1
|
Weisbrot DM, Carlson GA. When No Diagnosis "Fits": Diagnostically Homeless and Emotionally Dysregulated Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:445-457. [PMID: 33743950 DOI: 10.1016/j.chc.2020.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Clinical experience supports the concept of children with severe disturbances in most areas of functioning, with psychiatric symptom onset before age 6. They are emotionally dysregulated and extremely anxious and have developmental difficulties. Given the absence of an appropriate diagnostic category, it is best to consider clinical phenomenology and then categorize each dysfunction domain (mood/anxiety problems, possible psychosis, language impairment/thought disorder, and relationship/social problems).
Collapse
Affiliation(s)
- Deborah M Weisbrot
- Putnam Hall-South Campus, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-0790, USA.
| | - Gabrielle A Carlson
- Putnam Hall-South Campus, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-0790, USA
| |
Collapse
|
2
|
Moreno-Giménez A, Campos-Berga L, Nowak A, Sahuquillo-Leal R, D'Ocon A, Hervás D, Navalón P, Vento M, García-Blanco A. Impact of maternal age on infants' emotional regulation and psychomotor development. Psychol Med 2021; 52:1-12. [PMID: 33663627 DOI: 10.1017/s0033291721000568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Maternal age has progressively increased in industrialized countries. Most studies focus on the consequences of delayed motherhood for women's physical and mental health, but little is known about potential effects on infants' neurodevelopment. This prospective study examines the association between maternal age and offspring neurodevelopment in terms of both psychomotor development (Ages & Stages Questionnaires-3) and emotional competences (Early Childhood Behavior Questionnaire). METHODS We evaluated a cohort of healthy pregnant women aged 20-41 years and their offspring, assessed at 38 weeks gestation (n = 131) and 24 months after birth (n = 101). Potential age-related variables were considered (paternal age, education level, parity, social support, maternal cortisol levels, and maternal anxiety and depressive symptoms). Bayesian ordinal regression models were performed for each neurodevelopmental outcome. RESULTS Maternal age was negatively associated with poor child development in terms of personal-social skills [odds ratio (OR) -0.13, 95% confidence interval (CI) 0.77-0.99] and with difficult temperament in terms of worse emotional regulation (OR -0.13, 95% CI 0.78-0.96) and lower positive affect (OR 0.16, 95% CI 0.75-0.95). As for age-related variables, whereas maternal anxiety symptoms and cortisol levels were also correlated with poor child development and difficult temperament, maternal social support and parental educational level were associated with better psychomotor and emotional competences. CONCLUSION Increasing maternal age may be associated with child temperament difficulties and psychomotor delay in terms of social interaction skills. Early detection of neurodevelopment difficulties in these babies would allow preventive psychosocial interventions to avoid future neuropsychiatric disorders.
Collapse
Affiliation(s)
- Alba Moreno-Giménez
- Department of Personality, Assessment and Psychological Treatment, University of Valencia, Valencia, Spain
| | | | - Alicja Nowak
- Department of Health Psychology and Clinical Psychology, Adam Mickiewicz University, Poznań, Poland
| | - Rosa Sahuquillo-Leal
- Department of Personality, Assessment and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Ana D'Ocon
- Department of Personality, Assessment and Psychological Treatment, University of Valencia, Valencia, Spain
| | - David Hervás
- Department of Personality, Assessment and Psychological Treatment, University of Valencia, Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | - Pablo Navalón
- University and Polytechnic Hospital La Fe, Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | - Máximo Vento
- University and Polytechnic Hospital La Fe, Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| | - Ana García-Blanco
- Department of Personality, Assessment and Psychological Treatment, University of Valencia, Valencia, Spain
- University and Polytechnic Hospital La Fe, Valencia, Spain
- Health Research Institute La Fe, Valencia, Spain
| |
Collapse
|
3
|
Potasiewicz A, Holuj M, Litwa E, Gzielo K, Socha L, Popik P, Nikiforuk A. Social dysfunction in the neurodevelopmental model of schizophrenia in male and female rats: Behavioural and biochemical studies. Neuropharmacology 2020; 170:108040. [DOI: 10.1016/j.neuropharm.2020.108040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/17/2020] [Accepted: 03/04/2020] [Indexed: 01/10/2023]
|
4
|
Family assessment among patients with various mental disorders. MIDDLE EAST CURRENT PSYCHIATRY 2018. [DOI: 10.1097/01.xme.0000530437.44931.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
5
|
Udal ABH. Renewed awareness of motor symptoms in psychiatric assessment. Lancet Psychiatry 2017; 4:353-354. [PMID: 28344043 DOI: 10.1016/s2215-0366(17)30106-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Anne Beate Helseth Udal
- Department of Mental Health and Addiction, Sørlandet Hospital, 4604 Kristiansand, Arendal, Norway.
