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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.
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.
Tyrer P, 2017, Comorbidity, consanguinity and co-occurrence, BJPsych Advances, Vol: 23, Pages: 167-168, ISSN: 2056-4678
<jats:title>Summary</jats:title><jats:p>The adjective ‘comorbid’, and its fellow noun ‘comorbidity’, are used repeatedly in psychiatric practice, but we frequently use them sloppily and ignore what they really mean. Here, I briefly define comorbidity of disorders, and suggest the alternative categories of consanguinity and co-occurrence.</jats:p>
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.
Tyrer P, Tyrer H, Morris R, et al., Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: multicentre, randomised controlled trial.Tyrer P, Tyrer H, Morriss R, Crawford M, Cooper S, Yang M, Guo B, Mulder R, Kemp S & Barrett B., Open Heart, ISSN: 2053-3624
Tyrer P, Tarabi SA, Bassett P, et al., 2017, Nidotherapy compared with enhanced care programme approach training for adults with aggressive challenging behaviour and intellectual disability (NIDABID): cluster-randomised controlled trial, Journal of Intellectual Disability Research, Vol: 61, Pages: 521-531, ISSN: 0964-2633
Background: Aggressive challenging behaviour is very common in care homes for people with intellectual disability, and better psychological treatments are needed. Nidotherapy aims to change the environment of people with mental illness and is an appropriate treatment for this group of disorders.Method: The design was a cluster randomised trial of 20 care homes in which the staff either received training in nidotherapy or the enhanced care programme approach (ECPA), with equivalent duration of treatment in each arm. Cluster randomisation of care homes was carried out at the beginning of the study by an independent statistician. Primary and secondary outcomes were not specified exactly in view of absence of previous study data, but changes over time in scores on two scales, the Modified Overt Aggression Scale and the Problem Behaviour Check List were the main outcome measures. Serious violent incidents were recorded using the Quantification of Violence Scale. All these measures were recorded monthly by research assistants who were carefully kept blind to the allocation of treatment.Results: A total of 200 residents entered the trial, 115 allocated to the ECPA arm and 85 to the nidotherapy one. Seven residents left the care homes in the course of the study, and six were replaced; these were included 79 in the analysis as the trial was a pragmatic one. There were no material reductions in challenging behaviour in the first 8 months of the trial in either group, but in the last 7 months, those allocated to nidotherapy had a 33% reduction in Modified Overt Aggression Scale (MOAS) scores and a 43% reduction in Problem Behaviour Check List scores compared with 5% and 13%, respectively, for the ECPA group, differences which for the MOAS were close to statistical significance.Discussion: Nidotherapy shows promise in the management of aggressive challenging behaviour in care homes, but a delay in its benefit might be expected if given to staff only. The treatment is worthy of
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.
Tyrer P, Tyrer H, Guo B, 2016, The general neurotic syndrome: a re-evaluation, Psychotherapy and Psychosomatics, ISSN: 1423-0348
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
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
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.
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.
Tyrer PJ, Nagar J, Evans R, et al., 2016, The Problem Behaviour Check List: a short scale to assess challengingbehaviours, BJPsych Open, Vol: 2, Pages: 45-49, ISSN: 2056-4724
Background: Challenging behaviour, especially in intellectual disability, covers a wide range that is in need of furtherevaluation.Aim: To develop a short but comprehensive instrument for all aspects of challenging behaviour. Method: In the first part of a two-stage enquiry, a 28 item scale was constructed to examine the components ofchallenging behaviour. Following a simple factor analysis this was developed further to create a new short scale, theProblem Behaviour Check List (PBCL). The scale was subsequently used in a randomised controlled trial and testedfor inter-rater reliability. Scores were also compared with a standard scale, the Modified Overt Aggression Scale(MOAS).Results: Seven identified factors - personal violence, violence against property, self-harm, sexually inappropriate,contrary, demanding and disappearing behaviour – were scored on a five point scale. A subsequent factor analysiswith the second population showed demanding, violent and contrary behaviour to account for most of the variance.Inter-rater reliability using weighted kappa showed good agreement (0.91; 95% CI 0.83-0.99). Good agreement wasalso shown with scores on the MOAS scale and a score of 1 on the PBCL showed high sensitivity (97%) and specificity(85%) for a threshold MOAS score of 4.Conclusions: The PBCL appears to be a suitable and practical scale for assessing all aspects of challenging behaviour.
