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Publications (80)
Purpose
Psychosis disproportionally affects ethnic minority groups in high-income countries, yet evidence of disparities in outcomes following intensive early intervention service (EIS) for First Episode Psychosis (FEP) is less conclusive. We investigated 5-year clinical and social outcomes of young people with FEP from different racial groups foll...
Early psychosis is characterised by heterogeneity in illness trajectories, where outcomes remain poor for many. Understanding psychosis symptoms and their relation to illness outcomes, from a novel network perspective, may help to delineate psychopathology within early psychosis and identify pivotal targets for intervention. Using network modelling...
Objective
The extant literature is inconsistent over whether manic symptoms in First Episode Psychosis (FEP) impact on its development and trajectory. This study addressed: 1) Does Duration of Untreated Illness (DUI) and Duration of Untreated Psychosis (DUP) differ between FEP patients with and without manic symptoms? 2) Do manic symptoms in FEP ha...
Background:
Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics.
Aims:
This paper aims to explore the prevalence o...
Background
Delayed treatment for first episodes of psychosis predicts worse outcomes. We hypothesised that delaying treatment makes all symptoms more refractory, with harm worsening first quickly, then more slowly. We also hypothesised that although delay impairs treatment response, worse symptoms hasten treatment, which at presentation mitigates t...
Background:
Previous evidence suggests that delusional disorder has a later onset and better functional outcomes compared to schizophrenia. However, studies have not examined longitudinal outcomes in a first episode population, where confounding factors may be adjusted for.
Methods:
A nested case control study was designed within the National ED...
Aim
Exploring how negative symptoms are experienced and understood by individuals with lived experience of psychosis has the potential to offer insights into the complex psychosocial processes underlying negative symptom presentations. The aim of the current study was to investigate lived experiences of negative symptoms through secondary analysis...
Aim Exploring how negative symptoms are experienced and understood by individuals with lived experience of psychosis has the potential to offer insights into the complex psychosocial processes underlying negative symptom presentations. The aim of the current study was to investigate lived experiences of negative symptoms through secondary analysis...
Background: We conducted a randomised controlled trial to evaluate the efficacy of enhancing social recovery from First Episode Psychosis (FEP) by augmenting Early Intervention Service (EIS) provision with Social Recovery Therapy (SRT). The primary hypothesis was that SRT plus EIS would lead to improvements in social recovery. Methods: SUPEREDEN3 w...
Background:
Provision of early intervention services has increased the rate of social recovery in patients with first-episode psychosis; however, many individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services augmented with social recovery therapy in patients...
Aim
Duration of untreated psychosis (DUP) is considered as a key prognostic variable in psychosis. Yet, it is unclear whether a longer DUP causes worse outcomes or whether reported associations have alternative explanations.
Methods
Data from 2 cohorts of patients with first episode psychosis were used (n = 2134). Measures of DUP were assessed at...
UK Dept of Health (RDD/ARF2) NIHR Programme Grant (RP-PG-0109-10074) Prof Peter Jones part funded by NIHR CLARHC
Aim:
Early intervention services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost-effectiveness of EIS according to how closely they adhered to the recommendations o...
Objective:
The incidence and outcome of first-episode substance-induced psychotic disorder (SIPD) are unclear. The study aimed to compare the 1-year outcomes of those given a SIPD diagnosis by clinicians compared to other psychosis diagnoses in a first-episode cohort.
Method:
Data were from a large (n = 1027) cohort of first-episode psychosis (F...
Aims:
To investigate trajectories of negative symptoms during the first 12months of treatment for first episode psychosis (FEP), their predictors and relationship to social recovery.
Method:
1006 participants were followed up for 12months following acceptance into Early Intervention in Psychosis services. Negative symptom trajectories were model...
Objective:
The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode of psychosis (FEP) and the link with symptomatic course and outcome over 1 year post psychosis onset.
Design and setting:
One thousand twe...
Background
Social disability is a hallmark of severe mental illness yet individual differences and factors predicting outcome are largely unknown.AimTo explore trajectories and predictors of social recovery following a first episode of psychosis (FEP).MethodA sample of 764 individuals with FEP were assessed on entry into early intervention in psych...
Background Early intervention services (EIS) comprise low-stigma, youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice. Aims By analysing carers' accounts of their daily lives and affective challenges during a relative's FEP a...
Social functioning difficulties are a common and disabling feature of psychosis and have also been identified in the prodromal phase. However, debate exists about how such difficulties should be defined and measured. Time spent in structured activity has previously been linked to increased psychological wellbeing in non-clinical samples and may pro...
Aims:
To disentangle the alcohol-related needs of short stay, revolving door, male prisoners, and offer a theoretically driven but practical approach for allocation of scarce service resources.
Methods:
A prospective longitudinal interview, questionnaire and records study of pre-trial men newly imprisoned in Wales and SW England.
Results:
Two...
