This community contains articles published by colleagues at Nottinghamshire Healthcare NHS Foundation Trust and the Institute of Mental Health.

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  • A systematic review of the cost-effectiveness of community and population interventions to reduce the modifiable risk factors for dementia

    Brain, Jacob; Stephan, Blossom C. M. (2022)
    Population-based health and lifestyle interventions, which change societal conditions such that everyone across a given community is more likely to live more healthily, have been under-researched within the context of dementia prevention and risk reduction. This systematic review finds such interventions highly cost-effective, and often also cost-saving, in both high- as well as low- and middle-income settings. The strongest evidence base was for interventions that changed the physical environment to decrease physical inactivity or obesity, financial interventions that improved access to or resources for education, and mass media programmes that changed the social environment around smoking.
  • Recovery Colleges Characterisation and Testing in England (RECOLLECT): rationale and protocol

    Repper, Julie; Brewin, John; Sara, Meddings; McPhilbin, Merly; Yeo, Caroline; Slade, Mike (2022)
    Recovery Colleges are a relatively recent initiative within mental health services. The first opened in 2009 in London and since then numbers have grown. They are based on principles of personal recovery in mental health, co-production between people with lived experience of mental health problems and professionals, and adult learning. Student eligibility criteria vary, but all serve people who use mental health services, with empirical evidence of benefit. Previously we developed a Recovery College fidelity measure and a preliminary change model identifying the mechanisms of action and outcomes for this group, which we refer to as service user students. The Recovery Colleges Characterisation and Testing (RECOLLECT) study is a five-year (2020–2025) programme of research in England. The aim of RECOLLECT is to determine Recovery Colleges’ effectiveness and cost-effectiveness, and identify organisational influences on fidelity and improvements in mental health outcomes. 
  • Brain-In-Hand technology for adults with acquired brain injury: A convergence of mixed methods findings

    das Nair, Roshan (2022)
    INTRODUCTION: Individuals with acquired brain injury may find it difficult to self-manage and live independently. Brain-in-Hand is a smartphone app designed to support psychological problems and encourage behaviour change, comprised of a structured diary, reminders, agreed solutions, and traffic light monitoring system. AIM: To evaluate the potential use and effectiveness of Brain-in-Hand for self-management in adults with acquired brain injury. METHODS: A-B mixed-methods case-study design. Individuals with acquired brain injury (n = 10) received Brain-in-Hand for up to 12 months. Measures of mood, independence, quality of life, cognition, fatigue, goal attainment, participation administered at baseline, 6 and 12 months. Semi-structured interviews conducted with acquired brain injury participants (n = 9) and healthcare workers (n = 3) at 6 months. RESULTS: Significant increase in goal attainment after 6 months use (t(7) = 4.20, p = .004). No significant improvement in other outcomes. Qualitative data suggested improvement in anxiety management. Contextual (personal/environmental) factors were key in influencing the use and effectiveness of Brain-in-Hand. Having sufficient insight, appropriate support and motivation facilitated use. CONCLUSIONS: Brain-in-Hand shows potential to support acquired brain injury, but further work is required to determine its effectiveness. Context played a pivotal role in the effectiveness and sustained use of Brain-in-Hand, and needs to be explored to support implementation.
  • Psychological flexibility, distress, and quality of life in secondary progressive multiple sclerosis: A cross-sectional study

