scholarly journals Understanding, identifying and managing severe dissociative disorders in general psychiatric settings

2018 ◽  
Vol 25 (1) ◽  
pp. 14-25 ◽  
Author(s):  
Melanie J. Temple
Keyword(s):  
Service Use ◽  
Poor Response ◽  
Revolving Door ◽  
Screening Tools ◽  
Dissociative Disorders ◽  
List Type ◽  
Clinical Interviews ◽  
Specialist Treatment ◽  
The Uk ◽  
Patient Service

SUMMARYThe severe dissociative disorders of dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) are complex, not uncommon presentations associated with severe symptoms, high rates of comorbidity, high service use compared with other psychiatric disorders, and high suicidality. They exact high personal and socioeconomic burdens and show poor response to standard treatments, with high levels of treatment attrition and ‘revolving-door’ out-patient and in-patient service use; patients are often misdiagnosed or labelled ‘untreatable’. DID and DDNOS diagnoses remain controversial, but they have been repeatedly validated internationally over the past 20 years and the disorders can be accurately identified using screening tools and structured clinical interviews. Neurobiological understanding of the disorders is increasing; findings are consistent with a trauma origin and have commonality with features seen in other trauma-related disorders. Specialist treatment that addresses the dissociative symptoms alongside their trauma origins shows promise in early evidence. Working knowledge of these disorders among non-specialist psychiatrists and psychologists in the UK remains poor, resulting in long delays before diagnosis and treatment.LEARNING OBJECTIVES•Understand trauma-related DID and DDNOS, in particular that they are ‘real’ and not rare disorders•Know when to suspect their presence in general psychiatric settings and how to assess for them•Understand (and help the patient to access) specialist treatments and be able to apply general approaches in the non-specialist settingDECLARATION OF INTERESTNone.

Peer workers in mental health services: literature overview

2014 ◽  
Vol 20 (4) ◽  
pp. 286-292 ◽  
Author(s):  
Steve Gillard ◽  
Jessica Holley
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Lived Experience ◽  
Service Use ◽  
Health Service Delivery ◽  
Careful Consideration ◽  
List Type ◽  
Mental Health Service Delivery ◽  
The Uk

SummaryPeer worker roles are being introduced in mental health services in the UK and internationally, to support individuals in their recovery. There is substantial qualitative evidence that demonstrates benefits at an individual level and some evidence of impact on service use and costs, although there are currently few high-quality randomised controlled trials supporting these findings, especially from the UK. A growing body of research indicates that careful consideration of organisational issues regarding the introduction of peer worker roles – the distinctiveness and shared expectations of the role, strategic alignment, organisational support – might maximise their impact. Properly supported and valued peer workers are an important resource to the multidisciplinary team, offering experiential knowledge and the ability to engage patients in their treatment through building relationships of trust based on shared lived experience.LEARNING OBJECTIVESAppreciate the origins of the peer worker role and how the role has been introduced into mental health services to date.Understand the evidence for the benefits of peer worker roles, for patients, peer workers and mental health service delivery.Demonstrate awareness of the organisational and team-level barriers to and facilitators of introducing peer workers into, or alongside, existing multidisciplinary mental health teams.

scholarly journals Randomised evaluation of assertive community treatment: 3-year outcomes

2009 ◽  
Vol 195 (1) ◽  
pp. 81-82 ◽  
Author(s):  
Helen Killaspy ◽  
Stella Kingett ◽  
Paul Bebbington ◽  
Robert Blizard ◽  
Sonia Johnson ◽  
...  
Keyword(s):  
Assertive Community Treatment ◽  
Service Use ◽  
Controlled Trial ◽  
Community Treatment ◽  
Short Period ◽  
Randomised Controlled ◽  
The Uk ◽  
Patient Service ◽  
React Study

SummaryThe only randomised controlled trial to test high-fidelity assertive community treatment (ACT) in the UK (the Randomised Evaluation of Assertive Community Treatment (REACT) study) found no advantage over usual care from community mental health teams in reducing the need for inpatient care and in other clinical outcomes, but participants found ACT more acceptable and engaged better with it. One possible reason for the lack of efficacy of ACT might be the short period of follow-up (18 months in the REACT study). This paper reports on participants' service contact, in-patient service use and adverse events 36 months after randomisation.

scholarly journals What families in the UK use to manage attention-deficit/hyperactivity disorder (ADHD): a survey of resource use

2020 ◽  
Vol 4 (1) ◽  
pp. e000771
Author(s):  
Philippa Fibert ◽  
Clare Relton
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Support Groups ◽  
Attention Deficit ◽  
Service Use ◽  
Behavioural Change ◽  
Behavioural Therapy ◽  
Autism Spectrum ◽  
Convenience Sample ◽  
Hyperactivity Disorder ◽  
The Uk

