Review: family interventions reduce relapse or hospitalisation in people with schizophrenia

Posted on April 30, 2011 by lancashirecarelibraryblog

Review: family interventions reduce relapse or hospitalisation in people with schizophrenia, Evidence Based Mental Health , 2011

González-Blanch C, Alvarez-Jiménez M

 

Abstract:

Question: Do community-based psychosocial family interventions show greater benefit for individuals with schizophrenia compared with standard care?

Outcomes: Primary outcomes were suicide and all-cause mortality, hospital admission and relapse. Relapse was defined according to each individual study’s definition. In addition, participants lost to follow-up, and those who committed suicide were considered to have relapsed in meta analyses.

 

Design: Systematic review and meta analysis.

Data sources: In the most recent update of this review, the Cochrane Schizophrenia Group Trials Register was searched in September 2008. Additional studies were identified by hand searching of reference lists and personal contact with authors.

Study selection and analysis: The review included randomised or quasi-randomised studies comparing community-based psychosocial interventions with standard care for families of people with diagnosed schizophrenia or schizoaffective disorder. Eligible interventions comprised more than five sessions and aimed to reduce the extent of selected expressed emotions (criticism, hostility or over involvement) in the ……..

 

Abstracted from:

Pharoah F, Mari J, Rathbone J, et al. Family intervention for schizophrenia. Cochrane Database Systematic Review, 2010;12:CD000088.

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

Filed under: family therapy, Psychosis, psychosocial, relapse prevention, Schizophrenia | Tagged: , , , , , , , , | Comments Off

Coping styles predict responsiveness to CBT in psychosis

Posted on April 29, 2011 by lancashirecarelibraryblog

Coping styles predict responsiveness to cognitive behaviour therapy in psychosis, Psychiatry Research, Volume 187, Issue 3, 30 May 2011, Pages 354-362

Premkumar P, Peters ER, Fannon D, Anilkumar AP, Kuipers E, Kumari V

Department of Psychology, Institute of Psychiatry, King’s College London, London, UK; Division of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, NG1 4BU, UK.

 

Abstract:

The study aimed to determine the clinical and neuropsychological predictors of responsiveness to cognitive behavioural therapy for psychosis (CBTp). Sixty patients with schizophrenia or schizoaffective disorder and 25 healthy individuals took part in the study. Thirty patients (25 protocol completers) received CBTp in addition to standard care (SC); 30 patients (18 protocol completers) received SC only. All patients were assessed on symptoms using the Positive and Negative Syndrome Scale (PANSS) and clinical and neuropsychological function before and after CBTp. Symptoms and self-esteem improved to a greater extent in the CBTp + SC than SC control group. Greater pre-therapy coping ability and the self-reflectiveness dimension of cognitive insight at baseline predicted improvement in symptoms in the CBTp + SC group, but not the SC control group, explaining up to 21% of the variance in symptom improvement. Pre-therapy neuropsychological function, duration of illness, clinical insight and gender did not predict CBTp responsiveness. Being able to have a range of coping strategies and reflect on one’s experiences while refraining from overconfidence in one’s interpretations before therapy is conducive to better CBTp responsiveness.

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

Filed under: CBT Cognitive Behaviour Therapy, Schizophrenia | Tagged: , | Comments Off

Multifamily Group Psychoeducation and Cognitive Remediation for First-Episode Psychosis: A RCT

Posted on April 29, 2011 by lancashirecarelibraryblog

Multifamily Group Psychoeducation and Cognitive Remediation for First-Episode Psychosis: A Randomized Controlled Trial, BMC Psychiatry, 2011 Jan 12;11 9-

Breitborde NJ et al.

Abstract:

BACKGROUND:

Multifamily group psychoeducation (MFG) has been shown to reduce relapse rates among individuals with first-episode psychosis. However, given the cognitive demands associated with participating in this intervention (e.g., learning and applying a structured problem-solving activity), the cognitive deficits that accompany psychotic disorders may limit the ability of certain individuals to benefit from this intervention. Thus, the goal of this study is to examine whether individuals with first-episode psychosis who participate simultaneously in MFG and cognitive remediation–an intervention shown to improve cognitive functioning among individuals with psychotic disorders–will be less likely to experience a relapse than individuals who participate in MFG alone.

METHODS/DESIGN:

Forty individuals with first-episode psychosis and their caregiving relative will be recruited to participate in this study. Individuals with first-episode psychosis will be randomized to one of two conditions: (i) MFG with concurrent participation in cognitive remediation or (ii) MFG alone. The primary outcome for this study is relapse of psychotic symptoms. We will also examine secondary outcomes among both individuals with first-episode psychosis (i.e., social and vocational functioning, health-related quality of life, service utilization, independent living status, and cognitive functioning) and their caregiving relatives (i.e., caregiver burden, anxiety, and depression)

DISCUSSION:

Cognitive remediation offers the possibility of ameliorating a specific deficit (i.e., deficits in cognitive functioning) that often accompanies psychotic symptoms and may restrict the magnitude of the clinical benefits derived from MFG.

TRIAL REGISTRATION:

ClinicalTrials (NCT): NCT01196286.

