scholarly journals A retrospective case-control service evaluation of CAARMS scores of patients with autism in York EIP, compared to age matched controls

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S59-S60
Author(s):  
Daniel Whitney ◽  
Stephen Wright
Keyword(s):  
At Risk ◽  
Statistical Significance ◽  
Mental States ◽  
Autism Spectrum ◽  
Mean Difference ◽  
Autism Spectrum Conditions ◽  
First Episode ◽  
Retrospective Case ◽  
Significant Difference ◽  
Early Intervention In Psychosis

AimsStudies show the prevalence of Autism Spectrum Conditions in Early Intervention in Psychosis (EIP) populations is 3.6-3.7%, compared to approximately 1-1.5% in the general population. The CAARMS (Comprehensive Assessment of At Risk Mental States) is a national tool used by EIP services as a screening tool to bring patients into services and stratify their symptoms to determine what pathway may be most appropriate (First Episode Psychosis pathway (FEP) or At Risk Mental State pathway (ARMS)). As far as we are aware the CAARMS has not been validated in an autistic population. It is our view that several of the questions in the CAARMS may be interpreted differently by people with autism, thus affecting the scores. The aim of this evaluation was to identify whether CAARMS scores differ between patients diagnosed with autism and matched controls in York EIP.MethodFrom their mental health records, we identified all patients in the service with a diagnosis of autism. We then compared the CAARMS scores, at the time of referral, to those of age matched controls (matched by being in the age range 16-30) without an autism diagnosis, using continuous sampling by date of referral.Result14 patients in the service had a diagnosis of autism and had completed a CAARMS. CAARMS domains are all scored between 0 and 6 (indicating increasing severity or frequency). Compared to the age matched controls, autistic patients had a higher mean difference in their scores for ‘Non-Bizarre Ideas’ (mean difference of 0.86 for severity and 0.57 for frequency) and ‘Disorganised Speech’ (mean difference of 0.28 for severity and 0.57 for frequency). These results did not reach statistical significance which was unsurprising given the sample size. The gender split between groups was similar.ConclusionOur evaluation suggests a difference in CAARMS scores between patients in our service with a diagnosis of autism and those without. A larger study would be needed to confirm a statistically significant difference and multicentre results would be needed as evidence of generalisability. However, if such a difference were confirmed it might question the validity of CAARMS in autistic patients or suggest that modifications, perhaps in the form of reasonable adjustments to the questions or scoring, were needed to increase the validity in this population. We would suggest that spending extra time checking the patient has understood the intended meaning of the questions in the CAARMS may increase validity, particularly in the ‘Non-Bizarre Ideas’ domain.

Correlation between hemodynamic parameters and response to high-dose interleukin-2 in metastatic melanoma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18012-18012
Author(s):  
J. P. Dutcher ◽  
C. Dasanu ◽  
I. Codreanu ◽  
M. Yeddu ◽  
H. Muniswamy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Statistical Significance ◽  
Interleukin 2 ◽  
Mean Difference ◽  
Mean Blood Pressure ◽  
Response To Treatment ◽  
High Dose ◽  
Separate Analysis ◽  
Significant Drop ◽  
Significant Difference

18012 Background: A direct correlation between the levels of hypotension during IL-2 treatment and response in melanoma has not yet been demonstrated, although both have been correlated with higher IL-2 doses and production of nitric oxide. Methods: A retrospective study analyzed the association between response to IL-2 and systolic, diastolic, mean blood pressure (BP), and heart rate (HR) at baseline and during treatment, by using the t-test. Further, same comparison was performed after BP was corrected for the amount of neosynephrine (neo) utilized during IL-2 treatment (subtracting the raise in BP produced by neo using individual patient coefficients). 22 patients (13 females, 9 males) with a median age of 54 years (range 36–71) received a total of 26 courses of IL-2 (between 2001–2005). Median number of prior treatments was 2.5 (range 0–5). Outcomes were divided in (A) responders (1CR, 3PRs and 4SDs), and (B) non-responders (18PD). Results: When adjusting for the effects of neo, the corrected mean BP during treatment was significantly lower in (A) compared to (B) (52.17 vs 64.34 mmHg, P = 0.018; mean difference −12.17, 95% CI −22.06 to −2.27). Similarly, the decrease in corrected mean blood pressure from baseline was greater in (A) (−34.89 vs −20.67 mmHg, P = 0.003; mean difference −14.22, 95% CI −23.09 to −5.37). A trend towards statistical significance was recorded for the variation in uncorrected mean BP (17.86 vs. 23.22 mmHg, P = 0.085; mean difference −5.36, 95% CI −11.53 to 0.80). Separate analysis demonstrated a significant drop in both systolic (−17.85 mmHg, P = 0.009; 95% −30.77 to −4.91) and diastolic (−12.05 mmHg, P = 0.01; 95% CI −21.02 to −3.07) corrected BP in (A) vs. (B), but no significant difference for either uncorrected parameters. No correlation between response and the HR, number of IL-2 doses or total quantity of neo was observed. Conclusions: Uncorrected variation in mean BP shows a trend towards significance in predicting response to IL-2. However, corrected mean, systolic and diastolic BP correlate closely with response to treatment. Implications of this association may reside in better outcomes for an intensive IL-2 treatment, with aggressive pressor support. A common pathogenetic basis for response to IL-2 and induction of hypotension is possible. No significant financial relationships to disclose.

