Let’s not go there: exploring the delivery of trauma-focused interventions in people with psychosis

Post-Traumatic Stress Disorder (PTSD) is prevalent in people with psychosis. Trauma-focused interventions are increasingly supported for this group by research trials and clinical guidelines. However, in clinical practice, trauma continues to be under-recognised and under-treated. This thesis explores pertinent barriers and facilitators to delivering trauma-focused interventions for people with psychosis. It is presented in three parts. Part 1: A Systematic Review This review examines available qualitative data regarding staff perceptions of the barriers and facilitators to delivering psychological interventions in clinical practice. Findings from twelve studies are presented in a narrative synthesis. Results identify a number of common factors which inhibit the delivery of psychological interventions for mental health disorders. Clinical and research implications of findings are discussed. Part 2: An Empirical Paper This paper explores the barriers and facilitators to trauma-focused interventions for people with psychosis through a Grounded Theory approach. Interviews were completed with 18 individuals working in the commissioning and delivery of clinical services for people with psychosis. Analysis generated a three-factor conceptualization of the barriers and facilitators to treatment with this clinical population. Recommendations are made for strategies to increase access to trauma-focused interventions for this group. Part 3: A Critical Appraisal This chapter offers a critical reflection on the process of research and follows the journey of clinical research from study design, recruitment, and interview through to analysis and writing. It considers the context within which research takes place including philosophical and theoretical underpinnings as well as tempo-socio-cultural context

Barriers to delivering trauma-focused interventions for people with psychosis and post-traumatic stress disorder: A qualitative study of health care professionals' views

OBJECTIVES: Trauma-focused interventions have been shown to be effective treatments for post-traumatic stress disorder (PTSD), and clinical guidelines support their use with people with psychosis. Despite this, they are used relatively infrequently in this population. We sought to explore UK health care professionals' perceptions of what impedes or facilitates the use of trauma-focused interventions among people with psychosis and PTSD. DESIGN: A qualitative study using constructivist grounded theory methodology. METHODS: We conducted semi-structured interviews with 18 health care professionals working within the commissioning and delivery of clinical services for people with psychosis. RESULTS: Three inter-related barriers to the use of trauma-focused interventions were conceptualized: coherent understanding; structural support; and safe space. CONCLUSIONS: Delivery of trauma-focused interventions within routine clinical practice may be supported by attention to the coherent integration of discussion of trauma into the clinical discourse of services; the processes, pathways, and organizational culture that facilitate access to treatment; and training that targets clinician confidence and skills

An exploration of sarcasm detection in children with Attention Deficit Hyperactivity Disorder

This document is the Accepted Manuscript version of the following article: Amanda K. Ludlow, Eleanor Chadwick, Alice Morey, Rebecca Edwards, and Roberto Gutierrez, ‘An exploration of sarcasm detection in children with Attention Deficit Hyperactivity Disorder’, Journal of Communication Disorders, Vol. 70: 25-34, November 2017. Under embargo. Embargo end date: 31 October 2019. The Version of Record is available at doi: https://doi.org/10.1016/j.jcomdis.2017.10.003.The present research explored the ability of children with ADHD to distinguish between sarcasm and sincerity. Twenty-two children with a clinical diagnosis of ADHD were compared with 22 age and verbal IQ matched typically developing children using the Social Inference–Minimal Test from The Awareness of Social Inference Test (TASIT, McDonald, Flanagan, & Rollins, 2002). This test assesses an individual’s ability to interpret naturalistic social interactions containing sincerity, simple sarcasm and paradoxical sarcasm. Children with ADHD demonstrated specific deficits in comprehending paradoxical sarcasm and they performed significantly less accurately than the typically developing children. While there were no significant differences between the children with ADHD and the typically developing children in their ability to comprehend sarcasm based on the speaker’s intentions and beliefs, the children with ADHD were found to be significantly less accurate when basing their decision on the feelings of the speaker, but also on what the speaker had said. Results are discussed in light of difficulties in their understanding of complex cues of social interactions, and non-literal language being symptomatic of children with a clinical diagnosis of ADHD. The importance of pragmatic language skills in their ability to detect social and emotional information is highlighted.Peer reviewe

The impact of introduced hosts on parasite transmission: opisthorchiid infections in American mink (Neovison vison)

Introduced animals may be considered at an advantage over native competitors because they have escaped natural parasites. In some cases however, generalist parasites in a novel environment can use introduced species as an alternative or reservoir host. This can change the dynamics of parasite populations, with implications for epidemiology. The key factor determining the impact of an alternative host is its ability to maintain a reproductively successful parasite and contribute to the transmission potential of that parasite. The digenean Pseudamphistomum truncatum is found in native otters Lutra lutra in Britain and has been reported in introduced American mink Neovison vison. To investigate whether introduced mink are competent hosts and to ask how mink compare with otters as hosts, we compared parasite prevalence, intensity and fecundity between the two host species in a region where both are common. Although prevalence was not statistically different between otters and mink (48 %, n = 27, compared to 33 %, n = 21 respectively), mean parasite intensity was higher in mink (253 ± 145 standard error parasites/infected host, compared to 46 ± 18 in otters). Parasite fecundity was lower in mink (mean egg count/parasite/host = 622 ± 64) than in otters (1,204 ± 108), and this difference was not confounded by host or parasite size or by intraspecific competition among parasites. Assuming the parasite eggs are equally viable from otters or mink, mink are not only a competent host for P. truncatum, but because of the higher parasite intensity in mink, they can potentially spread c.3 times as many parasite eggs to intermediate hosts, than otters. The naturalisation of mink to new habitats may therefore contribute to trematode infections in native fauna

