Associations between externalizing behavior problems and risky sexual behaviors in adolescence: Attachment as a mediator

INTRODUCTION

Risky sexual behaviors in adolescence are associated with negative health and psychological functioning outcomes. Although the association between behavior problems and risky sexual behaviors is well established, addressing these problems requires understanding the mechanisms that help explain this association. Adolescent attachment, while related to risky sexual behavior, has not been extensively explored as an outcome of childhood externalizing problems. The two objectives of this study were to explore the links between parental and peer attachment and risky sexual behaviors and to examine the mediating effect of attachment on the links between behavior problems and risky sexual behaviors.

METHODS

Five hundred and ninety-eight French-Canadian adolescents (46.2% girls), Mage at T1 = 13.23; Mage at T2 = 14.28; Mage at T3 = 17.35) participated in this longitudinal study.

RESULTS

The quality of parental attachment at T2 was significantly and negatively associated with risky sexual behaviors 3 years later, at T3. More specifically, a lower quality parental attachment relationship was associated with having nonexclusive partners as well as with inconsistent condom use. Finally, parental attachment (T2) was a significant mediator between behavior problems (T1) and risky sexual behaviors (T3), but only for younger adolescents.

CONCLUSIONS

Findings suggest that in addition to behavior problems in adolescence, the quality of parental attachment relationships may help in understanding risky sexual behaviors in adolescence.

The longitudinal association between externalizing and internalizing problems: An exploration of the dual failure model

The Dual Failure Model suggests that peer victimization (social failure) and academic difficulties (academic failure) mediate the association between externalizing and later internalizing problems. The present study sought to better understand why children with externalizing problems develop later internalizing problems by testing the Dual Failure Model using a sample of 744 children (aged 6 to 10 at Time 1 [T1]), of whom 434 (44.7% girls) presented with high levels of conduct problems at study inception. Both parent and teacher ratings of externalizing and internalizing problems support the social failure pathway, but not the academic failure pathway. Children with externalizing behaviors at T1 who developed internalizing problems 2 years later did so via their experiences of peer victimization. These results apply for both boys and girls and do not vary according to child age at T1 or the level of conduct problems at study inception. These findings underscore the importance of early screening and intervention for externalizing behavioral problems in order to reduce subsequent peer victimization and internalizing problems. Findings regarding the consequences of internalizing are also discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Clinical Utility of the Limited Prosocial Emotions Specifier in the Childhood-Onset Subtype of Conduct Disorder

OBJECTIVE

Clinicians may specify the diagnosis of conduct disorder (CD) as "with limited prosocial emotions" (LPE). This specifier is thought to identify youths with particularly severe and stable symptomatology. However, few studies have examined the clinical usefulness of the LPE specifier among children with childhood-onset CD. The current study examines whether the LPE specifier distinguishes children with particularly severe and persistent symptoms among those with childhood-onset CD. The study also aims to test whether the LPE specifier aids in identifying children with subclinical CD whose conduct problems are at risk of increasing.

METHOD

Two hundred sixty-four children showing at least one CD symptom before age 10 were divided based on the presence of CD and the specifier. Children with and without the specifier were compared on number of CD symptoms (assessed at study inception) and trajectory of conduct problems (assessed over 4 years). The analyses controlled for oppositional defiant and attention deficit hyperactivity symptomatology.

RESULTS

Compared with children with CD but without LPE, children with CD and the LPE specifier did not differ on likelihood of endorsing most symptoms nor on total numbers of symptoms. Moreover, they did not show a more stable pattern of conduct problems across the 4 years. Children with subclinical CD with and without the LPE specifier were also similar in terms of their symptoms, severity, and evolution of their problems.

CONCLUSIONS

Among youths with childhood-onset CD, the specifier appears to offer limited value in identifying those with particularly severe and stable CD symptomatology.

Trace elements among a sample of prisoners with mental and personality disorders and aggression: correlation with impulsivity and ADHD indices

OBJECTIVES

Mental, personality and substance use disorders are over represented among prisoners and aggressive individuals. The psychopathological and biological markers linked to mental functioning remain still unclear. In particular, the role of trace elements in mental illness is still matter of debate. Here, we investigated whether trace elements are correlated to specific psychopathological phenotype groups.

METHODS

Axis I and II disorders, aggression, impulsivity, adult attention deficit/hyperactivity disorders (ADHD) indices and serum levels of zinc, copper and cadmium were evaluated in 160 male prisoners.

RESULTS

Using latent class analysis we could subdivide prisoners into three distinct psychopathological classes: Class 1 characterized by low prevalence of aggression, personality disorders and substance abuse/dependence (alcohol, cannabis, cocaine); Class 2 represented by low prevalence of aggression and high prevalence of personality disorders and substance abuse/dependence; Class 3 defined by high prevalence of aggression, personality disorders and substance abuse/dependence. Serum levels of zinc were higher in Class 2 and 3 compared to Class 1. Moreover, Class 3 was associated with higher scores of impulsivity and ADHD indices.

CONCLUSION

Our results suggest that impulsivity but also adult ADHD indices are related to aggressive behaviour, and higher zinc levels are linked to personality disorders and addictions, but not to aggression.

