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Burton BK, Hjorthøj C, Jepsen JR, Thorup A, Nordentoft M, Plessen KJ. Research Review: Do motor deficits during development represent an endophenotype for schizophrenia? A meta-analysis. J Child Psychol Psychiatry 2016; 57:446-56. [PMID: 26577292 DOI: 10.1111/jcpp.12479] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early detection of schizophrenia risk is a critical goal in the field. Endophenotypes in children to relatives of affected individuals may contribute to this early detection. One of the lowest cost and longest theorized domains is motor development in children. METHODS A meta-analysis was conducted comparing individuals ≤21 years old with affected first-degree relatives (FDR) with (1) individuals from unaffected families (controls), or (2) individuals with FDR having other psychiatric disorders. Studies were classified by motor outcome and separate meta-analyses were performed across six correlated domains, with available N varying by domain. RESULTS Inclusion criteria were met by k = 23 independent studies with a total N = 18,582, and N across domains varying from 167 to 8619. The youth from affected families had delays in gross and fine motor development in infancy (k = 3, n = 167, Hedges'g = 0.644, confidence intervals (CI) = [0.328, 0.960], p < .001), walking milestones (k = 3, n = 608, g = 0.444, CI = [0.108, 0.780], p = .01), coordination (k = 8, n = 8619, g = 0.625, CI = [0.453, 0.797], p < .0001), and had more abnormal movements such as involuntary movements (k = 6, n = 8365, g = 0.291, CI = [0.041, 0.542], p = .02) compared with controls. However, not all effects survived correction for publication bias. Effects for neurological soft signs were small and not reliably different from zero (k = 4, n = 548, g = 0.238, CI = [-0.106, 0.583], p = .18). When comparing the FDR group to youth from families with other psychiatric disorders, the FDR group was distinguished by poorer gross and fine motor skills (k = 2, n = 275, g = 0.847, CI = [0.393, 1.300], p < .001). CONCLUSIONS Motor deficits during development likely represent an endophenotype for schizophrenia, although its specificity is limited in relation to other serious mental disorders. It holds promise as a low cost domain for early risk detection, although it will have to be combined with other indicators to achieve clinically usable prediction accuracy. Impaired coordination was the most robust result with a moderate effect size and lack of heterogeneity and publication bias.
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Affiliation(s)
- Birgitte Klee Burton
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, Research Unit, Copenhagen University Hospital, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Copenhagen, Denmark
| | - Jens Richardt Jepsen
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, Research Unit, Copenhagen University Hospital, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Centre for Neuropsychiatric Schizophrenia Research & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Mental Health Services Capital Region, Copenhagen, Denmark
| | - Anne Thorup
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, Research Unit, Copenhagen University Hospital, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Centre Copenhagen, Copenhagen University Hospital, Mental Health Services Capital Region, Copenhagen, Denmark
| | - Kerstin J Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, Research Unit, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Liu CH, Keshavan MS, Tronick E, Seidman LJ. Perinatal Risks and Childhood Premorbid Indicators of Later Psychosis: Next Steps for Early Psychosocial Interventions. Schizophr Bull 2015; 41:801-16. [PMID: 25904724 PMCID: PMC4466191 DOI: 10.1093/schbul/sbv047] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Schizophrenia and affective psychoses are debilitating disorders that together affect 2%-3% of the adult population. Approximately 50%-70% of the offspring of parents with schizophrenia manifest a range of observable difficulties including socioemotional, cognitive, neuromotor, speech-language problems, and psychopathology, and roughly 10% will develop psychosis. Despite the voluminous work on premorbid vulnerabilities to psychosis, especially on schizophrenia, the work on premorbid intervention approaches is scarce. While later interventions during the clinical high-risk (CHR) phase of psychosis, characterized primarily by attenuated positive symptoms, are promising, the CHR period is a relatively late phase of developmental derailment. This article reviews and proposes potential targets for psychosocial interventions during the premorbid period, complementing biological interventions described by others in this Special Theme issue. Beginning with pregnancy, parents with psychoses may benefit from enhanced prenatal care, social support, parenting skills, reduction of symptoms, and programs that are family-centered. For children at risk, we propose preemptive early intervention and cognitive remediation. Empirical research is needed to evaluate these interventions for parents and determine whether interventions for parents and children positively influence the developmental course of the offspring.
