15 results found
Thana L, O'Connell L, Carne-Watson A, et al., 2022, Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial, BMC Psychiatry, Vol: 22, ISSN: 1471-244X
Background: More than half of people who use antipsychotic medication for psychosis report having sexual dysfunction. The REMEDY trial aimed to find out if switching antipsychotic medication provides an effective way to reduce sexual dysfunction among people with psychosis. We set out to recruit 216 participants over a two-year period, but recruitment was stopped after an extended 12-month pilot phase, during which we recruited only 10 participants. As part of a nested process evaluation, we conducted qualitative interviews with front-line clinicians to examine barriers to recruitment to the trial.Methods: We developed a semi-structured interview schedule to explore staff views on factors that influenced whether they referred potential participants to the study. We interviewed a purposive sample of 51 staff from four National Health Service (NHS) Trusts in England, ensuring a range of different backgrounds, seniority, and levels of involvement in the trial. Audio recordings of interviews were transcribed for verbatim, and data were analysed using an inductive approach to thematic analysis. Results : Nine interconnected themes were generated. Six themes concerned barriers to recruitment; including; prioritising patients’ mental stability, mutual discomfort and embarrassment about discussing a “taboo” subject, and concerns about unintended consequences of asking people with psychosis about their sexual functioning. Three themes, including the quality of treatment relationships and strategies for opening dialogue suggested ways to improve recognition of these “hidden” side effects. Conclusion: The identification and management of sexual dysfunction among people with psychosis are not priorities for mental health services in England at this time. Many staff working in front-line services feel unprepared and uncomfortable asking people with psychosis about these problems. While greater use of screening tools may improve the identification of
Douglas N, Mays N, Al-Haboubi M, et al., 2022, Observations of community-based multidisciplinary team meetings in health and social care for older people with long term conditions in England, BMC HEALTH SERVICES RESEARCH, Vol: 22
Crawford MJ, Thana L, Evans R, et al., 2020, Switching antipsychotic medication to reduce sexual dysfunction in people with psychosis: the REMEDY RCT, HEALTH TECHNOLOGY ASSESSMENT, Vol: 24, Pages: 1-+, ISSN: 1366-5278
Crawford MJ, Thana L, Parker J, et al., 2020, Structured Psychological Support for people with personality disorder: feasibility randomised controlled trial of a low-intensity intervention, BJPsych Open, Vol: 6, ISSN: 2056-4724
BackgroundNational guidance cautions against low-intensity interventions for people with personality disorder, but evidence from trials is lacking.AimsTo test the feasibility of conducting a randomised trial of a low-intensity intervention for people with personality disorder.MethodSingle-blind, feasibility trial (trial registration: ISRCTN14994755). We recruited people aged 18 or over with a clinical diagnosis of personality disorder from mental health services, excluding those with a coexisting organic or psychotic mental disorder. We randomly allocated participants via a remote system on a 1:1 ratio to six to ten sessions of Structured Psychological Support (SPS) or to treatment as usual. We assessed social functioning, mental health, health-related quality of life, satisfaction with care and resource use and costs at baseline and 24 weeks after randomisation.ResultsA total of 63 participants were randomly assigned to either SPS (n = 33) or treatment as usual (n = 30). Twenty-nine (88%) of those in the active arm of the trial received one or more session (median 7). Among 46 (73%) who were followed up at 24 weeks, social dysfunction was lower (−6.3, 95% CI −12.0 to −0.6, P = 0.03) and satisfaction with care was higher (6.5, 95% CI 2.5 to 10.4; P = 0.002) in those allocated to SPS. Statistically significant differences were not found in other outcomes. The cost of the intervention was low and total costs over 24 weeks were similar in both groups.ConclusionsSPS may provide an effective low-intensity intervention for people with personality disorder and should be tested in fully powered clinical trials.
