Showing papers by "Max Birchwood published in 2000"

The power and omnipotence of voices: subordination and entrapment by voices and significant others.

Abstract: Background. Cognitive therapy for psychotic symptoms often embraces self-evaluative beliefs (e.g. self-worth) but whether and how such beliefs are related to delusions remains uncertain. In previous research we demonstrated that distress arising from voices was linked to beliefs about voices and not voice content alone. In this study we examine whether the relationship with the voice is a paradigm of social relationships in general, using a new framework of social cognition, ‘ranking’ theory.Method. In a sample of 59 voice hearers, measures of power and social rank difference between voice and voice hearer are taken in addition to parallel measures of power and rank in wider social relationships.Results. As predicted, subordination to voices was closely linked to subordination and marginalization in other social relationships. This was not the result of a mood-linked appraisal. Distress arising from voices was linked not to voice characteristics but social and interpersonal cognition.Conclusion. This study suggests that the power imbalance between the individual and his persecutor(s) may have origins in an appraisal by the individual of his social rank and sense of group identification and belonging. The results also raise the possibility that the appraisal of voice frequency and volume are the result of the appraisal of voices' rank and power. Theoretical and novel treatment implications are discussed.

Cognitive approach to depression and suicidal thinking in psychosis. 1. Ontogeny of post-psychotic depression.

Abstract: Background Depression in schizophrenia is a rather neglected field of study, perhaps because of its confused nosological status. Three course patterns of depression in schizophrenia, including post-psychotic depression (PPD), are proposed. Aims We chart the ontogeny of depression and psychotic symptoms from the acute psychotic episode over a 12-month period and test the validity of the proposed course patterns. Method One hundred and five patients with ICD-10 schizophrenia were followed up on five occasions over 12 months following the acute episode, taking measures of depression, positive symptoms, negative symptoms, neuroleptic exposure and side-effects. Results Depression accompanied acute psychosis in 70% of cases and remitted in line with the psychosis; 36% developed PPD without a concomitant increase in psychotic symptoms. Conclusions The results provided support for the validity of two of the three course patterns of depression in schizophrenia, including PPD. Post-psychotic depression occurs de novo without concomitant change in positive or negative symptoms.

The revised Beliefs About Voices Questionnaire (BAVQ-R).

Abstract: Background We present a revised Beliefs About Voices Questionnaire (BAVQ—R), a self-report measure of patients' beliefs, emotions and behaviour about auditory hallucinations. Aims To improve measurement of omnipotence, a pivotal concept in understanding auditory hallucinations, and elucidate links between beliefs about voices, anxiety and depression. Methods Seventy-one participants with chronic auditory hallucinations completed the BAVQ—R, and 58 also completed the Hospital Anxiety and Depression Scale. Results The mean Cronbach's α for the five sub-scales was 0.86 (range 0.74-0.88). The study supports hypotheses about links between beliefs, emotions and behaviour, and presents original data on how these relate to the new omnipotence sub-scale. Original data are also presented on connections with anxiety and depression. Conclusions The BAVQ—R is more reliable and sensitive to individual differences than the original version, and reliably measures omnipotence.

Cognitive approach to depression and suicidal thinking in psychosis. 2. Testing the validity of a social ranking model.

Abstract: Background In paper I we reported that depression in the acute stage remitted in line with the psychosis and that 36% of patients developed post-psychotic depression (PPD). Aims We apply our cognitive framework to PPD and chart the appraisal of self and psychosis and their link with the later emergence of PPD. Method Patients with ICD-10 schizophrenia ( n =105) were followed up over 12 months following the acute episode, taking measures of depression, working self-concept, cognitive vulnerability, insight and appraisals of psychosis. Results Before developing PPD, these patients felt greater loss, humiliation and entrapment by their illness than those who relapsed or did not become depressed, and were more likely to see their future selves in ‘ lower status’ roles. Upon becoming depressed, participants developed greater insight, lower self-esteem and a worsening of their appraisals of psychosis. Conclusions Depression in psychosis arises from the individual9s appraisal of psychosis and its implications for his/her perceived social identity, position and ‘group fit’. Patients developing PPD feel forced to accept a subordinate role without opportunity for escape. Implications for treatment are discussed.

