Anxiety Disorders: Oxford University

Birks J, Grimley Evans J. · Centre for Statistics in Medicine, University of Oxford, Wolfson College, Linton Road, Oxford, UK, OX2 6UD. · Cochrane Database Syst Rev. · Pubmed #19160216 No free full text.

Abstract: BACKGROUND: Extracts of the leaves of the maidenhair tree, Ginkgo biloba, have long been used in China as a traditional medicine for various disorders of health. A standardized extract is widely prescribed for the treatment of a range of conditions including memory and concentration problems, confusion, depression, anxiety, dizziness, tinnitus and headache. The mechanisms of action are thought to reflect the action of several components of the extract and include increasing blood supply by dilating blood vessels, reducing blood viscosity, modification of neurotransmitter systems, and reducing the density of oxygen free radicals. OBJECTIVES: To assess the efficacy and safety of Ginkgo biloba for dementia or cognitive decline. SEARCH STRATEGY: The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 20 September 2007 using the terms: ginkgo*, tanakan, EGB-761, EGB761, "EGB 761" and gingko*. The CDCIG Specialized Register contains records from all major health care databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources. SELECTION CRITERIA: Randomized, double-blind studies, in which extracts of Ginkgo biloba at any strength and over any period were compared with placebo for their effects on people with acquired cognitive impairment, including dementia, of any degree of severity. DATA COLLECTION AND ANALYSIS: Data were extracted from the published reports of the included studies, pooled where appropriate and the treatment effects or the risks and benefits estimated. MAIN RESULTS: 36 trials were included but most were small and of duration less than three months. Nine trials were of six months duration (2016 patients). These longer trials were the more recent trials and generally were of adequate size, and conducted to a reasonable standard. Most trials tested the same standardised preparation of Ginkgo biloba, EGb 761, at different doses, which are classified as high or low. The results from the more recent trials showed inconsistent results for cognition, activities of daily living, mood, depression and carer burden. Of the four most recent trials to report results three found no difference between Ginkgo biloba and placebo, and one found very large treatment effects in favour of Ginkgo biloba.There are no significant differences between Ginkgo biloba and placebo in the proportion of participants experiencing adverse events.A subgroup analysis including only patients diagnosed with Alzheimer's disease (925 patients from nine trials) also showed no consistent pattern of any benefit associated with Ginkgo biloba. AUTHORS' CONCLUSIONS: Ginkgo biloba appears to be safe in use with no excess side effects compared with placebo. Many of the early trials used unsatisfactory methods, were small, and publication bias cannot be excluded. The evidence that Ginkgo biloba has predictable and clinically significant benefit for people with dementia or cognitive impairment is inconsistent and unreliable.

Flint J, Shifman S. · Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK. · Curr Opin Genet Dev. · Pubmed #18657615 No free full text.

Abstract: Animal models of psychiatric diseases are useful tools for screening new drugs and for investigating the mechanisms of those disorders. Despite the difficulties inherent in modelling human psychiatric phenotypes in animals, there has been recent success identifying mutations in mice that give rise to some of the characteristic features of anxiety, depression, schizophrenia, autism, obsessive-compulsive disorder and bipolar disorder. In some cases these models have the additional strength that drugs used to treat the human condition alleviate the symptoms in mice. Robust genetic evidence of the involvement of multiple susceptibility genes in psychiatric disease will enable future studies to move from single-gene models to models with multiple modified loci, with the promise of better representing the complexity of the human diseases.

Spoormaker VI, Montgomery P. · Centre for Evidence-Based Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 2ER, United Kingdom. · Sleep Med Rev. · Pubmed #18424196 No free full text.

