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    ABSTRACT: The National Health Service (NHS) Stop Smoking Service (SSS) is an extremely cost-effective method of enabling smoking cessation. However, the SSS is only used by a minority of smokers. Developing interventions to maintain service attendance may help to increase the number of quitters. This study pilots an intervention aimed at maintaining attendance by (1) increasing motivation to attend through a booklet providing evidence of service effectiveness and (2) strengthening the link between motivation to attend and attendance through forming an implementation intention. A factorial randomized controlled trial. A total of 160 newly enrolled smokers at the Surrey NHS SSS were recruited and randomly assigned to one of four conditions: (1) standard care (SC), (2) SC + effectiveness booklet, (3) SC + implementation intention, and (4) SC + effectiveness booklet + implementation intention. The outcome measures included attendance at the SSS and the 4-week quit rate. The booklet increased service attendance (OR = 2.93, p < .01, 95% CI = 1.45-5.93; Number Needed to Treat = 3.3) but had no impact on the 4-week quit rate (OR = 1.55, 95% CI = 0.75-3.21). Forming an implementation intention had no impact on service attendance or the 4-week quit rate. Attending the service was associated with a higher 4-week quit rate (ρ = 87.52, p < .001). Presenting information about the effectiveness of the service improved service attendance. A larger trial now needs to evaluate whether this intervention can also increase the quit rate. What is already known on this subject? The NHS Stop Smoking Service is an effective yet underused method of enabling smoking cessation. Low uptake levels may be due to smokers' misconception that the service will not improve their chances of quitting successfully. Improving smokers' perceptions of service efficacy may be valuable for maintaining service attendance, and subsequently improving smoking cessation levels in the United Kingdom. What does this study add? This pilot randomized controlled trial is the first to target service attendance rather than cessation levels. The results demonstrate that providing evidence of service efficacy in a simple icon array format can significantly improve service attendance.
    British Journal of Health Psychology 12/2013;
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    ABSTRACT: It is now broadly accepted that psychological stress may change the internal homeostatic state of an individual. During acute stress, adaptive physiological responses occur, which include hyperactivity of the HPA axis. Whenever there is an acute interruption of this balance, illness may result. The social and physical environments have an enormous impact on our physiology and behavior, and they influence the process of adaptation or 'allostasis'. It is correct to state that at the same time that our experiences change our brain and thoughts, namely, changing our mind, we are changing our neurobiology. Increased adrenocortical secretion of hormones, primarily cortisol in major depression, is one of the most consistent findings in neuropsychiatry. A significant percentage of patients with major depression have been shown to exhibit increased concentrations of cortisol, an exaggerated cortisol response to adrenocorticotropic hormone, and an enlargement of both the pituitary and adrenal glands. The maintenance of the internal homeostatic state of an individual is proposed to be based on the ability of circulating glucocorticoids to exert negative feedback on the secretion of hypothalamic-pituitary-adrenal (HPA) hormones through binding to mineralocorticoid (MR) and glucocorticoid (GR) receptors limiting the vulnerability to diseases related to psychological stress in genetically predisposed individuals. The HPA axis response to stress can be thought of as a mirror of the organism's response to stress: acute responses are generally adaptive, but excessive or prolonged responses can lead to deleterious effects. Evidence indicates that early-life stress can induce persistent changes in the ability of the HPA axis to respond to stress in adulthood. These abnormalities appear to be related to changes in the ability of hormones to bind to GR and MR receptors. First episodes may begin with an environmental stressor, but if the cycles continue or occur unchecked, the brain becomes kindled or sensitized, and future episodes of depression, hypomania, or mania will occur independently of an outside stimulus, with greater frequency and intensity. Generally, HPA axis changes appear in chronic depressive and more severe episodes. Moreover, HPA axis changes appear to be state-dependent, tending to improve upon resolution of the depressive syndrome. Interestingly, persistent HPA dysfunction has been associated with higher rates of relapse and chronicity. This article is part of a Special Issue entitled NEWroscience 2013.
    Epilepsy & Behavior 11/2013;
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    ABSTRACT: BackgroundA major incident involving multiple fatalities occurred in Cumbria, England on 2 June 2010. The Cumbrian Constabulary deployed an organizational peer support response for personnel involved known as trauma risk management (TRiM).AimsTo examine data routinely gathered during the TRiM process to evaluate the relationship of the intervention to sickness absence.Methods Using incident databases, details were gathered regarding exposure to the murders and type of TRiM intervention, including an assessment of the psychological risk to the individual of developing a trauma-related mental health problem. Sociodemographic information was collated by the occupational health department. Cumulative sickness absence data in the 2 months following the murders were used as a proxy for mental health status.ResultsA total of 717 police officers and civilian support staff were identified. High levels of traumatic exposure were associated with subsequent receipt of a TRiM intervention. The majority of psychological risk indices reduced between the initial and subsequent evaluation. Greater traumatic exposure was associated with longer sickness absence lengths. Engagement in the TRiM process was associated with a reduction in sickness absence especially in more junior ranks.Conclusions In this study, we found that TRiM deployed within a police force responding to a major event offered a way of structuring a response for those involved. Our data suggest that TRiM may offer a way of assessing psychological risk so that officers can be offered early supportive interventions. Our data suggest that TRiM may help to ameliorate some of the negative effects of high trauma exposure.
