1
|
Backhouse T, Jeon YH, Killett A, Green J, Khondoker M, Mioshi E. Nurturing Attentiveness: A Naturalistic Observation Study of Personal Care Interactions Between People With Advanced Dementia and Their Caregivers. Gerontologist 2024; 64:gnae004. [PMID: 38267689 PMCID: PMC11102004 DOI: 10.1093/geront/gnae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Personal care interactions can provide vital opportunities for caregivers to engage with a person living with advanced dementia. However, interactions may also be a contentious experience, what makes this so is not fully understood. We aimed to examine features of personal care interactions between caregivers and people with advanced dementia to understand how care may be improved. RESEARCH DESIGN AND METHODS This was a naturalistic observation study using one-off video-recorded observations of personal care interactions between 14 people with advanced dementia and 12 caregivers (n = 7 care-home staff, n = 5 family carers) in the United Kingdom (total observation time 03:01:52). Observations were analyzed with observational video coding to determine the frequency of actions of people with dementia and qualitative content analysis for in-depth examination. RESULTS Refusals of care were present in 32% of video sections. Active engagement of people with dementia was observed in 66% of sections. Rare contentious interactional components were characterized by the person with dementia appearing to show uneasiness and caregivers being flustered and uncertain. However, caregivers typically emanated a nurturing attentiveness, were attuned to the person, and skilled in seamlessly supporting them through care activities. DISCUSSION AND IMPLICATIONS Findings draw on real-world empirical evidence to reinvigorate the notion of person-centeredness in dementia care. The findings provide much needed insight into practical ways to improve care interactions for people with advanced dementia and enhance their personhood. Appropriate training/guidance for caregivers could support positive personal care experiences for both the person with dementia and caregiver.
Collapse
Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Yun-Hee Jeon
- Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Jessica Green
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| |
Collapse
|
2
|
Morrissey S, Jeffs S, Gillings R, Khondoker M, Patel M, Fisher-Morris M, Manley E, Hornberger M. The Impact of Spatial Orientation Changes on Driving Behavior in Healthy Aging. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad188. [PMID: 38134234 PMCID: PMC10872713 DOI: 10.1093/geronb/gbad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Global cognitive changes in older age affect driving behavior and road safety, but how spatial orientation differences affect driving behaviors is unknown on a population level, despite clear implications for driving policy and evaluation during aging. The present study aimed to establish how spatial navigation changes affect driving behavior and road safety within a large cohort of older adults. METHODS Eight hundred and four participants (mean age: 71.05) were recruited for a prospective cohort study. Participants self-reported driving behavior followed by spatial orientation (allocentric and egocentric) testing and a broader online cognitive battery (visuomotor speed, processing speed, executive functioning, spatial working memory, episodic memory, visuospatial functioning). RESULTS Spatial orientation performance significantly predicted driving difficulty and frequency. Experiencing more driving difficulty was associated with worse allocentric spatial orientation, processing speed, and source memory performance. Similarly, avoiding challenging driving situations was associated with worse spatial orientation and episodic memory. Allocentric spatial orientation was the only cognitive domain consistently affecting driving behavior in under 70 and over 70 age groups, a common age threshold for driving evaluation in older age. DISCUSSION We established for the first time that worse spatial orientation performance predicted increased driving difficulty and avoidance of challenging situations within an older adult cohort. Deficits in spatial orientation emerge as a robust indicator of driving performance in older age, which should be considered in future aging driving assessments, as it has clear relevance for road safety within the aging population.
Collapse
Affiliation(s)
- Sol Morrissey
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Stephen Jeffs
- Department of Psychology, University of Exeter, Exeter, UK
| | - Rachel Gillings
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Martyn Patel
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, UK
| | | | - Ed Manley
- School of Geography, University of Leeds, Leeds, UK
| | | |
Collapse
|
3
|
Ambikairajah A, Khondoker M, Morris E, de Lange AG, Saleh RNM, Minihane AM, Hornberger M. Investigating the synergistic effects of hormone replacement therapy, apolipoprotein E and age on brain health in the UK Biobank. Hum Brain Mapp 2024; 45:e26612. [PMID: 38339898 PMCID: PMC10836173 DOI: 10.1002/hbm.26612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
Global prevalence of Alzheimer's Disease has a strong sex bias, with women representing approximately two-thirds of the patients. Yet, the role of sex-specific risk factors during midlife, including hormone replacement therapy (HRT) and their interaction with other major risk factors for Alzheimer's Disease, such as apolipoprotein E (APOE)-e4 genotype and age, on brain health remains unclear. We investigated the relationship between HRT (i.e., use, age of initiation and duration of use) and brain health (i.e., cognition and regional brain volumes). We then consider the multiplicative effects of HRT and APOE status (i.e., e2/e2, e2/e3, e3/e3, e3/e4 and e4/e4) via a two-way interaction and subsequently age of participants via a three-way interaction. Women from the UK Biobank with no self-reported neurological conditions were included (N = 207,595 women, mean age = 56.25 years, standard deviation = 8.01 years). Generalised linear regression models were computed to quantify the cross-sectional association between HRT and brain health, while controlling for APOE status, age, time since attending centre for completing brain health measure, surgical menopause status, smoking history, body mass index, education, physical activity, alcohol use, ethnicity, socioeconomic status, vascular/heart problems and diabetes diagnosed by doctor. Analyses of structural brain regions further controlled for scanner site. All brain volumes were normalised for head size. Two-way interactions between HRT and APOE status were modelled, in addition to three-way interactions including age. Results showed that women with the e4/e4 genotype who have used HRT had 1.82% lower hippocampal, 2.4% lower parahippocampal and 1.24% lower thalamus volumes than those with the e3/e3 genotype who had never used HRT. However, this interaction was not detected for measures of cognition. No clinically meaningful three-way interaction between APOE, HRT and age was detected when interpreted relative to the scales of the cognitive measures used and normative models of ageing for brain volumes in this sample. Differences in hippocampal volume between women with the e4/e4 genotype who have used HRT and those with the e3/e3 genotype who had never used HRT are equivalent to approximately 1-2 years of hippocampal atrophy observed in typical health ageing trajectories in midlife (i.e., 0.98%-1.41% per year). Effect sizes were consistent within APOE e4/e4 group post hoc sensitivity analyses, suggesting observed effects were not solely driven by APOE status and may, in part, be attributed to HRT use. Although, the design of this study means we cannot exclude the possibility that women who have used HRT may have a predisposition for poorer brain health.
Collapse
Affiliation(s)
- Ananthan Ambikairajah
- Discipline of Psychology, Faculty of HealthUniversity of CanberraCanberraAustralian Capital TerritoryAustralia
- Centre for Ageing Research and Translation, Faculty of HealthUniversity of CanberraCanberraAustralian Capital TerritoryAustralia
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | | | | | - Ann‐Marie G. de Lange
- Department of Clinical NeurosciencesLausanne University Hospital (CHUV) and University of LausanneLausanneSwitzerland
- Department of PsychologyUniversity of OsloOsloNorway
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Rasha N. M. Saleh
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Department of Clinical and Chemical Pathology, Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Anne Marie Minihane
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Norwich Institute of Healthy AgeingNorwichUK
| | | |
Collapse
|
4
|
Phillips J, Murdin L, Khondoker M, Grant K, Shepstone L, Sims E, Rea P, Harcourt J. Cluster Analysis to Identify Clinical Subtypes of Ménière's Disease. Laryngoscope 2024. [PMID: 38183314 DOI: 10.1002/lary.31272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/22/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVE To identify distinct clinical subtypes of Ménière's disease by analyzing data acquired from a UK registry of patients who have been diagnosed with Ménière's disease. STUDY DESIGN Observational study. METHODS Patients with Ménière's disease were identified at secondary/tertiary care clinics. Cluster analysis was performed by grouping participants sharing similar characteristics and risk factors into groups based on a defined measure of similarity. RESULTS A total of 411 participants were recruited into this study. Two main clusters were identified: participants diagnosed with ear infections (OR = 0.30, p < 0.014, 95% CI: 0.11-0.78) were more likely to be allocated in Cluster 1 (C1). Participants reporting tinnitus in both ears (OR = 11.89, p < 0.001, 95% CI: 4.08-34.64), low pitched tinnitus (OR = 21.09, p < 0.001, 95% CI: 7.47-59.54), and those reporting stress as a trigger for vertigo attacks (OR = 14.94, p < 0.001, 95% CI: 4.54-49.10) were significantly more likely to be in Cluster 2 (C2). Also, participants diagnosed with Benign Paroxysmal Positional Vertigo (OR = 13.14, <0.001, 95% CI: 4.35-39.74), autoimmune disease (OR = 5.97, p < 0.007, 95% CI: 1.62-22.03), depression (OR = 4.72, p < 0.056, 95% CI: 0.96-23.24), migraines (OR = 3.13, p < 0.008, 95% CI: 1.34-7.26), drug allergy (OR = 3.25, p < 0.029, 95% CI: 1.13-9.34), and hay fever (OR = 3.12, p < 0.009, 95% CI: 1.33-7.34) were significantly more likely to be clustered in C2. CONCLUSIONS This study supports the hypothesis that Ménière's disease is a heterogeneous condition with subgroups that may be identifiable by clinical features. Two main clusters were identified with differing putative etiological factors. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
Collapse
Affiliation(s)
- John Phillips
- Department of Otolaryngology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Louisa Murdin
- Department of Otolaryngology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Kelly Grant
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Erika Sims
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter Rea
- Department of Otolaryngology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jonny Harcourt
- Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
5
|
Rugg B, Khondoker M, Chester R. Shoulder pain: Is the outcome of manual therapy, acupuncture and electrotherapy different for people with high compared to low pain self-efficacy? An analysis of effect moderation. Shoulder Elbow 2023; 15:680-688. [PMID: 38028933 PMCID: PMC10656971 DOI: 10.1177/17585732221105562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/20/2022] [Indexed: 12/01/2023]
Abstract
Background High baseline pain self-efficacy (PSE) predicts a better outcome for people attending physiotherapy for musculoskeletal shoulder pain. A potential contributing factor is that PSE moderates the relationship between some treatment modalities and outcome. Our aim was to investigate whether there is a difference in outcome between participants with high compared to low PSE receiving manual therapy, acupuncture, and electrotherapy. Methods Participants were stratified into high or low baseline (i) PSE, (ii) shoulder pain and disability index (SPADI), and (iii) did or did not receive the treatment. Whether the effect of treatment differs for people with high compared to low PSE was assessed using the 95% confidence interval of the difference of difference (DoD) at a 5% significance level (p < 0.05). Results Six-month SPADI scores were consistently lower (less pain and disability) for those who did not receive passive treatments compared to those who did (statistically significant less pain and disability in 7 of 24 models). However, DoD was statistically insignificant. Conclusion PSE did not moderate the relationship between treatment and outcome. However, participants who received passive treatment experienced equal or more pain and disability at 6 months compared to those who did not. Results are subject to confounding by indication but do indicate the need for further appropriately designed research. Level of Evidence Level of evidence II-b.
Collapse
Affiliation(s)
- Bradley Rugg
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
- Physiotherapy Department, The Clementine Churchill Hospital, Sudbury Hill, Harrow, HA1 3RX, UK
| | - Mizanur Khondoker
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
| | - Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
| |
Collapse
|
6
|
Backhouse T, Khondoker M, Killett A, Mioshi E. Most Common Refusals of Personal Care in Advanced Dementia: Psychometric Properties of the Refusal of Care Informant Scale. Gerontologist 2023; 63:1330-1340. [PMID: 35583309 PMCID: PMC10474588 DOI: 10.1093/geront/gnac066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Refusals of care in dementia can be a source of distress for people with dementia and their caregivers. Informant-based measures to examine refusals of care are limited and often measure other behaviors such as agitation. We aimed to assess the validity and reliability of the newly developed, 14-item, Refusal of Care Informant Scale (RoCIS) and then use the scale to verify the most common refusal behaviors. RESEARCH DESIGN AND METHODS Data from 129 dyads were analyzed. Dyad was defined as a person with advanced dementia either living in a care home or supported in their own home and their caregiver. Data about the person with dementia were gathered using informant-based questionnaires. The psychometric properties of the RoCIS were investigated using Rasch analysis to determine validity and reliability. RESULTS Following Rasch analysis, the item "upset" was removed from the RoCIS. The reduced 13-item RoCIS is unidimensional and achieved a reliability index of 0.85 (Cronbach's alpha 0.88). Sixty-eight percent of people with dementia had refused care in the last month, with "verbally refused" the most common type of refusal behavior. People in the "very severe/profound" stage of dementia showed more refusal behaviors than those in the "severe" stage. DISCUSSION AND IMPLICATIONS Results provide initial evidence that the RoCIS is a valid and reliable informant-based scale measuring refusals of care in advanced dementia. Results indicate a need to develop new approaches and techniques to make assistance with personal care more acceptable to people with dementia.
