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  • Gender differences in diagnoses of mentally disordered offenders

    29 June 2018

    We investigated differences in psychiatric diagnoses and medicolegal insanity decisions between female and male forensic psychiatric patients. Data on all offenders (N = 4396) subjected to a court-ordered forensic psychiatric inpatient evaluation were obtained for the years 1992–2000. A significantly higher proportion of female mentally disordered offenders were given a diagnosis of personality disorder while mentally disordered male offenders more often had a diagnosis of alcohol and/or drug dependence or sexual disorders. There was an increased likelihood that violent women would be declared legally insane even after controlling for a number of potential confounders. This may reflect an underlying difference in the severity of psychiatric morbidity not accounted for diagnostically or that a gender bias exists in the forensic psychiatric evaluation process. © 2009 International Association of Forensic Mental Health Services.

  • A prospective, quantitative study of mental health act assessments in England following the 2007 amendments to the 1983 act: did the changes fulfill their promise?

    3 July 2018

    In 2008, the Mental Health Act (MHA) 2007 amendments to the MHA 1983 were implemented in England and Wales. The amendments were intended to remove perceived obstacles to the detention of high risk patients with personality disorders (PDs), sexual deviance and learning disabilities (LDs). The AMEND study aimed to test the hypothesis that the implementation of these changes would lead to an increase in numbers or proportions of patients with these conditions who would be assessed and detained under the MHA 2007.A prospective, quantitative study of MHA assessments undertaken between July-October 2008-11 at three English sites. Data were collected from local forms used for MHA assessment documentation and patient electronic databases.The total number of assessments in each four month period of data collection varied: 1034 in 2008, 1042 in 2009, 1242 in 2010 and 1010 in 2011 (n = 4415). Of the assessments 65.6% resulted in detention in 2008, 71.3% in 2009, 64.7% in 2010 and 63.5% in 2011. There was no significant change in the odds ratio of detention when comparing the 2008 assessments against the combined 2009, 2010 and 2011 data (OR = 1.025, Fisher's exact Χ 2 p = 0.735). Only patients with LD and 'any other disorder or disability of the mind' were significantly more likely to be assessed under the MHA post implementation (Χ2 = 5.485, P = 0.018; Χ2 = 24.962, P > 0.001 respectively). There was no significant change post implementation in terms of the diagnostic category of detained patients.In the first three years post implementation, the 2007 Act did not facilitate the compulsory care of patients with PDs, sexual deviance and LDs.

  • Are we speaking the same language? Finding theoretical coherence and precision in "Mindfulness-based mechanisms" in chronic pain

    29 June 2018

    © 2017 American Academy of Pain Medicine. All rights reserved Objective. Over the past 50 years, the field of chronic pain has witnessed an evolution of psychological approaches with some notable success. Some of this evolution has included "mindfulnessbased interventions" (MBIs), now regarded as having encouraging partial support for their effectiveness. However, several theoretical challenges remain that may inhibit the progress of MBIs. These challenges include a lack of clarity surrounding the mindfulness construct itself, the proliferation of purported underlying mechanisms arising from different theories, and limited evidence for the mechanisms through which MBIs work. The current conceptual review provides a critique of existing theoretical models of mindfulness that have been applied to understanding and treating chronic pain. Design. A conceptual narrative review was conducted. Setting. Treatment programs for people with chronic pain. Patients. Individuals with any type of chronic pain. Interventions. MBIs for chronic pain. Outcome Measures. Mindfulness-based mechanisms explored in relation to several domains of functioning. Results and Conclusions. Based on this assessment, a summary of available evidence for a particular contextual behavioral theory of "mindfulness"- psychological flexibility-is outlined. Findings show the need for further integration of existing mindfulness constructs to better guide development and evaluation of mindfulness-based treatment methods in the future.

  • Experiences of outcome monitoring in service users with psychosis: Findings from an Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) demonstration site.