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

Filed under: family therapy, Psychosis | Tagged: , , , , , | Comments Off

Treatment of anxiety in autism spectrum disorders using CBT: A systematic review

Posted on April 28, 2011 by lancashirecarelibraryblog

Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: A systematic review,Developmental Neurorehabilitation, 2010 Feb;13(1):53-63

Lang R

The Eli and Edythe L Broad Asperger Research Center, University of California, Santa Barbara, CA 93106-9490, USA

Abstract:

OBJECTIVE:

To review studies involving the treatment of anxiety in people with autism spectrum disorders (ASD) using Cognitive Behaviour Therapy (CBT) with the intent to inform practice and to identify areas for future research.

METHODS:

Systematic searches of electronic databases, reference lists and journals identified nine studies. Each identified study that met pre-determined inclusion criteria was analysed and summarized in terms of: (a) participants, (b) intervention procedures, (c) dependent variables, (d) results of intervention and (e) certainty of evidence. To assess the certainty of evidence, each study’s design and related methodological details were critically appraised.

RESULTS:

Positive outcomes were ubiquitous, suggesting CBT is an effective treatment for anxiety in individuals with Asperger’s. However, data involving other ASD diagnostic sub-types is limited.

CONCLUSIONS:

CBT has been modified for individuals with ASD by adding intervention components typically associated with applied behaviour analysis (e.g. systematic prompting and differential reinforcement). Future research involving a component analysis could potentially elucidate the mechanisms by which CBT reduces anxiety in individuals with ASD, ultimately leading to more efficient or effective interventions.

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

Filed under: Anxiety Disorder, Asperger, Autism, CBT Cognitive Behaviour Therapy | Tagged: , , , , , , | Comments Off

Reading Groups – The Power of Words

Posted on April 27, 2011 by lancashirecarelibraryblog

The Power of Words, Nursing Standard,  Aug 11-Aug 17, 2010. Vol. 24, Iss. 49; pg. 20, 2 pgs

Tina Walsh

Abstract:

Reading in a group can help patients with mental health conditions to build up their self-belief.

Reading as clinical therapy – or bibliotherapy- is a relatively new concept, but is being backed by a growing number of health professionals. Many credit it with profound changes in patients with acute depression and anxiety.

Bibliotherapy groups began to spring up in Merseyside in 2001 when the founder of The Reader Organisation charity, Jane Davis, used a £500 grant from the University of Liverpool to start the project Get Into Reading.

The scheme now delivers more than 230 outreach reading projects, mainly in Merseyside, but increasingly throughout the country, including east Lancashire, Durham, Essex, London, Salford and south west England.

Staff nurse Gillian Jones has worked at Ashworth for 22 years and is responsible for the day-to-day care of men with illnesses including personality disorders and psychosis.

She runs a weekly bibliotherapy session every Friday afternoon for an hour. The group was set up about two years ago by ward manager Sharon Eley, who noticed that many patients were already active readers. A facilitator from The Reader Organisation led the classes for the first six weeks, but Ms Jones now runs the sessions.

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

Filed under: Bibliotherapy, Reading, recovery | Tagged: , , , , , , , | Comments Off

WHICH – Care homes investigation

Posted on April 27, 2011 by lancashirecarelibraryblog

WHICH – Care homes investigation  , April 2011

Jo Williams responds to Which? report  – Care Quality Commission


Click on the title above to read the results

Abstract:

As part of a Which? investigation, we asked three actors to spend a week of their lives in four randomly chosen residential and nursing homes. The investigation raised serious worries about some of the care in the homes, including safety concerns, poor nutrition and even one case of potential abuse. 

We’re talking to the care homes regulator and looking to work with Age UK to address the problems we found and share our concerns about the industry. Find out how we think care homes could be improved.

See our experts and the actors talk about the findings in our care homes video.

Filed under: carers, dignity in care, elder abuse, Quality, Quality of Life, Quality Standard | Tagged: , , , , , , , | Comments Off

Spirituality in nursing care: a pocket guide – RCN

Posted on April 27, 2011 by lancashirecarelibraryblog

Spirituality in nursing care: a pocket guide  , 2011, RCN, Royal College of Nursing, UK

Click on the title above to access this pocket guide

Abstract:

This is a guide to enable nursing staff to address questions about the spiritual part of care. This guide hopes to define spiritual care, provide tips on preparing to give spiritual care and lists where to seek further information.

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

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

Use of the Breakthrough Series Collaborative to Support Broad and Sustained Use of Evidence-Based Trauma Treatment for Children in Community Practice Settings

Posted on April 27, 2011 by lancashirecarelibraryblog

Use of the Breakthrough Series Collaborative to Support Broad and Sustained Use of Evidence-Based Trauma Treatment for Children in Community Practice Settings, Administration Policy Mental Health, early view,  2011

Abstract:

Empirically supported treatments for posttraumatic stress reactions in children are not widely available. This observational study evaluates the feasibility and utility of adapting the Institute for Healthcare’s Breakthrough Series Collaborative (BSC) to support the broad implementation and sustained use of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in community practice settings. Study findings indicated that agency staff in diverse roles viewed the BSC methodology as a valuable and practicable approach for facilitating skillful delivery of TF-CBT with fidelity. Use of TF-CBT increased over the course of the collaborative and findings from a survey conducted one year later indicated that participating agencies were able to sustain and spread the practice.

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

Filed under: CAMHS, CBT Cognitive Behaviour Therapy, PTSD, Therapy, trauma | Tagged: , , , , , , , , , | Comments Off

Time-intensive CBT for OCD: A case series and matched comparison group – NICE

Posted on April 26, 2011 by lancashirecarelibraryblog

Time-intensive cognitive behaviour therapy for obsessive-compulsive disorder: A case series and matched comparison group, British Journal of Clinical Psychology, 2011, 50 (1) pp 7–18

Oldfield, V. B., Salkovskis, P. M. and Taylor, T.

Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Trust, London, UK

King’s College London, Institute of Psychiatry, London, UK

Abstract:

OBJECTIVES:

A time-intensive format may be both useful and effective for the delivery of cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD). Intensive treatments also offer a pragmatic alternative to in-patient admission for those in a geographically remote location. Published studies of intensive treatment include pioneering exposure-response prevention (ERP) trials that emphasized the requirement for high-intensity treatment; more recently several studies have used treatment protocols with a heavy emphasis on ERP. This study compares intensive versus standard weekly treatment format following the integrated formulation-driven CBT approach widely used in UK adult mental health settings.

DESIGN:

An analysis of patients undertaking intensive CBT using a matched comparison group of those who undertook weekly CBT for OCD.

METHODS:

Twenty-two adult patients undertook intensive format treatment (matched with a weekly group for age, gender, and initial symptoms). A range of self-report measures were examined at the end of treatment and at a 3-month follow-up.

RESULTS:

Significant treatment effects were found on a range of self-report measures; both conditions were found to be equally effective at the end of treatment and at 3-month follow-up. Uncontrolled effect sizes show that the intensive treatment was comparable to other trials of CBT for OCD.

CONCLUSION:

An intensive treatment format for the delivery of CBT for OCD was found to be as effective as weekly treatment. This is consistent with the recommendations from the National Institute for Clinical Excellence guidelines. This study adds to the growing literature on the effectiveness of intensive format treatment.

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

Filed under: CBT Cognitive Behaviour Therapy, NICE Guidelines, OCD | Tagged: , , , | Comments Off

Management of acute agitation in psychosis: an evidence-based approach in the USA

Posted on April 26, 2011 by lancashirecarelibraryblog

Management of acute agitation in psychosis: an evidence-based approach in the USA, Advances in Psychiatric Treatment (2011) 17: 91-100

Justin J. Schleifer

Abstract:

Agitation in psychiatric settings, particularly in psychosis,presents a staggering challenge for clinicians, who must bothmanage the patient’s acute symptoms and simultaneouslymake an accurate diagnosis. Too often, the management of theformer confounds the latter. Patients are very often sedatedmedically, which masks their underlying condition, renderingaccurate diagnosis delayed and inherently difficult. Significantdata are available regarding both pharmacological and non-pharmacologicalinterventions for agitation that maximise symptom control whileminimising confounding side-effects. In this article, a reviewof the historical evolution of agitation management in psychoticillness is presented, followed by an evidence-based clinicalguideline for managing agitation in psychosis in the USA.

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

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

In search of a framework for the treatment of alexithymia

Posted on April 25, 2011 by lancashirecarelibraryblog

 In search of a framework for the treatment of alexithymia, Psychology and Psychotherapy: Theory, Research and Practice, 2011 84 (1) pp 84–97

Vanheule, S., Verhaeghe, P. and Desmet, M

Abstract:

Purpose. Clinical observations and controlled studies indicate that the treatment of alexithymic patients is most difficult. Moreover, stronger degrees of alexithymia predict worse therapy outcome. We argue that in order to make therapy for alexithymia-related disorders fruitful, a conceptualization of alexithymia in terms of interpersonally imbedded affect regulation is needed.

 

Methods and results. Based on a re-interpretation of Freud’s actual neurosis via Lacan’s theory and contemporary attachment theory, we present a theoretical framework that incorporates these points. This framework helps us to explain why classic psychotherapeutic approaches fail, and to formulate principles for an alternative psychoanalytic therapeutic approach that addresses the theoretically discerned difficulties. A clinical vignette is used to examine how these principles can be implemented in clinical practice.

 

Conclusion. Therapy with actual-neurotic alexithymic patients should focus on distressing situations, starting from which a three-step logic can be deployed. During therapy, mental representations on difficult situations in patients’ lives need to be constructed by (1) putting into words the chain of events that makes up the distressing situation; (2) making the patient’s appraisal of the difficult situation explicit; and (3) addressing affective responses and discussing the patient’s way of dealing with the difficult situation.

 

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

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

Describing depression: congruence between patient experiences and clinical assessments

Posted on April 24, 2011 by lancashirecarelibraryblog

Describing depression: congruence between patient experiences and clinical assessments, British Journal of Clinical Psychology, 2011, 50 (1) pp 46–66

Kelly, M. A. R et al.

Abstract:

OBJECTIVES:

 

Efforts to describe depression have relied on top-down methods in which theory and clinical experience define depression but may not reflect the individuals’ experiences with depression. We assessed the degree of overlap between academic descriptions of depression and patient-reported symptoms as conceptualized in the Patient-Reported Outcomes Measurement Information System(®) (PROMIS(®)). By extension, this work assesses the degree of overlap between current clinical descriptions of depression and patient-reported symptoms.

DESIGN:

 

In this content analysis study, four focus groups were conducted across two sites to elicit symptoms and the experience of depression from depressed and medically ill patients.

METHODS:

 

Depressed and medically ill patients were asked to describe symptoms that characterize depression. Data were transcribed and then coded using an a priori list of 43 facets of depression derived from extant depression measures.

