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Staton A, Dawson D, Moghaddam N, McGrath B. Specificity and sensitivity of the social communication questionnaire lifetime screening tool for autism spectrum disorder in a UK CAMHS service. Clin Child Psychol Psychiatry 2022:13591045221137196. [PMID: 36472121 DOI: 10.1177/13591045221137196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Social Communication Questionnaire is used to identify children and young people (CYP) who may require formal ASD assessment. However, there is a paucity of research on its utility in Children and Adolescent Mental Health Services. This evaluation aimed to determine the sensitivity and specificity of the Social Communication Questionnaire (SCQ) in a UK, Midlands CAMHS service. METHOD Forty young people (mean age 13.75 years) were screened using the caregiver reported SCQ before completing 'gold standard' assessment. RESULTS The SCQ had a sensitivity of 80% and a specificity of 25.7%. ROC curve analysis indicated low diagnostic accuracy. Differences in predictive accuracy of SCQ and diagnostic standard were statistically significant (p < 0.0001). CONCLUSION This evaluation builds on previous research suggesting that the SCQ may not be an efficient screening tool in CAMHS settings.
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Affiliation(s)
- Amelia Staton
- 6123University of Nottingham, UK
- 4547University of Lincoln, UK
- 5314Nottinghamshire Healthcare NHS Foundation Trust, UK
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Pollard C, Bucci S, MacBeth A, Berry K. The revised Psychosis Attachment Measure: Measuring disorganized attachment. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:335-353. [PMID: 32415698 PMCID: PMC7496745 DOI: 10.1111/bjc.12249] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/03/2020] [Indexed: 11/30/2022]
Abstract
Objectives The Psychosis Attachment Measure (PAM) is currently the most widely used and validated measure of attachment in psychosis. However, the PAM does not assess disorganized attachment, the type of attachment that has been most closely linked with vulnerability to psychosis. This study aimed to expand the PAM to capture the concept of disorganized attachment and to examine its psychometric properties in a psychosis sample. Methods Clinical and academic experts in the field of psychosis and service user representatives were asked to assess the comprehensiveness and comprehensibility of the pool of disorganized items. This process resulted in 12 items hypothesized to capture disorganized attachment that were included with the original items of the PAM. A sample of 144 individuals with either a self‐reported diagnosis of, or treatment for, a psychosis‐related condition completed a battery of online measures comprising the revised PAM, existing measures of adult disorganized attachment and constructs hypothesized to be conceptually related to disorganized attachment. Results An exploratory factor analysis was conducted with three factors retained; these were labelled anxious, avoidant and disorganized attachment. The factors displayed good internal consistency and test–retest reliability and the disorganized factor displayed good construct validity with related measures and constructs. Conclusions These results provide preliminary evidence that the revised PAM captures the concept of disorganized attachment. However, confirmatory psychometric evaluation of the revised PAM is required, within a separate psychosis sample, to confirm its factor structure. The relationship between these results and the current literature, in addition to the clinical and research implications, are discussed. Practitioner points We present an expanded version of the Psychosis Attachment Measure (PAM), revised to capture the concept of disorganised attachment in adulthood. This expanded measure showed good reliability and the new disorganized subscale demonstrated construct validity. These results provide preliminary evidence that disorganized attachment can be measured using a simple self‐report measure with individuals with psychosis. Further research is required to confirm the structural dimensionality of the revised PAM within a new sample using confirmatory factor analysis. Following further psychometric validation the use of this measure has the potential to be expanded to other mental health conditions in which disorganized attachment has been implicated in the development and maintenance of difficulties, for example, trauma‐related conditions and borderline personality disorder.
