Community Nurses – the RCN’s UK position on the development of the registered nursing workforce in the community

Posted on August 31, 2010 by lancashirecarelibraryblog

Pillars of the community: the RCN’s UK position on the development of the registered nursing workforce in the community, August 2010, RCN

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

Abstract:

This policy statement highlights 27 core conditions that the Royal College of Nursing believes should be satisfied for community services to survive and develop as more care is delivered closer to home, while helping health services throughout the UK to become more efficient.

The Royal College of Nursing has launched a new policy statement on community nursing.

The statement highlights 27 core conditions that the RCN believes must be satisfied for community services to survive and develop as more care is delivered closer to home; while helping the health services throughout the UK to become more efficient.

The RCN says that nursing staff working in the community are and will continue to be a reassuring mainstay of locally-delivered health care. RCN Chief Executive & General Secretary Dr Peter Carter says:

“Our new vision recognises the standing of the service they provide and its value in the delivery of the right care to patients, in the right place and at the right time. It gives us a solid platform from which to champion with healthcare employers, providers, policy makers and politicians the climate that is needed to deliver effective community nursing and patient care.

“The world of community health care is changing rapidly in all four nations of the UK. This policy statement enables the RCN, as the voice of nursing, to be clear and consistent in its contribution to the development of community nursing services whilst respecting the differences in health care structures and reforms that come with devolved decision-making.”

The RCN will lobby for its policy statement to be applied in its entirety whenever community-based patient services are being reformed or restructured.

 

Lancashire Care staff can click on the full-text link above or request the report , email: susan.jennings@lancashirecare.nhs.uk

 

Filed under: CMHN, CMHTs, community mental health | Tagged: , , , , | Comments Off

The green shoots of good health – Join the Green Gym & Enhance Wellbeing

Posted on August 31, 2010 by lancashirecarelibraryblog

The green shoots of good health,  Mental Health Practice, 2010 Jul; 14 (1): 24-5

 Whitham J; Hunt Y

Abstract:

Gardening and walking can greatly enhance people’s physical and mental wellbeing. Jane Whitham and Yvonne Hunt report on the work of a nationwide scheme.

‘The potential benefits of physical activity to health are huge. If a medication existed which had a similar effect, it would be regarded as a “wonder drug” or “miracle cure”,’ wrote former chief medical officer Sir Liam Donaldson (2009) in his annual report.

 

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

Filed under: Gardening, OT - Evidence Based OT, OT - Occupational Therapy | Tagged: , , , , | Comments Off

Home treatment team reduces number of acute admissions

Posted on August 30, 2010 by lancashirecarelibraryblog

Home treatment team reduces number of acute admissions, Mental Health Practice, 2010 Jul; 14 (1): 26-8

Hawkins G

Abstract:

Gareth Hawkins highlights the work of a multidisciplinary team that acts as a point of entry into acute care, preventing unnecessary inpatient stays by providing short-term treatment in the community or a community unit.

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

Filed under: admission to hospital, community mental health, Home Treatment teams | Tagged: , , , | Comments Off

Nurse-led health checks for clients with severe mental illness

Posted on August 29, 2010 by lancashirecarelibraryblog

Nurse-led health checks for clients with severe mental illness, Mental Health Practice, 2010 Jul; 14 (1): 33-5

Sutherland M; Davis D

Abstract:

Poor diet, smoking, lack of exercise and being overweight can have a detrimental effect on mental wellbeing. Melissa Sutherland and Denise Davis describe a scheme that provides lifestyle advice to clients attending a crisis day hospital.

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

Filed under: Exercise and Health, obesity, PHI - Physical Health, Schizophrenia, smi, smoking cessation | Tagged: , , , , , , , , , | Comments Off

Illness perceptions in anorexia nervosa: A qualitative investigation

Posted on August 28, 2010 by lancashirecarelibraryblog

Illness perceptions in anorexia nervosa: A qualitative investigation, British Journal of Clinical Psychology,  Volume 49, Number 3, September 2010 , pp. 307-325(19)

Higbed, Laurie,  Fox, John R. E.

Division of Clinical Psychology, University of Manchester, UK

Abstract:

Anorexia nervosa (AN) is an eating disorder characterized by the egosyntonic nature of symptoms, denial of illness, and ambivalence about treatment engagement. Within the physical health literature, people’s beliefs about their illness have been found to impact upon coping and treatment outcomes and this has largely been explored using the self-regulation model. This model has also been applied to mental health and more recently to AN, with beliefs about the disorder being associated with readiness to change. However, qualitative investigations have indicated that physical health models have limited applicability for assessing people’s beliefs about mental illness. This may be particularly pertinent to AN, given the complexity of the disorder. Therefore, this study explored illness perceptions in AN using a qualitative design which was not restricted by a physical illness model but focused on personal models of AN from the perspective of those experiencing the disorder.

Semi-structured interviews were conducted with thirteen participants who were currently in treatment for AN.

Interview transcripts were analysed using grounded theory methodology. 

An interpretative theory of illness perceptions in AN was developed and comprised four related categories: `making sense of AN’, `the relationship between AN and the self’, `the recovery struggle’, and `coping with treatment’.

Conclusion:

Patients’ accounts transcended the dimensions offered by physical illness models, with the implication that methods for assessing illness beliefs in AN require adaptation for a full understanding to be gained and the complexity of perceptions to be captured.

