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Spencer HM, Dudley R, Johnston L, Freeston MH, Turkington D, Tully S. Case formulation-A vehicle for change? Exploring the impact of cognitive behavioural therapy formulation in first episode psychosis: A reflexive thematic analysis. Psychol Psychother 2022; 96:328-346. [PMID: 36480353 DOI: 10.1111/papt.12442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Formulation is considered a fundamental process of cognitive behavioural therapy for psychosis (CBTp). However, an exploration into the personal impact of different levels of case formulation (CF) from a service user perspective (SU) is lacking, particularly for those experiencing a first episode of psychosis. DESIGN This Big Q qualitative design used semi-structured interviews. METHODS Reflexive thematic analysis (TA) was used to analyse 10 participant interviews. NVivo 12 computer-assisted qualitative data analysis software aided data organisation and analysis. RESULTS One overarching theme 'CF - A vehicle for change?' was developed as a pattern of shared meaning across the data set. Three main themes related to the overarching theme: (1) Vicious cycles: 'I never really thought about it being me maintaining the problems' (including one subtheme - Self-empowerment: 'Only you can make the changes for yourself'); (2) Early life experiences: 'My experiences have shaped the person that I am, therefore, it's not my fault' (including one subtheme - Disempowerment: '[My] core beliefs have been damaged'); and (3) Keep it simple: 'Don't push it too far over the top in case it becomes like spaghetti'. CONCLUSIONS Maintenance formulations may be experienced as self-blaming, but also self-empowering, which may help to facilitate change. Longitudinal formulations may be experienced as non-blaming, but also disempowering, which may inhibit change. Simple CF diagrams may also facilitate change, whereas overly complex CFs may inhibit change. How CBTp therapists might look to improve the impact of different levels of CF for service users (SUs) in first episode psychosis (FEP) are described.
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Affiliation(s)
- Helen M Spencer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Dudley
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Psychology, University of York, York, UK
| | - Lynne Johnston
- Halley Johnston Associates Ltd, Newcastle upon Tyne, UK.,NHS Golden Jubilee, Glasgow, UK.,Clinical Psychology, Glasgow University, Glasgow, UK.,School of Psychology, University of Sunderland, Sunderland, UK
| | - Mark H Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Douglas Turkington
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sarah Tully
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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2
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Kovacs TZ, Hill RW, Watson S, Turkington D. Clusters, lines and webs-so does my patient have psychosis? reflections on the use of psychiatric conceptual frameworks from a clinical vantage point. Philos Ethics Humanit Med 2022; 17:6. [PMID: 35152913 PMCID: PMC8842805 DOI: 10.1186/s13010-022-00118-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/22/2022] [Indexed: 06/14/2023] Open
Abstract
Mental health professionals working in hospitals or community clinics inevitably face the realisation that we possess imperfect conceptual means to understand mental disorders. In this paper the authors bring together ideas from the fields of Philosophy, Psychiatry, Cognitive Psychology and Linguistics to reflect on the ways we represent phenomena of high practical importance that we often take for granted, but are nevertheless difficult to define in ontological terms. The paper follows through the development of the concept of psychosis over the last two centuries in the interplay of three different conceptual orientations: the categorical, dimensional and network approaches. Each of these represent the available knowledge and dominant thinking styles of the era in which they emerged and take markedly different stances regarding the nature of mental phenomena. Without particular commitment to any ontological positions or models described, the authors invite the reader into a thinking process about the strengths and weaknesses of these models, and how they can be reconciled in multidisciplinary settings to benefit the process of patient care.
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Affiliation(s)
- Tibor Zoltan Kovacs
- Early Intervention in Psychosis Service, Newcastle upon Tyne, Cumbria, UK.
- Northumberland Tyne and Wear NHS Foundation Trust, 1 Benton View, Forest Hall, Newcastle upon Tyne, NE12 7JJ, UK.
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.
| | - Reece William Hill
- School of Medical Education, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Stuart Watson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Douglas Turkington
- Cumbria, Northumberland, Tyne and Wear NHS Trust, Monkwearmouth Hospital, Newcastle Road, Sunderland, SR5 1NB, UK
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Kopelovich SL, Stiles B, Monroe-DeVita M, Hardy K, Hallgren K, Turkington D. Psychosis REACH: Effects of a Brief CBT-Informed Training for Family and Caregivers of Individuals With Psychosis. Psychiatr Serv 2021; 72:1254-1260. [PMID: 34015942 DOI: 10.1176/appi.ps.202000740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychosis Recovery by Enabling Adult Carers at Home (Psychosis REACH) is a training for families of individuals with psychosis that consists of recovery-oriented psychosis psychoeducation, caregiver self-care, and skills training informed by cognitive-behavioral therapy for psychosis (CBTp). The authors assessed the effects of a 1-day and a 4-day training on the natural supports (i.e., family and other caregivers) of individuals with psychotic disorders. METHODS Attendees of a 1-day (N=168) and a 4-day (N=29) Psychosis REACH training were surveyed at three timepoints: pretraining, posttraining, and 4-month follow-up. Longitudinal changes across the full sample were evaluated by paired-sample t tests or a one-way repeated-measures analysis of variance (ANOVA). Two-way mixed ANOVAs were conducted with training condition, time, and the training condition × time interactions entered into the model. RESULTS Reductions were noted in self-perceived depression, anxiety, negative aspects of the caregiving experience, and expressed emotion. Trainees also showed more prosocial attitudes toward psychosis immediately and at 4 months after the training. CONCLUSIONS This evaluation of the launch of Psychosis REACH in the United States suggests that the training can improve the mental health, attitudinal, and relational outcomes of family and caregivers of individuals with psychosis. Given the dearth of CBTp and family interventions for psychosis in mental health services in the United States, short-term, intensive training that supplements clinical services has intuitive appeal as a means of surmounting the barriers that have plagued family interventions.
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Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Bryan Stiles
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Kate Hardy
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Kevin Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Douglas Turkington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
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4
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Varese F, Douglas M, Dudley R, Bowe S, Christodoulides T, Common S, Grace T, Lumley V, McCartney L, Pace S, Reeves T, Morrison AP, Turkington D. Targeting dissociation using cognitive behavioural therapy in voice hearers with psychosis and a history of interpersonal trauma: A case series. Psychol Psychother 2021; 94:247-265. [PMID: 32914542 DOI: 10.1111/papt.12304] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/27/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniques specifically targeting dissociative symptoms could improve both dissociation and auditory hallucination severity in a sample of voice hearers with psychosis and a history of interpersonal trauma (e.g., exposure to sexual, physical, and/or emotional abuse). DESIGN Case series. METHODS A total of 19 service users with psychosis were offered up to 24 therapy sessions over a 6-month intervention window. Participants were assessed four times over a 12-month period using measures of dissociation, psychotic symptoms severity, and additional secondary mental-health and recovery measures. RESULTS Sixteen participants engaged in the intervention and were included in last-observation-carried-forward analyses. Dropout rates were in line with those of other CBT for psychosis trials (26.3%). Repeated measures ANOVAs revealed large and significant improvements in dissociation (drm = 1.23) and hallucination severity (drm = 1.09) by the end of treatment; treatment gains were maintained 6 months following the end of therapy. Large and statistically significant gains were also observed on measures of post-traumatic symptoms, delusion severity, emotional distress, and perceived recovery from psychosis. CONCLUSIONS The findings of this case series suggest that the reduction of dissociation represents a valuable and acceptable treatment target for clients with auditory verbal hallucinations and a trauma history. Future clinical trials might benefit from considering targeting dissociative experiences as part of psychological interventions for distressing voices. PRACTITIONER POINTS Practitioners should consider the role of dissociation when assessing and formulating the difficulties of voice hearers with a history of trauma. Techniques to reduce dissociation can be feasibly integrated within psychological interventions for voices. Voice hearers with histories of trauma can benefit from psychological interventions aimed at reducing dissociation.
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Affiliation(s)
- Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Maggie Douglas
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Dudley
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | | | | | - Tim Grace
- Tees Esk and Wear Valley, NHS Foundation Trust, Darlington, UK
| | - Victoria Lumley
- Tees Esk and Wear Valley, NHS Foundation Trust, Darlington, UK
| | - Laura McCartney
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sonia Pace
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas Reeves
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anthony P Morrison
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Douglas Turkington
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Abstract
Many patients with chronic fatigue syndrome (CFS) fail to derive benefit from evidence-based treatments such as cognitive-behavioural therapy (CBT) and graded exercise therapy leading to permanent disability. To discover whether a repeat prescription of modafinil might potentiate the benefits of CBT leading to social recovery as defined by 2 or more point improvement in energy and muscular pain/concentration and return to work or full-time training. Three patients with treatment-resistant CFS (mean duration 17.66 years) treated with modafinil and CBT in a Liaison Psychiatry clinic were retrospectively reviewed. Progress was reviewed at baseline, 4-6 months and 10-24 months. Patients rated their fatigue, pain and concentration using 10-point Likert scales. 2/3 achieved clinically meaningful improvements in energy and pain/concentration and 3/3 achieved social recovery. Modafinil, when prescribed over the medium term, would appear to be a potentially useful potentiating agent when added to CBT.