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Affiliation(s)
- Catherine Pollard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
| | - Angus MacBeth
- School of Health in Social Science, University of Edinburgh, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
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França G, Laranjeira E, Silva F, Monteiro L, Moreira AM, Carvalho S. Attachment Style and Insight in Schizophrenia: a Cross-Sectional Study. Psychiatr Q 2020; 91:31-43. [PMID: 31768908 DOI: 10.1007/s11126-019-09675-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Attachment theory provides a model for understanding impairments in social and interpersonal functioning. Schizophrenia is a neuropsychiatry disorder frequently associated with compromised social functioning and limited social support networks. However, the relationship between attachment style and psychopathology dimensions, including insight, isn't fully understood To determine whether there is a relationship between the attachment style and markers for severity of schizophrenia and insight. We conducted a cross-sectional study of 41 patients with schizophrenia and 34 patients with non-psychotic disorders used as a control group. Patients were assessed using semi-structured diagnostic interviews and self-reporting questionnaires, including Adult Attachment Scale-Revised. The schizophrenia group was also given the Positive and Negative Syndrome Scale and the Markova and Berrios Insight Scale. Insecure attachment was overrepresented in the schizophrenic group, and this difference was mainly accounted for lower levels of dependence, representing a moderate effect size (Cohen's d = 0.32). In the schizophrenia group, the closeness and the dependence subscale were negatively correlated with psychopathology severity. Using a multiple regression analysis, the insight was predicted by attachment anxiety, accounting for 20% of the total variance (R2 = 0.199, p <0.05). Our data confirm previous evidence that insecure attachment is associated with schizophrenia and suggest that the less comfortable the patient is with closeness and intimacy the greater the severity of symptoms. Furthermore, our findings indicate that higher separation anxiety might predict a better insight.
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Affiliation(s)
- Gustavo França
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal.
| | - Erika Laranjeira
- Center for Economics and Finance, Oporto University, Porto, Portugal
| | - Fabio Silva
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Lília Monteiro
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Ana Maria Moreira
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Serafim Carvalho
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
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Loughlin M, Bucci S, Brooks J, Berry K. Service users' and carers' experiences of engaging with early intervention services: A meta-synthesis review. Early Interv Psychiatry 2020; 14:26-36. [PMID: 30912274 DOI: 10.1111/eip.12803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 01/14/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
AIM The provision and implementation of early intervention for psychosis services (early intervention services [EIS]) has received increasing attention over recent years. Maximizing engagement with EIS is of clinical and economic importance, and exploring the experiences of those who access EIS is vital. Although research has been conducted exploring the experiences of engaging with EIS from both a service user and carer/family member point of view, these data have not been systematically collated to generate new understanding. The primary aim of this study is to review, critically appraise and synthesize qualitative findings relating to the experiences of service users and/or carers and family members engaging with EIS. METHODS Four databases were systematically searched. Studies were analysed using an inductive thematic analysis approach, within a critical realist epistemological framework. Studies were critically appraised using the critical appraisal skills programme tool. RESULTS Fourteen papers were identified for inclusion. Three main themes were identified: the importance of a personal relationship with an EIS staff member, the impact of this relationship and consideration of life after EIS. The importance of a strong relationship with EIS staff was the most prominent theme throughout the papers reviewed. CONCLUSIONS The quality of the therapeutic relationship with at least one EIS staff member was the single most important factor in determining whether the experience of accessing EIS was a positive or negative one. The majority of the studies reviewed were conducted in the United Kingdom or Australia. Therefore, more research across countries is needed to understand transferability of findings.
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Affiliation(s)
- Matthew Loughlin
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Loughlin M, Berry K, Brooks J, Bucci S. Moving on from early intervention for psychosis services: Service user perspectives on the facilitators and barriers of transition. Early Interv Psychiatry 2019; 13:1396-1403. [PMID: 30672143 DOI: 10.1111/eip.12780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/08/2018] [Accepted: 12/26/2018] [Indexed: 11/26/2022]
Abstract
AIM Early intervention for psychosis services (EIS) has been established worldwide and is offered to individuals experiencing a first episode of psychosis. Engagement with EIS typically lasts for 3 years, after which point, service users are either transferred to primary care or community mental health teams, according to perceived needs. Although UK National Institute for Clinical Excellence (NICE) guidelines recommend transfer of care should be arranged in conjunction with the receiving service, there exists little, if any, practical guidance as to how this should actually be managed. This study aims to investigate the barriers and facilitators of transition from EIS to both primary and secondary care services in the United Kingdom from the perspectives of service users. METHODS Fifteen EIS service users who had either been discharged to primary or secondary services were interviewed about their experience of discharge. Data were analysed using interpretive thematic analysis, adopting a critical realist stance. RESULTS Four themes were identified: feeling ready for discharge; relationships and trust; planning for discharge; life after EIS. CONCLUSIONS This is the first in-depth exploration of a sample of largely male service users' views on transition from EIS to primary and/or secondary care services. We highlight several practical steps that EIS and receiving services can take to facilitate a more optimal discharge and transition experience for EIS service users. Taking into account service pressures, the discharge process should be one that is gradual, allowing time for the service user to both process the news and gradually sever ties with keyworkers.
