Impulse control disorders and dopamine dysregulation in Parkinson's disease: a broader conceptual framework.

BACKGROUND: Impulse control disorders (ICDs) and dopamine dysregulation syndrome (DDS) in Parkinson's disease are motivation-based behaviours that involve repetitive occurrences of impulsive and uncontrolled activity. Psychiatric classification is currently inconsistent and unclear. An accurate conceptualisation of these problems is important to guide research and treatment. METHODS AND RESULTS: The review considers conceptual and methodological problems underlying the diagnosis of ICDs and the assessment of their severity. Whilst having features of obsessive-compulsive spectrum model, ICD-5 may bring them together for the first time into a single category of behavioural addictions. Whilst matching clinical and biological evidence, any such psychiatric classification in Parkinson's disease will remain complicated by the interactions of pathophysiology and medication and fail to capture the range of subthreshold but still clinically significant symptomatology. CONCLUSIONS: A non-diagnostic, dimensional construct of disinhibitory psychopathology may be a useful tool to guide research and inform treatment. The role of dysphoria is suggested as a further important factor in driving some of these problem behaviours. This opens the opportunity for adjunctive psychological approaches in management.

Merely a stepping stone? Professional identity and career prospects following postgraduate mental health nurse training.

ACCESSIBLE SUMMARY: Accelerated mental health nurse training attracts talented graduates, many with a psychology degree. Our study shows that such trainees feel incompatible with the nursing culture. Consequently, professional identification is inhibited, and on qualifying these nurses may choose to develop their careers elsewhere. Nurse educators and mentors should pay greater attention to nurturing a positive professional identity in trainees. Alongside their attainment of knowledge and skills, nursing trainees are moulded by a professional culture and inculcated to norms of beliefs and behaviour. The process of professional identification may be inhibited by accelerated nurse training and an influx of psychology graduates potentially using mental health nursing qualification as a springboard to other career opportunities. This study explored facilitators and barriers to professional identification in newly qualified nurses of accelerated postgraduate training. Qualitative interviews were conducted with 10 nurses who had recently completed a postgraduate diploma in mental health nursing at King's College London. Participants identified more with the mental health field than with the broader profession of nursing. They defined their practice in terms of values rather than skills and found difficulty in articulating a distinct role for mental health nursing. Although participants had found experience in training and as a registered practitioner rewarding, they were concerned that nursing may not fulfil their aspirations. Professional identity is likely to be a major factor in satisfaction and retention of nurses. Training and continuing professional development should promote career advancement within clinical nursing practice.

Cognitive behaviour therapy for common mental disorders in people with Multiple Sclerosis: A bench marking study.

BACKGROUND: Mental health problems such as depression and anxiety are common in Multiple Sclerosis (MS) and are often under treated. AIMS: This paper reports on the clinical effectiveness of a cognitive behaviour therapy service for common mental disorders in people with MS and compares it to previous randomised controlled trials (RCTs) of cognitive behaviour therapy (CBT) in this population. METHODS: 49 patients were deemed appropriate for CBT and 29 accepted treatment. Assessments were completed at baseline and end of treatment and included the Hospital Anxiety & Depression Scale. Results in the form of a standardized effect of treatment were compared with five previous RCTs. RESULTS: The results from this clinical service indicated statistically significant outcomes with reductions in depression and anxiety. The uncontrolled effect size was large but inferior to those found in published RCTs. CONCLUSIONS: Cognitive behaviour therapy is effective for people with MS in routine clinical practice. Possible limits on effectiveness include more liberal patient selection, lack of specificity in rating scales and heterogeneity of target problems. Given the high rates of distress in this population, routine psychological interventions within neurology services are justifiable. Future research should aim to maximise CBT in such settings.