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Biomedical subjects

A Hassiotis

Publications and source records attributed to A Hassiotis.

14 recordsLinked to original sources
PubMed2006

Working across boundaries: clinical outcomes for an integrated mental health service for people with intellectual disabilities.

BACKGROUND: The Mental Health Service for People with Learning Disabilities (MHSPLD) is a service development in keeping with UK government policy that promotes cross agency working and access to mainstream mental health services for people with intellectual disabilities. We aimed to show whether the service model brought about improvements in people's mental state and level of functioning. METHODS: Community and inpatient groups were compared across three time points using a range of clinical outcome measures that assessed psychiatric symptoms, risk, needs and level of functioning. RESULTS: Inpatients and community groups had similar mental health problems, but inpatients had higher unmet needs and lower functioning, and were at greater risk. There were significant improvements across the range of outcome measures in both groups. CONCLUSIONS: Working with mainstream mental health services and across health and social service boundaries delivers effective mental health care for people with intellectual disabilities.

Activities of Daily Living↗
PubMed2004

Behavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with learning disabilities.

BACKGROUND: Outwardly directed aggressive behaviour is a significant part of problem behaviours presented by people with learning disabilities. Prevalence rates between 3.3% to 36% have been reported in the literature. Such behaviours run a long term course and are a major cause of social exclusion OBJECTIVES: To determine the efficacy of behavioural and cognitive behavioural interventions for outwardly-directed aggressive behaviour for people with learning disabilities. SEARCH STRATEGY: The Cochrane Library (CENTRAL), MEDLINE, EMBASE, CINAHL, ERIC and PsycINFO were searched using a strategy combining (Learning or synonyms) and (Disabilities or synonyms) and (Behaviour or synonyms) and (treatment or synonyms) to late 2002. Where appropriate, research filters were used. SELECTION CRITERIA: Studies were selected if more than 4 participants, children or adults, were allocated by random or quasi-random methods to either intervention or standard treatment/wait list. DATA COLLECTION AND ANALYSIS: References identified by electronic searches, examinations of bibliography and personal contacts were screened against inclusion criteria by two independent reviewers. MAIN RESULTS: Three studies based on adult populations with learning disabilities were deemed to be suitable for inclusion but data were only available in a form suitable for meta-analysis in two studies. Direct interventions based on cognitive-behavioural methods (modified relaxation, assertiveness training with problem solving, and anger management) appear to have some impact on reduction of aggressive behaviour at the end of treatment but not at follow up (up to six months) as rated by individuals and their carers. REVIEWERS' CONCLUSIONS: The existing evidence on the efficacy of cognitive behavioural and behavioural interventions on outwards directed aggression in children and adults with ID is scant. There is a paucity of methodologically sound clinical trials. Given the impact of such behaviours on the affected individual, his or her carers and on service providers, effective interventions are essential. It is also important to investigate cost efficacy of treatment models against existing treatments. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes of reduction in outward directed aggression, improvement in quality of life and cost efficacy as measured by standardised scales.

Aggression↗
PubMed2004

Offenders with intellectual disability: a prospective comparative study.

BACKGROUND: Intellectually disabled offenders (IDO) are a poorly served and under-recognized group, who are likely to require long-term specialist treatments and interventions. METHOD: This prospective study investigated the characteristics and factors that influence outcome in this group, with particular reference to therapeutic interventions. Sixty-one individuals were identified from contact with either (1) specialist health and social services for people with intellectual disability (ID) or (2) nonspecialist services in the criminal justice or (forensic) mental health/social service systems. The participants were assessed at baseline and after a mean of 10 months in order to compare recidivism rates and the impact of therapeutic interventions. RESULTS: The findings suggest that IDO start offending at an early age, that they frequently have a history of multiple offences, and that sex offending and arson are over-represented offence types. Those participants recruited from nonspecialist ID services had significantly higher IQs and were less likely to have had contact with community social and health support agencies. Despite the high rates of psychopathology, there was little evidence for efficacy of therapeutic interventions, which, where offered, appeared to be of a nonspecific nature. At second interview, approximately half of the sample had re-offended.

Adult↗
PubMed2003

Big brother is watching you--the ethical implications of electronic surveillance measures in the elderly with dementia and in adults with learning difficulties.

Electronic surveillance has insidiously seeped into the fabric of society with little public debate about its moral implications. Perceived by some as a sinister Orwellian tool of repression and social control, the new technologies offer comfort and security to others; a benevolent parental watchful eye. Nervousness at being watched has been replaced increasingly by nervousness if we're not. These technologies are now becoming widely available to health care professionals who have had little opportunity to consider their ethical and moral ramifications. Electronic tagging and tracking devices may be seen as away of creating a more secure environment for vulnerable individuals such as the elderly with dementia or people with learning disabilities. However, the proponents of surveillance devices have met with considerable resistance and opposition,from those who perceive it as contrary to human dignity and freedom, with its connotations of criminal surveillance. In addition, they cite increased opportunity for abuse through, for example, the withdrawal of staff and financial resources from the care of people with complex needs. Implementing these technologies, therefore, has ethical implications for human rights and civil liberties. Optional alternatives to long-term and/or restrictive care, in the context of the practical difficulties involved in caring for those who represent a risk to themselves from wandering, demands rigorous exploration of pragmatic questions of morality, with reference to risk versus benefit strategies. Like reproductive cloning techniques, the mere existence of surveillance technologies is morally neutral. Rather it is the use (in this instance that of health and social care settings) to which it is put which has the potential for good or bad.

Aged↗
PubMed2003

A memory clinic for older people with intellectual disabilities.