Predicting Depression and Anxiety from Oppositional Defiant Disorder Symptoms in Elementary School-Age Girls and Boys with Conduct Problems

This study investigated the relationship between the three DSM-5 categories of oppositional defiant disorder (ODD) symptoms (irritable mood, defiant behavior, vindictive behavior) and anxiety/depression in girls and boys with conduct problems (CP) while controlling for comorbid child psychopathology at baseline. Data were drawn from an ongoing longitudinal study of 6- to 9-year-old French-Canadian children (N = 276; 40.8 % girls) receiving special educational services for CP at school and followed for 2 years. Using linear regression analysis, the results showed that irritable mood symptoms predicted a higher level of depression and anxiety in girls and boys 2 years later, whereas the behavioral symptoms of ODD (e.g., defiant, vindictive symptoms) were linked to lower depression scores. The contribution of ODD symptoms to these predictions, while statistically significant, remained modest. The usefulness of ODD irritable symptoms as a marker for identifying girls and boys with CP who are more vulnerable to developing internalizing problems is discussed.

Engineering n–p junction for photo-electrochemical hydrogen production

A Cu-based photoelectrode protected by a BaTiO₃ perovskite layer exhibits a photocurrent of −3.1 mA cm⁻² in a pH = 6 aqueous electrolyte.

Tryptophan via serotonin/kynurenine pathways abnormalities in a large cohort of aggressive inmates: markers for aggression

Aggressive behavior is one of the most challenging symptoms in psychiatry, and biological markers for aggression lack of large sample validations. Serotonin (5-HT) and other neuroactive compounds deriving from Tryptophan (Trp), including kynurenine (Kyn), have not yet been investigated in large cohorts of aggressive individuals to validate their potential as biomarkers of aggression. In 361 male inmates we measured serum levels of Trp, 5-hydroxytryptophan, 5-HT, Kyn, the ratios 5-HT/Trp∗1000 and Kyn/Trp∗1000, and performed Structured Clinical Interview for DSM-IV Axis-I and -II Disorders (SCID-I and -II), global assessment of functioning (GAF), and scales for aggressive behavior, impulsivity, adult attention-deficit/hyperactivity disorder (ADHD), and intelligent quotient (IQ). Aggressive compared to non-aggressive inmates exhibited lower Trp and Kyn serum levels but higher levels of 5-HT and 5-HT/Trp∗1000, higher levels of impulsivity and ADHD indices, lower IQ and GAF, higher prevalence of mood disorders, drug abuse/dependence, and borderline, conduct and antisocial behaviors. Interestingly, Kyn/Trp∗1000 was positively correlated to the number of severe aggressive acts (r=0.593, P<0.001). After adjusting for confounding factors, logistic regression analysis indicated that 5-HT/Trp∗1000, antisocial behavior, and GAF were predictors of aggressive behavior. The model combining these three predictors had an area under the ROC curve of 0.851 (95% CI 0.806-0.895). This study indicates that while circulating Trp is reduced in aggressive individuals, the combination of biological (5-HT/Trp ratio) and psychopathological (antisocial behavior and GAF) markers discriminates between aggressive and non-aggressive behavior suggesting the potential of a multi-marker approach in psychiatry given the heterogenic nature of mental diseases.

Longitudinal associations between conduct problems and depressive symptoms among girls and boys with early conduct problems

Youth with conduct problems (CP) may experience high rates of depressive symptoms (DS). However, little is known about the direction of the longitudinal associations between CP and DS in this specific population. Although girls with CP appear at greater risk than boys for presenting comorbid depression, empirical research on gender differences in these associations is even sparser. The current study used autoregressive latent trajectory models to compare four perspectives with hypotheses regarding the longitudinal associations between CP and DS, while taking into account the evolution of both problems. We also examined gender differences in the longitudinal associations. A total of 345 children (40.6 % female) presenting with a high level of CP in early elementary school (mean age at study inception = 8.52; SD = .94) were evaluated annually over a four-year period (5 measurement time points). The results revealed that CP and DS were quite stable over time. Moreover, CP and DS showed strong covariation at each measurement time point, but only one significant positive cross-lagged association between the two processes, indicating that higher levels of DS at time 3 were associated with higher levels of CP 1 year later. No differences were observed in the longitudinal associations between CP and DS in boys and girls. Given the comorbidity and stability of CP and DS, these findings suggest that DS should be systematically evaluated among children with early clinically significant CP, and treatment plans should include interventions aimed at both CP and DS among children who present with both types of problems.

Overt versus covert conduct disorder symptoms and the prospective prediction of antisocial personality disorder

Studies have shown strong continuity between conduct disorder (CD) in adolescence and antisocial personality disorder (APD) in adulthood. Researchers have been trying to explain why some adolescents with CD persist into adult APD and others do not. A few studies reported that overt and covert CD symptoms have a differential predictive power for APD, with mixed results. The present study aimed to evaluate the prospective association of overt and covert CD symptoms with APD in a sample of male adolescents with CD (N = 128, mean age = 15.6, SD = 1.6). Participants were recruited at intake in Quebec Youth Centers and reassessed 3 years later (n = 73). CD and ADHD symptoms were assessed at intake with the DISC-R while APD was assessed 3 years later with the SCID-II. Logistic regression results showed that, contrary to previous prospective studies (Lahey, Loeber, Burke, & Applegate, 2005; Washburn et al., 2007), overt (OR = 2.12, 95% CI [1.29, 3.50]) but not covert (OR = 1.04, 95% CI [0.69, 1.56]) symptoms predicted later APD, controlling for ADHD symptoms and socioeconomic status. It is hypothesized that the divergence with previous studies may be explained by the higher mean number and wider range of overt CD symptoms in our sample.

