Assertive Community Outreach – Randomised Evaluation

Randomised evaluation of assertive community treatment: 3-year outcomes, The British Journal of Psychiatry (2009) 195: 81-82.

Helen Killaspy, PhD, MRCPsych

Department of Mental Health Sciences, University College London (UCL) Medical School, Hampstead Campus and Camden and Islington NHS Foundation Trust, London

Stella Kingett, MRCPsych

Camden and Islington NHS Foundation Trust, London

Paul Bebbington, PhD, FRCP, FRCPsych

Department of Mental Health Sciences, UCL Medical School, Bloomsbury Campus and Camden and Islington NHS Foundation Trust, London

Robert Blizard, BSc, MSc, FRSS

Department of Mental Health Sciences, UCL Medical School, Hampstead Campus, London

Sonia Johnson, DM, MRCPsych

Department of Mental Health Sciences, UCL Medical School, Bloomsbury Campus and Camden and Islington NHS Foundation Trust, London

Fiona Nolan, BSc and Stephen Pilling, BSc, MSc PhD

Centre for Outcomes Research and Effectiveness, UCL, Torrington Place, London

Michael King, PhD, FRCP, FRCGP, FRCPsych

Department of Mental Health Sciences, University College London (UCL) Medical School, Hampstead Campus and Camden and Islington NHS Foundation Trust, London, UK

Abstract:

The only randomised controlled trial to test high-fidelity assertive community treatment (ACT) in the UK (the Randomised Evaluation of Assertive Community Treatment (REACT) study) found no advantage over usual care from community mental health teams in reducing the need for in-patient care and in other clinical outcomes, but participants found ACT more acceptable and engaged better with it. One possible reason for the lack of efficacy of ACT might be the short period of follow-up (18 months in the REACT study). This paper reports on participants’ service contact, in-patient service use and adverse events 36 months after randomisation.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

DSM–IV personality disorders in the WHO World Mental Health Surveys

DSM–IV personality disorders in the WHO World Mental Health Surveys , The British Journal of Psychiatry (2009) 195: 46-53

Abstract:

Background

Little is known about the cross-national population prevalence or correlates of personality disorders.

Aims

To estimate prevalence and correlates of DSM–IV personality disorder clusters in the World Health Organization World Mental Health (WMH) Surveys.

Method

International Personality Disorder Examination (IPDE) screening questions in 13 countries (n = 21 162) were calibrated to masked IPDE clinical diagnoses. Prevalence and correlates were estimated using multiple imputation.

Results

Prevalence estimates are 6.1% (s.e. = 0.3) for any personality disorder and 3.6% (s.e. = 0.3), 1.5% (s.e. = 0.1) and 2.7% (s.e. = 0.2) for Clusters A, B and C respectively. Personality disorders are significantly elevated among males, the previously married (Cluster C), unemployed (Cluster C), the young (Clusters A and B) and the poorly educated. Personality disorders are highly comorbid with Axis I disorders. Impairments associated with personality disorders are only partially explained by comorbidity.

Conclusions

Personality disorders are relatively common disorders that often co-occur with Axis I disorders and are associated with significant role impairments beyond those due to comorbidity.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Autism – Prenatal risk factors for autism: comprehensive meta-analysis

Prenatal risk factors for autism: comprehensive meta-analysis, The British Journal of Psychiatry (2009) 195: 7-14

Hannah Gardener, ScD

Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts

Donna Spiegelman, ScD

Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Boston, Massachusetts

Stephen L. Buka, ScD

Department of Community Health, Brown University, Providence, Rhode Island, USA

Correspondence: Hannah Gardener, Department of Neurology, University of Miami Miller School of Medicine

Abstract:

Background

The aetiology of autism is unknown, although prenatal exposures have been the focus of epidemiological research for over 40 years.

Aims

To provide the first quantitative review and meta-analysis of the association between maternal pregnancy complications and pregnancy-related factors and risk of autism.

Method

PubMed, Embase and PsycINFO databases were searched for epidemiological studies that examined the association between pregnancy-related factors and autism. Forty studies were eligible for inclusion in the meta-analysis. Summary effect estimates were calculated for factors examined in multiple studies.

Results

Over 50 prenatal factors have been examined. The factors associated with autism risk in the meta-analysis were advanced parental age at birth, maternal prenatal medication use, bleeding, gestational diabetes, being first born v. third or later, and having a mother born abroad. The factors with the strongest evidence against a role in autism risk included previous fetal loss and maternal hypertension, proteinuria, pre-eclampsia and swelling.

