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This paper firstly aims to explore the prevalence of mental health problems in young offenders and secondly, to review the factors which mean a young offender is at risk of developing more serious and chronic mental health problems, including psychosis.The literature in this field will be reviewed, and the highlighted risk factors explored in detail.Reviewing the evidence base highlights the complex needs of this population, as the prevalence of mental health problems in both detained and community-based young offenders is high, with the presence of at least one mental health problem found in up to 92%. There is much data to suggest that young offenders have many of the risk indicators that would place them at risk of significant mental health problems according to previously identified criteria. Factors such as intellectual level, difficulties in school, substance abuse problems, exposure to trauma and problems understood within an attachment framework are explored.The main conclusion is that this population have many risk factors which increase the possibility of developing serious mental health problems, therefore highlighting the need for early intervention.

After 4 years of debate, a decision has been made. The attenuated psychosis syndrome (APS) will not be a coded diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Formerly known as the psychosis risk syndrome, the proposed diagnosis was based on criteria developed in the mid-1990s that were informed by a comprehensive review of retrospective studies on the prodromal phase of nonaffective psychosis.

All good quality trials of psychological interventions need to check formally that therapists have used the techniques prescribed in the published therapy manuals, and that the therapy has been carried out competently. This paper reviews methods of assessing adherence and competence used in recent large-scale trials of Cognitive Behaviour Therapy (CBT) for psychosis in the UK carried out by our research groups. A combination of the Cognitive Therapy Rating Scale and specific versions of the Cognitive Therapy for Psychosis Adherence Scales provides an optimal assessment of adherence and competence. Careful assessment of the competence and adherence can help identify the procedures actually carried out with individuals within trials. The basic use of such assessments is to provide an external check on treatment fidelity on a sample of sessions. Such assessment can also provide the first step towards moving research towards making sense of CBT for psychosis as a complex intervention and identifying which techniques work for which problems of people with psychosis, at which stages of disorder?

Much research has begun to focus on the identification of people who are at high risk of developing psychosis, and clinical services have been initiated for this population. However, only a small number of studies have reported on the efficacy of interventions for preventing or delaying the onset of psychosis. The results of prior work suggest that cognitive therapy (CT) may be an effective, well-tolerated treatment. We report on the rationale and design for a large-scale, multi-site randomized, controlled trial of CT for people who are assessed to be at high risk of psychosis because of either state or state-plus-trait risk factors.The study employs a single-blind design in which all participants receive frequent mental-state monitoring, which will efficiently detect transition to psychosis, and half are randomized to weekly sessions of CT for up to 6 months. Participants will be followed-up for a minimum of 12 months and to a maximum of 2 years.We report the characteristics of the final sample at baseline (n=288).Our study aimed to expand the currently limited evidence base for best practice in interventions for individuals at high risk of psychosis.

BackgroundAlthough antipsychotic medication is the first line of treatment for schizophrenia, many service users choose to refuse or discontinue their pharmacological treatment. Cognitive therapy (CT) has been shown to be effective when delivered in combination with antipsychotic medication, but has yet to be formally evaluated in its absence. This study evaluates CT for people with psychotic disorders who have not been taking antipsychotic medication for at least 6 months.MethodTwenty participants with schizophrenia spectrum disorders received CT in an open trial. Our primary outcome was psychiatric symptoms measured using the Positive and Negative Syndromes Scale (PANSS), which was administered at baseline, 9 months (end of treatment) and 15 months (follow-up). Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning.ResultsTtests and Wilcoxon's signed ranks tests revealed significant beneficial effects on all primary and secondary outcomes at end of treatment and follow-up, with the exception of self-rated recovery at end of treatment. Cohen'sdeffect sizes were moderate to large [for PANSS total,d=0.85, 95% confidence interval (CI) 0.32–1.35 at end of treatment;d=1.26, 95% CI 0.66–1.84 at follow-up]. A response rate analysis found that 35% and 50% of participants achieved at least a 50% reduction in PANSS total scores by end of therapy and follow-up respectively. No patients deteriorated significantly.ConclusionsThis study provides preliminary evidence that CT is an acceptable and effective treatment for people with psychosis who choose not to take antipsychotic medication. An adequately powered randomized controlled trial is warranted.

Centred around the Early Psychosis Declaration (EPD), this book explores the declaration's five themes through contributions from a sizeable number of mental health practitioners, service-users and carers. It is designed to help those working with people experiencing psychosis at an early stage of illness to develop and implement effective early intervention skills, enabling them to examine and refine their practice. Most importantly, the book is a practical guide to delivering early intervention strategies with a unique focus on recovery. Includes an abundance of case studies to link theory to practice. Evidence-based. Edited by an team with a wealth of clinical and research experience. Suitable for qualified practitioners from all disciplines working in the Early Intervention field, including mental health nurses, psychiatrists, social workers, occupational therapists, clinical psychologists and lecturer/practitioners.

BackgroundDecline in social functioning occurs in individuals who later develop psychosis.AimsTo investigate whether baseline differences in disability are present in those who do and those who do not make a transition to psychosis in a group clinically at high risk and whether disability is a risk factor for transition.MethodProspective multicentre, naturalistic field study with an 18-month follow-up period on 245 help-seeking individuals clinically at high risk. Disability was assessed with the Disability Assessment Schedule of the World Health Organization (WHODAS–II).ResultsAt baseline, the transition group displayed significantly greater difficulties in making new friends (z =−3.40, P = 0.001), maintaining a friendship (z =−3.00, P = 0.003), dealing with people they do not know (z =−2.28, P = 0.023) and joining community activities (z =−2.0, P = 0.05) compared with the non-transition group. In Cox regression, difficulties in getting along with people significantly contributed to the prediction of transition to psychosis in our sample (β = 0.569, s.e. = 0.184, Wald = 9.548, P = 0.002, hazard ratio (HR) = 1.767, 95% CI 1.238–2.550).ConclusionsCertain domains of social disability might contribute to the prediction of psychosis in a sample clinically at high risk.

BackgroundThere have been recent advances in the identification of people at high risk of psychosis and psychological treatments have shown promise for preventionAimsTo compare the longitudinal course of psychotic experiences and emotional dysfunction in high-risk participants receiving cognitive therapy with those receiving treatment as usualMethodData from a recent randomised controlled trial of cognitive therapy for people at risk of developing psychosis were utilised to examine three different statistical models that were based on 432 measurements of psychotic experiences and 421 of emotional dysfunction (anxiety–depression) contributed by 57 participants across the 13 measurement occasions (monthly monitoring for a year)ResultsPsychotic experiences and emotional dysfunction were correlated and decreased significantly over the course of the study, with most improvement in the early months. The reduction in positive symptoms, but not emotional dysfunction, was enhanced by allocation to cognitive therapyConclusionsPsychotic experiences and emotional dysfunction appear to interact in people at risk of developing psychosis. There appears to be a specific benefit of cognitive therapy

Fluorescence offers many opportunities for optical molecular imaging and can provide information beyond simply the localisation of fluorescent labels. At Imperial we are developing technology to analyse and image fluorescence radiation with respect to wavelength, polarisation and, particularly, fluorescence lifetime, in order to maximise the information content. This talk will review our recent progress applying fluorescence lifetime imaging (FLIM) and multidimensional fluorescence imaging (MDFI) to tissue imaging and in vitro cell microscopy. Applying FLIM to autofluorescence of biological tissue can provide label-free contrast for non-invasive diagnostic imaging, as we have demonstrated in various tissues including atherosclerotic plaques, cartilage, pancreas and cervical tissue. FLIM and MDFI are also applicable to image intracellular structure and function for cell biology and drug discovery: hyperspectral imaging and FLIM can provide (quantitative) information concerning the local fluorophore environment and facilitate robust fluorescence resonant energy transfer (FRET) experiments while information concerning structure and rotational mobility may be obtained by applying polarisation resolution. Our most recent work includes high-speed and optically-sectioned FLIM for automated imaging and live cell studies, hyperspectral FLIM for acquiring excitation-emission –lifetime matrices to distinguish different fluorophores and microenvironments and imaging of rotational correlation time, particularly applied to microfluidic devices. Excitation sources are a particular challenge for confocal microscopy and other FLIM modalities including endoscopy, owing to the complexity and limited spectral coverage of available technology. Increasingly we are exploiting ultrafast fibre lasers and continuously tunable ultrafast sources based on continuum generation in photonic crystal fibres for wide-field and confocal FLIM applications.

Background. There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis and provides the opportunity to investigate psychological mechanisms that may confer vulnerability to psychosis.Method. Fifty-eight patients at ultra-high risk of developing a first episode of psychosis were compared with 56 non-patients matched for age and occupational status on measures of meta-cognition, schizotypal traits, dysfunctional attitudes and distress.Results. Analyses of covariance revealed that people at high risk of developing psychosis scored higher on measures of cognitive vulnerability, including negative meta-cognitive beliefs, beliefs about rejection and criticism from others, and discrepancies in self-perception, schizotypal traits and general mental distress. Correlational analyses revealed that negative meta-cognitive beliefs, dysfunctional attitudes and beliefs about rejection and criticism from others were positively associated with several dimensions of symptomatology in at-risk mental states (ARMS) patients.Conclusions. Cognitive and personality factors appear to characterize people at high-risk of developing psychosis and are associated with their distressing experiences. The clinical implications of these findings are discussed.

The incidence of drug-induced pancreatitis is rare. There have been no prior definite cases reported of ibuprofen-induced pancreatitis.We present a case of a young man with acute pancreatitis probably secondary to an ibuprofen overdose. Immediately preceding the onset of the attack he took a 51 mg/kg dose of ibuprofen. He had other causes of acute pancreatitis excluded by clinical history, serum toxicology and abdominal imaging.In the absence of re-challenge we believe it is probable that ibuprofen has a causative link with acute pancreatitis.

BackgroundAdvances in the ability to identify people at high risk of developing psychosis have generated interest in the possibility of preventing psychosis.AimsTo evaluate the efficacy of cognitive therapy for the prevention of transition to psychosis.MethodA randomised controlled trial compared cognitive therapy with treatment as usual in 58 patients at ultra-high risk of developing a first episode of psychosis. Therapy was provided over 6 months, and all patients were monitored on a monthly basis for 12 months.ResultsLogistic regression demonstrated that cognitive therapy significantly reduced the likelihood of making progression to psychosis as defined on the Positive and Negative Syndrome Scale over 12 months. In addition, it significantly reduced the likelihood of being prescribed antipsychotic medication and of meeting criteria for a DSM – IV diagnosis of a psychotic disorder. Analysis of covariance showed that the intervention also significantly improved positive symptoms of psychosis in this population over the 12-month period.ConclusionsCognitive therapy appears to be an acceptable and efficacious intervention for people at high risk of developing psychosis.