Collapse
Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| |
Collapse
|
7
|
Monk-Cunliffe J, Kadra-Scalzo G, Finamore C, Dale O, Khondoker M, Barrett B, Shetty H, Hayes RD, Moran P. Defining severity of personality disorder using electronic health records: short report. BJPsych Open 2023; 9:e137. [PMID: 37524373 PMCID: PMC10486230 DOI: 10.1192/bjo.2023.509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 08/02/2023] Open
Abstract
Severity of personality disorder is an important determinant of future health. However, this key prognostic variable is not captured in routine clinical practice. Using a large clinical data-set, we explored the predictive validity of items from the Health of Nation Outcome Scales (HoNOS) as potential indicators of personality disorder severity. For 6912 patients with a personality disorder diagnosis, we examined associations between HoNOS items relating to core personality disorder symptoms (self-harm, difficulty in interpersonal relationships, performance of occupational and social roles, and agitation and aggression) and future health service use. Compared with those with no self-harm problem, the total healthcare cost was 2.74 times higher (95% CI 1.66-4.52; P < 0.001) for individuals with severe to very severe self-harm problems. Other HoNOS items did not demonstrate clear patterns of association with service costs. Self-harm may be a robust indicator of the severity of personality disorder, but further replication work is required.
Collapse
Affiliation(s)
- Jonathan Monk-Cunliffe
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Giouliana Kadra-Scalzo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chloe Finamore
- Research Unit, The Cassel Hospital, West London NHS Trust, Richmond, UK
| | - Oliver Dale
- Research Unit, The Cassel Hospital, West London NHS Trust, Richmond, UK
| | | | - Barbara Barrett
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hitesh Shetty
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard D. Hayes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
8
|
Blake J, Aryankhesal A, Allan L, Ballard C, Briscoe S, Broomfield N, Green L, Hilton A, van Horik J, Khondoker M, Killett A, Lazar A, Litherland R, Livingston G, Maidment I, Medina-Lara A, Megson M, Reeve J, Rook G, Scott S, Shepstone L, Wong G, Fox C. Understanding primary care diagnosis and management of sleep disturbance for people with dementia or mild cognitive impairment: a realist review. Br J Gen Pract 2023; 73:bjgp23X734169. [PMID: 37479302 DOI: 10.3399/bjgp23x734169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Sleep disturbance (SD) is common among people living with dementia (PLwD) or mild cognitive impairment (MCI). It has a significant impact on the wellbeing of PLwD and caregivers, and makes care at home more difficult. Within primary care, assessment and management of SD for this population is complex and challenging. AIM To identify what works, how, and for whom, in the assessment and management of SD for PLwD or MCI in primary care. METHOD We conducted a realist review to develop explanations of causal relationships, using context-mechanism-outcome configurations (CMOCs). An initial programme theory was iteratively tested and refined, using data from relevant literature and stakeholder feedback. The study followed RAMESES reporting quality. RESULTS In total, 71 papers from OECD countries were included for analysis, generating 19 CMOCs. Low awareness of SD and assessment methods resulted in underdiagnosis in primary care. Assessment and treatment of PLwD/MCI were, respectively, more challenging when people were unable to accurately report concerns or implement interventions independently. Sedative medication was commonly used to manage SD, often driven by low confidence in nonpharmacological strategies. Long-term medication use was common despite guidelines indicating limited efficacy, which was driven by perceived pressures to prescribe or concerns of relapse. In nursing homes, environments and routines could exacerbate SD. CONCLUSION Increasing awareness, knowledge, and confidence in diagnosis and assessment of SD is needed. Primary care-specific assessment tools may help. Long-term medication use is the default option in absence of pragmatic and effective non-pharmacological interventions that can be easily incorporated into routine general practice.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - George Rook
- Lived Experience Advisory Panel (LEAP) for Dementia UK and Dementia Enabling Environment Project (DEEP)
| | | | | | | | | |
Collapse
|
9
|
Knight R, Stewart R, Khondoker M, Landau S. Borrowing strength from clinical trials in analysing longitudinal data from a treated cohort: investigating the effectiveness of acetylcholinesterase inhibitors in the management of dementia. Int J Epidemiol 2023; 52:827-836. [PMID: 36219788 PMCID: PMC10244047 DOI: 10.1093/ije/dyac185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 09/12/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Health care professionals seek information about effectiveness of treatments in patients who would be offered them in routine clinical practice. Electronic medical records (EMRs) and randomized controlled trials (RCTs) can both provide data on treatment effects; however, each data source has limitations when considered in isolation. METHODS A novel modelling methodology which incorporates RCT estimates in the analysis of EMR data via informative prior distributions is proposed. A Bayesian mixed modelling approach is used to model outcome trajectories among patients in the EMR dataset receiving the treatment of interest. This model incorporates an estimate of treatment effect based on a meta-analysis of RCTs as an informative prior distribution. This provides a combined estimate of treatment effect based on both data sources. RESULTS The superior performance of the novel combined estimator is demonstrated via a simulation study. The new approach is applied to estimate the effectiveness at 12 months after treatment initiation of acetylcholinesterase inhibitors in the management of the cognitive symptoms of dementia in terms of Mini-Mental State Examination scores. This demonstrated that estimates based on either trials data only (1.10, SE = 0.316) or cohort data only (1.56, SE = 0.240) overestimated this compared with the estimate using data from both sources (0.86, SE = 0.327). CONCLUSIONS It is possible to combine data from EMRs and RCTs in order to provide better estimates of treatment effectiveness.
Collapse
Affiliation(s)
- Ruth Knight
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| |
Collapse
|
10
|
Khondoker M, Macgregor A, Bachmann MO, Hornberger M, Fox C, Shepstone L. Multimorbidity pattern and risk of dementia in later life: an 11-year follow-up study using a large community cohort and linked electronic health records. J Epidemiol Community Health 2023; 77:285-292. [PMID: 36889910 DOI: 10.1136/jech-2022-220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/25/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Several long-term chronic illnesses are known to be associated with an increased risk of dementia independently, but little is known how combinations or clusters of potentially interacting chronic conditions may influence the risk of developing dementia. METHODS 447 888 dementia-free participants of the UK Biobank cohort at baseline (2006-2010) were followed-up until 31 May 2020 with a median follow-up duration of 11.3 years to identify incident cases of dementia. Latent class analysis (LCA) was used to identify multimorbidity patterns at baseline and covariate adjusted Cox regression was used to investigate their predictive effects on the risk of developing dementia. Potential effect moderations by C reactive protein (CRP) and Apolipoprotein E (APOE) genotype were assessed via statistical interaction. RESULTS LCA identified four multimorbidity clusters representing Mental health, Cardiometabolic, Inflammatory/autoimmune and Cancer-related pathophysiology, respectively. Estimated HRs suggest that multimorbidity clusters dominated by Mental health (HR=2.12, p<0.001, 95% CI 1.88 to 2.39) and Cardiometabolic conditions (2.02, p<0.001, 1.87 to 2.19) have the highest risk of developing dementia. Risk level for the Inflammatory/autoimmune cluster was intermediate (1.56, p<0.001, 1.37 to 1.78) and that for the Cancer cluster was least pronounced (1.36, p<0.001, 1.17 to 1.57). Contrary to expectation, neither CRP nor APOE genotype was found to moderate the effects of multimorbidity clusters on the risk of dementia. CONCLUSIONS Early identification of older adults at higher risk of accumulating multimorbidity of specific pathophysiology and tailored interventions to prevent or delay the onset of such multimorbidity may help prevention of dementia.
Collapse
Affiliation(s)
| | | | - Max O Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
11
|
Contreras M, Khondoker M, Mioshi E, Kishita N. Factors affecting the quality of life of family carers of people with dementia: the role of carer anxiety. PSYCHOL HEALTH MED 2023; 28:843-853. [PMID: 35769020 DOI: 10.1080/13548506.2022.2093926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The role of anxiety on the quality of life of family carers of people with dementia is somewhat neglected in the carer literature. The current study aimed to investigate the impact of common risk factors (i.e., care recipient's neuropsychiatric symptoms, carer depression, and burden) and anxiety on QoL. This cross-sectional study recruited 89 family carers. Most of the participants were looking after a spouse with Alzheimer's or mixed dementia. A multiple regression analysis was conducted with carer QoL as a dependent variable. All risk factors (i.e., people with dementia's neuropsychiatric symptoms, carer depression, anxiety, and burden) were entered into the model simultaneously as independent variables. The model's R2 was 33%. The results demonstrated that anxiety was the only significant independent variable predicting carer QoL (β = - 0.34, p = 0.03, 95% CI: - 0.64 to - 0.04). These results indicated that having more symptoms of anxiety was associated with worse QoL as measured by the ICEpop CAPability measure for Older people (ICECAP-O). These findings suggested that improving carer's anxiety may be particularly important in promoting QoL among family carers of people with dementia. Future interventions should target this variable to achieve the desired result of improving carer QoL.
Collapse
Affiliation(s)
- Milena Contreras
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Mizanur Khondoker
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Naoko Kishita
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| |
Collapse
|
12
|
Backhouse T, Killett A, Mioshi E, Khondoker M. What are the factors associated with people with advanced dementia refusing assistance with personal care? Int J Geriatr Psychiatry 2023; 38:e5857. [PMID: 36490270 PMCID: PMC10107826 DOI: 10.1002/gps.5857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with dementia sometimes refuse assistance with personal care activities such as washing or dressing. We aimed to investigate the factors associated with refusals of care in advanced dementia. METHODS A cross-sectional study using informant-based measures. Participants were people with advanced dementia and their caregivers (family carers or care-home staff) (n = 260, 130 dyads) in the UK. Mixed effects linear models were used to examine the effects of neuropsychiatric behaviours, ability with activities of daily living, professional input, co-morbidities, psychotropic medications, environment modifications, and caregiver factors including type and training status on refusals of care. The Refusal of Care Informant Scale was used, range 1-13; higher scores indicate more refusal behaviours. RESULTS Higher independence in activities of daily living was associated with less refusal behaviours (coefficient = -0.11, p < 0.001 [95% confidence interval -0.15, -0.07]). Higher agitation was associated with more refusal behaviours (0.11, p < 0.001 [0.06, 0.15]). No other statistically significant differences were found. There was no demonstrable evidence of differences in number of refusals of care between family and care-home caregivers or between dementia-trained or -untrained caregivers. CONCLUSIONS Results suggest refusals of care have similar prevalence regardless of caregiver type (family or care home) or dementia training status, indicating that current dementia training has no impact on refusals of care or may not be implemented as intended. Improving independence in activities of daily living and reducing agitations may help prevent refusals of care. To establish causality, future research should consider embedding these factors into interventions targeting refusal of care.
