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Graham Dunn

Publications and source records attributed to Graham Dunn.

At least 37 records · Page 2Linked to original sources
PubMed2005

Event attributes and the content of psychotic experiences in first-episode psychosis.

BACKGROUND: Previous psychosocial stress research, contemporary cognitive models, and new cognitive behavioural treatments for psychosis converge in suggesting that stressful events influence the content of psychotic experiences. In this paper we test whether the attributes of stressful events preceding the initial onset of psychosis are associated with core themes of the illness. METHOD: Forty-one people who had experienced a first episode of psychosis were assessed on the attributes of stressful events occurring in the year before onset, the themes (persecutory, depressive, and grandiose) associated with their delusions and the content of their auditory hallucinations. RESULTS: Principal component analysis yielded four components accounting for 72% of the variance. As hypothesized, intrusive events were associated with the development of delusions with persecutory themes. Grandiose delusions were negatively associated with loss events. Depressive delusions appear to be associated with danger events rather than loss events. CONCLUSION: There are links between stressful event attributes and core psychotic themes at first-episode psychosis. This has implications for theoretical models of, and early psychological intervention for, psychosis.

Adult↗
PubMed2005

A pilot validation study of a new measure of activity in psychosis.

BACKGROUND: Wing and Brown [Wing JK and Brown GW (1970) Institutionalism and schizophrenia: a comparative study of three mental health hospitals 1960-1968. Cambridge University Press, London] demonstrated a clear relationship between activity and clinical improvement, using time budget methodology with people with psychosis. However, existing time budget measures are demanding to complete, and simpler, check-box measures of activity rely on subjective frequency judgements and do not include the full range of activities in which an individual might be involved. We report on a pilot validation of a simplified time budget measure of activity levels for routine use as a measure of change with people with psychosis. METHODS: Forty-two participants living in the local community with a schizophrenia spectrum diagnosis were grouped according to length of illness and, within the longer duration group, into high/low activity. All completed the time budget. On a second occasion, 15 participants also completed the subscales of the Social Functioning Scale (SFS) (Br J Psychiatry 157:853-859, 1990) to assess construct validity, and 15 completed the time budget to assess test-retest reliability. RESULTS: The time budget discriminated between duration and activity level groups and showed good inter-rater reliability and test-retest reliability. On the SFS, correlations with subscales measuring withdrawal, activities of daily living and employment were found. CONCLUSIONS: Results indicate that our measure is tapping the activity component of social functioning. A larger scale validation study and investigation of sensitivity to change is underway.

Adolescent↗
PubMed2005

Delusions and decision-making style: use of the Need for Closure Scale.

Clinicians and researchers have suggested that rapidity in belief formation, due to having a high 'need for closure' (NFC), may contribute to the acceptance of delusional explanations. The aim of the study is to determine whether NFC has such a direct link with delusions. A secondary aim is to examine if NFC is related to the delusion-associated reasoning process of 'jumping to conclusions'. One hundred and eighty-seven patients with psychosis, recruited for a treatment trial of psychological therapy (the PRP trial), completed the Need for Closure Scale (NFCS), symptom measures, and probabilistic reasoning tasks. The NFCS was considered in terms of its two dimensions: a desire for simple structure and a preference for quick, decisive answers. The individuals with psychosis reported being poor at making quick, decisive answers but required a greater need for simple structure. NFC was associated with levels of anxiety and depression. There were weak links between NFC and both positive and negative symptoms of psychosis, but these were explained by differences in affect. NFCS scores were unrelated to jumping to conclusions. Contrary to the argument that NFC is directly linked to delusions, individuals with delusions actually perceive themselves as indecisive. There was no evidence that NFC-at least as assessed by the NFCS-could be a proximal cause of delusions. Any potential effect on psychotic symptom presentation is indirect, mediated through affect. The use of the NFCS on its own in the study of psychotic symptoms cannot be recommended.

Adult↗
PubMed2005

The ecological association between suicide rates and indices of deprivation in English local authorities.

