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Yirmiya K, Constantinou M, Simes E, Bateman A, Wason J, Yakeley J, McMurran M, Crawford M, Frater A, Moran P, Barrett B, Cameron A, Hoare Z, Allison E, Pilling S, Butler S, Fonagy P. The mediating role of reflective functioning and general psychopathology in the relationship between childhood conduct disorder and adult aggression among offenders. Psychol Med 2024:1-12. [PMID: 38563288 DOI: 10.1017/s003329172400062x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The nature of the pathway from conduct disorder (CD) in adolescence to antisocial behavior in adulthood has been debated and the role of certain mediators remains unclear. One perspective is that CD forms part of a general psychopathology dimension, playing a central role in the developmental trajectory. Impairment in reflective functioning (RF), i.e., the capacity to understand one's own and others' mental states, may relate to CD, psychopathology, and aggression. Here, we characterized the structure of psychopathology in adult male-offenders and its role, along with RF, in mediating the relationship between CD in their adolescence and current aggression. METHODS A secondary analysis of pre-treatment data from 313 probation-supervised offenders was conducted, and measures of CD symptoms, general and specific psychopathology factors, RF, and aggression were evaluated through clinical interviews and questionnaires. RESULTS Confirmatory factor analyses indicated that a bifactor model best fitted the sample's psychopathology structure, including a general psychopathology factor (p factor) and five specific factors: internalizing, disinhibition, detachment, antagonism, and psychoticism. The structure of RF was fitted to the data using a one-factor model. According to our mediation model, CD significantly predicted the p factor, which was positively linked to RF impairments, resulting in increased aggression. CONCLUSIONS These findings highlight the critical role of a transdiagnostic approach provided by RF and general psychopathology in explaining the link between CD and aggression. Furthermore, they underscore the potential utility of treatments focusing on RF, such as mentalization-based treatment, in mitigating aggression in offenders with diverse psychopathologies.
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Affiliation(s)
- Karen Yirmiya
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Matthew Constantinou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Elizabeth Simes
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Anthony Bateman
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jessica Yakeley
- Portman Clinic, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Mary McMurran
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Mike Crawford
- Division of Psychiatry, Imperial College, London, UK
| | - Alison Frater
- School of Law, Royal Holloway, University of London, London, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Angus Cameron
- National Probation Service London Division, London, UK
| | - Zoe Hoare
- NWORTH Clinical Trials Unit, School of Health Sciences, Bangor University, Bangor, UK
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stephen Butler
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
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Sappok T, Barrett B, Lutter S. A brief version of the Scale of Emotional Development - Short. J Intellect Disabil Res 2024; 68:340-357. [PMID: 38183318 DOI: 10.1111/jir.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/03/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The Scale of Emotional Development - Short (SED-S) captures the level of emotional development in persons with a disorder of intellectual development (DID) with 200 items on five developmental levels. The study aims to develop a brief version of the SED-S. METHODS Based on item analysis (proportions, χ2 -test, Spearman's ρ and corrected item-total correlation), a brief version of the SED-S was developed in a sample of 224 adults with a DID (n1 ) and validated in a second independent matched sample (n2 = 223). RESULTS Item reliability ranged per item set from Cronbach's α = 0.835 to 0.924. Weighted kappa resulted in κω = 0.743 (P < 0.001, 95% confidence interval = 0.690-0.802). Overall agreement of the brief version with the original SED-S was PO = 0.7. The brief version of the SED-S showed weaknesses in distinguishing level 2 from the adjacent levels. CONCLUSIONS The brief version of the SED-S showed good reliability and moderate to good validity results. Items of phase 2 and, to some degree, of phase 5 should be revised to further improve the psychometric properties of the scale.
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Affiliation(s)
- T Sappok
- University Clinic for People with Neurodevelopmental Disorders, Mara, University Hospital OWL, Bielefeld University, Bielefeld, Germany
| | - B Barrett
- St. Lukas-Klinik, Liebenau Kliniken, Liebenau, Germany
| | - S Lutter
- Lebenswissenschaftliche Fakultät - Institute for Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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3
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Tan MMC, Barbosa MG, Pinho PJMR, Assefa E, Keinert AÁM, Hanlon C, Barrett B, Dregan A, Su TT, Mohan D, Ferri C, Muniz-Terrera G, Prina M. Determinants of multimorbidity in low- and middle-income countries: A systematic review of longitudinal studies and discovery of evidence gaps. Obes Rev 2024; 25:e13661. [PMID: 38105610 DOI: 10.1111/obr.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 12/19/2023]
Abstract
Multimorbidity-the coexistence of at least two chronic health conditions within the same individual-is an important global health challenge. In high-income countries (HICs), multimorbidity is dominated by non-communicable diseases (NCDs); whereas, the situation may be different in low- and middle-income countries (LMICs), where chronic communicable diseases remain prominent. The aim of this systematic review was to identify determinants (including risk and protective factors) and potential mechanisms underlying multimorbidity from published longitudinal studies across diverse population-based or community-dwelling populations in LMICs. We systematically searched three electronic databases (Medline, Embase, and Global Health) using pre-defined search terms and selection criteria, complemented by hand-searching. All titles, abstracts, and full texts were independently screened by two reviewers from a pool of four researchers. Data extraction and reporting were according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality and risk of bias assessment was performed using the Newcastle-Ottawa Scale for cohort studies. Data were summarized using narrative synthesis. The search yielded 1782 records. Of the 52 full-text articles included for review, 8 longitudinal population-based studies were included for final data synthesis. Almost all studies were conducted in Asia, with only one from South America and none from Africa. All studies were published in the last decade, with half published in the year 2021. The definitions used for multimorbidity were heterogeneous, including 3-16 chronic conditions per study. The leading chronic conditions were heart disease, stroke, and diabetes, and there was a lack of consideration of mental health conditions (MHCs), infectious diseases, and undernutrition. Prospectively evaluated determinants included socio-economic status, markers of social inequities, childhood adversity, lifestyle behaviors, obesity, dyslipidemia, and disability. This review revealed a paucity of evidence from LMICs and a geographical bias in the distribution of multimorbidity research. Longitudinal research into epidemiological aspects of multimorbidity is warranted to build up scientific evidence in regions beyond Asia. Such evidence can provide a detailed picture of disease development, with important implications for community, clinical, and interventions in LMICs. The heterogeneity in study designs, exposures, outcomes, and statistical methods observed in the present review calls for greater methodological standardisation while conducting epidemiological studies on multimorbidity. The limited evidence for MHCs, infectious diseases, and undernutrition as components of multimorbidity calls for a more comprehensive definition of multimorbidity globally.
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Affiliation(s)
- Michelle M C Tan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Sunway City, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Sunway City, Selangor, Malaysia
- Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton Campus, Clayton, Victoria, Australia
| | - Matheus G Barbosa
- Psychogeriatric Unit, Department of Psychiatry, Medical School, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Pedro J M R Pinho
- Psychogeriatric Unit, Department of Psychiatry, Medical School, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Economics, College of Business and Economics, Jimma University, Jimma, Ethiopia
- Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Ana Á M Keinert
- Psychogeriatric Unit, Department of Psychiatry, Medical School, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Charlotte Hanlon
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Global Mental Health, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Barbara Barrett
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandru Dregan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tin Tin Su
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Sunway City, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Sunway City, Selangor, Malaysia
- Victorian Heart Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton Campus, Clayton, Victoria, Australia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Sunway City, Selangor, Malaysia
| | - Cleusa Ferri
- Psychogeriatric Unit, Department of Psychiatry, Medical School, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, University of Edinburgh and Western General Hospital, Edinburgh, UK
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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4
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Flachsmeyer M, Sterkenburg P, Barrett B, Zaal S, Vonk J, Morisse F, Gaese F, Heinrich M, Sappok T. Scale of Emotional Development - Short: reliability and validity in adults with intellectual disability. J Intellect Disabil Res 2023; 67:1046-1060. [PMID: 37661289 DOI: 10.1111/jir.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Intellectual disability (ID) is often associated with delays in emotional development (ED). The Scale of Emotional Development - Short (SED-S) was developed to assess the level of ED and to adapt treatment and care accordingly. METHODS In a sample of 724 adults from five study sites in three countries, a confirmatory factor analysis with a one-factor model was conducted on the entire dataset as well as in different subgroups. Furthermore, internal consistency was investigated using Cronbach's alpha. RESULTS The confirmatory factor analysis indicated that a single-factor model fits the SED-S data well. The subgroup analyses revealed good model fit, regardless of the severity of ID and irrespective of sex or the presence of autism spectrum disorder or psychiatric disorders. Internal consistency was excellent for the entire sample (Cronbach's alpha = 0.93) and various subgroups (0.869-0.938). CONCLUSION The results of this study suggest that the SED-S is psychometrically sound and can be used to assess the level of ED in adults with ID.
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Affiliation(s)
- M Flachsmeyer
- Medical Faculty, Charité University, Berlin, Germany
| | - P Sterkenburg
- Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department for Assessment and Treatment, Bartiméus, Doorn, The Netherlands
| | - B Barrett
- Department for Psychiatry and Psychotherapy, Stiftung Liebenau, Meckenbeuren, Germany
| | - S Zaal
- Cordaan, Amsterdam, The Netherlands
| | - J Vonk
- Lore behandel- en expertisecentrum, Het Warant, Helmond, The Netherlands
| | - F Morisse
- Outreach De Steiger, Psychiatric Centre Dr Guislain, Ghent, Belgium
| | - F Gaese
- Praxis for Psychiatry and Psychotherapy, Private Praxis, Munich, Germany
| | - M Heinrich
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - T Sappok
- Bielefeld University, Medical School and University Medical Center OWL, Mara Hospital, University Clinic for People with Neurodevelopmental Disorders, Bielefeld, Germany
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5
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Monk-Cunliffe J, Kadra-Scalzo G, Finamore C, Dale O, Khondoker M, Barrett B, Shetty H, Hayes RD, Moran P. Defining severity of personality disorder using electronic health records: short report. BJPsych Open 2023; 9:e137. [PMID: 37524373 PMCID: PMC10486230 DOI: 10.1192/bjo.2023.509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 08/02/2023] Open
Abstract
Severity of personality disorder is an important determinant of future health. However, this key prognostic variable is not captured in routine clinical practice. Using a large clinical data-set, we explored the predictive validity of items from the Health of Nation Outcome Scales (HoNOS) as potential indicators of personality disorder severity. For 6912 patients with a personality disorder diagnosis, we examined associations between HoNOS items relating to core personality disorder symptoms (self-harm, difficulty in interpersonal relationships, performance of occupational and social roles, and agitation and aggression) and future health service use. Compared with those with no self-harm problem, the total healthcare cost was 2.74 times higher (95% CI 1.66-4.52; P < 0.001) for individuals with severe to very severe self-harm problems. Other HoNOS items did not demonstrate clear patterns of association with service costs. Self-harm may be a robust indicator of the severity of personality disorder, but further replication work is required.
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Affiliation(s)
- Jonathan Monk-Cunliffe
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Giouliana Kadra-Scalzo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chloe Finamore
- Research Unit, The Cassel Hospital, West London NHS Trust, Richmond, UK
| | - Oliver Dale
- Research Unit, The Cassel Hospital, West London NHS Trust, Richmond, UK
| | | | - Barbara Barrett
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hitesh Shetty
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard D. Hayes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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6
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Barnhofer T, Dunn BD, Strauss C, Ruths F, Barrett B, Ryan M, Ladwa A, Stafford F, Fichera R, Baber H, McGuinness A, Metcalfe I, Harding D, Walker S, Ganguli P, Rhodes S, Young A, Warren F. A randomised controlled trial to investigate the clinical effectiveness and cost effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depressed non-responders to Increasing Access to Psychological Therapies (IAPT) high-intensity therapies: study protocol. Trials 2023; 24:43. [PMID: 36658663 PMCID: PMC9851098 DOI: 10.1186/s13063-022-06882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/03/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Major depression represents a pressing challenge for health care. In England, Increasing Access to Psychological Therapies (IAPT) services provide evidence-based psychological therapies in a stepped-care approach to patients with depression. While introduction of these services has successfully increased access to therapy, estimates suggest that about 50% of depressed patients who have come to the end of the IAPT pathway still show significant levels of symptoms. This study will investigate whether Mindfulness-Based Cognitive Therapy (MBCT), a group intervention combining training in mindfulness meditation and elements from cognitive therapy, can have beneficial effects in depressed patients who have not responded to high-intensity therapy in IAPT. It will seek to establish the effectiveness and cost-effectiveness of MBCT as compared to the treatment these patients would usually receive. METHODS In a 2-arm randomised controlled trial, patients who currently meet the criteria for major depressive disorder and who have not sufficiently responded to at least 12 sessions of IAPT high-intensity therapy will be allocated, at a ratio of 1:1, to receive either MBCT (in addition to treatment as usual [TAU]) or continue with TAU only. Assessments will take place at baseline, 10 weeks and 34 weeks post-randomisation. The primary outcome will be reduction in depression symptomatology 34 weeks post-randomisation as assessed using the Public Health Questionnaire-9 (PHQ-9). Secondary outcomes will include depressive symptomatology at 10 weeks post-randomisation and other clinical outcomes measured at 10-week and 34-week follow-up, along with a series of binarised outcomes to indicate clinically significant and reliable change. Evaluations of cost-effectiveness will be based on assessments of service use costs collected using the Adult Service Use Schedule and health utilities derived from the EQ-5D. DISCUSSION This trial will add to the evidence base for the use of MBCT in depressed treatment non-responders. It will constitute the first trial to test MBCT following non-response to psychological therapy, with results providing a direct estimate of efficacy within the IAPT pathway. As such, its results will offer an important basis for decisions regarding the adoption of MBCT for non-responders within IAPT. TRIAL REGISTRATION ClinicalTrials.gov NCT05236959. Registered on 11 February 2022. ISRCTN 17755571. Registered on 2 February 2021.
