Search results

The onset of psychosis typically develops during adolescence, a crucial period for beginning the transition from family to independence and developing a stable sense of self. Recovery amongst adolescents experiencing early onset psychosis has not yet been investigated with reference to its influence on self-identity. The purpose of this paper is to explore the impact living with early onset psychosis has on self-identity for adolescents in recovery.

A purposive sample of ten adolescents aged between 16 and 18 years from an Early Intervention Service in the Scottish National Health Service were recruited. All had experienced at least one episode of psychosis and were within three years of first contact with the service. Semi-structured interviews were adopted to capture adolescents’ perspectives concerning their experiences of recovery from psychosis and the impact on self-identity. All interviews were audio-recorded, transcribed and thematically analysed.

Qualitative analysis of adolescents’ accounts revealed how recovery from psychosis involves working with individual explanatory frameworks concerning uncertain identities and status ambiguity, a decrease in referent points and unfavourable social comparisons (emphasising loss, grief and self-criticism).

Supporting adolescents experiencing early psychosis involves education, rebuilding relationships with self and others and providing access to psychotherapeutic interventions to aid self-identity development when needed.

The originality of this paper lies in the importance of identity, recovery, human reconnection, advocacy and community reintegration for adolescents experiencing psychosis. Public mental health campaigns to tackle the stigma surrounding psychosis are essential to assisting adolescents in developing their sense of self through their recovery journeys.

Genetic and environmental factors are associated with psychosis risk, but the latter present more tangible markers for prevention. We conducted a theoretical exercise to estimate the proportion of psychotic illnesses that could be prevented if we could identify and remove all factors that lead to increased incidence associated with ethnic minority status and urbanicity. Measures of impact by population density and ethnicity were estimated from incidence rate ratios [IRR] obtained from two methodologically‐similar first episode psychosis studies in four UK centres. Multilevel Poisson regression was used to estimate IRR, controlling for confounders. Population attributable risk fractions [PAR] were estimated for our study population and the population of England. We considered three outcomes; all clinically relevant ICD‐10 psychotic illnesses [F10‐39], non‐affective psychoses [F20‐29] and affective psychoses [F30‐39]. One thousand and twenty‐nine subjects, aged 18‐64, were identified over 2.4 million person‐years. Up to 22% of all psychoses in England (46.9% within our study areas) could be prevented if exposures associated with increased incidence in ethnic minority populations could be removed; this is equivalent to 66.9% within ethnic minority groups themselves. For non‐affective psychoses only, PAR for population density was large and significant (27.5%); joint PAR with ethnicity was 61.7%. Effect sizes for common socio‐environmental risk indicators for psychosis are large; inequalities were marked. This analysis demonstrates potential importance in another light: we need to move beyond current epidemiological approaches to elucidate exact socio‐environmental factors that underpin urbanicity and ethnic minority status as markers of increased risk by incorporating gene‐environment interactions that adopt a multi disciplinary perspective.

This paper aims to investigate the feasibility of conducting research on a two-pronged vocational intervention for people with first episode psychosis. The paper also aims to empirically examine the impact of a two-pronged vocational intervention for people with first episode psychosis by determining what effect, if any, introducing a two-pronged vocational intervention to an early intervention for psychosis service (EIPS) has on vocational outcomes using a prospective follow-up design. The approach consisted of supported employment (individual placement and support, IPS) for participants without a productive role and a job retention programme for those employed or studying.

Between 2010 and 2013, a supported employment specialist joined an EIPS where occupational therapy was available to all attenders. The appropriate intervention was determined by the occupational therapist on the team. Participants were interviewed at baseline and one follow-up. Ethical approval was attained. The Individual Placement and Support Fidelity Scale was used to ensure the quality of IPS implementation.

