Comparison of Experiences of Stress and Coping Between Young People at Risk of Psychosis and a Non-Clinical Cohort

Comparison of Experiences of Stress and Coping Between Young People at Risk of Psychosis and a Non-Clinical Cohort, Behavioural and Cognitive Psychotherapy, 40 , pp 69-88

Lisa Jane Phillips, Jane Edwards, Nancy McMurray and Shona Francey

Abstract:

Background: Although the experience of stress and associated coping responses are thought to play a role in the onset of schizophrenia and other psychotic disorders, there is little empirical evidence to support such a relationship. The relatively recent development of validated and reliable criteria for identifying young people at “ultra” high-risk (UHR) of psychosis has enabled the process of illness onset to be studied more closely than was previously possible. Method: This longitudinal study compared the experiences of stress and coping between a UHR cohort (N = 143) and a healthy comparison group (HC group, N = 32). Results: The UHR group experienced significantly fewer life events over a 12-month period than the HC group, but there was no difference in the experience of minor events or “hassles”. However, the UHR group reported feeling significantly more distressed by events, felt they coped more poorly and utilized different coping strategies.

Conclusions: The appraisals made about stressors differentiated the groups and was associated with differences in coping and distress levels. This suggests that treatment strategies focusing on stress management and enhancing coping skills might be important components of preventive interventions.

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

 

LCFT staff – Helen Lockett – Using a Semi-Structured Interview to Explore Imagery Experienced During Social Anxiety for Clients with a Diagnosis of Psychosis: An Exploratory Study Conducted Within an Early Intervention for Psychosis Service

Using a Semi-Structured Interview to Explore Imagery Experienced During Social Anxiety for Clients with a Diagnosis of Psychosis: An Exploratory Study Conducted Within an Early Intervention for Psychosis Service, Behavioural and Cognitive Psychotherapy, 40 (1) , pp 55-68

S. Helen Lockett, Judith Hatton, Ruth Turner, Claire Stubbins, Joanne Hodgekins and David Fowler

Abstract:

Background: Social phobia frequently occurs as a comorbid condition, with high rates reported among people with psychosis. Little is known about the nature of social anxiety in this population or whether current psychological theories apply. Aims: This paper aims to develop and pilot a suitable measure to explore imagery experienced by participants with comorbid psychosis and social anxiety and to provide preliminary indications as to its nature. Method: A semi-structured interview exploring imagery was used with seven participants (adapted from Hackmann, Surawy and Clark, 1998) and the results were analysed using qualitative template analysis. Results: Initial indications from this sample suggest that some participants experience typical social anxiety images, as identified by Hackmann et al. (1998). However, some experience images that appear more threatening, and may be related to residual psychotic paranoia. Image perspective was also explored: typical social anxiety images tended to be seen from an observer perspective, while those that may have been more related to psychosis tended to be seen from a field perspective.

Conclusions: This exploratory study has facilitated the careful adaptation and development of an imagery interview for use in this population and has suggested areas for further research and raised questions around clinical implications.

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

Chronic Pain in Older Adults: A Controlled Pilot Trial of a Brief Cognitive-Behavioural Group Treatment

Chronic Pain in Older Adults: A Controlled Pilot Trial of a Brief Cognitive-Behavioural Group Treatment, Behavioural and Cognitive Psychotherapy, 2012

Gerhard Andersson

Abstract:

Background: Chronic pain is a common condition among older adults. While cognitive behaviour therapy (CBT) has been tested in numerous studies on adults and children there are fewer studies on older persons. The objective of this study was to investigate the effects of a six-session CBT group treatment for older persons with chronic pain. As a secondary aim we investigated whether treatment credibility was associated with outcome. Method: We included 21 persons (mean age = 72.0 years) who were randomly allocated to either a waitlist condition or treatment consisting of applied relaxation, with the addition of problem solving, assertiveness, communication strategies, sleep management, and relapse prevention. Results: Few statistically significant effects were found on measures of pain, mood, anxiety, and quality of life; however, a significant treatment effect with a between group effect size of d = 1.0 was observed with respect to perceived ability to function despite the discomfort of pain.

Conclusion: The study provides some preliminary support for the use of group-based CBT with a focus on applied relaxation for older adults with chronic pain.

