1
|
Modasi J, Khachadourian V, O'Hora K, Kushan L, Slavich GM, Shields GS, Velthorst E, Bearden CE. Associations between acute and chronic lifetime stressors and psychosis-risk symptoms in individuals with 22q11.2 copy number variants. Psychol Med 2023; 53:7222-7231. [PMID: 37078394 PMCID: PMC10719673 DOI: 10.1017/s0033291723000740] [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: 07/21/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The 22q11.2 deletion (22q11Del) is among the strongest known genetic risk factors for psychosis. Stress, a known risk factor for psychosis in the general population, has seldom been studied in 22q11Del. We investigated how lifetime stressors related to symptomatic outcomes in patients with 22q11Del. We also explored this association in individuals with 22q11.2 duplications (22q11Dup), which may be potentially protective against psychosis. METHOD One hundred individuals (46 with 22q11Del, 30 with 22q11Dup, and 24 healthy controls; Mage = 17.30 years±10.15) were included. Logistic models were used to examine cross-sectional associations between lifetime acute and chronic stressors (severity and count) and the presence (score ⩾3) of positive, negative, and general symptoms, assessed via the Structured Interview for Psychosis-risk Syndromes (SIPS). RESULTS The 22q11Dup group reported the greatest number and severity of acute lifetime stressors, but did not differ from 22q11Del in chronic stressor count or severity. Lifetime chronic and acute stressors were uniquely associated with positive symptoms in 22q11Del (chronic count: odds ratio [OR] = 2.35, p = 0.02; chronic severity: OR = 1.88, p = 0.03; acute count: OR = 1.78, p = 0.03), but not with negative or general symptoms (ps > 0.05). CONCLUSION Findings suggest that stress may play a role in psychotic symptoms in 22q1Del, while the 22q11Dup CNV appears protective against psychotic symptoms despite higher rates of stressors. Interventions that mitigate effects of stressors in 22qDel may reduce the odds of psychosis in this group. Prospective longitudinal research is needed to replicate these findings.
Collapse
Affiliation(s)
- Jasmine Modasi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathleen O'Hora
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Interdepartmental Program for Neuroscience, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Leila Kushan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Grant S. Shields
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Óskarsdóttir S, Boot E, Crowley TB, Loo JCY, Arganbright JM, Armando M, Baylis AL, Breetvelt EJ, Castelein RM, Chadehumbe M, Cielo CM, de Reuver S, Eliez S, Fiksinski AM, Forbes BJ, Gallagher E, Hopkins SE, Jackson OA, Levitz-Katz L, Klingberg G, Lambert MP, Marino B, Mascarenhas MR, Moldenhauer J, Moss EM, Nowakowska BA, Orchanian-Cheff A, Putotto C, Repetto GM, Schindewolf E, Schneider M, Solot CB, Sullivan KE, Swillen A, Unolt M, Van Batavia JP, Vingerhoets C, Vorstman J, Bassett AS, McDonald-McGinn DM. Updated clinical practice recommendations for managing children with 22q11.2 deletion syndrome. Genet Med 2023; 25:100338. [PMID: 36729053 DOI: 10.1016/j.gim.2022.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 02/03/2023] Open
Abstract
This review aimed to update the clinical practice guidelines for managing children and adolescents with 22q11.2 deletion syndrome (22q11.2DS). The 22q11.2 Society, the international scientific organization studying chromosome 22q11.2 differences and related conditions, recruited expert clinicians worldwide to revise the original 2011 pediatric clinical practice guidelines in a stepwise process: (1) a systematic literature search (1992-2021), (2) study selection and data extraction by clinical experts from 9 different countries, covering 24 subspecialties, and (3) creation of a draft consensus document based on the literature and expert opinion, which was further shaped by survey results from family support organizations regarding perceived needs. Of 2441 22q11.2DS-relevant publications initially identified, 2344 received full-text reviews, including 1545 meeting criteria for potential relevance to clinical care of children and adolescents. Informed by the available literature, recommendations were formulated. Given evidence base limitations, multidisciplinary recommendations represent consensus statements of good practice for this evolving field. These recommendations provide contemporary guidance for evaluation, surveillance, and management of the many 22q11.2DS-associated physical, cognitive, behavioral, and psychiatric morbidities while addressing important genetic counseling and psychosocial issues.