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Affiliation(s)
- Himanshu Garg
- Adult Services, Bradford District Care NHS Foundation Trust, Bradford, UK
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6
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Affiliation(s)
- L. Lebert
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D. Turkington
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - M. Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - R. Dudley
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
- Gateshead Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS, Newcastle upon Tyne, UK
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7
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Spencer HM, Dudley R, Freeston MH, Turkington D. What are the essential ingredients of a CBT case conceptualization for voices and delusions in schizophrenia spectrum disorders? A study of expert consensus. Schizophr Res 2020; 224:74-81. [PMID: 33069578 DOI: 10.1016/j.schres.2020.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022]
Abstract
Evidence supports the use of cognitive behavioural therapy (CBT) for the treatment of patients with schizophrenia spectrum disorders. A case conceptualization (CC) (or case formulation) is seen as the keystone of CBT in terms of making sense of a patient's difficulties, to guide and inform such treatment. Despite the importance placed on CC there is no known consensus amongst experts as to the essential ingredients involved in this fundamental process. This study used the Delphi method to establish expert consensus for the essential components of a CC when working to treat auditory hallucinations (voices), and persecutory delusions. An international panel of 78 CBT for psychosis (CBTp) experts from 12 different countries participated in the main stage of this study. This 3-stage process involved producing and rating statements that addressed key areas of CC in terms of: presenting issues, predisposing, precipitating, perpetuating and protective factors. One presenting issue and 6 perpetuating factors were endorsed as essential by >80% of the expert panel. The exact same items were endorsed for both voices, and persecutory delusions. The findings are unique in that a large panel of international experts reached consensus that case conceptualizations (CCs) should be parsimonious and focused on the perpetuating (maintaining) factors to facilitate change. Overall, the proposed recommendations should lead to core guidance for the process of developing CCs, and improvements in training for clinicians that conceptualize voices, and persecutory delusions in CBT for schizophrenia spectrum disorders.
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Affiliation(s)
- Helen M Spencer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom.
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
| | - Mark H Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
| | - Douglas Turkington
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
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8
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Turkington D, Moorhead S, Turkington GD, King C, Bell L, Pickersgill D. Improving patient flow in acute psychiatric wards: enhanced bed management and trusted assessment. BJPsych Bull 2020; 44:159-162. [PMID: 32070448 PMCID: PMC8058940 DOI: 10.1192/bjb.2020.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD In three localities in a mental health trust in England, an enhanced bed management team was established to improve patient flow and reduce out-of-area placements. Trusted assessments were provided to support risk management and conflict resolution. Two measures of flow were compared before and after the team was established. RESULTS The trusted assessment recommendation was for discharge in 70% of cases. The number of out-of-area placements was significantly reduced (P < 0.05), saving £616 876 over a 12-month period. Patient flow was significantly improved in one of the three localities as measured by patients/bed/6-month period (P < 0.05). In one of the other localities increased use of trusted assessment input and reduced numbers of patients being transferred in are recommended to improve flow. CLINICAL IMPLICATIONS Mental health trusts should consider the establishment of an enhanced bed management team, including trusted assessment, as a safe and cost-effective approach to improving patient flow and reducing the need for out-of-area placement.
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Affiliation(s)
- Douglas Turkington
- Monkwearmouth Hospital, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Sunderland, UK
| | - Steve Moorhead
- Monkwearmouth Hospital, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Sunderland, UK
| | - Gordon D Turkington
- Monkwearmouth Hospital, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Sunderland, UK
| | - Carla King
- Monkwearmouth Hospital, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Sunderland, UK
| | - Leigh Bell
- Monkwearmouth Hospital, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Sunderland, UK
| | - Denise Pickersgill
- Monkwearmouth Hospital, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Sunderland, UK
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9
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Morrison AP, Pyle M, Gumley A, Schwannauer M, Turkington D, MacLennan G, Norrie J, Hudson J, Bowe S, French P, Hutton P, Byrne R, Syrett S, Dudley R, McLeod HJ, Griffiths H, Barnes TR, Davies L, Shields G, Buck D, Tully S, Kingdon D. Cognitive-behavioural therapy for clozapine-resistant schizophrenia: the FOCUS RCT. Health Technol Assess 2020; 23:1-144. [PMID: 30806619 DOI: 10.3310/hta23070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of cognitive-behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome. DESIGN The Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU). SETTING Secondary care mental health services in five cities in the UK. PARTICIPANTS People with CRS aged ≥ 16 years, with an International Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms. INTERVENTIONS Individual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services. MAIN OUTCOME MEASURES The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs. RESULTS Participants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) -3.32 to 1.55 points; p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (-2.40 points, 95% CI -4.79 to -0.02 points; p = 0.049). CBT was associated with a net cost of £5378 (95% CI -£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability < 50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46; p = 0.58). CONCLUSIONS Cognitive-behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained. TRIAL REGISTRATION Current Controlled Trials ISRCTN99672552. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Douglas Turkington
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Centre for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Clinical Trials Unit, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Suzy Syrett
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Griffiths
- Department of Clinical Psychology, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | | | - Linda Davies
- Division of Population Health, University of Manchester, Manchester, UK
| | - Gemma Shields
- Division of Population Health, University of Manchester, Manchester, UK
| | - Deborah Buck
- Division of Population Health, University of Manchester, Manchester, UK
| | - Sarah Tully
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - David Kingdon
- Department of Psychiatry, University of Southampton, Academic Centre, Southampton, UK
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10
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Turner DT, Reijnders M, van der Gaag M, Karyotaki E, Valmaggia LR, Moritz S, Lecomte T, Turkington D, Penadés R, Elkis H, Cather C, Shawyer F, O'Connor K, Li ZJ, de Paiva Barretto EM, Cuijpers P. Efficacy and Moderators of Cognitive Behavioural Therapy for Psychosis Versus Other Psychological Interventions: An Individual-Participant Data Meta-Analysis. Front Psychiatry 2020; 11:402. [PMID: 32431633 PMCID: PMC7214739 DOI: 10.3389/fpsyt.2020.00402] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/21/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Study-level meta-analyses have demonstrated the efficacy of cognitive-behavioural therapy for psychosis (CBTp). Limitations of conventional meta-analysis may be addressed using individual-participant-data (IPD). We aimed to determine a) whether results from IPD were consistent with study-level meta-analyses and b) whether demographic and clinical characteristics moderate treatment outcome. METHODS We systematically searched PubMed, Embase, PsychInfo and CENTRAL. Authors of RCTs comparing CBTp with other psychological interventions were contacted to obtain original databases. Hierarchical mixed effects models were used to examine efficacy for psychotic symptoms. Patient characteristics were investigated as moderators of symptoms at post-treatment. Sensitivity analyses were conducted for risk of bias, treatment format and study characteristics. RESULTS We included 14 of 23 eligible RCTs in IPD meta-analyses including 898 patients. Ten RCTs minimised risk of bias. There was no significant difference in efficacy between RCTs providing IPD and those not (p >0.05). CBTp was superior vs. other interventions for total psychotic symptoms and PANSS general symptoms. No demographic or clinical characteristics were robustly demonstrated as moderators of positive, negative, general or total psychotic symptoms at post-treatment. Sensitivity analyses demonstrated that number of sessions moderated the impact of treatment assignment (CBTp or other therapies) on total psychotic symptoms (p = 0.02). CONCLUSIONS IPD suggest that patient characteristics, including severity of psychotic symptoms, do not significantly influence treatment outcome in psychological interventions for psychosis while investing in sufficient dosage of CBTp is important. IPD provide roughly equivalent efficacy estimates to study-level data although significant benefit was not replicated for positive symptoms. We encourage authors to ensure IPD is accessible for future research.
