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El-Hage D, Gao CX, Bedi G, Guerin A, Francey S, Stavely H, Rickwood D, Telford N, McGorry P, Thompson A, Brown E. Correlates of substance use in a large naturalistic cohort of young people with early and emerging psychosis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1447-1456. [PMID: 36808500 PMCID: PMC10460356 DOI: 10.1007/s00127-023-02436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Substance use remains a barrier to recovery for young people accessing early intervention services for psychosis. While correlates of use have been explored in populations experiencing a first episode of psychosis (FEP), sample sizes have been small and less research assesses cohorts at ultrahigh risk of psychosis (UHR). METHODS This study uses data from a naturalistic cohort including UHR and FEP participants (N = 1252) to elucidate clinical correlates of use in the past 3 months of any illicit substance, amphetamine-type stimulants (ATS), cannabis, and tobacco. Moreover, network analysis based on use of these substances and additionally alcohol, cocaine, hallucinogens, sedatives, inhalants, and opioids was completed. RESULTS Young people with FEP used substances at significantly higher rates than those at UHR. High concurrence of use was seen between substances. In the FEP group, participants who had used any illicit substance, ATS, and/or tobacco had increased positive symptoms and decreased negative symptoms. Young people with FEP who used cannabis had increased positive symptoms. In the UHR group, participants who had used any illicit substance, ATS, and/or cannabis in the past 3 months showed decreased negative symptoms compared to those who had not. CONCLUSION A distinct clinical picture of more florid positive symptoms and alleviated negative symptoms seen in those who use substances in the FEP group appears muted in the UHR cohort. Treating young people at UHR in early intervention services represents the earliest opportunity to address substance use early to improve outcomes.
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Affiliation(s)
- D El-Hage
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - C X Gao
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - G Bedi
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - A Guerin
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - S Francey
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - H Stavely
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - D Rickwood
- Headspace National, Melbourne City, VIC, Australia
- University of Canberra, Bruce, ACT, Australia
| | - N Telford
- Headspace National, Melbourne City, VIC, Australia
| | - P McGorry
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - A Thompson
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - Ellie Brown
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.
- Orygen, 35 Poplar Road, Parkville, VIC, Australia.
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2
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Bayer JMM, Spark J, Krcmar M, Formica M, Gwyther K, Srivastava A, Selloni A, Cotter M, Hartmann J, Polari A, Bilgrami ZR, Sarac C, Lu A, Yung AR, McGowan A, McGorry P, Shah JL, Cecchi GA, Mizrahi R, Nelson B, Corcoran CM. The SPEAK study rationale and design: A linguistic corpus-based approach to understanding thought disorder. Schizophr Res 2023; 259:80-87. [PMID: 36732110 PMCID: PMC10387495 DOI: 10.1016/j.schres.2022.12.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 02/04/2023]
Abstract
AIM Psychotic symptoms are typically measured using clinical ratings, but more objective and sensitive metrics are needed. Hence, we will assess thought disorder using the Research Domain Criteria (RDoC) heuristic for language production, and its recommended paradigm of "linguistic corpus-based analyses of language output". Positive thought disorder (e.g., tangentiality and derailment) can be assessed using word-embedding approaches that assess semantic coherence, whereas negative thought disorder (e.g., concreteness, poverty of speech) can be assessed using part-of-speech (POS) tagging to assess syntactic complexity. We aim to establish convergent validity of automated linguistic metrics with clinical ratings, assess normative demographic variance, determine cognitive and functional correlates, and replicate their predictive power for psychosis transition among at-risk youths. METHODS This study will assess language production in 450 English-speaking individuals in Australia and Canada, who have recent onset psychosis, are at clinical high risk (CHR) for psychosis, or who are healthy volunteers, all well-characterized for cognition, function and symptoms. Speech will be elicited using open-ended interviews. Audio files will be transcribed and preprocessed for automated natural language processing (NLP) analyses of coherence and complexity. Data analyses include canonical correlation, multivariate linear regression with regularization, and machine-learning classification of group status and psychosis outcome. CONCLUSIONS This prospective study aims to characterize language disturbance across stages of psychosis using computational approaches, including psychometric properties, normative variance and clinical correlates, important for biomarker development. SPEAK will create a large archive of language data available to other investigators, a rich resource for the field.
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Affiliation(s)
- J M M Bayer
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - J Spark
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - M Krcmar
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - M Formica
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - K Gwyther
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - A Srivastava
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Selloni
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Cotter
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Hartmann
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - A Polari
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - C Sarac
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Lu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alison R Yung
- Orygen, Parkville, Victoria, Australia; Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Australia; School of Health Sciences, University of Manchester, United Kingdom
| | - A McGowan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - P McGorry
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - J L Shah
- McGill Department of Psychiatry & Douglas Research Hospital, Montreal, Canada
| | - G A Cecchi
- IBM TJ Watson Research Center, Yorktown Heights, NY, USA
| | - R Mizrahi
- McGill Department of Psychiatry & Douglas Research Hospital, Montreal, Canada
| | - B Nelson
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - C M Corcoran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Administration, Bronx, NY, USA
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3
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Valmaggia L, Stahl D, Yung A, Nelson B, McGorry P, McGuire P. The structure of the ultra high risk mental state for psychosis. A latent class cluster analysis study. Eur Psychiatry 2020. [DOI: 10.1016/s0924-9338(11)73790-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
IntroductionIndividuals at Ultra High Risk (UHR) for psychosis typically present with attenuated psychotic symptoms. However it is difficult to predict which individuals will later develop frank psychosis when their mental state is rated in terms of individual symptoms.The objective of the study was to examine the phenomenological structure of the UHR mental state and identify symptom profiles that predict later transition to psychosis.MethodPsychopathological data from a large sample of UHR subjects were analysed using latent class cluster analysis.A total of 318 individuals with a UHR for psychosis. Data were collected from two specialised community mental health services for people at UHR for psychosis: OASIS in London and PACE, in Melbourne.ResultsLatent class cluster analysis produced 4 classes: Class 1 - Mild was characterized by lower scores on all the CAARMS items. Subjects in Class 2 - Moderate scored moderately on all CAARMS items and was more likely to be in employment. Those in Class 3 - Moderate-Severe scored moderately-severe on negative symptoms, social isolation and impaired role functioning. Class 4 - Severe was the smallest group and was associated with the most impairment: subjects in this class scored highest on all items of the CAARMS, had the lowest GAF score and were more likely to be unemployed. This group was also characterized by the highest transition rate (41%).ConclusionsDifferent constellations of symptomatology are associates with varying levels of risk to of transition to psychosis.
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Geros H, Sizer H, Mifsud N, Reynolds S, Kim DJ, Eaton S, McGorry P, Nelson B, O'Donoghue B. Migrant status and identification as ultra-high risk for psychosis and transitioning to a psychotic disorder. Acta Psychiatr Scand 2020; 141:52-59. [PMID: 31520527 DOI: 10.1111/acps.13099] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Certain migrant groups are more likely to develop a psychotic disorder compared to the native-born populations, and a younger age at migration is associated with greater risk. However, it is not known at which stage migration has an effect on the development of psychotic disorders. We examined whether migrants were more likely to be identified as ultra-high risk for psychosis (UHR) compared to native-born young people and whether migrant status was associated with the risk of transition to a full-threshold psychotic disorder. METHODS The cohort included all young people aged 15-24 who were identified as UHR at a specialist clinic over a five-year period (2012-16). Australian census data were used to obtain the at-risk population. Poisson regression was used to calculate rate ratios and Cox regression analysis determined hazard ratios. RESULTS 467 young people were identified as UHR, of which 13.5% (n = 63) were born overseas. First-generation migrants were 2.6-fold less likely to be identified as UHR compared to Australian-born young people (IRR = 0.39, 95% CI [0.30, 0.51], P < 0.001). There was no difference between migrant and native-born young people in their risk of transitioning to a psychotic disorder (HR = 0.90, 95% CI [0.39, 2.08], P = 0.81). CONCLUSIONS UHR first-generation migrants may be under-accessing mental health services.
