Cochrane review

Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults

Cochrane review finds evidence that individual trauma-focused cognitive behavioural therapy (TFCBT) and eye movement desensitisation and reprocessing (EMDR) did better than waitlist/usual care in reducing clinician-assessed PTSD symptoms.

The Improving Access to Psychological Therapies (IAPT) model raises many questions – Where does mental health nursing fit in primary care?

Where does mental health nursing fit in primary care? Nursing Times; 2011, 107: 45, 24-25

Jude Caie is mental health nurse therapist, Manchester Mental Health and Social Care Trust, HMP Manchester, Manchester, UK

Abstract:

The introduction of the Improving Access to Psychological Therapies scheme in primary mental health care has raised questions about mental health nurses’ role and function. This article considers some of the key questions around where and indeed whether nursing continues to have a place within primary mental health care.

KEY POINTS

 

  1. The remit of Imp
  2. Improving Access to Psychological Therapies (IAPT) is to provide timely and time-limited therapy
  3. New roles in the IAPT framework mean nurses can access new training
  4. Becoming part of the IAPT structure could give mental health nurses the opportunity to have their skills formally recognised
  5. It is up to individual mental health nurses to decide whether they can work within an IAPT model
  6. Nursing must fight to survive and establish its place within a changing healthcare environment

 

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

CBT & Family Intervention – NICE for Schizophrenia Recommends

Cognitive behavioural therapy and family intervention for psychosis – evidence-based but unavailable? The next stepsPsychoanalytic Psychotherapy, Vol. 25, (1), 2011, Pages 69 – 74

Elizabeth Kuipers – Department of Psychology, Institute of Psychiatry, King’s College London, London, UK

Abstract:

National Institute for Clinical Excellence updated guidelines for schizophrenia (2009) recommend two psychological treatments – cognitive behavioural therapy for psychosis (CBTp) and family intervention for psychosis (FI). Despite these recommendations being in place for nearly a decade, implementation problems remain, particularly for FI. It is argued that these problems can be overcome, if services prioritise improving access to psychological therapies for psychosis, and that carers in particular need their own services to be developed.

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

Promising Psychotherapies for Personality Disorders

Promising Psychotherapies for Personality Disorders, Canadian Journal of Psychiatry,  2010. Vol. 55, Iss. 4; pg. 202, 9 pgs

George Hadjipavlou, John S Ogrodniczuk.

Abstract:

To provide a narrative review of recent research on the psychotherapeutic treatment of patients with personality disorders (PDs). We conducted PubMed and PsycINFO searches of recently published articles that reported on the treatment outcomes of psychotherapies for PDs. Our focus was on studies that used randomized controlled trial (RCT) methodology. The search period was from January 2006 to June 2009. The effectiveness of various psychotherapy treatment packages for PDs is well supported by favourable results from RCTs. Beneficial effects of psychotherapy included reduced symptomatology, improved social and interpersonal functioning, reduced frequency of maladaptive behaviours, and decreased hospitalization. Equivalent effects among the interventions we compared were common. Many of the treatments studied required only limited training by therapists. Most studies were focused on treating patients with borderline personality disorder (BPD). Some findings were suggestive of psychotherapy being cost-effective; however, few studies actually included formal cost analyses. Only one study included follow-up of treated patients beyond 1-year posttreatment. There is strong support for the use of psychotherapy to treat patients with PDs. However, most of the evidence is limited to BPD. The findings of recent studies hold promise for training and practice. Future research should attend to identification of appropriate patient-treatment matches, elucidation of active treatment ingredients, and illumination of factors that are common among treatments that account for their equivalent effects.

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

A systematic review of behavioral experiments vs. exposure alone in the treatment of anxiety disorders: A case of exposure while wearing the emperor’s new clothes?

A systematic review of behavioral experiments vs. exposure alone in the treatment of anxiety disorders: A case of exposure while wearing the emperor’s new clothes?  Clinical Psychology Review, Volume 30, Issue 5, July 2010, Pages 467-478

Dean McMillan & Rachel Lee

Department of Health Sciences and Hull York Medical School, Seebohm Rowntree Building, University of York, YO10 5DD, United Kingdom

Abstract:

