Promoting recovery: service user and staff perceptions of resilience provided by a new Early Intervention in Psychosis service

Aim: The principles and practice of recovery are guiding many changes in mental health service provision. As a new Early Intervention in Psychosis (EIP) service, we were interested in finding out if both staff and users perceive the service as promoting resilience and in turn, recovery. Methods: A naturalistic sample of service users and staff completed the Organizational Climate questionnaire to assess the degree to which the service promotes resilience in overcoming a first episode psychosis. Results: The results indicated that both staff and service users similarly perceive the service as positively supporting resilience. The one exception was the staff rated the ‘available resources to meet people's needs’ as less than service users. Conclusions: The positive rating of resilience indicated that the service is working in a manner consistent with a recovery orientation. The results will act as a benchmark to compare with both other EIP services and future performance.     

Direct service staff and their perceptions of psychotropic medication in non-institutional settings for people with intellectual disability

Previous studies have surveyed a variety of service providers in school and institutional settings, and reported a pervasive lack of education and training with regard to the use of psychotropic medication in people with intellectual disability. Because an increasing number of people with intellectual disability are living in the community and since many of these people receive psychotropic medications, the present study extended research in this area by surveying direct service staff to determine their perceptions, knowledge and opinions with regard to the use of psychotropic medication in non-institutional settings for individuals with developmental disabilities. Consistent with the findings of previous studies, a majority of the 334 respondents in the present study reported that they had not received adequate training in the area of drug treatment. The knowledge and skills deficits of direct service staff appear to represent a significant barrier to the appropriate monitoring and management of pharmacotherapy for individuals with intellectual disability. Therefore, a systematic training programme to educate direct service staff about psychotropic medication needs to be designed, implemented and disseminated on a broad scale.     

A descriptive study of 'non-cases' and referral rates to an early intervention for psychosis service

Aim: Despite there being approximately 200 early intervention services for psychosis worldwide, little is known about the referral rates to these services, the diagnoses and needs of individuals found not to have a first episode of psychosis (FEP). Firstly, we aimed to describe the diagnoses for individuals who were found not to have a FEP (non‐cases) following an assessment using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV (SCID). We then aimed to examine the referral rates of cases and non‐cases to an early intervention service. Methods: All individuals referred to the early intervention service underwent a clinical assessment using the SCID. Results: In a 4‐year period, there were 632 referrals to the early intervention service for psychosis, and of these, 53% (n = 338) were found to have a FEP, 5% (n = 34) were found to have an at‐risk mental state for psychosis and 41% (n = 260) were found to be ‘non‐cases’. This represents a ratio of 1.9:1 of referrals to cases, or approximately 2:1. Of the non‐cases, 27% (n = 62) satisfied criteria for a mood disorder, with major depressive disorder the commonest diagnosis. A further 18% (n = 42) of non‐cases satisfied criteria for an anxiety disorder and nearly half of these were diagnosed with social phobia. The ratio of referrals to cases was not consistent over time and rose from 1.3:1 in the first year to 2:1 in the fourth year. Conclusion: A large proportion of individuals referred to an early intervention for psychosis service were found not to have psychotic disorder, however they still have significant needs regarding their mental health.     

Experience of child and adolescent mental health clinicians working within an at-risk mental state for psychosis service: a qualitative study

Aim: To qualitatively examine the common experiences of child and adolescent mental health clinicians working with adolescents suspected of having an ‘at‐risk mental state’ (ARMS) for psychosis. Methods: A semistructured interview was conducted with six experienced child and adolescent mental health clinicians working in North East England. Results: A thematic analysis of clinicians' experiences indicated that the identification and management of an ARMS within this patient group is particularly complex. In terms of treatment options, approaches that promoted social inclusion were favoured, but the use of antipsychotic medication was perceived as a ‘last resort’, requiring serious consideration. Clear guidelines and an overall consensus were judged to be lacking in terms of coordinating care and multi‐agency working practices. Conclusions: Establishing a formalized care pathway that also incorporates regular training and supervision may be required by this and other clinical services working with adolescents suspected of having an ARMS. Improved identification, a firmer evidence base regarding treatment practices and clear guidelines are required for this age group. This need will become more urgent should a psychosis risk syndrome be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐V).     

Vocabulary needs in augmentative and alternative communication: a sample of conversational topics between staff providing services to adults with learning difficulties and their service users

This paper describes an attempt to gather information about the vocabulary needs of a sample of people with learning difficulties in order to inform the content of local augmentative and alternative communication (AAC) resources and training programmes. The participants were staff members working in a range of local day care and residential services who were asked to record topics of conversation in diaries. The results were analysed in terms of the frequency of topic areas similar to those described by Maslow's model of human need. The influences on the development of vocabularies for AAC programmes and philosophies current in services for adults with learning difficulties are briefly discussed. The approaches of two of perhaps the most widely used resources (i.e. Makaton and Signalong) are described in the context of their rationale for vocabulary content. The results of the present study suggest that Physical Needs and Function were the most frequent topic areas for conversation. There were far fewer conversations recorded for Social and Emotional topics. Flexible topic‐based frameworks for AAC programmes are suggested as a model that might be able to respond to individual and local vocabulary needs more readily than any one prescribed vocabulary.     

Long-term benefits of mindfulness on white matter tracts underlying the cortical midline structures in panic disorder: A 2-year longitudinal study

Aims

We aimed to examine the long-term benefits of mindfulness-based cognitive therapy (MBCT) on white matter plasticity in the cortical midline structures (CMS) for a period of 2 years in patients with panic disorder and the relationships between white matter changes in the CMS and severity of state and trait symptoms.

Methods

Seventy-one participants were enrolled and underwent diffusion tensor imaging at baseline and after 2 years (26 who received MBCT as an adjunct to pharmacotherapy [MBCT+PT], 20 treated with pharmacotherapy alone [PT-alone], and 25 healthy controls [HCs]). The severity of symptoms and fractional anisotropy (FA) in white matter regions underlying the CMS were assessed at baseline and 2-year follow-up.

Results

The MBCT+PT group showed better outcomes after 2 years than the PT-alone group. The groups showed different FA changes: the MBCT+PT group showed decreased FA in the left anterior cingulate cortex (ACC); the PT-alone group showed increased FA in the bilateral dorsomedial prefrontal cortex, posterior cingulate cortex (PCC), and precuneus. Decreased white matter FA in the ACC, PCC, and precuneus was associated with improvements in the severity of state and trait symptoms in patients with panic disorder.

Conclusion

Alleviation of excessive white matter connectivity in the CMS after MBCT leads to improvements in clinical symptoms and trait vulnerability in patients with panic disorder. Our study provides new evidence for the long-term benefits of MBCT on white matter plasticity and its clinical applicability as a robust treatment for panic disorder.