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June 13, 2019 by Rachel H. Tribe | BJPsych Open

Open dialogue in the UK: qualitative study

Rachel H. TribeAbigail M. FreemanSteven LivingstoneJoshua C. H. Stott and Stephen Pilling

Open dialogue is an integrative approach to the organisation of specialist mental health services and therapeutic meetings.

This qualitative study sought to explore service users’ and clinicians’ experiences of network meetings during the implementation of open dialogue in a modified version, for a UK-based mental health service.

In total 19 participants were interviewed (8 service users and 11 clinicians) and an inductive thematic analysis of the data was conducted.

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June 12, 2019 by Dr John Read |

Making Sense of Madness

What causes psychosis, and what can help? Psychotherapy, with its interest in life history and circumstance, and its emphasis on the transformative power of the therapeutic relationship, has more to offer in this area than we are often trained to think. Ahead of an upcoming conference on the origins and meaning of psychosis, Dr John Read, Professor of Clinical Psychology, explains why the psycho-social model must be hauled back into view

( – During the 15 years or so that I worked as a nursing assistant, clinical psychologist and manager of mental health services, I was always struck by the fact that even the seemingly weirdest of behaviours and experiences (‘psychotic symptoms’) made sense once I knew a bit about the person’s history and circumstances. And much of what I heard about the early lives of these people was none too pleasant. Of course the trick, the hard bit, was gaining the trust of people so that they felt like telling me about themselves in the first place. I had entered the field, nearly 50 years ago, full of Ronnie Laing’s ideas about the meaning of madness, and my experience proved to me, over and over again, that he was right.

I was also repeatedly struck by the lack of interest in history and circumstances from many of my colleagues, including most (but not all) psychiatrists. But they had entered the field with a psychiatry textbook and the DSM in their heads. And their inability to reach the person in front of them, to form a ‘therapeutic relationship’ – partly because all they did was ask about symptoms and drug them – proved to them that what they had read about ‘schizophrenia’ being a devastating and intractable illness was right.

When I eventually left mental health services to return to academia I was determined to research what so many ‘psychotic patients’ had taught me about the origin of their distress, despair and confusion. It is more than 20 years ago now that I published the first of many reviews of the literature on childhood adversities and psychosis. The pivotal one, however, was eight years later, which we managed to get some media coverage for. The Guardian wrote, ‘The psychiatric establishment is about to experience an earthquake that will shake its intellectual foundations’.

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June 5, 2019 by Ruth E. Cooper et al | Schizophrenia Research

Psychosocial interventions for people with schizophrenia or psychosis on minimal or no antipsychotic medication: A systematic review

Ruth E.Cooper, Neelam Laxhman, Nadia CrellinJoanna MoncrieffStefan Priebe


Antipsychotics are the first-line treatment for people with schizophrenia or psychosis. There is evidence that they can reduce the symptoms of psychosis and risk of relapse. However many people do not respond to these drugs, or experience adverse effects and stop taking them.

In the UK, clinical guidelines have stressed the need for research into psychosocial interventions without antipsychotics. This systematic review examines the effects of psychosocial interventions for people with schizophrenia or psychosis who are on no/minimal antipsychotics.

Databases were searched for empirical studies investigating a psychosocial intervention in people with a schizophrenia spectrum disorder who were not taking antipsychotics or had received an antipsychotic minimisation strategy.

We identified nine interventions tested in 17 studies (N = 2250), including eight randomised controlled trials. Outcomes were generally equal to or in a small number of cases better than the control group (antipsychotics/treatment as usual) for Cognitive Behavioural Therapy (CBT), Need Adapted Treatment and Soteria. The remaining interventions provided some encouraging, but overall inconsistent findings and were Psychosocial Outpatient Treatment, Open Dialogue, Psychosocial Inpatient Treatment, Psychoanalysis/Psychodynamic Psychotherapy, Major Role Therapy, and Milieu Treatment.

Study quality was generally low with little recent research. In conclusion, nine psychosocial interventions have been studied for patients on no/minimal antipsychotics. The majority of studies reported outcomes for the intervention which were the same as the control group, however, study quality was problematic. Given the adverse effects of antipsychotics and that many people do not want to take them, high quality trials of psychosocial treatments for people on minimal/no antipsychotics are needed.


