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Biomedical subjects

Max Birchwood

Publications and source records attributed to Max Birchwood.

12 recordsLinked to original sources
PubMed2004

Acting on command hallucinations and dangerous behavior: a critique of the major findings in the last decade.

Command hallucinations (CH) have recently become the focus of research into positive symptoms of schizophrenia. The importance of CH has become clear for theoretical and practical reasons, because CH are regarded as potentially the most dangerous symptoms of schizophrenia. The aim is to critically review research that has attempted to better understand CH and develop theories that may predict behavior and shape psychological treatments. This review draws together, presents, and critically discusses the current disparate body of literature produced (1990-2000) considering compliance with CH. The literature can be grouped broadly into three overlapping classes. (1) Studies testing for a relationship between CH and compliance. (2) Studies considering factors associated with acting on CH (mediating variables). (3) Studies that look for a relationship between CH and dangerous behavior. The body of literature is in its infancy and marred by methodological difficulties. Researchers have asked differing questions about different samples while hoping to provide similar answers. While acknowledging difficulties in interpreting the literature, themes do emerge. The weight of the evidence is that some individuals who hear commands will act on them. However, some studies show no link or only a weak link and although methodological errors account for some of the inconsistent results, there are also clearly individual differences. The relationship between command and action is more complex than many researchers have assumed. One conjecture is that the relationship is established via psychological processes or mediating variables which include beliefs about the voice and content of instruction. Prediction of compliance with commands is of further interest when dangerous behavior results. It is postulated that the issue of dangerousness is subject to the same mediating variables as other commands. It is clear however, that CH are not sufficient to produce action in isolation and that psychological processes mediate the process.

Acting Out↗
PubMed2004

The trauma of first episode psychosis: the role of cognitive mediation.

OBJECTIVE: First episode psychosis can be a distressing and traumatic event which has been linked to comorbid symptomatology, including anxiety, depression and PTSD symptoms (intrusions, avoidance, etc.). However, the link between events surrounding a first episode psychosis (i.e. police involvement, admission, use of Mental Health Act, etc.) and PTSD symptoms remains unproven. In the PTSD literature, attention has now turned to the patient's appraisal of the traumatic event as a key mediator. In this study we aim to evaluate the diagnostic status of first episode psychosis as a PTSD-triggering event and to determine the extent to which cognitive factors such as appraisals and coping mechanisms can mediate the expression of PTSD (traumatic) symptomatology. METHOD: Approximately 1.5 years after their first episode of psychosis, patients were assessed for traumatic symptoms, conformity to DSM-IV criteria for posttraumatic stress disorder (PTSD), and their appraisals of the traumatic events and coping strategies. Psychotic symptomatology was also measured. RESULTS: 31% of the sample of 35 patients who agreed to participate reported symptoms consistent with a diagnosis of PTSD. Although no relationship was found between PTSD (traumatic) symptoms and potentially traumatic aspects of the first episode (including place of treatment, detention under the MHA etc.), intrusions and avoidance were positively related to retrospective appraisals of stressfulness of the ward (i.e. the more stressful they rated it the greater the number of PTSD symptoms) and the patient's coping style (sealers were less likely to report intrusive re-experiencing but more likely to report avoidance). CONCLUSIONS: The results call into question whether it is possible to make claims for a simple causal link between psychosis and PTSD. Instead patients' appraisals of potentially traumatic events and their coping styles may mediate the traumatic impact of a first episode of psychosis.

Adaptation, Psychological↗
PubMed2004

Cognitive therapy for command hallucinations: randomised controlled trial.

BACKGROUND: Command hallucinations are a distressing and high-risk group of symptoms that have long been recognised but little understood, with few effective treatments. In line with our recent research, we propose that the development of an effective cognitive therapy for command hallucinations (CTCH) would be enhanced by applying insights from social rank theory. AIMS: We tested the efficacy of CTCH in reducing beliefs about the power of voices and thereby compliance, in a single-blind, randomised controlled trial. METHOD: A total of 38 patients with command hallucinations, with which they had recently complied with serious consequences, were allocated randomly to CTCH or treatment as usual and followed up at 6 months and 12 months. RESULTS: Large and significant reductions in compliance behaviour were obtained favouring the cognitive therapy group (effect size 1.1). Improvements were also observed in the CTCH but not the control group in degree of conviction in the power and superiority of the voices and the need to comply, and in levels of distress and depression. No change in voice topography (frequency, loudness, content) was observed. The differences were maintained at 12 months' follow-up. CONCLUSIONS: The results support the efficacy of cognitive therapy for CTCH.

Adult↗
PubMed2004

Adapting to the challenge of psychosis: personal resilience and the use of sealing-over (avoidant) coping strategies.