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Affiliation(s)
- H Geros
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - H Sizer
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - N Mifsud
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - S Reynolds
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - D J Kim
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - S Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - P McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - B Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - B O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia.,Orygen Youth Health, Parkville, Vic., Australia
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5
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Perera S, Hetrick S, Cotton S, Parker A, Rickwood D, Davenport T, Hickie IB, Herrman H, McGorry P. Awareness of headspace youth mental health service centres across Australian communities between 2008 and 2015. J Ment Health 2019; 29:410-417. [DOI: 10.1080/09638237.2019.1630718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S. Perera
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S. Hetrick
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S. Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - A. Parker
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - D. Rickwood
- Faculty of Health, University of Canberra, Canberra, Australia
- Headspace, National Youth Mental Health Foundation, Melbourne, Australia
| | - T. Davenport
- Brain and Mind Centre, University of Sydney, Australia
| | - I. B. Hickie
- Brain and Mind Centre, University of Sydney, Australia
| | - H. Herrman
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - P. McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Abstract
SummaryInternational declarations that articulate core values, goals and standards have played an important role in enhancing the quality of care in a number of areas of medicine. This document attempts this task for early intervention in psychotic disorders. It was originally inspired by the St Vincents declaration on the care of diabetes and carefully developed by David Shiers and Jo Smith with support from the Initiative to Reduce the Impact of Schizophrenia, National Institute for Mental Health in England and Rethink, resulting in the UK-focused Newcastle Declaration. The World Health Organization and the International Early Psychosis Association then collaborated to produce an international version of the declaration, which articulates the universal principles of early intervention and tries to blend these with local capacities and cultural diversity.
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Affiliation(s)
- J Bertolote
- International Early Psychosis Association, and ORYGEN Research Centre, Locked Bag 10/35, Poplar Road, Parkville, Victoria 3052, Australia.
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7
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Wannan CMJ, Bartholomeusz CF, Cropley VL, Van Rheenen TE, Panayiotou A, Brewer WJ, Proffitt TM, Henry L, Harris MG, Velakoulis D, McGorry P, Pantelis C, Wood SJ. Deterioration of visuospatial associative memory following a first psychotic episode: a long-term follow-up study. Psychol Med 2018; 48:132-141. [PMID: 28625185 DOI: 10.1017/s003329171700157x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive deficits are a core feature of schizophrenia, and impairments in most domains are thought to be stable over the course of the illness. However, cross-sectional evidence indicates that some areas of cognition, such as visuospatial associative memory, may be preserved in the early stages of psychosis, but become impaired in later established illness stages. This longitudinal study investigated change in visuospatial and verbal associative memory following psychosis onset. METHODS In total 95 first-episode psychosis (FEP) patients and 63 healthy controls (HC) were assessed on neuropsychological tests at baseline, with 38 FEP and 22 HCs returning for follow-up assessment at 5-11 years. Visuospatial associative memory was assessed using the Cambridge Neuropsychological Test Automated Battery Visuospatial Paired-Associate Learning task, and verbal associative memory was assessed using Verbal Paired Associates subtest of the Wechsler Memory Scale - Revised. RESULTS Visuospatial and verbal associative memory at baseline did not differ significantly between FEP patients and HCs. However, over follow-up, visuospatial associative memory deteriorated significantly for the FEP group, relative to healthy individuals. Conversely, verbal associative memory improved to a similar degree observed in HCs. In the FEP cohort, visuospatial (but not verbal) associative memory ability at baseline was associated with functional outcome at follow-up. CONCLUSIONS Areas of cognition that develop prior to psychosis onset, such as visuospatial and verbal associative memory, may be preserved early in the illness. Later deterioration in visuospatial memory ability may relate to progressive structural and functional brain abnormalities that occurs following psychosis onset.
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Affiliation(s)
- C M J Wannan
- Melbourne Neuropsychiatry Centre,Department of Psychiatry,The University of Melbourne & Melbourne Health,Carlton South, VIC,Australia
| | - C F Bartholomeusz
- Melbourne Neuropsychiatry Centre,Department of Psychiatry,The University of Melbourne & Melbourne Health,Carlton South, VIC,Australia
| | - V L Cropley
- Melbourne Neuropsychiatry Centre,Department of Psychiatry,The University of Melbourne & Melbourne Health,Carlton South, VIC,Australia
| | - T E Van Rheenen
- Melbourne Neuropsychiatry Centre,Department of Psychiatry,The University of Melbourne & Melbourne Health,Carlton South, VIC,Australia
| | - A Panayiotou
- Melbourne Neuropsychiatry Centre,Department of Psychiatry,The University of Melbourne & Melbourne Health,Carlton South, VIC,Australia
| | - W J Brewer
- Orygen, The National Centre of Excellence in Youth Mental Health,Parkville, Victoria,Australia
| | - T M Proffitt
- Orygen, The National Centre of Excellence in Youth Mental Health,Parkville, Victoria,Australia
| | - L Henry
- Orygen, The National Centre of Excellence in Youth Mental Health,Parkville, Victoria,Australia
| | - M G Harris
- School of Public Health,The University of Queensland,Herston, Queensland,Australia
| | - D Velakoulis
- Melbourne Neuropsychiatry Centre,Department of Psychiatry,The University of Melbourne & Melbourne Health,Carlton South, VIC,Australia
| | - P McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health,Parkville, Victoria,Australia
| | - C Pantelis
- Melbourne Neuropsychiatry Centre,Department of Psychiatry,The University of Melbourne & Melbourne Health,Carlton South, VIC,Australia
| | - S J Wood
- Melbourne Neuropsychiatry Centre,Department of Psychiatry,The University of Melbourne & Melbourne Health,Carlton South, VIC,Australia
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8
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Lei P, Ayton S, Appukuttan AT, Moon S, Duce JA, Volitakis I, Cherny R, Wood SJ, Greenough M, Berger G, Pantelis C, McGorry P, Yung A, Finkelstein DI, Bush AI. Lithium suppression of tau induces brain iron accumulation and neurodegeneration. Mol Psychiatry 2017; 22:396-406. [PMID: 27400857 DOI: 10.1038/mp.2016.96] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/25/2016] [Accepted: 05/09/2016] [Indexed: 02/05/2023]
Abstract
Lithium is a first-line therapy for bipolar affective disorder. However, various adverse effects, including a Parkinson-like hand tremor, often limit its use. The understanding of the neurobiological basis of these side effects is still very limited. Nigral iron elevation is also a feature of Parkinsonian degeneration that may be related to soluble tau reduction. We found that magnetic resonance imaging T2 relaxation time changes in subjects commenced on lithium therapy were consistent with iron elevation. In mice, lithium treatment lowers brain tau levels and increases nigral and cortical iron elevation that is closely associated with neurodegeneration, cognitive loss and parkinsonian features. In neuronal cultures lithium attenuates iron efflux by lowering tau protein that traffics amyloid precursor protein to facilitate iron efflux. Thus, tau- and amyloid protein precursor-knockout mice were protected against lithium-induced iron elevation and neurotoxicity. These findings challenge the appropriateness of lithium as a potential treatment for disorders where brain iron is elevated (for example, Alzheimer's disease), and may explain lithium-associated motor symptoms in susceptible patients.
