What do parents and carers think about routine outcome measures and their use? A focus group study of CAMHS attenders

Currently service user involvement in routine outcomes monitoring has been minimal, particularly in Children's services. There needs to be a more sustained effort to involve service users because of the valuable information that they could provide for service development and improvement. Focus groups were conducted with service users, including parents, carers and young people from a London CAMHS. Their views were elicited on routine outcomes monitoring in general, three specific approaches and suggestions about what else might be important to capture when measuring outcomes. The focus groups raised a number of issues pertinent to routine outcomes monitoring in general, including the reliability of answers, the need for the measures to reflect more than just a tick-box approach and that different people will have different perspectives. Analysis also focused on feedback about the three specific measures discussed. It is important that service users are involved in the process of outcome measurement, from the development of measures, to their application in therapeutic encounters and in service development. Outcome monitoring needs to become a more collaborative process in order that services are measuring what service users think is important, as most would agree that a service should deliver the outcomes that its users want to see.     

Clients’ experiences of treatment and recovery in borderline personality disorder: A meta-synthesis of qualitative studies

Objective: This review synthesized findings from qualitative studies exploring clients’ experiences of their treatment for borderline personality disorder (BPD) and their perceptions of recovery. Method: Fourteen studies were identified through searches in three electronic databases. The Critical Appraisal Skills Programme was used to appraise the methodological quality of the studies. Thematic analysis was used to synthesize the findings. Results: The meta-synthesis identified 10 themes, grouped into 3 domains. The first domain, “Areas of change,” suggests that clients make changes in four main areas: developing self-acceptance and self-confidence; controlling difficult thoughts and emotions; practising new ways of relating to others; and implementing practical changes and developing hope. The second domain, “Helpful and unhelpful treatment characteristics,” highlights treatment elements that either supported or hindered recovery: safety and containment; being cared for and respected; not being an equal partner in treatment; and focusing on change. The third domain, “The nature of change,” refers to clients’ experience of change as an open-ended journey and a series of achievements and setbacks. Conclusions: The meta-synthesis highlights areas of change experienced by individuals receiving treatment for BPD, and treatment characteristics that they value. However, further research is needed to better understand how these changes are achieved.     

How do art therapists act in relation to people who experience borderline personality disorder? A review of the literature

Abstract

The difficulties described by the term borderline personality disorder represent a significant clinical population. The British Association of Art Therapists has prioritised the use of research to improve the effectiveness of art therapy. Defining therapist action in relation to the condition treated is an important part of theory building for such research, but this preparatory stage has arguably been underestimated in many art therapy outcome studies. The present study therefore used a literature review to ask how art therapists act in relation to borderline personality disorder. An international search between 1980 and 2014 revealed 17 relevant studies. Data relevant to the research question were extracted from each paper, grouped thematically and developed into nine propositions that linked therapist action with the condition-specific difficulty they claimed to address. This identified a practice concerned with the process rather than the content of thought. Avoiding interpretation of unconscious symbolism, art was used to enhance joint attention in a teleologically sympathetic process of thinking together with things. This differentiated it from a number of major art therapy models. While propositions were developed, they were not tested in the present study.     

Why do people with anxiety disorders become depressed? A prospective-longitudinal community study

OBJECTIVE: To examine the temporal relationships of anxiety and depressive disorders, their risk factors and to explore why people with anxiety develop depression. METHOD: Data from an original 4-5-year prospective-longitudinal community study (N= 3,021) of adolescents and young adults with DSM-IV anxiety and depressive disorders identified with the Composite International Diagnostic Interview are used to examine risk factors, as well as course and outcome. RESULTS: (i) Anxiety disorders, except for panic disorder, are almost always primary conditions. (ii) Over the follow-up period, rates of comorbid anxiety-depression increased substantially and resulted in increased impairment and disabilities. (iii) Predictors for first onset of 'pure' depressive and 'pure' anxiety disorders revealed recognizable differences. (iv) Baseline clinical characteristics of anxiety disorders were significantly associated with an increased risk to develop major depression over the follow-up period. CONCLUSION: Findings suggest that most anxiety disorders are primary disorders that substantially increase the risk for secondary depression.     

