Bloxwich Hospital

IntroductionWeight gain in the months/years after diagnosis/treatment of severe enduring mental illness (SMI) is a major predictor of future diabetes, dysmetabolic profile and increased risk of cardiometabolic diseases. There is limited data on the longer-term profile of weight change in people with a history of SMI and how this may differ between individuals. We here report a retrospective study on weight change over the 5 years following an SMI diagnosis in Greater Manchester UK, an ethnically and culturally diverse community, with particular focus on comparing non-affective psychosis (NAP) vs affective psychosis (AP) diagnoses.MethodsWe undertook an anonymised search in the Greater Manchester Care Record (GMCR). We reviewed the health records of anyone who had been diagnosed for the first time with first episode psychosis, schizophrenia, schizoaffective disorder, delusional disorder (non-affective psychosis = NAP) or affective psychosis (AP). We analysed body mass index (BMI) change in the 5-year period following the first prescription of antipsychotic medication. All individuals had taken an antipsychotic agent for at least 3 months. The 5-year follow-up point was anywhere between 2003 and 2023.ResultsWe identified 9125 people with the diagnoses above. NAP (n = 5618; 37.3% female) mean age 49.9 years; AP (n = 4131; 60.5% female) mean age 48.7 years. 27.0% of NAP were of non-White ethnicity vs 17.8% of AP individuals. A higher proportion of people diagnosed with NAP were in the highest quintile of social disadvantage 52.4% vs 39.5% for AP. There were no significant differences in baseline BMI profile. In a subsample with HbA1c data (n = 2103), mean HbA1c was higher in NAP at baseline (40.4 mmol/mol in NAP vs 36.7 mmol/mol for AP). At 5-year follow-up, there was similarity in both the overall % of individuals in the obese ≥ 30 kg/m2 category (39.8% NAP vs 39.7% AP), and % progressing from a normal healthy BMI transitioned to obese/overweight BMI (53.6% of NAP vs 55.6% with AP). 43.7% of those NAP with normal BMI remained at a healthy BMI vs 42.7% with AP. At 5-year follow-up for NAP, 83.1% of those with BMI ≥ 30 kg/m2 stayed in this category vs 81.5% of AP.ConclusionThe results of this real-world longitudinal cohort study suggest that the changes in BMI with treatment of non-affective psychosis vs bipolar disorder are not significantly different, while 43% maintain a healthy weight in the first 5 years following antipsychotic prescription.

This article reviews a Court of Protection case involving a woman, Ms X, with two severe medical conditions: anorexia nervosa and end-stage liver cirrhosis due to alcohol dependence. Each of these conditions alone warranted end-of-life care planning. When combined, they provided a far more unique and complex presentation because of the way they were intertwined. Ms X's life was in imminent danger. The Court implemented methodically the principles of the Mental Capacity Act 2005. Ms X was assessed as lacking capacity to make decisions in relation to treatment for her anorexia. However, she retained capacity to make decisions regarding treatment for her liver disease and the continued harmful use of alcohol. The Court ruled that it was not in Ms X's best interests to be subject to further compulsory treatment for her anorexia, even though this may have prolonged her life. It was also in her best interests and lawful not to provide nutrition and hydration with which she did not comply.