Abstract: Sleep disturbances are often viewed as a secondary symptom of post-traumatic stress disorder (PTSD), thought to resolve once PTSD has been treated. Specific screening, diagnosis and treatment of sleep disturbances is therefore not commonly conducted in trauma centres. However, recent evidence shows that this view and consequent practices are as much unhelpful as incorrect. Several sleep disorders-nightmares, insomnia, sleep apnoea and periodic limb movements-are highly prevalent in PTSD, and several studies found disturbed sleep to be a risk factor for the subsequent development of PTSD. Moreover, sleep disturbances are a frequent residual complaint after successful PTSD treatment: a finding that applies both to psychological and pharmacological treatment. In contrast, treatment focusing on sleep does alleviate both sleep disturbances and PTSD symptom severity. A growing body of evidence shows that disturbed sleep is more than a secondary symptom of PTSD-it seems to be a core feature. Sleep-focused treatment can be incorporated into any standard PTSD treatment, and PTSD research needs to start including validated sleep measurements in longitudinal epidemiologic and treatment outcome studies. Further clinical and research implications are discussed, and possible mechanisms for the role of disturbed (REM) sleep in PTSD are described.

Ramchandani PG, Stein A, O'Connor TG, Heron J, Murray L, Evans J. · Section of Child and Adolescent Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, UK. · J Am Acad Child Adolesc Psychiatry. · Pubmed #18388761 links to  free full text

Abstract: OBJECTIVE: Postnatal depression in women is associated with adverse effects on both maternal health and children's development. It is unclear whether depression in men at this time poses comparable risks. The present study set out to assess the association between depression in men in the postnatal period and later psychiatric disorders in their children and to investigate predisposing factors for depression in men following childbirth. METHOD: A population-based cohort of 10,975 fathers and their children from the Avon Longitudinal Study of Parents and Children (ALSPAC) was recruited in the prenatal period and followed for 7 years. Paternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale and later child psychiatric disorder (DSM-IV) with the Development and Well-Being Assessment. RESULTS: Depression in fathers in the postnatal period was significantly associated with psychiatric disorder in their children 7 years later (adjusted OR 1.72, 95% CI 1.07-2.77), most notably oppositional defiant/conduct disorders (adjusted OR 1.94, 95% CI 1.04-3.61), after adjusting for maternal depression and paternal educational level. A history of severe depression and high prenatal symptom scores for depression and anxiety were the strongest predictors of paternal depression in the postnatal period. CONCLUSIONS: Depression in fathers in the postnatal period is associated with later psychiatric disorders in their children, independently of maternal postnatal depression. Further research into the risks associated with paternal psychopathology is required because this could represent an important opportunity for public health intervention.

Holmes EA, Bourne C. · Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. · Acta Psychol (Amst). · Pubmed #18234153 No free full text.

Abstract: Highly affect-laden memory intrusions are a feature of several psychological disorders with intrusive images of trauma especially associated with post-traumatic stress disorder (PTSD). The trauma film paradigm provides a prospective experimental tool for investigating analogue peri-traumatic cognitive mechanisms underlying intrusion development. We review several historical papers and some more recent key studies that have used the trauma film paradigm. A heuristic diagram is presented, designed to simplify predictions about analogue peri-traumatic processing and intrusion development, which can also be related to the processing elements of recent cognitive models of PTSD. Results show intrusions can be induced in the laboratory and their frequency amplified/attenuated in line with predictions. Successful manipulations include competing task type (visuospatial vs. verbal) and use of a cognitive coping strategy. Studies show that spontaneous peri-traumatic dissociation also affects intrusion frequency although attempts to manipulate dissociation have failed. It is hoped that further use of this paradigm may lead to prophylactic training for at risk groups and an improved understanding of intrusions across psychopathologies.

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.

Harrison PJ, Tunbridge EM. · Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK. · Neuropsychopharmacology. · Pubmed #17805313 No free full text.

