Dignity and nutrition for older people – Care Quality Commission

Dignity and nutrition for older people , May 2011, Care Quality Commission

Click on the title above to access the full-text of the reports

Abstract:

The Care Quality Commission has published the first 12 reports from an inspection programme which examines whether elderly people receive essential standards of care in 100 NHS hospitals throughout England. The programme focuses on whether people are treated with dignity and respect, and whether they get food and drink that meets their needs. A national report into the findings of the programme will be published in September. These first 12 inspection reports identify three hospitals as failing to meet the essential standards required by law. Less serious concerns were identified in a further three hospitals, with the remaining six found to be meeting essential standards.

Lancashire Care staff can click on the title above to access copies of the reports

Monitoring Change in Families Receiving Primary Mental Health Specialist Services: A Pragmatic Evaluation Within an Existing Service for the Under-Fives

Monitoring Change in Families Receiving Primary Mental Health Specialist Services: A Pragmatic Evaluation Within an Existing Service for the Under-Fives, Child and Adolescent Mental Health, 2011, 15 (2) pp. 120–124

Jon Pollock and Sue Horrocks

School of Health & Social Care, Faculty of Health & Life Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, UK

Abstract:

Background:  Specialist CAMHS-based services for pre-school age children are being introduced in the UK using different models of care. The clinical value of these new services requires assessment.

 

Method:  Over 20 months a Primary Mental Health Specialist (Under 5s) service operating in South West UK was evaluated on a variety of themes including effectiveness. Recruited clients completed questionnaires on their own well-being (on two occasions) and their child’s behaviour (on three occasions) over the intervention period.

 

Results:  Of the 67 carers assessed at or shortly after recruitment using the General Health Questionnaire, 55.2% were at high risk of having a clinically significant affective mental condition. Despite a trend towards improvement, neither the GHQ-12 total score nor the proportion meeting the clinical criterion was statistically significantly reduced. The main index of child behaviour and emotional state demonstrated a statistically significant reduction in the number of disturbance-indicating behaviours over the service intervention period. The largest changes occurred between recruitment and the 4th visit. Selection bias cannot be excluded.

 

Conclusions:  Significant changes determined over a relatively short period of intervention is consistent with an effect of service, but direct attribution demands care as no control groups were included.

 

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

Diet and Mental Health in Children – Increasing interest to patients, parents, health professionals and public policy makers

Diet and Mental Health in Children. Child and Adolescent Mental Health, 2011, 14 (3) pp. 148–155

Diane Tomlinson, Heather Wilkinson and Paul Wilkinson

Specialist Registrar in Child and Adolescent Psychiatry, Bethel Child and Family Centre, Mary Chapman House, Hotblack Road, Norwich, NR4 2HN, UK

Abstract:

The role played by diet in mental health is of increasing interest to patients, parents, health professionals and public policy makers. This review examines the literature assessing the role of diet in childhood cognitive development, school performance and behaviour. The effects of inadequate dietary intake and of nutrient supplements are considered. Studies of diet and specific psychiatric diagnoses such as depression and psychosis are discussed, with a focus on the evidence for the child and adolescent population.

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

Assessment Measures for Child and Adolescent Eating Disorders: A Review

Assessment Measures for Child and Adolescent Eating Disorders: A Review, Child and Adolescent Mental Health, 2011, 16 (2) pp 122–127

Nadia Micali and Jennifer House

Department of Child and Adolescent Psychiatry, PO Box 85, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF

Abstract:

Background:  Several diagnostic and screening instruments are available for child and adolescent eating disorders. However, limitations have been identified in many of these.

 

Method:  We review the most frequently used assessment measures for eating disorders in children and adolescents.

 

Results:  Several of the available instruments have significant limitations, although relevant strengths are identified.

 

Conclusions:  Limitations in the current available instruments for child and adolescent eating disorders should be addressed in order to improve recognition and treatment.

 

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

Do we truly appreciate how difficult it is for patients with schizophrenia to adapt a healthy lifestyle?

