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Types of Communication About Delusions Among People with Psychosis

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Types of Communication About Delusions Among People with Psychosis Types of Communication about Delusions among People with Psychosis (A multi-centre cross sectional interview and record study) A Quantitative and Qualitative Research A thesis submitted to the School of Medicine, Cardiff University, in fulfillment of the requirements for the degree of Medical Doctorate (Psychiatry) by Dr. Karam A Fadhli MBBS, MSc, DPM, DPsych Supervised by Professor Pamela J Taylor MBBS, MRCP, FRCPsych, FMedSci & Professor Marianne van den Bree BSc, MSc, PhD Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University Abstract Background: Delusions are common in psychosis, defined as fixed, false beliefs. Some studies, however, have found that they may be less fixed than previously thought, possibly changing in response to talking about them. Relatives of people with psychosis or clinical staff often ask how to respond to them when they talk about their delusions, but no available advice appears to be evidence based. Aims: To review evidence on everyday communication about delusions and find out how people with delusions talk about them with others, taking three perspectives (patients, their nominated relatives and clinicians) and to construct a model for communication in relation to the delusion according to each party independently. Methods: 36 patients were engaged in semi-structured interviews about their mental state generally (Comprehensive Psychopathological Rating Scale) and their delusion (Maudsley Assessment of Delusions Schedule). Each patient was asked to nominate a relative and a professional to whom s/he spoke about the delusion. Relatives and staff were interviewed by different researchers. Results: Most patients reported speaking to others about their delusion and nominated an informant. Most felt emotionally disturbed by their delusions, but, against prediction, this did not affect nomination; nor did their delusion content. There was good agreement between the three parties on occurrence of such communication. Some patients had self-harmed; only some relatives or staff concurred with them on attributing this to the delusion. A testable hypothesis was generated that the intrusiveness of delusions resulted in personal change for the patient and sense of changed relationship and detachment for the others. Conclusions: No previous study has investigated communication about delusions between three parties. It was striking that so few relatives were engaged. If patients, their families and clinicians could improve mutual understanding of delusions, the safety of the patient and others as well as treatment might be improved. i Declaration This work has not previously been accepted in substance for any degree and is not concurrently submitted in candidature for any degree. Signed ……… …… Date……………27th January 2016….............. Statement 1 This thesis is being submitted in partial fulfillment of the requirements for the degree of MD Signed ………… ……… Date……………27th January 2016….............. Statement 2 This thesis is the result of my own independent work/investigation, except where otherwise stated. Other sources are acknowledged by explicit references. Signed …………… ………. Date……………27th January 2016 Statement 3 I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter-library loan, and for the title and summary to be made available to outside organisations. Signed ………… …………. Date…………27th January 2016….............. Statement 4: previously approved Bar on Access I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter-library loans after expiry of a bar on access previously approved by the Graduate Development Committee. Signed ………… ………Date………27th January 2016….............. ii Dedication I dedicate this work to my beloved wife Dr Mariam Matar whose unconditional encouragement and support made it possible for me to complete this work. I wish to express my heartfelt love to my daughter Sara for coping with the undue paternal deprivation during these years. Their sacrifices, which were realised by our loss of precious time together, were for me the most painful and humbling of all. To my family, I love you all. iii Acknowledgments First and foremost, I would like to express my gratitude to my esteemed Professor Dr. Pamela J Taylor for her expert guidance, suggestion and support which she provided during my years as a Clinical Researcher and during the time spent in preparation of this thesis. I am also very grateful to my Co-Supervisor Professor Marianne van den Bree for giving helpful comments, useful suggestions and proofreading the final draft version of the thesis. I have great pleasure in expressing my deep sense of gratitude to all