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Newman-Taylor K, Maguire T, Smart T, Bayford E, Gosden E, Addyman G, Bullard P, Simmons-Dauvin M, Margoum M, Smart B, Graves E. Screening for psychosis risk in primary mental health care services - Implementation, prevalence and recovery trajectories. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 38946546 DOI: 10.1111/bjc.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 06/18/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Early interventions improve outcomes for people at high risk of psychosis and are likely to be cost saving. This group tends to seek help for emotional problems - depression and anxiety - via primary care services, where early detection methods are poor. We sought to determine prevalence rates of high risk for psychosis in UK primary care mental health services and clinical outcomes following routinely delivered psychological therapies. METHODS We used a brief screen designed for settings with low base rates and significant time constraints to determine prevalence of high risk for psychosis in UK 'Talking Therapies' services. We examined socio-demographic characteristics, presenting problems and recovery trajectories for this group, compared with people not at risk of psychosis. RESULTS A 2-item screen selected for specificity yielded a prevalence rate of 3% in primary care mental health services. People at elevated risk of psychosis were younger and more likely to report at least one long-term physical condition. This group presented with higher levels of depression, anxiety and trauma symptoms at assessment and were less likely to have recovered at the end of treatment, compared to people not at risk. CONCLUSIONS Very brief screening tools can be implemented in busy health care settings. The 3% of referrals to UK primary care psychological therapies services at elevated risk of psychosis typically present with more severe symptoms and greater levels of comorbidity and may require augmented interventions to recover fully.
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Affiliation(s)
- Katherine Newman-Taylor
- University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Tess Maguire
- University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | | | | | - Emily Gosden
- Isle of Wight NHS Trust, Newport, Isle of Wight, UK
| | | | - Pete Bullard
- Isle of Wight NHS Trust, Newport, Isle of Wight, UK
| | | | - Morad Margoum
- Dorset HealthCare University NHS Foundation Trust, Bournemouth, UK
| | - Ben Smart
- Dorset HealthCare University NHS Foundation Trust, Bournemouth, UK
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Wiedemann A, Stochl J, Russo D, Patel U, Ashford PA, Ali N, Jones PB, Perez J. Clinical presentation of psychotic experiences in patients with common mental disorders attending the UK primary care improving access to psychological therapies (IAPT) Programme. J Affect Disord 2024; 344:233-241. [PMID: 37838262 DOI: 10.1016/j.jad.2023.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Improving Access to Psychological Therapies (IAPT) services address anxiety and depression in primary care, with psychotic disorders typically excluded. Our previous research found 1 in 4 patients report distressing psychotic experiences (PE) alongside common mental disorders, yet little is known about their clinical presentation and impact on recovery. METHODS We used the Community Assessment of Psychic Experiences - Positive Scale (CAPE-P15) to assess the clinical presentation and symptomatic profile of PE within IAPT settings across three National Health Service (NHS) trusts, serving a diverse population in Southern England. We identified different classes based on the reported PE frequencies using latent class analysis. RESULTS A total of 2042 IAPT patients completed the CAPE-P15. The mean age was 39.8 (±15.3) years. We identified five distinct classes of symptom profiles, findings that PE were common, especially self-referential and persecutory ideas. Prevalence and intensity increased across classes, extending to bizarre experiences and perceptual abnormalities in the fifth and least common class. Perceptual abnormalities were a strong indicator of symptom severity, with patients being the least likely to achieve recovery by the end of treatment. LIMITATIONS Data were collected during a service evaluation. Replication of these findings across other IAPT services could prove beneficial. We did not collect information on negative PE. CONCLUSIONS Patients seeking treatment for anxiety and depression in primary care commonly experience a wide range of positive PE. Self-referential and persecutory ideation were prevalent; perceptual abnormalities were infrequent. Providing information about prevalence and tailoring therapy may help reduce patient distress.
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Affiliation(s)
- Anna Wiedemann
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK; National Institute for Health Research, Applied Research Collaboration, East of England, UK.
