Sue Cotton - Academia.edu (original) (raw)

Papers by Sue Cotton

World Psychiatry

Illness staging is widely utilized in several medical disciplines to help predict course or progn... more Illness staging is widely utilized in several medical disciplines to help predict course or prognosis, and optimize treatment. Staging models in psychiatry in general, and bipolar disorder in particular, depend on the premise that psychopathology moves along a predictable path: an at-risk or latency stage, a prodrome progressing to a first clinical threshold episode, and one or more recurrences with the potential to revert or progress to late or end-stage manifestations. The utility and validity of a staging model for bipolar disorder depend on its linking to clinical outcome, treatment response and neurobiological measures. These include progressive biochemical, neuroimaging and cognitive changes, and potentially stage-specific differences in response to pharmacological and psychosocial treatments. Mechanistically, staging models imply the presence of an active disease process that, if not remediated, can lead to neuroprogression, a more malignant disease course and functional deterioration. Biological elements thought to be operative in bipolar disorder include a genetic diathesis, physical and psychic trauma, epigenetic changes, altered neurogenesis and apoptosis, mitochondrial dysfunction, inflammation, and oxidative stress. Many available agents, such as lithium, have effects on these targets. Staging models also suggest the utility of stage-specific treatment approaches that may not only target symptom reduction, but also impede illness neuroprogression. These treatment approaches range from prevention for at-risk individuals, to early intervention strategies for prodromal and newly diagnosed individuals, complex combination therapy for rapidly recurrent illness, and palliative-type approaches for those at chronic, late stages of illness. There is hope that prompt initiation of potentially disease modifying therapies may preclude or attenuate the cognitive and structural changes seen in the later stages of bipolar disorder. The aims of this paper are to: a) explore the current level of evidence supporting the descriptive staging of the syndromal pattern of bipolar disorder; b) describe preliminary attempts at validation; c) make recommendations for the direction of further studies; and d) provide a distillation of the potential clinical implications of staging in bipolar disorder within a broader transdiagnostic framework.

Social psychiatry and psychiatric epidemiology, 2017

Most patients with first episode psychosis (FEP) are neither studying nor employed (have a poor f... more Most patients with first episode psychosis (FEP) are neither studying nor employed (have a poor functional status) when first accessing care. Knowledge of the characteristics of patients with poor functioning and the features influencing functional status over time may pave the way to better treatment. A medical file audit was used to collect data on premorbid, entry, treatment and 18-month outcome characteristics on 661 FEP patients who consecutively attended the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, between 1998 and 2000. Functional status was ascertained using the modified vocational status index and was rated at baseline (poor or good) and according to its evolution over the treatment period (stable good, stable poor, deteriorating or improved functional status). 52.0% of patients had a poor functional status at service entry. They were more likely to be male with a non-affective psychosis. They also had lower levels of premorbid global functi...

Faculty of Health Institute of Health and Biomedical Innovation School of Psychology Counselling, 2013

Dysphagia, 2009

The prevalence of swallowing disorders (dysphagia) following a total laryngectomy remains unknown... more The prevalence of swallowing disorders (dysphagia) following a total laryngectomy remains unknown, with estimates varying from 17 to 70%. The primary aim of this study was to investigate the prevalence and nature of self-reported dysphagia following a total laryngectomy across New South Wales (NSW), Australia. A secondary aim was to document the effect of dysphagia on the respondents' social activities and participation. A questionnaire battery, with a prepaid envelope for return, was sent to all laryngectomy members (n = 197) of the Laryngectomee Association of NSW. One hundred twenty questionnaires (61%) were completed and returned. Dysphagia was self-reported by 71.8% of the cohort. In this cohort with dysphagia, the most commonly reported features included an increased time required to swallow, a need for fluids to wash down a bolus, and avoidance of certain food consistencies. Severe distress was reportedly associated with dysphagia for 39.7% of these respondents and prevented 57% of them from participating in social activities, such as eating at friends' houses and/or at restaurants. The prevalence of self-reported dysphagia following total laryngectomy in this Australian study was 72%. Dysphagia can result in laryngectomees making significant changes to their diets and it has a marked impact on their activities and social participation.

Head Neck J Sci Spec Head Nec, 2009

Background. This prospective study evaluated the impact of patient demographics, tumor characteri... more Background. This prospective study evaluated the impact of patient demographics, tumor characteristics, and radiotherapy treatment on swallowing before and after radiotherapy or chemoradiotherapy.

