Identification of the delivery of cognitive behavioural therapy for psychosis (CBTp) using a cross-sectional sample from electronic health records and open-text information in a large UK-based mental health case register

ObjectivesThe main objective of this study was to compare neutrophil–lymphocyte ratio (NLR), a marker of systemic inflammation, between patients diagnosed with International Classification of Diseases 10th Revision (ICD-10) psychiatric disorders and control participants.DesignA cross-sectional methodology was employed to retrospectively analyse electronic health records and records derived from a national health survey.SettingA secondary mental healthcare service consisting of four boroughs in South London.ParticipantsA diverse sample of 13 888 psychiatric patients extracted from South London and Maudsley electronic health records database and 3920 control participants extracted from National Health and Nutrition Survey (2015–2016) were included in the study.Primary and secondary outcome measuresPrimary: NLR levels in patients with mental health diagnoses, NLR between patients with different mental health diagnoses. Secondary: relationship of NLR to length of hospitalisation and to mortality.ResultsNLR was elevated compared with controls in patients with diagnoses including dementia, alcohol dependence, schizophrenia, bipolar affective disorder, depression, non-phobic anxiety disorders and mild mental retardation (p<0.05). NLR also correlated with age, antipsychotic use and hypnotic use. NLR was found to be higher in individuals of ‘white’ ethnicity and lower in individuals of ‘black’ ethnicity. Elevated NLR was associated with increased mortality (β=0.103, p=2.9e−08) but not with hospital admissions or face-to-face contacts.ConclusionsElevated NLR may reflect a transdiagnostic pathological process occurring in a subpopulation of psychiatric patients. NLR may be useful to identify and stratify patients who could benefit from adjunctive anti-inflammatory treatment.

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Digital cognitive–behavioural therapy for insomnia compared with digital patient education about insomnia in individuals referred to secondary mental health services in Norway: protocol for a multicentre randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2021-050661 ◽

2021 ◽

Vol 11 (6) ◽

pp. e050661

Author(s):

Håvard Kallestad ◽

Simen Saksvik ◽

Øystein Vedaa ◽

Knut Langsrud ◽

Gunnar Morken ◽

...

Keyword(s):

Mental Health ◽

Randomised Controlled Trial ◽

Patient Education ◽

Cognitive Behavioural Therapy ◽

Controlled Trial ◽

Behavioural Therapy ◽

Group Differences ◽

Post Intervention ◽

Cognitive Behavioural ◽

Randomised Controlled

IntroductionInsomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.Methods and analysisA parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.Ethics and disseminationThe study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.Trial registration numberClinicalTrials.gov Registry (NCT04621643); Pre-results.

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ETHNIC DIFFERENCES IN COGNITION AND AGE IN PEOPLE DIAGNOSED WITH DEMENTIA: A STUDY OF ELECTRONIC HEALTH RECORDS IN TWO LARGE MENTAL HEALTH CARE PROVIDERS

Alzheimer s & Dementia ◽

10.1016/j.jalz.2019.06.4397 ◽

2019 ◽

Vol 15 (7) ◽

pp. P189

Author(s):

Naaheed Mukadam ◽

Gemma Lewis ◽

Christoph Mueller ◽

Nomi Werbeloff ◽

Robert Stewart ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Electronic Health Records ◽

Mental Health Care ◽

Ethnic Differences ◽

Health Care Providers ◽

Care Providers ◽

Health Records ◽

Mental Health Care Providers ◽

Electronic Health

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Tranquility: An evaluation and co-design of an internet-based cognitive-behavioural therapy (iCBT) program for anxiety and depression (Preprint)

10.2196/preprints.33374 ◽

2021 ◽

Author(s):

Alissa Pencer ◽

Victoria C. Patterson ◽

Meghan A. Rossi ◽

Lori Wozney

Keyword(s):

Mental Health ◽

Cognitive Behavioural Therapy ◽

Design Process ◽

Behavioural Therapy ◽

Anxiety And Depression ◽

High Fidelity ◽

Case Examples ◽

Cognitive Behavioural ◽

Therapeutic Principles ◽

Preliminary Study

BACKGROUND Internet-based cognitive-behavioural therapy (iCBT) is a necessary step towards increasing the accessibility of mental health services. Yet, few iCBT programs have been evaluated for their fidelity to therapeutic principles of CBT or usability standards. Additionally, many existing iCBT programs do not include treatments targeting both anxiety and depression – commonly co-occurring conditions. OBJECTIVE Evaluate the usability and fidelity of Tranquility, a novel iCBT program for anxiety, to CBT principles, and engage in a co-design process to adapt Tranquility to include treatment elements for depression. METHODS CBT experts (n = 6) and mental health informed peers (n = 6) reviewed the iCBT program Tranquility. CBT experts assessed Tranquility’s fidelity to CBT principles and were asked to identify necessary interventions for depression using two simulated client case examples. Mental health informed peers engaged in two co-design focus groups to discuss adaptations to the existing anxiety program and the integration of interventions for depression. Both groups completed online surveys assessing Tranquility’s usability and the likelihood that they would recommend the program. RESULTS CBT experts’ mean rating of Tranquility’s fidelity to CBT was 91%, indicating a high fidelity to CBT. Five out of six CBT experts and all mental health informed peers (88% of participants) rated Tranquility as satisfactory, indicating that they may recommend Tranquility to others, and they rated its usability highly (M = 76.56, SD = 14.07). Mental health informed peers provided suggestions about how to leverage engagement with Tranquility (e.g., add incentives, notification control). CONCLUSIONS This preliminary study demonstrated Tranquility’s strong fidelity to CBT and usability standards. Results highlight the importance of involving stakeholders in the co-design process and future opportunities to increase engagement.

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A critique of the representation of human suffering in the cognitive behavioural therapy literature with implications for mental health nursing practice

Journal of Psychiatric and Mental Health Nursing ◽

10.1111/j.1365-2850.2010.01623.x ◽

2010 ◽

Vol 18 (1) ◽

pp. 35-40 ◽

Cited By ~ 5

Author(s):

A. GRANT

Keyword(s):

Mental Health ◽

Cognitive Behavioural Therapy ◽

Nursing Practice ◽

Behavioural Therapy ◽

Human Suffering ◽

Mental Health Nursing ◽

Cognitive Behavioural ◽

Health Nursing

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Computerised cognitive–behavioural therapy for depression in adolescents: 12-month outcomes of a UK randomised controlled trial pilot study

BJPsych Open ◽

10.1192/bjo.2019.91 ◽

2019 ◽

Vol 6 (1) ◽

Author(s):

Barry Wright ◽

Lucy Tindall ◽

Rebecca Hargate ◽

Victoria Allgar ◽

Dominic Trépel ◽

...

Keyword(s):

Mental Health ◽

Cost Effectiveness ◽

Pilot Study ◽

Cognitive Behavioural Therapy ◽

Care Pathway ◽

Intervention Group ◽

Behavioural Therapy ◽

Self Help ◽

Cognitive Behavioural ◽

Randomised Controlled

Background Computerised cognitive–behavioural therapy (CCBT) in the care pathway has the potential to improve access to psychological therapies and reduce waiting lists within Child and Adolescent Mental Health Services, however, more randomised controlled trials (RCTs) are needed to assess this. Aims This single-centre RCT pilot study compared a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression at referral to evaluate the clinical and cost-effectiveness of CCBT (trial registration: ISRCTN31219579). Method The trial ran within community and clinical settings. Adolescents (aged 12–18) presenting to their primary mental health worker service for low mood/depression support were assessed for eligibility at their initial appointment, 139 met inclusion criteria (a 33-item Mood and Feelings Questionnaire score of ≥20) and were randomised to Stressbusters (n = 70) or self-help websites (n = 69) using remote computerised single allocation. Participants completed mood, quality of life (QoL) and resource-use measures at intervention completion, and 4 and 12 months post-intervention. Changes in self-reported measures and completion rates were assessed by group. Results There was no significant difference between CCBT and the website group at 12 months. Both showed improvements on all measures. QoL measures in the intervention group showed earlier improvement compared with the website group. Costs were lower in the intervention group but the difference was not statistically significant. The cost-effectiveness analysis found just over a 65% chance of Stressbusters being cost-effective compared with websites. The 4-month follow-up results from the initial feasibility study are reported separately. Conclusions CCBT and self-help websites may both have a place in the care pathway for adolescents with depression.

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Learning longitudinal patterns and identifying subtypes of pediatric Crohn disease treated with infliximab via trajectory cluster analysis of electronic health records

10.1101/2021.04.14.21255354 ◽

2021 ◽

Author(s):

Andrew Chen ◽

Ronen Stein ◽

Robert N. Baldassano ◽

Jing Huang

Keyword(s):

Electronic Health Records ◽

Disease Activity ◽

Crohn Disease ◽

Cross Sectional ◽

Health Records ◽

Disease Evolution ◽

Current Classification ◽

Electronic Health ◽

Over Time

ABSTRACTBackgroundThe current classification of pediatric CD is mainly based on cross-sectional data. The objective of this study is to identify subgroups of pediatric CD through trajectory cluster analysis of disease activity using data from electronic health records.MethodsWe conducted a retrospective study of pediatric CD patients who had been treated with infliximab. The evolution of disease over time was described using trajectory analysis of longitudinal data of C-Reactive Protein (CRP). Patterns of disease evolution were extracted through functional principal components analysis and subgroups were identified based on those patterns using the Gaussian mixture model. We compared patient characteristics, a biomarker for disease activity, received treatments, and long-term surgical outcomes across subgroups.ResultsWe identified four subgroups of pediatric CD patients with differential relapse-and-remission risk profiles. They had significantly different disease phenotype (p < 0.001), CRP (p < 0.001) and calprotectin (p = 0.037) at diagnosis, with increasing percentage of inflammatory phenotype and declining CRP and fecal calprotectin levels from Subgroup 1 through 4. The risk of colorectal surgery within 10 years after diagnosis was significantly different between groups (p < 0.001). We did not find statistical significance in gender or age at diagnosis across subgroups, but the BMI z-score was slightly smaller in subgroup 1 (p =0.055).ConclusionsReadily available longitudinal data from electronic health records can be leveraged to provide a deeper characterization of pediatric Crohn disease. The identified subgroups captured novel forms of variation in pediatric Crohn disease that were not explained by baseline measurements and treatment information.SummaryThe current classification of pediatric Crohn disease mainly relies on cross-sectional data, e.g., the Paris classification. However, the phenotypic classification may evolve over time after diagnosis. Our study utilized longitudinal measures from the electronic health records and stratified pediatric Crohn disease patients with differential relapse-and-remission risk profiles based on patterns of disease evolution. We found trajectories of well-maintained low disease activity were associated with less severe disease at baseline, early initiation of infliximab treatment, and lower risk of surgery within 10 years of diagnosis, but the difference was not fully explained by phenotype at diagnosis.

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