RSS 1.0Innovation, Research and Clinical Effectiveness
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Opportunities and challenges to delivering a trial for depressive symptoms in primary care during the COVID-19 pandemic: Insights from the Alpha-Stim-D randomised controlled trialBACKGROUND: Randomised controlled trials (RCTs) are widely regarded as the most powerful research design for evidence-based practice. However, recruiting to RCTs can be challenging resulting in heightened costs and delays in research completion and implementation. Enabling successful recruitment is crucial in mental health research. Despite the increase in the use of remote recruitment strategies and digital health interventions, there is limited evidence on methods to improve recruitment to remotely delivered mental health trials. The paper outlines practical examples and recommendations on how to successfully recruit participants to remotely delivered mental health trials. METHODS: The Alpha Stim-D Trial was a multi-centre double-blind randomised controlled trial, for people aged 16 years upwards, addressing depressive symptoms in primary care. Despite a 6-month delay in beginning recruitment due to the COVID-19 pandemic, the trial met the recruitment target within the timeframe and achieved high retention rates. Several strategies were implemented to improve recruitment; some of these were adapted in response to the COVID-19 pandemic. This included adapting the original in-person recruitment strategies. Subsequently, systematic recruitment using postal invitations from criteria-specific search of the sites' electronic health records was added to opportunistic recruitment to increase referrals in response to sub-target recruitment whilst also reducing the burden on referring sites. Throughout the recruitment process, the research team collaborated with key stakeholders, such as primary care clinicians and the project's Patient and Public Involvement and Engagement (PPI/E) representatives, who gave advice on recruitment strategies. Furthermore, the study researchers played a key role in communicating with participants and building rapport from study introduction to data collection. CONCLUSIONS: Our findings suggest that trial processes can influence recruitment; therefore, consideration and a regular review of the recruitment figures and strategies is important. Recruitment of participants can be maximised by utilising remote approaches, which reduce the burden and amount of time required by referring sites and allow the research team to reach more participants whilst providing participants and researchers with more flexibility. Effectively communicating and working collaboratively with key stakeholders throughout the trial process, as well as building rapport with participants, may also improve recruitment rates.
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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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Breaking the silence: addressing domestic abuse in mental health settings—identification, screening, and respondingIndividuals experiencing domestic abuse (DA) struggle to disclose victimization, but as frequent users of mental health services, this is a pivotal setting for identification and addressing DA. This systematic review of 20 studies investigates DA identification, screening, and responses within mental health settings. Three databases were searched using these inclusion criteria: adults aged 18 and older accessing mental health services, samples comprising mental health professionals (or combination). No geographical restrictions were applied. All studies were peer-reviewed and published in English between January 2000 and December 2023. Studies had to incorporate screening for DA between (ex-)partners and/or response to disclosure within mental health settings. The findings revealed considerable variation in DA screening methods from direct screening tools to retrospective analyses of patient files. Professionals report barriers in identifying DA, including uncertainty about their role, time constraints, and the importance of building trust with service users. Nonetheless, many highlight the importance of routinely asking about DA. A small number of interventions have been effective in enhancing professionals’ readiness to address DA, but it remains unclear what format of training is most effective. Service users report feelings of shame and fear of not being believed when disclosing DA, but are aided by therapeutic engagement and enhanced professional awareness. There is a lack of diverse inclusion in the research. In summary, there is considerable scope to develop good practice to support mental health professionals’ ability to identify and respond to DA across assessment tool and training, but also in understanding what facilitates service users to disclose.
