Anxiety Disorders: University College London

Martino D, Giovannoni G. · Institute of Neurology, Department of Neuroimmunology, University College London, London, United Kingdom. · Adv Neurol. · Pubmed #16383229 No free full text.

Abstract: Poststreptococcal disorders exhibit a remarkable comorbidity of neurologic and psychiatric features. A similar combination of symptoms is also described in other conditions, such as connective tissue or paraneoplastic disorders, albeit less frequently. A better understanding of the underlying mechanisms associated with autoaggressive immune-mediated attack on the basal ganglia is required. This understanding will ideally aid clinicians in diagnosing these conditions and lead to appropriate clinical trials, for example, of chemoprophylaxis strategies to prevent recurrent streptococcal infection and of the use of immunosuppressive treatments.

Brewin CR. · University College London, London, England. · J Trauma Stress. · Pubmed #16281196 No free full text.

Abstract: The development of effective methods of screening for posttraumatic stress disorder (PTSD) is important in the context of mass trauma, the geographical dispersion of victims, and the restricted availability of specialists in psychological trauma. The review focused on published English-language screening instruments for civilian PTSD consisting of 30 items or fewer and validated against structured clinical interviews. Thirteen instruments were identified meeting these criteria, all consisting of symptoms of traumatic stress. The review concluded that the performance of some currently available instruments is near to their maximal potential effectiveness, and that instruments with fewer items, simpler response scales, and simpler scoring methods perform as well as if not better than longer and more complex measures.

Dale RC. · Neurosciences Unit, Great Ormond Street Hospital NHS Trust, London, UK. · Dev Med Child Neurol. · Pubmed #16225745 No free full text.

Abstract: Group A Streptococcus can induce autoimmune disease in humans with particular involvement of the heart, joints, and brain. The spectrum of post-streptococcal disease of the central nervous system (CNS) has been widened recently and includes movement disorders (chorea, tics, dystonia, and Parkinsonism), psychiatric disorders (particularly emotional disorders), and associated sleep disorders. Neuroimaging and pathological studies indicate that the most vulnerable brain region is the basal ganglia. The immunopathogenesis of the disease is incompletely defined, and although there is some support for autoantibody-mediated disease, several conflicting studies cast doubt on the autoantibody hypothesis. It has been speculated that post-streptococcal autoimmunity has a role in common neuropsychiatric disease but the evidence is conflicting and routine screening of patients with Tourette syndrome and obsessive-compulsive disorder for post-streptococcal autoimmune abnormalities is not be recommended at present. However, post-streptococcal disorders of the CNS remain a useful model of neuropsychiatric disease, which may improve our understanding of abnormal movements and behaviours in children.

Brewin CR. · Sub-Department of Clinical Health Psychology, University College London, WC1E 6BT, England, · J Trauma Dissociation. · Pubmed #16150674 No free full text.

Abstract: This paper reviews evidence concerning the major risk factors for posttraumatic stress disorder. Although there are a number of consistent risk factors, their effects tend to be small and to vary according to the nature of the study. This suggests that they are not well suited to identifying individuals who require early intervention following a traumatic event. In contrast, methods based on symptom reports offer a much more sensitive and practicable approach to screening. A recent instrument, the Trauma Screening Questionnaire, is brief, simple to administer, and highly efficient at identifying survivors in need of intervention.

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.

Anie KA. · Department of Haematology, Brent Sickle Cell and Thalassaemia Centre, Imperial College London, Central Middlesex Hospital, London, UK. · Br J Haematol. · Pubmed #15952997 No free full text.

Abstract: This review examines the evidence for some of the common psychological complications found across the life span of patients with sickle cell disease (SCD), which are likely to be encountered by haematologists responsible for their medical management. Electronic searches of medical and psychological databases were conducted with a focus on three main areas: psychological coping, quality of life and neuropsychology. Psychological complications were identified in both children and adults with SCD, and included inappropriate pain coping strategies; reduced quality of life owing to restrictions in daily functioning, anxiety and depression; and neurocognitive impairment. There were wide variations in design and consistency of the studies, therefore, some caution needs to be observed in the findings. Moreover, interventional studies were lacking in some areas such as neuropsychology. Utilization of psychological interventions including patient education, cognitive behavioural therapy, and special educational support to help improve the quality of life of patients are recommended.

