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Showing papers by "Max Birchwood published in 2013"


Journal ArticleDOI
TL;DR: The relatively new field of HR research in psychosis has the potential to shed light on the development of major psychotic disorders and to alter their course and provides a rationale for service provision to those in need of help who could not previously access it.
Abstract: Context During the past 2 decades, a major transition in the clinical characterization of psychotic disorders has occurred. The construct of a clinical high-risk (HR) state for psychosis has evolved to capture the prepsychotic phase, describing people presenting with potentially prodromal symptoms. The importance of this HR state has been increasingly recognized to such an extent that a new syndrome is being considered as a diagnostic category in the DSM-5. Objective To reframe the HR state in a comprehensive state-of-the-art review on the progress that has been made while also recognizing the challenges that remain. Data Sources Available HR research of the past 20 years from PubMed, books, meetings, abstracts, and international conferences. Study Selection and Data Extraction Critical review of HR studies addressing historical development, inclusion criteria, epidemiologic research, transition criteria, outcomes, clinical and functional characteristics, neurocognition, neuroimaging, predictors of psychosis development, treatment trials, socioeconomic aspects, nosography, and future challenges in the field. Data Synthesis Relevant articles retrieved in the literature search were discussed by a large group of leading worldwide experts in the field. The core results are presented after consensus and are summarized in illustrative tables and figures. Conclusions The relatively new field of HR research in psychosis is exciting. It has the potential to shed light on the development of major psychotic disorders and to alter their course. It also provides a rationale for service provision to those in need of help who could not previously access it and the possibility of changing trajectories for those with vulnerability to psychotic illnesses.

1,213 citations


Journal ArticleDOI
TL;DR: Three recent and rapidly evolving service structures from Australia, Ireland and the UK are presented that have each worked within their respective healthcare contexts to reorient existing services to provide youth-specific, evidence-based mental healthcare that is both accessible and acceptable to young people.
Abstract: Despite the evidence showing that young people aged 12-25 years have the highest incidence and prevalence of mental illness across the lifespan, and bear a disproportionate share of the burden of disease associated with mental disorder, their access to mental health services is the poorest of all age groups. A major factor contributing to this poor access is the current design of our mental healthcare system, which is manifestly inadequate for the unique developmental and cultural needs of our young people. If we are to reduce the impact of mental disorder on this most vulnerable population group, transformational change and service redesign is necessary. Here, we present three recent and rapidly evolving service structures from Australia, Ireland and the UK that have each worked within their respective healthcare contexts to reorient existing services to provide youth-specific, evidence-based mental healthcare that is both accessible and acceptable to young people.

437 citations


Journal ArticleDOI
TL;DR: There is evidence to suggest the JCPs were not fully implemented in all study sites, and were combined with routine clinical review meetings which did not actively incorporate patients' preferences.

153 citations


Journal ArticleDOI
TL;DR: It was found that delay in reaching EIS was strongly correlated with longer DUP, and community education and awareness campaigns to reduce DUP may be constrained by later delays within mental health services, especially access to EIS.
Abstract: Background Interventions to reduce treatment delay in first-episode psychosis have met with mixed results. Systematic reviews highlight the need for greater understanding of delays within the care pathway if successful strategies are to be developed. Aims To document the care-pathway components of duration of untreated psychosis (DUP) and their link with delays in accessing specialised early intervention services (EIS). To model the likely impact on efforts to reduce DUP of targeted changes in the care pathway. Method Data for 343 individuals from the Birmingham, UK, lead site of the National EDEN cohort study were analysed. Results A third of the cohort had a DUP exceeding 6 months. The greatest contribution to DUP for the whole cohort came from delays within mental health services, followed by help-seeking delays. It was found that delay in reaching EIS was strongly correlated with longer DUP. Conclusions Community education and awareness campaigns to reduce DUP may be constrained by later delays within mental health services, especially access to EIS. Our methodology, based on analysis of care pathways, will have international application when devising strategies to reduce DUP.

