Utility of risk-status for predicting psychosis and related outcomes: evaluation of a 10-year cohort of presenters to a specialised early psychosis community mental health service.

Psychosis transition rates by those at clinical high risk have been highly variable and few studies have compared service presenters across the full psychosis risk spectrum with respect to medium-term outcomes. A 10-year service cohort was examined (N=1997), comprising all presentations to an early psychosis service for young people experiencing a recent psychotic episode or at increased risk ('Psychological Assistance Service', Newcastle, Australia). Baseline and longitudinal service data (median follow-up =7.3 years) were used in a series of logistic regressions to examine relationships between psychosis risk-status and subsequent illness episodes, hospital admissions, and community contacts. Six baseline groups were identified: existing (14.5%) and recent psychosis (19.8%); ultra-high risk (UHR, 9.6%); non-psychotic disorders without (35.4%, the reference group) and with psychiatric admissions (8.3%); and incomplete assessments (12.5%). High comorbidity levels were reported by the cohort (psychosocial problems, 61.1%; depression, 54.1%; substance misuse, 40.7%). UHR clients experienced similar psychosis transition rates to the reference group (17.3% vs. 14.6%; 8.9% vs. 9.1% within 2-years) and comparable rates of subsequent non-psychosis outcomes. A 25.9% conversion rate from early psychosis to schizophrenia was detected. However, among transitioning individuals, UHR clients faired relatively better, particularly with respect to changes in comorbidity and mental health contacts. Interventions tailored to current problems, recovery and psychological strengthening may be more appropriate than those based on estimated psychosis risk, which currently lacks clinical utility.

Effect of Core Temperature and Embolic Load During Cardiac Surgery on Motion Perception.

BACKGROUND: Cognitive decline post-cardiac surgery is of clinical concern. To better understand it a sensitive and specific measure of post-surgery brain impairment is required. The cerebral territory most likely to be adversely affected by surgery is the posterior "watershed" territory. METHODS: We have designed a psychophysical task involving reading letters defined by motion aimed at measuring the integrity of a cortical area (MT) located in this territory. Patients undergoing coronary artery bypass grafting (CABG) and a healthy control group were given the psychophysical test twice, pre- and post-surgery for the patient group. RESULTS: There was no overall difference in performance between the surgery group and the control group at either pre- or post-surgery testing. However, multivariate analysis of surgical variables such as body temperature and embolic load to the brain as measured by Transcranial Doppler showed that patients with warmer core temperatures and higher embolic loads performed significantly worse on the motion defined letter reading tasks than those with more favourable surgical variables. CONCLUSIONS: These results demonstrate that high embolic load and warm core body temperatures lead to poor motion perception post-cardiac surgery, implying damage to the posterior watershed cortex.

Improving antenatal risk assessment in women exposed to high risks.

Antenatal substance use and related psychosocial risk factors are known to increase the likelihood of child protection involvement; less is known about the predictive nature of maternal reflective functioning (RF) in this population. This preliminary study assessed psychosocial and psychological risk factors for a group of substance dependent women exposed to high risks in pregnancy, and their impact on child protection involvement. Pregnant women on opiate substitution treatment (n = 11) and a comparison group (n = 15) were recruited during their third trimester to complete measures of RF (Pregnancy Interview), childhood trauma, mental health and psychosocial assessments. At postnatal follow-up, RF was reassessed (Parent Development Interview - Revised Short Version) and mother-infant dyads were videotaped to assess emotional availability (EA). Child protection services were contacted to determine if any concerns had been raised for infant safety. Significant between-group differences were observed for demographics, psychosocial factors, trauma and mental health symptoms. Unexpectedly, no significant differences were found for RF or EA between groups. Eight women in the 'exposed to high risks' group became involved with child protection services. Reflective functioning was not significantly associated with psychosocial risk factors, and therefore did not mediate the outcome of child protection involvement. Women 'exposed to high risks' were equally able to generate a model of their own and their infants' mental states and should not be seen within a deficit perspective. Further research is required to better understand the range of risk factors that predict child protection involvement in high risk groups.

