Biomedical subjects

Paul Bebbington

Publications and source records attributed to Paul Bebbington.

At least 19 recordsLinked to original sources

PubMed2006

Violence and psychiatric morbidity in a national household population--a report from the British Household Survey.

This study measured the prevalence of self-reported violence and associations with psychiatric morbidity in a national household population, based on a cross-sectional survey in 2000 of 8,397 respondents in Great Britain. Diagnoses were derived from computer-assisted interviews, with self-reported violent behavior over the previous 5 years. The 5-year prevalence of nonlethal violence in Britain was 12% (95% confidence interval: 11, 13). The risk of violence was substantially increased by alcohol dependence (odds ratio=2.72, 95% confidence interval: 1.85, 3.98), drug dependence (odds ratio=2.63, 95% confidence interval: 1.45, 4.74), and antisocial personality disorder (odds ratio=6.12, 95% confidence interval: 3.87, 9.66). Low prevalences of these conditions (7%, 4%, and 4%, respectively) contrasted with their relatively high proportions of attributed risk of violence (23%, 15%, and 15%). Hazardous drinking was associated with 56% of all reported violent incidents. Screening positive for psychosis did not independently increase risk (odds ratio=3.20, 95% confidence interval: 0.35, 29.6). The study concluded that psychiatric morbidity makes a significant public health impact on violence exerted primarily by persons with any personality disorder, substance dependence, and hazardous drinking. Population interventions for violent behavior are appropriate for hazardous drinking as are targeted interventions for substance dependence and antisocial personality disorder. Despite public concern, the risks of violence from persons with severe mental illness were very low.

Adolescent↗

PubMed2006

Obsessive-compulsive disorder and personality disorder: evidence from the British National Survey of Psychiatric Morbidity 2000.

BACKGROUND: Previous studies indicate that most individuals with obsessive-compulsive disorder (OCD) have comorbid personality disorders (PDs), particularly from the anxious cluster. However, the nature and strength of this association remains unclear, as the majority of previous studies have relied heavily on clinical populations. We analysed the prevalence of screen positive personality disorder in a representative sample of adults with OCD living in private households in the UK. METHODS: A secondary analysis of data from the 2000 British National Survey of Psychiatric Morbidity. The prevalence of PD, as determined by the SCID-II questionnaire, was compared in participants with OCD, with other neuroses and non-neurotic controls. Within the OCD group we also analysed possible differences relating to sex and subtypes of the disorder. RESULTS: The prevalence of any screen positive PD in the OCD group (N=108) was 74%, significantly greater than in both control groups. The most common screen positive categories were paranoid, obsessive-compulsive, avoidant, schizoid and schizotypal. Compared to participants with other neuroses, OCD cases were more likely to screen positively for paranoid, avoidant, schizotypal, dependent and narcissistic PDs. Men with OCD were more likely to screen positively for PDs in general, cluster A PDs, antisocial, obsessive-compulsive and narcissistic categories. The presence of comorbid neuroses in people with OCD had no significant effect on the prevalence of PD. CONCLUSIONS: Personality pathology is highly prevalent among people with OCD who are living in the community and should be routinely assessed, as it may affect help-seeking behaviour and response to treatment.

Adolescent↗

PubMed2006

Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms.

Psychosis used to be thought of as essentially a biological condition unamenable to psychological interventions. However, more recent research has shown that positive symptoms such as delusions and hallucinations are on a continuum with normality and therefore might also be susceptible to adaptations of the cognitive behavioral therapies found useful for anxiety and depression. In the context of a model of cognitive, emotional, and social processes in psychosis, the latest evidence for the putative psychological mechanisms that elicit and maintain symptoms is reviewed. There is now good support for emotional processes in psychosis, for the role of cognitive processes including reasoning biases, for the central role of appraisal, and for the effects of the social environment, including stress and trauma. We have also used virtual environments to test our hypotheses. These developments have improved our understanding of symptom dimensions such as distress and conviction and also provide a rationale for interventions, which have some evidence of efficacy. Therapeutic approaches are described as follows: a collaborative therapeutic relationship, managing dysphoria, helping service users reappraise their beliefs to reduce distress, working on negative schemas, managing and reducing stressful environments if possible, compensating for reasoning biases by using disconfirmation strategies, and considering the full range of evidence in order to reduce high conviction. Theoretical ideas supported by experimental evidence can inform the development of cognitive behavior therapy for persistent positive symptoms of psychosis.

