The role of shame and self-critical thinking in the development and maintenance of current threat in post-traumatic stress disorder

The role of shame and self-critical thinking in the development and maintenance of current threat in post-traumatic stress disorder, Clinical Psychology & Psychotherapy, 2010, Volume 17 Issue 1, Pages 13 – 24

Rachel Harman, Deborah Lee

Paediatric Psychology Service, Clare House, St George’s Hospital, London, UK
Sub-Department of Clinical Health Psychology, Torrington Place, London, UK

Abstract:

There is increasing recognition of emotions other than fear in post-traumatic stress disorder (PTSD), and recent research has looked at the role of shame. Cognitive theory suggests that PTSD is caused by traumatic experiences being processed in a way that causes ongoing current threat. In this paper we suggest that shame might contribute to the creation/maintenance of ongoing current threat as it attacks an individual’s psychological integrity. A correlational design was used to investigate some of the factors that might contribute to a shame response within a PTSD sample. It was hypothesized that individuals with PTSD who report higher levels of shame would be more prone to engage in self-critical thinking and less prone to engage in self-reassuring thinking than individuals with PTSD who report lower levels of shame. Data were gathered using self-report questionnaires, and results supported the hypotheses. It is suggested therapy for shame-based PTSD needs to incorporate strategies to help individuals develop inner caring, compassion and self-reassurance.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

The therapist-client relationship, computerized self-help and active therapy ingredients

The therapist-client relationship, computerized self-help and active therapy ingredients, Clinical Psychology & Psychotherapy, 2010, Volume 17 Issue 2, Pages 147 – 153

David F. Peck *
Clinical and Health Psychology, University of Edinburgh

Abstract:

There is strong evidence that a good relationship between therapist and client is associated with positive outcomes after all types of psychological therapy. There is also strong evidence that computer-guided cognitive behaviour therapy (CCBT), in which there may be little or no face-to-face contact, is associated with outcomes that are as good as outcomes after conventional therapy. These two sets of findings can be reconciled by reference to the common factors debate, in that common factors may be as important in CCBT as in conventional therapy; and by reconstruing the therapist-client relationship as a channel through which common and specific factors are brought into play

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Music therapy for autistic spectrum disorder

Music therapy for autistic spectrum disorder, Gold C, Wigram T, Elefant C. Music therapy for autistic spectrum disorder. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004381

Click on the title above to access the full-text of this Cochrane review

Abstract:

Background

The central impairments of people with autistic spectrum disorder (ASD) include social interaction and communication. Music therapy uses music and its elements to enable communication and expression, thus attempting to address some of the core problems of people with ASD.

Objectives

To review the effects of music therapy for individuals with autistic spectrum disorders.

Search strategy

The following databases were searched: CENTRAL, 2005, (Issue 3); Medline, (1966 to July 2004); Embase, (1980 to July 2004); LILACS, (1982 to July 2004); PsycINFO, (1872 to July 2004); CINAHL, (1982 to July 2004); ERIC, (1966 to July 2004); ASSIA, (1987 to July 2004); Sociofile, (1963 to July 2004); Dissertation Abstracts International, (late 1960’s to July 2004). These searches were supplemented by searching specific sources for music therapy literature and manual searches of reference lists. Personal contacts to some investigators were made.

Selection criteria

All randomised controlled trials or controlled clinical trials comparing music therapy or music therapy added to standard care to “placebo” therapy, no treatment or standard care.

Data collection and analysis

Studies were independently selected, quality assessed and data extracted by two authors. Continuous outcomes were synthesised using a standardised mean difference (SMD) in order to enable a meta-analysis combining different scales, and to facilitate the interpretation of effect sizes. Heterogeneity was assessed using the I² statistic.

Main results

Three small studies were included (total n = 24). These examined the short-term effect of brief music therapy interventions (daily sessions over one week) for autistic children. Music therapy was superior to “placebo” therapy with respect to verbal and gestural communicative skills (verbal: 2 RCTs, n = 20, SMD 0.36 CI 0.15 to 0.57; gestural: 2 RCTs, n = 20, SMD 0.50 CI 0.22 to 0.79). Effects on behavioural problems were not significant.

Authors’ conclusions

The included studies were of limited applicability to clinical practice. However, the findings indicate that music therapy may help children with autistic spectrum disorder to improve their communicative skills. More research is needed to examine whether the effects of music therapy are enduring, and to investigate the effects of music therapy in typical clinical practice.

