There is consistent evidence that incidence rates of psychotic disorders vary in different geographical areas. The variation of the distribution of a disease can give clues to the role played by different risk factors. In Italy there are only a few epidemiological studies on psychosis. In this thesis I aimed to contribute by a) widening Italian epidemiological research on the incidence of psychoses and b) investigating the role of some of the putative risk factors associated with this group of disorders. Results in this thesis are presented in two parts. The first part reports incidence rates of psychoses in Palermo. I collected data on 204 first episode psychosis patients, presenting to the mental health services, over a period of 3 years in a well-defined catchment area of Palermo, Italy. I carried out an incidence study and I calculated crude and adjusted incidence rates of affective and non-affective psychoses. I compared the Palermo incidence data I acquired with the existing UK data from the AESOP study. My findings were consistent with the literature indicating that there is an increased risk for all psychotic disorders in males and in migrants. Incidence rates of all psychoses in Palermo were lower than in UK except for schizophrenia and the most striking difference was in the likelihood to develop affective psychoses which was significantly greater in UK. The second chapter of results describes the prevalence of some putative risk factors associated with the development of psychotic disorders, such as cannabis and other illicit drug consumption, family history of psychiatric disorders and psychosis, childhood traumatic experiences, adult adverse life events. I carried out a case control study on a subsample of 68 first episode psychotic patients and a sample of 74 healthy controls representative of the local population. Family history for psychiatric disorders was more common among patients than controls; cannabis consumption was higher among cases at the time of assessment. Patients were more likely than healthy controls to have started to smoke cannabis before 15 years of age, and to report a higher frequency of use. Some experiences (having been injured or assaulted, having experienced having been expelled from school, running away from home, having been forced into authority care) and physical and sexual abuse in childhood were more common among cases than in controls.

The robust evidence that the incidence of psychosis is elevated in many migrant and minority ethnic population, especially the black population in the UK, has led to a resurgence of interest in the potential role of socio-environmental factors. A growing body of evidence suggests that experiences of social adversity can increase risk of psychosis, particularly in the presence of other known risk factors (e.g. genetic risk). The aims of this thesis are to investigate the relationship between psychosis and a number of current and long-term indicators of childhood and adulthood social adversity in patients suffering their first episode of psychosis (n = 507) and in a control sample (425). Detailed data on social adversity were collected as part of the GAP and EU-GEI studies. Across all the domains considered, cases were more likely to report social adversity than were controls. Social adversity, especially in the case of cumulative exposure, was associated with up to a 9 fold increased risk of psychosis, independent of potential confounders. Greater number of indicators present and longer exposure result in progressively greater risk (linear relationship). Contrary to my hypothesis, no evidence was found that social adversity was more common in Black and other minority groups compared to White British subjects. However, going beyond the study of each risk factor individually, I found evidence that childhood adversity and adulthood adversity combined synergistically to increase the odds of psychosis, and social adversity in adulthood, combine with cannabis use, conferring a greater risk than would be expected if each worked through a separate causal pathway. Although the results were not significant, there was a trend towards an additive interaction between adversity in adulthood and psychosis family history.

This study aimed to explore how in-patients who had been diagnosed with psychosis talked about their experiences. The participants who were included in the study were from a specialist psychiatric hospital. This hospital provides treatment for those who have failed to respond to standard NHS psychiatric services and therefore could be described as 'treatment resistant'.

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The study was conducted to explore the possibility of measuring the clinical supervisory relationship in an inter-professional population consisting of clinical psychologists, psychiatrists, mental health nurses and occupational therapists. An existing measure of the relationship was tested and the results explored through factor analysis. A revised scale, / the SRO-PO was then constructed, consisting of 34 items and four factors. This new scale was tested for psychometric properties and found to have strong, internal consistency, test retest reliability and convergent validity. An analysis of variance was conducted to examine group differences; when an effect of professional groups was found, post hoc tests were used to identify the locations of the differences. This information was used as the basis further to explore the possibility of measuring supervision in a cross-professional population and adopting a cross-professional model. There are a number of methodological limitations to the study; these are considered in the discussion chapter of this paper. It is concluded that findings from the research indicate that the revised scale SRO-PO is potentially a reliable and valid measure that can be used in inter-professional populations, but that its factor structure needs to be replicated in a new sample in accordance with recommendations from the literature before being adopted for practical application.

No description available.