There has been a longstanding debate about whether cognitive techniques in Cognitive Behavior Therapy add to effectiveness of behavioral ones. Cognitive proponents have suggested that behavioral experiments, a cognitive strategy, relative to exposure alone, a behavioral one, are an example of the value of cognitive interventions. Those who have argued that cognitive strategies may not be necessary have also recognized this as a key test. We conducted a systematic review and narrative synthesis of studies that compared these two techniques in the treatment of a range of anxiety difficulties in adults. PyscINFO, MEDLINE and EMBASE were searched from 1957 to 2008, reference lists were examined, and a citation search was conducted. Data were extracted to a standardized coding sheet, and at each stage of selection a proportion of citations were double-coded to establish reliability. 14 studies (total N = 644) met inclusion criteria covering obsessive compulsive disorder, panic, social anxiety and specific phobias. Although the methodological limitations of the studies, particularly the use of brief exposure durations and the possibility of therapeutic-allegiance effects, prevent definitive conclusions, there was some evidence that behavioral experiments were more effective than exposure alone.

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

Cognitive–behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials

Cognitive–behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials, The British Journal of Psychiatry (2010) 197: 11-19

Matthijs W. Beltman

Abstract:

Meta-analyses on psychological treatment for depression in individuals with a somatic disease are limited to specific underlying somatic diseases, thereby neglecting the generalisability of the interventions.

Aims

To examine the effectiveness of cognitive–behavioural therapy (CBT) for depression in people with a diversity of somatic diseases.

Method

Meta-analysis of randomised controlled trials evaluating CBT for depression in people with a somatic disease. Severity of depressive symptoms was pooled using the standardised mean difference (SMD).

Results

Twenty-nine papers met inclusion criteria. Cognitive–behavioural therapy was superior to control conditions with larger effects in studies restricted to participants with depressive disorder (SMD = –0.83, 95% CI –1.36 to –0.31, P<0.001) than in studies of participants with depressive symptoms (SMD = –0.16, 95% CI –0.27 to –0.06, P = 0.001). Subgroup analyses showed that CBT was not superior to other psychotherapies.

Conclusions

Cognitive–behavioural therapy significantly reduces depressive symptoms in people with a somatic disease, especially in those who meet the criteria for a depressive disorder.

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

Helping Young People Who Self-Harm – Manchester, UK

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

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

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

Abstract:

TOPIC: Interventions for young people who self-harm.

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

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

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

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

Mentalising – Mentalization – Website of Information & Resources

Mentalising  

Click on the title above to access this informative website

About:

Mentalising is simply being aware of what’s going on in our own heads and in others’ minds. Thoughts and feelings. Thoughts about feelings. Feelings about thoughts. A fractionally less awkward way of describing this process is ‘mind-awareness’. But let’s not get bogged down when there’s so much fun to be had rummaging around in the head department.

Please step this way and  discover just as there are perfectly runny organic poached eggs on crisp granary toast, so – um, well, we can all brush up how effectively tuned-in we are to what’s going on up top. Especially those of us with the weird and annoying borderline personality disorder.

Improving access to psychological therapies: Phase IV prospective cohort study

Improving access to psychological therapies: Phase IV prospective cohort study, British Journal of Clinical Psychology, Volume 48, Number 4, November 2009 , pp. 377-396(20)

Richards, David A.1; Suckling, Rupert2

University of Exeter, Exeter, Devon, UK 2: Doncaster Primary Care Trust, Mexborough, UK

 

Abstract:

To determine the effects of implementing stepped care evidence-based psychological treatments for anxiety and depression in routine practice using a collaborative care implementation model.

Design

Observational prospective cohort study/Phase IV field trial.

Methods

We collected data on depression and anxiety from a prospective cohort of 3,994 consecutive patients referred to the UK Improving Access to Psychological Therapies demonstration site in Doncaster for 12 months from August 2006 using PHQ-9 and GAD-7. We collected demographic and process information including the type and methods of treatments received. We calculated effect sizes, remission, and recovery rates for patients competing treatment and those who dropped out or were considered to be unsuitable.

Results

Two thousand seven hundred and ninety-five patients received an assessment, out of which 2,017 received two or more appointments. Out of these, 869 had completed treatment by the census date, 743 remained in treatment, 319 had dropped out, and 85 had been found to be unsuitable. Pre-post treatment effect sizes for anxiety and depression in those patients completing treatment were 1.39 and 1.41, respectively, with post-treatment relative risks of depression and anxiety 0.29 and 0.34. The combined remission and recovery rates were 76% for depression and 74% for anxiety. The mean number of treatment sessions was 5.15 in a mean time of 2 h and 45 min. On an average, patients received at least three of these contacts by telephone. Outcomes are comparable with benchmarked trials, reviews, and routine datasets.

