The Impact On Eye Movement And Desensitization Reprocessing Of Incomplete Memory In A Drug-Facilitated Rape: A Single Case Study.

In a drug-facilitated sexual assault (DFSA), the person's level of intoxication may result in incomplete memory. This paper describes eye movement and desensitization reprocessing (EMDR) with client-centered adaptations to address an incomplete trauma memory in a 26-year-old woman. The client was experiencing PTSD, characterized by nightmares and derealization. Therapy followed standard EMDR procedures with three minor modifications to help the client maintain current awareness. Although the memory remained incomplete, the client-centered adaptations promoted working through of the clients' trauma responses (e.g. disorientation, physical sensations) and a sense of competence and self-confidence were restored. At the end of reprocessing, and at follow-up, the client was no longer experiencing nightmares or derealization and her wellbeing had improved.

Jumping to conclusions and perceptions in early psychosis: relationship with delusional beliefs.

INTRODUCTION: Previous research has suggested that biases in cognitive processes involved in everyday reasoning may contribute to the development of delusional beliefs. The aim of this study was to explore jumping to conclusions (JTC), a data-gathering bias, and jumping to perceptions (JTP), a bias towards believing ambiguous perceptual events are real and external. METHODS: Individuals with current delusions (n=17), remitted delusions (n=17), both recruited from an early psychosis service, and nonclinical participants (n=35) were compared on a probabilistic reasoning task, an auditory perceptual bias task, and the Barely Visible Words task. RESULTS: The deluded participants did not demonstrate the expected JTC bias; therefore the relationship between JTC and JTP could not be examined. However, both clinical groups exhibited a JTP bias on the auditory perceptual bias task. In contrast, the lowered perceptual threshold for threat displayed by the control group was absent in the clinical groups. CONCLUSIONS: These results suggest that the JTP bias may be a trait characteristic in those with a propensity to delusions, and that these individuals may also show a bias away from threat.

Remission and relapse in psychosis: operational definitions based on case-note data.

BACKGROUND: In psychosis, the prime indicator of outcome has been relapse, but hospital readmission can no longer be used for this purpose. Researchers now require methods for assessing relapse that are objective, blind, reliable and valid. We describe the reliability and validity of such a technique using case-notes. METHOD: Information from routine clinical notes of participants in the Lambeth Early Onset (LEO) study (less all references that would unblind the assessor) were recorded on a form divided into 1-month sections. Operational definitions of remission and relapse enabled clinicians to identify remissions and relapses blindly from the summary information. We calculated reliability regarding both the fact and the timing of remission and relapse. PANSS ratings at 6 and 18 months provided a measure of validity. RESULTS: The kappa value for the identification of remission by individuals ranged from 0.64 to 0.82, while that for consensus between paired raters was 0.56. The corresponding values for relapse were 0.57-0.59 and 0.71. Intra-class correlations for time to remission and to relapse were very high. Raters guessed correctly whether the participants came from the intervention or control group on 60-75% of occasions. Independent PANSS ratings were strongly related to the remission/relapse status of participants. CONCLUSIONS: The reliability of the technique described here was moderate to good, its validity was good, and it provides a useful and timely addition to methods of evaluating remission and relapse in psychosis. On the basis of our experience, we recommend consensus rather than individual ratings.

Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: randomised controlled trial.

BACKGROUND: The provision of early intervention services for people with psychosis is UK government policy, although evidence for benefit of such services is sparse. AIMS: To evaluate the effects of a service providing specialised care for early psychosis (the Lambeth Early Onset Team) on clinical and social outcomes, and on service user satisfaction. METHOD: One hundred and forty-four people with psychosis, presenting to mental health services for the first or second time (if previously failed to engage in treatment), were randomly allocated to care by the early onset team or to standard care. Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Relapse and rehospitalisation data have been reported separately. RESULTS: Outcomes for the participants treated by the early onset team were significantly better at 18 months for aspects of social and vocational functioning, satisfaction, quality of life and medication adherence. Symptom improvement did not significantly differ between the groups. CONCLUSIONS: The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy.

Delusions and decision-making style: use of the Need for Closure Scale.

