Neural correlates of executive function and working memory in the 'at risk mental state'

Background and Aims: People with ‘prodromal’ symptoms have a very high risk of developing psychosis. We used functional MRI to examine the neurocognitive basis of this vulnerability. Method: Cross-sectional comparison of subjects with an ARMS (n=17), first episode schizophreniform psychosis (n=10) and healthy volunteers (n=15). Subjects were studied using functional MRI while they performed an overt verbal fluency task, a random movement generation paradigm and an N-Back working memory task. Results: During an N-Back task the ARMS group engaged inferior frontal and posterior parietal cortex less than controls but more than the first episode group. During a motor generation task, the ARMS group showed less activation in the left inferior parietal cortex than controls, but greater activation than the first episode group. During verbal fluency using ‘Easy’ letters, the ARMS group demonstrated intermediate activation in the left inferior frontal cortex, with first episode groups showing least, and controls most, activation. When processing ‘Hard’ letters, differential activation was evident in two left inferior frontal regions. In its dorsolateral portion, the ARMS group showed less activation than controls but more than the first episode group, while in the opercular part of the left inferior frontal gyrus / anterior insula activation was greatest in the first episode group, weakest in controls and intermediate in the ARMS group. Conclusions: The ARMS is associated with abnormalities of regional brain function that are qualitatively similar to those in patients who have just developed psychosis but less severe

Do they practice what we teach? Follow-up evaluation of a Schema Therapy training programme

This study evaluated a three-day Schema Therapy training programme for trainee clinical psychologists. The training used an experiential model of learning, which was intended to encourage the transfer of knowledge and techniques from the learning environment into clinical practice. Using a mixed-methods approach, the training programme was evaluated in terms of: (1) self-reported changes in knowledge, confidence and willingness to use Schema Therapy-informed techniques; (2) whether the training was integrated into clinical practice; and (3) the perceived barriers/facilitators to achieving practice integration. Participants – 17 of the 19 trainee clinical psychologists enrolled on the Schema Therapy training programme – completed assessments immediately pre- and post-training. Participants were subsequently followed-up for reassessment three months after the training. Group- and individual-level analyses showed that most participants reported training-related gains in knowledge and confidence; these were largely sustained at follow-up, and were associated with post-training practice integration of Schema Therapy concepts and techniques. Analysis of qualitative data identified factors moderating use of training in practice. Findings of the study have implications for future delivery and evaluation of training in cognitive-behavioural therapies

Enabling occupational therapy students to take a fresh approach to psychosis

This practice evaluation describes the implementation of a 2-day workshop on psychosis with third-year undergraduate occupational therapy students at Brunel University. The work was undertaken by the teaching team at Brunel University, a clinical psychologist working in assertive outreach and an occupational therapist working in community mental health. The background to the project and the way in which the 2-day workshop was adapted to accommodate the university timetable are outlined. An evaluation of the workshop, its place in the occupational therapy programme and the feedback from students are presented

Anxiety disorders in children and adolescents

Anxiety disorders are among the most common psychiatric disorders in children and adolescents. They commonly interfere with peer relationships, schooling and family life, and persist into adulthood if left untreated. This paper gives an overview of the identification, assessment and treatment of anxiety disorders in children and young people. Identification of anxiety disorders is often poor and many young people with anxiety disorders go untreated. We present a brief review of the evidence base for pharmacological and psychological treatment approaches to the management of anxiety disorders in youth. Both have been found to be effective in the treatment of anxiety disorders, although psychological treatments such as Cognitive Behavioural Therapy (CBT) are considered the first-line treatment due to relative benefits in terms of patient safety and parental preference. Low intensity CBT approaches such as bibliotherapy and online therapies are effective and have the potential to improve access to evidence-based interventions. CBT approaches have also been found to be effective with particular patient groups, such as those with long-term physical health conditions and autism spectrum disorders, who are at an increased risk of anxiety disorders

A comparison of the development of audiovisual integration in children with autism spectrum disorders and typically developing children

This study aimed to investigate the development of audiovisual integration in children with Autism Spectrum Disorder (ASD). Audiovisual integration was measured using the McGurk effect in children with ASD aged 7–16 years and typically developing children (control group) matched approximately for age, sex, nonverbal ability and verbal ability. Results showed that the children with ASD were delayed in visual accuracy and audiovisual integration compared to the control group. However, in the audiovisual integration measure, children with ASD appeared to ‘catch-up’ with their typically developing peers at the older age ranges. The suggestion that children with ASD show a deficit in audiovisual integration which diminishes with age has clinical implications for those assessing and treating these children

Assessment and management of over-activity and sleep disorder in mucopolysaccharidoses

There is a growing awareness, based on both research and clinical studies, that abnormal sleep and circadian functioning are associated with the various forms of mucopolysaccharidoses (MPS), with sleep respiratory problems seemingly common in many forms of MPS. In the case of MPS III, there is evidence of syndrome-specific sleep disturbance related to an abnormal and possibly unique circadian rhythm. The presence of such patterns of sleep and activity has detrimental consequences for both the person with MPS and also invariably for her/his family and carers. On the basis of current evidence, routine assessment of sleep functioning is clearly warranted for all children with MPS III together with appropriate medical and behavioral interventions as required