Lancashire care staff can either click on the link above, or email: susan.jennings@lancashirecare.nhs.uk

Supporting the dementia family caregiver: the effect of home care intervention on general well-being

Supporting the dementia family caregiver: the effect of home care intervention on general well-being, Aging & Mental Health, 2010 Jan; 14 (1): 44-56

Schoenmakers B; Buntinx F; DeLepeleire J;

Abstract:

Although high volumes of literature have been written on interventions in dementia home care, only a poor efficiency has been proved. Nevertheless, caregivers often express strong feelings of satisfaction about the proposed support. In this meta-analytic review, a quantitative analysis of the effect of the different types of professional dementia home care interventions was made. Method: A systematic literature search, covering the years 1980 until 2007, was performed using Medline, Embase, Cochrane DSR, Dare, CCTR, and ACP Journal Club). Limitations on publication type were determined as randomized controlled trial and controlled trial. Results: Psychosocial intervention in dementia home care was found to be beneficial in a non-significant way on caregivers’ burden. An almost negligible decrease in depression was found in the psychosocial intervention arm while multidisciplinary case management contributed to a larger though insignificant decrease of depression in caregivers. Respite care was responsible for an increase in burden. Conclusion: This review demonstrated, in accordance with other qualitative reviews, the weak evidence that supporting family caregivers could be beneficial. Although the rather small benefits of formal support, supporting family caregivers is an indispensable issue in dementia home care. Professional caregivers should keep in mind that family caregivers highly appreciate the intervention and that they feel less burdened or depressed in the short time follow up but that premature home care remains more rule than exception.

 

Lancashire care staff can request the full-text of this article, email: susan.jennings@lancashirecare.nhs.uk

Developing the role of advanced nurse practitioners in mental health

Developing the role of advanced nurse practitioners in mental health, Maria Gilfedder, Derek Barron, Eddie Docherty. Nursing Standard. Harrow-on-the-Hill: Mar 31-Apr 6, 2010. Vol. 24, Iss. 30; pg. 35, 6 pgs

Abstract:

This article describes the development of an advanced nurse practitioner (ANP) service in mental health. The ANPs worked within an existing hospital at night team based at Crosshouse Hospital, a district general hospital in Kilmarnock. Set against the agenda of Modernising Nursing Careers and Modernising Medical Careers, the article describes the professional and organisational background to the development, broad training requirements and skills set of this new team of ANPs. The role played by mental health ANPs in replacing junior psychiatric doctors in the out-of-hours period is of significant importance. In addition, these mental health ANPs covered the general wards in the hospital alongside their general ANP colleagues. The competency framework that the ANPs need to complete is discussed as well as the challenges faced in developing the service.
Keywords
Advanced practice, mental health, nurse specialists, out-of-hours care
These keywords are based on subject headings, from the British Nursing Index. All articles are subject to external double-blind peer review and checked for plagiarism using automated software. For author and research article guidelines visit the Nursing Standard home page at http://www.nursing-standard.co.uk. For related articles visit our online archive and search using the keywords.
 

 

MENTAL HEALTH NURSES in Scotland appear to have been slow to take up the challenge of advanced practice. Without a clear definition of advanced practice, nurses might struggle to see where the role fits into the way they provide services and work alongside service users. The Nursing and Midwifery Council (2006, 2007) has endorsed advanced practice as a means of enabling nurses to assess, diagnose, treat and refer patients. In addition, NHS Education for Scotland’s (2008) Advanced Nursing Practice Toolkit can be used to enhance nurses’ understanding and application of advanced practice.

Using the NMC documents and the toolkit as a guide, the authors, mental health nurses in NHS Ayrshire and Arran, planned to lead mental health nurses into advanced practice in what may be considered a unique way. Hurley et al (2009) suggested that mental health nurses frequently adopt approaches from other disciplines as the profession evolves. They caution that the ‘jack of all trades’ label may prevent them from being identified with any one particular role. The authors aim to demonstrate, however, that advanced nursing practice requires a wide range of skills, while developing an additional in-depth skill set.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Do we know when our clients get worse? an investigation of therapists’ ability to detect negative client change

Do we know when our clients get worse? an investigation of therapists’ ability to detect negative client change, Clinical Psychology & Psychotherapy, 2o1o, Volume 17 Issue 1, Pages 25 – 32

Derek Hatfield, Lynn McCullough, Shelby H. B. Frantz, Kenin Krieger

Abstract:

Routine clinical judgment is often relied upon to detect client deterioration. How reliable are therapists’ judgments of deterioration? Two related studies were conducted to investigate therapist detection of client deterioration and therapist treatment decisions in situations of deterioration. The first study examined therapists’ ability to detect client deterioration through the review of therapy progress notes. Therapist treatment decisions in cases of client deterioration were also explored. Therapists had considerable difficulty recognizing client deterioration, challenging the assumption that routine clinical judgment is sufficient when attempting to detect client deterioration. A second study was a survey of therapists asking how they detect client deterioration and what treatment decisions they make in response. Symptom worsening was the most commonly stated cue of deterioration

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk 

A Systematic Review and Meta-Analysis of Ethnic Differences in Use of Dementia Treatment, Care, and Research

A Systematic Review and Meta-Analysis of Ethnic Differences in Use of Dementia Treatment, Care, and Research, The American Journal of Geriatric Psychiatry.  Mar 2010. Vol. 18, Iss. 3; p. 193 (11 pages)

