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Cook C, Reid L, Elsharkawy AM, Radley A, Smith S, McPherson S, Crockford D, Dillon JF, Wright M, Morris D, Malik H, Keall S, Powell J, Catt J, Hampton H, Boothman H, Shah S, Spear J, Ustianoski A, John P, Stevens H, Khakoo SI, Parkes J, Buchanan RM. The implementation of a hepatitis C testing service in community pharmacies: I-COPTIC consensus statement. Public Health 2024; 232:153-160. [PMID: 38781782 DOI: 10.1016/j.puhe.2024.04.017] [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] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES This aimed to develop a blueprint for an effective community pharmacy Hepatitis C virus (HCV) testing service by producing a consensus statement. STUDY DESIGN This was a modified Delphi process. METHODS We recruited a heterogenous panel of experts (who had been involved in the setup or delivery of a community pharmacy HCV testing service) by purposive and chain referral methods. We had three rounds of a modified Delphi process. The first was a series of questions with free text responses and was analysed using thematic analysis, and the second and third were statements for the respondents to rate using a 7-point Likert scale. Consensus was predefined in a published protocol, and the results were reviewed by a public and patient involvement panel before the statement was finalised. RESULTS We had 24 participants, including community and hospital-based pharmacists, local pharmaceutical committee members, charity representatives (Hepatitis C Trust), local clinical service lead, nurse specialists and doctors. The response rate of the first, second and third rounds were 100%, 96% and 88%, respectively. After the third round, we had 60 statements that reached consensus. We discussed the accepted statements with a patient and public involvement group. We used these statements to produce the I-COPTIC statement and a graphical summary. CONCLUSIONS We developed a blueprint for the design of a gold standard community pharmacy HCV testing service. We believe this will support the successful implementation of community pharmacy testing for HCV. Community pharmacy testing is an important service to help achieve and maintain HCV elimination.
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Affiliation(s)
- C Cook
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - L Reid
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - A M Elsharkawy
- Liver Unit and NIHR Biomedical Research Centre at University Hospitals Birmingham NHS Trust and University of Birmingham, Edgbaston, Birmingham, B15 2TH, UK.
| | - A Radley
- NHS Tayside/University of Dundee, Nethergate, Dundee, DD1 4HN, UK.
| | - S Smith
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - S McPherson
- Liver Unit and NIHR Biomedical Research Centre, The Newcastle Upon Tyne Hospitals NHS Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - D Crockford
- Community Pharmacy South Central, Sentinel House, Harvest Crescent, Fleet, Hampshire, GU51 2UZ, UK.
| | - J F Dillon
- University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - M Wright
- University Hospitals Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - D Morris
- Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK.
| | - H Malik
- Carter's Chemist 114-116 Fowler Street, Southshields, NE33 1PZ, UK.
| | - S Keall
- Community Pharmacy Tees Valley, UK.
| | - J Powell
- Community Pharmacy Surrey and Sussex, PO Box 1061A, Surbiton, KT1 9HJ, UK.
| | - J Catt
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - H Hampton
- Royal Cornwall Hospital, Treliske, Truro, Cornwall, TR1 3LJ, UK.
| | - H Boothman
- St George's NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - S Shah
- Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - J Spear
- University Hospital of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - A Ustianoski
- Manchester University Foundation Trust & University of Manchester UK, Regional Infectious Diseases Unit, North Manchester General Hospital, Delaunays Road, Manchester, M8 5RB, UK.
| | - P John
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - H Stevens
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - S I Khakoo
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - J Parkes
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - R M Buchanan
- University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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Oute J, McPherson S. Conflict and antagonism within global psychiatry: A discourse analysis of organisational responses to the UN reports on rights-based approaches in mental health. Sociol Health Illn 2024; 46:473-494. [PMID: 37796528 DOI: 10.1111/1467-9566.13717] [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] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Between 2017 and 2020, the UN Special Rapporteur (SR) Dainius Puras published three reports that called for significant changes to organisation, funding and service provision in mental health care in ways that emphasise inclusive, rights-oriented, democratic and sustainable community health services. This article aims to examine formal organisational responses to the UN mental health reports and consider the underlying arguments that either support or delegitimise the SR stance on the need for a paradigmatic shift towards a human rights-based approach to mental health. By combining several different search strategies to identify organisational responses across the web, a total of 13 organisational responses were included in the analysis. Given the political nature of the responses, concepts from discourse theory were used to analyse the responses. The analysis showed how the responses articulated two binary positions and contesting articulations of good mental health care, which formed a backdrop for rejecting the SR reports in defence of psychiatry. The discussion elucidates how the responses tend to resemble previous ways in which critique has been dealt with mainly by 'biological psychiatry', but that the counter-critical nature of the medical and psychiatric organisational responses remains in contrast to the broader reception within the UN community.
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Affiliation(s)
- Jeppe Oute
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Drammen, Norway
| | - Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
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Senra H, Gaglianone CG, McPherson S, Unterrainer H. Prevalence of personality disorders in adults with binge eating disorder-A systematic review and Bayesian meta-analysis. Obes Rev 2024; 25:e13669. [PMID: 38114201 DOI: 10.1111/obr.13669] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 09/25/2023] [Accepted: 10/25/2023] [Indexed: 12/21/2023]
Abstract
Binge eating disorder (BED) is a complex mental health problem entailing high risk for obesity, overweight, and other psychiatric disorders. However, there is still unclear evidence of the prevalence of personality disorders (PDs) in BED patients. We conducted a systematic review and a Bayesian meta-analysis for studies examining the prevalence of any PD in adult BED patients. Data sources included PubMed, Cochrane library, EBSCO, PsycINFO, and Science Direct. A Bayesian meta-analysis was conducted to estimate effect sizes for the prevalence of any PD in BED patients. Twenty eligible articles were examined with a total of 2945 BED patients. Borderline personality disorder and "Cluster C" PD, particularly obsessive-compulsive and avoidant PD, were the most frequent PD found in BED patients. BED diagnosis was associated with 28% probability of a comorbid diagnosis of any PD (0.279, 95%CrI: [0.22, 0.34]), with high levels of between-study heterogeneity (τ = 0.61, 95% CrI [0.40, 0.90]). Sensitivity analysis suggested effect sizes ranging from 0.27 to 0.28. The high comorbidity of PDs in BED patients draws attention to the potential complexity of BED clinical presentations, including those that might also be comorbid with obesity. Clinical practice should address this complexity to improve care for BED and obesity patients.
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Affiliation(s)
- Hugo Senra
- Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal
- School of Health and Social Care, University of Essex, Essex, UK
| | - Catarina Gouveia Gaglianone
- School of Health in Social Sciences, Department of Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Susan McPherson
- School of Health and Social Care, University of Essex, Essex, UK
| | - Human Unterrainer
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
- University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
- Department of Religious Studies, University of Vienna, Vienna, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria
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McPherson S, Freedman DEP. Psychological Outcomes of 12-15-Year-Olds with Gender Dysphoria Receiving Pubertal Suppression in the UK: Assessing Reliable and Clinically Significant Change. J Sex Marital Ther 2023; 50:315-325. [PMID: 38030953 DOI: 10.1080/0092623x.2023.2281986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The evidence base for psychological benefits of GnRHA for adolescents with gender dysphoria (GD) was deemed "low quality" by the UK National Institute of Health and Care Excellence. Limitations identified include inattention to clinical importance of findings. This secondary analysis of UK clinical study data uses Reliable and Clinically Significant Change approaches to address this gap. The original uncontrolled study collected data within a specialist GD service. Participants were 44 12-15-year-olds with GD. Puberty was suppressed using "triptorelin"; participants were followed-up for 36 months. Secondary analysis used data from parent-report Child Behavior Checklists and Youth Self-Report forms. Reliable change results: 15-34% of participants reliably deteriorated depending on the subscale, time point and parent versus child report. Clinically significant change results: 27-58% were in the borderline (subclinical) or clinical range at baseline (depending on subscale and parent or child report). Rates of clinically significant change ranged from 0 to 35%, decreasing over time toward zero on both self-report and parent-report. The approach offers an established complementary method to analyze individual level change and to examine who might benefit or otherwise from treatment in a field where research designs have been challenged by lack of control groups and low sample sizes.