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Affiliation(s)
- Thorsten Barnhofer
- grid.5475.30000 0004 0407 4824School of Psychology, University of Surrey, Guildford, UK
| | - Barnaby D. Dunn
- grid.8391.30000 0004 1936 8024Department of Psychology, University of Exeter, Exeter, UK
| | - Clara Strauss
- grid.12082.390000 0004 1936 7590University of Sussex, Brighton, UK
| | - Florian Ruths
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Barbara Barrett
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, King’s College London, London, UK
| | - Mary Ryan
- grid.4756.00000 0001 2112 2291Department of Health and Social Care Innovation Lab, Southbank University, London, UK
| | - Asha Ladwa
- grid.8391.30000 0004 1936 8024Department of Psychology, University of Exeter, Exeter, UK
| | - Frances Stafford
- grid.12082.390000 0004 1936 7590University of Sussex, Brighton, UK
| | - Roberta Fichera
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Hannah Baber
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ailis McGuinness
- grid.8391.30000 0004 1936 8024Department of Psychology, University of Exeter, Exeter, UK
| | - Isabella Metcalfe
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Delilah Harding
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Walker
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Poushali Ganguli
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, King’s College London, London, UK
| | - Shelley Rhodes
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Allan Young
- grid.13097.3c0000 0001 2322 6764Centre for Affective Disorders, King’s College London, London, UK
| | - Fiona Warren
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
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Heslin M, Jin H, Trevillion K, Ling X, Nath S, Barrett B, Demilew J, Ryan EG, O'Connor S, Sands P, Milgrom J, Bick D, Stanley N, Hunter MS, Howard LM, Byford S. Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model. BMC Health Serv Res 2022; 22:774. [PMID: 35698125 PMCID: PMC9190075 DOI: 10.1186/s12913-022-08115-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although the effectiveness of screening tools for detecting depression in pregnancy has been investigated, there is limited evidence on the cost-effectiveness. This is vital in providing full information to decision makers. This study aimed to explore the cost-effectiveness of different screening tools to identify depression in early pregnancy compared to no screening. Methods A decision tree was developed to model the identification and treatment pathways of depression from the first antenatal appointment to 3-months postpartum using the Whooley questions, the Edinburgh Postnatal Depression Scale (EPDS) and the Whooley questions followed by the EPDS, compared to no screening. The economic evaluation took an NHS and Personal Social Services perspective. Model parameters were taken from a combination of sources including a cross-sectional survey investigating the diagnostic accuracy of screening tools, and other published literature. Cost-effectiveness was assessed in terms of the incremental cost per quality adjusted life years (QALYs). Cost-effectiveness planes and cost-effectiveness acceptability curves were produced using a net-benefit approach based on Monte Carlo simulations of cost-outcome data. Results In a 4-way comparison, the Whooley, EPDS and Whooley followed by the EPDS each had a similar probability of being cost-effective at around 30% for willingness to pay values from £20,000–30,000 per QALY compared to around 20% for the no screen option. Conclusions All three screening approaches tested had a higher probability of being cost-effective than the no-screen option. In the absence of a clear cost-effectiveness advantage for any one of the three screening options, the choice between the screening approaches could be made on other grounds, such as clinical burden of the screening options. Limitations include data availability and short time horizon, thus further research is needed. Clinical trials registration N/A Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08115-x.
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Affiliation(s)
- Margaret Heslin
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Huajie Jin
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Kylee Trevillion
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Xiaoxiao Ling
- Department of Statistical Science, University College London, London, UK
| | - Selina Nath
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Barbara Barrett
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Jill Demilew
- King's College Hospital NHS Foundation Trust, London, UK
| | - Elizabeth G Ryan
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | | | - Polly Sands
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jeannette Milgrom
- Parent-Infant Research Institute, Austin Health, Heidelberg West, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick & University Hospitals Coventry and Warwick NHS Foundation Trust, Coventry, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Myra S Hunter
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Louise M Howard
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sarah Byford
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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8
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Jha M, Barrett B, Brewin C, Bowker G, Harwood N, Jalil I, Crawford M, Phull J, Allen K, Duggan C, Yang M, Tyrer P. Matching ICD-11 personality status to clinical management in a community team-The Boston (UK) Personality Project: Study protocol. Personal Ment Health 2022; 16:130-137. [PMID: 35474611 DOI: 10.1002/pmh.1544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023]
Abstract
Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will be asked to agree to have their personality status assessed using scales recording the new ICD-11 classification, together with clinical ratings, social function and satisfaction. A control group of 100 patients from an adjacent service of similar demographics (Spalding) will also have similar ratings but no personality assessments. Changes in clinical status, social function and service satisfaction will be made after 6 and 12 months in both groups. The patients in the Boston group will be offered matched interventions using a stepped care approach for both the severity of disorder and its domain structure. These interventions will include shorter versions of existing psychological treatments, environmental therapies including nidotherapy, adaptive and acceptance models, drug reduction and social prescribing. Full costs of psychiatric care will be measured in both groups. The main hypothesis is that greater awareness of personality function will lead to better clinical outcomes and satisfaction.
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Affiliation(s)
- Mithilesh Jha
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK
| | | | - Chris Brewin
- Department of Psychology, University College Hospital, London, UK
| | - Geoff Bowker
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK
| | - Nick Harwood
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK
| | - Iram Jalil
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK
| | - Mike Crawford
- Division of Psychiatry, Commonwealth Building, Imperial College, London, UK
| | - Jaspreet Phull
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK
| | - Katherine Allen
- Birmingham and Solihull Mental Health Foundation Trust, Uffculme Centre, Birmingham, UK
| | | | - Min Yang
- West China School of Public Health, Sichuan University, Chengdu, China.,Faculty of Health, Art and Design, Swinburne, University of Technology, Melbourne, Sydney, Australia
| | - Peter Tyrer
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK.,Kings Health Economics, King's College London, London, UK
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9
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Crawford MJ, Leeson VC, Evans R, Barrett B, McQuaid A, Cheshire J, Sanatinia R, Lamph G, Sen P, Anagnostakis K, Millard L, Qurashi I, Larkin F, Husain N, Moran P, Barnes TRE, Paton C, Hoare Z, Picchioni M, Gibbon S. The clinical effectiveness and cost effectiveness of clozapine for inpatients with severe borderline personality disorder (CALMED study): a randomised placebo-controlled trial. Ther Adv Psychopharmacol 2022; 12:20451253221090832. [PMID: 35510087 PMCID: PMC9058570 DOI: 10.1177/20451253221090832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Data from case series suggest that clozapine may benefit inpatients with borderline personality disorder (BPD), but randomised trials have not been conducted. METHODS Multicentre, double-blind, placebo-controlled trial. We aimed to recruit 222 inpatients with severe BPD aged 18 or over, who had failed to respond to other antipsychotic medications. We randomly allocated participants on a 1:1 ratio to receive up to 400 mg of clozapine per day or an inert placebo using a remote web-based randomisation service. The primary outcome was total score on the Zanarini Rating scale for Borderline Personality Disorder (ZAN-BPD) at 6 months. Secondary outcomes included self-harm, aggression, resource use and costs, side effects and adverse events. We used a modified intention to treat analysis (mITT) restricted to those who took one or more dose of trial medication, using a general linear model fitted at 6 months adjusted for baseline score, allocation group and site. RESULTS The study closed early due to poor recruitment and the impact of the COVID-19 pandemic. Of 29 study participants, 24 (83%) were followed up at 6 months, of whom 21 (72%) were included in the mITT analysis. At 6 months, 11 (73%) participants assigned to clozapine and 6 (43%) of those assigned to placebo were still taking trial medication. Adjusted difference in mean total ZAN-BPD score at 6 months was -3.86 (95% Confidence Intervals = -10.04 to 2.32). There were 14 serious adverse events; 6 in the clozapine arm and 8 in the placebo arm of the trial. There was little difference in the cost of care between groups. INTERPRETATION We recruited insufficient participants to test the primary hypothesis. The study findings highlight problems in conducting placebo-controlled trials of clozapine and in using clozapine for people with BPD, outside specialist inpatient mental health units. TRIAL REGISTRATION ISRCTN18352058. https://doi.org/10.1186/ISRCTN18352058.
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Affiliation(s)
- Mike J Crawford
- Division of Psychiatry, Imperial College London, The Commonwealth Building, The Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | | | - Rachel Evans
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | | | | | - Jack Cheshire
- Department of Forensic Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Gary Lamph
- School of Nursing, University of Central Lancashire, Preston, UK
| | - Piyal Sen
- Department of Forensic Psychiatry, Elysium Healthcare, Milton Keynes, UK
| | | | - Louise Millard
- St Andrew's Academic Centre, St Andrew's Healthcare, Northampton, UK
| | - Inti Qurashi
- Ashworth Hospital, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Fintan Larkin
- Acute Mental Health Services, West London NHS Trust, London, UK
| | - Nusrat Husain
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Paul Moran
- Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | | | - Carol Paton
- Division of Psychiatry, Imperial College London, London, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Marco Picchioni
- Department of Forensic and Neurodevelopmental Science, Kings College London, London, UK
| | - Simon Gibbon
- Department of Forensic Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
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10
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Crawford MJ, Thana L, Evans R, Carne A, O'Connell L, Claringbold A, Saravanamuthu A, Case R, Munjiza J, Jayacodi S, Reilly JG, Hughes E, Hoare Z, Barrett B, Leeson VC, Paton C, Keown P, Pappa S, Green C, Barnes TR. Switching antipsychotic medication to reduce sexual dysfunction in people with psychosis: the REMEDY RCT. Health Technol Assess 2021; 24:1-54. [PMID: 32930090 DOI: 10.3310/hta24440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sexual dysfunction is common among people who are prescribed antipsychotic medication for psychosis. Sexual dysfunction can impair quality of life and reduce treatment adherence. Switching antipsychotic medication may help, but the clinical effectiveness and cost-effectiveness of this approach is unclear. OBJECTIVE To examine whether or not switching antipsychotic medication provides a clinically effective and cost-effective method to reduce sexual dysfunction in people with psychosis. DESIGN A two-arm, researcher-blind, pilot randomised trial with a parallel qualitative study and an internal pilot phase. Study participants were randomised to enhanced standard care plus a switch of antipsychotic medication or enhanced standard care alone in a 1 : 1 ratio. Randomisation was via an independent and remote web-based service using dynamic adaptive allocation, stratified by age, gender, Trust and relationship status. SETTING NHS secondary care mental health services in England. PARTICIPANTS Potential participants had to be aged ≥ 18 years, have schizophrenia or related psychoses and experience sexual dysfunction associated with the use of antipsychotic medication. We recruited only people for whom reduction in medication dosage was ineffective or inappropriate. We excluded those who were acutely unwell, had had a change in antipsychotic medication in the last 6 weeks, were currently prescribed clozapine or whose sexual dysfunction was believed to be due to a coexisting physical or mental disorder. INTERVENTIONS Switching to an equivalent dose of one of three antipsychotic medications that are considered to have a relatively low propensity for sexual side effects (i.e. quetiapine, aripiprazole or olanzapine). All participants were offered brief psychoeducation and support to discuss their sexual health and functioning. MAIN OUTCOME MEASURES The primary outcome was patient-reported sexual dysfunction, measured using the Arizona Sexual Experience Scale. Secondary outcomes were researcher-rated sexual functioning, mental health, side effects of medication, health-related quality of life and service utilisation. Outcomes were assessed 3 and 6 months after randomisation. Qualitative data were collected from a purposive sample of patients and clinicians to explore barriers to recruitment. SAMPLE SIZE Allowing for a 20% loss to follow-up, we needed to recruit 216 participants to have 90% power to detect a 3-point difference in total Arizona Sexual Experience Scale score (standard deviation 6.0 points) using a 0.05 significance level. RESULTS The internal pilot was discontinued after 12 months because of low recruitment. Ninety-eight patients were referred to the study between 1 July 2018 and 30 June 2019, of whom 10 were randomised. Eight (80%) participants were followed up 3 months later. Barriers to referral and recruitment included staff apprehensions about discussing side effects, reluctance among patients to switch medication and reticence of both staff and patients to talk about sex. LIMITATIONS Insufficient numbers of participants were recruited to examine the study hypotheses. CONCLUSIONS It may not be possible to conduct a successful randomised trial of switching antipsychotic medication for sexual functioning in people with psychosis in the NHS at this time. FUTURE WORK Research examining the acceptability and effectiveness of adjuvant phosphodiesterase inhibitors should be considered. TRIAL REGISTRATION Current Controlled Trials ISRCTN12307891. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 44. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Lavanya Thana
- Division of Psychiatry, Imperial College London, London, UK
| | - Rachel Evans
- North Wales Organisation for Randomised Trials in Health and Social Care, University of Bangor, Bangor, UK
| | - Alexandra Carne
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | | | | | | | - Rebecca Case
- Central and North West London NHS Foundation Trust, London, UK
| | - Jasna Munjiza
- Division of Psychiatry, Imperial College London, London, UK.,Central and North West London NHS Foundation Trust, London, UK
| | - Sandra Jayacodi
- Central and North West London NHS Foundation Trust, London, UK
| | - Joseph G Reilly
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | | | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health and Social Care, University of Bangor, Bangor, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Patrick Keown
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sofia Pappa
- Division of Psychiatry, Imperial College London, London, UK.,West London NHS Trust, London, UK
| | - Charlotte Green
- Central and North West London NHS Foundation Trust, London, UK
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11
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Esiso F, Lai F, Cunningham D, Garcia D, Barrett B, Sakkas D. P–225 The effect of rapid and delayed insemination on reproductive outcome in conventional insemination and intracytoplasmic sperm injection invitro-fertilization cycles. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does rapid or delayed insemination after egg retrieval affect fertilization, blastocyst development and live birth rates in CI and ICSI cycles?
Summary answer
When performing CI or ICSI <1.5h and >6.5h after retrieval, detrimental effects are moderate on fertilization but do not impact blastocyst usage and birth rates.
What is known already
Several studies have shown that CIor ICSI performed between 3 to 5 h after oocyte retrieval has improved laboratory outcomes. However, some studies indicate that insemination of oocytes, by either CI or ICSI, within 2 hours or more than 8 hours after oocyte retrieval has a detrimental effect on the reproductive outcome. With some ART centres experiencing an increase in workload, respecting these exact time intervals is frequently challenging.
Study design, size, duration
A single-center retrospective cohort analysis was performed on 6559 patients (9575 retrievals and insemination cycles) between January 1st2017 to July 31st2019. The main outcome measures were live-birth rates. Secondary outcomes included analysis of fertilization per all oocytes retrieved, blastocyst utilization, clinical pregnancy, and miscarriage rates. All analyses used time of insemination categorized in both CI and ICSI cycles. Fertilization rates across categories was analyzed by ANOVA and pregnancy outcomes compared using Chi-square tests.
Participants/materials, setting, methods
As part of laboratory protocol, oocyte retrieval was performed 36 h post-trigger. Cycles involving injection with testicular/epidydimal sperm, donor or frozen oocytes were excluded. The time interval between oocyte retrieval and insemination was analyzed in eight categories: 0 (0- <0.5h), 1 (0.5-<1.5h), 2 (1.5-<2.5h), 3 (2.5-<3.5h), 4 (3.5-<4.5), 5 (4.5-<5.5), 6 (5.5-<6.5) and 7 (6.5-<8h). The number of retrievals in each group (0–7) was 586, 1594, 1644, 1796, 1836, 1351, 641 and 127 respectively.
Main results and the role of chance
This study had a mean patient age of 36.0 years and mean of 12.2 oocytes per retrieval in each category. There were 4,955 CI and 4,620 ICSI retrievals. The smallest groups were time category 7 and 0 for CI and ICSI respectively. The results showed that the mean fertilization rate per egg retrieved for CI ranged from 54.1 to 64.9% with a significant difference between time category 0 and 5 (p < 0.001) and category 1 and 5 (p < 0.0.001). Mean fertilization rate for ICSI per egg retrieved ranged from 52.8 to 67.3% with no significant difference between time categories compared to category 5. Blastocyst utilization rate for CI and ICSI were not significantly different for all time categories. In the CI and ICSI groups there were 6,540 and 6,178 total fresh and frozen transfers. The miscarriage and clinical pregnancy rate in CI and ICSI were not significantly different across time categories. The overall mean live birth rate for CI was 32.4% (range: 23.1 to 35.5%). Live-birth rates differed significantly (p = 0.04) in CI with time categories 0 and 7 the lowest. In the ICSI group, the overall mean live birth rate was 30.8% (range: 29.1 to 35.7%),with no significant differences between time categories.
