Basic symptoms in offspring of parents with mood and psychotic disorders

Exploring the interplay between psychotic experiences, functional somatic symptoms and health anxiety in childhood and adolescence - A longitudinal cohort study

BACKGROUND

Similarities exist between contemporary explanatory models underlying psychosis development, functional somatic symptoms, and health anxiety. The current study aimed to examine the potential interplay between psychotic experiences (and alternate measures of anomalous self-experiences and aberrant attribution of salience) and functional somatic symptoms on the outcome of health anxiety in youths.

METHODS

In a prospective general-population birth cohort, the Copenhagen Child Cohort 2000 (CCC2000), data from two time-points were available for 1122 individuals. We assessed the associations between psychotic experiences and functional somatic symptoms with health anxiety both cross-sectionally at ages 11- and 16-years, and longitudinally from age 11 to 16. Further, we examined if there was an interaction between these two domains on the outcome of health anxiety using the interaction contrast ratio.

RESULTS

Functional somatic symptoms and psychotic experiences were strongly cross-sectionally associated with health anxiety at both ages 11 and 16, even after adjustment for general psychopathology. In the longitudinal analyses, functional somatic symptoms, and psychotic experiences at age 11 were not individually associated with health anxiety at age 16 but having both functional somatic symptoms and psychotic experiences was: odds ratio 3.90, 95%CI 1.7-8.9, with suggestion of evidence for interaction beyond the additive effects. This association was attenuated after adjustment for general psychopathology: odds ratio 2.6, 95 % CI 1.0-6.4.

CONCLUSION

The strong associations between the domains support the idea of possible overlapping mechanisms underlying psychotic experiences, functional somatic symptoms, and health anxiety.

Parental mental disorders and offspring schizotypy in middle childhood: an intergenerational record linkage study

PURPOSE

To investigate relationships between distinct schizotypy risk profiles in childhood and the full spectrum of parental mental disorders.

METHODS

Participants were 22,137 children drawn from the New South Wales Child Development Study, for whom profiles of risk for schizophrenia-spectrum disorders in middle childhood (age ~ 11 years) were derived in a previous study. A series of multinomial logistic regression analyses examined the likelihood of child membership in one of three schizotypy profiles (true schizotypy, introverted schizotypy, and affective schizotypy) relative to the children showing no risk, according to maternal and paternal diagnoses of seven types of mental disorders.

RESULTS

All types of parental mental disorders were associated with membership in all childhood schizotypy profiles. Children in the true schizotypy group were more than twice as likely as children in the no risk group to have a parent with any type of mental disorder (unadjusted odds ratio [OR] = 2.27, 95% confidence intervals [CI] = 2.01-2.56); those in the affective (OR = 1.54, 95% CI = 1.42-1.67) and introverted schizotypy profiles (OR = 1.39, 95% CI = 1.29-1.51) were also more likely to have been exposed to any parental mental disorder, relative to children showing no risk.

CONCLUSION

Childhood schizotypy risk profiles appear not to be related specifically to familial liability for schizophrenia-spectrum disorders; this is consistent with a model where liability for psychopathology is largely general rather than specific to particular diagnostic categories.

Toward Generalizable and Transdiagnostic Tools for Psychosis Prediction: An Independent Validation and Improvement of the NAPLS-2 Risk Calculator in the Multisite PRONIA Cohort

BACKGROUND

Transition to psychosis is among the most adverse outcomes of clinical high-risk (CHR) syndromes encompassing ultra-high risk (UHR) and basic symptom states. Clinical risk calculators may facilitate an early and individualized interception of psychosis, but their real-world implementation requires thorough validation across diverse risk populations, including young patients with depressive syndromes.

METHODS

We validated the previously described NAPLS-2 (North American Prodrome Longitudinal Study 2) calculator in 334 patients (26 with transition to psychosis) with CHR or recent-onset depression (ROD) drawn from the multisite European PRONIA (Personalised Prognostic Tools for Early Psychosis Management) study. Patients were categorized into three risk enrichment levels, ranging from UHR, over CHR, to a broad-risk population comprising patients with CHR or ROD (CHR|ROD). We assessed how risk enrichment and different predictive algorithms influenced prognostic performance using reciprocal external validation.

RESULTS

After calibration, the NAPLS-2 model predicted psychosis with a balanced accuracy (BAC) (sensitivity, specificity) of 68% (73%, 63%) in the PRONIA-UHR cohort, 67% (74%, 60%) in the CHR cohort, and 70% (73%, 66%) in patients with CHR|ROD. Multiple model derivation in PRONIA-CHR|ROD and validation in NAPLS-2-UHR patients confirmed that broader risk definitions produced more accurate risk calculators (CHR|ROD-based vs. UHR-based performance: 67% [68%, 66%] vs. 58% [61%, 56%]). Support vector machines were superior in CHR|ROD (BAC = 71%), while ridge logistic regression and support vector machines performed similarly in CHR (BAC = 67%) and UHR cohorts (BAC = 65%). Attenuated psychotic symptoms predicted psychosis across risk levels, while younger age and reduced processing speed became increasingly relevant for broader risk cohorts.

CONCLUSIONS

Clinical-neurocognitive machine learning models operating in young patients with affective and CHR syndromes facilitate a more precise and generalizable prediction of psychosis. Future studies should investigate their therapeutic utility in large-scale clinical trials.