Do we truly appreciate how difficult it is for patients with schizophrenia to adapt a healthy lifestyle? Acta Psychiatrica Scandinavica, 2011, 123 (6) pp. 409–410

Abstract:

Vancampfort et al. (1) compared 60 Belgian patients with schizophrenia and 40 healthy volunteers according to the distance they walked in 6 min and explored the relationship between their performance on this task with their routine participation in physical activities and their physical self-perception. Selection dictated that patients were more likely to be obese and have preexisting painful musculoskeletal conditions. They were also more likely to smoke. As expected, patients with schizophrenia walked significantly shorter distances than controls and became short of breath easily. Their performance improved with decreasing adiposity but even normal weight patients walked about 95 fewer meters in 6 min than the controls. Patients participated less in leisure or sport-related physical activities (and likely had fewer resources and opportunities to do so) than the controls. Regarding self-perception, patients were significantly more likely than controls to rank themselves poorly on sports competence, physical self-worth, and body attractiveness. A healthier body mass index (BMI) projected into a more favorable self-perception.

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

NICE Pathways – NICE Pathways is an interactive tool for health and social care professionals providing fast access to NICE guidance and associated products

NICE Pathways , 25th May, NICE

Click on the title above to access this resource

About:

New online tool provides quick and easy access, topic by topic, to the range of guidance from NICE, including quality standards, technology appraisals, clinical and public health guidance and NICE implementation tools. Simple to navigate, NICE Pathways allows you to explore in increasing detail NICE recommendations and advice, giving you confidence that you are up to date with everything we have recommended.

NICE – Common mental health disorders: identification and pathways to care

Common mental health disorders: identification and pathways to care , 25th May 2011, NICE

Click on the title to access the full guidance

Abstract:

This clinical guideline offers evidence-based advice on the care and treatment of adults who have common mental health disorders, with a particular focus on primary care. It brings together advice from existing guidelines and combines it with new recommendations on access to care, assessment and developing local care pathways for common mental health disorders. Common mental health disorders include depression, generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, post‑traumatic stress disorder and social anxiety disorder.

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

Supporting people with learning disabilities who self-injure

Supporting people with learning disabilities who self-injure, Tizard Learning Disability Review, Volume 16, Number 1 / January 2011, pp 5-15

Pauline Heslop1

 

1 Norah Fry Research Centre, Bristol, UK

Abstract:

This article reports on support that people with learning disabilities who self-injure say they have found, or would find, helpful in relation to their self-injury. It is an important issue, because most interventions and approaches are based on past patterns of support or what professionals think is helpful or appropriate. Rarely has the voice of the person concerned been heard. The clear message from people with learning disabilities, including those who use little or no verbal communication, is that they want opportunities to communicate their feelings and to be listened to. Being open to listening and developing one’s own communication skills is essential for supporters of people with learning disabilities who self-injure.

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

Targeting suicide – qualitative analysis of suicide prevention strategy documents in England and Finland

Targeting suicide – qualitative analysis of suicide prevention strategy documents in England and Finland, Mental Health Review Journal, Volume 16, Number 1 / March 2011, pp 5-14

Pia Solin1, Pirjo Nikander2

 

1MSocSc, School of Health Sciences, University of Tampere, Finland
2Institute for Social Research, University of Tampere, Finland

Abstract:

Suicide as a stigmatising issue presents a huge challenge for prevention policy. Also, policy itself is often difficult to turn into action. This research describes the interpretative repertoires found in the suicide prevention strategies of England and Finland, and explores their potential functions and audiences. It was found that the political repertoire was formed from four sub-repertoires: the public health epidemiology, the everyday, the preventive action and the reflective repertoires. This paper discusses the polyphonic and multilayered nature of these policy documents and how different repertoires may be used for various functions. The polyphonic nature of policy documents is necessary to reach a wide readership and to capture suicide as a controversial phenomenon. However, the downside is that the argumentative style may also undermine some of the measures and actions recommended.

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

Family outcomes from a randomized control trial of relapse prevention therapy in first-episode psychosis

Family outcomes from a randomized control trial of relapse prevention therapy in first-episode psychosis, Journal of Clinical Psychiatry,  2010 Apr;71(4):475-83

Gleeson, J F et al

Abstract:

OBJECTIVE:

 

We have previously reported that our combined individual and family cognitive-behavioral therapy (CBT) relapse prevention therapy (RPT) was effective in reducing relapse rates compared to treatment as usual (TAU) within a specialist program for young, first-episode psychosis patients who had reached remission on positive symptoms. Here, we report the outcomes for family participants of DSM-IV-diagnosed first-episode psychosis patients recruited between November 2003 and May 2005 over a 2.5-year follow-up period. The primary hypothesis was that, compared to family members receiving TAU, family participants who received RPT would have significantly improved appraisals of stressors related to caregiving. Secondary hypotheses were that RPT would be associated with reduced expressed emotion and improved psychological distress.

