Cancer patients’ perceptions of the good nurse: a literature review

Cancer patients’ perceptions of the good nurse: a literature review, Nursing Ethics, 2009 Sep; 16(5): 528-42

Rchaidia L


This article discusses findings from a mixed method literature review that investigated cancer patients’ perceptions of what constitutes a good nurse. To find pertinent articles, we conducted a systematic key word search of five journal databases (1998-2008). The application of carefully constructed inclusion criteria and critical appraisal identified 12 relevant articles. According to the patients, good nurses were shown to be characterized by specific, but inter-related, attitudes, skills and knowledge; they engage in person-to-person relationships, respect the uniqueness of patients, and provide support. Professional and trained skills as well as broad and specific nursing and non-nursing knowledge are important. The analysis revealed that these characteristics nurtured patient well-being, which manifests as optimism, trust, hope, support, confirmation, safety and comfort. Cancer patients’ perceptions of what constitutes a good nurse represent an important source of knowledge that will enable the development of more comprehensive and practice-based views on good nursing care for such patients. These perceptions help us to understand how nurses effectively make a difference in cancer patient care.

Lancashire Care staff can request the full-text of this paper, email:

Online support for smoking cessation: a systematic review of the literature

Online support for smoking cessation: a systematic review of the literature, Addiction, 2009, Volume 104 Issue 11, Pages 1792 – 1804

Lion Shahab, Andy McEwen


Aim  To examine the efficacy and acceptability of online, interactive interventions for smoking cessation and to identify treatment effect moderators and mediators.

Methods  A systematic review and meta-analysis of the literature (1990–2008) was conducted, finding 11 relevant randomized controlled trials. Data were extracted and risk ratios and risk differences estimated with a random effects model.

Results  There was no evidence of publication bias. Included trials were of variable methodological quality. Web-based, tailored, interactive smoking cessation interventions were effective compared with untailored booklet or e-mail interventions [rate ratio (RR) 1.8; 95% confidence interval (CI) 1.4–2.3] increasing 6-month abstinence by 17% (95% CI 12–21%). No overall effect of interactive compared with static web-based interventions was detected but there was significant heterogeneity, with one study obtaining a clear effect and another failing to find one. Few moderating or mediating factors were evaluated in studies and those that were had little effect. Pooled results suggest that only interventions aimed at smokers motivated to quit were effective (RR 1.3, 95% CI 1.0–1.7). Fully automated interventions increased smoking cessation rates (RR 1.4, 95% CI 1.0–2.0), but evidence was less clear-cut for non-automated interventions. Overall, the web-based interventions evaluated were considered to be acceptable and user satisfaction was generally high.

Conclusion  Interactive, web-based interventions for smoking cessation can be effective in aiding cessation. More research is needed to evaluate the relative efficacy of interactive web-based interventions compared with static websites.

Lancashire Care staff can request the full-text of this paper, email:


RCT of CBT for coexisting depression and alcohol problems: short-term outcome

Randomized controlled trial of cognitive–behavioural therapy for coexisting depression and alcohol problems: short-term outcome, Addiction, 2009

Amanda L. Baker, David J. Kavanagh et al..


Aims  Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone. The present study (Depression and Alcohol Integrated and Single-focused Interventions; DAISI) aimed to compare the effectiveness of brief intervention, single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems.

Methods  Participants (n = 284) with current depressive symptoms and hazardous alcohol use were assessed and randomly allocated to one of four individually delivered interventions: (i) a brief intervention only (single 90-minute session) with an integrated focus on depression and alcohol, or followed by a further nine 1-hour sessions with (ii) an alcohol focus; (iii) a depression focus; or (iv) an integrated focus. Follow-up assessments occurred 18 weeks after baseline.

Results  Compared with the brief intervention, 10 sessions were associated with greater reductions in average drinks per week, average drinking days per week and maximum consumption on 1 day. No difference in duration of treatment was found for depression outcomes. Compared with single-focused interventions, integrated treatment was associated with a greater reduction in drinking days and level of depression. For men, the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning. Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment.

Conclusions  Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems, at least in the short term. Gender differences between single-focused depression and alcohol treatments warrant further study.

Lancashire Care staff can request the full-text of this paper, email:

Improving the health and wellbeing of people with learning disabilities

Improving the health and wellbeing of people with learning disabilities  Department of Health, November 2009

Click on the title above to gain direct access to the full-text of this report


Recent inquiries have demonstrated the health inequalities faced by people with learning disabilities; and the reasonable adjustments needed to overcome them. This is a practical guide to support commissioners to meet the needs of this group, and ensure they are fulfilling their duty to promote equality.

