Effectiveness of brief training in cognitive behaviour therapy techniques for palliative care practitioners.

We describe training in CBT techniques for 20 palliative care practitioners delivered as 12 days' equivalent teaching plus skills-building supervision over a six month period. Audiotapes of trainees' interactions with patients during their usual work were rated using a specially devised 'Cognitive First Aid' rating scale (CFARS). The CFARS was highly internally consistent (Cronbach's Alpha 0.

Impact of training on rating competence in cognitive therapy.

This naturalistic study examines the impact of a training package on the inter-rater reliability scores of a scale devised to measure competence in cognitive therapy (CT). The study was conducted at the Newcastle Cognitive and Behavioural Therapies Centre, where trainees are routinely required to submit videotapes of their therapeutic work for marking independently by two supervisors. This process was used as vehicle for the present work, whereby the trainees' videos were assessed in terms of their competence using a recently revised rating scale (CTS-R).

Moderators of trainee therapists' competence in cognitive therapy.

Objectives: A revised version of the Cognitive Therapy Scale (CTS-R) was developed and used in an ecologically valid study designed to examine the acquisition of competence in cognitive therapy (CT). The relationship of therapist and patient variables to changes in competence was examined. Unlike most previous research, this study defines effectiveness of training in terms of therapist competence rather than patient outcome.

Effectiveness of cognitive therapy training.

Despite growing demands for effective training there remains a lack of convincing evaluations. Reviews of the training literature specify the need for multiple measures, homogeneous therapies, generalization assessments and longitudinal designs. The present analysis responds by evaluating the training of 20 mental health professionals in cognitive therapy (CT).

Co-morbid depression and drinking outcome in those with alcohol dependence.

Depressed and non-depressed (pre-admission and post-detoxification) alcohol-dependent patients were followed-up on two occasions over a period of 5 months following detoxification from alcohol. Detailed measures of alcohol consumption, alcohol-related problems and abstinence status were taken throughout the follow-up period. No significant differences were found between those with a diagnosis of depression and those with alcohol dependence alone, regardless of whether diagnosis of depression was made post-detoxification or pre-admission, on any drinking outcome measure including abstinence status, alcohol consumption, pattern of drinking, or alcohol-related problems.

A meta-analysis of the effects of cognitive therapy in depressed patients.

Background: Cognitive therapy (CT) has been studied in 78 controlled clinical trials from 1977 to 1996.

Method: The meta-analysis used Hedges and Olkin d+ and included 48 high-quality controlled trials. The 2765 patients presented non-psychotic and non-bipolar major depression, or dysthymia of mild to moderate severity.

Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression.

Background: We report a randomised controlled trial, in both the acute and maintenance stage of treatment, in 75 out-patients with recurrent major depression.

Method: Patients were allocated to three groups: 16 weeks of acute treatment and two years' maintenance treatment in the following way: antidepressants and maintenance antidepressants; cognitive therapy and maintenance cognitive therapy; antidepressants and maintenance cognitive therapy. Both completers' and end-point data were analysed.

Cognitive therapy with obsessive-compulsive disorder.

Background: People with obsessive-compulsive disorders (OCD) are widely treated with a combination of medication and behavioural techniques. The success rate is 50-85%, but both relapse and drop-out rates appear high. The use of cognitive therapy (CT) for the treatment of OCD has been suggested.

The relationship of sociotropy and autonomy to symptoms, cognition and personality in depressed patients.

A growing body of research suggests that the two personality characteristics of sociotropy and autonomy confer vulnerability to depression in response to interpersonal or achievement-related events. This study examined the relationships of these characteristics to severity of symptoms, measures of negative cognition, neuroticism and extraversion in a sample of 118 unipolar depressed patients. Sociotropy was found to be associated with self-reported depressive symptoms independently of anxiety level, with frequency of negative automatic thoughts, with dysfunctional attitudes and neuroticism.

Sociotropy, autonomy and personal memories in depression.

Recent research suggesting an association of sociotropy and autonomy with vulnerability to depression in response to different types of event remains to be integrated with the cognitive model. This study investigated the relationship of sociotropy and autonomy to specific cognitive processes in a sample of 20 unipolar depressed patients. In the autobiographical memory paradigm used, the hypothesis that sociotropy would be associated with faster recall of sociotropic negative memories was supported.

