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
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
Thalamic And Basal Forebrain Contributions To Auditory Cortical Reorganization Produced By Partial Hearing Loss
Funder
National Health and Medical Research Council
Funding Amount
$364,768.00
Summary
When part of the cochlea is damaged in adult animals, leading to a partial hearing loss, the auditory area of the cerebral cortex reorganizes itself, so that the area deprived of input by the peripheral lesion is not silent, but is occupied by expanded representations of adjacent frequencies. This reorganization has been observed in a number of species, including non-human primates, and it seems likely that it also occurs in humans with cochlear damage and hearing loss of this sort. If it does, ....When part of the cochlea is damaged in adult animals, leading to a partial hearing loss, the auditory area of the cerebral cortex reorganizes itself, so that the area deprived of input by the peripheral lesion is not silent, but is occupied by expanded representations of adjacent frequencies. This reorganization has been observed in a number of species, including non-human primates, and it seems likely that it also occurs in humans with cochlear damage and hearing loss of this sort. If it does, it would have important consequences for the way in which input from a hearing aid or cochlear prosthesis (bionic ear) is processed in the brain. This Project is designed to clarify the nature of the systems in the brain that contribute to this form of cortical plasticity, using an animal model. One aim is to determine whether the plasticity is intrinsic to the cortex or occurs in the pathways over which information is conveyed to the cortex. This will be assessed by determining whether such plasticity is also found in the auditory thalamus, the final subcortical auditory nucleus from which information is sent to the cortex. The second aim is to determine whether the occurrence of plasticity is controlled by modulatory influences from the basal part of the forebrain. Neurons in this area project to many parts of the cortex, and evidence from other sensory systems suggests that these projections exert a permissive function, allowing the cortex to reorganize when input is altered. This aim will be pursued by determining whether cortical reorganization occurs after hearing loss when this basal forebrain system is inactivated. The significance of these studies is that they will elucidate the way in which the brain reorganizes itself when it is confronted with altered input. This information is important for our understanding of normal auditory information processing mechanisms and of the way in which input from prosthetic devices is processed in the hearing-impaired.Read moreRead less
A Prospective Study Investigating Implications Of Bioactive Lipids For Diagnosis And Treatment Of Schizophrenia
Funder
National Health and Medical Research Council
Funding Amount
$324,480.00
Summary
This study will investigate the role of fatty acids (lipids) in schizophrenia. Studies in blood cells and in the brains of patients with schizophrenia have shown that these lipids and related products are altered in schizophrenia. We are now able to measure separate lipid metabolites in the living human brain using a technique called magnetic resonance spectroscopy. Until recently it was only possible to assess lipid metabolites as a group, limiting interpretation. Thanks to a newly available im ....This study will investigate the role of fatty acids (lipids) in schizophrenia. Studies in blood cells and in the brains of patients with schizophrenia have shown that these lipids and related products are altered in schizophrenia. We are now able to measure separate lipid metabolites in the living human brain using a technique called magnetic resonance spectroscopy. Until recently it was only possible to assess lipid metabolites as a group, limiting interpretation. Thanks to a newly available imaging system at the Brain Imaging Research Institute and a new analysis technique, we will be able to measure single lipid metabolites in the living human brain. Simultaneously we will also measure lipids and related enzymes in red blood cells that are responsible for the regulation of these lipids. Preliminary data has shown that there is a strong correlation between these two measures. Furthermore we will investigate the genes that are responsible for the production of these enzymes. By repeating the same tests after 12 weeks we hope to understand how the newer antipsychotic drugs act. Two easy clinical tests (a skin and breath test) will help us to implement the findings in daily clinical practice (diagnostic markers for patients at risk) . With such a multi-level approach we hope to contribute to a new understanding of the origins of schizophrenia going beyond the traditional concepts. The findings might also have direct implications for treatment. Preliminary results are very promising but also contradictory. Therefore it is even more important to carefully investigate the role of these lipids in schizophrenia.Read moreRead less
Improved Ways To Study The Effect Of Transient Exposures On The Risk Of An Illness, With Application To Flying And DVT
Funder
National Health and Medical Research Council
Funding Amount
$212,250.00
Summary
Improved methods of analysis will be developed to estimate the extent to which certain short-term activities trigger a particular illness and to determine who is most at risk. The new methods of analysis have many potential applications, including study of the effect of periods of intense exercise or intense alcohol consumption on the risk of a heart attack. Here we apply them to study the effect of air travel on illness due to blood clots in a vein (deep vein thrombosis, DVT), and the factors t ....Improved methods of analysis will be developed to estimate the extent to which certain short-term activities trigger a particular illness and to determine who is most at risk. The new methods of analysis have many potential applications, including study of the effect of periods of intense exercise or intense alcohol consumption on the risk of a heart attack. Here we apply them to study the effect of air travel on illness due to blood clots in a vein (deep vein thrombosis, DVT), and the factors that put individuals at greatest risk. The extra understanding that our improved analysis of the data provides will accelerate research into ways to minimise the risk of flight-induced DVT and implementation of preventative measures in the travel industry. This has the potential to prevent many cases, and deaths, because the number of flights taken, globally, by individuals in a year is now in the billions. Specifically, dependence of flight-induced DVT on age, sex, being pregnant, recent fractures and having certain cancers will identify individuals at greatest risk, while dependence on the duration of the flight will identify flights that present greater risk. The development of these new methods of analysis will make a lasting contribution to public health research, because they can be used to study many short-term-activity - illnesses combinations. The methods will see increasing applications because the type of data they rely on, namely the complete history of exposures over time periods, will increasingly become available as electronic recording of activities becomes more common place. For example, electronic records of flights are now almost universal and bookings at squash courts and other sporting venues are increasingly recorded electronically. The computer software to apply the new methods of analysis will be made available to other researchers, to promote studies of this type.Read moreRead less