Conclusions

Combining low-intensity stepped care psychological treatment with a telephony-based collaborative care organizational system can deliver good clinical outcomes in routine practice. 

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

Palliative Nurses & CBT – CBT group reported a positive change in their approach to patients. Nurses felt empowered, more skilled and effective

Palliative care nurses’ experiences of training in cognitive behaviour therapy and taking part in a randomized controlled trial, Elizabeth Cort, Barbara Monroe, Penny  Hansford, Stirling Moorey, Matthew  Hotopf, Marcia Kapari    International Journal of Palliative Nursing, Vol. 15, Iss. 6, 26 Jun 2009, pp 290 – 298

Abstract:

Background: This article describes the experiences of clinical nurse specialists in a palliative homecare team who took part in a cluster randomized controlled study. The study aimed to determine whether palliative care nurses given basic training in cognitive behavioural therapy (CBT) were able to use core components of this training when treating advanced cancer patients with anxiety or depression. Method: Fifteen nurses were randomly allocated to either receive training in cognitive behavioural techniques or to continue their practice as usual. Nurses were interviewed following the CBT training and after the research study. Results: The CBT group reported a positive change in their approach to patients. Nurses felt empowered, more skilled and effective not only to assess and support patients with symptoms of anxiety and depression but also to facilitate change. In addition, nurses placed considerable value on being given a psychological model and set of interventions. Conclusion: Nurses found taking part in the study demanding in terms of time and commitment; however, the authors conclude that research in the community palliative care setting is feasible.

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

Specific features of suicidal behavior in patients with narcissistic personality disorder

Specific features of suicidal behavior in patients with narcissistic personality disorder, The Journal of Clinical Psychiatry, early view, 2009

Blasco-Fontecilla H, et al …

Department of Psychiatry, Fundación Jiménez Diaz University Hospital, Avenida Reyes Catolicos 2, Madrid, Spain

Abstract:

OBJECTIVE: Suicidal behavior is a clinically significant but underestimated cause of mortality in narcissistic personality disorder. Currently, there are no reliable estimates of suicidal behavior for this population. The main objective of this study was to test whether or not suicide attempters diagnosed with narcissistic personality disorder are different in terms of impulsivity and expected lethality from suicide attempters with other cluster B personality disorders. METHOD: In a sample of 446 suicide attempters, patients with cluster B personality disorder diagnoses (n = 254) as assessed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), version of the International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were compared in terms of expected lethality and impulsivity (measured by the Beck Suicidal Intent Scale and the Barratt Impulsiveness Scale, respectively). The subjects were admitted to the emergency departments of the Ramón y Cajal Hospital and the Fundación Jiménez Diaz University Hospital in Madrid, Spain, between January 1999 and January 2003. RESULTS: Suicide attempts of subjects diagnosed with narcissistic personality disorder had higher expected lethality than those of subjects without narcissistic personality disorder (t = -4.24, df = 439, P < .001). There were no differences in expected lethality of the attempts when comparing subjects with and without histrionic personality disorder (t = 0.28, df = 439, P = .795), antisocial personality disorder (t = 0.66, df = 439, P = .504), and borderline personality disorder (t = 1.13, df = 439, P = .256), respectively. Suicide attempters diagnosed with narcissistic personality disorder did not significantly differ from suicide attempters without narcissistic personality disorder in terms of impulsivity measures (t = -0.33, df = 442, P = .738), while suicide attempters diagnosed with antisocial personality disorder, histrionic personality disorder, and borderline personality disorder were significantly more impulsive than suicide attempters without these diagnoses (t = -3.96, df = 442, P < .001; t = -3.88, df = 442, P < .001; and t = -7.44, df = 442, P < .001, respectively). CONCLUSIONS: Narcissistic personality disorder seems to be a distinct group among cluster B personality disorders with regard to suicidal behavior. In contrast to suicide attempters with other cluster B personality disorders, suicide attempters diagnosed with narcissistic personality disorder are less impulsive and have suicide attempts characterized by higher lethality. These distinctions may offer a basis for targeted therapies aimed at decreasing suicidal risk in patients with narcissistic personality disorder.