Predicting recidivism in adolescents with behavior problems using PCL-SV

Studies show that identifying persistent delinquents on the basis of early antisocial conduct yields a significant error rate. However, evaluating childhood or adolescent psychopathic traits is likely to improve matters in this regard. This study seeks to verify the contribution of psychopathic traits in adolescence to antisocial conduct prediction in early adulthood. To this end, a French version of the Psychopathy Checklist -Screening Version (PCL-SV) adapted to adolescents is used to evaluate psychopathic traits in 27 youths aged 15 to 19 years recruited in youth centres and presenting behavioral problems reaching a clinical threshold. The PCL-SV scores contribute significantly above and beyond indices of delinquent behavior to predict self-reported antisocial conduct 2 years later and, specifically, to predict criminal versatility and violent recidivism.

Overt Versus Covert Conduct Disorder Symptoms and the Prospective Prediction of Antisocial Personality Disorder

Studies have shown strong continuity between conduct disorder (CD) in adolescence and antisocial personality disorder (APD) in adulthood. Researchers have been trying to explain why some adolescents with CD persist into adult APD and others do not. A few studies reported that overt and covert CD symptoms have a differential predictive power for APD, with mixed results. The present study aimed to evaluate the prospective association of overt and covert CD symptoms with APD in a sample of male adolescents with CD (N = 128, mean age = 15.6, SD = 1.6). Participants were recruited at intake in Quebec Youth Centers and reassessed 3 years later (n = 73). CD and ADHD symptoms were assessed at intake with the DISC-R while APD was assessed 3 years later with the SCID-II. Logistic regression results showed that, contrary to previous prospective studies (Lahey, Loeber, Burke, & Applegate, 2005; Washburn et al., 2007), overt (OR = 2.12, 95% CI [1.29, 3.50]) but not covert (OR = 1.04, 95% CI [0.69, 1.56]) symptoms predicted later APD, controlling for ADHD symptoms and socioeconomic status. It is hypothesized that the divergence with previous studies may be explained by the higher mean number and wider range of overt CD symptoms in our sample.

[Characteristics of adolescent offenders receiving services in juvenile centers in Québec (Centres jeunesse du Québec, CJQ)]

This study aims at establishing a comparative psychological profile of male and female adolescents at the moment of the application of measures in juvenile centers in Québec (centres jeunesse du Québec, CJQ) as well as their family and social characteristics. The study compares 213 adolescents (12-17 years old) receiving services in CJQ in accordance with the juvenile offenders act (Loi sur les jeunes contrevenants), with 213 adolescents from high schools of impoverished neighbourhoods. Results reveal serious problems of adaptation, external disorders and interiorized disorders and a regular substance abuse among many juvenile offenders. These problems are much more frequent in CJQ than within the juvenile population. The situation of these adolescents is worrisome, given that a high prevalence of depression and sexual victimisation is also observed in females. Finally, families whose adolescent receives services in CJQ have less financial, personal and social resources, as well as more difficulty exercising their parental role compared to parents in the general population. In conclusion, recommendations are proposed concerning psychosocial services necessary for these adolescents and their families.

[Symptomatology and psychosocial adaptation in adolescents with depressive disorder and comorbid disruptive behaviour disorder]

OBJECTIVE

To describe symptomatology and specific psychological, social, and academic adaptation in adolescents with depressive disorder and comorbid disruptive behaviour disorder, as well as their family situation.

METHOD

Using binomial logistic regressions, this study compares adolescents with depressive disorder and comorbid disruptive behaviour disorder (n=25) with adolescents with the same behaviour problems but no comorbid depressive disorder (n=99). Sex-specific interaction impacts are examined.

RESULTS

While both groups have several similar characteristics, youth with a dual diagnosis have more oppositional symptoms and poorer self-esteem. Analyses show no interaction impact from sex variable.

CONCLUSIONS

Adolescents in both groups would benefit from similar interventions regarding disruptive behaviour disorders and some related problems, such as using psychoactive drugs, socializing with delinquent peers, and difficulty functioning in school. Adolescents with a comorbid depressive disorder need special attention, given the more significant oppositional symptomatology and the poorer self-esteem.

Évaluation des habiletés de vie autonome chez les personnes psychotiques

Ce texte détaille les caractéristiques métrologiques de l'Échelle des habiletés de Vie Autonome (EHVA) mesurant les habiletés requises chez des personnes psychotiques, pour fonctionner de façon autonome au sein de la communauté. Ce questionnaire, qui comprend 65 items répartis en dix échelles d'habiletés, a été administré à 276 personnes psychotiques. Les résultats indiquent que, dans l'ensemble, la fidélité de cet instrument est bonne, mesurée par l'accord interjuges et les coefficients alpha. Trois des 10 échelles, soit les échelles Déplacement, Recherche d'emploi et Maintien de l'emploi, n'ont pu être conservées dans la version finale. Les quatre aspects de la validité examinés dans cette étude se révèlent très satisfaisants; il s'agit du degré de convergence entre l'évaluation faite par les participants eux-mêmes et par un membre du personnel soignant, des analyses discriminantes, des corrélations convergentes-divergentes avec d'autres instruments de mesure du fonctionnement psychosocial et de l'analyse factorielle exploratoire. Après ces analyses, la version finale de l'EHVA comprend 48 items répartis sous sept échelles. La discussion fait ressortir les qualités psychométriques d'un tel instrument en langue française et suggère des pistes de recherche pour poursuivre le développement de l'EHVA.