| |
Collapse
|
6
|
Glenthøj LB, Jepsen JRM, Hjorthøj C, Bak N, Kristensen TD, Wenneberg C, Krakauer K, Nordentoft M, Fagerlund B. Negative symptoms mediate the relationship between neurocognition and function in individuals at ultrahigh risk for psychosis. Acta Psychiatr Scand 2017; 135:250-258. [PMID: 27988937 DOI: 10.1111/acps.12682] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Neurocognition is known to impact functioning in individuals at ultrahigh risk (UHR) for psychosis, but studies investigating potential mediators of this relationship are scarce. Building on evidence from schizophrenia spectrum disorders, the study tested whether negative symptoms and social skills act as mediators between neurocognition and functional outcome in UHR individuals. METHODS Ultrahigh risk participants (N = 84) underwent neurocognitive testing using the Brief Assessment of Cognition in Schizophrenia. Social skills and negative symptoms were assessed using the High-Risk Social Challenge task and the Scale for the Assessment of Negative Symptoms respectively. Four instruments were used to assess overall functioning, and one instrument assessed quality of life encompassing social functioning. RESULTS The cross-sectional analyses revealed that neurocognition was related to the measures of functioning. Negative symptoms mediated the relationship between neurocognition and four of the five measures of functioning. We did not find social skills to mediate between neurocognition and functioning. CONCLUSION Negative symptoms appear to mediate the relationship between neurocognition and functional outcome in UHR individuals, but the finding needs to be confirmed and extended to longitudinal studies. This underscores the importance of focusing on both neurocognition and negative symptoms when aiming at improving the functional outcome of UHR individuals.
Collapse
Affiliation(s)
- L B Glenthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - J R M Jepsen
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark.,Child and Adolescent Mental Health Centre, Mental Health Services Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - C Hjorthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - N Bak
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - T D Kristensen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - C Wenneberg
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Functional Imaging Unit, Department of Diagnostics, Copenhagen University Hospital, Glostrup, Denmark
| | - K Krakauer
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Functional Imaging Unit, Department of Diagnostics, Copenhagen University Hospital, Glostrup, Denmark
| | - M Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - B Fagerlund
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| |
Collapse
|
7
|
|
8
|
Müller M, Vetter S, Weiser M, Frey F, Ajdacic-Gross V, Stieglitz RD, Rössler W. Precursors of cognitive impairments in psychotic disorders: a population-based study. Psychiatry Res 2013; 210:329-37. [PMID: 23876280 DOI: 10.1016/j.psychres.2013.05.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 05/21/2013] [Accepted: 05/27/2013] [Indexed: 11/30/2022]
Abstract
Cognitive deficits have been found to be more prevalent in psychotic than in other disorders. Longitudinal research has shown that these deficits were generally already existent before onset of illness and are therefore not necessarily attributable to neurodegenerative processes. This study investigated whether both low IQ and markers of premorbid cognitive dysfunction independently contribute to an increased risk for psychoses. In a cross-sectional study about 50,000 young Swiss males completed a survey of intellectual problems in childhood/adolescence and other vulnerability factors during military call-up in 2005/2006. Subsequently, military IQ assessments were carried out on the entire sample. Diagnostic assessments were conducted according to International Classification of Diseases-10th edition (ICD-10). Low, especially performance, IQ was highly associated with an increased risk for psychotic disorders after adjusting for preexisting cognitive deficits and covariates, while in other disorders this association was less marked. Furthermore, preexisting intellectual problems emerged as important risk factors for psychoses. Our results confirm the importance of low IQ as characteristic of psychoses. Although premorbid intellectual deficits are common in people who go on to develop psychosis, neurodegenerative disease processes may also precipitate further declines in fluid cognitive functions. Assessment of cognitive functioning should be taken into account in early detection of psychoses.
