Roslyn Corney

Behavioural psychotherapy in the treatment of irritable bowel syndrome

The irritable bowel syndrome is a highly prevalent condition whose underlying aetiology is not understood. While many patients respond to a combination of gastrointestinal antispasmodics, bulking agents and dietary manipulation, controlled clinical trials have suggested that the benefit is only marginal and is due mainly to the large placebo effect found in this condition, which has been calculated to range between 54 and 81%. Associations between the syndrome and psychological and social stresses suggest, however, that treatment involving a systematic approach to the management of symptoms may hold out real therapeutic possibilities. In the current study, 42 IBS patients were randomly allocated to either medical treatment or to behavioural psychotherapy with a nurse therapist. They were assessed initially and at 4 and 9 months. There was a general improvement over the 9 months on a number of physical and psychological symptoms measured. However, no differences were found between treatment groups except for changes in two avoidance scores. A significant correlation was found, however, between improvement in the bowel symptoms of IBS (stomach pain and diarrhoea) and improvement in the psychological symptoms measured by the Clinical Interview Schedule, suggesting a close interrelationship between the two.

A survey of 658 women who report symptoms of premenstrual syndrome

A treatment trial was briefly mentioned in two British publications and women suffering from premenstrual syndrome were invited to write to us. After initial screening, postal questionnaires were sent to all eligible women. Six-hundred and ninety-nine questionnaires were returned and of these 658 were included in the analyses. Although the results of the study need to be considered cautiously because of the unrepresentative nature of the sample, the survey was helpful in ascertaining the views of women who report PMS symptoms and what they had found helpful. The majority of respondents were aged in their 30s and were married with children. Over 60% were chronic sufferers, having had symptoms for 5 years or more. High proportions of the women experienced both psychological and somatic symptoms but it was the psychological symptoms which were perceived as the most distressing. Over 60% of the sample were ascertained as suffering from some degree of psychological distress and the same proportion had one or more social problems. Overall 84% had visited their GP for this problem and many had also visited gynaecologists, family planning clinicians and psychiatrists. Agencies offering alternative medicine were also frequently contacted and often found more helpful. Most women had tried more than one type of medication but no one treatment was found to be particularly helpful.

Young childless women with breast cancer in the UK: a qualitative study of their fertility-related experiences, options, and the information given by health professionals

A proportion of young women diagnosed with breast cancer are childless. Fertility can be impaired by treatment, and women may have to wait for a number of years before pregnancy is advised. The aim of this qualitative study was to investigate in detail the fertility‐related experiences of young childless women with breast cancer, including the information they received, the fertility preservation options given, and the dilemmas they faced.

The mental and physical health of clients referred to social workers in a local authority department and a general practice attachment scheme.

Although numerous reports have strongly argued that there is a need for a closer collaboration between the health and social services, studies investigating the health of clients in contact with the personal social services have been few and limited. This study collected information regarding the physical and mental health of clients referred to social workers in a local authority intake team and to a general practice attachment scheme by means of questionnaires completed by the client and at interview. The results indicated that the proportions of patients with physical or mental illness were very high. However, while social workers in the attachment scheme had many contacts with members of the primary care team regarding these clients, contacts between intake social workers and medical personnel were very limited.

The role of the practice nurse in mental health: A survey

The role of the practice nurse is expanding as the profession grows. Mental health is an area of potentially great importance for the practice nurse, particularly as moves are made towards a more preventive approach in primary care. A response rate of 72% (n=71) was achieved in this survey of practices nurses in two health districts. 89% said that they dealt with mental health problems, while 87% felt inadequately trained and 91% wanted more training in this field. Relationship problems were most mentioned as being associated with psychological problems. Practice nurses, along with other primary care workers, need more training in this area if the most effective service is to be provided for the primary care client.

Mental health services in primary care: The overlap in professional roles

The present study was part of a two-stage study set up to examine the changes fundholding has made on the provision of mental health services in primary care. Detailed information was collected from mental health professionals and counsellors working in 20 fundholding and 20 non-fundholding practices in the South Thames Region. The findings suggest that there was a considerable degree of overlap between the mental health professionals in their training, the techniques they employed, the range of problems referred and whom they considered appropriate and inappropriate to treat. It is important that each professionals training and skills are used to their full potential and inappropriate referrals are avoided. There is a need for further, more detailed research into this area including comparative studies of effectiveness and efficacy. It is also important that the roles of these mental health professionals are clarified and relevant standards including core and specialist skills are developed and maintained.