Importance
Although many studies have explored the correlates of violence during first-episode psychosis (FEP), most have simply compared violent psychotic individuals with nonviolent psychotic individuals. Accumulating evidence suggests there may be subgroups within psychosis, differing in terms of developmental processes and proximal factors ass...
Background:
Interventions to reduce treatment delay in first-episode psychosis have met with mixed results. Systematic reviews highlight the need for greater understanding of delays within the care pathway if successful strategies are to be developed.
Aims:
To document the care-pathway components of duration of untreated psychosis (DUP) and thei...
Aims:
National EDEN aims to evaluate the implementation and impact on key outcomes of somewhat differently configured Early Intervention Services (EIS) across sites in England and to develop a model of variance in patient outcomes that includes key variables of duration of untreated psychosis (DUP), fidelity to the EIS model and service engagement...
Purpose:
To evaluate the psychometric properties of the EQ-5D and the usefulness of this instrument in psychiatric practice as a measure of health-related quality of life (HRQoL) in a sample of young adults with first-episode psychosis.
Methods:
The validity of individual questionnaire items is studied using an Item Response/Latent Trait Theory...
The role of primary care for young people with psychosis, and transitions between specialist mental health services and primary care, are underexplored areas, both clinically and in research terms.
To explore service users' perspectives of early intervention services and primary care, in-depth and over time.
Longitudinal qualitative methodology in...
Family caregivers of people with mental disorders are frequently involved in involuntary hospital admissions of their relatives.
To explore family caregivers' experience of involuntary admission of their relative.
30 in-depth interviews were conducted with family caregivers of 29 patients who had been involuntarily admitted to 12 hospitals across E...
To explore involuntary patients' retrospective views on why their hospitalisation was right or wrong.
Involuntary patients were recruited from 22 hospitals in England and interviewed in-depth. The study drew on grounded theory and thematic analysis.
Most of the patients felt mentally unwell before admission and out of control during their treatment...
This study described the views over time of young people referred to early intervention services (EIS), particularly as they relate to the importance of relationships.
A cohort of people aged 14 to 35 enrolled in a large multisite study of EIS for psychosis in the United Kingdom were recruited for a qualitative, longitudinal study in which they wer...
The Study aimed to assess clinical and social outcomes following involuntary admissions over 1 year and identify socio-demographic and clinical patient characteristics associated with more or less favourable outcomes. Seven hundred and seventy-eight involuntary patients admitted to one of 22 hospitals in England were assessed within the first week...
Clinical characteristics and risk factors associated with sudden unexplained death (SUD) in the psychiatric population are unclear. Psychiatric in-patients (England, Wales) who met criteria for SUD were identified (1 March 1999-31 December 2005). Cases were matched with controls (in-patients alive on the day a SUD occurred). Data were collected via...
Pre-trial prisoners have high rates of mental disorder, but to date, little is known about mental state change or stability among them.
The aim of this study was to describe mental state change over the first 4 weeks of imprisonment.
Two hundred and fifty-seven new pre-trial male prisoners consented to participate in a prospective interview study....
The purpose of this study was to examine the social, clinical and forensic characteristics of all convicted homicide perpetrators by different age-groups over an 8-year period (1997–2004) in England and Wales. Perpetrators aged under 25 were more likely to use hitting or kicking compared to other offenders, and their victims were more often young,...
Objective:
This study aimed to assess involuntary inpatients' satisfaction with treatment and explore how coercion and other factors are associated with satisfaction.
Methods:
An observational prospective study was conducted in 67 acute wards in 22 hospitals in England. A total of 778 involuntary inpatients were recruited, and their satisfaction...
This study aimed to assess involuntary inpatients' satisfaction with treatment and explore how coercion and other factors are associated with satisfaction.
An observational prospective study was conducted in 67 acute wards in 22 hospitals in England. A total of 778 involuntary inpatients were recruited, and their satisfaction with treatment was ass...
We assessed whether adult Black and minority ethnic (BME) patients detained for involuntary psychiatric treatment experienced more coercion than similar White patients. We found no evidence of this from patient interviews or from hospital records. The area (mental health trust) where people were treated was strongly associated with both the experie...
Background: Psychiatric reports can be prepared in homicide cases, pretrial, to determine the mental state of the offender at the time of the offence and to make recommendations to the court. Objective: To explore the recommendations and agreement between authors in the psychiatric court reports of homicide offenders and to establish the affect the...
Little is known about the long-term outcome of involuntary admissions to psychiatric hospitals.
To assess involuntary readmissions and patients' retrospective views of the justification of the admission as 1-year outcomes and to identify factors associated with these outcomes.
Socio-demographic data and readmissions were collected for 1570 involunt...
Few studies have described rates of schizophrenia in a national sample of homicide perpetrators. This study aimed to describe this group's social and clinical characteristics, mental state features, offense details, and outcome in court.
Analyses used a national clinical survey that collected data on people convicted of homicide in England and Wale...
Suicide prevention is a health service priority. Homeless mental health patients present a challenge to services because of their complex health and social needs.
