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Prisoners exhibit high rates of substance use and mental health problems. In the present study, we sought to gain a detailed understanding of substance use amongst young prisoners to inform early detection and early intervention... more
Prisoners exhibit high rates of substance use and mental health problems. In the present study, we sought to gain a detailed understanding of substance use amongst young prisoners to inform early detection and early intervention strategies in a prison setting. This is a cross-sectional study of 2102 prisoners who were screened by the London Early Detection and Prevention in Prison Team (LEAP). Data on the use of substances were collected including age of first use, recent use, duration of use and poly-drug use. The Prodromal Questionnaire - Brief Version was used to screen for the at-risk mental state. We found high rates of lifetime and recent use and low age of first use of a number of substances. We also found strong associations between substance use and screening positive for an at-risk mental state. Logistic regression analysis confirmed that use of any drug in the last year, poly-drug and early use, as well as heavy alcohol use, were related to an increased risk of screening ...
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Despite more than 100 years of study, there remains no definitive diagnostic validation of the functional psychoses. Factor analysis suggests the presence of three or more psychopathological syndromes in functional psychoses as a whole.... more
Despite more than 100 years of study, there remains no definitive diagnostic validation of the functional psychoses. Factor analysis suggests the presence of three or more psychopathological syndromes in functional psychoses as a whole. The relationship between these factors and cerebral anatomy has been investigated in schizophrenia only. This study aimed to address the relationship of symptom factors to clinically important variables and cerebral anatomy in a sample of psychotic patients with a spread of diagnoses. In a sample of patients with functional psychoses, symptom data was obtained on four consecutive admissions using the OPCRIT symptom checklist. OPCRIT data was used to generate operational diagnoses in accordance with pre-set criteria and a principle components analysis was performed on symptom data. Factor loadings were compared between each admission to examine factor stability over time. Factor scores at first admission were also correlated with clinical variables obtained from patients' case notes. From the sample of 204 patients, 64 subjects were recruited and underwent an MRI scan of the brain. Regional anatomical volumes were compared with diagnosis and factor loadings at first admission. A principal components analysis gave a four-factor solution of 'manic', 'depressive', 'disorganization' and 'reality distortion' factors at each admission. Factors showed a high degree of stability over the four admissions studied. The factors were significantly associated with several clinical variables. Three of the four factors were associated with a specific pattern of cerebral anatomy. This study suggests that factors may correspond to relatively specific disease processes underlying functional psychotic illness. We propose that the use of symptom factors may facilitate the investigation of the underlying mechanisms of psychotic illness.
Research Interests: Psychology, Magnetic Resonance Imaging, Adolescent, Delusions, Psychological Medicine, and 15 moreActivities of Daily Living, Brain, Humans, Psychological, Female, Male, Regression Analysis, Middle Aged, Adult, Public health systems and services research, Five Factor Model, Psychotic Disorders, Psychological Models, Neurosciences, and Severity of Illness Index
Neuropsychological assessments were compared among individuals at enhanced genetic risk of schizophrenia (n = 157) and controls (n = 34). The relationship between cognitive impairments and the presence of psychotic symptoms and measures... more
Neuropsychological assessments were compared among individuals at enhanced genetic risk of schizophrenia (n = 157) and controls (n = 34). The relationship between cognitive impairments and the presence of psychotic symptoms and measures of genetic risk was explored in the high-risk subjects. Neuropsychological differences were identified in many areas of function and were not accounted for by the presence of psychotic symptoms. Genetic liability was not associated with neuropsychological performance or with psychotic symptoms, but exploratory analysis showed some tests were associated with both liability measures. These results suggest that what is inherited is not the disorder itself but a state of vulnerability manifested by neuropsychological impairment, occurring in many more individuals than are predicted to develop the disorder.
