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    ABSTRACT: Background International studies indicate that the median prevalence of psychotic experiences in children is 7%. It has been proposed that environmental stress during pregnancy may affect the neurodevelopment of the foetus and lead to a vulnerability in the child to later stressors and psychopathology. Aim In this study we explore the relationship between environmental stress during pregnancy and psychotic experiences in children in the general population at 12 years. Methods We analysed a birth cohort of 5038 children from the Avon Longitudinal Study of Parents and Children. Environmental stress was measured as life event exposure. Data on life events were collected on women during their pregnancy, whilst psychotic experiences in the offspring were assessed at age 12. Results There was a weak association between maternal exposure to life events and psychotic experiences at twelve years (crude OR 1.10 95% CI 1.02–1.18) per quartile of life event score. This association was not reduced after adjustment for socio-economic status, family history of schizophrenia, maternal education or birth weight but after adjustment for maternal anxiety and depression and smoking in early pregnancy there was no longer any evidence for an association (OR 1.01 95% CI 0.93–1.10). Conclusion This study provides some evidence to suggest that stressful life events may affect child psychotic experiences through effects on maternal psychopathology, and possibly physiology, during pregnancy.
    Schizophrenia Research 12/2013; 152(1). DOI:10.1016/j.schres.2013.11.006
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    ABSTRACT: Objectives The National Health Service (NHS) Stop Smoking Service (SSS) is an extremely cost-effective method of enabling smoking cessation. However, the SSS is only used by a minority of smokers. Developing interventions to maintain service attendance may help to increase the number of quitters. This study pilots an intervention aimed at maintaining attendance by (1) increasing motivation to attend through a booklet providing evidence of service effectiveness and (2) strengthening the link between motivation to attend and attendance through forming an implementation intention. DesignA factorial randomized controlled trial. MethodsA total of 160 newly enrolled smokers at the Surrey NHS SSS were recruited and randomly assigned to one of four conditions: (1) standard care (SC), (2) SC+effectiveness booklet, (3) SC+implementation intention, and (4) SC+effectiveness booklet+implementation intention. The outcome measures included attendance at the SSS and the 4-week quit rate. ResultsThe booklet increased service attendance (OR=2.93, p<.01, 95% CI=1.45-5.93; Number Needed to Treat=3.3) but had no impact on the 4-week quit rate (OR=1.55, 95% CI=0.75-3.21). Forming an implementation intention had no impact on service attendance or the 4-week quit rate. Attending the service was associated with a higher 4-week quit rate (=87.52, p<.001). Conclusions Presenting information about the effectiveness of the service improved service attendance. A larger trial now needs to evaluate whether this intervention can also increase the quit rate.
    British Journal of Health Psychology 12/2013; 19(4). DOI:10.1111/bjhp.12078
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    ABSTRACT: In this article, we make the case for a systematic program of research into the causal relationship between the therapeutic alliance and outcomes of psychological treatments for the eating disorders. To make that case, we need to begin by considering the validity of existing assumptions about that alliance-outcome relationship. We will then suggest what research is needed to allow clinicians to structure their work to best effect (e.g., should therapists focus on establishing a strong alliance even if it means not applying more therapy-specific techniques, or should they stress the application of those techniques even when the working alliance might seem likely to be weakened as a result). Although the authors have a background in cognitive-behavioral therapy (CBT), our aim is to suggest a research base that applies to a variety of psychotherapies, allowing for common or different conclusions about the alliance-outcome relationship, depending on what the proposed research indicates. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013).