Limitations, reasons for caution
As this is a retrospective study, the influence of uncontrolled variables cannot be excluded. The group spread was uneven with the early and late time categories having the lowest number of representative retrievals and this could have affected the results obtained.
Wider implications of the findings: Our results indicate that both CI and ICSI are optimal when performed between 1.5–6.5 hours after oocyte retrieval. Further prospective studies on reproductive outcomes related to time of insemination are warranted. This data indicates a minimal detrimental effect when it is untenable to follow strict insemination time intervals.
Trial registration number
2015P000122
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Affiliation(s)
- F Esiso
- BSM-University Pompeo Fabrau, Masters in Human Assisted Reproduction Technology, Barcelona, Spain
| | - F Lai
- Boston IVF, Embryology, Waltham, USA
| | | | - D Garcia
- Clínica Eugin, Department of Research and Development, Barcelona, Spain
| | - B Barrett
- Boston IVF, Embryology, Waltham, USA
| | - D Sakkas
- Boston IVF, Embryology, Waltham, USA
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12
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Byford S, Petkova H, Barrett B, Ford T, Nicholls D, Simic M, Gowers S, Macdonald G, Stuart R, Livingstone N, Kelly G, Kelly J, Joshi K, Smith H, Eisler I. Cost-effectiveness of specialist eating disorders services for children and adolescents with anorexia nervosa: a national surveillance study. J Eat Disord 2021; 9:76. [PMID: 34174952 PMCID: PMC8235580 DOI: 10.1186/s40337-021-00433-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests specialist eating disorders services for children and adolescents with anorexia nervosa have the potential to improve outcomes and reduce costs through reduced hospital admissions. This study aimed to evaluate the cost-effectiveness of assessment and diagnosis in community-based specialist child and adolescent mental health services (CAMHS) compared to generic CAMHS for children and adolescents with anorexia nervosa. METHOD Observational, surveillance study of children and adolescents aged 8 to 17, in contact with community-based CAMHS in the UK or Republic of Ireland for a first episode of anorexia nervosa. Data were reported by clinicians at baseline, 6 and 12-months follow-up. Outcomes included the Children's Global Assessment Scale (CGAS) and percentage of median expected body mass for age and sex (%mBMI). Service use data included paediatric and psychiatric inpatient admissions, outpatient and day-patient attendances. A joint distribution of incremental mean costs and effects for each group was generated using bootstrapping to explore the probability that each service is the optimal choice, subject to a range of values a decision-maker might be willing to pay for outcome improvements. Uncertainty was explored using cost-effectiveness acceptability curves. RESULTS Two hundred ninety-eight children and adolescents met inclusion criteria. At 12-month follow-up, there were no significant differences in total costs or outcomes between specialist eating disorders services and generic CAMHS. However, adjustment for pre-specified baseline covariates resulted in observed differences favouring specialist services, due to significantly poorer clinical status of the specialist group at baseline. Cost-effectiveness analysis using CGAS suggests that the probability of assessment in a specialist service being cost-effective compared to generic CAMHS ranges from 90 to 50%, dependent on willingness to pay for improvements in outcome. CONCLUSIONS Assessment in a specialist eating disorders service for children and adolescents with anorexia nervosa may have a higher probability of being cost-effective than assessment in generic CAMHS. TRIAL REGISTRATION ISRCTN12676087 . Date of registration 07/01/2014.
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Affiliation(s)
- Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
| | - Hristina Petkova
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Level 5 Clifford Allbutt Building, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0AH, UK
| | - Dasha Nicholls
- Imperial College London, Division of Psychiatry, Department of Brain Sciences, Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, Michael Rutter Centre for Children and Young People, De Crespigny Park, London, SE5 8AZ, UK
| | - Simon Gowers
- University of Liverpool, Mount Pleasant, Liverpool, L69 3BX, UK
| | - Geraldine Macdonald
- University of Bristol, School for Policy Studies, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - Ruth Stuart
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Nuala Livingstone
- Queen's University Belfast, School of Social Sciences, Education & Social Work, 6 College Park Ave, Belfast, BT7 1PS, UK
| | - Grace Kelly
- Queen's University Belfast, University Road, Belfast, BT7 1NN, UK
| | - Jonathan Kelly
- Beat, Unit 1 Chalk Hill House, 19 Rosary Road, Norwich, Norfolk, NR1 1SZ, UK
| | - Kandarp Joshi
- NHS Grampian and University of Aberdeen, CAMHS, City Hospital, Park Road, Aberdeen, AB24 5AU, UK
| | - Helen Smith
- NHS Ayrshire and Arran, South CAMHS/NSAIU, CAMHS, Arrol Park Resource Centre, House 1, Doonfoot Road, Ayr, KA7 2DW, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, Maudsley Centre for Child and Adolescent Eating Disorders, Michael Rutter Centre for Children and Young People, De Crespigny Park, London, SE5 8AZ, UK
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13
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Tyrer P, Wang D, Tyrer H, Crawford M, Loebenberg G, Cooper S, Barrett B, Sanatinia R. Influence of apparently negative personality characteristics on the long-term outcome of health anxiety: Secondary analysis of a randomized controlled trial. Personal Ment Health 2021; 15:72-86. [PMID: 32985777 DOI: 10.1002/pmh.1496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND It is known that personality has an influence on the outcome of mental state disorders, but detailed studies on its long-term impact are few. We examined the influence of personality status on the 8-year outcome of health anxiety and its relationship to the effects of cognitive behaviour therapy in a randomized controlled trial. AIMS This study aims to examine both the usefulness of the diagnosis of personality disorder and an additional measure of pathological dependence, in predicting the outcome of medical patients with health anxiety treated with cognitive behaviour therapy. Because the influence of personality is often shown in the long term, these assessments covered the period of 8 years after randomization. An additional aim is to examine the costs of different levels of personality dysfunction in each treatment group. METHOD Personality dysfunction, using both ICD-10 and ICD-11 classifications of severity, was assessed at baseline by interview in a randomized controlled trial. Patients were also assessed for pathological dependence using the Dependent Personality Questionnaire, also scored along a severity dimension. Four hundred forty-four patients from medical clinics with pathological health anxiety were treated with a modified form of cognitive behaviour therapy for health anxiety (CBT-HA) or standard care. Total costs over follow-up were calculated from hospital data and compared by personality group. RESULTS At baseline, 381 (86%) had some personality dysfunction, mainly at the lower level of personality difficulty (not formally a disorder). One hundred eighty four (41%) had a personality disorder. A similar proportion was found with regard to dependent personality. Using the ICD-10 classification, 153 patients (34.6%) had a personality disorder, with 83 (54.2%) having anxious or dependent personality disorder, 20 (13.1%) having an anankastic disorder, but also with 66 (43.1%) having mixed disorder. During initial treatment, those with personality disorder adhered more closely to CBT-HA, and after 8 years, they had a significantly better outcome than those with personality difficulty and no personality disorder (p < 0.002). Similar results were found in those scoring high on the Dependent Personality Questionnaire. All these differences increased over the follow-up period. Costs were similar in all groups but were somewhat higher in the CBT-HA one; this finding is hypothesised to be due to fuller hospital treatment once health anxiety is discounted. CONCLUSION Personality disorder in people with health anxiety, particularly in those who have anxious and dependent traits, reinforces the benefits of cognitive behaviour therapy, particularly in the longer term. © 2020 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Peter Tyrer
- Centre for Mental Health, Imperial College, London, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Tyrer
- Centre for Mental Health, Imperial College, London, UK
| | - Mike Crawford
- Centre for Mental Health, Imperial College, London, UK
| | - Gemma Loebenberg
- North West London Clinical Research Network, Hammersmith Hospital, London, UK
| | - Sylvia Cooper
- Centre for Mental Health, Imperial College, London, UK
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14
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Fonagy P, Yakeley J, Gardner T, Simes E, McMurran M, Moran P, Crawford M, Frater A, Barrett B, Cameron A, Wason J, Pilling S, Butler S, Bateman A. Mentalization for Offending Adult Males (MOAM): study protocol for a randomized controlled trial to evaluate mentalization-based treatment for antisocial personality disorder in male offenders on community probation. Trials 2020; 21:1001. [PMID: 33287865 PMCID: PMC7720544 DOI: 10.1186/s13063-020-04896-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background Antisocial personality disorder (ASPD), although associated with very significant health and social burden, is an under-researched mental disorder for which clinically effective and cost-effective treatment methods are urgently needed. No intervention has been established for prevention or as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment that has shown some promising preliminary results for reducing personality disorder symptomatology by specifically targeting the ability to recognize and understand the mental states of oneself and others, an ability that is compromised in people with ASPD. This paper describes the protocol of a multi-site RCT designed to test the effectiveness and cost-effectiveness of MBT for reducing aggression and alleviating the wider symptoms of ASPD in male offenders subject to probation supervision who fulfil diagnostic criteria for ASPD. Methods Three hundred and two participants recruited from a pool of offenders subject to statutory supervision by the National Probation Service at 13 sites across the UK will be randomized on a 1:1 basis to 12 months of probation plus MBT or standard probation as usual, with follow-up to 24 months post-randomization. The primary outcome is frequency of aggressive antisocial behaviour as assessed by the Overt Aggression Scale – Modified. Secondary outcomes include violence, offending rates, alcohol use, drug use, mental health status, quality of life, and total service use costs. Data will be gathered from police and criminal justice databases, NHS record linkage, and interviews and self-report measures administered to participants. Primary analysis will be on an intent-to-treat basis; per-protocol analysis will be undertaken as secondary analysis. The primary outcome will be analysed using hierarchical mixed-effects linear regression. Secondary outcomes will be analysed using mixed-effects linear regression, mixed-effects logistic regression, and mixed-effects Poisson models for secondary outcomes depending on whether the outcome is continuous, binary, or count data. A cost-effectiveness and cost-utility analysis will be undertaken. Discussion This definitive, national, multi-site trial is of sufficient size to evaluate MBT to inform policymakers, service commissioners, clinicians, and service users about its potential to treat offenders with ASPD and the likely impact on the population at risk. Trial registration ISRCTN 32309003. Registered on 8 April 2016.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK. .,Anna Freud National Centre for Children and Families, London, UK.
| | - Jessica Yakeley
- Portman Clinic, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Tessa Gardner
- Anna Freud National Centre for Children and Families, London, UK
| | - Elizabeth Simes
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud National Centre for Children and Families, London, UK
| | - Mary McMurran
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mike Crawford
- Centre for Mental Health, Imperial College, London, UK
| | - Alison Frater
- School of Law, Royal Holloway, University of London, London, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Angus Cameron
- National Probation Service London Division, London, UK
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stephen Butler
- Psychology Department, University of Prince Edward Island, Charlottetown, Canada
| | - Anthony Bateman
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud National Centre for Children and Families, London, UK
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15
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Barrett B, Pamphile S, Yang F, Friedman B. 149 Association of ACE-I and ARB Prescriptions With Mortality in Patients Admitted to the Hospital With COVID-19 in New York City. Ann Emerg Med 2020. [PMCID: PMC7598733 DOI: 10.1016/j.annemergmed.2020.09.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Sin J, Galeazzi G, McGregor E, Collom J, Taylor A, Barrett B, Lawrence V, Henderson C. Digital Interventions for Screening and Treating Common Mental Disorders or Symptoms of Common Mental Illness in Adults: Systematic Review and Meta-analysis. J Med Internet Res 2020; 22:e20581. [PMID: 32876577 PMCID: PMC7495259 DOI: 10.2196/20581] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Digital interventions targeting common mental disorders (CMDs) or symptoms of CMDs are growing rapidly and gaining popularity, probably in response to the increased prevalence of CMDs and better awareness of early help-seeking and self-care. However, no previous systematic reviews that focus on these novel interventions were found. OBJECTIVE This systematic review aims to scope entirely web-based interventions that provided screening and signposting for treatment, including self-management strategies, for people with CMDs or subthreshold symptoms. In addition, a meta-analysis was conducted to evaluate the effectiveness of these interventions for mental well-being and mental health outcomes. METHODS Ten electronic databases including MEDLINE, PsycINFO, and EMBASE were searched from January 1, 1999, to early April 2020. We included randomized controlled trials (RCTs) that evaluated a digital intervention (1) targeting adults with symptoms of CMDs, (2) providing both screening and signposting to other resources including self-care, and (3) delivered entirely through the internet. Intervention characteristics including target population, platform used, key design features, and outcome measure results were extracted and compared. Trial outcome results were included in a meta-analysis on the effectiveness of users' well-being and mental health outcomes. We also rated the meta-analysis results with the Grading of Recommendations, Assessment, Development, and Evaluations approach to establish the quality of the evidence. RESULTS The electronic searches yielded 21 papers describing 16 discrete digital interventions. These interventions were investigated in 19 unique trials including 1 (5%) health economic study. Most studies were conducted in Australia and North America. The targeted populations varied from the general population to allied health professionals. All interventions offered algorithm-driven screening with measures to assess symptom levels and to assign treatment options including automatic web-based psychoeducation, self-care strategies, and signposting to existing services. A meta-analysis of usable trial data showed that digital interventions improved well-being (3 randomized controlled trials [RCTs]; n=1307; standardized mean difference [SMD] 0.40; 95% CI 0.29 to 0.51; I2=28%; fixed effect), symptoms of mental illness (6 RCTs; n=992; SMD -0.29; 95% CI -0.49 to -0.09; I2=51%; random effects), and work and social functioning (3 RCTs; n=795; SMD -0.16; 95% CI -0.30 to -0.02; I2=0%; fixed effect) compared with waitlist or attention control. However, some follow-up data failed to show any sustained effects beyond the post intervention time point. Data on mechanisms of change and cost-effectiveness were also lacking, precluding further analysis. CONCLUSIONS Digital mental health interventions to assess and signpost people experiencing symptoms of CMDs appear to be acceptable to a sufficient number of people and appear to have enough evidence for effectiveness to warrant further study. We recommend that future studies incorporate economic analysis and process evaluation to assess the mechanisms of action and cost-effectiveness to aid scaling of the implementation.
