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In the UK almost 60% of people with a diagnosis of schizophrenia who use
mental health services say they are not involved in decisions about their
treatment. Guidelines and policy documents recommend that shared
decision-making should be implemented, yet whether it leads to greater
treatment-related empowerment for this group has not been systematically
To examine the effects of shared decision-making on indices of
treatment-related empowerment of people with psychosis.
We conducted a systematic review and meta-analysis of randomised
controlled trials (RCTs) of shared decision-making concerning current or
future treatment for psychosis (PROSPERO registration CRD42013006161).
Primary outcomes were indices of treatment-related empowerment and
objective coercion (compulsory treatment). Secondary outcomes were
treatment decision-making ability and the quality of the therapeutic
We identified 11 RCTs. Small beneficial effects of increased shared
decision-making were found on indices of treatment-related empowerment (6
RCTs; g = 0.30, 95% CI 0.09–0.51), although the effect
was smaller if trials with >25% missing data were excluded. There was
a trend towards shared decision-making for future care leading to reduced
use of compulsory treatment over 15–18 months (3 RCTs; RR = 0.59, 95% CI
0.35–1.02), with a number needed to treat of approximately 10 (95% CI
5–∞). No clear effect on treatment decision-making ability (3 RCTs) or
the quality of the therapeutic relationship (8 RCTs) was found, but data
For people with psychosis the implementation of shared treatment
decision-making appears to have small beneficial effects on indices of
treatment-related empowerment, but more direct evidence is required.
Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses in which the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables.
Presence of these components during therapy is taken from therapist notes. The direct and indirect effect of the intervention is estimated by an instrumental variable analysis.
A significant decrease in the symptom score for case formulation (coefficient =–23, 95% CI –44 to –1.7, P = 0.036) and homework (coefficient =–0.26, 95% CI –0.51 to –0.001, P = 0.049) is found. Improvement with the inclusion of active change strategies is of borderline significance (coefficient =–0.23, 95% CI –0.47 to 0.005, P = 0.056).
There is a greater treatment effect if formulation and homework are involved in therapy. However, high correlation between components means that these may be indicators of overall treatment fidelity.
To investigate the experiences of women participating in a cooking and nutrition component of a health promotion research initiative in an Australian Aboriginal regional community.
Weekly facilitated cooking and nutrition classes were conducted during school terms over 12 months. An ethnographic action research study was conducted for the programme duration with data gathered by participant and direct observation, four yarning groups and six individual yarning sessions. The aim was to determine the ways the cooking and nutrition component facilitated lifestyle change, enabled engagement, encouraged community ownership and influenced community action.
Regional Bindjareb community in the Nyungar nation of Western Australia.
A sample of seventeen Aboriginal women aged between 18 and 60 years from the two kinships in two towns in one shire took part in the study. The recruitment and consent process was managed by community Elders and leaders.
Major themes emerged highlighting the development of participants and their recognition of the need for change: the impact of history on current nutritional health of Indigenous Australians; acknowledging shame; challenges of change around nutrition and healthy eating; the undermining effect of mistrust and limited resources; the importance of community control when developing health promotion programmes; finding life purpose through learning; and the need for planning and partnerships to achieve community determination.
Suggested principles for developing cooking and nutrition interventions are: consideration of community needs; understanding the impact of historical factors on health; understanding family and community tensions; and the engagement of long-term partnerships to develop community determination.
Traditional variables used to explain survival following out-of-hospital cardiac arrest (OHCA) account for only 72% of survival, suggesting that other unknown factors may influence outcomes. Research on other diseases suggests that neighbourhood factors may partly determine health outcomes. Yet, this approach has rarely been used for OHCA. This work outlines a methodology to investigate multiple neighbourhood factors as determinants of OHCA outcomes.
A retrospective, observational cohort study design will be used. All adult non-emergency medical service witnessed OHCAs of cardiac etiology within the city of Toronto between 2006 and 2010 will be included. Event details will be extracted from the Toronto site of the Resuscitation Outcomes Consortium Epistry—Cardiac Arrest, an existing population-based dataset of consecutive OHCA patients. Geographic information systems technology will be used to assign patients to census tracts. Neighbourhood variables to be explored include the Ontario Marginalization Index (deprivation, dependency, ethnicity, and instability), crime rate, and density of family physicians. Hierarchical logistic regression analysis will be used to explore the association between neighbourhood characteristics and 1) survival-to-hospital discharge, 2) return-of-spontaneous circulation at hospital arrival, and 3) provision of bystander cardiopulmonary resuscitation (CPR). Receiver operating characteristics curves will evaluate each model’s ability to discriminate between those with and without each outcome.
This study will determine the role of neighbourhood characteristics in OHCA and their association with clinical outcomes. The results can be used as the basis to focus on specific neighbourhoods for facilitating educational interventions, CPR awareness programs, and higher utilization of automatic defibrillation devices.
Internalised stigma in young people meeting criteria for at-risk mental states (ARMS) has been highlighted as an important issue, and it has been suggested that provision of cognitive therapy may increase such stigma.
To investigate the effects of cognitive therapy on internalised stigma using a secondary analysis of data from the EDIE-2 trial.
Participants meeting criteria for ARMS were recruited as part of a multisite randomised controlled trial of cognitive therapy for prevention and amelioration of psychosis. Participants were assessed at baseline and at 6, 12, 18 and 24 months using measures of psychotic experiences, symptoms and internalised stigma.
Negative appraisals of experiences were significantly reduced in the group assigned to cognitive therapy (estimated difference at 12 months was −1.36 (95% Cl −2.69 to −0.02), P = 0.047). There was no difference in social acceptability of experiences (estimated difference at 12 months was 0.46, 95% Cl −0.05 to 0.98, P = 0.079).
