Experiences of women in secure care who have been prescribed clozapine for borderline personality disorder

Background: Clozapine is an atypical antipsychotic medicine which can cause significant side-effects. It is often prescribed off-license in severe cases of borderline personality disorder contrary to national treatment guidelines. Little is known about the experiences of those who take clozapine for borderline personality disorder. We explored the lived-experience of women in secure inpatient care who were prescribed clozapine for borderline personality disorder. Findings: Adult females (N=20) participated in audio-taped semi-structured interviews. Transcripts were subject to thematic analysis. The central themes related to evaluation, wellbeing, understanding and self-management; for many, their subjective wellbeing on clozapine was preferred to prior levels of functioning and symptomatology, sometimes profoundly so. The negative and potentially adverse effects of clozapine were explained as regrettable but relatively unimportant. Conclusions: When psychological interventions are, at least initially, ineffective then clozapine treatment is likely to be evaluated positively by a group of women with borderline personality disorder in secure care despite the potential disadvantages

Assessing the mental health needs of looked after children : a study investigating the utility of the brief assessment checklist for children.

Background: Looked after children (LAC) are a unique clinical group who, as a result of multiple trauma and disrupted attachment in early life, often present with complex mental health needs. In order to develop a meaningful formulation and provide suitable treatment for these children, the assessment of mental health difficulties in LAC is paramount. However, limited measures have been developed with LAC in mind and very few have been validated in this population. A recent literature review (Denton, Frogley, Jackson, John & Querstret, 2016) identified the Brief Assessment Checklist for Children (BAC-C; Tarren-Sweeney, 2007) as a potential screening tool for LAC aged 4-11 years. The aim of the current study was to explore the utility and psychometric properties of the BAC-C in a UK LAC population. Design: The study used a mixed-method design. A total of 178 foster/kinship carers completed two questionnaires about a LAC aged 4-11 years: the BAC-C and Strengths and Difficulties Questionnaire (SDQ). Participants were also asked questions about the utility of both questionnaires. Secondly, telephone interviews with five foster carers and two focus groups with professionals working in Child and Adolescent Mental Health Services (CAMHS) were conducted to gather qualitative data about the utility of the BAC-C. Results: The BAC-C total score was significantly correlated with exposure to sexual abuse, a previous referral to CAMHS, SDQ total and subscale scores. The SDQ total scale was the strongest predictor of the BAC-C score, followed by Emotional Problems, Conduct and the remaining SDQ subscales. The factor analysis could not determine a clinically meaningful factor structure. Finally, the thematic analysis revealed three overarching themes regarding the BAC-C: content, format and design and ways of using the information. Conclusion: The BAC-C demonstrated many psychometric strengths in terms of reliability and validity. This was also supported by the qualitative data. However, several limitations of the measure were also revealed and were discussed in the context of mental health services for children

Assessing the mental health needs of looked after children : a study investigating the utility of the brief assessment checklist for children.

Background: Looked after children (LAC) are a unique clinical group who, as a result of multiple trauma and disrupted attachment in early life, often present with complex mental health needs. In order to develop a meaningful formulation and provide suitable treatment for these children, the assessment of mental health difficulties in LAC is paramount. However, limited measures have been developed with LAC in mind and very few have been validated in this population. A recent literature review (Denton, Frogley, Jackson, John & Querstret, 2016) identified the Brief Assessment Checklist for Children (BAC-C; Tarren-Sweeney, 2007) as a potential screening tool for LAC aged 4-11 years. The aim of the current study was to explore the utility and psychometric properties of the BAC-C in a UK LAC population. Design: The study used a mixed-method design. A total of 178 foster/kinship carers completed two questionnaires about a LAC aged 4-11 years: the BAC-C and Strengths and Difficulties Questionnaire (SDQ). Participants were also asked questions about the utility of both questionnaires. Secondly, telephone interviews with five foster carers and two focus groups with professionals working in Child and Adolescent Mental Health Services (CAMHS) were conducted to gather qualitative data about the utility of the BAC-C. Results: The BAC-C total score was significantly correlated with exposure to sexual abuse, a previous referral to CAMHS, SDQ total and subscale scores. The SDQ total scale was the strongest predictor of the BAC-C score, followed by Emotional Problems, Conduct and the remaining SDQ subscales. The factor analysis could not determine a clinically meaningful factor structure. Finally, the thematic analysis revealed three overarching themes regarding the BAC-C: content, format and design and ways of using the information. Conclusion: The BAC-C demonstrated many psychometric strengths in terms of reliability and validity. This was also supported by the qualitative data. However, several limitations of the measure were also revealed and were discussed in the context of mental health services for children

