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Polyarthralgia with oral risperidone.Risperidone is a commonly used antipsychotic. Due to its widespread use, health professionals are well aware of its common side-effects. However, there are some side-effects (though rare in practice) that are disabling, distressing and cause severe suffering to patients, and these can have the potential of being missed. Here the authors report one such side-effect of risperidone, namely polyarthralgia.
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“Flow” Transcranial Direct Current Stimulation (tDCS) for depression treatment in a Community Mental Health Team (CMHT) service: depression, functioning, and health-related quality of life outcomesBackground: People who experience severe mental illness (SMI) have a high prevalence of depression symptoms, which is linked to worse functioning and quality of life. Research evidence indicates that transcranial direct current stimulation (tDCS) can reduce symptoms of depression. Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application that delivered wellbeing behaviour therapy training. Purpose/Aim: This study investigates if Flow can be introduced to a Community Mental Health Team (CMHT) service and the impact of Flow in treating depression. The study addresses the questions: “what are the depression reliable improvement and remission rates?” and “can Flow significantly reduce depressive symptoms and improve real world functioning (everyday, social and occupational functioning) and health-related quality of life?”. Methods: An open-label patient cohort design with no control group. Pre-intervention and 6-week follow-up intervention assessments using the participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and EuroQol five-dimension (EQ-5D-5L). Participants were 31 CMHT patients, 15 males and 16 females, with an age range of 21 to 64 years, and average age of 42 years. Results: PHQ-9 reliable improvement and remission rates were 51.61% and 12.9%, respectively. PHQ-9 scores significantly improved, from 20.9 (SD 5.55) to 14.6 (SD 7.33) at 6 weeks, with large effect size. WSAS scores improved from 31.3 (SD 6.02) to 22.5 (SD 11.43) at 6 weeks, with large effect size. EQ-5D-5L results showed significant improvements in the health index score, and three EQ-5D-5L dimensions (“mobility”, “self-care”, and “pain”). Conclusion: Flow tDCS treatment was integrated into a CMHT service and was found to be beneficial in terms of improving functioning and quality of life and reducing depression symptoms. Flow FL100 tDCS and wellbeing behaviour therapy training could be offered through all CMHT services to people with SMI to treat depression, enable better functioning, and improve quality of life.
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Self-administered “Flow” Transcranial Direct Current Stimulation (tDCS) depression treatment in a Crisis Resolution and home Treatment (CRT) service: functioning, and health-related quality of life outcomesBackground: Transcranial direct current stimulation (tDCS) has research evidence that it can reduce symptoms of depression. Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application that delivers wellbeing behaviour therapy training. Purpose/aim: The purpose of this study was to investigate if Flow can be introduced to a Crisis Resolution & Home Treatment (CRT) service and the impact of Flow in treating depression. The study addresses the questions: 1) “what are the depression reliable improvement and remission rates?” and 2) “can Flow significantly reduce depressive symptoms and improve real world functioning (every-day, social and occupational functioning) and health-related quality of life?”. Methods: An open-label patient cohort design with no control group. Pre-intervention and 6-week follow-up intervention assessments using the participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and EuroQol five-dimension (EQ-5D-5L). Participants were 49 CRT patients, 19 males and 30 females, with an age range of 20 to 66 years, and average age of 42 years. Results: PHQ-9 reliable improvement and remission rates were 57.1% and 14.3%. PHQ-9 scores significantly improved, from 23.1 (SD 3.44) to 14.8 (SD 6.82) at 6 weeks, with a large effect size. PHQ-9 suicide/self-harm related question significantly improved from 2.51 (SD 0.77) to 1.08 (SD 1.17), with a large effect size. WSAS scores significantly improved, from 33.6 (SD 5.22) to 21.9 (SD 10.82) at 6 weeks, with a large effect size. EQ-5D-5L results showed significant improvements in the health index score, global assessment of health EQ-VAS from 34.2 (22.26) to 51.6 (24.95), and three EQ-5D-5L dimensions (“self-care”, “usual activity”, and “anxiety/depression”). Conclusion: A CRT service effectively integrated Flow tDCS treatment. Flow was beneficial in terms of improving functioning and quality of life and reducing depression symptoms and thoughts of suicide/self-harm. Flow FL100 tDCS and wellbeing behaviour therapy training could be offered through all CRT services to treat depression, reduce thoughts of suicide/self-harm, enable better functioning, and improve quality of life.