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, UK; National Institute for Health Research, Applied Research Collaboration, East of England, UK; Department of Kinanthropology and Humanities, Charles University, Czechia
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Ushma Patel
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | | | - Naima Ali
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK; National Institute for Health Research, Applied Research Collaboration, East of England, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK; National Institute for Health Research, Applied Research Collaboration, East of England, UK; Department of Kinanthropology and Humanities, Charles University, Czechia; Norwich Medical School, University of East Anglia, UK; Institute of Biomedical Research, Department of Medicine, University of Salamanca, Spain
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Strelchuk D, Wiles N, Derrick C, Zammit S, Turner K. The identification and management of people with an at-risk mental state (ARMS) for psychosis in primary and secondary care services: A qualitative interview study. Early Interv Psychiatry 2023; 17:1116-1124. [PMID: 37041715 DOI: 10.1111/eip.13412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/07/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
AIMS Early intervention in people with an at-risk mental state (ARMS) for psychosis can prevent the onset of psychosis. Clinical guidelines recommend that ARMS are referred to triage services, and then to Early Intervention (EI) teams in secondary care for assessment and treatment. However, little is known about how ARMS patients are identified and managed in UK primary and secondary care. This study explored patients' and clinicians' views of ARMS patients' care pathways. METHODS Eleven patients, 20 GPs, 11 clinicians from the triaging Primary Care Liaison Services (PCLS) and 10 EI clinicians were interviewed. Data were analysed thematically. RESULTS Most patients said their symptoms started in adolescence with depression and anxiety. Before being referred to EI teams, most patients were referred by their GP to well-being services for talking therapies, which they had not found helpful. Some GPs said secondary care's high acceptance thresholds and scarce treatment availability made them reluctant to refer to EI teams. Triage in PCLS was influenced by patients' risk of self-harm, and formulation of psychotic symptoms; only those without clear evidence of other pathology and not at high risk of self-harm were referred to EI teams, the others being referred to Recovery/Crisis services. Although patients referred to EI teams were offered an assessment, only some EI teams were commissioned to treat ARMS. CONCLUSIONS Individuals meeting ARMS criteria might not receive early intervention due to high treatment thresholds and limited treatment availability in secondary care, suggesting clinical guidelines are not being met for this patient group.
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Affiliation(s)
- Daniela Strelchuk
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Catherine Derrick
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stan Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Katrina Turner
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Zavlis O. Complex relational needs impede progress in NHS Talking Therapies (IAPT): implications for public mental health. Front Public Health 2023; 11:1270926. [PMID: 37849713 PMCID: PMC10577290 DOI: 10.3389/fpubh.2023.1270926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Orestis Zavlis
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Complex Needs Service, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Ashford PA, Knight C, Heslin M, Clark AB, Kanaan M, Patel U, Stuart F, Kabir T, Grey N, Murray H, Hodgekins J, Reeve N, Marshall N, Painter M, Clarke J, Russo D, Stochl J, Leathersich M, Pond M, Fowler D, French P, Swart AM, Dixon-Woods M, Byford S, Jones PB, Perez J. Treating common mental disorder including psychotic experiences in the primary care improving access to psychological therapies programme (the TYPPEX study): protocol for a stepped wedge cluster randomised controlled trial with nested economic and process evaluation of a training package for therapists. BMJ Open 2022; 12:e056355. [PMID: 35732378 PMCID: PMC9226877 DOI: 10.1136/bmjopen-2021-056355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION At least one in four people treated by the primary care improving access to psychological therapies (IAPT) programme in England experiences distressing psychotic experiences (PE) in addition to common mental disorder (CMD). These individuals are less likely to achieve recovery. IAPT services do not routinely screen for nor offer specific treatments for CMD including PE. The Tailoring evidence-based psychological therapY for People with common mental disorder including Psychotic EXperiences study will evaluate the clinical and cost-effectiveness of an enhanced training for cognitive behavioural therapists that aims to address this clinical gap. METHODS AND ANALYSIS This is a multisite, stepped-wedge cluster randomised controlled trial. The setting will be IAPT services within three mental health trusts. The participants will be (1) 56-80 qualified IAPT cognitive behavioural therapists and (2) 600 service users who are triaged as appropriate for cognitive behavioural therapy in an IAPT service and have PE according to the Community Assessment of Psychic Experiences-Positive 15-items Scale. IAPT therapists will be grouped into eight study clusters subsequently randomised to the control-intervention sequence. We will obtain pseudonymous clinical outcome data from IAPT clinical records for eligible service users. We will invite service users to complete health economic measures at baseline, 3, 6, 9 and 12-month follow-up. The primary outcome will be the proportion of patients with common mental disorder psychotic experiences who have recovered by the end of treatment as measured by the official IAPT measure for recovery. ETHICS AND DISSEMINATION The study received the following approvals: South Central-Berkshire Research Ethics Committee on 28 April 2020 (REC reference 20/SC/0135) and Health Research Authority (HRA) on 23 June 2020. An amendment was approved by the Ethics Committee on 01 October 2020 and HRA on 27 October 2020. Results will be made available to patients and the public, the funders, stakeholders in the IAPT services and other researchers. TRIAL REGISTRATION NUMBER ISRCTN93895792.
