Biomedical subjects

J Addington

Publications and source records attributed to J Addington.

At least 19 recordsLinked to original sources

PubMed2005

Patterns of premorbid functioning in first episode psychosis: relationship to 2-year outcome.

OBJECTIVE: To determine how different patterns of premorbid functioning relate to outcome longitudinally. METHOD: Premorbid adjustment was assessed in 194 first-episode of psychosis subjects. Positive and negative symptoms, depression, substance misuse and social and cognitive functioning were assessed over 2 years. RESULTS: Four patterns of premorbid adjustment: stable-good, stable-intermediate, poor-deteriorating and deteriorating were identified. Relative to the stable-good group, the deteriorating and poor-deteriorating groups had significantly more positive symptoms at 1-year follow-up but not at 2-year follow-up and significantly more negative symptoms and significantly poorer social functioning at both 1 and 2-years. Only verbal fluency and memory differentiated between the groups with the stable-good group having a superior performance. CONCLUSION: Those who demonstrated poor or deteriorating functioning prior to the onset of acute psychosis have a poorer outcome up to at least 2 years in terms of negative symptoms and social functioning.

Adolescent↗

PubMed2004

Factorial structure of the Scale of Prodromal Symptoms.

Data from the Scale of Prodromal Symptoms (SOPS) [Early Intervention in Psychotic Disorders, pp. 135-150] on 94 hitherto never-psychotic individuals were entered into a principal components analysis, revealing six components with an eigenvalue greater than 1.0. Based upon scree-plot analysis, further extractions were limited to three, then two, factors. Varimax rotation of the three-component extraction revealed factors with reasonable congruence with a priori content areas. All symptoms labeled as negative in the SOPS loaded on one factor, and four of five symptoms labeled as positive loaded on another. The remaining positive symptom, conceptual disorganization, has been found not to load with other positive-labeled symptoms in studies of schizophrenia using applicable instruments. All symptoms labeled as "general" in the SOPS loaded on a third factor, which appears to reflect the nonspecific psychological distress that might be expected in psychosis-naïve individuals experiencing the preliminary stages of a serious psychiatric disorder. The independence of this component from the positive and negative symptom factors suggests that the structure obtained suggests a clinical continuity between the at-risk presentations seen in this sample and established schizophrenia.

Adolescent↗

PubMed2004

Neuropsychological status of subjects at high risk for a first episode of psychosis.

Thirty-six subjects aged 16 years or older judged at risk for a first episode of psychosis within a North American multi-site study of the schizophrenia prodrome [McGlashan et al., Schizophr. Res. (2003); Miller et al., Schizophr. Res. (2003)] performed at levels intermediate to population norms and data reported for schizophrenia samples on a comprehensive neuropsychological exam. In the context of normal intelligence, this intermediate status suggests that, as a group, these subjects are not fully normal in neuropsychological functioning. Conversely, the finding that they do not show the levels of impairment commonly observed in schizophrenia, including within the first episode, suggests that prodromal interventions might conceivably prevent, delay, or lessen the severity of declines associated with first psychotic episodes.

Adolescent↗

PubMed2004

Duration of untreated psychosis: impact on 2-year outcome.

BACKGROUND: The duration of untreated psychosis has been postulated to be a predictor of clinical outcome in schizophrenia. Although several prospective studies support the relationship, some studies do not. These differences may be due to a number of methodological issues. The objectives of this study are: (i) to address many of the methodological limitations of earlier studies such as variations in sample size and selection, type of treatment provided, differences in measurement of DUP and outcome, and length of follow-up; and (ii) to examine the relationship between DUP and outcome in a prospective longitudinal study. METHOD: The DUP of 200 consecutive admissions to a first-episode programme was determined. The sample was followed over 2 years and pre-morbid functioning, symptoms, social and cognitive functioning and substance use were assessed longitudinally. RESULTS: Two years after admission to the programme, longer DUP was significantly associated with high levels of positive symptoms and poor social functioning. Independently of other variables, DUP predicted positive symptoms and social functioning at 1 and 2 years. CONCLUSIONS: There is evidence that long DUP continues to have an influence on outcome up to 2 years. These results support ongoing efforts for early detection and intervention.