Abstract: Sex differences in the genetic epidemiology and clinical features of psychiatric disorders are well recognized, but the individual genes contributing to these effects have rarely been identified. Catechol-O-methyltransferase (COMT), which metabolizes catechol compounds, notably dopamine, is a leading candidate. COMT enzyme activity, and the neurochemistry and behavior of COMT null mice, are both markedly sexually dimorphic. Genetic associations between COMT and various psychiatric phenotypes frequently show differences between men and women. Many of these differences are unconfirmed or minor, but some appear to be of reasonable robustness and magnitude; eg the functional Val(158)Met polymorphism in COMT is associated with obsessive-compulsive disorder in men, with anxiety phenotypes in women, and has a greater impact on cognitive function in boys than girls. Sex-specific effects of COMT are usually attributed to transcriptional regulation by estrogens; however, additional mechanisms are likely to be at least as important. Here we review the evidence for a sexually dimorphic influence of COMT upon psychiatric phenotypes, and discuss its potential basis. We conclude that despite the evidence being incomplete, and lacking a unifying explanation, there are accumulating and in places compelling data showing that COMT differentially impacts on brain function and dysfunction in men and women. Since sex differences in the genetic architecture of quantitative traits are the rule not the exception, we anticipate that additional evidence will emerge for sexual dimorphisms, not only in COMT but also in many other autosomal genes.

Griffiths J, Fortune G, Barber V, Young JD. · The John Radcliffe Hospital, Intensive Care Society Trials Group, Kadoorie Centre, Headley Way, OX3 9DU, Headington, Oxford, UK. · Intensive Care Med. · Pubmed #17558490 No free full text.

Abstract: OBJECTIVE: To determine the prevalence of post traumatic stress disorder in survivors of intensive care treatment. DESIGN: Systematic literature review including Medline, Embase, CINAHL, PsycINFO and references from identified papers. STUDY SELECTION: Studies determining the prevalence of PTSD in adult patients who had at least 24[Symbol: see text]h treatment on an intensive care unit. Independent duplicate data extraction. Study quality was evaluated in terms of study design and method and timing of PTSD assessment. DATA SYNTHESIS AND RESULTS: Of the 1472 citations identified, 30 studies meeting the selection criteria were reviewed. PTSD was diagnosed by standardised clinical interview alone in 2 studies. A self-report measure alone was used in 19 studies to measure PTSD symptomatology. The remaining 9 studies applied both standardised clinical interview and a self-report measure. The reported prevalence of PTSD was 0-64% when diagnosed by standardised clinical interview and 5-64% by self-report measure. PTSD assessments occurred 7 days to 8 years after intensive care discharge. CONCLUSION: The true prevalence of PTSD and the optimum timing and method of PTSD assessment have not yet been determined in intensive care unit survivors. Deficiencies in design, methodology and reporting make interpretation and comparison of quoted prevalence rates difficult, and rigorous longitudinal studies are needed.

Birks J, Grimley Evans J. · University of Oxford, Nuffield Department of Clinical Medicine, CDCIG Room 5802, John Radcliffe Hospital, Oxford, UK, OX3 9DU. · Cochrane Database Syst Rev. · Pubmed #17443523 No free full text.

