The Schizotypal Personality Questionnaire (SPQ) is a widely-used self-report instrument for the a... more The Schizotypal Personality Questionnaire (SPQ) is a widely-used self-report instrument for the assessment of schizotypal personality traits. However, the factor structure of scores on English and non-English translations of the SPQ has been a matter of debate. With little previous factorial evaluation of the German version of the SPQ (SPQ-G), we re-assessed the higher-order factor structure of the measure. A total of 2,428 German-speaking adults from Central Europe (CE) and the United Kingdom (UK) completed the SPQ-G. Confirmatory factor analysis - testing proposed 2-, 3-, and 4-factor models of SPQ-G scores - indicated that the 4-factor solution had best fit. Partial measurement invariance across cultural group (CE and UK) and sex was obtained for the 4-factor model. Further analyses showed CE participants had significantly higher scores than UK participants on one schizotypal facet. These results suggest that scores on the SPQ-G are best explained in terms of a higher-order, 4-fa...
Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists, Jan 5, 2017
The Schizotypal Personality Questionnaire (SPQ) is a widely used self-report measurement instrume... more The Schizotypal Personality Questionnaire (SPQ) is a widely used self-report measurement instrument for the assessment of schizotypal personality traits. However, the factor structure of the SPQ has been a matter of some debate. As a contribution to this debate, we examined the factor structure of the SPQ in Malaysian adults. A total of 382 Malaysian adults completed a Malay translation of the SPQ. Confirmatory factory analysis was used to examine the fit of 3- and 4-factor solutions for the higher-order dimensionality of the SPQ. Ethnic invariance for the best-fitting model was tested at the configural, metric, and scalar levels, and a multivariate analysis of variance was used to examine sex and ethnicity differences in domain scores. The 4-factor model provided a better fit to the data than did the 3-factor model. The 4-factor model also demonstrated partial measurement invariance across ethnic groups. Latent mean comparisons for sex and ethnicity revealed a number of significant...
Social Psychiatry and Psychiatric Epidemiology, 2008
Introduction In this study, we aimed to establish: (1) whether social isolation modifies the effe... more Introduction In this study, we aimed to establish: (1) whether social isolation modifies the effect of unemployment on first episode psychosis and duration of untreated psychosis (DUP); and (2) whether the gap between high employment expectations and perceived poor employment achievement is associated with first-episode psychosis; and (3) whether the relationship of this achievement-expectation gap and first-episode psychosis is strongest in the African-Caribbean population. Method All patients with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in southeast London and Nottingham over a 2-year period were included in the study. A random sample of healthy participants living within the same catchment areas was also recruited. Data were collected on sociodemographic and clinical characteristics, DUP, social contacts, and perceived levels of employment achievement and expectation. Analysis was conducted on data of 546 participants (224 cases, 322 controls) from the AESOP study. Results The relationship between unemployment and risk of non-affective psychosis was moderated by social contacts (unemployed/ low social contacts, OR 7.52, 95% CI 2.97-19.08; unemployed/medium social contacts, OR 3.27, 95% CI 1.66-6.47; unemployed/high social contacts, OR 1.36, 95% CI 0.47-3.93). Unemployed patients experienced a longer DUP when having reported lower levels of social contacts. Participants whose employment achievement was lower than their expectations were more likely to be cases than those in whom achievement matched or exceeded expectations (adjusted OR 1.84, 95% CI 1.13-3.02). This applied equally to both African-Caribbean and White British participants (the Mantel-Haenszel test for homogeneity of odds ratios, v 2 = 0.96, P = 0.33). Conclusions This study suggests that unemployment, social isolation, employment achievement and expectations are important environmental factors associated with risk of psychosis. More attention needs to be focused on interactions between environmental factors as well as subjective experience of those factors in future research on the aetiology of psychosis.
