Nordic OCD & Related Disorders Consortium: Rationale,design, and methods

Obsessive‐compulsive disorder (OCD) is a debilitating psychiatric disorder, yet its etiology is unknown and treatment outcomes could be improved if biological targets could be identified. Unfortunately, genetic findings for OCD are lagging behind other psychiatric disorders. Thus, there is a pressing need to understand the causal mechanisms implicated in OCD in order to improve clinical outcomes and to reduce morbidity and societal costs. Specifically, there is a need for a large‐scale, etiologically informative genetic study integrating genetic and environmental factors that presumably interact to cause the condition. The Nordic countries provide fertile ground for such a study, given their detailed population registers, national healthcare systems and active specialist clinics for OCD. We thus formed the Nordic OCD and Related Disorders Consortium (NORDiC, www.crowleylab.org/nordic ), and with the support of NIMH and the Swedish Research Council, have begun to collect a large, richly phenotyped and genotyped sample of OCD cases. Our specific aims are geared toward answering a number of key questions regarding the biology, etiology, and treatment of OCD. This article describes and discusses the rationale, design, and methodology of NORDiC, including details on clinical measures and planned genomic analyses.     

Acoustic radiation produced by B-71, B-72, and KH 70 bone vibrators

The amount of acoustic radiation produced by two samples of a Radioear B-71, B-72, and Pracitronic KH 70 bone vibrator was determined for 30 normal-hearing subjects at 4000 Hz. The mean amount of acoustic radiation was very similar for both samples of each vibrator type but significantly (p less than 0.05) different between the bone vibrator types. The mean amount of acoustic radiation averaged over both samples was 8.3 dB for the B-72, 4.3 dB for the B-71, and -0.3 dB for the KH 70. Individual subject data indicated that the B-72 produced excessive acoustic radiation (greater than 5 dB) for 80% of the subjects, the B-71 for 38% of the subjects, and the KH 70 for 8% of the subjects which could cause an invalid high-frequency air-bone gap. Precautions should be taken during bone conduction audiometry to eliminate the possibility of acoustic radiation produced by bone vibrators. A need for additional standards in this area is stressed.     

Assessment of premorbid function in first-episode schizophrenia: modifications to the Premorbid Adjustment Scale

Studies have found Cannon-Spoor's Premorbid Adjustment Scale (PAS) to be a useful measure of premorbid function and an effective predictor of outcome in patients with chronic schizophrenia. Despite its widespread use, the applicability and reliability of the scale for use with young patients who experience their first episode of schizophrenia have not been thoroughly examined. We review the studies that used the PAS to assess premorbid function in patients with either chronic or first-episode schizophrenia. Difficulties that have been encountered with the use of the PAS in first-episode patients are presented, and modifications that have been made to the scale by various research groups are described. Finally, we make recommendations to enhance the use of the PAS when evaluating patients who have experienced their first episode of schizophrenia.     

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.     

The course of cognitive functioning in first episode psychosis: changes over time and impact on outcome

This three year longitudinal study examined the cognitive performance of 247 individuals who recently presented with a first episode of psychosis. Using a comprehensive battery of cognitive tests, we assessed cognition at baseline, 1 year and 2-year follow-ups. Assessments also included positive and negative symptoms, depression, social outcome and substance use. There were several significant improvements in cognition over the two-year period which were usually matched by improvements in a matched non-psychiatric control group. Regression analyses demonstrated that after controlling for symptoms cognitive impairment accounted for 4-6% of the variance in social functioning. Our results suggest that impaired cognition exists in the very early stages of a psychotic illness and that there is no decline over time. Secondly, our results suggest that, although related, poor social functioning deficits may be independent of cognitive impairment. Finally there are implications for improved methodology in the assessment of both cognitive and social functioning.