    International Journal of Eating Disorders 12/2013; 46(8). DOI:10.1002/eat.22177
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    ABSTRACT: It is now broadly accepted that psychological stress may change the internal homeostatic state of an individual. During acute stress, adaptive physiological responses occur, which include hyperactivity of the HPA axis. Whenever there is an acute interruption of this balance, illness may result. The social and physical environments have an enormous impact on our physiology and behavior, and they influence the process of adaptation or 'allostasis'. It is correct to state that at the same time that our experiences change our brain and thoughts, namely, changing our mind, we are changing our neurobiology. Increased adrenocortical secretion of hormones, primarily cortisol in major depression, is one of the most consistent findings in neuropsychiatry. A significant percentage of patients with major depression have been shown to exhibit increased concentrations of cortisol, an exaggerated cortisol response to adrenocorticotropic hormone, and an enlargement of both the pituitary and adrenal glands. The maintenance of the internal homeostatic state of an individual is proposed to be based on the ability of circulating glucocorticoids to exert negative feedback on the secretion of hypothalamic-pituitary-adrenal (HPA) hormones through binding to mineralocorticoid (MR) and glucocorticoid (GR) receptors limiting the vulnerability to diseases related to psychological stress in genetically predisposed individuals. The HPA axis response to stress can be thought of as a mirror of the organism's response to stress: acute responses are generally adaptive, but excessive or prolonged responses can lead to deleterious effects. Evidence indicates that early-life stress can induce persistent changes in the ability of the HPA axis to respond to stress in adulthood. These abnormalities appear to be related to changes in the ability of hormones to bind to GR and MR receptors. First episodes may begin with an environmental stressor, but if the cycles continue or occur unchecked, the brain becomes kindled or sensitized, and future episodes of depression, hypomania, or mania will occur independently of an outside stimulus, with greater frequency and intensity. Generally, HPA axis changes appear in chronic depressive and more severe episodes. Moreover, HPA axis changes appear to be state-dependent, tending to improve upon resolution of the depressive syndrome. Interestingly, persistent HPA dysfunction has been associated with higher rates of relapse and chronicity. This article is part of a Special Issue entitled NEWroscience 2013.
    Epilepsy & Behavior 11/2013; 38. DOI:10.1016/j.yebeh.2013.10.020
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    ABSTRACT: The general health questionnaire (GHQ) is commonly used to assess symptoms of common mental disorder (CMD). Prevalence estimates for CMD caseness from UK population studies are thought to be in the range of 14-17%, and the UK occupational studies of which we are aware indicate a higher prevalence. This review will synthesise the existing research using the GHQ from both population and occupational studies and will compare the weighted prevalence estimates between them. We conducted a systematic review and meta-analysis to examine the prevalence of CMD, as assessed by the GHQ, in all UK occupational and population studies conducted from 1990 onwards. The search revealed 65 occupational papers which met the search criteria and 15 relevant papers for UK population studies. The weighted prevalence estimate for CMD across all occupational studies which used the same version and cut-off for the GHQ was 29.6% (95% confidence intervals (CIs) 27.3-31.9%) and for comparable population studies was significantly lower at 19.1% (95% CIs 17.3-20.8%). This difference was reduced after restricting the studies by response rate and sampling method (23.9% (95% CIs 20.5%-27.4%) vs. 19.2% (95 CIs 17.1%-21.3%)). Counter intuitively, the prevalence of CMD is higher in occupational studies, compared to population studies (which include individuals not in employment), although this difference narrowed after accounting for measures of study quality, including response rate and sampling method. This finding is inconsistent with the healthy worker effect, which would presume lower levels of psychological symptoms in individuals in employment. One explanation is that the GHQ is sensitive to contextual factors, and it seems possible that symptoms of CMD are over reported when participants know that they have been recruited to a study on the basis that they belong to a specific occupational group, as in nearly all "stress" surveys.
