Publications
656 results found
Campbell M, Fitzpatrick R, Haines A, et al., 2000, Framework for design and evaluation of complex interventions to improve health, BRITISH MEDICAL JOURNAL, Vol: 321, Pages: 694-696, ISSN: 0959-535X
- Author Web Link
- Cite
- Citations: 2184
Tyrer PJ, 2000, Personality Disorders, 2Ed Diagnosis, Management and Course, Publisher: CRC Press
Since the first edition of this book a great deal has happened in the field of personality disorders.
Van Horn E, Manley C, Leddy D, et al., 2000, Problems in developing an instrument for the rapid assessment of personality status., Eur Psychiatry, Vol: 15 Suppl 1, Pages: 29-33, ISSN: 0924-9338
PURPOSE: To assess the validity of a quick assessment instrument (10 minutes) for assessing personality status, the Rapid Personality Assessment Schedule (PAS-R). SUBJECTS AND METHODS: The PAS-R was evaluated in psychotic patients recruited in one of the centres involved in a multicentre randomised controlled trial of intensive vs standard case management (the UK700 case management trial). Patients were assessed using both a full version of the PAS (PAS-I - ICD version) and the PAS-R. The weighted kappa statistic was used to gauge the (criterion-related) validity of the PAS-R using the PAS-I as the gold standard. Both measure code personality status using a four-point rating of severity in addition to recording individual categories of personality disorder. RESULTS: One hundred fifty-five (77%) of 201 patients recruited were assessed with both instruments. The weighted kappa statistic was 0.31, suggesting only moderate agreement between the PAS-I and PAS-R instruments under the four-point rating format, and 0.39 for the dichotomous personality disorder/no disorder separation. The sensitivity (64%) and specificity (82%) of the PAS-R in predicting PAS-I personality disorder were as satisfactory as for other screening instruments but still somewhat disappointing, and the PAS-R had an overall diagnostic accuracy of 78%. CONCLUSION: The PAS-R is a quick and rough method of detecting personality abnormality but is not a substitute for a fuller assessment.
Tyrer P, Manley C, Van Horn E, et al., 2000, Personality abnormality in severe mental illness and its influence on outcome of intensive and standard case management: a randomised controlled trial., Eur Psychiatry, Vol: 15 Suppl 1, Pages: 7-10, ISSN: 0924-9338
One hundred fifty-five (77%) of 201 participants recruited in a trial of intensive vs standard case management of patients with recurrent psychotic illness had their personality status measured before treatment and were followed up for two years. The primary outcome was the total number of days spent in psychiatric hospitalisation in the two years following randomisation. Thirty-three (21%) of the patients had a personality disorder and their duration of hospital stay (105 days) was greater than in those without personality disorder (56 days). There was weak evidence that intensive case management more effective in reducing the duration of care in those with personality disorder than in those without personality disorder.
Shipley K, Hilborn B, Hansell A, et al., 2000, Patient satisfaction: a valid index of quality of care in a psychiatric service, Acta Psychiatrica Scandinavica, Vol: 101, Pages: 330-333, ISSN: 0001-690X
<jats:p>Shipley K, Hilborn B, Hansell A, Tyrer J, Tyrer P. Patient satisfaction: a valid index of quality of care in a psychiatric service.</jats:p><jats:p>Acta Psychiatr Scand 2000: 101: 330–333. © Munksgaard 2000.</jats:p><jats:p>Objective: To assess patients, clinicians' and referrers' satisfaction with care in newly referred psychiatric patients and to compare these with standard quality indicators such as waiting times used by the service.</jats:p><jats:p>Method: A random sample of all new adult psychiatric patients presenting over a 4–month period in 2 successive years to an inner‐city psychiatric service was assessed.</jats:p><jats:p>Results: One hundred and thirteen (68%) of 167 randomly selected patients were seen. Independent evidence of service performance showed that patient satisfaction, but not clinician or referrer satisfaction, was a more accurate indicator of quality of care than standard indicators.</jats:p><jats:p>Conclusion: Simple ratings of patient satisfaction alone may be useful indicators of quality of psychiatric care.</jats:p>
Shipley K, Hilborn B, Hansell A, et al., 2000, Patient satisfaction: a valid index of quality of care in a psychiatric service, ACTA PSYCHIATRICA SCANDINAVICA, Vol: 101, Pages: 330-333, ISSN: 0001-690X
- Author Web Link
- Cite
- Citations: 83
Lamont A, Ukoumunne OC, Tyrer P, et al., 2000, The geographical mobility of severely mentally ill residents in London, SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY, Vol: 35, Pages: 164-169, ISSN: 0933-7954