Hawkins SS, Radcliffe J. · Institute of Child Health, University College London. · J Pediatr Psychol. · Pubmed #15947119 No free full text.

Abstract: OBJECTIVE: To review measures of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PSS) for children and adolescents. METHODS: We reviewed broad-based child mental health journals within the disciplines of pediatrics, child psychology, and trauma, from 1995 to 2004, to identify measures of PTSD and PSS for children and adolescents. The review includes a summary of the psychometric properties and associated features of the measures and the clinical domains and types of studies using each measure. RESULTS: Seven measures of PTSD and PSS were identified, including clinician-administered interviews and self-report questionnaires. Sixty-five articles containing the measures were categorized into eight trauma domains. We found there is little consensus over measures used within each trauma domain. CONCLUSIONS: Few measures of PTSD and PSS have been designed specifically for young people. Further directions for measurement of PTSD in this age group are discussed to prevent under-diagnosis and under-treatment for youth.

Fonagy P. · Sub-Department of Clinical Health Psychology, Psychanalysis Unit, University College London, Gower Street, London WC1E 6BT. · Ann N Y Acad Sci. · Pubmed #15817738 No free full text.

Abstract: This article considers the development of violence with particular reference to family factors in violence such as the quality of the parent-child relationship. In taking a developmental approach to violence, a link is established between the maltreatment of children in an attachment context and the risk of violence via the child's capacity to envision mental states in the other. Evidence from epidemiology and neuroscience is brought to bear on this link. Finally, some studies of prevention of violence that are likely to enhance attachment and mentalizing are considered.

Gaitatzis A, Trimble MR, Sander JW. · Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, and The National Hospital for Neurology and Neurosurgery, London, UK. · Acta Neurol Scand. · Pubmed #15355484 No free full text.

Abstract: Several studies have assessed the prevalence of psychiatric disorders in epilepsy. They are characterized by considerable heterogeneity, because of differences in the population setting and type of study. A non-systematic review of the literature allows us to draw some useful, although not definite, conclusions. Six per cent of people with epilepsy in the general population appear to suffer from a psychiatric disorder, while this rises to 10-20% in populations with temporal lobe and/or refractory epilepsy. Mood disorders are the most common culprit (24-74%), particularly depression (30%), followed by anxiety disorders (10-25%), psychoses (2-7%) and personality disorders (1-2%). This comorbidity appears to be related to endogenous and exogenous (including iatrogenic) factors and to the severity and chronicity of epilepsy. Conditions such as schizophrenia-like psychosis of epilepsy and interictal dysphoric disorder are represented only in epilepsy. Adequate recognition and treatment of psychiatric conditions in epilepsy is essential for patient management because of their considerable burden in morbidity and quality of life.

Schrag A. · University Department of Clinical Neurosciences, Royal Free and University College Medical School, London NW3 2PF, UK. · J Neurol. · Pubmed #15258780 No free full text.

Abstract: In patients with Parkinson's disease (PD) disturbances of mental state constitute some of the most difficult treatment challenges of advanced disease, often limiting effective treatment of motor symptoms and leading to increased disability and poor quality of life. This article provides an update on the current knowledge of these complications and the use of old and new drugs in their management. Mental state alterations in PD include depression, anxiety, cognitive impairment, apathy, and treatment-related psychiatric symptoms. The latter range from vivid dreams and hallucinations to delusions, manic symptoms, hypersexuality, dopamine dysregulation syndrome and delirium. While some of these symptoms may be alleviated by anti-parkinsonian medication, especially if they are off-period related, treatment-related phenomena are usually exacerbated by increasing the number or dosage of antiparkinsonian drugs. Elimination of exacerbating factors and simplification of drug regimes are the first and most important steps in improvement of such symptoms. However, the advent of atypical antipsychotics such as clozapine has dramatically helped the management of treatment-related psychiatric complications in PD. In patients with dementia associated with PD cognitive functioning and behavioural problems appear to respond to cholinesterase inhibitors, such as rivastigmine or donepezil. Depression is a common problem in early as well as advanced PD, and selective serotonin reuptake inhibitors, reboxetine, and tricyclic antidepressants have been reported to be effective and well tolerated antidepressants. Randomised, controlled studies are required to assess the differential efficacy and tolerability of antidepressants in patients with PD, including the newer antidepressants with serotonergic and noradrenergic properties.

