Anxiety Disorders: King's College School of Medicine and Dentistry

Maughan B, Carroll J. · MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, London, UK. · Curr Opin Psychiatry. · Pubmed #16721162 No free full text.

Abstract: PURPOSE OF REVIEW: This review examines recent evidence on the comorbidity between literacy problems and psychiatric disorder in childhood and discusses possible contributory factors. RECENT FINDINGS: Recent studies confirm the substantial overlap of literacy problems with a range of emotional/behavioural difficulties in childhood. Literacy problems and inattention may share genetic influences, contributing to associations with attention deficit hyperactivity disorder. To an extent, links with conduct problems may be also mediated by attentional difficulties. In addition, findings suggest bidirectional influences whereby disruptive behaviours impede reading progress and reading failure exacerbates risk for behaviour problems. Associations between literacy problems and anxiety disorders are not entirely mediated by inattentiveness. Rather, comorbid anxiety disorders seem likely to arise from the stressors associated with reading failure. Findings in relation to depression are less consistent, but suggest that poor readers may be vulnerable to low mood. Children with autism seem more likely to face problems in reading comprehension than the decoding difficulties more prominent in other disorders. SUMMARY: Literacy problems are associated with increased risks of both externalizing and internalizing disorders in childhood, with different mechanisms likely to be implicated in each case. When comorbid problems occur, each is likely to require separate treatment.

Gournay K, Curran J, Rogers P. · Health Services Research Department, Institute of Psychiatry, King's College London. · Nurs Stand. · Pubmed #16681200 No free full text.

Abstract: This article outlines the nature of obsessive compulsive disorder and sets out an evidence-based approach to assessment and treatment. The article also examines the key elements of the National Institute for Health and Clinical Excellence (2005) guideline on this condition.

Mataix-Cols D, van den Heuvel OA. · Department of Psychological Medicine, King's College London, Institute of Psychiatry, London SE5 8AF, UK. · Psychiatr Clin North Am. · Pubmed #16650715 No free full text.

Abstract: Obsessive-compulsive disorder (OCD) often co-occurs with other anxiety disorders and a number of other disorders of similar phenomenology known as the "OCD spectrum" disorders. Neurobiologically, it is unclear how all these disorders relate to each other.The picture is further complicated by the clinical heterogeneity of OCD itself. This article reviews the literature on the common and distinct neural correlates of OCD, its symptom dimensions, and other anxiety and OCD spectrum disorders with the hope of providing a conceptual and heuristic framework to help understand the relationship between these phenomena.

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.

Treasure J. · Department Academic Psychiatry, King's College London, Guys Campus, UK. · Nord J Psychiatry. · Pubmed #16500796 No free full text.

Abstract: The aim of this paper is to review the concept of comorbidity as it pertains to eating disorders. The historical framing of eating disorders within medicine and psychiatry is described and then we move to what is understood by comorbidity in the current context of diagnostic compendiums. The issue of comorbidity highlights the unsatisfactory nature of the current description of illness phenotypes. There is a move to look for broader and more specific concepts such as that of endophenotypes, for example, in relationship to neuropsychology, and the response to reward and emotion. Finally, we consider how this approach may map onto treatment. For example, it may be necessary to have specific modules tailored to the relevant moderating and mediating factors.

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.

Moriarty J. · Department of Psychological Medicine, Kings College Hospital, Denmark Hill, London SE5 9RS, UK. · J Neurol Neurosurg Psychiatry. · Pubmed #15718220 links to  free full text

This publication has no abstract.

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").

Dewey ME, Chen CM. · Trent Institute for Health Services Research, Medical School, University Hospital, Nottingham, NG7 2UH, UK. · Int J Geriatr Psychiatry. · Pubmed #15211535 No free full text.

Abstract: BACKGROUND: No previous attempt has been made to synthesise information on mortality and neurosis in older people. Our objective was to estimate the influence on mortality of various types of neurosis in the older population. METHODS: Data sources were: Medline; Embase; and personal files. Studies were considered if they included a majority of persons aged 65 and over at baseline either drawn from a total community sample or drawn from a random sample from the community. Studies which sampled from a larger age range were also included if it was possible to retrieve results about those aged 65 and over. Samples from health care facilities were excluded. Effect sizes were extracted from the papers and if they were not included in the published papers effect sizes were calculated if possible. No attempt was made to contact authors for missing data. RESULTS: We found seven reports (six of which used a neurosis diagnosis and one which used a symptom scale). Using Fisher's method we found an increase in mortality which was not significant (p = 0.08). CONCLUSION: There have been few studies, and the evidence is weakly in favour of an increased mortality risk.

