Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-25T01:22:18.969Z Has data issue: false hasContentIssue false
  • English
  • Français

Early Intervention in Psychotic Relapse: Cognitive Approaches to Detection and Management

Published online by Cambridge University Press:  06 October 2014

Max Birchwood
Max Birchwood*
Affiliation:
University of Birmingham
*
Northern Birmingham Mental Health NHS Trust, at All Saints Hospital, Lodge Road, Winson Green, Birmingham B18 5SD, UK
Get access

Abstract

Clinical observation and retrospective and prospective studies of relapsing psychosis have demonstrated that early symptoms of decompensation are observable in one half to two thirds of patients over a period of 1 to 4 weeks. Whilst the sensitivity of prodromal symptoms is established, their specificity is less certain, particularly at the first episode. The appearance of an “at risk” mental state, if not leading to decompensation, may nevertheless be part of a “transitional” stage to psychosis that is affected by psychological factors concerning the attributions that are made about a change in mental life. The research on prodromal signs is reviewed, with three areas of focus: prodromes as continuous versus discrete phenomena, sensitivity and specificity, and early intervention studies. A psychological model of the transitional process is described with case examples, together with an exploration of its implications for early intervention, again illustrated by case material.

Type
Research Article
Information
Behaviour Change , Volume 12 , Issue 1 , March 1995 , pp. 2 - 19
Copyright
Copyright © The Author(s) 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association (1987). Diagnostic and statistical manuel and mental disorders. 3rd Ed. Washington DC: Author.Google Scholar
Birchwood, M.J. (1992). Early intervention in schizophrenia. British Journal of Clinical Psychology, 31, 257–278.Google Scholar
Birchwood, M., Mason, R., & Macmillan, F. (1993). Depression, demoralisation and control over psychotic illness. Psychological Medicine, 23, 387–395.CrossRefGoogle ScholarPubMed
Birchwood, M., Smith, J., & Cochrane, R. (1991). Specific and non-specific effects of educational intervention for families living with schizophrenia: A comparison of three methods. British Journal of Psychiatry, 160, 806–814.Google Scholar
Birchwood, M., Smith, J., Macmillan, F., Hogg, B., Prasad, R., Harvey, C., & Bering, S. (1989). Predicting relapse in schizophrenia: The development and implementation of an early signs monitoring system using patients and families as observers. Psychological Medicine, 19, 649–56.Google Scholar
Brewin, C. (1988). Cognitive foundations of clinical psychology. London: Lawrence Erlbaum.Google Scholar
Brier, A., & Strauss, J.S. (1983). Self control in psychotic disorders. Archives of General Psychiatry, 40, 1141–1145.Google Scholar
Buchanan, A. (1992). A two year prospective study of treatment compliance in patients with schizophrenia. Psychological Medicine, 22, 787–797.Google Scholar
Carpenter, W.I., Hanlon, T.E., Heinrichs, D.W., Summerfelt, A.T., Kirkpatrick, B., Levine, J., & Buchanan, R.W. (1990). Continuous versus targetted medication in schizophrenic outpatients: Outcome results. American Journal of Psychiatry, 147, 1138–1148.Google Scholar
Chadwick, P., & Birchwood, M. (1994). The omnipotence of voices: A cognitive approach to auditory hallucinations. British Journal of Psychiatry, 164, 190–201.Google Scholar
Chapman, J. (1966). The early symptoms of schizophrenia. British Journal of Psychiatry, 112, 225–251.Google Scholar
Clements, D., & Turpin, G. (1992). Vulnerability theories. In Birchwood, M. & Tarrier, N., Innovations in the psychological management of schizophrenia (pp. 21–48). Chichester, UK: Wiley.Google Scholar
Davis, E., & Birchwood, M. (1995). Learning to discriminate the relapse prodrome in psychosis: The impact of a relapse management intervention. Unpublished manuscript.Google Scholar
Davis, J.M. (1975). Overview: Maintenance therapy in psychiatry: I. Schizophrenia. American Journal of Psychiatry, 132, 1237–1245.Google ScholarPubMed
Derogatis, L., Lipman, R., Covi, L. (1973). SCL-90: An outpatient psychiatric rating scale: Preliminary report. Psychopharmacology Bulletin, 9, 13–17.Google Scholar
Donlon, P.T., & Blacker, K.H. (1975). Clinical recognition of early schizophrenic decompensation. Disorders of the Nervous System, 36, 323–330.Google Scholar
Falloon, J.R.H., Boyd, J.L., & McGill, C.W. (1985). Family management in the prevention of morbidity of schizophrenia. Archives of General Psychiatry, 42, 887–896.Google Scholar
Foulds, G.W. (1976). The hierarchical nature of personal illness. London: Academic.Google Scholar
Gaebel, V., Frick, W., Kopcke, M. (1994). Early neuroleptic intervention in schizophrenia. British Journal of Psychiatry, 163, 8–12.Google Scholar
Heinrichs, D. (1985). Early insight and the management of schizophrenic decompensation. The Journal of Nervous and Mental Disease, 173, 133.Google Scholar
Heinrichs, D.W., & Carpenter, W.T. (1985). Prospective study of prodromal symptoms in schizophrenic relapse. American Journal of Psychiatry, 143, 3–19.Google Scholar
