2020 COVID-19-Related Lockdown: the Relationships Between Coping Strategies, Psychological Adjustment and Resilience Among a Non-clinical Sample of British Adults.

To curb COVID-19 infections, the British government enforced a series of lockdowns resulting in restrictions on movement and socialisation. This study assessed which groups may have been at higher risk of emotional distress among a non-clinical sample of British adults. It also examined which coping strategies, if any, related to more positive psychological adjustment and higher resilience scores. A cross-sectional, correlational study was carried out. Using a convenience sample, an online survey was conducted in April-June 2020. One hundred ninety-four participants completed the Brief COPE (coping), the GAD-7 (anxiety), the PHQ-9 (depression), the CD-RISC (resilience), and provided demographic information. Participants used mainly coping strategies considered to be adaptive. They exhibited mild/moderate anxiety and depression symptoms, and moderate resilience scores. However, some individuals displayed significantly higher distress symptoms and lower resilience scores than others, especially those aged under 35 (particularly 18-24), those not working, those who were single and/or childless. Results also show that coping strategies including substance use, behavioural disengagement and self-blame were associated with anxiety and/or depression symptoms, conversely, positive reframing related to lower anxiety symptomatology. Interventions promoting positive reframing may be helpful. Similarly, interventions promoting connection to others, a factor known to enhance resilience, may be beneficial. This is particularly relevant to groups who may be more at risk of psychological distress, such as young individuals.

Living through lockdown: A qualitative exploration of individuals' experiences in the UK.

In response to the COVID-19 outbreak, the British government introduced a lockdown resulting in country wide restrictions on movement and socialisation. This research sought to explore individuals' experience of the first lockdown in the UK. A qualitative online survey was conducted between April and June 2020. Using a convenience sample, 29 individuals participated in the study. Data were analysed using thematic analysis. Four themes were identified: 'health and well-being', 'social connectedness and belonging', 'employment and finances' and 'personal and collective values'. Participants' experiences involved both challenges and opportunities. Participants reported challenges to their physical health, mental health, sense of connection to others as well as their employment and finances. However, they also viewed the lockdown as an opportunity to reassess their goals and values, and define a 'new normal' for society. Lockdown restrictions threatened individuals' well-being on many aspects of their lives. As anxiety, loneliness and a compromised grieving process may lead to severe mental health issues, early interventions are needed to prevent these and promote well-being. Interventions may include traditional therapies (e.g. Acceptance and Commitment Therapy), or focus specifically on developing social networks and social support (e.g. mutual help groups). These interventions may also be conducive to the experience of growth reported by some participants.

Stroke among African-Caribbean women: lay beliefs of risks and causes.

AIMS AND OBJECTIVES: To investigate African Caribbean women's subjective accounts of stroke and how this impacted on their lives and identify beliefs attributed to the causes of stroke in this post stroke. BACKGROUND: In the UK, those from African or African Caribbean ethnicity are at an increased risk of stroke, and stroke risks are double that of the UK White population. This is because diabetes and hypertension are more common in those of African and African Caribbean ethnic groups. The main risk factors for stroke are high blood pressure, alongside obesity and overweight, poor diet and lack of physical activity. DESIGN: A qualitative study using interpretative phenomenological analysis. METHODS: Data were collected via semi-structured indepth interviews for six African Caribbean women. Interviews were audio recorded and transcribed verbatim. Interpretative Phenomenological Analysis was used to deconstruct the data and facilitate developing themes. RESULTS: Six semi-structured interviews were completed with women aged 47-85 years. Two themes emerged (1) the role of lifestyle and biological risk factors linked to the causes of stroke and (2) the role of spirituality, in identifying the lay beliefs and causes of stroke. CONCLUSION: Alternative explanations of the causes of stroke that include witchcraft, or wishing someone wrong suggests a lack of perceived control over stroke. This may suggest a focus on less visible risk factors such as hypertension, familial history or diabetes and will need inclusion in health promotion materials. Lay beliefs such as witchcraft can co-exist amicably alongside modern medicine, as long as they do not hinder access to medication, treatment or risk factor management of stroke. RELEVANCE TO CLINICAL PRACTICE: The results demonstrated that nursing care and health promotion materials should emphasise on obesity, overweight and management of these through diet and physical activity to prevent stroke occurring.