Data Revues 09249338 Unassign S0924933814001394, Aug 1, 2014

Carers’ expressed emotion (EE) and patients’ cannabis misuse are two of the most robust predictor... more Carers’ expressed emotion (EE) and patients’ cannabis misuse are two of the most robust predictors of psychotic relapse. We aimed to examine the temporal relationship between EE and cannabis misuse. Sixty-three key carers of young people with first-episode psychosis (FEP) were assessed at baseline and 7-month follow-up. EE was measured in carers using the Family Questionnaire (FQ) and cannabis misuse in patients using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Correlational and hierarchical logistic regression analyses were conducted to examine the temporal relationship between EE components (i.e. criticism and emotional over involvement) and cannabis misuse. Carers’ criticism at baseline significantly predicted cannabis misuse according to the ASSIST at 7-month follow-up. The association remained significant after controlling for baseline symptom severity and social functioning (B = 0.15, P = .02). Conversely, baseline cannabis misuse was not associated with carers’ criticism at 7-month follow-up. Patients in families with high criticism showed a tendency to increase cannabis misuse over time whereas the opposite trend was observed in those with carers with low criticism. A family environment characterized by high criticism may become a key risk factor for worsening cannabis misuse over time in young people with FEP. Further studies should investigate the potential mechanisms (e.g., patient's anxiety or perceived stress) through which criticism increases cannabis misuse in FEP.

PloS one, 2015

The aim of the study was to investigate trajectories of social functioning in young people with f... more The aim of the study was to investigate trajectories of social functioning in young people with first-episode psychosis (FEP) with and without cannabis misuse using a secondary analysis of data from the Episode-II trial. Forty-two young people with FEP and comorbid cannabis use disorder were compared with 39 young people with FEP but without a cannabis use disorder. Social functioning was assessed every 6 months during a 30-month follow-up. Multilevel linear growth curve modeling was used to compare the social functioning trajectories over time for those with and without cannabis misuse. Cannabis misuse was not associated with social functioning at baseline assessment. Over a 30-month follow-up, FEP patients without cannabis disorder showed significant improvements in their social functioning, whereas patients with cannabis misuse at baseline displayed no such improvement. Patients with and without cannabis misuse differed significantly in their levels of social functioning after 24...

The Medical journal of Australia, 2011

To determine whether the addition of cognitive behaviour therapy and motivational interviewing (C... more To determine whether the addition of cognitive behaviour therapy and motivational interviewing (CBT/MI) to standard alcohol and other drug (AOD) care improves outcomes for young people with comorbid depression and substance misuse. Participants were young people with comorbid depression (Kessler Psychological Distress Scale score ≥ 17) and substance misuse (mainly alcohol and/or cannabis) seeking treatment at two youth AOD services in Melbourne, Australia. The study was conducted between September 2006 and September 2008. Sixty young people received CBT/MI in addition to standard care (SC) (the SC+CBT/MI group) and 28 received SC only (the SC group). Depressive symptoms and AOD use in the previous 30 days, measured at baseline and at 3-month and 6-month follow-up. Compared with participants in the SC group, those in the SC+CBT/MI group showed significant reductions in depression and cannabis use and increased social contact and motivation to change substance use at 3-month follow-up...

Journal of studies on alcohol and drugs, 2011

Inhalant use is a common form of drug misuse among young adolescents. However, very little is kno... more Inhalant use is a common form of drug misuse among young adolescents. However, very little is known about how chronic inhalant misuse affects cognition. Several studies have examined cognitive deficits among inhalant users, but no study has thoroughly addressed the confounding issues frequently associated with inhalant users (e.g., polysubstance use). The aim of the current study was to examine possible deficits in memory, learning, and executive components of memory (interference susceptibility) among young, regular inhalant users relative to a statistically equivalent drug-using control group (primarily cannabis users) and a community control group. Three groups of 21 young people (aged 13-24 years) were recruited: an inhalant- using group, a drug-using control group, and a community control group. The inhalant and drug-using controls were matched at the group level on demographic, clinical, and substance use measures. All three groups were statistically equivalent on age, sex, an...