INTRODUCTION: There are several published studies that have been focused on the ecological association between suicide rates in different areas with indices of deprivation or fragmentation. Most of these studies, however, have used census-based indices of deprivation or fragmentation. In the present study the newly developed Indices of Deprivation have been used, taking into account the results of the spatial autocorrelation tests. METHODS: Data on all deaths for which suicide or an open verdict was returned during 1996-1998 in England were subjects of this study. These data were provided by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The indices of deprivation and the population counts were provided by the Department of the Environment, Transport and the Region (DETR) and Office for National Statistics (ONS), respectively. RESULTS: The results show that, in England as a whole, the rates of suicide in young and middle-aged males were strongly associated with the indices of deprivation. However, the rates of suicide in females and in older age groups were less influenced by the indices of deprivation. In the present study all the indices of deprivation tended to show a similar pattern in which a better socio-economic status of local authorities was associated with a lower rate of suicide. CONCLUSION: These findings suggest that at the local authority level, the "hot spots" index of deprivation may represent the same level of magnitude in predicting the rates of suicide as the number of unemployed or income-deprived people. However, more studies using multilevel modelling are needed to shed more light on the ecological associations between suicide rates and socio-economic and social cohesion status.

Adolescent↗
PubMed2005

Reasoning, emotions, and delusional conviction in psychosis.

The aim of the study was to elucidate the factors contributing to the severity and persistence of delusional conviction. One hundred participants with current delusions, recruited for a treatment trial of psychological therapy (PRP trial), were assessed at baseline on measures of reasoning, emotions, and dimensions of delusional experience. Reasoning biases (belief inflexibility, jumping to conclusions, and extreme responding) were found to be present in one half of the sample. The hypothesis was confirmed that reasoning biases would be related to delusional conviction. There was evidence that belief inflexibility mediated the relationship between jumping to conclusions and delusional conviction. Emotional states were not associated with the reasoning processes investigated. Anxiety, but not depression, made an independent contribution to delusional conviction.

Adolescent↗
PubMed2005

The psychology of persecutory ideation II: a virtual reality experimental study.

A cognitive model of persecutory delusions is used to predict the occurrence of nonclinical paranoid thoughts in a virtual reality environment. Scorers across the range of paranoia entered a virtual reality scene populated by five computer characters programmed to behave neutrally (N = 30). Many appraisals of the computer characters were positive or neutral. However, there were also persecutory thoughts about the characters. Providing evidence of the validity of the experimental method, persecutory ideation was predicted by higher trait paranoia and a greater sense of presence in the environment. The psychological variables from the cognitive model that predicted persecutory ideation were anxiety, timidity, and hallucinatory predisposition. Further, hallucinatory predisposition distinguished the prediction of paranoid thoughts from social anxiety in virtual reality. It is concluded that nonclinical paranoid thoughts are most closely associated with emotional disturbances and anomalous experiences. Extreme reasoning bias may particularly contribute to the development of clinical phenomena.

Adult↗
PubMed2005

The psychology of persecutory ideation I: a questionnaire survey.

Paranoia is a complex phenomenon that is likely to arise from a number of factors. In a recent cognitive model of persecutory delusions, three key factors are highlighted: anomalous experiences, emotion, and reasoning. In the first of two linked studies, we report a questionnaire survey of nonclinical paranoia designed to assess the theoretical model. A nonclinical population (N = 327) completed measures of paranoia, anomalous experiences (hallucinatory predisposition, perceptual anomalies), emotion (depression, anxiety, self-focus, stress, interpersonal sensitivity), and reasoning (need for closure). Paranoia was best explained by separation anxiety, depression, fragile inner self, hallucinatory experiences, discomfort with ambiguity, stress, self-focus, perceptual anomalies, and anxiety. The findings are consistent with the central predictions within the model of paranoia.

Adult↗
PubMed2005

Trauma and hallucinatory experience in psychosis.

Recent research indicates that there may be phenomenological, symptom, and diagnostic associations between trauma and hallucinations. However, the nature of the relationship is poorly understood from a psychological perspective. We report a theoretically informed phenomenological study. From descriptions of reported traumas and hallucinations, we assessed the rates of four types of hypothesized association between traumas and hallucinations (direct, indirect, stress, and none) in 75 participants with nonaffective psychosis. In a subgroup who had experienced trauma (N = 40), 12.5% had hallucinations with similar themes and content to their traumas, 45% had hallucinations in which the themes were the same but not the content, and 42.5% had no identifiable associations between their hallucinations and previously experienced trauma. Traumas rated as intrusive were significantly associated with hallucinations rated as intrusive, although intrusive hallucinations were not associated with traumas in general. The traumas most likely to be associated with hallucinations were sexual abuse and bullying.

