Showing papers by "Max Birchwood published in 2009"

Development and implementation of early intervention services for young people with psychosis: case study

Abstract: Background The development of early intervention services for young people with first-episode psychosis is a priority internationally. Aims To evaluate the development, implementation and impact of existing and newly formed early intervention services in England. Method Multiple-case study involving staff, users, carers and commissioners of 14 early intervention services. Results Service numbers increased in response to national policy directives. They were still actively working with 90.6% of service users 12 months after inception. They were highly valued by users and carers as providing a personal service that contrasted with previous experiences of care. Tensions between providing a quality service and meeting case-load targets linked to future funding led teams to adopt a series of survival strategies with some unintended consequences. Conclusions Early intervention services are highly valued by consumers and engage users effectively after 12 months. Implementation of these services is threatened unless sufficient consistent funding is made available.

Exploring the attitudes of staff working within mental health settings toward clients who use cannabis

Abstract: Aims: This study aimed to explore the attitudes of staff working within mental health settings toward cannabis in general and cannabis use in individuals with severe mental-health problems. Method: Twenty members of staff working within community mental health teams in Birmingham, UK, were interviewed using qualitative research methods. The overarching themes within the staff accounts are described and the interrelationship between themes explored. Findings: Staff use an ‘individualized’ approach when working with cannabis-using clients dependent on a number of key components, including the positive and negative effects of use, wider evidence base, client vulnerability, engagement, professional and personal views and harm reduction. It is suggested that any approach staff may take toward cannabis use at any one time is greatly dependent upon the above factors and these factors are highly client specific. Conclusions: The findings may help to explain why interventions aimed at reducing substance use in peo...

Emotional and personality dysfunctions in early psychosis

Abstract: Emotion and psychosis During the 1800s, when the concept of psychosis was first introduced, it was used to refer to severe mental illness - illness of the mind - and was regarded as a subcategory of neuroses, which at that time were characterized by an organic aetiology. However, this soon changed, especially after the introduction of the term ‘psychoneurosis’ by Damerow, which signified the unity of psychosis and neurosis under the assumption that they both share an organic aetiology (Beer, 1996). The concept of psychoneurosis also underwent changes in meaning, especially after the influence of psychoanalytical theory. According to Freud, neuroses were characterized by an underlying, unconscious etiology and in that respect were related to psychoses which signified ‘… a disturbance between the ego and the outside world’ (cited in Beer, 1996, pp. 241-2). Subsequently, the concept of psychoneurosis was reversed from having an organic to having a psychological meaning. During the twentieth century, the relationship between psychosis and neurosis was neglected. Instead, theories about the dichotomy between the two concepts, primarily based on their distinct etiological origins, were receiving considerable attention. Kraepelin (1919) was among the most influential in classifying neuroses, which were initially regarded as conditions of physical cause. Later on, however, he postulated that neuroses were partly characterized by a psychogenic (e.g. nervous exhaustion) and partly by a constitutional (e.g. hysteria) nature (Beer, 1996).

Interactive highly realistic virtual reality as a tool for understanding the genesis and treatment of psychotic symptoms.

Abstract: Schizophrenia can be a devastating lifelong psychotic disorder with a poor prognosis. National guidelines in the UK recommend the provision of cognitive behavioral therapy (CBT) to all those suffering with psychotic disorders, but there is a lack of trained therapists in the UK able to provide such a treatment. Developing high quality automated technologies that can serve as an adjunct to conventional CBT should enhance the provision of this therapy, and increase the efficiency of the therapists in practice. The latter will occur by enabling alternate professionals to aid in the delivery of therapy, to enable behavioral experiments to be conducted in the clinic, and for sessions to be recorded and re-played such that the patient can deliver therapy to him or herself. As such the system will enable patients to become experts in, and providers of, their own treatment and decrease the number of sessions needed to be led by a trained CBT therapist. A key feature of any such system is the level of realism required to ensure a compelling session in which the user is not adversely affected by the system itself. This paper presents a high-fidelity virtual environment to help better understand the environmental triggers for psychosis.

Schizophrenia postdrome : a study of low-level psychotic experience after remission of first-episode schizophrenia

Abstract: Background: Despite remission being the primary objective following the first episode of schizophrenia, clinically stabilized patients nevertheless relapse. Aim: To assess the extent and fluctuation of low-level psychotic symptoms in patients who are in remission after first-episode schizophrenia and consider whether this is equivalent to symptomatology experienced by those at ‘ultra high risk’ (UHR) of developing first-episode psychosis. Methods: We examined the phenomenological characteristics of 11 patients who fulfilled international remission criteria using the Structured Interview for Prodromal Symptoms and compared this cohort with an UHR sample. Results: Remitted patients were experiencing attenuated positive symptoms (73%) and brief limited intermittent psychotic symptoms (18%), features that were similarly prevalent in the UHR group. There was no significant fluctuation in these low-level symptoms over the course of four interviews. Conclusions: Although further research is required in this novel field, such features could form the building blocks for better prediction of psychotic relapse.