important methodological issue in such studies. It is necessary to ensure that uniform techniques of practicing yoga are taught to all participants. In our study, the yoga therapist who imparted training in yoga and exercise to the patient groups was a trained therapist with a graduate (Bachelor of Science) degree in yoga therapy from a deemed university of yoga (Swami Vivekananda Yoga Anusandhana Samsthana), which has a prescribed curriculum for the training (http://www.svyasa.org).

BackgroundAmong the 10 categories of personality disorders (PDs), interventions for antisocial and borderline personality disorder are best studied. However, the remaining PDs also pose major problems in everyday health care settings. People affected often additionally present with Axis-I disorders such as substance-related, mood or anxiety disorders, and are among those most difficult to treat. Cluster A PDs (paranoid, schizoid, schizotypal) are of particular significance as some authors argue that they may be part of a continuum of mental disorders and be considered as sub-syndrome of schizophreniaMethodsIn the context of Cochrane Collaboration reviews for Cluster A, B and C PDs, exhaustive literature searches were completed to identify the current RCT evidence for PD treatments. Retrievals were assessed and evaluated by two reviewers independently and trials for Cluster A PD were identified.ResultsOnly very few (under five) RCTs specifically for Cluster A PDs were identified. Some studies reported on mixed PD samples but it was not always possible to extract data specifically for Cluster A disorders. Participants mostly also suffered from Axis-I disorders. Reported outcomes also focus on Axis-I disorder outcomes or general measures such as overall functioning rather than specific PD symptoms.ConclusionsThe current evidence for psychpathological treatment of Cluster A PD is sparse and does not allow for distinct treatment recommendations. Symptom-driven treatment regimes as suggested by several guidelines are not supported by current evidence.

IntroductionASPD has a prevalence of 2-3% in the general population but rates in prison have been reported as 50% to 75%. ASPD is associated with significant psychiatric and medical comorbidity, high offending rates, poor psychosocial adaptation and premature death. Outcomes are poor. There is little consensus regarding the most effective intervention for the condition.Aims and objectivesTo conduct systematic literature reviews to identify randomised controlled trials for either pharmacological or psychological interventions for ASPD.MethodsSystematic literature reviews (Cochrane reviews).ResultsFor the review on psychological interventions only 11 studies could be included with a total of 411 participants, but only five reported data separately for the subgroup of ASPD. Nine of the studies looked at participants with substance misuse problems who also suffered from ASPD. Only three types of interventions were effective (contingency management, CBT and a specific programme for those convicted for driving whilst intoxicated). These interventions showed positive results for substance misuse related outcomes but not for any others behaviours or symptoms. For the pharmacological review 10 studies were identified, anticonvulsants were the most commonly used drugs with some evidence of effectiveness on aggression, however, study quality was poor.ConclusionsDespite the considerable personal and societal consequences of ASPD, very little research is carried out with regards to interventions in this patient group and subsequently the evidence base to support any interventions is extremely limited.

Cormac I, Brown A, Creasey S, Ferriter M, Huckstep B. A retrospective evaluation of the impact of total smoking cessation on psychiatric inpatients taking clozapine.Objective: To investigate the effect of a complete smoking ban on a group of psychiatric inpatients maintained on the antipsychotic medication clozapine.Method: Retrospective data on clozapine dose and plasma levels were collected from a three month period before and a six month period after the introduction of the smoking ban.Results: Before the ban only 4.2% of patients who smoked had a plasma clozapine level ≥1000 μg/l but after the ban this increased to 41.7% of the sample within the six month period following the ban despite dose reductions.Conclusion: Abrupt cessation of smoking is associated with a potentially serious risk of toxicity in patients taking clozapine. Plasma clozapine levels must be monitored closely and adjustments made in dosage, if necessary, for at least six months after cessation.