RESULTS:

 

Participants described 93% of the symptoms from the a priori list, supporting the validity of current depression measures. Interpersonal difficulties were underscored as was anger. In general, results from the focus groups did not require the generation of new items for depression and supported the content validity of the PROMIS hierarchical framework and item pool created originally.

CONCLUSIONS:

 

This work supports the validity of current depression assessment, but suggests further investigation of interpersonal functioning and anger may add to the depth and breadth of depression assessment.

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

Filed under: depression, Patient Experiences | Tagged: , , , , , | Comments Off

Attachment states of mind, mentalization, and their correlates in a first-episode psychosis sample

Posted on April 23, 2011 by lancashirecarelibraryblog

Attachment states of mind, mentalization, and their correlates in a first-episode psychosis sample, Psychology and Psychotherapy: Theory, Research and Practice, 2011,  84 (1) pp 42–57

Angus MacBeth, Andrew Gumley, Matthias Schwannauer and Rebecca Fisher

University of Glasgow, UK

NHS Greater Glasgow and Clyde, Glasgow, UK

University of Edinburgh, UK

Abstract:

Objectives Although there has been increased interest in applying attachment theory to the psychological understanding of psychosis, research to date has focused on self-reported attachment and psychotic symptomatology. This study presents evidence for applying attachment and mentalization constructs to understanding engagement and adaptation to first-episode psychosis (FEP), using a narrative based interview. Design A cross-sectional cohort design was used. Methods Thirty-four individuals with a first episode of psychosis were interviewed using the Adult Attachment Interview. Attachment classifications and reflective function scores were derived from the interview. Psychotic symptomatology, premorbid adjustment, duration of untreated psychosis, and psychological variables were also measured. Results Attachment distribution was heterogeneous in the sample, although the majority of participants were classified dismissing of attachment. Mentalization scores were consistent with previous clinical samples. Attachment and mentalization were unrelated to psychotic symptomatology. Conclusions The current study demonstrates, albeit with a small clinical sample, the importance of assessing attachment and mentalization via narrative methods. The findings also have clinical implications for understanding the process of engagement and adaptation in FEP.

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

Filed under: Mentalization, Psychosis, Psychotherapy | Tagged: , , , , , | Comments Off

Stress in psychiatrists: coping with a decade of rapid change

Posted on April 22, 2011 by lancashirecarelibraryblog

, The Psychiatrist 2011 v. 35, p. 130-134

Shanaya Rathod, Minal Mistry, Ben Ibbotson, and David Kingdon

Abstract:

The study explored the impact of National HealthService changes on the working and personal lives of psychiatrists. A questionnaire survey was carried out with psychiatrists working in the South Eastern Division of the Royal College of Psychiatrists.

Results The response rate was 44.9%. Changes to services have reduced stress in some areas, but increased stress in others. Over the past decade early retirement has become less popular,but psychiatrists have been more likely to self-prescribe and have suicidal thoughts.

Clinical implications The increasing involvement of psychiatrists in leadership may be a way to reduce adverse impacts of future changes on their working lives.

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

Filed under: leadership, stress | Tagged: , , | Comments Off

Dementia & Green Exercise – ‘Living with dementia and connecting with nature – looking back and stepping forwards.’

Posted on April 21, 2011 by lancashirecarelibraryblog

‘Living with dementia and connecting with nature – looking back and stepping forwards.’ Neil Mapes, 2011

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

Abstract:

In late February 2011 Neil Mapes launched his research which explored the benefits of green exercise with people living with dementia called: ‘Living with dementia and connecting with nature – looking back and stepping forwards.’

This multi faceted research project included a ‘walking interview’ film of Brian and June who are living with dementia.  These two short films give us a deeper insight into the importance and benefits of green exercise for Brian and June.

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

Filed under: dementia, Physical Health, well-being | Tagged: , , , , , , , | Comments Off

Meduim Secure Services – Environmental Design

Posted on April 21, 2011 by lancashirecarelibraryblog

Environmental design guide: adult medium secure services , Department of Health, April 2011

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

Abstract:

The guidance describes overarching principles for the design of adult medium secure inpatient services in addition to setting out the  security requirements for these services.

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

Filed under: Department of Health 2011, Forensic Mental Healthcare | Tagged: , , , | Comments Off

It’s a walk in the park: exploring the benefits of green exercise and open spaces for people living with dementia

Posted on April 20, 2011 by lancashirecarelibraryblog

It’s a walk in the park: exploring the benefits of green exercise and open spaces for people living with dementia, Working with Older People, Volume 14, Number 4 / December 2010, pp. 25-31

Neil Mapes

 

Abstract:

This article explores the benefits of green exercise and open spaces for people living with dementia. These benefits are set within the existing general evidence base concerning well-being and connection with nature. The scale of the social, economic and demographic challenges are outlined to enable potential opportunities to be identified. The benefits of green exercise, contact and connection with nature and open spaces for people with dementia and the current research gaps are identified. A case study of Dementia Adventure is highlighted, as are implications for practice.

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

Filed under: dementia, Exercise and Health, Physical Health, well-being | Tagged: , , , , , , , , , , | Comments Off

Treatment completion in psychotherapy for borderline personality disorder – a systematic review and meta-analysis

Posted on April 20, 2011 by lancashirecarelibraryblog

Treatment completion in psychotherapy for borderline personality disorder – a systematic review and meta-analysis, Acta Psychiatrica Scandinavica, 2011, 123 (5): 327–338.

