Background: Abnormalities of the anterior cingulate cortex (ACC) are frequently implicated in the... more Background: Abnormalities of the anterior cingulate cortex (ACC) are frequently implicated in the pathophysiology of psychotic disorders, but whether such changes are apparent before psychosis onset remains unclear. In this study, we characterized prepsychotic ACC abnormalities in a sample of individuals at ultra-high-risk (UHR) for psychosis.
The anterior cingulate cortex (ACC) is consistently implicated in the pathophysiology of schizoph... more The anterior cingulate cortex (ACC) is consistently implicated in the pathophysiology of schizophrenia, and our own work has identified morphological anomalies in the ACC of people with this disorder. To examine whether ACC morphological anomalies are present in a group at ultra-high risk of psychosis and whether such anomalies can be used to predict the subsequent development of a psychotic illness. Magnetic resonance imaging of 75 healthy volunteers and 63 people at ultra-high risk of developing a psychotic disorder (all right-handed males) was used to examine ACC sulcal and gyral features. Compared with the controls, significantly fewer people in the ultra-high risk group had a well-developed left paracingulate sulcus and significantly more had an interrupted left cingulate sulcus. There was no difference between those who did (n=21) and did not (n=42) subsequently develop a psychotic illness. Although ACC anomalies are present in young people considered to be at ultra-high risk of psychosis, they do not identify individuals who subsequently make the transition to psychosis.
Abnormalities of the anterior cingulate cortex (ACC) are thought to be involved in the pathophysi... more Abnormalities of the anterior cingulate cortex (ACC) are thought to be involved in the pathophysiology of bipolar disorder, but structural Magnetic Resonance Imaging (MRI) studies have reported variable findings. Reasons for this include a failure to consider variability in regional cortical folding patterns and a reliance on relatively coarse measures (e.g., volume) to index anatomical change. We sought to overcome these limitations by combining a novel protocol for parcellating the ACC and adjacent paracingulate cortex (PaC) that accounts for inter-individual variations in sulcal and gyral morphology with a cortical surface-based approach that allowed calculation of regional grey matter volume, surface area and cortical thickness in 24 patients with bipolar I disorder and 24 matched controls. No changes in grey matter volume or surface area were identified in any region, but patients did show significant reductions in cortical thickness in the left rostral PaC and right dorsal PaC that were not attributable to group differences in cortical folding patterns. These findings suggest that bipolar disorder is associated with more pronounced changes in the PaC, and that reliance on volumetric measures alone may obscure more subtle differences.
While there is evidence that some cases of schizophrenia may be associated with microbial infecti... more While there is evidence that some cases of schizophrenia may be associated with microbial infections, the role of microbial agents has not been investigated in people with emerging psychosis. Participants were 105 help seeking ultra-high risk individuals. Psychiatric measures included the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Serum IgG antibodies against human herpesviruses and Toxoplasma gondii were determined using immunoassay methods. Multiple linear regression with adjustment for age and sex was applied to test associations between serum antibodies and psychiatric measures. Higher levels of serum IgG antibodies against Toxoplasma gondii in Toxoplasma-positive individuals were significantly associated with more severe positive psychotic symptoms. No significant association was observed between antibody levels and psychiatric measures in individuals positive for human herpesviruses. In some individuals infection with Toxoplasma gondii may be an environmental factor contributing to the manifestation of positive psychotic symptoms.
Over the last 15 years, a focus on early intervention in psychotic disorders has emerged. Initial... more Over the last 15 years, a focus on early intervention in psychotic disorders has emerged. Initially, the early psychosis movement focused on timely recognition and phase-specific treatment of first-episode psychosis. However, early psychosis researchers suspected that pushing the point of intervention even further back to the prodromal phase of psychotic disorders may result in even better outcomes. This article reviews intervention research in the ultra-high-risk phase of psychotic disorders. A literature search of intervention trials with ultra-high-risk cohorts published after 1980 was conducted on PubMed with the search terms prodrome and intervention. All published intervention trials with ultra-high-risk cohorts. The first generation of intervention trials indicated that both pharmacologic and psychological intervention strategies may be of value in terms of symptom reduction and delay or prevention of onset of threshold psychotic disorder. Further controlled intervention trials with larger sample sizes are required in order to confirm and extend these findings. We argue that the clinical staging model provides a framework for the rationale and design of such studies, with simpler, safer, and more benign interventions being better candidates for first-line treatment, while more complex and potentially harmful treatments should be reserved for those cases in which response has failed to occur. Recent evidence indicates that neuroprotective agents, such as essential fatty acids, may be a suitable form of intervention for the ultra-high-risk phase of psychotic disorders, with a positive risk-benefit balance. Ethical aspects have become more salient given the recently observed declining transition rate in ultra-high-risk samples. We outline the key questions for the next generation of ultra-high-risk intervention trials.