Collapse
Affiliation(s)
- Sólveig Óskarsdóttir
- Department of Pediatric Rheumatology and Immunology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Erik Boot
- Advisium, 's Heeren Loo Zorggroep, Amersfoort, The Netherlands; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
| | - Terrence Blaine Crowley
- The 22q and You Center, Clinical Genetics Center, and Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joanne C Y Loo
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Jill M Arganbright
- Department of Otorhinolaryngology, Children's Mercy Hospital and University of Missouri Kansas City School of Medicine, Kansas City, MO
| | - Marco Armando
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Adriane L Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Elemi J Breetvelt
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Genetics & Genome Biology Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Madeline Chadehumbe
- Division of Neurology, 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Christopher M Cielo
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Pulmonary and Sleep Medicine, 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Steven de Reuver
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephan Eliez
- Fondation Pôle Autisme, Department of Psychiatry, Geneva University School of Medecine, Geneva, Switzerland
| | - Ania M Fiksinski
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands; Department of Pediatric Psychology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Brian J Forbes
- Division of Ophthalmology, The 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Emily Gallagher
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Sarah E Hopkins
- Division of Neurology, 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Oksana A Jackson
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Cleft Lip and Palate Program, Division of Plastic, Reconstructive and Oral Surgery, 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lorraine Levitz-Katz
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Endocrinology and Diabetes, 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Michele P Lambert
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Hematology, 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bruno Marino
- Pediatric Cardiology Unit, Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Maria R Mascarenhas
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Gastroenterology, Hepatology and Nutrition, 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie Moldenhauer
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, 22q and You Center, The Children's Hospital of Philadelphia, Philadelphia, PA; Departments of Obstetrics and Gynecology and Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - Ani Orchanian-Cheff
- Library and Information Services and The Institute of Education Research (TIER), University Health Network, Toronto, Ontario, Canada
| | - Carolina Putotto
- Pediatric Cardiology Unit, Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Gabriela M Repetto
- Rare Diseases Program, Institute for Sciences and Innovation in Medicine, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Erica Schindewolf
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, 22q and You Center, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Cynthia B Solot
- Department of Speech-Language Pathology and Center for Childhood Communication, 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kathleen E Sullivan
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Allergy and Immunology, 22q and You Center, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ann Swillen
- Center for Human Genetics, University Hospital UZ Leuven, and Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Marta Unolt
- Pediatric Cardiology Unit, Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy; Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Jason P Van Batavia
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Urology, 22q and You Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Claudia Vingerhoets
- Advisium, 's Heeren Loo Zorggroep, Amersfoort, The Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Jacob Vorstman
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada; Genetics & Genome Biology Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne S Bassett
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Genetics & Genome Biology Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Clinical Genetics Research Program and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Donna M McDonald-McGinn
- The 22q and You Center, Clinical Genetics Center, and Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Human Biology and Medical Genetics, Sapienza University, Rome, Italy.
| |
Collapse
|
3
|
Nakajima N, Tanaka M, Kanehara A, Morishima R, Kumakura Y, Ohkouchi N, Hamada J, Ogawa T, Tamune H, Nakahara M, Mori S, Ichihashi K, Jinde S, Kano Y, Sakamoto I, Tanaka K, Hirata Y, Ohashi H, Shinohara T, Kasai K. Relationship between high trait anxiety in 22q11.2 deletion syndrome and the difficulties in medical, welfare, and educational services. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e80. [PMID: 38868412 PMCID: PMC11114383 DOI: 10.1002/pcn5.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/08/2023] [Accepted: 01/23/2023] [Indexed: 06/14/2024]
Abstract
Aim The 22q11.2 deletion syndrome (22q11DS) is associated with a high prevalence of mental health comorbidities. However, not enough attention has been paid to the elevated prevalence of high trait anxiety that begins early in life and may be enduring. We sought to identify specific medical, welfare, or educational difficulties associated with high trait anxiety in 22q11DS. Methods A questionnaire-based survey was conducted for the parents of 22q11DS individuals (N = 125). First, a multiple regression analysis was conducted to confirm the hypothesis that high trait anxiety in individuals with 22q11DS would be associated with parents' psychological distress. This was based on 19 questionnaire options regarding what difficulties the parents currently face about their child's disease, characteristics, and traits. Next, we explored what challenges faced in medical, welfare, and educational services would be associated with the trait anxiety in their child. Results The multiple regression analysis confirmed that the high trait anxiety was significantly associated with parental psychological distress (β = 0.265, p = 0.018) among the 19 clinical/personal characteristics of 22q11DS. Furthermore, this characteristic was associated with various difficulties faced in the medical care, welfare, and education services, and the parent-child relationship. Conclusion To our knowledge, this is the first study to clarify quantitatively how the characteristic of high anxiety level in 22q11DS individuals is related to the caregivers' perceived difficulties in medical, welfare, and educational services. These results suggest the necessity of designing service structures informed of the fact that high trait anxiety is an important clinical feature of the syndrome.
