Publications
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Bieleninik L, Geretsegger M, Mossler K, et al., 2017, Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder The TIME-A Randomized Clinical Trial, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 318, Pages: 525-535, ISSN: 0098-7484
Importance Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication.Objective To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD.Design, Setting, and Participants Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016.Interventions Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents’ concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child’s focus of attention, to help children develop affect sharing and joint attention.Main Outcomes and Measures The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months.Results Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects
Olajide K, Crawford M, Munjiza J, et al., 2017, Development and psychometric properties of the Standardized Assessment of Severity of Personality Disorder, Journal of Personality Disorders, Vol: 32, Pages: 44-56, ISSN: 1943-2763
AimsPersonality disorder is increasingly categorised according to its severity, but there is no simple way to screen for severity according to ICD-11 criteria.We set out to develop the Standardized Assessment of Severity of Personality Disorder (SASPD).Methods110 patients completed the SASPD together with a clinical assessment of the severity of personality disorder. We examined the predictive ability of the SASPD using the area under the ROC curve (AUC). Two to four weeks later 43 patients repeated the SASPD to examine reliability.ResultsThe SASPD had good predictive ability for determining mild (AUC =0.86) and moderate (AUC=0.84) PD at cut points of 8 and 10 respectively. Test retest reliability of the SASPD was high (intraclass correlation coefficient = 0.93, 95% CI = 0.88 to 0.96). ConclusionThe SASPD provides a simple, brief and reliable indicator of the presence of mild or moderate PD according to ICD-11 criteria.
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.
McMurran M, Day F, Reilly J, et al., 2017, Psychoeducation and problem solving (PEPS) therapy for adults with personality disorder: a pragmatic randomized-controlled trial, Journal of Personality Disorders, Vol: 31, Pages: 810-826, ISSN: 1943-2763
We compared psychoeducation and problem solving (PEPS) therapy against usual treatment in a multisite randomized-controlled trial. The primary outcome was social functioning. We aimed to recruit 444 community-dwelling adults with personality disorder; however, safety concerns led to an early cessation of recruitment. A total of 154 people were randomized to PEPS and 152 to usual treatment. Follow-up at 72 weeks was completed for 68%. PEPS therapy was no more effective than usual treatment for improving social functioning (adjusted difference in mean Social Functioning Questionnaire scores = -0.73; 95% CI [-1.83, 0.38]; p = 0.19). PEPS therapy is not an effective treatment for improving social functioning of adults with personality disorder living in the community.
Tyrer P, Tyrer H, Morris R, et al., 2017, Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: multicentre, randomised controlled trial, Open Heart, Vol: 4, ISSN: 2053-3624
Background: Non-cardiac chest pain is very common and generally managed inappropriately. Psychological interventions need more attention.Methods: We tested the effectiveness and cost-effectiveness of a modified form of cognitive behaviour therapy for chest pain (CBT-CP)(4-10 sessions) in patients who attended cardiology clinics or emergency medical services repeatedly. We planned to recruit 96 patients. Participants were randomised using a remote web-based system to CBT-CP or to standard care in the clinic. Assessments were made at baseline and at six and 12 months. The primary outcome was the change in the Health Anxiety Inventory score at six months. Other clinical measures, social functioning, quality of life, and costs of services were also recorded. Findings: 68 patients were randomised with low attrition rates at 6 and 12 months with 81% of all possible assessments completed at 6 and 12 months. Many more patients who were eligible were not referred. The Although there were no significant group differences between any of the outcome measures at either 6 or 12 months, patients receiving CBT-CP had between two and three times fewer hospital bed days, outpatient appointments, and A&E attendances than those allocated to standard care and total costs per patient were £1496.49 lower, though the differences in costs were not significant. There was a small non- significant gain in quality adjusted life years (QALY's) in those allocated to CBT-CP compared with standard care (0.76 vs 0.74). Interpretation: It is concluded that CBT-CP in the context of current hospital structures is not a feasible or viable treatment, but is worthy of further research as a potentially cost-effective treatment for non-cardiac chest pain.