International Journal of Language & Communication Disorders, 2015

Quality of life (QoL) is an important construct when assessing treatment outcomes. To examine the... more Quality of life (QoL) is an important construct when assessing treatment outcomes. To examine the relative contributions of functioning, psychological well-being and self-efficacy on self-perceived QoL with a sample of total laryngectomy patients in Australia who had surgery for advanced laryngeal cancer. In a cross-sectional study, 113 members of the Laryngectomy Associations of New South Wales and of Victoria, Australia, were recruited, and each was sent a series of questionnaires for postal return. Four psychometrically validated measures were used for participants to document their QoL, functioning (speech, swallowing), psychological well-being and general self-efficacy. Eighty-six (77%) questionnaires were returned and 83 were analysed. The cohort consists of 70 men and 13 women aged between 46 and 88 years. Overall, this sample of total laryngectomy survivors demonstrated significantly reduced physical health QoL (p < 0.001) and social relationship QoL (p = 0.011) and higher levels of depression (p = 0.008) and anxiety (p = 0.001) when compared with normative samples. This was in the context of them having higher than normal self-efficacy scores and, at worst, mild (self-rated) impairment of speech and of swallowing. Psychological well-being (sr(2) = 0.43, p < 0.001) had a stronger association than functioning (speech, swallowing, sr(2) = 0.08, p < 0.05) for their psychological QoL. Psychological well-being (sr(2) = 0.17, p < 0.001) and not functioning (sr(2) = 0.05, p > 0.05) were significantly associated with social relationship QoL. Self-efficacy scores were significantly higher than norms in this cohort, but were not associated with either their psychological QoL or social relationship QoL, after controlling for psychological well-being and functioning. For survivors of laryngeal cancer treated by total laryngectomy, it is important to be aware of the impact of psychological well-being (depression, anxiety, stress) on self-perceived QoL. In addition to rehabilitating function (speech, swallowing), specific interventions to assist these individuals better manage their psychological well-being will likely improve their perceived life satisfaction/QoL.

Revista Brasileira de Psiquiatria, 2014

European Psychiatry, 2015

Carers’ expressed emotion (EE) and patients’ cannabis misuse are two of the most robust predictor... more Carers’ expressed emotion (EE) and patients’ cannabis misuse are two of the most robust predictors of psychotic relapse. We aimed to examine the temporal relationship between EE and cannabis misuse. Sixty-three key carers of young people with first-episode psychosis (FEP) were assessed at baseline and 7-month follow-up. EE was measured in carers using the Family Questionnaire (FQ) and cannabis misuse in patients using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Correlational and hierarchical logistic regression analyses were conducted to examine the temporal relationship between EE components (i.e. criticism and emotional over involvement) and cannabis misuse. Carers’ criticism at baseline significantly predicted cannabis misuse according to the ASSIST at 7-month follow-up. The association remained significant after controlling for baseline symptom severity and social functioning (B = 0.15, P = .02). Conversely, baseline cannabis misuse was not associated...

Background: Alcohol is a major preventable cause of injury, disability and death in young people.... more Background: Alcohol is a major preventable cause of injury, disability and death in young people. Large numbers of young people with alcohol-related injuries and medical conditions present to hospital emergency departments (EDs). Access to brief, efficacious, accessible and cost effective treatment is an international health priority within this age group. While there is growing evidence for the efficacy of brief motivational interviewing (MI) for reducing alcohol use in young people, there is significant scope to increase its impact, and determine if it is the most efficacious and cost effective type of brief intervention available. The efficacy of personality-targeted interventions (PIs) for alcohol misuse delivered individually to young people is yet to be determined or compared to MI, despite growing evidence for school-based PIs. This study protocol describes a randomized controlled trial comparing the efficacy and cost-effectiveness of telephone-delivered MI, PI and an Assessment Feedback/Information (AF/I) only control for reducing alcohol use and related harm in young people. Methods/design: Participants will be 390 young people aged 16 to 25 years presenting to a crisis support service or ED with alcohol-related injuries and illnesses (including severe alcohol intoxication). This single blinded superiority trial randomized young people to (i) 2 sessions of MI; (ii) 2 sessions of a new PI or (iii) a 1 session AF/I only control. Participants are reassessed at 1, 3, 6 and 12 months on the primary outcomes of alcohol use and related problems and secondary outcomes of mental health symptoms, functioning, severity of problematic alcohol use, alcohol injuries, alcohol-related knowledge, coping self-efficacy to resist using alcohol, and cost effectiveness. Discussion: This study will identify the most efficacious and cost-effective telephone-delivered brief intervention for reducing alcohol misuse and related problems in young people presenting to crisis support services or EDs. We expect efficacy will be greatest for PI, followed by MI, and then AF/I at 1, 3, 6 and 12 months on the primary and secondary outcome variables. Telephone-delivered brief interventions could provide a youth-friendly, accessible, efficacious, cost-effective and easily disseminated treatment for addressing the significant public health issue of alcohol misuse and related harm in young people. Trial registration: This trial is registered with the Australian and New Zealand Clinical Trials Registry ACTRN12613000108718.

