Ann Day

Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care

Abstract Objectives: To determine whether problem solving treatment combined with antidepressant medication is more effective than either treatment alone in the management of major depression in primary care. To assess the effectiveness of problem solving treatment when given by practice nurses compared with general practitioners when both have been trained in the technique. Design: Randomised controlled trial with four treatment groups. Setting: Primary care in Oxfordshire. Participants: Patients aged 18-65 years with major depression on the research diagnostic criteria—a score of 13 or more on the 17 item Hamilton rating scale for depression and a minimum duration of illness of four weeks. Interventions: Problem solving treatment by research general practitioner or research practice nurse or antidepressant medication or a combination of problem solving treatment and antidepressant medication. Main outcome measures: Hamilton rating scale for depression, Beck depression inventory, clinical interview schedule (revised), and the modified social adjustment schedule assessed at 6, 12, and 52 weeks. Results: Patients in all groups showed a clear improvement over 12 weeks. The combination of problem solving treatment and antidepressant medication was no more effective than either treatment alone. There was no difference in outcome irrespective of who delivered the problem solving treatment. Conclusions: Problem solving treatment is an effective treatment for depressive disorders in primary care. The treatment can be delivered by suitably trained practice nurses or general practitioners. The combination of this treatment with antidepressant medication is no more effective than either treatment alone. Key messages Problem solving treatment is an effective treatment for depressive disorders in primary care Problem solving treatment can be delivered by suitably trained practice nurses as effectively as by general practitioners The combination of problem solving treatment and antidepressant medication is no more effective than either treatment alone Problem solving treatment is most likely to benefit patients who have a depressive disorder of moderate severity and who wish to participate in an active psychological treatment

Psychiatric disorder and gynaecological symptoms in middle aged women: a community survey.

In a community survey 521 women aged 35-59 were selected at random from all patients registered in two groups practices. They were interviewed at home and assessed by means of standardised psychiatric measures and detailed gynaecological inquiry. Levels of psychiatric morbidity were found to be within the expected range for such a sample. Both psychiatric morbidity and the personality dimension of neuroticism were significantly associated with gynaecological symptoms, including dysmenorrhoea and premenstrual tension, some symptoms of excessive menstruation, and flushes and sweats but not disappearance of menstruation for over six months. Current psychiatric state was significantly associated with recent adverse life events and with indices of psychiatric vulnerability (neuroticism and previous psychiatric history), suggesting possible aetiological links with gynaecological symptoms. The findings of this study have implications for the management of gynaecological complaints in general practice.

COGNITIVE THERAPY FOR PREMENSTRUAL SYNDROME: A CONTROLLED TRIAL

The aim of this study was to evaluate the effectiveness of cognitive therapy (CT) as a psychological treatment for premenstrual syndrome (PMS), by comparison with a waitlist control group. Women meeting selection criteria for PMS were randomly allocated to one of two treatment groups: (i) an immediate treatment group, who received 12 weekly sessions of individual CT; or (ii) a waiting list group who recorded symptoms of PMS for a length of time equivalent to the duration of an individual treatment in the immediate treatment group. General practitioners and gynecologists referred women who were complaining of distressing and disabling emotional and physical symptoms in the second half of the menstrual cycle, as verified by 2 months of prospective diary recording. Assessments of the womens psychological and social functioning were made on entry to the study, 2 months later, and at the end of the treatment period. This design allows evaluation of the efficacy of CT relative to any spontaneous remission that may have occurred as a consequence of the passage of time, the keeping of menstrual diaries, interview, and self-rated assessments. Results indicated that CT was significantly more effective than assignment to the waitlist group. Diary measures and self-report questionnaires indicated an almost complete remission of psychological and somatic symptoms and of impairment of functioning. It is concluded that CT for PMS is associated with substantial improvements that cannot be attributed to the passage of time or the completion of the diary and other assessments.

Psychological morbidity in women referred for treatment of hirsutism

Sixty-nine pre-menopausal hirsute women were studied to determine the prevalence of psychological morbidity, and to identify factors associated with psychiatric symptoms. Measures used included: GHQ and POMS to assess psychological morbidity; self-esteem; personality (EPQ); and social adjustment, amongst other. About a third of subjects were found to be GHQ cases, one third had never discussed their hirsutism before, and two thirds avoided some social situations. Psychological morbidity was associated with poor social adjustment, higher levels of neuroticism and introversion, and avoidance of some social situations, but not with the severity of hirsutism or testosterone levels. The results suggest that a proportion of women with hirsutism experiences psychological and social difficulties, and that factors other than their dermatological status play an important part in their psychological difficulties.

Social adversity and perinatal complications: their relation to postnatal depression.

almost 90 minutes. Computerised analyses of both dorsal and cavernosal arterial Doppler waveforms, recorded during the tumescent phase, also proved normal. Thus there was no evidence of penile haemodynamic disturbance. Electrophysiological elicitation of the bulbocavernosus reflex, whose afferent and efferent limbs are composed of somatic pudendal nerves relayed through sacral segments 2, 3, and 4, showed a normal latency of 26 ms to the onset of response (mean (2 SD) value for our laboratory 28-1 (5 7) ms).2 The mean (of three measurements) sensory perception threshold of the dorsal nerve of the penis was raised at 110 volts (mean (2 SD) value for our laboratory 64-2 (23 2) volts).2 Because a spontaneous improvement was already occurring he was treated conservatively. Three months later he reported complete resolution of his symptoms and a return to full potency.

Original ArticleCognitive therapy for premenstrual syndrome: A controlled trial

The aim of this study was to evaluate the effectiveness of cognitive therapy (CT) as a psychological treatment for premenstrual syndrome (PMS), by comparison with a waitlist control group. Women meeting selection criteria for PMS were randomly allocated to one of two treatment groups: (i) an immediate treatment group, who received 12 weekly sessions of individual CT; or (ii) a waiting list group who recorded symptoms of PMS for a length of time equivalent to the duration of an individual treatment in the immediate treatment group. General practitioners and gynecologists referred women who were complaining of distressing and disabling emotional and physical symptoms in the second half of the menstrual cycle, as verified by 2 months of prospective diary recording. Assessments of the womens psychological and social functioning were made on entry to the study, 2 months later, and at the end of the treatment period. This design allows evaluation of the efficacy of CT relative to any spontaneous remission that may have occurred as a consequence of the passage of time, the keeping of menstrual diaries, interview, and self-rated assessments. Results indicated that CT was significantly more effective than assignment to the waitlist group. Diary measures and self-report questionnaires indicated an almost complete remission of psychological and somatic symptoms and of impairment of functioning. It is concluded that CT for PMS is associated with substantial improvements that cannot be attributed to the passage of time or the completion of the diary and other assessments.

Social and psychiatric factors associated with the intention to breastfeed

Abstract In a sample of 483 women interviewed in the last trimester of pregnancy, 3.3 per cent were doubtful about whether they would breastfeed and 17 per cent expressed a clear intention not to do so. Possible psychiatric and social factors associated with not wishing to breastfeed were examined and a number of important associations emerged. In particular, psychiatric morbidity, working-class status, a number of indices of economic hardship, being young, already having children, and lack of a stable relationship were all significantly associated with not wishing to breastfeed. When a log linear analysis was conducted three of these factors were found to be independently associated with not wishing to breastfeed: being young, already having children, and not having a stable relationship. These findings have implications for early intervention.