Regional, National and International Studies Recruiting in East London

NIHR Portfolio

Prognostic Evaluation of Diagnostic IGRA Consortium - UK PREDICT Study

UK CRN ID no. 8489

R&D ref. no.  AB/000133/10

Chief Investigator: Dr Ibrahim Abubakar – 020 8327 7144 – ibrahim.abubakar@hpa.org.uk

Principal Investigator: Dr. Duncan Trathen – 020 8553 7460 – duncan.trathen@newhampct.nhs.uk

The objective of this study is to assess the efficacy of the two current TB (tuberculosis) blood tests (Interferon Gamma Release Assays (IGRA)) compared with the standard skin test (Mantoux Tuberculin Skin Test (TST)), for predicting active tuberculosis among those at increased risk of TB. Those at increased risk are defined as either newly arrived immigrants or people who have been in contact with TB cases. The study will also provide information on the cost effectiveness of different testing strategies, such as the two step testing approach recommended by NICE. The study is to be funded by the NIHR Health Technology Assessment programme.

10,000 participants will be recruited from 12 hospitals and a network of GP surgeries in London. All participants will have the skin test and blood taken for both assays. Disease status of participants will then be followed up for an average of 24 months using the national register of clinical reports, a phone call and the national microbiological database. The risk of developing active disease is highest in the first two years after exposure. During follow-up there will be no additional diagnostic procedures unless symptoms occur, i.e. in line with current NICE policy. A sub group of patients, selected as a random 25% of participants, will have a repeat IGRA test shortly after the first test to investigate whether the skin test affects the result of the blood test.

 

Sudden death in psychiatric in-patients and the relationship with psychotropic drugs

 UK CRN no. 5657

Chief Investigator: Professor Louis Appleby - 0161 275 0714

To establish the number and rate of sudden death (SUD) in psychiatric inpatients.

To establish the characteristics of patients who die suddenly and carry out a case-control study identifying independent risk factors for SUD.

 

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH)

UK CRN no. 5655

Chief Investigator: Professor Louis Appleby - 0161 275 0714

To collect detailed clinical information on patients of mental health services who die by suicide, or commit homicide.

To make recommendations for policy and clinical practice.

 

Safewards

UK CRN ID no. TBC

R&D ref. no.  PG1109/2

Chief Investigator: Professor Len Bowers – 020 7848 5323 –len.bowers@kcl.ac.uk

Local Point of Contact:  Mr. Jonathan Warren – 020 7655 4059 – jonathan.warren@eastlondon.nhs.uk

Mentally ill people in hospital sometimes behave aggressively. They may try to harm themselves, break ward rules, act in a hostile way or try to leave hospital. We call these types of behaviours ‘conflict’. Staff try to keep people safe, and sometimes have to use methods to reduce these risky behaviours, such as locking ward doors, giving patients medication or physically restraining them. We call these things ‘containment’.

Our previous research tells us that there is a complicated relationship between conflict behaviours and containment, and that the behaviour and attitudes of staff significantly influence both. We have looked at all the previous research published on this topic since 1960, as well as conducting many of our own studies. We now have a good idea what elements of staff behaviour can influence the safety of patients and staff, and have used this to devise an intervention. The intervention seeks to enhance and support existing structures of mutual respect and support between patients and staff, and between patients and other patients.

In this trial, we wish to test this intervention on acute psychiatric wards, comparing it to a control intervention, in what is called a cluster randomised controlled trial. Thirty wards in 15 hospitals will be recruited to the study, and rates of conflict and containment will be recorded before and after our intervention is implemented. If the intervention works, this study will provide a proven method that can be applied across the NHS which will improve the safety of patients and staff.

 

Oxford Community Treatment Order Evaluation Trial (OCTET)

UK CRN ID no. 5758

R&D ref. no.  N0811/2

Chief Investigator: Professor Tom Burns - 01865 226474 - tom.burns@psych.ox.ac.uk  

Local point of contact: Professor Stefan Priebe – 020 7540 4210 – s.priebe@qmul.ac.uk

Does the use of SCTOs reduce the rate of readmission to hospital in individuals with a psychotic disorder and an established history of frequent relapses?

More information: http://www.psychiatry.ox.ac.uk/research/researchunits/socpsych/research/

 

START (Systemic Therapy for At Risk Teens)

UK CRN no. 6194

R&D ref. no. K1001/3

Chief Investigator: Professor Peter Fonagy- 02076795960 - p.fonagy@ucl.ac.uk

We aim to carry out a pragmatic trial that will inform policy makers, commissioners of services and professionals about the potential of MST in a UK context, investigating whether the provision of MST could reduce the incidence of out of home placements for young people at risk of being removed from their homes because of antisocial behaviour, severe mental health problems, educational problems or unmet need. The trial will take referrals of families with an adolescent with severe antisocial behaviour problems who is considered to be at risk of custodial or other forms of out of home care. The trial will answer the question of whether MST can contribute to significantly reducing the rate of out of home placement.

