Centre for Psychiatry Newsletter

Centre for Psychiatry

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Latest News in Environmental, Cultural and Health Systems Research

Psychodermatology Clinic at the Royal London

Psychological wellbeing and quality of life of patients with head and neck cancer

Chronic stress and appearance concerns in facial surgery patients

Newsletter Summer 2012

Group music therapy for patients with persistent PTSD Issue 3

www.wolfson.qmul.ac.uk/psychiatry

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NEWSLETTER SUMMER 2012

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From the Editor and Centre Lead’s desk Stephen Stansfeld

Welcome to the summer edition of the Centre for Psychiatry Newsletter The Centre for Psychiatry continues to thrive despite the adverse weather both meteorological and economic.

This summer the focus of the world is on East London for the London 2012 Olympic Games.

East London is our home patch where we do a lot of our research in collaboration with the East London NHS Foundation Trust and where we try to apply the findings from our research to the local population. Because of the diversity of the population many of our studies in East London have relevance to a much wider area of the world represented in the multi-cultural mix of East London. We have celebrated the Olympics in two ways. First, in March Kam Bhui chaired the World Association of Cultural Psychiatry conference at Queen Mary on the theme of culture, young people and sport.

Secondly, in collaboration with the Department of Geography at Queen Mary, we have developed the ORiEL Study (Olympic Regeneration in East London) that is examining the impact of the massive regeneration in Newham surrounding the Olympics on young people’s wellbeing and physical activity and that of their CENTRE FOR PSYCHIATRY

parents. In the first wave of this study, funded by NIHR, we have collected questionnaire data on 3,104 young people from 25 East London schools. We plan to follow them up a year after our original data collection and then once again after that. This is the largest health study of young people involved in the London Games.

East London has a long tradition of social research typified by Michael Young and his work in the Institute of Community Studies, now the Young Foundation. That sociological tradition has been continued within our Centre by Dr Vicky Cattell, whose book, ‘Poverty, Community & Health: Co-operation and the Good Society’ was published by Palgrave MacMillan last December.

This study of poor housing estates, residents, social networks and their health draws from sociology, social policy, politics and epidemiology.

The focus on social influences on health and identifying possible routes for intervention to prevent ill-health is an important theme within our Centre. Increasingly, in times of reduced funding for the health service and increasing

NEWSLETTER SUMMER 2012

longevity there is more focus on prevention of illness and disability.

In common with the other Centres in the Wolfson Institute of Preventive Medicine we want to identify risk factors for illness and then examine the efficacy and effectiveness of preventive interventions.

These may include identifying and refining the knowledge on risk factors for depression, designing interventions to improve the health of employees in the workplace, or understanding the origins of violent behaviour in those people with existing mental illness and in the general population.

One important aspect of preventive medicine is the prevention of disability in those with existing disease. In this issue Ruth Taylor eloquently describes the sensitive way in which she approaches the psychological aspects of skin disease in her joint dermatology clinic with Tony Bewley. She describes how psychological problems can increase the degree of disability and stigma associated with skin disease and that a joint clinic approaching the problem, both physically and psychologically, is a way to understand and treat these difficult disorders. This is an excellent example of how,

as Peter White has shown in his recent BMJ article, throughout medicine, the dualism between psychological and physical illness is unhelpful and that many especially chronic conditions are best dealt with by a joint approach from both physicians and psychiatrists. This is again illustrated by the articles by two of our PhD students Emmylou Rahtz and Farah Shiraz who are studying the psychological aspects of physical disease and disability surrounding the outcomes for facial surgery patients. These important projects, funded by Saving Faces, will identify the often ignored emotional needs of patients going through these very traumatic experiences.

A focus by Farah Shiraz on social support from partners and family shows the importance of social influences on successful recovery from illness and disability.

There are many therapies within Psychiatry whose effectiveness are taken for granted and thought of as generally being ‘a good thing’. One of these is Music Therapy. Catherine Carr’s fascinating study evaluating the use of group music therapy for patients with Post Traumatic Stress Disorder is an important example of this. Such therapies need to be examined and the results will have implications for the treatment of many other disorders.

I wish you a happy summer and an enjoyable Olympics. If you would like to contribute anything to our newsletter please contact Jane Archer (j.archer@qmul. ac.uk).

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CONTENTS 4

Psychodermatology Clinic at the Royal London

by Ruth Taylor

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Group music therapy for patients with persistent PTSD

by Catherine Carr

11

Chronic Stress and appearance concerns in facial surgery patients

by Emmylou Rahtz

12

Psychological wellbeing and quality of life of patients with head and neck cancer; the influence of partner distress on patient outcome

by Farah Shiraz

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Postgraduate network, Ian Forristal

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William Harvey Day – Call for Abstracts

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Upcoming events

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Selected Publications CENTRE FOR PSYCHIATRY

NEWSLETTER SUMMER 2012

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Psychodermatology Clinic at the Royal London Dr Ruth Taylor

Senior Lecturer and Honorary Consultant in Liaison Psychiatry

Introduction

The psychodermatology clinic at the Royal London was set up in 2002 by Dr Ruth Taylor and Dr Tony Bewley, consultant dermatologist. All patients are seen jointly by both a dermatologist and a psychiatrist. We think this is the optimal model for provision of a psychodermatology service as many of the patients referred would decline to attend a purely psychiatry clinic. We believe that the successful engagement of the patient is the key to managing challenging psychodermatological conditions. We have developed an expertise in seeing these patients and have published a number of case reports and case series reporting our experience with these patients1-5. Many have disorders which are challenging to study and there is a paucity of good evidence for the treatment of many such conditions.