METHOD:

 

Family members were assessed at baseline and at 7-month, 12-month, 18-month, 24-month, and 30-month follow-up on appraisal of caregiving, expressed emotion, and psychological distress using the Experience of Caregiving Inventory, The Family Questionnaire, and the General Health Questionnaire of 28 Items, respectively. The family component of RPT was based on family behavioral therapy for schizophrenia with a specific focus on psychoeducation and CBT for relapse prevention.

RESULTS:

 

Thirty-two families received RPT, and 31 families received TAU. There were significant group effects for aspects of the appraisal of caregiving, including negative symptoms, positive personal experiences, and total positive score on the Experience of Caregiving Inventory. Time effects were evident for emotional overinvolvement and for aspects of the appraisal of caregiving. There were no significant effects for psychological distress.

CONCLUSIONS:

 

The relatives of patients who received RPT perceived less stress related to their relative’s negative symptoms and an increase in perceived opportunities to make a positive contribution to the care of their relative compared to carers in the TAU condition. Cognitive-behavioral therapy for relapse prevention showed promise in improving the experience of caregiving for family members of first-episode psychosis patients over a 2.5-year follow-up period.

TRIAL REGISTRATION:

 

anzctr.org.au Identifier: ACTRN12605000514606.

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

Development and Pilot Evaluation of a Manualized Cognitive-Behavioural Treatment Package for Adolescent Self-Harm

Development and Pilot Evaluation of a Manualized Cognitive-Behavioural Treatment Package for Adolescent Self-Harm, Behavioural and Cognitive Psychotherapy, 2011, early view

Lucy M. W. Taylor, Dialectical Behaviour Therapy (DBT) Service,

Michael Rutter Centre, Maudsley Hospital, De Crespigny Park, London SE5 8AZ, UK

Abstract:

Background: Manualized cognitive-behavioural therapy (MCBT) approaches to treating adolescent anxiety and depression have been shown to be effective in recent years, as have MCBT for adult self-harm (SH). Aims: This paper describes the rationale for, development and pilot evaluation of the efficacy of a novel manualized CBT package for adolescent self-harm (SH). It also addresses the acceptability of this treatment package to therapists and patients. Method: Twenty-five adolescents (aged 12–18 years) presenting to a Community Child and Adolescent Mental Health Service (CAMHS) in Greater London with SH behaviour began the “Cutting Down” programme and 16 (64%) completed the treatment. Outcomes were assessed at baseline, at the end of treatment and at 3 month follow up. Results: Significant reductions in self-harm behaviour, depression symptoms and trait anxiety were reported. There was no change in state anxiety or in levels of parental expressed emotion as perceived by the adolescent. Conclusion: These pilot findings provide preliminary support for the efficacy and acceptability of this time-limited CBT package for adolescents who self-harm.

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

Physical Health & Schizophrenia – What factors affect the lifestyle choices of people with schizophrenia?

What factors affect the lifestyle choices of people with schizophrenia? Mental Health Review Journal, Volume 15, Number 2 / June 2010, pp 21-27

Hosam Abed1

 

1 Nottinghamshire Healthcare NHS Trust, UK

Abstract:

People who have schizophrenia have higher rates of morbidity and mortality and a shorter life expectancy partly due to less healthy lifestyle choices such as a diet lacking in fruit and vegetables and lack of exercise. This study attempts to improve our understanding about the factors that affect lifestyle choices in this group of people. This is a qualitative study in which seven people with schizophrenia were interviewed using semi-structured interviews about their lifestyle, including their diet and exercise, and they were encouraged to talk about the various factors that might influence their decisions and behaviour with respect to these. The interviews were tape recorded, transcribed and then independently analysed by five analysts looking for themes. The themes were then cross-referenced by the interviewer looking for common themes. Four common themes were identified and were grouped as lack of motivation, psychotic symptoms, lack of physical health-related knowledge and side effects to medication. This study suggests that a holistic approach needs to be taken when considering physical health in these patients, and that physical health promotion and education should go hand in hand with physical health monitoring.

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

Personality disorder: taking a person-centred approach

Personality disorder: taking a person-centred approach, Mental Health Review Journal, Volume 15, Number 4 / December 2010, pp 6-9

Lord Victor Adebowale1

 

1 Turning Point, UK

Abstract:

Personality disorders manifest themselves in a variety of ways and there is also debate about the extent to which these conditions can be treated. The author debates the definition of personality disorder and considers the stigma that this diagnosis can attach to individuals. A new approach to the treatment of people with personality disorders is proposed, using the person-centred approach and placing the individual at the centre of services. With regards to personality disorder, this person-centred approach is able to treat the condition as well as addressing the negative effects of how it manifests itself.