Collapse
Affiliation(s)
- Tamara Backhouse
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
| | - Anne Killett
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
| | - Eneida Mioshi
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
| | | |
Collapse
|
13
|
Freitas DF, Walker S, Nyikavaranda P, Downs J, Patel R, Khondoker M, Bhui K, Hayes RD. Ethnic inequalities in involuntary admission under the Mental Health Act: an exploration of mediation effects of clinical care prior to the first admission. Br J Psychiatry 2023; 222:27-36. [PMID: 36281471 PMCID: PMC10250681 DOI: 10.1192/bjp.2022.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/26/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies show ethnic inequalities in rates of involuntary admission and types of clinical care (such as psychological therapies). However, few studies have investigated if there is a relationship between clinical care practices and ethnic inequalities in involuntary admission. AIMS This study investigated the impact of ethnicity and clinical care on involuntary admission and the potential mediation effects of prior clinical care. METHOD In this retrospective cohort study, we used data from the electronic records of the South London and Maudsley NHS Foundation Trust and identified patients with a first hospital admission between January 2008 and May 2021. Logistic regression and mediation analyses were used to investigate the association between ethnicity and involuntary admission, and whether clinical care, in the 12 months preceding admission, mediates the association. RESULTS Compared with White British people, higher odds of involuntary admission were observed among 10 of 14 minority ethnic groups; with more than twice the odds observed among people of Asian Chinese, of Asian Bangladeshi and of any Black background. There were some ethnic differences in clinical care prior to admission, but these had a minimal impact on the inequalities in involuntary admission. More out-patient appointments and home treatment were associated with higher odds of involuntary admission, whereas psychological therapies and having a care plan were associated with reduced odds of involuntary admission. CONCLUSIONS Ethnic inequalities in involuntary admission persist after accounting for potential mediating effects of several types and frequencies of clinical care. Promoting access to psychological therapies and ensuring that care plans are in place may reduce involuntary admissions.
Collapse
Affiliation(s)
- Daniela Fonseca Freitas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Psychiatry, University of Oxford, UK
| | - Susan Walker
- Division of Psychiatry, University College London, UK and Great Ormond Street Institute of Child Health, University College London, UK
| | - Patrick Nyikavaranda
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and South London and Maudsley NHS Foundation Trust, UK
| | - Rashmi Patel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and South London and Maudsley NHS Foundation Trust, UK
| | | | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, UK and Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Richard D. Hayes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
14
|
Greene L, Aryankhesal A, Megson M, Blake J, Wong G, Briscoe S, Hilton A, Killett A, Reeve J, Allan L, Ballard C, Broomfield N, van Horik J, Khondoker M, Lazar A, Litherland R, Livingston G, Maidment I, Medina-Lara A, Rook G, Scott S, Shepstone L, Fox C. Understanding primary care diagnosis and management of sleep disturbance for people with dementia or mild cognitive impairment: a realist review protocol. BMJ Open 2022; 12:e067424. [PMID: 36400725 PMCID: PMC9676996 DOI: 10.1136/bmjopen-2022-067424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The increasingly ageing population is associated with greater numbers of people living with dementia (PLwD) and mild cognitive impairment (MCI). There are an estimated 55 million PLwD and approximately 6% of people over 60 years of age are living with MCI, with the figure rising to 25% for those aged between 80 and 84 years. Sleep disturbances are common for this population, but there is currently no standardised approach within UK primary care to manage this. Coined as a 'wicked design problem', sleep disturbances in this population are complex, with interventions supporting best management in context. METHODS AND ANALYSIS The aim of this realist review is to deepen our understanding of what is considered 'sleep disturbance' in PLwD or MCI within primary care. Specifically, we endeavour to better understand how sleep disturbance is assessed, diagnosed and managed. To co-produce this protocol and review, we have recruited a stakeholder group comprising individuals with lived experience of dementia or MCI, primary healthcare staff and sleep experts. This review will be conducted in line with Pawson's five stages including the development of our initial programme theory, literature searches and the refinement of theory. The Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) quality and reporting standards will also be followed. The realist review will be an iterative process and our initial realist programme theory will be tested and refined in response to our data searches and stakeholder discussions. ETHICS AND DISSEMINATION Ethical approval is not required for this review. We will follow the RAMESES standards to ensure we produce a complete and transparent report. Our final programme theory will help us to devise a tailored sleep management tool for primary healthcare professionals, PLwD and their carers. Our dissemination strategy will include lay summaries via email and our research website, peer-reviewed publications and social media posts. PROSPERO REGISTRATION NUMBER CRD42022304679.
Collapse
Affiliation(s)
- Leanne Greene
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Aidin Aryankhesal
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Molly Megson
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | - Jessica Blake
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Simon Briscoe
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Andrea Hilton
- Faculty of Health Sciences, School of Paramedical PeriOperative and Advanced Practice, University of Hull, Hull, UK
| | - Anne Killett
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | - Louise Allan
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Clive Ballard
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Niall Broomfield
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jayden van Horik
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Mizanur Khondoker
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alpar Lazar
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Gill Livingston
- Faculty of Brain Sciences, Division of Psychiatry, University College London, London, UK
| | - Ian Maidment
- College of Health and Life Sciences, Aston Pharmacy School, Aston University, Birmingham, UK
| | - Antonieta Medina-Lara
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Sion Scott
- College of Life Sciences, School of Allied Health Professions, University of Leicester, Leicester, UK
| | - Lee Shepstone
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Chris Fox
- Clinical Trails Unit, University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
15
|
Camino J, Khondoker M, Trucco AP, Backhouse T, Kishita N, Mioshi E. Contributions of Caregiver Management Styles to the Discrepancy Between Reported and Observed Task Performance in People with Dementia. J Alzheimers Dis 2022; 88:1605-1614. [DOI: 10.3233/jad-220155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The identification and understanding of the discrepancy between caregivers’ reports of people with dementia’s (PwD) performance of activities of daily living (ADLs) and observed performance, could clarify what kind of support a PwD effectively needs when completing tasks. Strategies used by caregivers have not been included in the investigation of this discrepancy. Objective: To (1) investigate if caregivers’ report of PwD’s ADL performance are consistent with PwD’s observed performance; (2) explore if caregiver management styles, depression, and anxiety, contribute to this discrepancy. Methods: PwD (n = 64) were assessed with standardized performance-based (Assessment of Motor and Process Skills, AMPS) and informant-based (Disability Assessment for Dementia, DAD) ADL assessments. Caregivers completed depression (PHQ-9), anxiety (GAD-7), and dementia management style (DMSS: criticism, active-management, and encouragement) questionnaires. Cohen’s kappa determined agreement/disagreement in ADL performance. To investigate the potential discrepancy between the DAD and AMPS, a continuous variable was generated: comparative ADL score. Multiple linear regression analysis explored whether caregivers’ management styles, depression or anxiety could explain the ADL discrepancy. Results: Poor level of agreement between observed and reported ADL performance [k = –0.025 (95% CI –0.123 –0.073)] was identified, with most caregivers underestimating ADL performance. The combined model explained 18% (R2 = 0.18, F (5,55) = 2.52, p≤0.05) of the variance of the comparative ADL score. Active-management (β= –0.037, t (60) = –3.363, p = 0.001) and encouragement (β= 0.025, t (60) = 2.018, p = 0.05) styles made the largest and statistically significant contribution to the model. Conclusion: Encouragement style could be advised for caregivers who underestimate ADL performance, while active management style for those who overestimate it. Findings have scope to increase caregivers’ abilities to support PwD activity engagement in daily life.
Collapse
Affiliation(s)
- Julieta Camino
- School of Health Sciences, University of East Anglia, United Kingdom
| | | | - Ana Paula Trucco
- School of Health Sciences, University of East Anglia, United Kingdom
| | - Tamara Backhouse
- School of Health Sciences, University of East Anglia, United Kingdom
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, United Kingdom
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, United Kingdom
| |
Collapse
|
16
|
de Freitas DF, Patel I, Kadra-Scalzo G, Pritchard M, Shetty H, Broadbent M, Patel R, Downs J, Segev A, Khondoker M, MacCabe JH, Bhui K, Hayes RD. Ethnic inequalities in clozapine use among people with treatment-resistant schizophrenia: a retrospective cohort study using data from electronic clinical records. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1341-1355. [PMID: 35246709 PMCID: PMC9246775 DOI: 10.1007/s00127-022-02257-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/18/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Clozapine is the most effective intervention for treatment-resistant schizophrenia (TRS). Several studies report ethnic disparities in clozapine treatment. However, few studies restrict analyses to TRS cohorts alone or address confounding by benign ethnic neutropenia. This study investigates ethnic equity in access to clozapine treatment for people with treatment-resistant schizophrenia spectrum disorder. METHODS A retrospective cohort study, using information from 11 years of clinical records (2007-2017) from the South London and Maudsley NHS Trust. We identified a cohort of service-users with TRS using a validated algorithm. We investigated associations between ethnicity and clozapine treatment, adjusting for sociodemographic factors, psychiatric multi-morbidity, substance misuse, neutropenia, and service-use. RESULTS Among 2239 cases of TRS, Black service-users were less likely to be receive clozapine compared with White British service-users after adjusting for confounders (Black African aOR = 0.49, 95% CI [0.33, 0.74], p = 0.001; Black Caribbean aOR = 0.64, 95% CI [0.43, 0.93], p = 0.019; Black British aOR = 0.61, 95% CI [0.41, 0.91], p = 0.016). It was additionally observed that neutropenia was not related to treatment with clozapine. Also, a detention under the Mental Health Act was negatively associated clozapine receipt, suggesting people with TRS who were detained are less likely to be treated with clozapine. CONCLUSION Black service-users with TRS were less likely to receive clozapine than White British service-users. Considering the protective effect of treatment with clozapine, these inequities may place Black service-users at higher risk for hospital admissions and mortality.
Collapse
Affiliation(s)
- Daniela Fonseca de Freitas
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - India Patel
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Giouliana Kadra-Scalzo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Megan Pritchard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Rashmi Patel
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Johnny Downs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Aviv Segev
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | | | - James H MacCabe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard D Hayes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| |
Collapse
|
17
|
Fonseca De Freitas D, Patel I, Kadra-Scalzo G, Pritchard M, Shetty H, Broadbent M, Patel R, Downs J, Segev A, Khondoker M, Maccabe J, Bhui K, Hayes R. Ethnic inequalities in treatment with clozapine. Eur Psychiatry 2022. [PMCID: PMC9567955 DOI: 10.1192/j.eurpsy.2022.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Ethnic disparities in treatment with clozapine, the antipsychotic recommended for treatment-resistant schizophrenia (TRS), have been reported. However, these investigations frequently suffer from potential residual confounding. For example, few studies have restricted the analyses to TRS samples and none has controlled for benign ethnic neutropenia. Objectives This study investigated if service-users’ ethnicity influenced clozapine prescription in a cohort of people with TRS. Methods Information from the clinical records of South London and Maudsley NHS Trust was used to identify a cohort of service-users with TRS between 2007 and 2017. In this cohort, we used logistic regression to investigate any association between ethnicity and clozapine prescription while adjusting for potential confounding variables, including sociodemographic factors, psychiatric multimorbidity, substance use, benign ethnic neutropenia, and inpatient and outpatient care received. Results
We identified 2239 cases that met the criteria for TRS. Results show that after adjusting for confounding variables, people with Black African ethnicity had half the odds of being treated with clozapine and people with Black Caribbean or Other Black background had about two-thirds the odds of being treated with clozapine compared White British service-users. No disparities were observed regarding other ethnic groups, namely Other White background, South Asian, Other Asian, or any other ethnicity. Conclusions There was evidence of inequities in care among Black ethnic groups with TRS. Interventions targeting barriers in access to healthcare are recommended. Disclosure During the conduction of the study, DFdF, GKS, and RH received funds from the NIHR Maudsley Biomedical Research Centre. For other activities outside the submitted work, DFdF received research funding from the UK Department of Health and Social Care, Janss
Collapse
|
18
|
Fonseca De Freitas D, Khondoker M, Nazroo J, Hayes R, Bhui K. Ethnic inequalities in multiple comorbidities among people with psychosis. Eur Psychiatry 2022. [PMCID: PMC9567012 DOI: 10.1192/j.eurpsy.2022.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Studies have shown ethnic inequalities in health, with a higher incidence of illnesses among people of some minoritised ethnic groups. Furthermore, it has been observed that people with severe mental illnesses have a higher risk for multimorbidity. However, no study has investigated ethnic disparities in comorbidity in people with a schizophrenia spectrum disorder. Objectives This study investigates potential ethnic disparities in physical health comorbidity in a cohort of people with psychosis. Methods Using a cross-sectional design, we identified service-users of the South London and Maudsley NHS Trust who were diagnosed with a schizophrenia spectrum disorder between 2007 and 2020. We assessed the prevalence of asthma, bronchitis, diabetes, hypertension, low blood pressure, overweight or obesity, and rheumatoid arthritis. Latent class analyses were used to investigate distinct profiles of comorbidity. Multinomial regression was then used to investigate ethnic disparities in these profiles. The regression model was adjusted for gender, age, neighbourhood deprivation, smoking and duration of care. Results On a sample of 23,418 service-users with psychosis, we identified two classes of comorbidity: low comorbidity and multiple comorbidities. Compared to the White British ethnicity, a higher risk for multiple comorbidities was observed for people with any Black background, Indian, Pakistani, Asian British, and mixed-race ethnicities. Furthermore, Black African women had a significantly higher risk for multiple comorbidities than their male counterparts. Conclusions Ethnic disparities are observed in multiple comorbidities among people with psychosis. Further research is needed to understand the impact of these disparities, especially in relation to mortality. Disclosure No significant relationships.