Collapse
Affiliation(s)
- Mario Müller
- Centre for Disaster and Military Psychiatry, University of Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
9
|
Thermenos HW, Keshavan MS, Juelich RJ, Molokotos E, Whitfield-Gabrieli S, Brent BK, Makris N, Seidman LJ. A review of neuroimaging studies of young relatives of individuals with schizophrenia: a developmental perspective from schizotaxia to schizophrenia. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:604-35. [PMID: 24132894 DOI: 10.1002/ajmg.b.32170] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/24/2013] [Indexed: 11/08/2022]
Abstract
In an effort to identify the developing abnormalities preceding psychosis, Dr. Ming T. Tsuang and colleagues at Harvard expanded Meehl's concept of "schizotaxia," and examined brain structure and function in families affected by schizophrenia (SZ). Here, we systematically review genetic (familial) high-risk (HR) studies of SZ using magnetic resonance imaging (MRI), examine how findings inform models of SZ etiology, and suggest directions for future research. Neuroimaging studies of youth at HR for SZ through the age of 30 were identified through a MEDLINE (PubMed) search. There is substantial evidence of gray matter volume abnormalities in youth at HR compared to controls, with an accelerated volume reduction over time in association with symptoms and cognitive deficits. In structural neuroimaging studies, prefrontal cortex (PFC) alterations were the most consistently reported finding in HR. There was also consistent evidence of smaller hippocampal volume. In functional studies, hyperactivity of the right PFC during performance of diverse tasks with common executive demands was consistently reported. The only longitudinal fMRI study to date revealed increasing left middle temporal activity in association with the emergence of psychotic symptoms. There was preliminary evidence of cerebellar and default mode network alterations in association with symptoms. Brain abnormalities in structure, function and neurochemistry are observed in the premorbid period in youth at HR for SZ. Future research should focus on the genetic and environmental contributions to these alterations, determine how early they emerge, and determine whether they can be partially or fully remediated by innovative treatments.
Collapse
Affiliation(s)
- H W Thermenos
- Harvard Medical School, Boston, Massachusetts; Massachusetts Mental Health Center, Division of Public Psychiatry, Boston, Massachusetts; Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Diwadkar VA, Wadehra S, Pruitt P, Keshavan MS, Rajan U, Zajac-Benitez C, Eickhoff SB. Disordered corticolimbic interactions during affective processing in children and adolescents at risk for schizophrenia revealed by functional magnetic resonance imaging and dynamic causal modeling. ARCHIVES OF GENERAL PSYCHIATRY 2012; 69:231-42. [PMID: 22393216 PMCID: PMC7988184 DOI: 10.1001/archgenpsychiatry.2011.1349] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
CONTEXT Disordered functional architecture of brain networks may contribute to the well-documented increased risk for psychiatric disorders in offspring of patients with schizophrenia. OBJECTIVE To investigate aberrant interactions between regions associated with affective processing in children and adolescent offspring of patients with schizophrenia (HR-SCZ group) and healthy control subjects using dynamic causal modeling of functional magnetic resonance imaging data. DESIGN Subjects participated in a continuous affective processing task during which positive, negative, and neutral valenced faces were presented. Interactions between regions in the brain's face- and emotion-processing network were modeled using dynamic causal modeling. Multiple competing models were evaluated by a combinatorial approach and distinguished at the second level using Bayesian model selection before parameter inference. SETTING Participants were recruited from the community. PARTICIPANTS Twenty-four controls with no family history of psychosis (to the second degree) and 19 children and adolescent offspring of a parent with schizophrenia (age range, 8 to 20 years). RESULTS Bayesian model selection revealed a winning model, the architecture of which revealed bidirectional frontolimbic connections that were modulated by valence. Analyses of parameter estimates revealed that HR-SCZ group members were characterized by (1) decreased driving inputs to the visual cortex; (2) decreased intrinsic coupling, most robustly between frontolimbic regions; and (3) increased modulatory inhibition by negative valence of frontolimbic connections (all P < .01, Bonferroni corrected). CONCLUSIONS These results are the first demonstration of network analyses techniques for functional magnetic resonance imaging data in children and adolescents at risk for schizophrenia. Dysfunctional interactions within the emotional processing network provide evidence of latent vulnerabilities that may confer risk for disordered adolescent development and eventually the emergence of the manifest disorder.
