Background Catatonia is a psychomotor syndrome that has a wide range of aetiologies. Determining whether catatonia is due to a medical or psychiatric cause is important for directing treatment but is clinically challenging. We aimed to ascertain the performance of the electroencephalogram (EEG) in determining whether catatonia has a medical or psychiatric cause, conventionally defined. Methods In this systematic review and meta-analysis of diagnostic test accuracy (PROSPERO CRD42021239027), Medline, EMBASE, PsycInfo, and AMED were searched from inception to May 11, 2022 for articles published in peer-reviewed journals that reported EEG findings in catatonia of a medical or psychiatric origin and were reported in English, French, or Italian. Eligible study types were clinical trials, cohort studies, case–control studies, cross-sectional studies, case series, and case reports. The reference standard was the final clinical diagnosis. Data extraction was conducted using individual patient-level data, where available, by two authors. We prespecified two types of studies to overcome the limitations anticipated in the data: larger studies (n ≥ 5), which were suitable for formal meta-analytic methods but generally lacked detailed information about participants, and smaller studies (n < 5), which were unsuitable for formal meta-analytic methods but had detailed individual patient level data, enabling additional sensitivity analyses. Risk of bias and applicability were assessed with the QUADAS-2 tool for larger studies, and with a published tool designed for case reports and series for smaller studies. The primary outcomes were sensitivity and specificity, which were derived using a bivariate mixed-effects regression model. Findings 355 studies were included, spanning 707 patients. Of the 12 larger studies (5 cohort studies and 7 case series), 308 patients were included with a mean age of 48.2 (SD = 8.9) years. 85 (52.8%) were reported as male and 99 had catatonia due to a general medical condition. In the larger studies, we found that an abnormal EEG predicted a medical cause of catatonia with a sensitivity of 0.82 (95% CI 0.67–0.91) and a specificity of 0.66 (95% CI 0.45–0.82) with an I² of 74% (95% CI 42–100%). The area under the summary ROC curve offered excellent discrimination (AUC = 0.83). The positive likelihood ratio was 2.4 (95% CI 1.4–4.1) and the negative likelihood ratio was 0.28 (95% CI 0.15–0.51). Only 5 studies had low concerns in terms of risk of bias and applicability, but a sensitivity analysis limited to these studies was similar to the main analysis. Among the 343 smaller studies, 399 patients were included, resulting in a sensitivity of 0.76 (95% CI 0.71–0.81), specificity of 0.67 (0.57–0.76) and AUC = 0.71 (95% CI 0.67–0.76). In multiple sensitivity analyses, the results were robust to the exclusion of reports of studies and individuals considered at high risk of bias. Features of limbic encephalitis, epileptiform discharges, focal abnormality, or status epilepticus were highly specific to medical catatonia, but features of encephalopathy had only moderate specificity and occurred in 23% of the cases of psychiatric catatonia in smaller studies. Interpretation In cases of diagnostic uncertainty, the EEG should be used alongside other investigations to ascertain whether the underlying cause of catatonia is medical. The main limitation of this review is the differing thresholds for considering an EEG abnormal between studies. Funding Wellcome Trust, NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust.
Recent work in parental mental illness (PMI) has focused attention on mechanisms by which it impacts the lives of family members and is transmitted intergenerationally. This includes arguments for attending to how recovery and experiences of the illness in families are shaped relationally. In this article, we contribute to this area through presenting the results of in-depth qualitative research studying how family communication around PMI shapes families’ experiences of illness and recovery. This comprises thematic analysis of thirty-six semi-structured interviews and eight focus groups with families and multi-agency professionals who worked with them. Findings demonstrate a complex interplay of drivers of lack of communication and of the impacts of this on family relationships and well-being. Notably, families found it difficult to communicate around mental health due to guilt and shame felt by the unwell parent, a belief that concealing the illness will protect children and lack of capacity in families for communication in general. This lack of communication affects how families make sense of one another’s experiences and behaviours and impacts individual coping and family relationships. Fostering positive communication around the illness in social work settings has the potential to improve relationships, reduce perceived burdens of illness and aid recovery.
