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Publication Supporting safe use of clozapine(Wiley, 2024-12-16) Aigbekaen, Tolu; Parker, Caroline; Parker, Caroline; Additional Professional Scientific and TechnicalClozapine is the most effective antipsychotic for treatment resistant schizophrenia. It however can have serious side effects and interactions with other medicines which primary care clinicians should be cognisant of and able to monitor and manage.Publication Qualitative study of the impact on recovery of peer relationships between female inpatients during treatment for anorexia nervosa in the United Kingdom(Wiley, 2023-12-07) Lotery, Elizabeth; Bell, Rebecca; Combe, Gillian; Biddle, Lucy; Bould, Helen; Bould, Helen; Medical and DentalObjective: Admissions to hospitals for people with anorexia nervosa (AN) often last over 2 months, during which significant time is often spent with other patients, but there is little qualitative research on the impact on recovery of the inter-patient relationships. Our aim was to conduct qualitative interviews with people with a history of inpatient treatment for AN, focusing on the impact of interactions and relationships between patients during hospital admission on recovery, including short-term and long-term effects. Method: We conducted nine semi-structured, one-to-one interviews, specifically exploring the helpful and unhelpful aspects of inter-patient relationships during inpatient treatment for AN. No type of relationship was either included or excluded. Participants were recruited as volunteers in response to an online advertisement; all who met the eligibility criteria were selected. Interviews were transcribed and analyzed using thematic analysis. Results: Thematic analysis identified five themes: (1) comparison and justification, (2) learnt unhelpful behaviors, (3) dealing with distress, (4) compassion, and (5) role-modeling. All participants expressed conflicting feelings about their relationships with other patients, but generally described developing more resilience to negative effects as they got closer to recovery. Positive effects, such as compassion, appeared to hold significance long term in participants' recovered lives. Discussion: The detailed exploration of themes in this study provides a deeper understanding of inter-patient relationships during inpatient treatment for AN. This could aid clinical decision-making when choosing appropriate treatment settings for individual patients as well as informing clinical practice in hospital. Public significance: This study closely examines the effect on recovery of relationships with other patients during hospital treatment for AN, a severe eating disorder. Findings might help hospital staff to understand the feelings of those they look after and develop ways to protect patients from the negative effects of peer relationships and enhance the positive ones, to support recovery in hospital.Publication Proactive and integrated consultation-liaison psychiatry for older medical inpatients: A mixed methods description of training, care provided and clinician experience in the HOME study(Elsevier, 2024-01-06) Sharpe, Michael; Toynbee, Mark; van Niekerk, Maike; Solomons, Luke; Owens, Colm; Price, Annabel; Yousif, Michael; Palmer, Aelfrida; Clay, Felix; Berk, Gunes; Burns, Jonathan; Hill, Laura; Harris, Jessica; Bajorek, Tomasz; Sirois-Giguere, Gabrielle; Magill, Nicholas; Aitken, Peter; Dickens, Chris; Walker, Jane; Harris, Jessica; Medical and DentalObjectives: To describe the practical experience of delivering a proactive and integrated consultation-liaison (C-L) psychiatry service model (PICLP). PICLP is designed for older medical inpatients and is explicitly biopsychosocial and discharge-focused. In this paper we report: (a) observations on the training of 15 clinicians (seven senior C-L psychiatrists and eight assisting clinicians) to deliver PICLP; (b) the care they provided to 1359 patients; (c) their experiences of working in this new way. Method: A mixed methods observational study using quantitative and qualitative data, collected prospectively over two years as part of The HOME Study (a randomized trial comparing PICLP with usual care). Results: The clinicians were successfully trained to deliver PICLP according to the service manual. They proactively assessed all patients and found that most had multiple biopsychosocial problems impeding their timely discharge from hospital. They integrated with ward teams to provide a range of interventions aimed at addressing these problems. Delivering PICLP took a modest amount of clinical time, and the clinicians experienced it as both clinically valuable and professionally rewarding. Conclusion: The experience of delivering PICLP highlights the special role that C-L psychiatry