Psychotic-like experiences in a community sample of adolescents: implications for the continuum model of psychosis and prediction of schizophrenia.

OBJECTIVE: Studies conducted in community samples suggest that psychotic-like experiences are common in the general population, leading to suggestions that they are either variations of normal personality or are different expressions of underlying vulnerability to psychotic disorder. Different types of psychotic symptoms may exist, some being normal variants and some having implications for mental health and functioning. The aim of the present study was to determine if different subtypes of psychotic-like experiences could be identified in a community sample of adolescents and to investigate if particular subtypes were more likely to be associated with psychosocial difficulties, that is, distress, depression and poor functioning, than other subtypes. METHOD: Eight hundred and seventy-five Year 10 students from 34 schools participated in a cross-sectional survey that measured psychotic-like experiences using the Community Assessment of Psychic Experiences; depression using the Centre for Epidemiologic Studies Depression Scale; and psychosocial functioning using the Revised Multidimensional Assessment of Functioning Scale. Factor analysis was conducted to identify any subtypes of psychotic experiences. RESULTS: Four subtypes of psychotic-like experiences were identified: Bizarre Experiences, Perceptual Abnormalities, Persecutory Ideas, and Magical Thinking. Intermittent, infrequent psychotic experiences were common, but frequent experiences were not. Bizarre Experiences, Perceptual Abnormalities and Persecutory Ideas were strongly associated with distress, depression and poor functioning. Magical Thinking was only weakly associated with these variables. Overall these findings may suggest that infrequent psychotic-like experiences are unlikely to be a specific risk factor for onset of a psychotic disorder in community samples. CONCLUSIONS: Given that the different subtypes had varying associations with current difficulties it is suggested that not all subtypes confer the same risk for onset of psychotic disorder and poor outcome. Bizarre Experiences, Perceptual Abnormalities and Persecutory Ideas may represent expressions of underlying vulnerability to psychotic disorder, but Magical Thinking may be a normal personality variant.

A factor analytic investigation of the Tripartite model of affect in a clinical sample of young Australians.

BACKGROUND: The Mood and Anxiety Symptom Questionnaire (MASQ) was designed to specifically measure the Tripartite model of affect and is proposed to offer a delineation between the core components of anxiety and depression. Factor analytic data from adult clinical samples has shown mixed results; however no studies employing confirmatory factor analysis (CFA) have supported the predicted structure of distinct Depression, Anxiety and General Distress factors. The Tripartite model has not been validated in a clinical sample of older adolescents and young adults. The aim of the present study was to examine the validity of the Tripartite model using scale-level data from the MASQ and correlational and confirmatory factor analysis techniques. METHODS: 137 young people (M = 17.78, SD = 2.63) referred to a specialist mental health service for adolescents and young adults completed the MASQ and diagnostic interview. RESULTS: All MASQ scales were highly inter-correlated, with the lowest correlation between the depression- and anxiety-specific scales (r = .59). This pattern of correlations was observed for all participants rating for an Axis-I disorder but not for participants without a current disorder (r = .18). Confirmatory factor analyses were conducted to evaluate the model fit of a number of solutions. The predicted Tripartite structure was not supported. A 2-factor model demonstrated superior model fit and parsimony compared to 1- or 3-factor models. These broad factors represented Depression and Anxiety and were highly correlated (r = .88). CONCLUSION: The present data lend support to the notion that the Tripartite model does not adequately explain the relationship between anxiety and depression in all clinical populations. Indeed, in the present study this model was found to be inappropriate for a help-seeking community sample of older adolescents and young adults.

Identifying the ultra-high risk (prodromal) population: evaluation of training workshops with mental health services.

