Social Skills & Schizophrenia – A Meta-Analysis of Controlled Research on Social Skills Training for Schizophrenia.

A Meta-Analysis of Controlled Research on Social Skills Training for Schizophrenia, Journal of Consulting & Clinical Psychology. 76(3):491-504, June 2008

Abstract:   A meta-analysis of randomized, controlled trials of social skills training for schizophrenia was conducted. Outcome measures from 22 studies including 1,521 clients were categorized according to a proximal-distal continuum in relation to the presumed site of action of skills training interventions, with content mastery tests and performance-based measures of skills assumed to be most proximal, community functioning and negative symptoms intermediate, and general symptoms and relapse most distal. Results reveal a large weighted mean effect size for content-mastery exams (d = 1.20), a moderate mean effect size for performance-based measures of social and daily living skills (d = 0.52), moderate mean effect sizes for community functioning (d = 0.52) and negative symptoms (d = 0.40), and small mean effect sizes for other symptoms (d = 0.15) and relapse (d = 0.23). These results support the efficacy of social skills training for improving psychosocial functioning in schizophrenia.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Suicide – Feeling our way in the dark: The psychiatric nursing care of suicidal people—A literature review

Feeling our way in the dark: The psychiatric nursing care of suicidal people—A literature review, International Journal of Nursing Studies, Volume 45, Issue 6, June 2008, Pages 942-953

Abstract:

Psychiatric/Mental Health nurses have a long history of being front-line carers of suicidal people, and yet the international epidemiological literature, methodological problems notwithstanding, suggests that contemporary care practices for suicidal people have much room for improvement. As a result, this paper focuses on several areas/issuesnext term of care of the suicidal person, and in so doing, critiques the extant literature, such as it is. This critique illustrates that there is a disconcerting lack of empirically induced theory to guide practice and even less empirical evidence to support-specific interventions. The paper concludes, accepting the axiomatic complexity and multi-dimensionality of previous termsuicide,next term and the undeniable fact that previous termsuicidenext term is a human drama, played out in the everyday lives of people, that for Psychiatric/Mental Health nurses, caring for suicidal people must be an interpersonal endeavor; and one personified by talking and listening.

For the full-text of this journal article please email; susan.jennings@lancashirecare.nhs.uk

Forensic – Assessment of risk and special observations in mental health practice: A comparison of forensic and non-forensic settings

Assessment of risk and special observations in mental health practice: A comparison of forensic and non-forensic settings,  International Journal of Mental Health Nursing
Volume 15, Issue 4, Date: December 2006, Pages: 235-241

Elizabeth Whitehead and Tom Mason,  School of Health and Social Care, University of Chester, Chester, UK

Abstract:  The use of special observations in psychiatric practice may be employed as an alternative to more restrictive methods such as the use of seclusion and restraint. From the literature, special observations are used for a complex array of signs and symptoms (and risk behaviours) which include suicidal intent, self-injurious behaviour, hallucinatory experiences, and absconding. This paper reports on research into the use of special observations in both forensic and non-forensic psychiatric settings. A comparative approach was adopted to establish if the perceived risk factors leading to the adoption of special observations were similar in both settings. Three groups of nursing staff were requested to assess 30 patients who were placed on special observations. Before this, nurses were requested to rate the risk factors in terms of their severity on a 7-point Likert scale. The rank-ordering analysis revealed a similarity of identified risk factors and anova (one-way, unrelated) and the Jonckheere Trend Test revealed that there were significant differences between the scores in the forensic and the non-forensic settings. The statistical differences existed for risk factors relating to harm to self and others but not for psychiatric symptomatology.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Mindfulness – Using mindfulness-based therapeutic interventions in psychiatric nursing practice-part I: Description and empirical support for mindfulness-based interventions

Using mindfulness-based therapeutic interventions in psychiatric nursing practice-part I: Description and empirical support for mindfulness-based interventions , Archives of Psychiatric Nursing, Volume 18, Issue 5, October 2004, Pages 164-169

Abstract:

