William Sellwood | Lancaster University (original) (raw)

Papers by William Sellwood

Early Intervention in Psychiatry, 2018

Background: One of the largest drivers of poor health outcomes in those with schizophrenia is met... more Background: One of the largest drivers of poor health outcomes in those with schizophrenia is metabolic syndrome, which includes phenomena such as hyperlipidemia, hypertension, obesity, and diabetes mellitus. Due to factors such as sedentary lifestyle, poor diet, and medication side effects, individuals with schizophrenia are at high risk of developing metabolic syndrome. Methods: The study took place at the Prevention and Recovery Center (PARC) for early psychosis, the state of Indiana's first and only center dedicated to treating individuals with first-episode psychosis (FEP). Between 12/19/2014 and 08/31/2017, 171 individuals with FEP were enrolled in Fit Happens, a longitudinal metabolic monitoring and treatment program. Patients underwent baseline metabolic screening including weight, waist circumference, lipid panel, hemoglobin A1C (HbA1C), and blood pressure. From that point on, patients participated in metabolic monitoring and treatment according to the Fit Happens protocol. Results: Patients enrolled in Fit Happens demonstrated longitudinal stability in some metabolic parameters, including blood pressure and hemoglobin A1c. However, there was a progressive increase in weight, body mass index, and waist circumference. Conclusion: Results indicate that the Fit Happens program may be effective for addressing some metabolic issues associated with the early phase of psychosis, though not all. Additional research is needed to study effective interventions for metabolic dysfunction in FEP populations. An overview of the Fit Happens program will be offered and observations for future directions discussed.

Individual cognitive behavioural interventions for psychosis are rapidly developing and are being... more Individual cognitive behavioural interventions for psychosis are rapidly developing and are being shown to be effective. This paper examines the application of these interventions on a group basis. The nature of the group, treatment outcome and potential benefits of using this format are described. After the group intervention, all patients were less depressed, most had higher self-esteem and greater knowledge of schizophrenia, and half the group felt better able to cope with their symptoms. Patients reported feeling less isolated and two of the four group members stated a preference for group over individual treatment.

Background The relationship between trauma and psychosis is well established with a large amount ... more Background The relationship between trauma and psychosis is well established with a large amount of overlap between the ICD/DSM diagnostic criteria for Post-traumatic Stress Disorder (PTSD) and psychosis and/or schizophrenia. In spite of co-morbidity and evidence of the links and underlying mechanisms, trauma is rarely a focus of intervention in psychosis. Psychosis has often been on the list of exclusion criteria for PTSD research studies. There is a lack of literature on the impact of trauma work with people experiencing psychosis. The National Institute for Health and Care Excellence (NICE)(2014) suggest that Early Intervention in Psychosis (EIP) service users should be assessed for PTSD and PTSD guidelines (NICE, 2005) followed for those who show who show signs of post-traumatic stress. Aims There is a need to evaluate the effectiveness of therapeutic approaches for people with PTSD and co-morbid psychosis. These case studies aim to provide initial evidence of how two EIP clients experienced and responded to NICE-recommended psychological therapy for trauma. Method Two EIP clients received psychological therapy (including trauma-focused Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR)) for identified traumatic experiences. Assessment outcome measures were utilised to establish the effectiveness of the interventions.

Frontiers in Psychology, Mar 16, 2022

Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, in... more Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, increasing symptom burden, decreasing quality of life and moderating treatment response. A range of post-traumatic sequelae have been found to mediate the relationship between trauma and psychotic experiences, including the "traditional" symptoms of post-traumatic stress disorder (PTSD). The International Classification of Diseases-11th Edition recognizes a more complex post-traumatic presentation, complex PTSD (cPTSD), which captures both the characteristic symptoms of PTSD alongside more pervasive post-traumatic sequelae known as 'disturbances in selforganization' (DSOs). The prevalence and impact of cPTSD and DSOs in psychosis remains to be explored. In the first study of this kind, 144 participants with psychosis recruited from North West United Kingdom mental health services completed measures assessing trauma, PTSD and cPTSD symptoms and symptoms of psychosis. Forty-percent of the sample met criteria for cPTSD, compared to 10% who met diagnostic criteria for PTSD. PTSD and DSOs mediated the relationship between trauma and positive symptoms, controlling for dataset membership. Both PTSD and DSOs mediated the relationship between trauma and affective symptoms but did not explain a significant proportion of variance in negative symptoms. Cognitive and excitative symptoms of psychosis did not correlate with trauma, PTSD or DSO scores. These findings indicate the possible value of adjunct therapies to manage cPTSD symptoms in people with psychosis, pending replication in larger epidemiological samples and longitudinal studies.

