290 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, 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
Williams R, Natkulasingam S, Tooke B, et al., 2022, Examining the effects of national initiatives to improve the physical health of people with psychosis in England: secondary analysis of data from the National Clinical Audit of Psychosis, BJPsych Bulletin, Vol: 46, Pages: 140-147, ISSN: 2056-4694
Aims and Methods:To examine whether national initiatives have led to improvements in the physical health of people with psychosis. Secondary analysis of a national audit of services for people with psychosis. Proportions of patients in ‘good health’ according to seven measures, and one composite measure derived from national standards, were compared between multiple rounds of data collection.Results:The proportion of patients in overall ‘good health’ under the care of ‘Early Intervention in Psychosis’ teams increased from 2014–2019, particularly for measures of smoking, alcohol and substance use. There was no overall change in the proportion of patients in overall ‘good health’ under the care of ‘Community Mental Health Teams’ from 2011–2017. However, there were improvements in alcohol use, blood glucose and lipid levels.Clinical implications:There have been modest improvements in the health of people with psychosis over the last nine years. Continuing efforts are required to translate these improvements into reductions in premature mortality.
Crawford M, Leeson V, Evans R, et al., 2022, The clinical effectiveness and cost effectiveness of clozapine for inpatients with severe borderline personality disorder (CALMED study): A randomised placebo-controlled trial., Therapeutic Advances in Psychopharmacology, Vol: 12, Pages: 1-14, ISSN: 2045-1253
Background:Data from case series suggest that clozapine may benefit inpatients with borderline personality disorder (BPD), but randomised trials have not been conducted. Methods:Multicentre, double-blind, placebo-controlled trial. We aimed to recruit 222 inpatients with severe BPD aged 18 or over, who had failed to respond to other antipsychotic medications. We randomly allocated participants on a 1:1 ratio to receive up to 400mg of clozapine per day or an inert placebo using a remote web-based randomisation service. The primary outcome was total score on the Zanarini Rating scale for Borderline Personality Disorder (ZAN-BPD) at six months. Secondary outcomes included self-harm, aggression, resource use and costs, side effects and adverse events. We used a modified intention to treat analysis (mITT) restricted to those who took one or more dose of trial medication, using a general linear model fitted at six months adjusted for baseline score, allocation group and site. Results:The study closed early due to poor recruitment and the impact of the COVID-19 pandemic. Of 29 study participants, 24 (83%) were followed up at six months, of whom 21 (72%) were included in the mITT analysis. At six months, 11 (73%) participants assigned to clozapine and 6 (43%) of those assigned to placebo were still taking trial medication. Adjusted difference in mean total ZAN-BPD score at six months was -3.86 (95% Confidence Intervals = -10.04 to 2.32, p=0.22). There were 14 serious adverse events; six in the clozapine arm and eight in the placebo arm of the trial. There was little difference in the cost of care between groups. Interpretation:We recruited insufficient participants to test the primary hypothesis. The study findings highlight problems in conducting placebo-controlled trials of clozapine and in using clozapine for people with BPD, outside specialist inpatient mental health units.Trial registrationISRCTN18352058. https://doi.org/10.1186/ISRCTN18352058
Jha M, Barrett B, Brewin C, et al., 2022, Matching ICD-11 personality status to clinical management in a community team-The Boston (UK) Personality Project: Study protocol, Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 16, ISSN: 1932-8621
Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will be asked to agree to have their personality status assessed using scales recording the new ICD-11 classification, together with clinical ratings, social function and satisfaction. A control group of 100 patients from an adjacent service of similar demographics (Spalding) will also have similar ratings but no personality assessments. Changes in clinical status, social function and service satisfaction will be made after 6 and 12 months in both groups. The patients in the Boston group will be offered matched interventions using a stepped care approach for both the severity of disorder and its domain structure. These interventions will include shorter versions of existing psychological treatments, environmental therapies including nidotherapy, adaptive and acceptance models, drug reduction and social prescribing. Full costs of psychiatric care will be measured in both groups. The main hypothesis is that greater awareness of personality function will lead to better clinical outcomes and satisfaction.
