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Upthegrove R, Broome MR, Caldwell K, Ives J, Oyebode F, Wood SJ. Understanding auditory verbal hallucinations: a systematic review of current evidence. Acta Psychiatr Scand 2016; 133:352-67. [PMID: 26661730 DOI: 10.1111/acps.12531] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Auditory verbal hallucinations (AVHs) are core features of psychotic illness and remain significant in predicting poor outcome and risk. There has been a wide range of approaches to understanding these experiences. METHOD A systematic literature review summarizing different methods of investigation and their results; phenomenology, descriptive psychopathology, psychological, cognitive neurobiology, and neuroimaging. RESULTS A number of 764 papers and texts were screened and 113 reviewed. Phenomenological studies are comparably few in number, and psychopathology remains based on concepts defined in the early 20th century. Psychological models focus on voice content and emotional reaction, and suggest a continuum of AVHs from normal experience. Neuropsychological models include AVHs as misattribution of inner speech, whilst functional neuroimaging studies focus on the spontaneous activity and connectivity of auditory networks. CONCLUSION There has been a large growth in research on AVHs in recent decades dominated by neurobiological and neuroimaging studies. Future research should include focus on phenomenological aspects and AVHs change over the course of developing illness. Integration between branches of enquiry is needed, and the risk is that without this, models are proposed and investigated that bear scant relevance to the symptom itself.
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Upthegrove R, Jones I, Craddock N. Authors' reply. Br J Psychiatry 2016; 208:94. [PMID: 26729845 DOI: 10.1192/bjp.208.1.94a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Upthegrove R, Ives J, Broome MR, Caldwell K, Wood SJ, Oyebode F. Auditory verbal hallucinations in first-episode psychosis: a phenomenological investigation. BJPsych Open 2016; 2:88-95. [PMID: 27703759 PMCID: PMC4998935 DOI: 10.1192/bjpo.bp.115.002303] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In dimensional understanding of psychosis, auditory verbal hallucinations (AVH) are unitary phenomena present on a continuum from non-clinical voice hearing to severe mental illness. There is mixed evidence for this approach and a relative absence of research into subjective experience of AVH in early psychosis. AIMS To conduct primary research into the nature of subjective experience of AVH in first-episode psychosis. METHOD A phenomenological study using diary and photo-elicitation qualitative techniques investigating the subjective experience of AVH in 25 young people with first-episode psychosis. RESULTS AVH are characterised by: (a) entity, as though from a living being with complex social interchange; and (b) control, exerting authority with ability to influence. AVH are also received with passivity, often accompanied by sensation in other modalities. CONCLUSIONS A modern detailed phenomenological investigation, without presupposition, gives results that echo known descriptive psychopathology. However, novel findings also emerge that may be features of AVH in psychosis not currently captured with standardised measures. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Abstract
AIMS This review will focus on the rates, clinical characteristics, risk factors and methods of self-harm and suicide in different ethnic groups in the United Kingdom, providing an update synthesis of recent literature. METHODS Studies that met the inclusion criteria between 2003 and 2013 were reviewed using the following databases: MEDLINE, PsycINFO, EMBASE and CINAHL. The methodological quality of each study was then assessed using a structured scoring system. RESULTS A total of 2,362 articles were retrieved, 10 of which matched the inclusion criteria were reviewed. Significant differences were found in the rates of self-harm between ethnic groups with Asian males being least likely to self-harm and Black females being most likely to self-harm. Also, Black and South Asian people were less likely to repeat self-harm. Factors that may help protect or predispose individuals to self-harm or attempt suicide (such as religion, mental health and coping styles) also differ between ethnic groups. CONCLUSIONS There are clear ethnic differences in self-harm and suicide, which may be affected by factors such as cultural pressures and prevalence of mental illness. An awareness of these differences is vital to help prevent further attempts of self-harm and suicide. Further research into differences between ethnic and cultural groups and self-harm continues to be important.
