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Greenwood KE, Gurnani M, Ward T, Vogel E, Vella C, McGourty A, Robertson S, Sacadura C, Hardy A, Rus‐Calafell M, Collett N, Emsley R, Freeman D, Fowler D, Kuipers E, Bebbington P, Dunn G, Michelson D, Garety P. The service user experience of SlowMo therapy: A co-produced thematic analysis of service users' subjective experience. Psychol Psychother 2022; 95:680-700. [PMID: 35445520 PMCID: PMC9873386 DOI: 10.1111/papt.12393] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/18/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES SlowMo is the first blended digital therapy for paranoia, showing significant small-moderate reductions in paranoia in a recent large-scale randomized controlled trial (RCT). This study explored the subjective service-user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the triangle of the therapeutic alliance; and the experience of the digital aspects of the intervention. DESIGN Qualitative co-produced sub-study of an RCT. METHODS Participants were 22 adult service users with schizophrenia-spectrum psychosis and persistent distressing paranoia, who completed at least one SlowMo therapy session and a 24-week follow-up, at one of 3 sites in Oxford, London, and Sussex, UK. They were interviewed by peer researchers, using a topic guide co-produced by the Patient and Public Involvement (PPI) team. The transcribed data were analysed thematically. Multiple coding and triangulation, and lay peer researcher validation were used to reach a consensus on the final theme structure. RESULTS Six core themes were identified: (i) starting the SlowMo journey; (ii) the central role of the supportive therapist; (iii) slowing things down; (iv) value and learning from social connections; (v) approaches and challenges of technology; and (vi) improvements in paranoia and well-being. CONCLUSIONS For these service users, slowing down for a moment was helpful, and integrated into thinking over time. Learning from social connections reflected reduced isolation, and enhanced learning through videos, vignettes, and peers. The central role of the supportive therapist and the triangle of alliance between service user, therapist, and digital platform were effective in promoting positive therapeutic outcomes.
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Affiliation(s)
- Kathryn E. Greenwood
- School of PsychologyUniversity of SussexBrightonUK,Sussex Partnership NHS Foundation TrustWorthingUK
| | | | - Tom Ward
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Evelin Vogel
- Sussex Partnership NHS Foundation TrustWorthingUK
| | - Claire Vella
- Sussex Partnership NHS Foundation TrustWorthingUK
| | | | | | | | - Amy Hardy
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | | | | | - Richard Emsley
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Daniel Freeman
- Oxford Health NHS Foundation TrustOxfordUK,Department of PsychiatryOxford UniversityOxfordUK
| | - David Fowler
- School of PsychologyUniversity of SussexBrightonUK,Sussex Partnership NHS Foundation TrustWorthingUK
| | - Elizabeth Kuipers
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Graham Dunn
- Centre for BiostatisticsSchool of Health SciencesManchester Academic Health Science CentreThe University of ManchesterManchesterUK
| | | | - Philippa Garety
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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2
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Fielding-Smith SF, Greenwood KE, Wichers M, Peters E, Hayward M. Associations between responses to voices, distress and appraisals during daily life: an ecological validation of the cognitive behavioural model. Psychol Med 2022; 52:538-547. [PMID: 32646525 DOI: 10.1017/s0033291720002238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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 Cognitive models propose that behavioural responses to voices maintain distress by preventing disconfirmation of negative beliefs about voices. We used Experience Sampling Methodology (ESM) to examine the hypothesized maintenance role of behavioural responses during daily life. METHOD Thirty-one outpatients with frequent voices completed a smartphone-based ESM questionnaire 10 times a day over 9 days, assessing voice-related distress; resistance and compliance responses to voices; voice characteristics (intensity and negative content); appraisals of voice dominance, uncontrollability and intrusiveness. RESULTS In line with predictions, behavioural responses were associated with voice appraisals (dominance and uncontrollability), but not voice characteristics. Greater resistance and compliance were reported in moments of increased voice distress, but these associations did not persist after controlling for concurrent voice appraisals and characteristics. Voice distress was predicted by appraisals, and, unexpectedly, also by voice characteristics. As predicted, compliance and resistance were related to increases in distress at subsequent timepoints, whilst antecedent voice appraisals and characteristics had no such effect. Compliance, but not resistance, additionally predicted subsequent increases in voice uncontrollability. In both cases, the reverse models showed no association, indicating directional effects of responses on subsequent distress, and of compliance on uncontrollability appraisals. CONCLUSIONS These results provide support for the cognitive model by suggesting that momentary behavioural and emotional responses to voices are associated with concurrent negative voice appraisals. Findings suggest that behavioural responses may be driven by voice appraisals, rather than directly by distress, and may in turn maintain voice appraisals and associated distress during the course of daily life.
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Affiliation(s)
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Marieke Wichers
- University of Groningen, University Medical Centre of Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre of Groningen, Groningen, the Netherlands
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
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Wright AC, Davies G, Fowler D, Greenwood KE. Self-defining Memories Predict Engagement in Structured Activity in First Episode Psychosis, Independent of Neurocognition and Metacognition. Schizophr Bull 2019; 45:1081-1091. [PMID: 30388257 PMCID: PMC6737466 DOI: 10.1093/schbul/sby155] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Self-defining memories (SDMs) are vivid personal memories, related to narrative identity. Individuals with schizophrenia report less specific, more negative, and extract less meaning from these memories compared to control groups. SDMs have been shown to be predicted by neurocognition, associated with metacognition, and linked to goal outcomes in healthy controls. As neurocognition and metacognition are known predictors of poor functioning in psychosis, SDMs may also be a predictor. No study has assessed the relationship to functioning or pattern of SDMs in first episode psychosis (FEP). METHODS This was a cross-sectional study involving 71 individuals with FEP and 57 healthy controls who completed an SDM questionnaire. FEP participants completed measures of neurocognition, metacognition (Metacognitive Assessment Interview), functional capacity (The University of California, San Diego [UCSD] Performance-Based Skills Assessment), and functional outcome (Time-Use Survey). RESULTS SDMs reported by individuals with FEP were less integrated compared to healthy controls. Within the FEP sample, holding less specific memories was associated with engagement in significantly fewer hours of structured activity per week and specificity of SDMs mediated the relationship between neurocognition and functional outcome, independent of metacognition. CONCLUSION This is the first study to assess SDMs in FEP and to explore the important role of SDMs on clinical outcomes, compared to healthy controls. This study suggests that elaborating on specific SDMs is a valid therapeutic target and may be considered a tool to improve daily functioning in FEP.