Crawford M, Drummond C, 2022, Professor Robin Touquet, RD, FRCS, FRCP, FCEM obituary, Alcohol and Alcoholism, Vol: 57, ISSN: 0735-0414
Foye U, Stuart R, Trevillion K, et al., 2022, Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study, BMC Psychiatry, Vol: 22, ISSN: 1471-244X
BackgroundIndividuals with Complex Emotional Needs (CEN) services, a working description to refer to the needs experienced by people who may have been diagnosed with a “personality disorder”, face premature mortality, high rates of co-morbidity, service user and treatment costs. Service provision for this population is recurrently identified as needing to be transformed: there are serious concerns about quality, accessibility, fragmentation of the service system and the stigma and therapeutic pessimism service users encounter. Understanding clinician perspectives is vital for service transformation, as their views and experiences shed light on potential barriers to achieving good care, and how these might be overcome. In this study, we aimed to explore these views.MethodsWe used a qualitative interview design. A total of fifty participants from a range of professions across specialist and generic community mental health services across England who provide care to people with CEN took part in six focus groups and sixteen one-to-one interviews. We analysed the data using a thematic approach.FindingsMain themes were: 1) Acknowledging the heterogeneity of needs: the need for a person-centred care approach and flexibility when working with CEN, 2) ‘Still a diagnosis of exclusion’: Exploring the healthcare provider-level barriers to providing care, and 3) Understanding the exclusionary culture: exploring the system-based barriers to providing care for CEN. Across these themes, staff highlighted in particular the need for care that was person-centred, relational, empathic, and trauma informed. Major barriers to achieving this are stigmatising attitudes and behaviour towards people with CEN, especially in generic mental health services, lack of development of coherent service systems offering clear long-term pathways and ready access to high quality treatment, and lack of well-developed structures for staff training and support.DiscussionOverall, the
Trevillion K, Stuart R, Ocloo J, et al., 2022, Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study, BMC Psychiatry, Vol: 22, Pages: 1-18, ISSN: 1471-244X
BackgroundThere is consensus that services supporting people with complex emotional needs are part of a mental health care system in which change is needed. To date, service users’ views and co-production initiatives have had little impact on the development of interventions and care. This needs to change, and our paper evidences the experiences and perspectives of a diverse range of people on how community services can best address the needs of people with complex emotional needs.MethodsA co-produced qualitative research study. Lived experience researchers led data collection and analysis. Individual interviews were conducted with 30 people across England who had a diverse range of experiences and perspectives of using community services for complex emotional needs. Participants were asked about their experiences of using community services for their mental health, and views on how community services can best address their needs. Thematic analysis was used to analyse the data.ResultsParticipants reported some experiences of good practice but also of experiences of severely stigmatising interventions, a lack of effective support and service fragmentation. Relational Practice was identified as the central overarching theme and describes how community services can best support people with complex emotional needs. This approach involves care delivered in a non-stigmatising, individualised and compassionate way and care that is trauma-informed. It involves care that is planned collaboratively with service users to ensure their multiple needs are addressed in a flexible, holistic and consistent way which accounts for the long-term and fluctuating nature of their needs.ConclusionsRelational practice approaches have potential to facilitate better community care for people with complex emotional needs. Research and service development are needed to examine how best to implement such approaches across the mental health service system. This work must be co-produced with
Crawford M, McQuaid A, Sanatinia R, et al., 2021, Patient experience of lasting negative effects of psychological interventions for anxiety and depression in secondary mental health care services: A national cross-sectional study., BMC Psychiatry, Vol: 21, Pages: 1-7, ISSN: 1471-244X
BackgroundPatients who undergo psychological treatment can report both negative and positive effects, but evidence of factors influencing the likelihood of negative effects is limited.AimsTo identify aspects of the organisation and delivery of secondary care psychological treatment services that are associated with patient experiences of negative effects.MethodCross-sectional survey of people with anxiety and depression who ended psychological treatment delivered by 50 NHS trusts in England. Respondents were asked about how their treatment was organised and delivered and whether they experienced lasting negative effects.ResultsOf 662 respondents, 90 (14.1%) reported experiencing lasting negative effects. People over the age of 65 were less likely than younger respondents to report negative effects. There was an association between reporting neutral or negative effects and not being referred at what respondents considered to be the right time (OR = 1.712, 95% CI = 1.078–2.726), not receiving the right number of sessions (OR = 3.105, 95% CI = 1.934–4.987), and not discussing progress with their therapist (OR 2.063, 95% CI = 1.290–3.301).ConclusionsOne in seven patients who took part in this survey reported lasting negative effects from psychological treatment. Steps should be taken to prepare people for the potential for negative experiences of treatment, and progress reviewed during therapy in an effort to identify and prevent negative effects.
