Outreach and support in South-London (OASIS) 2001-2020:Twenty years of early detection, prognosis and preventive care for young people at risk of psychosis

This study aims to describe twenty years of early detection, prognosis and preventive care in the Outreach and Support In South-London (OASIS) mental health service for individuals at Clinical High risk of psychosis (CHR-P). The study presents a comprehensive analysis of the 2001– 2020 activity of the OASIS team encompassing core domains: (i) service characteristics, (ii) detection, (iii) prognosis, (iv) treatment and (v) clinical research. The analyses employed descriptive statistics, population-level data, the epidemiological incidence of psychosis, Kaplan Meier failure functions and Greenwood 95% CIs and Electronic Health Records. OASIS is part of the South London and Maudsley (SLaM) NHS trust, the largest European mental health provider, serving a total urban population of 1,358,646 individuals (population aged 16-35: 454,525). Incidence of psychosis in OASIS's catchment area ranges from 58.3 to 71.9 cases per 100,000 person-years, and it is higher than the national average of 41.5 cases per 100,000 person-year. OASIS is a standalone, NHS-funded, multidisciplinary (team leader, consultant and junior psychiatrists, clinical psychologists, mental health professionals), transitional (for those aged 14-35 years) community mental health service with a yearly caseload of 140 CHR-P individuals. OASIS regularly delivers a comprehensive service promotion outreach to several local community organisations. Referrals to OASIS (2366) are made by numerous agencies; about one-third of the referrals eventually met CHR-P criteria. Overall, 600 CHR-P individuals (55.33% males, mean age 22.63 years, white ethnicity 46.44%) have been under the care of the OASIS service: 80.43% met attenuated psychotic symptoms, 18.06% brief and limited intermittent psychotic symptoms and 1.51% genetic risk and deterioration CHR-P criteria. All CHR-P individuals were offered cognitive behavioural therapy and psychosocial support; medications were used depending on individual needs. The cumulative risk of psychosis at ten years was 0.365 (95%CI 0.302-0.437). At six years follow-up, across two-third of individuals non-transitioning to psychosis, 79.24% still displayed some mental health problem, and only 20.75% achieved a complete clinical remission. Research conducted at OASIS encompassed clinical, prognostic, neurobiological and interventional studies and leveraged local, national and international infrastructures; over the past ten years, OASIS-related research attracted about £ 50 million of grant income, with 5,922 citations in the international databases. Future developments may include broadening OASIS to prevent other serious mental disorders beyond psychosis and fostering translational risk prediction and interventional research. With a twenty-years activity, OASIS’ cutting-edge quality of preventive care, combined with translational research innovations, consolidated the service as a leading reference model for evidence-based prevention of psychosis worldwide

Oil Shocks and Equity Returns: An Empirical Analysis of the US Transportation Sector

The main purpose of this paper is to investigate the relation between oil price movements and stock returns in US transportation companies. We estimate oil price risk exposures of the US oil transport sector at the firm level as well as at the industry level over November 1999 to February 2008 period using the Fama–French–Carhart's (1997) four-factor asset pricing model augmented with oil price and interest rate factors. Overall, the results of our study suggest that oil price exposures of firms in the US transportation sector vary across firms and over time. The varying effects of oil shocks on stock returns may be attributed to several factors such as differences among firms' cost structure, financial policies, diversification activities, and hedging strategies.Oil shocks, stock returns, transportation industry

Oil shocks and stock returns: The case of the Central and Eastern European (CEE) oil and gas sectors

We analyze the relation between oil prices and the stock returns of oil and gas firms in Central and Eastern European (CEE) countries. The overall results indicate no significant association between oil prices and the stock returns over 1998-2010 period. In contrast, the sub-period analysis reveals that oil price exposures of some oil and gas companies do vary across firms and over time. These results are likely to be attributed to the systematic risk factors including global risk arising from the global financial crisis as well as local risk factors at the country, industry, and firm level.Oil price shocks Stock returns Central and Eastern Europe (CEE) Oil and gas sectors

Oil price movements and stock market returns: Evidence from Gulf Cooperation Council (GCC) countries

A number of recent studies have found a link between oil price changes and stock prices. However, these studies mostly concentrate on developed economies and analyze the impact of oil price shocks on stock returns at the aggregate stock market level. We assess the relation between changes in crude oil prices and equity returns in Gulf Cooperation Council (GCC) countries using country-level as well as industry-level stock return data. Our findings show that at the country level, except for Kuwait, stock markets have significant positive exposures to oil price shocks. At the industry level, the responses of industry-specific returns to oil shocks are significantly positive for only 12 out of 20 industries. Our study also provides evidence that oil price changes have asymmetric effects on stock market returns at the country level as well as at the industry level.Oil shocks Stock returns GCC countries

Balancing ACT: evaluating the effectiveness of psychoeducation and Acceptance and Commitment Therapy (ACT) groups for people with bipolar disorder: study protocol for pilot randomised controlled trial

Abstract Background Bipolar disorder is a chronic and disabling psychiatric condition, characterised by recurrent episodes of mania, hypomania and depression. It places a heavy burden on sufferers and families, with high societal and healthcare costs. Many service users with a diagnosis of bipolar disorder also experience prominent psychotic symptoms, with differential diagnoses of schizoaffective disorder, and relapses characterised by repeated manic psychotic episodes and grandiosity. Such presentations require specific adaptations to standard bipolar disorder interventions in order to address their psychosis, alongside mood regulation, with a particular emphasis on impulsivity, irritability, disinhibition and elation. The Balancing ACT study aims to evaluate an innovative group intervention combining Acceptance and Commitment Therapy and psychoeducation approaches (ACT/PE) with individuals experiencing bipolar disorder and/or symptoms within community psychosis services. Methods The Balancing ACT study is a randomised controlled trial comparing Balancing ACT groups (ACT/PE) plus routine care to routine care alone. Balancing ACT (ACT/PE) comprises ten group sessions, each lasting 2 hours, delivered weekly. The primary outcome is psychological wellbeing; secondary outcomes are mental health relapses (measured by service use averages for the 12 months pre baseline and 3 months post baseline). We will also measure mood, distress, recovery and psychological change processes. Participants will be randomised in a 1:1 ratio, after baseline assessment. Outcomes will be assessed by trained assessors blind to treatment condition at 0, 10 and 14 weeks. Recruitment began in April 2017 and is on-going until the end of October 2017. Discussion The Balancing ACT study will contribute to the currently limited evidence base for psychological interventions for people experiencing bipolar disorder and/or symptoms in the context of community psychosis services. Trial registration ISRCTN73327972. Registered on 27 March 2017. Balancing ACT: evaluating the effectiveness of psychoeducation and Acceptance and Commitment Therapy (ACT) groups for people with bipolar disorder

Why we need to pursue both universal and targeted prevention to reduce the incidence of affective and psychotic disorders: systematic review and meta-analysis

: The effectiveness of universal preventive approaches in reducing the incidence of affective/psychotic disorders is unclear. We therefore aimed to synthesise the available evidence from randomised controlled trials. For studies reporting change in prevalence, we simulated all possible scenarios for the proportion of individuals with the disorder at baseline and at follow-up to exclude them. We then combined these data with studies directly measuring incidence and conducted random effects meta-analysis with relative risk (RR) to estimate the incidence in the intervention group compared to the control group. Eighteen studies (k=21 samples) were included investigating the universal prevention of depression in 66,625 individuals. No studies were available investigating universal prevention on the incidence of bipolar/psychotic disorders. 63% of simulated scenarios showed a significant preventive effect on reducing the incidence of depression (k=9-19, RR=0.75-0.94, 95%CIs=0.55-0.87,0.93-1.15, p=0.007-0.246) but did not survive sensitivity analyses. There is some limited evidence for the effectiveness of universal interventions for reducing the incidence of depression but not for bipolar/psychotic disorders

The Early Youth Engagement (EYE-2) intervention in first episode psychosis services: a pragmatic cluster RCT and cost-effectiveness evaluation

Background: Early Intervention in Psychosis (EIP) services improve outcomes for young people but approximately 30% disengage. Aims: We aimed to test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective. Methods: We conducted a multi-centre, single-blind, parallel-group, cluster randomized controlled trial, involving 20 EIP teams in 5 UK National Health Service sites. Teams were randomised using permuted blocks stratified by NHS Trust. Participants were all young people (14-35 years) presenting with a first episode of psychosis between May 2019 and July 2020 (N=1,027). We compared the novel Early Youth Engagement (EYE-2) intervention plus standardised EIP (sEIP) to sEIP alone. The primary outcome was time to disengagement over 12-26 months. Economic outcomes were mental health costs, societal costs, and socio-occupational outcomes over 12-months. Assessors were masked to treatment allocation for primary disengagement and cost-effectiveness outcomes. Analysis followed intention to treat principles. The trial was registered with ISRCTN 51629746. Results: Disengagement was low at 15.9% overall in standardised stand-alone services. The adjusted hazard ratio for EYE-2+sEIP (n=652) versus sEIP alone (n=375) was 1.07 (95% CI: 0.76-1.49; p=0.713). The health economic evaluation indicated lower mental health care costs linked to reductions in unplanned mental health care with no compromise to clinical outcomes, some evidence for lower societal costs and more days in education, training, employment, and stable accommodation in EYE-2. Conclusions: We found no evidence that EYE-2 increased time to disengagement, but some evidence for cost-effectiveness. This is the largest study to date reporting positive engagement, health and cost outcomes in a total EIP population sample. Limitations included high loss to follow-up for secondary outcomes, and low completion of societal and socio-occupational data. COVID-19 impacted fidelity and implementation. Future engagement research should target engagement to those with greatest need, including inpatients and those with socio-occupational goals