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  • Patients’ and staff’s experiences of Well-Track physical activity and sleep quality intervention in an Early Intervention in Psychosis (EIP) service

    Walker, Kate; Griffiths, Chris; Willis, Andy (2024)
    Objective Individuals, who experience psychosis are found to have worse fitness levels, are less likely to be physically active, and experience greater sleep problems than the general population. The aim of this research was to examine the Well-Track psychical activity and sleep quality intervention which addresses these issues; it comprises using a Fitbit, motivational interviewing, goal identification and setting, exercise and sleep hygiene advice and feedback sessions with staff working in an Early Intervention in Psychosis (EIP) service. Method This qualitative study examined patients’ and staff’s experiences of Well-Track. Semi-structured interviews with thirteen patients and five staff were analysed using thematic analysis based on a structure-process-outcome framework. Results Key elements of the structure comprise supportive staff and the use of a wearable device (Fitbit). Process themes included the implementation of a multifaceted framework, setting realistic goals and a personal recovery process. Outcomes identified were knowledge (about exercise and sleep), implementation of action-orientated behaviours and improvements in well-being. Discussion Effective sleep and engagement with physical activity and exercise are important for the well-being and mental and physical health of EIP service patients and facilitating this can be achieved through Well-Track which comprises evidenced components to promote behaviour change. EIP services can implement Well-Track to meet service goals related to reducing weight gain, improving well-being, improving physical activity and enabling better self-management and healthier lifestyles.
  • Older adult forensic mental health patients’ views on barriers, facilitators and ‘what works’ to enable better quality of life, health and wellbeing and to reduce risk of reoffending and harm to self and others

    Walker, Kate; Griffiths, Chris (2022-03)
    Introduction Research evidence that can inform service provision and treatment requirements for older (aged 55 years and above) forensic mental health patients is lacking, particularly that which is based on patients’ own preferences and experiences. This study aimed to gain an effective understanding, based on patients’ perspectives, of the service provision in forensic mental health inpatient and community services; investigating what could improve or hinder their quality of life, health, wellbeing, progress, and recovery. Method A qualitative approach was taken to examine the accounts of patients. Interviews (semi-structured) with 37 older forensic mental health patients either residing in secure units or in the community were conducted. Data were analysed using thematic analysis. Results Two global themes: ‘Enablers and Facilitators’ and ‘Threats and Barriers’ were identified; these were at three levels: environmental, interpersonal and individual. Results indicated that: the physical and social environment should be adapted to accommodate the needs of older patients (e.g., for physical health, frailty, and poor mobility); prosocial interpersonal relationships with family, other patients and staff needed to be promoted; and hope and positive future focus needed to be embedded to aid recovery. Discussion Findings suggest that multilevel and comprehensive support, that is individualised, is required for this population. This is needed so that: patients are residing in suitable environments that address their physical, mental, and criminal justice needs; social connectedness forms part of their recovery journey; and hope, purposefulness and personal agency is facilitated.
  • Social prescribing: link workers’ perspectives on service delivery

    Griffiths, Chris; Jiang, Harmony; Walker, Kate (2023)
    Purpose: In social prescribing (SP) a primary care based “link worker” assesses patient needs and goals, and makes appropriate links and referrals to community-based resources and services. This study explored SP service provision in England’s NHS, investigating social prescribing link worker’s (SPLW’s) perspectives of service delivery, service goals, theories and approaches used, challenges, what works, and barriers to success. Methods: Semi-structured interviews were undertaken with eighteen SPLWs delivering SP. Data were analysed using thematic analysis. Results: Social prescribing mechanisms and frameworks were identified. Five organising themes describe a solution-focused, strengths-based theoretical underpinning; a patient-led process; role of SPLWs as a support person, guide, and facilitator; supporting collaborative networks; patient and wider outcomes; and threats to success of SP. A solution-focused, strengths-based approach underpins many aspects of SP. Conclusion: The effectiveness of SP could be improved by SPLW motivational interviewing and solution-focused training to promote patient behaviour-change, salutogenesis, and positive outcomes, enabling SPLWs to feel they have the skills required. Workload and referrals should be appropriate for the role of SPLWs. Now that there is widespread implementation of SP in the NHS, there is a need to interview patients in receipt of SP to gain their experience, views, and recommendations.
  • “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.
  • A qualitative study exploring the experience and value of “flow” transcranial direct current stimulation (tDCS) device and behaviour therapy training software application at home for symptoms of depression

