Enhancing memory in late-life depression: the effects of a combined psychoeducation and cognitive training program.

OBJECTIVE: To evaluate the efficacy of a multifactorial cognitive training (CT) program for older people with a lifetime history of depressive disorder. METHODS: This was a single-blinded waitlist control design. The study was conducted in the Healthy Brain Ageing Clinic, a specialist outpatient clinic at the Brain & Mind Research Institute, Sydney, Australia. Forty-one participants (mean age = 64.8 years, sd = 8.5) with a lifetime history of major depression were included. They were stabilized on medication and had depressive symptoms in the normal to mild range. The intervention encompassed both psychoeducation and CT. Each component was 1-hour in duration and was delivered in a group format over a 10-week period. Psychoeducation was multifactorial, was delivered by health professionals and targeted cognitive strategies, as well depression, anxiety, sleep, vascular risk factors, diet and exercise. CT was computer-based and was conducted by Clinical Neuropsychologists. Baseline and follow-up neuropsychological assessments were conducted by Psychologists who were blinded to group allocation. The primary outcome was memory whilst secondary outcomes included other aspects of cognition and disability. RESULTS: CT was associated with significant improvements in visual and verbal memory corresponding to medium to large effect sizes. CONCLUSION: CT may be a viable secondary prevention technique for late-life depression, a group who are at risk of further cognitive decline and progression to dementia.

The Acceptability and Efficacy of Electronic Data Collection in a Hospital Neurodevelopmental Clinic: Pilot Questionnaire Study.

BACKGROUND: There is a growing need for cost-efficient and patient-centered approaches to support families in hospital- and community-based neurodevelopmental services. For such purposes, electronic data collection (EDC) may hold advantages over paper-based data collection. Such EDC approaches enable automated data collection for scoring and interpretation, saving time for clinicians and services and promoting more efficient service delivery. OBJECTIVE: This pilot study evaluated the efficacy of EDC for the Child Development Unit, a hospital-based diagnostic assessment clinic in the Sydney Children's Hospital Network. Caregiver response rates and preference for EDC or paper-based methods were evaluated as well as the moderating role of demographic characteristics such as age, level of education, and ethnic background. METHODS: Families were sent either a paper-based questionnaire via post or an electronic mail link for completion before attending their first on-site clinic appointment for assessment. A total of 62 families were provided a paper version of the questionnaire, while 184 families were provided the online version of the same questionnaire. RESULTS: Completion rates of the questionnaire before the first appointment were significantly higher for EDC (164/184, 89.1%) in comparison to paper-based methods (24/62, 39%; P<.001). Within the EDC group, a vast majority of respondents indicated a preference for completing the questionnaire online (151/173, 87.3%), compared to paper completion (22/173, 12.7%; P<.001). Of the caregiver demographic characteristics, only the respondent's level of education was associated with modality preference, such that those with a higher level of education reported a greater preference for EDC (P=.04). CONCLUSIONS: These results show that EDC is feasible in hospital-based clinics and has the potential to offer substantial benefits in terms of centralized data collation, time and cost savings, efficiency of service, and resource allocation. The results of this study therefore support the continued use of electronic methods to improve family-centered care in clinical practices.

A national harmonised data collection network for neurodevelopmental disorders: A transdiagnostic assessment protocol for neurodevelopment, mental health, functioning and well-being.

Background: Children with neurodevelopmental disorders share common phenotypes, support needs and comorbidities. Such overlap suggests the value of transdiagnostic assessment pathways that contribute to knowledge about research and clinical needs of these children and their families. Despite this, large transdiagnostic data collection networks for neurodevelopmental disorders are not well developed. This paper describes the development of a nationally supported transdiagnostic clinical and research assessment protocol across Australia. The vision is to establish a harmonised network for data collection and collaboration that promotes transdiagnostic clinical practice and research. Methods: Clinicians, researchers and community groups across Australia were consulted using surveys and national summits to identify assessment instruments and unmet needs. A national research committee was formed and, using a consensus approach, selected assessment instruments according to pre-determined criteria to form a harmonised transdiagnostic assessment protocol. Results: Identified assessment instruments were clustered into domains of transdiagnostic assessment needs, which included child functioning/quality of life, child mental health, caregiver mental health, and family background information. From this, the research committee identified a core set of nine measures and an extended set of 14 measures that capture these domains with potential for further modifications as recommended by clinicians, researchers and community members. Conclusion: The protocol proposed here was established through a strong partnership between clinicians, researchers and the community. It will enable (i) consensus driven transdiagnostic clinical assessments for children with neurodevelopmental disorders, and (ii) research studies that will inform large transdiagnostic datasets across neurodevelopmental disorders and that can be used to inform research and policy beyond narrow diagnostic groups. The long-term vision is to use this framework to facilitate collaboration across clinics to enable large-scale data collection and research. Ultimately, the transdiagnostic assessment data can be used to inform practice and improve the lives of children with neurodevelopmental disorders and their families.

Investigating the neuropsychological and neuroanatomical changes that occur over the first 2-3 years of illness in patients with first-episode schizophrenia.