Background: Clozapine and olanzapine are widely prescribed. Adverse effects of clozapine that may... more Background: Clozapine and olanzapine are widely prescribed. Adverse effects of clozapine that may be dose-related include drowsiness, hypersalivation, constipation, and seizures. Longer-term effects of clozapine and of olanzapine include weight gain, dyslipidaemia, and diabetes, effects that are thought to be more frequent in females. In order to gather information on the doses used, and the plasma concentrations of clozapine and N-desmethylclozapine (norclozapine), and of olanzapine, attained in males and females, we have audited data from a therapeutic drug monitoring (TDM) service. Methods: The data arose from the analysis of plasma samples submitted for routine TDM from patients in the UK/Eire for (i) clozapine, 1993-2004, and (ii) olanzapine, 1999-2009. Information requested before the analysis included prescribed dose, age, sex, and smoking habit. Results: (i) Clozapine. There were 60,273 samples from 17,514 patients [12,276 male aged at time of first sample (median, range) 34 (9-97) yr and 5,146 female aged 38 (10-90) yr] (sex not recorded for the remaining samples). Where smoking status recorded, 72% of males and 59% of females smoked. Mean age at time of sampling was 36 (95% CI 36-36) yr in males and 39 (CI 39-39) yr in females (P<0.05). Clozapine/norclozapine were below 0.01 mg/L in 1.6 and 1.3% of samples from males and females, respectively. In the remainder, despite on average being prescribed higher doses (median 450 and 400 mg/d for males and females, respectively), a
Many studies have shown that rates of psychosis are elevated in the Black and minority ethnic (BM... more Many studies have shown that rates of psychosis are elevated in the Black and minority ethnic (BME) population in the UK. One important, but relatively less researched explanation of these high rates may be social adversity associated with acculturation processes. Strong identification with an ethnic minority group subjected to social disadvantage may exert adverse effects on individuals from BME groups. Using data from a large epidemiological casecontrol study of first-episode psychosis, we aimed to investigate whether strong ethnic identification is a factor contributing to the excess of psychosis in BME groups compared with the White British, after adjustment for perceptions of disadvantage. All cases with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in London and Nottingham, UK, and geographically matched community controls were included in the study. Data were collected on socio-demographic and clinical characteristics, perceptions of disadvantage, and identification with one's own ethnic group. Analysis was performed on data from 139 cases and 234 controls. There was evidence that, as levels of ethnic identification increased, the odds of psychosis increased in the BME but not in the White British group, independent of potential confounders. However, the association between strong ethnic identity and psychosis in BME individuals was attenuated and nonsignificant when controlled for perceived disadvantage. Strong identification with an ethnic minority group may be a potential contributory factor of the high rates of psychosis in the BME population, the effects of which may be explained by perceptions of disadvantage.
Childhood trauma and cognitive function in first-episode affective and non-affective psychosis
Schizophrenia Research, 2011
A history of childhood trauma is reportedly more prevalent in people suffering from psychosis tha... more A history of childhood trauma is reportedly more prevalent in people suffering from psychosis than in the general population. Childhood trauma has also been linked to cognitive abnormalities in adulthood, and cognitive abnormalities, in turn, are one of the key clinical features of psychosis. Therefore, this study investigated whether there was a relationship between childhood trauma and cognitive function in patients with first-episode psychosis. The potential impact of diagnosis (schizophrenia or affective psychosis) and gender on this association was also examined. Data were available for 138 first-episode psychosis patients and 138 geographically-matched controls recruited from a catchment area based organisation. History of childhood trauma was obtained using the Childhood Experience of Care and Abuse Questionnaire. Cognitive function was assessed through a comprehensive and standardised neuropsychological test battery. A history of childhood trauma was associated with worse cognitive performances, predominantly in affective psychoses, and in male patients. No association between a history of childhood trauma and cognition was found amongst female patients, or female controls. The results need replication, but underline the necessity of investigating biological and psychosocial mechanisms underlying these…
nomic research. Based on literature, it was assumed that as an effect of screening, diabetes was ... more nomic research. Based on literature, it was assumed that as an effect of screening, diabetes was detected 5 years earlier and complications of diabetes were correspondingly postponed for 5 years. In the Netherlands costs per QALY at €20000 have been suggested as threshold for favorable cos t-effectiveness. We determined the incidence that needed to be detected for a cost-effective screening. Results: Screening costs and costs for the treatment of diabetes were €12540 per newly detected diabetes patient. Complications of diabetes avoided by the screening led to savings at €9629,60 and 0.17964 QALYs gained. The screening was cost-effective for an incidence of diabetes of 1.3% per year. Conclusions: Annual screening for cardiovascular and metabolic diseases in schizophrenic patients was cost-effective if at least 1.3% new cases of diabetes were detected per year. [1] Hoerger T, Harris K, Hicks K et al. Screening for type 2 diabetes mellitus; a cost-effectiveness analysis. Annals of Internal Medicine 2004; 140 (4) 689-699 [2] Meyer J, Nasrallah H, McEnvoy et al. The CATIE study: clinical comparison of subgroups with and wi thout the metabolic syndrome. Schizophrenia Research 2005(80) 9-18
It is argued that current attempts to investigate the process of family therapy might benefit fro... more It is argued that current attempts to investigate the process of family therapy might benefit from the application of discursive and narrative analytic techniques. An example of such an analysis is given, taking the work of an experienced family therapist with one family seeking help in dealing with the aftermath of a marital separation.‘ The theme of how to deal with change’as it materializes in the discussions during therapy is selected for detailed examination in this paper. It is argued that there are two main discourses on this theme evident in the family's discussions, one being that the separation has occurred and its consequences should now he left to arise naturally; the other being that the effects of the separation need to be actively managed. It is suggested that this analytic procedure can dramatize the subtle changes in family discourses during therapy; its limitations in terms of generalizability, and the difficulties of dealing with huge amounts of complex materi...
