Recent Submissions

  • “Well-Track”: Fitbit based physical activity and sleep hygiene intervention for early intervention in psychosis (EIP) and at-risk mental state (ARMS) service patients

    Griffiths, Chris; Jugon, Sue; Jiang, Harmony; Rogers, Rowena; Althorpe, Thomas; Davis, Josephine; Morris, Andrea; Redding, Neil; Walker, Kate; Kelbrick, Marlene (2023)
    Background: Compared to the general population, people who are at a high risk of or experience severe mental illness (SMI) such as psychosis, are more likely to have low levels of physical activity, high levels of sedentary behaviour, and sleep problems. Intervention: The Well-Track intervention comprises a wearable activity and sleep tracker (Fitbit); one session with mental health service staff providing physical activity and sleep hygiene advice; a brief motivational interview; completing a goal setting workbook; and one or two further engagement, feedback and discussion sessions. Participants: Twenty-four participants using an early intervention in psychosis (EIP) or at-risk mental state (ARMS) service completed an eight-week, three session intervention (14 males and 10 females), with an age range of 18 - 61, and average age of 27.75 years. Methods: An open-label patient cohort design with no control group. Pre-intervention, 4-week and 8-week intervention assessments using participant self-report measures: Patient Health Questionnaire (PHQ-9) (depression), Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS), and Sleep Conditioning Index (SCI); and clinician measurement of body weight. Results: Mean scores showed a significant improvement in PHQ-9 from 9.29 (SD 5.89) to 5.58 (SD 3.68) at 4 weeks and to 5.83 (SD 4.40) at 8 weeks, with large effect sizes. For those who met a diagnosis of depression at baseline, at 4 week follow-up seven participants (26%) experienced remission and nine (33%) reliable improvement, and at 8 week follow-up four (21%) experienced remission and seven (37%) reliable improvement. WEMWBS scores significantly improved, from 44.04 (SD 9.44) to 48.54 (SD 8.71) at 4 weeks and to 48.67 (SD 8.76) at 8 weeks, with large effect sizes. Body weight did not change significantly, remaining unchanged at 4 weeks and reduced from a mean of 82.8 kg (baseline) to 80.15 kg at 8 weeks, a reduction of 2.65 kg. Conclusion: Well-Track was integrated into an EIP and ARMS service and was found to be beneficial in terms of wellbeing, depression, sleep, and preventing weight gain (either as a two or three engagement point intervention). Well-Track could be delivered through EIP and ARMS services to promote healthy lifestyle behaviours.
  • Patient reported experience of electroconvulsive therapy (ECT)

    Griffiths, Chris; O'Neill-Kerr, Alex (2018)
    Objective Negative attitudes towards Electro Convulsive Therapy (ECT) persist, despite the evidence of its clinical efficacy and benefits. This is partially due to negative media portrayals, inaccurate information and prohibitive consent processes. The aim of this study is to review patient ECT experience literature and report patients’ perspective of their ECT experience. Methods A patient data and insight platform was employed to gain patient satisfaction and patient feedback statements of their experiences of ECT in an UK National Health Service (NHS) provider. Results Patients feel well informed, involved in decisions made about them, treated with dignity and respect, and treated well by the staff; and almost all patients would recommend the hospital delivering ECT. Findings show that interactions with staff have a positive effect on patient satisfaction and experience. Patients describe how ECT gave them their lives back again and prevented suicide attempts. Conclusion The study highlights the importance to patient’s satisfaction and experience of staff’s engagement, relaying information, friendliness, support, and compassion. The results provide information to both patients and prescribers regarding patient’s experience of ECT. It is important to acknowledge that the patient experience of ECT literature identifies that patients frequently report memory loss.
  • Repetitive transcranial magnetic stimulation (rTMS) for depression: outcomes in a United Kingdom (UK) clinical practice

    Griffiths, Chris; O'Neill-Kerr, Alex; Millward, Tim (2019)
    Objective: The aim of this paper is to present the outcomes data from the largest United Kingdom’s (UK) National Health Service (NHS) clinical rTMS service treating treatment resistant depression (TRD). Methods: The study was a retrospective investigation of routinely collected data on patients receiving rTMS between 2015 and 2017. Measures used were the clinician-rated Clinical Global Impression (CGI) and Hamilton Depression Rating Scale (HAM-D), and patient rated Beck Depression Inventory (BDI). The outcome data of 73 patients with TRD were analysed. The sample included patients with co-morbid psychiatric diagnosis. Results: Response and remission rates, respectively, were 40.4% and 25.5% for the HAM-D; 35.6% and 20.8% for the BDI; and 51.1% and 52.1% for the CGI. Effect sizes were medium (0.54, 0.52 and 0.56, respectively). Conclusions: The results show that a UK-based clinical service achieves similar results to those published internationally and that clinical rTMS can have significant impact on symptoms of depression in many patients with TRD. Health services are under pressure to make financial savings, investment in rTMS could reduce the long-term treatment costs associated with TRD.
  • Repetitive transcranial magnetic stimulation (rTMS) in treatment resistant repression: retrospective data analysis from clinical practice