Ten-year audit of clients presenting to a specialised service for young people experiencing or at increased risk for psychosis.

BACKGROUND: Despite strong research interest in psychosis risk identification and the potential for early intervention, few papers have sought to document the implementation and evaluation of specialised psychosis related services. Assessment of Ultra High Risk (UHR) has been given priority, but it is equally as important to identify appropriate comparison groups and other baseline differences. This largely descriptive service evaluation paper focuses on the 'baseline characteristics' of referred clients (i.e., previously assessed characteristics or those identified within the first two months following service presentation). METHODS: Data are reported from a 10-year layered service audit of all presentations to a 'Psychological Assistance Service' for young people (PAS, Newcastle, Australia). Baseline socio-demographic and clinical characteristics (N =1,997) are described (including clients' psychosis and UHR status, previous service contacts, hospitalisation rates, and diagnostic and comorbidity profiles). Key groups are identified and comparisons made between clients who received ongoing treatment and those who were primarily assessed and referred elsewhere. RESULTS: Clients averaged 19.2 (SD =4.5) years of age and 59% were male. One-tenth of clients (9.6%) were categorised as UHR, among whom there were relatively high rates of attenuated psychotic symptoms (69.1%), comorbid depression (62.3%), anxiety (42.9%), and attentional and related problems (67.5%). Overall, one-fifth (19.8%) experienced a recent psychotic episode, while a further 14.5% were categorised as having an existing psychosis (46.7% with a schizophrenia diagnosis), amongst whom there were relatively high rates of comorbid substance misuse (52.9%), psychosocial (70.2%) and physical health (37.7%) problems. The largest group presenting to PAS were those with non-psychotic disorders (43.7%), who provide a valuable comparison group against which to contrast the health trajectories of those with UHR and recent psychosis. Ongoing treatment by PAS was preferentially given to those experiencing or at risk for psychosis and those reporting greater current distress or dysfunction. CONCLUSIONS: Whether or not UHR clients transition to psychosis, they displayed high rates of comorbid depression and anxiety at service presentation, with half receiving ongoing treatment from PAS. Although international comparisons with similar services are difficult, the socio-demographic and comorbidity patterns observed here were viewed as largely consistent with those reported elsewhere.

When I look into my baby's eyes . . . infant emotion recognition by mothers with borderline personality disorder.

Mothers with borderline personality disorder (BPD) have disturbed relationships with their infants, possibly associated with poor nonverbal cue perception. Individuals with BPD are poor at recognizing emotion in adults and tend to misattribute neutral (i.e., no emotion) as sad. This study extends previous research by examining how mothers with BPD perceive known (own) and unknown (control) infant stimuli depicting happy, sad, and neutral emotions. The sample consisted of 13 women diagnosed with BPD and 13 healthy control mothers. All participants completed clinical and parenting questionnaires and an infant emotion recognition task. Compared to control mothers, mothers with BPD were significantly poorer at infant emotion recognition overall, but especially neutral expressions which were misattributed most often as sad. Performance was not related to disturbed parenting but rather mothers' age and illness duration. Neither the BPD nor control mothers showed enhanced accuracy for emotional displays of their own verses unknown infant-face images. Although the sample size was small, this study provides evidence that mothers with BPD negatively misinterpret neutral images, which may impact sensitive responding to infant emotional cues. These findings have implications for clinical practice and the development of remediation programs targeting emotion-perception disturbances in mothers with BPD.

The role of resilience in adjustment and coping with chronic pain.