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Conditionally Discharged Restricted Patients in a General Adult Community Mental Health SettingLittle is known about the proportion and patient profile of conditionally discharged patients supervised by general adult community mental health teams (CMHTs). In this study, the authors evaluate the number of patients and their demographic, clinical and risk profile, and current practice in terms of supervision and structures. Supervision in the community is time- and resource-intensive. There is a need for NHS Trusts to ensure adequate support and structures, supervision, training and joint working opportunity with forensic services to ensure safe quality care.
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Psychometric attributes associated with attrition within a prison-based democratic therapeutic communityPurpose The purpose of this paper is to examine the psychometric characteristics of male offenders who joined a democratic therapeutic community and their relationship to attrition. Design/methodology/approach Residents who left therapy prematurely during the assessment phase (N = 46) and residents who left therapy prematurely during core therapy (N = 202) were compared to residents who completed therapy (N = 52) on two psychometric measures: Raven’s Standard Progressive Matrices and The Blame Attribution Inventory. Findings A multinomial logistic regression analysis showed higher levels of external blame can predict attrition during therapy; those with higher levels of external attribution are significantly more likely to leave therapy prematurely, including both during the assessment phase and during core therapy. Raven's Standard Progressive Matrices score did not significantly predict whether an individual left therapy prematurely. Originality/value Support was found for existing research within the academic evidence base. The findings have both empirical and clinical utility, suggesting during the assessment phase of therapy, practitioners can identify residents that may require additional support to maintain engagement, minimising the potential for premature departure. The implications of the findings are discussed, with suggestions made for future research.
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Community treatment orders in an early intervention for psychosis serviceLittle is known about the use and effectiveness of community treatment orders (CTOs) in early psychosis. Here, the authors describe their service evaluation of patients within an NHS early intervention for psychosis service subject to CTO over a period of three years in order to evaluate the rates of CTO use, demographic, and clinical characteristics of those subject to CTO, as well as clinical outcomes. This study demonstrates how CTO use, where deemed necessary, can create real-life, positive outcomes for service users.
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The experience of navigating sexuality for transgender and gender non-conforming people: a meta-ethnographic reviewBackground The current research builds on a previous review of the literature which explored sexuality during gender transition. There has been increased attention toward TGNC people across academic, political, and healthcare fields since the previous review, as well as shifts in language use and health interventions, justifying a need for more contemporary understandings. Aim The current systematic review explores the experience of sexuality during gender transition. Methods A meta-ethnography was conducted on 16 papers that focused specifically on TGNC people’s experiences of their sexualities. Results The main findings were the intersection of gender and sexuality; the importance of re-writing labels around sexuality, bodies and relationships; (re)negotiating changes in sexual, romantic and/or physical relationships due to transitioning; and changes in a sense of community and belonging. Discussion The results have implications for supporting TGNC people navigating their identities by recognizing the multiple and intersecting levels of influence within which they are situated.
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You can’t be too many things: the experiences of gender-affirming care for trans people of color – a thematic analysisBackground: Barriers to healthcare and negative healthcare experiences are frequently reported by transgender people, which is known to be compounded by intersectional issues including racism. Aims: The present study aimed to explore the experiences of trans people of color accessing a national Gender Service in the United Kingdom, to better understand the facilitators and barriers to positive healthcare experiences. Methods: Six transgender people of color attended two separate focus groups. Thematic analysis was used to identify themes in the data. Results: Three themes were identified: The Western-biased model of gender-affirming care; the lack of diversity in support provided throughout medical transition; and lack of visibility and community. Participants talked of various ways in which their ethnicity and cultural backgrounds raised apprehensions and negative experiences within their gender-related care, such as assumptions being made about their transition process, and a general lack of visibility such as not seeing examples of the outcomes of surgeries and in community spaces. Conclusions: The findings are discussed in relation to previous research, noting that culturally-inclusive models of transition, increased access to diverse, inclusive community spaces and further research in this field is needed to improve healthcare experiences.