Abstract: BACKGROUND: Extracts of the leaves of the maidenhair tree, Ginkgo biloba, have long been used in China as a traditional medicine for various disorders of health. A standardized extract is widely prescribed for the treatment of a range of conditions including memory and concentration problems, confusion, depression, anxiety, dizziness, tinnitus and headache. The mechanisms of action are thought to reflect the action of several components of the extract and include increasing blood supply by dilating blood vessels, reducing blood viscosity, modification of neurotransmitter systems, and reducing the density of oxygen free radicals. OBJECTIVES: To assess the efficacy and safety of Ginkgo biloba for dementia or cognitive decline. SEARCH STRATEGY: Trials were identified on 10 October 2006 through a search of the Cochrane Dementia and Cognitive Improvement Group's Specialized Register which contains records from all main medical databases (MEDLINE, EMBASE, CINAHL, PsycINFO, SIGLE, LILACS), from ongoing trials databases such as Clinicaltrials.gov and Current Controlled Trials and many other sources. The search terms used were ginkgo*, tanakan, EGB-761, EGB761, "EGB 761" and gingko*. SELECTION CRITERIA: Randomized, double-blind studies, in which extracts of Ginkgo biloba at any strength and over any period were compared with placebo for their effects on people with acquired cognitive impairment, including dementia, of any degree of severity. DATA COLLECTION AND ANALYSIS: Data were extracted from the published reports of the included studies, pooled where appropriate and the treatment effects or the risks and benefits estimated. MAIN RESULTS: Clinical global improvement as assessed by the physician, was dichotomized between participants who showed improvement or were unchanged and those who were worse. There are benefits associated with Ginkgo (dose greater than 200 mg/day) at 24 weeks (207/276 compared with 178/273, OR 1.66, 95% CI 1.12 to 2.46, P=.001) (2 studies), but not for the lower dose. Cognition shows benefit for Ginkgo (any dose) at 12 weeks (SMD -0.65, 95% CI -1.22 to -0.09 P=0.02, 5 studies) but not at 24 weeks.Five studies assessed activities of daily living (ADLs), using different scales. Some scales are more comprehensive than just ADLs. The results show benefit for Ginkgo (dose less than 200 mg/day) compared with placebo at 12 weeks (MD -5.0, 95% CI -7.88, -2.12, p=0.0007, one study), and at 24 weeks (SMD -0.16, 95% CI -0.31 to -0.01, p=0.03, 3 studies) but there are no differences at the higher dose. No study assessed mood and function separately, but one study used the ADAS-Noncog, which assesses function over several domains, but not cognitive function. There was no difference between Ginkgo and placebo.There are no significant differences between Ginkgo and placebo in the proportion of participants experiencing adverse events. There are no data available on Quality of Life, measures of depression or dependency. AUTHORS' CONCLUSIONS: Ginkgo biloba appears to be safe in use with no excess side effects compared with placebo. Many of the early trials used unsatisfactory methods, were small, and we cannot exclude publication bias. The evidence that Ginkgo has predictable and clinically significant benefit for people with dementia or cognitive impairment is inconsistent and unconvincing.

Williams JM, Barnhofer T, Crane C, Herman D, Raes F, Watkins E, Dalgleish T. · Department of Psychiatry, University of Oxford, Oxford, UK. · Psychol Bull. · Pubmed #17201573 No free full text.

Abstract: The authors review research showing that when recalling autobiographical events, many emotionally disturbed patients summarize categories of events rather than retrieving a single episode. The mechanisms underlying such overgeneral memory are examined, with a focus on M. A. Conway and C. W. Pleydell-Pearce's (2000) hierarchical search model of personal event retrieval. An elaboration of this model is proposed to account for overgeneral memory, focusing on how memory search can be affected by (a) capture and rumination processes, when mnemonic information used in retrieval activates ruminative thinking; (b) functional avoidance, when episodic material threatens to cause affective disturbance; and (c) impairment in executive capacity and control that limits an individual's ability to remain focused on retrieval in the face of distraction.

James A, Soler A, Weatherall R. · Warneford Hospital, Highfield Family and Adolescent Unit,University of Oxford, Oxford, UK OX3 7JX. · Cochrane Database Syst Rev. · Pubmed #16235374 No free full text.