Structural Neuroimaging in First-Episode Psychosis: a review of neuroimaging practice in an early intervention service

2011 ◽  
Vol 26 (S2) ◽  
pp. 947-947
Author(s):  
S. Otero ◽  
R. Mehrotra
Keyword(s):  
Early Intervention ◽  
Statistical Significance ◽  
First Episode Psychosis ◽  
First Episode ◽  
Analysis Tool ◽  
Early Intervention Service ◽  
Structural Neuroimaging ◽  
Intervention Service ◽  
Episode Psychosis ◽  
Significant Difference

IntroductionThe UK NICE technology guidance “Structural Neuroimaging in First-Episode Psychosis” concludes that CT/MRI is not routinely recommended as an initial investigation for first-episode psychosis.ObjectivesTo evaluate the use of CT/MRI in a group of Early Intervention Service (EIS) patients with a first-episode psychosis aged 18–35 years at presentation.AimsTo develop practice guidelines for use of neuroimaging in first-episode psychosis.MethodsAll 107 patients registered with the EIS in Hounslow, London, UK, were eligible for inclusion in this review. Data was collected from the medical records and the Picture Archiving and Communications System. Data was analysed using a microsoft excel data analysis tool. Additionally, comparisons were made between the group of patients with normal scans and that with abnormal scans. Statistical significance was determined using the chi-squared method with a significance of P < 0.05.Results17 patients had documented neuroimaging results. 4 scans were abnormal. There was no significant difference between the group with normal and abnormal scans in terms of gender, abnormalities of physical/neurological health, blood tests and whether the patient had any additional medical conditions. Abnormal scan results did not influence treatment or outcome for any patient.ConclusionsThe abnormal scans were not correlated to clinical indices of history, examination and laboratory tests. Abnormal scans appear to have a low yield in terms of clinical effectiveness. The findings support selective use of neuroimaging in this cohort of patients. The indications for it usage would appear to rely on clinical judgement as well clinical findings.

scholarly journals Cranial Nerve Injuries and the Retrojugular Approach in Carotid Endarterectomy

2008 ◽  
Vol 90 (8) ◽  
pp. 685-688 ◽  
Author(s):  
William D Beasley ◽  
Christopher P Gibbons
Keyword(s):  
Carotid Endarterectomy ◽  
Cranial Nerve ◽  
Statistical Significance ◽  
Cranial Nerves ◽  
Case Series ◽  
Surgical Approaches ◽  
Nerve Injuries ◽  
Retrospective Case ◽  
Significant Difference ◽  
Cranial Nerve Injuries

INTRODUCTION This is a retrospective case series analysis to compare the incidence of cranial nerve injuries in carotid endarterectomy by the retrojugular and anteromedial approaches. PATIENTS AND METHODS Data were extracted from a prospectively collected database. Ninety-one retrojugular carotid endarterectomies were compared with 145 anteromedial carotid endarterectomies. All were performed under local anaesthesia and used the eversion technique. Data were analysed using the chi-squared test. RESULTS Nine (3.8%) cases were complicated by cranial nerve injuries. In four cases, multiple nerves were involved. In total, 13 (5.5%) cranial nerves were injured. The affected nerves were: two (0.8%) marginal mandibular, two (0.8%) laryngeal, three (1.2%) accessory and six (2.5%) hypoglossal. There was no statistically significant difference in total or specific cranial nerve injuries between the two surgical approaches. CONCLUSIONS The risk of cranial nerve injuries was similar following either the retrojugular or anteromedial approach. Accessory nerve injuries were only seen in the retrojugular approach but this did not reach statistical significance.

scholarly journals Meta-analytical prognostic accuracy of the Comprehensive Assessment of at Risk Mental States (CAARMS): The need for refined prediction

2018 ◽  
Vol 49 ◽  
pp. 62-68 ◽  
Author(s):  
D. Oliver ◽  
M. Kotlicka-Antczak ◽  
A. Minichino ◽  
G. Spada ◽  
P. McGuire ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Meta Analysis ◽  
Mental States ◽  
Comprehensive Assessment ◽  
Sensitivity Analyses ◽  
First Episode ◽  
Index Test ◽  
Prognostic Accuracy ◽  
At Risk Mental States

