Search PubMed⌕ Search

Biomedical subjects

A P Morrison

Publications and source records attributed to A P Morrison.

At least 19 recordsLinked to original sources
PubMed2005

Relationships between trauma and psychosis: an exploration of cognitive and dissociative factors.

OBJECTIVE: There is a growing awareness of the relationship between trauma and psychosis. Studies have found associations between traumatic life experiences and the development of psychosis. METHOD: This study examined the prevalence of trauma exposure and post-traumatic stress disorder (PTSD) in 32 people with psychotic diagnoses and investigated associations between specific traumas and psychotic symptoms. The role of dissociation and cognitive factors was also explored. RESULTS: The prevalence of lifetime trauma was high (94% of the sample reported at least one traumatic event). The prevalence of current PTSD was 53%. Severity of trauma was associated with severity of PTSD and psychotic experiences. Physical abuse was associated with positive psychotic symptoms and sexual abuse was specifically related to hallucinations. Dissociative processes and negative beliefs formed as a result of trauma were associated with psychotic experiences (particularly hallucinations). CONCLUSION: These findings are consistent with the suggestion that psychosis may be trauma-induced, and other implications are considered.

Adult↗
PubMed2005

Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications.

OBJECTIVE: To review the research addressing the relationship of childhood trauma to psychosis and schizophrenia, and to discuss the theoretical and clinical implications. METHOD: Relevant studies and previous review papers were identified via computer literature searches. RESULTS: Symptoms considered indicative of psychosis and schizophrenia, particularly hallucinations, are at least as strongly related to childhood abuse and neglect as many other mental health problems. Recent large-scale general population studies indicate the relationship is a causal one, with a dose-effect. CONCLUSION: Several psychological and biological mechanisms by which childhood trauma increases risk for psychosis merit attention. Integration of these different levels of analysis may stimulate a more genuinely integrated bio-psycho-social model of psychosis than currently prevails. Clinical implications include the need for staff training in asking about abuse and the need to offer appropriate psychosocial treatments to patients who have been abused or neglected as children. Prevention issues are also identified.

Adult↗
PubMed2004

Delivering cognitive therapy to people with psychosis in a community mental health setting: an effectiveness study.

OBJECTIVE: Cognitive therapy (CT) has been shown to be an efficacious treatment for persistent psychotic symptoms. However, there is some debate regarding whether this is transportable to real life clinical settings. This study aimed to evaluate the effectiveness of CT for psychosis in a community mental health team (CMHT) setting. METHOD: Patients referred for CT for psychosis were naturalistically allocated (determined by the availability of a therapist) to CT or waiting-list (WL)/treatment-as-usual (TAU). Outcome assessments were performed at WL, pre-CT, post-CT and 1-year follow-up. Data from 59 patients were analysed. RESULTS: Random effects regression analyses showed there was a significant improvement, attributable to CT, on most outcome measures, and that many of the symptomatic improvements were maintained at follow-up. Wilcoxon signed ranks tests indicated that there was a significant reduction in psychiatric hospital use following CT. CONCLUSION: These results confirm that CT is an effective treatment for psychosis that is generalizable to a community setting.

Adolescent↗
PubMed2002

Imagery and psychotic symptoms: a preliminary investigation.

Recent cognitive accounts of psychotic symptoms have suggested that processes involved in the maintenance of emotional disorders may also be implicated in the maintenance of hallucinations and delusions, and particularly emphasise the appraisals of such symptoms as important. Imaginal appraisals have been identified in emotional disorders, and many studies have reported spontaneously occurring images in patients with anxiety disorders. Such images appear to be linked to affect, beliefs and memories. This study examined the occurrence of imagery, using a semi-structured interview, in 35 patients who were experiencing hallucinations and/or delusions and receiving cognitive therapy. The majority of patients (74.3%) reported images, and most of these were recurrent and associated with affect, beliefs and memories. Common themes included images about feared catastrophes associated with paranoia, traumatic memories, and images about the perceived source or content of voices. The theoretical and clinical implications of these findings are discussed and directions for further research considered.

