Neurocognition in the Extended Psychosis Phenotype: Performance of a Community Sample of Adolescents With Psychotic Symptoms on the MATRICS Neurocognitive Battery

Neurocognitive dysfunction is well established in psychosis, but recent work suggests that processing speed deficits might represent a particularly important cognitive deficit. A number of significant confounds, however, such as disease chronicity and antipsychotic medication use, have been shown to affect processing speed, causing debate as to the core cognitive features of psychosis. We adopted a novel strategy of testing neurocognitive performance in the “extended psychosis phenotype,” involving community-based adolescents who are not clinically psychotic but who report psychotic symptoms and who are at increased risk of psychosis in adulthood. This allows investigation of the earliest cognitive factors associated with psychosis risk, while excluding potential confounds such as disease chronicity and antipsychotic use. A population sample of 212 school-going adolescents aged 11–13 years took part in this study. Psychotic symptoms were assessed using the psychosis section of the Schedule for Affective Disorders and Schizophrenia. Neurocognition was assessed using the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus neurocognitive battery. Adolescents with psychotic symptoms performed significantly more poorly on 3 processing speed tasks: Trail Making Test-A (F = 3.3, P < .05), Trail Making Test-B (F = 3.1, P < .05), and digit symbol coding task (F = 7.0, P < .001)—as well as on a nonverbal working memory (spatial span) task (F = 3.2, P < .05). Our findings support the idea that neurocognitive impairment, and processing speed impairment in particular, is a core feature of psychosis risk. This group likely demonstrates some of the earliest cognitive impairments associated with psychosis vulnerability.Key words: epidemiology/adolescents/cognitionKey words: epidemiology, adolescents, cognition     

Using the Implicit Relational Assessment Procedure to Compare Implicit Pro-Thin/Anti-Fat Attitudes of Patients With Anorexia Nervosa and Non-Clinical Controls

Implicit pro-thin/anti-fat attitudes were investigated among a mixed group of patients with full and sub-threshold Anorexia Nervosa (n = 17), and a matched-age control group (n = 17). The Implicit Relational Assessment Procedure (IRAP) was employed to measure implicit pro-thin and anti-fat attitudes towards Self and Others in addition to “striving for thinness” and “avoidance of fatness.” The clinical group showed an implicit pro-fat attitude towards Others and stronger anti-fat attitudes towards Self and avoidance of fatness compared with controls. The findings are discussed in relation to the over-evaluation of weight and shape in the clinical group.     

Implicit attitudes towards children with autism versus normally developing children as predictors of professional burnout and psychopathology

Tutors trained in applied behaviour analysis (n = 16) and mainstream school teachers (n = 16) were exposed to an Implicit Relational Assessment Procedure (IRAP) designed to assess implicit attitudes towards individuals with autism versus normally developing individuals. Participants also completed a range of explicit measures, including measures of professional burnout and psychopathology. All participants produced more negative biases towards children with autism compared to children who were normally developing. Increased negativity towards autism on the IRAP predicted similar attitudes on some of the explicit measures and also correlated with increased levels of self-reported psychopathology and professional burnout for the tutors working with children with autism. Results suggest that implicit measures of attitudes may provide a marker for professional burnout.     

Primary care utilisation rates in pre-school children

A key objective of the Lifeways cross generation cohort study is to examine health and healthcare, according to socio-economic indicators, during the first five years of life. GP contact details were available for 1032 children. 772 GPs in 589 practices were approached and data were obtained on 640 children (59% of original cohort). The mean follow-up time was 3.0 years (95% CI 2.5-3.5). 20.5% of children had a medical card. The mean GP consultation rate was 5.5 visits per child per year, 6.6 visits for children with a medical card and 5.1 for those without (95% CI 1.1 to 1.9) p = 0.001. 68 had a diagnosis of asthma; 19.10% with a medical card and 8.9% without (95% CI 3.0-17.5) p = 0.0001. 138 children had ever been admitted to hospital; 26.2% with a medical card and 21.0% without (95% CI -3.3% to 13.6%) p = 0.2. Incremental increases in parental income significantly decreased both the risk of asthma (p = 0.02) or hospital admission (p = 0.008).     

Contraceptive patterns across the lifecourse in the SLAN populations

Little information is available on contraceptive practices of the Irish population. This study analyses data from the Surveys of Lifestyle, Attitudes and Nutrition (SLAN) 1998 and 2002, which sampled representative cross-sections of the Irish adult population. Both surveys reported 70.7% of respondents as sexually active. Marital status and age influence sexual activity and show no change over time. A small increase in the percentage using contraception was noted. At least 12% of sexually active single people report never using contraception. Condoms were the preferred contraceptive method for males, 66.2% and females, 34.1%. 88.6% of the sexually active report they belong to a religion (93.9% Catholic). There is no relationship between religiosity and sexual activity, or religiosity and use of contraception. We conclude that contraceptive practices have remained stable over time with religious affiliation having no effect.     

Assessing the use of the Family Affluence Scale (FAS) among Irish schoolchildren

The objective of this analysis was to examine the answering rates, internal reliability and external validity of the Family Affluence Scale (FAS) employing data from the 2002 Irish Health Behaviour in School-aged Children study HBSC; a cross-sectional survey of 8,424 Irish schoolchildren aged 10-18. Father's occupation was reported by 80.6% of the schoolchildren and 60.6% reported on mother's occupation, while over 96% reported on the FAS items. Lower answering rates on parental occupation were found among younger schoolchildren and among those with poorer material circumstances. Analysis of the FAS revealed a moderate internal reliability and FAS scores were significantly associated with reported parental occupation. The traditional SES measures suffer from poor answering rates that pose a serious methodological threat. The FAS has moderate internal reliability and does not capture the SES status in full, but it has high completion rates, and can be used as an additional measure of SES in late childhood and adolescence.     

Adolescents attending an adult emergency department: their utilisation characteristics and self-reported opinions of care provided

We aimed to examine the case mix of adolescents presenting to an adult Emergency Department (ED) and to survey a representative sample regarding their perceived care. Of the 323 visits reviewed, 215 (66.6%) were males. Presentations increased at the weekend (151/323, 46.7%). Most visits were non-urgent, 34 (10.5%) were admitted. Acute injuries accounted for 156/215 (72.6%) of male presentations. 12/17 (70.5%) of those with a psychosocial presenting problem registered between 9 p.m. and 9 a.m. 33 adolescents presented during the prospective study period. 6 were excluded, 3 were lost to follow-up. 10/24 (41.7%) described the time they were waiting to be seen by a doctor as unacceptable, 9 (37.5%) wanted more privacy and 11 (45.9%) reported a delay in receiving treatment. Adolescents represent a minority in the ED, but have specific needs. We recommend the availability of age specific health promotion information and training of staff in adolescent healthcare issues.