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Small babies and schizophrenia

Larry Rifkin, Shon W. Lewis, Ann Stewart, Robin M. Murray
1993 British Journal of Psychiatry  
doi:10.1192/bjp.163.4.553 pmid:8252304 fatcat:sdhvhbqcbnho7ore3gpaivtf3i

Advance Decision Making in Bipolar: A Systematic Review

Lucy A. Stephenson, Tania Gergel, Astrid Gieselmann, Matthé Scholten, Alex Ruck Keene, Larry Rifkin, Gareth Owen
2020 Frontiers in Psychiatry  
"Advance decision making" (ADM) refers to people planning for a future when they may lose the capacity to make decisions about treatment (decision making capacity for treatment or DMC-T). This can occur in a variety of physical and mental health scenarios. Statutory provision for ADM is likely to be introduced to mental health legislation in England and Wales, which will support planning for mental health crises. Conceptually, it may have particular utility for people with Bipolar Affective
more » ... rder (bipolar) due to the pattern of rapid loss and then recovery of DMC-T during episodes of illness. Furthermore, ADM is recommended by clinical experts in bipolar. However, the empirical evidence base for ADM in bipolar is unclear. Therefore, a systematic review is required to collate available evidence and define future research directions. A PRISMA concordant systematic review of empirical literature on the use of ADM in bipolar. We found 13 eligible articles which reported on 11 studies. Of the eligible studies 2 used a mixed methods design, 8 were quantitative descriptive studies and 1 was a randomised controlled trial. Outcomes of included studies fell into 4 categories: Interest in ADM, type of ADM preferred, barriers to completing ADM and impact of ADM. The available evidence suggests that people with bipolar are interested in engaging with ADM which is supported, collaborative and allows them to state treatment requests and refusals. Evidence in this area is limited. Clinicians should be aware that service users with bipolar are likely to value their support in creating ADM documents. In addition, it seems that people with bipolar may face fewer barriers and achieve greater success with ADM compared to those with other severe mental illnesses. Given the greater focus and likely demand for ADM following upcoming legal reform, further research is urgently needed to ensure available resources are most effectively targeted to achieve the best outcomes from ADM activities. This research should focus on clarifying: causal assumptions around ADM, the outcomes which are valued by key stakeholders, barriers to achieving these outcomes, stakeholder opinions on supporting 'self-binding' and the development and evaluation of models of ADM which are tailored for fluctuating DMC-T.
doi:10.3389/fpsyt.2020.538107 pmid:33192654 pmcid:PMC7596358 fatcat:kldujbdrfjcebeazg25qnn36va