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

The Illusory Beliefs Inventory: A New Measure of Magical Thinking and its Relationship with Obsessive Compulsive Disorder

The Illusory Beliefs Inventory: A New Measure of Magical Thinking and its Relationship with Obsessive Compulsive Disorder, Behavioural and Cognitive Psychotherapy, January 2012 40 (1) pp 39-53

Bianca L. Kingdon, Sarah J. Egan and Clare S. Rees

Abstract:

Background: Magical thinking has been proposed to have an aetiological role in obsessive compulsive disorder (OCD). Aims: To address the limitations of existing measures of magical thinking we developed and validated a new 24-item measure of magical thinking, the Illusory Beliefs Inventory (IBI). Method: The validation sample comprised a total of 1194 individuals across two samples recruited via an Internet based survey. Results: Factor analysis identified three subscales representing domains relevant to the construct of magical thinking: Magical Beliefs, Spirituality, and Internal State and Thought Action Fusion. The scale had excellent internal consistency and evidence of convergent and discriminant validity. Evidence of criterion-related concurrent validity confirmed that magical thinking is a cognitive domain associated with OCD and is largely relevant to neutralizing, obsessing and hoarding symptoms.

Conclusions: It is important for future studies to extend the evidence of the psychometric properties of the IBI in new populations and to conduct longitudinal studies to examine the aetiological role of magical thinking.

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

To meta-analyse or not to meta-analyse: abortion, birth and mental health

To meta-analyse or not to meta-analyse: abortion, birth and mental health, Brittish Journal of Psychiatry, 2012, January, Vol.200 (1) pp. 12-14

Tim Kendall, Victoria Bird, Roch Cantwell, and Clare Taylor

Abstract:

 

Two recent meta-analyses claim that abortion leads to a deterioration in mental health. Previous reviews concluded that the mental health outcomes following an unwanted pregnancy are much the same whether the woman gives birth or terminates the pregnancy, although there is an increased mental health risk with an unwanted pregnancy. Meta-analysis is particularly susceptible to bias in this area. The physical health outcomes for women with an unwanted pregnancy have improved greatly by making abortion legal. To further improve the mental health outcomes associated with an unwanted pregnancy we should focus practice and research on the individual needs of women with an unwanted pregnancy, rather than how the pregnancy is resolved.

 

 

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

Preventing progression to first-episode psychosis in early initial prodromal states – Integrated psychological intervention appears effective in delaying the onset of psychosis over a 24-month time period in people in an EIPS

Preventing progression to first-episode psychosis in early initial prodromal states, British Journal of Psychiatry, Jan. 2012, 200 (1) pp 22-29

Andreas Bechdolf et al.

Abstract:

Young people with self-experienced cognitive thought and perception deficits (basic symptoms) may present with an early initial prodromal state (EIPS) of psychosis in which most of the disability and neurobiological deficits of schizophrenia have not yet occurred.

Aims

 

To investigate the effects of an integrated psychological intervention (IPI), combining individual cognitive–behavioural therapy, group skills training, cognitive remediation and multifamily psychoeducation, on the prevention of psychosis in the EIPS.

 

Method

 

A randomised controlled, multicentre, parallel group trial of 12 months of IPI v. supportive counselling (trial registration number: NCT00204087). Primary outcome was progression to psychosis at 12- and 24-month follow-up.

 

Results

 

A total of 128 help-seeking out-patients in an EIPS were randomised. Integrated psychological intervention was superior to supportive counselling in preventing progression to psychosis at 12-month follow-up (3.2% v. 16.9%; P = 0.008) and at 24-month follow-up (6.3% v. 20.0%; P = 0.019).

 

Conclusions

 

Integrated psychological intervention appears effective in delaying the onset of psychosis over a 24-month time period in people in an EIPS.

 

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

Anxiety Disorders – Systematic Review – Self-help interventions appear to be an effective way of treating individuals diagnosed with social phobia and panic disorder

Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review, British Journal of Psychiatry, January 2012, Vol. 200 (1) pp. 15-21

Catrin Lewis, Jennifer Pearce, and Jonathan I. Bisson

 Department of Psychological Medicine, Cardiff University, Monmouth House, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK

Abstract:

Aims

To determine the efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders.

Method

Randomised controlled trials (RCTs) of self-help interventions for anxiety disorders were identified by searching nine online databases. Studies were grouped according to disorder and meta-analyses were conducted where sufficient data were available. Overall meta-analyses of self-help v. waiting list and therapist-administered treatment were also undertaken. Methodological quality was assessed independently by two researchers according to criteria set out by the Cochrane Collaboration.

Results

Thirty-one RCTs met inclusion criteria for the review. Results of the overall meta-analysis comparing self-help with waiting list gave a significant effect size of 0.84 in favour of self-help. Comparison of self-help with therapist-administered treatments revealed a significant difference in favour of the latter with an effect size of 0.34. The addition of guidance and the presentation of multimedia or web-based self-help materials improved treatment outcome.

Conclusions

Self-help interventions appear to be an effective way of treating individuals diagnosed with social phobia and panic disorder. Further research is required to evaluate the cost-effectiveness and acceptability of these interventions.

