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1.
Sleep Med ; 66: 61-67, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31791002

RESUMO

The importance of sleep for mental health has been known for some time. Although it was initially suggested that mental health conditions negatively impact sleep, it is now widely understood that this association is bidirectional. Adolescence is a period where people are at an increased risk of being sleep deprived largely due to a late shift in the circadian rhythm around puberty combined with early school start times. This combination may lead to adolescents being at an increased risk of mental health problems. Adolescence is also a period of continued brain development with white matter maturation continuing in the frontal brain regions throughout adolescence and into early adulthood. White matter development involves myelination of axons that link areas of grey matter and is integral for communication speed and efficiency. Studies have demonstrated that sufficient sleep is required for myelination to occur. The uncinate fasciculus (UF) is one of the last white matter tracts to be myelinated with this process occurring throughout adolescence and running between the amygdala in the limbic system and the orbitofrontal (OFC) and medial prefrontal cortices (mPFC). Recent studies have shown that connectivity between the amygdala and OFC is important for an individual's ability to exert top-down executive control over amygdala based automatic emotional responses to experiences perceived as threatening. The current literature review provides an overview of these mechanisms and concludes by proposing a model of adolescent sleep deprivation leading to potential life-long mental health issues through the moderating impact of reduced UF development.

2.
Hum Brain Mapp ; 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31797458

RESUMO

There is a dearth of research that has investigated the neural correlates of cyberbullying, using task-based functional magnetic resonance imaging (fMRI) and, specifically, in a real-time context such as observing cyberbullying scenarios. This article presents pilot data from a novel protocol designed to undertake such research with the overall aim being to elucidate the neurobiological underpinnings of cyberbullying via task-based fMRI (tb-fMRI)) in passive cyberbystanders. Young adults (N = 32, 18 to 25 years old) viewed six negative (cyberbullying) and six neutral stimuli from the Cyberbullying Picture Series (CyPicS) while undergoing tb-fMRI. Our results revealed 12 clusters of significantly greater blood-oxygenation-level-dependent (BOLD) responses (family wise error corrected p FWE < .05) in participants when viewing cyberbullying stimuli compared to neutral stimuli, across a distributed network of regions including left and right middle temporal gyrus, default mode network hubs, left and right posterior cerebellum/vermis, and putamen. Further analysis also revealed greater BOLD response in females compared to males, as well as in those with no prior experience of cyberbullying compared to those with prior experience (despite gender), when viewing the cyberbullying stimuli compared to the neutral stimuli. These results bring us closer to understanding the neurobiological underpinnings that may be associated with cybervictim/bully status and outcomes.