clinicians, working in a proactive and integrated way, can play in medical care.Publication Exploring the relationship between dissociative experiences and recovery in psychosis: cross-sectional study(Cambridge University Press, 2025-01-27) Calciu, Claudia; Macpherson, Rob; Rees, Kerry; Chen, Sui Yung; Ruxton, Sarah; White, Rhiannon; Almaskati, Mazen; Hill, Francesca; Vasilis-Peter, Anca; Desando, Sebastian; Pennell, Oliver; Nasubuga, Carolyn; Webb, Jackie; Walker, Mark; Soponaru, Camelia; Calciu, Claudia; Macpherson, Rob; Chen, Sui Yung; Ruxton, Sarah; White, Rhiannon; Almaskati, Mazen; Hill, Francesca; Vasilis-Peter, Anca; Desando, Sebastian; Pennell, Oliver; Nasubuga, Carolyn; Webb, Jackie; Walker, Mark; Admin and Clerical; Allied Health Professional; Medical and DentalAims and method: This study explored the association among dissociative experiences, recovery from psychosis and a range of factors relevant to psychosis and analysed whether dissociative experiences (compartmentalisation, detachment and absorption) could be used to predict specific stages of recovery. A cross-sectional design was used, and 75 individuals with psychosis were recruited from the recovery services of the Gloucestershire Health and Care NHS Foundation Trust. Five questionnaires were used - the Dissociative Experiences Scale - II (DES), Detachment and Compartmentalisation Inventory (DCI), Questionnaire about the Process of Recovery, Stages of Recovery Instrument (STORI), and Positive and Negative Syndrome Scale - and a proforma was used to collect demographic data. Results: Our findings indicated that compartmentalisation, detachment and absorption, as measured by DES and DCI, do not predict stages of recovery as measured by the STORI. Clinical implications: The results of this study suggest that there is no simple relationship between dissociative and psychotic symptoms. They also suggest a need to assess these symptoms separately in practice and indicate that special approaches to treatment of psychosis may be needed in cases where such symptoms have a significant role.Publication It's all about the journey! An online museum-based recovery-oriented art psychotherapy group(Taylor and Francis Group, 2023-06-13) Goodman-Casanova, Jessica Marian; Coles, Ali; Cuesta-Lozano, Daniel; Mayoral-Cleries, Fermin; Coles, Ali; Additional Professional Scientific and TechnicalBackground: Whilst there is evidence of the value of museums for art psychotherapy, evidence about online groups to improve mental health recovery is still scarce. The aim was to assess the impact on mental health recovery of an online museum-based recovery-oriented art psychotherapy group. Context: The group was designed to help adults under the care of a UK community mental health team with their journey of mental health recovery. Approach: The group consisted of six, weekly online sessions and used the collections of two local museums. Quantitative outcome measures and qualitative feedback were used to evaluate the group. Outcomes: Five women participated in the group, and four in the evaluation. Generic wellbeing after each session was rated 4 out of 5. Participants scored higher in the Questionnaire about the Process of Recovery (33.25 vs. 42) and a Visual Numerical Recovery Scale (3 vs. 3.25) after participating in the group. Feeling supported was what participants liked most and found most helpful, and they liked the short duration of the group least. Half found the online setting preferable to face-to-face, and all felt that the museum focus was inspirational, and enjoyed the artmaking. Participants gained a better understanding of their recovery journey and were able to express their emotions better. Conclusions: This group contributed towards participants’ mental health recovery and the museum focus was valued by them. Implications for research: The evaluation findings encourage further exploration of this way of working.Publication Dissociation and recovery in psychosis – an overview of the literature(Frontiers Media, 2024-04-05) Calciu, Claudia; Macpherson, Rob; Chen, Sui Yung; Zlate, Madalina; King, Rosemary; Rees, Kerry; Soponaru, Camelia; Webb, Jackie; Calciu, Claudia; Macpherson, Rob; Webb, Jackie; Medical and Dental; Admin and ClericalBackground: The relationship between dissociation and recovery from psychosis is a new topic, which could attract the interest of the researchers in the field of dissociation due to its relevance to their daily clinical practice. This review brings together a diversity of international research and theoretical views on the phenomenology of dissociation, psychosis and recovery and provides a synthesis by narrative and tabulation of the existing knowledge related to these concepts. Aims: The objective was to make a synthesis by narrative and tabulation about what is known on the topic. Methods: The systematic search was conducted according to the PRISMA-statement in the databases Medline, PsycInfo, PubMed and Google Scholar. 