Munjiza J, Britvic D, Radman M, et al., 2017, Severe war-related trauma and personality pathology: a case-control study, BMC Psychiatry, Vol: 17, ISSN: 1471-244X
Objective: To investigate whether people who have clinically significant personality-related problems 15 years after a war are more likely to have been exposed to severe war-related trauma than those who do not have significant personality difficulties.Methods: A case –control study was conducted in southern Croatia, fifteen years after the 1991-1995 war. We recruited 268 participants: 182 cases who scored positively on the International Personality Disorder Examination scale (IPDE), and 86 controls who were IPDE negative. Severity of war-related trauma was assessed according to the 17 items on the Harvard Trauma Questionnaire (HTQ) trauma event scale, which were considered to be of severe (catastrophic) nature based on the ICD-10 description of catastrophic trauma and the opinion of trauma experts. All participants also completed measures of mental health (depression, anxiety and PTSD), social functioning and current substance misuse. Results: Cases (IPDE positive) were eight times more likely to report exposure to severe war-related trauma than controls. This association increased after adjustments for demographic factors (OR= 10.1, 95% CI 5.0 to 20.4). The types of severe trauma most frequently reported were either the participants’own life being in direct danger or witnessing extreme violence inflicted on others or the result of violence towards others (murder, torture, seeing burned or disfigured bodies). Prevalences of depression, anxiety and PTSD were high among IPDE positive participants 15 years after exposure to war trauma. Their level of interpersonal dysfunction was considerably higher than that in controls (OR=10.39, 95% CI 3.51 to 30.75). Alcohol consumption in cases was significantly higher with a mean of 14.24 units per week (sd=11.03) when compared to controls whose mean number of alcohol units was 9.24 (sd=7.25), t (73)= 2.16, p<0.05, mean difference 4.99 (95% CI= 0.39 to 9.60). Similarly, a significantly higher number of cases
D'Lima D, Crawford M, Darzi A, et al., 2017, Patient safety and quality of care in mental health: a world of its own?, BJPsych Bulletin, Vol: 41, Pages: 241-243, ISSN: 2056-4694
Quality and safety in healthcare, as an academic discipline, has made significant progress over recent decades, and there is now an active and established community of researchers and practitioners. However, work has predominantly focused on physical health, despite broader controversy regarding the attention paid to, and significance attributed to, mental health. Work from both communities is required in order to ensure that quality and safety is actively embedded within mental health research and practice and that the academic discipline of quality and safety accurately represents the scientific knowledge that has been accumulated within the mental health community.
Bowden-Jones, Whitelock C, Abdulrahim D, et al., 2017, Prevalence of HIV-risk related drug use and sexual activity among men who have sex with men attending a specialist UK club drug clinic, Drugs and Alcohol Today, Vol: 17, Pages: 50-59, ISSN: 1745-9265
Aims: To examine patterns of drug use amongst a cohort of drug treatment-seeking drug-using gay men and other men who have sex with men (MSM), and whether these behaviours differ between, or predict, HIV status. Design: Cross-sectional study. Setting: Specialist club drug clinic in London. Participants: 407 consecutive attendees who identified as MSM. Measurements: Substance use, including injecting drug use (IDU), associated sexual activity, and self-reported HIV status were measured by clinical interview and National Drug Treatment Monitoring System data tool. Findings: Over a 45 month period, 407 MSM attended the clinic. 62.1% were HIV positive, 48.9% had injected drugs, 14.9% reported needle sharing and 73.3% used drugs to facilitate sex. The most commonly reported problem drugs were GHB/GBL (54.3%), methamphetamine (47.7%) and mephedrone (37.8%). HIV status was associated with methamphetamine, mephedrone, IDU, sharing equipment, using drugs to facilitate sex, older age and older age of drug initiation, as well as Hepatitis C (HCV) status. Use of methamphetamine, HCV infection, older age and IDU predicted HIV positive status in a logistic regression model. Conclusions: The findings describe a constellation of risk factors including high levels of IDU, sharing of equipment and high-risk sexual activity in a population with high rates of HIV positive serology. They also provide further evidence for a link between HIV infection and use of methamphetamine. We suggest a need for greater awareness of HIV-related risk behaviours and promotion of HIV prevention strategies for MSM by both sexual health and drug treatment services.