    Griffiths, Chris; O'Neill-Kerr, Alex (2019)
    Objective: The aim of this paper is to present the service data results from a clinical repetitive Transcranial Magnetic Stimulation (rTMS) service treating treatment resistant depression (TRD). Methods: The study was a retrospective investigation of routinely collected data on patients receiving rTMS between 2015 and 2018. Measures used were the clinician-rated Clinical Global Impression (CGI) and Hamilton Depression Rating Scale (HAM-D), and patient rated Physical Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7). The outcome data of 144 patients with TRD was analysed. The sample included patients with co-morbid psychiatric diagnosis. Results: Response and remission rates respectively were 34.6% and 20.6% for the HAM-D; 10% and 28.6% for the PHQ-9; 31% and 31.8% for the CGI; and 24.6% and 28.8% for GAD-7. Effect sizes were mostly medium (0.48, 0.27, 0.51, 0.43 respectively). GAD-7 reliable change improvement was 56.1% and PHQ-9 reliable change improvement was 40%. There was a medium positive correlation between anxiety (GAD-7) and depression recovery (HAM-D), r = 0.31, n = 46, p = 0.039, with lower pre-treatment anxiety associated with lower post-treatment HAM-D scores. Conclusions: TRD patients with low pre-treatment anxiety levels respond to treatment better than those with high pre-treatment anxiety. The results show that a clinical rTMS service can have a significant impact on symptoms of depression and anxiety in TRD. The findings support wider availability of rTMS as a treatment option for people with TRD.
  • Patients’, carers’, and the public’s perspectives on electroconvulsive therapy

    Griffiths, Chris; O'Neill-Kerr, Alex (2019-05)
    Aims and Method: The aim of this study was to present patients’, carers’, and the public’s perspectives on electroconvulsive therapy (ECT) through a narrative review of the literature. Results: People’s perspectives on ECT are often negative due to media and Internet portrayal. Perspectives are influenced by risks, short-term side effects, and the most commonly reported longer-term side effect: memory loss. However, many patients do not report memory loss. Most people who experience ECT and their carers report a positive perspective. In the future, people’s perspectives may become more positive with higher service delivery standards and a more balanced, well-informed view of modern ECT presented by the media. However, ECT has risks and side effects, and negative and critical perspectives on the use and effects of ECT will persist. Clinical Implications: Perspectives on ECT are important because of the impact on stigma, patient treatment choice, patient consent, and provision of and referral for ECT.
  • Experiences of shame and intellectual disabilities: Two case studies

    Marriott, Clare; Parish, Caroline; Griffiths, Chris (2020)
    Shame is a trans-diagnostic phenomenon that underlies a variety of mental health difficulties. People with intellectual disabilities (IDs) are reported to be one of the most stigmatized and excluded groups in society and are more likely to experience mental health problems than the general population. Consequently, this group may be at a significant risk of shame-related distress. However, there is a lack of research that investigates the experience of shame in people with ID, and there is currently a lack of interventions targeting shame in people with ID. Two case studies were undertaken to document the experiences of stigma, discrimination, and shame in people with ID and to explore how shame may present in this population. Shame was found to be a significant barrier to social inclusion and to contribute towards poor psychological health in people with ID. The development of interventions that specifically target shame in this population is recommended.
  • Impact of repetitive transcranial magnetic stimulation on generalized anxiety disorder in treatment-resistant depression

    Griffiths, Chris; O'Neill-Kerr, Alex (2019-11)
    Background Published evidence indicates the value of repetitive transcranial magnetic stimulation (rTMS) for generalized anxiety disorder in patients with treatment-resistant depression (TRD). As a part of routine clinical service, patients with TRD received right dorsolateral prefrontal cortex (DLPFC) inhibitory rTMS immediately prior to left DLPFC depression treatment delivered according to a US Food and Drug Administration protocol. Methods A retrospective investigation of routinely collected data between 2016 and 2018 was undertaken. Measures used were the clinicianrated Clinical Global Impressions-Severity (CGI-S) scale and Hamilton Depression Rating scale (HAM-D), and the patient-rated Generalized Anxiety Disorder scale-7 (GAD-7) and Patient Health Questionnaire (PHQ-9). The outcome data of 61 patients with TRD were analyzed. The sample included patients with comorbid psychiatric diagnoses. Results Response and remission rates, respectively, were 17.1% and 27.3% on the GAD-7; 20.7% and 12.5% on the HAM-D; 19% and 24% on the PHQ-9; and 20% and 23.5% on the CGI-S. Post-treatment scores significantly improved on the GAD-7, HAM-D, and CGI-S scales, with medium to large effect sizes (.61, .62, and .86 respectively). Conclusions Results indicate the potential value of rTMS in treating anxiety in patients who are referred for rTMS for TRD. Well-designed and adequately powered randomized controlled trials are required to determine clinical recommendations.
  • Transcranial magnetic stimulation for the treatment of cocaine addiction

