Sexual abuse and psychotic phenomena: a directed acyclic graph analysis of affective symptoms using English national psychiatric survey data

Background: Sexual abuse and bullying are associated with poor mental health in adulthood. We previously established a clear relationship between bullying and symptoms of psychosis. Similarly, we would expect sexual abuse to be linked to the emergence of psychotic symptoms, through effects on negative affect. // Method: We analysed English data from the Adult Psychiatric Morbidity Surveys, carried out in 2007 (N = 5954) and 2014 (N = 5946), based on representative national samples living in private households. We used probabilistic graphical models represented by directed acyclic graphs (DAGs). We obtained measures of persecutory ideation and auditory hallucinosis from the Psychosis Screening Questionnaire, and identified affective symptoms using the Clinical Interview Schedule. We included cannabis consumption and sex as they may determine the relationship between symptoms. We constrained incoming edges to sexual abuse and bullying to respect temporality. // Results: In the DAG analyses, contrary to our expectations, paranoia appeared early in the cascade of relationships, close to the abuse variables, and generally lying upstream of affective symptoms. Paranoia was consistently directly antecedent to hallucinations, but also indirectly so, via non-psychotic symptoms. Hallucinosis was also the endpoint of pathways involving non-psychotic symptoms. // Conclusions: Via worry, sexual abuse and bullying appear to drive a range of affective symptoms, and in some people, these may encourage the emergence of hallucinations. The link between adverse experiences and paranoia is much more direct. These findings have implications for managing distressing outcomes. In particular, worry may be a salient target for intervention in psychosis

Thérapie cognitive béhaviorale des psychoses

Bien que la médication neuroleptique ait démontré son efficacité pour le traitement des psychoses, les interventions psychologiques auprès des personnes qui en souffrent ont encore un rôle important à jouer. Les chiffres varient mais on estime qu'entre le quart et la moitié des personnes avec un diagnostic de schizophrénie souffrent de symptômes persistants, comme les délires et les hallucinations, qui provoquent de la détresse et interfèrent dans leur fonctionnement malgré la prise de médicaments (Fowler et al., 1995). Les rechutes se produisent souvent même chez les patients qui se conforment au régime de médication et plusieurs personnes sont réticentes à une médication suivie sur une longue période à cause de ses effets secondaires déplaisants et même débilitants. Ces dernières années, le développement de la thérapie cognitive béhaviorale (TCB) a connu un intérêt croissant pour les personnes atteintes de psychoses qui continuent d'éprouver des symptômes psychotiques malgré un traitement continu de médication anti-psychotique. La TCB des psychoses tente d'aborder directement ces structures de comportements, de pensées et de réactions émotionnelles qui sous-tendent et maintiennent les délires et les hallucinations graves et persistants.Although neuroleptic medication is clearly effective, there is still an important role for psychological interventions for people with psychosis. Figures vary, but it can be estimated that between one quarter and one half of people with a diagnosis of schizophrenia experience persistent symptoms such as delusions and hallucinations, which cause distress and interference with functioning, despite taking medication (Fowler et al. 1995). Relapse occurs commonly even amongst patients who do adhere to medication regimes, and many people are reluctant to take long-term medication, because of its unpleasant and even disabling side-effects. In recent years, there has been a growing interest in developing cognitive behavioural therapy for those people with psychosis who continue to experience psychotic symptoms despite ongoing treatment with anti-psychotic medication. Cognitive behaviour therapy for psychosis seeks to address directly those patterns of behaviour, thinking and emotional response which underpin and maintain severe and chronic delusions and hallucinations.Aunque los medicamentos neurolépticos hayan demostrado su efi-cacia en el tratamiento de las psicosis, las intervenciones psicologicas con las personas que los sufren, juegan todavia un papel importante. Las estadisticas varian, pero se estima que entre el cuarto y la mitad de las personas con un diagnôstico de esquizofrenia, sufren de sintomas per-sistentes como los delirios y las alucinaciones que provocan angustia e interfieren en su funcionamiento diario, a pesar de la toma de medicamentos (Fowler y al., 1995). Frecuentemente, las recaidas se producen en los mismos pacientes que se conforman al régimen de la medicacion y varias personas son réticentes a la medicacion tomada sobre un largo perîodo, a causa de sus efectos secundarios desagradables y hasta débilitantes. Estos ûltimos anos, el desarrollo de la terapia cognoscitiva be-haviorala (TCB) ha conocido un interés creciente para las personas afectadas por psicosis y que siguen padeciendo los sintomas psicôticos a pesar de un tratamiento continuo de medicamentos anti-psicoticos. La TCB de la psicosis intenta abordar directamente esos patterns (es-quemas) de comportamientos, de pensamientos y de reacciones emocio-nales qu apuntalan y mantien los delirios y las alucinaciones graves y persitentes

Delivering Cognitive-Behavioural Family Interventions for Schizophrenia

Background: In 1993, Kavanagh and colleagues outlined outcomes from a training programme designed to equip mental health practitioners to deliver evidence-based cognitive-behavioural family interventions within routine care. The authors highlighted how the training had not been able to deliver notable increases in the numbers of families being seen by the trained clinicians. There were significant issues in the translation and provision of family interventions within clinical settings, specifically difficulties with the integration of family interventions and caseload demands, and insufficient time within job plans and service settings to undertake the work. The authors posed the question: what can the matter be? Interestingly, the same question was being asked over a decade later. Objective: The current article provides a narrative review of the issues on implementation of family interventions in psychosis. Results: Current evidence suggests that while there exist pockets of good practice and provision for family interventions, it was a mistake to assume that care coordinators would be able to include these family interventions as part of their role, effectively to add duties without significant modification to their current roles and duties. It also seems to have been an underestimate of the skills required for delivering family work in psychosis and the ongoing requirements for high-quality supervision. Conclusion: We argue for carer specialists to be involved in mental health teams, particularly early intervention teams, and for a triage system to offer families a range of evidence-based support, as well as family interventions for more complex problems and presentations.</p

Efficacy of lanthionine-stabilized angiotensin-(1-7) in type I and type II diabetes mouse models

Native angiotensin-(1-7) exerts many therapeutic effects. However, it is rapidly degraded by ACE and other peptidases. This drawback is largely eliminated for lanthionine-stabilized angiotensin-(1-7), termed cAng-(1-7), which is fully resistant to ACE and has strongly increased resistance to other peptidases. Goal of the present study was to test whether cAng-(1-7) has therapeutic activity in diabetes mouse models: in a multiple low dose streptozotocin-induced model of type I diabetes and / or in a db/db model of type II diabetes. In the type I diabetes model cAng-(1-7) caused in an increase in the insulin level of 133% in week 4 (p < 0.001) compared to vehicle, and in the type II diabetes model an increase of 55% of the insulin level in week 8 (p < 0.05) compared to vehicle. cAng-(1-7) reduced blood glucose levels in the type I model by 37% at day 22 (p < 0.001) and in the type II diabetes model by 17% at day 63 of treatment (p < 0.001) and in an oral glucose tolerance test in a type II diabetes model, by 17% at week 4 (p < 0.01). cAng-(1-7) also caused a reduction of glycated hemoglobin levels in the type II diabetes model of 21% in week 6 (p < 0,001). These data are consistent with therapeutic potential of cAng-(1-7) in type I and II diabetes

Use of standardised outcome measures in adult mental health services - Randomised controlled trial

This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at http://bjp.rcpsych.or