AbstractPrimary indicated prevention is reliant on accurate tools to predict the onset of psychosis. The gold standard assessment for detecting individuals at clinical high risk (CHR-P) for psychosis in the UK and many other countries is the Comprehensive Assessment for At Risk Mental States (CAARMS). While the prognostic accuracy of CHR-P instruments has been assessed in general, this is the first study to specifically analyse that of the CAARMS. As such, the CAARMS was used as the index test, with the reference index being psychosis onset within 2 years. Six independent studies were analysed using MIDAS (STATA 14), with a total of 1876 help-seeking subjects referred to high risk services (CHR-P+: n = 892; CHR-P–: n = 984). Area under the curve (AUC), summary receiver operating characteristic curves (SROC), quality assessment, likelihood ratios, and probability modified plots were computed, along with sensitivity analyses and meta-regressions. The current meta-analysis confirmed that the 2-year prognostic accuracy of the CAARMS is only acceptable (AUC = 0.79 95% CI: 0.75–0.83) and not outstanding as previously reported. In particular, specificity was poor. Sensitivity of the CAARMS is inferior compared to the SIPS, while specificity is comparably low. However, due to the difficulties in performing these types of studies, power in this meta-analysis was low. These results indicate that refining and improving the prognostic accuracy of the CAARMS should be the mainstream area of research for the next era. Avenues of prediction improvement are critically discussed and presented to better benefit patients and improve outcomes of first episode psychosis.

Mind Reading in Films Task to Assess Social Cognitive Deficits in Autism Spectrum Conditions

2020 ◽  
Vol 20 (2) ◽  
pp. 79-100
Author(s):  
Soraya TAHAZADEH ◽  
Usha BARAHMAND ◽  
Fereshteh YAGHOOTI ◽  
Mohamad Ali NAZARI
Keyword(s):  
Theory Of Mind ◽  
Social Cognitive ◽  
Cognitive Theory ◽  
High Functioning Autism ◽  
Mental States ◽  
Diagnostic Value ◽  
Autism Spectrum ◽  
Autism Spectrum Conditions ◽  
Mind Reading ◽  
Eyes Task

"Background and Objectives. Various tasks with a variety of stimuli have been devised to measure aspects of theory of mind. In the present study, with due consideration of Iranian culture, we introduce a sensitive video-based test, called Mind Reading in Films Task (Films Task), for the evaluation of complex emotions and mental states. This new social ecological task for mindreading comprises several short film scenes, some measuring cognitive theory of mind and some measuring affective theory of mind. Method. This study included two experiments. In experiment 1, the validity of the newly devised Films Task was investigated by comparing the responses of 342 students to the Films Task and to the Reading the Mind in the Eyes Task (Eyes Test). In experiment 2, the predictive power and sensitivity of the Films Task was assessed. Twenty adults with high functioning autism spectrum conditions (ASC) were compared with 20 matched healthy controls in terms of their responses to the Eyes Task, Films Task and Empathy Quotient questionnaire. The ROC curve was used to determine the best cut-off point and the diagnostic value. Results. Our findings substantiate the discriminative capacity of the Films Task to distinguish individuals with autism spectrum conditions from their healthy non-clinical counterparts. Limitations: Intelligence and comorbid psychiatric conditions were not controlled, limiting the utility of the measure. Conclusions. Results imply the potential utility of the Films Task as a viable alternative to the Eyes Task in measuring individual differences in social cognitive ability in the general population."

scholarly journals Pituitary gland volume in at-risk mental state for psychosis: a longitudinal MRI analysis

CNS Spectrums ◽  
2014 ◽  
Vol 20 (2) ◽  
pp. 122-129 ◽  
Author(s):  
Anna Walter ◽  
Erich Studerus ◽  
Renata Smieskova ◽  
Corinne Tamagni ◽  
Charlotte Rapp ◽  
...  
Keyword(s):  
At Risk ◽  
Mental State ◽  
First Episode ◽  
Volume Increase ◽  
Significant Difference ◽  
Longitudinal Mri ◽  
Pituitary Enlargement ◽  
Magnetic Resonance Imaging Mri ◽  
Changes Over Time ◽  
At Risk Mental State

IntroductionPituitary enlargement has been reported in individuals with schizophrenic psychosis or an at-risk mental state for psychosis (ARMS). In a previous study, our group could show pituitary volume increase in first episode and ARMS patients with later transition to psychosis (ARMS-T). However, there are no longitudinal studies on this issue so far. We therefore examined longitudinally whether transition to psychosis would be accompanied by a further increase of pituitary volume in antipsychotic-naïve ARMS patients.MethodsMagnetic resonance imaging (MRI) data were acquired from 23 antipsychotic-naïve individuals with an ARMS. Ten subjects developed psychosis (ARMS-T) and 13 did not (ARMS-NT). ARMS-T were re-scanned after the onset of psychosis, and ARMS-NT were re-scanned at the end of the study period.ResultsThere was no significant difference of the pituitary volume between ARMS-T and ARMS-NT in our sample, and there were no significant pituitary volume changes over time.DiscussionLongitudinally, we could not detect any further volumetric changes in the pituitary volume with transition to psychosis.ConclusionsThis, together with the result of our previous study, could indicate that the perceived level of stress in ARMS patients is constantly high from very early onward.

Risk factors for transition to first episode psychosis among individuals with ‘at-risk mental states’

2004 ◽  
Vol 71 (2-3) ◽  
pp. 227-237 ◽  
Author(s):  
Oliver Mason ◽  
Mike Startup ◽  
Sean Halpin ◽  
Ulrich Schall ◽  
Agatha Conrad ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Mental States ◽  
First Episode Psychosis ◽  
First Episode ◽  
Episode Psychosis ◽  
At Risk Mental States
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