Neuropsychological and P300 abnormalities in schizophrenics and their relatives.

Schizophrenic subjects (N = 30) performed less well than controls (N = 30) on neuropsychological tests sensitive to frontal and temporal lobe impairment and showed prolonged latency of the P300 event-related potential. Relatives of schizophrenic probands were also tested. Relatives with an abnormal P300 had a similar range of neuropsychological deficits as were found in the schizophrenic group and relatives with a normal P300 response performed as well as the normal control group.

How specific are negative automatic thoughts to a depressed population? An exploratory study.

This paper is concerned with the relationship between negative or dysfunctional automatic thoughts and dysphoric mood in a non-clinical population. It addresses the question of how specific are these automatic thoughts to a depressed population. Negative automatic thoughts were obtained from 27 normal subjects via a thought-sampling method using the Daily Record of Dysfunctional Thoughts Form (Beck, Rush, Shaw & Emery, 1979) over a two-week period.

Perceptual and physiological dysfunction in depression.

P300 responses to emotive words of different hedonic tones were assessed in depressed patients (unipolar major), patients recovered from the same type of depression and normal controls. Depressed patients showed a smaller amplitude of P300 in response to negatively toned words than to positive words; normal controls showed the opposite pattern and recovered patients showed a pattern of response which resembled that of depressed patients. The experimental trials comparing responses to negative and positive stimuli in relation to neutral words showed significant differences for negative as compared with neutral stimuli, but not for positive as compared with neutral stimuli.

Disturbed endocrine function in the psychoses. II: Discriminant function analysis of multihormone data.

Discriminant function analyses were performed on plasma concentrations of prolactin, growth hormone, cortisol, TSH, and the neurophysins measured over 17 hours in 70 newly admitted drug-free psychiatric patients and 35 control subjects. The hormone data distinguished between patients with different classes of drug-free psychosis (26 schizophrenic, 12 with manic disorder, 10 with major depressive disorder, psychotic subtype, 9 with schizoaffective mania (SAM]. Higher plasma cortisol and lower TSH concentrations separated eight of nine SAM patients from all others.

Disturbed endocrine function in the psychoses. I: Disordered homeostasis or disease process?

Plasma concentrations of prolactin, growth hormone, cortisol, TSH, and the neurophysins were measured over 17 hours in 98 newly admitted psychiatric patients and 35 control subjects. Seventy patients had been free of psychotropic medication for three months. Patients with schizoaffective mania (SAM) differed significantly from control subjects by increased plasma cortisol concentrations and decreased night-time TSH concentrations.

Specificity of the salivary cortisol dexamethasone suppression test across psychiatric diagnoses.

One hundred forty-eight psychiatric inpatients, 12 outpatients, and 17 normal controls were given the 1.0-mg overnight Dexamethasone Suppression Test (DST), with salivary cortisol concentrations being measured as the dependent variable. Based on the Structured Clinical Interview for DSM-III, the patients were diagnosed as having major depression with melancholia (n = 21), nonmelancholic major depression (n = 50), mania (n = 15), schizophrenia (n = 32), dementia (n = 6), substance dependence/abuse n = 18), and miscellaneous (n = 18).

A content analysis of thoughts and emotions elicited from depressed patients during cognitive therapy.

A sample of 200 thoughts obtained from 50 depressed patients at the beginning of a course of cognitive therapy were analysed within the context of Beck's cognitive theory of depression. The results indicated that, of the three elements of the negative cognitive triad, negative view of self and of the world occurred more frequently than negative view of the future. Correspondingly, the principal themes referred to self-deprecation and a hostile world, with hopelessness occurring less frequently; inter- and intra-personal situations were equally represented.

Magnetic resonance imaging in pre-senile dementia of the Alzheimer-type, multi-infarct dementia and Korsakoff's syndrome.

Magnetic resonance imaging T1 values in Alzheimer's disease (ATD) were similar to age-matched controls although frontal T1 values tended to increase intraindividually with progression of the dementia. T1 values were raised, in both cortical grey and white matter, in Korsakoff's syndrome and multi-infarct dementia. T1 values appear of little value in studying the neuropathological changes in ATD in relationship to the neuropsychological deficits, but can assist in the differential diagnosis of pre-senile dementia.

Measuring the course of Alzheimer's disease. A longitudinal study of neuropsychological function and changes in P3 event-related potential.

