Many clients with severe mental health problem, live in the community with their relatives. Research in the area has indicated that exacerbation of psychotic symptoms in clients is strongly associated with the emotional atmosphere in the family. The presence of high expressed emotion has been linked with relapse. However, recent research suggests that it is the causal attributions which relatives make to explain the illness symptomatology, which is most predictive of relapse. Relatives viewing clients' symptoms as being controllable by the client has been associated with hostility in relatives. Little has been said in the literature about the subjective experiences of clients. The present study investigated the causal attributions which clients and relatives made to explain the manifestation of the illness. Causal attributions made to explain positive symptoms, negative symptoms and behavioural problems were examined and compared. Clients! perception of their relationship with a key relative and their affective state was measured. Participants knowledge about schizophrenia, and relatives levels of distress were also examined. The clients in the present study were men under fifty with a diagnosis of schizophrenia. Key relatives also participated. A cross sectional correlational and comparative methodology was employed. A mixture of quantitative data and qualitative information was generated. A key finding was that the nature of attributions made was determined by symptom category. Positive Symptoms were deemed to be the least controllable symptom and Behavioural Problems were considered the most controllable. Relationships existed between the attributions made by clients and relatives. Depression in clients was related to them attributing their illness to personal factors, and a reporting negative feelings about there relationship with a key relative. Findings are discussed in relation to literature, research and clinical practice.

Background Research suggests that early intervention for schizophrenia improves prognosis and prevents relapse, but factors which influence early access to services still remain unclear. Two factors which have been implicated, however, are family involvement and gender of the person. Aims The current study set out to explore relatives' experience of seeking help for a person during the early stages of schizophrenia. This was to be considered in general terms and with particular reference to the influence that the gender of the person had on this process. Participants Clients with a diagnosis of schizophrenia in the last fifteen years were identified through routine clinical services and their permission sought to contact a relative. Eight relatives of men, and eight relatives of women, with schizophrenia were recruited. Methodology A qualitative, methodology was used. Relatives were interviewed about their experience using a semi-structured interview schedule. Results were analysed using a Grounded Theory method (Glaser and Strauss, 1990). Major Findings A theoretical framework for understanding the process of relative's adjustment to their experience was developed. The framework suggests that there are four inter-related phases that relatives go through during their help seeking experience. The framework also suggests that resolution is achieved when relatives' needs are adequately met in the following four areas: Understanding; Action; Integration of Difference; and Communication/Interaction. implications for Clinical Practice, Service Delivery and further research are discussed.

Study one is a meta-analysis of the relationship between childhood adversity and bipolar disorder. The results suggest that individuals with bipolar disorder are 2.63 times more likely to experience childhood adversity than non-clinical controls. This effect remained significant even when controlling for bias and when considering epidemiological and case control studies separately. Levels of adversity in bipolar disorder were comparable to those observed in samples diagnosed with unipolar depression and schizophrenia. In adversity subtype analysis, emotional abuse conveyed the greatest risk of bipolar disorder with an odds ratio of 4.04. The results suggest that childhood adversity, particularly emotional abuse, may play an important role in the development of bipolar disorder. This challenges the notion that bipolar disorder is solely the result of a genetic predisposition. Study two is cross-sectional research investigating the association between childhood adversity and social functioning across the continuum of psychosis, and possible mediators of this relationship (i.e. attachment style, theory of mind ability, clinical symptoms). Fifty-four clinical and 120 non-clinical participants completed self-report questionnaires, interviews and tasks of theory of mind ability. The author used multiple group structural equation modelling to fit mediation models, whilst allowing for differential relationships across the samples. In the final model, only depression mediated the relationship between childhood adversity and social functioning. Childhood adversity did not significantly predict theory of mind ability in this data. The results suggest that psychosocial interventions for improving social functioning should also target low mood, particularly in individuals with a history of childhood adversity. Taken together this thesis suggests that childhood adversity can have long-reaching and negative effects on individuals' mental well-being. The author explores the wider clinical, academic and theoretical implications, and potential limitations, of the research in paper three. This section also contains the author's reflections on the research process and a justification of key methodological and analytical decisions.

