Overcontrolled Tendencies in Refractory Depression compared to Acute Non-Chronic Depression; The Importance of Treating Maladaptive Personality Style

By 2020 depression is predicted to be the second most frequent cause of disability worldwide. Research suggests that existing methods of treatment are ineffective for many resulting in a large number of chronic, treatment resistant courses (termed refractory depression [RD]). Further evidence suggests that up to 60% of individuals with RD have a co-morbid Personality Disorder (PD), namely Clusters A and C. As such, it has been proposed that individuals with RD fail to respond to existing treatment interventions because these treatments fail to address maladaptive personality styles (i.e., overcontrol tendencies) that may complicate treatment. This project aimed to test this novel assertion by examining whether individuals with RD exhibit higher levels of overcontrol (e.g., skills deficits in the expression and experience of emotion, in forming close relationships and in receptivity and openness) compared to individuals with current, but not chronic, depression and a normal control group. A total of 180 individuals were recruited and based on eligibility criteria were allocated to the following groups: RD, n = 56; acute, non-chronically depressed (ANCD), n = 61; normal control (NC), n = 63. Participants completed a series of self-report questionnaires and as a whole, between group analyses supported study predictions; individuals with RD displayed significantly higher levels of overcontrol compared to both the ANCD and NC groups. More specifically, individuals with RD demonstrated significantly more difficulties with interpersonal relationships and expressing emotions, a significantly greater need for structure and significantly higher levels of maladaptive perfectionism compared to controls. This study forms part of a large multi-centre randomised controlled trial (RCT; REFRAMED) that is designed to study the efficacy of a novel treatment intervention - Radically Open-Dialectical Behaviour Therapy – for individuals with RD

An Investigation into the Implementation of CYP-IAPT Routine Outcome Measures in their First Year of Integration into Child Psychotherapy Practice

This thesis examines the impact on child and adolescent psychotherapists within CAMHS of the introduction of routine outcome measures (ROMs) associated with the Children and Young People’s Improving access to Psychological Therapies programme (CYP-IAPT). All CAMHS therapists working within a particular NHS mental health Trust1 were required to trial CYP-IAPT ROMs as part of their everyday clinical practice from October 2013-September 2014. During this period considerable freedom was allowed as to which of the measures each therapist used and at what frequency. In order to assess the impact of CYP-IAPT ROMs on child psychotherapy, I conducted semi-structured interviews with eight psychotherapists within a particular CAMHS partnership within one NHS Trust. Each statement was coded and grouped according to whether it related to initial (generic) assessment, goal setting / monitoring, monitoring on-going progress, therapeutic alliance, or to issues concerning how data might be used or interpreted by managers and commissioners. Analysis of interviews revealed greatest concern about session-by session ROMs, as these are felt to impact most significantly on psychotherapy; therapists felt that session-by-session ROMs do not take account of negative transference relationships, they are overly repetitive and used to reward / punish the therapist. Measures used at assessment and review were viewed as most compatible with psychotherapy, although often experienced as excessively time consuming. The Goal Based Outcome Measure was generally experienced as compatible with psychotherapy so long as goals are formed collaboratively between therapist and young person. There was considerable anxiety about how data may be (mis)used and (mis)interpreted by managers and commissioners, for example to end treatment prematurely, trigger change of therapist in the face of negative ROMs data, or to damage psychotherapy. Use of ROMs for short term and generic work was experienced as less intrusive and contentious

An investigation into the health-related quality of life of refugees and asylum seekers in Britain and France

This thesis is concerned with the health-related quality of life of two groups of refugees and asylum seekers from the Democratic Republic of the Congo, who are resident in Britain and France. Drawing on theories of health inequalities and psycho-social stress, the thesis argues that the health-related quality of life of refugees and asylum seekers is mediated by their immigration and citizenship status. Introductory chapters set the scene for the study, giving consideration to patterns of immigration and the emergence of minority ethnic groups in Britain and France, thus setting the context for the arrival and reception of refugees and asylum seekers during the 1990s. Citizenship, health inequalities, and the existing knowledge concerning the health of refugees and asylum seekers are addressed. Qualitative research, informed by phenomenology, is used to explore the health-related quality of life of these refugees and asylum seekers. The findings are presented and discussed in three chapters in the body of the thesis. Problems with psychological health dominate the findings; issues relating to physical health are presented largely within the context of seeking access to health care. A fourth chapter critically interprets the findings and locates them within wider literature. The thesis concludes that the health-related quality of life of refugees and asylum seekers is affected by their immigration status and by their lack of citizenship in their host countries. In the absence of citizenship of either Britain or France, refugees and asylum seekers are located in hierarchical societies, characterized by civic stratification, which confers a different set of rights on citizens, refugees and asylum seekers. Asylum seekers have fewer rights than refugees, who, in turn, have fewer rights than citizens. This thesis suggests that these relative statuses contribute to psycho-social stress and thus the health-related quality of life of refugees and asylum seekers.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