Botham J, Clark A, Steare T, et al., 2021, Community interventions for people with complex emotional needs that meet the criteria for personality disorder diagnoses: systematic review of economic evaluations and expert commentary, BJPSYCH OPEN, Vol: 7, ISSN: 2056-4724
Tyrer P, Tyrer H, Yang M, et al., 2021, Is social function a good proxy measure of personality disorder?, Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 15, Pages: 261-272, ISSN: 1932-8621
Background:Personality assessment is often difficult and proxy measures may be useful. Aims: To examine the assessment of social functioning in relationship to personality disorder. Method:Secondary analysis of data from three clinical studies; following deliberate self-harm (n=460), cognitive behaviour therapy for health anxiety (n=444), and a 30-year follow up of 200 anxious/depressed patients. Social function and personality were assessed using the Social Functioning Questionnaire (SFQ) and the Personality Assessment Schedule. A five item short version of the SFQ, the Short Social Functioning Questionnaire (SSFQ) was also developedResults:The SFQ score in the first two studies (area under curve (AUC) 0.64 and 0.65) partly predicted personality status; in the third study this achieved close agreement (AUC SFQ 0.85 (95% CI 0.8-0.9; AUC SSFQ 0.84 (95% CI 0.78-0.89). In all studies social function deteriorated linearly with increasing personality pathology. Cut-off points of 4 on the SSFQ and 7 on the SFQ had high sensitivity (SSFQ 82-90%; SFQ 82-83%) and acceptable specificity (SSFQ 66-75%; SFQ 69-75%) in identifying personality disorder in the third study. Conclusions: Social functioning recorded in either a 5-item or 8-item self-rating is a useful proxy measure of personality disturbance, and may be the core of disorder.
Lodder A, Mehay A, Pavlickova H, et al., 2021, Evaluating the effectiveness and cost effectiveness of the 'strengthening families, strengthening communities' group-based parenting programme: study protocol and initial insights, BMC Public Health, Vol: 21, Pages: 1-13, ISSN: 1471-2458
BackgroundUp to 20% of UK children experience socio-emotional difficulties which can have serious implications for themselves, their families and society. Stark socioeconomic and ethnic inequalities in children’s well-being exist. Supporting parents to develop effective parenting skills is an important preventive strategy in reducing inequalities. Parenting interventions have been developed, which aim to reduce the severity and impact of these difficulties. However, most parenting interventions in the UK focus on early childhood (0–10 years) and often fail to engage families from ethnic minority groups and those living in poverty. Strengthening Families, Strengthening Communities (SFSC) is a parenting programme designed by the Race Equality Foundation, which aims to address this gap. Evidence from preliminary studies is encouraging, but no randomised controlled trials have been undertaken so far.Methods/designThe TOGETHER study is a multi-centre, waiting list controlled, randomised trial, which aims to test the effectiveness of SFSC in families with children aged 3–18 across seven urban areas in England with ethnically and socially diverse populations. The primary outcome is parental mental well-being (assessed by the Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes include child socio-emotional well-being, parenting practices, family relationships, self-efficacy, quality of life, and community engagement. Outcomes are assessed at baseline, post intervention, three- and six-months post intervention. Cost effectiveness will be estimated using a cost-utility analysis and cost-consequences analysis. The study is conducted in two stages. Stage 1 comprised a 6-month internal pilot to determine the feasibility of the trial. A set of progression criteria were developed to determine whether the stage 2 main trial should proceed. An embedded process evaluation will assess the fidelity and acceptability of the intervention.DiscussionIn t
Crawford M, Sanatinia R, Burns A, et al., 2021, Factors associated with shorter length of admission among people with dementia in England and Wales: Retrospective cohort study., BMJ Open, Vol: 11, Pages: 1-7, ISSN: 2044-6055
Objectives To identify aspects of the organisation and delivery of acute inpatient services for people with dementia that are associated with shorter length of hospital stay.Design and setting Retrospective cohort study of patients admitted to 200 general hospitals in England and Wales.Participants 10 106 people with dementia who took part in the third round of National Audit of Dementia.Main outcome measure Length of admission to hospital.Results The median length of stay was 12 days (IQR=6–23 days). People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission (estimated effect −0.24, 95% CI: −0.29 to −0.18, p<0.001). People from ethnic minorities had shorter length of stay (difference −0.066, 95% CI: −0.13 to −0.002, p=0.043). Patients with documented evidence of discussions having taken place between their carers and medical staff spent longer in hospital (difference 0.26, 95% CI: 0.21 to 0.32, p<0.001). These associations held true in a subsample of 669 patients admitted with hip fracture and data from 74 hospitals with above average carer-rated quality of care.Conclusions The way that services for inpatients with dementia are delivered can influence how long they spend in hospital. Initiating discharge planning within the first 24 hours of admission may help reduce the amount of time that people with dementia spend in hospital.
