6 results
Increasing ethnicity reporting to better understand cultural needs accessing a primary care talking therapy service
- Maisha Murshed, Rebecca Doherty, Sepideh Mhojatoleslami, Said Aris Tarabi, Anupama Rammohan
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 51 / Issue 5 / September 2023
- Published online by Cambridge University Press:
- 02 June 2023, pp. 479-484
- Print publication:
- September 2023
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Background:
The COVID-19 pandemic highlighted the under-utilisation of statutory mental health care services by minority ethnic groups in the United Kingdom (UK).
Aim:To improve ethnicity reporting to better understand the needs of patients accessing a primary care talking therapies service.
Method:We conducted a clinical audit to observe outcomes from pre-COVID (2019), first wave of COVID-19 (2020) and 2021 for three broad ethnic categories: black African/Caribbean, Asian and white British. Intervention was conducted on staff to improve data recording of ethnicity. A patient survey was sent to those identified as dropped out from treatment from May 2020 to April 2021. A total of 229 patients responded to the survey. The survey asked for reasons that impacted on not continuing with sessions.
Results:Quantitative analysis showed a statistically significant difference on discharge outcome between white British and black African/Caribbean (p=<0.0001), with black African/Caribbean patients most likely to drop out of treatment, and in 2020 the Asian population was below the recovery target of 50%. Qualitative analysis revealed therapist factors included lack of confidence in therapist and not being listened to, patient factors included neurodiversity, being unsure whether it would be helpful and confidentiality concerns, and service factors included being notified of discharge from the service, remote delivery of therapy, treatment options, and treatment materials.
Discussions:Services must work towards improving service provision by capturing hidden disparities and socialising treatment to meet the needs of minority ethnic groups in the UK. The present study recommends culturally adapted treatment and co-producing therapy materials.
The psychological and social impact of the digital self-support system ‘Brain in Hand’ on autistic people: prospective cohort study in England and Wales
- Samuel Tromans, William Henley, Ian Summers, Danielle Bilkey, Jenna Datson, Nicola Doherty, Louise Morpeth, Sarah Benbow, Rebecca Jelbert, Ashok Roy, Lance Watkins, Bhathika Perera, Saman Shazad, Richard Pender, Regi Alexander, Richard Laugharne, Rohit Shankar
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- Journal:
- BJPsych Open / Volume 9 / Issue 3 / May 2023
- Published online by Cambridge University Press:
- 26 May 2023, e96
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Background
Brain in Hand (BIH) is a UK-based digital self-support system for managing anxiety and social functioning.
AimsTo identify the impact of BIH on the psychological and social functioning of adults with autism.
MethodAdults with diagnosed or suspected DSM-5 (level 1) autism, identified by seven NHS autism services in England and Wales, were recruited for a 12-week prospective mixed-methods cohort study. The primary quantitative outcome measures were the Health of the Nation Outcome Scales for People with Learning Disabilities (HONOS-LD) and the Hospital Anxiety and Depression Scale (HADS). Fisher's exact test explored sociodemographic associations. Paired t-test was utilised for pre–post analysis of overall effectiveness of BIH. Multivariable linear regression models, univariable pre–post analysis, Wilcoxon signed-rank test, logistic regression analysis, Bonferroni correction and normative analysis were used to give confidence in changes identified. A thematic analysis of semi-structured exist interviews following Braun and Clarke's six-step process of 10% of participants who completed the study was undertaken.
ResultsSixty-six of 99 participants completed the study. There was significant reduction in mean HONOS-LD scores, with 0.65 s.d. decrease in those who used BIH for 12 weeks. Significant positive changes were identified in HONOS-LD subdomains of ‘self-injurious behaviours’, ‘memory and orientation’, ‘communication problems in understanding’, ‘occupation and activities’ and ‘problems with relationship’. A significant reduction in the anxiety, but not depression, component of the HADS scores was identified. Thematic analysis showed high confidence in BIH.
ConclusionsBIH improved anxiety and other clinical, social and functioning outcomes of adults with autism.