PURPOSE: In clinical practice, it is often noted that some individuals struggle with chronic pain, while others find effective means to cope. The purpose of this study was to better understand how resilience fits into coping with persistent pain problems. Of interest was whether measures of resilience add to the prediction of adjustment to chronic pain over and above measures of pain coping as typically used with this patient group. METHOD: Individuals (N = 101) with chronic pain who attended an initial assessment at a pain clinic completed self-report measures of resilience and coping. Pain related outcome data were also collected. RESULTS: Bivariate correlations indicated that higher resilience was associated with significantly less fear avoidance, less pain-related disability, and lower reported pain intensity. Consistent with theoretical propositions, bivariate analyses also indicated that more resilient individuals with chronic pain reported better social support, and were more likely to be working. Higher resilience was also positively correlated with greater pain self-efficacy. However, when hierarchical regression analyses were performed, resilience did not add significantly to the prediction of depression scores and disability scores, over and above the contribution made by existing measures of pain coping. CONCLUSION: These findings suggest that, although the construct of resilience appears to have important relationships with various dimensions of chronic pain, as currently operationalized, it does not add significantly to the understanding of chronic-pain adjustment. Rather than abandoning the resilience construct, our findings suggest that resilience as applied to the problem of chronic pain may require a refinement in measurement with this population.

Brief neuropsychological profiles in psychosis: a pilot study using the Audio Recorded Cognitive Screen (ARCS).

UNLABELLED: Loughland CM, Allen J, Gianacas L, Schofield PW, Lewin TJ, Hunter M, Carr VJ. Brief neuropsychological profiles in psychosis: a pilot study using the Audio Recorded Cognitive Screen (ARCS). OBJECTIVE: This pilot study examines the utility of a novel, standardised brief neuropsychological assessment tool (the ARCS, Audio Recorded Cognitive Screen) in a different clinical setting to that in which it was initially developed. We hypothesised that the ARCS would be feasible to administer to individuals with a psychotic illness and that it would detect cognitive deficits similar to those identified by an established instrument (the RBANS, Repeatable Battery for the Assessment of Neuropsychological Status). METHODS: Twenty-five people with psychosis (mean age = 43.72, SD = 9.78) and 25 age- and gender-matched controls were recruited from the Newcastle community (NSW, Australia). The ARCS and RBANS were completed about 1 week apart in a counterbalanced order. RESULTS: The ARCS was well received, performed satisfactorily and both the ARCS and RBANS were sensitive to deficits typically associated with psychosis (e.g. memory and attention). After controlling for memory deficits, the largest disparity between the psychosis and control groups was on the ARCS fluency domain [p < 0.001, partial Eta-squared (η p 2) = 0.21]. CONCLUSION: The ARCS uses audio administration (approximately 34 min) to reduce clinician time (to 3-5 min for scoring) and appears to be a useful brief assessment tool for examining the cognitive deficits associated with psychosis. However, the potential clinical utility of the ARCS needs to be investigated further in larger samples drawn from a wider variety of specialist and non-specialist settings.

Changes in mid-to-late latency auditory evoked responses in the chicken during neural maturation.

Utilizing the special advantages offered by the protracted maturation of neural circuits in chicken forebrain this study investigates the functional consequence of maturation using auditory evoked response potentials (AERPs) in behaving animals. Repeated measures AERP recordings were undertaken between weeks 1 and 8 posthatch. Quantitative analysis revealed a significant decrease in amplitude of the positive AERP component and a decrease in latency of the negative AERP component with maturation. AERPs were also utilized to investigate perturbed maturation via the induction of chemically induced hypothyroidism. Results from this study showed that the induction of late onset hypothyroidism produces measurable effects on the chicken AERP consistent with perturbation in maturation of neuronal circuits and synapses. This suggests that AERPs may be useful noninvasive functional measures of brain maturation that can be used to study the effects of endogenous or exogenous factors on brain maturation in the chicken. Since human brain also exhibits a protracted maturation period the availability of a well-characterized animal model for protracted brain maturation provides an opportunity to identify molecules, genes and environmental factors that are important in the regulation of maturation. The protracted maturation of neuronal circuits observed in chicken forebrain offers such a model.

