Gennady N. Baksheev

Psychotic-like experiences in a community sample of adolescents: implications for the continuum model of psychosis and prediction of schizophrenia

Objective: Studies conducted in community samples suggest that psychotic-like experiences are common in the general population, leading to suggestions that they are either variations of normal personality or are different expressions of underlying vulnerability to psychotic disorder. Different types of psychotic symptoms may exist, some being normal variants and some having implications for mental health and functioning. The aim of the present study was to determine if different subtypes of psychotic-like experiences could be identified in a community sample of adolescents and to investigate if particular subtypes were more likely to be associated with psychosocial difficulties, that is, distress, depression and poor functioning, than other subtypes. Method: Eight hundred and seventy-five Year 10 students from 34 schools participated in a cross-sectional survey that measured psychotic-like experiences using the Community Assessment of Psychic Experiences; depression using the Centre for Epidemiologic Studies Depression Scale; and psychosocial functioning using the Revised Multidimensional Assessment of Functioning Scale. Factor analysis was conducted to identify any subtypes of psychotic experiences. Results: Four subtypes of psychotic-like experiences were identified: Bizarre Experiences, Perceptual Abnormalities, Persecutory Ideas, and Magical Thinking. Intermittent, infrequent psychotic experiences were common, but frequent experiences were not. Bizarre Experiences, Perceptual Abnormalities and Persecutory Ideas were strongly associated with distress, depression and poor functioning. Magical Thinking was only weakly associated with these variables. Overall these findings may suggest that infrequent psychotic-like experiences are unlikely to be a specific risk factor for onset of a psychotic disorder in community samples. Conclusions: Given that the different subtypes had varying associations with current difficulties it is suggested that not all subtypes confer the same risk for onset of psychotic disorder and poor outcome. Bizarre Experiences, Perceptual Abnormalities and Persecutory Ideas may represent expressions of underlying vulnerability to psychotic disorder, but Magical Thinking may be a normal personality variant.

Validity of the 12-item General Health Questionnaire (GHQ-12) in detecting depressive and anxiety disorders among high school students.

Despite the common use of the 12-item General Health Questionnaire (GHQ-12) with adolescents, there is limited data supporting its validity with this population. The aims of the study were to investigate the psychometric properties of the GHQ-12 among high school students, to validate the GHQ-12 against the gold standard of a diagnostic interview, and to suggest a threshold score for detecting depressive and anxiety disorders. Six hundred and fifty-four high school students from years 10 to 12 (ages 15-18) completed the GHQ-12 (Likert scored) and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV-Test Revision (DSM-IV-TR). Receiver operating characteristic (ROC) curves were plotted. The mean GHQ-12 score for the total sample was 9.9 (S.D.=5.4). Results from the ROC curve indicated that the GHQ-12 performed better than chance at identifying depressive and anxiety disorders (area under the curve (AUC)=0.781). A GHQ-12 threshold score of 9/10 for males and 10/11 for females was found to be optimal. Given the significant proportion of mental illness among high school students, there may be a need to introduce screening for mental illnesses as part of the school curriculum. This can assist with the early identification and enable low stigma preventive intervention within the school environment.

Psychiatric disorders and unmet needs in Australian police cells

Objective: To determine the prevalence of current psychiatric disorders and unmet needs in a sample of police cell detainees in Victoria. Method: A cross-sectional descriptive study was conducted, including data linkage with the Victoria Police database and the Victorian Psychiatric Case Register. In Melbourne, Australia, 150 detainees were recruited from two busy metropolitan police stations. Outcome measures included estimated rates of psychiatric disorders, using the Structured Clinical Interview for DSM-IV-TR, and individual needs, using the Camberwell Assessment of Need – Forensic Version. Results: One quarter (n = 32, 25.4%) of detainees had a prior admission to a psychiatric hospital, and three quarters met current criteria for a diagnosable mental disorder. The most common disorders were substance dependence (n = 81, 54%) and mood disorders (n = 60, 40%). A third met diagnostic criteria for both a mental illness and a substance use disorder. The odds of being classified with mood (OR = 10.1), anxiety (OR = 2.2), psychotic (OR = 15.4) and substance use disorders (OR = 26.3) were all significantly higher in the current sample as compared with the general population. Detainees with a mental illness identified significantly more needs and significantly more unmet needs (e.g. psychological distress) than those who did not rate as having a current mental illness. Conclusions: There remains a pressing need to evaluate standardized screening tools for mental illnesses in police cells to provide timely access to assessment and treatment services. The need for functional interagency collaborations are highlighted and discussed.