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

Filed under: Eating Disorders | Tagged: , , , | Comments Off

Defence and coping in bipolar affective disorder: Stability and change of adaptational processes

Posted on August 27, 2010 by lancashirecarelibraryblog

Defence and coping in bipolar affective disorder: Stability and change of adaptational processes, British Journal of Clinical Psychology, Volume 49, Number 3, September 2010 , pp. 291-306(16)

 Kramer, Ueli

Abstract:

Defence mechanisms and coping have rarely been investigated from an integrative point of view. We are particularly interested in stability and change of these adaptational processes in clinical crisis situations of in-patients presenting with bipolar affective disorder.

Design:

We conducted a controlled interview study including an in-patient and a matched control group; longitudinal data are provided by follow-up interviewing for all participants.

Methods:

A total of N=18 participants per group (patients presenting with bipolar affective disorder and non-clinical controls) were recruited and interviewed twice. All interviews were transcribed and analysed according to observer-rater systems for coping (Coping Action Patterns) and defence mechanisms (Defence Mechanism Rating Scales). Symptom check list-90-R, as well as specific symptomatic measures, were used for symptomatic assessment and hierarchical linear modelling was used for statistical computation.

Results:

Overall, defensive functioning remains stable over a 3 month period, whereas overall, coping functioning increases over the same period in-patients, as they are discharged from in-patient treatment; no such effect was found in controls.

Conclusions:

Overall, stability in adaptational processes may be attributed to defensive functioning, whereas change over short periods of time are related to coping concepts in in-patients presenting with bipolar affective disorder .

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

Filed under: bipolar | Tagged: , | Comments Off

OT’s & ABI – Guidance and direction: occupational therapy in brain injury rehabilitation

Posted on August 26, 2010 by lancashirecarelibraryblog

Guidance and direction: occupational therapy in brain injury rehabilitation, New Zealand Journal of Occupational Therapy 2009 Sep; 56(2): 4-8

Abstract:

A range of guidelines exist to direct and support occupational therapists working in acquired brain injury rehabilitation to provide services based on best practice. Many of these guidelines are not based on empirical evidence or integrated well into clinical practice. This article reviews some of the evidence that does exist, and reports an exploration of the related practices of occupational therapists working in brain injury rehabilitation in one region of New Zealand, to critique the realities of current practice. It proposes the development of an ongoing supportive community of practice as one way to develop and integrate evidence into best practice both in clinical areas and undergraduate curricula.

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

Filed under: ABI Acquired Brain Injury, OT - Evidence Based OT, OT - Occupational Therapy | Tagged: , , , , | Comments Off

Social problem solving, autobiographical memory, trauma, and depression in women with borderline personality disorder and a history of suicide attempts

Posted on August 26, 2010 by lancashirecarelibraryblog

Social problem solving, autobiographical memory, trauma, and depression in women with borderline personality disorder and a history of suicide attempts, British Journal of Clinical Psychology, Volume 49, Number 3, September 2010 , pp. 327-342(16)

Maurex, Liselotte

Abstract:

Objectives:

The primary aim of this study was to compare the retrieval of autobiographical memory and the social problem-solving performance of individuals with borderline personality disorder (BPD) and a history of suicide attempts, with and without concurrent diagnoses of depression and/or post-traumatic stress disorder (PTSD), to that of controls. Additionally, the relationships between autobiographical memory, social problem-solving skills, and various clinical characteristics were examined in the BPD group.

Design:

Individuals with BPD who had made at least two suicide attempts were compared to controls with regard to specificity of autobiographical memory and social problem-solving skills. Autobiographical memory specificity and social problem-solving skills were further studied in the BPD group by comparing depressed participants to non-depressed participants; and autobiographical memory specificity was also studied by comparing participants with and without PTSD.

Method:

A total of 47 women with a diagnosis of BPD and 30 controls completed the Autobiographical Memory Test, assessing memory specificity, and the means-end problem solving-procedure, measuring social problem-solving skills. The prevalence of suicidal/self-injurious behaviour, and the exposure to violence, was also assessed in the BPD group.

Results:

Compared to controls, participants with BPD showed reduced specificity of autobiographical memory, irrespective of either concurrent depression, previous depression, or concurrent PTSD. The depressed BPD group displayed poor problem-solving skills. Further, an association between unspecific memory and poor problem-solving was displayed in the BPD group.

Conclusion:

Our results confirmed that reduced specificity of autobiographical memory is an important characteristic of BPD individuals with a history of suicide attempt, independent of depression, or PTSD. Reduced specificity of autobiographical memory was further related to poor social problem-solving capacity in the BPD group. 

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

Filed under: Personality Disorders, trauma | Tagged: , , , , | Comments Off

Brief cognitive screening instruments: an update

Posted on August 25, 2010 by lancashirecarelibraryblog

Brief cognitive screening instruments: an update, International  Journal of Geriatric Psychiatry.2010 Feb;25(2):111-20.

Ismail Z, Rajji TK, Shulman KI

Abstract:

OBJECTIVE: To review the recent literature on cognitive screening with a focus on brief screening methods in primary care as well as geriatric services.

DESIGN: The Medline search engine was utilized using the keyword search terms ‘cognitive screening’, ‘cognitive assessment’, and ‘dementia screening’ limiting articles to those published in English since 1998.

