232 results found
Crawford MJ, Sanatinia R, Tan W, 2018, No Effect of Lamotrigine in Subgroups of Patients With Borderline Personality Disorder: Response to Smith., Am J Psychiatry, Vol: 175, Pages: 1265-1266
Barnicot K, Crawford M, 2018, Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder: Treatment Outcomes and Mediators., J Trauma Stress
Posttraumatic stress disorder (PTSD) is highly comorbid with personality disorder (PD). We evaluated whether comorbid PTSD has a negative effect on patients' ability to benefit from evidence-based psychological treatments for PD and tested potential mediators of any effect. The effect of PTSD on self-harm and borderline PD symptoms was evaluated in 90 patients with borderline PD who were receiving dialectical behavior therapy or mentalization-based therapy. Self-report and interview measures were administered every 3 months over a 12-month period. Three-quarters of participants met criteria for PTSD. In the 12 months after beginning treatment, participants with PTSD did not engage in self-harm more often or present with more severe borderline PD symptoms. However, a higher level of PTSD symptom severity at baseline was associated with more frequent self-harm during follow-up, incidence rate ratio = 1.03, 95% CI [1.01, 1.06], p = .005. Participants whose PTSD did not improve or worsened were more likely to still self-harm, odds ratio (OR) = 0.91, 95 % CI [0.85, 0.97], p = .004, and report more severe borderline PD symptoms, b = 0.53, 95% CI [0.34, 0.73], p < .001, at the end of 12 months. The negative effects of PTSD symptoms remained significant after adjusting for potential confounders and were partially mediated by high ongoing levels of emotional dysregulation, indirect effect b = 0.32, 95% CI [0.19, 0.50]. These findings identify subgroups at risk of poorer outcomes from evidence-based psychological treatments for PD and support the idea that treating PTSD may improve outcomes.
Barnicot K, Crawford M, 2018, Dialectical behaviour therapy v. mentalisation-based therapy for borderline personality disorder., Psychol Med, Pages: 1-9
BACKGROUND: Dialectical behaviour therapy (DBT) and mentalisation-based therapy (MBT) are both widely used evidence-based treatments for borderline personality disorder (BPD), yet a head-to-head comparison of outcomes has never been conducted. The present study therefore aimed to compare the clinical outcomes of DBT v. MBT in patients with BPD. METHODS: A non-randomised comparison of clinical outcomes in N = 90 patients with BPD receiving either DBT or MBT over a 12-month period. RESULTS: After adjusting for potentially confounding differences between participants, participants receiving DBT reported a significantly steeper decline over time in incidents of self-harm (adjusted IRR = 0.93, 95% CI 0.87-0.99, p = 0.02) and in emotional dysregulation (adjusted β = -1.94, 95% CI -3.37 to -0.51, p < 0.01) than participants receiving MBT. Differences in treatment dropout and use of crisis services were no longer significant after adjusting for confounding, and there were no significant differences in BPD symptoms or interpersonal problems. CONCLUSIONS: Within this sample of people using specialist personality disorder treatment services, reductions in self-harm and improvements in emotional regulation at 12 months were greater amongst those receiving DBT than amongst those receiving MBT. Experimental studies assessing outcomes beyond 12 months are needed to examine whether these findings represent differences in the clinical effectiveness of these therapies.
