RESEARCH:

A major strength of PEPP is the high level of integration between clinical service and research. One of the key objectives of the program is to generate new knowledge regarding the early stages of psychotic disorders.

Research within PEPP focuses on furthering our understanding of the nature of psychotic disorders, the impact of such disorders on those afflicted and their families, and the development and evaluation of new approaches to treatment and prevention. In carrying out this research a wide range of expertise is required. Researchers affiliated with PEPP include those with expertise in psychiatry, psychology, epidemiology, economics, neurosciences, nursing and health services research. The work of our researchers has been sponsored by a variety of funding agencies including the Medical Research Council of Canada, the Ontario Mental Health Foundation, Canadian Psychiatric Research Foundation, Scottish Rite Schizophrenia Research Fund as well as industry sources. The results of research in PEPP are frequently presented in articles published in international journals and papers at research conferences.

Several research projects currently underway in PEPP are of particular importance to the field of early intervention. One focuses on evaluating the impact of a community outreach initiative in reducing duration of untreated psychosis and, thereby, improving treatment outcome for individuals with psychotic disorders. The community outreach involves media advertising, strengthening links with community agencies and family physicians and other interventions designed to facilitate early detection and treatment. The effects of this outreach program are being assessed on several outcomes including length of time to treatment response, likelihood of relapse and improved community functioning and quality of life.

Other foci of recent and current research include:

  • predictors of treatment outcome in early psychosis.
  • early warning signs of psychotic disorders.
  • pathways to care for individuals with psychotic disorders.
  • the relationship between dimensions of treatment outcome - such as symptoms, cognitive functioning and quality of life.
  • movement disorders in early psychosis.
  • the effectiveness of psychosocial interventions such as stress management for individuals with psychotic disorders.
  • investigation of the prodromal phase of psychotic illness.

Recent Research Grants (Peer Reviewed)

  1. Medical Research Council of Canada (1999-2004). An evaluation of the impact of early intervention on outcome in schizophrenia. (A. Malla and R. Norman – Co-principal Investigators; L. Voruganti, T. McLean and R. Manchanda). $290,030 [Peer reviewed).
  2. Ontario Mental Health Foundation (2001-2003). Tracking service use and outcomes from first episode psychosis in Ontario. A. Malla, R. Norman, R. Zipursky, J. Sylvestre, P. Roy, S. Archie, H. Hobbs, J. Trainor. $200,000.
  3. Ontario Mental Health Foundation Transition Fund (1998-2003). Explaining outcomes: Developing instruments to assess the critical characteristics of community support programs for people with severe mental illness. (B. Rush and R. Norman – Co-principal Investigators, B. Kirsh and C. Wild – Co-investigators). $397,697.
  4. Lawson Health Research Institute Internal Research Fund (2001-2002). Early case detection in psychosis: Who should be targeted? A.K. Malla, D.J. Scholten, R.M.G. Norman, T.S. McLean, E. McIntosh. $12,000.
  5. Scottish Rite Schizophrenia Research Program (1997-99). The effects of environmental stressors on cognitive and neurotransmitter function in schizophrenia. (R. Norman, A.K. Malla, R.W.J. Neufeld, N. Rajakumar (Co-principal Investigators), D. Vollick, S. Tokmakejian. $63,825 (US).
  6. Ontario Mental Health Foundation (1997-1999). Evaluation of a stress management program for individuals with schizophrenia. (R. Norman, A. Malla, R.W.J. Neufeld, T. McLean, L.P. Voruganti, S. Cheng, L. Cortese, K. Diaz and A. Rickwood). $115,900

PEPP Publications by Year

2004

  1. Manchanda, R., & Norman, R. (2003). Schizophrenia: Early Intervention. The Canadian Journal of CME, 16(2), 123-27.

  2. Townsend, L., & Manchanda, R. (2004). Letter to the Editor: Gains in speeded information processing following treatment of schizophrenia with clozapine: a case report. Canadian Journal of Psychiatry, 49(1), 77-78.

