Anxiety Disorders: Institute of Psychiatry

Mataix-Cols D. · Departments of Psychological Medicine and Psychology, Institute of Psychiatry, King's College London, London, UK. · Curr Opin Psychiatry. · Pubmed #16612185 No free full text.

Abstract: PURPOSE OF REVIEW: The aim of this article is to critically summarize the most promising attempts to split obsessive-compulsive disorder into subgroups based on clinical characteristics (i.e. age of onset, presence of comorbid tics, positive family history) and symptom theme, with particular emphasis on the latter. RECENT FINDINGS: Attempts to split obsessive-compulsive disorder into mutually exclusive sub-groups based on clinical characteristics have been useful but not exempt of problems. The complex clinical presentation of the condition can be reduced to a few consistent, temporally stable symptom dimensions that can coexist in any given individual. Researchers have begun to investigate the genetics and neural mechanisms of these symptom dimensions and to develop specific assessment and treatment protocols for each particular problem. SUMMARY: The multidimensional model of obsessive-compulsive disorder proposes a middle ground between the 'lumping' and 'splitting' perspectives. The disorder can be better understood as a spectrum of multiple potentially overlapping syndromes. The most fruitful research strategy will be to examine the common and specific etiological factors implicated in each symptom dimension.

Mataix-Cols D, Marks IM. · Institute of Psychiatry, King's College London, PO BOX 69, De Crespigny Park, London SE5 8AF, UK. · Eur Psychiatry. · Pubmed #16360307 No free full text.

Abstract: Though there are effective psychological and drug treatments for obsessive-compulsive disorder (OCD), many patients remain inadequately treated or untreated. Making effective self-treatment guidance available may increase the number of patients being helped. In this review, database and manual literature searches were performed of case studies, open and randomised controlled trials (RCTs) of bibliotherapy, self-help groups, telecare and computer-aided self-help for OCD. We found no RCTs of bibliotherapy or self-help groups for OCD. Three open studies showed the efficacy of brief exposure and ritual prevention (ERP) instructions delivered by a live therapist by phone. A vicarious ERP computer program was effective in a small open study. Fully interactive computer-aided self-help by ERP for OCD was efficacious in two open studies and a large multicentre RCT, and in a small RCT compliance and outcome with that program was enhanced by brief scheduled support from a clinician. Although more research is needed, self-help approaches have the potential to help many more patients who would otherwise remain inadequately treated or untreated. Their dissemination could save resources used by health care providers. We propose a stepped care model for the treatment of OCD.

Asherson P. · MRC Social Genetic Developmental Psychiatry Centre, Institute of Psychiatry, Kings College London, London, SE5 8AF, UK. · Expert Rev Neurother. · Pubmed #16026236 No free full text.

Abstract: Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder that frequently persists into adulthood, with significant levels of inattentive, hyperactive and impulsive behavior. Impairments associated with adult ADHD include distress from the symptoms, impaired ability to function in work and academic settings, and problems sustaining stable relationships. The disorder is commonly associated with volatile moods, antisocial behavior, and drug and alcohol misuse. There is an increased risk of developing comorbid anxiety, depression, personality disorders, and drug and alcohol dependence. Despite the proven effectiveness of drugs such as methylphenidate, dexamphetamine and atomoxetine, few cases of ADHD are recognized and treated in the UK. The reasons for this are unclear, since most psychiatrists working with children and adolescents are aware that ADHD commonly persists into adult life and they also see the disorder affecting parents of children with ADHD. Issues of transition from the care of child to adult psychiatry and the need to refer adult relatives of children with ADHD to suitable psychiatric services are a major concern. Furthermore, many cases of adult ADHD go unrecognized or are seen by mental health teams that are not familiar with the subtleties of the adult presentation. As a result, misdiagnosis and treatment for conditions such as atypical depression, mixed affective disorder, cyclothymia, and borderline and unstable emotional personality disorders is not uncommon. There is therefore a requirement for further training in this area. This review will describe the common clinical presentation and provide guidelines for the diagnosis and treatment of ADHD in adults. Any psychiatrically trained physician using standard psychiatric assessment procedures can perform clinical evaluations for adult ADHD. As with other psychiatric disorders in adulthood, ADHD has its own characteristic onset, course and psychopathology. Symptoms of ADHD are trait-like, being stable characteristics from early childhood, and commonly co-occur with affective instability. Stimulants are the mainstay of treatment and are effective in around 70% of cases. Psychotherapeutic interventions also have an important role. These guidelines will assist psychiatrists and other adult mental health workers in identifying and treating individuals with adult ADHD.

