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The SUPEREDEN3 study, a phase II randomized controlled trial, suggests that social recovery therapy (SRT) is useful in improving functional outcomes in people with first episode psychosis. SRT incorporates cognitive behavioural therapy (CBT) techniques with case management and employment support, and therefore has a different emphasis to traditional CBT for psychosis, requiring a new adherence tool.
This paper describes the SRT adherence checklist and content of the therapy delivered in the SUPEREDEN3 trial, outlining the frequency of SRT techniques and proportion of participants who received a full therapy dose. It was hypothesized that behavioural techniques would be used frequently, consistent with the behavioural emphasis of SRT.
Research therapists completed an adherence checklist after each therapy session, endorsing elements of SRT present. Data from 1236 therapy sessions were reviewed to determine whether participants received full, partial or no therapy dose.
Of the 75 participants randomized to receive SRT, 57.3% received a full dose, 24% a partial dose, and 18.7% received no dose. Behavioural techniques were endorsed in 50.5% of sessions, with cognitive techniques endorsed in 34.9% of sessions.
This report describes an adherence checklist which should be used when delivering SRT in both research and clinical practice. As hypothesized, behavioural techniques were a prominent feature of the SRT delivered in SUPEREDEN3, consistent with the behavioural emphasis of the approach. The use of this adherence tool would be considered essential for anyone delivering SRT looking to ensure adherence to the model.
Affective attitudes and behaviours manifested within the family environment have been characterised as expressed emotion (EE). High EE environments have been robustly shown to put psychosis patients at a greater risk of relapse compared with low EE exposure. Positive EE dimensions (warmth; positive remarks) have received far less attention than negative EE dimensions such that EE has become synonymous with a negative family atmosphere; the predictive value of positive EE dimensions is largely ignored. A systematic review examining the relationship between positive family EE and outcomes in psychosis is needed.
A systematic search was conducted. Studies reporting bias and study quality were assessed.
A total of 2368 studies were identified. Of these, 27 met eligibility criteria reporting outcomes including relapse, symptomatology, social functioning and life satisfaction. Relapse was the most commonly measured outcome. Stronger evidence emerged for the association between EE warmth and outcomes compared with EE positive remarks, with effects mostly evident in the early phase of psychosis. Evidence for protective effects of warmth on relapse was found up to 9 months follow-up. No effects were evident between positive remarks and relapse. Studies assessing symptom outcomes showed inconsistent findings. Evidence for an association with social functioning was evident, primarily in at risk mental states. Warmth and positive remarks predicted life satisfaction.
The positive aspects of EE require further investigation with longitudinal research designs. Clinical interventions should focus not only on reducing negative aspects of EE but also foster warmth within families in the context of psychosis.
This paper describes three case examples from a recent trial of family intervention specifically designed for people of African-Caribbean descent. These examples, told from the therapists’ perspectives, highlight key components of the intervention and issues that arose in working with this client group. Findings from the study suggest that it is possible to engage this client-group in family therapy similar to traditional evidenced-based family interventions, although as illustrated in the paper, it is important that therapists pay attention to themes that are likely to be particularly pertinent for this group, including experiences of discrimination and mistrust of services. The use of Family Support Members, consisting of members of the person's care team or volunteers recruited from the community, may also help support people to engage in therapy in the absence of biological relatives.
Background: Guilt is commonly associated with distress and psychopathology. However, there is a lack of validated measures that assess how people cope with this aversive emotional and cognitive experience. Aims: We therefore developed and validated a self-report measure that assesses how people manage their guilt: the Guilt Management Scale (GMS). Method: The GMS was administered to a non-clinical (n = 339) and clinical (n = 67) sample, alongside other validated measures of guilt severity, coping, thought control and psychological distress. Results from a principal component analysis (PCA) and assessments of test–retest reliability and internal consistency are presented. Results: The PCA yielded a six subscale solution (Self-Punishment, Reparation, People-Focused, Spirituality, Avoidance and Metacognition), accounting for 56.14% of variance. Test–retest reliability and internal consistency was found to be good–excellent for the majority of subscales. Across samples, Self-Punishment was related to higher levels of guilt and distress whilst Metacognition and Reparation were related to less guilt and distress in the non-clinical sample only. Conclusions: This paper provides preliminary evidence for the psychometric properties of the GMS in a non-clinical sample. With development and validation in clinical samples, the GMS could be used to inform psychological formulations of guilt and assess therapy outcomes.
