[Sexual and physical abuse during childhood; what is the impact on outcome in first episode psychosis patients?]

BACKGROUND

If exposure to childhood trauma increases the risk to later develop a psychotic disorder, the impact of such events on clinical presentation and outcome after a first psychotic episode deserves attention both in order to identify specific patients' needs and to develop adapted therapeutic interventions.

METHODS

Three hundred and sixty-two patients treated at TIPP-Lausanne, a specialized program for the treatment of the early phase of psychotic disorders, were assessed prospectively, from baseline and every six months until the end of the 36 months of treatment. We compared characteristics of patients exposed to childhood sexual and/or physical abuse to those of non-exposed patients.

RESULTS

One hundred and eight patients (29.8 %) were exposed to at least one episode of physical and/or sexual abuse during childhood. Exposed patients displayed higher levels of positive and depressive symptoms and had lower levels of functioning throughout the entire three year follow-up period.

CONCLUSIONS

The prevalence of exposure to major traumatic events during childhood in early psychosis patients is very high, and it has an important impact on symptomatic and functional outcome. However, when clinical care is adapted, such patients seem to have a great potential for recovery. This justifies the implementation of specialized early psychosis programs and additional research in order to develop specific and adapted therapeutic strategies for such patients.

Latent class analysis of the health of the nation outcome scales: A comparison of Swiss and English profiles and exploration of their predictive utility

The Health of the nation outcome scales (HoNOS) [1] were designed to measure the health and social functioning of adults with severe mental health problems. They form part of the English mental health minimum data set and are recommended by the department of health and are part of the attempt to develop “payment by results” (PbR) for mental health [2]. They are also widely used in Australia, New Zealand and Canada [3, 4], and have also been used in Europe [5]. Although they are widely used there are still questions about their psychometric validity and their ability to predict anything useful.

Insight as a social identity process in the evolution of psychosocial functioning in the early phase of psychosis

BACKGROUND

Awareness of illness (insight) has been found to have contradictory effects for different functional outcomes after the early course of psychosis. Whereas it is related to psychotic symptom reduction and medication adherence, it is also associated with increased depressive symptoms. In this line, the specific effects of insight on the evolution of functioning over time have not been identified, and social indicators, such as socio-occupational functioning have barely been considered. Drawing from social identity theory we investigated the impact of insight on the development of psychosocial outcomes and the interactions of these variables over time.

METHOD

The participants, 240 patients in early phase of psychosis from the Treatment and Early Intervention in Psychosis Program (TIPP) of the University Hospital of Lausanne, Switzerland, were assessed at eight time points over 3 years. Cross-lagged panel analyses and multilevel analyses were conducted on socio-occupational and general functioning [Social and Occupational Functioning Assessment Scale (SOFAS) and Global Assessment of Functioning (GAF)] with insight, time and depressive symptoms as independent variables.

RESULTS

Results from multilevel analyses point to an overall positive impact of insight on psychosocial functioning, which increases over time. Yet the cross-lagged panel analysis did not reveal a systematic positive and causal effect of insight on SOFAS and GAF scores. Depressive symptoms seem only to be relevant in the beginning of the treatment process.

CONCLUSIONS

Our results point to a complex process in which the positive impact of insight on psychosocial functioning increases over time, even when considering depressive symptoms. Future studies and treatment approaches should consider the procedural aspect of insight.

Perceptions of schizophrenia and coping styles in caregivers: comparison between India and Switzerland

WHAT IS KNOWN ON THE SUBJECT?: Negative perceptions of illnesses can increase caregivers' use of ineffective coping strategies, which may increase their burdens and distress. Scientific and theoretical framework showed that culture and health organization system influence perception of illnesses and thus also has an impact on the coping strategies used. There is a lack of data on comparative perceptions of illnesses and coping styles between India and Switzerland and that is why this hypothesis needs to be confirmed. The comparison between two countries with large cultural and socioeconomics differences will provide a more significant impact. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This cultural comparative study explores the associations between representations of illness and three forms of coping styles (i.e. problem-focused, emotion-focused and social support-focused coping) among caregivers of people diagnosed with schizophrenia spectrum disorders in Mangalore, India, and in French-speaking Switzerland. Results showed significant differences between Swiss and Indian caregivers practically in all illness' perceptions and coping styles, which is in accord with the theoretical framework. However, two results showed also similarities: the perception that schizophrenia can have cyclical episodes and that it can have negative consequences for caregivers. These differences and similarities allow to confirm the hypothesis that culture and health organization system influence illness' perception which impact the used coping styles. However, to develop specific nursing interventions for each culture, more research is needed to specify qualitatively the content of these differences and similarities. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Knowledge of how culture influences perceptions and coping styles is essential to develop quality interventions. Nurses should evaluate caregivers' perceptions and the causes they attribute to illnesses to help them maintain or develop efficient coping strategies. Knowledge of specific cultural differences and similarities can help nurses to provide individualized care that takes into account personal values to ensure recovery processes.

