ORCID Profile
0000-0001-8456-9154
Current Organisation
University Of Strathclyde
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Publisher: IEEE
Date: 06-2019
Publisher: Oxford University Press (OUP)
Date: 13-04-2021
Abstract: Generalised anxiety disorder (GAD) is the most common anxiety disorder in older people. First-line management includes pharmacological and psychological therapies, but many do not find these effective or acceptable. Little is known about how to manage treatment-resistant generalised anxiety disorder (TR-GAD) in older people. To examine the acceptability, feasibility and preliminary estimates of the effectiveness of acceptance and commitment therapy (ACT) for older people with TR-GAD. People aged ≥65 years with TR-GAD (defined as not responding to GAD treatment, tolerate it or refused treatment) recruited from primary and secondary care services and the community. Participants received up to 16 one-to-one sessions of ACT, developed specifically for older people with TR-GAD, in addition to usual care. Co-primary outcomes were feasibility (defined as recruitment of ≥32 participants and retention of ≥60% at follow-up) and acceptability (defined as participants attending ≥10 sessions and scoring ≥21/30 on the satisfaction with therapy subscale). Secondary outcomes included measures of anxiety, worry, depression and psychological flexibility (assessed at 0 and 20 weeks). Thirty-seven participants were recruited, 30 (81%) were retained and 26 (70%) attended ≥10 sessions. A total of 18/30 (60%) participants scored ≥21/30 on the satisfaction with therapy subscale. There was preliminary evidence suggesting that ACT may improve anxiety, depression and psychological flexibility. There was evidence of good feasibility and acceptability, although satisfaction with therapy scores suggested that further refinement of the intervention may be necessary. Results indicate that a larger-scale randomised controlled trial of ACT for TR-GAD is feasible and warranted.
Publisher: Wiley
Date: 15-10-2020
DOI: 10.1111/BJHP.12478
Abstract: With few empirically supported treatments, functional movement disorders (FMD) can be challenging to manage. To enable service providers to better support people with FMD, this study sought to understand the lived experience of FMD: to gain insight into how in iduals make sense of their experience from symptom onset through medical evaluation and diagnosis to post‐diagnostic adaptation. An interpretative phenomenological analysis (IPA) of patient accounts of living with FMD. Eight participants were recruited from a UK teaching hospital adult neurology service: seven females, varying in age (20s‐70s), FMD symptom type (tremor, dystonia, and tics), and time to diagnosis (10 ‐ 192 months). Semi‐structured interviews facilitated participant accounts of key events. Interviews lasted 75‐125 minutes and were transcribed verbatim. Three super‐ordinate themes were apparent. The first covered the experiences of onset (‘Something is wrong with me’), including loss of control ‐ with the affected body part often described as a separate entity ‐ threats to identity and disturbance in relationships. ‘At last! What now?’ outlined the bittersweet experience of diagnosis and of treatments. Third, ‘Living my life with it’ incorporated ongoing experiences of coping with symptoms. While some continued to struggle with the emotional impact of symptoms, others developed a compassionate relationship with their self and maintained satisfying activities. FMD has a significant impact on patients’ relationships with themselves and others, which in turn affects well‐being. These findings suggest some nuanced additions to interventions (diagnosis, psychotherapy, physiotherapy, public education.)
Publisher: Wiley
Date: 10-01-2023
DOI: 10.1111/BJHP.12643
Abstract: Uncertainty regarding the legitimacy of functional neurological disorder (FND) remains among some health care professionals. Despite treatment guidelines and consensus recommendations, variability in clinical practice referral decisions persists. Evidence from other conditions suggests such clinical decision making is impacted by practitioners' implicit and explicit attitudes. We aimed to identify whether health care professionals hold implicit and/or explicit attitudes about the legitimacy of FND and whether these attitudes are associated with referral decision making. We included 66 health care professionals who work with people with neurological conditions: n = 37 medical doctors, mainly neurologists ( n = 18) and psychiatrists ( n = 10), and n = 29 doctoral level practitioner psychologists. Participants completed an Implicit Association Test (IAT), Implicit Relational Assessment Procedure (IRAP), a referral decision‐making vignette task and self‐report measures of explicit attitudes on FND‐legitimacy, therapeutic optimism and clinician confidence. Multiple Sclerosis (MS) was used as a comparator condition. Participants self‐reported strong explicit FND‐legitimate and MS‐legitimate attitudes but demonstrated an implicit FND‐illegitimate/MS‐legitimate bias. Deeper examination provided by the IRAP data indicated pro‐FND‐legitimate attitudes, but no bias for or against FND‐illegitimate—contrasting the pro‐MS‐legitimate, anti‐MS‐illegitimate attitudes for the comparator condition. Attitudes about FND‐illegitimacy were negatively associated with likelihood of referral to physical interventions such as physiotherapy. Medical doctors had lower treatment optimism and stronger explicit attitudes that FND is illegitimate than psychologists. At an implicit level, clinicians are uncertain about the illegitimacy of FND, and such attitudes are associated with lower likelihood of referral to physiotherapy in particular. Improved education on FND among health care professionals is indicated.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 06-2019
Publisher: Springer Science and Business Media LLC
Date: 21-09-2018
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.JNS.2022.120251
Abstract: Studies of Functional Neurological Disorders (FND) are usually outpatient-based. To inform service development, we aimed to describe patient pathways through healthcare events, and factors affecting risk of emergency department (ED) reattendance, for people presenting acutely with FND. Acute neurology/stroke teams at a UK city hospital were contacted regularly over 8 months to log FND referrals. Electronic documentation was then reviewed for hospital healthcare events over the preceding 8 years. Patient pathways through healthcare events over time were mapped, and mixed effects logistic regression was performed for risk of ED reattendance within 1 year. In 8 months, 212 patients presented acutely with an initial referral suggesting FND. 20% had subsequent alternative diagnoses, but 162 patients were classified from documentation review as possible (17%), probable (28%) or definite (55%) FND. In the preceding 8 years, these 162 patients had 563 ED attendances and 1693 inpatient nights with functional symptoms, but only 26% were referred for psychological therapy, only 66% had a documented diagnosis, and care pathways looped around ED. Three better practice pathway steps were each associated with lower risk of subsequent ED reattendance: documented FND diagnosis (OR = 0.32, p = 0.004), referral to clinical psychology (OR = 0.35, p = 0.04) and outpatient neurology follow-up (OR = 0.25, p < 0.001). People that present acutely to a UK city hospital with FND tend to follow looping pathways through hospital healthcare events, centred around ED, with low rates of documented diagnosis and referral for psychological therapy. When better practice occurs, it is associated with lower risk of ED reattendance.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Christopher Graham.