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Affiliation(s)
- Abigail C Wright
- School of Psychology, University of Sussex, Brighton, East Sussex, United Kingdom
- Sussex Partnership NHS Foundation Trust, Swandean, West Sussex, United Kingdom
- To whom correspondence should be addressed; School of Psychology, University of Sussex, Brighton, BN19RH, UK; tel: +44(0)1273 877698, e-mail:
| | - Geoff Davies
- Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, East Sussex, United Kingdom
- Sussex Partnership NHS Foundation Trust, Swandean, West Sussex, United Kingdom
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, East Sussex, United Kingdom
- Sussex Partnership NHS Foundation Trust, Swandean, West Sussex, United Kingdom
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4
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Westman J, Eberhard J, Gaughran FP, Lundin L, Stenmark R, Edman G, Eriksson SV, Jedenius E, Rydell P, Overgaard K, Abrams D, Greenwood KE, Smith S, Ismail K, Murray R, Ösby U. Outcome of a psychosocial health promotion intervention aimed at improving physical health and reducing alcohol use in patients with schizophrenia and psychotic disorders (MINT). Schizophr Res 2019; 208:138-144. [PMID: 30979666 DOI: 10.1016/j.schres.2019.03.026] [Citation(s) in RCA: 5] [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: 12/18/2017] [Revised: 02/23/2019] [Accepted: 03/26/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Life expectancy is reduced by 19 years in men and 17 in women with psychosis in Sweden, largely due to cardiovascular disease. AIM Assess whether a psychosocial health promotion intervention improves cardiometabolic risk factors, quality of life, and severity of illness in patients with psychotic disorders more than treatment as usual. METHODS A pragmatic intervention trial testing a manual-based multi-component health promotion intervention targeting patients with psychosis. The Swedish intervention was adapted from IMPaCT therapy, a health-promotion program based on motivational interviewing and cognitive behavioral therapy, designed to be incorporated into routine care. The intervention group consisted of 119 patients and the control group of 570 patients from specialized psychosis departments. Outcome variables were assessed 6 months before intervention during the run-in period, again at the start of intervention, and 12 months after the intervention began. The control group received treatment as usual. RESULTS The intervention had no significant effect on any of the outcome variables. However, BMI, waist circumference, systolic BP, heart rate, HbA1c, general health, and Clinical Global Impressions Scale score improved significantly during the run-in period before the start of the active intervention (observer effect). The multi-component design meant that treatment effects could only be calculated for the intervention as a whole. CONCLUSION The results of the intervention are similar to those of the U.K. IMPaCT study, in which the modular health-promotion intervention had little effect on cardiovascular risk indicators. However, in the current study, the run-in period had a positive effect on cardiometabolic risk factors.
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Affiliation(s)
- Jeanette Westman
- Dept of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Sweden.
| | - Jonas Eberhard
- Division of Psychiatry, Dept of Clinical Sciences, Lund University, Lund, Sweden; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Fiona P Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Lennart Lundin
- Sahlgrenska University Hospital, Gothenburg, Sweden; Swedish Schizophrenia Fellowship, Stockholm, Sweden
| | - Richard Stenmark
- Division of Psychiatry, Dept of Clinical Sciences, Lund University, Lund, Sweden
| | - Gunnar Edman
- Norrtälje Hospital, Tiohundra AB, Norrtälje, Sweden; Dept of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sven V Eriksson
- Department of Internal Medicine, Enköping Hospital, Enköping, Sweden; Aleris Specialist Care, Gothenburg, Sweden
| | - Erik Jedenius
- Dept of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Psychiatry, Dept of Clinical Sciences, Lund University, Lund, Sweden
| | - Pia Rydell
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, UK
| | - Shubulade Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Khalida Ismail
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Robin Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Urban Ösby
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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Holt RI, Hind D, Gossage-Worrall R, Bradburn MJ, Saxon D, McCrone P, Morris TA, Etherington A, Shiers D, Barnard K, Swaby L, Edwardson C, Carey ME, Davies MJ, Dickens CM, Doherty Y, French P, Greenwood KE, Kalidindi S, Khunti K, Laugharne R, Pendlebury J, Rathod S, Siddiqi N, Wright S, Waller G, Gaughran F, Barnett J, Northern A. Structured lifestyle education to support weight loss for people with schizophrenia, schizoaffective disorder and first episode psychosis: the STEPWISE RCT. Health Technol Assess 2019; 22:1-160. [PMID: 30499443 DOI: 10.3310/hta22650] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Obesity is twice as common in people with schizophrenia as in the general population. The National Institute for Health and Care Excellence guidance recommends that people with psychosis or schizophrenia, especially those taking antipsychotics, be offered a healthy eating and physical activity programme by their mental health care provider. There is insufficient evidence to inform how these lifestyle services should be commissioned. OBJECTIVES To develop a lifestyle intervention for people with first episode psychosis or schizophrenia and to evaluate its clinical effectiveness, cost-effectiveness, delivery and acceptability. DESIGN A two-arm, analyst-blind, parallel-group, randomised controlled trial, with a 1 : 1 allocation ratio, using web-based randomisation; a mixed-methods process evaluation, including qualitative case study methods and logic modelling; and a cost-utility analysis. SETTING Ten community mental health trusts in England. PARTICIPANTS People with first episode psychosis, schizophrenia or schizoaffective disorder. INTERVENTIONS Intervention group: (1) four 2.5-hour group-based structured lifestyle self-management education sessions, 1 week apart; (2) multimodal fortnightly support contacts; (3) three 2.5-hour group booster sessions at 3-monthly intervals, post core sessions. Control group: usual care assessed through a longitudinal survey. All participants received standard written lifestyle information. MAIN OUTCOME MEASURES The primary outcome was change in weight (kg) at 12 months post randomisation. The key secondary outcomes measured at 3 and 12 months included self-reported nutrition (measured with the Dietary Instrument for Nutrition Education questionnaire), objectively measured physical activity measured by accelerometry [GENEActiv (Activinsights, Kimbolton, UK)], biomedical measures, adverse events, patient-reported outcome measures and a health economic assessment. RESULTS The trial recruited 414 participants (intervention arm: 208 participants; usual care: 206 participants) between 10 March 2015 and 31 March 2016. A total of 341 participants (81.6%) completed the trial. A total of 412 participants were analysed. After 12 months, weight change did not differ between the groups (mean difference 0.0 kg, 95% confidence interval -1.59 to 1.67 kg; p = 0.964); physical activity, dietary intake and biochemical measures were unchanged. Glycated haemoglobin, fasting glucose and lipid profile were unchanged by the intervention. Quality of life, psychiatric symptoms and illness perception did not change during the trial. There were three deaths, but none was related