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
BackgroundPrevious research has demonstrated the clinical effectiveness of long-term psychological treatment for people with some types of personality disorder. However, the high intensity and cost of these interventions limit their availability. Lower-intensity interventions are increasingly being offered to people with personality disorder, but their clinical and cost effectiveness have not been properly tested in experimental studies. We therefore set out to develop a low intensity intervention for people with personality disorder and to test the feasibility of conducting a randomized controlled trial to compare the clinical effectiveness of this intervention with that of treatment as usual (TAU).MethodsA two-arm, parallel-group, single-blind, randomized controlled trial of Psychological Support for Personality (PSP) versus TAU for people aged over 18 years, who are using secondary care mental health services and have personality disorder. We will exclude people with co-existing organic or psychotic mental disorders (dementia, bipolar affective disorder, delusional disorder, schizophrenia, schizoaffective disorder, or schizotypal disorder), those with cognitive or language difficulties that would preclude them from providing informed consent or compromise participation in study procedures, and those who are already receiving psychological treatment for personality disorder. Participants will be randomized via a remote system in a ratio of PSP to TAU of 1:1. Randomization will be stratified according to the referring team and gender of the participant.A single follow-up assessment will be conducted by masked researchers 24 weeks after randomization to assess mental health (using the Warwick and Edinburgh Well-Being Schedule), social functioning (using the Work and Social Adjustment Scale), health-related quality of life (EQ-5D-5 L), incidence of suicidal behavior, satisfaction with care (Client Satisfaction Questionnaire), and resource use and costs using a modifi
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
Background:Preliminary studies have indicated that music therapy may benefit children with autismspectrum disorders (ASD).Objectives:To examine the effects of improvisational music therapy (IMT) on social affect andresponsiveness of children with ASD.Design:International, multicentre, three-arm, single-masked randomised controlled trial, including aNational Institute for Health Research (NIHR)-funded centre that recruited in London and the east ofEngland. Randomisation was via a remote service using permuted blocks, stratified by study site.Setting:Schools and private, voluntary and state-funded health-care services.Participants:Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent orguardian who provided written informed consent. We excluded children with serious sensory disorder andthose who had received music therapy within the past 12 months.Interventions:All parents and children received enhanced standard care (ESC), which involved three60-minute sessions of advice and support in addition to treatment as usual. In addition, they wererandomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESCalone, over 5 months in a ratio of 1 : 1 : 2.Main outcome measures:The primary outcome was measured using the social affect score derived fromthe Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment.Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and12 months (higher scores indicated greater impairment).Results:A total of 364 participants were randomised between 2011 and 2015. A total of 182 children wereallocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocatedto ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) inthe intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171(94.0
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
Background:In 2008, the Mental Health Act (MHA) 2007 amendments to the MHA 1983 were implemented in England and Wales. The amendments were intended to remove perceived obstacles to the detention of high risk patients with personality disorders (PDs), sexual deviance and learning disabilities (LDs). The AMEND study aimed to test the hypothesis that the implementation of these changes would lead to an increase in numbers or proportions of patients with these conditions who would be assessed and detained under the MHA 2007.Method:A prospective, quantitative study of MHA assessments undertaken between July–October 2008–11 at three English sites. Data were collected from local forms used for MHA assessment documentation and patient electronic databases.Results:The total number of assessments in each four month period of data collection varied: 1034 in 2008, 1042 in 2009, 1242 in 2010 and 1010 in 2011 (n = 4415). Of the assessments 65.6% resulted in detention in 2008, 71.3% in 2009, 64.7% in 2010 and 63.5% in 2011. There was no significant change in the odds ratio of detention when comparing the 2008 assessments against the combined 2009, 2010 and 2011 data (OR = 1.025, Fisher‘s exact Χ 2 p = 0.735). Only patients with LD and ‘any other disorder or disability of the mind’ were significantly more likely to be assessed under the MHA post implementation (Χ2 = 5.485, P = 0.018; Χ2 = 24.962, P > 0.001 respectively). There was no significant change post implementation in terms of the diagnostic category of detained patients.Conclusions:In the first three years post implementation, the 2007 Act did not facilitate the compulsory care of patients with PDs, sexual deviance and LDs.
Crawford MJ, Thana L, 2016, Authors' reply, British Journal of Psychiatry, Vol: 209, Pages: 262-262, ISSN: 1472-1465
Crawford MJ, Thana L, 2016, Cognitive-behavioural toxicity? Reflections from Westminster: Reply, British Journal of Psychiatry, Vol: 209, Pages: 262-262, ISSN: 1472-1465
Olajide K, Tyrer P, Singh SP, et al., 2016, Likelihood and predictors of detention in patients with personality disorder compared with other mental disorders: A retrospective, quantitative study of Mental Health Act assessments., Personality and Mental Health, Vol: 10, Pages: 191-204, ISSN: 1932-863X
BACKGROUND: The UK guidelines on the treatment of personality disorder recommend avoiding compulsory treatment except in extreme situations. Little is known about how often patients with personality disorder are detained or how this compares with the treatment of other mental disorders. OBJECTIVES: Our aim is to test the hypothesis that people with personality disorder are infrequently detained under the Mental Health Act (MHA) and that risk factors associated with detention are the same as those for people with other mental disorders. METHOD: We used a retrospective, quantitative study of MHA assessments. RESULTS: Of the 2 087 assessments undertaken, 204 (9.8%) patients had a diagnosis of personality disorder; 40.7% of assessments in the personality disorder group resulted in detention, as did 69.7% of patients with other mental disorders. A higher proportion of people with personality disorder received no intervention following assessment compared with those with other mental disorders (20.6% vs. 4.7%, p < 0.001). Study centre and a history of admission were risk factors for detention in both groups. Risk was a predictor of detention in those with other mental disorders. CONCLUSIONS: Detention rates in patients with personality disorder are lower than those for other disorders but are still substantial. Risk factors for detention in patients with personality disorder differ from those with other mental disorders. Copyright © 2016 John Wiley & Sons, Ltd.
