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8 results

  • Predicting the emergence of full-threshold bipolar I, bipolar II and psychotic disorders in young people presenting to early intervention mental health services

  • Joanne S. Carpenter, Jan Scott, Frank Iorfino, Jacob J. Crouse, Nicholas Ho, Daniel F. Hermens, Shane P. M. Cross, Sharon L. Naismith, Adam J. Guastella, Elizabeth M. Scott, Ian B. Hickie
  • Journal:
    Psychological Medicine / Volume 52 / Issue 10 / July 2022
    Published online by Cambridge University Press:
    30 October 2020, pp. 1990-2000
  • Background

    Predictors of new-onset bipolar disorder (BD) or psychotic disorder (PD) have been proposed on the basis of retrospective or prospective studies of ‘at-risk’ cohorts. Few studies have compared concurrently or longitudinally factors associated with the onset of BD or PDs in youth presenting to early intervention services. We aimed to identify clinical predictors of the onset of full-threshold (FT) BD or PD in this population.

    Method

    Multi-state Markov modelling was used to assess the relationships between baseline characteristics and the likelihood of the onset of FT BD or PD in youth (aged 12–30) presenting to mental health services.

    Results

    Of 2330 individuals assessed longitudinally, 4.3% (n = 100) met criteria for new-onset FT BD and 2.2% (n = 51) met criteria for a new-onset FT PD. The emergence of FT BD was associated with older age, lower social and occupational functioning, mania-like experiences (MLE), suicide attempts, reduced incidence of physical illness, childhood-onset depression, and childhood-onset anxiety. The emergence of a PD was associated with older age, male sex, psychosis-like experiences (PLE), suicide attempts, stimulant use, and childhood-onset depression.

    Conclusions

    Identifying risk factors for the onset of either BD or PDs in young people presenting to early intervention services is assisted not only by the increased focus on MLE and PLE, but also by recognising the predictive significance of poorer social function, childhood-onset anxiety and mood disorders, and suicide attempts prior to the time of entry to services. Secondary prevention may be enhanced by greater attention to those risk factors that are modifiable or shared by both illness trajectories.

  • Chapter 5 - The Utility of Clinical Staging in Youth Mental Health Settings

  • from Section 2 - Progress with Clinical Staging
  • Edited by Patrick D. McGorry, University of Melbourne, Ian B. Hickie, University of Sydney
  • Book:
    Clinical Staging in Psychiatry
    Published online:
    08 August 2019
    Print publication:
    29 August 2019, pp 81-102

  • Summary

    For over a decade a transdiagnostic clinical staging framework for youth with anxiety, mood and psychotic disorders (linked with measurement of multidimensional outcomes), has been utilised in over 8,000 young people presenting to the enhanced primary (headspace) and secondary care clinics of the Brain and Mind Centre of the University of Sydney. This framework has been evaluated alongside a broad range of other clinical, neurobiological, neuropsychological, brain imaging, circadian, metabolic, longitudinal cohort and controlled intervention studies. This has led to specific tests of its concurrent, discriminant and predictive validity. These extensive data provide strong preliminary evidence that: i) varying stages of illness are associated with predicted differences in a range of independent and objectively measured neuropsychological and other biomarkers (both cross-sectionally and longitudinally); and, ii) that earlier stages of illness progress at variable rates to later and more severe or persistent disorders. Importantly, approximately 15-20% of those young people classed as stage 1b or ‘attenuated’ syndromes at presentation progress to more severe or persistent disorders. Consequently, this cohort should be the focus of active secondary prevention trials. In clinical practice, we are moving to combine the staging framework with likely pathophysiological paths (e.g. neurodevelopmental-psychotic, anxiety-depression, circadian-bipolar) to underpin enhanced treatment selection.

  • Chapter 13 - Transforming Cultures to Enable Stage-Related Care of Mental Ill-Health

  • from Section 4 - Novel Treatment Strategies
  • Edited by Patrick D. McGorry, University of Melbourne, Ian B. Hickie, University of Sydney
  • Book:
    Clinical Staging in Psychiatry
    Published online:
    08 August 2019
    Print publication:
    29 August 2019, pp 261-277

  • Summary

    Although mental health issues are the key health concern for young people, contributing 45% of the total burden of disease for those aged 10-24 years, young people have the poorest access to mental health care. Current service approaches are insufficient, poorly designed and not well supported. Transformational reform of mental health care is needed, based on principles of evidence-informed care, early intervention, and a focus on the developmental period of greatest need and capacity to benefit from investment: emerging adulthood. The most appropriate care models for this period place emphasis on offering care that is appropriate to early stages of illness, pre-emptive in nature, and with a strong preventive focus. This sits best with a clinical staging approach, which distinguishes earlier and milder clinical phenomena from those that accompany illness progression and chronicity. This provides a clinically useful framework that is sensitive to risk/benefit considerations and facilitates the selection of earlier, safer interventions, and favours a preventive or pre-emptive treatment approach. In this chapter, rapidly emerging examples of modern, stigma-free cultures of care designed and operated with young people themselves are described. This includes headspace and technologically enhanced service delivery models. Future directions for youth services are also described.