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

Ethical perspectives on suicide and suicide prevention

Chris Kelly and Eric Dale

Abstract:

Philosophy both influences and is influenced by clinical and legal practice relating to suicide. This article begins with a brief history of attitudes in the UK and Europe towards those who attempt suicide. It describes the main philosophical positions regarding suicide, including the principle of respect for life,the utilitarian position, the theological principle, and the principles of autonomy and duty to others. It concludes that short-term interventions are justified in most cases, for example when the suicide attempt is a ‘cry for help’ and/or the individual is ambivalent in their attempt or likely to havea mental illness.

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

Hope in psychiatry

Beate Schrank, Mark Hayward, Giovanni Stanghellini, and Larry Davidson

Hope has long been considered a relevant variable in medical disciplines, but little attention has been paid to the concept,and its clinical and research implications, in psychiatry. This article illuminates the topic of hope from four different perspectives relevant to psychiatric research and practice. The four authors discuss hope from the viewpoint of their specific area of expertise,providing an overview of philosophical, conceptual, research and recovery-related reflections concerning hope in psychiatry.

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

Treatment of personality disorder: skills-based therapies

,   Advances in Psychiatric Treatment 2011 v. 17, p. 206-213

Sue Evershed is Lead Psychologist in the Personality Disorder Directorate at Rampton Hospital. She has previously worked as a Consultant Psychologist in the Learning Disability Directorate at Rampton Hospital, and prior to this she was employed by HM Prison Service, working with young offenders, high secure offenders, and ‘dangerous and disturbed’ prisoners in the first of the ‘special units’ at HMP Parkhurst. Her research interests currently include treatment outcome and process with personality disorder, including therapeutic alliance, therapeutic boundaries and therapy attrition.

Abstract:

A variety of therapies have been developed or adapted to treat personality disorder over recent years. This article will reviewskills-based treatments (as opposed to insight-based treatments).Two approaches are outlined: cognitive–behavioural therapy and dialectical behaviour therapy. The article details the underpinning theory and the model of personality disorder utilised by the two approaches, and describes how the therapy is applied. Evidenceof therapeutic efficacy is presented along with information about accessing training and therapy materials.

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

Mindfulness in Forensic Mental Health: Does It Have a Role?

Mindfulness in Forensic Mental Health: Does It Have a Role?, Mindfulness. 2010. Volume 1, Number 1, 4-9

Kevin Howells, Allison Tennant, Andrew Day and Robert Elmer

Nottingham University, Clair Chilvers Building, Rampton Hospital Institute of Mental Health Retford Nottinghamshire DN22 OPD UK

Rampton Hospital Peaks Unit Retford UK

Abstract:

Treatment and rehabilitation in forensic settings have been largely based on cognitive behavioural models and therapies. In the past decade, “third wave” approaches have developed in cognitive behavioural therapy, strongly influenced by spiritual and contemplative traditions such as Buddhism. Mindfulness is the most analysed and researched of such approaches. In this paper, we ask whether mindfulness is relevant to therapeutic work with offenders in forensic mental health and criminal justice services. We review the known criminogenic and other needs of offender groups and discuss whether the psychological processes affected by mindfulness are relevant to reducing risk, alleviating distress and facilitating coping. We conclude that they are. Finally, we address some of the problems that may arise in implementing mindfulness interventions in forensic settings.

 

 

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

Management of self-harming patients in an acute psychiatric ward

Management of self-harming patients in an acute psychiatric ward, Journal of Clinical Audits 2010, Vol 2(3) pp 53-59

Edwin Ugoh, Ashaye Olakunle, Jane Anderson, Hemachandran Pathmanandam

Specialty Registrar, General Adult Psychiatry, Hertfordshire Foundation Partnership Mental NHS

Abstract:

Aims This audit compared the current management of self-harming patients, admitted to Aston ward, Lister Hospital Mental Health Unit, Stevenage, with the National Institute of Clinical Excellence(NICE) Clinical Guidelines(CG)16 published 07-2004 on: The short term physical and psychological management and secondary prevention of selfharm in primary and secondary care.