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Affiliation(s)
- Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
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5
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McPherson S, Oute J, Speed E. Quality-of-life measurement in depression trials: A consumerist relic. Health (London) 2023; 27:647-663. [PMID: 35088607 PMCID: PMC10423430 DOI: 10.1177/13634593221074887] [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] [Indexed: 11/17/2022]
Abstract
Quality-of-life measurement in depression is advocated as a patient-centred indicator of recovery, but may instead enhance the mimetic authority of randomised controlled trials (RCTs) which have been roundly critiqued in mental health. In this paper we draw on the social life of methods approach to extend the well-developed critique of RCTs into the field of quality-of-life measurement. We accomplish this through consideration and critique of the conceptual and epistemological development of quality-of-life measurement in depression, including the role of psychometrics in its development. Examining conceptual developments from the 1970s onwards, we consider how the scientific literature on quality-of-life in depression aligns with behavioural economics and consumerism but falls short of engaging with genuinely patient-centred approaches to recovery. We argue that quality-of-life measures in depression were developed within a consumerist model of healthcare in which the medical model was a central pillar and 'choice' a rhetorical device only. While quality-of-life instrument development was largely funded by industry, psychometrics provided no coherent solution to the 'affective fallacy' (high correlations between quality-of-life and depressive symptoms). Industry has largely abandoned the measures, while psychotherapy research has increasingly endorsed them. We argue that in their design and implementation, quality-of-life measures for depression remain based on a commercial model of healthcare, are conceptually flawed and do not support concepts of patient-centred healthcare.
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Affiliation(s)
| | - Jeppe Oute
- University of South-Eastern Norway, Norway
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6
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Buus N, Petersen A, McPherson S, Meadows G, Brand G, Ong B. The relatives of people with depression: A systematic review and methodological critique of qualitative studies. Fam Process 2023. [PMID: 37604511 DOI: 10.1111/famp.12927] [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] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
Being a close relative of a person with depression can take a heavy toll on the former, but these relatives are increasingly made responsible for taking on extensive carer roles. Research on relatives of people with depression is currently dominated by a focus on "carer burden" and although such a focus can explain many relatives' experiences and daily lives, it provides very limited insight into the everyday life of a person living with someone with depression. Therefore, we scoped qualitative research on people who are relatives of people living with depression and identified knowledge gaps caused by explicit or implicit theoretical or methodological assumptions. We conducted an exhaustive literature search in CINAHL, PubMed, PsycINFO, Sociological Abstracts, and Eric. In total, 34 publications were included, their quality evaluated and their findings mapped and summarized. We identified four interrelated and overlapping themes that dominated the findings of the publications: (a) recognition of "depression", (b) emotional responses, (c) interruptions of relationships, and (d) a staged psychosocial process. The vast majority of studies presented de-contextualized and underinterpreted analyses assuming a homogeneity of (illness) experiences and disregarded the important influence of social contributors to social relationships, connectedness, and mental health problems.
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Affiliation(s)
- Niels Buus
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Open Dialogue Centre, Sydney, New South Wales, Australia
| | - Alan Petersen
- Sociology, School of Social Sciences, Faculty of Arts, Monash University, Melbourne, Victoria, Australia
| | - Susan McPherson
- School of Health and Social Care, University of Essex, Essex, UK
| | - Graham Meadows
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Mental Health, School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia
- Monash Health, Melbourne, Victoria, Australia
| | - Gabrielle Brand
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ben Ong
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Open Dialogue Centre, Sydney, New South Wales, Australia
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7
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Solanki J, Wood L, McPherson S. Experiences of adults from a Black ethnic background detained as inpatients under the Mental Health Act (1983). Psychiatr Rehabil J 2023; 46:14-20. [PMID: 36809012 DOI: 10.1037/prj0000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE People from a Black ethnic (BE) background in England and Wales are disproportionately detained as inpatients under the United Kingdom's Mental Health Act (MHA). Qualitative research into the lived experiences of this group is sparse. This study, therefore, aims to explore the experiences of people from a BE background detained under the MHA. METHOD Semistructured interviews were conducted with 12 self-identified adults from a BE background who were currently detained as inpatients under the MHA. Thematic analysis was used to identify themes across the interviews. RESULTS Four themes emerged from the interviews: "Help is decided by others, not tailored to me"; "I am not a person-I am a Black patient"; "Mistreated or neglected instead of cared for"; and "Sectioning can be a space for sanctuary and support." CONCLUSIONS AND IMPLICATIONS FOR PRACTICE People from a BE background report inpatient detention to be a racist and racialized experience, inseparable from a wider context of systemic racism and inequality. Experiences of detention were also discussed in terms of stigma within BE families and communities, as well as social support that appeared to be lacking outside of the hospital. Systemic racism must be addressed across mental health care, led by the lived experiences of BE people. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Jay Solanki
- School of Health and Social Care, University of Essex
| | - Lisa Wood
- School of Health and Social Care, University of Essex
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8
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McPherson S, Senra H. Psychological treatments for persistent depression: A systematic review and meta-analysis of quality of life and functioning outcomes. Psychotherapy (Chic) 2022; 59:447-459. [PMID: 35758983 DOI: 10.1037/pst0000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
[Correction Notice: An Erratum for this article was reported in Vol 59(3) of Psychotherapy (see record 2022-94545-001). In the article, there were errors in the abstract. The confidence interval in the sentence Quality of life at follow-up: pooled g = 0.21 should appear as follows: 95% CI, 0.10-0.32. In the sentence The psychological interventions were associated with improvements in patients' functioning at end-of-treatment, the pooled g should appear as g = 0.35. The confidence interval in the sentence Functioning at follow-up resulted in: pooled g = 0.33 should appear as follows: 95% CI, 0.15-0.51. Figure 5 also has been corrected. All versions of this article have been corrected.] To date it is unclear whether psychological therapies have potential to improve quality of life and functioning in patients with persistent depression. This meta-analysis examines the effect of psychological therapies for improving quality of life and functioning in patients with persistent forms of depression. Data sources include Medline and Meta-Analytic Psychotherapy Database (METAPSY), searched 07/2021. Eligible studies were randomized controlled trials where participants had major depressive disorder on entry and met criteria for a persistent form of depression, for example, chronic, treatment resistant or recurrent depression. Standardized mean differences (Hedge's g) were calculated in random-effects meta-analyses. Fourteen studies met inclusion criteria (N = 1898). Psychological interventions were associated with improvements in patients' quality of life at the end of treatment: pooled g = 0.24 (95% confidence intervals [CIs] 0.13-0.34); low to moderate levels of heterogeneity (I² = 0% [95% CI 0%-41.2%]). Quality of life at follow-up: pooled g = 0.21 (95% CI 0.01-0.32); low to high levels of heterogeneity considering the wide CI for I² (I² = 10.36% [95% CI 0%-77.5%]). The psychological interventions were associated with improvements in patients' functioning at end of treatment: pooled g = 0.34 (95% CI 0.21-0.48); low to high levels of heterogeneity considering the wide CI for I² (I² = 0% [95% CI 0%-81.7%]). Functioning at follow-up resulted in: pooled g = 0.33 (95% CI 0.15-0.50); low to high levels of heterogeneity considering the wide CI for I² (I² = 0% [95% CI 0%-86.2%]). This meta-analysis highlights the potential benefits of psychological therapies for improving quality of life and functioning in patients with persistent depression, with strongest long-term effects for mindfulness-based cognitive therapy, interpersonal therapy in combination with antidepression medication, and long-term psychoanalytic psychotherapy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Hugo Senra
- School of Health and Social Care, University of Essex
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9
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McPherson S, Kelly J, Pan L, Guo L, Wu R, Chen M, Zhou T. P21-15 Comparison of routine toxicology parameters between the Göttingen and the Chinese Bama Minipig. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.695] [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: 11/30/2022]
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10
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McPherson S, Yang C, Ding J. Investigation of pre and postnatal developmental toxicity of caffene in rats. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00648-2] [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: 11/26/2022]
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McPherson S. War of conscience: antivaccination and the battle for medical freedom during World War I. Med Humanit 2021; 47:e7. [PMID: 34031185 DOI: 10.1136/medhum-2020-012069] [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] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
The nineteenth century British antivaccination movement attracted popular and parliamentary support and ultimately saw the 1853 law which had made smallpox vaccination compulsory nullified by the 1898 'conscientious objector' clause. In keeping with popular public health discourse of the time, the movement had employed rhetoric associated with sanitary science and liberalism. In the early twentieth century new discoveries in bacteriology were fuelling advances in vaccination and the medical establishment was increasingly pushing for public health to move towards more interventionist medical approaches. With the onset of war in 1914, the medical establishment hoped to persuade the government to introduce compulsory typhoid inoculation for soldiers. This article analyses antivaccination literature, mainstream newspapers and medical press along with parliamentary debates to examine how the British antivaccination movement engaged with this new threat of compulsion by expanding the rhetoric of 'conscience' and emphasising medical freedom while also asserting scientific critique concerning the effectiveness of vaccines and the new laboratory based diagnostic practices. In spite of 'conscience' fitting well with an emerging public health discourse of individual subjectivity, the mainstream press ridiculed the idea of working-class soldiers having a conscience, coalescing around the idea that 'conscientious objection' be reserved for spiritual, philosophical and educated men who objected to military service. Moreover, in spite of engaging in reasoned scientific critique, parliament and press consorted in the demarcation of scientific knowledge as exclusive to medical scientists, reflecting a growing allegiance between the state and the medical establishment during the war. Any scientific arguments critical of medical orthodoxy were subjugated, labelled as 'crank' or 'faddist' as well as unpatriotic. The antivaccination narratives around conscience contributed to or were part of an evolving discourse on consent and ethics in medicine. Potential parallels are drawn with current and likely future debates around vaccination and counterhegemonic scientific approaches.