Perry BI, Champaneri N, Griffiths F, et al., 2017, Exploring professionals' understanding, interpretation and implementation of the 'appropriate medical treatment test' in the 2007 amendment of the Mental Health Act 1983., BJPsych Open, Vol: 3, Pages: 57-63, ISSN: 2056-4724
BACKGROUND: The appropriate medical treatment test (ATT), included in the Mental Health Act (MHA) (1983, as amended 2007), aims to ensure that detention only occurs when treatment with the purpose of alleviating a mental disorder is available. AIMS: As part of the Assessing the Impact of the Mental Health Act (AMEND) project, this qualitative study aimed to assess professionals' understanding of the ATT, and its impact on clinical practice. METHOD: Forty-one professionals from a variety of mental health subspecialties were interviewed. Interviews were coded related to project aims, and themes were generated in an inductive process. RESULTS: We found that clinicians are often wholly relied upon for the ATT. Considered treatment varied depending on the patient's age rather than diagnosis. The ATT has had little impact on clinical practice. CONCLUSIONS: Our findings suggest the need to review training and support for professionals involved in MHA assessments, with better-defined roles. This may enable professionals to implement the ATT as its designers intended. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
Pearce S, Scott L, Attwood G, et al., 2017, Democratic therapeutic community treatment for personality disorder: randomised controlled trial, British Journal of Psychiatry, Vol: 210, Pages: 149-156, ISSN: 1472-1465
BACKGROUND: Democratic therapeutic community (DTC) treatment has been used for many years in an effort to help people with personality disorder. High-quality evidence from randomised controlled trials (RCTs) is absent. AIMS: To test whether DTC treatment reduces use of in-patient services and improves the mental health of people with personality disorder. METHOD: An RCT of 70 people meeting DSM-IV criteria for personality disorder (trial registration: ISRCTN57363317). The intervention was DTC and the control condition was crisis planning plus treatment as usual (TAU). The primary outcome was days of in-patient psychiatric treatment. Secondary outcomes were social function, mental health status, self-harm and aggression, attendance at emergency departments and primary care, and satisfaction with care. All outcomes were measured at 12 and 24 months after randomisation. RESULTS: Number of in-patient days at follow-up was low among all participants and there was no difference between groups. At 24 months, self- and other directed aggression and satisfaction with care were significantly improved in the DTC compared with the TAU group. CONCLUSIONS: DTC is more effective than TAU in improving outcomes in personality disorder. Further studies are required to confirm this conclusion.
Andreas S, Schulz H, Volkert J, et al., 2017, Prevalence of mental disorders in elderly people: the European MentDis_ICF65+study, BRITISH JOURNAL OF PSYCHIATRY, Vol: 210, Pages: 125-131, ISSN: 0007-1250
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- Citations: 175
Drummond C, Gilburt H, Burns T, et al., 2016, Assertive Community Treatment For People With Alcohol Dependence: A Pilot Randomized Controlled Trial, ALCOHOL AND ALCOHOLISM, Vol: 52, Pages: 234-241, ISSN: 0735-0414
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.