The stressors and vulnerabilities of young single childless women with breast cancer: A qualitative study

PURPOSE OF THE RESEARCH Marital or partnership status is seldom investigated as a primary contributing factor to womens wellbeing after a diagnosis of breast cancer. It has been suggested, however, that single childless women with breast cancer may face unique stressors. This paper explores the stressors and vulnerabilities of young single childless women with a first episode of breast cancer. METHODS AND SAMPLE A qualitative descriptive method was used. As part of a larger study examining fertility concerns of young childless women with first episode of breast cancer, in-depth semi-structured interviews were conducted with 10 single women. Recorded interviews were analysed using the framework approach. KEY RESULTS Findings cover three main themes: partnership worries; fertility concerns; and views about emotional and practical support received. Partnership worries included concerns about having to undergo treatment without a partner to support them; the fear of rejection by potential partners; and feelings about the precious time lost in diagnosis and treatment. Fertility concerns included dilemmas about having children and feelings about the options of pursuing Assisted Reproductive Techniques. Views about the emotional and practical support received included the overall support received as well as perceptions about the attitudes of health professionals towards fertility issues. CONCLUSIONS Findings indicate that single childless women with breast cancer face additional vulnerabilities and may benefit from tailored support from health care professionals and interventions specifically targeted at them.

Why some adults with intellectual disability consult their general practitioner more than others

BACKGROUND This research identifies factors affecting why some adults with intellectual disability (AWIDs) consult their general practitioner (GP) more than others. Little is known about these factors, despite AWIDs having higher health needs and reduced longevity. Current barriers to accessing health care need to be understood and overcome to achieve improved health outcomes. METHODS A secondary analysis of data obtained from a stratified randomised sample of AWIDs participating in a cluster randomised trial of hand held health records. The number of GP consultations was obtained retrospectively for the year preceding initial health interviews from GP records. AWIDs and their carers were given separate health interviews using identical/adapted questions where possible. RESULTS Two hundred and one AWIDs and or their carers from 40 practices participated (response rate 64.6%) with GP consultation data extracted for 187 AWIDs. Overall consulting levels were low, 3.2 per annum for women and 2.2 for men. Increased age, gender (women) and type of carer (paid) were all significantly associated with increased consultations. Carers reporting health problems, medications reported by AWIDs, medications recorded in GP records, and pain reported by AWIDs were also significant factors affecting consultations to GP practices after adjustment for age and type of carer. CONCLUSIONS Overall consultation rates were lower than expected, and affected by age, gender and type of carer. Targeted interventions are needed to improve attendance and promote health.

The development of a self-report questionnaire to identify social problems — a pilot study

The construction of a short self-report questionnaire identifying social problems, difficulties and dissatisfactions is described. The questionnaire covers housing, occupation, finance, social and leisure activities, child—parent and marital relationships, relationships with relatives, friends, neighbours and workmates, and legal problems. Results of a preliminary testing in a general practice are provided and discussed, and plans for a more comprehensive assessment are outlined.

Adults with Intellectual Disabilities and Their Carers as Researchers and Participants in a RCT.

BACKGROUND This article describes the process of including people with intellectual disabilities (ID) and carers of people with ID as researchers and participants in randomised controlled trial (RCT) research. People with ID are rarely involved in research about their health, either as researchers or participants. Carers are often included as research informants, but family carers are rarely involved as researchers. METHOD Four teams of researchers each comprising a researcher with ID, a supporting professional and a carer researcher, were recruited to complete a health intervention RCT. Accessible measures were selected and/or devised. Baseline interviews were completed by researchers with ID and/or carers of people with ID by asking participants with ID and/or carers of the participant about the health of the person with ID. Follow-up health interviews were administered after the intervention had been in place for a year. RESULTS The researchers completed 331 interviews with carers and 196 with participants with ID. Over 50% of participants with ID completed baseline assessments. Positive feedback on the process and outcomes was given by the researchers involved. CONCLUSION The inclusion of people with ID both as researchers and as participants was achieved through an appropriate design, strong research partnerships, adequate and flexible resources, promotion of teamwork and a strong task focus.