Who cares? Pathways to psychiatric care for young people experiencing a first episode of psychosis

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.     

Personality changes in chronic schizophrenics following their first hospitalization

Diazepam was metabolized by human foetal liver microsomes to N-desmethyldiazepam and N-methyloxazepam as early as the 13th week of gestation. The metabolic activity was lower than that of microsomes from adult human liver. Diazepam was shown mainly to be hydroxylated to N-methyloxazepam at substrate concentrations higher than 0.1 mM. Diazepam levels above 1.0 mM were inhibitory to the overall metabolic reaction. SKF 525-A inhibited diazepam metabolism by foetal liver microsomes at a concentration of 0.1 mM. The addition of diazepam to foetal and adult human liver microsomes resulted in a type II spectral change. Its inhibition by carbon monoxide indicated that biotransformation of diazepam was performed by the cytochrome P-450-linked mono-oxygenase system.     

Short-term mortality after a first episode of status epilepticus

PURPOSE: Studies evaluating short-term mortality among people who experience status epilepticus (SE) have produced conflicting results. Most studies are derived from clinical series with results affected by unspecified follow-up period and select referral of cases. This study was planned to evaluate short-term mortality after a first episode of SE. METHODS: We performed a population-based retrospective cohort study to determine the short-term mortality following a first episode of SE. Between January 1, 1965 and December 31, 1984, we studied all first episodes of afebrile SE who received medical attention in Rochester, Minnesota. Cases were followed until death or end of the study (February 1996). RESULTS: Mortality within the first 30 days was 19% (38 deaths out of 201 incident SE). Thirty-four deaths (89%) occurred among those with nonfebrile acute symptomatic SE, while 4 deaths (11%) occurred among those with unprovoked SE. Within the acute symptomatic group, after adjusting for age, there was a decreased risk of death in women (RR = 0.4; 95% CI: 0.2-0.9). No effect of duration or seizure type was shown after adjusting for other risk factors. CONCLUSIONS: One out of 5 subjects with SE died within the first 30 days. Short-term mortality is associated with the presence of an underlying acute etiology. Among acute symptomatic cases, women had a decreased risk of dying.     

Aberrant semantic and affective processing in people at risk for psychosis.

Semantic and affective processing were examined in people at risk for psychosis. The participants were 3 groups of college students: 41 people with elevated Perceptual Aberration and Magical Ideation (PerMag) scores, 18 people with elevated Social Anhedonia (SocAnh) scores, and 100 control participants. Participants completed a single-word, continuous presentation pronunciation task that included semantically related words, affectively valenced words, and semantically unrelated and affectively neutral words. PerMag participants exhibited increased semantic priming and increased sensitivity to affectively valenced primes. SocAnh participants had increased sensitivity to affectively valenced targets. (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.     

Prodromal period of the first episode of schizophrenia

The purpose of this study was to test the effectiveness of an AIDS education intervention for methadone-dependent, African American women. The women were randomly assigned to experimental (n=107) or control (n=97) group. The experimental group participated in a peer counseling and leadership training program conducted by two experienced nurse counselors over an 8-week period, followed by 8 weeks of reinforcement. The program was designed to reduce AIDS high-risk sexual behavior, increase self-esteem, decrease depressive affect, and increase the women's community-based AIDS prevention communication activities. A total of 130 women completed all phases of the study, including longitudinal Posttests at 2, 4, and 7 months after enrollment. Compared to the control group, there were statistically significant differences in three of the outcomes for the experimental group: The experimental group reported an increased number of safer sexual behaviors (p=.029), showed decreases in depression (p=.001), and reported engaging in more AIDS-related, community-based communication activities regarding prevention (p=.005).     

