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In 2021, there was a significant increase in the number of reported drink spiking incidents across the UK. The new phenomenon of spiking via injection also emerged, which gained significant media attention. Campaigns encouraged potential spiking victims to attend an ED for testing. However, there is limited published research on drink spiking and no published studies on injection spiking. One UK guideline for the management of spiking exists, advising testing ‘if clinically indicated’ and is likely underused. Therefore, patients are often managed without drug testing, psychological support or a clear onward referral pathway. This practice review will explore the background of spiking, discuss drug testing options and highlight the psychological sequelae of spiking. An example guideline for the management of spiking incidents is attached.

Psychological distress has been repeatedly quantified over the course of the pandemic, however this has not always included broader healthcare workers, and has mostly focused on prevalence and occupational factors. This study investigated intolerance of uncertainty (IOU), fear of contamination and perceived social support as key predictors of psychological distress in healthcare professionals, between the 10

BackgroundPatients with inflammatory rheumatic diseases (IRDs) face challenges including pain, fatigue and disease flares. Evidence suggests their levels of anxiety and depression are higher compared to the general population. Rheumatology teams report psychologically distressed patients have additional support needs and require more clinical time. Little is currently known about models of support and their integration into care pathways.AimTo understand rheumatology health professionals' perspectives on patients' psychological distress and ways to meet support needs.MethodsThe study used a qualitative design, with data collected in telephone semi-structured interviews. Inductive thematic analysis was used to analyse the data.ResultsFifteen interviews were conducted. Two main themes with sub-themes represent the data: Theme 1: ‘No one shoe fits all’—the many manifestations of distress in patients (sub-themes: recognising distress, dealing with distress, dealing with life events alongside an IRD) and Theme 2: ‘If rheumatology could be interwoven with psychological principles’—the need to attend to the psychological impact of IRDs, alongside the physical impact (sub-themes: priority given to physical health, working together to help patients in distress, how should patient distress be measured?, the need for extra time and resources).ConclusionDistress can be obvious or hidden, cause issues for patients and health professionals and lead to poor engagement with care provision. Health professionals described the powerful link between physical and mental distress. This study suggests psychological support provision should be embedded within the rheumatology team and that patients' emotional wellbeing should be given equal priority to their physical wellbeing.

This systematic literature review surveyed the evidence for the acceptability and effectiveness of CBT and psychologically based interventions for emergency department (ED) attenders with physical health complaints as their primary concern, in light of over-burdened EDs and the existing evidence base for psychological interventions in other medical settings. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018087860). A systematic search of three databases (APAPsychNet, Cochrane and PubMed) was performed to identify psychological treatment studies targeting physical health problems presenting in the ED, with broad inclusion criteria to capture a coherent understanding of the current knowledge base. A total of 2606 potential studies for inclusion were identified; 45 proceeded to full review. Twenty papers met the full inclusion. Included studies covered four clinical areas: trauma/PTSD-prevention, panic attacks, non-cardiac chest-pain and miscellaneous. A narrative description of findings reflected positive outcomes across all groups, but this was not consistent across any group. Few studies measured ED attendance (20%) or satisfaction/acceptability (10%). The majority of studies (90%) were underpinned by a cognitive behavioural framework, consistent with the current evidence base as applied to the management of medical conditions. Findings suggest there is some evidence that interventions in the ED are effective and acceptable to patients, but interpretation of findings is limited by the mixed quality of designs and risk of bias. Key learning aims (1) To understand the current body of evidence for the feasibility and effectiveness of psychological interventions in the emergency department. (2) To gain a clear understanding of the models and format of the delivery of CBT and psychological interventions in an acute setting. (3) To identify gaps in the evidence to inform future development of CBT-based interventions to improve outcomes and clinical care.

ObjectiveTo quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in the UK and Ireland.MethodsInitial cross-sectional electronic survey distributed during acceleration phase of the first pandemic wave of COVID-19 in the UK and Ireland (UK: 18 March 2020–26 March 2020 and Ireland: 25 March 2020–2 April 2020). Surveys were distributed via established specialty research networks, within a three-part longitudinal study. Participants were doctors working in emergency, anaesthetic and intensive medicine during the first pandemic wave of COVID-19 in acute hospitals across the UK and Ireland. Primary outcome measures were the General Health Questionnaire-12 (GHQ-12). Additional questions examined personal and professional characteristics, experiences of COVID-19 to date, risk to self and others and self-reported perceptions of health and well-being.Results5440 responses were obtained, 54.3% (n=2955) from emergency medicine and 36.9% (n=2005) from anaesthetics. All levels of doctor seniority were represented. For the primary outcome of GHQ-12 score, 44.2% (n=2405) of respondents scored >3, meeting the criteria for psychological distress. 57.3% (n=3045) had never previously provided clinical care during an infectious disease outbreak but over half of respondents felt somewhat prepared (48.6%, n=2653) or very prepared (7.6%, n=416) to provide clinical care to patients with COVID-19. However, 81.1% (n=4414) either agreed (31.1%, n=2709) or strongly agreed (31.1%, n=1705) that their personal health was at risk due to their clinical role.ConclusionsFindings indicate that during the acceleration phase of the COVID-19 pandemic, almost half of frontline doctors working in acute care reported psychological distress as measured by the GHQ-12. Findings from this study should inform strategies to optimise preparedness and explore modifiable factors associated with increased psychological distress in the short and long term.Trial registration numberISRCTN10666798.