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

Innovation – Our aim is to develop a novel, person-centred, non-discriminatory model of mental healthcare delivery

‘Fair Horizons’: a person-centred, non-discriminatory model of mental healthcare delivery, The Psychiatrist, January 2012 36(1) pp. 25-30

Chris Fear, Mark Scheepers, Martin Ansell, Rosemary Richards, and Paul Winterbottom

The ²gether NHS Foundation Trust, Gloucester, UK

Abstract:

Aims and method Service access is currently determined primarily by age and intellectual function and, unwittingly, is discriminatory. Our aim is to develop a novel, person-centred, non-discriminatory model of mental healthcare delivery. We sought the views of people who use services, carers, commissioners and local politicians.

Results The model represents a major change programme that commenced in September 2011.

Clinical implications By integrating specialist mental health services, with a single access point, and mapping of care to the person’s needs, rather than their circumstances we hope to have developed a greatly improved and fairer service. A similar model could be adopted in other locations nationally.

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

Compulsion under the Mental Health Act 1983: audit of the quality of medical recommendations

Compulsion under the Mental Health Act 1983: audit of the quality of medical recommendations, The Psychiatrist, January 2012 36(1) pp. 11-15

Julian Mason et al.

Abstract:

Aims and method To audit the quality of medical recommendations for detention under the Mental Health Act 1983, Section 2 and 3. The recommendations were tested against a gold standard based on the statutory criteria. Two cycles were completed, the first containing 214 recommendations, the second 202. Relevant education took place after the first cycle.

Results The percentage of medical recommendations containing clear statements of why each of the statutory criteria was met increased in the second cycle. It reached 87% for mental disorder; 87% for nature and/or degree; 75% for why community treatment was not possible; 64% for why detention was in the interests of health; 60% for safety; 55% for protection of others; and 70% why informal admission was not possible.

Clinical implications Doctors, scrutineers and approved mental health practitioners welcomed clear guidance about what is expected in a medical recommendation for detention and endorsed the gold standard described. Armed with a better understanding of what is expected and a template to follow, there was an improvement in the reasons given for detention.

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

Self-Harm & Forensic – There is a significant need for nursing staff working with young people who self-harm to have access to relevant educational programmes. A focus on harm minimization ..

Exploring the antipathy of nursing staff who work within secure healthcare facilities across the United Kingdom to young people who self-harm, Journal of Advanced Nursing, 2012, 68(1), pp. 147–158

Tommy Dickinson and Margaret Hurley

Tommy Dickinson MSc BSc (Hons) RN Senior Lecturer in Mental Health School of Nursing and Caring Sciences, The University of Central Lancashire, Preston, UK

Margaret Hurley PhD Senior Lecturer in Medical Statistics School of Health The University of Central Lancashire, Preston, UK

Abstract:

Aims.  This paper is a report of a study that compared relevant attitudinal dimensions of Registered Nurses and nursing aides working within a Young Offenders’ Institute and two young people’s forensic units in the United Kingdom towards young people in their care who self-harm.

Background.  Nurses caring for young people within secure environments may engage at some point with patients who harm themselves. These staff often experience strong negative emotional reactions which can lead to antipathy and alienation.

Methods.  Forty seven Registered Nurses and 22 nursing aides completed the Self-Harm Antipathy Scale, which consists of 30 attitudinal self-report items. The data were collected between June 2008 and December 2008, and analysed using spss version 17.

Results.  Results displayed that age per se, length of service with self-harming clients, and whether the participant was a Registered Nurse or nursing aide, and number of self-harming clients worked with did not influence the Self-Harm Antipathy Scale score or any of its component sub-scores. However, field of nursing the nurse was registered under, previous study of self-harm, year first registered and gender showed significant effects.

Conclusions.  Given that responses reflect a degree of both empathy and apathy it seems that there is a need to promote greater therapeutic alliances and communication; for example, the use of positive regard to help reduce the incidence of labelling and the negative effects this has upon relationships. There is a significant need for nursing staff working with young people who self-harm to have access to relevant educational programmes. A focus on harm minimization could be key areas for further development.

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

Suicide Intent Scale in the prediction of suicide

Suicide Intent Scale in the prediction of suicide, Journal of Affective Disorders, 2012, Volume 136, Issues 1–2 pp.167-171

J. Stefansson, P. Nordström, J. Jokinen

Abstract:

Objective

To assess the predictive value of the Suicide Intent Scale in patients with high suicide risk. The secondary aim was to assess if the use of the factors of the Suicide Intent Scale may offer a better predictive value in suicide risk detection. Finally a shorter version of the scale was created after an item analysis.