to the intervention. Most adverse events were expected and related to the psychiatric illness. The process evaluation showed that the intervention was acceptable, with participants valuing the opportunity to interact with others facing similar challenges. Session feedback indicated that 87.2% of participants agreed that the sessions had met their needs. Some indicated the desire for more ongoing support. Professionals felt that the intervention was under-resourced and questioned the long-term sustainability within current NHS settings. Professionals would have preferred greater access to participants' behaviour data to tailor the intervention better. The incremental cost-effectiveness ratio from the health-care perspective is £246,921 per quality-adjusted life-year (QALY) gained and the incremental cost-effectiveness ratio from the societal perspective is £367,543 per QALY gained. CONCLUSIONS Despite the challenges of undertaking clinical research in this population, the trial successfully recruited and retained participants, indicating a high level of interest in weight management interventions; however, the STEPWISE intervention was neither clinically effective nor cost-effective. Further research will be required to define how overweight and obesity in people with schizophrenia should be managed. The trial results suggest that lifestyle programmes for people with schizophrenia may need greater resourcing than for other populations, and interventions that have been shown to be effective in other populations, such as people with diabetes mellitus, are not necessarily effective in people with schizophrenia. TRIAL REGISTRATION Current Controlled Trials ISRCTN19447796. 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. 22, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Richard Ig Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | | | - David Saxon
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tiyi A Morris
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Katharine Barnard
- Faculty of Health & Social Sciences, Bournemouth University, Poole, UK
| | - Lizzie Swaby
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Marian E Carey
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Yvonne Doherty
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK.,Psychological Medicine, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn E Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Sridevi Kalidindi
- Rehabilitation and Recovery, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Richard Laugharne
- Research and Innovation, Cornwall Partnership NHS Foundation Trust, Redruth, UK
| | | | - Shanaya Rathod
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Stephen Wright
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Glenn Waller
- Sheffield Health & Social Care NHS Foundation Trust, Sheffield, UK.,Department of Psychology, University of Sheffield, Sheffield, UK
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Psychosis Unit and Research and Development Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Janette Barnett
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
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6
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Holt RIG, Gossage-Worrall R, Hind D, Bradburn MJ, McCrone P, Morris T, Edwardson C, Barnard K, Carey ME, Davies MJ, Dickens CM, Doherty Y, Etherington A, French P, Gaughran F, Greenwood KE, Kalidindi S, Khunti K, Laugharne R, Pendlebury J, Rathod S, Saxon D, Shiers D, Siddiqi N, Swaby EA, Waller G, Wright S. Structured lifestyle education for people with schizophrenia, schizoaffective disorder and first-episode psychosis (STEPWISE): randomised controlled trial. Br J Psychiatry 2019; 214:63-73. [PMID: 30251622 PMCID: PMC6330076 DOI: 10.1192/bjp.2018.167] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is a major challenge for people with schizophrenia.AimsWe assessed whether STEPWISE, a theory-based, group structured lifestyle education programme could support weight reduction in people with schizophrenia. METHOD In this randomised controlled trial (study registration: ISRCTN19447796), we recruited adults with schizophrenia, schizoaffective disorder or first-episode psychosis from ten mental health organisations in England. Participants were randomly allocated to the STEPWISE intervention or treatment as usual. The 12-month intervention comprised four 2.5 h weekly group sessions, followed by 2-weekly maintenance contact and group sessions at 4, 7 and 10 months. The primary outcome was weight change after 12 months. Key secondary outcomes included diet, physical activity, biomedical measures and patient-related outcome measures. Cost-effectiveness was assessed and a mixed-methods process evaluation was included. RESULTS Between 10 March 2015 and 31 March 2016, we recruited 414 people (intervention 208, usual care 206) with 341 (84.4%) participants completing the trial. At 12 months, weight reduction did not differ between groups (mean difference 0.0 kg, 95% CI -1.6 to 1.7, P = 0.963); physical activity, dietary intake and biochemical measures were unchanged. STEPWISE was well-received by participants and facilitators. The healthcare perspective incremental cost-effectiveness ratio was £246 921 per quality-adjusted life-year gained. CONCLUSIONS Participants were successfully recruited and retained, indicating a strong interest in weight interventions; however, the STEPWISE intervention was neither clinically nor cost-effective. Further research is needed to determine how to manage overweight and obesity in people with schizophrenia.Declaration of interestR.I.G.H. received fees for lecturing, consultancy work and attendance at conferences from the following: Boehringer Ingelheim, Eli Lilly, Janssen, Lundbeck, Novo Nordisk, Novartis, Otsuka, Sanofi, Sunovion, Takeda, MSD. M.J.D. reports personal fees from Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceuticals International Inc.; and, grants from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, Janssen. K.K. has received fees for consultancy and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Servier and Merck Sharp & Dohme. He has received grants in support of investigator and investigator-initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. K.K. has received funds for research, honoraria for speaking at meetings and has served on advisory boards for Lilly, Sanofi-Aventis, Merck Sharp & Dohme and Novo Nordisk. D.Sh. is expert advisor to the NICE Centre for guidelines; board member of the National Collaborating Centre for Mental Health (NCCMH); clinical advisor (paid consultancy basis) to National Clinical Audit of Psychosis (NCAP); views are personal and not those of NICE, NCCMH or NCAP. J.P. received personal fees for involvement in the study from a National Institute for Health Research (NIHR) grant. M.E.C. and Y.D. report grants from NIHR Health Technology Assessment, during the conduct of the study; and The Leicester Diabetes Centre, an organisation (employer) jointly hosted by an NHS Hospital Trust and the University of Leicester and who is holder (through the University of Leicester) of the copyright of the STEPWISE programme and of the DESMOND suite of programmes, training and intervention fidelity framework that were used in this study. S.R. has received honorarium from Lundbeck for lecturing. F.G. reports personal fees from Otsuka and Lundbeck, personal fees and non-financial support from Sunovion, outside the submitted work; and has a family member with professional links to Lilly and GSK, including shares. F.G. is in part funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care Funding scheme, by the Maudsley Charity and by the Stanley Medical Research Institute and is supported by the by the Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.