- Author Web Link
- Cite
- Citations: 34
Seivewright N, Tyrer P, Ferguson B, et al., 2000, Longitudinal study of the influence of life events and personality status on diagnostic change in three neurotic disorders, Depression and Anxiety, Vol: 11, Pages: 105-113, ISSN: 1091-4269
Seivewright N, Tyrer P, Ferguson B, et al., 2000, Longitudinal study of the influence of life events and personality status on diagnostic change in three neurotic disorders, DEPRESSION AND ANXIETY, Vol: 11, Pages: 105-113, ISSN: 1091-4269
- Author Web Link
- Cite
- Citations: 22
Tyrer P, 1999, Borderline personality disorder: a motley diagnosis in need of reform, The Lancet, Vol: 354, Pages: 2095-2096, ISSN: 0140-6736
Tyrer P, 1999, The national service framework: a scaffold for mental health, BMJ, Vol: 319, Pages: 1017-1018, ISSN: 0959-8138
Tyrer P, Hassiotis A, Ukoumunne O, et al., 1999, Intensive case management for psychotic patients with borderline intelligence, LANCET, Vol: 354, Pages: 999-1000, ISSN: 0140-6736
Tyrer P, 1999, Anxiety: A Multidisciplinary Review, Publisher: World Scientific, ISBN: 9781783262496
This book by a clinician and research worker who has been involved in the treatment of anxiety for over 30 years aims to combine the important factors of anxiety into an integrated framework which allows the biological, psychological and ...
Hassiotis A, Ukoumunne O, Tyrer P, et al., 1999, Prevalence and characteristics of patients with severe mental illness and borderline intellectual functioning - Report from the UK700 randomised controlled trial of case management, BRITISH JOURNAL OF PSYCHIATRY, Vol: 175, Pages: 135-140, ISSN: 0007-1250
- Author Web Link
- Cite
- Citations: 35
Burns T, Creed F, Fahy T, et al., 1999, Intensive versus standard case management for severe psychotic illness: a randomised trial, The Lancet, Vol: 353, Pages: 2185-2189, ISSN: 0140-6736
Tyrer P, Seivewright N, Seivewright H, 1999, Long-term outcome of hypochondriacal personality disorder, Journal of Psychosomatic Research, Vol: 46, Pages: 177-185, ISSN: 0022-3999
Weaver T, Renton A, Stimson G, et al., 1999, Severe mental illness and substance misuse - Research is needed to underpin policy and services for patients with comorbidity, BMJ-BRITISH MEDICAL JOURNAL, Vol: 318, Pages: 137-138, ISSN: 1756-1833
- Author Web Link
- Cite
- Citations: 27
Evans K, Tyrer P, Catalan J, et al., 1999, Manual-assisted cognitive-behaviour therapy (MACT): a randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm, PSYCHOLOGICAL MEDICINE, Vol: 29, Pages: 19-25, ISSN: 0033-2917
- Author Web Link
- Cite
- Citations: 166
MacLeod AK, Tata P, Evans K, et al., 1998, Recovery of positive future thinking within a high-risk parasuicide group: Results from a pilot randomized controlled trial, BRITISH JOURNAL OF CLINICAL PSYCHOLOGY, Vol: 37, Pages: 371-379, ISSN: 0144-6657
- Author Web Link
- Cite
- Citations: 55
SEIVEWRIGHT H, TYRER P, JOHNSON T, 1998, Prediction of outcome in neurotic disorder: a 5-year prospective study, Psychological Medicine, Vol: 28, Pages: 1149-1157, ISSN: 0033-2917
<jats:p><jats:bold>Background.</jats:bold> There have been no previous studies of the outcome of different neurotic disorders in which a prospective group with original randomization to treatment have been followed up over a long period. Such studies are important in identifying the factors associated with good and poor outcome.</jats:p><jats:p><jats:bold>Methods.</jats:bold> A 5-year follow-up assessment was made of a cohort of 210 psychiatric out-patients seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74) or dysthymic disorder (65) and randomized to drug treatment, cognitive and behaviour therapy, and self-help. A total of 182 of the patients (87%) were assessed after 5 years by examination of hospital and GP records using a standardized procedure and outcome determined with a four-point outcome scale.</jats:p><jats:p><jats:bold>Results.</jats:bold> One hundred and seven (60%) of the patients had a favourable outcome but the remainder continued to be handicapped either intermittently or continuously throughout the 5-year period. Analysis of the value of initial data in predicting outcome using polychotomous step-wise logistic regression revealed that five variables were significant predictors of poor prognosis: older age; recurrent episodes; the presence of personality disorder at entry; general neurotic syndrome at entry; and symptom severity after 10 weeks. The initial DSM diagnosis and original treatment given, together with ten other variables, were of no predictive value.</jats:p><jats:p><jats:bold>Conclusions.</jats:bold> The long-term outcome of neurotic disorder is better predicted by age, personality and recency of onset than by other clinical variables with the exception of initial response to treatment.</jats:p>