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Affiliation(s)
- David T Turner
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands.,Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Lucia R Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Trust, London, United Kingdom
| | - Steffen Moritz
- Klinik für Psychiatrie und Psychotherapie, Arbeitsgruppe Klinische Neuropsychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Tania Lecomte
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada
| | - Douglas Turkington
- Wolfson Unit, Centre for Aging and Vitality, Newcastle-upon-Tyne, United Kingdom
| | - Rafael Penadés
- Hospital Clínic Barcelona, University of Barcelona, IDIBAPS-CIBERSAM, Barcelona, Spain
| | - Helio Elkis
- Department and Institute of Psychiatry, University de São Paulo Medical School, São Paulo, Brazil
| | - Corinne Cather
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Frances Shawyer
- Southern Synergy, Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Kieron O'Connor
- Department Psychiatrie, Université de Montréal, Montréal, QC, Canada
| | - Zhan-Jiang Li
- Department of Clinical Psychology, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
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11
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Little B, Gallagher P, Zimmerer V, Varley R, Douglas M, Spencer H, Çokal D, Deamer F, Turkington D, Ferrier IN, Hinzen W, Watson S. Language in schizophrenia and aphasia: the relationship with non-verbal cognition and thought disorder. Cogn Neuropsychiatry 2019; 24:389-405. [PMID: 31550981 DOI: 10.1080/13546805.2019.1668758] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To determine the relationship between language abnormalities and broader cognitive impairment and thought disorder by examining language and cognition in schizophrenia and aphasia (a primary language disorder).Methods: Cognitive and linguistic profiles were measured with a battery of standardised tests, and compared in a clinical population of n = 50 (n = 30 with schizophrenia and n = 20 with aphasia) and n = 61 non-clinical comparisons (n = 45 healthy controls and n = 16 non-affected first-degree relatives of patients with schizophrenia).Results: Both clinical groups showed linguistic deficits. Verbal impairment was more severe in participants with aphasia, whereas non-verbal performance was more affected in participants with schizophrenia. In schizophrenia, but not in aphasia, verbal and non-verbal performance were associated. Formal thought disorder was associated with impairment in executive function and in grammatical, but not naming, tasks.Conclusion: While patients with schizophrenia and aphasia showed language impairments, the nature and cognitive basis of these impairments may be different; language performance disassociates from broader cognitive functioning in aphasia but may be an intrinsic expression of a broader cognitive impairment in schizophrenia. Thought disorder may represent a core malfunction of grammatical processing. Results suggests that communicative ability may be a valid target in cognitive remediation strategies in schizophrenia.
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Affiliation(s)
- Bethany Little
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Vitor Zimmerer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Rosemary Varley
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Maggie Douglas
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Spencer
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Derya Çokal
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,School of Electronic Engineering and Computer Science, Cognitive Science Research Group, Queen Mary University of London, London
| | - Felicity Deamer
- Department of Philosophy, Durham University, Durham, UK.,Department of English Studies, Durham University, Durham, UK
| | - Douglas Turkington
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - I Nicol Ferrier
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Wolfram Hinzen
- ICREA (Catalan Institute of Advanced Studies and Research), Universitat Pompeu Fabra, Barcelona, Spain.,Department of Translation and Language Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,FIDMAG Germanes Hospitalaries Research Foundation, Benito Menni Hospital, Barcelona, Spain
| | - Stuart Watson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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12
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Guo ZH, Li ZJ, Ma Y, Sun J, Guo JH, Li WX, Wang ZQ, Xu HL, Ng RMK, Turkington D, Kingdon D. Brief cognitive-behavioural therapy for patients in the community with schizophrenia: Randomised controlled trial in Beijing, China - RETRACTION. Br J Psychiatry 2019; 215:435. [PMID: 31111798 DOI: 10.1192/bjp.2019.91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Stevens LH, Turkington D, Drage L, Morrison T, Muncer S, Spencer HM, Dudley R. Investigation of a traumatic psychosis subgroup: a cluster analysis of an antipsychotic free cohort. Psychosis 2019. [DOI: 10.1080/17522439.2019.1628290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Lucy H. Stevens
- Department of Clinical Psychology, Teesside University, Middlesbrough, UK
| | - Douglas Turkington
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Laura Drage
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Tony Morrison
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Steven Muncer
- Department of Clinical Psychology, Teesside University, Middlesbrough, UK
| | - Helen M. Spencer
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Dudley
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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14
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Çokal D, Zimmerer V, Turkington D, Ferrier N, Varley R, Watson S, Hinzen W. Disturbing the rhythm of thought: Speech pausing patterns in schizophrenia, with and without formal thought disorder. PLoS One 2019; 14:e0217404. [PMID: 31150442 PMCID: PMC6544238 DOI: 10.1371/journal.pone.0217404] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/11/2019] [Indexed: 12/20/2022] Open
Abstract
Everyday speech is produced with an intricate timing pattern and rhythm. Speech units follow each other with short interleaving pauses, which can be either bridged by fillers (erm, ah) or empty. Through their syntactic positions, pauses connect to the thoughts expressed. We investigated whether disturbances of thought in schizophrenia are manifest in patterns at this level of linguistic organization, whether these are seen in first degree relatives (FDR) and how specific they are to formal thought disorder (FTD). Spontaneous speech from 15 participants without FTD (SZ-FTD), 15 with FTD (SZ+FTD), 15 FDRs and 15 neurotypical controls (NC) was obtained from a comic strip retelling task and rated for pauses subclassified by syntactic position and duration. SZ-FTD produced significantly more unfilled pauses than NC in utterance-initial positions and before embedded clauses. Unfilled pauses occurring within clausal units did not distinguish any groups. SZ-FTD also differed from SZ+FTD in producing significantly more pauses before embedded clauses. SZ+FTD differed from NC and FDR only in producing longer utterance-initial pauses. FDRs produced significantly fewer fillers than NC. Results reveal that the temporal organization of speech is an important window on disturbances of the thought process and how these relate to language.
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Affiliation(s)
- Derya Çokal
- School of Engineering and Computer Science, Queen Mary University of London, London, United Kingdom
- * E-mail: ,
| | - Vitor Zimmerer
- Department of Language and Cognition, University College London, London, United Kingdom
| | - Douglas Turkington
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, United Kingdom
| | - Nicol Ferrier
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, United Kingdom
| | - Rosemary Varley
- Department of Language and Cognition, University College London, London, United Kingdom
| | - Stuart Watson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, United Kingdom
| | - Wolfram Hinzen
- ICREA (Institució Catalana de Recerca i Estudis Avançats), Barcelona, Spain
- Department of Translation and Language Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- FIDMAG Germanes Hospitalaries Research Foundation, Benito Menni Hospital, Barcelona, Spain
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15
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Hutton P, Di Rienzo F, Turkington D, Spencer H, Taylor P. Suicidal Ideation in People With Psychosis Not Taking Antipsychotic Medication: Do Negative Appraisals and Negative Metacognitive Beliefs Mediate the Effect of Symptoms? Schizophr Bull 2019; 45:37-47. [PMID: 30388270 PMCID: PMC6293212 DOI: 10.1093/schbul/sby153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Between 5% and 10% of people with psychosis will die by suicide, a rate which is 20-75 times higher than the general population. This risk is even greater in those not taking antipsychotic medication. We examined whether negative appraisals of psychotic experiences and negative metacognitive beliefs about losing mental control mediated a relationship between psychotic symptoms and suicidal ideation in this group. Participants were diagnosed with schizophrenia spectrum disorders, antipsychotic-free for 6 months at baseline, and were participating in an 18-month randomized controlled trial of cognitive therapy vs treatment as usual. We conducted a series of mediation analyses with bootstrapping on baseline (N = 68), follow-up data (9-18 mo; n = 49), and longitudinal data (n = 47). Concurrent general symptoms were directly associated with suicidal ideation at baseline, and concurrent negative symptoms were directly associated with suicidal ideation at 9-18 months. Concurrent positive, negative, general, and overall symptoms were each indirectly associated with suicidal ideation via negative appraisals and/or negative metacognitive beliefs, at baseline and 9-18 months, except for negative symptoms at baseline. Controlling for baseline suicidal ideation and treatment allocation, baseline general symptoms were indirectly associated with later suicidal ideation, via baseline negative appraisals and negative metacognitive beliefs. Baseline negative metacognitive beliefs also had a direct association with later suicidal ideation. These findings suggest the clinical assessment of suicidal ideation in psychosis may be enhanced by considering metacognitive beliefs about the probability and consequences of losing mental control.
