Imperial College London

Emeritus ProfessorPeterTyrer

Faculty of MedicineDepartment of Brain Sciences

Emeritus Professor in Community Psychiatry - Clinical
 
 
 
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Contact

 

+44 (0)20 3313 4161p.tyrer

 
 
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Location

 

Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Publication Type
Year
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640 results found

Mittal TK, Evans E, Pottle A, Lambropoulos C, Morris C, Surawy C, Chuter A, Cox F, de Silva R, Mason M, Banya W, Thakrar D, Tyrer Pet al., 2022, Mindfulness-based intervention in patients with persistent pain in chest (MIPIC) of non-cardiac cause: a feasibility randomised control study, OPEN HEART, Vol: 9, ISSN: 2053-3624

Journal article

Yang M, Tyrer P, Tyrer H, 2022, The recording of personality strengths: An analysis of the impact of positive personality features on the long‐term outcome of common mental disorders, Personality and Mental Health, Vol: 16, Pages: 120-129, ISSN: 1932-8621

Journal article

Tyrer P, Tyrer H, Yang M, 2022, Relationships between treatments received in the Nottingham Study of Neurotic Disorder over 30 years and personality status, Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 16, Pages: 99-110, ISSN: 1932-8621

We compared the drug treatments and health service contacts of anxious and depressed patients with and without personality disturbance in a cohort of 200 patients over 30 years. Details of all contacts made with health professionals at 5, 12 and 30 years were recorded. Multilevel models based on follow-up data at all time points were used. Over 30 years, patients with dependent and anankastic personality disturbance and cothymia ( the general neurotic syndrome) were 2.27 times more likely to receive SSRI and new antidepressants (95%CI: 1.22-4.24), and were 1.6 weeks (95% CI: 1.2-2.3) longer on the drug than those without the syndrome. Similar results with SSRI’s and new antidepressants in patients with personality disorder fell short of significance after adjusting for age, gender and DSM status. Most patients had a DSM diagnosis at follow-up points, and these had increased psychological treatment, psychiatric admissions, multiple drugs, SSRI’s and new antidepressants. At later follow-up most drug treatments decreased apart from psychological treatment, SSRI’s and new antidepressants. Over 30 years, those with personality disorder had longer drug treatments than others. It is concluded that anxiety and depressive disorders, whether or not associated with personality disturbance, receive many treatments without resolution of symptoms.

Journal article

Tyrer P, 2022, Debate: Young people with personality disorder should be recognised and appropriately managed, Child and Adolescent Mental Health, Vol: 27, Pages: 199-200, ISSN: 1475-357X

Journal article

Tyrer P, Tyrer H, Yang M, 2022, The influence of personality disorder in predicting suicidal behaviour in common mental disorders: A 30‐year study, Personality and Mental Health, Vol: 16, Pages: 111-119, ISSN: 1932-8621

Journal article

Jha M, Barrett B, Brewin C, Bowker G, Harwood N, Jalil I, Crawford M, Phull J, Allen K, Duggan C, Yang M, Tyrer Pet al., 2022, Matching ICD-11 personality status to clinical management in a community team-The Boston (UK) Personality Project: Study protocol, Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 16, ISSN: 1932-8621

Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will be asked to agree to have their personality status assessed using scales recording the new ICD-11 classification, together with clinical ratings, social function and satisfaction. A control group of 100 patients from an adjacent service of similar demographics (Spalding) will also have similar ratings but no personality assessments. Changes in clinical status, social function and service satisfaction will be made after 6 and 12 months in both groups. The patients in the Boston group will be offered matched interventions using a stepped care approach for both the severity of disorder and its domain structure. These interventions will include shorter versions of existing psychological treatments, environmental therapies including nidotherapy, adaptive and acceptance models, drug reduction and social prescribing. Full costs of psychiatric care will be measured in both groups. The main hypothesis is that greater awareness of personality function will lead to better clinical outcomes and satisfaction.

Journal article

Duggan C, Tyrer P, 2022, Specialist teams as constituted are unsatisfactory for treating people with personality disorders., BJPsych Bull, Vol: 46, Pages: 100-102, ISSN: 2056-4694

It is now becoming standard practice in most advanced economies to provide specialist services for those with personality disorder. Such services, almost exclusively, provide complex well-structured psychological interventions lasting many months for a small number of those with borderline personality disorder pathology. The evidence suggests that these treatments are effective but they can only be provided for a small number of people. However, in every area the numbers of patients with significant personality disorder far exceeds those that are treated, and most of these have other personality disorders. It is argued that the current service system is not working efficiently and should be replaced by one that provides resources and expertise within community teams with some external advice from specialists but no transfer of responsibility to a designated team.

