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Evaluation of a brief online universal intervention for university students’ understanding of psychotic experiences: a randomised controlled experimental study
No full textThe data was collected online via Qualtrics Software. All analyses were done in SPSS (version 30.0). Both excel and SPSS formats are uploaded
Jerica Radez - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Full text linkIdentifying individuals at risk of developing psychosis: A systematic review of the
literature in primary care services.
Aim: Psychosis and related disorders are a major public health issue. Early identification and prevention for those at high risk (at-risk-mental-state, ARMS) is important. General practitioners (GPs) are often the first point of contact for health services. In this review we aim to identify 1) the most common methods for identifying individuals with an ARMS in primary care, 2) the methods for improving identification of individuals with an ARMS in primary care, and 3) the most common barriers that prevent GPs from screening for individuals with an ARMS.
Methods: We conducted a systematic review (PROSPERO CRD42021245095) of quantitative and qualitative studies with no date restriction. Searches were performed in September 2021. Studies’ quality was appraised using Mixed Methods Appraisal tool (MMAT).
Results: We identified 16 eligible studies, and all but one provided quantitative data. Nearly two-thirds of studies were classified as ‘medium’ quality. Employing narrative synthesis, we identified three themes relating to 1) improving GP knowledge and confidence in identifying individuals with an ARMS, 2) balancing the over- and under-identification of individuals with an ARMS in primary care, and 3) supporting GPs as significant stakeholders in early diagnosis and treatment of individuals with an ARMS.
Conclusions: Improved identification of individuals with an ARMS is needed. We identified various strategies, including development and implementation of identification methods (e.g., screening measures), educational interventions for GPs (e.g., workshops), and systemic interventions (e.g., simplifying referrals to secondary care, developing integrated services). When implemented successfully, these interventions may help facilitate the access to appropriate care for individuals with an ARMS
Paranoia in adolescents: assessment, prevalence, and clinical understanding
Full text linkBackground
Adolescence is the age when paranoia is most likely to first arise. Believing that others intend to harm you is likely to be corrosive for social relationships; this, in turn, could worsen outcomes for young people with mental health disorders. To date, however, paranoia has been predominantly studied in adults. Very little is known about its clinical presentation in adolescents. In this thesis, a systematic programme of research examining paranoia in adolescents - particularly those in clinical services - was conducted. The aims were to 1) develop an age-appropriate assessment of paranoia for young people, 2) establish the extent to which paranoia is a problem in adolescents attending mental health services, and 3) improve the clinical and theoretical understanding of paranoia at this age.
Method
After a systematic review of existing measures used to assess paranoia in the adolescent literature (Chapter 2), the development of a new measure of adolescent paranoia is described in Chapter 3. This measure was validated extensively using classical test theory and item response theory approaches in two cohorts: adolescents from the general population (n = 801) and patients accessing child and adolescent mental health services (CAMHS) (n = 301). A simulation of 10,000 responses was also conducted to evaluate the potential of the new measure as a computerised adaptive test. Next, this measure was used to examine the prevalence and potential correlates of paranoia in adolescents across the two cohorts of adolescents from a secondary school (Chapter 4) and patients accessing CAMHS (Chapter 5).
In the school cohort, an undirected network model and a Bayesian network with directed acyclic graphs (DAGs) was used to estimate probabilistic causal pathways between paranoia and theoretically important psychological factors and social factors relevant to adolescents (i.e. social media and peer interactions). In the CAMHS cohort, relationships between paranoia and both clinician-report and self-report psychiatric symptoms were examined using linear regressions and undirected network methods. The persistence of paranoia and its relationship with other difficulties several months later was assessed in a subgroup of the patients (n = 105). Finally, an interpretative phenomenological analysis (IPA) study using semi-structured interviews was conducted with 12 adolescent patients with paranoia in the context of non-psychotic mental health problems (Chapter 6).