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Affiliation(s)
- Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom,To whom correspondence should be addressed; tel: +44(0)131-455-3335, e-mail:
| | - Francesca Di Rienzo
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Douglas Turkington
- Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Newcastle upon Tyne, United Kingdom,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen Spencer
- Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Newcastle upon Tyne, United Kingdom,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Peter Taylor
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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16
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Turkington D, Gega L, Lebert L, Douglas-Bailey M, Rustom N, Alberti M, Deighton S, Naeem F. A training model for relatives and friends in cognitive behaviour therapy (CBT) informed care for psychosis. Cogent Psychology 2018. [DOI: 10.1080/23311908.2018.1497749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Douglas Turkington
- Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle-upon-Tyne, UK
| | - Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, Alcuin Research Resource Centre, York, Heslington, UK
| | - Latoyah Lebert
- Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle-upon-Tyne, UK
| | - Maggie Douglas-Bailey
- Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle-upon-Tyne, UK
| | | | - Mary Alberti
- Schizophrenia Society of Ontario, Toronto, Canada
| | | | - Farooq Naeem
- Department of Psychiatry, Queen’s University, Kingston, Canada
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17
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Spencer HM, McMenamin M, Emsley R, Turkington D, Dunn G, Morrison AP, Brabban A, Hutton P, Dudley R. Cognitive Behavioral Therapy for antipsychotic-free schizophrenia spectrum disorders: Does therapy dose influence outcome? Schizophr Res 2018; 202:385-386. [PMID: 30017459 DOI: 10.1016/j.schres.2018.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Abstract
This study investigated the effect of "dose" and the components of Cognitive Behavioral Therapy (CBT) on treatment effects. It is a secondary analysis of the ACTION (Assessment of Cognitive Therapy Instead of Neuroleptics) trial which investigated CBT for people with schizophrenia spectrum disorders that chose not to take antipsychotic medication. Using instrumental variable methods, we found a "dose-response" such that each CBT session attended, reduced the primary outcome measure (the PANSS total score) by approximately 0.6 points (95% CI -1.20 to -0.06, p = 0.031). This suggests that length of therapy is important for those that receive CBT in the absence of antipsychotic medication. Secondly, using principal stratification we examined the process variables that modified treatment effects. Findings revealed that those who received a longitudinal formulation in the first 4 sessions of CBT had poorer treatment effects than those who did not, however this finding was not statistically significant (95% CI -37.244, 6.677, p = 0.173). However, it is important to note that these findings were evident in an exploratory analysis with a small sample. Future larger scale studies are needed to help understand components of effective treatment.
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Affiliation(s)
- Helen M Spencer
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom; Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Martina McMenamin
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Richard Emsley
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, United Kingdom
| | - Douglas Turkington
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom; Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Graham Dunn
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Anthony P Morrison
- Division of Psychological and Mental Health, University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Alison Brabban
- Tees, Esk and Wear Valley NHS Foundation Trust, United Kingdom
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, United Kingdom
| | - Robert Dudley
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
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18
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Guo ZH, Li ZJ, Ma Y, Sun J, Guo JH, Li WX, Wang ZQ, Xu HL, Ng RMK, Turkington D, Kingdon D. Brief cognitive-behavioural therapy for patients in the community with schizophrenia: Randomised controlled trial in Beijing, China - Expression of Concern. Br J Psychiatry 2018; 214:119. [PMID: 30221619 DOI: 10.1192/bjp.2018.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Morrison AP, Pyle M, Gumley A, Schwannauer M, Turkington D, MacLennan G, Norrie J, Hudson J, Bowe SE, French P, Byrne R, Syrett S, Dudley R, McLeod HJ, Griffiths H, Barnes TRE, Davies L, Kingdon D. Cognitive behavioural therapy in clozapine-resistant schizophrenia (FOCUS): an assessor-blinded, randomised controlled trial. Lancet Psychiatry 2018; 5:633-643. [PMID: 30001930 PMCID: PMC6063993 DOI: 10.1016/s2215-0366(18)30184-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although clozapine is the treatment of choice for treatment-refractory schizophrenia, 30-40% of patients have an insufficient response, and others are unable to tolerate it. Evidence for any augmentation strategies is scarce. We aimed to determine whether cognitive behavioural therapy (CBT) is an effective treatment for clozapine-resistant schizophrenia. METHODS We did a pragmatic, parallel group, assessor-blinded, randomised controlled trial in community-based and inpatient mental health services in five sites in the UK. Patients with schizophrenia who were unable to tolerate clozapine, or whose symptoms did not respond to the drug, were randomly assigned 1:1 by use of randomised-permuted blocks of size four or six, stratified by centre, to either CBT plus treatment as usual or treatment as usual alone. Research assistants were masked to allocation to protect against rater bias and allegiance bias. The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months, which provides a continuous measure of symptoms of schizophrenia; PANSS total was also assessed at the end of treatment (9 months). The primary analysis was by randomised treatment based on intention to treat, for all patients for whom data were available. This study was prospectively registered, number ISRCTN99672552. The trial is closed to accrual. FINDINGS From Jan 1, 2013, to May 31, 2015, we randomly assigned 487 participants to either CBT and treatment as usual (n=242) or treatment as usual alone (n=245). Analysis included 209 in the CBT group and 216 in the treatment as usual group. No difference occurred in the primary outcome (PANSS total at 21 months, mean difference -0·89, 95% CI -3·32 to 1·55; p=0·48), although the CBT group improved at the end of treatment (PANSS total at 9 months, mean difference -2·40, -4·79 to -0·02; p=0·049). During the trial, 107 (44%) of 242 participants in the CBT arm and 104 (42%) of 245 in the treatment as usual arm had at least one adverse event (odds ratio 1·09, 95% CI 0·81 to 1·46; p=0·58). Only two (1%) of 242 participants in the CBT arm and one (<1%) of 245 in the treatment as usual arm had a trial-related serious adverse event. INTERPRETATION At 21-month follow-up, CBT did not have a lasting effect on total symptoms of schizophrenia compared with treatment as usual; however, CBT produced statistically, though not clinically, significant improvements on total symptoms by the end of treatment. There was no indication that the addition of CBT to treatment as usual caused adverse effects. The results of this trial do not support a recommendation to routinely offer CBT to all people who meet criteria for clozapine-resistant schizophrenia; however, a pragmatic individual trial might be indicated for some. FUNDING National Institute for Health Research Technology Assessment programme.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Zochonis Building, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, Zochonis Building, University of Manchester, Manchester, UK.
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Zochonis Building, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, Zochonis Building, University of Manchester, Manchester, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, School of Health in Social Science, Old Medical School, The University of Edinburgh, Edinburgh, UK
| | - Douglas Turkington
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Centre for Aging and Vitality, Newcastle General Hospital, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences & Informatics, Nine Edinburgh BioQuarter, The University of Edinburgh, Edinburgh, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Samantha E Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Zochonis Building, University of Manchester, Manchester, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Zochonis Building, University of Manchester, Manchester, UK; Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Zochonis Building, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, Zochonis Building, University of Manchester, Manchester, UK
| | - Suzy Syrett
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK; Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS Foundation Trust, Tranwell Unit, Queen Elizabeth Hospital, Gateshead, UK
| | - Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Helen Griffiths
- Department of Clinical Psychology, School of Health in Social Science, Old Medical School, The University of Edinburgh, Edinburgh, UK
| | | | - Linda Davies
- Division of Population Health, Zochonis Building, University of Manchester, Manchester, UK
| | - David Kingdon
- University Department of Psychiatry, Academic Centre, University of Southampton, Southampton, UK
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20
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Aguilar EJ, Corripio I, García-Martí G, Grasa E, Martí-Bonmatí L, Gómez-Ansón B, Sanjuán J, Núñez-Marín F, Lorente-Rovira E, Escartí MJ, Brabban A, Turkington D. Emotional fMR auditory paradigm demonstrates normalization of limbic hyperactivity after cognitive behavior therapy for auditory hallucinations. Schizophr Res 2018; 193:304-312. [PMID: 28720416 DOI: 10.1016/j.schres.2017.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/08/2017] [Accepted: 07/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Eduardo J Aguilar
- Department of Medicine, Valencia University, Avda. Blasco Ibáñez 15-17, 46010 Valencia, Spain; INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain; Psychiatry Unit, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain; Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain.
| | - Gracián García-Martí
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain; Radiology Department, Quirón Hospital, Avda. Blasco Ibáñez 14, 46010 Valencia, Spain.
| | - Eva Grasa
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain; Psychiatry Unit, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain; Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain.
| | - Luis Martí-Bonmatí
- Department of Medicine, Valencia University, Avda. Blasco Ibáñez 15-17, 46010 Valencia, Spain; Radiology Department, Quirón Hospital, Avda. Blasco Ibáñez 14, 46010 Valencia, Spain; Radiology Department and GIBI230 Research Group, La Fe University and Polytechnic Hospital, Bulevar Sur, s/n, 46026 Valencia, Spain.
| | - Beatriz Gómez-Ansón
- Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain; Neuroradiology Unit, Radiology Department, Neuroradiology Research Group, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain.
| | - Julio Sanjuán
- Department of Medicine, Valencia University, Avda. Blasco Ibáñez 15-17, 46010 Valencia, Spain; INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - Fidel Núñez-Marín
- Autonoma University, Plaça Cívica, Campus de la UAB, 08193 Cerdanyola del Vallés Barcelona, Spain; Neuroradiology Unit, Radiology Department, Neuroradiology Research Group, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Santa Creu i Sant Pau Hospital, C/ Sant Quintí, 89, 08026 Barcelona, Spain.
| | - Esther Lorente-Rovira
- INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - María J Escartí
- INCLIVA Health Research Institute, Clinical University Hospital, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/ Monforte de Lemos 3-5, Pabellón 6-Sótano, 28029 Madrid, Spain.
| | - Alison Brabban
- Durham University, Stockton Rd, Durham, County Durham DH1, United Kingdom.
| | - Douglas Turkington
- Newcastle University, Newcastle upon Tyne, Tyne and Wear NE1 7RU, United Kingdom.