Conclusions

There is insufficient evidence to implicate any one prenatal factor in autism aetiology, although there is some evidence to suggest that exposure to pregnancy complications may increase the risk.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

 

Post-traumatic stress disorder and suicidal behavior: A narrative review

Post-traumatic stress disorder and suicidal behavior: A narrative review, Clinical Psychology Review. Online early view, 2009

Maria Panagioti^a, Patricia Gooding^{, a,}  and Nicholas Tarrier^a

^aSchool of Psychological Sciences, University of Manchester, UK

Abstract:

There is a large literature investigating the underlying mechanisms, risk factors and demographics of suicidal thoughts and behaviors across a number of psychiatric disorders, such as, major depression, anxiety and schizophrenia. However, less research has focused on the relationship between Post-Traumatic Stress Disorder (PTSD) and suicide. There were two broad aims of this review. The first was to assess the extent to which PTSD is associated with suicide, and the second was to determine the effects of co-morbid disorders on this relationship. Overall, there was a clear relationship between PTSD and suicidal thoughts and behaviors irrespective of the type of trauma experienced. Very few studies directly examined whether depression was a mediating factor in the relationships reported. However, where this was investigated, the presence of co-morbid depression appeared to boost the effect of PTSD on suicidality. It was noteworthy that hardly any studies had investigated concepts thought to be key in other domains of research into suicidality, such as, feelings of entrapment, defeat and hopelessness.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Special Issue – Dementia – Practice Nurse

Practice Nursing, Volume 20 Issue 6 supplement,   4 June 2009

The epidemiology of dementia – David Jolley
David Jolley explains that dementia is a syndrome characterised by a loss of core abilities, often complicated by abnormalities of mood, perception and behaviour. He defines the different forms of dementia, provides an overview of its epidemiology, pathophysiology, risk factors and increasing prevalence, and explains the disease trajectory

How to recognise the early signs of dementia –  Dr Louise Robinson
Louise Robinson explores the reasons why the early signs and symptoms of dementia are sometimes overlooked, ignored, misunderstood or misdiagnosed. She explains the key signs and symptoms of the different types of dementia and provides an overview of the key assessments used in diagnosis. The importance of referral for specialist assessment and issues about communicating a diagnosis are considered.

A glimmer of hope – Chris O’Connor
Dementia has been making headline news this year. The Department of Health launched its National Dementia Strategy in February (2009); newsreader John Suchet spoke about his experiences of caring for his wife who has been diagnosed with dementia in her early 60s; and author Terry Pratchett explored his own dementia in a BBC documentary. Like many of my colleagues who have worked with underresourced services for people with dementia, I have read and watched with interest media reports of ‘our dementia cr isis’, as though this is something that has just been discovered.

Effective use of drugs in Alzheimer’s disease – Bernadette McGuinness, David Wilson, Stephen Todd, Peter Passmore
Bernadette McGuinness, David Wilson, Stephen Todd and Peter Passmore provide an introduction to the use of acetylcholinesterase inhibitors in Alzheimer’s disease. They look at the potential benefits and limitations of the drugs, highlight the importance of regular review, and provide guidance about maximising the benefits of treatment, and deciding when to discontinue or switch medications.

Better understanding makes diagnosis faster – Helen Dickens
Helen Dickens explains why it is so important for people to seek advice if concerned about their memory.

Lancashire Care staff can request the full-text of all the articles from the special issue, email: susan.jennings@lancashirecare.nhs.uk

Waquas Waheed – Development and pilot testing of a social intervention for depressed women of Pakistani family origin in the UK

Development and pilot testing of a social intervention for depressed women of Pakistani family origin in the UK, Journal of Mental Health, Online early view 2009

Authors: Nasim Chaudhry ^a;  Waquas Waheed ^a;  Nusrat Husain ^a;  Shabana Bhatti ^a; Francis Creed ^a

Affiliation:

a University of Manchester, Manchester, UK

Abstract:

Background: Depressive disorders are common in women of Pakistani origin living in the UK. In a pilot study we developed and tested a culturally sensitive social group intervention for persistently depressed Pakistani women.

Methods: A total of 55 persistently depressed women were identified in a population-based study. The first consecutive 18 who agreed to participate were enrolled into the study. Out of these, eight women dropped out before the start of the intervention, one woman attended the first session only and nine women attended 10 weekly sessions of the group. Outcome measures at baseline and at the end of the intervention were the 20 item Self Reporting Questionnaire (SRQ) and the Schedule for Clinical Assessment in Neuropsychiatry (SCAN).

Results: All 9 women attended at least six of the 10 sessions. Mean SRQ score at baseline was 15.0 (SD = 3.08) and 11.7 (SD = 5.95) at the end of the intervention (p = 0.039). Three women reported reduction in suicidal ideas.

Conclusions: A culturally appropriate social intervention successfully brought together a group of isolated chronically depressed Pakistani women, enabling them to form informal networks and forming the basis of an RCT to treat the depression.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

CBT for Early Psychosis – Comprehensive review of individual vs group treatment studies

Cognitive Behavior Therapy for Early Psychosis: A Comprehensive Review of Individual vs. Group Treatment Studies, International Journal of Group Psychotherapy, 2009 – 59 – 3 – 357

Cohen, Shuki J. – Srihari, Vinod H. – Woods, Scott W.