Affect↗

PubMed2006

Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations.

BACKGROUND: The role of emotion in psychosis is being increasingly recognised. Cognitive conceptualisations of psychosis (e.g. [Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D., Bebbington, P.E., 2001. A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189-195]) emphasise a central, normal, direct and non-defensive role for negative emotion in the development and maintenance of psychosis. This study tests specific predictions made by Garety et al. [Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D., Bebbington, P.E., 2001. A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189-195] about the role of emotion and negative evaluative beliefs in psychosis. METHODS: 100 participants who had suffered a recent relapse in psychosis were recruited at baseline for the Prevention of Relapse in Psychosis (PRP) trial. In a cross-sectional analysis, we examined the role of depression, self-esteem and negative evaluative beliefs in relation to specific positive symptoms (persecutory delusions, auditory hallucinations and grandiose delusions) and symptom dimensions (e.g. distress, negative content, pre-occupation and conviction). RESULTS: Analysis indicated that individuals with more depression and lower self-esteem had auditory hallucinations of greater severity and more intensely negative content, and were more distressed by them. In addition, individuals with more depression, lower self-esteem and more negative evaluations about themselves and others had persecutory delusions of greater severity and were more pre-occupied and distressed by them. The severity of grandiose delusions was related inversely to depression scores and negative evaluations about self, and directly to higher self-esteem. CONCLUSIONS: This study provides evidence for the role of emotion in schizophrenia spectrum-disorders. Mood, self-esteem and negative evaluative beliefs should be considered when conceptualising psychosis and designing interventions.

Adolescent↗

PubMed2006

The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples.

BACKGROUND: Traditional instruments that measure self-esteem may not relate directly to the schema construct as outlined in recent cognitive models. The Brief Core Schema Scales (BCSS) aim to provide a theoretically coherent self-report assessment of schemata concerning self and others in psychosis. The scales assess four dimensions of self and other evaluation: negative-self, positive-self, negative-other, positive-other. METHOD: We analysed the psychometric properties of the BCSS using a sample of 754 students recruited by email and 252 people with psychosis recruited as part of a trial of cognitive therapy. We report the internal consistency, stability and the factor structure of the scale, and the association of the BCSS with measures of self-esteem and with symptoms of paranoia and grandiosity. RESULTS: The BCSS have good psychometric properties and have more independence from mood than the Rosenberg Self-Esteem Schedule. People with chronic psychosis reported extreme negative evaluations of both self and others on these scales, but their levels of self-esteem and positive evaluations of self and others were similar to the student sample. CONCLUSIONS: Extreme negative evaluations of self and others appear to be characteristic of the appraisals of people with chronic psychosis, and are associated with symptoms of grandiosity and paranoia in the non-clinical population. The BCSS may provide a more useful measure of schemata about self and others than traditional measures of self-esteem.

Adult↗

PubMed2006

The REACT study: randomised evaluation of assertive community treatment in north London.

OBJECTIVE: To compare outcomes of care from assertive community treatment teams with care by community mental health teams for people with serious mental illnesses. DESIGN: Non-blind randomised controlled trial. SETTING: Two inner London boroughs. PARTICIPANTS: 251 men and women under the care of adult secondary mental health services with recent high use of inpatient care and difficulties engaging with community services. INTERVENTIONS: Treatment from assertive community treatment team (127 participants) or continuation of care from community mental health team (124 participants). MAIN OUTCOME MEASURES: Primary outcome was inpatient bed use 18 months after randomisation. Secondary outcomes included symptoms, social function, client satisfaction, and engagement with services. RESULTS: No significant differences were found in inpatient bed use (median difference 1, 95% confidence interval -16 to 38) or in clinical or social outcomes for the two treatment groups. Clients who received care from the assertive community treatment team seemed better engaged (adapted homeless engagement acceptance schedule: difference in means 1.1, 1.0 to 1.9), and those who agreed to be interviewed were more satisfied with services (adapted client satisfaction questionnaire: difference in means 7.14, 0.9 to 13.4). CONCLUSIONS: Community mental health teams are able to support people with serious mental illnesses as effectively as assertive community treatment teams, but assertive community treatment may be better at engaging clients and may lead to greater satisfaction with services.

Adult↗

PubMed2006

Attributional style in psychosis--the role of affect and belief type.

