Earlier this month, Dr David Raune, Clinical Psychologist at CNWL organised and delivered an international Symposium on 'Early Intervention in Psychosis' at the European Cognitive Behavioural Therapy conference (CBT) in Barcelona.

He was joined by his team - Monica Huerga (Assistant Psychologist), Cassie Hazell (Lecturer in Psychology), Zareena Ahmed (postgraduate student) and Roman Hamza (postgraduate student) who highlighted the implications for early intervention CBT of the prevalence and cognitive predictors of physical harm in the early stage of psychosis. The results will be further distributed through CNWL and Pan-London Early Intervention in Psychosis clinical networks and publications in international journals. 

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David Raune, with Monica Huerga, Cassie Hazell, Zareena Ahmed and Roman Hamza

This Lived Experience Symptom Survey (LESS) QI project started because there wasn’t enough information published to guide the Early Intervention in Psychosis team on:

  • what number of delusion/hallucination patients with each symptom could be expected to have problems with physical harm (harm from others/to others/accidents/neglect/harm to self) after the symptoms first appeared and where the harm was at least partly caused by the symptoms; 
  • what type of physical harm there was for each symptom; and 
  • amongst a large amount of symptom features, what it is about the symptom that independently predicts physical harm being present in the patient’s case history. 

This information is important for CBT so that practitioners can know:

  1. how many patients will need CBT for physical harm, 
  2. which particular patients, and 
  3. therapeutic target choice to lower physical harm 

The team looked at the case notes of 273 of their patients.  They found out that one third of patients had actual physical harm influenced by delusions/hallucinations with another (at least 20 percent) who had potential for actual physical harm. The rates and type of physical harm also varied according to the symptom. Neglect, for instance not eating, drinking or sleeping was the most common physical harm at about 20 percent, which surprisingly was often influenced by rare hallucinations.   
When looking back at the findings, certain micro delusion or auditory hallucination (hearing voices that aren’t real) cognitive features retrospectively predicted a significant increase in the likelihood of physical harm in the cases history. This included an increased risk of violence by three times towards other people with certain delusional features and a 20 times increased risk in self-harm for one aspect of auditory hallucination content. The team were also able to find the exact prevalence of all types of physical harms for each symptom and cognitive feature. 

Dr Raune said: “Before this QI study, no one knew the exact rate of the full range of physical harms influenced by delusions/hallucinations after first episode psychosis. We could only guess which of the many cognitive features would be the strongest independent predictors of physical harm. Once distributed to the relevant teams, these rates, types and predictors of physical harm in delusions and hallucinations, may help staff to lower physical harm rates in the Trust. 

Acknowledgements are due in particular to UCL (academic collaborator), NOCLOR (funders), the visionary CNWL Management team of Alastair Penman and Krishan Sahota, and also Honorary Dissemination Co-ordinator Jonathan Souray.