Method

Eighty-one suicide attempters were assessed with the Beck’s Suicide Intent Scale (SIS). All patients were followed up for cause of death. Receiver-operating characteristic (ROC) curves and tables were created to establish the optimal cut-off values for SIS and SIS factors to predict suicide.

Results

Seven patients committed suicide during a mean follow up of 9.5 years. The major finding was that mean SIS scores distinguished between suicides and survivors. The positive predictive value was 16.7% and the Area Under Curve (AUC) was 0.74. Only the planning subscale reached statistical significance. Four items were used to test a shorter version of the SIS in the suicide prediction. The positive predictive value was 19% and the AUC was 0.82.

Conclusions

The Suicide Intent Scale is a valuable tool in clinical suicide risk assessment, a shorter version of the scale may offer a better predictive value.

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

Physical Health – The experiences of people with severe and enduring mental illness engaged in a physical activity programme integrated into the mental health service

The experiences of people with severe and enduring mental illness engaged in a physical activity programme integrated into the mental health service, Mental Health & Physical Acitivity, 2011, Volume 4, Issue 1, pp 23-29

Margot H. Hodgson, Heather P. McCulloc

Department of Exercise, Briston, UK

 

h, Kenneth R. Fox

Abstract:

Objectives

Regular physical activity can be beneficial for people with severe and enduring mental illness (SEMI). However there is little information about how this might be initiated and maintained. This work reports findings from qualitative research, the aim of which was to identify factors influencing adherence to an activity programme and the perceived effects of physical activity on well-being.

Methods

Seventeen people (18–65 years of age) with SEMI were recruited from several groups within an established physical activity programme (specifically designed for mental health service users). One-to-one semi-structured interviews were recorded with audio equipment, transcribed and member checked. Thematic analysis was adopted to extract perceptions about programme participation, its benefits and drawbacks.

Results

Results indicated that a combination of the mental illness and effects of medication were the main barriers to participation. The main enabling factors to participation were the support of the mental health staff and the organisation and structure of the physical activity sessions. Emerging themes illustrate the benefits of physical activity in enhancing mental well-being, physical health and in providing social opportunities.

Conclusion

This qualitative research demonstrates that a physical activity programme integrated into the mental health service and supported by partnership working can address several of the unique barriers faced by this population. Through the provision of opportunity, appropriate support and structure of the sessions, people with SEMI can take part in sustained regular physical activity. Outcomes indicate benefits to mental well-being which can assist in recovery of those with SEMI and help with adherence to the programme.

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

Creativity and bipolar disorder: Touched by fire or burning with questions?

Creativity and bipolar disorder: Touched by fire or burning with questions? Clinical Psychology Review, 2012, Volume 32, Issue 1, pp. 1-12

Johnson, Sheri, L. et al.

Abstract:

Substantial literature has linked bipolar disorder with creative accomplishment. Much of the thinking in this area has been inspired by biographical accounts of poets, musicians, and other highly accomplished groups, which frequently document signs of bipolar disorder in these samples. A smaller literature has examined quantitative measures of creativity among people with bipolar disorder or at risk for the disorder. In this paper, we provide a critical review of such evidence. We then consider putative mechanisms related to the link of bipolar disorder with creativity, by drawing on literature outside of bipolar disorder on personality, motivational, and affective predictors of creativity. Because so little research has directly evaluated whether these factors could help explain the elevations of creativity in bipolar disorder, we conclude with an agenda for future research on the theoretically and clinically compelling topic of creativity in bipolar disorder.

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

The Measure of Insight into Cognition: Reliability and validity of clinician-rated and self-report scales of neurocognitive insight for schizophrenia

The Measure of Insight into Cognition: Reliability and validity of clinician-rated and self-report scales of neurocognitive insight for schizophrenia, Schizophrenia Research, 2012,Volume 134, Issue 1, pp.54-58

Alice M. Saperstein, Julie Thysen, Alice Medalia

Abstract:

