Dissociative seizures (DSs), also called psychogenic non-epileptic seizures, are a distressing an... more Dissociative seizures (DSs), also called psychogenic non-epileptic seizures, are a distressing and disabling problem for many patients in neurological settings with high and often unnecessary economic costs. The COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES) trial is an evaluation of a specifically tailored psychological intervention with the aims of reducing seizure frequency and severity and improving psychological well-being in adults with DS. The aim of this paper is to report in detail the quantitative and economic analysis plan for the CODES trial, as agreed by the trial steering committee. The CODES trial is a multicentre, pragmatic, parallel group, randomised controlled trial performed to evaluate the clinical effectiveness and cost-effectiveness of 13 sessions of cognitive behavioural therapy (CBT) plus standardised medical care (SMC) compared with SMC alone for adult outpatients with DS. The object...
Neurodegenerative diseases, such as dementia, have a profound impact on those with the conditions... more Neurodegenerative diseases, such as dementia, have a profound impact on those with the conditions and their family carers. Consequently, the accurate measurement of family carers' quality of life (QOL) is important. Generic measures may miss key elements of the impact of these conditions, so using disease-specific instruments has been advocated. This systematic review aimed to identify and examine the psychometric properties of disease-specific outcome measures of QOL of family carers of people with neurodegenerative diseases (Alzheimer's disease and other dementias; Huntington's disease; Parkinson's disease; multiple sclerosis; and motor neuron disease). Systematic review. Instruments were identified using 5 electronic databases (PubMed, PsycINFO, Web of Science, Scopus and the International Bibliography of the Social Sciences (IBSS)) and lateral search techniques. Only studies which reported the development and/or validation of a disease-specific measure for adult ...
Alzheimer's & dementia : the journal of the Alzheimer's Association, Jan 5, 2017
Family carers of people with dementia are their most important support in practical, personal, an... more Family carers of people with dementia are their most important support in practical, personal, and economic terms. Carers are vital to maintaining the quality of life (QOL) of people with dementia. This review aims to identify factors related to the QOL of family carers of people with dementia. Searches on terms including "carers," "dementia," "family," and "quality of life" in research databases. Findings were synthesized inductively, grouping factors associated with carer QOL into themes. A total of 909 abstracts were identified. Following screening, lateral searches, and quality appraisal, 41 studies (n = 5539) were included for synthesis. A total of 10 themes were identified: demographics; carer-patient relationship; dementia characteristics; demands of caring; carer health; carer emotional well-being; support received; carer independence; carer self-efficacy; and future. The quality and level of evidence supporting each theme varied. We n...
Social psychiatry and psychiatric epidemiology, 2017
Mental health-related stigma affects people with mental disorders and their families. We aimed to... more Mental health-related stigma affects people with mental disorders and their families. We aimed to investigate the experience of stigma among relatives of patients with schizophrenia in Belarus and formulate recommendations for anti-stigma interventions. We conducted and thematically analysed 20 interviews with relatives of people diagnosed with schizophrenia. Experience of discrimination, strategies to cope with it, and requests for interventions were examined. A number of themes related to the experience of stigma in the public life of relatives of people with schizophrenia were elicited in relation to: (1) mental health care (difficulties in contacting mental health professionals; in getting appropriate information; lack of alternatives to hospital treatment; absence of appropriate long-term care services); (2) employment of people living with schizophrenia and (3) contact with the police. Analysis of the strategies used to overcome difficulties revealed resignation and passive ac...
SynopsisAfter the journalists of a national newspaper had been issued with redundancy notices, a ... more SynopsisAfter the journalists of a national newspaper had been issued with redundancy notices, a prospective study was carried Out to examine the effect of the threat of their redundancy on minor psychiatric morbidity. Following the subsequent withdrawal of redundancy notices, there was considerable reduction in minor symptomatology, and the implications of this are discussed.
Journal of the American Medical Directors Association, Jan 18, 2017
Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people ... more Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people with dementia living in care homes is very limited. We investigated the people with dementia living in 67 care homes in London and Buckinghamshire, United Kingdom. Pain, dementia severity, neuropsychiatric symptoms, depression, agitation, and quality-of-life were measured using appropriate instruments at baseline (N = 967) and after 9 months (n = 629). Baseline prevalence of pain was 35.3% (95% CI 32.3-38.3). Pain severity was significantly correlated with dementia severity, neuropsychiatric symptoms, depression, agitation, and quality of life at both time points. Regular treatment with analgesics significantly reduced pain severity. Pain was significantly associated with more antipsychotic prescriptions. Pain was significantly associated (OR 1.48; 95% CI 1.18-1.85) with all-cause mortality during follow-up. Pain is an important determinant of neuropsychiatric symptoms, mortality, qualit...
