Anna Lavis

The UK national evaluation of the development and impact of Early Intervention Services (the National EDEN studies): study rationale, design and baseline characteristics

National EDEN aims to evaluate the implementation and impact on key outcomes of somewhat differently configured Early Intervention Services (EIS) across sites in England and to develop a model of variance in patient outcomes that includes key variables of duration of untreated psychosis (DUP), fidelity to the EIS model and service engagement. The cohort is being followed up for two further years as patients are discharged, to observe the stability of change and the impact of the discharge settings.

Seeking help for first-episode psychosis: a family narrative

Delayed help‐seeking can have serious consequences for young people with first‐episode psychosis (FEP), in terms of treatment response and outcome. Young peoples narratives about help‐seeking are important to understand why delays occur; however, as the majority of help‐seeking is initiated by family members, through a general practitioner (GP), family narratives are also of interest. The aim of this study was to explore help‐seeking for FEP, including first contact with a GP.

Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial

Summary Background Provision of early intervention services has increased the rate of social recovery in patients with first-episode psychosis; however, many individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services augmented with social recovery therapy in patients with first-episode psychosis. The primary hypothesis was that social recovery therapy plus early intervention services would lead to improvements in social recovery. Methods We did this single-blind, phase 2, randomised controlled trial (SUPEREDEN3) at four specialist early intervention services in the UK. We included participants who were aged 16–35 years, had non-affective psychosis, had been clients of early intervention services for 12–30 months, and had persistent and severe social disability, defined as engagement in less than 30 h per week of structured activity. Participants were randomly assigned (1:1), via computer-generated randomisation with permuted blocks (sizes of four to six), to receive social recovery therapy plus early intervention services or early intervention services alone. Randomisation was stratified by sex and recruitment centre (Norfolk, Birmingham, Lancashire, and Sussex). By necessity, participants were not masked to group allocation, but allocation was concealed from outcome assessors. The primary outcome was time spent in structured activity at 9 months, as measured by the Time Use Survey. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN61621571. Findings Between Oct 1, 2012, and June 20, 2014, we randomly assigned 155 participants to receive social recovery therapy plus early intervention services (n=76) or early intervention services alone (n=79); the intention-to-treat population comprised 154 patients. At 9 months, 143 (93%) participants had data for the primary outcome. Social recovery therapy plus early intervention services was associated with an increase in structured activity of 8·1 h (95% CI 2·5–13·6; p=0·0050) compared with early intervention services alone. No adverse events were deemed attributable to study therapy. Interpretation Our findings show a clinically important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received social recovery therapy plus early intervention services. Social recovery therapy might be useful in improving functional outcomes in people with first-episode psychosis, particularly in individuals not motivated to engage in existing psychosocial interventions targeting functioning, or who have comorbid difficulties preventing them from doing so. Funding National Institute for Health Research.

Not Eating or Tasting Other Ways to Live: A Qualitative Analysis of ‘Living Through’ and Desiring to Maintain Anorexia

Whilst recent discussions of anorexia nervosa have recognised key aspects of the illness experience, such as control and emotion regulation, there remains a cross-disciplinary emphasis on body image concerns as central. In dialogue with clinical, psychological and social analyses, this paper draws on ethnography and qualitative interviews with individuals diagnosed with anorexia to offer an alternative perspective. Focusing on individuals’ engagements with food and (not) eating suggests that material moments of starving, calorie counting, and thinking about food provide a critical lens onto what anorexia does for, as well as to, individuals living with the illness. Participants’ narratives suggest that anorexia can make it possible to retreat into a numb and protective ‘bubble.’ The illness may thereby offer a way to be in the world that both responds to and ameliorates distress; some individuals describe the ambivalent ‘safety’ of living through their anorexia. As such, food practices are a modality of holding onto anorexia’s valued safety. By outlining this relationship between practices of (not) eating and a desire amongst some individuals to maintain the illness, this paper contributes to discussions of treatment resistance. Intersecting with wider reflections on trauma, recovery and harm minimisation in mental health, the discussion considers how this desire might be approached ethically in both research and therapeutic practice. Individuals’ narratives suggest the need to reposition attention away from anorexia itself to the distress and traumatic life events that may underlie both the illness and the desire to maintain it.

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

Early intervention services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost‐effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG).

Becoming fit to be a mother: class, learning, and redemption in Supersize vs Superskinny

Abstract The UK Channel Four reality television programmes Supersize vs Superskinny and Supersize vs Superskinny: Kids present their viewers with a stark, and supposedly educative, reforming of food practices. Pairing participants defined as underweight with others defined as morbidly obese, the programmes are premised on a so-called ‘diet swap’, in which participants consume their foils’ (either meagre or excessive) meals in order to face the supposed follies of their ways. While the programmes include both male and female participants, in-depth content analysis reveals that their televisual storytelling has gendered underpinnings, centred on the theme of ‘fitness’ to mother. Notably, this ‘fitness’, as the programmes frame it, entails reforming women’s food consumption: from ‘perilous’ working-class eating and feeding practices, which ‘threaten’ women’s and children’s bodies with obesity, to ‘appropriate’ middle class tastes and choices, poised to foster trans-generational wellbeing. Thus, presented as ‘public pedagogy’ that implicates both participant and viewer, Supersize vs Superskinny evokes classed abjection and shame to cast population obesity as the outcome of maternal ‘failings’. We argue, then, that at the core of Supersize vs Superskinny’s focus on ‘balanced diets’ lies a neoliberal prescription for women’s moral citizenship as anchored in upwardly mobile, middle classed, responsibilised motherhood.

Lived experiences of negative symptoms in first-episode psychosis: A qualitative secondary analysis.

Exploring how negative symptoms are experienced and understood by individuals with lived experience of psychosis has the potential to offer insights into the complex psychosocial processes underlying negative symptom presentations. The aim of the current study was to investigate lived experiences of negative symptoms through secondary analysis of interviews conducted with individuals recovering from first‐episode psychosis.