Lancashire Care staff can request the full-text of this paper, email:

Literature Searching – Strategies for Mental Health Nurses

Conducting Efficient Literature Searches: Strategies for Mental Health Nurses,  Michelle Cleary, Glenn E Hunt, Jan Horsfall. Journal of Psychosocial Nursing & Mental Health Services, Nov 2009. Vol. 47, Iss. 11; p. 34 – 42



Access to the most recent evidence is essential for informing best practice clinical decision making, undertaking research, and writing articles for publication. We often hear clinicians remark that nothing has been published on a particular topic and that they know this because they did a database search. However, we do not know if the person completed a thorough search to back up this statement. A clear method is needed to undertake a comprehensive review, and choosing the right key words, search strategies, and databases are essential starting points. Regardless of whether a search is basic or advanced, stages of the search procedures, such as determining key terms, databases used and the date range used within each, fields selected, dates of access, history of search sets, and the justification for excluding data, should be documented to provide an audit trail.

The purpose of this article is to discuss the steps involved in the execution of a thorough literature search for busy mental health nurses (either baccalaureate or advanced practice) in clinical practice. Although a great deal of information is available on websites about search techniques, often this information is ignored by nurses, poorly explained, or only pertinent for a single website. Many researchers are unfamiliar with the strengths and weaknesses of particular databases and search features for systematic reviewing of the literature. In this article, we outline some tips on conducting basic and advanced searches of the literature in several databases and use an example of searching for information regarding patients with dual diagnosis, a common clinical issue for nurses.

Lancashire Care staff can request the full-text of this paper, email:

Reach Out – National Action Strategy on Suicide Prevention 2005-2014

Reach Out – National Action Strategy on Suicide Prevention 2005-2014   2009

Click on the report title to gain direct full-text access


Suicidal behaviour represents a global public health problem and its prevention continues to provide a major challenge to health and social services at all levels of Irish society. More people die by suicide in Ireland each year than in road traffic accidents. Currently, youth suicide rates in Ireland are fifth highest in the European Union (World Health Organisation, 2005). Older people, especially older men, may also be vulnerable and suicide is affecting increasing numbers of Irish people across the lifespan.

Deliberate self-harm is also a significant problem. According to the National Parasuicide Registry,over 11,000 cases of deliberate self-harm are seen in the accident and emergency departments of our hospitals annually and many more cases of deliberate self-harm never come to the attention of the health services.

The causes of suicide are complex and are likely to involve an inter-play of psychological, biological, social and environmental factors in the context of a person’s negative experiences over a lifetime, sometimes aggravated by a recent personal difficulty. Premature death from suicide has many adverse consequences, not only for the family and friends of those who die but for all of those in the wider community who have to cope with the impact of the tragedy.

Lancashire Care staff can request the full-text of this report:

CBT for Suicide Prevention

Cognitive-Behavioral Therapy for Suicide Prevention (CBT-SP): Treatment Model, Feasibility, and Acceptability, Journal of the  American Academy of  Child Adolescent Psychiatry, 2009

Stanley B, et al..


OBJECTIVE –  To describe the elements of a manual-based cognitive-behavioral therapy for suicide prevention (CBT-SP) and to report its feasibility in preventing the recurrence of suicidal behavior in adolescents who have recently attempted suicide. METHOD:: The CBT-SP was developed using a risk reduction and relapse prevention approach and theoretically grounded in principles of cognitive-behavioral therapy, dialectical behavioral therapy, and targeted therapies for suicidal youths with depression. The CBT-SP consists of acute and continuation phases, each lasting about 12 sessions, and includes a chain analysis of the suicidal event, safety plan development, skill building, psychoeducation, family intervention, and relapse prevention. RESULTS:: The CBT-SP was administered to 110 recent suicide attempters with depression aged 13 to 19 years (mean 15.8 years, SD 1.6) across five academic sites. Twelve or more sessions were completed by 72.4% of the sample. CONCLUSIONS:: A specific intervention for adolescents at high risk for repeated suicide attempts has been developed and manual based, and further testing of its efficacy seems feasible.

Lancashire Care staff can request the full-text of this paper, email:

SAMS & Suicide – Self-appraisals may be important for buffering suicidal thoughts and behaviours, potentially providing a key source of resilience

Resilience as positive coping appraisals: Testing the schematic appraisals model of suicide (SAMS). Behaviour Research and Therapy, 2009

Johnson J, Gooding PA, Wood AM, Tarrier N.

School of Psychological Sciences, University of Manchester, UK.