Neonatal lipopolysaccharide and adult stress exposure predisposes rats to anxiety-like behaviour and blunted corticosterone responses: implications for the double-hit hypothesis.

The double-hit hypothesis posits that an early life genetic or environmental insult sets up a neural predisposition to psychopathology, which may emerge in the presence of a subsequent insult, or 'second hit' in later life. The current study assessed the effect of neonatal lipopolysaccharide (LPS) exposure on anxiety-like behaviours in the adult Wistar rat. Rats were administered either LPS (Salmonella enterica, serotype enteritidis, 0.05 mg/kg, i.p.) or saline (equivolume) on days 3 and 5 of life (birth=day 1). In adulthood (85 days), subjects were allocated to either "stress" or "no stress" treatment groups. For the "stress" group, subjects were exposed to a three-day stress protocol consisting of a 30 min period of restraint and isolation. The "no stress" group was left unperturbed but were handled during this period to control for handling effects between adult "stress" and "no stress" conditions. All animals then underwent behavioural testing using standardised tests of anxiety-like behaviour, including either the Hide Box/Open Field, Elevated Plus Maze (EPM) or Acoustic Startle Response (ASR). Time and event measures for restraint and isolation, the Hide Box/Open Field and EPM were recorded using automated tracking software. Startle amplitude and habituation across time was measured in the ASR test. Prior to and following behavioural test sessions, peripheral blood was collected to assess serum corticosterone and ACTH levels. Data analysis indicated that LPS-treated animals exposed to stress in adulthood exhibited increased anxiety-like behaviour across all behavioural tests compared to controls. Sexually dimorphic effects were observed with males exhibiting increased anxiety-related behaviours compared to females (p<.05). Neonatal LPS exposure induced a significant increase in corticosterone compared to controls (p<.05), whereas corticosterone responses to stress in adulthood were associated with a significantly blunted HPA axis response (p<.05). No differences in ACTH were observed. These results lend support to the double-hit hypothesis of anxiety-related behaviour, demonstrating that neonatal immune activation produces an enhanced propensity toward anxiety-related behaviour following stress in adulthood, and that this susceptibility is associated with alterations to HPA axis ontogeny.

Distinguishing childhood absence epilepsy patients from controls by the analysis of their background brain electrical activity (II): a combinatorial optimization approach for electrode selection.

In this sequel to our previous work [Rosso OA, Mendes A, Rostas JA, Hunter M, Moscato P. Distinguishing childhood absence epilepsy patients from controls by the analysis of their background brain electrical activity. J. Neurosci. Methods 2009;177:461-68], we extend the analysis of background electroencephalography (EEG), recorded with scalp electrodes in a clinical setting, in children with childhood absence epilepsy (CAE) and control individuals. The same set of individuals was considered-five CAE patients, all right-handed females and aged 6-8 years. The EEG was obtained using bipolar connections from a standard 10-20 electrode placement. The functional activity between electrodes was evaluated using a wavelet decomposition in conjunction with the Wootters distance. In the previous study, a Kruskal-Wallis statistical test was used to select the pairs of electrodes with differentiated behavior between CAE and control samples (classes). In this contribution, we present the results for a combinatorial optimization approach to select the pairs of electrodes. The new method produces a better separation between the classes, and at the same time uses a smaller number of features (pairs of electrodes). It managed to almost halve the number of features and also improves the separation between the CAE and control samples. The new results strengthen the hypothesis that mostly fronto-central electrodes carry useful information and patterns that can help to discriminate CAE cases from controls. Finally, we provide a comprehensive set of tests and in-depth explanation of the method and results.

Aggression and trauma experiences among carer-relatives of people with psychosis.

