Group programmes for recovery from early psychosis

BACKGROUND: We evaluate the impact of a group-based, transitional, psychosocial programme, within a comprehensive service (the Early Psychosis Prevention and Intervention Centre, EPPIC), on recovery from first-episode psychosis. METHOD: Individuals using the service (and meeting study criteria) were assessed on a range of symptom and functioning instruments at entry, after 6 weeks and 6 months. Participants received comprehensive case management and services according to their identified needs. Thirty-four people who had attended the group programme were compared at 6 month follow-up with 61 EPPIC patients who had not attended. RESULTS: The people attending the group programme had a lower level of premorbid adjustment than the comparison group, and a trend towards exhibiting a higher level of negative symptoms, prior to commencing the group programme. However, at 6 month follow-up, no significant differences were found between the groups. CONCLUSIONS: Involvement in the group programme may have had a positive impact on a subgroup of EPPIC subjects with poor level of premorbid adjustment, by providing a 'holding pattern' in the critical period following the emergence of first-onset psychosis, and thus prevented deterioration and the development of disability.     

Cognitively-oriented psychotherapy for early psychosis (COPE). Preliminary results

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.     

Early intervention, untreated psychosis and the course of early schizophrenia

BACKGROUND: Studies have proved that early intervention can delay psychotic relapses, and prevent psychosocial deterioration in people with schizophrenia and related disorders. METHOD: Our study with young people with recent onset schizophrenia has shown that an intensive intervention programme had a beneficial effect on the occurrence of psychotic relapse and the course of psychotic syndromes. This effect lasted until the end of the 15-month intervention. No significant effect of the two different intervention conditions became apparent. RESULTS: The results of a follow-up study showed that this beneficial effect did not last. Fifteen per cent of the people had a psychotic relapse during the intervention, whereas 64% relapsed during follow-up. CONCLUSIONS: These results show that referral to other mental health agencies after intervention is not sufficient and that more support is required to continue disease management, medication compliance and stress management.     

Women and cognitive-behavioural therapies for depression.

Presents 5 major comments on J. M. Stoppard's (see record 1989-29654-001) discussion of the adequacy of cognitive/behavioral theories for understanding depression in women. These include the author's agreement with the importance that Stoppard places on differential rates of depression in men and women and disagreement with Stoppard's emphasis on the need to achieve a sense of control in psychotherapy. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control study

OBJECTIVE: To examine prenatal and perinatal risk factors for subsequent development of schizophrenia and affective and reactive psychosis. DESIGN: Three population based, case-control studies conducted within a Sweden-wide cohort of all children born during 1973-9. This was done by linking individual data from the Swedish birth register, which represents 99% of all births in Sweden, to the Swedish inpatient register. SUBJECTS: Patients listed in inpatient register as having been first admitted to hospital aged 15-21 years with a main diagnosis of schizophrenia (n=167), affective psychosis (n=198), or reactive psychosis (n=292). For each case, five controls were selected. MAIN OUTCOME MEASURES: Risks of schizophrenia and affective and reactive psychosis in relation to pregnancy and perinatal characteristics. RESULTS: Schizophrenia was positively associated with multiparity (odds ratio 2.0), maternal bleeding during pregnancy (odds ratio 3.5), and birth in late winter (odds ratio 1.4). Affective psychosis was associated with uterine atony (odds ratio 2.2) and late winter birth (odds ratio 1.5). Reactive psychosis was related to multiparity (odds ratio 2.1). An increased risk for schizophrenia was found in boys who were small for their gestational age at birth (odds ratio 3.2), who were number four or more in birth order (odds ratio 3.6), and whose mothers had had bleeding during late pregnancy (odds ratio 4.0). CONCLUSIONS: A few specific pregnancy and perinatal factors were associated with the subsequent development of psychotic disorder, particularly schizophrenia, in early adult life. The association of small size for gestational age and bleeding during pregnancy with increased risk of early onset schizophrenia among males could reflect placental insufficiency.     

Individual differences in early adolescents' beliefs in the legitimacy of parental authority.

Adolescents differ in the extent to which they believe that parents have legitimate authority to impose rules restricting adolescents' behavior. The purpose of the current study was to test predictors of individual differences in legitimacy beliefs during the middle school years. Annually, during the summers following Grades 5, 6, and 7, early adolescents (n = 218; 51% female, 47% African American, 73% in 2-parent homes) reported their beliefs regarding the legitimacy of parents' rules that restrict and monitor adolescents' free time activities. Cross-lagged analyses revealed that legitimacy beliefs were bidirectionally associated with independent decision making, psychological control, antisocial peer involvement, and resistance to control. Legitimacy beliefs declined more rapidly during the middle school years for boys than for girls and for adolescents who were older relative to their classmates. More independent decision making in Grades 5 and 6 predicted larger than expected declines in legitimacy beliefs in Grades 6 and 7. In sum, legitimacy beliefs weaken developmentally, and weaker legitimacy beliefs relative to same-grade peers are anteceded by premature autonomous experiences, psychological control, and adolescent attributes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Prevention of intellectual disabilities: early interventions to improve cognitive development