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Affiliation(s)
- Matthew Loughlin
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Woodward S, Bucci S, Edge D, Berry K. Barriers and facilitators to "moving on" from early intervention in psychosis services. Early Interv Psychiatry 2019; 13:914-921. [PMID: 30051626 DOI: 10.1111/eip.12708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 12/30/2017] [Accepted: 06/10/2018] [Indexed: 11/28/2022]
Abstract
AIM Transition from early intervention in psychosis services (EIPS) to ongoing care can be challenging for staff and service users. This study aims to explore staff views of the barriers and facilitators to transition from EIPS. METHODS Eighteen EIPS staff were interviewed about their experiences of discharge processes and interviews were analysed thematically. RESULTS Four themes were identified: (1) "nowhere to go": illustrated how service users remained in EIPS because other teams lacked capacity to take them; (2) "collaboration between agencies" highlights the challenges of working across boundaries; (3) "therapeutic relationships": reflects the loss service users and staff experienced at discharge; (4) "advanced planning" relates to the necessity for advanced planning and service user empowerment to facilitate the discharge process. CONCLUSIONS This is the first in-depth exploration of EIPS staff views on discharge processes. To ensure seamless transitions throughout care pathways, services need better inter-agency collaboration and more adequate preparation for transition.
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Affiliation(s)
- Sarah Woodward
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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McGonagle G, Bucci S, Varese F, Raphael J, Berry K. Is adult attachment associated with engagement with services? A systematic literature review. J Ment Health 2019; 30:607-618. [DOI: 10.1080/09638237.2019.1608922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- G. McGonagle
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S. Bucci
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - F. Varese
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J. Raphael
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - K. Berry
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Adams GC, Wrath AJ, Meng X. The Relationship between Adult Attachment and Mental Health Care Utilization: A Systematic Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:651-660. [PMID: 29916269 PMCID: PMC6187440 DOI: 10.1177/0706743718779933] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Several studies have shown a relationship between individual attachment and various aspects of treatment utilization in individuals with medical problems as well as mental health disorders. This review systematically evaluates existing literature targeting the relationship between attachment and all aspects of treatment utilization, such as engagement, participation, and completion, in adults with mental health problems. METHOD A computerized search of PsycINFO, Medline, Embase, PubMed, and Healthstar and a manual search were employed. Of 5733 titles, 105 abstracts were selected. Of these, 18 studies met full inclusion criteria. The quality of studies was evaluated and scored according to 9 characteristics. RESULTS Most studies supported an association between attachment and treatment engagement and participation. In general, attachment anxiety was associated with higher engagement and participation in services while attachment avoidance was associated with less. Data regarding attachment dimensions and treatment completion were less conclusive. CONCLUSIONS The review suggests a clear relationship between attachment and stages of treatment engagement and participation in a variety of psychiatric populations and treatments. The 2 attachment dimensions appear to have opposite effects, with possible risks for either treatment over- or underutilization. Clinical implications are discussed.
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Affiliation(s)
- G. Camelia Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Andrew J. Wrath
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Xiangfei Meng
- Department of Psychiatry, Douglas Institute, McGill University, Montreal, Québec
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Ashton RA, Morris L, Smith I. A qualitative meta-synthesis of emergency department staff experiences of violence and aggression. Int Emerg Nurs 2018; 39:13-19. [PMID: 29326038 DOI: 10.1016/j.ienj.2017.12.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/22/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patient and visitor violence or aggression against healthcare workers in the Emergency Department (ED) is a significant issue worldwide. This review synthesises existing qualitative studies exploring the first-hand experiences of staff working in the ED to provide insight into preventing this issue. METHOD A meta-ethnographic approach was used to review papers. RESULTS Four concepts were identified: 'The inevitability of violence and aggression'; 'Staff judgments about why they face violence and aggression'; 'Managing in isolation'; and 'Wounded heroes'. DISCUSSION Staff resigned themselves to the inevitability of violence and aggression, doing this due to a perceived lack of support from the organisation. Staff made judgements about the reasons for violent incidents which impacted on how they coped and subsequently tolerated the aggressor. Staff often felt isolated when managing violence and aggression. Key recommendations included: Staff training in understanding violence and aggression and clinical supervision. CONCLUSION Violence and aggression in the ED can often be an overwhelming yet inevitable experience for staff. A strong organisational commitment to reducing violence and aggression is imperative.
