Objectives: Research has shown that analyzing intrusion errors generated on verbal learning and memory measures is helpful for distinguishing between the memory disorders associated with Alzheimer’s disease (AD) and other neurological disorders, including Huntington’s disease (HD). Moreover, preliminary evidence suggests that certain clinical populations may be prone to exhibit different types of intrusion errors. Methods: We examined the prevalence of two new California Verbal Learning Test-3 (CVLT-3) intrusion subtypes – across-trial novel intrusions and across/within trial repeated intrusions – in individuals with AD or HD. We hypothesized that the encoding/storage impairment associated with medial-temporal involvement in AD would result in a greater number of novel intrusions on the delayed recall trials of the CVLT-3, whereas the executive dysfunction associated with subcortical-frontal involvement in HD would result in a greater number of repeated intrusions across trials. Results: The AD group generated significantly more across-trial novel intrusions than across/within trial repeated intrusions on the delayed cued-recall trials, whereas the HD group showed the opposite pattern on the delayed free-recall trials. Conclusions: These new intrusion subtypes, combined with traditional memory analyses (e.g., recall versus recognition performance), promise to enhance our ability to distinguish between the memory disorders associated with primarily medial-temporal versus subcortical-frontal involvement.

Walk tall: The story of REX Bionics is about the key decisions faced by the founders Richard Little and Robert (Robbie) Irving to commercialise a ‘walking skeleton’ for people who are wheelchair-bound for extended periods. The changing role of the founders in a technology-based business and the interplay between the founders’ vision and the reality of growing technology-based businesses is the focus. The history of REX Bionics lies in the founders’ first-hand experiences with people diagnosed with multiple sclerosis. Over 15 years the company evolved from a ‘workshop idea’ in a garage to public listing on the London AIM Stock Exchange. Facing multiple institutional hurdles, rapidly moving technology and high start-up costs, REX Bionics successfully commercialised the walking robotic exoskeleton inspirited by the ‘Power Load’ in the movie Aliens. Little and Irving faced some tough choices about which commercialisation pathways to pursue in the light of diverse perspectives from the board of directors, an advisory board, various investors to their personal mission.

Objectives: Although subjective cognitive complaints (SCC) are an integral component of the diagnostic criteria for mild cognitive impairment (MCI), previous findings indicate they may not accurately reflect cognitive ability. Within the Alzheimer’s Disease Neuroimaging Initiative, we investigated longitudinal change in the discrepancy between self- and informant-reported SCC across empirically derived subtypes of MCI and normal control (NC) participants. Methods: Data were obtained for 353 MCI participants and 122 “robust” NC participants. Participants were classified into three subtypes at baseline via cluster analysis: amnestic MCI, mixed MCI, and cluster-derived normal (CDN), a presumptive false-positive group who performed within normal limits on neuropsychological testing. SCC at baseline and two annual follow-up visits were assessed via the Everyday Cognition Questionnaire (ECog), and discrepancy scores between self- and informant-report were calculated. Analysis of change was conducted using analysis of covariance. Results: The amnestic and mixed MCI subtypes demonstrated increasing ECog discrepancy scores over time. This was driven by an increase in informant-reported SCC, which corresponded to participants’ objective cognitive decline, despite stable self-reported SCC. Increasing unawareness was associated with cerebrospinal fluid Alzheimer’s disease biomarker positivity and progression to Alzheimer’s disease. In contrast, CDN and NC groups over-reported cognitive difficulty and demonstrated normal cognition at all time points. Conclusions: MCI participants’ discrepancy scores indicate progressive underappreciation of their evolving cognitive deficits. Consistent over-reporting in the CDN and NC groups despite normal objective cognition suggests that self-reported SCC do not predict impending cognitive decline. Results demonstrate that self-reported SCC become increasingly misleading as objective cognitive impairment becomes more pronounced. (JINS, 2018, 24, 842–853)

