Skip to main page content

• HOME
• Current
• Archive
• Feedback
• Subscribe
• Help

This Article Full Text Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by BIRCHWOOD, M. Articles by TROWER, P. Search for Related Content PubMed PubMed Citation Articles by BIRCHWOOD, M. Articles by TROWER, P.

Cognitive approach to depression and suicidal thinking in psychosis

2. Testing the validity of a social ranking model

Northern Birmingham Mental Health NHS Trust and University of Birmingham, Birmingham

ZAFFER IQBAL, PhD

Department of Psychology, Institute of Psychiatry, London

PAUL CHADWICK, PhD

Department of Clinical Psychology, University of Exeter

PETER TROWER, PhD

School of Psychology, University of Birmingham, UK

Correspondence: Max Birchwood, Department of Clinical Psychology, University of Birmingham, Harry Watton House, 97 Church Lane, Aston, Birmingham B6 5UG, UK

Declaration of interest As paper I.

See pp. 516-521, this issue.

Background In paper I we reported that depression in the acute stage remitted in line with the psychosis and that 36% of patients developed post-psychotic depression (PPD).

Aims We apply our cognitive framework to PPD and chart the appraisal of self and psychosis and their link with the later emergence of PPD.

Method Patients with ICD-10 schizophrenia (n=105) were followed up over 12 months following the acute episode, taking measures of depression, working self-concept, cognitive vulnerability, insight and appraisals of psychosis.

Results Before developing PPD, these patients felt greater loss, humiliation and entrapment by their illness than those who relapsed or did not become depressed, and were more likely to see their future selves in ‘lower status’ roles. Upon becoming depressed, participants developed greater insight, lower self-esteem and a worsening of their appraisals of psychosis.

Conclusions Depression in psychosis arises from the individual's appraisal of psychosis and its implications for his/her perceived social identity, position and ‘group fit’. Patients developing PPD feel forced to accept a subordinate role without opportunity for escape. Implications for treatment are discussed.

This article has been cited by other articles:

				K. E. Greenwood, A. Sweeney, S. Williams, P. Garety, E. Kuipers, J. Scott, and E. Peters CHoice of Outcome In Cbt for psychosEs (CHOICE): The Development of a New Service User-Led Outcome Measure of CBT for Psychosis Schizophr Bull, October 30, 2009; (2009) sbp117v1. [Abstract] [Full Text] [PDF]

				S. Tai and D. Turkington The Evolution of Cognitive Behavior Therapy for Schizophrenia: Current Practice and Recent Developments Schizophr Bull, September 1, 2009; 35(5): 865 - 873. [Abstract] [Full Text] [PDF]

				R. Upthegrove Depression in schizophrenia and early psychosis: implications for assessment and treatment Adv. Psychiatr. Treat., September 1, 2009; 15(5): 372 - 379. [Abstract] [Full Text] [PDF]

				T. M. Lincoln, E. Lullmann, and W. Rief Correlates and Long-Term Consequences of Poor Insight in Patients With Schizophrenia. A Systematic Review Schizophr Bull, November 1, 2007; 33(6): 1324 - 1342. [Abstract] [Full Text] [PDF]

				D. Freeman and P. Garety Helping patients with paranoid and suspicious thoughts: a cognitive-behavioural approach Adv. Psychiatr. Treat., November 1, 2006; 12(6): 404 - 415. [Abstract] [Full Text] [PDF]

				M. BIRCHWOOD and P. TROWER The future of cognitive-behavioural therapy for psychosis: not a quasi-neuroleptic The British Journal of Psychiatry, February 1, 2006; 188(2): 107 - 108. [Abstract] [Full Text] [PDF]

				L. TAIT, M. BIRCHWOOD, and P. TROWER Predicting engagement with services for psychosis: insight, symptoms and recovery style The British Journal of Psychiatry, February 1, 2003; 182(2): 123 - 128. [Abstract] [Full Text] [PDF]