Publications
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Zarska A, Barnicot K, Lavelle M, et al., 2023, A Systematic Review of Training Interventions for Emergency Department Providers and Psychosocial Interventions delivered by Emergency Department Providers for Patients who self-harm, ARCHIVES OF SUICIDE RESEARCH, Vol: 27, Pages: 829-850, ISSN: 1381-1118
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- Citations: 1
Barnicot K, Parker J, Kalwarowsky S, et al., 2023, Mother and clinician experiences of a trial of a video feedback parent-infant intervention for mothers experiencing difficulties consistent with 'personality disorder': A qualitative interview study, PSYCHOLOGY AND PSYCHOTHERAPY-THEORY RESEARCH AND PRACTICE, Vol: 96, Pages: 480-503, ISSN: 1476-0835
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- Citations: 1
King J, McQuaid A, Leeson VC, et al., 2023, The association of severe COVID anxiety with poor social functioning, quality of life, and protective behaviours among adults in United Kingdom: a cross-sectional study, BMC Psychiatry, Vol: 23, ISSN: 1471-244X
Background:Anxiety about COVID-19 is common. For most people this is an appropriate response to the loss of livelihoods and loved-ones, disruptions to social networks, and uncertainty about the future. However, for others these anxieties relate to contracting the virus itself, a phenomenon termed COVID anxiety. Little is known about the characteristics of people with severe COVID anxiety or the impact it has on their daily lives.Methods:We conducted a two-phase cross-sectional survey of people aged 18 or over who were living in United Kingdom, self-identified as anxious about COVID-19, and had a score of ≥9 on the Coronavirus Anxiety Scale. We recruited participants nationally through online adverts and locally via primary care services in London. Data on demographic and clinical factors were used in multiple regression modelling to examine the greatest contributors to functional impairment, poor health-related quality of life and protective behaviours in this sample of individuals with severe COVID anxiety.Results:We recruited 306 people with severe COVID anxiety between January and September 2021. Most were female (n = 246, 81.2%); they had a median age of 41 (range = 18–83). The majority of participants also had generalised anxiety (n = 270, 91.5%), depression (n = 247, 85.5%), and a quarter (n = 79, 26.3%) reported a physical health condition which put them at increased risk of hospitalisation with COVID-19. Half had severe social dysfunction (n = 151, 52.4%). One in ten reported never leaving their home, one in three washed all items brought into their house, one in five washed their hands constantly, and one in five of those with children reported not sending them to school because of fears of COVID-19. Increasing co-morbid depressive symptoms best explained functional impairment and poor quality of life after controlling for other factors.Conclusions:This study highli
Barnicot K, Welsh M, Kalwarowsky S, et al., 2022, Video feedback parent-infant intervention for mothers experiencing enduring difficulties in managing emotions and relationships: A randomised controlled feasibility trial, British Journal of Clinical Psychology, Vol: 61, Pages: 1188-1210, ISSN: 0144-6657
ObjectivesParents experiencing mental health difficulties consistent with “personality disorder”, often related to a history of complex trauma, may face increased challenges in parent–child relationships and child socioemotional development. There are no published randomised controlled trials (RCTs) evaluating perinatal parent–child interventions for this population. We evaluated the feasibility and acceptability of undertaking an RCT of the video feedback intervention for positive parenting adapted for perinatal mental health (VIPP-PMH).DesignFeasibility study incorporating a pilot RCT.MethodsMothers with enduring difficulties in managing emotions and relationships, consistent with a “personality disorder”, and their 6- to 36-month old infants were randomly allocated to receive six sessions of VIPP-PMH (n = 20) or usual care alone (n = 14).Results76% of eligible mothers consented to participate. Intervention uptake and completion rates were 95% (≥1 VIPP-PMH session) and 70% (6 sessions), respectively. Follow-up rates were 85% at month 5 and 65% at month 8 post-baseline. Blinded observer-ratings of maternal sensitivity in parent–child interaction favoured the intervention group at month 5 (RR = 1.94, 95% CI 0.67–5.63) and month 8 (RR = 1.91, 95% CI 0.68–5.33). Small changes over time in self-rated parenting confidence and stress favoured the intervention group. There were no clear intervention effects on maternal non-intrusiveness or mental health, or on child behaviour problems, emotional functioning, or self-regulation.ConclusionsAn RCT of VIPP-PMH is feasible and acceptable to implement with mothers experiencing difficulties consistent with perinatal “personality disorder”. A fully powered definitive RCT should be undertaken.