RESULTS: 679 abstracts were retrieved. Articles focusing on attitudes toward cognitive screening, current screening practices, promising new instruments and more recent updates contributing significant information on established instruments were retrieved and incorporated into this review. Reference lists were reviewed for relevant contributing articles. Instruments recommended from previous reviews of cognitive screening and those identified in surveys as most frequently used in primary care and geriatric settings were emphasized in this review.

CONCLUSIONS: Dementia remains under-diagnosed in the elderly population. Despite significant limitations, the Mini Mental State Exam remains the most frequently used cognitive screening instrument. Its best value in the community and primary care appears to be for the purpose of ruling out a diagnosis of dementia. Instruments such as the Mini-Cog, Memory Impairment Screen (MIS), and the General Practitioner Assessment of Cognition (GPCOG) have consistently been recognized for utility in primary care. The clock drawing test (CDT) and newer instruments such as the Montreal Cognitive Assessment (MoCA) and the Rowland Universal Dementia Assessment Scale (RUDAS) are gaining credibility due to improvements in sensitivity, addressing frontal/executive functioning, and decreasing susceptibility to cultural and educational biases.

 

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

Filed under: alzheimers, dementia | Tagged: , , , , , | Comments Off

The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients

Posted on August 24, 2010 by lancashirecarelibraryblog

The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients, International  Journal of  Geriatric Psychiatry. 2005 Jul;20(7):629-34.

Most Read Article

Kari Kvaal, Ingun Ulstein, Inger Hilde Nordhus, Knut Engedal

Abstract:

BACKGROUND: In geriatric psychiatry assessment scales are often used in clinical praxis in the diagnostic work-up of mental disorders.

AIM: To assess whether the state part of the STAI is useful as a case-finding instrument of mental disorders.

MATERIALS AND METHOD: Data came from 70 non demented geriatric in-patients in stable clinical condition. Mean age was 83.3 years (range 64-96), and 74.3% were women. The 20-item STAI state instrument was used to measure current anxiety symptoms. Without knowledge of the score on STAI state a psychiatrist examined all patients and set diagnosis according to DSM-IV-TR criteria, but hierarchical rules were not used. Sensitivity, specificity, Likelihood ratio and accuracy were calculated for different cut-points of the mean sumscore on the STAI state.

RESULTS: 15.7% of the participants suffered from a mental disorder: GAD = 1, mixed anxiety-depression = 5, depression = 1, dysthymic = 1, adjustment disorder (mixed anxiety-depression) = 1, and personality disorder = 1. The mean STAI sumscore in this group was 56.3 compared with 39.2 in the 59 patients without any psychiatric diagnosis. The optimal cut-off score on the STAI mean sumscore corresponding to the highest accuracy of 0.87 was 55/54 with sensitivity 0.82, specificity 0.88, and LR + 6.8.

CONCLUSION: The STAI state scale is a useful instrument for detecting a variety of mental disorders in older people. Further studies should be carried out in different populations.

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

Filed under: dementia | Tagged: , , , , , , | Comments Off

Ethical dilemmas: should antipsychotics ever be prescribed for people with dementia

Posted on August 24, 2010 by lancashirecarelibraryblog

Ethical dilemmas: should antipsychotics ever be prescribed for people with dementia, The British Journal of Psychiatry (2010) 197: 88-90

Adrian Treloar, Monica Crugel, Aparna Prasanna, Luke Solomons, Chris Fox, Carol Paton, and Cornelius Katona

Abstract:

The use of antipsychotics for the treatment of behavioural and psychological symptoms of dementia (BPSD) is controversial. Antipsychotics cause harm and evidence-based guidelines advise against their use. We argue that antipsychotics may be justified using a palliative model: by reducing severe distress in those whose life expectancy is short.

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

Filed under: antidepressants, dementia | Tagged: , , , , | Comments Off

Reviewing the concept of advanced nurse practice

Posted on August 23, 2010 by lancashirecarelibraryblog

Reviewing the concept of advanced nurse practice, Practice Nursing 21(7) 371 – 375 (Jul 2010)

Hilary Paniagua

Abstract:

Hilary Paniagua outlines the concept of advanced nurse practice and how the advanced nurse practitioner’s role differs from other types of nursing.

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

Filed under: Advanced nurse practitioner | Tagged: , , , | Comments Off

Emergency nurses’ provision of spiritual care: a literature review

Posted on August 22, 2010 by lancashirecarelibraryblog

Emergency nurses’ provision of spiritual care: a literature review, British Journal of Nursing 19(12) 768 – 773 (24 Jun 2010)

Barry McBrien

Abstract:

The emergency setting has undergone significant changes in recent years. Notably, the throughput and acuity of patients has increased, with a concomitant improvement in the clinical and technical management of these patients (Dolan, 1998; Coughlan and Corry, 2007). However, there is evidence to suggest that the increase in workload and proliferation of technology, at such a fast pace, has potentially threatened the caring component of nursing, including spiritual care (Wilkin and Selvin, 2004). During hospitalization, the majority of patients tend to become anxious because of the fear of the unknown, an uncertain future, and possible resultant complications of their respective illnesses. In this regard, patients being treated in emergency departments are at vulnerable periods of their lives. Consequently, while the emergency department can be physically demanding, nurses spend considerable time in intense interactions with patients. In spite of this, changes have brought associated pressures on both nurses and patients (Bailie, 2005). Therefore, although advances in technology can enable nurses to objectively measure responses to care; conversely, it can supersede the premise of holistic health care. Nonetheless, it has been empirically shown that caring and the provision of spiritual care is not only possible within the technological world of emergency nursing, but it can be positively enhanced by the mastery of the technological environment (Locin, 1995; Little, 2000).