Suicide following an inpatient hospitalization for a suicide attempt: a Canadian follow-up study

This study contributes a Canadian perspective to a growing body of international studies examining suicide among cohorts of suicide attempters, and a much more limited literature on the epidemiology of suicide in Canada. We evaluated the 13-year mortality experience of a regional cohort of 876 first-ever inpatient hospital admissions for a suicide attempt admitted between 1979 and 1981. Compared to the general population, study subjects were 4 times more likely to die of any cause, but 25 times more likely to commit suicide and 15 times more likely to die of accidental or adverse causes. Ten years after then first hospitalization for attempted suicide, 5.9% of study subjects had committed suicide. Baseline age appeared to be a risk factor for women, but not for men. Women under 60 years had the best 10-year survival (3.6% had committed suicide) and women over 60 years had the poorest (17.5%). A total of 8.7% of men under 60 years and 10% of those over 60 years committed suicide within 10 years. The remainder of the analysis focused on those under 60 years of age at the time of their index inpatient hospitalization. Three factors were prognostic for suicide: being male, which had a relative risk (RR) of 5.0, living in a lower income area (RR = 3.2), and having used a violent method during the index attempt (RR = 2.5). The periods of greatest risk for suicide were within the 1st and 4th years following first-ever inpatient hospitalization, with the 4th year representing the time of highest risk. The identification of time periods subsequent to first-ever hospitalization when patients are at greatest risk of suicide can be used to guide the timing and duration of clinical interventions and aftercare to ensure that patients are appropriately supported during periods of highest risk.     

On-line brain potential correlates of right parietal patients' attentional deficit

EEG potentials evoked by cues and targets were recorded in Posner's visual cueing task from 10 patients with lesions of the right parietal cortex and from age-matched healthy subjects. The patients' N1 component evoked by left-side cues was reduced at the right-parietal recording site, suggesting a general impairment in processing left-side visual input. As usual, patients' keypress responses were delayed when left targets were preceded by right cues. There were two correlates of this delay in the patients' EEG potentials evoked by the critical combination of right cue/left target: their mean amplitude 160-280 ms after target onset ('Nd') was less negative than with other combinations of cue and target, and the following frontal P300 was enhanced. The Nd reduction seems to be an on-line measure of patients' momentary decrease of attention for the left hemifield, while the frontal P300 might reflect the patients' attempts at reorienting. In conclusion, different components were sensitive to different aspects of the patients' disorder, suggesting the utility of this approach for developing detailed hypotheses on the mechanisms of attentional deficits involved in visual extinction and neglect.     

No effect of inversion on attentional and affective processing of facial expressions.

The decrease in recognition performance after face inversion has been taken to suggest that faces are processed holistically. Three experiments, 1 with schematic and 2 with photographic faces, were conducted to assess whether face inversion also affected visual search for and implicit evaluation of facial expressions of emotion. The 3 visual search experiments yielded the same differences in detection speed between different facial expressions of emotion for upright and inverted faces. Threat superiority effects, faster detection of angry than of happy faces among neutral background faces, were evident in 2 experiments. Face inversion did not affect explicit or implicit evaluation of face stimuli as assessed with verbal ratings and affective priming. Happy faces were evaluated as more positive than angry, sad, or fearful/scheming ones regardless of orientation. Taken together these results seem to suggest that the processing of facial expressions of emotion is not impaired if holistic processing is disrupted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The correlates of dogmatism and flexibility in psychiatric hospitalization.

All patients admitted to a short-term, intensive therapy psychiatric hospital were administered the Rokeach Dogmatism and Gough Flexibility scales on entry and exit. Independent of the patient's socioeconomic characteristics, patient dogmatism scores were significantly correlated with selected indexes of impairment, treatment, and outcome. Flexibility scores followed the same pattern, but yielded fewer significant correlations. Therapist scores on dogmatism and flexibility were not so predictive of patient impairment, treatment, and outcome as were patient dogmatism scores alone. Similarly, various combinations of therapist and patient dogmatism and flexibility scores (e.g., dogmatic patients with dogmatic therapists or dogmatic patients with flexible therapists) failed to achieve higher correlations than patient dogmatism scores. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence and correlates of major depressive episode among the elderly in a community in Japan