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Upthegrove R, Jones I, Craddock N. Authors' reply. Br J Psychiatry 2015; 207:272. [PMID: 26329573 DOI: 10.1192/bjp.207.3.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kam SM, Singh SP, Upthegrove R. What needs to follow early intervention? Predictors of relapse and functional recovery following first-episode psychosis. Early Interv Psychiatry 2015; 9:279-83. [PMID: 24251970 DOI: 10.1111/eip.12099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/22/2013] [Indexed: 11/27/2022]
Abstract
AIM As a foundation for considering how gains may be maintained following early intervention in first-episode psychosis (FEP), this study aimed to describe and investigate factors predicting post-discharge relapse and longer term functioning. METHOD An evaluation via case-note review obtained quantitative data on 163 patients sequentially discharged from Birmingham Early Intervention Service (EIS) followed up for a median of 3.6 years. Time to relapse was calculated and hierarchical regression was used to determine predictors of relapse and functioning. RESULTS Patients likely to relapse do so within the first year post-discharge; however, over 40% did not relapse during the follow-up period. The number of relapses occurring during EIS care predicted time-to-relapse post-discharge. At discharge from the EIS and study end-point, the proportion with low social and vocational functioning remained high. Predictors of positive 'Not in Education Employment or Training' status at end-point include being in a minority ethnic group, substance misuse and number of relapses. CONCLUSIONS Increased emphasis on relapse prevention and early post-discharge monitoring may be needed, especially in the first year, for those who have experienced previous relapse. To maintain early outcomes in FEP, targeted interventions to address substance misuse and functional recovery need to be sustained in the long term. EISs should aim to make the first episode of psychosis the last. Services providing care for patients with psychosis post EIS should be designed to deliver care for ongoing need, with continued emphasis on relapse prevention and social recovery.
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Upthegrove R. Bullying, victimisation, and psychosis. Lancet Psychiatry 2015; 2:574-6. [PMID: 26303536 DOI: 10.1016/s2215-0366(15)00176-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 11/26/2022]
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Hashmat H, Upthegrove R, Marzanski M. Impact of functionalisation on staff morale in CMHTs. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2015. [DOI: 10.1002/pnp.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lisiecka DM, Suckling J, Barnes TRE, Chaudhry IB, Dazzan P, Husain N, Jones PB, Joyce EM, Lawrie SM, Upthegrove R, Deakin B. The benefit of minocycline on negative symptoms in early-phase psychosis in addition to standard care - extent and mechanism (BeneMin): study protocol for a randomised controlled trial. Trials 2015; 16:71. [PMID: 25886254 PMCID: PMC4351843 DOI: 10.1186/s13063-015-0580-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Negative symptoms of psychosis do not respond to the traditional therapy with first- or second-generation antipsychotics and are among main causes of a decrease in quality of life observed in individuals suffering from the disorder. Minocycline, a broad-spectrum tetracyclic antibiotic displaying neuroprotective properties has been suggested as a new potential therapy for negative symptoms. In the two previous clinical trials comparing minocycline and placebo, both added to the standard care, patients receiving minocycline showed increased reduction in negative symptoms. Three routes to neuroprotection by minocycline have been identified: neuroprotection against grey matter loss, anti-inflammatory action and stabilisation of glutamate receptors. However, it is not yet certain what the extent of the benefit of minocycline in psychosis is and what its mechanism is. We present a protocol for a multi-centre double-blind randomised placebo-controlled clinical trial entitled The Benefit of Minocycline on Negative Symptoms of Psychosis: Extent and Mechanism (BeneMin). METHODS After providing informed consent, 226 participants in the early phase of psychosis will be randomised to receive either 100 mg modified-release capsules of minocycline or similar capsules with placebo for 12 months in addition to standard care. The participants will be tested for outcome variables before and after the intervention period. The extent of benefit will be tested via clinical outcome measures, namely the Positive and Negative Syndrome Scale score, social and cognitive functioning scores, antipsychotic medication dose equivalent and level of weight gain. The mechanism of action of minocycline will be tested via blood screening for circulating cytokines and magnetic resonance imaging with three-dimensional T1-weighted rapid gradient-echo, proton density T2-weighted dual echo and T2*-weighted gradient echo planar imaging with N-back task and resting state. Eight research centres in UK and 15 National Health Service Trusts and Health Boards will be involved in recruiting participants, performing the study and analysing the data. DISCUSSION The BeneMin trial can inform as to whether in minocycline we have found a new and effective therapy against negative symptoms of psychosis. The European Union Clinical Trial Register: EudraCT 2010-022463-35 with the registration finalised in July 2011. The recruitment in the trial started in January 2013 with the first patient recruited in March 2013.
