Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-31T15:55:17.440Z Has data issue: false hasContentIssue false
  • English
  • Français

The Effects of Non-Prescribing of Anxiolytics in General Practice: II. Factors Associated with Outcome

Published online by Cambridge University Press:  29 January 2018

Jose Catalan ,
Dennis Gath ,
Alison Bond  and
Pauline Martin
Jose Catalan*
Affiliation:
University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX
Dennis Gath
Affiliation:
University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX
Alison Bond
Affiliation:
University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX
Pauline Martin
Affiliation:
University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX
*
∗Correspondence.
Get access Rights & Permissions [Opens in a new window]

Summary

Factors associated with psychiatric outcome were examined in a series of 87 patients who had presented in general practice with new episodes of minor affective disorder. Two outcome measures were used: (i) Status on Present State Examination (PSE) seven months after initial consultation; (ii) prescribing of psychotropic medication between one-month and seven-month follow-up assessments. Outcome according to the PSE was significantly associated with: worse measures of psychiatric state (General Health Questionnaire, Profile of Mood states) and of social functioning (SAS-M) at initial consultation and one month later; and with persistent anxious or depressed mood during the follow-up period; but not with life events. During the follow-up period 20 patients received at least one psychotropic prescription; they were significantly associated with worse initial GHQ scores, consumption of tobacco and non-prescribed medication, and initial anxiety. A sub-group of 11 patients received multiple psychotropic prescriptions; they were significantly associated with the same initial measures, and also with poor outcome measures (psychiatric and social).

Type
Papers
Information
The British Journal of Psychiatry , Volume 144 , Issue 6 , June 1984 , pp. 603 - 610
Copyright
Copyright © 1984 The Royal College of Psychiatrists 