Clinicians and researchers have suggested that rapidity in belief formation, due to having a high 'need for closure' (NFC), may contribute to the acceptance of delusional explanations. The aim of the study is to determine whether NFC has such a direct link with delusions. A secondary aim is to examine if NFC is related to the delusion-associated reasoning process of 'jumping to conclusions'. One hundred and eighty-seven patients with psychosis, recruited for a treatment trial of psychological therapy (the PRP trial), completed the Need for Closure Scale (NFCS), symptom measures, and probabilistic reasoning tasks. The NFCS was considered in terms of its two dimensions: a desire for simple structure and a preference for quick, decisive answers. The individuals with psychosis reported being poor at making quick, decisive answers but required a greater need for simple structure. NFC was associated with levels of anxiety and depression. There were weak links between NFC and both positive and negative symptoms of psychosis, but these were explained by differences in affect. NFCS scores were unrelated to jumping to conclusions. Contrary to the argument that NFC is directly linked to delusions, individuals with delusions actually perceive themselves as indecisive. There was no evidence that NFC-at least as assessed by the NFCS-could be a proximal cause of delusions. Any potential effect on psychotic symptom presentation is indirect, mediated through affect. The use of the NFCS on its own in the study of psychotic symptoms cannot be recommended.

Need for closure and anxiety in delusions: a longitudinal investigation in early psychosis.

This study investigated the role of need for closure (NFC) and anxiety in delusions. The Need For Closure Scale (NFCS) and measures of trait and state anxiety were administered to an early psychosis group with current delusions, a clinical (generalised anxiety disorder--GAD) control group and a non-clinical control group. The battery of questionnaires was repeated at follow-up one year later. The NFCS did not meet criteria for a unidimensional scale and two sub-scales were removed from all further analyses. At baseline the deluded and GAD groups scored significantly higher on the reduced NFCS (NFCS-R) than the control group. Trait anxiety was related to NFCS-R in the GAD and non-clinical control groups, but not in the deluded group. At follow-up all groups scored significantly lower on the NFCS-R, perhaps suggesting a practice effect, although the two clinical groups continued to have higher scores than the non-clinical control group. The recovered and non-recovered deluded groups did not differ on the NFCS-R one year later, unlike in the GAD group where recovered participants had significantly lower scores than the non-recovered. Change scores on the NFCS-R and trait anxiety were correlated at trend level in the GAD and non-clinical control groups, but not in the deluded group. These findings suggest that whilst NFC and trait anxiety are related in non-psychotic groups, NFC may be implicated in the formation of delusions, independently of anxiety, in psychotic individuals.

The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis.

OBJECTIVE: To evaluate the effectiveness of a service for early psychosis. DESIGN: Randomised controlled clinical trial. SETTING: Community mental health teams in one London borough. PARTICIPANTS: 144 people aged 16-40 years presenting to mental health services for the first or second time with non-organic, non-affective psychosis. INTERVENTIONS: Assertive outreach with evidence based biopsychosocial interventions (specialised care group) and standard care (control group) delivered by community mental health teams. PRIMARY OUTCOME MEASURES: Rates of relapse and readmission to hospital. RESULTS: Compared with patients in the standard care group, those in the specialised care group were less likely to relapse (odds ratio 0.46, 95% confidence interval 0.22 to 0.97), were readmitted fewer times (beta 0.39, 0.10 to 0.68), and were less likely to drop out of the study (odds ratio 0.35, 0.15 to 0.81). When rates were adjusted for sex, previous psychotic episode, and ethnicity, the difference in relapse was no longer significant (odds ratio 0.55, 0.24 to 1.26); only total number of readmissions (beta 0.36, 0.04 to 0.66) and dropout rates (beta 0.28, 0.12 to 0.73) remained significant. CONCLUSIONS: Limited evidence shows that a team delivering specialised care for patients with early psychosis is superior to standard care for maintaining contact with professionals and for reducing readmissions to hospital. No firm conclusions can, however, be drawn owing to the modest sample size.

Need for closure and jumping-to-conclusions in delusion-prone individuals.

Members of the general population were screened for delusion-proneness using the Peters et al. Delusions Inventory (PDI). Two groups were formed from the participants who scored in the upper and lower quartiles of the PDI and compared on a probability judgment task and on the Need for Closure scale (NFC). The study investigated whether the "jump-to-conclusions" (JTC) reasoning bias, characteristic of deluded participants, could be found in delusion-prone individuals. NFC was investigated as a motivational factor that may correlate with this reasoning bias. Evidence for the existence of the data-gathering, but not the probability judgment, part of the JTC reasoning bias was found in the delusion-prone individuals. This group also scored significantly higher on the NFC scale. As the data-gathering reasoning bias was found in delusion-prone individuals this suggests that it may be involved in the formation, rather than merely the maintenance, of delusional beliefs.