BACKGROUND: Exposure to aggression and associated psychological outcomes are poorly characterised among carer-relatives of people with psychosis. METHOD: Carer-relatives (N = 106) completed questionnaires assessing socio-demographics and perceived prevalence of aggression in their caring role in the last 12 months. Carers exposed to moderate-severe levels of aggression were re-approached to assess PTSD and coping strategies. RESULTS: Most respondents (77.4%) reported experiencing moderate-severe levels of aggression. Increased contact with (M = 15.12 vs. M = 6.71 days per month), and significantly higher ratings of affective, antisocial, negative and psychotic symptomology in affected relatives were associated with experiences of moderate-severe aggression. Approximately half of the moderate-severe respondents reported potentially significant levels of PTSD (52%, N = 34), which was associated with greater exposure to verbal aggression and increased usage of coping strategies. CONCLUSIONS: Comparable ratios of physical to non-physical aggression to those reported by professional carers working in acute psychiatric treatment settings were reported. Carer-relatives require greater levels of information and support to assist them in their community caring roles.

'Traumatisers or traumatised': Trauma experiences and personality characteristics of Australian prisoners.

BACKGROUND: Post-traumatic stress disorder (PTSD) is over represented in the prisoner population and is predictive of violence and suicide. This raises issues in relation to prisoner management, as well as theoretical issues such as why there is a range of vulnerability for PTSD. The current study examines the relationship between PTSD and personality profiles of prisoners. METHOD: Data from 1305 participants in the NSW survey of health in prisoners are examined to identify relationships between personality profiles derived from the Temperament and Character Inventory (TCI) and PTSD. Participants are grouped as experiencing no trauma; with a trauma history but no PTSD; and being diagnosed with PTSD. A logistic regression modelled significant predictors of PTSD. These data indicated that women prisoners report PTSD at twice the rate of males. An increased risk for PTSD is associated with high Harm Avoidance, low Self-Directedness, high Persistence and high Self-Transcendence. CONCLUSIONS: A combination of both temperament and character traits influences the trajectory towards PTSD development. Targeted treatment of these traits is needed in addressing the problems of prisoners with PTSD and managing the associated risks of violence and suicide.

Distinguishing childhood absence epilepsy patients from controls by the analysis of their background brain electrical activity.

Background electroencephalography (EEG), recorded with scalp electrodes, in children with childhood absence epilepsy (CAE) and control individuals has been analyzed. We considered 5 CAE patients, all right-handed females and aged 6-8 years. The 15 control individuals had the same characteristics of the CAE ones, but presented a normal EEG. The EEG was obtained using bipolar connections from a standard 10-20 electrode placement (Fp1, Fp2, F7, F3, Fz, F4, F8, T3, C3, Cz, C4, T4, T5, P3, Pz, P4, T6, O1 and O2). Recordings were undertaken in the resting state with eyes closed. EEG hallmarks of absence seizure activity are widely accepted, but there is a recognition that the bulk of interictal EEG in CAE appears normal to visual inspection. The functional activity between electrodes was evaluated using a wavelet decomposition in conjunction with the Wootters distance. Then, pairs of electrodes with differentiated behavior between CAE and controls were identified using a test statistic-based feature selection technique. This approach identified clear differences between CAE and healthy control background EEG in the frontocentral electrodes, as measured by Principal Component Analysis. The findings of this pilot study can have strong implications in future clinical practice.

Biochemical, behavioural and electrophysiological investigations of brain maturation in chickens.

