Fear of recurrence: Results of a randomized trial of relapse detection in schizophrenia

Gumley, Andrew; MacBeth, Angus; Reilly, James; O’Grady, Margaret; White, Ross; McLeod, Hamish J.; Schwannauer, Matthias; Power, Kevin

doi:10.1111/bjc.12060

Cited by 44 publications

(63 citation statements)

References 45 publications

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“…Interventions using early signs of deterioration to prompt timely preventative action can prevent relapse ( Gumley et al, 2003 , Herz et al, 2000 , Lee et al, 2010 ), but could be further developed. Predictive validity of checklists such as the Early Signs Scale (ESS; Birchwood et al, 1989 ) could be improved by adding other hypothesised predictors such as basic symptoms ( Eisner et al, 2013 , Gumley et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Comparing early signs and basic symptoms as methods for predicting psychotic relapse in clinical practice

Eisner

Drake

Lobban

et al. 2018

Schizophrenia Research

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BackgroundEarly signs interventions show promise but could be further developed. A recent review suggested that ‘basic symptoms’ should be added to conventional early signs to improve relapse prediction. This study builds on preliminary evidence that basic symptoms predict relapse and aimed to: 1. examine which phenomena participants report prior to relapse and how they describe them; 2. determine the best way of identifying pre-relapse basic symptoms; 3. assess current practice by comparing self- and casenote-reported pre-relapse experiences.MethodsParticipants with non-affective psychosis were recruited from UK mental health services. In-depth interviews (n = 23), verbal checklists of basic symptoms (n = 23) and casenote extracts (n = 208) were analysed using directed content analysis and non-parametric statistical tests.ResultsThree-quarters of interviewees reported basic symptoms and all reported conventional early signs and ‘other’ pre-relapse experiences. Interviewees provided rich descriptions of basic symptoms. Verbal checklist interviews asking specifically about basic symptoms identified these experiences more readily than open questions during in-depth interviews. Only 5% of casenotes recorded basic symptoms; interviewees were 16 times more likely to report basic symptoms than their casenotes did.ConclusionsThe majority of interviewees self-reported pre-relapse basic symptoms when asked specifically about these experiences but very few casenotes reported these symptoms. Basic symptoms may be potent predictors of relapse that clinicians miss. A self-report measure would aid monitoring of basic symptoms in routine clinical practice and would facilitate a prospective investigation comparing basic symptoms and conventional early signs as predictors of relapse.

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Section: Introductionmentioning

confidence: 99%

Comparing early signs and basic symptoms as methods for predicting psychotic relapse in clinical practice

Eisner

Drake

Lobban

et al. 2018

Schizophrenia Research

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“…Although most investigations studying variations pertain to crises or symptomatic relapses, people with psychotic disorders can experience daily changes in their symptoms as well as important improvements in their psychotic symptoms and in other symptoms of distress (e.g., depression or anxiety) during treatments such as cognitive behaviour therapy for psychosis (Wykes, Steel, Everitt, & Tarrier, ). Various recent studies have investigated psychosocial determinants of symptom fluctuations in people with psychosis, looking for instance at daily stressors and negative emotions (Myin‐Germeys & van Os, ; Wigman et al ., ), fear or recurrence of relapse (Gumley et al ., ) as well as self‐esteem (Thewissen, Bentall, Lecomte, van Os, & Myin‐Germeys, ).…”

Section: Introductionmentioning

confidence: 99%

Symptom fluctuations, self‐esteem, and cohesion during group cognitive behaviour therapy for early psychosis

Lecomte

Wykes

2017

Psychol Psychother

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This study emphasizes the interrelation between self-esteem improvements and symptom improvements, with improvements in one leading to improvements in the other, during group CBT for psychosis. Group cohesion, in this study, is a predictor of self-esteem and symptom improvements, suggesting that a special attention should be given to developing a strong alliance and group cohesion early on during CBT for psychosis.

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“…EWS monitoring is well established for the detection of relapse, but evidence for routine implementation is poor. 7 This may in part be because of the relatively poor sensitivity of formal EWS monitoring (median sensitivity 61%) 8 and fear of relapse 9 leading to avoidance of help-seeking. 4 Lack of meaningful relationships between patients and mental health staff prevents implementation of crisis care plans and is a missed opportunity for shared decision-making.…”

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confidence: 99%

Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation

et al. 2019

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on behalf of the EMPOWER Research Group* Background Relapse prevention strategies based on monitoring of early warning signs (EWS) are advocated for the management of psychosis. However, there has been a lack of research exploring how staff, carers and patients make sense of the utility of EWS, or how these are implemented in context. AimsTo develop a multiperspective theory of how EWS are understood and used, which is grounded in the experiences of mental health staff, carers and patients. MethodTwenty-five focus groups were held across Glasgow and Melbourne (EMPOWER Trial, ISRCTN: 99559262). Participants comprised 88 mental health staff, 21 patients and 40 carers from UK and Australia (total n = 149). Data were analysed using constructivist grounded theory. ResultsAll participants appeared to recognise EWS and acknowledged the importance of responding to EWS to support relapse prevention. However, recognition of and acting on EWS were constructed in a context of uncertainty, which appeared linked to risk appraisals that were dependent on distinct stakeholder roles and experiences. Within current relapse management, a process of weighted decision-making (where one factor was seen as more important than others) described how stakeholders weighed up the risks and consequences of relapse alongside the risks and consequences of intervention and help-seeking. ConclusionsMental health staff, carers and patients speak about using EWS within a weighted decision-making process, which is acted out in the context of relationships that exist in current relapse management, rather than an objective response to specific signs and symptoms.

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Fear of recurrence: Results of a randomized trial of relapse detection in schizophrenia

Cited by 44 publications

References 45 publications

Comparing early signs and basic symptoms as methods for predicting psychotic relapse in clinical practice

Comparing early signs and basic symptoms as methods for predicting psychotic relapse in clinical practice

Symptom fluctuations, self‐esteem, and cohesion during group cognitive behaviour therapy for early psychosis

Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation

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