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
Tyrer P, Wang D, Crawford M, et al., 2021, Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over eight years: randomised controlled trial (vol 51, pg 1714, 2021), PSYCHOLOGICAL MEDICINE, Vol: 51, Pages: 1723-1723, ISSN: 0033-2917
Tyrer P, Wang D, Crawford M, et al., 2021, Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial., Psychological Medicine, Vol: 51, Pages: 1714-1722, ISSN: 0033-2917
BACKGROUND: Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals. METHODS: We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822. RESULTS: There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25-3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI -0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42-2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function. CONCLUSIONS: CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.
Trevillion K, Stuart R, Ocloo J, et al., 2021, Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study, Publisher: Cold Spring Harbor Laboratory
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>There is consensus that services supporting people with complex emotional needs are part of a mental health care system in which change is needed. To date, service users’ views and co-production exercises have had little impact on the development of treatment and care. This needs to change, and our paper evidences the experiences and perspectives of a diverse range of people on how community services can best address the needs of people with complex emotional needs.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A co-produced qualitative research study. Lived experience researchers led data collection and analysis. Individual interviews were conducted with 30 people across England who had a diverse range of experiences and perspectives of using community services for complex emotional needs. Participants were asked about their experiences of using community services for their mental health, and views on how community services can best address their needs. Thematic analysis was used to analyse the data.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Participants reported some experiences of good practice but also of experiences of severely stigmatising treatment, a lack of effective support and service fragmentation. <jats:italic>Relational Practice</jats:italic> was identified as the central overarching theme and describes how community services can best support people with complex emotional needs. This approach involves care delivered in a non-stigmatising, individualised, compassionate and trauma-informed manner. It involves care that is planned collaboratively with service users to ensure their multiple needs are addressed in a flexible, holistic and consistent way which accounts for the long-term and fluctuatin
Prevolnik Rupel V, Jagger B, Fialho LS, et al., 2021, Standard set of patient-reported outcomes for personality disorder, Quality of Life Research, Vol: 30, Pages: 3485-3500, ISSN: 0962-9343
PurposeThe purpose of the article is to present standard set of outcomes for people with personality disorder (PD), in order to facilitate patient outcome measurement worldwide.MethodsThe International Consortium for Health Outcomes Measurement (ICHOM) gathered a multidisciplinary international working group, consisting of 16 experts, including clinicians, nurses, psychologists, methodologists and patient representatives, to develop a standard set of outcome measures for people with PD. The Delphi method was used to reach consensus on the scope of the set, outcome domains, outcome measures, case-mix variables and time points for measuring outcomes in service users. For each phase, a project team prepared materials based on systematic literature reviews and consultations with experts.ResultsThe working group decided to include PD, as defined by International Classification of Diseases 11th revision (ICD-11). Eleven core outcomes and three optional outcomes across four health domains (mental health, behaviour, functioning and recovery) were defined as those relevant for people with PD. Validated measures for the selected outcomes were selected, some covering more than one outcome. Case-mix variables were aligned to other ICHOM mental health standard sets and consisted of demographic factors and those related to the treatment that people received. The group recommended that most outcomes are measured at baseline and annually.ConclusionThe international minimum standard set of outcomes has the potential to improve clinical decision making through systematic measurement and comparability. This will be key in improving the standard of health care for people with PD across the world.