Lingford-Hughes AR, Patel Y, Bowden-Jones O, et al., 2016, Improving GHB withdrawal with baclofen: study protocol for a feasibility study for a randomised controlled trial, Trials, Vol: 17, ISSN: 1745-6215
BackgroundGHB (gamma-hydroxybutyrate) and its pro-drugs GBL (gamma-butyrolactone) 1,4-butanediol(1.4-BD) are central nervous system depressants whose street names include ‘G’ and ‘liquidecstasy’. They are used recreationally predominately for their stimulant and pro-sexual effectsor for sedation to help with sleep and/or to “come down” after stimulant recreational drugs.Although overall population prevalence is low (0.1%), in some groups such as men who havesex with men, GHB/GBL use may reach 20%. GHB/GBL dependence may be associated withsevere withdrawal with individuals presenting either acutely to Emergency Departments or toaddiction services for support. Benzodiazepines are currently prescribed for GHB/GBLdetoxification but do not prevent all complications such as behavioural disinhibition that mayrequire hospitalisation or admission to a High Dependency/Intensive Care Unit. The GABABreceptor mediates most effects of GHB/GBL and the GABAB agonist, baclofen, has shownpromise as an adjunct to benzodiazepines in reducing withdrawal severity when prescribedboth during withdrawal and as a 2 day ‘pre-load’ prior to detoxification.Methods / DesignThis is a randomised, double-blind, placebo-controlled feasibility study which will recruitparticipants (>18years) who are GHB/GBL dependent and wish to undergo planned GHB/GBLdetoxification or are at risk of acute withdrawal and are inpatients requiring unplannedwithdrawal. We aim to recruit 88 participants, 28 unplanned inpatients and 60 plannedoutpatients.During detoxification we will compare baclofen 10mg three times a day with placebo as anadjunct to usual benzodiazepine regimen. In the planned outpatient arm, we will alsocompare a 2-day preload of baclofen 10mg three times a day with placebo. Ratings ofGHB/GBL withdrawal, sleep, depression, anxiety as well as GHB/GBL use will be collected. Themain data analyses will be descriptive about recruitment and characterizing the
Aimola L, Jasim S, Tripathi N, et al., 2016, Impact of peer-led quality improvement networks on quality of inpatient mental health care: study protocol for a cluster randomized controlled trial, BMC Psychiatry, Vol: 16, ISSN: 1471-244X
BACKGROUND: Quality improvement networks are peer-led programmes in which members of the network assess the quality of care colleagues provide according to agreed standards of practice. These networks aim to help members identify areas of service provision that could be improved and share good practice. Despite the widespread use of peer-led quality improvement networks, there is very little information about their impact. We are conducting a cluster randomized controlled trial of a quality improvement network for low-secure mental health wards to examine the impact of membership on the process and outcomes of care over a 12 month period. METHODS: Standalone low secure units in England and Wales that expressed an interest in joining the quality improvement network were recruited for the study from 2012 to 2014. Thirty-eight units were randomly allocated to either the active intervention (participation in the network n = 18) or a control arm (delayed participation in the network n = 20). Using a 5 % significance level and 90 % power, it was calculated that a sample size of 60 wards was required taking into account a 10 % drop out. A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at follow up. Researchers masked to the allocation status of the units assessed all study outcomes at baseline and follow-up 12 months later. The primary outcome is the quality of the physical environment and facilities on the wards. The secondary outcomes are: safety of the ward, patient-rated satisfaction with care and mental well-being, staff burnout, training and supervision. Relative to control wards, it is hypothesized that the quality of the physical environment and facilities will be higher on wards in the active arm of the trial 12 months after randomization. DISCUSSION: To our knowledge, this is the first randomized evaluation of a peer-led quality improvement network
Pearce S, Scott L, Attwood G, et al., 2016, A randomized controlled trial of democratic therapeutic community treatment for personality disorder., British Journal of Psychiatry, ISSN: 1472-1465
Background: Democratic therapeutic community (DTC) treatment has been used for many years in an effort to help people with personality disorder. High quality evidence from randomized controlled trials is absent.Aims: The aim of this study was to test whether DTC treatment reduces use of inpatient services and improves mental health of people with personality disorder.Method: A randomized controlled trial of 70 subjects meeting DSM-IV criteria for personality disorder. The intervention was DTC and the control condition was crisis planning plus treatment as usual. The primary outcome was days of inpatient psychiatric treatment. Secondary outcomes were social function, mental health status, self-harm and aggression, attendance at emergency departments and primary care, and satisfaction with care. All outcomes were measured at 12 and 24 months after randomization.Results: Among 35 allocated to DTC, 28 (80%) attended at least one treatment session. Number of inpatient days at follow-up was low among all participants and there was no difference between groups. At 24 months, self and other directed aggression and satisfaction with care were significantly improved in those allocated to DTC treatment compared to those receiving TAU. No adverse reactions were detected. Conclusion: DTC is more effective than TAU in improving outcomes in personality disorder. Further studies are required to confirm this conclusion.