Secondarily, the trial will ask if MST can bring about

  1. decrease in antisocial behaviour,
  2. increase in the young person’s well-being,
  3. improved educational outcomes and
  4. improved family functioning.

Moreover, we aim to establish the cost of MST relative to management as usual, and the cost-effectiveness of providing this intensive form of intervention against the background of costs incurred in the 18 months period following randomisation. The immediate objectives of the trial are:

  1. to confirm recruitment of ten MST service providers and agree on an acceptable protocol for randomisation of cases (month 3);
  2. to recruit and train outcome assessors (OAs) to a predetermined level of reliability (month 4);
  3. to identify a representative clinical sample of 700 young people to be recruited from ten sites (month 21);
  4. to randomise 350 cases to MST and 350 to MAU (month 21 – this figure allows for a significant number who may not consent to enter the trial);
  5. to assess outcome of randomised cases at 6, 12 and 18 months post recruitment (month 39);
  6. to estimate the total social, health, educational and criminal justice cost of interventions at 18 months post-randomisation (month 42);
  7. to identify the key cost and outcome drivers and the value for money of the treatments at 18 months (month 44) and
  8. to analyse data, write reports and prepare papers for publication in peer reviewed journals 4 years after the commencement of the trial (month 48).

 

Intervention within the British Autism Study of Infant Siblings (I-BASIS)

UK CRN ID no. 9666

Chief Investigator: Prof Jonathan Green – 01613 067 966 – jonathan.green@manchester.ac.uk

Local Point of Contact:  Dr. Ben Ko - Ben.Ko@newhampct.nhs.uk  - 020 8271 1396

Autism spectrum disorder (ASD) is one of the most persistent and burdensome of child developmental disorders affecting up to 1% of UK children.  It is not currently diagnosed before 2 years and much research is now focussing on the pre-diagnostic period in infancy – when early signs of later autism can become apparent.  The BASIS network has been set up to coordinate such research in the UK.

Recent studies in diagnosed autism (including our own) have shown that interventions focussing on parent-child communication pre-school (2-5 years) can substantially improve child functioning in the short term.  This current project is to undertake a similar earlier intervention before diagnosis in the infancy period – when there may be additional opportunities for a benefit.  The research question is whether an intervention of this kind is feasible and acceptable to parents and whether it shows evidence of improving child development and social interaction.  The key practical relevance is whether such infancy intervention could delay, reduce or even prevent the later development of autism in children at risk.

Families will be recruited into the study though a recruitment database of the British Autism Study of Infant Siblings, a collaborative research network for the study of infants at risk for autism.  The study will invite families from the BASIS network to participate in a 5 month intervention period when the infants are 8-13 months old.  This works with parents to help them understand infant communication and interaction and thus to bring out the best in their child.  The infants will be assessed before and after the intervention using measures for the BASIS phase 1 study, which has been used with over 100 families so far at the Centre for Brain and Cognitive Development.

 

Seroquel XL Hospital-Event Monitoring Study (OASIS)

UK CRN ID no. 7435

R&D ref. no. L1011/2

Chief Investigator: Prof Anthony Hale - anthony.hale@kmpt.nhs.uk  - 01227 865815

Principal Investigator:  Prof Dave Curtis  -davidcurtis@nhs.net  - 020 7377 7729

A study to evaluate the short term safety of Seroquel XL in real-life usage in patients diagnosed with schizophrenia and mania associated with bipolar disorder in the Mental Health Trust Setting.

Seroquel XL (extended release Seroquel) is a new formulation of the product and this study aims to evaluate its short term safety when used by patients with schizophrenia and mania associated with bipolar disorder in real life. This study was requested by the Medicines and Healthcare Regulatory Authority (MHRA) who oversee the safety of all medicines in the UK.

The study will be recruiting patients started on Seroquel XL as well as a comparator group started on Seroquel IR (the older formulation) and asking their care team to answer some simple questions about them at the time they start and again in 12 weeks time. If a participant has an adverse event (side effect) during that 12 week period, we may ask the patient’s care team to fill out a further follow up questionnaire.

 

Effectiveness of perinatal psychiatry services

UK CRN no. 8047

R&D ref. no. A1101/1

Chief Investigator: Dr Louise Howard - louise.howard@kcl.ac.uk  - 020 7848 0851

Principal Investigator:  Dr. Liz McDonald - Liz.McDonald@eastlondon.nhs.uk – 020 8510 8071

This pilot study aims to investigate how to measure the effectiveness of perinatal psychiatry services. This will inform a future study which will investigate the clinical and cost effectiveness of psychiatric services for women with severe perinatal psychiatric disorder.

We know that in the weeks around the time of birth, women are at a higher risk of experiencing mental health difficulties than at any other time in their lives. The importance of identifying and supporting women experiencing an episode of mental illness is well known. However, there is little research to guide the NHS on which services provide the best experiences and outcomes for women suffering from a perinatal psychiatric episode.