Results
In Chapter 3, a new 18-item measure of paranoid thoughts for adolescents - the Bird Checklist of Adolescent Paranoia (B-CAP) - was created. The B-CAP was shown to be a valid and reliable measure with excellent psychometric properties for assessing paranoia in clinical and non-clinical populations of youth, with potential as an efficient adaptive test. In Chapter 4, paranoia in the adolescent general population was shown to follow a continuous distribution that closely fit an exponential curve. Occasional suspicions were common, and 15% of adolescents reported elevated levels. Paranoia was significantly higher in adolescent girls compared to boys, and was associated with clinical levels of anxiety, depression, and insomnia. DAGs analysis found paranoia closely interacted with affective processes and bullying, was more likely to impact peer relationships than vice versa, and had no causal relationship with problematic social media use.
The adolescent patients from the CAMHS cohort (Chapter 5) were primarily accessing services for emotional disorders. Only 2% had suspected psychosis. Rates of paranoia in these patients were approximately double those in the general population, with 35% reporting elevated levels. Yet paranoia was recorded in the clinical notes of only one participant. Paranoia was significantly higher in girls than boys and was associated with a range of clinician-rated problems including affective symptoms, self-harm, trauma, and impaired social functioning. Network analyses showed paranoia most strongly interacted with peer difficulties, and that paranoia had a central mediating role in the relationship between peer difficulties and most other symptoms. Follow-up data showed that paranoia remained persistent for three-quarters and was associated with greater psychological problems over time.
In the qualitative study (Chapter 6), young patients described a range of distressing paranoid concerns that were broadly overlooked by clinicians and untreated, despite regular contact with services. The young people’s accounts reflected a journey from the emergence of paranoia to the experience, and then, to adjusting to paranoia in daily life. Paranoia onset was rooted in the discovery of interpersonal threat and personal vulnerability, shaped by challenging peer interactions, becoming aware of danger in the world, and personal adverse experience. The paranoia experience included a struggle to trust friends, a state of threat anticipation, intense fear, and defensive strategies to keep safe. The patients described how the paranoia experience was confusing, negatively impacted self-concept, held them back from normal teenage life, and caused a disconnection from friends. Longer term responses to paranoia reflected a tension between reluctantly resigning to the experience and trying to resist the impact. Decisions about how adolescents respond to paranoia will determine the next stage of their journey.
Conclusions
There is a continuum of paranoia in the adolescent general population. Occasional suspicions are common at this age - more frequent paranoid thoughts, however, may indicate greater psychopathology. In patients attending CAMHS, paranoia is highly prevalent across a range of clinical presentations. It is likely to occur in the context of emotional problems, self-harm, adverse interpersonal experiences, and social impairment. Yet it may often be overlooked in services. Consistent with cognitive models of persecutory delusions, paranoia in adolescents is likely to build upon feelings of vulnerability and is closely linked to anxiety-processes concerned with anticipating danger. At this age, paranoia may involve navigating multiple tensions, with adolescents balancing independence with vulnerability, trust with mistrust, and the desire to socialise with a fear of danger and deception. Although the effects are potentially wide-reaching, there is a clear social impact of paranoia on adolescent peer relationships. Paranoia can be an understandable response to a changing and often-threatening social world in adolescence, but it is not inevitable nor without negative consequence. Greater awareness of paranoia in adolescents attending CAMHS is needed. Once identified, targeted interventions for paranoia, suitably adapted for this age group, would be the next step to help young people feel safer in their daily lives
Precision in the understanding and treatment of paranoia
