Biomedical subjects

Philippa Garety

Publications and source records attributed to Philippa Garety.

13 recordsLinked to original sources

PubMed2006

Remission and relapse in psychosis: operational definitions based on case-note data.

BACKGROUND: In psychosis, the prime indicator of outcome has been relapse, but hospital readmission can no longer be used for this purpose. Researchers now require methods for assessing relapse that are objective, blind, reliable and valid. We describe the reliability and validity of such a technique using case-notes. METHOD: Information from routine clinical notes of participants in the Lambeth Early Onset (LEO) study (less all references that would unblind the assessor) were recorded on a form divided into 1-month sections. Operational definitions of remission and relapse enabled clinicians to identify remissions and relapses blindly from the summary information. We calculated reliability regarding both the fact and the timing of remission and relapse. PANSS ratings at 6 and 18 months provided a measure of validity. RESULTS: The kappa value for the identification of remission by individuals ranged from 0.64 to 0.82, while that for consensus between paired raters was 0.56. The corresponding values for relapse were 0.57-0.59 and 0.71. Intra-class correlations for time to remission and to relapse were very high. Raters guessed correctly whether the participants came from the intervention or control group on 60-75% of occasions. Independent PANSS ratings were strongly related to the remission/relapse status of participants. CONCLUSIONS: The reliability of the technique described here was moderate to good, its validity was good, and it provides a useful and timely addition to methods of evaluating remission and relapse in psychosis. On the basis of our experience, we recommend consensus rather than individual ratings.

Data Collection↗

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

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

Cognitive functioning in delusions: a longitudinal analysis.

BACKGROUND: This study explored the longitudinal course of the relationship between delusions and different aspects of cognitive functioning. METHODS: Deluded patients were compared to psychiatric and non-clinical controls on three tasks: negative priming, a probabilistic judgement task (the 'beads' task), and the pragmatic inference task (PIT). All groups were tested at two time points, once when actively symptomatic, and once when in remission. RESULTS: Deluded individuals exhibited a 'jump-to-conclusions' (JTC) reasoning bias: i.e., they made decisions on the basis of limited evidence and were more likely to revise their estimates when faced with disconfirmatory evidence. This JTC bias remained stable over time, although probability judgments seemed to normalise in remission. No deficits in cognitive inhibition were found on negative priming. The deluded group displayed an excessive self-focus on the PIT at both time points, but did not show a depressive attributional style. Only a small sub-sample, characterised by the "bad-me" type of paranoia [Trower & Chadwick, 1995 Clinical Psychology: Science and Practice, 2, 263-278.], demonstrated depressive schemas when symptomatic, but no longer did so when remitted. Few relationships were found between tasks, suggesting that different areas of functioning are relatively independent. The only measures associated with delusion symptom scores were from the 'beads' task. CONCLUSIONS: Overall these findings suggest that the JTC bias is a stable factor associated with delusional thinking, while the depressive attributional style characteristic of a small sub-sample of paranoid patients fluctuates with delusional course.

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

Predicting recovery from schizophrenia: a retrospective comparison of characteristics at onset of people with single and multiple episodes.

A retrospective study was designed to determine whether socio-demographic and clinical factors at onset, previously shown to relate to outcome, differentiated those with a single episode with no persistent symptoms of schizophrenia from other outcome groups. In a geographically determined sample of 436 people with schizophrenia spectrum disorder and a minimum followup period of at least 6 years, 68 people (15.6%) had a single episode with complete remission. The single episode group differed significantly from the rest of the sample at onset on nine variables. On a logistic regression, employment status independently predicted single episodes. Although those with single episodes differed from the rest of the sample on a number of variables, they did not differ significantly at onset from the other better outcome group (repeated episodes without persistent symptoms) on any variables with the exception of insight. Two possibilities are considered: (1) the two better outcome groups differed very little at onset but subsequent treatment or experiences accounted for the differences in outcome; or (2) important differences, not routinely assessed at onset, influenced outcome. The implications of these findings for research into the prevention of relapse in psychosis are considered.

Adolescent↗

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

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↗

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

Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI).

There is increasing evidence that in the general population there are schizotypal traits and symptoms that can be measured psychometrically. Norms are reported for a new 21-item version of the Peters et al. Delusions Inventory (PDI; Peters et al. 1999b). The PDI, originally based on the Present State Examination, incorporates the multidimensionality of delusions by including measures of distress, preoccupation, and conviction. A total of 444 healthy individuals completed the 21-item PDI and two other questionnaires measuring florid delusions and social desirability. A subsample also filled out an in-depth schizotypal personality scale. Thirty-three deluded inpatients also completed the PDI. The PDI's psychometric properties confirmed that it remains a reliable and valid instrument to measure delusional ideation in the general population. Consistent with the 40-item PDI, it was normally distributed, no sex differences were found, and there was an inverse relationship with age. Individual items were endorsed by just over one in four healthy adults. Although the deluded sample scored significantly higher, the range of scores overlapped considerably, with 11 percent of healthy adults scoring higher than the mean of the deluded group. As with our previous findings, the two samples were differentiated by their ratings on the distress, preoccupation, and conviction scales. These results suggest that these dimensions may be more important than the content of belief alone for placing an individual on the continuum between normal and delusional thinking.

Adolescent↗