Collapse
Affiliation(s)
- Naomi Nakajima
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Miho Tanaka
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Akiko Kanehara
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Ryo Morishima
- The Health Care Science InstituteTokyoJapan
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yousuke Kumakura
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
- Department of Mental Health, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Noriko Ohkouchi
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Junko Hamada
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Tomoko Ogawa
- Department of Child PsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Hidetaka Tamune
- Department of Cellular Neurobiology, Graduate School of MedicineThe University of TokyoTokyoJapan
- World‐Leading Innovative Graduate Study Program for Life Science and Technology (WINGS‐LST)The University of TokyoTokyoJapan
| | - Mutsumi Nakahara
- Graduate School of Clinical PsychologyKagoshima UniversityKagoshimaJapan
| | - Shunsuke Mori
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kayo Ichihashi
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
| | - Seiichiro Jinde
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yukiko Kano
- Department of Child PsychiatryThe University of Tokyo HospitalTokyoJapan
- Department of Child Neuropsychiatry, Graduate, School of MedicineThe University of TokyoTokyoJapan
| | - Ichiro Sakamoto
- Department of Cardiovascular MedicineKyushu University Graduate School of Medical SciencesFukuokaJapan
| | - Kyoko Tanaka
- Department of Psychosocial MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Yoichiro Hirata
- Department of PediatricsKitasato University School of MedicineKanagawaJapan
| | - Hirofumi Ohashi
- Division of Medical GeneticsSaitama Children's Medical CenterSaitamaJapan
| | - Tokuko Shinohara
- Department of Pediatric Cardiology and Adult Congenital CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Kiyoto Kasai
- Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan
- Department of Neuropsychiatry, Graduate School of MedicineThe University of TokyoTokyoJapan
- The International Research Center for Neurointelligence (IRCN), The University of Tokyo Institutes for Advanced Study (UTIAS)The University of TokyoTokyoJapan
- UTokyo Institute for Diversity and Adaptation of Human Mind (UTIDAHM)The University of TokyoTokyoJapan
| |
Collapse
|
4
|
Snihirova Y, Linden DEJ, van Amelsvoort T, van der Meer D. Environmental Influences on the Relation between the 22q11.2 Deletion Syndrome and Mental Health: A Literature Review. Genes (Basel) 2022; 13:genes13112003. [PMID: 36360240 PMCID: PMC9690390 DOI: 10.3390/genes13112003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
22q11.2 deletion syndrome (22q11DS) is a clinically heterogeneous genetic syndrome, associated with a wide array of neuropsychiatric symptoms. The clinical presentation is likely to be influenced by environmental factors, yet little is known about this. Here, we review the available research literature on the role of the environment in 22q11DS. We find that within-patient design studies have mainly investigated the role of parental factors, stress, and substance use, reporting significant effects of these factors on the clinical profile. Case-control studies have been less successful, with almost no reports of significant moderating effects of the environment. We go on to hypothesize which specific environmental measures are most likely to interact with the 22q11 deletion, based on the genes in this region and their involvement in molecular pathways. We end by discussing potential reasons for the limited findings so far, including modest sample sizes and limited availability of environmental measures, and make recommendations how to move forward.