Zuranolone, a Positive Allosteric Modulator of the GABAA Receptor: Hypothesized Mechanism of Action in Major Depressive Disorder
- Stephen M. Stahl, Rebecca Hammond, Manny Garcia, Simon Kyaga, Mona Kotecha, Mark Pollack, James Doherty
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- Journal:
- CNS Spectrums / Volume 28 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 14 April 2023, pp. 260-261
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Major depressive disorder (MDD) is a heterogeneous condition characterized by depressed mood and/or loss of interest/pleasure in activities, among other symptoms. Most currently available treatments for depression were developed on the hypothesis that depressive symptoms arise from a depletion of monoamines within the central nervous system (CNS). However, clinical understanding has advanced to identify brain network dysregulation as the primary driver of depression, with monoamines playing a lesser role. Prolonged inability to regulate brain networks may lead to the core symptoms and clinical presentation of MDD. Depression has been linked to impaired neuronal activity in brain networks (e.g., central executive network [CEN], default mode network [DMN], and salience network [SN]). It is hypothesized that improvement in depressive symptoms may result from restoring balance in brain networks governing mood.
γ-aminobutyric acid (GABA) is critical for maintaining and restoring excitatory-inhibitory balance in the brain and regulating brain networks. Approximately one-third of neurons in the CNS are GABAergic, regulating network activity throughout the brain, including regions involved in mood, sleep, and cognition. GABA activates GABAA receptors (GABAAR), inhibiting neuronal activity through phasic (via synaptic GABAAR) and tonic (via extrasynaptic GABAAR) currents. Tonic GABA currents may play a particularly important role in regulating network activity, since they produce a large net inhibitory effect and are also involved in controlling the excitability of inhibitory interneurons, the key regulators of rhythmic brain network activity.
Zuranolone is an investigational oral GABAAR positive allosteric modulator and neuroactive steroid. In clinical trials, treatment with zuranolone has shown significant improvement over placebo in depressive symptoms in adults with MDD or postpartum depression, with a generally well-tolerated and consistent safety profile.
The hypothesized mechanism of zuranolone differs from monoamine-based antidepressants and from benzodiazepines. Unlike benzodiazepines, which bind to the α/γ subunit interface in synaptic GABAAR and enhance phasic inhibitory currents, zuranolone binds to the α/β subunit interface present in nearly all GABAAR, leading to enhanced phasic (synaptic) and tonic (extrasynaptic) inhibitory currents. Furthermore, in vitro evidence suggests that whereas benzodiazepines are associated with GABAAR downregulation, zuranolone upregulates the surface expression of GABAAR.
In conclusion, by upregulating GABAAR expression and increasing phasic and tonic inhibitory GABAergic signaling, zuranolone may rapidly restore and maintain excitatory-inhibitory balance in brain networks, thus allowing the brain to potentially respond appropriately to internal and external stimuli.
FundingSage Therapeutics, Inc., and Biogen Inc.