Moulds ML, Nixon RD. · Department of Psychology, Institute of Psychiatry, King's College London, UK. · J Anxiety Disord. · Pubmed #15993561 No free full text.

Abstract: Exposure techniques have now been used in the treatment of anxiety disorders for several decades. Although such techniques are a dominant feature of current therapies for disorders such as posttraumatic stress disorder and acute stress disorder, examination of their relative merits has been less studied. The purpose of this review is to suggest the usefulness of in vivo flooding in the treatment of posttraumatic stress. We discuss the relevant exposure literature by briefly examining the efficacy of these techniques in the treatment of anxiety. The theoretical and methodological limitations of investigations to date of exposure methods that have been used in posttraumatic stress treatment studies are then reviewed. We highlight the fact that in vivo flooding, an exposure technique that has been used to treat some anxiety-based disorders, has received scant clinical and research attention as a treatment for posttraumatic stress. A case is made for further study of in vivo flooding in the treatment of posttraumatic stress.

Ohlsen RI, Pilowsky LS. · Institute of Psychiatry, De Crespigny Park, London, UK. · J Psychopharmacol. · Pubmed #15982997 No free full text.

Abstract: Drugs used to treat psychiatric disorders, although effective, are often restricted by adverse events. The use of partial agonists for treating hypertension was found to limit some of the side-effects in some patients. This led to the investigation of partial agonists as a treatment modality in psychiatric disorders. Partial agonists have a lower intrinsic efficacy than full agonists leading to reduced maximum response. They can act as antagonists by competing for receptor binding with full agonists. The level of activity depends on the level of endogenous receptor activity. Buprenorphine, a partial agonist at the mu-opioid receptor, is used to treat patients with addiction and decreases the symptoms of withdrawal and risks of overdose and intoxication. The anxiolytic buspirone shows partial agonism at 5-HT(1A) receptors, and this seems to provide anxioselective effects, without inducing extrapyramidal side-effects, convulsions, tolerance or withdrawal reactions. In schizophrenia, partial dopamine agonism results in antagonistic effects at sites activated by high concentrations of dopamine and agonistic effects at sites activated by low concentrations of dopamine. This stabilizes the dopamine system to effect antipsychotic action without inducing adverse motor or hormonal events. Aripiprazole is the first 'dopamine system stabilizer', and the data are promising, with efficacy at least equivalent to that with current atypical antipsychotics but fewer of the troublesome side-effects. Partial agonists seem to provide a way to fine-tune the treatment of psychiatric disorders by maximizing the treatment effect while minimizing undesirable adverse events.

Hemsley DR. · Psychology Department, Institute of Psychiatry, King's College, University of London, London SE5 8AF, England, UK. · Neurosci Biobehav Rev. · Pubmed #15964074 No free full text.

Abstract: This review provides a historical perspective on a model for schizophrenia based on results of experiments derived from learning theory. It was developed by the author in collaboration with Jeffrey Gray and numerous colleagues, (e.g. [Gray, J.A., McNaughton, N., 2000. The Neuropsychology of Anxiety. second ed. Oxford University Press, Oxford; Hemsley, D.R., 1987a An experimental psychological model for schizophrenia. In: Hafner, H., Gattaz, W.F., Janzarik, W. (Eds.), Search for the Causes of Schizophrenia, vol. 1. Springer, New York, pp. 179-188.; Hemsley, D.R., 1993. A simple (or simplistic?) cognitive model for schizophrenia. Behaviour Research and Therapy 31, 633-646]. It contrasts with earlier cognitive formulations [e.g. Hemsley, D.R., 1975. A two stage model of attention in schizophrenia research. British Journal of Social and Clinical Psychology 14, 81-88], which emphasised a weakening of contextually elicited response biases, and lacked a link to potential neural bases of the disorder. The model emphasizes the need to demonstrate patterns of performance that are not interpretable in terms of the well established 'generalized deficit' manifest in schizophrenia. It proposes that the cognitive disturbance is a change in the way stored material is integrated with sensory input and ongoing motor programmes. In particular, spatial and temporal context fail to activate appropriate stored regularities. A number of possible pathways from the cognitive disturbance to the symptoms of schizophrenia are outlined; again the term 'context' is widely employed. Thus, it has been invoked to explain the occurrence of hallucinations, delusions, thought disorder and disruptions in the sense of personal identity. However the term 'context' is ill-defined and the review indicates the variety of ways in which it may exert its influence. These are unlikely to reflect the operation of a unitary mechanism.