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Affiliation(s)
- Jacqueline Sin
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
- Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Gian Galeazzi
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elicia McGregor
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jennifer Collom
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Anna Taylor
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Barbara Barrett
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Vanessa Lawrence
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Claire Henderson
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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17
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Bhide A, Sedgwick P, Barrett B, Cupples G, Coates R, Goode R, Linton S, McCourt C. Prostaglandin insert dinoprostone versus trans-cervical balloon catheter for outpatient labour induction: a randomised controlled trial of feasibility (PROBIT-F). Pilot Feasibility Stud 2020; 6:113. [PMID: 32821419 PMCID: PMC7429688 DOI: 10.1186/s40814-020-00661-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/03/2020] [Indexed: 01/25/2023] Open
Abstract
Background The aim was to assess the feasibility of conducting a randomised controlled trial (RCT) of induction of labour comparing use of two methods in the outpatient setting. Methods An open-label feasibility RCT was conducted in two UK maternity units from October 2017 to March 2019. Women aged ≥ 16 years, undergoing induction of labour (IOL) at term, with intact membranes and deemed suitable for outpatient IOL according to local guidelines were considered eligible. They were randomised to cervical ripening balloon catheter (CRB) or vaginal dinoprostone (Propess). The participants completed a questionnaire and a sub-group underwent detailed interview. Service use and cost data were collected via the Adult Service Use Schedule (AD-SUS). Women who declined to participate were requested to complete a decliners’ questionnaire. Results During the study period, 274 eligible women were identified. Two hundred thirty (83.9%) were approached for participation of whom 84/230 (36.5%) agreed and 146 did not. Of these, 38 were randomised to Propess (n = 20) and CRB (n = 18). Decliner data were collected for 93 women. The reasons for declining were declining IOL (n = 22), preference for inpatient IOL (n = 22) and preference for a specific method, Propess (n = 19). The intended sample size of 120 was not reached due to restrictive criteria for suitability for outpatient IOL, participant preference for Propess and shortage of research staff. The intervention as randomised was received by 29/38 (76%) women. Spontaneous vaginal delivery was observed in 9/20 (45%) women in the dinoprostone group and 11/18 (61%) women in the CRB group. Severe maternal adverse events were recorded in one woman in each group. All babies were born with good condition and all except one (37/38, 97.4%) remained with the mother after delivery. No deaths were recorded. − 21% of women in the dinoprostone group were re-admitted prior to diagnosis of active labour compared to 12% in the CRB group. Conclusions A third of the approached eligible women agreed for randomisation. An RCT is not feasible in the current service context. Modifications to the eligibility criteria for outpatient IOL, better information provision and round the clock availability of research staff would be needed to reach sufficient numbers. Trial registration NCT03199820. Registered on June 27, 2017
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Affiliation(s)
- Amarnath Bhide
- Fetal Medicine Unit, St. George's University Hospital Foundation Trust, Blackshaw Road, London, SW17 0QT UK.,St George's, University of London, London, UK.,UiT: The Arctic University of Norway, Tromsø, Norway
| | | | | | - Georgina Cupples
- Fetal Medicine Unit, St. George's University Hospital Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | | | - Rosie Goode
- Maternity Voices Partnership Chair, St. George's University Hospital Foundation Trust, London, UK
| | - Sandra Linton
- Fetal Medicine Unit, St. George's University Hospital Foundation Trust, Blackshaw Road, London, SW17 0QT UK
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18
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Groff G, Barrett B, Rogers P. Florida Model Task Force on Diabetic Retinopathy: Development of An Interagency Network. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x9008400902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes the development of a mechanism to organize a network in Florida for individuals who are at risk for diabetic retinopathy. The Florida Model Task Force on Diabetic Retinopathy, although tailored to meet the needs of Florida, was structured and documented to serve as a national model.
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Affiliation(s)
- G. Groff
- American Foundation for the Blind, 100 Peachtree Street, Suite 1016, Atlanta GA 30303
| | - B. Barrett
- Government affairs and special projects, Greater Orlando Aviation Authority, Orlando International Airport, 1 Airport Blvd., Orlando, FL 32827–4399
| | - P. Rogers
- Client services, Florida Division of Blind Services, 2540 Executive Center West, Tallahassee, FL 32301
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19
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Harrison P, Carr E, Goldsmith K, Young AH, Ashworth M, Fennema D, Barrett B, Zahn R. Study protocol for the antidepressant advisor (ADeSS): a decision support system for antidepressant treatment for depression in UK primary care: a feasibility study. BMJ Open 2020; 10:e035905. [PMID: 32448796 PMCID: PMC7252992 DOI: 10.1136/bmjopen-2019-035905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The Antidepressant Advisor Study is a feasibility trial of a computerised decision-support tool which uses an algorithm to provide antidepressant treatment guidance for general practitioners (GPs) in the UK primary care service. The tool is the first in the UK to implement national guidelines on antidepressant treatment guidance into a computerised decision-support tool. METHODS AND ANALYSIS The study is a parallel group, cluster-randomised controlled feasibility trial where participants are blind to treatment allocation. GPs were assigned to two treatment arms: (1) treatment-as-usual (TAU) and (2) computerised decision-support tool to assist with antidepressant choices. The study will assess recruitment and lost to follow-up rates, GP satisfaction with the tool and impact on health service use. A meaningful long-term roll-out unit cost will be calculated for the tool, and service use data will be collected at baseline and follow-up to inform a full economic evaluation of a future trial. ETHICS AND DISSEMINATION The study has received National Health Service ethical approval from the London-Camberwell St Giles Research Ethics Committee (ref: 17/LO/2074). The trial was pre-registered in the Clinical Trials.gov registry. The results of the study will be published in a pre-publication archive within 1 year of completion of the last follow-up assessment. TRIAL REGISTRATION NUMBER NCT03628027.
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Affiliation(s)
- Phillippa Harrison
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kimberley Goldsmith
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mark Ashworth
- Department of Population Health Sciences, King's College London, London, UK
| | - Diede Fennema
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Barbara Barrett
- Department of Health Services & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Roland Zahn
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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20
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Crawford MJ, Thana L, Parker J, Turner O, Carney A, McMurran M, Moran P, Weaver T, Barrett B, Roberts S, Claringbold A, Bassett P, Sanatinia R, Spong A. Structured Psychological Support for people with personality disorder: feasibility randomised controlled trial of a low-intensity intervention. BJPsych Open 2020; 6:e25. [PMID: 32115015 PMCID: PMC7176836 DOI: 10.1192/bjo.2020.7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND National guidance cautions against low-intensity interventions for people with personality disorder, but evidence from trials is lacking. AIMS To test the feasibility of conducting a randomised trial of a low-intensity intervention for people with personality disorder. METHOD Single-blind, feasibility trial (trial registration: ISRCTN14994755). We recruited people aged 18 or over with a clinical diagnosis of personality disorder from mental health services, excluding those with a coexisting organic or psychotic mental disorder. We randomly allocated participants via a remote system on a 1:1 ratio to six to ten sessions of Structured Psychological Support (SPS) or to treatment as usual. We assessed social functioning, mental health, health-related quality of life, satisfaction with care and resource use and costs at baseline and 24 weeks after randomisation. RESULTS A total of 63 participants were randomly assigned to either SPS (n = 33) or treatment as usual (n = 30). Twenty-nine (88%) of those in the active arm of the trial received one or more session (median 7). Among 46 (73%) who were followed up at 24 weeks, social dysfunction was lower (-6.3, 95% CI -12.0 to -0.6, P = 0.03) and satisfaction with care was higher (6.5, 95% CI 2.5 to 10.4; P = 0.002) in those allocated to SPS. Statistically significant differences were not found in other outcomes. The cost of the intervention was low and total costs over 24 weeks were similar in both groups. CONCLUSIONS SPS may provide an effective low-intensity intervention for people with personality disorder and should be tested in fully powered clinical trials.
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Affiliation(s)
| | - Lavanya Thana
- Research and Development, Central & North West London NHS Foundation Trust, UK
| | - Jennie Parker
- Research and Development, Central & North West London NHS Foundation Trust, UK
| | - Oliver Turner
- Division of Specialist Services, Barnet, Enfield & Haringey NHS Trust, UK
| | - Aidan Carney
- Adult Mental Health Directorate, Central & North West London NHS Foundation Trust, UK
| | - Mary McMurran
- Psychiatry and Applied Psychology Department, University of Nottingham, UK
| | - Paul Moran
- Centre for Academic Mental Health, University of Bristol, UK
| | - Timothy Weaver
- School of Health and Education, Middlesex University London, UK
| | - Barbara Barrett
- Health Service and Population Research, King's College London, UK
| | - Sarah Roberts
- Health Service and Population Research, King's College London, UK
| | | | | | | | - Amanda Spong
- Clinical Psychology, Cambridgeshire and Peterborough NHS Foundation Trust, UK
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21
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Rugs D, Chavez M, Melillo C, Cowan L, Barrett B, Toyinbo P, Sullivan SC, Powell-Cope G. Evaluating an Evidence-Based Practice Curriculum for Nurses Entering Clinical Practice in the Veterans Health Administration. J Health Sci Educ 2020; 4:1-6. [PMID: 38293279 PMCID: PMC10825804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Introduction The Veterans Health Administration (VHA) registered nurse (RN) Transition to Practice (TTP) program is a 1-year comprehensive, standardized curriculum taught for entry-level nurses to assist them in transitioning to VA-trained, competent, professional RNs. The TTP program includes revised modules on Evidence-Based Practice (EBP) clinical decision making. The revised curriculum emphasizes EBP as a problem-solving approach to clinical decision making rather than a project-based approach to implement practice changes. The goal of this quality improvement project was to evaluate the content, delivery, and outcomes of a revised Evidence-Based Practice Curriculum (EBPC) for use in the VHA RN TTP program. Methods Focus groups were conducted with TTP coordinators, who teach the program and facility EBP content experts from 32 VHA Medical Centers. All attended a three-day face-to-face training at a central location. Qualitative data were managed and analyzed with a rapid assessment process. Discussion Leaders within and outside of organizations are commonly believed to affect the success of implementing and sustaining any program or initiative through their influence on organizational climate, leadership processes, and leadership alignment across multiple levels of leadership. Our findings were in line with other research showing that leaders should prioritize EBP and fuel it with resources to create sustainable change. Conclusions In conclusion, the EBPC was reviewed very favorably by all who planned to use it in their facilities in teaching the content to practicing registered nurses. Future evaluation will focus on the degree to which faculty use the program, how they use the modules, and what feedback nurses provide after exposure to EBPC.
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Affiliation(s)
- D Rugs
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - M Chavez
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - C Melillo
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - L Cowan
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - B Barrett
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - P Toyinbo
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - SC Sullivan
- Office of Nursing Services, Veterans Health Administration, Washington, DC
| | - G Powell-Cope
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
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22
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Melillo C, Chavez M, Powell-Cope G, Rugs D, Cowan L, Shaw SM, Barrett B, Rugen KW. Using Clinical Narratives in Program and Curriculum Evaluation. J Health Sci Educ 2020; 4:203. [PMID: 38014358 PMCID: PMC10680199 DOI: 10.61545/jhse-1-203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Using personal experience stories as teaching tools, clinical narratives are an effective means for sharing the art of nursing practice and provide insight into nurses' critical thinking and clinical proficiency. Using clinical narratives to assess curriculum effectiveness provides important insights into changed practice and learning beyond the classroom. Aim This article provides an example of using clinical narratives in the evaluation of the Department of Veterans Health Affairs Office of Nursing Services (ONS) Evidence Based Practice Curriculum (EBPC). Methods As part of a larger mixed-method evaluation of the EBPC, clinical narrative methods were employed to describe one incident where participants (n=3) applied at least two of three evidence based practice components (best available evidence; clinical expertise; patient preference). Results Examination of clinical narratives demonstrated successful application of key components of evidence based practice and an integration into individual nursing practice beyond data obtained from other evaluation methods. Conclusions Incorporating rich clinical narratives into a rigorous mixed-method program evaluation protocol provides insights beyond information uptake, satisfaction, efficacy, or competency assessment scores.
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Affiliation(s)
- C Melillo
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - M Chavez
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - G Powell-Cope
- Retired Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - D Rugs
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - L Cowan
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - SM Shaw
- Providence VA Medical Center, Providence, RI, USA
| | - B Barrett
- Nursing Innovations Center for Evaluation (NICE), Department of Research and Development, James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - KW Rugen
- Providence VA Medical Center, Providence, RI, USA
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23
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Condon G, Rabault M, Barrett B, Chichet L, Arguel R, Eneriz-Imaz H, Naik D, Bertoldi A, Battelier B, Bouyer P, Landragin A. All-Optical Bose-Einstein Condensates in Microgravity. Phys Rev Lett 2019; 123:240402. [PMID: 31922832 DOI: 10.1103/physrevlett.123.240402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Indexed: 06/10/2023]
Abstract
We report on the all-optical production of Bose-Einstein condensates in microgravity using a combination of grey molasses cooling, light-shift engineering and optical trapping in a painted potential. Forced evaporative cooling in a 3-m high Einstein elevator results in 4×10^{4} condensed atoms every 13.5 s, with a temperature as low as 35 nK. In this system, the atomic cloud can expand in weightlessness for up to 400 ms, paving the way for atom interferometry experiments with extended interrogation times and studies of ultracold matter physics at low energies on ground or in Space.
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Affiliation(s)
- G Condon
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - M Rabault
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - B Barrett
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - L Chichet
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - R Arguel
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - H Eneriz-Imaz
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - D Naik
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - A Bertoldi
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - B Battelier
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - P Bouyer
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - A Landragin
- LNE-SYRTE, Observatoire de Paris, Université PSL, CNRS, Sorbonne Université, 61 avenue de l'Observatoire, 75014 Paris, France
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24
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Byford S, Petkova H, Stuart R, Nicholls D, Simic M, Ford T, Macdonald G, Gowers S, Roberts S, Barrett B, Kelly J, Kelly G, Livingstone N, Joshi K, Smith H, Eisler I. Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study. Health Serv Deliv Res 2019. [DOI: 10.3310/hsdr07370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Evidence suggests that investing in specialist eating disorders services for young people with anorexia nervosa could have important implications for the NHS, with the potential to improve health outcomes and reduce costs through reductions in the number and length of hospital admissions.
Objectives
The primary objectives were to evaluate the costs and cost-effectiveness of alternative community-based models of service provision for young people with anorexia nervosa and to model the impact of potential changes to the provision of specialist services.
Design
Observational surveillance study using the Child and Adolescent Psychiatry Surveillance System.
Setting
Community-based secondary or tertiary child and adolescent mental health services (CAMHS) in the UK and the Republic of Ireland.
Participants
A total of 298 young people aged 8–17 years in contact with CAMHS for a first episode of anorexia nervosa in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria.
Interventions
Community-based specialist eating disorders services and generic CAMHS.
Main outcome measures
Children’s Global Assessment Scale (CGAS) score (primary outcome) and percentage of median expected body mass index (BMI) for age and sex (%mBMI) (secondary outcome) were assessed at baseline and at 6 and 12 months.
Data sources
Data were collected by clinicians from clinical records.
Results
Total costs incurred by young people initially assessed in specialist eating disorders services were not significantly different from those incurred by young people initially assessed in generic CAMHS. However, adjustment for baseline covariates resulted in observed differences favouring specialist services (costs were lower, on average) because of the significantly poorer clinical status of the specialist group at baseline. At the 6-month follow-up, mean %mBMI was significantly higher in the specialist group, but no other significant differences in outcomes were evident. Cost-effectiveness analyses suggest that initial assessment in a specialist service has a higher probability of being cost-effective than initial assessment in generic CAMHS, as determined by CGAS score and %mBMI. However, no firm conclusion can be drawn without knowledge of society’s willingness to pay for improvements in these outcomes. Decision modelling did not support the hypothesis that changes to the provision of specialist services would generate savings for the NHS, with results suggesting that cost per 10-point improvement in CGAS score (improvement from one CGAS category to the next) varies little as the percentage of participants taking the specialist or generic pathway is varied.
Limitations
Follow-up rates were lower than expected, but the sample was still larger than has been achieved to date in RCTs carried out in this population in the UK, and an exploration of the impact of missing cost and outcome data produced very similar results to those of the main analyses.
