Jacqueline Sin

An evaluation of education and implementation of psychosocial interventions within one UK mental healthcare trust.

Psychosocial interventions (PSI), though recommended in the NICE guidelines for schizophrenia and bipolar affective disorder, are not routinely available to people with a serious mental illness in the UK. Education and training initiatives to equip mental health professionals with skills in PSI have grown over the last decade; yet the literature indicates serious problems in implementation of PSI in routine service provision. This paper examines on a local level the factors which support and limit the education and practice of PSI in one UK mental healthcare trust. It reports on a survey of trainees and their managers which aims to evaluate the impact of a PSI training programme and practice development strategy on staff, managers and service provision. The key findings are: a high rate of implementation of PSI by PSI-trained staff in the Trust; a strong association between PSI training and career progression for staff; and the support mechanisms which are most effective in the education and implementation of PSI. The paper concludes that certain measures and support mechanisms have facilitated the successful implementation of PSI with positive outcomes for staff and service provision. Further recommendations are made identifying measures which facilitate the implementation of PSI through an integrated education and practice development strategy owned by all stakeholders.

Understanding the experiences and service needs of siblings of individuals with first-episode psychosis: a phenomenological study

Background: Despite recent focus on developing family‐inclusive services to meet the needs of young people with first‐episode psychosis, the needs of their siblings are often overlooked.

A systematic review of the psychological correlates of adjustment outcomes in adults with inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic long term condition which poses significant psychosocial adjustment challenges. The purpose of this review was to systematically identify psychological factors related to adjustment in adults with IBD with the aim of suggesting evidence based targets that may be modifiable though psychological intervention. Twenty five studies met inclusion criteria and were included in the systematic review and a narrative synthesis was conducted. A wide range of psychological variables were addressed covering six broad categories; personality traits, interpersonal traits, stress and coping, emotions and emotional control, IBD related cognitions and non IBD related cognitions. The most consistent relationship was found between certain emotion focused coping strategies and worse adjustment outcomes in IBD. Some evidence also hi-lighted a relationship between personality traits (such as neuroticism,) perceived stress, emotions and emotional control (such as alexithymia) and IBD related cognitions (such as illness perceptions) and negative adjustment outcomes. The results of this review suggest that interventions to improve adjustment in IBD may benefit from a focus on coping strategies, perceived stress and IBD related cognitions.

Psychological interventions for trauma in individuals who have psychosis: A systematic review and meta-analysis

Background: Psychological interventions, in particular those derived from cognitive-behavioural therapy frameworks, and eye movement desensitisation and reprocessing, are effective for reducing post-traumatic stress disorder and associated distress. To date, studies have tended to exclude individuals who have psychosis; a clinical population who are known to be at risk of experiencing trauma. Whether people with psychosis also benefit from trauma-focussed psychological therapies (TFPT) warrants further investigation. Method: A systematic search for randomised controlled trials was undertaken. Data were synthesised using narrative and meta-analytic approaches. Results: Five studies met the review inclusion criteria. Study findings overall indicate that TFPT are effective for reducing intrusive thoughts and images, negative beliefs associated with traumatic memories, hypervigilance, and avoidance. Limited data were available about the utility of interventions for improving mood, anxiety and quality of life. Attrition rates were comparable for participants offered active and control conditions. Conclusion: Findings are consistent with those reported for the non-psychosis population. Future studies should establish which interventions are more acceptable and glean more favourable outcomes for this clinical population.

Cognitive behaviour therapy for social anxiety in autism spectrum disorder: a systematic review

Purpose Individuals who have autism spectrum disorders (ASD) commonly experience anxiety about social interaction and social situations. Cognitive behaviour therapy (CBT) is a recommended treatment for social anxiety (SA) in the non-ASD population. Therapy typically comprises cognitive interventions, imagery-based work and for some individuals, behavioural interventions. Whether these are useful for the ASD population is unclear. Therefore, the purpose of this paper is to undertake a systematic review to summarise research about CBT for SA in ASD. Design/methodology/approach Using a priori criteria, the authors searched for English-language peer-reviewed empirical studies in five databases. The search yielded 1,364 results. Titles, abstracts, and relevant publications were independently screened by two reviewers. Findings Four single case studies met the review inclusion criteria; data were synthesised narratively. Participants (three adults and one child) were diagnosed with ASD and SA. There were commonalities in interventions and techniques used: participants were encouraged to identify and challenge negative thoughts, enter anxiety-provoking social situations, and develop new ways of coping. Unlike CBT for SA in non-ASD individuals, treatment also included social skills interventions. Outcomes were assessed using self- or informant-reports. Improvements in SA, depressive symptoms, social skills, and activity levels were noted. Generalisability of results is hampered, however, by the small number of studies and participants and lack of randomised controlled trial conditions employed. Research limitations/implications Future studies should investigate how beliefs and behaviours indicative of SA can be ameliorated in individuals with ASD. Originality/value This is the first review to synthesise empirical data about CBT for SA in ASD.