AIMS: The Schematic Appraisals Model of Suicide (SAMS) suggests that positive self-appraisals may be important for buffering suicidal thoughts and behaviours, potentially providing a key source of resilience. The current study aimed to explore whether positive self-appraisals buffered individuals from suicidality in the face of stressful life events. METHOD: 78 participants who reported experiencing some degree of suicidality were recruited from a student population. They completed a battery of questionnaires including measures of suicidality, stressful life events and positive self-appraisals. RESULTS: Positive self-appraisals moderated the association between stressful life events and suicidality. For those reporting moderate or high levels of positive self-appraisals, raised incidence of stressful life events did not lead to increases in suicidality. DISCUSSION: These results support the SAMS framework, and suggest that positive self-appraisals may confer resilience to suicide. Positive self-appraisals may be a promising avenue for further resilience research, and an important area to target for suicide interventions.

Lancashire Care staff can request the full-text of this paper, email:

Self-harm in adolescents

Self-harm in adolescents, Advances in Psychiatric Treatment (2009) 15: 434-441

Alison Wood 

has worked as a consultant in child and adolescent mental health services (CAMHS) for 13 years, 7 of those in Tier 4 services providing in-patient and out-patient/outreach care in partnership with Tier 3 CAMHS for young people with severe mental health disorders. Dr Wood has been actively involved in research of both self-harm and depression.


Self-harm in adolescents is common and is increasing. It can present to professionals as a symptom of major mental health disturbance or it can form part of a cultural ‘norm’. This article reviews current knowledge about self-harm in 12- to 18-year-olds. Definitions of self-harming behaviour, epidemiological and aetiological factors, risk assessment and management of self-harming in various settings are discussed in terms of pragmatic clinical approaches and evidence-based practice.

Lancashire Care staff can request the full-text of this paper, email:

Family Intervention for Suicide Prevention: A specialized emergency department intervention for suicidal youths.

Family Intervention for Suicide Prevention: A specialized emergency department intervention for suicidal youths, Professional Psychology: Research and Practice. Vol 40(2), Apr 2009, 118-125

Asarnow, Joan Rosenbaum; Berk, Michele S.; Baraff, Larry J.


Suicide attempts and suicidal ideation are common problems among youths seen in clinical practice. Despite the high risk of repeated suicidal behavior in these patients, clinicians are faced with a lack of empirically supported treatments for these youths. This article describes the Family Intervention for Suicide Prevention (FISP), a second-generation adaptation of the Specialized Emergency Room Intervention, an evidence-based practice. Although designed for use in emergency settings, the FISP can be used by practitioners working in a wide range of settings where youths present with suicidal emergencies. Rooted in cognitive–behavioral and family systems theory, the FISP is designed to mobilize family support and problem solving, reframe the suicide attempt as a critical event that requires treatment, reinforce more adaptive coping, motivate patients and families to initiate and adhere to follow-up treatment, and promote linkage to follow-up care. This approach can be used with a wide range of patients and offers an evidence-informed tool for practicing clinicians

Lancashire Care staff can request the full-text of this paper, email:

Suicide & Prevention – Investigation into West London Mental Health NHS Trust

Investigation into West London Mental Health NHS Trust  Care Quality Commission, July 2009

Click on the report title to gain direct access to the full-text of this report


This reports on an investigation into West London Mental Health NHS Trust that was triggered by concerns about the trust’s response to suicides within the trust. The investigators carried out two unannounced visits to see the environment in which care was being delivered, how staff engaged with service users and interview staff and managers. The findings are discussed under the following headings: national context; the trust’s history and role; providing a safe environment and protecting people from harm; enabling good outcomes for people through high quality care. The report concludes that one of the things that a trust must do is to learn the lessons from serious incidents and take action to prevent the same things happening again; the system that the trust had in place to do this was seriously flawed. A number of recommendations are made.

Lancashire Care staff can request the full-text of this report, email:

The National Suicide Prevention Strategy for England – Annual Report

The national suicide prevention annual report  of progress in 2008 was published on 10 July 2009, National Mental Health Development Unit

Click on the title above to gain full-text access to this report


The report highlights progress made on a number of specific initiatives during 2008 as well as outlining some key issues for 2009. The suicide rate continues to fall and is now the lowest rate on record.   In addition, there has bee a further fall in the rate of suicide amongst young men under the age of 35. There has also been a further reduction in suicides amongst mental health in-patients and in prisons.  We cannot afford to be complacent however. Previously periods of high unemployment or severe economic problems have had an adverse effect on the mental health of the population and have been associated with higher rates of suicide.  PCTs and other front-line agencies are aware of the situation and continue to identify and support vulnerable individuals who are at risk. …..

