Aileen O'Brien

St. George's School, Middletown, Rhode Island, United States

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Publications (4)25.65 Total impact

  • Aileen O'Brien
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    ABSTRACT: Clozapine is the most effective antipsychotic available for the treatment of schizophrenia that has proved resistant to other medications and the only antipsychotic licensed for this indication. Although the drug is increasingly being used more widely in patients with schizophrenia and with other psychiatric and neurological disorders, it is still underused. The main reasons for this are that it can cause adverse effects such as weight gain and sedation, and the need for regular blood test monitoring because of the risk of agranulocytosis. While these hurdles are unavoidable, another problem in the UK has been the historical practice of admitting patients to hospital to initiate treatment with clozapine. However, protocols have now been developed for both home and day-hospital initiation. The experience of one assertive community treatment team of starting clozapine in patients' own homes has been positive, with no major adverse events reported. This approach is, however, extremely demanding of staff resources and for many services the use of day-hospitals to initiate treatment with clozapine is more appropriate. Research into staff and patients' views about community initiation of clozapine, and its economic costs, would be welcome.
    CNS Drugs 02/2004; 18(13):845-52. · 4.38 Impact Factor
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    ABSTRACT: To investigate the impact of training CMHT members in the practice of Individual Placement and Support on the vocational status of long-term patients. Six CMHTs received vocational training by a work co-ordinator; four continued with standard care. The best vocational status of the 1037 subjects was ascertained after one year. Factors associated with improvement in vocational status were identified. There was no difference in change of vocational status. Age, previous employment and diagnosis influenced outcome. Training in IPS at team level did not improve employment status. A dedicated, vocational worker appears to be essential for successful IPS.
    Community Mental Health Journal 09/2003; 39(4):333-47. · 1.03 Impact Factor
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    ABSTRACT: The validity of the SCOFF delivered orally as a screening tool for eating disorders has previously been established, but clinical screening for eating disorders also occurs via written format, for example, in occupational health settings. The objective was to compare responses to the SCOFF between verbal and written administration. In a volunteer group of nursing and midwifery students at a South London University SCOFF was delivered orally at interview and via written questionnaire. Order was allocated randomly with repeat administration interrupted by distraction questions. There were 185 students who participated, providing 178 fully completed responses. Twenty subjects were male. There was overall agreement in the scores of 157 subjects (88.2%), providing a kappa coefficient of 0.811, with agreement in prediction of eating disorder for 167 (93.8%) and a kappa value of 0.824 (both p < 0.001). For 82 subjects administered the SCOFF verbally first followed by the written version, the kappa statistic was 0.752 (p < 0.001). For 96 subjects with SCOFF administered in reverse order (written form first), kappa was 0.862 (p < 0.001). Results demonstrated overall good replicability of the SCOFF administered as a written questionnaire compared to oral interview. Two trends were noted. The first was towards higher scores with written versus oral delivery irrespective of order, possibly indicating enhanced disclosure via written format. The second was of less consistency where verbal preceded written responses. Altogether findings support use of the SCOFF where a concise, valid and reliable screening for eating disorders is required in written form.
    International Journal of Eating Disorders 01/2003; 32(4):466-72. · 3.03 Impact Factor
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    ABSTRACT: Standards 2 and 3 of the national service framework for mental health outline the need to improve health care for patients with anorexia nervosa and bulimia nervosa.1 Healthcare workers in primary care are at the forefront of screening and managing these disorders. Assessment tools available to primary healthcare professionals can take a long time to administer and may need to be interpretedby specialists2; this may limit improvements in care. A screening tool was developed, but only to facitate epidemiological research.3The SCOFF questionnaire is a brief and memorable tool designed to detect eating disorders and aid treatment (see figure). It showed excellent validity in a clinical population and reliability in a student population. 