Neuropsychiatric disorders: What do neurologists think about conversion disorder?

A new survey of British neurologists shows that no commonly accepted model exists for the diagnosis of conversion disorder. Instead, the results indicate that the neurologist’s diagnosis is influenced largely by their communication with the patients.     

A relationship between bipolar II disorder and borderline personality disorder?

BACKGROUND: The relationship between DSM-IV-TR borderline personality disorder (BPD) and bipolar disorders, especially bipolar II disorder (BP-II), is still unclear. Many recent reviews on this topic have come to opposite or different conclusions. STUDY AIM: The aim was to test the association between hypomania symptoms and BPD traits, as hypomania is the defining feature of BP-II in DSM-IV-TR. METHODS: During follow-up visits in a private practice, consecutive 138 remitted BP-II outpatients were re-diagnosed by a mood disorder specialist psychiatrist, using the Structured Clinical Interview for DSM-IV (as modified by Benazzi and Akiskal for better probing hypomania). Soon after, patients self-assessed (blind to interviewer) the SCID-II Personality Questionnaire for BPD. Associations and confounding were tested by logistic regression, between each criteria symptom of hypomania (apart from "racing thoughts" and "distractibility", not assessed as probing focused mainly on behavioral, observable signs), and the entire set of BPD traits. Multivariate regression was also used to jointly regress the entire set of hypomanic symptoms on the entire set of BPD traits. RESULTS: Mean (SD) age was 39.0 (9.8) years, females were 76.3%. Frequency of BPD traits ranged between 17% and 66% (e.g. impulsivity trait 41%, affective instability trait 63%), mean (SD) number of traits was 4.2 (2.3). The most common episodic hypomanic symptoms were elevated mood (91%) and overactivity (93%); frequency of excessive risky, impulsive activities (impulsivity) was 62%. By logistic regression the only significant association was between the episodic impulsivity of hypomania and the trait impulsivity of BPD. Multivariate regression of the entire set of hypomanic symptoms jointly regressed on the entire set of BPD traits was not statistically significant. DISCUSSION: The core feature of BP-II, i.e. hypomania, does not seem to have a close relationship with BDP traits in the study setting, partly running against a strong association between BPD and BP-II and a bipolar spectrum nature of BPD.     

Antisocial personality disorder and anxiety disorder: A diagnostic variant?

Antisocial personality disorder (ASPD) with co-morbid anxiety disorder may be a variant of ASPD with different etiology and treatment requirements. We investigated diagnostic co-morbidity, ASPD criteria, and anxiety/affective symptoms of ASPD/anxiety disorder. Weighted analyses were carried out using survey data from a representative British household sample. ASPD/anxiety disorder demonstrated differing patterns of antisocial criteria, co-morbidity with clinical syndromes, psychotic symptoms, and other personality disorders compared to ASPD alone. ASPD criteria demonstrated specific associations with CIS-R scores of anxiety and affective symptoms. Findings suggest ASPD/anxiety disorder is a variant of ASPD, determined by symptoms of anxiety. Although co-morbid anxiety and affective symptoms are the same as in anxiety disorder alone, associations with psychotic symptoms require further investigation.     

What do all personality disorders have in common? Ineffectiveness and uncooperativeness