Preterm birth and structural brain alterations in early adulthood

Chiara Nosarti, Kie Woo Nam, Muriel Walshe, Robin M. Murray, Marion Cuddy, Larry Rifkin, Matthew P.G. Allin
2014 NeuroImage: Clinical  
Alterations in cortical development and impaired neurodevelopmental outcomes have been described following very preterm (VPT) birth in childhood and adolescence, but only a few studies to date have investigated grey matter (GM) and white matter (WM) maturation in VPT samples in early adult life. Using voxel-based morphometry (VBM) we studied regional GM and WM volumes in 68 VPT-born individuals (mean gestational age 30 weeks) and 43 term-born controls aged 19-20 years, and their association
more » ... cognitive outcomes (Hayling Sentence Completion Test, Controlled Oral Word Association Test, Visual Reproduction test of the Wechsler Memory Scale-Revised) and gestational age. Structural MRI data were obtained with a 1.5 Tesla system and analysed using the VBM8 toolbox in SPM8 with a customized study-specific template. Similarly to results obtained at adolescent assessment, VPT young adults compared to controls demonstrated reduced GM volume in temporal, frontal, insular and occipital areas, thalamus, caudate nucleus and putamen. Increases in GM volume were noted in medial/anterior frontal gyrus. Smaller subcortical WM volume in the VPT group was observed in temporal, parietal and frontal regions, and in a cluster centred on posterior corpus callosum/thalamus/fornix. Larger subcortical WM volume was found predominantly in posterior brain regions, in areas beneath the parahippocampal and occipital gyri and in cerebellum. Gestational age was associated with GM and WM volumes in areas where VPT individuals demonstrated GM and WM volumetric alterations, especially in temporal, parietal and occipital regions. VPT participants scored lower than controls on measures of IQ, executive function and nonverbal memory. When investigating GM and WM alterations and cognitive outcome scores, subcortical WM volume in an area beneath the left inferior frontal gyrus accounted for 14% of the variance of full-scale IQ (F = 12.9, p b 0.0001). WM volume in posterior corpus callosum/thalamus/fornix and GM volume in temporal gyri bilaterally, accounted for 21% of the variance of executive function (F = 9.9, p b 0.0001) and WM in the posterior corpus callosum/thalamus/fornix alone accounted for 17% of the variance of total non-verbal memory scores (F = 9.9, p b 0.0001). These results reveal that VPT birth continues to be associated with altered structural brain anatomy in early adult life, although it remains to be ascertained whether these changes reflect neurodevelopmental delays or long lasting structural alterations due to prematurity. GM and WM alterations correlate with length of gestation and mediate cognitive outcome.
doi:10.1016/j.nicl.2014.08.005 pmid:25379430 pmcid:PMC4215396 fatcat:dhau7unvmjeqrheg3exj2bmlku

Restructuring Patient Review and Allocation in a South London Home Treatment Team

Theo Boardman-Pretty, John Tweed, Camilla Day, Lucy Stephenson, Jalon Quinn, Larry Rifkin
2022 BJPsych Open  
Rifkin South London & Maudsley NHS Trust, London, United Kingdom *Presenting author. doi: 10.1192/bjo.2022.282 1,2,3and Dr Elizabeth Gonzalez Malaga 4 S88 Poster Presentations  ...  action Dr Chiara Cattra Restructuring Patient Review and Allocation in a South London Home Treatment TeamDr Theo Boardman-Pretty*, Dr John Tweed, Dr Camilla Day, Dr Lucy Stephenson, Dr Jalon Quinn and Dr Larry  ... 
doi:10.1192/bjo.2022.282 fatcat:n5dsbkyhgrejbebklfui23tsti

Cerebellar growth and behavioural & neuropsychological outcome in preterm adolescents

Jennifer Parker, Ann Mitchell, Anastasia Kalpakidou, Muriel Walshe, Hee-Yeon Jung, Chiara Nosarti, Paramala Santosh, Larry Rifkin, John Wyatt, Robin M. Murray, Matthew Allin
2008 Brain  
Adolescence is a time of social and cognitive development associated with changes in brain structure and function. These developmental changes may show an altered path in individuals born before 33 weeks' gestation (very preterm; VPT). The cerebellum is affected by VPT birth, but no studies have yet assessed the adolescent development of this structure, or whether developmental changes in cerebellar structure are associated with cognitive and behavioural outcome. We measured cerebellar volumes
more » ... n structural magnetic resonance images in 65 adolescents who were born before 33 weeks' gestation (VPT) and 34 term-born adolescents (mean age VPT = 15.09, SD = 1.43/mean age term-born = 15.43, SD = 0.56) and again in adulthood (mean age VPT = 18.61, SD = 1.02/mean age term-born = 19.17, SD = 0.95). Participants also underwent neuropsychological tests; the Wechsler Abbreviated Scale of Intelligence and the Controlled Oral Word Association Test and completed the General Health Questionnaire-12. Repeated measures ANOVA showed a main effect of time-point (F = 4.59, df = 1, P = 0.035) and a time-point by group interaction (F = 8.03, df = 1, P = 0.006) on cerebellar growth. By adulthood, cerebellar volumes were 3.11% smaller in the preterm group than they had been in early adolescence (P = 0.000). Cerebellar volume did not change significantly in the control group (P = 0.612). There were significant negative correlations between change in cerebellar volume and GHQ-12 in the VPT group; total score (r = 20.324 P = 0.028) and several subscales; concentration (r = 20.378 P = 0.010), feeling useful (r = 20.311 P = 0.035), decision-making capability (r = 20.348 P = 0.018), overcoming difficulties (r = 20.331 P = 0.025), feeling confident (r = 20.309 P = 0.037) and feeling worthless (r = 20.329 P = 0.026). In the VPT group there were positive correlations between cerebellar volume and full-scale IQ (adolescence; r = 0.471, P = 0.002/adulthood; r = 0.309, P = 0.047), performance IQ (adolescence; r = 0.434, P = 0.004/adulthood; r = 0.345, P = 0.025) and verbal IQ (adolescence; r = 0.401, P = 0.008) which were not maintained after controlling for white matter volume. We have demonstrated a reduction in cerebellar volume between adolescence and young adulthood in VPT individuals, which is correlated with reduced self-reported wellbeing.
doi:10.1093/brain/awn062 pmid:18372312 fatcat:4jpuwn5w55feziqviij4cszb5a