Substantial controversy has been generated since the proposal to include "Attenuated Psychos... more Substantial controversy has been generated since the proposal to include "Attenuated Psychosis Syndrome" in DSM-5, based on research criteria used to identify young people at "ultra high risk" (UHR) for psychosis. The syndrome was ultimately included in the section for further research. The criteria specified that the person experienced attenuated psychotic symptoms (APS) that were sufficiently distressing to warrant clinical attention. Although APS are the main means of determining whether a person meets UHR criteria, clinical experience suggests that such symptoms are often not the main source of clinical distress in this patient group. However, little is known about the sources of distress in the UHR group. We aimed to assess the main sources of clinical distress in UHR patients at the time of referral to a specialized UHR clinic. Sources and intensity of distress in 73 UHR patients were gathered from treating clinicians. The association with transition to psy...
We have previously reported that olfactory identification (OI) deficits are a promising premorbid... more We have previously reported that olfactory identification (OI) deficits are a promising premorbid marker of transition from ultra-high risk (UHR) to schizophrenia, but not to psychotic illness more generally. Whether this remains the case at longer follow-up, and whether there is decline in OI ability are unclear. Method: The University of Pennsylvania Smell Identification Test (UPSIT) was administered to 81 participants at baseline (identification of risk for psychosis) and 254 individuals at follow-up. Forty-nine participants underwent UPSIT assessment at both time points. UPSIT scores were investigated at an average of 7.08 years after identification of risk in relation to transition to psychosis, a diagnosis of schizophrenia, and psychosocial/ functional outcome. Results: UPSIT scores at baseline and follow-up did not differ between participants who transitioned to psychosis and those who did not. Similarly, there were no significant differences on UPSIT scores at baseline or follow-up between individuals with a diagnosis of schizophrenia and transitioned individuals without schizophrenia. Those with a poor functional outcome showed significantly lower baseline UPSIT scores than participants with good outcome. There was no significant association between functional outcome and follow-up UPSIT scores. There were no significant changes in UPSIT over time for any group. Conclusions: These results suggest that impaired OI is not a good marker of the onset of psychosis and schizophrenia, but may differentiate UHR individuals who experience a poor functional outcome, regardless of transition status.
Three types of orbitofrontal cortex (OFC) sulcogyral patterns have been identified in the general... more Three types of orbitofrontal cortex (OFC) sulcogyral patterns have been identified in the general population. The distribution of these three types has been found to be altered in individuals at genetic risk of psychosis, and in patients with first episode psychosis (FEP) and chronic schizophrenia. This study aims at establishing whether altered OFC sulcogyral patterns were present in a large cohort of individuals at ultra high risk (UHR) for psychosis. OFC pattern type was classified and the number of posterior and intermediate sulci present on the surface of the OFC was counted. OFC sulcogyral type and the number of sulci were compared between controls (n = 58) and UHR participants who transitioned (n = 49) versus those who did not transition (n = 77) to psychosis. Finally, the relationship between sulcogyral type and number of sulci with intellectual quotient (IQ), symptom severity and social functioning of UHR individuals was explored. In line with other studies conducted in chronic schizophrenia and FEP, UHR individuals who later transitioned to psychosis showed a reduced incidence of the Type I OFC on the right hemisphere compared to controls (χ 2 = 19.847, p b 0.001). These highly consistent results point towards the protective effect of possessing a Type I OFC in the right hemisphere. Furthermore, OFC sulcus counts revealed that controls presented with a higher number of posterior (right hemisphere; χ 2 = 11.658, p = 0.003) and intermediate sulci (left: χ 2 = 6.643, p = 0.036; right: χ 2 = 11.726, p = 0.020) when compared to UHR individuals. However, no associations between OFC types or sulcus count and IQ, symptoms and functioning were observed.