Lancashire Care staff can request the full-text of this report, email:

Suicide Prevention – Understanding and strengthening

Public involvement in suicide prevention: understanding and strengthening lay responses to distress, BMC Public Health 2009, 9:308

Owens C, Owen G, Lambert H, Donovan J, Belam J, Rapport F, Lloyd K

1Peninsula Medical School (Universities of Exeter & Plymouth), Wonford House, Dryden Road, Exeter, Devon, EX2 5AF, UK

2Department of Social Medicine, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PS, UK

3PAPYRUS prevention of young suicide, Burnley, Lancashire, UK

4School of Medicine, University of Swansea, Grove Building, Singleton Park, Swansea SA2 8PP, UK



The slogan “Suicide prevention is everyone’s business” has been used in a number of campaigns worldwide in recent years, but most research into suicide prevention has focused on the role of medical professionals in identifying and managing risk. Little consideration has been given to the role that lay people can play in suicide prevention, or to the resources they need in order to do so.

The majority of people who take their own lives are not under the care of specialist mental health services, and around half have not had recent contact with their general practitioner. These individuals are not known to be ‘at risk’ and there is little or no opportunity for clinical intervention. Family members and friends may be the only ones to know that a person is troubled or distressed, and their capacity to recognise, assess and respond to that distress is therefore vitally important. This study aims to discover what the suicidal process looks like from the point of view of relatives and friends and to gain insight into the complex and difficult judgements that people have to make when trying to support a distressed individual.


The study uses qualitative methods to build up a detailed picture of 15–20 completed suicides, aged 18–34. Data are gathered by means of in-depth interviews with relatives, friends and others who knew the deceased well. In each case, as many informants as possible are sought using a purposive snowballing technique. Interviews focus on the family and social network of the deceased, the ways in which relatives and friends interpreted and responded to his/her distress, the potential for intervention that may have existed within the lay network and the knowledge, skills and other resources that would have helped members to support the distressed individual more effectively.


The study will inform interventions to promote public mental health awareness and will provide a basis on which to develop community-focussed suicide prevention strategies.

Lancashire Care staff can request the full-text of this paper, email:

Suicide Prevention Programs & Europe

Optimizing Suicide Prevention Programs and Their Implementation in Europe (OSPI-Europe): An evidence-based multi-level approach  BMC Public Health 2009, 9:428

Hegerl U, Wittenburg L et al..

Click on the title above to gain direct full-text access


Suicide and non-fatal suicidal behaviour are significant public health issues in Europe requiring effective preventive interventions. However, the evidence for effective preventive strategies is scarce. The protocol of a European research project to develop an optimized evidence based programme for suicide prevention is presented.


The groundwork for this research has been established by a regional community based intervention for suicide prevention that focuses on improving awareness and care for depression performed within the European Alliance Against Depression (EAAD). The EAAD intervention consists of (1) training sessions and practice support for primary care physicians,(2) public relations activities and mass media campaigns, (3) training sessions for community facilitators who serve as gatekeepers for depressed and suicidal persons in the community and treatment and (4) outreach and support for high risk and self-help groups (e.g. helplines). The intervention has been shown to be effective in reducing suicidal behaviour in an earlier study, the Nuremberg Alliance Against Depression. In the context of the current research project described in this paper (OSPI-Europe) the EAAD model is enhanced by other evidence based interventions and implemented simultaneously and in standardised way in four regions in Ireland, Portugal, Hungary and Germany. The enhanced intervention will be evaluated using a prospective controlled design with the primary outcomes being composite suicidal acts (fatal and non-fatal), and with intermediate outcomes being the effect of training programs, changes in public attitudes, guideline-consistent media reporting. In addition an analysis of the economic costs and consequences will be undertaken, while a process evaluation will monitor implementation of the interventions within the different regions with varying organisational and healthcare contexts.


This multi-centre research seeks to overcome major challenges of field research in suicide prevention. It pools data from four European regions, considerably increasing the study sam-ple, which will be close to one million. In addition, the study will gather important information concerning the potential to transfer this multilevel program to other health care systems. The results of this research will provide a basis for developing an evidence-based, efficient con-cept for suicide prevention for EU-member states.