BackgroundSeveral studies have suggested that neuropsychological and structural brain deficits ar... more BackgroundSeveral studies have suggested that neuropsychological and structural brain deficits are implicated in poor insight. Few insight studies however have combined neurocognitive and structural neuroanatomical measures.AimsFocusing on the ability to relabel psychotic symptoms as pathological, we examined insight, brain structure and neurocognition in first-onset psychosis.MethodVoxel-based magnetic resonance imaging data were acquired from 82 individuals with psychosis and 91 controls assessed with a brief neuropsychological test battery. Insight was measured using the Schedule for the Assessment of Insight.ResultsThe principal analysis showed reduced general neuropsychological function was linked to poor symptom relabelling ability. A subsequent between-psychosis group analysis found those with no symptom relabelling ability had significant global and regional grey matter deficits primarily located at the posterior cingulate gyrus and right precuneus/cuneus.ConclusionsThe cing...
The Schizotypal Personality Questionnaire (SPQ) is a widely-used self-report instrument for the a... more The Schizotypal Personality Questionnaire (SPQ) is a widely-used self-report instrument for the assessment of schizotypal personality traits. However, the factor structure of scores on English and non-English translations of the SPQ has been a matter of debate. With little previous factorial evaluation of the German version of the SPQ (SPQ-G), we re-assessed the higher-order factor structure of the measure. A total of 2,428 German-speaking adults from Central Europe (CE) and the United Kingdom (UK) completed the SPQ-G. Confirmatory factor analysis - testing proposed 2-, 3-, and 4-factor models of SPQ-G scores - indicated that the 4-factor solution had best fit. Partial measurement invariance across cultural group (CE and UK) and sex was obtained for the 4-factor model. Further analyses showed CE participants had significantly higher scores than UK participants on one schizotypal facet. These results suggest that scores on the SPQ-G are best explained in terms of a higher-order, 4-fa...
Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists, Jan 5, 2017
The Schizotypal Personality Questionnaire (SPQ) is a widely used self-report measurement instrume... more The Schizotypal Personality Questionnaire (SPQ) is a widely used self-report measurement instrument for the assessment of schizotypal personality traits. However, the factor structure of the SPQ has been a matter of some debate. As a contribution to this debate, we examined the factor structure of the SPQ in Malaysian adults. A total of 382 Malaysian adults completed a Malay translation of the SPQ. Confirmatory factory analysis was used to examine the fit of 3- and 4-factor solutions for the higher-order dimensionality of the SPQ. Ethnic invariance for the best-fitting model was tested at the configural, metric, and scalar levels, and a multivariate analysis of variance was used to examine sex and ethnicity differences in domain scores. The 4-factor model provided a better fit to the data than did the 3-factor model. The 4-factor model also demonstrated partial measurement invariance across ethnic groups. Latent mean comparisons for sex and ethnicity revealed a number of significant...