Adolescent↗
PubMed2002

Randomised controlled trial of early detection and cognitive therapy for preventing transition to psychosis in high-risk individuals. Study design and interim analysis of transition rate and psychological risk factors.

BACKGROUND: There is interest in the possibility of indicated prevention of psychosis. There is a strong case for using psychological approaches to prevent transition to psychosis in high-risk patients. AIMS: To identify individuals at high risk of transition to psychosis, and psychological characteristics relevant to the development of psychosis in this group. METHOD: The design of a randomised controlled trial of cognitive therapy for the prevention of psychosis in people at high risk (meeting operational criteria of brief or attenuated psychotic symptoms, or first-degree family history with functional decline) is outlined. The first patients recruited are compared with non-patient samples on cognitive and personality factors; an interim analysis of transition rate is reported. RESULTS: Cases (n = 31) were recruited mainly from primary care. Of the 23 high-risk patients monitored for 6-12 months, 5 (22%) made the transition to psychosis. The high-risk group scored significantly higher than non-patients on measures of schizotypy, metacognitive beliefs and dysfunctional self-schemas (sociotropy). CONCLUSIONS: The findings validate the methods of identifying individuals at high risk of experiencing a psychotic episode. Compared with non-patient controls, the cases showed dysfunctional metacognitive beliefs and self-schemas.

Adult↗
PubMed2000

Intrusive thoughts and auditory hallucinations: a comparative study of intrusions in psychosis.

Several theories of auditory hallucinations implicate the involvement of intrusive thoughts and other theories suggest that the interpretation of voices determines the distress associated with them. This study tested the hypotheses that patients who experience auditory hallucinations will experience more intrusive thoughts and be more distressed by them and interpret them as more uncontrollable and unacceptable than the control groups. It also examines whether the interpretation of hallucinations is associated with the distress caused by them and whether there are differences in the way that patients respond to and interpret their thoughts and voices. A questionnaire examining the frequency of intrusive thoughts and the reactions to them was administered to a group of patients with a diagnosis of schizophrenia who experienced auditory hallucinations, a psychiatric control group and a non-patient control group. In addition, the patients in the first group completed a similar questionnaire in relation to their voices. Analyses of covariance showed that patients who experienced auditory hallucinations had more intrusive thoughts than the control groups and that they found their intrusive thoughts more distressing, uncontrollable and unacceptable than the control groups. Correlational analyses revealed that patients' interpretations of their voices were associated with the measures of distress in relation to them. Repeated measures analyses of covariance found no differences between thoughts and voices on the dimensions assessed. The theoretical and clinical implications of these findings are discussed.

Adult↗
PubMed2000

Thought control strategies in schizophrenia: a comparison with non-patients.

This study tested the hypothesis that patients with a diagnosis of schizophrenia would report the use of different thought control strategies in comparison with non-patients. The Thought Control Questionnaire [TCQ; Wells, A. & Davies, M. (1994). The thought control questionnaire: a measure of individual differences in the control of unwanted thoughts. Behaviour Research and Therapy, 32, 871-878.] was administered to 22 patients who met DSM-IV criteria for schizophrenia and 22 non-patients. The results showed that schizophrenic patients used different thought control strategies (more worry and punishment-based strategies, less distraction-based strategies) in compairison with non-patients. The theoretical and clinical implications of these findings are discussed.

Adult↗
PubMed2000

Cognitive factors in predisposition to auditory and visual hallucinations.

