Paul French

Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial

Objective To determine whether cognitive therapy is effective in preventing the worsening of emerging psychotic symptoms experienced by help seeking young people deemed to be at risk for serious conditions such as schizophrenia. Design Multisite single blind randomised controlled trial. Setting Diverse services at five UK sites. Participants 288 participants aged 14-35 years (mean 20.74, SD 4.34 years) at high risk of psychosis: 144 were assigned to cognitive therapy plus monitoring of mental state and 144 to monitoring of mental state only. Participants were followed-up for a minimum of 12 months and a maximum of 24 months. Intervention Cognitive therapy (up to 26 (mean 9.1) sessions over six months) plus monitoring of mental state compared with monitoring of mental state only. Main outcome measures Primary outcome was scores on the comprehensive assessment of at risk mental states (CAARMS), which provides a dichotomous transition to psychosis score and ordinal scores for severity of psychotic symptoms and distress. Secondary outcomes included emotional dysfunction and quality of life. Results Transition to psychosis based on intention to treat was analysed using discrete time survival models. Overall, the prevalence of transition was lower than expected (23/288; 8%), with no significant difference between the two groups (proportional odds ratio 0.73, 95% confidence interval 0.32 to 1.68). Changes in severity of symptoms and distress, as well as secondary outcomes, were analysed using random effects regression (analysis of covariance) adjusted for site and baseline symptoms. Distress from psychotic symptoms did not differ (estimated difference at 12 months −3.00, 95% confidence interval −6.95 to 0.94) but their severity was significantly reduced in the group assigned to cognitive therapy (estimated between group effect size at 12 months −3.67, −6.71 to −0.64, P=0.018). Conclusions Cognitive therapy plus monitoring did not significantly reduce transition to psychosis or symptom related distress but reduced the severity of psychotic symptoms in young people at high risk. Most participants in both groups improved over time. The results have important implications for the at risk mental state concept. Trial registration Current Controlled Trials ISRCTN56283883.

A systematic review and meta-analysis of exercise interventions in schizophrenia patients.

BACKGROUND The typically poor outcomes of schizophrenia could be improved through interventions that reduce cardiometabolic risk, negative symptoms and cognitive deficits; aspects of the illness which often go untreated. The present review and meta-analysis aimed to establish the effectiveness of exercise for improving both physical and mental health outcomes in schizophrenia patients. METHOD We conducted a systematic literature search to identify all studies that examined the physical or mental effects of exercise interventions in non-affective psychotic disorders. Of 1581 references, 20 eligible studies were identified. Data on study design, sample characteristics, outcomes and feasibility were extracted from all studies and systematically reviewed. Meta-analyses were also conducted on the physical and mental health outcomes of randomized controlled trials. RESULTS Exercise interventions had no significant effect on body mass index, but can improve physical fitness and other cardiometabolic risk factors. Psychiatric symptoms were significantly reduced by interventions using around 90 min of moderate-to-vigorous exercise per week (standardized mean difference: 0.72, 95% confidence interval -1.14 to -0.29). This amount of exercise was also reported to significantly improve functioning, co-morbid disorders and neurocognition. CONCLUSIONS Interventions that implement a sufficient dose of exercise, in supervised or group settings, can be feasible and effective interventions for schizophrenia.

Disability in people clinically at high risk of psychosis

BACKGROUND Decline in social functioning occurs in individuals who later develop psychosis. AIMS To investigate whether baseline differences in disability are present in those who do and those who do not make a transition to psychosis in a group clinically at high risk and whether disability is a risk factor for transition. METHOD Prospective multicentre, naturalistic field study with an 18-month follow-up period on 245 help-seeking individuals clinically at high risk. Disability was assessed with the Disability Assessment Schedule of the World Health Organization (WHODAS-II). RESULTS At baseline, the transition group displayed significantly greater difficulties in making new friends (z = -3.40, P = 0.001), maintaining a friendship (z =-3.00, P = 0.003), dealing with people they do not know (z =-2.28, P = 0.023) and joining community activities (z =-2.0, P = 0.05) compared with the non-transition group. In Cox regression, difficulties in getting along with people significantly contributed to the prediction of transition to psychosis in our sample (β = 0.569, s.e. = 0.184, Wald = 9.548, P = 0.002, hazard ratio (HR) = 1.767, 95% CI 1.238-2.550). CONCLUSIONS Certain domains of social disability might contribute to the prediction of psychosis in a sample clinically at high risk.

