McLean OnTrack: a transdiagnostic program for early intervention in first-episode psychosis.

AIMS: Most programs specializing in the treatment of first-episode psychosis in the United States focus on schizophrenia. However, many early psychosis patients do not fit into this diagnostic category. Here we describe McLean OnTrack, an intensive outpatient treatment program that accepts all comers with first-episode psychosis. METHODS: We assessed baseline characteristics of patients in the 2.5 years since program initiation. We examined how initial referral diagnoses compare with current diagnoses, calculating the proportion of diagnostic changes. RESULTS: At 2.5 years, patients in McLean OnTrack consist of 30 (33.0%) individuals with primary psychotic disorder, 40 (44.0%) with affective psychosis, 19 (20.9%) with psychotic disorder not otherwise specified (NOS) who do not meet full criteria for either category and two (2.2%) individuals with no psychosis. Although patients with affective psychosis had higher pre-morbid functioning, all three categories of psychosis had similar rates of prior hospitalizations and substance use. The retention rate in the psychotic disorder NOS group was lower than that in affective and primary psychotic disorders. Finally, diagnoses changed over the course of treatment in 50.5% of patients. CONCLUSIONS: Diagnostic heterogeneity appears to be the norm among patients with first-episode psychosis, and diagnoses commonly evolve over the illness course. Baseline indices of illness severity were similar across categories and suggest the need for early intervention, irrespective of specific diagnosis. We discuss the benefits and challenges of a transdiagnostic approach to early intervention in first-episode psychosis, treating patients who share many but not all characteristics.

Quantifying talk: developing reliable measures of verbal productivity.

Measuring talkativeness is of interest to several areas of research. However, there are few brief, validated measures available. We examined test-retest reliability, inter-relationships and convergent/divergent validity for five brief measures of verbal productivity. Nineteen men and 32 women participated in four sessions, completing five speech tasks that varied in demand, purpose of speech and sociability. Several potential metrics (word count, duration and rate) were examined. All tasks except a novel Unprompted Speech task demonstrated good word count test-retest reliability (interclass correlation coefficients from .71 to .85). Factor analysis revealed low-demand, non-functional tasks formed one factor ("Voluntary Talkativeness"), while higher demand tasks formed a second factor ("Speech Ability"). This finding and examination of relationships with IQ, personality and gender indicate "Voluntary Talkativeness" is not wholly accounted for by verbal ability, and is only weakly related to self-reported personality. Recommendations for the measurement of "Voluntary Talkativeness" are made.