Social Psychiatry and Psychiatric Epidemiology, 2008
Introduction In this study, we aimed to establish: (1) whether social isolation modifies the effe... more Introduction In this study, we aimed to establish: (1) whether social isolation modifies the effect of unemployment on first episode psychosis and duration of untreated psychosis (DUP); and (2) whether the gap between high employment expectations and perceived poor employment achievement is associated with first-episode psychosis; and (3) whether the relationship of this achievement-expectation gap and first-episode psychosis is strongest in the African-Caribbean population. Method All patients with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in southeast London and Nottingham over a 2-year period were included in the study. A random sample of healthy participants living within the same catchment areas was also recruited. Data were collected on sociodemographic and clinical characteristics, DUP, social contacts, and perceived levels of employment achievement and expectation. Analysis was conducted on data of 546 participants (224 cases, 322 controls) from the AESOP study. Results The relationship between unemployment and risk of non-affective psychosis was moderated by social contacts (unemployed/ low social contacts, OR 7.52, 95% CI 2.97-19.08; unemployed/medium social contacts, OR 3.27, 95% CI 1.66-6.47; unemployed/high social contacts, OR 1.36, 95% CI 0.47-3.93). Unemployed patients experienced a longer DUP when having reported lower levels of social contacts. Participants whose employment achievement was lower than their expectations were more likely to be cases than those in whom achievement matched or exceeded expectations (adjusted OR 1.84, 95% CI 1.13-3.02). This applied equally to both African-Caribbean and White British participants (the Mantel-Haenszel test for homogeneity of odds ratios, v 2 = 0.96, P = 0.33). Conclusions This study suggests that unemployment, social isolation, employment achievement and expectations are important environmental factors associated with risk of psychosis. More attention needs to be focused on interactions between environmental factors as well as subjective experience of those factors in future research on the aetiology of psychosis.
Background: Clozapine and olanzapine are widely prescribed. Adverse effects of clozapine that may... more Background: Clozapine and olanzapine are widely prescribed. Adverse effects of clozapine that may be dose-related include drowsiness, hypersalivation, constipation, and seizures. Longer-term effects of clozapine and of olanzapine include weight gain, dyslipidaemia, and diabetes, effects that are thought to be more frequent in females. In order to gather information on the doses used, and the plasma concentrations of clozapine and N-desmethylclozapine (norclozapine), and of olanzapine, attained in males and females, we have audited data from a therapeutic drug monitoring (TDM) service. Methods: The data arose from the analysis of plasma samples submitted for routine TDM from patients in the UK/Eire for (i) clozapine, 1993-2004, and (ii) olanzapine, 1999-2009. Information requested before the analysis included prescribed dose, age, sex, and smoking habit. Results: (i) Clozapine. There were 60,273 samples from 17,514 patients [12,276 male aged at time of first sample (median, range) 34 (9-97) yr and 5,146 female aged 38 (10-90) yr] (sex not recorded for the remaining samples). Where smoking status recorded, 72% of males and 59% of females smoked. Mean age at time of sampling was 36 (95% CI 36-36) yr in males and 39 (CI 39-39) yr in females (P<0.05). Clozapine/norclozapine were below 0.01 mg/L in 1.6 and 1.3% of samples from males and females, respectively. In the remainder, despite on average being prescribed higher doses (median 450 and 400 mg/d for males and females, respectively), a
Many studies have shown that rates of psychosis are elevated in the Black and minority ethnic (BM... more Many studies have shown that rates of psychosis are elevated in the Black and minority ethnic (BME) population in the UK. One important, but relatively less researched explanation of these high rates may be social adversity associated with acculturation processes. Strong identification with an ethnic minority group subjected to social disadvantage may exert adverse effects on individuals from BME groups. Using data from a large epidemiological casecontrol study of first-episode psychosis, we aimed to investigate whether strong ethnic identification is a factor contributing to the excess of psychosis in BME groups compared with the White British, after adjustment for perceptions of disadvantage. All cases with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in London and Nottingham, UK, and geographically matched community controls were included in the study. Data were collected on socio-demographic and clinical characteristics, perceptions of disadvantage, and identification with one's own ethnic group. Analysis was performed on data from 139 cases and 234 controls. There was evidence that, as levels of ethnic identification increased, the odds of psychosis increased in the BME but not in the White British group, independent of potential confounders. However, the association between strong ethnic identity and psychosis in BME individuals was attenuated and nonsignificant when controlled for perceived disadvantage. Strong identification with an ethnic minority group may be a potential contributory factor of the high rates of psychosis in the BME population, the effects of which may be explained by perceptions of disadvantage.
