I. Marks - Academia.edu (original) (raw)

Papers by I. Marks

The Journal of Clinical Psychiatry, 2002

Journal of Neurology, Neurosurgery & Psychiatry, 1961

The basic principle of treatment of phobias and obsessions is exposure of the patient to the evok... more The basic principle of treatment of phobias and obsessions is exposure of the patient to the evoking stimulus. Utilizing this principle, exposure in vivo seems an effective treatment for many, but not all, obsessional patients. The role of tricyclic drugs is at present being investigated. Nurse therapists have been found to be very competent in delivering treatment. Similar results, using an exposure in vivo model, have been obtained in the managment of phobias. Some reasons why patients do not comply with, or adhere to, treatment recommendations are put foward. Finally, the vexed question of the cost-effectiveness of treatment is considered.

Background The concept of fixed, unshakeable (delusional) beliefs within the context of obsessive... more Background The concept of fixed, unshakeable (delusional) beliefs within the context of obsessive–compulsive disorder (OCD) is one that has received varying amounts of attention in the literature, and has not yet received universal acknowledgement. There are good grounds for including these cases within the diagnostic concepts of OCD, with significant implications for clinical management. Aims To present cases with unusual OCD, in order to re-evaluate the issue of delusions and OCD. Method The cases of five subjects with delusions in the course of obsessive–compulsive disorder are presented to illustrate ‘delusional’ OCD. The management and outcome of these cases are discussed. Results Fixity and bizarreness of beliefs in OCD occur on a continuum from ‘none’ to ‘delusional intensity’ and may fluctuate within subjects. Conclusions The idea that these cases may represent a form of OCD has implications for management, as, if this is correct, they should be able to respond to appropriat...

BACKGROUND General psychiatrists have recently been encouraged to provide treatment to heroin add... more BACKGROUND General psychiatrists have recently been encouraged to provide treatment to heroin addicts, including in-patient detoxification. No comparison has previously been made of specialist versus general psychiatric in-patient care. METHOD During a randomised study of cue exposure, 186 opiate addicts were also randomised to either specialist in-patient (DDU; n = 115) or general psychiatric (GEN; n = 71) wards in the same hospital. RESULTS From pre-treatment (post-randomisation) onwards, patient outcomes differed across the two in-patient settings. Of the original randomised sample, significantly more DDU than GEN subjects accepted their randomisation (100 v. 77%), were subsequently admitted (60 v. 42%), and completed in-patient detoxification (45 v. 18%). Of patients admitted, more DDU than GEN patients completed detoxification (75 v. 43%). During seven-month follow-up, of those 43 patients who reached the end of treatment, significantly more ex-DDU than ex-GEN subjects were opi...

British Dental Journal, 1979

This article reviews the evolutionary origins and functions of the capacity for anxiety, and rele... more This article reviews the evolutionary origins and functions of the capacity for anxiety, and relevant clinical and research issues. Normal anxiety is an emotion that helps organisms defend against a wide variety of threats. There is a general capacity for normal defensive arousal, and subtypes of normal anxiety protect against particular kinds of threats. These normal subtypes correspond somewhat to mild forms of various anxiety disorders. Anxiety disorders arise from dysregulation of normal defensive responses, raising the possibility of a hypophobic disorder (too little anxiety). If a drug were discovered that abolished all defensive anxiety, it could do harm as well as good. Factors that have shaped anxiety-regulation mechanisms can explain prepotent and prepared tendencies to associate anxiety more quickly with certain cues than with others. These tendencies lead to excess fear of largely archaic dangers, like snakes, and too little fear of new threats, like cars. An understanding of the evolutionary origins, functions, and mechanisms of anxiety suggests new questions about anxiety disorders.

P sychological treatments improve PTSD but leave many patients with residual symptoms. 1 Identify... more P sychological treatments improve PTSD but leave many patients with residual symptoms. 1 Identifying patients who may not respond well to standard treatment is essential for the provision of appropriate clinical care. It is therefore important to examine what factors influence treatment outcome. However, other than type of treatment received, relatively little is known about what predicts outcome. 2-4 Meta-analyses of the natural development of PTSD following trauma identify poorer social support as the predictor with the greatest weighted effect size. 5,6 However, no research has directly examined whether social support also predicts treatment response. Social support as a putative predictor of treatment outcome merits research attention as it is directly amenable to social and (or) clinical intervention.