Claudia Cooper, Alec Robert Tandy, Thana B S Balamurali, Gill Livingston

Department of Mental Health Sciences, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London N19 5LW, United Kingdom

Abstract:

The number of people with dementia from minority ethnic (ME) groups in western countries is projected to rise dramatically, and they may be less able to access dementia services. To compare the use of health and social services, treatments for dementia and dementia research between different ethnic groups. A systematic review of 33 articles fitting predetermined criteria. Compatible results were pooled in a meta-analysis. ME people with dementia were more cognitively impaired, and Hispanic people reported a longer duration of memory loss than non-ME people, at the time of referral to diagnostic dementia services in the United States and Australia {pooled weighted mean difference on Mini-Mental State Examination = 3.48 (95% confidence interval [CI]: 2.87-4.09); z = 11.19, p <0.0001; N = 2,090}. These differences remained after controlling for premorbid level of education. The use of community social services did not vary between ME and non-ME people with dementia, but African Americans were 30% less likely to be prescribed cholinesterase inhibitors {odds ratio (OR) 0.7 [0.6-0.9]; z = -3.1, p = 0.002; N = 175}, and ME groups were underrepresented in U.S. dementia drug trials. ME people with dementia were 40% less likely to enter 24-hour care (pooled hazard ratio 0.59 [95% CI: 0.52-0.69]; z = -7.15, p <0.0001; N = 12,053). The authors found consistent evidence, mostly from the United States, that ME people accessed diagnostic services later in their illness, and once they received a diagnosis, were less likely to access antidementia medication, research trials, and 24-hour care. Increasing community engagement and specific recruitment strategies for ME groups might help address inequalities, and these need to be evaluated. More research is also needed to evaluate ME access to dementia services outside the United States.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Caring for people with end-stage dementia

Caring for people with end-stage dementia, Nursing Older People.  Mar 2010. Vol. 22, Iss. 2; p. 31 (6 pages)

Deborah Birch, David Stokoe

Abstract:

This article considers the role of palliative care in the management of patients with dementia. It aims to broaden the knowledge of nurses providing general care as well as specialist palliative and end of life care to patients with dementia in all settings. The article helps nurses to identify the characteristics of end-stage dementia and meet the associated challenges that this diagnosis poses. Nurses should then be in a better position to recognise and support patients and their families and ensure that palliative care is included in care planning for this group of patients.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

The Tower of London test: a test for dementia.

The Tower of London test: a test for dementia, Aging & Mental Health 2010 Mar; 14(2): 155-8

Marchegiani A; Giannelli MV; Odetti PR

Abstract:

Objectives: The Tower of London (ToL) is a problem-solving task, which is a valuable tool for the neuropsychological examination of a patient with a possible cognitive decline. The aim of the present study was to evaluate the ToL in comparison to the Mini Mental State Examination (MMSE) in a group of older people with or without dementia. Method: Seventy outpatients of both sexes, 30 with low-moderate dementia and 40 with apparently normal cognition were evaluated with the MMSE and the ToL task in the same day. The ToL score was calculated according to the Krikorian method and also the execution time was measured. The differences between groups were assessed with the unpaired t-test, and the relationship between two parameters was assessed with the analysis of the coefficient of linear regression. The results were adjusted for age and education. Results: The evaluation of cognitive impairment by MMSE showed a significant difference in the two groups (p < 0.001). The mean scores (p < 0.001) and execution times (p < 0.05) of the ToL, resulted significantly lower in the patients affected by dementia. However, seven participants with dementia had a normal score in the ToL test, indicating that the executive neuropsychological tasks could be preserved notwithstanding the cognitive decline and nine participants with normal MMSE obtained a low ToL score, suggestive of the higher sensibility of the ToL for the executive task that reveals an unknown cognitive deficit. Conclusion: The correlation between MMSE and ToL is good, but ToL test provides complementary information to the MMSE and vice versa.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Mindfulness courses have positive impact – Wigan – Manchester

Mindfulness courses have positive impact

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Some residents from Wigan on incapacity benefit recently took part in a Breathworks “Living Well” eight week course. Breathworks Community Interest Company (C.I.C.)  runs “Living Well” courses around the country.  It is a ‘not for profit’ social enterprise based in Manchester and operating throughout the UK and Europe.

The Worklessness Neighbourhood Fund enabled Breathworks to set up a series of 8 week “Living Well” courses, based on “mindfulness techniques”, for people living with pain, long term illness and stress related disorders. The aim was to help participants manage their condition and improve their quality of life, leading to increased employability. Mindfulness Based Approaches (MBA) are characterised by the ability to pay deliberate attention, in a particular way, to our experience from moment to moment without judgment.

The North West has a high level of people on incapacity benefits (IB).  In Ashton, Leigh and Wigan almost 4,000 claim IB due to musculo-skeletal pain and over 7,000 claim IB due to mental health problems. Courses were designed to shift people’s immediate relationship with long term health conditions using mindfulness.