Finding effective nursing interventions for the treatment of mental illness is a major concern for advanced practice psychiatric nurses (APPN). Increasingly, innovative psychotherapeutic treatment modalities are being used for the treatment of individuals with seriuos mental illness. One such innovative approach, mindfulness-based therapeutic interventions, has been shown to relieve distress for individuals with medical and psychiatric illnesses. In part one of this two-part article, the investigators describe principle concepts of mindfulness, review current research in the usefulness of mindfulness practice for treatment of psychiatric illnesses, and outline the theoretical basis for this treatment modality, including mindfulness-based cognitive therapy (MBCT). In Part II, the writers detail the therapy phases of MBCT and present a clinical case in which an advance practice psychiatric nurse integrates mindfulness-based psychotherapeutic approaches into her treatment. This clinical case may inform future clinical nursing research and advanced psychiatric nursing practice.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Mindfulness – Using mindfulness-based therapeutic interventions in psychiatric nursing practice-part II: Mindfulness-based approaches for all phases of psychotherapy-clinical case study

Using mindfulness-based therapeutic interventions in psychiatric nursing practice-part II: Mindfulness-based approaches for all phases of psychotherapy-clinical case study, Archives of Psychiatric NursingVolume 18, Issue 5,  October 2004, Pages 170-177

Abstract:

In Part I of this two-part article, the authors described principle concepts of mindfulness, reviewed current research in the usefulness of mindfulness practice for treatment of psychiatric illnesses. The structure and content of mindfulness-based cognitive therapy (MBCT) was also outlined and provided the theoretical basis for this treatment approach. This alternative therapeutic approach offers potential usefulness for the treatment of individuals suffering from mental illness. Part II of this article presents a more detailed explanation of mindfulness-based therapeutic approaches for all phases of psychotherapy and identifies relevant research questions that will provide an empirical base to guide clinical practice. A case study illustrates mindfulness-based therapeutic interventions.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Alzheimer’s Latest News – New drug may halt Alzheimer’s progress

New drug may halt Alzheimer’s progress. 29th July 2008 from the Alzheimer’s Research Trust

British scientists have discovered a treatment that appears to slow the progress of Alzheimer’s disease by 81%.

Professor Claude Wischik and colleagues from the University of Aberdeen and TauRx Therapeutics, where he is Chairman, used the drug rember (methylthionium chloride) to act on the tangles present in brains with Alzheimer’s disease.

In the largest ever Phase II clinical trial of a disease modifying treatment, 321 patients with mild and moderate Alzheimer’s disease in the UK and Singapore were found to experience an 81% reduction in cognitive decline over one year when treated with rember. There was no significant decline in mental function over 19 months.

Patient Information – Self-Help Guides

    The new Lancashire Care Patient Information site is now under development. Information and resources will be continually added over the next few weeks …..  If you need to give out information to Patients and are looking for accredited, up-to-date information look no further than the new site.

On site now is:

Self-Help GuidesClick on the title to gain full-text pdf file, for printing or download

12 Steps to Positive Mental Heatlh

CVS East Lancashire – Downloadable Directory coming soon ..

Occupational Therapy – Factors that impede the discharge of long-term schizophrenic inpatients

Factors that impede the discharge of long-term schizophrenic inpatients, Scandinavian Journal of Occupational Therapy, 2008, Online early article

Abstract:

The aim of the present study was to explore factors that impede the discharge of long-term schizophrenic inpatients, and it was focused on the patients’ subjective views. Semi-structured interviews based on the Occupational Self Assessment (OSA) of 73 long-term inpatients with schizophrenia and 24 schizophrenic patients who had been discharged from hospitals after a long-term stay were conducted. Logistic regression analysis was performed. The results revealed that the factors that impeded the discharge of schizophrenic patients from hospitals were advanced age, severe mental symptoms, and higher rating of one’s own capabilities in daily living. These results suggest that schizophrenic long-term inpatients require occupational interventions that help patients to have a realistic image of their daily life after discharge and that invite them to update their self-assessments of competence related to the skills needed for daily life.