130 citations


Journal ArticleDOI
TL;DR: The First Episode of Psychosis (FEP) represents a period of heightened risk for aggression, however, it is not known whether this risk is significantly altered following contact with mental health services.
Abstract: OBJECTIVE: The First Episode of Psychosis (FEP) represents a period of heightened risk for aggression. However, it is not known whether this risk is significantly altered following contact with mental health services. METHOD: Meta-analytic methods were used to estimate pooled prevalence of 'any' and 'serious' aggression during FEP, while meta-regression analyses were conducted to explore reasons for heterogeneity between studies. RESULTS: Fifteen studies comprising 3, 294 FEP subjects were analysed. Pooled prevalence of 'any aggression' before service contact was 28% (95% CI: 22-34) and following contact 31% (95% CI: 20-42). Pooled prevalence of 'serious aggression' was 16% (95% CI: 11-20) before service contact and 13% (95% CI: 6-20) following contact. Four studies reporting repeated assessments within the same cohort revealed that aggression rates did not significantly differ post and pre service contact: Odds Ratios for any aggression: 1.18 (95% CI: 0.46-2.99) and serious aggression: 0.61 (95% CI: 0.31-1.21). CONCLUSION: Rates of aggression are high during FEP, both before and following initial service contact, and seem not to alter following contact. This conclusion remains tentative due to considerable heterogeneity between studies and a lack of prospective cohort studies. Language: en

98 citations


Journal ArticleDOI
TL;DR: This supplement provides an overview of the epidemiological, conceptual and service structures for young people with emergent and existing mental health problems, and asks the question, ‘How should the authors design services for youngPeople to promote prevention and service engagement, and to improve outcomes?’
Abstract: It is now known that the onset of severe and recurring mental health problems begins for the most part before the age of 25: this provides a clear focus for preventive strategies and public mental health that are a feature of many health policy frameworks. The present distinction between child and adolescent mental health services and adult services at 16 or 18 does not fit easily with these data and the now well-documented problems of transition suggest that a fundamental review of services for young people is overdue. This supplement provides an overview of the epidemiological, conceptual and service structures for young people with emergent and existing mental health problems, and asks the question, ‘How should we design services for young people to promote prevention and service engagement, and to improve outcomes?’

70 citations


Journal ArticleDOI
TL;DR: Understanding this dimension of psychosis in and of itself has the potential to improve and aid development of more effective and appropriately targeted interventions and associated outcomes.

69 citations


Journal ArticleDOI
18 Sep 2013-BMJ
TL;DR: Their problems are more than economic as mentioned in this paper The term NEET (not in employment, education, or training) refers to economically inactive adolescents and young adults, referred to as economically inactive adults.
Abstract: Their problems are more than economic The term NEET (not in employment, education, or training) refers to economically inactive adolescents and young adults.1 2 During economic crises, youth unemployment rises faster and recovers more slowly than general unemployment.1 In 2012, there were 7.5 million 15-24 year old (13% of the age group) and 6.5 million 25-29 year old (20%) economically inactive young people in the European Union. Together, they cost €153bn (£131bn; $204bn) in welfare benefits and lost productivity—1.2% of EU gross domestic product.2 International publications confirm global rates of 10-20% youth unemployment and highlight that the optimal solution is to increase retention in education and training.1 2 3 4 5 Prolonged economic inactivity has profound effects on mental health: the risks of depression (odds ratio 2.7), alcohol or substance misuse (3.4), and suicidal attempts (3.6) are significantly increased in economically inactive young people versus their economically active peers.3 However, action plans fail to recognise subgroups within the economically inactive population who are functionally impaired because of evolving or pre-existing mental disorders. During economic downturns, these people are especially disadvantaged and risk lifelong social exclusion and economic marginalisation unless their ill health is recognised early and their needs targeted more directly.4 5 Preventing or limiting economic inactivity alone could reduce rates of common mental disorders by 8-17%,6 but it would not completely solve the problem of the threefold greater risk of severe mental disorders in this group.3 The explanation for this is complex, but it is noteworthy that the peak age of onset of …