Poor insight into the neurocognitive deficits in schizophrenia-spectrum disorders may have significant clinical implications for treatment. The purpose of this study was to replicate and extend the psychometric findings initially reported on the Measure of Insight into Cognition Clinician-Rated (MIC-CR) and Self-Report (MIC-SR) which assess awareness, attribution, and frequency of neurocognitive deficits. Assessments conducted one week apart allowed for internal consistency, test–retest reliability, concurrent validity, and administration order effects to be determined. In this study sample (N = 80), 73 demonstrated significant neurocognitive impairment, yet on the MIC-CR, the average awareness and attribution scores indicated only partial awareness and attribution of neurocognitive deficits. The average MIC-SR score indicated rare frequency of cognitive difficulty in everyday life. Cronbach’s alphas for the MIC-CR (0.83) and MIC-SR (0.93) were consistent with the initial validation study; test–retest reliability for both MIC assessments was significant (p < 0.001). In new analyses, concurrent validity was demonstrated by significant correlations between the MIC-CR and MIC-SR in the first validation sample: r = − 0.75 (p < 0.001) and the current replication sample: r = − 0.70 (p < 0.001). Effect sizes were large when frequencies of neurocognitive complaints (MIC-SR) were compared between subjects with good versus poor awareness on the MIC-CR. Reliability and concurrent validity results were similar and significant regardless of order of MIC-CR and MIC-SR administration. The MIC-CR and MIC-SR are thus reliable and valid complementary instruments to assess neurocognitive insight in people with schizophrenia spectrum disorders.

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

Action Research & Innovation – An action research approach for developing research and innovation in nursing and midwifery practice: Building research capacity in one NHS foundation trust

An action research approach for developing research and innovation in nursing and midwifery practice: Building research capacity in one NHS foundation trust, Nurse Education Today, 2012, Vol. 32 (1) pp.39-45

Jenny Moore, Kenda Crozier, Katharine Kite

Abstract:

The National Health Service in the United Kingdom is committed to a process of reform centred on quality care and innovative practice. Central to this process is the need for research capacity building within the workforce. The aim of this study was to develop an infrastructure for research capacity building within one National Health Service Foundation Trust. Using an Action Research methodology, sixteen individuals were purposefully selected from a population of nurses and midwives to participate in the study. This nonprobability sampling method enabled the researchers to select participants on the basis of who would be most informative about existing research capacity building structures and processes within the Trust. Data were collected in the form of semi-structured individual interviews with each participant. The main findings were that research activity was not embedded in the culture of the organisation, and initiating and undertaking change was a complex process. As a result, a range of structures and processes which were considered necessary to enable the Trust move forward in developing capacity and capability for research were developed and implemented. This paper reports the first two stages of this process, namely: the findings from the pre-step and an outline of how these findings were used to create an infrastructure to support research capacity building within one NHS Foundation Trust Hospital in the United Kingdom.

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

Innovation & Nursing – Team learning and innovation in nursing, a review of the literature

Team learning and innovation in nursing, a review of the literature, Nurse Education Today, 2012, Volume 32, Issue 1, pp. 65-70

Olaf Timmermans, et al.

Abstract:

The capability to learn and innovate has been recognized as a key-factor for nursing teams to deliver high quality performance. Researchers suggest there is a relation between team-learning activities and changes in nursing teams throughout the implementation of novelties. A review of the literature was conducted in regard to the relation between team learning and implementation of innovations in nursing teams and to explore factors that contribute or hinder team learning. The search was limited to studies that were published in English or Dutch between 1998 and 2010. Eight studies were included in the review. The results of this review revealed that research on team learning and innovation in nursing is limited. The included studies showed moderate methodological quality and low levels of evidence. Team learning included processes to gather, process, and store information from different innovations within the nursing team and the prevalence of team-learning activities was contributed or hindered by individual and contextual factors. Further research is needed on the relation between team learning and implementation of innovations in nursing.

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

MBSR – 8-week mindfulness training program might increase mindful awareness in daily life and have beneficial impact on clinically relevant emotion regulation processes

Effects of mindfulness-based stress reduction on emotional experience and expression: a randomized controlled trial, Journal of Clinical Psychology, 2012,  68 (1) pp. 117–131

Robins, C. J., Keng, S.-L., Ekblad, A. G. and Brantley, J. G.

Abstract:

Objectives: Mindfulness-based stress reduction (MBSR) has been found to reduce psychological distress and improve psychological adjustment in medical, psychiatric, and nonclinical samples. We examined its effects on several processes, attitudes, and behavior patterns related to emotion regulation. Design: Fifty-six adults were randomly assigned to MBSR or to a waiting list (WL). Results: Compared with WL completers (n = 21), MBSR completers (n = 20) reported significantly greater increases in trait mindfulness and decreases in absent-mindedness, greater increases in self-compassion, and decreases in fear of emotions, suppression of anger, aggressive anger expression, worry, and difficulties regulating emotions. The WL group subsequently received MBSR, and the two groups combined showed significant changes on all of these variables from pre-MBSR to post-MBSR, and on all except the 2 anger variables from pre-test to 2-month follow-up, as well as significant reductions in rumination. Conclusion: An 8-week mindfulness training program might increase mindful awareness in daily life and have beneficial impact on clinically relevant emotion regulation processes.

