Exploring anxiety, depression and their correlates among Implantable Cardioverter Defibrillator (ICD) recipients and people with chronic heart failure

Aims and Objectives:To systematically review factors influencing anxiety and depression in implantable cardioverter defibrillator (ICD) recipients. Background: An ICD is a device used to prevent life-threatening ventricular arrhythmias. While the ICD is accepted by most recipients: a considerable number of patients experience distress following implant. The socio-demographic, clinical, ICD- specific and psychosocial factors associated with distress in ICD-recipients has received increasing attention. Methods:Six electronic databases (Applied Social Science Index and Abstract, CINAHL, EMBASE, Medline, Psychology and Behavioral Sciences Collection and PsycINFO) were searched on the 24/07/2020. Additional papers were identified by hand searching relevant journals, forward citation searching and reviewing the reference lists of included studies. This review was limited to studies on adult patients who received a transvenous or automatic ICD or ICD with cardiac resynchronisation therapy for primary or secondary prevention purposes. Other inclusion criteria were peer reviewed quantitative papers published in English from January 2014 to July 2020, which examined factors influencing anxiety and depression. The quality of the papers was rated using the Crowe Critical Appraisal Tool. Results: Anxiety and depression were linked to socio-demographic factors (female sex, younger age, living alone), clinical factors (heart failure, coronary heart-disease or history of emotional distress/psychotropic medication use), ICD-specific factors (elevated ICD-related concerns, low ICD knowledge, negative treatment expectations), and psychosocial factors (avoidance, perceived control, Type D personality and optimism). Conclusions: All papers suffered from methodological limitations and the findings should be interpreted with caution. Future research employing prospective longitudinal designs with controls for confounding factors is required to understand the relationship between socio-demographic, clinical, ICD-specific and psychosocial factors and distress in ICD-recipients over time. Relevance to clinical practice: Results demonstrated a relationship between elevated ICD-related concerns and increased distress in ICD-recipients. Routine screening for ICD-related concerns may identify patients at risk of anxiety and depression post ICD- implant. Aims and Objectives: To describe the trajectory of anxiety and depression in Chronic Heart Failure (CHF) patients during 12-month follow-up and to identify characteristics independently associated with anxiety and depression. Background: CHF patients with depression and anxiety are at increased risk of poorer outcomes including hospital readmission. There is limited research describing the trajectories of anxiety and depression in CHF patients over time. Design: The study was a secondary analysis of data collected in a longitudinal study investigating the palliative care needs of 272 CHF patients in Glasgow. Methods: Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) at baseline and every four-months. Results: From baseline to 12-months, there was a significant reduction in the proportion of CHF patients reporting symptoms of anxiety (43.5% vs 25%) and depression (40% vs 27.4%). Looking at change in HADS scores over 12-months, 54.3% of patients were free of significant anxiety at all assessments, 21.7% showed an improvement in initially distressing anxiety, and 2.2% developed anxiety as the study progressed. Based on change in HADS depression scores across 12-months, 53.7% did not report significant depression, 18.9% experienced resolution of depression symptoms, and 6.3% went on to develop depression as the study progressed. One in five patients experienced persistent anxiety and depression throughout. In regression analysis, baseline anxiety, health- related quality of life, history of depression and female sex emerged as predictors of anxiety, while baseline depression, history of depression, antidepressant medication use, and female sex predicted depression. Conclusions: Results suggest a significant reduction in the proportion of CHF patients reporting clinically significant anxiety and depression from baseline to 12-month follow- up. Although there was a subset of participants that experienced persistent symptoms of anxiety and depression. Relevance to Clinical Practice: Routine screening for anxiety and depression in CHF patients is recommended

Restorative justice and the prevention of youth reoffending

D.App.Ed.Psy ThesisThis thesis is made up of three papers. The first is a systematic literature review investigating the effectiveness of restorative justice interventions on reducing the reoffending rate of young people. The review consists of nine studies, the majority of which (N=8) found that there was no significant difference between the impact of restorative justice interventions, and other interventions targeting young offenders, on the rate of reoffending. One study found that restorative justice interventions had a significant positive effect at a three-year follow-up period. Following this, recommendations were made for future research. This included the exploration of the views of restorative justice Case Managers as to what factors are important in enabling restorative justice interventions to prevent young people reoffending. The second paper is a bridging document which explains how key decisions throughout the process of completing this piece of work were made, and makes explicit the journey from the Systematic Review to the Research Project. This includes the focus of the research, methodology, method and analysis. The bridging document also explores the areas of ontology, epistemology, reflexivity and ethical issues. The third paper describes a piece of empirical research. In line with recommendations in the Systematic Review, the views of restorative justice Case Managers from a Youth Justice Service were explored regarding the factors that they considered important in delivering a restorative justice intervention that is successful in reducing reoffending. A group interview was used to elicit the views of the Case Managers. Through applying a thematic analysis to the data, six themes emerged; learning, community, enabling change, a holistic approach, professional skill and overcoming systemic barriers. A model is proposed to highlight the relationship between dialogic space and the six themes identified through analysis, in supporting the competence, autonomy and relatedness of young people as conceptualised in self-determination theory. It was concluded that Educational Psychologists have an important role to play in supporting services to develop and deliver interventions with positive outcomes for children and young people. The benefits and limitations of using a group interview are discussed. Implications for the practice of Educational Psychologists, and suggestions for further research, are explored