Abstract: BACKGROUND: Childhood and adolescent anxiety disorders are relatively common, occurring in between 5-18% of all children and adolescents. They are associated with significant morbidity and impairment in social and academic functioning, and when persistent, there is a risk of depression, suicide attempts and substance abuse in adulthood. There is accumulating evidence for the efficacy of cognitive behavioural therapy (CBT), with a number of randomised controlled trials (RCTs) suggesting benefit. OBJECTIVES: To determine whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or attention controls. SEARCH STRATEGY: Search of the Cochrane Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register, which includes relevant randomised controlled trials from the bibliographic databases - The Cochrane Library ( to January 2004), EMBASE, (1970-2004) MEDLINE (1970-2004) and PsycINFO (1970-2004). We also searched the references of all included studies and relevant textbooks, and contacted authors in order to identify further trials. SELECTION CRITERIA: . Each identified study was assessed for possible inclusion by two reviewers independently. Inclusion criteria consisted of randomised controlled trials of CBT versus waiting list/attention controls in children (more than six years of age) and adolescents (under the age of 19 years) with a DSM (Diagnostic Statistical Manual) or ICD (International Classification of Diseases) anxiety diagnosis; and excluding simple phobia, obsessive compulsive disorder and post-traumatic stress disorder. Each study was required to conform to the principles of CBT through use of a protocol and comprising at least eight sessions of CBT. DATA COLLECTION AND ANALYSIS: The methodological quality of included trials was assessed by two reviewers independently. The dichotomous outcome of remission of anxiety diagnosis was pooled using relative risk (RR) with 95% confidence intervals. Means and standard deviations of anxiety symptom continuous scores were pooled using the standardised mean difference (SMD). Heterogeneity was assessed and intention-to-treat (ITT) analyses undertaken. The presence of publication bias was assessed using funnel plots. MAIN RESULTS: Thirteen studies with 498 subjects and 311 controls met the inclusion criteria and were included in the analyses. The studies involved community or outpatient subjects only, with anxiety of only mild to moderate severity. ITT analyses showed a response rate for remission of any anxiety diagnosis of 56% for CBT versus 28.2% for controls (RR 0.61,95%CI 0.53 to 0.69), with no evidence of heterogeneity. The number needed to treat (NNT) was 3.0 (95%CI 2.5 to 4.5). For reduction in anxiety symptoms, the SMD was -0.58 (95% CI 0.76 to -0.40) with no significant heterogeneity indicated. Individual, group and family/parental formats of CBT produced fairly similar outcomes. AUTHORS' CONCLUSIONS: Cognitive behavioural therapy appears an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or attention control. There was no evidence for a difference between an individual, group or parental/family format. CBT can be recommended for the treatment of childhood and anxiety disorders, although with only just over half improving, there is a need for further therapeutic developments.

Cipriani A, Pretty H, Hawton K, Geddes JR. · Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. · Am J Psychiatry. · Pubmed #16199826 links to  free full text

Abstract: OBJECTIVE: Observational studies suggest that long-term lithium treatment has a strong antisuicidal effect in mood disorders, but it is uncertain whether this association is a genuine therapeutic effect or is due to confounding factors in nonrandomized studies. The authors conducted a systematic review and meta-analysis of randomized trials to investigate the effect of lithium, compared to placebo and other active treatments, on the risk of suicide, deliberate self-harm, and all-cause mortality in patients with mood disorder. METHOD: The data source was the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register, incorporating results of searches of MEDLINE (1966-June 2002), EMBASE (1980-June 2002), CINAHL (1982-March 2001), PsycLIT (1974-June 2002), PSYNDEX (1977-October 1999), and LILACS (1982-March 2001). The Cochrane Central Register of Controlled Trials (CENTRAL) was searched with the term "lithium" for new records entered into the database from 1999 to 2003. Studies selected included randomized, controlled trials comparing lithium with placebo or all other compounds used in long-term treatment for mood disorders (unipolar depression, bipolar disorder, schizoaffective disorder, dysthymia, and rapid cycling, diagnosed according to DSM or ICD criteria). Of 727 references identified in the search, 52 articles were marked as possibly relevant on the basis of the abstract, and 32 randomized, controlled trials were eligible for inclusion in the review. Two independent reviewers extracted the data, and disagreements were resolved by consensus with a third reviewer. Methodological quality was assessed according to the criteria of the Cochrane Collaboration. When the outcomes of interest were not reported, an attempt was made to obtain the required data from the original authors. RESULTS: In 32 trials, 1,389 patients were randomly assigned to receive lithium and 2,069 to receive other compounds. Patients who received lithium were less likely to die by suicide (data from seven trials; two versus 11 suicides; odds ratio=0.26; 95% confidence interval [CI]=0.09-0.77). The composite measure of suicide plus deliberate self-harm was also lower in patients who received lithium (odds ratio=0.21; 95% CI=0.08-0.50). There were fewer deaths overall in patients who received lithium (data from 11 trials; nine versus 22 deaths; odds ratio=0.42, 95% CI=0.21-0.87). CONCLUSIONS: Lithium is effective in the prevention of suicide, deliberate self-harm, and death from all causes in patients with mood disorders.