Parental mental illness and their offspring's mental health in Rwanda: neuropsychiatric hospital of Rwanda

BACKGROUND

Offspring of the parents with mental disorders are at higher risk to have the mental diseases throughout the world. This study examined the association between psychopathology of parents and the mental health of their offspring in Neuropsychiatric Hospital of Rwanda, Butare Branch.

METHODS

A cross-sectional study made up of case and control offspring was conducted on the case group made up of 80 offspring born to parents with mental diseases and a control group of 80 offspring from parents without mental disease. Hamilton Rating Scale for Depression (HRSD, α = 0.82), Posttraumatic stress disorders scale (PTSD, α = 0.73) and the Test of Psychological Problems (TPP, α = 0.93) were used. STATISTICA version 8 was used for statistical analysis.

RESULTS

Results indicated a significance difference between the two groups on depressive symptoms, psychological problems and PTSD symptomatology. The case group seemed to experience high level symptoms than the control group. Results indicated that, among the offspring born to parents with mental disease, there was a significant correlation between anxiety and depression symptoms (r = 0.71, p < .001), PTSD and eating disorder (r = 0.75, p < .001), domestic violence and PTSD (r = 0.78, p < .001), aggressive behavior and PTSD (r = 0.79, p < .001), somatoform disorders and PTSD (r = 0.98, p < .001). No significant association between the low self-esteem, depression, anxiety, mental disorders induced drug abuse and PTSD was found.

CONCLUSION

Offspring of the parents with mental disorders had higher risk to develop mental diseases than the offspring born to the parents without mental diseases. Taking into account the assessment of parents' mental illness when taking care of the offspring's psychological disorders is needed in the neuropsychiatric hospital.

Intergenerational transmission of psychiatric disorders: the 1987 Finnish Birth Cohort study

The causes of mental disorders are multifactorial including genetic and environmental exposures, parental psychopathology being the greatest risk factor for their offspring. We set out to quantify the risk of parental psychiatric morbidity with the incidence of mental disorders among their offspring before the age of 22 years and study the sex- and age-specific associations. The present study utilises the 1987 Finnish Birth Cohort (FBC) data, which is a register-based follow-up of all 60,069 children born in Finland 1987 and followed-up until 2008. Data on psychiatric morbidity are based on inpatient care episodes of parents and both inpatient and outpatient visits of offspring and were collected from the Finnish Hospital Discharge Register which covers all Finnish citizens accessing specialized care. Altogether 7.6% of the cohort members had a parent or both parents treated at psychiatric inpatient care during the follow-up. Parental psychiatric morbidity increased the offspring's risk for psychiatric diagnoses two to threefold versus those children without parental psychiatric hospitalization, mother's morbidity comprising a greater risk than that of father's. The risk was prominent for both sexes of the offspring throughout childhood and adolescence. Psychiatric disorders possess significant intergenerational continuum. It is essential to target preventive efforts on the high-risk population that comprises families with a parent or both having mental disorders. It also implies developing appropriate social and health care interventions to support the whole family.

The Role of Gut Microbiota in the High-Risk Construct of Severe Mental Disorders: A Mini Review

Severe mental disorders (SMD) are highly prevalent psychiatric conditions exerting an enormous toll on society. Therefore, prevention of SMD has received enormous attention in the last two decades. Preventative approaches are based on the knowledge and detailed characterization of the developmental stages of SMD and on risk prediction. One relevant biological component, so far neglected in high risk research, is microbiota. The human microbiota consists in the ensemble of microbes, including viruses, bacteria, and eukaryotes, that inhabit several ecological niches of the organism. Due to its demonstrated role in modulating illness and health, as well in influencing behavior, much interest has focused on the characterization of the microbiota inhabiting the gut. Several studies in animal models have shown the early modifications in the gut microbiota might impact on neurodevelopment and the onset of deficits in social behavior corresponding to distinct neurosignaling alterations. However, despite this evidence, only one study investigated the effect of altered microbiome and risk of developing mental disorders in humans, showing that individuals at risk for SMD had significantly different global microbiome composition than healthy controls. We then offer a developmental perspective and provided mechanistic insights on how changes in the microbiota could influence the risk of SMD. We suggest that the analysis of microbiota should be included in the comprehensive assessment generally performed in populations at high risk for SMD as it can inform predictive models and ultimately preventative strategies.

Advances in early identification of children and adolescents at risk for psychiatric illness

PURPOSE OF REVIEW

Childhood and adolescence are a crucial time window for the early identification of perspectival risk for adult psychopathology. This article reviews current advances in the field.

RECENT FINDINGS

Converging developmentally focused and predictive approaches are rapidly expanding in the field of early identification of children and adolescents at risk for psychiatric illness. Although the former emphasizes early phenotypic trajectories emerging in childhood and adolescence, the latter operate in terms of clinical risk staging. Decisive advances in the field include the metaanalytical evidence of the predictive value of clinical high-risk criteria in childhood-adolescence; the systematization of premorbid manifestations of psychotic vulnerability and bipolar prodromes; the corroboration of certain sets of anomalous subjective experiences as transdiagnostic index of familial genetic risk (i.e., basic symptoms) and early developmental expression of schizophrenia spectrum vulnerability (i.e., self-disorders).

SUMMARY

Childhood phenotypic manifestations of liability to mental disorders are often cooccurrent and undergo a plastic, heterotypic modification along the transition to adolescence. In general, they represent epiphenomenic flags of a broad vulnerability for the subsequent structuration of mental illness. This perspective coheres with the p-factor model of psychopathology and complements the clinical staging model which informs the early detection paradigm of severe mental disorders.