Alicia Spidel

Predictors and profiles of treatment non-adherence and engagement in services problems in early psychosis

Treatment adherence in early psychosis individuals is considered problematic. Some studies have tried to understand reasons for medication non-adherence in this population, though few have also considered engagement in services. We conducted a cross-sectional study with 118 early psychosis individuals, assessing multiple constructs (symptoms, insight, personality traits, alliance, childhood trauma, substance abuse, social functioning and sociodemographics) suggested in the literature as potentially linked to medication adherence or engagement in services. Forward Wald logistic regression suggested that more positive symptoms, having witnessed violence as a child and high agreeableness as a personality trait predicted poor medication adherence. Forward linear regression revealed that physical abuse as a child, lack of knowledge regarding consumer rights, difficulties in building an alliance, low neuroticism and high agreeableness predicted poor service engagement. Profiles of non-adherers or low service engagement were strongly linked to childhood trauma, and high agreeableness, as well as more severe symptoms and poor alliance. Males with histories of legal problems were also more prevalent in both groups. No significant differences were found for insight or substance abuse. Overall, individuals with early psychosis who adhered less to treatment in general could have issues with trusting authority and place more importance on peer acceptance. Results are presented in light of the existing literature and clinical implications are discussed.

Group Cognitive Behavior Therapy or Social Skills Training for Individuals With a Recent Onset of Psychosis? Results of a Randomized Controlled Trial

This study aimed at determining the effectiveness of group cognitive behavior therapy (CBT) for recent onset psychosis in comparison with a recognized intervention for individuals with severe mental illness–social skills training. One hundred twenty-nine participants took part in a single-blind randomized controlled trial with repeated measures (baseline, 3 months, and 9 months). Participants were randomized to 1 of 3 conditions: group CBT, group social skills training for symptom management, or a wait-list control group. Both interventions were delivered by mental health staff with minimal training. Both treatments resulted in improvements on positive and negative symptoms compared with the wait-list control group, with the CBT group having significant effects over time on overall symptoms, and post-treatment effects on self-esteem, and active coping skills compared with the wait-list control group and lower drop-out rates than the skills training group. Therapist fidelity was adequate for both treatment conditions. Group CBT for psychosis is a promising intervention for individuals with recent onset of psychosis and their mental health professionals.

Female Perpetrators of Intimate Abuse.

Abstract A review is made of female intimate abuse. It is concluded that females are as abusive as males in intimate relationships according to survey and epidemiological studies. This is especially so for younger “cohort” community samples followed longitudinally. Predictors of intimate violence with women appear to be similar to those of men; including antisocial criminal records, alcohol abuse, and personality disorders.

Early psychosis and aggression: Predictors and prevalence of violent behaviour amongst individuals with early onset psychosis

Studies in the area of psychosis and violence to date suggest that those who suffer from psychosis are at higher risk for perpetration of such aggressive behaviours. In fact, it has been suggested that variables such as substance use and personality may mediate this relationship. Other variables, such as childhood physical abuse, might also be implicated in the etiology. In the current study, a sample of one hundred and eighteen participants with a primary diagnosis of psychosis were interviewed and prevalence rates for aggressive experiences were as follows: history of trouble with the law (45%), history of emotional abuse (9.6%), physical abuse (38.8%), and sexual abuse (60.2%). With regard to perpetration, 69.6% reported verbal or physical aggression (69.6%), and further, 61% reported problems with substances. Logistic regression procedures were used with a number of the variables under study and relationships were evidenced between psychopathy scores, history of abuse, and regular drug use. History of child abuse was related to violence history, with those who were victims of child abuse being more likely to be violent in later life. In addition higher scores on the psychopathy measure were linked with violence history. This study was a first step towards identifying persons suffering from a mental illness who may be at risk for violence by identifying who, among first episode clients, may be more likely to perpetrate violent behaviours. Targeted interventions and strategies may be further refined so that individuals receiving mental health services may be better served.

Psychopathy and deception detection using indirect measures

Purpose. The goal of the current study was to examine psychopathy and indirect measures of deception detection.Methods. Undergraduate students (N=444) viewed video clips of adult male offenders telling true and false stories about crimes. For each story, participants rated indirect measures of deception (thinking hard, nervousness, emotional arousal, and attempting to control behaviour) and credibility. Participants also chose the story they believed to be true and rated the confidence in their decision. Offenders were rated on the psychopathy checklist - revised.Results. Consistent with past research, deception detection accuracy was at chance level and unrelated to confidence. Ratings on indirect measures by undergraduates did not distinguish true and false statements in offenders. Psychopathic offenders were less successful at deception than non-psychopathic offenders. Psychopathic traits were associated with lower perceived credibility during deception and ratings of thinking harder while lying.Conclusions. The results suggest that indirect measures of deception detection may be less useful in offender samples. Further, the findings are consistent with the general inability of psychopathic offenders to demonstrate superior deception skills in empirical studies. Indirect measures of deception uniquely related to psychopathic traits offer new insight into the relationship between psychopathy and deception. Language: en

Community Implementation Successes and Challenges of a Cognitive-Behavior Therapy Group for Individuals with a First Episode of Psychosis

CBT for psychosis has recently been called a best practice, suggesting that studies have demonstrated its efficacy with many populations. Community settings are encouraged to implement best practices such as CBT yet many factors can make the implementation of CBT challenging. Issues such as clinician resistance, setting, as well as client variables (refusal, denial of symptoms, etc.) come into play. Examples of successes and challenges of a community based study of CBT groups for first episodes will be described. The strategies used to overcome these challenges and the successes of the program will be presented.

'Wasn't me!' A field study of the relationship between deceptive motivations and psychopathic traits in young offenders

Purpose. Evaluating truthfulness is an integral part of any forensic assessment. Unfortunately, the motives underlying the use of deceptive strategies by offenders and how these may be mediated by personality are not well established, particularly in adolescent samples. Accordingly, the aim of the present study was to identify different deception-related motivations in a sample of juvenile offenders, with special emphasis placed on the relationship between these motivations and psychopathic traits.Methods. Archived file and videotaped information for 60 Canadian federal juvenile offenders were reviewed in order to identify real-life (spontaneous) patterns of deceptive motivations.Results. It was found that there were significant differences between the low, medium, and high groups across psychopathic traits for the motivations of (1) lies to obtain a reward; (2) to heighten self-presentation; and (3) for duping delight.Conclusions. Not only were juvenile offenders found to lie for a variety of reasons, but also psychopathy was found to mediate the specific motivational patterns leading to offender perpetrated deception. The relevance of these findings to the assessment of truthfulness in offender populations is discussed. Language: en

Childhood trauma and somatic symptoms among psychiatric outpatients: Investigating the role of shame and guilt

Previous research suggests a link between experiences of childhood maltreatment and adult somatic symptom distress. Contributing mechanisms, however, are not yet well understood. It is possible that shame and guilt may function as mediators in the relationship between childhood trauma and adult somatic distress. The present study was developed to investigate the relationship between childhood maltreatment and adult somatic distress, including the potential mediating role of shame and guilt, among psychiatric outpatients. Using data from a sample of 99 Canadian psychiatric outpatients, mediation models with shame and guilt as parallel mediators were evaluated for relationships between childhood emotional abuse, sexual abuse, emotional neglect, and somatic symptoms. Controlling for current depressive symptoms, a significant indirect effect was found for the relationship between emotional abuse and shame, but not guilt, in contributing to somatic symptoms. A similar result was obtained regarding the mediating role of shame in the relationship between emotional neglect and somatic symptoms. Mediation was non-significant regarding childhood sexual abuse, which was directly related to somatic distress after controlling for depressive symptoms. The findings provide further evidence of the link between childhood trauma and somatic symptom distress, with shame as a mechanism for the effects of emotional abuse and neglect.

A comparison of treatment adherence in individuals with a first episode of psychosis and inpatients with psychosis.

In predicting treatment compliance in individuals with severe mental illness, research has focused on variables such as substance abuse, personality, history of child abuse, and symptomatology, although these relationships have not been investigated in great detail in individuals at the onset of mental illness. To better understand these correlates of treatment compliance, two samples were examined: a sample of 117 individuals presenting with a first episode of psychosis and a more chronic forensic sample of 65 participants recruited from a psychiatric hospital. These samples were investigated for service engagement in terms of violence history, substance abuse, symptom severity, psychopathic traits and history of childhood abuse. Linear regressions performed for the first episode sample revealed that childhood physical abuse was the strongest predictor of poor service engagement, followed by problems with alcohol, a history of physical violence, any history of violence and higher psychopathic traits. Linear regression revealed for the forensic group that a lower level of service engagement was most strongly predicted by a history of childhood abuse and a higher score on the Brief Psychiatric Rating Scale (BPRS). Results are presented in light of the existing literature and clinical implications are discussed.