Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T05:34:54.320Z Has data issue: false hasContentIssue false
  • English
  • Français

The Nottingham Study of Neurotic Disorder

Effect of Personality Status on Response to Drug Treatment, Cognitive Therapy and Self-help over Two Years

Published online by Cambridge University Press:  02 January 2018

Peter Tyrer ,
Nicholas Seivewright ,
Brian Ferguson ,
Siobhan Murphy  and
A. L. Johnson
Peter Tyrer*
Affiliation:
St Charles Hospital, London W10 6DZ
Nicholas Seivewright
Affiliation:
University of Manchester, Department of Psychiatry
Brian Ferguson
Affiliation:
Mapperley Hospital, Nottingham
Siobhan Murphy
Affiliation:
St Thomas's Hospital, London
A. L. Johnson
Affiliation:
Medical Research Council Biostatistics Unit, Cambridge
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Abstract

Repeated assessments of psychopathology, together with personality status, were made over two years on 181 psychiatric out-patients with generalised anxiety disorder (59), panic disorder (66), or dysthymic disorder (56) diagnosed using an interview schedule for DSM–III. Patients were randomly allocated to drug treatment, cognitive and behaviour therapy, or a self-help treatment programme. Although there were no overall differences in compliance rate and efficacy between the three modes of treatment, the psychological treatment methods, particularly self-help, were more effective in patients without personality disorder, and those with personality disorder responded better to drug treatment, primarily antidepressants. The findings suggest that assessment of personality status could be a valuable aid to selection of treatment in neurotic disorders and that self-help approaches are particularly valuable once personality disorder has been excluded.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 162 , Issue 2 , February 1993 , pp. 219 - 226
Copyright
Copyright © Royal College of Psychiatrists, 1993 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, H. S. (1983) Diagnosis and classification of affective disorders: new insights from clinical and laboratory approaches. Psychiatric Developments, 1, 123–160.Google Scholar
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn. revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Asberg, M., Montgomery, S. A., Perris, C., et al (1978) A comprehensive psychopathological rating scale. Acta Psychiatrica Scandinavica (suppl. 271), 5–29.CrossRefGoogle Scholar
Ballenger, J. C., Burrows, G. D., Dupont, R. L., et al (1988) Alprazolam in panic disorder and agoraphobia: results from a multicenter trial: I. Efficacy in short-term treatment. Archives of General Psychiatry, 45, 413–422.CrossRefGoogle ScholarPubMed
Blackburn, I. M., Bishop, S., Glen, A. I. M., et al (1981) The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination. British Journal of Psychiatry, 139, 181–189.CrossRefGoogle ScholarPubMed
Cloninger, C. R. (1987) A systematic method for clinical description and classification of personality variants. Archives of General Psychiatry, 44, 573–588.Google Scholar
Elkin, I., Shea, T., Watkins, J. T., et al (1989) National Institute of Mental Health Treatment of Depression Collaborative Research Program. Archives of General Psychiatry, 46, 971–982.Google Scholar
Ghosh, A. & Marks, I. M. (1987) Self-treatment of agoraphobia by exposure. Behavior Therapy, 18, 3–16.CrossRefGoogle Scholar
Johnstone, E. C., Cunningham Owens, D. G., Frith, C. D., et al (1980) Neurotic illness and its response to anxiolytic and antidepressant treatment. Psychological Medicine, 10, 321–328.Google Scholar
Kahn, R. J., Mcnair, D. M., Lipman, R. S., et al (1986) Imipramine and chlordiazepoxide in depressive and anxiety disorders: II. Efficacy in anxious out-patients. Archives of General Psychiatry, 43, 79–85.CrossRefGoogle Scholar
Klein, D. F. (1981) Anxiety reconceptualized. In Anxiety: New Research and Changing Concepts (eds Klein, D. F. & Rabkin, J. G.), pp. 235–263. New York: Raven Press.Google Scholar
Klein, D. F. & Klein, H. (1989) The definition and psychopharmacology of spontaneous panic and phobia. In Psychopharmacology of Anxiety (ed. Tyrer, P.), pp. 135–162. Oxford: Oxford University Press.Google Scholar
Kocsis, J. H., Frances, A. J., Mann, J. J., et al (1985) Imipramine for the treatment of chronic depression. Psychopharmacology Bulletin, 21, 698–700.Google ScholarPubMed
Landis, J. R. & Koch, G. G. (1977) The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.Google Scholar
Lieberman, M. A. & Borman, L. D. (1979) Self-Help Groups for Coping with Crisis. San Francisco: Jossey-Bass.Google Scholar