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Affiliation(s)
- P Lei
- Department of Neurology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Sichuan, China.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - S Ayton
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - A T Appukuttan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - S Moon
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - J A Duce
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.,Faculty of Biological Sciences, School of Biomedical Sciences, University of Leeds, West Yorkshire, UK
| | - I Volitakis
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - R Cherny
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - S J Wood
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Parkville, VIC, Australia.,School of Psychology, University of Birmingham, Birmingham, UK
| | - M Greenough
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - G Berger
- ORYGEN Research Centre, University of Melbourne and Melbourne Health, Parkville, VIC, Australia.,Department of Child and Adolescent Psychiatry, University of Zürich, Zurich, Switzerland
| | - C Pantelis
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Parkville, VIC, Australia.,Centre for Neural Engineering, Department of Electrical and Electronic Engineering, University of Melbourne, Parkville, VIC, Australia
| | - P McGorry
- ORYGEN Research Centre, University of Melbourne and Melbourne Health, Parkville, VIC, Australia
| | - A Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester and Greater Manchester West NHS Mental Health Trust, Manchester, UK
| | - D I Finkelstein
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - A I Bush
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
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9
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Carney R, Yung AR, Amminger GP, Bradshaw T, Glozier N, Hermens DF, Hickie IB, Killackey E, McGorry P, Pantelis C, Wood SJ, Purcell R. Substance use in youth at risk for psychosis. Schizophr Res 2017; 181:23-29. [PMID: 27590573 DOI: 10.1016/j.schres.2016.08.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND People with schizophrenia have high rates of substance use which contributes to co-morbidity and premature mortality. Some evidence suggests people at-risk for psychosis have high rates of substance use. We aimed to assess substance use in a help-seeking cohort, comparing those at-risk and not at-risk for psychosis, and to establish any relationship with clinical symptoms. METHOD Participants were help-seeking youth presenting to mental health services in Sydney and Melbourne. 279 (34.8%) were at-risk for psychosis, and 452 (56.4%) did not meet criteria for a psychotic disorder or risk for psychosis. The excluded individuals were made up of 59 (7.4%) young people who met criteria for a psychotic disorder and 11 (1.4%) who were unable to be evaluated. We assessed the association of substance use involvement with risk status and clinical symptoms using multivariate regression. RESULTS Individuals at-risk for psychosis had significantly higher tobacco, alcohol and cannabis use than those not at-risk. Multivariate analysis revealed at-risk status was significantly associated with higher alcohol involvement scores when adjusting for age and gender, but no association was found for cannabis or tobacco. At-risk status was no longer associated with alcohol involvement when cannabis or tobacco use was added into the analysis. CONCLUSION Tobacco smoking, alcohol consumption and cannabis use are common in help-seeking youth, particularly those at-risk for psychosis. It is important to consider co-occurring use of different substances in adolescents. Early substance misuse in this phase of illness could be targeted to improve physical and mental health in young people.
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Affiliation(s)
- R Carney
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
| | - A R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - G P Amminger
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Australia
| | - T Bradshaw
- School of Nursing, Midwifery and Social Work, University of Manchester, UK
| | - N Glozier
- Brain & Mind Centre, University of Sydney, New South Wales, Australia
| | - D F Hermens
- Brain & Mind Centre, University of Sydney, New South Wales, Australia
| | - I B Hickie
- Brain & Mind Centre, University of Sydney, New South Wales, Australia
| | - E Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
| | - P McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
| | - C Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Victoria, Australia
| | - S J Wood
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Victoria, Australia; School of Psychology, University of Birmingham, UK
| | - R Purcell
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
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10
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Yung AR, Cotter J, Wood SJ, McGorry P, Thompson AD, Nelson B, Lin A. Childhood maltreatment and transition to psychotic disorder independently predict long-term functioning in young people at ultra-high risk for psychosis. Psychol Med 2015; 45:3453-3465. [PMID: 26166153 DOI: 10.1017/s003329171500135x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals identified as at ultra-high risk (UHR) for psychosis are at risk of poor functional outcome regardless of development of psychotic disorder. Studies examining longitudinal predictors of poor functioning have tended to be small and report only medium-term follow-up data. We sought to examine clinical predictors of functional outcome in a long-term longitudinal study. METHOD Participants were 268 (152 females, 116 males) individuals identified as UHR 2-14 years previously. A range of clinical and sociodemographic variables were assessed at baseline. Functioning at follow-up was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS). RESULTS Baseline negative symptoms, impaired emotional functioning, disorders of thought content, low functioning, past substance use disorder and history of childhood maltreatment predicted poor functioning at follow-up in univariate analyses. Only childhood maltreatment remained significant in the multivariate analysis (p < 0.001). Transition to psychosis was also significantly associated with poor functioning at long-term follow-up [mean SOFAS score 59.12 (s.d. = 18.54) in the transitioned group compared to 70.89 (s.d. = 14.00) in the non-transitioned group, p < 0.001]. Childhood maltreatment was a significant predictor of poor functioning in both the transitioned and non-transitioned groups. CONCLUSIONS Childhood maltreatment and transition to psychotic disorder independently predicted poor long-term functioning. This suggests that it is important to assess history of childhood maltreatment in clinical management of UHR individuals. The finding that transition to psychosis predicts poor long-term functioning strengthens the evidence that the UHR criteria detect a subgroup at risk for schizophrenia.
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Affiliation(s)
- A R Yung
- Institute of Brain,Behaviour and Mental Health,University of Manchester,Manchester,UK
| | - J Cotter
- Institute of Brain,Behaviour and Mental Health,University of Manchester,Manchester,UK
| | - S J Wood
- School of Psychology,University of Birmingham,Birmingham,UK
| | - P McGorry
- Orygen,The National Centre of Excellence in Youth Mental Health,University of Melbourne,Melbourne,Australia
| | - A D Thompson
- Warwick Medical School,University of Warwick,Coventry,UK
| | - B Nelson
- Orygen,The National Centre of Excellence in Youth Mental Health,University of Melbourne,Melbourne,Australia
| | - A Lin
- Telethon Kids Institute,The University of Western Australia,Subiaco,Australia
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Morgan VA, McGrath JJ, Jablensky A, Badcock JC, Waterreus A, Bush R, Carr V, Castle D, Cohen M, Galletly C, Harvey C, Hocking B, McGorry P, Neil AL, Saw S, Shah S, Stain HJ, Mackinnon A. Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychol Med 2014; 44:2163-76. [PMID: 24365456 PMCID: PMC4045165 DOI: 10.1017/s0033291713002973] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/05/2013] [Accepted: 11/09/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are insufficient data from nationwide surveys on the prevalence of specific psychotic disorders and associated co-morbidities. METHOD The 2010 Australian national psychosis survey used a two-phase design to draw a representative sample of adults aged 18-64 years with psychotic disorders in contact with public treatment services from an estimated resident population of 1 464 923 adults. This paper is based on data from 1642 participants with an International Classification of Diseases (ICD)-10 psychotic disorder. Its aim is to present estimates of treated prevalence and lifetime morbid risk of psychosis, and to describe the cognitive, physical health and substance use profiles of participants. RESULTS The 1-month treated prevalence of psychotic disorders was 3.10 cases per 1000 population aged 18-64 years, not accounting for people solely accessing primary care services; lifetime morbid risk was 3.45 per 1000. Mean premorbid intelligence quotient was approximately 0.5 s.d.s below the population mean; current cognitive ability (measured with a digit symbol coding task) was 1.6 s.d.s below the population mean. For both cognitive tests, higher scores were significantly associated with better independent functioning. The prevalence of the metabolic syndrome was high, affecting 60.8% of participants, and pervasive across diagnostic groups. Of the participants, two-thirds (65.9%) were current smokers, 47.4% were obese and 32.4% were sedentary. Of the participants, half (49.8%) had a lifetime history of alcohol abuse/dependence and 50.8% lifetime cannabis abuse/dependence. CONCLUSIONS Our findings highlight the need for comprehensive, integrative models of recovery to maximize the potential for good health and quality of life for people with psychotic illness.