Crawford MJ, Thana L, 2016, Cognitive-behavioural toxicity? Reflections from Westminster: Reply, British Journal of Psychiatry, Vol: 209, Pages: 262-262, ISSN: 1472-1465
Sanatinia R, Wang D, Tyrer P, et al., 2016, Impact of personality status on the outcomes and cost of cognitive–behavioural therapy for health anxiety, British Journal of Psychiatry, Vol: 209, Pages: 244-250, ISSN: 1472-1465
BACKGROUND: Health anxiety, hypochondriasis and personality disturbance commonly coexist. The impact of personality status was assessed in a secondary analysis of a randomised controlled trial (RCT). AIMS: To test the impact of personality status using ICD-11 criteria on the clinical and cost outcomes of treatment with cognitive-behavioural therapy for health anxiety (CBT-HA) and standard care over 2 years. METHOD: Personality dysfunction was assessed at baseline in 444 patients before randomisation and independent assessment of costs and outcomes made on four occasions over 2 years. RESULTS: In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no treatment differences (P = 0.90) and worse social function with CBT-HA compared with standard care (P<0.03) whereas all other personality groups showed greater improvement with CBT-HA maintained over 2 years (P<0.001). Less benefit was shown in those with more severe personality disorder (P<0.05). Costs were less with CBT-HA except for non-significant greater differences in those with moderate or severe personality disorder. CONCLUSIONS: The results contradict the hypothesis that personality disorder impairs response to CBT in health anxiety in both the short and medium term.
McMurran M, Crawford MJ, Reilly J, et al., 2016, Psychoeducation with problem-solving (PEPS) therapy for adults with personality disorder: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manualised intervention to improve social functioning, Health Technology Assessment, Vol: 20, ISSN: 1366-5278
BACKGROUND: If effective, less intensive treatments for people with personality disorder have the potential to serve more people. OBJECTIVES: To compare the clinical effectiveness and cost-effectiveness of psychoeducation with problem-solving (PEPS) therapy plus usual treatment against usual treatment alone in improving social problem-solving with adults with personality disorder. DESIGN: Multisite two-arm, parallel-group, pragmatic randomised controlled superiority trial. SETTING: Community mental health services in three NHS trusts in England and Wales. PARTICIPANTS: Community-dwelling adults with any personality disorder recruited from community mental health services. INTERVENTIONS: Up to four individual sessions of psychoeducation, a collaborative dialogue about personality disorder, followed by 12 group sessions of problem-solving therapy to help participants learn a process for solving interpersonal problems. MAIN OUTCOME MEASURES: The primary outcome was measured by the Social Functioning Questionnaire (SFQ). Secondary outcomes were service use (general practitioner records), mood (measured via the Hospital Anxiety and Depression Scale) and client-specified three main problems rated by severity. We studied the mechanism of change using the Social Problem-Solving Inventory. Costs were identified using the Client Service Receipt Inventory and quality of life was identified by the European Quality of Life-5 Dimensions questionnaire. Research assistants blinded to treatment allocation collected follow-up information. RESULTS: There were 739 people referred for the trial and 444 were eligible. More adverse events in the PEPS arm led to a halt to recruitment after 306 people were randomised (90% of planned sample size); 154 participants received PEPS and 152 received usual treatment. The mean age was 38 years and 67% were women. Follow-up at 72 weeks after randomisation was completed for 62% of participants in the usual-treatment arm and 73% in the PEPS arm. Inten
Crawford MJ, Kessel AS, 2016, Not listening to patients - The use and misuse of patient satisfaction studies, INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY, Vol: 45, Pages: 1-6, ISSN: 0020-7640
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- Citations: 25
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.
