Jose Catalan

A home-based treatment program for agoraphobia: Replication and controlled evaluation*

Twenty-eight agoraphobic women were randomly allocated to one of two treatments: programmed practice in entering feared situations or a treatment aimed at anxiety reduction by resolving life problems. Each treatment was conducted by one of two therapists and both were carried out at the patients home, involved the spouse, and used the same structured format of delivery. Behavioral changes were assessed by the patient, spouse, and an independent psychiatrist. Assessments were made before and after treatment and 3 and 6 months later. Results replicated the findings of a previous study and showed the superiority of programmed practice over the problem solving treatment. However, changes in the latter were unexpectedly large, and one therapist obtained results comparable to these which both therapists obtained with programmed practice. This finding does not support the hypothesis that systematic practice in entering the feared situations is essential for the treatment of agoraphobia.

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.

Domiciliary and out-patient treatment of self-poisoning patients by medical and non-medical staff.

In a study of domiciliary and out-patient treatment of self-poisoning patients, using a brief problem-orientated approach, it was found that domiciliary treatment resulted in much higher attendance rates but no difference in outcome. Patients who completed out-patient treatment had a better outcome than those who failed to attend treatment sessions. Completion of out-patient treatment was more frequent among higher social class patients. Domiciliary treatment may be more appropriate in some cases for married patients and for those of lower social class. Medical and non-medical staff proved to be equally effective therapists. Future research should be concerned with evaluation of alternative methods of provision of help and further identification of patients who are most likely to benefit from treatment.

The psychosocial impact of HIV infection in men with haemophilia: controlled investigation and factors associated with psychiatric morbidity.

The aim of the investigation was to establish the prevalence of psychosocial problems in men with haemophilia and HIV infection, and to identify factors associated with psychological morbidity. A cross-sectional controlled study including 37 HIV seropositive and 36 HIV seronegative men with haemophilia under the care of the Oxford Haemophilia Centre were included in the investigation. The outcome measures included current psychological status (PSE, POMS, Beck Hopelessness Scale and Self-Esteem) and psychiatric history; coping and health beliefs (Self-Control Schedule, Hardiness Scale, Health Locus of Control Scale); social functioning (Modified Social Adjustment Scale); and sexual functioning. The results showed that seropositive individuals, whether symptomatic or not, had significantly worse total PSE scores and had higher levels of hopelessness. In addition, symptomatics had worse depression scores (POMS) than seronegatives. However, levels of psychiatric morbidity were generally low, even in the seropositive group. High levels of psychological morbidity were associated with high levels of hopelessness, unfavourable social adjustment, past psychiatric history and symptomatic HIV disease. Seropositives reported greater negative impact on their sex lives, and sexually active seropositives reported a significantly greater prevalence of sexual dysfunction than seronegatives. The majority of seropositives reported regular condom use during intercourse, and also continuing concerns about infecting their sexual partners in spite of it. In summary, it was found that men with haemophilia an HIV infection have higher levels of psychological distress and sexual problems than seronegatives. The skilled staff involved in their treatment are in a good position to identify their difficulties and ensure that good care is provided.

Sex therapy for vaginismus: Characteristics of couples and treatment outcome

Abstract Thirty couples in which the female partners suffered from vaginismus were treated by sex therapy. Of the 30 couples, 80% had a positive outcome, these gains being sustained at three months follow up. The only prognostic indicator of importance was the extent to which couples were carrying out the homework assignments by the time of the third treatment session. The generally superior outcome of sex therapy for vaginismus by comparison with other female sexual dysfunctions is probably due to the very specific nature of the dysfunction in most cases and because couples with this problem have better general relationships, less psychopathology and higher motivation for treatment than other couples who enter sex therapy.

Confidentiality in a case-report.

SIR,-In their letter on anorexia nervosa presenting as morbid exercising, Dr Chalmers and colleagues (Feb 2, p 285) make what I am sure are informative comments of benefit to psychiatrists. Whilst accepting that interesting cases are often reported, I query the ethics of publishing psychiatric cases, particularly when the patient can be readily identified by colleagues. I was grateful to the Oxford staff for their help but was very distressed when colleagues in my London office informed me that I was the subject of the letter: Oxford, exercising, three months in hospital, knee injuries, and age

Primary male anorgasmia and its treatment: Three case reports

Abstract Primary anorgasmia in men is a relatively rare dysfunction. Here three such cases are described, with emphasis on the clarification of the contributing factors both during the individuals upbringing and previous experience and at the time of assessment. The three men responded rapidly to cognitive-behavioural intervention, and the techniques used are described.

HIV Infection, the Brain and Behaviour: Major Psychiatric Disorder without Cognitive Impairment before or after the Episode

A 39-year-old man with haemophilia and HIV disease was admitted to an infectious diseases unit with poor memory, impaired thinking, and fears of AIDS and death. HIV infection had been diagnosed 5 years earlier, and he was started on zidovudine (AZT) 8 months before episode, but had to be stopped after 6 months due to lymphopenia. He had no psychiatric or substance misuse history, and had coped well with the diagnosis of HIV. There was a family psychiatric history: maternal grandmother, patients mother (and two of her siblings), and patients sister had been treated for depression. Four weeks before admission he became febrile and had productive cough, and AZT was restarted. Over next 2 weeks he developed night sweats without fever, headache, fatigue, and became forgetful, had difficulty finding words, and complained of recurrent intrusive thoughts about ill health. On examination he was found to have slight pyrexia, but had no other abnormalities (for investigations see Table 1). A provisional diagnosis of CNS disease was made, with the possibility of psychiatric disorder. Mental state assessment found