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Abstract
In a survey of district plans for Mental Health services (Kingdon, 1988) befriending schemes, where volunteers are recruited to visit isolated and lonely users of psychiatric services, were planned or in existence in 14 of the 127 districts who responded. However, lists of the components of a comprehensive community service (MIND, 1983) and Hirsch (1988) surprisingly do not include references to such schemes, although Griffiths (1988) alludes to them in his recent report. There are moreover no reports in the psychiatric literature of such enterprises. The scheme established by MIND in Bassetlaw (population (103,000) is therefore described.
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Abstract
The community psychiatry service in Bassetlaw District has been developing since 1984 and provision includes hospital hostels, supervised flatlets, nursing and rest homes, group homes, cluster flats and warden assisted accommodation. Close liaison with an enthusiastic Local Authority Housing Department has also led to the development of a new initiative, an unstaffed flat for use in crisis intervention and rehabilitation. Placements in the flat are described over the first 12 months of its existence.
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Abstract
Consultation–liaison psychiatry in renal medicine provides a unique experience for the psychiatrist. There is the opportunity to work with a specialist multi-disciplinary team managing patients with chronic and complex physical problems in in-patient and out-patient settings. We aim to consider the common psychiatric problems experienced by renal patients and the particular problems that face the renal team and the liaising psychiatrist in relation to assessment and treatment.
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Turkington D, Lebert L, Spencer H. Auditory hallucinations in schizophrenia: helping patients to develop effective coping strategies. BJPsych advances 2018. [DOI: 10.1192/apt.bp.115.015214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryAuditory hallucinations (voices) are the most common symptom in schizophrenia, occurring in 70% of those with the diagnosis. A proportion respond to antipsychotic medication, but despite adequate concordance with prescribed medication, voices may still remain. Voice hearers often inadvertently activate coping strategies that maintain the symptoms and linked distress. Assessment can identify ineffective strategies. Effective strategies can then be initiated, starting with distraction to reduce distress in the short term and leading to focusing approaches that give an improved understanding of voice maintenance. This article describes how to recognise voice hearers' ineffective coping strategies and how to teach effective approaches that are a crucial catalyst in the recovery process.
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Kingdon D, Vincent S, Vincent S, Kinoshita Y, Turkington D. Destigmatising schizophrenia: does changing terminology reduce negative attitudes? Psychiatr bull 2018. [DOI: 10.1192/pb.bp.107.018515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodHealth promotion campaigns using current terminology have had limited success in reducing stigma to schizophrenia. Terminology and subgroups based on historical precedent, clinical experience and psychosocial research have been developed to provide an alternative to existing terminology, and the attitudes to schizophrenia and alternative terminology of a sample of medical students (n=241) were compared.ResultsOverall attitudes were significantly less negative with the alternatives. the students were less negative about the potential for recovery in relation to all the subgroups than for schizophrenia. Concerns about dangerousness were also less prominent with the exception of the drug-related group.Clinical ImplicationsSubgroups and alternative terminology should be further explored in programmes to destigmatise schizophrenia.
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Abstract
SummaryThe evidence base for cognitive-behavioural therapy (CBT), family therapy, psychoeducation and cognitive remediation as adjuncts to antipsychotic medication in the treatment of schizophrenia is well established. It is, however, clear that the moderate effect size of the best researched of these treatments (CBT) compared with treatment as usual reduces to small when compared with an active psychological treatment. It would seem that many different psychosocial interventions de liver benefit in schizophrenia. We are now at a stage in their development when new treatments are being energetically piloted and combination treatments tested. This article outlines the most promising of these new interventions and attempts to answer the crucial question as to their differential effects on different psychotic presentations.Learning Objectives• Be aware of the most promising new psychosocial treatments for schizophrenia• Learn the key elements of each intervention• Understand which of these approaches might be best suited to particular presentations of schizophrenia spectrum disorder
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Abstract
Traditionally, delusions have been viewed as false, unshakeable beliefs which arise out of internal morbid processes and are out of keeping with a person's educational and cultural background (Hamilton, 1978). Primary delusions appear to arise without understandable cause, and secondary delusions appear more understandable in relation to the prevailing affective state or cultural climate (Sims, 1995), for example. However, during the cognitive therapy process we would expect that even primary delusions might become more understandable as the patient's life history and belief profile are gradually disclosed.
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Abstract
Befriending allows for control of the non-specific factors of the therapist-patient interaction in psychosocial research. Manualised befriending is at the very least an active placebo and potentially an effective intervention. Befriending now merits increased research attention to determine indications for use and to elucidate mechanisms of action.
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Affiliation(s)
- Douglas Turkington
- Douglas Turkington, MD, FRCPsych, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and Institute of Neuroscience, Newcastle University; Helen Spencer, BA, Latoyah Lebert, BSc, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University; Robert Dudley, PhD, DCIinPsy, Early Intervention in Psychosis Service, Tranwell Unit, Queen Elizabeth Hospital, Gateshead, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University, UK
| | - Helen Spencer
- Douglas Turkington, MD, FRCPsych, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and Institute of Neuroscience, Newcastle University; Helen Spencer, BA, Latoyah Lebert, BSc, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University; Robert Dudley, PhD, DCIinPsy, Early Intervention in Psychosis Service, Tranwell Unit, Queen Elizabeth Hospital, Gateshead, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University, UK
| | - Latoyah Lebert
- Douglas Turkington, MD, FRCPsych, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and Institute of Neuroscience, Newcastle University; Helen Spencer, BA, Latoyah Lebert, BSc, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University; Robert Dudley, PhD, DCIinPsy, Early Intervention in Psychosis Service, Tranwell Unit, Queen Elizabeth Hospital, Gateshead, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University, UK
| | - Robert Dudley
- Douglas Turkington, MD, FRCPsych, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and Institute of Neuroscience, Newcastle University; Helen Spencer, BA, Latoyah Lebert, BSc, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University; Robert Dudley, PhD, DCIinPsy, Early Intervention in Psychosis Service, Tranwell Unit, Queen Elizabeth Hospital, Gateshead, Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, and School of Psychology, Newcastle University, UK
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Tully S, Wells A, Pyle M, Hudson J, Gumley A, Kingdon D, Schwannauer M, Turkington D, Morrison AP. Measuring common responses to psychosis: Assessing the psychometric properties of a new measure. Schizophr Res 2017; 181:131-136. [PMID: 27746054 DOI: 10.1016/j.schres.2016.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
Responses to psychotic experiences are central to cognitive models of psychosis. The current study aimed to develop and validate a self-report measure of common responses to the experience of psychosis. This measure is needed as cognitive and behavioural responses are implicated in the maintenance of psychosis, but there is currently no measure that comprehensively assesses these maintaining factors. The Measure of Common Responses to psychosis (MCR) was developed and utilised in a sample of 487 participants who met criteria for treatment-resistant schizophrenia. Principal components analysis using data from 287 participants reduced the initial item pool of 31 items to 15 items with a three component structure. The components represented social control and reassurance seeking, threat monitoring and avoidance and conscious self-regulation attempts. Confirmatory factor analysis using data from the remaining 200 participants generally supported this three factor structure. The three subscales were found to have good internal consistency and convergent validity. The MCR, therefore, appears to be a useful tool to identify and monitor response styles, and could be utilised in further research to increase our understanding of the complex relationships between responses, symptoms and distress. It can also be used in clinical practice to elicit information that will be helpful in the psychological formulation and treatment of psychosis.