Tyrer PJ, Tyrer H, Cooper S, et al., 2015, Cognitive behaviour therapy for non-cardiac pain in the chest (COPIC): a multicentre randomized controlled trial with economic evaluation, BMC Psychology, Vol: 3, ISSN: 2050-7283
BackgroundMost patients with chest pain have nothing wrong with their cardiac function. Psychological forms of treatment for this condition are more likely to be successful than others.Methods/designA two-arm parallel controlled randomized trial of standard care versus a modified form of cognitive behaviour therapy for chest pain (CBT-CP) in patients who have attended emergency hospital services. Inclusion criteria include (i) emergency attendance more than once in the previous year with chest pain when no physical pathology has been found, (ii) aged between 16 and 75, (iii) signed consent to take part in the study. Exclusion criteria are (i) under current psychiatric care, (ii) those who have had new psychotropic drugs prescribed within the last two months, (iii) are receiving or about to receive a formal psychological treatment. Those satisfying these criteria will be randomized to 4–10 sessions of CBT-CP or to continue with standard care.Participants are randomized using a remote web-based system using permuted stacked blocks stratified by study centre. Assessment is carried out at baseline by researchers subsequently masked to allocation and at 6 months and 1 year after randomization. The primary outcome is the Health Anxiety Inventory score at 6 months, and secondary outcomes are generalised anxiety and depressive symptoms, the Lucock Health Anxiety Questionnaire adapted for chest pain, visual analogue scales for chest pain and discomfort (Inskip Scale), the Schedule for Evaluating Persistent Symptoms (SEPS), health related quality of life, social functioning and medical resource usage. Intention to treat analyses will be carried out with clinical and functioning data, and a cost-utility analysis will compare differences in total costs and differences in quality of life using QALYs derived from the EQ-5D. The data will also be linked to another parallel study in New Zealand where 126 patients with the same inclusion criteria have been treated in a similar
Kim Y-R, Tyrer P, Lee H-S, et al., 2015, Preliminary field trial of a putative research algorithm for diagnosing ICD-11 personality disorders in psychiatric patients: 2. Proposed trait domains, Personality and Mental Health, Vol: 9, Pages: 298-307, ISSN: 1932-8621
Tyrer P, Tyrer H, 2015, Nidotherapy: The expansion of environmental treatment, Australian and New Zealand Journal of Psychiatry, Vol: 49, Pages: 934-934, ISSN: 1440-1614
Crawford MJ, Sanatinia R, Barrett B, et al., 2015, Lamotrigine versus inert placebo in the treatment of borderline personality disorder: study protocol for a randomized controlled trial and economic evaluation, TRIALS, Vol: 16, ISSN: 1745-6215
Newton-Howes G, Mulder R, Tyrer P, 2015, Diagnostic neglect: the potential impact of losing a separate axis for personality disorder, BRITISH JOURNAL OF PSYCHIATRY, Vol: 206, Pages: 355-356, ISSN: 0007-1250
Tyrer P, Duggan C, Cooper S, et al., 2015, The lessons and legacy of the programme for dangerous and severe personality disorders, PERSONALITY AND MENTAL HEALTH, Vol: 9, Pages: 96-106, ISSN: 1932-8621
Tyrer H, Tyrer P, Lisseman-Stones Y, et al., 2015, Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients, INTERNATIONAL JOURNAL OF NURSING STUDIES, Vol: 52, Pages: 686-694, ISSN: 0020-7489
Tyrer P, Reed GM, Crawford MJ, 2015, Classification, assessment, prevalence, and effect of personality disorder, LANCET, Vol: 385, Pages: 717-726, ISSN: 0140-6736
Tyrer P, 2015, Personality dysfunction is the cause of recurrent non-cognitive mental disorder: A testable hypothesis, Personality and Mental Health, Vol: 9, Pages: 1-7, ISSN: 1932-8621
Tyrer P, Oliver P, Tarabi SA, 2014, Prevalence of aggressive challenging behaviours in intellectual disability and its relationship to personality status: Jamaican study, JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Vol: 58, Pages: 1083-1089, ISSN: 0964-2633
Tyrer P, Crawford M, Sanatinia R, et al., 2014, Preliminary studies of the ICD-11 classification of personality disorder in practice, PERSONALITY AND MENTAL HEALTH, Vol: 8, Pages: 254-263, ISSN: 1932-8621
Newton-Howes G, Tyrer P, Johnson T, et al., 2014, INFLUENCE OF PERSONALITY ON THE OUTCOME OF TREATMENT IN DEPRESSION: SYSTEMATIC REVIEW AND META-ANALYSIS, JOURNAL OF PERSONALITY DISORDERS, Vol: 28, Pages: 577-593, ISSN: 0885-579X
Tyrer P, Cooper S-A, Hassiotis A, 2014, Drug treatments in people with intellectual disability and challenging behaviour., BMJ, Vol: 349
Crawford MJ, Sanatinia R, Barrett B, et al., 2014, The clinical and cost-effectiveness of brief advice for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial, Sexually Transmitted Infections, Vol: 91, Pages: 37-43, ISSN: 1472-3263
Objectives To examine the clinical and costeffectivenessof brief advice for excessive alcoholconsumption among people who attend sexual healthclinics.Methods Two-arm, parallel group, assessor blind,pragmatic, randomised controlled trial. 802 people aged19 years or over who attended one of three sexualhealth clinics and were drinking excessively wererandomised to either brief advice or control treatment.Brief advice consisted of feedback on alcohol and health,written information and an offer of an appointment withan Alcohol Health Worker. Control participants receiveda leaflet on health and lifestyle. The primary outcomewas mean weekly alcohol consumption during theprevious 90 days measured 6 months afterrandomisation. The main secondary outcome wasunprotected sex during this period.Results Among the 402 randomised to brief advice,397 (99%) received it. The adjusted mean difference inalcohol consumption at 6 months was −2.33 units perweek (95% CI −4.69 to 0.03, p=0.053) among thosein the active compared to the control arm of the trial.Unprotected sex was reported by 154 (53%) of thosewho received brief advice, and 178 (59%) controls(adjusted OR=0.89, 95% CI 0.63 to 1.25, p=0.496).There were no significant differences in costs betweenstudy groups at 6 months.Conclusions Introduction of universal screening andbrief advice for excessive alcohol use among peopleattending sexual health clinics does not result inclinically important reductions in alcohol consumption orprovide a cost-effective use of resources.
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