Abstract:

Several recent studies of individually administered cognitive behavior therapy (CBT) for early psychosis have reported only modest treatment benefits. The purpose of the current study was to review the literature to determine how outcomes of group CBT differ from outcomes of individually administered CBT among early cases.

Our findings suggest that group CBT for early psychosis may be a more effective modality for this group of patients. We speculate that patients’ uncertainty about illness in general may impair the effectiveness of individually administered CBT for early cases and that group CBT may be more effective for these young patients by better addressing those factors with the aid of peer-to-peer interactions, identification, and modeling.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Patient Care – Nurses can take a leading role in championing patient care. A small group of mental health nurses in a London Trust embarked on ‘getting the fundamentals right’

Essence of Care – a key approach in improving patient care, Danny Ho, Eric Craig
British Journal of Nursing, Vol. 18, Iss. 12, 25 Jun 2009, pp 740 – 744

Abstract:

This project work is an illustration of how nurses can take a leading role in championing patient care. A small group of mental health nurses in a London Trust embarked on ‘getting the fundamentals right’ in their quest to improve care given to patients. A working group was formed to take this idea forward: The Essence of Care Steering Group. The group uses the Essence of Care benchmarking principles as a base, and an integral part of clinical governance as a guide. It takes a structured approach to sharing and comparing practice, enabling it to identify best practice and to develop action plans to remedy poor practice. Success is seen in the improvements in the quality and care experience of patients, carers and staff at local levels. Common standards in care across the service areas can be achieved and care can be measured in a more structured way across the service areas with easier, more constructive and meaningful sharing of information and skills. Staff morale is also enhanced.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Reflection: an educational strategy to develop emotionally-competent nurse leaders

Reflection: an educational strategy to develop emotionally-competent nurse leaders, Journal of Nursing Management, 2008, Volume 16 Issue 8, Pages 946 - 954

SARA HORTON-DEUTSCH PhD, RN ¹ and GWEN SHERWOOD PhD, RN, FAAN ² Abstract:

Aim This paper explores educational strategies for nurses that focus on reflectivity and promote the development of self-awareness, relationship and communication skills and ability to lead with presence and compassion in the midst of change.

Background Today nurses move rapidly from carefully-controlled educational experiences to a fast- paced clinical world of increasing patient complexity amid calls for improved quality of care. Making the transition to clinical competence and leadership in practice requires a strong sense of self and emotional intelligence.

Evaluation Pedagogies that integrate theoretical and data-based textbook learning with experiential learning and reflection are a foundation for the development of emotionally- and intellectually-competent leaders and requires new ways of assessing learner outcomes.

Key issues Reflection is a key instructional strategy for preparing transformational nurse leaders for interdisciplinary settings where they lead patient care management. The remarkable global spread of reflection in nursing education, practice and research follows an emphasis on developing self-awareness as a leadership strategy for improving individual and organizational performance.

Conclusions Empirical, experiential and anecdotal evidence suggests that reflection has the potential to prepare emotionally-capable nurse leaders.

Implications for Nursing Management As educators create more reflective and nurturing learning environments, they will promote the development of emotionally-competent nurse leaders who will, in turn, inspire individual and organizational growth and positive change in society.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

 

  ¹ Associate Professor and Coordinator of the Graduate, Psychiatric Mental Health Nursing Program, School of Nursing, Indiana University, Indianapolis, IN and   ² Professor and Associate Dean for Academic Affairs, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Drugs misuse treatment in offender populations – Annual Evidence Update

Drugs misuse treatment in offender populations, NHS Evidence – National Library for Public Health, June 2009

Click on the title above to gain direct full-text access to this resource

 

 Welcome to the first Annual Evidence Update on Drugs focussing on Drugs misuse treatment in offender populations.

This evidence update covers drugs misuse treatments in the offender population. As it is the first AEU, the period it covers is wider. Evidence is presented from January 2005 to March 2009. Other AEUs on other topics can be viewed in the Annual Evidence Update archive.

 This AEU also coincides with the Home Office annual National Tackling Drugs Week. National Tackling Drugs Week is designed to provide local agencies and police forces with a platform to publicise the work you do to tackle drugs and reduce drug-related crime. Further details can be found by visiting the National Tackling Drugs Week website.