For the full-text of this journal article please email: susan.jennings@lancashirecare.nhs.uk

Psychological Therapies – While we are waiting: Experiences of waiting for and receiving psychological therapies on the NHS

While we are waiting: Experiences of waiting for and receiving psychological therapies on the NHS, 25th July 2008, We Need to Talk Coalition

Click on the report title for Full-text Access

Abstract:A group of leading mental health charities has published a report which says that the lives of those stuck on long NHS waiting lists for psychological treatments are being damaged as a result. Mental health problems can worsen, relationships can break down and some people are forced to take time off from work – or give up a job completely – according to While we are waiting.

National clinical guidelines recommend that psychological treatments, such as cognitive behavioural therapy and psychotherapy, should be made available on the NHS. But such therapies remain difficult to access and the wait for patients is long – often more than six months, sometimes years.

One participant who took part in the report’s research said: “The assessment was incredible…I felt that someone finally understood. When I was told that the wait after assessment was two years it felt like a real let down, offering a life line and [then] snatching it away.”

The report comes ahead of the roll out of the Government’s Improving Access to Psychological Therapies (IAPT) programme, which is expected to bring 3,600 extra therapists to half of England’s primary care trusts (PCTs) in the next three years and to reduce waiting times in those areas dramatically.

Empirical evidence on the use and effectiveness of telepsychiatry via videoconferencing: Implications for forensic and correctional psychiatry

Empirical evidence on the use and effectiveness of telepsychiatry via videoconferencing: Implications for forensic and correctional psychiatry, Behavioral Sciences & the Law, Volume 26 Issue 3, Pages 253 - 269

Abstract:  A growing body of literature now suggests that use of telepsychiatry to provide mental health services has the potential to solve the workforce shortage problem that directly affects access to care, especially in remote and underserved areas. Live interactive two-way audio-video communication - videoconferencing - is the modality most applicable to psychiatry and has become synonymous with telepsychiatry involving patient care, distance education, and administration. This article reviews empirical evidence on the use and effectiveness of videoconferencing in providing diagnostic and treatment services in mental health settings that serve child, adolescent, and adult populations. Descriptive reports, case studies, research articles, and randomized controlled trials related to clinical outcomes were identified and reviewed independently by two authors. Articles related to cost-effectiveness, technological issues, or legal or ethical aspects of telepsychiatry were excluded. The review of the evidence broadly covers mental health service provision in all settings, including forensic settings. Given the sparse literature on telepsychiatry in forensic settings, we discuss implications for mental health care across settings and populations and comment on future directions and potential uses in forensic or correctional psychiatry.

 

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

A critical review of explanatory models for self-mutilating behaviors in adolescents

A critical review of explanatory models for self-mutilating behaviors in adolescents, Clinical Psychology ReviewVolume 28, Issue 1, January 2008, Pages 162-178

Click on the Article title for free full-text access 

Abstract:

The present paper presents critical reviews of studies that have explored models of adolescent self-mutilation. Current definitional problems were addressed, as well as a proposal for a classification system of self-mutilation. Seven historically significant explanatory models were included, the sexual/sadomachistic model, the depersonalization model, the interpersonal/systemic model, the suicide model, the physiological/biological model, the affect regulation model, and the behavioral/environmental model. Each model was briefly described, and studies were critiqued according to methodology, research design, and basis upon which authors provided support or rejection of a model. Suggestions for improvement in the literature were made throughout the paper. Studies often overlapped within the models, and the strongest empirical support was shown for the behavioral/environmental model, which included components of the affect regulation model, interpersonal/systemic model, and depersonalization model. Explaining adolescent self-mutilation is a complex task, and evidence provided in this paper suggests that aspects of several models, or an integration of models, likely contribute to the understanding of this phenomenon.

The NHS forensic mental health R&D programme: Developing new talent or maintaining a stage army?