Lancashire Care staff can request a copy of this paper, email: susan.jennings@lancashirecare.nhs.uk

Narcissism – Drop-Out – CBT for Eating Disorders – Pilot study

The Impact of Narcissism on Drop-out From Cognitive-Behavioral Therapy for the Eating Disorders: A Pilot Study. Journal of Nervous & Mental Disease. 197(4):278-281, April 2009

 Author Campbell, Mari A. BSc, DClinPsy *; Waller, Glenn MClinPsychol, DPhil [S]; Pistrang, Nancy MA, PhD * Institution From the *Sub-department of Clinical Health Psychology, University College London, United Kingdom; +Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; ++Institute of Psychiatry, King’s College London, London, United Kingdom; and [S]Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, London, United Kingdom.

Abstract:

 

 

This study examined the relationship between narcissism and drop-out from the early stage of cognitive behavioral therapy (CBT) for the eating disorders. Narcissism was defined in terms of both its core elements and the narcissistic defense styles. The participants were 41 patients presenting for CBT at a specialist eating disorders service. Each completed measures of narcissism and eating disorder psychopathology. Attendance at sessions was also recorded. The presence of the narcissistically abused personality defense style was associated with a higher likelihood of dropping out of outpatient CBT. This “martyred” form of narcissism appears to have a significant role in the adherence to treatment for the eating disorders. The limitations and the clinical implications of this preliminary research are discussed, and future directions for research are suggested.

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

Transdiagnostic Cognitive-Behavioral Therapy for Patients With Eating Disorders: A Two-Site Trial With 60-Week Follow-Up

Transdiagnostic Cognitive-Behavioral Therapy for Patients With Eating Disorders: A Two-Site Trial With 60-Week Follow-Up, American Journal of  Psychiatry 2009;March  166:311-319

Christopher G. Fairburn, Zafra Cooper, Helen A. Doll, Marianne E. O’Connor, Kristin Bohn, Deborah M. Hawker, Jackie A. Wales, and Robert L. Palmer

Abstract:

OBJECTIVE: The aim of this study was to compare two cognitive-behavioral treatments for outpatients with eating disorders, one focusing solely on eating disorder features and the other a more complex treatment that also addresses mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties. METHOD: A total of 154 patients who had a DSM-IV eating disorder but were not markedly underweight (body mass index over 17.5), were enrolled in a two-site randomized controlled trial involving 20 weeks of treatment and a 60-week closed period of follow-up. The control condition was an 8-week waiting list period preceding treatment. Outcomes were measured by independent assessors who were blind to treatment condition. RESULTS: Patients in the waiting list control condition exhibited little change in symptom severity, whereas those in the two treatment conditions exhibited substantial and equivalent change, which was well maintained during follow-up. At the 60-week follow-up assessment, 51.3% of the sample had a level of eating disorder features less than one standard deviation above the community mean. Treatment outcome did not depend on eating disorder diagnosis. Patients with marked mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties appeared to respond better to the more complex treatment, with the reverse pattern evident among the remaining patients. CONCLUSIONS: These two transdiagnostic treatments appear to be suitable for the majority of outpatients with an eating disorder. The simpler treatment may best be viewed as the default version, with the more complex treatment reserved for patients with marked additional psychopathology of the type targeted by the treatment.

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

The ANTOP study – Psychodynamic Psychotherapy, CBT for Anorexia Nervosa – RCT

The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa–a randomized controlled trial.   Trials,  2009 Apr 23;10:23

Wild B, Friederich HC, Gross G, Teufel M, Herzog W, Giel KE, de Zwaan M, Schauenburg H,  Schade-Brittinger C, Schäfer H, Zipfel S.

Department of Psychosomatic and General Internal Medicine, Medical University Hospital, Heidelberg, Germany. beate.wild@med.uni-heidelberg.de

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

Abstract:

BACKGROUND: Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide. The seriousness of the disorder requires extensive knowledge of effective treatment options. However, evidence for treatment efficacy in this area is remarkably weak. A recent Cochrane review states that there is an urgent need for large, well-designed treatment studies for patients with anorexia nervosa. The aim of this particular multi-centre study is to evaluate the efficacy of two standardized outpatient treatments for patients with anorexia nervosa: focal psychodynamic (FPT) and cognitive behavioural therapy (CBT). Each therapeutic approach is compared to a “treatment-as-usual” control group. METHODS/DESIGN: 237 patients meeting eligibility criteria are randomly and evenly assigned to the three groups – two intervention groups (CBT and FPT) and one control group. The treatment period for each intervention group is 10 months, consisting of 40 sessions respectively. Body weight, eating disorder related symptoms, and variables of therapeutic alliance are measured during the course of treatment. Psychotherapy sessions are audiotaped for adherence monitoring. The treatment in the control group, both the dosage and type of therapy, is not regulated in the study protocol, but rather reflects the current practice of established outpatient care. The primary outcome measure is the body mass index (BMI) at the end of the treatment (10 months after randomization). DISCUSSION: The study design surmounts the disadvantages of previous studies in that it provides a randomized controlled design, a large sample size, adequate inclusion criteria, an adequate treatment protocol, and a clear separation of the treatment conditions in order to avoid contamination. Nevertheless, the study has to deal with difficulties specific to the psychopathology of anorexia nervosa. The treatment protocol allows for dealing with the typically occurring medical complications without dropping patients from the protocol. However, because patients are difficult to recruit and often ambivalent about treatment, a drop-out rate of 30% is assumed for sample size calculation. Due to the ethical problem of denying active treatment to patients with anorexia nervosa, the control group is defined as “treatment-as-usual”.