2003

  1. Manchanda, R., Malla, A., Harricharan, R., Cortese, L., Takhar, J. (2003). EEG abnormalities and outcome in first-episode psychosis. Canadian Journal of Psychiatry, 48(11), 722-26.

  2. Scholten, D.J., Malla, A.K., Norman, R.M., McLean, T.S., McIntosh, E.M., McDonald, C.L., Eliasziw, M., & Speechley, K.N. (2003). Removing barriers to treatment of first-episode psychotic disorders. Canadian Journal of Psychiatry, 48(8), 561-65.

  3. Takhar, J., & Scholten, D.J. (2003). CME evaluation 2001-2002 at Department of Psychiatry, University of Western Ontario. CPA Bulletin, 39-40.

2002

  1. Forchuk, Ch., Norman, R., Malla, A., Martin, M-L., McLean, T., Cheng, S., Diaz, K., McIntosh, E., Rickwood, A., Vos, S., & Gibney, C. (2002). Schizophrenia and the motivation for smoking. Perspectives in Psychiatric Care, 38(2), 41-9.

  2. Malla, A.K., Mittal, C., Lee, M., Scholten, D.J., Assis, J., and Norman, R. (2002). Computed tomography of the brain morphology of patients with first-episode schizophrenic psychosis. Journal of Psychiatry and Neuroscience, 27, 350-58.

  3. Malla, A.K. & Norman, R.M.G. (2002). Early intervention in schizophrenia and related disorders: advantages and pitfalls. Current Opinion in Psychiatry, 15, 17-23.

  4. Malla, A.K., Norman, R.M.G., Manchanda, R., Ahmed, R.M., Scholten, D., Harricharan, R., Cortese, L., & Takhar, J. (2002). One year outcome in first episode psychosis: influence of DUP and other predictors. Schizophrenia Research, 54, 231-42.

  5. Malla, A.K. Norman, R.G., Manchanda, R., McLean, T.S., Harricharan, R., Cortese, L., Townsend, L.A., & Scholten, D.J. (2002). Status of patients with first-episode psychosis after one year of phase-specific community-oriented treatment. Psychiatric Services, 53(4), 458-63.

  6. Malla, A.K., Norman, R.M.G., Manchanda, R., & Townsend, L. (2002). Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis. Psychological Medicine, 32, 1109-119.

  7. Malla, A.K., Takhar, J.J., Norman, R.M.G., Manchanda, R., Cortese L., Harricharan, R., Verdi, M., & Ahmed, R. (2002). Negative symptoms in first episode non-affective Psychosis. Acta Psychiatrica Scandinavica, 105, 431-39.

  8. Manchanda, R. (2002). Psychiatric disorders in epilepsy: clinical aspects. Epilepsy & Behavior, 3, 39-45.

  9. Norman, R.G. & Malla, A.K. (2002). Examining adherence to dedication and substance use as possible confounds of duration of untreated psychosis. The Journal of Nervous and Mental Disease, 190(5), 331-34.

  10. Norman, R.G., Malla, A.K., McLean, T.S., McIntosh, E.M., Neufeld, R.W.J., Voruganti, L.P., & Cortese, L. (2002). An evaluation of a stress management program for individuals with schizophrenia. Schizophrenia Research, 58, 293-303.

  11. Takhar, J. (2002). Brief CME report from the University of Western Ontario. CPA Bulletin, 22.

  12. Takhar, J. (2002). The evaluation of a personal learning project. CPA Bulletin, 34-35.

  13. Takhar, J. Malla, A.K., MacPherson, C., & Fan, Y.S. (2002). An interstitial deletion of
    the long arm of chromosome 21 in a case of a first episode of psychosis. Acta Psychiatrica Scandinavica, 105, 1-5.

