Showing papers by "Max Birchwood published in 2011"

Views of young people in early intervention services for first-episode psychosis in England.

Abstract: Objective:This study described the views over time of young people referred to early intervention services (EIS), particularly as they relate to the importance of relationships. Methods:A cohort of people aged 14 to 35 enrolled in a large multisite study of EIS for psychosis in the United Kingdom were recruited for a qualitative, longitudinal study in which they were interviewed within six months of admission to EIS and 12 months later. Transcripts of the interviews were analyzed using Charmaz's constructivist grounded-theory methodology. Results:A total of 63 individuals were interviewed during the six months after their first service contact, and 36 (57%) were interviewed 12 months later. Service users generally viewed IES key workers as supportive and youth sensitive, but up to one-third felt that the three years of sustained engagement expected was too intensive. Family support was highly valued by service users, and key workers and families worked well together to support the young people as they rec...

Early detection and intervention evaluation for people at high-risk of psychosis-2 (EDIE-2): Trial rationale, design and baseline characteristics.

Abstract: AIMS: Much research has begun to focus on the identification of people who are at high risk of developing psychosis, and clinical services have been initiated for this population. However, only a small number of studies have reported on the efficacy of interventions for preventing or delaying the onset of psychosis. The results of prior work suggest that cognitive therapy (CT) may be an effective, well-tolerated treatment. We report on the rationale and design for a large-scale, multi-site randomized, controlled trial of CT for people who are assessed to be at high risk of psychosis because of either state or state-plus-trait risk factors. METHODS: The study employs a single-blind design in which all participants receive frequent mental-state monitoring, which will efficiently detect transition to psychosis, and half are randomized to weekly sessions of CT for up to 6 months. Participants will be followed-up for a minimum of 12 months and to a maximum of 2 years. RESULTS: We report the characteristics of the final sample at baseline (n=288). CONCLUSIONS: Our study aimed to expand the currently limited evidence base for best practice in interventions for individuals at high risk of psychosis.

A multi-centre, randomised controlled trial of cognitive therapy to prevent harmful compliance with command hallucinations

Abstract: Background Command hallucinations are among the most distressing, high risk and treatment resistant symptoms for people with psychosis; however, currently, there are no evidence-based treatment options available for this group. A cognitive therapy grounded in the principles of the Social Rank Theory, is being evaluated in terms of its effectiveness in reducing harmful compliance with command hallucinations.

The efficacy of psychotherapy in reducing post-psychotic trauma.

Abstract: There is now growing evidence to suggest that the experience of psychosis may be so traumatic for some that it can lead to Post Traumatic Stress Disorder (PTSD)-type symptoms or post-psychotic trauma symptoms (PPTS). There is, however, less knowledge about what psychological interventions may be helpful in reducing these symptoms. Evidence from the literature, to date, suggests that of the seven studies that have addressed this issue only four were randomized controlled trials (RCTs). However, all these studies included less than 100 patients with the vast majority reporting positive results. Overall, it seems that although cognitive-behavioural treatment (CBT)-based psychological interventions appear to be efficacious in the treatment of PPTS, the studies are too small to draw any firm conclusions and should be subjected to larger good-quality RCTs. Further research will also need to establish the role of mediating variables such as shame and depression in the treatment of PPTS.

Treating prolactinoma and psychosis: medication and cognitive behavioural therapy.

Abstract: The patient in this case report had two severe medical conditions that require oppositional treatment: prolactinoma and psychosis. A prolactinoma is a benign tumour of the pituitary gland that produces prolactin. Dopamine agonist medication is the first-line treatment in patients with prolactinoma. The psychotic symptoms started after a dosage increase of a dopamine D2-receptor agonist. Several antipsychotic medications were tried with and without the dopamine D2-receptor agonist, but severe command hallucinations remained. Cognitive behavioural therapy (CBT) was added which reduced the impact of the hallucinations to a great extent, indicating that CBT can have an additional positive effect in prolactinoma patients with psychosis that shows incomplete recovery after antipsychotic medication. Future research should be aimed at the severe and prolonged side effects of dopamine agonists in the treatment of prolactinoma patients with multiple risk factors for a psychotic decompensation.

Understanding the Role of Emotion in Psychosis: Social Anxiety Disorder in First-Episode Psychosis

Abstract: Affective disturbances are highly prevalent in non-affective psychosis and exert significant impact upon its course and outcome. Low mood and associated suicidality, anxiety symptoms, withdrawal and isolation have been consistently observed throughout the course of psychosis, during the prodromal phase and following symptomatic recovery. Social anxiety disorder in particular is among the most prevailing disturbances manifest in people with psychosis. Prevalence rates range between 17 and 36% in people with psychosis. The nature and phenomenology of social anxiety in psychosis are not well understood and the need to identify the developmental and psychological origins is of fundamental importance. In this chapter we will thoroughly examine the phenomenology of social anxiety in first-episode psychosis and we will also investigate its relationship with positive symptoms and particularly paranoia Understanding the pathways and psychological processes that lead to the development of affective dysfunction in psychosis will have important implications for psychological interventions and treatments.