Genes, environment, and mental health wellness

Adolescent social functioning in offspring at high risk for schizophrenia spectrum disorders in the Finnish Adoptive Family Study of Schizophrenia

BACKGROUND

Children and adolescents with a genetic risk for schizophrenia are often found to have poorer social functioning compared to their controls. However, less is known about high-risk offspring who have not been reared by a biological parent with schizophrenia. The purpose of this study was to examine deficits in social functioning in adolescence as a possible factor related to genetic vulnerability to schizophrenia spectrum disorders, and also to examine possible gender differences in these associations.

METHOD

The present sample consisted of 88 genetic high-risk (HR) adoptees whose biological mothers were diagnosed with schizophrenia spectrum disorders and 83 genetic low-risk (LR) adoptees with biological mothers with non-schizophrenia spectrum disorders or no psychiatric disorders. Adoptees' social functioning at ages 16-20 was assessed using the UCLA Social Attainment Survey.

RESULTS

Compared to LR adoptees, HR adoptees displayed statistically significant deficits in their peer relationships, involvement in activities and overall social functioning during adolescence. HR males were distinguished from LR males by their significantly poorer overall social functioning. Compared to HR females, HR males showed significant deficits in their romantic relationships. Of marginal significance was that HR females displayed more social functioning deficits relative to LR females, mainly in the areas of peer relationships, involvement in activities and overall social functioning.

CONCLUSIONS

These results from the adoption and high-risk study design suggest that deficits in social functioning in adolescence may be related to genetic vulnerability to schizophrenia spectrum disorders and that some of these deficits may be gender-specific.

A Review of the Relationships among the Key Determinants Affecting the Mental Health Disorders of the People in Greater Mekong Subregion Countries

BACKGROUND

ASEAN integration aims to transform the GMS into a single market with free flows of products, services, and skilled labor, as well as investment openness, which will ultimately force regional economic growth. Therefore, this integration is likely to bring about a big change to this area in the new era; it can subsequently cause many problems as well, including mental health issues of the people in this region. The characteristic differences among the GMS member countries in terms of trade and investment, so-cial and cultural values, medical information and technology, and the living and working environment have become major problems affecting mental health disorders, which are usually identified as depression, stress, and substance abuse.

METHODS

This review paper is a literature review of the relationship of the determinants affecting GMS mental disorders conducted using the following strategies: 1) collecting data from previous qualitative and quantitative research studies, com-paratively analyzing the literature, articles, published papers, and reports relevant to the existing policies on economic, environmental, and healthcare issues obtained from the GMS; and 2) exchanging information from the institutions involved, including reports and papers regarding the determinants affecting mental health disorders of the people in the GMS, which were used to generate the synthesis of the existing knowledge of the mental health and to provide recommenda-tion programs for the GMS people.

RESULTS

Based on the reviewed literature there are four key factors affecting mental health, especially mental health in GMS populations: 1) the living and work environments; 2) trade and investment; 3) technology and medical information; and 4) social and cultural values. The study found that the increasing number of mental health dis-orders is a big burden for national healthcare spending. Financial issues have become a major key to the wide prevalence of mental disorders in the GMS. Health issues related to mental health disorders are also caused by the environment and other related factors and therefore a stable and a well-balanced environment is an indicator of healthy mental status. In addition, the environment is a way to pursue both physical and mental health because green spaces serve as a mood freshener and can al-leviate anxiety, stress, and depression.

CONCLUSION

Globalization and urbanization should follow sustainable development instructions and concerns about the population's health, especially regarding mental health. These key determinants affect the people's life, especially in terms of mental health thus leading to mental health disorders.