In total, 39 (20 men, 19 women) consented; 21 (54 per cent) of these participants were unoccupied; 18 (46 per cent) had a productive role; 87 per cent (n = 34) were followed up. The mean length of follow-up was 18 months. At follow-up, 50 per cent (n = 10) of unoccupied participants had attained a productive role, and 17 of the 18 participants had retained their productive role. Overall, participants were found to have spent an average of 62 per cent of the follow-up period in a productive role.

Rates of vocational recovery among people affected by psychosis may be enhanced by a two-pronged approach that allows for the persons individual work circumstances to be taken into account.

This study highlights the impact of a two-progroned vocational intervention for people with first episode psychosis in Ireland. It is the first study of its kind to be published in the Republic of Ireland and the first world-wide to include a job retention element in its design.

Social capital is a complex and multidimensional construct, which has been used widely in the social sciences, and which focuses attention on non‐monetary resources and relationships. The aim of this analysis study was to test the feasibility of deriving social capital variables from an epidemiological dataset, to explore associations between social capital and psychosis and to investigate the utility of the concept for understanding and treating mental illness. We set out to derive social capital variables from an existing epidemiological study, and tested their associations with first episode psychosis. Associations were found between psychosis and one form of social capital, active engagement in social activities. We conclude that social capital is a promising construct that can be utilised in analysing social dimensions of mental illness. Secondary analysis is possible, but longitudinal surveys with comprehensive measures of social capital and mental health are needed.

This paper presents the outcomes of a small qualitative study investigating the experience of mental health practitioners working with dual diagnosis in an early intervention in psychosis (EIP) team with a focus on the use of a specifically developed screening tool. Interviews were conducted with mental health professionals who were employed as care co‐ordinators within an EIP team. Grounded theory was adopted as a method for making sense of the data obtained. Six themes that emerged from the data are described: the importance of the cycle of change in treatment planning; service accountability and responsibility; the nature of psychotic illness; assumptions about substance use; confidence; and using the tool as part of the recovery process. These themes were discussed in relation to research surrounding psychosis, substance use and screening methods.Despite identifying the importance of a more integrated method of working with this complex service user group, gaps remain in practice. Modifications to the screening tool are recommended and a need for substance‐use‐specific interventions training for practitioners working within EIP services is identified.

The purpose of this paper is to draw together key literature and analyses of data on admissions for cannabis psychosis in National Health Service hospitals in England (extracted from Hospital Episode Statistics (HES)) to highlight what is known about gender differences in cannabis psychosis and point towards suggestions for improving gender-sensitive treatment and future research.

Analysis of British Crime Survey data and HES data were used in combination with data from previously published epidemiological studies to compare gender differences.

Male cannabis users outnumber female users by 2:1, a similar gender ratio is found for those admitted to hospital with a diagnosis of schizophrenia or psychosis. However this ratio increases significantly for those admitted to hospital with a diagnosis of cannabis psychosis, with males outnumbering females by 4:1.

Consistent patterns in gender ratios for people admitted to hospital with cannabis psychosis over a period of 11 years are reported, it is not clear why this gender difference persists but it warrants further investigation which would be aided by improved gender recording at a systemic level.

This review brings into focus the marked gender differences in cannabis psychosis. Attending to gender is important for research and treatment with the aim of improving understanding and providing gender-sensitive services.

This paper adds to the literature on gender differences in cannabis psychosis.

The purpose of this paper is to investigate health care professionals’ (HCPs) and service-users’ (SUs) attitudes towards different treatment options in an Early Intervention for Psychosis (EIP) service as well as the topical issue of offering choice over treatment.

Seven SUs accessing an EIP service and nine HCPs completed qualitative surveys about treatment for psychosis. Data were analysed thematically.

Both HCPs and SUs appeared to have a generally positive attitude to the range of interventions offered by the EIP service and SUs talked about the importance of all treatment options being explored. There was variation in attitudes towards SUs having choice over their treatment and a number of factors were identified as crucial in influencing attitudes including mental capacity, risk and level of engagement.

Small sample size, recruitment from only one EIP service and using a survey design limit generalisability and depth of analysis.

