Screening for anxiety, depression and suicidality by epilepsy specialists in adult services in Scotland.

OBJECTIVE: Clinical guidelines recommend screening people with epilepsy (PWE) regularly for mental distress, but it is unclear how guidelines are implemented. We surveyed epilepsy specialists in adult Scottish services to determine approaches used to screen for anxiety, depression, and suicidality; the perceived difficulty of screening; factors associated with intention to screen; and treatment decisions made following positive screens. METHODS: An anonymous email-based questionnaire survey of epilepsy nurses and epilepsy neurology specialists (n = 38) was conducted. RESULTS: Two in every three specialists used a systematic screening approach; a third did not. Clinical interview was employed more often than standardized questionnaire. Clinicians reported positive attitudes towards screening but found screening difficult to implement. Intention to screen was associated with favorable attitude, perceived control, and social norm. Pharmacological and non-pharmacological interventions were proposed equally often for those screening positive for anxiety or depression. CONCLUSION: Routine screening for mental distress is carried out in Scottish epilepsy treatment settings but is not universal. Attention should be paid to clinician factors associated with screening, such as intention to screen and resulting treatment decisions. These factors are potentially modifiable, offering a means of closing the gap between guideline recommendations and clinical practice.

Questionnaire-based screening for mental distress in epilepsy: Outline and feasibility of an outpatient screening and intervention pathway.

OBJECTIVE: Mental distress is present in a significant proportion of people with epilepsy (PWE), with a negative impact across life domains. It is underdiagnosed and under-treated despite guidelines recommending screening for its presence (e.g., SIGN, 2015). We describe a tertiary-care epilepsy mental distress screening and treatment pathway, with a preliminary investigation of its feasibility. METHODS: We selected psychometric screening instruments for depression, anxiety, quality of life (QOL), and suicidality, establishing treatment options matched to instrument scores on the Patient Health Questionnaire 9 (PHQ-9), along 'traffic light' lines. We determined feasibility outcomes including recruitment and retention rates, resources required to run the pathway, and level of psychological need. We undertook a preliminary investigation of change in distress scores over a 9-month interval and determined PWE engagement and the perceived usefulness of pathway treatment options. RESULTS: Two-thirds of eligible PWE were included in the pathway with an 88% retention rate. At the initial screen, 45.8% of PWE required either an 'Amber-2' intervention (for moderate distress) or a 'Red' one (for severe distress). The equivalent figure at the 9-month re-screen was 36.8%, reflective of an improvement in depression and QOL scores. Online charity-delivered well-being sessions and neuropsychology were rated highly for engagement and perceived usefulness, but computerized cognitive behavioral therapy was not. The resources required to run the pathway were modest. CONCLUSION: Outpatient mental distress screening and intervention are feasible in PWE. The challenge is to optimize methods for screening in busy clinics and to determine the best (and most acceptable) interventions for screening positive PWE.

A systematic review of the effectiveness of compassion focused imagery in improving psychological outcomes in clinical and non-clinical adult populations.

BACKGROUND: Compassion-focused imagery (CFI) is a technique used to facilitate self-compassion by constructing and exploring imagery of a compassionate ideal. It is commonly used in Compassionate Mind Training, as part of a wider skills training intervention. This review aimed to explore the effectiveness of CFI on psychological outcomes when used as a brief standalone intervention across clinical and non-clinical adult populations. Population-specific effects were also explored. METHODS: Following an extensive literature search, 20 studies were identified for inclusion in the review. Quality and risk of bias assessment were completed using the Effective Public Health Practice Project (EPHPP) tool. Where available, effect sizes were calculated for outcome measures of self-compassion, self-criticism and shame. Study findings were qualitatively synthesized. RESULTS: Most of the studies reported improvements in psychological outcomes, such as improvements in self-compassion and positive affect, reduction in self-criticism, shame and paranoia. Across measures of self-compassion, self-criticism and shame, the effect sizes ranged between 0.02 and 1.1 and estimated treatment effects range between 0.09 and 1.39. Preliminary evidence is promising, with most studies reporting improvements in psychological outcomes; however, the evidence is limited by the methodological challenges and heterogeneity within the literature. Studies that implemented CFI in severe head injury samples reported limited improvements. Improvements in paranoia measures were more consistently reported in non-clinical samples, when compared to studies using clinical samples. High levels of self-criticism emerged as an important potential barrier in individuals' ability to engage with CFI tasks.