Barnicot, K., Katsakou, C., Marougka, S. and Priebe, S

Abstract:

Objective:  Psychotherapy for borderline personality disorder (BPD) has been associated with problematically low treatment completion rates. Method:  PsycInfo and Medline were systematically searched to identify studies providing information on treatment completion in psychotherapy models that have been shown to be effective for BPD. A meta-analysis of treatment completion rates and a narrative analysis of factors predicting dropout were conducted. Results:  Forty-one studies were included, with completion rates ranging from 36% to 100%- a substantial between-study heterogeneity. Random effects meta-analyses yielded an overall completion rate of 75% (95% CI: 68-82%) for interventions of <12 months duration, and 71% (95% CI: 65-76%) for longer interventions. Egger’s test for publication bias was significant for both analyses (P ≤ 0.01). Study characteristics such as treatment model and treatment setting did not explain between-study heterogeneity. In individual studies, factors predicting dropout status included commitment to change, the therapeutic relationship and impulsivity, whilst sociodemographics were consistently non-predictive. Conclusion:  Borderline personality disorder should no longer be associated with high rates of dropout from treatment. However, the substantial variation in completion rates between studies remains unexplained. Research on the psychological processes involved in dropping out of treatment could further improve dropout rates.

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

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

Prevention & QIPP – Outcomes of a drug and alcohol relapse prevention programme in a population of mentally disordered offenders

Posted on April 20, 2011 by lancashirecarelibraryblog

Outcomes of a drug and alcohol relapse prevention programme in a population of mentally disordered offenders, British Journal of Forensic Practice, 2011 Feb; 13 (1): 32-43

Ritchie G; Weldon S; Freeman L; MacPherson G; Davies K

Forensic Clinical Psychology Service, The State Hospital, Scotland, UK

Abstract:

Substance misuse that is co-morbid with mental disorder may increase the risk of crime, particularly of a violent nature. It is therefore essential that dual-diagnosis patients in forensic services receive adequate intervention and treatment to minimise future substance use and potential for criminal behaviour. One such intervention is the Relapse Prevention Programme (Saying No; Coping and Social Skills Programme) developed in a high secure forensic hospital. An evaluation of the programme was conducted, with pre- and post- intervention using four measures, the Drug Taking Confidence Questionnaire (DTCQ), the Multidimensional Locus of Control Questionnaire, the Stages of Change Questionnaire and the Rosenberg Self-Esteem Scale, with 83 male participants who had completed the programme. Results indicate that there was significant change in the DTCQ post-treatment while no other measures yielded a statistically significant result. Possible reasons, implication for practice and limitations of the current study are discussed.

 

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

Filed under: Drugs & Substance Misuse, Forensic Mental Healthcare, Innovation, prevention, QIPP | Tagged: , , , | Comments Off

The Healthy Quality of Mindful Breathing: Associations With Rumination and Depression

Posted on April 19, 2011 by lancashirecarelibraryblog

Mindful Breathing: Associations With Rumination and Depression, Cognitive Therapy and Research, 2011, Volume 35, Number 2, 179-185

Jan M. Burg and Johannes Michalak

Abstract:

The present study examines the relationships between mindfulness and rumination, repetitive negative thinking, and depressive symptoms, employing a newly developed paradigm for the assessment of mindfulness. Derived from a central exercise of mindfulness-based interventions, 42 undergraduates were asked to observe their breath for about 18 min. Within this time period, they were prompted 22 times at irregular intervals to indicate whether they had lost mindful contact with their breath as a result of mind wandering. The results show negative correlations between the degree of the ability to stay mindfully in contact with the breath and measures of rumination, repetitive negative thinking, and depression. Moreover, positive associations with self-report data of mindfulness and a negative relationship to fear of bodily sensations support the construct validity of our new approach for the assessment of mindfulness. In summary, findings suggest the healthy quality of mindful breathing regarding depression-related processes.

 

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

Filed under: depression, mindfulness | Tagged: , , , , , , | Comments Off

Considerations for working with personality-disordered patients

Posted on April 19, 2011 by lancashirecarelibraryblog

Considerations for working with personality-disordered patients, British Journal of Forensic Practice, 2011 Feb; 13 (1): 44-53

Sheldon K; Tennant A

Rampton Hospital and Institute of Mental Health, University of Nottingham, UK

Abstract:

This paper provides a clinical practice overview of the challenges that can arise when working with dangerous and severe personality-disordered patients in a high secure hospital. Poor engagement and treatment readiness, mistrust, paranoia and dominant interpersonal styles are all clinical features that affect treatment delivery. The paper discusses the impact of these features, and suggests how clinicians can engage effectively with individuals who have personality disorders in regard to therapy in general.

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

Filed under: Forensic Mental Healthcare, Personality Disorders | Tagged: , | Comments Off

The prevention and treatment of complicated grief: A meta-analysis

Posted on April 19, 2011 by lancashirecarelibraryblog

The prevention and treatment of complicated grief: A meta-analysis , Clinical Psychology Review, Volume 31, Issue 1, February 2011, Pages 69-78

Ciska Wittouck

Abstract:

Bereaved individuals are at increased risk of mental and physical disorders, and prevention and treatment of complicated grief is indicated. Earlier quantitative reviews have not focused on the effect of bereavement interventions on (complicated) grief. Therefore the main objective of this meta-analysis was to determine the short-term and long-term effect of both preventive and treatment interventions on complicated grief.