The mental and physical health of individuals with a psychotic illness are typically poor. Access to psychosocial interventions is important but currently limited. Telephone-delivered interventions may assist. In the current systematic review, we aim to summarise and critically analyse evidence for telephone-delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder, including (i) relapse, (ii) adherence to psychiatric medication and/or (iii) modifiable cardiovascular disease risk behaviours.
Ten peer-reviewed and four grey literature databases were searched for English-language studies examining psychosocial telephone-delivered interventions targeting relapse, medication adherence and/or health behaviours in adults with a psychotic disorder. Study heterogeneity precluded meta-analyses.
Twenty trials [13 randomised controlled trials (RCTs)] were included, involving 2473 participants (relapse prevention = 867; medication adherence = 1273; and health behaviour = 333). Five of eight RCTs targeting relapse prevention and one of three targeting medication adherence reported at least 50% of outcomes in favour of the telephone-delivered intervention. The two health-behaviour RCTs found comparable levels of improvement across treatment conditions.
Although most interventions combined telephone and face-to-face delivery, there was evidence to support the benefit of entirely telephone-delivered interventions. Telephone interventions represent a potentially feasible and effective option for improving key health priorities among people with psychotic disorders. Further methodologically rigorous evaluations are warranted.
The objective of the present study was to evaluate intakes and serum levels of vitamin A, vitamin E, and related compounds in a cohort of maternal–infant pairs in the Midwestern USA in relation to measures of health disparities. Concentrations of carotenoids and tocopherols in maternal serum were measured using HPLC and measures of socio-economic status, including food security and food desert residence, were obtained in 180 mothers upon admission to a Midwestern Academic Medical Center labour and delivery unit. The Kruskal–Wallis and independent-samples t tests were used to compare measures between groups; logistic regression models were used to adjust for relevant confounders. P < 0·05 was considered statistically significant. The odds of vitamin A insufficiency/deficiency were 2·17 times higher for non-whites when compared with whites (95 % CI 1·16, 4·05; P = 0·01) after adjustment for relevant confounders. Similarly, the odds of being vitamin E deficient were 3·52 times higher for non-whites (95 % CI 1·51, 8·10; P = 0·003). Those with public health insurance had lower serum lutein concentrations compared with those with private health insurance (P = 0·05), and living in a food desert was associated with lower serum concentrations of β-carotene (P = 0·02), after adjustment for confounders. Subjects with low/marginal food security had higher serum levels of lutein and β-cryptoxanthin compared with those with high food security (P = 0·004 and 0·02 for lutein and β-cryptoxanthin). Diet quality may be a public health concern in economically disadvantaged populations of industrialised societies leading to nutritional disadvantages as well.
Background: Childhood adversity, dissociation and adult attachment have all been implicated in the development of hallucinations or ‘voice-hearing’. Testing psychological models in relation to subclinical phenomena, such as proneness to hallucinations in non-clinical samples, provides a convenient methodology to develop understanding of the processes and mechanisms underlying clinical symptoms. Aims: This paper investigates the relative contribution of childhood adversity, dissociation and adult attachment in explaining hallucination proneness in a non-clinical sample. Methods: Students and staff with no previous contact with secondary care at the University of Manchester were recruited. Participants completed a series of self-report measures: the Launay‒Slade Hallucination Scale (LSHS), the Relationship Scale Questionnaire (RSQ), the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Schedule (DES II) and the Positive and Negative Affect Schedule (PANAS). Results: As hypothesized, insecure attachment, childhood adversity and dissociative symptoms were correlated with hallucination proneness. Multiple regression analysis, controlling for confounds of age and negative affect, indicated that the RSQ, CTQ and DES II predicted hallucination proneness. Only DES II and RSQ avoidant attachment were significant independent predictors in the final model. Conclusions: This study provides further evidence to support the idea that attachment and dissociation are important psychological mechanisms involved in voice-hearing proneness. Further testing is required with a clinical population.