Collapse
Affiliation(s)
- Yelyzaveta Snihirova
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - David E. J. Linden
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Therese van Amelsvoort
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Dennis van der Meer
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway
- Correspondence:
| |
Collapse
|
5
|
Ilen L, Feller C, Eliez S, Micol E, Delavari F, Sandi C, Zanoletti O, Schneider M. Exploring associations between diurnal cortisol, stress, coping and psychopathology in adolescents and young adults with 22q11.2 deletion syndrome. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 9:100103. [PMID: 35755923 PMCID: PMC9216249 DOI: 10.1016/j.cpnec.2021.100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/10/2021] [Indexed: 01/15/2023] Open
Abstract
Background 22q11.2 deletion syndrome (22q11DS) is a neurogenetic condition associated to a high risk for psychiatric disorders, including psychosis. Individuals with 22q11DS are thought to experience increased levels of chronic stress, which could lead to alterations in hypothalamic-pituitary-adrenocortical (HPA)-axis functioning. In the current study, we investigated for the first time diurnal salivary cortisol profiles in adolescents and young adults with 22q11DS as well as their link with stress exposure, coping strategies and psychopathology, including psychotic symptoms. Methods Salivary cortisol was collected from adolescents and young adults with 22q11DS (n = 30, age = 19.7) and matched healthy controls (HC; n = 36, age = 18.5) six times a day for two days. Exposure to stressful life events, including peer victimization, coping strategies and general psychopathology were assessed with questionnaires. Psychotic symptoms and psychiatric comorbidities were evaluated with clinical interviews. Results We observed similar daily levels and diurnal profiles of salivary cortisol in adolescents and young adults with 22q11DS compared to HCs. However, participants with 22q11DS reported less frequent exposure to stress than HCs. In 22q11DS, we observed a significant association between the use of non-adaptive coping strategies and the severity of psychotics symptoms. Cortisol level was not associated to severity of psychotic symptoms, but elevated cortisol awakening response (CAR) was found in participants with 22q11DS with higher levels of general psychopathology. Conclusions Our results do not support earlier propositions of altered HPA-axis functioning in 22q11DS but highlight the need to further investigate diurnal cortisol as an indicator of HPA-axis functioning and its link with (earlier) stress exposure and psychopathology in this population. Interventions should target the development of adaptive coping skills in preventing psychosis in 22q11DS. Adolescents and young adults with 22q11DS report reduced exposure to stress. Non-adaptive coping is linked with the severity of psychotic symptoms in 22q11DS. Youth with 22q11DS show typical diurnal cortisol profiles. Elevated cortisol awakening response is related to greater general psychopathology.
Collapse
Affiliation(s)
- Laura Ilen
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Corresponding author. Clinical Psychology Unit for Intellectual and Developmental Disabilities Faculty of Psychology and Educational Sciences University of Geneva 40, Boulevard du Pont-d’Arve, 1205, Geneva, Switzerland.
| | - Clémence Feller
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Stephan Eliez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Developmental Imaging and Psychopathology Lab Research Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eva Micol
- Developmental Imaging and Psychopathology Lab Research Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Farnaz Delavari
- Developmental Imaging and Psychopathology Lab Research Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Carmen Sandi
- Behavioral Genetics Laboratory, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland
| | - Olivia Zanoletti
- Behavioral Genetics Laboratory, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland
| | - Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Impact of Equine-Assisted Interventions on Heart Rate Variability in Two Participants with 22q11.2 Deletion Syndrome: A Pilot Study. CHILDREN 2021; 8:children8111073. [PMID: 34828786 PMCID: PMC8617898 DOI: 10.3390/children8111073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022]
Abstract
People with disabilities due to genetic origin often present high levels of stress: non-pharmacological interventions such as Equine-Assisted Interventions (EAI) may be a useful strategy. The objective of this pilot study was to evaluate stress levels in two participants with 22q11.2 deletion syndrome diagnosis, immediately after carrying out the EAI. A single case experimental design methodology was chosen due to the small sample size. Two participants with 22q11.2 Deletion Syndrome, a rare disease, with different comorbidities were included. The present study considered the EAI as the independent variable while the Heart Rate Variability (HRV) represented the dependent one, as HRV is considered an indicator of stress level. Measurements were performed before and after carrying out the interventions. The results showed an HRV increase in one of the participants and an increase in the arousal level evidenced by a decrease in his HRV. After having carried out the program, EAI seems to cause an impact on the activation level of the participants depending on the typology and nature of the intervention. However, these results should be treated with caution due to the small sample size. This study is a pilot to test the feasibility of the proposed interventions on the variable under study.
