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  • Examining the feed forward model of problem drinking and co-morbid panic disorder using a single case approach

    3 July 2018

    Alcohol use and anxiety disorder frequently co-occur. Despite this, no research has satisfactorily examined the effect of alcoholism treatment on anxiety states. The effect of Relapse Prevention (RP) treatment on alcohol dependence and co-morbid panic disorder in a single case was therefore examined. RP reduced alcohol intake and anxiety levels, and eliminated panic attacks, although carrying alcohol to prevent panic attack remained. Belief change was achieved when this behaviour was eliminated. Results are consistent with a "feed-forward" model of co-morbidity. The need for further research exploring RP and co-morbid anxiety disorder is emphasized, as is work examining alcohol-related safety-seeking behaviour.

  • Sensitivity and specificity of measures of the insomnia experience: a comparative study of psychophysiologic insomnia, insomnia associated with mental disorder and good sleepers.

    3 July 2018

    STUDY OBJECTIVES: To explore proposed explanatory mechanisms in psychophysiologic insomnia by investigating the sensitivity and specificity of commonly used insomnia research tools in discriminating psychophysiologic insomnia, insomnia associated with mental disorder, and good sleepers. DESIGN: Cross-sectional, between-group comparison of responses from subjects with psychophysiologic insomnia, those with insomnia associated with mental disorder, and good sleepers to psychometrically robust self-report instruments. SETTING: Attendees at adult community outpatient clinics. PARTICIPANTS: Fifty-four adults (36 women, 18 men; average age 40 years) across 3 groups (n = 18 per group). Participants with psychophysiologic insomnia met combined Inteernational Classification of Sleep Disorders, Revised and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and had no history of mental disorder. Participants with insomnia associated with mental disorder satisfied the same criteria for sleep disturbance and met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Structured Clinical Interview for DSM-IV axis-I Disorders) criteria for depressive disorder. The majority had comorbid anxiety disorder. Insomnia duration in the groups with psychophysiologic insomnia and insomnia associated with mental disorder was around 10 years. Good sleepers served as a control group and included self-reported good sleepers with no history of sleep problems or psychiatric disorder. INTERVENTION: N/A. MEASUREMENTS AND RESULTS: Analyses of variance, adjusted for multiple comparisons, indicated no between-group differences on a measure of sleep-related stimulus control, and self-reported somatic arousal was higher in subjects with insomnia associated with mental disorder than in good sleepers or those with psychophysiologic insomnia. Subjects with insomnia associated with mental disorder and psychophysiologic insomnia had poorer sleep hygiene and were characterized by heightened mental arousal. Logistic regression indicated that "effortful preoccupation with sleep" discriminated subjects with both psychophysiologic insomnia (100% sensitivity, 94% specificity) and insomnia associated with mental disorder (100%, 100%) from good sleepers and that only depressive symptomatology discriminated insomnia associated with mental disorder from psychophysiologic insomnia. CONCLUSION: Psychophysiologic insomnia and insomnia associated with mental disorder may be on a continuum of insomnia severity, rather than categorically distinct. Insomnia associated with mental disorder may respond to psychological intervention. Factors specifically discriminating insomniacs from good sleepers require further investigation.

  • A systematic review of the contribution of qualitative research to the study of quality of life in children and adolescents with epilepsy.

    3 July 2018

    A sizeable literature focusing on QOL in children and adolescents with epilepsy has been produced over the last few years. However, relatively little emphasis has been placed on defining these issues from direct exploration of children's and adolescents' views. Qualitative methodologies are proposed in this review as an appropriate means of eliciting such information. This review systematically investigated the extent to which studies of QOL in children and adolescents with epilepsy have used recognised qualitative methodology. Articles for inclusion were identified by searching the term 'epilepsy', combined with 'adolescent(s) and/or child(ren)' and 'psychosocial and/or quality of life'. Selected articles were reviewed and rated using CASP Guidelines for qualitative research by two independent raters. Seventeen studies were retrieved through literature search. Of these six used some form of qualitative methodology either individually or combined with quantitative methods. However, only one study met quality criteria for selection in this systematic review. A summary of both selected and excluded studies is presented and methodological limitations discussed. Recommendations for appropriate methodology for investigation of QOL issues in children and adolescents are given.

  • Quality of life and psychosocial development in adolescents with epilepsy: a qualitative investigation using focus group methods.

    3 July 2018

    The majority of previous studies investigating the impact of epilepsy on the QOL of adolescents have used proxy opinions from clinicians and/or parents. This study highlights the need for research to investigate QOL from the direct perspective of adolescents and consider issues in the context of a developmental perspective. A focus group technique was used. Twenty-two adolescents aged between 12 years 4 months and 18 years 0 months (6 males and 16 females) were stratified by age (12-13, 14-15 and 16+ years) into six focus groups. Data were transcribed and QSR NUD*IST 4.0 was used to help generate central themes. Several procedures were undertaken to increase validity and reliability of findings. Analysis identified two main themes comprising (a) issues related to adolescent development (identity formation) and (b) epilepsy related variables, with five and four main sub-themes, respectively ('peer acceptance', 'development of autonomy', 'school related issues', 'epilepsy as part of me' and 'future', and 'medication issues', 'seizures', 'knowledge of epilepsy' and 'sense of uncertainty'). The main issues related to peer acceptance and development of autonomy. In contrast to previous studies, academic difficulties were not highlighted as an issue. No significant age-related differences in issues were identified. A conceptual model representing these findings is presented and clinical implications and suggestions for future research are reported.

  • Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID): Development and psychometric properties of a new measure for use with people with mild intellectual disability

    3 July 2018

    Background. Self-rating scales are widely used in general adult practice; however, there is no reliable and valid method for assessing state anxiety in people with intellectual disability (ID). The present study describes the development and psychometric evaluation of a new scale, the Glasgow Anxiety Scale for People with an Intellectual Disability (GAS-ID). Methods. First, an item pool was generated from focus groups, a review of the literature and clinician feedback. Secondly, a draft scale was administered to 19 anxious and 16 non-anxious people with ID for further validation and appraisal of reliability. Thirdly, the scale was completed by 19 anxious, non-ID people for cross-validation with the Beck Anxiety Inventory (BAI). Finally, physiological concomitants were validated by pulse-oximetry. Results. The 27-item GAS-ID discriminated anxious from non-anxious participants, had good test-retest reliability (r=0.95) and internal consistency (α=0.96), and was reasonably correlated with the BAI (ρ=0.75). The correlation between the physiological subscale of the GAS-ID and changes in pulse rate was moderately significant (ρ=0.52). Conclusions. This preliminary study suggests that the GAS-ID offers a psychometrically robust and practical (5-10 min) approach to the appraisal of anxiety in this population.

  • Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID): development and psychometric properties of a new measure for use with people with mild intellectual disability.

    3 July 2018

    BACKGROUND: Self-rating scales are widely used in general adult practice; however, there is no reliable and valid method for assessing state anxiety in people with intellectual disability (ID). The present study describes the development and psychometric evaluation of a new scale, the Glasgow Anxiety Scale for People with an Intellectual Disability (GAS-ID). METHODS: First, an item pool was generated from focus groups, a review of the literature and clinician feedback. Secondly, a draft scale was administered to 19 anxious and 16 non-anxious people with ID for further validation and appraisal of reliability. Thirdly, the scale was completed by 19 anxious, non-ID people for cross-validation with the Beck Anxiety Inventory (BAI). Finally, physiological concomitants were validated by pulse-oximetry. RESULTS: The 27-item GAS-ID discriminated anxious from non-anxious participants, had good test-retest reliability (r = 0.95) and internal consistency (alpha = 0.96), and was reasonably correlated with the BAI (rho = 0.75). The correlation between the physiological subscale of the GAS-ID and changes in pulse rate was moderately significant (rho = 0.52). CONCLUSIONS: This preliminary study suggests that the GAS-ID offers a psychometrically robust and practical (5-10 min) approach to the appraisal of anxiety in this population.

  • Insomniacs' reported use of CBT components and relationship to long-term clinical outcome.

    3 July 2018

    Although there is considerable evidence for the efficacy of non-pharmacological treatment of insomnia, many of the larger trials have delivered CBT in multicomponent format. This makes it impossible to identify critical ingredients responsible for improvement. Furthermore, compliance with home implementation is difficult to ascertain in psychological therapies, and even more so when trying to differentiate across a range of elements. In the present report, 90 patients who had completed 12 month follow-up after participation in a clinical effectiveness study of CBT in general medical practice, responded to a questionnaire asking them about their use of the ten components of the programme. Reports of home use were then entered as predictors of clinical response to treatment. Results indicated that reported home use of stimulus control/sleep restriction was the best predictor of clinical improvement in sleep latency and nighttime wakefulness. Cognitive restructuring also contributed significantly to reduction in wakefulness. In spite of being the most highly endorsed component (by 79% of respondents) use of relaxation did not predict improvement on any variable. Similarly, sleep hygiene was unrelated to sleep pattern change and use of imagery training was modestly predictive of poor response in terms of sleep latency. There are methodological limitations to this type of post hoc analysis, nevertheless, these results being derived from a large patient outcome series raise important issues both for research and clinical practice.

  • The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: implementation and evaluation of a sleep clinic in general medical practice.

    3 July 2018

    Chronic insomnia is a very common clinical condition which may respond well to non-pharmacological treatment. Indeed, the literature supports the efficacy of cognitive behaviour therapy (CBT). However, there has been no substantial study of clinical effectiveness. Since insomniacs typically present in general medical practice this is a crucial gap in the outcome research. This study, therefore, specifically investigated the clinical effectiveness of CBT delivered by Health Visitors (primary care nurses) trained as therapists. One hundred and thirty-nine insomniacs (mean age 51 yr) were randomised to CBT or Self-Monitoring Control (SMC) in a controlled trial. CBT comprised six group sessions (n=4 to 6 patients). After the controlled phase, SMC patients entered deferred treatment (CBT-DEF), allowing both treatment replication and long-term outcome to be investigated for a sizeable, treated sample. Repeated measures ANOVAs demonstrated superiority of CBT over SMC in substantially reducing sleep latency and wakefulness during the night. CBT-DEF replicated similar effects and maintained improvement was observed in both groups one year later. Furthermore, total sleep increased significantly during follow-up and 84% of patients initially using hypnotics remained drug-free. Results suggest that CBT administered by Health Visitors offers a clinically effective treatment for insomnia.

  • Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group.

    3 July 2018

    Insomnia is a highly prevalent, often debilitating, and economically burdensome form of sleep disturbance caused by various situational, medical, emotional, environmental and behavioral factors. Although several consensually-derived nosologies have described numerous insomnia phenotypes, research concerning these phenotypes has been greatly hampered by a lack of widely accepted operational research diagnostic criteria (RDC) for their definition. The lack of RDC has, in turn, led to inconsistent research findings for most phenotypes largely due to the variable definitions used for their ascertainment. Given this problem, the American Academy of Sleep Medicine (AASM) commissioned a Work Group (WG) to review the literature and identify those insomnia phenotypes that appear most valid and tenable. In addition, this WG was asked to derive standardized RDC for these phenotypes and recommend assessment procedures for their ascertainment. This report outlines the WG's findings, the insomnia RDC derived, and research assessment procedures the WG recommends for identifying study participants who meet these RDC.