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Background: The incidence of psychotic disorders is higher in ethnic minorities groups. The 'ethnic density effect', in which living in a neighbourhood with a low own-group proportion increases the risk of psychosis, is one explanatory factor. The density effect in the ethno-religious and sectarian context of Northern Ireland has been found to be reversed, particularly for Catholics, in which there is harmful effect of high own-group density areas. This is partly explained by high urbanicity, deprivation and unemployment, but is otherwise not well understood. Aims: This study aimed to examine the density effect at the level of symptomology (positive and negative psychosis symptoms and depressive symptoms) in a representative sample of people with a first episode of psychosis in Northern Ireland. Method: Data linkage methodology was used drawing on data from the Northern Ireland First Episode Psychosis Study (NIFEPS) and the 2001 Census of Northern Ireland. Results: In total, 223 people between the ages of 18 to 64 were included in the study. A significant density effect was found for Catholics for total psychosis scores, but not for positive, negative and depressive symptoms, nor for general psychopathology, after adjusting for individual and area characteristics. The model accounted for just over 12% of the variance. No effect was found for Protestants. Conclusion: The findings suggest that the density effect for Catholics is unrelated to the core features of psychosis (hallucinations, delusions and anhedonia) but rather to broader cognitive and emotional disturbances and area deprivation. Explanations of exposure to social adversity and inequality are proposed, with implications for public mental health and social policy. [ABSTRACT FROM AUTHOR]

Background: Concerns have repeatedly been expressed about the quality of physical healthcare that people with psychosis receive.Aims: To examine whether the introduction of a financial incentive for secondary care services led to improvements in the quality of physical healthcare for people with psychosis.Method: Longitudinal data were collected over an 8-year period on the quality of physical healthcare that people with psychosis received from 56 trusts in England before and after the introduction of the financial incentive. Control data were also collected from six health boards in Wales where a financial incentive was not introduced. We calculated the proportion of patients whose clinical records indicated that they had been screened for seven key aspects of physical health and whether they were offered interventions for problems identified during screening.Results: Data from 17 947 people collected prior to (2011 and 2013) and following (2017) the introduction of the financial incentive in 2014 showed that the proportion of patients who received high-quality physical healthcare in England rose from 12.85% to 31.65% (difference 18.80, 95% CI 17.37-20.21). The proportion of patients who received high-quality physical healthcare in Wales during this period rose from 8.40% to 13.96% (difference 5.56, 95% CI 1.33-10.10).Conclusions: The results of this study suggest that financial incentives for secondary care mental health services are associated with marked improvements in the quality of care that patients receive. Further research is needed to examine their impact on aspects of care that are not incentivised. [ABSTRACT FROM AUTHOR]

Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users' negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance ('pre-diabetes'), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these. [ABSTRACT FROM AUTHOR]

There is an overlap between the neurocognitive deficits observed in adult survivors of childhood trauma and individuals with psychosis. Few studies examine the relationship between trauma and neurocognition in psychosis. The purpose of this study was to examine this in a first episode population. Thirty individuals with first episode psychosis who had completed a battery of neurocognitive testing in the longitudinal Northern Ireland First Episode Psychosis Study were subsequently interviewed and separated into two groups on the basis of childhood trauma. Between groups analysis was used to compare differences on measures of memory, executive functioning and verbal fluency. Twenty-one (70%) participants reported childhood trauma and nine (30%) reported no such history. Participants with a history of childhood trauma had a significantly higher pre-morbid IQ than the no childhood trauma group and experienced a significant decline in IQ when pre-morbid IQ estimates were compared to current IQ estimates. After controlling for pre-morbid IQ on all domains, the childhood trauma group had significantly poorer performance on tasks of semantic fluency, delayed visual recall, and visuospatial working memory. Childhood trauma may contribute to specific neurocognitive deficits and may predict a lower level of functioning relative to pre-morbid ability. [ABSTRACT FROM PUBLISHER]

Background: Substance misuse is a common comorbid problem in people presenting with first-episode psychosis and is associated with a poor short-term outcome.Aims: The aim of this study is to examine differences in baseline characteristics and 1-year outcome between individuals with first-episode psychosis who have never misused substances, those who stop misusing substances after initial presentation and those who persistently misuse substances over the 1-year assessment period.Method: Patients were recruited to the Northern Ireland First Episode Psychosis Study (n = 272). Clinical assessments were performed at baseline and at 1 year (n = 194) and data were collected from the case notes.Results: Individuals with persistent substance misuse had more severe depression, more positive symptoms, poorer functional outcome and greater rates of relapse at 1 year than those who stopped and those who had never misused substances. There were no differences in outcome between people who had never misused substances and those who stopped misusing after presentation.Conclusions: These results support assertive intervention targeted at comorbid substance misuse in individuals with first-episode psychosis. [ABSTRACT FROM AUTHOR]

Background: Researching psychotic disorders in unison rather than as separate diagnostic groups is widely advocated, but the viability of such an approach requires careful consideration from a neurocognitive perspective.Aims: To describe cognition in people with bipolar disorder and schizophrenia and to examine how known causes of variability in individual's performance contribute to any observed diagnostic differences.Method: Neurocognitive functioning in people with bipolar disorder (n = 32), schizophrenia (n = 46) and healthy controls (n = 67) was compared using analysis of covariance on data from the Northern Ireland First Episode Psychosis Study.Results: The bipolar disorder and schizophrenia groups were most impaired on tests of memory, executive functioning and language. The bipolar group performed significantly better on tests of response inhibition, verbal fluency and callosal functioning. Between-group differences could be explained by the greater proclivity of individuals with schizophrenia to experience global cognitive impairment and negative symptoms.Conclusions: Particular impairments are common to people with psychosis and may prove useful as endophenotypic markers. Considering the degree of individuals' global cognitive impairment is critical when attempting to understand patterns of selective impairment both within and between these diagnostic groups. [ABSTRACT FROM AUTHOR]

Tryptophan depletion is used to reduce central serotonergic function and to investigate its role in psychiatric illness. Despite widespread clinical use, its effects on serotonin (5-HT) receptors have not been well characterized. The aim of this study was to examine the effect of acute (ATD) and chronic tryptophan depletion (CTD) on free-plasma tryptophan (TRP), central TRP and 5-HT and brain 5-HT1A and 5-HT2A receptor binding in the rat. TRP and 5-HT were measured by high-performance liquid chromatography and receptor levels determined by homogenate radioligand binding and in-vitro receptor autoradiography. Free-plasma TRP, central TRP and central 5-HT levels were significantly and similarly reduced by ATD and 1- and 3-week CTD compared to controls. ATD significantly reduced 5-HT1A binding in the dorsal raphe (14%) but did not significantly alter postsynaptic 5-HT1A binding (frontal cortex, remaining cortex and hippocampus) or 5-HT2A binding (cortex and striatum). One-week CTD did not significantly alter cortical 5-HT2A binding or postsynaptic 5-HT1A binding. Furthermore, 3-week CTD did not significantly alter 5-HT1A binding but significantly increased cortical 5-HT2A binding without affecting striatal or hippocampal levels. In the CTD 1 and 3-week groups, rat body weight was significantly decreased as compared to controls. However, weight loss was not a confounding factor for decreased cortical 5-HT2A-receptor binding. ATD-induced reduction in somatodendritic 5-HT1A autoreceptor binding may represent an intrinsic ‘homeostatic response’ reducing serotonergic feedback in dorsal raphe projection areas. In contrast, the increase in 5-HT2A receptor after CTD may be a compensatory response to a long-term reduction in 5-HT. [ABSTRACT FROM AUTHOR]

Noradrenergic function has been shown to be disrupted in depressive illness. The plasma noradrenaline response to a cognitive stressor (the Stroop test) was used to investigate noradenergic activity in subtypes of depressive illness. A Stroop test was carried out, under standardised conditions, on patients with melancholic or psychotic depression, non-melancholic depression, general anxiety disorder and normal controls. Blood samples were taken during testing for measurement of plasma noradrenaline. Although there was a trend for the plasma noradrenergic response to be reduced in the melancholic/psychotic depressed patients compared to all other groups, this did not reach statistical significance. No other inter-group comparisons were statistically significant. The plasma noradrenaline response to a cognitive stressor does not discriminate subtypes of depressive illness from normal controls. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article focuses on the role of infection in mental disorders. Early studies have been conducted including that in 1974 which first reported increased prevalence and titers of herpes simplex virus in psychotic depression. It is also likely that cases of schizophrenia have a viral etiology. It was suggested that suppression of the immune response rather than enhancement occurs both in physiological states and in psychiatric disease. It was also believed that under conditions of stress or depression, there is an increased vulnerability to infection, tumor growth and autoimmunity.

The incidence of schizophrenia among psychiatric and general trained nurses was investigated for the period 1955-1979 in Northern Ireland. No difference was found. These results do not support the hypothesis of schizophrenia as a horizontally transmitted infectious disease. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about a link between cerebral ventricular size and the development of facial dyskinesia in the May 1991 issue.

Abstract: Schizophrenia (SCZ) and bipolar disorder (BP) are associated with neuropathological brain changes, which are believed to disrupt connectivity between brain processes and may have common properties. Patients at first psychotic episode are unique, as one can assess brain alterations at illness inception, when many confounders are reduced or absent. SCZ (N =25) and BP (N =24) patients were recruited in a regional first episode psychosis MRI study. VBM methods were used to study gray matter (GM) and white matter (WM) differences between patient groups and case by case matched controls. For both groups, deficits identified are more discrete than those typically reported in later stages of illness. SCZ patients showed some evidence of GM loss in cortical areas but most notable were in limbic structures such as hippocampus, thalamus and striatum and cerebellum. Consistent with disturbed neural connectivity WM alterations were also observed in limbic structures, the corpus callosum and many subgyral and sublobar regions in the parietal, temporal and frontal lobes. BP patients displayed less evidence of volume changes overall, compared to normal healthy participants, but those changes observed were primarily in WM areas which overlapped with regions identified in SCZ, including thalamus and cerebellum and subgyral and sublobar sites. At first episode of psychosis there is evidence of a neuroanatomical overlap between SCZ and BP with respect to brain structural changes, consistent with disturbed neural connectivity. There are also important differences however in that SCZ displays more extensive structural alteration. [Copyright &y& Elsevier]