This pilot will examine the feasibility of undertaking an evaluation of mother and baby units compared with admissions to general psychiatric wards or care by home treatment teams. Service users within these settings who are approaching discharge and considered well enough by a responsible clinician will be asked to take part. They will be asked about the symptoms they have experienced, care received, how satisfied they were with this care and any wider support that they had from family or friends. We would also like to examine mother-infant interaction, and make a short video (no longer than 5 minutes) with mother and baby playing as they normally would. With service users permission we would like to explore carers' experiences and perceptions of psychiatric services, and about their health more generally. Finally we would like to hear from staff about the care they provide and their experiences of work.

Collecting this information will inform how we approach future work that will evaluate which components of services are acceptable to and effective for which patients.

 

TAS2: Therapeutic alliance and service user satisfaction

UK CRN no. 9900

R&D ref. no. A1103/2

Chief Investigator: Professor. Sonia Johnson – 020 76790953 –s.johnson@ucl.ac.uk

Local point of contact: Dr. Rose McCabe – 020 7540 4210 – r.mccabe@qmul.ac.uk

Acute inpatient mental health services are costly and often experienced by service users as unsatisfactory. A range of Community-based crisis houses have been developed to provide a residential alternative to hospital admission during mental health crises. A recent UK study found that service users prefer crisis houses to acute wards but this was not explained by greater clinical improvement during admission or differences in care received. Service users reported the quality of relationships with staff as key to their experience of admission.

This study will compare therapeutic alliance (service users’ perception of the quality of their relationships with staff) at crisis houses and acute wards. We will compare service users’ perceived recovery, support from other patients and experience of negative events during admission. We will also interview service users and staff for their views on how to promote good relationships between staff and patients and how the organisation of services can contribute to this.

We will collect data at four crisis houses in North and East London and up to eight acute psychiatric wards within the same NHS Trusts. The crisis houses will represent a range of service models including NHS and voluntary sector-run services. We will complete questionnaires with 108 service users at crisis houses and at least than number on acute wards. We will conduct in-depth interviews with 32 service users and 16 staff.

This study will test whether therapeutic alliance between staff and service users is stronger in crisis houses than acute wards. It will also help understand what influences satisfaction with acute services and how the structure and organisation of services can promote or impede good relationships. It will generate recommendations for how to provide residential crisis care which is acceptable to service users.

 

Observational study of resource use and cost of Alzheimer's disease in Europe (GERAS)

UK CRN no. 6927

R&D ref. no. L1010/1

Chief Investigator: Prof. Roy Jones

Local point of contact: Dr. Nicholas Bass - 020 7377 7000 ext 7967 - nick.bass@thht.org   

This study aims to describe resource use and associated costs of Alzheimer’s disease (AD) for both patients and caregivers and caregiver burden, over a sufficiently long period of time to capture changing levels of severity or changes in formal caregiving situations. The study is an 18month prospective, multicentre, pan-European, naturalistic, noninterventional, cohort study reflecting routine care in Alzheimer disease, with 1year enrolment.

 

Hospital Management of Self-ham in England (HoMaSH 2)

UK CRN ID no. 7333

R&D ref. no. E1006/3

Chief Investigator:  Prof. Navneet Kapur – 01612750737 – nav.kaput@manchester.ac.uk

Comparing the management (e.g. levels of assessment and admission) and outcome of self-harm in 32 hospitals to determine which aspects of care affect the risk of repeat self-harm and assess whether improvements in services have followed recent NICE guidance.

 

Rehabilitation Effectiveness & Activities for Life (REAL)

UK CRN no. 5664

R&D ref. no. K0907/4

Chief Investigator: Dr Helen Killaspy - 02077940500/33950 - h.killaspy@medsch.ucl.ac.uk

The programme of research has three primary research objectives:

  1. What is the current provision and quality of mental health rehabilitation services in England?
  2. What is the clinical effectiveness of a simple staff training intervention to increase inpatient mental health rehabilitation service users' activity?
  3. What are the service and service user characteristics associated with better outcomes from inpatient mental health rehabilitation?

The secondary research questions are:

  1. Does the current provision of inpatient rehabilitation services reflect relative levels of socio-economic deprivation and variation in clinical need?
  2. What is the range of quality of rehabilitation services in England?
  3. What are the characteristics of the users of these services and do they vary between services?
  4. Do areas with poorer quality rehabilitation services have higher proportions of service users placed out of area?
  5. Is training front-line staff to promote service users’ activities for community living a cost-effective intervention to improve poorer quality services?
  6. Is service user activity associated with better clinical and social outcomes?
  7. Is greater quality of the rehabilitation service associated with better outcomes for service users?

