Randomised Controlled Trial Of Cognitive Behaviour Therapy To Prevent Psychosis Among People With At-risk Mental States.
Funder
National Health and Medical Research Council
Funding Amount
$619,604.00
Summary
Recent advances in the accurate identification of individuals at high risk of developing a psychotic disorder, such as schizophrenia, have inspired the development of interventions designed to delay, ameliorate or even prevent the onset of such disorders. To date, the results of only three randomised controlled trials of such interventions have been published. Although these results have shown that interventions are able to delay the onset of psychosis, and may even prevent psychosis in some cas ....Recent advances in the accurate identification of individuals at high risk of developing a psychotic disorder, such as schizophrenia, have inspired the development of interventions designed to delay, ameliorate or even prevent the onset of such disorders. To date, the results of only three randomised controlled trials of such interventions have been published. Although these results have shown that interventions are able to delay the onset of psychosis, and may even prevent psychosis in some cases, it is unclear which treatment should be preferred for this population because the three trials have assessed, respectively, a combination of anti-psychotic medication and cognitive behaviour therapy (CBT), CBT alone, and anti-psychotic medication alone. Since the trial of CBT alone produced results that were at least as favourable as the two other trials, and since ethical and clinical objections have been raised concerning the use of anti-psychotic medications with young people who may never develop a psychotic disorder, CBT may be the preferred treatment. Far from posing unnecessary risks, CBT has the potential to provide important therapeutic benefits even to those not destined to develop a psychosis. The current study is significant in that it proposes a controlled trial of a form of CBT which has been specially adapted for preventing transition to psychosis among young high-risk individuals, to test whether the previous favourable results for CBT can be independently replicated. It will be compared with a control treatment. Since cannabis abuse is common among young people who are at risk, and is a known risk factor for psychosis, CBT will include elements of treatment for cannabis abuse. The trial will be run in both Newcastle and Orange, NSW, enabling us to compare the effectiveness of CBT in urban and rural settings. This study has the potential to have large impacts on the quality of life of young people at risk of psychosis.Read moreRead less
Studies On The Expression Of Muscarinic Receptors: Implications For The Pathology Of Schizophrenia
Funder
National Health and Medical Research Council
Funding Amount
$498,791.00
Summary
Schizophrenia is a severe psychiatric disorder that affects approximately 1% of the population. This project will help define changes in the molecules in the brain of subjects with schizophrenia which are likely to be involved in two symptoms of the disorder, the psychoses and cognitive deficits. Understanding the cause of the cognitive deficits of schizophrenia is a high priority because they are the most disabilitating symptom of the disorder and do not respond to current drug treatments.
Longitudinal Brain Changes In First-episode Psychosis: A 10 Year Follow-up MRI Study
Funder
National Health and Medical Research Council
Funding Amount
$165,250.00
Summary
It is now widely accepted that schizophrenia is associated with changes in the structure of the brain. Until recently these structural changes were considered to predate the onset of illness and to remain static. However, our own work has suggested an alternative model, which relates schizophrenia to brain changes at specific life stages. In order to demonstrate this, we intend to acquire repeat brain images on 100 patients who were initially scanned 10 years ago at the start of their psychotic ....It is now widely accepted that schizophrenia is associated with changes in the structure of the brain. Until recently these structural changes were considered to predate the onset of illness and to remain static. However, our own work has suggested an alternative model, which relates schizophrenia to brain changes at specific life stages. In order to demonstrate this, we intend to acquire repeat brain images on 100 patients who were initially scanned 10 years ago at the start of their psychotic illness. This would be the largest follow-up study of first episode psychosis in the world, with the longest interval between the first and second brain scan. Further, for a proportion of patients we will have 3 MRI scans, at illness onset, 2-4 years post-onset, followed by a third scan at 10 years, thereby providing unique follow-up brain imaging data. Based on our own and other research, we intend to explore the relationship between progressive brain change over a ten year period and: (i) the diagnosis of the patient (schizophrenia or other disorder), (ii) the clinical and functional outcome of the patient (still chronically ill or with no further episode of psychosis), and (iii) the cognitive state of the patient (their ability to perform well on tests of memory, planning and so on). We are able to conduct this study because of the existence of an infrastructure developed to follow-up patients, with a recontact rate of 70% of those patients admitted in 1992 and 1993. In this study we seek to implement these strategies for the patients identified after 1994. The results of this study will test our ideas derived from our model of the major psychotic illnesses and may identify the structural brain changes which are associated with the development of chronic schizophrenia and other psychoses. A further novel outcome will be the inclusion of patients who have remained well and identiifying the structural correlates of a good prognosis.Read moreRead less
Intervention For Tobacco Dependence Among People With A Psychotic Illness
Funder
National Health and Medical Research Council
Funding Amount
$387,625.00
Summary
