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Depression is one of the main reasons for youth accessing mental health services, yet we know little about how symptoms change once youth are in routine care. This study used multilevel modeling to examine the average trajectory of change and the factors associated with change in depressive symptoms in a large sample of youth seen in routine mental health care services in England. Participants were 2336 youth aged 8–18 (mean age 14.52; 77% females; 88% white ethnic background) who tracked depressive symptoms over a period of up to 32 weeks while in contact with mental health services. Explanatory variables were age, gender, whether the case was closed, total length of contact with services, and baseline severity in depression scores. Faster rates of improvement were found in older adolescents, males, those with shorter time in contact with services, closed cases, and those with more severe symptoms at baseline. This study demonstrates that when youth self-report their depressive symptoms during psychotherapy, symptoms decrease in a linear trajectory. Attention should be paid to younger people, females, and those with lower than average baseline scores, as their symptoms decrease at a slower pace compared to others. [ABSTRACT FROM AUTHOR]

Background Assessments of personality disorder (PD) by clinicians or researchers are not always congruent with the problems that clients view as most salient. This can result in disagreement over areas for change, leading to dissatisfaction and the risk of treatment attrition. Method The sample comprised 141 treatment-seeking adults with PD. Each described the five things they most wanted to change about themselves. These target problems were compared with PD diagnoses obtained from the International Personality Disorder Examination. Results The congruence between the clients' target problems and PD traits identified by the professionals was generally weak. Disagreement arose where a client's target problem was not a PD trait and, less frequently, where the client and the professional agreed on the presence of a trait but not on its importance. Surprisingly, doubting the trustworthiness of others was the most commonly reported target problem in this treatment-seeking sample even though many such participants did not qualify for that particular paranoid trait. Conclusion Personality disorder diagnoses were generally poor indicators of the problems these clients cited as most important. This lack of correspondence may explain some of the lack of effectiveness of interventions for PD. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message: The problem that a client with personality disorder (PD) views as most important may only be weakly identified in a formal diagnostic assessment., Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PD traits are insufficient to describe fully the things clients most want to change about themselves., Many clients with PD consider difficulty trusting others to be their most important problem, despite not qualifying for that particular paranoid trait., Risk of disagreement between the clinician and the client might be reduced if both parties can engage in a discussion about the results of any formal diagnostic assessment. [ABSTRACT FROM AUTHOR]

In straightened times counselling must evidence the changes it promotes on reputable measures. Patient-generated measures complement nomothetic measures and may be nearer the ethos of counselling in eliciting individuals' problems. Scores from such measures from non-clinical samples are rarely reported, making their test-retest stability uncertain. We report the prevalence and stability of self-reported problems using PSYCHLOPS (Psychological Outcome Profiles) in a non-clinical student population. PSYCHLOPS is a four-item, self-administered, patient-generated instrument. PSYCHLOPS was completed twice, 7-10 days apart. A wide range of problems was reported and showed satisfactory test-retest stability: Pearson, 0.66; Spearman, 0.68; intra-class correlation coefficient, 0.70. This is reassuring as instability would undermine PSYCHLOPS as a sensitive change measure. [ABSTRACT FROM AUTHOR]

Examines factors on the occurrence of menstrual and ovulatory disturbances in bulimic women in Oxford, England. Implications of bulimia for altering hormonal changes in the menstrual cycle; Reliability of the luteinising hormone releasing hormone test for assessing hormonal irregularities; Probable causes of menstrual disturbances.

Summary: Concentrations of dissolved organic carbon (DOC) in soil and stream waters in upland catchments are widely monitored, in part due to the potential of DOC to form harmful by-products when chlorinated during treatment of water for public supply. DOC can be measured directly, though this is expensive and time-consuming. Light absorbance in the UV–vis spectrum is often used as a surrogate measurement from which a colour-carbon relationship between absorbance and DOC can be derived, but this relationship can be confounded by numerous variables. Through the analysis of data from eight sites in England and Wales we investigate the possibility of using the concentration of phenolic compounds in water samples as a proxy for DOC concentration. A general model using data from all the sites allowed DOC to be calculated from phenolics at an accuracy of 81–86%. A detailed analysis at one site revealed that a site-specific calibration was more accurate than the general model, and that this compared favourably with a colour-carbon calibration. We therefore recommend this method for use where estimates of DOC concentration are needed, but where time and money are limiting factors, or as an additional method to calculate DOC alongside colour-carbon calibrations. Tests demonstrated only small amounts of phenolic degradation over time; a loss of 0.92mgL−1 after 8months in storage, and so this method can be used on older samples with limited loss of accuracy. [ABSTRACT FROM AUTHOR]

This study examined rates of improvement in psychotherapy as a function of the number of sessions attended. The clients (N=1,868; 73.1% female; 92.4% White; average age=40), who were seen for a variety of problems in routine primary care mental health practices, attended 1 to 12 sessions, had planned endings, and completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. The percentage of clients achieving reliable and clinically significant improvement (RCSI) on the CORE-OM did not increase with number of sessions attended. Among clients who began treatment above the CORE-OM clinical cutoff (n=1,472), the RCSI rate ranged from 88% for clients who attended 1 session down to 62% for clients who attended 12 sessions (r=-.91). Previously reported negatively accelerating aggregate curves may reflect progressive ending of treatment by clients who had achieved a good enough level of improvement., (Copyright (c) 2006 APA, all rights reserved.)

This study extended client-focused research by using the nearest neighbor (NN) approach, a client-specific sampling and prediction strategy derived from research on alpine avalanches. Psychotherapy clients (N=203) seen in routine practice settings in the United Kingdom completed a battery of intake measures and then completed symptom intensity ratings before each session. Forecasts of each client's rate of change and session-by-session variability were computed on the basis of that client's NNs (n=10-50 in different comparisons). Alternative forecasts used linear or log-linear slopes and were compared with an alternative prediction strategy. Results showed that the NN approach was superior to the alternative model in predicting rate of change, though the advantage was less clear for predicting variability., (((c) 2005 APA, all rights reserved).)

Introduction: Treatability is currently a crucial component for detention under the Mental Health Act (England and Wales) for the Psychopathic Disorder (personality disorder) classification and there is continuing debate about the nature and assessment of treatability of individuals with personality disorder. Previous research has identified motivation to engage in treatment as a significant factor in the assessment of treatability; however, motivation is not a static predictor but a state of readiness or eagerness to change, which may fluctuate from one time or situation to another. While previous studies have explored factors within the individual that are used to assess treatability, this study aims to explore what, if any, aspects of an inpatient forensic setting influence patients' motivation to engage in treatment., Method: The study examines patients' experiences of engaging in treatment in an inpatient forensic Personality Disorder Directorate using a qualitative approach to identify possible service-, ward- and therapist-level influences on patients' motivation to engage., Results: Preliminary categories were identified across the data, including: support, treatment, safety, external belief, belonging, internal motivation and therapeutic relationship., Conclusions: Implications for the service are identified and areas for further qualitative exploration are highlighted.