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Affiliation(s)
- Polly-Anna Ashford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Clare Knight
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Margaret Heslin
- King's Health Economics, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Mona Kanaan
- Health Sciences, University of York, York, UK
| | - Ushma Patel
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | - Freya Stuart
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Thomas Kabir
- The McPin Foundation, London, Greater London, UK
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
- Psychology, University of Sussex, Brighton, Brighton and Hove, UK
| | | | - J Hodgekins
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Nesta Reeve
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Nicola Marshall
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | | | - James Clarke
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | - Debra Russo
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Jan Stochl
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
- Kinanthropology, Charles University, Prague, Czechia
| | - Maria Leathersich
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Martin Pond
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | | | - Paul French
- Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Ann Marie Swart
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK
| | - Sarah Byford
- Centre for the Economics of Mental and Physical Health, King's College London, London, UK
| | - Peter B Jones
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Jesus Perez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, Cambridgeshire, UK
- Medicine, Universidad de Salamanca, IBSAL, Salamanca, Castilla y León, Spain
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The Community Assessment of Psychic Experiences-Positive scale (CAPE-P15) accurately classifies and differentiates psychotic experience levels in adolescents from the general population. PLoS One 2021; 16:e0256686. [PMID: 34437593 PMCID: PMC8389461 DOI: 10.1371/journal.pone.0256686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/12/2021] [Indexed: 02/05/2023] Open
Abstract
Background There is increasing interest in studying psychotic symptoms in non-clinical populations, with the Community Assessment of Psychic Experiences-Positive scale (CAPE-P15) being one of the self-screening questionnaires used most commonly for this purpose. Further research is needed to evaluate the ability of the scale to accurately identify and classify positive psychotic experiences (PE) in the general population. Aim To provide psychometric evidence about the accuracy of the CAPE-P15 for detecting PE in a sample of Chilean adolescents from the general population and classifying them according to their PE severity levels. Method We administered the CAPE-P15 to a general sample of 1594 students aged 12 to 19. Based on Item Response Theory (IRT), we tested the accuracy of the instrument using two main parameters: difficulty and discrimination power of the 15 items. Results We found that the scale provides very accurate information about PE, particularly for high PE levels. The items with the highest capability to determine the presence of the latent trait were those assessing perceptual anomalies (auditory and visual hallucinations), bizarre experiences (a double has taken the place of others; being controlled by external forces), and persecutory ideation (conspiracy against me). Conclusions The CAPE-P15 is an accurate and suitable tool to screen PE and to accurately classify and differentiate PE levels in adolescents from the general population. Further research is needed to better understand how maladaptive psychological mechanisms influence relationships between PE and suicidal ideation (SI) in the general population.
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Martin C, Iqbal Z, Airey ND, Marks L. Improving Access to Psychological Therapies (IAPT) has potential but is not sufficient: How can it better meet the range of primary care mental health needs? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:157-174. [PMID: 34124792 DOI: 10.1111/bjc.12314] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Improving Access to Psychological Therapies (IAPT) programme has been impactful in increasing access to psychological therapies at primary care level. However, it remains unclear whether IAPT's widely disseminated achievements include the reduction in service users' transition to secondary care services and whether IAPT services are providing interventions that match the level of complexity of presenting problems of those who are referred. AIMS This review sets out to clarify the clinical characteristics of IAPT cohorts, whether the interventions provided target these characteristics, and whether outcomes are related to the use of the stepped-care model advocated in the operationalization of IAPT services. METHOD A systematic literature search was undertaken on PsycINFO, MEDLINE, and Embase using the terms: IAPT, anxiety, and depression. RESULTS Of 472 paper identified, 24 articles were deemed pertinent. It appears that IAPT cohorts are complex and current service delivery frameworks may not meet their needs. IAPT developments and research for long-term physical health conditions and serious mental illness have been recently advocated, though whether these are sufficient and viable when set in IAPT's prescriptive backdrop remains unclear. CONCLUSIONS Improving Access to Psychological Therapies provision and research at present does not adequately consider the complexity of its clientele in the context of treatment outcomes and service delivery. Recommendations are provided for future research and practice to tackle these deficiencies. PRACTITIONER POINTS Improving Access to Psychological Therapies (IAPT) has significantly increased access to psychological therapies within primary care over the last decade, though it is unclear whether its interventions are sufficiently tailored to meet the actual levels of complexity of its clientele and prevent them from needing onward referral to secondary care as originally envisaged. Given the ongoing focus on and investment in IAPT informed developments into long-term conditions and serious mental illness, this review considers whether additional elucidation of the model's original objectives is required, as a precursor to its expansion into other clinical areas. The review indicates that there is a stark lack of data pertaining to the generalisable, real-world clinical benefits of the IAPT programme as it currently stands. Recommendations are provided for future areas of research, and practice enhancements to ensure the value of IAPT services to clients in the wider context of NHS mental health services, including the interface with secondary care, are considered.
