The tertiary service for psychosis: Holistic recommendations for people with complex psychosis.

OBJECTIVE: To describe (i) the clinical characteristics of individuals referred to the Tertiary Referral Service for Psychosis (TRSP) and (ii) the recommendations TRSP made for future treatment across psychopharmacological and other intervention domains. METHOD: Retrospective audit of clinical data collected during the assessment process of individuals who accessed TRSP between 02/06/2020 and 31/12/2022. Categories of recommendations made following collaborative care planning comprised psychopharmacological, neuropsychological, psychological, psychosocial, physical health, substance misuse and other domains. RESULTS: Eighty-two individuals were included, with diagnoses most commonly of schizophrenia (54.9%) and schizoaffective disorder (30.5%). The median PANSS score was 88.0 (73-100). Social occupational functioning was very poor (SOFAS M = 37.0, SD = 15.1). Cognitive functioning was poor (RBANS: M = 74.6; SD: 15.0). 67.1% had physical health comorbidities, with high prevalence of smoking (52.4%) and substance misuse (25.6%). Psychopharmacological recommendations (made for 81.7%) included clozapine trial (25.6%), clozapine dose change/augmentation (22.0%) and rationalisation of polypharmacy (12.2%). Neuropsychological (73.2%), psychological (39.0%) and psychosocial (85.4%) recommendations included access to cognitive remediation, psychological therapy and disability support. Physical health and substance misuse interventions were recommended for 91.5% and 20.7%, respectively. CONCLUSIONS: Individuals referred to the TRSP had marked clinical and functional impairments. Holistic collaborative care planning complemented psychopharmacological interventions with psychological, psychosocial and physical healthcare recommendations.

Cognitive remediation therapy - implementation and translation into clinical practice in rural and metropolitan New South Wales mental health services.

OBJECTIVE: Cognitive Remediation Therapy (CRT) is an effective intervention in managing the significant cognitive deficits experienced by those living with psychosis. Given its strong evidence base CRT is recommended in Australian and international guidelines for rehabilitation of people with psychosis, however, access to CRT remains limited. In this commentary, we describe recent efforts to implement CRT programs within NSW mental health services. Development of CRT delivery has been successfully achieved in both rural and metropolitan settings, utilising both face-to-face and telehealth methods. CONCLUSIONS: The delivery of CRT in public mental health services is feasible and adaptable to diverse settings. We strongly advocate for sustainable implementation of CRT into routine clinical practice. This will require policy and practice change to enable resources for CRT training and delivery to become embedded in the roles of the clinical workforce.

The Parent and Child Memory Questionnaires: Convergent validity, factor structure, internal consistency, and cross-informant reliability in typically developing children.

The Parent Memory Questionnaire (PMQ) and Child Memory Questionnaire (Child MQ) assess children's memory functioning in daily activities. Their psychometric properties are largely unknown. Hence, this study aimed to establish the psychometric properties of the PMQ and Child MQ. A sample included 239 neurotypical children (113 females; Mage = 12.3 years) from Australia and Canada and their parents (n = 306; 149 females). Children also completed standardized and experimental verbal memory tests that assessed working memory, immediate recall, and recall after short (2 min, 30 min) and long (7 day) delays. Convergent validity with memory tests was low for both questionnaires, with significant, albeit small, correlations found for the WISC IV Digit Span Forward only. Exploratory factor analysis (Principal Axis Factoring with Promax rotation) of the PMQ and Child MQ yielded two (Forgetting and Remembering) and four factors (Forgetting, Remembering, Retrieval, and Episodic Memory) accounting for 49.3% and 40.6% of the variance, respectively, and reduced the number of items from 28 to 17. Both PMQ factors showed good internal consistency. Inter-rater reliability was adequate but children rated their memory as significantly poorer than their parents. The present study revealed different factorial structures for the PMQ and Child MQ. Our findings highlighted that memory questionnaires assess several aspects of memory and may complement objective memory tests in children's memory evaluation.