Rate and characteristics of men with an intellectual disability in pre-trial detention

BACKGROUND

Various lines of research point to the overrepresentation of individuals with intellectual disability (ID) in the criminal justice system. Studies have also shown that individuals with ID are vulnerable to mental health problems. To date there have been no Canadian studies of individuals with an ID in the criminal justice system.

METHOD

The present study reports on the sociodemographic, mental health and criminological characteristics of 281 individuals with an ID from a Canadian study of men in a pre-trial holding centre.

RESULTS

Almost 19% of the men had a probable ID, and nearly one-third (29.9%) were in the borderline IQ range. As was the case for their non-ID counterparts, the mean age of the probable ID group was in the early 30s, few were employed, and most had low incomes. Individuals in the probable and borderline ID groups had lower rates of high school completion than those in the average intellectual ability range. Over 60% of individuals with an ID had a substance use disorder, and 1 in 5 was intoxicated at the time of assessment. These rates were similar across groups, and to those found in the literature. A large majority of individuals with ID had a previous conviction, and most had previously committed a violent offence.

CONCLUSIONS

Among other limitations, the sample may not have been entirely representative of the total population of men in the pre-trial detention centre, given the relatively high refusal rate (39.5%). Results are discussed in terms of orienting criminological and mental health services as a function of the level of intellectual and adaptive functioning of individuals with ID.

Frequency of mental health disorders in a sample of elementary school students receiving special educational services for behavioural difficulties

OBJECTIVE

Despite being essential for defining and planning special educational services, very few data are available in Quebec regarding the nature and extent of behavioural difficulties presented by children who receive special educational services at school. This study provides a picture of the frequency of disruptive behaviour disorders (that is, attention-deficit hyperactivity disorder [ADHD], oppositional defiant disorder [ODD], and conduct disorder [CD]) and internalized disorders (including generalized anxiety disorder [GAD] and major depressive episode [MDE]) in a sample of elementary school students receiving special educational services for behavioural difficulties (n = 324).

METHOD

In this descriptive study, we established the presence of mental health disorders according to teacher-, parent-, and child-reported data that were obtained using structured diagnostic interviews based on DSM-IV criteria. We also examined prevalence rates by sex and age group.

RESULTS

Three-quarters of the students met the criteria for ADHD, one-half for ODD, and one-third for CD. About 14% of the students presented with a GAD or met the criteria for an MDE in the past year. Only 2% of the students presented with an internalized disorder without a comorbid disruptive behaviour disorder.

CONCLUSIONS

Our results suggest that among students receiving special educational services for behavioural difficulties, a large proportion may have difficulties severe enough to meet the criteria for at least one DSM-IV disruptive behaviour disorder. Such findings may underscore the need to develop more collaboration between the mental health and education sectors in rehabilitating these children.

Enfants manifestant un trouble des conduites et utilisant des services psychoéducatifs : un portrait social, familial et psychologique

Les études contemporaines suggèrent que la plupart des enfants qui manifestent un trouble des conduites présentent également des difficultés personnelles et familiales. Ceci est particulièrement vrai pour les jeunes dont le trouble est précoce. L’identification des caractéristiques personnelles et des facteurs sociaux et familiaux de risque et de protection associés aux difficultés sont d’une grande utilité pour la planification des interventions et l’organisation des services à offrir aux jeunes et aux familles du Québec. En conséquence, les objectifs de cette étude sont d’identifier les facteurs sociaux, familiaux et psychologiques qui caractérisent les enfants présentant un trouble des conduites. Pour y parvenir 62 enfants en traitement, âgés entre 7 et 12 ans et présentant un diagnostic de trouble des conduites sont comparés à 36 enfants du même âge sans trouble des conduites. Les résultats établissent que les enfants ayant un trouble des conduites proviennent de familles moins stables et cohésives, ainsi que d’un niveau socioéconomique plus faible. De plus, les enfants ont un réseau de soutien social moins développé. L’étude révèle également que les parents des enfants qui présentent un trouble des conduites utilisent davantage la punition. Enfin, la recherche démontre que les enfants de ce groupe ont une probabilité beaucoup plus grande de présenter un autre trouble extériorisé (66 %) que les enfants du groupe témoin (8 %). L’ensemble de ces caractéristiques distinctives permet de classifier correctement 93,8 % des enfants de l’étude dans les 2 groupes. Les résultats obtenus indiquent l’intérêt d’améliorer les pratiques éducatives des parents, d’augmenter le réseau social de l’enfant et de réduire les conduites d’opposition et d’inattention chez l’enfant. Enfin, la complexité des difficultés relevées chez les enfants et les familles invitent à une intervention professionnelle concertée.

Predictors of maternal support: the point of view of adolescent victims of sexual abuse and their mothers

Maternal support received by sexual abuse victims is considered a key factor in coping with the aftermath of abuse. The present study looked at four groups of potential predictors of maternal support: mothers' psychosocial characteristics, abuse characteristics, victim's characteristics, and disclosure characteristics. A total of 120 adolescents aged 12 to 17 years and their mothers, who were recruited from Child Protective Services, completed questionnaires and semi-structured interviews. Multiple regression analyses performed separately on mother and child data sets revealed five significant predictors of maternal support in each analysis, four of which were common to both. The discussion underscores the importance of taking into account both the mother's and the victim's perceptions regarding psychological adjustment and family environment.