Initiatives in biological research in Indian psychiatry

Biological psychiatry is an exploratory science for mental health. These biological changes provide some explicit insight into the complex area of 'brain-mind and behavior'. One major achievement of research in biological field is the finding to explain how biological factors cause changes in behavior. In India, we have a clear history of initiatives in research from a biological perspective, which goes back to 1958. In the last 61 years, this field has seen significant evolution, precision and effective utilization of contemporary technological advances. It is a matter of great pride to see that in spite of difficult times in terms of challenges of practice and services, administration, resource, funding and manpower the zest for research was very forthcoming. There was neither dedicated time nor any funding for conducting research. It came from the intellectual insight of our fore fathers in the field of mental health to gradually grow to the state of strategic education in research, training in research, international research collaborations and setting up of internationally accredited centers. During difficult economic conditions in the past, the hypothesis tested and conclusions derived have not been so important. It is more important how it was done, how it was made possible and how robust traditions were established. Almost an entire spectrum of biological research has been touched upon by Indian researchers. Some of these are electroconvulsive therapy, biological markers, neurocognition, neuroimaging, neuroendocrine, neurochemistry, electrophysiology and genetics. A lot has been published given the limited space in the Indian Journal of Psychiatry and other medical journals published in India. A large body of biological research conducted on Indian patients has also been published in International literature (which I prefer to call non-Indian journals). Newer research questions in biological psychiatry, keeping with trend of international standards are currently being investigated by the younger generation with great enthusiasm. What we have achieved so far is the foundation work in last 60 years. Our main challenge in development of biological psychiatry research in India remains resources in terms of manpower, funding and dedicated time for research psychiatrists. Developing basic sciences laboratories, discrete research questions, high quality methodology, and logistical support are some of the essentials. In the present time the culture of research has changed. It is specific and evidence-based. We have time-tested examples of International collaborative research. We need to get more resources, develop education, collaboration and effective leadership. In times to come, India will provide international leadership in basic and clinical biological psychiatry. There is hope.

Genetic variation in 5HTTLPR is associated with emotional resilience

Emotional resilience can be defined as the ability to maintain healthy and stable levels of psychological functioning in the wake of stress and trauma. Although genes that contribute to psychopathology (often in interaction with environmental stressors) are being detected with increasing consistency, genes that influence resilience to stress have been less studied. In this study, 423 undergraduate college students completed a psychometrically sound 10-item self-report measure of resilience (CDRISC-10) and provided blood for DNA. Linear and logistic regression analyses were used to model relationships between the serotonin transporter promoter polymorphism (5HTTLPR) and CDRISC-10 scores and categories, respectively. CDRISC-10 scores were normally distributed (mean 26.17, SD 5.88 [range 5-40]). In models adjusting for ancestry proportion scores (to mitigate confounding by population stratification) and other covariates, each copy of the "s" allele of 5HTTLPR was associated with approximately 1-point lower CDRISC-10 score. Each copy of the "s" allele was associated with increased (adjusted OR = 1.53, 95% CI 1.06-2.21, P = 0.024) odds of being in the low resilient category (>1 SD below the mean), compared to being homozygous for the "l" allele. These findings suggest that variation in 5HTTLPR is associated with individual differences in emotional resilience, defined as an individual's ability to withstand and bounce back from stress. This relationship may explain the frequently observed interaction between 5HTTLPR and life stressors in predicting adverse mental health outcomes (e.g., depressive symptoms). Replication is needed, in concert with identification of other genes that influence emotional resilience and related phenotypes.

The antidepressant agomelatine blocks the adverse effects of stress on memory and enables spatial learning to rapidly increase neural cell adhesion molecule (NCAM) expression in the hippocampus of rats

Agomelatine, a novel antidepressant with established clinical efficacy, acts as a melatonin receptor agonist and 5-HT(2C) receptor antagonist. As stress is a significant risk factor in the development of depression, we sought to determine if chronic agomelatine treatment would block the stress-induced impairment of memory in rats trained in the radial-arm water maze (RAWM), a hippocampus-dependent spatial memory task. Moreover, since neural cell adhesion molecule (NCAM) is known to be critically involved in memory consolidation and synaptic plasticity, we evaluated the effects of agomelatine on NCAM, and polysialylated NCAM (PSA-NCAM) expression in rats given spatial memory training with or without predator stress. Adult male rats were pre-treated with agomelatine (10 mg/kg i.p., daily for 22 d), followed by a single day of RAWM training and memory testing. Rats were given 12 training trials and then they were placed either in their home cages (no stress) or near a cat (predator stress). Thirty minutes later the rats were given a memory test trial followed immediately by brain extraction. We found that: (1) agomelatine blocked the predator stress-induced impairment of spatial memory; (2) agomelatine-treated stressed, as well as non-stressed, rats exhibited a rapid training-induced increase in the expression of synaptic NCAM in the ventral hippocampus; and (3) agomelatine treatment blocked the water-maze training-induced decrease in PSA-NCAM levels in both stressed and non-stressed animals. This work provides novel observations which indicate that agomelatine blocks the adverse effects of stress on hippocampus-dependent memory and activates molecular mechanisms of memory storage in response to a learning experience.