Crawford M, Leeson V, McQuaid A, et al., 2022, Severe COVID anxiety among adults in the United Kingdom: protocol for a cohort study and nested feasibility trial of modified Cognitive Behaviour Therapy for Health Anxiety., BMJ Open, Vol: 12, Pages: 1-9, ISSN: 2044-6055
IntroductionSome people are so anxious about COVID that it impairs their functioning. However, little is known about the course of severe COVID anxiety or what can be done to help people who experience it. Methods and analysisCohort study with a nested feasibility trial with follow-up at three and six months. We recruited 306 people who were aged 18 and over, lived in the United Kingdom and had severe COVID anxiety (indicated by a score of nine or more on the Coronavirus Anxiety Scale). To take part in the nested feasibility trial, participants also had to have a score of 20 or more on the Short Health Anxiety Inventory. We excluded people from the trial if they had had COVID-19 within the previous four weeks, if they were currently self-isolating or if they were already receiving psychological treatment. We publicised the study nationally through adverts, social media and posts on chat boards. We also recruited participants via clinicians working in primary and secondary care NHS services in London. All those in the active arm will be offered five to ten sessions of remotely delivered modified Cognitive Behaviour Therapy for Health Anxiety (CBT-HA). We will examine the proportion of participants who remain above threshold on the Coronavirus Anxiety Scale at three and six months and factors that influence levels of COVID anxiety over six months using mixed-effects logistic regression. The key feasibility metrics for the nested trial are the level of uptake of CBT-HA and the rate of follow-up.Ethics and disseminationApproved by Leicester Central Research Ethics Committee (reference: 20/EM/0238). The results of the study will be published in peer-reviewed scientific journals. Trial registration: International Standard Randomised Control Trial Number Register - ISRCTN14973494
Barnicot K, Crawford M, Kalwarowsky S, et al., 2022, The BOOST Trial: Feasibility trial of a video feedback parent-infant intervention for parents with personality disorder and their infants, Publisher: ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, Pages: LXXVII-LXXVII, ISSN: 0264-6838
Cook E, Markham S, Parker J, et al., 2022, Risk, responsibility, and choice in research ethics, LANCET PSYCHIATRY, Vol: 9, Pages: 5-6, ISSN: 2215-0374
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- Citations: 3
Sen P, Barnicot K, Podder P, et al., 2022, Exploring the prevalence of personality disorder and the feasibility of using the SAPAS as a screening tool for personality disorder in an emergency department in India, MEDICINE SCIENCE AND THE LAW, Vol: 62, Pages: 8-16, ISSN: 0025-8024
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- Citations: 1
Barnicot K, Redknap C, Coath F, et al., 2021, Patient experiences of therapy for borderline personality disorder: Commonalities and differences between dialectical behaviour therapy and mentalization-based therapy and relation to outcomes, Psychology and Psychotherapy: theory, research and practice, Pages: 1-22, ISSN: 1476-0835
ObjectivesDialectical behaviour therapy (DBT) and mentalization-based therapy (MBT) are widely used evidence-based psychological treatments for borderline personality disorder (BPD). The study aimed to establish evidence on common and unique, and helpful and unhelpful, treatment processes.DesignMixed-methods.MethodsIn-depth qualitative interview data on patient experiences during treatment were combined with quantitative outcome measures in 73 patients diagnosed with a personality disorder and receiving DBT or MBT.ResultsAcross both DBT and MBT, accounts of learning not to react impulsively, learning to question one’s thoughts and assumptions, learning to communicate more effectively, and exposure to painful emotions that may previously have been avoided were each associated with less baseline-adjusted self-harm at the end of treatment. Difficulties in interacting with other group members were more likely to be described by patients receiving MBT than DBT, whilst difficulties in the therapeutic relationship were equally common. Both of these types of difficult experience were associated with higher baseline-adjusted levels of BPD traits and emotional dysregulation, at the end of the 12-month study period.ConclusionsThe findings identify novel evidence of common therapeutic processes across DBT and MBT that may help to reduce self-harm. The findings also highlight the potential iatrogenic effect of difficulties in the alliance with therapists or with other group members. This underscores the importance of listening to patients’ voices about what they are finding difficult during therapy and working to address these relational challenges, so that the patient is able to progress and make best use of the treatment.Practitioner pointsRegardless of whether dialectical behaviour therapy or mentalization based therapy is used, helping service-users to learn not to react impulsively, to question their thoughts and assumptions, and to communicate more effectively
Barnicot K, Michael C, Trione E, et al., 2020, Psychological interventions for acute psychiatric inpatients with schizophrenia-spectrum disorders: A systematic review and meta-analysis, Clinical Psychology Review, Vol: 82, ISSN: 0272-7358