Collapse
|
19
|
Govind R, de Freitas DF, Pritchard M, Khondoker M, Teo JT, Stewart R, Hayes RD, MacCabe JH. COVID-related hospitalization, intensive care treatment, and all-cause mortality in patients with psychosis and treated with clozapine. Eur Neuropsychopharmacol 2022; 56:92-99. [PMID: 35152033 PMCID: PMC8784620 DOI: 10.1016/j.euroneuro.2022.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 01/08/2023]
Abstract
Clozapine, an antipsychotic, is associated with increased susceptibility to infection with COVID-19, compared to other antipsychotics. Here, we investigate associations between clozapine treatment and increased risk of adverse outcomes of COVID-19, namely COVID-related hospitalisation, intensive care treatment, and death, amongst patients taking antipsychotics with schizophrenia-spectrum disorders. Using the clinical records of South London and Maudsley NHS Foundation Trust, we identified 157 individuals who had an ICD-10 diagnosis of schizophrenia-spectrum disorders, were taking antipsychotics (clozapine or other antipsychotics) at the time of COVID-19 pandemic in the UK and had a laboratory-confirmed COVID-19 infection. The following health outcomes were measured: COVID-related hospitalisation, COVID-related intensive care treatment and death. We tested associations between clozapine treatment and each outcome using logistic regression models, adjusting for gender, age, ethnicity, neighbourhood deprivation, obesity, smoking status, diabetes, asthma, bronchitis and hypertension using propensity scores. Of the 157 individuals who developed COVID-19 while on antipsychotics (clozapine or other antipsychotics), there were 28% COVID-related hospitalisations, 8% COVID-related intensive care treatments and 8% deaths of any cause during the 28 days follow-up period. amongst those taking clozapine, there were 25% COVID-related hospitalisations, 7% COVID-related intensive care treatments and 7% deaths. In both unadjusted and adjusted analyses, we found no significant association between clozapine and any of the outcomes. Thus, we found no evidence that patients with clozapine treatment at time of COVID-19 infection had increased risk of hospitalisation, intensive care treatment or death, compared to non-clozapine antipsychotic-treated patients. However, further research should be considered in larger samples to confirm this.
Collapse
Affiliation(s)
- Risha Govind
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Daniela Fonseca de Freitas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Megan Pritchard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mizanur Khondoker
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - James T Teo
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; King's College Hospital, Denmark Hill, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Richard D Hayes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - James H MacCabe
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
20
|
Rugg B, Chester R, Khondoker M. Is the outcome of hands-on treatment interventions different for people with high compared to low pain self-efficacy? A secondary analysis. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
21
|
Bradford B, Rio E, Wells J, Khondoker M, Chan Y, Chester R. A comparison of the effects of two, isometric calf muscle exercises on pain in patients with chronic, mid-portion Achilles tendinopathy. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
22
|
Camino J, Kishita N, Bregola A, Rubinsztein J, Khondoker M, Mioshi E. How does carer management style influence the performance of activities of daily living in people with dementia? Int J Geriatr Psychiatry 2021; 36:1891-1898. [PMID: 34378808 DOI: 10.1002/gps.5607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/05/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION People with Dementia (PwD)'s performance of activities of daily living (ADLs) has been associated with apathy, cognitive deficits, carers' depression and burden. However, it is not known if the carers' management style affects ADL performance, particularly alongside PwD's cognitive deficits and apathy. Thus, the aim of this study was to explore the contribution of intrinsic (cognition, apathy) and extrinsic (carer management styles) dementia factors to ADL performance. METHODS PwD (n = 143) were assessed on global cognition (ACE-III); apathy (CBI-R); ADLs (Disability Assessment for Dementia-DAD). Carers' (n = 143) criticism, encouragement and active-management styles were assessed with the Dementia Management Strategy Scale (DMSS). Multiple linear regression analysis investigated contributions of carer styles, cognition, apathy (independent variables) on ADLs (dependent variable). RESULTS The best model explaining the variance of the DAD scores included cognition (β = 0.413, t(142) = 4.463, p = 0.001), apathy (β = -0.365, t(142) = -5.556, p = 0.001), carer criticism (β = -0.326, t(142) = -2.479, p = 0.014) and carer encouragement styles (β = 0.402, t(142) = 2.941, p = 0.004) accounting for 40% of the variance of the DAD scores. CONCLUSIONS This novel study demonstrated that PwD's level of apathy and the carer's use of criticism negatively affected ADL performance while PwD's cognitive abilities and carer encouragement style improved ADL performance. These findings have critical implications for the development of novel multi-component non-pharmacological interventions to maintain function and delay disease progression in dementia, as well as direct relevance to current carers and families.
Collapse
Affiliation(s)
- Julieta Camino
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Allan Bregola
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Judy Rubinsztein
- Cambridge and Peterborough Foundation Trust, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
| |
Collapse
|
23
|
Camino J, Kishita N, Trucco AP, Khondoker M, Mioshi E. A New and Tidier Setting: How Does Environmental Clutter Affect People With Dementia's Ability to Perform Activities of Daily Living? Alzheimer Dis Assoc Disord 2021; 35:335-341. [PMID: 34393190 DOI: 10.1097/wad.0000000000000469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between the physical environment and the person with dementia's (PwD) activities of daily living (ADLs) task performance is controversial. Although the general assumption is that this population benefits from their home environment when performing ADLs, very few experimental studies have been conducted to date. OBJECTIVES The aim was to investigate the influence of the environment (home vs. Research-lab) and the role of clutter on ADL performance. METHODS Sixty-five PwD were evaluated with a performance-based ADL assessment (at home and clutter-free Research-lab). Paired t tests compared ADL performance and level of clutter in both environments. Multiple regression analysis investigated factors associated with better ADL performance. RESULTS Overall, PwD performed better at home even though clutter was significantly lower in the Research-lab. When stratified by dementia stage, PwD in the moderate stage of the disease performed better at home. CONCLUSION Absence of clutter in the Research-Lab did not appear to play a beneficial role in ADLs. When stratified by dementia stage, only PwD in the moderate stage appeared to benefit from their home environment when performing ADL tasks. Future studies are required to elucidate the wider role of the environment in supporting engagement in daily activities in different dementia stages.
Collapse
Affiliation(s)
| | | | | | - Mizanur Khondoker
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | |
Collapse
|
24
|
Ryan A, Crehan E, Khondoker M, Fell M, Curtin R, Johns LC. An emotional regulation approach to psychosis recovery: The Living Through Psychosis group programme. J Behav Ther Exp Psychiatry 2021; 72:101651. [PMID: 33667827 DOI: 10.1016/j.jbtep.2021.101651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 01/25/2021] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Research indicates the value of targeting emotional regulation (ER) skills in psychological interventions for psychosis. These skills can be delivered in a group format, thereby increasing access to therapy. This pilot study examined the acceptability and clinical effects of teaching ER skills in The Living Through Psychosis (LTP) group programme. METHODS Patients with a psychotic illness were offered the LTP programme, comprising eight sessions over four weeks. Measures were completed by 55 participants. Acceptability was assessed by attendance rates and group cohesion. Measures of intervention targets, recovery and clinical outcomes were completed at baseline, pre-group, post-group, and one-month follow-up. RESULTS High group attendance and cohesion support the acceptability of the group. Participants reported less difficulty with ER (Coeff. = -8.29, 95% CI: -13.40 to -3.18, within participant uncontrolled effect size (ES) d = 0.29), increased mindful relating to distressing symptoms (Coeff. = 11.20, 95% CI: 7.02 to 15.38, d = 0.65), and improvements in recovery dimensions (Coeff. = 10.07, 95% CI: 5.6 to 14.54, d = 0.42) from pre-to post-intervention, and maintained at one-month follow-up. Participants' hallucinations and delusions reduced from pre-intervention to follow-up (t(18) = 4.64, p < 0.001; t(18) = 5.34, p < 0.001). There was no change in fear of relapse. LIMITATIONS The uncontrolled, pre-post design precluded blinded assessments, and may have inflated effect sizes. Other factors may have contributed to the improvements. CONCLUSIONS The LTP programme was acceptable to people with psychosis. The preliminary findings indicate the potential utility of teaching ER and mindfulness skills in a brief group programme. Findings require replication in a randomized controlled trial.
Collapse
Affiliation(s)
- Aisling Ryan
- School of Psychology, Trinity College Dublin, Ireland; Health Service Executive, Ireland
| | - Edel Crehan
- Department of Psychology, St Patrick's Mental Health Services, Dublin, Ireland
| | | | - Mary Fell
- School of Psychology, Trinity College Dublin, Ireland; Health Service Executive, Ireland
| | - Roisin Curtin
- Department of Psychology, St Patrick's Mental Health Services, Dublin, Ireland
| | - Louise C Johns
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| |
Collapse
|
25
|
Bradford B, Rio E, Murphy M, Wells J, Khondoker M, Clarke C, Chan Y, Chester R. Immediate Effects of two Isometric Calf Muscle Exercises on Mid-portion Achilles Tendon Pain. Int J Sports Med 2021; 42:1122-1127. [PMID: 33782936 DOI: 10.1055/a-1398-5501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objectives of this randomized, cross-over pilot study were to determine whether isometric plantarflexion exercises resulted in an immediate change in Achilles tendon pain during a loading task, and whether this differed in knee extension or flexion. Eleven participants with mid-portion Achilles tendinopathy were recruited from NHS community physiotherapy services and local running clubs. Participants were then randomized to complete an isometric calf muscle exercise with the knee fully extended or flexed to 80°. Participants switched to the alternate exercise after a minimum seven-day period. Achilles tendon pain during a specific, functional load test was measured on a 11-point numeric pain rating scale (NPRS) pre- and post-intervention. There was a small, immediate, mean reduction in pain following isometric plantar flexion performed in both knee extension (1.6, 95%CI 0.83 to 2.45, p=0.001) and knee flexion (1.3, 95%CI 0.31 to 2.19, p=0.015). There were no significant differences between the two positions. A non-significant, potentially clinically relevant finding was a 20% larger reduction in symptoms in knee extension versus flexion (p=0.110). In conclusion, isometric plantarflexion holds gave an approximately 50% immediate reduction in Achilles tendon pain with a functional load test. There were no significant differences between the two positions and both were well tolerated.
Collapse
Affiliation(s)
- Ben Bradford
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom of Great Britain and Northern Ireland
| | - Ebonie Rio
- LASEM Research Centre, La Trobe University - Bundoora Campus, Melbourne, Australia
| | - Myles Murphy
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Jacob Wells
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom of Great Britain and Northern Ireland
| | - Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom of Great Britain and Northern Ireland
| | - Celia Clarke
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom of Great Britain and Northern Ireland
| | - York Chan
- Physiotherapy Department, Ipswich Hospital NHS Trust, Colchester, United Kingdom of Great Britain and Northern Ireland
| | - Rachel Chester
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
26
|
Naughton F, Ward E, Khondoker M, Belderson P, Marie Minihane A, Dainty J, Hanson S, Holland R, Brown T, Notley C. Health behaviour change during the UK COVID‐19 lockdown: Findings from the first wave of the C‐19 health behaviour and well‐being daily tracker study. Br J Health Psychol 2021; 26:624-643. [PMID: 33410229 PMCID: PMC9291054 DOI: 10.1111/bjhp.12500] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/04/2020] [Indexed: 12/25/2022]
Abstract
Objectives To provide baseline cohort descriptives and assess change in health behaviours since the UK COVID‐19 lockdown. Design A prospective cohort (N = 1,044) of people recruited online, purposively targeting vulnerable populations. Methods After a baseline survey (April 2020), participants completed 3 months of daily ecological momentary assessments (EMA). Dietary, physical activity, alcohol, smoking, vaping and substance use behaviours collected retrospectively for the pre‐COVID‐19 period were compared with daily EMA surveys over the first 30 days during early lockdown. Predictors of behaviour change were assessed using multivariable regression models. Results 30% of the cohort had a COVID‐19 at risk health condition, 37% were classed as deprived and 6% self‐reported a mental health condition. Relative to pre‐pandemic levels, participants ate almost one portion of fruit and vegetables less per day (vegetables mean difference −0.33, 95% CI −0.40, −0.25; fruit −0.57, 95% CI −0.64, −0.50), but showed no change in high sugar portions per day (−0.03, 95% CI −0.12, 0.06). Participants spent half a day less per week doing ≥30 min of moderate to vigorous physical activity (−0.57, 95% CI −0.73, −0.40) but slightly increased days of strength training (0.21, 95% CI 0.09, 0.34), increased alcohol intake (AUDIT‐C score change 0.25, 95% CI 0.13, 0.37), though did not change smoking, vaping or substance use behaviour. Worsening health behaviour change was associated with being younger, female and higher body mass index. Conclusions The cohort reported worsening health behaviours during early lockdown. Longer term changes will be investigated using further waves of data collection.