Objectives: The third edition of the California Verbal Learning Test (CVLT-3) includes a new index termed List A versus Novel/Unrelated recognition discriminability (RD) on the Yes/No Recognition trial. Whereas the Total RD index incorporates false positive (FP) errors associated with all distractors (including List B and semantically related items), the new List A versus Novel/Unrelated RD index incorporates only FP errors associated with novel, semantically unrelated distractors. Thus, in minimizing levels of source and semantic interference, the List A versus Novel/Unrelated RD index may yield purer assessments of yes/no recognition memory independent of vulnerability to source memory difficulties or semantic confusion, both of which are often seen in individuals with primarily frontal-system dysfunction (e.g., early Huntington’s disease [HD]). Methods: We compared the performance of individuals with Alzheimer’s disease (AD) and HD in mild and moderate stages of dementia on CVLT-3 indices of Total RD and List A versus Novel/Unrelated RD. Results: Although AD and HD subgroups exhibited deficits on both RD indices relative to healthy comparison groups, those with HD generally outperformed those with AD, and group differences were more robust on List A versus Novel/Unrelated RD than on Total RD. Conclusions: Our findings highlight the clinical utility of the new CVLT-3 List A versus Novel/Unrelated RD index, which (a) maximally assesses yes/no recognition memory independent of source and semantic interference; and (b) provides a greater differentiation between individuals whose memory disorder is primarily at the encoding/storage level (e.g., as in AD) versus at the retrieval level (e.g., as in early HD). (JINS, 2018, 24, 833–841)

Background: This research examined the impact of a programme integrating therapeutic music and group discussions (Holyoake's DRUMBEAT programme) on disadvantaged adolescents’ mental wellbeing, psychological distress, post-traumatic stress symptoms and antisocial behaviour. Method: Students displaying antisocial behaviours in grades eight to ten at three socio-economically disadvantaged secondary schools in Perth, Western Australia were invited to participate in a 10-week DRUMBEAT programme (incorporating drumming with djembes, therapeutic discussions and a final performance). Eight DRUMBEAT programmes were held in 2014. Pre- and post-intervention questionnaires measured mental wellbeing (Warwick–Edinburgh Mental Wellbeing Scale), psychological distress (Kessler-5), post-traumatic stress symptoms (Abbreviated Post-Traumatic Stress Disorder Checklist- Civilian Version) and antisocial behaviours (Adapted Self-Reported Delinquency Scale). Results: Of the 62 students completing DRUMBEAT, 41 completed pre- and post-questionnaires. Post-programme boys scored an average 7.6% higher mental wellbeing (WEMWBS) (p = .05), 19.3% lower post-traumatic stress symptoms (A PCL-C) (p = .05) and 23.9% lower antisocial behaviour (ARSDC) (p = .02). These changes were not evident for girls. No significant differences were detected for differences in psychological distress for either gender. Conclusion: This research highlights the potential of the DRUMBEAT programme as an effective, targeted strategy to reduce post-traumatic stress symptoms and antisocial behaviour and increase mental wellbeing in socio-economically disadvantaged adolescent boys.

This study examined the association and directionality of effect between mental wellbeing and depressive symptoms in Australian adolescents. Data were collected on two occasions 21 months apart. At Time 1, 1,762 10- to 14-year-old adolescents from a range of socio-economic status areas participated. At Time 2 (T2), 1,575 participated again. On both occasions, the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) and the Children's Depression Inventory 2 (CDI 2) were administered via online survey. Cross-lagged, longitudinal path analyses demonstrated a negative association between earlier symptoms of depression and later positive mental wellbeing, and that the reverse was also true, though weaker. The model accounted for 20% of the variance in males’ T2 CDI 2 depressive symptom scores (26% for females) and 21% of the variance in males’ T2 SWEMWBS mental wellbeing scores (23% for females). Depressive symptomatology and mental wellbeing were highly correlated, but symptoms of depression were more strongly associated with later mental wellbeing than vice versa. This has implications for educational psychologists, teachers, health professionals, and policy makers seeking to reduce depressive symptoms or promote mental wellbeing. Focusing solely on the promotion of mental wellbeing, without intervening to reduce symptoms of depression, may limit the potential outcomes that might be achieved.

