Improving attitudes toward electroconvulsive therapy.

Aims And Method: Electroconvulsive therapy (ECT) often causes fear in the general public because of media representation and negative reported side-effects. This study evaluates a new video focusing on experiences of ECT and how this can aid communicating medical information to the public. Knowledge and attitudes toward ECT after watching the video were compared with a group that received no information and a group that read the current NHS leaflet on ECT.

Protocol for a multicentre study to assess feasibility, acceptability, effectiveness and direct costs of TRIumPH (Treatment and Recovery In PsycHosis): integrated care pathway for psychosis.

Introduction: Duration of untreated psychosis (time between the onset of symptoms and start of treatment) is considered the strongest predictor of symptom severity and outcome. Integrated care pathways that prescribe timeframes around access and interventions can potentially improve quality of care.

Methods And Analysis: A multicentre mixed methods study to assess feasibility, acceptability, effectiveness and analysis of direct costs of an integrated care pathway for psychosis.

Jumping to perceptions and to conclusions: specificity to hallucinations and delusions.

Background: There is evidence that people with psychosis display a "jump-to-conclusions" (JTC) reasoning style, and that this bias may be specific to delusions. A "jump-to-perceptions" (JTP) cognitive bias has also been found and is typically linked to hallucinations. However, there is some evidence for an association between JTP and delusions, and its specificity to hallucinations remains unclear.

Spatial working memory ability in individuals at ultra high risk for psychosis.

The goal of this investigation was to clarify the nature of spatial working memory difficulties in individuals at ultra high risk (UHR) for psychosis. We evaluated spatial working memory and intelligence in 96 individuals at UHR for psychosis, 28 patients with first episode psychosis (FEP), and 23 healthy controls. Fourteen UHR individuals developed a psychotic disorder during follow-up.

Reduced mismatch negativity predates the onset of psychosis.

Background: Individuals with an "At Risk Mental State" have a 20-30% chance of developing a psychotic disorder within two years; however it is difficult to predict which individuals will become ill on the basis of their clinical symptoms alone. We examined whether mismatch negativity (MMN) could help to identify those who are particularly likely to make a transition to psychosis.

Method: 41 cases meeting PACE criteria for the At Risk Mental State (ARMS) and 50 controls performed a duration-deviant passive auditory oddball task whilst their electroencephalogram was recorded.

White matter alterations related to P300 abnormalities in individuals at high risk for psychosis: an MRI-EEG study.

Background: Psychosis onset is characterized by white matter and electrophysiologic abnormalities. The relation between these factors in the development of illness is almost unknown. We studied the relation between white matter volumes and P300 in prodromal psychosis.

Gray matter alterations related to P300 abnormalities in subjects at high risk for psychosis: longitudinal MRI-EEG study.

Background: Psychotic disorders are characterized by gray matter and volumetric and electrophysiological abnormalities. The relationship between these factors in the onset of psychotic illness is unclear.

Methods: Eighty English-native right-handed subjects (39 subjects at ultra high risk for psychosis "ARMS" and 41 healthy volunteers) were scanned with MRI, and studied using EEG during an oddball task.

Spatial working memory in individuals at high risk for psychosis: longitudinal fMRI study.

Background: Neurocognitive impairments in executive and mnemonic domains are already evident in the pre-psychotic phases. The longitudinal dynamic course of the neurofunctional abnormalities underlying liability to psychosis and their relation to clinical outcomes is unknown.

Methods: In this study we used functional magnetic resonance imaging (fMRI) in a cohort of subjects at ultra high clinical risk for psychosis (with an "At Risk Mental State", ARMS) and in healthy controls.

Altered brain function directly related to structural abnormalities in people at ultra high risk of psychosis: longitudinal VBM-fMRI study.

Background: Several studies have indicated that people with prodromal signs of psychosis show alterations in the structure and function of the brain when they first present to clinical services. However, the longitudinal course of these abnormalities, and how they relate to subsequent clinical and functional outcome is relatively unclear.

Methods: A cohort of subjects at ultra high risk of psychosis were studied using functional magnetic resonance imaging (fMRI) in conjunction with the N-Back task, and volumetric MRI at first clinical presentation and again after one year.

Neural correlates of visuospatial working memory in the 'at-risk mental state'.

Background: Impaired spatial working memory (SWM) is a robust feature of schizophrenia and has been linked to the risk of developing psychosis in people with an at-risk mental state (ARMS). We used functional magnetic resonance imaging (fMRI) to examine the neural substrate of SWM in the ARMS and in patients who had just developed schizophrenia.

Method: fMRI was used to study 17 patients with an ARMS, 10 patients with a first episode of psychosis and 15 age-matched healthy comparison subjects.

Neural correlates of movement generation in the 'at-risk mental state'.

Objective: People with 'prodromal' symptoms have a very high risk of developing psychosis. We examined the neurocognitive basis of this vulnerability by using functional MRI to study subjects with an at-risk mental state (ARMS) while they performed a random movement generation task.

Method: Cross-sectional comparison of individuals with an ARMS (n = 17), patients with first episode schizophreniform psychosis (n = 10) and healthy volunteers (n = 15).

Impaired verbal self-monitoring in individuals at high risk of psychosis.

Background: Cognitive models suggest that auditory verbal hallucinations arise through defective self-monitoring and the external attribution of inner speech. We used a paradigm that engages verbal self-monitoring (VSM) to examine whether this process is impaired in people experiencing prodromal symptoms, who have a very high risk of developing psychosis.

Method: We tested 31 individuals with an At-Risk Mental State (ARMS) and 31 healthy volunteers.