The evidence base for the effectiveness of psychological interventions for patients with dissocia... more The evidence base for the effectiveness of psychological interventions for patients with dissociative non-epileptic seizures (DS) is currently extremely limited, although data from two small pilot randomised controlled trials (RCTs), including from our group, suggest that Cognitive Behavioural Therapy (CBT) may be effective in reducing DS occurrence and may improve aspects of psychological status and psychosocial functioning. The study is a multicentre, pragmatic parallel group RCT to evaluate the clinical and cost-effectiveness of specifically-tailored CBT plus standardised medical care (SMC) vs SMC alone in reducing DS frequency and improving psychological and health-related outcomes. In the initial screening phase, patients with DS will receive their diagnosis from a neurologist/epilepsy specialist. If patients are eligible and interested following the provision of study information and a booklet about DS, they will consent to provide demographic information and fortnightly data ...
Only a third of people with mental disorders seek professional help. In this study, we aimed to i... more Only a third of people with mental disorders seek professional help. In this study, we aimed to investigate attitudes toward help-seeking among non-help-seekers drawn from a community survey in South London. We conducted qualitative interviews with 24 participants with symptoms of mental disorders. We analyzed data using thematic analysis. Participants' reasons for not seeking professional help included perceiving their problems as normal or unsuitable for professional help, negative expectations of professional help, believing informal strategies were sufficient, fearing being stigmatized for having a mental disorder and help-seeking, and self-perceptions of being strong and/or self-reliant. A small number (n = 4) had resolved their problems. Participants with unresolved mental disorders (n = 20) had more chronic stressors, particularly about finances and family relationships, and greater concerns about professional help and stigma than other participants. Potential targets for...
The Journal of the Royal College of General Practitioners, Nov 1, 1988
The growth of alternative medicine poses particular problems for general practitioners working in... more The growth of alternative medicine poses particular problems for general practitioners working in the National Health Service. This paper reviews the subject and presents preliminary results of a two-stage study of the prevalence of use of alternative medicine in a south London practice. Extended interviews with users explored motivations for choice of treatment and attitudes towards orthodox and alternative health care. The study suggests that many patients are making use of alternative medicine in addition to their NHS consultations without the knowledge of their general practitioners. The clinical and ethical implications of this pattern of illness behaviour are discussed.
Aims. Decisions regarding disclosure of a mental health problem are complex and can involve recon... more Aims. Decisions regarding disclosure of a mental health problem are complex and can involve reconciling conflicting needs and values. This article provides a qualitative account of the beliefs and experiences of mental health service users regarding disclosure in employment contexts. Methods. Total sample of 45 individuals were interviewed in two study phases. In phase one, semi-structured interviews were carried out with 15 mental health service users. The transcripts were analysed using interpretative phenomenological analysis (IPA). In phase two, identified themes were further explored through interviews with mental health service users (n = 30) in three employment contexts: in paid employment (n = 10); in study or voluntary work (n = 10); and currently unemployed (n = 10). These were analysed using directed content analysis. Results. Four super-ordinate themes were drawn from phase one analysis: (1) public understanding of mental health problems; (2) the employment context; (3) ...
In a South London general practice a substantial proportion of patients in some age groups (35 an... more In a South London general practice a substantial proportion of patients in some age groups (35 and 45 yr) had tried alternative treatment. Satisfaction with the outcome was limited. The use of alternatives was associated with higher general practice consultation rates, especially among women. Qualitative interviews with users suggested that rapid cures for chronic conditions were rarely expected; rather, an alternative explanation for health problems was sought and a greater sense of autonomy in dealing with them. Negative attitudes towards modern medicine arose from perceptions of excessive technological intervention and iatrogenic disorders arising from long term drug treatment.
... cultural di-versity in health has most often been studied in the Asian community (Cochrane an... more ... cultural di-versity in health has most often been studied in the Asian community (Cochrane and Stopes-Roe 1977, 1981; Ananth 1978; Brewin ... Table 4. Joint effects on general practitioner consultation B (sc) Difference df P in deviance Males GM -3.307 (0.188) - SAH (2) 1.198 ...
