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Articles by G Murray
Total Records ( 4 ) for G Murray
  J Stone , A Carson , R Duncan , R Coleman , R Roberts , C Warlow , C Hibberd , G Murray , R Cull , A Pelosi , J Cavanagh , K Matthews , R Goldbeck , R Smyth , J Walker , A.D MacMahon and M. Sharpe
 

It has been previously reported that a substantial proportion of newly referred neurology out-patients have symptoms that are considered by the assessing neurologist as unexplained by ‘organic disease’. There has however been much controversy about how often such patients subsequently develop a disease diagnosis that, with hindsight, would have explained the symptoms. We aimed to determine in a large sample of new neurology out-patients: (i) what proportion are assessed as having symptoms unexplained by disease and the diagnoses given to them; and (ii) how often a neurological disorder emerged which, with hindsight, explained the original symptoms. We carried out a prospective cohort study of patients referred from primary care to National Health Service neurology clinics in Scotland, UK. Measures were: (i) the proportion of patients with symptoms rated by the assessing neurologist as ‘not at all’ or only ‘somewhat explained’ by ‘organic disease’ and the neurological diagnoses recorded at initial assessment; and (ii) the frequency of unexpected new diagnoses made over the following 18 months (according to the primary-care physician). One thousand four hundred and forty-four patients (30% of all new patients) were rated as having symptoms ‘not at all’ or only ‘somewhat explained’ by ‘organic disease’. The most common categories of diagnosis were: (i) organic neurological disease but with symptoms unexplained by it (26%); (ii) headache disorders (26%); and (iii) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow-up only 4 out of 1030 patients (0.4%) had acquired an organic disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients’ original symptoms. Eight patients had died at follow-up; five of whom had initial diagnoses of non-epileptic attacks. Seven other types of diagnostic change with very different implications to a ‘missed diagnosis’ were found and a new classification of diagnostic revision is presented. One-third of new neurology out-patients are assessed as having symptoms ‘unexplained by organic disease’. A new diagnosis, which with hindsight explained the original symptoms, rarely became apparent to the patient's primary care doctor in the 18 months following the initial hospital consultation.

  K McGorm , C Burton , D Weller , G Murray and M. Sharpe
 

Background. Patients with medically unexplained symptoms (MUS) are commonly referred to specialist clinics. Repeated referrals suggest unmet patient need and inefficient use of resources.

Objectives. How often does this happen, who are the patients and how are they referred?

Methods. The design of the study is a case-control survey. The setting of the study is five general practices in Scotland, UK. The cases were 193 adults with three or more referrals over 5 years, at least two of which resulted in a diagnosis of MUS. The controls were (i) patients referred only once over 5 years and (ii) patients with three or more referrals with symptoms always diagnosed as medically explained. The measures of the study are SF-12 physical and mental component summaries; symptom count; and number of referrals, number of different GPs who had referred and number of specialist follow-up appointments.

Results. A total of 1.1% [95% confidence interval (CI) 1.0–1.2%] of patients had repeated (median 3, range 2–6) referrals with MUS. Compared to infrequently referred controls, they were older and more likely to be female, living alone and unemployed. Compared to controls with medically explained symptoms, their health status was comparable or worse: odds ratio for SF-12 physical component summary <40, 1.2 (95% CI 0.72–2.0); SF-12 mental component summary <40, 1.8 (95% CI 1.1–3.0); reporting eight or more physical symptoms, 2.2 (95% CI 1.2–3.8). They were referred by more GPs and received less specialist follow-up.

Conclusions. A small proportion of primary care patients are repeatedly referred to specialist clinics where they receive multiple diagnoses of MUS. The needs of these patients and how they are managed merits greater attention.

  D Castle , C White , J Chamberlain , M Berk , L Berk , S Lauder , G Murray , I Schweitzer , L Piterman and M. Gilbert
 

Background

Psychosocial interventions have the potential to enhance relapse prevention in bipolar disorder.

Aims

To evaluate a manualised group-based intervention for people with bipolar disorder in a naturalistic setting.

Method

Eighty-four participants were randomised to receive the group-based intervention (a 12-week programme plus three booster sessions) or treatment as usual, and followed up with monthly telephone interviews (for 9 months post-intervention) and face-to-face interviews (at baseline, 3 months and 12 months).

Results

Participants who received the group-based intervention were significantly less likely to have a relapse of any type and spent less time unwell. There was a reduced rate of relapse in the treatment group for pooled relapses of any type (hazard ratio 0.43, 95% CI 0.20–0.95; t343 = –2.09, P = 0.04).

Conclusions

This study suggests that the group-based intervention reduces relapse risk in bipolar disorder.

 
 
 
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