Biomedical subjects

Nick Huband

Publications and source records attributed to Nick Huband.

3 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

Does the non-randomized controlled study have a place in the systematic review? A pilot study.

BACKGROUND: A major issue in any systematic review is deciding which trials or studies to include and which to exclude. The Cochrane Collaboration and similar respected organizations have traditionally viewed the randomized trial (RCT) as the only acceptable evidence on treatment outcome. However, many systematic reviews are indeterminate because they include insufficient RCTs whilst they reject large numbers of non-randomized controlled studies. This is particularly true in forensic mental health, a domain where RCT methodology can be problematic. Systematic reviews could become more informative if reviewers knew when, and under what circumstances, non-randomized designs are acceptable for inclusion alongside RCTs. METHOD: This pilot study explores whether good-quality, controlled, non-randomized studies can be reliable surrogates for RCTs. We examined two published reviews from the Cochrane Schizophrenia Group. We compared outcomes between (a) randomized trials (that had been included) and non-randomized studies (that had been excluded), and (b) between high- and low-quality studies using an established quality checklist. RESULTS: In the first review, effect scores were similar for randomized and non-randomized studies and relatively insensitive to study quality. In the second review, the treatment effect was considerably lower for the RCT group - here, however, studies of high-quality showed much smaller effect scores than those of low-quality on two separate outcomes. CONCLUSIONS: Non-randomized controlled studies of high quality can produce outcomes that approximate to those found in RCTs. Trial quality may have a greater impact on treatment effect size than randomization alone, suggesting that randomization should not be seen as a reliable proxy for overall quality. The problems and issues still to be resolved are discussed with recommendations for future research.

Humans↗

PubMed2004

Repeated self-wounding: women's recollection of pathways to cutting and of the value of different interventions.

BACKGROUND: More information is needed on the processes that result in self-wounding and how these are modulated by the selection and delivery of interventions available to those working in non-specialist settings. METHODS: Ten women participated in a semi-structured interview where they recalled their experiences of cutting and the helpfulness of specific interventions. Transcripts of these self-reports were analysed using grounded theory methods. RESULTS: Having a long-term relationship with a key worker and being encouraged to express feelings were viewed as the most helpful strategies, whereas relaxation was often reported as making self-injury worse. The helpfulness of a given intervention was reduced when delivered by someone perceived as underconcerned, overprotective or incompetent. Two pathways to self-wounding were identified: cutting may result when there is a steady increase of tension until a threshold is reached (the 'spring' path), or as a result of the 'switching on' of the impulse (the 'switch' path). Dissociation during cutting and a craving for cutting were more often associated with switching to the impulse. Different management strategies are called for when the switch path has developed, which appears particularly the case for individuals who have been repeatedly self-wounding over a substantial period of time.

Adult↗