Dissociative seizures (DSs), also called psychogenic non-epileptic seizures, are a distressing an... more Dissociative seizures (DSs), also called psychogenic non-epileptic seizures, are a distressing and disabling problem for many patients in neurological settings with high and often unnecessary economic costs. The COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES) trial is an evaluation of a specifically tailored psychological intervention with the aims of reducing seizure frequency and severity and improving psychological well-being in adults with DS. The aim of this paper is to report in detail the quantitative and economic analysis plan for the CODES trial, as agreed by the trial steering committee. The CODES trial is a multicentre, pragmatic, parallel group, randomised controlled trial performed to evaluate the clinical effectiveness and cost-effectiveness of 13 sessions of cognitive behavioural therapy (CBT) plus standardised medical care (SMC) compared with SMC alone for adult outpatients with DS. The object...
Neurodegenerative diseases, such as dementia, have a profound impact on those with the conditions... more Neurodegenerative diseases, such as dementia, have a profound impact on those with the conditions and their family carers. Consequently, the accurate measurement of family carers' quality of life (QOL) is important. Generic measures may miss key elements of the impact of these conditions, so using disease-specific instruments has been advocated. This systematic review aimed to identify and examine the psychometric properties of disease-specific outcome measures of QOL of family carers of people with neurodegenerative diseases (Alzheimer's disease and other dementias; Huntington's disease; Parkinson's disease; multiple sclerosis; and motor neuron disease). Systematic review. Instruments were identified using 5 electronic databases (PubMed, PsycINFO, Web of Science, Scopus and the International Bibliography of the Social Sciences (IBSS)) and lateral search techniques. Only studies which reported the development and/or validation of a disease-specific measure for adult ...
Alzheimer's & dementia : the journal of the Alzheimer's Association, Jan 5, 2017
Family carers of people with dementia are their most important support in practical, personal, an... more Family carers of people with dementia are their most important support in practical, personal, and economic terms. Carers are vital to maintaining the quality of life (QOL) of people with dementia. This review aims to identify factors related to the QOL of family carers of people with dementia. Searches on terms including "carers," "dementia," "family," and "quality of life" in research databases. Findings were synthesized inductively, grouping factors associated with carer QOL into themes. A total of 909 abstracts were identified. Following screening, lateral searches, and quality appraisal, 41 studies (n = 5539) were included for synthesis. A total of 10 themes were identified: demographics; carer-patient relationship; dementia characteristics; demands of caring; carer health; carer emotional well-being; support received; carer independence; carer self-efficacy; and future. The quality and level of evidence supporting each theme varied. We n...
Social psychiatry and psychiatric epidemiology, 2017
Mental health-related stigma affects people with mental disorders and their families. We aimed to... more Mental health-related stigma affects people with mental disorders and their families. We aimed to investigate the experience of stigma among relatives of patients with schizophrenia in Belarus and formulate recommendations for anti-stigma interventions. We conducted and thematically analysed 20 interviews with relatives of people diagnosed with schizophrenia. Experience of discrimination, strategies to cope with it, and requests for interventions were examined. A number of themes related to the experience of stigma in the public life of relatives of people with schizophrenia were elicited in relation to: (1) mental health care (difficulties in contacting mental health professionals; in getting appropriate information; lack of alternatives to hospital treatment; absence of appropriate long-term care services); (2) employment of people living with schizophrenia and (3) contact with the police. Analysis of the strategies used to overcome difficulties revealed resignation and passive ac...
SynopsisAfter the journalists of a national newspaper had been issued with redundancy notices, a ... more SynopsisAfter the journalists of a national newspaper had been issued with redundancy notices, a prospective study was carried Out to examine the effect of the threat of their redundancy on minor psychiatric morbidity. Following the subsequent withdrawal of redundancy notices, there was considerable reduction in minor symptomatology, and the implications of this are discussed.
Journal of the American Medical Directors Association, Jan 18, 2017
Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people ... more Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people with dementia living in care homes is very limited. We investigated the people with dementia living in 67 care homes in London and Buckinghamshire, United Kingdom. Pain, dementia severity, neuropsychiatric symptoms, depression, agitation, and quality-of-life were measured using appropriate instruments at baseline (N = 967) and after 9 months (n = 629). Baseline prevalence of pain was 35.3% (95% CI 32.3-38.3). Pain severity was significantly correlated with dementia severity, neuropsychiatric symptoms, depression, agitation, and quality of life at both time points. Regular treatment with analgesics significantly reduced pain severity. Pain was significantly associated with more antipsychotic prescriptions. Pain was significantly associated (OR 1.48; 95% CI 1.18-1.85) with all-cause mortality during follow-up. Pain is an important determinant of neuropsychiatric symptoms, mortality, qualit...