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Affiliation(s)
- Richard I. G. Holt
- Professor in Diabetes and Endocrinology, Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton andHonorary Consultant Physician, Division B, University Hospital Southampton NHS Foundation Trust, UK,Correspondence: Richard I. G. Holt, The IDS Building (MP887), Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
| | - Rebecca Gossage-Worrall
- Trial Manager (Research Associate), Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, UK
| | - Daniel Hind
- Reader in Complex Interventions and Assistant Director, Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, UK
| | - Michael J. Bradburn
- Senior Medical Statistician, Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, UK
| | - Paul McCrone
- Professor of Health Economics and Director of King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Tiyi Morris
- Research Assistant, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Charlotte Edwardson
- Associate Professor in Physical Activity, Sedentary Behaviour and Health, Diabetes Research Centre, University of Leicester, UK
| | - Katharine Barnard
- Health Psychologist and Visiting Professor, Faculty of Health and Social Science, University of Bournemouth, UK
| | - Marian E. Carey
- Director: Structured Education Research Portfolio, Leicester Diabetes Centre, University Hospitals of Leicesterand Honorary Associate Professor, Diabetes Research Centre, University of Leicester, UK
| | - Melanie J. Davies
- Professor of Diabetes Medicine, Diabetes Research Centre, University of Leicester, UK
| | - Chris M. Dickens
- Professor of Psychological Medicine, Institute of Health Research, University of Exeter Medical School, UK
| | - Yvonne Doherty
- Consultant Clinical Psychologist and Senior Research Associate, Leicester Diabetes Centre, University Hospitals of Leicester, UK
| | | | - Paul French
- Associate Director, Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Fiona Gaughran
- Reader, Institute of Psychiatry, Psychology & Neuroscience, King's College London and Consultant Psychiatrist and Director of Research, National Psychosis Service, South London and Maudsley NHS Foundation Trust, UK
| | - Kathryn E. Greenwood
- Consultant Clinical Psychologist, Sussex Partnership NHS Foundation Trust and Professor in Clinical Psychology, Sussex Psychosis Research Interest Group, School of Psychology, University of Sussex, UK
| | - Sridevi Kalidindi
- Consultant Psychiatrist, Rehabilitation and Recovery, South London and Maudsley NHS Foundation Trust and Senior Clinical Lecturer, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Kamlesh Khunti
- Professor of Primary Care Diabetes and Vascular Medicine, Diabetes Research Centre, University of Leicester, UK
| | - Richard Laugharne
- Consultant Psychiatrist and Honorary Senior Lecturer, Cornwall Partnership NHS Foundation Trust, UK
| | | | - Shanaya Rathod
- Consultant Psychiatrist and Director of Research, Southern Health NHS Foundation Trust and Visiting Professor, Faculty of Science, University of Portsmouth, UK
| | - David Saxon
- Research Fellow, Mental Health Unit, School of Health and Related Research, University of Sheffield, UK
| | - David Shiers
- Honorary Research Consultant, Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust andHonorary Reader in Early Psychosis, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, UK
| | - Najma Siddiqi
- Clinical Senior Lecturer in Psychiatry, Health Sciences, University of York, Hull York Medical School and Consultant Psychiatrist, Bradford District Care NHS Foundation Trust, UK
| | - Elizabeth A. Swaby
- Study Manager, Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, UK
| | - Glenn Waller
- Professor of Psychology, Department of Psychology, University of Sheffield, UK
| | - Stephen Wright
- Lead Consultant, Early Intervention Psychiatry, Tees Esk & Wear Valleys NHS Foundation Trust, UK
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7
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Wright AC, Fowler D, Greenwood KE. Developing a dynamic model of anomalous experiences and function in young people with or without psychosis: a cross-sectional and longitudinal study protocol. BMJ Open 2018; 8:e022546. [PMID: 30391913 PMCID: PMC6231554 DOI: 10.1136/bmjopen-2018-022546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/06/2018] [Accepted: 09/21/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Anomalous experiences are common within the general population, but the frequency and intensity is increased in young people with psychosis. Studies have demonstrated that perceptual biases towards noticing these phenomena plays a role, but the way one thinks about one's experience (metacognition) may also be relevant. While poor metacognitive function has been theoretically associated with anomalous experiences, this relationship is currently unclear. However, metacognition may work along a continuum with various metacognitive levels, many of which have been demonstrated as impaired in psychosis. These metacognitive components may interact via processes that maintain poor metacognition across levels, and that potentially impact both what people do in their everyday lives (functional outcome) and how people feel about their everyday lives (subjective recovery outcome) in young people with psychosis compared with healthy control participants. METHODS AND ANALYSIS This study will investigate the association and contribution of metacognition to anomalous experiences and outcome measures cross-sectionally and longitudinally in a 36-month follow-up. First, young people with psychosis will be compared with healthy control participants on selected measures of anomalous experience, metacognition, and function, using analysis of covariance to identify group differences. Next, the relationship between metacognitive components and processes will be explored, including processes connecting the different components, using regression analyses. Finally, mediation analyses will be used to assess the predictive value of metacognitive measures on outcome measures, both cross-sectionally and longitudinally at 36 months, while controlling for symptoms and cognition. ETHICS AND DISSEMINATION Ethical and Health Research Authority approval has been obtained through Camberwell St. Giles Research Ethics Committee (reference number: 17/LO/0055). This research project will be reported within a PhD thesis and submitted for journal publication. Once key predictive components of poor outcome in psychosis are identified, this study will develop a series of dynamic models to understand influences on outcome for young people with psychosis.