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Affiliation(s)
- Carla Martin
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Zaffer Iqbal
- Faculty of Health Sciences, University of Hull, Hull, UK.,NAViGO Health and Social Care CiC, Grimsby, UK
| | - Nicola D Airey
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lucy Marks
- Independent Consultant Clinical Psychologist, London, UK
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Abstract
Psychiatry's most recent foray into the area of risk and prevention has been spear-headed by work on at-risk mental states for psychotic disorders. Twenty-five years' research and clinical application have led us to reformulate the clinical evolution of these syndromes, blurred unhelpful conceptual boundaries between childhood and adult life by adopting a developmental view and has changed the shape of many mental health services as part of a global movement to increase quality. But there are problems: fragmentary psychotic experiences are common in young people but transition from risk-state to full syndrome is uncommon away from specialist clinics with rarefied referrals and can, anyway, be subtle; diagnostic over-shadowing by the prospect of schizophrenia and other psychotic disorders may divert clinical attention from the kaleidoscopic and disabling range of probably treatable psychopathology with which people with risk syndromes present. We use a 19th Century lyric poem, The Lady of Shallot, as an allegory for Psychiatry warning us against regarding these mental states only as pointers towards diagnoses that probably will not occur. Viewed from the fresh perspective of common mental disorders they tell us a great deal about the psychopathological crucible of the second and third decades, the nature of diagnosis, and point towards new treatment paradigms.
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Affiliation(s)
- Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, CB21 5EF, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, NR4 7TJ, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, CB21 5EF, UK
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Bhavsar V, Dorrington S, Morgan C, Hatch SL, McGuire P, Fusar-Poli P, Mills J, MacCabe JH, Hotopf M. Psychotic experiences, psychiatric comorbidity and mental health need in the general population: a cross-sectional and cohort study in Southeast London. Psychol Med 2021; 51:147-157. [PMID: 31713511 PMCID: PMC7116680 DOI: 10.1017/s0033291719003106] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/02/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Co-occurrence of common mental disorders (CMD) with psychotic experiences is well-known. There is little research on the public mental health relevance of concurrent psychotic experiences for service use, suicidality, and poor physical health. We aim to: (1) describe the distribution of psychotic experiences co-occurring with a range of non-psychotic psychiatric disorders [CMD, depressive episode, anxiety disorder, probable post-traumatic stress disorder (PTSD), and personality dysfunction], and (2) examine associations of concurrent psychotic experiences with secondary mental healthcare use, psychological treatment use for CMD, lifetime suicide attempts, and poor self-rated health. METHODS We linked a prospective cross-sectional community health survey with a mental healthcare provider database. For each non-psychotic psychiatric disorder, patients with concurrent psychotic experiences were compared to those without psychotic experiences on use of secondary mental healthcare, psychological treatment for CMD, suicide attempt, physical functioning, and a composite multimorbidity score, using logistic regression and Cox regressions. RESULTS In all disorders except for anxiety disorder, concurrent psychotic experiences were accompanied by a greater odds of all outcomes (odds ratios) for a unit change in composite multimorbidity score ranged between 2.21 [95% confidence interval (CI) 1.49-3.27] and 3.46 (95% CI 1.52-7.85). Hazard ratios for secondary mental health service use for non-psychotic disorders with concurrent psychotic experiences, ranged from 0.53 (95% CI 0.15-1.86) for anxiety disorders with psychotic experiences to 4.99 (95% CI 1.22-20.44) among those with PTSD with psychotic experiences. CONCLUSIONS Co-occurring psychotic experiences indicate greater public mental health burden, suggesting psychotic experiences could be a marker for future preventive strategies improving public mental health.