Lancashire Care staff, if you have difficulty accessing this paper, please email: susan.jenning@lancashirecare.nhs.uk

Personality Disorders – Community-based psychodynamic treatment program

Community-Based Psychodynamic Treatment Program for Severe Personality Disorders: Clinical Description and Naturalistic Evaluation, Journal of Psychiatric Practice:Volume 15 Issue 1    January 2009   pp 12-24

Marco Chiesa, MD, FRCPsych; Peter Fonagy, PhD, FBA; John Gordon

*The Cassel Hospital, Richmond, and University College London

University College London and The Anna Freud Centre, London

The Cassel Hospital and Imperial College Medical School

Please send correspondence and reprint requests to: Marco Chiesa MD, FRCPsych, Consultant Psychiatrist in Psychotherapy, Head of Research Unit & Personality Disorder Outreach Service, The Cassel Hospital, Richmond, TW10 7JF, UK. m.chiesa@ucl.ac.uk

Abstract:

Long-term inpatient treatment for personality disorders has become infrequent in the last two decades, and the gap left in service provision has been filled by psychodynamically and cognitively oriented partial hospitalization and outpatient, community-based approaches. It is still uncertain how these low-cost, lower-intensity models have fared relative to residential models that treat patients with severe personality disorders with the containment and control offered by the inpatient setting. In this article, we describe key features of a community-based psychodynamic program developed at the Cassel Hospital in the United Kingdom and present preliminary findings of a 2-year prospective naturalistic outcome study that monitored psychiatric morbidity (Brief Symptom Inventory General Severity Index [BSI-GSI]) and clinical outcome (self-mutilation, suicide attempts, and hospital admissions) in 68 patients with personality disorders who were consecutively admitted to the program. Improvements shown by the community-based sample on all variables were compared with the results in a comparable sample of inpatients treated in a long-term psychosocial treatment program in the same institution. The naturalistic comparison of the two non-randomized treatment models revealed that the community-based sample improved to a significantly greater degree on all three clinical outcome dimensions and had significantly lower early dropout rates than those who received the long-term residential treatment. The findings indicate that, at least in terms of impulsive behavior and treatment adherence, the community-based program appears to offer a viable adequate alternative to long-term inpatient admission.

Lancashire Care staff can request full-text articles,  please email: susan.jennings@lancashirecare.nhs.uk

 

Psychological Therapies – While we are waiting: Experiences of waiting for and receiving psychological therapies on the NHS

While we are waiting: Experiences of waiting for and receiving psychological therapies on the NHS, 25th July 2008, We Need to Talk Coalition

Click on the report title for Full-text Access

Abstract:A group of leading mental health charities has published a report which says that the lives of those stuck on long NHS waiting lists for psychological treatments are being damaged as a result. Mental health problems can worsen, relationships can break down and some people are forced to take time off from work – or give up a job completely – according to While we are waiting.

National clinical guidelines recommend that psychological treatments, such as cognitive behavioural therapy and psychotherapy, should be made available on the NHS. But such therapies remain difficult to access and the wait for patients is long – often more than six months, sometimes years.

One participant who took part in the report’s research said: “The assessment was incredible…I felt that someone finally understood. When I was told that the wait after assessment was two years it felt like a real let down, offering a life line and [then] snatching it away.”

The report comes ahead of the roll out of the Government’s Improving Access to Psychological Therapies (IAPT) programme, which is expected to bring 3,600 extra therapists to half of England’s primary care trusts (PCTs) in the next three years and to reduce waiting times in those areas dramatically.