The NHS forensic mental health R&D programme: Developing new talent or maintaining a stage army? , Personality and Mental Health, Volume 2 Issue 3,  Pages 183 - 191
Abstract:
This paper considers the successful recipients of the 79 project awards made during the 12-year life (1996-2007) of the NHS Forensic Mental Health (FMH) R&D programme. The focus is on whether the 213 persons (principal investigators (PIs) and/or co-investigators (CIs)) represent new talent or existing academic entrepreneurs in the FMH field. Amongst PIs, awards were almost without exception given to researchers with an established research track record. Forensic psychiatrists continue to be the main players, but other research groupings are emerging as PIs. In contrast, CIs range more widely in terms of previous research experience and professional background. 38.5 percent had no apparent experience of previous funded research projects apart from grants funded by the FMH programme. Hence, CIs are the source of new talent amongst the programme’s project awards. The authors warn of the dangers of losing the benefits of this investment as policy priorities shift.
For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Suicide & Prisons – Changes in male suicides in Scottish prisons: 10-year study

Changes in male suicides in Scottish prisons: 10-year study, The British Journal of Psychiatry, Jun 2008; 192: 446 – 449.

Abstract:

Background In 1999 I estimated the expected number of UK prison suicides, taking into account that opioid users’ deaths from suicide were 10 times the number expected for their age and gender. Changes have since taken place in Scottish prisons.

Aims

To estimate the expected number of male suicides in Scottish prisons in 1994–2003, having taken age and opioid dependency into account; and to consider the extremes of prisoner age.

Method

The effective number that prisons safeguard in terms of suicide risk was approximated as 10 times the number of opioid-dependent inmates plus other inmates. By applying age-appropriate suicide rates for Scottish males to these effective numbers, expectations for male suicides in Scottish prisons were calculated.

Results

In 1994–98, there were at least 57 male suicides, significantly exceeding the age- and opioid-adjusted expectation of 41. In 1999–2003, the 51 male suicides in prison were consistent with expectation (upper 95% limit: at least 54). During the decade 1994–2003, observed and expected suicides were mismatched at both extremes of age: 40 males aged 15–24 years died by suicide v. 24 expected, and 13 males aged 45+ v. 2 expected. Against 4.5 prison suicides expected for males aged 15–24 years during a 2-year period, actual suicides were 3 in 2002 + 2003 and 4 in 2004 + 2005.

Conclusions

Scotland has redressed an excess of male suicides, especially by its youngest prisoners

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

CBT & Psychosis – Cognitive–behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised controlled trial

Cognitive–behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised controlled trial, The British Journal of Psychiatry, Jun 2008; 192: 412 – 423.

Abstract:

Background

Family intervention reduces relapse rates in psychosis. Cognitive–behavioural therapy (CBT) improves positive symptoms but effects on relapse rates are not established.

Aims

To test the effectiveness of CBT and family intervention in reducing relapse, and in improving symptoms and functioning in patients who had recently relapsed with non-affective psychosis.

Method

A multicentre randomised controlled trial (ISRCTN83557988) with two pathways: those without carers were allocated to treatment as usual or CBT plus treatment as usual, those with carers to treatment as usual, CBT plus treatment as usual or family intervention plus treatment as usual. The CBT and family intervention were focused on relapse prevention for 20 sessions over 9 months.

Results

A total of 301 patients and 83 carers participated. Primary outcome data were available on 96% of the total sample. The CBT and family intervention had no effects on rates of remission and relapse or on days in hospital at 12 or 24 months. For secondary outcomes, CBT showed a beneficial effect on depression at 24 months and there were no effects for family intervention. In people with carers, CBT significantly improved delusional distress and social functioning. Therapy did not change key psychological processes.

Conclusions

Generic CBT for psychosis is not indicated for routine relapse prevention in people recovering from a recent relapse of psychosis and should currently be reserved for those with distressing medication-unresponsive positive symptoms. Any CBT targeted at this acute population requires development. The lack of effect of family intervention on relapse may be attributable to the low overall relapse rate in those with carers.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Self-Injury – Harm minimisation after repeated self-harm: development of a trust handbook

Harm minimisation after repeated self-harm: development of a trust handbook, Psychiatric Bulletin,  Feb 2008; 32: 60 – 63.

