Subclinical psychotic experiences and subsequent contact with mental health services.

Background: Although psychotic experiences in people without diagnosed mental health problems are associated with mental health service use, few studies have assessed this prospectively or measured service use by real-world clinical data.

Aims: To describe and investigate the association between psychotic experiences and later mental health service use, and to assess the role of symptoms of common mental health disorders in this association.

Method: We linked a representative survey of south-east London (SELCoH-1, =1698) with health records from the local mental healthcare provider.

Occupation and first episode psychosis in Northern Italy: better outcomes for migrants.

Aims: Many studies show that migrants have a higher incidence of psychosis compared to natives, but the influence of migration on psychosis outcomes is little investigated. We aimed to evaluate the occupational outcomes of a first episode psychosis (FEP) sample in Bologna (Northern Italy).

Methods: An incidence cohort of FEP patients presenting at the Bologna West Community Mental Health Centers between 2002 and 2009 was assessed at the baseline and at 12th month follow-up.

Risk of psychosis and internal migration: Results from the Bologna First Episode Psychosis study.

Background: Incidence of psychotic disorders is higher in many migrant groups; however little is known about internal migrants (IM). This study aims to describe the IR in natives (NA), IM and external migrants (EM).

Method: All patients aged 18-64years, with First Episode Psychosis (FEP), who made contact with the Bologna West psychiatric services, between 2002 and 2010, were included.

Delays before Diagnosis and Initiation of Treatment in Patients Presenting to Mental Health Services with Bipolar Disorder.

Background: Bipolar disorder is a significant cause of morbidity and mortality. Although existing treatments are effective, there is often a substantial delay before diagnosis and treatment initiation. We sought to investigate factors associated with the delay before diagnosis of bipolar disorder and the onset of treatment in secondary mental healthcare.

Gender differences in the association between childhood physical and sexual abuse, social support and psychosis.

Purpose: Childhood adversity (variously defined) is a robust risk factor for psychosis, yet the mitigating effects of social support in adulthood have not yet been explored. This study aimed to investigate the relationships between childhood sexual and physical abuse and adult psychosis, and gender differences in levels of perceived social support.

Methods: A sample of 202 individuals presenting for the first time to mental health services with psychosis and 266 population-based controls from south-east London and Nottingham, UK, was utilised.

Self esteem and self agency in first episode psychosis: Ethnic variation and relationship with clinical presentation.

The impact of self esteem and Locus of Control (LoC) on clinical presentation across different ethnic groups of patients at their first psychotic episode (FEP) remains unknown. We explored these constructs in 257 FEP patients (Black n=95; White British n=119) and 341 controls (Black n=70; White British n=226), and examined their relationship with symptom dimensions and pathways to care. FEP patients presented lower self-esteem and a more external LoC than controls.

Duration of untreated psychosis and pathway to care in Riyadh, Saudi Arabia.

Aim: Recent studies of 'duration of untreated psychosis' (DUP) indicate that some patients remain untreated in the community for some time. Considerable emphasis has been placed on reducing the DUP. However, most studies investigating DUP have been conducted in Western countries, where well-developed primary care systems are available.

Clozapine in borderline personality disorder: a review of the evidence.

Background: Borderline personality disorder (BPD) is a serious mental disorder that is difficult to treat. Possible targets for pharmacotherapy include affective symptoms, cognitive disturbances, and impulsive, self-injurious behaviors. Although many of the medications tested for treatment of BPD have been demonstrated to be useful, no clear pharmacologic treatment has emerged.

Identifying aspects of neighbourhood deprivation associated with increased incidence of schizophrenia.

Background: Several studies have found an association between area deprivation and incidence of schizophrenia. However, not all studies have concurred and definitions of deprivation have varied between studies. Relative deprivation and inequality seem to be particularly important, but which aspects of deprivation or how this effect might operate is not known.

The impact of substance use at psychosis onset on First Episode Psychosis course: results from a 1 year follow-up study in Bologna.

Objectives: Substance abuse is a well established risk factor for First-Episode Psychosis (FEP), but its influence on FEP course is less clear. Starting from our baseline observation that substance users were younger than non-users at the psychosis onset, we hypothesized that substance use at baseline could be an independent risk factor for a worse clinical course.

Methods: An incidence cohort of patients with FEP collected in an 8year period (2002-2009) at the Bologna West Community Mental Health Centers (CMHCs) was assessed at baseline and at 12month follow-up.

Interplay between childhood physical abuse and familial risk in the onset of psychotic disorders.

Background: Childhood abuse is considered one of the main environmental risk factors for the development of psychotic symptoms and disorders. However, this association could be due to genetic factors influencing exposure to such risky environments or increasing sensitivity to the detrimental impact of abuse. Therefore, using a large epidemiological case-control sample, we explored the interplay between a specific form of childhood abuse and family psychiatric history (a proxy for genetic risk) in the onset of psychosis.

