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      Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis

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          Abstract

          Background

          There are insufficient data from nationwide surveys on the prevalence of specific psychotic disorders and associated co-morbidities.

          Method

          The 2010 Australian national psychosis survey used a two-phase design to draw a representative sample of adults aged 18–64 years with psychotic disorders in contact with public treatment services from an estimated resident population of 1 464 923 adults. This paper is based on data from 1642 participants with an International Classification of Diseases (ICD)-10 psychotic disorder. Its aim is to present estimates of treated prevalence and lifetime morbid risk of psychosis, and to describe the cognitive, physical health and substance use profiles of participants.

          Results

          The 1-month treated prevalence of psychotic disorders was 3.10 cases per 1000 population aged 18–64 years, not accounting for people solely accessing primary care services; lifetime morbid risk was 3.45 per 1000. Mean premorbid intelligence quotient was approximately 0.5 s .d.s below the population mean; current cognitive ability (measured with a digit symbol coding task) was 1.6 s .d.s below the population mean. For both cognitive tests, higher scores were significantly associated with better independent functioning. The prevalence of the metabolic syndrome was high, affecting 60.8% of participants, and pervasive across diagnostic groups. Of the participants, two-thirds (65.9%) were current smokers, 47.4% were obese and 32.4% were sedentary. Of the participants, half (49.8%) had a lifetime history of alcohol abuse/dependence and 50.8% lifetime cannabis abuse/dependence.

          Conclusions

          Our findings highlight the need for comprehensive, integrative models of recovery to maximize the potential for good health and quality of life for people with psychotic illness.

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          Most cited references33

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          A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes.

          Cognitive remediation therapy for schizophrenia was developed to treat cognitive problems that affect functioning, but the treatment effects may depend on the type of trial methodology adopted. The present meta-analysis will determine the effects of treatment and whether study method or potential moderators influence the estimates. Electronic databases were searched up to June 2009 using variants of the key words "cognitive," "training," "remediation," "clinical trial," and "schizophrenia." Key researchers were contacted to ensure that all studies meeting the criteria were included. This produced 109 reports of 40 studies in which ≥70% of participants had a diagnosis of schizophrenia, all of whom received standard care. There was a comparison group and allocation procedure in these studies. Data were available to calculate effect sizes on cognition and/or functioning. Data were independently extracted by two reviewers with excellent reliability. Methodological moderators were extracted through the Clinical Trials Assessment Measure and verified by authors in 94% of cases. The meta-analysis (2,104 participants) yielded durable effects on global cognition and functioning. The symptom effect was small and disappeared at follow-up assessment. No treatment element (remediation approach, duration, computer use, etc.) was associated with cognitive outcome. Cognitive remediation therapy was more effective when patients were clinically stable. Significantly stronger effects on functioning were found when cognitive remediation therapy was provided together with other psychiatric rehabilitation, and a much larger effect was present when a strategic approach was adopted together with adjunctive rehabilitation. Despite variability in methodological rigor, this did not moderate any of the therapy effects, and even in the most rigorous studies there were similar small-to-moderate effects. Cognitive remediation benefits people with schizophrenia, and when combined with psychiatric rehabilitation, this benefit generalizes to functioning, relative to rehabilitation alone. These benefits cannot be attributed to poor study methods.
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            SCAN. Schedules for Clinical Assessment in Neuropsychiatry.

            After more than 12 years of development, the ninth edition of the Present State Examination (PSE-9) was published, together with associated instruments and computer algorithm, in 1974. The system has now been expanded, in the framework of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration Joint Project on Standardization of Diagnosis and Classification, and is being tested with the aim of developing a comprehensive procedure for clinical examination that is also capable of generating many of the categories of the International Classification of Diseases, 10th edition, and the Diagnostic and Statistical Manual of Mental Disorders, revised third edition. The new system is known as SCAN (Schedules for Clinical Assessment in Neuropsychiatry). It includes the 10th edition of the PSE as one of its core schedules, preliminary tests of which have suggested that reliability is similar to that of PSE-9. SCAN is being field tested in 20 centers in 11 countries. A final version is expected to be available in January 1990.
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              Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"?

              There has been a surge of interest in the functional consequences of neurocognitive deficits in schizophrenia. The published literature in this area has doubled in the last few years. In this paper, we will attempt to confirm the conclusions from a previous review that certain neurocognitive domains (secondary verbal memory, immediate memory, executive functioning as measured by card sorting, and vigilance) are associated with functional outcome. In addition to surveying the number of replicated findings and tallying box scores of results, we will approach the review of the studies in a more thorough and empirical manner by applying a meta-analysis. Lastly, we will discuss what we see as a key limitation of this literature, specifically, the relatively narrow selection of predictor measures. This limitation has constrained identification of mediating variables that may explain the mechanisms for these relationships.
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                Author and article information

                Journal
                Psychol Med
                Psychol Med
                PSM
                Psychological Medicine
                Cambridge University Press (Cambridge, UK )
                0033-2917
                1469-8978
                July 2014
                02 January 2014
                : 44
                : 10
                : 2163-2176
                Affiliations
                [1 ]Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia , Crawley, WA, Australia
                [2 ]Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia , Crawley, WA, Australia
                [3 ]Queensland Brain Institute, The University of Queensland , Brisbane, QLD, Australia
                [4 ]Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
                [5 ]School of Psychology, The University of Western Australia , Crawley, Western Australia
                [6 ]Clinical Research Centre, North Metropolitan Health Service-Mental Health, Mount Claremont, WA, Australia
                [7 ]School of Population Health, The University of Queensland , Ipswich, QLD, Australia
                [8 ]School of Psychiatry, The University of New South Wales , Sydney, NSW, Australia
                [9 ]Schizophrenia Research Institute , Sydney, NSW, Australia
                [10 ]Department of Psychiatry, The University of Melbourne , Melbourne, VIC, Australia
                [11 ]St Vincent's Hospital , Melbourne, VIC, Australia
                [12 ]Hunter New England Mental Health, Newcastle, NSW, Australia
                [13 ]School of Medicine and Public Health, The University of Newcastle , Newcastle, NSW, Australia
                [14 ]School of Medicine, University of Adelaide , Adelaide, SA, Australia
                [15 ]Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
                [16 ]Northern Sector, Adelaide Metro Mental Health Directorate, Adelaide, SA, Australia
                [17 ]Psychosocial Research Centre, North West Area Mental Health Services, Coburg, VIC, Australia
                [18 ]SANE Australia, Melbourne, VIC, Australia
                [19 ]Orygen Youth Health Research Centre, Melbourne, VIC, Australia
                [20 ]Centre for Youth Mental Health, The University of Melbourne , Melbourne, VIC, Australia
                [21 ]Menzies Research Institute Tasmania, University of Tasmania , Hobart, Australia
                [22 ]Australian Government Department of Health and Ageing, Canberra, ACT, Australia
                [23 ]Centre for Rural and Remote Mental Health, University of Newcastle , Newcastle, NSW, Australia
                [24 ]School of Medicine, Pharmacy and Health, Durham University , Durham, UK
                Author notes
                [* ]Address for correspondence: V. A. Morgan, Ph.D., Neuropsychiatric Epidemiology Research Unit M571, School of Psychiatry and Clinical Neurosciences, The University of Western Australia , 35 Stirling Highway, Crawley 6009, WA, Australia. (Email: vera.morgan@ 123456uwa.edu.au )
                Article
                S0033291713002973 00297
                10.1017/S0033291713002973
                4045165
                24365456
                0b4f2f8e-1685-4004-a56c-e7972987e03a
                © Cambridge University Press 2014

                The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence http://creativecommons.org/licenses/by/3.0/

                History
                : 21 August 2013
                : 05 November 2013
                : 09 November 2013
                Page count
                Tables: 4, References: 72, Pages: 14
                Categories
                Original Articles

                Clinical Psychology & Psychiatry
                bipolar disorder,schizo-affective disorder,schizophrenia,speed of information processing,substance abuse

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