Preterm Birth and Psychiatric Disorders in Young Adult Life

Chiara Nosarti, Abraham Reichenberg, Robin M. Murray, Sven Cnattingius, Mats P. Lambe, Li Yin, James MacCabe, Larry Rifkin, Christina M. Hultman
2012 Archives of General Psychiatry  
Context: Preterm birth, intrauterine growth restriction, and delivery-related hypoxia have been associated with schizophrenia. It is unclear whether these associations pertain to other adult-onset psychiatric disorders and whether these perinatal events are independent. Objective: To investigate the relationships among gestational age, nonoptimal fetal growth, Apgar score, and various psychiatric disorders in young adult life. Design: Historical population-based cohort study. Setting:
more » ... tion of adult-onset psychiatric admissions using data from the National Board of Health and Welfare, Stockholm, Sweden. Participants: All live-born individuals registered in the nationwide Swedish Medical Birth Register between 1973 and 1985 and living in Sweden at age 16 years by December 2002 (n = 1 301 522). Main Outcome Measures: Psychiatric hospitalization with nonaffective psychosis, bipolar affective disorder, depressive disorder, eating disorder, drug dependency, or alcohol dependency, diagnosed according to the International Classification of Diseases codes for 8 through 10. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs. Results: Preterm birth was significantly associated with increased risk of psychiatric hospitalization in adulthood (defined as Ն16 years of age) in a monotonic manner across a range of psychiatric disorders. Compared with term births (37-41 weeks), those born at 32 to 36 weeks' gestation were 1.6 (95% CI, 1.1-2.3) times more likely to have nonaffective psychosis, 1.3 (95% CI, 1.1-1.7) times more likely to have depressive disorder, and 2.7 (95% CI, 1.6-4.5) times more likely to have bipolar affective disorder. Those born at less than 32 weeks' gestation were 2.5 (95% CI, 1.0-6.0) times more likely to have nonaffective psychosis, 2.9 (95% CI, 1.8-4.6) times more likely to have depressive disorder, and 7.4 (95% CI, 2.7-20.6) times more likely to have bipolar affective disorder. Conclusions: The vulnerability for hospitalization with a range of psychiatric diagnoses may increase with younger gestational age. Similar associations were not observed for nonoptimal fetal growth and low Apgar score.
doi:10.1001/archgenpsychiatry.2011.1374 pmid:22660967 fatcat:5x2ktucxijgzfdco24doh7u7xq

Preparing for Mental Health Act reform: Pilot study of co-produced implementation strategies for Advance Choice Documents