    das Nair, Roshan (2022)
    INTRODUCTION: One of the strongest predictors of successful coping in multiple sclerosis (MS) is the extent to which one can accept the diagnosis and limitations associated with the disease. Acceptance is also one of three core processes of psychological flexibility - a malleable treatment target of some psychological therapies. This is the ability to notice and accept the presence of thoughts and feelings without being swept along by them, engaging in the present moment, and making decisions in line with personal values. Poor psychological flexibility is associated with elevated levels of distress in the general population. However, we do not know the level of psychological flexibility in people with MS, or its relationship to distress or quality of life when the disease becomes more physically disabling. The aims of this study were to determine the level of psychological flexibility, and its relationship with distress and quality of life in secondary progressive multiple sclerosis (SPMS), a subtype of MS with increased severity of disability and distress. METHOD: This cross-sectional analytic study used data collected by the UK MS Register. Pre-existing data on distress, quality of life, disability, and demographics collected by the UK MS Register were combined with a psychological flexibility measure and its component parts, collected for the purpose of this study. Patient demographics and questionnaire data were recorded for distress, quality of life, and psychological flexibility. Pearson's correlations were used to examine bivariate relationships between distress, quality of life, disability and psychological flexibility. Whether psychological flexibility moderated the relationship between disability (predictor), distress and quality of life (outcomes) was also investigated. RESULTS: Between February and March 2020, 628 participants with SPMS completed the CompACT and had a recent (<12 months) HADS questionnaire (M(age) = 60.66, 70.90% women). On the HADS questionnaire subscales, 44% of the sample scored above the MS clinical cut-off (≥8) for anxiety (M = 7.09, SD = 4.57), and 30% above the clinical cut off (≥11) for depression (M = 8.35, SD = 4.21). Psychological flexibility (M = 81.94, SD = 22.60) and its components were each moderately negatively correlated with total distress (r = -0.65), anxiety (r = -0.58), and depression (r = -0.56). A second subsample (n = 434) completed the EQ-5D-5L health-related quality of life measure, which was moderately positively correlated with psychological flexibility (r = 0.47). A third subsample (n = 210) found a weak negative relationship between psychological flexibility and disability (r = -0.16), a weak positive relationship between distress and disability (r = 0.26), and a moderate negative relationship between quality of life and disability (r = -0.56). Psychological flexibility was not found to moderate the relationships between disability and anxiety, depression, or quality of life in SPMS. DISCUSSION: Greater psychological flexibility was associated with lower self-reported distress and higher quality of life in this SPMS sample. It was not shown to moderate the extent to which physical disability predicts distress or quality of life in SPMS. These findings demonstrate that greater psychological flexibility is related to better coping outcomes (lower distress, higher quality of life) in SPMS. If psychological flexibility can be increased in people with SPMS, this could lead to a reduction in distress and improvement in quality of life, although directionality could not be attributed with these methods. Further longitudinal evidence and trials of psychological flexibility-focussed interventions are needed.
  • Systematic review and meta-analysis of the effectiveness of teacher delivered interventions for externalizing behaviors

    Aldabbagh, Reem; Glazebrook, Cris; Sayal, Kapil; Daley, David (2022)
    This systematic review and meta-analysis explores the effectiveness of teacher interventions supporting children with externalizing behaviors based on teacher and child outcomes. A systematic search was conducted using 5 electronic databases. From 5714 papers, 31 papers that included interventions delivered directly to teachers and aimed to benefit either teachers and/or children with externalizing behaviors were included. The review focused on qualified teachers working with children aged 2-13. The results of the current meta-analysis revealed a positive effect of teacher intervention on teacher and child outcomes, including the increased use of teacher-appropriate strategies, as well as significant and moderate improvements in teacher-child closeness, and small reductions in teacher-child conflict. For child outcomes, the interventions reduced externalizing behavior problems and ADHD symptoms and enhanced prosocial behavior. Only one fully blinded analysis for conduct problems was possible and revealed a moderate but significant reduction in favor of intervention. These findings provide evidence to support the role of teacher interventions for both teachers and children with externalizing behaviors. Future research should include more PBLIND measurements so that MPROX findings can be confirmed. More research should be done to evaluate the influence of teacher interventions on teachers' well-being.
  • Practitioners’ views on enabling people with dementia to remain in their homes during and after crisis

    Coleston-Shields, Donna M.; Stanyon, Miriam R.; Yates, Jennifer A.; Streater, Amy; Orrell, Martin (2022)
    One way of supporting people living with dementia is assisting them to live in their homes (as opposed to being admitted to hospital or other facility) and providing them with a specialist service that responds to crises. This makes it important to understand how best to organize such crisis response services. This study examines practitioners’ actions to reduce inpatient admissions among this population. Through interviews with healthcare practitioners, we find that practitioners negotiate a complex intersection between (1) what constitutes a crisis in relation to the patient and/or the carer, (2) the demands of building a working relationship with both the patient and their family carers, and (3) ensuring effective communications with social services responsible for long-term community support. Findings suggest that policies aimed at reducing admissions should be based on a model of care that more closely maps practitioners’ relational and bio-medical work in these services.
  • Therapist-supported internet-delivered exposure and response prevention for children and adolescents with Tourette syndrome: A randomized clinical trial