    Griffiths, Chris; Walker, Kate; Jiang, Harmony; Noel-Johnson, Alexandra (2023)
    Background: Flow FL-100 is a self-administered transcranial direct current stimulation (tDCS) device used in combination with a software application delivered well-being behaviour therapy training, which has evidence of effectiveness in treating symptoms of depression. In this study, the combined Flow FL-100 and well-being behaviour therapy training app, an intervention known as “Flow”, was offered by a participant’s general practitioner (GP) in a United Kingdom (UK) primary care setting to those who experienced depressive symptoms. Participants completed six weeks of use of Flow. This study explored participants’ experiences and views on the feasibility, acceptability, useability, and value of Flow. Methods: A qualitative approach was employed, involving in-depth semi-structured interviews. Thematic and content analyses were applied. Out of a sample of 47 participants using Flow, 18 participants consented to be interviewed. The age range of the participants was 23 - 75 years (M = 52.78, SD = 16.27); 10 (55.6%) were female and 8 (44.4%) male. Results: There was support for the feasibility, acceptability, useability and value of combined Flow FL-100 and well-being behaviour therapy training. Most participants described a positive impact on depressive symptoms, sleep, and functioning. Findings provide support for the approach of delivering together both tDCS and evidence-backed well-being behaviour therapy training. Conclusion: Flow has been successfully integrated into a primary care service depression treatment. It is important to offer patients an evidence-based alternative to existing depression treatments (anti-depressant medication and talking therapies). The results support the use of Flow as a treatment option for people with symptoms of depression.
  • An interpretative phenomenological analysis of practitioners’ experiences of delivering a mental health treatment requirement, what works to engage service users and facilitate change

    Walker, Kate; Griffiths, Chris (2023)
    This interpretive phenomenological analysis explored psychologists' experiences delivering mental health treatment requirements which seek to address offenders' mental health and criminal needs. Three superordinate themes were constructed. ”Client placed at the centre of the individualized intervention approach” explored how an individual, non-prescriptive approach was taken. ”Embedded therapeutic working relationship” relates to how therapeutic relationships and skills were central to delivery. ”Barriers that impede or threaten engagement” included feeling forced to attend, situational/behavioral factors and previous negative experiences with intervention providers. Findings highlight that using formulation, taking an individualized approach, and a strong therapeutic/working relationship promotes engagement, enabling positive behavior change.
  • 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.
  • Service provision for older forensic mental health patients: a scoping review of the literature

    Walker, Kate; Griffiths, Chris (2021)
    Older forensic psychiatric patients (defined as aged 50 or over) have complex needs and require specialized treatment to enable recovery and reduce risk. Little is known about what service provision is available for this population, so a scoping literature review was undertaken to establish the extent of service provision and if services are specifically modified or designed for this population. The literature was searched through academic journal databases and Google Scholar, and outputs were screened for suitability and assessed for quality. Eight studies (four qualitative, four quantitative) were included in the review. Studies were mixed in terms of methodological quality, and with several limitations. Qualitative data provided perceptions regarding positive (e.g., sufficient types of therapy) and negative (e.g., lack of age-appropriate services) aspects of interventions. Quantitative data were descriptive, focusing mainly on identifying provision available (e.g., art therapy, violence reduction) and where needs were not being met (e.g., physical needs, education). Results indicate little provision in place adapted specifically for older forensic psychiatric patients. Findings highlight the need for further research to understand and effectively implement interventions and service provision for older forensic mental health patients to ensure practice is evidence based.
  • 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.
  • Prisoner’s insomnia prevalence, insomnia associated factors and interventions with sleep as an outcome: a review and narrative analysis