Understanding the coexistence of alcohol misuse and depression

Understanding the coexistence of alcohol misuse and depression, British Journal of Nursing, Vol. 17, Iss. 11, 12 Jun 2008, pp 696 – 699

Abstract:  This article sets out to discuss some issues of this comorbid disorder. Initially the article defines both alcohol misuse and depression and provides indications of symptomatology, many of which overlap. The article identifies that prevalence is high and draws attention to issues of risk, self-harm and suicide. There is a short discussion on causative factors and the article describes the interrelation of these two disorders and goes on to compare the evidence for a cyclic comorbid disorder, where one increases the severity of the other. It goes on to identify issues of assessment, case management and treatment, including a brief discussion on pharmacotherapy and three psychological therapies.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Occupational Therapy – An Overview of Evidence-Based Support for the Therapeutic Use of Music in Occupational Therapy

   An Overview of Evidence-Based Support for the Therapeutic Use of Music in Occupational Therapy , Occupational Therapy in Health Care:  a journal of contemporary practice , January 2008, Volume: 22 Issue: 1

Abstract: Music is a modality present in occupational therapy, yet little educational material about music exists within the field. This paper presents a myriad of possibilities for practitioners considering using music, providing a resource of research within and outside the field. Applications are organized around enhancement of occupational performance, utilizing three distinct methods: (1) Music-assisted occupation, (2) Music as occupation, and (3) Music in preparation for occupation. The potential effects of music in the areas of pain/discomfort, movement, emotion, cognition, self-expression/communication, relationships/groups, culture/society and community, and personal meaning/motivation, are discussed in terms of enhancing occupation.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Behavioural Activation Over CBT – Behavioural activation for depression

Behavioural activation for depression, Advances in Psychiatric Treatment 2008 14: 29-36, David Veale

Abstract: A formal therapy for depression, behavioural activation focuses on activity scheduling to encourage patients to approach activities that they are avoiding and on analysing the function of cognitive processes (e.g. rumination) that serve as a form of avoidance. Patients are thus refocused on their goals and valued directions in life. The main advantage of behavioural activation over traditional cognitive–behavioural therapy for depression is that it may be easier to train staff in it and it can be used in both in-patient and out-patient settings. This article describes the theory and rationale of behavioural activation, its evidence base and how to develop a formulation that guides the strategy.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Acta Psychiatrica Scandinavica – March 2008 (All full-text) – Vol. 117 VIRTUAL ISSUE: Clinical Overview articles

  Acta Psychiatrica Scandinavica – March 2008 (All full-text) – Vol. 117 VIRTUAL ISSUE: Clinical Overview articles

For the full-text of the articles below click on the article title.  Any problems gaining full-text access please email: susan.jennings@lancashirecare.nhs.uk

Augmentation of antidepressants with atypical antipsychotics for treatment-resistant major depressive disorder

Making sense of neuroimaging in psychiatry

Neurostimulation therapies in depression: a review of new modalities

CBT & Case Formulation – Clients’ experience of case formulation in cognitive behaviour therapy for psychosis

  Clients’ experience of case formulation in cognitive behaviour therapy for psychosis , British Journal of Clinical Psychology, Volume 47, Number 2, June 2008 , pp. 127-138(12)

Abstract: Objectives Case formulation (CF) is considered essential to the practice of cognitive behaviour therapy, and crucial when working with more complex problems such as psychosis. Several claims are made for the beneficial impact of CF on clients, although little empirical research has been conducted.

Design The study used content analysis methodology to assess clients’ experience of the CF process in cognitive behaviour therapy for psychosis. In addition, therapists ranked seven documented benefits for them of CF.
Method Thirteen clients and their respective therapists were interviewed 2-3 weeks after shared written formulation.
Results Overall, clients’ reactions to CF were cognitively, behaviourally, and emotionally complex, and subject to change over time. Therapists reported that they found the CF to be most useful in increasing their understanding of their clients.Conclusions Formulation is a complex process for clients, and future research into CF faces methodological challenges.

Fo

r the full-text of the above article please email: susan.jennings@lancashirecare.nhs.uk

The 10 Most Frequently Read Journal Articles from Evidence Based Mental Health Journal

evide-base-ment.gif   These articles have received the most “hits” in Evidence-Based Mental Health during February 2008

There will be some full-text and some abstracts, just click on the links to find, if you only locate an abstract please email susan.jennings@lancashirecare.nhs.uk to request the full-text.

