Thursday Busy day.

In to Hammy House for 8.50 dropping Ally off on the way. Poor training system trainer boy is late. Problems with trains - roads were bad too. Have the necessary and then its up to meet with Tony via the library. Tracey kindly fills in Allys work experience form for next year. Good meeting with Tony - then half a days annual leave.
Meet with Darren - then of to MRC trial steering group gig. A bit of background :-

BACKGROUND OF THE PROJECT

The project is funded by the Medical Research Council (MRC) and is a cluster randomised controlled trial designed to assess the feasibility and effectiveness of training Key Workers in an enhanced form of relapse prevention for people with bipolar disorder and their relatives. The study is based at the University of Liverpool and participants will be recruited from 3 NHS trusts in the North West. The Principal Investigator is Dr Fiona Lobban.

Summary of protocol

Co-applicants : Prof Richard Morriss, Dr Peter Kinderman, Dr Carol Gamble

Bipolar Disorder (BD) is a common and severe form of mental illness characterised by repeated relapses of mania or depression. Recurrence rates are high at around 50% at one year and 70% at four years. Pharmacotherapy is the main treatment currently offered, but this has only limited effectiveness. Surveys of patient organisations in the US and UK reveal a strong wish by patients for both self-help and psychological treatments in addition to pharmacotherapy. One form of intervention is to teach patients with BD to recognise and manage early warning signs (EWS) of mania and depressive episodes.

In this study we aim to develop the RP approach described by Perry et al. The key developments will involve increased focus on identifying and coping with early signs of depressive relapse, and involving a friend or relative to aid this process. Experience with RP suggests that with refinement this intervention alone can be delivered in 4 sessions. The ERP intervention in this study will be six sessions in total and will be designed to be offered by Key Workers in Community Mental Health Teams (CMHTs), thus increasing availability within an NHS setting. The approach is consistent with the Department of Health remit for CMHTs to offer psychological interventions aimed at preventing relapse in people with severe mental illnesses ("such as schizophrenia and bipolar disorder") and to work with both patients and carers. The study therefore addresses the important issue of transferring evidence-based interventions from psychological research settings into NHS practice, which can then be implemented nationally and internationally.

Ten CMHTs will be randomised in a 1:1 ratio to receive training in ERP or to administer TAU. It is estimated that there will be 4 KWs in each team who have active caseloads of people with BD. Training will be offered in 2 separate groups of 10 KWs in order to allow training to be run using a workshop format. It is estimated that each KW will have a current caseload of approximately 3 patients eligible for the study giving a sample of 120 patients.

The proportion of KWs meeting criteria for successful demonstration of all key components of ERP at the end of training will be reported. Estimates of treatment effect will be calculated for each outcome allowing for the effects of within and between cluster variation. Qualitative interviews with service users, carers and key workers to assess their experiences of the intervention will be analysed using thematic analysis.

Then off to gym for pre booked meeting with Marvin who is a great encourager. He is busy - Sarah steps in and rewrites me a program. Well impressed and it feels good. I go on a rowing machine for the first time. Top stuff.