Volume I consists of three chapters. The first chapter is a systematic review exploring the factors associated with coercion in those who are involuntarily admitted to hospital. Those with psychosis, aggression and poor global functioning were some of the factors associated with a higher likelihood of experiencing coercion. The second chapter outlines an empirical research study exploring the experience of being detained under Section 136 of the Mental Health Act (1983, 2007) using Critical Incident Technique (Flanagan 1954, Butterfield, Borgen Maglio & Edmunson, 2009). The importance of meaningful human relationships was found to underpin many of the critical incidents. The third and final chapter is a public domain briefing document which provides a concise and accessible summary of both the systematic review and the empirical research study. Volume II consists of five chapters, each containing a Clinical Practice Report (CPR). The first report outlines the details of a 14 year old girl with anxiety formulated using cognitive-behavioural and systemic models. The second report presents a service evaluation of a dialectical behaviour therapy group provided by a CAMHS service. The third report outlines the case study of a 72 year old woman with a fear of falling, formulated using a cognitive-behavioural approach. The fourth report documents a single case experimental design, evaluating the efficacy of a cognitive-behavioural therapy for psychosis. The fifth chapter is the abstract of an oral presentation made outlining the use of cognitive analytic therapy with a 32 year old male.

This thesis explores the impact of instrumentalism on the praxis of counselling and psychotherapy in Britain, and is based on an ethnographic study of responses to state and organisational authority in the form of the social actions of therapists within several therapy-based institutions. Following a brief social history of British psychotherapy, the thesis includes an autoethnographic account of my entry into a psychotherapy habitus and my emerging self-identified role as an involved observer. This is followed by a discussion of material (from the period 2006-2015) arising from an analysis of six case studies and forty-five in-depth interviews. During this time, therapy organisations acted partly to facilitate the expected statutory regulation of counselling and psychotherapy, and partly in anticipation of the Improving Access to Psychological Therapy scheme. These actions included the codification and componentisation of therapy praxis in compliance with NICE guidelines for the empirical evaluation and approval of psychological therapy, using outcome measures and randomised controlled trials. They took place against a backdrop of neoliberal imperatives, designed to reduce welfare payments, (including the use of therapy as workfare), and the recasting of therapy knowledge within an economistic perspective. My informants include: senior therapy managers and training course directors within counselling and psychotherapy organisations who were collectively engaged in the production of monistic representations of therapy, therapy trainers subjected to numericised emotion management, and students on training courses aligned to digitally-Taylorised representations of therapy praxis. The thesis concludes with an interpretation of these actions, using a range of sources, followed by a discussion of the acts of resistance (since the beginning of 2016) by factions of therapists.

This portfolio thesis has three parts. Part one is a systematic literature review in which the existing research literature on the psychological and systemic factors that influence healthcare staff’s decision to whistleblow on poor care is examined and its quality evaluated. Part two is an empirical paper which uses Interpretative Phenomenological Analysis (IPA; Smith, 1996) to explore the experiences of families of people with intellectual disabilities when noticing and reporting concerns in healthcare services. Part three comprises the Appendices, containing supporting information relating to parts one and two and epistemological and reflective statements. Abstract - Systematic literature review: Purpose This systematic literature review aimed to investigate the psychological and systemic variables influencing whistleblowing decisions in healthcare settings. Design/methodology/approach A search of academic databases was undertaken and reference lists of the resulting articles were searched. In total 17 studies using a range of methodologies were analysed using Narrative Synthesis. Methodological quality was assessed. Findings Psychological variables were grouped into beliefs about advocacy and professional roles, fear and diverse responses to wrongdoing. Systemic variables were grouped into relationships with peers, the culture of the organisation and feedback, however there was a complex interplay of factors. Research Implications Further research is needed to examine the efficacy of these interventions and to represent the views of a wider range of healthcare professionals. Originality/value This was a timely review given recent reports on the treatment of whistleblowers in healthcare, indicating interventions to facilitate whistleblowing such as increasing the ease of reporting systems, providing feedback and creating a more compassionate organisational culture. Abstract : empirical paper Background: This study aimed to increase understanding of the lived experiences of families of people with intellectual disabilities when noticing and raising concerns in services. A qualitative design was employed. Methods: Seven participants were recruited through local and national voluntary agencies; five were mothers of people with intellectual disabilities, one was the aunt and one the sister. Participants took part in semi structured interviews centred on their experiences of noticing and raising concerns, these were recorded and transcribed. The data was analysed using Interpretative Phenomenological Analysis (IPA; Smith, 1996). Results: The data was grouped into three overarching themes: relationships between staff, family and service user, the nature and importance of concerns and the process of raising concerns. Conclusions: This research highlights important implications for services such as the need to simplify the process of raising concerns, attend to the relationship with families and ensure advocacy services are available for those without family.