Rosemary Purcell

Neuropsychological function in young patients with unipolar major depression

BACKGROUND While neuropsychological studies have consistently reported impaired cognition in elderly patients with unipolar depression, studies of cognitive function in younger patients with depression have produced equivocal results. The aim of this study was to examine the presence and nature of cognitive deficits in young patients with depression. METHODS Neuropsychological function was assessed in 20 young patients with unipolar depression, in comparison to 20 age-, education- and IQ- matched controls. Subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were employed, as this battery has proved sensitive to deficits in middle-aged and elderly patients with depression. RESULTS The patients were not impaired for short-term memory capacity, spatial working memory, planning ability, cognitive speed, delayed matching to sample or recognition memory. Compared to controls, the patients showed impaired subsequent movement latencies on the Tower of London task, suggesting deficits in the ability to sustain motor responses in depression. The depression group were also impaired on the task of attentional set shifting, requiring more trials to criterion at the intradimensional stage of the task and being more likely to fail the task at the extradimensional shift stage than controls. Further analysis indicated that half of the depression group failed to complete all stages of the set shifting task. These patients were more likely to have required in-patient hospitalization at some time during their illness. CONCLUSIONS These results indicate that there are specific cognitive deficits in young patients with depression and that their presence may be related to a history of hospitalization.

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.

Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care.

Purpose of review To provide an update of the recent studies on the age of onset of the major mental illnesses, with a special focus on the prospects for prevention and early intervention. Recent findings The studies reviewed here confirm previous reports on the age of onset of the major mental disorders. While the behaviour disorders, and certain anxiety disorders, emerge during childhood, most of the high prevalence disorders (anxiety, mood and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early age of onset has been shown to be associated with a longer duration of untreated illness and poorer clinical and functional outcomes. Summary Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. Although there is increasing evidence to suggest that intervention during the early stages of a disorder may help reduce the severity and/or the persistence of the initial or primary disorder and prevent secondary disorders, additional research is needed into appropriate treatment for early stage cases as well as the long-term effects of early intervention, and to appropriate service design for those in the early stages of a mental illness. This will mean not only the strengthening and re-engineering of existing systems but also, crucially, the construction of new streams of care for young people in transition to adulthood.

The prevalence and nature of stalking in the Australian community

Objective: This study examines the extent and nature of stalking victimisation in a random community sample. Method: A postal survey was distributed to 3700 adult men and women selected from the electoral roll in the State of Victoria. Outcome measures included the lifetime and annual cumulative incidence of stalking, the duration and methods of harassment, rates of associated violence and responses to victimisation. Results: Almost one in four respondents (23.4%;432) had been stalked, the unwanted behaviour they were subjected to being both repeated and fear-provoking. One in 10 (197) had experienced a protracted course of stalking involving multiple intrusions spanning a period of at least one month. Women were twice as likely as men to report having been stalked at some time in their lives, though the rates of victimisation in the 12 months prior to the study did not differ significantly according to gender. Younger people were significantly more likely than older respondents to report having been stalked. Victims were pursued by strangers in 42% of cases. The most common methods of harassment involved unwanted telephone calls, intrusive approaches and following. Associated threats (29%) and physical assaults (18%) frequently arose out of the stalking. Significant social and economic disruption was created by the stalking for 63% of victims. Most sought assistance to manage their predicament (69%). Conclusions: The experience of being stalked is common and appears to be increasing. Ten percent of people have been subjected at some time to an episode of protracted harassment. Assaults by stalkers are disturblingly frequent. Most victims report significant disruption to their daily functioning irrespective of exposure to associated violence.

Tourette’s and comorbid syndromes: Obsessive compulsive and attention deficit hyperactivity disorder. a common etiology?

Tourettes syndrome (TS), a neuropsychiatric movement disorder that manifests itself in childhood, is often associated with comorbid symptomatology, such as obsessions, compulsions, hyperactivity, distractibility, and impulsivity. Epidemiological studies suggest that a substantial number of TS patients develop clinical levels of obsessive-compulsive disorder (OCD) and/or attention deficit hyperactivity disorder (ADHD). This review aims to provide an integrated account of the three disorders in terms of their comorbidity. Neuroimaging studies suggest that all three disorders involve neuropathology of the basal-ganglia thalamocortical (BGTC) pathways: TS in the sensorimotor and limbic BGTC circuits; OCD in the prefrontal and limbic BGTC pathways; and ADHD in the sensorimotor, orbitofrontal, and limbic BGTC circuits. The pattern of comorbidity and other evidence indicates that the TS gene(s) may be responsible for a spectrum of disorders, including OCD and ADHD, but also that the disorders OCD and ADHD can exist in their own right with their own etiologies.

Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles

PURPOSE OF REVIEW In this review, we provide an update of recent studies on the age of onset (AOO) of the major mental disorders, with a special focus on the availability and use of services providing prevention and early intervention. RECENT FINDINGS The studies reviewed here confirm previous reports on the AOO of the major mental disorders. Although the behaviour disorders and specific anxiety disorders emerge during childhood, most of the high-prevalence disorders (mood, anxiety and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early AOO has been shown to be associated with a longer duration of untreated illness, and poorer clinical and functional outcomes. SUMMARY Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. There is increasing evidence that intervention during the early stages of disorder may help reduce the severity and/or the persistence of the initial or primary disorder, and prevent secondary disorders. However, additional research is needed on effective interventions in early-stage cases, as well as on the long-term effects of early intervention, and for an appropriate service design for those with emerging mental disorders. This will mean not only the strengthening and re-engineering of existing systems, but is also crucial the construction of new streams of care for young people in transition to adulthood.

Early identification and intervention in depressive disorders: towards a clinical staging model

Background: Depressive disorders are common and associated risks include the onset of secondary disorders, substance use disorders, impairment in social and occupational functioning, and an increase in suicidality. As the onset often occurs in youth, there is a clear imperative for early identification and intervention to ameliorate, if not prevent, associated distress. Methods: An extensive search of relevant databases and an ancestry search was undertaken. Results: There is a limited but growing body of literature on this topic that is discussed in relation to a clinical staging model, which may prove to be a useful framework for identifying where an individual lies along the continuum of the course of a depressive illness thus allowing interventions to be matched for that stage. The identification of a subsyndromal and prodromal stage of depressive disorders provides early intervention opportunities. Conclusions: It is argued that a clinical staging heuristic may increase the number of those treated early, which may in turn delay or prevent onset, reduce severity, or prevent progression in the course of depressive disorders.

Editorial : when do repeated intrusions become stalking?

Stalking is a prevalent crime which can significantly compromise the victims quality of life. It occurs when one person repeatedly inflicts on another unwanted contacts or communications which induce fear. Many of the behaviours associated with stalking overlap with common, albeit irritating, experiences (e.g. being persistently telephoned or approached for a date). The difficulty for victims is recognizing the difference between brief episodes of intrusiveness or social awkwardness, and the beginnings of a more persistent campaign of harassment. This study sought to define empirically the foremost juncture at which instances of intrusiveness can be distinguished from persistent stalking which is ultimately damaging to the victims psychosocial functioning. The results indicate that continuation of unwanted intrusions beyond a threshold of 2 weeks is associated with a more intrusive, threatening and psychologically damaging course of harassment. Recognition that 2 weeks is the watershed between brief, self-limiting instances of intrusiveness and protracted stalking allows an opportunity for early intervention to assist victims of this crime.

Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources

BACKGROUND Although mental health information on the internet is often of poor quality, relatively little is known about the quality of websites, such as Wikipedia, that involve participatory information sharing. The aim of this paper was to explore the quality of user-contributed mental health-related information on Wikipedia and compare this with centrally controlled information sources. METHOD Content on 10 mental health-related topics was extracted from 14 frequently accessed websites (including Wikipedia) providing information about depression and schizophrenia, Encyclopaedia Britannica, and a psychiatry textbook. The content was rated by experts according to the following criteria: accuracy, up-to-dateness, breadth of coverage, referencing and readability. RESULTS Ratings varied significantly between resources according to topic. Across all topics, Wikipedia was the most highly rated in all domains except readability. CONCLUSIONS The quality of information on depression and schizophrenia on Wikipedia is generally as good as, or better than, that provided by centrally controlled websites, Encyclopaedia Britannica and a psychiatry textbook.

The prevention of schizophrenia

Preventive strategies can be divided into universal, selective and indicated prevention and early intervention. Universal interventions are directed to the general population. Selective approaches are targeted at people who have risk factors for an illness, but who do not show any current signs. Indicated approaches target high risk individuals with minimal signs or symptoms foreshadowing mental disorder, but who do not meet diagnostic levels at the current time. Early intervention involves treating those with already diagnosable disorder in a timely and optimal manner aiming to decrease the severity of the illness, and reduce secondary morbidity. Although universal and selective interventions are not yet viable strategies, indicated prevention and early intervention are now realistic possibilities in schizophrenia. Development of methods to identify those at risk of psychosis continues to evolve. Promising results in the prevention and delay of transition to psychotic disorder from high risk state have been found. Early intervention in schizophrenia, including promotion of early help-seeking, has been shown to reduce the duration of untreated psychosis, which is known to be associated with poor outcome in schizophrenia. Early intervention programmes which optimise the care of the first episode have been shown to produce better outcomes than routine management.