The impact of food industry reformulation, innovation and consumer preference on dietary intakes in Ireland: a probabilistic intake model
- Maeve Cushen, Noel Rogers, Rebecca Barron, Jasmin Wonik, Beata Stanek, Sandrine Pigat, Dermot Doherty, Linda Sturat-Trainor, Cronan McNamara
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E417
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Strong evidence exists linking poor diet to increased risk of overweight, obesity and non-communicable diseases. Reformulation initiatives, whereby the food industry gradually reduces energy, sodium, sugar, fat and saturated fat content of their products, are identified as important strategies to improve dietary intakes. The analysis aimed to examine the impact of voluntary reformulation, changes to products on the market and changes in consumer preferences on dietary intakes in Ireland from 2005 to 2017. Data on composition and volume sales (kg/ year) of products available on the market in 2005 and 2017 were collected from 15 Food Drink Ireland (FDI) member companies via online templates. These products were assigned to appropriate food and beverage groups identified in four Irish University Nutrition Alliance (IUNA) surveys of preschool children (1–4 years), children (5–12 years), teenagers (13–17 years) and adults (18–90 years). Assignment of FDI products to IUNA foods and beverages was carried out using weighted distributions for a given group of foods. The weightings were taken from the sales volumes of similar products relative to one another in a given category in a given year. Monte Carlo simulations were used to run the IUNA survey consumption data with both sets of weighted composition data from 2005 and 2017. The Creme Global intake model was used to estimate daily energy and nutrient intakes for all four populations during 2005 and 2017. The Wilcoxon-signed rank test was used to test for differences between the two years. Changes in both the products available on the market and market share of these products were observed from 2005 to 2017. The nutrient with the greatest intake reduction between the two years for all ages was sugar. Children and teens were the most affected, where total sugar intakes reduced by 3.2g/d and 2.7g/d, respectively. This reduction was primarily driven by the beverage category. There were modest saturated fat intake reductions observed for teens and adults (0.2g/d and 0.5g/d, respectively). Energy, total fat and sodium intakes for all ages remained relatively stable between the two years. This analysis highlights the impact of not only food industry efforts but also consumer choices on nutrient intakes in Ireland. It is worth noting that the data collected predates the sugar tax on sugar-sweetened beverages in Ireland. Reductions in sugar intakes were not compensated by total fat or energy increases.
Structured lifestyle education for people with schizophrenia, schizoaffective disorder and first-episode psychosis (STEPWISE): randomised controlled trial
- Richard I. G. Holt, Rebecca Gossage-Worrall, Daniel Hind, Michael J. Bradburn, Paul McCrone, Tiyi Morris, Charlotte Edwardson, Katharine Barnard, Marian E. Carey, Melanie J. Davies, Chris M. Dickens, Yvonne Doherty, Angela Etherington, Paul French, Fiona Gaughran, Kathryn E. Greenwood, Sridevi Kalidindi, Kamlesh Khunti, Richard Laugharne, John Pendlebury, Shanaya Rathod, David Saxon, David Shiers, Najma Siddiqi, Elizabeth A. Swaby, Glenn Waller, Stephen Wright
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- Journal:
- The British Journal of Psychiatry / Volume 214 / Issue 2 / February 2019
- Published online by Cambridge University Press:
- 25 September 2018, pp. 63-73
- Print publication:
- February 2019
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Background
Obesity is a major challenge for people with schizophrenia.
AimsWe assessed whether STEPWISE, a theory-based, group structured lifestyle education programme could support weight reduction in people with schizophrenia.
MethodIn this randomised controlled trial (study registration: ISRCTN19447796), we recruited adults with schizophrenia, schizoaffective disorder or first-episode psychosis from ten mental health organisations in England. Participants were randomly allocated to the STEPWISE intervention or treatment as usual. The 12-month intervention comprised four 2.5 h weekly group sessions, followed by 2-weekly maintenance contact and group sessions at 4, 7 and 10 months. The primary outcome was weight change after 12 months. Key secondary outcomes included diet, physical activity, biomedical measures and patient-related outcome measures. Cost-effectiveness was assessed and a mixed-methods process evaluation was included.
ResultsBetween 10 March 2015 and 31 March 2016, we recruited 414 people (intervention 208, usual care 206) with 341 (84.4%) participants completing the trial. At 12 months, weight reduction did not differ between groups (mean difference 0.0 kg, 95% CI −1.6 to 1.7, P = 0.963); physical activity, dietary intake and biochemical measures were unchanged. STEPWISE was well-received by participants and facilitators. The healthcare perspective incremental cost-effectiveness ratio was £246 921 per quality-adjusted life-year gained.
ConclusionsParticipants were successfully recruited and retained, indicating a strong interest in weight interventions; however, the STEPWISE intervention was neither clinically nor cost-effective. Further research is needed to determine how to manage overweight and obesity in people with schizophrenia.