HCPs working in EIP services should explore different treatment options fully with SUs but be aware that they may feel unable to make the decision themselves. Such discussions should be revisited throughout an individual’s care as their ability and desire to make informed choices may change over time. Continuing Professional Development and clinical supervision should be used to help HCPs reflect on the choice agenda and the implications of this for clinical practice.

Few studies have examined attitudes towards treatments for psychosis. This is an evolving and important clinical area that remains under researched. Recommendations for service-development, future research and clinical practice are made.

Early interventions focusing on exercise and lifestyle are important for individuals with a diagnosis of psychosis due to increased risk of poor physical health and reduced life expectancy. This study aims to test the feasibility of a multicomponent lifestyle intervention for individuals with first episode psychosis (FEP).

Individuals attending an Irish FEP service were invited to engage in an eight-week programme including individual and group exercise sessions, group educational sessions and one dietician consultation. Physical activity, physical health, mental health, cognition and personal goals measures were completed pre- and post-intervention and analysed using descriptive statistics. Feasibility data was collected via a non-standardised participant questionnaire and informal data on completion of measures and engagement with the programme.

Ten participants with a diagnosis of FEP completed the intervention. Participants were satisfied with the intervention and adherence rates were high for weekly individual gym sessions but lower for group exercise and education sessions. Mean time spent engaging in physical activity increased and sedentary behaviours decreased. Participants indicated increased readiness for change with 90% moving to the action or maintenance stages of change. Participants attained 74% of their personal goals. There were no changes in average body mass index, cognition or mental health. Data relating to blood pressure, blood tests and steps was missing or incomplete.

This study indicates an eight-week exercise and lifestyle programme is feasible and acceptable in a clinical setting. Recommendations relating to satisfaction, clinical markers and resource requirements are made for future studies.

“Social recovery” is a long-cited aim within the UK early intervention in psychosis (EIP) services; however, there is a lack of evidence regarding existing social recovery provisions and how these can be improved. This paper aims to evaluate an existing social drop-in facility within an EIP team, ran within the Birmingham and Solihull Mental Health NHS Foundation Trust, and highlight the potential benefits of delivering such services for people diagnosed with first episode psychosis.

Attendance and basic demographic statistics (age, gender and ethnicity of attendees) were collected over a period of 13 weeks. In addition, two semi-structured focus groups were conducted: one with EIP staff members (community psychiatric nurses and support workers) and the other with current service users, with both groups describing their satisfaction and experience of the drop-in facility and how it can be improved.

Inductive thematic analysis was used to analyse data from both focus groups, with six overarching meta-themes being identified: reflection, environment, emotional experience, recovery, activities and interactions. Service users and staff reflected that the drop-in facility was an asset to the service, although work could be done to improve overall attendance.

This paper explores how a social drop-in facility can provide a supportive, positive environment that aids recovery from psychosis for service users and improves working conditions for the EIP staff.

The purpose of this paper is to review representative literature on social inclusion and evaluate the usefulness of the concept in current mental health policy.

The paper employs a selective review of the cost‐effectiveness of interventions aimed at improving social inclusion in children, young adults with first episode psychosis and unemployed adults of working age.

Social inclusion remains a useful concept in understanding both the causes of mental health problems and how these might best be addressed. Although measurement is not easy, it can be operationalised through a mixture of subjective and objective indicators. There is strong evidence for the effectiveness and cost‐effectiveness of interventions aimed at improving social inclusion for the groups selected. These findings provide strong support for prioritising these interventions, especially in times of severe financial restrictions.

The selection of literature for review limits the generalisability of the conclusions.

The paper sets out a clear and simple analysis of the concept of social inclusion and how it may be measured. It also brings together the cost‐effectiveness literature on attempts to improve social inclusion for three, key high‐risk groups. The paper strongly supports the value of retaining the concept of social inclusion, despite the fact that it has become temporarily unfashionable.