Psychiatric Bulletin, 1996

A controlled study of community care in serious mental illness (SMI) was carried out. Patients wi... more A controlled study of community care in serious mental illness (SMI) was carried out. Patients with SMI were randomised to have hospital care or be looked after by a community psychiatric care team in a Daily Living Programme (DIP). The day-to-day work of a clinical team with the difficulties encountered in delivering community psychiatric care in an inner city is described. There were seven deaths from self-harm during the 45-month study. One DIP patient committed homicide. An ordeal by media following this and the suicides are described. Lessons learnt include the need for the community care team to be responsible for discharge from any in-patient phases and for attention to team morale, especially during adversity, and to time spent working under pressure.

and vivo Germany Traumatic stress due to conflict and war causes major mental health problems in ... more and vivo Germany Traumatic stress due to conflict and war causes major mental health problems in many resource-poor countries. The objective of this study was to examine whether trained lay counselors can carry out effective treatment of posttraumatic stress disorder (PTSD) in a refugee settlement. In a randomized controlled dissemination trial in Uganda with 277 Rwandan and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by lay counselors. Strictly manualized narrative exposure therapy (NET) was compared with more flexible trauma counseling (TC) and a no-treatment monitoring group (MG). Fewer participants (4%) dropped out of NET treatment than TC (21%). Both active treatment groups were statistically and clinically superior to MG on PTSD symptoms and physical health but did not differ from each other. At follow-up, a PTSD diagnosis could not be established anymore in 70% of NET and 65% TC participants, whereas only 37% in MG did not meet PTSD criteria anymore. Short-term psychotherapy carried out by lay counselors with limited training can be effective to treat war-related PTSD in a refugee settlement.

British Medical Journal, 1976

Four elderly women had intense fears of falling when there was no visible support at hand or on s... more Four elderly women had intense fears of falling when there was no visible support at hand or on seeing space cues while driving. Two patients had cervical spondylosis. The mean age at onset of the fear was 54-thirty years later than that for agoraphobia. Fear of public places and of heights was not prominent, nor was depersonalisation or depression. These "space phobias" might be a hitherto unrecognised syndrome or an unusual variant of agoraphobia. The visuospatial reflexes involved might illuminate the pathogenesis of certain fears.

The British Journal of Psychiatry, 2001

British Medical Journal, 1996

Objective: To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to th... more Objective: To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome. Design: Randomised controlled trial with final assessment ...

BMJ, 1969

ummary : A new technique is described for the treatment of phobic patients which may be more effe... more ummary : A new technique is described for the treatment of phobic patients which may be more effective than other available methods to date. Three out of four patients treated by implosion (flooding) became almost symptom-free after a mean of 14 sessions and remained so over six-and-a-half months' follow-up. The mechanism of action of the method is not yet clear.

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2010

To understand what predicts good outcome in psychiatric treatments, thus creating a pathway to im... more To understand what predicts good outcome in psychiatric treatments, thus creating a pathway to improving efficacy. Our study investigated relations between predictor variables and outcome (on the Clinician Administered Posttraumatic Stress Disorder [PTSD] Scale [CAPS]) at posttreatment for 77 treatment completers in a randomized controlled trial of exposure therapy and (or) cognitive restructuring, compared with relaxation, for chronic PTSD in adults. More social support on the Significant Others Scale significantly predicted better outcome on the CAPS, even after controlling for the effects of treatment group and of pretreatment severity. Importantly, social support was only a significant predictor of outcome for participants receiving cognitive restructuring and (or) exposure therapy and not for participants in the relaxation condition. Better social support is associated with significantly greater gain following cognitive restructuring and (or) exposure therapy for PTSD. Future i...

The British journal of psychiatry : the journal of mental science, 1999

Psychological treatments for hypochondriasis Sir: Clark et aPs (1998) loose use of terms is misle... more Psychological treatments for hypochondriasis Sir: Clark et aPs (1998) loose use of terms is misleading. Their "cognitive" therapy was in fact cognitive-behavioural therapy (CBT) with (p. 219) "A mixture of cognitive and behavioural techniques" including "behavioural experiments" by imaginal exposure ("inducing symptoms by deliberate body focusing or dwelling on fearful thoughts"), live exposure ("increasing engagement in activities that were avoided because of illness beliefs (for example, exercise)"), and "response prevention for repeated bodily checking and prevention

Health trends, 1993

In health care training, professional examinations of competence test trainees' knowledge rat... more In health care training, professional examinations of competence test trainees' knowledge rather than their actual contribution to the improvement of patients' health. Clinical training programmes have the ultimate aim of improving patients' health, but rarely measure their success in attaining it. This paper provides an analysis of the results of clinical outcome for 2,032 patients treated during eight consecutive English National Board 650 courses, in which 68 nurse behaviour therapist trainees were trained at the Maudsley Hospital from 1978-91. The outcome of 668 patients treated in three recent courses (1987-91) is compared with that of 1,384 patients treated in five earlier courses (1978-86). Measures and diagnostic categories were similar over the whole study period. The trainees in 1987-91 achieved a similar health gain for most of their patients as did their counterparts in 1979-86, but this was achieved over a shorter time spent with each patient, and with great...