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

Betts, T. A., Clayton, A. B. & MacKay, G. M. (1972) Effects of four commonly used tranquillisers on low speed driving performance tests. British Medical Journal, 4, 580–4.Google Scholar
British Medical Journal (1975) Tranquillisers causing aggression. 113–14.Google Scholar
Committee on the Review of Medicines (1980) Systematic review of the benzodiazepines. British Medical Journal, 1, 910–12.Google Scholar
Cooper, B. (1972) Clinical and social aspects of chronic neurosis. Proceedings of the Royal Society of Medicine, 65, 19–22.Google Scholar
Cooper, B. & Sylph, J. (1973) Life events and the onset of neurotic illness: an investigation in general practice. Psycholgical Medicine, 3, 421–35.Google Scholar
Cooper, P, Osborn, M., Gath, D. & Feggetter, G. (1982) Evaluation of a modified self-report measure of social adjustment. British Journal of Psychiatry, 141, 68–75.Google Scholar
Corney, R. (1981) Social work effectiveness in the management of depressed women: a clinical trial. Psychological Medicine, 11, 417–23.Google Scholar
Covi, L., Lipman, R. S., Pattison, J. H., Derogatis, L. R. & Uhlenhuth, E. H. (1973) Length of treatment with anxiolytic sedatives and response to their sudden withdrawal. Acta Psychiatrica Scandinavica, 49, 51–64.Google Scholar
Dasberg, H. & van Praag, H. M. (1974) The therapeutic effect of short-term oral diazepam treatment on acute clinical anxiety in a crisis centre. Acta Psychiatric Scandinavica, 50, 326–40.Google Scholar
Edwards, J. G. (1974) Doctors, drugs and drug abuse. The Practitioner, 212, 815–22.Google Scholar
Edwards, J. G. (1979) Overprescribing of psychotropic drugs. In Current Themes in Psychiatry (eds. Gaind R. N. and Hudson B. L.). London: Macmillan.Google Scholar
Gardos, G., Dimascio, A., Salzman, C. & Shader, R. I. (1968) Differential actions of chlordiazepoxide and oxazepam on hostility. Archives of General Psychiatry, 18, 757–60.CrossRefGoogle ScholarPubMed
Goldberg, D. (1972) The detection of Psychiatric Illness by Questionnaire. Oxford University Press.Google Scholar
Goldberg, D. & Blackwell, B. (1970) Psychiatric illness in general practice. A detailed study using a new method of case identification. British Medical Journal, 2, 439–43.Google Scholar
Goldberg, D. & Hillier, V. F. (1979) A scaled version of the General Health Questionnaire. Psychological Medicine, 9, 139–45.Google Scholar
Goldberg, D. & Huxley, P. (1980) Mental Illness in the Community. Tavistock Publications, London.Google Scholar
Goldberg, D., Kay, C. & Thompson, L. (1976) Psychiatric morbidity in general practice and the community. Psychological Medicine, 6, 565–9.Google Scholar
Goldney, R. D. (1977) Paradoxical reaction to a new minor tranquilliser. Medical Journal of Australia, 1, 139–40.Google Scholar
Grahame-Smith, D. G. (1975) Self-medication with mood-changing drugs. Journal of Medical Ethics, 1, 132–7.Google Scholar
Gurland, B. J., Yorkston, N. J., Stone, A. R., et al. (1972) The Structured and Scaled Interview to Assess Maladjustment (SSIAM): I. Description, rationale, and development. Archives of General Psychiatry, 27, 259–64.Google Scholar
Hall, R. C. W. & Joffe, J. R. (1972) Aberrant response to diazepam: a new syndrome. American Journal of Psychiatry, 129, 738–42.Google Scholar
Hawton, K. E. & Blackstock, E. (1976) General practice aspects of self-poisoning and self-injury. Psychological Medicine, 6, 571–5.Google Scholar
Hayes, S. L., Pablo, G., Radomski, T. & Palmer, R. F. (1977) Ethanol and oral diazepam abortion. The New England Journal of Medicine, 296, 186–9.Google Scholar
Huxley, P., Goldberg, D., Maguire, G. & Kincey, V. (1979) The prediction of the course of minor psychiatric disorders. British Journal of Psychiatry, 135, 535–43.Google Scholar
Johnstone, E. C., Owens, D. C. G., Frith, C. D., McPherson, K., Dowie, C., Riley, G. & Gold, A. (1980) Neurotic illness and its response to anxiolytic and antidepressant treatment. Psychological Medicine, 10, 321–8.Google Scholar
Kedward, H. (1969) The outcome of neurotic illness in the community. Social Psychiatry, 4, 1–4.Google Scholar
Keeler, M. H. & McCurdy, R. L. (1975) Medical practice without anti-anxiety drugs. American Journal of Psychiatry, 132, 654–5.Google Scholar
Lancet (1973) Benzodiazepines: use, over-use, misuse, abuse? 1, 1101–2.Google Scholar
Lancet (1978) Stress, distress and drug treatment. 1, 1347–8.Google Scholar
Leach, R. H. & White, P. L. (1978) Use and wastage of prescribed medicines in the home. Journal of the Royal College of General Practitioners, 28, 32–6.Google Scholar
McNair, D. M. & Lorr, M. (1964) An analysis of mood in neurotics. Journal of Abnormal and Social Psychology, 69, 620–7.Google Scholar
Mann, A., Jenkins, R. & Belsey, E. (1981) The twelvemonth outcome of patients with neurotic illness in general practice. Psychological Medicine, 11, 535–50.Google Scholar
Paykel, E. S., Myers, J. K., Dievelt, M. N., Klerman, G. L., Lindenthal, J. L., & Pepper, M. (1969) Life events and depression. Archives of General Psychiatry, 21, 753–60.Google Scholar
Petursson, H. & Loader, M. H. (1981) Withdrawal from long-term benzodiazepine treatment. British Medical Journal, 283, 643–5.Google Scholar
Priest, R. G. (1980) The benzodiazepines: a clinical review. In: Benzodiazepines Today and Tomorrow (eds. Priest R. G., Filho U. V., Amrein R. and Skreta M.). Lancaster, Lancs: MTP Press.Google Scholar
Rickels, K. & Downing, R. W. (1967) Drug and placebo treated neurotic out-patients. Archives of General Psychiatry, 16, 369–72.Google Scholar
Salzman, C., Kochansky, G. E., Shader, R. I., Porrino, L. J., Harmatz, J. S. & Swett, C. P. (1974) Chlordiazepoxide-induced hostility in a small group setting. Archives of General Psychiatry, 31, 401–5.Google Scholar
Seppala, T., Korttila, K., Hakkinen, S. & Linnoila, M. (1976) Residual effects and skills related to driving after a single oral administration of diazepam, medazepam or lorazepam. British Journal of Clinical Pharmacology, 3, 831–41.Google Scholar
Shepherd, M., Cooper, B., Brown, A. C. & Kalton, G. (1981) Psychiatric Illness in General Practice. Second edition, Oxford University Press.Google Scholar
Skegg, D. C. G., Doll, R. & Perry, J. (1977) Use of medicines in general practice. British Medical Journal, 1, 1561–3.Google Scholar
Skegg, D. C. G., Richards, S. M. & Doll, R. (1979) Minor tranquillisers and road accidents. British Medical Journal, 1, 917–19.Google Scholar
Tennant, C., Bebbington, P. & Hurry, J. (1981) The short term outcome of neurotic disorders in the community: the relation of remission to clinical factors and to ‘Neutralizing’ life events. British Journal of Psychiatry, 139, 213–20.Google Scholar
Trethowan, W. H. (1975) Pills for personal problems. British Medical Journal, 3, 749–51.Google Scholar
Tyrer, P. (1978) Drug treatment of psychiatric patients in general practice. British Medical Journal, 2, 1008–10.Google Scholar
Wells, F. O. (1973) Prescribing barbiturates: drug substitution in general practice. Journal of the Royal College of General Practitioners, 23, 164–7.Google Scholar
Wheatley, D. (1972) Evaluation of psychotropic drugs in general practice. Proceedings of the Royal Society of Medicine, 65, 317–20.Google Scholar
Williams, P. (1980) Recent trend in the prescribing of psychotropic drugs. Health Trends, 12, 6–7.Google Scholar
Williams, P., Murray, J., & Clare, A. (1982) A longitudinal study of psychotropic drug prescription. Psychological Medicine, 12, 201–6.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorious, N. (1974) The Measurement and Classification of Psychiatric Symptoms. London: Cambridge University Press.Google Scholar
Winokur, A., Rickels, K., Greenblatt, D. J., Snyder, P. & Schatz, N. J. (1980) Withdrawal reaction from long-term, low dosage administration of diazepam. Archives of General Psychiatry, 37, 101–5.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.