Psychiatry Research-neuroimaging, Aug 1, 2015

Acta Psychiatrica Scandinavica, Nov 1, 2001

To examine longer-term effectiveness of a needs-based family intervention for carers and out-pati... more To examine longer-term effectiveness of a needs-based family intervention for carers and out-patients suffering from schizophrenia. Seventy-nine unselected patient-carer pairs were recruited from a geographical area and allocated randomly to one of two conditions. One group received needs-based cognitive-behavioural family intervention in combination with general family support plus the standard care. The control group received the general family support and standard care only. Analysis was carried out on an intention-to-treat basis. There was a significant advantage for family intervention, in terms of relapse (37% relapsed compared to 72%, NNT=3) and on other clinical measures. Treatment group and medication compliance were significant and independent predictors of relapse. There was a significant reduction in carer needs in the intervention group. Family intervention directed at carers' needs within a standard mental health service can produce benefits for patients beyond the term of intervention.

Psychiatry Research-neuroimaging, Jul 1, 2014

Accumulated evidence over the past decade consistently demonstrates a relationship between childh... more Accumulated evidence over the past decade consistently demonstrates a relationship between childhood adversity and psychosis in adulthood. There is some evidence of specific associations between childhood sexual abuse and hallucinations, and between insecure attachment and paranoia. Data from the National Comorbidity Survey were used in assessing whether current attachment styles influenced the association between adverse childhood experiences and psychotic symptoms in adulthood. Hallucinations and paranoid beliefs were differentially associated with sexual abuse (rape and sexual molestation) and neglect, respectively. Sexual abuse and neglect were also associated with depression. The relationship between neglect and paranoid beliefs was fully mediated via anxious and avoidant attachment. The relationship between sexual molestation and hallucinations was independent of attachment style. The relationship between rape and hallucinations was partially mediated via anxious attachment; however this effect was no longer present when depression was included as a mediating variable. The findings highlight the importance of addressing and understanding childhood experiences within the context of current attachment styles in clinical interventions for patients with psychosis.

Wynne & Singer, 1963a, 1963b). These atypicalities are subtle and can range from ambiguous lingui... more Wynne & Singer, 1963a, 1963b). These atypicalities are subtle and can range from ambiguous linguistic references (e.g. "Kid stuff that's one thing but something else is different too"; Velligan, et al., 1990, p. 18) or contradictions (e.g. "I didn't get much sleep last night (interviewer: are you tired?) Yeah, I ain't tired", Docherty, 1993, p. 753) to more overarching non-verbal atypicalities at the level of the pragmatics of communication (e.g. mistimed turn-taking, Wynne et al., 1977). Lyman Wynne and Margaret Singer, who originally coined the term, argued that CD in parents contributes to the development of psychiatric symptoms in children through its pervasive effect on the offspring's socio-cognitive development during formative years (Wynne et al., 1977). They argued that, children learn to share and sustain foci of attention, and thereby derive meaning from the world around them, through communication with their parents (Wynne, 1981, 1984). It was initially hypothesized that CD in the caregiver, in interaction with genetic vulnerability in the 4 offspring, would lead to the escalation of the cognitive and affective atypicalities, especially thought disorder, later observed in schizophrenia (Wynne, 1981). Consistent with this hypothesis, Wahlberg and colleagues (1997, 2000) used an adoption study to show that the interaction between adoptees' genetic risk (having a biological mother diagnosed with schizophrenia) and adoptive parents' CD was a significant predictor of thought disorder (TD) in the adoptee. In this study, high genetic risk alone did not predict TD and, in fact, high genetic-risk adoptees when exposed to low CD parents displayed less TD than low risk adoptees. However, it is not yet clear whether parental CD is a risk factor specific to TD, schizophrenia or a wider range of psychiatric conditions (Roisko, Wahlberg, Hakko, & Tienari, 2014). Indeed, it is possible that CD may reflect an important environmental risk for a range of mental health disorders (Wahlberg et al., 2004). Evidence on mechanisms linking CD to specific developmental processes in childhood is limited. Cross sectional studies have found that CD in the caregiver is associated with poorer social, cognitive and emotional development in 7 and 10 year olds offspring of parents diagnosed with severe mental health disorders (Doane et al., 1982), and with social withdrawal and behavioral problems in 9 year olds (Velligan, Christensen, Goldstein, & Margolin, 1988). Findings from longitudinal studies using measures based on concepts allied to CD have been consistent with early effects. For example, disrupted caregiver-infant communication (e.g. caregiver's contradictory affective cues or withdrawal, Lyons-Ruth, Bronfman, 1999) at the age of 18 months has been shown to significantly predict symptoms of dissociation 20 years later

