(2016) The management of scabies outbreaks in residential care facilities for the elderly in England: a review of current health protection guidelines. Epidemiology and Infection, 144 (15).
Previous research has shown that psychoeducation for bipolar disorder (BD) improves symptoms and reduces relapse risk, but there is little research on how this impacts stigma, perceived recovery and views about diagnosis. The aim of this study was to explore whether a cognitive behaviour therapy (CBT)-based 12-week BD psychoeducation group conducted in a community mental health team for adults impacted perceived stigma, diagnosis-related self-esteem, recovery and views about diagnosis. The case series pre- and post-group had 23 participants across three groups. The Brief Illness Perception Questionnaire, views on Manic Depression Questionnaire, Bipolar Recovery Questionnaire and author-constructed questions were completed pre and post. Twenty participants completed the group. An intent-to-treat repeated measures multiple analysis of variance showed significantly improved perceived recovery and improvements in sense of control and understanding around their diagnosis. Other specific questions such as understanding of triggers and impact of thinking patterns also improved. However, there was no change in the perceived stigma or self-esteem associated with living with BD. CBT-based psychoeducation groups may help improve perceived recovery and factors such as sense of control in BD. However, there appears to be no impact on stigma and self-esteem, and the role of non-specific factors needs to be examined further.Key learning aims (1)To raise awareness of the impact of stigma and self-esteem in bipolar disorder.(2)To understand the content and structure of CBT-based psychoeducation groups.(3)To consider the potential benefits of CBT-based psychoeducation groups beyond symptoms and relapse reduction on factors such as perceived recovery.
Objectives. To evaluate whether demographic and clinical variables are related to disengagement rates in cognitive behavioural therapy (CBT) for psychosis in a clinical setting.Methods. The medical records and symptom severity data (from Health of the Nation Outcome Scales) were analysed retrospectively for 103 referrals for CBT for psychosis in a National Health Service secondary care and Early Intervention in Psychosis team.Results. Overall, 42.7% (n = 44) disengaged from CBT. There was no impact of gender or ethnicity, and no impact of clinical variables such as risk history and comorbid diagnosis. However, risk of disengagement was significantly higher for those who were younger, F = 6.89, partial g 2 = .064, p = <.05; those with greater total HoNOS scores, F = 4.22, partial g 2 = .04, p < .05; more severe symptoms on the HoNOS items of overactive, aggressive, disruptive, or agitated behaviour, v 2 = 6.13, p < .01; problem drinking or drug taking, v 2 = 7.65, p < .05; depressed mood, v 2 = 7.0, p < .01; and problems with occupation and activities: v 2 = 3.68, p < .05. There was a non-significant trend for shorter waiting times to be associated with greater levels of disengagement. Conclusions.These results indicate that it may not be psychosis per se that disrupts engagement in CBT, but linked behavioural and emotional factors. A more assertive approach to these factorsoveractive, aggressive, disruptive, or agitated behaviour, problem drinking or drug taking, depressed mood, and problems with occupation and activities, particularly in younger peoplemay be valuable prior to or early on in therapy as a means of increasing engagement in CBT for psychosis. Practitioner PointsRisk of disengagement from CBT for psychosis increases with overactive, aggressive, disruptive, or agitated behaviour (54.9% vs. 30.8%), problem drinking and drug taking (61.1% vs. 32.8%), depressed mood (56% vs. 30.2%), and problems with occupation and activities (53.3% vs. 34.5%), with a trend for younger age.An assertive and motivational approach to engagement and a focus on addressing low mood and problematic behaviours, prior to or early in therapy, may be warranted, particularly for younger people. This evaluation is limited by small sample size and being retrospective. These results speak to the question of whether psychosis itself renders people inappropriate for CBT for psychosis, or whether problems arise due to behavioural and emotional factors that might be addressed to increase access to CBT for psychosis. Disengagement in psychosis 441
Aim To evaluate current clinical practice, with a focus on risk assessment at time of admission, and to compare this with the risk assessment framework proposed by the Royal College of Psychiatrists. Methods All patients with an eating disorder requiring paediatric inpatient admission were identified over the period of June 2009 to February 2014. A retrospective casenote analysis was performed and data extracted using a standard proforma. Initial assessment of each patient was reviewed for documentation of BMI, weight, cardiovascular health (heart rate, syncope, significant orthostatic changes, irregular heart rate), ECG abnormalities, hydration status, temperature, biochemical abnormalities, disordered eating behaviours, engagement with management plan, activity and exercise, muscular weakness, self-harm/suicide, other mental health diagnoses as well as other potential co-existing risk factors. Results A total of 14 patients were identified with 22 admissions over the data collection period. 15 patients were admitted electively via the local CAMHS team, 4 patients via A&E and 3 patients following GP referral. No patients had a formal risk assessment performed. Assessment performed at the time of admission was highly variable. With the information available 10 patients were categorised as high risk, 11 patients were categorised as alert to high concern, and 1 admission was categorised as moderate risk. No patients were classified as low risk. Conclusion This study highlighted the fact that children with eating disorders are treated in paediatric inpatient wards as well as in specialist centres. Admissions to the paediatric wards are infrequent. Initial assessment and investigation of this patient group is highly variable and does not adhere to current guidance. Implementation of a formal risk assessment framework is required in order to identify patients at risk of complications. The development of specific admission documentation based on Royal College guidance would aid assessment and help guide inpatient management, thereby providing a more consistent approach to patient care.
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