    29 June 2018

    Psychological therapy services are increasingly required to instate routine outcome monitoring (ROM), to demonstrate the clinical and economic impact of interventions. Professionals' views of ROM are an acknowledged barrier to implementation. Service user perspectives have rarely been examined, but acceptability and perceptions of ROM are critical to successful implementation. We investigated service users' experiences of ROM in an Improving Access to Psychological Therapies for people with Severe Mental Illness psychosis demonstration site.ROM comprised a periodic assessment battery completed at baseline, mid-therapy, and end-of-therapy and a single measure completed session-by-session. Qualitative and quantitative feedback were sought at each periodic ROM administration, and, for sessional ROM, at mid-therapy and end-of-therapy. Demographic and clinical correlates of satisfaction were examined cross-sectionally at baseline. Consistency of satisfaction over time and associations of satisfaction with engagement were examined longitudinally.Service users rated baseline (n = 281/289), mid-therapy (n = 114/121), end-of-therapy (n = 124/154), and session-by-session (mid-therapy n = 63/87 and end-of-therapy n = 90/123) ROM from 0 ('extremely unhelpful') to 10 ('extremely helpful') and gave qualitative feedback.Service users predominantly found ROM helpful (score 6-10; 64-72%) or neutral (score 5; 19-29%). Finding ROM less helpful was associated with younger age and poorer general outcomes, but not with psychotic symptoms or therapy dropout. Emerging qualitative themes included feeling understood, valuing opportunities to reflect, expressing feelings, and tracking progress towards goals. Shorter batteries would be preferable, particularly for younger respondents, and those with poorer outcomes.ROM is acceptable for people with psychosis. Tailoring assessments to specific subgroups should be considered.Routine outcome monitoring for psychological therapy is acceptable to people with psychosis. Most respondents experienced outcome monitoring as an opportunity to feel understood. Younger people and those with poorer functioning and well-being might be at higher risk of dissatisfaction. Short assessment batteries and less frequent outcome monitoring might be preferable for some service users. Limitations of the study Feedback about session-by-session outcome monitoring was not contemporaneous with completion and may be subject to memory or other biases. Only two-thirds of service users provided feedback about session-by-session ROM (compared to >94% for periodic ROM) so findings may not be fully representative. Feedback about measures was not provided anonymously, and it is possible that service users were reluctant to express criticism about ROM to the assessor.

  • Characterizing the experience of auditory verbal hallucinations and accompanying delusions in individuals with a diagnosis of bipolar disorder: A systematic review.

    29 June 2018

    OBJECTIVES: The aim of the current study was to inform ongoing attempts to identify clinically meaningful subcategories of auditory verbal hallucination (AVH), and to evaluate evidence that might pertain to the suitability of current psychological interventions for people with bipolar disorder (BD) who experience psychotic symptoms. METHODS: A comprehensive synthesis of findings on the phenomenology of AVH and delusions in BD is included, alongside a critical review of clinical and cognitive correlates. Studies published in the previous 20 years, until December 2016, were retrieved from the following databases: Embase, CINAHL, MEDLINE, PsycINFO and Web of Science. Thirty-two articles were reviewed after applying a set of predetermined inclusion criteria. RESULTS: Psychotic symptoms were common in both manic and depressive phases, although higher frequencies were indicated in mania. Few detailed characterizations of AVH phenomenology were identified. Delusions with persecutory, grandiose and referential themes were the most common in BD. AVHs were associated with delusions and there was evidence to suggest that delusion subtype may vary according to mood state and type of AVH. Data on clinical correlates of AVH in BD were sparse. However, the results indicated that cognitive appraisals or interpretations of voices might be different in BD from those established to be predictive of clinical outcomes in schizophrenia spectrum disorders. CONCLUSIONS: Clear gaps exist in our current understanding of the first-person experience of AVH in BD and the potential relationship to co-occurring symptoms, including delusions. Further research into cognitive interpretations of AVH in BD might inform adapted psychological interventions for psychotic symptoms in this population.