Collapse
Affiliation(s)
- Felix Naughton
- Behavioural and Implementation Science Group School of Health Sciences University of East Anglia UK
| | - Emma Ward
- Addictions Research Group Norwich Medical School University of East Anglia UK
| | | | - Pippa Belderson
- Addictions Research Group Norwich Medical School University of East Anglia UK
| | - Anne Marie Minihane
- Nutrition and Preventive Medicine Group Norwich Medical School University of East Anglia UK
| | - Jack Dainty
- Norwich Medical School University of East Anglia Norwich UK
| | - Sarah Hanson
- Behavioural and Implementation Science Group School of Health Sciences University of East Anglia UK
| | | | - Tracey Brown
- Addictions Research Group Norwich Medical School University of East Anglia UK
| | - Caitlin Notley
- Addictions Research Group Norwich Medical School University of East Anglia UK
| |
Collapse
|
27
|
Giebel CM, Knopman D, Mioshi E, Khondoker M. Distinguishing Frontotemporal Dementia From Alzheimer Disease Through Everyday Function Profiles: Trajectories of Change. J Geriatr Psychiatry Neurol 2021; 34:66-75. [PMID: 32054376 PMCID: PMC7423644 DOI: 10.1177/0891988720901791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Different dementia syndromes display different patterns of everyday functioning. This article explored different patterns of functioning at baseline and trajectories of change in behavioral variant frontotemporal dementia (bvFTD) and Alzheimer disease (AD). METHODS Data from the Uniform Data Set of the National Alzheimer's Coordinating Centre were employed. The Functional Assessment Questionnaire assessed functioning at up to 7 follow-up visits. Independent t tests assessed variations in functioning between syndromes at baseline. Linear mixed-effect modeling explored longitudinal functional trajectories between syndromes. RESULTS Data from 3351 patients (306 bvFTD and 3,045AD) were analyzed. At baseline, patients with bvFTD performed all daily activities poorer than AD dementia. Linear mixed models showed a significant effect of syndrome and time on functioning, and evidence of interaction between syndrome and time, with bvFTD showing a steeper decline for using the stove and travel. CONCLUSIONS Findings can help in the effective care planning of everyday functioning for bvFTD and AD dementia.
Collapse
Affiliation(s)
- Clarissa M. Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom,NIHR ARC NWC, Liverpool, United Kingdom
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom,Mizanur Khondoker, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.
| |
Collapse
|
28
|
Chapin BA, Khondoker M, Coughlan G, Spiers H, Hornberger M. Navigation ability before and after menopause. Alzheimers Dement 2020. [DOI: 10.1002/alz.043085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Hugo Spiers
- University College London London United Kingdom
| | | |
Collapse
|
29
|
Jolley S, Johns LC, O'Donoghue E, Oliver J, Khondoker M, Byrne M, Butler L, De Rosa C, Leal D, McGovern J, Rasiukeviciute B, Sim F, Morris E. Group acceptance and commitment therapy for patients and caregivers in psychosis services: Feasibility of training and a preliminary randomized controlled evaluation. Br J Clin Psychol 2020; 59:524-551. [PMID: 32944971 DOI: 10.1111/bjc.12265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/16/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Psychological interventions reduce the impact of psychosis, but widescale implementation is problematic. We tested the feasibility of group acceptance and commitment therapy for Psychosis (G-ACTp), delivered by frontline staff, and co-facilitated by service-user experts-by-experience (SU-EbyE), for service-users and informal caregivers (ISRCTN: 68540929). We estimated recruitment/retention rates and outcome variability for future evaluation. METHODS Staff and SU-EbyE facilitators completed 1-day workshops, then delivered closely supervised G-ACTp, comprising four sessions (weeks 1-4) and two boosters (10 and 12 weeks). Participants recruited from adult community psychosis services were randomized to receive G-ACTp immediately or after 12 weeks, completing outcome assessments at 0, 4, and 12 weeks. Service-use/month was calculated for 1-year pre-randomization, weeks 0-12, and 5-year uncontrolled follow-up. RESULTS Of 41 facilitators trained (29 staff, 12 SU-EbyE), 29 (71%; 17 staff, 12 SU-EbyE) delivered 18 G-ACTp courses. Participant refusal rates were low (9% of service-users [10/112]; 5% of caregivers [4/79]); 60% of those invited to participate attended ≥1 G-ACTp session (64% of service-users [39/61]; 56% of caregivers [35/63]). Randomization of facilitators and participants proved problematic and participant follow-up was incomplete (78% [66/85]; 82% of service-users [36/44]; 73% of caregivers [30/41]). Effect sizes ranged from very small to large mostly favouring treatment. Service-use reductions require cautious interpretation, as very few participants incurred costs. CONCLUSIONS Implementation appears feasible for service-users; for caregivers, retention needs improving. Outcome variability indicated n = 100-300/arm followed up (α = 0.05, 90% power). Methodological limitations' mean replication is needed: identified sources of potential bias may be reduced in a cluster randomized design with sessional outcome completion. PRACTITIONER POINTS Group acceptance and commitment therapy can be successfully adapted for people with psychosis and their caregivers. Implementation (training and delivery) is possible in routine community mental health care settings. Clinical and economic outcomes are promising, but replication is needed. Recommendations are made for future studies.
Collapse
Affiliation(s)
- Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Louise C Johns
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,Department of Psychiatry, University of Oxford, UK
| | - Emma O'Donoghue
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Majella Byrne
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Lucy Butler
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Daniela Leal
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jessica McGovern
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Brigita Rasiukeviciute
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Faye Sim
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Eric Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
30
|
Gurney C, Khondoker M, Shepstone L, Jersoch Herold C, Lewis J, Chester R. Is there an association between pain self-efficacy and adherence to physiotherapy treatment for musculoskeletal shoulder pain? Secondary analysis of data. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
31
|
Colling C, Khondoker M, Patel R, Fok M, Harland R, Broadbent M, McCrone P, Stewart R. Predicting high-cost care in a mental health setting. BJPsych Open 2020; 6:e10. [PMID: 31950891 PMCID: PMC7001466 DOI: 10.1192/bjo.2019.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/01/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The density of information in digital health records offers new potential opportunities for automated prediction of cost-relevant outcomes. AIMS We investigated the extent to which routinely recorded data held in the electronic health record (EHR) predict priority service outcomes and whether natural language processing tools enhance the predictions. We evaluated three high priority outcomes: in-patient duration, readmission following in-patient care and high service cost after first presentation. METHOD We used data obtained from a clinical database derived from the EHR of a large mental healthcare provider within the UK. We combined structured data with text-derived data relating to diagnosis statements, medication and psychiatric symptomatology. Predictors of the three different clinical outcomes were modelled using logistic regression with performance evaluated against a validation set to derive areas under receiver operating characteristic curves. RESULTS In validation samples, the full models (using all available data) achieved areas under receiver operating characteristic curves between 0.59 and 0.85 (in-patient duration 0.63, readmission 0.59, high service use 0.85). Adding natural language processing-derived data to the models increased the variance explained across all clinical scenarios (observed increase in r2 = 12-46%). CONCLUSIONS EHR data offer the potential to improve routine clinical predictions by utilising previously inaccessible data. Of our scenarios, prediction of high service use after initial presentation achieved the highest performance.
Collapse
Affiliation(s)
- Craig Colling
- Applied Clinical Informatics Lead, SLaM Biomedical Research Center, South London & Maudsley Foundation NHS Trust, UK
| | - Mizanur Khondoker
- Senior Lecturer in Medical Statistics, University of East Anglia, Norwich Medical School, UK
| | - Rashmi Patel
- MRC UKRI Health Data Research UK Fellow, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London; and South London & Maudsley Foundation NHS Trust, UK
| | - Marcella Fok
- Visiting Researcher, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London; and Central and North West London NHS Foundation Trust, UK
| | - Robert Harland
- Clinical Director of Psychosis, Psychosis CAG, South London & Maudsley Foundation NHS Trust, UK
| | - Matthew Broadbent
- Informatics Lead, SLaM Biomedical Research Center, South London & Maudsley Foundation NHS Trust, UK
| | - Paul McCrone
- Professor of Health Economics, School of Health Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Robert Stewart
- Professor of Psychiatric Epidemiology and Clinical Informatics, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London; and South London & Maudsley Foundation NHS Trust, UK
| |
Collapse
|
32
|
Smith TO, Jimoh OF, Cross J, Allan L, Corbett A, Sadler E, Khondoker M, Whitty J, Valderas JM, Fox C. Social Prescribing Programmes to Prevent or Delay Frailty in Community-Dwelling Older Adults. Geriatrics (Basel) 2019; 4:geriatrics4040065. [PMID: 31783654 PMCID: PMC6960851 DOI: 10.3390/geriatrics4040065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 11/28/2022] Open
Abstract
The increasing incidence of frailty is a health and social care challenge. Social prescription is advocated as an important approach to allow health professionals to link patients with sources of support in the community. This study aimed to determine the current evidence on the effectiveness of social prescribing programmes, to delay or reduce frailty in frail older adults living in the community. A systematic literature review of published (DARE, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, NICE and SCIE, National Health Service (NHS) Economic Evaluation Database) and unpublished databases (OpenGrey; WHO Clinical Trial Registry; ClinicalTrials.gov) were searched to July 2019. Studies were eligible if they reported health, social or economic outcomes on social prescribing, community referral, referral schemes, wellbeing programmes or interventions when a non-health link worker was the intervention provider, to people who are frail living in the community. We screened 1079 unique studies for eligibility. No papers were eligible. There is therefore a paucity of evidence reporting the effectiveness of social prescribing programmes for frail older adults living in the community. Given that frailty is a clinical priority and social prescribing is considered a key future direction in the provision of community care, this is a major limitation.
Collapse
Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (O.F.J.); (J.C.); (M.K.); (J.W.); (C.F.)
- Correspondence: ; Tel.: +44-1865-227665
| | - Oluseyi F Jimoh
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (O.F.J.); (J.C.); (M.K.); (J.W.); (C.F.)
| | - Jane Cross
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (O.F.J.); (J.C.); (M.K.); (J.W.); (C.F.)
| | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter EX4 4QJ, UK; (L.A.); (A.C.); (J.M.V.)