Life after Stroke: Coping mechanisms among African Caribbean Women.

In the UK, stroke is the third most common cause of death for women and the incidence in African Caribbean women is higher than that in the general population. Stroke burden has major consequences for the physical, mental and social health of African Caribbean women. In order to adjust to life after stroke, individuals affected employ a range of strategies which may include personal, religious (church) or spiritual support (i.e. prayer), individual motivation or resignation to life with a disability. This study explored these areas through the coping mechanisms that African Caribbean women utilised post stroke in the context of stroke recovery and lifestyle modification efforts needed to promote healthy living post stroke. A qualitative approach using interpretative phenomenological analysis was adopted. Seven women were recruited into the study. Semi-structured, in-depth interviews were audio recorded and were transcribed verbatim. Data were analysed using a four-stage framework: familiarisation, sense making, developing themes, and data refinement and analysis. Three main themes on coping emerged: the need to follow medical rules to manage stroke, strength and determination, and the use of religion and faith to cope with life after stroke. These findings illustrate both a tension between religious beliefs and the medical approach to stroke and highlight the potential benefits that religion and the church can play in stroke recovery. Implications for practice include acknowledgement and inclusion of religion- and church-based health promotion in post-stroke recovery.

OPRM1 A118G genotype fails to predict the effectiveness of naltrexone treatment for alcohol dependence.

Given the evidence from retrospective studies indicating that alcohol-dependent patients with homozygous or heterozygous A118G variant of the µ-opioid receptor, OPRM1, gene have significantly better outcomes when treated with naltrexone; this study examined this prospectively in 100 alcohol-dependent participants prescribed naltrexone for 12 weeks and offered six sessions of cognitive-behavioral therapy or intervention. Comparisons were made among OPRM1 genotypic groups on several outcome measures. Naltrexone treatment produced significant decreases in self-reported and objective indicators of alcohol use and craving from baseline (P<0.0001 and 0.017, respectively), particularly during the first 2 months of treatment, with 68% completing the study. However, there was no evidence of a significant association between OPRM1 A118G genotype and treatment success on any of the outcome measures. Therefore, while naltrexone was an effective treatment for alcohol dependence, the OPRM1 A118G genotype was not a predictor of success.

The Psychostimulant Check-Up: A pilot study of a brief intervention to reduce illicit stimulant use.

INTRODUCTION AND AIMS: This study is to test the acceptability of a single-session 'check-up' intervention for psychostimulant users and document participants' subsequent progress in reducing psychostimulant use and related harms. DESIGN AND METHODS: The design was pre-experimental single-group repeated measures. Eighty participants received the Psychostimulant Check-Up, with 62% completing a 3 month follow up. RESULTS: Participants were predominantly young adult methamphetamine users. The majority indicated that the Check-Up answered their questions, increased their awareness of services, and they would recommend it to their friends. At follow up, there was a significant reduction in self-reported methamphetamine use, the number of self-reported psychostimulant-related negative consequences experienced in the previous month and rates of injecting: 62% self-reported at least a 1 g reduction in methamphetamine use. DISCUSSION AND CONCLUSIONS: The intervention was well accepted and the majority of those who received it subsequently made meaningful reductions in psychostimulant use and related harm. The intervention offers sufficient promise to warrant a randomised trial to establish whether improvements were specific to the intervention.

Randomized controlled trial of dexamphetamine maintenance for the treatment of methamphetamine dependence.