Conclusions
The results of this study suggest that initial assessment in a specialist eating disorders service for young people with anorexia nervosa may have a higher probability of being cost-effective than initial assessment in generic CAMHS, although the associated uncertainty makes it hard to draw firm conclusions. Although costs and outcomes were similar, young people in specialist services were more severely ill at baseline, suggesting that specialist services were achieving larger clinical effectiveness gains without the need for additional expenditure. The results did not suggest that providing more specialist services would save money for the NHS, given similar costs and outcomes, so decisions about which service type to fund could be made with reference to other factors, such as the preferences of patients and carers.
Future work
Data on measures of quality of life capable of generating quality-adjusted life-years are needed to confirm the cost-effectiveness of specialist services.
Trial registration
Current Controlled Trials ISRCTN12676087.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Hristina Petkova
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ruth Stuart
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Dasha Nicholls
- Department of Medicine, Imperial College London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Institute of Health Research, Department of Psychological Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Sarah Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Barbara Barrett
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Grace Kelly
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Nuala Livingstone
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Kandarp Joshi
- Child and Adolescent Mental Health Service, Royal Cornhill Hospital, NHS Grampian, Aberdeen, UK
- Mental Health Division, University of Aberdeen, Aberdeen, UK
| | | | - Ivan Eisler
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Boyapati R, Patel S, Barrett B. Referral route patterns for head and neck cancers treated at a single regional unit in 2017 in South East England. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Garg M, Walker D, Barrett B, Gulati A. 2B or not 2B or maybe 2B: is that the question? Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Salomone E, Leadbitter K, Aldred C, Barrett B, Byford S, Charman T, Howlin P, Green J, Le Couteur A, McConachie H, Parr JR, Pickles A, Slonims V. The Association Between Child and Family Characteristics and the Mental Health and Wellbeing of Caregivers of Children with Autism in Mid-Childhood. J Autism Dev Disord 2019; 48:1189-1198. [PMID: 29177606 PMCID: PMC5861164 DOI: 10.1007/s10803-017-3392-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We examined predictors of mental health difficulties and wellbeing in caregivers of children with autism in the Pre-school Autism Communication Trial cohort in middle childhood (N = 104). Child’s intellectual disability, daily living skills impairment, elevated emotional and behavioural difficulties, high educational level of caregiver and household income below the median significantly predicted caregivers’ mental health difficulties, but autism severity, child communication skills and family circumstances did not. Lower caregiver mental wellbeing was predicted by elevated child emotional and behavioural difficulties. The need to support the mental health and wellbeing of caregivers of children with autism is discussed in light of the results.
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Affiliation(s)
- Erica Salomone
- University of Turin, Via Po, 14, 10123, Turin, Italy. .,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | | | | | - Barbara Barrett
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jonathan Green
- University of Manchester, Manchester, UK.,UK Royal Manchester Children's Hospital, Manchester Academic Health Sciences Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ann Le Couteur
- Newcastle University, Newcastle, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vicky Slonims
- Evelina London Children's Hospital, Guys and St Thomas University NHS Trust, London, UK
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Crawford MJ, Sanatinia R, Barrett B, Cunningham G, Dale O, Ganguli P, Lawrence-Smith G, Leeson VC, Lemonsky F, Lykomitrou-Matthews G, Montgomery A, Morriss R, Munjiza J, Paton C, Skorodzien I, Singh V, Tan W, Tyrer P, Reilly JG. Lamotrigine for people with borderline personality disorder: a RCT. Health Technol Assess 2019; 22:1-68. [PMID: 29651981 DOI: 10.3310/hta22170] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND No drug treatments are currently licensed for the treatment of borderline personality disorder (BPD). Despite this, people with this condition are frequently prescribed psychotropic medications and often with considerable polypharmacy. Preliminary studies have indicated that mood stabilisers may be of benefit to people with BPD. OBJECTIVE To examine the clinical effectiveness and cost-effectiveness of lamotrigine for people with BPD. DESIGN A two-arm, double-blind, placebo-controlled individually randomised trial of lamotrigine versus placebo. Participants were randomised via an independent and remote web-based service using permuted blocks and stratified by study centre, the severity of personality disorder and the extent of hypomanic symptoms. SETTING Secondary care NHS mental health services in six centres in England. PARTICIPANTS Potential participants had to be aged ≥ 18 years, meet diagnostic criteria for BPD and provide written informed consent. We excluded people with coexisting psychosis or bipolar affective disorder, those already taking a mood stabiliser, those who spoke insufficient English to complete the baseline assessment and women who were pregnant or contemplating becoming pregnant. INTERVENTIONS Up to 200 mg of lamotrigine per day or an inert placebo. Women taking combined oral contraceptives were prescribed up to 400 mg of trial medication per day. MAIN OUTCOME MEASURES Outcomes were assessed at 12, 24 and 52 weeks after randomisation. The primary outcome was the total score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. The secondary outcomes were depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment and adverse events. Higher scores on all measures indicate poorer outcomes. RESULTS Between July 2013 and October 2015 we randomised 276 participants, of whom 195 (70.6%) were followed up 52 weeks later. At 52 weeks, 49 (36%) of those participants prescribed lamotrigine and 58 (42%) of those prescribed placebo were taking it. At 52 weeks, the mean total ZAN-BPD score was 11.3 [standard deviation (SD) 6.6] among those participants randomised to lamotrigine and 11.5 (SD 7.7) among those participants randomised to placebo (adjusted mean difference 0.1, 95% CI -1.8 to 2.0; p = 0.91). No statistically significant differences in secondary outcomes were seen at any time. Adjusted costs of direct care for those prescribed lamotrigine were similar to those prescribed placebo. LIMITATIONS Levels of adherence in this pragmatic trial were low, but greater adherence was not associated with better mental health. CONCLUSIONS The addition of lamotrigine to the usual care of people with BPD was not found to be clinically effective or provide a cost-effective use of resources. FUTURE WORK Future research into the treatment of BPD should focus on improving the evidence base for the clinical effectiveness and cost-effectiveness of non-pharmacological treatments to help policy-makers make better decisions about investing in specialist treatment services. TRIAL REGISTRATION Current Controlled Trials ISRCTN90916365. FUNDING Funding for this trial was provided by the Health Technology Assessment programme of the National Institute for Health Research (NIHR) and will be published in full in Health Technology Assessment; Vol. 22, No. 17. See the NIHR Journals Library website for further project information. The Imperial Biomedical Research Centre Facility, which is funded by NIHR, also provided support that has contributed to the research results reported within this paper. Part of Richard Morriss' salary during the project was paid by NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands.
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Affiliation(s)
| | | | - Barbara Barrett
- Centre for the Economics of Mental and Physical Health, King's College London, London, UK
| | | | - Oliver Dale
- West London Mental Health NHS Trust, London, UK
| | - Poushali Ganguli
- Centre for the Economics of Mental and Physical Health, King's College London, London, UK
| | | | | | | | | | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Richard Morriss
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Jasna Munjiza
- Central and North West London NHS Foundation Trust, London, UK
| | | | - Iwona Skorodzien
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Vineet Singh
- Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Wei Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Peter Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | - Joseph G Reilly
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
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Barrett B, Cheiney P, Battelier B, Napolitano F, Bouyer P. Multidimensional Atom Optics and Interferometry. Phys Rev Lett 2019; 122:043604. [PMID: 30768283 DOI: 10.1103/physrevlett.122.043604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Indexed: 06/09/2023]
Abstract
We propose new multidimensional atom optics that can create coherent superpositions of atomic wave packets along three spatial directions. These tools can be used to generate light-pulse atom interferometers that are simultaneously sensitive to the three components of acceleration and rotation, and we discuss how to isolate these inertial components in a single experimental shot. We also present a new type of atomic gyroscope that is insensitive to parasitic accelerations and initial velocities. The ability to measure the full acceleration and rotation vectors with a compact, high-precision, low-bias inertial sensor could strongly impact the fields of inertial navigation, gravity gradiometry, and gyroscopy.
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Affiliation(s)
- B Barrett
- iXblue, 34 rue de la Croix de Fer, 78105 Saint-Germain-en-Laye, France
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - P Cheiney
- iXblue, 34 rue de la Croix de Fer, 78105 Saint-Germain-en-Laye, France
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - B Battelier
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
| | - F Napolitano
- iXblue, 34 rue de la Croix de Fer, 78105 Saint-Germain-en-Laye, France
| | - P Bouyer
- LP2N, Laboratoire Photonique, Numérique et Nanosciences, Université Bordeaux-IOGS-CNRS:UMR 5298, 1 rue François Mitterrand, 33400 Talence, France
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Crawford MJ, Thana L, Parker J, Turner O, Xing KP, McMurran M, Moran P, Weaver T, Barrett B, Claringbold A, Bassett P, Sanatinia R. Psychological Support for Personality (PSP) versus treatment as usual: study protocol for a feasibility randomized controlled trial of a low intensity intervention for people with personality disorder. Trials 2018; 19:547. [PMID: 30305148 PMCID: PMC6180621 DOI: 10.1186/s13063-018-2920-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Previous research has demonstrated the clinical effectiveness of long-term psychological treatment for people with some types of personality disorder. However, the high intensity and cost of these interventions limit their availability. Lower-intensity interventions are increasingly being offered to people with personality disorder, but their clinical and cost effectiveness have not been properly tested in experimental studies. We therefore set out to develop a low intensity intervention for people with personality disorder and to test the feasibility of conducting a randomized controlled trial to compare the clinical effectiveness of this intervention with that of treatment as usual (TAU). Methods A two-arm, parallel-group, single-blind, randomized controlled trial of Psychological Support for Personality (PSP) versus TAU for people aged over 18 years, who are using secondary care mental health services and have personality disorder. We will exclude people with co-existing organic or psychotic mental disorders (dementia, bipolar affective disorder, delusional disorder, schizophrenia, schizoaffective disorder, or schizotypal disorder), those with cognitive or language difficulties that would preclude them from providing informed consent or compromise participation in study procedures, and those who are already receiving psychological treatment for personality disorder. Participants will be randomized via a remote system in a ratio of PSP to TAU of 1:1. Randomization will be stratified according to the referring team and gender of the participant. A single follow-up assessment will be conducted by masked researchers 24 weeks after randomization to assess mental health (using the Warwick and Edinburgh Well-Being Schedule), social functioning (using the Work and Social Adjustment Scale), health-related quality of life (EQ-5D-5 L), incidence of suicidal behavior, satisfaction with care (Client Satisfaction Questionnaire), and resource use and costs using a modified version of the Adult Service Use Schedule. In addition to this, each participant will be asked to complete the patient version of the Clinical Global Impression Scale. Feasibility and acceptability will primarily be judged by study recruitment rate and engagement and retention in treatment. The analysis will focus principally on descriptive data on the rate of recruitment, characteristics of participants, attrition, adherence to therapy, and follow-up. We will explore the distribution of study outcomes to investigate assumptions of normality in order to plan the analysis and sample size of a future definitive trial. Discussion Most people with personality disorder do not currently receive evidence-based interventions. While a number of high intensity psychological treatments have been shown to be effective, there is an urgent need to develop effective low intensity approaches to help people unable to use existing treatments. PSP is a low intensity intervention for individuals, which was developed following extensive consultation with users and providers of services for people with personality disorder. This study aims to examine the feasibility of a randomized trial of PSP compared to TAU for people with personality disorder. Trial registration ISRCTN Registry, ISRCTN14994755. Registered on 18 July 2017.
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Affiliation(s)
- Mike J Crawford
- Personality Disorder Research Unit, Centre for Psychiatry, Imperial College London, London, UK. .,Department of Medicine, Division of Brain Sciences, Centre for Psychiatry, 7th Floor Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK.
| | - Lavanya Thana
- Personality Disorder Research Unit, Centre for Psychiatry, Imperial College London, London, UK.,Department of Medicine, Division of Brain Sciences, Centre for Psychiatry, 7th Floor Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Jennie Parker
- Research and Development Department, Central and North West London NHS Foundation Trust, Stephenson House, 75 Hampstead Road, London, NW1 2PL, UK
| | - Oliver Turner
- Barnet, Enfield and Haringey NHS Foundation Trust, St Ann's Hospital, St Ann's Road, Haringey, London, N15 3TH, UK
| | - Kwek Pei Xing
- Personality Disorder Research Unit, Centre for Psychiatry, Imperial College London, London, UK.,Department of Medicine, Division of Brain Sciences, Centre for Psychiatry, 7th Floor Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Mary McMurran
- Section of Forensic Mental Health, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Paul Moran
- School of Social and Community Medicine, Bristol University, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Timothy Weaver
- Mental Health Social Work & Integrative Medicine, Middlesex University, The Burroughs, Hendon, London, NW4 4BT, UK
| | - Barbara Barrett
- Centre for the Economics of Mental and Physical Health, King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Amy Claringbold
- Personality Disorder Research Unit, Centre for Psychiatry, Imperial College London, London, UK.,Department of Medicine, Division of Brain Sciences, Centre for Psychiatry, 7th Floor Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Paul Bassett
- Statsconsultancy Limited, 40 Longwood Lane, Amersham, Buckinghamshire, HP7 9EN, UK
| | - Rahil Sanatinia
- Personality Disorder Research Unit, Centre for Psychiatry, Imperial College London, London, UK.,Department of Medicine, Division of Brain Sciences, Centre for Psychiatry, 7th Floor Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
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Crawford MJ, Sanatinia R, Barrett B, Cunningham G, Dale O, Ganguli P, Lawrence-Smith G, Leeson V, Lemonsky F, Lykomitrou G, Montgomery AA, Morriss R, Munjiza J, Paton C, Skorodzien I, Singh V, Tan W, Tyrer P, Reilly JG. The Clinical Effectiveness and Cost-Effectiveness of Lamotrigine in Borderline Personality Disorder: A Randomized Placebo-Controlled Trial. Am J Psychiatry 2018; 175:756-764. [PMID: 29621901 DOI: 10.1176/appi.ajp.2018.17091006] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined whether lamotrigine is a clinically effective and cost-effective treatment for people with borderline personality disorder. METHOD This was a multicenter, double-blind, placebo-controlled randomized trial. Between July 2013 and November 2016, the authors recruited 276 people age 18 or over who met diagnostic criteria for borderline personality disorder. Individuals with coexisting bipolar affective disorder or psychosis, those already taking a mood stabilizer, and women at risk of pregnancy were excluded. A web-based randomization service was used to allocate participants randomly in a 1:1 ratio to receive either an inert placebo or up to 400 mg/day of lamotrigine. The primary outcome measure was score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. Secondary outcome measures included depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment, and adverse events. RESULTS A total of 195 (70.6%) participants were followed up at 52 weeks, at which point 49 (36%) of those in the lamotrigine group and 58 (42%) of those in the placebo group were taking study medication. The mean ZAN-BPD score was 11.3 (SD=6.6) among those in the lamotrigine group and 11.5 (SD=7.7) among those in the placebo group (adjusted difference in means=0.1, 95% CI=-1.8, 2.0). There was no evidence of any differences in secondary outcomes. Costs of direct care were similar in the two groups. CONCLUSIONS The results suggest that treating people with borderline personality disorder with lamotrigine is not a clinically effective or cost-effective use of resources.
