Treatments for chronic anxiety have received considerable interest recently. Firstly, there is a body of research which has shown problems of dependence and habituation in the long-term use of anti-anxiety drugs. A second development is that of psychological treatments for anxiety. Because of the problems involved in the use of benzodiazepines, it is important to determine whether or not psychological treatments are a reasonable alternative when treating chronic anxiety. This study was designed to test the relative effectiveness of cognitive-behavioural therapy, anxiety management training and treatment by benzodiazepines against a waiting list control. Measures were taken on both the process and outcome of treatment. The most immediate and greatest improvements in anxiety were seen in the group receiving drugs. However, these improvements reduced as the trial progressed and were minimal at the end of therapy. Both psychological treatment groups improved as the trial progressed with the most significant and consistent changes seen in the cognitive-behaviour therapy group. However, at follow-up there was no difference between the two groups receiving psychological treatments. Because of their lack of sustained improvement, over half of the group receiving drugs refused to wait without treatment until the follow-up assessment.
The concurrent validity of the survey version of the Clifton Assessment Procedures for the Elderly (CAPE) was assessed by comparing the performance of four groups of elderly women selected to represent different levels of impairment and dependency. It was found to discriminate significantly among patients with severe (n = 100), moderate (n = 40), mild (n = 50) and no (n = 20) dementia; it also significantly distinguished between patients with severe and moderate dementia and patients with physical disability (n = 100) and with signs of 'institutionalization' (n = 25). Patients in the severe, moderate, mild and no dementia groups had all been judged clinically to have been placed appropriately as, respectively, geriatric psychiatry in-patients, geriatric psychiatry day-patients or local authority home residents, or as being able to live independently in the community. However, although the survey version dependency grade is intended for use in allocating patients to health and social services facilities, overall agreement between grades and clinically determined placement was only 63 per cent. Thus while the survey version may be useful in discriminating among groups of elderly people of different levels of impairment for research or screening purposes, its clinical value with individual patients remains uncertain.
One hundred and sixteen elderly female in-patients with confirmed diagnoses of senile or arteriosclerotic dementia were tested on the Paired-Associate Learning Test (PALT) and Cognitive Assessment Scale (CAS) of CAPE and were followed up annually for six years. Comparison of those patients who had died by each follow-up date with those who had survived showed that in general the latter had had better PALT and CAS scores.
One hundred and seven elderly female in-patients with confirmed or suspected diagnoses of dementia were assessed by the Paired-Associate Learning Test (PALT), and the Cognitive Assessment Scale (CAS) and Behaviour Rating Scale (BRS) of CAPE. Eighteen months later, 62 patients were still alive. These had significantly better scores on the 'easy' set of PALT and on BRS than the non-survivors; the differences on the 'mediate' and 'hard' sets, and on CAS, while in the predicted direction, were not significant.
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