Clomipramine and Exposure for Obsessive-Compulsive Rituals: 1

1980 ◽  
Vol 136 (1) ◽  
pp. 1-25 ◽  
Author(s):  
I. M. Marks ◽  
R. S. Stern ◽  
D. Mawson ◽  
J. Cobb ◽  
R. McDonald
Keyword(s):  
Social Adjustment ◽  
Depressed Mood ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Exposure In Vivo ◽  
One Year ◽  
Interactional Effect

SummaryForty chronic obsessive-compulsive ritualizers were randomly assigned to treatment with oral clomipramine or placebo for 8 months. During weeks 4 to 7 these two groups were each randomly split into treatment by relaxation or by exposure in vivo, and during weeks 7 to 10 all patients had exposure in vivo. Double blind assessments were made at weeks 4, 7, 10, 18, 36, 62 and 114.Results are reported to one year. Clomipramine produced significant improvement in rituals, mood and social adjustment, but only in those patients who initially had depressed mood. The clomipramine effect was maximum from weeks 10 to 18 and diminished thereafter. On stopping clomipramine patients often relapsed and improved again on restarting the drug. Relaxation produced little change. Exposure produced significant lasting improvement in rituals, but less change in mood; improvement generalized to social adjustment at follow-up. Clomipramine plus exposure had a slight additive but not interactional effect. Clomipramine enhanced compliance both with exposure and with relaxation.Clomipramine is useful for compulsive ritualizers with depressed mood, but may need continuation for over a year and combination with exposure in vivo. Exposure in vivo remains the treatment of choice for rituals without depressed mood.

Clomipramine and Exposure for Chronic Obsessive-Compulsive Rituals: III. Two Year Follow-Up and Further Findings

1982 ◽  
Vol 140 (1) ◽  
pp. 11-18 ◽  
Author(s):  
D. Mawson ◽  
I. M. Marks ◽  
L. Ramm
Keyword(s):  
Social Adjustment ◽  
Age Of Onset ◽  
Drug Effect ◽  
Obsessive Compulsive ◽  
Exposure In Vivo

SummaryForty chronic ritualizers were given clomipramine or placebo from weeks 0 to 36; also all had exposure in vivo, half from weeks 4 to 10 (30 hours) and half from weeks 7 to 10 (15 hours). In the 37 patients available at week 114 there were substantial and maintained improvements in rituals, mood and social adjustment compared to week 0. Reduction of rituals was even greater in those who had 30 hours of exposure. There was no drug effect on rituals at two year follow-up. Greater initial anxiety or depression predicted the superiority of clomipramine over placebo from weeks 10 to 36 and more prescription of tricyclics in follow-up. However, two year outcome was not predicted by initial anxiety or depression, nor by sex, age, age of onset nor duration of rituals.

Symptomatic Treatment of Agoraphobia and Social Phobias: A Follow-up Study

1975 ◽  
Vol 127 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Peter Tyrer ◽  
Derek Steinberg
Keyword(s):  
Personality Disorder ◽  
Social Adjustment ◽  
Prolonged Treatment ◽  
Comparable Efficacy ◽  
List Type ◽  
Behaviour Therapy ◽  
Double Blind ◽  
Social Phobias ◽  
One Year

Summary1.Twenty-six out of 28 out-patients with agoraphobia and social phobias who had originally been treated with phenelzine or placebo in a double-blind clinical trial were followed up for a mean period of one year. During the follow-up period patients received further pharmacotherapy or behaviour therapy, except that those patients originally receiving placebo were not allowed therapy with monoamine oxidase inhibitors.2.Ratings of phobic and additional symptoms, social adjustment and degree of personality disorder were made after one year by one of the authors (D.S.) who had no prior knowledge of the treatment each patient had received.3.There were no significant differences in any of the ratings between the patients of the two groups, but those originally receiving placebo had more additional treatment in the follow-up period. Patients continuing to receive phenelzine frequently experienced a return of symptoms if the drug was withdrawn before six months treatment had elapsed.4.Degree of personality disorder showed a significant negative correlation (p = –0.6) with improvement in the phenelzine group but not in those receiving placebo originally.5.Improvement in social adjustment items was less than improvement in symptoms at follow-up. The implications of this are discussed.6.The results suggest that phenelzine is of comparable efficacy to other symptomatic treatments for agoraphobia and social phobias, but that it acts mainly by symptom suppression. Prolonged treatment in patients with personality disorders is not indicated, for improvement is less likely and the dangers of dependence are greater.