Lader M. · Institute of Psychiatry, Denmark Hill, London, SE5 8AF, UK. · Expert Rev Neurother. · Pubmed #15853495 No free full text.

Abstract: Selective serotonin reuptake inhibitors are the first-line treatment for panic disorder. They are effective and well tolerated. Although tricyclic antidepressants are equally effective, they are less well tolerated than the selective serotonin reuptake inhibitors. Monoamine oxidase inhibitors can be efficacious but have a range of unwanted effects that preclude their use as first-line treatments. Benzodiazepines should be reserved for short-term use and for treatment-resistant patients who do not have a history of dependence and tolerance. Also, they can be combined with selective serotonin reuptake inhibitors in the first weeks of treatment to tide the patient over before the onset of the response. Cognitive behavioral therapy is the psychologic treatment of first choice. The methods of combining drug and nondrug treatments need careful and thorough exploration.

Huezo-Diaz P, Tandon K, Aitchison KJ. · MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, UK. · Curr Psychiatry Rep. · Pubmed #15802088 No free full text.

Abstract: There is considerable evidence that genetic factors play a major role in the etiology of unipolar depression. Investigations into vulnerability genes for unipolar depression are underway and for more broadly defined depression-related traits, such as anxiety, neuroticism, and harm avoidance. This review discusses some of the core issues related to study design and molecular genetic methodology, followed by an overview of recent molecular genetic findings for unipolar depression. The research to date has identified regions within certain chromosomes that may contain risk genes. Improved study design and the use of new molecular techniques hold promise for the identification of more specific vulnerability genes for unipolar depression.

Hirsch CR, Clark DM. · Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, United Kingdom. · Clin Psychol Rev. · Pubmed #15501557 No free full text.

Abstract: Social phobia is a persistent disorder that is unlikely to be maintained by avoidance alone. One reason for the enduring nature of social phobia may be the way individuals with the disorder process social information. It is important for those involved in social phobia to have an understanding of information-processing biases, because it has the potential to guide psychological interventions. In this review of social phobia, probability and cost estimates of social situations are examined, interpretive biases are evaluated and findings relating to memory and negative imagery are also reviewed. The clinical implications of social-phobia-related information-processing biases are discussed and possible avenues for future research are outlined.

Ehlers A, Hackmann A, Michael T. · Department of Psychology, Institute of Psychiatry, London, UK. · Memory. · Pubmed #15487537 No free full text.

Abstract: The article describes features of trauma memories in post-traumatic stress disorder (PTSD), including characteristics of unintentional re-experiencing symptoms and intentional recall of trauma narratives. Reexperiencing symptoms are usually sensory impressions and emotional responses from the trauma that appear to lack a time perspective and a context. The vast majority of intrusive memories can be interpreted as re-experiencing of warning signals, i.e., stimuli that signalled the onset of the trauma or of moments when the meaning of the event changed for the worse. Triggers of re-experiencing symptoms include stimuli that have perceptual similarity to cues accompanying the traumatic event. Intentional recall of the trauma in PTSD may be characterised by confusion about temporal order, and difficulty in accessing important details, both of which contribute to problematic appraisals. Recall tends to be disjointed. When patients with PTSD deliberately recall the worst moments of the trauma, they often do not access other relevant (usually subsequent) information that would correct impressions/predictions made at the time. A theoretical analysis of re-experiencing symptoms and their triggers is offered, and implications for treatment are discussed. These include the need to actively incorporate updating information ("I know now ...") into the worst moments of the trauma memory, and to train patients to discriminate between the stimuli that were present during the trauma ("then") and the innocuous triggers of re-experiencing symptoms ("now").