    PLoS ONE 11/2013; 8(11):e78693. DOI:10.1371/journal.pone.0078693
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    ABSTRACT: Psychological treatments for eating disorders (ED) rely on mastery of effortful attentional control to divert attention from anxiety provoking thoughts. This paper assesses the potential suitability of attentional bias modification treatment (ABMT) for EDs as a way to target early automatic attentional processes and implicitly retune threat perception that happens outside of conscious control. We review data on anxiety in EDs, the neurobiological and behavioural relationship between anxiety disorders and EDs, attentional biases (AB) in EDs and the use of ABMT. Co-morbidities between EDs and anxiety disorders are common and negatively affect illness outcome. EDs and anxiety disorders share many underlying elements, including AB towards threatening and disorder-relevant stimuli. AB has been modified across a range of anxiety disorders using ABMT. It is possible to modify AB in EDs. There is evidence to suggest that ABMT has potential as a targeted, rapid and convenient treatment option for EDs. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 11/2013; 21(6). DOI:10.1002/erv.2248
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    ABSTRACT: Neurofeedback is defined as the training of voluntary regulation of localised neural activity using real-time feedback through a brain-computer interface. It has shown initial success as a potential clinical treatment tool in proof of concept studies, but has yet to be evaluated with respect to eating disorders. This paper (i) provides a brief overview of the current status of eating disorder treatments; (ii) describes the studies to date that use neurofeedback involving electroencephalography, real-time functional magnetic resonance imaging or near-infrared spectroscopy; and (iii) considers the potential of these technologies as treatments for eating disorders. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 11/2013; 21(6). DOI:10.1002/erv.2250
  • European Eating Disorders Review 11/2013; 21(6). DOI:10.1002/erv.2253
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    ABSTRACT: BackgroundA major incident involving multiple fatalities occurred in Cumbria, England on 2 June 2010. The Cumbrian Constabulary deployed an organizational peer support response for personnel involved known as trauma risk management (TRiM).AimsTo examine data routinely gathered during the TRiM process to evaluate the relationship of the intervention to sickness absence.Methods Using incident databases, details were gathered regarding exposure to the murders and type of TRiM intervention, including an assessment of the psychological risk to the individual of developing a trauma-related mental health problem. Sociodemographic information was collated by the occupational health department. Cumulative sickness absence data in the 2 months following the murders were used as a proxy for mental health status.ResultsA total of 717 police officers and civilian support staff were identified. High levels of traumatic exposure were associated with subsequent receipt of a TRiM intervention. The majority of psychological risk indices reduced between the initial and subsequent evaluation. Greater traumatic exposure was associated with longer sickness absence lengths. Engagement in the TRiM process was associated with a reduction in sickness absence especially in more junior ranks.Conclusions In this study, we found that TRiM deployed within a police force responding to a major event offered a way of structuring a response for those involved. Our data suggest that TRiM may offer a way of assessing psychological risk so that officers can be offered early supportive interventions. Our data suggest that TRiM may help to ameliorate some of the negative effects of high trauma exposure.
    Occupational Medicine 10/2013; 63(8). DOI:10.1093/occmed/kqt113
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    ABSTRACT: Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are both highly prevalent conditions associated with extreme disability and with the development of co-morbid psychiatric disorders, such as depression and anxiety. Childhood stressors have been shown to induce persistent changes in the function of biological systems potentially relevant to the pathogenesis of both CFS and FM, such as the inflammatory system and the hypothalamic-pituitary-adrenal (HPA) axis. In this review, we examined whether multiple forms of childhood stressors are contributing factors to the development of these disorders, and of the associated psychiatric symptoms. Using PubMed, we identified 31 papers relevant to this narrative review. We included cohort studies and case-control studies, without any exclusion in terms of age and gender. No study characteristics or publication date restrictions were imposed. Most studies across the literature consistently show that there is a strong association between experiences of childhood stressors and the presence of CFS and FM, with rates of CFS/FM being two- to three-fold higher in exposed than in unexposed subjects. We also found evidence for an increased risk for the development of additional symptoms, such as depression, anxiety and pain, in individuals with CFS and FM with a previous history of childhood stressors, compared with individuals with CFS/FM and no such history. Our review confirms that exposure to childhood stressors is associated with the subsequent development of fatigue syndromes such as CFS and FM, and related symptoms. Further studies are needed to identify the mechanisms underlying these associations.
    Psychological Medicine 10/2013; 44(9):1-15. DOI:10.1017/S0033291713002468
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