OBJECTIVE: Recent years have witnessed widespread interest in the early phase of psychotic disorders. The most widely used approach to identify individuals in the prodromal phase is the ultra-high risk (UHR) approach, which combines known trait and state risk factors for psychotic disorder. The Personal Assessment and Crisis Evaluation Clinic introduced the Comprehensive Assessment of At Risk Mental States (CAARMS) in order to assess UHR status. A training DVD and manual in the use of the CAARMS was recently developed in order to assist with UHR identification. The current paper reports the outcome of a series of training workshops with mental health professionals based around this DVD. The research aim was to investigate whether the training workshops assisted mental health professionals in their confidence and ability to accurately identify UHR cases and distinguish these from non-UHR and first-episode psychosis (FEP) cases. METHOD: A total of 137 mental health workers participated in the training sessions across eight training sites. The training sessions consisted of four modules: theoretical background; rating written vignettes for UHR, non-UHR or FEP status; viewing and discussing the CAARMS Training DVD; and re-rating matched written vignettes for UHR, non-UHR or FEP status. RESULTS: Participants' confidence in identifying UHR cases and in using the CAARMS increased as a result of the workshop. Participants' ability to correctly identify UHR-positive cases did not improve as a result of the workshop. This may have been the result of a ceiling effect due to the baseline ability to identify UHR-positive cases being high. But there was a trend for participants' ability to correctly identify UHR-negative cases to improve as a result of the workshop. CONCLUSIONS: UHR training workshops are a valuable means of increasing mental health workers' confidence in identifying UHR patients. Future UHR training programmes with experienced mental health professionals should pay particular attention to the correct identification of UHR-negative cases.

Motives for substance use among young people seeking mental health treatment.

AIMS: To explore substance use motives among young people seeking mental health treatment. METHODS: Participants consisted of 103 young people seeking mental health treatment, who had used drugs or alcohol in the past year. The young people completed a 42-item substance use motives measure based on the Drinking Motives Measure for their most frequently used substance in the past year. RESULTS: Exploratory factor analysis of the substance use motives scale indicated the young people reported using substances for positive and negative drug effects, to socialize with their peers, and to cope with a negative affect. They did not report using substances for enhancement or conformity motives. Coping motives predicted the presence of a current substance use disorder. CONCLUSIONS: The findings support the need for integrated treatment approaches within mental health settings, particularly targeted at young people with co-occurring mental health and substance use problems.

Impact of co-occurring substance use on 6 month outcomes for young people seeking mental health treatment.

OBJECTIVE: Co-occurring substance use and mental health disorders are highly prevalent among young people attending services, yet few studies have examined the effect of such comorbidity among those referred for treatment. The aim of the current study was to examine the impact of co-occurring substance use disorders (SUDs) on 6 month outcomes for young people seeking mental health treatment. METHOD: One hundred and six young people (aged 15-24 years) with a non-psychotic DSM-IV Axis I disorder were assessed following referral to a specialist youth public mental health service. Participants were given a structured interview, as well as questionnaires assessing drug use, psychopathology, psychosocial functioning and self-esteem at baseline and 6 month follow up. RESULTS: At baseline, 23 participants met criteria for a co-occurring SUD and 83 had a non-psychotic Axis I disorder. Both the non-SUD and the co-occurring SUD groups had high levels of psychopathology, serious impairments in functioning and moderate levels of suicidal ideation, although those with co-occurring SUD had significantly poorer levels of functioning. At 6 month follow up the co-occurring SUD group continued to experience substantial problems with symptoms and functioning whereas the non-SUD group had significant improvement in both of these domains. CONCLUSIONS: The present findings are consistent with studies examining the impact of co-occurring substance use and mental health issues across different treatment settings, and reinforce recommendations that young people with co-occurring disorders require more intensive and integrated interventions. The present findings also highlight the need for routine assessment and management of substance use issues within youth mental health settings.

Clinical utility of the Mood and Anxiety Symptom Questionnaire (MASQ) in a sample of young help-seekers.