BACKGROUND: Acute inpatient psychiatric wards are important yet challenging environments in which to implement psychological interventions for people with schizophrenia-spectrum disorders. No meta-analysis to date has evaluated whether psychological interventions are effective in this context. METHODS: We systematically searched Embase, Medline and PsycInfo databases for randomised controlled trials (RCTs) of psychological interventions implemented in acute inpatient psychiatric settings with individuals with schizophrenia-spectrum disorders. We conducted random effects meta-analyses of between-groups outcomes at post-intervention and relapse/re-hospitalisation rates by follow-up. RESULTS: Twenty-nine trials were suitable for meta-analysis. Psychological interventions improved post-intervention positive symptoms, social functioning and treatment compliance and reduced the risk of relapse/ re-hospitalisation, relative to control conditions. Analyses of specific intervention effects found positive effects of psychoeducation on several key outcomes (power > 80%) and preliminary evidence for positive effects of acceptance and commitment therapy (ACT), cognitive behaviour therapy (CBT) and metacognitive training (MCT) on some outcomes (power < 80%). CONCLUSION: Psychological interventions can be helpful for acute inpatients with schizophrenia-spectrum disorders. However, risk of bias was often high or unclear, and some analyses were underpowered. Further research should use more rigorous RCT designs and publish meta-analysable data on positive symptoms, general psychopathology, relapse/ re-hospitalisation, social functioning and treatment compliance.
Barnicot K, Allen K, Hood C, et al., 2020, Older adult experience of care and staffing on hospital and community wards: a cross-sectional study, BMC Health Services Research, Vol: 20, ISSN: 1472-6963
BackgroundRecent major concerns about the quality of healthcare delivered to older adults have been linked to inadequate staffing and a lack of patient-centred care. Patient experience is a key component of quality care - yet there has been little research on whether and how staffing levels and staffing types affect satisfaction amongst older adult hospital inpatients. This study aimed to evaluate the association between registered nurse and healthcare assistant staffing levels and satisfaction with care amongst older adult hospital inpatients, and to test whether any positive effect of higher staffing levels is mediated by staff feeling they have more time to care for patients.MethodsSurvey data from 4928 inpatients aged 65 years and older and 2237 medical and nursing staff from 123 acute and community medical wards in England, United Kingdom (UK) was collected through the Royal College of Psychiatrist’s Elder Care Quality Mark. The cross-sectional association between staffing ratios and older adult patient satisfaction, and mediation by staff perceived time to care, was evaluated using multi-level modelling, adjusted for ward type and with a random effect for ward identity.ResultsHigher numbers of patients per healthcare assistant were associated with poorer patient satisfaction (adjusted β = − 0.32, 95% CI − 0.55 to 0.10, p < 0.01), and this was found to be partially mediated by all ward staff reporting less time to care for patients (adjusted β = − 0.10, bias-corrected 95% CI − 1.16 to − 0.02). By contrast, in both unadjusted and adjusted models, the number of patients per registered nurse was not associated with patient satisfaction.ConclusionsOlder adult hospital patients may particularly value the type of care provided by healthcare assistants, such as basic personal care and supportive communication. Additionally, higher availa
Barnicot K, Crawford M, 2019, Conclusions and questions from a non-randomised comparison of routine clinical services implementing different treatment models for borderline personality disorder, Psychological Medicine, Vol: 49, Pages: 2812-2814, ISSN: 0033-2917
Katsakou C, Pistrang N, Barnicot K, et al., 2019, Processes of recovery through routine or specialist treatment for borderline personality disorder (BPD): a qualitative study, JOURNAL OF MENTAL HEALTH, Vol: 28, Pages: 604-612, ISSN: 0963-8237
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- Citations: 8
Lei H, Barnicot K, Maynard E, et al., 2019, Factors influencing use of community treatment orders and quality of care that people receive: results of a national survey in England and Wales, BJPsych Bulletin, Vol: 43, Pages: 227-235, ISSN: 2056-4694
Aims and method: We conducted a secondary analysis of data from the National Audit of Psychosis to identify factors associated with use of community treatment orders (CTOs) and assess the quality of care that people on CTOs receive.Results: Between 1.1 and 20.2% of patients in each trust were being treated on a CTO. Male gender, younger age, greater use of in-patient services, coexisting substance misuse and problems with cognition predicted use of CTOs. Patients on CTOs were more likely to be screened for physical health, have a current care plan, be given contact details for crisis support, and be offered cognitive-behavioural therapy.Clinical implications: CTOs appear to be used as a framework for delivering higher-quality care to people with more complex needs. High levels of variation in the use of CTOs indicate a need for better evidence about the effects of this approach to patient care.Declaration of interest: None.