Accidents↗
PubMed2005

Estimating treatment effects from randomized clinical trials with noncompliance and loss to follow-up: the role of instrumental variable methods.

Perfectly implemented randomized clinical trials, particularly of complex interventions, are extremely rare. Almost always they are characterized by imperfect adherence to the randomly allocated treatment and variable amounts of missing outcome data. Here we start by describing a wide variety of examples and then introduce instrumental variable methods for the analysis of such trials. We concentrate mainly on situations in which compliance is all or nothing (either the patient receives the allocated treatment or they do not--in the latter case they may receive no treatment or a treatment other than the one allocated). The main purpose of the review is to illustrate the use of latent class (finite mixture) models, using maximum likelihood, for complier-average causal effect estimation under varying assumptions concerning the mechanism of the missing outcome data.

Depression↗
PubMed2005

Psychological investigation of the structure of paranoia in a non-clinical population.

BACKGROUND: Previous studies of paranoia have assessed only limited numbers of paranoid thoughts, and have not considered the experience from a multidimensional perspective or examined the relationship between different suspicious thoughts. AIMS: To assess a wide range of paranoid thoughts multidimensionally and examine their distribution, to identify the associated coping strategies and to examine social-cognitive processes and paranoia. METHOD: Six questionnaire assessments were completed by 1202 individuals using the internet. RESULTS: Paranoid thoughts occurred regularly in approximately a third of the group. Increasing endorsement of paranoid thoughts was characterised by the recruitment of rarer and odder ideas. Higher levels of paranoia were associated with emotional and avoidant coping, less use of rational and detached coping, negative attitudes to emotional expression, submissive behaviours and lower social rank. CONCLUSIONS: Suspiciousness is common and there may be a hierarchical arrangement of such thoughts that builds on common emotional concerns.

Adaptation, Psychological↗
PubMed2005

The prediction of hallucinatory predisposition in non-clinical individuals: examining the contribution of emotion and reasoning.

BACKGROUND: Emotion, especially anxiety, has been implicated in triggering hallucinations. Reasoning processes are also likely to influence the judgments that lead to hallucinatory experiences. We report an investigation of the prediction of hallucinatory predisposition by emotion and associated processes (anxiety, depression, stress, self-focused attention) and reasoning (need for closure, extreme responding). METHOD: Data were analysed from a questionnaire survey in a student population (N = 327). RESULTS: Higher levels of anxiety, self-focus, and extreme responding were associated with hallucinatory predisposition. Interactions between these three variables did not strengthen the predictive effect of each. Depression, stress, and need for closure were not found to be predictors of hallucinatory experience in the regression analysis. CONCLUSION: Emotional and reasoning processes may both need to be considered in the understanding of hallucinatory experience.

Adult↗
PubMed2005

Dendritic cells and HNSCC: a potential treatment option? (Review).

Patient survival in head and neck squamous cell cancer (HNSCC) has not changed significantly in many years, despite progress in surgical, radiotherapy and chemotherapy techniques. Immunotherapy, a rapidly progressing alternative cancer treatment, aims to prompt or assist the body's immune system to combat the disease itself. A number of strategies exist including the use of dendritic cells, natural antigen presenting cells capable of stimulating an anti-tumor immune response. Encouraging work has been performed using these cells as vaccines against a number of tumors especially melanoma. Work with head and neck cancer is also encouraging, but less advanced. Dendritic cell presence in head and neck squamous cell cancers is associated with an improved prognosis, however due to immunosuppression, the exact mechanism of which remains poorly understood, these cells do not function efficiently. This prevents the stimulation of an effective anti-tumor immune response by the patient and allows tumor growth to continue. This review summarises the current level of understanding of dendritic cells and their relationship with HNSCC. It briefly summarises work with dendritic cells and other cancers where relevant to HNSCC; dendritic cells and head and neck cancer; the possible causes of dendritic cell impairment; the techniques used to restore their function and the methods used to prime the dendritic cells prior to their use as vaccines for the stimulation of an anti-tumor response.

Antigen Presentation↗
PubMed2004

Personality disorder, depression and functioning: results from the ODIN study.