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Affiliation(s)
- Abigail C Wright
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
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8
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Rae CL, Davies G, Garfinkel SN, Gabel MC, Dowell NG, Cercignani M, Seth AK, Greenwood KE, Medford N, Critchley HD. Deficits in Neurite Density Underlie White Matter Structure Abnormalities in First-Episode Psychosis. Biol Psychiatry 2017; 82:716-725. [PMID: 28359565 DOI: 10.1016/j.biopsych.2017.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 08/03/2016] [Revised: 01/30/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Structural abnormalities across multiple white matter tracts are recognized in people with early psychosis, consistent with dysconnectivity as a neuropathological account of symptom expression. We applied advanced neuroimaging techniques to characterize microstructural white matter abnormalities for a deeper understanding of the developmental etiology of psychosis. METHODS Thirty-five first-episode psychosis patients, and 19 healthy controls, participated in a quantitative neuroimaging study using neurite orientation dispersion and density imaging, a multishell diffusion-weighted magnetic resonance imaging technique that distinguishes white matter fiber arrangement and geometry from changes in neurite density. Fractional anisotropy (FA) and mean diffusivity images were also derived. Tract-based spatial statistics compared white matter structure between patients and control subjects and tested associations with age, symptom severity, and medication. RESULTS Patients with first-episode psychosis had lower regional FA in multiple commissural, corticospinal, and association tracts. These abnormalities predominantly colocalized with regions of reduced neurite density, rather than aberrant fiber bundle arrangement (orientation dispersion index). There was no direct relationship with active symptoms. FA decreased and orientation dispersion index increased with age in patients, but not control subjects, suggesting accelerated effects of white matter geometry change. CONCLUSIONS Deficits in neurite density appear fundamental to abnormalities in white matter integrity in early psychosis. In the first application of neurite orientation dispersion and density imaging in psychosis, we found that processes compromising axonal fiber number, density, and myelination, rather than processes leading to spatial disruption of fiber organization, are implicated in the etiology of psychosis. This accords with a neurodevelopmental origin of aberrant brain-wide structural connectivity predisposing individuals to psychosis.
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Affiliation(s)
- Charlotte L Rae
- Sackler Centre for Consciousness Science, University of Sussex, Falmer, Brighton; Division of Neuroscience, University of Sussex, Falmer, Brighton.
| | - Geoff Davies
- Brighton & Sussex Medical School, School of Psychology, University of Sussex, Falmer, Brighton; Sussex Partnership National Health Service Foundation Trust, United Kingdom
| | - Sarah N Garfinkel
- Sackler Centre for Consciousness Science, University of Sussex, Falmer, Brighton; Division of Neuroscience, University of Sussex, Falmer, Brighton
| | - Matt C Gabel
- Division of Neuroscience, University of Sussex, Falmer, Brighton
| | | | - Mara Cercignani
- Division of Neuroscience, University of Sussex, Falmer, Brighton
| | - Anil K Seth
- Sackler Centre for Consciousness Science, University of Sussex, Falmer, Brighton; School of Engineering & Informatics, University of Sussex, Falmer, Brighton
| | - Kathryn E Greenwood
- Brighton & Sussex Medical School, School of Psychology, University of Sussex, Falmer, Brighton; Sussex Partnership National Health Service Foundation Trust, United Kingdom
| | - Nick Medford
- Sackler Centre for Consciousness Science, University of Sussex, Falmer, Brighton; Division of Neuroscience, University of Sussex, Falmer, Brighton; Sussex Partnership National Health Service Foundation Trust, United Kingdom
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Falmer, Brighton; Division of Neuroscience, University of Sussex, Falmer, Brighton; Sussex Partnership National Health Service Foundation Trust, United Kingdom
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9
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Lally J, Ajnakina O, Stubbs B, Williams HR, Colizzi M, Carra E, Fraietta S, Gardner-Sood P, Greenwood KE, Atakan Z, Mondelli V, Ismail K, Howes O, Taylor DM, Smith S, Hopkins D, Murray RM, Gaughran F. Hyperprolactinaemia in first episode psychosis - A longitudinal assessment. Schizophr Res 2017; 189:117-125. [PMID: 28755878 DOI: 10.1016/j.schres.2017.07.037] [Citation(s) in RCA: 23] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 07/14/2017] [Accepted: 07/16/2017] [Indexed: 02/02/2023]
Abstract
Little is known about hyperprolactinaemia (HPL) in first episode psychosis (FEP) patients. We investigated longitudinal changes in serum prolactin in FEP, and the relationship between HPL, and antipsychotic medication and stress. Serum prolactin was recorded in FEP patients at recruitment and again, 3 and 12months later. HPL was defined as a serum prolactin level >410mIU/L (~19.3ng/ml) for males, and a serum prolactin level >510mIU/L (~24.1ng/ml) for females. From a total of 174 people with serum prolactin measurements at study recruitment, 43% (n=74) had HPL, whilst 27% (n=21/78) and 27% (n=26/95) had HPL at 3 and 12months respectively. We observed higher serum prolactin levels in females versus males (p<0.001), and in antipsychotic treated (n=68) versus antipsychotic naïve patients (p<0.0001). Prolactin levels were consistently raised in FEP patients taking risperidone, amisulpride and FGAs compared to other antipsychotics. No significant relationship was observed between perceived stress scores (β=7.13, t=0.21, df=11, p=0.0.84 95% CI -72.91-87.16), or objective life stressors (β=-21.74, t=-0.31, df=8, p=0.77 95% CI -218.57-175.09) and serum prolactin. Our study found elevated rates of HPL over the course of the first 12months of illness. We found no evidence to support the notion that stress is related to elevated serum prolactin at the onset of psychosis.
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Affiliation(s)
- John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland; Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's Hospital, Dublin, Ireland.
| | - Olesya Ajnakina
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Brendon Stubbs
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK.
| | - Hugh R Williams
- Lewisham Promoting Recovery Neighbourhood 3 Team, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Marco Colizzi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Elena Carra
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; University of Modena and Reggio Emilia, Italy.
| | - Sara Fraietta
- Villa Letizia, Psychiatric Rehabilitation Center, Rome, Italy.
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK; Early Intervention in Psychosis Service, Sussex Partnership NHS Foundation Trust, West Sussex, UK.
| | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK; King's College Hospital NHS Foundation Trust, UK.
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - David M Taylor
- Department of Pharmacy, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Shubalade Smith
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - David Hopkins
- King's College Hospital NHS Foundation Trust, UK; Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK.
