Objectives Improving Access to Psychological Therapies (IAPT) is a national‐level dissemination programme for provision of evidence‐based psychological treatments for anxiety and depression in the United Kingdom. This paper sought to review and meta‐analyse practice‐based evidence arising from the programme. Design A pre‐registered (CRD42018114796) systematic review and meta‐analysis. Methods A random effects meta‐analysis was performed only on the practice‐based IAPT studies (i.e. excluding the clinical trials). Subgroup analyses examined the potential influence of particular methodologies, treatments, populations, and target conditions. Sensitivity analyses investigated potential sources of heterogeneity and bias. Results The systematic review identified N = 60 studies, with N = 47 studies suitable for meta‐analysis. The primary meta‐analysis showed large pre‐post treatment effect sizes for depression (d = 0.87, 95% CI [0.78–0.96], p < .0001) and anxiety (d = 0.88, 95% CI [0.79–0.97], p < .0001), and a moderate effect on functional impairment (d = 0.55, 95% CI [0.48–0.61], p < .0001). The methodological features of studies influenced ESs (e.g., such as whether intention‐to‐treat or completer analyses were employed). Conclusions Current evidence suggests that IAPT enables access to broadly effective evidence‐based psychological therapies for large numbers of patients. The limitations of the review and the clinical and methodological implications are discussed. Practitioner points IAPT interventions are associated with large pre‐post treatment effect sizes in depression and anxiety measures. IAPT interventions are associated with moderate treatment effect sizes with regards to work and social adjustment. A reduction in dropout and also the prevention of post‐treatment relapse via the offer of follow‐up support are important areas for future development.

YesObjective\ud \ud This study explores whether the profile of patients’ interactional behaviour in memory clinic conversations with a doctor can contribute to the clinical differentiation between functional memory disorders (FMD) and memory problems related to neurodegenerative diseases.\ud \ud Methods\ud \ud Conversation Analysis of video recordings of neurologists’ interactions with patients attending a specialist memory clinic. “Gold standard” diagnoses were made independently of CA findings by a multi-disciplinary team based on clinical assessment, neuropsychological testing and brain imaging.\ud \ud Results\ud \ud Two discrete conversational profiles for patients with memory complaints emerged, including (i) who attends the clinic (i.e., whether or not patients are accompanied), and (ii) patients’ responses to neurologists’ questions about memory problems, such as difficulties with compound questions and providing specific and elaborated examples and frequent “I don’t know” responses.\ud \ud Conclusion\ud \ud Specific communicative difficulties are characteristic of the interaction patterns of patients with a neurodegenerative pathology. Those difficulties are manifest in memory clinic interactions with neurologists, thereby helping to differentiate patients with dementia from those with FMD.\ud \ud Practical implications\ud \ud Our findings demonstrate that conversational profiles based on patients’ contributions to memory clinic encounters have diagnostic potential to assist the screening and referral process from primary care, and the diagnostic service in secondary care

Objectives: In the UK dementia is under-diagnosed and there is national variation in memory clinic service provision. At present the clinical differentiation between dementia and functional (nonprogressive) memory complaints is complex and involves extensive neuropsychological testing. Government initiatives on 'timely diagnosis' aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve methods of diagnostic screening by analysing communication between clinicians and patients during diagnostic assessment and establishing conversational profiles from which clinicians can establish differential diagnoses.Method: The data corpus consists of video-and audio recording of 105 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used explore recurrent communicative practices within these data.Results: Two discrete conversational profiles began to emerge to help differentiate between patients with dementia and functional memory complaints based on, 1) whether the patient is able to answer questions about personal information; 2) whether they can display working memory in interaction; 3) whether they are able to respond to compound questions; 4) the time taken to respond to questions; and 5) the level of detail they offer when providing an account of their memory failure experiences.Conclusion: Conversational profiles can differentiate patients with dementia from those with functional memory complaints. Conversational profiling has potential clinical application; using conversation as a method of diagnostic screening and assessment could hold differential diagnostic value.

The accurate distinction of premorbid dementia syndromes from benign non-progressive memory problems. Studies of treatment options for people with benign non-progressive memory problems and longer-term follow-up to determine which patients develop chronic problems.

This study indicates that interactional and linguistic features can help distinguish between patients developing dementia and those with FMD and could aid the stratification of patients with memory problems.