Methods Data was collected retrospectively from the Hertfordshire Partnership Trust computerised care notes for a period of three months from 08-09- 2008 to 08-12- 2008. Questionnaires were given to service users on admission to Aston ward (from 11-12- 2008 to 11-02-2009), and at the same time to ward staff.

Results There were four standards derived from the above NICE Guidelines (CG16).i Questionnaires were given to staff on the ward including doctors, however all the respondents were nurses- 14/ 26 nurses. 5/ 10 service users on admission with self – harming behaviour responded. 78 service users admitted with history of self –harming behaviour three months prior to the audit had all their clinical entries examined retrospectively. 73 / 78 service users had a comprehensive assessment from healthcare professionals. 14/14 nurses stated they were respectful and understanding to service users but one service user disagreed on this standard. 9 of the nurses had in-house training but none had formal training; 40% of the service users were not happy with the quality of information about treatment options.

Conclusions The audit revealed that the current management of service users with self-harming history falls short of the NICE Guidelines (CG16). Therefore, the conclusion of this comparison is that there is a need for service improvement.

Recommendations. All nurses, doctors and relevant healthcare professionals should receive adequate training in the short term physical and psychological management and secondary prevention of self harm in primary and secondary care. A re-audit will be done in 12 months.

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

Mindfulness & Meduim-Secure – The impact of a ward-based mindfulness programme on recorded aggression

The impact of a ward-based mindfulness programme on recorded aggression in a medium secure facility for women with learning disabilities,Journal of Learning Disabilities and Offending Behaviour, Volume 2, Number 1 / January 2011, pp 27-41

Jane Chilvers, Cathy Thomas and Alex Stanbury

Care Learning Disabilities Services, UK

Abstract:

Mindfulness is the practice of focusing attention effectively/purposefully, in a non-judgemental manner, on current circumstances (Kabat-Zinn, 2009; Crane, 2009). It has been increasingly used as a tool for managing a range of difficulties associated with personal suffering, including stress and chronic pain, as well as some aspects of mental disorder. In this study the practice of mindfulness was introduced to a medium secure ward for female patients with learning disabilities in the form of twice-weekly, 30-minute group sessions. Proxy measures of institutional aggression namely the number of observations (Obs), physical interventions (PI), and seclusions (Sec) were recorded at baseline (during the month prior to the introduction of the mindfulness sessions and at two months and six months following the introduction of the sessions). Friedman’s Analysis of Variance and post-hoc analyses using Wilcoxon’s Signed Ranks showed a significant reduction at six months. The potential influence of basic mindfulness practice sessions in reducing aggression is discussed.

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

Multifamily group psychoeducation and cognitive remediation for first-episode psychosis: RCT

Multifamily group psychoeducation and cognitive remediation for first-episode psychosis: a randomized controlled trial, BMC Psychiatry,  2011 , Jan 12;11:9 pp 1-7

Breitborde NJ, Moreno FA, Mai-Dixon N, Peterson R, Durst L, Bernstein B, Byreddy S, McFarlane WR

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

Family Interventions – Carers reported less isolation, improved confidence, greater understanding of psychosis, reduction in guilt and increased coping in their caring role after the group

Carer’s education groups for relatives with a first episode of psychosis: an evaluation of an eight-week education group, Early Intervention in Psychiatry, Volume 5, Issue 1, February 2011, Pages: 57–63

Genevieve Riley, Nathan Gregory, Jane Bellinger, Natalie Davies, Gabby Mabbott and Robina Sabourin

Together NHS Foundation Trust, Gloucester, UK,

Trustee Grippers Charity, Cirencester, UK

Abstract:

AIM:

 

This study aimed to evaluate an eight-week carers group for people with first episode of psychosis receiving services from the Gloucestershire Recovery in Psychosis Early Intervention Team. Potential benefits for carers were assessed including changes in feelings of stress, isolation, recognition, and of being appreciated and valued.

METHODS:

 

Following completion of the group, all 12 carers participated in an independently facilitated focus group to evaluate the course. Transcripts were imported into the QSR NVivo 8 (QSR International, Doncaster, Victoria, Australia) software package for thematic analysis. An independent coding and correlational analysis of data was used to identify any common themes.

RESULTS:

 

Results identified five key themes reported by carers: the emotional impacts of being a carer (loss, grief, guilt, shock, acceptance), the wider impacts of mental illness within a family (isolation, stigma), the caring role and how this affected relationships (improved relationships), the design of the group (barriers, course content, timing of invitations, moving forward) and the wider impacts of participation (carer education, importance of sharing real-life experiences, navigating the National Health Service).