Research Interests: Genetics, Psychology, Abnormal Psychology, Schizophrenia, Nonparametric Statistics, and 17 moreAdolescent, Multivariate Analysis, Humans, Neuropsychological Assessment, Female, Male, Risk factors, Abnormal, Cognitive impairment, Adult, Psychotic Disorders, Risk Factors, Exploratory Analysis, Cognition disorders, Socioeconomic Factors, Severity of Illness Index, and Neuropsychological Tests
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Acceptance and Commitment Therapy (ACT) is a contextual cognitive-behavioural approach with a developing evidence base for clinical and cost-effectiveness as an individually-delivered intervention to promote recovery from psychosis. ACT... more
Acceptance and Commitment Therapy (ACT) is a contextual cognitive-behavioural approach with a developing evidence base for clinical and cost-effectiveness as an individually-delivered intervention to promote recovery from psychosis. ACT also lends itself to brief group delivery, potentially increasing access to therapy without inflating costs. This study examined, for the first time, the feasibility and acceptability of ACT groups for people with psychosis (G-ACTp). Participants were recruited from community psychosis teams. Ratings of user satisfaction, and pre-post change in self-rated functioning (primary outcome), mood (secondary outcome) and ACT processes were all completed with an independent assessor. Of 89 people recruited, 83 completed pre measures, 69 started the four-week G-ACTp intervention, and 65 completed post measures. Independently assessed acceptability and satisfaction were high. Functioning (Coeff. = -2.4, z = -2.9, p = 0.004; 95% CI: -4.0 to -0.8; within subject...
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BackgroundIt is unknown whether prodromal services improve outcomes in those who go on to develop psychosis, and whether these patients are demographically different from the overall first-episode population.AimsTo compare... more
BackgroundIt is unknown whether prodromal services improve outcomes in those who go on to develop psychosis, and whether these patients are demographically different from the overall first-episode population.AimsTo compare sociodemographic features, duration of untreated psychosis, hospital admission and frequency of compulsory treatment in the first year after the onset of psychosis in patients who present to prodromal services with patients who did not present to services until the first episode of psychosis.MethodWe compared two groups of patients with first-episode psychosis: one who made transition after presenting in the prodromal phase and the other who had presented with a first episode.ResultsThe patients who had presented before the first episode were more likely to be employed and less likely to belong to an ethnic minority group. They had a shorter duration of untreated psychosis, and were less likely to have been admitted to hospital and to have required compulsory trea...
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Studies of groups of individuals who have a genetically high risk of developing schizophrenia, have found neuropsychological impairments that highlight likely trait markers of the schizophrenic genotype. This paper describes the change in... more
Studies of groups of individuals who have a genetically high risk of developing schizophrenia, have found neuropsychological impairments that highlight likely trait markers of the schizophrenic genotype. This paper describes the change in neuropsychological function and associations with psychiatric state of high risk participants during the first two assessments of the Edinburgh High Risk Study. Seventy-eight high risk participants and 22 normal controls, age and sex matched completed two neuropsychological assessments 18 months to 2 years apart. The areas of function assessed include intellectual function, executive function, learning and memory, and verbal ability and language. The high risk participants performed significantly worse on particular tests of verbal memory and executive function over the two assessments than matched controls. Those high risk participants who experienced psychotic symptoms were found to exhibit a decline in IQ and perform worse on tests of verbal mem...
Research Interests: Genetics, Psychology, Psychometrics, Intelligence, Schizophrenia, and 27 moreCognition, Prediction, Evolution, Language, Adolescent, Comparative Study, Young People, Psychological Medicine, Learning, Memory, Humans, Psychological, Neuropsychological Assessment, Female, Male, Young Adult, Follow-up studies, Genetic determinism, Risk factors, Schizotypal Personality Disorder, Adult, Public health systems and services research, Risk Factors, Intelligence quotient, Neurosciences, Predictive value of tests, and Neuropsychological Tests
Sustained attention has been found to be impaired in individuals suffering from schizophrenia and their close relatives. This has led to the hypothesis that impaired sustained attention is an indicator of vulnerability to schizophrenia.... more
Sustained attention has been found to be impaired in individuals suffering from schizophrenia and their close relatives. This has led to the hypothesis that impaired sustained attention is an indicator of vulnerability to schizophrenia. The Edinburgh High Risk Study used the Continuous Performance Test-Identical Pairs version (CPT-IP) to assess sustained attention in 127 high risk participants, 30 controls and 15 first-episode schizophrenic patients. A second assessment was completed by 59 high risk and 18 control participants 18 months to 2 years after the first. No differences in attentional capacity were found between the high risk and control groups and there was no association between genetic liability to schizophrenia and poor performance on the CPT-IP. Additionally, no association between occurrence of psychotic symptoms in the high risk group and impaired attentional capacity was found. The results suggest that deficits in sustained attention are not indicative of a genetic ...
