Emma M. Parrish

Neuropsychology and Youth Mental Health in Victoria: The Results of a Clinical Service Audit

Objective The allocation of neuropsychology services in Victorias public youth mental health system is very limited. The objective of this study was to evaluate the utility of a youth mental health neuropsychology service over a 16‐month period, and to evaluate referrer feedback about the service. Methods A 16‐month clinical data audit and referrer survey of the Eastern Health Child and Youth Mental Health Service neuropsychology service. Results A total of 45 clients were seen for assessment during the audit period with an age range of 7–25-years. Neuropsychological involvement identified DSM diagnoses in 42% of clients, as well as findings that were considered to be of neuropsychological importance in a further 51%. Case manager referrer surveys were returned at a rate of 58%, with 100% of responses indicating that the neuropsychological input had assisted with treatment planning, and that 79% of responders had altered their therapeutic approach after receiving the neuropsychological results. Conclusions Neuropsychology input in youth mental health services is useful from both a diagnostic and treatment planning perspective and often results in alterations in the therapeutic approach of case managers.

A Comparison of Vocational Engagement Among Young People with Psychosis, Depression and Borderline Personality Pathology

Poor vocational engagement is well documented among young people experiencing first-episode psychosis (FEP). The aim of the present study was to establish and compare rates of vocational engagement across young people with first-episode psychosis, depression, and borderline personality pathology. A file audit was used to collect vocational data of young people aged 15–25 entering tertiary mental health treatment in 2011. Rates of vocational engagement were similar across groups, indicating that like those with FEP, young people with depression and borderline personality pathology experience impaired vocational engagement and are in need of targeted vocational interventions. Post hoc analysis indicated that that the depression group had significantly more people who were partially vocationally engaged compared with the psychosis group, suggesting that vocational interventions might need to be targeted differently across different diagnostic groups. Future research should explore risk factors for vocational disengagement across diagnostic groups in order to inform intervention development.

Reasons for referral and findings of clinical neuropsychological assessment in youth with mental illness: A clinical file audit

ABSTRACT Study aims were to 1) determine the characteristics and reasons for referral for Clinical Neuropsychological Assessment (CNA) and 2) characterize the findings and recommendations contained in the CNA reports, of clients attending a youth mental health service. File audit of all CNA reports (N = 140) of youth attending a mental health service. Cognitive performances on neuropsychological tests that were administered to >50% of clients were examined. Referral reasons, findings, and recommendations for future treatment were coded and described from neuropsychological files. Age of clients referred for CNA ranged from 13–29, the majority were male (62.5%), referred primarily from the early psychosis clinic (63.2%), and had a mean number of 3.5 presenting problems. Cognitive performances ranged from extremely low to very superior. Mean number of reasons for referral was 2, with treatment recommendation (55%) and diagnostic clarification (50.7%) being the most common. Mean number of findings from CNA was 5.8; most commonly, a diagnosis of clinically meaningful cognitive impairment (85%), followed by a recommendations for additional services/investigations (77.1%). CNA provides diagnostic clarification and treatment recommendations for youth receiving mental health treatment. Future studies should examine the cost-effectiveness, implementation, and objective impact of CNA in clinical practice.

S203. COMPENSATORY COGNITIVE APPROACHES TO IMPROVING FUNCTIONING IN PSYCHOSIS: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background Cognitive impairments in domains such as attention, memory, processing speed and executive functions are a central feature of psychotic disorders that have significant negative consequences for daily functioning, including activities of daily living, social and vocational roles. Compensatory approaches aim to minimise the impact of cognitive impairment on daily functioning through the use of aids or strategies to reduce cognitive load, in much the same way as glasses reduce the impact of vision impairment. The primary treatment target is real world community functioning and functional capacity, rather than cognition. There is now a need to synthesise the available evidence in this field so that treatment recommendations and future research directions can be better informed. A large body of research into compensatory approaches to cognition in psychosis exists, but this has never been comprehensively synthesised. The aim of this systematic review and meta-analysis is to examine the effects of compensatory approaches for cognitive deficits in psychotic disorders on i) functional outcomes and ii) other outcomes such as symptoms and quality of life. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines. PsycINFO and MEDLINE electronic databases were searched from inception to October 2017 using multiple terms for ‘psychosis’, ‘cognition’ and ‘compensatory’. All papers retrieved from this search were double-screened and final inclusion/exclusion was determine by consensus. Data were double-extracted and risk of bias rated by two independent authors. Meta-analysis only included randomised-controlled trials. Standardised Mean Differences (SMD) were calculated to produce a single summary estimate using the random-effects model with 95% Confidence Intervals using Comprehensive Meta-Analysis (CMA) software. When means or standard deviations were not reported in the original articles, SMDs were calculated from data provided by the study authors. Results 2192 articles were identified via electronic and manual searches. Forty-two papers describing 40 independent studies were included in the review: case studies (n=4), case series (n=2), uncontrolled single arm pilot studies (n=5), within-subjects designs (n=1), quasi-randomised trials (n=2), and randomised controlled trials (n=26). The types of compensatory interventions included environmental adaptation and supports, internal and external self-management strategies, and errorless learning. Compensatory interventions were associated with improvements in global functioning post intervention (N=1,449; SMD=0.506; 95%CI=0.347, 0.665; p<.001). Improvements in global symptoms (N=849; SMD=-0.297; 95%CI=-0.484, -0.111; p=.002) and positive symptoms (N=784; SMD=-0.227; 95%CI=-0.416, -0.038; p=.018) were also found. Compensatory interventions were not associated with improvements in negative symptoms (N=736; SMD=-0.162; 95%CI=-0.382, 0.058; p=.150). The heterogeneity of findings was low. Discussion Compensatory approaches are effective for improving functioning in psychosis, with a medium effect size. General symptoms and positive symptoms appear to benefit from compensatory approaches, but compensatory approaches are not effective for improving negative symptoms. Future analyses will examine the durability of effects, effects of study quality and moderating factors such as pure vs. partially compensatory, treatment intensity/length, mode of delivery (group vs. individual), baseline functioning level and age of participants.

Clinical high risk for psychosis: The effects of labelling on public stigma in a undergraduate population

Schizophrenia is a highly stigmatized disorder. Identification of youth at high risk for psychosis has the potential for improved outcomes. However, identifying youth at risk could subject them to increased public stigma. Using an experimental vignette design, this study examined relative levels of public stigma elicited by the labels “schizophrenia,” “clinical high risk (CHR),” “attenuated psychotic symptoms syndrome (APSS),” a label implying normative adolescent development (“a bad breakup”), and a no‐label control condition.

Factors associated with vocational disengagement among young people entering mental health treatment

Most mental disorders have their onset by age 25, disrupting normative vocational engagement. Factors associated with vocational disengagement at first contact with specialist treatment are important for service planning. The aim of this paper was to investigate the association between theoretically important factors and vocational disengagement for youth entering mental health treatment.