CONCLUSIONS:

 

Carers reported less isolation, improved confidence, greater understanding of psychosis, reduction in guilt and increased coping in their caring role after the group. Carers reported that they gained new knowledge, obtained support from staff and graduate carers, increased the recognition of their caring role and had improved relationships with their relative with mental illness.

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

Psychosis: Psychodynamic work with families

Psychosis: Psychodynamic work with families, Psychoanalytic Psychotherapy, Volume 25, Issue 1, 2011, Pages 75 – 91

Brian Martindale; Judith Smith

South of Tyne EIP Service, Monkwearmouth Hospital, Sunderland, UK

Abstract:

Psychoanalysts suggested psychological work with families where a member has a psychosis back in the 1950s and 1960s. The paper gives a brief historical outline and then describes a number of reasons – including compatibility with NICE Guidelines – why a psychodynamic approach should be made available.

A case example is given of psychodynamic family work in an Early Intervention in Psychosis service where the father of three children had a protracted psychosis and the mother’s own history had played into a lack of expectations of her husband; this couple dynamic played an important role in infantilizing the patient rather than supporting him in his role as father and husband. Psychological work that involved the mother was an essential key to supporting her husband’s development and confidence with substantive benefits to all members of the family including the children.

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

OT – Animal-Assisted Therapy with Farm Animals for Persons with Psychiatric Disorders: Effects on Anxiety and Depression, a Randomized Controlled Trial

Animal-Assisted Therapy with Farm Animals for Persons with Psychiatric Disorders: Effects on Anxiety and Depression, a Randomized Controlled Trial, Occupational Therapy in Mental Health, 1541-3101, Volume 27, Issue 1, 2011, Pages 50 – 64

Bente Berget; Øivind Ekeberg; Ingeborg Pedersen; Bjarne O. Braastad

Abstract:

This study examined the effects of Animal-Assisted Therapy with farm animals during a 12 weeks’ intervention on anxiety and depression among psychiatric patients by using a randomized controlled trial with a follow-up investigation at 6 months. Ninety adult patients were included, with 41 completers in the treatment group and 28 in the control group. Anxiety measured using Spielberger State Anxiety Inventory did not decrease significantly during the intervention for the treatment group but was significantly lower at follow-up compared with baseline (p = 0.002) and with the end of the intervention (p = 0.004). There was no significant change for the control group. Depression measured using Beck Depression Inventory was significantly lower at follow-up compared with baseline for both groups, but there were no significant differences between the groups.

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

Memory Clinics – Case finding in dementia: comparative utility of three brief instruments in the memory clinic setting

Case finding in dementia: comparative utility of three brief instruments in the memory clinic setting, International Psychogeriatrics (2011), 23(5) 788-796

Gerard J. Byrne, Discipline of Psychiatry, School of Medicine, University of Queensland, K Floor, Mental Health Centre, Royal Brisbane & Women’s Hospital, Herston 4029 QLD, Australia

Abstract:

Background: The principal goal of this study was to compare the diagnostic accuracy of three brief instruments in memory clinic attendees. Two of the instruments were based on face-to-face clinical assessment (Standardized Mini-mental State Examination and Rowland Universal Dementia Assessment Scale), whereas the third group used proxy information from an informant (Informant Questionnaire on Cognitive Decline in the Elderly). Dementia diagnosis as provided by a specialist physician (geriatrician, psychiatrist or neurologist) was used as the reference standard.

Methods: This was a cross-sectional study. Data were collected from 204 consecutive memory clinic attendees (M = 76.90, 56% female) and their family caregivers. Comparative utility was assessed through receiver operating characteristic (ROC) analyses.

Results: One hundred and fifty-two patients (75%) were diagnosed as having dementia. Diagnostic accuracy, as indicated by the area under the ROC curve (AUC), was similar for the three instruments as follows: SMMSE (AUC = 0.82, 95% CI = 0.76, 0.87, p < 0.0001) and RUDAS (AUC = 0.83, 95% CI = 0.77, 0.88, p < 0.0001), and slightly lower for IQCODE (AUC = 0.77, 95% CI = 0.71, 0.83, p < 0.0001). There was no significant difference between the areas under the curve (χ2 = 2.57, df = 2, p = 0.28).