Abstract:

Repeated self-harm without suicidal intent occurs in approximately 2% of adults (Meltzer et al, 2002). Service users report that professionals can respond to self-harm with unhelpful attitudes and ineffective care. Although evidence for effective treatments is poor (Hawton et al, 1999), this therapeutic pessimism is not found in the self-help approaches promoted by voluntary organisations such as Mind: ‘If you feel the need to self-harm, focus on staying within safe limits’ (Harrison & Sharman, 2005). User websites frequently offer advice on harm minimisation: ‘Support the person in beginning to take steps to keep herself safe and to reduce her self-injury — if she wishes to. Examples of very valuable steps might be: taking fewer risks (e.g. washing implements used to cut, avoiding drinking if she thinks she is likely to self-injure)’ (Bristol Crisis Service for Women, 1997).

Recent studies suggest manual-assisted cognitive—behavioural therapy can be a cost-effective method of reducing self-harming behaviour (Fagin, 2006). Our conversations with local mental health workers revealed that many did not feel skilled, comfortable or empowered to discuss harm minimisation strategies with service users. Staff were concerned that this approach could be construed as encouraging self-harm, leaving them open to complaints.

For these reasons, we decided to develop a handbook for use within Selby and York Primary Care Trust to promote collaborative working between people who repeatedly self-harm and front-line health professionals. This paper specifically focuses on the issues that arose surrounding harm minimisation.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Ethnic variations in the experiences of mental health service users in England: Results of a national patient survey programme

Ethnic variations in the experiences of mental health service users in England: Results of a national patient survey programme, The British Journal of Psychiatry, Oct 2007; 191: 304 – 312.

Abstract:  Background Minority ethnic groups in the UK are reported to have a poor experience of mental health services, but comparative information is scarce. Aims To examine ethnic differences in patients’ experience of community mental health services.

Method Trusts providing mental health services in England conducted surveys in 2004 and 2005 of users of community mental health services. Multiple regression was used to examine ethnic differences in responses.

Results About 27 000 patients responded to each of the surveys, of whom 10% were of minority ethnic origin. In the 2004 survey, age, living alone, the 2004 survey, age, living alone, detention and hospital admissions were stronger predictors of patient experience than ethnicity. Self-reported mental health status had the strongest explanatory effect. In the 2005 survey, the main negative differences relative to the White British were for Asians.

Conclusions Ethnicity had a smaller effect on patient experience than other variables. Relative to the White British, the Black group did not report negative experiences whereas the Asian group were most likely to respond negatively. However, there is a need for improvements in services for minority ethnic groups, including access to talking therapies and better recording of ethnicity.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Perceptions of disadvantage, ethnicity and psychosis

Perceptions of disadvantage, ethnicity and psychosis, The British Journal of Psychiatry, Mar 2008; 192: 185 – 190.

Abstract:

Background

People from Black ethnic groups (African–Caribbean and Black African) are more prone to develop psychosis in Western countries. This excess might be explained by perceptions of disadvantage.

Aims

To investigate whether the higher incidence of psychosis in Black people is mediated by perceptions of disadvantage.

Method

A population-based incidence and case–control study of first-episode psychosis (Aetiology and Ethnicity in Schizophrenia and Other Psychoses (ÆSOP)). A total of 482 participants answered questions about perceived disadvantage.

Results

Black ethnic groups had a higher incidence of psychosis (OR= 4.7, 95% CI 3.1–7.2). After controlling for religious affiliation, social class and unemployment, the association of ethnicity with psychosis was attenuated (OR=3.0, 95% CI 1.6–5.4) by perceptions of disadvantage. Participants in the Black non-psychosis group often attributed their disadvantage to racism, whereas Black people in the psychosis group attributed it to their own situation.

Conclusions

Perceived disadvantage is partly associated with the excess of psychosis among Black people living in the UK. This may have implications for primary prevention.