People holding persecutory beliefs have been hypothesised to show a self-serving attributional style, which functions to protect self-esteem Bentall, Corcoran, Howard, Blackwood, and Kinderman (2001). Experimental support for this has been mixed. Freeman et al. (1998) suggested depressed and grandiose subgroups of those with persecutory beliefs might explain events differently. In this study, 71 participants completed measures of delusional beliefs, depression and attributional style. We hypothesised that those with persecutory beliefs would form grandiose and depressed subgroups, and that a self-serving attributional style would characterise only the grandiose subgroup. Hypotheses were partially confirmed. Clear subgroups were evident and only those with both persecutory and grandiose beliefs showed an externalising attributional style for negative events. Depression, irrespective of co-occurring persecutory beliefs, was related to a reduced self-serving bias and an externalising attributional style for positive events. On their own, persecutory beliefs were not related to any particular attributional style. Depressed and grandiose subgroups of those with persecutory beliefs might account for some of the inconsistencies in the attribution literature. Even within a single symptom group, care should be taken in both research and therapy to consider individual symptom patterns.

Adaptation, Psychological↗

PubMed2006

Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years.

STUDY OBJECTIVES: To compare age-group differences in somatic/psychiatric comorbidity, impact, and pharmacotherapy associated with sleep disturbance across a broad adult age range. DESIGN: Cross-sectional national mental health survey. SETTING: Adults living in private households in England, Scotland, and Wales. PARTICIPANTS: 8,580 people aged 16 to 74 years. MEASUREMENTS AND RESULTS: Insomnia (4 symptom/syndrome definitions), depression, generalized anxiety disorder, and daytime fatigue were defined from the revised Clinical Interview Schedule. Any insomnia was reported by 37% of the sample, moderate insomnia by 12%, insomnia with fatigue by 13%, and symptoms fulfilling diagnostic criteria for primary/secondary insomnia by 5%. All categories of insomnia were associated with mental disorders, worse physical health, and fatigue to a similar degree in all decade age groups. The associations between insomnia categories and separated, divorced, or widowed marital status were strongest in younger participants. Insomnia categories were of longer reported duration and more strongly associated with worse physical health-related quality of life (SF-12) in older age groups. For participants with any definition of insomnia, benzodiazepine hypnotics were more commonly reported in older age groups. CONCLUSIONS: The association between insomnia and impaired quality of life is most pronounced in older age groups. Associations with physical and mental health status and those with daytime fatigue do not vary in strength between age groups. Older people with insomnia in this population were more likely to be taking benzodiazepine hypnotics.

Adolescent↗

PubMed2006

Violence and psychiatric morbidity in the national household population of Britain: public health implications.

BACKGROUND: It is unclear whether psychiatric morbidity contributes to the small proportion of the population responsible for a large percentage of antisocial behaviour, including violence. AIMS: To measure associations between psychiatric morbidity and severity, chronicity and types of victims of violence in the national household population of Britain. METHOD: Cross-sectional survey of persons in households (n = 8397).Data included self-reported location, victims and outcome of violence over the previous 5 years. Diagnoses were determined by computer-assisted interviews. RESULTS: Hazardous drinking was associated with over half of all incidents involving injury. Antisocial personality disorder conveyed an attributable risk of 24% of respondents reporting victim injuries, but screening positive for psychosis conveyed an attributable risk of only 1.2%. CONCLUSIONS: The burden of care resulting from violence associated with hazardous drinking supports population interventions. Despite exceptional risks, half of respondents with antisocial personality disorder were not violent, indicating limitations in targeted interventions to detain high-risk individuals.

Adolescent↗

PubMed2006

Self-reported psychotic symptoms in the general population: results from the longitudinal study of the British National Psychiatric Morbidity Survey.

BACKGROUND: Scarce longitudinal data exist on the occurrence of psychotic symptoms in the general population. AIMS: To estimate the incidence of, and risk factors for, self-reported psychotic symptoms in Great Britain. METHOD: Data from the 18-month follow-up of a national survey were used. Incident cases were those who endorsed one or more items on the Psychosis Screening Questionnaire at follow-up, but not at baseline. The association between factors recorded at baseline and incident self-reported symptoms was examined. RESULTS: At follow-up, 4.4% of the general population reported incident psychotic symptoms. Six factors were independently associated with incident symptoms: living in a rural area; having a small primary support group; more adverse life events; smoking tobacco; neurotic symptoms; and engaging in a harmful pattern of drinking. CONCLUSIONS: A small but not insignificant percentage of the population of Great Britain reported incident psychotic symptoms over 18 months. The risk factors for psychotic symptoms showed some similarities with risk factors for schizophrenia, but there were also some striking differences. The relationship between such risk factors and the factors that perpetuate psychotic symptoms remains to be ascertained.

