Study protocol: a randomised controlled trial of a telephone delivered social wellbeing and engaged living (SWEL) psychological intervention for disengaged youth.

BACKGROUND: Internationally, from 12.2-23.4% of youth (aged 16-24 years) are not in employment, education or training (NEET). These disengaged youth are more likely to experience social exclusion, increased psychological distress and poor quality of life. Youth at risk of disengagement are less likely to access traditional support services, requiring development of innovative interventions. METHODS: The trial is a single blind, three arm, randomised controlled trial evaluating the effectiveness of a telephone delivered psychological intervention for disengaged youth (12-25 years). Participants will be randomised to receive either (i) SWEL, (ii) Befriending, or (iii) Single Session Psycho-Education. Therapy will be over an 8 week period with a minimum of four and maximum of eight sessions for the SWEL or Befriending conditions, or a single session for the Psycho-Education condition. Outcomes will be assessed at baseline and at 2, 8 and 14-month follow-up with the primary outcome being re-engagement in education, training or employment. DISCUSSION: This large, multi-site, randomised controlled trial will inform the delivery of services for young people at risk of disengaging from education or training. The provision of psychological therapy by telephone increases access by youth - especially those in rural and remote areas - both to the trial and the treatment, if adopted by services. The outcomes of this trial could have meaningful societal impact for a vulnerable population. It is expected that recruitment, intervention and retention will present challenges for the trial given the focus on disengaged youth. TRIAL REGISTRATION: ANZCTR, ACTRN12614001212640 , Registered 18 Nov 2014. Retrospectively registered. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the participating institutions. Results of the trial will be submitted for publication in peer reviewed journals and findings presented at scientific conferences and to key service providers and policy makers.

Facial emotion processing in schizophrenia: no evidence for a deficit specific to negative emotions in a differential deficit design.

People with schizophrenia perform poorly when recognising facial expressions of emotion, particularly negative emotions such as fear. This finding has been taken as evidence of a "negative emotion specific deficit", putatively associated with a dysfunction in the limbic system, particularly the amygdala. An alternative explanation is that greater difficulty in recognising negative emotions may reflect a priori differences in task difficulty. The present study uses a differential deficit design to test the above argument. Facial emotion recognition accuracy for seven emotion categories was compared across three groups. Eighteen schizophrenia patients and one group of healthy age- and gender-matched controls viewed identical sets of stimuli. A second group of 18 age- and gender-matched controls viewed a degraded version of the same stimuli. The level of stimulus degradation was chosen so as to equate overall level of accuracy to the schizophrenia patients. Both the schizophrenia group and the degraded image control group showed reduced overall recognition accuracy and reduced recognition accuracy for fearful and sad facial stimuli compared with the intact-image control group. There were no differences in recognition accuracy for any emotion category between the schizophrenia group and the degraded image control group. These findings argue against a negative emotion specific deficit in schizophrenia.

Evaluation of a motivational interview for substance use within psychiatric in-patient services.

AIMS: To assess the effectiveness of a motivational interview among hospitalized psychiatric patients with comorbid substance use disorder in reducing alcohol and other drug (AOD) use. DESIGN: Subjects were assigned randomly to receive an individual motivational interview (n=79) or a self-help booklet (control condition; n=81). SETTING: Subjects were volunteers recruited from a major public psychiatric hospital. PARTICIPANTS: Subjects met abuse or dependence criteria on the structured clinical interview for diagnosis (SCID) for alcohol, cannabis or amphetamine or they reported hazardous use during the last month of one or more of these drug types on the opiate treatment index (OTI). INTERVENTION: Either one 30-45-minute motivational interview or brief advice. MEASUREMENTS: The SCID and OTI were the main measures. FINDINGS: There was a modest short-term effect of the motivational interview on an aggregate index of alcohol and other drug use (polydrug use on the OTI). Cannabis use remained high among the sample over the 12-month follow-up period. CONCLUSION: Although motivational interviewing appears feasible among in-patients in psychiatric hospital with comorbid substance use disorders, more extensive interventions are recommended, continuing on an out-patient basis, particularly for cannabis use.