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Affiliation(s)
- Vishal Bhavsar
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Dorrington
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - John Mills
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - James H. MacCabe
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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Personalized Medicine and Cognitive Behavioral Therapies for Depression: Small Effects, Big Problems, and Bigger Data. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00094-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Waite F, Kabir T, Johns L, Mollison J, Tsiachristas A, Petit A, Černis E, Maughan D, Freeman D. Treating sleep problems in young people at ultra-high-risk of psychosis: study protocol for a single-blind parallel group randomised controlled feasibility trial (SleepWell). BMJ Open 2020; 10:e045235. [PMID: 33172953 PMCID: PMC7656948 DOI: 10.1136/bmjopen-2020-045235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Effective interventions, targeting key contributory causal factors, are needed to prevent the emergence of severe mental health problems in young people. Insomnia is a common clinical issue that is problematic in its own right but that also leads to the development and persistence of psychotic experiences. The implication is that treating sleep problems may prevent the onset of psychosis. We collected initial case series data with 12 young people at ultra-high-risk of psychosis. Post-intervention, there were improvements in sleep, depression and psychotic experiences. Now we test the feasibility of a randomised controlled trial, with a clinical aim to treat sleep problems and hence reduce depression, psychotic experiences, and prevent transition to psychosis. METHODS AND ANALYSIS A randomised controlled feasibility trial will be conducted. Forty patients aged 14 to 25 years who are at ultra-high-risk of psychosis and have sleep disturbance will be recruited from National Health Service (NHS) mental health services. Participants will be randomised to receive either a novel, targeted, youth-focussed sleep intervention in addition to usual care or usual care alone. Assessor-blinded assessments will be conducted at baseline, 3 months (post-intervention) and 9 months (follow-up). The eight-session psychological intervention will target the key mechanisms which disrupt sleep: circadian rhythm irregularities, low sleep pressure, and hyperarousal. To gain an in-depth understanding of participants' views on the acceptability of the intervention and study procedures, 16 participants (n=10 intervention, n=6 control) will take part in qualitative interviews. Analyses will focus on feasibility outcomes (recruitment, retention, and treatment uptake rates) and provide initial CI estimates of intervention effects. Thematic analysis of the qualitative interviews will assess the acceptability of the intervention and trial procedures. ETHICS AND DISSEMINATION The trial has received ethical approval from the NHS Health Research Authority. Findings will be disseminated through peer-reviewed publications, conference presentations, and lay networks. TRIAL REGISTRATION NUMBER ISRCTN85601537.
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Affiliation(s)
- Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | | | - Louise Johns
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Jill Mollison
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Ariane Petit
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Emma Černis
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Daniel Maughan
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
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Knight C, Russo D, Stochl J, Jones PB, Perez J. More sensitive identification of psychotic experiences in common mental disorder by primary mental healthcare services - effect on prevalence and recovery: casting the net wider. BJPsych Open 2020; 6:e136. [PMID: 33153513 PMCID: PMC7745243 DOI: 10.1192/bjo.2020.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Psychotic experiences may emerge in more severe cases of common mental disorders (CMD). Previous work identified that 30% of patients treated by mental health services in primary healthcare, specifically the Improving Access to Psychological Therapies (IAPT) programme in England, reported psychotic experiences, began treatment with more severe CMD and were less likely to reach recovery. AIMS To replicate our previous assessment of psychotic experiences in the IAPT programme using a more sensitive threshold and determine its impact on the prevalence of psychotic experience and likelihood of recovery. Additionally, to compare recovery rates between patients with and without psychotic experiences at the end of therapy. METHOD The Community Assessment of Psychic Experiences (CAPE-P15) with a cut-off of 1.30 was used to determine the prevalence of psychotic experiences. Recovery rates were determined using measures collected in the IAPT programme for depression (PHQ-9) and anxiety (GAD-7). Multi-group growth models estimated improvement trajectories. RESULTS In total, 2042 patients with CMD completed the CAPE-P15. The mean age was 39.8. The prevalence of psychotic experiences was 18% higher when using a lower threshold. The recovery rate for patients with psychotic experiences was lower (36%) than for those without (64%). Despite sharing similar improvement trajectories, the higher initial severity of CMD among patients with psychotic experiences impeded likelihood of recovery. CONCLUSIONS As psychotic experiences may be a marker of severity in CMD, the benefits of identifying these in IAPT populations may also apply to patients with milder experiences. Further investigation of the consequential demands on service provision and how this would affect clinical practice is recommended.
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Affiliation(s)
- Clare Knight
- Department of Psychiatry, University of Cambridge, UK
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge; and NIHR Applied Research Collaboration (ARC) East of England, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge; and NIHR Applied Research Collaboration (ARC) East of England, Cambridge, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge; NIHR Applied Research Collaboration (ARC) East of England, Cambridge; and Norwich Medical School, University of East Anglia, Norwich, UK
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13
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Knight C, Russo D, Stochl J, Croudace T, Fowler D, Grey N, Reeve N, Jones PB, Perez J. Prevalence of and recovery from common mental disorder including psychotic experiences in the UK Primary Care Improving Access to Psychological Therapies (IAPT) Programme. J Affect Disord 2020; 272:84-90. [PMID: 32379625 DOI: 10.1016/j.jad.2020.04.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/13/2020] [Accepted: 04/18/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Psychotic experiences (PE) may co-occur with common mental disorders (CMD), such as depression and anxiety. However, we know very little about the prevalence of and recovery from PE in primary mental health care settings, such as the Improving Access to Psychological Therapies (IAPT) services in the UK National Health Service (NHS), where most CMD are treated. METHODS We used the Community Assessment of Psychic Experiences - Positive 15-item Scale (CAPE-P15) to determine the prevalence of PE in patients receiving treatment from IAPT services. Patient-reported measures of depression (PHQ-9) and anxiety (GAD-7) are routinely collected and establish recovery in IAPT services. We studied recovery rates according to the absence and presence of PE. Multi-group growth models estimated improvement trajectories for each group. RESULTS A total of 2,042 patients with CMD completed the CAPE-P15. The mean age was 39.8. The overall prevalence of PE was 29.68%. The recovery rate was 27.43% compared to 62.08% for those without PE. Although patients with or without PE shared similar improvement trajectories, the initial severity of patients with PE impeded their likelihood of recovery. LIMITATIONS We mirrored routine data collection in IAPT services, including self-report questionnaires that may affect valid reporting of symptoms. Missing data in the calculation of improvement trajectories may reduce generalisability. CONCLUSIONS At least one in four patients receiving treatment from IAPT services in primary care experience CMD and PE. This significant group of people experience a lower recovery rate, with adverse implications not only for them but also for efficiency of services.