Methods

Randomized controlled trials for prevention or treatment of complicated grief were identified through a systematic literature search. Electronic databases and reference lists of earlier review articles served as data sources. Data were analyzed with REVMAN 5.0.14.

Results

Fourteen randomized controlled trials met the inclusion criteria. Study quality differed among the trials. Contrary to preventive interventions, treatment interventions yielded significant pooled standardized mean differences in favor of the (specific) grief intervention at post-test and follow-up. During the follow-up period, the positive effect of treatment interventions for complicated grief even increased.

Conclusions

Treatment interventions can effectively diminish complicated grief symptoms. Preventive interventions, on the other hand, do not appear to be effective. Limitations of the meta-analysis and future research options are discussed.

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

Filed under: Bereavement/Grief | Tagged: | Comments Off

Implementing a Therapeutic Team Parenting Approach to Fostering: The Experiences of One Independent Foster-Care Agency

Posted on April 18, 2011 by lancashirecarelibraryblog

Implementing a Therapeutic Team Parenting Approach to Fostering: The Experiences of One Independent Foster-Care Agency, British Journal of Social Work, 2011,Volume41, Issue2, pp. 314-332

Jo Staines et al.

Dr Jo Staines, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TH, UK

Abstract:

This paper reports some of the findings from a study (Farmer et al., 2007), commissioned by an independent foster-care agency (IFA), to examine the support services offered to foster-carers and the young people in their care. In particular, this paper documents the use of a ‘team parenting’ approach within a ‘therapeutic’ fostering environment. Whilst there were some issues regarding the comprehensive assessments and the provision of therapy, foster-carers were positive about the support provided both to themselves and directly to the young people within the team parenting approach. On the other hand, communication and inter-agency working between the IFA and the local authority could be problematic, particularly in relation to funding decisions, which could limit the effectiveness of the team parenting approach.

 

 

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

Filed under: CAMHS, social care | Tagged: , , , , , , | Comments Off

Adult Asperger Syndrome and the Utility of Cognitive-Behavioral Therapy

Posted on April 18, 2011 by lancashirecarelibraryblog

Adult Asperger Syndrome and the Utility of Cognitive-Behavioral Therapy, Journal of Contemporary Psychotherapy, Volume 41, Number 1, 47-56

Gaus

Abstract:

Asperger syndrome (AS) is a developmental disorder that was first recognized in the United States in 1994 with the publication of DSM-IV (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 1994). As a relatively new concept to the United States, both within the professional community and public awareness, the diagnosis has most often applied to children, but there is a large cohort of affected adults who have never been diagnosed or properly treated. Many of these individuals are now seeking treatment for the symptoms of AS and/or comorbid mental health problems (e.g., mood and anxiety disorders). Clinicians are in need of practical and evidence-based interventions to address the problems presented by this growing patient population, but there are few such resources available. This article will present a framework for conceptualizing the mental health needs of adults with AS, using the evidence-based approaches found in the cognitive-behavior therapy (CBT) literature to inform treatment.

 

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

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ABI – That which doesn’t kill us can make us stronger (and more satisfied with life): The contribution of personal and social changes to well-being after acquired brain injury

Posted on April 17, 2011 by lancashirecarelibraryblog

That which doesn’t kill us can make us stronger (and more satisfied with life): The contribution of personal and social changes to well-being after acquired brain injury. Psychology and Health, 2011,  26 (3), 353-369

Jones, J., Haslam, S., Jetten, J., Williams, W., Morris, R., and Saroyan, S.

School of Psychology, University of Exeter, Exeter, UK

 
Abstract:

This study examined the roles of personal and social changes on the relationship between injury severity and life satisfaction among individuals with acquired brain injury (ABI). Personal change (i.e. having developed a survivor identity, identity strength), social changes (i.e. improved social relationships, support from services), injury severity (i.e. length of time in coma) and well-being (i.e. life satisfaction) were assessed in a sample of 630 individuals with ABIs. A counterintuitive positive relationship was found between injury severity and life satisfaction. Bootstrapping analyses indicated that this relationship was mediated by personal and social changes. Although identity strength was the strongest individual mediator, both personal and social changes each explained unique variance in this relationship. These findings suggest that strategies that strengthen personal identity and social relationships may be beneficial for individuals recovering from ABIs.

Psychologists investigating the well-being of patients with an acquired brain injury (ABI) have documented a curious phenomenon, whereby the more serious a person’s brain injury, the higher their self-reported life-satisfaction.

With the help of the charity Headway UK, Janelle Jones and her colleagues recruited 630 people (aged 9 to 81) with an acquired brain injury. Most had sustained their injuries from road accidents, with other causes including stroke and falls. Based on the time they’d spent in a coma, the majority of the participants’ injuries were judged to be moderate to severe.

The participants answered a brief, 20-item questionnaire about their sense of identity (e.g. ‘I think of myself as someone who has survived a brain injury’), their social support, relationship changes since their injury, and their life-satisfaction.

Having a strong sense of identity, seeing oneself as a survivor, having plenty of social support and improved relationships were all independently related to higher life satisfaction. These different factors also influenced each other. ‘…[I]t is likely that personal identity and social network support factors operate in a cyclical way,’ the researchers said, ‘whereby becoming personally stronger from effectively relying on social support also makes individuals more likely to continue to seek out social support and, in that way, to develop social capital.’

Perhaps the most curious finding was that participants who’d sustained more serious injuries tended to report being more satisfied with their lives. This association was mediated by the social and identity factors – that is, participants who’d sustained a more serious injury also tended to identify more strongly as a survivor, and to have more social support and improved relationships.