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Caldwell K, Upthegrove R, Ives J, Broome M, Wood S, Oyebode F. How We Understand Hallucinations (HUSH). Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Upthegrove R, Chard C, Jones L, Gordon-Smith K, Forty L, Jones I, Craddock N. Adverse childhood events and psychosis in bipolar affective disorder. Br J Psychiatry 2015; 206:191-7. [PMID: 25614532 DOI: 10.1192/bjp.bp.114.152611] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There has been increasing interest in the association between childhood trauma and psychosis. Proposals for potential mechanisms involved include affective dysregulation and cognitive appraisals of threat. AIMS To establish if, within bipolar disorder, childhood events show a significant association with psychosis, and in particular with symptoms driven by dysregulation of mood or with a persecutory content. METHOD Data on lifetime-ever presence of psychotic symptoms were determined by detailed structured interview with case-note review (n = 2019). Childhood events were recorded using a self-report questionnaire and case-note information. RESULTS There was no relationship between childhood events, or childhood abuse, and psychosis per se. Childhood events were not associated with an increased risk of persecutory or other delusions. Significant associations were found between childhood abuse and auditory hallucinations, strongest between sexual abuse and mood congruent or abusive voices. These relationships remain significant even after controlling for lifetime-ever cannabis misuse. CONCLUSIONS Within affective disorder, the relationship between childhood events and psychosis appears to be relatively symptom-specific. It is possible that the pathways leading to psychotic symptoms differ, with delusions and non-hallucinatory symptoms being influenced less by childhood or early environmental experience.
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Kissane M, Szymanski L, Upthegrove R, Katona C. Complex posttraumatic stress disorder in traumatised asylum seekers: a pilot study. EUROPEAN JOURNAL OF PSYCHIATRY 2014. [DOI: 10.4321/s0213-61632014000300001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Upthegrove R, Ross K, Brunet K, McCollum R, Jones L. Depression in first episode psychosis: the role of subordination and shame. Psychiatry Res 2014; 217:177-84. [PMID: 24726817 DOI: 10.1016/j.psychres.2014.03.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/11/2014] [Accepted: 03/21/2014] [Indexed: 12/22/2022]
Abstract
Depression in early psychosis is linked to poor outcome, relapse and risk of suicide, yet remains poorly understood. This article aims to examine the development of depression in acute and post psychotic phases of first episode psychosis (FEP), and its relationship to persecutors, voices, insight, and recovery. Data were gathered on 92 patients with acute FEP on depression course, severity and experience of positive symptoms, insight and appraisals of illness using validated semi-structured interviews and questionnaires. Measures were repeated at 12 months. Malevolent voices, use of safety behaviours and subordination to persecutors were associated with depression and suicidal behaviour in acute FEP. Loss, Shame, low level continuing positive symptoms and longer duration of untreated psychosis were associated with post psychotic depression. Negative appraisals remained stable despite recovery in other symptom domains. Thus, depression and risk in early psychosis may be propagated by the personal significance and content of positive symptoms experienced. When in recovery, low level symptoms, longer period of illness and negative appraisals are significant factors.