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Affiliation(s)
- V. A. Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - J. J. McGrath
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - A. Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - J. C. Badcock
- School of Psychology, The University of Western Australia, Crawley, Western Australia
- Clinical Research Centre, North Metropolitan Health Service-Mental Health, Mount Claremont, WA, Australia
| | - A. Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - R. Bush
- School of Population Health, The University of Queensland, Ipswich, QLD, Australia
| | - V. Carr
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
- Schizophrenia Research Institute, Sydney, NSW, Australia
| | - D. Castle
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- St Vincent's Hospital, Melbourne, VIC, Australia
| | - M. Cohen
- Hunter New England Mental Health, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - C. Galletly
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
- Northern Sector, Adelaide Metro Mental Health Directorate, Adelaide, SA, Australia
| | - C. Harvey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- Psychosocial Research Centre, North West Area Mental Health Services, Coburg, VIC, Australia
| | - B. Hocking
- SANE Australia, Melbourne, VIC, Australia
| | - P. McGorry
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- Orygen Youth Health Research Centre, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - A. L. Neil
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - S. Saw
- Australian Government Department of Health and Ageing, Canberra, ACT, Australia
| | - S. Shah
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - H. J. Stain
- Centre for Rural and Remote Mental Health, University of Newcastle, Newcastle, NSW, Australia
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - A. Mackinnon
- Orygen Youth Health Research Centre, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Abstract
BACKGROUND The past two decades have seen exponential clinical and research interest in help-seeking individuals presenting with potentially prodromal symptoms for psychosis. However, the epidemiological validity of this paradigm has been neglected, limiting future advancements in the field. METHOD We undertook a critical review of core epidemiological issues underlying the clinical high-risk (HR) state for psychosis and which model of prodromal intervention is best suited for mental health. RESULTS The HR state for psychosis model needs refining, to bring together population-based findings of high levels of psychotic experiences (PEs) and clinical expression of risk. Traditionally, outcome has been attributed to 'HR criteria' alone rather than taking into account sampling strategies. Furthermore, the exclusive focus on variably defined 'transition' obscures true variation in the slow and non-linear progression across stages of psychopathology. Finally, the outcome from HR states is variable, indicating that the underlying paradigm of 'schizophrenia light progressing to schizophrenia' is inadequate. CONCLUSIONS In the general population, mixed and non-specific expression of psychosis, depression, anxiety and subthreshold mania is common and mostly transitory. When combined with distress, it may be considered as the first, diagnostically neutral stage of potentially more severe psychopathology, which only later may acquire a degree of diagnostic specificity and possible relative resistance to treatment. Therefore, rather than creating silos of per-disorder ultra-HR syndromes, an early intervention focus on the broad syndrome of early mental distress, requiring phase-specific interventions, may be more profitable.
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Affiliation(s)
- P Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London and OASIS Team, South London and the Maudsley NHS Foundation Trust, London, UK
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McGorry P. Early intervention for psychosis in Asia. East Asian Arch Psychiatry 2012; 22:88-89. [PMID: 23019279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Schimmelmann B, Kupferschmid S, Conus P, Cotton S, McGorry P, Lambert M. Cannabis use disorders and age at onset of psychosis in 606 patients with first episode psychosis. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73204-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BackgroundAge at onset of psychosis (AAO) may be younger in patients with cannabis use disorders (CUD) compared to those without CUD (NCUD). Most previous studies did not control for potential confounders, did not report effect sizes and included mostly adult patients from non-representative samples.MethodsControlling for relevant confounders, differences in AAO between patients with and without lifetime CUD were analysed in a large epidemiologically based cohort of 606 first-episode psychosis (FEP) patients (age 14 to 29 years) admitted within three years to the Melbourne Early Psychosis Prevention and Intervention Centre. Data were collected from medical files using a standardized scale.ResultsOverall, AAO was not significantly different in CUD (n = 449; 74.1%) compared to NCUD, neither univariate nor when controlling for gender and premorbid functioning. However, AAO was younger in those with early CUD (starting before age 14) compared to NCUD (F(1) = 11.3; p = 0.001; partial η2 = 0.042). When considering the subgroups of early versus late onset psychosis, AAO was even later in early onset psychosis patients with CUD compared to those with NCUD (F(1) = 8.4; p = 0.004; partial η2 = 0.072). These findings were consistent for patients with non-affective psychoses, in those with CUD without other substance use disorders and in those with CUD explicitly starting in the pre-psychotic phase. Notably, 89.1% started cannabis before the onset of psychotic symptoms.ConclusionsCUD starting before age 14 was associated with an earlier AAO at a small effect size, but only in adult onset FEP patients.
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Abstract
Omega-3 fatty acid supplementation studies are inconclusive. We performed two intervention studies. The first study (Berger et al 2007) was a double blind, placebo-controlled randomized trial comparing 2 g Ethyl-eicosapentaenoic acid (EPA) versus placebo in addition to antipsychotic medication in 79 first episode psychosis patients. Mixed model analysis suggests that EPA augmented first episode psychosis patients respond quicker compared to placebo for time to response (p = 0.06). Post hoc analysis for cumulative response rates confirm a higher response rate at week 6 (42.9% versus 17.6% for all subjects, p = .036; 54,2% versus 17.2% for non-affective psychosis, p = .008) that was not significant anymore at week 12 (potential ceiling effect). In the second study (Amminger et al, 2010) using 840 mg EPA and 700 mg docosahexaenoic acid per day as sole treatment in 81 prodromal adolescents only 1 of 38 UHR adolescents (2.6%) in the EPA/DHA group compared to 8 of 38 (21.1%) prodromal adolescents in the placebo group met exit criteria for psychotic disorder (Chi-square Fisher's exact test =6.2, df = 1, p = 0.028; OR = 9.9). The change from baseline on the PANSS total symptom score (p = 0.006), and the GAF score (p = 0.025) were also significant between the treatment groups showing a clinically relevant advantage of EPA/DHA over placebo. Stage of illness may be more relevant for the use of the benign treatments such as omega-3 fatty acids in emerging psychosis and explain previous inconclusive findings. Research designs for future omega-3 fatty acid intervention trials and potential pitfalls will be discussed.