Schizophrenia Research, 2012

Background: Depressive symptoms in 'non-affective' first episode schizophrenia spectrum disorders... more Background: Depressive symptoms in 'non-affective' first episode schizophrenia spectrum disorders (FES) are common, but poorly understood, resulting in a range of conceptual and clinical management issues. This study had three aims: (i) to determine the prevalence of moderate to severe depressive symptoms (defined as a Clinical Global Impressions Scale-Bipolar Disorder (CGI-BP depression) score N3) in a large representative sample of FES patients; (ii) to compare the clinical and functional characteristics of FES patients with and without these depressive symptoms at service entry; and (iii) to compare the characteristics of FES patients with and without persistent depressive symptoms. Methods: Medical file audit methodology was employed to collect information on 405 patients with FES treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. Results: 26.2% (n = 106) of the patients had moderate to severe depression at service entry. At service entry and at discharge, those with depressive symptoms had greater insight into their illness but did not differ from those without depressive symptoms in terms of severity of overall psychopathology. Substance use was significantly less common in those with depressive symptoms at service entry and at discharge. Of those who were depressed at baseline, 14.2% (n = 15) continued to have moderate to severe depressive symptoms at discharge. Discussion: Depressive symptoms are common in patients with FES. Understanding the nature and characteristics of depression in FES has important clinical implications for both early intervention and treatment.

Schizophrenia Research, 2013

The results of a recent double-blind, randomized, placebo-controlled trial performed in 81 young ... more The results of a recent double-blind, randomized, placebo-controlled trial performed in 81 young patients at ultra-high risk for psychosis indicated that a 12-week intervention of 1.2g/day of ω-3 polyunsaturated fatty acids (PUFA) significantly reduced the risk of transition to psychosis and improved positive, negative and general symptoms as well as functioning. The aim of this post-hoc analysis was to determine at which time point ω-3 PUFAs start to significantly differ from placebo in improving psychopathology and functioning in young people at risk of developing psychosis. Analyses were performed using the mixed model repeated-measures analysis of variance. Compared to placebo, ω-3 PUFAs' significant effects on the amplitude of the reduction in General and Total PANSS scores are evident after the first four weeks of treatment; a reduction of positive symptoms and a lower mean PANSS positive score were apparent after eight weeks, whereas the significant drop in negative symptoms and the significant change and higher mean scores in global functioning occur later at 12weeks. The delay of onset of ω -3 PUFAs seems comparable to that of antipsychotics and antidepressants.

Schizophrenia Research, 2013

Aims: To examine whether baseline neurocognition and social cognition predict vocational outcomes... more Aims: To examine whether baseline neurocognition and social cognition predict vocational outcomes over 6 months in patients with first-episode psychosis (FEP) enrolled in a randomised controlled trial of Individual Placement and Support (IPS) versus treatment as usual (TAU). Methods: 135 FEP participants (IPS n = 69; TAU n = 66) completed a comprehensive neurocognitive and social cognitive battery. Principal axis factor analysis using PROMAX rotation was used to determine the underlying cognitive structure of the battery. Setwise (hierarchical) logistic and multivariate linear regressions were used to examine predictors of: (a) enrolment in education and employment; and (b) hours of employment over 6 months. Neurocognition and social cognition factors were entered into the models after accounting for premorbid IQ, baseline functioning and treatment group. Results: Six cognitive factors were extracted: (i) social cognition; (ii) information processing speed; (iii) verbal learning and memory; (iv) attention and working memory; (v) visual organisation and memory; and (vi) verbal comprehension. Enrolment in education over 6 months was predicted by enrolment in education at baseline (p = .002) and poorer visual organisation and memory (p = .024). Employment over 6 months was predicted by employment at baseline (p = .041) and receiving IPS (p = .020). Better visual organisation and memory predicted total hours of paid work over 6 months (p b .001). Conclusions: Visual organisation and memory predicted the enrolment in education and duration of employment, after accounting for premorbid IQ, baseline functioning and treatment. Social cognition did not contribute to the prediction of vocational outcomes. Neurocognitive interventions may enhance employment duration in FEP.

