A genome-wide association study of schizophrenia using brain activation as a quantitative phenotype

BACKGROUND

Genome-wide association studies (GWASs) are increasingly used to identify risk genes for complex illnesses including schizophrenia. These studies may require thousands of subjects to obtain sufficient power. We present an alternative strategy with increased statistical power over a case-control study that uses brain imaging as a quantitative trait (QT) in the context of a GWAS in schizophrenia.

METHODS

Sixty-four subjects with chronic schizophrenia and 74 matched controls were recruited from the Functional Biomedical Informatics Research Network (FBIRN) consortium. Subjects were genotyped using the Illumina HumanHap300 BeadArray and were scanned while performing a Sternberg Item Recognition Paradigm in which they learned and then recognized target sets of digits in an functional magnetic resonance imaging protocol. The QT was the mean blood oxygen level-dependent signal in the dorsolateral prefrontal cortex during the probe condition for a memory load of 3 items.

RESULTS

Three genes or chromosomal regions were identified by having 2 single-nucleotide polymorphisms (SNPs) each significant at P < 10(-6) for the interaction between the imaging QT and the diagnosis (ROBO1-ROBO2, TNIK, and CTXN3-SLC12A2). Three other genes had a significant SNP at <10(-6) (POU3F2, TRAF, and GPC1). Together, these 6 genes/regions identified pathways involved in neurodevelopment and response to stress.

CONCLUSION

Combining imaging and genetic data from a GWAS identified genes related to forebrain development and stress response, already implicated in schizophrenic dysfunction, as affecting prefrontal efficiency. Although the identified genes require confirmation in an independent sample, our approach is a screening method over the whole genome to identify novel SNPs related to risk for schizophrenia.

Assessing daily stress processes in social surveys by combining stressor exposure and salivary cortisol

This article presents a research method for assessing stress and mental health in ongoing population-based social surveys that combines self-reports of naturally occurring daily stressors with a primary marker of stress physiology, salivary cortisol. We first discuss the relevance of stress processes to mental health and introduce a model for examining daily stress processes, which highlights multiple components of daily stressor exposure. A primary aim of this approach is to capture variability across stressful situations, between persons of different groups, or within persons over a period of time. Next, we describe how the assessment of diurnal salivary cortisol is a promising approach to examining naturally occurring stress physiology in large social surveys. We then present findings from the National Study of Daily Experiences (a substudy of the Midlife in the United States Study) that document the feasibility and reliability of the collection of daily stressors and salivary cortisol and provide examples of research findings linking stressor exposure to cortisol. The final portion of the article describes ways that this approach can leverage the strengths of various features of longitudinal social surveys to extend research on stress and mental health.

Alcohol and illicit drug dependence among parents: associations with offspring externalizing disorders

BACKGROUND

Previous research indicates that alcohol and drug dependence constitute aspects of a general vulnerability to externalizing disorders that accounts for much of the parent-offspring resemblance for these and related disorders. This study examined how adolescent offspring risk for externalizing psychopathology varies with respect to parental alcoholism and illicit drug dependence.

METHOD

Data from the Minnesota Twin Family Study, a community-based investigation of adolescents (age 17 years, n=1252) and their parents, were used. Lifetime diagnoses of alcohol and drug dependence (among both parents and offspring) and offspring attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, adult antisocial behavior, and nicotine dependence were assessed via structured interviews.

RESULTS

Parental alcohol dependence and parental drug dependence were similarly associated with increased risk for nearly all offspring disorders, with offspring of alcohol and drug-dependent parents having approximately 2-3 times the odds for developing a disorder by late adolescence compared to low-risk offspring. Compared to parental dependence on other illicit drugs, parental cannabis dependence was associated with weaker increased risk for offspring externalizing disorders.

CONCLUSIONS

Both parental alcohol and drug dependence are independently associated with an increased risk for a broad range of externalizing psychopathology among late-adolescent offspring.

Clinician-Assisted Internet-Based Treatment is Effective for Generalized Anxiety Disorder: Randomized Controlled Trial

Objective: The aim of the present study was to determine the efficacy of an Internet-based clinician-assisted computerized cognitive behavioural treatment (CaCCBT) programme for generalized anxiety disorder (the Worry programme).

Methods: Forty-eight individuals meeting diagnostic criteria for generalized anxiety disorder (GAD) were randomly assigned to the Worry programme or to a waitlist control group. In the clinician-assisted Worry programme, participants complete six online lessons, weekly homework assignments, receive weekly email contact from a clinical psychologist, and contribute to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses. The main outcome measures were Generalized Anxiety Disorder–7 Item Scale (GAD-7) and the Penn State Worry Questionnaire (PSWQ).

Results: A total of 75% of treatment group participants completed all six lessons within the 9 week programme and post-treatment data were collected from 21/24 treatment group and 19/21 control group participants. Treatment group participants reported significantly reduced symptoms of worry as measured on the GAD-7 and PSWQ and reduced symptoms of depression as measured on the Patient Health Questionnaire–9 Item Scale (PHQ-9). Mean within- and between-groups effect sizes (Cohen's d) across the two measures of GAD were 1.3 and 1.1, respectively. Participants found the treatment programme acceptable and satisfactory. The clinician spent a total mean of 130 min per person over the programme.

Conclusions: The Worry programme, the first randomized controlled trial of CaCCBT for GAD, resulted in clinically significant improvements. These results are consistent with literature indicating that Internet-based programmes, when combined with clinical guidance, can significantly reduce the symptoms of common mental disorders.

Moderate versus severe early life stress: associations with stress reactivity and regulation in 10-12-year-old children

Early life stress (ELS) is expected to increase reactivity of the hypothalamic-pituitary-adrenocortical (HPA) axis; however, several recent studies have shown diminished cortisol reactivity among adults and children with ELS exposure. The goal of this study was to examine cortisol activity in 10-12-year-old internationally adopted children to determine if moderate and severe ELS have different impacts on the HPA axis. Salivary cortisol and two measures of autonomic activity were collected in response to the Trier Social Stress Test for Children (TSST-C). Three groups reflecting moderate, severe, and little ELS were studied: early adopted children who came predominantly from foster care overseas (early adopted/foster care (EA/FC), n=44), later adopted children cared for predominantly in orphanages overseas (late adopted/post-institutionalized (LA/PI), n=42) and non-adopted (NA) children reared continuously by their middle- to upper-income parents in the United States (n=38). Diminished cortisol activity was noted for the EA/FC group (moderate ELS), while the LA/PI group (severe ELS) did not differ from the NA group. Overall, few children showed cortisol elevations to the TSST-C in any group. The presence/absence of severe growth delay at adoption proved to be a critical predictive factor in cortisol activity. Regardless of growth delay, however, LA/PI children exhibited higher sympathetic tone than did NA children. These results suggest that moderate ELS is associated with diminished cortisol activity; however, marked individual differences in cortisol activity among the LA/PI children suggest that child factors modify the impact of severe ELS. Lack of effects of severe ELS even for growth delayed children may reflect the restorative effects of adoption or the generally low responsiveness of this age group to the TSST-C.