 

Deprivation of Liberty Safeguards, Human Rights and Care

UK CRN no. 9400

R&D ref. no. A1103/4

Chief Investigator: Joan Langan – j.langan@bris.ac.uk

Local point of contact: Dr. Kevin Cleary – 020 7655 4177 – Kevin.Cleary@eastlondon.nhs.uk  

 

 

An evaluation of Protected Engagement Time in mental health wards

UK CRN no. 7802

R&D ref. no. A1105/1

Chief Investigator: Fiona Nolan – 020 7679 5911 – f.nolan@ucl.ac.uk

Local point of contact: Prof. Alan Simpson – 020 7040 5937 – a.simpson@city.ac.uk

Patients on acute psychiatric wards in the UK have recurrently reported that they are unhappy with the ward environment, that they are bored and have little to do, that wards are intimidating, and above all, that contact between staff and patients is often identified as too limited in both quantity and quality, and as lacking therapeutic content. Despite various local and national initiatives, we do not yet have an evidence-based way of addressing this problem. Protected Engagement Time (PET) has emerged as a promising initiative for improving quantity and usefulness of Staff-patient contact. During fixed periods of the day, staff are asked to focus solely on patient contact: visitors are not admitted and administrative duties and meetings not allowed. This approach is popular and inexpensive to implement. However, we do not have any evidence about whether it works or how it should be implemented to achieve the best results.

Our study, in three components, aims to address this;

  1. A national survey investigating how widespread PET now is in England, and how it has been implemented.
  2. Evaluation of the effects of PET on patients and staff by comparing 12 wards with PET and 12 wards without. We will observe whether there is more contact between staff and patients on wards with PET, and will use questionnaires and interviews to compare patients’ satisfaction with care and staff burnout on all wards. We will also examine the frequency of conflict between staff and patients and staff and patient perceptions of the ward environment.
  3. In-depth case studies on three wards with PET, using open-ended interviews with patients, staff and service managers, exploring their experiences of the effects of PET and how best to implement it.

The study will provide initial evidence on how PET is implemented and with what effect.

 

HCVtx: A qualitative study of the barriers and facilitators to hepatitis C treatment for people who inject drugs

UK CRN no. TBC

R&D ref. no. A1105/2

Chief Investigator: Professor Tim Rhodes – tim.rhodes@ishtm.ac.uk  

Local point of contact: Mandie Wilkinson – 020 8121 5341 -- Mandie.Wilkinson@eastlondon.nhs.uk

This is a qualitative case study that aims to explore the barriers and facilitators to hepatitis C (HCV) treatment for people who inject drugs (PWID) in two London settings. The burden of HCV disease is concentrated among PWID; modelling studies show that providing HCV treatment to PWID is an effective preventative measure, reducing the pool of communicable disease in the population. Research evidences that PWID are interested in HCV treatment uptake, and the British National Institute for Health and Clinical Excellence (NICE) guidelines do not preclude PWID from treatment access. Yet, in the UK and internationally, HCV treatment uptake among PWID is low. The study will focus on two models of institutional partnership that seek to facilitate HCV treatment access and support for PWID. The first is an established community-based partnership between the Royal London Hospital and Specialist Addiction Unit. The second partnership, between Kings College Hospital and Lorraine Hewitt House, is in the initial stages of piloting an outreach programme. Data collection will comprise qualitative in-depth interviews with approximately 30 HCV positive PWID, purposively sampled to include those with no experience, recent experience and established experience of HCV treatment, and with approximately 12 HCV treatment providers and stakeholders, including representatives of hepatology, clinics, procurement, and treatment advocacy. The study aims to: (a) describe pathways to hepatitis C treatment, including referral, as well as factors mediating treatment access; (b) explore the experience of hepatitis C treatment access and delivery from patient, provider and ‘system’ perspectives; and (c) develop guidance regarding hepatitis C treatment system improvement, including referral and coordination, and the provision of psychosocial interventions targeting patients and providers. Analyses of the individual, social and structural factors shaping the accessibility and quality of hepatitis C treatment service delivery will be used to shape local community advocacy and policy guidance.

 

The validation of new risk assessment instruments for use with patients discharged from medium secure services (VoRAMSS)

UK CRN no. 8185

R&D ref. no. E1004/8

Chief Investigator: Prof. Jenny Shaw - 01772 406631

Local point of contact: Prof. Jeremy Coid – 020 7601 8138 - j.w.coid@qmul.ac.uk

The protection of the public from violent and high risk individuals is increasingly expected from healthcare professionals. Violence risk is highest in the community where it is most difficult to manage, therefore new risk assessments focusing on the community need to be tested.

Previous research has suffered from methodological problems which have threatened the validity and reliability of the findings. Previous research has relied on official records, community samples tend to exclude high risk patients most likely to be violent. There is also significant selection bias, the generalisability of findings are limited by the fact that at least a significant minority of participants will refuse to participate. Those patients who do not consent are the group most likely to be noncompliant and antisocial and therefore more likely to be violent post release. This impacts on the validity of the assessments meaning that the ability to reduce the risk of community violence and the public protection may be lost.

The aim of this study is to test new risk assessment tools that focus on community violence and overcome previous methodological problems.