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Affiliation(s)
- Susan McPherson
- School of Health and Social Care, University of Essex, Colchester CO4 3SQ, UK
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12
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Abstract
Chronic diseases commonly entail disability and are highly comorbid with mental health problems, particularly depression. Prevalence of depression across different disabling conditions affecting adult patients, as well as risk factors for depression in these patient groups are reviewed in the current work, with a particular focus on the literature published in the past 5 years. The prevalence of depression in disabling conditions is higher than in the general population and is associated with different factors. Examples of disease-specific factors include neurological implications of stoke, diabetic related conditions (e.g. amputation), limitations imposed by vision loss caused by age-related eye diseases, fatigue in rheumatoid arthritis, and pain in cancer. Common factors identified across different conditions include pre-morbid depression, history of mental health problems, poor social support, disease-related disability, multi-morbidity, and less adaptive coping strategies. We also reviewed studies suggesting a potential bidirectional relationship between depression and chronic disease, particularly for stroke, cardiovascular disease, diabetes, and potential factors mediating that relationship. Current findings suggested that long-term depression might be associated with an increased risk of subsequent physical health problems, although the nature of that relationship and its underlying mechanisms are still unclear.
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Affiliation(s)
- Hugo Senra
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), University of Coimbra, Coimbra, Portugal.,School of Health and Social Care, University of Essex, Colchester, UK
| | - Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
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13
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Postal KS, Bilder RM, Lanca M, Aase DM, Barisa M, Holland AA, Lacritz L, Lechuga DM, McPherson S, Morgan J, Salinas C. Inter Organizational Practice Committee Guidance/Recommendation for Models of Care During the Novel Coronavirus Pandemic. Arch Clin Neuropsychol 2021; 36:17-28. [PMID: 32997103 PMCID: PMC7543271 DOI: 10.1093/arclin/acaa073] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective The Inter Organizational Practice Committee (IOPC) convened a workgroup to develop guidance on models to provide neuropsychological (NP) care during the COVID-19 pandemic while minimizing risks of novel coronavirus transmission as lockdown orders are lifted and ambulatory clinical services resume. Method A collaborative panel of experts from major professional organizations developed provisional guidance for models of neuropsychological practice during the pandemic. The stakeholders included the American Academy of Clinical Neuropsychology/American Board of Clinical Neuropsychology, the National Academy of Neuropsychology, Society of Clinical neuropsychology (Division 40) of the American Psychological Association, the American Board of Professional Neuropsychology, and the American Psychological Association Services, Inc. Results This guidance reviews the risks and benefits of conducting NP exams in several ways, including standard in-person, mitigated in-person, in-clinic teleneuropsychology (TeleNP), and in-home TeleNP. Strategies are provided for selecting the most appropriate model for a given patient, taking into account four levels of patient risk stratification, level of community risk, and the concept of stepped models of care. Links are provided to governmental agency and professional organization resources as well as an outline and discussion of essential infection mitigation processes based on commonalities across recommendations from diverse federal, state, local, and professional organization recommendations. Conclusion This document provides recommendations and guidance with analysis of the risks relative to the benefits of various models of NP care during the COVID-19 pandemic. These recommendations may be revised as circumstances evolve, with updates posted continuously on the IOPC website (https://iopc.online/).
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Affiliation(s)
- Karen S Postal
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - Robert M Bilder
- Psychiatry & Biobehavioral Sciences and Psychology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Margaret Lanca
- Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Boston, MA, USA
| | - Darrin M Aase
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Mark Barisa
- Performance Neuropsychology, Frisco, TX, USA.,University of North Texas, Denton, TX, USA
| | - Alice Ann Holland
- Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA.,Children's Medical Center of Dallas, Dallas, TX, USA
| | - Laura Lacritz
- Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - David M Lechuga
- Neurobehavioral Clinic and Counseling Center, Lake Forest, CA, USA
| | | | | | - Christine Salinas
- Neuropsychology Concierge, Indialantic, FL, USA.,College of Medicine, University of Central Florida, Orlando, FL, USA
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14
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Postal KS, Bilder RM, Lanca M, Aase DM, Barisa M, Holland AA, Lacritz L, Lechuga DM, McPherson S, Morgan J, Salinas C. InterOrganizational practice committee guidance/recommendation for models of care during the novel coronavirus pandemic. Clin Neuropsychol 2020; 35:81-98. [PMID: 32996823 DOI: 10.1080/13854046.2020.1801847] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: The Inter Organizational Practice Committee (IOPC) convened a workgroup to develop guidance on models to provide neuropsychological (NP) care during the COVID-19 pandemic while minimizing risks of novel coronavirus transmission as lockdown orders are lifted and ambulatory clinical services resume.Method: A collaborative panel of experts from major professional organizations developed provisional guidance for models of neuropsychological practice during the pandemic. The stakeholders included the American Academy of Clinical Neuropsychology/American Board of Clinical Neuropsychology, the National Academy of Neuropsychology, Society of Clinical neuropsychology (Division 40) of the American Psychological Association, the American Board of Professional Neuropsychology, and the American Psychological Association Services, Inc.Results: This guidance reviews the risks and benefits of conducting NP exams in several ways, including standard in-person, mitigated in-person, in-clinic teleneuropsychology (TeleNP), and in-home TeleNP. Strategies are provided for selecting the most appropriate model for a given patient, taking into account four levels of patient risk stratification, level of community risk and the concept of stepped models of care. Links are provided to governmental agency and professional organization resources as well as an outline and discussion of essential infection mitigation processes based on commonalities across recommendations from diverse federal, state, local, and professional organization recommendations.Conclusion: This document provides recommendations and guidance with analysis of the risks relative to the benefits of various models of neuropsychological care during the COVID-19 pandemic. These recommendations may be revised as circumstances evolve, with updates posted continuously on the IOPC website (https://iopc.online/).
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Affiliation(s)
- Karen S Postal
- Harvard Medical School, Department of Psychiatry, Camribdge, MA, USA
| | - Robert M Bilder
- University of California Los Angeles, David Geffen School of Medicine, Psychiatry & Biobehavioral Sciences and Psychology, Los Angeles, CA, USA
| | - Margaret Lanca
- Harvard Medical School, Dept. of Psychiatry, Cambridge Health Alliance, Boston, MA, USA
| | - Darrin M Aase
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Mark Barisa
- Performance Neuropsychology, Frisco, TX, USA.,University of North Texas, Denton, TX, USA
| | - Alice Ann Holland
- University of Texas Southwestern Medical School, Psychiatry, Dallas, TX, USA.,Children's Medical Center of Dallas, Dallas, TX, USA
| | - Laura Lacritz
- University of Texas Southwestern Medical School, Psychiatry, Dallas, TX, USA
| | - David M Lechuga
- Neurobehavioral Clinic and Counseling Center, Lake Forest, CA, USA
| | | | | | - Christine Salinas
- Neuropsychology Concierge, Indialantic, FL, USA.,University of Central Florida, College of Medicine, Orlando, FL, USA
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15
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Abstract
Categorising mental disorders for purposes of diagnosis, research and practice has historically been justified on philosophical terms as a pragmatic activity; categories which have been subject to wide-ranging philosophical critique have been defended on the grounds that they serve as heuristic devices providing loose representations of shared experiences, not labels for real structures. In acknowledgement of this, there has been increasing recognition that subclassifying multiple discrete forms of persistent depression moves too far away from the notion of a heuristic and that attempts to create more precise categories become less clinically useful. Hence the most recent Diagnostic and Statistical Manual of Mental Disorders (V.5) and International Classification of Diseases (V.11) both group persistent forms of depression together. However, the UK National Institute for Health and Care Excellence has delineated certain subclassifications of persistent depression in its new guideline, which grossly distorts the phenomenology of depression. This approach commits a fundamental philosophical error in conflating absence of knowledge with knowledge of absence. In this sense, the new guideline appears to be engaging in an activity akin to the digital game Minecraft, in which the craft of building structures from units of construction is largely divorced from the laws of physics. The risk of ignoring these philosophical errors and making false claims about scientific plausibility is that the guideline recommendations inevitably represent a highly distorted phenomenology of depression and will be of very little value to patients or practitioners looking for guidance on best possible treatment options.