Journal article

Yang M, Tyrer H, Johnson T, Tyrer Pet al., 2022, Personality change in the Nottingham Study of Neurotic Disorder: 30-Year cohort study, Australian & New Zealand Journal of Psychiatry, Vol: 56, Pages: 260-269, ISSN: 0004-8674

Background:Persistence is said to be a feature of personality disorder, but there are few long-term prospective studies of the condition. A total of 200 patients with anxiety and depressive disorders involved in a randomised controlled trial initiated in 1983 had full personality status assessed at baseline. We repeated assessment of personality status on three subsequent occasions over 30 years.Methods:Personality status was recorded using methods derived from the Personality Assessment Schedule, which has algorithms for allocating Diagnostic and Statistical Manual of Mental Disorders (DSM) and the 11th International Classification of Diseases (ICD-11) categories. The category and severity of personality diagnosis were recorded at baseline in the randomised patients with DSM-III anxiety and depressive diagnoses. The same methods of assessing personality status was repeated at 2, 12 and 30 years after baseline.Results:Using the ICD-11 system, 47% of patients, mainly those with no personality disturbance at baseline, retained their personality status; of the others 16.8% improved and 20.4% worsened to more severe disorder. In DSM-III diagnosed patients, those diagnosed as Cluster A and Cluster C increased in frequency (from 14% to 40%, p < 0.001, and 21.5% to 36%, p < 0.001, respectively) over follow-up, while those with Cluster B showed little change in frequency (22% to 18%, p = 0.197).Conclusion:In this population of patients with common mental disorders, personality status showed many changes over time, inconsistent with the view that personality disorder is a persistent or stable condition. The increase in diagnoses within the Cluster A and C groups suggests personality disorder generally increases in frequency as people age.

Journal article

Tyrer P, Mulder R, Newton-Howes G, Duggan Cet al., 2022, Galenic syndromes: combinations of mental state and personality disorders too closely entwined to be separated, The British Journal of Psychiatry, Vol: 220, Pages: 1-2, ISSN: 0007-1250

Many mental disorders are linked to personality, but this is rarely recognised in clinical practice. It is suggested here that when the links are very close, the two can be joined. Galenic syndromes are so named because Galen was the first physician to recognise the links between personality and disease.

Journal article

Tyrer PJ, Mulder R, 2022, Personality Disorder From Evidence to Understanding, ISBN: 9781108948371

We are frequently asked to remember George Santayana&#39;s comment, made by many others, that &quot;those who cannot remember the past are condemned to repeat it&quot; (Santayana, 1905). But this is hardly relevant for a textbook on The Wheel.

Book

Tyrer P, Tyrer H, Yang M, Crawford Met al., 2021, Is social function a good proxy measure of personality disorder?, Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 15, Pages: 261-272, ISSN: 1932-8621

Background:Personality assessment is often difficult and proxy measures may be useful. Aims: To examine the assessment of social functioning in relationship to personality disorder. Method:Secondary analysis of data from three clinical studies; following deliberate self-harm (n=460), cognitive behaviour therapy for health anxiety (n=444), and a 30-year follow up of 200 anxious/depressed patients. Social function and personality were assessed using the Social Functioning Questionnaire (SFQ) and the Personality Assessment Schedule. A five item short version of the SFQ, the Short Social Functioning Questionnaire (SSFQ) was also developedResults:The SFQ score in the first two studies (area under curve (AUC) 0.64 and 0.65) partly predicted personality status; in the third study this achieved close agreement (AUC SFQ 0.85 (95% CI 0.8-0.9; AUC SSFQ 0.84 (95% CI 0.78-0.89). In all studies social function deteriorated linearly with increasing personality pathology. Cut-off points of 4 on the SSFQ and 7 on the SFQ had high sensitivity (SSFQ 82-90%; SFQ 82-83%) and acceptable specificity (SSFQ 66-75%; SFQ 69-75%) in identifying personality disorder in the third study. Conclusions: Social functioning recorded in either a 5-item or 8-item self-rating is a useful proxy measure of personality disturbance, and may be the core of disorder.