Social dysfunction predicts two years clinical outcome in people at ultra high risk for psychosis.

The experience of a first psychotic episode is associated with a marked impairment in psychosocial functioning. However, the decline may be already evident in the pre-psychotic phases and play a significant role in the etiopathology of the disease onset. A sample of subjects at ultra high clinical risk for psychosis ("At Risk Mental State", ARMS, n=152) was compared with a demographically-matched general population (n=98,072) on different measures of psychosocial functioning.

Prefrontal function at presentation directly related to clinical outcome in people at ultrahigh risk of psychosis.

Background: The prodromal phase of psychosis is characterized by impaired executive function and altered prefrontal activation. The extent to which the severity of these deficits at presentation predicts subsequent clinical outcomes is unclear.

Methods: We employed functional magnetic resonance imaging in a cohort of subjects at clinical risk for psychosis and in healthy controls.

Economic impact of early intervention in people at high risk of psychosis.

Background: Despite the increasing development of early intervention services for psychosis, little is known about their cost-effectiveness. We assessed the cost-effectiveness of Outreach and Support in South London (OASIS), a service for people with an at-risk mental state (ARMS) for psychosis.

Method: The costs of OASIS compared to care as usual (CAU) were entered in a decision model and examined for 12- and 24-month periods, using the duration of untreated psychosis (DUP) and rate of transition to psychosis as key parameters.

Elevated striatal dopamine function linked to prodromal signs of schizophrenia.

Context: A major limitation on the development of biomarkers and novel interventions for schizophrenia is that its pathogenesis is unknown. Although elevated striatal dopamine activity is thought to be fundamental to schizophrenia, it is unclear when this neurochemical abnormality develops in relation to the onset of illness and how this relates to the symptoms and neurocognitive impairment seen in individuals with prodromal symptoms of schizophrenia.

Objectives: To determine whether striatal dopamine function is elevated in individuals with prodromal symptoms of schizophrenia before the onset of psychosis and to assess how this relates to the symptoms and neurocognitive impairment.

Neural correlates of executive function and working memory in the 'at-risk mental state'.

Background: People with prodromal symptoms have a very high risk of developing psychosis.

Aims: To use functional magnetic resonance imaging to examine the neurocognitive basis of this vulnerability.

Method: Cross-sectional comparison of regional activation in individuals with an'at-risk mental state' (at-risk group: n=17), patients with first-episode schizophreniform psychosis (psychosis group: n=10) and healthy volunteers (controls: n=15) during an overt verbal fluency task and an N-back working memory task.

Abnormal P300 in people with high risk of developing psychosis.

Background: Individuals with an "at-risk mental state" (or "prodromal" symptoms) have a 20-40% chance of developing psychosis; however it is difficult to predict which of them will become ill on the basis of their clinical symptoms alone. We examined whether neurophysiological markers could help to identify those who are particularly vulnerable.

Method: 35 cases meeting PACE criteria for the at-risk mental state (ARMS) and 57 controls performed an auditory oddball task whilst their electroencephalogram was recorded.

Delusion formation and reasoning biases in those at clinical high risk for psychosis.

Background: Cognitive models propose that faulty appraisal of anomalous experiences is critical in developing psychosis, particularly delusions. A data gathering bias may be fundamental to abnormal appraisal.

Aims: To examine whether there is a data gathering bias in people at high risk of developing psychosis.

Appraisals of Anomalous Experiences Interview (AANEX): a multidimensional measure of psychological responses to anomalies associated with psychosis.

Background: Cognitive models of psychosis suggest that whether anomalous experiences lead to clinically relevant psychotic symptoms depends on how they are appraised, the context in which they occur and the individual's emotional response.

Aims: To develop and validate a semi-structured interview (the Appraisals of Anomalous Experiences Interview; AANEX) to assess (a) anomalous experiences and (b) appraisal, contextual and response variables.

Method: Following initial piloting, construct validity was tested via cross-sectional comparison of data from clinical and non-clinical samples with anomalous experiences.

Street slang and schizophrenia.

Young people often use language in an unconventional way. This may create communication difficulties for older doctors, particularly in the identification of disorganised speech, say

Insight in individuals with an At Risk Mental State.

Purpose: On average, people with an At Risk Mental State (ARMS) for psychosis are more willing to seek and accept clinical help than patients with psychotic disorders, suggesting that insight in this group is relatively less impaired. We compared the level and quality of insight in the ARMS and in first episode psychosis.

Materials And Methods: Insight about illness was assessed in subjects with an ARMS and in patients with first episode psychosis (FEP) who were and were not help-seeking, using the Schedule for Assessment of Insight (SAI-E).

What causes the onset of psychosis?

It has become increasingly clear that the simple neurodevelopmental model fails to explain many aspects of schizophrenia including the timing of the onset, and the nature of the abnormal perceptions. Furthermore, we do not know why some members of the general population have anomalous experiences but remain well, while others enter the prodrome of psychosis, and a minority progress to frank schizophrenia. We suggest that genes or developmental damage result in individuals vulnerable to dopamine deregulation.

Outreach and support in south London (OASIS): implementation of a clinical service for prodromal psychosis and the at risk mental state.

Background: While recent research points to the potential benefits of clinical intervention before the first episode of psychosis, the logistical feasibility of this is unclear.

Aims: To assess the feasibility of providing a clinical service for people with prodromal symptoms in an inner city area where engagement with mental health services is generally poor.

Method: Following a period of liaison with local agencies to promote the service, referrals were assessed and managed in a primary care setting.