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  • 1
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2013
    In:  Social Psychiatry and Psychiatric Epidemiology Vol. 48, No. 1 ( 2013-1), p. 125-136
    In: Social Psychiatry and Psychiatric Epidemiology, Springer Science and Business Media LLC, Vol. 48, No. 1 ( 2013-1), p. 125-136
    Type of Medium: Online Resource
    ISSN: 0933-7954 , 1433-9285
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2013
    detail.hit.zdb_id: 1463160-X
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  • 2
    In: The Canadian Journal of Psychiatry, SAGE Publications, Vol. 57, No. 10 ( 2012-10), p. 626-633
    Abstract: There has been increasing interest in the psychiatric literature on research and service delivery focused on first-episode psychosis (FEP), and accurate information on the incidence of FEP is crucial for the development of services targeting patients in the early stages of illness. We sought to obtain a population-based estimate of the incidence of first-episode schizophrenia-spectrum psychosis (SSP) among adolescents and young adults in Montreal. Methods: Population-based administrative data from physician billings, hospitalizations, pharmacies, and public health clinics were used to estimate the incidence of first-episode SSP in Montreal. A 3-year period (2004–2006) was used to identify patients with SSP aged 14 to 25 years. We used a 4- to 6-year clearance period to remove patients with a history of any psychotic disorder or prescription for an antipsychotic. Results: We identified 456 patients with SSP, yielding a standardized annual incidence of 82.9 per 100 000 for males (95% CI 73.7 to 92.1), and 32.2 per 100 000 for females (95% CI 26.7 to 37.8). Using ecologic indicators of material and social deprivation, we found a higher-incidence proportion of SSP among people living in the most deprived areas, relative to people living in the least deprived areas. Conclusions: Clinical samples obtained from psychiatric services are unlikely to capture all treatment-seeking patients, and epidemiologic surveys have resource-intensive constraints, making this approach challenging for rare forms of psychopathology; therefore, population-based administrative data may be a useful tool for studying the frequency of psychotic disorders.
    Type of Medium: Online Resource
    ISSN: 0706-7437 , 1497-0015
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2035338-8
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  • 3
    In: Frontiers in Psychiatry, Frontiers Media SA, Vol. 14 ( 2023-2-21)
    Abstract: Mental health problems are common globally, and typically have their onset in adolescence and early adulthood—making youth (aged 11–25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation via the pan-Canadian ACCESS Open Minds (AOM) project, for which a key focus is on improving access to mental health care and reducing unmet need in community settings. Approach As a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses. Anticipated results Across urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care. Discussion Complex interventions such as AOM aim to shift care “upstream”: away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.
    Type of Medium: Online Resource
    ISSN: 1664-0640
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 2564218-2
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  • 4
    Online Resource
    Online Resource
    Informa UK Limited ; 2013
    In:  Journal of Mental Health Vol. 22, No. 4 ( 2013-08), p. 384-395
    In: Journal of Mental Health, Informa UK Limited, Vol. 22, No. 4 ( 2013-08), p. 384-395
    Type of Medium: Online Resource
    ISSN: 0963-8237 , 1360-0567
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2013
    detail.hit.zdb_id: 2007227-2
    SSG: 5,2
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  • 5
    Online Resource
    Online Resource
    Cambridge University Press (CUP) ; 2023
    In:  Psychological Medicine Vol. 53, No. 5 ( 2023-04), p. 2008-2016
    In: Psychological Medicine, Cambridge University Press (CUP), Vol. 53, No. 5 ( 2023-04), p. 2008-2016
