Caragh Behan

Mental state decoding v . mental state reasoning as a mediator between cognitive and social function in psychosis

Theory of mind deficits in schizophrenia have been parsed into mental state reasoning and mental state decoding components. We report that mental state decoding as measured by the ‘Eyes task’ better predicted social function than mental state reasoning as measured by the ‘Hinting task’ in 73 out-patients with chronic schizophrenia. Mental state decoding task performance also partly mediated the influence of basic neuropsychological performance on social function. We discuss these findings in terms of the accumulating evidence that mental state decoding has particular relevance for understanding deficits in social function in schizophrenia.

Depression and quality of life in first-episode psychosis

AIM Quality of life (QOL) has gained recognition as a valid measure of outcome in first-episode psychosis (FEP). This study aimed to determine the influence of specific groups of depressive symptoms on separate domains of subjectively appraised QOL. METHODS We assessed 208 individuals with first-episode non-affective psychosis using measures of diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), symptoms (Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and Calgary Depression Scale for Schizophrenia), functioning (Global Assessment of Functioning), insight (Birchwood Scale), duration of untreated psychosis (Beiser Scale), and QOL World Health Organisation Quality of Life Instrument (WHOQOL-Bref). We used multiple regression to determine the contribution of depressive symptoms to QOL domains while controlling for socio-demographic and other clinical characteristics. RESULTS There were complete data for 146 individuals with FEP. Quality-of-life domains were consistently predicted by depressive symptoms including depressive mood and hopelessness rather than biological symptoms of depression with those experiencing more depressive symptoms reporting worse QOL. Those who were treated as in-patients reported improved QOL, and hospitalization was an independent predictor of most QOL domains. In-patients displayed greater levels of positive symptoms with those involuntarily detained displaying greater levels of bizarre behavior, thought disorder, and delusions. CONCLUSIONS These findings suggest that QOL is heavily influenced by depressive symptoms at initial presentation; however, as QOL domains are also influenced by admission status with in-patients being more symptomatic in terms of positive symptoms, subjective QOL assessment may be compromised during the acute phase of illness by both positive and depressive symptom severity.

The economic cost of schizophrenia in Ireland : a cost of illness study

OBJECTIVES Although there are many published reports about the human cost of schizophrenia, there are far fewer estimates of its economic cost, particularly in Ireland. The aim of this study was to provide a prevalence-based estimate of the costs associated with schizophrenia in Ireland during 2006. METHOD Using standard Cost of Illness (COI) procedures we compiled data from many sources including the Health Research Board, the Department of Health and Children and other government publications. Costs relating to health and social care, informal care, lost productivity, premature mortality and other public expenditures were included. Where national data were unavailable, we used bottom-up data from a geographically defined catchment area study and, in some instances, costs from two catchment areas were averaged. We did not measure human or intangible costs. RESULTS The estimated total cost of schizophrenia was €460.6 million in 2006. The direct cost of care was €117.5 million and the burden of indirect costs was €343 million. The cost of lost productivity due to unemployment, absence from work and premature mortality was €277 million. Within indirect costs, the expenditure on informal care borne by families was €43.8 million. CONCLUSIONS Schizophrenia is not a very common condition but is an expensive one. This is attributable to its young age at onset, relatively low mortality rate and high severity particularly in terms of its impact on future employment. Measures to improve outcomes coupled with measures to improve employment such as supported employment strategies may impact significantly on the cost of schizophrenia. The study is limited because the national unit costs of many variables are not directly available and these Irish data are likely to be an underestimate. However, the results are comparable with a 2005 cost of illness study UK study.

Caregiver psychoeducation for first-episode psychosis

INTRODUCTION International best-practice guidelines for the management of first-episode psychosis have recommended the provision of psychoeducation for multifamily groups. While there is ample evidence of their efficacy in multiepisode psychosis, there is a paucity of evidence supporting this approach specifically for first-episode psychosis. We sought to determine whether a six-week caregiver psychoeducation programme geared specifically at first-episode psychosis improves caregiver knowledge and attitudes. METHODS Caregivers of people with first-episode psychosis completed a 23-item adapted version of the self-report Family Questionnaire (KQ) and a 17-item adapted version of the self-report Drug Attitudes Inventory (DAI) before and after the six-week DETECT Information and Support Course (DISC). Using a Generalised Linear Repeated Measures Model, we analyzed the differences in proportions of correct answers before and after the programme. RESULTS Over a 24-month study period, 31 caregivers (13 higher socioeconomic; 13 lower socioeconomic; five unspecified socioeconomic; 19 female; 12 male) participated in the DISC programme and completed inventories before and after the course. Knowledge of psychosis and specific knowledge of medication treatment improved among caregivers overall (p<.01; effect sizes 0.78 and 0.94 respectively). There were no significant gender or socioeconomic differences in any improvement. DISCUSSION This study confirms that caregiver psychoeducation specifically for first-episode psychosis directly improves knowledge of the illness overall and, in particular, knowledge of medication. Gender is not a factor in this, while the lack of any socioeconomic differences dispels the myth that patients in lower socioeconomic groups are disadvantaged because their caregivers know less.

Early intervention service for psychosis: views from primary care.

Aim: Although General Practitioners (GPs) have a pivotal role in early detection and treatment of psychosis, there is sparse information on their views of early intervention (EI) services and how information related to EI should be delivered.

First rank symptoms in first episode psychosis and their relationship to the duration of untreated illness.