Cognitive decline in older people with intellectual disabilities (ID) is often under-recognized. Following the publication of the National Service Framework for Older People and the white paper Valuing People, older people with intellectual disabilities of all aetiologies should have access to a systematic assessment of their cognitive function in order to detect decline in cognition and adaptive skills and implement appropriate treatments as early as possible. The development of a memory clinic for older people with ID is described, including instruments used and characteristics of attendees. Such projects are in line with current UK government policies and can contribute to the improvement of standards of care and support research in this vulnerable group of people.

Aged↗
PubMed2003

Diagnostic instruments for dementia in older people with intellectual disability in clinical practice.

There is a need for simple and reliable screening instruments for dementia in the intellectual disability (ID) population that can also be used to follow their progress, particularly if they are being treated with anti-dementia drugs. Commonly used tests for the general population such as the Mini Mental State Examination (MMSE) are not appropriate for many people with ID. This paper is a literature review of alternative instruments that have been used in research or recommended by experts since 1991 and have the potential to be used as screening instruments. Two types of tests have been identified: those administered to informants, and those that rely on direct assessment of the individual. The most promising informant rated screening tool in most adults with ID including Down syndrome (DS) diagnosis is the Dementia Questionnaire for Persons with Mental Retardation (DMR). However, sensitivity in single assessments is variable and cut-off scores need further optimisation. In those with DS, the Dementia Scale for Down Syndrome (DSDS) has good specificity but mediocre sensitivity. The Test for Severe Impairment and Severe Impairment Battery are two direct assessment tools that show promise as screening instruments, but need further evaluation.

Cognition Disorders↗
PubMed2002

Offenders with intellectual disability: the size of the problem and therapeutic outcomes.

BACKGROUND: People with intellectual disability (ID) who offend may be subject to a variety of dispositions within the criminal justice system, or via diversion to health and social services in inpatient units or in community ID teams. Offenders with ID are a group with complex needs who may pose a recurrent risk to the public. Despite the significant number of offenders with ID, there is limited evidence on treatment effectiveness and outcomes. METHODS: A literature search of all electronic databases was undertaken, and journals were hand-searched for clinical trials or case studies of interventions for offenders with ID. The main outcome was recidivism rates. RESULTS: There were no published clinical trials of offenders with ID. A series of small-scale group cognitive-behavioural treatments for sex offenders offers the most persuasive evidence of success in reducing recidivism. CONCLUSION: Offenders with ID often receive inadequate services as a result of poor identification through the criminal justice system and research into effective treatments is rudimentary. Further studies are necessary in order to improve treatment efficacy and service provision for a complex group of individuals.

Behavior Therapy↗
PubMed2001

Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management. Report from the UK700 trial.

BACKGROUND: Little research has been carried out on the benefits of intensive case management (ICM) for people with borderline IQ and severe mental illness. AIMS: To compare outcome and costs of care of patients with severe psychotic illness with borderline IQ to patients of normal IQ and to assess whether ICM is more beneficial for the former than for the latter. METHOD: The study utilises data from the UK700 multi-centre randomised controlled trial of case management. The main outcome measure was the number of days spent in hospital for psychiatric reasons. Secondary outcomes were costs of care and clinical outcome. RESULTS: ICM was significantly more beneficial for borderline-IQ patients than those of normal IQ in terms of reductions in days spent in hospital, hospital admissions, total costs and needs and increased satisfaction. CONCLUSIONS: ICM appears to be a cost-effective strategy for a subgroup of patients with severe psychosis with cognitive deficits.

Case Management↗
PubMed1999

Prevalence and characteristics of patients with severe mental illness and borderline intellectual functioning. Report from the UK700 randomised controlled trial of case management.

BACKGROUND: Low cognitive ability and developmental delays have been implicated in the causation of mental illness. AIMS: To examine the prevalence, socio-demographic characteristics, psychopathology and social functioning profiles of people with low intelligence and recurrent psychotic illness. METHOD: A multi-centre randomised controlled trial of case management provided the opportunity to explore associations between mental illness and borderline intellectual functioning (assessed using the National Adult Reading test). RESULTS: Overall prevalence of borderline intelligence was 18%. Significant positive associations were shown with: being Black Caribbean; having a father who worked in a manual occupation; lower educational achievement; having had special education; longer course of illness. Those with borderline intelligence had greater disability and were more likely to suffer extrapyramidal side-effects and show evidence of negative symptoms. Educational achievement, history of special education and social class were the best socio-demographic predictors of intellectual level. CONCLUSIONS: Many patients who attend generic psychiatric services have considerable intellectual deficits. This may lead to difficulties in other domains of adaptive functioning, and merits further investigation as well as clinical vigilance.

Adolescent↗
PubMed1996

Clinical examples of cross-cultural work in a community learning disability service.

The debate on the correct application of the terms race and ethnicity continues while community care takes place in a multicultural society. The impact of mental illness and mental handicap (currently referred to as learning disability) on different ethnic groups partly depends on societal influences which also determine the policy for service organisation. As the treatment and support of the mentally handicapped has moved away from the custodial care of yesteryear, professionals must ensure that their practice is sensitive to the religion, ethnicity and languages of the communities they serve. This paper describes examples of psychiatric clinical practice with two families of Greek and Kuwaiti background, in the setting of a community learning disability team.

Adult↗
PubMed1992

Psychotic illness following 'mabi bark tea' consumption.

A first episode of psychosis occurred in a young woman of West Indian parentage and one of identical twins following a brief period of high consumption of a drink made from Colubrina plant extract (mabi bark). The course of the psychosis is described and possible underlying mechanisms and the relationship to amphetamine psychosis are discussed.

Adult↗