Neuropsychological functioning in first-episode schizophrenia.

Background: Identifying neurocognitive subtypes in schizophrenia may help establish neurobiologically meaningful subtypes of the disorder, but is frequently confounded by differences in intellectual function between individuals with schizophrenia and controls.

Aims: To examine neuropsychological performance in individuals with epidemiologically based, first-onset schizophrenia and intellectually matched controls.

Method: Using standard IQ and reading tests, we examined the proportions of 101 people with epidemiologically derived, first-onset schizophrenia/schizoaffective disorder and 317 community controls, falling into three a priori defined intellectual categories: 'stable good', 'deteriorated poor' and 'stable poor'.

Reliability and comparability of psychosis patients' retrospective reports of childhood abuse.

An increasing number of studies are demonstrating an association between childhood abuse and psychosis. However, the majority of these rely on retrospective self-reports in adulthood that may be unduly influenced by current psychopathology. We therefore set out to explore the reliability and comparability of first-presentation psychosis patients' reports of childhood abuse.

Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment.

First-episode psychosis (FEP) patients show hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, but the mechanisms leading to this are still unclear. The aim of this study was to investigate the role of stress and antipsychotic treatment on diurnal cortisol levels, and on cortisol awakening response, in FEP. Recent stressful events, perceived stress and childhood trauma were collected in 50 FEP patients and 36 healthy controls using structured instruments.

Selective deficits in semantic verbal fluency in patients with a first affective episode with psychotic symptoms and a positive history of mania.

Objectives: Neurocognitive dysfunction is likely to represent a trait characteristic of bipolar disorder, but the extent to which it comprises 'core' deficits as opposed to those secondary to longstanding illness or intellectual decline is unclear. We investigated neuropsychological performance in an epidemiologically derived sample of patients with a first affective episode with psychotic symptoms and a positive history of mania, compared to community controls.

Methods: Using a nested case-control, population-based study, measures of episodic and working memory, executive function, processing speed, and visual-spatial perception were compared between 35 patients with a first affective episode with psychotic symptoms and a positive history of mania, and 274 community controls, as well as a subgroup of 105 controls matched on current IQ ('good' versus 'poor') and IQ trajectory ('stable', 'declined', or 'improved') with the patients (three controls per case).

Gender differences in the association between childhood abuse and psychosis.

Background: Studies demonstrating an association between childhood trauma and psychosis in adulthood have not systematically explored gender differences.

Aims: To investigate gender differences in the prevalence of childhood sexual and physical abuse among people with psychosis in comparison with healthy controls.

Method: The Childhood Experiences of Care and Abuse Questionnaire was completed to elicit experiences of sexual and physical abuse during childhood in first-episode psychosis cases and population-based controls.

The prevalence, diagnostic significance and demographic characteristics of Schneiderian first-rank symptoms in an epidemiological sample of first-episode psychoses.

Background: The diagnostic significance of first-rank symptoms (FRSs) remains uncertain. Ethnic differences in FRSs may account for high rates of schizophrenia in minority groups. This study aims to examine the prevalence of FRSs in an epidemiological sample of first-episode psychoses stratified by relevant demographic variables.

Is early intervention in psychosis effective?

Aims: Psychosis is a traumatic experience for both sufferers and their families. The morbidity and mortality associated with psychosis may be improved by an assertive, specialised, multidisciplinary approach to care, provided at the earliest opportunity. Early Intervention in Psychosis (EIP) uses such approach to improve the individual's short and long-term symptomatic and functional outcome, as well as quality of life.

Neurological abnormalities and cognitive ability in first-episode psychosis.

Background: It remains unclear if the excess of neurological soft signs, or of certain types of neurological soft signs, is common to all psychoses, and whether this excess is simply an epiphenomenon of the lower general cognitive ability present in psychosis.

Aims: To investigate whether an excess of neurological soft signs is independent of diagnosis (schizophrenia v. affective psychosis) and cognitive ability (IQ).

Pituitary volume in unaffected relatives of patients with schizophrenia and bipolar disorder.

Background: Hypothalamic-pituitary-adrenal (HPA) axis hyperactivity has been demonstrated in both schizophrenia and bipolar disorder, but the mechanisms underlying this abnormality are still unclear. Enlarged pituitary volume has been recently reported in patients with first episode psychosis and been interpreted as a consequence of an increased activation of the HPA axis. The aim of this study was to assess the contribution of familial liability to pituitary volume in schizophrenia and bipolar disorder.

Unemployment, social isolation, achievement-expectation mismatch and psychosis: findings from the AESOP Study.

Introduction: In this study, we aimed to establish: (1) whether social isolation modifies the effect of unemployment on first episode psychosis and duration of untreated psychosis (DUP); and (2) whether the gap between high employment expectations and perceived poor employment achievement is associated with first-episode psychosis; and (3) whether the relationship of this achievement-expectation gap and first-episode psychosis is strongest in the African-Caribbean population.

Method: All patients with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in south-east London and Nottingham over a 2-year period were included in the study. A random sample of healthy participants living within the same catchment areas was also recruited.

Perceptions of disadvantage, ethnicity and psychosis.

Background: 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.

Aims: To investigate whether the higher incidence of psychosis in Black people is mediated by perceptions of disadvantage.

Self-harm in first-episode psychosis.

Background: Little is known about self-harm occurring during the period of untreated first-episode psychosis.

Aims: To establish the prevalence, nature, motivation and risk factors for self-harm occurring during the untreated phase of first-episode psychosis.

Method: As part of the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study, episodes of self-harm were identified among all incident cases of psychosis presenting to services in south-east London and Nottingham over a 2-year period.

