Recognising and treating psychological issues in people with diabetes mellitus.

Diabetes mellitus is a long-term condition that can lead to complications such as diabetic ketoacidosis, retinopathy and cardiovascular disease as a result of uncontrolled high blood glucose levels. In addition to these physical health complications, people with diabetes are more likely to experience psychological issues such as guilt, distress and depression compared with the general population. These issues can negatively affect an individual's ability to effectively monitor and self-manage their condition; however, they are often an overlooked aspect of diabetes care. This article explains how nurses can prevent, recognise and treat some of the psychological issues that people with diabetes commonly experience.

A qualitative study on becoming cared for in Alzheimer's disease: the effects to women's sense of identity.

OBJECTIVE: To explore the lived experience of becoming cared for and the impact this has on the identity and sense of self of women with Alzheimer's disease. METHOD: Eight women with mild-to-moderate Alzheimer's disease were interviewed in Northamptonshire, England, on two separate occasions about their experiences relating to needing assistance with instrumental activities of daily living (IADL) tasks. Interpretative phenomenological analysis was the approach used to underpin this research. RESULTS: Changes in the women's identity affected by the increased need for assistance with IADL tasks were expressed in terms of: who I am; unhappy being me; fighting to remain me; I'm not the same, but it doesn't worry me; and acceptance and contentment. CONCLUSION: This study offers an alternative perspective to the view that all women with Alzheimer's disease experience becoming cared for as a negative event in their lives. Some factors universally perceived as being a result of Alzheimer's disease may be a normal part of the life course.

Is adherence therapy an effective adjunct treatment for patients with schizophrenia spectrum disorders? A systematic review and meta-analysis.

BACKGROUND: Poor adherence to medication in schizophrenia spectrum disorders leads to inadequate symptom control. Adherence therapy (AT) is an intervention that seeks to reduce patients' psychiatric symptoms by enhancing treatment adherence. We aimed to systematically review the trial evidence of the effectiveness of AT on improving clinical outcomes in these patients. METHOD: Systematic review and meta-analysis of published RCTs. We included studies testing AT as an adjunct intervention against treatment as usual or a comparator intervention in the general adult psychiatric population. The primary outcome of interest was improvement in psychiatric symptoms. RESULTS: We included six studies testing AT in schizophrenia spectrum disorders published since 2006. A meta-analysis showed AT significantly reduced psychiatric symptoms compared to usual treatment over a follow-up period of less than 1 year. We found no significant effects of AT on patients' adherence and adherence attitudes. CONCLUSIONS: AT is an effective adjunctive treatment for people with schizophrenia spectrum disorders. PROSPERO: CRD42015016779.

Evaluating the clinical and cost effectiveness of a behaviour change intervention for lowering cardiovascular disease risk for people with severe mental illnesses in primary care (PRIMROSE study): study protocol for a cluster randomised controlled trial.

BACKGROUND: People with severe mental illnesses die up to 20 years earlier than the general population, with cardiovascular disease being the leading cause of death. National guidelines recommend that the physical care of people with severe mental illnesses should be the responsibility of primary care; however, little is known about effective interventions to lower cardiovascular disease risk in this population and setting. Following extensive peer review, funding was secured from the United Kingdom National Institute for Health Research (NIHR) to deliver the proposed study. The aim of the trial is to test the effectiveness of a behavioural intervention to lower cardiovascular disease risk in people with severe mental illnesses in United Kingdom General Practices. METHODS/DESIGN: The study is a cluster randomised controlled trial in 70 GP practices for people with severe mental illnesses, aged 30 to 75 years old, with elevated cardiovascular disease risk factors. The trial will compare the effectiveness of a behavioural intervention designed to lower cardiovascular disease risk and delivered by a practice nurse or healthcare assistant, with standard care offered in General Practice. A total of 350 people will be recruited and followed up at 6 and 12 months. The primary outcome is total cholesterol level at the 12-month follow-up and secondary outcomes include blood pressure, body mass index, waist circumference, smoking status, quality of life, adherence to treatments and services and behavioural measures for diet, physical activity and alcohol use. An economic evaluation will be carried out to determine the cost effectiveness of the intervention compared with standard care. DISCUSSION: The results of this pragmatic trial will provide evidence on the clinical and cost effectiveness of the intervention on lowering total cholesterol and addressing multiple cardiovascular disease risk factors in people with severe mental illnesses in GP Practices. TRIAL REGISTRATION: Current Controlled Trials ISRCTN13762819. Date of Registration: 25 February 2013. Date and Version Number: 27 August 2014 Version 5.