Barnicot K, Crawford M, 2019, Dialectical behaviour therapy v. mentalisation-based therapy for borderline personality disorder, Psychological Medicine, Vol: 49, Pages: 2060-2068, ISSN: 0033-2917
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.
Hall K, Barnicot K, Crawford M, et al., 2019, A systematic review of interventions aimed at improving the cardiovascular health of people diagnosed with personality disorders, Social Psychiatry and Psychiatric Epidemiology, Vol: 54, Pages: 897-904, ISSN: 0933-7954
PURPOSE: People with personality disorders have significantly reduced life expectancy and increased rates of cardiovascular disease compared to members of the general population. Given that more people die annually of cardiovascular disease across the globe than from any other cause, it is important to identify the evidence for interventions aimed at improving cardiovascular health among people with personality disorders. METHODS: Systematic literature review. PsycINFO, MEDLINE and EMBASE were searched using NICE Healthcare Databases, as well as CENTRAL and trial registries. We sought to identify randomised controlled trials of interventions pertaining to adults with a primary diagnosis of personality disorder, where the primary outcome measure was cardiovascular health before and after the intervention. RESULTS: A total of 1740 records were identified and screened by two independent reviewers. No papers meeting the inclusion criteria were identified. CONCLUSIONS: This systematic review did not identify any randomised controlled trials testing interventions aimed at improving the cardiovascular health of people with personality disorders. Research in this area could have important public health implications, spanning the fields of psychiatry and general medicine.
Yiend J, Barnicot K, Williams M, et al., 2018, The influence of positive and negative affect on emotional attention, Journal of Behavior Therapy and Experimental Psychiatry, Vol: 61, Pages: 80-86, ISSN: 0005-7916
BACKGROUND AND OBJECTIVES: Mechanisms of engagement and disengagement of attention to emotional information are thought to contribute to the onset and maintenance of anxiety and depression, a conclusion based largely on findings in analogue subclinical samples. However, we argue that traditionally defined analogue samples can be misleading. Firstly, research has challenged the adequacy of conventional measures of subclinical traits by illustrating that supposedly distinct scales are highly inter-correlated and do not therefore measure independent constructs. Secondly, recent research in clinical groups has revealed results opposite to those expected from the analogue literature, suggesting speeded, rather than impaired, disengagement from threat. METHODS: We present analogue findings, from a sample of 70 healthy participants, allowing a purer distinction between the phenomenology of anxiety versus depression using the orthogonal traits of positive and negative affect to classify individuals. RESULTS: Using emotional peripheral cueing we found that, at short cue durations, dysphoric individuals' (those with low positive and high negative affect) attention to facial expressions was slowed by emotional compared to neutral invalid cues. LIMITATIONS: Limitations included a small sample size and limited generalisability due to sampling from a student population. CONCLUSIONS: The data suggest that, in line with the previous subclinical literature, dysphoric individuals are slow to disengage attention from emotional information at early stages of processing and are consistent with the possibility that patterns of orienting of attention might be qualitatively different in subclinical versus clinical populations.
Barnicot K, Crawford M, 2018, Posttraumatic stress disorder in patients with borderline personality disorder: Treatment outcomes and mediators, Journal of Traumatic Stress, Vol: 31, Pages: 899-908, ISSN: 0894-9867
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.