Collapse
Affiliation(s)
- Vaibhav A Diwadkar
- Division of Brain Research and Imaging Neuroscience, Department of Psychiatry and Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI 48201, USA.
| | | | | | | | | | | | | |
Collapse
|
11
|
Macmanus D, Laurens KR, Walker EF, Brasfield JL, Riaz M, Hodgins S. Movement abnormalities and psychotic-like experiences in childhood: markers of developing schizophrenia? Psychol Med 2012; 42:99-109. [PMID: 21740623 DOI: 10.1017/s0033291711001085] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Both involuntary dyskinetic movements and psychotic-like experiences (PLEs) are reported to be antecedents of schizophrenia that may reflect dysfunctional dopaminergic activity in the striatum. The present study compared dyskinetic movement abnormalities displayed by children with multiple antecedents of schizophrenia (ASz), including speech and/or motor developmental lags or problems, internalising/externalising problems in the clinical range, and PLEs, with those displayed by children with no antecedents (noASz). METHOD The sample included 21 ASz and 31 noASz children, aged 9-12 years old. None had taken psychotropic medication or had relatives with psychosis. The antecedents of schizophrenia were assessed using questionnaires completed by children and caregivers. A trained rater, blind to group status, coded dyskinetic movement abnormalities using a validated tool from videotapes of interviews with the children. RESULTS ASz children reported, on average, 'certain experience' of 2.5 PLEs, while noASz children, by definition, reported none. The ASz children, as compared with noASz children, displayed significantly more dyskinetic movement abnormalities in total, and in the facial and the upper-body regions, after controlling for sex and age. Receiver operator characteristics analyses yielded high area under the curve values for the total score (0.94), facial score (0.91) and upper-body score (0.86), indicating that these scores distinguished between the ASz and noASz children with great accuracy. CONCLUSIONS Brief questionnaires identified children with multiple antecedents of schizophrenia who displayed significantly more involuntary dyskinetic movement abnormalities than children without antecedents. The presence of PLEs and dyskinesias could reflect early disruption of striatal dopamine circuits.
Collapse
Affiliation(s)
- D Macmanus
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK.
| | | | | | | | | | | |
Collapse
|
12
|
Barbour T, Murphy E, Pruitt P, Eickhoff SB, Keshavan MS, Rajan U, Zajac-Benitez C, Diwadkar VA. Reduced intra-amygdala activity to positively valenced faces in adolescent schizophrenia offspring. Schizophr Res 2010; 123:126-36. [PMID: 20716480 PMCID: PMC3174012 DOI: 10.1016/j.schres.2010.07.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/21/2010] [Accepted: 07/23/2010] [Indexed: 11/29/2022]
Abstract
Studies suggest that the affective response is impaired in both schizophrenia and adolescent offspring of schizophrenia patients. Adolescent offspring of patients are developmentally vulnerable to impairments in several domains, including affective responding, yet the bases of these impairments and their relation to neuronal responses within the limbic system are poorly understood. The amygdala is the central region devoted to the processing of emotional valence and its sub-nuclei including the baso-lateral and centro-medial are organized in a relative hierarchy of affective processing. Outputs from the centro-medial nucleus converge on regions involved in the autonomous regulation of behavior, and outputs from the baso-lateral nucleus modulate the response of reward processing regions. Here using fMRI we assessed the intra-amygdala response to positive, negative, and neutral valenced faces in a group of controls (with no family history of psychosis) and offspring of schizophrenia parents (n=44 subjects in total). Subjects performed an affective continuous performance task during which they continually appraised whether the affect signaled by a face on a given trial was the same or different from the previous trial (regardless of facial identity). Relative to controls, offspring showed reduced activity in the left centro-medial nucleus to positively (but not negatively or neutral) valenced faces. These results were independent of behavioral/cognitive performance (equal across groups) suggesting that an impaired affective substrate in the intra-amygdala response may lie at the core of deficits of social behavior that have been documented in this population.