  14. Theberge, J., Bartha, R., Drost, D.J., Menon, R.S., Malla, A., Takhar, J., Neufeld, R.W., Rogers, J., Pavlosky, W., Schaefer, B., Densmore, M., Al-Semaan, Y., & Williamson, P.C. (2002). Glutamate and Glutamine measured with 4.0 T Proton MRS in never-treated patients with schizophrenia and healthy volunteers. American Journal of Psychiatry, 159(11), 1944-46.

  15. Townsend, L.A., Norman, R.M.G., Malla, A.K., Rychlo, A.D., and Ahmed, R.R. (2002).
    Changes in cognitive functioning following comprehensive treatment for first episode patients with schizophrenia spectrum disorder. Psychiatry Research, 113, 69-81.

2001

  1. Jiwa, A. & Takhar, J. (2001). Seborrheic Dermatitis associated with psychosis: two case studies. The Canadian Journal of CME, 79-83.

  2. Lapierre, Y.D., Angus, C., Awad, A.G., Saxena, B.M., Jones, B., Williamson, P., Vincent, P., Carl, R., Lavallee, Y.J., Manchanda, R., Gauthier, B., Wolf, M.A., Teehan, M.D., Denis, J.F., Malla, A.K., Oyewumi, L.K., Busse, E., Labelle, A., Gustafsson, B., Claesson, L., & Grafford, K. (2001). Tratamiento de los sintomas negativos: un studio clinico y metodologico. Revista de Toxicoamias, 31-46.

  3. Malla, A.K. & Norman, R.M.G. (2001). Treating psychosis: Is there more to early intervention than intervening early? Canadian Journal of Psychiatry, 46, 645-47.

  4. Malla, A.K., Norman, A.K., McLean, T.S., & McIntosh, E. (2001). Impact of phase-specific treatment of first episode of psychosis on Wisconsin Quality of Life Index (client version). Acta Psychiatrica Scandinavica, 103, 355-61.

  5. Malla, A.K., Norman, R.M.G., Morrison-Stewart, S., Williamson, P.C., Helmes, E., & Cortese, L. (2001). Does sex influence the relation between symptoms and neurocognitive functions in schizophrenia? Canadian Medical Association, 26(1), 49-54.

  6. Malla, A.K., Norman, R.M.G., Zirul, S., & Kotteda, V. (2001). A comparison of long-term outcome in first-episode schizophrenia following treatment with Risperidone or a typical antipsychotic. Journal of Clinical Psychiatry, 62(3), 179-84.

  7. Maryniak, O., Manchanda, R., & Velani, A. (2001). Methotrimeprazine in the treatment of agitation in acquired brain injury patients. Brain Injury, 15(2), 167-74.

  8. Norman, R.M.G. & Malla, A.K. (2001). Duration of untreated psychosis: a critical examination of the concept and its importance. Psychological Medicine, 31, 381-400.

  9. Norman, R.M.G., Townsend, L., & Malla, A.K. (2001). Duration of untreated psychosis and cognitive functioning in first-episode patients. British Journal of Psychiatry, 179, 340-45.

  10. Sharma, V., Kazarian, S., Whitney, D., & Manchanda, R. (2001). Patient or client? Psychiatric Services (Reply to Letter to the Editor), 25(7), 277.

  11. Townsend, L.A., Malla, A.K., & Norman, R.M.G. (2001). Cognitive functioning in stabilized first-episode psychosis patients. Psychiatry Research, 104, 119-31.

  12. Takhar, J. & Steele, M. (2001). Current status of formalized standard training objectives in psychiatry fellowship programs across Canada. Annales CRMCC, 34(5), 302-05.

2000

  1. Malla, A.K., Norman, R.M.G., Scholten, D. (2000). Predictors of service use and social conditions in patients with psychotic disorders. Canadian Journal of Psychiatry, 45, 269-73.

  2. Manchanda, R., Freeland, A., Schaefer, B., McLachlan, R.S., & Blume, W.T. (2000). Auras, seizure focus, and psychiatric disorders. Neuropsychiatry, Neurospychology, and Behavioral Neurology, 13(1), 13-19.