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Affiliation(s)
- Susan McPherson
- Health and Social Care, University of Essex, Colchester CO4 3SQ, UK
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16
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Simpson H, Manley P, Lawler J, Morey S, Buchanan E, Hewett M, Knowles J, Miller C, McCarron B, Valappil M, McPherson S. Distance to treatment as a factor for loss to follow up of hepatitis C patients in North East England. J Public Health (Oxf) 2020; 41:700-706. [PMID: 30351415 DOI: 10.1093/pubmed/fdy190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/24/2018] [Revised: 09/21/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A large proportion of the 200 000 HCV-infected individuals in the UK are undiagnosed or lost to follow-up. Engaging known infected individuals in treatment is essential for elimination. METHODS Using PHE surveillance data and HCV treatment registers from North East of England (NE) treatment centres for 1997-2016, we estimated the number of HCV cases not linked to treatment and the proportion with active infection. We compared distances of treated and untreated cases to treatment services, and assessed the effect of expanding HCV treatment into existing drug and alcohol treatment centres in the NEE on treatment accessibility. RESULTS The odds of being treated was associated with distance to treatment services. Confirmatory results for ~50% were not reported to PHE NE. Overall, 3385 patients reported to PHE NE had no record of treatment; we estimated 1621 of these may have been lost to follow-up after confirmation of active infection. CONCLUSIONS Poor access to healthcare services may contribute to under-diagnosis or loss to follow-up. Expanding HCV treatment delivery into NEE drug and alcohol treatment centres would improve the accessibility of treatment services to people infected with/at risk of HCV. This may increase the proportion receiving treatment and support progress towards elimination.
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Affiliation(s)
- H Simpson
- London School of Hygiene and Tropical Medicine, London, UK
| | - P Manley
- Field Epidemiology Service Newcastle, National Infection Service, Public Health England, Newcastle upon Tyne, UK
| | - J Lawler
- Public Health England, North East Health Protection Team, Newcastle upon Tyne, UK
| | - S Morey
- Department of Health and Life Science, Northumbria University, Newcastle upon Tyne, UK
| | - E Buchanan
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - M Hewett
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - J Knowles
- Centre for Infection, James Cook University Hospital, Middlesbrough, UK
| | - C Miller
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - B McCarron
- Centre for Infection, James Cook University Hospital, Middlesbrough, UK
| | - M Valappil
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Public Health Laboratory North East, PHE, Newcastle upon Tyne, UK
| | - S McPherson
- Viral Hepatitis Service, Newcastle upon Tyne Hospitals NHS Foundation Trust (Institute of Cellular Medicine, Newcastle University), Newcastle upon Tyne, UK
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17
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Abstract
BACKGROUND Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments. A review of patient experience research can provide a comprehensive overview of this important form of evidence and thus enable the voices and subjectivities of those affected by depression to have an impact on the treatments and services they are offered. This review aims to seek a comprehensive understanding of patient experiences of psychological therapies for depression using a systematic and rigorous approach to review and synthesis of qualitative research. METHOD PsychINFO, PsychARTICLES, MEDLINE, and CINAHL were searched for published articles using a qualitative approach to examine experiences of psychological therapies for depression. All types of psychological therapy were included irrespective of model or modes of delivery (e.g. remote or in person; group or individual). Each article was assessed following guidance provided by the Critical Appraisal Skill Programme tool. Articles were entered in full into NVIVO and themes were extracted and synthesized following inductive thematic analysis. RESULTS Thirty-seven studies, representing 671 patients were included. Three main themes are described; the role of therapy features and setting; therapy processes and how they impact on outcomes; and therapy outcomes (benefits and limitations). Subthemes are described within these themes and include discussion of what works and what's unhelpful; issues integrating therapy with real life; patient preferences and individual difference; challenges of undertaking therapy; influence of the therapist; benefits of therapy; limits of therapy and what happens when therapy ends. CONCLUSIONS Findings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account.
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Affiliation(s)
- Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, CO4 3SQ, UK.
| | - Claire Wicks
- grid.8356.80000 0001 0942 6946School of Health and Social Care, University of Essex, Colchester, CO4 3SQ UK
| | - Ilaria Tercelli
- grid.8356.80000 0001 0942 6946School of Health and Social Care, University of Essex, Colchester, CO4 3SQ UK
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18
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McPherson S, Sunkin M. The Dobson-Rawlins pact and the National Institute for Health and Care Excellence: impact of political independence on scientific and legal accountability. Br J Psychiatry 2020; 216:231-234. [PMID: 31138337 DOI: 10.1192/bjp.2019.121] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This analysis considers whether the independence of the National Institute for Health and Care Excellence (NICE), while safeguarding guidelines from commercial lobbying, may render NICE legally and scientifically unaccountable. The analysis examines the role of judicial reviews and stakeholder consultations in place of peer review in light of current debates concerning the depression guideline.
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Affiliation(s)
- Susan McPherson
- Senior Lecturer, School of Health and Social Care, University of Essex, UK
| | - Maurice Sunkin
- QC (Hon), Professor of Public Law, School of Law, University of Essex, UK
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19
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Jovicic A, McPherson S. To support and not to cure: general practitioner management of loneliness. Health Soc Care Community 2020; 28:376-384. [PMID: 31577381 DOI: 10.1111/hsc.12869] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 08/13/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
Loneliness is associated with numerous detrimental effects on physical health, mental health, cognition and lifestyle. Older adults are one of the groups at highest risk of loneliness, and indeed about 46% of older adults in England feel lonely. Those experiencing loneliness visit their general practitioner (GP) more frequently than those who are not, which has the capacity to put a strain on GPs and primary care waiting lists and costs. This study's aim was to explore GPs' views and experiences of loneliness within their older adult patients, and to understand GPs' awareness and feelings of agency within this. Nineteen UK GPs were recruited using purposive sampling and snowballing techniques. Individual semi-structured interviews were conducted either in person or over the telephone. Data were analysed using thematic analysis. Four overarching themes were identified from the data: Whose responsibility is it anyway?, Pandora's box of shame; Keeping distance; and Community responsibility. Themes emphasise that GPs tend to hold a medicalised and individualistic view of loneliness. This intensifies stigma which in turn creates barriers to raising the topic. GPs felt powerless in their ability to fix the 'problem' and tended to believe that the solution had to lie in the community, the individual or in social care rather than in primary care. The findings are discussed in the context of literature on GP management of other social problems which give rise to similar issues concerning the restrictions of the medical model and the need for joined-up approaches in which the GP is one part of a wider social support structure. It is suggested that it might be useful for training and support for GPs to address management of social problems jointly rather than training specific to loneliness which GPs tend to see as peripheral to their core remit.
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Affiliation(s)
- Ana Jovicic
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
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20
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Abstract
The forthcoming National Institute for Health and Care Excellence depression guideline reviews short-term outcomes for long-term depression. We present effect sizes for long-term outcomes in trials that report these data. Psychological therapies become more effective, whereas antidepressants become less effective over the long term. We review other forms of longitudinal research that support these findings.