An obvious suggestion is that the more seriously injured participants might not have complete insight into their lives. Jones and her colleagues doubt this is the case, in part because of the logic of the results, with identity and social support mediating the higher life satisfaction among these participants.

‘Sustaining a head injury does not always lead to a deterioration in one’s quality of life,’ the researchers concluded. ‘…[D]ata from this study serves to tell a coherent story about the way in which the quality of life of those who experience ABIs can be enhanced by the personal and social “identity work” that these injuries require them to perform. … Nietzsche, then, was correct to observe that that which does not kill us can make us stronger.

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

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Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation

Posted on April 16, 2011 by lancashirecarelibraryblog

Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation, BMJ 2011;342:doi:10.

J M Green, A J Wood, M J Kerfoot, G Trainor, C Roberts, J Rothwell, A Woodham, E Ayodeji, B Barrett, S Byford, R Harrington

Psychiatry Research Group, University of Manchester, Manchester M13 9PL, UK.

Abstract:

OBJECTIVE: To examine the effectiveness and cost-effectiveness of group therapy for self harm in young people.

DESIGN: Two arm, single (assessor) blinded parallel randomised allocation trial of a group therapy intervention in addition to routine care, compared with routine care alone. Randomisation was by minimisation controlling for baseline frequency of self harm, presence of conduct disorder, depressive disorder, and severity of psychosocial stress.

PARTICIPANTS: Adolescents aged 12-17 years with at least two past episodes of self harm within the previous 12 months. Exclusion criteria were: not speaking English, low weight anorexia nervosa, acute psychosis, substantial learning difficulties (defined by need for specialist school), current containment in secure care. Setting Eight child and adolescent mental health services in the northwest UK.

INTERVENTIONS: Manual based developmental group therapy programme specifically designed for adolescents who harm themselves, with an acute phase over six weekly sessions followed by a booster phase of weekly groups as long as needed. Details of routine care were gathered from participating centres.

MAIN OUTCOME MEASURES: Primary outcome was frequency of subsequent repeated episodes of self harm. Secondary outcomes were severity of subsequent self harm, mood disorder, suicidal ideation, and global functioning. Total costs of health, social care, education, and criminal justice sector services, plus family related costs and productivity losses, were recorded.

RESULTS: 183 adolescents were allocated to each arm (total n=366). Loss to follow-up was low (<4%). On all outcomes the trial cohort as a whole showed significant improvement from baseline to follow-up. On the primary outcome of frequency of self harm, proportional odds ratio of group therapy versus routine care adjusting for relevant baseline variables was 0.99 (95% confidence interval 0.68 to 1.44, P=0.95) at 6 months and 0.88 (0.59 to 1.33, P=0.52) at 1 year. For severity of subsequent self harm the equivalent odds ratios were 0.81 (0.54 to1.20, P=0.29) at 6 months and 0.94 (0.63 to 1.40, P=0.75) at 1 year. Total 1 year costs were higher in the group therapy arm (£21 781) than for routine care (£15 372) but the difference was not significant (95% CI -1416 to 10782, P=0.132).

CONCLUSIONS: The addition of this targeted group therapy programme did not improve self harm outcomes for adolescents who repeatedly self harmed, nor was there evidence of cost effectiveness. The outcomes to end point for the cohort as a whole were better than current clinical expectations. Trial registration ISRCTN 20496110.

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

Filed under: Self Harm, Self Harm Men | Tagged: , , , | Comments Off

Psychotherapy and Recovery from Schizophrenia: A Model of Treatment as Informed by a Dialogical Model of the Self Experience in Psychosis

Posted on April 15, 2011 by lancashirecarelibraryblog

Psychotherapy and Recovery from Schizophrenia: A Model of Treatment as Informed by a Dialogical Model of the Self Experience in Psychosis, Journal of Contemporary Psychotherapy, 2011, early view

Paul H. Lysaker and John T. Lysaker

Abstract:

Since the term schizophrenia was coined, the disorder has been linked to experiences of self-diminishment. This link calls for theoretical work that helps us understand experiences of diminishment wherein persons find themselves less than they once were but nevertheless able to recognize and describe their diminishment. In response this paper describes how dialogical psychology may help us both understand this feature of schizophrenia and inform the practice of psychotherapy. In particular, we suggest that some alterations in sense of self in schizophrenia may proceed from a range of losses in a person’s ability to sustain intrapersonal and interpersonal dialogues. Moreover, we suggest that these losses lead to at least three different forms of disturbed self experience: barren, monological and cacophonous selves. We then explore the unique challenges each poses to psychotherapy and suggest that attention to dialogical deficits may enrich self-experience if it attends to aspects of self-experience that emerge within session.