  3. McAuley, J. & Manchanda, R., (2000). Restructuring of mental health services in London. OPA Dialogue, 9.

  4. Norman, R.M.G. & Malla, A.K. (2000). Family history of schizophrenia and the relationship of stress to symptoms: preliminary findings. Australian and New Zealand Journal of Psychiatry, 35, 217-23.

  5. Norman, R.M.G., Malla, A.K., McLean, T., Voruganti, L.P.N., Cortese, L., McIntosh, E., Cheng, S., & Rickwood, A. (2000). The relationship of symptoms and level of functioning in schizophrenia to general well-being and the Quality of Life Scale. Acta Psychiatrica Scandinavica, 102, 303-09.

  6. Savard, G. & Manchanda, R. (2000). Psychiatric Assessment of Candidates for Epilepsy Surgery. The Canadian Journal of Neurological Sciences, 27, Suppl.1, S44-S49.

  7. Sharma, V., Whitney, D., Kazarian, S.S., & Manchanda, R. (2000). Preferred terms for users of mental health services among service providers and recipients. Psychiatric Services, 51(2), 203-209.

  8. Takhar, J. & Bishop, J. (2000). Influence of chronic barbiturate administration on sleep apnea after hypersomnia presentation: case study. Journal of Psychiatry & Neuroscience, 25(4), 321-24.

  9. Takhar, J. & Manchanda, R. (2000). Nephrolithiasis on Topiramate therapy (letters to Editor). The Canadian Journal of Psychiatry, 45(5), 491-93.

1999

  1. Al-Semaan, Y., Malla, A.K., & Lazosky, A. (1999). Schizoaffective disorder in a fragile-X carrier. Australian and New Zealand Journal of Psychiatry, 33, 436-40.

  2. Bartha, R., Al-Semaan, M., Williamson, P.C., Drost, D.J., Malla, A.K., Carr, T.J., Densmore, M., Canaran, G., & Neufeld, R.W.J. (1999). A short echo proton magnetic responance spectroscopy study of the left mesial-temporal lobe in first-onset schizophrenic patients. Society of Biological Psychiatry, 45, 1403-11.

  3. Chouinard, G., Saxena, B., Belanger, M-C., Ravindran, A., Bakish, D., Beauclair, L., Morris, P., Vasavan Nair, N.P., Manchanda, R., Reesal, R., Remick, R., & O'Neill, M.C. (1999). A Canadian multicenter, double-blind study of paroxetine and fluoxetine in major depressive disorder. Journal of Affective Disorders, 54, 39-48.

  4. Cortese, L., Malla, A.K., McLean, T., Diaz, J.F. (1999). Exploring the longitudinal course of psychotic illness: a case-study approach. The Canadian Journal of Psychiatry, 44, 881-85.

  5. Lapierre, Y.D., Angus, C., Awad, A.G., Saxena, B.M., Jones, B., Williamson, P., Vincent, P., Carle, R., Lavallee, Y.J., Manchanda, R., Gauthier, B., Wolf, M.A., Teehan, M.D., Denis, J.F., Malla, A.K., Oyewumi, L.K., Busse, E., Labelle, A., Claesson, L., & Grafford, K. (1999). The treatment of negative symptoms: a clinical and methodological study. International Clinical Psychopharmacology, 14(2), 101-12.

  6. Malla, A.K. & Norman, R.M.G. (1999). Facing the challenges of intervening early in psychosis. Annals RCPSC, 32(7), 394-97.

  7. Malla, A.K., Norman, R.M.G., Kotteda, V., & Zirul, S. (1999). Switching from therapy with typical antipsychotic agents to Risperidone: long-term impact on patient outcome. Clinical Therapeutics, 21(5), 806-17.

  8. Malla, A.K., Norman, R.M.G., & Voruganti, L.P. (1999). Improving outcome in schizophrenia: the case for early intervention. CMAJ, 160(6), 843-45.