1.  Julie Glanville, Carol Lefebvre
Identifying systematic reviews: key resources
Evid. Based Ment. Health 2000; 3: 68-69.
(In “EBMH notebook”)      
2.  Laura Mufson
Group interpersonal therapy reduces depression in adolescent survivors of war
Evid. Based Ment. Health 2008; 11: 17-17.
(In “Therapeutics”)     
3.  Nick Freemantle, John Geddes
Understanding and interpreting systematic reviews and meta-analyses. Part 2: meta-analyses
Evid. Based Ment. Health 1998; 1: 102-104.
(In “EBMH notebook”) 
4.  Kapil Sayal
Alcohol consumption in pregnancy as a risk factor for later mental health problems
Evid. Based Ment. Health 2007; 10: 98-100.
(In “EBMH notebook”) 
5.  Brandon A Gaudiano
Cognitive-behavioural therapies: achievements and challenges
Evid. Based Ment. Health 2008; 11: 5-7.
(In “EBMH notebook”)
6.  Judith A Skala
Severe mental illness increases the risk of death from coronary heart disease or stroke
Evid. Based Ment. Health 2007; 10: 105-105.
(In “Prognosis”)
7.  Günter H Seidler, Frank E Wagner
Review: Trauma-focused psychological treatments improve post-traumatic stress disorder symptoms
Evid. Based Ment. Health 2007; 10: 117-117.
(In “Therapeutics”)  
8.  David Benton, Bernard Gesch
Vitamin and fatty acid supplements may reduce antisocial behaviour in incarcerated young adults
Evid. Based Ment. Health 2003; 6: 41-41.
(In “Therapeutics”)
9. 
Purpose and procedure
Evid. Based Ment. Health 2008; 11: 1-2.
(In “Purpose and procedure”)  
10.  Deborah Blacker
Neither vitamin E nor donepezil delays progression from amnestic mild cognitive impairment to Alzheimer’s disease in the long term
Evid. Based Ment. Health 2006; 9: 20-20.
(In “Therapeutics”)

For the full-text of any of these articles please email susan.jennings@lancashirecare.nhs.uk

Forensic Mental Health Services – Facts and Figures on Current Provision

sa.jpg   Forensic Mental Health Services – Facts and Figures on Current Provision, September 2007, Sainsbury Centre for Mental Health

Abstract: Forensic mental health services provide care for people who have come into contact with the criminal justice system and have been transferred to secure NHS services.

This factfile brings together figures from many sources about forensic services and shows that:

  • Fewer than half of people admitted to secure hospital stay for more than five years.
  • Most people are admitted to secure hospitals from prison.
  • Over one-third of people detained in 2004 had committed violent offences.
  • About 40 people per quarter have to wait in prison for over three months before a transfer to secure hospital.
  • Fewer than one patient in ten re-offends within two years of being discharged from secure hospital.
  • In 2005, 26 people died while being detained in a secure hospital.

Arts Therapies for People with Schizophrenia: An Emerging Evidence Base

 schizo-colourfu.jpg   Arts Therapies for People with Schizophrenia: An Emerging Evidence Base, Evidence-Based Mental Health 2007;10:69-70

Abstract: Throughout history there has been considerable speculation about the possibility of a link between creative expression and mental distress. Plato described artistic talent as “madness that comes from God”, and Aristotle claimed that “all men who are outstanding in … the arts are melancholic”.1 In recent years the relationship betweenship creativity and mental distress has been explored in retrospective studies which have compared levels of mental disorder among successful artists with those among the general public. Andreasen2 reported that among a sample of 30 well known authors 24 had experienced depression, and 13 had received treatment for bipolar affective disorder. Schildkraut and colleagues3 reported that 40% of notable abstract expressionists sought treatment for mental disorder and 20% were hospitalised for psychiatric problems.

For the full-text please log in via Athens any problems please email: susan.jennings@lancashirecare.nhs.uk

Schema Focused Therapy in Forensic Settings – Also know as “Schema Focused Cognitive Therapy,”

Schema Focused Therapy in Forensic Settings: Theoretical Model and Recommendations for Best Clinical PracticeInternational Journal of Forensic Mental Health 2007, Vol. 6, No. 2, pages 169-183

Abstract: Until recently few empirically supported treatments for patients with personality disorders were available. Schema Focused Therapy (SFT) has recently shown efficacy in (non-forensic) outpatients with Borderline Personality Disorder, raising the question if it may also be effective in forensic PD patients. For the past two years, we have been collaborating with Dutch forensic hospitals to adapt the SFT approach to meet the challenges posed by this population. In this article, we present our forensic modification of the SFT theoretical model, and make recommendations for the implementation of SFT in forensic clinical practice.