BackgroundClozapine is widely prescribed and, although effective, can cause weight gain and dysglycemia. The dysmetabolic effects of clozapine are thought to be more prevalent in women with this gender on average attaining 17 % higher plasma clozapine concentrations than men.MethodsWe investigated the relationship between dose, body mass index (BMI), plasma glucose concentration, and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations in 100 individuals with a severe enduring mental illness.ResultsMean (10th/90th percentile) plasma clozapine concentrations were higher for women [0.49 (0.27–0.79) mg/L] compared with men [0.44 (0.26–0.70) mg/L] (F = 2.2; p = 0.035). There was no significant gender difference in the prescribed clozapine dose. BMI was significantly higher in women [mean (95 % CI) = 34.5 (26.0–45.3)] for females compared with 32.5 (25.2–41.0) for males. Overall, BMI increased by 0.7 kg/m2 over a mean follow-up period of 210 days. A lower proportion, 41 % of women had a fasting blood glucose ≤6.0 mmol/L (<6.0 mmol/L is defined by the International Diabetes Federation as normal glucose handling), compared with 88 % of men (χ2 = 18.6, p < 0.0001).ConclusionsWe have shown that mean BMI and blood glucose concentrations are higher in women prescribed clozapine than in men. Women also tended to attain higher plasma clozapine concentrations than men. The higher BMI and blood glucose in women may relate to higher tissue exposure to clozapine, as a consequence of sex differences in drug metabolism.

Individual Cognitive Behaviour Therapy for psychosis (CBTp) is the first line recommended psychological intervention for adults diagnosed with schizophrenia. However, little is yet known about service users' subjective experiences of CBTp. This study aimed to conduct a systematic review of qualitative literature to examine service user perspective of CBTp. A thematic synthesis of qualitative studies examining service users' experiences of CBTp was conducted. A total of six studies were included in the analysis. Three superordinate themes were identified: therapeutic alliance; facilitating change; and challenges of applying CBTp. Overall, CBTp is a helpful and acceptable therapeutic approach to service users. Developing a collaborative therapeutic relationship is essential. The applications of CBTp can be problematic and the therapist and client need to work together to overcome these difficulties.

This paper describes how Service Users and researchers worked together to develop a measure of recovery from psychosis “the Questionnaire about the Process of Recovery from psychosis” (QPR, Neil et al., 2009), and illustrates this experience from both perspectives. The obstacles faced and how these were overcome are described. It was found that it was possible for Service Users and non-Service Users to work collaboratively, that there were unique contributions from each and a sharing of areas of expertise, for example, research knowledge and expertise by experience. This paper highlights advantages of working collaboratively. It is hoped that sharing these experiences will encourage other researchers and Service Users to embrace this way of working.

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Heterogeneity hinders our understanding of sexual violence; but does this problem extend to stranger rape and, if so, would the construction of homogeneous subtypes advance our understanding of this crime and aid criminal investigations and clinical practice? To answer these questions, 41 stranger rapists from the English high security hospitals were examined using version 3 of the Massachusetts Treatment Centre rapist typology (MTC:R3) and multidimensional scaling (MDS). The MTC:R3 suggested that sexual desire and opportunism were the primary motivations for these men, but that proportionately more psychopaths were violent and sadistic. In accordance with previous research, the men experienced problematic childhoods and displayed high rates of criminality and psychiatric morbidity in adulthood. However, MDS found that rapist histories and offence behaviours generally divide into sexual and violent themes. These results have important implications for theory, criminal investigations and clinical practice.

Proponents of action research claim that it is not just for researchers, but helps to empower research participants to make changes in practice. This literature review examines some of the evidence for and against a research methodology that might still be unfamiliar to many nurses. Action research often lends itself to small-scale studies and is time-consuming. The value of such a methodology is that it provides a powerful means of improving and enhancing practice.

Morrison, Anthony P. B.Sc., Clin.Psy.D.; Bowe, Samantha B.Sc.; Larkin, Warren B.Sc.; Nothard, Sarah B.Sc. Author Information

The self-report questionnaire method was employed to determine the prevalence and pattern of drinking, smoking and illicit substance use among 2888 11-16-year-olds in Blackburn secondary schools. Substances reported most commonly used were alcohol, cigarettes, hallucinogenic substances, glue/solvents and cannabis. Use increased steadily with advancing school year. Boys were significantly greater users of cannabis and hallucinogenic substances. The baseline data provided could form the basis of a well-targeted preventative programme. The need for more comprehensive surveys, preferably longitudinal in design, is stressed.