Contents

 Introduction, Expert editorial

• Drugs misuse treatment in the offender population

 Evidence

• Guidance, toolkits, & strategies
• Evidence

Person-centred planning with people who have learning disabilities

Person-centred plans: empowering or controlling? Learning Disability Practice, 2009 – 12 – 1 – 32

Example of an essential lifestyle plan

Anne-Marie Martin RNID,
BSc(Hons), Grad Dip,
intellectual disability
nurse, Daughters
of Charity, Lisnagry,
Limerick

Eileen Carey RNID,
BSc(Hons), RNT, MSc,
lecturer, Department of
Nursing and Midwifery,
University of Limerick

Abstract:

Person-centred planning with people who have learning disabilities raises issues of power and control. Anne-Marie Martin and Eileen Carey describe how a woman with moderate intellectual disability was helped to develop her own person-centred approach to her care.

Person-centred planning is not an activity ‘done’ to people with an intellectual disability; rather it is about the person taking the lead with those who are important to them (Duffy and Sanderson 2004). This involves helping people to communicate what is important to them, supporting them to get what they need and ensuring they are in control of their own lives.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Psychotic reactivity in borderline personality disorder

Psychotic reactivity in borderline personality disorder, Acta Psychiatrica Scandinavica, Online early view, 2009

P. Glaser ¹ , J. Van Os ^1,2 , V. Thewissen ^1,3 , I. Myin-Germeys ^1,4

Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, Maastricht, the Netherlands ,   ² Division of Psychological Medicine, Institute of Psychiatry, London, UK ,   ³ Faculty of Psychology, Open University of the Netherlands, Heerlen, the Netherlands and   ⁴ School of Psychological Sciences, University of Manchester, Manchester, UK

 Abstract:

Objective: To investigate the stress relatedness and paranoia specificity of psychosis in borderline personality disorder (BPD).

Method: Fifty-six borderline patients, 38 patients with cluster C personality disorder, 81 patients with psychotic disorder and 49 healthy controls were studied with the experience sampling method (a structured diary technique) to assess: i) appraised subjective stress and ii) intensity of psychotic experiences.

Results: All patient groups experienced significantly more increases in psychotic experiences in relation to daily life stress than healthy controls, borderline patients displaying the strongest reactivity. Borderline patients, moreover, reported significantly more hallucinatory reactivity than healthy controls and subjects with cluster C personality disorder. Paranoid reactivity to daily life stress did not differ between the patient groups.

Conclusion: These results are the first to ecologically validate stress-related psychosis in BPD. However, psychotic reactivity was not limited to expression of paranoia but involved a broader range of psychotic experiences including hallucinations.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Exposure to Aggression and the Impact on Staff in a Child and Adolescent Inpatient Unit

Exposure to Aggression and the Impact on Staff in a Child and Adolescent Inpatient Unit, Archives of Psychiatric Nursing, Online early view 2009

Abstract:

Aggression is common in mental health services, but little research has examined exposure to aggression and its impact on staff in children and adolescent settings. Staff members within a child and adolescent psychiatric inpatient unit were interviewed to examine exposure to aggression and perceptions about the impact of aggression. Involvement in episodes of physical aggression was common (84.8%, 28/33) and was linked to difficulty attending work and other emotional and professional sequelae. These findings suggest that aggression is an important issue for staff working in child and adolescent settings and that aggression may impair the therapeutic capacity of staff.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Most Read Article – Falls – Stand Up – This study examines the 9-month impact of a 12-week falls prevention program

Impact of a Community-Based Falls Prevention Program on Maintenance of Physical Activity Among Older Adults, Journal of Aging and Health, Vol. 21, No. 3, 480-500 (2009)

Sophie Laforest, PhD et al.

Abstract:

Objective: This study examines the 9-month impact of a 12-week falls prevention program (called Stand Up!) which included balance exercises and educational components on maintenance of physical activity among community-dwelling seniors. Method: Data were collected among 98 experimental and 102 control participants at baseline, immediately after the program and 9 months later. Involvement in physical activity was measured with three indicators. Program effects were examined using linear and logistic regression procedures. Results: Both groups showed similar increases in weekly frequency of exercise at the 9-month posttest. However, the program’s participants showed higher increases in their variety of exercises at the 9-month posttest (especially among those with greater baseline scores). Among seniors reporting lower levels of energy expenditure at baseline, the program’s participants showed significantly greater increases in energy expenditure than control participants. Discussion: These preliminary findings suggest that programs such as Stand Up! have the potential to stimulate continued involvement in physical activity.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Suicide in dementia: 9-year national clinical survey in England and Wales

Suicide in dementia: 9-year national clinical survey in England and Wales,  The British Journal of Psychiatry (2009) 194: 175-180

Purandare N, Voshaar RC, Rodway C, Bickley H, Burns A, Kapur N.