Slow versus Rapid Exposure in vivo of Phobics

1984 ◽  
Vol 12 (3) ◽  
pp. 249-256 ◽  
Author(s):  
Sahika Yuksel ◽  
Isaac Marks ◽  
Elizabeth Ramm ◽  
Anindya Ghosh
Keyword(s):  
Social Adjustment ◽  
Treatment Time ◽  
Final Outcome ◽  
Balanced Design ◽  
Exposure In Vivo

Twenty-eight chronically phobic patients had therapist-aided exposure either rapidly or slowly. During therapist-aided exposure move to the next hierarchy item occurred after subjective anxiety had dropped, on a scale of 0–8 by two points (rapid) or by four points (slow). Exposure began with the lowest of eight hierarchy items. All patients had self-exposure homework between sessions. In a balanced design 12 patients were treated in London and 16 in Istanbul. Peak anxiety during sessions was comparable in both groups. Compared to slow exposure patients, rapid exposure patients completed treatment to criterion in fewer sessions and less time (4·7 vs. 5·8 sessions P< 0·01; 360 vs. 484 min P< 0·005). Criterion for termination of treatment was toleration of the highest hierarchy item with minimal discomfort, or a maximum of eight sessions. Both in London and in Istanbul rapid and slow groups improved substantially and similarly in phobias, social adjustment and mood; gains continued to 6 months follow-up. Compared to slower exposure, rapid exposure does not enhance final outcome but does shorten treatment time without increasing peak anxiety during sessions.

Individualized Behavioural Treatment of Severe Stuttering

1991 ◽  
Vol 19 (4) ◽  
pp. 347-357 ◽  
Author(s):  
Willi Ecker ◽  
Victor Meyer
Keyword(s):  
Oral Reading ◽  
Reading Improvement ◽  
Behavioural Treatment ◽  
Communication Situations ◽  
Cognitive Techniques ◽  
One Year

This case study illustrates the reduction of severe stuttering by an individually tailored treatment programme. Interventions are derived from a tripartite analysis (Lang, 1971) and include EMG biofeedback, regulated breathing, exposure in vivo to stressful communication situations and cognitive techniques to reduce relapse risk. The role of dysfunctional response system interactions in stuttering is emphasized. Treatment resulted in a marked reduction of stuttering and associated facial contortions during videotaped conversations with strangers and oral reading. Improvement was maintained at one-year follow-up.

A Successful Adaptation of Systematic Desensitization in the Treatment of a Phobia of Babies

1985 ◽  
Vol 2 (1) ◽  
pp. 59-64
Author(s):  
Michael Free ◽  
Margaret Beekhuis
Keyword(s):  
Young Woman ◽  
Skin Conductance ◽  
Treatment Strategy ◽  
Physiological Measures ◽  
Systematic Desensitization ◽  
Physiological Measure ◽  
One Year

A case study is presented of a young woman with an unusual phobia, a fear of babies. Barabasz's (1977) technique of systematic desensitization using psycho-physiological measures was chosen as the main treatment strategy. Difficulties arose as the client was unable to visualise scenes involving babies. Nor could she look at photographs of babies long enough for the hierarchy to be ordered using a psycho-physiological measure (skin conductance). A set of photographs was eventually used for the hierarchy, but it was ordered in terms of the length of time the client could look at the various photographs. Systematic desensitization was carried out using the set of photographs instead of imaginary scenes, together with some in vivo exposure in the latter stages of treatment. At termination the client could approach babies without discomfort. Improvement was maintained at one year follow-up.

In Vivo Sensitivity Test in Otitis Media: Efficacy of Antibiotics

PEDIATRICS ◽  
1985 ◽  
Vol 75 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Virgil M. Howie ◽  
Ruth Dillard ◽  
Barbara Lawrence
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Penicillin G ◽  
Treatment Results ◽  
Double Blind ◽  
Phenoxymethyl Penicillin ◽  
Procaine Penicillin ◽  
The Poor

During a 10-year period, antibiotics were assigned in random, double-blind fashion in six combinations to treat 948 episodes of otitis media in children. Exudate from the middle ear of all patients was cultured before treatment. Three follow-up visits were conducted; the first follow-up visit was three to five days after the start of therapy, and the second and third visits were 14 and 31 days after onset of treatment. Exudates were recultured for 75% of the patients on the first follow-up visit. Comparison of treatment results showed that triple sulfonamide combined with either phenoxymethyl penicillin, or benzathine and procaine penicillin G given intramuscularly (IM) was as effective as was ampicillin or amoxicillin. Phenoxymethyl penicillin and cyclacillin alone were usually effective against pneumococci but relatively ineffective against Haemophilus influenzae. Cefaclor and trimethoprim-sulfamethoxazole produced unsatisfactory results in about half the cases caused by pneumococci or H influenzae. Although production of β-lactamase by some otitis-causing Haemophilus and Staphylococcus species may explain the ineffectiveness of some treatments, the percentage of organisms positive for β-lactamase was too small to be responsible for the poor results with certain drugs.

