Biomedical subjects

Lynsey Gregg

Publications and source records attributed to Lynsey Gregg.

15 recordsLinked to original sources

PubMed2006

Suicide behaviour over 18 months in recent onset schizophrenic patients: the effects of CBT.

The results of a trial of cognitive behaviour therapy, supportive counselling and treatment as usual in recent onset schizophrenia on suicide behaviour are reported. Treatment was delivered over a five week period during hospitalisation for an acute episode. Participants were assessed at baseline, 6 weeks, 3 and 18 months. Over the 18 months there were 3 definite suicides and 2 deaths by accidental causes. The rates of moderate to severe suicidal behaviour were 13% at admission, 4% at six weeks, 1.5% at three months and 6% at 18 months. There were no beneficial or adverse effects of psychological treatment on suicide behaviour that reduced significantly with clinical recovery. There is a general picture of those who suffer persistently higher levels of psychotic symptoms, poorer functioning, depression and low self-esteem have higher severity of suicide behaviour, although the numbers with clinically significant suicide behaviour are low. CBT may need to be modified to directly target suicide behaviour and its antecedents to significantly reduce risk; recommendations on this are made.

Acute Disease↗

PubMed2006

The acceptability and preference for the psychological treatment of PTSD.

The acceptability and preference of psychological treatments is important in understanding patient treatment seeking, choice, engagement and attrition and possibly treatment response in health care. The acceptability of, and preference for, 14 different types of psychological treatment for posttraumatic stress disorder (PTSD) were investigated in a student population through invitation to participate in a web-based survey. Respondents were asked to rate each treatment on 10 scales and to rank the treatments in order of preference. Respondents were also asked whether they would seek treatment themselves, recommend treatment to friends and family, feel stigmatised by suffering from PTSD, had any prior knowledge of the treatments and if this had been positive or negative and whether they had a history of psychological problems or treatment. A total of 330 respondents completed the survey. A past or current history of psychological problems and treatment was surprisingly high. Almost all respondents indicated that they would seek or recommend treatment in spite of high levels of stigmatisation. Factor analysis of the 10 scales indicated two factors: Endorsement and Discomfort. Rank ordering on preference and Endorsement scores was highly consistent. The highly preferred and endorsed treatments involved cognitive therapy, exposure or psycho-education in spite of high levels of discomfort anticipated with exposure. Treatments involving new technologies, EMDR and psychodynamic psychotherapy received the lowest Endorsement and preference. There was a modest influence of prior knowledge of a treatment.

Adolescent↗

PubMed2006

Impaired verbal self-monitoring in psychosis: effects of state, trait and diagnosis.

BACKGROUND: Cognitive models propose that auditory verbal hallucinations arise through defective self-monitoring and external attribution of inner speech. We used a paradigm that engages verbal self-monitoring to examine how deficits in this process are related to symptoms and diagnosis in patients with psychosis. METHOD: We tested 45 patients with schizophrenia. Fifteen had current auditory hallucinations, 15 had a history of (but no current) auditory hallucinations, and 15 had delusions but neither current nor previous hallucinations. We also tested 10 patients with affective psychosis and current auditory hallucinations, and 20 healthy volunteers. Participants read single adjectives aloud while the source and the pitch of the on-line auditory verbal feedback was manipulated, then immediately identified the source of the speech they heard ('self'/'other'/'unsure'). RESULTS: When reading aloud with distorted feedback of their own voice, patients with schizophrenia who had auditory hallucinations were more likely than controls to misidentify its source as 'other'. Patients with delusions but no current hallucinations displayed a similar deficit, although there was a trend for this to be less marked. Patients with a history of hallucinations did not differ from controls. Patients with hallucinations in the context of an affective disorder made more unsure responses rather than misattributions. CONCLUSIONS: Difficulty with source monitoring was related to the acute psychotic state rather than a predisposition to hallucinations, and was evident in patients with affective psychosis as well as schizophrenia. External misattribution of source may reflect an impairment in verbal self-monitoring and/or the appraisal of ambiguous sensory material.