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Affiliation(s)
- Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK; National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, Douglas House, Trumpinton Road, Cambridge, CB2 8AH, UK.
| | - Tim Croudace
- School of Nursing and Health Sciences, University of Dundee, Dundee, DD1 4HJ, UK.
| | - David Fowler
- School of Psychology, Pevensey Building, University of Sussex, Brighton, BN1 9QH, UK.
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Aldrington House, 35 New Church Road, Hove, BN3 4AG, UK.
| | - Nesta Reeve
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK.
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK; National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, Douglas House, Trumpinton Road, Cambridge, CB2 8AH, UK; Cambrigeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Cambridge, CB21 5EF, UK.
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK; National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, Douglas House, Trumpinton Road, Cambridge, CB2 8AH, UK; Cambrigeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Cambridge, CB21 5EF, UK; Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ.
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14
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Soneson E, Russo D, Stochl J, Heslin M, Galante J, Knight C, Grey N, Hodgekins J, French P, Fowler D, Lafortune L, Byford S, Jones PB, Perez J. Psychological interventions for people with psychotic experiences: A systematic review and meta-analysis of controlled and uncontrolled effectiveness and economic studies. Aust N Z J Psychiatry 2020; 54:673-695. [PMID: 32462893 PMCID: PMC7324911 DOI: 10.1177/0004867420913118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Many people with psychotic experiences do not develop psychotic disorders, yet those who seek help demonstrate high clinical complexity and poor outcomes. In this systematic review and meta-analysis, we evaluated the effectiveness and cost-effectiveness of psychological interventions for people with psychotic experiences. METHOD We searched 13 databases for studies of psychological interventions for adults with psychotic experiences, but not psychotic disorders. Our outcomes were the proportion of participants remitting from psychotic experiences (primary); changes in positive and negative psychotic symptoms, depression, anxiety, functioning, distress, and quality of life; and economic outcomes (secondary). We analysed results using multilevel random-effects meta-analysis and narrative synthesis. RESULTS A total of 27 reports met inclusion criteria. In general, there was no strong evidence for the superiority of any one intervention. Five studies reported on our primary outcome, though only two reports provided randomised controlled trial evidence that psychological intervention (specifically, cognitive behavioural therapy) promoted remission from psychotic experiences. For secondary outcomes, we could only meta-analyse trials of cognitive behavioural therapy. We found that cognitive behavioural therapy was more effective than treatment as usual for reducing distress (pooled standardised mean difference: -0.24; 95% confidence interval = [-0.37, -0.10]), but no more effective than the control treatment for improving any other outcome. Individual reports indicated that cognitive behavioural therapy, mindfulness-based cognitive therapy, sleep cognitive behavioural therapy, systemic therapy, cognitive remediation therapy, and supportive treatments improved at least one clinical or functional outcome. Four reports included economic evaluations, which suggested cognitive behavioural therapy may be cost-effective compared with treatment as usual. CONCLUSION Our meta-analytic findings were primarily null, with the exception that cognitive behavioural therapy may reduce the distress associated with psychotic experiences. Our analyses were limited by scarcity of studies, small samples and variable study quality. Several intervention frameworks showed preliminary evidence of positive outcomes; however, the paucity of consistent evidence for clinical and functional improvement highlights a need for further research into psychological treatments for psychotic experiences. PROSPERO PROTOCOL REGISTRATION NUMBER CRD42016033869.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Margaret Heslin
- Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Joanne Hodgekins
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | - Louise Lafortune
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Sarah Byford
- Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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15
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Kim SW, Kim JK, Han JH, Jhon M, Kim JW, Lee JY, Kim JM, Na HJ, Kang YS, Chung YC, Yoon JS. Validation of the Korean Version of the 15-Item Community Assessment of Psychic Experiences in a College Population. Psychiatry Investig 2020; 17:306-311. [PMID: 32200606 PMCID: PMC7176566 DOI: 10.30773/pi.2019.0215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/20/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate the reliability and validity of the Korean version of the Community Assessment of Psychic Experiences-15 item positive scale (CAPE-15) in college students. METHODS This study had two stages: initial screening with self-report questionnaires including the CAPE-15, and semi-structured interviews to investigate the instrument's diagnostic validity. The initial screening involved 1,749 college students. The modified Korean version of Prodromal Questionnaire-16 item (mKPQ-16) was also administered. The criteria for ultra-high risk (UHR) of psychosis in the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis. RESULTS Twelve of the interviewed subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve was highest (0.936) for the CAPE-15 distress score (p<0.001). The use of 6 as the cutoff for the CAPE-15 distress score resulted in the best balance of sensitivity (91.7%) and specificity (85.2%), with a favorable positive predictive value of 32.4%. The coefficients of correlation between the CAPE-15 and mKPQ-16 were significant. CONCLUSION The Korean version of the CAPE-15 is a good instrument for screening for psychosis risk in collegiate settings. The validation of this scale could contribute to the early identification of psychosis in the Korean community.