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Affiliation(s)
- Susan McPherson
- Researcher, School of Health and Social Care, University of Essex, UK
| | - Michael P Hengartner
- Senior Lecturer and Researcher, School of Applied Psychology, Zurich University of Applied Sciences, Switzerland
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21
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Doncaster E, Hiskey S, McPherson S, Andrews L. "I'm Still Fighting for the Two of Us": How Partners of UK Veterans Construct Their Experience of Living with Combat-Related Trauma. J Marital Fam Ther 2019; 45:464-479. [PMID: 29876957 DOI: 10.1111/jmft.12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There has been little qualitative research into the experiences of UK partners of veterans with PTSD. This study therefore aimed to explore how partners constructed their experiences of living with the condition. Fifteen female partners of male UK veterans were recruited and interviewed. Using a social constructionist thematic analysis, five themes were constructed: the women's need to subdue own emotional and behavioral responses; dilemmas about whether the veteran was unwell or 'bad'; attempts at negotiating multiple roles; challenging the narrative of veterans as heroes; and the relational struggle with the transition to nonmilitary life. This study highlighted the importance of considering the veteran as existing within a relational and cultural context, and the need to include partners in therapeutic interventions.
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Affiliation(s)
| | - Syd Hiskey
- Essex Partnership University NHS Foundation Trust
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22
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McPherson S, Rost F, Sidhu S, Dennis M. Non-strategic ignorance: Considering the potential for a paradigm shift in evidence-based mental health. Health (London) 2018; 24:3-20. [DOI: 10.1177/1363459318785720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Randomised controlled trials form a central building block within the prevailing evidence-based mental health paradigm. Both methodology and paradigm have been widely problematised since their emergence in the mid-late twentieth century. We draw on the concept of ‘strategic ignorance’ to understand why the paradigm still prevails. We present focus group data gathered from 37 participants (service users, public, carers, general practitioners, commissioners) concerning the way they made sense of a randomised controlled trial of psychotherapy for treatment-resistant depression. Thematic analysis of the findings revealed an overall critique of randomised controlled trial methods which we refer to as ‘non-strategic ignorance’. Specifically, participants problematised the construct of depression, unseating the premise of the randomised controlled trial; they were sceptical about the purpose and highlighted its failure to show how therapy works or who might benefit; the randomised controlled trial was seen as inadequate for informing decisions about how to select a therapy. Participants assumed the treatment would be cost-effective given the client group and nature of the therapy, irrespective of any randomised controlled trial findings. Each area of lay (‘non-strategic’) critique has an analogous form within the methodological expert domain. We argue that ‘expert’ critiques have generally failed to have paradigmatic impact because they represent strategic ignorance. Yet parallel non-strategic critiques have common sense appeal, highlighting the potential power of lay voices. The discussion considers whether the evidence-based mental health paradigm is faced with epistemological problems of such complexity that the conditions exist for a new paradigm in which service user views are central and randomised controlled trials peripheral.
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23
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Abstract
From the 1980s onwards, discourses of risk have continued to grow, almost in ubiquity. Ideas and practices of risk and risk aversion have extended to UK mental health care where services are expected to assess and manage risks, and high-quality clinical assessment has been revised to incorporate risk assessment. This article problematises practices of risk assessment in mental health provision, focussing on the base-rate problem. It presents an analysis of audio recordings of risk assessments completed within a primary care mental health service. The analysis is informed by a critical logics approach which, using ideas from discourse theory as well as Lacanian psychoanalysis, involves developing a set of logics to describe, analyse and explain social phenomena. We characterise the assessments as functioning according to social logics of well-oiled administration and preservation, whereby bureaucratic processes are prioritised, contingency ironed out or ignored, and a need to manage potential risks to the service are the dominant operational frames. These logics are considered in terms of their beatific and horrific fantasmatic dimensions, whereby risk assessment is enacted as infallible (beatific) until clients become threats (horrific), creating a range of potential false negatives, false positives and so forth. These processes function to obscure or background problems with risk assessment, by generating practices that favour and offer protection to assessors, at the expense of those being assessed, thus presenting a challenge to the stated aim of risk assessment practice.
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24
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McPherson S, Rost F, Town J, Abbass A. Epistemological flaws in NICE review methodology and its impact on recommendations for psychodynamic psychotherapies for complex and persistent depression. Psychoanalytic Psychotherapy 2018. [DOI: 10.1080/02668734.2018.1458331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Felicitas Rost
- Portman Clinic, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Joel Town
- Faculty of Medicine, Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Allan Abbass
- Faculty of Medicine, Centre for Emotions and Health, Dalhousie University, Halifax, Canada
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25
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Affiliation(s)
- T Hardy
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK.,Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - S McPherson
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Liver Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
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26
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Wentink MQ, Verheul HM, Griffioen AW, Schafer KA, McPherson S, Early RJ, van der Vliet HJ, de Gruijl TD. A safety and immunogenicity study of immunization with hVEGF 26-104 /RFASE in cynomolgus monkeys. Vaccine 2018. [DOI: 10.1016/j.vaccine.2018.02.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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27
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Doherty EM, Walsh R, Andrews L, McPherson S. Measuring Emotional Intelligence Enhances the Psychological Evaluation of Chronic Pain. J Clin Psychol Med Settings 2017; 24:365-375. [PMID: 29150727 DOI: 10.1007/s10880-017-9515-x] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The assessment of emotional factors, in addition to other psychosocial factors, has been recommended as a means of identifying individuals with chronic pain who may not respond to certain pain treatments. Systematic reviews of the evidence regarding the prediction of responsiveness to a treatment called the spinal cord stimulator (SCS) have yielded inconclusive results. Emotional intelligence is a term which refers to the ability to identify and manage emotions in oneself and others and has been shown to be inversely associated with emotional distress and acute pain. This study aims to investigate the relationship between emotional intelligence, chronic pain, and the more established psychosocial factors usually used for SCS evaluations by clinical psychologists in medical settings. A sample of 112 patients with chronic pain on an acute hospital waiting list for SCS procedures in a pain medicine service were recruited. Psychological measures were completed including: a novel measure of emotional intelligence; usual measures of emotional distress and catastrophizing; and a numerical rating scale designed to assess pain intensity, pain-related distress, and interference. As predicted, findings revealed significant associations between most of the measures analyzed and current pain intensity. When entered into a simultaneous regression analysis, emotional intelligence scores remained the only significant predictor of current pain intensity. There are potential clinical, ethical, and organizational implications of emotional intelligence processes partially predicting pain in patients on a waiting list for a medical procedure. These results may offer new insight, understanding, and evaluation targets for clinical psychologists in the field of pain management.
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Affiliation(s)
- Eva M Doherty
- National Surgical Training Centre, Royal College of Surgeons in Ireland, 123, St Stephens Green, Dublin 2, Ireland.
| | - Rosemary Walsh
- Pain Management Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Leanne Andrews
- School of Health and Human Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK
| | - Susan McPherson
- School of Health and Human Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK
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28
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Priestley J, McPherson S, Davies F. Couples' Disease: The Experience of Living with a Partner with Chronic Depression. Journal of Couple & Relationship Therapy 2017. [DOI: 10.1080/15332691.2017.1372833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jemma Priestley
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Fran Davies
- School of Health and Social Care, University of Essex, Colchester, UK
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29
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Stirnimann G, Berg T, Spahr L, Zeuzem S, McPherson S, Lammert F, Storni F, Banz V, Babatz J, Vargas V, Geier A, Stallmach A, Engelmann C, Trepte C, Capel J, De Gottardi A. Treatment of refractory ascites with an automated low-flow ascites pump in patients with cirrhosis. Aliment Pharmacol Ther 2017; 46:981-991. [PMID: 28940225 PMCID: PMC5698811 DOI: 10.1111/apt.14331] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/17/2017] [Accepted: 08/30/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Refractory ascites (RA) is a frequent complication of cirrhosis, requiring large volume paracentesis or placement of a transjugular intrahepatic portosystemic shunt (TIPSS). The automated low-flow ascites pump (alfapump, Sequana Medical AG, Zurich, Switzerland) is an innovative treatment option for patients with RA. AIM To assess safety and efficacy of this treatment in patients with a contraindication to TIPSS. METHODS Fifty-six patients (43 males; mean age 62 years) from centres in Germany, Switzerland, UK and Spain were included and followed for up to 24 months. Complications, device deficiencies, paracentesis frequency and patient survival were recorded. RESULTS At the time of this analysis, 3 patients completed the 24-month observation period, monitoring of 3 was ongoing, 9 underwent liver transplantation, 17 patients were withdrawn due to serious adverse events and 23 patients died. Most frequently observed technical complication was blocking of the peritoneal catheter. Twenty-three pump-related reinterventions (17 patients) and 12 pump exchanges (11 patients) were required during follow-up. The pump system was explanted in 48% of patients (in 17 patients due to serious adverse events, in 9 at the time of liver transplantation and in 1 due to recovery from RA). Median frequency of paracentesis dropped from 2.17 to 0.17 per month. CONCLUSIONS The alfapump can expand therapeutic options for cirrhotic patients with RA. Continuous drainage of ascites in a closed loop automated system led to significant reduction in paracentesis frequency. Technical and procedural improvements are required to reduce the rate of adverse events and reinterventions. https://clinicaltrials.gov/ct2/show/NCT01532427.