Romeu D, Guthrie E, Czoski-Murray C, et al., 2021, Experiences of people seen in an acute hospital setting by liaison mental health services: responses from an online survey, Publisher: CAMBRIDGE UNIV PRESS, Pages: S346-S346, ISSN: 2056-4724
Venturelli R, Ntouva A, Porter J, et al., 2021, Use of AUDIT-C alcohol screening tool in NHS general dental practices in North London, BRITISH DENTAL JOURNAL, ISSN: 0007-0610
Guo B, Li L, Crawford MJ, et al., 2021, The factor structure of the Zanarini Rating Scale for Borderline Personality Disorder: Exploratory Structural Equation Modelling and measurement invariance over time, INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Vol: 30, ISSN: 1049-8931
Codling D, Hood C, Bassett P, et al., 2021, Delirium screening and mortality in patients with dementia admitted to acute hospitals, Aging and Mental Health, Vol: 25, Pages: 889-895, ISSN: 1360-7863
Objectives: Delirium is associated with increased mortality in older adults. National guidance recommends that all people with dementia who are admitted to hospital are screened for delirium. However, the impact of screening for delirium among inpatients with dementia has not been examined. This study aims to examine this relationship.Methods: Secondary analysis of data from 10,047 patients admitted to 199 hospitals in England and Wales that took part in the third round of the National Audit of Dementia. Data on patients with dementia who died during their admission were compared with those who survived. We calculated odds of mortality among those who were screened for delirium, received cognitive testing, and, in those with delirium, an expert clinical review.Results: The mean age of study patients was 84 years (SD = 7.9), 40.1% were male and 82.1% white British. 1,285 patients (12.8%) died during their admission to hospital. Overall, 4,466 (44.5%) patients were screened for delirium, of whom 2,603 (58.6%) screened positive. The odds of mortality were lower in patients who underwent delirium screening (OR: 0.79, 95% confidence interval (CI): 0.69-0.90) and in those receiving cognitive testing (OR: 0.71, 95%CI: 0.61-0.82).Conclusion: These results demonstrate that, among people with dementia who are admitted to hospital, screening for delirium and assessment of cognitive functioning are associated with lower mortality. While we cannot be certain that these associations are causal, the findings support efforts that are being made to increase levels of screening for delirium among people with dementia who are admitted to hospital.
Khajuria A, Tomaszewski W, Fleming S, et al., 2021, Workplace factors associated with mental health of healthcare workers during the COVID-19 pandemic: an international cross-sectional study, BMC Health Services Research, Vol: 21, Pages: 1-11, ISSN: 1472-6963
BACKGROUND:The association of workplace factors on mental health of healthcare workers (HCWs) during the COVID-19 pandemic needs to be urgently established. This will enable governments and policy-makers to make evidence-based decisions. This international study reports the association between workplace factors and the mental health of HCWs during the pandemic.METHODS:An international, cross-sectional study was conducted in 41 countries. The primary outcome was depressive symptoms, derived from the validated Patient Health Questionnaire-2 (PHQ-2). Multivariable logistic regression identified factors associated with mental health outcomes. Inter-country differences were also evaluated. RESULTS:A total of 2,527 responses were received, from 41 countries, including China (n=1,213; 48.0%), UK (n=891; 35.3%), and USA (n=252; 10.0%). Of all participants, 1343 (57.1%) were aged 26 to 40 years, and 2021 (80.0%) were female; 874 (34.6%) were doctors, and 1367 (54.1%) were nurses. Factors associated with an increased likelihood of depressive symptoms were: working in the UK (OR=3.63; CI=[2.90-4.54]; p<0.001) and USA (OR=4.10; CI=[3.03-5.54]), p<0.001); being female (OR=1.74; CI=[1.42-2.13]; p<0.001); being a nurse (OR=1.64; CI=[1.34-2.01]; p<0.001); and caring for a COVID-19 positive patient who subsequently died (OR=1.20; CI=[1.01-1.43]; p=0.040). Workplace factors associated with depressive symptoms were: redeployment to Intensive Care Unit (ICU) (OR=1.67; CI=[1.14-2.46]; p=0.009); redeployment with perceived unsatisfactory training (OR=1.67; CI=[1.32-2.11]; p<0.001); not being issued with appropriate personal protective equipment (PPE) (OR=2.49; CI=[2.03-3.04]; p<0.001); perceived poor workplace support within area/specialty (OR=2.49; CI=[2.03-3.04]; p<0.001); and perceived poor mental health support (OR=1.63; CI=[1.38-1.92]; p<0.001).CONCLUSION:This is the first international study, demonstrating that workplace factors, including PPE availabil
Hood C, Morris A, Corrado O, et al., 2021, IMPACT OF COVID 19 PANDEMIC ON HOSPITAL CARE FOR PEOPLE WITH DEMENTIA-FEEDBACK FROM HOSPITAL LEADS AND CARERS, Publisher: OXFORD UNIV PRESS, ISSN: 0002-0729
Spong AJ, Clare ICH, Galante J, et al., 2021, Brief psychological interventions for borderline personality disorder. A systematic review and meta-analysis of randomised controlled trials, Clinical Psychology Review, Vol: 83, Pages: 101937-101937, ISSN: 0272-7358