The qualitative community embraces transparent dialogue through sharing knowledge to improve rigour and develop new initiatives. In this paper, we recognise there are many complexities within qualitative research, leading to important debates. We explore the benefits and challenges, as well as the practicalities and technicalities, of conducting research that 1) employs multiple methods within the qualitative paradigm, 2) is interdisciplinary, and 3) examines a sensitive research topic 4) with a vulnerable group of participants. Specifically, when research is also 5) cross-cultural and 6) utilises participatory techniques. Through our discussion, we draw upon an existing project and examine the complexity of designing and completing intra-paradigmatic mixed methods research with children from different sociocultural contexts, underpinned by interdisciplinary perspectives, in a complex area like mental health.
Community nurses deliver comprehensive nursing care to patients living outside of hospital settings and play a crucial role in meeting individual and public health needs. Research is essential in providing evidence-based care for patients; however, most community nurses are not research active, with few relevant studies and little funding for community nursing research. To address this, four National Institute for Health Research senior nurse researchers in England conducted a James Lind Alliance priority setting partnership in community nursing with the aim of raising the international profile of community nursing research through the identification of meaningful research priorities that matter to this community. Community nurses, patients, and carers were integral to the process, which aimed to identify the top ten unanswered questions to inform community nursing practice. The Priority Setting Partnership process utilised a coproduction, mixed-methods approach. It involved consultation meetings with stakeholder partners and nested quantitative surveys. The study ran from March 2020 until September 2021, and numerous unanswered evidence uncertainties were identified. The top ten priority questions included nursing and patient focussed issues, which reflect the complexity of care delivered to patients and the workforce pressures community nurses face. Findings reflect the views of community nurses, patients, and carers and highlight areas that need attention to ensure research is embedded within community nursing settings. Identification of the top ten priorities has provided an international platform for community nursing research. This must be sustained through engagement, collaboration, funding, and innovation and has widespread implications for developing the community nursing workforce and optimising the safety and quality of patient care.
To date, the study of how health and wellbeing are actualized in organizations and how an organization’s interactional practices shape an environment that is potentially harmful to health is understudied. Much of the research around this topic has centered on personality and individual differences, as well as health and safety or ergonomics. Little understanding exists of how interactional practices might serve to prioritize health and wellbeing. In this paper, we introduce discursive psychology (DP) – a qualitative approach to studying talk and text that focuses on examining what is accomplished through people’s interactional practices. We provide an overview of DP and discuss its underlying assumptions, analytic process, and quality measures. To illustrate the application of DP to HRD, we include data extracts that highlight the impact of question design. To conclude, we point to how DP might afford HRD scholars opportunities to generate new theoretical understandings about organizational practices.
The digital divide is especially pertinent in Majority World Countries (MWCs), and this was exacerbated greatly by the pandemic. Tackling the digital divide underpins the work of Human–Computer Interaction for Development (HCI4D) and remains an important global endeavour. Our project aimed to understand how children and young people (CYP) in MWC coped during the pandemic and how technology played a role. Voices of CYP were complemented by those of their parents and professionals with whom CYP interacted regularly. Our empirical study involved 73 CYP and 76 adults from Brazil, Kenya, Pakistan, South Africa, and Turkey. Qualitative data from diaries, drawings and focus groups were analysed thematically. Four major themes were identified – ‘access’, ‘usage’, ‘risk’, and ‘future Among others, some intriguing findings were that CYP acutely felt the peer pressure on ICT ownership and tended to direct frustration at parents, who grappled with their untenable roles as gatekeepers to digital worlds. Implications for addressing the digital divide include long-term strategies to improve infrastructures and mobilise community-based collaborative efforts and enhance digital literacy.
Objectives: We determined the prevalence of psychological distress, and the associations between sociodemographic factors, anxiety, depression, COVID-19-related experiences, and psychological distress, among nurses and doctors in Nigeria. Methods: The study was a cross-sectional descriptive study, conducted over a month (1st of July–31st of July 2021) among 434 Health Care Workers (HCWs) [225 (51.8%) nurses and 209 (48.2%) doctors] from two tertiary health facilities in southwestern Nigeria. Binary logistic regression was carried out to determine the factors associated with psychological distress (dependent variable), while the independent variables were anxiety, depression, and COVID-19 experience-related factors. Results: The prevalence of moderate and severe psychological distress was 49.1% and 5.8%, respectively. Individuals who had the first degree had significantly lower odds (AOR: 0.43; p = 0.037) of experiencing psychological distress while being a nurse (AOR: 2.03; p = 0.014), higher levels of anxiety (1.28; p < 0.001), and depression (AOR: 1.17; p = 0.005) were associated with significantly higher odds of experiencing moderate to severe levels of psychological distress. Conclusion: There is a high level of psychological distress experienced by these health workers. Hence, they will benefit from strategies to reduce their distress.