3.
Med J Aust ; 211 Suppl 9: S3-S46, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31679171

RESUMO

Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change. Consequently, the effects of adolescent-onset mood and psychotic syndromes can have long term consequences. A key clinical challenge for youth mental health is to develop and test new systems that align with current evidence for comorbid presentations and underlying neurobiology, and are useful for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. Our highly personalised and measurement-based care model includes three core concepts: ▶ A multidimensional assessment and outcomes framework that includes: social and occupational function; self-harm, suicidal thoughts and behaviour; alcohol or other substance misuse; physical health; and illness trajectory. ▶ Clinical stage. ▶ Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). The model explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within this highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care as well as utilisation of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality, mental health care for young people. CHAPTER 1: MULTIDIMENSIONAL OUTCOMES IN YOUTH MENTAL HEALTH CARE: WHAT MATTERS AND WHY?: Mood and psychotic syndromes present one of the most serious public health challenges that we face in the 21st century. Factors including prevalence, age of onset, and chronicity contribute to substantial burden and secondary risks such as alcohol or other substance misuse. Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change; thus, effects can have long term consequences. We propose five key domains which make up a multidimensional outcomes framework that aims to address the specific needs of young people presenting to health services with emerging mental illness. These include social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Impairment and concurrent morbidity are well established in young people by the time they present for mental health care. Despite this, services and health professionals tend to focus on only one aspect of the presentation - illness type, stage and trajectory - and are often at odds with the preferences of young people and their families. There is a need to address the disconnect between mental health, physical health and social services and interventions, to ensure that youth mental health care focuses on the outcomes that matter to young people. CHAPTER 2: COMBINING CLINICAL STAGE AND PATHOPHYSIOLOGICAL MECHANISMS TO UNDERSTAND ILLNESS TRAJECTORIES IN YOUNG PEOPLE WITH EMERGING MOOD AND PSYCHOTIC SYNDROMES: Traditional diagnostic classification systems for mental disorders map poorly onto the early stages of illness experienced by young people, and purport categorical distinctions that are not readily supported by research into genetic, environmental and neurobiological risk factors. Consequently, a key clinical challenge in youth mental health is to develop and test new classification systems that align with current evidence on comorbid presentations, are consistent with current understanding of underlying neurobiology, and provide utility for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. This chapter outlines a transdiagnostic framework for classifying common adolescent-onset mood and psychotic syndromes, combining two independent but complementary dimensions: clinical staging, and three proposed pathophysiological mechanisms. Clinical staging reflects the progression of mental disorders and is in line with the concept used in general medicine, where more advanced stages are associated with a poorer prognosis and a need for more intensive interventions with a higher risk-to-benefit ratio. The three proposed pathophysiological mechanisms are neurodevelopmental abnormalities, hyperarousal and circadian dysfunction, which, over time, have illness trajectories (or pathways) to psychosis, anxious depression and bipolar spectrum disorders, respectively. The transdiagnostic framework has been evaluated in young people presenting to youth mental health clinics of the University of Sydney's Brain and Mind Centre, alongside a range of clinical and objective measures. Our research to date provides support for this framework, and we are now exploring its application to the development of more personalised models of care. CHAPTER 3: A COMPREHENSIVE ASSESSMENT FRAMEWORK FOR YOUTH MENTAL HEALTH: GUIDING HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE USING MULTIDIMENSIONAL AND OBJECTIVE MEASURES: There is an urgent need for improved care for young people with mental health problems, in particular those with subthreshold mental disorders that are not sufficiently severe to meet traditional diagnostic criteria. New comprehensive assessment frameworks are needed to capture the biopsychosocial profile of a young person to drive highly personalised and measurement-based mental health care. We present a range of multidimensional measures involving five key domains: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Objective measures include: neuropsychological function; sleep-wake behaviours and circadian rhythms; metabolic and immune markers; and brain structure and function. The recommended multidimensional measures facilitate the development of a comprehensive clinical picture. The objective measures help to further develop informative and novel insights into underlying pathophysiological mechanisms and illness trajectories to guide personalised care plans. A panel of specific multidimensional and objective measures are recommended as standard clinical practice, while others are recommended secondarily to provide deeper insights with the aim of revealing alternative clinical paths for targeted interventions and treatments matched to the clinical stage and proposed pathophysiological mechanisms of the young person. CHAPTER 4: PERSONALISING CARE OPTIONS IN YOUTH MENTAL HEALTH: USING MULTIDIMENSIONAL ASSESSMENT, CLINICAL STAGE, PATHOPHYSIOLOGICAL MECHANISMS, AND INDIVIDUAL ILLNESS TRAJECTORIES TO GUIDE TREATMENT SELECTION: New models of mental health care for young people require that interventions be matched to illness type, clinical stage, underlying pathophysiological mechanisms and individual illness trajectories. Narrow syndrome-focused classifications often direct clinical attention away from other key factors such as functional impairment, self-harm and suicidality, alcohol or other substance misuse, and poor physical health. By contrast, we outline a treatment selection guide for early intervention for adolescent-onset mood and psychotic syndromes (ie, active treatments and indicated and more specific secondary prevention strategies). This guide is based on experiences with the Brain and Mind Centre's highly personalised and measurement-based care model to manage youth mental health. The model incorporates three complementary core concepts: ▶A multidimensional assessment and outcomes framework including: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness trajectory. ▶Clinical stage. ▶Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on three underlying pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). These core concepts are not mutually exclusive and together may facilitate improved outcomes through a clinical stage-appropriate and transdiagnostic framework that helps guide decisions regarding the provision of appropriate and effective care options. Given its emphasis on adolescent-onset mood and psychotic syndromes, the Brain and Mind Centre's model of care also respects a fundamental developmental perspective - categorising childhood problems (eg, anxiety and neurodevelopmental difficulties) as risk factors and respecting the fact that young people are in a period of major biological and social transition. Based on these factors, a range of social, psychological and pharmacological interventions are recommended, with an emphasis on balancing the personal benefit-to-cost ratio. CHAPTER 5: A SERVICE DELIVERY MODEL TO SUPPORT HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE IN YOUTH MENTAL HEALTH: Over the past decade, we have seen a growing focus on creating mental health service delivery models that better meet the unique needs of young Australians. Recent policy directives from the Australian Government recommend the adoption of stepped-care services to improve the appropriateness of care, determined by severity of need. Here, we propose that a highly personalised approach enhances stepped-care models by incorporating clinical staging and a young person's current and multidimensional needs. It explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within a highly personalised approach is the incorporation of other evidence-based processes, includingreal-time measurement-based care and use of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality of, mental health care for young people.

