Temporal patterns of change in panic disorder during cognitive behaviour therapy: an Indian study.

BACKGROUND: CBT has been proven to be effective in the treatment of panic disorder; however, attempts to study the process of change are limited. AIM: The study evaluated the temporal patterns of change in the panic symptoms, cognitions, behaviours, and anxiety sensitivity in subjects with panic disorder being treated with CBT. METHOD: Thirty subjects with panic disorder were allocated to two groups: Cognitive Behaviour Therapy (CBT, n = 15) and Behaviour Therapy (BT, n = 15). Assessments were carried out weekly for five consecutive weeks using the Semi-Structured Interview Schedule, the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire, and the Texas Panic Attack Record Form. The CBT group received comprehensive CBT and the BT group received psycho-education and Applied Relaxation. RESULTS: Following intervention the change was continuous and gradual on all the variables in the CBT group and the scores reduced to a functional range after 4-5 weeks of therapy. Such a change was not evident in the BT group. Significant change was evident in cognitive domains following the introduction of the exposure and cognitive restructuring within the CBT group. Both cognitive and behavioural techniques contributed to the overall change. CONCLUSION: CBT had an impact on the cognitive domains and significant changes were evident corresponding to the addition of cognitive restructuring and exposure techniques in the 3rd to 5th week. Both cognitive and behavioural components are therefore crucial for overall improvement to occur.

Cross-cultural differences in simple taste preferences.

A population of Indian laborers who show high preferences for sour and bitter tastes has been studied. Their judgments of taste intensity and pleasantness of sweet and salty stimuli are in accord with European population estimates, which suggests that dietary history may alter preferences for simple taste stimuli without affecting the gustatory system.

Transient pseudoleukocytosis caused by cryocrystalglobulinemia.

A patient with Sjögren's syndrome and cryoglobulinemia was found to have pseudoleukocytosis when a leukocyte count was performed on an electronic particle counter. This apparent increase in the leukocyte count was found to be caused by spontaneous crystallization of the cryoglobulin. Further studies showed that this phenomenon was transient. Disappearance of the spontaneous crystal formation without a change in the level of cryoglobulin suggests the possibility of an interaction between the cryoglobulin and a plasma component. Factors affecting spontaneous crystallization of cryoglobulins and the laboratory as well as the clinical implications of pseudoleukocytosis are discussed.

Behavioural intervention in the management of compliance in young type-I diabetics.

OBJECTIVES: a) To examine the efficacy of a behavioural intervention programme in the management of compliance in young Type I diabetics, b) To examine the efficacy of a behavioural management programme in enhancing metabolic control in young Type I diabetics, c) To examine the effect of behavioural intervention on level of diabetes knowledge and quality of life in young Type I diabetics. METHODS: A total of 40 patients (Experimental group n = 20, Control group n = 20) was selected from local hospitals' pediatric, endocrinology and diabetology units. The experimental group received 15 individual sessions of behavioural intervention, consisting of behavioural counseling for family and significant others, relaxation, diabetes education and specific behavioural and cognitive strategies such as reinforcement, target-setting and cognitive restructuring. Assessment was carried out on various psychological measures as well as the glycosylated hemoglobin test (HbA1), at pre and post treatment periods. RESULTS: The scores of the two groups were compared at post treatment point. Results indicate that there was significant improvement in the experimental group in compliance and metabolic control. There were also significant changes noted in the level of diabetes knowledge as well as the reported quality of life. These changes in compliance and metabolic control were maintained at a three month follow-up period. CONCLUSIONS: Behavioural intervention can be included as an effective adjunct to routine medical care in the management of young Type I diabetics, especially in the management of compliance and metabolic control, enhancement of knowledge and quality of life.

Cognitive behavioural intervention in bronchial asthma.

OBJECTIVE: The aim of the present study was to find out the efficacy of cognitive behaviour therapy, as an adjunct to standard pharmacotherapy in bronchial asthma. DESIGN: An experimental design with pre- and post-therapy assessments was adopted. SETTING: The Medicine Out-patient Department of St. John's Medical College and Hospital, and Department of Clinical Psychology, NIMHANS, Bangalore. PATIENTS: Ten asthma patients who fulfilled the inclusion and exclusion criteria, matched for use of drugs, were sequentially allotted to two groups: a) experimental group, who were exposed to cognitive behaviour therapy along with standard pharmacotherapy, b) control group, who were exposed to standard pharmacotherapy alone. INTERVENTION: Cognitive behaviour therapy included 15 individual sessions consisting of asthma education, Jacobson progressive muscle relaxation (JPMR), behavioural techniques, cognitive restructuring, cognitive coping skills and behavioural counseling to significant others. MEASUREMENTS: The measures used for pre- and post-therapy assessments were--Asthma symptom checklist, asthma diary, state trait anxiety inventory-Y1 and Y2, Beck depression inventory, asthma quality of life questionnaire and peak expiratory flow rate. RESULTS: There was significant decrease in asthma symptoms, anxiety and depression; and significant increase in quality of life in the experimental group (p < 0.05) at the post-assessment. The control group did not show any significant change at the post-assessment. CONCLUSION: Cognitive behaviour therapy helps in improving the management of asthma.

Emg biofeedback I: treatment outcome in anxiety neurosis.

