State of the art in psychological therapies for psychosis: Family interventions for psychosis.

PURPOSE: It is a half-century since the coalescence of social psychiatry and systemic family therapy approaches started to inform condition-specific therapeutic work with families to reduce relapse and hospital readmission for people with schizophrenia. Today, family interventions are a cornerstone of international guidelines for the treatment of psychosis, and of workforce development initiatives. Effect sizes for clinical and economic outcomes are large, and the evidence base is robust and reliable, not only for outcomes but also for the underpinning theoretical models, which are coherent and consistent. Few, if any, psychological therapies, have so powerful a framework to drive widespread implementation. Nevertheless, delivery in clinical services is variable, often lagging behind that of individual cognitive behavioural therapy, notwithstanding its considerably weaker implementation framework. Our aim in this article is to formulate this translation failure and offer potential solutions. METHOD: We summarise the model/intervention and supporting evidence, then consider why delivery remains problematic. RESULTS: We highlight the inter-linked issues of conceptual confusion between and conflation of, different approaches to working with families; of addressing diagnostic uncertainty, complex comorbidity and adapting interventions for specific populations; and of translation from gold-standard research trial practice, through educational curricula and training programmes, to routine delivery in frontline services. CONCLUSION: We present our view of clinical, research and workforce development priorities to address these issues and continue the collective effort, moving into the next half-century, to work more effectively with people with psychosis and their families, to further improve outcomes.

Caregiver reports of patient-initiated violence in psychosis.

OBJECTIVE: Aggressive behaviour in psychosis is not uncommon. Community provision for people with psychosis has left informal caregivers to take on a greater role in their care. However, few studies have explored links between patient-initiated violence in mental health caregiving relationships and caregiver functioning. Our study investigated caregiver reports of aggressive acts committed by their relative with psychosis and their links to caregiver appraisals of the caregiving relationship and caregiver outcomes. METHOD: Caregivers of patients with a recent relapse of psychosis, recruited to a psychological therapy trial, completed the audiotaped Camberwell Family Interview at baseline. This semi-structured interview includes questions on the quality of the relationship between caregiver and patient, and patient history of violence. Seventy-two transcripts of interviews were assessed for reports of patient-initiated violence. RESULTS: One-half of the caregiver sample (52.9%) reported an incident of patient-initiated violence during their interview; 62.2% of these involved violence toward themselves, and 24.3% toward property. Reports of patient violence were associated with caregiver ratings of hostility expressed toward patients, lower self-esteem, and emotion-focused coping. People caring on their own were more likely to report incidents of patient violence. Younger patients, males, and inpatients were more frequently identified as having a history of this kind of violence. CONCLUSIONS: Our findings suggested that caregiver reports of patient-initiated violence in psychosis are not uncommon. Mental health staff need to be aware of the risks of such violence for caregivers of people with psychosis, and consider appropriate procedures for minimizing it.

Preparation of collagen-glycosaminoglycan sponges with open surface porous structures using ice particulate template method.

Funnel-like sponges of collagen incorporated with glycosaminoglycan (GAG) were prepared by freeze-drying using ice particulates as templates. The funnel-like collagen-GAG sponges showed similar porous structures to those of funnel-like collagen sponges. The funnel-like collagen-GAG and collagen sponges have one top surface layer and one bulk porous layer. The large, top surface pores were determined by ice particulates that were used as templates, and the inner bulk pores were determined by freezing temperature. The funnel-like pore structures facilitated homogenous cell distribution, improved cell viability, and resulted in homogenous tissue formation. Incorporation of GAG increased the mechanical property and cell viability of collagen sponges.

Neural correlates of eye-gaze detection in young children with autism.

Various reports have demonstrated difficulties in eye-gaze processing in older children and adults with autism. However, little is known about the neural or developmental origin of such difficulties. In the present study, we used high-density Event-Related Potentials (HD-ERPs) to record the neural correlates of gaze processing in young children with autism, and their age-matched controls. In addition, to determine normal gaze processing development we also tested a non-autism adult group. The data obtained from the children with autism resembled that previously observed in typical 4-month old infants. In contrast, the control group showed the same pattern as typical adults. These findings suggest that the neural correlates of gaze direction processing may be delayed in young children with autism.

Exploring the Williams syndrome face-processing debate: the importance of building developmental trajectories.

