Ba Daniels

Controlled comparison of computer-aided vicarious exposure versus live exposure in the treatment of spider phobia

Forty-five participants diagnosed as having specific phobia of spiders were randomly assigned to one of three treatment groups: (a) computer-aided vicarious exposure; (b) therapist-delivered live exposure; (c) relaxation placebo. Each group received three 45-minute sessions. Phobic symptom severity was measured at pretreatment, post-treatment, and at a 3-month follow-up assessment with the Spider Questionnaire, Fear Questionnaire, Phobic Targets and Work Adjustment Ratings Scale, and a Behavioral Assessment Test with Subjective Units of Distress Rating Scale. The results showed that the computer-aided vicarious exposure was an effective treatment for spider phobia and comparable to live exposure therapy in significantly reducing phobic symptoms. Both the computer and live exposure treatments were more effective than the relaxation placebo treatment.

A pilot study of computer-aided vicarious exposure for obsessive-compulsive disorder

Objective: This study reports the use of an interactive computer program to instruct vicarious exposure and ritual prevention for obsessive-compulsive disorder (OCD). Method: Thirteen OCD volunteers and 10 non-OCD volunteers completed three 45-minute sessions at weekly intervals. Subjects with OCD completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Padua Inventory (PI) and the Beck Depression Inventory (BDI) 1 week prior to and 1 week after the three computer treatment sessions. Non-OCD subjects only completed these measures at baseline, allowing confirmation that they had no significant level of OCD symptomatology. Results: In the OCD subjects, scores fell significantly on the PI and BDI, and Y-BOCS scores fell non-significantly. Engagement in vicarious exposure with ritual prevention improved from sessions 1–3. Compared to the non-OCD participants, OCD subjects did less vicarious exposure in session 1 but not sessions 2 and 3. Performance of vicarious exposure by OCD subjects in session 1 correlated with pre-post improvement in PI and BDI scores. Conclusions: The vicarious exposure program may have a role to play as an adjunct in behaviour therapy.

Computer-aided vicarious exposure versus live graded exposure for spider phobia in children.

The efficacy of computer-aided vicarious exposure (CAVE) for the treatment of spider phobia in children was evaluated in a single blind, randomised, controlled trial. Twenty-eight participants, aged 10-17 years, received three 45-min sessions of either Live graded exposure (LGE), CAVE or were assigned to a Waitlist. Phobic symptomatology was measured at pre- and post-treatment, and at one month follow-up on a range of behavioural and subjective assessments. The results showed the superiority of the LGE treatment over the CAVE and Waitlist conditions. Effect sizes support CAVE treatment as being superior to the Waitlist and resulting in reductions of phobic symptomatology.

Seasonal variation in hospital admission for bipolar disorder, depression and schizophrenia in Tasmania

Objective: Seasonal variation has been reported for both affective disorders and schizophrenia. The current study examines seasonal variation in admissions in schizophrenia, depression and bipolar disorder in Tasmania, the southernmost state of Australia.

The differential effect of personality on computer-based treatment of agoraphobia

The differential effects of the revised NEO Personality Inventory (NEO PI-R) personality factors and intelligence on response to a computerized vicarious exposure treatment for agoraphobia were investigated. The Fear Questionnaire (FQ), the Agoraphobia Cognitions Questionnaire (ACQ), and the Body Sensations Questionnaire (BSQ) were used to assess agoraphobic symptomatology. Fourteen females and four males with agoraphobia diagnoses completed three 45-minute weekly treatment sessions. There was a significant decrease in scores on all three measures following treatment. Compared with published population norms, the agoraphobic subjects showed very high neuroticism, low extroversion, and high openness. Lower agreeableness factor scores predicted good treatment outcome. The NEO PI-R openness factor was negatively correlated with proficiency on the computer program; however, proficiency on the computer program did not correlate with symptom improvement. Overall, these results suggest that personality interacts with treatment at different stages of the therapeutic process.

Predictability of rehospitalisation over 5 years for schizophrenia, bipolar disorder and depression

Objective: The aim of this study was to examine the rate of rehospitalisation for schizophrenia, bipolar disorder and depression over a 5-year period in Tasmania, and to identify predictors of the number and duration of readmissions. Method: The Tasmanian Mental Health Register was used to study the 5-year pattern of rehospitalisation for all patients admitted to a Tasmanian public psychiatric inpatient facility with a primary diagnosis of schizophrenia, bipolar disorder or depression, in 1983 or 1984. Results: Seventy-one percent of patients receiving a diagnosis of schizophrenia were readmitted in the 5-year period, compared to 59% for bipolar disorder and 48% for depression. For all three diagnoses, the number of prior admissions was a predictor of the number of readmissions and the total number of days spent in hospital in the follow-up period. Age and sex also had significant effects, which varied across diagnostic groups. Conclusions: A substantial proportion of patients hospitalised for schizophrenia, bipolar disorder or schizophrenia were rehospitalised during the next 5 years. Patients with more previous admissions had more readmissions than those with fewer previous admissions.