Research Interests: Psychology, Sustained Attention, Schizophrenia, Attention, Risk, and 14 moreYoung People, Psychological Medicine, Humans, Discrimination Learning, Psychological, Female, Male, Schizotypal Personality Disorder, Adult, Public health systems and services research, Neurosciences, Psychomotor Performance, Neuropsychological Tests, and Attention deficit disorder with hyperactivity
Research Interests: Schizophrenia, Dermatoglyphics, Pregnancy, Humans, Female, and 5 moreMale, Risk factors, Palm, Adult, and Risk Factors
ABSTRACT Background: Around one third of people referred to prodromal clinics for the diagnosis and treatment of ultra-high-risk symptoms present with overt first episode psychosis (FEP). We investigated clinical outcomes among this group... more
ABSTRACT Background: Around one third of people referred to prodromal clinics for the diagnosis and treatment of ultra-high-risk symptoms present with overt first episode psychosis (FEP). We investigated clinical outcomes among this group compared to those presenting to standard mental health services in South London. Method: 164 people with FEP presenting to the OASIS prodromal clinic were compared with 2,779 presenting to standard mental health services. Outcome data on number of hospital admissions, number of inpatient days and compulsory hospital admission were obtained from electronic clinical records. Age, gender, ethnicity, marital status, employment status, diagnosis, borough of residence and antipsychotic therapy were entered as covariates in multivariable analyses. Results: People with FEP presenting to OASIS were more likely to be male (68.3%), younger (mean age 23.6 years) and from a Black and Minority Ethnic (BME) group (68.9%) compared with FEP people in standard mental health services (59.8% male; mean age 25.1 years; 55.5% BME). Presentation to the prodromal clinic was associated with reduced frequency of hospital admission (IRR 0.49, 95% CI 0.39–0.61), fewer days spent in hospital (B coefficient −17.0 days, 95% CI −33.7, −0.3) and reduced likelihood of compulsory hospital admission (OR 0.52, 95% CI 0.34–0.81) at 2 year follow-up. Conclusions: Presentation with FEP to a prodromal clinic was associated with better clinical outcomes compared to standard mental health services. These findings suggest a potential role for prodromal clinics to facilitate access to healthcare for people with FEP who may otherwise face difficulties in engaging with traditional mental health services.
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Research Interests: Demography, Social Work, Schizophrenia, Risk assessment, Adolescent, and 15 moreSocial Class, Humans, Female, Male, Young Adult, Risk factors, Parents, Adult, Time Factors, Reproducibility of Results, Psychotic Disorders, Risk Factors, Risk Assessment, Severity of Illness Index, and Psychiatric Status Rating Scales
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Several studies have found an association between indicators of fetal growth and/or obstetric complications and schizophrenia but only a few studies have investigated the possible association between these factors and bipolar disorder.... more
Several studies have found an association between indicators of fetal growth and/or obstetric complications and schizophrenia but only a few studies have investigated the possible association between these factors and bipolar disorder. Furthermore, the results of these studies have been contradictory. The aim of this study was to investigate whether the risk of bipolar disorder is associated with exposure to indicators of fetal growth. A national population nested case-control study based on Danish longitudinal register databases was carried out. Conditional logistic regression was used, controlling for potential confounding factors such as parental age at birth, socio-economic indicators and psychiatric history. We identified 196 cases, and each case was time-, age- and sex-matched with 25 normal population-based controls. All cases were between the ages of 12 and 26 years at the time of diagnosis, were born between 1973 and 1983 and were admitted and diagnosed between 1987 and 1999. During the study period 1973-1983, none of the individual variables available for analyses (birthweight, birth length, gestational age and number of previous pregnancies in the mother) was associated with receiving a diagnosis of bipolar disorder. None of the indicators of fetal growth under study could be identified as risk factors for bipolar disorder, suggesting that the etiologies of schizophrenia and bipolar disorder, at least in part, are different.
