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Biomedical subjects

Conor Duggan

Publications and source records attributed to Conor Duggan.

10 recordsLinked to original sources
PubMed2006

Brief psychoeducation for people with personality disorder: a pilot study.

BACKGROUND: The Patients' Charter for Mental Health Services (DOH, 1997) states that a patient is entitled to both know and understand his or her diagnosis. Despite this, personality disordered clients are not always well informed about their disorder. Some will not be told their diagnosis because of concern that to do so would damage the therapeutic alliance. OBJECTIVE: To test the hypothesis that the therapeutic alliance is not compromised by engaging in a psychoeducation programme that informs about personality disorder. DESIGN: Pilot study, pre-post design. METHODS: Eighteen forensic in-patients and 16 community out-patients separately participated in a 4-session individual programme that focused on personality, personality disorder, and their own diagnosis. Understanding of these concepts was explored in a brief structured interview. Therapeutic alliance was assessed pre- and post-intervention using the Agnew relationship measure. RESULTS: For both samples, participation in the intervention resulted in a positive change in four of the five measured components of the therapeutic alliance. This change was rated more strongly by clients than therapists, and reached statistical significance for bond, partnership, and confidence subscales. Participants demonstrated improved knowledge of their disorder following the intervention, and all but one gave positive feedback. CONCLUSION: These findings support the hypothesis and suggest the therapeutic relationship is not impaired when a diagnosis of personality disorder is imparted using this psychoeducation programme.

Adult↗
PubMed2005

The manualization of a treatment programme for personality disorder.

BACKGROUND: The advantages of manualized psychological treatments include: the promotion of evidence-based practice, the enhancement of treatment integrity, the facilitation of staff training, and the potential replicability of treatment. ARGUMENT: The manualization of a multi-component, multidisciplinary treatment programme for male personality-disordered offenders is described. The background to this development is explained and the treatment setting is described briefly, followed by a description of the eight treatment manuals: (1) the treatment overview, (2) Psychoeducation focusing on personality disorder diagnosis and core beliefs, (3) Trust and Self-awareness group exercises, (4) Stop and Think! -- a social problem-solving intervention, (5) Controlling Angry Aggression, (6) Controlling Substance Use, (7) Criminal Thinking/Belief Therapy, and (8) Skills for Living -- a social skills manual. CONCLUSIONS: In addition to the original aims of manualization, this exercise has clarified the treatment programme, included less highly trained staff in the delivery of therapy and permitted the evaluation of treatment modules, thus contributing to the incremental evaluation of the overall programme. These manuals may usefully be shared with other practitioners in the field.

Adult↗
PubMed2004

Does personality change and, if so, what changes?

BACKGROUND: Although the question of whether or not personality changes is fundamental to much of what clinicians do, we do not appear to be very curious about the question itself. METHOD: This paper considers three separate but related issues: (a) Does personality change? (b) If it does, then what changes? (c) How can we show that change has taken place? Costa and McCrea have produced a model of personality that helps to answer (a) and (b), as it distinguishes 'Basic Tendencies' from 'Characteristic Adaptations'. The former are largely innate, fixed dispositions that produce the latter (which are highly variable) depending on its interaction with differing environments. Thus, personality is both static and dynamic depending on its definition. It will also be argued that detecting change is complex as there are many alternative definitions of the relevant outcome variable. Moreover, measuring several different outcomes does not help as change in one measure is often not matched by a concordant change in another. Some practical examples are provided to support this position. CONCLUSIONS: In the absence of a firm theoretical base, the author believes that only limited conclusions can be drawn about the efficacy of treatment in personality disorder.

Adolescent↗
PubMed2004

Does treatment really make psychopaths worse? A review of the evidence.

We aimed to evaluate critically the evidence behind the perceived inverse association between the degree of psychopathy as reflected by a high score on the Hare Psychopathy Checklist-Revised (PCL-R) and treatment response. A literature search with the key identifiers of PCL-R (or its derivatives) and treatment response produced 24 studies that were then systematically evaluated. This showed that only three studies were of an appropriate research design to answer the question and of these, none met our standard for an acceptable study. We conclude therefore that the commonly held belief of an inverse relationship between high-scores on the PCL-R and treatment response has not been established.

Antisocial Personality Disorder↗
PubMed2003

Referred to high secure care: determinants of a bed offer/admission and placement after one year.