Should Nurses Administer Electroconvulsive Therapy?

In England, electroconvulsive therapy (ECT) has been traditionally administered by trainee or consultant psychiatrists with support from nurses. We believe that providing senior nurses, who specialize in ECT, with the appropriate training support to administer ECT will increase the capacity and capability of the team and improve the service for patients.

Integrating psychological screening into reviews of patients with COPD.

BACKGROUND: People with chronic obstructive pulmonary disease (COPD) have a high prevalence of anxiety and depression, which can have an impact on their symptoms and the way they manage their condition. Intervention that takes psychological distress into account may lead to better outcomes than simple advice-giving. AIM: To explore the feasibility of integrating psychological screening and intervention into nurse-led reviews of patients with COPD. METHOD: Nurses were given training on a pathway developed for patients with COPD. This included screening for depression and anxiety and assessing their severity; providing self-management education by means of a motivational approach; and offering pulmonary rehabilitation. RESULTS: The nurses' level of confidence increased following training. Patients were accepting of the screening process and felt more able and motivated to manage their condition after the intervention. Eleven of the 35 patients that took part in the study period had evidence of anxiety and/or depression. Out of a total of 16 patients eligible for pulmonary rehabilitation, 12 agreed to referral. Of these, three patients were seen by their GP, one was started on antidepressants, and one was referred to the psychology service. CONCLUSION: Training practice nurses to screen for depression and anxiety, and to offer self-management education using a motivational interviewing approach, increased the reported capability and motivation of patients with COPD to manage their condition. It may also improve the uptake of pulmonary rehabilitation. Use of this pathway does not place a burden on other care providers or greatly increase prescribing costs.

Does training practice nurses to carry out physical health checks for people with severe mental illness increase the level of screening for cardiovascular risk?

BACKGROUND: Compared to the general population, people with severe mental illness (SMI) have a higher risk of developing cardiovascular disease (CVD). Authors of clinical guidelines advise annual screening for CVD risk factors with appropriate lifestyle counselling. There are seven recommended elements of this health check: blood pressure, body mass index (or waist circumference), blood glucose, serum cholesterol, diet advice, exercise recommendations and smoking cessation guidance. AIM: To establish whether training practice nurses increases the proportion of patients with SMI who are screened for CVD risk factors and given lifestyle advice in primary care. METHOD: A before-and-after audit of 400 patients on the SMI registers in five primary care centres in Northampton, England. RESULTS: Following the training, the proportion of patients with SMI who received all elements of the health check significantly increased (pre-training: n = 33, 8%, 95% CI = 6-11; post-training: n = 60, 15%, 95% CI = 12-19; RR = 1.82, 95% CI = 1.22-2.72, p = .01). CONCLUSION: Training practice nurses about CVD prevention in people with SMI may be effective in increasing the proportion of patients in this group who receive a comprehensive health check.

Screening for metabolic risk among patients with severe mental illness and diabetes: a national comparison.