    Soomro, Hanif; O'Neill-Kerr, Alex; Griffiths, Chris; De Vai, Robert (2020)
    Objective: The aim of this paper is to present the clinical data analysis results from a service delivering repetitive transcranial magnetic stimulation (rTMS) for people with cocaine-use disorder (CUD). Methods: The study was a retrospective investigation of routinely collected data on patients receiving rTMS between 2018 and 2019. Measures used were a cocaine craving Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire (PHQ-9) self-rated depression measures. Results: The outcome data of 10 patients with CUD were analysed. There was a statistically significant reduction and a large effect size on CUD and depression scales. Conclusions: Reductions in craving and depression indicate the potential benefits to patients and to society of rTMS in treating CUD. Further sufficiently powered RCTs are warranted with studies focusing on the optimization of rTMS treatment and exploring the underlying mechanisms.
  • A qualitative study of patients' experience of ketamine treatment for depression: The ‘Ketamine and me’ project

    Griffiths, Chris; Walker, Kate; Reid, Isabel; O'Neill-Kerr, Alex (2021-01)
    Background: There has been a lack of in-depth interviews investigating patient experience of ketamine treatment for depression. We examined participants’ pathways to receiving ketamine infusion to treat their depression, and their responses to, lived experiences of, and attitudes towards ketamine treatment. Methods: Qualitative methods were used to conduct in-depth interviews with 13 patients (6 male; 7 female) diag- nosed with treatment resistant depression (TRD) with experience of receiving ketamine treatment for depression. Interpretative phenomenological analysis (IPA) was employed. Results: For the majority of participants ketamine infusion causes a reported initial ‘high’, enhanced perception, and dissociative experience; followed by a lifting of mood and a reduction in or removal of suicidal ideation and depression symptoms lasting around 3–6 days. This leads to a reported increase in motivation, socialisation, and activity. All participants valued the therapeutic alliance with clinicians which enhanced the treatment experience and all advocated treatment access for those with depression who have not responded to other treatments. Limitations: Small numbers, purposive sample, participant self-selection, and single site recruitment limit gener- alisability. Conclusions: Ketamine for depression can have many beneficial effects, and it is potentially life-transforming for some. Ketamine may be a source of hope for patients for whom other treatments have not been effective. For some, ketamine is not tolerated or does not have anti-depressive effects. Further qualitative in-depth exploration of patient experience and consideration of how ketamine depression treatment access can be appropriately made available are warranted.
  • Ketamine Infusion (KI) in Treatment Resistant Depression (TRD): Retrospective clinical data analysis

    Griffiths, Chris; O'Neill-Kerr, Alex; De Vai, Robert; Sore, Tina (2019)
    Objective: The aim of this paper is to present the clinical data analysis results from a service delivering ketamine infusion, repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy for people with treatment resistant depression (TRD). Methods: The study was a retrospective investigation of routinely collected data on patients receiving ketamine infusion between 2017 and 2019. Measures used were the clinician-rated Clinical Global Impression (CGI) and self-reported Beck Depression Inventory (BDI) and Quick Inventory of Depressive Symptomatology (QIDS-SR). The outcome data of 28 patients with TRD were analysed. A minimum course of treatment was defined as three ketamine infusions. Results: Response combined with partial response, response, and remission rates respectively were 42.3%, 23.1% and 4.2% for the BDI; 18.2%, 9.1% and 0% for the QIDS-SR; 50%, 18.2% and 4.6% for the CGI. There was a statistically significant improvement on the BDI with a medium effect size (0.63). There was not a significant improvement in the CGI or QIDS-SR. Conclusions: The results show a mixed picture the impact ketamine on symptoms of depression in TRD over the course of multiple infusions. The results need to be viewed in the context of clinical outcome data collection: outcome scores are taken prior to treatment and so are at a point when ketamine is not having an active effect. The findings can inform the availability of ketamine infusion as a treatment option for TRD where treatment adhering to national guidelines has not succeeded. A qualitative investigation of the experience of people receiving ketamine would provide further insights.
  • A qualitative study of early intervention psychosis (EIP) service patient’s experience of sleep, exercise, sleep hygiene advice and Fitbit wearable activity and sleep tracker

