Interventions to Support Integrated Psychological Care and Holistic Health Outcomes in Paediatrics

There are strong calls from many national and international bodies for there to be a ‘holistic’ and integrated approach to the understanding and management of psychological and physical health needs. Such holistic approaches are characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease. Holistic approaches can impact on mental and physical health and are cost-effective. Several psychological interventions have demonstrated efficacy in improving holistic health outcomes, for example Cognitive Behaviour Therapy, Behavioural Therapies and Problem Solving Therapies. They have shown to impact upon a wide range of outcomes, including psychological distress, pain, physical health, medication adherence, and family outcomes. There is increasing recognition that the holistic goals of the child and family should be prioritised, and that interventions and outcomes should reflect these goals. A focus on holistic goals in therapy can be achieved through a combination of personalised goal-based outcomes in addition to symptom-based measures. View Full-Tex

An experimental investigation into the use of eye‐contact in social interactions in women in the acute and recovered stages of anorexia nervosa

Cognitive remediation therapy (CRT) is a low-intensity treatment adjunct for individuals with severe and complex anorexia nervosa (AN) with difficulties in globally oriented, flexible thinking. Previously trialled in adults, this study investigated whetherindividual and group CRT was a feasible, acceptable and beneficial treatment for 125 adolescent inpatients with severe and complex AN. Seventy patients (mean age=15.22, SD=1.44) received 10 sessions of individual CRT and 55 patients (mean age=14.89, SD=1.74) received 10 sessions of group CRT. In individual CRT, 1 patient (1.43%) dropped out and there were medium-sized improvements in bigger picture thinking and set-shifting, small to large-sized improvements in switching-related initiation and inhibition skills and large-sized improvements in motivation to recover. Group CRT had higher drop-out (9.09%;n=5) and produced small-sized improvements in global information processing and medium-sized improvements in self-reported cognitive flexibility and high acceptability ratings. Data suggest a randomised controlled trial for adolescents with AN is warranted

Development of a Novel EEG Paradigm to Investigate the Neural Correlates of Children’s Emotion Understanding

Emotion understanding is a key foundation of social skills (e.g. Denham et al., 2003; Izard et al., 2001) and thus research into its determinants is a potentially important area for clinical and developmental psychology. This thesis investigates the development of emotion understanding in young children. Part one is a literature review of 23 papers examining the relationship between attachment and emotion understanding in children. A summary of the papers is presented, before reflections on the meaning of the results. Overall, secure attachment appears to be related to superior emotion understanding. However, larger, well-controlled studies are needed to better understand the association. Part two presents an empirical paper focused on the development of a novel Electroencephalogram (EEG) paradigm to investigate emotion understanding in 6-year-old children. The children tested formed part of a cohort of children who had taken part in a previous study, in which their attachment to their primary care-giver was profiled. The study is the first to demonstrate Event Related Potentials (ERPs) associated with emotion understanding in young children. Specifically, a Late Positive Potential (LPP) was found to be an index of emotion understanding. The paper investigates associations between ERPs and social competence measures, and with security of attachment. The empirical research was undertaken with Sarah Carman (Carman, 2013). Part three provides a critical appraisal of the research process. It considers difficulties encountered in producing externally valid research. Issues in the development of the EEG paradigm, methodological difficulties in ERP research, and measure selection are discussed

Commentary: All that glisters is not gold – reflections on Hollis et al. 2017

Digital Health Innovations have great potential to improve access to evidence-based psychological therapies. This comprehensive review and meta-analysis sets out the current state of the field including the efficacy of the interventions for different types of mental health problems and the desirability of the interventions from the patients’ perspective. It also highlights the poor methodology of much of the research and suggests important ways forward to improve the quality of the data. The importance of assessing and understanding the potential negative impact of such interventions is emphasised both in the review and the commentary, and suggestions are made to maximise the likelihood that such interventions are accessible within routine services

A multivariate analysis of the relationship between response and survival among patients with higher-risk myelodysplastic syndromes treated within azacitidine or conventional care regimens in the randomized AZA-001 trial.

The phase III AZA-001 study established that azacitidine significantly improves overall survival compared with conventional care regimens (hazard ratio 0.58 [95% confidence interval 0.43–0.77], P<0.001). This analysis was conducted to investigate the relationship between treatment response and overall survival. AZA-001 data were analyzed in a multivariate Cox regression analysis with response as a time-varying covariate. Response categories were “Overall Response” (defined as complete remission, partial remission, or any hematologic improvement) and “Stable Disease” (no complete or partial remission, hematologic improvement, or progression) or “Other” (e.g. disease progression). Achieving an Overall Response with azacitidine reduced risk of death by 95% compared with achieving an Overall Response with the conventional care regimens (hazard ratio 0.05 [95%CI: 0.01–0.43], P=0.006). Sensitivity analyses indicated that significantly improved overall survival remained manifest for patients with a hematologic improvement who had never achieved complete or partial remission (hazard ratio 0.19 [95%CI: 0.08–0.46], P<0.001). Stable Disease in both azacitidine-treated and conventional care-treated patients was also associated with a significantly reduced risk of death (hazard ratio 0.09, [95%CI: 0.06–0.15]; P<0.001). These results demonstrate azacitidine benefit on overall survival compared with conventional care regimens in patients with higher-risk myelodysplastic syndromes who achieve hematologic response but never attain complete or partial remission, in addition to the survival advantage conferred by achievement of complete or partial remission. This study was registered with clinicaltrials.gov (NCT00071799)