Dominant-negative DISC1 transgenic mice display schizophrenia-associated phenotypes detected by measures translatable to humans

Here, we report generation and characterization of Disrupted-In-Schizophrenia-1 (DISC1) genetically engineered mice as a potential model for major mental illnesses, such as schizophrenia. DISC1 is a promising genetic risk factor for major mental illnesses. In this transgenic model, a dominant-negative form of DISC1 (DN-DISC1) is expressed under the alphaCaMKII promoter. In vivo MRI of the DN-DISC1 mice detected enlarged lateral ventricles particularly on the left side, suggesting a link to the asymmetrical change in anatomy found in brains of patients with schizophrenia. Furthermore, selective reduction in the immunoreactivity of parvalbumin in the cortex, a marker for an interneuron deficit that may underlie cortical asynchrony, is observed in the DN-DISC1 mice. These results suggest that these transgenic mice may be used as a model for schizophrenia. DN-DISC1 mice also display several behavioral abnormalities, including hyperactivity, disturbance in sensorimotor gating and olfactory-associated behavior, and an anhedonia/depression-like deficit.

Recent advances in the understanding and treatment of anxiety disorders. Resilience: determinants, measurement, and treatment responsiveness

In human terms, resilience is an ability to cope with stress and varies with context, time, age, gender, and cultural origin. Resilience shifts the focus of psychological investigation onto increasing the positive rather than reducing the negative. Inquiry into resilience has evolved from descriptions of resilient qualities, to discovery of the process to attain resilience, to uncovering the motivation to reintegrate in a resilient manner. Much of the research on resilience has focused on children in settings such as family violence, extreme poverty, war, and natural disasters. A coherent pattern of characteristics associated with successful adaptation has emerged. Salient characteristics include commitment, dynamism, humor in the face of adversity, patience, optimism, faith, and altruism. As such, resilience may represent an important target of treatment in anxiety, depression, and stress reactions. Resilience can be quantified, but available measures need to be validated transculturally. There exist many possible determinants of resilience, including neurobiologic, genetic, temperament, and environmental influences. Resilience is modifiable on individual and cultural levels. Posttraumatic stress disorder is an example of a serious disorder associated with impaired stress coping that can improve with treatment.

Treating early psychosis: who, what, and when?

Early intervention and prevention in schizophrenia is just over 10 years old. The assumption guiding this field is that intervention is likely to be most effective if it begins before psychosis sets in, ie, during the prodromal phase. Although a substantial number of prodromal treatment programs have been initiated around the world, three early programs have generated most of the intervention findings to date: Personal Assessment and Crisis Evaluation (PACE) in Australia, and the Prevention through Risk Identification, Management, and Education (PRIME) and Recognition and Prevention (RAP) programs in the USA. The data suggest that early intervention leads to a reduction in prodromal symptoms and clinical distress. However, prevention of psychosis remains an unresolved question. Other issues include defining who should be treated, with what, and when. In addition, treatment targets associated with functional disability, such as early prodromal negative symptoms and risk factors, continue to emerge. Newly identified targets, in turn, suggest the need for a variety of novel interventions and treatment strategies.

Relationship of resilience to personality, coping, and psychiatric symptoms in young adults

Developing a comprehensive understanding of resilience across the lifespan is potentially important for mental health promotion, yet resilience has been vastly understudied compared to disease and vulnerability. The present study investigated the relationship of resilience to personality traits, coping styles, and psychiatric symptoms in a sample of college students. Measures included the Connor-Davidson Resilience Scale, NEO Five Factor Inventory, Coping Inventory for Stressful Situations, and Brief Symptom Inventory. Results supported hypotheses regarding the relationship of resilience to personality dimensions and coping styles. Resilience was negatively associated with neuroticism, and positively related to extraversion and conscientiousness. Coping styles also predicted variance in resilience above and beyond the contributions of these personality traits. Task-oriented coping was positively related to resilience, and mediated the relationship between conscientiousness and resilience. Emotion-oriented coping was associated with low resilience. Finally, resilience was shown to moderate the relationship between a form of childhood maltreatment (emotional neglect) and current psychiatric symptoms. These results augment the literature that seeks to better define resilience and provide evidence for the construct validity of the Connor-Davidson Resilience Scale.