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10
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Vassos E, Di Forti M, Coleman J, Iyegbe C, Prata D, Euesden J, O'Reilly P, Curtis C, Kolliakou A, Patel H, Newhouse S, Traylor M, Ajnakina O, Mondelli V, Marques TR, Gardner-Sood P, Aitchison KJ, Powell J, Atakan Z, Greenwood KE, Smith S, Ismail K, Pariante C, Gaughran F, Dazzan P, Markus HS, David AS, Lewis CM, Murray RM, Breen G. An Examination of Polygenic Score Risk Prediction in Individuals With First-Episode Psychosis. Biol Psychiatry 2017; 81:470-477. [PMID: 27765268 DOI: 10.1016/j.biopsych.2016.06.028] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [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: 10/29/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Polygenic risk scores (PRSs) have successfully summarized genome-wide effects of genetic variants in schizophrenia with significant predictive power. In a clinical sample of first-episode psychosis (FEP) patients, we estimated the ability of PRSs to discriminate case-control status and to predict the development of schizophrenia as opposed to other psychoses. METHODS The sample (445 case and 265 control subjects) was genotyped on the Illumina HumanCore Exome BeadChip with an additional 828 control subjects of African ancestry genotyped on the Illumina Multi-Ethnic Genotyping Array. To calculate PRSs, we used the results from the latest Psychiatric Genomics Consortium schizophrenia meta-analysis. We examined the association of PRSs with case-control status and with schizophrenia versus other psychoses in European and African ancestry FEP patients and in a second sample of 248 case subjects with chronic psychosis. RESULTS PRS had good discriminative ability of case-control status in FEP European ancestry individuals (9.4% of the variance explained, p < 10-6), but lower in individuals of African ancestry (R2 = 1.1%, p = .004). Furthermore, PRS distinguished European ancestry case subjects who went on to acquire a schizophrenia diagnosis from those who developed other psychotic disorders (R2 = 9.2%, p = .002). CONCLUSIONS PRS was a powerful predictor of case-control status in a European sample of patients with FEP, even though a large proportion did not have an established diagnosis of schizophrenia at the time of assessment. PRS was significantly different between those case subjects who developed schizophrenia from those who did not, although the discriminative accuracy may not yet be sufficient for clinical utility in FEP.
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Affiliation(s)
- Evangelos Vassos
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| | - Marta Di Forti
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jonathan Coleman
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Conrad Iyegbe
- Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Diana Prata
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Jack Euesden
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paul O'Reilly
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Charles Curtis
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Anna Kolliakou
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Hamel Patel
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Stephen Newhouse
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Matthew Traylor
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | - Olesya Ajnakina
- Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Valeria Mondelli
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Tiago Reis Marques
- Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Poonam Gardner-Sood
- Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Katherine J Aitchison
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - John Powell
- Basic and Clinical Neuroscience; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Zerrin Atakan
- Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton and Sussex Partnership National Health Service Foundation Trust, West Sussex
| | - Shubulade Smith
- Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; South London and Maudsley National Health Service Foundation Trust, London; United Kingdom
| | - Khalida Ismail
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Carmine Pariante
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Fiona Gaughran
- Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paola Dazzan
- Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Hugh S Markus
- Department of Clinical Neurosciences, Neurology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Anthony S David
- Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Cathryn M Lewis
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Robin M Murray
- Departments of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Gerome Breen
- Medical Research Council, Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust and King's College London, London, United Kingdom
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11
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Gardner-Sood P, Lally J, Smith S, Atakan Z, Ismail K, Greenwood KE, Keen A, O'Brien C, Onagbesan O, Fung C, Papanastasiou E, Eberherd J, Patel A, Ohlsen R, Stahl D, David A, Hopkins D, Murray RM, Gaughran F. Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT RCT study--Corrigendum. Psychol Med 2015; 45:2631. [PMID: 26165543 PMCID: PMC4971543 DOI: 10.1017/s0033291715001154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The author regrets to announce that affiliation 8, in the above article (Gardner-Sood et al. 2015), contained an error in the author affiliation address and author surname, which were published in the approved article. The correct surname and affiliation address are given below. J. Eberhard, Clinical Psychiatric Research Center, Lund University, Skåne, Sweden
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12
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Peters ER, Moritz S, Schwannauer M, Wiseman Z, Greenwood KE, Scott J, Beck AT, Donaldson C, Hagen R, Ross K, Veckenstedt R, Ison R, Williams S, Kuipers E, Garety PA. Cognitive Biases Questionnaire for psychosis. Schizophr Bull 2014; 40:300-13. [PMID: 23413104 PMCID: PMC3932080 DOI: 10.1093/schbul/sbs199] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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: 11/13/2022]
Abstract
OBJECTIVE The Cognitive Biases Questionnaire for psychosis (CBQp) was developed to capture 5 cognitive distortions (jumping to conclusions, intentionalising, catastrophising, emotional reasoning, and dichotomous thinking), which are considered important for the pathogenesis of psychosis. Vignettes were adapted from the Cognitive Style Test (CST),(1) relating to "Anomalous Perceptions" and "Threatening Events" themes. METHOD Scale structure, reliability, and validity were investigated in a psychosis group, and CBQp scores were compared with those of depressed and healthy control samples. RESULTS The CBQp showed good internal consistency and test-retest reliability. The 5 biases were not independent, with a 2-related factor scale providing the best fit. This structure suggests that the CBQp assesses a general thinking bias rather than distinct cognitive errors, while Anomalous Perception and Threatening Events theme scores can be used separately. Total CBQp scores showed good convergent validity with the CST, but individual biases were not related to existing tasks purporting to assess similar reasoning biases. Psychotic and depressed populations scored higher than healthy controls, and symptomatic psychosis patients scored higher than their nonsymptomatic counterparts, with modest relationships between CBQp scores and symptom severity once emotional disorders were partialled out. Anomalous Perception theme and Intentionalising bias scores showed some specificity to psychosis. CONCLUSIONS Overall, the CBQp has good psychometric properties, although it is likely that it measures a different construct to existing tasks, tentatively suggested to represent a bias of interpretation rather than reasoning, judgment or decision-making processes. It is a potentially useful tool in both research and clinical arenas.
