The epidemiology of first-episode psychosis is poorly understood because of the paucity of systematic studies, yet it constitutes the fundamental basis for understanding the disorder and the foundations on which clinical, biological, therapeutic, and long-term outcome studies are built. A particular need is to clarify the diagnostic breadth of first-episode psychosis and, on this basis, to undertake systematic comparisons across representative populations of the psychoses, to include comparisons with first-episode mania. Considered here is the new generation of prospective studies that may be able to inform in some way on these issues. Attainment of the above goals requires prolonged accrual of "all" cases of nonaffective, affective, and any other psychotic illness, including first-episode mania, to derive the required representative populations. To illustrate some of the challenges, the structure of the Cavan-Monaghan prospective first episode study is described and its interim findings are outlined, as rural Ireland provides psychiatric care based on strict catchment areas and is characterized by substantive ethnic and socioeconomic homogeneity and stability. It is argued that there are 3 primary diagnostic nodes (schizophrenia spectrum psychosis, bipolar disorder, and major depressive disorder with psychotic features) around which there exist numerous additional, overlapping, and well-populated diagnostic categories that are distinct only in terms of their operational definition. Only through systematic, epidemiologically based studies that access this intrinsic diversity are we likely to understand fully the origins and pathobiology of first-episode psychosis.
A complex array of factors influences the implementation of inclusion within educational systems. This article examines decision making regarding young children's participation in inclusive programs. A qualitative design was employed to study influential factors over the course of a 5-year period as children moved from inclusive preschool placements to elementary school. Family, classroom, school, and societal influences were examined through families' perspectives on children's school experiences. At the end of the 5-year follow-along period, 60% of the children remained in some level of inclusive placement. Placements were influenced by professionals' decisions and school options, families' abilities to access information, advocates, the match between family needs and expectations and school options, and the influence of specific child and family characteristics. Downloaded fromI t's really imperative to me that he's in a regular classroom because he learns so much that you're not aware of him learning . . . I don't want to shortchange him. (Mother of Lester, a kindergartner diagnosed with autism) I think we have to try [inclusion]. If it doesn't work . . . then we can always make a change. (Mother of Ella, a first grader with Down syndrome) If he were in a regular classroom, he wouldn't get as much attention as he does now. (Mother of Lenny, a second grader with physical disabilities)These quotations from parents hint at the many factors that influence educational placement decisions for children with disabilities in the early school years. Though the provision of educational services in least restrictive or inclusive environments has been a central goal in recent decades, the decision to place a child in an inclusive or self-contained special education program is seldom a clear cut decision. Rather, these decisions reflect a complex transactional process involving multiple factors that often interact and may change over time. Educational placements and the goals and decisions surrounding placements, thus, are not static phenomena.Inclusion in the early years has been the target of many educational initiatives (Buysse, Inclusion is a complex process influenced by many factors within families, classrooms, communities, and society. An individual child's experience both affects and is affected by her or his family beliefs and values, aspects of the classroom (e.g., curricular activities, teacher's philosophy) and school (e.g., services offered, philosophy), as well as the policies and values espoused in the larger community.Children's placement decisions are rarely made on the basis of a single factor. The nature of decision making with respect to inclusion highlights the complexity of these decisions. Often professionals and parents must weigh a variety of factors in this process. Bailey, McWilliam, Buysse, and Wesley (1998) identified potentially competing factors families must weigh as they consider various educational alternatives; these factors included program quality, availability of specialized services t...
BackgroundThe potential of first-episode studies in schizophrenia is maximised through systematic epidemiological, clinical and biological comparisons between homogeneous populations of the psychoses.AimsTo conduct prolonged accrual of ‘all’ cases of non-affective and affective psychotic illness on an epidemiologically complete basis.MethodWithin the region covered by Cavan–Monaghan psychiatric service (population 102 810), all putative cases of first-episode psychosis were diagnosed using DSM–IV.ResultsFrom 1995 to 2000, 69 cases of psychosis were ascertained, the incidence being 2.3-fold lower in females than in males. On resolving the ‘core’ diagnoses of schizophrenia and bipolar disorder, incidence of schizophrenia among women was 7.5-fold lower than among men whereas incidence of bipolar disorder among women was 6.6-fold lower than among men.ConclusionsThis homogeneous population, which eliminates factors associated with urbanicity and minimises confounding factors such as socioeconomic, ethnic and geographical diversity, shows a markedly reduced incidence among females both of schizophrenia and of bipolar disorder.
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