Despite decades of research and the development of many psychiatric medications, widespread suffering remains among people who hear voices. Hearing voices groups (HVGs) encourage an in-depth exploration of the meaning of voices and use peer support to develop coping strategies. Although HVGs continue to spread around the world, their effectiveness remains unknown and only a few studies have examined members’ experiences. To understand the mechanisms by which these groups operate, we recruited a diverse sample of 113 participants from across the US, who completed detailed qualitative questionnaires describing their voice-hearing histories, experiences in HVGs and changes in their lives outside the group. A subset also participated in follow-up interviews. A collaborative team of researchers and voice hearers used phenomenological, grounded theory and thematic analyses to identify a distinctive set of elements that make HVGs unique: in their style of interaction (non-judgmental, curious, reciprocal and unstructured dialogue among people regarded as equals, in a shared community); and in the content of meetings (welcoming multiple perspectives and exploring coping strategies in non-prescriptive ways, with a focus on expertise by experience). We propose a three-phase model to explain how these elements interact within HVGs to enable significant transformation to occur.
Ninety young people were randomised by computer, 46 to placebo and 44 antipsychotic medication and 33% of those who commenced trial medication completed the entire 6 month trial period. On the SOFAS, both groups improved, and group differences were small and clinically trivial, indicating that treatment with placebo medication was no less effective than conventional antipsychotic treatment (Mean Difference=-0.2, 2-sided 95% confidence interval -7.5 to 7.0, t=0.060, p=0.95).
Within the context of a specialised early intervention service, and with a short duration of untreated psychosis, the immediate introduction of antipsychotic medication may not be required for all cases of first episode psychosis in order to see functional improvement. However, this finding can only be generalised to a very small proportion of FEP cases at this stage, and a larger trial is required to clarify whether antipsychotic-free treatment can be recommended for specific subgroups of those with FEP.
In a time where social distancing is being strongly encouraged in the U.S. and other countries, Hearing Voices Network-USA trainers Caroline Mazel-Carlton and Cindy Marty Hadge from the Western Massachusetts Recovery Learning Community (WMRLC) are helping to coordinate national efforts to ensure that voice hearers and their loved ones have uninterrupted access to life-giving mutual support and connection.
“Having the Foundation’s support has allowed us to expand our online offerings,” Mazel-Carlton told EXCELLENCE. Mazel-Carlton and Hadge helped to support the formation of some of the first online Hearing Voices groups in America, including a new Family and Friends online support group that began last year. Now, the Hearing Voices Network in the USA is quickly ramping up online offerings in response to COVID-19, thanks to the efforts of Hadge, Mazel-Carlton, and others.
Read MoreConventional wisdom in the treatment of psychosis suggests that the longer psychosis goes untreated, the worse outcomes people will have long term. This position is often used to support the use of antipsychotics early in the course of treatment. A new study, published in The American Journal of Psychiatry, challenges the evidence for this position.
The researchers, led by Katherine Jonas at Stony Brook University, find that past research documenting a relationship between the duration of untreated psychosis (DUP) and worse long-term outcomes is likely an illusion created by lead-time bias. Their study found that rather than untreated psychosis causing adverse outcomes, those with a shorter duration of untreated psychosis “are in an earlier stage and therefore appear to have better outcomes than those with a long DUP, who are in a later stage.”
Read MoreStressful life events have been implicated in the onset of psychotic disorders, but there are few robust studies. We sought to examine the nature and magnitude of associations between adult life events and difficulties and first-episode psychoses, particularly focusing on contextual characteristics, including threat, intrusiveness, and independence.
This study forms part of the Childhood Adversity and Psychosis Study (CAPsy), an epidemiological case-control study in London, United Kingdom. Data on life events and difficulties (problems lasting 4 wk or more) during 1 year prior to onset (cases) or interview (controls) were assessed using the semi-structured Life Events and Difficulties Schedule (LEDS). Data were available on 253 individuals with a first episode of psychosis and 301 population-based controls.
We found strong evidence that odds of exposure to threatening and intrusive events in the 1 year prior to onset were substantially higher among cases compared with controls, independent of age, gender, ethnicity, and social class (ORs > 3). This was consistent across diagnostic categories. We found further evidence that the effect of threatening events and difficulties was cumulative (1 event odds ratio [OR] 2.69 [95% confidence interval (CI) 1.51–4.79]; 2 events OR 4.87 [95% CI 2.34–10.16]; ≥3 events OR 5.27 [95% CI 1.83–15.19]; 1 difficulty OR 3.02 [95% CI 1.79–5.09]; 2 difficulties OR 9.71 [95% CI 4.20–22.40]; ≥3 difficulties OR 12.84 [95% CI 3.18–51.85]).
Threatening and intrusive life events and difficulties are common in the year pre-onset among individuals with a first episode of psychosis. Such experiences may contribute to the development of psychotic disorders.
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Several studies have found that patients with schizophrenia experience cognitive benefits from exercise.
A study in Psychiatric Research suggests schizophrenia patients who participate in a 12-week aerobic exercise program may continue to experience cognitive benefits months after the program ends.
“These findings encourage the incorporation of [aerobic exercise] in psychosocial treatment regimens [for schizophrenia],” wrote Takeshi Shimada, Ph.D., of the Medical Corporation Seitaikai Mental Support Soyokaze Hospital in Japan and colleagues.
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People with a history of severe infection such as hepatitis or sepsis may be more likely to develop substance-induced psychosis than people without such history, suggests a report in AJP in Advance.
As the course of schizophrenic disorders is often chronic, treatment guidelines recommend continuous maintenance treatment to prevent relapses, but antipsychotic drugs can cause many side effects. It, therefore, seems reasonable to try to reduce doses in stable phases of the illness or even try to stop medication. We conducted a 26 weeks, randomized, rater blind, feasibility study to examine individualized antipsychotic dose reduction versus continuous maintenance treatment (Register Number: NCT02307396). We included chronic, adult patients with schizophrenia or schizoaffective disorder, who were treated with any antipsychotic drug except clozapine, who had not been hospitalized in the last 3 years and who were in symptomatic remission at baseline. The primary outcome was relapse of positive symptoms. Symptom severity, social functioning and side effects were also examined as secondary outcomes. 20 patients were randomized. Relapse rates in the two groups were not significantly different. No patient had to be hospitalized. One patient in the control group dropped out. The mean reduction of antipsychotic dose in the individualized dose-reduction group was 42%, however only one patient discontinued drug completely. There were no significant differences in efficacy or safety outcomes. This randomized trial provides evidence, that reduction of antipsychotic medication in chronic stable schizophrenic patients may be feasible. The results need to be confirmed in a larger trial with a longer follow-up period.
In this paper we focus on the psychiatric approach of Open Dialogue (OD) and seek to explain why the intersubjective process of dialogue, one of OD’s core clinical principles, is effective in schizophrenia treatment.
We address this question from an interdisciplinary viewpoint, by linking the OD approach with a theoretical account of the self as endorsed by enactive cognitive science.
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Abstract