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Affiliation(s)
- Mike J Crawford
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Rahil Sanatinia
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Barbara Barrett
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Gillian Cunningham
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Oliver Dale
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Poushali Ganguli
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Geoff Lawrence-Smith
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Verity Leeson
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Fenella Lemonsky
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Georgia Lykomitrou
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Alan A Montgomery
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Richard Morriss
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Jasna Munjiza
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Carol Paton
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Iwona Skorodzien
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Vineet Singh
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Wei Tan
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Peter Tyrer
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
| | - Joseph G Reilly
- From the Centre for Psychiatry, Imperial College London, Hammersmith Campus, London; the Centre for the Economics of Mental and Physical Health, King's College London; Tees, Esk and Wear Valley NHS Trust, Middlesbrough, U.K.; West London NHS Mental Health Trust, Southall; Oxleas NHS Foundation Trust, Dartford, U.K.; the Division of Psychiatry and Applied Psychology and the Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, U.K.; the Central and North West London NHS Foundation Trust, London; and the Derbyshire Healthcare NHS Foundation Trust, Derby, U.K
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Tyrer P, Salkovskis P, Tyrer H, Wang D, Crawford MJ, Dupont S, Cooper S, Green J, Murphy D, Smith G, Bhogal S, Nourmand S, Lazarevic V, Loebenberg G, Evered R, Kings S, McNulty A, Lisseman-Stones Y, McAllister S, Kramo K, Nagar J, Reid S, Sanatinia R, Whittamore K, Walker G, Philip A, Warwick H, Byford S, Barrett B. Cognitive-behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years. Health Technol Assess 2018; 21:1-58. [PMID: 28877841 DOI: 10.3310/hta21500] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Health anxiety is an under-recognised but frequent cause of distress that is potentially treatable, but there are few studies in secondary care. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive-behaviour therapy (CBT) for health anxiety (CBT-HA) compared with standard care in medical outpatients. DESIGN Randomised controlled trial. SETTING Five general hospitals in London, Middlesex and Nottinghamshire. PARTICIPANTS A total of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored ≥ 20 points on the Health Anxiety Inventory (HAI) and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded, but those with concurrent medical illnesses were not. INTERVENTIONS Cognitive-behaviour therapy for health anxiety - between 4 and 10 1-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care. MAIN OUTCOME MEASURES Primary - researchers masked to allocation assessed patients at baseline, 3, 6, 12, 24 months and 5 years. The primary outcome was change in the HAI score between baseline and 12 months. Main secondary outcomes - costs of care in the two groups after 24 and 60 months, change in health anxiety (HAI), generalised anxiety and depression [Hospital Anxiety and Depression Scale (HADS)] scores, social functioning using the Social Functioning Questionnaire and quality of life using the EuroQol-5 Dimensions (EQ-5D), at 6, 12, 24 and 60 months, and deaths over 5 years. RESULTS Of the 28,991 patients screened over 21 months, 5769 had HAI scores of ≥ 20 points. Improvement in HAI scores at 3 months was significantly greater in the CBT-HA group (mean number of sessions = 6) than in the standard care, and this was maintained over the 5-year period (overall p < 0.0001), with no loss of efficacy between 2 and 5 years. Differences in the generalised anxiety (p = 0.0018) and depression scores (p = 0.0065) on the HADS were similar in both groups over the 5-year period. Gastroenterology and cardiology patients showed the greatest CBT gains. The outcomes for nurses were superior to those of other therapists. Deaths (n = 24) were similar in both groups; those in standard care died earlier than those in CBT-HA. Patients with mild personality disturbance and higher dependence levels had the best outcome with CBT-HA. Total costs were similar in both groups over the 5-year period (£12,590.58 for CBT-HA; £13,334.94 for standard care). CBT-HA was not cost-effective in terms of quality-adjusted life-years, as measured using the EQ-5D, but was cost-effective in terms of HAI outcomes, and offset the cost of treatment. LIMITATIONS Many eligible patients were not randomised and the population treated may not be representative. CONCLUSIONS CBT-HA is a highly effective treatment for pathological health anxiety with lasting benefit over 5 years. It also improves generalised anxiety and depressive symptoms more than standard care. The presence of personality abnormality is not a bar to successful outcome. CBT-HA may also be cost-effective, but the high costs of concurrent medical illnesses obscure potential savings. This treatment deserves further research in medical settings. TRIAL REGISTRATION Current Controlled Trials ISRCTN14565822. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | | | - Helen Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Simon Dupont
- Central and North West London NHS Foundation Trust, London, UK
| | - Sylvia Cooper
- Centre for Psychiatry, Imperial College London, London, UK
| | - John Green
- Central and North West London NHS Foundation Trust, London, UK
| | - David Murphy
- Imperial College Healthcare NHS Trust, London, UK
| | - Georgina Smith
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Valentina Lazarevic
- East Midlands & South Yorkshire Mental Health Research Network, Nottingham, UK
| | | | - Rachel Evered
- North London Hub, Mental Health Research Network, London, UK
| | - Stephanie Kings
- East Midlands & South Yorkshire Mental Health Research Network, Nottingham, UK
| | | | | | | | - Kofi Kramo
- Centre for Psychiatry, Imperial College London, London, UK
| | - Jessica Nagar
- North London Hub, Mental Health Research Network, London, UK
| | - Steven Reid
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Gemma Walker
- Centre for Psychiatry, Imperial College London, London, UK
| | - Aaron Philip
- Centre for Psychiatry, Imperial College London, London, UK
| | - Hilary Warwick
- Centre for Psychiatry, Imperial College London, London, UK
| | - Sarah Byford
- King's Health Economics, King's College London, London, UK
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Richards DA, Rhodes S, Ekers D, McMillan D, Taylor RS, Byford S, Barrett B, Finning K, Ganguli P, Warren F, Farrand P, Gilbody S, Kuyken W, O'Mahen H, Watkins E, Wright K, Reed N, Fletcher E, Hollon SD, Moore L, Backhouse A, Farrow C, Garry J, Kemp D, Plummer F, Warner F, Woodhouse R. Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive-behavioural therapy for depression. Health Technol Assess 2018; 21:1-366. [PMID: 28857042 DOI: 10.3310/hta21460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression is a common, debilitating and costly disorder. The best-evidenced psychological therapy - cognitive-behavioural therapy (CBT) - is complex and costly. A simpler therapy, behavioural activation (BA), may be an effective alternative. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of BA compared with CBT for depressed adults at 12 and 18 months' follow-up, and to investigate the processes of treatments. DESIGN Randomised controlled, non-inferiority trial stratified by depression severity, antidepressant use and recruitment site, with embedded process evaluation; and randomisation by remote computer-generated allocation. SETTING Three community mental health services in England. PARTICIPANTS Adults aged ≥ 18 years with major depressive disorder (MDD) recruited from primary care and psychological therapy services. INTERVENTIONS BA delivered by NHS junior mental health workers (MHWs); CBT by NHS psychological therapists. OUTCOMES Primary: depression severity (as measured via the Patient Health Questionnaire-9; PHQ-9) at 12 months. Secondary: MDD status; number of depression-free days; anxiety (as measured via the Generalised Anxiety Disorder-7); health-related quality of life (as measured via the Short Form questionnaire-36 items) at 6, 12 and 18 months; and PHQ-9 at 6 and 18 months, all collected by assessors blinded to treatment allocation. Non-inferiority margin was 1.9 PHQ-9 points. We undertook intention-to-treat (ITT) and per protocol (PP) analyses. We explored cost-effectiveness by collecting direct treatment and other health- and social-care costs and calculating quality-adjusted life-years (QALYs) using the EuroQol-5 Dimensions, three-level version, at 18 months. RESULTS We recruited 440 participants (BA, n = 221; CBT, n = 219); 175 (79%) BA and 189 (86%) CBT participants provided ITT data and 135 (61%) BA and 151 (69%) CBT participants provided PP data. At 12 months we found that BA was non-inferior to CBT {ITT: CBT 8.4 PHQ-9 points [standard deviation (SD) 7.5 PHQ-9 points], BA 8.4 PHQ-9 points (SD 7.0 PHQ-9 points), mean difference 0.1 PHQ-9 points, 95% confidence interval (CI) -1.3 to 1.5 PHQ-9 points, p = 0.89; PP: CBT 7.9 PHQ-9 points (SD 7.3 PHQ-9 points), BA 7.8 PHQ-9 points (SD 6.5 PHQ-9 points), mean difference 0.0 PHQ-9 points, 95% CI -1.5 to 1.6 PHQ-9 points, p = 0.99}. We found no differences in secondary outcomes. We found a significant difference in mean intervention costs (BA, £975; CBT, £1235; p < 0.001), but no differences in non-intervention (hospital, community health, social care and medication costs) or total (non-intervention plus intervention) costs. Costs were lower and QALY outcomes better in the BA group, generating an incremental cost-effectiveness ratio of -£6865. The probability of BA being cost-effective compared with CBT was almost 80% at the National Institute for Health and Care Excellence's preferred willingness-to-pay threshold of £20,000-30,000 per QALY. There were no trial-related adverse events. LIMITATIONS In this pragmatic trial many depressed participants in both groups were also taking antidepressant medication, although most had been doing so for a considerable time before entering the trial. Around one-third of participants chose not to complete a PP dose of treatment, a finding common in both psychotherapy trials and routine practice. CONCLUSIONS We found that BA is as effective as CBT, more cost-effective and can be delivered by MHWs with no professional training in psychological therapies. FUTURE WORK Settings and countries with a paucity of professionally qualified psychological therapists, might choose to investigate the delivery of effective psychological therapy for depression without the need to develop an extensive and costly professional infrastructure. TRIAL REGISTRATION Current Controlled Trials ISRCTN27473954. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David A Richards
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Shelley Rhodes
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - David Ekers
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Rod S Taylor
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Katie Finning
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Fiona Warren
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Paul Farrand
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Willem Kuyken
- Oxford Mindfulness Centre, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Heather O'Mahen
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Ed Watkins
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Kim Wright
- Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Nigel Reed
- Lived Experience Group, care of Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Emily Fletcher
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Lucy Moore
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Amy Backhouse
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Claire Farrow
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Julie Garry
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Deborah Kemp
- Psychological Therapy, Tees, Esk & Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Faye Plummer
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary, Bradford, UK
| | - Faith Warner
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
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Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial. Health Technol Assess 2018; 21:1-94. [PMID: 28394249 DOI: 10.3310/hta21120] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years. OBJECTIVE To determine whether or not either of two specialist psychological treatments, cognitive-behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief psychosocial intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment. DESIGN Observer-blind, parallel-group, pragmatic superiority randomised controlled trial. SETTING A total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London. PARTICIPANTS Adolescents aged 11-17 years with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses. INTERVENTIONS In total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up. MAIN OUTCOME MEASURES Mean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation. RESULTS There were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = -0.578, 95% confidence interval (CI) -2.948 to 4.104; p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = -1.898, 95% CI -4.922 to 1.126; p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49-52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome. CONCLUSIONS The three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings. LIMITATIONS Neither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data. TRIAL REGISTRATION Current Controlled Trials ISRCTN83033550. FUNDING This project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 12. See the National Institute for Heath Research Journals Library website for further project information. Funding was also provided by the Department of Health. The funders had no role in the study design, patient recruitment, data collection, analysis or writing of the study, any aspect pertinent to the study or the decision to submit to The Lancet.
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Affiliation(s)
- Ian M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | - Sarah Byford
- David Goldberg Centre, King's College London, London, UK
| | - Bernadka Dubicka
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Jonathan Hill
- Child and Adolescent Psychiatry, University of Manchester, Manchester, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Fiona Holland
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Raphael Kelvin
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Nick Midgley
- Anna Freud National Centre for Children and Families, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chris Roberts
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Rob Senior
- Tavistock and Portman NHS Foundation Trust, London, UK
| | - Mary Target
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Barry Widmer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paul Wilkinson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Tyrer P, Milošeska K, Whittington C, Ranger M, Khaleel I, Crawford M, North B, Barrett B. Nidotherapy in the treatment of substance misuse, psychosis and personality disorder: secondary analysis of a controlled trial. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.110.029983] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo examine the clinical outcome and bed usage in patients with comorbid substance misuse and psychosis. The patients were randomised to ordinary assertive outreach team care or to enhanced assertive outreach with nidotherapy. Ratings of clinical symptoms, social function, engagement with services, bed usage (primary outcome after 1 year) and economic costs were assessed at baseline and at 6 and 12 months after randomisation.ResultsPatients referred to nidotherapy had similar reduction in symptoms and engagement, with marginal superiority in social function (P= 0.045). There was a 110% reduction in hospital bed use after 1 year compared with control assertive care (P= 0.03). The mean cost savings for each patient allocated to nidotherapy was £14705 per year, mainly as a consequence of reduced psychiatric bed use.Clinical implicationsNidotherapy shows promise in the treatment of substance misuse and psychosis and may reduce hospital bed usage.
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Barrett B, Bulat T, Schultz S, Luther S. MORTALITY AND ASSOCIATED RISK FACTORS IN COMMUNITY-DWELLING PERSONS WITH EARLY DEMENTIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B. Barrett
- HSR&D Center of Innovation on Disability and Rehabilitation Research, Department of Veterans Affairs, Tampa, Florida,
- Patient Safety Center of Inquiry, Department of Veterans Affairs, Tampa, Florida
| | - T. Bulat
- HSR&D Center of Innovation on Disability and Rehabilitation Research, Department of Veterans Affairs, Tampa, Florida,
- Patient Safety Center of Inquiry, Department of Veterans Affairs, Tampa, Florida
| | - S.K. Schultz
- HSR&D Center of Innovation on Disability and Rehabilitation Research, Department of Veterans Affairs, Tampa, Florida,
| | - S. Luther
- HSR&D Center of Innovation on Disability and Rehabilitation Research, Department of Veterans Affairs, Tampa, Florida,
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Tyrer P, Tyrer H, Morriss R, Crawford M, Cooper S, Yang M, Guo B, Mulder RT, Kemp S, Barrett B. Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: a multicentre, randomised controlled trial. Open Heart 2017; 4:e000582. [PMID: 28674627 PMCID: PMC5471860 DOI: 10.1136/openhrt-2016-000582] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/18/2017] [Accepted: 02/07/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the cost-effectiveness of a modified form of cognitive behavioural therapy (CBT) for recurrent non-cardiac chest pain. METHODS We tested the effectiveness and cost-effectiveness of a modified form of CBT for chest pain (CBT-CP)(4-10 sessions) in patients who attended cardiology clinics or emergency medical services repeatedly. Patients were randomised using a remote web-based system to CBT-CP or to standard care in the clinic. Assessments were made at baseline and at 6 months and 12 months. The primary outcome was the change in the Health Anxiety Inventory Score at 6 months. Other clinical measures, social functioning, quality of life and costs of services were also recorded. RESULTS Sixty-eight patients were randomised with low attrition rates at 6 months and 12 months with 81% of all possible assessments completed at 6 months and 12 months. Although there were no significant group differences between any of the outcome measures at either 6 months or 12 months, patients receiving CBT-CP had between two and three times fewer hospital bed days, outpatient appointments, and A&E attendances than those allocated to standard care and total costs per patient were £1496.49 lower, though the differences in costs were not significant. There was a small non-significant gain in quality adjusted life years in those allocated to CBT-CP compared with standard care (0.76 vs 0.74). CONCLUSIONS It is concluded that CBT-CP in the context of current hospital structures is not a viable treatment, but is worthy of further research as a potentially cost-effective treatment for non-cardiac chest pain. TRIAL REGISTRATION NUMBER ISRCTN 14711101.