Tyrer P, Evans K, Gandhi N, et al., 1998, Randomised controlled trial of two models of care for discharged psychiatric patients, BRITISH MEDICAL JOURNAL, Vol: 316, Pages: 106-109, ISSN: 0959-8138
- Author Web Link
- Cite
- Citations: 62
, 1996, Establishing the severity of personality disorder, American Journal of Psychiatry, Vol: 153, Pages: 1593-1597, ISSN: 0002-953X
Weaver T, Renton A, Tyrer P, et al., 1996, Combining qualitative studies with randomised controlled trials is often useful, BRITISH MEDICAL JOURNAL, Vol: 313, Pages: 629-629, ISSN: 0959-8138
- Author Web Link
- Cite
- Citations: 14
Puri BK, Hall AD, Reefat R, et al., 1996, General practitioners' views of an open referral system to a community mental health service, ACTA PSYCHIATRICA SCANDINAVICA, Vol: 94, Pages: 133-136, ISSN: 0001-690X
- Author Web Link
- Cite
- Citations: 7
Kingdon D, Tyrer P, Seivewright N, et al., 1996, The Nottingham Study of Neurotic Disorder: Influence of Cognitive Therapists on Outcome, British Journal of Psychiatry, Vol: 169, Pages: 93-97, ISSN: 0007-1250
<jats:sec><jats:title>Background</jats:title><jats:p>In previously published papers from the Nottingham Study of Neurotic Disorder a short treatment package of cognitive–behaviour therapy was no more effective than placebo drug treatment after 10 weeks' assessment in a cohort of 210 patients with neurotic disorders. This paper examines the outcome over two years of the patients treated by cognitive–behaviour therapy separated into two therapist groups, those who were competent in administering treatment and those of uncertain competence.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>The therapists (mainly community psychiatric nurses) of 70 patients with an original DSM–III diagnosis of either dysthymic, panic or generalised anxiety disorder were separated into two groups on the basis of their perceived competence by their supervisor (DK). Ratings of psychopathology were made at regular intervals over two years by assessors blind to knowledge of treatment or therapist.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The patients treated by competent therapists (<jats:italic>n</jats:italic>=30) generally showed greater improvement than those allocated to therapists of uncertain competence (<jats:italic>n</jats:italic>=40), mainly with respect to depressive symptoms, and the difference persisted over two years, long after the cognitive–behaviour therapy had been completed.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Cognitive–behaviour therapy given by competent therapists over a 10 week period is of lasting benefit in neurotic disorder.</jats:p></jats:sec>
Tyrer P, Ferguson B, Hallström C, et al., 1996, A Controlled Trial of Dothiepin and Placebo in Treating Benzodiazepine Withdrawal Symptoms, British Journal of Psychiatry, Vol: 168, Pages: 457-461, ISSN: 0007-1250
<jats:sec><jats:title>Background</jats:title><jats:p>The possibility that treatment with tricyclic antidepressants, in the form of dothiepin, might attenuate benzodiazepine withdrawal symptoms was investigated in a double-blind trial.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Eighty-seven non-depressed psychiatric out-patients with putative normal dose benzodiazepine dependence had their benzodiazepines reduced in stepwise amounts of 20% of the original dose for eight weeks. The patients were randomised to receive dothiepin (with dosage increasing to 150 mg/day) or placebo as an aid to withdrawal before benzodiazepine reduction and these drugs were taken for four further weeks before being stopped.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Fewer patients entered and completed the study than expected and a Type II error was possible in the results. Although there was some evidence of withdrawal symptoms being less marked in those patients allocated to dothiepin this was independent of any antidepressant effect as depression scores were lower in the placebo group in the early phase of withdrawal (<jats:italic>P</jats:italic><0.01). Of those completing the study, greater satisfaction (<jats:italic>P</jats:italic>=0.03) was recorded by those who had received dothiepin; no other differences reached statistical significance.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Dothiepin (and by implication other tricyclic antidepressants) might have some value in reducing benzodiazepine withdrawal symptoms but does not aid drug withdrawal.</jats:p></jats:sec>
Harrison-Read PE, Tyrer P, Lawson C, et al., 1996, Flumazenil-precipitated panic and dysphoria in patients dependent on benzodiazepines: a possible aid to abstinence, Journal of Psychopharmacology, Vol: 10, Pages: 89-97, ISSN: 0269-8811