Lipman, R. S., Covi, L., Rickels, K., et al (1986) Imipramine and chlordiazepoxide in depressive and anxiety disorders: I. Efficacy in depressed out-patients. Archives of General Psychiatry, 43, 68–77.CrossRefGoogle Scholar
Marks, I. & O'Sullivan, G. (1989) Anti-anxiety drug and psychological treatment effects in agoraphobia/panic and obsessive-compulsive disorders. In Psychopharmacology of Anxiety (ed. Tyrer, P.), pp. 196–242. Oxford: Oxford University Press.Google Scholar
Montgomery, S. A. & Asberg, M. (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.Google Scholar
Paykel, E. S., Hollyman, J. A., Freeling, P., et al (1988) Predictors of therapeutic benefit from amitriptyline in mild depression: a general practice placebo-controlled trial. Journal of Affective Disorders, 14, 83–95.Google Scholar
Rush, A. J., Beck, A. T., Kovacs, M., et al (1977) Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed out-patients. Cognitive Research and Therapy, 1, 17–37.CrossRefGoogle Scholar
Salkovskis, P. M., Jones, D. R. O. & Clark, D. M. (1985) Respiratory control in the treatment of panic attack: application and extension with concurrent measurement of behaviour and pCO2 . British Journal of Psychiatry, 148, 526–532.Google Scholar
Siever, L. J., Coccaro, E. F., Zemishlany, Z., et al (1987) Psychobiology of personality disorders: pharmacologic implications. Psychopharmacology Bulletin, 23, 333–335.Google Scholar
Sloane, R. B., Staples, F. R., Cristol, A. H., et al (1976) Shortterm analytically orientated psychotherapy versus behavior therapy. American Journal of Psychiatry, 132, 373–377.Google Scholar
Spitzer, R. L. & Williams, J. B. W. (1983) Structured Clinical Interview for DSM-III (SCID). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
Tyrer, P. (1984) Psychiatric clinics in general practice - an extension of community care. British Journal of Psychiatry, 145, 9–14.CrossRefGoogle ScholarPubMed
Tyrer, P. (1985) Neurosis divisible? Lancet, i, 685–688.CrossRefGoogle Scholar
Tyrer, P. (1990) The division of neurosis: a failed classification. Journal of the Royal Society of Medicine, 83, 614–616.CrossRefGoogle ScholarPubMed
Tyrer, P. & Alexander, J. (1979) Classification of personality disorder. British Journal of Psychiatry, 135, 163–167.Google Scholar
Tyrer, P. & Alexander, J., Casey, P. & Gall, J. (1963) The relationship between neurosis and personality disorder. British Journal of Psychiatry, 142, 404–408.Google Scholar
Tyrer, P. & Alexander, J., Casey, P. & Gall, J., Owen, R. T. & Cicchetti, D. (1984) The Brief Scale for Anxiety: a subdivision of the Comprehensive Psychopathological Rating Scale. Journal of Neurology, Neurosurgery and Psychiatry, 47, 970–975.Google Scholar
Tyrer, P. & Alexander, J., & Gall, J., Owen, R. T. & Cicchetti, D., Casey, P. & Seivewright, N. (1986) Common personality features in neurotic disorder. British Journal of Medical Psychology, 59, 289–294.Google Scholar
Tyrer, P. & Alexander, J., & Gall, J., Owen, R. T. & Cicchetti, D., Casey, P., Seivewright, N., Murphy, S., et al (1988a) The Nottingham study of neurotic disorder: comparison of drug and psychological treatments. Lancet, ii, 235–240.CrossRefGoogle Scholar
Tyrer, P. & Gall, J., Owen, R. T. & Cicchetti, D., Casey, P., Seivewright, N., Murphy, S., Alexander, J. & Ferguson, B. (1988b) Personality assessment schedule. In Personality Disorders: Diagnosis, Management and Course (ed. Tyrer, P.), pp. 140–167. London: Wright.Google Scholar
Tyrer, P. & Gall, J., Owen, R. T. & Cicchetti, D., Casey, P., Murphy, S., Alexander, J. & Ferguson, B., Seivewright, N., Ferguson, B., et al (1990) The Nottingham study of neurotic disorder: relationships between personality status and symptoms. Psychological Medicine, 20, 423–431.CrossRefGoogle ScholarPubMed
Weissman, M. M., Klerman, G. L., Paykel, E. S., et al (1974) Treatment effects on the social adjustment of depressed patients. Archives of General Psychiatry, 30, 771–778.CrossRefGoogle ScholarPubMed
Weissman, M. M., Klerman, G. L., Paykel, E. S., Prusoff, B. A., Dimascio, A., et al (1979) The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. American Journal of Psychiatry, 136, 555–558.CrossRefGoogle ScholarPubMed
Wilson, J. (1989) The role of self-help groups in the management of depression. In Depression: an Integrative Approach (eds Herbst, K. & Paykel, E. S.), pp. 232–249. London: Hememann.Google Scholar
Zigmond, A. S. & Snaith, R. P. (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 57, 361–370.Google Scholar
Zimmerman, M., Coryell, W., Pfohl, B., et al (1986) ECT response in depressed patients with and without a DSM-III personality disorder. American Journal of Psychiatry, 143, 1030–1032.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.