'Better Health Choices' by telephone: a feasibility trial of improving diet and physical activity in people diagnosed with psychotic disorders.

The study objective was to evaluate the feasibility of a telephone delivered intervention consisting of motivational interviewing and cognitive behavioural strategies aimed at improving diet and physical activity in people diagnosed with psychotic disorders. Twenty participants diagnosed with a non-acute psychotic disorder were recruited. The intervention consisted of eight telephone delivered sessions targeting fruit and vegetable (F&V) consumption and leisure screen time, as well as smoking and alcohol use (as appropriate). F&V frequency and variety, and overall diet quality (measured by the Australian Recommended Food Score, ARFS), leisure screen time, overall sitting and walking time, smoking, alcohol consumption, mood, quality of life, and global functioning were examined before and 4-weeks post-treatment. Nineteen participants (95%) completed all intervention sessions, and 17 (85%) completed follow-up assessments. Significant increases from baseline to post-treatment were seen in ARFS fruit, vegetable and overall diet quality scores, quality of life and global functioning. Significant reductions in leisure screen time and overall sitting time were also seen. Results indicated that a telephone delivered intervention targeting key cardiovascular disease risk behaviours appears to be feasible and relatively effective in the short-term for people diagnosed with psychosis. A randomized controlled trial is warranted to replicate and extend these findings.

Functional MRI of facial emotion recognition deficits in schizophrenia and their electrophysiological correlates.

Empirical evidence suggests impaired facial emotion recognition in schizophrenia. However, the nature of this deficit is the subject of ongoing research. The current study tested the hypothesis that a generalized deficit at an early stage of face-specific processing (i.e. putatively subserved by the fusiform gyrus) accounts for impaired facial emotion recognition in schizophrenia as opposed to the Negative Emotion-specific Deficit Model, which suggests impaired facial information processing at subsequent stages. Event-related potentials (ERPs) were recorded from 11 schizophrenia patients and 15 matched controls while performing a gender discrimination and a facial emotion recognition task. Significant reduction of the face-specific vertex positive potential (VPP) at a peak latency of 165 ms was confirmed in schizophrenia subjects whereas their early visual processing, as indexed by P1, was found to be intact. Attenuated VPP was found to correlate with subsequent P3 amplitude reduction and to predict accuracy when performing a facial emotion discrimination task. A subset of ten schizophrenia patients and ten matched healthy control subjects also performed similar tasks in the magnetic resonance imaging scanner. Patients showed reduced blood oxygenation level-dependent (BOLD) activation in the fusiform, inferior frontal, middle temporal and middle occipital gyrus as well as in the amygdala. Correlation analyses revealed that VPP and the subsequent P 3a ERP components predict fusiform gyrus BOLD activation. These results suggest that problems in facial affect recognition in schizophrenia may represent flow-on effects of a generalized deficit in early visual processing.

Motivational interviewing among psychiatric in-patients with substance use disorders.

OBJECTIVE: There were three aims of the present study: 1) to document patterns of substance misuse among psychiatric in-patients with comorbid alcohol and other drug (AOD) use; 2) to examine associations among psychiatric and substance use diagnoses and readiness to change; and 3) to evaluate the effectiveness of an opportunistic motivational interview on engagement in a Specialist Substance Misuse Service (SSMS). METHOD: One hundred and sixty subjects were randomly assigned to receive either a motivational interview or no intervention. RESULTS: Overall, 66.3% of subjects met intervention threshold for cannabis, 60.6% for alcohol and 22.5% for amphetamines. There was a bimodal distribution of stage of change for cannabis use which was associated with age, with precontemplation being associated with older age and less frequent use. Attendance at the SSMS was low and unrelated to intervention status. CONCLUSION: A different approach to treatment is recommended, including early intervention among cannabis users.