Simple or complex? a case study of physical and mental health comorbidity

People with epilepsy are significantly more likely to have a mental health disorder than those without a chronic illness. The reasons for this are multiple but may include the mental health difficulties being perceived as complex due to the presence of a chronic illness. In part due to the apparent complexity of the co-occurring physical and mental illness, many are not offered evidence-based treatment (EBT) for the mental health disorder. There is little guidance to inform clinicians about the interventions to use to treat mental health disorders in people with epilepsy. The present paper reports a case of treatment for depression using a standard EBT in a young person with epilepsy. The patient also had clinically significant symptoms of anxiety and an eating disorder and would be considered ‘complex’ according to standard criteria. The intervention, however, was relatively simple and was delivered as guided self-help via 10 weekly telephone calls of approximately 30 minutes duration, and two follow-up calls at one month and three months post-intervention. Self-report and parent-report questionnaire measures were completed before and after the intervention, and at both follow-up time points. A blind-rated online diagnostic interview measure was also completed before and after the intervention. The young person and her family also completed a qualitative interview of their experiences of the intervention. This simple intervention was effective in working towards the client's goals, although pre–post measurement on standard measures was variable. This interesting case raises questions about whether patients with mental and physical comorbidities are complex, or just perceived as complex

Measurement Issues: The measurement of obsessive compulsive disorder in children and young people in clinical practice

BACKGROUND: If left untreated, obsessive compulsive disorder (OCD) can cause significant distress and impact on functioning throughout the lifespan. Despite the severity of the disorder, there is often a significant delay between the onset of symptoms and successful treatment. This is in part due to delays in recognising OCD symptoms in young people, particularly if the symptom forms are less common. Once OCD is accurately diagnosed, cognitive behavioural therapy (CBT) is known to be an efficacious treatment, sometimes in combination with medication, producing good long-term prognosis. It is therefore important to accurately detect OCD in children and young people so that they can be offered timely intervention. Use of the best tools in clinical and research settings improves detection and diagnosis, as well as enabling the tracking of progress through treatment. The aim of this current paper was to review measurement tools for OCD in young people with a focus on the practicalities of using tools in busy child mental health clinical settings. METHOD: To discover what measurement tools are available for OCD in young people, we conducted a pragmatic literature of measurement tools for OCD in young people. We searched PsycINFO, Med-Line and the Cochrane databases for reports relating to the measurement of OCD. Additionally, we sought information from the National Institute for Health and Care Excellence (NICE) guidance, the Child Outcomes Research Consortium (CORC) website and the Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) Programme. We also reviewed large trials and meta-analyses of the treatment of OCD in young people and communicated with relevant researchers/clinicians. RESULTS: Seventeen questionnaire measurement tools, with variable psychometric properties, and four commonly used semistructured clinician administered interview measures were identified. CONCLUSIONS: There are several measurement tools with good psychometric properties that are useful for initial screening/identification of OCD, as well as formal diagnosis, symptom tracking and treatment evaluation. With the availability of brief screens, as well as online diagnostic measures, such tools should not be a burden on clinical practice, but rather a helpful aid to support clinicians' assessment and treatment of OCD

A Mental Health Drop-In Centre Offering Brief Transdiagnostic Psychological Assessment and Treatment in a Paediatric Hospital Setting: A One-Year Descriptive Study

Aim: This study was part of a broader project to examine the acceptability, feasibility and impact of a transdiagnostic mental health drop-in centre offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long-term physical health conditions (LTCs). The aims of this investigation were to characterise: (i) the use of such a centre, (ii) the demographics and symptoms of those presenting to the centre, and (iii) the types of support that are requested and/or indicated. Methods: A mental health “booth” was located in reception of a national paediatric hospital over one year. Characteristics of young people with LTCs and their siblings/parents attending the booth were defined. Emotional/behavioural symptoms were measured using standardised questionnaires including the Strengths and Difficulties Questionnaire (SDQ). Participants subsequently received one of four categories of intervention: brief transdiagnostic cognitive behaviour therapy (CBT), referral to other services, neurodevelopmental assessment or signposting to resources. Results: One hundred and twenty-eight participants were recruited. The mean age of young people was 9.14 years (standard deviation: 4.28); 61% identified as white and 45% were male. Over half of young people recruited scored in the clinical range with respect to the SDQ. Presenting problems included: anxiety (49%), challenging behaviour (35%), low mood (22%) and other (15%). Conclusions: A considerable proportion of young people with LTC in a paediatric hospital scored in the clinical range for common mental health problems, indicating a potential for psychological interventions

Neural correlates of children's emotion understanding

This study aimed to develop an EEG paradigm to identify neural correlates of emotion understanding in children. In Experiment 1, children took part in an emotional story task. In Experiment 2, children completed an emotional task and a physical story task Late Positive Potentials (LPP) were demonstrated in response to emotional content in both studies. Together, The study demonstrates the potential value of the LPP as a flexible probe for studying children’s emotion understanding and encourages further work into the specificity versus generality of cognitive processes underpinning the LPP in social information processing

Overdiagnosis in breast cancer screening: the importance of length of observation period and lead time

PMCID: PMC3706885This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited