27 results found
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
Sanatinia R, Crawford MJ, Quirk A, et al., 2020, Identifying features associated with higher-quality hospital care and shorter length of admission for people with dementia: a mixed-methods study, Health Services and Delivery Research, Vol: 8, Pages: 1-92, ISSN: 2050-4349
<jats:sec id="abs1-1"> <jats:title>Background</jats:title> <jats:p>Concerns have repeatedly been expressed about the quality of inpatient care that people with dementia receive. Policies and practices have been introduced that aim to improve this, but their impact is unclear.</jats:p> </jats:sec> <jats:sec id="abs1-2"> <jats:title>Aims</jats:title> <jats:p>To identify which aspects of the organisation and delivery of acute inpatient services for people with dementia are associated with higher-quality care and shorter length of stay.</jats:p> </jats:sec> <jats:sec id="abs1-3"> <jats:title>Design</jats:title> <jats:p>Mixed-methods study combining a secondary analysis of data from the third National Audit of Dementia (2016/17) and a nested qualitative exploration of the context, mechanism and outcomes of acute care for people with dementia.</jats:p> </jats:sec> <jats:sec id="abs1-4"> <jats:title>Setting</jats:title> <jats:p>Quantitative data from 200 general hospitals in England and Wales and qualitative data from six general hospitals in England that were purposively selected based on their performance in the audit.</jats:p> </jats:sec> <jats:sec id="abs1-5"> <jats:title>Participants</jats:title> <jats:p>Quantitative data from clinical records of 10,106 people with dementia who had an admission to hospital lasting ≥ 72 hours and 4688 carers who took part in a cross-sectional survey of carer experience. Qualitative data from interviews with 56 hospital staff and seven
Crawford MJ, Thana L, Parker J, et al., 2020, Structured Psychological Support for people with personality disorder: feasibility randomised controlled trial of a low-intensity intervention, BJPsych Open, Vol: 6, ISSN: 2056-4724
BackgroundNational guidance cautions against low-intensity interventions for people with personality disorder, but evidence from trials is lacking.AimsTo test the feasibility of conducting a randomised trial of a low-intensity intervention for people with personality disorder.MethodSingle-blind, feasibility trial (trial registration: ISRCTN14994755). We recruited people aged 18 or over with a clinical diagnosis of personality disorder from mental health services, excluding those with a coexisting organic or psychotic mental disorder. We randomly allocated participants via a remote system on a 1:1 ratio to six to ten sessions of Structured Psychological Support (SPS) or to treatment as usual. We assessed social functioning, mental health, health-related quality of life, satisfaction with care and resource use and costs at baseline and 24 weeks after randomisation.ResultsA total of 63 participants were randomly assigned to either SPS (n = 33) or treatment as usual (n = 30). Twenty-nine (88%) of those in the active arm of the trial received one or more session (median 7). Among 46 (73%) who were followed up at 24 weeks, social dysfunction was lower (−6.3, 95% CI −12.0 to −0.6, P = 0.03) and satisfaction with care was higher (6.5, 95% CI 2.5 to 10.4; P = 0.002) in those allocated to SPS. Statistically significant differences were not found in other outcomes. The cost of the intervention was low and total costs over 24 weeks were similar in both groups.ConclusionsSPS may provide an effective low-intensity intervention for people with personality disorder and should be tested in fully powered clinical trials.
Lei H, Barnicot K, Maynard E, et al., 2019, Factors influencing use of community treatment orders and quality of care that people receive: results of a national survey in England and Wales, BJPsych Bulletin, Vol: 43, Pages: 227-235, ISSN: 2056-4694
Aims and method: We conducted a secondary analysis of data from the National Audit of Psychosis to identify factors associated with use of community treatment orders (CTOs) and assess the quality of care that people on CTOs receive.Results: Between 1.1 and 20.2% of patients in each trust were being treated on a CTO. Male gender, younger age, greater use of in-patient services, coexisting substance misuse and problems with cognition predicted use of CTOs. Patients on CTOs were more likely to be screened for physical health, have a current care plan, be given contact details for crisis support, and be offered cognitive-behavioural therapy.Clinical implications: CTOs appear to be used as a framework for delivering higher-quality care to people with more complex needs. High levels of variation in the use of CTOs indicate a need for better evidence about the effects of this approach to patient care.Declaration of interest: None.