‘They don’t meet the stereotypes in the boxes…’ - Foster carers' and clinicians' views on the utility of psychometric tools in the mental health assessment of Looked After Children

Background: Looked-after children (LAC) frequently experience greater mental health challenges than the general child population. There has been a call for greater focus on early preventative interventions and priority access to specialist mental health support for this population. Brief mental health screening tools often provide the gateway to services and yet there is a lack of suitable assessment tools available for LAC. The current study is the first to explore the perspectives of foster carers and CAMHS clinicians’ in relation to the use of two brief screening tools; the Strengths and Difficulties Questionnaire (SDQ) and the Brief Assessment Checklists (BAC’s). Method: Qualitative data was collected via semi-structured telephone interviews and face-to-face focus groups with female foster carers (N=13) and clinicians working in a CAMHS setting (N=9). Results: Thematic analyses generated six themes which were organised into three superordinate themes centred around: 1) relevance to LAC, 2) using measures to inform care planning and; 3) current problems when using psychometric measures within the LAC population. Foster carers and clinicians emphasised the need for a comprehensive understanding of LAC given the complexity of their difficulties. There was acknowledgement that psychometric measures could facilitate and contribute to this by highlighting difficulties, providing accurate feedback to carers and clinicians, and enabling access to support. However, both groups seldom felt that current measures were nuanced enough to adequately capture the needs of LAC. Conclusion: Screening tools play a crucial role in identifying the mental health needs of LAC and facilitating access to services. Further research is needed to establish the ability of such measures to increase the sensitivity of the complex needs’ assessment of LAC. A number of clinical recommendations are also discussed in relation to the assessment of mental health in the LAC population.</p

‘They don’t meet the stereotypes in the boxes…’ - Foster carers' and clinicians' views on the utility of psychometric tools in the mental health assessment of Looked After Children

Background: Looked-after children (LAC) frequently experience greater mental health challenges than the general child population. There has been a call for greater focus on early preventative interventions and priority access to specialist mental health support for this population. Brief mental health screening tools often provide the gateway to services and yet there is a lack of suitable assessment tools available for LAC. The current study is the first to explore the perspectives of foster carers and CAMHS clinicians’ in relation to the use of two brief screening tools; the Strengths and Difficulties Questionnaire (SDQ) and the Brief Assessment Checklists (BAC’s). Method: Qualitative data was collected via semi-structured telephone interviews and face-to-face focus groups with female foster carers (N=13) and clinicians working in a CAMHS setting (N=9). Results: Thematic analyses generated six themes which were organised into three superordinate themes centred around: 1) relevance to LAC, 2) using measures to inform care planning and; 3) current problems when using psychometric measures within the LAC population. Foster carers and clinicians emphasised the need for a comprehensive understanding of LAC given the complexity of their difficulties. There was acknowledgement that psychometric measures could facilitate and contribute to this by highlighting difficulties, providing accurate feedback to carers and clinicians, and enabling access to support. However, both groups seldom felt that current measures were nuanced enough to adequately capture the needs of LAC. Conclusion: Screening tools play a crucial role in identifying the mental health needs of LAC and facilitating access to services. Further research is needed to establish the ability of such measures to increase the sensitivity of the complex needs’ assessment of LAC. A number of clinical recommendations are also discussed in relation to the assessment of mental health in the LAC population.</p

The assessment of developmental trauma in children and adolescents: A systematic review