ObjectiveTo identify interventions being used to manage attention-deficit/hyperactivity disorder (ADHD) in the UK.DesignA survey within the Sheffield Treatments for ADHD Research project. A convenience sample of participants in the UK who consented to join an observational cohort were asked closed questions about medication, behavioural change programmes and service use, and an open-ended question about what else they used.SettingA broad variety of non-National Health Service, non-treatment seeking settings throughout the UK, including local authority organisations, schools, ADHD and autism spectrum condition support groups and social media.ParticipantsFamilies of children aged 5–18 with carer reported ADHD and Conners Global Index (CGI) T scores of 55+.ResultsResponses from 175 families were analysed. The mean age of the children was 10.21 (2.44), and two-thirds (n=114) had additional diagnoses. The majority used medications to manage ADHD (n=120) and had participated in a parenting class (n=130). Just over a quarter (28%, n=49) did not use ADHD medications, and used sleep medications. Just under half had consulted psychologists (n=83), and 32 had participated in other talking therapies such as psychotherapy, counselling and cognitive–behavioural therapy. A few used aids such as reward charts or fiddle toys (n=17) and participated in activities (mostly physical) (n=14). A substantial minority (78/175) had used non-mainstream treatments, the most popular being homoeopathy (n=32), nutritional interventions (n=21) and bodywork such as massage or cranial osteopathy (n=9).ConclusionsFamilies reported use of a wide variety of treatments to help with management of their children with ADHD in addition to their use of mainstream treatments.

scholarly journals The future of social care funding: who pays?

2016 ◽  
Vol 22 (1) ◽  
pp. 10-44 ◽  
Author(s):  
T. Kenny ◽  
J. Barnfield ◽  
L. Daly ◽  
A. Dunn ◽  
D. Passey ◽  
...  
Keyword(s):  
Phase 1 ◽  
List Type ◽  
Political Debate ◽  
Term Care ◽  
Means Testing ◽  
Financial Products ◽  
Funding System ◽  
The Government ◽  
The Uk ◽  
Care Costs

AbstractWith the UK population ageing, deciding upon a satisfactory and sustainable system for the funding of people’s long-term care (LTC) needs has long been a topic of political debate. Phase 1 of the Care Act 2014 (“the Act”) brought in some of the reforms recommended by the Dilnot Commission in 2011. However, the Government announced during 2015 that Phase 2 of “the Act” such as the introduction of a £72,000 cap on Local Authority care costs and a change in the means testing thresholds1 would be deferred until 2020. In addition to this delay, the “freedom and choice” agenda for pensions has come into force. It is therefore timely that the potential market responses to help people pay for their care within the new pensions environment should be considered. In this paper, we analyse whether the proposed reforms meet the policy intention of protecting people from catastrophic care costs, whilst facilitating individual understanding of their potential care funding requirements. In particular, we review a number of financial products and ascertain the extent to which such products might help individuals to fund the LTC costs for which they would be responsible for meeting. We also produce case studies to demonstrate the complexities of the care funding system. Finally, we review the potential impact on incentives for individuals to save for care costs under the proposed new means testing thresholds and compare these with the current thresholds. We conclude that:∙Although it is still too early to understand exactly how individuals will respond to the pensions freedom and choice agenda, there are a number of financial products that might complement the new flexibilities and help people make provision for care costs.∙The new care funding system is complex making it difficult for people to understand their potential care costs.∙The current means testing system causes a disincentive to save. The new means testing thresholds provide a greater level of reward for savers than the existing thresholds and therefore may increase the level of saving for care; however, the new thresholds could still act as a barrier since disincentives still exist.

Dissociative disorder – unraveling the mystery

2016 ◽  
Vol 33 (S1) ◽  
pp. S327-S327
Author(s):  
L. Sousa ◽  
A. Antunes ◽  
S. Oliveira
Keyword(s):  
Romantic Relationship ◽  
Clinical Information ◽  
Dissociative Disorders ◽  
Dissociative Disorder ◽  
Clinical Interviews ◽  
Medical Interventions ◽  
Brazilian Woman ◽  
History Of ◽  
Competing Interest ◽  
Car Accident

IntroductionDissociative disorders are among the most enigmatic and controversial psychiatric pathologies. In the last decades, great interest has emerged in understanding its pathophysiology, nonetheless, problems in recognition and management of these disorders are still challenging the psychiatric community.ObjectivesWe describe a paradigmatic case of a dissociative disorder illustrating the “choice” of dissociation as a strategy for coping with a traumatic reality.AimCall attention to problems that interfere with the recognition, diagnosis and management of dissociative disorders.MethodsBibliographic research was conducted through the PubMed in the Medline library and clinical information was obtained through medical records and clinical interviews with the patient.ResultsA 51-year-old Brazilian woman with no psychiatric history presented to the psychiatric outpatient care with apparent dissociative symptoms, these consisted of amnesia for episodes of agitation and aggressive behavior that occurred mainly at bed time. She had been previously on general practice and neurology consultations but none organic diagnose was made. Already in psychiatry, it was recognized that those symptoms developed together after a car accident and the beginning of a romantic relationship. It was also recognized that she has sexual dysfunction and a history of sexual abuse by a family member during her childhood, a known risk factor to dissociative disorders.ConclusionsSkepticism and lack of understanding might be the reason for late psychiatric referral after the realization of various expensive and time-consuming medical exams. Improving the recognition of dissociative disorders will conduce not only to better clinical outcomes but also improve cost effectivity of medical interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

15 Triggers for the pharmacological management of delirium in palliative care: a mixed methods study

2018 ◽  
Vol 8 (3) ◽  
pp. 365.2-365
Author(s):  
Catherine L Fairfield ◽  
Anne M Finucane ◽  
Juliet A Spiller
Keyword(s):  
Palliative Care ◽  
Severe Form ◽  
Screening Tools ◽  
Pharmacological Intervention ◽  
Inpatient Setting ◽  
List Type ◽  
Structured Interviews ◽  
Retrospective Case ◽  
Pharmacological Management ◽  
High Prevalence

IntroductionDelirium is a serious neurocognitive disorder with a high prevalence in palliative care and debate regarding its management is ongoing.AimsTo describe how delirium and its symptoms is documented in patient recordsTo determine the use of delirium screening tools and how these are viewed by staffTo identify triggers for pharmacological intervention in delirium management in a terminally ill population.MethodsA retrospective case-note review concerning all patients admitted to a hospice inpatient setting between 1–17th August 2017 and semi-structured interviews with 7 hospice doctors and nurses.Results21 patients were reviewed. 62% were screened for delirium using the 4AT on admission. 76% had documented symptoms of delirium and of these 81% died without delirium resolution. There were inconsistencies in the documentation of delirium and the term itself was used infrequently. Non-pharmacological measures were poorly documented. Midazolam was the most commonly used medication. Triggers for pharmacological intervention included failure of non-pharmacological measures distress agitation and risk of patient harm. Nursing staff recognised delirium in its severe form but were less likely to do so in milder cases.ConclusionsTriggers for pharmacological intervention are in-keeping with guidelines however the level of understanding of delirium’s presentation varied between participants. This along with the high prevalence of delirium frequent use of midazolam and limited awareness and documentation of non-pharmacological measures (e.g. structured family support) highlights the need for further training and research.

The State of the Art in Management Education Applicable to Aerospace Activities

1967 ◽  
Vol 71 (677) ◽  
pp. 344-348
Author(s):  
J. V. Connolly
Keyword(s):  
Management Education ◽  
State Of The Art ◽  
Aerospace Industry ◽  
List Type ◽  
Industrial Training ◽  
The Past ◽  
The Subject ◽  
Economic Necessity ◽  
The Uk ◽  
The Impact

During the past two years, there has been a sharp acceleration to the interest which industry has displayed in the subject of management education. This can be attributed to these factors: —(a) A more widespread realisation of the gap developing between the UK and a number of foreign economies, as manifested by diverging rates of the major economic indicators.(b) The attainment of top-management responsibilities by a younger generation of managers, many of whom had been given some earlier training and who were more conscious of its value than the incumbents of the job from earlier generations.(c) The publication of the Franks, Robbins and (in the aerospace industry) the Plowden reports.(d) The impact of the Industrial Training Boards making it manifest, in terms of serious levies, that training was an economic necessity and therefore must be investigated thoroughly.Notwithstanding the widespread awakening of interest, it is very belated and sets numerous problems. The problems are in two areas—scale and quality.

scholarly journals Day services and home care for adults with learning disabilities across the UK

2017 ◽  
Vol 22 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Chris Hatton
Keyword(s):  
Learning Disabilities ◽  
Northern Ireland ◽  
Home Care ◽  
Service Use ◽  
Social Care ◽  
Content Type ◽  
Adults With Learning Disabilities ◽  
Day Services ◽  
The Uk ◽  
Over Time

Purpose The purpose of this paper is to compare data from national social care statistics on day services and home care for people with learning disabilities across England, Scotland, Wales and Northern Ireland. Design/methodology/approach National social care statistics (England, Scotland, Wales and Northern Ireland) reporting the number of adults with learning disabilities accessing day services and home care were reviewed, with data extracted on trends over time and rate of service use. Findings Regarding day services, despite some variations in definitions, the number of adults with learning disabilities in England, Scotland and Wales (but not Northern Ireland) using building-based day services decreased over time. Data from Scotland also indicate that adults with learning disabilities are spending less time in building-based day services, with alternative day opportunities not wholly compensating for the reduction in building-based day services. Regarding home care, there are broadly similar rates of usage across the four parts of the UK, with the number of adults with learning disabilities using home care now staying static or decreasing. Social implications Similar policy ambitions across the four parts of the UK have resulted (with the exception of Northern Ireland) in similar trends in access to day services and home care. Originality/value This paper is a first attempt to compare national social care statistics concerning day services and home care for adults with learning disabilities across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.