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Affiliation(s)
- Cindy H Liu
- Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA; Department of Psychology, University of Massachusetts, Boston, MA;
| | - Matcheri S Keshavan
- Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ed Tronick
- Department of Psychology, University of Massachusetts, Boston, MA; Department of Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA; Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Effect of psychosocial environment in children having mother with schizophrenia. Psychiatry Res 2015; 226:418-24. [PMID: 25700567 DOI: 10.1016/j.psychres.2014.11.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 11/04/2014] [Accepted: 11/08/2014] [Indexed: 11/21/2022]
Abstract
The process of child׳s mental development depends heavily on the social interrelationship between the mother and her child. Schizophrenia in mothers potentially disrupts mother-infant relationship and adaptation to motherhood. Literature is limited on evaluating the emotional and behavioral problems of children of mother having schizophrenia with nearly none from the Indian subcontinent. The aim of the current study was to examine the effect of psychosocial environment in children of females with schizophrenia. Thirty children of mothers suffering with schizophrenia were evaluated with Child Behavior Checklist (CBCL) and Mini International Neuropsychiatric Interview for children and adolescents. The psychosocial environment was assessed using Parent Interview Schedule. Control group of 30 children were evaluated in the same way as the cases. The children of female patients with schizophrenia were found to score significantly higher on internalizing and externalizing behavioral problems on CBCL as compared to control group, along with significant differences in the psychosocial environment between the groups. We conclude that there is a need for screening and evaluation of children of mothers diagnosed with schizophrenia, for identifying and managing possible mental and behavioral problems in them, and to assess the psychosocial environment and provide interventions for issues related to it.
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Oei JL, Abdel-Latif ME, Craig F, Kee A, Austin MP, Lui K. Short-term outcomes of mothers and newborn infants with comorbid psychiatric disorders and drug dependency. Aust N Z J Psychiatry 2009; 43:323-31. [PMID: 19296287 DOI: 10.1080/00048670902721087] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of the present study was to determine the characteristics and short-term outcomes of mother-infant pairs with comorbid drug dependency and psychiatric disorders. METHODS A population-based retrospective chart review was carried out of 879 drug-dependent mother and infant pairs in New South Wales (NSW) and the Australian Capital Territory (ACT) who delivered between 1 January and 31 December 2004. RESULTS Psychiatric comorbidity (dual diagnosis, DD) was identified in 396 (45%) of the 879 drug-dependent women. DSM-IV depression (79%), followed by anxiety (20%), was most prevalent. DD women were more likely to use amphetamines (29% vs 18%, p < 0.05), less likely to use opiates (42% vs 51%, p < 0.05) and to have had no antenatal care (24% vs 8%, p < 0.05). They also had more previous pregnancies (4, range = 2-5 vs 3, range = 2-5, p < 0.05) and domestic violence (29% vs 14%, p < 0.05) was more common. DD infants were less likely to be admitted to a nursery (47% vs 55%, p < 0.05). Withdrawal scores were similar (maximum median Finnegan scores = 4 (interquartile range = 3-8) vs 10 (interquartile range = 7-12, p = 0.30) but fewer needed withdrawal medication (19% vs 27%, p < 0.05). Maternal psychotropic agents did not worsen the severity of neonatal withdrawal. CONCLUSIONS Psychiatric comorbidity, especially depression, is common and affects almost half of drug-using mothers. Antenatal care, drug use and social outcomes are worse for DD mothers and their infants. It is recommended that all drug-using women be assessed antenatally for psychosocial disorders so that timely mental health intervention can be offered, if required.
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Affiliation(s)
- Ju Lee Oei
- Department of Newborn Care, Royal Hospital for Women, NSW, Australia.
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Hornstein C, Trautmann-Villalba P, Hohm E, Rave E, Wortmann-Fleischer S, Schwarz M. [Interactional therapy program for mothers with postpartum mental disorders. First results of a pilot project]. DER NERVENARZT 2007; 78:679-84. [PMID: 17426951 DOI: 10.1007/s00115-006-2251-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The period around delivery frequently causes psychiatric diseases that may disturb maternal competence and influence bonding behaviour with the child. Until now only a few possibilities have existed for inpatient treatment and therapy for these problems. The therapy program developed in Wiesloch, Germany, is especially well suited to such patients. METHODS Fifty-three mothers with postpartum disorders (33 depressive, 20 psychotic) were examined before and after therapy. Psychopathologic severity, psychosocial level of functioning, and parameters of the mother-child interaction were assessed and compared. RESULTS Overall the results showed clear improvements in the assessed parameters at the end of treatment for both psychotic mothers and those with affective disorders. CONCLUSION The interactional treatment program for postpartum mental disorders leads to a significant reduction in psychic/psychiatric severity and the associated psychosocial impairment and disturbed mother-child interaction. Considerations of the effects of therapy were not possible due to the study design.