These findings suggest that, rather than increasing internalised stigma, cognitive therapy decreases negative appraisals of unusual experiences in young people at risk of psychosis; as such, it is a non-stigmatising intervention for this population.
Arctic arthropods are essential prey for many vertebrates, including birds, but arthropod populations and phenology are susceptible to climate change. The objective of this research was to model the relationship between seasonal changes in arthropod abundance and weather variables using data from a collaborative pan-Canadian (Southampton, Herschel, Bylot, and Ellesmere Islands) study on terrestrial arthropods. Arthropods were captured with passive traps that provided a combined measure of abundance and activity (a proxy for arthropod availability to foraging birds). We found that 70% of the deviance in daily arthropod availability was explained by three temperature covariates: mean daily temperature, thaw degree-day, and thaw degree-day2. Models had an adjusted R2 of 0.29–0.95 with an average among sites and arthropod families of 0.67. This indicates a moderate to strong fit to the raw data. The models for arthropod families with synchronous emergence, such as Tipulidae (Diptera), had a better fit (average adjusted R2 of 0.80) than less synchronous taxa, such as Araneae (R2 = 0.60). Arthropod abundance was typically higher in wet than in mesic habitats. Our models will serve as tools for researchers who want to correlate insectivorous bird breeding data to arthropod availability in the Canadian Arctic.
Background: More effective psychological treatments for psychosis are required. Case series data and pilot trials suggest metacognitive therapy (MCT) is a promising treatment for anxiety and depression. Other research has found negative metacognitive beliefs and thought-control strategies may be involved in the development and maintenance of hallucinations and delusions. The potential of MCT in treating psychosis has yet to be investigated. Aims: Our aim was to find out whether a short number of MCT sessions would be associated with clinically significant and sustained improvements in delusions, hallucinations, anxiety, depression and subjective recovery in patients with treatment-resistant long-standing psychosis. Method: Three consecutively referred patients, each with a diagnosis of paranoid schizophrenia and continuing symptoms, completed a series of multiple baseline assessments. Each then received between 11 and 13 sessions of MCT and completed regular assessments of progress, during therapy, post-therapy and at 3-month follow-up. Results: Two out of 3 participants achieved clinically significant reductions across a range of symptom-based outcomes at end-of-therapy. Improvement was sustained at 3-month follow-up for one participant. Conclusions: Our study demonstrates the feasibility of using MCT with people with medication-resistant psychosis. MCT was acceptable to the participants and associated with meaningful change. Some modifications may be required for this population, after which a controlled trial may be warranted.
Evidence regarding overestimation of the efficacy of antipsychotics and
underestimation of their toxicity, as well as emerging data regarding
alternative treatment options, suggests it may be time to introduce patient
choice and reconsider whether everyone who meets the criteria for a
schizophrenia spectrum diagnosis requires antipsychotics in order to
The association between cannabis and depression has received less attention than the links between cannabis use and psychosis. Some have suggested that cannabis use may be a contributory cause of suicidal behaviors. A number of studies have found association between cannabis use and suicide, but the quality of control for confounding variables has varied widely. There is increasing evidence that regular cannabis use and depression occur together more often than we might expect by chance. The association between cannabis use and depression may arise because the same factors that predispose people to use cannabis also increase their risk of depression. Cross-sectional and longitudinal studies have provided mixed evidence on the association between cannabis use and depression. There is a need for longitudinal and twin studies that assess the relationship between cannabis use, depression and confounding factors.
Background: Cognitive behavioural therapy (CBT) can be helpful for many people who experience psychosis; however most research trials have been conducted with people also taking antipsychotic medication. There is little evidence to know whether CBT can help people who choose not to take this medication, despite this being a very frequent event. Developing effective alternatives to antipsychotics would offer service users real choice. Aims: To report a case study illustrating how brief CBT may be of value to a young person experiencing psychosis and not wishing to take antipsychotic medication. Method: We describe the progress of brief CBT for a young man reporting auditory and visual hallucinations in the form of a controlling and dominating invisible companion. We describe the formulation process and discuss the impact of key interventions such as normalising and detached mindfulness. Results: Seven sessions of CBT resulted in complete disappearance of the invisible companion. The reduction in frequency and duration followed reduction in conviction in key appraisals concerning uncontrollability and unacceptability. Conclusions: This case adds to the existing evidence base by suggesting that even short-term CBT might lead to valued outcomes for service users experiencing psychosis but not wishing to take antipsychotic medication.
Pseudoprogression (psPD) is now recognised following radiotherapy with concurrent temozolomide (RT/TMZ) for glioblastoma multiforme (GBM). The aim of this study was to determine the incidence of psPD following RT/TMZ and the effect of psPD on prognosis.
All patients receiving RT/TMZ for newly diagnosed GBM were identified from a prospective database. Clinical and radiographic data were retrospectively reviewed. Early progression was defined as radiological progression (RECIST criteria) during or within eight weeks of completing RT/TMZ. Pseudoprogression was defined as early progression with subsequent disease stabilization, without salvage therapy, for at least six months from completion of RT/TMZ. The primary outcome was overall survival (Kaplan-Meier) and log rank analysis was used to compare groups.
Out of 111 patients analyzed, 104 were evaluable for radiological response. Median age was 58 years and median follow-up 55 weeks. Early progression was confirmed in 26% and within this group 32% had psPD. Median survival for the whole cohort was 56.7 weeks [95% CI (51.0, 71.3)]. Median survival for patients with psPD was significantly higher than for patients with true early progression (124.9 weeks versus 36.0 weeks, p=0.0286).
Approximately one third of patients with early progression were found to have psPD which was associated with a favourable prognosis. Maintenance TMZ should not be abandoned on the basis of seemingly discouraging imaging features identified within the first three months after RT/TMZ.