Lancashire Care staff can request the full-text of this paper, email:

Suicide in Older Adults – Podcast from Derek Beeston, Principal Lecturer in Ageing and Mental Health, Centre for Ageing and Mental Health, Staffordshire University

Suicide in Older Adults      Lets Respect Podcasts   click here for other podcasts

Click on the title above to listen to the live podcast

Derek Beeston, Principal Lecturer in Ageing and Mental Health, Centre for Ageing and Mental Health, Staffordshire University


Derek Beeston, Principal Lecturer in Ageing and Mental Health, Centre for Ageing and Mental Health, Staffordshire University, discusses the key issues of ageing and risk factors surrounding older adults and suicide. This podcast was produced in partnership with NMHDU’s Lets Respect Campaign

The attitudes of nursing staff in secure environments to young people who self-harm

The attitudes of nursing staff in secure environments to young people who self-harm , Journal of Psychiatric and Mental Health Nursing, Volume 16 Issue 10, Pages 947 – 951


1 Senior Lecturer
University of Central Lancashire
Preston, Lancashire, UK
  2 Principal Lecturer
University of Central Lancashire
Preston, Lancashire, UK
  3 Lecturer, University of Bradford, Yorkshire, UK

Lancashire Care staff can request the full-text of this paper, email:

SUICIDE RISK Assessment: 6 Steps to a Better Instrument

SUICIDE RISK Assessment: 6 Steps to a Better Instrument, Brenda Hermes, Kathy Deakin, Kathy Lee, Sherry Robinson. Journal of Psychosocial Nursing & Mental Health Services. Jun 2009. Vol. 47, Iss. 6; p. 44-50


Recent research indicates that commonly used instruments to assess suicidal ideation identify patients at chronic risk for suicide but do not identify those who are at acute (imminent) risk for suicide while hospitalized. Items to measure anxiety and agitation, identified as more appropriate risk factors, should be incorporated into suicide risk assessments. The purpose of this article was to develop an evidence-based imminent suicide risk instrument for an inpatient psychiatric unit. The Iowa Model of Evidence-Based Practice to Promote Quality Care guided development. Two validated instruments, the Hamilton Anxiety Scale (to measure anxiety) and the Behavioral Activity Rating Scale (to measure agitation) were applied to 75 patients to help create an evidence-based instrument, which should more accurately identify hospitalized patients at risk for imminent suicide.

Lancashire Care staff can request the full-text of this paper, email:

Suicide & Elderly – Are sedatives and hypnotics associated with increased suicide risk of suicide in the elderly?

Are sedatives and hypnotics associated with increased suicide risk of suicide in the elderly? BMC Geriatrics 2009, 9:20 (4 June 2009)

Click on the title to access the full-text of this Highly Accessed article

Carlsten A, Waern M


While antidepressant-induced suicidality is a concern in younger age groups, there is mounting evidence that these drugs may reduce suicidality in the elderly. Regarding a possible association between other types of psychoactive drugs and suicide, results are inconclusive. Sedatives and hypnotics are widely prescribed to elderly persons with symptoms of depression, anxiety, and sleep disturbance. The aim of this case-control study was to determine whether specific types of psychoactive drugs were associated with suicide risk in late life, after controlling for appropriate indications.


The study area included the city of Gothenburg and two adjacent counties (total 65+ population 210 703 at the start of the study). A case controlled study of elderly (65+) suicides was performed and close informants for 85 suicide cases (46 men, 39 women mean age 75 years) were interviewed by a psychiatrist. A population based comparison group (n = 153) was created and interviewed face-to-face. Primary care and psychiatric records were reviewed for both suicide cases and comparison subjects. All available information was used to determine past-month mental disorders in accordance with DSM-IV.


Antidepressants, antipsychotics, sedatives and hypnotics were associated with increased suicide risk in the crude analysis. After adjustment for affective and anxiety disorders neither antidepressants in general nor SSRIs showed an association with suicide. Antipsychotics had no association with suicide after adjustment for psychotic disorders. Sedative treatment was associated with an almost fourteen-fold increase of suicide risk in the crude analyses and remained an independent risk factor for suicide even after adjustment for any DSM-IV disorder. Having a current prescription for a hypnotic was associated with a four-fold increase in suicide risk in the adjusted model.


Sedatives and hypnotics were both associated with increased risk for suicide after adjustment for appropriate indications. Given the extremely high prescription rates, a careful evaluation of the suicide risk should always precede prescribing a sedative or hypnotic to an elderly individual.

Lancashire Care staff can request the full-text of this article, email:

Second-generation antipsychotics for schizophrenia: can we resolve the conflict?

Second-generation antipsychotics for schizophrenia: can we resolve the conflict? Psychological Medicine (2009), 39 : 1591-1602

S. Leucht, W. Kissling and J. M. Davis


The initial enthusiasm about the second-generation or atypical antipsychotic drugs soon changed into criticism and debate, culminating in the controversial CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness), CUtLASS (Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study) and EUFEST (European First-Episode Schizophrenia Trial) effectiveness trials. This review summarizes the results of three recent meta-analyses that compared second-generation antipsychotics (SGAs) with placebo, with conventional antipsychotics, and with SGAs head-to-head. We compare the meta-analyses with previous reviews and put them in the perspective of CATIE, CUtLASS and EUFEST. The data show that the SGAs are not a homogeneous group and that this confusing classification should be abandoned. We find that, overall, the data are consistent but experts interpret the same results differently. The debate seems to be driven more by values than by data; some place an emphasis on cost, others focus on extrapyramidal side-effects (EPS), weight gain, or efficacy. In our opinion, the SGAs are not the breakthrough that industry would like to maintain. They have different properties, so a clinician may individualize a treatment plan to a given patient’s problems, a decision that should be shared with the patient. However, these drugs are important contributions to treatment, and most psychiatrists, let alone patients, would probably not want to do without them.