[Children with conducts disorder and using psychoeducational services: a social, psychological and family portrait]

Contemporary studies suggest that most of the children who manifest conducts disorder also present personal as well as family problems. This is particularly true for children whose disorder is precocious. The identification of personal characteristics as well as social and family risk and protection factors associated with children with such problems are of great use for intervention planning and service organization for them and their families in Québec. In consequence, the objectives of this study are to identify the social, family and psychological factors that characterize children presenting conducts disorder. To do so, 62 children in treatment between the ages of 7 and 12 and with a diagnosis of conducts disorder are compared with 36 children of the same age without such diagnosis. Results show that children with conduct problems come from less stable and cohesive families as well as a lower socio-economic level. Moreover, their network of social support is less developed. The study reveals that the parents of children with conducts disorder use punishment more often. Finally, the research demonstrates that the children of this group have a much higher probability of presenting an exteriorized disorder (66 %) than the children of the other group (8 %). All these distinctive characteristics allows to correctly classify 93,8 % of the children of this study in the 2 groups. The results indicate the need to improve the parents'educational practices, increase the child's social network as well as reduce the conducts of opposition and inattention of the child. Finally, the complexity of the problems raised with the child and families commands a concerted professional intervention.

Unmet needs in the community: can existing services meet them?

OBJECTIVE

This prospective study of community cases examined: (a) needs for care; (b) whether services meet the needs; and (c) personal factors associated with unmet needs.

METHOD

Two separate 'Needs for Care Assessment Schedule Community version' evaluations identified 38 subjects with No Need (NN), 19 with Met Needs (MN) and 25 with Unmet Needs (UNM). Other instruments included the Diagnostic Interview Schedule-Abridged Version (DISSA) and repeated measures of symptoms and social functioning.

RESULTS

(a) Cases did not equate needs. (b) Services utilization did not equate having met needs. (c) Respondents with UNM were more likely to present high rates of lifetime DSM-II-R disorders, no marital relationship ever, no employment, high rates of life events, and physical or sexual abuse in childhood. They have worse outcome in terms of distress and social functioning.

CONCLUSION

Personal factors may prevent respondents from seeking, engaging and benefiting from treatment.

Cognitive and familial contributions to conduct disorder in children

Although young children with conduct disorder (CD) are suspected of having verbal and executive function deficits, most studies that investigated this hypothesis did not control for attention deficit hyperactivity disorder (ADHD). Furthermore, relatively little is known about the interaction between cognitive deficits and familial factors in explaining the onset and persistence of CD in children. The participants in this study were 57 children with CD and 35 controls aged 7 to 12 years. At 1-year follow-up, 41 of the participants with CD were reassessed. Children with CD were found to be significantly impaired in four of five executive function measures after ADHD symptoms and socioeconomic status (SES) were controlled. Executive function test performance, number of ADHD symptoms, and familial characteristics (SES, parental punishment) together correctly classified 90% of the participants. Only the number of ADHD symptoms was found to significantly improve prediction of CD 1 year later beyond that afforded by number of CD symptoms a year earlier. Findings indicate that children with CD and ADHD symptoms are especially at risk for persistent antisocial behaviour. Results also highlight the importance of treatment programs that cover both cognitive and familial aspects associated with CD.

Criminal activities and substance use of patients with major affective disorders and schizophrenia: a 2-year follow-up

BACKGROUND

Compelling findings demonstrate that persons who develop major mental disorders, as compared to those who do not, are at increased risk to commit non-violent and violent crimes. This conclusion has recently been shown to apply to persons with major affective disorders.

METHODS

Thirty males with major affective disorders and 74 with schizophrenia were followed for 2 years. At discharge, patients were intensively assessed including diagnoses using SADs and RDC. During follow-up, alcohol and drug use were measured, subjectively and objectively. At discharge, the two groups were similar as to secondary diagnoses of antisocial personality disorder, drug abuse/dependence, socio-demographic characteristics, and criminal history, but more of the patients with major affective disorders than those with schizophrenia had a history of alcohol abuse/dependence. During the follow-up period, the two groups were similar as to rehospitalization, treatment intensity, and substance use.

RESULTS

By the end of the follow-up period, 33% of the patients with major affective disorders and only 15% of those with schizophrenia had committed crimes, most violent. Co-morbid antisocial personality disorder was associated with criminality among the patients with schizophrenia but not among those with major affective disorders. Among these latter patients, drug use and the intensity of out-patient care were associated with violent criminality.

LIMITATIONS

The small number of subjects limited the conclusions.

CONCLUSIONS

Violent behavior among patients with major affective disorders may not be uncommon and may be preventable by out-patient treatment which limits drug use.

Neuropsychological characteristics of adolescents with conduct disorder: association with attention-deficit-hyperactivity and aggression

The purpose of this study was to determine whether an association exists between neuropsychological deficits and conduct disorder (CD) with and without concurrent attention-deficit-hyperactivity disorder (ADHD). In addition, we explored the differential neuropsychological performance of aggressive and nonaggressive CD adolescents and the combined effect of this behavioral status and ADHD on performance. Fifty-nine adolescents (mean age of 15.4 years) who met the criteria for CD were compared with 29 controls comparable in age, gender, and socioeconomic status. A neuropsychological battery of current tests measuring executive functions and a battery of language tests were used in the study. Multivariate analyses showed that, compared with controls, CD adolescents had significantly lower verbal skills but did not differ on executive function measures. However, the lower verbal performance of CD adolescents is not explained by the existence of a CD subgroup with concomitant ADHD or aggressiveness. The study confirms with a sample of CD adolescents the association between verbal deficits and antisocial behavior when socioeconomic status is controlled. Our results also demonstrate that CD per se can be a sufficient condition for such deficits.