Objectives: Research demonstrates heterogeneous neuropsychological profiles among individuals with mild cognitive impairment (MCI). However, few studies have included visuoconstructional ability or used latent mixture modeling to statistically identify MCI subtypes. Therefore, we examined whether unique neuropsychological MCI profiles could be ascertained using latent profile analysis (LPA), and subsequently investigated cerebrospinal fluid (CSF) biomarkers, genotype, and longitudinal clinical outcomes between the empirically derived classes. Methods: A total of 806 participants diagnosed by means of the Alzheimer’s Disease Neuroimaging Initiative (ADNI) MCI criteria received a comprehensive neuropsychological battery assessing visuoconstructional ability, language, attention/executive function, and episodic memory. Test scores were adjusted for demographic characteristics using standardized regression coefficients based on “robust” normal control performance (n=260). Calculated Z-scores were subsequently used in the LPA, and CSF-derived biomarkers, genotype, and longitudinal clinical outcome were evaluated between the LPA-derived MCI classes. Results: Statistical fit indices suggested a 3-class model was the optimal LPA solution. The three-class LPA consisted of a mixed impairment MCI class (n=106), an amnestic MCI class (n=455), and an LPA-derived normal class (n=245). Additionally, the amnestic and mixed classes were more likely to be apolipoprotein e4+ and have worse Alzheimer’s disease CSF biomarkers than LPA-derived normal subjects. Conclusions: Our study supports significant heterogeneity in MCI neuropsychological profiles using LPA and extends prior work (Edmonds et al., 2015) by demonstrating a lower rate of progression in the approximately one-third of ADNI MCI individuals who may represent “false-positive” diagnoses. Our results underscore the importance of using sensitive, actuarial methods for diagnosing MCI, as current diagnostic methods may be over-inclusive. (JINS, 2017, 23, 564–576)

Background: Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory. Aims: The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis. Method: Previous literature is reviewed, critiqued and synthesized to develop the model. It draws upon previous social cognitive models of internalized stigma and integrates cognitive behavioural theory and social mentality theory. Results: This paper identifies key cognitive, behavioural and emotional processes that contribute to the development and maintenance of internalized stigma, whilst also recognizing the central importance of cultural context in creating negative stereotypes of psychosis. Moreover, therapeutic strategies to alleviate internalized stigma are identified. A case example is explored and a formulation and brief intervention plan was developed in order to illustrate the model in practice. Conclusion: An integrative cognitive model is presented, which can be used to develop individualized case formulations, which can guide cognitive behavioural interventions targeting internalized stigma in those who experience psychosis. More research is required to examine the efficacy of such interventions. In addition, it is imperative to continue to research interventions that create change in stigma at a societal level.

Objectives: Within the Alzheimer’s Disease Neuroimaging Initiative (ADNI)’s mild cognitive impairment (MCI) cohort, we previously identified MCI subtypes as well as participants initially diagnosed with MCI but found to have normal neuropsychological, biomarker, and neuroimaging profiles. We investigated the functional change over time in these empirically derived MCI subgroups. Methods: ADNI MCI participants (n=654) were classified using cluster analysis as Amnestic MCI (single-domain memory impairment), Dysnomic MCI (memory+language impairments), Dysexecutive/Mixed MCI (memory+language+attention/executive impairments), or Cluster-Derived Normal (CDN). Robust normal control participants (NCs; n=284) were also examined. The Functional Activities Questionnaire (FAQ) was administered at baseline through 48-month follow-up. Multilevel modeling examined FAQ trajectories by cognitive subgroup. Results: The Dysexecutive/Mixed group demonstrated the fastest rate of decline across all groups. Amnestic and Dysnomic groups showed steeper rates of decline than CDNs. While CDNs had more functional difficulty than NCs across visits, both groups’ mean FAQ scores remained below its suggested cutoff at all visits. Conclusions: Results (a) show the importance of executive dysfunction in the context of other impaired cognitive domains when predicting functional decline in at-risk elders, and (b) support our previous work demonstrating that ADNI’s MCI criteria may have resulted in false-positive MCI diagnoses, given the CDN’s better FAQ trajectory than those of the cognitively impaired MCI groups. (JINS, 2017, 23, 521–527)