Childhood trauma and cognitive function in first-episode affective and non-affective psychosis
Schizophrenia Research, 2011
A history of childhood trauma is reportedly more prevalent in people suffering from psychosis tha... more A history of childhood trauma is reportedly more prevalent in people suffering from psychosis than in the general population. Childhood trauma has also been linked to cognitive abnormalities in adulthood, and cognitive abnormalities, in turn, are one of the key clinical features of psychosis. Therefore, this study investigated whether there was a relationship between childhood trauma and cognitive function in patients with first-episode psychosis. The potential impact of diagnosis (schizophrenia or affective psychosis) and gender on this association was also examined. Data were available for 138 first-episode psychosis patients and 138 geographically-matched controls recruited from a catchment area based organisation. History of childhood trauma was obtained using the Childhood Experience of Care and Abuse Questionnaire. Cognitive function was assessed through a comprehensive and standardised neuropsychological test battery. A history of childhood trauma was associated with worse cognitive performances, predominantly in affective psychoses, and in male patients. No association between a history of childhood trauma and cognition was found amongst female patients, or female controls. The results need replication, but underline the necessity of investigating biological and psychosocial mechanisms underlying these…
nomic research. Based on literature, it was assumed that as an effect of screening, diabetes was ... more nomic research. Based on literature, it was assumed that as an effect of screening, diabetes was detected 5 years earlier and complications of diabetes were correspondingly postponed for 5 years. In the Netherlands costs per QALY at €20000 have been suggested as threshold for favorable cos t-effectiveness. We determined the incidence that needed to be detected for a cost-effective screening. Results: Screening costs and costs for the treatment of diabetes were €12540 per newly detected diabetes patient. Complications of diabetes avoided by the screening led to savings at €9629,60 and 0.17964 QALYs gained. The screening was cost-effective for an incidence of diabetes of 1.3% per year. Conclusions: Annual screening for cardiovascular and metabolic diseases in schizophrenic patients was cost-effective if at least 1.3% new cases of diabetes were detected per year. [1] Hoerger T, Harris K, Hicks K et al. Screening for type 2 diabetes mellitus; a cost-effectiveness analysis. Annals of Internal Medicine 2004; 140 (4) 689-699 [2] Meyer J, Nasrallah H, McEnvoy et al. The CATIE study: clinical comparison of subgroups with and wi thout the metabolic syndrome. Schizophrenia Research 2005(80) 9-18
It is argued that current attempts to investigate the process of family therapy might benefit fro... more It is argued that current attempts to investigate the process of family therapy might benefit from the application of discursive and narrative analytic techniques. An example of such an analysis is given, taking the work of an experienced family therapist with one family seeking help in dealing with the aftermath of a marital separation.‘ The theme of how to deal with change’as it materializes in the discussions during therapy is selected for detailed examination in this paper. It is argued that there are two main discourses on this theme evident in the family's discussions, one being that the separation has occurred and its consequences should now he left to arise naturally; the other being that the effects of the separation need to be actively managed. It is suggested that this analytic procedure can dramatize the subtle changes in family discourses during therapy; its limitations in terms of generalizability, and the difficulties of dealing with huge amounts of complex materi...
BackgroundSeveral studies have suggested that neuropsychological and structural brain deficits ar... more BackgroundSeveral studies have suggested that neuropsychological and structural brain deficits are implicated in poor insight. Few insight studies however have combined neurocognitive and structural neuroanatomical measures.AimsFocusing on the ability to relabel psychotic symptoms as pathological, we examined insight, brain structure and neurocognition in first-onset psychosis.MethodVoxel-based magnetic resonance imaging data were acquired from 82 individuals with psychosis and 91 controls assessed with a brief neuropsychological test battery. Insight was measured using the Schedule for the Assessment of Insight.ResultsThe principal analysis showed reduced general neuropsychological function was linked to poor symptom relabelling ability. A subsequent between-psychosis group analysis found those with no symptom relabelling ability had significant global and regional grey matter deficits primarily located at the posterior cingulate gyrus and right precuneus/cuneus.ConclusionsThe cing...
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