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Meisenzahl E, Wege N, Stegmüller V, Schulte-Körne G, Greimel E, Dannlowski U, Hahn T, Romer G, Romanos M, Deserno L, Klingele C, Theisen C, Kieckhäfer C, Forstner A, Ruhrmann S, Schultze-Lutter F. Clinical high risk state of major depressive episodes: Assessment of prodromal phase, its occurrence, duration and symptom patterns by the instrument the DEpression Early Prediction-INventory (DEEP-IN). J Affect Disord 2024; 351:403-413. [PMID: 38181843 DOI: 10.1016/j.jad.2023.12.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND To decrease the incidence of major depressive episodes, indicated prevention that targets clinical high-risk individuals with first detectable signs that forecast mental disorder is a highly relevant topic of preventive psychiatry. Still little is known about the prodrome of MDE. The aim of the current study was to identify the occurrence of a clinical high-risk state of depression, its duration and symptom constellation. METHODS Seventy-three patients with a diagnosed affective disorder in partial remission were assessed with our newly developed semi-structured extensive clinical instrument, the DEpression Early Prediction-INventory (DEEP-IN). Within DEEP-IN the course of prodromal symptoms was explored by using a life-chart method. RESULTS The significant majority of patients (93.2 %) reported a prodromal phase. The mean duration was 7.9 months (SD = 12.5). Within the group with an identified prodromal phase, psychopathological (95.6 %) as well as somatic symptoms (88.2 %) were reported. Somatic symptoms showed a moderate-to-strong effect of sex with higher prevalence in females than in males (97.6 % vs 73.1 %; V = 0.370). LIMITATIONS This feasibility study had only a small sample size. CONCLUSIONS The majority of patients with affective disorders reported a clinical prodromal phase with both psychopathological and somatic symptoms that developed months before the onset of the depressive episode. The development of structured instruments for the assessment of depressive risk states is a promising approach for indicated prevention of depression in the future.
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Affiliation(s)
- Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany.
| | - Natalia Wege
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Veronika Stegmüller
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ellen Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child Adolescence Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Marcel Romanos
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Lorenz Deserno
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany; Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Neuroimaging Center, Technical University of Dresden, Dresden, Germany
| | - Cosima Klingele
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Christian Theisen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Carolin Kieckhäfer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Andreas Forstner
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Stefan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
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Sun X, Zhang X, Liu L, Zhang L, Zhan T, Chen Y. A qualitative of stable symptomatology for patients with schizophrenia: do they have adequate post-discharge rehabilitative resources? SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:29. [PMID: 37156777 PMCID: PMC10167338 DOI: 10.1038/s41537-023-00358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
Many patients diagnosed with schizophrenia face obstacles to rehabilitation and discharge into the community, particularly with regard to the way resources are structured. Clarifying the difficulties will help health care providers address rehabilitation shortcomings. Semistructured in-depth interviews and participatory observations were conducted in various locations (family home, hospital ward, outpatient clinic, and on the street) with families, social workers, doctors, nursing staff, and patients with schizophrenia. These patients met the medical facility's hospital discharge standards and either had not been discharged or had been discharged within two weeks of meeting the discharge criteria. This study explores the complex and interdependent role of social differences in the rehabilitation of patients with schizophrenia after acute treatment. The study identified five topics related to structural difficulties in resources for the rehabilitation of patients diagnosed with schizophrenia: (1) the role of policy; (2) inadequate facilities and responsibilities; (3) rejecting communities; (4) difficult families; and (5) the threat of stigma. The rehabilitation of patients diagnosed with schizophrenia is a systemic problem. Systemic rehabilitation policies and integrated social support would be more conducive to the rehabilitation of patients. Perhaps cognitive remediation therapy or the Assertive Community Treatment (ACT) Model could benefit individuals with complex disorders.
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Affiliation(s)
- Xirong Sun
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Xiyan Zhang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Liang Liu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Lei Zhang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Ting Zhan
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Yanhua Chen
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China.
