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This commentary accompanies Clare et al.’s study investigating psychotropic drug prescribing for adults with intellectual disability who were referred to specialist community learning disability teams in the east of England. The purpose of this paper is to explore some of the background to psychotropic drug prescribing for people with intellectual disability, review important contextual factors that influence prescribing decisions, and consider how we might make the best use of psychotropic drugs in this group.

Narrative summary and opinion, supported by reference to recent research literature.

Psychotropic drug use for people with intellectual disability raises complex issues, not least because of the lack of research evidence that exists on the topic. Psychotropic drugs can be an important part of treatment for people with mental illness but further research is needed to support prescribing for challenging behaviour. Medication optimisation is a framework within which individual preferences and values are considered alongside the evidence base and clinical judgement in order to inform safe, effective, and collaborative management decisions.

Prescribing decisions should be individualised and reviewed regularly, incorporating evidence from patients and carers. Improving the use of psychotropic medication requires concerted action, adequate social support, and the provision of alternative, non-pharmacological interventions that are acceptable and effective.

This paper reviews some of the current concerns about the use of psychotropic drugs and opens up new avenues of discussion.

The purpose of this paper is to establish and evaluate a psychotropic medication education group for men with intellectual disability on a secure psychiatric ward.

A multi-disciplinary team was convened to oversee the project. A curriculum was developed that covered major classes of psychotropic drugs as well as broader themes related to taking medication and general wellbeing. Each group session incorporated a range of teaching methods supported by accessible materials. Evaluation was by qualitative and quantitative methods.

There was interest and enthusiasm for the group. Participant feedback was generally positive and most of those who completed the group reported achieving their personal learning goals. There was no significant difference in results of a medication knowledge test at baseline and at the end of the course. Feedback from group members and reflections of the course facilitators are discussed.

The results of this small-scale study may not be applicable to other groups or settings. Evaluation measures seemed unable to capture some elements of the group processes and outcomes.

Establishing and running a psychoeducational group on a low-secure ward for men with intellectual disabilities is possible and potentially valuable. Learning from this project will be useful for others considering group-based interventions for people with intellectual disability.

This paper adds to the limited literature describing interventions to improve medication knowledge in people with intellectual disability.

There is ongoing discussion around how to structure psychiatric services to meet the needs of people with intellectual disability and co‐morbid mental illness and several different models have been suggested. With research evidence lacking, there is a lack of consensus as to the best model of service provision. This paper aims to review the current knowledge in this area and discuss the salient issues.

This is a review article summarising the current debate. Evidence from original research is presented and combined with opinion from clinical experience.

The authors find a lack of robust research evidence to support any particular model of service provision. However, it seems to be increasingly accepted that purely generic models of care for people with intellectual disabilities and co‐morbid mental illness are not appropriate. Integration of the expertise from specialist services within mainstream services is presented as potentially the most advantageous approach.

This article will be of benefit to clinicians working in the field of intellectual disability and mental illness, and to managers and commissioners with responsibility for providing services. It will also be useful for those new to the discipline to gain an overview of the current issues and debate within service planning for this population.

The aim of this paper is twofold. First, it seeks to understand how different forms of anthropomorphism, namely verbal and visual, can enhance or detract from the subjective well-being of consumers and their co-creation behaviors whilst collaborating with artificial intelligence (AI) service agents. Second, it seeks to understand if AI anxiety and trust in message, function as primary and secondary consumer appraisals of collaborating with AI service agents.

A conceptual model is developed using the theories of the uncanny valley and cognitive appraisal theory (CAT) with three hypotheses identified to guide the experimental work. The hypotheses are tested across three experimental studies which manipulate the level of anthropomorphism of AI.

Results demonstrate that verbal and visual anthropomorphism can assist consumer well-being and likelihood of co-creation. Further, this relationship is explained by the mediators of anxiety and trust.

The empirical results and theorizing suggest verbal anthropomorphism should be present (absent) and paired with low (high) visual anthropomorphism, which supports the “uncanny valley” effect. A moderated mediation relationship is established, which confirms AI anxiety and trust in a message as mediators of the AI service agent anthropomorphism-consumer subjective well-being/co-creation relationship. This supports the theorizing of the conceptual model based on the “uncanny valley” and CAT.

The purpose of this paper is to examine the impact of a structured clinical leadership programme on healthcare professionals working within the British National Health Service (NHS). Clinical leadership is now regarded as essential in addressing the complex challenges in the NHS, yet few trainees of any healthcare discipline receive formal training. The study describes a peer-led evaluation of a year-long, multidisciplinary, experiential programme, the “Darzi Fellowship”, based in London.

An anonymous survey was analysed using a mixed-methods approach. Individual and collective experiences of fellows were evaluated, in particular the perceived impact the fellowship had on: the fellows themselves, their “host” organisation and the NHS as a whole.

A 90 per cent return rate was achieved. In all, 94 per cent reported that the experience had been valuable to them, 85 per cent feeling more empowered to effect change in healthcare systems. Crucial mechanisms to achieve this included increased self-awareness, personal reflection and the freedom to gain a greater understanding of organisations. Particular emphasis was placed on the value of developing clinical networks which promote collaboration across boundaries. Fellows emerged as more reflexive, critical and strategic thinkers.

This paper demonstrates the positive impact that clinical leadership training can have on participants, and the mechanisms by which future leaders can be created.

The novel, non-commissioned, peer-initiated and peer-led evaluation describes the personal experiences of fellows in a unique, multidisciplinary clinical leadership programme. The authors hope this will inform the development of future schemes in the NHS and provide learning for an international healthcare audience.