Adult↗

PubMed2006

Group cognitive-behavioural therapy for schizophrenia. Randomised controlled trial.

BACKGROUND: The efficacy of cognitive-behavioural therapy for schizophrenia is established, but there is less evidence for a group format. AIMS: To evaluate the effectiveness of group cognitive-behavioural therapy for schizophrenia. METHOD: In all, 113 people with persistent positive symptoms of schizophrenia were assigned to receive group cognitive-behavioural therapy or treatment as usual. The primary outcome was positive symptom improvement on the Positive and Negative Syndrome Scales. Secondary outcome measures included symptoms, functioning, relapses, hopelessness and self-esteem. RESULTS: There were no significant differences between the cognitive-behavioural therapy and treatment as usual on measures of symptoms or functioning or relapse, but group cognitive-behavioural therapy treatment resulted in reductions in feelings of hopelessness and in low self-esteem. CONCLUSIONS: Although group cognitive-behavioural therapy may not be the optimum treatment method for reducing hallucinations and delusions, it may have important benefits, including feeling less negative about oneself and less hopeless for the future.

Adult↗

PubMed2005

Expressed emotion and attributions in relatives of schizophrenia patients with and without substance misuse.

OBJECTIVE: To test the hypotheses that carers of patients with schizophrenia (single diagnosis) and schizophrenia and co-occurring drug or alcohol misuse (dual diagnosis) will differ in terms of expressed emotion (EE) and their attributions for patient problems. METHOD: In a cross-sectional study, two samples of 42 single- and dual-diagnosis carers are compared in terms of EE and attributions. Patient symptoms are assessed to control for differences other than substance misuse. RESULTS: The study supports the hypothesis that high-EE, dual-diagnosis carers tend to see patient problems as more blaming (internal, controllable and personal) than do single-diagnosis patients. This difference was particularly marked when making causal ascriptions for deficit behaviours. Although there were no differences in overall EE levels in the two groups, there were significantly more carers who were rated as hostile and rejecting in the dual-diagnosis group. CONCLUSIONS: The findings highlight the importance of family intervention for this patient group.

Adult↗

PubMed2005

A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England.

Expressed emotion (EE) research has been productive in investigating the influence of the interpersonal environment on a range of disorders. The majority of EE research on the influence of carers has been carried out in the west. This is the first EE study of the carers of people with dementia in Japan. The aim of this study was to investigate the relationships between EE status and aspect of burden through cross-cultural comparison of the two countries, Japan and England, with large cultural and linguistic differences. Comparisons were made between samples of EE of carers of dementia and schizophrenic patients. In total, data on 80 carer/relative-patient dyads were collected and examined: (1) 20 Japanese carers of people with dementia (JD), (2) 20 English carers of patients with Alzheimer's disease (ED), (3) 20 Japanese relatives of patients with schizophrenia (JS), and (4) 20 English relatives of patients with schizophrenia (ES). The Camberwell Family Interview was administered in each country to ascertain levels of EE. Large differences between Japan and England were found in the frequency of critical comments, in which ES>ED>JS>JD. EE correlated significantly with burden in the JD sample alone. With an operational cut-off of 2CC (CC, critical comments), EE correlated significantly with cognitive impairment as well as with clinical severity in the JD sample. There was a tendency for lower expression of both positive and negative emotional reactions towards family members in the Japanese sample. The results of this study indicate that EE is an appropriate measure for use with carers of sufferers of dementia and can be utilized across different cultures. However, flexibility with the cut-offs may be required in Eastern cultures. This needs to be tested on larger samples with sensitivity to illness and cross-cultural differences.

Adolescent↗

PubMed2005

The influence of pre-existing psychiatric illness on recovery in burn injury patients: the impact of psychosis and depression.