For the full-text of this article please email susan.jennings@lancashirecare.nhs.uk

Self-harm in first-episode psychosis

Self-harm in first-episode psychosis, The British Journal of Psychiatry, Mar 2008; 192: 178 – 184

Abstract: Little is known about self-harm occurring during the period of untreated first-episode psychosis.

Aims

To establish the prevalence, nature, motivation and risk factors for self-harm occurring during the untreated phase of first-episode psychosis.

Method

As part of the ÆSOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study, episodes of self-harm were identified among all incident cases of psychosis presenting to services in south-east London and Nottingham over a 2-year period.

Results

Of the 496 participants, 56 (11.3%) had engaged in self-harm between the onset of psychotic symptoms and first presentation to services. The independent correlates of self-harm were: male gender, belonging to social class I/II, depression and a prolonged period of untreated psychosis. Increased insight was also associated with risk of self-harm.

Conclusions

Self-harm is common during the pre-treatment phase of first-episode psychosis. A unique set of fixed and malleable risk factors appear to operate in those with first-episode psychosis. Reducing treatment delay and modifying disease attitudes may be key targets for suicide prevention.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Eating Disorders & Maudsley – An examination of the impact of “the Maudsley eating disorder collaborative care skills workshops” on the well being of carers

An examination of the impact of “the Maudsley eating disorder collaborative care skills workshops” on the well being of carers, Social Psychiatry and Psychiatric Epidemiology, Volume 43, (7) July, 2008

Abstract  

Carers of people with eating disorders experience high levels of distress due to the difficulties in their care giving role and their perceived lack of resources to help their relative. This paper describes an intervention where some of the skills used by specialist nurses and other staff from an eating disorder intensive care setting are taught to carers to improve their sense of competency and alleviate their distress. The aim of this study was to examine the feasibility and acceptability of ‘‘the Maudsley eating disorder collaborative care skills workshops’’ programme among care givers and whether the difficulties and distress involved in caring for a person with an eating disorder were reduced.

For the full-text of this journal article please email: susan.jennings@lancashirecare.nhs.uk

New July Current Awareness in Mental Health Bulletin

   Volume 1 Issue 10 July 2008 Current Awareness in Mental Health Bulletin is now available at the following Link

The focus this week is Evidence-Based Practice.  The bulletin also includes a range of articles in relation to current mental health topics.

Remember any articles you require full-text from the current or archive issues please email:

susan.jennings@lancashirecare.nhs.uk

Understanding the coexistence of alcohol misuse and depression

Understanding the coexistence of alcohol misuse and depression, British Journal of Nursing, Vol. 17, Iss. 11, 12 Jun 2008, pp 696 – 699

Abstract:  This article sets out to discuss some issues of this comorbid disorder. Initially the article defines both alcohol misuse and depression and provides indications of symptomatology, many of which overlap. The article identifies that prevalence is high and draws attention to issues of risk, self-harm and suicide. There is a short discussion on causative factors and the article describes the interrelation of these two disorders and goes on to compare the evidence for a cyclic comorbid disorder, where one increases the severity of the other. It goes on to identify issues of assessment, case management and treatment, including a brief discussion on pharmacotherapy and three psychological therapies.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Special Issue: Treating Comorbid Personality Disorders

  Special Issue: Treating Comorbid Personality Disorders, Journal of Clinical Psychology, Volume 64 Issue 2 , Pages 127 – 230 February 2008

Click on the title above to access the abstracts, for the full-text please email: susan.jennings@lancashirecare.nhs.uk

  • Treating patients with two or more personality disorders: an introduction (p 127-138)
  • Treatment of an avoidant patient with comorbid psychopathology: a plan analysis perspective (p 139-153)
  • Dialectical behavior therapy for comorbid personality disorders (p 154-167)
  • Metacognitive interpersonal therapy in a case of obsessive-compulsive and avoidant personality disorders (p 168-180)
  • Comorbid antisocial and borderline personality disorders: mentalization-based treatment (p 181-194)
  • Supportive-expressive psychotherapy for comorbid personality disorders: a case study (p 195-206
  • Integrated therapy for complex cases of personality disorder (p 207-221)
  • Clinical approaches to axis II comorbidity: commentary (p 222-230)