Background ADHD in adults is a common and debilitating neurodevelopmental mental health condition. Yet, diagnosis, clinical management and monitoring are frequently constrained by scarce resources, low capacity in specialist services and limited awareness or training in both primary and secondary care. As a result, many people with ADHD experience serious barriers in accessing the care they need. Methods Professionals across primary, secondary, and tertiary care met to discuss adult ADHD clinical care in the United Kingdom. Discussions identified constraints in service provision, and service delivery models with potential to improve healthcare access and delivery. The group aimed to provide a roadmap for improving access to ADHD treatment, identifying avenues for improving provision under current constraints, and innovating provision in the longer-term. National Institute for Health and Care Excellence (NICE) guidelines were used as a benchmark in discussions. Results The group identified three interrelated constraints. First, inconsistent interpretation of what constitutes a ‘specialist’ in the context of delivering ADHD care. Second, restriction of service delivery to limited capacity secondary or tertiary care services. Third, financial limitations or conflicts which reduce capacity and render transfer of care between healthcare sectors difficult. The group recommended the development of ADHD specialism within primary care, along with the transfer of routine and straightforward treatment monitoring to primary care services. Longer term, ADHD care pathways should be brought into line with those for other common mental health disorders, including treatment initiation by appropriately qualified clinicians in primary care, and referral to secondary mental health or tertiary services for more complex cases. Long-term plans in the NHS for more joined up and flexible provision, using a primary care network approach, could invest in developing shared ADHD specialist resources. Conclusions The relegation of adult ADHD diagnosis, treatment and monitoring to specialist tertiary and secondary services is at odds with its high prevalence and chronic course. To enable the cost-effective and at-scale access to ADHD treatment that is needed, general adult mental health and primary care must be empowered to play a key role in the delivery of quality services for adults with ADHD.
The aim of the study was to reach consensus on modifiable risk factors for a novel system of care to address Manifestations of Frailty in hospitalized older adults. Consensus study. A modified nominal group technique, incorporating expert group face‐to‐face interaction, review of existing evidence and pre/post‐meeting questionnaire completion was undertaken November 2019–February 2020. Seventy‐one risk factors, within seven risk factor domains (pain, medication, fluid and nutrition intake, mobility, elimination, infection, additional patient factors) were considered. It was agreed that 44 risk factors incorporating patient, organizational and environmental risk factors were modifiable and should be included in a novel system of care.
Background Anxiety is one of the most common psychological difficulties reported among people with HD (pwHD) and has been shown to negatively impact on quality of life and everyday functioning. Expert guidelines recommend psychological therapy as the first treatment offered to people experiencing anxiety in early-stage HD. Guided self-help, an evidence-based psychological approach, is known to improve anxiety but has not yet been specifically applied to HD. Aims GUIDE-HD aims to identify whether it is feasible to undertake a randomised controlled trial (RCT) to assess the use of guided self-help, aimed at improving anxiety among pwHD, compared to treatment as usual (TAU). Methods/Techniques Participants will be at an early disease stage or pre-manifest HD. GUIDE-HD compares guided self-help with TAU and fifteen participants will be allocated to each group. Recruitment is ongoing in the UK. The 10-module intervention uses process-based cognitive behavioural therapy adapted to meet the specific needs of pwHD. Data gathered will assess whether the intervention and study design meet pre-determined feasibility criteria. HD participants and carers (where applicable) will be interviewed post-intervention and these data will be analysed qualitatively. Results The study ends in Dec 2023. Thereafter, the results will be fully reported. Discussion GUIDE-HD is a new psychological approach designed specifically to reduce anxiety among pwHD. This feasibility trial will help determine whether a fully powered RCT is warranted.