5.
Dev Neurosci ; : 1-10, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31480044

RESUMO

The hippocampus and amygdala have justifiably been the focus of much mental health research due to their putative roles in top-down processing control of emotion, fear, and anxiety. However, understanding the causal relationship between these regions and mental illness has been limited as current literature is lacking in the observation of neuro-structural changes preceding first episodes. Here, we report whole and sub-structural hippocampal and amygdala volume correlates of psychological distress in early adolescence. Automated hippocampal subfield and amygdala nuclei segmentation was carried out in 32 participants (12-13 years old) recruited for the Longitudinal Adolescent Brain Study (LABS) who had psychological distress scores measured by the Kessler-10. Partial correlation analyses revealed significant negative association between left whole amygdala volume and psychological distress. Sub-structure analysis revealed that smaller left hippocampal CA1 volume and left basal and accessory basal amygdala nuclei volumes were all significantly associated with higher levels of psychological distress. Four-month follow-up analysis also revealed an association between change in K10 and CA1 volume suggesting a continued relationship between this hippocampal substructure and psychological distress. Grey matter volume of subcortical sub-structures involved within the hippocampal-basolateral amygdala-prefrontal cortex loop are highly correlated and are significantly reduced in adolescents with higher levels of psychological distress, indicating these nuclei and subfields play an important role in the emergence of mental illness.

6.
JAMA Psychiatry ; 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31461129

RESUMO

Importance: The large contribution of psychiatric disorders to premature death and persistent disability among young people means that earlier identification and enhanced long-term care for those who are most at risk of developing life-threatening or chronic disorders is critical. Clinical staging as an adjunct to diagnosis to address emerging psychiatric disorders has been proposed for young people presenting for care; however, the longer-term utility of this system has not been established. Objectives: To determine the rates of transition from earlier to later stages of anxiety, mood, psychotic, or comorbid disorders and to identify the demographic and clinical characteristics that are associated with the time course of these transitions. Design, Setting, and Participants: A longitudinal, observational study of 2254 persons aged 12 to 25 years who obtained mental health care at 2 early intervention mental health services in Sydney, Australia, and were recruited to a research register between June 18, 2008, and July 24, 2018 (the Brain and Mind Centre Optymise Cohort). Main Outcomes and Measures: The primary outcome of this study was transition from earlier to later clinical stages. A multistate Markov model was used to examine demographic (ie, age, sex, engagement in education, employment, or both) and clinical (ie, social and occupational function, clinical presentation, personal history of mental illness, physical health comorbidities, treatment use, self-harm, suicidal thoughts and behaviors) factors associated with these transitions. Results: Of the 2254 individuals included in the study, mean (SD) age at baseline was 18.18 (3.33) years and 1330 (59.0%) were female. Data on race/ethnicity were not available. Median (interquartile range) follow-up was 14 (5-33) months. Of 685 participants at stage 1a (nonspecific symptoms), 253 (36.9%) transitioned to stage 1b (attenuated syndromes). Transition was associated with lower social functioning (hazard ratio [HR], 0.77; 95% CI, 0.66-0.90), engagement with education, employment, or both (HR, 0.47; 95% CI, 0.25-0.91), manic-like experiences (HR, 2.12; 95% CI, 1.19-3.78), psychotic-like experiences (HR, 2.13; 95% CI, 1.38-3.28), self-harm (HR, 1.42; 95% CI, 1.01-1.99), and older age (HR, 1.27; 95% CI, 1.11-1.45). Of 1370 stage 1b participants, 176 (12.8%) transitioned to stage 2 (full-threshold) disorders. Transition was associated with psychotic-like experiences (HR, 2.31; 95% CI, 1.65-3.23), circadian disturbance (HR, 1.66; 95% CI, 1.17-2.35), psychiatric medication (HR, 1.43; 95% CI, 1.03-1.99), childhood psychiatric disorder (HR, 1.62; 95% CI, 1.03-2.54), and older age (HR, 1.24; 95% CI, 1.05-1.45). Conclusions and Relevance: Differential rates of progression from earlier to later stages of anxiety, mood, psychotic, or comorbid disorders were observed in young persons who presented for care at various stages. Understanding the rate and factors associated with transition assists planning of stage-specific clinical interventions and secondary prevention trials.

