Amanda Tetley

A systematic review of measures of therapeutic engagement in psychosocial and psychological treatment.

This article reports a systematic review of engagement measures for psychosocial therapy. MEDLINE, EMBASE, and PsycINFO databases were searched to identify English-language studies (published 1980 to February 2010) that reported on an instrument/rating scale to measure engagement in psychosocial treatment for mental health difficulties. Forty-seven studies were identified, reporting information on 40 measures of treatment engagement. Although our findings suggest that therapeutic engagement appears to be considered an important construct to assess, they also reveal that there is little consensus in the definition of engagement employed. Few measures are generalizable across treatment settings and clinical populations, and limited information is reported on the indices of reliability and validity. It is concluded that further work is required to develop adequate measures of therapeutic engagement.

Parental bonding and eating disorders: A systematic review

This article systematically reviewed studies of parental bonding in people with eating disorders. MEDLINE, PsychINFO, EMBASE and CINAHL were searched to identify studies that compared parental bonding in people diagnosed with an eating disorder relative to non-clinical controls. Twenty-four studies were identified. Women with eating disorders typically reported lower parental care and higher parental protection compared to non-clinical, but not psychiatric, controls. Interestingly, a modest number of studies found that these relationships were mediated by avoidant problem solving style and several schemas from the Young Schema Questionnaire (YSQ; Schmidt, Joiner, Young, & Telch, 1995). While there are methodological limitations associated with the reviewed studies, they do offer some support for the proposal that difficulties in parent-child relationships predispose women to eating disorders and other psychiatric diagnoses.

Difficulties in the pathway from high to medium secure services for personality-disordered patients

Personality-disordered patients detained in high secure psychiatric hospitals appear to experience difficulties progressing to medium secure services. Accordingly, this study sought to explore the problems encountered in this pathway. To do this, data relating to referrals to medium secure services were collated for previous and current patients from a Personality Disorder service (n = 68) and a Dangerous and Severe Personality Disorder service (n = 12) in one English high secure hospital. The results highlighted the poor success rate of referrals to medium secure units and revealed the extensive delays encountered in the transfer process. Further to this, they also identified the poor success rate of patients periods of trial leave at medium secure units. Taken together, these findings are consistent with reports that consultants in medium secure units are reluctant to accept personality-disordered patients and that these units lack the infrastructure to treat this patient group.

Are they different? A comparison of risk in Dangerous and Severe Personality Disordered and Personality Disordered hospitalized populations

Abstract There has been considerable interest internationally in the assessment and treatment of individuals who have a severe personality disorder and who might pose a high risk of future recidivism. In the UK, the Dangerous and Severe Personality Disorder (DSPD) programme was initiated to deal with just this group. It is unclear, yet, whether those admitted to these services are different from those admitted to conventional personality disorder (PD) services. In the present study, 60 patients admitted to DSPD services, under DSPD criteria, were compared with 44 patients admitted to personality disordered (non-DSPD) services within the same high secure psychiatric hospital, on risk measures, including (1) an index of predicted future violence, (2) previous offending behaviour and (3) ‘pre-treatment’ levels of institutional risk-related behaviour. Results indicated that DSPD patients do pose a greater clinical and management risk, have a higher number of ‘pre-treatment’ risk-related behaviour, and have a greater number of convictions and imprisonments after age 18, relative to PD patients. The implications and limitations of these results are discussed.

P02-449 - Are they Different? a Comparison of Risk in Dangerous and Severe Personality Disordered and Personality Disordered Hospitalized Populations

Introduction There has been considerable interest internationally in the assessment and treatment of individuals who have a severe personality disorder and who might pose a high-risk of future recidivism. In the United Kingdom, the ‘Dangerous and Severe Personality Disorder’ (DSPD) programme was initiated to deal with just this group. It is important, however, that the DSPD service is filling a treatment void and not competing with already well-established and effective services for (non-DPSD) personality disordered patients. Objective: To establish whether those admitted to innovative DSPD services are different from those admitted to conventional personality disorder (PD) services. Aim To compare patients admitted to DSPD services with those admitted to personality disordered (non-DPSD) services. Method Sixty patients admitted to DSPD services, under DSPD criteria, were compared with 44 patients admitted to personality disordered (non-DSPD) services within the same high secure psychiatric hospital, on risk measures, including (1) an index of predicted future violence (2) previous offending behaviour and (3) pre-treatment levels of institutional risk-related behaviour. Results DSPD patients do pose a greater clinical and management risk, have a higher number of pre-treatment risk-related behaviour, and have a greater number of convictions and imprisonments after age 18, relative to PD patients. Conclusion The findings broadly confirm the hypotheses as to the higher risk in DSPD patients and thus offer support for the main purpose of DSPD services: to provide treatment for those who represent the highest priority in terms of treatment need and risk to public protection. Implications are discussed.