The prevalence of smoking among people with a psychiatric illness, especially schizophrenia, is greater than that in the general population. Exposure to tobacco smoke has been identified as a cause of 32 different diseases as well as a cause of fire injuries. Tobacco smoke is known to contain carcinogens, as well as nicotine and numerous other poisonous substances. An extensive body of scientific evidence shows that active cigarette smoking increases the risk of many different cancers. Smoking r ....The prevalence of smoking among people with a psychiatric illness, especially schizophrenia, is greater than that in the general population. Exposure to tobacco smoke has been identified as a cause of 32 different diseases as well as a cause of fire injuries. Tobacco smoke is known to contain carcinogens, as well as nicotine and numerous other poisonous substances. An extensive body of scientific evidence shows that active cigarette smoking increases the risk of many different cancers. Smoking related diseases rate second in frequency to suicide as the greatest contributor to early mortality in schizophrenia. Popular opinion holds that people with mental illness are lacking in motivation to change their behaviour due to the effects of their mental illness. However, a recent survey of inpatients in a psychiatric hospital in Newcastle, NSW, revealed that over a quarter of smokers were either preparing to quit or cut down on their smoking or already had taken action to reduce their smoking. The present research proposal represents the first large randomised controlled trial of an intervention for tobacco dependence among people with a mental illness. This project will compare the effectiveness of nicotine replacement therapy combined with counselling with a self-help booklet on smoking. The proposed research follows a small clinical study of the feasibility of the intervention and a small randomised controlled trial supported by the Australian Rotary Health Research Fund. The proposed study brings together the expertise of several people across Australia who have experience in treating people with mental illness and drug dependence, including tobacco dependence. The results will inform future clinical interventions for smokers with a mental illness.Read moreRead less
An Impirical Investigation Of Psychosis Proneness In Amphetamine Users: Current And Predictive Validity
Funder
National Health and Medical Research Council
Funding Amount
$462,750.00
Summary
The use of amphetamines has increased in Australia in the last decade. According to the 1998 National Household Survey, lifetime use of amphetamines has increased by over 50% from approximately 6% in 1995 to approximately 9% in 1998; recent use (last 12 months) has increased from 2% in 1995 to approximately 4% in 1998. This increase appears to be even greater in Queensland, the site of the proposed study, which has seen both an overall increase in the use of illicit drugs and an increase in the ....The use of amphetamines has increased in Australia in the last decade. According to the 1998 National Household Survey, lifetime use of amphetamines has increased by over 50% from approximately 6% in 1995 to approximately 9% in 1998; recent use (last 12 months) has increased from 2% in 1995 to approximately 4% in 1998. This increase appears to be even greater in Queensland, the site of the proposed study, which has seen both an overall increase in the use of illicit drugs and an increase in the use of amphetamines specifically. The most recent estimate of the number of current users (use within the last 12months) aged 14 years and over in Queensland is 85.5000. This compares to 17.000 recent heroin users in the same age range. Of particular concern is the increase in the use of methamphetamine, which has high abuse potential producing euphoric effects that are similar to, but longer lasting than, those of cocaine. Also of concern, given the increasing purity and availablity of methamphetamine, is the link between amphetamine use and psychosis, a psychotic disorder characterised by sensory hallucinations, paranoid delusions and a loosening of associations. Despite this well established link, there are surprisingly few studies in which the course and onset of amphetamine psychosis has been studied. In this reseach the relationship between subclinical features of psychosis, measures of psychosis proneness and other factors implicated in the development of schizophrenia will be investigated in a prospective cohort in which amphetamine users will be followed up once per month for twelve months.Read moreRead less
A Comparison Of An Integrated Psychological Intervention With 'befriending' In First-presentation Psychosis
Funder
National Health and Medical Research Council
Funding Amount
$356,113.00
Summary
The project aims to test the efficacy of two treatments to determine whether 'integrated' psychological treatment leads to better outcomes for those individuals presenting for treatment for the first time. Neuroleptic medication is the main treatment for the positive symptoms (i.e., delusions, hallucinations and thought disorder) which typify the psychoses, including schizophrenia. Yet, there are reasons why other approaches should be investigated. Firstly, not all patients respond to medication ....The project aims to test the efficacy of two treatments to determine whether 'integrated' psychological treatment leads to better outcomes for those individuals presenting for treatment for the first time. Neuroleptic medication is the main treatment for the positive symptoms (i.e., delusions, hallucinations and thought disorder) which typify the psychoses, including schizophrenia. Yet, there are reasons why other approaches should be investigated. Firstly, not all patients respond to medications. Secondly, medication may not totally alleviate the positive symptoms, and thirdly, other aspects of the condition are not helped to any extent by medication. These aspects include negative symptoms (e.g., lack of motivation and asociality), depression, social anxiety and functioning in the various life domains, e.g., school, work and socialization. In the last 15 years a viable psychological treatment known as cognitive-behavioural therapy (CBT) has emerged. This appears to be effective in the treatment of hallucinations and delusions and has an effect over and above that produced by medication. However, such treatments have not yet been applied to treating those symptoms in first presentation psychotic patients when they are in the acute stage of their illness. It is important to determine whether CBT produces positive effects in this group and whether used in conjunction with medication it can produce greater and more rapid reductions in the level and severity of positive symptoms. Whilst CBT is expected to produce positive changes in delusions and hallucinations, the applicants believe this needs to be integrated with CBT interevention focussed on other aspects of a patient's presentation, such as negative and depressive symptoms, and also on improving functioning in various life domains.Read moreRead less
Understanding The Pathology Of Muscarinic Receptor Deficit Schizophrenia: A Biochemically Defined Form Of The Disorder.