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30
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Gallacher J, McPherson S. Editorial: progress towards a simple tool for screening for hepatic steatosis in the general population. Aliment Pharmacol Ther 2017; 46:559-560. [PMID: 28776747 DOI: 10.1111/apt.14217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- J Gallacher
- Gastroenterology, South Tyneside Hospital Foundation Trust, South Shields, UK
| | - S McPherson
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
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31
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Mansour D, McPherson S. Editorial: further evidence for the use of advanced magnetic resonance imaging techniques to monitor NAFLD. Aliment Pharmacol Ther 2017; 45:1269-1270. [PMID: 28370048 DOI: 10.1111/apt.14005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- D Mansour
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - S McPherson
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
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32
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McPherson S, Dyson JK, Hudson M. Editorial: improving in-hospital management of decompensated cirrhosis by a 'care bundle' - hope, frustration and lessons to learn. Authors' reply. Aliment Pharmacol Ther 2017; 45:755-756. [PMID: 28150450 DOI: 10.1111/apt.13933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- S McPherson
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - J K Dyson
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - M Hudson
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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33
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Dyson JK, Rajasekhar P, Wetten A, Hamad AH, Ng S, Paremal S, Baqai MF, Lamb CA, Masson S, Hudson M, Dipper C, Cowlam S, Hussaini H, McPherson S. Implementation of a 'care bundle' improves the management of patients admitted to hospital with decompensated cirrhosis. Aliment Pharmacol Ther 2016; 44:1030-1038. [PMID: 27666418 PMCID: PMC5412833 DOI: 10.1111/apt.13806] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 07/05/2016] [Revised: 08/09/2016] [Accepted: 08/31/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Since 1970, there has been a 400% increase in liver-related deaths due to the increasing prevalence of chronic liver disease in the United Kingdom (UK). The 2013 UK National Confidential Enquiry into Patient Outcome and Death report found that only 47% of patients who died from alcohol-related liver disease received 'good care' during their hospital stay. AIM To develop a 'care bundle' for patients with decompensated cirrhosis, aiming to ensure that evidence-based treatments are delivered within the first 24 h of hospital admission. METHODS This work gives practical advice about how to implement the bundle and examines its effects on patient care at three National Health Service Hospital Trusts in the UK by collecting data on patient care before and after introduction of the bundle. RESULTS Data were collected on 228 patients across three centres (59% male, median age 53 years). Alcohol-related liver disease was the aetiology of chronic liver disease in 85% of patients. The overall mortality rate during hospital admission was 15%. The audits demonstrated improvements in patient care for patients with a completed care bundle who were significantly more likely to have a diagnostic ascitic performed within the first 24 h (P = 0.020), have an accurate alcohol history documented (P < 0.0001) and be given antibiotics as prophylaxis against infection following a variceal haemorrhage (P = 0.0096). In Newcastle, the bundle completion rate increased from 25% to 90% during the review periods. CONCLUSIONS The introduction of a care bundle was associated with increased rates of diagnostic paracentesis and antibiotic prophylaxis with variceal haemorrhage in patients with decompensated cirrhosis.
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Affiliation(s)
- J. K. Dyson
- Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | | | - A. Wetten
- City Hospitals SunderlandSunderlandUK
| | | | - S. Ng
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - S. Paremal
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | | | - C. A. Lamb
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - S. Masson
- Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - M. Hudson
- Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - C. Dipper
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - S. Cowlam
- City Hospitals SunderlandSunderlandUK
| | | | - S. McPherson
- Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
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McPherson S, Wilkinson M. Health informatics and the cultural divide: a UK perspective. Health Informatics J 2016. [DOI: 10.1177/146045820100700202] [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
This paper discusses the concerns about the growing ‘digital divide’ within society which has implications for maintaining both health and social inequalities in the UK. The main focus of the paper is about inequalities in health relating to culture and ethnicity. Different theoretical approaches to cultural differences in health are set out as well as different ways of classifying cultural and ethnic differences in health service research. The argument then goes on to suggest that the emphasis on cultural and ethnic categorization only further divides people and fails to reduce inequalities. Transculturalism is defined and set out as a more useful way of approaching cultural difference as it is less restrictive and prescriptive. The paper sets out how this approach can be used to develop better quality health content in health informatics that is useful and relevant to a wider range of users, thus tackling both the digital divide and health inequalities.a
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Affiliation(s)
- S. McPherson
- Health Informatics Group, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, London, WC1B 3DP,
| | - M. Wilkinson
- Health Informatics Group, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, London, WC1B 3DP,
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Abstract
Non-alcoholic fatty liver disease (NAFLD) affects up to a third of the population in many developed countries. Between 10% and 30% of patients with NAFLD have non-alcoholic steatohepatitis (NASH) that can progress to cirrhosis. There are metabolic risk factors common to both NAFLD and cardiovascular disease, so patients with NASH have an increased risk of liver-related and cardiovascular death. Management of patients with NAFLD depends largely on the stage of disease, emphasising the importance of careful risk stratification. There are four main areas to focus on when thinking about management strategies in NAFLD: lifestyle modification, targeting the components of the metabolic syndrome, liver-directed pharmacotherapy for high risk patients and managing the complications of cirrhosis.
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Affiliation(s)
- J K Dyson
- Liver Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Q M Anstee
- Liver Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - S McPherson
- Liver Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Priestley J, McPherson S. Experiences of adults providing care to a partner or relative with depression: A meta-ethnographic synthesis. J Affect Disord 2016; 192:41-9. [PMID: 26706831 DOI: 10.1016/j.jad.2015.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/25/2015] [Accepted: 12/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND International interest in the informal carer role has grown in part because of the relationship between caring and caregiver burden. It has been suggested that living with someone with depression is comparable to that of other serious mental health problems, such as schizophrenia or dementia. METHODS This meta-ethnography included 15 studies exploring experiences of living with a relative or partner with depression. Studies were heterogeneous regarding types of relationship with the depressed individual. RESULTS The synthesis revealed a cyclical, psychosocial process that family caregivers undergo whilst providing care to a person with depression. The process consists of four phases: making sense of depression; changes in family dynamics; overcoming challenges; and moving forward. The findings illustrate that care giving is not a static process and that the needs of the depressed person are constantly changing. LIMITATIONS Some of the studies presented in the review represent caregivers recruited via support groups and so the person cared for may not have had professional diagnoses of depression. CONCLUSIONS This synthesis indicated the need for professional support to be available to caregivers for their own mental health needs. The model put forward suggests that different types of support may be useful for caregivers at different stages of the process including couples or systemic therapy at the initial stages of management, addressing stigma to help those overcoming challenges of caring for their partner or relative and self-compassionate approaches for caregivers who may need support to look after themselves, avoid feelings of guilt and move forward towards acceptance.
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Affiliation(s)
- Jemma Priestley
- School of Health and Human Sciences, University of Essex, Colchester CO4 3SQ, UK.
| | - Susan McPherson
- School of Health and Human Sciences, University of Essex, Colchester CO4 3SQ, UK.
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Abstract
Foster placements are more likely to break down where the foster carers already have birth children. Studies that explore the impact of fostering on foster carers and their birth children have suggested that relational changes occur, but these changes have not been examined in depth. This study aimed to explore the impact of fostering on parent-child relationships within foster families. Nine foster carers (including three couples) were interviewed separately, and the data were analysed using constructivist grounded theory methods. Analysis indicated that birth children may attribute particular importance to their position in the family (e.g. oldest child, youngest child) and that this is a key element of the way in which they relate to their parents. Emotional security and parent-child relationships can therefore be strained by a foster placement not taking this into account. Foster children also introduce significant competition for parental resources, putting a strain on relationships. Foster carers seem to prioritise, consciously or not, the preservation of relationships within the biological family. Reflecting on relationships and making changes to maximise potential improvements in relationships can lead to positive outcomes, and this can have an impact on whether families continue fostering or not.
