Does case management improve outcomes for people with schizophrenia?

The Australian and New Zealand clinical practice guidelines recommend intensive case management for people with first-episode psychosis or an acute relapse of schizophrenia. Often initiated following discharge from hospital or transfer from community-based acute care, case management is a collaborative, community-based program designed to ensure people receive quality health care and integrated support services. Case management may provide substantial benefits for people suffering severe mental illnesses like schizophrenia, however, before case management services are made universally available, more work needs to be done to determine when, and for whom, these services are most effective

Are our policies and laws leading to treatment delays for people with schizophrenia?

Under Australian mental health laws, people with schizophrenia can only be involuntarily committed to a mental health facility if they are assessed and it is determined that their illness is making them dangerous to themselves or others. To determine whether they are to undergo involuntary treatment, mental health workers must assess people against an ‘Obligatory Dangerousness Criterion’. This criterion is an advance on methods used prior to the mid-1970s, when many countries authorised involuntary commitment to a mental health facility on medical certification alone, without court approval or any proof of an emergency situation. An Obligatory Dangerousness Criterion is now widely used in Australia, the USA, and some areas of Canada and Europe as the means by which patients are assessed for the appropriateness of involuntary (compulsory) treatment. There is no doubt the policy underpinning its use was well intentioned; an Obligatory Dangerousness Criterion was originally developed in an attempt to bett er balance the rights of the mentally ill with the need to protect the public. However, over time some experts have begun to raise questions about the utility of this criterion, suggesting that it sometimes means patients don’t get access to necessary treatment as quickly as they should

Multivariate neuroanatomical classification of cognitive subtypes in schizophrenia: A support vector machine learning approach

AbstractHeterogeneity in the structural brain abnormalities associated with schizophrenia has made identification of reliable neuroanatomical markers of the disease difficult. The use of more homogenous clinical phenotypes may improve the accuracy of predicting psychotic disorder/s on the basis of observable brain disturbances. Here we investigate the utility of cognitive subtypes of schizophrenia – ‘cognitive deficit’ and ‘cognitively spared’ – in determining whether multivariate patterns of volumetric brain differences can accurately discriminate these clinical subtypes from healthy controls, and from each other. We applied support vector machine classification to grey- and white-matter volume data from 126 schizophrenia patients previously allocated to the cognitive spared subtype, 74 cognitive deficit schizophrenia patients, and 134 healthy controls. Using this method, cognitive subtypes were distinguished from healthy controls with up to 72% accuracy. Cross-validation analyses between subtypes achieved an accuracy of 71%, suggesting that some common neuroanatomical patterns distinguish both subtypes from healthy controls. Notably, cognitive subtypes were best distinguished from one another when the sample was stratified by sex prior to classification analysis: cognitive subtype classification accuracy was relatively low (<60%) without stratification, and increased to 83% for females with sex stratification. Distinct neuroanatomical patterns predicted cognitive subtype status in each sex: sex-specific multivariate patterns did not predict cognitive subtype status in the other sex above chance, and weight map analyses demonstrated negative correlations between the spatial patterns of weights underlying classification for each sex. These results suggest that in typical mixed-sex samples of schizophrenia patients, the volumetric brain differences between cognitive subtypes are relatively minor in contrast to the large common disease-associated changes. Volumetric differences that distinguish between cognitive subtypes on a case-by-case basis appear to occur in a sex-specific manner that is consistent with previous evidence of disrupted relationships between brain structure and cognition in male, but not female, schizophrenia patients. Consideration of sex-specific differences in brain organization is thus likely to assist future attempts to distinguish subgroups of schizophrenia patients on the basis of neuroanatomical features

Self-harm and suicidal ideation among young people is more often recorded by child protection than health services in an Australian population cohort

OBJECTIVE: We investigated patterns of service contact for self-harm and suicidal ideation recorded by a range of human service agencies - including health, police and child protection - with specific focus on overlap and sequences of contacts, age of first contact and demographic and intergenerational characteristics associated with different service responses to self-harm.METHODS: Participants were 91,597 adolescents for whom multi-agency linked data were available in a longitudinal study of a population cohort in New South Wales, Australia. Self-harm and suicide-related incidents from birth to 18 years of age were derived from emergency department, inpatient hospital admission, mental health ambulatory, child protection and police administrative records. Descriptive statistics and binomial logistic regression were used to examine patterns of service contacts.RESULTS: Child protection services recorded the largest proportion of youth with reported self-harm and suicidal ideation, in which the age of first contact for self-harm was younger relative to other incidents of self-harm recorded by other agencies. Nearly 40% of youth with a health service contact for self-harm also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm than boys, but not child protection or police services.CONCLUSION: Suicide prevention is not solely the responsibility of health services; police and child protection services also respond to a significant proportion of self-harm and suicide-related incidents. High rates of overlap among different services responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people.</p

Advancing Impact Evaluations of Agricultural Climate Services in Africa

The design and implementation of effective climate information services (CIS) requires understanding the extent to which they impact the decisions and lives of those who use them

Making Climate Services Work for Africa's Farmers at Scale

The substantial body of knowledge about good practice in climate services suggests that making climate services work for farmers at a national scale requires managing tradeoffs between meeting farmers’ context-specific needs and providing cost-effective services at scale

The Case for Agricultural Climate Services in Africa

Ninety percent of the world’s farms are managed by small-scale farmers, feeding millions of people. Unfortunately, those farmers face significant impacts from climate variability and change. These impacts disrupt their ability to meet livelihoods and sustenance needs, and to produce enough food for a growing world. Climate services provide information about these impacts and aim to support agricultural decision-making for improved livelihoods, resilience, and food security

A randomised controlled trial of cognitive behaviour therapy versus non-directive reflective listening for young people at ultra high risk of developing psychosis:The detection and evaluation of psychological therapy (DEPTh) trial

Background: Intervention trials for young people at ultra high risk (UHR) for psychosis have shown cognitive behaviour therapy (CBT) to have promising effects on treating psychotic symptoms but have not focused on functional outcomes. We hypothesized that compared to an active control, CBT would: (i) reduce the likelihood of, and/or delay, transition to psychosis; (ii) reduce symptom severity while improving social functioning and quality of life, whether or not transition occurred. Method: This was a single-blind randomised controlled trial for young people at UHR for psychosis comparing CBT to an active control condition, Non Directive Reflective Listening (NDRL), both in addition to standard care, with a 6 month treatment phase and 12 months of follow-up. Statistical analysis is based on intention-to-treat and used random effect models to estimate treatment effects common to all time-points. Results: Fifty-seven young people (mean age = 16.5 years) were randomised to CBT (n = 30) or NDRL (n = 27). Rate of transition to psychosis was 5%; the 3 transitions occurred in the CBT condition (baseline, 2 months, 5 months respectively). The NDRL condition resulted in a significantly greater reduction in distress associated with psychotic symptoms compared to CBT (treatment effect = 36.71, standard error = 16.84, p = 0.029). There were no significant treatment effects on frequency and intensity of psychotic symptoms, global, social or role functioning. Conclusion: Our sample was higher functioning, younger and experiencing lower levels of psychotic like experiences than other trials. The significantly better treatment effect of NDRL on distress associated with psychotic symptoms supports the recommendations for a stepped-care model of service delivery. This treatment approach would accommodate the younger UHR population and facilitate timely intervention