Journal article

Tyrer P, 2021, Remembered jewels: The role of diagnosis in psychiatry by Robert Kendell, BJPsych Advances, Pages: 1-2, ISSN: 2056-4678

This is the first of a series of articles on key works in psychiatry that should not be forgotten. Many were published before our current generation of psychiatrists had easy access to them, but they need recall. It is my strong belief that originality of thought only occurs in youth. Robert Kendell's book The Role of Diagnosis in Psychiatry (1975) illustrates this perfectly.

Journal article

Tyrer P, Wang D, Crawford M, Dupont S, Cooper S, Nourmand S, Lazarevic V, Philip A, Tyrer Het al., 2021, Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over eight years: randomised controlled trial (vol 51, pg 1714, 2021), PSYCHOLOGICAL MEDICINE, Vol: 51, Pages: 1723-1723, ISSN: 0033-2917

Journal article

Tyrer P, Wang D, Crawford M, Dupont S, Cooper S, Nourmand S, Lazarevic V, Philip A, Tyrer Het al., 2021, Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial., Psychological Medicine, Vol: 51, Pages: 1714-1722, ISSN: 0033-2917

BACKGROUND: Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals. METHODS: We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822. RESULTS: There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25-3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI -0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42-2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function. CONCLUSIONS: CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.

Journal article

Halder N, Tyrer P, Casey P, 2021, Peer reviewing made easier: your questions answered, BJPsych Advances, Vol: 27, Pages: 255-262, ISSN: 2056-4678

<jats:title>SUMMARY</jats:title><jats:p>Peer reviewing is a hugely important part of the scientific process that ensures published articles are of sufficient quality to deserve dissemination to the wider scientific community. Building on a previous article published in this journal, this article addresses topics that potential or practising peer reviewers may find useful. These include what peer reviewing is, why do peer reviews, how to become a reviewer, what to write in a review and where to find more information. It includes a template for writing a review, and lists various websites and guidelines that can help ease the entire process depending on what type of article is being reviewed. Peer reviewing can be enormously rewarding and help clinicians diversify their scope of work while also benefiting the scientific community by contributing to the quality control of published work.</jats:p>

Journal article

Tyrer P, Tyrer H, Johnson T, Yang Met al., 2021, Thirty year outcome of anxiety and depressive disorders and personality status: comprehensive evaluation of mixed symptoms and the general neurotic syndrome in the follow-up of a randomised controlled trial, Psychological Medicine, Pages: 1-10, ISSN: 0033-2917

BackgroundCohort studies of the long-term outcome of anxiety, depression and personality status rarely join together.MethodsTwo hundred and ten patients recruited with anxiety and depression to a randomised controlled trial between 1983 and 1987 (Nottingham Study of Neurotic Disorder) were followed up over 30 years. At trial entry personality status was assessed, together with the general neurotic syndrome, a combined diagnosis of mixed anxiety–depression (cothymia) linked to neurotic personality traits. Personality assessment used a procedure allowing conversion of data to the ICD-11 severity classification of personality disorder. After the original trial, seven further assessments were made. Observer and self-ratings of psychopathology and global outcome were also made. The primary outcome at 30 years was the proportion of those with no Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis.Data were analysed using multilevel repeated measures models that adjusted for age and gender. Missing data were assumed to be missing at random, and the models allowed all subjects to be included in the analysis with missing data automatically handled in the model estimation.ResultsAt 30 years, 69% of those with a baseline diagnosis of panic disorder had no DSM diagnosis compared to 37–47% of those with generalised anxiety disorder, dysthymia or mixed symptoms (cothymia) (p = 0.027). Apart from those with no personality dysfunction at entry all patients had worse outcomes after 30 years with regard to total psychopathology, anxiety and depression, social function and global outcome.ConclusionsThe long-term outcome of disorders formerly called ‘neurotic’ is poor with the exception of panic disorder. Personality dysfunction accentuates poor recovery.