Lucy A. Stephenson, Tania Gergel, Alex Ruck Keene, Larry Rifkin, Gareth Owen
2022 Wellcome Open Research  
Advance Decision Making (ADM) is strongly supported by stakeholders but implementation remains challenging. In England and Wales, implementation strategies are urgently required to prepare for the introduction of mental health 'Advance Choice Documents' (ACDs) as part of Mental Health Act reforms. We report on a pilot project which aimed to co-produce and evaluate implementation strategies for ACDs with those who experience fluctuating mental capacity in the context of bipolar. Methods A
more » ... uced prototype ACD template was piloted in 'Plan, Do, Study Act' (PDSA) cycles. Implementation strategies were co-produced with participants and mapped onto the Expert Recommendations for Implementing Change (ERIC) framework. Strategies were evaluated during thematically analysed qualitative interviews. Results We piloted the template with 17 service users during 5 successive PDSA cycles and conducted 75 in depth interviews with stakeholders. Key strategies identified as accessible, appropriate and feasible were: interactive assistance from an independent 'supporter', a structured template and active offers of involvement to service users and informal carers. Conclusions Mental health professionals and organisations must prepare for increased expectations around mental health ADM. We recommend further pilot projects and the establishment of 'ACD workshops'. Resource is essential to fund independent 'supporters', training, network building and embedding ADM in clinical pathways.
doi:10.12688/wellcomeopenres.17947.1 pmid:36081756 pmcid:PMC9433915 fatcat:wldwa4yvn5fnvp5duzmrdovzli

White Matter and Cognition in Adults Who Were Born Preterm

Matthew P. G. Allin, Dimitris Kontis, Muriel Walshe, John Wyatt, Gareth J. Barker, Richard A. A. Kanaan, Philip McGuire, Larry Rifkin, Robin M. Murray, Chiara Nosarti, Joseph Najbauer
2011 PLoS ONE  
and Purpose: Individuals born very preterm (before 33 weeks of gestation, VPT) are at risk of damage to developing white matter, which may affect later cognition and behaviour. Methods: We used diffusion tensor MRI (DT-MRI) to assess white matter microstructure (fractional anisotropy; FA) in 80 VPT and 41 term-born individuals (mean age 19.1 years, range 17-22, and 18.5 years, range17-22 years, respectively). VPT individuals were part of a 1982-1984 birth cohort which had been followed up since
more » ... birth; term individuals were recruited by local press advertisement. General intellectual function, executive function and memory were assessed. Results: The VPT group had reduced FA in four clusters, and increased FA in four clusters relative to the Term group, involving several association tracts of both hemispheres. Clusters of increased FA were associated with more severe neonatal brain injury in the VPT group. Clusters of reduced FA were associated with lower birth weight and perinatal hypoxia, and with reduced adult cognitive performance in the VPT group only. Conclusions: Alterations of white matter microstructure persist into adulthood in VPT individuals and are associated with cognitive function.
doi:10.1371/journal.pone.0024525 pmid:22022357 pmcid:PMC3192037 fatcat:rj2f3yojfbcllbqfdpp4ayyuxi

PUFA levels in erythrocyte membrane phospholipids are differentially associated with colorectal adenoma risk