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Affiliation(s)
- Sarah Tully
- School of Psychological Sciences, University of Manchester, UK; Psychosis Research Unit, Greater Manchester West NHS Trust, UK.
| | - Adrian Wells
- School of Psychological Sciences, University of Manchester, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester West NHS Trust, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, UK
| | | | | | | | - Anthony P Morrison
- School of Psychological Sciences, University of Manchester, UK; Psychosis Research Unit, Greater Manchester West NHS Trust, UK
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Guo ZH, Li ZJ, Ma Y, Sun J, Guo JH, Li WX, Wang ZQ, Xu HL, Ng RMK, Turkington D, Kingdon D. Brief cognitive-behavioural therapy for patients in the community with schizophrenia: randomised controlled trial in Beijing, China. Br J Psychiatry 2017; 210:223-229. [PMID: 28069563 DOI: 10.1192/bjp.bp.116.183285] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/17/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022]
Abstract
BackgroundBrief cognitive-behavioural therapy (CBT) is an emerging treatment for schizophrenia in community settings; however, further trials are needed, especially in non-Western countries.AimsTo test the effects of brief CBT for Chinese patients with schizophrenia in the community (trial registration: ChiCTR-TRC-13003709).MethodA total of 220 patients with schizophrenia from four districts of Beijing were randomly assigned to either brief CBT plus treatment as usual (TAU) or TAU alone. Patients were assessed at baseline, post-treatment and at 6- and 12-month follow-ups by raters masked to group allocation.ResultsAt the post-treatment assessment and the 12-month follow-up, patients who received brief CBT showed greater improvement in overall symptoms, general psychopathology, insight and social functioning. In total, 37.3% of those in the brief CBT plus TAU group experienced a clinically significant response, compared with only 19.1% of those in the TAU alone group (P = 0.003).ConclusionsBrief CBT has a positive effect on Chinese patients with schizophrenia in the community.
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Affiliation(s)
- Zhi-Hua Guo
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Zhan-Jiang Li
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Yun Ma
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Jing Sun
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Jun-Hua Guo
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Wen-Xiu Li
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Zhi-Qiang Wang
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Hui-Li Xu
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Roger M K Ng
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Douglas Turkington
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - David Kingdon
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
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Murphy EK, Tully S, Pyle M, Gumley AI, Kingdon D, Schwannauer M, Turkington D, Morrison AP. The Beliefs about Paranoia Scale: Confirmatory factor analysis and tests of a metacognitive model of paranoia in a clinical sample. Psychiatry Res 2017; 248:87-94. [PMID: 28033512 DOI: 10.1016/j.psychres.2016.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 09/13/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
Abstract
This study aimed to confirm the factor structure of the Beliefs about Paranoia Scale (BaPS), a self-report measure to assess metacognitive beliefs about paranoia, and to test hypotheses of a metacognitive model. We hypothesised that positive and negative beliefs about paranoia would be associated with severity of suspiciousness, and that the co-occurrence of positive and negative beliefs would be associated with increased suspiciousness. A total of 335 patients meeting criteria for a schizophrenia spectrum disorder completed the BaPS, the Positive and Negative Syndromes Scale (PANSS), and the Psychotic Symptom Rating Scales (PSYRATS). Confirmatory factor analysis verified that the three BaPS subscales (negative beliefs about paranoia, paranoia as a survival strategy, and normalizing beliefs) were an adequate fit of the data. Ordinal regression showed that positive beliefs about paranoia as a survival strategy and negative beliefs were both associated with severity of suspiciousness. This was the first study to show that the co-occurrence of positive and negative beliefs was associated with increased suspiciousness. All hypotheses were confirmed, suggesting that a metacognitive approach has utility for the conceptualization of paranoia. Clinical implications suggest a role for metacognitive therapy, including strategies such as detached mindfulness and worry postponement.
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Affiliation(s)
| | - Sarah Tully
- Psychosis Research Unit, Greater Manchester West NHS Trust, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester West NHS Trust, UK; School of Psychological Sciences, University of Manchester, UK
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, UK
| | | | | | | | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester West NHS Trust, UK; School of Psychological Sciences, University of Manchester, UK
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Zimmerer VC, Watson S, Turkington D, Ferrier IN, Hinzen W. Deictic and Propositional Meaning-New Perspectives on Language in Schizophrenia. Front Psychiatry 2017; 8:17. [PMID: 28239361 PMCID: PMC5301015 DOI: 10.3389/fpsyt.2017.00017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/23/2017] [Indexed: 01/09/2023] Open
Abstract
Emerging linguistic evidence points at disordered language behavior as a defining characteristic of schizophrenia. In this article, we review this literature and demonstrate how a framework focusing on two core functions of language-reference and propositional meaning-can conceptualize schizophrenic symptoms, identify important variables for risk assessment, diagnosis, and treatment, and inform cognitive behavioral therapy and other remedial approaches. We introduce the linguistic phenomena of deictic anchoring and propositional complexity, explain how they relate to schizophrenic symptoms, and show how they can be tracked in language behavior.
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Affiliation(s)
- Vitor C Zimmerer
- Department of Language and Cognition, University College London , London , UK
| | - Stuart Watson
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK
| | - Douglas Turkington
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK
| | - I Nicol Ferrier
- Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK
| | - Wolfram Hinzen
- ICREA (Institució Catalana de Recerca i Estudis Avançats), Departament de Traducció i Ciències del Llenguatge, Universitat Pompeu Fabra, Barcelona, Spain; Department of Philosophy, Durham University, Durham, UK
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Stevens LH, Spencer HM, Turkington D. Identifying Four Subgroups of Trauma in Psychosis: Vulnerability, Psychopathology, and Treatment. Front Psychiatry 2017; 8:21. [PMID: 28243211 PMCID: PMC5303718 DOI: 10.3389/fpsyt.2017.00021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/25/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lucy H Stevens
- Tees Esk and Wear Valley NHS Mental Health Foundation Trust , Cleveland , UK
| | - Helen M Spencer
- Northumberland, Tyne and Wear NHS Mental Health Foundation Trust , Newcastle upon Tyne , UK
| | - Douglas Turkington
- Northumberland, Tyne and Wear NHS Mental Health Foundation Trust , Newcastle upon Tyne , UK
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Pyle M, Norrie J, Schwannauer M, Kingdon D, Gumley A, Turkington D, Byrne R, Syrett S, MacLennan G, Dudley R, McLeod HJ, Griffiths H, Bowe S, Barnes TRE, French P, Hutton P, Davies L, Morrison AP. Design and protocol for the Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial: a randomised controlled trial. BMC Psychiatry 2016; 16:280. [PMID: 27496180 PMCID: PMC4974812 DOI: 10.1186/s12888-016-0983-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For around a third of people with a diagnosis of schizophrenia, the condition proves to respond poorly to treatment with many typical and atypical antipsychotics. This is commonly referred to as treatment-resistant schizophrenia. Clozapine is the only antipsychotic with convincing efficacy for people whose symptoms are considered treatment-resistant to antipsychotic medication. However, 30-40 % of such conditions will have an insufficient response to the drug. Cognitive behavioural therapy has been shown to be an effective treatment for schizophrenia when delivered in combination with antipsychotic medication, with several meta-analyses showing robust support for this approach. However, the evidence for the effectiveness of cognitive behavioural therapy for people with a schizophrenia diagnosis whose symptoms are treatment-resistant to antipsychotic medication is limited. There is a clinical and economic need to evaluate treatments to improve outcomes for people with such conditions. METHODS/DESIGN A parallel group, prospective randomised, open, blinded evaluation of outcomes design will be used to compare a standardised cognitive behavioural therapy intervention added to treatment as usual versus treatment as usual alone (the comparator group) for individuals with a diagnosis of schizophrenia for whom an adequate trial of clozapine has either not been possible due to tolerability problems or was not associated with a sufficient therapeutic response. The trial will be conducted across five sites in the United Kingdom. DISCUSSION The recruitment target of 485 was achieved, with a final recruitment total of 487. This trial is the largest definitive, pragmatic clinical and cost-effectiveness trial of cognitive behavioural therapy for people with schizophrenia whose symptoms have failed to show an adequate response to clozapine treatment. Using a prognostic risk model, baseline information will be used to explore whether there are identifiable subgroups for which the treatment effect is greatest. TRIAL REGISTRATION Current Controlled Trials ISRCTN99672552 . Registered 29(th) November 2012.