Neal JA, Edelmann RJ. · School of Psychology and Counselling, Whitelands College, University of Surrey Roehampton, West Hill, SW15 3SN, London, UK. · Clin Psychol Rev. · Pubmed #14529697 No free full text.

Abstract: Social phobia is an extremely disruptive and distressing anxiety disorder that can impact on many areas of an individual's life. Yet, despite the fact that lifetime prevalence rates are relatively high, its etiology is still poorly understood. The aim of this review is to draw together findings from the broad base of nonclinical literature associated with behavioral inhibition (BI), shyness, social anxiety, and passive-anxious withdrawal and to compare these findings with those from the limited number of clinical studies with social phobics. Such comparison is not unproblematic due to conceptual differences between terms used and methodological divergence; these issues are discussed in some detail. The consonance of findings, however, suggests a viable profile for the developmental course of social phobia. This profile incorporates temperament variables, behavioral motivational, parenting styles, peer relationships, and internalization problems. Finally, specific suggestions for future research are offered.

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.

Brewin CR, Holmes EA. · Subdepartment of Clinical Health Psychology, University College London, Gower Street, London WC1E 6BT, UK. · Clin Psychol Rev. · Pubmed #12729677 No free full text.

Abstract: We summarize recent research on the psychological processes implicated in posttraumatic stress disorder (PTSD) as an aid to evaluating theoretical models of the disorder. After describing a number of early approaches, including social-cognitive, conditioning, information-processing, and anxious apprehension models of PTSD, the article provides a comparative analysis and evaluation of three recent theories: Foa and Rothbaum's [Foa, E. B. & Rothbaum, B. O. (1998). Treating the trauma of rape: cognitive behavioral therapy for PTSD. New York: Guilford Press] emotional processing theory; Brewin, Dalgleish, and Joseph's [Psychological Review 103 (1996) 670] dual representation theory; Ehlers and Clark's [Behaviour Research and Therapy 38 (2000) 319] cognitive theory. We review empirical evidence relevant to each model and identify promising areas for further research.

Dale RC. · Neurosciences Unit, Institute of Child Health, London, UK. · QJM. · Pubmed #12615982 links to  free full text

Abstract: Sydenham's chorea (SC) occurs weeks or months after Group A streptococcal infection, and is characterized by involuntary, purposeless movements of the limbs, in addition to behavioural alteration. There is a body of evidence which suggests that SC is an immune-mediated brain disorder with regional localization to the basal ganglia. Recent reports have suggested that the spectrum of post-streptococcal CNS disease is broader than chorea alone, and includes other hyperkinetic movement disorders (tics, dystonia and myoclonus). In addition, there are high rates of behavioural sequelae, particularly emotional disorders such as obsessive-compulsive disorder, anxiety and depression. These findings have lead to the hypothesis that similar immune-mediated basal ganglia processes may be operating in common neuropsychiatric disease such as tic disorders, Tourette syndrome and obsessive-compulsive disorder. This review analyses the historical aspects of post-streptococcal CNS disease, and the recent immunological studies which have addressed the hypothesis that common neuropsychiatric disorders may be secondary to basal ganglia autoimmunity.

Trimble MR, Krishnamoorthy ES. · Department of Behavioural Neurology, Institute of Neurology, London, United Kingdom. · Epilepsia. · Pubmed #12558827 No free full text.