Samara B. Rifkin, Martha J. Shrubsole, Qiuyin Cai, Walter E. Smalley, Reid M. Ness, Larry L. Swift, Wei Zheng, Harvey J. Murff
2017 British Journal of Nutrition  
Dietary intake of PUFA has been associated with colorectal neoplasm risk; however, results from observational studies have been inconsistent. Most prior studies have utilised self-reported dietary measures to assess fatty acid exposure which might be more susceptible to measurement error and biases compared with biomarkers. The purpose of this study was to determine whether erythrocyte phospholipid membrane PUFA percentages are associated with colorectal adenoma risk. We included data from 904
more » ... denoma cases and 835 polyp-free controls who participated in the Tennessee Colorectal Polyp Study, a large colonoscopy-based case–control study. Erythrocyte membrane PUFA percentages were measured using GC. Conditional logistic regression was used to calculate adjusted OR for risk of colorectal adenomas with erythrocyte membrane PUFA. Higher erythrocyte membrane percentages of arachidonic acid was associated with an increased risk of colorectal adenomas (adjusted OR 1·66; 95 % CI 1·05, 2·62, P trend=0·02) comparing the highest tertile to the lowest tertile. The effect size for arachidonic acid was more pronounced when restricting the analysis to advanced adenomas only. Higher erythrocyte membrane EPA percentages were associated with a trend towards a reduced risk of advanced colorectal adenomas (P trend=0·05). Erythrocyte membrane arachidonic acid percentages are associated with an increased risk of colorectal adenomas.
doi:10.1017/s0007114517001490 pmid:28660850 pmcid:PMC5891121 fatcat:4aveivhcy5eljgnsd54yvtfkyi

Reasons for endorsing or rejecting self-binding directives in bipolar disorder: a qualitative study of survey responses from UK service users

Tania Gergel, Preety Das, Gareth Owen, Lucy Stephenson, Larry Rifkin, Guy Hindley, John Dawson, Alex Ruck Keene
2021 Lancet psychiatry  
Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having the potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, the views of service users on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service
more » ... users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human rights. This qualitative study used data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision making for patients with bipolar disorder. We included participants who reported that they have been diagnosed with bipolar disorder by a professional (doctor or psychiatrist). In a previous study, quantitative analysis of a closed question about self-binding directives had shown endorsement among a high proportion of participants with bipolar disorder who completed the survey. In this study, we did a thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was done within a multidisciplinary team, including team members with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methods associated with all these areas of expertise were used in the thematic analysis to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Between Oct 23, 2017, and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 individuals (154 men, 400 women, 11 transgender or other), predominantly white British, providing free-text answers to the open question. 463 (82%) of the 565 participants endorsed self-binding directives, of whom 411 (89%) describing a determinate shift to distorted thinking and decision making when unwell as their key justification. Responses indicating ambivalence (37 [7%) of the 565 responses) were dominated by logistical concerns about the drafting and implementation of self-binding directives, whereas those who rejected self-binding directives (65 [12%] of the 565 responses) cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. This study is, to our knowledge, the first large study assessing the reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health services as well as advance decision-making practice and policy, and might help address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. The Wellcome Trust.
doi:10.1016/s2215-0366(21)00115-2 pmid:34022972 fatcat:hgipaqfmhnbdlpwwugtuqvh67a

The PACT advance decision-making template: preparing for Mental Health Act reforms with co-production, focus groups and consultation

Lucy A. Stephenson, Tania Gergel, Alex Ruck Keene, Larry Rifkin, Gareth Owen
2020 International Journal of Law and Psychiatry  
Advance decision making (ADM) in mental health is supported by stakeholders but faces significant barriers. These must be overcome, not least to support the UK government's commitment to introduce statutory mental health ADM in England and Wales. To build understanding and address the gap between aspirations for ADM and actuality, with feasible co-produced ADM resources. We used focus groups and consultation to explore experience and views of stakeholders on ADM processes and materials.
more » ... ons included feedback on an ADM template which was adapted accordingly throughout the research process. Between September 2017 and December 2019, 94 individuals, representing stakeholders advised on design and process of ADM, alongside wider discussion at stakeholder events. Collaborative ADM was universally supported. Valued outcomes were diverse and combining aspirations with practicality required resolving dilemmas. A prototype template and guidance, the PACT (Preferences and Advance decisions for Crisis and Treatment) was co-produced, designed to help manage fluctuating mental capacity through collaborative decision making. The PACT enables direct engagement with medico-legal frameworks, with provision to facilitate person-centred assessments, treatment refusals and requests. Resources including supported engagement and cross-agency awareness and accessibility were seen as essential. Our research confirms high stakeholder motivation to engage in ADM is hampered by multiple barriers. We identified enabling conditions for ADM and co-produced an ADM template and guidance which supports achievement of a range of valued outcomes. Further developments to support and evaluate the process of implementation are now needed to prepare for statutory change.
doi:10.1016/j.ijlp.2020.101563 pmid:32768120 pmcid:PMC7435693 fatcat:jl7mw2kmibhw7gpnmbgywbtmby