We hypothesised that patients with a co-morbid psychiatric illness would show poorer outcomes in recovery from their burn injury compared to patients with equivalent burn injury but without a pre-existing psychiatric illness. A secondary aim was to investigate the effect of self-inflicted burn injury. Consecutive admissions (n = 190) to a burns inpatient unit were screened for the existence of a formal pre-burn psychiatric disorder. Nine patients suffering from psychosis and eight suffering from depression were matched with 18 and 15 patients, respectively not suffering a pre-burn psychiatric disorder on gender, age, burn severity, type, depth and location. Patients with a pre-burn psychiatric diagnosis spent significantly longer in hospital, spent more time in care until discharged from outreach and their burn injuries took longer to heal than matched burn injury patients without a pre-existing psychiatric illness. Time in hospital and to wound healing were significantly greater in psychotic patients compared to their controls but not between depressed patients and their matched controls. Both psychotic and depressed patients had significantly more surgery than their matched controls. Patients whose burn was self-inflicted spent significantly longer in hospital and their wounds took longer to heal. Patients with pre-existing psychiatric conditions, especially psychosis, and those with self-inflicted injuries are associated with difficulties in clinical management and higher economic cost yet staff receive very little specialist training in their management.

Adult↗

PubMed2004

Behavior problems antecede the development of wheeze in childhood: a birth cohort study.

RATIONALE: It is not clear to what extent behavior problems observed in children with asthma antecede asthma development, or are a consequence of the disease. OBJECTIVES: We investigated psychologic factors at age 3 years and subsequent development of wheeze by age 5 in an unselected birth cohort study. Children were recruited prenatally, followed prospectively, and reviewed at age 3 and 5 years. The rate of significant behavior problems at age 3 (above the clinically relevant cut-off on the Eyberg Child Behavior Inventory) was compared between children who had never wheezed (n = 397) and those developing late-onset wheezing (after age 3 years; n = 39). Late-onset wheezers were more likely to be above cut-offs for behavior problems at 3 years (before wheeze onset), compared with children who never wheezed, on Intensity (23.1% vs. 6.0%, p < 0.001) and Problem scores (10.8% vs. 1.3%, p < 0.001). Families of late-onset wheezers had poorer scores on family functioning variables, but we found no evidence of increased anxiety or depression scores in parents. In the multivariate analysis, significant and independent associates of late-onset wheeze were as follows: maternal asthma (odds ratio [OR] 5.4, 95% confidence intervals [CI] 2.1-13.8, p < 0.001), maternal smoking when child was 3 years (OR 3.3, CI 1.2-8.7, p = 0.02), expressiveness (OR 0.71, CI 0.55-0.9, p = 0.005), and significant behavior problems at age 3 years (OR 3.5, CI 1.2-9.9, p = 0.02). CONCLUSIONS: Behavior problems in early life are associated with increased risk of subsequent development of wheeze.

Age of Onset↗

PubMed2004

Suicide risk in civilian PTSD patients--predictors of suicidal ideation, planning and attempts.

BACKGROUND: There appears to be a strong connection between suicidality and the experience of trauma. The study investigated suicidality in chronic civilian post-traumatic stress disorder (PTSD). METHOD: Ninety-four participants suffering from chronic PTSD were assessed for suicidal ideation, plans and attempts since the index trauma as part of a comprehensive assessment. The prevalence of these was assessed and characteristics of those reporting suicide-related thoughts and behaviour were investigated through logistic and multinominal regression analyses. RESULTS: Over half of the sample (56.4%) reported some aspect of suicidality with 38.3% reporting ideation, 8.5% reporting suicide plans and 9.6% having made suicide attempts since the trauma. Of the nine participants who reported suicide attempts, six had made more than one attempt. The proportions of participants who reported suicidality in this sample were significantly greater than reported within the general population, when comparisons were made with an epidemiological study. Logistic regression analysis indicated that a unit increase in life impairment (OR = 3.1) and depression (OR = 1.14) scores were independently and significantly associated with suicidality. Multinominal regression indicated that life impairment (OR = 2.71) and depression (OR = 1.13) scores were associated with the presence of suicidal ideation compared to no ideation, and life impairment (OR = 5.75), depression (OR = 1.2) scores and receiving psychotropic medication (OR = 10.6) were associated with the presence of plans and attempts compared to no suicidal behaviour. CONCLUSIONS: Suicide risk is elevated in those suffering from chronic PTSD and is associated with impaired functioning in combination with depression.