Journal article

Tyrer P, Tyrer H, Yang M, 2021, Premature mortality of people with personality disorder in the Nottingham Study of Neurotic Disorder, Personality and Mental Health, Vol: 15, Pages: 32-39, ISSN: 1932-8621

Journal article

Tyrer P, Wang D, Tyrer H, Crawford M, Loebenberg G, Cooper S, Barrett B, Sanatinia Ret al., 2021, Influence of apparently negative personality characteristics on the long-term outcome of health anxiety: Secondary analysis of a randomized controlled trial., Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 15, Pages: 72-86, ISSN: 1932-8621

BACKGROUND: It is known that personality has an influence on the outcome of mental state disorders, but detailed studies on its long-term impact are few. We examined the influence of personality status on the 8-year outcome of health anxiety and its relationship to the effects of cognitive behaviour therapy in a randomized controlled trial. AIMS: This study aims to examine both the usefulness of the diagnosis of personality disorder and an additional measure of pathological dependence, in predicting the outcome of medical patients with health anxiety treated with cognitive behaviour therapy. Because the influence of personality is often shown in the long term, these assessments covered the period of 8 years after randomization. An additional aim is to examine the costs of different levels of personality dysfunction in each treatment group. METHOD: Personality dysfunction, using both ICD-10 and ICD-11 classifications of severity, was assessed at baseline by interview in a randomized controlled trial. Patients were also assessed for pathological dependence using the Dependent Personality Questionnaire, also scored along a severity dimension. Four hundred forty-four patients from medical clinics with pathological health anxiety were treated with a modified form of cognitive behaviour therapy for health anxiety (CBT-HA) or standard care. Total costs over follow-up were calculated from hospital data and compared by personality group. RESULTS: At baseline, 381 (86%) had some personality dysfunction, mainly at the lower level of personality difficulty (not formally a disorder). One hundred eighty four (41%) had a personality disorder. A similar proportion was found with regard to dependent personality. Using the ICD-10 classification, 153 patients (34.6%) had a personality disorder, with 83 (54.2%) having anxious or dependent personality disorder, 20 (13.1%) having an anankastic disorder, but also with 66 (43.1%) having mixed disorder. During initial treatment, those

Journal article

Tyrer P, Fox C, Gardiner C, Mulder R, Tyrer Het al., 2021, Initial assessment of patients with putative functional disorders in medical settings, Clinical Medicine, Vol: 21, Pages: 8-12, ISSN: 1470-2118

Patients presenting with symptoms suggestive of functionaldisorder are very frequent in practice. While it is alwaysnecessary to exclude treatable organic pathology, there areimportant clues in the presentation that can help the clinician.In particular, it is important to identify pathological healthanxiety early in assessment, as failure to do so may leadto unnecessary investigations and the dangerous path ofreinforcing reassurance. Because full assessment of functionalsymptoms takes time, it is suggested that a clinical supportnurse with some training in psychological management shouldbe available to guide the management of the patients withthese disorders. Such support nurses, based in the clinic, offera seamless way of providing care that is not achieved byexternal referral to psychologists or equivalent staff.

Journal article

Tyrer P, 2020, COVID‐19 health anxiety, World Psychiatry, Vol: 19, Pages: 307-308, ISSN: 1723-8617

Journal article

Tyrer P, Howard R, 2020, Late-onset personality disorder: a condition still steeped in ignorance, BJPsych Advances, Vol: 26, Pages: 219-220, ISSN: 2056-4678

Personality disorder is likely to be common in late life, but our ignorance is such that, at present, we can only speculate about its frequency and importance. The only firm evidence we have is that antisocial personality features tend to be attenuated in older age and obsessional and detached features accentuated. Differentiating personality change following organic disease from personality disorder requires more attention as it is important for good clinical management.

Journal article

Tyrer P, 2020, Why health anxiety needs to be recognised in hospital practice, Clinical Medicine, Vol: 20, Pages: 339-342, ISSN: 1470-2118

Journal article

Tyrer P, 2020, Why we need to take personality disorder out of the doghouse, The British Journal of Psychiatry, Vol: 216, Pages: 65-66, ISSN: 0007-1250

The diagnosis of personality disorder is sometimes tolerated but often reviled as a label to attach to people we do not like. This is hardly surprising when we consider that problems in interpersonal relationships constitute the main feature of the disorder. But we cannot escape the fact that personality problems are extremely common and rejection on grounds of perceived undesirability is doltish. Both the DSM-5 (2013) alternative model and new ICD-11 classification of personality may help understanding as they are more in tune with science. Most of the previous classifications have failed to help practitioners or patients.