Neonatal Brain Injury and Neuroanatomy of Memory Processing following Very Preterm Birth in Adulthood: An fMRI Study

Anastasia K. Kalpakidou, Matthew P. Allin, Muriel Walshe, Vincent Giampietro, Kie-woo Nam, Philip McGuire, Larry Rifkin, Robin M. Murray, Chiara Nosarti, Yong He
2012 PLoS ONE  
Altered functional neuroanatomy of high-order cognitive processing has been described in very preterm individuals (born before 33 weeks of gestation; VPT) compared to controls in childhood and adolescence. However, VPT birth may be accompanied by different types of adverse neonatal events and associated brain injury, the severity of which may have differential effects on brain development and subsequent neurodevelopmental outcome. We conducted a functional magnetic resonance imaging (fMRI)
more » ... to investigate how differing degrees of neonatal brain injury, detected by neonatal ultrasounds, affect the functional neuroanatomy of memory processing in VPT young adults. We used a verbal paired associates learning task, consisting of four encoding, four cued-recall and four baseline condition blocks. To further investigate whether differences in neural activation between the groups were modulated by structural brain changes, structural MRI data were also collected. We studied 12 VPT young adults with a history of periventricular haemorrhage with associated ventricular dilatation, 17 VPT individuals with a history of uncomplicated periventricular haemorrhage, 12 individuals with normal ultrasonographic findings, and 17 controls. Results of a linear trend analysis demonstrated that during completion of the paired associates learning task right frontal and right parietal brain activation decreased as the severity of neonatal brain injury increased. There were no statistically significant between-group differences in on-line task performance and participants' intelligence quotient (IQ) at assessment. This pattern of differential activation across the groups was observed particularly in the right middle frontal gyrus during encoding and in the right posterior cingulate gyrus during recall. Structural MRI data analysis revealed that grey matter volume in the right superior temporal gyrus, right cerebellum, left middle temporal gyrus, right globus pallidus and right medial frontal gyrus decreased with increasing severity of neonatal brain injury. However, the significant between-group functional neuroanatomical differences were not directly attributable to the detected structural regional differences.
doi:10.1371/journal.pone.0034858 pmid:22532832 pmcid:PMC3332056 fatcat:w3j4g7ec5ndf7atumg5yqamyry

Functional Neuroanatomy of Executive Function after Neonatal Brain Injury in Adults Who Were Born Very Preterm

