Profiles and trajectories of mental health service utilisation during early intervention in psychosis.

BACKGROUND: Early intervention in psychosis services (EIS) support individuals experiencing a first episode of psychosis. Support required will vary in response to the remittance and reoccurrence of symptoms, including relapses. Characterising individuals who will need more intensive support can inform care planning. This study explores service utilisation profiles and their trajectories of service use in a sample of individuals referred to EIS. METHOD: We analysed service utilisation during the 3 years following referral to EIS (n = 2363) in West London between 2011 and 2020. Mental health service utilisation data were submitted to model-based clustering. Latent growth models were then estimated for identified profiles. Profiles were compared regarding clinical and demographic characteristics and onward pathways of care. RESULTS: Analyses revealed 5 profiles of individuals attending EIS based on their service utilisation over 3 years. 55.5% of the sample were members of a low utilisation and less clinically severe profile. The distinct service use patterns of these profiles were associated with Health of the Nations Outcome Scale scores at treatment initiation (at total, subscale, and individual item level), along with age and gender. These patterns of use were also associated with onward care and ethnicity. CONCLUSIONS: Profiles and trajectories of service utilisation call for development of integrated care pathways and use of more personalised interventions. Services should consider patient symptoms and characteristics when making clinical decisions informing the provision of care. The profiles represent typical patterns of service use, and identifying factors associated with these subgroups might help optimise EIS support.

The effects of licit and illicit recreational drugs on prospective memory: a meta-analytic review.

RATIONALE: There are no recent reports summarising the magnitude of prospective memory (PM) impairments in recreational drug users. OBJECTIVE: We performed a meta-analysis of studies (with a parallel group design) examining PM performance in users of common recreational drugs (including alcohol and tobacco) who were not intoxicated during testing. Studies were also evaluated for the presence of methodological bias. METHODS: Twenty-seven studies were included in the meta-analysis following literature searches of MEDLINE, EMBASE and PsycINFO. Effect sizes (standardised mean difference; SMD) were calculated separately for the effects of alcohol, cannabis, ecstasy, methamphetamine and tobacco use. The influences of drug use and study characteristics on effect sizes were explored using meta-regressions. Sources of study bias were also assessed. RESULTS: Heavy drinkers and regular drug users tended to perform worse than controls on event and time-based PM tasks. Effect sizes (standardised mean differences; SMDs) for event-based PM impairment across the different drug-using groups/heavy drinkers ranged between - 1.10 and - 0.49, with no 95% CI crossing 0.00. SMDs for time-based PM ranged between - 0.98 and - 0.70. Except for the CIs associated with the ES for smokers' time-based PM performance, no CIs crossed 0.00. CONCLUSIONS: Although all drug-using groups showed moderate-large impairments in event and time-based PM, effect sizes had low precision and moderate-high levels of heterogeneity. In addition, several methodological and reporting issues were identified in the majority of studies. As such, considerable uncertainty remains regarding the role of confounds and the magnitude of PM impairments in non-intoxicated recreational drug users.

Prospective memory impairments in heavy social drinkers are partially overcome by future event simulation.

BACKGROUND: Recent research suggests that alcohol acutely impairs prospective memory (PM), and this impairment can be overcome using a strategy called 'future event simulation' (FES). Impairment in event-based PM found in detoxifying alcohol-dependent participants is reversed through FES. However, the impact of the most common problematic drinking patterns that do not involve alcohol dependence on PM remains unclear. AIMS: Here, we examine the impact of frequent heavy drinking on PM and the degree to which any impairments can be reversed through FES. METHODS: PM was assessed in 19 heavy drinkers (AUDIT scores ≥ 15) and 18 matched control participants (AUDIT scores ≤ 7) using the 'Virtual Week' task both at baseline and again following FES. RESULTS: Heavy drinkers performed significantly worse than controls on regular and irregular time-based PM tasks. FES improved the performance of controls but not of heavy drinkers on time-based tasks. In contrast, FES improved heavy drinkers' performance on event-based PM tasks. CONCLUSIONS: These findings suggest that heavy drinkers experience deficits in strategic monitoring processing associated with time-based PM tasks which do not abate after FES. That the same strategy improves their event-based PM suggests that FES may be helpful for individuals with problematic drinking patterns in improving their prospective memory.

Processing of facial affect in social drinkers: a dose-response study of alcohol using dynamic emotion expressions.

RATIONALE: Studies of affect recognition can inform our understanding of the interpersonal effects of alcohol and help develop a more complete neuropsychological profile of this drug. OBJECTIVES: The objective of the study was to examine affect recognition in social drinkers using a novel dynamic affect-recognition task, sampling performance across a range of evolutionarily significant target emotions and neutral expressions. METHODS: Participants received 0, 0.4 or 0.8 g/kg alcohol in a double-blind, independent groups design. Relatively naturalistic changes in facial expression-from neutral (mouth open) to increasing intensities of target emotions, as well as neutral (mouth closed)-were simulated using computer-generated dynamic morphs. Accuracy and reaction time were measured and a two-high-threshold model applied to hits and false-alarm data to determine sensitivity and response bias. RESULTS: While there was no effect on the principal emotion expressions (happiness, sadness, fear, anger and disgust), compared to those receiving 0.8 g/kg of alcohol and placebo, participants administered with 0.4 g/kg alcohol tended to show an enhanced response bias to neutral expressions. Exploration of this effect suggested an accompanying tendency to misattribute neutrality to sad expressions following the 0.4-g/kg dose. CONCLUSIONS: The 0.4-g/kg alcohol-but not 0.8 g/kg-produced a limited and specific modification in affect recognition evidenced by a neutral response bias and possibly an accompanying tendency to misclassify sad expressions as neutral. In light of previous findings on involuntary negative memory following the 0.4-g/kg dose, we suggest that moderate-but not high-doses of alcohol have a special relevance to emotional processing in social drinkers.

Processing dynamic facial affect in frequent cannabis-users: evidence of deficits in the speed of identifying emotional expressions.

BACKGROUND: While heavy cannabis-users seem to show various cognitive impairments, it remains unclear whether they also experience significant deficits in affective functioning. Evidence of such deficits may contribute to our understanding of the interpersonal difficulties in cannabis-users, and the link between cannabis-use and psychological disorders (Moore et al., 2007). METHOD: Emotion recognition performance of heavy cannabis-users and non-using controls was compared. A measure of emotion recognition was used in which participants identified facial expressions as they changed from neutral (open-mouth) to gradually more intense expressions of sadness, neutral, anger or happiness (open or closed mouth). Reaction times and accuracy were recorded as the facial expressions changed. Participants also completed measures of 'theory of mind,' depression and impulsivity. RESULTS: Cannabis-users were significantly slower than controls at identifying all three emotional expressions. There was no difference between groups in identifying facial expressions changing from open-mouth neutral expressions to closed-mouth neutral expressions suggesting that differences in emotion recognition were not due to a general slowing of reaction times. Cannabis-users were also significantly more liberal in their response criterion for recognising sadness. CONCLUSION: Heavy cannabis-use may be associated with affect recognition deficits. In particular, a greater intensity of emotion expression was required before identification of positive and negative emotions. This was found using stimuli which simulated dynamic changes in emotion expression, and in turn, suggests that cannabis-users may experience generalised problems in decoding basic emotions during social interactions. The implications of these findings are discussed for vulnerability to psychological and interpersonal difficulties in cannabis-users.