Aggression Management in and Adolescent Forensic Setting

Aggression Management in and Adolescent Forensic Setting  International Journal of Forensic Mental Health 2007, Vol. 6, No. 2, pages 185-196

Abstract: The present study aimed at describing and evaluating the effectiveness of a comprehensive aggression management program in an adolescent forensic unit. Six-month trends in figures for aggressive behaviors against staff, and rates and characteristics of physical interventions to control aggression were studied over 2 years using irregularity reports from the study unit, and structured forms filled in by the nursing staff immediately after each event. Events of verbal and physical aggression decreased as the implementation of the aggression management program stabilised. Physical interventions became shorter over time. Injuries to the staff became less frequent. A systematic and comprehensive aggression management program allows improvement of aggression management without increasing use of coercion. As the use of coercion decreases, the staff injuries decrease.

The Prediction of Imminent Aggression and Self-Harm

The Prediction of Imminent Aggression and Self-Harm in Personality Disordered Patients of a High Security Hospital Using the HCR-20 Clinical Scale and the Dynamic Appraisal of Situational Aggression  International Journal of Forensic Mental Health 2007, Vol. 6, No. 2, pages 137-143

Abstract

Drawing on recent advances in the violence risk assessment literature, this study tested the predictive validity of two structured measures designed to support risk related decision making, the HCR-20 and the Dynamic Appraisal of Situational Aggression (DASA), for the prediction of imminent aggression and self-harm in personality disordered patients of a high secure psychiatric hospital. For four months nursing staff completed daily assessments of patients using the DASA and the Clinical scale items from the HCR-20. On the following day they documented whether patients had behaved aggressively and/or self-harmed. Results revealed modest predictive validity, significantly better than chance, for both the prediction of imminent self-harm and aggression for both measures. Furthermore, these results suggest that personality disordered patients in a negative psychological state characterized by irritability, impulsivity and disagreeableness are at an increased risk of aggression and self-harm during involuntary psychiatric inpatient treatment and that this state is sensitive to structured risk assessment.

Cognitive Behavioural Therapy & Interpersonal Therapy Comparably Effective for Major Depression

evide-base-ment.gif    Cognitive Behavioural Therapy & Interpersonal Therapy Comparably Effective for Major Depression, Evidence Based Mental Health, Feb 2008, V11 (1) 12

QUESTION
Question:
Cognitive behavioural therapy (CBT) or interpersonal psychotherapy (IPT): which is more effective for depression?
Patients: 177 adults (aged over 18 years) with DSM-IV nonpsychotic major depression. Main exclusions: history of mania, schizophrenia, major physical illness, moderate or severe current alcohol or drug dependence, antisocial personality disorder or failure to respond to a recent (within
the last year) trial of either CBT or IPT.
Setting: Recruitment from various sources including mental health out-patient clinics, psychiatric emergency services, selfreferral and general practitioners between August 1998 and
February 2003; treatment delivered in a university-based outpatient research unit.
Intervention: CBT or IPT for up to 16 weeks. Both approaches were delivered as 50-minute weekly sessions.
Outcomes: Change in depression symptoms (% change in Montgomery-Asberg Depression Rating Scale (MADRS) score) between baseline and follow-up.
Patient follow-up: 89.8% of people completed adequate treatment (at least 8 sessions of weekly therapy); 100% included in intention-to-treat analyses.

You will need your Athens username and password to access the full-text of this article, if you need an athens, or you would like the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

SFBT the new ‘Buzz’ word in Therapy

head-and-therapy.jpg    The integration of solution-focused brief therapy principles in nursing: a literature review, Journal of Psychiatric and Mental Health Nursing, 2008, 15, 37–44

Full-text just click on link above

The two examples used are USA & Uk, the later being in an A&E department in relation to self-harm.

Abstract

The ongoing movement from institutional care to community-orientated care has gradually spread around the developed world. This shift in the philosophy of care has resulted in a reduction in the length of inpatient admissions and contributed to a decline in the number of inpatient beds. This literature review seeks to establish the suitability and relevance of solution-focused brief therapy (SFBT) to mental health nursing practice, with particular emphasis being given to acute inpatient settings.

There are some indications from the literature that the application of such an approach may positively impact on nurses’ willingness to communicate with patients. There are also indications that the use of SFBT may help nurses develop a collaborative, goalorientated approach to working with patients.

susan.jennings@lancashirecare.nhs.uk

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