2110 articles were selected according to the inclusion and exclusion criteria detailed in the methods, and 19 records were included in the review. Outcomes: None of the included publications put together, in the same conceptualisation or hypothesis, dissociation and the recovery from an episode of psychosis, therefore this matter remains unstudied at this time. Conclusion: The process of reviewing the existing scientific literature in the field of dissociation and recovery from psychosis has been very useful for charting the direction that future research will take.Publication Demographic, socioeconomic and life-course risk factors for internalized weight stigma in adulthood: evidence from an English birth cohort study(Elsevier, 2024-04-15) Hughes, Amanda; Flint, Stuart; Clare, Ken; Kousoulis, Antonis; Rothwell, Emily; Bould, Helen; Howe, Laura; Bould, Helen; Medical and DentalBackground: Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with demographic, socioeconomic, and wider social factors in a large general population birth cohort study for the first time. Methods: In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences, using confounder-adjusted multivariable regression. Findings: In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (standardized beta: 0.56, 95% CI: 0.50, 0.61), sexual minorities (0.17 S.D. higher, 95% CI: 0.09, 0.24), and less socioeconomically advantaged individuals (e.g., 0.16 S.D. higher (95% CI: 0.08, 0.24) for participants whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (by 0.13 S.D., 95% CI: 0.03, 0.23), and the media (by 0.17, 95% CI: 0.10, 0.25), or had experienced bullying (e.g., 0.25 S.D., 95% CI: 0.17, 0.33 for bullying at age 23 years). Interpretation: Internalized weight stigma differs substantially between demographic groups. Risk is elevated for females, sexual minorities, and socioeconomically disadvantaged adults, and this is not explained by differences in BMI. Pressure to lose weight from family and the media in adolescence may have long-lasting effects on IWS.Publication Autopsy of a failed trial part 2: Outcomes, challenges, and lessons learnt from the DAISIES trial(Wiley, 2023-12-18) İnce, Başak; Phillips, Matthew; Zenasni, Zohra; Shearer, James; Dalton, Bethan; Irish, Madeleine; Mercado, Daniela; Webb, Hannah; McCombie, Catherine; Au, Katie; Kern, Nikola; Clark-Stone, Sam; Connan, Frances; Johnstone, Louise; Lazarova, Stanimira; Zadeh, Ewa; Newell, Ciarán; Pathan, Tayeem; Wales, Jackie; Cashmore, Rebecca; Marshall, Sandra; Arcelus, Jon; Robinson, Paul; Byford, Sarah; Landau, Sabine; Lawrence, Vanessa; Himmerich, Hubertus; Treasure, Janet; Schmidt, Ulrike; Clark-Stone, Sam; Nursing and Midwifery RegisteredObjective: The relative merits of inpatient or day-treatment for adults with anorexia nervosa (AN) are unknown. The DAISIES trial aimed to establish the non-inferiority of a stepped-care day patient treatment (DPT) approach versus inpatient treatment as usual (IP-TAU) for improving body mass index (BMI) at 12 months in adults with AN. The trial was terminated due to poor recruitment. This paper presents outcomes and investigates the reasons behind the trial's failure. Method: Fifteen patients with AN (of 53 approached) participated and were followed-up to 6 or 12 months. Summary statistics were calculated due to low sample size, and qualitative data concerning treatment experiences were analysed using thematic analysis. Results: At baseline, participants in both trial arms rated stepped-care DPT as more acceptable. At 12 months, participants' BMIs had increased in both trial arms. Qualitative analysis highlighted valued and challenging aspects of care across settings. Only 6/12 sites opened for recruitment. Among patients approached, the most common reason for declining participation was their treatment preference (n = 12/38). Conclusions: No conclusions can be drawn concerning the effectiveness of IP-TAU and stepped-care DPT, but the latter was perceived more positively. Patient-related, service-related and systemic factors (COVID-19) contributed to the trial's failure. Lessons learnt can inform future studies.Publication CSP2023: 390 - “My Life” Group Evaluation: How a Co-produced Lifestyle Programme can support Individuals with Severe Mental Illness to live well(Elsevier, 2024-06-18) Dowdeswell, Nicola; Walker, Mark; Willmore, Elaine; Vidal, S; Bayliss, Nigel; MacFarland, Simon; Chidgey, Helen; Vincze, Andrea; Dowdeswell, Nicola; Walker, Mark; Willmore, Elaine; Vidal, S; Bayliss, N; MacFarland, S; Chidgey, Helen; Vincze, Andrea; Allied Health Professional; Admin and Clerical; OtherNo abstract available