In March 2020, individuals shielding from coronavirus reported high rates of distress. This study investigated whether fear of contamination (FoC) and use of government-recommended behaviours (GRB; e.g., handwashing and wearing masks) were associated with psychological distress during February 2021. An online cross-sectional questionnaire assessed psychological distress in three groups (shielding self, shielding other/s, and control), and those shielding others also completed an adapted measure of health anxiety (α = 0.94). The sample (N = 723) was predominantly female (84%) with a mean age of 41.72 (SD = 15.15). Those shielding (self) demonstrated significantly higher rates of health anxiety and FoC in comparison to other groups (p < 0.001). The use of GRB was significantly lower in controls (p < 0.001), with no significant difference between the two shielding groups (p = 0.753). Rates of anxiety were higher when compared to March 2020 findings, except for controls. Hierarchical regressions indicated FoC and GRB accounted for 24% of variance in generalised anxiety (p < 0.001) and 28% in health anxiety, however, the latter was a non-significant predictor in final models. Those shielding themselves and others during the pandemic have experienced sustained levels of distress; special consideration must be given to those indirectly affected. Psychological interventions should account for realistic FoC and the impact of government-recommended health behaviours, as these factors are associated with distress in vulnerable groups and may extend beyond the pandemic. Future research should focus on longitudinal designs to monitor and better understand the clinical needs of those shielding, and those shielding others post-pandemic.

Health-related fear is a normal and common response in the face of the global pandemic of COVID-19. Children and young people are frequently being exposed to messages about the threat to health, including from the media and authorities. Whilst for most, their anxiety will be proportionate to the threat, for some, existing pre-occupation with physical symptoms and illness will become more problematic. There is a growing body of evidence that health anxiety may occur in childhood, however much of the literature is taken from research using adult samples. This practitioner review aims to give an overview of the assessment and treatment of health-related worries in children and young people in the context of the COVID-19 pandemic. This review is based on the limited existing evidence in this population and the more substantial evidence base for treating health anxiety in adults. We consider the adaptations needed to ensure such interventions are developmentally appropriate.

Background/Aims Autoimmune rheumatic conditions are multisystem chronic disorders associated with increased psychological distress. Consequences include poor medication adherence and high levels of disease activity. Psychological interventions may reduce distress and change health behaviours. We aimed to determine the effectiveness of interventions for psychological distress in patients with autoimmune rheumatic conditions. Methods This was a systematic review of effectiveness which included randomised controlled trials of psychological interventions in adults with autoimmune rheumatic conditions. We searched MEDLINE, BNI, CINAHL, EMBASE, EMCARE, PsycINFO, NICE Evidence and The Cochrane Library. Two reviewers screened titles and abstracts and assessed the methodological quality of the included studies using Cochrane Risk of Bias 2 tool. Data were extracted by one reviewer and checked by a second. In each study, the effectiveness data were determined by extracting the reported means (and standard deviation) for each group and calculating the standardised mean differences using RevMan 5.4 software (The Cochrane Collaboration, 2020). The data on primary outcomes (anxiety and depression) are reported here. Results The search identified 96 studies. The process of screening and assessing for eligibility resulted in 20 studies for inclusion. Of these, one study had an overall low risk of bias and 19 had ‘some concerns’, mainly due to inadequate blinding and no information on pre-specified analysis plan. Only eight studies reported the effects on anxiety and 10 studies reported on depression. These studies included 919 patients in total. Most interventions were based on cognitive behavioural therapy and the context of delivery ranged from face-to-face individualised treatment to online group therapy. They often included education on topics such as stress and fatigue. Interventions often trained participants to develop skills in relaxation, problem-solving, and thought reframing. Goal setting and action planning were common to help participants make behaviour changes and apply their learning. Table 1 summarises disease group, type of intervention, comparator, outcome measure, and effects. Conclusion Conclusion: Most interventions were effective in reducing anxiety and depression in autoimmune rheumatic conditions. However, given the clinical heterogeneity and ‘some concerns’ about the included quality of studies, more work is needed to understand the mechanisms of the intervention effectiveness. Disclosure J. Hulley-Mills: None. C. Sliverthorne: None. B. Jones: None. J. Hooper: None. J. Robson: None. E. Dures: None. J. Daniels: None. M. Thompson: None. M. Ndosi: None.

Received 12th May 2021. Accepted 17th May 2021. Published online 28th May 2021. Issue published 1st August 2021.