  • Predicting early transition from sub-syndromal presentations to major mental disorders

  • Shane P.M. Cross, Jan Scott, Ian B. Hickie
  • Journal:
    BJPsych Open / Volume 3 / Issue 5 / September 2017
    Published online by Cambridge University Press:
    02 January 2018, pp. 223-227
    • Article
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      • Open access
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  • Background

    Transition from at-risk state to full syndromal mental disorders is underexplored for unipolar and bipolar disorders compared with psychosis.

    Aims

    Prospective, trans-diagnostic study of rates and predictors of early transition from sub-threshold to full syndromal mental disorder.

    Method

    One-year outcome of 243 consenting youth aged 15–25 years with a sub-syndromal presentation of a potentially severe mental disorder. Survival analysis and odds ratio (OR) for predictors of transition identified from baseline clinical and demographic ratings.

    Results

    About 17% (n=36) experienced transition to a major mental disorder. Independent of syndromal diagnosis, transition was significantly more likely in individuals who were NEET (not in education, employment or training), in females and in those with more negative psychological symptoms (e.g. social withdrawal).

    Conclusions

    NEET status and negative symptoms are modifiable predictors of illness trajectory across diagnostic categories and are not specific to transition to psychosis.

  • The Ecological implications of a Yakutian mammoth's last meal

  • Bas van Geel, André Aptroot, Claudia Baittinger, Hilary H. Birks, Ian D. Bull, Hugh B. Cross, Richard P. Evershed, Barbara Gravendeel, Erwin J.O. Kompanje, Peter Kuperus, Dick Mol, Klaas G.J. Nierop, Jan Peter Pals, Alexei N. Tikhonov, Guido van Reenen, Peter H. van Tienderen
  • Journal:
    Quaternary Research / Volume 69 / Issue 3 / May 2008
    Published online by Cambridge University Press:
    20 January 2017, pp. 361-376

  • Part of a large male woolly mammoth (Mammuthus primigenius) was preserved in permafrost in northern Yakutia. It was radiocarbon dated to ca. 18,50014C yr BP (ca. 22,500 cal yr BP). Dung from the lower intestine was subjected to a multiproxy array of microscopic, chemical, and molecular techniques to reconstruct the diet, the season of death, and the paleoenvironment. Pollen and plant macro-remains showed that grasses and sedges were the main food, with considerable amounts of dwarf willow twigs and a variety of herbs and mosses. Analyses of 110-bp fragments of the plastid rbcL gene amplified from DNA and of organic compounds supplemented the microscopic identifications. Fruit-bodies of dung-inhabiting Ascomycete fungi which develop after at least one week of exposure to air were found inside the intestine. Therefore the mammoth had eaten dung. It was probably mammoth dung as no bile acids were detected among the fecal biomarkers analysed. The plant assemblage and the presence of the first spring vessels of terminal tree-rings of dwarf willows indicated that the animal died in early spring. The mammoth lived in extensive cold treeless grassland vegetation interspersed with wetter, more productive meadows. The study demonstrated the paleoecological potential of several biochemical analytical techniques.

  • Listening as Covert Performance

  • Ian Cross
  • Journal:
    Journal of the Royal Musical Association / Volume 135 / Issue S1 / 2010
    Published online by Cambridge University Press:
    01 January 2020, pp. 67-77
    Print publication:
    2010

  • This paper presents a view of musical listening as an active, dynamic and interactive process. After briefly considering the historical valorization of listening as critical act within Western musical culture, the paper describes the cognitive processes of schematization that are involved in musical listening. The central role of active engagement with the auditory environment in eliciting emotional responses to music is then sketched out, and the scope and limits of the attentional and motoric processes involved in processes of entrainment – focal in the experience of musical time – are outlined. Neuroscientific evidence that suggests that music is best conceived in terms of a perception–action cycle is reviewed, and the paper concludes by proposing that music is best conceptualized – from a biological perspective – as a communicative medium that is optimal for the management of situations of social uncertainty.