Recruitment was difficult, Breathworks needed to put extra effort into encouraging people to sign up to the free courses. Once on the courses, the retention rate of participants was high and the evaluation results showed that all who took part felt there had been a positive impact on their lives. Government Office North West have highlighted this project as a practice exemplar to the audit commission around worklessness and health interventions.

For more information contact Cate Clark on 0161 834 1110
www.breathworks-mindfulness.co.uk

Interpersonal Psychotherapy for Depressed Adolescents (IPT- A): Extending the Reach from Academic to Community Settings

Interpersonal Psychotherapy for Depre, ssed Adolescents (IPT- A): Extending the Reach from Academic to Community Settings, Child and Adolescent Mental Health, 2010,Volume 15 Issue 2, Pages 66 – 72

Laura Mufson

Abstract:

Depression is a persistent and impairing illness for adolescents. Many adolescents have limited access to care and/or do not receive adequate treatment for their depression. Researchers have developed a number of empirically supported interventions for adolescent depression; the challenge is to bring these treatments into community settings and assess their effectiveness under real world conditions. This paper provides a critical examination of research conducted on the use of Interpersonal Psychotherapy for depressed adolescents (IPT-A). The paper presents evidence for the efficacy and effectiveness of IPT-A. Implementation and dissemination efforts are discussed in regard to lessons learned and directions for future research.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Group CBT reduces child anxiety diagnoses compared with nonspecific group support

Group CBT reduces child anxiety diagnoses compared with nonspecific group support, Evidence Based Mental Health 2010;13:18

Abstract:

Question:

Is cognitive-behavioural therapy (CBT) more effective than group support and attention for reducing both mother and child reported anxiety?

Patients:

112 children aged between 7 and 16 years with DSM-IV anxiety disorder (mean age 10.2 years, 57% male) and their parents. Exclusion criteria were mental retardation, psychosis, receiving concurrent psychological treatment or with major depression. Children taking medication for anxiety or depression were included if the dose was stable.

Setting:

Australia; recruitment period not reported.

Intervention:

Group CBT or group support and attention (GSA). CBT used the Cool Kids programme which involves affect recognition, cognitive restructuring, child management, social skills training, assertiveness and gradual exposure. It was delivered in ten 2 h sessions once a week. Therapist time was divided equally between the children and parents together and separately. Exposure tasks were planned with the child’s family and completed by the children as homework. GSA contained no aspects of CBT and aimed to provide a supportive environment to express emotions and build relationships.

Outcomes:

Principal anxiety or any anxiety diagnosis (diagnosis considered present if Clinical …

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Cognitive Behavior Therapy: Basic Principles and Recent Advances – Most Read Article

Cognitive Behavior Therapy: Basic Principles and Recent Advances, FOCUS (APPI) Apr 01, 2006; 4: 173-178.

Jesse H. Wright

Most Read Article

Abstract:

Cognitive behavior therapy (CBT) is a pragmatic, action-oriented treatment approach that has become a widely used psychotherapy for major mental disorders. CBT methods were initially developed for depression and anxiety disorders (13), and later they were modified for many other conditions, including personality disorders, eating disorders, and substance abuse; they have also been adapted for use as an adjunct to medication in the management of schizophrenia and bipolar disorder (3, 47). This article delineates the core principles of CBT, describes procedures used in clinical practice, and notes some of the recent advances that have been made in this treatment method. The extensive research supporting the efficacy of CBT is briefly reviewed.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk 

NICE update – Bipolar

Bipolar disorder  NICE

Click on the title to access the full-text of the update

The management of bipolar disorder in adults, children and adolescents, in primary and secondary care

Description

The NICE clinical guideline on bipolar disorder covers: what treatment people with bipolar disorder can expect to be offered, including medication and psychological therapies advice on self-help the services that may help people with bipolar disorder, including psychiatric or specialist …

The NICE clinical guideline on bipolar disorder covers:

  • what treatment people with bipolar disorder can expect to be offered, including medication and psychological therapies
  • advice on self-help
  • the services that may help people with bipolar disorder, including psychiatric or specialist mental health services
  • how families and carers may be able to support people with bipolar disorder, and get support for themselves.

 This guidance has replaced TA66 Bipolar disorder – new drugs

Second generation antipsychotics reduce dropout rates compared with first generation antipsychotics

Second generation antipsychotics reduce dropout rates compared with first generation antipsychotics, Evidence Based Mental Health 2010;13:24

Abstract:

Question:

Do second generation medications for schizophrenic disorders result in similar dropout rates to first generation treatments?

Outcomes:

Dropout, predictors of dropout rates (eg, trial duration, number of treatment groups, patient type, type of dosing, inpatients, dosage and study year).

Methods

Design:

Systematic review with meta-analysis.

Data sources:

Pubmed and the Cochrane Central Register of Controlled Trials were searched from 1990 to 2006.