Fazel M, Wheeler J, Danesh J. · Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK. · Lancet. · Pubmed #15823380 No free full text.

Abstract: BACKGROUND: About 13 million people are classified as refugees worldwide, and many more former refugees have been granted citizenship in their new countries. However, the prevalence of post-traumatic stress disorder, major depression, or psychotic illnesses in these individuals is not known. We did a systematic review of surveys about these disorders in general refugee populations in western countries. METHODS: We searched for psychiatric surveys that were based on interviews of unselected refugee populations and that included current diagnoses of post-traumatic stress disorder, major depression, psychotic illnesses, or generalised anxiety disorder. We did computer-assisted searches, scanned reference lists, searched journals, and corresponded with authors to determine prevalence rates of these mental disorders and to explore potential sources of heterogeneity, such as diagnostic criteria, sampling methods, and other characteristics. FINDINGS: 20 eligible surveys provided results for 6743 adult refugees from seven countries, with substantial variation in assessment and sampling methods. In the larger studies, 9% (99% CI 8-10%) were diagnosed with post-traumatic stress disorder and 5% (4-6%) with major depression, with evidence of much psychiatric comorbidity. Five surveys of 260 refugee children from three countries yielded a prevalence of 11% (7-17%) for post-traumatic stress disorder. Larger and more rigorous surveys reported lower prevalence rates than did studies with less optimum designs, but heterogeneity persisted even in findings from the larger studies. INTERPRETATION: Refugees resettled in western countries could be about ten times more likely to have post-traumatic stress disorder than age-matched general populations in those countries. Worldwide, tens of thousands of refugees and former refugees resettled in western countries probably have post-traumatic stress disorder.

McCleery JM, Harvey AG. · Department of Psychiatry, University of Oxford, Oxford, UK. · J Trauma Stress. · Pubmed #15730067 No free full text.

Abstract: Although memory processes play a central role in both psychological and neurobiological accounts of the development of posttraumatic stress disorder (PTSD), there has been little integration of the two literatures. This paper aims to consider the implications of an integrated account of trauma memory for pharmacological treatments that have been proposed for the prevention of PTSD. The idea of reprocessing trauma memories to bring about recovery, central to the psychological account of PTSD, is translated into terms more familiar in the biological literature using the concept of reconsolidation of active memories. It is suggested that physiological arousal enhances the reprocessing of trauma memories. Drugs that influence arousal may have effects after trauma which depend on the psychosocial context, helping to prevent the development of PTSD in some trauma victims, but impeding recovery in others who would do well without treatment.

Flouri E. · University of Oxford. · J Interpers Violence. · Pubmed #15722490 No free full text.

Abstract: This article discusses the biomedical and the social constructionist models applied to response to trauma, presents the prevalence and the etiology of post-traumatic stress disorder (PTSD), and describes its biological and psychological correlates in children and adults. It concludes that future research might benefit from investigating factors that may protect people who have been exposed to an event likely to be traumatic from presenting with PTSD symptoms, and factors that may affect the longitudinal course of PTSD and treatment effectiveness.

Donaghy M. · Department of Clinical Neurology, University of Oxford, Radcliffe Infirmary. · Clin Med. · Pubmed #15656480 No free full text.

Abstract: Any symptom represents a perception of an abnormal internal body state. The threshold for perceiving the internal body state as abnormal varies and depends particularly on psychological influences. As a result, a symptom can either reflect pathology, whether serious or not, or be generated wholly psychologically. Intuition allowing discrimination between these possibilities is central to the physician's art. Particular difficulty arises in differentiating between those psychologically generated symptoms which are produced unconsciously, often as a result of anxiety or depression, and those that constitute deliberate deception. Such malingering has the unstated intent of accessing a secondary gain, such as welfare benefit. The art of diagnosis includes estimation of whether symptoms resonate with known pathophysiological processes, using history-taking as a story which unfolds logically towards a diagnosis, assessing how a patient reacts to their symptoms compared to neutral matters, detecting exaggeration or falsification, and documenting evidence of psychologically generated abnormalities during examination. Scientific ability is only one of the attributes of a good diagnostician; equally important are abilities to notice things, to weigh up human nature and to recognise dilemmas. Our procedures for selecting medical students and physicians need to assess these skills as well as scientific qualifications.