An investigation into the implementation of CYP-IAPT routine outcome measures in their first year of integration into child psychotherapy practice

This thesis examines the impact on child and adolescent psychotherapists within CAMHS of the introduction of routine outcome measures (ROMs) associated with the Children and Young People’s Improving access to Psychological Therapies programme (CYP-IAPT). All CAMHS therapists working within a particular NHS mental health Trust1 were required to trial CYP-IAPT ROMs as part of their everyday clinical practice from October 2013-September 2014. During this period considerable freedom was allowed as to which of the measures each therapist used and at what frequency. In order to assess the impact of CYP-IAPT ROMs on child psychotherapy, I conducted semi-structured interviews with eight psychotherapists within a particular CAMHS partnership within one NHS Trust. Each statement was coded and grouped according to whether it related to initial (generic) assessment, goal setting / monitoring, monitoring on-going progress, therapeutic alliance, or to issues concerning how data might be used or interpreted by managers and commissioners. Analysis of interviews revealed greatest concern about session-by session ROMs, as these are felt to impact most significantly on psychotherapy; therapists felt that session-by-session ROMs do not take account of negative transference relationships, they are overly repetitive and used to reward / punish the therapist. Measures used at assessment and review were viewed as most compatible with psychotherapy, although often experienced as excessively time consuming. The Goal Based Outcome Measure was generally experienced as compatible with psychotherapy so long as goals are formed collaboratively between therapist and young person. There was considerable anxiety about how data may be (mis)used and (mis)interpreted by managers and commissioners, for example to end treatment prematurely, trigger change of therapist in the face of negative ROMs data, or to damage psychotherapy. Use of ROMs for short term and generic work was experienced as less intrusive and contentious

Interprofessional clinical placement involving speech pathology and counselling psychology: Two students\u27 experiences

This paper examines the interprofessional learning of a speech pathology and counselling psychology student in an interprofessional placement within an institution of the Department of Corrective Services in Perth, Western Australia. The institution is a pre-release centre that promotes rehabilitation and community reintegration in which up to six women are able to have their children, aged 0–4 years of age, live with them. The students provided a program to the mothers to facilitate development of a healthy mother–child relationship and the children’s communication development. This paper utilised qualitative descriptive analysis to explore two examples of student learning and found perceived growth in the students’ clinical skills, their understanding of the other profession and the concept of interprofessional collaboration. While students experience growth in a range of placements, the journey described in this paper is unusual in both the nature of the student collaboration and the placement itself. The research highlights the importance of joint clinical placements in the development of interprofessional collaborative relationships

Basic fibroblast growth factor modifies the hypoxic response of human bone marrow stromal cells by ERK-mediated enhancement of HIF-1α activity

Human bone marrow stromal cells (hBMSCs, also known as bone marrow-derived mesenchymal stem cells) are promising tools for the cellular therapy of human pathologies related to various forms of hypoxia. Although the current concepts of their clinical use include the expansion of hBMSC in standard cell culture conditions, the effect of the mitogen-driven ex vivo expansion on the adaptation to the hypoxic environment is unknown. Here, we provide data that the basic fibroblast growth factor (FGF2) enhances the induction of a wide range of hypoxia-related adaptive genes in hypoxic hBMSCs. We identified that the FGF2 signal is transmitted by the ERK pathway similar to that of hypoxia that also utilises the distal elements of the same signalling machinery including the extracellular signal-regulated kinase 1/2 (ERK1/2) and mitogen-activated protein kinase kinases (MEK1/2) in hBMSCs. We found that the simultaneous activation of ERK1/2 by FGF2 and hypoxia transforms the activation dynamics from oscillatory into sustained one. Activated ERKs co-localise with stabilised hypoxia inducible factor-1α (HIF-1α) followed by the reduction of its nuclear mobility as well as increased DNA binding capacity leading to the up-regulation of hypoxia-adaptive genes. Our findings indicate that the status of the ERK pathway has significant impacts on the molecular adaptation of hBMSCs to the hypoxic milieu