Sumathipala A, Siribaddana SH, Bhugra D. · Section of Epidemiology, Institute of Psychiatry, London, UK. · Br J Psychiatry. · Pubmed #14990517 links to  free full text

Abstract: BACKGROUND: Culture-bound syndrome is a term used to describe the uniqueness of some syndromes in specific cultures. Dhat (semen-loss anxiety) has been considered to be an exotic 'neurosis of the Orient'. AIMS: To ascertain the presence of similar symptoms and syndromes in different cultures and historical settings. METHOD: Electronic and manual literature searches were used to gather information on the existence and description of semen-loss anxiety in different cultures and settings. RESULTS: Most of the empirical studies on dhat syndrome have emerged from Asia, whereas its concepts have been described historically in other cultures, including Britain, the USA and Australia. The different sources indicate the universality of symptoms and global prevalence of this condition, despite its image as a 'neurosis of the Orient'. CONCLUSIONS: It appears that dhat (semen-loss anxiety) is not as culture-bound as previously thought. We propose that the concept of culture-bound syndromes should be modified in line with DSM-IV recommendations.

Goldberg D. · Institute of Psychiatry, King's College, London, UK. · Acta Psychiatr Scand Suppl. · Pubmed #12956820 No free full text.

Abstract: OBJECTIVE: To summarize what is known about vulnerability and resilience to common mental disorders, and the psychosocial factors associated with speed of recovery. METHOD: Recent genetic factors are summarized, and taken together with known facts about social factors encouraging or reducing likelihood of an episode. RESULTS: Multiple genes are likely, controlling both vulnerability and resilience, with the manifestation in phenotype modified by environmental factors. Restitution must be thought of separately from vulnerability. CONCLUSION: Instead of specific genes causing specific mental disorders, we need a more complex model.

Ehlers A, Clark D. · Department of Psychology, Institute of Psychiatry, London, United Kingdom · Biol Psychiatry. · Pubmed #12725974 No free full text.

Abstract: Psychological interventions after traumatic events have only recently been evaluated in randomized, controlled trials. Recent systematic reviews concluded that single sessions of individual psychological debriefing are not effective in reducing distress or subsequent posttraumatic stress disorder (PTSD) symptoms. The present article reviews trials of early cognitive behavior therapy (CBT) after trauma. Cognitive behavioral therapy was more effective than supportive counseling in preventing chronicity of PTSD symptoms; however, in most available studies it remained unclear whether supportive counseling facilitated or retarded recovery, compared with no intervention. A brief CBT program given in the first month of trauma was not superior to repeated assessment; however, a course of CBT of up to 16 sessions given at 1-4 months after trauma was superior to self-help, repeated assessment, and no intervention. Possible reasons for the difference in efficacy between CBT and debriefing or self-help are discussed. These include the way of working through traumatic memories and the impact of the interventions on patients' interpretations of their PTSD symptoms. Possible ways of identifying people who are in need of specialist psychological intervention after trauma and who are unlikely to recover on their own are discussed. Some ideas for alternative ways of offering help to trauma survivors are presented, and methodologic suggestions for future research are given.

Meiser-Stedman R. · Department of Psychology, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, United Kingdom. · Clin Child Fam Psychol Rev. · Pubmed #12495267 No free full text.

Abstract: Posttraumatic stress disorder in children and adolescents has been studied only for the past 15-20 years and is the subject of a burgeoning corpus of research. Much research has focused on examining whether children and adolescents have the same responses to trauma as those experienced by adults. Many of the research tools used to investigate children's responses are taken from measures designed for use with adults, and these measures have proven to be useful. However, it has not been established that children's responses to traumatic events are related to the same underlying processes as are adults' responses. The possible application of 2 recent cognitive models of PTSD in adults to understanding PTSD in children and adolescents is discussed in this paper, within the context of what is already known about children's reaction to trauma and existing theoretical accounts of childhood PTSD. Particular attention is paid toward the nature of children's memories of traumatic events and how these memories relate to the reexperiencing symptoms of PTSD, and cognitive processes that may play a role in the maintenance of PTSD. It is proposed that the adoption of a more specific cognitive-behavioral framework in the study of this disorder may be beneficial and lead to better treatment outcomes.

Summerfield D. · Institute of Psychiatry, London SE5 8AF. · BMJ. · Pubmed #12424176 links to  free full text

This publication has no abstract.

Hotopf M, Chidgey J, Addington-Hall J, Ly KL. · Division of Psychological Medicine, Guy's King's and St. Thomas' School of Medicine, and Institute of Psychiatry, King's College London, 103 Denmark Hill, London SE5 8AZ, UK. · Palliat Med. · Pubmed #11969152 No free full text.