Factors related to utilization of services for mental health reasons in Montreal, Canada

This study examines factors related to the utilization of services for mental health reasons by Montreal residents. Data were drawn from telephone interviews. A random sample of 893 respondents completed a questionnaire on service utilization and the Diagnostic Interview Schedule Self Administered to assess DSM-III-R psychiatric disorders. Results indicate that 12.8% of the population had used such services in the past year. Medical doctors and psychiatrists, whose services are free of charge under universal health coverage, were consulted, respectively, by 4.1% and 2.0% of respondents. Psychologists, whose services are not free, were seen by 3.4% of respondents. In all, 42.0% of respondents who presented a current diagnosis used services in the past year. The highest proportion of users (48.0%) was found among respondents who presented both current and lifetime diagnoses and among respondents with comorbidity. The choice of caregiver was related also to pattern of disorders: respondents with current and comorbid disorders tended to consult general practitioners, while respondents with lifetime disorders or with lifetime and current disorders favoured specialized care. In line with other studies, self-perception of mental health, gender and marital status were related to utilization; unlike other studies, attitudes and age were not. It is argued that particularities found in this study stem not only from methodological considerations, but also from the configuration of the mental health system in Quebec, where the greater availability of psychologists may facilitate service utilization.

Telephone surveys as an alternative for estimating prevalence of mental disorders and service utilization: a Montreal catchment area study

BACKGROUND

Large-scale mental health surveys have provided invaluable information regarding the prevalence of specific mental disorders and service use for mental health reasons. Unfortunately, because vast surveys conducted face to face are very costly, many countries and provinces do not embark upon this path of research, thus depriving themselves of a rich source of data useful for service planning.

METHOD

As an alternative, the authors undertook a telephone survey with a sample of 893 residents from a Montreal catchment area. Mental disorders were assessed by the Composite International Diagnostic Interview Simplified (CIDIS), an instrument especially designed to be used in mail or telephone surveys. Service utilization was measured by an instrument similar to those used in recent large Canadian or American surveys.

RESULTS

The prevalence rate for any mental disorder was lower in this study than in some large-scale epidemiological surveys reviewed. This could be explained by methodological differences, such as number of disorders covered and period of reference. With regard to specific mental disorders, results appeared very similar to those of other studies. Concerning service utilization, rates tended to be higher than in other studies, and this finding could reflect real differences between Quebec and other Canadian provinces or the United States.

CONCLUSIONS

Aside from being lower in cost, telephone surveys can yield results comparable to those obtained in large-scale epidemiological surveys conducted by means of face-to-face interviews.

The reliability of the community version of the MRC Needs for Care Assessment

One hundred and nine adults were screened in the community using the abridged version of the CIDI (CIDIS). The subjects comprised DSM-III-R current cases (N = 48), lifetime cases (N = 31) and non-cases (N = 30). The interviews with the 109 subjects were conducted by one of two pairs of clinicians and videotaped. Each interviewer-pair included a psychiatrist and a clinical psychologist. They rated the community version of the Needs for Care (NFCAS-C) by consensus. The other pair of judges then viewed the video and rated the NFCAS-C independently. The agreement on overall needs was excellent (kappa = 0.75), and very good for four of the seven specific sections (from kappa = 0.61 to 0.81). One section could not be rated because of low prevalence, and agreement was less good for the remaining two sections. Agreement was good on specific interventions (medication, kappa = 0.60; specific psychotherapy, kappa = 0.55), but poor on non-specific interventions. The majority of disagreements were due to differences in clinical judgement rather than to technical errors. A new instruction manual has been produced and should help training as well as stabilizing reliability. In devising reliable and valid instruments based on clinical judgement, a balance must be achieved between enhancing reliability with more precise rules and constraining clinical judgement so tightly that validity is lost.

[Socioprofessional integration of users of a service teaching work habits]

Programs for the social and professional rehabilitation of people suffering from mental illness are more or less successful. A substantial proportion of people cannot with this help, find or maintain a job; moreover many prematurely leave their rehabilitation program. This retrospective study attempts to identify variables associated to 1) the fact of completing the program and related to 2) maintaining a working activity in a regular environment, once the program is completed. The research is conducted with 67 people registered in an apprenticeship of working habilities program. The study shows that the fact of being in a first stage of socioprofessional rehabilitation is associated with participants staying in the program. The time spent in the program and the participants' level of education are also related to the success of integration. Variables regarding diagnosis are not associated to the different trajectories of the people. Suggestions to adjust intervention are proposed in this paper.

Neurological soft signs in schizophrenia: are they related to negative or positive symptoms, neuropsychological performance, and violence?

