A randomized controlled trial of a caregiver-facilitated problem-solving-based self-learning program for family carers of people with early psychosis

Facilitated self-help and problem-solving strategies can empower and support family carers to cope with caregiving for people with severe mental illness. This single-blind multi-site randomized controlled trial examined the effects of a 5-month family-facilitated problem-solving based self-learning program (PBSP in addition to usual care), versus a family psycho-education group program and usual psychiatric care only in recent-onset psychosis, with a 6-month follow-up. In each of three study sites (integrated community centers for mental wellness), 114 people with early psychosis (≤5 years illness onset) and their family carers were randomly selected and allocated to one of three study groups (n=38). Caregiving burden (primary outcome) and patients’ and carers’ health conditions were assessed at recruitment, and 1-month and 6-month post-intervention. Overall, 106 (94.7%) participants completed the assigned intervention and ≥1 post-test. Generalized Estimating Equations and subsequent contrast tests indicated that the PBSP participants showed significant greater improvements in carers’ burden, caregiving experiences and problem-solving ability, and patients’ psychotic symptoms, recovery and duration of re-hospitalizations over the 6-month follow-up, compared with the other two groups (moderate to large effect size, η2= 0.12-0.24). Family-assisted problem-solving based self-learning program is found effective to improve both psychotic patients’ and their carers’ psychosocial health in over a medium term, thus reducing patients’ risk of relapse

Patterns in reduction or cessation of drinking in Australia (2001-2013) and motivation for change

Aims: This paper examines: 1) change over time (2001-2013) in recently reducing or ceasing drinking in the Australian population, and 2) the reasons given for reducing or ceasing drinking in the most recent survey (2013); stratified by sex and age group. Methods: Data are from five waves of the National Drug Strategy Household Survey (N=119,397). Logistic regression models with interaction terms were used to identify a shift in sex or age over time in predicting reduction or cessation of drinking, and to predict motivations for reducing or ceasing drinking by sex and age. Results: Reports of recently reducing the quantity or frequency of drinking increased from 2001 to 2007, and remained stable between 2007 and 2013. There was a steady increase in the number of Australians reporting recently ceasing drinking from 2001 to 2013, with a significant effect for age (younger groups more likely than older groups to cease drinking in the past two waves). Reasons for reducing or ceasing drinking varied by age, with older people more likely to report health reasons, and younger people more likely to report lifestyle reasons or enjoyment. Conclusion: Increases over time in reports of reduction or cessation of drinking due to health, lifestyle, social and enjoyment reasons, suggests that the social position of alcohol in Australia may be shifting, particularly among young people

Alteration to hippocampal shape in cannabis users with and without schizophrenia

Abnormalities in hippocampal morphology are characteristic of schizophrenia and have also been reported in chronic cannabis users. There is a paucity of research investigating potential additive effects of cannabis use on brain pathology associated with schizophrenia. In this study, we performed hippocampal shape analysis in cannabis-using and non-using patients with schizophrenia, healthy cannabis users and healthy non-using controls. Hippocampal shape changes were observed in each group relative to controls, with the greatest degree of alterations (i.e., deflations across the hippocampus, and with an anterior predisposition), in cannabis-using schizophrenia patients. These alterations were associated with cannabis use patterns and psychotic symptoms

Declining drinking among adolescents: are we seeing a denormalisation of drinking and a normalisation of non-drinking?

Background In the early 2000s, alcohol use among young people began to decline in many western countries, especially among adolescents (aged between 12-17 years old). These declines have continued steadily over the past two decades, against the backdrop of much smaller declines among the general population. Argument Hypotheses examining individual factors fail adequately to provide the necessary ‘big picture’ thinking needed to understand declines in adolescent drinking. We use the normalisation thesis to argue that there is strong international evidence for both processes of denormalisation of drinking and normalisation of non-drinking occurring for adolescents in many western countries. Conclusions Research on declining adolescent drinking provides evidence of both denormalisation of alcohol consumption and normalisation of non-drinking. This has implications for enabling policy environments more amenable to regulation and increasing the acceptability of non-drinking in social contexts. Normalisation theory (and its various interpretations) provides a useful multi-dimensional tool for understanding declines in adolescent drinking

Verbal learning and memory in adolescent cannabis and alcohol users

Abstract of a conference paper presented at the 2010 summer meeting of the British Association for Psychopharmacology

The impact of regular cannabis use on human brain structure

Abstract from the 25th ECNP Congress, Vienna, Austria, 13-17 October 201

Reflection impulsivity in adolescent cannabis users

Abstract of a conference paper presented at the 2010 summer meeting of the British Association for Psychopharmacology

Cognitive bias modification training during inpatient alcohol detoxification reduces early relapse: a randomized controlled trial

BACKGROUND: Relapse is common in alcohol-dependent individuals and can be triggered by alcohol-related cues in the environment. It has been suggested that these individuals develop cognitive biases, in which cues automatically capture attention and elicit an approach action tendency that promotes alcohol seeking. The study aim was to examine whether cognitive bias modification (CBM) training targeting approach bias could be delivered during residential alcohol detoxification and improve treatment outcomes. METHODS: Using a 2-group parallel-block (ratio 1:1) randomized controlled trial with allocation concealed to the outcome assessor, 83 alcohol-dependent inpatients received either 4 sessions of CBM training where participants were implicitly trained to make avoidance movements in response to pictures of alcoholic beverages and approach movements in response to pictures of nonalcoholic beverages, or 4 sessions of sham training (controls) delivered over 4 consecutive days during the 7-day detoxification program. The primary outcome measure was continuous abstinence at 2 weeks postdischarge. Secondary outcomes included time to relapse, frequency and quantity of alcohol consumption, and craving. Outcomes were assessed in a telephonic follow-up interview. RESULTS: Seventy-one (85%) participants were successfully followed up, of whom 61 completed all 4 training sessions. With an intention-to-treat approach, there was a trend for higher abstinence rates in the CBM group relative to controls (69 vs. 47%, p = 0.07); however, a per-protocol analysis revealed significantly higher abstinence rates among participants completing 4 sessions of CBM relative to controls (75 vs. 45%, p = 0.02). Craving score, time to relapse, mean drinking days, and mean standard drinks per drinking day did not differ significantly between the groups. CONCLUSIONS: This is the first trial demonstrating the feasibility of CBM delivered during alcohol detoxification and supports earlier research suggesting it may be a useful, low-cost adjunctive treatment to improve treatment outcomes for alcohol-dependent patients