Early Intervention in Psychiatry, Nov 22, 2020

AimTraumatic events are involved in the development and maintenance of psychotic symptoms. There ... more AimTraumatic events are involved in the development and maintenance of psychotic symptoms. There are few trials exploring trauma‐focused treatments as interventions for psychotic symptoms, especially in individuals with early psychosis. This trial will evaluate the feasibility and acceptability of conducting a definitive trial of Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) in people with early psychosis.MethodsSixty participants with first episode psychosis and a history of a traumatic/adverse life event(s)will be recruited from early intervention services in the North West of England and randomized to receive16 sessions of EMDRp + Treatment as Usual (TAU) or TAU alone. Participants will be assessed at baseline, 6 and 12 months post‐randomization using several measures of psychotic symptoms, trauma symptoms, anxiety, depression, functioning, service‐user defined recovery, health economics indicators and quality of life. Two nested qualitative studies to assess participant feedback of therapy and views of professional stakeholders on the implementation of EMDRp into services will also be conducted. The feasibility of a future definitive efficacy and cost‐effectiveness evaluation of EMDRp will be tested against several outcomes, including ability to recruit and randomize participants, trial retention at 6‐ and 12‐month follow‐up assessments, treatment engagement and treatment fidelity.ConclusionsIf it is feasible to deliver a multi‐site trial of this intervention, it will be possible to evaluate whether EMDRp represents a beneficial treatment to augment existing evidence‐based care of individuals with early psychosis supported by early intervention services.

Health Technology Assessment, Jun 1, 2020

Assessment (HTA) programme during the conduct of the study. Fiona Lobban and Lesley Chapman were ... more Assessment (HTA) programme during the conduct of the study. Fiona Lobban and Lesley Chapman were involved in the design and development of the Relatives' Education And Coping Toolkit (REACT); hence, this is not an independent evaluation. Bruce Hollingsworth reports that he was a NIHR Health Services and Delivery Research Commissioned Board member (2013-15). Paula Williamson reports grants from NIHR during the conduct of the study, and that the Clinical Trials Research Centre at the University of Liverpool was in receipt of NIHR Support Funding

Bipolar Disorders, Feb 1, 2005

Bipolar disorder (BD) is a complex potentially devastating illness, associated with losing 14 yea... more Bipolar disorder (BD) is a complex potentially devastating illness, associated with losing 14 years of effective activity and dying 9 years early (1). There are substantially elevated risks of substance abuse (2, 3) and suicidal behaviour (4); a recent study indicated a 16% additional risk for suicide attempts for BD and comorbid substance abuse (5). Studies of the course of BD indicate that, if anything, the pattern of relapse and recurrence worsens as the individual ages (6). Pharmacotherapy of BD presents complex challenges, because of the need to treat effectively the different phases (e.g. manic, depressed and subsyndromal) of the disorder. A number of recent guidelines have drawn together evidence from available research (7-10). The British Association for Psychopharmacology (BAP) guidelines recognized the shortage of high quality studies and the need to combine scientific data with clinical experience in their recommendations (7). BAP, World Federation of Societies of Biological Psychiatry (WFSBP) and American Psychiatric Association (APA) guidelines all recognize the importance of lithium, valproate, oral antipsychotics and benzodiazpenes as treatment options in Jones SH, Sellwood W, McGovern J. Psychological therapies for bipolar disorder: the role of model-driven approaches to therapy integration.