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

Filed under: Spirituality | Tagged: , , , , , , , | Comments Off

Thinking falls – taking action: a guide to action for falls prevention

Posted on August 22, 2010 by lancashirecarelibraryblog

Thinking falls – taking action: a guide to action for falls prevention, British Journal of Community Nursing 15(8) 406 – 410 (Aug 2010)

Kate Robertson, Philippa Logan, Dr Simon Conroy, Verity Dods, Dr Adam Gordon, Linda Challands, Sue Smith, Sally Humpage, Ann Burn

Abstract:

Clinical guidelines and research papers help clinicians measure and understand the risk of falling in their older clients but very few provide the assessor with recommendations as to which interventions they can use to reduce the risk of a fall.


The Guide to Action for Falls Prevention tool (GtA) was developed to help professionals from a broad range of organizations to recognize factors that might increase falls risk and know which actions to take to lessen that risk.


Twenty four professionals tested the GtA in a clinical setting and found it quick (15 minutes) and easy to complete. The GtA needs further evaluation to test whether it is a practical way of delivering a falls prevention intervention.

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

Filed under: Falls Elderly | Tagged: , , , | Comments Off

Supporting prison nurses: an action research approach to education

Posted on August 21, 2010 by lancashirecarelibraryblog

Supporting prison nurses: an action research approach to education, British Journal of Nursing 19(12) 782 – 786 (24 Jun 2010)

Clare Bennett, Jane Perry, Tracy Lapworth, Judith Davies, Vicky Preece

Abstract:

Since April 2006, commissioning responsibility for healthcare services in public prisons has been fully devolved to NHS primary care trusts (PCTs), with the expectation that offenders will have access to the same range and quality of health services available to the wider population. In order to support prison nurses in meeting this goal, a PCT and university established a partnership, which used an action research approach to develop, instigate and evaluate a bespoke educational programme for nurses working in two local prisons. This article outlines the processes involved in the design and implementation of the programme. It also reports on findings from pre- and post-intervention questionnaires and focus groups with course participants, and semi-structured interviews with key stakeholders, which suggest that the innovation had a positive impact on the nurses’ confidence, assertiveness, clinical expertise and approach to change. The article concludes that the action research project should continue, but its scope should now broaden to address educational support for healthcare assistants, collaborative learning between prison officers and prison nurses, and the implementation of clinical supervision and action learning sets.

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

Filed under: Forensic Mental Healthcare, Mental Health Nurses, prisons | Tagged: , , , , , | Comments Off

Regional Toolkit- Ensuring better involvement of BME Service Users and Carers

Posted on August 21, 2010 by lancashirecarelibraryblog

Regional Toolkit- Ensuring better involvement of BME Service Users and Carers 18th August 2010

Mental Health Services. Nottinghamshire Healthcare NHS Trust 2010

Click on the title to access the full-text of this resource

Abstract:

This toolkit offers a coherent framework for increasing and enhancing the involvement of Black and Minority Ethnic (BME) service users and carers in decisions that shape the way mental health services are designed, managed, delivered and monitored in the East Midlands. It provides practical advice on involving and consulting BME mental health service users and carers.

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

Filed under: Equality & Diversity, ethnic minorities | Tagged: , , , | Comments Off

Pharmacological interventions for borderline personality disorder – Cochrane

Posted on August 20, 2010 by lancashirecarelibraryblog

Pharmacological interventions for borderline personality disorder, 16 JUN 2010, DOI : 10.1002/14651858.CD005653

Click on the title to access the direct full-text link

The Cochrane Library

Jutta Stoffers, Birgit A Völlm, Gerta Rücker, Antje Timmer, Nick Huband and Klaus Lieb

Abstract:

Background

Drugs are widely used in borderline personality disorder (BPD) treatment, chosen because of properties known from other psychiatric disorders (“off-label use”), mostly targeting affective or impulsive symptom clusters.

Objectives

To assess the effects of drug treatment in BPD patients.

Search strategy

We searched bibliographic databases according to the Cochrane Developmental, Psychosocial and Learning Problems Group strategy up to September 2009, reference lists of articles, and contacted researchers in the field.

Selection criteria

Randomised studies comparing drug versus placebo, or drug versus drug(s) in BPD patients. Outcomes included total BPD severity, distinct BPD symptom facets according to DSM-IV criteria, associated psychopathology not specific to BPD, attrition and adverse effects.

Data collection and analysis

Two authors selected trials, assessed quality and extracted data, independently.

Main results

Twenty-eight trials involving a total of 1742 trial participants were included. First-generation antipsychotics (flupenthixol decanoate, haloperidol, thiothixene); second-generation antipsychotics (aripirazole, olanzapine, ziprasidone), mood stabilisers (carbamazepine, valproate semisodium, lamotrigine, topiramate), antidepressants (amitriptyline, fluoxetine, fluvoxamine, phenelzine sulfate, mianserin), and dietary supplementation (omega-3 fatty acid) were tested. First-generation antipsychotics were subject to older trials, whereas recent studies focussed on second-generation antipsychotics and mood stabilisers. Data were sparse for individual comparisons, indicating marginal effects for first-generation antipsychotics and antidepressants.

