Diversity learning through story and connection: ZHE:[noun] undefined

This is a pre-print of an article published in Clinical Psychology Forum. The definitive publisher-authenticated version for Nolte, L. & Kramo, K. (2016) Diversity learning through story and connection: ZHE:[noun] undefined, Clinical Psychology Forum, 283: 20-24 can be found here: http://shop.bps.org.uk/publications/publication-by-series/clinical-psychology-forum/clinical-psychology-forum-no-283-july-2016.htmlThis paper reports on a diversity theatre workshop at University of Hertfordshire Doctorate in Clinical Psychology Programme as an example of enabling, rigorous and adventurous diversity learning.Peer reviewedFinal Accepted Versio

Reviewing the Evidence for NICE Recommended Psychotherapies for Depression

Introduction: Depression is a common mental health problem affecting 1 in 6 people in the UK, which represents a considerable burden (Lépine and Briley, 2011). Cognitive behavioural therapy (CBT) is recommended by the National Institute for Heath and Care Excellence (NICE) as first line treatment for depression on the basis of the evidence available in the depression guidelines (NCCMH, 2010). However, there remains controversy and debate about the strength of the evidence supporting CBT, the relative efficacy of psychotherapies and concerns about the current evidence‐based practice paradigm used by NICE to recommend psychotherapies. The current project aimed to examine the secondary evidence base for CBT and other psychological therapies recommended by NICE for the treatment and management of adult depression. Methods: An exploratory data analysis was conducted to assess the strength of the evidence, using meta‐analytic outcomes as units of analysis (effect sizes and risk associations) for CBT and other psychotherapies. Further analysis examined the relationship between different evidence characteristics (including treatment comparators, study quality etc.) and meta‐analytic outcomes for the two psychotherapy groups. Results: The analyses revealed significant differences in the overall mean effect sizes for CBT and other psychotherapies, which consisted of larger mean effects within the other psychotherapy group. However, the evidence base within the CBT group was stronger than the other psychotherapies group when the two groups were compared to medication comparators. Furthermore, significant relationships were found between the psychotherapy effects and evidence quality, suggesting that greater amounts of low quality evidence associated with favourable effects for CBT. Implications: The findings in this review question the strength of the evidence base for CBT as a front line psychological intervention for the treatment of depression, particularly when considered against the collective evidence for other psychotherapies. The findings highlight how guideline evidence used to recommend psychological treatments of depression are constructed to fit within a medical context and the impact that this has on the choice of psychotherapies available to clients and practitioners are considered

Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial

Background Aggressive challenging behaviour is frequently reported in adults with intellectual disability and it is often treated with antipsychotic drugs. However, no adequate evidence base for this practice exists. We compared fl exible doses of haloperidol (a typical, fi rst generation antipsychotic drug), risperidone (an atypical, second-generation antipsychotic), and placebo, in the treatment of this behaviour. Methods 86 non-psychotic patients presenting with aggressive challenging behaviour from ten centres in England and Wales, and one in Queensland, Australia, were randomly assigned to haloperidol (n=28), risperidone (n=29), or placebo (n=29). Clinical assessments of aggression, aberrant behaviour, quality of life, adverse drug eff ects, and carer uplift (positive feelings about the care of the disabled person) and burden, together with total costs, were recorded at 4, 12, and 26 weeks. The primary outcome was change in aggression after 4 weeks’ treatment, which was recorded with the modifi ed overt aggression scale (MOAS). Analysis was by intention to treat. This study is registered as ISRCTN 11736448. Findings 80 patients had adherence of 80% or more to prescribed drug. Aggression decreased substantially with all three treatments by 4 weeks, with the placebo group showing the greatest change (median decrease in MOAS score after 4 weeks=9 [95% CI 5–14] for placebo, 79% from baseline; 7 [4–14] for risperidone, 58% from baseline; 6·5 [5–14] for haloperidol, 65% from baseline; p=0·06). Furthermore, although no important diff erences between the treatments were recorded, including adverse eff ects, patients given placebo showed no evidence at any time points of worse response than did patients assigned to either of the antipsychotic drugs. Interpretation Antipsychotic drugs should no longer be regarded as an acceptable routine treatment for aggressive challenging behaviour in people with intellectual disability

Prevalence of health anxiety problems in medical clinics

Objectives: To determine the prevalence of significant health anxiety (hypochondriasis) in patients aged 16-75 in cardiology, respiratory medicine, neurological, endocrine and gastrointestinal clinics in general hospitals in London, Middlesex and North Nottinghamshire. Method: The Health Anxiety Inventory (HAI) (short form) was administered to patients attending the five clinics over a 21. month period and all those who scored 20 or more invited to take part in a further assessment for a randomised controlled trial. Results: Of 43,205 patients attending the clinics 28,991 (67.1%) were assessed and of these, after exclusion of ineligible patients 5747 (19.8%) had significant health anxiety. 444 subsequently agreed to take part in a randomised controlled trial of treatment. The prevalence levels varied by clinic with neurology (24.7%) having the highest prevalence followed by respiratory medicine (20.9%), gastroenterology (19.5%), cardiology (19.1%), and endocrinology (17.5%). Conclusion: Abnormal health anxiety is common and a significant problem in those attending medical clinics and deserves greater awareness. © 2011 Elsevier Inc.