A random sample of 205 persons from a community of about 45,500 residents, aged 65 years or older, in a city in Japan, was surveyed using an interview schedule including a structured psychiatric interview to analyze prevalence of major depressive episode (DSM-III-R). A total of 157 (77%) participated in the study. Results were as follows: 1) The Prevalence of major depressive episode during the past 6 months was 2.1% for males and 3.7% for females among the 155 respondents who completed the psychiatric interview. 2) Significantly higher prevalence during the past 6 months was observed in those who were physically inactive in the past year than in those physically active (p < 0.05). 3) Levels of satisfaction with available social support were significantly lower in those who experienced major depressive episode during the past six months than in those who experienced no depressive episode (p < 0.05). 4) Levels of life satisfaction (PGC scale score) and cognitive functioning were significantly lower in those experienced major depressive episode during the past six months than in those who experienced no depressive episode (p < 0.05).     

Person–school environment correlates of children's affective characteristics.

Adopted an interactionism framework to examine relations between children's school-related affective characteristics and measures of intellectual ability and personality (Otis Intermediate Test and Children's Personality Questionnaire—Form A, respectively) at different perceived school environment levels. Data were collected on 255 female and 275 male 12-yr-old Australians. Regression surfaces were constructed from models that examined possible linear, curvilinear, and interaction associations among the variables. A new schedule was developed to measure Ss' perceptions of 4 interrelated school learning contexts (regulative, instructional, imaginative, and interpersonal). Two general propositions are suggested: (a) Changes in person variables are related differentially to affective characteristics depending on the level and nature of the perceived school learning context. (b) Ss' perceptions of school-learning contexts are associated differentially with affective characteristics depending on the level and nature of person variables. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violent thoughts and violent behavior following hospitalization for mental disorder.

Using a standardized schedule of questions, this study examined (a) the prevalence of self-report of violent thoughts by patients hospitalized for mental disorders compared with nonpatients, (b) the persistence of violent thoughts after discharge, and (c) the relation between patients' violent thoughts while hospitalized and violent acts within 20 weeks after hospital discharge. About 1/3 of the patients reported thoughts of violence while hospitalized, more than twice the proportion found among nonpatients. Reporting violent thoughts in hospital was significantly related to engaging in violent acts within 20 weeks after discharge for non-White patients, patients without major mental disorder but with substance abuse diagnoses, patients with high symptom severity, and patients whose reports of violent thoughts persisted after discharge. Reporting violent thoughts was significantly related to measures of psychopathy, anger, and impulsiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infant preference for both male and female infant-directed talk: A developmental study of attentional and affective responsiveness.

12 infants (aged 18–30 wks) in Exp 1 were significantly more attentive to a video recording of both a male and a female speaker delivering infant-directed talk (IDT) rather than adult-directed talk (ADT). Results were extended and replicated in Exp 2 with 32 infants (aged 4–5.5 mo or 7.5–9 mo). Younger Ss were significantly more responsive than older Ss on both attentional and affective measures. 16 infants (aged 4–5.5 mo) in Exp 3 preferred vocal features of IDT over ADT even with facial features held constant. 20 undergraduates in Exp 4 rated infants listening to IDT as more appealing, suggesting that IDT may facilitate the establishment of an emotional relationship between adults and infants. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opioid control of the fetal stretch response: Implications for the first suckling episode.