Herz, M., & Melville, C. (1980). Relapse in schizophrenia. American Journal of Psychiatry, 137, 801–812.Google ScholarPubMed
Hirsch, S.R., & Jolley, A.G. (1989). The dysphoric syndrome in schizophrenia and its implications for relapse. British Journal of Psychiatry, (Suppl. 5), 46–50.Google Scholar
Hogan, T.P., Awad, A.G., & Eastwood, M.R. (1985). Early subjective response and prediction of outcome to neuroleptic drug treatment in schizophrenia. Canadian Journal of Psychiatry, 30, 246–48.Google Scholar
Hogarty, G.E., Anderson, C.M., Reiss, D.J. (1991). Family psycho-education, social skills training and maintenance chemotherapy in the after care treatment of schizophrenia: II. Two year effects of a controlled study on relapse and adjustment. Archives of General Psychiatry, 48, 340–347.Google Scholar
Hogarty, G.E., McEvoy, J.P., Munetz, M. (1988). Dose of fluphenazine, familial expressed emotion and outcome in schizophrenia. Archives of General Psychiatry, 45, 797–805.Google Scholar
Hoge, S.K. (1990). A prospective multicentre study of patients' refusal of anti-psychotic medication. Archives of General Psychiatry, 47, 949–56.Google Scholar
Jolley, A.G., Hirsch, S.R., Morrison, G., McRink, A., & Wilson, L. (1990). Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenia outpatients: Clinical and social outcome at two years. British Medical Journal, 301, 847–42.Google Scholar
Loebel, A., Lieberman, J., & Jose, M. (1992). Duration of psychosis and outcome in first episode schizophrenia. American Journal of Psychiatry, 149, 1183–1188.Google Scholar
Maher, B.A. (1988). Anomalous experiences and delusional thinking: The logic of explanations. In Oltmanns, T.F. & Maher, B.A. (Eds.), Delusional Beliefs. New York: Wiley.Google Scholar
Malla, A.K., & Norman, R. (1994). Prodromal symptoms in schizophrenia. British Journal of Psychiatry, 164, 487–493.Google Scholar
Marder, S.R., Mintz, J., Van Putten, T., Lebell, M., Wirsching, W., & Johnstone-Cronk, K. (1991). Psychopharmacology Bulletin, 27, 79–82.Google Scholar
Marder, S.R., Van Putten, T., Mintz, J., Lebell, M., McKenzie, J., & Faltico, G. (1984a). Maintenance therapy in schizophrenia: New findings. In Kane, J. (Ed.), Drug maintenance strategies in schizophrenia (pp. 31–49). Washington, DC: American Psychiatric Press.Google Scholar
Marder, S.R., Van Putten, T., Mintz, J., McKenzie, J., Lebell, M., Faltico, G., & May, R.P. (1987). Low and conventional dose maintenance therapy with fluphenazine decanoate. Archives of General Psychiatry, 44, 518–521.Google Scholar
Marder, S.R., Van Putten, T., Mintz, J., McKenzie, J., Lebell, M., Faltico, G., & May, R.P. (1984b). Costs and benefits of two doses of fluphenazine. Archives of General Psychiatry, 41, 1025–1029.Google Scholar
McCandless-Glincher, L., McKnight, S., Hamera, E., Smith, B.L., Peterson, K., Plumlee, A.A. (1986). Use of symptoms by schizophrenics to monitor and regulate their illness. Hospital and Community Psychiatry, 37, 929–933.Google Scholar
McGlashan, T.H. (1988). A selective review of recent North American follow-up studies of schizophrenia. Schizophrenia Bulletin, 14, 515–542.Google Scholar
Mueser, K.T., Bellack, A.S., Wade, J.H., Sayers, S.Z., & Rosenthal, L.K. (1992). An assessment of the educational needs of chronic psychiatric patients and their relatives. British Journal of Psychiatry, 160, 668–673.CrossRefGoogle ScholarPubMed
Overall, J.E., & Graham, D.R. (1962). The brief psychiatric rating scale. Psychological Reports, 10, 99–812.Google Scholar
Roberts, G. (1991). Delusional belief systems and meaning in life: A preferred reality. British Journal of Psychiatry, 159(Suppl. 14), 19–28.Google Scholar
Sashidharan, S. (1993). Afro-Caribbeans and schizophrenia: The ethnic vulnerability hypothesis examined. International Review of Psychiatry, 5, 129–144.Google Scholar
Shepherd, G. (1990). Case management. Health Trends, 22, 59–61.Google Scholar
Smith, M., & Birchwood, M., (1990). Relatives and patients as partners in the management of schizophrenia. British Journal of Psychiatry, 156, 654–660.Google Scholar
Smith, J., Birchwood, M., & Haddrell, A. (1992). Challenging schizophrenic patients' construction and understanding of their illness: The effect of residual symptoms. Journal of Mental Health, 1, 61–70.CrossRefGoogle Scholar
Strauss, J.S. (1991). The person with delusions. British Journal of Psychiatry, 159(Suppl. 14), 57–61.Google Scholar
Subotnik, K.L., & Nuechterlein, K.H. (1988). Prodromal signs and symptoms of schizophrenic relapse. Journal of Abnormal Psychology, 97, 405–412.Google Scholar
Tarrier, N., Barrowclough, C., & Bamrah, J. (1991). Prodromal signs of relapse in schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 26, 157–161.CrossRefGoogle ScholarPubMed
Weiner, B. (1985). Spontaneous causal thinking. Psychological Bulletin, 97, 74–84.Google Scholar
Weiner, B. (1986). An attributional theory of motivation and emotion. New York: Springer-Verlag.Google Scholar
Wing, J.K., Cooper, J., & Sartorious, N. (1974). The description and classification of psychiatric symptomology: An instruction manual for the PSE and CATEGO systems. London: Cambridge University Press.Google Scholar