Collapse
Affiliation(s)
- Tracy Barbour
- Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Eric Murphy
- Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Patrick Pruitt
- Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Simon B. Eickhoff
- Institut für Neurowissenschaften und Biophysik Medizin, Forschungszentrum Juelich, Juelich, Germany,Psychiatry and Psychotherapy, School of Medicine, RWTH Aachen University, Aachen, Germany
| | - Matcheri S. Keshavan
- Psychiatry & Behavioral Neuroscience, Wayne State University SOM,Psychiatry, Beth Israel Deaconness Medical Center, Harvard Medical School
| | - Usha Rajan
- Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | | | - Vaibhav A. Diwadkar
- Psychiatry & Behavioral Neuroscience, Wayne State University SOM,Psychiatry, University of Pittsburgh SOM
| |
Collapse
|
13
|
Picchioni MM, Walshe M, Toulopoulou T, McDonald C, Taylor M, Waters-Metenier S, Bramon E, Regojo A, Murray RM, Rijsdijk F. Genetic modelling of childhood social development and personality in twins and siblings with schizophrenia. Psychol Med 2010; 40:1305-1316. [PMID: 19863839 DOI: 10.1017/s0033291709991425] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Abnormalities in early social development and personality are present in patients with schizophrenia and their unaffected relatives. This study aimed to establish the degree to which these childhood and adolescent developmental abnormalities are genetically determined. METHOD We used a combined twin and family study design (n=531) to assess childhood and adolescent social adjustment and schizotypal personality traits in 98 twin pairs (n=196) varying in their zygosity and concordance for schizophrenia and 156 sibling clusters (n=335) varying in their concordance for schizophrenia. RESULTS Schizophrenia was significantly associated with childhood and adolescent deficits in social adjustment and personality, with additive genetic effects being the main source of these phenotypic correlations. CONCLUSIONS Abnormalities of social adjustment and personality are present in children and adolescents who later develop schizophrenia, reflecting the influence of common genetic risk.
Collapse
Affiliation(s)
- M M Picchioni
- Division of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
The impact of maternal psychopathology on child-mother attachment. Arch Womens Ment Health 2009; 12:123-34. [PMID: 19337701 DOI: 10.1007/s00737-009-0066-5] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 03/04/2009] [Indexed: 10/20/2022]
Abstract
This review aims to consider evidence for the impact of maternal psychopathology on the child's attachment to the mother, and the role of this in mediating the known transmission of developmental and clinical risk to children. The studies reviewed focus on mothers with depression and psychotic disorder. A number of studies (mainly of mothers with depression) demonstrate an association between insecure/disorganised infant attachments and severe maternal psychopathology, whether chronic or current, in the presence of comorbid disorder, maternal insecure or unresolved attachment state of mind, trauma/loss, or low parenting sensitivity. Whether such effects last into middle childhood, however, is unclear. Our understanding of the role of attachment in determining developmental trajectories in this group is at an early stage. Some evidence suggests that attachment may have a role in mediating the intergenerational transmission of internalizing and other problems in this group, although the presence of co-occurring contextual risk factors may account for the variability in findings. A multifactorial longitudinal approach is needed to elucidate such factors. However, the current literature highlights which subgroups are likely to be vulnerable and provides an evidence-based rationale for taking an attachment-based approach to intervention in this group.
Collapse
|
15
|
Integrating functional brain neuroimaging and developmental cognitive neuroscience in child psychiatry research. J Am Acad Child Adolesc Psychiatry 2008; 47:1273-88. [PMID: 18827719 PMCID: PMC2627505 DOI: 10.1097/chi.0b013e318185d2d1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To provide an overview of clinical research aiming to develop a mechanistic understanding of brain dysfunction in child psychiatric disorders. METHOD Technological, conceptual, and translational approaches relevant to the investigation of brain function in pediatric psychiatric illnesses are explored. Research in the area of pediatric bipolar disorder is used as a prototypic model illustrating the use of complementary techniques of functional magnetic neuroimaging and neurocognitive studies to identify abnormalities in neural circuitry function. RESULTS Studies of bipolar youths indicate impairment in cognitive and affective neural systems and in the interface of these two circuits. This evolving field paves a future pathway for identifying diagnostic biomarkers for the disorder, providing tools for monitoring response to pharmacotherapy, examining illness-associated alterations in developmental trajectory, and facilitating the use of animal research for guiding the development of novel treatment strategies. CONCLUSIONS Studies of brain function in child psychiatry are establishing a platform of knowledge and methods that offer promise for revolutionizing both models of illness pathophysiology and future diagnostic and therapeutic practice.