For the full-text of any of the above articles please email: susan.jennings@lancashirecare.nhs.uk

Cognitive-Behavioral Treatment for Anxiety in Patients With Dementia: Two Case Studies

Cognitive-Behavioral Treatment for Anxiety in Patients With Dementia: Two Case Studies, Journal of Psychiatric Practice. 14(3):186-192, May 2008.

Abstract:   Anxiety is common in dementia and is associated with decreased independence and increased risk of nursing home placement. However, little is known about the treatment of anxiety in dementia. This article reports results from two patients who were treated with a modified version of cognitive-behavioral therapy for anxiety in dementia (CBT-AD). Modifications were made in the content, structure, and learning strategies of CBT to adapt skills to the cognitive limitations of these patients and include collaterals (i.e., family members, friends, or other caregivers) in the treatment process. The patients received education and awareness training and were taught the skills of diaphragmatic breathing, coping self-statements, exposure, and behavioral activation. The Clinical Dementia Rating (CDR) Scale was used to characterize dementia severity and determine eligibility for treatment (a CDR score of 0.5 to 2.0 was required for participation). Other measures included the Rating Anxiety in Dementia scale, the Neuropsychiatric Inventory Anxiety subscale, and the Mini International Neuropsychiatric Interview. Outcome data showed improvement in anxiety as measured by standardized rating scales. We conclude that CBT-AD is potentially useful in treating anxiety in dementia patients and that this technique merits further study.

For the full-text of this journal article please email: susan.jennings@lancashirecare.nhs.uk

Mental Health Nursing – The Medium, the Message, and Evidence-Based Practice

The Medium, the Message, and Evidence-Based Practice, Issues in Mental Health Nursing Volume 29 Issue 3 2008

Abstract: Marshal McLuhan, the media guru of the 1960s, famously observed “we shape our tools, and thereafter our tools shape us” (McLuhan, 1994, p. ix).Tools influence thewaywe think and behave, “we become what we behold” (McLuhan, 1994, p. 19).We extend ourselves through the tools we use but inevitably we also lose something in the process.

McLuhan (1994, p. 5) proposed that “every age has its favourite model of perception and knowledge that it is inclined to prescribe for everybody and everything.” In health care the current dominant, if not entirely favoured, model is embodied in the term “evidence based practice.” It has been described as “ubiquitous” (Tanenbaum, 2005, p.163), the “mantra of the moment” (Jennings & Loan, 2001, p. 121), a “core value” (King, Lloyd, & Meehan, 2007, p. 7), and promoted as a concept that “should apply to all of health care”

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Support, time and recovery (STR) workers: a competence framework: best practice guidance

Support, time and recovery (STR) workers: a competence framework: best practice guidance, 3rd July 2008, Department  of Health

Abstract:

This best practice guidance sets out the background, purpose, and development of the Competence Framework for Support, Time and Recovery (STR) workers employed across health and social care sectors of mental health. It supports the original STR guidance of 2003 and the STR handbook of 2007.

Chronic Insomnia

Chronic Insomnia,   American Journal of Psychiatry 2008 165:6, 678-686

Abstract: Insomnia is used to refer to both a symptom and a disorder.  The symptom of insomnia is defined as a subjective complaint of difficulty falling asleep, difficulty staying asleep, or poor quality sleep.  In DSM-IV-TR, insomnia symptoms are included among the diagnostic criteria for several other mental disorders, including major depressive disorder and generalized anxiety disorder.

This article begins with a hypothetical case illustrating a problem in current clinical practice, it concludes with recommendations.

