Changing practice: assessing attitudes toward a NICE-informed collaborative treatment pathway for bipolar disorder.

BACKGROUND: Bipolar disorder is a chronic mental health condition, which can result in functional impairment despite medication. A large evidence base supports use of psychological therapies and structured care in the treatment of mood disorders, but these are rarely implemented. e-Pathways are digital structures that inform and record patient progress through a healthcare system, although these have not yet been used for bipolar disorder. AIMS: To assess the perceived benefits and costs associated with implementing a collaborative NICE-informed e-pathway for bipolar disorder. METHOD: Healthcare professionals and people with bipolar disorder attended a workshop to share feedback on e-pathways. Data were collected through questionnaires (n = 26) and transcription of a focus group, analysed qualitatively by a framework analysis. RESULTS: Patients and healthcare professionals welcomed the development of an e-pathway for bipolar disorder. There were five elements to the framework: quality and delivery of care, patient-clinician collaboration, flexibility and adaptability, impact on staff and impact on healthcare services. CONCLUSIONS: Identification of benefits and costs ensures that future development of e-pathways addresses concerns of healthcare professionals and people with bipolar disorder, which would be essential for successful implementation. Recommendations for this development include making e-pathways less complicated for patients, ensuring sufficient training and ensuring clinicians do not feel their skills become invalidated. Limitations of the study, and directions for future research, are discussed.

Physician heal thyself (Luke 4:23).

The performance culture of the health service means that the psychological well-being of staff is becoming paramount in maintaining the workforce and in sustaining psychological health and morale. A Charter for Psychological Staff Wellbeing and Resilience is introduced that puts the onus on us and on employers to make the necessary adjustments to their workplace cultures and encourage professionals - us - to break through the barrier of stigma.

Measurement of body size and shape perception in eating-disordered and control observers using body-shape software.

A disturbance in the perception of personal body size and shape is a key feature of both anorexia and bulimia nervosa, but it has proved difficult to quantify. Previous attempts have used methods like the distorting video technique (DVT), which alters an image by stretching the figure in either the X- or Y-axis. This is a poor representation of the way fat is added to or lost from the body, and the pattern of distortion provides a host of cues to the degree to which the image has been altered. To overcome these problems we have used a specially designed software system that uses biometric data based on real body shapes, instead of simply stretching or compressing images of bodies. This technique also allows individual body parts to be altered separately, so we can determine whether a specific body part is overestimated relative to others. We can also calculate the apparent body mass index (BMI) of our modified pictures, using the perimeter-area ratio (PAR). This allows us to compare an observer's actual BMI with that calculated for their estimated and ideal bodies. We tested 30 anorexic, 30 bulimic and 137 control observers. Our results show that all three observer groups tend to overestimate their body size, but not significantly so. Both the control and bulimic observers prefer an ideal body with a BMI of 20, which is at the lower end of the 'normal' BMI range. However, the anorexics ideal BMI is 15, which is on the border between the emaciated and underweight BMI categories.