  9. Malla, A.K., Takhar, J., Norman, R.M.B., & Assis, L. (1999). Computed tomographic findings in schizophrenia: relation with symptom dimensions and sex differences. Journal of Psychiatry and Neuroscience, 24(2), 131-38.

  10. Norman, R.M.G. & Townsend, L.A. (1999). Cognitive-behavioural approaches to the reduction of psychosis. The Canadian Journal of Psychiatry, 44(3), 245-52.

  11. Norman, R.M.G. & Lownsend, L.A. (1999). Cognitive-behavioural therapy for psychosis: a status report. The Canadian Journal of Psychiatry, 44, 245-52.

  12. Norman, R.M.G., Malla, A.K., Cortese, L., Cheng, S., Diaz, K., McIntosh, E., McLean, T.S., Rickwood, A., & Voruganti, M.D. (1999). Symptoms and cognition as predictors of community functioning: a prospective analysis. American Journal of Psychiatry, 156(3), 400-04.

  13. Takhar, J. (1999). Pimozide augmentation in a patient with drug-resistant psychosis previously treated with olenzapine (letters to Editor). Journal of Psychiatry & Neuroscience, 24(3), 248-49.

  14. Takhar, J. & Williamson, P. (1999). Hypoglycemia associated with high doses of sertaline and sulphonylurea compound in a noninsulin-dependent diabetes mellitus patient. The Canadian Journal of Clinical Pharmacology, 6(1), 12-14.

1998

  1. Malla, A.K. (1998). Can we prevent mental illness? The Canadian Journal of CME, 77-87.

  2. Malla, A.K., Norman, R.M.G., McLean, T.S., Cheng, S., Rickwood, A., McIntosh, E., Cortese, L., Diaz, K., & Voruganti, L.P. (1998). An integrated medical and psychosocial treatment program for psychotic disorders: patient characteristics and outcome. The Canadian Journal of Psychiatry, 43, 698-705.

  3. Norman, R.M.G., Davies, F., Nicholson, I.R., Cortese, L., & Malla, A.K. (1998). The relationship of two aspects of perfectionism with symptoms in a psychiatric outpatient population. Journal of Social and Clinical Psychology, 17(1), 50-68.

  4. Norman, R.M.G., Malla, A.K., Cortese, L., Diaz, F. (1998). Aspects of dysphoria and symptoms of schizophrenia. Psychological Medicine, 28, 1433-41.

1997

  1. Bartha, R., Williamson, P.C., Drost, D.J., Malla, A.K., Carr, T.J., Cortese, L., Canaran, G., Rylett, J., Neufeld, R.W.J. (1997). Measurement of Glutamate and Glutamine in the medical prefrontal cortex of never-treated schizophrenic patients and healthy controls by proton magnetic resonance spectroscopy. The Archives of General Psychiatry, 54, 959-65.

  2. Carnahan, H., Aguilar, O., Malla, A., & Norman, R. (1997). An investigation into movement planning and execution deficits in individuals with schizophrenia. Schizophrenia Research, 23, 213-21.

  3. Forchuk, C., Norman, R., Malla, A., Vos, S., & Martin, M.-L. (1997). Smoking and schizophrenia. Journal of Psychiatric and Mental Health Nursing, 4, 355-59.

  4. Malla, A.K., Norman, R.M.G., Aguilar, O., & Cortese, L. (1997). Relationship between neurological 'soft signs' and syndrome of schizophrenia. Acta Psychiatrica Scandinavica, 96, 274-80.

  5. Malla, A.K., Lazosky, A., McLean, T., Rickwood, A., Cheng, S., & Norman, R.M.G.
    (1997). Neuropsychological assessment as an aid to psychological rehabilitation in severe mental disorders. Psychiatric Rehabilitation Journal, 21(2), 169-73.

  6. Norman, R.M.G., Malla, A.K., Morrison-Stewart, S.L., Helmes, E., Williamson, P.C., Thomas, J., & Cortese, L. (1997). Neuropsychological correlates of syndromes in schizophrenia. British Journal of Psychiatry, 170, 134-139.