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Affiliation(s)
- Melissa Pyle
- The Psychosis Research Unit, Department of Psychology, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, M25 3BL UK
- Department of Psychology, University of Manchester, Zochonis Building, Manchester, M13 9PL UK
| | - John Norrie
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, 3rd Floor Health Sciences Building, Aberdeen, AB25 2ZD UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, University of Edinburgh. Medical School, Teviot Place, Edinburgh, EHY8 9AG UK
| | - David Kingdon
- University Department of Psychiatry, University of Southampton, Academic Centre, College Keep 4 - 12 Terminus Terrace, Southampton, SO14 3DT UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - Douglas Turkington
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Centre for Aging and Vitality, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, NE4 6BE UK
| | - Rory Byrne
- The Psychosis Research Unit, Department of Psychology, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, M25 3BL UK
- Department of Psychology, University of Manchester, Zochonis Building, Manchester, M13 9PL UK
| | - Suzy Syrett
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, 3rd Floor Health Sciences Building, Aberdeen, AB25 2ZD UK
| | - Robert Dudley
- School of Psychology, Newcastle University, 4th Floor, Ridley Building 1, Queen Victoria Road, Newcastle Upon Tyne, NE1 7RU UK
| | - Hamish J. McLeod
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - Helen Griffiths
- Department of Clinical Psychology, University of Edinburgh. Medical School, Teviot Place, Edinburgh, EHY8 9AG UK
| | - Samantha Bowe
- The Psychosis Research Unit, Department of Psychology, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, M25 3BL UK
| | - Thomas R. E. Barnes
- Centre for Mental Health, Imperial College London, Charing Cross Campus, St Dunstans Road, London, W6 8RP UK
| | - Paul French
- The Psychosis Research Unit, Department of Psychology, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, M25 3BL UK
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Block B, 2nd Floor, Liverpool, L69 3BX UK
| | - Paul Hutton
- Department of Clinical Psychology, University of Edinburgh. Medical School, Teviot Place, Edinburgh, EHY8 9AG UK
| | - Linda Davies
- Department of Psychology, University of Manchester, Zochonis Building, Manchester, M13 9PL UK
| | - Anthony P. Morrison
- The Psychosis Research Unit, Department of Psychology, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, M25 3BL UK
- Department of Psychology, University of Manchester, Zochonis Building, Manchester, M13 9PL UK
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Li ZJ, Guo ZH, Wang N, Xu ZY, Qu Y, Wang XQ, Sun J, Yan LQ, Ng RMK, Turkington D, Kingdon D. Cognitive-behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China. Psychol Med 2015; 45:1893-1905. [PMID: 25532460 DOI: 10.1017/s0033291714002992] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Meta-analyses support the efficacy of cognitive-behavioural therapy (CBT) for schizophrenia in western cultures. This study aimed to compare the efficacy of CBT and supportive therapy (ST) for patients with schizophrenia in China. METHOD A multicentre randomized controlled, single-blinded, parallel-group trial enrolled a sample of 192 patients with schizophrenia. All patients were offered 15 sessions of either CBT or ST over 24 weeks and followed up for an additional 60 weeks. All measures used were standardized instruments with good reliability and validity. The Positive and Negative Syndrome Scale (PANSS) was used to assess symptoms of schizophrenia. The Schedule for Assessing Insight (SAI) was used to assess patients' insight and the Personal and Social Performance Scale (PSP) was used to assess their social functioning. RESULTS Effect-size analysis showed that patients made rapid improvements in all symptoms, insight and social functioning as measured by the PANSS, SAI and PSP at 12 and 24 weeks and maintained these improvements over the course of the study to 84 weeks. Patients in the CBT group showed significantly greater and more durable improvement in PANSS total score (p = 0.045, between-group d = 0.48), positive symptoms (p = 0.018, between-group d = 0.42) and social functioning (p = 0.037, between-group d = 0.64), with significant differences emerging after completion of therapy. CONCLUSIONS Both CBT and ST combined with medication had benefits on psychopathology, insight and social functioning of patients with schizophrenia. CBT was significantly more effective than ST on overall, positive symptoms and social functioning of patients with schizophrenia in the long term.
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Affiliation(s)
- Z-J Li
- Department of Clinical Psychology,Beijing Key Lab of Mental Disorders,Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders,Beijing,People's Republic of China
| | - Z-H Guo
- Department of Clinical Psychology,Beijing Key Lab of Mental Disorders,Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders,Beijing,People's Republic of China
| | - N Wang
- Department of Clinical Psychology,Beijing Key Lab of Mental Disorders,Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders,Beijing,People's Republic of China
| | - Z-Y Xu
- Department of Clinical Psychology,Beijing Key Lab of Mental Disorders,Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders,Beijing,People's Republic of China
| | - Y Qu
- Beijing Huilongguan Hospital,Beijing,People's Republic of China
| | - X-Q Wang
- Institute of Mental Health, Peking University (The Sixth Hospital, Peking University),Beijing,People's Republic of China
| | - J Sun
- Griffith Health Institute and School of Medicine, Griffith University,QLD 4222,Australia
| | - L-Q Yan
- The Third Hospital of Chaoyang District,Beijing,People's Republic of China
| | - R M K Ng
- Department of Psychiatry,Kowloon Hospital,Hong Kong,People's Republic of China
| | | | - D Kingdon
- University of Southampton,Southampton,UK
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Velligan DI, Tai S, Roberts DL, Maples-Aguilar N, Brown M, Mintz J, Turkington D. A randomized controlled trial comparing cognitive behavior therapy, cognitive adaptation training, their combination and treatment as usual in chronic schizophrenia. Schizophr Bull 2015; 41:597-603. [PMID: 25193976 PMCID: PMC4393683 DOI: 10.1093/schbul/sbu127] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Following baseline assessment, 166 patients in medication maintenance at a community mental health center who were experiencing both persistent positive symptoms of schizophrenia and impairments in functioning were randomized to 1 of 4 treatments for 9 months: (1) Cognitive Behavior Therapy for psychosis (CBTp)-a therapy designed to identify and alter reasoning and appraisal biases that contribute to the formation and maintenance of positive symptoms, (2) Cognitive Adaptation Training (CAT)-a treatment using environmental supports including signs, alarms, checklists and the organization of belongings established at weekly home visits to compensate for impairments in cognitive functioning and improve everyday functional outcomes, (3) Multi-modal Cognitive treatment-a combination of CBTp and CAT, and (4) Treatment as Usual. Data on symptoms and functional outcomes were obtained every 3 months. A mixed effects regression model with repeated measures using a 2 (CAT/no CAT) × 2 (CBT/no CBT) design indicated that functioning as measured by the Multnomah Community Ability Scale improved more in groups receiving CAT than other treatment groups. Auditory hallucinations and associated distress improved slightly more in groups receiving CAT. In this study, CBTp did not improve outcomes. Combining CAT with CBTp did not improve outcomes more than CAT alone.
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Affiliation(s)
- Dawn I Velligan
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, San Antonio, TX;
| | - Sara Tai
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - David L Roberts
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, San Antonio, TX
| | - Natalie Maples-Aguilar
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, San Antonio, TX
| | - Matt Brown
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, San Antonio, TX
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, San Antonio, TX
| | - Douglas Turkington
- School of Neurology, Neurobiology and Psychiatry, Newcastle University, Newcastle upon Tyne, UK
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Thase ME, Kingdon D, Turkington D. The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments. World Psychiatry 2014; 13:244-50. [PMID: 25273290 PMCID: PMC4219058 DOI: 10.1002/wps.20149] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cognitive behavior therapy (CBT), as exemplified by the model of psychotherapy developed and refined over the past 40 years by A.T. Beck and colleagues, is one of the treatments of first choice for ambulatory depressive and anxiety disorders. Over the past several decades, there have been vigorous efforts to adapt CBT for treatment of more severe mental disorders, including schizophrenia and the more chronic and/or treatment refractory mood disorders. These efforts have primarily studied CBT as an adjunctive therapy, i.e., in combination with pharmacotherapy. Given the several limitations of state-of-the-art pharmacotherapies for these severe mental disorders, demonstration of clinically meaningful additive effects for CBT would have important implications for improving public health. This paper reviews the key developments in this important area of therapeutics, providing a summary of the current state of the art and suggesting directions for future research.
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Affiliation(s)
- Michael E Thase
- Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Affairs Medical Center3535 Market St., Philadelphia, PA, 19104, USA
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Affiliation(s)
- Timothy A Carey
- Centre for Remote Health, a joint Centre of Flinders University and Charles Darwin University, Alice Springs, NT, Australia; Central Australian Mental Health Service, Northern Territory Department of Health, Alice Springs, NT, Australia.