Taylor MJ, Carney SM, Goodwin GM, Geddes JR. · Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK. · J Psychopharmacol. · Pubmed #15260915 No free full text.

Abstract: The objective of this review was to determine the effectiveness, adverse effects and acceptability of folate in the treatment of depression. Electronic databases (Cochrane Controlled Trials Register and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register) and reference lists were searched, and authors, experts and pharmaceutical companies contacted to identify randomized controlled trials that compared treatment with folic acid or 5'-methyltetrahydrofolic acid to an alternative treatment, for patients with a diagnosis of depressive disorder. Three randomized trials (247 participants) were included. Two studies assessed the use of folate in addition to other treatment, and found that adding folate reduced Hamilton Depression Rating Scale (HDRS) scores on average by a further 2.65 points [95% confidence interval (CI) 0.38-4.93]. Fewer patients treated with folate experienced a reduction in their HDRS score of less than 50% at 10 weeks (relative risk 0.47, 95% CI 0.24-0.92). The remaining study found no statistically significant difference when folate alone was compared with trazodone. The identified trials did not find evidence of any problems with the acceptability or safety of folate. The limited available evidence suggests folate may have a potential role as a supplement to other treatment for depression. It is currently unclear if this is the case both for people with normal folate levels, and for those with folate deficiency.

Shafran R, Rachman S. · Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, UK. · J Behav Ther Exp Psychiatry. · Pubmed #15210372 No free full text.

Abstract: The cognitive bias of "Thought Action Fusion" (TAF) has received significant research attention in the past decade. The review addresses the assessment of TAF, its place in cognitive theories of obsessional difficulties, and the evidence demonstrating that TAF is relevant to disorders beyond Obsessive Compulsive Disorder (OCD). Data on the components of TAF, its extension to positive outcomes and its role in the aetiology, maintenance and treatment of OCD are reviewed. It is concluded that the moral form of TAF is less robust than the likelihood form and that scales may be best used as a starting point in identifying beliefs and conducting experimental investigations. It is also suggested that the scales be amended to include harm avoidance, which would also increase their clinical utility.

Taylor MJ, Wilder H, Bhagwagar Z, Geddes J. · Department of Psychiatry, University of Oxford, Neurosciences Building, Warneford Hospital, Oxford, Oxfordshire, UK, OX3 7JK. · Cochrane Database Syst Rev. · Pubmed #15106232 No free full text.

Abstract: BACKGROUND: There are a number of effective interventions for the treatment of depression. It is possible that the efficacy of these treatments will be improved further by the use of adjunctive therapies such as inositol. OBJECTIVES: 1. To determine the effectiveness of inositol in the treatment of depression.2. To determine the adverse effects and acceptability of treatment with inositol. SEARCH STRATEGY: The Cochrane Controlled Trials Register (CCTR), The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) incorporating results of group searches of EMBASE, MEDLINE, LILACS, CINAHL, PSYNDEX and PsycLIT were searched. Reference lists of relevant papers and major textbooks of affective disorder were checked. Experts in the field and pharmaceutical companies were contacted regarding unpublished material. SELECTION CRITERIA: All randomised controlled trials that compare treatment with inositol, whether as monotherapy or adjunctive therapy, to an alternative treatment, whether another antidepressant medication or placebo, for patients with a diagnosis of depressive disorder (diagnosed according to explicit criteria). DATA COLLECTION AND ANALYSIS: Data were independently extracted from the original reports by two reviewers. Statistical analysis was conducted using Review Manager version 4.2.1. MAIN RESULTS: Four trials were identified, with a total of 141 participants. These were short term trials of double-blind design. The trials did not show clear evidence of a therapeutic benefit, nor any evidence of poor acceptability. REVIEWERS' CONCLUSIONS: It is currently unclear whether or not inositol is of benefit in the treatment of depression. Ongoing studies should reduce this uncertainty.