Insua-Summerhays B, Hart A, Plummer E, et al., 2018, Staff and patient perspectives on therapeutic engagement during one-to-one observation, Journal of Psychiatric and Mental Health Nursing, Vol: 25, Pages: 546-557, ISSN: 1351-0126
IntroductionPolicies increasingly focus on staff‐patient interactions during one‐to‐one psychiatric nursing observations as an opportunity for therapeutic engagement – yet if and how this is feasible is unknown.AimThis study aimed to integrate staff and patient perspectives to determine what factors facilitate or impede therapeutic engagement during one‐to‐one observation.MethodThematic analysis of qualitative interviews with 31 psychiatric inpatient staff at different levels of seniority and 28 inpatients spanning a range of diagnoses and risk profiles.ResultsNegative experiences of observation were characterized by a reciprocal dynamic where both patients and staff withdrew from interactions, having felt the other did not want to engage with them. Staff and patients agreed that these difficulties could be overcome when staff showed patients that they cared, gradually building trust through simple demonstrations of compassion and ‘normalizing’ conversation about everyday things. This approach helped patients to feel safe enough to open up about their distress, which in turn helped staff to better understand their experiences and work with them to find solutions.Implications for practiceEngagement during observation could be facilitated if staff receive more supervision in understanding difficult dynamics that impede rapport‐building and in managing their emotions towards patients they experience as “hard‐to‐engage”.
Collins A, Barnicot K, Sen P, 2018, A Systematic Review and Meta-Analysis of Personality Disorder Prevalence and Patient Outcomes in Emergency Departments., J Pers Disord, Pages: 1-24
The objectives of this study were to perform a systematic review and meta-analysis of studies reporting prevalence of personality disorders (PDs) in emergency departments (EDs) and evaluate the effect of comorbid PDs on clinical outcomes. A systematic search of five databases along with manual searching and expert consultation was performed. A quality appraisal was conducted. A total of 29 articles were included. Prevalence of PDs in ED attendees varied depending on presenting complaint, Q(4) = 577.5, p < .01, with meta-analytic prevalence rates of suicide and self-harm at 35% and 22%, respectively. The assessment method had a significant effect on prevalence rates, Q(3) = 17.36, p < .01. Comorbid PD was a risk factor for repeating presenting complaint, subsequent ED return, and hospitalization. Better identification of PDs using screening tools in EDs could improve patient management and clinical outcomes. Future research should focus on PD prevalence in unselected ED populations using validated diagnostic interviews.
Sharp M, Gulati A, Barker C, et al., 2018, Developing an emotional coping skills workbook for inpatient psychiatric settings: a focus group investigation, BMC Psychiatry, Vol: 18, ISSN: 1471-244X
BackgroundEvidence suggests an unmet need for provision of psychological interventions in inpatient psychiatric settings. However, inpatient wards can present a challenging environment in which to implement interventions. The authors developed the Emotional Coping Skills workbook, a psychosocial intervention designed to overcome these challenges and provide inpatients with an opportunity for psychologically-informed therapeutic engagement. The workbook includes information and exercises to empower inpatients to understand their emotions and learn to cope with their distress.MethodsA qualitative study using thematic analysis was undertaken in two UK inpatient psychiatric hospitals to explore staff’s views about whether and how the workbook could be implemented, and on barriers to its use. Thirty-five nursing and occupational therapy staff members participated in four focus groups, and a further two psychologists in semi-structured interviews.ResultsStaff identified key barriers to successful implementation of the workbook. These were firstly, the difficulty in finding time and space for therapeutic work in the stressful ward environment. Secondly, staff identified a culture of emotional neglect whereby neither staff nor inpatients felt able to talk about emotions, and patients’ physical needs and medication were prioritised. Thirdly, staff discussed how psychotic symptoms and emotional distress could limit patients’ ability to engage with the workbook material. Staff suggested ways in which the feasibility of using the workbook could be enhanced. Firstly, they discussed the importance of encouraging staff to value psychological approaches and to view the workbook as a resource to help them manage their existing tasks. Secondly, they emphasised the value of staff drawing on their expertise to deliver the workbook flexibly in different formats and settings, depending on each patient’s particular presentation. Thirdly, they advocated empowering s
Innocent S, Podder P, Ram JR, et al., 2017, Using the SAPAS to identify risk for personality disorders among psychiatric outpatients in India: A feasibility study., Personality and Mental Health, Vol: 12, Pages: 15-24, ISSN: 1932-8621
Personality disorders (PDs) are common among psychiatric outpatients and are associated with increased morbidity and worse treatment outcomes. Epidemiological research conducted among this population in Asian countries is limited, reflecting a significant gap in the current literature. One barrier to this research is the lack of appropriate screening tools. The current research assessed the feasibility of using the SAPAS (Standardized Assessment of Personality-Abbreviated Scale) screening tool to identify individuals at high risk of PD in an Indian psychiatric outpatient population and provides an initial estimate of PD prevalence by using a validated diagnostic interview, the ICD-10 International Personality Disorder Examination. The findings suggest that whilst use of the SAPAS was feasible, acceptable to patients and led to clinically useful findings, when using the recommended cut-off score of 4, the SAPAS largely overdiagnoses the risk for PD in psychiatric outpatients in India (positive predictive value = 26.3%). The estimated prevalence of personality disorder in the sample was 11.1%, based on administering the International Personality Disorder Examination diagnostic interview to high-risk patients scoring 4 and above on the SAPAS, which is higher than previous estimates for this population and still likely to be an underestimation. Future studies should translate the measure into Bengali and evaluate its sensitivity and specificity at different cut-off points in order to optimize its use in Indian populations. Copyright © 2017 John Wiley & Sons, Ltd.