Most studies of First Rank Symptoms (FRS) are based on cross-sectional inpatient samples of people with schizophrenia at various stages of illness. We sought to examine the prevalence of FRS in a representative sample of first episode psychosis patients and compare those with and without FRS clinically and in terms of duration of untreated illness. Information was gathered from 158 consecutive cases of first episode psychosis presenting in a defined geographical region through semi-structured interview tools. Of this sample, 40.5% of cases received a diagnosis of schizophrenia. The prevalence of FRS among the entire group was 52.5%. After controlling for multiple testing, no FRS contributed significantly to predicting a diagnosis of schizophrenia. There was no significant relationship between the duration of untreated illness and FRS.

Physical health and attendance at primary care in people with schizophrenia

Objectives: People with schizophrenia are at increased risk of cardiovascular and endocrine disease. National guidelines recommend the physical health of people with schizophrenia be monitored by primary care, but little is known about whether such people attend primary care. We sought to examine the prevalence of cardiovascular and endocrine disease in a stable population with schizophrenia, and factors associated with attending primary care. Method: A cross sectional survey of people with a diagnosis of schizophrenia/schizoaffective disorder was taken from a larger cohort participating in the Resource for Psychoses and Genomics in Ireland (RPGI) study. Participants were interviewed using standardised clinical assessments, and underwent anthropometric measurements, and further information was collected by medical record review and contacting the general practitioner (GP). Results: Thirteen percent (n = 14) had established cardiovascular disease and 4.3% (n = 4) had type 2 diabetes. Risk factors for cardiovascular disease and type 2 diabetes were higher than the general population. Sixty-eight point five percent (n = 63) had attended their GP at least once in the previous year. Only 35% self reported a physical illness. Females (p = 0.03), those with both self-reported presence of physical illness (p = 0.007), and diagnosed physical illness (p = 0.001) were more likely to attend their GP. Other psychosocial, psychological and illness related variables did not predict attendance at primary care. Conclusion: While established patients attend their GP, they had significant unidentified risk factors for cardiovascular disease and type 2 diabetes. It is likely that non-attendees at secondary care would fare worse yet.

The prognostic value of formal thought disorder following first episode psychosis.

BACKGROUND Formal thought disorder (FTD) is associated with poor outcome in established psychotic illnesses and it can be assessed as a categorical or dimensional variable. However, its influence on functional outcome and hospitalisation patterns in early psychosis has not been investigated. We evaluated the relationship between FTD and these outcomes in a first episode psychosis (FEP) sample. MATERIALS AND METHODS A mixed diagnostic FEP cohort was recruited through an Early Intervention in Psychosis Service in Ireland. Participants were assessed at initial presentation and one year later with the MIRECC GAF to evaluate social and occupational functioning domains. Disorganisation (disFTD), verbosity (verFTD) and poverty (povFTD) dimensions of FTD were examined at both time points, as well as a unitary FTD construct. Analyses were controlled for demographic, clinical and treatment variables. RESULTS DisFTD was the only FTD dimension associated with functional outcome, specifically social functioning, on multivariate analysis (beta=0.13, P<0.05). The unitary FTD construct was not associated with functional outcome. DisFTD at FEP presentation predicted a greater number of hospitalisations (adjusted beta=0.24, P<0.001) and prolonged inpatient admission (adjusted OR=1.08, 95% CI 1.02-1.15, P<0.05) following FEP. CONCLUSIONS Longitudinal and dimensional evaluation of FTD has a clinical utility that is distinct from a cross-sectional or unitary assessment. Dimensions of FTD may map onto different domains of functioning. These findings are supportive of some of the changes in DSM-V with an emphasis on longitudinal and dimensional appraisal of psychopathology. Communication disorders may be considered a potential target for intervention in psychotic disorders.

Factors that influence patients' attitudes to antipsychotic medication

OBJECTIVE The aim of this study was to investigate the attitudes to medication in relation to insight, purpose in life, symptoms and sociodemographic factors among a cohort of stable patients with a diagnosis of schizophrenia and schizoaffective disorder. METHOD We included 70 patients with a diagnosis of schizophrenia and schizoaffective disorder attending a Dublin suburban mental health service. All participants were 18 years or older and were excluded if they had a learning disability, acquired brain injury resulting in unconsciousness, and psychosis secondary to a general medical condition or illicit substance misuse. All participants were given self report questionnaires which included Drug Attitude Inventory (DAI-30), Birchwood Insight Scale, and Purpose in Life test. Symptoms were assessed using the Scale for Assessment of Positive and Negative symptoms. All data was analysed using the Statistical Package for the Social Sciences. RESULTS We found that 86% (n = 60) of the participants had positive attitudes to medication, and 82% (n = 58) had good insight into their illness. Only 27% (n = 19) were found to have a definite purpose in life. There was a significant negative relationship between attitudes to medication and delusions (r = -0.25, n = 70, p < 0.05) and a significant positive relationship between insight and attitudes to medication (r = 0.0.28, n = 70, p < 0.05). CONCLUSION Many factors are involved in the multifaceted issue of attitudes to medication. Researchers must realise that these factors do not remain constant and may change with time and over the course of illness and treatment.

Systematic review of the evidence for service models delivering early intervention in psychosis outside the stand-alone centre

Although early intervention in psychosis is an accepted policy internationally, the evidence base for this paradigm, originates mostly from the specialist model. In a real world setting, variations of this model are often implemented. The aim of this paper is to systematically evaluate the evidence for delivering early intervention outside the specialist stand‐alone centre.