Frontiers in Psychology, Jul 15, 2022

Background: Providing long-term care for a family member with psychosis can cause significant dis... more Background: Providing long-term care for a family member with psychosis can cause significant distress for informal carers due to the trauma of seeing their loved one in crisis, dealing with the difficult symptoms of psychosis and the burden of providing care. An important aspect of carers' adjustment can be construed as their personal recovery in relation to having a relative affected by psychosis. Self-report measures are increasingly used to assess personal recovery in service users, but less is known about the utility of such tools for carers. Aims: This review aimed to identify all self-report measures assessing aspects of carers' personal recovery, and to quality appraise them. Methods: Academic Search Ultimate, CINAHL, MEDLINE, PsychINFO and PubMed were searched for articles that reported the development of self-report measures created for carers of those with psychosis. Studies were appraised using the Consensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) checklist. A Levels of Evidence synthesis provided overall quality scores for each measure. Results: The search identified 3,154 articles for initial screening. From a total of 322 full text articles, 95 self-report measures were identified with a final 10 measures included for the quality assessment showing varying levels of psychometric rigor. Conclusions: The results show that no single self-report measure is currently available for use to comprehensively assess personal recovery for carers, highlighting the need for further research in this area and the development of a new measure.

Acta Psychiatrica Scandinavica, Jul 18, 2008

Behavioural and Cognitive Psychotherapy, Jul 1, 2002

We conducted a pilot group intervention for negative symptoms, particularly targeting avolition/a... more We conducted a pilot group intervention for negative symptoms, particularly targeting avolition/apathy. A baseline control design was used. Six patients were recruited, and four completed the group. The main inclusion criteria were clinically significant negative symptoms, plus associated distress and concern. The group involved 16 sessions, which were cognitive behavioural in approach. The main outcome measures were the Scale for the Assessment of Negative Symptoms, and the Subject Experience of Negative Symptoms Scale. Patients showed a reduction in avolition/apathy, and two patients reported reduced distress. These preliminary results suggest that group CBT is a possible intervention for negative symptoms.

British Journal of Psychiatry, Feb 1, 2019

Background: Poor social cognition is prevalent in schizophrenia-spectrum disorders. Some authors ... more Background: Poor social cognition is prevalent in schizophrenia-spectrum disorders. Some authors argue that these effects are symptom-specific and that socio-cognitive difficulties (e.g. Theory-of-Mind) are strongly associated with thought disorder (TD) and symptoms of disorganisation. Aims: The current review tests the strength of this association. Method: We meta-analysed studies published between 1980 and 2016 that tested the association between social cognition and these symptoms in schizophrenia-spectrum disorders. Results: Our search (PsycINFO, MEDLINE and Web of Science) identified 123 studies (N= 9107). Overall effect-size (ES) was r=-0.313, indicating a moderate association between symptoms and social cognition. Sub-analyses yielded a moderate association between symptoms and ToM (r=-0.349), emotion recognition (r=-0.334) but smaller ES for social perception (r=-0.188), emotion regulation (r=-0.169) and attributional biases (r=-0.143). Conclusions: The association is interpreted within models of communication that highlight the importance of mentalisation and processing of partner-specific cues in conversational alignment and grounding.

British Journal of Clinical Psychology, Sep 1, 2000

Objectives. Non-compliance with neuroleptic medication in schizophrenia is a major cause of relap... more Objectives. Non-compliance with neuroleptic medication in schizophrenia is a major cause of relapse. A number of sociodemographic variables, and illness, attitudinal and treatment variables, have been demonstrated to be associated with non-compliance. The present study examined a range of these variables and their predictive value in determining past and current compliance. Methods. Thirty-nine patients suåering from schizophrenia and three patients suåering from schizoaåective disorder completed a series of questionnaires assessing psychological reactance, insight, subjective response to medication, perceived threat to freedom of choice, and degree of current and past compliance. Logistic regression analyses were performed to determine which factors best predicted past and current compliance. Results. Psychological reactance and age were found to be the best predictors of past compliance, with an interaction between reactance and perceived threat to freedom of choice posed by treatment provision also making a signi®cant contribution. Past compliance behaviour and subjective response to medication predicted current compliance most signi®cantly. Conclusions. Reactance is an important predictor of compliance history especially when patients perceive treatment to be a threat to freedom of choice. Subjective response to neuroleptics is most important in predicting current compliance. Implications for intervention are discussed.