OBJECTIVES: This study adapted the Launay Slade Hallucination Scale (LSHS) to measure predisposition to auditory and visual hallucinations and examine the relationship between meta-cognition and predisposition in a non-psychiatric population. It also tested the hypothesis that individuals highly predisposed to hallucination would show positive and negative meta-cognitive beliefs and report the use of different thought control strategies. DESIGN: A within participants correlational design was employed. METHODS: A revised LSHS was administered to 105 normal participants who were also asked to complete questionnaires assessing paranoia, meta-cognitive beliefs, thought control strategies, anxiety, depression and beliefs about unusual perceptual experiences. RESULTS: Two empirically distinct but correlated hallucinatory traits (auditory and visual) were measured by the modified LSHS. Consistent with predictions, it was found that positive beliefs about unusual perceptual experiences were the best predictor of predisposition to auditory and visual hallucinations and that those participants who scored higher on predisposition to hallucination used different thought control strategies and had different negative meta-cognitive beliefs in comparison with participants of low predisposition. CONCLUSIONS: Meta-cognitive beliefs about thoughts and hallucinatory phenomena appear to be implicated in predisposition to hallucination. The theoretical and clinical implications of the findings are discussed.

Adult↗
PubMed1999

A pilot study evaluating the effectiveness of individual inpatient cognitive-behavioural therapy in early psychosis.

BACKGROUND: Recent research indicates that cognitive-behaviour therapy (CBT) can be effective in ameliorating persistent positive symptoms in chronic psychotic patients. The effectiveness of CBT in acute and recent-onset psychosis has been little explored, although a recent pilot study indicated that CBT could significantly improve recovery in acutely psychotic inpatients. METHOD: Short-term individual CBT was compared to supportive counselling/psychoeducation (SC) as an adjunct to standard inpatient hospital care and medication in 21 inpatients experiencing a recent-onset acute schizophrenic episode. RESULTS: Both groups showed significant reductions in Brief Psychiatric Rating Scale (BPRS) scores following treatment, although there were no group differences. Time to discharge did not differ significantly between the groups, although there was a greater variance for the SC patients. Two-year follow-up showed no significant differences between the groups, although the number of patients who relapsed, the number of relapses and the time to recurrence of psychotic symptoms was lower in the CBT group than the SC group. Interestingly, the time to readmission was shorter in the CBT group. CONCLUSIONS: CBT and SC are acceptable treatments for recent-onset acutely psychotic inpatients. A larger randomised controlled trial over multiple hospital sites is warranted.

Acute Disease↗
PubMed1998

Cognitive processes in auditory hallucinations: attributional biases and metacognition.

BACKGROUND: Cognitive models suggest that auditory hallucinations are experienced when mental events are misattributed to an external source; therefore, this study was designed to examine attributional biases in patients experiencing auditory hallucinations. The study also examined the role of metacognitive beliefs in the experience of auditory hallucinations, as some theories have implicated metacognition in the development and maintenance of auditory hallucinations. METHODS: Fifteen participants with a diagnosis of schizophrenia experiencing auditory hallucinations were compared with 15 non-hallucinating schizophrenics and 15 non-psychiatric control subjects on several measures, including an immediate source monitoring task and a questionnaire assessing metacognitive beliefs. RESULTS: Results indicated that patients experiencing hallucinations exhibited the predicted bias towards misattributing internal events to an external source, as measured by ratings of internality of responses in a word association task. All groups had lower perceived levels of internality and control for emotionally salient words, which provides further evidence for the importance of emotional content in hallucinations. Patients experiencing hallucinations were found to score higher than the other two groups on metacognitive beliefs about uncontrollability and danger and positive beliefs about worry. In addition, a logistic regression analysis showed that beliefs about uncontrollability and danger were predictive of whether subjects experienced auditory hallucinations or not. CONCLUSIONS: These results offer considerable support to cognitive bias models of auditory hallucinations, particularly those that implicate metacognition.

Adult↗
PubMed1998

Individual cognitive-behavioural interventions in early psychosis.

BACKGROUND: Cognitive-behavioural treatments have previously been explored in the treatment of chronic psychotic problems, but recently, the effectiveness of these treatments has been investigated with regard to recent onset and acute psychosis. METHOD: The literature relating to cognitive-behavioural treatments in psychosis is explored and the application of the approach to recent onset psychosis is described in detail. RESULTS: There appears to be a growing body of evidence that the advances made in the treatment of people with chronic treatment resistant psychosis can be similarly applied to people with recent onset and acute psychosis. CONCLUSIONS: Cognitive-behavioural treatments are feasible with recent onset psychotic patients although further evaluation of their effectiveness is necessary.