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June 5, 2019 by

Tobacco increases risk of schizophrenia and psychosis

Meta-analysis finds a two-fold increased risk of developing schizophrenia and psychosis amongst those who smoke tobacco. Researchers speculate nicotine is most likely responsible for the link. They suggest future research looks at the link between e-cigarettes and a possible increased risk of psychosis in young adults, the largest consumer group for the products.

Source: Frontiers

Tobacco smokers are at increased risk of psychotic disorders such as schizophrenia, according to University of Queensland researchers.

Their review of eight long-running studies has found strong evidence of an association between smoking and mental illness, which they suggest is most likely caused by nicotine.

Associate Professor James Scott said the findings raised serious concerns about the increasing use of nicotine through e-cigarettes by young adults.

“People who smoke tobacco have an approximately twofold increased risk of developing schizophrenia or psychosis,” Dr Scott said.

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June 4, 2019 by Peter Simons |

Genetic Models of ‘Schizophrenia’ Explain Very Little, Researchers Find

All genetic models combined still explain less than 3% of whether someone gets a schizophrenia diagnosis.

( – In the past few years, the search for a genetic cause for schizophrenia appeared to have stalled. No single gene—or distinct group of genes—could be found to explain the diagnosis. However, researchers soon came up with an alternative hypothesis: the “polygenic model.” Large groups of genes, responsible for all sorts of functions within the human body, were grouped together based on studies that analyzed large portions of the human genome. Although results were mixed, some studies found statistically significant effects, indicating that these gene groupings might have some relationship to schizophrenia.

A new study, just published online in the journal Neuropsychopharmacology, analyzed the explanatory power of these polygenetic models. The research was led by Kristin K. Nicodemus, at the University of Edinburgh, and Kevin J. Mitchell, at Trinity College Dublin.

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May 29, 2019 by Micah Ingle, MA |

Open Dialogue Approach Reduces Future Need for Mental Health Services

The Open Dialogue psychiatric treatment approach is associated with reduced utilization of mental and general health services for Danish youth.

( – A recent study, published in the International Journal of Nursing Studies, investigates Danish mental health outcomes associated with the Open Dialogue approach to psychiatric treatment. The results of the register-based cohort youth study suggest that Open Dialogue may lead to a long-term reduced risk of emergency psychiatric hospitalization as well as reduced utilization of general healthcare services.

The researchers, led by Niels Buus at the University of Sydney, write that “while the relationship between social factors and mental health is well-established, biopsychosocial interventions tend to focus on psychological and pharmacological mechanisms rather than extending social support and community intervention.”

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May 17, 2019 by Nathan Filer | The Guardian

Why what we think we know about schizophrenia is wrong

When novelist and former mental health nurse Nathan Filer met a patient who wouldn’t take his pills, it started him on a journey into the complex and contradictory world of schizophrenia

(The Guardian) – I remember the first time I forcibly medicated a person against his will. It was 13 years ago, not long after I’d qualified as a mental health nurse, and I had started my career working on a psychiatric ward providing assessment and treatment for adults in acute phases of serious mental illness.

There was a patient (or service user or client or son or brother or friend, depending on who you ask) whom I’ll call Amit. Amit had been refusing any medication for nearly three weeks and with good reason. The medicine we were offering him contained a poison. It had been prescribed by a doctor who wished to harm him. In fact, this doctor – a consultant psychiatrist – had been struck off the medical register for his abuse of Amit during previous admissions and so was now working illegally on the ward. Many of the nursing staff knew this, and were in on it.

During morning medication round, Amit stood in the doorway of the ward clinic, watching me closely. He watched the movement of my hands over the drugs trolley as I secretly replaced his regular tablets with harmful ones.

He was wearing the same clothes that he’d slept in and a pair of old trainers, one with a huge split down the side. Amit knew the water supply to his room was deliberately contaminated and so hadn’t washed since he was admitted. I would try to talk to him about that again later – to find the right words – but for now, at least, the medication was the priority.