Discriminating between Autism and Disinhibited Social Engagement Disorder in a clinical context

Clinicians are concerned about making accurate differential diagnoses between Autism and Disinhibited Social Engagement Disorder (DSED) because both groups of children may present with social relationship and communication difficulties, yet DSED is associated with maltreatment and Autism is not. The overall objective of the thesis was to identify any skills or behaviours which may help clinicians discriminate between these two diagnostically distinct groups. This thesis brings together the findings of an-depth case study investigation, discussed across four separate but related papers, each of which addresses a gap in our knowledge regarding DSED, and how it may be differentiated from Autism. Paper 1 is a systematic review assessing the social functioning of children with DSED. Paper 2 directly compares the profiles of children with Autism, children with DSED and children who are typically developing (TD) via current ‘gold standard’ autism assessment and an unstructured behavioural observation called the Live assessment. Papers 3 and 4 expand on the areas of possible differentiation which were highlighted in papers 1 and 2; language and social communication (paper 3) and sensory processing (paper 4). Specific differences in skills/behaviours of children with Autism in the case study, compared to the children with DSED, were most apparent within the domain of social communication, suggesting that future research focused on differentiating Autism from DSED should focus on this area. There was also a tentative suggestion that some sensory behaviours may be more ‘Autism-specific.’ For complex cases, a change in approach from standardised structured Autism assessment to a holistic neurodevelopmental approach using unstructured observation, which includes conversational elements, and increases the social challenge may more easily elucidate the differences between core Autism behaviours, DSED-specific behaviours and other co-occurring neurodevelopmental conditions like Attention-Deficit/Hyperactivity Disorder (ADHD) which can complicate the picture. While awareness raising and training may be indicated, we do have tools, like the Live assessment and clinical expertise, such as Speech and Language Therapists (SLTs), available, which can be utilised to support differential diagnosis of the ‘hard to assess’ cases

A Four-Nation Comparison of Kinship Care in the UK: The Relationship between Formal Kinship Care and Deprivation

The practice of extended family and friends helping to care for children when their parents are unable to is an enduring tradition in many cultures. Kinship care provides the largest proportion of out of home care in Western society but many of these carers experience poverty and deprivation, and do not receive comparable levels of support, financial or professional, to other placement types. This study provides UK evidence for the relationship between kinship care and deprivation and examines how the welfare state frames kinship care in policy and practice

Scurvy, Abnormal MRI, and Gelatinous Bone Marrow in an Adolescent with Avoidant Restrictive Food Intake Disorder

BACKGROUND: Although medical literature describes pediatric scurvy as rare , a growing number of case reports suggests otherwise. Patients often undergo costly and unnecessary workup due to unfamiliarity with the presentation of scurvy. This case report further supports the small yet growing literature documenting scurvy and its manifestations in patients with eating disorders. CASE PRESENTATION: A 15-year-old female presented to the emergency department with bilateral knee and ankle swelling and pain in the setting of chronic lower limb rash and BMI of 16.3. For years, she had restricted her diet to carbohydrates. Exam showed perifollicular petechial hemorrhagic rash with corkscrew hairs, knee edema, ankle edema with restricted range of motion, and antalgic gait. She was admitted for severe malnutrition from avoidant restrictive food intake disorder. Her hospital course was complicated by recurrent normocytic anemia and fever. Hematology workup revealed anemia from iron deficiency, vitamin K deficiency, and anemia of chronic disease. Rheumatology workup was negative. MRI findings showed dark T1 and bright T2 signals and were read as consistent with leukemia/lymphoma, chronic multifocal osteomyelitis, or Langerhans cell histiocytosis. However, bone marrow biopsy showed gelatinous transformation secondary to malnutrition. She was treated with vitamin C and a nutrition plan and her symptoms improved. CONCLUSIONS: Although this patient had common manifestations of scurvy, including perifollicular petechial hemorrhagic rash, joint effusions, anemia, and recurrent fevers, she still underwent an extensive workup. Clinicians should be aware that scurvy can present with multiple symptoms that mimic infectious, rheumatic, oncologic and hematological disease. Clinicians should have a high index of suspicion for scurvy in patients with malnutrition and eating disorders