Hate crimes and stigma-related experiences among sexual minority adults in the United States: prevalence estimates from a national probability sample

Using survey responses collected via the Internet from a U.S. national probability sample of gay, lesbian, and bisexual adults (N = 662), this article reports prevalence estimates of criminal victimization and related experiences based on the target's sexual orientation. Approximately 20% of respondents reported having experienced a person or property crime based on their sexual orientation; about half had experienced verbal harassment, and more than 1 in 10 reported having experienced employment or housing discrimination. Gay men were significantly more likely than lesbians or bisexuals to experience violence and property crimes. Employment and housing discrimination were significantly more likely among gay men and lesbians than among bisexual men and women. Implications for future research and policy are discussed.

Autism spectrum disorders and childhood-onset schizophrenia: clinical and biological contributions to a relation revisited

OBJECTIVE

To highlight emerging evidence for clinical and biological links between autism/pervasive developmental disorder (PDD) and schizophrenia, with particular attention to childhood-onset schizophrenia (COS).

METHOD

Clinical, demographic, and brain developmental data from the National Institute of Mental Health (and other) COS studies and selected family, imaging, and genetic data from studies of autism, PDD, and schizophrenia were reviewed.

RESULTS

In the two large studies that have examined this systematically, COS is preceded by and comorbid with PDD in 30% to 50% of cases. Epidemiological and family studies find association between the disorders. Both disorders have evidence of accelerated trajectories of anatomic brain development at ages near disorder onset. A growing number of risk genes and/or rare small chromosomal variants (microdeletions or duplications) are shared by schizophrenia and autism.

CONCLUSIONS

Biological risk does not closely follow DSM phenotypes, and core neurobiological processes are likely common for subsets of these two heterogeneous clinical groups. Long-term prospective follow-up of autistic populations and greater diagnostic distinction between schizophrenia spectrum and autism spectrum disorders in adult relatives are needed.

Attention shaping: a reward-based learning method to enhance skills training outcomes in schizophrenia

Disturbances in sustained attention commonly interfere with the ability of persons with schizophrenia to benefit from evidence-based psychosocial treatments. Cognitive remediation interventions have thus far demonstrated minimal effects on attention, as have medications. There is thus a gap between the existence of effective psychosocial treatments and patients' ability to effectively engage in and benefit from them. We report on the results of a multisite study of attention shaping (AS), a behavioral intervention for improving attentiveness and learning of social skills among highly distractible schizophrenia patients. Patients with chronic schizophrenia who were refractory to skills training were assigned to receive either the UCLA Basic Conversation Skills Module (BCSM) augmented with AS (n = 47) or in the standard format (n = 35). AS, a reward-based learning procedure, was employed to facilitate patients' meeting clearly defined and individualized attentiveness and participation goals during each session of a social skills training group. Primary outcome measures were observational ratings of attentiveness in each session and pre- and post-BCSM ratings of social skill and symptoms. Patients receiving social skills training augmented with AS demonstrated significantly more attentiveness in group sessions and higher levels of skill acquisition; moreover, significant relationships were found between changes in attentiveness and amount of skills acquired. Changes in attentiveness were unrelated to level or change in antipsychotic medication dose. AS is an effective example of supported cognition, in that cognitive abilities are improved within the environmental context where the patient is experiencing difficulty, leading to gains in both attention and functional outcome.

Widespread cortical dysfunction in schizophrenia: the FBIRN imaging consortium

This Special Theme issue presents a series of related papers describing fMRI data collected as part of a multi-site brain imaging consortium, the Functional Imaging Biomedical Informatics Research Network (FBIRN) on the same subject population ( approximately 125 patients and approximately 125 controls), a larger sample than would have been possible from a single-site, and from a broader clinical and demographic range of patients. Potkin et al observe cortical inefficiency during retrieval of items from memory but not during encoding of those items; Brown et al showed that the lawful relationship between memory retrieval time and neural activation is decoupled in patients with schizophrenia. Wible et al analyzed the same memory data and report activations of left auditory and parietal cortices are especially abnormal in patients who tend to hallucinate. Using an auditory target detection task, Ford et al report abnormal activation of left primary auditory cortex in the hallucinators. A multivariate analysis of those auditory data by Kim et al found differences in connectivity in patients and controls. These studies on the same patient sample suggest that abnormal circuitry characterizes schizophrenic performance in both auditory target detection and memory retrieval, and that patients who hallucinate have reduced left auditory cortical activation on both tasks. Segall et al report anatomical differences between patients and controls in the largest sample yet published. Finally, Potkin et al. identified six genes that influence DLPFC activation and have functions related to forebrain development and stress responses in schizophrenia. These related publications indicate the power of multisite neuroimaging.

Gratitude influences sleep through the mechanism of pre-sleep cognitions

OBJECTIVES

To test whether individual differences in gratitude are related to sleep after controlling for neuroticism and other traits. To test whether pre-sleep cognitions are the mechanism underlying this relationship.

METHOD

A cross-sectional questionnaire study was conducted with a large (186 males, 215 females) community sample (ages=18-68 years, mean=24.89, S.D.=9.02), including 161 people (40%) scoring above 5 on the Pittsburgh Sleep Quality Index, indicating clinically impaired sleep. Measures included gratitude, the Pittsburgh Sleep Quality Index (PSQI), self-statement test of pre-sleep cognitions, the Mini-IPIP scales of Big Five personality traits, and the Social Desirability Scale.

RESULTS

Gratitude predicted greater subjective sleep quality and sleep duration, and less sleep latency and daytime dysfunction. The relationship between gratitude and each of the sleep variables was mediated by more positive pre-sleep cognitions and less negative pre-sleep cognitions. All of the results were independent of the effect of the Big Five personality traits (including neuroticism) and social desirability.

CONCLUSION

This is the first study to show that a positive trait is related to good sleep quality above the effect of other personality traits, and to test whether pre-sleep cognitions are the mechanism underlying the relationship between any personality trait and sleep. The study is also the first to show that trait gratitude is related to sleep and to explain why this occurs, suggesting future directions for research, and novel clinical implications.

Correlated genetic and non-shared environmental influences account for the co-morbidity between female sexual dysfunctions

BACKGROUND

Previous studies have shown moderate heritability for female orgasm. So far, however, no study has addressed the pattern of genetic and environmental influences on diverse sexual dysfunctions in women, nor how genetic and environmental factors contribute to the associations between them.

METHOD

The sample was drawn from the Genetics of Sex and Aggression (GSA) sample and consisted of 6, 446 female twins (aged 18-43 years) and 1994 female siblings (aged 18-49 years). The participants responded to the Female Sexual Function Index (FSFI), either by post or online.