Establishing a set of mental health indicators for Europe

AIMS

This review presents the background work for developing a set of mental health indicators as part of a comprehensive health monitoring system in the European Union. The review focuses on the appraisal of mental health at population level with special emphasis on assessments that could be useful for mental health promotion.

METHODS

A functional model of mental health is used to delineate variables important for a set of mental health indicators. Variables that are not possible to monitor at population level are not discussed here. Literature searches were conducted through the MEDLINE, PSYCHLIT, and SOCIOLOGICAL ABSTRACTS databases and available textbooks.

RESULTS

The review presents findings from research seeking associations between mental health and ill health and different individual, social, economic, ecological, and service-related characteristics. Specific domains as key starting points in establishing a set of mental health indicators are outlined according to the research findings.

CONCLUSION

A set of mental health indicators can enhance the visibility of mental health issues in the European context. Ultimately the indicators could be used in estimating how the targets set for health policies are met, and whether there has been a measurable decrease in disability, suffering, and disease.

Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC)

Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement.

Schizophrenia: two-faced meaning of vulnerability

The authors stress the current two-faced meaning of vulnerability that conveys both an objective and a subjective direction of sense, leading to a naturalistic model as well as a humanistic one. These models are heirs of both the Kraepelinian and Bleulerian conceptions of schizophrenia. Coping strategies and resilience are core concepts of the humanistic model. Research on these protective factors may be of major importance in the current debate on prevention in schizophrenia.

Understanding predisposition to schizophrenia: toward intervention and prevention

OBJECTIVE

Early intervention to prevent schizophrenia is one of the most important goals of schizophrenia research. However, the field is not yet ready to initiate trials to prevent prodromal or psychotic symptoms in people who are at risk for developing the disorder. In this paper, we consider some of the major obstacles that must be studied before prevention strategies become feasible.

METHOD AND RESULTS

One of the most important hurdles is the identification of a syndrome or set of traits that reflects a predisposition to schizophrenia and that might provide potential targets for intervention. In a recent reformulation of Paul Meehl's concept of schizotaxia, we integrate research findings obtained over the last 4 decades to propose a syndrome with meaningful clinical manifestations. We review the conceptualization of this syndrome and consider its multidimensional clinical expression. We then describe preliminary research diagnostic criteria for use in adult, nonpsychotic, first-degree relatives of patients diagnosed with schizophrenia, based on negative symptoms and neuropsychological deficits. We follow this with evidence supporting the validity of the proposed syndrome, which mainly includes social dysfunction and response to a low dosage of one of the newer antipsychotic medications.

CONCLUSIONS

Continued progress toward the eventual initiation of prevention strategies for schizophrenia will include sustained efforts to validate the traits reflecting a predisposition to develop the disorder (for example, schizotaxia), follow-up studies to confirm initial findings, and the identification of potentially useful preventive interventions.

Nature vs. nurture: two brothers with schizophrenia

TOPIC

The nature vs. nurture argument as it pertains to two brothers.

PURPOSE

To explore the synergistic effects of heritability and environment in the cases of two brothers with schizophrenia.

SOURCES

Review of the literature and the authors' clinical experience.

CONCLUSIONS

The nature vs. nurture dichotomy may not be as relevant as looking at the interaction between these two forces.

Towards the prevention of schizophrenia

There is a growing emphasis on attempts to identify the early signs and symptoms of schizophrenia, largely because early detection and treatment of psychosis (i.e., secondary prevention) are associated with relatively favorable clinical outcomes. This raises the issue of whether prevention of psychosis itself is possible. The achievement of this goal will require the identification of a premorbid state that could serve as the foundation for treatment strategies aimed ultimately at the prevention of schizophrenia. Fortunately, evidence for such a state is emerging, in part because schizophrenia may result from a neurodevelopmental disorder that is associated with a variety of clinical, neurobiological, and neuropsychologic features occurring well before the onset of psychosis. These features may serve as both indicators of risk for subsequent deterioration and the foundation of treatment efforts. We reformulated Meehl's term schizotaxia to describe this liability and discuss here how its study could form the basis for future strategies of prevention. We also include a description of our initial attempts to devise treatment protocols for schizotaxia. It is concluded that schizotaxia is a feasible concept on which to base prevention efforts, and that treatment of adult schizotaxia may be among the next steps in the process.