7.
J Psychiatr Res ; 116: 51-60, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31195164

RESUMO

BACKGROUND: Impulsivity is considered a possible phenotype underlying the expression of self-harm and suicidal behaviors. Yet impulsivity is a not a unitary construct and there is evidence that different facets of impulsivity follow different neurodevelopmental trajectories and that some facets may be more strongly associated with such behaviors than others. Moreover, it is unclear whether impulsivity is a useful predictor of self-harm or suicidal behavior in young people, a population already considered to display heightened impulsive behavior. METHODS: A systematic review and meta-analysis of studies published in Medline, PubMed, PsychInfo or Embase between 1970 and 2017 that used a neurocognitive measure to assess the independent variable of impulsivity and the dependent variable of self-harm and/or suicidal behavior among young people (mean age < 30 years old). RESULTS: 6183 titles were identified, 141 full texts were reviewed, and 18 studies were included, with 902 young people with a self-harm or suicidal behavior and 1591 controls without a history of these behaviors. Deficits in inhibitory control (13 studies, SMD 0.21, p-value = 0.002, 95% confidence interval (CI) (0.08-0.34), prediction interval (PI) = 0.06-0.35) and impulsive decision-making (14 studies, SMD 0.17, p-value = 0.008, 95% CI (0.045-0.3), PI = 0.03-0.31) were associated with self-harm or suicidal behavior. There were no significant differences between measures of different facets of impulsivity (ie. delay discounting, risky decision-making, cognitive or response inhibition) and self-harm or suicidal behavior. CONCLUSION: Multiple facets of impulsivity are associated with suicidal behavior in young people. Future suicide research should be designed to capture impulsive states and investigate the impact on different subtypes of impulsivity.

8.
BMJ Open ; 9(5): e025674, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31138580

RESUMO

OBJECTIVES: To report the distribution and predictors of insulin resistance (IR) in young people presenting to primary care-based mental health services. DESIGN: Cross-sectional. SETTING: Headspace-linked clinics operated by the Brain and Mind Centre of the University of Sydney. PARTICIPANTS: 768 young people (66% female, mean age 19.7±3.5, range 12-30 years). MAIN OUTCOME MEASURES: IR was estimated using the updated homeostatic model assessment (HOMA2-IR). Height and weight were collected from direct measurement or self-report for body mass index (BMI). RESULTS: For BMI, 20.6% of the cohort were overweight and 10.2% were obese. However, <1% had an abnormally high fasting blood glucose (>6.9 mmol/L). By contrast, 9.9% had a HOMA2-IR score >2.0 (suggesting development of IR) and 11.7% (n=90) had a score between 1.5 and 2. Further, there was a positive correlation between BMI and HOMA2-IR (r=0.44, p<0.001). Participants in the upper third of HOMA2-IR scores are characterised by younger age, higher BMIs and depression as a primary diagnosis. HOMA2-IR was predicted by younger age (ß=0.19, p<0.001) and higher BMI (ß=0.49, p<0.001), together explaining 22% of the variance (F(2,361)=52.1, p<0.001). CONCLUSIONS: Emerging IR is evident in a significant subgroup of young people presenting to primary care-based mental health services. While the major modifiable risk factor is BMI, a large proportion of the variance is not accounted for by other demographic, clinical or treatment factors. Given the early emergence of IR, secondary prevention interventions may need to commence prior to the development of full-threshold or major mood or psychotic disorders.

9.
Psychiatry Res ; 276: 232-238, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31121529

RESUMO

Neuropsychological assessments have provided the field of psychiatry with important information about patients. As an assessment tool, a neuropsychological battery can be useful in a clinical setting; however, implementation as standard clinical care in an inpatient unit has not been extensively evaluated. A computerized cognitive battery was administered to 103 current young adult inpatients (19.2 ±â€¯3.1 years; 72% female) with affective disorder. Neurocognitive tasks included Verbal Recognition Memory (VRM), Attention Switching (AST), Paired Association Learning (PAL), and Rapid Visual Processing (RVP). Patients also completed a computerized self-report questionnaire evaluating subjective impressions of their cognition. Hierarchical cluster analysis determined three neurocognitive subgroups: cluster 1 (n = 17) showed a more impaired neurocognitive profile on three of the four variables compared to their peers in cluster 2 (n = 59), and cluster 3 (n = 27), who had the most impaired attentional shifting. Two of the four neurocognitive variables were significantly different between all three cluster groups (verbal learning and sustained attention). Overall group results showed an association between poorer sustained attention and increased suicidal ideation. These findings strengthen the idea that neurocognitive profiles may play an important role in better understanding the severity of illness in young inpatients with major psychiatric disorders.