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Alpha-Stim AID Cranial Electrotherapy Stimulation (CES) anxiety and depression treatment for adults in a social prescribing service: anxiety and depression outcomesBackground: Generalised anxiety disorder (GAD) is common and can negatively impact people’s wellbeing and functioning. GAD treatment includes psychotherapy and/or anti-anxiety medication, which are not acceptable to or effective for many people experiencing GAD. Alpha-Stim AID cranial electrotherapy stimulation (CES) has evidence of effectiveness in the treatment of anxiety and depression. Purpose: Evaluation of Alpha-Stim AID on anxiety and depression for adults with GAD symptoms using a social prescribing service. Methods: An open-label patient cohort design with no control group. Twenty-six adult patients, 22 females and 4 males, with an age range of 24 to 68 years and an average age of 49 years, completed 6 weeks of Alpha-Stim AID use. Pre- and post-intervention assessments were undertaken using participant self-report measures: Generalised Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9). Results: Reliable improvement and remission rates were 42% and 19% for GAD-7; 38% and 27% for PHQ-9. GAD-7 and PHQ-9 significantly improved with large effect sizes. Conclusions: A social prescribing service can offer, and patients will choose to use Alpha-Stim AID, which may be useful in the treatment of anxiety and depression. This study addresses the need for real-world data on Alpha-Stim AID in relation to response rates. It contributes to how Alpha-Stim Aid can be used in social prescribing services, including through a group-based pathway.
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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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“Well-Track” healthy lifestyle (physical activity, sleep hygiene, diet, wearable activity tracker) coaching in Severe Mental Illness (SMI)Background: People who experience Severe Mental Illness (SMI) often have low levels of physical activity, high levels of sedentary behaviour, poor diet, and sleep problems. These factors are linked to worse mental health symptoms, lower wellbeing, greater hopelessness, lower quality-of-life, and physical health-related diseases, including cardiovascular disease, stroke, hypertension, osteoarthritis, cancer, chronic obstructive pulmonary disease, obesity, and diabetes, contributing to 15 - 20 years reduced life expectancy. Purpose/Aim: This study investigates the impact of Well-Track healthy lifestyle intervention in SMI, it addresses the question: “What is the effect of Well-Track on mental wellbeing and sleep quality/insomnia for SMI patients?”. 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: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and Sleep Conditioning Index (SCI). Participants were seventy-six Community Mental Health Team (CMHT) participants, 35 males and 41 females, with an age range of 20 - 65, and average age of 41 years. An eight-week intervention: a free-to-keep wearable tracker (instructions, set up, and access to apps), exercise, diet and sleep hygiene advice, a motivational interview and goal-setting session and two follow-up support sessions with a health coach. Results: WEMWBS scores significantly improved, from 37.52 (SD 10.18) to 42.35 (SD 7.14) at 4 weeks and to 44.06 (SD 6.03) at 8 weeks, with large effect sizes. SCI scores significantly improved, from 12.03 (SD 7.29) to 15.45 (SD 8.00) at 4 weeks and to 17.26 (SD 8.12) at 8 weeks, with large effect sizes. Conclusion: Well-Track was integrated into a SMI physical health check service and was found to be beneficial in terms of improving wellbeing and sleep quality and reducing incidence of insomnia. Well-Track could be delivered through all CMHT and SMI physical health check services to promote healthy lifestyle behaviours.
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“Flow” Transcranial Direct Current Stimulation (tDCS) for depression treatment in a primary healthcare general practice — an open-label cohort study measuring Montgomery-Åsberg Depression Rating Scale (MADRS-S) outcomes.Background: Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application delivered wellbeing behaviour therapy training. tDCS has evidence of effectiveness in treating symptoms of depression. Purpose/Aim: This post marketing study evaluated the effect of Flow on depression for primary care general practice patients with depression symptoms. Methods: Open-label patient cohort design with no control group. Inclusion criteria were aged 18 years or over and reporting depression symptoms. Participants self-administered five 30 minute tDCS sessions per week for the first three weeks, and then 3 sessions per week following this. Three, six and ten week assessment with participant self-report measure: Montgomery- Åsberg Depression Rating Scale (MADRS-S). Results: MADRS-S remission rates were between 29% - 30% at three weeks, 33% - 34% at six-weeks and 50% at 10-weeks treatment. There was a significant improvement in MADRS-S with large effect sizes at all time points. Conclusions: Flow tDCS can be delivered through a primary healthcare general practice service and patients will choose to use. Flow tDCS provides an effective depression treatment in addition and as an alternative to antidepressants and psychotherapy. tDCS has evidence as an effective depression treatment, and the widespread availability of tDCS in primary care general practice should be considered.
