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Neurocognitive impairments robustly predict functional outcome. However, heterogeneity in neurocognition is common within diagnostic groups, and data-driven analyses reveal homogeneous neurocognitive subgroups cutting across diagnostic boundaries.
To determine whether data-driven neurocognitive subgroups of young people with emerging mental disorders are associated with 3-year functional course.
Model-based cluster analysis was applied to neurocognitive test scores across nine domains from 629 young people accessing mental health clinics. Cluster groups were compared on demographic, clinical and substance-use measures. Mixed-effects models explored associations between cluster-group membership and socio-occupational functioning (using the Social and Occupational Functioning Assessment Scale) over 3 years, adjusted for gender, premorbid IQ, level of education, depressive, positive, negative and manic symptoms, and diagnosis of a primary psychotic disorder.
Cluster analysis of neurocognitive test scores derived three subgroups described as ‘normal range’ (n = 243, 38.6%), ‘intermediate impairment’ (n = 252, 40.1%), and ‘global impairment’ (n = 134, 21.3%). The major mental disorder categories (depressive, anxiety, bipolar, psychotic and other) were represented in each neurocognitive subgroup. The global impairment subgroup had lower functioning for 3 years of follow-up; however, neither the global impairment (B = 0.26, 95% CI −0.67 to 1.20; P = 0.581) or intermediate impairment (B = 0.46, 95% CI −0.26 to 1.19; P = 0.211) subgroups differed from the normal range subgroup in their rate of change in functioning over time.
Neurocognitive impairment may follow a continuum of severity across the major syndrome-based mental disorders, with data-driven neurocognitive subgroups predictive of functional course. Of note, the global impairment subgroup had longstanding functional impairment despite continuing engagement with clinical services.
Acute alcohol consumption is a major risk factor for suicide, therefore
investigating factors associated with alcohol-related self-harm warrant
To investigate the influence of prescribed psychotropic medications on
the odds of co-ingesting alcohol preceding or during intentional efforts
A cross-sectional analysis of consecutive hospital presentations
following intentional self-poisoning was conducted. A total of 7270
patients (4363 women) aged 18–96 were included.
The odds of alcohol co-ingestion were increased in those not prescribed
any medication (odds ratio (OR) = 1.27, 99% CI 1.10–1.46, P50.001) and in
impulsive self-poisonings (OR= 1.39, 99% CI 1.11–1.74, P50.001). Odds
were decreased in those prescribed anticonvulsants (OR = 0.69, 99% CI
0.51–0.93), antipsychotics (OR = 0.55, 99% CI 0.45–0.66) and
antidepressants (OR = 0.87, 99% CI 0.77–0.99).
Findings indicate that being medicated for a psychiatric illness may
reduce the likelihood of alcohol consumption during times of acute
distress, hence perhaps may reduce the risk of intentional
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