10.
J Psychiatr Res ; 113: 83-89, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30921632

RESUMO

Impairments in mismatch negativity (MMN) in schizophrenia are well-established; these findings have been extended to show impairments at early illness stages and in bipolar disorder. A substantial literature supports MMN as an index of NMDA receptor output, however, few studies have conducted in vivo assessments to elucidate the neurochemical underpinnings of MMN. Sixty young (16-33 years) participants with bipolar disorder (n = 47) or schizophrenia (n = 13) underwent 1H-MRS and MMN assessment. Glutamate over creatine (Glu/Cr) levels in the anterior cingulate cortex (ACC) and hippocampus were determined and MMN was measured frontally and temporally. Correlational analyses assessed the relationship between MMN amplitudes and Glu/Cr. Any significant relationships were assessed for specificity with a follow up correlation analysis of MMN and n-acetyleaspartate (NAA/Cr). No associations between frontal or temporal MMN and ACC or hippocampal Glu/Cr were noted in the bipolar group. In the schizophrenia group, frontal and right temporal MMN amplitudes corresponded with increased ACC Glu/Cr at the trend-level. Right temporal MMN was similarly significantly associated with NAA/Cr. MMN was not associated with hippocampal Glu/Cr. This work provides in vivo evidence that glutamatergic processes may underlie MMN generation in early stage schizophrenia but not in early stage bipolar disorder suggesting differences in the MMN mechanism in these groups. The negative association between ACC Glu/Cr and MMN is consistent with findings of reduced MMN and increased in vivo glutamatergic neurometabolite levels in early stage schizophrenia. Furthermore, these results indicate that examining in vivo NAA/Cr may have provide additional insights into the MMN mechanism in schizophrenia.

11.
Australas Psychiatry ; 27(3): 302-306, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30777445

RESUMO

OBJECTIVES: Neurocognitive assessment and feedback to a young adult inpatient. METHODS: Computerised neurocognitive assessment and feedback. RESULTS: A collaborative process of personalised intervention. CONCLUSIONS: Personalised feedback in this setting can be employed as a management tool to identify and prioritise care.

12.
Autism ; 23(7): 1675-1686, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30654629

RESUMO

In this study, we consecutively recruited treatment-seeking young autistic adults without intellectual impairment aged 16-30 years who presented to a mental health service and evaluated general health (distress, quality of life, and disability), functioning (work loss days and social functioning), and mood symptoms (depression, anxiety, and stress) in those diagnosed with autism spectrum disorder (n = 96). This group was compared to young adults presenting to the same service with primary mental health disorders (depression, n = 343; bipolar, n = 132; psychosis, n = 166; and anxiety, n = 303). This study also investigated the influence of mood symptoms on general health and functioning in the autism spectrum disorder group. Young autistic adults reported significant general health and functioning impairments that were of similar degree to those presenting with primary mental health disorders. Interestingly, the autistic group also reported similarly high levels of mood symptoms to those with primary depressive and anxiety disorders. In the autistic group, depressive symptoms were strongly associated with distress, quality of life, and work loss days, while stress symptoms were strongly associated with disability. This study highlights further research, and mental health services are required specifically targeting young autistic adults to address their significant unmet needs.