Lee M, Shafran R. · Department of Psychiatry, Warneford Hospital, Oxford University, Oxford, OX3 7JX, UK. · Clin Psychol Rev. · Pubmed #15081517 No free full text.

Abstract: Research has supported a link between emotional disorders (such as depression and anxiety) and information processing biases of attention and memory. This article reviews the extension of this approach to such biases in eating disorders. Two paradigms are considered in detail: the modified Stroop task and the dot probe task. In addition, the relative merits and problems associated with both approaches are considered. The limitations of the current research for clinical practice are discussed and suggestions are made for ways in which the research may be made more ecologically valid.

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.

Taylor MJ, Carney S, Geddes J, Goodwin G. · Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JK. · Cochrane Database Syst Rev. · Pubmed #12804463 No free full text.

Abstract: BACKGROUND: There are a number of effective interventions for the treatment of depression. It is possible that the efficacy of these treatments will be improved further by the use of adjunctive therapies such as folate. OBJECTIVES: 1. To determine the effectiveness of folate in the treatment of depression 2. To determine the adverse effects and acceptability of treatment with folate. SEARCH STRATEGY: The Cochrane Controlled Trials Register (CCTR), and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) incorporating results of group searches of EMBASE, MEDLINE, LILACS, CINAHL, PSYNDEX and PsycLIT were searched. Reference lists of relevant papers and major textbooks of affective disorder were checked. Experts in the field and pharmaceutical companies were contacted regarding unpublished material. SELECTION CRITERIA: All randomised controlled trials that compared treatment with folic acid or 5'-methyltetrahydrofolic acid to an alternative treatment, whether another antidepressant medication or placebo, for patients with a diagnosis of depressive disorder (diagnosed according to explicit criteria). DATA COLLECTION AND ANALYSIS: Data were independently extracted from the original reports by two reviewers. Statistical analysis was conducted using Review Manager version 4.1. MAIN RESULTS: Three trials involving 247 people were included. Two studies involving 151 people assessed the use of folate in addition to other treatment, and found that adding folate reduced Hamilton Depression Rating Scale scores on average by a further 2.65 points (95% confidence interval 0.38 to 4.93). Fewer patients treated with folate experienced a reduction in their HDRS score of less than 50% at ten weeks (relative risk (RR) 0.47, 95% CI 0.24 to 0.92) The number needed to treat with folate for one additional person to experience a 50% reduction on this scale was 5 (95% confidence interval 4 to 33). One study involving 96 people assessed the use of folate instead of the antidepressant trazodone and did not find a significant benefit from the use of folate. The trials identified did not find evidence of any problems with the acceptability or safety of folate. REVIEWER'S CONCLUSIONS: The limited available evidence suggests folate may have a potential role as a supplement to other treatment for depression. It is currently unclear if this is the case both for people with normal folate levels, and for those with folate deficiency.

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, Bryant RA, Tarrier N. · Department of Experimental Psychology, University of Oxford, Oxford, UK. · Clin Psychol Rev. · Pubmed #12729682 No free full text.

Abstract: Following considerable empirical scrutiny, cognitive behaviour therapy (CBT) has proven to be a safe and effective treatment for posttraumatic stress disorder (PTSD). This article overviews the general principles of treatment and describes the components that comprise CBT for PTSD. We then move on to review the efficacy of CBT for the treatment of PTSD caused by various traumas, including assault, road traffic accident (RTA), combat, and terrorism. Recent advances in early intervention and in the treatment of disorders that are comorbid with PTSD are reviewed. Finally, future directions are discussed. In particular, it is proposed that randomised controlled trials (RCT) of CBT for PTSD must be conducted with enhanced methodological rigour and public health relevance.

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.