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

Beliefs and personality disorders: an overview of the personality beliefs questionnaire

Beliefs and personality disorders: an overview of the personality beliefs questionnaire, Journal of Clinical Psychology, 2012, vol.68 (1) pp. 88–100

Bhar, S. S., Beck, A. T. and Butler, A. C

Abstract:

Objective: This article presents an overview of the Personality Beliefs Questionnaire (PBQ)—a 126-item self-report measure of beliefs associated with 10 personality disorders. Design: It consolidates the literature on the PBQ over the last 20 years to provide a summary of the psychometric status, revisions and applications of the PBQ scales. Results: The PBQ scales are psychometrically reliable (α = 77–94, test-retest stability r=.57–.93) and discriminate between individuals with and without a specific personality disorder. Two revisions have been made to the measure: A 14-item subscale measuring beliefs central to borderline personality disorder has been identified, and a short form version of the PBQ has been validated. The PBQ has been used to measure cognitive mechanisms of treatment outcomes, and has been found to be sensitive to changes in beliefs. Conclusions: Given the proposed shift in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) to a dimensional conceptualization of psychological components of personality dysfunction, the PBQ is likely to remain relevant and useful for identifying such components in individuals with personality disorders.

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

Art therapy can facilitate verbal and non-verbal communication about psychotropic medication treatment, especially when shame and stigma affects an individual’s compliance with and/or decision to choose medication treatment

Psychotropic medication and art therapy: Overview of literature and clinical considerations, The Arts in Psychotherapy (February 2011), 38 (1), pg. 29-35 

Charleen Dere-Meyer, Brooke Bender, Einat Metzl, Kathryn Diaz

Abstract:

This paper reviews literature regarding psychopharmacological treatment options for ADHD, depression and dual diagnosis, and explores perceptions of treatment and considerations for art therapy in conjunction with psychotropic medication. This review attempts to initiate discussion and propel further research in the expressive arts field regarding the growing need to conceptualize our understandings of the role art therapy plays in combined treatment with psychopharmacology.

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

Arts therapies for young offenders in secure care – A practice-based research

Arts therapies for young offenders in secure care—A practice-based research, The Arts in Psychotherapy (February 2011), 38 (1), pg. 41-51 

Henk Smeijsters, Julie Kil, Han Kurstjens, Jaap Welten, Gemmy Willemars

Abstract:

This article describes the results of the first phase of a research project to develop, implement, evaluate, and improve arts therapies interventions for young offenders in secure care. By means of a naturalistic/constructivistic research methodology in combination with grounded therapy methodology, practice-based evidence has been generated. Core problems of young offenders that are connected to delinquency have been described and arts therapies interventions have been developed that can be used to change these core problems. Core problems are problems with self-image, with expressing and discharging emotions, the inability to resolve interpersonal problems and finally, negative cognitions. In co-creation with practitioners, interventions have been developed for drama therapy, music therapy, art therapy and dance-movement therapy. A treatment theory has been developed that explains the working of arts therapies by means of the first author’s theory of analogy. This theory explains arts therapies by means of the equality between forms of expression in art and the core self consciousness as described by Damasio and the vitality affects within the core self as described by Stern.

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

Establishing a new Personality Disorder Service is akin to constructing a ‘home’ within which the therapeutic work with patients can develop

Emerging as a Personality Disorder Service, Psychoanalytic Psychotherapy, Volume 25, Issue 2, 2011, pp. 191-208

 

Barry Jones & Steve Miller

 

Touchstone Centre, Bethlem Royal Hospital, Kent, UK

SW London and St George’s Mental Health NHS Trust, Springfield University Hospital, London, UK

 

Abstract:

Personality Disorder Services working along psychotherapeutic lines are gaining appeal with Health Care Commissioners following the publication of the NICE guidelines for Borderline & Antisocial Personality Disorders and the emerging successful application of psychoanalytically-derived approaches.

Establishing a new Personality Disorder Service is akin to constructing a ‘home’ within which the therapeutic work with patients can develop. As clinicians, we are required to question what facets are important to the development of this new home, and to further to endure the unfamiliar state of being ‘not at home’ while the identity of the service is established.

We address how this process parallels the task facing the patient as they struggle to establish their own identity. We also highlight some important tenets in the work of securing a robust identity for both the service and the patient suffering from a personality disorder.

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

Gender dysphoria: recognition and assessment

Gender dysphoria: recognition and assessment,  Advances in Psychiatric Treatment, 2012, Vol.18 (1) pp. 2-11

Dr Kevan Wylie, Porterbrook Clinic, Nether Edge Hospital, Sheffield S11 9BF, UK

Abstract:

 

The role of the mental health professional, and of the psychiatrist in particular, is evolving and changing. As the recognition of transsexualism and gender identity disorder expands across the transgender spectrum, it has been recommended that gender dysphoria should replace existing diagnostic terminology. Patient-focused care is evolving and this article considers the limitations of current healthcare settings and how the mental health professional can support patients undergoing the real-life experience. Differentiation from other mental health conditions that may present as gender dysphoria is outlined, as well as specific clinical situations.