RESULTS

Model fitting analyses indicated that individual differences on all six subdomains of the FSFI (desire, arousal, lubrication, orgasm, satisfaction, and pain) were primarily due to non-shared (individual-specific) environmental influences. Genetic influences were modest but significant, whereas shared environmental influences were not significant. A correlated factors model including additive and non-additive genetic and non-shared environmental effects proved to have the best fit and suggested that both correlated additive and non-additive genetic factors and unique environmental factors underlie the co-occurrence of the sexual function problems.

CONCLUSIONS

The findings suggest that female sexual dysfunctions are separate entities with some shared aetiology. They also indicate that there is a genetic susceptibility for sexual dysfunctions. The unique experiences of each individual are, however, the main factors determining if, and which, dysfunction develops.

Anxiety, Inhibition, Efficiency, and Effectiveness

Effects of anxiety on the antisaccade task were assessed. Performance effectiveness on this task (indexed by error rate) reflects a conflict between volitional and reflexive responses resolved by inhibitory processes (Hutton, S. B., & Ettinger, U. (2006). The antisaccade task as a research tool in psychopathology: A critical review. Psychophysiology, 43, 302–313). However, latency of the first correct saccade reflects processing efficiency (relationship between performance effectiveness and use of resources). In two experiments, high-anxious participants had longer correct antisaccade latencies than low-anxious participants and this effect was greater with threatening cues than positive or neutral ones. The high- and low-anxious groups did not differ in terms of error rate in the antisaccade task. No group differences were found in terms of latency or error rate in the prosaccade task. These results indicate that anxiety affects performance efficiency but not performance effectiveness. The findings are interpreted within the context of attentional control theory (Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7 (2), 336–353).

Preventing eating disorders

This article reviews eating disorder (ED) prevention programs, highlighting features that define successful programs and particularly promising interventions, and how they might be further refined. The field of ED prevention has advanced considerably both theoretically and methodologically compared with the earlier ED prevention programs, which were largely psychoeducational and met with limited success. Recent meta-analytic findings show that more than half (51%) of ED prevention interventions reduced ED risk factors and more than a quarter (29%) reduced current or future eating pathology (EP). A couple of brief programs have been shown to reduce the risk for future onset of EP and obesity. Selected interactive, multisession programs offered to participants older than 15 years, delivered by professional interventionists and including body acceptance or dissonance-induction content, produced larger effects. Understanding and applying these results can help inform the design of more effective prevention programs in the future.

Bringing the bedside to the bench, and then to the community: a prospectus for intervention research in late-life anxiety disorders

BACKGROUND

Anxiety disorders are highly prevalent in elderly persons, and they are associated with functional impairment, poorer quality of life, and adverse long-term consequences such as cognitive decline. Intervention research in late-life anxiety disorders (LLAD) lags behind where it ought to be. Research in cognitive neuroscience, aging, and stress intersects in LLAD and provides the opportunity to develop innovative interventions to prevent chronic anxiety and its consequences in this age group.

METHODS

This paper evaluates gaps in the evidence base for treatment of LLAD and synthesizes recent research in cognitive neuroscience, basic behavioral science, stress, and aging.

RESULTS

We examine three intervention issues in LLAD: (1) prevention; (2) acute treatment; and (3) pre-empting adverse consequences. We propose combining randomized controlled trials (RCTs) with mechanistic biobehavioral methodologies as an optimal approach for developing novel, optimized, and personalized treatments. Additionally, we examine three barriers in the field of LLAD research: (1) How do we measure anxiety?; (2) How do we raise awareness?; (3) How will we ensure our research is applicable to underserved populations (particularly minority groups)?

CONCLUSIONS

This prospectus outlines approaches for intervention research that can reduce the morbidity of LLAD.

Ameliorating prefrontal cortical dysfunction in mental illness: inhibition of phosphotidyl inositol-protein kinase C signaling

BACKGROUND

Bipolar disorder and schizophrenia are associated with profound dysfunction of the prefrontal cortex (PFC), with bipolar disorder most associated with changes in ventromedial PFC and schizophrenia more associated with changes in dorsolateral PFC.

DISCUSSION

Recent genetic and biochemical studies have also linked these illnesses to disinhibition of phosphotidyl inositol-protein kinase C signaling. For example, DAG kinase eta, an enzyme that metabolizes DAG and thus reduces protein kinase C activity, is the gene most altered in bipolar disorder. Similarly, regulator of G protein signaling 4 is the molecule most altered in the PFC of patients with schizophrenia, and this molecule normally serves to inhibit Gq signaling. Animal studies have shown that high levels of phosphotidyl inositol-protein kinase C signaling in the PFC markedly impair PFC function at the behavioral and cellular levels. Most importantly, many effective medications for bipolar disorder and schizophrenia inhibit phosphotidyl inositol-protein kinase C signaling, either through intracellular actions (lithium, valproate) or through extracellular blockade of receptors coupled to this pathway (5HT2 receptors and alpha-1 adrenoceptors). Recent data suggest that lithium and valproate can protect gray matter in patients with bipolar disorder. These findings encourage the development of protein kinase C inhibitors for the treatment of mental illness.

Evolução do DSM quanto ao critério categorial de diagnóstico para o distúrbio da personalidade antissocial

OBJETIVO: Realizar um breve percurso sobre o desenvolvimento conceitual de um dos construtos psicológicos de maior evidência nos dias atuais, a saber: o transtorno de personalidade antissocial (TPAS). Especificamente, esse percurso se realiza no sistema categórico proposto pela Associação Americana de Psiquiatria (APA), o Manual Diagnóstico e Estatístico de Distúrbios Mentais (DSM). MÉTODO: Utilizou-se a revisão literária sobre a evolução e a avaliação do construto associada a pesquisas empíricas consultadas nos principais livros e periódicos de reconhecimento internacional na área, tais como: Personality and Individual Differences, Psychological Medicine, Annual Review of Clinical Psychology, Psychological Bulletin, Journal of Abnormal Psychology, Journal of Personality Assessment, International Journal of Offender Therapy and Comparative Criminology, Aggression and Violent Behavior, Handbook of Psychopathy, entre outros. RESULTADO: Observa-se que o diagnóstico do TPAS é baseado nos critérios categóricos e não dimensionais. Isso significa que o sistema não consegue predizer a priori a variabilidade (intensidade) dos traços desse transtorno por ser o DSM desenvolvido no reconhecimento de sintomas e síndromes. CONCLUSÃO: Apesar de o TPAS ter passado por diversas revisões e de apresentar insuficiência taxonômica, ele ainda é amplamente utilizado no diagnóstico e no prognóstico clínico de condições relacionadas ao comportamento social desviante.

