Memory, coping strategies and resilience immediately following a loss have been shown to predict the path of a bereaved person’s grief according to new research. The study, published in the Journal of Consulting and Clinical Psychology last month, also suggested that clinical intervention in the first months following a loss may help individuals to better adapt to their grief.

Bereavement is an inevitable part of human experience and grieving is an important process in adapting to life without a lost loved one. However, for some individuals the process of mourning continues for longer or takes a more complex path than normal. By identifying which individuals are vulnerable to experiencing a severe reaction to grief it may be possible design early interventions to improve outcomes.

Dr Kirsten Smith who led the research adds ‘individuals are 3 times more likely to take their own life if they have lost a close loved one in the last year. We need more evidence based targeted interventions that facilitate adaptation after loss.’

The study gathered data from 275 bereaved adults in the first year to eighteen months following a loss. Participants were asked to complete measures of grief severity, cognitive factors and interpersonal differences.  Researchers then used the data to categorise responses to loss and identified four different classes of grief including three classes of high grief and a low grief class. They found that parents who had lost a child were particularly vulnerable to experiencing a severe reaction to grief and that it was possible to use cognitive factors to predict membership of the high grief classes. They showed that, by targeting modifiable cognitive factors early in the grieving process, it may be possible to change the way individuals adapt to grief.

Kirsten Smith explains ‘our results suggest that treatments that work to transform the distressing aspects of loss-related memories, social isolation, unhelpful coping strategies such as avoidance and rumination, and the negative meaning of loss that often arises after losing a loved one, have the potential to help reduce post-loss mental health problems.’

The findings have implications for clinical practice and highlight the importance of cognitive predictors in identifying and treating those likely to have a severe reaction to grief.

Results of a network meta-analysis published in The Lancet this month will aid clinicians in balancing the risks and benefits of the antipsychotic drugs they are prescribing to treat schizophrenia.

Schizophrenia is one of the most common psychiatric disorders in adults worldwide – one in 100 people globally are affected over a lifetime. Significant advances have been made in our understanding of the causes of the condition but antipsychotic drugs remain the firstline treatment for symptoms of psychosis such as hallucinations, delusions, and cognitive impairment.

The analysis reported in The Lancet is the largest and most comprehensive meta-analysis of antipsychotic medication for acute psychosis to date. It included 402 studies of 32 different antipsychotics with data for 53,463 participants and the method of analysis enabled comparisons between drugs that may not have been directly compared in clinical trials.

The study’s findings show that antipsychotics are clearly more effective than placebo in treating acute psychotic episodes and their use is associated with considerable reduction in all-cause mortality compared with no treatment. However, while these drugs provide effective treatment, they can also cause serious side effects and striking a balance between efficacy and tolerability is a key consideration for clinicians prescribing these medications.

Both newer and older antipsychotics were included in the analysis and the difference in their efficacy was found to be relatively small. In contrast the paper highlights a more marked difference in side effects between first and second generation drugs, with newer drugs being associated with less tolerable side-effects.

Many current prescribing guidelines recommend newer antipsychotics as the treatment of choice but information provided by this analysis will help to inform future prescribing decisions. Many older antipsychotics, which are still widely available, may provide an equally effective and more tolerable first line treatment for some patients. These drugs are also often less costly, an important consideration in lower income countries.

Professor Andrea Cipriani, co-author of the study added “We have summarised the best evidence, but now the real challenge is to personalise treatment to each individual. We are already working on this (not only in schizophrenia, but also in depression) and the big challenge is to use the best data in combination with real world outcomes, incorporating preferences and values of patients and clinicians.”

Join our focus group to help develop a new research project!

About the research

The anonymous use of health records for mental health research has the potential to lead to great breakthroughs to improve the lives of patients.

A key step in making this data available for research is the ‘de-identification’ of information in health records, to make the data anonymous and protect the privacy of patients.

We are a team of researchers at Oxford University developing a study to assess how well the de-identification of electronic health records is done currently.

This research will, ultimately, help ensure the protection of the privacy for patients in Oxford Health NHS Foundation Trust.

Join our focus group

We would like to hold a focus group with Oxford Health service users to share more details about our proposed research, and to hear your feedback.

The focus group will help make sure the project delivers maximum benefit to patients and addresses the concerns of service users in the delivery of the research.

The focus group will be held in Oxford, in November, and will last up to 2.5 hours. Participant expenses will be refunded, and a payment will be offered for time of £30.

If you are an Oxford Health NHS Foundation Trust patient, carer or service user, have an interest in mental health research, and would like to discuss how clinical data can contribute to mental health research, please get in touch!

Niall.Taylor@psych.ox.ac.uk