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter EX4 4QJ, UK; (L.A.); (A.C.); (J.M.V.)
| | - Euan Sadler
- School of Health Sciences, University of Southampton, Southampton SO16 7PP, UK;
| | - Mizanur Khondoker
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (O.F.J.); (J.C.); (M.K.); (J.W.); (C.F.)
| | - Jennifer Whitty
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (O.F.J.); (J.C.); (M.K.); (J.W.); (C.F.)
| | - Jose M Valderas
- College of Medicine and Health, University of Exeter, Exeter EX4 4QJ, UK; (L.A.); (A.C.); (J.M.V.)
| | - Christopher Fox
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (O.F.J.); (J.C.); (M.K.); (J.W.); (C.F.)
| |
Collapse
|
33
|
Oram S, Colling C, Pritchard M, Khondoker M, Fonseca de Freitas D, Ter-Minassian L, Downs J, Lloyd-Evans B, Markham S, Werbeloff N, Chang CK, Johnson S, Hotopf M, Hayes RD. Patterns of use of the Mental Health Act 1983, from 2007-2008 to 2016-2017, in two major London secondary mental healthcare providers. BJPsych Open 2019; 5:e102. [PMID: 31771677 PMCID: PMC7000989 DOI: 10.1192/bjo.2019.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Trends in detention under the Mental Health Act 1983 in two major London secondary mental healthcare providers were explored using patient-level data in a historical cohort study between 2007-2008 and 2016-2017. An increase in the number of detention episodes initiated per fiscal year was observed at both sites. The rise was accompanied by an increase in the number of active patients; the proportion of active patients detained per year remained relatively stable. Findings suggest that the rise in the number of detentions reflects the rise of the number of people receiving secondary mental healthcare.
Collapse
Affiliation(s)
- Sian Oram
- Senior Lecturer in Women's Mental Health, NIHR Mental Health Policy Research Unit & Section for Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Craig Colling
- Information Manager, NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, UK
| | - Megan Pritchard
- CRIS Training and Development Lead, NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, UK
| | - Mizanur Khondoker
- Senior Lecturer in Medical Statistics, Norwich Medical School, University of East Anglia, UK
| | - Daniela Fonseca de Freitas
- Postdoctoral Researcher, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lucile Ter-Minassian
- Research Worker, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Johnny Downs
- Clinical Lecturer, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Brynmor Lloyd-Evans
- Senior Lecturer, NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, UK
| | - Sarah Markham
- Visiting Researcher, Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nomi Werbeloff
- Senior Research Associate, Division of Psychiatry, UCL; and Camden and Islington NHS Foundation Trust, UK
| | - Chin-Kuo Chang
- Associate Professor, Department of Health and Welfare, University of Taipei, Taiwan
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL; and Camden and Islington NHS Foundation Trust, UK
| | - Matthew Hotopf
- Professor of General Hospital Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Richard D Hayes
- Senior Lecturer, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
34
|
Johns L, Jolley S, Garety P, Khondoker M, Fornells-Ambrojo M, Onwumere J, Peters E, Milosh C, Brabban A, Byrne M. Improving Access to psychological therapies for people with severe mental illness (IAPT-SMI): Lessons from the South London and Maudsley psychosis demonstration site. Behav Res Ther 2019; 116:104-110. [PMID: 30877877 DOI: 10.1016/j.brat.2019.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 02/05/2019] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
Abstract
Implementation of evidence-based cognitive behavioural therapy for psychosis (CBTp) remains low in routine services. The United Kingdom Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) initiative aimed to address this issue. The project evaluated whether existing services could improve access to CBTp and demonstrate effectiveness using a systematic approach to therapy provision and outcome monitoring (in a similar way to the Improving Access to Psychological Therapies (IAPT) model for people with anxiety and depression). We report the clinical outcomes and key learning points from the South London and Maudsley NHS Foundation Trust IAPT-SMI demonstration site for psychosis. Additional funding enabled increased therapist capacity within existing secondary care community mental health services. Self-reported wellbeing and psychotic symptom outcomes were assessed, alongside service use and social/occupational functioning. Accepted referrals/year increased by 89% (2011/12: n = 106/year; 2012-2015: n = 200/year); 90% engaged (attended ≥5 sessions) irrespective of ethnicity, age and gender. The assessment protocol proved feasible, and pre-post outcomes (n = 280) showed clinical improvements and reduced service use, with medium effects. We conclude that, with appropriate service structure, investment allocated specifically for competent therapy provision leads to increased and effective delivery of CBTp. Our framework is replicable in other settings and can inform the wider implementation of psychological therapies for psychosis.
Collapse
Affiliation(s)
- Louise Johns
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; University of Oxford, Department of Psychiatry, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Suzanne Jolley
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Philippa Garety
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust (SLaM), UK
| | | | - Miriam Fornells-Ambrojo
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK; University College London, Department of Clinical, Educational and Health Psychology, London, UK
| | - Juliana Onwumere
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Emmanuelle Peters
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Craig Milosh
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Majella Byrne
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
35
|
Boyd PJ, Nevard M, Ford JA, Khondoker M, Cross JL, Fox C. The electronic frailty index as an indicator of community healthcare service utilisation in the older population. Age Ageing 2019; 48:273-277. [PMID: 30590413 DOI: 10.1093/ageing/afy181] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/25/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND older people with frailty are particularly high users of healthcare services, however a lack of standardised recording of frailty in different healthcare electronic datasets has limited investigations into healthcare service usage and demand of the older frail population. OBJECTIVES to investigate the community service demand of frail patients using the electronic frailty index (eFI) as a measure of frailty. STUDY DESIGN AND SETTING a retrospective cohort study using anonymised linked healthcare patient data from primary care, community services and acute hospitals in Norfolk. PARTICIPANTS patients aged 65 and over who had an eFI assessment score established in their primary care electronic patient record in Norwich based General Practices. RESULTS we include data from 22,859 patients with an eFI score. Frailty severity increased with age and was associated with increased acute hospital admission within a 6-month window. Patients with a frail eFI score were also more likely to have a community service referral within a 6-month window of frailty assessment, with a RR of 1.84 (1.76-1.93) for mild frailty, 1.96 (1.83-2.09) for moderate frailty and 2.95 (2.76-3.14) for severe frailty scores. We also found that frail patients had more community referrals per patient then those classified as fit and required more care plans per community referral. CONCLUSIONS eFI score was an indicator of community service use, with increasing severity of frailty being associated with higher community healthcare requirements. The eFI may help planning of community services for the frail population.
Collapse
Affiliation(s)
- Penelope J Boyd
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Matthew Nevard
- NHS North East London Commissioning Support Unit, Lakeside 400, Norwich, UK
| | - John A Ford
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Mizanur Khondoker
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Jane L Cross
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Chris Fox
- Faculty of Medicine and Health Sciences, Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| |
Collapse
|
36
|
Barnes GL, Lawrence V, Khondoker M, Stewart R, Brown JSL. Participant Experiences of Attending a Community CBT Workshop for Insomnia: A Qualitative Six-Year Follow-Up. Behav Sleep Med 2019; 17:156-173. [PMID: 28388220 DOI: 10.1080/15402002.2017.1301942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective/Background: Our aim was to qualitatively explore the experiences of people who attended a one-day sleep workshop six years previously. Participants: Of the 95 people who originally attended the workshop and a three-month follow-up, 14 individuals (mean age = 63.6 years) participated. Methods: Semi-structured interviews were used to explore: participants' experiences of insomnia since the workshop, memories of the techniques and information provided and the perceived impact of the workshop on their lives. Qualitative data were analyzed using the principles of Framework Analysis. Results: Interviews produced rich accounts of attributions of changes in sleep, the application of taught strategies and general experiences of the workshop. Conclusions: This research highlights which aspects of a large-scale intervention may be most helpful for individuals experiencing sleep difficulties and what factors may contribute to changes in sleep over time.
Collapse
Affiliation(s)
- Georgina L Barnes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Vanessa Lawrence
- Department of Health Sciences and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Mizanur Khondoker
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - June S L Brown
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| |
Collapse
|
37
|
Chester R, Khondoker M, Shepstone L, Lewis JS, Jerosch-Herold C. Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis. Br J Sports Med 2019; 53:825-834. [PMID: 30626599 DOI: 10.1136/bjsports-2018-099450] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To (i) identify predictors of outcome for the physiotherapy management of shoulder pain and (ii) enable clinicians to subgroup people into risk groups for persistent shoulder pain and disability. METHODS 1030 people aged ≥18 years, referred to physiotherapy for the management of musculoskeletal shoulder pain were recruited. 810 provided data at 6 months for 4 outcomes: Shoulder Pain and Disability Index (SPADI) (total score, pain subscale, disability subscale) and Quick Disability of the Arm, Shoulder and Hand (QuickDASH). 34 potential prognostic factors were used in this analysis. RESULTS Four classification trees (prognostic pathways or decision trees) were created, one for each outcome. The most important predictor was baseline pain and/or disability: higher or lower baseline levels were associated with higher or lower levels at follow-up for all outcomes. One additional baseline factor split participants into four subgroups. For the SPADI trees, high pain self-efficacy reduced the likelihood of continued pain and disability. Notably, participants with low baseline pain but concomitant low pain self-efficacy had similar outcomes to patients with high baseline pain and high pain self-efficacy. Cut-off points for defining high and low pain self-efficacy differed according to baseline pain and disability. In the QuickDASH tree, the association between moderate baseline pain and disability with outcome was influenced by patient expectation: participants who expected to recover because of physiotherapy did better than those who expected no benefit. CONCLUSIONS Patient expectation and pain self-efficacy are associated with clinical outcome. These clinical elements should be included at the first assessment and a low pain self-efficacy response considered as a target for treatment intervention.
Collapse
Affiliation(s)
- Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Mizanur Khondoker
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jeremy S Lewis
- Department of Allied Health Professions, School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Christina Jerosch-Herold
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| |
Collapse
|
38
|
Richardson M, Chester R, Lewis J, Khondoker M. Physiotherapy for musculoskeletal shoulder pain: baseline assessment and patient characteristics associated with patient expectation of recovery. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Knight R, Khondoker M, Magill N, Stewart R, Landau S. A Systematic Review and Meta-Analysis of the Effectiveness of Acetylcholinesterase Inhibitors and Memantine in Treating the Cognitive Symptoms of Dementia. Dement Geriatr Cogn Disord 2018; 45:131-151. [PMID: 29734182 DOI: 10.1159/000486546] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/29/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acetylcholinesterase inhibitors (AChEIs) and memantine are commonly used in the management of dementia. In routine clinical practice, dementia is often monitored via the Mini-Mental State Examination (MMSE). We conducted a systematic review and meta-analysis of the effects of these drugs on MMSE scores. SUMMARY Eighty trials were identified. Pooled effect estimates were in favour of both AChEIs and memantine at 6 months. Meta-regression indicated that dementia subtype was a moderator of AChEI treatment effect, with the effect of treatment versus control twice as high for patients with Parkinson disease dementia/ dementia with Lewy bodies (2.11 MMSE points at 6 months) as for patients with Alzheimer disease/vascular dementia (0.91 MMSE points at 6 months). Key Messages: AChEIs demonstrate a modest effect versus control on MMSE scores which is moderated by dementia subtype. For memantine the effect is smaller.
Collapse
Affiliation(s)
- Ruth Knight
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Nicholas Magill
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
40
|
Fernandes AC, Chandran D, Khondoker M, Dewey M, Shetty H, Dutta R, Stewart R. Demographic and clinical factors associated with different antidepressant treatments: a retrospective cohort study design in a UK psychiatric healthcare setting. BMJ Open 2018; 8:e022170. [PMID: 30185574 PMCID: PMC6129089 DOI: 10.1136/bmjopen-2018-022170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate the demographic and clinical factors associated with antidepressant use for depressive disorder in a psychiatric healthcare setting using a retrospective cohort study design. SETTING Data were extracted from a de-identified data resource sourced from the electronic health records of a London mental health service. Relative risk ratios (RRRs) were obtained from multinomial logistic regression analysis to ascertain the probability of receiving common antidepressant treatments relative to sertraline. PARTICIPANTS Patients were included if they received mental healthcare and a diagnosis of depression with antidepressant treatment between March and August 2015 and exposures were measured over the preceding 12 months. RESULTS Older age was associated with increased use of all antidepressants compared with sertraline, except for negative associations with fluoxetine (RRR 0.98; 95% CI 0.96 to 0.98) and a combination of two selective serotonin reuptake inhibitors (SSRIs) (0.98; 95% CI 0.96 to 0.99), and no significant association with escitalopram. Male gender was associated with increased use of mirtazapine compared with sertraline (2.57; 95% CI 1.85 to 3.57). Previous antidepressant, antipsychotic and mood stabiliser use were associated with newer antidepressant use (ie, selective norepinephrine reuptake inhibitors, mirtazapine or a combination of both), while affective symptoms were associated with reduced use of citalopram (0.58; 95% CI 0.27 to 0.83) and fluoxetine (0.42; 95% CI 0.22 to 0.72) and somatic symptoms were associated with increased use of mirtazapine (1.60; 95% CI 1.00 to 2.75) relative to sertraline. In patients older than 25 years, past benzodiazepine use was associated with a combination of SSRIs (2.97; 95% CI 1.32 to 6.68), mirtazapine (1.94; 95% CI 1.20 to 3.16) and venlafaxine (1.87; 95% CI 1.04 to 3.34), while past suicide attempts were associated with increased use of fluoxetine (2.06; 95% CI 1.10 to 3.87) relative to sertraline. CONCLUSION There were several factors associated with different antidepressant receipt in psychiatric healthcare. In patients aged >25, those on fluoxetine were more likely to have past suicide attempt, while past use of antidepressant and non-antidepressant use was also associated with use of new generation antidepressants, potentially reflecting perceived treatment resistance.