Collapse
|
7
|
Bong SH, Kim KM, Seol KH, Kim JW. Bullying perpetration and victimization in elementary school students diagnosed with attention-deficit/hyperactivity disorder. Asian J Psychiatr 2021; 62:102729. [PMID: 34120014 DOI: 10.1016/j.ajp.2021.102729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/21/2021] [Accepted: 05/30/2021] [Indexed: 12/17/2022]
Abstract
Previous research has found that attention-deficit/hyperactivity disorder (ADHD) in children is related to bullying perpetration. This study examined the correlation between ADHD and bullying perpetration, and aimed to identify which factors, including bullying victimization, predicted bullying. Forty-nine elementary school students, aged 6-12, participated voluntarily in a comparative study between children with ADHD and non-ADHD control children; none of them had previously undergone psychiatric treatment. Both parents' and participants' social demographic information (gender, age) and clinical variables were obtained from self-report questionnaires. The participants' bullying victimization experience, impulsivity, and parents' history of ADHD had significant relationships with bullying. The status of ADHD and other self-reported scales had no significant relationships with bullying. The association between bullying victimization and bullying perpetration was notable among all factors examined. This was consistent with the claims of prior studies that past victimization led to perpetration of bullying. Therefore, it seems that when treating victims of bullying, care should be taken, through proper intervention, to ensure the incident is neither repeated nor replicated. Characteristics associated with ADHD, including impulsivity and parents' history of ADHD, were significantly related to bullying. However, we could not confirm our hypothesis that ADHD itself might be associated with bullying behavior.
Collapse
Affiliation(s)
- Su Hyun Bong
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Kyoung Min Kim
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Ki Ho Seol
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea.
| |
Collapse
|
8
|
Cowan HR, Mittal VA, McAdams DP. Narrative identity in the psychosis spectrum: A systematic review and developmental model. Clin Psychol Rev 2021; 88:102067. [PMID: 34274799 DOI: 10.1016/j.cpr.2021.102067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 01/19/2023]
Abstract
Individuals with schizophrenia-spectrum disorders face profound challenges as they attempt to maintain identity through the course of illness. Narrative identity-the study of internalized, evolving life stories-provides a rich theoretical and empirical perspective on these challenges. Based on evidence from a systematic review of narrative identity in the psychosis spectrum (30 studies, combined N = 3859), we argue that the narrative identities of individuals with schizophrenia-spectrum disorders are distinguished by three features: disjointed structure, a focus on suffering, and detached narration. Psychotic disorders typically begin to emerge during adolescence and emerging adulthood, which are formative developmental stages for narrative identity, so it is particularly informative to understand identity disturbances from a developmental perspective. We propose a developmental model in which a focus on suffering emerges in childhood; disjointed structure emerges in middle and late adolescence; and detached narration emerges before or around the time of a first psychotic episode. Further research with imminent risk and early course psychosis populations would be needed to test these predictions. The disrupted life stories of individuals on the psychosis spectrum provide multiple rich avenues for further research to understand narrative self-disturbances.