This investigation was carried out on 31 unemployed schizophrenic outpatient men. The general purpose was to explore new aspects of neurological soft signs in schizophrenia. A 108-item version of the Nathan Kline Institute scale of soft signs, the Schedule for Affective Disorders and Schizophrenia psychiatric interview, the negative and positive symptom scale (PANSS), a comprehensive scale of life-time history of violence, and a large set of neuropsychological tests were administered. It was found that "motor" soft signs were significantly more prevalent than "sensory-perceptual" signs, but that each body side manifested equal numbers of neurological signs. Before and after statistical correction for age, education, alcoholism, drug abuse disorder, and daily and cumulative neuroleptic dosage, orbitofrontal-type neuropsychological tasks measuring "impulsivity" related very robustly to the soft signs. Furthermore, before and after the same statistical corrections, right body-side signs correlated significantly with the same neuropsychological tests, whereas left body-side signs did not. The PANSS scores and levels of lifetime violence generally did not correlate significantly with neurological soft signs. The latter negative findings, we think relate to the fact that these were relatively high-functioning (i.e., outpatient) schizophrenics. Overall, the results support notions of frontal lobe and left hemisphere involvement in schizophrenia, these two dysfunctional systems being apparently linked at the level of the orbitofrontal area of the brain.

[Correlation between symptoms and social adjustment in patients suffering from schizophrenia or major affective disorder]

With a view to examining the appropriateness of relying solely on pharmacotherapy rather than on a program of multimodal therapy, the goal of this study is to test the hypothesis that there is little relationship between psychotic and affective symptoms on the one hand, and life skills and social functioning on the other. Eighty-four male subjects presenting a diagnosis of schizophrenia, mania or severe depression were therefore recruited in hospitals in the Montreal region. The relationships previously identified were studied, while factors likely to affect them, such as the chronicity of the disorder, the level of intellectual functioning, and the presence of additional symptoms, were controlled as necessary. The results suggest poorer social functioning among the schizophrenics having a high level of negative symptoms. In addition, the relationship between negative symptoms and IQ suggests that the intellectual functioning of these individuals can potentially affect the acquisition of skills required for adequate social functioning. Among subjects with a major affective disorder, the results reveal poor social functioning even during quasi-asymptomatic periods. These results suggest that patients suffering from schizophrenia or a major affective disorder require interventions aimed at increasing their level of psychosocial functioning.

Neuropsychological correlates of violence in schizophrenia

Thirty-one outpatient men with schizophrenia were assessed with various measures of lifelong history of physical violence as well as psychopathology, neuropsychological performance, and neurological intactness. Most of the results consisted of nonsignificant positive relationships between physical aggression and neuropsychological performance in these schizophrenia subjects. Some neuropsychological test performances did show significant positive correlations with levels of aggressivity. In contrast with previous studies that have established a relation between neuropsychological impairment (as opposed to performance) and violence in schizophrenia, subjects of the present study were high-functioning outpatients who may not have attained a level of neurological impairment inducing constant uncontrollable outbursts of irritative aggression in their daily living. The importance of defining in detail the clinical characteristics of the subjects studied and the type of violence assessed is discussed, and an ecological interpretation of these counterintuitive results is provided.

Problems and needs for care of patients suffering from severe mental illness

Recently, evaluative research has yielded a procedure, the Needs for Care Assessment Schedule (NFCAS), which articulates the problems and the corresponding interventions required by psychiatric patients in a systematic and reproducible manner that is of interest to both administrators and clinicians. Although the NFCAS decisions are ultimately subjective and there is no absolute standard, the procedure limits variation and offers a framework for comparison and further elaboration. A group of 98 patients who were receiving treatment at the Louis-Hippolyte Lafontaine Psychiatric Hospital in Montréal, Québec and who were suffering from severe mental disorders were assessed with the NFCAS procedure. Subjects were selected from four treatment settings representing different levels of problems and needs: long-term in- and outpatients and short-term in- and outpatients. Results of the NFCAS were examined, along with those of standardized questionnaires. The NFCAS allowed a comprehensive understanding of the clinical realities for problem and need assessment. There was an average of 3.9 clinical problems and 4.5 social problems per patient. Long-term patients and patients residing in the hospital had more problems. A total of 76% of the problems assessed were rated as receiving appropriate interventions, whereas 17% of the problems assessed were considered in need of an assessment or in need of treatment. A greater need for intervention was found for social problems than for clinical problems.

Further reliability and validity studies of a procedure to assess the needs for care of the chronically mentally ill

The Needs for Care Assessment Schedule (NFCAS; Brewin et al. 1987) is an itemized and systematic procedure that aims to evaluate the needs for care of long-term mentally ill patients. The present study pursues reliability and validity related issues with the NFCAS in a different cultural context applying the procedure to 98 severely mentally ill patients belonging to different patient groups: short-term, long-term, in-patient and out-patient. Inter-rater reliability was found to be excellent. The results suggest that a clinician with little practical experience and adequate training may effectively use the procedure. The assessment of clinical relevance suggested that the procedure is both applicable and pertinent to all the patients in the study. Additional guidelines were developed for its use with long-term in-patients.

