Papers, case formulation and hyperbole

I am enjoying a three night break in Keswick where it is dry, windy and chilly. Invigorating for all that.

In between taking in the hills and the atmospherics of the skies I am working on completing the revision to the - scope of nursing - paper. There is still a paragraph to lose to reduce the length for the target journal.

The case formulation and h2cm paper is taking shape too - 5,000 words. I am sure the ongoing advice and thoughts of my co-author on the scope effort is making a difference. As a result the case formulation paper will be in final draft form soon. Then I'll seek some feedback from a CBT therapist before trying to locate a journalistic home. Here's a snippet from the draft:

... If the talking therapies are specialised forms of conversation then we should also be able see case formulation as being on a continuum, derived from narratives that can include extreme case formulation, and hyperbole (Norrick, 2004). The specific therapies discussed here [cognitive behavioural therapy and cognitive analytical therapy] are concerned with overstatement and exaggeration in thought not just speech. Things may be said in everyday speech that are rhetorical and not necessarily indicative of deeply held core, dysfunctional beliefs. ...

Norrick, N.R. (2004). Hyperbole, extreme case formulation. Journal of Pragmatics 36. 1727–1739.

I receive regular reminders about a part time PhD application that remains incomplete. So I will address this too (and check other opportunities) over the next few days.

Post on a new laptop and a socio-technical-existential addiction to follow ....

Update on new papers: 1. Case formulation & 2. Scope of Nursing

At present, with the support of a co-author, I am editing a paper on Hodges' model and the scope of nursing. The text some 6000 words was submitted to a journal last April and rejected, but as ever feedback is golden and the comments are being used to revise. The referees have set a challenge as amongst several points I tease out where the inherent theoretical perspectives lie in Hodges' model and how their identification within h2cm helps to define the scope of nursing.

Another paper in final draft - 4400 words - concerns the model and case formulation. At last I've arrived at this topic. Hodges' model is basically a simple drawing with care concepts superimposed. Cognitive behavioural therapy [CBT] and cognitive analytical therapy [CAT] make use of case formulation and CAT utilizes what are called sequential diagrammatic formulations.

The old website pages were written rather on the fly. They almost comprise a 'to-do-list' of thoughts and findings to revisit and check. Of two old pages one dealt with possible ideas and sources that might inform the structure of Hodges' model; the other page theory.

On the latter page I learned of SDRs - the sequential diagrammatic reformulations used in CAT and related this to the care domains of h2cm -

It feels good to be able to address this theme at long last.

In just over a week I'm looking f/w to a three day break in the Lakes. Weather permitting some  walking and a few runs, a bike ride, writing and Drupal - which I have put down of late...

Conceptual Reflections on Schizophrenia - Hodges' model

A decade ago I was studying the Psychosocial Interventions for Psychosis (COPE) pathway part-time at Manchester University. The student body was interprofessinal made up of nurses, psychologists, occupational therapists, nurses and if memory serves me right people from the voluntary (third) sector. What I learned then left me wondering where I had been all those years since qualifying (lost in IT....).

There are many universities now delivering this curriculum, presenting the very latest research. The lecturers are frequently the researchers themselves, working in ongoing multicenter trials studying  various aspects of the treatment and care management of psychosis.

This is why it is very alarming to hear of the lack of progress not just within in-patient care as per the findings of the Schizophrenia Commission, but the delivery of care for these individuals and their families across the health and social care system. Of course, as a former student and holder of a PG(Dip.) I am not at present practising these skills formally.