Long-term follow-up of computer-aided vicarious exposure versus live graded exposure in the treatment of spider phobia

This study investigated the long-term efficacy of three 45-minute sessions of live graded exposure, computer-aided vicarious exposure, or progressive muscle relaxation placebo for the treatment of spider phobia, and is a follow-up of the results previously reported by Gilroy, Kirkby, Daniels, Menzies, and Montgomery (2000). Forty-two out of 45 participants were assessed, using both subjective and behavioral assessments, at a mean of 33 months after completing treatment. The assessor was unaware of treatment group. Results showed significant improvement from pretreatment to 33-month follow-up across a range of measures in all treatment groups, although the group by time interaction was not statistically significant. Between 3-month and 33-month follow-up, no significant change was observed in any group, indicating sustained long-term improvement. The results support previous reports of the long-term efficacy of live graded exposure and indicate similar durable treatment outcome effects for computer-aided vicarious exposure.

Cortical excitability of psychiatric disorders: reduced post-exercise facilitation in depression compared to schizophrenia and controls.

Objective: In normal subjects, motor evoked potentials (MEPs) produced by transcranial magnetic stimulation (TMS) from the motor cortex are increased after non-fatiguing exercise of hand muscles. This phenomenon is called post-exercise facilitation. This study aims to test the hypothesis that psychiatric syndromes (major depressive episode, schizophrenia) have different levels of post-exercise facilitation compared to controls. Methods: Patients with DSM-IV major depressive episode (six female, four male), schizophrenia (two female, nine male) and a control group (nine female, four male) participated. MEPs were elicited pre- and post-exercise from the contralateral abductor pollicis brevis by TMS over the primary motor cortex. Results: Post-exercise facilitation expressed as a percentage of baseline was 510% in controls, 110% in depression and 190% in schizophrenia. There were significant differences in patients with depression and schizophrenia compared to controls (p = 0.0001, p = 0.0008). Conclusions: Post-exercise facilitation was reduced in depression and schizophrenia, suggesting impaired cortical excitability in these disorders. Further studies may discriminate between the two groups.

Comparison between register and structured interview diagnoses of schizophrenia: a case for longitudinal diagnostic profiles

Objective: Mental health registers contain diagnoses from serial contacts with mental health facilities over many years. This study examines the relationship between longitudinal diagnostic profiles and structured interview diagnoses. The aim is to improve the definition of diagnoses drawn from clinical case registers. Method: The Tasmanian Mental Health Case Register includes 1922 individuals, each with at least one diagnosis of schizophrenia between 1965 and 1990. A representative subsample of 29 individuals were assessed by the structured diagnostic interview for DSM-Ill-R (SCID). Diagnostic agreement between Register and SClD diagnoses was compared. Results: Twenty-four subjects (82.8%) received a lifetime diagnosis of schizophrenia on the SCID. For each subject, ‘schizophrenia diagnostic dominance’, the percentage of register entries with schizophrenia diagnoses over total entries, was calculated. Agreement between register and SClD correlated positively with schizophrenia diagnostic dominance and negatively with register mood diagnoses. Conclusions: Longitudinal diagnostic profiles on databases may be superior to cross-sectional clinical diagnoses in predicting structured interview diagnoses, and may be useful in defining caseness in epidemiological studies using register diagnoses.

Decline in diagnoses of schizophrenia in Tasmania during the period 1965–1990

Changes in the rates of diagnosis of schizophrenia in Tasmania, Australia during the period 1965–1990 were examined using records from the State mental health case register. Analyses were restricted to subjects with diagnoses recorded between the ages of 20 and 29 years in order to reduce possible errors caused by age‐standardized methods. There was a significant decrease in the rate of non‐paranoid subtypes of schizophrenia in female subjects, accompanied by a, commensurate rise in the rate of bipolar diagnoses in that group. Differential changes in male and female subjects support explanations of phenotypic shifts in presentation of psychosis as well as changes in diagnostic practice.