To explore the prevalence of health anxiety in stroke survivors and its relative impact on quality of life. A cross-sectional design was used including between group comparisons of high and low health anxious stroke survivors. Stroke survivors (n = 105) were recruited via online stroke community forums. Participants completed measures of health anxiety (Short Health Anxiety Inventory), general anxiety and depression (Hospital and Anxiety and Depression Scale), disability (WHO Disability Assessment Schedule), and quality of life (Quality of Life Index). Demographics and medical histories were also assessed. Thirty percent of the sample scored above the clinical cut off for health anxiety. Stroke survivors with high health anxiety (HiHA) were found to have significantly lower quality of life (p < 0.001) and higher rates of depression (p < 0.001). Regression analysis found health anxiety to be a significant predictor of quality of life (β = –0.12; p < 0.05) in addition to levels of depression (β = –0.33; p < 0.001) and disability (β = –0.53; p < 0.001). Almost a third of stroke survivors were experiencing clinical levels of health anxiety, with HiHA significantly associated with lower quality of life. Future research should explore the use of existing evidence based psychological interventions for health anxiety in this population.Implications for rehabilitationOur findings suggest almost one in three stroke survivors residing in the community have clinical levels of health anxiety.High health anxiety in stroke survivors was significantly related to lower levels of quality of life.Given this finding, evidence-based treatments for health anxiety may improve quality of life and reduce distress for a significant proportion of stroke survivors.Rehabilitation approaches aimed at improving overall quality of life for stroke survivors should consider both physical and psychological interventions, with levels of physical disability, depression and anxiety all significantly associated with quality of life. Our findings suggest almost one in three stroke survivors residing in the community have clinical levels of health anxiety. High health anxiety in stroke survivors was significantly related to lower levels of quality of life. Given this finding, evidence-based treatments for health anxiety may improve quality of life and reduce distress for a significant proportion of stroke survivors. Rehabilitation approaches aimed at improving overall quality of life for stroke survivors should consider both physical and psychological interventions, with levels of physical disability, depression and anxiety all significantly associated with quality of life.

This study aimed to gain an uncensored insight into the most difficult aspects of working as a frontline doctor across successive COVID-19 pandemic waves. Data collected by the parent study (CERA) was analysed using conventional content analysis. Participants comprised frontline doctors who worked in emergency, anaesthetic, and intensive care medicine in the UK and Ireland during the COVID-19 pandemic (n = 1379). All seniority levels were represented, 42.8% of the sample were male, and 69.2% were white. Four themes were identified with nine respective categories (in parentheses): (1) I’m not a COVID hero, I’m COVID cannon fodder (exposed and unprotected, “a kick in the teeth”); (2) the relentlessness and pervasiveness of COVID (“no respite”, “shifting sands”); (3) the ugly truths of the frontline (“inhumane” care, complex team dynamics); (4) an overwhelmed system exacerbated by COVID (overstretched and under-resourced, constant changes and uncertainty, the added hinderance of infection control measures). Findings reflect the multifaceted challenges faced after successive pandemic waves; basic wellbeing needs continue to be neglected and the emotional impact is further pronounced. Steps are necessary to mitigate the repeated trauma exposure of frontline doctors as COVID-19 becomes endemic and health services attempt to recover with inevitable long-term sequelae.

This study aimed to develop empirically grounded recommendations and a coherent model of psychological care derived from the experiences and psychological care needs of COVID-19 frontline doctors, using semi-structured interviews and thematic analysis. Participants were UK frontline doctors specialising in Emergency Medicine, Anaesthetics, or Intensive Care (n = 31) purposively sampled for maximum variation on gender, specialty, ethnicity, and trauma-related distress, most worked in ICU during the pandemic (71%). Four themes were derived: (1) ‘coping strategies’, participants used many, including exercise, mindfulness, and “wait until it gets really bad”, (2) ‘sources of support’, participants valued embedded psychological support, digital services, and informal conversations with colleagues or family, though there was little opportunity, (3) ‘organisational influences on wellbeing’, participants reported a love–hate relationship for concepts like ‘wellbeing’, seen as important but insulting when basic workplace needs were unmet, (4) ‘improving engagement with support’, analysis suggests we must reduce physical and psychological barriers to access and encourage leaders to model psychologically supportive behaviours. Doctors’ frontline COVID-19 working experiences shine a ‘spotlight’ on pre-existing problems such as lack of physical resources and access to psychological care. Empirically grounded recommendations and a model of incremental psychological care are presented for use in clinical services.

The current pandemic wave of COVID-19 has resulted in significant uncertainty for the general public. Mental health and examining factors that may influence distress have been outlined as key research priorities to inform interventions. This research sought to examine whether intolerance of uncertainty and coping responses influence the degree of distress experienced by the U.K. general public during the COVID-19 pandemic. Using a cross-sectional online questionnaire design, participants were recruited (N = 842) using snowball sampling over a 10-day period in the early "lockdown" phase of the pandemic. Around a quarter of participants demonstrated significantly elevated anxiety and depression, with 14.8% reaching clinical cutoff for health anxiety. A one-way multivariate analysis of variance indicated those in "vulnerable" groups were significantly more anxious (p < .001), and also more anxious in relation to their health (p < .001). Mediation modeling demonstrated maladaptive coping responses partially mediated the predictive relationship between intolerance of uncertainty and psychological distress. Mental health difficulties have become significantly raised during the first wave of the COVID-19 pandemic in the United Kingdom, particularly for the vulnerable. Findings support emerging research suggesting the general public is struggling with uncertainty, more so than normal. Vulnerable groups are more anxious about their health, but not more intolerant of uncertainty than the nonvulnerable. Finally, this study indicated two modifiable factors that could act as treatment targets when adapting interventions for mental health during the COVID-19 global health crisis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of a multiple pandemic waves, longitudinal data on the impact of COVID-19 is vital to ensure an adequate psychological response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in Emergency Medicine (EM), Anaesthetics and Intensive Care Medicine (ICM) doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported. Methods: A prospective online three-part longitudinal survey of frontline doctors across the UK and Ireland, administered at the acceleration, peak and deceleration of the COVID-19 first wave. Primary outcome measures were psychological distress and trauma, measured using the General Health Questionnaire-12 and the Impact of Events-Revised. Findings: Acceleration survey response rate was 15.9% (n=5440), of an estimated 34,188 doctors. Peak and deceleration response rates were 71·6% (n=3896) and 56·6% (n=3079) respectively. Prevalence of psychological distress was 44·7% (n=1334) during the acceleration, 36·9% (n=1098) at peak and 31·5% (n=918) at the deceleration phase. The prevalence of trauma was 23·7% (n=647) at peak and 17·7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12·6% (n=343) at peak and 10·1% (n=276) at deceleration. Worry of family infection due to clinical work was most strongly associated with both distress (R2 = 0·06) and trauma (R2 =0·10). Interpretation: Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a)provision of vital equipment to mitigate physical and psychological harm (b)increased awareness and recognition of signs of psychological distress and (c)the development of clear pathways to effective psychological care. Funding: Funding received from the Royal College of Emergency Medicine. Declaration of Interests: Many of the authors have been working as frontline clinicians during the COVID-19 pandemic. They have no competing interests to declare. Ethics Approval Statement: Ethical approval was obtained from the University of Bath (UK) and Children’s Health Ethics Committee (Ireland). Regulatory approval was obtained from the Health Regulation Authority (UK), Health and Care Research Wales. Participants provided electronic informed consent for each survey.