Sanatinia R, Afzal S, MacLaren T, et al., 2019, Improved mental health among LABILE study participants: a qualitative exploration, Personality and Mental Health, Vol: 13, Pages: 75-83, ISSN: 1932-8621
Results of the LABILE trial showed no difference between people with borderline personality disorder who were prescribed lamotrigine,and those on placebo. However, most study participants experienced sustained improvement in their mental health during the trial.We conducted a thematic analysis of qualitative data from interviews with 47 LABILE study participants to identify factors that may have contributedto this improvement.We identified three main themes: initial reasons and expectations regarding trial participation,patients’experiencesof the trial,and areas of change.Reasons for participating in the trial included a searchfor consistent and stable professional careas well as altruistic motives. Improvements in symptoms over the course of the trial were explained by severalfactors including consistency provided by the research team, salience of the social context,and theavailability of alternative support networks.Whilst participants appreciated the autonomy provided by the voluntary nature of the trial, they felt that improvements stemmedfromthe ‘structure’ brought about by their actively engaging in the study. 2Thisstudy highlights the importance of clear, and transparent communication when treating people with borderline personality disorder. Mental health professionals should ensurethat services for people with borderline personality disorder areconsistentand structured.
Crawford MJ, Sanatinia R, Tan W, 2018, No effect of lamotrigine in subgroups of patients with Borderline Personality Disorder: Response to Smith, American Journal of Psychiatry, Vol: 175, Pages: 1265-1266, ISSN: 0002-953X
Crawford MJ, Thana L, Parker J, et al., 2018, Psychological Support for Personality (PSP) versus treatment as usual: study protocol for a feasibility randomized controlled trial of a low intensity intervention for people with personality disorder, Trials, Vol: 19, ISSN: 1745-6215
BackgroundPrevious research has demonstrated the clinical effectiveness of long-term psychological treatment for people with some types of personality disorder. However, the high intensity and cost of these interventions limit their availability. Lower-intensity interventions are increasingly being offered to people with personality disorder, but their clinical and cost effectiveness have not been properly tested in experimental studies. We therefore set out to develop a low intensity intervention for people with personality disorder and to test the feasibility of conducting a randomized controlled trial to compare the clinical effectiveness of this intervention with that of treatment as usual (TAU).MethodsA two-arm, parallel-group, single-blind, randomized controlled trial of Psychological Support for Personality (PSP) versus TAU for people aged over 18 years, who are using secondary care mental health services and have personality disorder. We will exclude people with co-existing organic or psychotic mental disorders (dementia, bipolar affective disorder, delusional disorder, schizophrenia, schizoaffective disorder, or schizotypal disorder), those with cognitive or language difficulties that would preclude them from providing informed consent or compromise participation in study procedures, and those who are already receiving psychological treatment for personality disorder. Participants will be randomized via a remote system in a ratio of PSP to TAU of 1:1. Randomization will be stratified according to the referring team and gender of the participant.A single follow-up assessment will be conducted by masked researchers 24 weeks after randomization to assess mental health (using the Warwick and Edinburgh Well-Being Schedule), social functioning (using the Work and Social Adjustment Scale), health-related quality of life (EQ-5D-5 L), incidence of suicidal behavior, satisfaction with care (Client Satisfaction Questionnaire), and resource use and costs using a modifi
Crawford MJ, Sanatinia R, Barrett B, et al., 2018, The clinical effectiveness and cost effectiveness of lamotrigine for people with borderline personality disorder: a randomized, placebo-controlled trial, American Journal of Psychiatry, Vol: 175, Pages: 756-764, ISSN: 0002-953X
Objectives:To examine whether lamotrigine is a clinically effective and cost-effective treatment for people with borderline personality disorder. Method:Multicentre, double-blind, placebo-controlled randomized trial. Between July 2013 to November 2016, we recruited 276 people aged 18 or over, who met diagnostic criteria for borderline personality disorder. We excluded those with co-existing bipolar affective disorder or psychosis, those already taking a mood stabiliser, and women at risk of pregnancy. We randomly allocated participants on a 1:1 ratio to up to 400mg of lamotrigine per day or an inert placebo using a remote web-based randomization service. The primary outcome was total score on the Zanarini Rating scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. Secondary outcomes included depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment and adverse events. Results:195 (70.6%) participants were followed up at 52 weeks, at which point 49 (36%) of those prescribed lamotrigine and 58 (42%) of those prescribed placebo were taking it. Mean total ZAN-BPD score was 11.3 (SD = 6.6) among those randomized to lamotrigine and 11.5 (SD = 7.7) among those randomized to placebo (adjusted difference in means = 0.1, 95% C.I = -1.8 to 2.0, p=0.91). There was no evidence of any differences in secondary outcomes. Costs of direct care for those prescribed lamotrigine were similar to those prescribed placebo. Conclusions:Treating people with borderline personality disorder with lamotrigine is not a clinically effective or cost-effective use of resources.