    Hall, Charlotte L.; Davies, E. Bethan; Hollis, Chris P. (2022)
    The availability of behavior therapy for individuals with Tourette syndrome (TS) and chronic tic disorder (CTD) is limited.To determine the efficacy and cost-effectiveness of internet-delivered exposure and response prevention (ERP) for children and adolescents with TS or CTD.This single-masked, parallel group, superiority randomized clinical trial with nationwide recruitment was conducted at a research clinic in Stockholm, Sweden. Out of 615 individuals assessed for eligibility, 221 participants meeting diagnostic criteria for TS or CTD and aged 9 to 17 years were included in the study. Enrollment began in April 2019 and ended in April 2021. Data were analyzed between October 2021 and March 2022.Participants were randomized to 10 weeks of therapist-supported internet-delivered ERP for tics (111 participants) or to therapist-supported internet-delivered education for tics (comparator group, 110 participants).The primary outcome was change in tic severity from baseline to the 3-month follow-up as measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS). YGTSS-TTSS assessors were masked to treatment allocation. Treatment response was operationalized as a score of 1 (“Very much improved”) or 2 (“Much improved”) on the Clinical Global Impression–Improvement scale.Data loss was minimal, with 216 of 221 participants (97.7%) providing primary outcome data. Among randomized participants (152 [68.8%] boys; mean [SD] age, 12.1 [2.3] years), tic severity improved significantly, with a mean reduction of 6.08 points on the YGTSS-TTSS in the ERP group (mean [SD] at baseline, 22.25 [5.60]; at 3-month follow-up, 16.17 [6.82]) and 5.29 in the comparator (mean [SD] at baseline, 23.01 [5.92]; at 3-month follow-up, 17.72 [7.11]). Intention-to-treat analyses showed that the 2 groups improved similarly over time (interaction effect, −0.53; 95% CI, −1.28 to 0.22; P = .17). Significantly more participants were classified as treatment responders in the ERP group (51 of 108 [47.2%]) than in the comparator group (31 of 108 [28.7%]) at the 3-month follow-up (odds ratio, 2.22; 95% CI, 1.27 to 3.90). ERP resulted in more treatment responders at little additional cost compared with structured education. The incremental cost per quality-adjusted life-year gained was below the Swedish willingness-to-pay threshold, at which ERP had a 66% to 76% probability of being cost-effective.Both interventions were associated with clinically meaningful improvements in tic severity, but ERP led to higher response rates at little additional identifier: NCT03916055
  • Protocol for a feasibility randomised controlled study of a multicomponent intervention to promote a sustainable return to work of workers on long-term sick leave — PROWORK: PROmoting a Sustainable and Healthy Return to WORK

    Bartle, Craig; Marwaha, Steven; Newman, Kristina; Thomson, Louise (2022)
    The cost of sickness absence has major social, psychological and financial implications for individuals and organisations. Return-to-work (RTW) interventions that support good quality communication and contact with the workplace can reduce the length of sickness absence by between 15 and 30 days. However, initiatives promoting a sustainable return to work for workers with poor mental health on long-term sickness absence across small, medium and large enterprises (SMEs and LEs) are limited. This paper describes the protocol of a pilot randomised controlled trial (RCT) to test the feasibility of implementing a RTW intervention across SMEs and LEs across all sectors.
  • Mental health workers’ perspectives on peer support in high-, middle- and low income settings: a focus group study

    Charles, Ashleigh (2022)
    Peer support is increasingly acknowledged as an integral part of mental health services around the world. However, most research on peer support comes from high-income countries, with little attention to similarities and differences between different settings and how these affect implementation. Mental health workers have an important role to play in integrating formal peer support into statutory services, and their attitudes toward peer support can represent either a barrier to or facilitator of successful implementation. Thus, this study investigates mental health workers’ attitudes toward peer support across a range of high- (Germany, Israel), middle- (India), and low-income country (Tanzania, Uganda) settings.
  • Knife crime offender characteristics and interventions – A systematic review

    Green, Kathleen (2022)
    Knives and sharp objects are tools used in a wide range of violent offences. However, knife offending may have different risk factors than general violence, thus requiring tailored interventions. This systematic review aims to synthesise evidence on the characteristics of knife offenders and interventions aimed at the reduction of knife crime. After screening 1352 titles and abstracts, 344 articles were fully considered of which 21 papers met the inclusion criteria and were quality assessed. These consisted of 15 offender characteristic studies and six intervention studies. Findings suggested that knife crime may be associated with illicit drug use, exposure to any violence as a witness, victim or perpetrator and mental health problems. Males were more at risk of engaging in knife crime in the community and females in domestic settings. Different risk factors were found between gang involved and non-involved knife offenders. Primary prevention strategies, such as stop and search, knife amnesties, media campaigns and curfews did not show a significant impact in reducing knife crime. By contrast, increasing offenders' access to tailored support regarding housing, education, and employment showed an impact in reducing weapon carrying. Further research is required in the area to support the reliability of outcomes.
  • Feasibility and acceptability of experience sampling among LGBTQ+ young people with self-harmful thoughts and behaviours