 

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

Self-harm – The solution not the problem: The Dialectical Behaviour Therapy Model

Self-harm – The solution not the problem: The Dialectical Behaviour Therapy Model, Psychoanalytic Psychotherapy, Volume 24, Issue 2, 2010, pp. 115-134

Janet Feigenbaum

 

Abstract:

Self-harming behaviour is an increasing problem for families and health services. Over the past two decades a number of models to explain and treat self-harming behaviour have emerged. One such model arises from Dialectical Behaviour Therapy (DBT), which was originally developed and evaluated for the treatment of women diagnosed with Borderline Personality Disorder (BPD) in the community. This paper will review how the DBT model provides an understanding of self-harming behaviour and provide evidence for the efficacy of DBT. The DBT model suggests that self-harming behaviour arises as a strategy to manage overwhelming affect. Thus interventions aimed at increasing emotional regulation and problem-solving are likely to be effective in reducing self-harming behaviour.

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

Eating disorders: clinical features and the role of the general psychiatrist

Eating disorders: clinical features and the role of the general psychiatrist, Advances in Psychiatric Treatment, 2012, Vol.18 (1) pp 34-43

William Rhys Jones, Monique Schelhase, and John F. Morgan

Yorkshire Centre for Eating Disorders, Newsam Centre, Seacroft Hospital, York Road, Seacroft, Leeds, West Yorkshire LS14 6WB, UK

Abstract:

Although most patients with severe eating disorders are treated in specialist eating disorder services, general psychiatrists are often responsible for the care of many with mild to moderate disorder. Treating and supporting these patients in a non-specialist setting can sometimes be challenging but this need not be the case. Having a clear understanding of the clinical features of these conditions forms the foundation on which a comprehensive assessment and management plan can be made. We summarise the clinical features of eating disorders and explore the unique role of the general psychiatrist in identifying people with these conditions, supporting them and directing them into evidence-based treatments.

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

Rare and unusual dementias – Further rare and unusual dementias

Further rare and unusual dementias, Advances in Psychiatric Treatment, 2012, Vol.18 (1) pp. 67-77

Susham Gupta, Olivia Fiertag, Thanakumar Thanulingam, Elena Ros, Bryan Strange, and James Warner

Abstract:

In the second of two articles on rare causes of dementia, the authors describe toxic, iatrogenic, nutritional, traumatic, metabolic, neoplastic and autoimmune causes of dementia. Disorders are graded according to their prevalence, to give an idea of the likelihood of their presentation. Guidance is given on the investigation of uncommon cognitive impairment and dementia, especially in early-onset illness.

1st Article

Rare and unusual dementias , Advances in Psychiatric Treatment, 2009 15:364-371

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

Personality disorder: its impact on staff and the role of supervision

Personality disorder: its impact on staff and the role of supervision,  Advances in Psychiatric Treatment, January 2012 Vol.18 (1) pp.44-55

Estelle Moore – Lead Psychologist, Centralised Groupwork Service, Broadmoor Hospital, Crowthorne RG45 7EG, UK

Abstract:

Over the past decade attention to the provision of healthcare for individuals with personality disorder, particularly those who pose a risk to others, has substantially increased. Keeping pace with such developments with a suitably trained, consistent and motivated workforce, interfacing health and criminal justice systems where necessary, presents an enormous challenge. Staff must be experts in managing conflict at every level, while sustaining an optimistic and therapeutic orientation. Boundaried relationships provide the context for recovery for patients. Key principles and practices likely to promote resilience in personality disorder services, with a focus on the role of supervision, are outlined in order to support staff in keeping themselves afloat, their patients safe, and their services on target.

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

Staging the HCR-20: towards successful implementation of team-based structured professional judgement schemes

Staging the HCR-20: towards successful implementation of team-based structured professional judgement schemes, Advances in Psychiatric Treatment, 2012, Vol.18 (1), pp. 59-66

Quazi Haque and Christopher D. Webster

Partnerships in Care, 2 Imperial Place, Maxwell Road, Borehamwood, Hertfordshire, WD6 1JN, UK

Abstract:

Structured professional judgement risk management schemes such as the Historical, Clinical, Risk Management – 20 (HCR-20) can be described as clinical guidelines produced by a collaborative process between mental health clinicians and researchers. The purpose is to provide clinicians with a framework to guide interventions designed to manage specific risks such as violence against others. The use of evidence-based clinical methods, especially in a multidisciplinary setting, is now commonly considered a best-practice approach when managing violence and related risks. This article describes some of the practical implementation challenges that may arise when using schemes such as the HCR-20 in multi-disciplinary team meetings.

