Publications
656 results found
Tyrer P, 2020, Why health anxiety needs to be recognised in hospital practice, Clinical Medicine, Vol: 20, Pages: 339-342, ISSN: 1470-2118
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.
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>
Tyrer P, Cooper S, Tyrer H, et 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.
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.
Mulder R, Zarifeh J, Boden J, et 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.
Tyrer P, 2019, Nidotherapy: a cost‐effective systematic environmental intervention, World Psychiatry, Vol: 18, Pages: 144-145, ISSN: 1723-8617
Tyrer P, 2019, Reforming care without bureaucracy, BJPsych Bulletin, Vol: 43, Pages: 104-105, ISSN: 2056-4694
The Care Programme Approach was a valiant attempt to improve the aftercare of people with severe mental illness after discharge from hospital. It was introduced as a response to a scandal, not an advance in knowledge, and has always suffered by being a reaction to events rather than a trailblazer for the future. It may have dragged the worst of care upwards, but at the expense of creating a bureaucratic monstrosity that has hindered good practice by excessive attention to risk, and vastly increased paperwork with intangible benefit. It needs to be simplified to allow practitioners greater scope for collaborative solutions, less minatory oversight and better use of strained resources.</jats:p><jats:sec id="S2056469418000694_sec_a1"><jats:title>Declaration of interest</jats:title><jats:p>None.</jats:p></jats:sec>
Tyrer P, Mulder R, Kim Y-R, et al., 2019, The development of the ICD-11 classification of personality disorders: An amalgam of science, pragmatism, and politics., Annual Review of Clinical Psychology, Vol: 15, Pages: 481-502, ISSN: 1548-5943
The nomenclature of personality disorders in the 11th revision of the International Classification of Diseases and Related Health Problems represents the most radical change in the classification history of personality disorders. A dimensional structure now replaces categorical description. It was argued by the Working Group that only a dimensional system was consistent with the empirical evidence and, in the spirit of clinical utility, the new system is based on two steps. The first step is to assign one of five levels of severity, and the second step is to assign up to five prominent domain traits. There was resistance to this structure from those who feel that categorical diagnosis, particularly of borderline personality disorder, should be retained. After lengthy discussion, described in detail here, there is now an option for a borderline pattern descriptor to be selected as a diagnostic option after severity has been determined. Expected final online publication date for the Annual Review of Clinical Psychology Volume 15 is May 7, 2019. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Pitman A, Underwood R, Hamilton A, et al., 2019, Enhanced peer-review for optimising publication of biomedical papers submitted from low- and middle-income countries: feasibility study for a randomised controlled trial, BJPSYCH OPEN, Vol: 5, ISSN: 2056-4724
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- Citations: 6
Reed GM, First MB, Kogan CS, et al., 2019, Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders, World Psychiatry, Vol: 18, Pages: 3-19, ISSN: 1723-8617
Following approval of the ICD-11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD-10 to the ICD-11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders following ICD-11's approval. The development of the ICD-11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD-11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture-related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery-based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, and the development of two new ICD-11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD-11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD-11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.
Mulder R, Tyrer P, 2019, Diagnosis and classification of personality disorders, Current Opinion in Psychiatry, Vol: 32, Pages: 27-31, ISSN: 0951-7367
Tyrer P, 2019, Critical psychiatry is becoming Luddite, BJPsych Advances, Vol: 25, Pages: 55-56, ISSN: 2056-4678
<jats:title>SUMMARY</jats:title><jats:p>The critical psychiatry movement has a part to play in correcting some of the exaggerated claims sometimes made by inveterate optimists in our profession. But it has gone too far in creating increasingly destructive commentaries that add little to knowledge and only serve as a brake on progress.</jats:p><jats:sec id="S2056467818000610_sec_a1"><jats:title>DECLARATION OF INTEREST</jats:title><jats:p>None.</jats:p></jats:sec>
Tyrer PJ, Tyrer H, 2019, Nidotherapy Harmonising the Environment with the Patient
This comprehensive guide shows how nidotherapy can be used across the range of mental disorders and gives evidence for its value"--Provided by publisher.