Funder
National Health and Medical Research Council
Funding Amount
$451,804.00
Summary
Schizophrenia is a group of disorders with similar symptoms and no way of distinguishing the different disorders. In our brain collection 25% of the subjects with schizophrenia have a particular chemical deficit. Screening gene expression in people with schizophrenia, with and without this deficit will give a global picture of chemical differences between the groups. Understanding the differences between sub-groups of people with schizophrenia will aid the development of better drugs for them.
The Neurobiology Of Auditory Hallucinations: Characterisation Of Dysfunction Within A Neural Circuitry Model.
Funder
National Health and Medical Research Council
Funding Amount
$299,625.00
Summary
This is a highly innovative research proposal which is based on years of extensive research by our group. Auditory hallucinations are a prominent and potentially disabling symptom of psychosis, however it is extremely difficult to study them scientifically. Past research by our group (and other groups internationally) has indicated that an extensive network in the brain is activated whenever auditory hallucinations occur, but the source of this brain activity is unclear. It was thought that the ....This is a highly innovative research proposal which is based on years of extensive research by our group. Auditory hallucinations are a prominent and potentially disabling symptom of psychosis, however it is extremely difficult to study them scientifically. Past research by our group (and other groups internationally) has indicated that an extensive network in the brain is activated whenever auditory hallucinations occur, but the source of this brain activity is unclear. It was thought that the source may be the same brain circuits that are involved in generating inner speech or monitoring it, but our past research has ruled out these possibilities. Instead, our recent work suggests that auditory hallucinations may be associated with poorly functioning connections within central auditory processing circuits, specifically between left and right auditory association cortical regions. We conceptualise hallucinations as an abnormal and involuntary form of memory retrieval consequent to this dysfunction. Our study will pioneer methods of measuring connectivity in the brain circuits identified in our model, using a combination of functional magnetic resonance imaging (fMRI) and electroencephalographic (EEG) techniques in tandem with tests of central auditory processing. We believe that sufferers may benefit from understanding the physical processes which cause hallucinations. We also believe that a better understanding of hallucinations may lead to a better understanding of schizophrenia and the psychoses, which may in turn help in the development of better ways of treating these illnesses.Read moreRead less
Evaluation Of Cognitive-behaviour Therapy For Alcohol And Other Drug Problems Among People With A Psychotic Illness
Funder
National Health and Medical Research Council
Funding Amount
$217,465.00
Summary
Abuse of alcohol and other drugs among people with a major psychiatric illness is a serious public health problem and cost-effective treatments need to be developed and assessed. The aim of this project is to evaluate the effectiveness of a counselling intervention. 180 individuals with a psychotic illness and concurrent alcohol and other drug (AOD) problems will be randomly assigned to counselling or usual treatment and followed up for a period of 12 months. The indicators of interest include: ....Abuse of alcohol and other drugs among people with a major psychiatric illness is a serious public health problem and cost-effective treatments need to be developed and assessed. The aim of this project is to evaluate the effectiveness of a counselling intervention. 180 individuals with a psychotic illness and concurrent alcohol and other drug (AOD) problems will be randomly assigned to counselling or usual treatment and followed up for a period of 12 months. The indicators of interest include: current drug use; psychiatric symptoms; self-harm; social functioning; and use of health services. Findings from the proposed study will assist in the selection of particular treatment strategies and will aid the overall development of services for people with both major mental illness and substance abuse.Read moreRead less