Background: The assessment of children and young people with history of complex developmental trauma presents a significant challenge to services. Traditional diagnostic categories such as post-traumatic stress disorder (PTSD) are argued to be of limited value, and while the proposed ‘Developmental Trauma Disorder’ definition attempts to address this debate, associated assessment tools have yet to be developed. This review builds on a previous review of assessment measures, undertaken in 2005. Aim: To identify trauma assessment tools developed or evaluated since 2004 and determine which are developmentally appropriate for children or adolescents with histories of complex trauma. Method: A systematic search of electronic databases was conducted with explicit inclusion and exclusion criteria. Results: A total of 35 papers were identified evaluating 29 measures assessing general functioning and mental health (N = 10), PTSD (N = 7) and trauma symptomatology outside, or in addition to, PTSD (N = 11). Studies were evaluated on sample quality, trauma/adversity type, as well as demographic and psychometric data. Distinction was made between measures validated for children (0–12 years) and adolescents (12–18 years). Conclusion: Few instruments could be recommended for immediate use as many required further validation. The Assessment Checklist questionnaires, designed with a developmental and attachment focus, were the most promising tools.</p

The assessment of developmental trauma in children and adolescents: A systematic review

Background: The assessment of children and young people with history of complex developmental trauma presents a significant challenge to services. Traditional diagnostic categories such as post-traumatic stress disorder (PTSD) are argued to be of limited value, and while the proposed ‘Developmental Trauma Disorder’ definition attempts to address this debate, associated assessment tools have yet to be developed. This review builds on a previous review of assessment measures, undertaken in 2005. Aim: To identify trauma assessment tools developed or evaluated since 2004 and determine which are developmentally appropriate for children or adolescents with histories of complex trauma. Method: A systematic search of electronic databases was conducted with explicit inclusion and exclusion criteria. Results: A total of 35 papers were identified evaluating 29 measures assessing general functioning and mental health (N = 10), PTSD (N = 7) and trauma symptomatology outside, or in addition to, PTSD (N = 11). Studies were evaluated on sample quality, trauma/adversity type, as well as demographic and psychometric data. Distinction was made between measures validated for children (0–12 years) and adolescents (12–18 years). Conclusion: Few instruments could be recommended for immediate use as many required further validation. The Assessment Checklist questionnaires, designed with a developmental and attachment focus, were the most promising tools.</p

Confinement of iodine molecules into triple-helical chains within robust metal–organic frameworks

During nuclear waste disposal process, radioactive iodine as a fission product can be released. The widespread implementation of sustainable nuclear energy thus requires the development of efficient iodine stores that have simultaneously high capacity, stability and more importantly, storage density (and hence minimized system volume). Here, we report high I₂ adsorption in a series of robust porous metal–organic materials, MFM-300­(M) (M = Al, Sc, Fe, In). MFM-300­(Sc) exhibits fully reversible I₂ uptake of 1.54 g g^–1, and its structure remains completely unperturbed upon inclusion/removal of I₂. Direct observation and quantification of the adsorption, binding domains and dynamics of guest I₂ molecules within these hosts have been achieved using XPS, TGA-MS, high resolution synchrotron X-ray diffraction, pair distribution function analysis, Raman, terahertz and neutron spectroscopy, coupled with density functional theory modeling. These complementary techniques reveal a comprehensive understanding of the host–I₂ and I₂–I₂ binding interactions at a molecular level. The initial binding site of I₂ in MFM-300­(Sc), I₂^I, is located near the bridging hydroxyl group of the [ScO₄(OH)₂] moiety [I₂^I···H–O = 2.263(9) Å] with an occupancy of 0.268. I₂^II is located interstitially between two phenyl rings of neighboring ligand molecules [I₂^II···phenyl ring = 3.378(9) and 4.228(5) Å]. I₂^II is 4.565(2) Å from the hydroxyl group with an occupancy of 0.208. Significantly, at high I₂ loading an unprecedented self-aggregation of I₂ molecules into triple-helical chains within the confined nanovoids has been observed at crystallographic resolution, leading to a highly efficient packing of I₂ molecules with an exceptional I₂ storage density of 3.08 g cm^–3 in MFM-300­(Sc)

CCDC 1558482: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures

CCDC 1558481: Experimental Crystal Structure Determination

An entry from the Cambridge Structural Database, the world’s repository for small molecule crystal structures. The entry contains experimental data from a crystal diffraction study. The deposited dataset for this entry is freely available from the CCDC and typically includes 3D coordinates, cell parameters, space group, experimental conditions and quality measures