    Griffiths, Chris; Farah, Hina; Pollard, Lorraine; Jugon, Sue; Sam, Mary; Kelbrick, Marlene (2021)
    Background: In psychosis physical activity, sleep, mental health, physical health, wellbeing, quality of life, cognition and functioning are interconnected. People who experience psychosis are more likely than the general population to have low levels of physical activity, high levels of sedentary behaviour and sleep problems. This project was innovative in seeking to address these issues through provision of a wearable activity and sleep tracker (a Fitbit) and sleep hygiene advice. Participants: Participants using an early intervention psychosis (EIP) service took part in an eight-week intervention, which incorporated the provision of a Fitbit, sleep hygiene advice as well as three engagement, feedback and discussion points with a clinician. Methods: A qualitative approach was used to conduct in-depth semi-structured interviews with 12 of the 25 intervention participants (5 male; 7 female). Thematic and content analyses were employed to analyse the data. Results: Participants provided valuable insights into their experience of sleep, exercise, Fitbit use and sleep hygiene advice use. It was found that participants placed a high value on effective night time sleep, recognized improvements in physical activity and noted a positive effect on mood and wellbeing as a result of Fitbit use. The negative impact of having ineffective night time sleep and insufficient physical activity was described. Participants demonstrated a good level of understanding of the connection between sleep, exercise, wellbeing, and health. Conclusion: Participants reported the Fitbit and sleep hygiene advice received through an EIP service to be beneficial for improved levels of physical activity and exercise, and more effective sleep. This is a simple and low cost intervention which could be made widely available through EIP and other mental health services.
  • Effectiveness of a Fitbit Based Sleep and Physical Activity Intervention in an Early Intervention Psychosis (EIP) Service

    Griffiths, Chris; Hina, Farah; Jugon, Sue; Willis, Gemma; Yardley, Samantha; Walker, Jonathon; Kelbrick, Marlene (2022)
    Purpose: Compared to levels in the general population, people with experiences of psychosis have poorer physical fitness, more sedentary behaviour, lower physical activity, more sleep problems, and a higher incidence of insomnia. The aim of the current study was to examine the feasibility and impact of an intervention with the goal of addressing these issues. Method: Design: intervention with outcome measure data collection, with no control group. Forty-nine early intervention psychosis (EIP) service patients took part in an intervention: provision of a Fitbit, Fitbit software apps, sleep hygiene, and physical activity guidance, and three discussion sessions with clinicians. The sample consisted of 29 males and 20 females, with age range of 17 - 54 years, and average age of 29.5 years. Measures used were Fitbit activity and sleep data, and self-rated Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS) and Positive and Negative Affect Schedule (PANAS). Results: WEMWBS scores significantly improved, with a medium effect size. PANAS negative affect (NA) dropped significantly. Analysis of Fitbit activity and sleep data yielded non-significant results. Conclusion: The intervention was acceptable to EIP patients and is feasible. Improvements in mental wellbeing and negative affect indicate the positive impact of the intervention on mental health. EIP services should consider assessing sleep quality and physical activity/exercise levels, and using this study’s intervention to promote wellbeing and mental health within recovery focused practice. Further research could be undertaken through a sufficiently powered randomised control trial (RCT) comparing this intervention and treatment as usual (TAU).
  • The impact of COVID-19 on acute psychiatric admissions for first and repeated episode psychosis

    Kelbrick, Marlene; Griffiths, Chris; Saba, Ansari; Paduret, Gabriela; Tanner, James; Mann, Nick; Johnson, Sara (2023)
    Abstract Background: There is limited evidence of the longer-term impact of the COVID-19 pandemic on acute admissions for psychosis in the UK. Aims: We examined the impact of COVID-19 on rates of admissions for first and repeated episode psychosis, and changes in patient profile and seasonal patterns, over a period of 12 months. Method: We conducted a retrospective case note review of all patients admitted with a primary psychosis (F20-29 ICD 10 diagnosis) to an NHS psychiatric inpatient unit. We compared the 12 months pre-COVID-19 period between 1 March 2019 and 28 February 2020, and the 12 months post-COVID-19 period between 1 March 2020 and 28 February 2021. Results: The results showed increase rates of admissions post-COVID-19 in both first and repeated episode psychosis, the patient profile had more females and older age in the repeated episode group, with increased employment rates. Combined group data for both pre- and post-COVID-19 periods showed an increased trend in spring and summer admissions, and even though not statistically significant, more pronounced post-COVID-19. Conclusions: Our findings highlight the effect of the COVID-19 pandemic on acute psychosis admissions over a 12-month period. The results provide evidence for the ‘stress-pathogenesis’ in the context of genetic vulnerability in psychosis. Preventative strategies in the context of the ‘stress-pathogenesis model’, improved access to and responsiveness within NHS transformation efforts needs to be adjusted to fit local need and environmental changes.