Selective, age-related autobiographical memory deficits in children with severe traumatic brain injury.

OBJECTIVES: Autobiographical memory (AM) is a complex function that involves re-experiencing of past personal events (episodic memory) scaffolded by personal facts (semantic memory). While AM is supported by a brain network and cognitive skills that are vulnerable to disruption by child traumatic brain injury (TBI), AM has not been examined in this patient population. DESIGN: Cross-sectional study. METHODS: Participants included children with severe closed TBI (n = 14) and healthy control (NC) children (n = 20) of comparable age, sex, and socioeconomic status. Participants completed (1) the Child Autobiographical Interview (Willoughby et al., 2012, Front. Psychol., 3, 53), which required recall of autobiographical events and distinguished episodic (internal) from non-episodic (external) details, and self-rating of event phenomenological qualities, and (2) a battery of neuropsychological tests. RESULTS: Children with TBI recalled significantly fewer internal details relative to NCs, but the between-group difference was eliminated when specific probes were provided. The groups did not differ in either recall of external details or in ratings of events' phenomenological qualities. The gap between the groups in recall of internal details increased with age, as the greater number of internal details was associated with older age in the NC group, but not in the TBI group. Poorer verbal memory and lower IQ were related to recall of fewer internal details in the TBI group. CONCLUSIONS: This study unveils, to our knowledge for the first time, that severe child TBI is associated with a selective deficit in autobiographical memory that involves episodic, but spares semantic details, and identifies the risk factors for this impairment.

Imagining the Future in Children with Severe Traumatic Brain Injury.

Imagining future events is thought to rely on recombination and integration of past episodic memory traces into future events. Future and past events contain episodic and nonepisodic details. Children with severe traumatic brain injury (TBI) were found to have impaired recall of past episodic (but not semantic) event details. Here, we examined whether severe TBI impairs construction of future events. Children with severe TBI (n = 15) and healthy controls (NC; n = 33) 1) completed tests of anterograde (narrative and relational) memory and executive skills, 2) recalled past events and generated future events, and 3) rated events' phenomenological qualities. Events were scored for episodic (internal) and semantic (external) details. The groups did not differ in generating details of future events, although children with TBI recalled significantly fewer past internal (but not external) events' details relative to NCs. Moreover, the number of past internal details relative to future internal details was significantly higher in the NC group, but not in the TBI groups. Significant correlations between past and future were found for 1) internal details in both groups and 2) external details in the NC group. The TBI group rated their events as being less significant than did the NC group. The groups did not differ on ratings of visual intensity and rehearsal. Our study has shown that children who have sustained severe TBI had impoverished recall of past, but not generation of future, events. This unexpected dissociation between past and future event construction requires further research.

Cognitive change trajectories in virally suppressed HIV-infected individuals indicate high prevalence of disease activity.