    Arcelus, Jon (2022)
    This study was the first to determine whether it was feasible and acceptable to use experience sampling methods (ESM) among LGBTQ+ young people, who had current experiences of self-harm. Sixteen LGBTQ+ young people (16–25 years old) took part in the experience sampling study. This included a baseline assessment, a 7-day ESM assessment (participants were sampled six times a day using a phone app), and the option of an interview at the end of the 7-day ESM assessment. Feasibility data was descriptively analysed, with pilot ESM data presented. Qualitative data was thematically analysed to determine the acceptability (barriers and facilitators) of taking part in this study. Study feasibility was assessed by enrolment rate (55.2%), participant retention across assessment period (100%), ESM app feasibility (87.5%), and good adherence to total number of ESM surveys (67.6%). Individual study adherence ranged between 43 and 95.2%. Study acceptability was assessed by participant interviews. Thematic analysis indicated four superordinate themes; (i) Self-reflection and awareness; (ii) Practicalities of ESM surveys; (iii) Daily timeframes; and (iv) Suggestions for future studies. Pilot ESM data demonstrates that there was fluctuation of depressive and anxiety symptoms within- and between- participants over the course of the study, however, greater sample power is needed for full analysis. This study demonstrated that ESM designs are feasible and acceptable among LGBTQ+ young people with current experiences of self-harm. Pilot data indicated that specific experiences and moods are likely to be important to self-harm. These potentially have a temporal influence on self-harm behaviour or ideation, and therefore should be examined in a fully powered sample.
  • "I'm in pain and I want help": An online survey investigating the experiences of tic-related pain and use of pain management techniques in people with tics and tic disorders

    Davies, E. Bethan (2022)
    OBJECTIVES: Tic disorders (TDs) are complex neurological conditions characterized by involuntary, persistent vocalizations and motor movements called tics. Tics involve brief muscle movements and can impair many aspects of daily functioning and quality of life in patients - and their physical nature can cause pain. Understanding individuals' experiences of tic-related pain and pain management could help explore this under-researched area and identify additional support needs for this population. The aim of this study was to investigate experiences of pain and use of pain management techniques in people with tic disorders. METHODS: An online survey consisting of multiple choice and open-ended questions exploring experiences of tic-related pain, help-seeking behavior for tic-related pain, and use of pain relief techniques for tic-related pain, was circulated online via international Tourette syndrome patient associations, and one online support group for Tourette syndrome. The online survey was open to adults (≥16 years) with self-reported tics. Open-ended questions were analyzed using thematic analysis. RESULTS: One hundred eighty-one participants (16-71 years; 58.0% female) from 18 countries completed the online survey. Several aspects of tics were associated with pain, including the physical effort of motor tics (n = 177, 97.8%), repetitive tics (n = 141, 77.9%) and the consequences of tics (n = 131, 72.4%). Nearly two-thirds (n = 118, 64.6%) had sought professional help for tic-related pain. Distraction techniques (n = 126, 69.6%), taking pain relief medication (n = 125, 69.1%) and altering tics (n = 111, 61.3%) were the most commonly-reported methods used to relieve and cope with tic-related pain. Thematic analysis found an interrelated complex relationship between participants' tics, pain, and pain management techniques, reflected in four themes: the "tic-pain" cycle, the impact of pain, the importance of support, and the perceived successfulness of pain management techniques. CONCLUSIONS: Tic-related pain was reported to have a significant physical and psychological impact which impacted aspects of daily living in people with tic disorders. The findings add to limited research suggesting tic-related pain is a dominant issue for individuals with tic disorders, potentially impacting upon their quality of life. Increased understanding of tic-related pain and its influence may be helpful in the long-term management of tic disorders, both in terms of clinical management and patients' self-management.
  • The last chance to get it right: the experience of health professionals delivering end-of-life care in an in-patient mental health setting. A modified critical review of literature