East-West divide: temperature and land cover drive spatial variation of Toxoplasma gondii infection in Eurasian otters (Lutra lutra) from England and Wales

Toxoplasma gondii, a zoonotic parasite of global importance, infects all endothermic vertebrates, with extensive health implications. The prevalence of this parasite is seldom monitored in wildlife. Here, a semi-aquatic species, the Eurasian otter (Lutra lutra) was used as a model to assess the potential effect of climate, land cover and biotic factors on T. gondii seroprevalence in British wildlife. The Sabin–Feldman cytoplasm-modifying dye test identified T. gondii antibodies in 25·5% of blood samples from otters found dead, mainly as road kill, in England and Wales, between 2004 and 2010. Otters in the east of England were more likely to be infected with T. gondii than those in western regions. Land cover and temperature are key determinants of T. gondii infection risk, with more infection in arable areas and lower infection where temperatures are higher. The probability of T. gondii infection increased with host age, reflecting cumulative exposure with time, but there was no association between T. gondii seroprevalence and cause of host death

Abiotic and biotic factors associated with tick population dynamics on a mammalian host: Ixodes hexagonus infesting otters, Lutra lutra

The Eurasian otter, Lutra lutra, hosts several parasites with zoonotic potential. As this semiaquatic mammal has large ranges across terrestrial, freshwater and marine habitats, it has the capacity for wide dispersion of pathogens. Despite this, parasites of otters have received relatively little attention. Here, we examine their ectoparasite load and assess whether this is influenced by abiotic or biotic variables. Climatic phenomena such as the North Atlantic Oscillation (NAO) affect weather conditions in northern Europe. Consequently parasite distributions, particularly species with life stages exposed to the external environment, can be affected. We assessed the extent to which inter-annual variations in large-scale weather patterns (specifically the NAO and Central England (CE) temperatures) and host characteristics influenced tick prevalence and intensity. Ectoparasites consisted of a single species, the nidiculous tick Ixodes hexagonus (prevalence = 24.3%; mean intensity = 7.2; range = 1–122; on n = 820 otter hosts). The prevalence, but not intensity of infestation, was associated with high CE temperatures, while both prevalence and intensity were associated with positive phases of the NAO. Such associations indicate that I. hexagonus are most abundant when weather conditions are warmer and wetter. Ticks were more prevalent on juvenile than sub-adult or adult otters, which probably reflects the length of time the hosts spend in the holt where these ticks quest. High tick number was associated with poor host condition, so either poor condition hosts are more susceptible to ticks, or tick infestations negatively impact on host condition. Otters are clearly an important and common host for I. hexagonus, which has implications for vector-borne diseases. This work is the first to consider the impacts of long-term weather patterns on I. hexagonus and uses wild-animal cadavers to illustrate the importance of abiotic and biotic pressures impacting parasitic populations

Odour dialects among wild mammals

Across multiple taxa, population structure and dynamics depend on effective signalling between individuals. Among mammals, chemical communication is arguably the most important sense, underpinning mate choice, parental care, territoriality and even disease transmission. There is a growing body of evidence that odours signal genetic information that may confer considerable benefits including inbreeding avoidance and nepotism. To date, however, there has been no clear evidence that odours encode population-level information in wild mammals. Here we demonstrate for the first time the existence of ‘odour dialects’ in genetically distinct mammalian subpopulations across a large geographical scale. We found that otters, Lutra lutra, from across the United Kingdom possess sex and biogeography-specific odours. Subpopulations with the most distinctive odour profiles are also the most genetically diverse but not the most genetically differentiated. Furthermore, geographic distance between individuals does not explain regional odour differences, refuting other potential explanations such as group odour sharing behaviour. Differences in the language of odours between subpopulations have the potential to affect individual interactions, which could impact reproduction and gene-flow

Spatial and seasonal factors are key determinants in the aggregation of helminths in their definitive hosts: Pseudamphistomum truncatum in otters (Lutra lutra)

Parasites are typically aggregated within their host populations. The most heavily infected hosts are frequently cited as targets for optimal disease control. Yet a heavily infected individual is not necessarily highly infective and does not automatically contribute a higher proportion of infective parasitic stages than a host with fewer parasites. Here, Pseudamphistomum truncatum (Opisthorchiida) parasitic infection within the definitive otter host (Lutra lutra) is used as a model system. The hypothesis tested is that variation in parasite abundance, aggregation and egg production (fecundity, as a proxy of host infectivity) can be explained by abiotic (season and region) or biotic (host age, sex and body condition) factors. Parasite abundance was affected most strongly by the biotic factors of age and body condition, such that adults and otters with a higher condition index had heavier infections than sub-adults or those with a lower condition index, whilst there were no significant differences in parasite abundance among the seasons, regions (ecological regions defined by river catchment boundaries) or host sexes. Conversely, parasite aggregation was affected most strongly by the abiotic factors of season and region, which were supported by four different measures of parasite aggregation (the corrected moment estimate k, Taylor’s Power Law, the Index of Discrepancy D, and Boulinier’s J). Pseudamphistomum truncatum was highly aggregated within otters, with aggregation stronger in the Midlands (England) and Wales than in the southwestern region of the United Kingdom. Overall, more parasites were found in fewer hosts during the summer, which coincides with the summer peak in parasite fecundity. Combined, these data suggest that (i) few otters carry the majority of P. truncatum parasites and that there are more infective stages (eggs) produced during summer; and (ii) abiotic factors are most influential when describing parasite aggregation whilst biotic factors have a greater role in defining parasite abundance. Together, parasite abundance, aggregation and fecundity can help predict which hosts make the largest contribution to the spread of infectious diseases