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Core20PLUS5: His Majesty’s Prison and Probation Service – an approach to address inequities in healthcare for people in contact with the criminal justice systemPeople involved in the criminal justice system are one of the population target cohorts of Core20PLUS5, a national National Health Service (NHS) England approach to support reduction of healthcare inequalities. For the health and justice system to be socially equitable, fair and just, the leadership across the health landscape has a central role to play to ensure this vulnerable group has an equitable opportunity for improved healthy life expectancy, regardless of their multiple disadvantages. On the 75th year of the inception of the NHS, this article is a call to action to bring about sustainable change through data reporting, digital innovation, accelerating preventative programmes and system leadership in order to achieve equitable access, excellent experience and optimal outcomes. It acknowledges the detrimental impact of crime and the importance of improving a range of health and social outcomes for this group.
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Birth trauma: the elephant in the nurseryMethod The current study used a multiperspectival (dyadic) IPA approach to interview eight participants (N = 4 heterosexual couples) where one parent was help-seeking for the experience of birth trauma. Results Analysis resulted in four superordinate themes: (1) From perfect plan to shattered reality, (2) Trauma in the healthcare system, (3) Trauma in the family system and (4) The post-trauma family: Navigating the new normal. Discussion Parents described a shared experience of birth trauma during birth. However, fathers’ perceived trauma ended in the delivery room whilst mothers’ continued far beyond this. The dyadic focus showed a divergence of experience postnatally: differing levels of awareness to distress existed between partners, mothers experienced bonding difficulties and parents took to separate coping mechanisms. The trauma remained invisible and unspoken as couples avoided discussions about the birth, coped silently and separately. The parents identity changed following the trauma as individuals, couples and as a family. Conclusion The time following a traumatic birth is experienced differently by mothers and fathers. Parents seldom discuss the trauma, hold differing perceptions of roles and needs, and struggle to support each postnatally. Clinical implications and recommendations are discussed.
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A service evaluation of the Behavioural Treatment for Substance Abuse (BTSA) programme for forensic dual diagnosis populationsLiterature links mental health problems comorbid with substance abuse with increased recovery time. There is limited research evaluating the effectiveness of substance abuse treatments for dual-diagnosis patients. This project aimed to evaluate the effectiveness of the BTSA group with this population. Questionnaires measuring motivation, locus of control, confidence to abstain and self-efficacy were administered to six different cohorts of BTSA participants (N = 38) at baseline, post, and follow-up stages. In addition, participants from the most recent BTSA cohort (N = 4) attended a post-program focus group, to provide information about their experiences of the intervention. Statistical analyses revealed that participants’ confidence in their ability to manage substance abuse was significantly higher post group, but the hypotheses that there would also be significant improvements in participants’ self-efficacy, motivation, and locus of control following completion of the program were not supported. Thematic analysis identified three key themes relevant to participants, namely validation, psychoeducation and identifying progress. This project provided valuable insights into participants’ experiences of the group, highlighting what they had gained form the intervention, and the impact on them from having Recovery Champions working in conjunction with NHS staff to facilitate the intervention. Limitations are discussed, alongside recommendations for improving the program.