    Furby, Robert (2022)
    The purpose of this modified critical review of literature is to draw upon the contemporary evidence base to explore the lived experiences of healthcare professionals delivering end-of-life care to patients cared for in mental healthcare settings. People of severe and persistent mental illness are a very vulnerable cohort of patients. They often live with higher-than-average co-morbidities, low than average life expectancy and high mortality rates. Little is known about the experience of mental health professionals delivering end-of-life care to those patients whose care needs can only be met in an in-patient facility. This review aims to provide a window into this experience and draw out the barriers and enablers to good care. For this review, 64 unique titles and abstracts were identified through the search of six databases. The appraisal of these papers resulted in six meeting the inclusion and quality criteria and subsequent syntheses of the findings were presented into three themes:1) There was a recurrent lack of preparedness of both services and staff to assess and meet the needs of patients at the end-of-life in mental healthcare settings.2) There was a clear need for collaborative work between mental and physical healthcare professionals; however, this was often difficult to achieve.3) Patients at the end-of-life with Severe Mental Illness poses specifically challenges which professional caring for them need to be aware of.The findings of the review were in keeping with other work in the area and provides four main recommendations for practice:1) Services must have a clearly defined collaborative approach to working relationships between palliative care and mental healthcare professionals.2) Specific training and education for mental healthcare professionals in end-of-life care and visa verse for physical healthcare professionals when caring for a patient with a comorbid serious mental illness.3) Thought should be put into the environment of an in-patient mental healthcare ward. While it is recognised the need to maintain safety of patients in these environments, considerations such as the availability to the correct equipment, décor and access to meaningful activity is invaluable for both care giver and patient.4) Services should consider that their policies and procedures reflect that end-of-life care could be a need of any patient in a services care. The ability to refer to policy and procedure was found to be a comfort and a supportive measure for staff caring for patients at the end-of-life.
  • Strengthening Mental Abilities with Relational Training (SMART) in multiple sclerosis (MS): study protocol for a feasibility randomised controlled trial

    Turton, James; Frost, Alexandra (2022)
    Multiple sclerosis (MS) is a chronic condition of the central nervous system, affecting around 1 in every 600 people in the UK, with 130 new diagnoses every week. Cognitive difficulties are common amongst people with MS, with up to 70% experiencing deficits in higher-level brain functions—such as planning and problem-solving, attention, and memory. Cognitive deficits make it difficult for people with MS to complete everyday tasks and limit their abilities to work, socialise, and live independently. There is a clear need—and recognised research priority—for treatments that can improve cognitive functioning in people with MS. The absence of effective cognitive interventions exacerbates burdens on the services accessed by people with MS—requiring these services to manage sequelae of untreated cognitive deficits, including reduced quality of life, greater disability and dependence, and poorer adherence to disease-modifying treatments. Our planned research will fill the evidence gap through developing—and examining the feasibility of trialling—a novel online cognitive rehabilitation programme for people with MS (SMART). The SMART programme directly trains relational skills (the ability to flexibly relate concepts to one another) based on theory that these skills are critical to broader cognitive functioning.
  • ‘Maybe I shouldn’t talk’: The role of power in the telling of mental health recovery stories

    Llewellyn-Beardsley, Joy; Rennick-Egglestone, Stefan; Ali, Yasmin; Watson, Emma; Yeo, Caroline; Ng, Fiona; Slade, Mike (2022)
    Mental health ?recovery narratives? are increasingly used within teaching, learning and practice environments. The mainstreaming of their use has been critiqued by scholars and activists as a co-option of lived experience for organisational purposes. But how people report their experiences of telling their stories has not been investigated at scale. We present accounts from 71 people with lived experience of multiple inequalities of telling their stories in formal and informal settings. A reflexive thematic analysis was conducted within a critical constructivist approach. Our overarching finding was that questions of power were central to all accounts. Four themes were identified: (1) Challenging the status quo; (2) Risky consequences; (3) Producing ?acceptable? stories; (4) Untellable stories. We discuss how the concept of narrative power foregrounds inequalities in settings within which recovery stories are invited and co-constructed, and conclude that power imbalances complicate the seemingly benign act of telling stories of lived experience.
  • Self-help digital interventions targeted at improving psychological well-being in young people with perceived or clinically diagnosed reduced well-being: Systematic review