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Schimmelmann B, Cotton S, Conus P, Kupferschmid S, McGorry P, Lambert M. P01-345-Prevalence and impact of cannabis use disorders in adolescents with early onset first episode psychosis. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
ObjectivePrevious studies on the impact of cannabis use disorders (CU) on outcome in psychosis were mostly based on non-representative samples, have often not controlled for confounders and rarely focused on adolescents. Thus, the aims of the present study were to assess;(i) prevalence of CU;(ii) pre-treatment and baseline differences between CU and those without CU (NCU); and(iii) the impact of baseline and course of CU on 18-month outcomes in a representative cohort of adolescents with early onset first episode psychosis (EOP).MethodThe sample comprised 99 adolescents (age 14 to 18) with EOP (onset age 14 to 17), admitted to the Early Psychosis Prevention and Intervention Centre in Australia. Data were collected from medical files using a standardized questionnaire.ResultsPrevalence of lifetime CU was 65.7%, baseline CU 53.5%, and persistent CU 26.3%. Baseline CU compared to NCU was associated with higher illness-severity, lower functioning, less insight, lower premorbid functioning and longer duration of untreated psychosis. Compared to both NCU and those who decreased or stopped CU during treatment, only persistent CU was linked to worse outcomes and more service disengagement. Effect sizes were medium controlling for relevant confounders. Medication non-adherence did not explain the link between persistent CU and worse outcome.ConclusionsThe prevalence of CU in adolescents with EOP is high, while only persistent CU use was associated with worse outcome with medium effect sizes. Specific needs of adolescent patients with respect to cannabis interventions within integrated care settings should be addressed in future studies.
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Berk M, Kapczinski F, Andreazza AC, Dean OM, Giorlando F, Maes M, Yücel M, Gama CS, Dodd S, Dean B, Magalhães PVS, Amminger P, McGorry P, Malhi GS. Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neurosci Biobehav Rev 2010; 35:804-17. [PMID: 20934453 DOI: 10.1016/j.neubiorev.2010.10.001] [Citation(s) in RCA: 834] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/29/2010] [Accepted: 10/01/2010] [Indexed: 12/11/2022]
Abstract
There is now strong evidence of progressive neuropathological processes in bipolar disorder (BD). On this basis, the current understanding of the neurobiology of BD has shifted from an initial focus on monoamines, subsequently including evidence of changes in intracellular second messenger systems and more recently to, incorporating changes in inflammatory cytokines, corticosteroids, neurotrophins, mitochondrial energy generation, oxidative stress and neurogenesis into a more comprehensive model capable of explaining some of the clinical features of BD. These features include progressive shortening of the inter-episode interval with each recurrence, occurring in consort with reduced probability of treatment response as the illness progresses. To this end, emerging data shows that these biomarkers may differ between early and late stages of BD in parallel with stage-related structural and neurocognitive alterations. This understanding facilitates identification of rational therapeutic targets, and the development of novel treatment classes. Additionally, these pathways provide a cogent explanation for the efficacy of seemingly diverse therapies used in BD, that appear to share common effects on oxidative, inflammatory and neurotrophic pathways.
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Affiliation(s)
- M Berk
- Department of Clinical and Biomedical Sciences, University of Melbourne, Victoria 3010, Australia.
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McGorry P, Johanessen JO, Lewis S, Birchwood M, Malla A, Nordentoft M, Addington J, Yung A. Early intervention in psychosis: keeping faith with evidence-based health care. Psychol Med 2010; 40:399-404. [PMID: 19775497 DOI: 10.1017/s0033291709991346] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- P McGorry
- Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne, Australia.
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Sim K, Swapna V, Mythily S, Mahendran R, Kua EH, McGorry P, Chong SA. Psychiatric comorbidity in first episode psychosis: the Early Psychosis Intervention Program (EPIP) experience. Acta Psychiatr Scand 2004; 109:23-9. [PMID: 14674955 DOI: 10.1111/j.0001-690x.2004.00196.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the prevalence rates of psychiatric comorbidity in a hospitalized Asian patient group with first episode psychosis and examine its clinical correlates. METHOD Seventy-nine consecutively admitted patients with first episode psychosis were assessed using the Structured Clinical Interview for DSM-IV-axis I disorders (patient edition), Positive and Negative Symptom Scale (PANSS), Scale to assess Unawareness of Mental Disorders (SUMD) and Global Assessment of Functioning (GAF) scales. RESULTS Psychiatric comorbidity was present in 36.7% (n = 29) of the patients. Patients with psychiatric comorbidity were younger (P < 0.05), had an earlier onset of illness (P < 0.05) and better insight on social consequences and flat affect items (P < 0.05) on the SUMD. No significant differences were found between the two groups with and without psychiatric comorbidity in gender, ethnicity, marital status, length of education, employment status, living arrangements, duration of hospitalization and untreated psychosis as well as total PANSS and GAF scores. CONCLUSION Psychiatric comorbidity is common thus calling for a greater awareness in clinicians of these conditions, which are often under-recognized, under-diagnosed and untreated.
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Affiliation(s)
- K Sim
- Department of Early Psychosis Intervention, Woodbridge Hospital and Institute of Mental Health, Singapore.
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20
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Chong SA, Verma SK, McGorry P. Psychosis--a need for preemptive intervention? Singapore Med J 2003; 44:426-7. [PMID: 14700424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
With the advent of newer antipsychotic medications with fewer side-effects both clinicians and patients may be more willing to take early preemptive measures in treating psychotic disorders. We present a case report of use of pharmacotherapeutic intervention in an individual with either possible prodromal symptoms of schizophrenia or a subthreshold disorder. This case presented to us with the ethical dilemma inherent in treating a patient with subthreshold disorder. The options were either watchful waiting or preemptive treatment. In this case the patient was very distressed by his symptoms and had requested treatment with medications. Indeed, treatment has resulted in the remission of his symptoms and restored him to his previous level of functioning.
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Affiliation(s)
- S A Chong
- Department of Early Psychosis Intervention, Institute of Mental Health and Woodbridge Hospital 10, Buangkok View, Singapore 539747.
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21
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McGorry P. Response to 'better mental health services for young people: responsibility, partnerships and projects'. Aust N Z J Psychiatry 2001; 35:392-4. [PMID: 11437825 DOI: 10.1046/j.1440-1614.2001.0905k.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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McGorry P. Rationale for and the substantial potential benefits linked to early recognition and optimal treatment of psychotic disorders, specifically schizophrenia. Acta Psychiatr Scand 2001; 103:402-3. [PMID: 11398782 DOI: 10.1034/j.1600-0447.2001.103005401.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jackson H, McGorry P, Henry L, Edwards J, Hulbert C, Harrigan S, Dudgeon P, Francey S, Maude D, Cocks J, Power P. Cognitively oriented psychotherapy for early psychosis (COPE): a 1-year follow-up. Br J Clin Psychol 2001; 40:57-70. [PMID: 11317949 DOI: 10.1348/014466501163481] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Cognitively oriented psychotherapy for early psychosis (COPE) is aimed at facilitating the adjustment of the person, and at preventing or alleviating secondary morbidity in the wake of the first psychotic episode. DESIGN A total of 80 people participated in the initial trial and completed assessments on a range of outcome measures. Post-treatment assessment results from a non-randomized controlled trial of COPE have been previously reported. The present paper describes the results obtained from 51 patients who attended a follow-up assessment 1 year subsequent to the end-of-treatment assessment. METHOD The 51 patients formed three groups: (1) those who were offered and accepted COPE; (2) those who were offered COPE but refused it, and continued to receive other services from the Early Psychosis Prevention and Intervention Centre (EPPIC) (refusal subjects); and (3) those who were offered neither COPE nor any other continuing treatment from EPPIC (control subjects). RESULTS At 1-year follow-up, there was only one significant difference and this was between the COPE and refusal groups on the Integration/Sealing Over (I/SO) measure (p = .008). End-of-treatment differences were mostly sustained over the 1-year follow-up period. When the complete sample of 80 was considered, there were no differences between the three groups in terms of hospital admissions, community episodes, or time taken to first in-patient re-admission. CONCLUSIONS The study was weakened by the poor follow-up rates in the two control groups. This reduced power to detect differences between groups on the seven major measures. However, the relapse data gathered on the complete set of 80 patients were discouraging and suggest that the present formulation of COPE does not confer any advantage to those patients receiving the therapy over those not receiving the therapy.