Crawford MJ, Sanatinia R, Barrett B, et al., 2018, Lamotrigine for people with borderline personality disorder: a RCT, HEALTH TECHNOLOGY ASSESSMENT, Vol: 22, Pages: 1-+, ISSN: 1366-5278
Background:No drug treatments are currently licensed for the treatment of borderline personality disorder (BPD). Despite this, people with this condition are frequently prescribed psychotropic medications and often with considerable polypharmacy. Preliminary studies have indicated that mood stabilisers may be of benefit to people with BPD.Objective:To examine the clinical effectiveness and cost-effectiveness of lamotrigine for people with BPD.Design:A two-arm, double-blind, placebo-controlled individually randomised trial of lamotrigine versus placebo. Participants were randomised via an independent and remote web-based service using permuted blocks and stratified by study centre, the severity of personality disorder and the extent of hypomanic symptoms.Setting:Secondary care NHS mental health services in six centres in England.Participants:Potential participants had to be aged ≥ 18 years, meet diagnostic criteria for BPD and provide written informed consent. We excluded people with coexisting psychosis or bipolar affective disorder, those already taking a mood stabiliser, those who spoke insufficient English to complete the baseline assessment and women who were pregnant or contemplating becoming pregnant.Interventions:Up to 200 mg of lamotrigine per day or an inert placebo. Women taking combined oral contraceptives were prescribed up to 400 mg of trial medication per day.Main outcome measures:Outcomes were assessed at 12, 24 and 52 weeks after randomisation. The primary outcome was the total score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. The secondary outcomes were depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment and adverse events. Higher scores on all measures indicate poorer outcomes.Results:Between July 2013 and October 2015 we randomised 276 participants, of whom 195 (70.6%) were followed up 52
Tyrer P, Salkovskis P, Tyrer H, et al., 2017, Cognitive behaviour therapy for health anxiety in medical patients (CHAMP): randomised trial with outcomes to five years, Health Technology Assessment, Vol: 21, ISSN: 1366-5278
Background: Health anxiety is an under-recognised but frequent cause of distress that is potentially treatable but there are few studies in secondary care. Objective: To determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive-behaviour therapy (CBT-HA) for health anxiety compared with standard care in medical outpatients Design: Randomised controlled trialSetting: Five general hospitals in London, Middlesex and Nottinghamshire Participants:444 patients aged 16-75 seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored 20 or more on the Health Anxiety Inventory (HAI), and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded but those concurrent medical illnesses were not. Interventions:Cognitive behaviour therapy for health anxiety (CBT-HA): 4-10 one-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care. Main outcome measures: Primary: Researchers masked to allocation assessed patients at baseline, 3m, 6m, 12m, 24m and 5 years. The primary outcome was change in HAI score between baseline and 12 months. Main secondary outcome: Costs of care in the two groups after 24 months and 60 months, change in health anxiety (HAI), generalised anxiety and depression (Hospital Anxiety and Depression (HADS-A and HADS-D) scores, social functioning using the Social Functioning Questionnaire (SFQ), and quality of life using the Euroqol (EQ-5D), at 6, 12, 24 and 60 months, deaths over 5 years. Results: Of 28,991 patients screened over 21m, 5769 had HAI scores of 20 or above. CBT-HA patients (mean sessions 6) had significantly greater improvement in HAI scores than those in standard care at 3m and this was maintained over the five-year period (overall P<0.0001), with no loss of efficacy between 2 and 5 years. Generalised anxiety
Ntouva A, Sanatinia R, Watt RG, 2016, Evaluation of an alcohol screening and brief advice training programme for NHS general dental practitioners., Eur J Dent Educ
INTRODUCTION: Primary care dentists are in a unique position to screen for alcohol misuse and provide brief advice to patients; however, lack of knowledge and confidence are some of the barriers cited for their reluctance to do so. AIMS: This study describes the evaluation of a novel brief alcohol advice training programme specifically designed and tailored to the needs of NHS general dental practitioners. MATERIALS AND METHODS: The training programme was developed as part of a feasibility trial and included a mixture of theoretical and practical elements. During 8 h of highly interactive sessions, participants took part in role-plays, including scenarios of patients of varying age groups, oral health status, dental attendance and different levels of motivation. Training manuals and other resources were also given. Knowledge, attitudes and confidence scores were assessed before and after the sessions. Wilcoxon matched-pairs signed-ranks and McNemar's tests were used to compare participants' performance before and after the completion of the programme. RESULTS: Significant positive changes were observed in all training objectives. There was an overall improvement of 23% in levels of knowledge, a 40% increase in positive attitudes towards alcohol screening and intervention and 80% increase in confidence scores. Fidelity assessments of the implementation of the intervention in the trial showed that dentists who completed the training successfully went on to screen for alcohol misuse and provide brief advice to patients. CONCLUSION: NHS dentists can be successfully trained with the relevant knowledge, attitudes and confidence needed to deliver alcohol screening and brief advice to patients.
