Mick Hunter

Background: The transition to adulthood is a major developmental milestone; a time of self‐discovery and increased independence. For young adults (YA) with intellectual disabilities (ID), however, this period is especially challenging. The increased incidence of mental health disorders in this population, such as depression and anxiety, make this transition even more difficult, increasing caregiver burden at a time when the young adult would traditionally be gaining independence. It is not clear, however, why YA with ID are more susceptible and what factors may predict mental health symptoms.Method: Potential risk and protective factors (demographic variables, coping styles, sense of hopelessness, unmet achievement of adulthood milestones, self‐reflection and insight) of anxiety and depression symptoms were assessed in 55 YA with ID and a sample of age‐matched controls.Results: Insight was the strongest predictor of anxiety (with gender in the controls) for YA with and without ID, with increased insight predicting fewer anxiety symptoms. However, YA with ID had significantly less insight than their aged‐matched counterparts and significantly higher levels of anxiety. They were also less likely to have achieved traditional adulthood milestones. Maladaptive coping was the strongest predictor of depression for YA with ID. In comparison, both maladaptive coping and insight predicted depression in controls. More maladaptive coping predicted increased depressive symptoms in both populations, whilst increased insight predicted fewer depressive symptoms in controls.Conclusions: Insight and maladaptive coping are potential targets in the treatment of anxiety and depression among YA with ID. Longitudinal intervention studies exploring the efficacy of such targeted programmes in reducing mental health symptoms and improving the transition to adulthood for these young people are recommended.

Aim: Mental Health workers bear responsibility for preventing suicide in their client group. Survey studies have indicated that staff can be seriously adversely affected when a client suicides. The aim of the current study is to describe and evaluate the effects on mental health (MH) workers of their ongoing role in managing suicidal behaviours and to identify the thoughts and feelings associated with this role. Method: A survey was administered to 135 MH workers via an on-line self-report vehicle. The survey comprised standardised measures of anxiety and burnout as well as a questionnaire developed for this study concerning perceptions and attitudes to suicide and suicide prevention. Results: Factor analysis of 12 retained items of the questionnaire identified three factors: 1) preventability beliefs (beliefs about suicide being always and/or permanently preventable); 2) associated distress (stress/anxiety about managing suicidal behaviour); and 3) the prevention role (covering views about personal roles and responsibilities in preventing suicidal behaviours). Analysis of these factors found that many MH workers experience an elevation of stress/anxiety in relation to their role in managing suicidal behaviours. This distress was associated with the emotional exhaustion component of burnout. Measures showed adverse responses were higher for outpatient than inpatient workers; for those who had received generic training in suicide prevention: and for those who had experienced a workplace related client suicide. Conclusion: There is a need for the development of appropriate self-care strategies to alleviate stress in MH workers exposed to suicide.

Despite strong research interest in psychosis risk identification and the potential for early intervention, few papers have sought to document the implementation and evaluation of specialised psychosis related services. Assessment of Ultra High Risk (UHR) has been given priority, but it is equally as important to identify appropriate comparison groups and other baseline differences. This largely descriptive service evaluation paper focuses on the `baseline characteristics’ of referred clients (i.e., previously assessed characteristics or those identified within the first two months following service presentation). Data are reported from a 10-year layered service audit of all presentations to a `Psychological Assistance Service’ for young people (PAS, Newcastle, Australia). Baseline socio-demographic and clinical characteristics (N =1,997) are described (including clients’ psychosis and UHR status, previous service contacts, hospitalisation rates, and diagnostic and comorbidity profiles). Key groups are identified and comparisons made between clients who received ongoing treatment and those who were primarily assessed and referred elsewhere. Clients averaged 19.2 (SD =4.5) years of age and 59% were male. One-tenth of clients (9.6%) were categorised as UHR, among whom there were relatively high rates of attenuated psychotic symptoms (69.1%), comorbid depression (62.3%), anxiety (42.9%), and attentional and related problems (67.5%). Overall, one-fifth (19.8%) experienced a recent psychotic episode, while a further 14.5% were categorised as having an existing psychosis (46.7% with a schizophrenia diagnosis), amongst whom there were relatively high rates of comorbid substance misuse (52.9%), psychosocial (70.2%) and physical health (37.7%) problems. The largest group presenting to PAS were those with non-psychotic disorders (43.7%), who provide a valuable comparison group against which to contrast the health trajectories of those with UHR and recent psychosis. Ongoing treatment by PAS was preferentially given to those experiencing or at risk for psychosis and those reporting greater current distress or dysfunction. Whether or not UHR clients transition to psychosis, they displayed high rates of comorbid depression and anxiety at service presentation, with half receiving ongoing treatment from PAS. Although international comparisons with similar services are difficult, the socio-demographic and comorbidity patterns observed here were viewed as largely consistent with those reported elsewhere.