Study selection and analysis:

Double blind randomised controlled trials comparing second generation antipsychotic medications versus each other, first generation antipsychotics or placebo in any adult population with a diagnosis of schizophrenia, schizoaffective or schizophreniform disorder were included. Eligible second generation drugs were risperidone, olanzapine, clozapine, quetiapine, amisulpride, ziprasidone, sertindole and aripiprazole. The proportions of patients who dropped out from each study group were calculated as well as the odds ratios and 95% CI for those studies that compared first and second generation drugs. Random effects meta-analysis was used to compare dropout rates, firstly for all studies and then for subgroups by study size (at least 30, 50 and 100 patients), dose (removing high…

Lancashire care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

White Matter Integrity and Cognitive Impairment in First-Episode Psychosis

White Matter Integrity and Cognitive Impairment in First-Episode Psychosis, American Journal of Psychiatry 2010 167: 451-458

Rocío Pérez-Iglesias

Abstract:

Objective: Impaired cognitive function has been identified as a core feature of schizophrenia. However, a significant proportion of patients do not show any cognitive deficits. The aim of this study was to assess if there were differences in white matter integrity between patients with and without cognitive impairment.

Method: A diffusion tensor imaging study and neurocognitive assessment were conducted in 49 patients with first-episode psychosis and 41 healthy comparison subjects. Subjects were assessed using the Continuous Performance Test, the Grooved Pegboard Test, the Rey Auditory Verbal Learning Test, and the Trail Making Test Part B. For each test, the patient sample was subdivided according to performance, with those scoring more than one standard deviation below the normative mean categorized as impaired. For each cognitive domain, white matter fractional anisotropy in deficit and nondeficit subgroups was compared using a voxel-based analysis. A nonparametric statistical method, controlling for multiple comparisons, was applied.

Results: Impairment on the Trail Making Test Part B was associated with reduced fractional anisotropy in the right/left anterior thalamic radiation and inferior fronto-occipital fasciculus, forceps minor, and left superior and inferior longitudinal fasciculi. Patients exhibiting Grooved Pegboard Test impairment showed reduced fractional anisotropy in the forceps minor, inferior fronto-occipital fasciculus, anterior thalamic radiation, and corticospinal and corticopontine tracts. Impaired performance on the Rey Auditory Verbal Learning Test and Continuous Performance Test was not associated with significant differences in fractional anisotropy.

Conclusion: Deficits in executive and motor functioning in patients with first-episode psychosis are associated with reductions in white matter integrity in the major fasciculi that connect the frontal and temporal cortices as well as in pathways connecting cortical and subcortical regions. Their presence at the onset of illness, in minimally medicated patients, indicates that these findings are not attributable to effects of chronic illness or its treatment.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms?

Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms? Addiction, 2010, Volume 105 Issue 4, Pages 626 – 636

John F. Kelly

Abstract:

Rationale  Indices of negative affect, such as depression, have been implicated in stress-induced pathways to alcohol relapse. Empirically supported continuing care resources, such as Alcoholics Anonymous (AA), emphasize reducing negative affect to reduce relapse risk, but little research has been conducted to examine putative affective mechanisms of AA’s effects.

Methods  Using lagged, controlled, hierarchical linear modeling and mediational analyses this study investigated whether AA participation mobilized changes in depression symptoms and whether such changes explained subsequent reductions in alcohol use. Alcohol-dependent adults (n = 1706), receiving treatment as part of a clinical trial, were assessed at intake, 3, 6, 9, 12 and 15 months.

Results  Findings revealed elevated levels of depression compared to the general population, which decreased during treatment and then remained stable over follow-up. Greater AA attendance was associated with better subsequent alcohol use outcomes and decreased depression. Greater depression was associated with heavier and more frequent drinking. Lagged mediation analyses revealed that the effects of AA on alcohol use was mediated partially by reductions in depression symptoms. However, this salutary effect on depression itself appeared to be explained by AA’s proximal effect on reducing concurrent drinking.

Conclusions  AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery-related change.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Mindfulness-based treatments for co-occurring depression and substance use disorders: what can we learn from the brain?

Mindfulness-based treatments for co-occurring depression and substance use disorders: what can we learn from the brain? Addiction, 2010

Judson A. Brewer, Sarah Bowen, Joseph T. Smith, G. Alan Marlatt, Marc N. Potenza

Abstract:

Both depression and substance use disorders represent major global public health concerns and are often co-occurring. Although there are ongoing discoveries regarding the pathophysiology and treatment of each condition, common mechanisms and effective treatments for co-occurring depression and substance abuse remain elusive. Mindfulness training has been shown recently to benefit both depression and substance use disorders, suggesting that this approach may target common behavioral and neurobiological processes. However, it remains unclear whether these pathways constitute specific shared neurobiological mechanisms or more extensive components universal to the broader human experience of psychological distress or suffering. We offer a theoretical, clinical and neurobiological perspective of the overlaps between these disorders, highlight common neural pathways that play a role in depression and substance use disorders and discuss how these commonalities may frame our conceptualization and treatment of co-occurring disorders. Finally, we discuss how advances in our understanding of potential mechanisms of mindfulness training may offer not only unique effects on depression and substance use, but also offer promise for treatment of co-occurring disorders.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Low Secure Units & Offending Risk – Evidence