36 subjects were included in a study on the efficacy of EMC biofeedback training in the management of anxiety neurosis. The outcome measures included a physiological stress profile and measures of anxiety symptoms, frontalis muscle tension, skin temperature and electrodermal activity. The data analysis indicated that the subjects were able to maintain reduced levels of frontalis muscle tension at rest and during the stress condition without concomitant changes in skin temperature or in electrodermal activity. This pattern of results supported the prediction of the motor skills learning model of EMG biofeedback. The clinical benefits of the training were manifested in the decreased anxiety symptom scores.

Electromyograph feedback: treatment outcome in anxiety neurosis.

Twenty two clients were assessed before and after ten sessions of Electromyograph [EMG] feedback assisted relaxation on both psychological and physiological measures. Results demonstrated significant decreases in the symptom scores and anxiety, as seen on the self-report measures. The clients were found to be significantly less anxious on the Hamilton's Anxiety Rating Scale. Though there was a significant reduction in resting EMG levels, there was no significant decrease in the GSR of the clients. Clients could acquire feedback control as well as self-control.

Autogenic therapy in tension headache.

Ten subjects diagnosed as Psychalgia were taken for study. A multiple baseline design was adapted and clients were subjected to 30 sessions of autogenic training. They were assessed using physiological (EMG and thermal change) and behavioural measures (Visual analogue scale and behavioural symptom checklist). Findings revealed autogenic therapy to be effective in reducing tension headache.

Emg biofeedback ii: the dose-response relationship.

36 clients with anxiety neurosis were trained to reduce frontalis muscle tension over two phases of ten sessions each. They were assessed on psychological and physiological measures, before, during and after the phases. The data analysis indicated that the clients succeeded in lowering frontalis muscle tension levels during the feedback and no-feedback phases of the training sessions. The inter-correlations among the outcome measures indicated that with an increasing amount of control of muscle tensior, the clients perceived greater amounts of change in state anxiety and in anxiety symptoms. This implies that EMG biofeedback can effect cognitive changes in clients.

Role of family in the management of Type-I diabetes: an Indian experience.

The role of the family in the management of Type-I diabetes is gaining recognition. In countries where the adolescent is dependent on the family for medical needs, the family's role is all the more important. At times, when the family is uncooperative, the care of the adolescent is hampered, making psychosocial intervention even more difficult. The following case study illustrates the difficulty encountered while working with a young diabetic belonging to an Indian family. The issues related to parental role and management of diabetes-related problems are discussed.

Cognitive-behavioural intervention in deliberate self-harm.

OBJECTIVE: The objective of the study was to find the efficacy of cognitive behaviour therapy (CBT) in the management of deliberate self-harm (DSH) patients. METHOD: The experimental group (n=20) was given 10 sessions of CBT. CBT included cognitive methods, behavioural methods, problem-solving skills training and behavioural counselling to significant others. The control group (n=20) was given routine medical treatment. Post-assessment was done for both groups at the end of 3 months. RESULTS: The analysis of pre-post-assessment revealed that only the experimental group showed significant improvement on all the variables, except on impulsivity. CONCLUSION: CBT was effective in the management of DSH patients.

Behavior therapy for transsexualism.

Transsexualism is a rare disorder, and there is little literature available on its treatment. A case is presented of transsexualism with homosexual orientation in a 24 year old male. Since the disorder appeared to have behavioral antecedents, it was treated with a behavior therapy package comprising relaxation, aversion therapy with aversion relief, modelling, hypnosis, orgasmic reconditioning, behavioral counselling and sex education. Therapy resulted in normalization of gender identity, but the homosexual orientation persisted.

Visual information processing deficits in clinically remitted outpatient schizophrenics.

Twenty four remitted schizophrenics and twenty four neurotic depressives were studied on three measures of visual information processing, viz., simple reaction time, choice reaction time, and a forced choice span of apprehension test. The groups were matched for age, sex, and educational status. The remitted schizophrenics performed poorly on these measures compared to neurotic depressives. The findings suggest that information processing deficits are present in outpatient schizophrenics even during clinical remission.

Sexual dysfunction in single males: a perspective from India.

Various personal, familial, and socio-cultural factors play a crucial role in the development of sexuality and sexual practices. They often influence the occurrence and maintenance of sexual dysfunctions. Therapies with individuals with sexual dysfunctions often emphasize the involvement of both the partners. Issues related to single males, especially in the Indian context, have not been explored. The present study is a retrospective analysis of clinical case records of single males who reported sexual dysfunctions between the years 1990 to 2000. Thirty-eight clinical case records were analyzed for the demographic details, nature of the problems, and interventions provided with the aim of exploring the reported symptomatology, precipitating and maintaining factors, prevalent beliefs about the causation of sexual dysfunction, and the outcome of interventions. The role of cultural and psychosocial issues is discussed and the need for research in this area is emphasized.

Erythrocyte survival in patients with porcine xenograft aortic and mitral valves.

Ten patients with porcine xenograft aortic and mitral valve prostheses were studied three to 36 months (mean 15 months) postoperatively for evidence of hemolysis. Studies included complete blood count, reticulocyte count, red cell indices, percentage of schistocytes on blood smears, bilirubin concentration, lactic dehydrogenase, serum iron, total iron binding capacity, haptoglobin, serum folate and vitamin B12 levels, Coombs' test, methemoglobin reduction test, autologous 51Cr erythrocyte survival, and urinary examination for iron and hemosiderin. All patients were hemodynamically stable. Nine patients had normal valve function and no evidence of hemolysis. One patient with paravalvular aortic regurgitation had mechanical hemolytic anemia with a negative Coombs' test. Porcine valve xenografts do not seem to be associated with hemolysis unless complicated by a paravalvular leak.