Collapse
Affiliation(s)
- Andrea C Fernandes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London (KCL), London, UK
| | - David Chandran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London (KCL), London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mizanur Khondoker
- Department of Medical Statistics, University of East Anglia, Norwich, UK
| | - Michael Dewey
- Freelance Health Statistics Consultant and KCL, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rina Dutta
- Institute of Psychiatry, Psychology and Neuroscience, King's College London (KCL), London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London (KCL), London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
41
|
Taylor CL, Broadbent M, Khondoker M, Stewart RJ, Howard LM. Predictors of severe relapse in pregnant women with psychotic or bipolar disorders. J Psychiatr Res 2018; 104:100-107. [PMID: 30015264 DOI: 10.1016/j.jpsychires.2018.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/18/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
Pregnancy in women with severe mental illness is associated with adverse outcomes for mother and infant. There are limited data on prevalence and predictors of relapse in pregnancy. A historical cohort study using anonymised comprehensive electronic health records from secondary mental health care linked with national maternity data was carried out. Women with a history of serious mental illness who were pregnant (2007-2011), and in remission at the start of pregnancy, were studied; severe relapse was defined as admission to acute care or self-harm. Predictors of relapse were analysed using random effects logistic regression to account for repeated measures in women with more than one pregnancy in the study period. In 454 pregnancies (389 women) there were 58 (24%) relapses in women with non-affective psychoses and 25 (12%) in women with affective psychotic or bipolar disorders. Independent predictors of relapse included non-affective psychosis (adjusted OR = 2.03; 95% CI = 1.16-3.54), number of recent admissions (1.37; 1.03-1.84), recent self-harm (2.24; 1.15-4.34), substance use (2.15; 1.13-4.08), smoking (2.52; 1.26-5.02) and non-white ethnicity (black ethnicity: 2.37; 1.23-4.57, mixed/other ethnicity: 2.94; 1.32-6.56). Women on no regular medication throughout first trimester were also at greater risk of relapse in pregnancy (1.99; 1.05-3.75). There was no interaction between severity of illness and medication status as relapse predictors. Therefore, women with non-affective psychosis and higher number of recent acute admissions are at significant risk of severe relapse in pregnancy. Continuation of medication in women with severe mental illness who become pregnant may be protective.
Collapse
Affiliation(s)
- Clare L Taylor
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK.
| | | | - Mizanur Khondoker
- University of East Anglia, Norwich Medical School, Norwich Research Park, Norwich, UK.
| | - Robert J Stewart
- Psychological Medicine Department, Institute of Psychiatry, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| |
Collapse
|
42
|
Bogdanowicz KM, Stewart R, Chang CK, Shetty H, Khondoker M, Day E, Hayes RD, Strang J. Excess overdose mortality immediately following transfer of patients and their care as well as after cessation of opioid substitution therapy. Addiction 2018; 113:946-951. [PMID: 29179255 DOI: 10.1111/add.14114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/20/2017] [Accepted: 11/15/2017] [Indexed: 11/30/2022]
Abstract
AIMS To investigate clustering of all-cause and overdose deaths after a transfer of patients and their care to alternative treatment provider and after the end of opioid substitution therapy (OST) in opioid-dependent individuals in specialist addiction treatment. DESIGN, SETTING AND PARTICIPANTS Mortality data were identified within a sample of 5335 patients with opioid use disorder who had received OST treatment between 1 April 2008 and 31 December 2013 from a large mental health-care provider in the United Kingdom. We investigated the circumstances and distribution of the 332 deaths identified within the observation window with a specific focus on overdose deaths (n = 103) after a planned discharge, dropout and transfer between services. MEASUREMENTS Crude mortality rates for overdose mortality 14 days, 28 days and more than 1 month after the end of treatment/transfer for overdose mortality. FINDINGS Of 47 individuals who died from overdose after having been transferred between services, nine died during the first 2 weeks [crude mortality rate (CMR) = 136.4, 95% confidence interval (CI) = 64.3-243.1] and a further five died during the first month post-transfer (CMR= 79.5, 95% CI = 44.2-129.7). Of the 32 individuals who died from overdose after planned OST cessation, five died during the first 2 weeks (CMR = 151.5, 95% CI = 51.1-319.0) and a further four died during the first month post-discharge (CMR = 82.6, 95% CI = 38.4-151.0). CONCLUSIONS In the United Kingdom, opioid-dependent people who are transferred to an alternative treatment provider for continuation of their opioid substitution therapy experience high overdose mortality rates, with substantially higher rates during the first month (especially during the first 14 days) following transfer.
Collapse
Affiliation(s)
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Chin-Kuo Chang
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mizanur Khondoker
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Norwich Research Park, University of East Anglia, Norwich Medical School, Norwich, UK
| | - Edward Day
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
| | - Richard D Hayes
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - John Strang
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
43
|
Khondoker M, Rafnsson SB, Morris S, Orrell M, Steptoe A. Positive and Negative Experiences of Social Support and Risk of Dementia in Later Life: An Investigation Using the English Longitudinal Study of Ageing. J Alzheimers Dis 2018; 58:99-108. [PMID: 28387667 PMCID: PMC5438469 DOI: 10.3233/jad-161160] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Having a network of close relationships may reduce the risk of developing dementia. However, social exchange theory suggests that social interaction entails both rewards and costs. The effects of quality of close social relationships in later life on the risk of developing dementia are not well understood. Objective: To investigate the effects of positive and negative experiences of social support within key relationships (spouse or partner, children, other immediate family, and friends) on the risk of developing dementia in later life. Methods: We analyzed 10-year follow up data (2003/4 to 2012/13) in a cohort of 10,055 dementia free (at baseline) core participants aged 50 years and over from the English Longitudinal Study of Ageing (ELSA). Incidence of dementia was identified from participant or informant reported physician diagnosed dementia or overall score of informant-completed IQCODE questionnaire. Effects of positive and negative experiences of social support measured at baseline on risk of developing dementia were investigated using proportional hazards regression accommodating interval censoring of time-to-dementia. Results: There were 340 (3.4%) incident dementia cases during the follow-up. Positive social support from children significantly reduced the risk of dementia (hazard ratio, HR = 0.83, p = 0.042, 95% CI: 0.69 to 0.99). Negative support from other immediate family (HR = 1.26, p = 0.011, CI: 1.05 to 1.50); combined negative scores from spouse and children (HR = 1.23, p = 0.046, CI: 1.004 to 1.51); spouse, children, and other family (HR = 1.27, p = 0.021, CI = 1.04 to 1.56); other family & friends (HR = 1.25, p = 0.033, CI: 1.02 to 1.55); and the overall negative scores (HR = 1.31, p = 0.019, CI: 1.05 to 1.64) all were significantly associated with increased risk of dementia. Conclusion: Positive social support from children is associated with reduced risk of developing dementia whereas experiences of negative social support from children and other immediate family increase the risk. Further research is needed to better understand the causal mechanisms that drive these associations.
Collapse
Affiliation(s)
- Mizanur Khondoker
- Norwich Medical School, University of East Anglia, Norwich, England, UK.,Department of Applied Health Research, University College London, London, UK
| | - Snorri Bjorn Rafnsson
- Department of Epidemiology and Public Health, University College London, London, UK.,Centre for Primary Health and Social Care, London Metropolitan University, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
| |
Collapse
|
44
|
Palacios J, Khondoker M, Mann A, Tylee A, Hotopf M. Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs. J Psychosom Res 2018; 104:1-8. [PMID: 29275777 DOI: 10.1016/j.jpsychores.2017.10.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND As mortality from coronary heart disease (CHD) falls, years lived with disability increase. Depression and anxiety are known indicators of poor outcomes in CHD, but most research has measured distress symptoms at one time point, often following acute events. Here we consider the long-term trajectories of these symptoms in established CHD, and examine their association to distinct measures of disability and impact on costs. METHODS AND RESULTS 803 patients with diagnosis of CHD were recruited from primary care, and completed detailed assessments every 6months for 3years. Latent class growth analysis (LCGA) was used to identify 5 distinct symptom trajectories based on the Hospital Anxiety and Depression Questionnaire (HADS): 'stable low', 'chronic high', 'improving', 'worsening', and 'fluctuating'. The 'chronic high' group had highest association with reporting of chest pain (RRR 5.8, CI 2.9 to 11.7), smoking (2.9, 1.1 to 6.3), and poorer physical (0.88, 0.83-0.93) and mental (0.78, 0.73-0.84) quality of life. The 'chronic high' and 'worsening' trajectories had significantly higher health-care costs over the 'stable low' trajectory (107.2% and 95.5% increase, respectively). In addition, our trajectories were the only significant variable associated with increased health-care costs across the 3years. CONCLUSIONS Symptoms of depression and anxiety are highly prevalent in stable CHD patients, and their long-term trajectories are the single biggest driver of health care costs. Managing morbidity in these patients, in which depression and anxiety play a key role in, should become the primary focus of policy makers and future clinical trials.
Collapse
Affiliation(s)
- Jorge Palacios
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, UK.
| | | | - Anthony Mann
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Andre Tylee
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Matthew Hotopf
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, UK; South London and Maudsley NHS Foundation Trust, UK
| |
Collapse
|
45
|
Woodhead C, Khondoker M, Lomas R, Raine R. Impact of co-located welfare advice in healthcare settings: prospective quasi-experimental controlled study. Br J Psychiatry 2017; 211:388-395. [PMID: 29051176 PMCID: PMC5709676 DOI: 10.1192/bjp.bp.117.202713] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/23/2017] [Accepted: 09/03/2017] [Indexed: 11/23/2022]
Abstract
BackgroundEvaluations of primary healthcare co-located welfare advice services have been methodologically limited.AimsTo examine the impact and cost-consequences of co-located benefits and debt advice on mental health and service use.MethodProspective, controlled quasi-experimental study in eight intervention and nine comparator sites across North Thames. Changes in the proportion meeting criteria for common mental disorder (CMD, 12-item General Health Questionnaire); well-being scores (Shortened Warwick and Edinburgh Mental Well-being Scale), 3-month GP consultation rate and financial strain were measured alongside funding costs and financial gains.ResultsRelative to controls, CMD reduced among women (ratio of odds ratios (rOR) = 0.37, 95% CI 0.20-0.70) and Black advice recipients (rOR = 0.09, 95% CI 0.03-0.28). Individuals whose advice resulted in positive outcomes demonstrated improved well-being scores (β coefficient 1.29, 95% CI 0.25-2.32). Reductions in financial strain (rOR = 0.42, 95% CI 0.23-0.77) but no changes in 3-month consultation rate were found. Per capita, advice recipients received £15 per £1 of funder investment.ConclusionsCo-located welfare advice improves short-term mental health and well-being, reduces financial strain and generates considerable financial returns.