Anastasia K. Kalpakidou, Matthew P. G. Allin, Muriel Walshe, Vincent Giampietro, Philip K. McGuire, Larry Rifkin, Robin M. Murray, Chiara Nosarti, Yu-Feng Zang
2014 PLoS ONE  
Individuals who were born very preterm (VPT; ,33 gestational weeks) are at risk of experiencing deficits in tasks involving executive function in childhood and beyond. In addition, the type and severity of neonatal brain injury associated with very preterm birth may exert differential effects on executive functioning by altering its neuroanatomical substrates. Here we addressed this question by investigating with functional magnetic resonance imaging (fMRI) the haemodynamic response during
more » ... tive-type processing using a phonological verbal fluency and a working memory task in VPT-born young adults who had experienced differing degrees of neonatal brain injury. 12 VPT individuals with a history of periventricular haemorrhage and ventricular dilatation (PVH+VD), 17 VPT individuals with a history of uncomplicated periventricular haemorrhage (UPVH), 13 VPT individuals with no history of neonatal brain injury and 17 controls received an MRI scan whilst completing a verbal fluency task with two cognitive loads ('easy' and 'hard' letters). Two groups of VPT individuals (PVH+VD; n510, UPVH; n58) performed an n-back task with three cognitive loads (1-, 2-, 3-back). Results demonstrated that VPT individuals displayed hyperactivation in frontal, temporal, and parietal cortices and in caudate nucleus, insula and thalamus compared to controls, as demands of the verbal fluency task increased, regardless of type of neonatal brain injury. On the other hand, during the n-back task and as working memory load increased, the PVH+VD group showed less engagement of the frontal cortex than the UPVH group. In conclusion, this study suggests that the functional neuroanatomy of different executive-type processes is altered following VPT birth and that neural activation associated with specific aspects of executive OPEN ACCESS Citation: Kalpakidou AK, Allin MPG, Walshe M, Giampietro V, McGuire PK, et al. (2014) Functional Neuroanatomy of Executive Function after Neonatal Brain Injury in Adults Who Were Born Very Preterm. PLoS ONE 9(12): e113975.
doi:10.1371/journal.pone.0113975 pmid:25438043 pmcid:PMC4250191 fatcat:j27k4za7lvc6bpshyfd7zz4gfe

Neurological abnormalities and cognitive ability in first-episode psychosis

Paola Dazzan, Tuhina Lloyd, Kevin D. Morgan, Jolanta Zanelli, Craig Morgan, Ken Orr, Gerard Hutchinson, Paul Fearon, Matthew Allin, Larry Rifkin, Philip K. McGuire, Gillian A. Doody (+5 others)
2008 British Journal of Psychiatry  
Morgan, Jolanta Zanelli, Craig Morgan, Ken Orr, Gerard Hutchinson, Paul Fearon, Matthew Allin, Larry Rifkin, Philip K. McGuire, Gillian A. Doody, John Holloway, Julian Leff, Glynn Harrison, Peter B.  ... 
doi:10.1192/bjp.bp.107.045450 pmid:18757976 fatcat:5nfbyi6m25azxbm3ebihu3p754

"Why have I not been told about this?": a survey of experiences of and attitudes to advance decision-making amongst people with bipolar

Guy Hindley, Lucy A. Stephenson, Alex Ruck Keene, Larry Rifkin, Tania Gergel, Gareth Owen
2019 Wellcome Open Research  
The idea that people with severe mental illness should be able to plan in advance for periods of illness as a means of enhancing autonomy has been long debated and is increasingly being enshrined in codes of practice and mental health legislation. It has been argued that the ethical imperative for this is especially pronounced in bipolar (BP), a condition in which sufferers often experience episodic crises interspersed with periods of wellness. However, there is a paucity of published research
more » ... nvestigating experiences of advance decision making (ADM) in people with BP or their attitudes towards it. Methods: An online survey of BPUK's mailing list was conducted. 932 people with BP completed the survey (response rate 5.61%). Descriptive statistics and regression analysis were conducted to compare experience of with attitudes towards ADM and variables associated with interest in ADM. Results: A majority indicated a desire to plan care in advance of losing capacity (88%) but most had not done so (64%). High numbers of respondents expressed a wish to request as well as refuse treatment and most wanted to collaborate with psychiatrists, including on issues around self-binding. The most frequent motivation to utilise ADM was a desire to be more involved in mental health decisions. Interest in self-binding was associated with experience of compulsory treatment and trust in mental health services. Interest in refusals of all medication was associated with younger age and lack of trust in mental health services. Interest in ADM in general was associated with younger age but not educational level, ethnicity or gender. Conclusions: This study demonstrates an appetite for ADM amongst people with bipolar that is independent of educational status and ethnicity. As states reform their mental health laws, attention needs to be given to the distinctive attitudes toward ADM amongst people with bipolar.
doi:10.12688/wellcomeopenres.14989.1 pmid:31080892 pmcid:PMC6492047 fatcat:bi6smul6pfexphypaopaqom77y
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