Impact of co-occurring substance use on 6 month outcomes for young people seeking mental health treatment.

Objective: Co-occurring substance use and mental health disorders are highly prevalent among young people attending services, yet few studies have examined the effect of such comorbidity among those referred for treatment. The aim of the current study was to examine the impact of co-occurring substance use disorders (SUDs) on 6 month outcomes for young people seeking mental health treatment. Method: One hundred and six young people (aged 15–24 years) with a non-psychotic DSM-IV Axis I disorder were assessed following referral to a specialist youth public mental health service. Participants were given a structured interview, as well as questionnaires assessing drug use, psychopathology, psychosocial functioning and self-esteem at baseline and 6 month follow up. Results: At baseline, 23 participants met criteria for a co-occurring SUD and 83 had a non-psychotic Axis I disorder. Both the non-SUD and the co-occurring SUD groups had high levels of psychopathology, serious impairments in functioning and moderate levels of suicidal ideation, although those with co-occurring SUD had significantly poorer levels of functioning. At 6 month follow up the co-occurring SUD group continued to experience substantial problems with symptoms and functioning whereas the non-SUD group had significant improvement in both of these domains. Conclusions: The present findings are consistent with studies examining the impact of co-occurring substance use and mental health issues across different treatment settings, and reinforce recommendations that young people with co-occurring disorders require more intensive and integrated interventions. The present findings also highlight the need for routine assessment and management of substance use issues within youth mental health settings.

The relative contribution of neurocognition and social cognition to 6-month vocational outcomes following Individual Placement and Support in first-episode psychosis

AIMS To examine whether baseline neurocognition and social cognition predict vocational outcomes over 6 months in patients with first-episode psychosis (FEP) enrolled in a randomised controlled trial of Individual Placement and Support (IPS) versus treatment as usual (TAU). METHODS 135 FEP participants (IPS n=69; TAU n=66) completed a comprehensive neurocognitive and social cognitive battery. Principal axis factor analysis using PROMAX rotation was used to determine the underlying cognitive structure of the battery. Setwise (hierarchical) logistic and multivariate linear regressions were used to examine predictors of: (a) enrolment in education and employment; and (b) hours of employment over 6 months. Neurocognition and social cognition factors were entered into the models after accounting for premorbid IQ, baseline functioning and treatment group. RESULTS Six cognitive factors were extracted: (i) social cognition; (ii) information processing speed; (iii) verbal learning and memory; (iv) attention and working memory; (v) visual organisation and memory; and (vi) verbal comprehension. Enrolment in education over 6 months was predicted by enrolment in education at baseline (p=.002) and poorer visual organisation and memory (p=.024). Employment over 6 months was predicted by employment at baseline (p=.041) and receiving IPS (p=.020). Better visual organisation and memory predicted total hours of paid work over 6 months (p<.001). CONCLUSIONS Visual organisation and memory predicted the enrolment in education and duration of employment, after accounting for premorbid IQ, baseline functioning and treatment. Social cognition did not contribute to the prediction of vocational outcomes. Neurocognitive interventions may enhance employment duration in FEP.

Predictors of Vocational Recovery Among Young People With First-Episode Psychosis: Findings From a Randomized Controlled Trial

OBJECTIVE The current study sought to examine demographic and clinical predictors of vocational recovery among young people with first-episode psychosis who participated in a randomized controlled trial (RCT) investigating the effectiveness of the supported employment model among this population. METHOD Our original RCT compared Individual Placement and Support + treatment as usual (n = 20) with treatment as usual alone (n = 21) (Killackey, Jackson, & McGorry, 2008). A series of logistic regression analyses were conducted to assess the predictive power of demographic and clinical factors on the vocational recovery of young people with first-episode psychosis. RESULTS Vocational recovery (defined as securing a position in competitive employment or attending a course of education at any point during the 6-month follow-up period) was predicted by participating in the vocational intervention (OR = 14.17, p = .001), having never been married (compared to those married/de facto: OR = 6.56, p = .044), and the instrumental role functioning subscale from the Quality of Life scale (OR = 1.21, p = .037). When considered together, only treatment group remained significant: Participants randomized to the vocational intervention were 16.26 times more likely to obtain work or study during the follow-up period compared to participants randomized to treatment as usual. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE It is critical that vocational services are introduced as part of an evidence-based, multidisciplinary approach in routine clinical care at early psychosis services. Further replication of these findings is indicated with a larger sample, particularly with the addition of cognitive training interventions to further improve vocational outcomes for young people with first-episode psychosis.