Crawford MJ, Thana L, Parker J, et al., 2018, Psychological Support for Personality (PSP) versus treatment as usual: study protocol for a feasibility randomized controlled trial of a low intensity intervention for people with personality disorder, TRIALS, Vol: 19, ISSN: 1745-6215
House A, Guthrie E, Walker A, et al., 2018, A programme theory for liaison mental health services in England, BMC HEALTH SERVICES RESEARCH, Vol: 18, ISSN: 1472-6963
Walker A, Barrett JR, Lee W, et al., 2018, Organisation and delivery of liaison psychiatry services in general hospitals in England: results of a national survey, BMJ OPEN, Vol: 8, ISSN: 2044-6055
Crawford MJ, Sanatinia R, Barrett B, et al., 2018, The Clinical Effectiveness and Cost-Effectiveness of Lamotrigine in Borderline Personality Disorder: A Randomized Placebo-Controlled Trial, AMERICAN JOURNAL OF PSYCHIATRY, Vol: 175, Pages: 756-764, ISSN: 0002-953X
Deb S, Leeson V, Aimola L, et al., 2018, Aggression Following Traumatic brain injury: Effectiveness of Risperidone (AFTER): study protocol for a feasibility randomised controlled trial, TRIALS, Vol: 19, ISSN: 1745-6215
Das-Munshi J, Bhugra D, Crawford MJ, 2018, Ethnic minority inequalities in access to treatments for schizophrenia and schizoaffective disorders: findings from a nationally representative cross-sectional study, BMC MEDICINE, Vol: 16, ISSN: 1741-7015
Crawford MJ, Sanatinia R, Barrett B, et al., 2018, Lamotrigine for people with borderline personality disorder: a RCT, HEALTH TECHNOLOGY ASSESSMENT, Vol: 22, Pages: 1-+, ISSN: 1366-5278
Hassiotis A, Poppe M, Strydom A, et al., 2018, Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT., Health Technology Assessment, Vol: 22, Pages: 1-110, ISSN: 1366-5278
BACKGROUND: Preliminary studies have indicated that training staff in Positive Behaviour Support (PBS) may help to reduce challenging behaviour among people with intellectual disability (ID). OBJECTIVE: To evaluate whether or not such training is clinically effective in reducing challenging behaviour in routine care. The study also included longer-term follow-up (approximately 36 months). DESIGN: A multicentre, single-blind, two-arm, parallel-cluster randomised controlled trial. The unit of randomisation was the community ID service using an independent web-based randomisation system and random permuted blocks on a 1 : 1 allocation stratified by a staff-to-patient ratio for each cluster. SETTING: Community ID services in England. PARTICIPANTS: Adults (aged > 18 years) across the range of ID with challenging behaviour [≥ 15 Aberrant Behaviour Checklist - Community total score (ABC-CT)]. INTERVENTIONS: Manual-assisted face-to-face PBS training to therapists and treatment as usual (TAU) compared with TAU only in the control arm. MAIN OUTCOME MEASURES: Carer-reported changes in challenging behaviour as measured by the ABC-CTover 12 months. Secondary outcomes included psychopathology, community participation, family and paid carer burden, family carer psychopathology, costs of care and quality-adjusted life-years (QALYs). Data on main outcome, service use and health-related quality of life were collected for the 36-month follow-up. RESULTS: A total of 246 participants were recruited from 23 teams, of whom 109 were in the intervention arm (11 teams) and 137 were in the control arm (12 teams). The difference in ABC-CTbetween the intervention and control arms [mean difference -2.14, 95% confidence interval (CI) -8.79 to 4.51;p = 0.528] was not statistically significant. No treatment effects were found for any of the secondary outcomes. The mean cost per participant in the intervention arm was £1201. Over 12 months, there
Hassiotis A, Poppe M, Strydom A, et al., 2018, Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial, BRITISH JOURNAL OF PSYCHIATRY, Vol: 212, Pages: 161-168, ISSN: 0007-1250
Olajide K, Munjiza J, Moran P, et al., 2018, Development and Psychometric Properties of the Standardized Assessment of Severity of Personality Disorder (SASPD)., J Pers Disord, Vol: 32, Pages: 44-56
Personality disorder (PD) is increasingly categorized according to its severity, but there is no simple way to screen for severity according to ICD-11 criteria. We set out to develop the Standardized Assessment of Severity of Personality Disorder (SASPD). A total of 110 patients completed the SASPD together with a clinical assessment of the severity of personality disorder. We examined the predictive ability of the SASPD using the area under the ROC curve (AUC). Two to four weeks later, 43 patients repeated the SASPD to examine reliability. The SASPD had good predictive ability for determining mild (AUC = 0.86) and moderate (AUC = 0.84) PD at cut points of 8 and 10, respectively. Test-retest reliability of the SASPD was high (intraclass correlation coefficient = 0.93, 95% CI [0.88, 0.96]). The SASPD thus provides a simple, brief, and reliable indicator of the presence of mild or moderate PD according to ICD-11 criteria.