Crawford MJ, Thana L, Farquharson L, et al., 2016, Patient experience of negative effects of psychological treatment: results of a national survey., British Journal of Psychiatry, Vol: 208, Pages: 260-265, ISSN: 1472-1465
BackgroundTo make informed choices, patients need information about negative as well as positive effects of treatments. There is little information about negative effects of psychological interventions.AimsTo determine the prevalence of and risk factors for perceived negative effects of psychological treatment for common mental disorders.MethodCross-sectional survey of people receiving psychological treatment from 184 services in England and Wales. Respondents were asked whether they had experienced lasting bad effects from the treatment they received. ResultsOf 14,587 respondents, 763 (5.2%) reported experiencing lasting bad effects. People aged over 65 were less likely to report such effects and sexual and ethnic minorities were more likely to report them. People who were unsure what type of therapy they received were more likely to report negative effects (Odds Ratio = 1.51, 95% CI = 1.22 to, 1.87), and those that stated that they were given enough information about therapy before it started they were less likely to report them (Odds Ratio = 0.63, 95% CI = 0.52 to 0.76).ConclusionOne in 20 people responding to this survey reported lasting bad effects from psychological treatment. Clinicians should discussthe potential for both the positive and negative effects of therapybefore it starts.
Crawford MJ, Robotham D, Thana L, et al., 2011, Selecting outcome measures in mental health: the views of service users, JOURNAL OF MENTAL HEALTH, Vol: 20, Pages: 336-346, ISSN: 0963-8237
Crawford MJ, Thana L, Methuen C, et al., 2011, Impact of screening for risk of suicide: randomised controlled trial, BRITISH JOURNAL OF PSYCHIATRY, Vol: 198, Pages: 379-384, ISSN: 0007-1250
de Lusignan S, Hague N, van Vlymen J, et al., 2006, A study of cardiovascular risk in overweight and obese people in England., Eur J Gen Pract, Vol: 12, Pages: 19-29, ISSN: 1381-4788
OBJECTIVES: To report current levels of obesity and associated cardiac risk using routinely collected primary care computer data. METHODS: 67 practices took part in an educational intervention to improve computer data quality and care in cardiovascular disease. Data were extracted from 435,102 general practice computer records. 64.3% (229,108/362,861) of people age 15 y and older had a body mass index (BMI) recording or a valid height and weight record that enabled BMI to be derived. Data about cardiovascular disease and risk factors were also extracted. The prevalence of disease and the control of risk factors in the overweight and obese population were compared with those of normal body weight. RESULTS: 56.8% of men and 69.3% of women aged over 15 y had a BMI record. 22% of men and 32.3% of women aged 15 to 24 y were overweight or obese; rising each decade to a peak of 65.6% of men and 57.5% of women aged 55 to 64 y. Thereafter, the proportion who were overweight or obese declined. The prevalence of ischaemic heart disease, diabetes mellitus and hypertension rose with increasing levels of obesity; their prevalence in those who are moderately obese was between two and three times that of the general population. Systolic and diastolic blood pressure, blood glucose even in non-diabetics, cholesterol and triglycerides were all elevated in the overweight and obese population. CONCLUSION: Based on the recorded data over half of men and nearly half of women are overweight or obese. They have increased cardiovascular risk, which is not adequately controlled by current practice.
de Lusignan S, Van Vlymen J, Hague N, et al., 2005, Preventing stroke in people with atrial fibrillation: a cross-sectional study, JOURNAL OF PUBLIC HEALTH, Vol: 27, Pages: 85-92, ISSN: 1741-3842
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