Schizophrenia: early warning signs

Abstract: Relapse in schizophrenia remains common and cannot be entirely eliminated even by the best combination of biological and psychosocial interventions ([Linszen et al , 1998][1]). Relapse prevention is crucial as each relapse may result in the growth of residual symptoms ([Shepherd et al , 1989][2])

Early intervention in psychosis : a guide to concepts, evidence, and interventions

Abstract: About the Editors. List of Contributors. Preface. THE CONCEPT OF EARLY INTERVENTION. The Scope for Preventive Strategies in Early Psychosis: Logic, Evidence and Momentum (P. McGorry). The Critical Period for Early Intervention (M. Birchwood). Psychological Adjustment to Early Psychosis (C. Jackson and Z. Iqbal). Psychological Formulation of Early Episodes of Psychosis: A Cognitive Model (D. Fowler). The Early Development of Expressed Emotion and Burden in the Families of First Onset Psychosis (E. Kuipers and D. Raune). STRATEGIES FOR EARLY INTERVENTION. Can Duration of Untreated Illness be Reduced? (T. Larsen, et al.). Early Intervention in Psychosis: Pharmacotherapeutic Strategies (P. Bebbington). Cognitive Behaviour Therapy in Early Psychosis (V. Drury). The Treatment of Secondary Morbidity in First-Episode Psychosis (H. Jackson, et al.). Relapse Prevention in Early Psychosis (E. Spencer, et al.). The Early Phase of Psychosis and Schizophrenia: A Critical Period for Patients, Families and the Profession (D. Linszen and M. Birchwood). IMPLEMENTATION. Models of Early Intervention in Psychosis: An Analysis of Service Approaches (J. Edwards, et al.). The IRIS Programme (F. Macmillan and D. Shiers). Creative Journeys of Recovery: A Survivor Perspective (A. Reeves). Early Intervention: The Economic Issues (N. Bosanquet). Index.

The Critical Period for Early Intervention

Abstract: Therapeutic intervention in psychotic disorders has been evolving steadily in recent years with notable changes in the content of treatment (e.g., atypical neuroleptics and the cognitive/psychosocial interventions) and the locus of care. While the therapeutic focus continues to emphasize acute and treatment symptoms, and longer-term interventions, for example assertive community treatment, the primary and secondary prevention of psychosis has received little attention since Cameron's (1938) pioneering work. It is now believed that the variables influencing the early phase of psychosis are sufficiently well developed to begin exploring their therapeutic implications. More speculatively, the early phase of psychosis is believed to be formative in biological, psychological, and social terms, thus affording major opportunities for secondary prevention. Three key elements of an early intervention strategy are proposed: early detection of “at-risk” mental states; early treatment of first psychotic epis...

Preventing the entrenchment of high expressed emotion in first episode psychosis: early developmental attachment pathways.

Abstract: Objective: As part of a strategy to consider the options for preventing the developmental entrenchment of expressed emotion (EE), we examine the early ontogeny of EE in a first-episode sample of individuals with psychosis and its links with the process of adaptation to change.Methods: The key relatives of 50 first-episode psychosis patients from two locations were interviewed soon after patient referral and again 9 months later using measures of expressed emotion and loss.Results: The developmental pathways of components of expressed emotion, particularly criticism and emotional over-involvement, were independent despite having a similar effect on outcome for patients. Initially, high levels of emotional over-involvement were reduced by follow up, with 37% resolving into high criticism. Overall expressed emotion status changed in 28.2% of key relatives (all parental), predominantly from high to low. High emotional over-involvement and low criticism are associated with significantly high levels of perceive...

Early intervention and sustaining the management of vulnerability.

Abstract: Objective: The purpose of this article is to consider the issue of how long early intervention needs to be sustained to have a long-term impact on the course of psychosis.Method: Factors relevant to the concept of secondary prevention in psychosis are discussed. The need for sustained intervention for long-term impact on psychosis is examined. Evidence concerning the length of time required for the maximal impact of early intervention services and interventions that have been demonstrated as effective in achieving long-term change is reviewed. The article discusses individuals of low and high vulnerability to schizophrenia and the interaction between this vulnerability and the length and type of treatment they require to change the deteriorating course of psychosis.Results: There is increasing evidence for the concept of a ‘critical period’ lasting up to 5 years after first presentation, during which the long-term level of vulnerability to relapse and disability may be determined.Conclusions: For many hig...