    Occupational Medicine 10/2013;
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    ABSTRACT: Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are both highly prevalent conditions associated with extreme disability and with the development of co-morbid psychiatric disorders, such as depression and anxiety. Childhood stressors have been shown to induce persistent changes in the function of biological systems potentially relevant to the pathogenesis of both CFS and FM, such as the inflammatory system and the hypothalamic-pituitary-adrenal (HPA) axis. In this review, we examined whether multiple forms of childhood stressors are contributing factors to the development of these disorders, and of the associated psychiatric symptoms. Using PubMed, we identified 31 papers relevant to this narrative review. We included cohort studies and case-control studies, without any exclusion in terms of age and gender. No study characteristics or publication date restrictions were imposed. Most studies across the literature consistently show that there is a strong association between experiences of childhood stressors and the presence of CFS and FM, with rates of CFS/FM being two- to three-fold higher in exposed than in unexposed subjects. We also found evidence for an increased risk for the development of additional symptoms, such as depression, anxiety and pain, in individuals with CFS and FM with a previous history of childhood stressors, compared with individuals with CFS/FM and no such history. Our review confirms that exposure to childhood stressors is associated with the subsequent development of fatigue syndromes such as CFS and FM, and related symptoms. Further studies are needed to identify the mechanisms underlying these associations.
    Psychological Medicine 10/2013;
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    ABSTRACT: Post-traumatic stress disorder (PTSD) was formally recognised as a psychiatric disorder in 1980, largely in response to America's attempts to make sense of the costs of the Vietnam war [Wessely, S., & Jones, E. (2004). Psychiatry and the 'lessons of Vietnam': What were they, and are they still relevant? War & Society, 22(1), 89-103.]. Interestingly, all of this occurred without much contribution from epidemiology, which came later (Wessely & Jones, 2004). This cannot be said of the current conflicts, where from the outset there has been a focus of attention on the epidemiology of PTSD in those who served in either Iraq or Afghanistan, even whilst the conflicts were ongoing. In this editorial, we focus on this recent epidemiological contribution to the understanding of PTSD in military personnel.
    Journal of Mental Health 10/2013; 22(5):397-401.
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    ABSTRACT: Neurofeedback is defined as the training of voluntary regulation of localised neural activity using real-time feedback through a brain-computer interface. It has shown initial success as a potential clinical treatment tool in proof of concept studies, but has yet to be evaluated with respect to eating disorders. This paper (i) provides a brief overview of the current status of eating disorder treatments; (ii) describes the studies to date that use neurofeedback involving electroencephalography, real-time functional magnetic resonance imaging or near-infrared spectroscopy; and (iii) considers the potential of these technologies as treatments for eating disorders. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 09/2013;
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    ABSTRACT: Brain structure alterations have been reported in anorexia nervosa, but findings have been inconsistent. This may be due to inadequate sample size, sample heterogeneity or differences in methodology. High resolution magnetic resonance images were acquired of 33 adult participants with anorexia nervosa and 33 healthy participants, the largest study sample to date, in order to assess whole-brain volume, ventricular cerebrospinal fluid, white matter and grey matter volume. Voxel-based morphometry was conducted to assess regional grey matter volume. Levels of depression, anxiety, obsessionality and eating disorder-related symptoms were measured and used to explore correlations with brain structure. Participants with anorexia nervosa had smaller brain volumes as well as a global decrease in grey matter volume with ventricular enlargement. Voxel-based morphometry revealed a decrease in grey matter volume spanning across the cerebellum, temporal, frontal and occipital lobes. A correlation was found between grey matter volume loss and duration of illness in the cerebellum and mesencephalon. No correlations were found with clinical measures. Findings are in accordance with several previous studies on brain structure and match functional studies that have assessed the symptomatology of anorexia nervosa, such as body image distortion and cognitive bias to food. The correlation with duration of illness supports the implication of cerebellar atrophy in the maintenance of low weight and disrupted eating behaviour and illustrates its role in the chronic phase of anorexia nervosa. The lack of other correlations suggests that these findings are not related to the presence of co-morbid disorders.
    Psychological Medicine 09/2013;
  • European Eating Disorders Review 09/2013;
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    ABSTRACT: Psychological treatments for eating disorders (ED) rely on mastery of effortful attentional control to divert attention from anxiety provoking thoughts. This paper assesses the potential suitability of attentional bias modification treatment (ABMT) for EDs as a way to target early automatic attentional processes and implicitly retune threat perception that happens outside of conscious control. We review data on anxiety in EDs, the neurobiological and behavioural relationship between anxiety disorders and EDs, attentional biases (AB) in EDs and the use of ABMT. Co-morbidities between EDs and anxiety disorders are common and negatively affect illness outcome. EDs and anxiety disorders share many underlying elements, including AB towards threatening and disorder-relevant stimuli. AB has been modified across a range of anxiety disorders using ABMT. It is possible to modify AB in EDs. There is evidence to suggest that ABMT has potential as a targeted, rapid and convenient treatment option for EDs. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 09/2013;
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    ABSTRACT: Objective. There is substantial uncertainty regarding the prevalence of depression in RA. We conducted a systematic review aiming to describe the prevalence of depression in RA.Methods. Web of Science, PsycINFO, CINAHL, Embase, Medline and PubMed were searched for cross-sectional studies reporting a prevalence estimate for depression in adult RA patients. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and a meta-analysis was performed.Results. A total of 72 studies, including 13 189 patients, were eligible for inclusion in the review. Forty-three methods of defining depression were reported. Meta-analyses revealed the prevalence of major depressive disorder to be 16.8% (95% CI 10%, 24%). According to the PHQ-9, the prevalence of depression was 38.8% (95% CI 34%, 43%), and prevalence levels according to the HADS with thresholds of 8 and 11 were 34.2% (95% CI 25%, 44%) and 14.8% (95% CI 12%, 18%), respectively. The main influence on depression prevalence was the mean age of the sample.Conclusion. Depression is highly prevalent in RA and associated with poorer RA outcomes. This suggests that optimal care of RA patients may include the detection and management of depression.
    Rheumatology (Oxford, England) 09/2013;
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