Metacognitive Therapy for Individuals at High Risk of Developing Psychosis: A Pilot Study.

Developing effective interventions for preventing first episode psychosis have been an important research focus in the last decade. Cognitive behavioral therapy is a currently indicated treatment for people at ultra-high risk of psychosis, however, access and resource issues limit its delivery within the NHS. Treatments which partial out potential active ingredients and are aimed at a range of psychological difficulties seen within this population have the potential to be more efficacious and efficient. We conducted a single-arm exploratory pilot trial, designed to investigate the feasibility and acceptability of Metacognitive therapy for individuals at ultra-high risk (UHR) of developing psychosis. Trial uptake was good, with 11 out of 12 referred individuals meeting for an eligibility assessment (one individual was excluded prior to the assessment). Of these, 10 individuals were eligible and included in the trial. Retention to treatment was high with 80% treatment adherence gained and an overall average of 8 sessions completed. All participants were offered follow-up assessments immediately post-treatment and at 6 months, which comprised measures of psychotic like experiences, anxiety and depression, and metacognitive processes implicated in the model. Retention to the post-treatment (12-week) follow-up was good, with 80% completion; however retention to the 6-month follow-up was lower at 60%. Clinically significant results were observed in psychotic like experiences, anxiety, depression and functioning with medium to large effect sizes. Measures related to beliefs and processes targeted within MCT showed clinically significant change with medium to large effect sizes. Our results suggest that MCT based upon a specific metacognitive model for individuals meeting ARMS criteria may be an important treatment target and warrants further attention. Limitations and possible focuses for future research are discussed. Registration: ISRCTN53190465 http://www.isrctn.com/ISRCTN53190465.

Antimicrobial treatment of serious gram-negative infections in newborns.

The choice of antibiotics for serious Gram-negative bacterial infections in the newborn must balance delivery of effective antibiotics to the site(s) of infection with the need to minimize selection of antibiotic resistance. To reduce the risk of selective pressure from large-scale cephalosporin usage, a penicillin-aminoglycoside combination is recommended as empiric therapy for neonatal sepsis. Where Gram-negative sepsis is strongly suspected or proven, a third-generation cephalosporin should ordinarily replace penicillin. Piperacillin-tazobactam can provide better Gram-negative cover than penicillin-aminoglycoside combinations, without the risk of selecting antibiotic resistance seen with cephalosporins, but further clinical studies are required before this approach to empiric therapy can be recommended. For antibiotic-resistant infections, a carbapenem remains the mainstay of treatment. However, rapid emergence and spread of resistance to these antibiotics means that in the future, neonatologists may have to rely on antibiotics such as colistin, whose pharmacokinetics, safety, and clinical efficacy in neonates are not well-defined.

Clinical presentation and early care relationships in 'poor-me' and 'bad-me' paranoia.

OBJECTIVE. To test the proposal that 'poor-me' (PM) and 'bad-me' (BM) paranoia can be differentiated in terms of (1) current emotional experience and presence of grandiose delusions and (2) early caregiving and threats to self-construction. METHOD. Participants experiencing persecutory delusions were separated into PM (N= 21) and BM (N= 15) groups on the basis of perceived deservedness of the persecution. The groups were compared on measures examining grandiose delusions, shame and depression, parental care, and threats of alienation and insecurity. RESULTS. As predicted, BM patients scored higher on shame and depression, and lower on grandiose delusions, than PM patients. BM patients reported higher levels of parental overprotection, but PM patients were not characterized by neglect, and the groups did not differ in type of threat to self-construction. Conclusion. The two paranoia types were differentiated on symptomatic and emotional presentation, but predicted differences in early relationships and self-construction were not fully supported.

The experiences of postnatal depression in women from black and minority ethnic communities in Wiltshire, UK.

OBJECTIVES: To describe the experiences of women suffering from postnatal depression in black and minority ethnic communities in Wiltshire, UK. DESIGN: Semi-structured interviews and focus groups with women across Wiltshire with current and past experience of postnatal depression. EPDS data are also reported. Qualitative data (via telephone and face-to-face interviews) were also collected from GPs and health visitors who worked with these women. RESULTS: Qualitative analysis identified four main themes that were part of the experience of postnatal depression for the women and the primary health care professionals in contact with them--issues specific to pregnancy and birth (including postnatal depression), issues specific to primary health care, issues relating to culture, and 'other' issues. This latter theme describes the multitude of problems that many of the women endured, e.g. family/marital problems, violence, drinking alcohol, bereavement, financial difficulties, unemployment, accommodation and (racial) harassment. CONCLUSIONS: All the women had problematic lives, affected by a multitude of factors, and raised a number of serious concerns that related to health and social care. This has implications for practice and service provision, as demonstrated by the data from GPs and health visitors, in, for example, the provision of advice and information (and in different languages), training, improved communication and inter-agency working, in this area (where the research was conducted) and elsewhere in England. More research is needed to further explore the needs of women from minority ethnic groups, taking issues of, for example, cultural specificity and urbanity/rurality into account. Further research also needs to investigate ways of offering help and support to this patient group.

Inequalities in the provision and monitoring of primary care counselling: views from Wiltshire, England.

This study reviewed the provision of counselling services through 30 general practices in Wiltshire, a rural county in South West England, by means of a postal questionnaire, which had an 80% response rate, and interviews with key stakeholders. While 83% of general practices had a practice-based counsellor and 87% referred patients to counselling agencies, significant inequities were identified across the area for the level of counselling provision. Systems for the monitoring, management and evaluation of counselling services were found to be inadequate and concerns were raised regarding the absence of standardised practice guidelines. These findings lend support to the Government's intention to pursue statutory regulation of psychotherapists, counsellors and related groups working in the NHS.