Collapse
Affiliation(s)
- Charlotte Woodhead
- Charlotte Woodhead, PhD, Department of Applied Health Research, University College London, London; Mizanur Khondoker, PhD, Norwich Medical School, University of East Anglia, Norwich; Robin Lomas, BA, Haringey Citizens Advice, London; Rosalind Raine, PhD, Department of Applied Health Research, University College London, London, UK
| | | | | | | |
Collapse
|
46
|
Fazal K, Perera G, Khondoker M, Howard R, Stewart R. Associations of centrally acting ACE inhibitors with cognitive decline and survival in Alzheimer's disease. BJPsych Open 2017; 3:158-164. [PMID: 28713585 PMCID: PMC5495996 DOI: 10.1192/bjpo.bp.116.004184] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cognitive improvement has been reported in patients receiving centrally acting angiotensin-converting enzyme inhibitors (C-ACEIs). AIMS To compare cognitive decline and survival after diagnosis of Alzheimer's disease between people receiving C-ACEIs, non-centrally acting angiotensin-converting enzyme inhibitors (NC-ACEIs), and neither. METHOD Routine Mini-Mental State Examination (MMSE) scores were extracted in 5260 patients receiving acetylcholinesterase inhibitors and analysed against C-/NC-ACEI exposure at the time of Alzheimer's disease diagnosis. RESULTS In the 9 months after Alzheimer's disease diagnosis, MMSE scores significantly increased by 0.72 and 0.19 points per year in patients on C-ACEIs and neither respectively, but deteriorated by 0.61 points per year in those on NC-ACEIs. There were no significant group differences in score trajectories from 9 to 36 months and no differences in survival. CONCLUSIONS In people with Alzheimer's disease receiving acetylcholinesterase inhibitors, those also taking C-ACEIs had stronger initial improvement in cognitive function, but there was no evidence of longer-lasting influence on dementia progression. DECLARATION OF INTEREST R.S. has received research funding from Pfizer, Lundbeck, Roche, Janssen and GlaxoSmithKline. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
Collapse
Affiliation(s)
- Karim Fazal
- , MRCPsych, South West London and St George's Mental Health NHS Trust, London, UK
| | - Gayan Perera
- , PhD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Mizanur Khondoker
- , PhD, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Robert Howard
- , MD, MRCPsych, Division of Psychiatry, University College London, London, UK
| | - Robert Stewart
- , MD, FRCPsych, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
47
|
Baker E, Iqbal E, Johnston C, Broadbent M, Shetty H, Stewart R, Howard R, Newhouse S, Khondoker M, Dobson RJB. Trajectories of dementia-related cognitive decline in a large mental health records derived patient cohort. PLoS One 2017; 12:e0178562. [PMID: 28591196 PMCID: PMC5462385 DOI: 10.1371/journal.pone.0178562] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/15/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Modeling trajectories of decline can help describe the variability in progression of cognitive impairment in dementia. Better characterisation of these trajectories has significant implications for understanding disease progression, trial design and care planning. METHODS Patients with at least three Mini-mental State Examination (MMSE) scores recorded in the South London and Maudsley NHS Foundation Trust Electronic Health Records, UK were selected (N = 3441) to form a retrospective cohort. Trajectories of cognitive decline were identified through latent class growth analysis of longitudinal MMSE scores. Demographics, Health of Nation Outcome Scales and medications were compared across trajectories identified. RESULTS Four of the six trajectories showed increased rate of decline with lower baseline MMSE. Two trajectories had similar initial MMSE scores but different rates of decline. In the faster declining trajectory of the two, a higher incidence of both behavioral problems and sertraline prescription were present. CONCLUSIONS We find suggestive evidence for association of behavioral problems and sertraline prescription with rate of decline. Further work is needed to determine whether trajectories replicate in other datasets.
Collapse
Affiliation(s)
- Elizabeth Baker
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ehtesham Iqbal
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Caroline Johnston
- National Institute for Health Research (NIHR) Biomedical Research for mental health and Dementia Unit at South London and Maudlsey NHS Foundation Trust, London, United Kingdom
| | - Matthew Broadbent
- National Institute for Health Research (NIHR) Biomedical Research for mental health and Dementia Unit at South London and Maudlsey NHS Foundation Trust, London, United Kingdom
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Robert Howard
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Stephen Newhouse
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research for mental health and Dementia Unit at South London and Maudlsey NHS Foundation Trust, London, United Kingdom
- Farr Institute of Health Informatics Research, UCL institute of Health Informatics, University College London, London, United Kingdom
| | - Mizanur Khondoker
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard J. B. Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research for mental health and Dementia Unit at South London and Maudlsey NHS Foundation Trust, London, United Kingdom
- Farr Institute of Health Informatics Research, UCL institute of Health Informatics, University College London, London, United Kingdom
| |
Collapse
|
48
|
Bowers L, Cullen AE, Achilla E, Baker J, Khondoker M, Koeser L, Moylan L, Pettit S, Quirk A, Sethi F, Stewart D, McCrone P, Tulloch AD. Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES): combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services. Health Serv Deliv Res 2017. [DOI: 10.3310/hsdr05210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSeclusion (the isolation of a patient in a locked room) and transfer to a psychiatric intensive care unit (PICU; a specialised higher-security ward with higher staffing levels) are two common methods for the management of disturbed patient behaviour within acute psychiatric hospitals. Some hospitals do not have seclusion rooms or easy access to an on-site PICU. It is not known how these differences affect patient management and outcomes.ObjectivesTo (1) assess the factors associated with the use of seclusion and PICU care, (2) estimate the consequences of the use of these on subsequent violence and costs (study 1) and (3) describe differences in the management of disturbed patient behaviour related to differential availability (study 2).DesignThe electronic patient record system at one trust was used to compare outcomes for patients who were and were not subject to seclusion or a PICU, controlling for variables, including recent behaviours. A cost-effectiveness analysis was performed (study 1). Nursing staff at eight hospitals with differing access to seclusion and a PICU completed attitudinal measures, a video test on restraint-use timing and an interview about the escalation pathway for the management of disturbed behaviour at their hospital. Analyses examined how results differed by access to PICU and seclusion (study 2).ParticipantsPatients on acute wards or PICUs in one NHS trust during the period 2008–13 (study 1) and nursing staff at eight randomly selected hospitals in England, with varying access to seclusion and to a PICU (study 2).Main outcome measuresAggression, violence and cost (study 1), and utilisation, speed of use and attitudes to the full range of containment methods (study 2).ResultsPatients subject to seclusion or held in a PICU were more likely than those who were not to be aggressive afterwards, and costs of care were higher, but this was probably because of selection bias. We could not derive satisfactory estimates of the causal effect of either intervention, but it appeared that it would be feasible to do so for seclusion based on an enriched sample of untreated controls (study 1). Hospitals without seclusion rooms used more rapid tranquillisation, nursing of the patient in a side room accompanied by staff and seclusion using an ordinary room (study 2). Staff at hospitals without seclusion rated it as less acceptable and were slower to initiate manual restraint. Hospitals without an on-site PICU used more seclusion, de-escalation and within-eyesight observation.LimitationsOfficial record systems may be subject to recording biases and crucial variables may not be recorded (study 1). Interviews were complex, difficult, constrained by the need for standardisation and collected in small numbers at each hospital (study 2).ConclusionsClosing seclusion rooms and/or restricting PICU access does not appear to reduce the overall levels of containment, as substitution of other methods occurs. Services considering expanding access to seclusion or to a PICU should do so with caution. More evaluative research using stronger designs is required.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Len Bowers
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Alexis E Cullen
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Evanthia Achilla
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Mizanur Khondoker
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Leonardo Koeser
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Lois Moylan
- Department of Nursing, Molloy College, Rockville, NY, USA
| | - Sophie Pettit
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Alan Quirk
- Royal College of Psychiatrists, London, UK
| | - Faisil Sethi
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Duncan Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul McCrone
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Alex D Tulloch
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
49
|
Rona RJ, Burdett H, Khondoker M, Chesnokov M, Green K, Pernet D, Jones N, Greenberg N, Wessely S, Fear NT. Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial. Lancet 2017; 389:1410-1423. [PMID: 28215661 DOI: 10.1016/s0140-6736(16)32398-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 09/06/2016] [Accepted: 09/20/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for post-traumatic stress disorder (PTSD), depression, anxiety, or alcohol misuse was effective. We defined screening as the presumptive identification of a previously unrecognised disorder using tests to distinguish those who probably had the disorder from those who probably did not so that those people with a probable disorder could be referred appropriately, and assessed effectiveness and consequences for help-seeking by the odds ratio at follow-up between those receiving tailored help-seeking advice and those who received general mental health advice. METHODS We did a cluster randomised controlled trial among Royal Marines and Army personnel in the UK military after deployment to Afghanistan. Platoons were randomly assigned (1:1 initially, then 2:1) by stratified block randomisation with randomly varying block sizes of two and four to the screening group, which received tailored help-seeking advice, or the control group, which received general mental health advice. Initial assessment took place 6-12 weeks after deployment; follow-up assessments were done 10-24 months later. Follow-up measures were the PTSD Checklist-Civilian Version, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 scale, Alcohol Use Disorder Identification Test (AUDIT), and self-reported help-seeking from clinical and welfare providers comparing those receiving tailored advice and those receiving only general advice. All participants and all investigators other than the person who analysed the data were masked to allocation. The primary outcomes were PTSD, depression or generalised anxiety disorder, and alcohol misuse at follow-up. A key secondary outcome was assessment of whether post-deployment screening followed by tailored advice would modify help-seeking behaviour. Comparisons were made between screening and control groups, with primary analyses by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN19965528. FINDINGS Between Oct 24, 2011, and Oct 31, 2014, 434 platoons comprising 10 190 personnel were included: 274 (6350 personnel) in the screening group and 160 (3840 personnel) in the control group. 5577 (88%) of 6350 personnel received screening and 3996 (63%) completed follow-up, whereas 3149 (82%) of 3840 received the control questionnaire and 2369 (62%) completed follow-up. 1958 (35%) of 5577 personnel in the screening group declined to see the tailored advice, but those with PTSD (83%) or anxiety or depression (84%) were more likely than non-cases (64%) to view the advice (both p<0·0001). At follow-up, there were no significant differences in prevalence between groups for PTSD (adjusted odds ratio 0·92, 95% CI 0·75-1·14), depression or anxiety (0·91, 0·71-1·16), alcohol misuse (0·88, 0·73-1·06), or seeking support for mental disorders (0·92, 0·78-1·08). INTERPRETATION Post-deployment screening for mental disorders based on tailored advice was not effective at reducing prevalence of mental health disorders nor did it increase help-seeking. Countries that have implemented post-deployment screening programmes for mental disorders should consider monitoring the outcomes of their programmes. FUNDING The US Army Medical Research and Materiel Command-Military Operational Medicine Research Program (USAMRMC-MOMRP).
Collapse
Affiliation(s)
- Roberto J Rona
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK.
| | - Howard Burdett
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | | | - Melanie Chesnokov
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Kevin Green
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK; Navy Command Headquarter Operational Stress Management/Trauma Risk Management, West Battery, Whale Island, Portsmouth, UK
| | - David Pernet
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Norman Jones
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| | - Neil Greenberg
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| | - Simon Wessely
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Nicola T Fear
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| |
Collapse
|
50
|
Palacios J, Khondoker M, Mann A, Tylee A, Hotopf M. Trajectories of depression and anxiety symptoms in coronary heart disease strongly predict health care costs. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IntroductionThere is little information describing the trajectories of depression and anxiety symptomatology in the context of coronary heart disease (CHD), and their comparison according to sociodemographic and disability measures, cardiac risk factors, and health care costs.MethodsUsing a primary care cohort of 803 patients with a diagnosis of CHD, a latent class growth curve model was developed to study the distinct trajectories of depression and anxiety symptoms (using the hospital anxiety and depression scale) over a 3-year period comprised of 7 distinct follow-up points. Multinomial regression analysis was then conducted to study the association between latent classes, baseline risk factors, and total health care costs across time.ResultsThe 5-class model yielded the best combination of statistical best-fit analysis and clinical correlation. These classes were as follows: “stable asymptomatic” (n = 558), “worsening” (n = 64), “improving” (n = 15), “chronic high” (n = 55), and “fluctuating symptomatology” (n = 111). The comparison group was the “stable asymptomatic” class. The symptomatic classes were younger and had higher proportion of women, and were also associated with non-white ethnicity, being a current smoker, and having chest pain. Other measures of disease severity, such as a history of myocardial infarction and comorbidities, were not associated with class membership. The highest mean total health care costs across the 3 years were the “chronic high” and “worsening” class, with the lowest being the “improving” and “stable low” classes. The total societal costs for patients in the “chronic high” and “worsening” class were significantly higher, as compared to the “stable low” class.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|