Full text linkImprovements are needed in the effectiveness and accessibility of cognitive behavioural therapy (CBT) for psychosis. One route to improving efficacy is to take a translational approach, focussing on one proposed causal mechanism at a time, and testing specific therapeutic techniques that may help to modify this mechanism. This thesis aims for precision at multiple stages. First, through focussing on a single psychotic experience, paranoia, and a single putative causal mechanism, negative cognition. Second, through testing interventions that target specific aspects of negative cognition in order to reduce paranoia. Third, through conducting studies using a manipulation method to gain precise causal evidence. Finally, using immersive virtual reality (VR) to accurately measure paranoia, train therapeutic techniques in a controlled setting, and, when automated, increase access to evidence-based therapy. Chapter 1 introduces these conceptual and methodological approaches to precision. A systematic review (Chapter 2) found that the manipulation method has to date been infrequently used in psychosis research. Chapters 3, 4, and 5 each report a study that combines the three approaches – specificity, manipulation, and VR. Chapter 3 found that training in compassionate coach imagery, practised in VR social environments, caused significant reductions in paranoia mediated by increases in self-compassion. Chapter 4 found that training in loving kindness meditation, practised in VR, caused significant reductions in paranoia that were mediated by increases in compassion for others. Chapter 5, in contrast, found that altering body posture prior to entering VR had a negligible effect on increasing feelings of power, and no subsequent effect on paranoia. Following this experimental work on modifying negative beliefs, Chapter 6 considered how such beliefs might form in the first place. Using a large epidemiologically representative adolescent sample and a smaller adult sample it was found that parental verbal and physical abuse, over-control, and lack of care were significantly associated with paranoia and negative self and other beliefs. Network analysis did not find that the relationship between parenting and paranoia was mediated by negative self and other beliefs. Finally, given the limited access to CBT for psychosis, Chapter 7 explored the feasibility of implementing automated VR therapy onto psychiatric inpatient wards. A thematic analysis of qualitative data found that both patients and staff believed VR would be beneficial in this setting, but that certain practical barriers needed to be overcome. Overall, this thesis provides initial evidence of the benefits in taking an early-stage translational approach to treatment development for paranoia, showing that even single therapeutic interventions can bring about large effects, and these techniques can now be tested in clinical populations
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The efficacy of a new translational treatment for persecutory delusions: study protocol for a randomised controlled trial (The Feeling Safe Study)
Full text linkBackground
Persecutory delusions (strong unfounded fears that others intend harm to the person) occur in more than 70 % of the patients diagnosed with schizophrenia. This major psychotic experience is a key clinical target, for which substantial improvement in treatment is needed. Our aim is to use advances in theoretical understanding to develop a much more efficacious treatment that leads to recovery in at least 50 % of people with persistent persecutory delusions. Our cognitive conceptualisation is that persecutory delusions are threat beliefs, developed in the context of genetic and environmental risk, maintained by a number of psychological processes including excessive worry, low self-confidence, intolerance of anxious affect and other internal anomalous experiences, reasoning biases, and safety-seeking strategies. The clinical implication is that safety has to be relearned, by entering the feared situations after reduction of the influence of the maintenance factors. We have been individually evaluating modules targeting causal factors. These will now be tested together as a full treatment, called The Feeling Safe Programme. The treatment is modular, personalised, and includes patient preference. We will test whether the new treatment leads to greater recovery in persistent persecutory delusions, psychological well-being, and activity levels compared to befriending (that is, controlling for therapist attention).
Methods/design
The Feeling Safe Study is a parallel group randomised controlled trial for 150 patients who have persecutory delusions despite previous treatment in mental health services. Patients will be randomised (1:1 ratio) to The Feeling Safe Programme or befriending (both provided in 20 sessions over 6 months). Standard care will continue as usual. Online randomisation will use a permuted blocks algorithm, with randomly varying block size, stratified by therapist. Assessments, by a rater blind to allocation, will be conducted at 0, 6 (post treatment), and 12 months. The primary outcome is the level of delusional conviction at 6 months. Secondary outcomes include levels of psychological well-being, suicidal ideation, and activity. All main analyses will be intention-to-treat. The trial is funded by the NHS National Institute for Health Research.
Discussion
The Feeling Safe study will provide a Phase II evaluation of a new targeted translational psychological treatment for persecutory delusions.
Trial registration
Current Controlled Trials ISRCTN18705064 (registered 11 November 2015)
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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