Tyrer P, 2018, Dimensions fit the data, but can clinicians fit the dimensions?, World Psychiatry, Vol: 17, Pages: 295-296, ISSN: 1723-8617
Crawford MJ, Sanatinia R, Barrett B, et al., 2018, The clinical effectiveness and cost effectiveness of lamotrigine for people with borderline personality disorder: a randomized, placebo-controlled trial, American Journal of Psychiatry, Vol: 175, Pages: 756-764, ISSN: 0002-953X
Objectives:To examine whether lamotrigine is a clinically effective and cost-effective treatment for people with borderline personality disorder. Method:Multicentre, double-blind, placebo-controlled randomized trial. Between July 2013 to November 2016, we recruited 276 people aged 18 or over, who met diagnostic criteria for borderline personality disorder. We excluded those with co-existing bipolar affective disorder or psychosis, those already taking a mood stabiliser, and women at risk of pregnancy. We randomly allocated participants on a 1:1 ratio to up to 400mg of lamotrigine per day or an inert placebo using a remote web-based randomization service. The primary outcome was total score on the Zanarini Rating scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. Secondary outcomes included depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment and adverse events. Results:195 (70.6%) participants were followed up at 52 weeks, at which point 49 (36%) of those prescribed lamotrigine and 58 (42%) of those prescribed placebo were taking it. Mean total ZAN-BPD score was 11.3 (SD = 6.6) among those randomized to lamotrigine and 11.5 (SD = 7.7) among those randomized to placebo (adjusted difference in means = 0.1, 95% C.I = -1.8 to 2.0, p=0.91). There was no evidence of any differences in secondary outcomes. Costs of direct care for those prescribed lamotrigine were similar to those prescribed placebo. Conclusions:Treating people with borderline personality disorder with lamotrigine is not a clinically effective or cost-effective use of resources.
Tyrer P, 2018, Accurate recording of personality disorder in clinical practice, BJPsych Bulletin, Vol: 42, Pages: 135-136, ISSN: 2056-4694
<jats:title>Summary</jats:title><jats:p>Disturbances of personality are recorded very poorly in official statistics, but there are signs that this is changing. For many years, personality disorder has been either regarded as a secondary diagnosis that can be forgotten in the presence of another mental disorder, or avoided as the diagnosis gives the impression of untreatability or stigma. What is now abundantly clear is that under-diagnosis of personality disorder represents a disservice to patients and practitioners. It prevents a proper understanding of the longitudinal course of psychiatric disorder and an appreciation of some of the positive aspects of abnormal personality that can be used in treatment. We must no longer bury personality disorder, ostrich-like, in the diagnostic sand. It is there for the asking and needs to be embraced honestly and without fear if we are to improve the management of psychiatric patients.</jats:p><jats:sec id="S2056469418000402_sec_a1"><jats:title>Declaration of interest</jats:title><jats:p>None.</jats:p></jats:sec>
Tyrer P, 2018, Recent Advances in the Understanding and Treatment of Health Anxiety, Current Psychiatry Reports, Vol: 20, ISSN: 1523-3812
Purpose of ReviewTo examine the diagnosis of health anxiety, its prevalence in different settings, public health significance, treatment, and outcome.Recent FindingsHealth anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Lifetime prevalence rates are 6% in the population and as high as 20% in hospital out-patients, leading to greater costs to health services through unnecessary medical contacts. Its prevalence may be increasing because of excessive internet browsing (cyberchondria). Drug treatment with antidepressants has some efficacy but is not well-liked, but psychological treatments, including cognitive behavior therapy, stress management, mindfulness training, and acceptance and commitment therapy, given either individually, in groups, or over the Internet, have all proved efficacious in both the short and longer term. Untreated health anxiety leads to premature mortality.SummaryHealth anxiety has become an increasing clinical and public health issue at a time when people are being formally asked to take more responsibility in monitoring their own health. More attention by health services is needed.
Tyrer P, 2018, The importance of nidotherapy and environmental change in the management of people with complex mental disorders., International Journal of Environmental Research and Public Health, Vol: 15, ISSN: 1660-4601
Much has been done in the last 50 years to achieve a better understanding of the psychosocial causes and other factors influencing the manifestation of mental illness, but there has been a conspicuous omission. Although gross environmental deficiencies were exposed in old mental institutions, 70 years ago the more subtle maladaptive settings that reinforce chronicity in mental illness have often been forgotten. In this review, the potential of systematic environmental manipulation as a treatment (nidotherapy) and other similar forms of management, used many times in the past but now mainly in forensic settings, is examined. There is now accumulating evidence, reinforced by controlled trials, that planned environmental change, preferably carried out with the full cooperation of the patient, can be a major contributor to therapeutic benefit. It is also very cost-effective. All forms of the environment, physical, social and personal, can be addressed in making assessments, and once a planned way forward has been chosen, progress can be monitored by personnel with limited mental health experience. These interventions have applications in general mental health and occupational health services and deserve much wider use.