Journal article

Tyrer P, 2020, Threading a pathway through the forest of mood and personality disorders, BJPsych Advances, Vol: 26, Pages: 58-60, ISSN: 2056-4678

<jats:title>SUMMARY</jats:title><jats:p>The classification of mood and personality disorders has become unnecessarily complicated. It has become bogged down by well-meaning but unhelpful subcategories that puzzle the will of clinicians to make useful judgements. The answer is to think of bipolar, depressive and personality disorders as each constituting a spectrum of severity and not to be too preoccupied with individual labels. It would also be useful to avoid the diagnostic chimera of borderline personality disorder, a condition that defies proper classification.</jats:p>

Journal article

Tyrer P, Cooper S, Tyrer H, Wang D, Bassett Pet al., 2019, Increase in the prevalence of health anxiety in medical clinics: Possible cyberchondria, International Journal of Social Psychiatry, Vol: 65, Pages: 566-569, ISSN: 0020-7640

Background:Health anxiety may be an increasing problem because of the focus on monitoring health and increasing use of the Internet for self-diagnosis (cyberchondria). There is very little information about changes in the prevalence of health anxiety.Aim:We compared the prevalence of health anxiety in four medical clinics in one hospital over a 4-year period using the Health Anxiety Inventory (HAI) as a diagnostic marker.Method:Patients attending cardiology, endocrine, gastroenterology and respiratory medicine clinics at King’s Mill Hospital, North Nottinghamshire, completed the HAI while waiting for their appointments. There were eight research assistants involved in collecting data, two in the 2006–2008 period and six in the 2008–2010 period. As a consequence, more data were collected on the second occasion.Results:There was an increase in the prevalence of health anxiety from 14.9% in 2006–2008 (54 positive of 362 assessed) to 19.9% (1,132 positive out of 5,704 assessed) in 2008–2010. This increase was primarily noted in gastroenterology clinics (increase of 10%) and not shown in endocrine ones.Conclusion:The prevalence of health anxiety is increasing in those who attend medical out-patient clinics. Reasons are given that this may be a possible result of cyberchondria, as the excessive use of the Internet to interpret troubling symptoms is growing. Further studies are needed in other populations, but there is reason to be concerned at this trend as it is likely to increase the number of medical consultations unnecessarily.

Journal article

Tyrer P, 2019, Dissociative identity disorder needs re-examination, BJPsych Advances, Vol: 25, Pages: 294-295, ISSN: 2056-4678

Dissociative identity disorder (DID) is as real as any other psychiatric disorder but has been over-diagnosed by gullible clinicians, especially in forensic settings. Its classification has been poor, but the new ICD-11 classification, especially of partial DID, should help research and practice.

Journal article

Mulder R, Zarifeh J, Boden J, Lacey C, Tyrer P, Tyrer H, Than M, Troughton Ret al., 2019, An RCT of brief cognitive therapy versus treatment as usual in patients with non-cardiac chest pain., Int J Cardiol, Vol: 289, Pages: 6-11

BACKGROUND: Non-cardiac chest pain (NCCP) is a common reason for presenting to an emergency department (ED). Many patients re-present with similar symptoms despite reassurance. OBJECTIVE: To investigate the clinical value of a brief cognitive behavioural treatment (CBT) in reducing re-presentations of patients who present with NCCP. METHOD: A randomised controlled trial (RCT) comparing three or four sessions of NCCP directed CBT with treatment as usual (TAU). The primary outcome measure was reducing health service use measured as re-presentations to the ED and hospitalisations for NCCP over 12 months of follow-up. Secondary outcomes were chest pain, health anxiety, depression, anxiety, quality of life and social functioning. RESULTS: 214 patients received CBT and 210 TAU. There was no difference in ED visits or hospitalisation at three months or 12 months follow-up. Those with prior ED presentations for NCCP were significantly less likely to present with NCCP at three months follow-up but not at 12 months. Health anxiety was less at three months in those who received CBT but this effect was not present at 12 months. No other differences in secondary outcome measures were present. CONCLUSIONS: A brief CBT intervention for NCCP failed to reduce representations or improve psychological health over 12 months. We do not recommend such an intervention to unselected patients with NCCP. Patients presenting with prior episodes of NCCP obtain benefit for a three month period. Working with those patients to sustain their improvement might be worthwhile.

Journal article

Tyrer P, 2019, Nidotherapy: a cost‐effective systematic environmental intervention, World Psychiatry, Vol: 18, Pages: 144-145, ISSN: 1723-8617

Journal article

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