Assessment of independent living skills for psychotic patients. Further validity and reliability

It is well known that psychotic patients have severe social and life-skill deficits. Psychiatric rehabilitation programs are designed to teach these skills to patients. Before implementing such a program, patient deficits should be evaluated with reliable measures. The present study assessed the psychometric properties of the French version of the "Independent Living Skills Survey" (ILSS) developed by Wallace, Kochanowicz and Wallace (Wallace C J, Kochanowicz N, Wallace J [1985] Independent living skills survey. Unpublished manuscript, Mental Health Clinical Research Center for the Study of Schizophrenia, West Los Angeles Veterans Administration Medical Center, Rehabilitation Medicine Service [Brentwood Division], Los Angeles, CA). Although widely used, the patient version of this scale has unknown psychometric properties. The ILSS was composed of 75 items, rated as present or absent and distributed in 10 scales. The French version was administered to 145 patients with a psychotic diagnosis who were living in the community. All scales had very good psychometric qualities with the exception of the job-maintenance scale. The test-retest reliability varied from .48 to .85, and alpha coefficients were good for seven of the nine scales. Various aspects of construct validity were explored. The scales discriminated between patients as a function of their subgroups, sex, and diagnosis. Concurrent validity confirmed the specificity of the ILSS dimensions. Factor analysis revealed two factors, one for basic skills and one representing higher order skills. Recommendations for future development of the ILSS are proposed.

Validation D'un Questionnaire D'évaluation du Fonctionnement Social Des Personnes Ayant Des Troubles Mentaux Chroniques

Recognition of the crucial role of social adjustment in the assessment and understanding of major mental disorders is now well established. Deterioration of social relations is one of the criteria to diagnose schizophrenia according to the DSM-III-R. Recent findings (Bellack, Morrison, Wixted, & Mueser, 1990) suggest variable correlations between social adjustment and positive symptoms. This may indicate that the impairments in social functioning are not simply consequences of positive symptoms. Adequate assessment of social functioning is also needed to prescribe proper interventions and for planning purposes. This study was conducted in order to examine the psychometric properties of a modified version of the social adjustment scale (SAS-II). The French version of the SAS-II was modified to allow the assessment of social functioning in hospital settings and other supervised settings. Participants were 276 persons suffering from major mental disorders, mainly schizophrenia (57.4%). Respondents were selected in psychiatric hospitals, psychiatric units of general hospitals, and in the community. Five trained interviewers conducted interviews with the participants. Agreement between independent rates was strong, since 42 out of 45 items yielded intraclass correlations or kappa coefficients above .6. Testretest reliability was satisfactory. Alpha values ranged between ,47 and ,81, Validity was mainly assessed through discriminant analyses of the SAS-II scales with diagnostic groups and current program provision. Reliability and validity results confirmed the relevance of the modified version of the SAS-II for assessing individuals with severe psychiatric disorders in contact with psychiatric services. Recommendations for future development of the scale are proposed.

[Training of interviewers in the utilization of standardized questionnaires in psychiatry: studies realized with the Present State Examination (PSE)]

Interview questionnaires offer more validity than self-administered format in exploring psychopathological or psychosocial phenomena of interest in psychiatric research. If used, special care needs to be paid to interviewers' training and ensuring that they maintain their reliability. No widespread training standards exist and each schedule may carry its own procedure. Our aims are to indicate how we trained interviewers with the French version of the Present State Examination (Wing, Cooper and Sartorius, 1974) and how we checked and kept acceptable interraters reliability during one study. We will provide data on the interraters reliability during the training and the study, as well as the test-retest reliability. These results will be used to support some guidelines when using this sort of psychiatric research questionnaires in order to ensure comparability both within the study and between studies.

Reliable use of the Present State Examination by psychiatric nurses for clinical studies of psychotic and nonpsychotic patients

Four psychiatric nurses were trained with the French version of the Present State Examination, 9th edition (PSE-9). Reliability was tested on 18 cases of psychotic and nonpsychotic patients. The reliability indexes were comparable to those reported for the English version of PSE-9. These preliminary results indicate that further training may improve reliability for the nurses. It also warrants other trials in which psychiatric nurses will be used as interviewer with instruments that require clinical judgement.

Earthworm coelomocytes in vitro

Contamination and low viability of earthworm coelemocytes in tissue culture have delayed in vitro studies. Using penicillin, streptomycin, tetracycline and Amphotericin B, Lumbricus terrestis coelomocytes were maintained viable and uncontaminated for 10 days at 15degreesC in medium L-15 supplemented with 5 to 10% fetal bovine serum. The coelomocytes survived for at least 10 days with 85% viability as assessed by trypan blue exclusion assays and phagocytosis of heat-killed yeast. Studies on the thymidine uptake, however, were negative. With the involvement of coelomocytes in tissue graft rejection, in vitro techniques can now be applied to study their capacity in the immune response.

[Multiple sclerosis: a multi-specific immune deficiency disease]

New immunological data (Brit. med. J., 1976, 1, 183-186) lead us to a fundamental reconsideration of the immunopathological concept of multiple sclerosis (MS). The increased incidence of the infection rate during childhood, the low humoral and cell-mediated immune responses towards many bacterial and viral antigens and the presence of these specific immune deficiencies in a group of doubtful MS cases being at the first bout of the disease, led us to consider MS as a multi-specific immune deficiency disease, possibly having its origin in the genes controlling the immune response to these specific antigens. We now consider MS as being the end result of multi-specific immune deficiencies, which would explain the increased incidence of tonsillectomies, appendicectomies and repeated infections during childhood and the presence of numerous small inflammatory and pyrexic processes, often benign, but susceptible to cause in the target tissue--the central nervous tissue--the demyelinization process which could well be not specific at all. This new optic opens the way to the use of different immunotherapy regimens including transfer factor or whole lymphokines, and stimulation of the immune response with immunological adjuvants rather than immunosuppressive agents used during recent years (like steroids, ACTH) which have an antiinflammatory as well as an immunosuppressive function.