Cannabis use is associated with increased psychotic symptoms and poorer psycho-social functioning in first-episode psychosis: A report from the UK National EDEN study

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Schizophrenia Bulletin following peer review. The version of record Seddon, J. L., et al. (2016). Cannabis Use Is Associated With Increased Psychotic Symptoms and Poorer Psychosocial Functioning in First-Episode Psychosis: A Report From the UK National EDEN Study. Schizophrenia Bulletin, 42(3), 619-625. https://doi.org/10.1093/schbul/sbv154 is available online at: https://academic.oup.com/schizophreniabulletin/article/42/3/619/2413898#39400533Background: The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode psychosis (FEP) and the link with symptomatic course and outcome over one year post psychosis onset. Method: 1027 FEP patients were recruited upon inception to specialised early intervention services for psychosis in the UK. Participants completed assessments at baseline, six and twelve months. Results: The results indicate that the use of cannabis was significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psycho-social functioning. Continued use of cannabis following the first episode of psychosis was prognostic of outcome at one year. These associations were significant after adjusting for age, gender, DUP, age of psychosis onset, ethnicity and other drug use. Conclusion: This is the largest cohort study of first-episode psychosis patients receiving care within early intervention services. Cannabis use, in particular continued use, is associated with poorer symptomatic and functional outcome during the first-episode of psychosis. The results highlight the need for effective and early intervention for cannabis use in FEP

The course of negative symptom in first episode psychosis and the relationship with social recovery.

AIMS: To investigate trajectories of negative symptoms during the first 12months of treatment for first episode psychosis (FEP), their predictors and relationship to social recovery. METHOD: 1006 participants were followed up for 12months following acceptance into Early Intervention in Psychosis services. Negative symptom trajectories were modelled using latent class growth analysis (LCGA) and predictors of trajectories examined using multinomial regression. Social recovery trajectories - also modelled using LCGA - of members of each negative symptom trajectory were ascertained and the relationship between negative symptom and social recovery trajectories examined. RESULTS: Four negative symptom trajectories were identified: Minimal Decreasing (63.9%), Mild Stable (13.5%), High Decreasing (17.1%) and High Stable (5.4%). Male gender and family history of non-affective psychosis predicted stably high negative symptoms. Poor premorbid adolescent adjustment, family history of non-affective psychosis and baseline depression predicted initially high but decreasing negative symptoms. Members of the Mild Stable, High Stable and High Decreasing classes were more likely to experience stably low functioning than the Minimal Decreasing class. CONCLUSIONS: Distinct negative symptom trajectories are evident in FEP. Only a small subgroup present with persistently high levels of negative symptoms. A substantial proportion of FEP patients with elevated negative symptoms at baseline will achieve remission of these symptoms within 12months. However, elevated negative symptoms at baseline, whether or not they remit, are associated with poor social recovery, suggesting targeted interventions for service users with elevated baseline negative symptoms may help improve functional outcomes.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.schres.2016.04.01

Developing observational methods to drive future hydrological science: can we make a start as a community?

Hydrology is still, and for good reasons, an inexact science, even if evolving hydrological understanding has provided a basis for improved water management for at least the last three millennia. The limitations of that understanding have, however, become much more apparent and important in the last century as the pressures of increasing populations, and the anthropogenic impacts on catchment forcing and responses, have intensified. At the same time, the sophistication of hydrological analyses and models has been developing rapidly, often driven more by the availability of computational power and geographical data sets than any real increases in understanding of hydrological processes. This sophistication has created an illusion of real progress but a case can be made that we are still rather muddling along, limited by the significant uncertainties in hydrological observations, knowledge of catchment characteristics and related gaps in conceptual understanding, particularly of the sub-surface. These knowledge gaps are illustrated by the fact that for many catchments we cannot close the water balance without significant uncertainty, uncertainty that is often neglected in evaluating models for practical applications

Structure and stability of symptoms in first episode psychosis: a longitudinal network approach.

Early psychosis is characterised by heterogeneity in illness trajectories, where outcomes remain poor for many. Understanding psychosis symptoms and their relation to illness outcomes, from a novel network perspective, may help to delineate psychopathology within early psychosis and identify pivotal targets for intervention. Using network modelling in first episode psychosis (FEP), this study aimed to identify: (a) key central and bridge symptoms most influential in symptom networks, and (b) examine the structure and stability of the networks at baseline and 12-month follow-up. Data on 1027 participants with FEP were taken from the National EDEN longitudinal study and used to create regularised partial correlation networks using the 'EBICglasso' algorithm for positive, negative, and depressive symptoms at baseline and at 12-months. Centrality and bridge estimations were computed using a permutation-based network comparison test. Depression featured as a central symptom in both the baseline and 12-month networks. Conceptual disorganisation, stereotyped thinking, along with hallucinations and suspiciousness featured as key bridge symptoms across the networks. The network comparison test revealed that the strength and bridge centralities did not differ significantly between the two networks (C = 0.096153; p = 0.22297). However, the network structure and connectedness differed significantly from baseline to follow-up (M = 0.16405, p = <0.0001; S = 0.74536, p = 0.02), with several associations between psychosis and depressive items differing significantly by 12 months. Depressive symptoms, in addition to symptoms of thought disturbance (e.g. conceptual disorganisation and stereotyped thinking), may be examples of important, under-recognized treatment targets in early psychosis, which may have the potential to lead to global symptom improvements and better recovery

Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial

SUMMARY Background: We conducted a randomised controlled trial to evaluate the efficacy of enhancing social recovery from First Episode Psychosis (FEP) by augmenting Early Intervention Service (EIS) provision with Social Recovery Therapy (SRT). The primary hypothesis was that SRT plus EIS would lead to improvements in social recovery. Methods: SUPEREDEN3 was an assessor blind randomised controlled trial. It was conducted at 4 specialist Early Intervention Services across the UK. Participants had (a) been clients of Early Intervention Services for 12-30 months; and (b) showed persistent and severe social disability defined as engaged in less than 30 hours per week of structured activity. Participants were randomised 1:1. Assessment of outcomes was conducted at baseline, 9 months (post intervention) and 15 month follow up. The primary outcome was time spent in structured activity at 9 months. The trial is registered (ISRCTN61621571). Findings: 75 (49%) of 154 participants were assigned to SRT plus EIS and 79 (51%) were assigned to EIS alone. At 9 months 143 participants (93%) provided data on the primary outcome. Randomisation to SRT plus EIS was associated with an increase in structured activity of 8.1 hours greater than EIS alone (95% CI 2.5 to 13.6; p = 0.0050). Jointly modelling loss to follow up and secondary outcomes provided supportive evidence of continued effects of SRT plus EIS. Interpretation: The findings show a clinically important benefit of enhanced social recovery for the SRT plus EIS group on the primary outcome of structured activity. Funding: National Institute for Health Research (NIHR)

Acoustic Doppler Current Profiler measurements near a weir with fish pass: assessing solutions to compass errors, spatial data referencing and spatial flow heterogeneity

There has been an increasing interest in the use of Acoustic Doppler Current Profilers (ADCPs) to characterise the hydraulic conditions near river engineering structures such as dams, fish passes and groins, as part of ecological and hydromorphological assessments. However, such ADCP applications can be limited by compass errors, obstructed view to navigation satellites, frequent loss of bottom tracking and spatially heterogeneous flow leading to erroneous water velocity measurements. This study addresses these limitations by (i) developing a heading sensor integration algorithm that corrects compass errors from magnetic interference, (ii) testing a Total Station based technique for spatial ADCP data referencing and (iii) evaluating a recently proposed data processing technique that reduces bias from spatial flow heterogeneity. The integration of these techniques on a radio control ADCP platform is illustrated downstream of a weir with fish pass on the River Severn, UK. The results show that each of the techniques can have a statistically significant effect on the estimated total water velocities and can strongly affect measures of vorticity. The obtained three-dimensional flow maps are suitable to describe the magnitude and orientation of the fish pass attraction flow in relation to competing flows and to highlight areas of increased vorticity