 

Evaluation of Exercise on Individuals with Dementia and their Carers, as a Therapy for BPSD (EVIDEM-E)

UK CRN ID no. 6685

R&D ref. no. A1103/5

Chief Investigator: Dr James Warner - j.warner@imperial.ac.uk  - 020 8206 7156

Principal Investigator:  Dr Rahul Bhattacharya - Rahul.Bhattacharya@eastlondon.nhs.uk - 020 8121 5550

Dementia can cause many problems including difficulties with memory and thinking, and more commonly occurs in older people. Dementia can also cause changes in personality, mood and behavior and these are called Behavioural and Psychological Symptoms of Dementia (BPSD).

Behavioural and Psychological Symptoms of Dementia can be very distressing for those who experience them as well as their families and carers. We recognize that managing these symptoms can play a very important role in everyday life. Symptoms such as anxiety, aggression, restlessness, agitation and wandering are known to increase the distress experienced by caregivers. This can make caring for people at home difficult due to the extra demands on caregiver's time and attention.

Evidence suggests an overreliance on medication for the treatment of behavioural and psychological symptoms of dementia. Also, we are beginning to understand that the long term use of some drugs can sometimes have a negative effect on the quality of life for people with dementia as well as their safety. Therefore, it is important to identify effective treatments other than drugs. Early indications suggest exercise might be useful for treating behavioural and psychological symptoms of dementia and promoting wellbeing amongst people with dementia.

EVIDEM-E is a trial of a walking program for people with dementia, administered and supervised by carers at home. We will evaluate its impact on medication use, quality of life, behavioural disturbance and burden of caregiving. Our intervention could have a significant impact for both people with dementia and their carers.

 

Own Account Studies

Addressing low treatment rates of chronic HCV in injecting drug users

R&D ref. no. A1103/7

Chief Investigator: Prof Graham Foster – 020 78827242 – g.r.foster@qmul.ac.uk

Local point of contact: Mandie Wilkinson – 020 8121 5341 -- Mandie.Wilkinson@eastlondon.nhs.uk

Chronic hepatitis C virus (HCV) is a virus that infects the liver and can lead to liver cirrhosis and cancer. In the United Kingdom the majority of people infected with hepatitis C acquired the virus as the result of injecting drug use, but only a very small proportion of people with HCV in this group have been treated (310%) This is despite the fact that with treatment most people can be cured of the virus. We wish to address the reasons behind this and increase the proportion of injecting drug users who start and complete treatment for hepatitis C.

The study will consist of three stages, the first of which will involve a qualitative analysis of the reasons for declining or accepting treatment amongst injecting drug users, the second will involve a retrospective audit of the health and social outcomes of those who have been treated, and the third will involve a pilot study into nurse led prescribing of antiviral treatment for hepatitis C with the aim of making treatment more accessible to this population.

A greater understanding of the reasons behind low treatment uptake, and of the benefits of treatment, and more accessible treatment models should enable us to offer treatment programmes that will engage a greater proportion of this vulnerable group, leading to higher treatment and cure rates.

 

Genetic case control and brain imaging studies of mental illness, autism and Alzheimer’s dementia

R&D ref. no. K0911/2-I

Chief Investigator: Prof Hugh Gurling - 0705 0016265 - h.gurling@ucl.ac.uk

Local point of contact: Prof David Curtis - 020 7377 7729 - davidcurtis@nhs.net

The study will investigate which narrow regions within the broad regions implicated harbour susceptibility genes and whether variations in candidate genes are associated with increased susceptibility to disease. Genetic association analysis will be carried out to test for relationship between disease status and genotype using polymorphic DNA markers.

 

Forensic Personality Disorder Services Evaluation Database

R&D ref. no. N0904/1

Chief Investigator: Prof Anthony Maden – 01344 754720 – a.maden@ic.ac.uk

Principal Investigator:  Dr. Mark Freestone -- 020 8510 2600 x2625 – Mark.Freestone@eastlondon.nhs.uk

The main objective is to describe in a consistent way all patients admitted to the newly established high-security services for dangerous and severe personality disorder at Broadmoor and Rampton Hospitals, and at Frankland and Whitemoor prisons, and to collect basic outcome data.

The study will bring together demographic, psychological, clinical, offending and risk assessment data on all patients.  Data will be collected on admission, at regular intervals during the admission, and at discharge.  If patients are discharged, we will attempt to obtain data on reconviction from the Offenders Index.  We will collect data to test the following hypotheses:

  1. the Null hypothesis is: The outcome of treatment in DSPD pilot units is no worse for men with high psychopathy scores than it is for men with low or medium psychopathy scores on the PCL-R
  2. men with high levels of psychopathy have a worse outcome on all measures but,
  3. the DSPD service is successful in retaining some men with high levels of psychopathy and
  4. completion of treatment is associated with a reduction in risk, even in men with high levels of psychopathy.