Collapse
|
16
|
Hill SK, Harris MSH, Herbener ES, Pavuluri M, Sweeney JA. Neurocognitive allied phenotypes for schizophrenia and bipolar disorder. Schizophr Bull 2008; 34:743-59. [PMID: 18448479 PMCID: PMC2632447 DOI: 10.1093/schbul/sbn027] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psychiatric disorders are genetically complex and represent the end product of multiple biological and social factors. Links between genes and disorder-related abnormalities can be effectively captured via assessment of phenotypes that are both associated with genetic effects and potentially contributory to behavioral abnormalities. Identifying intermediate or allied phenotypes as a strategy for clarifying genetic contributions to disorders has been successful in other areas of medicine and is a promising strategy for identifying susceptibility genes in complex psychiatric disorders. There is growing evidence that schizophrenia and bipolar disorder, rather than being wholly distinct disorders, share genetic risk at several loci. Further, there is growing evidence of similarity in the pattern of cognitive and neurobiological deficits in these groups, which may be the result of the effects of these common genetic factors. This review was undertaken to identify patterns of performance on neurocognitive and affective tasks across probands with schizophrenia and bipolar disorder as well as unaffected family members, which warrant further investigation as potential intermediate trait markers. Available evidence indicates that measures of attention regulation, working memory, episodic memory, and emotion processing offer potential for identifying shared and illness-specific allied neurocognitive phenotypes for schizophrenia and bipolar disorder. However, very few studies have evaluated neurocognitive dimensions in bipolar probands or their unaffected relatives, and much work in this area is needed.
Collapse
Affiliation(s)
- S. Kristian Hill
- To whom correspondence should be addressed; tel: 312 996-2107, fax: 312 413-8837, e-mail:
| | | | | | | | | |
Collapse
|
17
|
Seeman MV. Prevention inherent in services for women with schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:332-41. [PMID: 18551854 DOI: 10.1177/070674370805300508] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Effective care to women with serious mental illness provides an opportunity for prevention of mental health problems in their offspring. The objective of this study is to outline the preventive possibilities of a service targeted to women with schizophrenia. METHOD An analysis of recently published literature on women suffering from schizophrenia, focusing on intervention. RESULTS Genetic counselling, prenatal care, prevention of obstetrical complications, substance abuse reduction, appropriate antipsychotic treatment, parenting support, safety issues, quality of life, ethics, cultural competence, and advocacy are components of a comprehensive service to women with schizophrenia. CONCLUSIONS These components improve maternal health and, by also ensuring fetal and neonatal health, are potentially preventive against schizophrenia in the second generation.
Collapse
Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Ontario.
| |
Collapse
|
18
|
Bender S, Weisbrod M, Resch F. Which perspectives can endophenotypes and biological markers offer in the early recognition of schizophrenia? J Neural Transm (Vienna) 2007; 114:1199-215. [PMID: 17514428 DOI: 10.1007/s00702-007-0742-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 04/12/2007] [Indexed: 02/07/2023]
Abstract
The early recognition of schizophrenia seems crucial; various studies relate a longer duration-of-untreated-psychosis to a worse prognosis. We give an overview over common psychopathological early recognition instruments (BSABS, CAARMS, SIPS, IRAOS, ERIraos). However, many clinical symptoms of prodromal schizophrenia stages are not sufficiently specific. Thus we review recent contributions of neuroimaging and electrophysiological as well as genetic studies: which new diagnostic perspectives offer endophenotypes (such as P300, P50 sensory gating, MMN, smooth pursuit eye movements; indicating a specific genetic vulnerability) together with a better understanding of schizophrenic pathophysiology (state-dependent biological markers, e.g. aggravated motor neurological soft signs during psychosis) in prodromal schizophrenia when still ambiguous clinical symptoms are present. Several examples (e.g. from COMT polymorphisms to working memory deficits) illustrate more specific underlying neuronal mechanisms behind behavioural symptoms. This way, a characteristic pattern of disturbed cerebral maturation might be distinguished in order to complement clinical instruments of early schizophrenia detection.
Collapse
Affiliation(s)
- S Bender
- Centre for Psychosocial Medicine, Department for Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany.
| | | | | |
Collapse
|