Antipsychotic Agents↗
PubMed1997

Cognitive factors in source monitoring and auditory hallucinations.

BACKGROUND: In order to elucidate further the cognitive processes underlying auditory hallucinations, an experiment investigating delayed and immediate source monitoring for positive, negative and neutral verbal material was conducted with schizophrenic patients. METHODS: Patients experiencing auditory hallucinations, patients not experiencing auditory hallucinations and normal subjects participated in a word association task, rating their responses for how much a self-generated thought was their own, how controllable and involuntary it was and their confidence in these ratings. A delayed source monitoring test in which subjects had to recall the source (self or experimenter) of the words from the association task was also administered. RESULTS: Hallucinators showed a greater bias towards external attribution of their thoughts compared with both control groups for immediate attributions of source, but not for delayed attributions. Hallucinators showed a bias towards external attribution of emotional material for immediate source monitoring and all subjects showed a bias towards misattribution of positive material to an external source and negative material to an internal source for the delayed source monitoring task. CONCLUSIONS: These findings appear to be most consistent with theories proposing that hallucinations result from an external attributional bias for internal events. The implications of these results for research and practice are also discussed.

Adult↗
PubMed1994

Qualitative dimensions of normal worry and normal obsessions: a comparative study.

Despite the crucial role typically given to negative thoughts in cognitive conceptualizations of emotional problems, few studies have compared the characteristics of varieties of such thoughts. The present study compared the process features of naturally occurring worries and obsessions in a non-patient group. Analyses of variance revealed several significant differences between these types of thought. The relationship between worries and obsessions, and the clinical and conceptual importance of the observed differences is briefly discussed.

Adult↗
PubMed1984

Working with shame in psychoanalytic treatment.

Shame is a central human affect, reflecting feelings of defect, inferiority, and failure of the self. It is, therefore, a proper focus for psychoanalytic treatment. Beginning with Freud's seminal attention to narcissism and the ego ideal, the possibility for studying shame and its relation to the ego ideal (i.e. the loving function of the superego) was inherent in psychoanalytic theory, but Freud's pursuit of intrapsychic conflict and the punitive superego postponed further elaboration of shame. Interest in the relation of the ego ideal to the superego (Hartmann, 1950; Reich, 1954), and in the ideal self (Sandler et al., 1963; Schafer, 1960, 1967) opened the way to further study of shame. Kohut's contributions, with their focus on narcissism and self-pathology, have given a language and perspective on self-deficits allowing elaboration of shame's place in psychoanalytic treatment. In this paper, I have focused on the treatment of shame in two patients. I suggest that shame lies at the very center of the narcissistic patient's pathology, with primary internal shaming (directed at the self's failures and inadequacies) permeating all aspects of the treatment. For the neurotic patient, shame is more circumscribed, reflecting partial failures of the self; it tends to be reactive, relating to passive withdrawal from internal conflict and castration fears, and is intermixed with oedipal manifestations. I have described clinical sequences that demonstrate my approach to working with shame in each of these patients. In both cases, the task is to recognize, acknowledge, accept, and investigate the patient's shame. Only after such empathic investigation can underlying conflictual and genetic derivatives be productively pursued. This sequence is often intuitively followed in analysis, but in this paper I have attempted to articulate more systematically shame's role in psychoanalytic treatment.

Adult↗
PubMed1981

Psychiatric role conflicts in the neighborhood health setting.

The current movement of psychiatrists toward the health care system, and away from community mental health, has led to increased psychiatric presence in neighborhood health centers. Neighborhood settings confront the traditionally trained psychiatrist with role and value conflicts, some of which parallel those experienced in community mental health. These conflicts include definition of professionalism, the nature of psychotherapy, and hierarchical power. Other conflicts are specific to the neighborhood health setting, including the place of confidentiality, multidisciplinary relations, and the medical model and remedicalization in psychiatric practice. Residency training must be altered to adequately prepare psychiatrists for these new roles.

Community Mental Health Centers↗