William Sellwood

The questionnaire about the process of recovery (QPR): A measurement tool developed in collaboration with service users

Aims: To develop and validate a short recovery questionnaire in collaboration with service users. Method: 126 people with experience of psychosis were recruited via the National Health Service (NHS) Trust and self‐help organisations nationwide. Items were generated from in‐depth interviews into recovery and developed into a 25‐item self‐report questionnaire. Data were factor analysed, and a final 22‐item measure (the QPR) was tested for reliability and validity. To assess validity the QPR was administered together with measures of: psychological distress (the General Health Questionnaire – GHQ); empowerment (the Making Decisions and Empowerment Scale – MDES), and quality of life (the Schizophrenia Quality of Life Scale – SQLS). The QPR was administered again at two weeks to assess reliability. Results: The QPR is comprised of two subscales (intrapersonal and interpersonal). Internal consistency and reliability of the scale was satisfactory. There was a high level of association with MDES, GHQ and SQLS scores, and between QPR scores at time one and time two. Conclusions: The QPR possesses internal consistency, construct validity and reliability, and promises to be a useful tool for assisting clients to set goals, evaluation of these goals and promoting recovery from psychosis in routine service evaluation and research trials.

Associations between specific psychotic symptoms and specific childhood adversities are mediated by attachment styles: An analysis of the National Comorbidity Survey

Accumulated evidence over the past decade consistently demonstrates a relationship between childhood adversity and psychosis in adulthood. There is some evidence of specific associations between childhood sexual abuse and hallucinations, and between insecure attachment and paranoia. Data from the National Comorbidity Survey were used in assessing whether current attachment styles influenced the association between adverse childhood experiences and psychotic symptoms in adulthood. Hallucinations and paranoid beliefs were differentially associated with sexual abuse (rape and sexual molestation) and neglect, respectively. Sexual abuse and neglect were also associated with depression. The relationship between neglect and paranoid beliefs was fully mediated via anxious and avoidant attachment. The relationship between sexual molestation and hallucinations was independent of attachment style. The relationship between rape and hallucinations was partially mediated via anxious attachment; however this effect was no longer present when depression was included as a mediating variable. The findings highlight the importance of addressing and understanding childhood experiences within the context of current attachment styles in clinical interventions for patients with psychosis.

Demographic factors associated with extreme non-compliance in schizophrenia

Having identified total non-compliance with neuroleptic medication as a major problem in a significant proportion of schizophrenic patients, an analysis of potentially important demographic factors associated with this problem was carried out. The in-patient records of 256 schizophrenic patients were examined with reference to ethnicity, gender, age, number of admissions and amount of time spent in hospital over a 3-year period. Non-compliant patients differed from those who were at least partially compliant in that they were more likely to be Afro-Caribbean and male, have shorter stays in hospital and have more admissions. There was no difference between these groups in terms of age, although certain subgroups exhibited some age differences. Logistic regression analyses revealed that gender and ethnicity were significant predictors of extreme non-compliance, to the extent that in male Afro-Caribbeans there was a 31% chance that prophylactic medication would be completely refused. The implications of these results and methodological issues are discussed.

Needs-based cognitive-behavioural family intervention for carers of patients suffering from schizophrenia: 12-month follow-up

Objective: To examine longer‐term effectiveness of a needs‐based family intervention for carers and out‐patients suffering from schizophrenia.

Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial

BACKGROUND Relapse prevention for bipolar disorder increases time to relapse but is not available in routine practice. AIMS To determine the feasibility and effectiveness of training community mental health teams (CMHTs) to deliver enhanced relapse prevention. METHOD In a cluster randomised controlled trial, CMHT workers were allocated to receive 12 h training in enhanced relapse prevention to offer to people with bipolar disorder or to continue giving treatment as usual. The primary outcome was time to relapse and the secondary outcome was functioning. RESULTS Twenty-three CMHTs and 96 service users took part. Compared with treatment as usual, enhanced relapse prevention increased median time to the next bipolar episode by 8.5 weeks (hazard ratio 0.79, 95% CI 0.45-1.38). Social and occupational functioning improved with the intervention (regression coefficient 0.68, 95% CI 0.05-1.32). The clustering effect was negligible but imprecise (intracluster correlation coefficient 0.0001, 95% CI 0.0000-0.5142). CONCLUSIONS Training care coordinators to offer enhanced relapse prevention for bipolar disorder may be a feasible effective treatment. Large-scale cluster trials are needed.

Group CBT for People with Schizophrenia: A preliminary evaluation

Individual cognitive behavioural interventions for psychosis are rapidly developing and are being shown to be effective. This paper examines the application of these interventions on a group basis. The nature of the group, treatment outcome and potential benefits of using this format are described. After the group intervention, all patients were less depressed, most had higher self-esteem and greater knowledge of schizophrenia, and half the group felt better able to cope with their symptoms. Patients reported feeling less isolated and two of the four group members stated a preference for group over individual treatment.

