Recent Submissions

  • Developing an Intervention to Improve Occupational Participation for Justice-Involved People with a Personality Disorder: Defining and Describing Intervention Components

    Connell, Catriona; Furtado, Vivek; McKay, Elizabeth A.; Singh, Swaran P; Singh, Swaran P.; Psychiatry; Medical and Dental; University of Warwick; Birmingham and Solihull Mental Health NHS Foundation Trust; Edinburgh Napier University; Coventry and Warwickshire Partnership NHS Trust (Sage Publications, 2022-05)
    Occupational participation is undertaking personally meaningful and socially valued activities and roles. It is an important outcome for health and justice interventions, as it is integral to health and desistance. We report the third of a four-stage research project to develop an intervention to improve occupational participation for justice-involved people with a personality disorder in the community. We completed a Delphi survey to produce expert consensus on intervention components and their content, ascertain participant ratings of 28 factors for their level of influence on occupational participation, and the modifiability of the factors with this population. Thirty multi-disciplinary participants completed three survey rounds. Most factors were rated very influential, but few were considered easily modifiable. Participants agreed 121 statements describing intervention components and content. Twenty-seven statements did not reach consensus. In targeting specific factors in intervention, practitioners must balance their degree of influence with potential modifiability. The results will inform intervention manualization and modeling.
  • Group dynamic interpersonal therapy (GDIT): adapting an individual interpersonal therapy to a group setting in an NHS IAPT service: a pilot study

    Folkes-Skinner, Julie; Collins, Letitia; Folkes-Skinner, Julie; Collins, Letitia; IAPT; Additional Professional Scientific and Technical Field; Coventry and Warwickshire Partnership Trust (Taylor and Francis Group, 2021-11-30)
    Dynamic interpersonal therapy (DIT) was developed for individual clients. This pilot project set out to evaluate if DIT could be adapted to group psychotherapy. Three consecutive groups were run in an NHS IAPT service over two years. Twenty-seven clients (10 men and 17 women, median age 34) were offered treatment. Groups were facilitated by accredited DIT therapists. Clients completed the PHQ9 and the GAD7 at assessment and then weekly. Scores were used to evaluate the impact of GDIT on client symptoms. Data collected during routine treatment was later analysed. The delivery of key aspects of the model that included the formulation of the IPAF and the Goodbye Letter were changed. Results suggest that DIT can be adapted to a group setting and that this way of working may have significant benefits for clients. 74% of patients (n = 19) who completed treatment were above Caseness on the PHQ9 (p = < .00001, d = 1.82) and 58% on the GAD7 (p = < .000001, d = 1.63). Only one client (5%) dropped out of treatment. Given the small size of the sample and no control, the reduction in client symptoms cannot be reliably attributed to GDIT. More research is needed.
  • The Efficacy and Tolerability of Continuation and Maintenance Electroconvulsive Therapy for Depression A Systematic Review of Randomized and Observational Studies

    Rowland, Tobias; Mann, Roshani; Azeem, Samina; Rowland, Tobias MBBS, BSc, MSc, MRCPsych; Azeem, Samina MBBS, MSc, DPM, MRCPsych; Mental Health Adult, Consultant Psychiatrist; Mental Health Older Adults, Consultant Psychiatrist; Medical and Dental; Coventry and Warwickshire NHS Partnership Trust; Division of Mental Health and Wellbeing, Warwick Medical School, Coventry, United Kingdom (Lippincott, Williams & Wilkins, 2022-10-27)
    Electroconvulsive therapy (ECT) is a highly effective treatment for severe and treatment-resistant depression, but relapse rates remain high despite maintenance pharmacotherapy. Continuation or maintenance ECT (C/M-ECT) offers the potential to prevent relapses in the most unwell patients, but there remains disagreement among guidelines regarding its efficacy and tolerability. This review aims to summarize and assess the current evidence for the efficacy and tolerability of continuation and maintenance ECT for depression, including data from randomized and observational studies, which included an appropriate control group. Twenty studies were found meeting inclusion criteria. There was evidence from 14 studies suggesting that relapse rates are reduced in those receiving C/M-ECT. There was evidence from 6 studies suggesting that C/M-ECT had no effect on global cognitive function. Detailed neuropsychological testing was limited, but within studies that assessed specific cognitive domains, there was not consistent evidence for deficits in C/M-ECT compared with the control group. The certainty of evidence across outcomes was low or very low because of inclusion of observational studies, heterogeneity of study design, and patient populations. The findings add further weight to evidence suggesting that C/M-ECT is a viable treatment option to prevent relapse in severe depression and provides clinicians with further evidence for the benefits and risks of C/M-ECT when discussing treatment options with patients. Future research should focus on randomized or well-designed prospective studies with sufficient follow-up to determine longer-term outcomes, while including a standardized, detailed neurocognitive battery to assess potential adverse effects.