Identifying atypical cortisol patterns in young children: The benefits of group-based trajectory modeling

The introduction of growth curve modeling into the field of neuroendocrinology has enabled researchers to examine mean patterns of change in unbalanced and/or incomplete repeated measures data. However, growth curve modeling assumes population homogeneity, or that all individuals follow roughly the same pattern of change, with differences expressed as deviation around the mean curve. Group-based trajectory modeling, in contrast, is designed for heterogeneous populations and as a result is able to identify atypical patterns of change over time that may exist within a population. To illustrate the strengths and weaknesses of each technique, we apply both to a sample of diurnal cortisol data measured at home in young children (N=106, 46 male, M age=3.81 years, S.D.=0.24). We find three distinct trajectories of cortisol and demonstrate that the members of these trajectories are measurably different in terms of cortisol levels across context and time and in terms of the relationship between behavioral problems and parenting. At the same time, our growth curve analysis finds differential response patterns for high vs. low internalizing children with high vs. low parenting quality. We discuss these results in terms of their implications for the proper application of each method.

Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients

AIMS

Dependence on or problematic use of prescription drugs (PD) is estimated to be between 1 and 2% in the general population. In contrast, the proportion of substance-specific treatment in PD use disorders at 0.5% is comparatively low. With an estimated prevalence of 4.7%, PD-specific disorders are widespread in general hospitals compared to the general population. Brief intervention delivered in general hospitals might be useful to promote discontinuation or reduction of problematic prescription drug use.

DESIGN

A randomized, controlled clinical trial.

SETTING

Internal, surgical and gynaecological wards of a general and a university hospital.

PARTICIPANTS

One hundred and twenty-six patients fulfilling criteria for either regular use of PD (more than 60 days within the last 3 months) or dependence on or abuse of PD, respectively, were allocated randomly to two conditions.

INTERVENTION

Subjects received two counselling sessions based on Motivational Interviewing plus an individualized written feedback (intervention group, IG) or a booklet on health behaviour (control group, CG).

MEASUREMENTS

The outcome was measured as reduction (>25%) and discontinuation of PD intake in terms of defined daily dosages (DDD).

FINDINGS

After 3 months, more participants in the IG reduced their DDD compared to the participants in the CG (51.8% versus 30%; chi(2) = 6.17; P = 0.017). In the IG 17.9%, in the CG 8.6% discontinued use of PD (chi(2) = 2.42; P = 0.17). Conclusions Brief intervention based on Motivational Interviewing is effective in reducing PD intake in non-treatment-seeking patients.

The case for cultural competency in psychotherapeutic interventions

Cultural competency practices have been widely adopted in the mental health field because of the disparities in the quality of services delivered to ethnic minority groups. In this review, we examine the meaning of cultural competency, positions that have been taken in favor of and against it, and the guidelines for its practice in the mental health field. Empirical research that tests the benefits of cultural competency is discussed.

Chronic and acute stress and the prediction of major depression in women

BACKGROUND

This study explored the relatively neglected role of chronic stress in major depression, examining the independent contributions of co-occurring chronic and acute stress to depression, whether chronic stress predicts acute life events, and whether the two types of stress interact such that greater chronic stress confers greater sensitivity-or resistance-to the depressive effects of acute stressors.

METHODS

From a sample of 816 community women, those who had a major depression onset in the past 9 months and those without major depressive episodes (MDE) onset and with no history of current or recent dysthymic disorder were compared on interview-based measures of antecedent acute and chronic stress. Chronic stress interviews rated objective stress in multiple everyday role domains, and acute stress was evaluated with contextual threat interviews.

RESULTS

MDE onset was significantly associated with both chronic and acute stress; chronic stress was also associated with the occurrence of acute events, and there was a trend suggesting that increased acute stress is more strongly associated with depression in those with high versus low chronic stress.

CONCLUSIONS

Results suggest the importance of including assessment of chronic stress in fully understanding the extent and mechanisms of stress-depression relationships.

The emerging role of meditation in addressing psychiatric illness, with a focus on substance use disorders

Over the past 30 years the practice of meditation has become increasingly popular in clinical settings. In addition to evidence-based medical uses, meditation may have psychiatric benefits. In this review, the literature on the role of meditation in addressing psychiatric issues, and specifically substance use disorders, is discussed. Each of the three meditation modalities that have been most widely studied-transcendental meditation, Buddhist meditation, and mindfulness-based meditation-is critically examined in terms of its background, techniques, mechanisms of action, and evidence-based clinical applications, with special attention given to its emerging role in the treatment of substance use disorders. The unique methodological difficulties that beset the study of meditation are also considered. A brief discussion then integrates the research that has been completed thus far, elucidates the specific ways that meditation may be helpful for substance use disorders, and suggests new avenues for research.

Bridging the gap between schizophrenia and psychotic mood disorders: Relating neurocognitive deficits to psychopathology

BACKGROUND

The neurobiological relationship between schizophrenia and psychotic mood disorders is not well understood. Neurocognitive deficits have been described in both types of disorders and have been proposed to reflect underlying neurobiological dysfunction. Examining the relationship between neurocognitive function and psychopathology could help illuminate the neurobiological relationship between schizophrenia and psychotic mood disorders.

METHODS

Participants included 72 individuals with DSM-IV schizophrenia, 25 individuals with schizoaffective disorder or bipolar disorder with psychotic features, and 72 community controls. Standardized scores and correlations between four domains of neurocognition and psychopathology were examined.

RESULTS

Individuals with schizophrenia and psychotic mood disorders scored similarly on several dimensions of neurocognitive function and psychopathology. The relationships between neurocognitive function and psychopathology were similar in the two groups.

CONCLUSIONS

Individuals with schizophrenia and psychotic mood disorders were similar in terms of both the level of impairment in neurocognitive function and psychopathology, as well as in the relationship between the two dimensions of illness. These results suggest that schizophrenia and psychotic mood disorders such as schizoaffective disorder and bipolar disorder with psychotic features are on a neurobiological continuum.

Neurobiological correlates of coping through emotional approach

This investigation considered possible health-related neurobiological processes associated with "emotional approach coping" (EAC), or intentional efforts to identify, process, and express emotions surrounding stressors. It was hypothesized that higher dispositional use of EAC strategies would be related to neural activity indicative of greater trait approach motivational orientation and to lower proinflammatory cytokine and cortisol responses to stress. To assess these relationships, 46 healthy participants completed a questionnaire assessing the two components of EAC (i.e., emotional processing and emotional expression), and their resting frontal cortical asymmetry was measured using electroencephalography (EEG). A subset (N=22) of these participants' levels of the soluble receptor for tumor necrosis factor-alpha (sTNFalphaRII), interleukin-6 (IL-6), and cortisol (all obtained from oral fluids) were also assessed before and after exposure to an acute laboratory stressor. Consistent with predictions, higher reported levels of emotional expression were significantly associated with greater relative left-sided frontal EEG asymmetry, indicative of greater trait approach motivation. Additionally, people who scored higher on EAC, particularly the emotional processing component, tended to show a less-pronounced TNF-alpha stress response. EAC was unrelated to levels of IL-6 and cortisol. Greater left-sided frontal EEG asymmetry was significantly related to lower baseline levels of IL-6 and to lower stress-related levels of sTNFalphaRII, and was marginally related to lower stress-related levels of IL-6. The findings suggest that the salubrious effects of EAC strategies for managing stress may be linked to an approach-oriented neurocognitive profile and to well-regulated proinflammatory cytokine responses to stress.

Blood pressure in firefighters, police officers, and other emergency responders

Elevated blood pressure is a major risk factor for cardiovascular morbidity and mortality. Increased risk begins in the prehypertensive range and increases further with higher pressures. The strenuous duties of emergency responders (firefighters, police officers, and emergency medical services (EMS) personnel) can interact with their personal risk profiles, including elevated blood pressure, to precipitate acute cardiovascular events. Approximately three-quarters of emergency responders have prehypertension or hypertension, a proportion which is expected to increase, based on the obesity epidemic. Elevated blood pressure is also inadequately controlled in these professionals and strongly linked to cardiovascular disease morbidity and mortality. Notably, the majority of incident cardiovascular disease events occur in responders who are initially prehypertensive or only mildly hypertensive and whose average premorbid blood pressures are in the range in which many physicians would hesitate to prescribe medications (140-146/88-92). Laws mandating public benefits for emergency responders with cardiovascular disease provide an additional rationale for aggressively controlling their blood pressure. This review provides a background on emergency responders, summarizes occupational risk factors for hypertension and the metabolic syndrome, their prevalence of elevated blood pressure, and evidence linking hypertension with adverse outcomes in these professions. Next, discrepancies between relatively outdated medical standards for emergency responders and current, evidence-based guidelines for blood pressure management in the general public are highlighted. Finally, a workplace-oriented approach for blood pressure control among emergency responders is proposed, based on the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

In search of meaning: values in modern clinical behavior analysis

Skinner described behavior analysis as the field of values and purpose. However, he defined these concepts in terms of a history of reinforcement and failed to specify whether and how human and nonhuman values might differ. Human values have been seen as theoretically central within a number of nonbehavioral traditions in psychology, including humanism and positive psychology. However, these approaches have failed to provide explanations of the behavior-environment relations involved in valuing that might allow prediction and influence with respect to this phenomenon. Modern clinical behavior analysis in the form of acceptance and commitment therapy (ACT), however, succeeds in providing a functional definition of human values that meets this latter criterion. ACT is rooted in behavior analysis and relational frame theory (RFT) and defines values in terms of verbally established motivation. ACT empirical research into values has begun to blossom in recent years, and ACT-RFT researchers are currently investigating the concept at the most basic empirical level as well as in the applied clinical arena, heralding new interest in and insight into values within clinical behavioral psychology.

An RCT Comparing Effect of Two Types of Support on Severity of Symptoms for People Completing Internet-Based Cognitive Behaviour Therapy for Social Phobia

Objective: The present study (Shyness 6) compares the benefits and acceptability of two types of guidance on severity of symptoms during Internet treatment for social phobia.

Methods: Non-inferiority randomized controlled trial of Internet treatment, supplemented with weekly telephone calls from a technician (computerized cognitive-behavioural treatment (CCBT + Tel), or regular access to a clinician-moderated online discussion forum (CCBT + Forum), was carried out. An intention-to-treat model was used for data analyses. The participants consisted of 82 volunteers with social phobia. The intervention consisted of six lessons of CCBT for social phobia (the Shyness programme) with complex automated reminders. The main outcome measures were the Social Interaction Anxiety Scale and Social Phobia Scale.

Results: A total of 79% of CCBT + Tel and 79% of CCBT + Forum group participants completed all six lessons. Large mean within-groups effect sizes (Cohen's d) for the two social phobia measures were found for the CCBT + Tel and CCBT + Forum groups (1.31 and 1.54, respectively). Each participant in the CCBT + Tel group received a mean total of 38 min of technician time over the 8 week programme, while participants in the CCBT + Forum group received a mean total of 37 min of clinician time. Quantitative and qualitative data indicate that both the CCBT + Tel and CCBT + Forum procedures were equally and highly acceptable to participants.

Conclusions: The Shyness programme with either telephone support or access to a clinician-moderated online forum resulted in good clinical outcomes with equivalent patient acceptability. These results confirm that people with social phobia may significantly benefit from a highly structured education programme administered by clinical or non-clinical staff.

Clinical characteristics and long-term response to mood stabilizers in patients with bipolar disorder and different age at onset

INTRODUCTION

Bipolar disorder (BD) is a prevalent, comorbid, and impairing condition. Potential predictors of response to pharmacological treatment are object of continuous investigation in patients with BD. The present naturalistic study was aimed to assess clinical features and long-term response to mood stabilizers in a sample of bipolar subjects with different ages at onset.

METHODS

The study sample included 108 euthymic patients, diagnosed as affected by BD, either type I or II, according to the DSM-IV-TR, who were started on mood stabilizer treatment. Patients were followed-up for 24 months and the occurrence of any mood episode collected. At the end of the follow-up, patients were divided in 3 subgroups according to the age at onset (early-onset </=30 years, middle-onset >30-</=45 years, and late-onset >45 years, respectively) and the long-term response to mood stabilizers was compared between them along with other clinical features.

RESULTS

The three subgroups showed significant differences in terms of clinical and demographic features and, with respect to long-term response to mood stabilizers, the early-onset subgroup showed a better outcome in terms of reduction of major depressive episodes during the 24-month follow-up compared to the other subgroups (one way ANOVA, F = 3.57, p = 0.032).

CONCLUSIONS

Even though further controlled studies are needed to clarify the relationship between age at onset and outcome in BD, the present follow-up study suggests clinical peculiarities and different patterns of response to mood stabilizers across distinct subgroups of patients with BD and different ages at onset.

Measurement and data analysis in research addressing health disparities in substance abuse

This article describes concrete strategies for conducting substance abuse research with ethnic minorities. Two issues associated with valid analysis, measurement and data analysis, are included. Both empirical (e.g., confirmatory factor analysis, item response theory, and regression) and nonempirical (e.g., focus groups, expert panels, pilot studies, and translation equivalence) approaches to improve measures are described. A discussion of the use of norms and cutoff scores derived from a different ethnic group along with the effects of the ethnicity of the interviewer or coder on measurement is included. The section on data analysis describes why the use of race-comparison designs may lead to misleading conclusions. Alternatives to race-comparison analysis including within-group and between-group analyses are described. The shortcomings of combining ethnic groups for analyses are discussed. The article ends with a list of recommendations for research with ethnic minorities.

