Developing a Dynamic Understanding of Risk Factors for People Admitted to Long-term High Dependency Units

Even with developments in supporting people with enduring psychosis, some people living with these difficulties still require specialised care in inpatient rehabilitation facilities. To optimise the support provided a service evaluation was conducted for people admitted to a Long-term High Dependency Unit service. Data collected routinely with the Short-Term Assessment for Risk and Treatability tool was used to identify dynamic risk factors for the residents. Completed assessments were analysed for frequency and severity of risk behaviours; historic prevalence of risk behaviours; judgements on future risk; and strengths and vulnerabilities. The evaluation indicated a picture of a group of people who have a variety of historic risks and currently engage regularly in aggression and self-neglect, whilst experiencing limited insight, social exclusion, and limited coping abilities. Strengths and vulnerabilities linked to risk behaviours were also grouped into conceptually similar domains to aid intervention. Recommendations are made for using such data to enhance recovery

Acute aggression risk: an early warning signs methodology

1. Abstract 1.1. Purpose Predicting the imminence of high risk behaviours in in-patients with schizophrenia is an ongoing concern. This study explores the utility, validity and reliability of an adapted early warning signs methodology for dynamic risk assessment. 1.2. Design Nursing staff were interviewed to identify operationally defined early warning signs of high risk behaviours. Frequency of occurrence of the early warning signs and the high risk behaviour were rated over a one week period to establish the predictive validity of the methodology. 1.3. Findings Support was found for the reliability of staff ratings of the relevance of identified early warning signs and their occurrence within a specified time period. ROC analysis indicates some modest predictive validity in predicting aggressive risk behaviours but effect sizes were small, and there were high rates of false positive predictions. 1.4. Value A dynamic risk assessment methodology to assess changes in risk for inpatients would benefit both staff and inpatients. No such methodology has been assessed to date. 1.5. Research Limitations The small sample size limits generalisability. A longitudinal prospective study to better establish the added predictive power of the method over the use of largely actuarial methods is needed

A 10-year follow-up service evaluation of the treatment pathway outcomes for patients in nine in-patient psychiatric rehabilitation services

Aims and method This study examines the treatment pathway outcomes over a 10-year period for patients in nine rehabilitation wards at the beginning of this time period. Results Data were obtained on 85 patients, of whom 59 were discharged during the 10-year period; 29 were readmitted, of whom 15 had further in-patient rehabilitation admissions. Nineteen patients remained in hospital throughout the period. Only nine patients were living independently at the time of follow-up or death, and 34 were in longer-term in-patient settings. Eighteen patients had died during the 10-year period. Clinical implications New planning of rehabilitation services needs to ensure an integrated whole-systems approach, across in-patient and community settings, with specialist mental health rehabilitation teams to support people moving from hospital to the community, and for the small number remaining in hospital for very long periods, development of sufficient high-quality, local in-patient provision

Endophytic bacterial diversity in the phyllosphere of Amazon Paullinia cupana associated with asymptomatic and symptomatic anthracnose

Background Acting on harmful command hallucinations is a major clinical concern. Our COMMAND CBT trial approximately halved the rate of harmful compliance (OR = 0.45, 95% CI 0.23–0.88, p = 0.021). The focus of the therapy was a single mechanism, the power dimension of voice appraisal, was also significantly reduced. We hypothesised that voice power differential (between voice and voice hearer) was the mediator of the treatment effect. Methods The trial sample (n = 197) was used. A logistic regression model predicting 18-month compliance was used to identify predictors, and an exploratory principal component analysis (PCA) of baseline variables used as potential predictors (confounders) in their own right. Stata's paramed command used to obtain estimates of the direct, indirect and total effects of treatment. Results Voice omnipotence was the best predictor although the PCA identified a highly predictive cognitive-affective dimension comprising: voices’ power, childhood trauma, depression and self-harm. In the mediation analysis, the indirect effect of treatment was fully explained by its effect on the hypothesised mediator: voice power differential. Conclusion Voice power and treatment allocation were the best predictors of harmful compliance up to 18 months; post-treatment, voice power differential measured at nine months was the mediator of the effect of treatment on compliance at 18 months

The COMMAND trial of cognitive therapy for harmful compliance with command hallucinations (CTCH) : a qualitative study of acceptability and tolerability in the UK

Objectives To explore service user experiences of a 9-month cognitive behavioural therapy for command hallucinations in the context of a randomised controlled trial including their views on acceptability and tolerability of the intervention. Design Qualitative study using semistructured interviews. Setting The study took place across three sites: Birmingham, Manchester and London. Interviews were carried out at the sites where therapy took place which included service bases and participants’ homes. Participants Of 197 patients who consented to the trial, 98 received the Cognitive Behavior Therapy for Command Hallucinations (CTCH) intervention; 25 (15 males) of whom were randomly selected and consented to the qualitative study. The mean age of the sample was 42 years, and 68% were white British. Results Two superordinate themes were identified: participants’ views about the aspects of CTCH they found most helpful; and participants’ concerns with therapy. Helpful aspects of the therapy included gaining control over the voices, challenging the power and omniscience of the voices, following a structured approach, normalisation and mainstreaming of the experience of voices, and having peer support alongside the therapy. Concerns with the therapy included anxiety about completing CTCH tasks, fear of talking back to voices, the need for follow-up and ongoing support and concerns with adaptability of the therapy. Conclusions Interpretation: CTCH was generally well received and the narratives validated the overall approach. Participants did not find it an easy therapy to undertake as they were challenging a persecutor they believed had great power to harm; many were concerned, anxious and occasionally disappointed that the voices did not disappear altogether. The trusting relationship with the therapist was crucial. The need for continued support was expressed

Developing a Dynamic Understanding of Risk Factors for People Admitted to Long-term High Dependency Units

Even with developments in supporting people with enduring psychosis, some people living with these difficulties still require specialised care in inpatient rehabilitation facilities. To optimise the support provided a service evaluation was conducted for people admitted to a Long-term High Dependency Unit service. Data collected routinely with the Short-Term Assessment for Risk and Treatability tool was used to identify dynamic risk factors for the residents. Completed assessments were analysed for frequency and severity of risk behaviours; historic prevalence of risk behaviours; judgements on future risk; and strengths and vulnerabilities. The evaluation indicated a picture of a group of people who have a variety of historic risks and currently engage regularly in aggression and self-neglect, whilst experiencing limited insight, social exclusion, and limited coping abilities. Strengths and vulnerabilities linked to risk behaviours were also grouped into conceptually similar domains to aid intervention. Recommendations are made for using such data to enhance recovery.</p