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Affiliation(s)
- Emmanuelle R. Peters
- Department of Psychology, King’s College London, Institute of Psychiatry, London;,National Institute of Mental Health (NIHR) Biomedical Research Centre for Mental Health, King’s Health Partners, London;,*To whom correspondence should be addressed; De Crespigny Park, London SE5 8AF, UK; tel: +44 (0) 207 848 0347, fax: +44 (0) 207 848 5006, e-mail:
| | - Steffen Moritz
- Department for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Zoe Wiseman
- Department of Psychology, King’s College London, Institute of Psychiatry, London
| | - Kathryn E. Greenwood
- School of Psychology, University of Sussex, Brighton;,Early Intervention in Psychosis Service, Sussex Partnership NHS Foundation Trust, West Sussex
| | - Jan Scott
- Early Intervention in Psychosis Service, Sussex Partnership NHS Foundation Trust, West Sussex;,Academic Psychiatry, Institute of Neuroscience, Newcastle University, Tyne and Wear; ,FondaMental Foundation, Foundation de Coopération Scientifique Hôpital A. Chenevier, Creteil, France
| | - Aaron T. Beck
- INSERM, U 955, IMRB, Psychiatry Genetic, Creteil, France
| | - Catherine Donaldson
- Department of Psychology, King’s College London, Institute of Psychiatry, London
| | - Roger Hagen
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Kerry Ross
- Department of Psychology, King’s College London, Institute of Psychiatry, London
| | - Ruth Veckenstedt
- Department for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Ison
- Department of Psychology, King’s College London, Institute of Psychiatry, London
| | - Sally Williams
- Department of Psychology, King’s College London, Institute of Psychiatry, London
| | - Elizabeth Kuipers
- Department of Psychology, King’s College London, Institute of Psychiatry, London;,National Institute of Mental Health (NIHR) Biomedical Research Centre for Mental Health, King’s Health Partners, London;,Joint last authors.
| | - Philippa A. Garety
- Department of Psychology, King’s College London, Institute of Psychiatry, London;,National Institute of Mental Health (NIHR) Biomedical Research Centre for Mental Health, King’s Health Partners, London;,Joint last authors.
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Sweeney A, Greenwood KE, Williams S, Wykes T, Rose DS. Hearing the voices of service user researchers in collaborative qualitative data analysis: the case for multiple coding. Health Expect 2013; 16:e89-99. [PMID: 22958162 PMCID: PMC5060679 DOI: 10.1111/j.1369-7625.2012.00810.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Health research is frequently conducted in multi-disciplinary teams, with these teams increasingly including service user researchers. Whilst it is common for service user researchers to be involved in data collection--most typically interviewing other service users--it is less common for service user researchers to be involved in data analysis and interpretation. This means that a unique and significant perspective on the data is absent. AIM This study aims to use an empirical report of a study on Cognitive Behavioural Therapy for psychosis (CBTp) to demonstrate the value of multiple coding in enabling service users voices to be heard in team-based qualitative data analysis. DESIGN The CBTp study employed multiple coding to analyse service users' discussions of CBT for psychosis (CBTp) from the perspectives of a service user researcher, clinical researcher and psychology assistant. Multiple coding was selected to enable multiple perspectives to analyse and interpret data, to understand and explore differences and to build multi-disciplinary consensus. RESULTS Multiple coding enabled the team to understand where our views were commensurate and incommensurate and to discuss and debate differences. Through the process of multiple coding, we were able to build strong consensus about the data from multiple perspectives, including that of the service user researcher. DISCUSSION Multiple coding is an important method for understanding and exploring multiple perspectives on data and building team consensus. This can be contrasted with inter-rater reliability which is only appropriate in limited circumstances. CONCLUSION We conclude that multiple coding is an appropriate and important means of hearing service users' voices in qualitative data analysis.
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Affiliation(s)
- Angela Sweeney
- Department of Mental Health SciencesUniversity College LondonUK
- Health Service and Population Research DepartmentInstitute of PsychiatryKing's College London
| | - Kathryn E Greenwood
- Early Intervention in Psychosis ServiceSussex Partnership NHS Foundation Trust and School of PsychologyUniversity of SussexUK
- Department of PsychologyInstitute of PsychiatryUK
- PICuP ClinicThe Maudsley Hospital, Maudsley NHS Foundation TrustSouth LondonUK
| | - Sally Williams
- PICuP ClinicThe Maudsley Hospital, Maudsley NHS Foundation TrustSouth LondonUK
| | - Til Wykes
- Department of PsychologyInstitute of PsychiatryUK
| | - Diana S Rose
- Health Service and Population Research DepartmentInstitute of PsychiatryKing's College London
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14
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Gaughran F, Stahl D, Ismail K, Atakan Z, Lally J, Gardner-Sood P, Patel A, David A, Hopkins D, Harries B, Lowe P, Orr D, Arbuthnot M, Murray RM, Greenwood KE, Smith S. Improving physical health and reducing substance use in psychosis--randomised control trial (IMPACT RCT): study protocol for a cluster randomised controlled trial. BMC Psychiatry 2013; 13:263. [PMID: 24131496 PMCID: PMC3852764 DOI: 10.1186/1471-244x-13-263] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 09/17/2013] [Accepted: 09/19/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cardiovascular morbidity and mortality is increased in individuals with severe mental illnesses.We set out to establish a multicentre, two arm, parallel cluster randomized controlled trial (RCT) of a health promotion intervention (HPI), IMPACT Therapy. The patient-tailored IMPACT Therapy aims to target one or more health behaviours from a pre-defined list that includes cannabis use; alcohol use; other substance use; cigarette smoking; exercise; diet and diabetic control, prioritising those identified as problematic by the patient, taking a motivational interviewing and CBT approach. METHODS Impact therapy will be delivered by care coordinators in the community to the treatment group and will be compared to treatment as usual (TAU). The main hypothesis is that the addition of IMPACT Therapy (HPI) to TAU will be more effective than TAU alone in improving patients' quality of life as measured by the Short Form-36, including mental health and physical health subscales on completion of the intervention at 12 months post randomisation. A subsidiary hypothesis will be that addition of IMPACT Therapy (HPI) will be more cost-effective than TAU alone in improving health in people with SMI 12 months from baseline. The IMPACT therapy patient groups' improvement in quality of life, as well as its cost effectiveness, is hypothesised to be maintained at 15 months. Outcomes will be analyzed on an intention-to-treat (ITT) basis. DISCUSSION The results of the trial will provide information about the effectiveness of the IMPACT therapy programme in supporting community mental health teams to address physical comorbidity in severe mental illness. TRIAL REGISTRATION ISRCTN58667926.