Laser Welding of Aluminium Alloy 5083

There are two laser welding mechanisms, keyhole mode and conduction mode. Keyhole welding is widely used because it produces welds with high aspect ratios and narrow heat affected zones. However keyhole welding can be unstable, as the keyhole oscillates and closes intermittently. This intermittent closure causes porosity due to gas entrapment. Conduction welding, on the other hand, is more stable since vaporisation is minimal and hence there is no further absorption below the surface of the material.Conduction welds are usually produced using low-power focused laser beams. This results in shallow welds with a low aspect ratio. In this work, high-power CO2 and YAG lasers have been used to produce laser conduction welds on 2mm and 3mm gauge AA5083 respectively by means of defocused beams. Full penetration butt-welds of 2mm and 3mm gauge AA5083 using this process have been produced. It has been observed that in this regime the penetration depth increases initially up to a maximum and then decreases with increasing spot size (corresponding to increase in distance of focus above the workpiece). Results of comparison of tensile strength tests for keyhole and conduction welds are shown.This process offers an alternative method of welding aluminium alloys, which have a high thermal conductivity.There are two laser welding mechanisms, keyhole mode and conduction mode. Keyhole welding is widely used because it produces welds with high aspect ratios and narrow heat affected zones. However keyhole welding can be unstable, as the keyhole oscillates and closes intermittently. This intermittent closure causes porosity due to gas entrapment. Conduction welding, on the other hand, is more stable since vaporisation is minimal and hence there is no further absorption below the surface of the material.Conduction welds are usually produced using low-power focused laser beams. This results in shallow welds with a low aspect ratio. In this work, high-power CO2 and YAG lasers have been used to produce laser conduction welds on 2mm and 3mm gauge AA5083 respectively by means of defocused beams. Full penetration butt-welds of 2mm and 3mm gauge AA5083 using this process have been produced. It has been observed that in this regime the penetration depth increases initially up to a maximum and then decreases with incr...

Impact of cognitive therapy on internalised stigma in people with at-risk mental states

BACKGROUND Internalised stigma in young people meeting criteria for at-risk mental states (ARMS) has been highlighted as an important issue, and it has been suggested that provision of cognitive therapy may increase such stigma. AIMS To investigate the effects of cognitive therapy on internalised stigma using a secondary analysis of data from the EDIE-2 trial. METHOD Participants meeting criteria for ARMS were recruited as part of a multisite randomised controlled trial of cognitive therapy for prevention and amelioration of psychosis. Participants were assessed at baseline and at 6, 12, 18 and 24 months using measures of psychotic experiences, symptoms and internalised stigma. RESULTS Negative appraisals of experiences were significantly reduced in the group assigned to cognitive therapy (estimated difference at 12 months was -1.36 (95% CI -2.69 to -0.02), P = 0.047). There was no difference in social acceptability of experiences (estimated difference at 12 months was 0.46, 95% CI -0.05 to 0.98, P = 0.079). CONCLUSIONS These findings suggest that, rather than increasing internalised stigma, cognitive therapy decreases negative appraisals of unusual experiences in young people at risk of psychosis; as such, it is a non-stigmatising intervention for this population.

Effects of cognitive therapy on the longitudinal development of psychotic experiences in people at high risk of developing psychosis

BACKGROUND There have been recent advances in the identification of people at high risk of psychosis and psychological treatments have shown promise for prevention. AIMS To compare the longitudinal course of psychotic experiences and emotional dysfunction in high-risk participants receiving cognitive therapy with those receiving treatment as usual. METHOD Data from a recent randomised controlled trial of cognitive therapy for people at risk of developing psychosis were utilised to examine three different statistical models that were based on 432 measurements of psychotic experiences and 421 of emotional dysfunction (anxiety-depression) contributed by 57 participants across the 13 measurement occasions (monthly monitoring for a year). RESULTS Psychotic experiences and emotional dysfunction were correlated and decreased significantly over the course of the study, with most improvement in the early months. The reduction in positive symptoms, but not emotional dysfunction, was enhanced by allocation to cognitive therapy. CONCLUSIONS Psychotic experiences and emotional dysfunction appear to interact in people at risk of developing psychosis. There appears to be a specific benefit of cognitive therapy.