On two occasions one year apart, the cognitive performance of 12 patients with presenile dementia Alzheimer type (ATD) and 14 with alcoholic Korsakoff syndrome (KS) was assessed both psychologically using the Christensen version of Luria's neuropsychological investigation and physiologically by measuring P300 (P3) and other long-latency auditory event-related potentials. All patients with ATD showed evidence of psychological deterioration and most also showed changes in auditory P3, whereas on all measures the KS group remained essentially unchanged. The extent of the changes in the ATD group varied, but in general those patients with most psychological deterioration also displayed the biggest changes in P3 wave form.

Mood, cognition and cortisol: their temporal relationships during recovery from depressive illness.

Single-case methodology, using cross-lagged panel correlations, was applied to study the order of change in mood, cognition and cortisol concentration in eight in-patients with a diagnosis of major, endogenous depression. Daily measures included: two visual analogue scales measuring depressed mood and general feeling of unwellness; cortisol concentration in saliva (sampled four times a day) and in 24-h urine; two cognitive scales, the Automatic Thoughts Questionnaire and the Cognitive Style Test. The results relating to the temporal relationship between biological and psychological data were ambiguous as the pattern of change was inconsistent among individuals.

Characteristic plasma hormone changes in Alzheimer's disease.

A systematic endocrine investigation in dementia, depression and control subjects showed that plasma growth hormone (GH) was higher in the morning and plasma TSH concentrations were higher throughout the day in Alzheimer-type dementia (ATD) than in age-matched depressed patients (MDD), and plasma TSH concentrations were also higher throughout the day in female ATD compared with age-matched female control subjects. The increased plasma TSH concentrations could not be due to reduced negative feedback because plasma T3, T4 and rT3 were in the normal range. Plasma concentrations of oestrogen-stimulated neurophysin (ESN) were lower throughout the day in ATD compared with MDD and controls and lower in the morning compared with other dementias.

Cognitive brain potentials and psychological deficits in Alzheimer's dementia and Korsakoff's amnesic syndrome.

Auditory-event-related potentials, including the P300 response, were recorded from 20 patients with Alzheimer-type dementia (ATD), 17 patients with Korsakoff's syndrome (KS) and 23 age-matched control subjects. Each of the subjects was assessed using a version of the Luria Neuropsychological Investigation. Prolonged P300 latency and reduced P300 latency and reduced P300 amplitude, which are features of normal ageing and which also occur, to a greater degree, in ATD, correlated significantly with degree of impairment of language ability in both Alzheimer patients and controls.

Changes in auditory P3 event-related potential in schizophrenia and depression.

Event-related potentials during a two-tone discrimination task were recorded in 24 schizophrenic patients, 16 depressed patients and 59 control subjects. Recordings were made when patients were medication-free. Fourteen schizophrenic and 13 depressed patients were retested at 1 and 4 weeks after the start of treatment, and 13 schizophrenic patients were also tested between 6 and 24 months after the initial recordings.

Cognitive style in depression.

A revised version of the CST was validated by comparing depressed patients with anxious patients, recovered depressed and anxious patients and normal controls. Other measures included three severity of illness scales (the Beck Depression Inventory, the Hamilton Rating Scale for Depression and the state version of the State-Trait Anxiety Inventory) and three well-established cognitive scales (the Automatic Thought Questionnaire, the Hopelessness Scale and the Dysfunctional Attitude Scale). Depressed patients were differentiated from normal controls on all subscales of the CST and the three other cognitive scales.

DSM-III melancholia: do the criteria accurately and reliably distinguish endogenous pattern depression?

The Structured Clinical Interview for DSM-III (SCID), Newcastle Endogenous/Reactive Index, Feinberg-Carroll Discriminant Index, and Hamilton Depression Scale were used to assess 70 depressed patients in order to determine similarities and differences in symptom structure and severity in those patients with and without endogenous/melancholic depression. All patients with melancholia according to DSM-III had definite endogenous major depression by the Research Diagnostic Criteria (RDC), but only 20 out of 35 patients with RDC definite endogenous depression were DSM-III melancholic. There was a greater difference in symptom pattern between those patients with definite endogenous depression and those with probable or non-endogenous depression than there was between the melancholic and non-melancholic definite endogenous depressives.