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Evaluating social drop-in facilities and their impact on social recovery in early intervention in psychosis services“Social recovery” is a long-cited aim within the UK early intervention in psychosis (EIP) services; however, there is a lack of evidence regarding existing social recovery provisions and how these can be improved. This paper aims to evaluate an existing social drop-in facility within an EIP team, ran within the Birmingham and Solihull Mental Health NHS Foundation Trust, and highlight the potential benefits of delivering such services for people diagnosed with first episode psychosis. Attendance and basic demographic statistics (age, gender and ethnicity of attendees) were collected over a period of 13 weeks. In addition, two semi-structured focus groups were conducted: one with EIP staff members (community psychiatric nurses and support workers) and the other with current service users, with both groups describing their satisfaction and experience of the drop-in facility and how it can be improved. Inductive thematic analysis was used to analyse data from both focus groups, with six overarching meta-themes being identified: reflection, environment, emotional experience, recovery, activities and interactions. Service users and staff reflected that the drop-in facility was an asset to the service, although work could be done to improve overall attendance. This paper explores how a social drop-in facility can provide a supportive, positive environment that aids recovery from psychosis for service users and improves working conditions for the EIP staff.
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Clinical practice guideline for clozapine use in patients with COVID-19National and local guidelines focus mainly on clozapine monitoring frequency, and actions based on full blood count results. Prescribing clozapine in the context of COVID-19-positive patients brings a complexity of challenge beyond this. In this article the authors put forward an example of a practical clinical guideline in this regard.
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Changes in parental sleep from pregnancy to postpartum: a meta-analytic review of actigraphy studiesSleep changes in new parents are widely observed but there is no extant meta-analysis of changes to sleep parameters in this group. We completed a meta-analysis of changes in actigraphy-measured parent sleep between pregnancy and the end of the first year of a child's life. A search of six databases was completed. Following review using predetermined inclusion and exclusion criteria, 16 papers were left for review. Data were extracted, analysed and each paper was reviewed for methodological quality. Where possible, subgroup analysis was completed based on time since birth and location of the study, and meta-regression of parent age. Parents' total sleep time and sleep efficiency were shown to decrease following the birth of a child, with wake after sleep onset increasing. This change was most notably observed in the first four weeks after birth. Up to 16 weeks post-birth, differences were still apparent, but sleep parameters were beginning to return to pre-birth levels. New parents experience a significant change in multiple sleep parameters following the birth of a child. Future data collection, using best practice actigraphy measurement, reporting a broader range of variables and including fathers, as well as mothers, is warranted.
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Compassion and gender diversity: evaluation of an online compassion-focused therapy group in a gender serviceTransgender and gender non-conforming (TGNC) people may experience minority stress and internalised transnegativity, leading to increased psychological distress. Self-compassion has been suggested as a protective factor which can buffer against the impact of minority stress and stigma. This service evaluation study examined the outcomes of a novel compassion-focused therapy group intervention delivered online in a Gender Service. Twenty-one TGNC adults participated in the group and completed pre-group and post-group measures of psychological distress, internalised transnegativity, and compassion to self, to others, and from others. Participants had high levels of psychological distress and low levels of self-compassion pre-group. At the group level, there was a significant increase in levels of compassion to self and from others, and a significant decrease in pride (reverse scored) and alienation internalised transnegativity subscales. At an individual level, compassion to self and compassion from others were the most frequent areas where significant change was observed post-group. The compassion-focused therapy group appears to be effective in increasing levels of self-compassion and reducing aspects of internalised transnegativity, but without clear impact on psychological distress. This is preliminary evidence in support of the use of compassion-focused therapy groups within gender services, but further research is warranted and encouraged.