OBJECTIVES:To evaluate computerised cognitive behaviour therapy (CCBT) for the treatment of anxiety, depression, phobias, panic and obsessive-compulsive behaviour (OCD). The software packages to be considered include Beating the Blues (BtB), Overcoming Depression: a five areas approach, FearFighter (FF), Cope and BT Steps. Other packages or programmes incorporating CCBT were also considered. DATA SOURCES:Electronic databases from 1966 to March 2004. Evidence submitted by sponsors for CCBT products. REVIEW METHODS:A systematic review was a review of the literature and the evidence submitted by sponsors for each of the products. A series of cost-effectiveness models was developed and run by the project team for the five CCBT products across the three mental health conditions. RESULTS:Twenty studies were identified in the clinical effectiveness review. The analysis of these results showed some evidence that CCBT is as effective as therapist-led cognitive behaviour therapy (TCBT) for the treatment of depression/anxiety and phobia/panic and is more effective than treatment as usual (TAU) in the treatment of depression/anxiety. CCBT also appears to reduce therapist time compared with TCBT. When reviewing cost-effectiveness studies, only one published economic evaluation of CCBT was found. This was an economic evaluation of the depression software BtB alongside a randomised controlled trial (RCT), which found that BtB was cost-effective against TAU in terms of cost per quality-adjusted life-year (QALY) (less than 2000 pounds), however it contained weaknesses that were then addressed in the cost-effectiveness model developed for the study. The results of the model for the depression software packages in terms of incremental cost per QALY compared with TAU and the chance of being cost-effective at 30,000 pounds per QALY were for BtB 1801 pounds and 86.8%, for Cope 7139 pounds and 62.6% and for Overcoming Depression 5391 pounds and 54.4%. The strength of the BtB software being that it has been evaluated in the context of an RCT with a control group. The subgroup analysis found no differences across the severity groupings. For phobia/panic software, the model showed an incremental cost per QALY of FF over relaxation was 2380 pounds. Its position compared with TCBT is less clear. When modelling OCD packages, using the practice-level licence cost meant that BT Steps was dominated by TCBT, which had significantly better outcomes and was cheaper. However, the cheaper PCT licence resulted in the incremental cost-effectiveness of BT Steps over relaxation being 15,581 pounds and TCBT over BT Steps being 22,484 pounds. CONCLUSIONS:The study findings are subject to substantial uncertainties around the organisational level for purchasing these products and the likely throughput. This is in addition to concerns with the quality of evidence on response to therapy, longer term outcomes and quality of life. The position of CCBT within a stepped care programme needs to be identified, as well as its relationship to other efforts to increase access to CBT and psychological therapies. Research is needed to compare CCBT with other therapies that reduce therapist time, in particular bibliotherapy and to explore the use of CCBT via the Internet. Independent research is needed, particularly RCTs, that examine areas such as patient preference and therapist involvement within primary care.

Objectives: To summarise the available evidence on the clinical effectiveness and cost- effectiveness of psychological therapies including dialectical behaviour therapy ( DBT) for borderline personality disorder ( BPD).Data sources: Electronic databases were searched up to March 2005.Review methods: Relevant studies were assessed using standard checklists and data were abstracted by two reviewers using standardised forms. Separate economic evaluations were undertaken for six selected randomised controlled trials ( RCTs). Cost- effectiveness was assessed in terms of cost per parasuicide event avoided in all six trials and cost per quality- adjusted life- year ( QALY) in four of them. All results are at 2003 - 4 prices and for 12 months follow- up.Results: Nine RCTs and one non- RCT of moderate to poor quality were identified in the clinical effectiveness review. They provided some evidence that DBT is more effective than treatment as usual ( TAU) for the treatment of chronically parasuicidal and drug-dependent borderline women; that DBT- orientated therapy is more effective than client- centred therapy ( CCT) for the treatment of BPD; and that DBT is as effective as comprehensive validation therapy plus 12-Step for the treatment of opioid- dependent borderline women. There was also some evidence that partial hospitalisation is more effective than TAU in the treatment of BPD, good evidence that manual- assisted cognitive behavioural therapy ( MACT) is no more effective than TAU in the treatment of BPD and some evidence that interpersonal group therapy is no more effective than individual mentalisation- based partial hospitalisation ( MBT) for the treatment of BPD. However, these results should be interpreted with caution as not all studies were primarily targeted to borderline symptoms and there were considerable differences between the studies. The assessment of cost- effectiveness found a mix of results in the four trials of DBT, along with the high levels of uncertainty and the limitations in the analyses. The findings do not support the cost- effectiveness of DBT though they suggest it has the potential to be cost- effective. The results for MBT are promising, though again surrounded by a high degree of uncertainty and for MACT, the analysis suggests that the intervention is unlikely to be cost- effective.Conclusions: The overall efficacy of psychological therapies is promising; however, at this stage the evidence is inconclusive. The cost- effectiveness of the intervention in six RCTs examined, however, does not support the cost- effectiveness of DBT although potential is suggested. There is a need for considerable research in this area. This research should involve appropriately powered head- to- head RCTs of psychological therapies; a survey of current practice and the use of the full range of services by people with BPD to inform future economic analyses; full resource-use data collected in the context of pragmatic clinical trials; psychometric assessment of the validity of the EQ- 5D or other generic and condition- specific preference- based measures in BPD, and the development of a more formal cost- effectiveness model using the above data.