The long-term effects of homeopathic treatment of chronic headaches: one year follow-up and single case time series analysis

2001 ◽  
Vol 90 (02) ◽  
pp. 63-72 ◽  
Author(s):  
H Walach ◽  
T Lowes ◽  
D Mussbach ◽  
U Schamell ◽  
W Springer ◽  
...  
Keyword(s):  
Time Series ◽  
Single Case ◽  
Double Blind Study ◽  
Long Term Effects ◽  
Double Blind ◽  
Homeopathic Treatment ◽  
Chronic Headaches ◽  
One Year

AbstractLittle is known about long-term effects of homeopathic treatment. Following a double-blind, placebo controlled trial of classical homeopathy in chronic headaches, we conducted a 1-year observational study of 18 patients following the double-blind phase, and a complete follow-up study of all trial participants. Eighteen patients received free treatment for daily diary data (frequency, intensity, duration of headaches) over the course of 1 y. All patients enrolled in the double-blind study were sent a 6-week headache diary, a follow-up questionnaire, a personality inventory and a complaint list. Eighty-seven, of the original 98 patients enrolled returned questionnaires, 81 returned diaries. There was no additional change from the end of the trial to the one-year follow-up. The improvement seen at the end of the 12-week trial was stable after 1 y. No differential effects according to treatment after the trial could be seen. Patients with no treatment following the trial had the most improvement after 1 y. Five of 18 patients can be counted responders according to ARIMA analysis of single-case time-series. Patients with double diagnoses and longer treatment duration tended to have clearer improvements than the rest of the patients. Approximately 30% of patients in homeopathic treatment will benefit after 1 y of treatment. There is no indication of a specific, or of a delayed effect of homeopathy.

scholarly journals Topical Diltiazem Versus Topical Glyceryl Trinitrate In The Management Of Chronic Anal Fissure

JMS SKIMS ◽  
2014 ◽  
Vol 17 (2) ◽  
pp. 55-58
Author(s):  
Shams Ul Bari ◽  
Ajaz Ahmad Malik ◽  
Khurshid Alam Wani ◽  
Ajaz A Rather
Keyword(s):  
Side Effects ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
P Value ◽  
Double Blind ◽  
Surgical Methods ◽  
Significant Difference ◽  
Topical Glyceryl Trinitrate ◽  
One Year

Background: Chemical sphincterotomy is a novel way for treating patients of chronic anal fissure which avoids the risk of fecal incontinence associated with traditional surgical methods. Aims and objectives: The aim of this study was to compare the results of topical Diltiazem with topical Glyceril trinitrate in the management of chronic anal fissure. Methods: 71 patients in the age group of 15 - 61 years with chronic anal fissure were included in this prospective, randomized, double-blind trial over a period of two years with further follow up for one year. The patients were randomly allocated to either Diltiazem gel 2% (37 patients) or Glyceril trinitrate ointment 0.2% (34 patients) and were asked to use the treatment twice daily for 8 weeks. Each patient was reviewed every two weeks. Symptoms, healing, side effects and recurrence were compared using SPSS version 10 employing X2 test. A p-value below 0.05 was considered statistically significant. Results: Patients who received topical diltiazem (DTZ) showed statistically significant difference than those who were prescribed topical glyceril trinitrate in terms of symptoms, wound healing, side effects ( headaches) and recurrence (p=0.03 and 0.003 respectively). Healing occurred in 34 of 37 (92%) patients treated with Diltiazem after 6 weeks and 27 of 34 (80%) patients treated with Glyceril trinitrate after 8 weeks, which shows a significant difference in favour of Diltiazem (P < 0.001). The rest of the patients did not heal and underwent sphincterotomy (SILS). Headache occurred in all of the patients treated with Glyceril trinitrate but none of the patients treated with Diltiazem. Conclusion: Diltiazem gel was found to be better than Glyceril trinitrate ointment due to significantly higher healing rate and fewer side-effects. JMS 2014;17(2):55-58

scholarly journals Brief Intermittent Neuroleptic Prophylaxis for Selected Schizophrenic Out-patients

1989 ◽  
Vol 155 (05) ◽  
pp. 702-706 ◽  
Author(s):  
H. A. McClelland ◽  
G. Harrison ◽  
S. D. Soni
Keyword(s):  
Psychotic Symptoms ◽  
Intermittent Treatment ◽  
Double Blind ◽  
Prodromal Symptoms ◽  
Novel Approach ◽  
Depot Neuroleptic ◽  
One Year ◽  
Depot Injections ◽  
To Receive

“A study was conducted to investigate a novel approach to the prophylaxis of schizophrenic relapse. The treatment strategy comprised brief intermittent courses of neuroleptic agents begun as soon as non-psychotic symptoms believed to be early signs of relapse appeared. Fifty four stable, remitted outpatients meeting the American Psychiatric Association's DSM–III criteria for schizophrenia were randomised double blind to receive brief intermittent treatment with either active or placebo depot neuroleptic injections. Only three patients given placebo injections and two controls were admitted to hospital during one year of follow up. Eight (30%) of the patients given placebo injections and only 2 (7%) of the controls, however, had a recurrence of schizophrenic symptoms. Patients given placebo injections experienced fewer extrapyramidal side effects and showed a trend towards a reduction in tardive dyskinesia. Dysphoric and neurotic symptoms were identified before eight out of 11 relapses, and these symptoms were more frequent in patients given placebo depot injections. These results suggest a viable but not necessarily better alternative to continuous oral or depot treatment for less ill, chronic, stabilised schizophrenics based on the early treatment of putative prodromal symptoms of relapse.”

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