Wellbeing, mental health knowledge and caregiving experiences of siblings of people with psychosis, compared to their peers and parents: An exploratory study

PurposeThe wellbeing and caregiving experiences of family carers supporting people with psychosis has garnered increasing interest. Evidence indicates that the burden of caregiving can adversely impact on parents’ wellbeing, few studies have investigated whether this is also the case for siblings, who often take on caregiving responsibilities. This exploratory study investigated the wellbeing, mental health knowledge, and appraisals of caregiving in siblings of individuals with psychosis.MethodUsing a cross-sectional design, 90 siblings completed three validated questionnaires: Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS), Mental Health Knowledge Schedule (MAKS), and Experience of Caregiving Inventory (ECI). Data obtained were compared to general population norms and parent-carers’ scores. Multi-variable regression analyses were conducted to examine relationships between questionnaire scores and demographic characteristics including age, sex, birth order, marital status, accommodation and educational level.ResultsSiblings, especially sisters, had significantly poorer mental wellbeing, compared to normative scores. Conversely, they had better mental health knowledge. Siblings and parent-carers had comparable high levels of negative appraisals of caregiving experiences, but siblings reported more satisfaction with personal experiences and relationships. Education level was a significant predictor for better mental health knowledge; there were no other relationships between siblings’ demographic factors and outcomes.ConclusionStudy findings suggest that siblings have overlapping as well as distinct needs, compared to parent-carers. Further research is required to better understand siblings’ experiences so as to inform development of targeted interventions that enhance wellbeing and caregiving capacity.

Siblings of individuals with severe mental illness

Purpose – The importance of providing information, support and interventions for family members and carers of people who have severe mental illness (SMI) has garnered increasing attention in recent years. However, research to date has primarily focused on parents; the purpose of this paper is to review the literature investigating the experiences of siblings of individuals who have SMI. Design/methodology/approach – A literature review was undertaken to summarise the empirical data regarding the experiences and needs of siblings, and their potential contribution to supporting their siblings’ recovery journey. Findings – Sibling views, experiences and needs have thus far been little explored. Yet siblings often make significant contributions to their brothers/sisters care and social and emotional well-being, and their support can positively shape the recovery trajectory. This review finds that siblings require information and support for two reasons: to maintain their own well-being, and to be able to be...

A systematic review of evidence-based treatment for individuals with treatment-resistant schizophrenia and a suboptimal response to clozapine monotherapy

Background: Currently, only clozapine is licensed for ‘treatment-resistant schizophrenia’ (TRS). However, ad hoc clozapine augmentation strategies are frequently resorted to, without clear guideline from evidence-based medicine, for individuals with a suboptimal response to clozapine monotherapy. Aims: To identify the optimal evidence-based clozapine augmentation regime with either pharmacological or psychosocial interventions, or a combination of pharmacological and psychosocial approaches. Method: Systematic analysis of randomised controlled trials of clozapine monotherapy versus clozapine/adjunctive medication and clozapine/psychosocial adjunctive therapies Results: No trial was identified investigating clozapine augmentation with both psychosocial and pharmacological strategies. Six trials investigating clozapine augmentation with various medication, such as Lamotrigine, Risperidone, Aripiprazole and Sulpiride, were identified. These trials reported some effects on overall symptoms. Two trials of clozaoine augmentation with Cognitive Behavioural Therapy found positive effects on overall mental state and discussed an improved quality of life. One trial on Occupational Therapy-clozapine augmentation reported improved occupational performance and interpersonal relationships. Conclusion: Our review findings suggest psychosocial intervention augmentations are potentially effective treatments for service users with TRS. Less conclusive results are identified from the many pharmacological augmentation strategies. Longer and larger trials are required to demonstrate long-term effects. Declaration of Interest: None

What factors influence successful recruitment of siblings of individuals with first episode psychosis to e-health interventions? A qualitative study

Recruitment to clinical research studies can prove complex. This is particularly true of mental health research, given factors such as confidentiality, capacity and consent, or when attempting to recruit family members as opposed to service users themselves.

Effectiveness of trauma-focused psychological therapies compared to usual postnatal care for treating post-traumatic stress symptoms in women following traumatic birth: A systematic review protocol

Introduction Maternal mental health has been largely neglected in the literature. Women, however, may be vulnerable to developing post-traumatic stress symptoms or post-traumatic stress disorder (PTSD), following traumatic birth. In turn, this may affect their capacity for child rearing and ability to form a secure bond with their baby and impact on the wider family. Trauma-focused psychological therapies (TFPT) are widely regarded as effective and acceptable interventions for PTSD in general and clinical populations. Relatively little is known about the effectiveness of TFPT for women postpartum who have post-traumatic stress symptoms. Methods and analysis We will conduct a review to assess the effectiveness of TFPT, compared with usual postpartum care, as a treatment for post-traumatic stress symptoms or PTSD for women following traumatic birth. Using a priori search criteria, we will search for randomised controlled trials (RCT) in four databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO and OpenGrey. We will use search terms that relate to the population, TFPT and comparators. Screening of search results and data extraction will be undertaken by two reviewers, independently. Risk of bias will be assessed in RCTs which meet the review criteria. Data will be analysed using the following methods, as appropriate: narrative synthesis; meta-analysis; subgroup analysis and meta-regression. Dissemination and ethics As this work comprises a synthesis of existing studies, ethical approvals are not required. Results will be disseminated at conferences and in publications.