Needs-based cognitive-behavioural family intervention for patients suffering from schizophrenia: 5-year follow-up of a randomized controlled effectiveness trial.

Objective:  To determine whether a 24‐week, needs‐based cognitive‐behaviourally oriented family intervention for patients suffering from schizophrenia led to improved relapse profiles over a 5‐year follow‐up period.

Enhanced relapse prevention for bipolar disorder – ERP trial. A cluster randomised controlled trial to assess the feasibility of training care coordinators to offer enhanced relapse prevention for bipolar disorder

BackgroundBipolar Disorder (BD) is a common and severe form of mental illness characterised by repeated relapses of mania or depression. Pharmacotherapy is the main treatment currently offered, but this has only limited effectiveness. A recent Cochrane review has reported that adding psycho-social interventions that train people to recognise and manage the early warning signs of their relapses is effective in increasing time to recurrence, improving social functioning and in reducing hospitalisations. However, the review also highlights the difficulties in offering these interventions within standard mental health services due to the need for highly trained therapists and extensive input of time. There is a need to explore the potential for developing Early Warning Sign (EWS) interventions in ways that will enhance dissemination.Methods and designThis article describes a cluster-randomised trial to assess the feasibility of training care coordinators (CCs) in community mental health teams (CMHTs) to offer Enhanced Relapse Prevention (ERP) to people with Bipolar Disorder. CMHTs in the North West of England are randomised to either receive training in ERP and to offer this to their clients, or to continue to offer treatment as usual (TAU). The main aims of the study are (1) to determine the acceptability of the intervention, training and outcome measures (2) to assess the feasibility of the design as measured by rates of recruitment, retention, attendance and direct feedback from participants (3) to estimate the design effect of clustering for key outcome variables (4) to estimate the effect size of the impact of the intervention on outcome. In this paper we provide a rationale for the study design, briefly outline the ERP intervention, and describe in detail the study protocol.DiscussionThis information will be useful to researchers attempting to carry out similar feasibility assessments of clinical effectiveness trials and in particular cluster randomised controlled trials.

Parental Communication and Psychosis: A Meta-analysis

BACKGROUND Parental communication deviance (CD) has long been suggested as a potential risk factor for the development of psychosis and thought disorder in genetically sensitive offspring. However, the findings of the studies on the prevalence of CD in parents of psychotic patients have never been submitted to quantitative synthesis. METHOD PsycINFO was searched from January 1959 to January 2012 for studies on the prevalence of CD in parents of psychotic patients. This search was supplemented with the results from a much larger systematic search (PsycINFO, PubMed, EMBASE, and Web of Science) on childhood trauma and psychosis. RESULTS A total of 20 retrieved studies (n = 1753 parents) yielded a pooled g of large magnitude (0.97; 95% CI [0.76; 1.18]) with a significant amount of heterogeneity (Q = 33.63; P = .014; I (2) = 46.47). Subgroup and sensitivity analysis of methodological features (studys design, comparison group, diagnostic criteria, CD rating method, inter-rater reliability not reported, year of publication, and verbosity) and demographic characteristics (level of education or offsprings age) revealed that pooled effect size was stable and unlikely to have been affected by these features. CONCLUSION CD is highly prevalent in parents of psychotic offspring. This is discussed in the broader context of adoption and longitudinal studies that have reported a G × E interaction in the development of psychosis and thought disorder. A potential developmental mechanism is suggested to explain how CD may affect the developing offspring. The importance of further studies on CD and its potential value as a clinical concept are discussed.

A randomised controlled trial of home based rehabilitation versus outpatient based rehabilitation for patients suffering from chronic schizophrenia

Background: Outpatient-based treatments for patients suffering from chronic schizophrenia inadvertently exclude a significant proportion of subjects because they are often too poorly motivated to attend for treatment. In addition there are also concerns about whether the skills that are learnt in a hospital setting will generalise to situations when the individuals are at home. This study attempted to redress some of these potential deficiencies and followed on from an earlier local study which found that a community-based team met more of the needs of patients suffering from chronic schizophrenia. Method: Seventy-five patients suffering from chronic schizophrenia were allocated randomly to receive traditional outpatient-based or home-based rehabilitation from a clinical psychologist and an occupational therapist. They were assessed before and after 9 months of treatment on a range of clinical, social and quality of life outcomes. Distress to carers was also assessed. Readmission to hospital was recorded for each subject. Results: There were significant reductions in socially embarrassing behaviour (SBS), increases in interpersonal functioning and recreational activities and a trend for quality of life to improve in the home-based group. There were fewer admissions in the home-based group but the differences, although financially substantial, were not statistically significant. Conclusions: The home-based rehabilitation service was well received by the majority of patients suffering from chronic schizophrenia and led to some improvement in social behaviour, interpersonal functioning, recreational activities and quality of life.