Tyrer P, Mulder R, 2018, Dissecting the elements of borderline personality disorder, Personality and Mental Health, Vol: 12, Pages: 91-92, ISSN: 1932-8621
Crawford MJ, Sanatinia R, Barrett B, et al., 2018, Lamotrigine for people with borderline personality disorder: a RCT, HEALTH TECHNOLOGY ASSESSMENT, Vol: 22, Pages: 1-+, ISSN: 1366-5278
Background:No drug treatments are currently licensed for the treatment of borderline personality disorder (BPD). Despite this, people with this condition are frequently prescribed psychotropic medications and often with considerable polypharmacy. Preliminary studies have indicated that mood stabilisers may be of benefit to people with BPD.Objective:To examine the clinical effectiveness and cost-effectiveness of lamotrigine for people with BPD.Design:A two-arm, double-blind, placebo-controlled individually randomised trial of lamotrigine versus placebo. Participants were randomised via an independent and remote web-based service using permuted blocks and stratified by study centre, the severity of personality disorder and the extent of hypomanic symptoms.Setting:Secondary care NHS mental health services in six centres in England.Participants:Potential participants had to be aged ≥ 18 years, meet diagnostic criteria for BPD and provide written informed consent. We excluded people with coexisting psychosis or bipolar affective disorder, those already taking a mood stabiliser, those who spoke insufficient English to complete the baseline assessment and women who were pregnant or contemplating becoming pregnant.Interventions:Up to 200 mg of lamotrigine per day or an inert placebo. Women taking combined oral contraceptives were prescribed up to 400 mg of trial medication per day.Main outcome measures:Outcomes were assessed at 12, 24 and 52 weeks after randomisation. The primary outcome was the total score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. The secondary outcomes were depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment and adverse events. Higher scores on all measures indicate poorer outcomes.Results:Between July 2013 and October 2015 we randomised 276 participants, of whom 195 (70.6%) were followed up 52
Tyrer P, 2018, Classification of stress disorders, Adjustment Disorders From Controversy to Clinical Practice, Publisher: Oxford University Press, ISBN: 9780198786214
'Adjustment Disorders' provides concise and comprehensive information on adjustment disorders and advances a greater understanding and better diagnostic skills among those clinicians working with this group of patients
Tyrer P, Tyrer H, 2018, Health anxiety: detection and treatment, BJPsych Advances, Vol: 24, Pages: 66-72, ISSN: 2056-4678
<jats:title>SUMMARY</jats:title><jats:p>Health anxiety is an important new diagnosis that is increasing in frequency because of changing attitudes towards health, particularly excessive use of health information on the internet (cyberchondria). People with abnormal health anxiety become over-diligent monitors of their health, misinterpret most somatic sensations as evidence of disease, consult medical professionals unnecessarily and frequently, and are often over-investigated. Relatively few patients with health anxiety present to psychiatrists; most are seen in primary and secondary medical care. This paper reviews the diagnosis and presenting features of health anxiety, its identification in practice and its treatment. A range of simple psychological treatments have been shown to have long-lasting benefit for the disorder but are greatly under-used.</jats:p><jats:sec id="S2056467817000056_sec_a1"><jats:title>LEARNING OBJECTIVES</jats:title><jats:p><jats:list list-type="bullet"><jats:list-item><jats:label>•</jats:label><jats:p>To be able to identify abnormal health anxiety with the aid of probe questions</jats:p></jats:list-item><jats:list-item><jats:label>•</jats:label><jats:p>To respond to people whom you have identified with excessive health anxiety in a way that facilitates its treatment</jats:p></jats:list-item><jats:list-item><jats:label>•</jats:label><jats:p>To learn a few simple techniques derived from cognitive–behavioural therapy that can lead to long-term benefit</jats:p></jats:list-item></jats:list></jats:p></jats:sec><jats:sec id="S2056467817000056_sec_a2"><jats:title>DECLARATION OF INTEREST</jats:title><jats:p>None.</jats:p></jats:sec>
Spears B, Tyrer H, Tyrer P, 2017, Nidotherapy in the successful management of comorbid depressive and personality disorder, Personality and Mental Health, Vol: 11, Pages: 344-350, ISSN: 1932-8621
Tyrer P, 2017, Borderline hits the diagnostic buffers again, BIPOLAR DISORDERS, Vol: 19, Pages: 599-600, ISSN: 1398-5647
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Olajide K, Munjiza J, Moran P, et al., 2017, Development and Psychometric Properties of the Standardized Assessment of Severity of Personality Disorder (SASPD) (vol 32, pg 44, 2017), JOURNAL OF PERSONALITY DISORDERS, Vol: 31, Pages: 720-720, ISSN: 0885-579X
Tyrer P, Salkovskis P, Tyrer H, et al., 2017, Cognitive behaviour therapy for health anxiety in medical patients (CHAMP): randomised trial with outcomes to five years, Health Technology Assessment, Vol: 21, ISSN: 1366-5278