Background Psychological distress is common among people with Huntington’s disease (HD), including gene expansion carriers who have not yet received a clinical diagnosis. In later stages, people with HD (pwHD) can sometimes express their psychological distress with aggressive, risky, or disinhibited behaviours which others might find challenging. Clinical formulation is an approach used by mental health professionals to help understand the various factors that contribute to psychological distress. While formulations have been previously applied to other neurodegenerative diseases, a specific framework has not yet been developed for HD. Aims The aim was to develop a new clinical formulation model for understanding distress among pwHD based on a biopsychosocial framework. The theoretical rationale for the model, and potential practical applications to HD care, will be discussed. Methods/Technique The formulation model was conceptualised by UK-based clinical psychologists specialising in HD. It uses a temporal approach and draws upon several biological, psychological, and social/environmental factors that can contribute to distress. These include key elements regarding life story, HD experience and narratives, current presentations (e.g., triad of symptoms, social circumstances), as well as anticipatory cognitions and emotions about the future. Results/Outcome Following its development, the model has been successfully implemented at a specialist UK HD service, both in multi-disciplinary team meetings and in clinical sessions with pwHD and/or caregivers. Conclusions This clinical formulation model offers an individualised, evidence-based framework to help enhance the psychological understanding of distress in HD. Its successful implementation shows the potential to improve person-centred care approaches for affected individuals worldwide.
Aims This paper focuses on the benefits of inclusive leadership when undertaking a priority setting partnership in community nursing, through providing a collaborative and committed nurse‐led forum for initiating impactful changes, identifying evidence uncertainties and driving research capacity‐building initiatives. Design This is a Discussion paper. The project was undertaken between 2020 and 2021. Data sources This paper is based on shared reflections as 70@70 Senior Nurse Research Leaders and is supported by literature and theory. It draws on issues relating to collective leadership, stakeholder engagement, diversity, inclusivity and COVID‐19. Implications for nursing The James Lind Alliance Priority Setting Partnership catalysed the development of a rigorous evidence‐base in community nursing. The collaborative opportunities, networks and connections developed with patients, carers, nursing leaders, policy makers and healthcare colleagues raised the profile of community nursing research. This will benefit nursing research, practice, education and patients in receipt of community nursing care. Collective buy in from national leaders in policy, education, funding and commissioning has secured a commitment that the evidence uncertainties will be funded. Conclusion Four key learnings emerged: collective leadership can ensure learning is embedded and sustained; developing an engaged stakeholder community to promote community nursing research is essential; a diverse membership ensures inclusivity and representation; and insights into the impact of COVID‐19 aid progress. The process increased research engagement and created capacity and capability‐building initiatives. This will help community nurses feel empowered to lead changes to practice. Sustained engagement and commitment are required to integrate research priorities into community nursing research, education and practice and to drive forward changes to commissioning and service delivery. Impact The study promoted research capacity building through inclusive leadership. This can increase community nurses' research engagement and career development and patient care quality and safety; this can incentivize funders and policy makers to prioritize community nursing research.
Background This article focuses on approaches to qualitative research interviewing that draw direct inspiration from psychoanalytic therapy. The reflective discussion piece provides a critical spotlight on this method to promote reflection and ethical application. Aim To provide clarity regarding the meaning of psychoanalytically informed, psycho-social research and the interpretive nature of qualitative interviews and of therapy, and to reflect on nurse researchers’ partiality for using quasi-dynamic interpretative comments and the sharing of formulations in interviews. Discussion The authors review relevant literature, and comment on the apprehension and uncertainty researchers may experience with this type of research approach. Conclusion Researchers should consider how they conduct themselves as interviewers and what to share of the analysis of participants’ accounts based on the specifics of the research, including their or their team’s experience of conducting psychotherapy and their and participants’ expectations about what may be therapeutic about interviews. Implications for practice Psychoanalytically informed research interviewing should be used in a reflective way by nurse researchers with attention paid to the limitations and possibilities of parallels between psychotherapeutic and research interview dialogue.