 

An Epidemiological ASD Study and Establishing a Research Database

R&D ref. no. A1101/1

Chief Investigator: Dr Jeremy Parr

Local Point of Contact:  Dr. Ben Ko - Ben.Ko@newhampct.nhs.uk  - 020 8271 1396

The aim of this project is to undertake epidemiological research about families and children with Autism Spectrum Disorder (ASD), whilst also establishing a UK ASD Research Register. For families, participation will mean they have an opportunity to take part in research studies the Register will be a recruitment mechanism for large scale UK ASD studies (including large genetic studies that will require separate ethical permissions). For researchers, this will mean there are more families easily contactable about research projects. We will collect some information from families about themselves and their child, allowing us to answer important epidemiological research questions. This data will be provided by the parents, who will be asked to complete two questionnaires; and taken from medical and educational reports. Families will be recruited through paediatricians and their colleagues, who will approach every family who has a child with a recent diagnosed of ASD. Over 30 child development teams in the UK have confirmed that they will participate in the Register project. Using the information we collect, we will be able to answer some important research questions about ASD, and also see which children are appropriate for a particular study. Researcher’s applications, for families to be contacted about their project, will be assessed by a Steering Committee who will decide which studies are appropriate to support. The Register team will then contact families so that they can choose whether they would like to participate, or not. Families will be kept informed of the progress of the Register, and the results of our research, through an annual newsletter and the Register website.

 

Mentorship capacity in nursing

ReDA ref. no.  AD1110/2

Chief Investigator:  Dr. Sarah Robinson – 020 7848 3063 – scrobinson@pdr.demon.co.uk

Local Point of Contact:  Mr. Jonathan Warren – 020 7655 4059 – jonathan.warren@eastlondon.nhs.uk

This project investigates whether mentorship capacity is perceived as being sufficient to meet preregistration Student nurse need. Preregistration nursing education comprises university-based study and periods of practical experience (placements). During the latter, student nurses are allocated to a qualified nurse (mentor) who guides their practice and assesses their progress. Nurses acting as mentors have obtained a mentorship qualification through attendance at a course provided by the higher education institution (HEI)with which their trust is associated for educational purposes. Mentorship therefore involves NHS trusts and HEIs and is an essential part of ensuring that newly qualified nurses are competent at the point of registration which, in turn, is an important aspect of patient safety.

This project explores the experiences and perceptions of mentorship capacity of senior staff in HEIs and their associated trusts. It is a two-stage project. Stage 1, nearing completion, comprises semi-structured interviews with senior staff (24 in total) in two London-based HEIs. Ethical approval was required and obtained from King's College London and from both the HEIs. Stage 2 comprises semi-structured interviews with a total of up to 28 senior staff in a sample of trusts (7) associated with the two HEIs. Ethical approval is now sought for Stage 2. The personnel selected will be asked to participate in one semi-structured interview lasting about an hour covering three aspects of mentorship capacity: i) resources in terms of mentors, placements and costs; ii) education and experience of mentors and iii) factors that help or hinder delivery of mentorship in practice settings. Staff include: senior postholders with a remit for education; practice education facilitators, and placement managers (titles vary by trust).

 

Aging with Down Syndrome and Intellectual Disability (ADSID) Research Database

ReDA ref. no.  AD1012/2

Chief Investigator:  Dr. Andre Strydom – 020 7679 9308 – a.strydom@ucl.ac.uk  

Local Point of Contact:  Dr. David Thomas

To establish a new research database (ADSID database), based on clinical information, consisting of anonymised clinical data of people with Down Syndrome or Intellectual Disabilities who have been assessed or screened for memory problems in the collaborating centres. All collaborating sites regularly screen or assess older adults with Intellectual disabilities for memory decline or dementia and will provide data on adults with Down Syndrome and/ or Intellectual Disabilities that have participated in these screens or assessments.

The study has the potential to benefit the care of adults with DS and dementia by helping clinicians and local areas to better predict the course of dementia and associated care needs e.g. when to consider nursing care. It will enable clinicians to advise carers more accurately about what to expect and how to respond to the development of particular symptoms. The study will also show the benefits and harms associated with acetylcholine esterase inhibitors in this population – this is a pertinent issue as it is unclear what the efficacy of these treatments are in this population.

 

Parents'/Carers' Hopes and Expectations for their Child's Psychotherapy Treatment (HETA)

R&D ref. no. S0908/3

Chief Investigator: Dr Cathy Urwin – 02089382568 - curwin@tavi-port.nhs.uk

Can a framework using parents/ carers' and child psychotherapists' hopes and expectations for what the child's psychotherapy treatment might achieve -the 'Hopes and Expectations for Treatment Approach' (HETA)- demonstrate change or relative change occurring in the child during and after child psychotherapy treatment?

Can HETA be successfully used in different settings where Child Psychotherapy is offered? Can HETA help develop understanding about the child psychotherapy process?  Can the HETA framework illuminate the impact of Child Psychotherapy on the family and how it is experienced by parents/carers? Can the HETA framework clarify relationships between the parents'/carers' work and the Child's Psychotherapy and develop our understanding about the processes of change set in motion in child psychotherapy?