Despite the known impact of a cancer diagnosis and related treatments on quality of life, and the complexity of patient journeys in low-resource settings, there has been little published research into the relevant issues faced by South African women living with breast cancer. In this study, we aimed to understand the experiences of breast cancer diagnosis and treatment among a sample of South African women who access primary health care. A convenience sample of 12 women between the ages of 48 and 66 years attending a primary health care facility took part in our study. Women undergoing breast cancer treatment were invited to take part in face-to-face interviews. The interviews were semi-structured and guided by an interview schedule. Interviews were analysed thematically using ATLAS.ti v 8 computer software. We identified three important themes that explained how women experience diagnosis and treatment, namely, (1) reactions to the diagnosis experience, (2) the importance of faith, and (3) the value in having a sense of agency. Women’s initial reaction to their cancer diagnosis was one of shock and disbelief. Despite these reactions, faith and agency played an important role in how women in this study made sense of their illness experience and how they coped. Our findings demonstrate that women’s experiences of breast cancer diagnosis and treatment were accompanied by some psychological distress for which they need support. Furthermore, supporting women to make positive choices about coping and valuing the role of religion when appropriate should form part of any therapeutic engagement, medical or otherwise.

Introduction: Pain accounts for the majority of attendances to the Emergency Department (ED), with insufficient alleviation of symptoms resulting in repeated attendance. People who frequently attend the ED are typically considered to be psychologically and socially vulnerable in addition to experiencing health difficulties. This service development study was commissioned to identify the defining characteristics and unmet needs of frequent attenders (FAs) in a UK acute district general hospital ED, with a view to developing strategies to meet the needs of this group. Methods: A mixed-methods multi-pronged exploratory approach was used, involving staff interviews, focus groups, business data and case note analysis. Results: Findings reflect an absence of a coherent approach to meeting the needs of FAs in the ED, especially those experiencing pain. FAs to this ED tend to be vulnerable, complex and report significant worry and anxiety. Elevated anxiety on the part of the patient may be contributing to a ‘better safe than sorry’ culture within the ED and is reported to bear some influence on the clinical decision-making process. Discussion: It is recommended that a systemic approach is taken to improve the quality and accessibility of individualised care plans, provision of patient education, psychological care and implementation of policies and procedures. Change on an organisational level is likely to improve working culture, staff satisfaction and staff relationships with this vulnerable group of patients. A structured care pathway and supportive changes are likely to lead to economic benefits. Further research should build on findings to implement and test the efficacy of these interventions.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition, characterised by unexplained and excessive fatigue, muscle pain and sleep disturbances. Health anxiety is common in ME/CFS and accurate measurement is essential in facilitating therapeutic gains. However, there are clinical concerns over the utility of the Short Health Anxiety Inventory (SHAI) in measuring health anxiety in this population. This study aims to use qualitative responses from two ex-service users and specialist health clinicians to explore the barriers to completing the SHAI within a specialist ME/CFS service. Qualitative responses from a focus group consisting of 15 specialist health professionals including occupational therapists, physiotherapists, dieticians, cognitive behavioural therapists, counsellors, clinical psychologists and assistant psychologists were transcribed and analysed for themes. Patient voices were represented by two former service users through individual semi-structured interviews on the telephone, which were recorded, transcribed and later analysed thematically. Clinicians and service user involvement agreed on core difficulties with the utility of the SHAI in the ME/CFS population. The timing of the SHAI being administered pre-diagnosis, the language of the SHAI and lack of context around the questionnaire were identified as barriers that were likely to contribute to the SHAI not being completed by service users. Sensitive and accurate measurement is required in order to retain patient engagement, which could further facilitate appropriate assessment and treatment of health anxiety and ME/CFS. Findings suggest that adaption of the SHAI is vital for use with ME/CFS. Key learning aims (1) To understand the different barriers to completing the SHAI in a ME/CFS service. (2) To understand the implications of administering the SHAI to ME/CFS service users. (3) To learn from multi-disciplinary ME/CFS health professionals about perceived difficulties in administering the SHAI.

Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative. Key learning aims (1) To explore whether gCBT and individual CBT yield significant symptom reduction in self-reported anxiety and depression in GAD patients from a routine IAPT service. (2) To explore gCBT and individual CBT clinical recovery rates in non-optimum routine conditions. (3) To explore whether gCBT for GAD produces unacceptable attrition rates and if this differs from attrition rates in individual CBT for GAD in a routine IAPT service.

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a debilitating condition that affects 0.2-0.4% of the population. Health focussed anxiety is common across medical conditions, and may be relevant in CFS/ME. This study sought to identify the prevalence and impact of health anxiety (HA) in CFS/ME and evaluate the effectiveness of Cognitive Behavioural Therapy for HA in CFS/ME. Cross-sectional questionnaire methods and case-series design were used to achieve study aims. Analysis indicated that 41.9% of the CFS/ME clinic sample experienced threshold levels of health anxiety, which was associated with elevated symptom severity across several dimensions. Stepwise multiple regression indicated physical functioning and depression accounted for 23.8% of variance in fatigue; depression, fatigue and HA, accounted for 32.9% of variance in physical functioning. Large effect sizes and clinically significant changes were generated in the treatment study. HA is common in CFS/ME and likely to exacerbate fatigue and physical functioning. This study identifies HA as an important target for treatment, trial findings should be further replicated on a larger scale.El Síndrome de Fatiga Crónica/Encefalomielitis Miálgica (SFC/EM) es una enfermedad que afecta al 0,2-0.4% de la población. La ansiedad por la salud (AS) es común en condiciones médicas y puede ser relevante en el SFC/EM. El objetivo de este estudio fue identificar la prevalencia e impacto de la AS en el SFC/EM y evaluar la efectividad de la terapia cognitivo conductual para tratar la AS en el SFC/EM. Se utilizaron cuestionarios en base a un diseño transversal y de estudio de casos. El 41.9% de la muestra clínica de SFC/EM experimentó niveles umbrales de HA, lo que se asoció a una mayor gravedad de algunos síntomas. Modelos de regresión lineal múltiple indicaron que el funcionamiento físico y la depresión representaron el 23.8% de la varianza en la fatiga; la depresión, la fatiga y la AS representaron el 32.9% de la varianza en el funcionamiento físico. Se identificaron grandes tamaños de efecto y cambios clínicamente significativos por el tratamiento. Lla AS es común en el SFC/EM y podría empeorar la fatiga y el funcionamiento físico. Este estudio identifica la HA como factor importante para el tratamiento del SFC/ME. Los resultados deberían replicarse a mayor escala.

Objectives Chronic Fatigue Syndrome (CFS) is a debilitating condition that affects 0.2–0.4% of the population. First-line treatments are Cognitive Behaviour Therapy or graded exercise therapy; however, these treatments yield only moderate effect sizes. Emerging research suggests that anxiety about health may be common in CFS. Health anxiety treatment models demonstrate good therapeutic outcomes; however, these models have yet to be applied to CFS. This paper describes the application of a novel cognitive behavioural approach to the treatment of both physical and anxiety related symptoms in a patient with CFS and, furthermore, presents a conceptual hypothesis regarding the mutually maintaining relationship between these two co-occurring conditions. Design A single-case design was used, with pre-data, post-data and follow-up data. The cognitive behavioural model of health anxiety was adapted and delivered as an eight-session intervention. The intervention was driven by an individualized formulation developed collaboratively with the patient. Results The application of this approach generated reliable and clinically significant reductions in physical and psychological symptoms, which were maintained at 12-month follow-up. The participant no longer fulfilled the criteria for CFS or health anxiety following eight treatment sessions. The treatment approach was found to be agreeable to the patient. All treatment hypotheses were supported. Conclusions An adapted cognitive behavioural approach to treating CFS and health anxiety yields positive results and shows promise for application to the broader CFS population. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Messages Chronic Fatigue Syndrome (CFS) is a debilitating condition that is difficult to treat successfully; first-line recommended treatments achieve only moderate effect sizes. Anxiety, particularly about health, is reported to be common in CFS. However, anxiety is not specifically targeted within treatment and may negatively influence outcome due to the potentially mutually maintaining nature of these complex conditions. The present study demonstrates that an integrated treatment approach designed to encompass physical and psychological symptoms yields reliable and clinically significant outcomes in 50% of time recommend for first line treatments. Results reflected non-case level status for both CFS and health anxiety at end of treatment, in addition to reductions across all clinical measures. This study demonstrates the fundamental importance of an individualized, rather than generic, treatment approach to complex cases; the ‘meaning’ of experience is a central tenet within a cognitive approach that should be reflected in treatment.

