Objective: To examine the effect of contact with a stroke family care worker on the physical, social, and psychological status of stroke patients and their carers.

Background and Purpose-Although the physical and, to a lesser extent, emotional outcome of stroke survivors has been well documented, there are far fewer data relating to the outcomes of those who care for them. We aimed to describe the outcome of those caring for stroke patients and to identify both patient and caregiver factors that are associated with poor caregiver outcomes. Methods-As part of a randomized trial to evaluate a stroke family care worker, we identified 417 patients (67% of all referrals to our institution). We followed up 376 survivors of whom 246 identified a caregiver at a 6-month follow-up interview. The patients and caregivers were asked to complete 2 measures of emotional distress ( 30-item General Health Questionnaire and Hospital Anxiety and Depression [HAD] Scale). A regression analysis was used to identify factors that were independently associated with poor caregiver outcomes. Results-Fifty-five percent of responding caregivers scored more than 4 on the GHQ-30, indicating that emotional distress is common in this group. Caregivers were more likely to be depressed if the patients were severely dependent (PϽ0.01) or emotionally distressed themselves (PϽ0.01). Female caregivers reported more anxiety (median HADϭ8) than male caregivers (median HADϭ5; PϽ0.01) but caregivers' levels of anxiety were not so clearly related to the patients' degree of physical disability as their levels of depression. Caregivers suffered more emotional distress if the patients had been dependent before their strokes. Conclusions-These data may help to identify those caregivers at greatest risk of poor emotional outcomes and thus help in the planning of trials and delivery of interventions aimed at preventing or treating distress among caregivers. (Stroke. 1998;29:1867-1872.)

The study of discrete organic cerebral lesions resulting in clearly definable psychiatric disorders may provide an understanding of the underlying pathophysiological basis of these disorders. However, the relation between lesion location and psychiatric illness after stroke remains unclear. Fifty five patients referred to hospital were identified who had a single lesion on CT which was consistent with their neurological presentation and who did not have evidence of a persistent aVective disorder at the time of the stroke. Six months after stroke standardised psychiatric assessment disclosed that 26% of the patients met DSM-IV criteria for an anxiety or depressive disorder, with depression the most common diagnosis (20%). Pathological emotionalism was diagnosed in 18% of patients, particularly those who were depressed (p<0.0001). Depression was significantly associated with larger lesions involving the right cerebral hemisphere (p=0.01). The importance of depression as a consequence of stroke has been clarified by the studies in this area. However, wide confidence intervals support the possibility that significant results may be due to chance. A systematic review of these studies is now needed if a consensus is to be reached.

These data may help identify those patients at greatest risk of poor emotional outcomes and thus help in planning trials and delivering appropriate interventions.

No previous studies regarding either structured, strictly controlled pet visitation programmes in paediatric hospital wards or hospital staff attitudes towards them have been conducted in Australia. Information regarding these is essential in order to minimize problems during implementation of such programmes. The aim of the study was to analyse hospital staff perceptions regarding the introduction of a pet visitation programme in an acute paediatric medical ward prior to and following implementation of the programme and to compare attitudes between the various professional groups. The study consisted of two cross-sectional surveys. A total of 224 anonymous questionnaires were distributed to administrators, doctors, nursing staff and therapists 6 weeks before and 195 were distributed 12 weeks after the introduction of a pet visitation programme. Responses were received from 115 respondents (before the programme introduction) and 45 respondents (after the programme introduction). Prior to the introduction of the dog visitation programme, there were high staff expectations that the programme would distract children from their illness, relax children and that it was a worthwhile project for the hospital to undertake. Following implementation of the programme these expectations were strongly endorsed, in addition to the perception that the ward was a happier place, the work environment was more interesting and that nurses accepted the dogs. After implementation staff were less concerned about the possibility of dog bites and dogs doing damage to equipment. Allied health staff and non-clinical staff were more positive about the programme with respect to ward climate and acceptance than were doctors and nurses. We conclude that well-planned dog visitation programmes result in positive anticipation among staff and high levels of satisfaction following programme impact.