BACKGROUND: People with Borderline Personality Disorder (BPD) have limited access to long term psychological therapies. Briefer interventions have been developed but trial evidence to support their use has not been reviewed. AIMS: To examine whether psychological interventions for adults with BPD of six months duration or less improve symptoms, mood, self-harm, suicidal behaviour, and service use. METHODS: The protocol was prospectively registered (PROSPERO CRD42017063777). Database searches were conducted up to April 2020. Inclusion, data extraction and risk of bias were assessed in duplicate. We identified 27 randomised controlled trials. We conducted random-effects meta-analyses sub-grouping data into delivery method, additional support, and comparison type. RESULTS: High levels of bias were found for attrition and reporting. Heterogeneity was high in some pooled data. Borderline symptom reductions were greatest for interventions including additional support (SMD. -1.23, 95% C.I. -2.13, -0.33). Planned generic support may be as effective as specialist interventions for borderline symptoms (SMD = -0.11, 95% C.I. -0.51, 0.29) and social functioning (SMD = -0.16., 95% C.I. -0.65, 0.33). Follow-up was limited and direct comparison with post-intervention results was unreliable. CONCLUSIONS: Short-term interventions may be effective. Access to additional support has an impact on outcomes. It is unclear if symptomatic change is sustained.
Tyrer P, Wang D, Tyrer H, et al., 2021, Influence of apparently negative personality characteristics on the long-term outcome of health anxiety: Secondary analysis of a randomized controlled trial., Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 15, Pages: 72-86, ISSN: 1932-8621
BACKGROUND: It is known that personality has an influence on the outcome of mental state disorders, but detailed studies on its long-term impact are few. We examined the influence of personality status on the 8-year outcome of health anxiety and its relationship to the effects of cognitive behaviour therapy in a randomized controlled trial. AIMS: This study aims to examine both the usefulness of the diagnosis of personality disorder and an additional measure of pathological dependence, in predicting the outcome of medical patients with health anxiety treated with cognitive behaviour therapy. Because the influence of personality is often shown in the long term, these assessments covered the period of 8 years after randomization. An additional aim is to examine the costs of different levels of personality dysfunction in each treatment group. METHOD: Personality dysfunction, using both ICD-10 and ICD-11 classifications of severity, was assessed at baseline by interview in a randomized controlled trial. Patients were also assessed for pathological dependence using the Dependent Personality Questionnaire, also scored along a severity dimension. Four hundred forty-four patients from medical clinics with pathological health anxiety were treated with a modified form of cognitive behaviour therapy for health anxiety (CBT-HA) or standard care. Total costs over follow-up were calculated from hospital data and compared by personality group. RESULTS: At baseline, 381 (86%) had some personality dysfunction, mainly at the lower level of personality difficulty (not formally a disorder). One hundred eighty four (41%) had a personality disorder. A similar proportion was found with regard to dependent personality. Using the ICD-10 classification, 153 patients (34.6%) had a personality disorder, with 83 (54.2%) having anxious or dependent personality disorder, 20 (13.1%) having an anankastic disorder, but also with 66 (43.1%) having mixed disorder. During initial treatment, those
Baldwin DS, Dang M, Farquharson L, et al., 2021, Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression., Comprehensive Psychiatry, Vol: 104, ISSN: 0010-440X
BACKGROUND: Clinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. PROCEDURES: Thirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England were asked to submit details of between 20 and 100 eligible service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. FINDINGS: Data from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care
Williams R, Farquharson L, Rhodes E, et al., 2021, Impact of substance use disorder on quality of inpatient mental health services for people with anxiety and depression, Journal of Dual Diagnosis, Vol: 17, Pages: 80-93, ISSN: 1550-4263
