Biomedical subjects

Nicholas Tarrier

Publications and source records attributed to Nicholas Tarrier.

At least 19 recordsLinked to original sources

PubMed2007

Developing psychological perspectives of suicidal behaviour and risk in people with a diagnosis of schizophrenia: we know they kill themselves but do we understand why?

People with a diagnosis of schizophrenia are at increased risk of suicidal behaviour yet little is understood of the psychological underpinnings of this vulnerability. The biopsychosocial 'Cry of Pain' model [Williams, J.M.G. (1997). Cry of pain. Harmondsworth: Penguin.] provides a broad framework from which to understand suicidal behaviour. However, the utility of the model in relation to suicide in schizophrenia has not yet been explored. This was the primary goal of this paper. Six components of the 'Cry of Pain' model were identified and evaluated with respect to whether they contributed to i. common transdiagnostic factors underlying suicide, ii. factors relating to co-morbid depression which account for suicidal behaviour, or iii. factors which are specific to schizophrenia and underlie suicide risk. The potential for applying the model to clinical management of suicide in schizophrenia is illustrated.

Cognition Disorders↗

PubMed2007

Treatment and prevention of depression after surgery for hip fracture in older people: randomized, controlled trials.

OBJECTIVES: To evaluate the effect of a psychiatric intervention in treating depression (treatment study) and the effect of a psychological treatment in preventing depression (prevention study) after hip fracture in older people. DESIGN: Two linked randomized, controlled trials. SETTING: Orthopedic units in Manchester, England. PARTICIPANTS: Two hundred ninety-three older people who had undergone surgery for a fractured hip: 121 in the treatment study and 172 in the prevention study. MEASUREMENTS: The Geriatric Depression Scale and Hospital Anxiety and Depression Scale for mood, functional tests for mobility and pain measures. RESULTS: There was a slight reduction in depressive symptoms in the active arm of the treatment study. In the prevention study, there was no significant difference in incident depression between the psychological intervention and treatment as usual. There were no differences in the functional and pain outcomes. CONCLUSION: The results from these two randomized, controlled trials show that, after hip fracture surgery, no statistically significant benefits can be achieved from a psychiatric intervention in people who are depressed or a psychological intervention to prevent the onset of depression.

Aged, 80 and over↗

PubMed2006

The Psychotic Symptom Rating Scales (PSYRATS): their usefulness and properties in first episode psychosis.

The aim of this study was to investigate the reliability, validity and structure of the Psychotic Symptom Rating Scales (PSYRATS) in 257 subjects presenting with acute first episodes of schizophrenia or related disorders. The PSYRATS have been shown to assess dimensions of hallucination and delusions reliably and validly in chronically psychotic patients but not in first episode patients. Item reliability was investigated and subscale performance compared to the PANSS. The PSYRATS had good inter-rater and retest reliability. Validity was good, as assessed by internal consistency, sensitivity to change, and in relation to the PANSS. There was evidence of two delusion factors and three for hallucinations. The scales are useful complements to existing measures of symptom severity.

Acute Disease↗

PubMed2006

The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour.

BACKGROUND: The subjective impact of a psychotic breakdown can be profound, potentially resulting in loss of social roles, hopes and aspirations and leading to stigmatisation, trauma and elevated suicide risk. This study aimed to assess the subjective effect and consequences of suffering a first episode of psychosis. It was hypothesised that suicide behaviour would be associated with the negative consequences of psychosis and co-morbid symptomatic-PTSD. METHODS: Patients were assessed by means of a semi-structured interview on their reactions and experience of their psychotic episode and its treatment and by means of standardised methods for psychotic (PANSS) and trauma-related (CAPS) symptoms. RESULTS: A total of 35 patients suffering their first episode of psychosis were interviewed. As a result of the onset of their illness, 77% indicated they had suffered loss or disruption to their life, 60% had thwarted future aspirations, 38% had suffered violence or harassment, 53% had suffered stigma and 50% social exclusion. Totally, 80% felt they had been traumatised by their treatment and 38% were cases for symptomatic-PTSD. Symptomatic-PTSD was significantly associated with involuntary hospitalisation but not psychotic symptoms. Positive psychotic symptoms were associated with harassment, stigma and social exclusion. Suicidal ideation was reported by 40% and 31% reported attempting suicide. Suicidal behaviour was greater in those suffering symptomatic-PTSD but this was not significant, suicidal behaviour was significantly associated with the experience of trauma, but not the severity of that trauma, prior to the onset of their psychosis. CONCLUSIONS: The negative consequences of a psychotic episode are significant. The potential iatrogenic effect of psychiatric care needs to be considered. Interventions need to be developed to reduce traumatisation and suicide risk.

