Attachment and social functioning in psychosis

Individuals who experience psychosis typically have diminished social networks and difficulties with social and interpersonal functioning. Therefore, factors underlying social functioning are an intensively studied topic. As attachment theory is by its very nature a theory about interpersonal relationships, it provides insight into these difficulties experienced in psychosis and helps to further develop existing models and conceptualisations of psychosis. Another factor closely related to social dysfunction is social cognition, referring to skill sets or mental processes which help an individual to understand and to accurately interpret the social world. Secure attachment bonds provide optimal conditions for the development of these skills and can be disrupted by negative interpersonal experiences, including difficulties in early attachment relationships. In this chapter, we discuss state of the art research on the link between social cognition, interpersonal difficulties and attachment style in psychosis

Relationship between childhood adversity and bipolar affective disorder:A systematic review and meta-analysis

Background The relationship between childhood adversity and bipolar affective disorder remains unclear. Aims To understand the size and significance of this effect through a statistical synthesis of reported research. Method Search terms relating to childhood adversity and bipolar disorder were entered into Medline, EMBASE, PsycINFO and Web of Science. Eligible studies included a sample diagnosed with bipolar disorder, a comparison sample and a quantitative measure of childhood adversity. Results In 19 eligible studies childhood adversity was 2.63 times (95% CI 2.00–3.47) more likely to have occurred in bipolar disorder compared with non-clinical controls. The effect of emotional abuse was particularly robust (OR = 4.04, 95% CI 3.12–5.22), but rates of adversity were similar to those in psychiatric controls. Conclusions Childhood adversity is associated with bipolar disorder, which has implications for the treatment of this clinical group. Further prospective research could clarify temporal causality and explanatory mechanisms

Zener transitions between dissipative Bloch bands. II: Current Response at Finite Temperature

We extend, to include the effects of finite temperature, our earlier study of the interband dynamics of electrons with Markoffian dephasing under the influence of uniform static electric fields. We use a simple two-band tight-binding model and study the electric current response as a function of field strength and the model parameters. In addition to the Esaki-Tsu peak, near where the Bloch frequency equals the damping rate, we find current peaks near the Zener resonances, at equally spaced values of the inverse electric field. These become more prominenent and numerous with increasing bandwidth (in units of the temperature, with other parameters fixed). As expected, they broaden with increasing damping (dephasing).Comment: 5 pages, LateX, plus 5 postscript figure

Cognitive behavioural therapy for thought disorder in psychosis

Clinicians are often sceptical about offering cognitive behavioural therapy (CBT) to individuals experiencing thought disorder. This view may result from perceived difficulties in clients being able to learn and better understand their experiences through verbal dialogue. However, it may also partly be due to the lack of clear guidance on how to address and work with these difficulties within therapy. This paper provides recommendations for delivering CBT in individuals experiencing thought disorder. It considers how clinicians might conduct their cognitive behavioural assessment, formulation, and intervention, targeting unhelpful appraisals and behaviour, and generating insight. The aim is to better disseminate the techniques sometimes applied in clinical practice

Mood instability, mental illness and suicidal ideas : results from a household survey

Purpose: There is weak and inconsistent evidence that mood instability (MI) is associated with depression, post traumatic stress disorder (PTSD) and suicidality although the basis of this is unclear. Our objectives were first to test whether there is an association between depression and PTSD, and MI and secondly whether MI exerts an independent effect on suicidal thinking over and above that explained by common mental disorders. Methods: We used data from the Adult Psychiatric Morbidity Survey 2007 (N = 7,131). Chi-square tests were used to examine associations between depression and PTSD, and MI, followed by regression modelling to examine associations between MI and depression, and with PTSD. Multiple logistic regression analyses were used to assess the independent effect of MI on suicidal thinking, after adjustment for demographic factors and the effects of common mental disorder diagnoses. Results: There are high rates of MI in depression and PTSD and the presence of MI increases the odds of depression by 10.66 [95 % confidence interval (CI) 7.51–15.13] and PTSD by 8.69 (95 % CI 5.90–12.79), respectively, after adjusting for other factors. Mood instability independently explained suicidal thinking, multiplying the odds by nearly five (odds ratio 4.82; 95 % CI 3.39–6.85), and was individually by some way the most important single factor in explaining suicidal thoughts. Conclusions: MI is strongly associated with depression and PTSD. In people with common mental disorders MI is clinically significant as it acts as an additional factor exacerbating the risk of suicidal thinking. It is important to enquire about MI as part of clinical assessment and treatment studies are required

Social recovery therapy: a treatment manual

Social Recovery Therapy is an individual psychosocial therapy developed for people with psychosis. The therapy aims to improve social recovery through increasing the amount of time individuals spend in meaningful structured activity. Social Recovery Therapy draws on our model of social disability arising as functional patterns of withdrawal in response to early socio-emotional difficulties and compounded by low hopefulness, self-agency and motivation. The core components of Social Recovery Therapy include using an assertive outreach approach to promote a positive therapeutic relationship, with the focus of the intervention on using active behavioural work conducted outside the clinical room and promoting hope, values, meaning, and positive schema. The therapy draws on traditional Cognitive Behavioural Therapy techniques but differs with respect to the increased use of behavioural and multi-systemic work, the focus on the development of hopefulness and positive self, and the inclusion of elements of case management and supported employment. Our treatment trials provide evidence for the therapy leading to clinically meaningful increases in structured activity for individuals experiencing first episode and longer-term psychosis. In this paper, we present the core intervention components with examples in order to facilitate evaluation and implementation of the approach