Objectives: We examined florbetapir positron emission tomography (PET) amyloid scans across stages of preclinical Alzheimer’s disease (AD) in cortical, allocortical, and subcortical regions. Stages were characterized using empirically defined methods. Methods: A total of 312 cognitively normal Alzheimer’s Disease Neuroimaging Initiative participants completed a neuropsychological assessment and florbetapir PET scan. Participants were classified into stages of preclinical AD using (1) a novel approach based on the number of abnormal biomarkers/cognitive markers each individual possessed, and (2) National Institute on Aging and the Alzheimer’s Association (NIA-AA) criteria. Preclinical AD groups were compared to one another and to a mild cognitive impairment (MCI) sample on florbetapir standardized uptake value ratios (SUVRs) in cortical and allocortical/subcortical regions of interest (ROIs). Results: Amyloid deposition increased across stages of preclinical AD in all cortical ROIs, with SUVRs in the later stages reaching levels seen in MCI. Several subcortical areas showed a pattern of results similar to the cortical regions; however, SUVRs in the hippocampus, pallidum, and thalamus largely did not differ across stages of preclinical AD. Conclusions: Substantial amyloid accumulation in cortical areas has already occurred before one meets criteria for a clinical diagnosis. Potential explanations for the unexpected pattern of results in some allocortical/subcortical ROIs include lack of correspondence between (1) cerebrospinal fluid and florbetapir PET measures of amyloid, or between (2) subcortical florbetapir PET SUVRs and underlying neuropathology. Findings support the utility of our novel method for staging preclinical AD. By combining imaging biomarkers with detailed cognitive assessment to better characterize preclinical AD, we can advance our understanding of who is at risk for future progression. (JINS, 2016, 22, 978–990)

This study examined associations between loneliness, a construct associated with serious adverse mental health outcomes, and positive mental wellbeing. Validated measures of loneliness (represented by friendship-related loneliness, isolation, positive attitude to solitude, and negative attitude to solitude) and positive mental wellbeing were administered to 1,143 adolescents from urban and rural schools. Confirmatory factor analyses revealed satisfactory model fit for both measures. A structural equation model confirmed significant positive associations between positive mental wellbeing and friendship-related loneliness and positive attitude to solitude; a significant negative association was found for isolation. Regression analyses provided support for significant differences in these associations according to gender, age, and geographical location (although only marginally). The implications of these findings during adolescence are reviewed.

The prevalence of violent behaviour within acute psychiatric services is about 10%.

Background: Low social rank and external shame have been found to be significantly associated with anxiety and depression. However, their relevance to experiences of psychosis has rarely been explored. Aims: This study aims to examine the relationship of social rank and external shame to personal recovery, depression and positive symptoms in psychosis. Method: A cross sectional correlational design was adopted to examine the relationship between all variables. Fifty-two service users, aged between 18 to 65 years, with experiences of psychosis were recruited for the study. Participants were administered outcome measures examining social rank, external shame, positive symptoms of psychosis, depression and personal recovery. Multiple regression analyses were conducted on the data. Results: Significant correlations were found between all variables. Low social rank was significantly associated with lower reported personal recovery, and higher levels of external shame and depression symptomology. The relationship between external shame and positive symptoms of psychosis and personal recovery was found to be mediated by participants’ level of depression. Conclusion: Findings suggest that social rank and external shame are relevant to those who experience psychosis. Therapeutic approaches may need to focus on perceptions of social rank and external shame in working with experiences of psychosis.

While there is increasing recognition of the need to go beyond measures of mental ill health, there is a relative dearth of validated tools for assessing mental well-being among adolescents. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) is a promising tool for use in this context, and this study evaluated its use in an Australian context. The WEMWBS was completed by 829 Western Australian adolescents, aged from 13 to 16 years old, drawn from Grades 8, 9 and 10 in seven separate high schools. Using confirmatory factor analytic techniques, the utility of the full 14-item scale was not supported, but good fit for a previously validated seven-item short version (SWEMWBS) was supported. Strong measurement invariance was demonstrated across age, and weak measurement invariance was demonstrated across gender. The scale has good internal reliability. There were no differences in SWEMWBS scores across Grades 8 to 10. Overall, the SWEMWBS represents a useful tool for educational, developmental, and school psychologists investigating positive mental wellbeing in younger adolescents.

This article discusses the development, implementation and impact of a social development program developed by the Holyoake Institute in Western Australia for use in schools. The program DRUMBEAT uses hand drumming to engage young people in social learning that assists them in integrating more fully into mainstream school and community life. DRUMBEAT was developed in response to a range of issues that disadvantaged Indigenous youth experienced within the educational system and acted to reinforce entrenched social exclusion. Operational for five years, DRUMBEAT is currently being delivered in over 350 schools across Australia. Since its inception the program has undergone several evaluations. The most recent of these, and the subject of this report, was conducted by researchers at The University of Western Australia and relates to participants in the program during the 2008 school year. This study demonstrated that participants in the program improved their level of self-confidence, reduced their level of behavioural incidents and reduced their level of school absenteeism.