INTRODUCTION: Substance use disorders (SUD) are commonly comorbid with anxiety and depressive disorders, and are associated with poor treatment outcomes.The mechanisms underlying this association remain unclear–one possibility is that patients with anxiety/depressive disorders and SUD receive poorer treatment.Concerns have been raised about the quality of inpatient care received by patients with SUD. OBJECTIVES: To examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing sub-groups with or without a comorbid SUD. METHOD: Retrospective case-note review of 3,795 patients admitted to inpatient psychiatric wards in England. Data were gathered on all acute admissions with anxiety/depressive illness over a 6 month period, for a number of measures of quality of care derived from national standards. Association of co-existing SUD with a variety of quality of care outcomes (relating to assessment, care planning, medication management, psychological therapies, discharge, crisis planning and follow-up) was investigated using multivariable regression analyses. RESULTS: 543(14.3%) patients in the study had a secondary diagnosis of a SUD. Patients with SUD were less likely to have had care plans that were developed jointly, (i.e.,with input from both patient and clinician; OR= 0.76, 95% CI [0.55,0.93], p =.034),and less likely to have had their medication reviewed either during the admission (OR = 0.83, 95% CI [0.69, 0.94], p=.030) or at follow-up after discharge (OR= 0.58, 95% CI [0.39,0.86], p=.007). Carers of patients with SUD were less likely to have been provided with information about available support services (OR= 0.79, 95% CI [0.57, 0.98], p=.047). Patients with SUD were less likely to have received adequate (at least 24 hours) notice in advance of their discharge (OR= 0.72, 95% CI [0.54,0.96], p=.033), as were their carers (OR= 0.63, 95% CI [0.41,0.85], p=.007). They were less likely to have a crisis plan in place at th
Fonagy P, Yakeley J, Gardner T, et al., 2020, Mentalization for Offending Adult Males (MOAM): study protocol for a randomized controlled trial to evaluate mentalization-based treatment for antisocial personality disorder in male offenders on community probation, Trials, Vol: 21, ISSN: 1745-6215
BackgroundAntisocial personality disorder (ASPD), although associated with very significant health and social burden, is an under-researched mental disorder for which clinically effective and cost-effective treatment methods are urgently needed. No intervention has been established for prevention or as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment that has shown some promising preliminary results for reducing personality disorder symptomatology by specifically targeting the ability to recognize and understand the mental states of oneself and others, an ability that is compromised in people with ASPD. This paper describes the protocol of a multi-site RCT designed to test the effectiveness and cost-effectiveness of MBT for reducing aggression and alleviating the wider symptoms of ASPD in male offenders subject to probation supervision who fulfil diagnostic criteria for ASPD.MethodsThree hundred and two participants recruited from a pool of offenders subject to statutory supervision by the National Probation Service at 13 sites across the UK will be randomized on a 1:1 basis to 12 months of probation plus MBT or standard probation as usual, with follow-up to 24 months post-randomization. The primary outcome is frequency of aggressive antisocial behaviour as assessed by the Overt Aggression Scale – Modified. Secondary outcomes include violence, offending rates, alcohol use, drug use, mental health status, quality of life, and total service use costs. Data will be gathered from police and criminal justice databases, NHS record linkage, and interviews and self-report measures administered to participants. Primary analysis will be on an intent-to-treat basis; per-protocol analysis will be undertaken as secondary analysis. The primary outcome will be analysed using hierarchical mixed-effects linear regression. Secondary outcomes will be analysed using mixed-effects linear regression, mixed
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.
Botham J, Clark A, Steare T, et al., 2020, Community interventions for people with complex emotional needs that meet the criteria for ‘personality disorder’ diagnoses: a systematic review of economic evaluations
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Diagnoses of “personality disorder” are prevalent among people using community secondary mental health services. Whilst the effectiveness of a range of community-based treatments have been considered, as the NHS budget is finite, it is also important to consider the cost-effectiveness of those interventions.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs that meet criteria for a diagnosis of “personality disorder” to inform healthcare policy making.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Systematic review (PRESPORO #: CRD42020134068) of five databases, supplemented by reference list screening and citation tracking of included papers. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of ‘personality disorder’ in community mental health settings published between before 18 September 2019. Study quality was assessed using the CHEERS statement. Narrative synthesis was used to summarise study findings.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified which evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>There is no robust economic evidence to support a single intervention or mod
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