Adult↗

PubMed2004

Risk of non-fatal suicide ideation and behaviour in recent onset schizophrenia--the influence of clinical, social, self-esteem and demographic factors.

BACKGROUND: Suicide rates amongst schizophrenic patients are high. There are disadvantages in investigating successfully completed suicides which make suicidal ideation and previous attempts important proxy measures of suicidal risk. The aim of this study was to investigate factors associated with these risk measures. METHOD: Fifty-nine patients suffering recent onset schizophrenia were assessed for suicidal ideation and history, and a range of demographic, clinical, social (including relatives' Expressed Emotion) and self-esteem measures. Univariate comparisons were made between those with and without suicide ideation and previous attempts. Path analysis was conducted to identify factors directly or indirectly associated with a composite scale of risk (low, medium or high). RESULTS: Approximately 25% of the sample reported a current desire to kill themselves and 47% had made one or more previous attempts. There were numerous significant univariate differences between those with or without ideation or history. Path analysis indicated that greater hopelessness (OR 1.22) and longer duration of illness (OR 1.13) increased risk. Hopelessness was associated with higher negative self-evaluation and social isolation. Negative self-evaluation was associated with more relatives' criticism which was associated with more negative symptoms. Being a male, unmarried and unemployed were all significantly associated with an increase in negative symptoms. Social isolation was associated with being unemployed, older, more positive symptoms and longer illness duration. Duration of illness was not itself predicted by any other variables. CONCLUSION: Non-fatal suicide ideation and behaviour are significantly associated with an array of demographic, clinical, interpersonal and psychological factors. To reduce risk of suicide, these factors need to be assessed and methods developed to reduce their influence.

Adolescent↗

PubMed2003

Establishing the reliability of a verbal self-monitoring paradigm.

BACKGROUND: Auditory hallucinations in schizophrenia are associated with defective monitoring of inner speech. This process can be examined using a computerised task of verbal self-monitoring. Cognitive therapy for voices aims to improve the patients' self-monitoring ability, and changes in self-monitoring could be assessed using this task. Before using the paradigm in this way, we sought to determine its test re-test reliability. SAMPLING AND METHODS: 20 normal volunteers were tested on the paradigm on two occasions, 3 months apart. The task involved reading single adjectives under the following randomized conditions: reading aloud; reading aloud with acoustic distortion of their own voice; reading aloud with alien feedback (someone else's voice), and reading aloud with distorted alien feedback. Immediately after articulating each word, the participants were required to identify the source of the speech they heard ('self'/'other'/'unsure') via a button press. Response choice and reaction time were recorded. RESULTS: There was no change in error rate over the two testing occasions; however, participants had faster reaction times when tested for the second time. This reduction in reaction time was not specific to type of response (correct, error, unsure). CONCLUSIONS: Participants showed no evidence of practice on the paradigm in terms of making fewer errors or responding faster for correct responses. The overall reduction in reaction times on the second occasion may reflect increased familiarity with the task. The verbal self-monitoring paradigm appears to be a reliable measure, which could be used to evaluate changes in self-monitoring ability in hallucinators following psychological therapy.

Adolescent↗

PubMed2003

Childhood asthma, behavior problems, and family functioning.