For the full-text of this journal article please email: susan.jennings@lancashirecare.nhs.uk

Early Intervention & CBT – Early Intervention for Adults at High Risk of Recurrent/Chronic Depression: Cognitive Model and Clinical Case Series

Early Intervention for Adults at High Risk of Recurrent/Chronic Depression: Cognitive Model and Clinical Case Series, Behavioural and Cognitive Psychotherapy 2008, 36: 263-282

Abstract: This paper describes a cognitive model for first/second onset depression that has been precipitated by major life stress, entrenched for several months and is unresponsive to pharmacotherapy. These conditions create high risks for recurrent/chronic depression and early intervention is proposed to identify, treat and protect against relapse/recurrence. Severe life stress interacts with an individual’s core self-representations and personal values, identity is disrupted and depression is maintained by dysfunctional goal engagement and disengagement. Treatment aims to restore functional self-regulation by increasing self-diversification and creating balanced goal investments. Outcome and follow-up data are reported in a case series of five consecutive patients. There was good therapist adherence to the prescribed targets and pre-post effect sizes were comparable or larger than published outcome studies. At the 12 month follow-up, three of the four treatment completers (75%) had made reliable and clinically significant changes and were in full remission. This provides encouraging preliminary evidence for the model’s validity and the therapy’s efficacy.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Anger & CBT – The Development of CBT Programmes for Anger: The Role of Interventions to Promote Perspective-Taking Skills

The Development of CBT Programmes for Anger: The Role of Interventions to Promote Perspective-Taking Skills, Behavioural and Cognitive Psychotherapy (2008), 36:299-312

Abstract:Although the emotion of anger has, in recent years, been the subject of increasing theoretical analysis, there are relatively few accounts of how interventions designed to reduce problematic anger might be related to cognitively oriented theories of emotion. In this review of the literature we describe how a cognitive-behavioural approach to the treatment of those with anger-related problems might be understood in relation to conceptualizations of anger from a cognitive perspective. Three additional interventions (visual feedback, chair-work, forgiveness therapy) are identified that aim to improve the perspective-taking skills of angry clients. It is concluded that such interventions might be considered for use within the context of cognitive-behavioural treatment.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Yoga – Development and evaluation of a yoga exercise programme for older adults

Development and evaluation of a yoga exercise programme for older adults, Journal of Advanced NursingVolume 57, Issue 4, Date: February 2007, Pages: 432-441

Abstract:  The study was conducted in 2005 and it had two phases. Phase I consisted of sending a survey to 10 experts to help develop the Silver Yoga Programme. A hard copy and a video containing detailed descriptions and demonstrations of the programme were then sent to the experts for review and critique regarding the clarity and feasibility of the yoga postures. Phase II was an enquiry into older adults’ views on the programme using a quantitative evaluation and semi-structured qualitative inquiry. Fourteen women participants from a senior activity centre were interviewed individually after 1 month of Silver Yoga group practice, three times per week, 70 minutes per session. They were asked to evaluate the appropriateness of postures based on the criteria of difficulty, acceptability, feasibility and helpfulness. Five open-ended questions asked participants to reflect on their yoga experiences

For the full-text of this journal article please email: susan.jennings@lancashirecare.nhs.uk

Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know

Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know, Journal of Clinical Psychology, Volume 63, Issue 7, Date: July 2007, Pages: 611-631
Abstract:  The history and meaning of evidence-based practice (EBP) in the health disciplines was described to the Council of University Directors of Clinical Psychology (CUDCP) training programs. Evidence-based practice designates a process of clinical decision-making that integrates research evidence, clinical expertise, and patient preferences and characteristics. Evidence-based practice is a transdisciplinary, idiographic approach that promotes lifelong learning. Empirically supported treatments (ESTs) are an important component of EBP, but EBP cannot be reduced to ESTs. Psychologists need additional skills to act as creators, synthesizers, and consumers of research evidence, who act within their scope of clinical expertise and engage patients in shared decision-making. Training needs are identified in the areas of clinical trial methodology and reporting, systematic reviews, search strategies, measuring patient preferences, and acquisition of clinical skills to perform ESTs
For the full-text of this journal article please email: susan.jennings@lancashirecare.nhs.uk
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