Addressing offending risk in low secure mental health services for men: a descriptive review of available evidence, British Journal of Forensic Practice, 2010 Feb; 12 (1): 38-47

Nagi C; Davies J

Abstract:

The topic of offender rehabilitation has been subject to much research over the past decade. Numerous meta-analytic reviews of offender treatment, particularly group treatment based on cognitive behavioural principles, have been reported. Together with the ‘triad of principles’ – risk, need and responsivity – they have formed the foundation upon which most offending behaviour interventions have developed. However, outcome data from existing programmes provides mixed evidence, and evidence for interventions for those in forensic mental health settings are still in their infancy. This paper critically considers the current evidence for the treatment of offending behaviour, and its application in forensic mental health settings, in order to inform development of such treatments in low secure mental health care. Most of the research focuses on non-mental health settings, and is largely what will be considered here. The paper concludes that low secure interventions need to capitalise on the evidence of ‘what works’ while revisiting key concepts such as ‘dose’ and responsivity in order to design appropriate treatments. Individual outcome evaluation needs to form part of development in this area.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Exploring factors that influence nurses: judgements of violence risk in a female forensic populat

Exploring factors that influence nurses: judgements of violence risk in a female forensic population, British Journal of Forensic Practice, 2010 Feb; 12 (1): 4-14

Allen S; Beech AR

Abstract:

The study examined how nursing staff in a secure forensic unit make judgements about female patients’ level of risk and whether a patient’s lack of engagement in therapy was a salient factor. Results indicate that staff accounted for the following historical factors when making judgements: past aggression, substance misuse, symptoms of psychosis and personality disorder, and the following clinical factors: lack of insight, non-compliance and lack of motivation. A positive therapeutic alliance between patient and key-worker, high levels of self-confidence in staff members, a supportive nursing team and an institution with good procedural security were perceived to be protective factors.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

NICE Guidance – CG16 Self-Harm

NICE Guidance – CG16 Self-Harm

Click on the title above to access the full-text of this guidance

Abstract:

The NICE clinical guideline on self-harm covers:

  • the care people who harm themselves can expect to receive from healthcare professionals in hospital and out of hospital
  • the information they can expect to receive
  • what they can expect from treatment
  • what kinds of services best help people who harm themselves

The guideline does not attempt to explain self-harm or describe the treatment in detail

Click on the link above to access the guidance

NICE – Raising the Standard of Care and Treatment for People who Self Harm

Raising the Standard of Care and Treatment for People who Self Harm  NICE

Using Guidance Shared learning, Implementing NICE Guidance Example

Click on the title above to access the example

Title:

Raising the Standard of Care and Treatment for People who Self Harm

Description:

County Durham and Darlington Foundation Trust consists of 3 acute hospitals, it is estimated there are approximately 2,500 attendances at accident and emergency for self harm annually, care treatment and interventions following self harm is important as patients are statistically at higher risk of suicide (Hawton 2003). Service user’s describe contact with services as often being difficult characterised by ignorance and negative attitudes and it is no longer acceptable for healthcare professionals to fail to address this experience of care by service users and their carers. With such statistics and issues the Mental Health Liaison Team from Tees, Esk & Wear Valleys NHS Trust in collaboration with the Acute hospital were awarded a place on a national quality improvement program with the aim of optimising and improving services for self harm and increasing compliance with NICE self harm guidelines.

Click on the title above to access the example from the NICE site

Ligature Strangulation – Self-Harm – Safe from Harm

Safe from harm: preventing ligature strangulation , British Journal of Healthcare Assistants , 2010, 4 (1) pp 19 – 21 

Ian Peate

Abstract:

An awareness and understanding of the risks associated with ligatures can help to prevent the death or serious injury of a service user. Healthcare assistants (HCA) and assistant practitioners (AP) are members of a multidisciplinary team and should work together in order to minimize risk. Environmental factors and possible prevention methods are discussed. Key terms are defined and the issue of audit is emphasized.

Lancashire care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Skin Picking & Systematic Review – Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: A systematic review

Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: A systematic review, Research in Developmental DisabilitiesVol. 31 (2) 2010, pp 304-315

Russell Lang et al..