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Affiliation(s)
- H Jackson
- Early Psychosis Prevention and Intervention Centre (EPPIC), Departments of Psychology and Psychiatry, University of Melbourne, Australia.
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McGorry P. Preventive strategies in early psychosis: verging on reality. Br J Psychiatry Suppl 2000; 172:1-2. [PMID: 9764118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Copolov D, Velakoulis D, McGorry P, Yung A, Rees S, Jackson G, Rehn A, Brewer W, Pantelis C. Neurobiological findings in early phase schizophrenia. Brain Res Brain Res Rev 2000; 31:157-65. [PMID: 10719144 DOI: 10.1016/s0165-0173(99)00033-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper summarises the available information on MRI-determined hippocampal morphometry in first-episode patients as an illustration of the value and interpretation of findings in the neurobiology of early phase schizophrenia. We report a thin slice (1.5 mm) study of 32 first episode and 39 high risk patients which demonstrated significantly smaller hippocampi (right -9%, left -11%) in first episode patients that were of a similar magnitude to those found in chronic patients (right -10%, left -11%) but non-significant volume reductions in high risk individuals, including the 15 subjects who subsequently developed psychoses. Consideration is given to the implications of these findings, including the possible role of early and later neurodevelopmental influences. We present animal data showing that chronic placental insufficiency, as elicited by uterine artery ligation can give rise to substantial reduction (31%) in hippocampal volumes and reflect on other potentially relevant pathophysiological mechanisms, including those that may occur during the early phases of psychotic illnesses, including their prodromes. Greater attention needs to be paid to the study of early phase psychosis in order to obtain a clearer understanding of the nature and time course of neurobiological changes associated with it. Although there is a growing literature on first episode psychosis, there is a striking dearth of information on the neurobiology of the prodrome.
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Affiliation(s)
- D Copolov
- The Mental Health Research Institute of Victoria, 155 Oak St., Parkville, Victoria, Australia.
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Abstract
OBJECTIVE Deriving diagnoses from retrospective case note examination is a common practice in psychiatric research. The Operational Criteria (OPCRIT) diagnostic checklist is essentially a checklist built up of operational criteria defined by a comprehensive glossary and is designed to assign reliable diagnoses from case notes. However, the validity of such a procedure compared with procedures involving prospective assessment has never been tested. We examined the procedural validity of the OPCRIT diagnostic system in relation to four other diagnostic procedures mostly employing prospectively gathered information. METHOD Three experienced psychopathology raters rated the case notes and clinical abstracts, using the OPCRIT method of diagnostic assignment, of 50 subjects who had participated in an early procedural validity study as an adjunct to the DSM-IV Field Trial for psychotic disorders. The setting was the Early Psychosis Prevention and Intervention Centre (EPPIC), which focuses on first episode psychosis. RESULTS The pairwise concordance with the other procedures for DSM-III-R diagnoses assigned by OPCRIT using ratings derived from either the clinical abstracts or the case notes was found to be only poor to moderate when compared with the pairwise concordance of the four other procedures. The per cent agreement between OPCRIT clinical abstracts diagnoses and the other procedures ranged from 49% to 60% with kappa values between 0.30 and 0.45, and for OPCRIT case note diagnoses and the other procedures the per cent agreement range was between 44% and 57% and the kappa values were between 0.35 and 0.49. CONCLUSIONS The procedural validity of diagnoses assigned via the application of checklists of operational criteria to case notes and clinical abstracts alone is unacceptably poor. Such sources need to be buttressed by other data, particularly direct patient interview and informant material.
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Affiliation(s)
- C Mihalopoulos
- Early Psychosis Research Centre, University of Melbourne Department of Psychiatry, Parkville, Victoria, Australia
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Cosgrave E, McGorry P, Allen N, Jackson H. Depression in young people. A growing challenge for primary care. Aust Fam Physician 2000; 29:123-7. [PMID: 10743265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Recent research indicates that 27% of young people aged 18-24 have a mental health problem involving mood, anxiety, personality and/or substance abuse disorders and 15-40% report depressive symptomatology. A proportion of these young people will suicide. The morbidity associated with depressive illness in this age group is high, with those experiencing a depressive episode having reduced vocational and life prospects and being highly vulnerable to further episodes in later life. OBJECTIVE To outline the clinical features of depression in young people and to provide strategies for appropriate management. DISCUSSION Presentation of depression in young people is likely to vary from accepted diagnostic criteria with non specific symptoms such as boredom, anxiety, failing adjustment and sleep disturbance predominating. Management includes attending to key social problems, ensuring a safe environment and counselling, which may be supportive counselling or more specific treatments of cognitive behavioural therapy or interpersonal psychotherapy. Medication is indicated for more severe depression or with failure of response to psychological strategies. Early case identification and intensive treatment of first episodes of depression is important in reducing prevalence, cost and morbidity.
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Affiliation(s)
- E Cosgrave
- Older Adolescent Service, Mental Health Services for Kids and Youth, Victoria
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Abstract
Over the last decade, western countries have reduced their intake of refugees, even though a substantial number of persons continue to be displaced by war and persecution. At the same time, there has been a substantial increase in the number of asylum seekers who apply for refugee status after entering western countries without resettlement documents. Evidence is accruing that asylum seekers are at high risk to trauma-related psychiatric and physical disorders. Increasing concerns have been raised, therefore, about the difficulties that asylum seekers face in accessing health and welfare services. The present Australian-based volunteer study compared Tamil asylum seekers (n = 62) from Sri Lanka with compatriots (30 refugees; 62 immigrants) on a number of indices relating to difficulties accessing medical, counselling and welfare services. The majority of asylum seekers (>60%) reported serious difficulties accessing medical and dental services and a sizeable minority reported problems obtaining assistance with welfare (40%), counselling (34%), and charity (23%). Difficulties accessing medical and dental services consistently exceeded those reported by refugees and immigrants. In spite of the inevitable sampling limitations, the data support past research as well as clinical impressions in suggesting that asylum seekers are particularly disadvantaged in accessing health care services.
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Affiliation(s)
- D Silove
- School of Psychiatry, University of New South Wales, at Liverpool Hospital, Australia
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Abstract
Path analysis was used to examine the antecedents of posttraumatic stress (PTS) symptoms in Tamil asylum-seekers, refugees, and immigrants in Australia. The Harvard Trauma Questionnaire and a postmigration living difficulties questionnaire were completed by 62 asylum-seekers, 30 refugees, and 104 immigrants who responded to a mail-out. Demographic characteristics, residency status, and measures of trauma and postmigration stress were fitted to a structural model in PTS symptoms. Premigration trauma exposure accounted for 20% of the variance of PTS symptoms. Postmigration stress contributed 14% of the variance. Although limited by sampling constraints and retrospective measurement, the study supports the notion that both traumatic and posttraumatic events contribute to the expression of PTS symptoms.