OBJECTIVE: People with severe mental illness have a higher risk of developing cardiovascular disease and die sooner than the general population. This study of a national sample of primary care patients in the United Kingdom compared screening for cardiometabolic risk factors among patients with severe mental illness and diabetes. METHODS: Screening for cardiovascular disease among 2,488,948 patients with diabetes (2010-2011) and 422,966 patients with severe mental illness (2011-2012) at 8,123 primary care practices was compared. RESULTS: The percentage of patients who received screening across four parameters (body mass index, blood pressure, blood glucose, and cholesterol) in the previous 15 months was higher among patients with diabetes than among those with severe mental illness (97.3% versus 74.7%, p<.001). CONCLUSIONS: The proportion of patients in primary care who were given screening for cardiometabolic risk was much lower among those with severe mental illness than among those with diabetes.

Prevention and management of depression in primary care.

Depression is a common mental health condition in which severe and persistent symptoms can lead to suicidal ideation. Timely recognition of depression is essential to improve patients' mental health and quality of life. This article outlines strategies to manage depression in primary care. It is anticipated that after reading this article nurses will feel more confident in screening and treating patients with this debilitating condition.

Screening for cardiovascular risk in patients with severe mental illness in primary care: a comparison with patients with diabetes.

BACKGROUND: People with severe mental illness (SMI) have a higher risk of developing cardiovascular disease (CVD) compared with the general population. Clinical guidelines recommend annual screening for CVD risk factors with appropriate lifestyle counselling. Aims To establish the proportion of patients with SMI being screened for CVD risk factors in their primary care practice compared with those with diabetes and determine whether people with SMI receive lifestyle advice. METHOD DESIGN: a retrospective audit. SETTING: five primary care centres in Northampton, England. PARTICIPANTS: three hundred and eighty-six patients with SMI and 1875 with diabetes. RESULTS: Just over a fifth of patients with SMI received a full CVD screen compared with the 96% of those with diabetes (OR = 90.37; 95% CI = 64.53-126.55, p < 0.01). Fifty-seven per cent of the SMI patients were given smoking advice but only 13% and 14% received guidance regarding diet and exercise, respectively. On average of each patient with SMI received fewer than two (from four) screening interventions and less than one (from three) components of lifestyle advice. CONCLUSIONS: In primary care, the number of people with SMI receiving screening for CVD risk is much lower than those with diabetes.

Training practice nurses to improve the physical health of patients with severe mental illness: effects on beliefs and attitudes.

Annual health checks are recommended for patients with severe mental illness (SMI) as they are at high risk of cardiovascular disease. Ideally, these health checks should be carried out in primary care. Practice nurses are already competent in carrying out physical health checks, but might have misconceptions about mental illness, which is a barrier to offering the service. We used a mirror imaging study to establish the effectiveness of a training package for practice nurses that aims to address common misconceptions about the physical health of people with SMI. This 2-hour training package (Northampton Physical Health and Wellbeing Project) was delivered to eight practice nurses. Their misconceptions and beliefs were assessed before and after training. Motivation to work with community mental health workers was assessed after training. The practice nurses involved in the study rejected commonly held misconceptions about the physical health of people with SMI after training. Their attitudes towards their role in providing health checks appeared to be modified in a positive direction. Their motivation to work with community mental health workers also seemed to be enhanced. The Northampton Physical Health and Wellbeing Project training was effective in modifying practice nurses' misconceptions about physical health in people with SMI.

Is the use of an invitation letter effective in prompting patients with severe mental illness to attend a primary care physical health check?

BACKGROUND: Annual physical health checks are recommended for patients with severe mental illness (SMI) as this group has a higher risk of developing cardiovascular disease than the rest of the general population. There is little guidance for healthcare professionals to assist them in encouraging patients to attend a health check. AIMS: To explore whether an invitation appointment letter is effective in prompting patients with SMI to attend a physical health check in primary care compared with those with diabetes. METHOD: A retrospective audit comparing the response rate of patients with SMI and diabetes to an appointment letter inviting them to attend a primary care health check. RESULTS: Two-thirds (n = 61, 66%) of the patients with SMI (n = 92) and three-quarters (n = 338, 81%) of those with diabetes (n = 416) attended the practice on the date and time stipulated in the letter. Patients with diabetes were 2.2 times more likely to attend a health check compared with those with SMI (OR = 2.20, 95% CI = 1.13-3.62). CONCLUSION: Although attendance rates were lower than in patients with diabetes, they were higher than expected from the SMI group. An invitation appointment letter is an effective way of ensuring that patients with SMI have a physical health check.