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Asimakidou E, Job X, Kilteni K. The positive dimension of schizotypy is associated with a reduced attenuation and precision of self-generated touch. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:57. [PMID: 35854009 PMCID: PMC9261081 DOI: 10.1038/s41537-022-00264-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023]
Abstract
The brain predicts the sensory consequences of our movements and uses these predictions to attenuate the perception of self-generated sensations. Accordingly, self-generated touch feels weaker than an externally generated touch of identical intensity. In schizophrenia, this somatosensory attenuation is substantially reduced, suggesting that patients with positive symptoms fail to accurately predict and process self-generated touch. If an impaired prediction underlies the positive symptoms of schizophrenia, then a similar impairment should exist in healthy nonclinical individuals with high positive schizotypal traits. One hundred healthy participants (53 female), assessed for schizotypal traits, underwent a well-established psychophysics force discrimination task to quantify how they perceived self-generated and externally generated touch. The perceived intensity of tactile stimuli delivered to their left index finger (magnitude) and the ability to discriminate the stimuli (precision) was measured. We observed that higher positive schizotypal traits were associated with reduced somatosensory attenuation and poorer somatosensory precision of self-generated touch, both when treating schizotypy as a continuous or categorical variable. These effects were specific to positive schizotypy and were not observed for the negative or disorganized dimensions of schizotypy. The results suggest that positive schizotypal traits are associated with a reduced ability to predict and process self-generated touch. Given that the positive dimension of schizotypy represents the analogue of positive psychotic symptoms of schizophrenia, deficits in processing self-generated tactile information could indicate increased liability to schizophrenia.
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Affiliation(s)
- Evridiki Asimakidou
- Department of Neuroscience, Karolinska Institutet, Solnavägen 9, 17165, Stockholm, Sweden
| | - Xavier Job
- Department of Neuroscience, Karolinska Institutet, Solnavägen 9, 17165, Stockholm, Sweden
| | - Konstantina Kilteni
- Department of Neuroscience, Karolinska Institutet, Solnavägen 9, 17165, Stockholm, Sweden.
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Schultze-Lutter F, Meisenzahl E, Michel C. [Psychotic disorders in ICD-11: the revisions]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 49:453-462. [PMID: 33287579 DOI: 10.1024/1422-4917/a000777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Psychotic disorders in ICD-11: the revisions Abstract. This article provides an overview of the main changes to the chapter "Schizophrenia or Other Primary Psychotic Disorders" (6A2) from ICD-10 to ICD-11 and compares them with the psychosis chapter of DSM-5. These changes include abandoning the classical subtypes of Schizophrenia as well as of the special significance of Schneider's first-rank symptoms, resulting in the general requirement of two key features (one must be a positive symptom) in the definition of "Schizophrenia" (6A20) and the allowance for bizarre contents in "Delusional Disorder" (6A24), which now includes "Induced Delusional Disorder" (F24). Further introduced are the focus on the current episode, the restriction of "Acute and Transient Psychotic Disorder" (6A23) to the former Polymorphic Disorder Without Schizophrenic Symptoms (F23.0), the diagnosis of delusional "Obsessive-Compulsive or Related Disorders" (6B2) exclusively as Obsessive-Compulsive Disorders, the specification of "Schizoaffective Disorder" (6A21), and the formulation of a distinct subchapter "Catatonia" (6A4) for the assessment of catatonic features in the context of several disorders. In analogy to DSM-5, ICD-11 now includes the optional category "Symptomatic Manifestations of Primary Psychotic Disorders" (6A25) for the dimensional quantification of symptoms. Again, developmental aspects remain unattended in in the ICD-11-definitions of psychotic disorders.
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Affiliation(s)
- Frauke Schultze-Lutter
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.,Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Eva Meisenzahl
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Chantal Michel
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz
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Abstract
BACKGROUND Longitudinal cohort studies with early start and life span perspectives are increasingly recognized as being crucial to uncover developmental trajectories as well as risk and resilience factors of psychiatric disorders. OBJECTIVE The importance of longitudinal studies is presented and the main findings of the Mannheim study of children at risk (MARS), the adolescent brain cognitive development (ABCD), the pediatric and adolescent health survey (Kinder- und Jugendgesundheitssurvey, KiGGS) and the AIMS longitudinal European autism project (LEAP) cohort studies are described. MATERIAL AND METHODS A literature search was carried out in MEDLINE. RESULTS The MARS followed participants with psychosocial and organic risks over more than 30 years starting from birth and showed the importance of early risk factors (prenatal period up to early childhood) for neuropsychosocial development. The ABCD cohort study (start 9-10 years old) underlined the developmental significance of early socioemotional and prenatal risks as well as toxin exposure. The KiGGS cohort followed children and adolescents from age 0-17 years up to the ages of 10-28 years. Main findings underline the importance of the socioeconomic status and gender-specific effects with respect to sensitive periods for the onset and trajectories of psychiatric disorders. The AIMS cohort followed patients with and without autism spectrum disorders aged between 6 and 30 years and first results revealed small effects regarding group differences. Further, cohort studies starting prenatally along with deep phenotyping are warranted to uncover the complex etiology of mental disorders. CONCLUSION Existing cohort studies on early mental development have shown specific focal points. To identify general and specific risk and resilience factors for psychiatric disorders and to model trajectories, there is a need for multimodal integration of data sets.
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