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Affiliation(s)
- Z Steel
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Liverpool Hospital, Australia
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Power P, Elkins K, Adlard S, Curry C, McGorry P, Harrigan S. Analysis of the initial treatment phase in first-episode psychosis. Br J Psychiatry Suppl 1998; 172:71-6. [PMID: 9764130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Early Psychosis Prevention and Intervention Centre (EPPIC) commenced operation in Melbourne, Australia, in 1992. It offers a model for management of first-episode psychosis, utilising principles of early detection, low-dose medication and comprehensive psychosocial interventions within the least restrictive setting. METHOD Data were examined from the first three months of treatment for all consecutive people with first-episode psychosis (n = 231) accepted in the programme in 1995-1996. A subsample of patients (n = 120) was assessed comparing clinical ratings with variables of gender, diagnosis, hospitalisation, and medication. RESULTS Hospitalisations were brief, and avoided for a third of the people. Low-dose antipsychotic medication was maintained in both in-patient and community settings. Those people with manic psychosis were more likely to be hospitalised. Hospitalised people received higher antipsychotic dosages, and had a greater rate of reduction in Brief Psychiatric Rating Scale psychotic subscale scores at three months follow-up. Eighty per cent of a representative subsample had responded to treatment and 63% were in remission by the end of the three months. CONCLUSION This naturalistic study suggests that the feasibility of implementing the EPPIC model in a range of clinical settings is promising and applicable in practice.
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Affiliation(s)
- P Power
- Early Psychosis Prevention and Intervention Centre, Parkville, Victoria, Australia.
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Jackson H, McGorry P, Edwards J, Hulbert C, Henry L, Francey S, Maude D, Cocks J, Power P, Harrigan S, Dudgeon P. Cognitively-oriented psychotherapy for early psychosis (COPE). Preliminary results. Br J Psychiatry Suppl 1998; 172:93-100. [PMID: 9764134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The present study describes the results of the pilot testing of a therapy we have developed for people with first-episode psychosis. Cognitively-oriented psychotherapy for early psychosis (COPE) is aimed at facilitating the adjustment of the person, and at preventing or alleviating secondary morbidity in the wake of the first psychotic episode. METHOD Eighty people formed three groups: those who were offered and accepted COPE (COPE subjects); those who refused COPE (refusal subjects); and those who were offered neither COPE nor any other continuing treatment from our service (control subjects). The individuals were assessed prior to, and at the end of, COPE treatment (a 12-month period) on the Integration/Sealing Over, Explanatory Model, Scale for the Assessment of Negative Symptoms, Brief Psychiatric Rating Scale, Quality of Life, SCL-90-R, and Beck Depression Inventory measures. RESULTS People who received COPE obtained significantly superior scores (P < 0.05) to the control group on four of the seven measures but only significantly out-performed the refusal group on one of the seven measures (P < 0.05). The COPE group performed significantly worse on the BDI than the refusal group (P < 0.05). Effect sizes are also provided for each measure. CONCLUSIONS There seems to be a place for psychological therapy in this group of people but our results need to be replicated in a more definitive randomised controlled trial and such a study is now in progress.
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Affiliation(s)
- H Jackson
- Department of Psychology, School of Behavioural Science, University of Melbourne, Parkville, Victoria, Australia.
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Silove D, Steel Z, McGorry P, Mohan P. Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum-seekers: comparison with refugees and immigrants. Acta Psychiatr Scand 1998; 97:175-81. [PMID: 9543304 DOI: 10.1111/j.1600-0447.1998.tb09984.x] [Citation(s) in RCA: 214] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Compared to research on displaced persons whose refugee status has been endorsed prior to arriving in Western countries, there is little systematic information available about levels of past trauma, postmigration living difficulties and psychiatric symptoms amongst asylum-seekers who claim refugee status only after arrival. Asylum-seekers, authorized refugees and immigrants of Tamil background were recruited by personal contact and mail-out in Sydney, Australia. A total of 62 subjects, constituting approximately 60% of the estimated pool of Tamil asylum-seekers, agreed to participate in the study. They returned statistically significantly higher scores than immigrants (n = 104) on measures of past trauma, symptoms of anxiety, depression and post-traumatic stress, and on all dimensions of postmigration difficulties. Asylum-seekers did not differ from refugees (n = 30) on measures of past trauma or psychiatric symptoms, but they scored higher on selective components of postmigration stress relating to difficulties associated with their insecure residency status. Although limited by sampling and diagnostic constraints, the present study suggests that asylum-seekers may be a high-risk group in relation to ongoing stress in the postmigration period.
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Affiliation(s)
- D Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Australia
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Parker G, Lambert T, McGrath J, McGorry P, Tiller J. Neuroleptic management of schizophrenia: a survey and commentary on Australian psychiatric practice. Aust N Z J Psychiatry 1998; 32:50-8; discussion 59-60. [PMID: 9565183 DOI: 10.3109/00048679809062705] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We seek to assess Australian psychiatrists' views and practices concerning provision of neuroleptic medication to patients with schizophrenia, and to determine whether such management strategies are likely to have changed over time and the extent to which they correspond to published treatment guidelines. METHOD A sample of 139 psychiatrists based in three Australian capital cities was derived, with respondents completing a brief questionnaire by choosing from a limited-option answer set. Co-authors of this paper comment on the extent to which responses are in line with contemporary recommendations driven by experts or empirical studies. RESULTS Overall, survey findings indicate that there has been considerable change in clinical practice over the last decade and provide some estimate of the extent to which Australian management practices are congruent with contemporary recommendations. We identify a number of issues of concern (more in relation to dose levels of neuroleptic medication rather than treatment duration) revealed by survey data and make recommendations for addressing a number of practical clinical issues. CONCLUSIONS As this report focuses on central issues involved in managing schizophrenia, and integrates a number of treatment guidelines, we suggest that it should be of assistance for practice review by clinicians.
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Affiliation(s)
- G Parker
- School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Randwick, Australia
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McGorry P. Beyond adolescent psychiatry: the logic of a youth mental health model. Aust N Z J Psychiatry 1998; 32:138-40. [PMID: 9565197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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McGorry P. Commentary on Munczek's "short-term treatment of a Central American torture survivor.". Psychiatry 1998; 61:330-4. [PMID: 9919627 DOI: 10.1080/00332747.1998.11024845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ellis P, McGorry P, Ungvari G, Chaplin R, Chapman M, Collings S, Hantz P, Little J, Mellsop G, Purdie G, Richards J, Silfverskjold P. Australasian field trials of the draft multi-axial version of the ICD-10 (mental and behavioural disorders section). Eur Psychiatry 1996. [DOI: 10.1016/0924-9338(96)89252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Affiliation(s)
- P McGorry
- Department of Psychiatry, University of Melbourne, Parkville, Victoria
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Abstract
OBJECTIVE The authors reviewed the literature to better understand pathways to psychiatric care among young persons experiencing a first episode of psychosis. Because no discrete body of literature exists about how young people with psychotic illness gain access to psychiatric services, the authors examined three related areas: illness recognition, help-seeking, and referral pathways. METHODS Automated and manual searches of primarily medical and psychological sources from 1977 to 1995 were conducted. RESULTS The review found evidence of delay in obtaining early treatment among young people with an emerging psychosis, although comparisons between studies are difficult. Early psychiatric intervention is believed to significantly aid recovery and is an increasingly important clinical issue. Recognizing psychiatric illness is problematic for professionals and nonprofessionals. CONCLUSIONS Understanding of help seeking by patients experiencing a first psychotic episode and of their referral pathways is limited. Taken together, studies suggest factors affecting access to treatment but provide neither sufficient empirical information nor an adequate conceptual framework to better target secondary prevention strategies. Formulation of a pathways-to-care model appears to offer a useful way of understanding mental health care use. Exploration of consumer experiences would enrich the model. Strategies to reduce treatment delay could then be developed and evaluated. Increased consumer involvement might help ensure that services are better tailored to patients' needs.
