Showing papers by "Max Birchwood published in 2016"

Impact of contact on adolescents’ mental health literacy and stigma: the SchoolSpace cluster randomised controlled trial

Abstract: Objectives To investigate whether intergroup contact in addition to education is more effective than education alone in reducing stigma of mental illness in adolescents. Design A pragmatic cluster randomised controlled trial compared education alone with education plus contact. Blocking was used to randomly stratify classes within schools to condition. Random allocation was concealed, generated by a computer algorithm, and undertaken after pretest. Data was collected at pretest and 2-week follow-up. Analyses use an intention-to-treat basis. Setting Secondary schools in Birmingham, UK. Participants The parents and guardians of all students in year 8 (age 12–13 years) were approached to take part. Interventions A 1-day educational programme in each school led by mental health professional staff. Students in the ‘contact’ condition received an interactive session with a young person with lived experience of mental illness. Outcomes The primary outcome was students’ attitudinal stigma of mental illness. Secondary outcomes included knowledge-based stigma, mental health literacy, emotional well-being and resilience, and help-seeking attitudes. Results Participants were recruited between 1 May 2011 and 30 April 2012. 769 participants completed the pretest and were randomised to condition. 657 (85%) provided follow-up data. At 2-week follow-up, attitudinal stigma improved in both conditions with no significant effect of condition (95% CI −0.40 to 0.22, p=0.5, d=0.01). Significant improvements were found in the education-alone condition compared with the contact and education condition for the secondary outcomes of knowledge-based stigma, mental health literacy, emotional well-being and resilience, and help-seeking attitudes. Conclusions Contact was found to reduce the impact of the intervention for a number of outcomes. Caution is advised before employing intergroup contact with younger student age groups. The education intervention appeared to be successful in reducing stigma, promoting mental health knowledge, and increasing mental health literacy, as well as improving emotional well-being and resilience. A larger trial is needed to confirm these results. Trial registration number ISRCTN07406026; Results.

Cannabis Use Is Associated With Increased Psychotic Symptoms and Poorer Psychosocial Functioning in First-Episode Psychosis: A Report From the UK National EDEN Study

Abstract: This is a pre-copyedited, author-produced PDF of an article accepted for publication in Schizophrenia Bulletin following peer review. The version of record Seddon, J. L., et al. (2016). Cannabis Use Is Associated With Increased Psychotic Symptoms and Poorer Psychosocial Functioning in First-Episode Psychosis: A Report From the UK National EDEN Study. Schizophrenia Bulletin, 42(3), 619-625. https://doi.org/10.1093/schbul/sbv154 is available online at: https://academic.oup.com/schizophreniabulletin/article/42/3/619/2413898#39400533

Barriers to shared decision making in mental health care: qualitative study of the Joint Crisis Plan for psychosis.

Abstract: Background: Despite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear Sharing decisions in mental health care may be especially complex Fluctuations in service user capacity and significant power differences are particular barriers Objective and design: We trialled a form of facilitated SDM that aimed to generate patients' treatment preferences in advance of a possible relapse The ‘Joint Crisis Plan’ (JCP) intervention was trialled in four mental health trusts in England between 2008 and 2011 This qualitative study used grounded theory methods to analyse focus group and interview data to understand how stakeholders perceived the intervention and the barriers to SDM in the form of a JCP Results: Fifty service users with psychotic disorders and 45 clinicians participated in focus groups or interviews between February 2010 and November 2011 Results suggested four barriers to clinician engagement in the JCP: (i) ambivalence about care planning; (ii) perceptions that they were ‘already doing SDM’; (iii) concerns regarding the clinical ‘appropriateness of service users’ choices'; and (iv) limited ‘availability of service users’ choices' Service users reported barriers to SDM in routine practice, most of which were addressed by the JCP process Barriers identified by clinicians led to their lack of constructive engagement in the process, undermining the service users' experience Conclusions: Future work requires interventions targeted at the engagement of clinicians addressing their concerns about SDM Particular strategies include organizational investment in implementation of service users' choices and directly training clinicians in SDM communication processes

Ethnicity and detention: are Black and minority ethnic (BME) groups disproportionately detained under the Mental Health Act 2007?

Abstract: Purpose There is substantial evidence to suggest that Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act (MHA). We examined ethnic differences in patients assessed for detention and explored the effect of ethnicity after controlling for confounders.

Views of early psychosis clinicians on discontinuation of antipsychotic medication following symptom remission in first episode psychosis

Abstract: Aims Discontinuation of antipsychotics following remission in first episode psychosis (FEP) is a contentious area of practice. We aimed to investigate the views of early psychosis clinicians on this important clinical question. Methods We designed an 11 question online survey on medication discontinuation following remission of symptoms in FEP. The questionnaire was distributed to early intervention team workers in England and Wales via members of the National Early Psychosis Network who were requested to distribute it to their teams. Results We received 172 questionnaire responses; 37% were nurses, 33% doctors, 11% psychologists and 19% were other allied health professionals. The average years of experience in psychiatry was 16.9. 75.4% of respondents thought that greater than 60% of patients would like to be considered for guided medication reduction/discontinuation. Only 31.4% of respondents said that medication should be continued for over a year following remission. 61.4% of respondents felt that the quality of life of individuals was better in those who stop medication following remission. There was a significant difference in the response of professional groups to this question. 82.6% of respondents said they would be happy to support their patients in participating in a randomized trial of graded antipsychotic reduction/discontinuation versus maintenance medication. Conclusions The views of clinicians regarding prophylactic antipsychotic medication following remission in FEP are much less conservative than those in current guidelines; concern was expressed by many about the impact of antipsychotic medication on quality of life. A randomized trial of maintenance antipsychotic medication versus graded reduction/discontinuation is feasible and has considerable clinician support.

