A 4-Year Randomized Controlled Trial The Parkinson Study Group* Background: The best way to initiate dopaminergic therapy for early Parkinson disease remains unclear. Objective: To compare initial treatment with pramipexole vs levodopa in early Parkinson disease, followed by levodopa supplementation, with respect to the development of dopaminergic motor complications, other adverse events, and functional and quality-of-life outcomes. Design: Multicenter, parallel-group, double-blind, randomized controlled trial. Setting: Academic movement disorders clinics at 22 sites in the United States and Canada. Patients: Patients with early Parkinson disease (N=301) who required dopaminergic therapy to treat emerging disability, enrolled between October 1996 and August 1997 and observed until August 2001. Intervention: Subjects were randomly assigned to receive 0.5 mg of pramipexole 3 times per day with levodopa placebo (n = 151) or 25/100 mg of carbidopa/ levodopa 3 times per day with pramipexole placebo (n=150). Dosage was escalated during the first 10 weeks for patients with ongoing disability. Thereafter, investigators were permitted to add open-label levodopa or other antiparkinsonian medications to treat ongoing or emerging disability. Main Outcome Measures: Time to the first occurrence of dopaminergic complications: wearing off, dyskinesias, on-off fluctuations, and freezing; changes in the Unified Parkinson's Disease Rating Scale and quality-oflife scales; and adverse events. Results: Initial pramipexole treatment resulted in a significant reduction in the risk of developing dyskinesias (24.5% vs 54%; hazard ratio, 0.37; 95% confidence interval [CI], 0.25-0.56; PϽ.001) and wearing off (47% vs 62.7%; hazard ratio, 0.68; 95% CI, 0.49-0.63; P=.02). Initial levodopa treatment resulted in a significant reduction in the risk of freezing (25.3% vs 37.1%; hazard ratio, 1.7; 95% CI, 1.11-2.59; P =.01). By 48 months, the occurrence of disabling dyskinesias was uncommon and did not significantly differ between the 2 groups. The mean improvement in the total Unified Parkinson's Disease Rating Scale score from baseline to 48 months was greater in the levodopa group than in the pramipexole group (2 ± 15.4 points vs-3.2 ± 17.3 points, P = .003). Somnolence (36% vs 21%, P = .005) and edema (42% vs 15%, PϽ.001) were more common in pramipexole-treated subjects than in levodopa-treated subjects. Mean changes in quality-of-life scores did not differ between the groups. Conclusions: Initial treatment with pramipexole resulted in lower incidences of dyskinesias and wearing off compared with initial treatment with levodopa. Initial treatment with levodopa resulted in lower incidences of freezing, somnolence, and edema and provided for better symptomatic control, as measured by the Unified Parkinson's Disease Rating Scale, compared with initial treatment with pramipexole. Both options resulted in similar quality of life. Levodopa and pramipexole both appear to be reasonable options as initial dopaminergic therapy for Parkinson disease, but...

Cognitive therapy is likely to be more effective than psychodynamic psychotherapy with chronically anxious patients. Significant improvements in symptoms can be achieved by trainee psychiatrists after only brief instruction in behaviourally based anxiety management. However, the superiority of cognitive therapy at follow-up suggests that the greater investment of resources required for this approach is likely to pay off in terms of more sustained improvement. There is no evidence that 16-20 sessions of treatment is more effective, on average, than 8-10 sessions.

Background: In Scotland, as elsewhere, there has been growing political and public interest in the function and process of parole accompanied by a lack of empirical research on the operation and effectiveness of parole. Aims: Against the backdrop of a Scottish Government review of parole aimed, among other things, at improving the transparency of the process, the aim of the study was to explore the experiences of prisoners seeking early release on licence. Methods: In conjunction with the Scottish Prison Service a national survey was conducted of 197 long-term prisoners who had experience of seeking early release on parole. Findings: The survey revealed that prisoners did not have a clear understanding of parole and often did not feel fully engaged in the process. Conclusions: It is argued that better support for prisoners prior to, during and following parole hearings might foster their increased engagement and alleviate some of the anxiety associated with the parole process.

A one year follow-up is reported of a randomized clinical trial with generalized anxiety disorder (GAD) in which the main comparison was between analytic psychotherapy (AP) and cognitive therapy (CT), each delivered at weekly or fortnightly intervals over a six month period. CT was found to be significantly more effective than AP. However, GAD is a chronic and relapsing condition and follow-up data are needed to assess the durability of improvement and the possibility that the benefits of analytic psychotherapy may be more apparent over the longer term. Data were collected in three areas: (1) symptomatology and overall improvement; (2) medication usage and contact with GPs; and (3) attitudes to therapy. CT was clearly superior to AP on the main outcome measures and only a minority of AP patients made significant improvements. CT but not AP was associated with significant reductions in medication usage, and patients receiving CT were generally more positive about treatment received. Differences between treatments were less evident in the less intensive treatment condition where overall results were relatively poor. The most positive outcomes were achieved in the more intensive CT condition in which approximately two-thirds of patients achieved clinically significant improvements.

This article describes an innovative drama project that took place in a forensic psychiatric unit in Perth, Scotland. The project aimed to engage mentally disordered patients in a meaningful and creative activity. We sought to measure any individual changes in behaviour, self-confidence and self-awareness using questionnaires given to the participating patients and nursing staff. Patients attended weekly drama sessions and devised a performance using their own ideas and improvisations. Six patients participated in the full drama project. They reported that they had enjoyed the project, and that the performance was well received by the audience. Patient and nursing feedback reported improvements in behaviour, interaction with others, self-confidence, self-awareness of feelings and ability to control negative feelings. Most patients hoped to become involved in another similar project. Participation in a creative activity such as drama in this group of participants has found a promising initial outcome that merits further work.