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Affiliation(s)
- C V Lincoln
- Department of Psychiatry, Melbourne University, Parkville, Victoria, Australia
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Abstract
The health and welfare needs of refugee survivors of torture and trauma have in recent years belatedly found a prominent place on the policy agendas of Federal and State Governments. The development of a statewide service to meet these needs provides an opportunity to illustrate some of the general issues in developing a model specialist community health service, as well as the specific and complex elements involved in the care and resettlement of refugee survivors of torture and trauma. The early experience of the Victorian Foundation for Survivors of Torture is described and some descriptive data presented. Unresolved issues are highlighted, particularly the difficulty in providing skilled psychotherapeutic assistance to relatively large numbers of traumatised refugees.
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Affiliation(s)
- P McGorry
- Department of Psychiatry, University of Melbourne, Victoria
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Abstract
Torture has existed since the earliest times, usually as public punishment prior to death. Today it is predominantly used in secret with the aim of destroying the individual's personality. The effects of torture include severe physical and psychological sequelae which have only recently come under scrutiny. In recent years many Chilean and El Salvadorean migrants have left their countries after being tortured and severely traumatised as a result of organised violence. The aim of this study was to pilot an investigation into the psychological sequelae of torture. Subjects were 30 Chileans and El Salvadoreans classified into three groups: torture, trauma and non-torture/trauma migrants. It was found to be feasible to access and interview survivors from a clinical research perspective without causing additional psychological morbidity. The subjects were interviewed and administered three scales: the Post-Traumatic Stress Disorder Scale, SCL-90-R, and the Impact of Event Scale. The results from the scales and the descriptive data presented indicate some support for the hypothesis that torture survivors show higher levels of PTSD, psychosomatic impairment and stress response disturbance than the trauma and non-torture/trauma groups. Methodological issues are discussed. The strengths and limitations of this preliminary study are considered in relation to future research.
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Affiliation(s)
- M Thompson
- Department of Psychiatry, University of Melbourne, Royal Park Hospital, Parkville, Victoria
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Herrman H, Mills J, Doidge G, McGorry P, Singh B. The use of psychiatric services before imprisonment: a survey and case register linkage of sentenced prisoners in Melbourne. Psychol Med 1994; 24:63-68. [PMID: 8208895 DOI: 10.1017/s0033291700026830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Information about contact with psychiatric services before imprisonment was obtained for a stratified random sample of sentenced prisoners, who were not receiving prison psychiatric care, in Melbourne's three metropolitan prisons. The sample of 158 men and 31 women was matched with the longitudinal person-linked records of state psychiatric service use in the Victorian Psychiatric Case Register (VPCR). Records of contact with the state services were found for 54 men (34%) and 19 women (61%), including records of in-patient treatment for 25 men (16%) and 15 women (48%). For 64% of individuals with a positive match, the case-note diagnoses were substance use disorders only. Diagnoses of psychotic disorders were recorded for four prisoners, and mood disorders for another six. In addition, clinicians conducted standardized diagnostic interviews and enquired about treatment and personal history. A further 24 prisoners reported specialist psychiatric treatment outside the state treatment sector. This study links the findings from an interview survey of psychiatric morbidity in prisoners with the records available in the VPCR, and emphasizes a number of matters important to the public health. The high rates of previous treatment for substance abuse disorders, the apparent pool of prisoners with largely untreated major depression, and the service needs of those with chronic psychotic disorders are discussed.
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Affiliation(s)
- H Herrman
- Department of Psychiatry, University of Melbourne, Victoria, Australia
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McGorry P. Negative symptoms and PTSD. Aust N Z J Psychiatry 1991; 25:9, 12-3. [PMID: 2049025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
OBJECTIVE The aim of this survey was to estimate the prevalence of severe mental disorders in a representative sample of sentenced prisoners. METHOD The subjects were selected as a random sample of sentenced prisoners in Melbourne's three metropolitan prisons. Interviews were conducted with 158 men and 31 women. Clinicians used the Structured Clinical Interview for DSM-III-R (SCID) to diagnose psychotic, affective, and substance use disorders. RESULTS Six prisoners (3%) received current diagnoses of psychotic disorders, and 23 (12%) were diagnosed as having current mood disorders, mainly major depression. A lifetime diagnosis of at least one mental disorder each was made for 82% of the respondents, and in 26% more than one lifetime disorder was diagnosed. Sixty-nine percent received lifetime diagnoses of dependence on or abuse of alcohol, other psychoactive substances, or a combination of these. CONCLUSIONS These findings do not indicate a large-scale shift of deinstitutionalized psychotically ill people from mental hospitals to prisons. They do, however, highlight the diversion into the corrections system of substance-dependent people and the apparent pool of prisoners with largely untreated major depression.
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Affiliation(s)
- H Herrman
- Department of Psychological Medicine, Monash University, Melbourne, Australia
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Abstract
Functional psychosis in the puerperal period is a dramatic phenomenon that presents a unique set of diagnostic and therapeutic challenges. Despite its omission from modern classificatory systems such as DSM-III and DSM-III-R, the concept of puerperal psychosis continues to receive support from clinicians on the basis of the apparently distinctive clinical picture that characterizes psychoses occurring at this time. The range of possible nosological models is considered in light of relevant studies of puerperal illness, and the evidence for and against each model is presented. The question of the prognosis of puerperal psychosis is reviewed and guidelines for its estimation in the individual case proposed. The heuristic importance of puerperal psychosis in terms of basic research and preventive psychiatry is also stressed.
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Affiliation(s)
- P McGorry
- National Health and Medical Research Council Schizophrenia Research Unit, Royal Park Hospital, Parkville, Victoria, Australia
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Abstract
This study explored the relationship between level of expressed emotion (EE) and level of family burden in 20 families of individuals with psychotic disorder. Results indicated that a relationship between EE and family burden did exist, but it appeared to be strongly influenced by demographic and illness-related variables. The usefulness of the 5-min speech sample method of assessing EE was limited by the aversion of some family members to being videotaped and by denial of patient symptoms by some relatives. Other methodological weaknesses are discussed. The relationship between demographic and illness-related variables and level of EE needs further exploration.
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Affiliation(s)
- H J Jackson
- NH&MRC Schizophrenia Research Unit, Royal Park Hospital, Melbourne, Australia
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Keks NA, Copolov DL, Kulkarni J, Mackie B, Singh BS, McGorry P, Rubin RT, Hassett A, McLaughlin M, van Riel R. Basal and haloperidol-stimulated prolactin in neuroleptic-free men with schizophrenia defined by 11 diagnostic systems. Biol Psychiatry 1990; 27:1203-15. [PMID: 2354227 DOI: 10.1016/0006-3223(90)90418-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Forty-four male, neuroleptic-free, acutely psychotic patients with at least one diagnosis of schizophrenia among 11 diagnostic systems, and 28 healthy controls, underwent measurement of prolactin (PRL) concentrations before and after intravenous administration of haloperidol (0.5 mg). Basal PRL concentrations were lower in the patients with Research Diagnostic Criteria (RDC) DSM-III, Cloninger, and Taylor and Abrams schizophrenias than in controls. Compared with the controls, the PRL response to haloperidol was lower in the patients with schizophrenia defined by all diagnostic systems except those of Schneider and M. Bleuler. Neither basal nor stimulated PRL concentrations were correlated with positive symptoms, but basal PRL was correlated with the Brief Psychiatric Rating Scale (BPRS) depression-related subscore. This study lends further support for the presence of dopaminergic dysfunction in schizophrenia, and demonstrates the advantages and problems in the use of multidiagnostic psychopathological evaluation to categorize a disorder where there is major disagreement among diagnostic systems.
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Affiliation(s)
- N A Keks
- National Health and Medical Research Council Schizophrenia Research Unit, Mental Health Research Institute of Victoria, Australia
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