Adolescent↗

PubMed2006

Content and affect in persecutory delusions.

OBJECTIVES: The study aimed to explore the content of persecutory delusions and its potential links with levels of affective disturbance. Detailed examinations of the phenomenology of delusional beliefs have been rare, but are important for furthering theoretical and clinical understanding. DESIGN: A cross-sectional investigation of 70 individuals with current persecutory delusions was conducted. METHODS: Taped semi-structured clinical interviews were transcribed for each participant. Using a coding frame devised for the current study, a detailed description of persecutory content was made. Scores on the Beck Depression and Anxiety Inventories, the Rosenberg Self-esteem Scale and the Psychotic Symptom Rating Scales were used as indicators of emotional distress. RESULTS: Data were gathered on the identity and type of persecutor, pervasiveness of threat and the power of the persecutor. Reliability was good. Beliefs involving multiple persecutors, human in nature and identifiable to the individual were common. For the majority threat was severe, ongoing and enduring and coupled with frequent feelings of vulnerability. Specific aspects of delusional content were found to be associated with emotional distress. For example, if participants felt more power in the face of persecution this was coupled with lower depression and higher self-esteem. CONCLUSIONS: Persecutory delusions are beliefs concerning severe threat, particularly of physical harm including death, which is personally significant, frequently involving multiple persecutors known to the individual. Depression is higher in those who felt less powerful than their persecutors. Associations, such as this, with emotional distress support a direct role for emotion in delusion formation and maintenance. It is consistent with cognitive models of delusions which emphasize the importance of considering emotional distress in the context of belief appraisal, although interpretation of the results is limited by the cross-sectional study design. Recognizing these links may in turn aid therapists in identifying aspects of beliefs that might be targeted to facilitate emotional change.

Adolescent↗

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

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

Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study.

OBJECTIVE: To evaluate the effectiveness of a crisis resolution team. DESIGN: Randomised controlled trial. PARTICIPANTS: 260 residents of the inner London Borough of Islington who were experiencing crises severe enough for hospital admission to be considered. INTERVENTIONS: Acute care including a 24 hour crisis resolution team (experimental group), compared with standard care from inpatient services and community mental health teams (control group). MAIN OUTCOME MEASURES: Hospital admission and patients' satisfaction. RESULTS: Patients in the experimental group were less likely to be admitted to hospital in the eight weeks after the crisis (odds ratio 0.19, 95% confidence interval 0.11 to 0.32), though compulsory admission was not significantly reduced. A difference of 1.6 points in the mean score on the client satisfaction questionnaire (CSQ-8) was not quite significant (P = 0.07), although it became so after adjustment for baseline characteristics (P = 0.002). CONCLUSION: Crisis resolution teams can reduce hospital admissions in mental health crises. They may also increase satisfaction in patients, but this was an equivocal finding.

Adolescent↗

PubMed2005

Psychiatric and social aspects of suicidal behaviour in prisons.

BACKGROUND: Suicidal behaviour and completed suicide are serious problems within British prisons, leading to significant morbidity and mortality, and are the focus of major efforts towards their prevention. AIM: To explore the demographic, social and psychiatric correlates of suicidal behaviour in prisons in England and Wales and their relationship with health service use; and to develop a combined psychosocial model of risk. METHOD: This report analyses the prevalence of suicidal ideation and suicide attempts in the ONS National Prison Survey, and their association with the presence of psychiatric disorders, personality disorder, substance abuse and social risk factors. These data were compared with data from the second national survey of psychiatric morbidity in adults living at home. In both surveys, a two-phase interviewing procedure was used, covering general health, health service use, assessment of psychiatric disorders, life events, social supports, suicidal behaviour, activities of daily living, sociodemographic data, substance abuse and intelligence. RESULTS: Suicidal thoughts and suicide attempts were commoner in prisons than in the general population and these were significantly associated with higher rates of psychosis, neurosis and personality disorder in prisons. In addition, demographic and factors such as being young, single, white, leaving school early and experiencing poor social support and significant social adversity were important risk factors for suicidal thoughts. Crucially, there was no separate category of people at suicidal risk who did not have psychiatric disorders. CONCLUSIONS: The high rates of suicidal behaviour in prisons cannot be addressed without adequate attention to the high rates of psychiatric disorder and vulnerability factors in prisoners.

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↗