Lynsey Gregg

Suicide risk in civilian PTSD patients - Predictors of suicidal ideation, planning and attempts

AbstractBackgroundThere appears to be a strong connection between suicidality and the experience of trauma. The study investigated suicidality in chronic civilian post–traumatic stress disorder (PTSD).MethodNinety–four participants suffering from chronic PTSD were assessed for suicidal ideation, plans and attempts since the index trauma as part of a comprehensive assessment. The prevalence of these was assessed and characteristics of those reporting suicide–related thoughts and behaviour were investigated through logistic and multinominal regression analyses.ResultsOver half of the sample (56.4%) reported some aspect of suicidality with 38.3% reporting ideation, 8.5% reporting suicide plans and 9.6% having made suicide attempts since the trauma. Of the nine participants who reported suicide attempts, six had made more than one attempt. The proportions of participants who reported suicidality in this sample were significantly greater than reported within the general population, when comparisons were made with an epidemiological study. Logistic regression analysis indicated that a unit increase in life impairment (OR = 3.1) and depression (OR = 1.14) scores were independently and significantly associated with suicidality. Multinominal regression indicated that life impairment (OR = 2.71) and depression (OR = 1.13) scores were associated with the presence of suicidal ideation compared to no ideation, and life impairment (OR = 5.75), depression (OR = 1.2) scores and receiving psychotropic medication (OR = 10.6) were associated with the presence of plans and attempts compared to no suicidal behaviour.ConclusionsSuicide risk is elevated in those suffering from chronic PTSD and is associated with impaired functioning in combination with depression.

Expressed emotion and attributions in the carers of patients with Alzheimer's disease: The effect on carer burden.

Burden of care, expressed emotion (EE), causal attributions, and salivary cortisol were assessed in 100 carers of patients with Alzheimers disease. Forty-one carers were rated high EE, which was associated with higher scores of carer distress and strain, and greater reports of noncognitive features in the patient, but not with cortisol levels. High EE carers made more attributions personal to, and controllable by, the patient for negative events. Critical carers made more attributions of the patients behavior that was idiosyncratic. Warmth toward the patient was associated with the opposite of this pattern. Overinvolved carers made attributions of the patients behavior to causes external to the patient and internal to themselves. Cortisol levels were associated with self-reports of strain and distress.

Risk of non-fatal suicide ideation and behaviour in recent onset schizophrenia--the influence of clinical, social, self-esteem and demographic factors.

Abstract.Background:Suicide rates amongst schizophrenic patients are high. There are disadvantages in investigating successfully completed suicides which make suicidal ideation and previous attempts important proxy measures of suicidal risk. The aim of this study was to investigate factors associated with these risk measures.Method:Fifty-nine patients suffering recent onset schizophrenia were assessed for suicidal ideation and history, and a range of demographic, clinical, social (including relatives’ Expressed Emotion) and self-esteem measures. Univariate comparisons were made between those with and without suicide ideation and previous attempts. Path analysis was conducted to identify factors directly or indirectly associated with a composite scale of risk (low, medium or high).Results:Approximately 25% of the sample reported a current desire to kill themselves and 47% had made one or more previous attempts. There were numerous significant univariate differences between those with or without ideation or history. Path analysis indicated that greater hopelessness (OR 1.22) and longer duration of illness (OR 1.13) increased risk. Hopelessness was associated with higher negative self-evaluation and social isolation. Negative self-evaluation was associated with more relatives’ criticism which was associated with more negative symptoms. Being a male, unmarried and unemployed were all significantly associated with an increase in negative symptoms. Social isolation was associated with being unemployed, older, more positive symptoms and longer illness duration. Duration of illness was not itself predicted by any other variables.Conclusion:Non-fatal suicide ideation and behaviour are significantly associated with an array of demographic, clinical, interpersonal and psychological factors. To reduce risk of suicide, these factors need to be assessed and methods developed to reduce their influence.

Suicide behaviour over 18 months in recent onset schizophrenic patients: The effects of CBT

The results of a trial of cognitive behaviour therapy, supportive counselling and treatment as usual in recent onset schizophrenia on suicide behaviour are reported. Treatment was delivered over a five week period during hospitalisation for an acute episode. Participants were assessed at baseline, 6 weeks, 3 and 18 months. Over the 18 months there were 3 definite suicides and 2 deaths by accidental causes. The rates of moderate to severe suicidal behaviour were 13% at admission, 4% at six weeks, 1.5% at three months and 6% at 18 months. There were no beneficial or adverse effects of psychological treatment on suicide behaviour that reduced significantly with clinical recovery. There is a general picture of those who suffer persistently higher levels of psychotic symptoms, poorer functioning, depression and low self-esteem have higher severity of suicide behaviour, although the numbers with clinically significant suicide behaviour are low. CBT may need to be modified to directly target suicide behaviour and its antecedents to significantly reduce risk; recommendations on this are made.

A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England.

Expressed emotion (EE) research has been productive in investigating the influence of the interpersonal environment on a range of disorders. The majority of EE research on the influence of carers has been carried out in the west. This is the first EE study of the carers of people with dementia in Japan. The aim of this study was to investigate the relationships between EE status and aspect of burden through cross-cultural comparison of the two countries, Japan and England, with large cultural and linguistic differences. Comparisons were made between samples of EE of carers of dementia and schizophrenic patients. In total, data on 80 carer/relative–patient dyads were collected and examined: (1) 20 Japanese carers of people with dementia (JD), (2) 20 English carers of patients with Alzheimer’s disease (ED), (3) 20 Japanese relatives of patients with schizophrenia (JS), and (4) 20 English relatives of patients with schizophrenia (ES). The Camberwell Family Interview was administered in each country to ascertain levels of EE. Large differences between Japan and England were found in the frequency of critical comments, in which ES>ED>JS>JD. EE correlated significantly with burden in the JD sample alone. With an operational cut-off of 2CC (CC, critical comments), EE correlated significantly with cognitive impairment as well as with clinical severity in the JD sample. There was a tendency for lower expression of both positive and negative emotional reactions towards family members in the Japanese sample. The results of this study indicate that EE is an appropriate measure for use with carers of sufferers of dementia and can be utilized across different cultures. However, flexibility with the cut-offs may be required in Eastern cultures. This needs to be tested on larger samples with sensitivity to illness and cross-cultural differences.

Expressed emotion and attributions in relatives of schizophrenia patients with and without substance misuse

ObjectiveTo test the hypotheses that carers of patients with schizophrenia (single diagnosis) and schizophrenia and co-occurring drug or alcohol misuse (dual diagnosis) will differ in terms of expressed emotion (EE) and their attributions for patient problems.MethodIn a cross-sectional study, two samples of 42 single- and dual-diagnosis carers are compared in terms of EE and attributions. Patient symptoms are assessed to control for differences other than substance misuse.ResultsThe study supports the hypothesis that high-EE, dual-diagnosis carers tend to see patient problems as more blaming (internal, controllable and personal) than do single-diagnosis patients. This difference was particularly marked when making causal ascriptions for deficit behaviours. Although there were no differences in overall EE levels in the two groups, there were significantly more carers who were rated as hostile and rejecting in the dual-diagnosis group.ConclusionsThe findings highlight the importance of family intervention for this patient group.

The Impact of Cannabis Use on Clinical Outcomes in Recent Onset Psychosis

BACKGROUND There are inconsistencies in findings as to whether cannabis use has a negative impact on clinical outcomes for people with established psychosis. Effects may be more evident on patients with recent onset psychosis. AIM To investigate the relationship between cannabis use and clinical outcome, including whether change in cannabis use affects psychotic symptoms, affective symptoms, functioning and psychotic relapse in a sample of people in early psychosis with comorbid cannabis abuse or dependence. METHODS One hundred and ten participants were examined prospectively with repeated measures of substance use antecedent to psychopathology at baseline, 4.5, 9, and 18 months. We used random intercept models to estimate the effects of cannabis dose on subsequent clinical outcomes and whether change in cannabis use was associated with change in outcomes. RESULTS There was no evidence of a specific association between cannabis use and positive symptoms, or negative symptoms, relapse or hospital admissions. However, a greater dose of cannabis was associated with subsequent higher depression and anxiety. Change in the amount of cannabis used was associated with statistically significant corresponding change in anxiety scores, but not depression. Additionally, reductions in cannabis exposure were related to improved patient functioning. CONCLUSIONS Reducing cannabis may be directly associated with improvements in anxiety and functioning, but not other specific symptoms.

A phase-specific psychological therapy for people with problematic cannabis use following a first episode of psychosis: a randomized controlled trial

BACKGROUND Cannabis use is high amongst young people who have recently had their first episode of psychosis, and is associated with worse outcomes. To date, interventions to reduce cannabis consumption have been largely ineffective, and it has been suggested that longer treatment periods are required. METHOD In a pragmatic single-blind randomized controlled trial 110 participants were randomly allocated to one of three conditions: a brief motivational interviewing and cognitive behavioural therapy (MI-CBT) intervention (up to 12 sessions over 4.5 months) with standard care from an early intervention service; a long MI-CBT intervention (up to 24 sessions over 9 months) with standard care; or standard care alone. The primary outcome was change in cannabis use as measured by Timeline Followback. RESULTS Neither the extended nor the brief interventions conferred benefit over standard care in terms of reductions in frequency or amount of cannabis use. Also the interventions did not result in improvements in the assessed clinical outcomes, including symptoms, functioning, hospital admissions or relapse. CONCLUSIONS Integrated MI and CBT for people with cannabis use and recent-onset psychosis does not reduce cannabis use or improve clinical outcomes. These findings are consistent with those in the published literature, and additionally demonstrate that offering a more extended intervention does not confer any advantage. Many participants were not at an action stage for change and for those not ready to reduce or quit cannabis, targeting associated problems rather than the cannabis use per se may be the best current strategy for mental health services to adopt.

Self-reported reasons for substance use in schizophrenia: A Q methodological investigation

Background: Large numbers of people with a diagnosis of schizophrenia use drugs and alcohol, resulting in poorer symptomatic and functional outcomes for many. Aims: To examine the reasons that people with a diagnosis of schizophrenia give for their own alcohol and drug use. Method: Q methodology was used to examine reasons for use. Forty-five people with a diagnosis of schizophrenia or schizoaffective disorder and comorbid substance misuse completed the sorting procedure. Results: Analysis of the Q Sorts revealed three distinct groups of substance users: (1) those who predominantly used for social and enhancement reasons, to ‘chill out and have a good time with others:’ (2) those who used to regulate negative affect and alleviate positive symptoms, to ‘cope with distressing emotions and symptoms:’ (3) those who used substances to augment themselves and intensify their experiences, to ‘feel bigger, better and inspired.’ Conclusion: People with a diagnosis of schizophrenia who use substances explain their s...

Reasons for substance use and their relationship to subclinical psychotic and affective symptoms, coping, and substance use in a nonclinical sample

This paper examines self-reported reasons for substance use in a cross-sectional sample of university students, and investigates the relationship of these reasons for use to psychopathology, coping strategies, and to drug and alcohol consumption. A model of substance use, which hypothesizes that reasons for use and coping strategies mediate the link between psychopathology and substance use, is proposed and is tested and refined using structural equation modeling. Results confirm that substance use is related to psychopathology and that the relationship is partially mediated by reasons for substance use and coping; specifically, dysfunctional coping. These findings suggest that interventions that emphasize the use of different, more adaptive coping strategies to cope with negative states could potentially help substance users with and without significant psychopathology to abstain from or reduce their substance use.