Don’t turn your back on the symptoms of psychosis : the results of a proof-of-principle, quasi-experimental intervention to reduce duration of untreated psychosis

Abstract: No evidence based approach to reduce duration of untreated psychosis (DUP) has been effective in the UK. Existing interventions have many components and have been difficult to replicate. The majority of DUP in Birmingham, UK is accounted for by delays within mental health services (MHS) followed by help-seeking delay and, we hypothesise, these require explicit targeting. This study examined the feasibility and impact of an intervention to reduce DUP, targeting help-seeking and MHSs delays.

Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in-patient settings.

Abstract: Objective This proof of principle study evaluated the effectiveness and feasibility of a brief motivational intervention, delivered in mental health in-patient settings, to improve engagement in treatment for drug and alcohol misuse. Method A randomised controlled trial using concealed randomisation, blind, independent assessment of outcome at 3 months. Participants were 59 new adult admissions, to six acute mental health hospital units in one UK mental health service, with schizophrenia related or bipolar disorder diagnoses, users of community mental health services and also misusing alcohol and/or drugs. Participants were randomised to Brief Integrated Motivational Intervention (BIMI) with Treatment As Usual (TAU), or TAU alone. The BIMI took place over a 2-week period and encouraged participants to explore substance use and its impact on mental health. Results Fifty-nine in-patients (BIMI n = 30; TAU n = 29) were randomised, the BIMI was associated with a 63% relative odds increase in the primary outcome engagement in treatment [OR 1.63 (95% CI 1.01–2.65; P = 0.047)], at 3 months. Qualitative interviews with staff and participants indicated that the BIMI was both feasible and acceptable. Conclusion Mental health hospital admissions present an opportunity for brief motivational interventions focussed on substance misuse and can lead to improvements in engagement.

Depression predicts persistence of paranoia in clinical high-risk patients to psychosis: results of the EPOS project.

Abstract: The link between depression and paranoia has long been discussed in psychiatric literature. Because the causality of this association is difficult to study in patients with full-blown psychosis, we aimed to investigate how clinical depression relates to the presence and occurrence of paranoid symptoms in clinical high-risk (CHR) patients. In all, 245 young help-seeking CHR patients were assessed for suspiciousness and paranoid symptoms with the structured interview for prodromal syndromes at baseline, 9- and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood adversities by the Trauma and Distress Scale, trait-like suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressiveness by the Positive and Negative Syndrome Scale. At baseline, 54.3 % of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 and 24.4 %. Depressive, obsessive–compulsive and somatoform disorders, emotional and sexual abuse, and anxiety and suspiciousness associated with paranoid symptoms. In multivariate modelling, depressive and obsessive–compulsive disorders, sexual abuse, and anxiety predicted persistence of paranoid symptoms. Depressive disorder was one of the major clinical factors predicting persistence of paranoid symptoms in CHR patients. In addition, obsessive–compulsive disorder, childhood sexual abuse, and anxiety associated with paranoia. Effective pharmacological and psychotherapeutic treatment of these disorders and anxiety may reduce paranoid symptoms in CHR patients.

Short-term outcome of substance-induced psychotic disorder in a large UK first episode psychosis cohort

Abstract: OBJECTIVE: The incidence and outcome of first-episode substance-induced psychotic disorder (SIPD) are unclear. The study aimed to compare the 1-year outcomes of those given a SIPD diagnosis by clinicians compared to other psychosis diagnoses in a first-episode cohort. METHOD: Data were from a large (n = 1027) cohort of first-episode psychosis (FEP) patients admitted to early intervention services in the UK (National EDEN). Diagnosis, including that of SIPD, was made by treating psychiatrists at baseline using ICD10 criteria. Details on symptoms, functioning, quality of life, relapse and recovery were available at baseline and 12 months. RESULTS: There were 67 cases of SIPD (6.5% of the cohort). At baseline, SIPD patients were no different to other psychoses on symptoms, functioning and quality of life. At 12 months, there was no difference in SIPD and other psychoses on functioning, quality of life or relapse and recovery rates. Levels of psychotic and general symptomatology were similar but depressive symptoms were higher in the SIPD group. CONCLUSIONS: First-episode psychosis patients with a diagnosis of SIPD do not appear to have better outcomes than those with other primary psychotic diagnoses. The higher levels of depressive symptoms may be a specific marker in these patients.