13.
PLoS One ; 14(1): e0210877, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30653581

RESUMO

Neuropsychiatric disorders (including substance misuse) are associated with the greatest burden of functional disability in young people, and contributory factors remain poorly understood. Early-onset substance use is one candidate risk factor which may inform functional prognosis and facilitate direction of interventions aiming to curtail impairment. Accordingly, we modelled associations between early-onset use of alcohol, tobacco, cannabis and amphetamine-type stimulants (ATSs) and longitudinal socio-occupational functioning (indexed by the Social and Occupational Functioning Assessment Scale) in an observational cohort presenting to early intervention mental health services. A clinical proforma collated demographic, clinical, and socio-occupational information for up to 60-months from presentation to services in young people aged 17-30. Of the wider cohort (n = 2398), 446 participants were selected with complete alcohol and substance use data. Latent class analysis was used to derive an 'early-onset' (n = 243) and 'later-onset' class (n = 203) based on age of first use of alcohol, tobacco, cannabis and ATSs. Maximum-likelihood multilevel analyses modelled functioning over time in care and tested associations with substance use latent class, age, gender and diagnosis. Membership in the 'early-onset' class (B = -1.64, p = 0.05), male gender (B = -3.27, p<0.001) and psychotic disorder diagnosis (B = -7.62, p<0.001) were associated with poorer functioning at presentation and at least one other time-point. To our knowledge, this is the first study to explore associations of early-onset substance use and longitudinal functioning in a cohort of young people with mental disorders. The identified factors may be useful for directing specific social (e.g. Social Recovery Therapy) or occupational (e.g. Individual Placement and Support) interventions to at-risk individuals, early in illness course.


Assuntos
Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Idade de Início , Estudos de Coortes , Comorbidade , Intervenção Médica Precoce , Emprego , Feminino , Humanos , Funções Verossimilhança , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Serviços de Saúde Mental , Modelos Psicológicos , New South Wales/epidemiologia , Apoio Social , Fatores Socioeconômicos , Adulto Jovem
14.
Cogn Neuropsychiatry ; 24(1): 40-53, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30621505

RESUMO

INTRODUCTION: Evidence suggests that patients with psychosis who have a history of cannabis use, but currently abstain, demonstrate superior cognitive performance than patients who have never used cannabis. The present study aimed to determine the neurocognitive profiles of patients who are in adolescence or early adulthood, when both illness- and drug-onset typically occur. METHODS: Subjects were 24 cannabis-using and 79 cannabis-naïve psychosis patients between 16 and 25 years of age. Patients and controls were administered a neurocognitive battery, indexing estimated pre-morbid intelligence, psychomotor speed, mental flexibility, verbal learning and memory, verbal fluency, sustained attention, motor and mental response, and visuospatial learning and memory. RESULTS: While healthy controls outperformed both patient groups across most cognitive measures, no significant differences between cannabis-using and cannabis-abstinent patients were evident. CONCLUSION: Evidently although there may be a group of patients who are diagnosed with a non-affective psychosis disorder regardless of external factors (i.e. cannabis use), some may instead have their illness precipitated through cannabis use at a young age, presenting with unique cognitive and symptomatic repercussions later in life. These results demonstrate no cognitive differences between cannabis-using patients and abstinent patients at the time of illness-onset, providing partial support for an alternative pathway to schizophrenia through early cannabis use.


Assuntos
Fumar Maconha/epidemiologia , Fumar Maconha/psicologia , Testes Neuropsicológicos , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Adolescente , Adulto , Fatores Etários , Atenção/efeitos dos fármacos , Atenção/fisiologia , Cannabis , Feminino , Humanos , Inteligência/efeitos dos fármacos , Inteligência/fisiologia , Masculino , Fumar Maconha/efeitos adversos , Memória/efeitos dos fármacos , Memória/fisiologia , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Adulto Jovem
15.
Neurosci Lett ; 698: 186-191, 2019 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-30659914

RESUMO

Aging is associated with a decline in performance and speed of attentional processing. Mindfulness has been shown to enhance attentional performance, however evidence of this is lacking in aging cohorts. A longitudinal RCT was conducted to examine the effect of mindfulness training on attentional performance in healthy older adults (n = 49) together with an active control computer-based attention training group (n = 30). While both groups displayed decreased N2 amplitudes at frontal and central regions during an auditory oddball task after training, only the mindfulness group showed reductions in frontal N2 and P3 latency. These results suggest that programs targeting sustained attention may result in efficient allocation of attentional resources in older adults. In particular, mindfulness may enhance the speed of attentional processes which are known to decline in aging, thereby providing benefits against age-related cognitive decline.


