Henry J. Jackson

Emotion recognition via facial expression and affective prosody in schizophrenia: a methodological review.

Disturbances in affect recognition may be one of the most pervasive and serious aspects of the schizophrenic patients interpersonal problems. Interest in the decoding of emotional information in schizophrenia has focused on facial affect recognition with 29 experimental papers on that topic published since 1987. A smaller literature exists on the topic of recognition of affect in speech and there are at least seven studies, which have examined both face and voice perception in the same individuals with schizophrenia. This paper includes a comprehensive analysis of the schizophrenia facial affect recognition research over the past decade and the schizophrenia literature on affective prosody, and provides the first review of the schizophrenia literature on multichannel emotion recognition research. The weight of evidence would suggest that individuals with schizophrenia experience problems in the perception of emotional material; however, the specificity, extent, and nature of the deficits are unclear. Emotion recognition research in schizophrenia should be informed by the general literature on emotion recognition with serious attention paid to methodological issues.

Facial affect and affective prosody recognition in first-episode schizophrenia.

Individuals with schizophrenia experience problems in the perception of emotional material; however, the specificity, extent, and nature of the deficits are unclear. Facial affect and affective prosody recognition were examined in representative samples of individuals with first-episode psychosis, assessed as outpatients during the early recovery phase of illness, and non-patients. Perception tasks were selected to allow examination of emotion category results across face and voice modalities. Facial tasks were computerised modifications of the Feinberg et al. procedure (Feinberg, T.E., Rifkin, A., Schaffer, C., Walker, E., 1986. Arch. Gen. Psychiatry 43, 276--279). Prosody tasks were developed using four professional actors, and item selections were based on responses of undergraduates. Participant groups did not differ in their understanding of the words used to describe emotions. Findings supported small but consistent deficits in recognition of fear and sadness across both communication channels for the combined schizophrenia (n=29) and other psychotic disorders (n=28) groups as compared to the affective psychoses (n=23) and non-patients (n=24). A diagnostic effect was evident that was independent of the contribution of intelligence. The detection of emotion recognition impairments in first-episode schizophrenia suggests a trait deficit. The pattern of results is consistent with amygdala dysfunction in schizophrenia and related psychoses.

Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual

BACKGROUND Unemployment is a major problem for people with first-episode psychosis and schizophrenia. This has repercussions for the economy, social functioning and illness prognosis. AIMS To examine whether a vocational intervention - individual placement and support (IPS) - which has been found to be beneficial in populations with chronic schizophrenia, was a useful intervention for those with first-episode psychosis. METHOD A total of 41 people with first-episode psychosis were randomised to receive either 6 months of IPS + treatment as usual (TAU) (n=20) or TAU alone (n=21). RESULTS The IPS group had significantly better outcomes on level of employment (13 v. 2, P<0.001), hours worked per week (median 38 v. 22.5, P=0.006), jobs acquired (23 v. 3) and longevity of employment (median 5 weeks v. 0, P=0.021). The IPS group also significantly reduced their reliance on welfare benefits. CONCLUSIONS Individual placement and support has good potential to address the problem of vocational outcome in people with first-episode psychosis. This has economic, social and health implications.

The prevalence of prodromal features of schizophrenia in adolescence: a preliminary survey

In most cases of schizophrenia the onset of frank psychosis is preceded by a period of prodromal features. This period has been relatively neglected by researchers and is potentially important in promoting early intervention. The prevalence of DSM‐III‐R schizophrenia prodrome symptoms was assessed as part (n= 657) of a large (n= 2525) questionnaire‐based survey of high school students. Individual symptoms were highly prevalent and the prevalence of DSM‐III‐R prodromes ranged from 10–15% to 50%. Despite methodological weaknesses, the data suggest that DSM‐III‐R prodromal features are extremely prevalent among older adolescents and unlikely to be specific for subsequent schizophrenia. Clinically these features cannot be regarded as sufficient evidence of early schizophrenia and more accurate predictors of incipient schizophrenia need to be defined.

The relationship between duration of untreated psychosis and outcome: an eight-year prospective study.