Collapse
Affiliation(s)
| | - Vijay A Mittal
- Psychology, Psychiatry, Medical and Social Sciences, Institute for Policy Research, Northwestern University, United States
| | - Dan P McAdams
- Psychology, School of Education and Social Policy, Northwestern University, United States
| |
Collapse
|
9
|
Longitudinal Psychiatric and Developmental Outcomes in 22q11.2 Deletion Syndrome: A Systematic Review. J Dev Behav Pediatr 2021; 42:415-427. [PMID: 34110308 DOI: 10.1097/dbp.0000000000000927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/28/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE 22q11.2 deletion syndrome (22q11DS) is a common genetic deletion syndrome associated with psychiatric disorders and developmental delays. A significant amount of 22q11DS research literature is published annually; here, we focus exclusively on longitudinal data that have been published in the past 5 years regarding psychiatric disorders and/or cognitive and social development. After a review, areas for future research consideration and clinical recommendations are presented. METHODS Articles were reviewed and organized in adherence with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for conducting systematic reviews. The literature search identified 852 studies, and 22 studies met inclusion criteria. RESULTS Longitudinal study findings indicate that developmental considerations for youth with 22q11DS should focus on the primacy and enduring nature of social and executive functioning deficits, attention-deficit/hyperactivity disorder, anxiety, and negative symptoms of psychosis. CONCLUSION From the diathesis of physiological conditions and genetic variance, 22q11DS and its associated phenotype of persistent cognitive deficits, comorbid psychiatric disorders, and social impairments likely conspire to increase the risk for stress in adolescence. The diathesis-stress framework, along with chronic stress, increases psychosis risk in individuals with 22q11DS. The existing literature has a heavy focus on the impact of the deletion on individual skills and attributes, such as cognition, but lacks information on the impact of the environment. Future 22q11DS research should consider specific aspects of social functioning, including interactions with parenting styles and family communication, as well as high demands in educational settings, as possible risk factors for psychosis.
Collapse
|
10
|
Gur RE, White LK, Shani S, Barzilay R, Moore TM, Emanuel BS, Zackai EH, McDonald-McGinn DM, Matalon N, Weinberger R, Gur RC, Gothelf D. A binational study assessing risk and resilience factors in 22q11.2 deletion syndrome. J Psychiatr Res 2021; 138:319-325. [PMID: 33894539 DOI: 10.1016/j.jpsychires.2021.03.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presentation of neurogenetic disorders such as 22q11.2 Deletion Syndrome (22q11.2DS) includes broad neuropsychiatric phenotypes that impact functioning and require assessment and treatment. Like in non-syndromal neuropsychiatric disorders, there is heterogeneity in symptom severity and illness course. The study of risk and resilience in the general population has benefited from measurement tools that parse heterogeneity and guide treatment. Suitability of such tools in neurogenetic disorders has not been examined and is essential to establish as prerequisite for examining whether similar processes modulate psychopathology in these populations. METHOD We applied the Risk & Resilience Battery assessing intrapersonal, interpersonal, and environmental domains, to 80 patients with 22q11.2DS, 30 from Philadelphia, USA and 50 from Tel-Aviv, Israel. We also evaluated global functioning and obtained self-reports of anxiety and depression. We examined the Risk & Resilience Battery reliability for each factor and used partial correlations to examine relations between the Risk & Resilience Battery factors and clinical measures. RESULTS Across samples, items within each risk and resilience factor showed good to excellent internal consistency. Higher scores on peer victimization, emotion dysregulation, and hostile close relationships were related to reports of anxiety and depression. Higher levels of self-reliance related to lower anxiety while greater security in close relationships related to lower depression. CONCLUSION The Risk & Resilience Battery can be applied to 22q11.2DS samples and advance Gene X Environment research and interventions.