Research Interests: Psychology, Schizophrenia, Bipolar Disorder, Adolescent, Psychological Medicine, and 18 moreFetal development, Denmark, Pregnancy, Humans, Child, Female, Fetal Growth, Follow-up studies, Registries, Foetus, Adult, Maternal Age, Public health systems and services research, Fetus, Neurosciences, Case Control Studies, Socioeconomic Factors, and health status indicators
Despite more than 100 years of study, there remains no definitive diagnostic validation of the functional psychoses. Factor analysis suggests the presence of three or more psychopathological syndromes in functional psychoses as a whole.... more
Despite more than 100 years of study, there remains no definitive diagnostic validation of the functional psychoses. Factor analysis suggests the presence of three or more psychopathological syndromes in functional psychoses as a whole. The relationship between these factors and cerebral anatomy has been investigated in schizophrenia only. This study aimed to address the relationship of symptom factors to clinically important variables and cerebral anatomy in a sample of psychotic patients with a spread of diagnoses. In a sample of patients with functional psychoses, symptom data was obtained on four consecutive admissions using the OPCRIT symptom checklist. OPCRIT data was used to generate operational diagnoses in accordance with pre-set criteria and a principle components analysis was performed on symptom data. Factor loadings were compared between each admission to examine factor stability over time. Factor scores at first admission were also correlated with clinical variables obtained from patients' case notes. From the sample of 204 patients, 64 subjects were recruited and underwent an MRI scan of the brain. Regional anatomical volumes were compared with diagnosis and factor loadings at first admission. A principal components analysis gave a four-factor solution of 'manic', 'depressive', 'disorganization' and 'reality distortion' factors at each admission. Factors showed a high degree of stability over the four admissions studied. The factors were significantly associated with several clinical variables. Three of the four factors were associated with a specific pattern of cerebral anatomy. This study suggests that factors may correspond to relatively specific disease processes underlying functional psychotic illness. We propose that the use of symptom factors may facilitate the investigation of the underlying mechanisms of psychotic illness.
Research Interests: Psychology, Magnetic Resonance Imaging, Adolescent, Delusions, Psychological Medicine, and 15 moreActivities of Daily Living, Brain, Humans, Psychological, Female, Male, Regression Analysis, Middle Aged, Adult, Public health systems and services research, Five Factor Model, Psychotic Disorders, Psychological Models, Neurosciences, and Severity of Illness Index
Several studies suggest that many patients with schizophrenia have pre-morbid neurodevelopmental abnormalities. This study examines how behavioural abnormalities are associated with mild psychotic symptoms and later schizophrenic illness.... more
Several studies suggest that many patients with schizophrenia have pre-morbid neurodevelopmental abnormalities. This study examines how behavioural abnormalities are associated with mild psychotic symptoms and later schizophrenic illness. Maternal ratings on the Child Behavior Checklist (CBCL) of the early behaviour of 155 subjects were obtained at entry to the Edinburgh study of people at high risk of schizophrenia. These maternal ratings were compared in those with and without psychotic symptoms and used to predict the later onset of psychosis. The CBCL syndrome scores for the children prior to age 13 did not distinguish any of the study groups at entry to the study. In the ratings made for the subjects when aged from 13 to 16, delinquent behaviour and 'other problems' were weakly associated with these symptoms. However, with the exception of somatic symptoms and thought problems, the age 13-16 scales were significant predictors of later schizophrenic illness. This was true also for some of the ratings prior to age 13. Various behaviours, in particular, withdrawn and delinquent-aggressive behaviour in adolescents at risk of schizophrenia may predict later onset of the illness. These behaviours, however, are far less predictive of isolated psychotic symptoms prior to psychosis onset.
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Finding risk indicators for schizophrenia among groups of individuals at high genetic risk for the disorder, has been the driving force of the high risk paradigm. The current study describes the preliminary results of a neuropsychological... more
Finding risk indicators for schizophrenia among groups of individuals at high genetic risk for the disorder, has been the driving force of the high risk paradigm. The current study describes the preliminary results of a neuropsychological assessment battery conducted on the first 50% of subjects from the Edinburgh High Risk Study. One hundred and four high risk subjects and 33 normal controls, age and sex matched, were given a neuropsychological assessment battery. The areas of function assessed and reported here include intellectual function, executive function, perceptual motor speed, mental control/ encoding, verbal ability and language, learning and memory measures, and handedness. The high risk subjects performed significantly more poorly than the control subjects in the following domains of neuropsychological function: intellectual function, executive function, mental control/encoding and learning, and memory. Controlling for IQ, high risk subjects made significantly more errors on the Hayling Sentence Completion Test (HSCT), took longer to complete section A of the HSCT, had lower scores on the delayed recall condition of the visual reproductions subtest of the Wechsler Memory Scale-Revised, and had significantly poorer Rivermead Behavioural Memory Test (RBMT) standardized scores. The presence of significant group by IQ interactions for the RBMT and time to complete section A of the HSCT suggested that differences among the groups were more marked in the lower IQ range. Performance on the HSCT was found to be related to the degree of family history of schizophrenia. High risk subjects performed more poorly than controls on all tests of intellectual function and on aspects of executive function and memory.