Cognition Disorders↗

PubMed2004

Suicidal behaviour in early psychosis.

OBJECTIVE: This was to determine the prevalence of suicidal behaviours prior to and during the first year of treatment in a comprehensive early psychosis program (EPP) and to identify predictors of suicidal behaviour. METHOD: In a cohort study of 238 subjects, patients were assessed at initial presentation to an EPP and 1 year later. Measures included a range of demographic variables, suicide attempts, depression, positive and negative symptoms, social functioning and substance misuse. RESULTS: Although 15.1% attempted suicide prior to program entry, only 2.9% made an attempt in the year after program entry and 0.4% completed suicide. No further attempts were seen in those with previous parasuicide. These rates are lower than other published rates for first-episode patients. CONCLUSION: It is possible that specifically designed first-episode programs can reduce the suicidal behaviour in this high-risk population. The low prevalence of attempted suicide makes modeling predictors difficult.

Analysis of Variance↗

PubMed2003

The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. I. Study rationale and design.

Adolescent↗

PubMed2003

The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. II. Baseline characteristics of the "prodromal" sample.

The first double-blind placebo-controlled clinical trial of an atypical neuroleptic medication is being conducted in symptomatic treatment-seeking patients meeting new diagnostic criteria for a putative prodromal syndrome. This identifies them as being at high risk for developing psychosis in the near future. The study aims include prevention of psychosis onset and disability, as well as palliation of ongoing symptomatology. The purpose of this report is to describe the study's "prodromally symptomatic" sample at baseline, i.e., at intake immediately prior to randomization and prior to receiving study medication. Sixty treatment-seeking patients meeting prodromal inclusion criteria were recruited across four sites: New Haven, CT (n=39), Toronto, Ontario (n=9), Calgary, Alberta (n=6), and Chapel Hill, NC (n=6). The sample was young (median age 16), largely male (65%), and came from families with high titers of serious mental illness (44%). Most patients (93%) met criteria for the Attenuated Positive Symptom (APS) prodromal syndrome and presented with significant but nonpsychotic suspiciousness, perceptual aberrations, unusual thought content, and conceptual disorganization. They presented with minimal to mild affective symptoms and substance use/abuse, but they were quite functionally compromised (mean Global Assessment of Functioning (GAF) score=42). The prodromal sample was compared with other clinical-trial samples of adolescent depression, adolescent mania, and first episode schizophrenia. Prodromal patients proved not to be depressed or manic. They were less severely ill than untreated first episode schizophrenia but more severely ill than treated first episode schizophrenia. While not psychotically disabled, these patients nevertheless present with a clinical syndrome. Subsequent reports will detail the effects of drug versus placebo on prodromal symptoms, neuropsychological profile, and the rate of conversion to psychosis.

Adolescent↗

PubMed2003

Social outcome in early psychosis.

BACKGROUND: It has been demonstrated that patients experiencing their first-episode of psychosis have social functioning deficits that are equivalent to those seen in patients with a more chronic course of illness. The purpose of this study is to examine social functioning over the course of the first year after admission to an early psychosis programme. METHOD: The social functioning of 177 first-episode subjects was assessed on admission and 1 year later and compared with that of 40 non-psychiatric controls. Assessment measures included the Quality of Life Scale (QLS). RESULTS: At the 1-year follow-up there was significant improvement in quality of life. However, even those first-episode patients experiencing a remission from positive symptoms had lower QLS scores than the non-psychiatric controls. CONCLUSIONS: These results are encouraging and supportive of early intervention. There is room for more improvement in the application and development of psychological interventions for these young patients.

Adult↗

PubMed2003

The first episode of psychosis: the experience of relatives.