What is psychodermatology?

Psychodermatology or psychocutaneous medicine refers to the interface between psychiatry and dermatology. Psychodermatologic conditions which involve an interaction and crossover between the mind and the skin can be classified into three main categories.

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Psychodermatologic practice: Some important points.

Both psychiatric and psychological factors are important in at least 30% of dermatology patients6. Psychodermatologic conditions are therefore common, forming a substantial part of dermatologic practice.

•

Dermatology does not routinely offer psychological support in the form of therapists or direct links to psychiatric services.

•

Our patients are often reluctant to accept psychiatric referral.

It is therefore usually fruitless for a doctor to refer directly for psychiatric assessment. However these patients can usually be successfully managed in a joint clinic, where they will engage with an integrated assessment of both dermatologic and psychological factors together.

•

The provision of joint psychodermatology clinics is scarce, so dermatologists and GPs often have to manage these patients without psychiatric input. There is an urgent need for greater service provision.

•

Quality of life and disability in dermatology patients is more influenced by associated psychiatric morbidity than by severity of their dermatologic disease, which makes the argument for greater service provision more compelling.

Primary dermatological disorders precipitated or exacerbated by stress It is well known by many sufferers of skin conditions that their skin seems to suffer when they are under stress. Research evidence into the brain-skin axis supports this lay perception that stress plays a role in both the initiation

NEWSLETTER SUMMER 2012

and relapse of many skin conditions including psoriasis, eczema, alopecia, acne, rosacea, and urticaria. Integrated management, which includes psychological treatments aimed to cope better with stress and specific treatment of concurrent mood disorders, will have a positive influence on the skin itself. We see relatively few of these types of patient.

Psychodermatology Clinic at the Royal London

Secondary psychiatric disorders arising from a primary dermatological disorder

The second main group of patients are those who develop secondary psychiatric disorders.

The main types of psychiatric disorder seen in patients with chronic skin disorders are depression, anxiety, body image disorder, and social anxiety.

Primary psychiatric disorders manifest via the skin

delusional disorder. Patients are desperate to prove the existence of organisms. They may bring containers to the doctor containing “parasites”, which used to be called the “matchbox sign”8. We have suggested the term “specimen sign” as our patients use a variety of media to illustrate the parasites including video, digital microscope images, photographs etc. Most often the analysis of samples show skin debris only.

Patients may take extreme mea-

sures to eradicate the organisms from their bodies8. They frequently cause severe secondary damage to their skin through applying noxious substances or even burning the skin. Many patients experience tactile hallucinations which may drive the delusional belief. Often other members of the family also present, believing they are also infested; a “folie a deux”. Recently there has emerged a new but similar presentation of patients who believe

The third broad grouping of patients we see are those who have little or no skin condition but whose psychiatric disorder presents via their skin. There are several psychiatric disorders which present this way: delusional parasitosis , dermatitis artefacta, body dysmorphic disorder, trichotillomania, neurotic excoriation, and skin damage through compulsive behaviours such as skin-picking or repeated handwashing e.g. in obsessive compulsive disorder.

When we first started the clinic we expected to see mostly patients in the first two categories.

However to our surprise it is the third group of patients who mostly fill our clinic. In particular we see large numbers of patients with delusional parasitosis, body dysmorphic disorder, acne excoriee and dermatitis artefacta.

The joint approach to management is particularly valuable in these groups.

Delusional Parasitosis

Delusional Parasitosis (also known as Ekbom’s syndrome) is the false belief that one’s body is infested with one or many organisms. It is a form of

Figure 1: Diagram brought by delusional infestation patient illustrating what he believes to be the problem and how it evolves.

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NEWSLETTER SUMMER 2012

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Psychodermatology Clinic at the Royal London they have Morgellon’s disease.

The term Morgellon’s was coined by a mother, Mary Leitao, for the “mystery illness” developed by her two year old son. She presented him to various physicians saying she was finding coloured fibres extruding from the child’s skin but no diagnosis could be reached.

Mary Leitao founded the Morgellon’s Research Foundation which has an extensive web site and has been an extraordinarily powerful patient group, which successfully lobbied the US government to fund a big study of this condition.

The study reported recently,9 and found no evidence of an infectious agent nor of any other common underlying medical condition, but reported a high incidence of psychiatric disorder and psychoactive substance use (50%) in these patients. They suggested a similarity to delusional parasitosis, a view which has always been fiercely rejected by the Morgellon’s patient organisation.

Dermatitis Artefacta This is a condition in which the patient creates skin lesions possibly to satisfy an internal psycho-

Figure 2: Dermatitis artefacta lesions-linear tears on the arms.

logical need, most commonly the need to be cared for. The term dermatitis artefacta classically describes patients who produce their artefacts secretly, deny complicity, and may be unaware of their psychological drives. The patient is puzzled and the relatives may be angry with doctors’ inability to diagnose and treat the mysterious problem. The skin lesions may be very varied e.g. linear tears, bruises, cuts, non healing ulcers. This condition is most common in young women. Many patients have personality disorders, commonly with borderline (emotionally unstable) features.