On their 1st experience with milk, fetal rats express a stretch response that is similar to the postnatal behavior exhibited by infant rats at the nipple. Fetuses also possess a functional opioid system that is activated by prenatal milk exposure. The opioid receptor antagonist naloxone and the specific kappa antagonist nor-binaltorphimine blocked the stretch response and prevented the increase in rearlimb activity that is typically induced by milk. The mu antagonist β-funaltrexamine blocked the stretch while permitting the expression of rearlimb activity. The kappa agonist U50,488 promoted rearlimb activity in the absence of milk, whereas the mu agonist [{d}-Ala–2,NMe-Phe–4,Gly–5-ol]-enkephalin (DAMGO) exerted little influence on fetal behavior. Fetuses pretreated with U50,488 stretched to nonmilk stimuli (saline or lemon), but fetuses pretreated with DAMGO did not. Opioid activation is part of a chain of events that culminates in the fetal stretch response and may be important in promoting milk ingestion during the newborn's 1st suckling episode. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intactness of inhibitory attentional mechanisms following severe closed-head injury.

Attentional problems are a common sequelae of closed-head injury (CHI). Research in the area of selective attention has pointed to the role of inhibitory mechanisms in the suppression of irrelevant information. In the current study, a negative priming paradigm was used to assess the inhibitory mechanisms of individuals suffering from a severe CHI. Twenty participants with severe CHIs (greater than 1 year postinjury) and 20 matched controls completed a negative priming task, as well as several other standardized tests of cognitive functioning. Within the negative priming task, 2 conditions were used to elicit information regarding facilitation by attended and ignored information and 1 condition was used to elicit inhibition of ignored information, as compared with a neutral control condition. Despite poorer performances on several tests of attention, there were no significant differences in the amount of inhibition displayed by the CHI participants as compared with the controls. Findings suggest that inhibitory processing deficits may not underlie the selective attention difficulties commonly seen following a severe CHI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic analgesia: A preliminary investigation of quantitated hemispheric electroencephalographic and attentional correlates.

The effects of hypnotically induced analgesia were studied in 6 undergraduate Ss rated as moderately hypnotizable and 5 Ss rated as highly hypnotizable. Subjective pain reports and EEG activation were recorded during 1-min periods of cold-pressor stimulation. Both groups reported decreased pain during hypnosis, but the decrease was greater for the highly hypnotizable group. During hypnotic analgesia, immersion of either the right or the left hand in ice water was correlated with contralateral EEG activation for moderately hypnotizable but not for highly hypnotizable Ss. Lack of contralateral shift was correlated for the whole sample and within groups with success on an attentional task related by previous research to hypnotizability as well as with reports of reduced pain. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experimental study of the first suckling episode: rat pups ingest fluids through a surrogate nipple

The present study reported a new technique in which pups ingested fluids from a surrogate nipple. Cesarean-delivered pups tested before suckling experience showed oral grasp responses and ingested milk from the surrogate nipple. Pups ingested equal amounts of distilled water and milk and rejected saline. After ingesting milk from the surrogate nipple, pups remained attached to an empty surrogate nipple, while pups exposed to distilled water or saline did not show sustained attachment. Brief experience with milk from an oral cannula or from a surrogate nipple elicited sustained attachment to an empty nipple. Pups ingesting milk from a surrogate nipple showed increased intake of water and saline from the nipple when tested subsequently. The surrogate nipple provides a new technique for experimental study of early suckling behavior. The results suggest that initial experiences with milk may reinforce components of early suckling behavior.     

Age on first hospitalization of schizophrenics: A developmental approach.

Compared ages at 1st hospitalization of 3 groups of schizophrenics: 64 males in a VA hospital and 60 male and 60 female patients in a state hospital. Paranoid Ss were approximately 8 yrs older when first admitted than the nonparanoids. In both diagnostic categories males were hospitalized about 5 yrs earlier than females. Working females with a diagnosis of paranoia were hospitalized approximately 10 yrs later than the paranoid females who remained at home and the nonparanoid females of either employment status. State hospital males were younger on 1st admission than VA hospital males. The ages of the 2 diagnostic groups in the VA were comparable, whereas in the state hospital the nonparanoid group was younger than the paranoid group by about 8 yrs. The need to pay greater attention to the differences between schizophrenic males and females and to scrutinize more closely differences between state and VA hospital patients is emphasized. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)