Chaudhuri KR. · Regional Movement Disorders Unit, King's College Hospital, University Hospital Lewisham, Guy's, King's and St Thomas' School of Biomedical Medicine, King's College, London, United Kingdom. · Neurology. · Pubmed #14504376 No free full text.

This publication has no abstract.

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.

File SE, Seth P. · Psychopharmacology Research Unit, Centre for Neuroscience, King's College London, Guy's Campus, UK. · Eur J Pharmacol. · Pubmed #12600701 No free full text.

Abstract: The social interaction test of anxiety was developed 25 years ago to provide an ethologically based test that was sensitive to both anxiolytic and anxiogenic effects. It is sensitive to a number of environmental and physiological factors that can affect anxiety. It has detected anxiogenic effects of peptides such as corticotropin-releasing factor (CRF) and adrenocorticotropic hormone (ACTH), and anxiolytic effects of neuropeptide Y and substance P receptor antagonists. It has successfully identified neuropharmacological sites of action of anxiogenic compounds and drug withdrawal. Effects of compounds acting on the gamma-aminobutyric acid (GABA) and 5-hydroxytryptamine (5-HT) systems have been extensively investigated after both systemic administration and microinjection into specific brain regions. The use of this test has, thus, played a crucial role in unravelling the neural basis of anxiety. It is hoped that in the next 25 years, the test will play a crucial role in determining the genetic basis of anxiety disorders.

Fleminger S, Greenwood RJ, Oliver DL. · Lishman Brain Injury Unit, Maudsley Hospital, Denmark Hill, London, UK, SE5 8AZ. · Cochrane Database Syst Rev. · Pubmed #12535468 No free full text.

Abstract: BACKGROUND: Of the many psychiatric symptoms that may result from brain injury, agitation and/or aggression are often the most troublesome. It is therefore important to evaluate the efficacy of psychotropic medication used in its management. OBJECTIVES: To evaluate the effects of drugs for agitation and/or aggression following acquired brain injury (ABI). SEARCH STRATEGY: We searched MEDLINE (1966-2002), EMBASE (1980-2002) and the Cochrane Controlled Trials Register (1996-2002), Web of Science Citation Index, reference lists of papers meeting the inclusion criteria and recent reviews. We handsearched Brain Injury and the Journal of Head Trauma Rehabilitation. There were no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) that evaluated the efficacy of drugs acting on the central nervous system for agitation and/or aggression, secondary to ABI, in participants over 10 years of age. Studies using lower levels of evidence (i.e. case series studies, single case studies and controlled group comparison studies), were collated in an appendix. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. Authors were contacted where necessary for additional information. Studies of patients within six months after brain injury and/or in a confusional state, were distinguished from those of patients more than six months post-injury, or who were not confused. MAIN RESULTS: Six randomised controlled trials were identified. Four RCTs evaluated the beta-blockers, propranolol and pindolol, one RCT evaluated the central nervous system stimulant, methylphenidate and one RCT evaluated amantadine, a drug normally used in parkinsonism and related disorders. The best evidence of effectiveness in the management of agitation and/or aggression following ABI was for beta-blockers. Two RCTs found propranolol to be effective (one study early and one late after injury). However, these studies used relatively small numbers, have not been replicated, used large doses, and did not use a global outcome measure or long-term follow-up. Comparing early agitation to late aggression, there was no evidence for a differential drug response. Firm evidence that carbamazepine or valproate is effective in the management of agitation and/or aggression following ABI is lacking. REVIEWER'S CONCLUSIONS: Numerous drugs have been tried in the management of aggression in ABI but without firm evidence of their efficacy. It is therefore important to choose drugs with few side effects and to monitor their effect. Beta-blockers have the best evidence for efficacy and deserve more attention. The lack of evidence highlights the need for better evaluations of drugs for this important problem.

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.

McDonough M, Kennedy N. · Maudsley Hospital, Denmark Hill, London, England. · Harv Rev Psychiatry. · Pubmed #12023928 No free full text.

Abstract: Obsessive-compulsive disorder (OCD) has been treated pharmacologically with drugs that enhance availability of the neurotransmitter serotonin. This review summarizes the available literature on the pharmacological treatments of OCD. Numerous randomized controlled trials have attested to the efficacy of serotonin-reuptake inhibitors (SRIs) in treating this disorder, although a coherent model of serotonin dysfunction in OCD has not been established. Meta-analyses of randomized controlled trials have found better results with clomipramine than with other SRIs, but comparative studies have so far not replicated this finding. Aspects of the methodology in these studies that might explain this discrepancy are considered. Tolerability, side effects, dosing, and safety during pregnancy of the SRIs are discussed. Treatment of OCD with poor insight and of OCD comorbid with a tic disorder, augmentation strategies, and management of partial response to SRIs are reviewed. Finally, the available interventions for refractory OCD are considered.

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.

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.