The findings were suggestive in supporting the use of second-generation antipsychotics, mood stabilisers, and omega-3 fatty acids, but require replication, since most effect estimates were based on single studies. The long-term use of these drugs has not been assessed.

Adverse event data were scarce, except for olanzapine. There was a possible increase in self-harming behaviour, significant weight gain, sedation and changes in haemogram parameters with olanzapine. A significant decrease in body weight was observed with topiramate treatment. All drugs were well tolerated in terms of attrition.

Direct drug comparisons comprised two first-generation antipsychotics (loxapine versus chlorpromazine), first-generation antipsychotic against antidepressant (haloperidol versus amitriptyline; haloperidol versus phenelzine sulfate), and second-generation antipsychotic against antidepressant (olanzapine versus fluoxetine). Data indicated better outcomes for phenelzine sulfate but no significant differences in the other comparisons, except olanzapine which showed more weight gain and sedation than fluoxetine. The only trial testing single versus combined drug treatment (olanzapine versus olanzapine plus fluoxetine; fluoxetine versus fluoxetine plus olanzapine) yielded no significant differences in outcomes.

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

Filed under: cochrane, Personality Disorders | Tagged: , , | Comments Off

The development of a tool to measure service user satisfaction with in-patient forensic services: The Forensic Satisfaction Scale

Posted on August 19, 2010 by lancashirecarelibraryblog

The development of a tool to measure service user satisfaction with in-patient forensic services: The Forensic Satisfaction Scale, Journal of Mental Health, June 2010, Vol. 19, No. 3 , Pages 272-281

Douglas Macinnes, Dominic Beer, Peter Keeble, David Rees,Leon Reid

Canterbury Christ Church University, Canterbury, Kent

Formerly Cane Hill Forensic Mental Health Unit, South London and Maudesley NHS Trust, London, UK

Abstract:

Background:Service-user satisfaction helps determine the quality of services. No valid measure of service-user satisfaction in forensic mental health settings has been developed.

Aims:To develop and validate a scale designed to measure satisfaction with forensic mental health services.

Method:Participants were from three forensic mental health units. Items generated from focus groups were developed into a self-report scale and factor analysed. This was administered with a non-forensic satisfaction self-report scale, the Verona Service Satisfaction Scale (VSSS) and assessed for internal consistency and validity.

Results:A 60-item scale was produced comprising seven subscales recording moderate to high levels of internal consistency and concurrent validity with the VSSS.

Conclusions:The scale is a promising instrument for assessing service-user satisfaction with forensic mental health in-patient services.

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

Filed under: Forensic Mental Healthcare, user involvement | Tagged: , , , , | Comments Off

DSM-V and the stigma of mental illness

Posted on August 18, 2010 by lancashirecarelibraryblog

DSM-V and the stigma of mental illness, Journal of Mental Health,  August 2010, Vol. 19, No. 4 , Pages 318-327

Dror Ben-Zeev, Michael A. Young, Patrick W. Corrigan

Abstract:

Stigma associated with mental illness has been shown to have devastating effects on the lives of people with psychiatric disorders, their families, and those who care for them. In the current article, the relationship between diagnostic labels and stigma is examined in the context of the forthcoming DSM-V. Three types of negative outcomes are reviewed in detail – public stigma, self-stigma, and label avoidance. The article illustrates how a clinical diagnosis may exacerbate these forms of stigma through socio-cognitive processes of groupness, homogeneity, and stability. Initial draft revisions recently proposed by the DSM-V work groups are presented, and their possible future implications for stigma associated with mental illness are discussed.

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

Filed under: DSM-IV Codes, social inclusion, stigma | Tagged: , , , , , | Comments Off

Diagnosis, diagnosis, diagnosis: towards DSM-5

Posted on August 18, 2010 by lancashirecarelibraryblog

Diagnosis, diagnosis, diagnosis: towards DSM-5, Journal of Mental Health, Aug 2010, Vol. 19, No. 4, Pages 301-304

Til Wykes, Felicity Callard

King’s College London and the NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Kings College London, UK

Abstract:

The allocation of diagnoses in psychiatry has always been controversial. Diagnoses usually indicate possible treatments, as well as determining who will receive support from health and social services. Some regard the formulation and sharing of a psychiatric diagnosis as itself therapeutic, in that psychological symptoms can be given meaning and effectively discussed with the patient (e.g., Brody & Waters, 1980). However, detractors also comment on how diagnosis can medicalize patterns of behaviour (Conrad, 2007) as well as the human condition itself (Chodoff, 2002), compound stigma (Sartorius, 2002), pre-determine which interventions are deemed appropriate, and also narrowly define the frameworks through which mental health problems  ………..

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

Filed under: DSM-IV Codes | Tagged: , , | Comments Off

Sir Terry Pratchett & Dementia – Diagnosing Clapham Junction Syndrome

Posted on August 17, 2010 by lancashirecarelibraryblog

Diagnosing Clapham Junction syndrome, Journal of Mental Health, August 2010, Vol. 19, No. 4 , Pages 363-365

Sir Terry Pratchett

Abstract:

People who have dementia in this country are not heard. I’m fortunate; I can be heard. Regrettably, it’s amazing how people listen if you stand up in public and give away $1million for research into the disease, as I have done. Why did I do it? I regarded finding I had a form of Alzheimer’s as an insult and decided to do my best to marshal any kind of forces I could against this wretched disease.

