Max Birchwood

Bio: Max Birchwood is an academic researcher from University of Warwick. The author has contributed to research in topics: Mental health & Psychological intervention. The author has an hindex of 65, co-authored 259 publications receiving 18491 citations. Previous affiliations of Max Birchwood include University of Birmingham & Royal College of Psychiatrists.

The Person in Recovery From Acute and Severe Psychosis: The Role of Dependency, Self‐Criticism, and Efficacy

Abstract: The role of 3 personality dimensions (i.e., dependency, self-criticism, and efficacy) in recovery from an acute and severe psychosis was examined. Conceptualizing psychosis as involving difficulties in establishing psychological boundaries, the authors hypothesized that dependency has a greater disruptive effect on recovery than self-criticism. Results of a reanalysis of longitudinal data (N = 76) of people with schizophrenia spectrum disorders during recovery from acute psychosis were consistent with this hypothesis: Dependency predicted depressive and negative symptoms, and, under low efficacy, perceived loss of independence and insight into the presence of the illness. These findings elucidate the central role of interpersonal relatedness as a foundation for self-definition in recovery from psychosis.

A preliminary evaluation of integrated treatment for co-existing substance use and severe mental health problems: impact on teams and service users

Abstract: Aim: This study sought to develop a methodology to measure the integration of substance use treatment within five existing assertive outreach (AO) teams in Birmingham, UK. Changes in the way teams approach and discuss drug and alcohol problems amongst clients with severe mental health problems were anticipated. This was assessed at team meetings, through clinical sessions and case notes. The impact of change in team practice was also measured at the level of service users by assessing psychiatric symptoms, engagement, amount of substance used, and conviction ratings of positive substance-related beliefs. Method: Each team were provided with training and supervision to deliver cognitive behavioural integrated treatment (C-BIT). This aimed to increase awareness of the relationship between psychosis and problem substance use and provide skills to manage these difficulties. Data was collected at intervals over a 36 month period. Results: Staff within teams increased in self reported confidence and skills to deliver C-BIT and these gains were maintained over time. Findings suggest that following training, integration was achieved to a degree and changes in teams practice were observed. Improvements in client engagement and reduction in alcohol intake and positive alcohol-related beliefs were also noted but occurred regardless of team training. Conclusions: Training and supporting AO staff to use an integrated treatment approach is well received and produces lasting changes in confidence and practice. Whether this can go on to impact upon client outcome is yet to be established.

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.

Innovations in the psychological management of schizophrenia : assessment, treatment and services

Abstract: Part 1 Assessment: Assessment of symptoms and behaviour, Philippa Garety vulnerability models - the assessment and prediction of relapse, Keith Clements and Graham Turpin monitoring recovery from acute psychosis, Valerie Drury. Part 2 Treatment: interventions with families, Christine Barrowclough and Nicholas Tarrier teaching social and coping skills, Jerome Vaccaro and Liza Roberts early intervention, Max Birchwood et al management and modification of residual positive psychotic symptoms, Nicholas Tarrier management of long-term impairments and challenging behaviour, Lorna Hogg and John Hall. Part 3 Services: models of continuing are, Tony Lavender and Frank Holloway family interventions - service implications, Jo Smith the balance of care, Mattijs Muijen service organisation and planning, Kate Woof the future of psychological treatments, Nick Tarrier and Max Birchwood.

Barriers and facilitators to partnership working between Early Intervention Services and the voluntary and community sector.

Abstract: Partnership working between health and the voluntary and community sector has become an increasing political priority. This paper describes and explores the extent and patterns of partnership working between health and the voluntary and community sector in the context of Early Intervention Services for young people with a first episode of psychosis. Data were collected from 12 Early Intervention Services and through semistructured interviews with 47 voluntary and community sector leads and 42 commissioners across the West Midlands of England. Most partnerships were described as ad hoc and informal in nature although four formal partnerships between Early Intervention Services and voluntary and community sector organizations had been established. Shared agendas, the ability to refer clients onto an organization that could provide a service they could not and shared training facilitated partnership working in this context. Barriers to closer working included differences in culture such as managing risk, the time required to make and maintain relationships and recognition of the advantages of remaining a small and autonomous organization. The four more formal partnerships were also built on the organizations' experience of working together informally, in one case through a specific pilot project. The voluntary and community organizations involved were also branches of larger national organizations for whom finding sustainable funding was less of an issue. In theoretical terms, eight Early Intervention Service: voluntary and community sector partnerships were at a stage of 'pre-partnership collaboration', three at 'partnership creation and consolidation' and one at 'partnership programme delivery'. The empirical data viewed through the lens of the partnership life-cycle model could help early intervention services, and voluntary and community sector professionals better understand where they are, why they are there and the conditions needed to realise the full potential of partnership working.

Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

Abstract: Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.

Constructing Grounded Theory: A Practical Guide through Qualitative Analysis

Abstract: การวจยเชงคณภาพ เปนเครองมอสำคญอยางหนงสำหรบทำความเขาใจสงคมและพฤตกรรมมนษย การวจยแบบการสรางทฤษฎจากขอมล กเปนหนงในหลายระเบยบวธการวจยเชงคณภาพทกำลงไดรบความสนใจ และเปนทนยมเพมสงขนเรอยๆ จากนกวชาการ และนกวจยในสาขาสงคมศาสตร และศาสตรอนๆ เชน พฤตกรรมศาสตร สงคมวทยา สาธารณสขศาสตร พยาบาลศาสตร จตวทยาสงคม ศกษาศาสตร รฐศาสตร และสารสนเทศศกษา ดงนน หนงสอเรอง “ConstructingGrounded Theory: A Practical Guide through Qualitative Analysis” หรอ “การสรางทฤษฎจากขอมล:แนวทางการปฏบตผานการวเคราะหเชงคณภาพ” จะชวยใหผอานมความรความเขาใจถงพฒนาการของปฏบตการวจยแบบสรางทฤษฎจากขอมล ตลอดจนแนวทาง และกระบวนการปฏบตการวจยอยางเปนระบบ จงเปนหนงสอทควรคาแกการอานโดยเฉพาะนกวจยรนใหม เพอเปนแนวทางในการนำความรความเขาใจไประยกตในงานวจยของตน อกทงนกวจยผเชยวชาญสามารถอานเพอขยายมโนทศนดานวจยใหกวางขวางขน

Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia.

Abstract: OBJECTIVE: The clinical hallmark of schizophrenia is psychosis. The objective of this overview is to link the neurobiology (brain), the phenomenological experience (mind), and pharmacological aspects of psychosis-in-schizophrenia into a unitary framework. METHOD: Current ideas regarding the neurobiology and phenomenology of psychosis and schizophrenia, the role of dopamine, and the mechanism of action of antipsychotic medication were integrated to develop this framework. RESULTS: A central role of dopamine is to mediate the “salience” of environmental events and internal representations. It is proposed that a dysregulated, hyperdopaminergic state, at a “brain” level of description and analysis, leads to an aberrant assignment of salience to the elements of one’s experience, at a “mind” level. Delusions are a cognitive effort by the patient to make sense of these aberrantly salient experiences, whereas hallucinations reflect a direct experience of the aberrant salience of internal representations. Antipsyc...