The isothermal enthalpy changes with time of a dental composite were examined by microcalorimetry to isolate the effects of different filler concentrations and curing times on chemical aging of these composites. Urethane dimethacrylate (UDMA) monomer, zirconia-silica (ZS) powder, and 3-methacryloxypropyltrimethoxysilane (MAPM) were used as organic and inorganic matrices, and a coupling agent, respectively. The composite was mixed in different ratios and cured by visible light. The enthalpy changes with time for 0, 15, 45, 75% ZS-filled UDMA and 75% MAPM-silanated ZS-filled UDMA cured for 13, 30, 90, 150, and 300 s were measured at 37.0 degrees, 57.0 degrees, and 65.5 degrees C until equilibrium. Increased curing time and filler concentration caused the excess enthalpy changes (dH) and their rate of change (dH/dt) to increase with annealing time and apparent equilibrium was reached faster. In addition, dH showed nonlinear dependence with the increase in filler concentration by showing a maxima for samples containing 25 wt% filler. Further, filler silanation caused dH/dt to increase and required shorter times to reach apparent equilibrium. dH also reached a minimum when samples contained silanated filler, compared to composites containing unsilanated filler. It was concluded that the shorter curing time caused the occurrence of spontaneous densification, which facilitated continual resin curing; and longer curing time caused higher crosslinking of the organic phase. Moderate concentration of inorganic phase restricts the molecular motion of the surface layer of polymer onto filler particles, and the polymer is regarded as highly crosslinked, while a higher filler concentration forms aggregates that are covered by the polymer which causes a decrease in the molecular packing of the resin, and is reflected as low enthalpy values. Finally, silanation of the filler showed a highly endothermic reaction that is probably due to breaking and forming of bonds at the interface between the organic and the inorganic phases in the composites.     

Individual differences, early work challenge, and participation in continuing education.

Relationships of individual differences and early work challenge to participation of engineers in continuing education were investigated in a 14-yr longitudinal study. 110 newly hired engineers completed a battery of cognitive and interest tests. Engineers and managers rated work challenge 2 yrs later. Number of graduate and in-house courses completed was ascertained from company records. Results show that cognitive tests and work challenge correlated positively with graduate course participation but negatively with in-house courses completed early in the career. Enjoyment of challenging work was related to lower early in-house participation. Graduate work was positively related to interest in ideas for those strong in engineering ability. Later in the career, in-house participation was positively related to interest in things and negatively related to interest in people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding the topography of the early psychosis pathways. An opportunity to reduce delays in treatment

BACKGROUND: This study aims to gain an understanding of treatment delays and their nature in initial psychotic episodes. We investigated to whom people turn for help, how long that approach takes and subsequent delays in commencing treatment. METHOD: Qualitative and quantitative methods were combined with interviews of 62 people suffering from first-episode psychoses, aged 16-30 years, who had recently accessed a specialist mental health service in Melbourne, Australia. A modified version of the World Health Organization Encounter Form was analysed in conjunction with other data. RESULTS: Pathways to care and the ways in which they were experienced were highly variable, with 50% of people experiencing psychotic symptoms before approaching any service. The general practitioner played a key role with 50% of people having had GP contact at some point prior to commencing effective treatment. Where an individual's own efforts to seek early help failed, the role of relatives and others was subsequently vital. CONCLUSIONS: Opportunities exist for shortening delays through targeted health promotion activities and professional training. The need is indicated for a multi-layered or topographical strategy to identify and minimise critical barriers on the route to early intervention. Refinement of interview techniques and instruments of measurement are needed to enhance the explanatory power of data collected.     

Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood.

Is early preventive intervention effective in enhancing parental sensitivity and infant attachment security, and if so, what type of intervention is most successful? Seventy studies were traced, producing 88 intervention effects on sensitivity (n=7,636) and/or attachment (n=1,503). Randomized interventions appeared rather effective in changing insensitive parenting (d=0.33) and infant attachment insecurity (d=0.20). The most effective interventions used a moderate number of sessions and a clear-cut behavioral focus in families with, as well as without, multiple problems. Interventions that were more effective in enhancing parental sensitivity were also more effective in enhancing attachment security, which supports the notion of a causal role of sensitivity in shaping attachment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lyme psychosis

A woman aged 64 was admitted to the psychiatric department because of a psychotic decompensation with visual hallucinations, disorientation in time and space and associative thinking. On psychotropic drugs the condition failed to improve; subsequently neurological symptoms developed. EEG abnormalities prompted a lumbar puncture. In the CSF a strong plasma cell reaction with atypical cells was observed. The enzyme immunoassay for Borrelia burgdorferi was positive and after treatment with penicillin the psychiatric and neurological signs and symptoms disappeared. From the history which could then be taken it appeared that the patient had been bitten by ticks. Her husband aged 66 years passed through a similar episode of disease.     

Brief early psychological interventions following trauma: a systematic review of the literature

A systematic literature search/review was undertaken of brief early psychological interventions following trauma. Only six randomized controlled trials were found, and none of these included group interventions. Of the six trials, two studies associated the intervention with a positive outcome, two demonstrated no difference on outcome between intervention and non-intervention groups, and two showed some negative outcomes in the intervention group. This review suggests that early optimism for brief early psychological interventions including debriefing was misplaced and that there is an urgent need for randomized controlled trials of group debriefing and other early interventions.     

Post operative psychosis

The dimerization of the variable fragment of the Bence-Jones protein Au was examined in phosphate buffers at pH 6.8-6.9 And ionic strength of 0.1 M or 0.2 M at 20 degrees C. The dimerization constant was about 1 X 10(5) M-1. The reaction enthalpy was positive and the process was entropy driven. The association and dissociation rate constants were 9 X 10(6) M-1 s-1 and 1.5 X 10(2) s-1 respectively. Temperature-jump experiments exhibited the presence of two isomers of the dimer, which are present at equilibrium in a ratio of about 1:1. Isomerization occurred with a half-life of about 0.1 s.