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Affiliation(s)
| | - Lucy Morris
- Merseycare NHS Foundation Trust, Whalley, Lancashire BB7 9PE, UK
| | - Ian Smith
- Furness College, Lancaster University, Lancaster LA1 4YG, UK.
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McKenzie R, Dallos R. Autism and attachment difficulties: Overlap of symptoms, implications and innovative solutions. Clin Child Psychol Psychiatry 2017; 22:632-648. [PMID: 28530116 DOI: 10.1177/1359104517707323] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores overlap of symptoms between autism and attachment difficulties and suggests innovative solutions based on formulation. Currently, clinicians express difficulties in differentiating between these conditions contributing to misdiagnosis. Research into the prevalence of attachment difficulties among children with autism often fails to reflect detailed knowledge of attachment theory. Consequently, studies in this area employ questionable modifications to attachment measures and methods of analysis. The findings of such studies are confusing and inconsistent. Children with autism and their parents are, however, known to be at high risk of developing insecure attachment patterns. Clinical assessments based on formulation may be helpful in these cases, as they include consideration of developmental and relational factors contributing to symptom presentation. Research suggests that where parents of children with autism establish secure relationships with their children outcomes are improved. Consequently, interventions, which improve dyadic synchrony and sensitivity of parents, are likely to benefit families living with autism and attachment difficulties.
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Woodward S, Berry K, Bucci S. A systematic review of factors associated with service user satisfaction with psychiatric inpatient services. J Psychiatr Res 2017; 92:81-93. [PMID: 28412601 DOI: 10.1016/j.jpsychires.2017.03.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Satisfaction is seen as an indicator of the quality of mental health services and has been related to outcomes and compliance with treatment. The current review seeks to examine the factors relating to satisfaction with inpatient services. METHOD A search was conducted of PsycInfo, Web of Science, Cinahl, Embase and Medline databases. Screening resulted in 32 papers being included in the review. Papers were subject to quality assessment using the Mixed Methods Appraisal Tool (MMAT). RESULTS Review of the included papers suggested factors relating to satisfaction could be broadly classified as either service user or service/ward related. Service user related factors included findings that satisfaction was higher when service users were admitted voluntarily. Service related factors included findings that satisfaction was negatively associated with experiences of coercion and positively associated with being on an open ward. CONCLUSION It appears that coercion has a key role in ratings of satisfaction. Additionally, service users reported an impact of staff relationships, and the ward environment. Satisfaction is associated with a range of factors, an awareness of which will allow for the development of quality services that meet the needs of service users.
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Affiliation(s)
- Sarah Woodward
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, United Kingdom
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, United Kingdom.