 

Educational Projects

Emotional processing of virtual reality aggression

R&D ref. no. AD1108/4

Chief Investigator:  Dr. Stephen Butler – 020 7679 5985 – stephen.butler@ucl.ac.uk

Local point of contact: Dr Celia Taylor – 020  8510 2624 – Celia.Taylor@eastlondon.nhs.uk

This research investigates whether individuals with antisocial personality disorder (ASPD) relative to healthy volunteers, show greater activation of negative emotional states and confrontational behaviour when witnessing aggression escalate between two virtual characters in a virtual reality (VR) scenario. Negative emotional states will be measured across autonomic (electrocardiographs; ECG), motor activity (electromyograms; EMG) and self-report (questionnaires/interview) domains. Confrontational behaviour will be coded from participants’ video-recorded responses during VR. Another aim is to investigate whether negative emotional traits (via questionnaires) are related to confrontational behaviour in VR.

This research aims to contribute to an understanding of the role psychophysiological reactivity plays in aggression in ASPD. It may also highlight biological indicators of vulnerability which can be used to identify candidates for prevention programs and contribute to risk assessments in forensic services.

Participants will be male aged 1860. Healthy volunteers (n=20) will be recruited from University College London (UCL) and the wider London community. Participants with ASPD diagnoses (n=20) will be recruited from forensic inpatient (patients only deemed suitable to participate by their clinical team; possessing capacity to consent and with sufficient unescorted community leave agreed by the Ministry of Justice to partake), forensic outpatient and non-forensic community personality disorder NHS services.

 

Maternal Filicide: An Exploration from the Perspective of Mothers

R&D ref. no. A1105/3

Chief Investigator:  Gerrie Holloway – gerrie.holloway@awp.nhs.uk  

Local point of contact: Dr Mari Koskelainen – 020  8510 2127 – mari.koskelainen@eastlondon.nhs.uk

It is widely acknowledged that the killing of one's child is a relatively rare but under-researched event. Violence is rare in women in general but mothers are overrepresented as perpetrators of child deaths of all ages. In the case of filicide (the killing of one's child aged over 1 year) an association of mental disorder and mothers has been found. Socioeconomic and personal history factors have also been associated with filicide. The body of existing knowledge is limited, however, in the degree to which it can inform understanding of the conditions under which filicide occurs, which has implications for the identification, assessment and treatment of at risk mothers.

No studies have interviewed women themselves about the experience of filicide and this is true of studies of mentally ill mothers. Therefore little is known about the processes that lead mothers including those with mental illness to harm their children. This study represents an exploration into the development of filicidal behaviour in mentally ill women.  The exploration will seek to elucidate the pathway leading up to the act as narrated by women themselves.

This study aims to conduct 68, face-to-face interviews with mothers who had a diagnosable mental illness when perpetrating filicide, using Grounded Theory Method. The interviews will aim to gain in-depth and rich accounts from mothers who will have been identified from a range of forensic mental health services. The design includes a number of safeguards to participants to support their participation in the research. These include: the use of a service user panel to review research materials, the CI's professional qualification and expertise as Clinical Psychologist and a close relationship between the researcher and clinical teams who will act as gatekeepers and will be responsible for making decisions about participants' inclusion in the study based on their clinical assessment.

 

Psychological impact of inpatient admission upon South Asian families

R&D ref. no. E1005/4

Chief Investigator:  Rupa Kataria – r.kataria@surrey.ac.uk

Local point of contact: Dr Rachel Smith - 020 8510 2105 - Rachel.Smith@eastlondon.nhs.uk

The study is being carried out with South Asian families as very little is known about how families from this community experience their family member being sectioned and admitted into a medium secure forensic inpatient unit; the impact of this on the family, relationships with the family and in their community.  The information gathered will aid professionals understand how South Asian families experience the impact of a family member’s inpatient admission and how to best support them.

 

Does forgiveness influence trajectories of PTSD during treatment?

R&D ref. no. AD1108/3

Chief Investigator:  Dr. John King – 020 76791897 – john.king@ucl.ac.uk

Local point of contact: Dr. Sarah Heke – 020 3645 6928 – Sarah.Heke@eastlondon.nhs.uk

Research has demonstrated that shame, anger and guilt are important in the development and maintenance of Post Traumatic Stress Disorder (PTSD). Over the last decade much research and clinical interest has focused on the influence of shame on PTSD and the development of therapeutic techniques to reduce shame. Contrastingly, research into the influence of anger and guilt has been much neglected. One well-documented way of overcoming feelings of anger and guilt is through forgiveness. The current study will investigate the influence of forgiveness on anger and guilt in participants with PTSD, and will explore the effect of forgiveness on the trajectory of PTSD during the beginning of treatment. A prospective, longitudinal, correlation design will be used. Clients about to receive PTSD-focused psychological therapy from psychology services will be invited to take part in the study. Participants must be about to begin psychological therapy for PTSD, be aged between 18 and 65, and be fluent in English. Participants will be asked to complete a battery of questionnaires prior to beginning psychological therapy and again three months into therapy. The battery will assess levels of forgiveness, anger, guilt and PTSD, and will include some additional outcome measures. It is hypothesised that higher levels of forgiveness for others will be associated with lower levels of anger, whereas higher levels of forgiveness for themselves will be associated with lower levels of guilt. It is also expected that higher levels of forgiveness at the beginning of therapy will be associated with lower levels of PTSD severity three months into therapy. It is hoped that the findings will lead to the development of improved psychological therapy for clients experiencing anger and/or guilt related to PTSD.