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Affiliation(s)
| | - Susan McPherson
- School of Health and Human Sciences, University of Essex, UK
| | - Louise Marsland
- School of Health and Human Sciences, University of Essex, UK
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Fonagy P, Rost F, Carlyle JA, McPherson S, Thomas R, Pasco Fearon RM, Goldberg D, Taylor D. Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS). World Psychiatry 2015; 14:312-21. [PMID: 26407787 PMCID: PMC4592654 DOI: 10.1002/wps.20267] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [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] [Indexed: 12/21/2022] Open
Abstract
This pragmatic randomized controlled trial tested the effectiveness of long-term psychoanalytic psychotherapy (LTPP) as an adjunct to treatment-as-usual according to UK national guidelines (TAU), compared to TAU alone, in patients with long-standing major depression who had failed at least two different treatments and were considered to have treatment-resistant depression. Patients (N=129) were recruited from primary care and randomly allocated to the two treatment conditions. They were assessed at 6-monthly intervals during the 18 months of treatment and at 24, 30 and 42 months during follow-up. The primary outcome measure was the 17-item version of the Hamilton Depression Rating Scale (HDRS-17), with complete remission defined as a HDRS-17 score ≤8, and partial remission defined as a HDRS-17 score ≤12. Secondary outcome measures included self-reported depression as assessed by the Beck Depression Inventory - II, social functioning as evaluated by the Global Assessment of Functioning, subjective wellbeing as rated by the Clinical Outcomes in Routine Evaluation - Outcome Measure, and satisfaction with general activities as assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire. Complete remission was infrequent in both groups at the end of treatment (9.4% in the LTPP group vs. 6.5% in the control group) as well as at 42-month follow-up (14.9% vs. 4.4%). Partial remission was not significantly more likely in the LTPP than in the control group at the end of treatment (32.1% vs. 23.9%, p=0.37), but significant differences emerged during follow-up (24 months: 38.8% vs. 19.2%, p=0.03; 30 months: 34.7% vs. 12.2%, p=0.008; 42 months: 30.0% vs. 4.4%, p=0.001). Both observer-based and self-reported depression scores showed steeper declines in the LTPP group, alongside greater improvements on measures of social adjustment. These data suggest that LTPP can be useful in improving the long-term outcome of treatment-resistant depression. End-of-treatment evaluations or short follow-ups may miss the emergence of delayed therapeutic benefit.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Felicitas Rost
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Jo-Anne Carlyle
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Susan McPherson
- School of Health and Human Sciences, University of Essex, Colchester, UK
| | - Rachel Thomas
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
| | - R M Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - David Goldberg
- Institute of Psychiatry, Psychology and Neuro science, King's College London, London, UK
| | - David Taylor
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
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Abstract
Non-alcoholic fatty liver disease (NAFLD) encompasses a histological spectrum of liver disease, from simple steatosis through to cirrhosis. As the worldwide rates of obesity have increased, NAFLD has become the commonest cause of liver disease in many developed countries, affecting up to a third of the population. The majority of patients have simple steatosis that carries a relatively benign prognosis. However, a significant minority have non-alcoholic steatohepatitis, and have increased liver related and cardiovascular mortality. Identifying those at risk of progressive disease is crucial. Liver biopsy remains the gold standard investigation for assessing stage of disease but its invasive nature makes it impractical for widespread use as a prognostic tool. Non-invasive tools for diagnosis and disease staging are required, reserving liver biopsy for those patients where it offers clinically relevant additional information. This review discusses the non-invasive modalities available for assessing steatosis, steatohepatitis and fibrosis. We propose a pragmatic approach for the assessment of patients with NAFLD to identify those at high risk of progressive disease who require referral to specialist services.
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Affiliation(s)
- J K Dyson
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, , Newcastle upon Tyne, UK
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40
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Abstract
This research examines how individuals diagnosed with dissociative identity disorder construe their experiences of being labeled with a contested diagnosis. Semistructured interviews were conducted in the United Kingdom with 5 women and 2 men diagnosed with dissociative identity disorder. A framework analysis was conducted. The analysis identified 2 overarching themes: diagnosis cross-examined and navigating care systems. The diagnosis appeared to be continually assessed by participants for its fit with symptoms, and the doubt among professionals seemed to be unhelpfully reflected in participants' attempts to understand and come to terms with their experiences. The findings are considered in light of labeling theory, the iatrogenic effects of professional doubt, and current debates concerning the reliability and validity of psychiatric diagnostic systems that have been reinvigorated by the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
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Affiliation(s)
- Jessica Floris
- a John Howard Centre for Forensic Mental Health , East London NHS Foundation Trust , Hackney , United Kingdom
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41
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Dyson JK, Anstee QM, McPherson S. Non-alcoholic fatty liver disease: a practical approach to treatment. Frontline Gastroenterol 2014; 5:277-286. [PMID: 25285192 PMCID: PMC4173737 DOI: 10.1136/flgastro-2013-100404] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [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] [Received: 10/12/2013] [Revised: 12/26/2013] [Accepted: 01/01/2014] [Indexed: 02/04/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) affects up to a third of the population in many developed countries. Between 10% and 30% of patients with NAFLD have non-alcoholic steatohepatitis (NASH) that can progress to cirrhosis. There are metabolic risk factors common to both NAFLD and cardiovascular disease, so patients with NASH have an increased risk of liver-related and cardiovascular death. Management of patients with NAFLD depends largely on the stage of disease, emphasising the importance of careful risk stratification. There are four main areas to focus on when thinking about management strategies in NAFLD: lifestyle modification, targeting the components of the metabolic syndrome, liver-directed pharmacotherapy for high risk patients and managing the complications of cirrhosis.
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Affiliation(s)
- J K Dyson
- Liver Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Q M Anstee
- Liver Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - S McPherson
- Liver Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Abstract
OBJECTIVES Researcher, clinical professional and lay understandings of the meaning of trauma may differ. An awareness of older people's perspectives on trauma may be important, given the potential for historical and cultural features to shape how the term is conceptualised among this group, thereby influencing related help-seeking behaviour. METHOD Older people living in Essex, Cambridgeshire and Suffolk were interviewed about their perceptions of the term, as was a group of mental health professionals who work with the elderly. RESULTS Many older people regarded significant adversity as just part of life, with collectively understood methods of avoidance or limited support-seeking pointing to emotional management through non-disclosure. This position seemed further informed by views that disclosure may be self-indulgent, which is in stark contrast to the historical and cultural background in which many older people were raised. The professionals also suggested that some older people may be unused to expressing their emotions. The concept of trauma seems to be relative, with stigma and shame appearing to influence the way that responses to adversity are managed by this age group. CONCLUSION [corrected] We conclude that focused history taking by clinicians may be needed to help elicit symptoms of trauma among elderly patients, while at the same time services might engage in a compassionate dialogue to encourage those suffering in silence to seek help.
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Affiliation(s)
- Syd Hiskey
- North Essex Partnership NHS Foundation Trust, Department of Older Adult Psychology, The Abberton Centre, Colchester General Hospital, UK.
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McPherson S, Clayton S, Wood H, Hiskey S, Andrews L. The Role of Childhood Experiences in the Development of Sexual Compulsivity. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/10720162.2013.803213] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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44
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McPherson S, Valappil M, Moses SE, Eltringham G, Miller C, Baxter K, Chan A, Shafiq K, Saeed A, Qureshi R, Hudson M, Bassendine MF. Targeted case finding for hepatitis B using dry blood spot testing in the British-Chinese and South Asian populations of the North-East of England. J Viral Hepat 2013; 20:638-44. [PMID: 23910648 DOI: 10.1111/jvh.12084] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 09/26/2012] [Accepted: 12/28/2012] [Indexed: 12/19/2022]
Abstract
Chronic infection with the hepatitis B virus (HBV) is a frequent cause of cirrhosis and liver cancer. Targeted HBV screening is recommended by the Centre for Disease Control (CDC) and Prevention for subjects born in countries with >2% HBV prevalence. However, there are no UK guidelines. Here, we applied the (CDC) recommendations to the British-Chinese and British-South Asian community of North-East (NE) England. British-Chinese and South Asian subjects were invited to attend for HBV education and screening sessions held in community centres. Hepatitis B surface antigen (HBsAg) and hepatitis B core total antibody (HBcAb) were tested with dry blood spot tests. South Asians were also tested for hepatitis C antibody (HCVAb). A total of 1126 subjects (606 Chinese and 520 South Asian) were screened. Sixty-two (5.5%) were HBsAg positive. Ten of these reported a previous diagnosis of HBV. The prevalence of HBsAg positivity was 4.6% when previously diagnosed individuals were excluded. The HBsAg prevalence was significantly higher in the Chinese subjects compared with South Asians (8.7% VS. 1.7% P < 0.001). In Chinese subjects, HBsAg positivity was highest in subjects born in Vietnam (17.4%), followed by China (11%), Hong Kong (7.8%) and the UK (6.7%). Subjects from Pakistan had the highest HBsAg and HCV Ab prevalence in the South Asians (3.1% and 1.8%, respectively). Ten percentage of HBsAg positive patients who had follow-up assessment had active disease requiring antiviral treatment. Undiagnosed HBV infection was above the 2% threshold for screening suggested by the CDC in the British-Chinese and Pakistani community of NE England, which provides evidence for a UK HBV-targeted screening programme.