ObjectivesRaynaud’s phenomenon (RP) is a significant cause of morbidity. Vasodilator medications cause unwanted adverse effects, with behavioural and lifestyle changes forming the mainstay of self-management; this is difficult to implement successfully. The objectives of this study were to evaluate the efficacy of behaviour change interventions for RP and identify learning points for future treatment development.DesignSystematic literature review and narrative synthesis of findings.Data sourcesEMBASE, MEDLINE, Cochrane and PsycINFO were searched for eligible studies on 22 August 2017.Eligibility criteriaRandomised controlled trials (RCTs) of behaviour change interventions with at least one control comparator arm.Data extraction and synthesisStudy selection, data extraction and risk of bias were assessed independently by two reviewers, reaching consensus with a third when necessary. Primary outcomes of interest included severity/impact, frequency and duration of RP episodes, pain, disability, adverse events and study withdrawal.ResultsOf 638 articles retrieved, eight studies fulfilled criteria for inclusion. Biofeedback was the active behaviour change treatment arm for seven studies, with one study reporting a behavioural intervention. Studies were published 1978–2002; six were USA-based studies, one German and one Swedish. Using Cochrane Risk of Bias assessment, studies were assessed to be overall at high risk of bias, with the exception of one large RCT. The total sample included 495 participants (study median=29), with a median age of 39.5 years and preponderance towards females (73%). Five studies reported significant effects in primary outcomes of interest; however, due to missing data, relative efficacy of interventions could not be reliably assessed.ConclusionsThere is no evidence to support or refute claims of the efficacy of behaviour change interventions for the management of RP. There remains a strong case for developing and testing behaviour change interventions that focus on self-management; however, theoretical development and advancement in trial quality is imperative to underpin future work.PROSPERO registration numberCRD42017049643.

The importance of training non-psychology healthcare professionals to offer psychological support to people with cancer is becoming increasingly recognized. This small-scale pilot project sought to identify the training and support needs of oncology staff and to evaluate the effectiveness of a Level 2 Psychological Support Training Program workshop. Semi-structured interviews with five members of multidisciplinary oncology staff identified that training needs were primarily around communication skills, recognizing and dealing with emotions, offering support and empathy, and self-care. Pre and post-training questionnaires developed with these themes in mind revealed that the Level 2 Training Program workshops run in this network of hospitals are effective in increasing participants' levels of perceived knowledge and confidence across each of these domains. Recommendations are made for further enhancing this effectiveness.

IntroductionRaynaud's phenomenon (RP) describes excessive peripheral vasospasm to cold exposure and/or emotional stress. RP episodes are associated with digital colour changes, pain and reduced quality of life. Pharmacological interventions are of low to moderate efficacy and often result in adverse effects such as facial flushing and headaches. Recommended lifestyle and behavioural interventions have not been evaluated. The objectives of the proposed systematic review are to assess the comparative safety and efficacy of behaviour change interventions for RP and identify what we can learn to inform future interventions.Methods and analysisStudies eligible for inclusion include randomised controlled trials testing behaviour change interventions with a control comparator. A comprehensive search strategy will include peer review and grey literature up until 30 April 2017. Search databases will include Medline, Embase, PsychINFO and Cochrane. Initial sifting, eligibility, data extraction, risk of bias and quality assessment will be subject to review by two independent reviewers with a third reviewer resolving discrepancies. Risk of bias assessment will be performed using Cochrane risk of a bias assessment tool with quality of evidence assessed using Grading of Recommendations Assessment, Development and Evaluation(GRADE). A meta-analysis will be performed if there are sufficient data. Two subgroup analyses are planned: primary versus secondary RP outcomes; comparison of theoretically informed interventions with pragmatic interventions.Ethics and disseminationThis review does not require ethical approval as it will summarise published studies with non-identifiable data. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Findings will be disseminated in peer-reviewed articles and reported according to PRISMA. This review will make a significant contribution to the management of RP where no review of behaviour-change interventions currently exist. The synopsis and protocol for the proposed systematic review is registered in the International Prospective Register of Systematic Reviews (registration number CRD42017049643).

Objectives: Addison's Disease is a rare chronic illness caused by adrenocortical insufficiency, commonly treated with synthetic hormones. Due to the pivotal role of the regulating hormone cortisol in Addison’s Disease, there is a common symptom overlap between the presentation of anxiety and adrenal crisis. Previous literature has identified the prevalence of anxiety and depression in endocrinological disorders, however there is a paucity of research examining the complex interplay between Addison’s Disease and anxiety. This paper describes a single case treatment of a patient with severe health anxiety and co-morbid Addison’s Disease who frequently attended and were admitted to the Emergency Department. The aims of the study were to establish if standard cognitive behavioural therapy for health anxiety in Addison’s Disease can lead to a reduction in psychological distress, and whether this approach is an effective intervention for the reduction of Emergency Department admissions. Method: A single case design was used, with pre and post measures of health anxiety, general anxiety and depression. Data on Emergency Department admissions prior to and following treatment were used to assess change in this domain. Results: Reliable and clinically significant reductions were seen across all measures, from severe to sub-clinical levels. There was a complete amelioration of Emergency Department admissions in the 12 months following completion of treatment.Conclusions: This preliminary study provides a sound rationale for further research into Addison’s Disease complicated by anxiety. Findings support the clinical utility of the cognitive behavioural therapy model for complex presentations of Addison’s Disease, offering a potential treatment option where anxiety is elevated and interfering with self-management and leading to high levels of health service use.