Muñoz M, Ausín B, Santos-Olmo AB, et al., 2018, Alcohol use, abuse and dependence in an older European population: Results from the MentDis_ICF65+ study., PLoS One, Vol: 13
BACKGROUND: Alcohol use disorders (AUD) in older people have been the subject of increasing interest in Europe and worldwide. However, thus far, no reliable data exist regarding the prevalence of AUD in people over the age of 65 years in Europe. OBJECTIVE: To assess the current (past month), 12-month and lifetime prevalence of alcohol use, abuse and dependence in people aged 65-84 years. STUDY DESIGN: The MentDis_ICF65+ study was a representative stepwise cross-sectional survey that was conducted in six European and associated cities (Hamburg, Germany; Ferrara, Italy; London/Canterbury, England; Madrid, Spain; Geneva, Switzerland and Jerusalem, Israel). METHOD: In total, 3,142 community-dwelling people aged between 65 and 84 years who lived in participating cities were assessed with an age-sensitive diagnostic interview (CIDI65+). RESULTS: The prevalence of lifetime alcohol use was 81% for the overall sample. The observed AUD (DSM-IV-TR) prevalence was as follows: current, 1.1%; 12-month, 5.3% and lifetime, 8.8%. Alcohol consumption and AUD were more prevalent in males, and a significant interaction between gender and city was observed; greater gender differences in the prevalence of these disorders were observed in Hamburg, London/Canterbury and Geneva in comparison to the other cities. The prevalence of lifetime alcohol consumption and 12-month AUD tended to be lower in older persons. CONCLUSION: The results highlight the appropriateness of using age-adjusted diagnostic tools (CIDI65+) to identify alcohol use and AUD in older people. Different alcohol use patterns were observed in males and females. The results seem to indicate the presence of different alcohol use patterns between northern and southern European countries. Specialized services are proposed, including brief and/or more intensive interventions framed intensive and more simple interventions framed in stepped care strategies, to improve the social and health resources available for older people across
Day C, Briskman J, Crawford MJ, et al., 2017, Feasibility trial of a psychoeducational intervention for parents with personality difficulties: The Helping Families Programme, CONTEMPORARY CLINICAL TRIALS COMMUNICATIONS, Vol: 8, Pages: 67-74, ISSN: 2451-8654
McMurran M, Day F, Reilly J, et al., 2017, Psychoeducation and Problem Solving (PEPS) Therapy for Adults With Personality Disorder: A Pragmatic Randomized-Controlled Trial., J Pers Disord, Vol: 31, Pages: 810-826
We compared psychoeducation and problem solving (PEPS) therapy against usual treatment in a multisite randomized-controlled trial. The primary outcome was social functioning. We aimed to recruit 444 community-dwelling adults with personality disorder; however, safety concerns led to an early cessation of recruitment. A total of 154 people were randomized to PEPS and 152 to usual treatment. Follow-up at 72 weeks was completed for 68%. PEPS therapy was no more effective than usual treatment for improving social functioning (adjusted difference in mean Social Functioning Questionnaire scores = -0.73; 95% CI [-1.83, 0.38]; p = 0.19). PEPS therapy is not an effective treatment for improving social functioning of adults with personality disorder living in the community.
Volkert J, Härter M, Dehoust MC, et al., 2017, Study approach and field work procedures of the MentDis_ICF65+ project on the prevalence of mental disorders in the older adult European population., BMC Psychiatry, Vol: 17
BACKGROUND: This study describes the study approach and field procedures of the MentDis_ICF65+ study, which aims to assess the prevalence of mental disorders in older adults. METHODS: An age-appropriate version of the Composite International Diagnostic Interview (CIDI65+) was developed and tested with regard to its feasibility and psychometric properties in a pre-test and pilot phase. In the cross-sectional survey an age-stratified, random sample of older adults (65-84 years) living in selected catchment areas of five European countries and Israel was recruited. RESULTS: N = 3142 participants (mean age 73.7 years, 50.7% female) took part in face-to-face interviews. The mean response rate was 20% and varied significantly between centres, age and gender groups. Sociodemographic differences between the study centres appeared for the place of birth, number of grandchildren, close significants, retirement and self-rated financial situation. The comparison of the MentDis_ICF65+ sample with the catchment area and country population of the study centres revealed significant differences, although most of these were numerically small. CONCLUSIONS: The study will generate new information on the prevalence of common mental disorders among older adults across Europe using an age-appropriate, standardized diagnostic instrument and a harmonized approach to sampling. Generalizability of the findings and a potentially limited representativeness are discussed.
Crawford MJ, Gold C, Odell-Miller H, et al., 2017, International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study, HEALTH TECHNOLOGY ASSESSMENT, Vol: 21, Pages: 1-+, ISSN: 1366-5278
D'Lima D, Crawford MJ, Darzi A, et al., 2017, Patient safety and quality of care in mental health: a world of its own?, BJPSYCH BULLETIN, Vol: 41, Pages: 241-243, ISSN: 2056-4694
Canuto A, Weber K, Baertschi M, et al., 2017, Anxiety Disorders in old age: Psychiatric comorbidities, quality of life, and prevalence according to age, gender, and country, American Journal of Geriatric Psychiatry, Vol: 26, Pages: 174-185, ISSN: 1064-7481
Objectives: Previous estimates of the prevalence of anxiety disorders in late life vary greatly due to the lack of reliable diagnostic tools. This MentDis_ICF65+ study assessed 12-month prevalence rates of anxiety disorders and age- and gender-related differences in comorbidities, as well as impact on quality of life. Design: The study used a cross-sectional multicenter survey. Participants: The study sample comprised 3,142 men and women aged 65 to 84 years, living in five European countries and Israel. Measurements: Anxiety disorders were assessed using computer-assisted face-to-face interviews with an age-appropriate diagnostic interview (CIDI65+). Results: The prevalence of anxiety disorders was 17.2%. Agoraphobia was the most frequent disorder (4.9%), followed by panic disorder (3.8%), animal phobia (3.5%), general anxiety disorder (3.1%), post-traumatic stress disorder (1.4%), social phobia (1.3%), and obsessive-compulsive disorder (0.8%). The prevalence rate of any anxiety disorder dropped by 40% to 47% in adults aged 75–84 years compared with those aged 65–74 years. Women were twice as likely to present with agoraphobia or general anxiety disorder as men. Only panic disorder and phobia were associated with comorbid major depression. The negative relationship with quality of life was limited to agoraphobia and generalized anxiety disorder. Conclusions: The age-appropriate CIDI65+ led to higher prevalence rates of anxiety disorders in the elderly, yet to weaker associations with comorbidities and impaired quality of life compared with previous studies.
