From the margins to the NICE guidelines: British clinical psychology and the development of Cognitive Behaviour Therapy for Psychosis between 1982-2002

Although histories of Cognitive Behaviour Therapy have begun to appear, their use with people with psychosis diagnoses has received relatively little attention. In this article we elucidate the conditions of possibility for the emergence of Cognitive Behaviour Therapy for Psychosis (CBTp) in England between 1982-2002. We present an analysis of policy documents, research publications and books, participant observation and interviews with a group of leading researchers and senior policy actors. Informed by Derksen and Beaulieu’s (2011) articulation of social technologies, we show how CBTp was developed and stabilised through the work of a variety of overlapping informal, academic, clinical, professional and policy networks. The profession of clinical psychology played a key role in this development, successfully challenging the traditional ‘division of labour’ where psychologists focused on ‘neurosis’ and left ‘psychosis’ to psychiatry. Following Abbott’s (1988) systems approach to professions, we identify a number of historical factors which created a jurisdictional vulnerability for psychiatry whilst strengthening the jurisdictional legitimacy of clinical psychology in providing psychological therapies to service users with psychosis diagnoses. The National Institute for Health and Clinical Excellence (NICE) played a significant role in adjudicating jurisdictional legitimacy and its 2002 schizophrenia guidelines, recommending the use of psychological therapies, marked a radical departure from the psychiatric consensus. Our analysis may be of wider interest in its focus on social technologies in a context of jurisdictional contestation. We discuss the implications of our study for the field of mental health and for the relationship between clinical psychology and psychiatry

A “trigger”, a cause or obscured? How trauma and adversity are constructed in psychiatric stress-vulnerability accounts of “psychosis”

How do mental health professionals link adverse life experiences with the kinds of beliefs and experiences which attract a diagnosis of psychosis and what implications does this have for women with these diagnoses? Drawing on a broadly critical realist framework, we present data from two studies relevant to these questions. First, we analyse the discursive practices engaged in during a staff-only discussion of a female in-patient with a psychosis diagnosis who had been raped some years previously. Staff oriented to the irrationality and factuality of her ostensibly delusional statements about rape and pregnancy in the present and formulated adverse experience as a ‘stress factor’ triggering a manic episode, thereby precluding alternative contextualising interpretations. In a second, interview-based, study, psychiatrists drew on a range of discursive resources which differentiated psychosis from other forms of distress, constructed trauma as a stressor which could trigger psychosis because of a genetic predisposition, and constructed medication as the primary intervention whilst a focus on trauma was de-emphasised. We discuss the implications of these findings for the kinds of explanations and forms of help offered and suggest ways in which distress might be contextualised as well as possible future directions for feminist research and practic

Inductive Reasoning Games as Influenza Vaccination Models: Mean Field Analysis

We define and analyze an inductive reasoning game of voluntary yearly vaccination in order to establish whether or not a population of individuals acting in their own self-interest would be able to prevent influenza epidemics. We find that epidemics are rarely prevented. We also find that severe epidemics may occur without the introduction of pandemic strains. We further address the situation where market incentives are introduced to help ameliorating epidemics. Surprisingly, we find that vaccinating families exacerbates epidemics. However, a public health program requesting prepayment of vaccinations may significantly ameliorate influenza epidemics.Comment: 20 pages, 7 figure

Inhibition of Acid Production from Oral Bacteria by Fluorapatite-derived Fluoride

The inhibitory effect of fluorapatite (FAP)-derived fluoride upon resting cell suspensions of Streptococcus mutans incubated at pH 4.5 and 6.5 was studied using lactic acid production from 0.1% sucrose as an indicator of fermentation activity. Cells incubated with FAP produced significantly less lactic acid than did cells incubated with hydroxyapatite (HAP). Addition of HAP to cell suspensions containing FAP reduced this inhibition, suggesting that dissolution of the FAP was necessary for inhibition. Incubation with low concentrations of NaF showed significant inhibition in cell suspensions incubated with as little as 0.45 μg/mL F at pH 5.0. These results provide further support to the hypothesis that fluoride levels in plaque and enamel, achievable through use of fluoridated water and/or fluoride dentifrices, may produce appreciable inhibition of glycolysis at the acidic pH levels which are readily achieved in plaque. Thus, bacterial acid production may activate plaque and enamel-bound fluoride, resulting in inhibition of further acid production, and thereby contribute substantially to the other cariostatic mechanisms of fluoride.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66960/2/10.1177_00220345860650010401.pd