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Affiliation(s)
- C Hornstein
- Allgemeinpsychiatrie und Psychotherapie 1, Mutter-Kind Behandlung (Station 43), Psychiatrisches Zentrum Nordbaden, Akademisches Lehrkrankenhaus der Universität Heidelberg, Heidelberger Strasse 1a, 69168 Wiesloch.
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Clarke MC, Cannon M, Hogg MW, Marks MN, Conroy S, Pawlby SJ, Greenough A, Nicolaides K. Foetal brain development in offspring of women with psychosis. Br J Psychiatry 2007; 190:445-6. [PMID: 17470961 DOI: 10.1192/bjp.bp.106.023747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cerebral ventricular enlargement and reduced cortical volume are correlates of chronic schizophrenia. We investigated whether genetic risk for psychosis related to differences in foetal brain development as measured by prenatal ultrasonography. Routine foetal cerebral measures at 19-23 weeks of gestation were compared between the offspring of 35 women with a history of psychosis and 105 control women matched for gestational age. Overall, no significant differences were found between the high-risk and control groups. There was a non-significant trend in the adjusted analysis towards increased lateral ventricular width in the offspring of mothers with psychosis.
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Affiliation(s)
- Mary C Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland.
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Rice F, Harold GT, Thapar A. The effect of birth-weight with genetic susceptibility on depressive symptoms in childhood and adolescence. Eur Child Adolesc Psychiatry 2006; 15:383-91. [PMID: 16604377 PMCID: PMC1705530 DOI: 10.1007/s00787-006-0545-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2006] [Indexed: 12/02/2022]
Abstract
Low birth-weight has been associated with depression and related outcomes in adults, and with problem behaviours in children. This study aimed to examine the association between low birth-weight for gestation and depressive symptoms in children and adolescents and to examine whether the relationship is moderated by genetic risk for depression. An epidemiological, genetically sensitive design was used including 2,046 twins aged 8-17 years (1,023 families). Data were obtained by parental report and analysed using regression analysis. A small but significant association between birth-weight for gestation and early depressive symptoms was observed. The unit increase in depressive symptoms per unit decrease in birth-weight for gestation was greater for individuals at genetic or familial risk for depression. For low birth-weight children, genetic risk for depression moderated the influence of birth-weight for gestation in predicting early depressive symptoms. Birth-weight for gestation is moderated by genetic and familial risk for depression in influencing early depression symptoms. These observations have clinical implications in that the impact of being small for gestational age on depressive symptoms is greater in children at familial/genetic risk although the association between birth weight and depression does not imply causality.
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Affiliation(s)
- Frances Rice
- Dept. of Psychological Medicine School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK.
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Abstract
Section 1 describes the benefits of breastfeeding to both mother and infant as well as the potential risks to the infant from maternal drug use. The extent of adverse drug-related events and the need for quality information on drug transfer is stated. Section 2 describes the physiology of lactation and the effects of drugs that stimulate or decrease milk production. Section 3 deals with transport mechanisms for drug passage into milk and factors that may modify the infant's exposure to drugs. The critical descriptors of 'absolute' and 'relative' infant dose are defined to give an objective measure of infant exposure to drugs in milk. Section 4 reviews new or commonly used drugs under the headings of analgesics and anti-inflammatory agents, neurological, endocrine, psychotropic and antihypertensive drugs. Section 5 concludes with an expert opinion of the drug industry and drug use in lactation, herbal preparations, the process of 'risk-benefit' analysis, minimising infant exposure, understanding drug-related adverse events and fostering good experimental design for drugs in lactation studies.
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Affiliation(s)
- Kenneth F Ilett
- University of Western Australia, School of Medicine and Pharmacology, Crawley, 6009, Australia.
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