Psychiatry Research Group, School of Community Based Medicine, University of Manchester, University Place, Oxford Road, Manchester M13 9PL, UK

Abstract:

BACKGROUND: Knowledge of suicide in people with dementia is limited to small case series. AIMS: To describe behavioural, clinical and care characteristics of people with dementia who died by suicide. METHOD: All dementia cases (n=118) from a 9-year national clinical survey of suicides in England and Wales (n=11 512) were compared with age- and gender-matched non-dementia cases (control group) (n=492) by conditional logistic regression. RESULTS: The most common method of suicide in patients with dementia was self-poisoning, followed by drowning and hanging, the latter being less frequent than in controls. In contrast to controls, significantly fewer suicides occurred within 1 year of diagnosis in patients with dementia. Patients with dementia were also less likely to have a history of self-harm, psychiatric symptoms and previous psychiatric admissions. CONCLUSIONS: Known indicators of suicide risk are found less frequently in dementia suicide cases than non-dementia suicide cases. Further research should clarify whether suicide in dementia is a response to worsening dementia or an underappreciation of psychiatric symptoms by clinicians.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

 

How to help someone who is suicidal – MIND

How to help someone who is suicidal    MIND, 2008

Click on title above to gain direct full-text access

Sorry you won’t be able to print out the Guide, but paper copies are being ordered for the library, please contact: susan.jennings@lancashirecare.nhs.uk for a copy.

Abstract:

• When are feelings “suicidal”?
  Is self-harming behaviour suicidal?
  Why do people become suicidal?
  How do I know if someone close to me is suicidal?
  Don’t people have a right to kill themselves, if they want to?
  How can I help someone who feels that bad?
  Useful organisations
  Further reading

“Only when you know what it is like to feel depressed, to feel you are dying inside, can you know what it is like to be suicidal, to think that the whole dreadful, terrible, nagging, awful pain of it all might be swept away by a simple, single act of self destruction.” Spike Milligan

“One becomes trapped in a situation, stepping into another world with them, yet because you love them, you can’t let go of the hope that they will change back to the person they were… They hold something of you in their hands… and if they were to go down, they take part of you with them. So, you have to protect them in order to protect yourself.”

If Lancashire Care staff have any difficulty accessing the full-text email: susan.jennings@lancashirecare.nhs.uk

Role of the forensic psychiatric nurse

Role of the forensic psychiatric nurse, Journal of Forensic Nursing, 2009, Volume 5, Issue 1, Pages 53-57

Tamsen Lyons, BA, BS – MS Nursing Program, University of Southern Maine, Portland, Maine

 Abstract:

The article clarifies the role of the forensic psychiatric nurse (FPN) and challenges interchangeable terms confusing forensic and correctional nursing. It addresses the varied venues where the FPN may assess the patient (victim or perpetrator) and gather evidence that may influence conviction, sentencing, recidivism, treatment, and prevention. In depth knowledge of medical and psychiatric nursing as well as the criminal justice system is germane to competent advanced practice forensic nursing. An analogy is drawn between the forensic assessment for risk of violence which is commonly performed by psychiatric nurses in Emergency Departments and the collection and preservation of evidence by medical nurses in Emergency Departments. Both instances require evidence-based techniques and a familiarity with forensic procedures and are often performed by nurses who are not specifically trained in these areas. A case analysis demonstrates the value of an in depth and broad assessment of victim and perpetrator. Evidence based training and the application of structured clinical judgment used in the evaluation of victims and perpetrators make it possible for the FNP to provide expert testimony and to make recommendations for treatment.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Cognitive impairment in dual diagnosis inpatients with schizophrenia and alcohol use disorder

Cognitive impairment in dual diagnosis inpatients with schizophrenia and alcohol use disorder, Schizophrenia Research, Online early view 2009

Manning V, Betteridge S, Wanigaratne S, Best D, Strang J,  Gossop M.

National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, 4 Windsor Walk, London SE5 8BB, UK.

Abstract:

Cognitive impairment has been found independently among individuals with schizophrenia and individuals with alcohol use disorders. Less is known about the nature and severity of cognitive impairment in patients with a dual diagnosis, though the co-occurrence of these disorders may further exacerbate cognitive impairment. The study investigates the possible additive effect of alcohol use disorder and schizophrenia on cognitive impairment among patients diagnosed with schizophrenia. Participants were inpatients with schizophrenia (n=30), inpatients with a dual diagnosis of schizophrenia and alcohol use disorder (n=30), and matched controls (n=30): all completed a comprehensive neuropsychological battery. Both patient groups were significantly impaired, relative to controls, across the battery. Dual diagnosis patients were significantly more impaired than schizophrenia patients on delayed verbal memory, and executive functioning, primarily set-shifting, working memory, and planning, and had higher psychiatric morbidity scores. The findings provide support for an additive effect of the two disorders on cognitive impairment. These cognitive deficits may affect capacity to engage in treatment, increase risk of relapse, and adversely affect treatment outcomes. An understanding of the cognitive profile of people with dual diagnosis may help to tailor treatment delivery to meet their specific needs, enhance cognitive strengths, accommodate deficits and improve treatment outcomes.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Solution Focused Therapy – An Evaluation of a Solution Focused Computer Game in Adolescent Interventions