Longer duration of untreated psychosis (DUP) prior to the initiation of treatment has been found to predict poorer short-term clinical and functional outcomes in patients with first-episode psychosis (FEP). The extent to which the relationship between DUP and outcome is maintained in the medium-to-long term however remains unclear. We examined the influence of DUP on clinical and functional outcomes in a prospective, naturalistic study of 318 FEP patients followed up 8 years after initial treatment at a specialist early psychosis service. Quality of life, social and occupational functioning, positive and negative symptoms at 8 years were assessed using standardized instruments. Multiple linear regression analyses indicated that, after controlling for the effects of other factors, shorter DUP correlated moderately with decreased severity of positive symptoms, and enhanced social and occupational functioning and quality of life. There was no uniform point associated with medium-to-long term impairment, with some domains of outcome more sensitive to treatment delay than others. However a consistent finding was that outcomes for these domains were significantly worse when DUP exceeded 3 months. Among those with a schizophrenia-spectrum diagnosis, DUP exceeding 1 year was associated with poorer outcome. No association was found between DUP and negative symptoms in either diagnostic group. As with short-term prognosis, DUP appears to be an independent predictor of prognosis in the medium-to-long term. Results support the need for assertive early detection strategies to facilitate the timely delivery of effective intervention programs to those with emerging psychotic illness in order to reduce the risk of long term deleterious outcomes.

The recognition and management of early psychosis : a preventive approach

Dedication List of contributors Foreword Jan Olav Johannessen Acknowledgements Part I. Introduction: 1. Rationale for and overview of the 2nd edition of The Recognition and Management of Early Psychosis Henry J. Jackson, Patrick D. McGorry and Kelly Allott 2. Diagnosis and the staging model of psychosis Patrick D. McGorry, Kelly Allott and Henry J. Jackson Part II. Risk and Vulnerability: 3. Genetic vulnerability Daniel Weinberger and Gregor Berger 4. Environmental vulnerability and genetic-environmental interactions Jim van Os and Richie Poulton 5. Neurobiological endophenotypes of psychosis and schizophrenia: are there biological markers of illness onset? Christos Pantelis, Murat Yucel, Stephen J. Wood, Warrick J. Brewer, Alex Fornito, Gregor Berger, Tyrone Cannon and Dennis Velakoulis Part III. At Risk Mental State: 6. At risk mental state and prediction Alison R. Yung, Joachim Klosterkoetter, Barbara Cornblatt and Frauke Schultze-Lutter 7. At risk mental state: management Lisa J. Phillips, Jean Addington and Anthony P. Morrison Part IV. Access and Reducing Delay to Treatment: Reducing DUP: 8. Duration of untreated psychosis: definition, measurement and association with outcome Max Marshall, Susy Harrigan and Shon Lewis 9. Improving the communitys mental health literacy as a means of facilitating early intervention Anthony F. Jorm and Annemarie Wright 10. Pathways to care and reducing treatment delay in early psychosis Ross M. G. Norman and Ashok K. Malla Part V. The First Episode: 11. Initial assessment and initial pharmacological treatment in the acute phase Martin Lambert 12. Complete and incomplete recovery from first-episode psychosis Jean Addington, Tim Lambert and Peter Burnett 13. Preventive strategies in bipolar disorders: identifying targets for early intervention Philippe Conus, Michael Berk, Nellie Lucas, Jose Luis Vazquez-Barquero and Craig Macneil Part VI. The Critical Period: Other Psychopathology and Comorbidity: 14. Substance misuse in first-episode psychosis Darryl Wade, Leanne Hides, Amanda Baker and Dan Lubman 15. Suicide prevention in first-episode psychosis Paddy Power and Jo Robinson 16. Emotional and personality dysfunctions in early psychosis Max Birchwood, John Gleeson, Andrew Chanen, Louise K. McCutcheon, Shona M. Francey and Maria Michail Part VII. The Critical Period: Specific Interventions: 17. Family intervention in early psychosis Catharine McNab and Don Linszen 18. Enhancing work functioning in early psychosis Eoin Killackey, Henry J. Jackson, David Fowler and Keith H. Nuechterlein 19. Relapse prevention in early psychosis John Gleeson, Don Linszen and Durk Wiersma 20. Treatment resistance in first-episode psychosis Christian G. Huber and Martin Lambert Part VIII. Service Models: 21. Using research and evaluation to inform the development of early psychosis service models: international examples Meredith Harris, Thomas Craig, Robert B. Zipursky, Donald Addington, Merete Nordentoft and Paddy Power.

Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial

BACKGROUND No accepted intervention exists for borderline personality disorder presenting in adolescence. AIMS To compare the effectiveness of up to 24 sessions of cognitive analytic therapy (CAT) or manualised good clinical care (GCC) in addition to a comprehensive service model of care. METHOD In a randomised controlled trial, CAT and GCC were compared in out-patients aged 15-18 years who fulfilled two to nine of the DSM-IV criteria for borderline personality disorder. We predicted that, compared with the GCC group, the CAT group would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24 months. RESULTS Eighty-six patients were randomised and 78 (CAT n=41; GCC n=37) provided follow-up data. There was no significant difference between the outcomes of the treatment groups at 24 months on the pre-chosen measures but there was some evidence that patients allocated to CAT improved more rapidly. No adverse effect was shown with either treatment. CONCLUSIONS Both CAT and GCC are effective in reducing externalising psychopathology in teenagers with sub-syndromal or full-syndrome borderline [corrected] personality disorder. Larger studies are required to determine the specific value of CAT in this population.