BACKGROUND: Studies of families of asthmatic children indicate associations between psychological factors and asthma symptoms. OBJECTIVE: We investigated relations between psychosocial factors and the development of respiratory symptoms within a large prospective cohort study. METHODS: The children were prenatally assigned to high, medium, or low risk for asthma development on the basis of parental atopy and family history of allergic disease. When the children were 3 years of age, parents completed the Eyberg Child Behavior Inventory (ECBI), Family Relationships Index (FRI), Hospital Anxiety and Depression Scale (HAD), and General Health Questionnaire (GHQ). RESULTS: Data from 663 participants were analyzed. ECBI intensity scores were significantly higher for children with parentally reported respiratory symptoms. Symptomatic low-risk children (both parents nonatopic, no family history of allergic disease) were particularly likely to have elevated behavior problem ratings. None of the other family psychosocial variables showed this pattern. Child behavior problems were, however, significantly positively correlated with the other family psychosocial variables. Logistic regression indicated that behavior problem scores were associated with 3 or more attacks of wheeze (P =.03, OR = 1.023), irrespective of risk group. CONCLUSIONS: Children at 3 years of age with symptoms suggestive of asthma are at elevated risk of behavior problems. Children from families without a history of asthma and allergic diseases may be particularly vulnerable to behavioral disturbance. Families may benefit from additional advice on management of their child's behavior, particularly if parents do not have the experience of having the illness themselves.

Asthma↗

PubMed2003

Self-esteem in schizophrenia: relationships between self-evaluation, family attitudes, and symptomatology.

Participants with schizophrenia (N = 59) were assessed on self-evaluation, symptomatology, and positive and negative affect (expressed emotion) from significant others. An interview-based measure of self-evaluation was used and two independent dimensions of self-esteem were derived: negative and positive evaluation of self. As predicted, negative self-evaluation was strongly associated with positive symptoms, a more critical attitude from family members was associated with greater negative self-evaluation, and analyses supported a model whereby the impact of criticism on patients' positive symptoms was mediated by its association with negative self-evaluation. The interview-based method of self-esteem assessment was found to be superior to the questionnaire because its predictive effects remained after depressed mood was accounted for.

Adolescent↗

PubMed2002

Expressed emotion and attributions in the carers of patients with Alzheimer's disease: the effect on carer burden.

Burden of care, expressed emotion (EE), causal attributions, and salivary cortisol were assessed in 100 carers of patients with Alzheimer's disease. Forty-one carers were rated high EE, which was associated with higher scores of carer distress and strain, and greater reports of noncognitive features in the patient, but not with cortisol levels. High EE carers made more attributions personal to, and controllable by, the patient for negative events. Critical carers made more attributions of the patient's behavior that was idiosyncratic. Warmth toward the patient was associated with the opposite of this pattern. Overinvolved carers made attributions of the patient's behavior to causes external to the patient and internal to themselves. Cortisol levels were associated with self-reports of strain and distress.

Adaptation, Psychological↗

PubMedDate not supplied

Psychological adjustment and asthma in children and adolescents: the UK Nationwide Mental Health Survey.

OBJECTIVE: Data from a nationwide child mental health survey were analyzed to examine relationships between asthma and psychological adjustment. METHODS: Survey design with random selection based on national computer records of 10,438 children aged 5 to 15 from 12,529 eligible families (83%). Strengths and Difficulties Questionnaire (SDQ) was completed by parents, teachers, and 11- to 17-year-olds, providing scores for total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, social behavior, and total impact. The Development and Well-Being Assessment (DAWBA) generated ICD-10 diagnoses. Parents reported physical disorders and disabilities, other child mental health risk factors, and rated child's general level of health. RESULTS: Children with organic conditions other than asthma were excluded, leaving 9,834 children, 49.9% male. Preliminary comparisons indicated higher parent and teacher rated scores for children with asthma. New variables combined asthma and general health to produce four groups. Logistic regressions were conducted with children without asthma and in good health as the reference group. Children with asthma in good health showed greater parent-rated emotional problems, but otherwise, few elevated odds ratios. Children without asthma in poor health were at significantly greater risk of disorder, as were children with asthma in poor health. Findings on ratings of hyperactivity are discussed. CONCLUSION: Findings that children with asthma have elevated psychological difficulties may result from poor health rather than asthma itself.

Adaptation, Psychological↗