We still lack operative and theoretically founded definitions of what a personality disorder (PD) is, as well as empirically validated and feasible instruments to measure the disorder construct. The Temperament and Character Inventory (TCI) is the only personality instrument that explicitly distinguishes personality style and disordered functioning. Here, we seek to (1) confirm in a clinical sample that the character dimensions of the TCI capture a general construct of PD across all specific PD subtypes, (2) determine whether such core features can be used to detect the presence of PD, and (3) analyze whether such detection is affected by the presence and severity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I symptoms. Two hundred five anxious/depressed outpatients were evaluated with the Structural Clinical Interview for DSM-IV Axis I and II Disorders. Assessment also included the TCI, the Hamilton rating scales for depression and anxiety, and the Panic and Agoraphobia Scale. Sixty-one patients (29.8%) were diagnosed as having a DSM-IV PD. Self-directedness and Cooperativeness, but no other TCI dimensions, predicted the presence of PD (Nagelkerke R(2) = 0.35-0.45) and had a moderate diagnostic utility (kappa = 0.47-0.58) when Axis I symptoms were absent or mild. However, accuracy decreased in anxious or depressed patients. Our study supports the hypothesis of a disorder construct that is not related to the intensity of any specific PD subtype but which is common to all PDs. This construct relies largely on internal representations of the self revealing ineffectiveness and uncooperativeness.     

What do you think of it so far?

A consumer survey into the opinions of 20 mentally handicapped men, former long stay hospital residents, two years after moving into warden-controlled, independent living accommodation has shown that the men are generally satisfied with the move and are able to cope with the demands of independent living after a long period of institutional-isation.     

What do predict anxiety and depression in breast cancer patients? A follow-up study

Introduction  

Psychological adjustment following cancer occurrence remains a key issue among the survivors. This study aimed to investigate psychological distress in patients with breast cancer following completion of breast cancer treatments and to determine its associated factors.     

A qualitative and quantitative study of psychotherapists’ congruence in Singapore

Abstract

This study explores the phenomenological world of 11 Satir-based Singaporean Chinese therapists with regard to their experience of congruence. A mixed qualitative-cum-quantitative research method was used in this study. A phenomenological methodology was used to explore (a) the phenomenological world of therapists with regard to their lived experience of congruence in their personal or inner lives, (b) how this congruence is used in psychotherapy, and (c) how therapists can enhance their level of congruence. Quantitative findings include (a) significant nonparametric correlations among the intrapersonal, interpersonal, and transpersonal levels of congruence with overall congruence; (b) significant nonparametric correlation between intrapersonal congruence and interpersonal congruence; (c) significant nonparametric correlations between overall congruence and interpersonal congruence with self-esteem and life satisfaction; and (d) significant nonparametric correlations between intrapersonal congruence and self-esteem. These results may have research and clinical implications for the practice of psychotherapy.     

Comorbid personality disorders in subjects with panic disorder: do personality disorders increase clinical severity?

Personality disorders are common in subjects with panic disorder. Personality disorders have been shown to affect the course of panic disorder. The purpose of this study was to examine which personality disorders affect clinical severity in subjects with panic disorder. This study included 122 adults (71 women, 41 men) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ) criteria for panic disorder (with or without agoraphobia). Clinical assessment was conducted by using the Structured Clinical Interview for DSM-IV Axis I Disorders, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and the Panic and Agoraphobia Scale, Global Assessment Functioning Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory. Patients who had a history of sexual abuse were assessed with Sexual Abuse Severity Scale. Logistic regressions were used to identify predictors of suicide attempts, suicidal ideation, sexual abuse, and early onset of disorder. The rates of comorbid Axes I and II psychiatric disorders were 80.3% and 33.9%, respectively, in patients with panic disorder. Patients with panic disorder with comorbid personality disorders had more severe anxiety, depression, and agoraphobia symptoms, had earlier ages at onset, and had lower levels of functioning. The rates of suicidal ideation and suicide attempts were 34.8% and 9.8%, respectively, in subjects with panic disorder. The rate of patients with panic disorder and a history of childhood sexual abuse was 12.5%. The predictor of sexual abuse was borderline personality disorder. The predictors of suicide attempt were comorbid paranoid and borderline personality disorders, and the predictors of suicidal ideation were comorbid major depression and avoidant personality disorder in subjects with panic disorder. In conclusion, this study documents that comorbid personality disorders increase the clinical severity of panic disorder. Borderline personality disorder may be the predictor of a history of sexual abuse and early onset in patients with panic disorder. Paranoid and borderline personality disorders may be associated with a high frequency of suicide attempts in patients with panic disorder.