The Impact of Engagement Processes on the First Appointment Attendance Rate at a Regional Outpatient Psychological Trauma Service.

The effectiveness of simple measures to increase attendance at first appointments is briefly reviewed. The Family Trauma Centre’s remit and pre-study engagement process are described. The perceived idiosyncratic aspects of inviting people suffering from psychological trauma to attend a clinical service are noted as contributory factors in initially tolerating a high first appointment DNA rate. Three new initial engagement processes are then described and results of their application to 30 referrals in total are presented. The overwhelming finding is that paying close attention to any of the three initial engagement processes significantly increases first appointment attendance. Based on these findings the Centre developed a new initial engagement protocol.. The principle that services should pay more attention to their engagement processes than on the characteristics of their client groups when seeking to reduce first appointment DNA rates is supported.

School Refusal, Parental Control and Wider Systems: Lessons from the management of two cases. Journal of Psychological Medicine, .

Two cases of school refusal are presented. From the experience of these two cases, and support from the literature, early assessment of parental control in cases of school refusal is advocated. When parental control, even with professional therapeutic support, is not sufficient to effect an early return to school, intervention in the wider systems organised around the problem is recommended.

A Multiple Indicators Multiple Causes (MIMIC) model of Behavioural and Psychological Symptoms in Dementia (BPSD)

Introduction: Although there is evidence for distinct behavioural sub-phenotypes in Alzheimer's disease (AD), their inter-relationships and the effect of clinical variables on their expression have been little investigated.

Dealing with post-traumatic stress disorder: The psychological sequelae of bloody Sunday and the response of state services

Objective: This article describes the political context of health and social care services in Northern Ireland at a the of intense social conflict. Method: Concepts from post-traumatic stress disorder (PTSD) and other relevant international psychological literature are then used to study the experience of the Bloody Sunday families, victims of a traumatic event that happened in Derry in January 1972. Results: High levels of psychological morbidity within this population are reported, alongside some evidence that families had not received services that may have helped resolve the trauma. Conclusions: The authors noted that new services planned as a result of the current peace process may offer social workers and other professionals new ways to address the unmet needs of people traumatized by the Troubles.

The psychological effects of organizational restructuring on nurses

This paper reports a comparison of nurses affected by the restructuring associated with healthcare organization mergers (1998-2000) in the United Kingdom and those of non-affected nurses in the UK.

Psychological and social profile of family caregivers upon commencement of palliative care provision

Context
Palliative care services are required to support patients who have advanced, life-threatening, noncurable disease, and their family caregivers. Comprehensive psychological and social support for bereaved family members also is expected. However, recent systematic reviews have demonstrated significant gaps in evidence-based approaches for such support. Furthermore, a comprehensive understanding of the psychological and social response to the family caregiver role is required for support to be optimized.

Objectives
We sought to examine the psychological and social profile of family caregivers on commencement of receiving palliative care services.

Methods
A self-report questionnaire was administered to primary family caregivers of patients within two weeks of admission to three palliative care services in Melbourne, Australia. The questionnaire incorporated six instruments that measured 11 family caregiver-related psychosocial factors; four instruments that measured caregiver psychological distress factors; 14 mental health lifetime risk factors; and a sociodemographic questionnaire.

Results
Three hundred and two family caregivers participated. Nearly half (44%) of the caregivers had a probable anxiety and/or depressive disorder, with 40% scoring more than the cutoff score for probable anxiety and 20% scoring more than the cutoff score for probable depression. Additionally, approximately 15% of caregivers met the criteria for pre-loss grief, and around 10% reported moderate to severe levels of demoralization. Caregivers who had a probable anxiety and/or depressive disorder also reported higher levels of pre-loss grief.

Conclusion
This study provides further evidence of the prevalence of poor psychosocial well-being in this population. The results reinforce the need to develop suitable strategies for psychological and social support for family caregivers.

A Community Study of the Psychological Effects of the Omagh Car Bomb on Adults

Background: The main aims of the study were to assess psychological morbidity among adults nine months after a car bomb explosion in the town of Omagh, Northern Ireland and to identify predictors of chronic posttraumatic stress disorder symptoms.

Method: A questionnaire was sent to all adults in households in The Omagh District Council area. The questionnaire comprised established predictors of PTSD (such as pre-trauma personal characteristics, type of exposure, initial emotional response and long-term adverse physical or financial problems), predictors derived from the Ehlers and Clark (2000) cognitive model, a measure of PTSD symptoms and the General Health Questionnaire.

Results: Among respondents (n = 3131) the highest rates of PTSD symptoms and probable casesness (58.5%) were observed among people who were present in the street when the bomb exploded but elevated rates were also observed in people who subsequently attended the scene (21.8% probable caseness) and among people for whom someone close died (11.9%). People with a near miss (left the scene before the explosion) did not show elevated rates. Exposure to the bombing increased PTSD symptoms to a greater extent than general psychiatric symptoms. Previously established predictors accounted for 42% of the variance in PTSD symptoms among people directly exposed to the bombing. Predictors derived from the cognitive model accounted for 63%.

Conclusions: High rates of chronic PTSD were observed in individuals exposed to the bombing. Psychological variables that are in principle amenable to treatment were the best predictors of PTSD symptoms. Teams planning treatment interventions for victims of future bombings and other traumas may wish to take these results into account.