Abstract:

Skin-picking is a type of self-injurious behavior involving the pulling, scratching, lancing, digging, or gouging of one’s own body. It is associated with social impairment, and increased medical and mental health concerns. While there are several reports showing that skin-picking is common in individuals with developmental disabilities, knowledge about effective treatment approaches is sparse. We therefore reviewed studies involving the treatment of chronic previous termskin-picking in individuals with developmental disabilities. Systematic searches of electronic databases, journals, and reference lists identified 16 studies meeting the inclusion criteria. These studies were evaluated in terms of: (a) participants, (b) functional assessment procedures and results, (c) intervention procedures, (d) results of the intervention, and (e) certainty of evidence. Across the 16 studies, intervention was provided to a total of 19 participants aged 6–42 years. Functional assessment procedures included direct observations, analog functional analyses, and functional assessment interviews. The most commonly identified function was automatic reinforcement. Treatment approaches included combinations of differential reinforcement, providing preferred items and activities stimuli (e.g., toys), wearing protective clothing (e.g., helmets or gloves), response interruption and redirection, punishment, and extinction. Improvements in behavior were reported in all of the reviewed studies. Suggestions for future intervention research are offered.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Suicide rates in the United Kingdom: 1991-2008 – ONS January 2010

Suicide rates in the United Kingdom: 1991-2008 , London: Office for National Statistics, January 2010

Click on the title above to access the full-text

Abstract:

Suicide is defined as deaths given an underlying cause of intentional self-harm or injury/poisoning of undetermined intent. This bulletin summarises suicide rates for the UK, England, government office regions in England, and Wales. The key statistics highlighted are: in 2008 there were 5,706 suicides in the UK, an increase from 5,377 in 2007; despite a peak in 1998, the trend in suicide rates has been generally downward since 1991; there are more suicides in males than females (17.7 suicides per 100,000 population in men and 5.4 per 100,000 population in women in 2008).

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Cochrane – Psychosocial and pharmacological treatments for deliberate self harm

Psychosocial and pharmacological treatments for deliberate self harm,  Hawton KKE, Townsend E, Arensman E, Gunnell D, Hazell P, House A, van Heeringen K. Psychosocial and pharmacological treatments for deliberate self harm. Cochrane Database of Systematic Reviews 1999, Issue 4. Art. No.: CD001764

Publication status and date: Edited (no change to conclusions), published in Issue 1, 2009.

Keith KE Hawton, University Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK

Click on the title above to access the full-text of this Cochrane review

Abstract:

Background

Deliberate self-harm is a major health problem associated with considerable risk of subsequent self-harm, including completed suicide.

Objectives

To identify and synthesise the findings from all randomised controlled trials that have examined the effectiveness of treatments of patients who have deliberately harmed themselves.

Search strategy

Electronic databases screened: MEDLINE (from 1966-February 1999); PsycLit (from 1974-March 1999); Embase (from 1980-January 1999); The Cochrane Controlled Trials Register (CCTR) No.1 1999. Ten journals in the field of psychiatry and psychology were hand searched for the first version of this review. We have updated the hand search of three specialist journals in the field of suicidal research until the end of 1998. Reference lists of papers were checked and trialists contacted.

Selection criteria

All RCTs of psychosocial and/or psychopharmacological treatment versus standard or less intensive types of aftercare for patients who shortly before entering a study engaged in any type of deliberately initiated self-poisoning or self-injury, both of which are generally subsumed under the term deliberate self-harm.

Data collection and analysis

Data were extracted from the original reports independently by two reviewers. Studies were categorized according to type of treatment. The outcome measure used to assess the efficacy of treatment interventions for deliberate self-harm was the rate of repeated suicidal behaviour. We have been unable to examine other outcome measures as originally planned (e.g. compliance with treatment, depression, hopelessness, suicidal ideation/thoughts, change in problems/problem resolution).

Main results

A total of 23 trials were identified in which repetition of deliberate self-harm was reported as an outcome variable. The trials were classified into 11 categories. The summary odds ratio indicated a trend towards reduced repetition of deliberate self-harm for problem-solving therapy compared with standard aftercare (0.70; 0.45 to 1.11) and for provision of an emergency contact card in addition to standard care compared with standard aftercare alone (0.45; 0.19 to 1.07). The summary odds ratio for trials of intensive aftercare plus outreach compared with standard aftercare was 0.83 (0.61 to 1.14), and for antidepressant treatment compared with placebo was 0.83 (0.47 to 1.48). The remainder of the comparisons were in single small trials. Significantly reduced rates of further self-harm were observed for depot flupenthixol vs. placebo in multiple repeaters (0.09; 0.02 to 0.50), and for dialectical behaviour therapy vs. standard aftercare (0.24; 0.06 to 0.93).

Authors’ conclusions

There still remains considerable uncertainty about which forms of psychosocial and physical treatments of self-harm patients are most effective, inclusion of insufficient numbers of patients in trials being the main limiting factor. There is a need for larger trials of treatments associated with trends towards reduced rates of repetition of deliberate self-harm. The results of small single trials which have been associated with statistically significant reductions in repetition must be interpreted with caution and it is desirable that such trials are also replicated.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Development and Evaluation of a Guideline for Nursing Care of Suicidal Patients With Schizophrenia

Development and Evaluation of a Guideline for Nursing Care of Suicidal Patients With Schizophrenia, Perspectives in Psychiatric Care, 2010,Volume 46 Issue 1, Pages 65 – 73

Esther L. Meerwijk, Berno van Meijel, Jan van den Bout, Ad Kerkhof, Wim de Vogel, Mieke Grypdonck

Abstract:

PURPOSE. The purpose of this study was to develop and test an evidence-based guideline that would support nursing care for suicidal patients with schizophrenia.