    Abstract: Rapid progression from the first identifiable symptom to the onset of first-episode psychosis (FEP) allows less time for early intervention. The aim of this study was to examine the association between the first identifiable symptom and the subsequent speed of illness progression. Methods Data were available for 390 patients attending a catchment-based early intervention service for FEP. Exposure to non-psychotic and subthreshold psychotic symptoms was retrospectively recorded using semi-structured interviews. Outcomes following the onset of the first identifiable symptom were (1) time to onset of FEP and (2) symptom incidence rate (i.e. number of symptoms emerging per person-year until FEP onset). These outcomes were respectively analyzed with Cox proportional hazards and negative binomial regressions. Results After Bonferroni correction, having a subthreshold psychotic ( v. non-psychotic) symptom as the first symptom was not associated with time to FEP onset [hazard ratio (HR) = 1.39; 95% CI 0.94–2.04] but was associated with higher symptom incidence [incidence rate ratio (IRR) = 1.92; 95% CI 1.10–3.48]. A first symptom of suspiciousness was associated with shorter time to FEP onset (HR = 2.37; 95% CI 1.38–4.08) and higher symptom incidence rate (IRR = 3.20; 95% CI 1.55–7.28) compared to other first symptoms. In contrast, a first symptom of self-harm was associated with lower symptom incidence rate (IRR = 0.06; 95% CI 0.01–0.73) compared to other first symptoms. Several associations between symptoms and illness progression were moderated by the age at symptom onset. Conclusions Appreciating the content and timing of early symptoms can identify windows and treatment targets for early interventions in psychosis.
    Type of Medium: Online Resource
    ISSN: 0033-2917 , 1469-8978
    RVK:
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1470300-2
    SSG: 5,2
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  • 6
    Online Resource
    Online Resource
    Cambridge University Press (CUP) ; 1991
    In:  Psychological Medicine Vol. 21, No. 4 ( 1991-11), p. 897-903
    In: Psychological Medicine, Cambridge University Press (CUP), Vol. 21, No. 4 ( 1991-11), p. 897-903
    Abstract: The relationships between depression, anxiety and positive and negative symptoms of schizophrenia were examined in a study of 95 schizophrenic patients who were receiving out-patient care. Various measures of depression and anxiety showed a pattern of interrelationships which suggested that they were measuring a general state of dysphoria rather than separate dimensions of anxiety and depression. Dysphoria was found to be more reliably related to level of positive symptomatology than to negative symptoms.
    Type of Medium: Online Resource
    ISSN: 0033-2917 , 1469-8978
    RVK:
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 1991
    detail.hit.zdb_id: 1470300-2
    SSG: 5,2
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  • 7
    Online Resource
    Online Resource
    Cambridge University Press (CUP) ; 2020
    In:  Psychological Medicine Vol. 50, No. 11 ( 2020-08), p. 1923-1936
    In: Psychological Medicine, Cambridge University Press (CUP), Vol. 50, No. 11 ( 2020-08), p. 1923-1936
    Abstract: Longitudinal studies of first episode of psychosis (FEP) patients are critical to understanding the dynamic clinical factors influencing functional outcomes; negative symptoms and verbal memory (VM) deficits are two such factors that remain a therapeutic challenge. This study uses white-gray matter contrast at the inner edge of the cortex, in addition to cortical thickness, to probe changes in microstructure and their relation with negative symptoms and possible intersections with verbal memory. Methods T 1-weighted images and clinical data were collected longitudinally for patients ( N = 88) over a two-year period. Cognitive data were also collected at baseline. Relationships between baseline VM (immediate/delayed recall) and rate of change in two negative symptom dimensions, amotivation and expressivity, were assessed at the behavioral level, as well as at the level of brain structure. Results VM, particularly immediate recall, was significantly and positively associated with a steeper rate of expressivity symptom decline ( r = 0.32, q = 0.012). Significant interaction effects between baseline delayed recall and change in expressivity were uncovered in somatomotor regions bilaterally for both white-gray matter contrast and cortical thickness. Furthermore, interaction effects between immediate recall and change in expressivity on cortical thickness rates were uncovered across higher-order regions of the language processing network. Conclusions This study shows common neural correlates of language-related brain areas underlying expressivity and VM in FEP, suggesting deficits in these domains may be more linked to speech production rather than general cognitive capacity. Together, white-gray matter contrast and cortical thickness may optimally inform clinical investigations aiming to capture peri-cortical microstructural changes.