4 5 We assessed the SCOFF questionnaire in primary care. Participants, methods, and results We invited sequential women attenders (aged 18-50) at two general practices in southwest London to participate. We gave participants information sheets that described the study. Women who verbally consented to participate were asked the SCOFF questions in a separate room; this took about two minutes. A researcher blind to the woman's score on the SCOFF questionnaire conducted a clinical diagnostic interview lasting 10-15 minutes, based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (fourth edition). Women identified by the interview as having an eating disorder were invited to discuss this and were offered the contact number for the Eating Disorders Association. The local research and ethics committee approved the study. Of the 341 women who agreed to take participate, one (who had a body mass index of 17 (weight (kg)/height (m)2)) had anorexia nervosa, three had bulimia nervosa, and nine had an “eating disorder not otherwise specified.” A receiver operating curve set the optimal threshold for the questionnaire at two or more positive answers to the five questions. With this cut off, the SCOFF questionnaire detected all four cases of anorexia nervosa and bulimia nervosa and seven of nine cases of eating disorders not otherwise specified (figure). The questionnaire had a sensitivity of 84.6% (95% confidence interval 54.6% to 98.1%). In the 328 women confirmed not to have an eating disorder, the questionnaire indicated 34 false positives. It had a specificity of 89.6% (86.3% to 92.9%), positive predictive value of 24.4% (12.9% to 39.5%), and negative predictive value of 99.3% (97.6% to 99.9%). View larger version:In a new windowDownload as PowerPoint SlideReceiver operating curve showing the effect of cut-off points (1 to 5) for the SCOFF questionnaire to detect cases and non-cases of eating disorders. 1 to 5=minimum number of positive responses to questionnaire Comments The SCOFF questionnaire detected all cases of anorexia and bulimia nervosa. It is an efficient screening tool for eating disorders. Two missed cases of eating disorders not otherwise specified reflect the reality of clinical situations, in which denial or non-disclosure by patients may occur. One of the patients in whom the diagnosis was missed later disclosed disordered eating behaviour. It may be more difficult and perhaps less pertinent to detect patients who do not meet full criteria for anorexia nervosa or bulimia nervosa. The positive predictive value of the questionnaire is low because of the low prevalence of eating disorders in this sample, which was consistent with the Western population as a whole. Overinclusion is acceptable for screening instruments designed for disorders with high mortality rates, particularly as the questionnaire is short and easy to administer. Positive results should be followed by further questioning rather than by automatic referral. The SCOFF questionnaire is efficient at detecting cases of eating disorders in adult women in primary care. We recommend its use by healthcare professionals in primary care. Future work will assess the validity of the questionnaire in other populations, such as adolescents, in whom the prevalence may be higher. Acknowledgments Study to be attributed to the Department of Psychiatry at St George's Hospital Medical School, University of London, London. We thank K Kennett for her help with data collection. We also thank Wandle Valley Surgery and Brocklebank Group Practice, particularly T Coffey, who provided study patients. We thank the volunteers for their kind participation. Contributors: All authors contributed to the conception and design of the study. AL, AO'B, JB, and CP were responsible for the collection and management of data. AL, FR, and JM analysed and interpreted data. AL wrote the paper and all other authors oversaw the writing and edited the paper. JM and HL will act as guarantors. Footnotes Funding None Competing interests None declaredReferences1.↵Department of Health.A national service framework for mental health: modern standards and service models. London:Stationery Office,1999.2.↵Garner DM, Olmstead MA, Polivy J.Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia.Int J Eat Disord 1983; 2:15–34.3.↵Beglin SJ, Fairburn CG.Evaluation of a new instrument for the detection of eating disorders in community samples.Psychiatry Res 1992; 44:191–201.OpenUrlCrossRefMedlineWeb of Science4.↵Morgan JF, Reid F, Lacey JH.The SCOFF questionnaire: assessment of a new screening tool for eating disorders.BMJ 1999; 319:1467–1468.OpenUrlFREE Full Text5.↵Perry L, Morgan J, Reid F, O'Brien A, Brunton J, Luck A, et al.Oral versus written administration of the SCOFF.Int J Eating Disorders (in press).
    BMJ (online) 11/2002; 325(7367):755-6. · 17.22 Impact Factor