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.

Schizophrenia: early warning signs

Abstract: Relapse in schizophrenia remains common and cannot be entirely eliminated even by the best combination of biological and psychosocial interventions ([Linszen et al , 1998][1]). Relapse prevention is crucial as each relapse may result in the growth of residual symptoms ([Shepherd et al , 1989][2])

Early Intervention in Schizophrenia

Abstract: The management of schizophrenia may be characterised by two paradigms. The first approaches the schizophrenias as episodic relapsing disorders, where treatment is provided through both acute (crisis) care and to achieve prophylaxis. The second paradigm, sometimes arising from a failure of the first, is of “rehabilitation’, involving amelioration of disabilities, occasionally within a framework of relative asylum. We would propose a third paradigm of “early intervention”, involving a combination of medical and psychosocial interventions targeted at young, vulnerable people with the aim of preventing or limiting likely social, psychological and mental deterioration. Vigorous intervention early in the course of illness, early recognition and treatment of relapse and the promotion of psychological adjustment to psychotic illness are proposed as key elements of this third paradigm.

Early attachment experience and recovery from psychosis

Abstract: Objectives. Two studies were carried out to investigate the relationship between coping styles and co-morbid depression in people adjusting to the onset of psychosis. Evaluative thinking and early attachment experiences were also examined. Methods and design. In Study 1, a 39-item Recovery Style Questionnaire (RSQ) was developed to measure recovery style in people with psychosis, based on McGlashan, Levy & Carpenter's (1975) interview measure of recovery style. Fifty-six participants completed both the RSQ and McGlashan's interview-based measure. Study 2 explores the relationship between these styles of recovery, depression and early childhood attachment experiences. Thirty-six people participated. Results The RSQ was both reliable and correlated highly with McGlashan's interview-based measure. We found that the RSQ, in keeping with the interview-based measure, was bimodally distributed, thus supporting McGlashan's contention that they define two distinct recovery styles termed ‘integration’ and ‘sealing over’. As predicted, 88 per cent of the ‘sealers’ were moderately to severely depressed compared to 52 per cent of the ‘integrators’ who were mildly depressed with no members of the ‘integration’ group experiencing moderate to severe depression (p < .0003). Patients who employed the sealing over recovery style also made significantly more negative self-evaluations than did patients in the integration group and also perceived their parents to be significantly less caring than those in the integration group. Conclusions. These findings are explained in terms of a multi-axial model incorporating personality structure and development as well as mental disorder. It is suggested that those individuals with a poorly developed sense of self defend against the threat of psychosis using denial. Clinical implications are discussed and more research is suggested to further investigate the links between evaluative and inferential thinking in co-morbid depression, and how such thinking relates to early childhood experience.

Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services

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.

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...