    Griffiths, Chris; Farah, Hina (2022)
    Purpose Insomnia is highly prevalent in prisoners. The purpose of this paper is a review of research evidence on interventions with sleep as an outcome (2000 to 2020) and rates of insomnia prevalence and associated factors in prisons (2015 to 2020). Design/methodology/approach An internet-based search used Medline, PubMed, PsycINFO (EBSCOhost), Embase, Web of Science and Scopus. Seven interventions and eight sleep prevalence or sleep-associated factor papers were identified. Findings Intervention research was very limited and the quality of the research design was generally poor. Interventions such as cognitive behavioural therapy for insomnia (CBT-I), yoga and mindfulness can be beneficial in a prison setting. This review identified a high prevalence of insomnia in prisons across the world, which was supported by recent evidence. Factors associated with insomnia include anxiety, depression, post-traumatic stress disorder, personality disorder and pain. Research limitations/implications There is a need for appropriately powered randomised control trials of CBT-I in prisons and a need to use objective measures of sleep quality. Originality/value Due to a lack of an up-to-date review, this paper fulfils the need for a review of the evidence on interventions in prison settings with sleep as an outcome, rates of insomnia prevalence and associated factors in prisons.
  • Alpha-Stim cranial electrotherapy stimulation (CES) for anxiety treatment: outcomes in a United Kingdom (UK) primary care practice

    Griffiths, Chris; Leathlean, Chloe (2021)
    Background: Anxiety disorders are the most common mental disorders, typically treated with psychotherapy and medication. These treatments are not suitable for, acceptable to, or effective for everyone. Alpha-Stim AID is a Cranial Electrotherapy Stimulation (CES) treatment with evidence of effectiveness in treating anxiety disorders. Objective: The aim of this paper is to present outcomes on anxiety, depression, and quality of life of Alpha-Stim use in primary care patients in the United Kingdom’s (UK) National Health Service (NHS) who reported symptoms of anxiety. Methods: Open label patient cohort design. Self-report measures: PHQ-9 (depression), GAD-7 (anxiety) and EQ-5D-5L (health related quality of life). Twenty-three patients with symptoms of anxiety completed a six-week course of Alpha-Stim intervention. Results: Reliable improvement and remission rates respectively were 60.9% and 17.4% for the GAD-7; 42.9% and 22.7% for the PHQ-9. Significant improvement and medium/large effect sizes (n2 = 0.59 and 0.56 respectively). EQ-5D-5L results showed significant improvements in quality of life. Perceived quality of life doubled with an improvement of 0.36 on the health index score, this intervention adds 3.64 Quality Adjusted Life Years (QALYs). Limitations: The study was not an RCT, there was no control group. Conclusions: Alpha-Stim AID CES can be delivered through a UK primary care practice, and can have a significant impact on symptoms of anxiety and depression, and improve quality of life in primary care patients with anxiety symptoms. Further feasibility studies in primary care and sufficiently powered RCT are required.
  • Integrated review of lifestyle interventions targeting diet and exercise in early or first-episode psychosis

    Griffiths, Chris; Hina, Farah (2021)
    Aims: Life expectancy is reduced by 10 - 20 years in psychotic disorders compared with the general population, largely due to high incidence of physical health disorders: heart attack, stroke, obesity, cardiovascular disease (CVD), and type 2 diabetes. Early or first-episode psychosis patients can be especially vulnerable to physical health, psychological and social consequences of antipsychotic medication weight gain. The aim of this paper is to review diet and exercise lifestyle interventions employed to address these issues. Method: A review of research evidence on lifestyle interventions (diet and exercise) for individuals with early or first-episode psychosis (2000 to 2020) was undertaken. An internet-based literature search employed Medline, PsycINFO, Embase, PubMed and Web of Science. Results: Nine studies meeting the criteria were identified: comprising of three exercise intervention studies, one diet intervention study, and five combined diet and exercise intervention studies. Only one study used a RCT design with prior power analysis to determine participant numbers, two had a RCT design, two had a comparison group and four had no control group. Overall, these studies show that exercise and diet focused interventions may provide beneficial physical and mental health outcomes, but participant engagement and behaviour change may be difficult to achieve in early or first-episode psychosis due to individual factors associated with the experience of psychosis and medication prescribed, and health service related factors. Conclusion: There is a need for evidence-based lifestyle programmes in early or first-episode psychosis that includes individually targeted evidence based exercise and diet interventions. Further appropriately powered RCTs are required to strengthen the evidence base.

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