BACKGROUND: The longitudinal rate and profile of cognitive decline in persons with stable, treated, and virally suppressed HIV infection is not established. To address this question, the current study quantifies the rate of cognitive decline in a cohort of virally suppressed HIV+ persons using clinically relevant definitions of decline, and determine cognitive trajectories taking into account historical and baseline HAND status. METHODS: Ninety-six HIV+ (clinically stable and virally undetectable) and 44 demographically comparable HIV- participants underwent standard neuropsychological testing at baseline and 18-months follow-up. We described clinically relevant cognitive trajectories based on standard definitions of historical and baseline HAND status and cognitive decline. Historical, moderate to severe HAND was formally diagnosed at the start of the cART era in 15/96 participants based on clinical neurological and neuropsychological assessment. The same standard of care has been applied to all participants at St. Vincent's Hospital Infectious Disease Department for the duration of their HIV infection (median of 20 years). RESULTS: Relative to HIV- controls (4.5%), 14% of HIV+ participants declined (p = .11), they also scored significantly lower on the global change score (p = .03), processing speed (p = .02), and mental flexibility/inhibition (p = .02) domains. Having HAND at baseline significantly predicted cognitive decline at follow up (p = .005). We determined seven clinically relevant cognitive trajectories taking into account whether participant has a history of HAND prior to study entry (yes/no); their results on the baseline assessment (baseline impairment: yes/no) and their results on the 18-month follow up (decline or stable) which in order of prevalence were: 1) No HAND history, no baseline impairment, 18-month follow-up stable (39%), 2) No HAND history, baseline impairment, 18-month follow-up stable (35%), 3) History of HAND; baseline impairment, 18-month follow-up stable (9%) 4) No history of HAND, baseline impairment, 18-month follow-up decline (7%), 5) History of HAND, no baseline impairment, 18-month follow-up stable (3%), 6) No HAND history, no baseline impairment, 18-month follow-up decline (3%) 7) History of HAND, baseline impairment, 18-month follow-up decline (3%). There was no relationship between cognitive decline (taking into account historical and baseline HAND) and traditional HIV disease biomarkers. CONCLUSIONS: Despite long-term viral suppression, we found mostly subclinical levels of decline in psychomotor speed and executive functioning (mental flexibility and cognitive inhibition); well-established markers of HAND progression. Moreover, 57% of our cohort is undergoing slow evolution of their disease, challenging the notion of prevalent neurocognitive stability in virally suppressed HIV infection.

Accelerated Long-Term Forgetting Is Not Epilepsy Specific: Evidence from Childhood Traumatic Brain Injury.

Accelerated long-term forgetting (ALF) is characterized by adequate recall after short, but not long delays. ALF is not detected by standardized neuropsychological memory tests. Currently, the prevailing conceptualization of ALF is of a temporal lobe seizure-related phenomenon. Nevertheless, Mayes and colleagues (2003) proposed that ALF may occur when any of the components of the brain network involved in long-term memory formation, or their interaction, is disrupted. This disruption does not have to be caused by temporal lobe seizures for ALF to occur. Here, we investigate this possibility in a group of school-age children who have sustained traumatic brain injury (TBI) (n = 28), as TBI typically disrupts the brain network that is important for long-term memory formation and recall. Healthy control children (n = 62) also participated. Contrary to the dominant conceptualization of ALF being a seizure-related phenomenon, children with TBI showed ALF. Sustaining a severe TBI and diffuse subcortical damage was related to ALF. Individually, 8 of the 13 children with severe TBI presented with ALF. ALF would remain undetected on standardized testing in six of these eight children. One child had the opposite pattern of dissociation, an impaired score on standardized testing, but an average long-term memory score. This is the first study, to our knowledge, to show ALF in patients with TBI, which has remained undiagnosed and untreated in this patient population. Our study also challenges the dominant hypothesis of ALF being a temporal lobe seizure-related phenomenon, and raises a possibility that short-term and long-term memory systems may be independent.

Episodic future thinking in children compared to adolescents.

Episodic thinking involves the ability to re-create past and to construct future personal events, which contain event-specific (episodic) and general (semantic) details. The richness of episodic thought for past events improves as children move into adolescence. The current study aims to examine changes in episodic future thinking and to establish the cognitive underpinning of these changes. Typically developing children (n = 14) and adolescents (n = 15) were tested using an adapted version of the Child Autobiographical Interview (CAI) that required generation of past and future personally relevant events. Relational memory and executive skills were also examined. Significant developmental gains were found in richness of events recall across temporal directions (past and future) and across different types of details (episodic and semantic). Developmental gains in richness of past events were also shown to correspond to developmental gains in generation of future events. Moreover, developmental changes in relational memory and (to a lesser extent) executive functions were found to relate to increases in the amount of episodic (but not semantic) details provided. Our study highlighted the similarities between past and future episodic thinking in typically developing children and adolescents. It also raises a possibility that children with developmental and neurological disorders with impaired relational memory and/or executive skills may be at risk of difficulties with episodic thinking.