The Northampton Physical Health and Wellbeing Project: the views of patients with severe mental illness about their physical health check.

Background Annual health checks are recommended for people with severe mental illness, as they are at high risk of cardiovascular disease. We trained practice nurses from six primary care centres in Northampton, in the UK, how to deliver health checks for this population. Aims The purpose of this study was to examine patients' views about the physical health check delivered by a nurse trained in the Northampton Physical Health and Wellbeing (PhyHWell) project. Method We interviewed five patients from three primary care centres using a topic guide. Results From a total of 29 patients who were invited, five attended. They had a good understanding of the importance of a healthy diet and taking regular exercise, but did not appear to be aware of the risk of cardiovascular disease. Being treated consistently by the same healthcare professional and/or by a nurse was cited as a helpful factor in managing their physical health. Most of the patients were glad to be invited for a health check and thought that it was worthwhile. They would have liked more information about blood tests and medication. All of the patients reported that they had started to make changes to their lifestyle since the health check. Recommendations Training for practice nurses to provide physical health checks for people with severe mental illness should emphasise the patients' views of what will make them effective.

A Depression Recognition and Treatment package for families living with Stroke (DepReT-Stroke): study protocol for a randomised controlled trial.

BACKGROUND: Depression occurs in up to 50% of patients after stroke and limits rehabilitation and recovery. Mood disorders are also highly prevalent in carers; their mental health intertwined with the physical and mental wellbeing of the person they are caring for. We argue that working with families, rather than patients alone may improve the treatment of depression in both patients and their carers enhancing the mental wellbeing and quality of life of both. METHODS: A single blind cluster randomised controlled trial to evaluate whether families after stroke who are treated with the Depression Recognition and Treatment package (DepReT-Stroke) in addition to treatment as usual (TAU) show improved mental well being compared to those families who receive only TAU. We aim to recruit one hundred and twenty-six families (63 in each group). The DepReT-Stroke intervention will help families to consider the various treatment options for depression, make choices about which are likely to fit best with their lives and support them in the use of self-help therapies (e.g. computerised Cognitive Behavioural Therapy or exercise). An essential component of the DepReT-Stroke package will be to help people adhere to their chosen treatment(s). The primary outcome will be the Mental Component Subscale of the SF-36 assessed at baseline and again six months post intervention. Effectiveness of the intervention will be determined using analysis of co-variance; comparing the mean change in MCS scores from baseline to six months follow-up adjusting for the clustering effects of baseline scores and family. An economic evaluation of the intervention will help us determine whether the intervention represents a cost-effective use of resources. DISCUSSION: Depression both for patients and their carers is common after stroke. Our Depression Recognition and Treatment package (DepReT-stroke) may help clinicians be more effective at detecting and managing a common co-morbidity that limits rehabilitation and recovery. TRIAL REGISTRATION: ISRCTN: ISRCTN32451749 Research Ethics Committee Reference Number: 10/H0310/23 Grant Reference Number: (NIHR) PB-PG-0808-17056.

Adapting the severe mental illness physical Health Improvement Profile for use in primary care.

People with severe mental illness (SMI) have a higher incidence of long-term physical conditions, including diabetes and cardiovascular disease. This can dramatically reduce their life expectancy. In the UK, it is the duty of health-care professionals in primary care to monitor the physical health of this group of people. However, these professionals have been given no specific training in order to do this effectively. The Northampton Physical Health and Well-Being Project has been developed in order to reduce the mortality of people with SMI, improve their physical and emotional health, and increase their support network. We have adapted the Health Improvement Profile (a tool to help mental health nurses profile the physical health of people with SMI) for use in primary care by creating a manual and website and will provide bespoke training in its use to the health-care professionals.