Determinants of adult functional outcome in adolescents receiving special educational assistance

BACKGROUND

This study investigates the role of IQ, autistic traits and challenging behaviours in affecting adult outcomes among adolescents who receive special educational assistance.

METHODS

A total of 58 participants were recruited from an ongoing longitudinal study. All received assessments of IQ, behavioural patterns (using the Childhood Behaviour Checklist - CBCL) and autistic traits (using the Social Communication Questionnaire - SCQ) during adolescence and were followed up 6 years later (at a mean age of 22 years) using the World Health Organization Disability Assessment Schedule II (WHO-DAS II) to assess functional outcome.

RESULTS

A significant positive relationship was found between CBCL score and WHO-DAS II score (β = 0.511, P = 0.001). IQ score showed a negative relationship with total WHO-DAS II score (β = -0.247, P = 0.04). SCQ score was not found to significantly influence total WHO-DAS II score (β = -0.028, P = 0.84).

CONCLUSIONS

Although the role of global intellectual ability is important, these results stress the highly predictive value of adolescent behaviours on functional outcomes in adult life among young adults receiving special educational assistance.

2-COM: an instrument to facilitate patient-professional communication in routine clinical practice

OBJECTIVE

A simple patient-completed self-report instrument may facilitate patient-professional carer communication.

METHOD

A 19-item self-report needs schedule was used in a sample of 243 out-patients with non-affective psychosis. Patients and professional carers commented on the usefulness of the instrument. In a subgroup of 95 patient-carer dyads, the professional carer was asked to rate the needs in addition to the patient.

RESULTS

Patients scored their needs reliably and lower than the professionals (OR = 0.9, 95% CI: 0.9, 0.97). Concordance between patients and professional carers on individual needs was very low. More than 50% of the professional carers and more than 80% of the patients found 2-COM useful. The higher the number of needs indicated by the patient, the greater the discrepancy between patients and professional carers with regard to the usefulness of the schedule.

CONCLUSION

2-COM is a useful instrument to expose, and subsequently bridge, patient-professional carer discordance on patient needs.

Principles of practice from the European expert panel on the contemporary treatment of schizophrenia

Providing optimal treatment for people with schizophrenia is a difficult long-term problem for clinicians and healthcare providers. Over the years a variety of approaches to treatment have evolved and, until now, there have been no widely accepted standards for care. To determine the principles underpinning the best practice for schizophrenia treatment, an Expert Panel of European psychiatrists and psychologists has worked to distil current theory, collective practical experiences and published literature into 17 basic Principles of Practice . These are not intended to duplicate or replace local treatment policies or guidelines. Instead, they describe best practice in diagnosis, patient assessment and long-term treatment of schizophrenia as it exists at the beginning of the 21st century and is likely to exist in the near future. The Principles of Practice broadly fall into four main categories: (1) assessment, diagnosis and care provision; (2) treatment in day-to-day practice; (3) building a positive therapeutic alliance; and (4) a long-term clinical commitment. Running through all the Principles are several common threads - the fundamental importance of the therapeutic alliance between the clinician and the patient, the need to plan both for treatment efficacy and avoidance of side-effects and the importance of long-term treatment planning. It is intended that psychiatrists and other healthcare professionals can use the Principles as a benchmark for optimum patient management, and as a tool when negotiating the future of local and national schizophrenia management services. Furthermore, the Principles of Practice represent a first step in the development of a new patient-centred philosophy for the care of people with schizophrenia.

Neuropsychological assessment of young people at high genetic risk for developing schizophrenia compared with controls: preliminary findings of the Edinburgh High Risk Study (EHRS)

BACKGROUND

Finding risk indicators for schizophrenia among groups of individuals at high genetic risk for the disorder, has been the driving force of the high risk paradigm. The current study describes the preliminary results of a neuropsychological assessment battery conducted on the first 50% of subjects from the Edinburgh High Risk Study.

METHODS

One hundred and four high risk subjects and 33 normal controls, age and sex matched, were given a neuropsychological assessment battery. The areas of function assessed and reported here include intellectual function, executive function, perceptual motor speed, mental control/ encoding, verbal ability and language, learning and memory measures, and handedness.

RESULTS

The high risk subjects performed significantly more poorly than the control subjects in the following domains of neuropsychological function: intellectual function, executive function, mental control/encoding and learning, and memory. Controlling for IQ, high risk subjects made significantly more errors on the Hayling Sentence Completion Test (HSCT), took longer to complete section A of the HSCT, had lower scores on the delayed recall condition of the visual reproductions subtest of the Wechsler Memory Scale-Revised, and had significantly poorer Rivermead Behavioural Memory Test (RBMT) standardized scores. The presence of significant group by IQ interactions for the RBMT and time to complete section A of the HSCT suggested that differences among the groups were more marked in the lower IQ range. Performance on the HSCT was found to be related to the degree of family history of schizophrenia.

CONCLUSIONS

High risk subjects performed more poorly than controls on all tests of intellectual function and on aspects of executive function and memory.

Reducing persistent auditory hallucinations by wearing an ear-plug

A case study is presented of the effects of wearing an ear-plug in a single patient with persistent auditory hallucinations. Beneficial effects were detected when the plug was in the dominant ear only.