my research collages particularly Dr Maria D Bragado-Jimenez and Dr Shuja Reagu for the assistance in collecting data. I am grateful to Miss Gemma Plant for her statistical advice and assistance. I would like to thank all the NHS professionals who helped me and allowed me to recruit participants. This includes all ward managers and nursing staff especially Mr Paul Sussex, and all consultant psychiatrists particularly Professor Bill Fraser, Dr Sudad Jawad, Dr Seth Mensah and Dr Sirwan Abdul who provided sound advice and full cooperation when required. I am extremely grateful to all the individuals with psychosis, the clinical staff and relatives who gave their time during their participation in the research. I would also like to thank all the staff at the PGR Office at the University for their kindness and support. Last but not least, I am deeply thankful to my family for their love, care, and sacrifices. Without them, this thesis would never have been written especially my sister Dr Hala and my grandmother Sabeeha, whose role in my life was, and remains, immense. This last word of acknowledgment I have saved for my precious wife Dr Mariam Matar, who has been the eye in the storm, an unfailing source of love and motivation. iv Table of Contents Abstract ……………………………………………..……………………….……..……....i Declaration………………………………………………………………………….……..ii Dedication…………………………………….………………………………………...…iii Acknowledgments…………………………………………………….…………………iv Table of Contents………………………………………………………………………...v Publications, Abstracts and Presentations……………………………..…………..vi Abbreviations……………………………………………………………….……….…..vii List of figures……………………………………………………………………………viii List of tables………………………………………………….……………………..……ix Chapters……………………………………………………………………………...……x References……………………………………………………………..……………......xiv Appendices………………………………………………………………….……..........xiv v Publications, Abstracts and Presentations . Fadhli K and Taylor P: Congruence and dissonance of the perspectives of patients, relatives and hospital staff on assertive and harmful actions on delusional beliefs, 2015. For publication . Fadhli K and Taylor P: Perspectives on delusions and communication: A qualitative study, 2015. For publication . Fadhli K and Taylor P: Do people with delusions talk about them in ordinary conversation? A systematic review, 2013. In the press . Fadhli K and Taylor P: Do people with psychosis who are experiencing delusions talk about them with other people? The Annual Postgraduate Research Day. Cardiff, 19 Nov 2010. Fadhli K and Taylor P: Do people with psychosis who are experiencing delusions talk about them with other people? The Royal College of Psychiatrists’ Celtic Division Meeting. Cardiff, 8 Oct 2010. Bragdo-Jimenez MD, Fadhli K, Gilling H, Reagu S and Taylor PJ: Talking about delusions: Preliminary steps in the pathway from delusion to violence. The 10th International Association of Forensic Mental health Services (IAFMHS) Congress, Vancouver, (draft participation) 25-27 May 2010. Fadhli K and Taylor P: Types of communication about delusions among people with psychosis: A systematic review. Royal College of Psychiatrists’ Faculty of Forensic Psychiatry, Annual Meeting. Dublin, 10-12 Feb 2010. Fadhli K: Delusions, social interaction and violence; Preliminary results. Cardiff, 7 Dec 2009 . Fadhli K, Bragdo-Jimenez MD,Reagu S and Taylor PJ: Delusions, social interaction and violence. The 24th Annual Postgraduate Research Day. Cardiff, 20 Nov 2009 . Fadhli K, Bragdo-Jimenez MD,Reagu S and Taylor PJ: Delusions and violence. Sir William Castell Poster Competition. Cardiff, 28 Oct 2009. Fadhli K and Taylor P: Types of communication about delusions among people with psychosis: The 6th Annual European Perspectives on Forensic Mental Health Services and Training in Forensic Psychiatry (The Ghent Group). Cardiff, 31 Sep-1 Oct 2009. Fadhli K, Bragdo-Jimenez MD, Reagu S and Taylor P: Delusions, social interaction and violence. The 6th Annual European Perspectives on Forensic Mental Health Services and Training in Forensic Psychiatry (The Ghent Group). Cardiff, 31 Sep-1 Oct 2009. vi Abbreviations The following table describes the abbreviations and acronyms used throughout the thesis. The page on which each one is defined or first used is also given. Abbreviation Meaning ANOVA Analysis of variance……………................………..........................46 CBT Cognitive-behaviour therapy/treatment…………………................30 CPRS Comprehensive Psychopathological Rating Scale .…….............39 DSM Diagnostic and Statistical Manual ………………………….............9 EE Expressed Emotion………………………………………................14 FMSS Five Minute Speech Sample………………………........................44 GT Grounded theory……………………………………........................47 ICD International Statistical Classification of Diseases.....................149
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