Australian and New Zealand Journal of Psychiatry, 2007
Co-occurring substance use and mental health disorders are highly prevalent among young people at... more Co-occurring substance use and mental health disorders are highly prevalent among young people attending services, yet few studies have examined the effect of such comorbidity among those referred for treatment. The aim of the current study was to examine the impact of co-occurring substance use disorders (SUDs) on 6 month outcomes for young people seeking mental health treatment. One hundred and six young people (aged 15-24 years) with a non-psychotic DSM-IV Axis I disorder were assessed following referral to a specialist youth public mental health service. Participants were given a structured interview, as well as questionnaires assessing drug use, psychopathology, psychosocial functioning and self-esteem at baseline and 6 month follow up. At baseline, 23 participants met criteria for a co-occurring SUD and 83 had a non-psychotic Axis I disorder. Both the non-SUD and the co-occurring SUD groups had high levels of psychopathology, serious impairments in functioning and moderate levels of suicidal ideation, although those with co-occurring SUD had significantly poorer levels of functioning. At 6 month follow up the co-occurring SUD group continued to experience substantial problems with symptoms and functioning whereas the non-SUD group had significant improvement in both of these domains. The present findings are consistent with studies examining the impact of co-occurring substance use and mental health issues across different treatment settings, and reinforce recommendations that young people with co-occurring disorders require more intensive and integrated interventions. The present findings also highlight the need for routine assessment and management of substance use issues within youth mental health settings.
Youth with mental health problems often have difficulties engaging in education and employment. I... more Youth with mental health problems often have difficulties engaging in education and employment. In Australia, youth mental health services have been widely established with a key aim of improving role functioning; however, there is little knowledge of those who are not engaged in employment, education or training (NEET) and the factors which may influence this. This study aimed to examine NEET status and its correlates in a sample of such youth. Cross-sectional data from a longitudinal cohort study. Between January 2011 and August 2012, young people presenting to one of the four primary mental health centres in Sydney or Melbourne were invited to participate. Young adults (N=696) aged between 15 and 25 years (M=19.0, SD=2.8), 68% female, 58% (n=404) attended headspace in Sydney. Individuals 'Not in any type of Education, Employment or Training' in the past month were categorised as NEET. Demographic, psychological and clinical factors alongside disability and functioning wer...
There has been recent optimism with regard to improving the predictive validity of those individu... more There has been recent optimism with regard to improving the predictive validity of those individuals who develop a psychotic disorder from the "Ultra High Risk" (UHR) or putatively prodromal population using combinations of clinical variables. We aimed to test the recent results from a large collaborative consortium in an independent cohort from the PACE (Personal Assistance and Clinical Evaluation) clinic in Australia. The North American Prodrome Longitudinal Study (NAPLS) consortium study reported 5 important clinical predictive variables within their US sample of UHR patients: genetic risk with functional decline; high unusual thought content score; high suspicion/paranoia score; low social functioning and history of substance abuse. We examined the predictive validity of these variables using data from a cohort of 104 UHR patients from the PACE clinic in Melbourne, Australia. Cox regression was used to explore the relationship between these variables at baseline and transition to psychosis by 28months. Three of the five variables were found to be associated with transition in our sample: high unusual thought content scores; low functioning; and having genetic risk with functional decline. A combination of two out of three of these features produced a reasonable predictive validity (positive predictive value (PPV) 65.4%, sensitivity 37.3%, and specificity 87.2%) but with overall lower PPVs than that reported by the NAPLS consortium. Three out of five of the identified clinical predictors for transition to psychosis from the NAPLS study were replicated in an independent sample. Using a combination of clinical variables the predictive validity of determining whether a UHR individual develops a psychotic disorder was improved above UHR criteria alone. Although psychosis prediction is improved using this model, the probability of a person not developing psychotic disorder is still quite high at 35%.