OBJECTIVE: The aim was to determine the extent of and the correlates of the distress and impact of care families of patients with first episode psychosis were experiencing when they first came for treatment. METHOD: Subjects were 238 individuals who had presented with a first episode of psychosis and their family members. Family members were assessed with the Psychological General Well-Being Scale, and the Experience of Caregiving Inventory. Patient data included assessment of positive and negative symptoms, depression, quality of life, and substance use. RESULTS: Family members of these first-episode patients were experiencing distress and difficulties. It was the family's appraisal of the impact of the illness that was associated with their psychological well-being. CONCLUSION: As the majority of these first episode families are keen to be involved early and have engaged in an intervention programme, the next step should be an evaluation of their involvement to determine if it is effective.

Adult↗

PubMed2002

Pathways to care: help seeking behaviour in first episode psychosis.

OBJECTIVE: To determine the number of attempts it took before patients with a first episode of psychosis received adequate help, the signs or symptoms that led them to seek help and the people from whom they attempted to seek help. METHOD: Subjects were 86 individuals with a schizophrenia spectrum disorder, mainly schizophrenia, who were attending a comprehensive program for early psychosis treatment. RESULTS: Help-seeking attempts began in the prodromal phase of the illness and continued into the psychotic phase. Concerning behaviours ranged from more general symptoms to psychotic symptoms. A range of contacts were made early on but emergency services were most often the contact that helped individuals obtain appropriate treatment for psychosis. CONCLUSION: Improved public education and gatekeeper education might reduce the time required for individuals developing a psychosis to receive timely and adequate care.

Adolescent↗

PubMed2002

Medication adherence of individuals with a first episode of psychosis.

OBJECTIVE: To determine rates of adherence to antipsychotic medication in first episode patients and the correlates of adherence in this group. METHOD: Subjects were the first 200 admissions to an Early Psychosis Program. Adherence was determined on a three-point scale. Symptoms, medication side-effects, quality of life, substance use and family involvement were examined longitudinally. RESULTS: In their first year in the program 39% were non-adherent, 20% inadequately adherent, and 41% adherent. Non-adherent patients demonstrated more positive symptoms, more relapses, more alcohol and cannabis use, reduced insight, and poorer quality of life. They were younger, had an earlier age of onset and less likely to have a family member involved in treatment. CONCLUSION: Results for this group are similar to those reported in the literature. Correlates are often the consequence of non-adherence. Non-compliance has to be anticipated and relationships maintained with patients and families to intervene as soon as possible to minimize the consequence of non-compliance.

Adult↗

PubMed2001

Neurocognitive and social functioning in schizophrenia and other diagnoses.

Explore the source record for details and available documents.

Adult↗

PubMed2001

The psychological well-being of family members of individuals with schizophrenia.

BACKGROUND: The purpose of the study was to attempt to understand the experience of family members of individuals with schizophrenia. More specifically, we wanted to determine whether a measure of caregiving would be a stronger predictor of the psychological well-being of families who have a member with schizophrenia than a measure of burden. METHOD: Forty-one family members of 30 individuals with schizophrenia were recruited. A measure of burden, a measure of the experience of caregiving, and the duration of the illness were used to determine the best predictor of psychological wellbeing. RESULTS: Regression analyses indicated that the strongest predictor of psychological well-being was the negative scale of the Experience of Caregiving Inventory (ECI). There was also a significant relationship between poor psychological well-being and short duration of illness. CONCLUSIONS: The findings of the study indicated that family members are significantly distressed as a result of having a family member with schizophrenia. There is support for using newer scales, like the ECI. Furthermore, increased family support is required in the early stages of the illness.

Adult↗

PubMed2001

Impact of an early psychosis program on substance use.

Approximately 37% of admissions to a recently developed program for first episode patients met criteria for substance abuse or dependence as well as criteria for one of the schizophrenia spectrum disorders. In this program the issue of substance use is addressed at the initial assessment and throughout the program. Several intervention strategies are integrated within the range of available psychosocial treatments. Additionally, we offer a specifically designed treatment strategy. This paper describes our 2-year experience with an integrated approach to reduce substance use in a specialized treatment program for individuals experiencing a first episode of psychosis.

Adolescent↗

PubMed2001

Social functioning in first- and multiepisode schizophrenia.

OBJECTIVE: To compare the social functioning of individuals experiencing their first episodes of schizophrenia with those who have experienced multiple episodes and with nonpsychiatrically ill control subjects. METHOD: Subjects included 40 patients with first-episode (FE) schizophrenia, 40 patients with multiepisode (ME) schizophrenia, and a control group of 40 nonpsychiatrically ill individuals. Three social-functioning measures were used: the Social Functioning Scale (SFS), the Quality of Life Scale (QOL), and the Assessment of Interpersonal Problem-Solving Skills (AIPSS). RESULTS: Control subjects significantly outperformed FE and ME participants on all social-functioning measures. FE and ME samples did not differ in their performance on the SFS and the AIPSS. On the QLS, ME participants outperformed FE participants. CONCLUSIONS: This study demonstrated that deficits in social functioning are present near the onset of schizophrenia.

Adult↗

PubMed2000

Neurocognitive and social functioning in schizophrenia: a 2.5 year follow-up study.

In our previous study we demonstrated that, in 80 schizophrenia subjects, verbal ability, verbal memory and executive functioning were significantly associated with social problem solving. The objective of this present study was to assess the longitudinal stability of the relationship between social and neurocognitive functioning in schizophrenia. This 2.5 year longitudinal cohort study re-assessed community functioning, social problem solving and symptoms in 65 of the 80 original subjects to determine the predictive ability of neurocognitive functioning. Neurocognition was not re-assessed at this follow-up. Positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale. Social functioning was assessed using the Social Functioning Scale, the Quality of Life Scale, and the Assessment of Interpersonal Problem-Solving Skills (AIPSS). Verbal ability, verbal memory and vigilance were significant predictors of social problem solving as assessed by the AIPSS. Results suggest that the association between neurocognition and social functioning remains consistent over time.

Adult↗

PubMed1999

Using measures of readiness to change in individuals with schizophrenia.

The literature suggests that substance abuse treatment for schizophrenia patients should consider both the patients' readiness for active treatment and matching phases of intervention with phases of the patient's acceptance of his or her dual problems. This study assessed the suitability of existing measures of "readiness to change" for use with individuals with schizophrenia. Outpatients (n = 39) with a diagnosis of schizophrenia and alcohol and/or drug dependency or abuse were given three measures to assess the stage of readiness to change. Results suggested that there was no agreement between stages defined by the interviewer and stages defined by self-report. This has implications for assessing readiness to change in terms of substance use in a population with schizophrenia.

Alcoholism↗

PubMed1999

Neurocognitive and social functioning in schizophrenia.

This cross-sectional study examined the relationships between neurocognitive and social functioning in a sample of 80 outpatients with DSM-III-R schizophrenia. The neurocognitive battery included measures of verbal ability, verbal memory, visual memory, executive functioning, visual-spatial organization, vigilance, and early information processing. Positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale. A range of social behaviors were assessed using the Social Functioning Scale (SFS), the Quality of Life Scale (QLS), and a video-based test, the Assessment of Interpersonal Problem-Solving Skills (AIPSS). Social functioning as assessed by the SFS was unrelated to neurocognitive functioning. Poor cognitive flexibility was associated with low scores on the QLS and the AIPSS. Verbal ability and verbal memory were also significantly associated with the AIPSS. Visual-spatial ability and vigilance were associated with the sending skills subscale of the AIPSS. In this study, which used a wide range of neurocognitive tests and measures of community functioning and social problem solving, results support earlier research that suggests an association between certain aspects of neurocognitive functioning and social functioning.

Adult↗