BACKGROUND: The overlap between Depression and Anxiety has led some researchers to conclude that they are manifestations of a broad, non-specific neurotic disorder. However, others believe that they can be distinguished despite sharing symptoms of general distress. The Tripartite Model of Affect proposes an anxiety-specific, a depression-specific and a shared symptoms factor. Watson and Clark developed the Mood and Anxiety Symptom Questionnaire (MASQ) to specifically measure these Tripartite constructs. Early research showed that the MASQ distinguished between dimensions of Depression and Anxiety in non-clinical samples. However, two recent studies have cautioned that the MASQ may show limited validity in clinical populations. The present study investigated the clinical utility of the MASQ in a clinical sample of adolescents and young adults. METHODS: A total of 204 Young people consecutively referred to a specialist public mental health service in Melbourne, Australia were approached and 150 consented to participate. From this, 136 participants completed both a diagnostic interview and the MASQ. RESULTS: The majority of the sample rated for an Axis-I disorder, with Mood and Anxiety disorders most prevalent. The disorder-specific scales of the MASQ significantly discriminated Anxiety (61.0%) and Mood Disorders (72.8%), however, the predictive accuracy for presence of Anxiety Disorders was very low (29.8%). From ROC analyses, a proposed cut-off of 76 was proposed for the depression scale to indicate 'caseness' for Mood Disorders. The resulting sensitivity/specificity was superior to that of the CES-D. CONCLUSION: It was concluded that the depression-specific scale of the MASQ showed good clinical utility, but that the anxiety-specific scale showed poor discriminant validity.

Distinguishing between anxiety and depression using the Mood and Anxiety Symptoms Questionnaire (MASQ).

OBJECTIVE: To examine the discriminant validity of the Mood and Anxiety Symptom Questionnaire (MASQ) in a sample of young help-seekers. METHOD: 136 young people referred to a psychiatric service completed a diagnostic interview and the MASQ. RESULTS: Participants were classified according to diagnostic status: Mood Only; Anxiety Only; Mixed Anxiety-Depression; Other DSM-IV Disorder; and No Axis-I Disorder. Participants in the Mood Only and Mixed groups scored significantly higher than the remaining groups on all MASQ scales. Participants in the Anxiety Only group did not score significantly higher than participants in the Other DSM-IV or No Diagnosis groups for any scale. CONCLUSION: Our finding supported the specificity of the depression-specific scale, however the purported anxiety-specific scale did not distinguish between those with and those without Anxiety disorders. It was hypothesised that in clinical samples, the MASQ may measure general psychological distress.

Association between psychotic experiences and depression in a clinical sample over 6 months.

Psychotic-like experiences (PLEs) are used to identify individuals considered to be at Ultra High Risk (UHR) of, or prodromal for, psychotic disorder. They are also common in the general population and in clinical samples of non-psychotic individuals. Depression has been found to be an important factor in mediating outcome in those with PLEs in both community and UHR populations. It is associated with increased risk of transition to psychotic disorder in the UHR group, and with need for care in relation to PLEs in community samples. In this study we aimed to examine the 6-month outcome of PLEs in a sample of help-seeking young people aged 15 to 24 years in relation to their level of depression. Subjects (n=140) were assessed at baseline and 6 months for PLEs and depression. PLEs were measured by the Community Assessment of Psychic Experiences (CAPE). Depression was assessed as a continuous measure using the Mood and Anxiety Symptom Questionnaire (MASQ) and categorically according to DSM-IV diagnosis of mood disorder. PLEs reduced in conjunction with an improvement in depression level and with remission of diagnosis of mood disorder. It is important to assess depression in those with PLEs and consider the need for treatment of the comorbid depressive syndrome. This may reduce the risk of worsening of PLEs and transition to psychotic disorder.

Psychotic-like experiences in nonpsychotic help-seekers: associations with distress, depression, and disability.

Psychotic-like experiences (PLEs) increase the risk of schizophrenia and other psychotic disorders yet are common in the community. Some PLEs, such as those associated with depression, distress, and poor functioning, may confer increased risk. The aim of this study is to determine the prevalence of PLEs in a nonpsychotic clinical sample and to investigate whether any subtypes of PLEs are associated with the above factors. Consecutive referrals to a youth psychiatric service (N = 140) were assessed to measure PLEs, depression, and functioning. PLE data were factor analyzed, and the associations of psychotic subtypes and distress, depression, and disability were analyzed. Three subtypes of PLEs were identified: Bizarre Experiences, Persecutory Ideas, and Magical Thinking. Bizarre Experiences and Persecutory Ideas were associated with distress, depression, and poor functioning. Magical Thinking was not, unless accompanied by distress. Bizarre Experiences and Persecutory Ideas may be more malignant forms of psychotic symptoms, as they are associated with current disability, and may confer increased risk of development of full-blown psychotic disorder.