Psychotic-like experiences (PLEs) increase the risk of schizophrenia and other psychotic disorder... more Psychotic-like experiences (PLEs) increase the risk of schizophrenia and other psychotic disorders yet are common in the community. Some PLEs, such as those associated with depression, distress, and poor functioning, may confer increased risk. The aim of this study is to determine the prevalence of PLEs in a nonpsychotic clinical sample and to investigate whether any subtypes of PLEs are associated with the above factors. Consecutive referrals to a youth psychiatric service (N = 140) were assessed to measure PLEs, depression, and functioning. PLE data were factor analyzed, and the associations of psychotic subtypes and distress, depression, and disability were analyzed. Three subtypes of PLEs were identified: Bizarre Experiences, Persecutory Ideas, and Magical Thinking. Bizarre Experiences and Persecutory Ideas were associated with distress, depression, and poor functioning. Magical Thinking was not, unless accompanied by distress. Bizarre Experiences and Persecutory Ideas may be more malignant forms of psychotic symptoms, as they are associated with current disability, and may confer increased risk of development of full-blown psychotic disorder.
Australian and New Zealand Journal of Psychiatry, 2003
Objective: To discuss the rationale for early intervention in psychotic disorders and to explore ... more Objective: To discuss the rationale for early intervention in psychotic disorders and to explore why the widespread implementation of early intervention services has stalled.Method: Four central questions are explored regarding early intervention in psychosis: (i) what is the rationale for early intervention services in psychosis and is it justified? (ii) what are the obstacles to the implementation of early intervention
Australian and New Zealand Journal of Psychiatry, 1996
... Page 3. AR YUNG. PD MCGORRY 5 89 cantly from the refusers or those not approached in demograp... more ... Page 3. AR YUNG. PD MCGORRY 5 89 cantly from the refusers or those not approached in demographic or diagnostic characteristics, and seemed to be a representative sample of first-episode patients presenting to the EPPIC. ... Data analysis ... Instrument Qualitative data analysis ...
Background: Abnormalities of the anterior cingulate cortex (ACC) are frequently implicated in the... more Background: Abnormalities of the anterior cingulate cortex (ACC) are frequently implicated in the pathophysiology of psychotic disorders, but whether such changes are apparent before psychosis onset remains unclear. In this study, we characterized prepsychotic ACC abnormalities in a sample of individuals at ultra-high-risk (UHR) for psychosis.
The anterior cingulate cortex (ACC) is consistently implicated in the pathophysiology of schizoph... more The anterior cingulate cortex (ACC) is consistently implicated in the pathophysiology of schizophrenia, and our own work has identified morphological anomalies in the ACC of people with this disorder. To examine whether ACC morphological anomalies are present in a group at ultra-high risk of psychosis and whether such anomalies can be used to predict the subsequent development of a psychotic illness. Magnetic resonance imaging of 75 healthy volunteers and 63 people at ultra-high risk of developing a psychotic disorder (all right-handed males) was used to examine ACC sulcal and gyral features. Compared with the controls, significantly fewer people in the ultra-high risk group had a well-developed left paracingulate sulcus and significantly more had an interrupted left cingulate sulcus. There was no difference between those who did (n=21) and did not (n=42) subsequently develop a psychotic illness. Although ACC anomalies are present in young people considered to be at ultra-high risk of psychosis, they do not identify individuals who subsequently make the transition to psychosis.
Abnormalities of the anterior cingulate cortex (ACC) are thought to be involved in the pathophysi... more Abnormalities of the anterior cingulate cortex (ACC) are thought to be involved in the pathophysiology of bipolar disorder, but structural Magnetic Resonance Imaging (MRI) studies have reported variable findings. Reasons for this include a failure to consider variability in regional cortical folding patterns and a reliance on relatively coarse measures (e.g., volume) to index anatomical change. We sought to overcome these limitations by combining a novel protocol for parcellating the ACC and adjacent paracingulate cortex (PaC) that accounts for inter-individual variations in sulcal and gyral morphology with a cortical surface-based approach that allowed calculation of regional grey matter volume, surface area and cortical thickness in 24 patients with bipolar I disorder and 24 matched controls. No changes in grey matter volume or surface area were identified in any region, but patients did show significant reductions in cortical thickness in the left rostral PaC and right dorsal PaC that were not attributable to group differences in cortical folding patterns. These findings suggest that bipolar disorder is associated with more pronounced changes in the PaC, and that reliance on volumetric measures alone may obscure more subtle differences.