Assuntos
Atenção/fisiologia , Eletroencefalografia , Potenciais Evocados/fisiologia , Idoso , Análise de Variância , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Plena/métodos , Alocação de Recursos
16.
Artigo em Inglês | MEDLINE | ID: mdl-30171994

RESUMO

Diffusion tensor imaging (DTI) has been utilized to index white matter (WM) integrity in the major psychiatric disorders. However, the findings within and across such disorders have been mixed. Given this, transdiagnostic sampling with data-driven statistical approaches may lead to new and better insights about the clinical and functional factors associated with WM abnormalities. Thus, we undertook a cross-sectional DTI study of 401 young adult (18-30 years old) outpatients with a major psychiatric (depressive, bipolar, psychotic, or anxiety) disorder and 61 healthy controls. Participants also completed self-report questionnaires and underwent neuropsychological assessment. Fractional anisotropy (FA) as well as axial (AD) and radial (RD) diffusivity was determined via a whole brain voxel-wise approach (tract-based spatial statistics). Hierarchical cluster analysis was performed on FA scores in patients only, obtained from 20 major WM tracts (that is, association, projection and commissural fibers). The three cluster groups derived were distinguished by having consistently increased or decreased FA scores across all tracts. Compared to controls, the largest cluster (N = 177) showed significantly increased FA in 55% of tracts, the second cluster (N = 169) demonstrated decreased FA (in 90% of tracts) and the final cluster (N = 55) exhibited the most increased FA (in 95% of tracts). Importantly, the distribution of primary diagnosis did not significantly differ among the three clusters. Furthermore, the clusters showed comparable functional, clinical and neuropsychological measures, with the exception of alcohol use, medication status and verbal fluency. Overall, this study provides evidence that among young adults with a major psychiatric disorder there are subgroups with either abnormally high or low FA and that either pattern is associated with suboptimal functioning. Importantly, these neuroimaging-based subgroups appear despite diagnostic and clinical factors, suggesting differential treatment strategies are warranted.


Assuntos
Transtornos de Ansiedade/diagnóstico por imagem , Transtorno Bipolar/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Transtorno Depressivo/diagnóstico por imagem , Transtornos Psicóticos/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Adolescente , Adulto , Análise por Conglomerados , Estudos Transversais , Imagem de Tensor de Difusão , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Escalas de Graduação Psiquiátrica , Adulto Jovem
17.
Psychiatry Res ; 271: 335-342, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30529316

RESUMO

The utility of key phenotypes of depression in predicting response to repetitive transcranial magnetic stimulation (rTMS), namely sleep-wake behaviour, cognition and illness chronicity, has been understudied and not been extended to young samples. This study aimed to determine whether sleep-wake disturbance, cognition or depression chronicity are associated with rTMS outcome in young depressed adults. Sixteen depressed young adults diagnosed with mood disorders (aged 18-29 years) completed this open-label study. Neuronavigationally targeted high-frequency rTMS was administered at 110% of motor threshold on the left dorsolateral prefrontal cortex for 20 sessions over 4 weeks. Clinical, sleep-wake and cognitive assessments were undertaken pre- and post-treatment. Repeated-measures and correlational analyses determined pre- and post-treatment changes and predictors of treatment outcome. rTMS significantly reduced depression and anxiety. Better cognitive flexibility, verbal learning, later age of onset and greater number of depressive episodes were associated with better treatment outcome. There were no other significant/trend-level associations. rTMS had no effect on sleep-wake or cognitive measures. We provide the first evidence for the utility of cognitive flexibility and verbal learning in predicting rTMS outcome in depressed young adults. This research provides preliminary support for rTMS as an early intervention for depression and supports the need for sham-controlled trials.


Assuntos
Disfunção Cognitiva/terapia , Transtornos do Humor/terapia , Avaliação de Resultados (Cuidados de Saúde)/métodos , Transtornos do Sono-Vigília/terapia , Estimulação Magnética Transcraniana/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
18.
J Affect Disord ; 242: 80-86, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30172228

RESUMO

BACKGROUND: There is growing evidence to support the need for personalised intervention in the early stages of a major psychiatric illness, as well as the clear delineation of subgroups in psychiatric disorders based on cognitive impairment. Affective disorders are often accompanied by neurocognitive deficits; however a lack of research among young adult inpatients highlights the need to assess the utility of cognitive testing in this population. METHODS: A computerised cognitive battery was administered to 50 current inpatient young adults (16-30 years; 75% female) with an affective disorder. Patients also completed a computerised self-report questionnaire (to measure demographics and clinical features) that included items evaluating subjective impressions of their cognition. RESULTS: Hierarchical cluster analysis determined two neurocognitive subgroups: cluster 1 (n = 16) showed more severe impairments in sustained attention and memory as well as higher anxiety levels, compared to their peers in cluster 2 (n = 30) who showed the most impaired attentional switching. Across the sample, poor sustained attention was significantly correlated with higher levels of current anxiety and depressive symptoms, whereas poor verbal memory was significantly associated with increased psychological distress. LIMITATIONS: This study has a relatively small sample size (due to it being a pilot/feasibility study). Furthermore, future studies should aim to assess inpatient samples compared to community care samples, as well as healthy controls, on a larger scale. CONCLUSIONS: The findings suggest neurocognitive profiles are important in understanding phenotypes within young people with severe affective disorders. With clear subgroups based on cognitive impairment being demonstrated, the clinical utility and use of new and emerging technologies is warranted in such inpatients facilities. This pilot/feasibility study has strengthened the utility of cognitive screening as standard clinical care in an inpatient unit.