The evidence base for the effectiveness of psychological interventions for patients with dissocia... more The evidence base for the effectiveness of psychological interventions for patients with dissociative non-epileptic seizures (DS) is currently extremely limited, although data from two small pilot randomised controlled trials (RCTs), including from our group, suggest that Cognitive Behavioural Therapy (CBT) may be effective in reducing DS occurrence and may improve aspects of psychological status and psychosocial functioning. The study is a multicentre, pragmatic parallel group RCT to evaluate the clinical and cost-effectiveness of specifically-tailored CBT plus standardised medical care (SMC) vs SMC alone in reducing DS frequency and improving psychological and health-related outcomes. In the initial screening phase, patients with DS will receive their diagnosis from a neurologist/epilepsy specialist. If patients are eligible and interested following the provision of study information and a booklet about DS, they will consent to provide demographic information and fortnightly data ...
Only a third of people with mental disorders seek professional help. In this study, we aimed to i... more Only a third of people with mental disorders seek professional help. In this study, we aimed to investigate attitudes toward help-seeking among non-help-seekers drawn from a community survey in South London. We conducted qualitative interviews with 24 participants with symptoms of mental disorders. We analyzed data using thematic analysis. Participants' reasons for not seeking professional help included perceiving their problems as normal or unsuitable for professional help, negative expectations of professional help, believing informal strategies were sufficient, fearing being stigmatized for having a mental disorder and help-seeking, and self-perceptions of being strong and/or self-reliant. A small number (n = 4) had resolved their problems. Participants with unresolved mental disorders (n = 20) had more chronic stressors, particularly about finances and family relationships, and greater concerns about professional help and stigma than other participants. Potential targets for...
The Journal of the Royal College of General Practitioners, Nov 1, 1988
The growth of alternative medicine poses particular problems for general practitioners working in... more The growth of alternative medicine poses particular problems for general practitioners working in the National Health Service. This paper reviews the subject and presents preliminary results of a two-stage study of the prevalence of use of alternative medicine in a south London practice. Extended interviews with users explored motivations for choice of treatment and attitudes towards orthodox and alternative health care. The study suggests that many patients are making use of alternative medicine in addition to their NHS consultations without the knowledge of their general practitioners. The clinical and ethical implications of this pattern of illness behaviour are discussed.
Aims. Decisions regarding disclosure of a mental health problem are complex and can involve recon... more Aims. Decisions regarding disclosure of a mental health problem are complex and can involve reconciling conflicting needs and values. This article provides a qualitative account of the beliefs and experiences of mental health service users regarding disclosure in employment contexts. Methods. Total sample of 45 individuals were interviewed in two study phases. In phase one, semi-structured interviews were carried out with 15 mental health service users. The transcripts were analysed using interpretative phenomenological analysis (IPA). In phase two, identified themes were further explored through interviews with mental health service users (n = 30) in three employment contexts: in paid employment (n = 10); in study or voluntary work (n = 10); and currently unemployed (n = 10). These were analysed using directed content analysis. Results. Four super-ordinate themes were drawn from phase one analysis: (1) public understanding of mental health problems; (2) the employment context; (3) ...
In a South London general practice a substantial proportion of patients in some age groups (35 an... more In a South London general practice a substantial proportion of patients in some age groups (35 and 45 yr) had tried alternative treatment. Satisfaction with the outcome was limited. The use of alternatives was associated with higher general practice consultation rates, especially among women. Qualitative interviews with users suggested that rapid cures for chronic conditions were rarely expected; rather, an alternative explanation for health problems was sought and a greater sense of autonomy in dealing with them. Negative attitudes towards modern medicine arose from perceptions of excessive technological intervention and iatrogenic disorders arising from long term drug treatment.
... cultural di-versity in health has most often been studied in the Asian community (Cochrane an... more ... cultural di-versity in health has most often been studied in the Asian community (Cochrane and Stopes-Roe 1977, 1981; Ananth 1978; Brewin ... Table 4. Joint effects on general practitioner consultation B (sc) Difference df P in deviance Males GM -3.307 (0.188) - SAH (2) 1.198 ...
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Papers by Joanna Murray