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Automated virtual reality cognitive therapy versus virtual reality mental relaxation therapy for the treatment of persistent persecutory delusions in patients with psychosis (THRIVE): a parallel-group, single-blind, randomised controlled trial in England with mediation analysesBackground Persecutory delusions are a major psychiatric problem that often do not respond sufficiently to standard pharmacological or psychological treatments. We developed a new brief automated virtual reality (VR) cognitive treatment that has the potential to be used easily in clinical services. We aimed to compare VR cognitive therapy with an alternative VR therapy (mental relaxation), with an emphasis on understanding potential mechanisms of action. Methods THRIVE was a parallel-group, single-blind, randomised controlled trial across four UK National Health Service trusts in England. Participants were included if they were aged 16 years or older, had a persistent (at least 3 months) persecutory delusion held with at least 50% conviction, reported feeling threatened when outside with other people, and had a primary diagnosis from the referring clinical team of a non-affective psychotic disorder. We randomly assigned (1:1) patients to either THRIVE VR cognitive therapy or VR mental relaxation, using a permuted blocks algorithm with randomly varying block size, stratified by severity of delusion. Usual care continued for all participants. Each VR therapy was provided in four sessions over approximately 4 weeks, supported by an assistant psychologist or clinical psychologist. Trial assessors were masked to group allocation. Outcomes were assessed at 0, 2 (therapy mid-point), 4 (primary endpoint, end of treatment), 8, 16, and 24 weeks. The primary outcome was persecutory delusion conviction, assessed by the Psychotic Symptoms Rating Scale (PSYRATS; rated 0–100%). Outcome analyses were done in the intention-to-treat population. We assessed the treatment credibility and expectancy of the interventions and the two mechanisms (defence behaviours and safety beliefs) that the cognitive intervention was designed to target. This trial is prospectively registered with the ISRCTN registry, ISRCTN12497310. Findings From Sept 21, 2018, to May 13, 2021 (with a pause due to COVID-19 pandemic restrictions from March 16, 2020, to Sept 14, 2020), we recruited 80 participants with persistent persecutory delusions (49 [61%] men, 31 [39%] women, with a mean age of 40 years [SD 13, range 18–73], 64 [80%] White, six [8%] Black, one [1%] Indian, three [4%] Pakistani, and six [8%] other race or ethnicity). We randomly assigned 39 (49%) participants assigned to VR cognitive therapy and 41 (51%) participants to VR mental relaxation. 33 (85%) participants who were assigned to VR cognitive therapy attended all four sessions, and 35 (85%) participants assigned to VR mental relaxation attended all four sessions. We found no significant differences between the two VR interventions in participant ratings of treatment credibility (adjusted mean difference –1·55 [95% CI –3·68 to 0·58]; p=0·15) and outcome expectancy (–0·91 [–3·42 to 1·61]; p=0·47). 77 (96%) participants provided follow-up data at the primary timepoint. Compared with VR mental relaxation, VR cognitive therapy did not lead to a greater improvement in persecutory delusions (adjusted mean difference –2·16 [–12·77 to 8·44]; p=0·69). Compared with VR mental relaxation, VR cognitive therapy did not lead to a greater reduction in use of defence behaviours (adjusted mean difference –0·71 [–4·21 to 2·79]; p=0·69) or a greater increase in belief in safety (–5·89 [–16·83 to 5·05]; p=0·29). There were 17 serious adverse events unrelated to the trial (ten events in seven participants in the VR cognitive therapy group and seven events in five participants in the VR mental relaxation group). Interpretation The two VR interventions performed similarly, despite the fact that they had been designed to affect different mechanisms. Both interventions had high uptake rates and were associated with large improvements in persecutory delusions but it cannot be determined that the treatments accounted for the change. Immersive technologies hold promise for the treatment of severe mental health problems. However, their use will likely benefit from experimental research on the application of different therapeutic techniques and the effects on a range of potential mechanisms of action.