Stress and the neuroendocrinology of anxiety disorders

Stress is a risk factor for depressive and anxiety disorders. Changes in lifestyle patterns that are associated with increased stress therefore place a greater burden on mental health. Stress challenges the organism's homeostatic mechanisms, triggering a cascade of events that should, normally, maintain or allow a return to equilibrium. Stressful events are perceived by sensory systems in the brain, facilitating evaluation and comparison of the existing and previous stimuli as well as the activation of hormones responsible for energy mobilization. The limbic system coordinates the release of corticosteroids, the primary stress hormones, by modulating activation of the hypothalamic paraventricular nucleus (PVN). The amygdala, a limbic structure related to emotional behavior, has a putative role in the evaluation of emotional events and formation of fearful memories; it is also a target of the neurochemical and hormonal mediators of stress. Clinical and experimental data have correlated changes in the structure/function of the amygdala with emotional disorders such as anxiety. In this chapter we review the neuroendocrinology of the stress response, focusing on the role of the limbic system in its establishment and supplementing that information with new experimental data that demonstrates the relationship between stress and anxiety disorders; we also discuss the structural changes that occur in the amygdala after stress.

CNTRICS final task selection: working memory

The third meeting of the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) was focused on selecting promising measures for each of the cognitive constructs selected in the first CNTRICS meeting. In the domain of working memory, the 2 constructs of interest were goal maintenance and interference control. CNTRICS received 3 task nominations for each of these constructs, and the breakout group for working memory evaluated the degree to which each of these tasks met prespecified criteria. For goal maintenance, the breakout group for working memory recommended the AX-Continuous Performance Task/Dot Pattern Expectancy task for translation for use in clinical trial contexts in schizophrenia research. For interference control, the breakout group recommended the recent probes and operation/symmetry span tasks for translation for use in clinical trials. This article describes the ways in which each of these tasks met the criteria used by the breakout group to recommend tasks for further development.

Empirical Support for Resilience as More than the Counterpart and Absence of Vulnerability and Symptoms of Mental Disorder

The construct of resilience has been viewed as the direct counterpart of factors jeopardizing mental health, i.e., vulnerability and psychopathology. Any operationalization of resilience, thus, risks lying on the same latent continuum as indicators of mental illness, although indicating their absence. A factor analysis combining items from these measurement domains, followed by analyses of second-order factor scores was performed to test this assumption. A random selection of 1,724 participants (34% response rate) from the general population of Norway responded. All items were discriminated well by their primary factors. A second-order factor analysis extracted two components, which was confirmed on a hold-out sample by confirmatory factor methods. The Resilience Scale for Adults (RSA), which measures protective factors, correlated with both second-order factors. Thus, the RSA shared common variance with vulnerability and psychopathology, as well as being unique from illness indices. A hierarchical regression analysis that tested interactions between vulnerability and resilience further supported the unique contributions of the RSA. Thus, the notion of resilience-protective indicators as solely counterparts of vulnerability and psychopathology is not empirically supported.

Contemporary psychotherapy research: implications for substance misuse treatment and research

This article provides an overview of the major findings of psychotherapy research and discusses the possible implications of these findings for substance user treatment researchers and practitioners. While the centrality of relationship for human change processes was historically understood, twentieth century research tended to see relationship and person variables as secondary to operationalized "mechanisms of action" unique to particular psychotherapies. Interestingly, recent meta-analytic investigations have uncovered the weakness of randomized controlled trials (RCT) comparison investigations that have, until recently, represented the "gold standard" for the field. There has been a resurgent interest in the "common factors" that appear to be important across many effective psychotherapies. In addition, psychiatric anthropologists have contributed important information about the problems of client noncompliance with mental health treatment that parallel quantitative investigations. Substance misuse researchers have also found that client characteristics, especially clients' readiness to engage treatment, are important to investigate. The importance of the "therapeutic alliance" and the characteristics of clients and clinicians have become central areas for study, rather than variables to be controlled or excluded. Emphasis on these factors may represent the future for research in psychotherapy and substance user treatment, especially if researchers and community practitioners can join together to overcome methodological feasibility and dissemination problems that plague effectiveness research. However, the continued attractiveness of comparative studies and treatment efficacy studies may represent longstanding epistemological assumptions and responses to economic incentives that will be difficult to challenge.

For better or worse? Stress inoculation effects for implicit but not explicit anxiety

BACKGROUND

Severe early life stress (ELS) is associated with negative outcomes. It is not clear, however, what impact moderate ELS has. A growing stress inoculation literature suggests that moderate (vs. low or high) ELS is associated with diminished behavioral and physiological anxiety responses. At the same time, studies of trait anxiety suggest that moderate (vs. low) ELS is associated with greater self-reported anxiety. This study tested the hypothesis that stress inoculation effects are evident for implicit (nonconscious) but not explicit (conscious) aspects of anxiety.

METHODS

Ninety-seven healthy women were assessed for ELS and explicit anxiety using questionnaires and assessed for implicit anxiety using a version of the Implicit Association Test.

RESULTS

Results indicated a quadratic relation between ELS and implicit anxiety, such that moderate ELS was associated with lower implicit anxiety levels than low or high ELS. By contrast, the relation between ELS and explicit anxiety was linear.

CONCLUSION

These findings support the stress inoculation hypothesis and suggest that stress inoculation applies for implicit but not explicit aspects of anxiety.

Diagnostic issues in eating disorders and obesity

A thorough understanding of weight related issues is required for the assessment of patients with obesity and eating disorders. Body weight adjusted for height is used for the diagnosis of both anorexia nervosa (AN) and obesity. For AN, the DSM IV A criterion refers to 85 % of expected weight as a guideline, for overweight and obesity BMI cut-offs are commonly used. Because the BMI distribution changes during childhood and adolescence, the 85(th) and 95(th) BMI centiles are used in the USA to classify children as at risk of overweight and obesity, respectively. 85 % of expected weight is approximately equivalent to the 10(th) BMI centile.

Childhood emotional maltreatment and later psychological distress among college students: the mediating role of maladaptive schemas

OBJECTIVE

Theoretically, exposure to experiences of emotional abuse (EA) and emotional neglect (EN) in childhood may threaten the security of attachment relationships and result in maladaptive models of self and self-in-relation to others. The purpose of this study was to explore the extent to which EA and EN treatment by parents contributed uniquely to young adult maladaptive long-term outcome with respect to symptoms of anxiety, depression, and dissociation. The extent to which the relationships between EA and EN and later symptoms were mediated by specific internalized maladaptive interpersonal schemas was also explored.

METHODS

Questionnaires completed by 301 college men and women (52% female) assessed perceptions of experiences of childhood abuse and neglect, exposure to parental alcoholism, current symptoms of psychological distress, and endorsement of maladaptive interpersonal schemas.

RESULTS

Hierarchical regression analyses revealed that perceptions of childhood EA and EN each continued to exert an influence on later symptoms after controlling for gender, income, parental alcoholism, and other child abuse experiences. Both EA and EN were associated with later symptoms of anxiety and depression and were mediated by schemas of vulnerability to harm, shame, and self-sacrifice. Only EN was related to later symptoms of dissociation; this relationship was mediated by the schemas of shame and vulnerability to harm.

CONCLUSION

The findings are discussed from an attachment perspective, focusing on how early interactions with parents contribute to the development of internal working models of self and self-in-relation to others that influence later cognitive schemas and psychological adjustment.