I have posterior cortical atrophy or PCA. They say, rather ingenuously, that if you have Alzheimer’s it’s the best form of Alzheimer’s to have. This is a moot point, but what it does do, while gradually robbing you of memory, visual acuity and other things you didn’t know you had until you miss them, is leave you more or less as fluent and coherent as you always have been.

I spoke to a fellow sufferer recently (or as I prefer to say, “a person who is thoroughly annoyed with the fact they have dementia”) who talked in the tones of a university lecturer and in every respect was quite capable of taking part in an animated conversation. Nevertheless, he could not see the teacup in front of him. His eyes knew that the cup was there; his brain was not passing along the information. This disease slips you away a little bit at a time and lets you watch it happen.

When I look back now, I suspect there may be some truth in the speculation that dementia (of which Alzheimer’s is the most common form) may be present in the body for quite some time before it can be diagnosed. For me, things came to a head in the late summer of 2007. My typing had been getting progressively worse and my spelling had become erratic. I grew to recognize what I came to call Clapham Junction days when the demands of the office grew too much to deal with. ………………….

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

Filed under: alzheimers, dementia | Tagged: , , , | Comments Off

The Brøset Violence Checklist: clinical utility in a secure psychiatric intensive care setting

Posted on August 17, 2010 by lancashirecarelibraryblog

The Brøset Violence Checklist: clinical utility in a secure psychiatric intensive care setting, Journal of Psychiatric and Mental Health Nursing, Volume 17, Issue  7 , pages 614–620, September 2010

CLARKE, D. E., BROWN, A.-M. and GRIFFITH, P

Abstract:

Fear of violence from patients may affect the quality of care mental health nurses provide.

The Brøset Violence Checklist (BVC), a six-item instrument, has the potential to assist health-care providers in identifying patients who may become aggressive.

A trial of the BVC on a secure psychiatric intensive care unit suggested that the tool was well accepted by staff and may have contributed to reduced seclusion rates.

Five-year follow-up has revealed an incorporation of the BVC into routine practice on the psychiatric intensive care unit.

Abstract

Violence towards health-care workers, especially in areas such as mental health/psychiatry, has become increasingly common, with nursing staff suggesting that a fear of violence from their patients may affect the quality of care they provide. Structured clinical tools have the potential to assist health-care providers in identifying patients who have the potential to become violent or aggressive. The Brøset Violence Checklist (BVC), a six-item instrument that uses the presence or absence of three patient characteristics and three patient behaviours to predict the potential for violence within a subsequent 24-h period, was trialled for 3 months on an 11-bed secure psychiatric intensive care unit. Despite the belief on the part of some nurses that decisions related to risk for violence and aggression rely heavily on intuition, there was widespread acceptance of the tool. During the trial, use of seclusion decreased suggesting that staff were able to intervene before seclusion was necessary. The tool has since been implemented as a routine part of patient care on two units in a 92-bed psychiatric centre. Five-year follow-up data and implications for practice are presented.

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

Filed under: aggression, Forensic Mental Healthcare, Violence and Staff | Tagged: , , , , , , , , | Comments Off

Forensic Mental Health Nurses & Therapeutic Relationships with Patients

Posted on August 16, 2010 by lancashirecarelibraryblog

Detached Concern of Forensic Mental Health Nurses in Therapeutic Relationships With Patients: The Application of the Early Recognition Method Related to Detached Concern,  Archives of Psychiatric Nursing, Volume 24, Issue 4, August 2010, Pages 266-274

Frans Fluttert, Berno van Meijel, Henk Nijman, Stål Bjørkly, Mieke Grypdonck

Abstract:

Objective

Improvement of the interaction between forensic mental health nurses and patients may lead to a reduction of inpatient violence. The concept under study is detached concern, which refers to nurses’ skills to neutralize the emotional appeal of patients by a balanced attitude between objectivity and emotional involvement. The Patient Contact Questionnaire (PCQ) aims at measuring the degree of concern of nurses for their patients.

Methods

The PCQ was applied in a pretest–posttest design, evaluating the effects of the Early Recognition Method (ERM). This method aims at the prevention of inpatient violence in forensic psychiatry. Subjects were 116 forensic mental heath nurses working on 16 wards of a large Dutch forensic hospital. First, the baseline scores were compared to scores reported in an earlier study conducted in general psychiatry. Second, pretest–posttest comparisons were carried out for all nurses, and for subgroups of nurses with regard to gender, educational level, years of working experience, and patient population. Third, pretest–posttest comparisons were made on the PCQ item level.

Results

The baseline scores of male nurses indicated significantly higher levels of concern than those of female nurses. In addition, more experienced nurses scored significantly higher with regard to concern than less experienced nurses. When comparing the scores before and after applying ERM, no significant differences were found. However, the sores of female nurses showed a tendency toward more concern after implementation of ERM.

Conclusions

Detached concern may be a meaningful concept in forensic mental health nursing in measuring nurses’ concern for their patients. Levels of detached concern did not change significantly after application of ERM. However, the application of the PCQ could contribute to a better understanding of the interaction between nurses and their patients.