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Racialised minority women's experiences of psychological intervention across perinatal and maternal mental health services.Policies such as The Perinatal Mental Health Care Pathways document (2018) state mothers and birthing people experiencing psychological difficulties should have timely access to evidence-based psychological therapies. However, psychological distress often goes unidentified in racialised minority women and birthing people who have poorer experiences and outcomes within perinatal contexts compared to White women. Whilst limited research has focused on this within the perinatal period, there is greater recognition concerning how culturally sensitive practices can facilitate equity in care outcomes. This service evaluation aimed to explore racialised minority women's experiences of psychological intervention within a Perinatal and a Maternal Mental Health Service to evaluate service provision and inform service development. Semi-structured interviews with eight women who accessed psychological intervention were analysed using thematic analysis. Two superordinate themes were constructed, with findings suggesting participants had mostly positive experiences of psychological intervention. Cornerstones of therapeutic engagement comprised six subthemes: empathy, flexibility, the utility of psychological approaches, acknowledging family and community systems, points of difference and cultural context as a 'spotlight'. This theme encapsulated psychological therapist's relational and interventional approaches alongside participant preferences which influenced intervention experiences. Therapists were generally experienced as empathic and flexible although some participants desired greater flexibility relating to various practical aspects. Psychological approaches were experienced as beneficial although some wanted greater exploration of childhood trauma and found trauma-focused CBT emotionally demanding. Most participants preferred female therapists due to various socio-cultural reasons and felt systemic factors and their cultural context were acknowledged which enhanced the therapeutic relationship and outcomes where relevant with the inverse also apparent. History repeating itself comprised three subthemes (lack of representation, mistrust of the system and disorientation in help-seeking). This reflected mainly Black participants' negative healthcare experiences and structural racism. Therapeutic and organisational implications are discussed. Copyright © 2024, British Psychological Society. All rights reserved.
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What next for adolescent forensic mental health research?Background A small proportion of every nation's young people become sufficiently antisocial to come into contact with the criminal justice system. Many also have disorders of mental health or emotional well-being. Although countries vary in designating age of criminal responsibility, all must provide services for offenders, perhaps as young as 10, both to help them and safeguard their peers and the wider public. Aim The aim of this article is to map the range of research required to support the development of satisfactory services for young mentally disordered offenders and identify knowledge gaps from a practitioner's perspective. Methods Using a public health prevention framework, we identified the main streams of research pertinent to young, mentally disordered offenders and sought examples of each to consider the extent to which they have been used to inform service development in England. Findings As in most countries, service development seems first driven by unusual, newsworthy cases. Overall, however, current English provision follows sound primary, secondary, and tertiary prevention principles with parallel tiers of service, including public health initiatives. Primary prevention and more specific treatments are likely to be informed by research findings, but service structure tends to emerge from a wider review base, including criminal justice, social and educational practitioner reviews, and also politics. Thus, services and populations of service users may change in advance of research evidence. Substantial reduction in numbers of young offenders in prison in England, for example, is clearly good in principle, but the intensity of need in the residual group is posing new challenges to which there are, yet, few answers. Conclusions Although the last 15 years of coordinated service development in England has been broadly theoretically based, it has not been systematically assessed to establish what works best for whom. New problems emerging, such as new drugs of misuse, and new opportunities, such as technology for supporting and monitoring, require model studies. More research focusing on correlates of success is essential.
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What racialised aspiring clinical psychologists need from a mentoring schemeIt has been long recognised that there is an increased gap between the application and acceptance rates of racialised applicants to clinical psychology training in the UK, relative to White applicants. In 2020, Health Education England released funding for UK training programmes to develop mentoring schemes for aspiring clinical psychologists from racialised groups. This study was undertaken to explore how such mentoring schemes might best support racialised applicants. Three focus groups, comprising a total of 24 racialised aspiring, trainee, and qualified clinical psychologists, were undertaken to gather views regarding how a mentoring scheme could support racialised aspiring clinical psychologists. Data was analysed utilising reflexive thematic analysis. Three themes were developed: ‘Gaining Access to a White Profession – What’s the White thing to say?’ captured participants’ views that mentoring schemes should support mentees to present themselves in ways that fit with what selection assessors will be looking for. ‘A Safe Space to Explore the Impact of Racialisation’ related to the importance of mentoring schemes creating safe opportunities to make sense of the impact of racism within their career. ‘Troubling Whiteness’ spoke to the importance of mentees being empowered to think with other racialised individuals about ways they could actively address Whiteness within the profession and services. The three themes have implications for the delivery and evaluation of mentoring schemes for racialised aspiring clinical psychologists.