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Patel M, Chawla R, Krynicki CR, Rankin P, Upthegrove R. Health beliefs and carer burden in first episode psychosis. BMC Psychiatry 2014; 14:171. [PMID: 24913656 PMCID: PMC4094457 DOI: 10.1186/1471-244x-14-171] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 06/05/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Carer burden is high during First Episode Psychosis (FEP) and evidence suggests that this is a predictor of poor long-term outcome. However our understanding of factors associated with higher burden is poor. We propose that carers' cultural backgrounds and health belief models will influence their perceived burden of care, over and above that explained by severity of illness. METHODS Patients with FEP and their primary Carers were recruited from the Early Intervention Service. Patients and Carers completed a range of validated measures, self-report ethnicity and demographic information together with the Multidimensional Health Locus of Control and Caregiver Burden Inventory. RESULTS Significant correlations were found between carer burden and health beliefs, which differed by ethnicity and gender. High physical burden was experienced by Black carers with an external locus of control; time restrictions and emotional burden correlated with an external locus of control in Asian carers. For White carers, external locus of control correlated with time dependence burden. In all ethnic groups female carers experienced more time dependency, physical and developmental burden. No significant correlations were found between patient measures of severity or duration of illness and carer burden. CONCLUSIONS The type of burden experienced by carers differed between gender and ethnicity and was related to their health belief models. Thus the explanation and understanding of illness appears to be more salient than simply a patient's severity of illness when considering the development of carer burden. Interventions to tackle high carer burden, and thus expressed emotion to improve outcome in patients, may need increasing focus here.
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Upthegrove R, Manzanares-Teson N, Barnes NM. Cytokine function in medication-naive first episode psychosis: a systematic review and meta-analysis. Schizophr Res 2014; 155:101-8. [PMID: 24704219 DOI: 10.1016/j.schres.2014.03.005] [Citation(s) in RCA: 348] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/09/2014] [Accepted: 03/10/2014] [Indexed: 01/07/2023]
Abstract
This systematic review sets out to give a comprehensive overview of the cytokine profile at the onset of psychosis un-confounded by medication. We aim to provide insight into the early pathophysiological process of psychosis and areas for future research of potential biomarkers able to chart the extent of illness or effectiveness of treatment. Following PRISMA guidelines, a systematic primary search identified 4638 citations, 4651 studies were retrieved and screened, and 23 studies met the inclusion criteria (published in English before June 2013, patients with neuroleptic naive first episode psychosis, and assessed circulating cytokines). These reported 570 patients, 683 healthy control subjects, and 20 cytokine/cytokine receptors. Papers that contained sufficient stratified data were included in a random-effects pooled effect size meta-analysis. Highly significant effect sizes were found for elevated IL-1β, sIL-2r, IL-6, and TNF-α. Non-significant effect size estimates were obtained for IL-2, IL-4, and IFN-γ. Thus, we found significant elevation in pro-inflammatory cytokine levels in the serum of patients with medication-naive first episode psychosis. This adds to the evidence of a pro-inflammatory immune deregulation in schizophrenia and suggests these cytokines should be the focus for further research in biomarkers of progress and extent of illness. Future studies should focus on the medication-naive group at the early stages of illness with numbers large enough to allow for the control of other potential confounding factors.
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Upthegrove R, Atulomah O, Brunet K, Chawla R. Cultural and social influences of negative illness appraisals in first-episode psychosis. Early Interv Psychiatry 2013; 7:399-406. [PMID: 22947417 DOI: 10.1111/j.1751-7893.2012.00389.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 05/26/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the UK, there has been growing concern about the incidence and prognosis of psychosis in minority ethnic groups for a number of years. Negative self-appraisals after first-episode psychosis (FEP) are associated with post-psychotic depression, poor functioning and suicidality. In carers, appraisals of loss and decreased control are linked with high expressed emotion and relapse; however, as yet there has been no investigation as to how ethnicity and culture relate to these negative appraisals in FEP. AIMS The study aims to investigate the occurrence of negative illness appraisals, for example, loss and shame, in FEP within different ethnic and social-cultural groups. In addition, it aims to explore influence of insight, recovery style and carers' appraisals in the development of negative appraisals. METHODS There were 67 patients and 46 carers who completed reliable and valid measures on beliefs about illness, insight and recovery style. Data on ethnicity and deprivation were also collected. RESULTS Black patients experienced significantly less loss, lack of control and entrapment than White, Asian and mixed ethnicity patients, yet these were not explained by lower levels of insight or recovery style. Patient's and carer's appraisals were highly correlated. CONCLUSION Black patients, in spite of higher incidence and poorer outcome in FEP, experienced less loss and shame. Possible explanations, including a protective aspect of alternative health belief models, are explored. This area provides much scope for further investigation. Strong relationships between patient and carer appraisals indicate that family interventions are essential to improved clinical outcomes.
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Sandhu A, Ives J, Birchwood M, Upthegrove R. The subjective experience and phenomenology of depression following first episode psychosis: a qualitative study using photo-elicitation. J Affect Disord 2013; 149:166-74. [PMID: 23414936 DOI: 10.1016/j.jad.2013.01.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depression following first episode psychosis (FEP) is a frequent occurrence, with profound impact on recovery and outcome. Whilst many theories exist about the causes of depression here, research to date has been based on nosology imported wholesale from affective disorder, with little primary research on the subjective experience. This study aimed to explore the subjective experience and phenomenological features of post-psychotic depression in FEP. METHOD A qualitative methodology, photo-elicitation, together with unstructured interviews, was used to characterise aspects of depression following FEP and analysed using contemporary framework analysis. RESULTS Depression was reported by participants as linked to the experience of and recovery from psychosis. The psychotic episode was a traumatic event followed by subjective doubt, shame and embarrassment. Loss and social isolation were central. Core biological symptoms did not feature. LIMITATIONS Despite the relatively small sample size, this study was able to generate in-depth data that provides useful and novel insight. Whilst generalisability is incompatible with qualitative methodology, further research using the same methodology would generate a wider range of experiences and perspectives. CONCLUSIONS Understanding this dimension of psychosis in and of itself has the potential to improve and aid development of more effective and appropriately targeted interventions and associated outcomes.
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Upthegrove R, Birchwood M, Brunet K, McCollum R, Jones L, Ross K. 484 – Depression and suicidality in first episode psychosis. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)75804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Brunet K, Birchwood M, Upthegrove R, Michail M, Ross K. A prospective study of PTSD following recovery from first-episode psychosis: The threat from persecutors, voices, and patienthood. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2012; 51:418-33. [DOI: 10.1111/j.2044-8260.2012.02037.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Upthegrove R, Birchwood M, Ross K, Brunett K, McCollum R, Jones L. The evolution of depression and suicidality in first episode psychosis. Acta Psychiatr Scand 2010; 122:211-8. [PMID: 19922525 DOI: 10.1111/j.1600-0447.2009.01506.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To have a clearer understanding of the ebb and flow of depression and suicidal thinking in the early phase of psychosis, whether these events are predictable and how they relate to the early course of psychotic symptoms. METHOD Ninety-two patients with first episode psychosis (FEP) completed measures of depression, including prodromal depression, self-harm and duration of untreated psychosis. Follow-up took place over 12 months. RESULTS Depression occurred in 80% of patients at one or more phases of FEP; a combination of depression and suicidal thinking was present in 63%. Depression in the prodromal phase was the most significant predictor of future depression and acts of self-harm. CONCLUSION Depression early in the emergence of a psychosis is fundamental to the development of future depression and suicidal thinking. Efforts to predict and reduce depression and deliberate self-harm in psychosis may need to target this early phase to reduce later risk.