PRACTICE IMPLICATIONS

Although emotional abuse and emotional neglect are the least studied of all forms of child maltreatment, they may be the most prevalent. The current findings suggest that how college students have evaluated and internalized these experiences may be even more important than the events themselves in determining the extent to which these experiences exert a long-term impact. For this reason, early intervention might be particularly important in helping to modify internal working models of the self as worthless, others as abusive, or the world as threatening and dangerous as a result of past abuse experiences. This study underscores the need for counselors to actively elicit and explore experiences of emotional abuse and neglect in clients, in addition to inquiring about other abuse experiences and types of family dysfunction. The results of this study also support existing data suggesting that internalized representational models of self and others are a key mechanism underlying the relationship between emotional maltreatment and later psychopathology. Young's schema questionnaire proved to be quite sensitive in detecting specific maladaptive schemas that mediated later difficulties with depression, anxiety, and dissociation. Targeting these negative schemas in therapy may help to ameliorate such symptoms. The therapeutic relationship provides a particularly effective context for developing more positive models of self and others, as well as providing a context to explore core relationship themes across different relationship contexts (e.g., intimate partner, parent, friend, and work relationships). In particular, if the assessment of the client reveals that dissociative symptoms are present, counselors can acknowledge the adaptive function that this strategy once served, while also addressing potential limitations to over-reliance on this coping strategy.

Children of low-income depressed mothers: psychiatric disorders and social adjustment

BACKGROUND

Although several studies have documented a higher prevalence of psychiatric disorders in children of depressed than nondepressed parents, previous research was conducted in predominantly White, middle, or upper-middle class populations. Only limited information is available on psychiatric disorders and psychosocial functioning in children of low-income depressed mothers.

METHODS

We report the findings in children of mothers with and without a lifetime history of major depressive disorder, who were recruited from a large urban primary-care practice. Bilingual clinical interviewers assessed 58 children with structured diagnostic interviews administered to most children (90%) and to their mothers as informants. Diagnostic assessments and best estimate diagnoses of the children were blind to the mothers' diagnostic status.

RESULTS

The families were poor and predominantly Hispanic, more than half of them headed by single mothers. After adjusting for child age and gender, and for any possible sibling correlation, children of depressed mothers had significantly higher rates of lifetime depressive, separation anxiety, oppositional defiant, and any psychiatric disorders than children of control mothers, with a lifetime prevalence of any psychiatric disorder of 84.6 versus 50.0%, respectively. Children of depressed mothers also reported significantly lower psychosocial functioning and had higher rates of psychiatric treatment.

CONCLUSIONS

We conclude that the risk for psychiatric disorders may be particularly high in children of low-income depressed mothers. The primary-care setting offers a unique opportunity for early intervention with this underserved group.

Self-harm in adolescents: self-report survey in schools in Scotland

BACKGROUND

The suicide rate in Scotland is twice as high as that in England. However, the prevalence of self-harm is unknown.

AIMS

To determine the prevalence of self-harm in adolescents in Scotland and the factors associated with it.

METHOD

A total of 2008 pupils aged 15-16 years completed an anonymous lifestyle and coping survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, social influences, psychological variables and self-harm.

RESULTS

Self-harm was reported by 13.8% of the respondents. The majority (71%) of those who had self-harmed had done so in the past 12 months and girls were approximately 3.4 times more likely to report self-harm than boys. In multivariate analyses, smoking, bullying, worries about sexual orientation, self-harm by family and anxiety were associated with self-harm in both genders. In addition, drug use, physical abuse, serious boy/girlfriend problems, self-harm by friends and low levels of optimism were also associated with self-harm in girls.

CONCLUSIONS

Despite markedly different national suicide rates, the prevalence of self-harm in Scotland is similar to that in England with girls at least three times more likely to report self-harm than boys. The findings suggest a role for emotional literacy programmes in schools and highlight the importance of promoting positive mental health among adolescents.

Role of glutamate in schizophrenia: integrating excitatory avenues of research

Schizophrenia is a debilitating lifelong disorder affecting up to 1% of the population worldwide, producing significant financial and emotional hardship for patients and their families. As yet, the causes of schizophrenia and the mechanism of action of antipsychotic drugs are unknown, and many patients do not respond well to currently available medications. Attempts to find risk factors for the disorder using epidemiological methods have shown that schizophrenia is highly heritable, and path analyses predict that the disorder is caused by several genes in combination with nongenetic factors. Therefore, intensive research efforts have been made to identify genes creating vulnerability to schizophrenia and also genes predicting response to treatment. Interactions of the glutamatergic system with dopaminergic and serotonergic circuitry are crucial for normal brain function, and their disruption may be a mechanism by which the pathophysiology of schizophrenia is manifest. Genes within the glutamatergic system are therefore strong candidates for investigation, and these include the glutamate receptor genes in addition to genes encoding neuregulin, dysbindin, D-amino acid oxidase and G72/G30. These genetic studies could eventually reveal new targets for antipsychotic drug treatment, which currently focuses on inhibition of the dopaminergic system. However, a recent breakthrough indicates clinical efficacy of a drug stimulating the metabotropic glutamate receptor II, LY2140023, which has improved efficacy for negative and cognitive symptoms of schizophrenia. Studies of larger patient samples are required to consolidate these data. Further investigation of glutamatergic targets is likely to reinvigorate antipsychotic drug development.

Refining psychiatric genetics: from 'mouse psychiatry' to understanding complex human disorders

Investigating the pathogenesis of psychiatric disorders is a complicated and rigorous task for psychiatric geneticists, as the disorders often involve combinations of genetic, behavioral, personality, and environmental factors. To nurture further progress in this field, a new set of conceptual tools is needed in addition to the currently accepted approaches. Concepts that consider cross-species trait genetics and the interplay between the domains of disorders, as well as the full spectrum of potential symptoms and their place along the pathogenetic continuum, are particularly important to address these needs. Here, we outline recent concepts and approaches that can help refine the field and enable more precise dissection of the genetic mechanisms contributing to psychiatric disorders.

Depression and reduced sensitivity to non-rewards versus rewards: Evidence from event-related potentials

Depression has been characterized in recent years in terms of deficits in positive affect and an underactive approach-related motivational system. Consistent with this view, behavioral and electrocortical studies suggest that reduced sensitivity to rewards may be a fundamental feature of depression. Within the event-related potential literature, the feedback negativity (FN) has been identified as a component that is sensitive to feedback indicating non-rewards versus rewards, and has been linked to phasic changes in midbrain dopamine levels that indicate whether events are better or worse than expected; thus, the FN may be a useful marker for abnormalities in reward sensitivity associated with depression. In the current study, a simple gambling task was used to elicit an FN in participants, and the magnitude of the FN was related to levels of depressive symptoms, as well as levels of anxiety and stress. The enhancement of the FN to non-rewards relative to rewards was found to be inversely related to depression and stress reactivity; only the relationship between the FN and stress remained significant after controlling for the other psychological variables. The P3 to feedback, meanwhile, was inversely related to depression and anxiety scores regardless of feedback type. These results are discussed within the context of current models of depression and reward sensitivity.

