Anxiety Disorders: Mayou R

Mayou R. · Department of Psychiatry, Oxford University, Oxford, UK. · Psychosom Med. · Pubmed #18040098 No free full text.

Abstract: OBJECTIVE: To consider whether the many types of treatments for mental disorders--both those specifically targeting illness mechanisms and nonspecific elements--are also effective in treating functional symptoms and syndromes. The paper discusses the need for well-organized care that emphasizes early treatment and recognition of more complex problems in primary and secondary medical care. METHODS: Evidence from a wide range of research and clinical experience is used to identify and illustrate general themes. RESULTS: Despite a limited evidence base, it is clear that both specific and nonspecific interventions that are effective with mental disorders are also effective in treating functional complaints. They are also helpful in the management of maladaptive reactions to physical disorders. Delivery is most effective as stepped care. CONCLUSIONS: There is a particular need for more evidence on the effectiveness of the nonspecific elements of treatment and of their most appropriate delivery by nonspecialists in general medical settings. Experience with a variety of treatment methods will enhance our understanding of psychological and other etiological variables and thereby influence the development of improved definitions in Diagnostic and Statistical Manual of Mental Disorders-5(th) Edition. It is argued that a main focus of review of somatoform disorder should be the resolution of conceptual problems.

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.

Ehlers A, Clark DM, Hackmann A, McManus F, Fennell M, Herbert C, Mayou R. · Department of Psychology, Institute of Psychiatry, London, UK. · Arch Gen Psychiatry. · Pubmed #14557148 links to  free full text

Abstract: BACKGROUND: It is unclear what psychological help should be offered in the aftermath of traumatic events. Similarly, there is a lack of clarity about the best way of identifying people who are unlikely to recover from early posttraumatic symptoms without intervention. OBJECTIVE: To determine whether cognitive therapy or a self-help booklet given in the initial months after a traumatic event is more effective in preventing chronic posttraumatic stress disorder (PTSD) than repeated assessments. DESIGN: Randomized controlled trial.Patients Motor vehicle accident survivors (n = 97) who had PTSD in the initial months after the accident and met symptom criteria that had predicted persistent PTSD in a large naturalistic prospective study of a comparable population. SETTING: Patients were recruited from attendees at local accident and emergency departments. INTERVENTIONS: Patients completed a 3-week self-monitoring phase. Those who did not recover with self-monitoring (n = 85) were randomly assigned to receive cognitive therapy (n = 28), a self-help booklet based on principles of cognitive behavioral therapy (n = 28), or repeated assessments (n = 29). MAIN OUTCOME MEASURES: Symptoms of PTSD as assessed by self-report and independent assessors unaware of the patient's allocation. Main assessments were at 3 months (posttreatment, n = 80) and 9 months (follow-up, n = 79). RESULTS: Twelve percent (n = 12) of patients recovered with self-monitoring. Cognitive therapy was more effective in reducing symptoms of PTSD, depression, anxiety, and disability than the self-help booklet or repeated assessments. At follow-up, fewer cognitive therapy patients (3 [11%]) had PTSD compared with those receiving the self-help booklet (17 [61%]; odds ratio, 12.9; 95% confidence interval, 3.1-53.1) or repeated assessments (16 [55%]; odds ratio, 10.3; 95% confidence interval, 2.5-41.7). There was no indication that the self-help booklet was superior to repeated assessments. On 2 measures, high end-state functioning at follow-up and request for treatment, the outcome for the self-help group was worse than for the repeated assessments group. CONCLUSIONS: Cognitive therapy is an effective intervention for recent-onset PTSD. A self-help booklet was not effective. The combination of an elevated initial symptom score and failure to improve with self-monitoring was effective in identifying a group of patients with early PTSD symptoms who were unlikely to recover without intervention.

Mayou R, Sprigings D, Birkhead J, Price J. · University of Oxford Department of Psychiatry, Warneford Hospital, Oxford. · Psychol Med. · Pubmed #12102384 No free full text.

Abstract: BACKGROUND: We sought to determine whether a brief psycho-educational intervention reduced disability in patients with benign palpitation. METHOD: In a pragmatic randomized controlled trial within a cardiology clinic at a district general hospital, 80 consecutive patients diagnosed as having benign palpitation--either palpitation due to awareness of extrasystoles or sinus rhythm--with associated distress or disability were randomized to an intervention group (usual care plus nurse-delivered intervention based on cognitive-behavioural principles) or to a control group (usual care). Principal outcome was difference in proportion of participants with good or excellent researcher-rated activity levels at 3 months. Subsidiary outcomes were self-rated symptoms, distress and disability, researcher-rated unmet treatment needs. RESULTS: The principal outcome showed a statistically and clinically significant benefit for the intervention group, with a number needed to treat of 3 (95% CIs 2 to 7). All but one subsidiary outcomes also showed a difference in favour of the intervention group, and several differences reached statistical significance. Significantly more of the control group had unmet treatment needs at 3 months. CONCLUSIONS: A brief, nurse-delivered, psycho-educational intervention, was an effective treatment for benign palpitation. Further evaluation, including assessment of cost-effectiveness, is needed. The findings have application to the care of patients presenting with other types of 'unexplained' medical symptoms.

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.

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 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.