BACKGROUND: The admission process to high secure care ought to ensure that those admitted (a) receive mental health care that meets their needs and (b) that this is provided at an appropriate level of security. AIMS: A study was undertaken to test the effectiveness of the gate keeping process according to these two criteria. METHOD All referrals for admission to Rampton high security hospital over one year were examined and, in addition, all women, all Anglo-Caribbeans and a random 50% sample of the Caucasian male majority were selected for interview. Each case was followed up for 12 months following the panel decision to determine his/her placement at that time. RESULTS: Of 138 referred, 56 (41%) were initially offered a bed although nearly half (66) had been subsequently admitted by the end of the study period. Seriousness of mental disorder and offence were independently associated with admission. After one year, one third of those admitted were no longer in high secure care. CONCLUSIONS: The variables predictive of admission (i.e. seriousness of both mental disorder and offence) suggest that the decision-making process was valid. Placement at 12 months tended to endorse the decision not to offer a bed, but it is more difficult to interpret the reverse as short admissions to high security for those who left within 12 months may have been appropriate. There was no apparent advantage in having a panel reviewing the decision of the assessing clinician.

Admitting Department, Hospital↗
PubMed2003

Counseling versus antidepressant therapy for the treatment of mild to moderate depression in primary care: economic analysis.

OBJECTIVE: To compare the cost-effectiveness of generic psychological therapy (counseling) with routinely prescribed antidepressant drugs in a naturalistic general practice setting for a follow-up period of 12 months. METHODS: Economic analysis alongside a randomized clinical trial with patient preference arm. Comparison of depression-related health service costs at 12 months. Cost-effectiveness analysis of bootstrapped trial data using net monetary benefits and acceptability curves. RESULTS: No significant difference between the mean observed costs of patients randomized to antidepressants or to counseling (342 pounds sterling vs 302 pounds sterling , p = .56 [t test]). If decision makers are not willing to pay more for additional benefits (value placed on extra patient with good outcome, denoted by K, is zero), then we find little difference between the treatment modalities in terms of cost-effectiveness. If decision makers do place value on additional benefit (K > 0 pounds sterling), then the antidepressant group becomes more likely to be cost-effective. This likelihood is in excess of 90% where decision makers are prepared to pay an additional 2,000 pounds sterling or more per additional patient with a good global outcome. The mean values for incremental net monetary benefits (INMB) from antidepressants are substantial for higher values of K (INMB = 406 pounds sterling when K = 2,500 pounds sterling). CONCLUSION: For a small proportion of patients, the counseling intervention (as specified in this trial) is a dominant cost-effective strategy. For a larger proportion of patients, the antidepressant intervention (as specified in this trial) is the dominant cost-effective strategy. For the remaining group of patients, cost-effectiveness depends on the value of K. Since we cannot observe K, acceptability curves are a useful way to inform decision makers.

Antidepressive Agents↗
PubMed2003

Theories of general personality and mental disorder.

BACKGROUND: A major shortcoming of current research into personality is its failure to explore the relationship between theories of general personality and mental disorder. AIMS: To provide preliminary data to address this deficit. METHOD: In the first of two studies, we examined the relationship between the Neuroticism, Extraversion and Other - Five-Factor Inventory (NEO-FFI) and DSM personality disorders in a consecutive series of mentally disordered offenders. In the second, we sought to separate the personality dimension neuroticism from symptoms of depressive disorder in a sample of subjects with current depression. RESULTS: Factors from the NEO-FFI were associated with different personality disorders in a predictable manner (first study). It was possible to identify a component of neuroticism (i.e. 'worry') that could be separated from depressive symptoms (second study). CONCLUSIONS: Theories of general personality theory can enlighten and refine descriptions of abnormal mental states by informing both their aetiology and their prognosis.

Adult↗
PubMed2002

Case history of co-morbid Asperger's syndrome and paraphilic behaviour.

We report a case of a man with Asperger's syndrome, paraphilic behaviour and convictions for sexual offences. We describe his assessment within a secure mental health setting to determine issues of diagnosis, treatment and risk. We also highlight the difficulty in reducing the risk of further offending because of the apparent ineffectiveness of interventions for the small group with Asperger's syndrome and an offending history. Consequently, they are likely to face long periods in institutional settings.

Adult↗