AIM: To investigate the safety and efficacy of once-daily supervised oral administration of sustained-release dexamphetamine in people dependent on methamphetamine. DESIGN: Randomized, double-blind, placebo-controlled trial. PARTICIPANTS: Forty-nine methamphetamine-dependent drug users from Drug and Alcohol Services South Australia (DASSA) clinics. INTERVENTION: Participants were assigned randomly to receive up to 110 mg/day sustained-release dexamphetamine (n = 23) or placebo (n = 26) for a maximum of 12 weeks, with gradual reduction of the study medication over an additional 4 weeks. Medication was taken daily under pharmacist supervision. MEASUREMENTS: Primary outcome measures included treatment retention, measures of methamphetamine consumption (self-report and hair analysis), degree of methamphetamine dependence and severity of methamphetamine withdrawal. Hair samples were analysed for methamphetamine using liquid chromatography-mass spectrometry. FINDINGS: Treatment retention was significantly different between groups, with those who received dexamphetamine remaining in treatment for an average of 86.3 days compared with 48.6 days for those receiving placebo (P = 0.014). There were significant reductions in self-reported methamphetamine use between baseline and follow-up within each group (P < 0.0001), with a trend to a greater reduction among the dexamphetamine group (P = 0.086). Based on hair analysis, there was a significant decrease in methamphetamine concentration for both groups (P < 0.0001). At follow-up, degree of methamphetamine dependence was significantly lower in the dexamphetamine group (P = 0.042). Dexamphetamine maintenance was not associated with serious adverse events. CONCLUSIONS: The results of this preliminary study have demonstrated that a maintenance pharmacotherapy programme of daily sustained-release amphetamine dispensing under pharmacist supervision is both feasible and safe. The increased retention in the dexamphetamine group, together with the general decreases in methamphetamine use, degree of dependence and withdrawal symptom severity, provide preliminary evidence that this may be an efficacious treatment option for methamphetamine dependence.

Psychometric evaluation of the Amphetamine Cessation Symptom Assessment.

Testing of a new scale, the Amphetamine Cessation Symptom Assessment (ACSA), in a sample of treatment-seeking amphetamine users (N = 133) showed satisfactory reliability, while factor analysis identified three components explaining 64.7% of the variance in scores. Scores were inversely related to subjective general well-being (r = -.33, p < .01) and directly related to the Beck Depression Inventory (r = .59, p < .01). There were positive relationships between the ACSA and measures of amphetamine dependence (r = .36, p < .01) and the intensity of recent amphetamine use (r = .24, p < .01). The ACSA discriminated between "low-dose" and "high-dose" users, indicating discriminant validity. In inpatients (n = 63), ACSA scores declined significantly over time, while higher scores in inpatient treatment dropouts indicated predictive validity. The ACSA showed satisfactory reliability and validity, with a three-factor solution providing the best fit to the data. The ACSA could play an important role in providing clinical outcome data, particularly in outcome evaluation of new treatment protocols.

Use of standardised outcome measures in adult mental health services: randomised controlled trial.

BACKGROUND: Routine use of standardised outcome measures is not universal. AIMS: To evaluate the effectiveness of standardised outcome assessment. METHOD: A randomised controlled trial, involving 160 representative adult mental health patients and paired staff (ISRCTN16971059). The intervention group (n=101) (a) completed monthly postal questionnaires assessing needs, quality of life, mental health problem severity and therapeutic alliance, and (b) received 3-monthly feedback. The control group (n=59) received treatment as usual. RESULTS: The intervention did not improve primary outcomes of patient-rated unmet need and of quality of life. Other subjective secondary outcome measures were also not improved. The intervention reduced psychiatric inpatient days (3.5 v.16.4 mean days, bootstrapped 95% CI1.6-25.7), and hence service use costs were 2586 UK pounds (95% CI 102-5391) less for intervention-group patients. Net benefit analysis indicated that the intervention was cost-effective. CONCLUSIONS: Routine use of outcome measures as implemented in this study did not improve subjective outcomes, but was associated with reduced psychiatric inpatient admissions.

Patient-rated mental health needs and quality of life improvement.

BACKGROUND: Patient-rated unmet need is cross-sectionally associated with quality of life. Its longitudinal relationship has not been established. AIMS: To test the hypotheses that: (a) higher patient-rated unmet need is associated with lower individual quality of life assessments by a patient over time; and (b) reduction in patient-rated unmet need precedes improvement in quality of life. METHOD: One hundred and one individuals using adult mental health services were asked to complete 6-monthly questionnaires, comprising quality of life (Manchester Short Assessment of Quality of Life, MANSA) and unmet need (Camberwell Assessment of Need Short Appraisal Schedule, CANSAS) assessments. RESULTS: Seventy-three participants provided 240 separate pairs of consecutive assessments. Random effects regression models indicated an impact on current quality of life for both average level of unmet need (B= -0.23, 95% CI -0.29 to -0.17) and change in unmet need over the past month (B= -0.04, 95% CI -0.02). CONCLUSIONS: Changes in patient-rated unmet needs may cause changes in quality of life.