OBJECTIVE: This study explored the concurrent courses of the neuroanatomical and neuropsychological changes that occurred over the first 2-3 years of illness in patients with first-episode schizophrenia (FES). METHODS: Fifty-two patients with FES underwent neuropsychological testing and a structural magnetic resonance imaging (sMRI) scan within three months of their first presentation to mental health services with psychotic symptoms (time1). Patients' cognitive performance was evaluated via an extensive neuropsychological test battery, which assessed 9 cognitive domains. Of the 52 patients at time1, 32 returned 2-3 years later (time2) for follow-up neuropsychological testing, and 20 of these also underwent follow-up sMRI. MR images were preprocessed in SPM99. Grey matter volumes of patients' whole-brain, frontal lobes and temporal lobes were calculated by convolving the preprocessed images with manually-drawn binary masks. RESULTS: Patients exhibited longitudinal improvements in full-scale IQ, performance IQ and visual memory. In contrast, concurrent reductions in grey matter were observed for the whole-brain (3% reduction) and the frontal lobe (3.65% reduction). Furthermore, the extent of patients' whole-brain and frontal-lobe grey matter changes were positively correlated with longitudinal changes in verbal learning and memory. DISCUSSION: The results of this study suggest that while the early stages of schizophrenia are associated with a mild improvement in patients' overall cognitive functioning, they are also associated with progressive grey matter atrophy.

Predictors of outcome three years after diagnosis of first episode psychosis.

This study aimed to determine which of demographic/premorbid, psychiatric or neuropsychological factors best predict functional outcome at 3 years after a first episode of psychotic illness. This will, it is hoped, identify prognostic indicators of longer term outcomes, as well as targets for rehabilitation. The Western Sydney First Episode Psychosis Project collected data on young people (aged 13 to 25) presenting with newly diagnosed psychosis at baseline and 3-year follow-up (n=52). Outcome was measured using the Role Functioning Scale (RFS) and the Clinical Global Impression Scale--severity of illness measure (CGI-S). Multiple regression analyses were performed to identify baseline predictors of outcome. The Premorbid Social Adjustment Scale in Adolescence (PSAS-Adolescent) and the Verbal Comprehension Index from the WAIS-III were found to be the two significant predictors for RFS, with only the former (PSAS-Adolescent) predicting CGI-S. Demographic and neuropsychological measures relating to premorbid functioning were the best predictors of long-term outcome in first episode psychosis, with baseline psychiatric symptoms not contributing.

A double-blind randomized controlled trial of oxytocin nasal spray and social cognition training for young people with early psychosis.

Social-cognitive deficits contribute to poor functional outcomes in early psychosis; however, no effective pharmacological treatments exist for these problems. This study was the first to investigate the efficacy of an extended treatment of oxytocin nasal spray combined with social cognition training (SCT) to improve social cognition, clinical symptoms, and social functioning in early psychosis. In a double-blind, randomized, placebo-controlled, between-subjects trial, 52 individuals (aged 16-35 years) diagnosed with an early psychosis schizophrenia-spectrum illness were recruited. Participants received oxytocin (24 International Units) or placebo nasal spray twice-daily for 6 weeks, combined with group SCT (2 × 1 hour weekly sessions for 6 weeks). An additional dose of oxytocin was administered before each weekly session. Assessments were conducted at baseline, post-treatment, and at 3-month follow-up. Primary outcomes included the Reading the Mind in the Eyes Test, the Scale for the Assessment of Positive and Negative Symptoms, and the Social Functioning Scale. Secondary outcomes included self-report and behavioral assessments of social cognition, symptom severity, and social functioning. Results showed that on all primary and secondary outcomes, there was no benefit of oxytocin nasal spray treatment in comparison to placebo. Exploratory post hoc analysis suggested that increased use of nasal spray was, however, associated with reductions in negative symptoms in the oxytocin condition only. This study represents the first evaluation of oxytocin treatment for early psychosis. Although results suggest no benefit of oxytocin treatment, results also highlight an urgent need to consider nasal spray delivery and dose-related variables for future clinical trials.

Relative contributions of psychiatric symptoms and neuropsychological functioning to quality of life in first-episode psychosis.

OBJECTIVE: To report on the relationship between quality of life (QOL), psychiatric symptoms and neuropsychological functioning in a sample of young people who have experienced a first episode of psychosis 2-3 years following initial presentation. METHOD: Fifty-one participants aged 15-27 years old completed the short form of the World Health Organization Quality of Life scale (WHOQOL-Bref), a self-report instrument assessing physical, psychological, social and environmental aspects of QOL. A comprehensive neuropsychological battery was administered. Measures of psychiatric symptoms including depression (as assessed by the Calgary Depression Scale), positive, negative and general psychopathology (as assessed by the Positive and Negative Syndrome Scale) were obtained. RESULTS: Multiple regression analyses were used to evaluate the ability of neuropsychological measures and psychiatric symptoms to predict QOL. When neuropsychological variables were considered on their own, cognitive flexibility, verbal fluency, verbal ability and sustained attention explained up to 28% of the variance in the four domains of QOL. However, in the presence of psychiatric symptoms, neuropsychological variables were no longer significant predictors for physical and psychological QOL; depression, general psychopathology and negative symptoms together explained up to 43% of the variance in QOL, with neuropsychological variables remaining significant for social and environmental QOL. CONCLUSIONS: In young people with their first episode of psychosis, QOL is more strongly related to levels of psychopathology, particularly depression, than neuropsychological deficits. This finding replicates previous studies in chronic schizophrenia that have suggested QOL is more strongly related to levels of psychopathology than the presence of neuropsychological deficits.