BACKGROUND: Face processing in Williams syndrome (WS) has been a topic of heated debate over the past decade. Initial claims about a normally developing ('intact') face-processing module were challenged by data suggesting that individuals with WS used a different balance of cognitive processes from controls, even when their behavioural scores fell within the normal range. Measurement of evoked brain potentials also point to atypical processes. However, two recent studies have claimed that people with WS process faces exactly like normal controls. METHOD: In this paper, we examine the details of this continuing debate on the basis of three new face-processing experiments. In particular, for two of our experiments we built task-specific full developmental trajectories from childhood to adolescence/adulthood and plotted the WS data on these trajectories. RESULTS: The first experiment used photos of real faces. While it revealed broadly equivalent accuracy across groups, the WS participants were worse at configural processing when faces were upright and less sensitive than controls to face inversion. In Experiment 2, measuring face processing in a storybook context, the face inversion effect emerged clearly in controls but only weakly in the WS developmental trajectory. Unlike the controls, the Benton Face Recognition Test and the Pattern Construction results were not correlated in WS, highlighting the different developmental patterns in the two groups. Again in contrast to the controls, Experiment 3 with schematic faces and non-face stimuli revealed a configural-processing deficit in WS both with respect to their chronological age (CA) and to their level of performance on the Benton. CONCLUSION: These findings point to both delay and deviance in WS face processing and illustrate how vital it is to build developmental trajectories for each specific task.

ERP abnormalities of illusory contour perception in Williams syndrome.

Williams syndrome is a genetic disorder in which visuo-spatial performance is poor. Theorists have claimed that the deficit lies in high-level processing, leaving low-level visual processes intact. We investigated this claim by examining an aspect of low-level processing, perceptual completion, i.e. the ability of this clinical group to perceive illusory Kanizsa squares. We then used event-related potentials to examine neural correlates of perceptual completion. While participants were able to perceive illusory contours, the neural correlates of this apparently normal perception were different from controls. Such differences in low-level visual processes may significantly impact on the development of higher-level visual processes. We conclude that, contrary to earlier claims, there is atypical neural processing during low-level visual perception in Williams syndrome.

Further evidence of preserved priming and impaired recall in adults with Asperger's syndrome.

Two experiments compared incidental (implicit) and intentional (explicit) memory performance in adults with Asperger's syndrome and individually matched controls. Experiment 1 involved perceptual tests using word fragment cues, following study tasks in which the participants either generated the words from contextual cues or read the words alone, with no contextual cues. Experiment 2 involved conceptual tests using paired associate cues, following study tasks in which the paired associates were rated either for their relatedness or for their readability. Performance in both the incidental tests was similar for both groups. Performance in both the intentional tests was also similar for both groups, with one exception. The adults with Asperger's syndrome were more likely to falsely recall words that had not actually been studied. These findings further delimit the nature of memory impairments in adults with Asperger's syndrome, which seem restricted to certain aspects of episodic memory that include the tendency to make more intrusion errors in recall.

Dethroning the myth: cognitive dissociations and innate modularity in Williams syndrome.

Despite increasing empirical data to the contrary, it continues to be claimed that mor-phosyntax and face processing skills of people with Williams syndrome are intact. This purported intactness, which coexists with mental retardation, is used to bolster claims about innately specified, independently functioning modules, as if the atypically developing brain were simply a normal brain with parts intact and parts impaired. Yet this is highly unlikely, given the dynamics of brain development and the fact that in a genetic microdeletion syndrome the brain is developing differently from the moment of conception, throughout embryogenesis, and during postnatal brain growth. In this article, we challenge the intactness assumptions, using evidence from a wide variety of studies of toddlers, children, and adults with Williams syndrome.

Neuroimaging of typical and atypical development: a perspective from multiple levels of analysis.

To date, research involving functional neuroimaging of typical and atypical development has depended on several assumptions about the postnatal maturation of the brain. We consider evidence from multiple levels of analysis that brings into question these underlying assumptions and advance an alternative view. This alternative view, based on an "interactive specialization" approach to postnatal brain development, indicates that there is a need to: obtain data from early in development; focus more on differences in interregional interactions rather than searching for localized, discrete lesions; examine the temporal dynamics of neural processing; and move away from deficits to image tasks in which atypical participants perform as well as typically developing participants.