Dale O, Sethi F, Stanton C, et al., 2017, Personality disorder services in England: findings from a national survey, BJPsych Bulletin, Vol: 41, Pages: 247-253, ISSN: 2056-4694
Barnicot K, Insua-Summerhayes B, Plummer E, et al., 2017, Staff and patient experiences of decision-making about continuous observation in psychiatric hospitals, SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY, Vol: 52, Pages: 473-483, ISSN: 0933-7954
PurposeContinuous observation of psychiatric inpatients aims to protect those who pose an acute risk of harm to self or others, but involves intrusive privacy restrictions. Initiating, conducting and ending continuous observation requires complex decision-making about keeping patients safe whilst protecting their privacy. There is little published guidance about how to balance privacy and safety concerns, and how staff and patients negotiate this in practice is unknown. To inform best practice, the present study, therefore, aimed to understand how staff and patients experience negotiating the balance between privacy and safety during decision-making about continuous observation.MethodsThematic analysis of qualitative interviews with thirty-one inpatient psychiatric staff and twenty-eight inpatients.ResultsMost patients struggled with the lack of privacy but valued feeling safe during continuous observation. Staff and patients linked good decision-making to using continuous observation for short periods and taking positive risks, understanding and collaborating with the patient, and working together as a supportive staff team. Poor decision-making was linked to insufficient consideration of observation’s iatrogenic potential, insufficient collaboration with patients, and the stressful impact on staff of conducting observations and managing risk.ConclusionsBest practice in decision-making about continuous observation may be facilitated by making decisions in collaboration with patients, and by staff supporting each-other in positive risk-taking. To achieve truly patient-centred decision-making, decisions about observation should not be influenced by staff’s own stress levels. To address the negative impact of staff stress on decision-making, it may be helpful to improve staff training, education and support structures.
Sanatinia R, Cowan V, Barnicot K, et al., 2016, Loss of relational continuity of care in schizophrenia: associations with patient satisfaction and quality of care., British Journal of Psychiatry Open, Vol: 2, Pages: 318-322, ISSN: 2056-4724
BackgroundUsers of mental health service are concerned about changes in clinicians providing their care, but little is known about their impact.AimsTo examine associations between changes in staff, and patient satisfaction and quality of care.MethodNational cross-sectional survey of 3379 people aged 18 or over treated in secondary care for schizophrenia or schizoaffective disorder. Results41.9% reported at least one change in their key worker during the previous 12 months and 10.5% reported multiple changes. Those reporting multiple changes were less satisfied with their treatment and less likely to report having a care plan, knowing how to obtain help when in a crisis or to have had recommended assessments of their physical health.ConclusionsFrequent changes in staff providing care for people with psychosis are associated with poorer quality of care. Greater efforts need to be made to protect relational continuity of care for such patients.
Barnicot K, Crawford MJ, 2016, Specific Mental Health Disorders: Personality Disorders, International Encyclopedia of Public Health, Pages: 55-59, ISBN: 9780128036785
Personality disorders (PDs) are maladaptive patterns of relating to self and others that have negative consequences for the individual and society at large. While debate continues about the most appropriate system for their classification, poor health and social outcomes experienced by people with these problems highlight their public health importance. Interpersonal problems inherent in PD mean that providing services for people with PD is not straightforward. However, clear links with childhood adversity provide a basis for the development of primary prevention strategies, and an evidence base is beginning to emerge that suggests that many forms of PD are amenable to psychosocial intervention.