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Hartley S, Jovanoska J, Roberts S, Burden N, Berry K. Case formulation in clinical practice: Associations with psychological mindedness, attachment and burnout in staff working with people experiencing psychosis. Psychol Psychother 2016; 89:133-47. [PMID: 26286105 DOI: 10.1111/papt.12074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 06/04/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Case formulation can impact on therapeutic relationships, staff understanding and outcomes, which might be particularly important when working with complex mental health problems such as psychosis. However, the evidence base is equivocal and there is insufficient understanding around the staff-related factors that influence effective psychological case formulation. This study investigated the influence of staff characteristics (both professional and personal) on case formulation skill. DESIGN This was a cross-sectional study, with all of the measures collected at the same time point. METHODS Fifty staff members working on inpatient wards with individuals experiencing psychosis were recruited. Measures included independently rated case formulation skill and psychological mindedness (the ability to draw together aspects of thoughts, feelings and actions), both in relation to hypothetical cases. Self-report questionnaires assessed psychological mindedness, attachment styles, symptoms of burnout and professional qualifications. RESULTS The preliminary analyses indicated that case formulation skill was associated with higher psychological mindedness (both self-reported and independently-rated) and lower levels of avoidant attachment styles. Simultaneous entry multiple regression demonstrated that the only independent predictor of case formulation skill was independently rated psychological mindedness. CONCLUSIONS These findings highlight the factors that contribute to staff's ability to case formulate and the possibility for services to develop psychological mindedness and case formulation skills through formal training, alongside fostering a psychological minded working environment. PRACTITIONER POINTS Case formulation skill is positively associated with the personal ability (or inclination) to draw together aspects of experience in a psychological manner (i.e., psychological mindedness) It might also be important to consider avoidant attachment tendencies in relation to formulation skills The sample was relatively small and drawn from a limited number of services, which might reduce the generalizability of the findings Psychological mindedness might not be captured adequately by self-report tools and services may wish to employ more novel ways of assessing this important skill in staff groups (such as the speech sample used in the current study).
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Affiliation(s)
| | | | - Susan Roberts
- School of Psychological Sciences, University of Manchester, UK
| | - Nicolas Burden
- School of Psychological Sciences, University of Manchester, UK.,Greater Manchester West NHS Mental Health Foundation Trust, Manchester, UK
| | - Katherine Berry
- School of Psychological Sciences, University of Manchester, UK
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Berry K, Bucci S. What does attachment theory tell us about working with distressing voices? PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2015. [DOI: 10.1080/17522439.2015.1070370] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Berry K, Ford S, Jellicoe-Jones L, Haddock G. Trauma in relation to psychosis and hospital experiences: the role of past trauma and attachment. Psychol Psychother 2015; 88:227-39. [PMID: 25044987 DOI: 10.1111/papt.12035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/12/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated rates of psychosis-related and hospital-related post-traumatic stress disorder (PTSD) in people with psychosis in secure settings. We also investigated relationships between PTSD symptoms and previous experiences of trauma and adult attachment. METHOD Using a cross-sectional design, 50 participants from medium-secure and low-secure settings were interviewed to identify distressing experiences related to psychosis and hospitalization. PTSD symptoms related to those experiences, past trauma and attachment were assessed using self-report measures. RESULTS The combined rate of psychosis-related and hospital-related PTSD was 30%. Twenty-four percent and 18% met criteria for psychosis-related and hospital-related PTSD, respectively. Severity of psychosis was associated with both psychosis-related and hospital-related PTSD symptoms. The prevalence of previous trauma was high, but previous trauma was not significantly correlated with psychosis-related or hospital-related PTSD symptoms. Anxiety in attachment relationships was significantly associated with both psychosis-related PTSD symptoms and hospital-related PTSD symptoms. CONCLUSIONS This study adds to the growing body of research highlighting the distressing nature of psychosis and the iatrogenic effects of treatments. It also highlights the potentially important role of attachment styles in PTSD in psychosis. PRACTITIONER POINTS 30% of patients met criteria for psychosis- or hospital-related PTSD. Severity of psychosis was associated with PTSD symptoms. Anxiety in attachment relationships was positively correlated with PTSD symptoms.