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Affiliation(s)
- Peter Tyrer
- Centre of Psychiatry, Imperial College London, London, UK
| | - Helen Tyrer
- Centre of Psychiatry, Imperial College London, London, UK
| | - Richard Morriss
- Department of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Sylvia Cooper
- Centre of Psychiatry, Imperial College London, London, UK
| | - Min Yang
- School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Boliang Guo
- Department of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Samuel Kemp
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Heslin M, Callaghan L, Barrett B, Lea S, Eick S, Morgan J, Bolt M, Thornicroft G, Rose D, Healey A, Patel A. Costs of the police service and mental healthcare pathways experienced by individuals with enduring mental health needs. Br J Psychiatry 2017; 210:157-164. [PMID: 26989094 PMCID: PMC5288083 DOI: 10.1192/bjp.bp.114.159129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 04/15/2015] [Accepted: 07/24/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Substantial policy, communication and operational gaps exist between mental health services and the police for individuals with enduring mental health needs. AIMS To map and cost pathways through mental health and police services, and to model the cost impact of implementing key policy recommendations. METHOD Within a case-linkage study, we estimated 1-year individual-level healthcare and policing costs. Using decision modelling, we then estimated the potential impact on costs of three recommended service enhancements: street triage, Mental Health Act assessments for all Section 136 detainees and outreach custody link workers. RESULTS Under current care, average 1-year mental health and police costs were £10 812 and £4552 per individual respectively (n = 55). The cost per police incident was £522. Models suggested that each service enhancement would alter per incident costs by between -8% and +6%. CONCLUSIONS Recommended enhancements to care pathways only marginally increase individual-level costs.
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Affiliation(s)
- Margaret Heslin
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lynne Callaghan
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Barbara Barrett
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Susan Lea
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Susan Eick
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - John Morgan
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mark Bolt
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Graham Thornicroft
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Diana Rose
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrew Healey
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anita Patel
- Margaret Heslin, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Lynne Callaghan, PhD, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth; Barbara Barrett, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Susan Lea, PhD, Department of Psychology, Social Work & Counselling, University of Greenwich, London; Susan Eick, BSc, Faculty of Health and Human Sciences, Plymouth University, Plymouth; John Morgan, DipClinPsychol, Centre for Mental Health and Justice, Cornwall Partnership NHS Foundation Trust, Bodmin; Mark Bolt, PGCE, Devon & Cornwall Constabulary, Camborne, Cornwall; Graham Thornicroft, PhD, Diana Rose, PhD, Andrew Healey, PhD, Anita Patel, PhD, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial. Lancet Psychiatry 2017; 4:109-119. [PMID: 27914903 PMCID: PMC5285447 DOI: 10.1016/s2215-0366(16)30378-9] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Psychological treatments for adolescents with unipolar major depressive disorder are associated with diagnostic remission within 28 weeks in 65-70% of patients. We aimed to assess the medium-term effects and costs of psychological therapies on maintenance of reduced depression symptoms 12 months after treatment. METHODS We did this multicentre, pragmatic, observer-blind, randomised controlled superiority trial (IMPACT) at 15 National Health Service child and adolescent mental health service (CAMHS) clinics in three regions in England. Adolescent patients (aged 11-17 years) with a diagnosis of DSM IV major depressive disorder were randomly assigned (1:1:1), via a web-based randomisation service, to receive cognitive behavioural therapy (CBT) or short-term psychoanalytical therapy versus a reference brief psychological intervention. Randomisation was stochastically minimised by age, sex, self-reported depression sum score, and region. Patients and clinicians were aware of group allocation, but allocation was concealed from outcome assessors. Patients were followed up and reassessed at weeks 6, 12, 36, 52, and 86 post-randomisation. The primary outcome was self-reported depression symptoms at weeks 36, 52, and 86, as measured with the self-reported Mood and Feelings Questionnaire (MFQ). Because our aim was to compare the two psychological therapies with the brief psychosocial intervention, we first established whether CBT was inferior to short-term psychoanalytical psychotherapy for the same outcome. Primary analysis was by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN83033550. FINDINGS Between June 29, 2010, and Jan 17, 2013, we randomly assigned 470 patients to receive the brief psychosocial intervention (n=158), CBT (n=155), or short-term psychoanalytical therapy (n=157); 465 patients comprised the intention-to-treat population. 392 (84%) patients had available data for primary analysis by the end of follow-up. Treatment fidelity and differentiation were established between the three interventions. The median number of treatment sessions differed significantly between patients in the brief psychosocial intervention group (n=6 [IQR 4-11]), CBT group (n=9 [5-14]), and short-term psychoanalytical therapy group (n=11 [5-23]; p<0·0001), but there was no difference between groups in the average duration of treatment (27·5 [SD 21·5], 24·9 [17·7], 27·9 [16·8] weeks, respectively; Kruskal-Wallis p=0·238). Self-reported depression symptoms did not differ significantly between patients given CBT and those given short-term psychoanalytical therapy at weeks 36 (treatment effect 0·179, 95% CI -3·731 to 4·088; p=0·929), 52 (0·307, -3·161 to 3·774; p=0·862), or 86 (0·578, -2·948 to 4·104; p=0·748). These two psychological treatments had no superiority effect compared with brief psychosocial intervention at weeks 36 (treatment effect -3·234, 95% CI -6·611 to 0·143; p=0·061), 52 (-2·806, -5·790 to 0·177; p=0·065), or 86 (-1·898, -4·922 to 1·126; p=0·219). Physical adverse events (self-reported breathing problems, sleep disturbances, drowsiness or tiredness, nausea, sweating, and being restless or overactive) did not differ between the groups. Total costs of the trial interventions did not differ significantly between treatment groups. INTERPRETATION We found no evidence for the superiority of CBT or short-term psychoanalytical therapy compared with a brief psychosocial intervention in maintenance of reduced depression symptoms 12 months after treatment. Short-term psychoanalytical therapy was as effective as CBT and, together with brief psychosocial intervention, offers additional patient choice for psychological therapy, alongside CBT, for adolescents with moderate to severe depression who are attending routine specialist CAMHS clinics. FUNDING National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and the Department of Health.
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Robinson P, Hellier J, Barrett B, Barzdaitiene D, Bateman A, Bogaardt A, Clare A, Somers N, O'Callaghan A, Goldsmith K, Kern N, Schmidt U, Morando S, Ouellet-Courtois C, Roberts A, Skårderud F, Fonagy P. The NOURISHED randomised controlled trial comparing mentalisation-based treatment for eating disorders (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of borderline personality disorder. Trials 2016; 17:549. [PMID: 27855714 PMCID: PMC5114835 DOI: 10.1186/s13063-016-1606-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/14/2016] [Indexed: 02/03/2023] Open
Abstract
Background In this multi-centre randomized controlled trial (RCT) we compared modified mentalisation-based treatment (MBT-ED) to specialist supportive clinical management (SSCM-ED) in patients with eating disorders (EDs) and borderline personality disorder symptoms (BPD). This group of patients presents complex challenges to clinical services, and a treatment which addresses their multiple problems has the potential to improve outcome. MBT has been shown to be effective in improving outcome in patients with BPD, but its use has not been reported in ED. Methods Sixty-eight eligible participants were randomised to MBT-ED or SSCM-ED. The primary outcome measure was the global score on the Eating Disorder Examination. Secondary outcomes included measures of BPD symptoms (the Zanarini Rating Scale for Borderline Personality Disorder), general psychiatric state, quality of life and service utilisation. Participants were assessed at baseline and at 6, 12 and 18 months after randomisation. Analysis was performed using linear mixed models. Results Only 15 participants (22 %) completed the 18 month follow-up. Early drop-out occurred significantly more in the SSCM-ED group. Drop-out did not vary with treatment model later in therapy and was sometimes attributed to participants moving away. There was higher drop--out amongst smokers and those with higher neuroticism scores. 47.1 % of participants in the MBT-ED arm and 37.1 % in the SSCM-ED arm attended at least 50 % of therapy sessions offered. Amongst those remaining in the trial, at 12 and 18 months MBT-ED was associated with a greater reduction in Shape Concern and Weight Concern in the Eating Disorder Examination compared to SSCM-ED. At 6, 12 and 18 months there was a decline of ED and BPD symptoms in both groups combined. Ten participants were reported as having had adverse events during the trial, mostly self-harm, and there was one death, attributed as ’unexplained’ by the coroner. Conclusions The high drop-out rate made interpretation of the results difficult. Greater involvement of research staff in clinical management might have improved compliance with both therapy and research assessment. MBT-ED may have had an impact on core body image psychopathology. Trial registration Current Controlled Trials: ISRCTN51304415. Registered on 19 April 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1606-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul Robinson
- University College London, London, UK. .,Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK.
| | | | | | | | | | - Alexandra Bogaardt
- Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK
| | - Ajay Clare
- Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK
| | - Nadia Somers
- Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK
| | - Aine O'Callaghan
- Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK
| | | | - Nikola Kern
- South London and the Maudsley NHS Trust, London, UK
| | | | - Sara Morando
- Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK
| | | | | | | | - Peter Fonagy
- University College London, London, UK.,Anna Freud Centre, London, UK
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Sanatinia R, Wang D, Tyrer P, Tyrer H, Crawford M, Cooper S, Loebenberg G, Barrett B. Impact of personality status on the outcomes and cost of cognitive-behavioural therapy for health anxiety. Br J Psychiatry 2016; 209:244-50. [PMID: 27445356 PMCID: PMC5007454 DOI: 10.1192/bjp.bp.115.173526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/08/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Health anxiety, hypochondriasis and personality disturbance commonly coexist. The impact of personality status was assessed in a secondary analysis of a randomised controlled trial (RCT). AIMS To test the impact of personality status using ICD-11 criteria on the clinical and cost outcomes of treatment with cognitive-behavioural therapy for health anxiety (CBT-HA) and standard care over 2 years. METHOD Personality dysfunction was assessed at baseline in 444 patients before randomisation and independent assessment of costs and outcomes made on four occasions over 2 years. RESULTS In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no treatment differences (P = 0.90) and worse social function with CBT-HA compared with standard care (P<0.03) whereas all other personality groups showed greater improvement with CBT-HA maintained over 2 years (P<0.001). Less benefit was shown in those with more severe personality disorder (P<0.05). Costs were less with CBT-HA except for non-significant greater differences in those with moderate or severe personality disorder. CONCLUSIONS The results contradict the hypothesis that personality disorder impairs response to CBT in health anxiety in both the short and medium term.
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Affiliation(s)
| | | | - Peter Tyrer
- Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK
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Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC, Barrett B, Farrand PA, Gilbody S, Kuyken W, O'Mahen H, Watkins ER, Wright KA, Hollon SD, Reed N, Rhodes S, Fletcher E, Finning K. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet 2016; 388:871-80. [PMID: 27461440 PMCID: PMC5007415 DOI: 10.1016/s0140-6736(16)31140-0] [Citation(s) in RCA: 301] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Depression is a common, debilitating, and costly disorder. Many patients request psychological therapy, but the best-evidenced therapy-cognitive behavioural therapy (CBT)-is complex and costly. A simpler therapy-behavioural activation (BA)-might be as effective and cheaper than is CBT. We aimed to establish the clinical efficacy and cost-effectiveness of BA compared with CBT for adults with depression. METHODS In this randomised, controlled, non-inferiority trial, we recruited adults aged 18 years or older meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for major depressive disorder from primary care and psychological therapy services in Devon, Durham, and Leeds (UK). We excluded people who were receiving psychological therapy, were alcohol or drug dependent, were acutely suicidal or had attempted suicide in the previous 2 months, or were cognitively impaired, or who had bipolar disorder or psychosis or psychotic symptoms. We randomly assigned participants (1:1) remotely using computer-generated allocation (minimisation used; stratified by depression severity [Patient Health Questionnaire 9 (PHQ-9) score of <19 vs ≥19], antidepressant use, and recruitment site) to BA from junior mental health workers or CBT from psychological therapists. Randomisation done at the Peninsula Clinical Trials Unit was concealed from investigators. Treatment was given open label, but outcome assessors were masked. The primary outcome was depression symptoms according to the PHQ-9 at 12 months. We analysed all those who were randomly allocated and had complete data (modified intention to treat [mITT]) and also all those who were randomly allocated, had complete data, and received at least eight treatment sessions (per protocol [PP]). We analysed safety in the mITT population. The non-inferiority margin was 1·9 PHQ-9 points. This trial is registered with the ISCRTN registry, number ISRCTN27473954. FINDINGS Between Sept 26, 2012, and April 3, 2014, we randomly allocated 221 (50%) participants to BA and 219 (50%) to CBT. 175 (79%) participants were assessable for the primary outcome in the mITT population in the BA group compared with 189 (86%) in the CBT group, whereas 135 (61%) were assessable in the PP population in the BA group compared with 151 (69%) in the CBT group. BA was non-inferior to CBT (mITT: CBT 8·4 PHQ-9 points [SD 7·5], BA 8·4 PHQ-9 points [7·0], mean difference 0·1 PHQ-9 points [95% CI -1·3 to 1·5], p=0·89; PP: CBT 7·9 PHQ-9 points [7·3]; BA 7·8 [6·5], mean difference 0·0 PHQ-9 points [-1·5 to 1·6], p=0·99). Two (1%) non-trial-related deaths (one [1%] multidrug toxicity in the BA group and one [1%] cancer in the CBT group) and 15 depression-related, but not treatment-related, serious adverse events (three in the BA group and 12 in the CBT group) occurred in three [2%] participants in the BA group (two [1%] patients who overdosed and one [1%] who self-harmed) and eight (4%) participants in the CBT group (seven [4%] who overdosed and one [1%] who self-harmed). INTERPRETATION We found that BA, a simpler psychological treatment than CBT, can be delivered by junior mental health workers with less intensive and costly training, with no lesser effect than CBT. Effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals. FUNDING National Institute for Health Research.