The present study investigated the causal predominance of cognition on anxiety, depression, paranoia, phobia and somatic concern over three time waves of self reported data measured every six months over one year, of 145 cases experiencing their first episodes of psychosis. In turn the symptoms of anxiety, depression, paranoia, phobia and somatic concern were examined for their cross-influential effects on cognition. Cognition was examined under a causal predominance hypothesis as the lead symptom because of its influence recognised in the literature under the neurodevelopmental hypothesis. These longitudinal effects were examined using structural equation modelling. Prior to this investigation, the research was able to demonstrate a stable 6-factor measurement model with these symptoms between two independent samples of early psychosis cases that met guidelines of treatment under the Australian national early psychosis treatment guidelines. This measurement model demonstrated good internal reliability and construct validity. Most symptoms over each time wave had a "domino effect" where the symptom prior to the next wave of assessment had an influence. This is known as a mediation effect. Somatic concern and depression demonstrated a "snow ball" or direct effect where the extent of the condition at time one influenced directly the condition at time three. Structural models, which examined the cross-influential effect between cognition and the other symptoms, demonstrated an effect between paranoia and cognition. This effect demonstrated that paranoia at Time 2 (i.e., 6 months after stabilisation of symptoms), had a crossinfluential effect on cognition at Time 3 (ie, 12 months after stabilisation of symptoms). / It was argued that poor thinking styles that lead to distortion in feelings of mistrust evident in the paranoia symptom, in turn led to deterioration in cognition. Other symptoms did not demonstrate a cross influential effect. Previous research suggesting that symptoms act independently of each other over time supports the results of independence of the other symptoms. Further research was suggested by linking different levels of psychosis research of the aetiological factors (e.g. genetic factors), neuropathology (e.g., reduced synapse density) and phenomenology (e.g., positive and negative symptoms) into an integrative framework. It was suggested that structural equation modelling as exemplified in the thesis could be used as a technique to examine how these differing levels could be investigated under a unified theory of psychosis based upon the neurodevelopmental hypothesis.

Elevated serum homocysteine concentrations are neurotoxic and are strongly implicated as a risk factor for neuropsychiatric disease (Fabender, Mielke, Bertsch, & Hennerici, 1999; Kim & Pae, 1996; Kruman et al., 2000; Reutens & Sachdev, 2002). This study compares homocysteine levels in early stages psychosis patients and healthy controls. Data from 48 healthy controls were compared with 50 previously diagnosed psychosis patients, 15-25 years, and with a gender ratio males: females 7:3. Patients were outpatients or inpatients at ORYGEN Youth Health, with a diagnosis of first episode of psychosis defined as daily psychotic symptoms lasting longer than a week that could not be explained by other means such as “drug-induced” or “organic”. / All subjects were interviewed to collect information relating to family psychotic history. A possible history of psychotic disease in control subjects was tested using the SCID Psych Screening Module, drug use recorded using Alcohol Use Disorders Identification Test (AUDIT) (for alcohol use), The Modified Fagerström Tolerance Questionnaire (mFTQ) (for smoking), Opiate Treatment Index (OTI) (for opiate-type drugs). Dietary and medication histories were also taken. Blood tests were performed to determine serum homocysteine, serum folate, red blood cell folate and serum vitamin B12 levels. / An independent sample t test to compare homocysteine levels in patients and controls was performed. Serum homocysteine levels were significantly higher for patients (M = 12.9, S.D. = 3.6) than controls (M = 11.1, S.D. = 2.7) (t(96) = 2.7, p = 0.007, two-tailed). After General Linear Model (GLM) analysis it was found that group (patients or controls), and not serum folate, vitamin B12 and the T allele of MTHFR C677 polymorphism had significant effect on homocysteine levels. Thus a number of factors that may increase homocysteine levels were ruled out. / Although it was not possible to obtain a complete data set for some factors (alcohol, smoking and caffeine consumption) (a weakness of the study), strengths included consecutive recruitment, minimisation of selection bias, good matching for age and gender between patients and controls, and the consideration of (serum) folate and (serum) vitamin B12 as potential confounding variables. / A number of other studies have found significantly increased homocysteine levels in young patients compared with controls, particularly males. Most related studies favoured the homocysteine-psychosis link. / The probability of symptomatic recovery is very high (80-90%) after treatment for first episode psychosis (Robinson et al., 1999) and delayed treatment, but prolonged duration of treatment is associated with poorer response in treatment and worse outcome (Malla & Norman, 2002). This justifies studying homocysteine levels and cognitive function in that first period of psychosis. / This research offers evidence for the importance of serum homocysteine levels as showing involvement in the etiology of psychosis. Lowering homocysteine may have a beneficial effect on symptoms and cognitive dysfunction in psychotic illness. / Two randomised controlled trials have demonstrated benefit in psychotic illness of giving folate and consequently reducing homocysteine.(Godfrey & Toone, 1990; Levine et al., 2006b). Benefits of taking folate were found in both trials for both cognition and psychotic symptoms. By reducing homocysteine levels early in the illness, some of the excess cardiovascular mortality may be prevented. / Secondary prevention of CVD does not appear to influence outcome (Hermann, Herrmann, & Obeid, 2007), so the right time to intervene and reduce risk would appear to be early in the course of psychosis. Additionally, by lowering homocysteine cognitive functioning and psychotic symptoms may be improved (Levine et al., 2006b).