Abstract: OBJECTIVE: To identify all literature regarding depression in patients with advanced cancer and among mixed hospice populations, and to summarise the prevalence of depression according to different definitions. METHODS: A systematic review was performed using extensive electronic and hand searches. All studies with quantitative data on prevalence of depression were included and categorised according to their definition of depression. RESULTS: We identified 46 eligible studies giving information on the prevalence of depression, and a further four which gave information on case finding. The most widely used assessment of depression was the Hospital Anxiety and Depression Scale (HADS), which gave a median prevalence of 'definite depression' (i.e., a score on the depression subscale of > 10) of 29%, (interquartile range, IQR, 19.50-34.25%). Studies that used psychiatric interviews indicated a prevalence of major depressive disorder ranging from 5% to 26%, with a median of 15%. Studies were generally small (median sample size 88.5, IQR 50-108), had high numbers of nonresponders, and rarely gave confidence intervals for estimates of prevalence. CONCLUSIONS: Depression is a common problem in palliative care settings. The quality of much of the available research is poor, based on small samples of patients with very high nonparticipation rates. The clinical importance of depression is described in subsequent papers.

Marks IM. · Institute of Psychiatry, London SE5 8AF, UK. · Br J Psychiatry. · Pubmed #11872510 links to  free full text

Abstract: BACKGROUND: Psychiatric therapy needs assessment regarding its maturation as a therapeutic science. AIMS: Judgement of whether such a science is emerging. METHOD: Four criteria are used: efficacy; identification of responsible treatment components; knowledge of their mechanisms of action; and elucidation of why they act only in some sufferers. RESULTS: Brief behavioural, interpersonal, cognitive, problem-solving and other psychotherapies have a mature ability to improve anxiety and depressive disorders reliably and enduringly, often only with instruction from a manual or a computer. Therapy's cost-effectiveness and acceptability deserve more attention. We know little about which treatment components produce improvement, how they do so and why they do not help all sufferers. CONCLUSIONS: Therapy is coming of age regarding efficacy for anxiety and depression, but is only a toddler regarding the scientific principles to explain its effects.

Clark DM, McManus F. · Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. · Biol Psychiatry. · Pubmed #11801234 No free full text.

Abstract: Cognitive theories suggest that information processing biases play a central role in the development and maintenance of emotional disorders. The present article reviews recent studies of information processing biases in social phobia and considers the significance of the findings for understanding the persistence of the condition. Taken together, the studies suggest that social phobia is characterized by biases in the following: interpretation of external social events; detection of negative responses from other people; the balance of attention between external and self-processing; the use of internal information to make inferences about how one appears to others; recall of negative information about one's perceived, observable self; and by a variety of problematic anticipatory and post-event types of processing. If such biases play a role in maintaining social anxiety, experimental manipulation of the biases should modulate anxiety responses. Several recent studies have confirmed this prediction, but further research is required. Methodological limitations of existing information processing studies are highlighted. Finally, possible neurobiological correlates are discussed and suggestions are made for future attempts to link neurobiology and cognitive psychology.

Lyons D, McLoughlin DM. · Section of Old Age Psychiatry, Institute of Psychiatry, London, UK. · BMJ. · Pubmed #11719415 links to  free full text

This publication has no abstract.

Yule W. · University of London Institute of Psychiatry, UK. · J Clin Psychiatry. · Pubmed #11495092 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) is a complex psychopathologic condition that represents a significant challenge to the psychiatric profession. This distressing disorder has been found to affect both adults and children, although the pattern of symptoms in children can differ from that commonly seen in adults. This article presents an overview of the prevalence and incidence of PTSD and discusses factors that may be influential in the development of this disorder following exposure to traumatic events. In addition. the clinical presentation of PTSD in children is reviewed and treatment options for affected children are discussed.

Perrin S, Smith P, Yule W. · Department of Psychology, Institute of Psychiatry, London, UK. · J Child Psychol Psychiatry. · Pubmed #10784075 No free full text.

Abstract: Post-traumatic Stress Disorder (PTSD) is a syndrome defined by the intrusive re-experiencing of a trauma, avoidance of traumatic reminders, and persistent physiological arousal. PTSD is associated with high levels of comorbidity and may increase the risk for additional disorders over time. While controversies remain regarding the applicability of the PTSD criteria to very young children, it has proved to be a useful framework for guiding assessment and treatment research with older children and adolescents. This article presents an overview of the literature on the clinical characteristics, assessment, and treatment of PTSD in children and adolescents.