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

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CBT for Obesity – Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up

Posted on August 16, 2010 by lancashirecarelibraryblog

Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up, Behaviour Research and Therapy, Volume 48, Issue 8, August 2010, Pages 706-713

Zafra Cooper, Helen A. Doll, Deborah M. Hawker, Susan Byrne, Gillie Bonner, Elizabeth Eeley, Marianne E. O’Connor, Christopher G. Fairburn

Oxford University, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom

Abstract:

It is remarkably difficult for people with obesity to maintain a new lower weight following weight loss. The aim of the present study was to examine the immediate and longer-term effects of a new cognitive behavioural treatment that was explicitly designed to minimise this post-treatment weight regain. One hundred and fifty female participants with obesity were randomized to the new treatment, behaviour therapy (the leading alternative psychological treatment) or guided self-help (a minimal intervention). Both of the main treatments resulted in an average weight loss of about ten percent of initial weight whereas weight loss was more modest with guided self-help. The participants were subsequently followed-up for three years post-treatment. The great majority regained almost all the weight that they had lost with the new treatment being no better than the behavioural treatment in preventing weight regain. These findings lend further support to the notion that obesity is resistant to psychological methods of treatment, if anything other than a short-term perspective is taken. It is suggested that it is ethically questionable to claim that psychological treatments for obesity “work” in the absence of data on their longer-term effects.

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

Filed under: CBT Cognitive Behaviour Therapy, Exercise and Health, obesity | Tagged: , , , , , , , , , | Comments Off

Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder

Posted on August 15, 2010 by lancashirecarelibraryblog

Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder, Behaviour Research and Therapy, Volume 48, Issue 9, September 2010, Pages 832-839

Andrada D. Neacsiu, Shireen L. Rizvi, Marsha M. Linehan

Abstract:

A central component of Dialectical Behavior Therapy (DBT) is the teaching of specific behavioral skills with the aim of helping individuals with Borderline Personality Disorder (BPD) replace maladaptive behaviors with skillful behavior. Although existing evidence indirectly supports this proposed mechanism of action, no study to date has directly tested it. Therefore, we examined the skills use of 108 women with BPD participating in one of three randomized control trials throughout one year of treatment and four months of follow-up. Using a hierarchical linear modeling approach we found that although all participants reported using some DBT skills before treatment started, participants treated with DBT reported using three times more skills at the end of treatment than participants treated with a control treatment. Significant mediation effects also indicated that DBT skills use fully mediated the decrease in suicide attempts and depression and the increase in control of anger over time. DBT skills use also partially mediated the decrease of nonsuicidal self-injury over time. Anger suppression and expression were not mediated. This study is the first to clearly support the skills deficit model for BPD by indicating that increasing skills use is a mechanism of change for suicidal behavior, depression, and anger control.

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

Filed under: Anger Management, dialectical behaviour therapy, Personality Disorders | Tagged: , , , , , , , , , , | Comments Off

Painful engagement in deliberate self-harm: The role of conditional goal setting

Posted on August 15, 2010 by lancashirecarelibraryblog

Painful engagement in deliberate self-harm: The role of conditional goal setting, Behaviour Research and Therapy, Volume 48, Issue 9, September 2010, Pages 915-920

Caroline L. Danchin, Andrew K. MacLeod, Philip Tata

Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 OEX, United Kingdom

Department of Psychology, Central and North West London NHS Foundation Trust, 7a Woodfield Road, London W9 2NW, United Kingdom

Abstract:

Conditional goal setting is the tendency for people to see attainment of their future personal goals as necessary for their well-being. It has been argued that this represents an unhealthy way of relating to one’s goals, as well as being particularly problematic when goals are perceived as unlikely. High conditional goal setting has been found to be related to depression and to hopelessness. The present study examined conditional goal setting in deliberate self-harm, where problematic thinking about the future is very prominent. A group of individuals attending hospital for a recent episode of deliberate self-harm (N = 25) were compared with controls attending hospital for minor injuries (N = 25) as well as a psychologically disordered but non-suicidal control group (N = 25). Participants generated goals and rated goal likelihood, the extent to which those goals were seen as necessary for their future well-being (conditional goal setting), and also the extent to which the goals were seen as sufficient for their future well-being (goal sufficiency). Deliberate self-harm patients showed a higher degree of both conditional goal setting and goal sufficiency than did both of the other groups, further confirming the idea of painful engagement with personal goals, rather than disengagement, as characterising deliberate self-harm.

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

Filed under: Self Harm, Self Harm Men, well-being | Tagged: , , , , , , | Comments Off

Resilience to suicidal ideation in psychosis: Positive self-appraisals buffer the impact of hopelessness

Posted on August 14, 2010 by lancashirecarelibraryblog

Resilience to suicidal ideation in psychosis: Positive self-appraisals buffer the impact of hopelessness, Behaviour Research and Therapy, Volume 48, Issue 9, September 2010, Pages 883-889

J. Johnson, P.A. Gooding, A.M. Wood, P.J. Taylor, D. Pratt, N. Tarrier

School of Psychological Sciences, University of Manchester, UK

Abstract:

Recent years have seen growing interest into concepts of resilience, but minimal research has explored resilience to suicide and none has investigated resilience to suicide amongst clinical groups. The current study aimed to examine whether a proposed resilience factor, positive self-appraisals of the ability to cope with emotions, difficult situations and the ability to gain social support, could buffer against the negative impact of hopelessness amongst individuals with psychosis-spectrum disorders when measured cross-sectionally. Seventy-seven participants with schizophrenia-spectrum disorders completed self-report measures of suicidal ideation, hopelessness and positive self-appraisals. Positive self-appraisals were found to moderate the association between hopelessness and suicidal ideation. For those reporting high levels of positive self-appraisals, increased levels of hopelessness were significantly less likely to lead to suicidality. These results provide cross-sectional evidence suggest that positive self-appraisals may buffer individuals with psychosis against the pernicious impact of a well known clinical risk factor, hopelessness. Accounting for positive self-appraisals may improve identification of individuals at high risk of suicidality, and may be an important area to target for suicide interventions.