The stigma associated with a mental illness can be an impediment to recovery and has been described as more long lasting and disabling than the illness itself (Schulze & Angermeyer, 2003). Thus reducing stigma is an important cornerstone in any mental health strategy. This study examined the impact of an educational presentation by the Edmonton Early Psychosis Intervention Clinic (EEPIC) on reducing stigma associated with psychosis and schizophrenia. Stigma was measured using the Attribution Questionnaire (Corrigan, Markowitz, Watson, Rowan, & Kubiak, 2003) and the World Psychiatric Association’s Presentation Evaluation (Sartorius & Schulze, 2005). Respondents’ knowledge about the causes of schizophrenia improved as a result of the presentation. In addition, respondents viewed people with schizophrenia as less dangerous and were less socially distancing after the educational presentation. These results provide preliminary evidence that a time-limited educational presentation can foster positive attitudes and reduce the stigma related to schizophrenia. / Measurement, Evaluation and Cognition

No description available.

No description available.

Elevated serum homocysteine concentrations are neurotoxic and are strongly implicated as a risk factor for neuropsychiatric disease (Fabender, Mielke, Bertsch, & Hennerici, 1999; Kim & Pae, 1996; Kruman et al., 2000; Reutens & Sachdev, 2002). This study compares homocysteine levels in early stages psychosis patients and healthy controls. Data from 48 healthy controls were compared with 50 previously diagnosed psychosis patients, 15-25 years, and with a gender ratio males: females 7:3. Patients were outpatients or inpatients at ORYGEN Youth Health, with a diagnosis of first episode of psychosis defined as daily psychotic symptoms lasting longer than a week that could not be explained by other means such as “drug-induced” or “organic”. / All subjects were interviewed to collect information relating to family psychotic history. A possible history of psychotic disease in control subjects was tested using the SCID Psych Screening Module, drug use recorded using Alcohol Use Disorders Identification Test (AUDIT) (for alcohol use), The Modified Fagerström Tolerance Questionnaire (mFTQ) (for smoking), Opiate Treatment Index (OTI) (for opiate-type drugs). Dietary and medication histories were also taken. Blood tests were performed to determine serum homocysteine, serum folate, red blood cell folate and serum vitamin B12 levels. / An independent sample t test to compare homocysteine levels in patients and controls was performed. Serum homocysteine levels were significantly higher for patients (M = 12.9, S.D. = 3.6) than controls (M = 11.1, S.D. = 2.7) (t(96) = 2.7, p = 0.007, two-tailed). After General Linear Model (GLM) analysis it was found that group (patients or controls), and not serum folate, vitamin B12 and the T allele of MTHFR C677 polymorphism had significant effect on homocysteine levels. Thus a number of factors that may increase homocysteine levels were ruled out. / Although it was not possible to obtain a complete data set for some factors (alcohol, smoking and caffeine consumption) (a weakness of the study), strengths included consecutive recruitment, minimisation of selection bias, good matching for age and gender between patients and controls, and the consideration of (serum) folate and (serum) vitamin B12 as potential confounding variables. / A number of other studies have found significantly increased homocysteine levels in young patients compared with controls, particularly males. Most related studies favoured the homocysteine-psychosis link. / The probability of symptomatic recovery is very high (80-90%) after treatment for first episode psychosis (Robinson et al., 1999) and delayed treatment, but prolonged duration of treatment is associated with poorer response in treatment and worse outcome (Malla & Norman, 2002). This justifies studying homocysteine levels and cognitive function in that first period of psychosis. / This research offers evidence for the importance of serum homocysteine levels as showing involvement in the etiology of psychosis. Lowering homocysteine may have a beneficial effect on symptoms and cognitive dysfunction in psychotic illness. / Two randomised controlled trials have demonstrated benefit in psychotic illness of giving folate and consequently reducing homocysteine.(Godfrey & Toone, 1990; Levine et al., 2006b). Benefits of taking folate were found in both trials for both cognition and psychotic symptoms. By reducing homocysteine levels early in the illness, some of the excess cardiovascular mortality may be prevented. / Secondary prevention of CVD does not appear to influence outcome (Hermann, Herrmann, & Obeid, 2007), so the right time to intervene and reduce risk would appear to be early in the course of psychosis. Additionally, by lowering homocysteine cognitive functioning and psychotic symptoms may be improved (Levine et al., 2006b).

The experience of stress and associated coping responses are often described as playing an important role in the onset of schizophrenia and other psychotic disorders. Despite widespread acceptance of this model, there is little empirical evidence to support such a relationship. This is partly due to a lack of well-designed prospective studies of the onset of psychotic disorders that incorporate different aspects of the stress and coping process. The relatively recent development of validated and reliable criteria for identifying young people at high-risk (UHR) of developing psychosis has enabled the process of onset of psychotic illnesses to be studied more closely than was previously possible. It has also opened the way to the development and evaluation of preventive interventions. This longitudinal study aimed to compare the experiences of stress and coping between a UHR cohort (N = 143) and a group of young people without mental health concerns (HC group, N = 32). In addition, the contribution of stress and coping in the development of acute psychosis in a subgroup of the UHR cohort (UHR-P, n = 18) was also investigated.