We predicted that participants with schizophrenia would be able to successfully &... more We predicted that participants with schizophrenia would be able to successfully "align" during conversation in the context of impaired theory of mind. Alignment is a process by which interlocutors' representations of the conversational situation converge; and it may, in part, explain how people with schizophrenia can often participate successfully in dialogue despite experiencing impaired mentalising. Fifty-nine people with schizophrenia and 38 healthy adults completed a standardised, empirical conversational alignment task with a mentalising component and a measure of current IQ. The patients also completed two independent theory of mind tests. We used ANCOVAs to compare the groups' performances. The participants with schizophrenia and the healthy participants demonstrated equivalent alignment skills even though the schizophrenia participants displayed clear theory of mind difficulties. Symptom subtype analyses found no differences between subtype groups in alignment, but healthy controls and remitted patients performed significantly better on the mentalising component than the paranoia group. These results are consistent with the schizophrenia participants having intact alignment skills alongside mentalising impairments. We propose that this explains why people with schizophrenia can often participate successfully in conversation but have difficulties with more complex dialogues, with resolving misunderstandings, and with untangling ambiguities during conversation.
BackgroundIt is uncertain whether antipsychotic long-acting injection (LAI) medication in schizop... more BackgroundIt is uncertain whether antipsychotic long-acting injection (LAI) medication in schizophrenia is associated with better clinical outcomes than oral preparations.AimsTo examine the impact of prior treatment delivery route on treatment outcomes and whether any differences are moderated by adherence.MethodAnalysis of data from two pragmatic 1-year clinical trials in which patients with schizophrenia were randomised to either an oral first-generation antipsychotic (FGA), or a non-clozapine second-generation antipsychotic (SGA, CUtLASS 1 study), or a non-clozapine SGA or clozapine (CUtLASS 2 study).ResultsAcross both trials, 43% (n = 155) of participants were prescribed an FGA-LAI before randomisation. At 1-year follow-up they showed less improvement in quality of life, symptoms and global functioning than those randomised from oral medication. This difference was confined to patients rated as less than consistently adherent pre-randomisation. The relatively poor improvement in...
BackgroundEvidence-based psychosocial treatments for schizophrenia founded on Western belief syst... more BackgroundEvidence-based psychosocial treatments for schizophrenia founded on Western belief systems and values may not be efficacious in different cultures without adaptation. This systematic review analyses the nature and outcomes of culturally-adapted psychosocial interventions in schizophrenia, examining how interventions have been adapted, their efficacy and what features drive heterogeneity in outcome.MethodArticles identified by searching electronic databases from inception to 3 March 2016, reference lists and previous reviews were independently screened by two authors for eligible controlled trials. Data on the nature of adaptations was analysed inductively using thematic analyses. Meta-analyses were conducted using random effects models to calculate effect sizes (Hedges’ g) for symptoms.ResultsForty-six studies with 7828 participants were included, seven adapted for minority populations. Cultural adaptations were grouped into nine themes: language, concepts and illness mode...
Background Suicide is a leading cause of death globally. Suicide deaths are elevated in those exp... more Background Suicide is a leading cause of death globally. Suicide deaths are elevated in those experiencing severe mental health problems, including schizophrenia. Psychological talking therapies are a potentially effective means of alleviating suicidal thoughts, plans, and attempts. However, talking therapies need to i) focus on suicidal experiences directly and explicitly, and ii) be based on testable psychological mechanisms. The Cognitive AppRoaches to coMbatting Suicidality (CARMS) project is a Randomised Controlled Trial (RCT) which aims to investigate both the efficacy and the underlying mechanisms of a psychological talking therapy for people who have been recently suicidal and have non-affective psychosis. Methods The CARMS trial is a two-armed single-blind RCT comparing a psychological talking therapy (Cognitive Behavioural Suicide Prevention for psychosis [CBSPp]) plus Treatment As Usual (TAU) with TAU alone. There are primary and secondary suicidality outcome variables, p...
Research and clinical translation in schizophrenia is limited by inconsistent definitions of trea... more Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus. Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimu...
Background Service users and carers using mental health services want more involvement in their c... more Background Service users and carers using mental health services want more involvement in their care and the aim of this research programme was to enhance service user and carer involvement in care planning in mental health services. Objectives Co-develop and co-deliver a training intervention for health professionals in community mental health teams, which aimed to enhance service user and carer involvement in care planning. Develop a patient-reported outcome measure of service user involvement in care planning, design an audit tool and assess individual preferences for key aspects of care planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of implementing service user- and carer-involved care planning. Disseminate resources to stakeholders. Methods A systematic review, focus groups and interviews with service users/carers/health professionals informed the training and determined the prior...
Aims and methodTo investigate the percentage of patients who commenced smoking after transferring... more Aims and methodTo investigate the percentage of patients who commenced smoking after transferring out of a non-smoking forensic psychiatric unit, the corresponding clozapine dose adjustments, the effects on plasma clozapine/norclozapine concentrations and observed changes in mental state. We reviewed the notes and plasma clozapine/norclozapine concentrations of 46 patients transferred to medium secure units between July 2008 and December 2013.ResultsThirty-five patients commenced smoking. Their median clozapine dose was increased by 50 mg/d. In the non-smokers, the median clozapine dose remained unchanged. Plasma clozapine/norclozapine concentrations were significantly reduced in smokers despite dosage adjustment. Eighteen patients experienced deterioration in mental state after transfer; almost all these patients were smokers.Clinical implicationsApproximately three-quarters of patients who were non-smokers by virtue of being in a secure non-smoking environment commenced smoking af...
The original Article did not feature the list of collaborators. This has now been corrected in th... more The original Article did not feature the list of collaborators. This has now been corrected in the PDF and HTML versions of this Article.