High prevalence disorders in urban and rural communities

Objective: High prevalence disorders (anxiety, depressive and substance use) are generally assumed to be more common in urban than rural dwellers. The aims of this paper are (i) to critically review studies measuring prevalence in rural as opposed to urban location, and (ii) to argue the need to look beyond the ‘quantity’ question to the quality question: how does urban or rural place influence mental health? Method: A literature review (Medline and PsychLIT) was carried out using the words ‘rural, urban, mental/psychiatric, illness/disorders and prevalence’, as well as a review of relevant papers and publications known to the authors. Results: Many studies examining urban/rural differences in the rate of high prevalence disorders have been reported. Most use a ‘one size fits all’ definition of urban and rural, which assumes location is the key issue. The majority fail to show the purported difference in prevalence between the two settings. In general, studies have not examined interaction effects, but have simply treated the independent variables as main effects. Available data suggest that a variety of socio-demographic factors are more powerful predictors of difference in prevalence than is the location of residence. Conclusion: Further studies are required to understand if and how rural or urban place contributes to the development of psychiatric morbidity. These studies should mirror the clinical situation by taking into account a variety of individual and community-based (including urban/rural place) risk factors which may be important determinants of mental health and mental illness, and examining the interaction between them. This may then identify the nature of any differences or what issues are specific to, or especially important, in the rural setting.

Personality disorders in the community: a report from the Australian National Survey of Mental Health and Wellbeing

Background: The first set of aims of the present study was to determine the prevalence of personality disorders (PDs) in a nation, and gender differences in the types and numbers of PDs endorsed. The second set of aims was to establish the relationship of PD to other, non-PD disorders, physical conditions, and disability. Method: Data were obtained from the Australian National Survey of Mental Health and Wellbeing, conducted between May and August 1997. A stratified random sample of households was generated, from which all those aged 18 or over were considered potential interviewees. There were 10,641 respondents to the survey, and this represented a response rate of 78%. Each interviewee was asked 59 questions indexing specific ICD-10 PD criteria. Results: Of the total survey sample, 704 persons had at least one PD. Using weighted replicate weights, it was estimated that approximately 6.5% of the adult population of Australia have one or more PDs (lifetime prevalence). Persons with PD were more likely to be younger, male, and not married, and to have an anxiety disorder, an affective disorder, a substance use disorder, or a physical condition. They were also more likely to have greater disability than those without PD. Conclusion: The study is the first nation-wide survey of mental disorders conducted within Australia. It provides an estimate of the prevalence of the various types of PD. The survey has considerable limitations, however, and these are discussed.

The dimensional structure of first episode psychosis: an exploratory factor analysis

BACKGROUND Recent research has focused upon the subdiagnostic level in an effort to derive more valid domains of psychotic disorder. This has led to the influential positive-negative dichotomy in schizophrenia being superseded by a three-syndrome model. The strategy of looking for syndromes within poorly validated diagnostic categories, such as schizophrenia, has limitations, particularly since it originated in, and has been largely restricted to, the more chronic subsamples. METHOD A representative sample of first episode psychosis (N = 509), which includes the full spectrum of functional psychosis, was utilized to re-examine the dimensional structure of functional psychosis from first principles. Patients were assessed with the Royal Park Multidiagnostic Instrument for Psychosis (MIP), a comprehensive procedure that documents the psychopathology of the first episode in a clinically valid manner. RESULTS Principal axis factor analysis was carried out on the tetrachoric correlation matrix of 92 core psychopathological items. A robust and clinically valid four-factor solution was obtained, comprising depression, mania and only two other factors. The first was a Bleulerian blend of negative symptoms, catatonic/motor symptoms and disorganization. The second was a combination of Schneiderian first rank symptoms, and other hallucinations and delusions. The data thus failed to support the three-syndrome model for non-affective symptoms in this population. A six-factor solution, although partially consistent with other studies, represented a more complex and confusing elaboration of the more clinically valid four-factor solution. CONCLUSIONS The findings have implications for the conceptualization of early psychosis, which need to be explored further in validation studies.