Structural brain abnormalities in individuals with an at-risk mental state who later develop psychosis.

Background: Neuroanatomical abnormalities are a well-established feature of schizophrenia. However, the timing of their emergence and the extent to which they are related to vulnerability to the disorder as opposed to psychotic illness itself is unclear.

Aims: To assess regional grey matter volume in the at-risk individuals who subsequently developed psychosis.

Duration of prodromal phase and severity of volumetric abnormalities in first-episode psychosis.

Background: First-episode psychosis is typically preceded by a prodrome in which there is deterioration in global and social functioning.

Aims: To examine whether the duration of the prodromal phase influences grey and white matter volumes at the onset of psychosis.

Methods: Eighty-two people were scanned using magnetic resonance imaging when they developed a first episode of psychosis.

Grey matter abnormalities in first-episode schizophrenia and affective psychosis.

Background: Grey matter and other structural brain abnormalities are consistently reported in first-onset schizophrenia, but less is known about the extent of neuroanatomical changes in first-onset affective psychosis.

Aims: To determine which brain abnormalities are specific to (a) schizophrenia and (b) affective psychosis.

Method: We obtained dual-echo (proton density/T2-weighted) magnetic resonance images and carried out voxel-based analysis on the images of 73 patients with first-episode psychosis (schizophrenia n=44, affective psychosis n=29) and 58 healthy controls.

Sexually dimorphic changes in the amygdala in relation to delusional beliefs in first episode psychosis.

Background: Few attempts have been made to examine the relationship between amygdala abnormalities and specific symptoms in psychosis. The present study explored the relationship between amygdala morphology and mood congruent and mood incongruent delusional beliefs.

Methods: Amygdala volumes were measured in 43 patients presenting with delusional beliefs in the context of their first episode of psychosis and 43 healthy volunteers matched for age and gender.

Duration of untreated psychosis and neuropsychological function in first episode psychosis.

Purpose: We investigated whether duration of untreated psychosis (DUP) prior to first presentation was associated with cognitive function in first episode psychosis (FEP) subjects. We predicted that longer DUP would be associated with greater neurocognitive impairment.

Method: 180 subjects with schizophrenia (and 93 subjects with Other Psychoses) performed a neurocognitive battery assessing IQ, verbal learning, working memory, visual learning and speed of processing.

Neighbourhood variation in the incidence of psychotic disorders in Southeast London.

Background: Urbanicity is a risk factor for schizophrenia, but it is unclear whether this risk is homogenous across urban areas.

Aims: To determine whether the incidence of psychotic disorders varied within an urban area, beyond variation attributable to individual-level characteristics.

Methods: All incident cases of ICD-10 psychoses from a large, 2-year, epidemiological study of first-episode psychoses in Southeast London were identified.

Neighbourhood-level effects on psychoses: re-examining the role of context.

Background: The incidence of schizophrenia varies by individual-level characteristics and neighbourhood-level attributes. Few specific socio-environmental risk factors (SERFs) have been identified at the neighbourhood level. Cross-level interactions are poorly understood.

Association study of dysbindin gene with clinical and outcome measures in a representative cohort of Italian schizophrenic patients.

There is evidence suggesting that Dysbindin (DTNBP1) is a susceptibility gene for schizophrenia in Caucasian, Chinese, and Japanese populations. We sought to determine if dysbindin was associated with schizophrenia and its symptoms in a representative group of schizophrenic patients from a Community-Based Mental Health Service (CMHS) in Verona, Italy. A prevalence cohort of schizophrenic patients (n = 141) was assessed at baseline and then 3 and 6 years later.

Regional gray matter volume abnormalities in the at risk mental state.

Background: Individuals with an At Risk Mental State (ARMS) have a very high risk of developing a psychotic disorder but the basis of this risk is unclear. We addressed this issue by studying gray matter volume in this group with magnetic resonance imaging (MRI).

Methods: Thirty-five individuals with an ARMS, 25 patients with first episode schizophrenia, and 22 healthy volunteers were studied using a 1.

Parental separation, loss and psychosis in different ethnic groups: a case-control study.

Background: Numerous studies have reported high rates of psychosis in the Black Caribbean and Black African populations in the UK. However, few studies have investigated the role of specific risk factors in different ethnic groups. We sought to investigate the relationship between long-term separation from, and death of, a parent before the age of 16 and risk of adult psychosis in different ethnic groups.

Clinical and social determinants of duration of untreated psychosis in the AESOP first-episode psychosis study.

Background: Despite considerable research investigating the relationship between a long duration of untreated psychosis (DUP) and outcomes, there has been much less considering predictors of a long DUP.

Aims: To investigate the clinical and social determinants of DUP in a large sample of patients with a first episode of psychosis.

Method: All patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined catchment areas in London and Nottingham, UK were included in the AESOP study.

Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study.

Background: The incidence of schizophrenia in the African-Caribbean population in England is reported to be raised. We sought to clarify whether (a) the rates of other psychotic disorders are increased, (b) whether psychosis is increased in other ethnic minority groups, and (c) whether particular age or gender groups are especially at risk.

Method: We identified all people (n=568) aged 16-64 years presenting to secondary services with their first psychotic symptoms in three well-defined English areas (over a 2-year period in Southeast London and Nottingham and a 9-month period in Bristol).

First episode psychosis and ethnicity: initial findings from the AESOP study.

In this paper we provide an overview of the design and the initial findings of the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study. The AESOP study is a major multi-centre incidence and case-control study conducted in the UK. Its primary aim is to investigate the high rates of psychosis in African-Caribbean populations from the UK, and from this to shed light on the aetiology of psychosis in general.