I double-checked the dose on his chart, put two tablets into a clear plastic pot and held it out for him to take. He stared at it. We both did. I tried some words of reassurance. “I know you’re finding it hard to trust us at the moment, Amit. I do understand that. We think that’s all a part of you being unwell again.” He knew I was lying. “I’ll take them in my room,” he said. I knew he was lying. “You know it doesn’t work that way. I’m sorry, but I need to see you take them.”

He cautiously reached out and took the pot from me. He prodded at the tablets inside. His fingers were stained dark yellow from tobacco. “Nah. You’re all right,” he said at last, placing the pot on top of the drugs trolley and backing out of the clinic, watching me the whole time. As he disappeared down the long corridor towards his bedroom, I wrote an “R” for “refused” on his medication chart. Of course he refused. Why wouldn’t he refuse? If I were in his position, I know I would.

But I don’t know if I would refuse with the same dignity he showed when later that afternoon the C&R team entered his bedroom.

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May 8, 2019 by

Broccoli sprout compound may restore brain chemistry imbalance linked to schizophrenia

Sulforaphane, a compound derived from broccoli sprouts, may be a useful new treatment for those suffering from schizophrenia. In a recent set of animal and human studies, researchers characterized novel chemical imbalances in the brain related to glutamate. Levels of glutamate, they discovered, can be altered by administering sulforaphane.

Source: Johns Hopkins Medicine

( – In a series of recently published studies using animals and people, Johns Hopkins Medicine researchers say they have further characterized a set of chemical imbalances in the brains of people with schizophrenia-related to the chemical glutamate. And they figured out how to tweak the level using a compound derived from broccoli sprouts.

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May 6, 2019 by Bernalyn Ruiz |

Service-Users See Long-Term Antipsychotic Use as Compromising Recovery, Review Finds

A new meta-review examines the experiences of antipsychotic drugs use among people diagnosed with a psychotic disorder.

( – An extensive systematic review and qualitative meta-analysis, published open-access in Journal of Mental Health, summarizes past qualitative studies of the perspectives of people diagnosed with psychosis on their experiences using antipsychotic medication. The researchers identified four meta-themes across past studies: short-term benefits, adverse effects and coping processes, surrender and autonomy, and long-term compromise of functional recovery.  Their results suggest that while people identify positive benefits of antipsychotics for acute and short-term use, they generally experience adverse effects and feel that antipsychotics compromise their long-term recovery.

“A reported challenge in psychosis is that a substantial sub-group of patients stop taking antipsychotic drugs before recommendations indicate,” the authors write. “Rather than assuming that this decision is due to denial or a lack of insight, as is often suggested, it should be explored whether such a decision results from an autonomous process in which the more experienced patient needs to negotiate the level of perceived freedom vis-à-vis his or her own psychotic experiences.”

Guidelines recommended treatment with antipsychotics for persons experiencing psychosis during the acute phase and throughout maintenance and recovery. However, while antipsychotic medications have been shown to be effective at reducing symptoms in the short term, they can bring severe side effects and challenges when used long-term, including adverse effects on cognitive functioning, reduced quality of life, diabetes, and metabolic syndrome, among others.

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May 2, 2019 by Kelly K Anderson | The Lancet

Towards a public health approach to psychotic disorders

(The Lancet) – The 21st century has brought about a burgeoning recognition of the central role of mental health and illness to overall population health. The emphasis of these public mental health efforts has largely been on mental wellbeing and common mental disorders, such as depression, anxiety, and substance use disorders, with less focus on rarer conditions, such as psychotic disorders.

Psychotic disorders, which include schizophrenia, bipolar disorder, depression with psychotic features, and substance-induced psychoses, are increasingly recognised as an important public health issue. Despite being a rare condition, schizophrenia is one of the top 20 leading contributors to years lived with disability globally, largely due to the young age at onset, high disability weighting, and often chronic course of illness. The public health effects are further compounded by the 15-year reduction in life expectancy faced by people with psychotic disorders, mainly attributable to the high prevalence of comorbid physical health conditions in this population.

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