Schizophrenia Research, 2013

Psychotherapy and Psychosomatics, 2013

World Psychiatry

Illness staging is widely utilized in several medical disciplines to help predict course or progn... more Illness staging is widely utilized in several medical disciplines to help predict course or prognosis, and optimize treatment. Staging models in psychiatry in general, and bipolar disorder in particular, depend on the premise that psychopathology moves along a predictable path: an at-risk or latency stage, a prodrome progressing to a first clinical threshold episode, and one or more recurrences with the potential to revert or progress to late or end-stage manifestations. The utility and validity of a staging model for bipolar disorder depend on its linking to clinical outcome, treatment response and neurobiological measures. These include progressive biochemical, neuroimaging and cognitive changes, and potentially stage-specific differences in response to pharmacological and psychosocial treatments. Mechanistically, staging models imply the presence of an active disease process that, if not remediated, can lead to neuroprogression, a more malignant disease course and functional deterioration. Biological elements thought to be operative in bipolar disorder include a genetic diathesis, physical and psychic trauma, epigenetic changes, altered neurogenesis and apoptosis, mitochondrial dysfunction, inflammation, and oxidative stress. Many available agents, such as lithium, have effects on these targets. Staging models also suggest the utility of stage-specific treatment approaches that may not only target symptom reduction, but also impede illness neuroprogression. These treatment approaches range from prevention for at-risk individuals, to early intervention strategies for prodromal and newly diagnosed individuals, complex combination therapy for rapidly recurrent illness, and palliative-type approaches for those at chronic, late stages of illness. There is hope that prompt initiation of potentially disease modifying therapies may preclude or attenuate the cognitive and structural changes seen in the later stages of bipolar disorder. The aims of this paper are to: a) explore the current level of evidence supporting the descriptive staging of the syndromal pattern of bipolar disorder; b) describe preliminary attempts at validation; c) make recommendations for the direction of further studies; and d) provide a distillation of the potential clinical implications of staging in bipolar disorder within a broader transdiagnostic framework.

Social psychiatry and psychiatric epidemiology, 2017

Most patients with first episode psychosis (FEP) are neither studying nor employed (have a poor f... more Most patients with first episode psychosis (FEP) are neither studying nor employed (have a poor functional status) when first accessing care. Knowledge of the characteristics of patients with poor functioning and the features influencing functional status over time may pave the way to better treatment. A medical file audit was used to collect data on premorbid, entry, treatment and 18-month outcome characteristics on 661 FEP patients who consecutively attended the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, between 1998 and 2000. Functional status was ascertained using the modified vocational status index and was rated at baseline (poor or good) and according to its evolution over the treatment period (stable good, stable poor, deteriorating or improved functional status). 52.0% of patients had a poor functional status at service entry. They were more likely to be male with a non-affective psychosis. They also had lower levels of premorbid global functi...

Faculty of Health Institute of Health and Biomedical Innovation School of Psychology Counselling, 2013

Dysphagia, 2009

The prevalence of swallowing disorders (dysphagia) following a total laryngectomy remains unknown... more The prevalence of swallowing disorders (dysphagia) following a total laryngectomy remains unknown, with estimates varying from 17 to 70%. The primary aim of this study was to investigate the prevalence and nature of self-reported dysphagia following a total laryngectomy across New South Wales (NSW), Australia. A secondary aim was to document the effect of dysphagia on the respondents' social activities and participation. A questionnaire battery, with a prepaid envelope for return, was sent to all laryngectomy members (n = 197) of the Laryngectomee Association of NSW. One hundred twenty questionnaires (61%) were completed and returned. Dysphagia was self-reported by 71.8% of the cohort. In this cohort with dysphagia, the most commonly reported features included an increased time required to swallow, a need for fluids to wash down a bolus, and avoidance of certain food consistencies. Severe distress was reportedly associated with dysphagia for 39.7% of these respondents and prevented 57% of them from participating in social activities, such as eating at friends' houses and/or at restaurants. The prevalence of self-reported dysphagia following total laryngectomy in this Australian study was 72%. Dysphagia can result in laryngectomees making significant changes to their diets and it has a marked impact on their activities and social participation.

Head Neck J Sci Spec Head Nec, 2009

Background. This prospective study evaluated the impact of patient demographics, tumor characteri... more Background. This prospective study evaluated the impact of patient demographics, tumor characteristics, and radiotherapy treatment on swallowing before and after radiotherapy or chemoradiotherapy.