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Burley K, Upthegrove R, Birchwood M, Patterson P, Skeate A. 'Schizophrenia postdrome': a study of low-level psychotic experience after remission of first-episode schizophrenia. Early Interv Psychiatry 2009; 3:296-9. [PMID: 22642733 DOI: 10.1111/j.1751-7893.2009.00141.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite remission being the primary objective following the first episode of schizophrenia, clinically stabilized patients nevertheless relapse. AIM To assess the extent and fluctuation of low-level psychotic symptoms in patients who are in remission after first-episode schizophrenia and consider whether this is equivalent to symptomatology experienced by those at 'ultra high risk' (UHR) of developing first-episode psychosis. METHODS We examined the phenomenological characteristics of 11 patients who fulfilled international remission criteria using the Structured Interview for Prodromal Symptoms and compared this cohort with an UHR sample. RESULTS Remitted patients were experiencing attenuated positive symptoms (73%) and brief limited intermittent psychotic symptoms (18%), features that were similarly prevalent in the UHR group. There was no significant fluctuation in these low-level symptoms over the course of four interviews. CONCLUSIONS Although further research is required in this novel field, such features could form the building blocks for better prediction of psychotic relapse.
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Burley K, Upthegrove R, Birchwood M, Patterson P, Skeate A. the ‘schizophrenia Postdrome’: A Study of Low-level Positive Symptoms after Remission of First Episode Schizophrenia. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)71353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background:Despite remission being the primary objective following the first episode of schizophrenia, clinically stabilised patients are rarely studied.Aims:To assess the extent and fluctuation of low-level positive symptoms in patients who are in remission following their first episode of schizophrenia, and consider whether symptoms displayed are similar to those exhibited in the prodromal population.Methods:Eleven patients who had recovered for at least six months following one episode of schizophrenia and subsequently fulfilled remission criteria were interviewed four times over the course of three months. Interviews were based on the Structured Interview of Prodromal Symptoms (SIPS), an in-depth assessment of low-level symptoms that is widely used in the prodromal group. Data was compared to equivalent results from the prodromal population (with data provided by the local ED:IT service).Results:Over the course of the interviews 73% of participants displayed attenuated positive symptoms, predominantly unusual thought content and suspiciousness. 18% experienced brief limited intermittent psychotic symptoms (BLIPS). Analysis with Friedman's test revealed no significant fluctuation in positive symptoms, indicating that they are stable over time. Furthermore, the symptoms exhibited in the sample were closely comparable to those in the prodromal group in the ED:IT service.Conclusions:The majority of patients in remission are experiencing a form of ‘postdrome’, which appears to be an enduring state. the presence of these symptoms may put patients at an increased risk of relapse. Larger-scale research is required to follow-up this novel preliminary study.Declaration of interest:None.
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Birchwood M, Iqbal Z, Upthegrove R. Psychological pathways to depression in schizophrenia: studies in acute psychosis, post psychotic depression and auditory hallucinations. Eur Arch Psychiatry Clin Neurosci 2005; 255:202-12. [PMID: 15995904 DOI: 10.1007/s00406-005-0588-4] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Upthegrove R, Oyebode F, George M, Haque MS. Insight, social knowledge and working memory in schizophrenia. Psychopathology 2002; 35:341-6. [PMID: 12590192 DOI: 10.1159/000068595] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is evidence that insight and social judgements are impaired in schizophrenia. The influence of these factors on the decision to treat compulsorily in schizophrenia is poorly understood. AIMS To investigate the contribution of insight, social knowledge, and working memory to the determination to treat coercively in schizophrenia. METHOD Insight rating scale, social knowledge questionnaire and working memory tests were administered to detained patients with schizophrenia. Results were compared with those of a control group of voluntary in-patients with schizophrenia. RESULTS Detained patients scored worse on insight and social knowledge, yet there was no significant correlation between these scores. There was no significant difference in severity of psychopathology between the experimental and control groups. Results for working memory were inconclusive. CONCLUSION Insight and social knowledge are significantly, but independently, associated with the determination to treat coercively in schizophrenia. This suggests that insight and social knowledge are distinct skills. The contribution of working memory remains unclear.
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