Motor impairment: a new ethanol withdrawal phenotype in mice

Alcoholism is a complex disorder with genetic and environmental risk factors. The presence of withdrawal symptoms is one criterion for alcohol dependence. Genetic animal models have followed a reductionist approach by quantifying various effects of ethanol withdrawal separately. Different ethanol withdrawal symptoms may have distinct genetic etiologies, and therefore differentiating distinct neurobiological mechanisms related to separate signs of withdrawal would increase our understanding of various aspects of the complex phenotype. This study establishes motor incoordination as a new phenotype of alcohol withdrawal in mice. Mice were made physically dependent on ethanol by exposure to ethanol vapor for 72 h. The effects of ethanol withdrawal in mice from different genetic backgrounds were measured on the accelerating rotarod, a simple motor task. Ethanol withdrawal disrupted accelerating rotarod behavior in mice. The disruptive effects of withdrawal suggest a performance rather than a learning deficit. Inbred strain comparisons suggest genetic differences in magnitude of this withdrawal phenotype. The withdrawal-induced deficits were not correlated with the selection response difference in handling convulsion severity in selectively bred Withdrawal Seizure-Prone and Withdrawal Seizure-Resistant lines. The accelerating rotarod seems to be a simple behavioral measure of ethanol withdrawal that is suitable for comparing genotypes.

The structure of genetic and environmental risk factors for DSM-IV personality disorders: a multivariate twin study

CONTEXT

Although both genetic and environmental factors affect risk of individual personality disorders (PDs), we know little of how they contribute to the pattern of comorbidity between the PDs in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV).

OBJECTIVE

To clarify the structure of the genetic and environmental risk factors for the 10 DSM-IV PDs.

DESIGN

Assessment of PDs at personal interview and multivariate twin modeling with the Mx program.

SETTING

General community.

PARTICIPANTS

A total of 2794 young adult members of the Norwegian Institute of Public Health Twin Panel. Main Outcome Measure Number of endorsed criteria for the 10 DSM-IV PDs.

RESULTS

The best-fit multivariate twin model required 3 genetic and 3 individual-specific environmental factors and genetic and individual-specific factors unique to each PD. The first genetic factor had high loadings on PDs from all 3 clusters including paranoid, histrionic, borderline, narcissistic, dependent, and obsessive-compulsive. The second genetic factor had substantial loadings only on borderline and antisocial PD. The third genetic factor had high loadings only on schizoid and avoidant PD. Several PDs had substantial disorder-specific genetic risk factors. The first, second, and third individual-specific environmental factors had high loadings on the cluster B, A, and C PDs, respectively, with 1 exception: obsessive-compulsive PD loaded with cluster B and not cluster C PDs.

CONCLUSIONS

Genetic risk factors for DSM-IV PDs do not reflect the cluster A, B, and C typology. Rather, 1 genetic factor reflects a broad vulnerability to PD pathology and/or negative emotionality. The 2 other genetic factors are more specific and reflect high impulsivity/low agreeableness and introversion. Unexpectedly, the cluster A, B, and C typology is well reflected in the structure of environmental risk factors, suggesting that environmental experiences may be responsible for the tendency of cluster A, B, and C PDs to co-occur.

Mood disorders and the outcome of suicidal thoughts and attempts

Suicidal ideation and attempts are common reasons for visits to the emergency department and critical care hospitalizations and a common public health problem. Most patients who make a suicide attempt have a psychiatric disorder, most frequently a mood, psychotic, substance use, or personality disorder. Patients who are at high risk of another attempt and cannot be transferred promptly to a psychiatric service should be managed jointly by the psychiatric and critical care teams with an emphasis on protection of the patient, identification of substance intoxication and withdrawal, making the environment safe, and instituting treatment of the psychiatric disorder. Antidepressants reduce suicide risk but their slow onset of action may make electroconvulsive therapy a desirable alternative for severely depressed patients. Parenteral treatment is possible with benzodiazepines and antipsychotic drugs but not antidepressants.

Chronic stress, drug use, and vulnerability to addiction

Stress is a well-known risk factor in the development of addiction and in addiction relapse vulnerability. A series of population-based and epidemiological studies have identified specific stressors and individual-level variables that are predictive of substance use and abuse. Preclinical research also shows that stress exposure enhances drug self-administration and reinstates drug seeking in drug-experienced animals. The deleterious effects of early life stress, child maltreatment, and accumulated adversity on alterations in the corticotropin releasing factor and hypothalamic-pituitary-adrenal axis (CRF/HPA), the extrahypothalamic CRF, the autonomic arousal, and the central noradrenergic systems are also presented. The effects of these alterations on the corticostriatal-limbic motivational, learning, and adaptation systems that include mesolimbic dopamine, glutamate, and gamma-amino-butyric acid (GABA) pathways are discussed as the underlying pathophysiology associated with stress-related risk of addiction. The effects of regular and chronic drug use on alterations in these stress and motivational systems are also reviewed, with specific attention to the impact of these adaptations on stress regulation, impulse control, and perpetuation of compulsive drug seeking and relapse susceptibility. Finally, research gaps in furthering our understanding of the association between stress and addiction are presented, with the hope that addressing these unanswered questions will significantly influence new prevention and treatment strategies to address vulnerability to addiction.

Lithium: bipolar disorder and neurodegenerative diseases Possible cellular mechanisms of the therapeutic effects of lithium

Bipolar illness is a major psychiatric disorder that affects 1-3% of the worldwide population. Epidemiological studies have demonstrated that this illness is substantially heritable. However, the genetic characteristics remain unknown and a clear personality has not been identified for these patients. The clinical history of lithium began in mid-19th century when it was used to treat gout. In 1940, it was used as a substitute for sodium chloride in hypertensive patients. However, it was then banned, as it had major side effects. In 1949, Cade reported that lithium could be used as an effective treatment for bipolar disorder and subsequent studies confirmed this effect. Over the years, different authors have proposed many biochemical and biological effects of lithium in the brain. In this review, the main mechanisms of lithium action are summarised, including ion dysregulation; effects on neurotransmitter signalling; the interaction of lithium with the adenylyl cyclase system; inositol phosphate and protein kinase C signalling; and possible effects on arachidonic acid metabolism. However, none of the above mechanisms are definitive, and sometimes results have been contradictory. Recent advances in cellular and molecular biology have reported that lithium may represent an effective therapeutic strategy for treating neurodegenerative disorders like Alzheimer's disease, due to its effects on neuroprotective proteins like Bcl-2 and its actions on regulators of apoptosis and cellular resilience, such as GSK-3. However, results are contradictory and more specific studies into the use of lithium in therapeutic approaches for neurodegenerative diseases are required.