To establish the numbers of homeless patients in contact with services who die by suicide; to describe their suicide methods and their social and clinical characteristics including aspect...
The annual number of homicide convictions in England and Wales is increasing. Previous studies have highlighted the aetiological role of alcohol and drugs in homicide.
To examine rates of alcohol and drug misuse and dependence in people convicted of homicide; the role of alcohol and drugs in the offence; the social and clinical characteristics of a...
Suicide prevention is a health service priority. Suicide risk may be greatest during psychiatric in-patient admission and following discharge.
To describe the social and clinical characteristics of a comprehensive sample of in-patient and post-discharge cases of suicide.
A national clinical survey based on a 4-year (1996-2000) sample of cases of su...
Previous studies of people convicted of homicide have used different definitions of mental disorder.
To estimate the rate of mental disorder in people convicted of homicide; to examine the relationship between definitions, verdict and outcome in court.
A national clinical survey of people convicted of homicide (n=1594) in England and Wales (1996-19...
There have been few studies of the most serious cases of deliberate self-harm (DSH). These cases represent an important clinical problem. They may also be suitable as a "proxy" for suicide in research studies.
We developed a definition of "near-fatal" deliberate self-harm (NFDSH) and identified all cases attending accident and emergency departments...
To establish changes over time in the frequency of homicides committed by strangers, and to describe the personal and clinical characteristics of perpetrators of stranger homicides.
Longitudinal study and national clinical survey.
People convicted of homicide in England and Wales between 1996 and 1999 and whether the victim was known to the perpetr...
Life events are often reported to precede suicide. This paper aims to determine the frequency, timing and type of life events preceding suicide by young people and those with and without a mental illness.
Informants, usually family members, were interviewed for a sample of young (less than 35 years) suicides. Information was recorded on events occu...
Self-asphyxiation using car exhaust gas is a common method of suicide in England and Wales, particularly in young males. The introduction of catalytic converters has reduced the toxicity of car exhausts. The main aims of the study were: to seek evidence of a fall in car exhaust suicides in the general population and in age and gender groups; to rel...
The death of the Princess of Wales in 1997 was followed by widespread public mourning. Such major events may influence suicidal behaviour.
To assess the impact of the Princess's death on suicide and deliberate self-harm (DSH).
Analysis, using Poisson regression, of the number of suicides and open verdicts ('suicides') in England and Wales following...
Suicide prevention is a health priority in many countries. Improved management of suicide risk may improve suicide prevention. This study aimed to assess the feasibility of health district-wide training in the assessment and management of people at risk of suicide; and to assess the impact of training on assessment and management skills.
Staff in t...
Rose ([2000][1], this issue) describes an interesting method of reviewing local serious incidents. The model appears to be a good one for other services to follow and adapt to local needs. The paper raises issues about the role of local reviews and what they can achieve in comparison with other
Reports of sudden death in people with mental illness who are taking antipsychotic medication have been a source of public and professional controversy for three decades. Psychiatric patients are at increased risk of death from a number of natural causes, including cardiovascular disease ([Sims &
This paper discusses the range of interpretative and communicational meanings accorded the giving and receiving of gifts within the psychotherapeutic encounter. It forms a first report of the qualitative analysis of an open-ended survey on this topic completed by eighty British psychotherapists. When a gift was given, as well as what it was, inform...
The characteristics of all admissions to a new service for patients requiring high levels of staff support in a low-security setting (the High Dependency Network) were examined and compared with the patient characteristics outlined in the service specification. A range of standardized measures was used to assess patients' social and clinical functi...
In the past two decades the suicide rate in young people has risen in the UK and other countries.
To identify the characteristics of people aged under 35 who commit suicide.
Psychological autopsy study with case-control design. Cases were 84 suicides and probable suicides (open verdicts). Controls were 64 age- and gender-matched non-suicides obtain...
To describe the clinical circumstances in which psychiatric patients commit suicide.
National clinical survey. Setting: England and Wales.
A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before death.
Proportion of suicides in people who had had recent c...
Objectives: To estimate the rate of mental disorder in those convicted of homicide and to examine the social and clinical characteristics of those with a history of contact with psychiatric services.
Design: National clinical survey.
Setting: England and Wales.
Subjects: Eighteen month sample of people convicted of homicide.
Main outcome measures:...
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, originally established in 1992, was relocated to Manchester in 1996 with the aim of studying homicides and suicides by people with mental illness in the UK. The Inquiry collects a comprehensive national sample of homicides and suicides, using data from the Ho...
Editor-There was much good sense in Nigel Eastman's article criticising the current guidance on mandatory inquiries after homicides by psychiatric patients.1 Systematic internal audit should surely follow all serious untoward incidents whether or not an independent inquiry is to be held. Independent inquiries are established primarily, however, at...
The suicide rate in young men, but not young women, is rising. One possible route to suicide prevention is through general practice but recent evidence suggests that young suicides are not likely to attend GP surgeries prior to death.
We carried out a retrospective examination of general practice contacts by a 2-year sample of suicides under 35 yea...