Basic Biological Sciences

Sucrose and glucose catabolism by seven strains of Streptococcus mutans belonging to six serotypes was assayed at pH's 6.5, 5.0, 4.5, and 4.0 with a radioisotopic tracer assay. The strains differed in their patterns of metabolic stimulation and inhibition at the different pH levels, falling into groups corresponding to the genetic groups described by Coykendall. The genogroup I (serotypes c and e) strains were the most acid-tolerant, having a pH optimum for lactic acid production at pH 5.0. These data furnish additional metabolic confirmation of the distinctiveness of these S. mutans subgroups.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67098/2/10.1177_00220345830620050101.pd

Disposal of Household Wastewater in Soils of High Stone Content (1981-1983)

Four experimental filter fields were constructed with built-in monitoring equipment in Nixa soils. These soils contain many chert fragments and a fragipan about 60 cm below the soil surface. The fragipan restricts downward movement of water and is the designlimitingfeature. The four filter fields were: 1. A standard filter field, 76 cm deep. The bottom of the trench was in the fragipan. 2. A modified standard filter field, 30 cm deep. The bottom of the trench was above the fragipan. 3. A modified pressure filter field, 40 cm deep. The bottom of the trench was above the fragipan. In addition, a pressure-distribution system was used to insure uniform distribution of effluent in the trench. Inadvertently, this field was installed in a different soil, and the results cannot be compared directly with the other three. 4. Another modified pressure filter field with the bottom of the trench only 6 cm below the soil surface. Observation of these systems confirms that placing filter fields higher in the soil above the hydraulically limiting horizon results in improved hydraulic performance. The presence of the fragipan amplified the adverse effects attributable to climatic stress. The seepage beds which are higher in the soil profile are able to handle the effluent load and climate load with less danger of surfacing

Far infrared maps of the ridge between OMC-1 and OMC-2

Dust continuum emission from a 6 ft x 20 ft region surrounding OMC-1 and OMC-2 were mapped at 55 and 125 microns with 4 ft resolution. The dominant features of the maps are a strong peak at OMC-1 and a ridge of lower surface brightness between OMC-1 and OMC-2. Along the ridge the infrared flux densities and the color temperature decreases smoothly from OMC-1 to OMC-2. OMC-1 is heated primarily by several optical and infrared stars situated within or just at the boundary of the cloud. At the region of minimum column density between OMC-1 and OMC-2 the nearby B0.5 V star NU Ori may contribute significantly to the dust heating. Near OMC-2 dust column densities are large enough so that, in addition to the OMC-2 infrared cluster, the nonlocal infrared sources associated with OMC-1 and NU Ori can contribute to the heating

Far infrared and submillimeter brightness temperatures of the giant planets

The brightness temperatures of Jupiter, Saturn, Uranus, and Neptune in the range 35 to 1000 micron. The effective temperatures derived from the measurements, supplemented by shorter wavelength Voyager data for Jupiter and Saturn, are 126.8 + or - 4.5 K, 93.4 + or - 3.3 K, 58.3 + or - 2.0 K, and 60.3 + or - 2.0 K, respectively. The implications of the measurements for bolometric output and for atmospheric structure and composition are discussed. The temperature spectrum of Jupiter shows a strong peak at approx. 350 microns followed by a deep valley at approx. 450 to 500 microns. Spectra derived from model atmospheres qualitatively reproduced these features but do not fit the data closely

Effects of Electron Correlations on Hofstadter Spectrum

By allowing interactions between electrons, a new Harper's equation is derived to examine the effects of electron correlations on the Hofstadter energy spectra. It is shown that the structure of the Hofstadter butterfly ofr the system of correlated electrons is modified only in the band gaps and the band widths, but not in the characteristics of self-similarity and the Cantor set.Comment: 13 pages, 5 Postscript figure

Quadratic invariants for discrete clusters of weakly interacting waves

We consider discrete clusters of quasi-resonant triads arising from a Hamiltonian three-wave equation. A cluster consists of N modes forming a total of M connected triads. We investigate the problem of constructing a functionally independent set of quadratic constants of motion. We show that this problem is equivalent to an underlying basic linear problem, consisting of finding the null space of a rectangular M × N matrix with entries 1, −1 and 0. In particular, we prove that the number of independent quadratic invariants is equal to J ≡ N − M* ≥ N − M, where M* is the number of linearly independent rows in Thus, the problem of finding all independent quadratic invariants is reduced to a linear algebra problem in the Hamiltonian case. We establish that the properties of the quadratic invariants (e.g., locality) are related to the topological properties of the clusters (e.g., types of linkage). To do so, we formulate an algorithm for decomposing large clusters into smaller ones and show how various invariants are related to certain parts of a cluster, including the basic structures leading to M* < M. We illustrate our findings by presenting examples from the Charney–Hasegawa–Mima wave model, and by showing a classification of small (up to three-triad) clusters