Til Wykes

Bio: Til Wykes is an academic researcher from King's College London. The author has contributed to research in topics: Mental health & Cognitive remediation therapy. The author has an hindex of 77, co-authored 433 publications receiving 21282 citations. Previous affiliations of Til Wykes include National Health Service & Population Research Institute.

A Meta-Analysis of Cognitive Remediation for Schizophrenia: Methodology and Effect Sizes

Abstract: Objective:Cognitive remediation therapy for schizophrenia was developed to treat cognitive problems that affect functioning, but the treatment effects may depend on the type of trial methodology adopted. The present meta-analysis will determine the effects of treatment and whether study method or potential moderators influence the estimates. Method:Electronic databases were searched up to June 2009 using variants of the key words “cognitive,” “training,” “remediation,” “clinical trial,” and “schizophrenia.” Key researchers were contacted to ensure that all studies meeting the criteria were included. This produced 109 reports of 40 studies in which ≥70% of participants had a diagnosis of schizophrenia, all of whom received standard care. There was a comparison group and allocation procedure in these studies. Data were available to calculate effect sizes on cognition and/or functioning. Data were independently extracted by two reviewers with excellent reliability. Methodological moderators were extracted th...

Cognitive Behavior Therapy for Schizophrenia: Effect Sizes, Clinical Models, and Methodological Rigor

Abstract: BACKGROUND: Guidance in the United States and United Kingdom has included cognitive behavior therapy for psychosis (CBTp) as a preferred therapy. But recent advances have widened the CBTp targets to other symptoms and have different methods of provision, eg, in groups. AIM: To explore the effect sizes of current CBTp trials including targeted and nontargeted symptoms, modes of action, and effect of methodological rigor. METHOD: Thirty-four CBTp trials with data in the public domain were used as source data for a meta-analysis and investigation of the effects of trial methodology using the Clinical Trial Assessment Measure (CTAM). RESULTS: There were overall beneficial effects for the target symptom (33 studies; effect size = 0.400 [95% confidence interval [CI] = 0.252, 0.548]) as well as significant effects for positive symptoms (32 studies), negative symptoms (23 studies), functioning (15 studies), mood (13 studies), and social anxiety (2 studies) with effects ranging from 0.35 to 0.44. However, there was no effect on hopelessness. Improvements in one domain were correlated with improvements in others. Trials in which raters were aware of group allocation had an inflated effect size of approximately 50%-100%. But rigorous CBTp studies showed benefit (estimated effect size = 0.223; 95% CI = 0.017, 0.428) although the lower end of the CI should be noted. Secondary outcomes (eg, negative symptoms) were also affected such that in the group of methodologically adequate studies the effect sizes were not significant. CONCLUSIONS: As in other meta-analyses, CBTp had beneficial effect on positive symptoms. However, psychological treatment trials that make no attempt to mask the group allocation are likely to have inflated effect sizes. Evidence considered for psychological treatment guidance should take into account specific methodological detail.

The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness.

Abstract: BACKGROUND People with severe mental illness often have a complex mixture of clinical and social needs The Camberwell Assessment of Need (CAN) is a new instrument which has been designed to provide a comprehensive assessment of these needs There are two versions of the instrument: the clinical version has been designed to be used by staff to plan patients' care; whereas the research version is primarily a mental health service evaluation tool The CAN has been designed to assist local authorities to fulfil their statutory obligations under the National Health Service and Community Care Act 1990 to assess needs for community services METHOD A draft version of the instrument was designed by the authors Modifications were made following comments from mental health experts and a patient survey Patients (n = 49) and staff (n = 60) were then interviewed, using the amended version, to assess the inter-rater and test-retest reliability of the instrument RESULTS The mean number of needs identified per patient ranged from 755 to 864 Correlations of the inter-rater and test-retest reliability of the total number of needs identified by staff were 099 and 078 respectively The percentage of complete agreement on individual items ranged from 100-816% (inter-rater) and 100-581% (test-retest) CONCLUSIONS The study suggests that the CAN is a valid and reliable instrument for assessing the needs of people with severe mental illness It is easily learnt by staff from a range of professional backgrounds, and a complete assessment took, on average, around 25 minutes

Patients' perspectives on electroconvulsive therapy: systematic review

Abstract: Objective To ascertain patients’ views on the benefits of and possible memory loss from electroconvulsive therapy. Design Descriptive systematic review. Data sources Psychinfo, Medline, Web of Science, and Social Science Citation Index databases, and bibliographies. Study selection Articles with patients’ views after treatment with electroconvulsive therapy. Data extraction 26 studies carried out by clinicians and nine reports of work undertaken by patients or with the collaboration of patients were identified; 16 studies investigated the perceived benefit of electroconvulsive therapy and seven met criteria for investigating memory loss. Data synthesis The studies showed heterogeneity. The methods used were associated with levels of perceived benefit. At least one third of patients reported persistent memory loss. Conclusions The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvulsive therapy and that memory loss is not clinically important is unfounded.

Medscape

Abstract: Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?