Mismatch negativity (MMN) is a scalp-recorded electrical potential that occurs in humans in response to an auditory stimulus that defies previously established patterns of regularity. MMN amplitude is reduced in people with schizophrenia. In this study, we aimed to develop a robust and replicable rat model of MMN, as a platform for a more thorough understanding of the neurobiology underlying MMN. One of the major concerns for animal models of MMN is whether the rodent brain is capable of producing a human-like MMN, which is not a consequence of neural adaptation to repetitive stimuli. We therefore tested several methods that have been used to control for adaptation and differential exogenous responses to stimuli within the oddball paradigm. Epidural electroencephalographic electrodes were surgically implanted over different cortical locations in adult rats. Encephalographic data were recorded using wireless telemetry while the freely-moving rats were presented with auditory oddball stimuli to assess mismatch responses. Three control sequences were utilized: the flip-flop control was used to control for differential responses to the physical characteristics of standards and deviants; the many standards control was used to control for differential adaptation, as was the cascade control. Both adaptation and adaptation-independent deviance detection were observed for high frequency (pitch), but not low frequency deviants. In addition, the many standards control method was found to be the optimal method for observing both adaptation effects and adaptation-independent mismatch responses in rats. Inconclusive results arose from the cascade control design as it is not yet clear whether rats can encode the complex pattern present in the control sequence. These data contribute to a growing body of evidence supporting the hypothesis that rat brain is indeed capable of exhibiting human-like MMN, and that the rat model is a viable platform for the further investigation of the MMN and its associated neurobiology.

Objective: The purpose of this study was to examine susceptibility factors in thalamic stroke, as well as outcomes in order to identify rehabilitation needs.Methods: Ten patients with thalamic stroke were interviewed and administered the Audio Recorded Cognitive Screen. Magnetic resonance imaging (MRI) scans were examined to determine location and size of the lesion, as well as basilar artery size and anatomical variances in the circle of Willis.Results: Risk factors such as high cholesterol, high blood pressure and pre-existing heart conditions were identified. Circle of Willis variations were found in 6 of the 10 participants, with MR angiography indicating that the posterior communication artery was absent or failed to join the posterior cerebral artery. Basilar artery diameter measurements were no larger than normal. All participants reported post-stroke changes, including decreased coordination and mobility, poor balance, reduced energy, memory deficits and mood changes. Participants’ overall scores on cognitive tests were significantly lower than age-matched norms. Performance on the test domains of memory, fluency, language and attention were all significantly below age norms.Conclusions: The variability of outcome measures demonstrates the difficulty of defining patterns of relationship between risk factors and severity of functional sequelae in thalamic stroke.

In clinical practice, it is often noted that some individuals struggle with chronic pain, while others find effective means to cope. The purpose of this study was to better understand how resilience fits into coping with persistent pain problems. Of interest was whether measures of resilience add to the prediction of adjustment to chronic pain over and above measures of pain coping as typically used with this patient group. Individuals (N = 101) with chronic pain who attended an initial assessment at a pain clinic completed self-report measures of resilience and coping. Pain related outcome data were also collected. Bivariate correlations indicated that higher resilience was associated with significantly less fear avoidance, less pain-related disability, and lower reported pain intensity. Consistent with theoretical propositions, bivariate analyses also indicated that more resilient individuals with chronic pain reported better social support, and were more likely to be working. Higher resilience was also positively correlated with greater pain self-efficacy. However, when hierarchical regression analyses were performed, resilience did not add significantly to the prediction of depression scores and disability scores, over and above the contribution made by existing measures of pain coping. These findings suggest that, although the construct of resilience appears to have important relationships with various dimensions of chronic pain, as currently operationalized, it does not add significantly to the understanding of chronic-pain adjustment. Rather than abandoning the resilience construct, our findings suggest that resilience as applied to the problem of chronic pain may require a refinement in measurement with this population.

Mothers with borderline personality disorder (BPD) have disturbed relationships with their infants, possibly associated with poor nonverbal cue perception. Individuals with BPD are poor at recognizing emotion in adults and tend to misattribute neutral (i.e., no emotion) as sad. This study extends previous research by examining how mothers with BPD perceive known (own) and unknown (control) infant stimuli depicting happy, sad, and neutral emotions. The sample consisted of 13 women diagnosed with BPD and 13 healthy control mothers. All participants completed clinical and parenting questionnaires and an infant emotion recognition task. Compared to control mothers, mothers with BPD were significantly poorer at infant emotion recognition overall, but especially neutral expressions which were misattributed most often as sad. Performance was not related to disturbed parenting but rather mothers' age and illness duration. Neither the BPD nor control mothers showed enhanced accuracy for emotional displays of their own verses unknown infant-face images. Although the sample size was small, this study provides evidence that mothers with BPD negatively misinterpret neutral images, which may impact sensitive responding to infant emotional cues. These findings have implications for clinical practice and the development of remediation programs targeting emotion-perception disturbances in mothers with BPD.