An Evaluation of a Solution Focused Computer Game in Adolescent Interventions, Clinical Child Psychology and Psychiatry, Vol. 14, No. 3, 345-360 (2009)

David Coyle , Trinity College Dublin, Gavin Doherty , Trinity College Dublin, John Sharry Mater Hospital Dublin

Abstract:

Many adolescents experience difficulties with traditional face-to-face mental health care approaches. Personal Investigator (PI) is a 3D computer game specifically designed for use in adolescent interventions. The game implements a model of Solution Focused Therapy. It aims to assist in easing the difficulties experienced by adolescents with direct face-to-face approaches. In sessions a therapist and adolescent sit together at a computer and play PI. Issues raised in the game serve as a context for more detailed discussions between the therapist and client. This article describes a study in which PI was used with 22 adolescent clients, attending mental health care services due to a variety of difficulties. Whilst further trials are required, results indicate positive benefits of using PI. PI can help in building an effective client—therapist relationship, can assist in structuring sessions, and can assist in improving client engagement in the therapeutic process.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Self-Harm – Calderstones – Paul, a service user with learning disabilities in a medium-secure unit, was asked if he would describe his experiences of self-injury

The good, the bad and the ugly: experiences of self-injury, Learning Disability Practice, 2009 – 12 – 1 – 21-23

Helen Duperouzel RNLD, MA, clinical
governance support, Calderstones NHS
Trust, Whalley, Lancashire
Paul Moores, service user, Calderstones
NHS Trust

Abstract:

Paul, a service user with learning disabilities in a medium-secure unit, was asked if he would describe his experiences of self-injury in an attempt to foster better understanding among nurses.

Nurses’ attitudes towards people who self-injure can be negative and often interfere with therapeutic relationships with service users. Prevention, with the aim of stopping self-injury, remains the goal of many nursing interventions and some nurses still believe that the function of self-injury is to seek attention from staff. These views are often fuelled by a lack of understanding and when providing any staff training these negative attitudes need to be
addressed.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Jenny Shaw – Homicide followed by suicide: a cross-sectional study

Homicide followed by suicide: a cross-sectional study, Journal of Forensic Psychiatry & Psychology, Volume 20, Issue 2 April 2009 , pages 306 – 321

 

Authors: Sandra Flynn ^a;  Nicola Swinson ^a;  David While ^a;  Isabelle M. Hunt ^a;  Alison Roscoe ^a;  Cathryn Rodway ^a;  Kirsten Windfuhr ^a;  Navneet Kapur ^a;  Louis Appleby ^a; Jenny Shaw ^a

 

Affiliation:

a Centre for Suicide Prevention, University of Manchester, UK

Abstract:

 

Background: Approximately 30 incidents of homicide followed by suicide occur in England and Wales each year. Previous studies have not examined mental health characteristics in any detail.

Aims: This study aims to identify the social, clinical, and criminological characteristics of a national sample of perpetrators, to identify any previous contact with mental health services and to establish risk of suicide after homicide.

Method: A national cross-sectional study of perpetrators in England and Wales 1996-2005.

Results: 203 incidents were recorded over 9 years. The median age of perpetrators was 41 years (range 18-88 years); most were male. Men more often killed a spouse/partner, whilst women more commonly killed their children. Eighty-four (42%) perpetrators died by suicide on the day of the homicide. The most common method of homicide was sharp instrument (44, 23%). Fifty-nine (29%) used hanging as a method of suicide. Twenty (10%) had previous contact with mental health services, 14 were seen within a year of the offence. The most common diagnoses were personality disorder and affective disorder. The risk of suicide increased the closer the relationship between the perpetrator and the victim.

Conclusions: Significantly fewer perpetrators of homicide-suicide compared with homicide or suicide only were in contact with mental health services. Prevention is discussed and suggestions made for the use of psychological autopsy methodology to study rates of mental disorder.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Measurement of Posttraumatic Growth in Young People: A Review

Measurement of Posttraumatic Growth in Young People: A Review, Clinical Child Psychology and Psychiatry, Vol. 14, No. 3, 411-422 (2009)

Rebecca Clay, Coventry Univ,ersity, UK ,

Jacky Knibbs,  Coventry University, UK

Stephen Joseph , University of Nottingham, UK

Abstract:

The potential of the positive psychology perspective to change the focus of clinical research and practice has become increasingly recognized. A variety of new psychometric instruments informed by positive psychology are now available to mental health clinicians, providing them with tools to assess change across the spectrum of human functioning. One area of research and practice in which this is evident is in posttrauma work, where it is becoming more common to assess posttraumatic growth alongside posttraumatic stress. The majority of work on posttraumatic growth has been with adults, but the last few years have also seen a new body of research with children and adolescents. The aim is to review literature relating to the measurement of growth. It is concluded that several measures with acceptable psychometric properties now exist for the assessment of posttraumatic growth in children and adolescents.