    Babbage, Camilla M.; Jackson, Georgina M.; Davies, E. Bethan; Nixon, Elena (2022)
    Background: Levels of well-being are declining, whereas rates of mental health problems remain high in young people. The World Health Organization defines mental health as not merely the absence of mental disorder but also includes social and psychological well-being as integral to positive mental health, highlighting that mental health is applicable to young people with mental health conditions and those without a diagnosis of a mental health condition. Reduced mental well-being have been identified in studies of young people with clinical populations, as well as in populations consisting of nonclinical young people. Self-help digital interventions can be delivered at mass at a low cost and without the need for trained input, thereby facilitating access to support for well-being. Self-help interventions are effective in young people with mental health conditions, but systematic reviews of such studies have been limited to randomized controlled trials, have not included reduced well-being as an inclusion criterion, and do not consider engagement factors such as retention. Objective: The objective of this study was to systematically review all controlled studies of digitally delivered, self-administered interventions for young people aged 9 to 25 years, with perceived or clinically diagnosed reduced psychological well-being. Participant retention and effectiveness of the interventions were also explored. Methods: A systematic search of the PsycInfo, EMBASE, Cochrane, Scopus, and MEDLINE databases from inception to 2021, reference searches of relevant papers, and gray literature was carried out for digitally controlled studies conducted with young people with perceived or clinically diagnosed reduced well-being, aimed at improving psychological well-being. Data were extracted to identify the effectiveness and retention rates of the interventions and the quality of the studies. Results: Overall, 1.04% (12/1153) of studies met the inclusion criteria: 83% (10/12) of studies were randomized controlled trials and 17% (2/12) were controlled pre-post studies. Most (6/12, 50%) studies aimed to improve symptoms of depression; 3 interventions aimed at both anxiety and depressive symptoms and 2 studies aimed at improving social functioning difficulties. Owing to the high risk of bias across interventions and lack of similar outcome measures, a meta-analysis was not conducted. Retention rates across studies were regarded as good, with moderate to high retention. Overall, the findings indicated that predominantly self-administered self-help interventions improved well-being in the areas targeted by the intervention and identified additional areas of well-being that were positively affected by interventions. Few interventions supported psychological well-being that was different from those used by young people with a clinical diagnosis of mental illness or young people from neurodiverse backgrounds. Conclusions: The findings, along with the advantages of self-help interventions, highlight the need for upscaling self-help interventions to better support vulnerable populations of young people who experience poor psychological well-being. Trial Registration: PROSPERO CRD42019129321;
  • Dietary nitrate and brain health. Too much ado about nothing or a solution for dementia prevention?

    Stephan, Blossom C. M. (2022)
    Dementia is a significant public health priority with approximately 55 million cases worldwide, and this number is predicted to quadruple by 2050. Adherence to a healthy diet and achieving optimal nutritional status are vital strategies to improve brain health. The importance of this area of research has been consolidated into the new term ‘nutritional psychiatry’. Dietary nitrate, closely associated with the intake of fruits and vegetables, is a compound that is increased in dietary patterns such as the Mediterranean and MIND diets and has protective effects on cognition and brain health. Nitrate is characterised by a complex metabolism and is the precursor of the nitrate–nitrite–nitric oxide (NO) pathway contributing to systemic NO generation. A higher intake of dietary nitrate has been linked to protective effects on vascular outcomes including blood pressure and endothelial function. However, the current evidence supporting the protective effects of dietary nitrate on brain health is less convincing. This article aims to provide a critical appraisal of the current evidence for dietary nitrate supplementation for improving brain health and provide suggestions for future research.
  • Dementia Early-Stage Cognitive Aids New Trial (DESCANT) of memory aids and guidance for people with dementia: randomised controlled trial

