosure reduces psychosis-related post-traumatic stress disorder symptoms in a small clinical sample recovering from a first episode of psychosis. METHOD: Approximately 2.5 years after their first episode of psychosis, 22 people completed measures of traumatic symptoms, recovery style, insight, anxiety and depression. Participants then wrote about the most stressful aspects of their illness (N = 12) or about emotionally neutral topics (N = 10) for 15 minutes on three separate occasions. Approximately 5 weeks later, participants re-completed the same dependent measures. RESULTS: Participants who wrote about their psychotic experiences showed less overall severity and avoidance of traumatic symptoms compared with participants who did not write about their psychotic experiences. There were no effects on the other dependent measures. CONCLUSIONS: Preliminary evidence with a small clinical sample suggests that providing people who are recovering from a psychotic episode with an opportunity to disclose the most stressful aspects of their illness and treatment may lessen the traumatic impact of these experiences. However, this finding requires replication with a larger sample.

Lovell K, Cox D, Haddock G, Jones C, Raines D, Garvey R, Roberts C, Hadley S. · Department of Nursing, Midwifery, and Social Work, University of Manchester, Manchester M13 9PL. · BMJ. · Pubmed #16935946 links to  free full text

Abstract: OBJECTIVES: To compare the effectiveness of cognitive behaviour therapy delivered by telephone with the same therapy given face to face in the treatment of obsessive compulsive disorder. DESIGN: Randomised controlled non-inferiority trial. SETTING: Two psychology outpatient departments in the United Kingdom. PARTICIPANTS: 72 patients with obsessive compulsive disorder. INTERVENTION: 10 weekly sessions of exposure therapy and response prevention delivered by telephone or face to face. MAIN OUTCOME MEASURES: Yale Brown obsessive compulsive disorder scale, Beck depression inventory, and client satisfaction questionnaire. RESULTS: Difference in the Yale Brown obsessive compulsive disorder checklist score between the two treatments at six months was -0.55 (95% confidence interval -4.26 to 3.15). Patient satisfaction was high for both forms of treatment. CONCLUSION: The clinical outcome of cognitive behaviour therapy delivered by telephone was equivalent to treatment delivered face to face and similar levels of satisfaction were reported. TRIAL REGISTRATION: Current Controlled Trials ISRCTN500103984 [controlled-trials.com].

Jones C, Harvey AG, Brewin CR. · Department of Experimental Psychology, University of Oxford, UK. · Behav Res Ther. · Pubmed #16563341 No free full text.

Abstract: We investigated the trauma narratives of 131 road traffic accident survivors prospectively, at 1 week, 6 weeks, and 3 months post-trauma. At 1 and 6 weeks, narratives of survivors with acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) were less coherent and included more dissociation content. By 3 months, their narratives also contained more repetition, more non-consecutive chunks, and more sensory words. Traumatic brain injury was associated with a separate characteristic, confusion, at all three time points. Three aspects of narrative organisation at 1 week--repetition, non-consecutive chunks, and coherence--predicted PTSD severity at 3 months after controlling for initial symptoms. The results suggest both a strong concurrent and predictive relationship between narrative disorganisation and ASD/PTSD but that as people recover from ASD, their narratives do not necessarily become less disorganised.

Jones C, Harvey AG, Brewin CR. · Department of Experimental Psychology, University of Oxford, Oxford, England. · J Trauma Stress. · Pubmed #16281212 No free full text.

Abstract: This study investigated the symptom profiles of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in participants who did and did not sustain traumatic brain injury (TBI), following a road traffic accident. The participants were assessed at three time points: as soon as possible posttrauma as well as at 6 weeks and 3 months posttrauma. At the first assessment, fewer participants from the TBI group recalled feeling fear and helplessness at the time of the trauma, fewer TBI participants reported recurrent intrusive thoughts and images, and more TBI participants reported dissociation since the trauma, relative to the non-TBI group. At the second assessment, fewer participants from the TBI group recalled feeling intense helplessness at the time of the trauma. Fewer TBI participants also reported reliving and physiological reactions on trauma reminders relative to the non-TBI group. At 3 months posttrauma, there was no difference in PTSD symptom profile between non-TBI and TBI groups. Our findings indicate that the presence of TBI is likely to influence the distribution of certain symptoms, but need not be a significant barrier to diagnosing ASD and PTSD.

Jones C, Griffiths RD, Humphris G, Skirrow PM. · Intensive Care Research Group, the Department of Medicine, University of Liverpool, UK. · Crit Care Med. · Pubmed #11373423 No free full text.

Abstract: OBJECTIVE: To examine prospectively the relationship between memories of intensive care (ICU) and levels of anxiety after ICU discharge, the stability of these memories with time, and their relationship to the development of acute posttraumatic stress disorder (PTSD)-related symptoms. DESIGN: Case series cohort assessed by interview at 2 and 8 wks after ICU discharge. SETTING: District general hospital (serving a population of 350,000) general intensive care unit. PATIENTS: Memories of ICU and anxiety levels were studied in 45 patients after ICU discharge. Thirty patients were examined again at 8 wks to assess memory stability and development of acute PTSD-related symptoms. MEASUREMENTS AND MAIN RESULTS: Standardized interviews and questionnaires were used to assess memory for ICU, anxiety, and depression 2 wks after ICU discharge. In addition, PTSD-related symptoms and panic were assessed 8 wks after ICU discharge. A total of 33 of 45 patients had delusional memories from ICU at 2 wks; nine of the patients with delusional memories had no factual memories, and these patients had higher anxiety levels 2 wks after ICU discharge (p < .0001). Thirty patients had paired assessments at 2 and 8 wks. Those patients who had no factual recall of ICU but had delusional memories at 2 wks scored highly for PTSD-related symptoms and panic attacks at 8 wks (p = .023 and .014, respectively). The only predictors of possible acute PTSD-related symptoms at the 8-wk assessment were trait anxiety (p = .006) and having delusional memories without recall of factual events in the ICU at 2 wks (p < .0001). Only delusional memories were retained over time, whereas the recall of factual events in the ICU declined. CONCLUSIONS: We propose that the development of acute PTSD-related symptoms may be related more to recall of delusions alone. This study suggests that even relatively unpleasant memories for real events during critical illness may give some protection from anxiety and the later development of PTSD-related symptoms when memories of delusions are prominent.

Griffiths RD, Jones C. · No affiliation provided · Crit Care Med. · Pubmed #19448490 No free full text.

This publication has no abstract.