Crawford MJ, Barnicot K, Patterson S, et al., 2016, Negative results in phase III trials of complex interventions: cause for concern or just good science?, British Journal of Psychiatry, Vol: 209, Pages: 6-8, ISSN: 1472-1465
Some phase III trials inevitably fail to replicate benefits of interventions seen in earlier smaller-scale studies. But the high failure rate in recent mental health trials is of concern. Proper consideration of trial processes and greater use of adaptive trial designs could ensure better use of available resources.
Barnicot K, Gonzalez R, McCabe R, et al., 2016, Skills use and common treatment processes in dialectical behaviour therapy for borderline personality disorder, Journal of Behavior Therapy and Experimental Psychiatry, Vol: 52, Pages: 147-156, ISSN: 0005-7916
BACKGROUND AND OBJECTIVES: Dialectical behaviour therapy (DBT) trains participants to use behavioural skills for managing their emotions. The study aimed to evaluate whether skills use is associated with positive treatment outcomes independently of treatment processes that are common across different therapeutic models. METHOD: Use of the DBT skills and three common treatment processes (therapeutic alliance, treatment credibility and self-efficacy) were assessed every 2 months for a year in 70 individuals with borderline personality disorder receiving DBT. Mixed-multilevel modelling was used to determine the association of these factors with frequency of self-harm and with treatment dropout. RESULTS: Participants who used the skills less often at any timepoint were more likely to drop out of DBT in the subsequent two months, independently of their self-efficacy, therapeutic alliance or perceived treatment credibility. More frequent use of the DBT skills and higher self-efficacy were each independently associated with less frequent concurrent self-harm. Treatment credibility and the alliance were not independently associated with self-harm or treatment dropout. LIMITATIONS: The skills use measure could not be applied to a control group who did not receive DBT. The sample size was insufficient for structural equation modelling. CONCLUSION: Practising the DBT skills and building an increased sense of self-efficacy may be important and partially independent treatment processes in dialectical behaviour therapy. However, the direction of the association between these variables and self-harm requires further evaluation.
Gonzalez RA, Kallis C, Ullrich S, et al., 2016, Childhood maltreatment and violence: Mediation through psychiatric morbidity, Child Abuse & Neglect, Vol: 52, Pages: 70-84, ISSN: 0145-2134
Childhood maltreatment is associated with multiple adverse outcomes in adulthood including poor mental health and violence. We investigated direct and indirect pathways from childhood maltreatment to adult violence perpetration and the explanatory role of psychiatric morbidity. Analyses were based on a population survey of 2,928 young men 21–34 years in Great Britain in 2011, with boost surveys of black and minority ethnic groups and lower social grades. Respondents completed questionnaires measuring psychiatric diagnoses using standardized screening instruments, including antisocial personality disorder (ASPD), drug and alcohol dependence and psychosis. Maltreatment exposures included childhood physical abuse, neglect, witnessing domestic violence and being bullied. Adult violence outcomes included: any violence, violence toward strangers and intimate partners (IPV), victim injury and minor violence. Witnessing domestic violence showed the strongest risk for adult violence (AOR 2.70, 95% CI 2.00, 3.65) through a direct pathway, with psychotic symptoms and ASPD as partial mediators. Childhood physical abuse was associated with IPV (AOR 2.33, 95% CI 1.25, 4.35), mediated by ASPD and alcohol dependence. Neglect was associated with violence toward strangers (AOR 1.73, 95% CI 1.03, 2.91), mediated by ASPD. Prevention of violence in adulthood following childhood physical abuse and neglect requires treatment interventions for associated alcohol dependence, psychosis, and ASPD. However, witnessing family violence in childhood had strongest and direct effects on the pathway to adult violence, with important implications for primary prevention. In this context, prevention strategies should prioritize and focus on early childhood exposure to violence in the family home.
Barnicot K, Ramchandani P, 2015, What's in a name? Borderline personality disorder in adolescence, European Child and Adolescent Psychiatry, Vol: 24, Pages: 1303-1305, ISSN: 1018-8827
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