• Comparing time use in individuals at different stages of psychosis and a non-clinical comparison group

      Hodgekins, Jo; French, Paul; Birchwood, Max; Mugford, Miranda; Christopher, Rose; Marshall, Max; Everard, Linda; Lester, Helen; Jones, Peter B.; Amos, Tim; et al. (Elsevier, 2014-12-23)
      Social functioning difficulties are a common and disabling feature of psychosis and have also been identified in the prodromal phase. However, debate exists about how such difficulties should be defined and measured. Time spent in structured activity has previously been linked to increased psychological wellbeing in non-clinical samples and may provide a useful way of assessing social functioning in clinical settings. The current study compared weekly hours in structured activity, assessed with the Time Use Survey, in three clinical groups at different stages of psychosis: individuals with at-risk mental states (N = 199), individuals with first-episode psychosis (N = 878), and individuals with delayed social recovery following the remission of psychotic symptoms (N = 77). Time use in the three clinical groups was also compared with norms from an age-matched non-clinical group (N = 5686) recruited for the Office for National Statistics UK 2000 Time Use Survey. Cut-off scores for defining social disability and recovery were examined. All three clinical groups spent significantly fewer hours per week in structured activity than individuals in the non-clinical group. Reduced activity levels were observed before the onset of psychosis in individuals with at-risk mental states. Additional reductions in activity were observed in the first-episode psychosis and delayed recovery groups compared to the at-risk mental state group. Assessing time spent in structured activity provides a useful way to assess social disability and recovery across the spectrum of psychosis.
    • The course of negative symptom in first episode psychosis and the relationship with social recovery

      Gee, Brioney; Hodgekins, Jo; Fowler, David; Marshall, Max; Everard, Linda; Lester, Helen; Jones, Peter B.; Amos, Tim; Singh, Swaran P.; Sharma, Vimal; et al. (Elsevier, 2016-04-28)
      AIMS: To investigate trajectories of negative symptoms during the first 12months of treatment for first episode psychosis (FEP), their predictors and relationship to social recovery. METHOD: 1006 participants were followed up for 12months following acceptance into Early Intervention in Psychosis services. Negative symptom trajectories were modelled using latent class growth analysis (LCGA) and predictors of trajectories examined using multinomial regression. Social recovery trajectories - also modelled using LCGA - of members of each negative symptom trajectory were ascertained and the relationship between negative symptom and social recovery trajectories examined. RESULTS: Four negative symptom trajectories were identified: Minimal Decreasing (63.9%), Mild Stable (13.5%), High Decreasing (17.1%) and High Stable (5.4%). Male gender and family history of non-affective psychosis predicted stably high negative symptoms. Poor premorbid adolescent adjustment, family history of non-affective psychosis and baseline depression predicted initially high but decreasing negative symptoms. Members of the Mild Stable, High Stable and High Decreasing classes were more likely to experience stably low functioning than the Minimal Decreasing class. CONCLUSIONS: Distinct negative symptom trajectories are evident in FEP. Only a small subgroup present with persistently high levels of negative symptoms. A substantial proportion of FEP patients with elevated negative symptoms at baseline will achieve remission of these symptoms within 12months. However, elevated negative symptoms at baseline, whether or not they remit, are associated with poor social recovery, suggesting targeted interventions for service users with elevated baseline negative symptoms may help improve functional outcomes.
    • Layers of listening: qualitative analysis of the impact of early intervention services for first-episode psychosis on carers’ experiences

      Anna, Lavis,; Lester, Helen; Everard, Linda; Freemantle, Nick; Amos, Tim; Fowler, David; Hodgekins, Jo; Jones, Peter B.; Marshall, Max; Sharma, Vimal; et al. (Cambridge University Press, 2015-08)
      Background: Early Intervention Services (EIS) comprise low-stigma youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice. Aims: By analysing carers’ accounts of their daily lives and affective challenges during a relative’s first-episode psychosis against the background of wider research into Early Intervention Services, this paper explores relationships between carers’ experiences and EIS. Methods: Semi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS. Results: Our data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these service user-focused engagements also emerge; they risk leaving carers’ emotions unacknowledged and compounding an existing lack of helpseeking. Conclusions: By focusing on EIS’s engagements with carers, this paper draws attention to an urgent broader question; as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?
    • Lived experiences of negative symptoms in first-episode psychosis: A qualitative secondary analysis

      Gee, Brioney; Hodgekins, Jo; Lavis, Anna; Notley, Caitlin; Birchwood, Max; Everard, Linda; Freemantle, Nick; Jones, Peter B.; Singh, Swaran P.; Amos, Tim; et al. (Wiley, 2018-03-24)
    • Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial

      Fowler, David; Hodgekins, Jo; French, Paul; Marshall, Max; Freemantle, Nick; McCrone, Paul; Everard, Linda; Lavis, Anna; Jones, Peter B.; Amos, Tim; et al. (Elsevier, 2017-12-11)
      Background - Provision of early intervention services has increased the rate of social recovery in patients with first episode psychosis; however, many individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services augmented with social recovery therapy in patients with first-episode psychosis. The primary hypothesis was that social recovery therapy plus early intervention services would lead to improvements in social recovery. Methods - We did this single-blind, phase 2, randomised controlled trial (SUPEREDEN3) at four specialist early intervention services in the UK. We included participants who were aged 16–35 years, had non-affective psychosis, had been clients of early intervention services for 12–30 months, and had persistent and severe social disability, defined as engagement in less than 30 h per week of structured activity. Participants were randomly assigned (1:1), via computer-generated randomisation with permuted blocks (sizes of four to six), to receive social recovery therapy plus early intervention services or early intervention services alone. Randomisation was stratified by sex and recruitment centre (Norfolk, Birmingham, Lancashire, and Sussex). By necessity, participants were not masked to group allocation, but allocation was concealed from outcome assessors. The primary outcome was time spent in structured activity at 9 months, as measured by the Time Use Survey. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN61621571. Findings Between Oct 1, 2012, and June 20, 2014, we randomly assigned 155 participants to receive social recovery therapy plus early intervention services (n=76) or early intervention services alone (n=79); the intention-to-treat population comprised 154 patients. At 9 months, 143 (93%) participants had data for the primary outcome. Social recovery therapy plus early intervention services was associated with an increase in structured activity of 8·1 h (95% CI 2·5–13·6; p=0·0050) compared with early intervention services alone. No adverse events were deemed attributable to study therapy. Interpretation - Our findings show a clinically important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received social recovery therapy plus early intervention services. Social recovery therapy might be useful in improving functional outcomes in people with first-episode psychosis, particularly in individuals not motivated to engage in existing psychosocial interventions targeting functioning, or who have comorbid difficulties preventing them from doing so.