Attachment theory may develop understanding of the occurrence and maintenance of persecutory delusions. This study investigates the role of dispositional attachment and contextually primed secure base attachment representations in the occurrence of paranoid thinking. Sixty participants were randomly allocated to one of three conditions: a secure attachment priming condition, a positive affect condition, or a neutral control condition. Following priming, all participants were exposed to a paranoia induction. State paranoia was measured at baseline and following the paranoia induction. Dispositional insecure attachment was associated with both trait and state paranoid thinking. Contrary to predictions, the secure attachment prime did not appear to buffer paranoid thinking and had a negative impact for participants with high levels of attachment anxiety, highlighting the potentially aversive effects of exposure to secure attachment material in those with existing insecure attachment styles.
Ways of coping with stressful situations can be categorized as problem-focused, emotion-focused, and dysfunctional. Methods of controlling intrusive thoughts, which are frequently associated with psychological distress, have also been classified into different subgroups. This study assesses associations between methods of coping and thought control, and how these relate to distress. Sixty-eight participants were recruited from outpatient psychology services and completed measures of distress, coping, and thought control. Problem-focused coping strategies and both distraction and social thought-control strategies were associated with each other and with lower distress. Conversely, dysfunctional coping strategies and both worry and punishment thought-control strategies were associated with each other and with higher distress. Future research and the clinical implications are discussed.
The common edible fig is a subcanopy tree that has invaded many of the remnant riparian forests of California's Central Valley. Fig is unusual in its ability to invade low-light, low-disturbance, native-plant–dominated environments. Dendrochronology combined with regression and spatial analyses allowed us to empirically quantify the expansion rate and spatial pattern of the fig invasion into the native plant community at Caswell Memorial State Park (Ripon, CA) over a 70-year invasion period. Fig uses a combination of short-distance dispersal, which results in constant, linear expansion at source population sites and long-distance dispersal, which eventually leads to high recruitment of satellite populations in ideal environments. Although fig initially experienced a long lag in its invasion rate, at the time of this study, it was expanding at an exponential rate at the landscape scale in Caswell. We identified a number of characteristics intrinsic to the fig population (shade suppression, pollinator presence, highly specialized reproduction, and propagule pressure) as well as extrinsic characteristics of the receiving environment (hydrologic alteration from the construction of a dam, safe sites for juvenile recruitment, and target effects from environmental heterogeneity) that may have influenced the rate and pattern of fig invasion. The Central Valley riparian forests have been reduced to less than 6% of their original area, and invasive fig is a significant threat to the remaining fragments of this important vegetation community. We include suggestions for fig eradication based on knowledge gained in this study.
Background: There is a strong evidence base for psychological treatments in younger adults with schizophrenia, but limited work has been done on adapting these interventions for older people. Aims: We describe a study of a pilot psychosocial intervention group specifically designed to meet the needs of older people with schizophrenia in NHS settings. Method: We used a mixed-methods approach to evaluate the group. We assessed feasibility and acceptability by monitoring uptake and retention in the study. We used a within groups design comparing participants on a range of potentially relevant outcomes at baseline and posttreatment. Treatment acceptability was also assessed by semi-structured interviews conducted at the end of treatment. Results: We recruited 11 participants to the study and 7 of these completed the majority of the group sessions. At a group level participants made improvements in self-esteem and negative symptoms that were statistically significant even in this small sample. Feedback interviews suggested that participants valued the social contact provided by the group and made actual changes in their day-to-day lives as a result of attending. Conclusion: The intervention could offer help with some of the secondary disability associated with the diagnosis of schizophrenia and is acceptable to older adults. Further evaluation is, however, warranted.
We evaluated A/H1N1 influenza in healthcare workers (HCWs) and in a flu room during the 2009 pandemic. The flu room aided HCW care and management by facilitating rapid diagnosis and treatment. Absence of fever was common, and symptoms were nonspecific. A higher rate of H1N1 occurred in HCWs deployed in acute services.