Lancashire Care staff can request the full-text of this paper, email:

Suicide Prevention Strategy Implementation Programme

Suicide Prevention Strategy Implementation Programme      National Mental Health Development Unit

Click on the title above to access the full range of resources


This programme commenced in September 2002 following the launch of the Suicide Prevention Strategy for England to support the target to reduce the death rate from suicide and undetermined injury by at least 20 per cent by 2010. The strategy sets out a coordinated set of activities that continue to be taken forward and has evolved as new priorities and new evidence on prevention emerge. Implementation of the strategy is being taken forward by the National Mental Health Development Unit (NMHDU) in collaboration with a wide range of organisations and individuals.

Latest News

A revision of Preventing Suicide: A toolkit for mental health service has been published. The toolkit, originally published in 2003, has been amended to reflect recent policy changes and has had input from key stakeholders, service users, carers and experts

Download Preventing Suicide: A toolkit for mental health services

Download the Toolkit Standards

Download the Toolkit Audit tool

Download the Toolkit`s Ward Manager Checklist

If Lancashire Care staff would like any of the resources above please email:

Peaks, Rampton – Clinical and risk characteristics of patients admitted to a secure hospital-based Dangerous and Severe Personality Disorder unit

Clinical and risk characteristics of patients admitted to a secure hospital-based Dangerous and Severe Personality Disorder unit, Journal of Forensic Practice , 2009 Sep; 11(3): 19-27

Sheldon K; Krishnan G

The Peaks Academic and Research Unit, Rampton Hospital and Institute of Mental Health, University of Nottingham, UK


This paper describes the clinical and risk characteristics of patients admitted over the first four years of operation of the Dangerous and Severe Personality Disordered (DSPD) NHS pilot at the Peaks Unit, Rampton Secure Hospital. There were 124 referrals, mainly from Category A and B prisons, resulting in 68 DSPD admissions. Clinically, 29% scored 30 or more on the Psychopathy Checklist. The most common personality disorders were antisocial, borderline, paranoid and narcissistic. There is a high risk of violent/sexual recidivism as measured by the Static-99, Violence Risk Scale, and the Historical, Clinical and Risk Management Scale.

Lancashire Care staff can request the full-text of this paper, email:

Self-Harm & Elderly

Management of self-harm in older people, Psychiatric Bulletin (2009) 33: 423-425

Nikki D. Toms, Senior Medical Advisor in General Medicine

Craig W. Ritchie, Senior Clinical Research Fellow and Honorary Consultant



The epidemiology of self-harm in older people is poorly understood and a low incidence rate hampers research efforts. Regional surveillance for this may assist with research and improve clinical services accordingly. This study involved undertaking a scoping exercise to explore current management of self-harm in elderly people in selected North London hospitals, by interviewing healthcare professionals directly involved in their treatment.


The study showed varied methods of coding clinical information across trusts, with no consistent method of surveillance.


Implications of this exercise involve generation of a summary document that will educate stage two of the project, which is the convention of a working party to implement a surveillance system across the region.

Lancashire Care staff can request the full-text of this paper, email:

OT – The Canadian Occupational Performance Measure: A Tool for Recovery-Based Practice

The Canadian Occupational Performance Measure: A Tool for Recovery-Based Practice, Psychiatric Rehabilition  Journal . 2009 Winter;32(3):171-6

Kirsh B, Cockburn L.


This paper discusses the Canadian Occupational Performance Measure (COPM) which is a tool that supports goal setting and the assessment of change with an individual participating in daily activity. The purpose of the paper is to examine the Canadian Occupational Performance Measure as a potential tool for use in psychiatric rehabilitation and recovery-oriented services. The paper considers the theoretical orientation of the Canadian Occupational Performance Measure and describes the instrument’s structure and properties. In addition, there is a delineation of the instrument’s utility in mental health and an examination of its relationship to psychiatric rehabilitation and recovery principles. The paper uses existing research on the instrument, examines psychosocial rehabilitation literature, and reflects on consultation with local and international researchers/practitioners. The Canadian Occupational Performance Measure is designed to foster partnership between clients and practitioners and it encourages identification of occupationally-focused issues and goals. This instrument promotes an agenda of participation, resumption of life roles, and inclusion in environments of choice.