BACKGROUND: Avoidance coping (e.g. sealing over) is common in people recovering from psychosis, but it is not understood why some individuals 'seal over'. AIMS: We examined the hypothesis that individuals who 'seal over' do not have the personal resilience to withstand this major life event. METHOD: Fifty participants were interviewed during an acute episode of psychosis and reassessed at 3-month and 6-month follow-up. Measures included psychotic symptoms, recovery style, service engagement, parental and adult attachment and self-evaluative beliefs. RESULTS: Sealing-over recovery styles are associated with negative early childhood experience, insecure adult attachment, negative self-evaluative beliefs and insecure identity. Insecure adult attachment was associated with less engagement with services. CONCLUSIONS: Sealing over was associated with multiple signs of low personal resilience in adapting to psychosis.

Adaptation, Psychological↗
PubMed2004

Autobiographical memory and post-psychotic depression in first episode psychosis.

OBJECTIVES: In unipolar depression, the action of early life events has been shown to be linked to a deficit in accessing details of such autobiographical events ('overgeneral memory'). In this study, we test whether a similar deficit can be observed in post-psychotic depression (PPD) in first-episode psychosis. METHOD: A group of 29 patients were followed up during the 12 months after their first onset, and monitored for PPD. RESULTS: Of the sample group, 45% developed PPD, which was associated with overgeneral memory (p <.05; effect size = 1.05) and a heightened awareness of the diagnosis. CONCLUSIONS: Our findings raise the possibility that anomalies of psychosocial development may confer vulnerability to depression in psychosis.

Autobiographies as Topic↗
PubMed2003

Predicting engagement with services for psychosis: insight, symptoms and recovery style.

BACKGROUND: Treatment non-adherence and service disengagement are commonly attributed to impaired insight. There is evidence that recovery style (i.e. psychological adjustment) may underlie service engagement. AIMS: We examined whether insight, psychotic symptoms or individuals' recovery style ('integration' v. 'sealing-over') predicts service engagement. METHOD: Fifty patients with schizophrenia were assessed during acute psychosis and at 3-month and 6-month follow-ups. Measures included recovery style, psychosis symptoms, insight and service engagement. RESULTS: Sealing-over at 3 months following onset of an episode of psychosis predicted low service engagement at 6 months. Neither insight nor symptoms predicted engagement. The clear shift from integration to sealing-over within the first 3 months was independent of changes in symptoms or insight. Sealing-over between 3 and 6 months was associated with improvement in psychosis symptoms. CONCLUSIONS: Recovery style contributed more to engagement than did insight, appears to be dynamic in the short term and is orthogonal to insight. Overall, this study demonstrated the importance of addressing psychological adjustment to psychosis as well as illness status when investigating treatment engagement in people with psychosis.

Acute Disease↗
PubMed2003

The concept of schizophrenia and phase-specific treatment: cognitive-behavioral treatment in pre-psychosis and in nonresponders.

The development of psychosis is often described as a process that goes through different linear stages such as a premorbid and a prodromal phase, with the onset of psychosis as the end state. In this article we elaborate a hierarchical model in which psychosis is understood at different levels of abstraction: we differentiate an etiological, a descriptive, and a therapeutical level, and finally a level of understanding. We regard coping as a special psychological process that starts when symptoms of psychosis first emerge (often many years before treatment is initiated) and continues throughout therapy. In patients who do not respond very well to standard treatment (approximately 15-20% of all patients who suffer from schizophrenia), coping strategies are probably some of the most important long-term prognostic factors. Two cognitive-oriented treatment programs are described: the German model for possible pre-psychosis and the UK tradition for treatment of chronic psychotic symptoms (nonresponders). We conclude that psychological treatment that focuses on coping strategies might be of help both in possible pre-psychotic stages and in nonresponders.

Adaptation, Psychological↗
PubMed2002

Duration of untreated psychosis and pathways to care in first-episode psychosis. Investigation of help-seeking behaviour in primary care.

BACKGROUND: Studies have consistently found that many individuals with first-episode psychosis experience significant delays before receiving treatment. Current research investigating treatment delays has focused on the relationship between demographic factors and duration of untreated psychosis (DUP). However, treatment-seeking behaviours in this group have not been investigated. AIMS: To examine psychological processes that influence the decision-making process to contact primary care, in individuals with emerging psychosis. METHOD: The influence of coping style, health locus of control and past health help-seeking behaviour on DUP was investigated in clients with a first episode of psychosis. This involved scrutiny of general practitioner (GP) records in an average of 6 years before the first treatment. RESULTS: Shorter DUP was associated with more frequent GP attendance in the 6 years before the onset of psychosis and lower health threat avoidant coping scores. CONCLUSIONS: Patients with short DUP have history of higher contact with their GP and, as a group, tend not to avoid health threats. The study underlines the importance of engaging young people and their families with primary care as one of a series of strategies to reduce DUP.

Adaptation, Psychological↗