Cognitive approach to depression and suicidal thinking in psychosis

Iqbal, Zaffer; Birchwood, Max; Chadwick, Paul; Trower, Peter

doi:10.1192/bjp.177.6.522

Cited by 196 publications

(160 citation statements)

References 29 publications

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“…The finding that clinically significant changes in depression can occur in the context of psychosis in the absence of marked changes in positive and negative symptoms is consistent with previous research evidence suggesting that 'post-psychotic' depression emerges independently of positive symptom severity, relapse and negative symptoms Iqbal et al, 2000). It has been suggested that depression is more closely associated with interpersonal adjustment than severity of psychiatric symptoms (Rocca et al, 2005).…”

Section: Insert Table 4 Here Discussionsupporting

confidence: 79%

Acceptance and Commitment Therapy for depression following psychosis: An examination of clinically significant change

White

Gumley

McTaggart

et al. 2015

Journal of Contextual Behavioral Science

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Depression following psychosis is common and can impact negatively on individuals' quality of life. This study conducted post-hoc analyses on 14 participants with psychosis from a larger randomised controlled trial who presented with clinically important levels of depression at baseline. Eight of the participants received Acceptance and Commitment Therapy (ACT), whilst the remaining six individuals received treatment as usual (TAU). The focus was on investigating clinically significant change in outcome measures between baseline and 3-months post-baseline in the participants. Participants completed measures assessing depression and anxiety (HADS), psychosis symptoms (PANSS) and psychological inflexibility (AAQ-II) between baseline and at 3-month post-baseline assessments. Odds ratio analysis indicated that participants receiving ACT, compared to TAU, were 15 times more likely to achieve clinically significant decreases in depression scores (Fisher's Exact Test p = 0.05). Differences between the ACT and TAU groups in clinically significant changes in anxiety, psychological inflexibility, positive symptoms, negative symptoms and general level of psychopathology were not statistically significant. The study provides tentative support for the use of ACT to treat depression emerging in the context of psychosis.

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Section: Insert Table 4 Here Discussionsupporting

confidence: 79%

Acceptance and Commitment Therapy for depression following psychosis: An examination of clinically significant change

White

Gumley

McTaggart

et al. 2015

Journal of Contextual Behavioral Science

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“…(a) Mood One of the more reliable findings in the literature is the positive correlation between metacognitive ability leading to awareness of illness, and low mood or depression (and between elevated mood and lack of awareness), which has been shown across different patient groups [4,5,17,18]. Although findings are variable, many studies have reported that increased awareness in SCZ is associated with greater depressive symptoms [37][38][39][40][41][42], including a meta-analysis [29]. In this way, poor insight is often conceptualized as a form of denial in order to maintain self-esteem, while good insight is equally regarded as an example of 'depressive realism'.…”

Section: Clinical Insightmentioning

confidence: 99%

Failures of metacognition and lack of insight in neuropsychiatric disorders

David

Bedford

Wiffen

et al. 2012

Phil. Trans. R. Soc. B

200

129

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Lack of insight or unawareness of illness are the hallmarks of many psychiatric disorders, especially schizophrenia (SCZ) and other psychoses and could be conceived of as a failure in metacognition. Research in this area in the mental health field h as burgeoned with the development and widespread use of standard assessment instruments and the mapping out of the clinical and neuropsychological correlates of insight and its loss. There has been a growing appreciation of the multi-faceted nature of the concept and of the different 'objects' of insight, such as the general awareness that one is ill, to more specific metacognitive awareness of individual symptoms, impairments and performance. This in turn has led to the notion that insight may show modularity and may fractionate across different domains and disorders, supported by work that directly compares metacognition of memory deficits and illness awareness in patients with SCZ, Alzheimer's disease and brain injury. The focus of this paper will be on the varieties of metacognitive failure in psychiatry, particularly the psychoses. We explore cognitive models based on self-reflectiveness and their possible social and neurological bases, including data from structural and functional MRI. The medial frontal cortex appears to play an important role in self-appraisal in health and disease.

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“…Consistent with this model, there is considerable evidence from cross-sectional studies to suggest that possessing good insight in psychosis is associated with measures of distress, such as depression (see Lincoln, Lüllmann & Rief, 2007), hopelessness (Carroll et al, 2004, Eneman & Sabbe, 2006Schwartz, Apter & Zalsman, 2006;Lysaker, Roe & Yanos, 2007), anxiety (Lysaker & Salyers, 2007) and suicidability (Schwartz et al, 2004, Crumlish et al, 2005Pompili et al, 2007). Although some longitudinal studies suggest that increases in insight are associated with worsening measures of distress and depression (Carroll et al, 1999;Iqbal et al, 2000;Schartz, 2001;Drake et al, 2004;Lincoln, Lüllmann & Rief, 2007), the existing evidence is still weak so that the direction of causality needs to be explored in future well designed longitudinal studies. More direct testing of the hypothesis that poor insight is related to the use of denial as a coping strategy can be found in studies comparing insight measures with measures of coping on a variety of tests.…”

Section: Models Of Poor Insight In Psychosismentioning

confidence: 99%