NICE v. SIGN on psychosis and schizophrenia: same roots, similar guidelines, different interpretations.

Abstract: A recent editorial claimed that the 2014 National Institute for Health and Care Excellence (NICE) guideline on psychosis and schizophrenia, unlike its equivalent 2013 Scottish Intercollegiate Guidelines Network (SIGN) guideline, is biased towards psychosocial treatments and against drug treatments. In this paper we underline that the NICE and SIGN guidelines recommend similar interventions, but that the NICE guideline has more rigorous methodology. Our analysis suggests that the authors of the editorial appear to have succumbed to bias themselves.

Disagio mentale in un campione comunitario di giovani adulti: l'help-seeking in un modello generalista di salute mentale Emerging mental disorders in a community sample of young adults in Italy: help-seeking in a Generalist Community Mental Health setting

Abstract: RIASSUNTO. Scopo. Il ritardo nell’accesso alle cure rappresenta uno dei principali ostacoli alla presa in carico dei giovani adulti con disturbi mentali all’esordio. Questo ritardo, troppo spesso osservato nella pratica clinica, ha diverse cause. Una di queste e la richiesta di aiuto inespressa (unexpressed help-seeking), che e influenzata da fattori di ordine storico-culturale, dalle caratteristiche della patologia stessa, ma anche dalle modalita con le quali sono organizzati i servizi di salute mentale. Gli obiettivi dello studio sono quelli di individuare: il livello di stress e di disagio mentale, le determinanti principali dell’unexpressed help-seeking all’interno di un campione comunitario di giovani adulti in un contesto nazionale in cui vige un modello generalista di salute mentale. Metodi. Il campione e costituito da 3446 studenti universitari. Sono stati somministrati contestualmente: un questionario esplorativo, la scala SVS per la valutazione dello stress percepito e il GHQ-12 per la valutazione del disagio mentale. E stata condotta un’analisi descrittiva seguita dalle correlazioni tra l’unexpressed help-seeking e le altre variabili. E stata effettuata una regressione logistica sul sottocampione con punteggi GHQ-12 ≥4 utilizzando la richiesta d’aiuto inespressa come variabile dipendente. Risultati. Il 46,8% del campione ha avuto un punteggio GHQ-12 ≥4. L’unexpressed help-seeking e pari al 63,6% e risulta significativamente correlata a: sesso maschile, status di fuorisede, elevato punteggio SVS, assenza di servizi di salute mentale specificamente dedicati ai giovani adulti, sfiducia nei confronti dei servizi esistenti. Conclusioni. Una riorganizzazione dei servizi di salute mentale, nel senso della creazione di contesti piu appropriati per utenti giovani, potrebbe portare a una riduzione della richiesta di aiuto inespressa.

Motivational interviewing and CBT to improve health and wellbeing

Abstract: Large epidemiological studies in the last two decades have shown that many people in the community experience mental health and substance use problems in their lifetime and, and they commonly co-occur. Although co-existing mental health and substance use problems are very common, psychological treatments for these problems have traditionally been delivered separately in different services. Consequently, many people with co-existing disorders do not receive adequate treatment, resulting in worse treatment outcomes, including increased rates of relapse, medication use and health care costs. In the longer term, mental health problems (e.g., depression) and substance use problems (e.g., smoking) are themselves associated with increased rates of cardiovascular and respiratory diseases and cancer. There is a life expectancy gap of around 20 years between people living with mental health and substance use problems versus those not experiencing such problems. The first National Mental Health Report Card in Australia in 2012 called the physical health status of people living with a mental health condition a 'national disgrace'. The report called upon researchers and clinicians to better address the physical health of people with mental health and substance use problems. Despite burgeoning research linking these comorbidities, treatment services remain siloed into separate delivery systems for mental ill health, substance misuse and physical ill health, and for young people versus adults.

Substance misuse brief interventions during psychiatric hospital admissions

Abstract: Purpose: To provide a summary of the principles, theories and basic components of a recently developed brief integrated motivational intervention (BIMI) for working with individuals experience co-ccurring severe mental health and substance use problems in inpatient settings, including the outcomes of a feasiblity randomised controlled trial (RCT). There are greater financial costs and a negative impact on functioning associated with psychiatric admissions for people who experience co-occurring severe mental heath and substance misuse problems. In addition, their engagement in treatment is often problematic. Design/methodology/approach: The BIMI described was evaluated via a feasibility RCT that assessed whether the opportunity to discuss use of substances whilst on an inpatient ward represented an opportunity to engage inpatients in thinking about their use and the impact it has on their mental health. Findings: The BIMI is delivered in short burst sessions of 15-30 minutes over a two-week period adopting a simple 3-step approach that can be delivered by routine ward staff. It incorporates an assessment of substance use, mental health and motivation followed by personalised feedback, a focus on increasing awareness of the impact on mental health and development of goals and a change plan. The intervention has been shown to lead to higher levels of engagement in clients exploration of substance use and the impact on mental health. Findings suggest both staff and inpatients found the intervention feasible and acceptable. Originality/value: Routine ward staff were trained to deliver a brief intervention to inpatients during an acute hospital admission.