Data Revues 09249338 Unassign S0924933814001394, Aug 1, 2014

Carers’ expressed emotion (EE) and patients’ cannabis misuse are two of the most robust predictor... more Carers’ expressed emotion (EE) and patients’ cannabis misuse are two of the most robust predictors of psychotic relapse. We aimed to examine the temporal relationship between EE and cannabis misuse. Sixty-three key carers of young people with first-episode psychosis (FEP) were assessed at baseline and 7-month follow-up. EE was measured in carers using the Family Questionnaire (FQ) and cannabis misuse in patients using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Correlational and hierarchical logistic regression analyses were conducted to examine the temporal relationship between EE components (i.e. criticism and emotional over involvement) and cannabis misuse. Carers’ criticism at baseline significantly predicted cannabis misuse according to the ASSIST at 7-month follow-up. The association remained significant after controlling for baseline symptom severity and social functioning (B = 0.15, P = .02). Conversely, baseline cannabis misuse was not associated with carers’ criticism at 7-month follow-up. Patients in families with high criticism showed a tendency to increase cannabis misuse over time whereas the opposite trend was observed in those with carers with low criticism. A family environment characterized by high criticism may become a key risk factor for worsening cannabis misuse over time in young people with FEP. Further studies should investigate the potential mechanisms (e.g., patient's anxiety or perceived stress) through which criticism increases cannabis misuse in FEP.

PloS one, 2015

The aim of the study was to investigate trajectories of social functioning in young people with f... more The aim of the study was to investigate trajectories of social functioning in young people with first-episode psychosis (FEP) with and without cannabis misuse using a secondary analysis of data from the Episode-II trial. Forty-two young people with FEP and comorbid cannabis use disorder were compared with 39 young people with FEP but without a cannabis use disorder. Social functioning was assessed every 6 months during a 30-month follow-up. Multilevel linear growth curve modeling was used to compare the social functioning trajectories over time for those with and without cannabis misuse. Cannabis misuse was not associated with social functioning at baseline assessment. Over a 30-month follow-up, FEP patients without cannabis disorder showed significant improvements in their social functioning, whereas patients with cannabis misuse at baseline displayed no such improvement. Patients with and without cannabis misuse differed significantly in their levels of social functioning after 24...

The Medical journal of Australia, 2011

To determine whether the addition of cognitive behaviour therapy and motivational interviewing (C... more To determine whether the addition of cognitive behaviour therapy and motivational interviewing (CBT/MI) to standard alcohol and other drug (AOD) care improves outcomes for young people with comorbid depression and substance misuse. Participants were young people with comorbid depression (Kessler Psychological Distress Scale score ≥ 17) and substance misuse (mainly alcohol and/or cannabis) seeking treatment at two youth AOD services in Melbourne, Australia. The study was conducted between September 2006 and September 2008. Sixty young people received CBT/MI in addition to standard care (SC) (the SC+CBT/MI group) and 28 received SC only (the SC group). Depressive symptoms and AOD use in the previous 30 days, measured at baseline and at 3-month and 6-month follow-up. Compared with participants in the SC group, those in the SC+CBT/MI group showed significant reductions in depression and cannabis use and increased social contact and motivation to change substance use at 3-month follow-up...

Journal of studies on alcohol and drugs, 2011

Inhalant use is a common form of drug misuse among young adolescents. However, very little is kno... more Inhalant use is a common form of drug misuse among young adolescents. However, very little is known about how chronic inhalant misuse affects cognition. Several studies have examined cognitive deficits among inhalant users, but no study has thoroughly addressed the confounding issues frequently associated with inhalant users (e.g., polysubstance use). The aim of the current study was to examine possible deficits in memory, learning, and executive components of memory (interference susceptibility) among young, regular inhalant users relative to a statistically equivalent drug-using control group (primarily cannabis users) and a community control group. Three groups of 21 young people (aged 13-24 years) were recruited: an inhalant- using group, a drug-using control group, and a community control group. The inhalant and drug-using controls were matched at the group level on demographic, clinical, and substance use measures. All three groups were statistically equivalent on age, sex, an...