Collapse
Affiliation(s)
- Raquel E Gur
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, The Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Lauren K White
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, The Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shachar Shani
- The Behavioral Neurogenetics Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Barzilay
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, The Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tyler M Moore
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, The Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Beverly S Emanuel
- Division of Human Genetics and 22q and You Center, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elaine H Zackai
- Division of Human Genetics and 22q and You Center, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Donna M McDonald-McGinn
- Division of Human Genetics and 22q and You Center, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Noam Matalon
- The Behavioral Neurogenetics Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Ronnie Weinberger
- The Behavioral Neurogenetics Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Ruben C Gur
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, The Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Doron Gothelf
- The Behavioral Neurogenetics Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
11
|
Fiksinski AM, Schneider M, Zinkstok J, Baribeau D, Chawner SJRA, Vorstman JAS. Neurodevelopmental Trajectories and Psychiatric Morbidity: Lessons Learned From the 22q11.2 Deletion Syndrome. Curr Psychiatry Rep 2021; 23:13. [PMID: 33625600 PMCID: PMC7904715 DOI: 10.1007/s11920-021-01225-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The 22q11.2 deletion syndrome (22q11DS) is associated with a broad spectrum of neurodevelopmental phenotypes and is the strongest known single genetic risk factor for schizophrenia. Compared to other rare structural pathogenic genetic variants, 22q11DS is relatively common and one of the most extensively studied. This review provides a state-of-the-art overview of current insights regarding associated neurodevelopmental phenotypes and potential implications for 22q11DS and beyond. RECENT FINDINGS We will first discuss recent findings with respect to neurodevelopmental phenotypic expression associated with 22q11DS, including psychotic disorders, intellectual functioning, autism spectrum disorders, as well as their interactions. Second, we will address considerations that are important in interpreting these data and propose potential implications for both the clinical care for and the empirical study of individuals with 22q11DS. Third, we will highlight variable penetrance and pleiotropy with respect to neurodevelopmental phenotypes in 22q11DS. We will discuss how these phenomena are consistently observed in the context of virtually all rare pathogenic variants and that they pose substantial challenges from both a clinical and a research perspective. We outline how 22q11DS could be viewed as a genetic model for studying neurodevelopmental phenotypes. In addition, we propose that 22q11DS research can help elucidate mechanisms underlying variable expression and pleiotropy of neurodevelopmental phenotypes, insights that are likely relevant for 22q11DS and beyond, including for individuals with other rare pathogenic genetic variants and for individuals with idiopathic neurodevelopmental conditions.
Collapse
Affiliation(s)
- Ania M. Fiksinski
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto General Hospital, University Health Network, Toronto, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Janneke Zinkstok
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Danielle Baribeau
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Samuel J. R. A. Chawner
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Jacob A. S. Vorstman
- Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- The Centre for Applied Genomics, Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON Canada
| |
Collapse
|
12
|
Bullying Victimization in Young Females with Fragile-X-Syndrome. Genes (Basel) 2020; 11:genes11091069. [PMID: 32933021 PMCID: PMC7565259 DOI: 10.3390/genes11091069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/24/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to investigate the risk associated with girls with fragile X syndrome (FXS) suffering bullying in the role of a victim and its effects on their adaptive behavior, socialization style, and emotional state. A neuropsychological assessment was carried out on a sample of 40 participants (26 FXS positive and 14 control group) using the following instruments: WISC-V, SENA, BAS-2, ABAS-II. The results show that the group of girls with FXS presented higher ratios of lack of social support and isolation from classmates. This finding suggests that problems with social interaction and communication in the group of girls with FXS could lead to difficulties in interpreting social signals and identifying situations of bullying correctly, placing them in a very vulnerable situation.
Collapse
|
13
|
Oxidative-Antioxidant Imbalance and Impaired Glucose Metabolism in Schizophrenia. Biomolecules 2020; 10:biom10030384. [PMID: 32121669 PMCID: PMC7175146 DOI: 10.3390/biom10030384] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 02/07/2023] Open
Abstract
Schizophrenia is a neurodevelopmental disorder featuring chronic, complex neuropsychiatric features. The etiology and pathogenesis of schizophrenia are not fully understood. Oxidative-antioxidant imbalance is a potential determinant of schizophrenia. Oxidative, nitrosative, or sulfuric damage to enzymes of glycolysis and tricarboxylic acid cycle, as well as calcium transport and ATP biosynthesis might cause impaired bioenergetics function in the brain. This could explain the initial symptoms, such as the first psychotic episode and mild cognitive impairment. Another concept of the etiopathogenesis of schizophrenia is associated with impaired glucose metabolism and insulin resistance with the activation of the mTOR mitochondrial pathway, which may contribute to impaired neuronal development. Consequently, cognitive processes requiring ATP are compromised and dysfunctions in synaptic transmission lead to neuronal death, preceding changes in key brain areas. This review summarizes the role and mutual interactions of oxidative damage and impaired glucose metabolism as key factors affecting metabolic complications in schizophrenia. These observations may be a premise for novel potential therapeutic targets that will delay not only the onset of first symptoms but also the progression of schizophrenia and its complications.
Collapse
|