Exercise as an intervention for first‐episode psychosis: a feasibility study

Exercise can improve psychiatric symptoms, neurocognitive functioning and physical health in schizophrenia. However, the effects in early psychosis have not been explored. This study aimed to assess the feasibility of an exercise intervention for early psychosis and to determine if it was associated with changes in physical and mental health.

Preparation of fiber optics for the delivery of high-energy high-beam-quality Nd:YAG laser pulses

Recent improvements in design have made it possible to build Nd:YAG lasers with both high pulse energy and high beam quality. These lasers are particularly suited for percussion drilling of holes of as much as 1-mm diameter thick (a few millimeters) metal parts. An example application is the production of cooling holes in aeroengine components for which 1-ms duration, 30-J energy laser pulses produce holes of sufficient quality much more efficiently than with a laser trepanning process. Fiber optic delivery of the laser beam would be advantageous, particularly when one is processing complex three-dimensional structures. However, lasers for percussion drilling are available only with conventional bulk-optic beam delivery because of laser-induced damage problems with the small-diameter (approximately 200-400-mum) fibers that would be required for preserving necessary beam quality. We report measurements of beam degradation in step-index optical fibers with an input beam quality corresponding to an M(2) of 22. We then show that the laser-induced damage threshold of 400-mum core-diameter optical fibers can be increased significantly by a CO(2) laser treatment step following the mechanical polishing routine. This increase in laser-induced damage threshold is sufficient to propagate 25-J, 1-ms laser pulses with a 400-mum core-diameter optical fiber and an output M(2) of 31.

Strain gauge analysis of laser forming

Laser forming has become a viable process for the shaping of metallic components, as a means of rapid prototyping and of adjusting and aligning. The laser forming process is of significant value to industries that previously relied on expensive stamping dies and presses for prototype evaluations. This investigation aims to complement the considerable amount of work already completed on two-dimensional laser forming, offering an insight into the mechanical behavior of a part during the process using a strain gauge analysis technique. The investigation was performed on mild steel CR4 sheet using a CO2 laser source. It includes empirical investigations to determine optimum processing parameters using the temperature gradient mechanism, thermocouple analysis to locate ideal strain gauge placement for temperature compensation, and strain gauge analysis of the transverse localized strains at a number of locations on the surface of the sheet during single and multipass laser forming. The results of the investiga...

The effects and determinants of exercise participation in first-episode psychosis: a qualitative study

BackgroundPrevious qualitative studies have found that exercise may facilitate symptomatic and functional recovery in people with long-term schizophrenia. This study examined the perceived effects of exercise as experienced by people in the early stages of psychosis, and explored which aspects of an exercise intervention facilitated or hindered their engagement.MethodsNineteen semi-structured interviews were conducted with early intervention service users who had participated in a 10-week exercise intervention. Interviews discussed people’s incentives and barriers to exercise, short- and long-term effects, and opinions on optimal interventions. A thematic analysis was applied to determine the prevailing themes.ResultsThe intervention was perceived as beneficial and engaging for participants. The main themes were (a) exercise alleviating psychiatric symptoms, (b) improved self-perceptions following exercise, and (c) factors determining exercise participation, with three respective sub-themes for each.ConclusionsParticipants explained how exercise had improved their mental health, improved their confidence and given them a sense of achievement. Autonomy and social support were identified as critical factors for effectively engaging people with first-episode psychosis in moderate-to-vigorous exercise. Implementing such programs in early intervention services may lead to better physical health, symptom management and social functioning among service users.Trial registrationCurrent Controlled Trials ISRCTN09150095. Registered 10 December 2013.