Social Interaction in Autism Spectrum Presentation: The Development of the Social Situation Stories Questionnaire (SSSQ)

Autism spectrum presentations are considered ‘lifelong developmental disabilities’ affecting the way individuals communicate and relate to others, thus significantly impacting on social interaction resulting in various social disadvantages. To date, the key psychological theory accepted, as an explanation for difficulties observed in autism presentations is the lack of ‘Theory of Mind’ (ToM), which is considered a facet of social cognition required in understanding how to interact socially with others, through the ability to recognise others as alike but also independent. Despite its popularity there are several limitations of this proposed theory. Furthermore many individuals with autism presentations can pass ToM tests at an older age or in adulthood. This has resulted in more sophisticated ToM tests being developed. This study aims to develop a more sensitive ToM test, which aims to operationalise a more subtle aspect of ToM that adults with autism presentations may have difficulty understanding. The concept of social overtures which are often present in normative social interaction is used in the current study to develop items to discriminate between individuals with and without autism presentations in a questionnaire format. This new test called the Social Situation Stories Questionnaire (SSSQ) was administered to 12 adults with autism presentation and 16 adults without this diagnosis in a matched cohort study. The SSSQ is a two part instrument consisting of general ToM skills and more subtle ToM skills (social overture detection). Findings show no difference between the two groups on the general part of the SSSQ, however individuals with autism presentations were less able to detect the social overtures, thus scoring less well on the more stringent ToM component of the SSSQ. This novel social cognition test will be used to further understand social interaction differences between adults with and without autism presentation. Taking a critical realistic epistemological approach differences observed are critically discussed

The association between subjective memory complaint and objective cognitive function in older people with previous major depression

The goal of this study is to investigate associations between subjective memory complaint and objective cognitive performance in older people with previous major depression-a high-risk sample for cognitive impairment and later dementia. A cross-sectional study was carried out in people aged 60 or over with previous major depression but not fulfilling current major depression criteria according to DSM-IV-TR. People with dementia or Mini-Mental State Examination score less than 17 were excluded. Subjective memory complaint was defined on the basis of a score ≧4 on the subscale of Geriatric Mental State schedule, a maximum score of 8. Older people aged equal or over 60 without any psychiatric diagnosis were enrolled as healthy controls. Cognitive function was evaluated using a series of cognitive tests assessing verbal memory, attention/speed, visuospatial function, verbal fluency, and cognitive flexibility in all participants. One hundred and thirteen older people with previous major depression and forty-six healthy controls were enrolled. Subjective memory complaint was present in more than half of the participants with depression history (55.8%). Among those with major depression history, subjective memory complaint was associated with lower total immediate recall and delayed verbal recall scores after adjustment. The associations between subjective memory complaint and worse memory performance were stronger in participants with lower depressive symptoms (Hamilton Depression Rating Scale score<7). The results suggest subjective memory complaint may be a valid appraisal of memory performance in older people with previous major depression and consideration should be given to more proactive assessment and follow-up in these clinical samples

Functional Status and All-Cause Mortality in Serious Mental Illness

Serious mental illness can affect many aspects of an individual's ability to function in daily life. The aim of this investigation was to determine if the environmental and functional status of people with serious mental illness contribute to the high mortality risk observed in this patient group.We identified cases of schizophrenia, schizoaffective and bipolar disorder aged ≥ 15 years in a large secondary mental healthcare case register linked to national mortality tracing. We modelled the effect of activities of daily living (ADLs), living conditions, occupational and recreational activities and relationship factors (Health of the Nation Outcome Scale [HoNOS] subscales) on all-cause mortality over a 4-year observation period (2007-10) using Cox regression.We identified 6,880 SMI cases (242 deaths) in the observation period. ADL impairment was associated with an increased risk of all-cause mortality (adjusted HR 1.9; 95% CI 1.3-2.8; p = 0.001, p for trend across ADL categories = 0.001) after controlling for a broad range of covariates (including demographic factors, physical health, mental health symptoms and behaviours, socio-economic status and mental health service contact). No associations were found for the other three exposures. Stratification by age indicated that ADLs were most strongly associated with mortality in the youngest (15 to <35 years) and oldest (≥ 55 years) groups.Functional impairment in people with serious mental illness diagnoses is a marker of increased mortality risk, possibly in younger age groups as a marker of negative symptomatology

The effect of using high facilitation when implementing the Gold Standards Framework in Care Homes programme:A cluster randomised controlled trial

Background: The provision of quality end-of-life care is increasingly on the national agenda in many countries. In the United Kingdom, the Gold Standards Framework for Care Homes programme has been promoted as a national framework for improving end-of-life care. While its implementation is recommended, there are no national guidelines for facilitators to follow to undertake this role. Aim: It was hypothesised that action learning alongside high facilitation when implementing the Gold Standards Framework for Care Homes programme will result in a reduced proportion of hospital deaths for residents and improvement in the care home staff ability to facilitate good end-of-life care. Design: A cluster randomised controlled trial where 24 nursing homes received high facilitation to enable them to implement the Gold Standards Framework for Care Homes programme. The managers of 12 nursing homes additionally took part in action learning sets. A third group (14 nursing homes) received the ‘standard’ Gold Standards Framework for Care Homes facilitation available in their locality. Setting/participants: In total, 38 nursing homes providing care for frail older people, their deceased residents and their nurse managers. Results: A greater proportion of residents died in those nursing homes receiving high facilitation and action learning but not significantly so. There was a significant association between the level of facilitation and nursing homes completing the Gold Standards Framework for Care Homes programme through to accreditation. Year-on-year change occurred across all outcome measures. Conclusion: There is a danger that without national guidelines, facilitation of the Gold Standards Framework for Care Homes programme will vary and consequently so will its implementation. The nurse manager of a care home must be actively engaged when implementing the Gold Standards Framework for Care Homes programme. </jats:sec