Declaration of interestR.I.G.H. received fees for lecturing, consultancy work and attendance at conferences from the following: Boehringer Ingelheim, Eli Lilly, Janssen, Lundbeck, Novo Nordisk, Novartis, Otsuka, Sanofi, Sunovion, Takeda, MSD. M.J.D. reports personal fees from Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceuticals International Inc.; and, grants from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, Janssen. K.K. has received fees for consultancy and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Servier and Merck Sharp & Dohme. He has received grants in support of investigator and investigator-initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. K.K. has received funds for research, honoraria for speaking at meetings and has served on advisory boards for Lilly, Sanofi-Aventis, Merck Sharp & Dohme and Novo Nordisk. D.Sh. is expert advisor to the NICE Centre for guidelines; board member of the National Collaborating Centre for Mental Health (NCCMH); clinical advisor (paid consultancy basis) to National Clinical Audit of Psychosis (NCAP); views are personal and not those of NICE, NCCMH or NCAP. J.P. received personal fees for involvement in the study from a National Institute for Health Research (NIHR) grant. M.E.C. and Y.D. report grants from NIHR Health Technology Assessment, during the conduct of the study; and The Leicester Diabetes Centre, an organisation (employer) jointly hosted by an NHS Hospital Trust and the University of Leicester and who is holder (through the University of Leicester) of the copyright of the STEPWISE programme and of the DESMOND suite of programmes, training and intervention fidelity framework that were used in this study. S.R. has received honorarium from Lundbeck for lecturing. F.G. reports personal fees from Otsuka and Lundbeck, personal fees and non-financial support from Sunovion, outside the submitted work; and has a family member with professional links to Lilly and GSK, including shares. F.G. is in part funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care Funding scheme, by the Maudsley Charity and by the Stanley Medical Research Institute and is supported by the by the Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.
Impact of dietary fatty acids on metabolic activity and host intestinal microbiota composition in C57BL/6J mice
- Elaine Patterson, Robert M. O' Doherty, Eileen F. Murphy, Rebecca Wall, Orla O' Sullivan, Kanishka Nilaweera, Gerald F. Fitzgerald, Paul D. Cotter, R. Paul Ross, Catherine Stanton
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- Journal:
- British Journal of Nutrition / Volume 111 / Issue 11 / 14 June 2014
- Published online by Cambridge University Press:
- 20 February 2014, pp. 1905-1917
- Print publication:
- 14 June 2014
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Different dietary fat and energy subtypes have an impact on both the metabolic health and the intestinal microbiota population of the host. The present study assessed the impact of dietary fat quality, with a focus on dietary fatty acid compositions of varying saturation, on the metabolic health status and the intestinal microbiota composition of the host. C57BL/6J mice (n 9–10 mice per group) were fed high-fat (HF) diets containing either (1) palm oil, (2) olive oil, (3) safflower oil or (4) flaxseed/fish oil for 16 weeks and compared with mice fed low-fat (LF) diets supplemented with either high maize starch or high sucrose. Tissue fatty acid compositions were assessed by GLC, and the impact of the diet on host intestinal microbiota populations was investigated using high-throughput 16S rRNA sequencing. Compositional sequencing analysis revealed that dietary palm oil supplementation resulted in significantly lower populations of Bacteroidetes at the phylum level compared with dietary olive oil supplementation (P< 0·05). Dietary supplementation with olive oil was associated with an increase in the population of the family Bacteroidaceae compared with dietary supplementation of palm oil, flaxseed/fish oil and high sucrose (P< 0·05). Ingestion of the HF-flaxseed/fish oil diet for 16 weeks led to significantly increased tissue concentrations of EPA, docosapentaenoic acid and DHA compared with ingestion of all the other diets (P< 0·05); furthermore, the diet significantly increased the intestinal population of Bifidobacterium at the genus level compared with the LF-high-maize starch diet (P< 0·05). These data indicate that both the quantity and quality of fat have an impact on host physiology with further downstream alterations to the intestinal microbiota population, with a HF diet supplemented with flaxseed/fish oil positively shaping the host microbial ecosystem.
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