Lancashire Care staff can request the full-text of this paper, email:


The evolution of depression and suicidality in first episode psychosis

The evolution of depression and suicidality in first episode psychosis, Acta Psychiatrica Scandinavica, 2009

R. Upthegrove, M. Birchwood, K. Ross, K. Brunett, R. McCollum, L. Jones

Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service


Objective: To have a clearer understanding of the ebb and flow of depression and suicidal thinking in the early phase of psychosis, whether these events are predictable and how they relate to the early course of psychotic symptoms.

Method: Ninety-two patients with first episode psychosis (FEP) completed measures of depression, including prodromal depression, self-harm and duration of untreated psychosis. Follow-up took place over 12 months.

Results: Depression occurred in 80% of patients at one or more phases of FEP; a combination of depression and suicidal thinking was present in 63%. Depression in the prodromal phase was the most significant predictor of future depression and acts of self-harm.

Conclusion: Depression early in the emergence of a psychosis is fundamental to the development of future depression and suicidal thinking. Efforts to predict and reduce depression and deliberate self-harm in psychosis may need to target this early phase to reduce later risk.

Lancashire Care staff can request the full-text of this paper, email:


The influence of medications on neurocognition in bipolar disorder

The influence of medications on neurocognition in bipolar disorder , Acta Psychiatrica Scandinavica, 2009,Volume 120 Issue 6, Pages 414 – 415

Eduard Vieta


The last decade has witnessed unprecedented scientific progress in the area of bipolar disorder. This is shown by the fact that there has been an exponential growth of publications (1) and of new drug indications. Nowadays, it is not rare to see journal issues like the present one, where articles on bipolar disorder represent a great deal of what is being published (2–7, even in journals like Acta Psychiatrica Scandinavica, which deal with all the range of mental disorders. One of the most recent and productive areas of research in the field of bipolar disorder has been neurocognition, as one can easily track by the number of citations of the publications that have focused on that topic. Bipolar disorder is no longer free of cognitive impairment, as assumed in the past, but actually a condition in which subtle and mild impairments persist over remission and have an outstanding impact on psychosocial functioning . In the latest years we have been able to disentangle the factors that lead to neurocognitive impairment in bipolar disorder, including genetics (11, 12), subthreshold depressive symptoms (13, 14), the number of episodes (15), particularly the manic ones (16), a history of psychotic features (17), substance abuse (18), poor adherence (19), and of course, medication (20, 21). Medication is actually a two-edge sword because on one hand it improves cognition by targeting psychotic and mood symptoms, but on the other hand it carries its own cognitive side-effects. A traditional example is lithium (22), which can be neuroprotective as well as neurotoxic (23), but in fact no psychotropic drug is free of neuropsychological side-effects. Potential mechanisms underlying those include anticholinergic, sedative, extrapyramidal, and blunting effects, which may vary from drug to drug. Although some drugs appear better than other with this regard (24), large and fully powered randomized comparative trials are not available as yet.

Lancashire Care staff can request the full-text of this paper, email:

CBT in the British NHS: Vague imposition or imposition of vagueness?

CBT in the British NHS: Vague imposition or imposition of vagueness? European Journal of Psychotherapy & Counselling, Volume 11 Issue 3 September 2009 , pages 323 – 339

David Pilgrim – School of Social Work, University of Central Lancashire, Preston, PR1 2HE, UK


The multi-faceted controversy created by the ascendance of cognitive behaviour therapy (CBT) in the British mental health industry is outlined. The historical and philosophical nature of this controversy is traced, by looking at CBT as a psychiatric form of treatment and eclectic form of applied psychology. CBT has become a policy battleground, which can be understood by putting its modernist credentials and its appeal to rationalism, pragmatism and techno-centric optimism into a mixed pre-modern and post-modern context. Given that there are diverse representatives of these realms of belief alive today in our society, the current singular policy emphasis on CBT is anti-democratic and insensitive to diversity. The paradox of this restrictive policy is that CBT itself is now a very diverse set of practices held together mainly by a faith in evidence-based practice. Consequently, a version of pluralism is being tolerated on the supply side of mental health services but a full offer of true choice is not being made on the demand side.