Patients' attitudes toward their illness seem to be associated with survival after stroke. Patients who feel that there is nothing they can do to help themselves 6 months after a stroke have a shorter survival. These findings need to be confirmed and any causal relationship between attitude and survival further explored in a randomized controlled trial to "improve" the attitude of stroke patients toward their illness.

Method: Forty participants with TBI and 32 matched healthy participants completed a battery of tests assessing the three functions of interest. In addition, self-and proxy reports of pre-and post-injury behaviour, mood, and community integration were collected. Results:The TBI group performed significantly poorer than the comparison group on all tasks of emotion recognition, understanding intention and on one task of response selection. Ratings of current behaviour suggested significant changes in the TBI group relative to before the injury and showed significantly poorer community integration and interpersonal behaviour than the comparison group. Of the three functions considered, emotion recognition was associated with both post-injury behaviour and community integration and this association could not be fully explained by injury severity, time since injury or education. Conclusions:The current study confirmed earlier findings of associations between emotion recognition and post-TBI behaviour, providing partial evidence for models proposing emotion recognition as one of the pre-requisites for adequate social functioning.. May. Social behaviour and social cognition impairments 3

P 2018, 'The paranoia as defence model of persecutory delusions: A systematic review and meta-analysis ', Lancet Psychiatry, vol. 5,no. 11,. https://doi. AbstractBackground An influential psychological model of persecutory delusions proposed they are caused by a bias towards holding others responsible for negative events, which serves to prevent underlying low self-esteem from reaching awareness. An early (1994) version of the model predicted self-esteem would therefore be preserved in people with these delusions, whereas a later (2001) version suggested it would be unstable, and that there would be a discrepancy between their explicit and implicit self-esteem, with the latter being lower. Our aim was to perform the first comprehensive meta-analytical test of the key predictions of this model, taking into account evidence quality. MethodsReports identified in previous systematic reviews were collated. Electronic databases (i.e., PsycINFO, MEDLINE, EMBASE and Web of Science) were searched from 2012 to September 2016. The review was pre-registered (PROSPERO registration number: CRD42016032782). Cross-sectional data from case-control, longitudinal or experimental studies that examined self-esteem or the externalising attributional bias in individuals diagnosed with schizophrenia-spectrum disorder were eligible for meta-analyses of group differences, but only if at least 50% of participants with psychosis also had current persecutory delusions. Uncontrolled and longitudinal studies were included in meta-analyses of correlations and self-esteem instability, respectively. Study and outcome quality were assessed using the Agency for Healthcare Research and Quality (AHRQ) assessment tool, and a modified version of Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectively. ResultsWe screened 3053 records, examined 104 full-text reports, and included 64 eligible studies. Consistent with the predictions of both versions of the model, paranoia severity in psychosis was positively correlated with the degree of externalising attributional bias (k=21, N=1128, r=0.18, 95% CI 0.08, 0.27; moderate quality). People with persecutory delusions also had a greater externalising attributional bias compared to non-clinical (k=27, N=1442, g=0.48, 95% CI 0.23, 0.73; moderate quality) and depressed individuals (k=10, N=421, g=1.06, 95% CI 0.48, 1.63; moderate quality), and those with psychosis without persecutory delusions (k=11; N=480; g=0.40, 95% CI 0.12, 0.68; moderate quality). Contrary to the 1994 version's predictions, paranoia severity in psychosis was negatively correlated with explicit self-esteem (k=23, N=1866, r=-0.26, 95% CI -0.34, -0.17; high quality). People with persecutory delusions also had lower explicit self-esteem than non-clinical individuals (k=22, N=1256, g=-0.88, 95% CI -1.10, -0.66; high quality) and similarly low explicit self-esteem to people with psychosis without persecutory delusions (k=11; N=644, g=-0.26; 95% CI -0.54, 0.02; moderate quality). Consistent with the 2001 version's pr...