    Type of Medium: Online Resource
    ISSN: 0033-2917 , 1469-8978
    RVK:
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2020
    detail.hit.zdb_id: 1470300-2
    SSG: 5,2
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  • 8
    Online Resource
    Online Resource
    Royal College of Psychiatrists ; 1993
    In:  British Journal of Psychiatry Vol. 162, No. 2 ( 1993-02), p. 166-174
    In: British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 162, No. 2 ( 1993-02), p. 166-174
    Abstract: Research on the relationship between stress and schizophrenia is fraught with conceptual and methodological problems. These problems include issues related to the nature and measurement of stress, the likelihood of reciprocal influences between stress and symptoms, and the adequate assessment of symptoms. Several recommendations are made regarding future research in this area. These include using multiple and broadly based measures of different types of stressors and symptoms, greater use of truly prospective research designs, and the evaluation of the effects of interventions specifically designed to reduce stress in patients who suffer from schizophrenia.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    RVK:
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 1993
    detail.hit.zdb_id: 2021500-9
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  • 9
    Online Resource
    Online Resource
    Royal College of Psychiatrists ; 2001
    In:  British Journal of Psychiatry Vol. 179, No. 4 ( 2001-10), p. 340-345
    In: British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 179, No. 4 ( 2001-10), p. 340-345
    Abstract: The ‘toxicity’ model of duration of untreated psychosis (DUP) suggests that longer DUP will be associated with poorer performance on cognitive tests in first-episode patients. Aims To test this hypothesis on a sample of 113 patients in a community-based early intervention programme for psychosis. Method Information was collected concerning a number of possible predictors of cognitive functioning including DUP. These were examined for their relation to performance on an extensive battery of cognitive tests administered shortly after the patients' admission to the programme. Results Although several variables such as gender, premorbid adjustment, education and handedness predicted cognitive functioning, no relation was found between DUP and performance on any component of the test battery. Conclusions Findings do not provide support for a toxic effect of DUP on cognitive functioning. Other mechanisms through which DUP might affect outcome such as psychological engulfment, social support and adherence to medication are discussed.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    RVK:
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2001
    detail.hit.zdb_id: 2021500-9
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  • 10
    Online Resource
    Online Resource
    Royal College of Psychiatrists ; 2012
    In:  British Journal of Psychiatry Vol. 200, No. 4 ( 2012-04), p. 300-307
    In: British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 200, No. 4 ( 2012-04), p. 300-307
    Abstract: Previous studies in schizophrenia have shown a strong relationship between memory deficits and a poor clinical outcome. However, no previous study has identified the functional neural correlates of memory encoding in relation to remission. Aims To determine whether functional magnetic resonance imaging (fMRI) activation patterns differed between individuals that later achieved remission v. those who did not. Method Forty-two participants with first-episode schizophrenia were divided into two groups after 1 year of treatment as per the 2005 remission in schizophrenia consensus definition. We then examined fMRI activation using three contrasts (associative v. item-oriented strategy, semantically unrelated v. related image pairs, and successful v. unsuccessful memory encoding) among 15 participants who had achieved remission (remitted group), 27 who had not (non-remitted group) and 31 healthy controls (control group). Results Participants in the non-remitted group displayed a positive activation in the posterior cingulate compared with those in the remitted group when encoding related images; no significant differences between the two groups were identified for the other contrasts. From the behavioural data, compared with the remitted and control groups, the non-remitted group demonstrated an inability to encode related images and displayed worse recognition memory overall. Conclusions This is the first study to identify differential neural activation between individuals with first-episode schizophrenia that later achieved remission v. those who did not. The behavioural and functional results together add to the growing evidence relating a poor clinical outcome in schizophrenia to memory-related deficits.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    RVK:
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2012
    detail.hit.zdb_id: 2021500-9
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