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Affiliation(s)
- Katherine Berry
- School of Psychological Sciences, University of Manchester, UK
| | - Sarah Ford
- School of Psychological Sciences, University of Manchester, UK.,Medium Secure Psychological Services, Preston, UK
| | | | - Gillian Haddock
- School of Psychological Sciences, University of Manchester, UK
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Bucci S, Roberts NH, Danquah AN, Berry K. Using attachment theory to inform the design and delivery of mental health services: a systematic review of the literature. Psychol Psychother 2015; 88:1-20. [PMID: 24729543 DOI: 10.1111/papt.12029] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 12/23/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this review was to propose and describe the design and delivery of an attachment-informed general mental health service. METHOD We systematically searched the PsycINFO, MEDLINE, Web of Knowledge, COPAC, CINAHL, and Science Direct databases from 1960 to 2013. We also searched reference lists of relevant papers and directly contacted authors in the field. Literature describing attachment theory and its applicability in designing and delivering general mental health services was synthesized using thematic analysis. Papers published in English, books or chapters in edited books that described applying attachment theory in designing and delivering mental health services for adults and adolescents were included in the review. Of the 1,105 articles identified, 14 met inclusion criteria for the review. Eight key themes, and four subthemes, were extracted and organized to reflect the experience of a service user moving through the mental health system. RESULTS Key themes extracted were as follows: service policy and evaluation; referrals; assessment and formulation; intervention; support for staff; support for carers; moving on; and potential service benefits. Papers reviewed suggested that service users with severe mental health problems have attachment needs that should be met in general mental health services. CONCLUSIONS Attachment theory provides a useful framework to inform the design and delivery of general mental health services. The resource implications for services are discussed, as are limitations of the review and recommendations for future research. PRACTITIONER POINTS Attachment theory should be used to inform the design and delivery of general mental health services. Mental health services should evaluate the extent to which they meet service users' attachment needs. Attachment-informed mental health services should assess outcomes, including cost-effectiveness over time. Papers included in this review focus on long-stay residential care or secure services and there is a limited experimental evidence base to show that providing an attachment-informed service improves patient outcomes.
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Affiliation(s)
- Sandra Bucci
- School of Psychological Sciences, University of Manchester, UK
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Campbell R, Allan S, Sims P. Service attachment: the relative contributions of ward climate perceptions and attachment anxiety and avoidance in male inpatients with psychosis. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2014; 24:49-59. [PMID: 24014501 DOI: 10.1002/cbm.1880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 05/22/2013] [Accepted: 07/16/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND It has been suggested that mental health services can help meet the attachment needs of inpatients and improve patient outcomes through the provision of a 'secure base'; however, what defines the latter is unclear. Perception of ward climate might be a useful indicator. AIM The aim of this study was to examine whether inpatient perceptions of the ward climate, which is partly under the control of the service, or inpatients' own personal levels of attachment anxiety and avoidance are more associated with their attachment to their service. METHOD Seventy-six men diagnosed with a psychotic illness, who were residents in one of four regional medium-security units in England, completed questionnaire measures of service attachment, personal attachment style and ward climate. RESULTS Ward climate was more strongly associated with service attachment than personal levels of attachment anxiety and avoidance. The most important aspect of ward climate for service attachment was the depth and influence of staff support for the inpatients. CONCLUSIONS Although patient characteristics are important influences on development of service attachment, ward climate is also important. The latter may be easily and reliably monitored with a brief questionnaire. Strategies to enhance and maintain its positive components are likely to be important for progress with forensic hospital inpatients who have a psychotic illness.
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Affiliation(s)
- Roslyn Campbell
- Ardenleigh, Birmingham and Solihull Mental Health Foundation Trust, 385 Kingsbury Road, Birmingham, B24 9SA, UK
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Service user attachments to psychiatric key workers and teams. Soc Psychiatry Psychiatr Epidemiol 2012; 47:817-25. [PMID: 21626057 DOI: 10.1007/s00127-011-0388-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The first aim of the study was to evaluate whether self-reported attachment styles of individuals with psychosis are consistent with their self-reported attachment in therapeutic relationships with both key workers and mental health teams. The second aim was to evaluate the level of concordance in attachment ratings given by different raters (self-report, key worker informant-report and team informant-report). METHODS Three self-report versions of the Psychosis Attachment Measure (PAM; attachment in general relationships, attachment towards key worker and attachment in relation to the mental health team) were administered to 24 individuals with a diagnosis of psychosis in psychiatric rehabilitation settings. Key worker and 'team' informant versions of the PAM were also completed. RESULTS There were strong, significant correlations among the three self-reported attachment measures. There was less consistent evidence of correlations between key worker ratings of attachment and self-report attachment ratings. The majority of the correlations between team ratings of attachment and self-report attachment were small and non-significant. CONCLUSIONS Strong correlations among the self-reported PAM scales suggest that self-reported attachment in specific therapeutic relationships is consistent with self-reported attachment in general relationships. The self-ratings were not consistently correlated with informant-ratings and team informant ratings were particularly poorly correlated with self-ratings. This suggests that it is vital that teams consult service users themselves when making decisions about their care.
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