Nineteenth century negatives and positives in the collections of the National Museums of Scotland (NMS) and the National Galleries of Scotland (NGS) were analysed non-destructively to identify the techniques used in their manufacture. Modern positive and negative images prepared using known nineteenth century processes were also analysed for comparison. Air-path energy dispersive x-ray fluorescence analysis and controlled pressure scanning electron microscopy with energy dispersive microanalysis enabled the images to be divided into groups based on the levels of bromine, iodine and silver, and the likely processes used inferred. An early group of positives were probably sensitised with either silver chloride or silver bromide and fixed with potassium bromide. However, most positives were probably sensitised with silver chloride and fixed with sodium thiosulphate. Most negatives were probably sensitized with silver iodide and fixed with potassium bromide (predominant), sodium thiosulphate or potassium iodide. Cobalt and arsenic are present due to the use of smalt in the production of white paper. Copper and zinc are attributed to incorporation of fragments of brass buttons left on the rags used in paper production, observed as small blue spots. The presence of iron, sometimes visible as orange spots, may be from rust off the paper making machines.
The inpatient unit faces many challenges in the effort to deliver comprehensive psychiatric care to acutely ill patients with minimal lengths of stay. Cognitive behaviour therapy (CBT), a structured, problem-focused, time-limited form of treatment has been shown to be a promising intervention with the inpatient population. This paper describes a group-oriented inpatient CBT programme for women and reports pilot data on the experiences of 78 adult female patients. Repeated-measures ANOVAs revealed that participants exhibited improved psychosocial functioning from admission to discharge, with gains maintained at 1 month post-discharge. Partial correlations indicated that participation and engagement in CBT groups is related to improved functioning at discharge. Participants diagnosed with major depressive disorder, bipolar disorder, and psychotic disorders all evidenced similar positive treatment trajectories, suggesting that group-oriented CBT programming may be a useful addition to standard inpatient care.
This article highlights the relevance of attachment theory for psychiatric rehabilitation services and discusses practice implications derived from the theory. Attachment theory can guide the development of interpersonal relationships during recovery and this aspect of rehabilitation is emphasised here. Attachment theory can also be used to help staff predict and understand problematic behaviours such as violence and aggression, and different styles of recovery. The theory can help promote positive staff–service-user relationships by highlighting the qualities of effective caregivers and the way in which people with different attachment styles might benefit from different approaches. We conclude by suggesting ways of teaching rehabilitation staff to become more effective attachment figures.
Basal bark treatments involve the application of concentrated herbicide solution on each individual stem of targeted plants. When applied to stands of invasive plants with high stem densities, basal bark treatments may result in the use of large quantities of herbicide in a given area. The effect of basal bark treatments using a solution of 25% triclopyr herbicide and 75% methylated seed oil was tested on research plots located in six different groves of invasive fig, a densely stemmed, problematic invader of riparian forests in California. The experimental treatments resulted in application rates that were equivalent to 28 to 44 kg ae/ha, greatly in excess of the labeled maximum use rate of 9 kg ae/ha (8 lb/ac). At 175 d after application, soils near the fig trunks contained high levels of triclopyr residues (up to 6.6 ppmw), suggesting that the chemical made its way into soils during this period and was not completely degraded. Although the mortality of native plants transplanted into treated fig groves was low (up to 16%), it was significantly greater than the mortality experienced by native plants transplanted into untreated control sites (0%). Although effective in controlling invasive fig trees (> 99% mortality), the high herbicide application rates from basal bark treatment preclude the use of this treatment in large fig groves. These treatments may be appropriate, however, when fig groves are small or isolated enough to prevent overapplication on a per-area basis. In addition, neither limited basal bark applications of triclopyr (< 40% of stems treated) nor foliar spray treatments of 2% glyphosate were effective control measures. Further investigation is needed on ways to control large invasive fig groves.
Background: Psychiatric staff play a key role in the lives of people with psychosis and the quality of staff and service user relationships is associated with relapse and recovery. One factor that might determine the capacity of staff to form positive therapeutic relationships is their appraisals of service users' mental health problems. Method: A pilot intervention was implemented with psychiatric staff that involved helping them develop psychological formulations for individual service users. Staff perceptions of service users' mental health problems were measured before and after the intervention using Likert scales. Data at the two time points were collated for 30 staff. Results: There was a significant increase in staff perceptions of the degree of control service users and themselves had over problems, an increase in the degree of effort they felt service users were making in coping, reductions in blame, and more optimism about treatment. Staff also reported an increase in understanding of service users' problems, more positive feelings towards service users, and an increase in confidence in their work. Conclusions: Results from this pilot are promising, but findings warrant replication in controlled studies. It is also important to establish whether changes in staff perceptions influence the actual nature of staff-service user relationships.
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