Lancashire Care staff can request the full-text of this article, email: susan.jennings@lancashirecare.nhs.uk

Help-seeking before and after episodes of self-harm: a descriptive study in school pupils in England.

Help-seeking before and after episodes of self-harm: a descriptive study in school pupils in England.   BMC Public Health. 2008; 8: 369.

Click on the article title above to gain direct full-text access

Fortune S, Sinclair J, Hawton K.

University of Oxford Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK. s.a.fortune@leeds.ac.uk

 

Abstract:

BACKGROUND: Deliberate self-harm in young people is a cause for concern in many countries. The vast majority of episodes of self-harm do not result in presentation to hospital and relatively little is known about to whom or where adolescents who harm themselves go for help. METHODS: This school-based survey of 5,293 15-16 year olds in the United Kingdom investigated sources of help and barriers to help seeking before and after an episode of self-harm. RESULTS: Friends (40%) and family (11%) were the main sources of support. Far fewer adolescents had sought help from formal services or health professionals. Barriers to help seeking include perceptions of self-harm as something done on the spur of the moment and therefore not serious or important or to be dwelt upon. Many adolescents felt they should be able to, or could cope on their own and feared that seeking help would create more problems for them and hurt people they cared about or lead to them being labelled as an ‘attention seeker’. The decision to seek help was in some cases hampered by not knowing whom to ask for help. Gender and exposure to self-harm in the peer group influenced perceived barriers to help-seeking. CONCLUSION: There are both push and pull factors’ acting on young people in their understanding of what leads them to want to harm themselves and potential mechanisms for seeking help. The implications for community based prevention programmes are discussed.

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Dialectical Behavior Therapy & Eating Disorder & Comorbid BPD

Differential Treatment Response for Eating Disordered Patients With and Without a Comorbid Borderline Personality Diagnosis Using a Dialectical Behavior Therapy (DBT)-Informed Approach, Eating Disorders, Volume 17, Number 3, May 2009 , pp. 225-241(17)

Authors: Denise D. Ben-Porath ^a;  Lucene Wisniewski ^b; Mark Warren ^b

Affiliations:	a Department of Psychology, John Carroll University, Cleveland, Ohio, USA
	b Cleveland Center for Eating Disorders, Beachwood, Ohio, USA

Abstract:

Studies have reported conflicting findings regarding the impact on treatment for eating disorder patients comorbidly diagnosed with borderline personality disorder. The current investigation sought to investigate whether individuals diagnosed with an eating disorder vs. those comorbidly diagnosed with an eating disorder and borderline personality disorder differ on measures of eating disorders symptoms and/or general distress over the course of treatment. In light of the success of DBT in treating individuals diagnosed with borderline personality disorder, a group known to have considerable difficulties in regulating affect, the current study also sought to examine whether these two groups would differ on expectancies to regulate affect over the course of DBT-informed treatment. Results indicated that while a comorbid diagnosis of borderline personality disorder did not impact eating disorder treatment outcomes, those comorbidly diagnosed did present overall with higher levels of general distress and psychological disturbance. With respect to affect regulation, results indicated that at the beginning of treatment, eating disordered individuals who carried a comorbid diagnosis of BPD were significantly less able to regulate affect than patients without a comorbid borderline diagnosis. However, at the end of treatment there was no statistically significant difference between the two groups. The role of affect regulation in treating eating disordered individuals with a comorbid borderline personality disorder diagnosis is discussed.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashircare.nhs.uk

Transdiagnostic Group CBT for Anxiety: Clinical Experience and Practical Advice

Transdiagnostic Group CBT for Anxiety: Clinical Experience and Practical Advice, Journal of Cognitive Psychotherapy, Volume 23, Number 1, 2009 , pp. 34-43(10)

Abstract:

Cognitive-behavioral treatments (CBT) for the six anxiety disorders are potent, but only a small portion of patients receive them. Among several factors limiting their broad dissemination is the diagnostically specific nature of CBT for anxiety; the multiplicity of protocols makes them ill-suited for many mental health programs. This article describes the development of a transdiagnostic treatment approach for anxiety disorders as one way to close the dissemination gap. In particular, we describe our experience with two generations of mixed anxiety groups, where our previous controlled and uncontrolled studies found medium effect sizes within the range of effect sizes found with diagnosis-specific treatments. We also describe lessons learned from the two protocols, which may be of value in the development of transdiagnostic approaches.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Assessment of Childhood Bipolar Disorder

Assessment of Childhood Bipolar Disorder, Clinical Psychology: Science and Practice , June 2009, Volume 16 Issue 2, Pages 166 - 181