| | - Warren Mansell
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Sara J Tai
- School of Psychological Sciences, University of Manchester, Manchester, UK
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Affiliation(s)
- Anthony P Morrison
- School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Douglas Turkington
- Newcastle University and Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK
| | - Melissa Pyle
- School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul Hutton
- School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
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Affiliation(s)
- Douglas Turkington
- Newcastle University Royal Victoria Infirmary, Richardson Unit Leazes Wing, Richardson Road, Newcastle-upon-Tyne United Kingdom, NE1 4LP E-mail:
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Morrison AP, Turkington D, Pyle M, Spencer H, Brabban A, Dunn G, Christodoulides T, Dudley R, Chapman N, Callcott P, Grace T, Lumley V, Drage L, Tully S, Irving K, Cummings A, Byrne R, Davies LM, Hutton P. Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. Lancet 2014; 383:1395-403. [PMID: 24508320 DOI: 10.1016/s0140-6736(13)62246-1] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antipsychotic drugs are usually the first line of treatment for schizophrenia; however, many patients refuse or discontinue their pharmacological treatment. We aimed to establish whether cognitive therapy was effective in reducing psychiatric symptoms in people with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs. METHODS We did a single-blind randomised controlled trial at two UK centres between Feb 15, 2010, and May 30, 2013. Participants aged 16-65 years with schizophrenia spectrum disorders, who had chosen not to take antipsychotic drugs for psychosis, were randomly assigned (1:1), by a computerised system with permuted block sizes of four or six, to receive cognitive therapy plus treatment as usual, or treatment as usual alone. Randomisation was stratified by study site. Outcome assessors were masked to group allocation. Our primary outcome was total score on the positive and negative syndrome scale (PANSS), which we assessed at baseline, and at months 3, 6, 9, 12, 15, and 18. Analysis was by intention to treat, with an ANCOVA model adjusted for site, age, sex, and baseline symptoms. This study is registered as an International Standard Randomised Controlled Trial, number 29607432. FINDINGS 74 individuals were randomly assigned to receive either cognitive therapy plus treatment as usual (n=37), or treatment as usual alone (n=37). Mean PANSS total scores were consistently lower in the cognitive therapy group than in the treatment as usual group, with an estimated between-group effect size of -6.52 (95% CI -10.79 to -2.25; p=0.003). We recorded eight serious adverse events: two in patients in the cognitive therapy group (one attempted overdose and one patient presenting risk to others, both after therapy), and six in those in the treatment as usual group (two deaths, both of which were deemed unrelated to trial participation or mental health; three compulsory admissions to hospital for treatment under the mental health act; and one attempted overdose). INTERPRETATION Cognitive therapy significantly reduced psychiatric symptoms and seems to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs. Evidence-based treatments should be available to these individuals. A larger, definitive trial is needed. FUNDING National Institute for Health Research.
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Affiliation(s)
- Anthony P Morrison
- School of Psychological Sciences, University of Manchester, Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.
| | - Douglas Turkington
- Newcastle University, Newcastle-upon-Tyne, UK; Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK
| | - Melissa Pyle
- School of Psychological Sciences, University of Manchester, Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Helen Spencer
- Newcastle University, Newcastle-upon-Tyne, UK; Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK
| | - Alison Brabban
- University of Durham, Durham, UK; Tees, Esk, and Wear Valley NHS Mental Health Foundation Trust, County Durham, UK
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Tom Christodoulides
- Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK
| | - Rob Dudley
- Newcastle University, Newcastle-upon-Tyne, UK; Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK
| | - Nicola Chapman
- School of Psychological Sciences, University of Manchester, Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Pauline Callcott
- Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK
| | - Tim Grace
- Tees, Esk, and Wear Valley NHS Mental Health Foundation Trust, County Durham, UK
| | - Victoria Lumley
- Tees, Esk, and Wear Valley NHS Mental Health Foundation Trust, County Durham, UK
| | - Laura Drage
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Sarah Tully
- School of Psychological Sciences, University of Manchester, Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Kerry Irving
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Anna Cummings
- Newcastle University, Newcastle-upon-Tyne, UK; Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK
| | - Rory Byrne
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Linda M Davies
- Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Paul Hutton
- School of Psychological Sciences, University of Manchester, Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
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Montesano VL, Sivec HJ, Munetz MR, Pelton JR, Turkington D. Adapting cognitive behavioral therapy for psychosis for case managers: increasing access to services in a community mental health agency. Psychiatr Rehabil J 2014; 37:11-6. [PMID: 24467392 DOI: 10.1037/prj0000037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this article is twofold: (a) to describe the adaptation of an evidence-based practice and, (b) using a dissemination framework, to describe the process of implementing the practice at a community mental health agency. METHOD The authors describe the training concept and dissemination framework of implementing an emerging practice: high-yield cognitive behavioral techniques for psychosis, which is rooted in cognitive behavioral therapy. RESULTS Thirteen case managers who represented teams from across the agency delivered the adapted practice at a community mental health agency. Implementation required buy in from all stakeholders, communication across disciplines, persistence, and flexibility. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE It appears that the use of a dissemination framework that is grounded in the literature, yet flexible, eases the process of implementing an adapted practice. Further research focusing on the effectiveness of this approach, along with the impact of implementing a full spectrum of cognitive behavioral therapy services for individuals with persistent psychotic symptoms, based on cognitive behavioral therapy principles, is indicated.
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Affiliation(s)
- Vicki L Montesano
- Best Practices in Schizophrenia Treatment (BeST) Center, Department of Psychiatry, Northeast Ohio Medical University
| | - Harry J Sivec
- Best Practices in Schizophrenia Treatment (BeST) Center, Department of Psychiatry, Northeast Ohio Medical University
| | - Mark R Munetz
- Best Practices in Schizophrenia Treatment (BeST) Center, Department of Psychiatry, Northeast Ohio Medical University
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Howard A, Forsyth A, Spencer H, Young EW, Turkington D. Do voice hearers naturally use focusing and metacognitive coping techniques? Psychosis 2013. [DOI: 10.1080/17522439.2012.668926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Morrison AP, Wardle M, Hutton P, Davies L, Dunn G, Brabban A, Byrne R, Drage L, Spencer H, Turkington D. Assessing Cognitive Therapy Instead Of Neuroleptics: Rationale, study design and sample characteristics of the ACTION trial. Psychosis 2013. [DOI: 10.1080/17522439.2012.756539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nafees B, van Hanswijck de Jonge P, Stull D, Pascoe K, Price M, Clarke A, Turkington D. Reliability and validity of the Personal and Social Performance scale in patients with schizophrenia. Schizophr Res 2012; 140:71-6. [PMID: 22749622 DOI: 10.1016/j.schres.2012.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 05/16/2012] [Accepted: 06/08/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The construct validity and test-retest reliability of the Personal and Social Performance (PSP) scale were used to assess social functioning in a cohort of ethnically diverse UK patients with schizophrenia. METHODS A total of 73 patients with schizophrenia took part in the study. At baseline, the PSP, two symptomatology scales and two other functioning scales were administered. A subset of the sample (N=40) took part in a retest where the Clinical Global Impression-Severity (CGI-S) and PSP scales were administered 8-10 days later. RESULTS PSP significantly correlated with all other measures, Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and Quality of Life Scale (QLS) at baseline (p<0.02) and with CGI-S at follow-up (p<0.01). In addition, the PSP scale was moderately sensitive to the severity of illness. Test-retest reliability for the PSP score was 0.45 and the scale was able to discriminate between known groups (mild and severe patients). CONCLUSION The PSP was easy to administer in this predominantly inpatient cohort and was moderately correlated with all other functioning measures tested. Due to patient homogeneity, the test-retest reliability statistic of the PSP was lower than that observed in other studies.
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Abstract
Evidence regarding overestimation of the efficacy of antipsychotics and underestimation of their toxicity, as well as emerging data regarding alternative treatment options, suggests it may be time to introduce patient choice and reconsider whether everyone who meets the criteria for a schizophrenia spectrum diagnosis requires antipsychotics in order to recover.
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Ormrod J, Shaftoe D, Cavanagh K, Freeston M, Turkington D, Price J, Dudley R. A pilot study exploring the contribution of working memory to "jumping to conclusions" in people with first episode psychosis. Cogn Neuropsychiatry 2012; 17:97-114. [PMID: 21722053 DOI: 10.1080/13546805.2011.569372] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION People with delusional beliefs "jump to conclusions" (JTC). This finding is well replicated. However, there is only limited exploration of the factors that might lead a person to JTC. The aim of the present study was to explore the contribution of working memory processes (WM) and IQ to hasty decision making and to investigate the stability of this bias over time. METHODS A single group cross-sectional design was utilised. The study was conducted in 2 phases: (1) an initial screening phase and (2) an experimental phase whereby we explored and tested hypotheses regarding the cognitive origins of the JTC bias. In Study 1, participants completed the beads task as well as measures of mood and symptoms. In Study 2, the same participants repeated the beads task, and completed a battery of neuropsychological tests designed to assess different facets of WM and IQ. RESULTS In most cases, "jumpers" were indistinguishable from "nonjumpers" in terms of their neuropsychological profiles. The only exception to this pattern was for visual working memory, in which "jumpers" performed better than "nonjumpers". In terms of the temporal stability of the JTC bias, 8 individuals (out of the 29) effectively switched from being "jumpers" at T1 to "nonjumpers" at T2. CONCLUSIONS This study casts doubt on reduced global WM as an explanation of JTC. Rather it may be that the differences in reasoning are related to the manipulation of visual material and do not extend to other areas of neuropsychological functioning. However, as our sample is small it may be underpowered to detect important differences. Future work is therefore needed to replicate these findings.
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Affiliation(s)
- John Ormrod
- Newcastle University, Newcastle-upon-Tyne, UK.
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