 

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

Filed under: Psychosis, Psychotherapy, recovery, Schizophrenia | Tagged: | Comments Off

Patient Experience & Recovery – Becoming ‘whole’ again: A qualitative study of women’s views of recovering from anorexia nervosa

Posted on April 15, 2011 by lancashirecarelibraryblog

Becoming ‘whole’ again: A qualitative study of women’s views of recovering from anorexia nervosa, European Eating Disorders Review, 2011

Jana Jenkins and Jane Ogden

Talking Therapies (IAPT), Berkshire Healthcare Foundation NHS Trust, UK

Department of Psychology, University of Surrey, UK

Abstract:

This study explored how women made sense of their recovery from Anorexia Nervosa (AN). Semi-structured telephone interviews were carried out with fifteen women who had received a diagnosis of AN and defined themselves as either recovered or in recovery. Data were analysed using interpretative phenomenological analysis (IPA). The women described their experiences in terms of three broad areas; being anorexic; the process of change; and being recovered. Transcending these themes was a series of dichotomies involving splits between their mind and body, AN behaviour and cognitions and their rational and irrational side. Further, they indicated that recovery reflects the time when these many different components of their selves are no longer divided and that this was often facilitated through therapy and close relationships which enabled them to find non bodily means to express their distress. Therapy should therefore aim to facilitate a sense of becoming ‘whole’ again.

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

Filed under: Eating Disorders, Patient Experiences, recovery | Tagged: , , , , , | Comments Off

Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis

Posted on April 15, 2011 by lancashirecarelibraryblog

Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis, BMJ. 2011 Mar 11;342:d1199

  1. David Baldwin, professor of psychiatry and honorary consultant psychiatrist
  2. Robert Woods, senior research executive
  3. Richard Lawson, statistician
  4. David Taylor, professor of psychopharmacology

Abstract:

OBJECTIVE: To appraise the evidence for comparative efficacy and tolerability of drug treatments in patients with generalised anxiety disorder.

DESIGN: Systematic review of randomised controlled trials. Primary Bayesian probabilistic mixed treatment meta-analyses allowed pharmacological treatments to be ranked for effectiveness for each outcome measure, given as percentage probability of being the most effective treatment. Secondary frequentist mixed treatment meta-analyses conducted with random effects model; effect size reported as odds ratio and 95% confidence interval.

DATA SOURCES: Medline, Embase, BIOSIS, PsycINFO, Health Economic Evaluations Database, National Health Service Economic Evaluation Database, and Database of Abstracts of Reviews of Effects via DataStar, and Cochrane Database of Systematic Reviews via Cochrane Library (January 1980 to February 2009). Eligibility criteria Double blind placebo controlled randomised controlled trials; published systematic reviews and meta-analyses of randomised controlled trials. Randomised controlled trials including adult participants (aged ≥18) receiving any pharmacological treatment for generalised anxiety disorder. Data abstraction methods Titles or abstracts reviewed initially, followed by review of full text publications for citations remaining after first pass. A three person team conducted screening; an independent reviewer checked a random selection (10%) of articles screened. Data extracted for meta-analysis were also independently reviewed.

MAIN OUTCOME MEASURES: Proportion of participants experiencing ≥50% reduction from baseline score on Hamilton anxiety scale (HAM-A) (response), proportion with final HAM-A score ≤7 (remission), proportion withdrawing from trial because of adverse events (tolerability).

RESULTS: The review identified 3249 citations, and 46 randomised controlled trials met inclusion criteria; 27 trials contained sufficient or appropriate data for inclusion in the analysis. Analyses compared nine drugs (duloxetine, escitalopram, fluoxetine, lorazepam, paroxetine, pregabalin, sertraline, tiagabine, and venlafaxine). In the primary probabilistic mixed treatment meta-analyses, fluoxetine was ranked first for response and remission (probability of 62.9% and 60.6%, respectively) and sertraline was ranked first for tolerability (49.3%). In a subanalysis ranking treatments for generalised anxiety disorder currently licensed in the United Kingdom, duloxetine was ranked first for response (third across all treatments; 2.7%), escitalopram was ranked first for remission (second across all treatments; 26.7%), and pregabalin was ranked first for tolerability (second across all treatments; 7.7%). Conclusions Though the frequentist analysis was inconclusive because of a high level of uncertainty in effect sizes (based on the relatively small number of comparative trials), the probabilistic analysis, which did not rely on significant outcomes, showed that fluoxetine (in terms of response and remission) and sertraline (in terms of tolerability) seem to have some advantages over other treatments. Among five UK licensed treatments, duloxetine, escitalopram, and pregabalin might offer some advantages over venlafaxine and paroxetine.

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

Filed under: Anxiety Disorder, Pharmacy | Tagged: , , , , | Comments Off

CBT for individuals with longstanding anorexia nervosa: Adaptations, clinician survival and system issues

Posted on April 14, 2011 by lancashirecarelibraryblog

Cognitive behavioural therapy for individuals with longstanding anorexia nervosa: Adaptations, clinician survival and system issues, European Eating Disorders Review, 2011

Bamford, B. H. and Mountford, V. A

Eating Disorders Research Team, Division of Psychological Medicine, St. George’s, University of London, London, UK

Eating Disorders Service, South West London and St. George’s Mental Health NHS Trust, Springfield Hospital, London, UK

Abstract:

Despite recent advances in the treatment of anorexia nervosa, some individuals will progress to a severe and enduring illness, with associated physical, psychological and social consequences. Working with these patients, however, may leave clinicians feeling overwhelmed, risking difficulties in the therapeutic relationship including disengagement or despair. Cognitive behaviour therapy has shown some promise in the treatment of eating disorders, yet some features may not be appropriate for this group. In this paper, we outline the ways in which we have adapted cognitive behaviour therapy to best meet the complex and challenging needs of this group. We stress the importance of maintaining a reassuring, accepting and motivational approach in combination with clear goal setting and boundaries.

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

Filed under: CBT Cognitive Behaviour Therapy, Eating Disorders | Tagged: , , , , | Comments Off

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