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“Flow” Transcranial Direct Current Stimulation (tDCS) for depression treatment in a primary healthcare general practice — depression, functioning, and health-related quality of life outcomes.Background: 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. tDCS has evidence of effectiveness in treating symptoms of depression. This post marketing study evaluated the effect of Flow on depression, functioning, and health-related quality of life for primary care general practice patients with depression symptoms. Methods: Open-label patient cohort design with no control group. Thirty-one adult patients completed six weeks of Flow treatment. Average age 45.6 years (SD = 13.72) range from 20-75 years; 24 (77.4%) females and six males (23.6%). Pre- and post-intervention assessment with participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and European Quality of Life Five Dimension (EQ-5D-5L). Results: PHQ-9 reliable improvement and remission rates were 58.1% and 32.3%. There was a significant improvement in PHQ-9 and WSAS with large effect sizes. EQ-5D-5L results showed significant improvements in three dimensions and the health index score with medium effect sizes. Conclusion: Flow tDCS can be delivered through a primary healthcare general practice service and patients use it as prescribed and complete treatment course. tDCS has evidence as an effective depression treatment, the widespread availability of tDCS in primary care general practice should be considered.
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A randomised controlled trial investigating the clinical and cost-effectiveness of Alpha-Stim AID cranial electrotherapy stimulation (CES) in patients seeking treatment for moderate severity depression in primary care (Alpha-Stim-D Trial)Major depression is the second leading cause of years lost to disability worldwide and is a leading contributor to suicide. However, first-line antidepressants are only fully effective for 33%, and only 40% of those offered psychological treatment attend for two sessions or more. Views gained from patients and primary care professionals are that greater treatment uptake might be achieved if people with depression could be offered alternative and more accessible treatment options. Although there is evidence that the Alpha-Stim Anxiety Insomnia and Depression (AID) device is safe and effective for anxiety and depression symptoms in people with anxiety disorders, there is much less evidence of efficacy in major depression without anxiety. This study investigates the effectiveness of the Alpha-Stim AID device, a cranial electrotherapy stimulation (CES) treatment that people can safely use independently at home. The device provides CES which has been shown to increase alpha oscillatory brain activity, associated with relaxation. The aim of this study is to investigate the clinical and cost-effectiveness of Alpha-Stim AID in treatment-seeking patients (aged 16 years upwards) with moderate to moderately severe depressive symptoms in primary care. The study is a multi-centre parallel-group, double-blind, non-commercial, randomised controlled superiority trial. The primary objective of the study is to examine the clinical efficacy of active daily use of 8 weeks of Alpha-Stim AID versus sham Alpha-Stim AID on depression symptoms at 16 weeks (8 weeks after the end of treatment) in people with moderate severity depression. The primary outcome is the 17-item Hamilton Depression Rating Scale at 16 weeks. All trial and treatment procedures are carried out remotely using videoconferencing, telephone and postal delivery considering the COVID-19 pandemic restrictions. This study is investigating whether participants using the Alpha-Stim AID device display a reduction in depressive symptoms that can be maintained over 8 weeks post-treatment. The findings will help to determine whether Alpha-Stim AID should be recommended, including being made available in the NHS for patients with depressive symptoms.
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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) serviceObjective 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.
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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 othersIntroduction 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.
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Social prescribing: link workers’ perspectives on service deliveryPurpose: 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.
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“Well-Track”: Fitbit based physical activity and sleep hygiene intervention for early intervention in psychosis (EIP) and at-risk mental state (ARMS) service patientsBackground: 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.
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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 depressionBackground: 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.
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An interpretative phenomenological analysis of practitioners’ experiences of delivering a mental health treatment requirement, what works to engage service users and facilitate changeThis 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.
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Patient reported experience of electroconvulsive therapy (ECT)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.
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Repetitive transcranial magnetic stimulation (rTMS) for depression: outcomes in a United Kingdom (UK) clinical practiceObjective: 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.
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Repetitive transcranial magnetic stimulation (rTMS) in treatment resistant repression: retrospective data analysis from clinical practiceObjective: 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.
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Patients’, carers’, and the public’s perspectives on electroconvulsive therapyAims 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.
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Experiences of shame and intellectual disabilities: Two case studiesShame 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.