Tyrer P, Salkovskis P, Tyrer H, et al., 2017, Cognitive-behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years, HEALTH TECHNOLOGY ASSESSMENT, Vol: 21, Pages: 1-+, ISSN: 1366-5278
Bieleninik L, Geretsegger M, Mossler K, et al., 2017, Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder The TIME-A Randomized Clinical Trial, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 318, Pages: 525-535, ISSN: 0098-7484
Singh SP, Paul M, Parsons H, et al., 2017, A prospective, quantitative study of mental health act assessments in England following the 2007 amendments to the 1983 act: did the changes fulfill their promise?, BMC PSYCHIATRY, Vol: 17, ISSN: 1471-244X
Crawford MJ, Zoha M, MacDonald A, et al., 2017, Improving the quality of mental health services using patient outcome data: Making the most of HoNOS, Psychiatrist, Vol: 41, Pages: 172-176, ISSN: 1758-3209
©2017 The Authors. Efforts to assess and improve the quality of mental health services are often hampered by a lack of information on patient outcomes. Most mental health services in England have been routinely collecting Health of the Nation Outcome Scales (HoNOS) data for some time. In this article we illustrate how clinical teams have used HoNOS data to identify areas where performance could be improved. HoNOS data have the potential to give clinical teams the information they need to assess the quality of care they deliver, as well as develop and test initiatives aimed at improving the services they provide.
Munjiza J, Britvic D, Radman M, et al., 2017, Severe war-related trauma and personality pathology: a case-control study, BMC PSYCHIATRY, Vol: 17, ISSN: 1471-244X
Drummond C, Gilburt H, Burns T, et al., 2017, Assertive Community Treatment For People With Alcohol Dependence: A Pilot Randomized Controlled Trial, ALCOHOL AND ALCOHOLISM, Vol: 52, Pages: 234-241, ISSN: 0735-0414
Pearce S, Scott L, Attwood G, et al., 2017, Democratic therapeutic community treatment for personality disorder: randomised controlled trial, BRITISH JOURNAL OF PSYCHIATRY, Vol: 210, Pages: 149-156, ISSN: 0007-1250
Andreas S, Schulz H, Volkert J, et al., 2017, Prevalence of mental disorders in elderly people: the European MentDis_ICF65+ study., Br J Psychiatry, Vol: 210, Pages: 125-131
BACKGROUND: Except for dementia and depression, little is known about common mental disorders in elderly people. AIMS: To estimate current, 12-month and lifetime prevalence rates of mental disorders in different European and associated countries using a standardised diagnostic interview adapted to measure the cognitive needs of elderly people. METHOD: The MentDis_ICF65+ study is based on an age-stratified, random sample of 3142 older men and women (65-84 years) living in selected catchment community areas of participating countries. RESULTS: One in two individuals had experienced a mental disorder in their lifetime, one in three within the past year and nearly one in four currently had a mental disorder. The most prevalent disorders were anxiety disorders, followed by affective and substance-related disorders. CONCLUSIONS: Compared with previous studies we found substantially higher prevalence rates for most mental disorders. These findings underscore the need for improving diagnostic assessments adapted to the cognitive capacity of elderly people. There is a need to raise awareness of psychosocial problems in elderly people and to deliver high-quality mental health services to these individuals.
Bowden-Jones O, Whitelock C, Abdulrahim D, et al., 2017, Prevalence of HIV risk-related drug use and sexual activity among men who have sex with men attending a specialist UK club drug clinic, DRUGS AND ALCOHOL TODAY, Vol: 17, Pages: 50-59, ISSN: 1745-9265
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