- Email: [email protected]
132 – Self-esteem: State or trait characteristic?
ABSTRACTS / Schizophrenia Research 98 (2008) 3–199 unique and a discussion point arises if all the early psychosis cases indeed have schizophrenia. High comorbidity is another interesting factor. Conclusions: Group therapy, relapse prevention and psycho education therapies need to be made structured in forthcoming phase. It is argued that program evaluation should depend on service users' level of satisfaction and reduction of disability rather than only on patient's recovery. doi:10.1016/j.schres.2007.12.197
131 – UTILISING TELEPSYCHIATRY FOR COGNITIVE ASSESSMENT OF EARLY PSYCHOSIS IN RURAL YOUTH H. Stain 1, B. Kelly 1, V. Carr 2, K. Payne 1. 1
Centre for Rural and Remote Mental Health, University of Newcastle, Australia 2 Centre for Brain and Mental Health Research, University of Newcastle, Australia Presenting Author details: [email protected] Bloomfield Hospital, Forest Rd, 2800 Orange, Australia, Tel.: +61 2 63607941; fax: +61 2 63612457. Background: Barriers to research in rural areas bear similarity to those for clinical service provision – vast distances, scattered and migrating populations, lack of specialist mental health services and reliance on primary health care workers [1], Telepsychiatry provides an opportunity for specialist assessment without the high costs of flying specialists to remote locations. While the reliability of telepsychiatry for clinical assessment [2] has been established, there is a lack of evidence for its reliability for cognitive assessment, Telepsychiatry has the potential to reduce research and clinical costs while providing greater access to services for rural youths. The aim of the study is to investigate the reliability of cognitive assessment by telepsychiatry for youth with early psychosis. Methods: Youth (aged 14–30 years) who were experiencing early psychosis were recruited through mental health services in a rural region of New South Wales, Australia. Administration of measures was counterbalanced for face to face and telepsychiatry modes. The measures included the BPRS, AQoL, SOFAS, WTAR, WMS-R Logical Memory, WAIS-III Digit Span, COWAT and the Opiate Treatment Index. Diagnosis was established by the DIP-DM interview. Participants provided feedback on their experience of telepsychiatry. Results: Early psychosis in rural areas is characterised by a substantial proportion of aboriginal youths in some areas, high levels of drug/alcohol problems and vast distances to access services. Assessment by telepsychiatry achieved reduced costs but maintained reliability compared to face to face, with positive correlations between modes of assessment, Telepsychiatry was favourably reviewed by participants. The research has implications for neuropsychological assessments by telepsychiatry, the use of which has traditionally been hampered by the nature of testing materials. Conclusions: The utility and reliability of neuropsychological assessment by telepsychiatry provides a platform to facilitate early psychosis research in rural areas and a service model that incorporates telepsychiatry. doi:10.1016/j.schres.2007.12.198
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132 – SELF-ESTEEM: STATE OR TRAIT CHARACTERISTIC? N. Vracotas 1, S.N. Iyer 1, A. Malla 1. Presenting Author details: [email protected] 6875 Boul. LaSalle, H4H 1R3 Montreal, Canada, Tel.: +1 514 761 6131x2405; fax: +1 514 888 4458. Background: Self-esteem has been implicated in the formation and maintenance of delusions and hallucinations, affective symptoms and subjective distress in patients with psychotic disorders. Whether selfesteem is a stable, trait-like characteristic refractory to any change with treatment, or a potentially malleable, state-like characteristic likely to change with treatment is not yet completely understood. The aim of the study, therefore, was to examine change in self-esteem over a 1-year course of treatment in individuals with first-episode psychosis. Methods: The study included a sample of 52 individuals with firstepisode psychosis (non-affective and affective) receiving treatment at the Prevention and Early Intervention Program for Psychoses at the Douglas University Mental Health Institute. The Self-Esteem Rating Scale (Nugent and Thomas, 1993) and Global Assessment of Functioning scale were administered at baseline, 6 and 12 months. A repeated measure of analysis of variance was utilized. Results: Self-esteem does not change from baseline to 6 months [F (Wilk's λ) = 0.003, p N .05]. In a smaller sample (n = 21) for whom we have self-esteem data at 12 months, the same results were observed [F (Wilk's λ) = 0.19, p N .05]. However, there was a significant change in GAF scores from baseline to 6 months [F (Wilk's λ) = 160.95, p b .001] and again from baseline to 12 months [F (Wilk's λ) = 108.73, p b .001]. Conclusions: Despite improvement in global clinical state, selfesteem tends to be stable over a course of treatment. This is particularly striking as individuals in this study were receiving specialized early intervention. Special psychotherapeutic interventions may, therefore, be needed to address low self-esteem early in the course of treatment. doi:10.1016/j.schres.2007.12.199
133 – OUTCOME IN FIRST-EPISODE PSYCHOSIS: THE ROLE OF SELF-ESTEEM AND INSIGHT N. Vracotas 1, S.N. Iyer 1, A. Malla 1. Presenting Author details: [email protected] 6875 Boul. LaSalle, H4H 1R3 Montreal, Canada, Tel.: +1 514 761 6131x2405; fax: +1 514 888 4458. Background: A better understanding of the factors that influence outcome early on in the course of psychosis also requires an understanding of putative mediators. Both self-esteem and insight have been implicated in understanding outcome in psychotic disorders. For example, selfesteem has been implicated in the formation and maintenance of delusions and hallucinations which may influence insight. However, the relationship between self-esteem, insight and outcome in first-episode psychosis remains to be studied. Therefore, the hypotheses tested were: The level of a patient's self-esteem early in the course of treatment of a first-episode psychosis will influence outcome as evaluated by the global assessment of functioning (GAF) measure at 6 months following initiation of treatment. Further, the relationship between self-esteem and outcome will likely be mediated by the patient's insight.