 

Adolescent Inpatient Care Evaluation (AICE)

R&D ref. no. N0902/1

Chief Investigator: Miss Farah Khalid - 020 7977 4970 - fkhalid@cru.rcpsych.ac.uk

Local point of contact: Dr Rafik Refaat - 02075406789 - Rafik.Refaat@eastlondon.nhs.uk

To identify the prevalence of co morbid conduct disorder, callous and unemotional traits, aggressive behaviour (violent and non-violent) and victimisation amongst adolescent inpatients with psychosis

 

Exploring clients’ experiences of Dynamic Interpersonal Therapy

R&D ref. no. AD1111/1

Chief Investigator: Miss Venetia Leonidaki – 01376 574 900 - vleoni@essex.ac.uk 

Local point of contact: Dr. Neelam Dosanjh  - 020 8536 2161 - neelam.dosanjh@newhampct.nhs.uk

Background: Dynamic Interpersonal Therapy (DIT) is a recently developed manualised, brief, psychodynamic intervention for depression, which will be offered by the Improving Access to Psychological Therapies programme. DIT was developed from other evidence-based, brief psychodynamic interventions. DIT is a very new therapy and thus there has been hardly any research evaluating DIT. Therefore, there is the need for exploring clients’ individual experiences of DIT and their views about this new therapy. This need and its importance are discussed in the context of some major areas of research and theory in psychotherapy, especially in psychoanalytic psychotherapy. Aim: To explore clients’ experiences of DIT and the meaning they gave to these experiences. Methods: A qualitative design will be adopted, employing Interpretative Phenomenological Analysis (IPA). Semi-structured interviews will be used to collect data from service users who completed DIT for depression between three weeks and 12 months before the interview. Participants will be recruited from the Psychological Services in Newham. The transcripts will be analysed using IPA.

 

Schemas and cognitive distortions in mentally disordered sex offenders

R&D ref. no. PG1109/1

Chief Investigator: Rebecca Szlachcic – 07791 188 415 – rebecca.szlachcic.2009@live.rhul.ac.uk

Local point of contact: Dr Alison Christie – 020 8510 2189 – alison.christie@eastlondon.nhs.uk

The investigation and treatment of sexual offenders has typically focused upon cognitive distortions, defined as a belief system which supports sexual offending, including justifications, judgments and rationalisations (Abel et al, 1984). Schema theories of sexual offending suggest that maladaptive schemas may bias social information processing such that sexual offending may be more likely to occur, with cognitive distortions being a product of this process. However this theoretical link has yet to be tested out.

Similarly sexual offenders with mental illness have been relatively neglected within the research due to the unsupported assumption that their sexual offending occurs as a result of their illness. Further investigation of the mechanisms through which sexual offending may occur in this population has implications for the development of further treatment.

This study therefore aims to investigate the proposed link between an individual's underlying schemas and cognitive distortions in sexual offenders with severe mental illness.

 

Understanding Recovery in Psychosis using a Compassion Framework

R&D ref. no. A1104/1

Chief Investigator: Lisa Wood – 07869127291 – u0300355@uel.ac.uk

Local point of contact: Darren Baker – 020 8525111 - Darren.Baker@eastlondon.nhs.uk 

This study aims to explore the relationship between attachment, internal fears (shame and compassion), external fears (others as shamers, social safeness and stigma) and recovery from psychosis.  These factors outlined are key to a Compassion Focused Therapy (CT) framework and examining their relationship could provide evidence for the usefulness of the CFT approach in understanding people’s recovery from psychosis.  The CFT model has been illustrated to be a useful framework when applied to anxiety and depression but has not been examined for relevance to psychosis.

Recovery from psychosis is a relatively new concept as when psychosis was originally conceptualised it was considered a lifelong biological disorder (Kraepelin, 1919). Service user led research has highlighted that recovery is a process not an endpoint and incorporates a number of idiosyncratic experiences (Chadwick, 1997). A service user led study (Pitt et al. 2007) outlined that rebuilding self (increasing self-awareness and self-esteem), rebuilding life (developing social networks and relationships) and hope for a better future (challenging stigma) are all important aspects in recovery from psychosis.  Examining the service user literature suggests that a CFT framework would be relevant to those who experience psychosis as factors such as attachment, internal fears and external fears are extremely similar to the service user defined concepts.  Therefore, this study aims to examine the relationship between these factors.  This would therefore provide evidence for the potential usefulness of the CFT model in understanding recovery from psychosis.