  • A neural basis of restrictive eating in Anorexia Nervosa

    29 November 2016

    Dr Jessica Scaife compares neural responses to high vs low calorie food pictures in restrictive Anorexia Nervosa.

  • Autoimmune causes of schizophrenia

    1 May 2013

    A proportion of patients with psychiatric disorders such as schizophrenia may have a treatable autoimmune condition underlying their symptoms. We have shown, for the first time that patients with a first episode of psychosis had antibodies against the NMDA receptor or Voltage Gated Potassium Channel.

  • Five new academic psychiatric training posts (ACFs) funded by National Institute of Health Research

    6 February 2014

    The Oxford NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) will fund 2 new academic clinical fellows (ACF) in core psychiatry and 1 new ACF run-through to child and adolescent psychiatry this year. This is in addition to 1 ACF in psychiatry funded by NIHR, and a further extra ACF post in child and adolescent psychiatry won in last year's national competition.

  • Brain injury survivors 3x more likely to die prematurely

    16 January 2014

    People who survive a traumatic brain injury are three times more likely to die prematurely than the general population, often from suicide or fatal injuries, according to a study led by Dr Seena Fazel, Wellcome Trust senior research fellow in Oxford University’s Department of Psychiatry. The study of 41 years' worth of Swedish medical records, published in JAMA Psychiatry, also found that TBI survivors were twice as likely to kill themselves (and 2.6 times as likely to die generally) before the age of 56 as unaffected siblings, who were included in the study to control for genetic factors and early upbringing. [The Guardian online, 16/01/2014, Haroon Siddique]

  • "Predicting violence in mentally disordered offenders needs considerable caution" says our Seena Fazel

    2 October 2013

    "Assessment tools used to predict how likely a psychopathic prisoner is to re-offend if freed from jail are "utterly useless" and parole boards might just as well flip a coin when deciding such risks, psychiatrists said on Tuesday. A Queen Mary University of London study found risk score tools are only around 46 percent accurate on how likely psychopathic convicts are to kill, rape or assault again. Seena Fazel, a consultant forensic psychiatrist at Britain's University of Oxford, said the reliability of the tests' predictive ability was so low that it might be best not to use them at all - and warned that at the very least, their results should only be noted by parole boards, rather than acted upon. "If you're going to use these instruments, be aware of their strengths and limitations," he said." (Reuters, 01/10/2013, Kate Kelland)

  • Oxford Medical School tops Times Higher Education World University Rankings for Clinical, Pre-Clinical and Health 2013-14

    2 October 2013

    "The 2013-2014 Times Higher Education World University Rankings' Clinical, Pre-Clinical and Health table judges world class universities across all of their core missions - teaching, research, knowledge transfer and international outlook. The ranking of the world's top 100 universities for clinical and health subjects employs 13 carefully calibrated performance indicators to provide the most comprehensive and balanced comparisons available, which are trusted by students, academics, university leaders, industry and governments."

  • Daniel Freeman on paranoia: 'At its heart is a mistaken idea of current threat'

    8 August 2016

    Professor Freeman writes for the Guardian on the paranoia spectrum and how founded perception of threat can slip into misreading intentions and excessive mistrust.

  • The Guardian: 'NHS clinical trials are the envy of the world'

    9 July 2018

    The Guardian highlights the PREVENT study with which Ivan Koychev, clinical lecturer in old age psychiatry at the Department of Psychiatry, is involved.

  • Blog: 'Taking part in True Colours'

    12 September 2017

    Michael Spiers shares his personal experience of bipolar and taking part in the Bipolar Disorder Research Network (BDRN) mood monitoring system True Colours, developed at the University of Oxford's Department of Psychiatry.

  • Nightmares: identifying potential causal factors

    8 August 2017

    Stephanie Rek, Bryony Sheaves and Daniel Freeman from the Department of Psychiatry have been exploring what contributes to bad dreams, and finding some surprising results.