We predicted that participants with schizophrenia would be able to successfully &... more We predicted that participants with schizophrenia would be able to successfully "align" during conversation in the context of impaired theory of mind. Alignment is a process by which interlocutors' representations of the conversational situation converge; and it may, in part, explain how people with schizophrenia can often participate successfully in dialogue despite experiencing impaired mentalising. Fifty-nine people with schizophrenia and 38 healthy adults completed a standardised, empirical conversational alignment task with a mentalising component and a measure of current IQ. The patients also completed two independent theory of mind tests. We used ANCOVAs to compare the groups' performances. The participants with schizophrenia and the healthy participants demonstrated equivalent alignment skills even though the schizophrenia participants displayed clear theory of mind difficulties. Symptom subtype analyses found no differences between subtype groups in alignment, but healthy controls and remitted patients performed significantly better on the mentalising component than the paranoia group. These results are consistent with the schizophrenia participants having intact alignment skills alongside mentalising impairments. We propose that this explains why people with schizophrenia can often participate successfully in conversation but have difficulties with more complex dialogues, with resolving misunderstandings, and with untangling ambiguities during conversation.
BackgroundIt is uncertain whether antipsychotic long-acting injection (LAI) medication in schizop... more BackgroundIt is uncertain whether antipsychotic long-acting injection (LAI) medication in schizophrenia is associated with better clinical outcomes than oral preparations.AimsTo examine the impact of prior treatment delivery route on treatment outcomes and whether any differences are moderated by adherence.MethodAnalysis of data from two pragmatic 1-year clinical trials in which patients with schizophrenia were randomised to either an oral first-generation antipsychotic (FGA), or a non-clozapine second-generation antipsychotic (SGA, CUtLASS 1 study), or a non-clozapine SGA or clozapine (CUtLASS 2 study).ResultsAcross both trials, 43% (n = 155) of participants were prescribed an FGA-LAI before randomisation. At 1-year follow-up they showed less improvement in quality of life, symptoms and global functioning than those randomised from oral medication. This difference was confined to patients rated as less than consistently adherent pre-randomisation. The relatively poor improvement in...
BackgroundEvidence-based psychosocial treatments for schizophrenia founded on Western belief syst... more BackgroundEvidence-based psychosocial treatments for schizophrenia founded on Western belief systems and values may not be efficacious in different cultures without adaptation. This systematic review analyses the nature and outcomes of culturally-adapted psychosocial interventions in schizophrenia, examining how interventions have been adapted, their efficacy and what features drive heterogeneity in outcome.MethodArticles identified by searching electronic databases from inception to 3 March 2016, reference lists and previous reviews were independently screened by two authors for eligible controlled trials. Data on the nature of adaptations was analysed inductively using thematic analyses. Meta-analyses were conducted using random effects models to calculate effect sizes (Hedges’ g) for symptoms.ResultsForty-six studies with 7828 participants were included, seven adapted for minority populations. Cultural adaptations were grouped into nine themes: language, concepts and illness mode...
Background Suicide is a leading cause of death globally. Suicide deaths are elevated in those exp... more Background Suicide is a leading cause of death globally. Suicide deaths are elevated in those experiencing severe mental health problems, including schizophrenia. Psychological talking therapies are a potentially effective means of alleviating suicidal thoughts, plans, and attempts. However, talking therapies need to i) focus on suicidal experiences directly and explicitly, and ii) be based on testable psychological mechanisms. The Cognitive AppRoaches to coMbatting Suicidality (CARMS) project is a Randomised Controlled Trial (RCT) which aims to investigate both the efficacy and the underlying mechanisms of a psychological talking therapy for people who have been recently suicidal and have non-affective psychosis. Methods The CARMS trial is a two-armed single-blind RCT comparing a psychological talking therapy (Cognitive Behavioural Suicide Prevention for psychosis [CBSPp]) plus Treatment As Usual (TAU) with TAU alone. There are primary and secondary suicidality outcome variables, p...
Research and clinical translation in schizophrenia is limited by inconsistent definitions of trea... more Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus. Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimu...
Background Service users and carers using mental health services want more involvement in their c... more Background Service users and carers using mental health services want more involvement in their care and the aim of this research programme was to enhance service user and carer involvement in care planning in mental health services. Objectives Co-develop and co-deliver a training intervention for health professionals in community mental health teams, which aimed to enhance service user and carer involvement in care planning. Develop a patient-reported outcome measure of service user involvement in care planning, design an audit tool and assess individual preferences for key aspects of care planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of implementing service user- and carer-involved care planning. Disseminate resources to stakeholders. Methods A systematic review, focus groups and interviews with service users/carers/health professionals informed the training and determined the prior...
Aims and methodTo investigate the percentage of patients who commenced smoking after transferring... more Aims and methodTo investigate the percentage of patients who commenced smoking after transferring out of a non-smoking forensic psychiatric unit, the corresponding clozapine dose adjustments, the effects on plasma clozapine/norclozapine concentrations and observed changes in mental state. We reviewed the notes and plasma clozapine/norclozapine concentrations of 46 patients transferred to medium secure units between July 2008 and December 2013.ResultsThirty-five patients commenced smoking. Their median clozapine dose was increased by 50 mg/d. In the non-smokers, the median clozapine dose remained unchanged. Plasma clozapine/norclozapine concentrations were significantly reduced in smokers despite dosage adjustment. Eighteen patients experienced deterioration in mental state after transfer; almost all these patients were smokers.Clinical implicationsApproximately three-quarters of patients who were non-smokers by virtue of being in a secure non-smoking environment commenced smoking af...
The original Article did not feature the list of collaborators. This has now been corrected in th... more The original Article did not feature the list of collaborators. This has now been corrected in the PDF and HTML versions of this Article.
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