In the h2cm table that follows I have highlighted some of the main concepts across the care domains of Hodges' model:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

beliefs, perception, attention, anxiety, stress, vulnerability, pleasure, feedback, motivation, mood, therapies, therapeutic relationship, communication, assets, cognitive triad, perception, delusions, hallucinations, positive and negative symptoms, person-centered care, existing coping strategies, mental health assessment, literacies (3Rs, emotional, health), salience, attention, attribution, meaning, creativity

physical health, weight, fitness, side effects, medication, atypical antipsychotics, evidence, genetics, research, diagnosis, (cognitive) information processing, dual diagnosis, risk, models of care, recovery, hierarchy of clinical evidence, care processes - assessment, care planning, access to interventions, audio recording of sessions, protocols, DSM IV

clinical supervision, social attitudes - family, friends, community, stigma, myth, media, carers, familes, social relationships, network, self help groups, survivors, www.hearing-voices.org/ activities, daily routine, 'value' of a diagnosis - pros & cons (discuss), community centers, clinical supervision, positive risk management, employment, social history of mental health, social psychiatry, stories,education - schools & community, 'community care', housing

mental health history, institutional vs. community care, mental health law, autonomy, consent, capacity, best interests, equity mental health services, early intervention, access, POLICY, antipsychiatry, equity, governance, data gathering, statistics, reporting, outcomes, services, secure provision, early intervention, crisis intervention, DSM V, commissioning, funding for mental health, education and training, sickness - welfare benefits - 'incapacity' review 'return to work'

The relative position of concepts above does not indicate priority.

Schizophrenia Commission - Recommendations

100 years since Eugen Bleuler coined the term, schizophrenia remains a stigmatised and misunderstood illness. Today a report is published on one of the largest ever reviews of the condition in England. We’d like to tell you about it - and how sharing a picture with your friends can help spread the message…

An independent inquiry

In November last year, Rethink Mental Illness launched the Schizophrenia Commission. Chaired by Professor Sir Robin Murray, this expert panel heard evidence from people with schizophrenia and psychosis, families, professionals, leaders of NHS and social services, academics, policy makers and journalists. Recommendations arising from their inquiry, released today, call for a radical overhaul of the current system of care.

The message that comes through loud and clear is that people are being badly let down by the system in every area of their lives    Robin Murray – Commission Chair
 
The commission found that

• Only 10% of people with schizophrenia are being offered potentially life-transforming talking therapies such as CBT
• Mental health hospital wards are often such appalling places they make patients worse rather than better
• 1 in 3 people affected say they can't get quick access to services when they need it - and many don't know where to go for help
• Major concerns remain about the lack of efficacy and side effects of anti-psychotic drugs, which can lead to rapid weight gain, diabetes, and heart disease

We need more people to understand the realities of living with schizophrenia. Share our infographic today so the public know more about what the illness is - and isn’t.

The messageThe report suggests priority actions that directly affect services for people with schizophrenia. Key recommendations include:

• A complete overhaul of inpatient units including more widespread use of community based “recovery houses”
• A redirection of funding from secure units into early intervention services, which save the taxpayer money and prevent people reaching crisis point
• More research on the causes and treatment of schizophrenia and psychosis including the development of better drugs with fewer side effects
• The elimination of poor prescribing by psychiatrists and the right to a second opinion on medication for patients
• Extending access to psychological therapies and assertive physical health interventions
• A stronger focus on prevention, including clear warnings about the risks of cannabis
• Greater partnership with people with psychosis - valuing their experiences and making their preferences and goals central to their recovery
• Action to meet the needs of all marginalised groups, especially those from African and Caribbean communities
• A better deal for long-term carers who should be treated as partners, not problems

Read the commission’s report and their full 42 recommendations
See what commissioners themselves say about the recommendations and clinical practice by reading their blogs.

You can help
Do you want more people to understand what schizophrenia is? Help combat the myths surrounding the illness. Please share our infographic on Facebook and Twitter.

Thanks in advance for your support.
Rethink Mental Illness

My source: Pam Pinder c/o
http://www.jiscmail.ac.uk/lists/psychiatric-nursing.html
and various media twitter and BBC Radio 4.

Do check the infographic link in the above text.
The next post will provide a conceptual reflection on the above using Hodges' model.