Abstract: PURPOSE: To review transcultural perspectives in the neuropsychiatry of epilepsy. METHODS: Systematic literature searches of standard databases, cross-referencing, chapters, and opinion leader articles. RESULTS: Articles from the Indian subcontinent, Africa, and Japan were identified and are reviewed herein. The spectrum of psychopathology in epilepsy is rather similar across cultures. However, psychopathology specific to epilepsy, the interictal behavioural syndrome of Geschwind, for example, has not been well studied outside the Western world. DISCUSSION: There is a need for well-designed epidemiological studies of neuropsychiatric disorders in epilepsy. These should use harmonised protocols and outcome measures. Special attention should be paid to the impact of aetiology on psychiatric co-morbidity and disablement.

Sidiki SS, Hamilton R, Dutton GN. · Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow G12 0YN. · BMJ. · Pubmed #12543840 links to  free full text

This publication has no abstract.

Crabb L. · National Hospital for Neurology and Neurosurgery, London. · Br J Nurs. · Pubmed #12170484 No free full text.

Abstract: The quality of life of people with Parkinson's disease (PD) and their carers is often made worse by impaired sleep. Sleep problems are common in PD and there are several causative factors in their aetiology including the ageing process, anti-Parkinson's disease medication, the disease process itself, and concomitant factors such as nocturia, anxiety and immobility. Non-pharmacological approaches are the most desirable method to treat sleep-related problems. The nurse can have an important role in assessing sleep, providing support, offering practical advice, and making appropriate referrals. This article will discuss the various sleep problems experienced in PD, the underlying aetiology, and the role of the nurse.

Veale D. · Department of Psychiatry and Behavioural Sciences, Royal Free and University College School of Medicine, University College, University of London, UK. · Behav Res Ther. · Pubmed #12002896 No free full text.

Abstract: Over-valued ideas are truly a neglected area of psychopathology with few experimental studies published. There is a different emphasis in the USA and Europe regarding their definition. For authors in the USA an over-valued idea has become shorthand for 'poor insight' in the middle of a continuum of obsessional doubts to delusional certainty. Compared to negative thoughts, obsessions and delusions, they are often more resistant to any treatment. A better understanding of over-valued ideas is required if advances are to be made in therapy and for the development of appropriate measures to evaluate the efficacy of novel treatments. A cognitive behavioural model of over-valued ideas is presented which draws upon the philosophical distinction between beliefs and values. It is argued that over-valued ideas are associated with idealised values, which have developed into such an over-riding importance, that they totally define the 'self' or identity of the individual. Idealised values are also characterised by the rigidity with which they are held. Such patients are unable to adapt to different circumstances and ignore the consequences of acting on their value. This analysis leads to a discussion of predictions that can be tested and various strategies that can be used in cognitive behaviour therapy.

Trimble MR. · Institute of Neurology, National Hospital for Neurology, London, UK. · Epilepsia. · Pubmed #11903479 No free full text.

Abstract: In this article, the use of benzodiazepines (BZDs) in epilepsy is reviewed. In particular, it concentrates on the use of oral BZDs, and, following a brief discussion as to their value in psychiatric disorders generally, their more specific use in epilepsy is then noted. The main oral drugs are the 1,4BZDs and 1,5-BZDs. The latter is represented only by clobazam (CLB), and the advantages of the 1,5-BZDs over the 1,4-BZDs are reviewed. It is concluded that CLB has a significant value in a number of situations. It is a first-line add-on therapy when standard medications have failed. It is useful in patients that have catamenial seizures, clusters of seizures, and also in the prevention of postictal syndromes. It is used in childhood epilepsy, and is also helpful in the management of febrile seizures.

Veale D. · Royal Free and University College Medical School, Priory Hospital, North London. · Practitioner. · Pubmed #11901781 No free full text.

This publication has no abstract.