Adult↗

PubMed2006

Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people.

BACKGROUND: Depression and cognitive functioning have a negative impact on functional recovery after hip fracture surgery in older people, and the same has been suggested for pain and fear of falling. These variables, however, have never been studied together, nor has the timing of psychiatric assessment been taken into account. METHOD: Two parallel, randomized controlled trials were undertaken aiming to prevent and treat depression after hip fracture surgery in older people. Multiple logistic regression analyses corrected for age and pre-morbid level of functioning were performed to evaluate the effect of depressive symptoms (15-item Geriatric Depression Scale, GDS), pain (Wong-Baker pain scale), cognitive functioning (Mini-mental State Examination, MMSE) and fear of falling (Modified Falls Efficacy Scale, MFES) within 2 weeks after surgery and 6 weeks later on functional recovery at 6 months. Main outcome measures were performance-based measures (up-and-go test, gait test, functional reach) and the self-report Sickness Impact Profile (SIP) questionnaire to assess the impact of the hip fracture on activities of daily living (ADL). RESULTS: Two hundred and ninety-one patients participated and outcome measures for 187 (64%) patients were available at 6 months. All mental health variables interfered with functional recovery. However, in the final multivariate model, cognitive functioning and fear of falling assessed 6 weeks after surgery consistently predicted functional recovery, whereas pain and depressive symptoms were no longer significant. CONCLUSION: Fear of falling and cognitive functioning may be more important than pain and depression to predict functional recovery after hip fracture surgery. Rehabilitation strategies should take this into account.

Accidental Falls↗

PubMed2006

Negative symptoms in schizophrenia: comments from a clinical psychology perspective.

The NIMH-MATRICS Consensus Statement on Negative Symptoms is covered from the perspective of Clinical Psychology. The neurobiological model implicit in the Statement can be criticized on the basis that it is scientifically restrictive and narrow and poorly serves clinical practice and service development. Aspects of the Statement relating to psychological treatments are discussed.

Humans↗

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

Influence of age on outcome of psychological treatments in first-episode psychosis.

BACKGROUND: Psychological treatments have been shown to be effective in patients with psychosis. However, the studies published to date have included participants across wide age ranges, so few conclusions can be reached about the effectiveness of such treatments in relation to age. AIMS: To evaluate outcomes by age in a randomised controlled trial designed to evaluate the effectiveness of cognitive-behavioural therapy (CBT), supportive counselling and treatment as usual. METHOD: Outcomes were evaluated in terms of symptoms, social functioning, insight and therapeutic alliance according to age at 3- and 18-month follow-up. RESULTS: Younger participants responded better to supportive counselling than to treatment as usual and CBTover 3 months. Older participants responded better to CBT than to supportive counselling over 18 months. Younger participants showed a greater increase in insight after CBT compared with treatment as usual and supportive counselling, and were more difficult to engage in therapy. CONCLUSIONS: Young people may have different needs with regard to engagement in psychological treatments. Treatment providers need to take age-specific factors into account.

Adolescent↗

PubMed2006

Post-traumatic stress disorder and illness perceptions over time following myocardial infarction and subarachnoid haemorrhage.

OBJECTIVES: This study investigated post-traumatic stress disorder (PTSD) symptoms and illness perceptions in people who suffered the acute medical trauma of a myocardial infarction (MI) or a subarachnoid haemorrhage (SAH). The study tested hypotheses regarding changes in PTSD symptoms and illness perceptions over time, associations between PTSD and illness perceptions and cognitive predictors of PTSD. DESIGN AND METHOD: The study employed a longitudinal design and measured the illness perceptions and PTSD symptoms of an MI group (N=17) and a SAH group (N=27). Data were collected within 2 weeks of admission (T1), 6 weeks after admission (T2) and 3 months after admission (T3). Statistical analysis was undertaken to examine associations between illness perceptions and PTSD and to examine cognitive predictors of PTSD. RESULTS: The prevalence of PTSD within the total acute medical trauma sample was 16% at 2 weeks, 35% at 6 weeks and 16% at 3 months. Illness perception factors of identity, timeline (acute/chronic), consequences and emotional representation were strongly correlated with PTSD at all three time points. PTSD symptoms and illness perceptions were shown to have changed over time. The results also showed that several illness perception factors are significant predictors of PTSD. CONCLUSIONS: Both PTSD symptoms and illness perceptions changed significantly over time following an MI or SAH. Illness perception factors are significant predictors of PTSD.

Attitude to Health↗

PubMed2006

Attributions for negative events in the partners of adults with type I diabetes: Associations with partners' expressed emotion and marital adjustment.