Research Interests: Genetics, Psychology, Intelligence, Schizophrenia, Cognition, and 20 moreLaterality, Handedness, Language, Young People, Psychological Medicine, Learning, Memory, Humans, Psychological, Neuropsychological Assessment, Female, Male, Genetic determinism, Risk factors, Risk Factor, Adult, Public health systems and services research, Risk Factors, Neurosciences, and Neuropsychological Tests
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Research Interests: Early Intervention, Social Interaction, Quality of life, Risk assessment, Adolescent, and 26 moreEmployment, Social behavior, Humans, Female, Male, Young Adult, Risk factors, Arms, Risk Factor, Questionnaires, Social Functioning, Longitudinal Studies, Adult, Sex Factors, Psychotic Disorders, Risk Factors, Psychiatric, Risk Assessment, Social Behavior, Social Behavior Disorders, Ultra High Risk, Predictive value of tests, General Population, Severity of Illness Index, Psychiatric Status Rating Scales, and Neuropsychological Tests
Neuropsychological assessments were compared among individuals at enhanced genetic risk of schizophrenia (n = 157) and controls (n = 34). The relationship between cognitive impairments and the presence of psychotic symptoms and measures... more
Neuropsychological assessments were compared among individuals at enhanced genetic risk of schizophrenia (n = 157) and controls (n = 34). The relationship between cognitive impairments and the presence of psychotic symptoms and measures of genetic risk was explored in the high-risk subjects. Neuropsychological differences were identified in many areas of function and were not accounted for by the presence of psychotic symptoms. Genetic liability was not associated with neuropsychological performance or with psychotic symptoms, but exploratory analysis showed some tests were associated with both liability measures. These results suggest that what is inherited is not the disorder itself but a state of vulnerability manifested by neuropsychological impairment, occurring in many more individuals than are predicted to develop the disorder.
Research Interests: Genetics, Psychology, Abnormal Psychology, Schizophrenia, Nonparametric Statistics, and 17 moreAdolescent, Multivariate Analysis, Humans, Neuropsychological Assessment, Female, Male, Risk factors, Abnormal, Cognitive impairment, Adult, Psychotic Disorders, Risk Factors, Exploratory Analysis, Cognition disorders, Socioeconomic Factors, Severity of Illness Index, and Neuropsychological Tests
Controversy continues regarding an association between obstetric complications and risk of schizophrenia in early adult life. To compare the rate of labour and delivery complications among persons who developed schizophrenia with... more
Controversy continues regarding an association between obstetric complications and risk of schizophrenia in early adult life. To compare the rate of labour and delivery complications among persons who developed schizophrenia with controls; to establish whether any complication is associated with later schizophrenia. We located the labour ward records of 431 individuals with schizophrenia and of same-gender controls from the same hospital birth series. Mothers were matched by age, socio-economic group and parity. Individual complications were evaluated blindly using two obstetric complication scales. Overall, the rate of labour and delivery complications for those who developed schizophrenia did not differ from that of controls. Males who had presented to psychiatric services before the age of 30 had a greater frequency of and more severe labour/delivery complications than their matched controls. Other than among young-onset males we found no increase in labour and delivery complications among cases.
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People from Black ethnic groups (African-Caribbean and Black African) are more prone to develop psychosis in Western countries. This excess might be explained by perceptions of disadvantage. To investigate whether the higher incidence of... more
People from Black ethnic groups (African-Caribbean and Black African) are more prone to develop psychosis in Western countries. This excess might be explained by perceptions of disadvantage. To investigate whether the higher incidence of psychosis in Black people is mediated by perceptions of disadvantage. A population-based incidence and case-control study of first-episode psychosis (Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP)). A total of 482 participants answered questions about perceived disadvantage. Black ethnic groups had a higher incidence of psychosis (OR= 4.7, 95% CI 3.1-7.2). After controlling for religious affiliation, social class and unemployment, the association of ethnicity with psychosis was attenuated (OR=3.0, 95% CI 1.6-5.4) by perceptions of disadvantage. Participants in the Black non-psychosis group often attributed their disadvantage to racism, whereas Black people in the psychosis group attributed it to their own situation. Perceived disadvantage is partly associated with the excess of psychosis among Black people living in the UK. This may have implications for primary prevention.