International Journal of Language & Communication Disorders, 2015

Quality of life (QoL) is an important construct when assessing treatment outcomes. To examine the... more Quality of life (QoL) is an important construct when assessing treatment outcomes. To examine the relative contributions of functioning, psychological well-being and self-efficacy on self-perceived QoL with a sample of total laryngectomy patients in Australia who had surgery for advanced laryngeal cancer. In a cross-sectional study, 113 members of the Laryngectomy Associations of New South Wales and of Victoria, Australia, were recruited, and each was sent a series of questionnaires for postal return. Four psychometrically validated measures were used for participants to document their QoL, functioning (speech, swallowing), psychological well-being and general self-efficacy. Eighty-six (77%) questionnaires were returned and 83 were analysed. The cohort consists of 70 men and 13 women aged between 46 and 88 years. Overall, this sample of total laryngectomy survivors demonstrated significantly reduced physical health QoL (p < 0.001) and social relationship QoL (p = 0.011) and higher levels of depression (p = 0.008) and anxiety (p = 0.001) when compared with normative samples. This was in the context of them having higher than normal self-efficacy scores and, at worst, mild (self-rated) impairment of speech and of swallowing. Psychological well-being (sr(2) = 0.43, p < 0.001) had a stronger association than functioning (speech, swallowing, sr(2) = 0.08, p < 0.05) for their psychological QoL. Psychological well-being (sr(2) = 0.17, p < 0.001) and not functioning (sr(2) = 0.05, p > 0.05) were significantly associated with social relationship QoL. Self-efficacy scores were significantly higher than norms in this cohort, but were not associated with either their psychological QoL or social relationship QoL, after controlling for psychological well-being and functioning. For survivors of laryngeal cancer treated by total laryngectomy, it is important to be aware of the impact of psychological well-being (depression, anxiety, stress) on self-perceived QoL. In addition to rehabilitating function (speech, swallowing), specific interventions to assist these individuals better manage their psychological well-being will likely improve their perceived life satisfaction/QoL.

Revista Brasileira de Psiquiatria, 2014

European Psychiatry, 2015

Carers’ expressed emotion (EE) and patients’ cannabis misuse are two of the most robust predictor... more Carers’ expressed emotion (EE) and patients’ cannabis misuse are two of the most robust predictors of psychotic relapse. We aimed to examine the temporal relationship between EE and cannabis misuse. Sixty-three key carers of young people with first-episode psychosis (FEP) were assessed at baseline and 7-month follow-up. EE was measured in carers using the Family Questionnaire (FQ) and cannabis misuse in patients using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Correlational and hierarchical logistic regression analyses were conducted to examine the temporal relationship between EE components (i.e. criticism and emotional over involvement) and cannabis misuse. Carers’ criticism at baseline significantly predicted cannabis misuse according to the ASSIST at 7-month follow-up. The association remained significant after controlling for baseline symptom severity and social functioning (B = 0.15, P = .02). Conversely, baseline cannabis misuse was not associated...

Background: Alcohol is a major preventable cause of injury, disability and death in young people.... more Background: Alcohol is a major preventable cause of injury, disability and death in young people. Large numbers of young people with alcohol-related injuries and medical conditions present to hospital emergency departments (EDs). Access to brief, efficacious, accessible and cost effective treatment is an international health priority within this age group. While there is growing evidence for the efficacy of brief motivational interviewing (MI) for reducing alcohol use in young people, there is significant scope to increase its impact, and determine if it is the most efficacious and cost effective type of brief intervention available. The efficacy of personality-targeted interventions (PIs) for alcohol misuse delivered individually to young people is yet to be determined or compared to MI, despite growing evidence for school-based PIs. This study protocol describes a randomized controlled trial comparing the efficacy and cost-effectiveness of telephone-delivered MI, PI and an Assessment Feedback/Information (AF/I) only control for reducing alcohol use and related harm in young people. Methods/design: Participants will be 390 young people aged 16 to 25 years presenting to a crisis support service or ED with alcohol-related injuries and illnesses (including severe alcohol intoxication). This single blinded superiority trial randomized young people to (i) 2 sessions of MI; (ii) 2 sessions of a new PI or (iii) a 1 session AF/I only control. Participants are reassessed at 1, 3, 6 and 12 months on the primary outcomes of alcohol use and related problems and secondary outcomes of mental health symptoms, functioning, severity of problematic alcohol use, alcohol injuries, alcohol-related knowledge, coping self-efficacy to resist using alcohol, and cost effectiveness. Discussion: This study will identify the most efficacious and cost-effective telephone-delivered brief intervention for reducing alcohol misuse and related problems in young people presenting to crisis support services or EDs. We expect efficacy will be greatest for PI, followed by MI, and then AF/I at 1, 3, 6 and 12 months on the primary and secondary outcome variables. Telephone-delivered brief interventions could provide a youth-friendly, accessible, efficacious, cost-effective and easily disseminated treatment for addressing the significant public health issue of alcohol misuse and related harm in young people. Trial registration: This trial is registered with the Australian and New Zealand Clinical Trials Registry ACTRN12613000108718.