It is convenient to divide the development of synaptic networks into two phases: synapse formation during which synaptic contacts are established, and a subsequent maturation phase during which synaptic circuits are fine tuned and the properties of individual synapses are modified. Understanding the complex factors that control the protracted maturation process in humans is likely to be important for understanding a variety of neurological and psychiatric disorders. Chickens provide an ideal experimental model in which maturation specific changes can be identified and the mechanisms controlling them can be elucidated because the maturation phase is protracted and temporally separated from the formation phase. This paper reviews the knowledge about the biological mechanisms involved in the maturation phase of brain development in chickens and presents some new data. Studies of synaptic physiology suggest that maturation may alter the basal set point for stimulus induced synaptic plasticity. Biochemical and pharmacological studies of N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) and metabotropic glutamate receptors (mGluRs) revealed major changes in receptor regulation and the intracellular signalling pathways linked to receptor activation. Not surprisingly, therefore, when immature or mature chickens learn the same behavioural task the learning induced molecular events at the synapse are different. Changes in the features of auditory event related potentials and the basal EEG provide non-invasive techniques for monitoring maturation changes in chicken brain but prepulse inhibition (PPI) is too small and variable in chickens to be useful. Experimentally induced mild late-onset hypothyroidism retards some aspects of brain maturation and may help identify some of the mechanisms controlling maturation.

Molecular changes in the intermediate medial mesopallium after a one trial avoidance learning in immature and mature chickens.

Because brain maturation in chickens is protracted and occurs well after the major developmental period of synaptogenesis, chicken forebrain is suitable to investigate whether the molecular mechanisms underlying memory consolidation are different in immature and mature animals. We have used antibodies and western blotting to analyze subcellular fractions from the intermediate medial mesopallium region of 14-day and 8-week chicken forebrain prepared 0, 45, and 120 min after learning a discriminative taste avoidance task. At both ages learning induced changes in the phosphorylation of the glutamate receptor subunit 1 at Ser831, the levels of calcium-calmodulin stimulated/dependent protein kinase II and the phosphorylation of calcium-calmodulin stimulated/dependent protein kinase II at Thr286 were observed only in the fraction enriched in post-synaptic densities. The changes were of the same type at the two ages but occurred faster in mature animals. The changes in extracellular signal regulated kinase and phosphorylated-extracellular signal regulated kinase were more complex with different subcellular fractions showing different patterns of change at the two ages. These results imply that the molecular changes induced by learning a behavioral task are faster in mature than immature brain and may involve a different balance of intracellular signaling pathways.

Cue gradient and cue density interact in the detection and recognition of objects defined by motion, contrast, or texture.

The human visual system is able to extract an object from its surrounding using a number of cues. These include foreground/background gradients in disparity, motion, texture, colour, and luminance. We have investigated normal subjects' ability to detect objects defined by either motion, texture, or luminance gradients. The effects of manipulating cue density and cue foreground/background gradient on both detection and recognition accuracy were also investigated. The results demonstrate a simple additive relationship between cue density and cue gradient across forms defined by motion, luminance, and texture. The results are interpreted as evidence for the notion that form parsing is achieved via a similar algorithm across anatomically distinct processing streams.

Discriminative taste aversion learning: a learning task for older chickens.

The study of learning and memory using the chicken model has relied on three learning paradigms, passive avoidance learning, imprinting and the pebble floor task. Passive avoidance learning and imprinting have been used predominantly in very young chickens and cannot be used to access learning and memory in older chickens. We have established a new behavioural learning paradigm, Discriminative Taste Aversion Learning (DTAL), that can be used with both young and older animals. The task requires chickens to discriminate between food crumbs dyed either red or yellow with one colour being associated with the aversive tasting substance, methylanthranilate. Learning can be tested at various times after the training session by presenting chickens with the coloured food crumbs without an aversive taste. Both chickens tested at 5 and 15 days post-hatch learned to avoid the aversive crumbs. Furthermore, the protein synthesis inhibitor anisomycin (30 mM; 10 microl per hemisphere) injected into the intermediate medial hyperstriatum ventrale 15 min pre-training or 45 min post-training blocked long-term memory for the DTAL task when tested 24 h later. Memory for the task was unaffected by anisomycin injection 120 min post-training or in control animals injected with saline at similar times. The timing of the cellular processes of protein synthesis needed for consolidation of the DTAL appears to be similar to those described for the other behavioural paradigms in young chickens.