Rose D, MacDonald D, Wilson A, et al., 2016, Service user led organisations in mental health today, JOURNAL OF MENTAL HEALTH, Vol: 25, Pages: 254-259, ISSN: 0963-8237
Tyrer P, Crawford M, Mulder R, et al., 2016, THE ADVANTAGES OF A SIMPLIFIED CLASSIFICATION OF PERSONALITY DISORDER IN INTERNATIONAL CLASSIFICATION OF DISEASES-11 REVISION, AUSTRALIAN AND NEW ZEALAND JOURNAL OF PSYCHIATRY, Vol: 50, Pages: 5-5, ISSN: 0004-8674
Kim Y-R, Tyrer P, Lee H-S, et al., 2016, Schedule for personality assessment from notes and documents (SPAN-DOC): Preliminary validation, links to the ICD-11 classification of personality disorder, and use in eating disorders, Personality and Mental Health, Vol: 10, Pages: 106-117, ISSN: 1932-8621
Background: The underlying core of personality is insufficiently assessed by any single instrument. This has led to the development of instruments adapted for written records in the assessment of personality disorder.Aims: To test the construct validity and inter-rater reliability of a new personality assessment method.Method: This study (four parts) assessed the construct validity of the Schedule for Personality Assessment from Notes and Documents (SPAN-DOC), a dimensional assessment from clinical records. We examined inter-rater reliability using case vignettes (Part 1) and convergent validity in three ways: by comparison with NEO Five-Factor Inventory in 130 Korean patients (Part 2), with agreed ICD-11 personality severity levels in two populations (Part 3) and determining its use in assessing the personality status in 90 British patients with eating disorders (Part 4).Results: Internal consistency (alpha = .90) and inter-rater reliability (intraclass correlation coefficient ≥ .88) were satisfactory. Each factor in the five-factor model of personality was correlated with conceptually valid SPAN-DOC variables. The SPAN-DOC domain traits in those with eating disorders were categorized into 3 clusters: self-aggrandisement, emotionally unstable, and anxious/dependent.Conclusions: This study provides preliminary support for the usefulness of SPAN-DOC in the assessment of personality disorder.
Tyrer PJ, Wang D, Tyrer H, et al., 2016, Dimensions of dependence and their influence on the outcome of cognitive behaviour therapy for health anxiety: randomised controlled trial, Personality and Mental Health, Vol: 10, Pages: 95-105, ISSN: 1932-863X
Background: The personality trait of dependence is somewhat difference from many others in that it is often regarded as adaptive and, when maladaptive, is of less pathological significance than many other traits. There is also some evidence that it may be a positive trait in health seeking behaviour. We therefore examined its impact in a large randomised controlled trial of psychological treatment for health anxiety. Aims: To test whether dependent personality traits were positive or negative in determining the outcome of an adapted form of cognitive behaviour therapy for health anxiety (CBT-HA) over their otv ce erh the hypotheses that personality dysfunction recorded using the new ICD-11 diagnostic system had a negative influence on the outcomes of treatment with cognitive behaviour therapy for health anxiety over 2 years and that personality dysfunction would be associated with increased cost. Method: Personality dysfunction was assessed at baseline in a randomised controlled trial of 444 patients from medical clinics with pathological health anxiety treated with a modified form of cognitive behaviour therapy for health anxiety (CBT-HA) or standard treatment in the medical clinics, with assessment on four occasions over 2 years. Personality dysfunction was assessed at baseline using a procedure that led to five ICD-11 proposed groups (0 = no personality dysfunction, 1 = personality difficulty, 2 = mild personality disorder, 3 = moderate personality disorder, 4 = severe personality disorder). The statistical analysis used a mixed model with the primary outcome as change in health anxiety scores after one year. Total costs over follow-up were calculated from service use and hospital data and compared by personality group. Results: In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no difference in health anxiety response to CBT compared with
Sheehan R, Gandesha A, Hassiotis A, et al., 2016, An audit of the quality of inpatient care for adults with learning disability in the UK, BMJ Open, Vol: 6, ISSN: 2044-6055
OBJECTIVES: To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver. SETTING: Nine acute general hospital Trusts and six mental health services. PARTICIPANTS: Adults with learning disability who received inpatient hospital care between May 2013 and April 2014. PRIMARY AND SECONDARY OUTCOME MEASURES: Data on seven key indicators of high-quality care were collected from 176 patients. These covered physical health/monitoring, communication and meeting needs, capacity and decision-making, discharge planning and carer involvement. The impact of services having an electronic system for flagging patients with learning disability and employing a learning disability liaison nurse was assessed. RESULTS: Indicators of physical healthcare (body mass index, swallowing assessment, epilepsy risk assessment) were poorly recorded in acute general and mental health inpatient settings. Overall, only 34 (19.3%) patients received any assessment of swallowing and 12 of the 57 with epilepsy (21.1%) had an epilepsy risk assessment. For most quality indicators, there was a non-statistically significant trend for improved performance in services with a learning disability liaison nurse. The presence of an electronic flagging system showed less evidence of benefit. CONCLUSIONS: Inpatient care for people with learning disability needs to be improved. The work gives tentative support to the role of a learning disability liaison nurse in acute general and mental health services, but further work is needed to confirm these benefits and to trial other interventions that might improve the quality and safety of care for this high-need group.