Journal of Psychiatric and Mental Health NursingVolume 12, Issue 3 p. 380-382 Review of seclusion policies in high secure hospitals and medium secure units in England, Scotland and Wales I. CORMAC, I. CORMAC Consultant Forensic Psychiatrist, Rampton Hospital, Retford, NottsSearch for more papers by this authorI. RUSSELL, I. RUSSELL Consultant Forensic Psychiatrist, Reaside Clinic, Birmingham Great Park, BirminghamSearch for more papers by this authorM. FERRITER, M. FERRITER Rampton Hospital, Retford, Notts, UKSearch for more papers by this author I. CORMAC, I. CORMAC Consultant Forensic Psychiatrist, Rampton Hospital, Retford, NottsSearch for more papers by this authorI. RUSSELL, I. RUSSELL Consultant Forensic Psychiatrist, Reaside Clinic, Birmingham Great Park, BirminghamSearch for more papers by this authorM. FERRITER, M. FERRITER Rampton Hospital, Retford, Notts, UKSearch for more papers by this author First published: 05 May 2005 https://doi.org/10.1111/j.1365-2850.2005.00833.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume12, Issue3June 2005Pages 380-382 RelatedInformation

There is a considerable body of literature supporting an association between separation from parent in childhood and later personality disorder. This study compares a 10-year cohort of high secure hospital patients who had either a personality disorder or schizophrenia, but with no other significant psychiatric comorbidity. The information source was the Special Hospitals Case Register. The most important finding was a statistically significant difference in the rates of child-parent separation between the two groups. In the personality disorder group, 119/147 (81%) of the patients had been separated from one or both parents before the age of 16 compared to 178/289 (62%) in the schizophrenia group.

There is a considerable body of literature supporting an association between separation from parent in childhood and later personality disorder. This study compares a 10-year cohort of high secure hospital patients who had either a personality disorder or schizophrenia, but with no other significant psychiatric comorbidity. The information source was the Special Hospitals Case Register. The most important finding was a statistically significant difference in the rates of child-parent separation between the two groups. In the personality disorder group, 119/147 (81%) of the patients had been separated from one or both parents before the age of 16 compared to 178/289 (62%) in the schizophrenia group.

Parents of 22 patients diagnosed with schizophrenia, and receiving care in a secure forensic setting, were interviewed to elicit their views on the causes of the disorder, the emotional burden and the helpfulness of others when seeking support. Pathological parenting theories of causation were rated the least important, and biological and life-event models the most. Stress, loss and fear were the most commonly reported reactions. Violence, withdrawal and verbal aggression were most often identified as behaviours causing difficulty. Many participants felt guilt, usually in the absence of being blamed. Family members and self-help groups were recalled as being of most help, and professional staff were considered to be of least help. Parenting a son or daughter with schizophrenia frequently causes considerable emotional distress, often with perception of unhelpful responses from professional staff. Parents often blame themselves for the disorder, even when not blamed by others. Guilt does not appear to arise from belief in a pathological parenting model of schizophrenia. Factors contributing to self-blame in this group are discussed, together with suggestions for appropriate therapeutic intervention.