  7. Norman, R.M.G., Malla, A.K., Williamson, P.C., Morrison-Stewart, S.L., Helmes, E., & Cortese, L. (1997). EEG coherence and syndromes in schizophrenia. British Journal of Psychiatry, 170, 411-15.

  8. Takhar, J. & Malla, A.K. (1997). Clozapine therapy for psychosis and Parkinsonism in a phenotypical case of Prader-Willi syndrome. The Canadian Journal of Clinical Pharmacology, 4(2), 79-81.

Some of our Conference presentations:

  1. Townsend, L., Norman, R., Malla, A. – Cognitive Functioning in First Episode Psychosis: Evidence for Improvement at One Year Follow-Up. Second International Conference on Early Psychosis (IEPA). New York, March 31-April 1 & 2, 2000.
  2. Norman, R., Malla, A., Townsend, L. – Duration of untreated psychosis and neurocognitive functioning in first episode patients. Meeting of International Early Psychosis Association. New York, March 31-April 2, 2000.
  3. Malla, A., Townsend, L., Norman, R., McLean, T., McIntosh, E. – Improvement in cognition and subjective quality of life following phase-specific community oriented treatment of first episode psychosis. World Association of Psychosocial Rehabilitation Conference. Paris, France, May 6-10, 2000.
  4. Malla, A., Norman, R., McLean, T., Cortese, L., McIntosh, E. – Happiness, Community Functioning and Symptoms in Schizophrenia: What Predicts What? ISPS Conference. Stavanger, Norway, June 5-8, 2000.
  5. Malla, A., McLean, T., Norman, R., Harricharan, R. – Challenges in Case Detection and Early Intervention in Schizophrenia. ISPS Conference. Stavanger, Norway, June 5-8, 2000.
  6. Norman, R., McLean, T., Malla, A., McIntosh, L., Cheng, S. and Rickwood, A. – A controlled trial evaluation of a stress management program for individuals with schizophrenia. World Association for Psychosocial Rehabilitation. Paris, France, May 7-10, 2000.
  7. Malla, A., Norman, R., McLean, T., Manchanda, R., Townsend, L., Cortese, L., Harricharan, R. and Takhar, J. – Development of a community focused early intervention program for psychosis: combining service, research and public education. World Association for Psychosocial Rehabilitation. Paris, France, May 7-10, 2000.
  8. Malla, A., Townsend, L.A., Norman, R.M.G. and McLean, T. – Designing phase specific medical, psychological and cognitive intervention for first-episode psychosis: The PEPP model. Annual Meeting of Canadian Psychiatric Association. Victoria, BC, October 3-6, 2000.
  9. Townsend, L.A., Norman, R.M.G., Malla, A.K. – Cognitive functioning and vocational outcome in first episode psychosis. Mount Sinai Conference on Cognition in Schizophrenia. Whistler, BC, April 27, 2001.
  10. Malla, A., Norman, R., Manchanda, R., Scholten, D., Cortese, L., Takhar, J. and Harricharan, R. – Does DUP predict outcome at one year in first episode psychosis? International Congress on Schizophrenia Research. Whistler, BC, April 28 – May 2, 2001.
  11. Scholten, D., Malla, A., Norman, R., McLean, T. and McIntosh, E. – Early intervention in psychosis: The impact of a novel approach to early case detection. International Congress on Schizophrenia Research. Whistler, BC, April 28-May 2, 2001.
  12. Norman, R., Malla, A. and Townsend, L. – Duration of untreated psychosis and cognitive functioning in first episode patients. International Congress on Schizophrenia Research. Whistler, BC, April 28-May 2, 2001.
  13. Norman, R.M.G., Malla, A.K. – Examining adherence to medication and substance use as possible confounds of duration of untreated psychosis. Eleventh Biennial Winter Workshop on Schizophrenia. Davos, Switzerland, February 24-March 1, 2002.