Research Interests: Religion, Epidemiology, Mental Health, Prejudice, Culture, and 22 morePublic Health, Social Perception, Adolescent, Employment, Social Class, England, Social Inequality, Humans, Female, Male, Social Environment, Incidence, Socioeconomic Status, Aged, Middle Aged, Self Concept, Adult, Ethnic Group, Educational Status, Psychotic Disorders, Case Control Study, and Cross sectional Study
The study of high-risk groups and the development of schizophrenia. To investigate further schizotypy, measured by the Structured Interview for Schizotypy (SIS), and to examine relationships between schizotypal components, psychotic... more
The study of high-risk groups and the development of schizophrenia. To investigate further schizotypy, measured by the Structured Interview for Schizotypy (SIS), and to examine relationships between schizotypal components, psychotic symptoms on the Present State Examination (PSE) and subsequent schizophrenia. The SIS and PSE were administered on entry. Schizophrenia onsets were recorded during follow-up. The SIS yielded four principal components labelled social withdrawal, psychotic symptoms, socio-emotional dysfunction and odd behaviour. On entry, these differentiated between controls, subjects at risk for schizophrenia with and without symptoms and patients with schizophrenia. Seven of 78 subjects at risk developed schizophrenia within 39 months. This was best predicted by combining the four SIS components. Schizotypy is heterogeneous and may become psychosis, particularly if several of its components are present. As psychosis develops, odd behaviour gives way to psychotic symptoms and social function deteriorates.
Research Interests: Mental Health, Schizophrenia, Principal Component Analysis, Prediction, Evolution, and 19 morePublic Health, Adolescent, Factor analysis, Humans, Female, Male, Young Adult, Follow-up studies, Social Environment, Risk factors, Schizotypal Personality Disorder, Adult, Analysis of Variance, Prognosis, Risk Factors, Sensitivity and Specificity, Cross Sectional Studies, Predictive value of tests, and Psychiatric Status Rating Scales
Neurological 'soft signs' and minor physical anomalies (MPAs) are reported to be more frequent in patients with schizophrenia than in controls. To determine whether these disturbances are genetically mediated, and whether... more
Neurological 'soft signs' and minor physical anomalies (MPAs) are reported to be more frequent in patients with schizophrenia than in controls. To determine whether these disturbances are genetically mediated, and whether they are central to the genesis of symptoms or epiphenomena. We obtained ratings in 152 individuals who were antipsychotic drug-free and at high risk, some of whom had experienced psychotic symptoms, as well as 30 first-episode patients and 35 healthy subjects. MPAs and Neurological Evaluation Scale (NES) 'sensory integration abnormalities' were more frequent in high-risk subjects than in healthy controls, but there were no reliable differences between high-risk subjects with and without psychotic symptoms. MPAs were most frequent in high-risk subjects with least genetic liability and NES scores showed no genetic associations. The lack of associations with psychotic symptoms and genetic liability to schizophrenia suggests that soft signs and physical anomalies are nonspecific markers of developmental deviance that are not mediated by the gene(s) for schizophrenia.
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The Edinburgh High-Risk Study is designed to explore the underlying pathogenesis of schizophrenia. To establish the sample characteristics of the first 100 subjects in this study of young adults at risk of schizophrenia for genetic... more
The Edinburgh High-Risk Study is designed to explore the underlying pathogenesis of schizophrenia. To establish the sample characteristics of the first 100 subjects in this study of young adults at risk of schizophrenia for genetic reasons, and to compare them with appropriate controls. Details of the recruitment of the first 100 high-risk subjects aged 16-25 years into a prospective Scotland-wide study are given. Subjects and 30 age- and gender-matched normal controls were interviewed using the PSE, SADS-L and SIS and an unstructured psychiatric interview. Some significant differences emerged between the high-risk group and the control group, namely in previous psychiatric history (31 v. 6.3%), forensic contacts (19 v. 3.1%) and delinquent behaviour (20 v. 3.1%). There were also differences in some parameters from the SIS: childhood social isolation, interpersonal sensitivity, social isolation, suicidal ideation, restricted affect, oddness and disordered speech. These differences may represent increased risk of developing schizophrenia although their true significance will not be revealed until the cohort has been followed through the at-risk years.