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Affiliation(s)
- Sung-Wan Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Mental Health Commission, Gwangju, Republic of Korea
| | - Jae-Kyeong Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Ji Hun Han
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Mental Health Commission, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyun Ju Na
- Department of Nursing, Dong Kang University, Gwangju, Republic of Korea
| | - Young-Shin Kang
- Department of Psychology, Chonnam National University, Gwangju, Republic of Korea
| | - Young-Chul Chung
- Department of Psychiatry, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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16
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Seiler N, Nguyen T, Yung A, O'Donoghue B. Terminology and assessment tools of psychosis: A systematic narrative review. Psychiatry Clin Neurosci 2020; 74:226-246. [PMID: 31846133 DOI: 10.1111/pcn.12966] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
AIM Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'. METHODS EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded. RESULTS A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization. DISCUSSION A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.
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Affiliation(s)
- Natalie Seiler
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Tony Nguyen
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Alison Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
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17
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Mikocka-Walus A, Hanlon I, Dober M, Emerson C, Beswick L, Selinger C, Taylor J, Olive L, Evans S, Hewitt C. Lived experience in people with inflammatory bowel disease and comorbid anxiety and depression in the United Kingdom and Australia. J Health Psychol 2020; 26:2290-2303. [PMID: 32175775 DOI: 10.1177/1359105320911427] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study explored the lived experience of people with inflammatory bowel disease and anxiety/depression. It utilised a deductive biopsychosocial framework. Overall, 24 patients and 20 healthcare professionals from two countries participated. In the United Kingdom, the main themes included (1) bidirectional relationship between inflammatory bowel disease and mental health, (2) the need for healthcare integration and (3) lack of awareness about the disease. In Australia, (1) the 'vicious cycle' of inflammatory bowel disease and psychosocial health, (2) the need for biopsychosocial healthcare integration and (3) the stigma of a hidden disease. Better communication around mental illness is essential in improving inflammatory bowel disease healthcare.
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18
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Knight C, Stochl J, Soneson E, Russo DA, Jones PB, Perez J. Revisiting CAPE-P15 cut-off values to increase sensitivity for detecting psychotic experiences in primary care. Schizophr Res 2020; 216:507-510. [PMID: 31813808 DOI: 10.1016/j.schres.2019.11.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 10/10/2019] [Accepted: 11/26/2019] [Indexed: 11/17/2022]
Abstract
Psychotic experiences (PE) co-occur with depression and anxiety, and indicate severity of general mental distress. Identifying PE in primary care mental health settings may facilitate access to evidence-based interventions. The Community Assessment of Psychic Experiences - Positive 15-items Scale (CAPE-P15) has shown promise in detecting those at ultra-high risk of developing psychosis. Based on a sample of 1131 individuals with common mental disorder we propose high-sensitivity thresholds of the CAPE-P15 to broaden its application across clinical settings.
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Affiliation(s)
- Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK.
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK.
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK.
| | - Debra A Russo
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK.
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn CB21 5EF, UK.