ABSTRACT

Introduction Scientific and theoretical framework showed that culture and health organization system influence perception of illnesses and thus also has an impact on the coping strategies used. Aim/question This cultural comparative study explores illness' perception and coping styles among the caregivers of people diagnosed with schizophrenia spectrum disorders in Mangalore, India, and Lausanne, Switzerland. Method The answers of 92 Swiss caregivers, using paper or electronic surveys depending on the participants' preference, and 100 Indian caregivers via an interview with a nurse were examined. Results The results confirm the hypothesis that culture and health organization system influence illness' perception which impact the used coping styles. Significant differences between Swiss and Indian caregivers practically in all illness' perceptions and coping styles were present, which is in accord with the theoretical framework. However, two results showed also similarities: the perception that schizophrenia can have cyclical episodes and that it can have negative consequences for caregivers. Discussion These differences will affect the development of interventions for caregivers in both countries. Implications for Practice The cultural differences observed in this study not only will allow interventions to be adapted to the specific needs of the two populations but also to identify their shared needs.

Impaired fornix-hippocampus integrity is linked to peripheral glutathione peroxidase in early psychosis

Several lines of evidence implicate the fornix-hippocampus circuit in schizophrenia. In early-phase psychosis, this circuit has not been extensively investigated and the underlying mechanisms affecting the circuit are unknown. The hippocampus and fornix are vulnerable to oxidative stress at peripuberty in a glutathione (GSH)-deficient animal model. The purposes of the current study were to assess the integrity of the fornix-hippocampus circuit in early-psychosis patients (EP), and to study its relationship with peripheral redox markers. Diffusion spectrum imaging and T1-weighted magnetic resonance imaging (MRI) were used to assess the fornix and hippocampus in 42 EP patients compared with 42 gender- and age-matched healthy controls. Generalized fractional anisotropy (gFA) and volumetric properties were used to measure fornix and hippocampal integrity, respectively. Correlation analysis was used to quantify the relationship of gFA in the fornix and hippocampal volume, with blood GSH levels and glutathione peroxidase (GPx) activity. Patients compared with controls exhibited lower gFA in the fornix as well as smaller volume in the hippocampus. In EP, but not in controls, smaller hippocampal volume was associated with high GPx activity. Disruption of the fornix-hippocampus circuit is already present in the early stages of psychosis. Higher blood GPx activity is associated with smaller hippocampal volume, which may support a role of oxidative stress in disease mechanisms.

Synopsis of recent developments in venomous snake systematics, No. 3

We present recent findings in the systematics of venomous snakes, with emphasis on those which affect the nomenclature and our understanding of species limits in these animals. Changes in systematics reviewed here include particularly the genera Acanthophis, Elapsoidea, Bitis, Lachesis, Porthidium, Trimeresurus/Tropidolaemus and Vipera. Other new publications of more general interest to toxinologists are also presented.

Synopsis of recent developments in venomous snake systematics, No. 2

Developments in our understanding of the systematics of venomous snakes since the beginning of 1996 are discussed and reviewed with special emphasis on their relevance and implications for toxinologists and clinicians. Groups of snakes affected by recent developments include the genera Elapomorphus, Rhabdophis, Vermicella, Atheris, Daboia, Agkistrodon/Gloydius, Bothrops/Bothriopsis and Trimeresurus. Other important publications on venomous snakes are noted.

Synopsis of recent developments in venomous snake systematics

Changes to our understanding of venomous snake systematics, and the consequent changes in the nomenclature of these animals, have traditionally been a great source of confusion among biomedical researchers. This paper aims to facilitate access to the taxonomic literature by presenting a synopsis of the changes in venomous snake systematics that have taken place recently (primarily since 1992), together with some comments on the implications of these changes for toxinologists and clinicians. Some long-standing problems in venomous snake taxonomy receive special attention. This includes Asiatic Naja, Asiatic Agkistrodon/Gloydius, Bothrops and related genera, Trimeresurus, Echis, Daboia (including Daboia russellii) and Vipera. It is hoped that this synopsis will result in the use of a more up-to-date and interpretable nomenclature for venomous snakes in the toxinological literature.