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Affiliation(s)
| | - David Ekers
- Psychological Therapy Department, Tees, Esk and Wear Valleys NHS Foundation Trust, Chester-le-Street, County Durham, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Rod S Taylor
- Medical School, University of Exeter, Exeter, UK
| | - Sarah Byford
- Institute of Psychiatry, Kings College London, London, UK
| | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, The Prince of Wales International Centre, Warneford Hospital, Oxford, UK
| | | | - Ed R Watkins
- School of Psychology, University of Exeter, Exeter, UK
| | - Kim A Wright
- School of Psychology, University of Exeter, Exeter, UK
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Nigel Reed
- Lived Experience Group, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
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Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, Lewis G, Watkins E, Morant N, Taylor RS, Byford S. The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomised controlled trial (the PREVENT study). Health Technol Assess 2016; 19:1-124. [PMID: 26379122 DOI: 10.3310/hta19730] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial. OBJECTIVES To establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT's acceptability and mechanism of action. DESIGN Single-blind, parallel, individual randomised controlled trial. SETTING UK general practices. PARTICIPANTS Adult patients with a diagnosis of recurrent depression and who were taking m-ADM. INTERVENTIONS Participants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT's acceptability and mechanism of action. MAIN OUTCOMES MEASURES The primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities. RESULTS In total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation. CONCLUSIONS There is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group. TRIAL REGISTRATION Current Controlled Trials ISRCTN26666654. FUNDING This project was funded by the NIHR Health Technology Assessment programme and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula and will be published in full in Health Technology Assessment; Vol. 19, No. 73. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Rachel Hayes
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Barbara Barrett
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
| | - Richard Byng
- Primary Care Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | | | - Nicola Morant
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Rod S Taylor
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Sarah Byford
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
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Goel N, Barrett B, Duncan A, Gallagher MB, Mackey M. FRI0346 Evaluating Differences in The Enrolled Populations of Randomized Clinical Trials of Systemic Lupus Erythematosus. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Winkler P, Barrett B, McCrone P, Csémy L, Janous̆ková M, Höschl C. Deinstitutionalised patients, homelessness and imprisonment: systematic review. Br J Psychiatry 2016; 208:421-8. [PMID: 27143007 DOI: 10.1192/bjp.bp.114.161943] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 10/12/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Reports linking the deinstitutionalisation of psychiatric care with homelessness and imprisonment have been published widely. AIMS To identify cohort studies that followed up or traced back long-term psychiatric hospital residents who had been discharged as a consequence of deinstitutionalisation. METHOD A broad search strategy was used and 9435 titles and abstracts were screened, 416 full articles reviewed and 171 articles from cohort studies of deinstitutionalised patients were examined in detail. RESULTS Twenty-three studies of unique populations assessed homelessness and imprisonment among patients discharged from long-term care. Homelessness and imprisonment occurred sporadically; in the majority of studies no single case of homelessness or imprisonment was reported. CONCLUSIONS Our results contradict the findings of ecological studies which indicated a strong correlation between the decreasing number of psychiatric beds and an increasing number of people with mental health problems who were homeless or in prison.
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Affiliation(s)
- Petr Winkler
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Barbara Barrett
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Paul McCrone
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Ladislav Csémy
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Miroslava Janous̆ková
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Cyril Höschl
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
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Byford S, Cary M, Barrett B, Aldred CR, Charman T, Howlin P, Hudry K, Leadbitter K, Le Couteur A, McConachie H, Pickles A, Slonims V, Temple KJ, Green J. Cost-effectiveness analysis of a communication-focused therapy for pre-school children with autism: results from a randomised controlled trial. BMC Psychiatry 2015; 15:316. [PMID: 26691535 PMCID: PMC4685630 DOI: 10.1186/s12888-015-0700-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/14/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Autism is associated with impairments that have life-time consequences for diagnosed individuals and a substantial impact on families. There is growing interest in early interventions for children with autism, yet despite the substantial economic burden, there is little evidence of the cost-effectiveness of such interventions with which to support resource allocation decisions. This study reports an economic evaluation of a parent-mediated, communication-focused therapy carried out within the Pre-School Autism Communication Trial (PACT). METHODS 152 pre-school children with autism were randomly assigned to treatment as usual (TAU) or PACT + TAU. Primary outcome was severity of autism symptoms at 13-month follow-up. Economic data included health, education and social services, childcare, parental productivity losses and informal care. RESULTS Clinically meaningful symptom improvement was evident for 53 % of PACT + TAU versus 41 % of TAU (odds ratio 1.91, p = 0.074). Service costs were significantly higher for PACT + TAU (mean difference £4,489, p < 0.001), but the difference in societal costs was smaller and non-significant (mean difference £1,385, p = 0.788) due to lower informal care rates for PACT + TAU. CONCLUSIONS Improvements in outcome generated by PACT come at a cost. Although this cost is lower when burden on parents is included, the cost and effectiveness results presented do not support the cost-effectiveness of PACT + TAU compared to TAU alone. TRIAL REGISTRATION Current Controlled Trials ISRCTN58133827.
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Affiliation(s)
- Sarah Byford
- King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Maria Cary
- King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Barbara Barrett
- King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | | | - Tony Charman
- Department of Psychology, Box P077, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Patricia Howlin
- Department of Psychology, Box P077, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Kathy Leadbitter
- Institute for Brain, Behaviour and Mental Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Andrew Pickles
- Biostatistics, Box P020, King`s College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Vicky Slonims
- Evelina Children`s Hospital, King`s College London, London, SE1 7EH, UK.
| | - Kathryn J. Temple
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Jonathan Green
- Manchester Academic Health Sciences Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
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Abstract
BACKGROUND Traditionally, classical test theory (CTT) has been used for instrument development and various methods have since been proposed for reducing outcome measures to shorter versions. These reduction methods have not previously been compared in mental or physical health. AIM To identify and compare the various methods used to develop brief versions of outcome measures from existing measures in mental health. METHOD A systematic review of the literature in Embase, Medline, PsychInfo and from a grey literature was done. Search strategies were developed in each database to identify all relevant literature based on the inclusion criteria. Each paper identified was briefly described and then assessed using a bespoke assessment checklist developed by the authors. Methods for reducing outcome measures found across all studies were compared. RESULTS Ten papers were identified. Five methods were used for scale reduction: Rasch analysis (RA), exploratory factor analysis (EFA), graded response models (GRMs), all-subset regression, and regression. RA was the most widely used process. CONCLUSION The Rasch model (RM) is the only model where "'specific objectivity"' is a defining property of the model. This property is necessary for constructing scales in line with the fundamental principles of measurement.
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Affiliation(s)
- Wayne Smith
- a Institute of Psychiatry , Centre for the Economics of Mental and Physical Health, King's College London , London , UK and
| | - Anita Patel
- a Institute of Psychiatry , Centre for the Economics of Mental and Physical Health, King's College London , London , UK and.,b Barts and The London School of Medicine and Dentistry , Centre for Primary Care and Public Health, Queen Mary University of London , London , UK
| | - Paul McCrone
- a Institute of Psychiatry , Centre for the Economics of Mental and Physical Health, King's College London , London , UK and
| | - Huajie Jin
- a Institute of Psychiatry , Centre for the Economics of Mental and Physical Health, King's College London , London , UK and
| | - Beatrice Osumili
- a Institute of Psychiatry , Centre for the Economics of Mental and Physical Health, King's College London , London , UK and
| | - Barbara Barrett
- a Institute of Psychiatry , Centre for the Economics of Mental and Physical Health, King's College London , London , UK and
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48
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Tyrer P, Tyrer H, Cooper S, Barrett B, Kings S, Lazarevic V, Bransby-Adams K, Whittamore K, Walker G, McNulty A, Donaldson E, Midgley L, McCoy S, Evered R, Yang M, Guo B, Lisseman-Stones Y, Doukani A, Mulder R, Morriss R, Crawford M. Cognitive behaviour therapy for non-cardiac pain in the chest (COPIC): a multicentre randomized controlled trial with economic evaluation. BMC Psychol 2015; 3:41. [PMID: 26596540 PMCID: PMC4657319 DOI: 10.1186/s40359-015-0099-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Most patients with chest pain have nothing wrong with their cardiac function. Psychological forms of treatment for this condition are more likely to be successful than others. Methods/design A two-arm parallel controlled randomized trial of standard care versus a modified form of cognitive behaviour therapy for chest pain (CBT-CP) in patients who have attended emergency hospital services. Inclusion criteria include (i) emergency attendance more than once in the previous year with chest pain when no physical pathology has been found, (ii) aged between 16 and 75, (iii) signed consent to take part in the study. Exclusion criteria are (i) under current psychiatric care, (ii) those who have had new psychotropic drugs prescribed within the last two months, (iii) are receiving or about to receive a formal psychological treatment. Those satisfying these criteria will be randomized to 4–10 sessions of CBT-CP or to continue with standard care. Participants are randomized using a remote web-based system using permuted stacked blocks stratified by study centre. Assessment is carried out at baseline by researchers subsequently masked to allocation and at 6 months and 1 year after randomization. The primary outcome is the Health Anxiety Inventory score at 6 months, and secondary outcomes are generalised anxiety and depressive symptoms, the Lucock Health Anxiety Questionnaire adapted for chest pain, visual analogue scales for chest pain and discomfort (Inskip Scale), the Schedule for Evaluating Persistent Symptoms (SEPS), health related quality of life, social functioning and medical resource usage. Intention to treat analyses will be carried out with clinical and functioning data, and a cost-utility analysis will compare differences in total costs and differences in quality of life using QALYs derived from the EQ-5D. The data will also be linked to another parallel study in New Zealand where 126 patients with the same inclusion criteria have been treated in a similar trial; the form of analysis of the combined data has yet to be determined. Discussion The morbidity and costs of non-cardiac chest pain are substantial and if a simple psychological treatment given by health professionals working in medical departments is beneficial it should prove to be of great value. Combining data with a similar study in New Zealand is an additional asset. Trial registration ISRCTN14711101 (registered 05/03/2015)
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Affiliation(s)
- Peter Tyrer
- Centre for Mental Health, Imperial College, Claybrook Road, London, W6 8LN, UK. .,Centre for Mental Health, Imperial College, 7th Floor, Commonwealth Building, Hammersmith Hospital, London, W12 0NN, UK.
| | - Helen Tyrer
- Centre for Mental Health, Imperial College, Claybrook Road, London, W6 8LN, UK.
| | - Sylvia Cooper
- Centre for Mental Health, Imperial College, Claybrook Road, London, W6 8LN, UK.
| | - Barbara Barrett
- King's Health Economics, King's College, London, De Crespigny Park, London, SE5 8AF, UK.
| | - Stephanie Kings
- East Midlands Clinical Research Network, Institute of Mental Health, Nottingham, NG7 2TU, UK.
| | - Valentina Lazarevic
- East Midlands Clinical Research Network, Institute of Mental Health, Nottingham, NG7 2TU, UK.
| | - Kate Bransby-Adams
- East Midlands Clinical Research Network, Institute of Mental Health, Nottingham, NG7 2TU, UK.
| | - Katherine Whittamore
- East Midlands Clinical Research Network, Institute of Mental Health, Nottingham, NG7 2TU, UK.
| | - Gemma Walker
- East Midlands Clinical Research Network, Institute of Mental Health, Nottingham, NG7 2TU, UK.
| | - Antoinette McNulty
- North West London Clinical Research Network, Hammersmith Hospital, London, W12 0NN, UK.
| | - Emma Donaldson
- Berkshire Healthcare NHS Foundation Trust, Skimped Hill Lane, Bracknell, Berkshire, RG12 1BQ, UK.
| | - Luke Midgley
- Berkshire Healthcare NHS Foundation Trust, Skimped Hill Lane, Bracknell, Berkshire, RG12 1BQ, UK.
| | - Shani McCoy
- Berkshire Healthcare NHS Foundation Trust, Skimped Hill Lane, Bracknell, Berkshire, RG12 1BQ, UK.
| | - Rachel Evered
- Central and North West London NHS Foundation Trust, Hampstead Road, London, NW1 7QY, UK.
| | - Min Yang
- School of Public Health, Sichuan University, Chengdu, Sichuan, China.
| | - Boliang Guo
- Faculty of Medicine & Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | | | - Asmae Doukani
- London School of Hygiene and Tropical Health, Keppel Street, London, WC1E 7HT, UK.
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Richard Morriss
- Faculty of Medicine & Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Mike Crawford
- Centre for Mental Health, Imperial College, Claybrook Road, London, W6 8LN, UK.
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Thornicroft G, Farrelly S, Szmukler G, Birchwood M, Waheed W, Flach C, Barrett B, Byford S, Henderson C, Sutherby K, Lester H, Rose D, Dunn G, Leese M, Marshall M. O-90 Randomised controlled trial of joint crisis plans to reduce compulsory treatment for people with psychosis: Clinical outcomes and implementation. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Crawford MJ, Sanatinia R, Barrett B, Byford S, Cunningham G, Gakhal K, Lawrence-Smith G, Leeson V, Lemonsky F, Lykomitrou G, Montgomery A, Morriss R, Paton C, Tan W, Tyrer P, Reilly JG. Lamotrigine versus inert placebo in the treatment of borderline personality disorder: study protocol for a randomized controlled trial and economic evaluation. Trials 2015; 16:308. [PMID: 26187496 PMCID: PMC4506596 DOI: 10.1186/s13063-015-0823-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/26/2015] [Indexed: 11/10/2022] Open
Abstract
Background People with borderline personality disorder (BPD) experience rapid and distressing changes in mood, poor social functioning and have high rates of suicidal behaviour. Several small scale studies suggest that mood stabilizers may produce short-term reductions in symptoms of BPD, but have not been large enough to fully examine clinical and cost-effectiveness. Methods/Design A two parallel-arm, placebo controlled randomized trial of usual care plus either lamotrigine or an inert placebo for people aged over 18 who are using mental health services and meet diagnostic criteria for BPD. We will exclude people with comorbid bipolar affective disorder or psychosis, those already taking a mood stabilizer, those who speak insufficient English to complete the baseline assessment and women who are pregnant or contemplating becoming pregnant. Those meeting inclusion criteria and provide written informed consent will be randomized to up to 200mg of lamotrigine per day or an inert placebo (up to 400mg if taking combined oral contraceptives).Participants will be randomized via a remote web-based system using permuted stacked blocks stratified by study centre, severity of personality disorder, and level of bipolarity. Follow-up assessments will be conducted by masked researchers 12, 24 weeks, and 52 weeks after randomization. The primary outcome is the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD). The secondary outcomes are depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment, adverse events and withdrawal of trial medication due to adverse effects. The main analyses will use intention to treat without imputation of missing data. The economic evaluation will take an NHS/Personal Social Services perspective. A cost-utility analysis will compare differences in total costs and differences in quality of life using QALYs derived from the EQ-5D. Discussion The evidence base for the use of pharmacological treatments for people with borderline personality disorder is poor. In this trial we will examine the clinical and cost-effectiveness of lamotrigine to assess what if any impact offering this has on peoples’ mental health, social functioning, and use of other medication and other resources. Trial registration Current Controlled Trials ISRCTN90916365 (registered 01/08/2012)
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Affiliation(s)
- Mike J Crawford
- Centre for Mental Health, Imperial College London, Du Cane Road, London, W12 ONN, UK.
| | - Rahil Sanatinia
- Centre for Mental Health, Imperial College London, Du Cane Road, London, W12 ONN, UK.
| | - Barbara Barrett
- King's Health Economics, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Sarah Byford
- King's Health Economics, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Gillian Cunningham
- School of Medicine, Pharmacy and Health, Durham University, Stockton Road, Durham, DH1 3LE, UK.
| | - Kavi Gakhal
- Centre for Mental Health, Imperial College London, Du Cane Road, London, W12 ONN, UK.
| | | | - Verity Leeson
- Centre for Mental Health, Imperial College London, Du Cane Road, London, W12 ONN, UK.
| | - Fenella Lemonsky
- Centre for Mental Health, Imperial College London, Du Cane Road, London, W12 ONN, UK.
| | - Georgia Lykomitrou
- Faculty of Medicine & Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Alan Montgomery
- Faculty of Medicine & Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Richard Morriss
- Faculty of Medicine & Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Carol Paton
- Oxleas NHS Foundation Trust, Pinewood Place, Dartford, DA2 7WG, UK.
| | - Wei Tan
- Faculty of Medicine & Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Peter Tyrer
- Centre for Mental Health, Imperial College London, Du Cane Road, London, W12 ONN, UK.
| | - Joseph G Reilly
- School of Medicine, Pharmacy and Health, Durham University, Stockton Road, Durham, DH1 3LE, UK.
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