<jats:p> Ten long-term users of benzodiazepines (average daily dose, 20 mg of diazepam or equivalent) who had experienced problems in withdrawing from the drugs were given an i.v. challenge with either the benzodiazepine antagonist flumazenil (1 mg injected over 30 s) or placebo (vehicle solution) in a randomized double-blind design. There were no 'pseudo withdrawal' responses to either single-blind or double-blind placebo injections, whereas flumazenil produced dramatic panic reactions in all four subjects tested, followed by characteristic benzodiazepine withdrawal symptoms. There were also small but significant rises in pulse rate and blood pressure, but no change in serum cortisol. Flumazenil-induced panic could not be entirely accounted for by a past or present diagnosis of panic disorder, and did not seem to be related to previous withdrawal problems, present benzodiazepine dosage, or to the severity of withdrawal symptoms precipitated by flumazenil in the same challenge test. Attempts to reduce benzodiazepine intake over the next 3 weeks tended to be more successful in the flumazenil group. The results are discussed with reference to possible changes in the GABA-benzodiazepine system in long-term benzodiazepine users. </jats:p>
Tyrer P, Morgan J, Van Horn E, et al., 1995, A randomised controlled study of close monitoring of vulnerable psychiatric patients., Lancet, Vol: 345, Pages: 756-759, ISSN: 0140-6736
The care programme approach was introduced in mental health services in the UK in 1991. It was intended to improve the quality of care and prevent patients losing contact with care services and, by implication, to reduce psychiatric admissions. We did a study to find out if the approach worked. 400 patients from a London inner-city area who had been identified as psychiatrically vulnerable and included on a case register of patients with special needs were randomised into two groups of 200 each. One group received close supervision by nominated key-workers (as recommended in the care programme approach of the UK Department of Health), and the other received standard follow-up from psychiatric and social services. Outcome was recorded after eighteen months. Data on 393 patients was available for analysis. Of 197 patients allocated to standard care, 64 (32.5%) were lost to follow-up compared with 40 (20.4%) of 196 patients receiving close supervision (p = < 0.005). However, patients under close supervision had significantly more admissions (30% vs 18%, chi 2 = 7.61, p < 0.01) and spent 68% more days in hospital than the standard group. The findings of greater hospital-bed use, which differ from those of studies with community-based psychiatric teams, suggest that close supervision by a single key worker, as recommended in the care programme approach, will lead to greater success in maintaining contact with vulnerable patients, but is likely to lead to more psychiatric admissions.
Tyrer P, Merson S, Onyett S, et al., 1994, The effect of personality disorder on clinical outcome, social networks and adjustment: a controlled clinical trial of psychiatric emergencies, Psychological Medicine, Vol: 24, Pages: 731-740, ISSN: 0033-2917
<jats:title>Synopsis</jats:title><jats:p>One hundred psychiatric emergencies presenting to an inner London teaching hospital had formal assessments of psychopathology, personality disorder (using both ICD-10 and the Personality Assessment Schedule), social networks and social functioning before being randomly assigned to a multidisciplinary community-based team (Early Intervention Service (<jats:italic>N</jats:italic> = 48) or conventional hospital-based psychiatric services (<jats:italic>N</jats:italic> = 52) and treated for a period of 12 weeks. The ICD-10 classification yielded a higher proportion (50%) of personality disordered patients than the Personality Assessment Schedule (34%) and those from ethnic minorities (mainly Afro-Caribbean) and upper social classes had a lower incidence of personality disorder. Social networks were smaller in personality disordered patients and there were fewer attachment figures. Improvement in social function, and to a lesser extent with depressive symptomatology, was better in patients with no personality disorder referred to the community service compared with the hospital service. No differences were found between the numbers and duration of social contacts in the two services and it is concluded that the better outcome in the community-treated patients was independent of changes in social networks.</jats:p>
Merson S, Tyrer P, Duke P, et al., 1994, Interrater Reliability of ICD-10 Guidelines for the Diagnosis of Personality Disorders, Journal of Personality Disorders, Vol: 8, Pages: 89-95, ISSN: 0885-579X
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.