While there is evidence that some cases of schizophrenia may be associated with microbial infecti... more While there is evidence that some cases of schizophrenia may be associated with microbial infections, the role of microbial agents has not been investigated in people with emerging psychosis. Participants were 105 help seeking ultra-high risk individuals. Psychiatric measures included the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Serum IgG antibodies against human herpesviruses and Toxoplasma gondii were determined using immunoassay methods. Multiple linear regression with adjustment for age and sex was applied to test associations between serum antibodies and psychiatric measures. Higher levels of serum IgG antibodies against Toxoplasma gondii in Toxoplasma-positive individuals were significantly associated with more severe positive psychotic symptoms. No significant association was observed between antibody levels and psychiatric measures in individuals positive for human herpesviruses. In some individuals infection with Toxoplasma gondii may be an environmental factor contributing to the manifestation of positive psychotic symptoms.
Over the last 15 years, a focus on early intervention in psychotic disorders has emerged. Initial... more Over the last 15 years, a focus on early intervention in psychotic disorders has emerged. Initially, the early psychosis movement focused on timely recognition and phase-specific treatment of first-episode psychosis. However, early psychosis researchers suspected that pushing the point of intervention even further back to the prodromal phase of psychotic disorders may result in even better outcomes. This article reviews intervention research in the ultra-high-risk phase of psychotic disorders. A literature search of intervention trials with ultra-high-risk cohorts published after 1980 was conducted on PubMed with the search terms prodrome and intervention. All published intervention trials with ultra-high-risk cohorts. The first generation of intervention trials indicated that both pharmacologic and psychological intervention strategies may be of value in terms of symptom reduction and delay or prevention of onset of threshold psychotic disorder. Further controlled intervention trials with larger sample sizes are required in order to confirm and extend these findings. We argue that the clinical staging model provides a framework for the rationale and design of such studies, with simpler, safer, and more benign interventions being better candidates for first-line treatment, while more complex and potentially harmful treatments should be reserved for those cases in which response has failed to occur. Recent evidence indicates that neuroprotective agents, such as essential fatty acids, may be a suitable form of intervention for the ultra-high-risk phase of psychotic disorders, with a positive risk-benefit balance. Ethical aspects have become more salient given the recently observed declining transition rate in ultra-high-risk samples. We outline the key questions for the next generation of ultra-high-risk intervention trials.
Substantial controversy has been generated since the proposal to include "Attenuated Psychos... more Substantial controversy has been generated since the proposal to include "Attenuated Psychosis Syndrome" in DSM-5, based on research criteria used to identify young people at "ultra high risk" (UHR) for psychosis. The syndrome was ultimately included in the section for further research. The criteria specified that the person experienced attenuated psychotic symptoms (APS) that were sufficiently distressing to warrant clinical attention. Although APS are the main means of determining whether a person meets UHR criteria, clinical experience suggests that such symptoms are often not the main source of clinical distress in this patient group. However, little is known about the sources of distress in the UHR group. We aimed to assess the main sources of clinical distress in UHR patients at the time of referral to a specialized UHR clinic. Sources and intensity of distress in 73 UHR patients were gathered from treating clinicians. The association with transition to psy...