Meldrum BS. · Department of Clinical Neurosciences, Institute of Psychiatry, London, SE5 8AF, UK. · J Nutr. · Pubmed #10736372 links to  free full text

Abstract: Glutamate is the principal excitatory neurotransmitter in brain. Our knowledge of the glutamatergic synapse has advanced enormously in the last 10 years, primarily through application of molecular biological techniques to the study of glutamate receptors and transporters. There are three families of ionotropic receptors with intrinsic cation permeable channels [N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and kainate]. There are three groups of metabotropic, G protein-coupled glutamate receptors (mGluR) that modify neuronal and glial excitability through G protein subunits acting on membrane ion channels and second messengers such as diacylglycerol and cAMP. There are also two glial glutamate transporters and three neuronal transporters in the brain. Glutamate is the most abundant amino acid in the diet. There is no evidence for brain damage in humans resulting from dietary glutamate. A kainate analog, domoate, is sometimes ingested accidentally in blue mussels; this potent toxin causes limbic seizures, which can lead to hippocampal and related pathology and amnesia. Endogenous glutamate, by activating NMDA, AMPA or mGluR1 receptors, may contribute to the brain damage occurring acutely after status epilepticus, cerebral ischemia or traumatic brain injury. It may also contribute to chronic neurodegeneration in such disorders as amyotrophic lateral sclerosis and Huntington's chorea. In animal models of cerebral ischemia and traumatic brain injury, NMDA and AMPA receptor antagonists protect against acute brain damage and delayed behavioral deficits. Such compounds are undergoing testing in humans, but therapeutic efficacy has yet to be established. Other clinical conditions that may respond to drugs acting on glutamatergic transmission include epilepsy, amnesia, anxiety, hyperalgesia and psychosis.

Lader MH. · Institute of Psychiatry, University of London, UK. · Eur Neuropsychopharmacol. · Pubmed #10622686 No free full text.

Abstract: The benzodiazepines are still extensively used in psychiatry, neurology and medicine in general. Anxiety disorder and severe insomnia are important syndromal indications, but these drugs are widely prescribed at the symptomatic level, resulting in potential overuse. The official data sheets recommend short durations of usage and conservative dosage. Although short-term efficacy is established, long-term efficacy remains controversial, as relevant data are scanty and relapse, rebound and dependence on withdrawal not clearly distinguished. The risks of the benzodiazepines are well-documented and comprise psychological and physical effects. Among the former are subjective sedation, paradoxical release of anxiety and/or hostility, psychomotor impairment, memory disruption, and risks of accidents. Physical effects include vertigo, dysarthria, ataxia with falls, especially in the elderly. Dependence can supervene on long-term use, occasionally with dose escalation. The benzodiazepines are now recognised as major drugs of abuse and addiction. Other drug and non-drug therapies are available and have a superior risk benefit ratio in long-term use. It is concluded that benzodiazepines should be reserved for short-term use--up to 4 weeks--and in conservative dosage.

Marks I. · Institute of Psychiatry, University of London, Bethlem Royal & Maudsley Hospital, United Kingdom. · Can J Psychiatry. · Pubmed #10497696 No free full text.

Abstract: Computer systems are being used increasingly to aid the assessment and self-treatment of mental health problems in adults. Systems vary hugely in the extent to which they meet all patients' assessment and therapy needs and save clinicians' time. Hardly any single system 1) performs every task required from initial screening to the end of follow-up, 2) works 100% independently of contact with a clinician or technician, and 3) is widely available and supported. Most systems use desk- or laptop computers. Some now use palmtop (hand-held) computers. A few employ computerized phone interviews (interactive voice response), usually from home. Virtual reality as a tool is embryonic. Computer aids save time in screening and outcome-tracking in a wide variety of problems. Computer aids to treatment have had promising outcomes in phobic, anxiety, panic, and obsessive-compulsive disorders, nonsuicidal depression, obesity, and smoking cessation. Some systems are installed in a few places as part of everyday clinical care. A growing number should soon be robust enough to ease the lives of many patients, practitioners, and researchers if use of the systems is carefully integrated into normal clinical practice.

de Silva P. · Department of Psychology, Institute of Psychiatry, London, UK. · Behav Res Ther. · Pubmed #10402702 No free full text.

Abstract: This paper discusses the work on thought-starting, a clinical technique developed by Durac, over many years. Much clinical work has taken place in using and further developing this approach, and some research has also been carried out. This paper attempts a review of these developments. A selective account of some of the major developments is given. The implications of these developments are also briefly discussed.