67 citations


Journal ArticleDOI
TL;DR: In an era when the physi-cal health of young people has never been better, they are vulnerable to developing potentially intractable and enduring mental health difficulties with the inevitable per-sonal, familial, social and vocational consequencesthat accompany the experience of mental ill-health.
Abstract: A recent and growing body of evidence on youngpeople’s mental health has pointed to the need foran international response to the increasing and con-cerning rates of mental ill-health among youngpeople.1,2The periods of adolescence and emergingadulthood3are considered the peak periods for theonset of mental ill-health4with 75% of all adult diag-noses of mental ill-health having had an onsetbefore the age of 25 years.5In an era when the physi-cal health of young people has never been better,6their psychological and mental health has neverbeen worse.7This leaves young people vulnerable todeveloping potentially intractable and enduringmental health difficulties with the inevitable per-sonal, familial, social and vocational consequencesthat accompany the experience of mentalill-health

65 citations


Journal ArticleDOI
TL;DR: It is suggested that shame cognitions arising from a stigmatizing illness play a significant role in social anxiety in psychosis and psychological interventions could be enhanced by taking into consideration these idiosyncratic shame appraisals when addressing symptoms of social anxiety and associated distress in psychosis.
Abstract: BACKGROUND: Social anxiety disorder (SAD) is surprisingly prevalent among people with psychosis and exerts significant impact on social disability. The processes that underlie its development remain unclear. The aim of this study was to investigate the relationship between shame cognitions arising from a stigmatizing psychosis illness and perceived loss of social status in co-morbid SAD in psychosis. METHOD: This was a cross-sectional study. A sample of individuals with SAD (with or without psychosis) was compared with a sample with psychosis only and healthy controls on shame proneness, shame cognitions linked to psychosis and perceived social status. RESULTS: Shame proneness (p < 0.01) and loss of social status (p < 0.01) were significantly elevated in those with SAD (with or without psychosis) compared to those with psychosis only and healthy controls. Individuals with psychosis and social anxiety expressed significantly greater levels of shame (p < 0.05), rejection (p < 0.01) and appraisals of entrapment (p < 0.01) linked to their diagnosis and associated stigma, compared to those without social anxiety. CONCLUSIONS: These findings suggest that shame cognitions arising from a stigmatizing illness play a significant role in social anxiety in psychosis. Psychological interventions could be enhanced by taking into consideration these idiosyncratic shame appraisals when addressing symptoms of social anxiety and associated distress in psychosis. Further investigation into the content of shame cognitions and their role in motivating concealment of the stigmatized identity of being 'ill' is needed.

62 citations



Journal ArticleDOI
25 Nov 2013-PLOS ONE
TL;DR: The evidence does not support the cost-effectiveness of JCPs for White or Asian ethnic groups, but there is at least a 90% probability of the JCP intervention being the more cost-effective option in the Black ethnic group.
Abstract: Background: Compulsory admission to psychiatric hospitals may be distressing, disruptive to patients and families, and associated with considerable cost to the health service. Improved patient experience and cost reductions could be realised by providing cost-effective crisis planning services. Methods: Economic evaluation within a multi-centre randomised controlled trial comparing Joint Crisis Plans (JCP) plus treatment as usual (TAU) to TAU alone for patients aged over 16, with at least one psychiatric hospital admission in the previous two years and on the Enhanced Care Programme Approach register. JCPs, containing the patient’s treatment preferences for any future psychiatric emergency, are a form of crisis intervention that aim to mitigate the negative consequences of relapse, including hospital admission and use of coercion. Data were collected at baseline and 18-months after randomisation. The primary outcome was admission to hospital under the Mental Health Act. The economic evaluation took a service perspective (health, social care and criminal justice services) and a societal perspective (additionally including criminal activity and productivity losses). Findings: The addition of JCPs to TAU had no significant effect on compulsory admissions or total societal cost per participant over 18-months follow-up. From the service cost perspective, however, evidence suggests a higher probability (80%) of JCPs being the more cost-effective option. Exploration by ethnic group highlights distinct patterns of costs and effects. Whilst the evidence does not support the cost-effectiveness of JCPs for White or Asian ethnic groups, there is at least a 90% probability of the JCP intervention being the more cost-effective option in the Black ethnic group. Interpretation: The results by ethnic group are sufficiently striking to warrant further investigation into the potential for patient gain from JCPs among black patient groups.