We have previously reported that olfactory identification (OI) deficits are a promising premorbid... more We have previously reported that olfactory identification (OI) deficits are a promising premorbid marker of transition from ultra-high risk (UHR) to schizophrenia, but not to psychotic illness more generally. Whether this remains the case at longer follow-up, and whether there is decline in OI ability are unclear. Method: The University of Pennsylvania Smell Identification Test (UPSIT) was administered to 81 participants at baseline (identification of risk for psychosis) and 254 individuals at follow-up. Forty-nine participants underwent UPSIT assessment at both time points. UPSIT scores were investigated at an average of 7.08 years after identification of risk in relation to transition to psychosis, a diagnosis of schizophrenia, and psychosocial/ functional outcome. Results: UPSIT scores at baseline and follow-up did not differ between participants who transitioned to psychosis and those who did not. Similarly, there were no significant differences on UPSIT scores at baseline or follow-up between individuals with a diagnosis of schizophrenia and transitioned individuals without schizophrenia. Those with a poor functional outcome showed significantly lower baseline UPSIT scores than participants with good outcome. There was no significant association between functional outcome and follow-up UPSIT scores. There were no significant changes in UPSIT over time for any group. Conclusions: These results suggest that impaired OI is not a good marker of the onset of psychosis and schizophrenia, but may differentiate UHR individuals who experience a poor functional outcome, regardless of transition status.
Three types of orbitofrontal cortex (OFC) sulcogyral patterns have been identified in the general... more Three types of orbitofrontal cortex (OFC) sulcogyral patterns have been identified in the general population. The distribution of these three types has been found to be altered in individuals at genetic risk of psychosis, and in patients with first episode psychosis (FEP) and chronic schizophrenia. This study aims at establishing whether altered OFC sulcogyral patterns were present in a large cohort of individuals at ultra high risk (UHR) for psychosis. OFC pattern type was classified and the number of posterior and intermediate sulci present on the surface of the OFC was counted. OFC sulcogyral type and the number of sulci were compared between controls (n = 58) and UHR participants who transitioned (n = 49) versus those who did not transition (n = 77) to psychosis. Finally, the relationship between sulcogyral type and number of sulci with intellectual quotient (IQ), symptom severity and social functioning of UHR individuals was explored. In line with other studies conducted in chronic schizophrenia and FEP, UHR individuals who later transitioned to psychosis showed a reduced incidence of the Type I OFC on the right hemisphere compared to controls (χ 2 = 19.847, p b 0.001). These highly consistent results point towards the protective effect of possessing a Type I OFC in the right hemisphere. Furthermore, OFC sulcus counts revealed that controls presented with a higher number of posterior (right hemisphere; χ 2 = 11.658, p = 0.003) and intermediate sulci (left: χ 2 = 6.643, p = 0.036; right: χ 2 = 11.726, p = 0.020) when compared to UHR individuals. However, no associations between OFC types or sulcus count and IQ, symptoms and functioning were observed.
Australian and New Zealand Journal of Psychiatry, 2007
Co-occurring substance use and mental health disorders are highly prevalent among young people at... more Co-occurring substance use and mental health disorders are highly prevalent among young people attending services, yet few studies have examined the effect of such comorbidity among those referred for treatment. The aim of the current study was to examine the impact of co-occurring substance use disorders (SUDs) on 6 month outcomes for young people seeking mental health treatment. One hundred and six young people (aged 15-24 years) with a non-psychotic DSM-IV Axis I disorder were assessed following referral to a specialist youth public mental health service. Participants were given a structured interview, as well as questionnaires assessing drug use, psychopathology, psychosocial functioning and self-esteem at baseline and 6 month follow up. At baseline, 23 participants met criteria for a co-occurring SUD and 83 had a non-psychotic Axis I disorder. Both the non-SUD and the co-occurring SUD groups had high levels of psychopathology, serious impairments in functioning and moderate levels of suicidal ideation, although those with co-occurring SUD had significantly poorer levels of functioning. At 6 month follow up the co-occurring SUD group continued to experience substantial problems with symptoms and functioning whereas the non-SUD group had significant improvement in both of these domains. The present findings are consistent with studies examining the impact of co-occurring substance use and mental health issues across different treatment settings, and reinforce recommendations that young people with co-occurring disorders require more intensive and integrated interventions. The present findings also highlight the need for routine assessment and management of substance use issues within youth mental health settings.