Summary\ud Consideration of psychological distress in long term endocrine conditions is of vital importance given the prevalence of anxiety and depression in such disorders. Poor mental health can lead to compromised self-care, higher utilisation of health services, lower rates of adherence, reduced quality of life and ultimately poorer outcomes. Adjuvant psychological therapy offers an effective resource to reduce distress in endocrinological disorders. While the vast majority of work in this area has focused on psychological screening and intervention in diabetes, identification and recognition of psychological distress is equally important in other endocrinological conditions, with supportive evidence in Polycystic Ovary Syndrome and Addison’s disease. Referral pathways and recommendations set out by UK guidelines and the Department of Health mandate requires greater attention across a wider range of long term endocrine disorders to facilitate improved quality of life and health outcome

Recurrent abdominal pain accounts for a significant proportion of attenders and high impact users in the emergency department. Due to the heterogeneity of presentation and the broad spectrum of possible causes, abdominal pain presents as a significant clinical challenge within the emergency department, particularly as distress and pain are commonly elevated. Patients in this group are routinely prescribed opiate-based interventions and repeated investigations in a ‘better safe than sorry’ culture which saturates the field of persistent physical symptoms. This approach is contributing to the growing problem, and fuelling a cycle of repeated attendance and failure to resolve. This article reviews the current clinical and psychophysiological understanding of recurrent abdominal pain, critiquing guidelines and approaches to diagnosis and management. We offer an alternative evidence-based biopsychosocial approach using the mnemonic ‘ERROR’, recommending five steps to assessment and clinical management of recurrent abdominal pain in the emergency department.

Objectives There is a lack of research examining the incidence of health anxiety in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), despite this being an important research area with potentially significant clinical implications. This preliminary study aimed to determine the incidence of anxiety and depression, more specifically health anxiety, in a sample of CFS/ME patients over a 3-month period. Design The research was a cross-sectional questionnaire-based study, using a consecutive sample of patients who were assessed in a CFS/ME service. Method Data were taken from the Short Health Anxiety Inventory and the Hospital Anxiety and Depression Scale to identify incidence of anxiety, depression, and health anxiety. Results Data were collected from 45 CFS/ME patients over the sampling period. Thirty-one patients (68.9%) scored above the normal range but within the subclinical range of health anxiety, and 19 patients (42.2%) scored within the clinically significant health anxiety range. Anxiety and depression were common, with prevalence rates of 42.2% and 33.3% respectively, which is comparable to data found in a recent large-scale trial. Conclusions Health anxiety in CFS/ME patients is likely to be common and warrants further investigation to provide a better insight into how this may influence treatment and symptom management. Practitioner points Anxiety and depression were common in a sample of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) patients, with a high proportion meeting criteria for severe health anxiety. While CFS/ME and health anxiety are distinct and separate conditions, it is unsurprising that patients with CFS/ME, who commonly report feeling ‘delegitimized’, may experience high levels of anxiety relating to their physical symptoms. Clinicians should consider screening for health anxiety due to the possible clinical implications for treatment; mutual maintenance may negatively influence treatment success in a complex condition such as CFS/ME. Health anxiety has been found to be common across other chronic medical conditions but has been shown to be effectively treated with appropriately tailored interventions.

Purpose Hospitalization can be stressful for patients and their families. Pre-hospitalization information is crucial in establishing a good basis for patient satisfaction. In order to develop better preparatory material for parents, this qualitative study explored whether parents of children with cystic fibrosis, admitted to a UK Children's Hospital, felt adequately prepared for their child's admission. Design and Methods Data were collected from twelve parents whose children had been admitted within the last two years for routine intravenous antibiotics. Semi-structured interviews were analyzed using thematic analysis. Results Four themes emerged from the analysis: (1) preparing for admission, (2) the ward as a challenging environment, (3) changes in the parent-professional relationship and (4) the parental role in medical care. Conclusion Provision of adequate preparatory information is essential in reducing parental stress, influencing how future experiences are appraised and managed. Effective parent-professional communication and opportunities to participate in care are likely to improve parental satisfaction. Practice Implications Preparatory information prior to hospital admission greatly assists parents in making informed decisions and working as joint advocates in their child's inpatient care.

Chronic Fatigue Syndrome (CFS) is a debilitating condition that affects 0.2-0.4% of the population. First-line treatments are Cognitive Behaviour Therapy or graded exercise therapy; however, these treatments yield only moderate effect sizes. Emerging research suggests that anxiety about health may be common in CFS. Health anxiety treatment models demonstrate good therapeutic outcomes; however, these models have yet to be applied to CFS. This paper describes the application of a novel cognitive behavioural approach to the treatment of both physical and anxiety related symptoms in a patient with CFS and, furthermore, presents a conceptual hypothesis regarding the mutually maintaining relationship between these two co-occurring conditions.A single-case design was used, with pre-data, post-data and follow-up data. The cognitive behavioural model of health anxiety was adapted and delivered as an eight-session intervention. The intervention was driven by an individualized formulation developed collaboratively with the patient.The application of this approach generated reliable and clinically significant reductions in physical and psychological symptoms, which were maintained at 12-month follow-up. The participant no longer fulfilled the criteria for CFS or health anxiety following eight treatment sessions. The treatment approach was found to be agreeable to the patient. All treatment hypotheses were supported.An adapted cognitive behavioural approach to treating CFS and health anxiety yields positive results and shows promise for application to the broader CFS population. Copyright © 2016 John WileySons, Ltd.Chronic Fatigue Syndrome (CFS) is a debilitating condition that is difficult to treat successfully; first-line recommended treatments achieve only moderate effect sizes. Anxiety, particularly about health, is reported to be common in CFS. However, anxiety is not specifically targeted within treatment and may negatively influence outcome due to the potentially mutually maintaining nature of these complex conditions. The present study demonstrates that an integrated treatment approach designed to encompass physical and psychological symptoms yields reliable and clinically significant outcomes in 50% of time recommend for first line treatments. Results reflected non-case level status for both CFS and health anxiety at end of treatment, in addition to reductions across all clinical measures. This study demonstrates the fundamental importance of an individualized, rather than generic, treatment approach to complex cases; the 'meaning' of experience is a central tenet within a cognitive approach that should be reflected in treatment.