131 – UTILISING TELEPSYCHIATRY FOR COGNITIVE ASSESSMENT OF EARLY PSYCHOSIS IN RURAL YOUTH H. Stain 1, B. Kelly 1, V. Carr 2, K. Payne 1. 1
Centre for Rural and Remote Mental Health, University of Newcastle, Australia 2 Centre for Brain and Mental Health Research, University of Newcastle, Australia Presenting Author details: [email protected] Bloomfield Hospital, Forest Rd, 2800 Orange, Australia, Tel.: +61 2 63607941; fax: +61 2 63612457. Background: Barriers to research in rural areas bear similarity to those for clinical service provision – vast distances, scattered and migrating populations, lack of specialist mental health services and reliance on primary health care workers [1], Telepsychiatry provides an opportunity for specialist assessment without the high costs of flying specialists to remote locations. While the reliability of telepsychiatry for clinical assessment [2] has been established, there is a lack of evidence for its reliability for cognitive assessment, Telepsychiatry has the potential to reduce research and clinical costs while providing greater access to services for rural youths. The aim of the study is to investigate the reliability of cognitive assessment by telepsychiatry for youth with early psychosis. Methods: Youth (aged 14–30 years) who were experiencing early psychosis were recruited through mental health services in a rural region of New South Wales, Australia. Administration of measures was counterbalanced for face to face and telepsychiatry modes. The measures included the BPRS, AQoL, SOFAS, WTAR, WMS-R Logical Memory, WAIS-III Digit Span, COWAT and the Opiate Treatment Index. Diagnosis was established by the DIP-DM interview. Participants provided feedback on their experience of telepsychiatry. Results: Early psychosis in rural areas is characterised by a substantial proportion of aboriginal youths in some areas, high levels of drug/alcohol problems and vast distances to access services. Assessment by telepsychiatry achieved reduced costs but maintained reliability compared to face to face, with positive correlations between modes of assessment, Telepsychiatry was favourably reviewed by participants. The research has implications for neuropsychological assessments by telepsychiatry, the use of which has traditionally been hampered by the nature of testing materials. Conclusions: The utility and reliability of neuropsychological assessment by telepsychiatry provides a platform to facilitate early psychosis research in rural areas and a service model that incorporates telepsychiatry. doi:10.1016/j.schres.2007.12.198
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132 – SELF-ESTEEM: STATE OR TRAIT CHARACTERISTIC? N. Vracotas 1, S.N. Iyer 1, A. Malla 1. Presenting Author details: [email protected] 6875 Boul. LaSalle, H4H 1R3 Montreal, Canada, Tel.: +1 514 761 6131x2405; fax: +1 514 888 4458. Background: Self-esteem has been implicated in the formation and maintenance of delusions and hallucinations, affective symptoms and subjective distress in patients with psychotic disorders. Whether selfesteem is a stable, trait-like characteristic refractory to any change with treatment, or a potentially malleable, state-like characteristic likely to change with treatment is not yet completely understood. The aim of the study, therefore, was to examine change in self-esteem over a 1-year course of treatment in individuals with first-episode psychosis. Methods: The study included a sample of 52 individuals with firstepisode psychosis (non-affective and affective) receiving treatment at the Prevention and Early Intervention Program for Psychoses at the Douglas University Mental Health Institute. The Self-Esteem Rating Scale (Nugent and Thomas, 1993) and Global Assessment of Functioning scale were administered at baseline, 6 and 12 months. A repeated measure of analysis of variance was utilized. Results: Self-esteem does not change from baseline to 6 months [F (Wilk's λ) = 0.003, p N .05]. In a smaller sample (n = 21) for whom we have self-esteem data at 12 months, the same results were observed [F (Wilk's λ) = 0.19, p N .05]. However, there was a significant change in GAF scores from baseline to 6 months [F (Wilk's λ) = 160.95, p b .001] and again from baseline to 12 months [F (Wilk's λ) = 108.73, p b .001]. Conclusions: Despite improvement in global clinical state, selfesteem tends to be stable over a course of treatment. This is particularly striking as individuals in this study were receiving specialized early intervention. Special psychotherapeutic interventions may, therefore, be needed to address low self-esteem early in the course of treatment. doi:10.1016/j.schres.2007.12.199
133 – OUTCOME IN FIRST-EPISODE PSYCHOSIS: THE ROLE OF SELF-ESTEEM AND INSIGHT N. Vracotas 1, S.N. Iyer 1, A. Malla 1. Presenting Author details: [email protected] 6875 Boul. LaSalle, H4H 1R3 Montreal, Canada, Tel.: +1 514 761 6131x2405; fax: +1 514 888 4458. Background: A better understanding of the factors that influence outcome early on in the course of psychosis also requires an understanding of putative mediators. Both self-esteem and insight have been implicated in understanding outcome in psychotic disorders. For example, selfesteem has been implicated in the formation and maintenance of delusions and hallucinations which may influence insight. However, the relationship between self-esteem, insight and outcome in first-episode psychosis remains to be studied. Therefore, the hypotheses tested were: The level of a patient's self-esteem early in the course of treatment of a first-episode psychosis will influence outcome as evaluated by the global assessment of functioning (GAF) measure at 6 months following initiation of treatment. Further, the relationship between self-esteem and outcome will likely be mediated by the patient's insight.