 

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

Filed under: Psychosis, Schizophrenia, suicide | Tagged: , , , , , , , | Comments Off

Rumination, experiential avoidance, and dysfunctional thinking in eating disorders

Posted on August 14, 2010 by lancashirecarelibraryblog

Rumination, experiential avoidance, and dysfunctional thinking in eating disorders, Behaviour Research and TherapyVolume 48, Issue 9, September 2010, Pages 851-859

Adhip Rawal, Rebecca J. Park, J. Mark G. Williams

Department of Psychiatry, University of Oxford, OX3 7JX, United Kingdom

Abstract:

The majority of research in eating disorders (ED) has investigated the content of disorder-specific thoughts, while few studies have addressed underlying cognitive-affective processes. A better understanding of processes underpinning ED may have important implications for treatment development. Two studies were conducted that investigated levels of rumination, beliefs about rumination, experiential avoidance, and aspects of schematic thinking in individuals with eating pathology. The latter was assessed with a newly designed ED-Sentence Completion Task (ED-SCT). Study 1 (N = 177) examined relations between ED psychopathology and these variables in a student population. Extending this, Study 2 (N = 26) assessed differences between patients with anorexia nervosa and healthy control participants. The results showed that ED psychopathology was related to disorder-specific cognitions, experiential avoidance as well as ruminative brooding but not reflection. A follow-up of anorexia nervosa patients indicated that changes in ED psychopathology were associated with changes in dysfunctional attitudes and maladaptive cognitive-affective processes. These findings highlight cognitive processes that may play an important role in the maintenance of eating pathology.

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

Filed under: Eating Disorders | Tagged: , , , , | Comments Off

Evidence based mental health and Web 2.0

Posted on August 13, 2010 by lancashirecarelibraryblog

Evidence based mental health and Web 2.0, Evidence Based Mental Health 2010;13:69-72

Stephen Ginn

 Correspondence to Dr Stephen Ginn, Current position: CT3 Psychiatry trainee; Ladywell Unit, Lewisham Hospital, Lewisham High Street, London SE13 6LH, UK

Abstract:

Introduction: Web 1.0 versus Web 2.0

Since its introduction in the early 1990s, the web has evolved significantly. Initially, most websites had a passive user role and either displayed static information or facilitated online transactions. However, recently the web has become more interactive and many of the most popular websites are now online applications which depend heavily on user participation.

This participatory model of web usage has come to be loosely known as ‘Web 2.0’ and the initial non-participatory web correspondingly as ‘Web 1.0’. The term has been popular since 20041 2 and it is as much ideological as technical. Applications associated with Web 2.0 commonly facilitate the creation and exchange of user generated content. Examples include blogs, social networking sites, wikis and media sharing sites. These sorts of sites have become some of the most visited and discussed about properties on the internet.

Web 2.0 applications are predominately easy to use and free of charge and respond much more rapidly to events than do traditional media. They offer new ways for clinicians to access, share and evaluate healthcare information. Due to their interactive nature they are constantly evolving and enriching and anyone who uses them assists in their development. However, they also have limitations that need to be understood.

Healthcare professionals have yet to take full advantage of Web 2.0 technologies. In this article I will discuss and critique Web 2.0′s major applications and their potential for the practice of evidence based medicine and mental health.

Web 2.0 Applications

Blogs, wikis and microblogs (together with Really Simple Syndication (RSS)) are reviewed first as they have had the greatest impact and share some of the same advantages and disadvantages.

Blogs, RSS, wikis and microblogging

Blogs

The blog was one of the earliest social software tools. Blogs are a very popular form of expression and account for 1.2% of UK internet traffic.3 They are …

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

 

Filed under: evidence-based practice, Web 2.0 | Tagged: , , , , | Comments Off

Quality of Life and Dementia: An Integrated Review of Literature

Posted on August 12, 2010 by lancashirecarelibraryblog

Quality of Life and Dementia: An Integrated Review of Literature, Alzheimer’s Care Today,July/September 2010 – Volume 11 – Issue 3 – p 186–195

Kwasky, A  et al

Abstract:

This article presents an integrated literature review of major concepts related to quality of life (QoL) for persons with dementia and demonstrates their application to nursing care. Researchers used an integrated review of literature from 3 health care databases. The concepts related to QoL for persons with dementia are emotional states, activities of daily living, communication, cognitive functioning, and caregiver(patient perception. The review finds that QoL is independent of cognitive functioning. Nursing care of persons with dementia needs to focus on interventions that integrate the concepts demonstrated to improve quality of life.

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

Filed under: alzheimers, dementia, Quality of Life | Tagged: , , , , , | Comments Off

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