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To examine if low parental social class increases children's risk of subsequently developing schizophrenia or modifies the presentation. Case-control study with historical controls. Geographically defined region in south Dublin.... more
To examine if low parental social class increases children's risk of subsequently developing schizophrenia or modifies the presentation. Case-control study with historical controls. Geographically defined region in south Dublin. 352 patients with first presentation of schizophrenia matched with the next registered same sex birth from the same birth registration district. Social class at birth. Age at presentation to psychiatric services, admission to hospital, and diagnosis of schizophrenia. Risk of schizophrenia was not increased in people from lower social classes. There was a slight excess risk among people in highest social classes (odds ratio 0.59, 95% confidence interval 0.40 to 0.85). However, the mean age at presentation was 24.8 years for patients whose parents were in the highest social class compared with 33.1 years for those in the lowest social class at birth. Although social class of origin does not seem to be an important risk factor for schizophrenia, it partially determines the age at which patients receive treatment. The relation between low social class at birth and poor outcome may be at least partially mediated through treatment delay.
Research Interests: Schizophrenia, Social Class, Ireland, British medical history, Birth, and 19 moreHumans, Age, Hospitalization, Female, Male, Social Environment, Risk factors, Newborn Infant, Risk Factor, Adult, Public health systems and services research, Odds ratio, BMJ, Age Factors, Risk Factors, Case Control Study, Age of Onset, Confidence Interval, and Case Control Studies
Neuropsychological assessments of relatives of schizophrenics have shown subtle impairments in verbal memory, executive and intellectual function, which are stable in those beyond the age of maximum risk for the disorder. We sought to:... more
Neuropsychological assessments of relatives of schizophrenics have shown subtle impairments in verbal memory, executive and intellectual function, which are stable in those beyond the age of maximum risk for the disorder. We sought to: (1) determine baseline neurocognitive predictors of psychosis, and (2) compare performance over time between relatives within the age of maximum risk, and controls. (1) and (2) were examined in 118 individuals at familial high risk of schizophrenia (HR) and 30 controls (C), using one-way analyses of variance (ANOVAs) and repeated measures analyses of covariance (ANCOVAs), controlling for intelligence quotient, time between and number of assessments, and correcting for multiple comparisons. HR who became ill (n = 13) performed nonsignificantly less well at baseline than HR who did not (n = 105) on a test of verbal learning (t(109) = 2.1, p = .03). Across assessments, C performed significantly better than the entire HR group on immediate (F(3,133) = 5.11, p = .002) and delayed (F(3,133) = 5.02, p = .002) story recall. There were no significant interactions of time by group. Results suggest greater verbal memory impairment in HR who go on to develop schizophrenia. Stable differences between groups over time suggest a trait deficit, which is relatively unaffected by the presence of psychotic symptoms and psychosis onset. Alternatively, small numbers may have precluded detection of group by time interactions.
Research Interests: Genetics, Neuropsychology, Psychometrics, Intelligence, Schizophrenia, and 19 moreRisk, Memory, Biological Sciences, TIME, Biological Psychiatry, Humans, Female, Male, Biological, Follow-up studies, Adult, Time Factors, Retrospective Studies, Time, Intelligence tests, Predictive value of tests, Verbal Learning, Case Control Studies, and Neuropsychological Tests
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To examine the associations between the Rust Inventory of Schizotypal Cognitions (RISC) and psychotic symptoms measured by the Present State Examination (PSE) and to assess the predictive validity of the RISC for later onset of... more
To examine the associations between the Rust Inventory of Schizotypal Cognitions (RISC) and psychotic symptoms measured by the Present State Examination (PSE) and to assess the predictive validity of the RISC for later onset of schizophrenia. A total of 154 subjects at high risk for schizophrenia but who were currently well, 35 well controls and 28 first episode schizophrenic patients were assessed on specified PSE symptoms and completed the RISC. A subsample of the high risk group was subsequently monitored for onset of schizophrenia over 39 months. RISC scores at entry were significantly higher in subjects with psychotic symptoms on PSE. There were indications that high scorers on the RISC were likely to develop schizophrenia. However, less than half of those falling ill exhibited high RISC scores on entry. The RISC scale is highly associated with presence of psychotic symptoms on PSE and high scorers may be at increased risk of schizophrenia onset.