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn CB21 5EF, UK; Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
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19
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Soneson E, Russo D, Knight C, Lafortune L, Heslin M, Stochl J, Georgiadis A, Galante J, Duschinsky R, Grey N, Gonzalez-Blanco L, Couche J, Griffiths M, Murray H, Reeve N, Hodgekins J, French P, Fowler D, Byford S, Dixon-Woods M, Jones PB, Perez J. Psychological interventions for people with psychotic experiences: protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:124. [PMID: 31122287 PMCID: PMC6533690 DOI: 10.1186/s13643-019-1041-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/10/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Many people who have common mental disorders, such as depression and anxiety, also have some psychotic experiences. These experiences are associated with higher clinical complexity, poor treatment response, and negative clinical outcomes. Psychological interventions have the potential to improve outcomes for people with psychotic experiences. The aims of this systematic review are to (1) synthesise the evidence on the effectiveness and cost-effectiveness of psychological interventions to reduce psychotic experiences and their associated distress and (2) identify key components of effective interventions. METHODS Our search strategy will combine terms for (1) psychological interventions, (2) psychotic experiences, and (3) symptoms associated with psychotic experiences. We will search the following online databases: MEDLINE, Embase, PsycINFO, all Cochrane databases, British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Management Information Consortium (HMIC), Education Resources Information Center (ERIC), and EconLit. Our primary outcome is the proportion of people who recovered or remitted from psychotic experiences after the intervention. Our secondary outcomes are changes in positive psychotic symptoms, negative psychotic symptoms, depression, anxiety, functioning (including social, occupational, and academic), quality of life, and cost-effectiveness. Two independent reviewers will judge each study against pre-specified inclusion and exclusion criteria and will extract study characteristics, outcome data, and intervention components. Risk of bias and methodological quality will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the Drummond Checklist. Results will be synthesised using random-effects meta-analysis and narrative synthesis. DISCUSSION The identification of effective psychological interventions and of specific components associated with intervention effectiveness will augment existing evidence that can inform the development of a new, tailored intervention to improve outcomes related to psychotic symptoms, anxiety and depression, distress, functioning, and quality of life. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033869.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Louise Lafortune
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Margaret Heslin
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Alex Georgiadis
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, CB2 0AH, UK
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Robbie Duschinsky
- The Primary Care Unit, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | | | - Leticia Gonzalez-Blanco
- Department of Psychiatry, University of Oviedo - CIBERSAM - Servicio de Salud del Principado de Asturias, Oviedo, Spain
| | - Juliet Couche
- Health in Mind, Sussex Partnership NHS Foundation Trust, Woodside, The Drive, Hellingly, East Sussex, BN27 4ER, UK
| | | | - Hannah Murray
- Oxford Centre for Anxiety Disorders and Trauma, Paradise Square, Oxford, OX1 1TW, UK
| | - Nesta Reeve
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK
| | - Joanne Hodgekins
- Department of Clinical Psychology, Elizabeth Fry Building, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - David Fowler
- School of Psychology, Pevensey Building, University of Sussex, Brighton, BN1 9QH, UK
| | - Sarah Byford
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, CB2 0AH, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
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20
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Georgiadis A, Duschinsky R, Perez J, Jones PB, Russo D, Knight C, Soneson E, Dixon-Woods M. Coproducing healthcare service improvement for people with common mental health disorders including psychotic experiences: a study protocol of a multiperspective qualitative study. BMJ Open 2018; 8:e026064. [PMID: 30413522 PMCID: PMC6231599 DOI: 10.1136/bmjopen-2018-026064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Some people, who have common mental health disorders such as depression and anxiety, also have some psychotic experiences. These individuals may experience a treatment gap: their symptoms neither reach the increasingly high threshold for secondary care, nor do they receive full benefit from current interventions offered by the Improving Access to Psychological Therapies (IAPT) programme. The result may be poorer clinical and functional outcomes. A new talking therapy could potentially benefit this group. Informed by principles of coproduction, this study will seek the views of service users and staff to inform the design and development of such a therapy. METHODS AND ANALYSIS Semistructured interviews will be conducted with IAPT service users, therapists and managers based in three different geographical areas in England. Our sample will include (1) approximately 15 service users who will be receiving therapy or will have completed therapy at the time of recruitment, (2) approximately 15 service users who initiated treatment but withdrew, (3) approximately 15 therapists each with at least 4-month experience in a step-3 IAPT setting and (4) three IAPT managers. Data analysis will be based on the constant comparative method. ETHICS AND DISSEMINATION The study has been approved by the London Harrow Research Ethics Committee (reference: 18/LO/0642), and all National Health Service Trusts have granted permissions to conduct the study. Findings will be published in peer-reviewed academic journals, and presented at academic conferences. We will also produce a 'digest' summary of the findings, which will be accessible, visual and freely available.
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Affiliation(s)
- Alexandros Georgiadis
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Robbie Duschinsky
- Applied Social Science Group, University of Cambridge, Cambridge, UK
| | - Jesus Perez
- CAMEO Early Intervention Services, Cambridgeshire andPeterborough NHS FoundationTrust, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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