Huntington’s disease (HD) is an inherited, life-limiting neurodegenerative condition. People with HD experience changes in cognitive, motor and emotional functioning, and can also, mainly at later stages, exhibit behaviours that professionals and carers might find distressing such as hitting others, throwing objects, swearing or making inappropriate comments. While clinical formulation (an individualised approach used by mental health professionals to describe an individual’s difficulties) is a helpful tool to conceptualise patients’ wellbeing, a specific formulation framework has not yet been developed for HD. However, evidence has shown that formulation can help guide clinical interventions and increase consistency of approach across multi-disciplinary teams, refine risk management, and improve staff or carers’ empathic skills and understanding of complex presentations. As a consequence, this paper proposes a new clinical formulation model for understanding distress among people with HD, based on a biopsychosocial framework. More specifically, this includes key elements centring on an individual’s past experience and personal narratives, as well as anticipatory cognitions and emotions about the future. In-depth discussions regarding the components of the model and their importance in HD formulations are included, and a fictional yet representative case example is presented to illustrate their application within the context of personalised care.
There has been growing concern about rising physical inactivity levels in female adolescents, with schools taking some responsibility to address this. Programmes designed for and by girls are increasingly being used by developing or delivering a programme of change and consultation to improve physical activity, physical education, and sport in school. However, to build an understanding of the nuances of such interventions, and better appreciate any gendered benefits and challenges, girls’ voices need to be heard. Based on data from 16 focus groups from 8 schools participating in a female-focused intervention trial (“Girls Active”), we explored adolescent girls’ views of this type of intervention. We used reflexive organic thematic analysis to understand key issues. Four themes were developed: stereotypes; choice; empowerment and voice; and equality. Our feminist approach centralised adolescent girls’ voices, thereby recognising that physical activity is rooted in patriarchal constructions that position girls as naturally uninterested in sport and activity. We suggest gender-focused interventions can actively address stereotypes by listening to girls.
Perceptions of self-injurious behaviour as refractory to treatment, and of treatment outcomes as unpredictable, in children and adults with intellectual disabilities and/or autism may lead to treatment inertia or nihilism, restrictive practices and overuse of psychotropic medication in its management. Recent research suggests, however, that from infancy to young adulthood prospects for a positive outcome are fair, and markers predictive of treatment outcome have begun to be identified. In this clinical reflection we briefly describe this work, consider how it may contribute to case stratification, and outline current thinking on further functional differentiation of cases of SIB, promoting non-restrictive practices.
What is new and objectives: Older people from ethnic minorities experience the intersectionality of age and ethnicity in relation to complex medication management and polypharmacy. Minority ethnic groups in the United Kingdom are at risk of poor medication management because factors such as cultural beliefs, language barriers, lack of knowledge of how the healthcare system works may affect their ability to safely manage their medications. The aim of this systematic review was to review the literature focussing on medication management in the older population amongst ethnic minority communities in United Kingdom. Methods: The review was conducted and reported according to methods in the Cochrane Handbook and in the PRISMA 2020 statement using databases such as EMBASE, ASSIA, MEDLINE, PsychINFO and others. Studies conducted in the United Kingdom on individuals over 60 years of age and from a minority ethnic background were included. A thematic analysis was used to synthesize the results. Results and discussion: Nine studies (eight from initial searches, one from a search update in 2021) met the inclusion criteria. Three main themes were identified: misbeliefs around medications, poor health literacy, communication and education as possible intervention to improve medication management. Misbeliefs around long-term illnesses exert a negative impact on medication management. Poor health literacy around medications influences patients' adherence to treatments. Poor communication is perceived as barrier to successful medication management. Despite extensive searching, the team identified a limited number of studies and a lack of intersectional studies focussing on minority ethnic groups and the older population. What is new and conclusion: Our findings suggest tailored education as a possible intervention to improve medication management amongst these minority groups. Future research should look at recruiting participants from specific ethnic groups and from rural as well as urban areas to explore how medication management operates in different areas of the United Kingdom.
COVID-19 lockdown enforced distressed reverse migration in Sundarban, which caused an unprecedented population addition to the already devastated fragile Sundarban ecosystem. Acute poverty and food crisis prompted many migrants to explore forest-based living, thus enhancing fatal human-tiger conflicts. Families of deceased migrants face significant mental health trauma and catastrophic psychosocial consequences.
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