OBJECTIVES: An attribution-emotion model of reactions to illness was tested in a sample of partners of 60 adult patients with type I diabetes. METHODS: Partners were interviewed using the Camberwell family interview (CFI), from which spontaneous attributions for negative events were extracted and coded. Events were classified into diabetes and non-diabetes events. Partners also completed questionnaire measures of marital adjustment, anxiety and depression. RESULTS: Compared with low expressed emotion (EE) partners, high-EE partners attributed proportionally more negative diabetes events (e.g. patient characteristics and behaviour) to factors controllable by and personal to the patient. High-EE partners were more anxious than low-EE partners, and made more responsibility attributions (attributions rated as both internal and controllable and personal). Partners with poorer marital adjustment made more responsibility attributions, but only for non-diabetes events. CONCLUSION: Whereas attributions for both diabetes and non-diabetes events were related to partners' EE, attributions for diabetes events were not significantly associated with partners' marital adjustment.

Adaptation, Psychological↗

PubMed2006

Idiosyncratic personal explanations for blood glucose events are associated with poorer self-management and glycemic control in adult patients with long-standing type 1 diabetes.

OBJECTIVE: To examine whether spontaneous causal attributions for blood glucose events were associated with blood glucose control (HbA(1c) [A1C]), self-management, and adjustment to diabetes. RESEARCH DESIGN AND METHODS: A total of 62 adults (31 female) with type 1 diabetes, recruited from a diabetes specialist clinic, with a mean age of 42.3 years and a mean illness duration of 19.6 years, were interviewed about the onset, history, course, and management of their diabetes. Spontaneous causal attributions for fluctuations in blood glucose level were extracted from the interviews and coded in accordance with the Leeds Attributional Coding System. Participants completed questionnaire measures of anxiety, depression, and appraisal of diabetes. Glycemic control (A1C) at the time of interview and 1 year later was extracted from notes. RESULTS: Participants who made proportionally more personal, or idiosyncratic, explanations for blood glucose fluctuations or events (such as hypoglycemic episodes) had higher A1C levels at time 1 and 1 year later and were judged to manage their diabetes less well. Furthermore, the association between personal attributions and A1C was partly accounted for by self-management behavior. Participants who made personal and stable attributions appraised their diabetes more negatively. CONCLUSIONS: Clinicians should be sensitive to patients' causal explanations for blood glucose events. Helping patients consider alternative explanations may produce benefits in terms of better management and control of diabetes.

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↗

PubMed2005

Cognitive behaviour therapy for schizophrenia -- a review of development, evidence and implementation.

BACKGROUND: Schizophrenia and other psychotic disorders were once thought to be impervious to psychological treatments; however, there is accumulating evidence that cognitive behaviour therapy (CBT) can result in significant clinical benefit to these patients. AIM: This paper aims to describe the development and adaptation of CBT in the treatment of schizophrenia, to summarise the evidence to support CBT as a viable treatment and to outline some of the issues in 'rolling out' this treatment into normal clinical settings. RESULTS: A number of clinical models of CBT have been developed and these typically consist of a variety of clinical methods with different models providing differing emphasis. Twenty controlled trials of CBT in schizophrenia in which 739 patients were included are reviewed. These studies have a mean effect size for CBT of 0.37 (SD 0.39). There is consistent evidence that CBT reduces persistent positive symptoms in chronic patients and may have modest effects in speeding recovery in acutely ill patients. The evidence of CBT reducing relapse rates is equivocal, although targeted early intervention is promising. The available evidence suggests that CBT can be utilised effectively in routine clinical practice. However, the dissemination of novel psychological treatments into widespread clinical practice is not without difficulty, and issues pertaining to the 'roll-out' of CBT are discussed. CONCLUSIONS: CBT as an adjunct treatment shows considerable promise for the future treatment of schizophrenia.

Cognitive Behavioral Therapy↗

PubMed2005

Cognitive-behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication. Randomised controlled trial.

BACKGROUND: There is increasing evidence that cognitive-behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia. AIMS: To investigate the effects of cognitive-behavioural therapy on in-patients with treatment-refractory psychotic symptoms. METHOD: Manualised therapy was compared with supportive counselling in a randomised controlled study. Both interventions were delivered by experienced psychologists over 16 sessions of treatment. Therapy fidelity was assessed by two independent raters. Participants underwent masked assessment at baseline, after treatment and at 6 months' follow-up. Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale. The analysis was by intention to treat. RESULTS: Participants receiving cognitive cognitive-behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up. CONCLUSIONS: Cognitive-behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia.

Adolescent↗

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↗