Barnes TR, Leeson VC, Paton C, et al., 2016, Antidepressant Controlled Trial For Negative Symptoms In Schizophrenia (ACTIONS): a double-blind, placebo-controlled, randomised clinical trial, Health Technology Assessment, Vol: 20, ISSN: 1366-5278
BACKGROUND: Negative symptoms of schizophrenia represent deficiencies in emotional responsiveness, motivation, socialisation, speech and movement. When persistent, they are held to account for much of the poor functional outcomes associated with schizophrenia. There are currently no approved pharmacological treatments. While the available evidence suggests that a combination of antipsychotic and antidepressant medication may be effective in treating negative symptoms, it is too limited to allow any firm conclusions. OBJECTIVE: To establish the clinical effectiveness and cost-effectiveness of augmentation of antipsychotic medication with the antidepressant citalopram for the management of negative symptoms in schizophrenia. DESIGN: A multicentre, double-blind, individually randomised, placebo-controlled trial with 12-month follow-up. SETTING: Adult psychiatric services, treating people with schizophrenia. PARTICIPANTS: Inpatients or outpatients with schizophrenia, on continuing, stable antipsychotic medication, with persistent negative symptoms at a criterion level of severity. INTERVENTIONS: Eligible participants were randomised 1 : 1 to treatment with either placebo (one capsule) or 20 mg of citalopram per day for 48 weeks, with the clinical option at 4 weeks to increase the daily dosage to 40 mg of citalopram or two placebo capsules for the remainder of the study. MAIN OUTCOME MEASURES: The primary outcomes were quality of life measured at 12 and 48 weeks assessed using the Heinrich's Quality of Life Scale, and negative symptoms at 12 weeks measured on the negative symptom subscale of the Positive and Negative Syndrome Scale. RESULTS: No therapeutic benefit in terms of improvement in quality of life or negative symptoms was detected for citalopram over 12 weeks or at 48 weeks, but secondary analysis suggested modest improvement in the negative symptom domain, avolition/amotivation, at 12 weeks (mean difference -1.3, 95% confidence inter
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.
Aimola L, Jasim S, Tripathi N, et al., 2016, Quality of low secure services in the UK: development and use of the Quality of Environment In Low Secure Services (QELS) checklist, Journal of Forensic Psychiatry & Psychology, Vol: 27, Pages: 504-516, ISSN: 1478-9957
Low secure services provide care for psychiatric patients whose risk cannot be safely managed in other settings. The physical environment in these units plays an important role in supporting recovery and risk management. We developed the Quality of Environment in Low secure Services (QELS) checklist to assess the quality of the physical environment of these services. Using recommendations from previously published standards we piloted a draft checklist with a weighted scoring system reflecting the views of patients and providers. The checklist showed good criterion validity and inter-rater reliability. Data collected from 33 low secure services showed considerable variation in the quality of the physical environment. The QELS checklist provides an accessible and reliable means for managers and clinicians to assess whether the quality of the physical environment of low secure units meets recommended standards and can be used to support efforts to improve the quality of care delivered by these services.
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