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Affiliation(s)
- S McPherson
- Liver Unit, Freeman Hospital, Newcastle upon Tyne Hospitals Foundation NHS Trust, Newcastle upon Tyne, UK.
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45
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Abstract
Many patients with depression do not recover despite medication or therapy. Individuals with treatment resistant depression often have co-morbid anxiety, personality difficulties and drug or alcohol misuse and have been characterised as difficult, heartsink or problem personalities by general practitioners. Yet critical studies of interaction in medical settings suggest that the context may have a role in constructing the patient. A total of 12 audio-recorded routine consultations were analysed following guidelines for qualitative analysis of medical discourse. The interpretation focused on ways in which the context and structure of primary care consultations in a UK setting construct difficult encounters, which may lead to patients with treatment resistant depression being seen as difficult to manage in various ways. Three overarching observations were that presentation of multiple problems in multiple domains clash with the consultation format; that patients' atypically high level of activity in a time-limited setting prevents patient-centred work; that the question and answer format restricts multifaceted discussions of social and emotional problems, preventing shared understandings emerging. However, although interactions appear uneasy, they are repaired and may be moderately palliative. Suggestions are made for re-orienting general practitioner work with treatment resistant depression towards long-term goal setting outside of the traditional consultation structure in order to develop shared understandings.
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46
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Abstract
Non-alcoholic fatty liver disease (NAFLD) encompasses a histological spectrum of liver disease, from simple steatosis through to cirrhosis. As the worldwide rates of obesity have increased, NAFLD has become the commonest cause of liver disease in many developed countries, affecting up to a third of the population. The majority of patients have simple steatosis that carries a relatively benign prognosis. However, a significant minority have non-alcoholic steatohepatitis, and have increased liver related and cardiovascular mortality. Identifying those at risk of progressive disease is crucial. Liver biopsy remains the gold standard investigation for assessing stage of disease but its invasive nature makes it impractical for widespread use as a prognostic tool. Non-invasive tools for diagnosis and disease staging are required, reserving liver biopsy for those patients where it offers clinically relevant additional information. This review discusses the non-invasive modalities available for assessing steatosis, steatohepatitis and fibrosis. We propose a pragmatic approach for the assessment of patients with NAFLD to identify those at high risk of progressive disease who require referral to specialist services.
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47
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Khavandi A, Bentham J, Marlais M, Martin RP, Morgan GJ, Parry AJ, Brooks MJ, Manghat NE, Hamilton MCK, Baumbach A, McPherson S, Thomson JD, Turner MS. Transcatheter and endovascular stent graft management of coarctation-related pseudoaneurysms. Heart 2013; 99:1275-81. [DOI: 10.1136/heartjnl-2012-303488] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Kang C, Lee GJ, Yi D, McPherson S, Rogers S, Tingus K, Lu PH. Normative data for healthy older adults and an abbreviated version of the Stroop test. Clin Neuropsychol 2012; 27:276-89. [PMID: 23259830 DOI: 10.1080/13854046.2012.742930] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Normative data for the Kaplan version of the Stroop Test are presented for 153 healthy, cognitively intact older adults aged 50-89 years. Increasing age was associated with decreased performance on all three subtests (Stroop A, Stroop B, and Stroop C), while years of education was only associated with Stroop B performance. Hence the normative data were stratified by age into three groups (50-64, 65-74, 75-89). Completion times for the first half of each trial (half-time scores) were found to have good split-half reliability and correlated highly with the original full administration scores. Means and standard deviations for the half-time administration are also presented for this sample. The current study provides more comprehensive normative data for older adults than previously available, as well as normative information for half-time scores that may have future clinical utility as an alternative, abbreviated version of the Kaplan Stroop Test.
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49
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Abstract
Understanding how primary care clinicians manage depression is a key backdrop to current and future initiatives to improve detection and treatment of depression. We systematically reviewed, identified, and extracted findings from 13 qualitative studies that examined general practitioner (GP) management of depression. We assessed articles for quality using Critical Appraisal Skills Program guidelines for assessing qualitative research but did not exclude any articles based on quality. We carried out a thematic analysis for systematic review of qualitative research in which we identified four main themes with various subthemes: "negotiating the nature of depression," "detect and diagnose," "interventions," and "burden." The results of the analysis illuminate the complex dilemma faced by GPs in managing depression, which appears to be characterized by a sense of dissonance between the medicalization of depression and a sense of its social determinants.
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Affiliation(s)
- Susan McPherson
- School of Health and Human Sciences, University of Essex, Colchester, United Kingdom.
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50
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Taylor D, Carlyle JA, McPherson S, Rost F, Thomas R, Fonagy P. Tavistock Adult Depression Study (TADS): a randomised controlled trial of psychoanalytic psychotherapy for treatment-resistant/treatment-refractory forms of depression. BMC Psychiatry 2012; 12:60. [PMID: 22686185 PMCID: PMC3395560 DOI: 10.1186/1471-244x-12-60] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 06/11/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Long-term forms of depression represent a significant mental health problem for which there is a lack of effective evidence-based treatment. This study aims to produce findings about the effectiveness of psychoanalytic psychotherapy in patients with treatment-resistant/treatment-refractory depression and to deepen the understanding of this complex form of depression. METHODS/DESIGN INDEX GROUP Patients with treatment resistant/treatment refractory depression. DEFINITION & INCLUSION CRITERIA Current major depressive disorder, 2 years history of depression, a minimum of two failed treatment attempts, ≥14 on the HRSD or ≥21 on the BDI-II, plus complex personality and/or psycho-social difficulties. EXCLUSION CRITERIA Moderate or severe learning disability, psychotic illness, bipolar disorder, substance dependency or receipt of test intervention in the previous two years. DESIGN Pragmatic, randomised controlled trial with qualitative and clinical components. TEST INTERVENTION 18 months of weekly psychoanalytic psychotherapy, manualised and fidelity-assessed using the Psychotherapy Process Q-Sort. CONTROL CONDITION Treatment as usual, managed by the referring practitioner. RECRUITMENT GP referrals from primary care. RCT MAIN OUTCOME HRSD (with ≤14 as remission). SECONDARY OUTCOMES depression severity (BDI-II), degree of co-morbid disorders Axis-I and Axis-II (SCID-I and SCID-II-PQ), quality of life and functioning (GAF, CORE, Q-les-Q), object relations (PROQ2a), Cost-effectiveness analysis (CSRI and GP medical records). FOLLOW-UP 2 years. Plus: a). Qualitative study of participants' and therapists' problem formulation, experience of treatment and of participation in trial. (b) Narrative data from semi-structured pre/post psychodynamic interviews to produce prototypes of responders and non-responders. (c) Clinical case-studies of sub-types of TRD and of change. DISCUSSION TRD needs complex, long-term intervention and extended research follow-up for the proper evaluation of treatment outcome. This pushes at the limits of the design of randomised therapeutic trials. We discuss some of the consequent problems and suggest how they may be mitigated. TRIAL REGISTRATION Current Controlled Trials ISRCTN40586372.
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Affiliation(s)
- David Taylor
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Jo-anne Carlyle
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
- Psychology, Psychotherapy, Consultancy and Training in the Community (PSYCTC), Hamilton House, Mabledon Place, London, UK
| | - Susan McPherson
- School of Health and Human Sciences, University of Essex, Colchester, UK
| | - Felicitas Rost
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Rachel Thomas
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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