Lancashire Care staff can request the full-text of this paper, email:

OT – Doing Daily Life: How Occupational Therapy Can Inform Psychiatric Rehabilitation Practice

Doing Daily Life: How Occupational Therapy Can Inform Psychiatric Rehabilitation Practice, Terry Krupa, Ellie Fossey, William A Anthony, Catana Brown, Deborah B Pitts Psychiatric Rehabilitation Journal. Winter 2009. Vol. 32, Iss. 3; pg. 155


TOPIC: This paper provides an overview of occupational therapy in the context of psychiatric rehabilitation and mental health recovery. PURPOSE: The paper delineates practical aspects of occupational therapy’s involvement in the mental health field with a discussion of occupation and the elements of conceptual models that guide the practice of occupational therapy. SOURCES USED: CINAHL, Psych Info, Medline. CONCLUSION: Occupational therapy is a key discipline in the field of psychiatric rehabilitation and brings to the field a strong theoretical and knowledge base along with unique procedures and practices. It is important for the psychiatric rehabilitation field to learn from all disciplines, including occupational therapy.

Lancashire Care staff can request the full-text of this paper, email:

Mental health outcome measures in the age of recovery-based services

Mental health outcome measures in the age of recovery-based services, British Journal of Nursing (BJN)2009 Aug 13; 18(15): 940-43

Dickens G – Research Nurse and Honorary Lecturer, St Andrew GTs Academic Centre Research Team, Institute of Psychiatry Kings College London, UK


Patient based outcomes tools such as Health of the Nation Outcome Scales can help users and providers to assess whether mental health services promote wellbeing, and can also inform research and clinical audit. With some exceptions, however, completion rates of routine outcomes ratings are poor, and some argue that current tools are not sufficiently service user-oriented. Concurrently, the recovery model as an approach to mental health care, emphasizing concepts such as hope, meaning and sense of self, has come to prominence. The emerging model creates a need to measure whether recovery-led services deliver positive outcomes. To answer this, it is necessary to first ask whether current routine outcomes tools are suitable measures of recovery-related concepts. This article examines the current state of outcomes measurement in UK mental health services in the age of the recovery model and proposes that a twin-track approach is required.

Lancashire Care staff can request the full-text of this paper, email:

Mental health nurses’ diabetes care skills – a training needs analysis

Mental health nurses’ diabetes care skills – a training needs analysis, British Journal of Nursing (BJN), 2009 May 28; 18(10): 626, 628-30

Nash M – Lecturer in Psychiatric Nursing, School of Nursing and Midwifery, Trinity College, Dublin


This article explores mental health nurses’ diabetes training needs. A survey of inpatient and community mental health nurses was undertaken using a 16-item self-reporting questionnaire. Two hundred and twenty questionnaires were sent out and 138 returned, providing a response rate of 63%. Analysis shows that mental health nurses are currently involved in a range of diabetes care activities, however, their knowledge and skills may not be up to date. Mental health nurses also report the growing impact of diabetes care on their workload. Areas of identified training needs include taking blood glucose readings, giving dietary advice, liaison with diabetes nurse specialists and weight management. Mental health services and education providers need toconsider developing specific training courses for mental health nurses.

Lancashire Care staff can request the full-text of this paper, email:

CCBT & Beating the Blues – The Acceptability of Computer-Aided Cognitive Behavioural Therapy: A Pragmatic Study

The Acceptability of Computer-Aided Cognitive Behavioural Therapy: A Pragmatic Study , Cognitive Behaviour Therapy, 2009

Kate Cavanagh;  David Alan Shapiro;  Susan Van Den Berg;  Sharon Swain;  Michael Barkham; Judy Proudfoot

Department of Clinical Psychology, Newcastle University, Newcastle, UK

The clinical and cost-effectiveness of a computer-aided cognitive behavioural therapy (CCBT) programme, Beating the Blues, is indicated by a number of studies, but relatively little is known about its acceptability for patients with depression, anxiety, or both. This study investigated the acceptability of Beating the Blues offered on eight scheduled clinic visits with brief face-to-face support. Pre and posttreatment measures explored the relationship among programme acceptability, treatment continuation, and outcomes for people accessing the programme in routine care. Two hundred and nineteen patients with depression, anxiety, or both were offered Beating the Blues in 11 primary and secondary care practices. One hundred and ninety-one (87%) completed the pretreatment measures and 84 (38%) completed a treatment feedback questionnaire. Analysis of treatment acceptability for CCBT indicated a positive patient experience with the programme. Pretreatment expectancies predicted CCBT treatment completion but not outcomes. No differences were found between men and women on pretreatment measures. Posttreatment, women reported more favourable responses to the therapy, finding the programme more helpful and more satisfactory, than did men. No relationship between treatment acceptability and age was found. Study limitations, including research methods and attrition rates, and implications for future research are discussed. It is concluded that the Beating the Blues CCBT programme is an acceptable treatment for common mental health problems in routine care.

Lancashire Care staff can request the full-text of this paper, email: