Pamela Jacobsen

Keeping the world a constant size: object constancy in human touch.

The perceived size of objects touching different regions of skin varies across the body surface by much less than is predicted from variations in tactile receptor density. Here we show that altering the visual experience of the body alters perceived tactile distances. We propose that the brain attempts to preserve tactile size constancy by rescaling the primary, distorted body-surface representation into object-centered space according to visual experience of the body.

Clinical, socio-demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a "need for care"

Individuals reporting persistent psychotic experiences (PEs) in the general population, but without a “need for care”, are a unique group of particular importance in identifying risk and protective factors for psychosis. We compared people with persistent PEs and no “need for care” (non‐clinical, N=92) with patients diagnosed with a psychotic disorder (clinical, N=84) and controls without PEs (N=83), in terms of their phenomenological, socio‐demographic and psychological features. The 259 participants were recruited from one urban and one rural area in the UK, as part of the UNIQUE (Unusual Experiences Enquiry) study. Results showed that the non‐clinical group experienced hallucinations in all modalities as well as first‐rank symptoms, with an earlier age of onset than in the clinical group. Somatic/tactile hallucinations were more frequent than in the clinical group, while commenting and conversing voices were rare. Participants in the non‐clinical group were differentiated from their clinical counterparts by being less paranoid and deluded, apart from ideas of reference, and having fewer cognitive difficulties and negative symptoms. Unlike the clinical group, they were characterized neither by low psychosocial functioning nor by social adversity. However, childhood trauma featured in both groups. They were similar to the controls in psychological characteristics: they did not report current emotional problems, had intact self‐esteem, displayed healthy schemas about the self and others, showed high life satisfaction and well‐being, and high mindfulness. These findings support biopsychosocial models postulating that environmental and psychological factors interact with biological processes in the aetiology of psychosis. While some PEs may be more malign than others, lower levels of social and environmental adversity, combined with protective factors such as intact IQ, spirituality, and psychological and emotional well‐being, may reduce the likelihood of persistent PEs leading to pathological outcomes. Future research should focus on protective factors and determinants of well‐being in the context of PEs, rather than exclusively on risk factors and biomarkers of disease states.

Mindfulness Groups for Psychosis; Key Issues for Implementation on an Inpatient Unit

BACKGROUND There is emerging evidence that mindfulness groups for people with distressing psychosis are safe and therapeutic. AIMS The present study aimed to investigate the feasibility of running and evaluating a mindfulness group on an inpatient ward for individuals with chronic and treatment resistant psychosis. METHOD Eight participants attended a 6-week mindfulness group on a specialist tertiary inpatient ward. RESULTS This study demonstrated that mindfulness exercises were acceptable and well-tolerated by participants. Measuring outcome, systemic challenges and participant experience are discussed.

Acetylcholinesterase Inhibitors (AChEI's) for the treatment of visual hallucinations in schizophrenia: A review of the literature

BackgroundVisual hallucinations occur in various neurological diseases, but are most prominent in Lewy body dementia, Parkinsons disease and schizophrenia. The lifetime prevalence of visual hallucinations in patients with schizophrenia is much more common than conventionally thought and ranges from 24% to 72%. Cortical acetylcholine (ACh) depletion has been associated with visual hallucinations; the level of depletion being related directly to the severity of the symptoms. Current understanding of neurobiological visual processing and research in diseases with reduced cholinergic function, suggests that AChEIs may prove beneficial in treating visual hallucinations. This offers the potential for targeted drug therapy of clinically symptomatic visual hallucinations in patients with schizophrenia using acetylcholinesterase inhibition.MethodsA systematic review was carried out investigating the evidence for the effects of AChEIs in treating visual hallucinations in Schizophrenia.ResultsNo evidence was found relating to the specific role of AChEIs in treating visual hallucinations in this patient group.DiscussionGiven the use of AChEIs in targeted, symptom specific treatment in other neuropsychiatric disorders, it is surprising to find no related literature in schizophrenia patients. The use of AChEIs in schizophrenia has investigated effects on cognition primarily with non cognitive effects measured more broadly.ConclusionsWe would suggest that more focused research into the effects of AChEIs on positive symptoms of schizophrenia, specifically visual hallucinations, is needed.

Acetylcholinesterase Inhibitors (AChEI's) for the treatment of visual hallucinations in schizophrenia: a case report

BackgroundVisual hallucinations are commonly seen in various neurological and psychiatric disorders including schizophrenia. Current models of visual processing and studies in diseases including Parkinsons Disease and Lewy Body Dementia propose that Acetylcholine (Ach) plays a pivotal role in our ability to accurately interpret visual stimuli. Depletion of Ach is thought to be associated with visual hallucination generation. AchEIs have been used in the targeted treatment of visual hallucinations in dementia and Parkinsons Disease patients. In Schizophrenia, it is thought that a similar Ach depletion leads to visual hallucinations and may provide a target for drug treatmentCase PresentationWe present a case of a patient with Schizophrenia presenting with treatment resistant and significantly distressing visual hallucinations. After optimising treatment for schizophrenia we used Rivastigmine, an AchEI, as an adjunct to treat her symptoms successfully.ConclusionsThis case is the first to illustrate this novel use of an AchEI in the targeted treatment of visual hallucinations in a patient with Schizophrenia. Targeted therapy of this kind can be considered in challenging cases although more evidence is required in this field.

Mindfulness-Based Crisis Interventions for patients with psychotic symptoms on acute psychiatric wards (amBITION study): protocol for a feasibility randomised controlled trial

BackgroundInpatient psychiatric care is a scarce and expensive resource in the National Health Service (NHS), with chronic bed shortages being partly driven by high re-admission rates. People often need to go to a hospital when they have a mental health crisis due to overwhelming distressing psychotic symptoms, such as hearing voices (hallucinations) or experiencing unusual beliefs (delusions). Brief talking therapies may be helpful for people during an acute inpatient admission as an adjunct to medication in reducing re-admission rates, and despite promising findings from trials in the USA, there have not yet been any clinical trials on this kind of intervention within NHS settings.Methods/designThe amBITION study is a feasibility randomised controlled trial (RCT) of a manualised brief talking therapy (Mindfulness-Based Crisis Intervention (MBCI)). Inpatients on acute psychiatric wards are eligible for the study if they report at least one positive psychotic symptom and are willing and able to engage in a talking therapy. In addition to treatment as usual (TAU), participants will be randomly allocated to receive either MBCI or a control intervention (social activity therapy (SAT)) which will be based on doing activities on the ward with the therapist. The primary objective of the study is to find out whether it is possible to carry out this kind of trial successfully within UK inpatient settings and to find out whether patients and staff find it an acceptable intervention. The secondary objective is to collect pilot data on primary and secondary outcome measures, including re-admission rates at 6-month follow-up. This will provide information on the appropriateness of re-admission as the primary outcome measure for future efficacy trials, as well as data on the acceptability and utility of the clinical self-report measures.DiscussionThe results of the feasibility trial will indicate whether a subsequent efficacy pilot trial is warranted and, if so, will provide vital information for the planning of such a trial (e.g. pilot data on expected effect sizes). If future research finds that MBCI is an effective and safe intervention, then patients will benefit from access to better treatment within inpatient care which would reduce re-admission rates. This trial therefore addresses an area of urgent concern for service users, clinicians and the wider NHS.Trial registrationCurrent controlled trials ISRCTN37625384

A systematic scoping review of psychological therapies for psychosis within acute psychiatric in-patient settings

BACKGROUND People with psychotic disorders account for most acute admissions to psychiatric wards. Psychological therapies are a treatment adjunct to standard medication and nursing care, but the evidence base for such therapies within in-patient settings is unclear.AimsTo conduct a systematic scoping review of the current evidence base for psychological therapies for psychosis delivered within acute in-patient settings (PROSPERO: CRD42015025623). METHOD All study designs, and therapy models, were eligible for inclusion in the review. We searched PubMed, PsycINFO, EThOS, ProQuest, conference abstracts and trial registries. RESULTS We found 65 studies that met criteria for inclusion in the review, 21 of which were randomised controlled trials (RCTs). The majority of studies evaluated cognitive-behavioural interventions. Quality was variable across all study types. The RCTs were mostly small (n<25 in the treatment arm), and many had methodological limitations including poorly described randomisation methods, inadequate allocation concealment and non-masked outcome assessments. We found studies used a wide range of different outcome measures, and relatively few studies reported affective symptoms or recovery-based outcomes. Many studies described adaptations to treatment delivery within in-patient settings, including increased frequency of sessions, briefer interventions and use of single-session formats. CONCLUSIONS Based on these findings, there is a clear need to improve methodological rigour within in-patient research. Interpretation of the current evidence base is challenging given the wide range of different therapies, outcome measures and models of delivery described in the literature.Declaration of interestNone.

Delivery of cognitive remediation therapy within a specialist inpatient psychosis service: a health-care assistant's perspective

Cognitive remediation therapy (CRT) is a psychological therapy which has been shown to be effective in improving cognitive functioning in service users with schizophrenia spectrum disorders. There are challenges to routinely implementing CRT within inpatient services due to a limited availability of therapists to deliver it. This paper describes a model of service delivery piloted in a specialist inpatient psychosis service which included health-care assistants (HCAs) working under the supervision of a clinical psychologist to help deliver CRT. The experience of the HCAs in undertaking this work is described from a first-person perspective.

After you’d gone: How mental health service users are affected when their consultant leaves

Mental health professionals often move across services in the National Health Service (NHS) as a result of organizational change. However, little is known about the impact this has on people who are in receipt of psychiatric services (service users). We conducted an exploratory qualitative study into the experiences of service users under a community mental health team following a service restructure. Nine service users took part in face-to-face interviews, which were subsequently analysed following the principles of Grounded Theory. We found that service users were affected by their consultant leaving in a variety of ways, ranging from grief reactions to improved self-effi cacy. We concluded that service users can be signifi cantly affected by their consultant leaving, and this should be taken into account when planning restructures of mental health services.