Assuntos
Transtornos do Humor/diagnóstico , Transtornos Neurocognitivos/diagnóstico , Adolescente , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Pacientes Internados , Masculino , Transtornos do Humor/psicologia , Transtornos Neurocognitivos/psicologia , Testes Neuropsicológicos , Projetos Piloto , Adulto Jovem
19.
Sleep Med ; 54: 53-61, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30529778

RESUMO

OBJECTIVES: We evaluated whether insomnia symptoms and short or long sleep duration, alone or in combination, are robustly associated with subsequent trajectory of mental health symptoms. METHODS: Participants were 2598 individuals (15 to 94 years of age) with elevated mental health symptoms at baseline (2013-14). Associations of baseline insomnia symptoms and sleep duration with two-year trajectory of mental health were estimated and adjusted for multiple potential confounders. Outcomes included recovery (well at both follow-up timepoints), intermittent symptoms (unwell at one follow-up timepoint), and chronic symptoms (unwell at each follow-up timepoint). RESULTS: Adjusted for age and sex, baseline insomnia symptoms predicted intermittent (OR 1.43, 95% CI 1.15-1.80) and chronic (OR 2.16, 95% CI 1.77-2.68) trajectories of mental health symptoms. Short sleep duration (<6 h and ≥6 to <7 h) only predicted a chronic trajectory (ORs 1.70-2.06). Associations were attenuated but significant after confounder adjustment. Those who experienced both insomnia and short (<7 h) sleep duration had the greatest risk of chronic mental health symptoms (OR 2.35, 95% CI 1.60-3.45). CONCLUSION: A focus on just sleep duration or insomnia symptoms in those with elevated mental health symptoms will not be adequate to address chronicity. Both components of sleep disturbance, and in particular their co-occurrence, should be addressed.

20.
BMJ Open ; 8(12): e022659, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30567821

RESUMO

OBJECTIVES: We sought to determine the unique and shared contributions of clinical, neurocognitive and demographic factors to functional impairment in a large, transdiagnostic, clinical cohort of adolescents and young adults. DESIGN: Cross-sectional baseline data from a prospective, cohort study. SETTING: Help-seeking youth referred from outpatient services were recruited to the Brain and Mind Youth Cohort (2008-2016) in Sydney, Australia. PARTICIPANTS: In total, 1003 outpatients were recruited, aged between 12 and 36 years (mean= 20.4 years, 54% female), with baseline diagnoses of affective, psychotic, developmental or behavioural disorders. INTERVENTIONS: Treatment as usual. PRIMARY OUTCOME MEASURES: Social and occupational functioning was used to index level of functional impairment. Structural equation modelling was used to examine associations between neurocognition, core clinical symptoms and alcohol and substance use, and clinician-rated and researcher-rated functional impairment. Moderator analyses were conducted to determine the potential influence of demographic and clinical factors (eg, medication exposure). RESULTS: Independent of diagnosis, we found that neurocognitive impairments, and depressive, anxiety and negative symptoms, were significantly associated with functioning. The association of neurocognition with social and occupational functioning remained significant even when constraining for age (15-25-year-olds only) or diagnosis (affective disorders only) in the final model. CONCLUSIONS: This study demonstrated that, in a clinically representative sample of youth, the key determinants of functioning may not be disorder specific. Further, evidence of neurocognitive dysfunction suggests that interventions that target cognition and functioning should not necessarily be reserved just for older adults with established illness.


Assuntos
Avaliação da Deficiência , Transtornos Neurocognitivos/diagnóstico , Adolescente , Adulto , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Alcoolismo/terapia , Austrália , Criança , Estudos de Coortes , Correlação de Dados , Estudos Transversais , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/terapia , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Transtornos Neurocognitivos/epidemiologia , Transtornos Neurocognitivos/terapia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Fatores de Risco , Adulto Jovem
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