    Orrell, Martin; Challis, David; Chester, Helen; Hughes, Jane (2022)
    Background Common memory aids for people with dementia at home are recommended. However, rigorous evaluation is lacking, particularly what guidance or support is valued.Objective To investigate effects of memory aids and guidance by dementia support practitioners (DSPs) for people in early-stage dementia through a pragmatic, randomised controlled trial.Methods Of 469 people with mild-to-moderate dementia and their informal carers, 468 were randomised to a DSP with memory aids or to usual care plus existing dementia guide. Allocation was stratified by Trust/Health Board; time since first attendance at memory service; gender; age; and living with primary carer or not. Primary outcome was Bristol Activities of Daily Living Scale (BADLS) Score at 3 and 6 months (primary end-point). Secondary outcomes for people with dementia: quality of life (CASP-19; DEMQOL); cognition and functioning (Clinical Dementia Rating Scale; S-MMSE); capability (ICECAP-O); social networks (LSNS-R); and instrumental daily living activities (R-IDDD). Secondary outcomes for carers: psychological health (GHQ-12); sense of competence (SSCQ).Results DSPs were successfully trained, compliance was good and welcomed by participants. Mean 6 months BADLS Score increased to 14.6 (SD: 10.4) in intervention and 12.6 (SD: 8.1) in comparator, indicative of greater dependence in the activities of daily living. Adjusted between-group difference was 0.38 (95% CI: −0.89 to 1.65, p=0.56). Though this suggests greater dependency in the intervention group the difference was not significant. No differences were found in secondary outcomes.Conclusions This intervention did not maintain independence in the activities of daily living with no improvement in other outcomes for people with dementia or carers.Trial registration number Current Controlled Trials ISRCTN12591717.Data are available upon reasonable request. Data are available on reasonable request from the corresponding author
  • Acute effects of physical activity on cognitive function in children and adolescents with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis

    Groom, Madeleine J. (2022)
    Attention-deficit/hyperactivity disorder (ADHD), one of the most common neurodevelopmental disorders in children and adolescents, is typically managed with medications which are associated with negative side effects. Therefore, non-pharmacological treatments, such as physical activity, are an attractive option. The aim of this meta-analysis was to explore the effects of acute physical activity on cognition in children and adolescents with ADHD. A comprehensive search of three literature databases yielded 14 studies for inclusion. An overall meta-analysis was conducted alongside sub-group analyses for cognitive domain, physical activity characteristics, and timing of cognitive measurements. Results revealed a small beneficial effect of physical activity on cognitive function (SMD = 0.18, [0.12,0.25], p < 0.01). Sub-group analyses revealed beneficial effects of physical activity on the domains of cognitive flexibility (SMD = 0.21, [0.09,0.32], p < 0.01), attention (SMD = 0.20, [0.09,0.32], p = 0.001), and inhibitory control (SMD = 0.18, [0.03,0.33], p = 0.02), but not memory (p = 0.87). Cognitive benefits also differed depending on physical activity duration (<10 min, p = 0.27; 11–20 min, SMD = 0.23, [0.14,0.31], p < 0.01; >20 min, SMD = 0.13, [-0.00,0.26], p = 0.05), and modality (running, SMD = 0.21, [0.12,0.29], p < 0.01; ‘other’, SMD = 0.39, [0.18,0.61], p < 0.01; cycling, p = 0.35), and the timing of cognitive measurement following physical activity (immediately, SMD = 0.17, [-0.01,0.35], p = 0.06; 2–10 min, SMD = 0.21, [0.12,0.30], p < 0.01; >10 min, SMD = 0.19, [-0.09,0.47], p = 0.19). Overall, physical activity has a positive acute effect on subsequent cognition in children and adolescents with ADHD, though effects may be domain specific and influenced by the duration and modality of physical activity. These findings have practical implications for those interested in using physical activity to enhance cognition in children and adolescents with ADHD.
  • Taking a position within powerful systems

    Coles, Steven (2022)
    Psychiatric diagnosis remains the dominant model for conceptualising mental health difficulties and psychological distress. Psychiatric discourses rooted in the biomedical and biopsychosocial models are structurally embedded within service design throughout the UK and determine service provision, access to help and support, research grants, and overwhelmingly shape policy and legislation. Within this socio-political context, clinical and community psychologists continue to develop alternative conceptual frameworks and practices to counter individualising and arguably pathologising constructs of disorder and mental illness. As practitioners become increasingly outwardly looking and focus efforts on changing the underlying socio-materialist conditions that shape psychological distress, the need to recalibrate clinical psychology to address inequality, discrimination and social injustice as a matter of course is irrevocable. For many psychologists working in organisations designed on the basis of diagnostic discourses, the question as to how one positions themselves in-line with pre-existing psychiatric practices is crucial. Does one integrate approaches or question and challenge these psychiatric practices more overtly? Alternatively, could clinical and community psychology achieve a more ethical and conceptually coherent practice through activism to protest against the dominance of psychiatric diagnosis? This chapter explores how clinical psychologists position themselves in contexts where psychiatric diagnosis is the prevailing mode of practice, and it then goes on to explore what lessons clinical psychology can learn from community psychology when it comes to questions of psychological distress and psychiatric disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Source: book)

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