Recording of body weight and body condition score of cats in electronic health records from UK veterinary practices

ObjectivesThe aim of this study was to determine how frequently body weight, body condition score (BCS) and terms pertaining to weight status are recorded in the electronic health records (EHRs) of veterinary practices in the UK, as well as to examine the variables affecting recording and associated with body weight, where recorded.MethodsData recorded in EHRs were searched in two 3-month periods in 2019 and 2020. For each visit, variables including type and time of consultation, signalment, recording of body weight, recording of BCS, weight (kg), BCS value and whether an overweight or weight-loss term was used in free text were recorded. Linear mixed-effects models were created to examine associations between body weight and variables, while mixed-effects logistic regression was used to determine associations between the same variables and weight or BCS recording.ResultsThe statistical data set comprised 129,076 visits from 129,076 cats at 361 practices. Weight was recorded at most (95.2%) visits, BCS was recorded at only 22.5% of visits, and terms associated with weight loss and overweight status were recorded in 10.0% and 7.2% of free-text records, respectively. Where BCS was recorded, approximately one-third of cats had an overweight score (8.0% of total visits). Using either an overweight term (P P P P P P P P Conclusions and relevanceCats are regularly weighed in UK practice, but BCS is less frequently recorded, and both are less often recorded in non-routine consultations. To improve both the treatment and assessment of health and nutrition in cats, veterinary professionals should record body weight and BCS concurrently at every consultation

Spatio-temporal expression patterns of anandamide-binding receptors in rat implantation sites: evidence for a role of the endocannabinoid system during the period of placental development

<p>Abstract</p> <p>Background</p> <p>Although there is growing evidence that endocannabinoids play a critical role in early pregnancy, there are no studies describing the possible targets for this system after implantation. The endometrial stroma, which undergoes extensive proliferation and differentiation giving rise to the decidua and the trophoblast cells that invade after the initial stages of implantation, are potential targets. Since high anandamide (AEA) levels, the main endocannabinoid, are detrimental to implantation and in order to gain insight into the role of the endocannabinoid system in the development of the fetoplacental unit, the spatio-temporal pattern of expression of the anandamide-binding receptors, CB1, CB2 and the vanilloid receptor (TRPV1), were investigated by quantitative RT-PCR, western blot and immunohistochemistry.</p> <p>Methods</p> <p>Rat uterine maternal tissues from different days of pregnancy were used to investigate the expression of CB1, CB2 and vanilloid receptors by quantitative RT-PCR, western blot and immunohistochemistry.</p> <p>Results</p> <p>The data indicate that all the three receptors were expressed in decidualized cells and placenta. Interestingly, CB1 and CB2 were also expressed in smooth muscle cells of maternal blood vessels and in endovascular trophoblast cells, whereas TRPV1 was mainly expressed in uterine natural killer (uNK) cells and in the longitudinal muscle layer throughout pregnancy. In all tissues, CB2 protein was present at a lower level than CB1.</p> <p>Conclusion</p> <p>These observations support a role for the endocannabinoid system during the period of decidualization and placental development.</p

Unprecedented flexibility of the 1,1′-bis(o-carborane) ligand:catalytically-active species stabilised by B-agostic B–H⇀Ru interactions

The compound (p-cymene)Ru[(C2B10H10)2], an effective Lewis acid catalyst, is the precursor to a number of products in which the 1,1′-bis(o-carborane) unit displays an unprecedented range of ligating modes.</p

Ameliorating Patient Stigma Amongst Staff Working With Personality Disorder: Randomized Controlled Trial of Self-Management Versus Skills Training.

Background: Patients diagnosed with a personality disorder (PD) are often stigmatized by the healthcare staff who treat them. Aims: This study aimed to compare the impact on front-line staff of a self-management Acceptance and Commitment Therapy-based training intervention (ACTr) with a knowledge- and skills-based Dialectical Behaviour Training intervention (DBTr). Method: A service-based randomized controlled trial was conducted comparing the effects of 2-day ACTr (N = 53) and DBTr (N = 47) staff workshops over 6 months. Primary outcome measures were staff attitudes towards patients and staff-patient relationships. Results: For both interventions, staff attitudes, therapeutic relationship, and social distancing all improved pre- to postintervention, and these changes were maintained at 6-month follow-up. Conclusions: Although offering different resources to staff, both ACTr and DBTr were associated with an improved disposition towards PD patients. Future research could evaluate a combined approach, both for staff working with PD patients and those working with other stigmatized groups