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Abstract Background Patients with psychosis frequently report difficulties getting or staying asleep (insomnia). Dissatisfaction with sleep is high. Insomnia should be treated in this group, but typically it is not even assessed. Importantly, recent evidence indicates that insomnia triggers and exacerbates delusions and hallucinations. The clinical implication is that if the insomnia is treated then the psychotic symptoms will significantly lessen. In a case series with 15 patients with persecutory delusions resistant to previous treatment this is exactly what we found: cognitive behavioural therapy for insomnia (CBT-I) led to large reductions in both the insomnia and delusions. The clear next step is a pilot randomized controlled test. The clinical aim is to test whether CBT-I can reduce both insomnia and psychotic symptoms. The trial will inform decisions for a definitive large-scale evaluation. Methods/design We will carry out a randomized controlled trial (the Better Sleep Trial, or the BEST study) with 60 patients with distressing delusions or hallucinations in the context of a schizophrenia spectrum diagnosis. Half of the participants will be randomized to receive CBT-I, in addition to their standard treatment, for up to eight sessions over 12 weeks. The other half will continue with treatment as usual. Blind assessments will take place at 0 weeks, 12 weeks (post-treatment) and 24 weeks (follow-up). The primary outcome hypotheses are that CBT-I added to treatment as usual will improve sleep, delusions and hallucinations compared with only treatment as usual. All main analyses will be carried out at the end of the last follow-up assessments and will be based on the intention-to-treat principle. The trial is funded by the NHS National Institute for Health Research (NIHR) Research for Patient Benefit Programme. Data collection will be complete by the end of 2014. Discussion This will be the first controlled test of CBT-I for patients with delusions and hallucinations. It will provide significant evidence for an easily administered intervention that is likely to prove very popular with patients experiencing the difficult-to-treat problems of delusions and hallucinations. Trial registration Current Controlled Trials ISRCTN 33695128

Background: Forensic patients with psychosis often engage in violent behaviour. There has been significant progress in understanding risk factors for violence, but identification of causal mechanisms of violence is limited. Aims: To develop a testable psychological framework explaining violence in psychosis – grounded in patient experience – to guide targeted treatment development. Method: We conducted in-depth interviews with 20 patients with psychosis using forensic psychiatric services across three regions in England. Interviews were analysed using reflexive thematic analysis. People with lived experience contributed to the analysis. Results: Analysis of interviews identified several psychological processes involved in the occurrence of violence. Violence was the dominant response mode to difficulties that was both habitual and underpinned by rules that engaged and justified an attack. Violence was triggered by a trio of sensitivities to other people: sensitivity to physical threat, from which violence protected; sensitivity to social disrespect, by which violence increased status; and sensitivity to unfairness, by which violence delivered revenge. Violence was an attempt to regulate difficult internal states: intense emotions were released through aggression and violence was an attempt to escape being overwhelmed by voices, visions or paranoia. There were different patterns of emphasis across these processes when explaining an individual participant's offending behaviour. Conclusions: The seven-factor model of violence derived from our analysis of patient accounts highlights multiple modifiable psychological processes that can plausibly lead to violence. The model can guide the research and development of targeted treatments to reduce violence by individuals with psychosis. [ABSTRACT FROM AUTHOR]

A lack of fractional understanding is a well-documented obstacle to student achievement in upper elementary and middle school math (National Center for Educational Statistics [NCES] 1999; Lamon 1999; National Research Council [NRC] 2001). Lamon (1999) notes that one major conceptual hurdle that students must overcome is the idea that fractions are numbers in and of themselves, not a composition of two, distinct, whole numbers. Further, it is likely that students fail to recognize fractions as discrete numbers because much of school mathematics focuses on understanding fractions as parts of wholes or parts of sets. To a great extent, children's earliest experiences with fractions are situated in part-whole contexts where both the part and the whole are whole numbers. Many of these experiences involve partitioning items like brownies or pizzas into equal regions. These are worthwhile endeavors for young children, but at some point, students must transition to thinking about fractions in ways that are more sophisticated. This article describes how Daniel Freeman pursued three concurrent goals while her fourth-grade class began to deeply explore fractions: (1) Build students' understanding of fractions as numbers with a definite magnitude (e.g., 3/4 falls between 3/5 and 1 on the number line); (2) Increase students' understanding of measuring with fractions; and (3) Develop fraction number sense by avoiding early introduction of traditional fraction algorithms. Several vignettes are then described to illustrate a pathway for developing the important concepts that relate to the measure subconstruct of fractions. The article concludes that understanding these concepts moves children along the continuum toward the increasingly abstract uses of fractions, which they will encounter in middle and high school.