Does Screening High School Students for Psychological Distress, Deliberate Self-Harm, or Suicidal Ideation Cause Distress - And Is It Acceptable?

BACKGROUND Programs designed to detect students at risk of depression and suicidality have shown success (Shaffer et al., 2004). AIMS The current study sought to examine whether or not such a program was acceptable to participants and whether or not it caused distress. METHODS Participants were boys aged 14 to 16. Participants were assessed using an on-line questionnaire; acceptability was measured via postal questionnaire. RESULTS Of 272 participants, 31 (11.4%) were considered at-risk; 13 required ongoing support, 8 of whom had not previously sought help. Overall screening did not appear to cause significant undue distress, although some differences were evident between at-risk and not at-risk students. All participants found the program acceptable. CONCLUSIONS When conducted carefully, early detection programs can be an effective and acceptable method of identifying at-risk adolescents.

Using internet enabled mobile devices and social networking technologies to promote exercise as an intervention for young first episode psychosis patients

BackgroundYoung people with first episode psychosis are at an increased risk for a range of poor health outcomes. In contrast to the growing body of evidence that suggests that exercise therapy may benefit the physical and mental health of people diagnosed with schizophrenia, there are no studies to date that have sought to extend the use of exercise therapy among patients with first episode psychosis. The aim of the study is to test the feasibility and acceptability of an exercise program that will be delivered via internet enabled mobile devices and social networking technologies among young people with first episode psychosis.Methods/DesignThis study is a qualitative pilot study being conducted at Orygen Youth Health Research Centre in Melbourne, Australia. Participants are young people aged 15-24 who are receiving clinical care at a specialist first episode psychosis treatment centre. Participants will also comprise young people from the general population. The exercise intervention is a 9-week running program, designed to gradually build a persons level of fitness to be able to run 5 kilometres (3 miles) towards the end of the program. The program will be delivered via an internet enabled mobile device. Participants will be asked to post messages about their running experiences on the social networking website, and will also be asked to attend three face-to-face interviews.DiscussionThis paper describes the development of a qualitative study to pilot a running program coupled with the use of internet enabled mobile devices among young people with first episode psychosis. If the program is found to be feasible and acceptable to patients, it is hoped that further rigorous evaluations will ultimately lead to the introduction of exercise therapy as part of an evidence-based, multidisciplinary approach in routine clinical care.

A randomized controlled trial of vocational intervention for young people with first-episode psychosis: method

Young people who are experiencing first‐episode psychosis (FEP) are at increased risk of being unemployed compared to either their same age peers in the general population, or those with other mental illnesses. Significant research has been conducted examining employment interventions for those with chronic psychotic illness. This has yielded strong results in favour of an intervention called individual placement and support (IPS). However, significantly less work has examined the benefit of this approach to those in FEP when the potential for vocational rehabilitation is perhaps greater. This study adds to the knowledge of vocational intervention in first‐episode psychotic illness. Additionally, it expands this work into the areas of cognition, social cognition, social inclusion and economics.

Identification of mental illness in police cells: a comparison of police processes, the Brief Jail Mental Health Screen and the Jail Screening Assessment Tool

Abstract The study investigated current police practices employed to identify those with a mental illness in police custody, and to evaluate the predictive utility of the Brief Jail Mental Health Screen (BJMHS) and the Jail Screening Assessment Tool (JSAT). One hundred and fifty detainees were recruited from two police stations in Melbourne, Australia. Measures included the Structured Clinical Interview for DSM-IV-TR, BJMHS and JSAT. Axis-I disorders were compared with police decisions regarding identification of mental illness based on their usual practices. Participants were classified as requiring referral for further mental health evaluation according to the screening tools. Results indicated that current police practices produced high false negatives, with many of those experiencing mental illness not identified. There was no significant difference in performance between BJMHS (AUC =0.722) and JSAT (AUC =0.779) in identifying those with a serious mental illness (p=0.109). However, JSAT performed significantly better at identifying any Axis-I disorder, excluding substance use disorders, as compared with BJMHS (AUC =0.815, vs AUC =0.729; p=0.018). Given the high prevalence of mental illness among detainees, there is a pressing need to introduce standardised screening tools for mental illness in police custody. This can assist the police in managing detainees appropriately and securing mental health services as required.