Caregiving in first-episode psychosis: social characteristics associated with perceived 'burden' and associations with compulsory treatment.

Aims: High incidence of psychosis and compulsory treatment within black and minority ethnic (BME) groups in the UK remain a concern. Psychosis has an impact on families and family involvement is important in predicting compulsory treatment. We therefore aimed to report the levels and predictors of caregiver burden in first-episode psychosis, in white British, and BME groups of carers, and investigate their relevance to compulsory treatment.

Meta-analytic approaches to determine gender differences in the age-incidence characteristics of schizophrenia and related psychoses.

A recent systematic review and meta-analysis of the incidence and prevalence of schizophrenia and other psychoses in England investigated the variation in the rates of psychotic disorders. However, some of the questions of interest, and the data collected to answer these, could not be adequately addressed using established meta-analysis techniques. We developed a novel statistical method, which makes combined use of fractional polynomials and meta-regression.

Ethnic density as a buffer for psychotic experiences: findings from a national survey (EMPIRIC).

Background: Aetiological mechanisms underlying ethnic density associations with psychosis remain unclear.

Aims: To assess potential mechanisms underlying the observation that minority ethnic groups experience an increased risk of psychosis when living in neighbourhoods of lower own-group density.

Method: Multilevel analysis of nationally representative community-level data (from the Ethnic Minorities Psychiatric Illness Rates in the Community survey), which included the main minority ethnic groups living in England, and a White British group.

Incidence of schizophrenia and other psychoses in England, 1950-2009: a systematic review and meta-analyses.

Background: We conducted a systematic review of incidence rates in England over a sixty-year period to determine the extent to which rates varied along accepted (age, sex) and less-accepted epidemiological gradients (ethnicity, migration and place of birth and upbringing, time).

Objectives: To determine variation in incidence of several psychotic disorders as above.

Data Sources: Published and grey literature searches (MEDLINE, PSycINFO, EMBASE, CINAHL, ASSIA, HMIC), and identification of unpublished data through bibliographic searches and author communication.

Increased use of antipsychotic long-acting injections with community treatment orders.

Background: Community treatment orders (CTOs) are increasingly being used, despite a weak evidence base, and problems continue regarding Second Opinion Appointed Doctor (SOAD) certification of medication.

Aims: The aim of the current study was to describe current CTO usage regarding patient characteristics, prescribed medication and CTO conditions.

Method: A 1-year prospective cohort study with consecutive sampling was conducted for all patients whose CTO was registered in a large mental health trust.

Long-term maternal recall of obstetric complications in schizophrenia research.

Obstetric complications (OCs) are consistently implicated in the aetiology of schizophrenia. Information about OCs is often gathered retrospectively, from maternal interview. It has been suggested that mothers of people with schizophrenia may not be accurate in their recollection of obstetric events.

Satisfaction with inpatient treatment for first-episode psychosis among different ethnic groups: a report from the UK AeSOP study.

Background: There is concern about the level of satisfaction with mental healthcare among minority ethnic patients in the UK, particularly as black patients have more compulsory admissions to hospital.

Aims: To determine and compare levels of satisfaction with mental healthcare between patients from different ethnic groups in a three-centre study of first-onset psychosis.

Method: Data were collected from 216 patients with first-episode psychosis and 101 caregivers from South London, Nottingham and Bristol, using the Acute Services Study Questionnaire (Patient and Relative Version) and measures of sociodemographic variables and insight.

Physical illness and lifestyle risk factors in people with their first presentation of psychosis.

Background: There is an increased prevalence of physical illness and poor lifestyle in patients with chronic schizophrenia. It is unclear whether these are present at the onset of psychosis or develop over the course of illness. We aimed to establish whether patients experiencing their first episode of psychosis have worse physical health and lifestyle than community controls without psychosis.

Review: the wider social environment and schizophrenia.

Rates of schizophrenia differ significantly between groups defined at the social level, eg, urban/rural comparisons, neighborhoods, and ethnic minority status. While earlier studies were not able to determine if the social environment influenced the development of schizophrenia (causation) or whether individuals at risk aggregated in adverse social environments (selection), the recent development of multilevel modeling should inform this debate. To date, there are few examples of multilevel analyses in schizophrenia research; however, the small number of studies suggest that there may be a neighborhood social contextual effect that influences rates of schizophrenia and other psychotic disorders.

Duration of untreated psychosis and ethnicity in the AESOP first-onset psychosis study.

Background: There is a common assumption that Black patients with a psychotic mental illness experience longer treatment delays during a first episode. We sought to investigate this issue in a large cohort of patients with a first episode of psychosis.

Method: All patients with a first episode of psychosis presenting to secondary mental health services within tightly defined catchment areas in south-east London and Nottingham over a 2-year period were included in the study.