Journal ArticleDOI
TL;DR: Findings suggest that, rather than increasing internalised stigma, cognitive therapy decreases negative appraisals of unusual experiences in young people at risk of psychosis; as such, it is a non-stigmatising intervention for this population.
Abstract: Background: Internalised stigma in young people meeting criteria for at-risk mental states (ARMS) has been highlighted as an important issue, and it has been suggested that provision of cognitive therapy may increase such stigma. Aims: To investigate the effects of cognitive therapy on internalised stigma using a secondary analysis of data from the EDIE-2 trial. Method: Participants meeting criteria for ARMS were recruited as part of a multisite randomised controlled trial of cognitive therapy for prevention and amelioration of psychosis. Participants were assessed at baseline and at 6, 12, 18 and 24 months using measures of psychotic experiences, symptoms and internalised stigma. Results: Negative appraisals of experiences were significantly reduced in the group assigned to cognitive therapy (estimated difference at 12 months was –1.36 (95% CI –2.69 to –0.02), P = 0.047). There was no difference in social acceptability of experiences (estimated difference at 12 months was 0.46, 95% CI –0.05 to 0.98, P = 0.079). Conclusions: These findings suggest that, rather than increasing internalised stigma, cognitive therapy decreases negative appraisals of unusual experiences in young people at risk of psychosis; as such, it is a non-stigmatising intervention for this population.

Journal ArticleDOI
TL;DR: The results support the importance of assessing shame as a multi-faceted construct and suggest that assessing shame directly associated with mental illness is a worthwhile endeavour.
Abstract: Objectives The current study examined shame in a clinical sample recovering from a first episode of psychosis by focusing on the contribution of different types of shame to post-psychotic trauma while controlling for current affective symptoms. Design The study used a cross-sectional correlational design. Method Fifty individuals who met the criteria for a psychotic disorder whose acute psychotic symptoms were in remission completed measures of internal and external shame associated with psychosis, general shame, post-psychotic trauma, and depression. Results Post-psychotic trauma symptoms were correlated with internal and external shame associated with psychosis and general shame. However, the relation between post-psychotic trauma and external shame associated with psychosis remained after controlling for general shame and current affective symptoms. In addition, internal shame had a stronger association with depression. Thus, internal and external shame due to psychosis had different associations with different types of post-psychotic emotional dysfunction. Conclusions The results support the importance of assessing shame as a multi-faceted construct and suggest that assessing shame directly associated with mental illness is a worthwhile endeavour. Practitioner Points Assessing different types of shame following psychosis can inform assessments, formulations, and interventions with post-psychotic trauma. Our results support the application of Compassionate Mind Therapy to psychosis. However, we did not assess self-criticism or self-reassurance. We also did not investigate the relation between specific psychotic symptoms and different types of shame.

Journal ArticleDOI
TL;DR: Clinical implications for the treatment of affective dysregulation in young people at UHR in relation to their attachment styles have been discussed and there was no support for a mediating role of social anxiety between attachment styles and depression.
Abstract: OBJECTIVE: Embedded in attachment theory is its association with affect regulation, which provides a framework for affective dysregulation in the emerging psychosis. METHOD: Fifty-one participants meeting criteria for ultra-high risk (UHR) of developing psychosis were recruited from a youth mental health service within the United Kingdom. At intake baseline, prior to starting therapeutic intervention, all clients were assessed on measures of affective dysregulation and attachment. RESULTS: A large proportion of our sample (N = 51) reported clinically significant levels of depression (78%), state anxiety (59%), and social anxiety (65%). Eighty per cent of the UHR sample was insecurely attached. Insecure attachment was significantly associated with elevated depression and social anxiety. Attachment styles were associated with anxiety, depression, and social anxiety. There was no support for a mediating role of social anxiety between attachment styles and depression. CONCLUSION: Clinically significant levels of distress and anxiety experienced by the young people at high risk of psychosis. Clinical implications for the treatment of affective dysregulation in young people at UHR in relation to their attachment styles have been discussed.