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

Metacognition in schizophrenia: The relationship of mastery to coping, insight, self-esteem, social anxiety, and various facets of neurocognition

Metacognition in schizophrenia: The relationship of mastery to coping, insight, self-esteem, social anxiety, and various facets of neurocognition, British Journal of Clinical Psychology, 2011, vol.50 (4) pp. 412–424

Paul H. Lysaker, Molly Erickson, Jamie Ringer, Kelly D. Buck, Antonio Semerari, Antonino Carcione and Giancarlo Dimaggio

Abstract:

Objectives. Deficits in metacognition, or the ability to think about thinking, are common in schizophrenia and associated with functional impairment. Unknown are what elements of function are affected by what aspects of metacognition.

Design. This study explored whether participants with differing capacities for Mastery, a domain of metacognition that reflects the ability to use knowledge about mental states to respond to psychological challenges, had difficulties in different elements of daily function.

Methods. Participants were 98 adults with schizophrenia or schizoaffective disorder in a non-acute phase, classified into three groups on the basis of ratings of their capacity for metacognitive Mastery using the Metacognitive Assessment Scale: low Mastery (those unable to plausibly represent psychological challenges), Intermediate Mastery (those able to plausibly represent psychological problems but cope primarily through passive measures or avoidance), and high Mastery (those able to cope with plausible problems through cognitive means). Participants completed assessments of coping preference, insight, self-esteem, and anxiety.

Results. Multivariate Analysis of Variance (MANOVA) and Analysis of Variance (ANOVA) revealed that the high-Mastery group had a greater preference for coping with stressors by thinking and talking about them, and greater insight than all other groups, and higher levels of feeling accepted by peers than the intermediate-Mastery group. The intermediate-Mastery group reported higher levels of resignation when facing stressors and more social phobia than the other two groups. These findings of Mastery group differences in self-esteem and anxiety persisted when neurocognition was controlled for in an Analysis of Covariance (ANCOVA).

Conclusions. Mastery appears linked to coping preference, insight, self-esteem, and anxiety in a generally non-linear manner.

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

Factors associated with length of admission at a medium secure forensic psychiatric unit

Factors associated with length of admission at a medium secure forensic psychiatric unit, Journal of Forensic Psychiatry & Psychology, 2011,Volume 22, Issue 4, pp. 496-512

Amar Shah, Gerard Waldron, Neil Boast, Jeremy W. Coid & Simone Ullrich

John Howard Centre, London, UK

Forensic Psychiatry Research Unit, Queen Mary University of London, UK

Abstract:

There is an increasing trend for patients detained in medium secure units (MSUs) to stay for longer than 2 years. Little information is currently available on factors which determine prolonged stay. The study aimed to identify characteristics associated with prolonged length of stay in a MSU in East London. Stay for more than 2 years was associated with diagnosis of psychotic disorder, multiple previous admissions, detention under a hospital order, being on a restriction order, and a history of moderately violent offending. Factors indicating risk of future violence were not found to be associated with length of admission. Beds in this MSU were blocked by a cohort of patients with specific clinical characteristics and needs, indicating that reconfiguration of services is required to provide rehabilitation at lower levels of security.

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

Women’s experience of forensic mental health services: implications for practice

Women’s experience of forensic mental health services: implications for practice, Journal of Mental Health Training, Education and Practice, The, 2011, Vol. 6 Iss: 4, pp.186 – 194

Kerry Cooke, Mental Health Social Worker at Homeless Services, St Nicholas Hospital, Newcastle upon Tyne, UK, Di Bailey, Professor of Mental Health at School of Social Sciences, Nottingham Trent University, Nottingham, UK

Abstract:

The aim of this pilot study is to explore women’s experiences of forensic mental health care with a view to designing a larger scale research project.

Methodology/approach – In-depth interviews were undertaken with seven self-selected women who had experience of using secure services currently or in the past.

Findings – The findings revealed three key themes: women’s experiences of settings and treatments; relationships with staff; and how placements impacted upon important social contacts with family and friends. Despite their relatively disadvantaged position, the women were able to articulate what worked and offered clear solutions for implementing best practice.

Originality/value – The women’s experiences testified to the importance of meaningful relationships with professionals, and with families and friends, as protective factors to help manage risk. This “relational security” is particularly for women in secure services and can be promoted in a range of ways, hinging upon consistency of care, well managed transitions, and appropriate therapeutic treatment.

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