Another common feature is a close connection of either patient

tory of physical or sexual abuse is not uncommon and many have experienced significant losses in early life. The condition can be very severe and even life threatening, when it requires specialist management. A joint approach is vital as confrontation is usually counter-productive. It is important to look after the patient’s skin at the same time as engaging them in looking at the psychosocial meaning of their symptom.

or family member with healthcare.

Studies have found that a his-

Psychological factors in skin disease There are many reasons why skin disorders make patients particularly vulnerable to psychiatric disorder: •

Being highly visible, skin disorders can devastate self esteem, and produce feelings of shame and humiliation. Many patients will have difficulty in employment and relationships as a consequence.

•

Disfiguring skin disease can lead to negative social feedback; e.g. from shop assistants and swimming pool attendants.

•

Patients can suffer discrimination because of fears of contagion.

•

Suicide risk can be increased. In psoriasis suicidal ideation has been reported to be 2.5% among outpatients with less than 30% total body surface area involved and 7.2% in the more severely affected, acne patients had the next highest prevalence with 5.8% having active suicidal ideation7.

•

Skin disorders which have a peak incidence during adolescence, such as acne, are particular risks for psychological morbidity. They can be very disruptive at a life stage when the individual is highly invested in appearance.6

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NEWSLETTER SUMMER 2012

Psychodermatology Clinic at the Royal London

Body dysmorphic disorder

ing the symptoms. For example

An eclectic approach to treat-

there are a number of important

ment is taken in the psychoder-

Body Dysmorphic disorder

(and sometimes reversible)

matology clinic. Patients receive

(BDD), also known as dysmor-

medical conditions which can

the full range of treatments

phophobia, is characterised by a

lead to delusional infestation.

for their skin including topical

preoccupation with an imagined

Appropriate investigations should

creams, systemic drugs, as well

defect in physical appearance,

be undertaken to exclude these.

as phototherapy. Where patients

or if there is a slight physical

Where the psychiatric disorder

can be persuaded, antipsychot-

anomaly, the concern is out of

is secondary to the skin disease

ics are prescribed for delusional

proportion to the anomaly. There

patients will often be much more

parasitosis. We find that anti-

is a spectrum from patients with

willing to explore their psychiatric

psychotics are effective in low

overvalued ideas to those whose

symptoms if they feel their skin

doses for delusional parasitosis

beliefs are held with delusional

is being appropriately treated.

if patient’s actually take them.

conviction (referred to in the USA

Some medical patients will refuse

It is also important to treat the

literature as BDD psychotic sub-

psychiatric referral as they fear

skin of patients with delusional

type). The latter is a delusional

that this will then result in their

parasitosis as they often have

disorder. Although in the gen-

physical disease not being taken

skin pathology – e.g. dry and

eral population the prevalence

seriously and treated appropri-

itchy skin, nodular prurigo, which

is 1-2% studies have shown it

ately. Joint management is a way

contributes to the problem. Anti-

to be much commoner in people

around this fear. The group of

depressants are useful for mood

receiving dermatological care

patients with psychiatric disor-

disorders, anxiety disorders and

(12%). It is often found with

ders which present via the skin

obsessive compulsive disorders,

other disorders such as mood

are particularly difficult to treat

as well as compulsions such as

disorders, obsessive compul-

as they frequently lack insight,

skin-picking. Psychological treat-

sive disorder and social phobia.

such as those with the psychotic

ments include habit reversal; a

There is a view that it is a variant

subtype of body dysmorphic

behavioural treatment which is

of obsessive compulsive disorder

disorder. They will usually refuse

effective in treating the “scratch-

as there is a genetic associa-

to see a psychiatrist. Although

itch cycle”, often established in

tion and it seems to respond to

I make it clear that I am a psy-

patients with chronic pruritis.

the same medications. There is

chiatrist, they will often accept

Cognitive behaviour therapy

a high incidence of personality

seeing me jointly with the derma-

(CBT) is widely used to treat anx-

disorder (72%) in patients with

tologist. Such patients will often

iety and depression, compulsive

BDD; commonly paranoid, avoid-

declare they don’t need me, but

behaviours, poor body image and

ant and obsessive compulsive.

I can stay in the room and will

social phobia. Recently the clinic

engage predominantly with the

has been able to offer CBT with

dermatologist in the first few

two part-time clinical psycholo-

visits. However with time, if they

gists within the clinic, as well as

feel their problems are being

by referral to the local psychol-

taken seriously, they will begin

ogy or psychotherapy service,

to discuss psychosocial aspects

facilitated by the psychiatrist.

Management of patients in the psychodermatology clinic For all such patients there is a great advantage to joint assessment and management by both a psychiatrist and dermatologist.

It is very important to identify and treat any organic disease which may be producing or exacerbat-

of their condition. Thus the joint approach is crucial to engaging them with psychiatric treatments, either in the form of medication or psychotherapy.

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NEWSLETTER SUMMER 2012

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Psychodermatology Clinic at the Royal London

Conclusion •

Psychological morbidity is commonly associated with skin disease, but it presents to dermatologists and is rarely seen in psychiatric practice.

•

The psychological morbidity has more impact on disability and quality of life in dermatology patients than the skin disease itself.

•

Joint management of dermatology patients with psychological problems is the ideal as it enables engagement of patients who would not otherwise agree to see a psychiatrist. Management includes psychotropics, CBT, psychotherapy, patient self-help groups as well as disease education and support in a joint clinic. There is a lack of a good evidence base for psychological treatments in dermatology and research in this area is urgently needed.

Ruth Taylor

Anthony Bewley

References 1. Delusional infestation with unusual pathogens: a report of three cases.

Dewan P, Miller J, Musters C, Taylor RE, Bewley AP. Clin Exp Dermatol.

2011 Oct;36(7):745-8.

delusional infestation. Bewley AP, Lepping P, Freudenmann RW, Taylor R. Br J Dermatol. 2010 Jul;163(1):12

caused by dopamine agonists. Flann S, Shotbolt J, Kessel B, Vekaria D, Taylor R, Bewley A, Pembroke A. Clin Exp Dermatol. 2010

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and suicidal ideation in dermatology

ogy /liaison psychiatry clinic. Healy

patients with acne, alopecia areata,

R, Taylor R, Dhoat S, Leschynska

atopic dermatitis and psoriasis. Br J

E, Bewley AP. Br J Dermatol. 2009

Dermatol. 1998;139:846-50.

5. Delusional parasitosis presenting

8. Trabert W. 100 years of delusional parasitosis. Meta-analysis of 1,223

as folie at trois: successful treat-

case reports. Psychopathology

ment with risperidone. Friedmann

1995;28:238-46.

AC, Ekeowa-Anderson A, Taylor R, Bewley A. Br J Dermatol. 2006

3. Three cases of delusional parasitosis

7. Gupta MA,.Gupta AK. Depression

sional parasitosis in a joint dermatol-

Jul;161(1):197-9.

2. Delusional parasitosis time to call it

Oct;35(7):740-2.

4. Management of patients with delu-

Oct;155(4):841-2.

6. Gupta MA,.Gupta AK. Psychiatric

9. Pearson ML, Selby JV, Katz KA, Cantrell V, Braden CR, et al. (2012) Clinical, Epidemiologic, Histopathologic and Molecular Features of an

and psychological co-morbidity in

Unexplained Dermopathy. PLoS

patients with dermatologic disorders:

ONE 7(1): e29908. doi:10.1371/jour-

epidemiology and management. Am

nal.pone.0029908

J Clin Dermatol. 2003;4:833-42.

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Group music therapy for patients with persistent PTSD

By Catherine Carr ELFT is committed to strengthening and developing the arts therapies services but further research is needed to underpin the delivery of these services and build an evidence base. A number of treatments are available to treat posttraumatic stress disorder (PTSD), including cognitive behaviour therapy (CBT). However, a small but significant number of people do not respond sufficiently and still have significant symptoms after therapy.

Literature suggests group music therapy might be beneficial in treating PTSD for a number of reasons. Patients sometimes perceive talking therapies as distressing and intrusive; whereas music engages people in a perceived safe and enjoyable context, and can be means of motivating and encouraging people to engage in treatment.

Previous studies suggest that music therapy can aid unwanted re-experiencing of trauma through its potential to evoke memories and emotional responses providing access for discussion and processing of the past. Active music making on instruments may provide a means of control and self-expression of the traumatic memory without necessarily requiring words. The social process of making music in a group

with others may also encourage and aid the building of trust and engagement whilst emotional responses can be experienced and explored.

Music therapy has been used to help people with mental health problems for many years but no research to date has been done to investigate its feasibility and few studies have been conducted to ascertain its effectiveness for different populations. A preliminary study by Carr et al. in Psychology and Psychotherapy sought to assess whether group music therapy was feasible for patients who did not respond to CBT, and whether it has an effect on PTSD symptoms and depression.

Mixed methods were used comprising an exploratory randomized controlled trial, qualitative content analysis of therapy, and patient interviews. Patients who had significant PTSD symptoms following completion of CBT were randomly assigned to treatment or control groups. The patients came from diverse backgrounds and had experienced very different types of trauma. The treatment group received ten weeks of group music therapy after which exit interviews were conducted. Control group patients were offered the intervention at the end of the study.

The first step in helping participants was through engagement with music therapy. Mean attendance of therapy was seven

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Group music therapy for patients with persistent PTSD

sessions, which is remarkably high. This engagement level supports suggestions that music can be enjoyable and motivating (Gold et al., 2009). Patients initially expressed anxiety and fear about what was expected of them, but then moved to describing experiences of safety and calm. Patients were provided with activities that were non-demanding, controlled, boundaried and explicit. Guidance and repetition of structured activities may have reduced initial fears and encouraged habituation to individual sounds. Patients spoke of music providing a point of focus and link to the present which may have enabled patients to associate and incorporate safer memories alongside traumatic memories (Van Der Kolk, 2006).

Within group music therapy, a wide range of instruments are provided with many requiring little or no prior musical knowledge. A combination of active music making and receptive listening are used, with an emphasis upon the group freely improvising music together. Music therapists support this process both musically and verbally, guiding the musical activities, providing musical support and encouraging verbal reflection on thoughts and feelings arising from the musical experience.

For the purposes of this study, the intervention was manualised, with a particular focus on building trust and safety, offering opportunities for socialisation and support, providing supportive psychotherapeutic interventions and using music to lower anxiety, enhance self-esteem, and alleviCENTRE FOR PSYCHIATRY

ate re-experiencing, avoidance, hyperarousal and associated depression.

Treatment-group patients experienced a significant reduction in severity of PTSD symptoms and a marginally significant reduction in depression. The qualitative findings provided detailed insights into the music therapy processes and subjective experiences of patients. Patients viewed music therapy as helpful and suggested that the group had helped them to feel calmer and more at ease.

The social opportunities offered by the group were of particular importance particularly the opportunity to meet others who shared traumatic experiences without having to explicitly speak of this.

Instruments were valued for their potential to express emotions and drums appeared to aid expression of anger and frustration. The sound qualities of instruments (particularly high-pitched, sonorous, or loud instruments) were most often cited as unhelpful, and a particular feature of the process was learning to deal with the conflicts this created within the group. Patients acknowledged the difficulty they had in sharing their traumatic memories, and expressed a wish for the group to have been able to share more of this.

Patients reported music therapy as a helpful means of emotional expression and regulation. Within this study, patients reported physically tapping rhythms outside of therapy to recall the group’s music and self-regulate arousal. Instruments and music eliciting strong emotional re-

NEWSLETTER SUMMER 2012

sponses were quickly identified; the capacity to tolerate particular sound qualities of instruments appears to have played a key role in the music therapy process.

Whilst instruments could evoke traumatic memories, patients learned to tolerate, communicate and acknowledge the impact of their instrument upon other group members.

This pilot study suggests that group music therapy is feasible and effective for PTSD patients who have not sufficiently responded to CBT. Limitations include the small sample size and lack of blinding. Outcomes could have been achieved through a group effect rather than specifically music therapy. We hope that further research will address these limitations, test sustainability, and identify specific factors that address symptoms in treatment.

Catherine Carr is a music therapist and is currently doing a PhD looking at modelling of intensive group music therapy for acute adult psychiatric inpatients. The PhD is funded by the NIHR Clinical Doctoral Research Fellowship for Allied Health Professionals and is supervised by Professor Stefan Priebe and Professor Helen OdellMiller.

Chronic stress and appearance concerns in facial surgery patients Emmylou Rahtz began her PhD in the Centre for Psychiatry in June 2011, supervised by Professors Ania Korszun, Kamaldeep Bhui and Iain Hutchison, and funded by Saving Faces, the Facial Surgery Research Foundation. One year into the project, she tells us about her work and the experience.

My background I originally studied English and earned a BA and MA in English Literature from Durham and King’s College London. My early career was in social research, specialising in learning and skills and carrying out research projects for universities and government bodies. I loved the research process and became increasingly interested in studying behaviour.

I enrolled at Birkbeck and earned a BSc in Psychology while working, hoping to move into clinical research. This particular project attracted me because it allowed me to combine my research skills with interests I had developed at Birkbeck, and to work under three supervisors who are eminent in their fields.

The project Facial surgery following trauma can have a profound effect on a person’s wellbeing. There can be a range of psychological sequelae, including posttraumatic stress disorder (PTSD), depression, problems adjusting to changed appearance and reduced quality of life. Over the past year I have attended specialist clinics for patients with

facial injuries at St Bartholomew’s Hospital and the Royal London.

The standard of care is very high and maxillofacial surgeons work hard to restore function and appearance. However, in the busy clinics, patients’ emotional needs can be overlooked and psychological problems can therefore go untreated.

This study seeks to understand the risk factors that predispose some patients to psychiatric disorders and poorer treatment outcome. The research will inform the use of appropriate screening tools to identify patients at risk of distress and to apply early interventions.

Patients will be recruited during their initial admission to hospital, when they will fill in a number of validated questionnaires. I will follow up the patients at three and six months, using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to diagnose disorders and asking participants to complete further questionnaires. These quantitative data will form a prospective study.

I will then carry out qualitative interviews with a small sub-group

of participants to understand the lived experience of adjusting to facial disfigurement.

Progress and next steps The first year has been busy: I’ve studied the existing literature, designed the project and obtained ethical approval. I’ve also carried out a three month audit as a preliminary assessment of the psychological needs of all patients attending the clinic, and am currently writing up the findings from that work. Ongoing training is crucial and I’ve learned how to administer the SCAN correctly at a WHO-approved training centre in Leicester, and will soon be attending a course in Advanced Epidemiological Analysis at the London School of Hygiene and Tropical Medicine. With ethical approval in place, I have just begun recruiting patients to the study.

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Psychological wellbeing and quality of life of patients with head and neck cancer; the influence of partner distress on patient outcome My life as a PHD student by Farah Shiraz

My project

About me I graduated from Cardiff University in 2005 with a BSc in Psychology. After graduating I worked as an assistant psychologist gaining clinical experience in delivering psychological interventions within a number of mental health specialities. From my clinical experience I learnt that when clinicians were supporting families as well as patients it often helped in the patients’ road to recovery. Stimulated by clinical experience, I was keen to conduct some research so enrolled in a Masters in Abnormal Psychology and also worked as a research assistant within a range of health related projects.

For my MSc thesis I conducted research using NHS patients, exploring the psychological outcomes of patients and partners living with Parkinson’s disease.

An interesting finding from my analysis was the psychological impact the condition had on partners’ quality of life and relationships. This sparked my interest to raise awareness about the psychological needs of families as well as patients, as it’s often families – particularly partners – that provide the support and care for patients. I felt doing a PhD was the perfect opportunity to explore my on-going interests in greater detail.

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The aim of my PhD project is to examine the psychological wellbeing and quality of life of patients with head and neck cancer with particular focus on the influence a distressed spouse can have on patients’ quality of life and psychological wellbeing.

The current literature in cancer has suggested that partners of patients with cancer can sometimes experience greater or the same level of distress as the patient. Caregivers who were the patient’s partner were more likely to develop anxiety, depression or both, if their ill spouse had developed these symptoms. In addition, the prevalence of affective disorders, (depression and anxiety) among female caregivers was similar to the prevalence among patients (23%). We currently do not know what impact this form of distress can have on the patient. To investigate this further, new head and neck cancer patients and their partners will be recruited from the head and neck outpatient cancer clinic at Barts Hospital, London, using validated self-report measures to collect data on patients’ and partners’ quality of life and psychological wellbeing over a six month period.

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Progress and next steps As I enter into year two of my PhD I am pleased with what I have achieved in my first year. I have studied and reviewed the relevant literature for my project with the aim of completing a systematic review in the next few months. I am confident in my study design and feel I have selected the appropriate questionnaires to answer my research aims. I have also conducted an audit which looked at the psychological needs of head and neck cancer patients. This not only gave an opportunity to look at some preliminary findings but also gave the opportunity to meet the patients and try to understand the impact head and neck cancer has on their everyday lives. I have also had the opportunity to present my study to other head and neck cancer clinics across London, which has resulted in additional sites for recruitment.

The surgeons are enthusiastic about our research and have been fully supportive in working with us to gain the best results for their patients. The biggest challenge of the year has been the ethics process, but I am very pleased to enter into the second year with the project approved and recruitment ready to begin.

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The Postgraduate Network The postgraduate network is for researchers based at Charterhouse Square and it’s broad aims are: To provide networking opportunities for postdocs and senior research leaders from Charterhouse Square and to enable postdocs to learn about the support provided by the college for their professional and career development.

With this in mind, Ian Forristal is running a new series of lunchtime Masterclasses and other career development activities for postdocs that will be delivered on the Charterhouse Square campus.

One of the aims is to provide development activities for postdocs who won’t be staying in academia

so looking at what other opportunities are about etc once you have a PhD.

Forthcoming Researcher Development Activities at Charterhouse Square •

Introduction to Leadership & Managing Teams (Sep 2012: 2 day programme) - date and room tbc Institute of Leadership & Managed Endorsed Dr Ian Forristal (The Learning Institute)

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Doctoral Transitions Event: Careers Beyond Academia for STEM researchers Oct/Nov 2012: 5.30-7.30pm) – date and room tbc A Panel of Former Researchers: Their Transition from Academia into Roles beyond Academic Research.

QM Careers

William Harvey Day – Call for Abstracts As you will have heard William Harvey Day is on 16th October this year. This is an excellent showcase for all the research work we are doing in the Centre. This year Ania Korszun and I are planning to collect and screen the abstracts before submission. I do hope you will be encouraged to submit an abstract. Please send your abstract to Lisa Kass (psychiatry@qmul.ac.uk) by Friday 10th August 2012.

Presenter: Institute/Organisation: Contact Address: Telephone: Mobile: Email: Fax: Title: Abstract:

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Upcoming Events 28th August, 2pm - 3pm

Discharges from medium secure services in England and Wales

17th September, 2pm - 3pm Institutional Care

Led by: Winnie Chow

Led by: Dr Mike Doyle (Programme Director, University of Manchester, Centre for Mental Health & Research)

Venue: Academic Unit Lecture Theatre, Newham

Venue: Cambridge Room, William Harvey House, Barts

The EPOS Trial

3rd September, 2pm - 3pm

Symptoms and quality of life in severe mental disorders Led by: Domenico Giacco Venue: Academic Unit LectureTheatre, Newham

5th September, 12.30pm – 1.30pm

Centre for Psychiatry – Lunchtime Seminar TBC Contact: Neil Smith Venue: Room 106, Old Anatomy Building, Charterhouse Square

6th September, 4.30pm

Centre for Psychiatry Late Summer Party Contact: Lisa Kass/Jane Archer Venue: The Green, Charterhouse Square

10th September, 2pm - 3pm Modelling of group music therapy for acute adult psychiatric inpatients

24th September, 2pm - 3pm

22nd October, 2pm - 3pm

Quality of life after experiences of war Led by: Aleksandra Matano Venue: Academic Unit Lecture Theatre, Newham

29th October, 2pm - 3pm

Led by: Domenico Scaringi

Process research in psychotherapy for BPD

Venue: Academic Unit Lecture Theatre, Newham

Led by: Kirsten Barnicott Venue: Academic Unit Lecture Theatre, Newham

1st October, 2pm - 3pm

Research programme on housing services for people with mental disorders

31st October, 2pm – 5pm

Led by: tbc

Contact: Pat Staples

Venue: Academic Unit Lecture Theatre, Newham

Venue: Charterhouse Square

8th October, 2pm - 3pm

Investigating the relationshipbetween changes in self-harm and clinical symptoms associated with BPD

Cultural Consultation Club

5th November, 2pm - 3pm Measuring social contacts in mental health Led by: Claudia Palumbo

Led by: Nyla Bhatti

Venue: Academic Unit Lecture Theatre, Newham

Venue: Academic Unit Lecture Theatre, Newham

12th November, 2pm - 3pm

15th October, 2pm - 3pm

Nonverbal communication in schizophrenia Led by: Mary Lavelle Venue: Academic Unit Lecture Theatre, Newham

NESS – Body psychotherapy in the treatment of negative symptoms of schizophrenia Led by: Mark Savill Venue: Academic Unit Lecture Theatre, Newham

28th November, 2pm - 5pm Cultural Consultation Club

Led by: Catherine Carr

Contact: Pat Staples

Venue: Academic Unit Lecture Theatre, Newham

Venue: Charterhouse Square

CENTRE FOR PSYCHIATRY

NEWSLETTER SUMMER 2012

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Centre for Psychiatry Selected Publications Bhui, K. S., Dinos, S., Stansfeld, S. A., & White, P. D. 2012, “A synthesis of the evidence for managing stress at work: a review of the reviews reporting on anxiety, depression and absenteeism”, Journal of Environmental and Public Health pp. 1-21.

Bhui, K. S., Hicks, M. H., Lashley, M., & Jones, E. 2012, “A public health approach to understanding and preventing violent radicalisation”, BMC.Med., vol. 10, no. 1, p. 16.

Bhui, K. S., Lenguerrand, E., Maynard, M. J., Stansfeld, S. A., & Harding, S. 2012, “Does cultural integration explain a mental health advantage for adolescents?”, Int.J.Epidemiol.

Bhui, K. S., Mohamud, S., Warfa, N., Curtis, S., Stansfeld, S., & Craig, T. J. 2012, “Forced residential mobility and social support: impacts on psychiatric disorders among Somali migrants”, BMC.Int.Health Hum. Rights., vol. 12, no. 1, p. 4.

Bogic, M., Ajdukovic, D., Bremner, S., Franciskovic, T., Galeazzi, G. M., Kucukalic, A., Lecic-Tosevski, D., Morina, N., Popovski, M., Schutzwohl, M., Wang, D., & Priebe, S. 2012, “Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK”, Br.J.Psychiatry.

Bourke, J., Soldan, J., Silk, D. B. A., Aziz Q, & Libby G W 2012, “Idiopathic’ intestinal failure - the importance of identifying and treating primary psychopathology”, Neurogastroenterol Motil, vol. 24, pp. 242-251.

Campion, J., Bhui, K., & Bhugra, D. 2012, “European Psychiatric Association (EPA) guidance on prevention of mental disorders”, Eur.Psychiatry, vol. 27, no. 2, pp.

68-80.

Cella, M., White, P. D., Sharpe, M., & Chalder, T. 2012, “Cognitions, behaviours and comorbid psychiatric diagnoses in patients with chronic fatigue syndrome”, Psychol.Med. pp. 1-6.

Clark, C., Crombie, R., Head, J., van Kamp, I., van Kempen, E., & Stansfeld, S. A. 2012, “Does traffic-related air pollution explain associations of aircraft and road traffic noise exposure on children’s health and cognition?

A secondary analysis of the UK sample from the RANCH project.”, American Journal of Epidemiology.

Clark, C., Pike, C., McManus, S., Harris, J., Bebbington, P., Brugha, T., Jenkins, R., Meltzer, H., Weich, S., & Stansfeld, S. 2012, “The contribution of work and non-work stressors to common mental disorders in the 2007 Adult Psychiatric Morbidity Survey”, Psychol.Med., vol. 42, no. 4, pp.

829-842.

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Centre for Psychiatry: Selected Publications Coid, J., Freestone, M., & Ullrich, S. 2012, “Subtypes of psychopathy in the British household population: findings from the national household survey of psychiatric morbidity”, Soc.Psychiatry Psychiatr Epidemiol, vol. 47, no. 6, pp. 879891.

Devasahayam, A., Lawn, T., Murphy, M., & White, P. D. 2012, “Alternative diagnoses to chronic fatigue syndrome in referrals to a specialist service: service evaluation survey”, JRSM.Short Rep., vol. 3, no. 1, p. 4.

Fisher, H. L., Cohen-Woods, S., Hosang, G. M., Uher, R., PowellSmith, G., Keers, R., Tropeano, M., Korszun, A., Jones, L., Jones, I., Owen, M., Craddock, N., Craig, I. W., Farmer, A. E., & McGuffin, P. 2012, “Stressful life events and the serotonin transporter gene (5-HTT) in recurrent clinical depression”, J.Affect.Disord., vol.

136, no. 1-2, pp. 189-193.

Freestone, M., Taylor, C., Milsom, S., Mikton, C., Ullrich, S., Phillips, O., & Coid, J. 2012, “Assessments and admissions during the first 6 years of a UK medium secure DSPD service”, Crim.Behav.Ment.Health , vol. 22, no. 2, pp. 91-107.

Henderson, M., Richards, M., Stansfeld, S., & Hotopf, M. 2012, “The association between childhood cognitive ability and adult long-term sickness absence in three British birth cohorts: a cohort study”, BMJ Open., vol. 2, no. 2, p. e000777.

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Katsakou, C., Marougka, S., Barnicot, K., Savill, M., White, H., Lockwood, K., & Priebe, S. 2012, “Recovery in Borderline Personality Disorder (BPD): A Qualitative Study of Service Users’ Perspectives”, PLoS One, vol. 7, no. 5, p. e36517.

Keers, R. & Uher, R. 2012, “Gene-environment interaction in major depression and antidepressant treatment response”, Curr.Psychiatry Rep., vol. 14, no. 2, pp. 129-137.

McCabe, R., Bullenkamp, J., Hansson, L., Lauber, C., Martinez-Leal, R., Rossler, W., Salize, H. J., Svensson, B., Torres-Gonzalez, F., van den, B. R., Wiersma, D., & Priebe, S. 2012, “The therapeutic relationship and adherence to antipsychotic medication in schizophrenia”, PLoS One, vol. 7, no. 4, p. e36080.

Owiti, J. & Bhui, K. S. 2012, “The reciprocal relationship between physical activity and depression in older European adults”, Evid.

Based.Nurs.

Priebe, S., Bhatti N, Barnicot, K., Bremner, S., Gaglia, A., Katsakou, C., Molosankwe, I., McCrone, P., & Zinkler, M. Effectiveness and cost effectiveness of dialectical behaviour therapy for self-harming patients with personality disorder: a pragmatic randomised controlled trial. Psychotherapy and Psychosomatics. Psychotherapy and Psychosomatics . 2012. Ref Type: In Press

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Centre for Psychiatry: Selected Publications Priebe, S., Matanov, A., Barros, H., Canavan, R., Gabor, E., Greacen, T., Holcnerova, P., Kluge, U., Nicaise, P., Moskalewicz, J., Duaz-Olalla, J. M., Straßmayr C, Schene AH, Soares JJF, Tulloch S, & Gaddini A 2012, “Mental health-care provision for marginalized groups across Europe: findings from the PROMO study.”, The European Journal of Public Health pp. 1-6.

Reininghaus, U., McCabe, R., Burns, T., Croudace, T., & Priebe, S. 2012, “The validity of subjective quality of life measures in psychotic patients with severe psychopathology and cognitive deficits: an item response model analysis”, Qual.Life Res., vol. 21, no. 2, pp. 237-246.

Rivera, M., Cohen-Woods, S., Kapur, K., Breen, G., Ng, M. Y., Butler, A. W., Craddock, N., Gill, M., Korszun, A., Maier, W., Mors, O., Owen, M. J., Preisig, M., Bergmann, S., Tozzi, F., Rice, J., Rietschel, M., Rucker, J., Schosser, A., Aitchison, K. J., Uher, R., Craig, I. W., Lewis, C. M., Farmer, A. E., & McGuffin, P. 2012, “Depressive disorder moderates the effect of the FTO gene on body mass index”, Mol. Psychiatry, vol. 17, no. 6, pp. 604611.

Strassmayr, C. C., Matanov, A. A., Priebe S Sp, Barros, H. H., Canavan, R. R., az-Olalla, J. M. J., Gabor E Eg, Gaddini, A. A., Greacen, T. T., Holcnerova, P. P., Kluge, U. U., Welbel, M. M., Nicaise, P. P., Schene, A. A., Soares, J. J., & Katschnig, H. 2012, “Mental health care for irregular migrants in Europe: Barriers and how they are overcome”, BMC.Public Health, vol. 12, no. 1, p. 367.

Virtanen, M., Stansfeld, S. A., Fuhrer, R., Ferrie, J. E., & Kivimaki, M. 2012, “Overtime Work as a Predictor of Major Depressive Episode: A 5-Year Follow-Up of the Whitehall II Study”, PLoS One, vol. 7, no. 1, p. e30719.

White, P. D., Rickards, H., & Zeman A Z J 2012, “Time to end the distinction between mental and neurological illnesses”, BMJ, vol. 344, p. e3454.

White, P. D. & Chalder, T. 2012, “Chronic fatigue syndrome: treatment without a cause”, Lancet, vol. 379, pp. 1372-1373.

Rothon, C., Goodwin, L., & Stansfeld, S. 2012, “Family social support, community “social capital” and adolescents’ mental health and educational outcomes: a longitudinal study in England”, Soc.Psychiatry Psychiatr Epidemiol, vol. 47, no. 5, pp. 697709.

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For further information, please contact: 18

Jane Archer Centre for Psychiatry Barts and The London School of Medicine and Dentistry Old Anatomy Building Charterhouse Square London EC1M 6BQ Tel: +44 (0)20 7882 2020 Fax: +44 (0)20 7882 5728 Email: j.archer@qmul.ac.uk

FOR PSYCHIATRY NEWSLETTER SUMMER 2012 IssueCENTRE 3 www.wolfson.qmul.ac.uk/psychiatry