In response to reported schizophrenia linkage findings on chromosomes 3, 6 and 8, fourteen research groups genotyped 14 microsatellite markers in an unbiased, collaborative (New) sample of 403-567 informative pedigrees per marker, and in the Original sample which produced each finding (the Johns Hopkins University sample of 46-52 informative pedigrees for chromosomes 3 and 8, and the Medical College of Virginia sample of 156-191 informative pedigrees for chromosome 6). Primary planned analyses (New sample) were two-point heterogeneity lod score (lod2) tests (dominant and recessive affected-only models), and multipoint affected sibling pair (ASP) analysis, with a narrow diagnostic model (DSM-IIIR schizophrenia and schizoaffective disorders). Regions with positive results were also analyzed in the Original and Combined samples. There was no evidence for linkage on chromosome 3. For chromosome 6, ASP maximum lod scores (MLS) were 2.19 (New sample, nominal p = 0.001) and 2.68 (Combined sample, p = .0004). For chromosome 8, maximum lod2 scores (tests of linkage with heterogeneity) were 2.22 (New sample, p = .0014) and 3.06 (Combined sample, p = .00018). Results are interpreted as inconclusive but suggestive of linkage in the latter two regions. We discuss possible reasons for failing to achieve a conclusive result in this large sample. Design issues and limitations of this type of collaborative study are discussed, and it is concluded that multicenter follow-up linkage studies of complex disorders can help to direct research efforts toward promising regions.

Background: Therapeutic alliance has been found to be a significant predictor of outcome in psychotherapy yet what constitutes therapeutic alliance remains unclear. Examining the common constructs of therapeutic alliance, it is possible that there may be a conceptual overlap between active components of therapeutic alliance and socialization to the treatment model. Aim: To investigate the relationship between socialization to the model and therapeutic alliance. Method: Participants (N = 43) were taken from the active treatment arm in a RCT for the treatment of chronic fatigue syndrome (CFS/ME). Therapeutic alliance was measured using a 5-item questionnaire (brief CALPAS) and socialization to the model was extracted from therapy tapes using a novel coding system. Results: Key findings were that when patients and therapists agreed about goals of treatment, there were higher levels of concordance, less evidence of applying principles incongruent to the model, and less resistance during the treatment sessions. Conclusions: The outcome of this preliminary study contributes to the potential understanding of active components in the therapeutic alliance, and supports further research to achieve a more detailed picture of “non-specific” factors in therapy, including the active process of socialization in therapeutic alliance.

We have recently described a family in which there is cosegregation of major affective disorder with Darier's disease and have mapped this autosomal dominant skin disorder to 12q23-q24.1. This has provided an interesting candidate region for genetic studies of bipolar disorder. We have studied the segregation of seven markers spanning the Darier's disease locus in 45 bipolar disorder pedigrees and found modest evidence in support of linkage under heterogeneity for 5 of these markers. Nonparametric analyses were suggestive of linkage with a marker at the gene encoding a secretory form of phospholipase A2. Our sample has relatively low power to detect linkage under heterogeneity and independent researchers should examine markers from this region in further samples of bipolar pedigrees.

Over the last 20 years several pedigrees have been reported which are suggestive of linkage between susceptibility to bipolar disorder and markers on chromosome Xq28. Other workers have failed to replicate these reports and the methodology of the positive reports has been criticised. Recently there have been several reports of an association between fragile X (FRA(X)) and affective disorder within families and in unrelated individuals compared with controls. Such reports could be consistent with the Xq28 marker reports because FRA(X) maps to Xq27.3. We report a study at the FRA(X) CGG repeat locus in 79 unrelated Caucasian bipolar probands without fragile X syndrome and 77 unrelated controls. We found no evidence that variation at this locus confers susceptibility to bipolar disorder.

Darier's disease is a rare autosomal dominant skin disorder in which there is abnormal adhesion between keratinocytes. It appears to be associated with an increased prevalence of neuropsychiatric disorders including mental retardation and epilepsy. In addition we have previously reported a family in which major affective disorder cosegregates with Darier's disease. In the present study we have localized the gene for Darier's disease to chromosome 12q23-q24.1 by linkage analysis in five British pedigrees. We obtained a maximum two point lod score of 4.29 with marker D12S84 at zero recombination fraction. All five families showed evidence of linkage between the disease gene and markers in this region. Subsequent identification of the Darier's disease gene will provide insights into normal mechanisms of cell adhesion and may be of importance in the genetic investigation of neuropsychiatric disorders as well as elucidating the pathogenesis of Darier's disease itself.