Youth with mental health problems often have difficulties engaging in education and employment. I... more Youth with mental health problems often have difficulties engaging in education and employment. In Australia, youth mental health services have been widely established with a key aim of improving role functioning; however, there is little knowledge of those who are not engaged in employment, education or training (NEET) and the factors which may influence this. This study aimed to examine NEET status and its correlates in a sample of such youth. Cross-sectional data from a longitudinal cohort study. Between January 2011 and August 2012, young people presenting to one of the four primary mental health centres in Sydney or Melbourne were invited to participate. Young adults (N=696) aged between 15 and 25 years (M=19.0, SD=2.8), 68% female, 58% (n=404) attended headspace in Sydney. Individuals 'Not in any type of Education, Employment or Training' in the past month were categorised as NEET. Demographic, psychological and clinical factors alongside disability and functioning wer...
There has been recent optimism with regard to improving the predictive validity of those individu... more There has been recent optimism with regard to improving the predictive validity of those individuals who develop a psychotic disorder from the "Ultra High Risk" (UHR) or putatively prodromal population using combinations of clinical variables. We aimed to test the recent results from a large collaborative consortium in an independent cohort from the PACE (Personal Assistance and Clinical Evaluation) clinic in Australia. The North American Prodrome Longitudinal Study (NAPLS) consortium study reported 5 important clinical predictive variables within their US sample of UHR patients: genetic risk with functional decline; high unusual thought content score; high suspicion/paranoia score; low social functioning and history of substance abuse. We examined the predictive validity of these variables using data from a cohort of 104 UHR patients from the PACE clinic in Melbourne, Australia. Cox regression was used to explore the relationship between these variables at baseline and transition to psychosis by 28months. Three of the five variables were found to be associated with transition in our sample: high unusual thought content scores; low functioning; and having genetic risk with functional decline. A combination of two out of three of these features produced a reasonable predictive validity (positive predictive value (PPV) 65.4%, sensitivity 37.3%, and specificity 87.2%) but with overall lower PPVs than that reported by the NAPLS consortium. Three out of five of the identified clinical predictors for transition to psychosis from the NAPLS study were replicated in an independent sample. Using a combination of clinical variables the predictive validity of determining whether a UHR individual develops a psychotic disorder was improved above UHR criteria alone. Although psychosis prediction is improved using this model, the probability of a person not developing psychotic disorder is still quite high at 35%.
Psychotic-like experiences (PLEs) increase the risk of schizophrenia and other psychotic disorder... more Psychotic-like experiences (PLEs) increase the risk of schizophrenia and other psychotic disorders yet are common in the community. Some PLEs, such as those associated with depression, distress, and poor functioning, may confer increased risk. The aim of this study is to determine the prevalence of PLEs in a nonpsychotic clinical sample and to investigate whether any subtypes of PLEs are associated with the above factors. Consecutive referrals to a youth psychiatric service (N = 140) were assessed to measure PLEs, depression, and functioning. PLE data were factor analyzed, and the associations of psychotic subtypes and distress, depression, and disability were analyzed. Three subtypes of PLEs were identified: Bizarre Experiences, Persecutory Ideas, and Magical Thinking. Bizarre Experiences and Persecutory Ideas were associated with distress, depression, and poor functioning. Magical Thinking was not, unless accompanied by distress. Bizarre Experiences and Persecutory Ideas may be more malignant forms of psychotic symptoms, as they are associated with current disability, and may confer increased risk of development of full-blown psychotic disorder.
Australian and New Zealand Journal of Psychiatry, 2003
Objective: To discuss the rationale for early intervention in psychotic disorders and to explore ... more Objective: To discuss the rationale for early intervention in psychotic disorders and to explore why the widespread implementation of early intervention services has stalled.Method: Four central questions are explored regarding early intervention in psychosis: (i) what is the rationale for early intervention services in psychosis and is it justified? (ii) what are the obstacles to the implementation of early intervention
Australian and New Zealand Journal of Psychiatry, 1996
... Page 3. AR YUNG. PD MCGORRY 5 89 cantly from the refusers or those not approached in demograp... more ... Page 3. AR YUNG. PD MCGORRY 5 89 cantly from the refusers or those not approached in demographic or diagnostic characteristics, and seemed to be a representative sample of first-episode patients presenting to the EPPIC. ... Data analysis ... Instrument Qualitative data analysis ...
Uploads
Papers by Alison Yung