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Working with Unaccompanied Asylum Seeking Children: from dislocation to location of what can be
No full textThis article is not academic; rather it reflects stories, voices and the meanings we create. It looks at the experience of dislocation from different perspectives and the transformative power of being heard which supported a collaboration of emergent actions that created steps towards the location of success.
It explores the experience of Unaccompanied Asylum Seeking Children in Kent in the journey they made through Europe to reach the UK, describes the disordered sleep patterns they experience and how these needs were explored and solutions were found
Psychotherapy in a primary health care setting: Lessons from England and reflections on South Africa
Get PDFLondon and South Africa: Medical psychotherapy is a recognized sub-speciality within UK psychiatry (unlike in South Africa
Within or without: negotiating psychic space with an adolescent at risk of developing a narcissistic personality structure
No full textThis paper examines a 22-month once weekly psychotherapy with an adolescent young man. My patient was one of a group of adolescents who, due in part to excessive aggression, envy, anxiety or confusion, has chronically evaded the intimate and dependent psychic contact with others that is necessary for psychological development. In my view, this comes about through a combination of external factors and internal predisposition, with the quality of care received during infancy playing a crucial role. These adolescents appear to be developing narcissistic modes of being in the world which if allowed to persist into adulthood would be seen as deeply entrenched clinical psychopathology. Managing separation and loss is one of the central aspects of adolescence, but these young people tend to intrude or merge with others with such aggressive force that recognising difference between self and other becomes difficult. In psychotherapy, this often takes the form of the patient’s inability to tolerate experiencing the therapist as a separate person, and when knowledge of the therapist as separate impinges on their view, they frequently react in a variety of primitively destructive ways. This paper seeks to explore these central ideas through a detailed examination of psychotherapy with a young man in whom such struggles predominate
NICU application and impact of AOP transfusion guidelines based on PINT study
No full textAnaemia of prematurity is, in part, an exacerbation of the physiological anaemia of the newborn, combining a suppressed postnatal response to erythropoietin, increased blood Sampling, short RBC span in the newborn and the rapid increase in blood volume with growth. The rapid decline in haemoglobin concentration is most severe in infants of smaller gestational age Most neonatal blood transfusions are administered to maintain minimal, although ill-defined, levels of haemoglobin. Maintenance or ‘topup’ transfusions are triggered by haemoglobin thresholds, which have been compared during clinical trials. the largest trial made is (the Premature Infants in Need of Transfusion [PINT] study), Which concluded that the use of restrictive versus liberal transfusion practices does not appear to have a significant impact on the combined outcomes of mortality or major morbidities
Success and scandal: The curious case of Mike Ashley
No full textSports Direct boss Mike Ashley hit the deadlines again this week for all the wrong reasons. He is the subject of a series of allegations ranging from brash behaviour at management meetings to claims of illicit payments. These come just a year after the sportswear tycoon was criticised by a parliamentary committee for overseeing a culture of poor working conditions at Sports Direct
Some comments on ‘The experience of puberty’ by Shirley Hoxter
No full textThe article presents the author's views on the article "The experience of puberty" by Shirley Hoxter that was published in 1964. Hoxter focuses on three teenagers who were struggling with anxiety that was aroused by pubertal sexual development. Also discussed are the factors that contributed to their anxiety, Hoxter's contributions to child psychotherapy, and the impact of puberty on mental health
Qualitative methods and public policy
No full textThe idea that policy should be driven by evidence is hardly controversial. However, as an aspiration it is not always easy to put into practice. Qualitative research has always had much to offer the policy process and – in the UK, at least – in recent years it has received a warmer reception. However, qualitative researchers who hope to have influence should be prepared to tailor their approaches to the needs and expectations of their audience. This article discusses qualitative methods and public policy
Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): A multicentre, pragmatic, observer-blind, randomised controlled superiority trial
No full textBACKGROUND:
Psychological treatments for adolescents with unipolar major depressive disorder are associated with diagnostic remission within 28 weeks in 65-70% of patients. We aimed to assess the medium-term effects and costs of psychological therapies on maintenance of reduced depression symptoms 12 months after treatment.
METHODS:
We did this multicentre, pragmatic, observer-blind, randomised controlled superiority trial (IMPACT) at 15 National Health Service child and adolescent mental health service (CAMHS) clinics in three regions in England. Adolescent patients (aged 11-17 years) with a diagnosis of DSM IV major depressive disorder were randomly assigned (1:1:1), via a web-based randomisation service, to receive cognitive behavioural therapy (CBT) or short-term psychoanalytical therapy versus a reference brief psychological intervention. Randomisation was stochastically minimised by age, sex, self-reported depression sum score, and region. Patients and clinicians were aware of group allocation, but allocation was concealed from outcome assessors. Patients were followed up and reassessed at weeks 6, 12, 36, 52, and 86 post-randomisation. The primary outcome was self-reported depression symptoms at weeks 36, 52, and 86, as measured with the self-reported Mood and Feelings Questionnaire (MFQ). Because our aim was to compare the two psychological therapies with the brief psychosocial intervention, we first established whether CBT was inferior to short-term psychoanalytical psychotherapy for the same outcome. Primary analysis was by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN83033550.
FINDINGS:
Between June 29, 2010, and Jan 17, 2013, we randomly assigned 470 patients to receive the brief psychosocial intervention (n=158), CBT (n=155), or short-term psychoanalytical therapy (n=157); 465 patients comprised the intention-to-treat population. 392 (84%) patients had available data for primary analysis by the end of follow-up. Treatment fidelity and differentiation were established between the three interventions. The median number of treatment sessions differed significantly between patients in the brief psychosocial intervention group (n=6 [IQR 4-11]), CBT group (n=9 [5-14]), and short-term psychoanalytical therapy group (n=11 [5-23]; p<0·0001), but there was no difference between groups in the average duration of treatment (27·5 [SD 21·5], 24·9 [17·7], 27·9 [16·8] weeks, respectively; Kruskal-Wallis p=0·238). Self-reported depression symptoms did not differ significantly between patients given CBT and those given short-term psychoanalytical therapy at weeks 36 (treatment effect 0·179, 95% CI -3·731 to 4·088; p=0·929), 52 (0·307, -3·161 to 3·774; p=0·862), or 86 (0·578, -2·948 to 4·104; p=0·748). These two psychological treatments had no superiority effect compared with brief psychosocial intervention at weeks 36 (treatment effect -3·234, 95% CI -6·611 to 0·143; p=0·061), 52 (-2·806, -5·790 to 0·177; p=0·065), or 86 (-1·898, -4·922 to 1·126; p=0·219). Physical adverse events (self-reported breathing problems, sleep disturbances, drowsiness or tiredness, nausea, sweating, and being restless or overactive) did not differ between the groups. Total costs of the trial interventions did not differ significantly between treatment groups.
INTERPRETATION:
We found no evidence for the superiority of CBT or short-term psychoanalytical therapy compared with a brief psychosocial intervention in maintenance of reduced depression symptoms 12 months after treatment. Short-term psychoanalytical therapy was as effective as CBT and, together with brief psychosocial intervention, offers additional patient choice for psychological therapy, alongside CBT, for adolescents with moderate to severe depression who are attending routine specialist CAMHS clinics