Background: Health anxiety is an under-recognised but frequent cause of distress that is potentially treatable but there are few studies in secondary care. Objective: To determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive-behaviour therapy (CBT-HA) for health anxiety compared with standard care in medical outpatients Design: Randomised controlled trialSetting: Five general hospitals in London, Middlesex and Nottinghamshire Participants:444 patients aged 16-75 seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored 20 or more on the Health Anxiety Inventory (HAI), and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded but those concurrent medical illnesses were not. Interventions:Cognitive behaviour therapy for health anxiety (CBT-HA): 4-10 one-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care. Main outcome measures: Primary: Researchers masked to allocation assessed patients at baseline, 3m, 6m, 12m, 24m and 5 years. The primary outcome was change in HAI score between baseline and 12 months. Main secondary outcome: Costs of care in the two groups after 24 months and 60 months, change in health anxiety (HAI), generalised anxiety and depression (Hospital Anxiety and Depression (HADS-A and HADS-D) scores, social functioning using the Social Functioning Questionnaire (SFQ), and quality of life using the Euroqol (EQ-5D), at 6, 12, 24 and 60 months, deaths over 5 years. Results: Of 28,991 patients screened over 21m, 5769 had HAI scores of 20 or above. CBT-HA patients (mean sessions 6) had significantly greater improvement in HAI scores than those in standard care at 3m and this was maintained over the five-year period (overall P<0.0001), with no loss of efficacy between 2 and 5 years. Generalised anxiety
Buszewicz M, Cape J, Serfaty M, et al., 2017, Pilot of a randomised controlled trial of the selective serotonin reuptake inhibitor sertraline versus cognitive behavioural therapy for anxiety symptoms in people with generalised anxiety disorder who have failed to respond to low-intensity psychological treatments as defined by the National Institute for Health and Care Excellence guidelines, HEALTH TECHNOLOGY ASSESSMENT, Vol: 21, Pages: 1-+, ISSN: 1366-5278
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Olajide K, Crawford M, Munjiza J, et al., 2017, Development and psychometric properties of the Standardized Assessment of Severity of Personality Disorder, Journal of Personality Disorders, Vol: 32, Pages: 44-56, ISSN: 1943-2763
AimsPersonality disorder is increasingly categorised according to its severity, but there is no simple way to screen for severity according to ICD-11 criteria.We set out to develop the Standardized Assessment of Severity of Personality Disorder (SASPD).Methods110 patients completed the SASPD together with a clinical assessment of the severity of personality disorder. We examined the predictive ability of the SASPD using the area under the ROC curve (AUC). Two to four weeks later 43 patients repeated the SASPD to examine reliability.ResultsThe SASPD had good predictive ability for determining mild (AUC =0.86) and moderate (AUC=0.84) PD at cut points of 8 and 10 respectively. Test retest reliability of the SASPD was high (intraclass correlation coefficient = 0.93, 95% CI = 0.88 to 0.96). ConclusionThe SASPD provides a simple, brief and reliable indicator of the presence of mild or moderate PD according to ICD-11 criteria.
Singh SP, Paul M, Parsons H, et al., 2017, A prospective, quantitative study of mental health act assessments in England following the 2007 amendments to the 1983 act: did the changes fulfill their promise?, BMC Psychiatry, Vol: 17, ISSN: 1471-244X
Background:In 2008, the Mental Health Act (MHA) 2007 amendments to the MHA 1983 were implemented in England and Wales. The amendments were intended to remove perceived obstacles to the detention of high risk patients with personality disorders (PDs), sexual deviance and learning disabilities (LDs). The AMEND study aimed to test the hypothesis that the implementation of these changes would lead to an increase in numbers or proportions of patients with these conditions who would be assessed and detained under the MHA 2007.Method:A prospective, quantitative study of MHA assessments undertaken between July–October 2008–11 at three English sites. Data were collected from local forms used for MHA assessment documentation and patient electronic databases.Results:The total number of assessments in each four month period of data collection varied: 1034 in 2008, 1042 in 2009, 1242 in 2010 and 1010 in 2011 (n = 4415). Of the assessments 65.6% resulted in detention in 2008, 71.3% in 2009, 64.7% in 2010 and 63.5% in 2011. There was no significant change in the odds ratio of detention when comparing the 2008 assessments against the combined 2009, 2010 and 2011 data (OR = 1.025, Fisher‘s exact Χ 2 p = 0.735). Only patients with LD and ‘any other disorder or disability of the mind’ were significantly more likely to be assessed under the MHA post implementation (Χ2 = 5.485, P = 0.018; Χ2 = 24.962, P > 0.001 respectively). There was no significant change post implementation in terms of the diagnostic category of detained patients.Conclusions:In the first three years post implementation, the 2007 Act did not facilitate the compulsory care of patients with PDs, sexual deviance and LDs.
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