Schizophrenia Research, 2012

Background: Depressive symptoms in 'non-affective' first episode schizophrenia spectrum disorders... more Background: Depressive symptoms in 'non-affective' first episode schizophrenia spectrum disorders (FES) are common, but poorly understood, resulting in a range of conceptual and clinical management issues. This study had three aims: (i) to determine the prevalence of moderate to severe depressive symptoms (defined as a Clinical Global Impressions Scale-Bipolar Disorder (CGI-BP depression) score N3) in a large representative sample of FES patients; (ii) to compare the clinical and functional characteristics of FES patients with and without these depressive symptoms at service entry; and (iii) to compare the characteristics of FES patients with and without persistent depressive symptoms. Methods: Medical file audit methodology was employed to collect information on 405 patients with FES treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. Results: 26.2% (n = 106) of the patients had moderate to severe depression at service entry. At service entry and at discharge, those with depressive symptoms had greater insight into their illness but did not differ from those without depressive symptoms in terms of severity of overall psychopathology. Substance use was significantly less common in those with depressive symptoms at service entry and at discharge. Of those who were depressed at baseline, 14.2% (n = 15) continued to have moderate to severe depressive symptoms at discharge. Discussion: Depressive symptoms are common in patients with FES. Understanding the nature and characteristics of depression in FES has important clinical implications for both early intervention and treatment.

Schizophrenia Research, 2013

The results of a recent double-blind, randomized, placebo-controlled trial performed in 81 young ... more The results of a recent double-blind, randomized, placebo-controlled trial performed in 81 young patients at ultra-high risk for psychosis indicated that a 12-week intervention of 1.2g/day of ω-3 polyunsaturated fatty acids (PUFA) significantly reduced the risk of transition to psychosis and improved positive, negative and general symptoms as well as functioning. The aim of this post-hoc analysis was to determine at which time point ω-3 PUFAs start to significantly differ from placebo in improving psychopathology and functioning in young people at risk of developing psychosis. Analyses were performed using the mixed model repeated-measures analysis of variance. Compared to placebo, ω-3 PUFAs' significant effects on the amplitude of the reduction in General and Total PANSS scores are evident after the first four weeks of treatment; a reduction of positive symptoms and a lower mean PANSS positive score were apparent after eight weeks, whereas the significant drop in negative symptoms and the significant change and higher mean scores in global functioning occur later at 12weeks. The delay of onset of ω -3 PUFAs seems comparable to that of antipsychotics and antidepressants.

Schizophrenia Research, 2013

Aims: To examine whether baseline neurocognition and social cognition predict vocational outcomes... more Aims: To examine whether baseline neurocognition and social cognition predict vocational outcomes over 6 months in patients with first-episode psychosis (FEP) enrolled in a randomised controlled trial of Individual Placement and Support (IPS) versus treatment as usual (TAU). Methods: 135 FEP participants (IPS n = 69; TAU n = 66) completed a comprehensive neurocognitive and social cognitive battery. Principal axis factor analysis using PROMAX rotation was used to determine the underlying cognitive structure of the battery. Setwise (hierarchical) logistic and multivariate linear regressions were used to examine predictors of: (a) enrolment in education and employment; and (b) hours of employment over 6 months. Neurocognition and social cognition factors were entered into the models after accounting for premorbid IQ, baseline functioning and treatment group. Results: Six cognitive factors were extracted: (i) social cognition; (ii) information processing speed; (iii) verbal learning and memory; (iv) attention and working memory; (v) visual organisation and memory; and (vi) verbal comprehension. Enrolment in education over 6 months was predicted by enrolment in education at baseline (p = .002) and poorer visual organisation and memory (p = .024). Employment over 6 months was predicted by employment at baseline (p = .041) and receiving IPS (p = .020). Better visual organisation and memory predicted total hours of paid work over 6 months (p b .001). Conclusions: Visual organisation and memory predicted the enrolment in education and duration of employment, after accounting for premorbid IQ, baseline functioning and treatment. Social cognition did not contribute to the prediction of vocational outcomes. Neurocognitive interventions may enhance employment duration in FEP.

Schizophrenia Research, 2013

Psychotherapy and Psychosomatics, 2013