BACKGROUND: There is little information of the prevalence of personality disorder (PD) in those with depressive disorder in community samples; neither is there any data on the impact of PD on service utilisation or outcome in this setting. METHODS: A two stage screening study to identify cases of depressive disorder using SCAN in five European countries. Personality assessed 6 months after the diagnostic interview. Follow-up for 1 year using symptom and social function measures. RESULTS: Personality disorder is present in 22% of a community sample with depressive disorders but the range varied from 13.7% to 33.3% across countries. Cluster C formed 43% of the total. Long-term psychotropic drug use was more common in the PD group even after depression was controlled. Those with PD had higher symptom scores at the outset and, although the PD group was more likely to be cases at follow-up, this disappeared when the depression score was co-varied. Only initial social function predicted outcome at 6 and 12 months. LIMITATIONS: The use of a non-treatment seeking population may limit the application of the findings to clinical populations. CONCLUSIONS: PD is common even in a non-treatment seeking population with depressive disorder. It impacts upon outcome at 6 and 12 months but this is related to the initial severity of depressed mood. Social function is the only independent predictor of outcome and should be assessed separately.

Activities of Daily Living↗
PubMed2004

The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis.

OBJECTIVE: To evaluate the effectiveness of a service for early psychosis. DESIGN: Randomised controlled clinical trial. SETTING: Community mental health teams in one London borough. PARTICIPANTS: 144 people aged 16-40 years presenting to mental health services for the first or second time with non-organic, non-affective psychosis. INTERVENTIONS: Assertive outreach with evidence based biopsychosocial interventions (specialised care group) and standard care (control group) delivered by community mental health teams. PRIMARY OUTCOME MEASURES: Rates of relapse and readmission to hospital. RESULTS: Compared with patients in the standard care group, those in the specialised care group were less likely to relapse (odds ratio 0.46, 95% confidence interval 0.22 to 0.97), were readmitted fewer times (beta 0.39, 0.10 to 0.68), and were less likely to drop out of the study (odds ratio 0.35, 0.15 to 0.81). When rates were adjusted for sex, previous psychotic episode, and ethnicity, the difference in relapse was no longer significant (odds ratio 0.55, 0.24 to 1.26); only total number of readmissions (beta 0.36, 0.04 to 0.66) and dropout rates (beta 0.28, 0.12 to 0.73) remained significant. CONCLUSIONS: Limited evidence shows that a team delivering specialised care for patients with early psychosis is superior to standard care for maintaining contact with professionals and for reducing readmissions to hospital. No firm conclusions can, however, be drawn owing to the modest sample size.

Adolescent↗
PubMed2004

The production and interpretation of disease mapsA methodological case-study.

BACKGROUND: The study of the spatial variation in disease incidence is a vital component of descriptive epidemiology. The production of attractive and informative disease maps complements any formal statistical analyses of spatial variations and often their visual impact will influence the recipient of the information much more than the accompanying statistics. Like any other graphical display, however, a map can both inform and mislead. METHODS: We describe methodological alternatives and pitfalls for the production of disease maps using data on recent suicides in England and Wales as an illustrative example. RESULTS: Decisions concerning the methods of mapping of suicide rates, including smoothing, choice of grouping criteria and colouring scheme dramatically influence the resulting map and how it might be interpreted by the reader. CONCLUSIONS: This study provides clinicians and other non-specialist research workers an insight into the methodological pitfalls of disease mapping and atlas production and should also act as a methodological framework for a critical appraisal of published maps and atlases.

Cause of Death↗
PubMed2004

Autosomal recessive hereditary spastic paraparesis with thin corpus callosum; report of two sisters.

OBJECTIVES: To describe the clinical, cognitive, neurophysiological and radiological features of autosomal recessive hereditary spastic paraparesis (ARHSP) with thin corpus callosum. PATIENTS AND METHODS: Two sisters with spastic paraparesis. RESULTS: MRI brain scans demonstrated thinning of the corpus callosum. The clinical features were progressive spastic paraparesis beginning in the second decade, dysarthria, minor dystonia and chorea, distal weakness and cognitive impairment with frontal dysfunction. Motor compound action potentials are reduced and EMG demonstrated minor chronic denervation. Magnetic stimulation studies demonstrated increased threshold consistent with pyramidal system axonal loss. CONCLUSIONS: AHRSP with thinned corpus callosum is a distinct clinical and genetic entity that may occur in non-Japanese individuals.

Adult↗