Zagon A. · Dept Anatomy and Developmental Biology, Royal Free and University College Medical School, Rowland Hill Street, NW3 2PF, London, UK. · Trends Neurosci. · Pubmed #11672813 No free full text.

Abstract: Can sensations originating from the internal environment modulate attitude and behaviour? Can the feedback about the operation of the viscera provide a calming and relaxing influence? Information from the chest and abdomen is delivered continuously by the vagus nerve, the largest visceral sensory nerve in the body. Because various 'stress-related' diseases can be associated with impaired functions in sensory vagal fibres, a better understanding of how sensory vagal information is processed in the CNS might offer new strategies for the treatment and/or prevention of several disorders, including 'drug-resistant' forms of eating disorder, anxiety, chronic depression and epilepsy. A neuronal circuitry that has been suggested by experimental data to mediate sensory vagal inputs to those brain areas that are involved in the generation of 'stress-related' disorders is outlined.

Turnbull G, Bebbington P. · Royal Free and University College Medical School, University College London, Department of Psychiatry and Behavioural Sciences, Whittington Hospital, London, UK. · Soc Psychiatry Psychiatr Epidemiol. · Pubmed #11515701 No free full text.

Abstract: BACKGROUND: The authors hypothesise that anxiety is an integral part of the development of schizophrenia in a significant sub-group of cases. This paper reviews the evidence for an epidemiological link between anxiety and schizophrenia, emphasising those studies that imply a temporal sequence. METHOD: An augmented systematic search of electronic databases was conducted, and the methods and results of the studies identified were reviewed. RESULTS: Panic disorder was identified in around 20% of cases of schizophrenia in clinical studies (range 5-33 %). Other anxiety disorders were less often studied, but were also frequent. Epidemiological studies from the Epidemiological Catchment Area Program confirm the strong association between anxiety disorders and schizophrenia. Finally, cohort studies identify anxiety as an early antecedent of schizophrenia. CONCLUSION: There is a significant link between anxiety and schizophrenia. This may represent a psychological process integral to an appreciable number of cases of schizophrenia. Focused psychological studies are needed to determine whether this is so.

Brewin CR. · University College London, Subdepartment of Clinical Health Psychology, UK. · Behav Res Ther. · Pubmed #11280338 No free full text.

Abstract: Recent research in the areas of animal conditioning, the neural systems underlying emotion and memory, and the effect of fear on these systems is reviewed. This evidence points to an important distinction between hippocampally-dependent and non-hippocampally-dependent forms of memory that are differentially affected by extreme stress. The cognitive science perspective is related to a recent model of posttraumatic stress disorder, dual representation theory, that also posits separate memory systems underlying vivid reexperiencing versus ordinary autobiographical memories of trauma. This view is compared with other accounts in the literature of traumatic memory processes in PTSD, and the contrasting implications for therapy are discussed.

Deahl M. · St Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, The University of London, UK. · Aust N Z J Psychiatry. · Pubmed #11127623 No free full text.

Abstract: OBJECTIVE: The efficacy of psychological debriefing following potentially traumatising events has become extremely controversial. This review aims to identify the issues underlying this controversy and their theoretical, social and political ramifications which are important in other areas of psychiatry and the social sciences. METHOD: The historical background to the debriefing debate and the (largely negative) results of recent randomised controlled trials (RCTs) are reviewed. RESULTS: Despite the negative results of recent RCTs, psychological debriefing remains the most widely used structured intervention following potentially traumatising events, designed to reduce the incidence of long-term psychiatric morbidity. The clinical relevance these trials and their applicability in vivo is questioned. There are implicit difficulties in conducting rigorous randomised controlled trials of group debriefing, and such trials may be unachievable. CONCLUSIONS: Demonstrating the efficacy of debriefing or other preventive interventions presents major challenges to investigators and it is unlikely the controversy will be resolved in the near future.

Turner S. · Traumatic Stress Clinic, Camden & Islington Community Trust & University College London. · Practitioner. · Pubmed #10715856 No free full text.

This publication has no abstract.