scholarly journals Adolescent Depression Screening: Not So Fast

2020 ◽  
Vol 10 (1) ◽  
pp. 59-69
Author(s):  
Edmund C. Levin
Keyword(s):  
Pharmaceutical Industry ◽  
Adolescent Depression ◽  
Conflicts Of Interest ◽  
Task Force ◽  
Third Party ◽  
Screening Tools ◽  
Depression Screening ◽  
The Us ◽  
National Organizations ◽  
The Uk

Background: Screening adolescents for depression has recently been advocated by two major national organizations. However, this practice is not without controversy. Objective: To review diagnostic, clinical, and conflict of interest issues associated with the calls for routine depression screening in adolescents. Method: The evaluation of depression screening by the US Preventive Services Task Force is compared and contrasted with those of comparable agencies in the UK and Canada, and articles arguing for and against screening are reviewed. Internal pharmaceutical industry documents declassified through litigation are examined for conflicts of interest. A case is presented that illustrates the substantial diagnostic limitations of self-administered mental health screening tools. Discussion: The value of screening adolescents for psychiatric illness is questionable, as is the validity of the screening tools that have been developed for this purpose. Furthermore, many of those advocating depression screening are key opinion leaders, who are in effect acting as third-party advocates for the pharmaceutical industry. The evidence suggests that a commitment to marketing rather than to science is behind their recommendations, although their conflicts of interest are hidden in what seem to be impartial third-party recommendations.

scholarly journals Prevalence of mental disorders in prisons in the UK: a systematic review and meta-analysis

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S283-S284
Author(s):  
Nivedita Rebbapragada ◽  
Vivek Furtado ◽  
George William Hawker-Bond
Keyword(s):  
General Population ◽  
Mental Disorders ◽  
Mental Health Problems ◽  
Prison Population ◽  
Psychiatric Morbidity ◽  
Revolving Door ◽  
Health Concern ◽  
Pooled Prevalence ◽  
Prevalence Estimates ◽  
The Uk

AimsTo report pooled prevalence of all mental disorders among the general prison population in the United Kingdom (UK). This includes individuals in Young Offender Institutions (YOI), youth custody and adult prisons across all categories. A secondary aim explores possible sources of heterogeneity by performing subgroup and meta-regression analysis across certain covariates (e.g. sex of prisoner). We hypothesise that contemporary estimates of mental disorders are higher than the general population.BackgroundPrevalence of mental health problems among prisoners are considerably higher than the general population; this poses an important public health concern. Individuals who require diversion to appropriate psychiatric services are becoming embroiled in the revolving door of the criminal justice system. However, there are no up-to-date reviews assessing prevalence of mental disorders across the general prison population in the UK. This study aims to address this gap.MethodWe conducted a systematic search of PsycINFO (1923 – October 2019), MEDLINE (1946 – October 2019), EMBASE (1947 – October 2019) and Web of Science (all years) of articles reporting prevalence of mental disorders in UK prison populations (PROSPERO registration number: CRD42019132685). The Joanna Briggs Institute (JBI) Appraisal Checklist for Studies Reporting Prevalence Data assessed study quality and bias. Pooled prevalence of each mental disorder was calculated using Stata statistical software 16.0 via the metaprop command. Forest plots present prevalence estimates with study weights and associated 95% confidence intervals (CI). Overall, 20 studies satisfied inclusion criteria, comprising of 12,335 prisoners across England, Wales and Scotland.ResultWe identified higher rates of neurotic disorders (28.9%, 95% CI 0.71–74.7%), personality disorders (23.5%, 95% CI 13.6–35.2%), alcohol (22.7%, 95% CI 12.2–35.1%) and drug dependence (26.7%, 95% CI 15.0–40.4%). The lowest prevalence rates included schizophrenia (2.42%, 95% CI 0.78–4.84%), panic disorders (3.88%, 95% CI 3.17% – 4.64%), adjustment disorders (3.83%, 95% CI 1.19–7.84%) and intellectual disability (2.90%, 95% CI 0.90–5.80%). Meta-regressions for psychotic disorder and personality disorder revealed no significant differences across study year, sample size and gender.ConclusionOur prevalence estimates of mental disorders in prisons are higher than the general English population. However, we should acknowledge the influence of considerable heterogeneity. These findings demonstrate the need to quantify current prevalence of mental disorders amongst prisoners in the UK. We recommend for the government to consider performing an up-to-date census of psychiatric morbidity to facilitate service provision.

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