Showing papers by "Max Birchwood published in 2018"

Metacognitive beliefs as psychological predictors of social functioning: An investigation with young people at risk of psychosis.

Abstract: Poor social functioning has been found to be present in those at risk for psychosis. This study aimed to examine metacognitive beliefs as potential predictors of structured activity (measure of social functioning) in those with an At Risk Mental State (ARMS). Regression and correlation analyses were conducted. The sample included 109 young people. Age was found to be positively correlated to structured activity. Metacognitive beliefs concerning uncontrollability and danger of worry were found to negatively predict structured activity. This was after controlling for age, gender, treatment allocation, cognitive schemas, positive symptom severity, social anxiety, and depression. Metacognitive danger items were most important. Age was the only control variable found to be an independent predictor of structured activity in the regression model, despite negative bi-variate relationships with structured activity found across three cognitive schema subscales and social anxiety. This is the first study to find that higher negative metacognitive beliefs about uncontrollability and danger predict lower social functioning in an ARMS sample, and that the perception of thoughts being dangerous was of particular importance. Psychological interventions should consider targeting this metacognitive dimension to increase social functioning. Future longitudinal research is required to strengthen findings in this area.

Carers' and service users' experiences of early intervention in psychosis services: implications for care partnerships.

Abstract: Aim To explore carers' and service users' experiences of UK Early Intervention Services following referral for first-episode psychosis. Methods Thirty-two semi-structured interviews (16 interviews with service users and 16 corresponding interviews with their carers) were completed and analysed. Results Carers spoke retrospectively and prospectively by framing their accounts into the periods before and since their engagement with Early Intervention Services. Desperation was evident as emotive experiences were recalled prior to referral. Relief then emerged as carers described support and engagement with key workers. Hope and optimism for the service user's prognosis and life trajectory were also expressed.Service users described similar positive experiences of Early Intervention Services and the support and insight they had gained through their relationships with key workers. They were however less focused on accounts of desperation and relief and more immersed in their current understanding and attempts to normalize their experiences of first-episode psychosis. Prognosis and future trajectories were only discussed tentatively. Conclusion Communication and 'partnerships' with service users and carers are essential for effective service engagement, delivery of care and the reduction in relapse following first-episode psychosis. This study highlights how key workers from Early Intervention Services are appropriately valued and situated to develop such relationships. Findings also reveal that service users' and carers' focus and expectations of recovery vary during the early stages of engagement with services. How key workers manage awareness and communication around such differing expectations is a crucial consideration for maintaining the 'partnerships' necessary for effective service provision.

Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance.

Abstract: UK Dept of Health (RDD/ARF2) NIHR Programme Grant (RP-PG-0109-10074) Prof Peter Jones part funded by NIHR CLARHC

The CIRCuiTS study (Implementation of cognitive remediation in early intervention services): protocol for a randomised controlled trial.

Abstract: Cognitive problems in people with schizophrenia predict poor functional recovery even with the best possible rehabilitation opportunities and optimal medication. A psychological treatment known as cognitive remediation therapy (CRT) aims to improve cognition in neuropsychiatric disorders, with the ultimate goal of improving functional recovery. Studies suggest that intervening early in the course of the disorder will have the most benefit, so this study will be based in early intervention services, which treat individuals in the first few years following the onset of the disorder. The overall aim is to investigate different methods of CRT. This is a multicentre, randomised, single-blinded, controlled trial based in early intervention services in National Health Service Mental Health Trusts in six English research sites. Three different methods of providing CRT (intensive, group, and independent) will be compared with treatment as usual. We will recruit 720 service users aged between 16 and 45 over 3 years who have a research diagnosis of non-affective psychosis and will be at least 3 months from the onset of the first episode of psychosis. The primary outcome measure will be the degree to which participants have achieved their stated goals using the Goal Attainment Scale. Secondary outcome measures will include improvements in cognitive function, social function, self-esteem, and clinical symptoms. It has already been established that cognitive remediation improves cognitive function in people with schizophrenia. Successful implementation in mental health services has the potential to change the recovery trajectory of individuals with schizophrenia-spectrum disorders. However, the best mode of implementation, in terms of efficacy, service user and team preference, and cost-effectiveness is still unclear. The CIRCuiTS trial will provide guidance for a large-scale roll-out of CRT to mental health services where cognitive difficulties impact recovery and resilience. ISRCTN, ISRCTN14678860 , Registered on 6 June 2016.

The COMMAND trial of cognitive therapy for harmful compliance with command hallucinations (CTCH): a qualitative study of acceptability and tolerability in the UK.

Abstract: Objectives To explore service user experiences of a 9-month cognitive behavioural therapy for command hallucinations in the context of a randomised controlled trial including their views on acceptability and tolerability of the intervention. Design Qualitative study using semistructured interviews. Setting The study took place across three sites: Birmingham, Manchester and London. Interviews were carried out at the sites where therapy took place which included service bases and participants’ homes. Participants Of 197 patients who consented to the trial, 98 received the Cognitive Behavior Therapy for Command Hallucinations (CTCH) intervention; 25 (15 males) of whom were randomly selected and consented to the qualitative study. The mean age of the sample was 42 years, and 68% were white British. Results Two superordinate themes were identified: participants’ views about the aspects of CTCH they found most helpful; and participants’ concerns with therapy. Helpful aspects of the therapy included gaining control over the voices, challenging the power and omniscience of the voices, following a structured approach, normalisation and mainstreaming of the experience of voices, and having peer support alongside the therapy. Concerns with the therapy included anxiety about completing CTCH tasks, fear of talking back to voices, the need for follow-up and ongoing support and concerns with adaptability of the therapy. Conclusions Interpretation: CTCH was generally well received and the narratives validated the overall approach. Participants did not find it an easy therapy to undertake as they were challenging a persecutor they believed had great power to harm; many were concerned, anxious and occasionally disappointed that the voices did not disappear altogether. The trusting relationship with the therapist was crucial. The need for continued support was expressed. Trial registration number ISRCTN62304114, Pre-results.

Impact and process evaluation of Forward Thinking Birmingham, the 0-25 Mental Health Service : Final Report

Abstract: This report provides the findings of a year-long evaluation of Forward Thinking Birmingham (FTB) which started just after the service went live in October 2015. Undertaken by a team from the University of Warwick and the GIFT Partnership, the purpose of the evaluation was to understand how the changes to mental health service provision for children and young people aged 0-25 and their parents and carers outlined in the new FTB model impact on key stakeholders across a range of service settings and types. The aim was to generate learning about the new model as to whether it worked/was achieving its specified objectives, what was perhaps less successful and needed amendment or further development. The evaluation would also provide an opportunity to think about the future development of the service in order to ensure a robust and sustainable model of provision.

O8.6. the relationship between cognition and functional improvement in the context of a psychosocial intervention targeting social disability in first episode psychosis.

Abstract: BackgroundWhilst Early Intervention Services (EIS) are the ‘gold standard’ treatment for young people with psychosis, in a recent study of over 1000 First Episode Psychosis (FEP) cases, 66% of individuals were experiencing a high level of poor functioning, despite receiving care under EIS for a period of 12 months (Hodgekins et al., 2015). This highlights the need to develop new interventions to target functional impairments in FEP.A specialised Social Recovery Cognitive Behavioural Therapy (SRCBT) has been developed which aims to address the underlying factors impeding social recovery, and has shown to be effective at improving structured activity in individuals with established illness and FEP (Fowler et al., 2013).Identifying the factors that contribute to functional change will ensure that targeted psychosocial therapies are being delivered appropriately. Impaired social cognition (SC) and neurocognition (NC) are closely related to poor functioning in psychosis. Exploration of SC and NC pre- and post-intervention will therefore be important to test underlying mechanisms of functional change, and identify individuals who are more likely to benefit from the specialized SRCBT.MethodsThis study ran alongside a multi-site proof of concept trial of SRCBT, for individuals with FEP experiencing social disability. Participants (M age = 25 years) had less than 30 hours a week of structured activity before entering the trial. At baseline, 123 participants completed a battery of SC and NC assessments. 59 participants were randomly allocated to the therapy group (SRCBT + EIS), and 64 were randomly allocated to the standard care group (care from an EIS alone). Participants completed a follow-up assessment at 9 months on the same cognitive battery, and a further assessment of their structured activity. The assessors were blind to group allocation. A small sub-sample of participants (N=6) allocated to the SRCBT group underwent functional magnetic resonance imaging (fMRI) scanning pre- and post- SRCBT, to explore any changes in the social brain regions following successful intervention.ResultsRegression analyses showed that SC was a significant predictor of treatment response (i.e. improved structured activity). Specifically, those who had better social knowledge at baseline were most likely to benefit from the SRCBT (Wald χ2 = 4.073; p = .044), accounting for 16% of the overall variance. To further illustrate this, individuals scoring in the top quartile for social knowledge achieved an additional 11 hours on average of structured activity post-intervention.Furthermore, in the group that underwent fMRI scanning pre- and post - intervention, there were increased activations in the social brain regions, namely the temporo-parietal junction (TPJ), which became more refined and localized by follow-up. There was also a trend for increased signal intensity in the TPJ, with increased structured activity post-SRCBT. Although this was not significant (r = .455; p = .365), there was a moderate strength relationshipDiscussionNo studies to-date have examined predictors of treatment response to a CBT intervention targeting functional impairment in FEP. These findings have implications for practice where remediation of SC may improve the efficacy of the SRCBT, particularly for individuals who have poorer social knowledge. This study is also the first to provide preliminary insights into a functional brain network associated with improved structured activity in psychosis; however, replication of these findings in a larger sample is needed.

T105. factor analyses of successive assessments by multiple scales have a consistent structure in a cohort of first episode psychoses

Abstract: Abstract Background Depending on the nature of their items factor analyses of different scales impose different structures on the underlying psychopathological dimensions, so a broader range of scale items should be more revealing. Few studies repeat analyses over successive interviews to investigate whether psychopathology has a consistent structure or evolves, especially after first presentations when the illness is most plastic and cohorts are unselected by chronicity. Methods A cohort was recruited from consecutive presentations aged 16–35 to NHS Early Intervention in Psychosis services from 14 catchments over 5 years during the National EDEN project. All met DSM IV-R criteria for schizophrenia spectrum psychoses, brief or substance induced psychoses, mania or severe depression with psychosis. At recruitment, after 6 and 12 months each was assessed with Positive and Negative Symptom Scale (PANSS), Calgary Depression Scale (CDS), Young’s Mania Rating Scale (MRS) and Birchwood’s Insight Scale (IS). At each point principal axis factoring with oblique (Promax) rotation included all scale items simultaneously, apart from using total scores for IS. Items below communality thresholds were excluded and the analyses repeated until stable solutions were achieved with fit metrics meeting conventional thresholds. Factor solutions were selected using breaks in the scree plot and eigenvalues>1.0. Results 1003 met diagnostic criteria and 948 provided data. Each time point produced 6 factors featuring consistent items: psychosis (PANSS delusions, hallucinations, suspicion, stereotyped thinking & bizarre ideation; MRS grandiose content); excitement/mania/disorganisation (PANSS agitation; MRS elation, overactivity, pressured and disorganised speech); hostility/suspiciousness (PANSS hostility, uncooperativeness & impulsive irritability; MRS irritability & aggression); depression/anxiety (PANSS anxiety, guilt, depression; CDS subjective & objective depression, guilt & guilty ideas of reference, hopelessness, self-depreciation, suicidality, early waking); negative symptoms (PANSS blunting, emotional & social withdrawal, poor rapport, poverty of speech, retardation and avolition), and poor insight (PANSS insight, MRS insight, IS total). Depression explained 29–32% of variance at different stages, Psychosis 28–29%, Negative 25–26%, Excitement 19–24%, Hostility 16–23% and Poor Insight 16–23%. Discussion The cohort, recruited from consecutive presentations, included a full range of psychoses in sufficient numbers to factor analyse the scales’ 51 parameters. There was evidence for 6 factors slightly different from the traditional 3 SAPS/SANS (Scales for the Assessment of Positive and Negative Symptoms) or 5 PANSS factors derived using chronically unwell samples with non-affective psychosis. There was more consistency than in previous first episode follow-up studies and affective and insight dimensions were more clearly defined.