Benjamin W. Fields  and Mary A. Fristad  – The Ohio State University Abstract:

Barriers to the comprehensive clinical assessment of child-onset bipolar disorder (BPD) are numerous and include factors common to many pediatric diagnoses (e.g., disentangling comorbid conditions and overlapping symptoms; cross-situational variability in behavior; limited reliability of child report), as well as issues more specific to child-onset BPD (e.g., lack of empirically validated screening instruments; disagreement over age-specific symptom presentation and temporal discontinuity of symptoms). Thorough assessment includes careful consideration of differential diagnosis, investigation of familial history of affective illness, a focus on longitudinal data collection, and the use of multiple informants. Though a number of standardized measures may assist clinicians in gathering diagnostic information, clinical judgment based on familiarity with the unique presentation of child-onset BPD remains essential.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Caroline Hampson – Lancashire Care – Occupational Therapist

Wellbeing groups in dementia care services: a review of attendee and carer satisfaction, The British Journal of Occupational Therapy, Volume 72, Number 6, June 2009 , pp. 275-278(4)

Caroline Hampson – Lancashire Care NHS Foundation Trust, UK

Abstract:

The recent development of the National Dementia Strategy and the National Institute for Health and Clinical Excellence guidelines have added to the proposals of the National Service Frameworks for Older Adults and Mental Health to improve services for people with a diagnosis of dementia. In line with this, the occupational therapy service in Rossendale began wellbeing groups in an attempt to increase the mental wellbeing of the service users accessing memory assessment services. A review was conducted using a satisfaction questionnaire to establish whether the group was meeting the initial aims for attendees and carers.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Treatment rights for prisoners with personality disorder: Substance or substantive?

Assessing the viability of treatment rights for prisoners with personality disorder: Substance or substantive? Personality and Mental Health, Online early view, 2009

Leon McRae *

School of Law, University of Nottingham, University Park, Nottingham, NG7 2RD

Abstract:

Personality disorder (PD) has long been criticized as a diagnosis, not least for the issue of its supposed untreatability. This has precluded many offenders with PD from receiving treatment for their disorder in a secure hospital, with detention in the potentially deleterious penal environment the result. However, transfers for public protection continue to occur. A further problematic issue for treatment considerations when diversion from prison hangs in the balance is the removal of the need for proposed treatment to provide a therapeutic benefit under the recently amended Mental Health Act 1983. In light of these developments, this paper considers the significance of human rights instruments, such as the European Prison Rules 2006, which aim to offer rights to treatment, giving the offender with a diagnosis of PD access to adequate and sustaining treatment, both in prison and secure hospitals.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Assessment Tools for Adult Bipolar Disorder

Assessment Tools for Adult Bipolar Disorder, Clinical Psychology: Science and Practice, June 2009, Volume 16 Issue 2, Pages 188 - 201

 Christopher J. Miller, Sheri L. Johnson , and Lori Eisner – University of Miami

Abstract:

This article reviews the current state of the literature on the assessment of bipolar disorder in adults. Research on reliable and valid measures for bipolar disorder has unfortunately lagged behind assessment research for other disorders, such as major depression. We review diagnostic tools, self-report measures to facilitate screening for bipolar diagnoses, and symptom severity measures. We briefly review other assessment domains, including measures designed to facilitate self-monitoring of symptoms. We highlight particular gaps in the field, including an absence of research on the reliable diagnosis of bipolar II and milder forms of disorder, a lack of empirical data on the best ways to integrate data from multiple domains, and a shortage of measures targeting a broader set of illness-related constructs relevant to bipolar disorder.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Cochrane – Statins for the prevention of dementia

Statins for the prevention of dementia

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McGuinness B, Craig D, Bullock R, Passmore P. Statins for the prevention of dementia. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD003160

Abstract:

There good evidence that statins given in late life to individuals at risk of vascular disease have no effect in preventing dementia
Evidence accumulating from biological and epidemiological studies suggest that high levels of serum cholesterol may promote the pathological processes that lead to Alzheimer’s disease. Lowering cholesterol in experimental animal models slows the expression of Alzheimer’s pathology. These findings raise the possibility that treating humans with cholesterol lowering medications might reduce the risk of developing Alzheimer’s disease. The statin family of medications (lovastatin, pravastatin,simvastatin, and others) are powerful cholesterol lowering agents of proven benefit in vascular disease. Several clinical studies comparing the occurrence of Alzheimer’s disease between users of statins and non-users of statins suggest that risk of Alzheimer’s disease is substantially reduced among the users. However, because these studies are not randomized trials, they provide insufficient evidence to recommend statin therapy. Two randomized trials have since been carried out and neither showed any reduction in occurrence of AD or dementia in patients treated with statins compared to those given placebo. Statins cannot therefore be recommended for the prevention of AD or dementia.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk