Publications (61)204.79 Total impact
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Article: Employment status amongst those with psychosis at first presentation.
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ABSTRACT: Employment is generally beneficial to health and quality of life. Despite many advances in the treatment of psychosis there are continuing reports of high levels of unemployment. In most studies of first episode psychosis (FEP) only rudimentary rates of employment are provided. We sought to establish the prevalence of employment amongst those with FEP from a geographically defined area, to compare employment categories for differences in demographical and clinical characteristics and finally, to examine factors associated with employment. All cases of FEP were assessed from a defined suburban area with a structured clinical interview for DSM-III-R diagnosis and a standardised assessment protocol. Employment status was divided into employed, non-labour force work and unemployed. Of 162 cases of psychosis, those employed (46%) were indistinguishable from those in non-labour force work (21%). Those unemployed (33%) had significantly longer DUP, more negative symptoms and lower quality of life than those engaged in non-labour force work or those employed. Having a non-affective psychosis (chi(2) = 0.05, OR = 1.2; 95% CI 1.0, 1.4) was associated with being unemployed at presentation. Better (beta = -0.2, P = 0.00) academic premorbid adjustment was associated with being employed at presentation. Although 67% of those with FEP from a geographically defined area are engaged in purposeful work, the rate of unemployment is nine times the local rate. Longer DUP and negative symptoms are associated with unemployment at presentation. Standardised reporting of employment status would greatly assist research in this area.Social Psychiatry 04/2009; 44(10):863-9. · 2.05 Impact Factor -
Article: Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis.
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ABSTRACT: The critical period hypothesis proposes that deterioration occurs aggressively during the early years of psychosis, with relative stability subsequently. Thus, interventions that shorten the duration of untreated psychosis (DUP) and arrest early deterioration may have long-term benefits. To test the critical period hypothesis by determining whether outcome in non-affective psychosis stabilises beyond the critical period and whether DUP correlates with 8-year outcome; to determine whether duration of untreated illness (DUI) has any independent effect on outcome. We recruited 118 people consecutively referred with first-episode psychosis to a prospective, naturalistic cohort study. Negative and disorganised symptoms improved between 4 and 8 years. Duration of untreated psychosis predicted remission, positive symptoms and social functioning at 8 years. Continuing functional recovery between 4 and 8 years was predicted by DUI. These results provide qualified support for the critical period hypothesis. The critical period could be extended to include the prodrome as well as early psychosis.The British journal of psychiatry: the journal of mental science 02/2009; 194(1):18-24. · 6.62 Impact Factor -
Article: Suicidality prior to presentation in first-episode psychosis.
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ABSTRACT: Suicide and attempted suicide contribute significantly to the increased mortality and morbidity associated with psychotic illness. The period of highest risk is reportedly in the early years of illness. While the literature concentrates on completed suicide in chronic psychosis, less is understood about attempted suicide in first-episode psychosis (FEP). We aimed to examine rates and correlates of suicide attempts in individuals with FEP. Individuals in this study were all those, both in- and outpatients, diagnosed with FEP over a 2-year period, from a defined catchment area. Assessment included Structured Clinical Interview for DSM-IV, Schedule for Assessment of Positive Symptoms, Schedule for Assessment of Negative Symptoms, Calgary Scale, Beiser Scale and Birchwood Insight Scale. Of 107 patients with FEP, 50 (47%) individuals reported suicidal ideation: 41 (38%) in the month prior to first presentation. Ten individuals (9%) made a suicide attempt. The only factor significantly associated with previous suicide attempt was higher insight scores at first presentation (P = 0.04). Individuals with a history of suicide attempt tend to have higher insight into having a mental illness at first presentation.Early Intervention in Psychiatry 11/2008; 2(4):242-6. · 0.92 Impact Factor -
Article: Early intervention service for psychosis: views from primary care.
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ABSTRACT: Although General Practitioners (GPs) have a pivotal role in early detection and treatment of psychosis, there is sparse information on their views of early intervention (EI) services and how information related to EI should be delivered. Since inception, DETECT (Dublin East Treatment and Early Care Team), Ireland's pilot EI project, mailed information packs and provided information through the local GP continuing medical education (CME) network. After 1 year, we surveyed GPs within DETECT's catchment area for their views on the service being provided. One hundred and twenty-six (36%) responded and 80% found the EI service very/extremely useful. GPs reported that the combination of CME session and information packs were more useful than information packs alone. Those who attended CME meetings were significantly more likely to refer suspected cases (P < 0.01) and more likely to find the service useful (P < 0.001). The EI service for psychosis is well-received among GPs. Information about EI delivered through CME appears to have a greater impact on referral rates and satisfaction levels than mailed information.Early Intervention in Psychiatry 11/2008; 2(4):285-90. · 0.92 Impact Factor -
Article: Mental health literacy among Internet users.
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ABSTRACT: Intervening early in the course of psychotic illness may improve the long-term outcome. Early intervention requires early recognition, and one factor that influences early recognition is the level of mental health literacy (MHL) in the population. To investigate the level of MHL regarding depression and psychosis in an Irish population. We invited the registered users of Ireland's most popular community website (http://www.boards.ie) to participate in an online survey. Two standardized vignettes depicting depression and psychosis were presented, and respondents were asked about what they thought the conditions were and who might be best placed to help the person. Participants were asked a series of knowledge-based questions about psychosis. Nine hundred and ninety-eight (770 males, 228 females) people participated. Using a case vignette model, 78% and 93% of respondents correctly identified depression and psychosis/schizophrenia, respectively. However, half of the participants described schizophrenia as a 'split personality disorder'. Neither age nor urbanicity influenced the probability of correctly identifying the diagnosis, but females and university students were more likely to correctly identify the diagnosis. More than 90% believed intervening early in psychosis is likely to improve outcome. The Internet users in this survey have high levels of MHL, identify appropriate pathways to care, and their views on management are consistent with evidence-based treatments.Early Intervention in Psychiatry 11/2008; 2(4):247-55. · 0.92 Impact Factor -
Article: Are relational style and neuropsychological performance predictors of social attributions in chronic schizophrenia?
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ABSTRACT: Attributional style is defined as the pervasive tendency to explain the cause of social actions in terms of oneself, or others, or the context of the event. While the clinical correlates of this aspect of social cognition have been widely researched, its links with relationship style and neuropsychological performance, although hypothesised, have received less attention. This study investigated whether attributional style is predicted by variance in either relationship style or neuropsychological performance in schizophrenia. We assessed attributional style (using the Internal, Personal and Situational Attributions Questionnaire [IPSAQ]), relationship style (using Bartholomew and Horowitz's Relationship Questionnaire), and neuropsychological function (using the Wechsler Abbreviated Scale of Intelligence, the Wechsler Memory Test, and the Cambridge Automated Test Battery) in 73 stabilised outpatients with chronic schizophrenia and 78 controls matched for age and gender. 'Externalising bias' (attributing positive rather than negative events to oneself) was predicted by verbal ability in both patients and controls. 'Personalising bias' (attributing negative events to others rather than to situational factors) was predicted by higher secure relationship style ratings, but only in the patient group. This study highlights the importance of relationship style and neuropsychological performance for different aspects of attributional style in schizophrenia.Psychiatry Research 10/2008; 161(1):19-27. · 2.52 Impact Factor -
Article: Does the ability to sustain attention underlie symptom severity in schizophrenia?
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ABSTRACT: An association between deficits in executive control, particularly inhibitory control, and more severe negative and disorganised symptoms of schizophrenia has been widely reported. The importance of more basic aspects of attention, often referred to as 'vigilant' or 'sustained' attention, to this relationship remains unclear. This study examined the contribution of sustained attention to symptom severity using the Sustained Attention to Response Task (SART) in 69 patients with schizophrenia. We found that negative and disorganised symptom severity scores were correlated with sustained attention, working memory, and psychomotor speed. The ability to sustain attention significantly predicted variance in negative symptom severity but not disorganised symptoms, which were instead predicted by working memory performance. These data suggest that this component of attention at least partly explains variance in negative symptoms.Schizophrenia Research 10/2008; 107(2-3):319-23. · 4.75 Impact Factor -
Article: Mental state decoding v. mental state reasoning as a mediator between cognitive and social function in psychosis.
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ABSTRACT: Theory of mind deficits in schizophrenia have been parsed into mental state reasoning and mental state decoding components. We report that mental state decoding as measured by the 'Eyes task' better predicted social function than mental state reasoning as measured by the 'Hinting task' in 73 out-patients with chronic schizophrenia. Mental state decoding task performance also partly mediated the influence of basic neuropsychological performance on social function. We discuss these findings in terms of the accumulating evidence that mental state decoding has particular relevance for understanding deficits in social function in schizophrenia.The British Journal of Psychiatry 08/2008; 193(1):77-8. · 6.62 Impact Factor -
Article: Chitinase-3-like 1 (CHI3L1) gene and schizophrenia: genetic association and a potential functional mechanism.
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ABSTRACT: Gene expression data and association analyses in two Chinese samples implicate chitinase 3-like 1 (CHI3L1), a cellular survival gene, in schizophrenia susceptibility. We tested whether the association data are robust to replication in a Caucasian schizophrenia sample and performed a comprehensive investigation of common genetic variation at the locus. In a sample of 375 case and 812 control subjects we identified significant association with the same risk allele at the promoter single nucleotide polymorphism (SNP) associated in the original study (rs10399805; p = .018) and with another SNP at intron 7 of CHI3L1 (rs2275351; p = .008). The rs10399805 SNP is located at position -247 and disrupts the C/EBP-AML-1 binding site in the gene promoter; the risk allele is predicted to increase CHI3L1 expression, as has been reported in several postmortem schizophrenia studies. Carriers of the risk variant presented with fewer positive symptoms and relatively spared cognitive performance compared with other schizophrenia patients. These findings support a functional mechanism for involvement of CHI3L1 in schizophrenia susceptibility, possibly contributing to a less severe illness. The associated variants in this study are not well tagged by all Whole-Genome Association (WGA) platforms, suggesting additional genotyping may be necessary despite the imminent availability of WGA data from large SZ samples. Because CHI3L1 may be involved in transmission of stress-induced cellular responses, studies of interaction with known environmental risk factors may also be warranted.Biological psychiatry 08/2008; 64(2):98-103. · 8.93 Impact Factor -
Article: Integrating primary care and early intervention in psychosis services: a general practitioner perspective.
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ABSTRACT: Earlier detection and treatment of psychosis is associated with improved health outcomes. While the role of specialist services to facilitate early diagnosis and treatment has been extensively described internationally, little data on their impact on general practice has been reported. A new specialist service for psychosis - the 'Dublin East Treatment and Early Care Team (DETECT)'- has recently been established. This study aimed to describe general practitioners' (GPs) attitudes towards working within the catchment area of an early intervention service. A purposive sample of GPs practising in DETECT's catchment area was identified from the Irish Medical Directory and invited to participate in a semi-structured interview. The sampling parameters were solo/practice and area of practice. Participants were provided with information regarding the new service and a range of educational material. Each interview was reviewed by two researchers who identified dominant themes. The study was approved by the Research Ethics Committee of the Irish College of GPs. 16 GPs were interviewed. The DETECT early intervention model was identified as reducing the challenges of managing psychosis in primary care including the practical difficulties of accessing psychiatric assessment and the pervasive effect of stigma. Participants viewed communication between primary and specialist care as essential to the success of early intervention services. General Practice has an important role in early detection of psychosis and accessing timely psychiatric evaluations of suspected psychosis. Increasing awareness among GPs and ensuring the early intervention model is responsive to primary care can support this role.Early Intervention in Psychiatry 05/2008; 2(2):103-7. · 0.92 Impact Factor -
Article: Evaluating Psychosocial Interventions in First-Episode Psychosis
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ABSTRACT: Little is known about what influences the success of psychosocial interventions for first-episode psychosis. One possible explanation for the mixed results of clinical trials is the influence of confounders on outcome. Psychosocial functioning prior to the onset of psychosis (premorbid adjustment) is one possible confounder. In order to examine the importance of premorbid adjustment to occupational therapists providing and evaluating psychosocial interventions, this study compared the baseline characteristics and premorbid adjustment of the people with first-episode psychosis referred to psychosocial rehabilitation with those of the people not referred, and the outcomes of both groups. All people with first-episode psychosis (n = 171) were assessed at baseline, including their premorbid adjustment. The participants were followed up 4 years later. A subgroup (n = 44) had been referred to psychosocial rehabilitation. The baseline presentation, premorbid adjustment and outcomes (symptoms and functioning) at 4 years of both groups were compared. The results showed that the people referred to a psychosocial rehabilitation programme had a poorer premorbid adjustment and fewer years in education than those not referred. Unsurprisingly, those not referred had better outcomes 4 years after initial presentation. It was concluded that premorbid psychosocial functioning is influential in determining the likelihood of referral to psychosocial rehabilitation and can influence evaluations of psychosocial interventions.The British Journal of Occupational Therapy. 03/2008; 71(4):155-160. -
Article: A little knowledge: caregiver burden in schizophrenia in Malawi.
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ABSTRACT: To determine the relationship between schizophrenia knowledge and burden of care among caregivers of people with schizophrenia in Mzuzu, Malawi. We recruited 90 patients and 90 caregivers to a randomized, controlled trial of group caregiver education in schizophrenia. At baseline, we administered the Family Questionnaire, which measures caregivers' knowledge of biomedical and psychosocial aspects of schizophrenia. We measured caregiver burden with the Involvement Evaluation Questionnaire. Using multivariate analysis, we examined the relationship between knowledge and burden, controlling for other patient and caregiver variables. We hypothesised that knowledge and burden would be inversely related. Caregiver burden was associated with knowledge (p = 0.001), but contrary to our hypothesis, greater knowledge was associated with greater burden. In this population, knowledge about schizophrenia was associated with higher caregiver burden. This does not prove that knowledge causes burden, but suggests that cultural factors may mediate the relationship between knowledge and burden, and that care is needed when introducing caregiver education in new cultures.Social Psychiatry and Psychiatric Epidemiology 03/2008; 43(2):160-4. · 2.70 Impact Factor -
Article: Minor physical anomalies in schizophrenia: is age a confounding factor?
Psychological Medicine 02/2008; 38(1):154-6. · 6.16 Impact Factor -
Article: Dysbindin (DTNBP1) and the biogenesis of lysosome-related organelles complex 1 (BLOC-1): main and epistatic gene effects are potential contributors to schizophrenia susceptibility.
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ABSTRACT: The DTNBP1 gene, encoding dysbindin, has been strongly implicated in schizophrenia (SZ) susceptibility by a series of independent genetic association and gene expression studies. Among its known functions, dysbindin is part of a protein complex, termed the biogenesis of lysosome-related organelles complex 1 (BLOC-1), the molecular components of which might be involved in the regulation of vesicular trafficking and dendrite branching. A systematic investigation of the other seven BLOC-1 genes (MUTED, PLDN, CNO, SNAPAP, BLOC1S1, BLOC1S2, and BLOC1S3) for evidence of association with SZ was undertaken in a sample of 373 SZ cases and 812 control subjects. Possible epistasis between combinations of BLOC-1 genes, including DTNBP1, was tested with a novel method of investigating for gene-gene interaction. Quality control measures were incorporated into genotyping strategy, and all results were corrected for multiple testing to prevent false positive results. We identified significant evidence of association between BLOC1S3 and SZ (odds ratio = 1.45, confidence interval = 1.13-1.86, p = .0028, corrected p = .0389). We also report evidence for epistatic interaction between DTNBP1 and MUTED contributing to SZ in the absence of a significant main effect at MUTED (p = .0009, corrected p = .0252). Single marker and epistasis results remained significant after correction for multiple testing. Together these data provide evidence for the involvement of the BLOC-1 protein complex in SZ pathogenesis.Biological psychiatry 02/2008; 63(1):24-31. · 8.93 Impact Factor -
Article: Insight, psychopathology and global functioning in schizophrenia in urban Malawi.
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ABSTRACT: Insight, psychopathology and functioning are related in schizophrenia, but it is unclear whether insight relates independently to functioning after controlling for psychopathology. Equally, any such relationship may vary culturally. We investigated the relationship between insight, psychopathology and functioning in 60 patients with schizophrenia in Mzuzu, a town in Malawi. After controlling for psychopathology, functioning was associated with the ;symptom relabelling' dimension of insight (P=0.01). This preliminary finding suggests that symptom-focused psychoeducation might be appropriate for African patients with schizophrenia.The British Journal of Psychiatry 10/2007; 191:262-3. · 6.62 Impact Factor -
Article: Is violence at presentation by patients with first-episode psychosis associated with duration of untreated psychosis?
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ABSTRACT: Violence in first episode psychosis poses significant challenges for mental health staff and patients' families. Violence has been shown to be related to psychopathology. Duration of untreated psychosis (DUP) has been shown to influence psychopathology at presentation in first-episode psychosis, but little is known about the direct relationship between violence at presentation and DUP. We therefore sought to examine the relationship between these two variables. Patients were all individuals aged between 16 and 65 years, with a DSM-III-R diagnosis of psychotic illness, taking part in a First Episode study. We used the Structured Clinical Interview (SCID-I), Positive and Negative Symptom Scale (PANSS), Beiser Scale and the Modified Overt Aggression Scale (MOAS) to evaluate diagnosis, psychopathology, DUP and violent behaviour respectively. Data for each case were retrospectively examined for violence, for the week prior to and week following first contact with psychiatric services, blind to diagnosis, DUP and psychopathology scores. We assessed 157 patients. About 46 patients (29%) were violent. Violence rates did not differ across diagnostic groups, while DUP varied significantly across diagnostic groups (P = 0.001). Violence was not associated with DUP across all psychoses (P = 0.41). In the schizophrenia subgroup (n = 94), thirty individuals (32%) were violent. In a logistic regression, logDUP was not associated with violence (P = 0.11). Violence was predicted by involuntary admission status (P = 0.04) and global positive symptoms (P = 0.03). DUP was associated weakly with negative symptoms (P = 0.01) but not associated with positive or general psychopathology. Neither pre nor post-contact violence was associated (P = 0.79 and P = 0.09 respectively) with DUP. Contrary to a recent study, we did not find an association between violence at presentation and DUP. The relationships between violence, DUP and psychopathology are complex and may be compounded by potential difficulties inherent in the PANSS. Programs to reduce DUP may not impact on rates of violence at presentation in First Episode Psychosis (FEP).Social Psychiatry and Psychiatric Epidemiology 09/2007; 42(8):606-10. · 2.70 Impact Factor -
Article: What Influences Purpose in Life in First-Episode Psychosis?
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ABSTRACT: Short ReportAlthough purpose in life (PIL) is significant to psychological wellbeing, there is little published research on PIL among those with a mental illness. This prospective study of first-episode psychosis (n = 54) included assessment of symptomatology, PIL and duration of untreated psychosis. The results showed that the baseline PIL scores of those with first-episode psychosis were lower than those of other populations. This was worsened by a long duration of untreated psychosis and was linked to depression. The study concludes that psychosis results in many losses for the individual, including PIL. Meaningful occupation can address this lost sense of purpose and the occupational difficulties associated with psychosis.The British Journal of Occupational Therapy. 08/2007; 70(9):401-406. -
Article: Caregiver psychoeducation for schizophrenia: is gender important?
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ABSTRACT: Females care for individuals with chronic illness more commonly than males and have different attitudes to illness. Additionally, they experience greater burden and reduced quality of life, when compared to their male counterparts. Since knowledge has been shown to be related to burden, we sought to determine whether there were gender differences in knowledge acquisition during a six-week caregiver psychoeducation programme (CPP). Caregivers of people with schizophrenia completed a 23-item adapted version of the self-report Family Questionnaire (FQ) before and after the six-week CPP. Using a Generalized Linear Mixed Model, we studied the differences in proportions of correct answers before and after the programme by gender. Over a 46-month study period, 115 caregivers (58% female) participated in the programme. There was an overall improvement in knowledge with an effect size of 1.12. The improvement was statistically significant (P<0.001) within each of six specific areas of knowledge. However, female caregivers gained more knowledge overall and specifically regarding signs and symptoms, recovery and especially caregiver support. Knowledge gains regarding medication were roughly equal, while male caregivers gained more knowledge about risk factors. Our findings indicate that there are gender differences in the amount and type of knowledge gained during a CPP, with female caregivers showing greater knowledge acquisition than their male counterparts in most areas. Interventions designed to assist caregivers may be improved by targeting areas of knowledge specific to each gender. Such an approach might further reduce burden and improve the outcome for their relatives affected by schizophrenia.European Psychiatry 07/2007; 22(5):323-7. · 2.77 Impact Factor -
Article: Untreated illness and outcome of psychosis.
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ABSTRACT: There has been controversy as to whether early intervention in psychosis can improve the outcome of the disorder. To establish if there is an association between duration of untreated psychosis and the 4-year outcome of persons with a first episode of psychosis. Prospective naturalistic follow-up study of the outcome of consecutive first presentations with DSM-IV psychosis attending a community-based psychiatric service. A longer duration of untreated psychosis was associated with a significantly poorer functional and symptomatic outcome 4 years later. For schizophrenia and schizophreniform disorder, each increment in duration of untreated psychosis was associated with a 7.8 point decrease in global functioning and an increase in positive symptoms scores by 1.9 points. This study extends the findings of short-term follow-up studies by confirming an association between duration of untreated psychosis and 'mid-term' outcome.The British Journal of Psychiatry 10/2006; 189:235-40. · 6.62 Impact Factor -
Article: Diagnostic specificity and predictors of neurological soft signs in schizophrenia, bipolar disorder and other psychoses over the first 4 years of illness.
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ABSTRACT: Neurological soft signs (NSS) are well described among patients with schizophrenia, the neurology of other psychoses is relatively unexplored and few comparative studies have prospectively examined these signs in first-episode patients. We assessed neurological functioning in 242 patients presenting with a first episode of psychosis (in accordance with DSM-IV diagnosis) using the Condensed Neurological Examination (CNE). We sought to determine whether NSS were specific to patients with schizophrenia, bipolar affective disorder and other forms of psychosis. We also examined the factors associated with and predictive of neurodysfunction at first presentation and at 4 year follow-up. NSS were not specific to any diagnostic group. Neurological functioning was closely associated with psychopathology and mixed-handedness at first presentation. At follow-up there was a statistically significant improvement in neurological functioning. Persistent neurodysfunction at this stage was related to enduring negative symptoms and associated with poorer outcome. Schizophrenia and bipolar disorder are indistinguishable in terms of neurodysfunction at presentation. At presentation and 4 years NSS closely parallel psychopathology and mixed-handedness indicating that NSS may be a function of these factors or possibly an independent factor operates equally upon both symptoms and neurological function.Schizophrenia Research 10/2006; 86(1-3):110-7. · 4.75 Impact Factor
Top co-authors
Top Journals
Institutions
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2012
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Trinity College Dublin
Dublin, L, Ireland (Republic of Ireland)
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2004–2012
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Saint John of God Hospitaller Services
Dublin, L, Ireland (Republic of Ireland) -
Royal College of Surgeons in Ireland
- Department of Clinical Pharmacology
Dublin, L, Ireland (Republic of Ireland)
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2003–2012
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St John of God Hospital
Dublin, L, Ireland (Republic of Ireland)
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2011
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St. Vincents University Hospital
Dublin, L, Ireland (Republic of Ireland)
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2001–2009
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University College Dublin
Dublin, L, Ireland (Republic of Ireland)
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2002
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Cavan Monaghan Hospital
Monaghan, U, Ireland (Republic of Ireland)
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