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.
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.
Sanatinia R, Middleton SM, Lin T, et al., 2015, Quality of physical health care among patients with personality disorder, PERSONALITY AND MENTAL HEALTH, Vol: 9, Pages: 319-329, ISSN: 1932-8621
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
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
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.
Crawford MJ, Sanatinia R, Barrett B, et al., 2014, The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR), HEALTH TECHNOLOGY ASSESSMENT, Vol: 18, Pages: 1-+, ISSN: 1366-5278
Crawford MJ, Parry AMH, Weston ARW, et al., 2012, Relationship Between Price Paid for Off-Trade Alcohol, Alcohol Consumption and Income in England: A Cross-Sectional Survey, ALCOHOL AND ALCOHOLISM, Vol: 47, Pages: 738-742, ISSN: 0735-0414
Sanatinia R, Barrett B, Byford S, et al., 2012, Brief intervention for alcohol misuse in people attending sexual health clinics: study protocol for a randomized controlled trial, TRIALS, Vol: 13, ISSN: 1745-6215
Sanatinia R; Barrett B; Byford S; Dean M; Green J; Jones R; Leurent B; Lingford-Hughes A; et alSweeting M; Touquet R; Tyrer P; Ward H; Crawford MJ, 2012, Brief intervention for alcohol misuse in people attending sexual health clinics: study protocol for a randomized controlled trial, Trials, Vol: 13
Crawford MJ; Parry AM; Weston AR; Seretis D; Zauter-Tutt M; Hussain A; Mostajabi P; Sanatinia R; North B, 2012, Relationship Between Price Paid for Off-Trade Alcohol, Alcohol Consumption and Income in England: A Cross-Sectional Survey, Alcohol Alcohol
Sanatinia, 2012, Brief intervention for alcohol misuse in people attending sexual health clinics: study protocol for a randomized controlled trial.
Tyrer P, Cooper S, Crawford M, et al., 2011, Prevalence of health anxiety problems in medical clinics, JOURNAL OF PSYCHOSOMATIC RESEARCH, Vol: 71, Pages: 392-394, ISSN: 0022-3999
Tyrer P; Cooper S; Crawford M; Dupont S; Green J; Murphy D; Salkovskis P; Smith G; et alWang D; Bhogal S; Keeling M; Loebenberg G; Seivewright R; Walker G; Cooper F; Evered R; Kings S; Kramo K; McNulty A; Nagar J; Reid S; Sanatinia R; Sinclair J; Trevor D; Watson C; Tyrer H, 2011, Prevalence of health anxiety problems in medical clinics, J Psychosom Res, Vol: 71, Pages: 392-394
Nejad AG, Sanatinia RZ, Yousofi K, 2004, Dream Contents in Patients With Major Depressive Disorder, CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE, Vol: 49, Pages: 866-867, ISSN: 0706-7437
Nejad AG, Sanatinia RZ, Yousofi K, 2004, Dream contents in patients with major depressive disorder., Can J Psychiatry, Vol: 49, Pages: 864-865, ISSN: 0706-7437
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