Conclusions: Diagnostic accuracy was similar for the three instruments, which all proved to be moderately useful tools for initial screening for cognitive impairment in the memory clinic environment. Being a proxy measure, the IQCODE had specific practical use in this context, where the patient might not be able to provide information. The RUDAS exhibited high specificity and proved to be less dependent upon cultural factors than the SMMSE, making it particularly valuable in a multicultural setting.

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

Occupational Therapists’ Perception of the Tree Theme Method™ as an Intervention in Psychosocial Occupational Therapy

Occupational Therapists’ Perception of the Tree Theme Method as an Intervention in Psychosocial Occupational Therapy, Occupational Therapy in Mental Health, 1541-3101, Volume 27, Issue 1, 2011, Pages 36 – 49

A. Birgitta Gunnarsson; Jan-Åke Jansson; Kerstin Petersson; Mona Eklund

Abstract:

This study investigated how occupational therapists experience utilization of the Tree Theme Method, an intervention based on creative activities and life-story telling and making. The Tree Theme Method is comprised of five sessions in which the therapist asks the client to paint symbolic trees, with specific themes representing their present life situation, childhood, adolescence, adulthood, and the future. Nine occupational therapists in mental health care were asked about their experiences when using the Tree Theme Method. The informants formed two focus groups and each group was interviewed twice. Qualitative content analysis was used to identify five categories including: (1) therapeutic frames, (2) therapist requirements, (3) client requirements, (4) the therapeutic relationship, and (5) the Tree Theme Method as a multi-dimensional process. Overall the informants were satisfied with the intervention with some variation as to therapists’ perception about the helpfulness of the tool. The Tree Theme Method was experienced as a structured method of starting a therapeutic process and initiating a therapist-client relationship. The therapeutic attitude, self-knowledge, and expert knowledge seemed to be important prerequisites for the therapists when using the Tree Theme Method intervention.

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

Psychosocial Interventions – The use of Cognitive Behavioural Therapy (CBT) self-help materials for depression is increasingly recommended as part of stepped care service models.

Training the Wider Workforce in Cognitive Behavioural Self-Help: The SPIRIT (Structured Psychosocial InteRventions in Teams) Training Course, Behavioural and Cognitive Psychotherapy (2011), 39 (2) 139-149

Chris Williams, Rebeca Martinez, Rebecca Dafters, Lisa Ronald and Anne Garland

a1 University of Glasgow, UK

a2 University Hospital Aintree, Liverpool, UK

a3 Strathdoon House, Ayr, UK

a4 Nottingham Trent Trust, UK

a5 Gartnavel Royal Hospital, Glasgow, UK

Abstract:

Background: The use of Cognitive Behavioural Therapy (CBT) self-help materials for depression is increasingly recommended as part of stepped care service models. Such resources can be delivered by both new specialist workers (such as the IAPT services in England), or by introducing this style of working into an existing workforce as described in the current paper. The Structured Psychosocial InteRventions in Teams (SPIRIT) course consists of 38.5 hours of workshops, and 5 hours of clinical supervision in the use of CBT self-help (CBSH). Method: This study describes an evaluation of the effectiveness of the course when offered to community and inpatient mental health staff from a wide range of adult and older adult mental health teams in NHS Greater Glasgow Mental Health Division. Results: Training resulted in both subjective and objective knowledge and skills gains at the end of training that were largely sustained 3 months later. At that time point, 40% of staff still reported use of CBSH in the last week. Satisfaction with the training is high, using validated rating scales.

Conclusions: The SPIRIT training has gone some way to increasing access to CBSH for use in everyday clinical practice.

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

Lisa Graham – Lancashire Care NHS Foundation Trust

Investigating the Use of CD-Rom CBT for Bulimia Nervosa and Binge Eating Disorder in an NHS Adult Outpatient Eating Disorders Service, Behavioural and Cognitive Psychotherapy, 2011 Early View

Lisa Graham and Mark Walton

Lancashire Care NHS Foundation Trust

East Lancashire Eating Disorders Service, Eating Disorders Managed Clinical Network, Lancashire Care NHS Foundation Trust, NHS Eating Disorders Service, 18 Euxton Lane, Chorley PR71PS, UK

Abstract:

Background: Many patients who experience bulimia nervosa (BN) and binge eating disorder (BED) find it hard to access evidence-based treatments. Rates of failure to enter outpatient services following initial assessment are high, as are dropout rates from specialist outpatient eating disorders services. Aims: To offer CD-Rom CBT, a cognitive-behavioural multi-media supported self-help treatment, in a locality-based outpatient NHS Eating Disorders Service to patients who have binge eating disorder and bulimia nervosa. Method: Patients referred to a catchment-based NHS outpatient eating disorders service who were assessed and had an eating disorder with a binge-eating component were offered CD-Rom based CBT (Overcoming Bulimia) whilst on the waiting list for individual CBT. Results: Forty patients completed the 8 sessions and attended the evaluation appointment (13 had BN, 27 had BED). For both groups, there were significant improvements in well-being and functioning, as well as significant reductions in problems and risk. There was also a significant reduction on the “Bulimic Subscale” of the EDI. These results were comparable with the original study findings (Schmidt, Treasure and Williams, 2001). Dropouts from the CD-Rom reflected rates common to other EDS treatments suggesting that CD-Rom did not directly impact upon service dropout rates.

Conclusions: Computer assisted CBT for Eating Disorders offers a promising, feasible and acceptable first step for patients who have bulimia nervosa or binge eating disorder and access treatment from specialist eating disorders services.

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

CBT for Youth with Body Dysmorphic Disorder: Current Status and Future Directions

Cognitive-Behavioral Therapy for Youth with Body Dysmorphic Disorder: Current Status and Future Directions, Child and Adolescent Psychiatric Clinics of North America, Volume 20, Issue 2 , Pages 287-304, April 2011

 

Phillips KA, Rogers J

 

Abstract:

Body dysmorphic disorder (BDD) usually begins during early adolescence and appears to be common in youth. BDD is characterized by substantial impairment in psychosocial functioning and high rates of suicidality. Cognitive-behavioral therapy (CBT) tailored to BDD is the best tested and most promising psychosocial treatment for adults. CBT has been used for youth with BDD, but has not been systematically developed for or tested in youth. This article focuses on CBT for BDD in adults and youth; possible adaptations and the need for treatment research in youth; and prevalence, clinical features, diagnosis, recommended pharmacotherapy, and treatments that are not recommended.

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

Special Article – The myth of mental illness: 50 years later

, The Psychiatrist 2011 v. 35 (5) p. 179-182

Thomas Szasz is professor of psychiatry emeritus, State University of New York Upstate Medical University, Department of Psychiatry, Syracuse, New York, USA

Abstract:

Fifty years ago I noted that modern psychiatry rests on a basic conceptual error – the systematic misinterpretation of unwanted behaviours as the diagnoses of mental illnesses pointing to underlying neurological diseases susceptible to pharmacological treatments. I proposed instead that we view persons called‘mental patients’ as active players in real life dramas, not passive victims of pathophysiological processes outside their control. In this essay, I briefly review the recent history of this culturally validated medicalisationof (mis)behaviours and its social consequences.

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

Impact of screening for risk of suicide: randomised controlled trial

, The British Journal of Psychiatry (2011) 198 (5) pp. 379-384

Mike J. Crawford, Lavanya Thana, Caroline Methuen, Pradip Ghosh, Sian V. Stanley, Juliette Ross, Fabiana Gordon, Grant Blair, and Priya Bajaj

Abstract:

BACKGROUND:

Concerns have been expressed about the impact that screening for risk of suicide may have on a person’s mental health.

AIMS:

To examine whether screening for suicidal ideation among people who attend primary care services and have signs of depression increases the short-term incidence of feeling that life is not worth living.

METHOD:

In a multicentre, single-blind, randomised controlled trial, 443 patients in four general practices were randomised to screening for suicidal ideation or control questions on health and lifestyle (trial registration: ISRCTN84692657). The primary outcome was thinking that life is not worth living measured 10-14 days after randomisation. Secondary outcome measures comprised other aspects of suicidal ideation and behaviour.

RESULTS:

A total of 443 participants were randomised to early (n = 230) or delayed screening (n = 213). Their mean age was 48.5 years (s.d. = 18.4, range 16-92) and 137 (30.9%) were male. The adjusted odds of experiencing thoughts that life was not worth living at follow-up among those randomised to early compared with delayed screening was 0.88 (95% CI 0.66-1.18). Differences in secondary outcomes between the two groups were not seen. Among those randomised to early screening, 37 people (22.3%) reported thinking about taking their life at baseline and 24 (14.6%) that they had this thought 2 weeks later.

CONCLUSIONS:

Screening for suicidal ideation in primary care among people who have signs of depression does not appear to induce feelings that life is not worth living.

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

Follow

Get every new post delivered to your Inbox.

Join 100 other followers