Journal ArticleDOI
TL;DR: The tendency to appraise the voice as powerful, to be impulsive, to experience anger and to regulate anger were significantly associated with compliance with command hallucinations to do harm.

Journal ArticleDOI
TL;DR: In this article, the authors studied psychosocial state and outcome in patients at clinical high risk (CHR) of psychosis, focusing on a broader outcome, and not only on preventing transition to psychosis.
Abstract: In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus of recent studies. Their broader outcome has received less attention. We studied psychosocial state and outcome in CHR patients. In the European Prediction of Psychosis Study, 244 young help-seeking CHR patients were assessed with the Strauss and Carpenter Prognostic Scale (SCPS) at baseline, and 149 (61.1 %) of them were assessed for the second time at the 18-month follow-up. The followed patients were classified into poor and good outcome groups. Female gender, ever-married/cohabitating relationship, and good working/studying situation were associated with good baseline SCPS scores. During follow-up, patients’ SCPS scores improved significantly. Good follow-up SCPS scores were predicted by higher level of education, good working/studying status at baseline, and white ethnicity. One-third of the followed CHR patients had poor global outcome. Poor working/studying situation and lower level of education were associated with poor global outcome. Transition to psychosis was associated with baseline, but not with follow-up SCPS scores or with global outcome. The majority of CHR patients experience good short-term recovery, but one-third have poor psychosocial outcome. Good working situation is the major indicator of good outcome, while low level of education and non-white ethnicity seem to be associated with poor outcome. Transition to psychosis has little effect on psychosocial outcome in CHR patients. In treating CHR patients, clinicians should focus their attention on a broader outcome, and not only on preventing transition to psychosis.

Journal ArticleDOI
TL;DR: This study aims to investigate the predictive value of the Strauss and Carpenter Prognostic Scale for transition to a first psychotic episode in subjects clinically at high risk (CHR) of psychosis.
Abstract: Objective: To investigate the predictive value of the Strauss and Carpenter Prognostic Scale (SCPS) for transition to a first psychotic episode in subjects clinically at high risk (CHR) of psychosis. Method: Two hundred and forty-four CHR subjects participating in the European Prediction of Psychosis Study were assessed with the SCPS, an instrument that has been shown to predict outcome in patients with schizophrenia reliably. Results: At 18-month follow-up, 37 participants had made the transition to psychosis. The SCPS total score was predictive of a first psychotic episode (P < 0.0001). SCPS items that remained as independent predictors in the Cox proportional hazard model were as follows: most usual quality of useful work in the past year (P = 0.006), quality of social relations (P = 0.006), presence of thought disorder, delusions or hallucinations in the past year (P = 0.001) and reported severity of subjective distress in past month (P = 0.003). Conclusion: The SCPS could make a valuable contribution to a more accurate prediction of psychosis in CHR subjects as a second-step tool. SCPS items assessing quality of useful work and social relations, positive symptoms and subjective distress have predictive value for transition. Further research should focus on investigating whether targeted early interventions directed at the predictive domains may improve outcomes.

Journal ArticleDOI
TL;DR: It is demonstrated that the virtual reality scenario was able to elicit paranoia in a nonclinical, healthy group and that an urban scene was more likely to lead to higher levels of paranoia than a virtual indoor environment.
Abstract: Psychotic disorders carry social and economic costs for sufferers and society. Recent evidence highlights the risk posed by urban upbringing and social deprivation in the genesis of paranoia and psychosis. Evidence based psychological interventions are often not offered because of a lack of therapists. Virtual reality (VR) environments have been used to treat mental health problems. VR may be a way of understanding the aetiological processes in psychosis and increasing psychotherapeutic resources for its treatment. We developed a high-fidelity virtual reality scenario of an urban street scene to test the hypothesis that virtual urban exposure is able to generate paranoia to a comparable or greater extent than scenarios using indoor scenes. Participants (n = 32) entered the VR scenario for four minutes, after which time their degree of paranoid ideation was assessed. We demonstrated that the virtual reality scenario was able to elicit paranoia in a nonclinical, healthy group and that an urban scene was more likely to lead to higher levels of paranoia than a virtual indoor environment. We suggest that this study offers evidence to support the role of exposure to factors in the urban environment in the genesis and maintenance of psychotic experiences and symptoms. The realistic high-fidelity street scene scenario may offer a useful tool for therapists.

Journal ArticleDOI
TL;DR: Findings suggest that voice-hearers self-critical thoughts are reflected in the type of relationship they have with their voice, and access to self-reassuring meta-cognitive capacity may serve as a protective factor for those who hear voices, resulting in more benign voice content.
Abstract: Aims: To examine the self-critical thoughts and self-reassuring meta-cognitive capacity of those who hear voices and explore whether they are associated with the theme of voice content and appraisals of voice power and voice expressed emotion. Method: A cross-sectional design was used, combining semi-structured interviews and self-report measures. Data on symptomatology, self-critical thoughts and self-reassuring meta-cognitive capacity, thematic voice content, and appraisals of voice power and expressed emotion were collected from 74 voice-hearers in Birmingham, UK. Results: Common themes of voice content reflected issues of shame, control, and affiliation. Controlling content was the most prevalent theme, however, no significant predictor of this theme was found; shaming thematic voice content linked with reduced capacity to self-reassure following self-critical thoughts. Voice-hearers with the greatest level of self-critical thoughts appraised their voices as powerful and high in voice expressed emotion. Conclusions: Findings suggest that voice-hearers self-critical thoughts are reflected in the type of relationship they have with their voice. However, access to self-reassuring meta-cognitive capacity may serve as a protective factor for those who hear voices, resulting in more benign voice content. These findings highlight the importance of this specific meta-cognitive capacity and will inform future therapeutic interventions for the management of voices in this vulnerable group.

Journal ArticleDOI
TL;DR: Analysis of the relationship between power and EE revealed that many voices perceived as low in power were, nevertheless, perceived as high in EE, highlighting the protective role that the supportive dimension of the voice/voice-hearer relationship may have.
Abstract: Considerable focus has been given to the interpersonal nature of the voice-hearing relationship and how appraisals about voices may be linked with distress and depression (the 'cognitive model'). Research hitherto has focused on appraisals of voice power, but the supportive and affiliative quality of voices, which may act to mitigate distress, is not understood. We explored appraisals of voices' power and emotional support to determine their significance in predicting depression and suicidal thought. We adapted the concept of expressed emotion (EE) and applied it to measure voice hearers' perception of the relationship with their voice(s). In a sample of 74 voice hearers, 55.4% were moderately depressed. Seventy-eight who rated their voices as high in both power and EE had a large and significant elevation in depression, suggesting that co-occurrence of these appraisals impacts on depression. Analysis of the relationship between power and EE revealed that many voices perceived as low in power were, nevertheless, perceived as high in EE. Those rating their voices as emotionally supportive showed the lowest levels of depression and suicidal thinking. These findings highlight the protective role that the supportive dimension of the voice/voice-hearer relationship may have.

Journal ArticleDOI
TL;DR: In response to Dr Killaspy's invited commentary on Dr Lodge’s piece favouring gneralist v. specialist mental health teams, professor Burns laments that ‘every change, no matter how hare-brained, is hailed ‘an innovation’’.
Abstract: In response to Dr Killaspy’s invited commentary[1][1] on Dr Lodge’s piece favouring gneralist v. specialist mental health teams,[2][2] professor Burns laments that ‘every change, no matter how hare-brained, is hailed “an innovation’”.[3][3] He implies that it is ‘hare-brained’ to

Journal ArticleDOI
10 Jan 2013
TL;DR: Mental health concerns, such as the impact of cannabis on relapse and psychotic symptom exacerbation were also found to motivate abstention, while psychosis related reasons do not appear to motivate the initial or continued use of cannabis.
Abstract: Cannabis use has been identified as a prognostic factor for poor outcome in first-episode psychosis (FEP) The research aimed to understand the factors that motivate or inhibit the use of cannabis in people with first-episode psychosis Thirty first-episode psychosis patients (18 cannabis users and 12 abstainers) were interviewed using qualitative semi-structured methods in order to investigate the self reported factors perceived to influence cannabis abstention, initiation, continued use and consumption change Interviews were transcribed verbatim and analysed using grounded theory based methods Psychosis specific reasons were not found to be motivationally salient for the initiation or continued use of cannabis, but were found to be important for decreased consumption and cessation Mental health concerns, such as the impact of cannabis on relapse and psychotic symptom exacerbation were also found to motivate abstention Psychosis related reasons do not appear to motivate the initial or continued use o