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Affiliation(s)
- Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King’s College London, London, UK
| | - Khalida Ismail
- Institute of Psychiatry, King’s College London, London, UK,King’s College Hospital NHS Foundation Trust, London, UK
| | - Zerrin Atakan
- Section of Neuroimaging, Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - John Lally
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK,Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Anita Patel
- Centre for the Economics of Mental and Physical Health (CEMPH), Institute of Psychiatry at King's College London, London, UK
| | - Anthony David
- Institute of Psychiatry, King’s College London, London, UK
| | - David Hopkins
- Division of Ambulatory Care & Local Networks, King’s College Hospital NHS Foundation Trust, London, UK,King’s College London School of Medicine, London, UK
| | - Bee Harries
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK
| | - Philippa Lowe
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK
| | - Diana Orr
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK
| | - Maurice Arbuthnot
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK
| | - Robin M Murray
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK,Institute of Psychiatry, King’s College London, London, UK
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK,Early Intervention in Psychosis Service, Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Shubulade Smith
- Institute of Psychiatry, King’s College London, London, UK,South London and Maudsley NHS Foundation Trust, London, UK
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15
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Greenwood KE, Sweeney A, Williams S, Garety P, Kuipers E, Scott J, Peters E. CHoice of Outcome In Cbt for psychosEs (CHOICE): the development of a new service user-led outcome measure of CBT for psychosis. Schizophr Bull 2010; 36:126-35. [PMID: 19880823 PMCID: PMC2800145 DOI: 10.1093/schbul/sbp117] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [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
Outcome measures for cognitive behavior therapy for psychosis (CBTp) have been derived from pharmacological studies, focusing on symptom change rather than outcomes such as distress or fulfillment. This study presents the development and psychometric properties of a new outcome measure (CHoice of Outcome In Cbt for psychosEs [CHOICE]), which reflects more strongly the aims of CBTp and the priorities of service users. Service users who had received CBTp participated in focus groups to discuss their outcome priorities, using a topic guide generated by a panel of experts in CBTp. A qualitative thematic analysis was undertaken to reach consensus on themes and generate items. Response scales were constructed for 3 dimensions: severity, satisfaction, and importance. The resulting questionnaire was piloted with service users who had not received CBTp, stratified by service type, ethnicity, and first language to ensure that it was user friendly and applicable prior to CBTp. The psychometric properties of the measure were then examined in a sample of 152 service users. Twenty-four items, and 2 of the dimensions (severity and satisfaction), were retained in the final measure. A factor analysis revealed a single psychological recovery factor interspersed throughout with both CBTp and recovery items. Test-retest reliability, construct validity, and sensitivity to change following CBTp were confirmed. The CHOICE measure is unique in being the first psychometrically adequate service user-led outcome measure of CBTp. It provides the opportunity to examine the evidence base for CBTp with an assessment approach that prioritizes service user definitions of recovery and CBT aims.
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Affiliation(s)
- Kathryn E. Greenwood
- Department of Psychology, Institute of Psychiatry, London, UK,To whom correspondence should be addressed; Department of Psychology, Maudsley Psychology Centre, Maudsley Hospital and Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK; tel: 00-44-203-228-2194, fax: 00-44-203-228-2920, e-mail:
| | - Angela Sweeney
- Service User Research Enterprise, Institute of Psychiatry, London, UK
| | - Sally Williams
- Department of Psychology, Institute of Psychiatry, London, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, London, UK,National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, London, UK,National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Jan Scott
- Department of Psychiatry, Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, London, UK,National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley National Health Service Foundation Trust, London, UK
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16
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Abstract
BACKGROUND Insight in psychosis has previously been associated with both depression and cognitive ability. Some studies have found a curvilinear relationship between insight and cognitive ability, but the roles of self-esteem and depression have not been taken into account. AIMS To investigate the relationships between insight and IQ, depression, and self-esteem. METHOD Correlations between self-reported and observer-rated insight, and measures of IQ, depression and self-esteem were examined in 67 people with psychosis. RESULTS Better self-reported insight was associated with higher IQ and poorer self-esteem, but not depression. There was some evidence for a curvilinear relationship between IQ and self-reported insight, specifically the ;awareness of illness' dimension, which survived correction for symptom variables. CONCLUSIONS The relationship between insight and IQ might reflect both the basis of insight in intellectual ability and the influence of a psychological mechanism that preserves self-esteem.
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Affiliation(s)
- Michael A Cooke
- King's College London, Institute of Psychiatry, Department of Psychology (PO77), 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
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Greenwood KE, Landau S, Wykes T. Negative symptoms and specific cognitive impairments as combined targets for improved functional outcome within cognitive remediation therapy. Schizophr Bull 2005; 31:910-21. [PMID: 16049165 DOI: 10.1093/schbul/sbi035] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Negative symptoms and poor cognition are both associated with poor functional outcome in schizophrenia. This poor functional outcome has been attributed to poor cognition rather than any independent contribution from symptoms. Identifying target cognitive processes and mechanisms that predict community function, and possible moderator effects of negative symptoms, will allow the development of cognitive remediation programs that are successful in improving functional outcome. A referred sample of 53 in- and outpatients with schizophrenia with general cognitive impairment (including 28 with severe negative symptoms) and 22 healthy controls, balanced for premorbid IQ, were compared cross sectionally on measures of community shopping skills, executive function, and working memory. Across the groups, there were direct relationships between community functioning and specific executive functions, and there were interactions between group membership and the types of associations found. Working memory was independently associated with accurate community functioning only in people with schizophrenia and negative symptoms. This association was not due to the sole presence of working memory impairment or just to negative symptoms. Poor community function is predicted both by specific cognitive impairments that are prominent in people with negative symptoms and through the moderating effect of negative symptoms on the working memory-community function relationship. This may reflect a synergistic association between symptoms and cognition: negative symptoms arise from cognitive impairment but also impact detrimentally on working memory functioning. Both cognitive processes and negative symptoms should be targeted in cognitive remediation to effect the greatest change in community functions.
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