Lisa J Jones

Phenotype evaluation and genomewide linkage study of clinical variables in schizophrenia

Genetic factors are likely to influence clinical variation in schizophrenia, but it is unclear which variables are most suitable as phenotypes and which molecular genetic loci are involved. We evaluated clinical variable phenotypes and applied suitable phenotypes in genome‐wide covariate linkage analysis. We ascertained 170 affected relative pairs (168 sibling‐pairs and two avuncular pairs) with DSM‐IV schizophrenia or schizoaffective disorder from the United Kingdom. We defined psychotic symptom dimensions, age at onset (AAO), and illness course using the OPCRIT checklist. We evaluated phenotypes using within sibling‐pair correlations and applied suitable phenotypes in multipoint covariate linkage analysis based on 372 microsatellite markers at ∼10 cM intervals. The statistical significance of linkage results was assessed by simulation. The positive and disorganized symptom dimensions, AAO, and illness course qualified as suitable phenotypes. There were no genome‐wide significant linkage results. There was suggestive evidence of linkage for the positive dimension on chromosomes 2q32, 10q26, and 20q12; the disorganized dimension on 8p21 and 17q21; and illness course on 2q33 and 22q11. The linkage peak for disorganization on 17q21 remained suggestive after correction for multiple testing. To our knowledge, this is the first study to integrate phenotype evaluation and genome‐wide covariate linkage analysis for symptom dimensions and illness history variables in sibling‐pairs with schizophrenia. The significant within‐pair correlations strengthen the evidence that some clinical variables within schizophrenia are suitable phenotypes for molecular genetic investigations. At present there are no genome‐wide significant linkage results for these phenotypes, but a number of suggestive findings warrant further investigation.

An exploration of compassion focused therapy following acquired brain injury

BACKGROUND People with acquired brain injuries (ABI) frequently experience psychological difficulties such as anxiety and depression, which may be underpinned and maintained by high self-criticism and shame alongside an inability to self-soothe. Compassionate focused therapy (CFT) was developed to address shame and self-criticism and foster the ability to self-soothe. OBJECTIVES This is a naturalistic evaluation with the aim of assessing the feasibility, safety, and potential value of CFT for ABI patients with emotional difficulties receiving neuropsychological rehabilitation. METHODS This study employed a mixed methods design combining self-report measures and qualitative interviews. Twelve patients received a combination of CFT group and individual intervention. Self-report measures of self-criticism, self-reassurance, and symptoms of anxiety and depression were collected pre and post programme and analysed using Wilcoxon signed rank test (N=12; five female, seven males). Follow-up data were analysed in the same manner (N=9). Interviews were conducted with six patients and analysed using interpretative phenomenological analysis. RESULTS CFT was associated with significant reductions in measures of self-criticism, anxiety, and depression and an increase in the ability to reassure the self. No adverse effects were reported. Three superordinate themes emerged from the interviews: psychological difficulties; developing trust and finding safeness; and a new approach. CONCLUSIONS This study suggests that CFT is well accepted in ABI survivors within the context of neuropsychological rehabilitation. Furthermore, the results indicate that further research into CFT for psychological problems after ABI is needed and that there may be key aspects, which are specific to CFT intervention, which could reduce psychological difficulties after ABI. PRACTITIONER POINTS CFT appears to be a feasible intervention for psychological problems after ABI. CFT was associated with a reduction in symptoms of anxiety and depression and associated self-criticism, as well as enhanced self-reassurance for ABI survivors. These ABI survivors reported that CFT provided them with tools to manage continued psychological difficulties.

Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia

BackgroundThis is a systematic review on the effectiveness of community interventions in improving maternal health care outcomes in South Asia.MethodsWe searched electronic databases to June 2017. Randomised or cluster randomised studies in communities within rural/remote areas of Nepal, Bangladesh, India and Pakistan were included. Data were analysed as risk ratios (RR) or odds ratios (OR), and effects were adjusted for clustering. Meta-analyses were performed using random-effects and evidence quality was assessed.ResultsEleven randomised trials were included from 5440 citations. Meta-analysis of all community interventions combined compared with control showed a small improvement in the number of women attending at least one antenatal care visit (RR 1.19, 95% CI 1.06 to 1.33). Two community mobilisation sub groups: home care using both male and female mobilisers, and education by community mobilisers, improved the number of women attending at least one antenatal visit. There was no difference in the number of women attending at least one antenatal visit for any other subgroup. There was no difference in the number of women attending 3 or more antenatal visits for all community interventions combined, or any community subgroup. Likewise, there was no difference in attendance at birth between all community interventions combined and control. Health care facility births were modestly increased in women’s education groups (adjusted RR (1.15, 95% CI 1.11 to 1.20; 2 studies)). Risk of maternal deaths after 2 years (RR 0.63, 95% CI 0.24 to 1.64; 5 studies), and 3 years (RR 1.11, 95% CI 0.52 to 2.36; 2 studies), were no different between women’s education groups and control. Community level mobilisation rather than health care messages at district level improved the numbers of women giving birth at health care facilities (RR1.09 (95%CI 1.06 to 1.13; 1 study)). Maternal health care knowledge scores improved in two community-based interventions, one involving education of male community members.ConclusionWomen’s education interventions may improve the number of women seeking birth at a health care facility, but the evidence is of low quality. No impact on maternal mortality was observed Future research should explore the effectiveness of including male mobilisers.Trial registrationThis systematic review is registered with PROSPERO CRD42016033201.