Journal ArticleDOI
TL;DR: The consultation-liaison service appears to be a helpful component within an overall service framework for dual diagnosis in a number of ways, for example through the enhancement of existing services such as assessment, advice, and consultation, as well as the delivery of a brief intervention.
Abstract: Objective: This article reports the results of an evaluation of a consultation-liaison service for people with combined mental health and substance use problems. The service is one component of an overall integrated service framework for this group of clients developed and delivered across one of the largest Mental Health Foundation Trusts in the UK. A full description of the client group referred to consultation-liaison over a 3-year period is provided, as well as a description of different referral pathways and a preliminary evaluation of a brief intervention offered as part of the service. Methods: Service evaluation data were collected through routine practice and provided demographic and diagnostic information on the clients who were referred to the consultation-liaison service (N = 173). A sample of these clients (n = 39) received a full brief motivational intervention consisting of six sessions delivered over a 12-week period. Quantitative questionnaire data collected for clients who received this ...

Journal ArticleDOI
TL;DR: A modification of the Community Mental Health Services in the sense of setting up more appropriate contexts for young users, could lead to a reduction of unexpressed help-seeking.
Abstract: Aim: Delays in the admission to care of young adults with emerging mental disorders represent one of the current major concern in psychiatry. This delay, often experienced in clinical practice, has several determinants. One of these is "unexpressed help-seeking" that is influenced by cultural and historical backgrounds and by the characteristics of the disorder itself, but most of all by the way community mental health services are developed. The aims are to identify: level of stress and mental unease and main determinants of unexpressed help-seeking within a community sample of young adults in a national contest of generalist community mental health model. Methods: the sample is made up of 3,446 university students. An explorative questionnaire together with SVS (Stress related Valuation Scale) for the assessment of subjective stress and GHQ-12 for the evaluation of mental health status were given. A descriptive analysis was carried out followed by correlations between unexpressed help-seeking variable and other variables. A logistic regression was carried out on the subsample with GHQ-12 ≥4 utilizing "non help-seeking" as a dependent variable. Results: 46.8% of the sample had a GHQ-12 ≥4 score. The amount of unexpressed help-seeking is equal to 63.6% and ends up being significantly correlated to: male sex, nonresident student, high SVS score, absence of Youth Mental Health Services, distrust manifested in relation to existing Services. Conclusions: A modification of the Community Mental Health Services in the sense of setting up more appropriate contexts for young users, could lead to a reduction of unexpressed help-seeking.

Book ChapterDOI
05 Sep 2013
TL;DR: A review of eight studies by F. Shawyer et al. as mentioned in this paper reported a median prevalence rate of 53 per cent with a wide range in a sample of adult psychiatric patients.
Abstract: Schizophrenia affects 0.8 per cent of the UK population, usually starts in early adult life and leads to persistent disability in most cases. It carries a high risk of suicide and deliberate self harm and, on a population basis, people with schizophrenia are more likely to perpetrate acts of aggression than their peers. Command hallucinations are very prevalent in people who experience schizophrenia. A review of eight studies by F. Shawyer et al. reported median prevalence rate of 53 per cent with a wide range in a sample of adult psychiatric patients. The relationship between command hallucinations and compliance is very complex. It is often assumed that the presence of such symptoms will inevitably trigger emotional and behavioural responses. Research has provided empirical support for the relationship between power beliefs and affective and behavioural responses to voices. The powerlessness and inferiority that voice hearers experience in their relationships with others in general is strongly linked to the power of voices.

Journal ArticleDOI
TL;DR: The physical health of patients defined to be at ultra-high risk of psychosis seems to be commonly impaired and associated with female gender, marital status, complications during pregnancy and birth, lifetime panic disorder, and genetic risk of psychotic illness.