DESIGN AND METHODS. Systematic review of the literature and consultation of experts preceded completion of the guideline. Twenty-one nurses from two mental health institutions tested the guideline for feasibility in nursing practice.

FINDINGS. The guideline was found to support discussing suicidality with patients and assessing suicide risk. Participants endorsed implementation of the guideline in mental health care.

PRACTICE IMPLICATIONS. Nurses who care for patients with schizophrenia are advised to use this guideline as a foundation for their care.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Helping Young People Who Self-Harm – Manchester, UK

Helping Young People Who Self-Harm: Perspectives From England, Journal of Child and Adolescent Psychiatric Nursing, 2010, Volume 23 Issue 2, Pages 52 – 60

Steven Pryjmachuk, PhD, MSc, PGDipEd, BA(Hons), RMN, CPsychol, and Gemma Trainor, PhD, MA Couns, Dip Couns, RMN

Steven Pryjmachuk, PhD, MSc, PGDipEd, BA(Hons), RMN, CPsychol, is Senior Lecturer, School of Nursing, Midwifery and Social Work, University of Manchester, UK; and Gemma Trainor, PhD, MA Couns, Dip Couns, RMN, is Nurse Consultant in Adolescent Self Harm, Greater Manchester West Mental Health Foundation NHS Trust, Manchester, UK.

Abstract:

TOPIC: Interventions for young people who self-harm.

PURPOSE: To inform the international community of concerns that have arisen in England in relation to self-harm in young people, the therapies available to young people, and the evidence base for these therapies.

SOURCE(S) USED: Published literature on the topic, together with the clinical and academic expertise of the paper’s authors.

CONCLUSIONS: A variety of treatment modalities (categorized according to whether they were individual, family, group, or psychopharmacological therapies) used in England with young people who self-harm are discussed. The overall picture regarding these interventions is unclear: a few have no research evidence; some, however, do show promise though limitations in study design, and a lack of replication means no definitive conclusions can be drawn. There needs to be further research and development in this area, especially evaluative research of interventions. Nurses should play a lead role here as they are often in the most unique position to help young people who self-harm.

Lancashire care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

The development of nurse-led suicide prevention training for multidisciplinary staff in a North Wales NHS Trust

The development of nurse-led suicide prevention training for multidisciplinary staff in a North Wales NHS Trust, Journal of Psychiatric and Mental Health Nursing, Volume 17, Issue 2, Date: March 2010, Pages: 178-183

R. JONES rmn bsc msc  

Nurse manager, Department of Liaison Psychiatry, Ysbyty Glan Clwyd, Bodelwyddan, North Wales, UK

Abstract:

Suicide and suicidal behaviour evoke strong feelings. That is so not only for those directly affected – the individual, family and friends, but for professional staff and the community at large.

•  Assessing the risk of suicide demands staff having the ability to connect and maintain rapport with people in varying degrees of distress.

•  Multidisciplinary training groups allow staff the opportunity to share their experiences and learn from one another.

•  Suicide awareness training for non mental health staff in the UK is variable and should be more of a priority.

There are 300 deaths in Wales each year as a result of suicide. Though the rate in England and Wales has fallen in recent years, it is still the second most common cause of death in men aged 15–44 behind accidental death. The majority of those who die by suicide make contact with health professionals within a relatively short time before their death. For those with mental ill health, relationships with professionals appear particularly important; indeed negative relationships have been cited as a key factor precipitating death by suicide. This paper outlines a suicide awareness programme which aims to restate the values of empathy and relationship building in everyday interaction. It acknowledges risk factors and risk assessment tools, but more than anything strives to demonstrate the value of encouraging personal expression in patients.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Safer self-injury or assisted self-harm?

Safer self-injury or assisted self-harm?  Theoretical Medicine and Bioethics 2010 February; 31(1): 79–92.

Kerry Gutridge

Centre for Ethics in Medicine, University of Bristol, 3rd Floor Hampton House, Cotham Hill, Bristol, BS6 6AU UK

Click on the link above to access the full-text of this paper

Abstract:

Psychiatric patients may try (or express a desire) to injure themselves in hospital in order to cope with overwhelming emotional pain. Some health care practitioners and patients propose allowing a controlled amount of self-injury to occur in inpatient facilities, so as to prevent escalation of distress. Is this approach an example of professional assistance with harm? Or, is the approach more likely to minimise harm, by ensuring safer self-injury? In this article, I argue that health care practitioners who use harm-minimisation can be considered to be helping physical injury to occur, although they do not encourage the act. I consider why there are compelling reasons to believe that a patient who self-injures is not maximally autonomous in relation to that choice. However, I then move onto argue that allowing a degree of self-injury may enable engagement with psychotherapy (enhancing autonomy) and behavioural change. In these circumstances, allowing injury (with precautions) may not be harm, all things considered.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

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