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Pappaianni E, Barona M, Doucet GE, Clark C, Frangou S, Micali N. Neurocognitive Endophenotypes for Eating Disorders: A Preliminary High-Risk Family Study. Brain Sci 2023; 13:brainsci13010099. [PMID: 36672080 PMCID: PMC9856317 DOI: 10.3390/brainsci13010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Eating disorders (EDs) are psychiatric disorders with a neurobiological basis. ED-specific neuropsychological and brain characteristics have been identified, but often in individuals in the acute phase or recovered from EDs, precluding an understanding of whether they are correlates and scars of EDs vs. predisposing factors. Although familial high-risk (FHR) studies are available across other disorders, this study design has not been used in EDs. We carried out the first FMH study in EDs, investigating healthy offspring of women with EDs and controls. We preliminarily aimed to investigate ED-related neurocognitive and brain markers that could point to predisposing factors for ED. Sixteen girls at FHR for EDs and twenty control girls (age range: 8−15), completed neuropsychological tests assessing executive functions. Girls also underwent a resting-state fMRI scan to quantify functional connectivity (FC) within resting-state networks. Girls at FHR for EDs performed worse on a cognitive flexibility task compared with controls (F = 5.53, p = 0.02). Moreover, they showed different FC compared with controls in several resting-state networks (p < 0.05 FDR-corrected). Differences identified in cognitive flexibility and in FC are in line with those identified in individuals with EDs, strongly pointing to a role as potential endophenotypes of EDs.
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Affiliation(s)
- Edoardo Pappaianni
- Mental Health Services in the Capital Region of Denmark, Eating Disorders Research Unit, Psychiatric Center Ballerup, 2750 Ballerup, Denmark
| | - Manuela Barona
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Gaelle E. Doucet
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Christopher Clark
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Nadia Micali
- Mental Health Services in the Capital Region of Denmark, Eating Disorders Research Unit, Psychiatric Center Ballerup, 2750 Ballerup, Denmark
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- Correspondence:
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Zwaigenbaum L, Brian J, Smith IM, Sacrey LAR, Franchini M, Bryson SE, Vaillancourt T, Armstrong V, Duku E, Szatmari P, Roberts W, Roncadin C. Symptom trajectories in the first 18 months and autism risk in a prospective high-risk cohort. J Child Psychol Psychiatry 2021; 62:1435-1443. [PMID: 33782970 DOI: 10.1111/jcpp.13417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although early autism spectrum disorder (ASD) detection strategies tend to focus on differences at a point in time, behavioral symptom trajectories may also be informative. METHODS Developmental trajectories of early signs of ASD were examined in younger siblings of children diagnosed with ASD (n = 499) and infants with no family history of ASD (n = 177). Participants were assessed using the Autism Observation Scale for Infants (AOSI) from 6 to 18 months. Diagnostic outcomes were determined at age 3 years blind to previous assessments. RESULTS Semiparametric group-based modeling using AOSI scores identified three distinct trajectories: Group 1 ('Low', n = 435, 64.3%) was characterized by a low level and stable evolution of ASD signs, group 2 ('Intermediate', n = 180, 26.6%) had intermediate and stable levels, and group 3 ('Inclining', n = 61, 9.3%) had higher and progressively elevated levels of ASD signs. Among younger siblings, ASD rates at age 3 varied by trajectory of early signs and were highest in the Inclining group, membership in which was highly specific (94.5%) but poorly sensitive (28.5%) to ASD. Children with ASD assigned to the inclining trajectory had more severe symptoms at age 3, but developmental and adaptive functioning did not differ by trajectory membership. CONCLUSIONS These prospective data emphasize variable early-onset patterns and the importance of a multipronged approach to early surveillance and screening for ASD.
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Affiliation(s)
| | - Jessica Brian
- Department of Paediatrics, Bloorview Research Institute, University of Toronto, Toronto, ON, Canada
| | - Isabel M Smith
- Departments of Pediatrics and Psychology and Neuroscience, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Lori-Ann R Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Susan E Bryson
- Departments of Pediatrics and Psychology and Neuroscience, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | | | - Eric Duku
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Peter Szatmari
- Department of Psychiatry, Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Wendy Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, ON, Canada
| | - Caroline Roncadin
- McMaster Children's Hospital Autism Program, Hamilton Health Sciences, Hamilton, ON, Canada
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Bose D, Saha S, Saxena U, Kesari H, Thatte UM, Gogtay NJ. Factors influencing recruitment and retention of participants in clinical studies conducted at a tertiary referral center: A five-year audit. Perspect Clin Res 2020; 11:81-85. [PMID: 32670833 PMCID: PMC7342334 DOI: 10.4103/picr.picr_198_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/09/2019] [Accepted: 02/25/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction: A key determinant of the success of any study is the recruitment and subsequent retention of participants. Screen failure and dropouts impact both the scientific validity and financial viability of any study. We carried out this audit with the objective of evaluating the recruitment and retention of participants in clinical studies conducted over the last five years at our center. Methods: Studies completed between 2014 and 2018 at our center were included. Screening ledgers and study trackers were hand searched for screen failures and dropouts. Four pre-identified predictors were evaluated – risk as per the classification of Indian Council of Medical Research 2017 Ethical Guideline, nature of funding, study design, and nature of participants. Association of the predictors with screen failures and dropouts was determined using crude odds ratios along with 95% confidence intervals. All analyses were done at 5% significance using Microsoft Excel 2016. Results: A total of n = 19 completed studies had n = 2567 screened and n = 2442 enrolled participants with a screen failure and dropout rate of 5% and 4%, respectively. We found 59% screen failures due to abnormal laboratory values. The main reasons for dropouts were lost to follow-up 86 (88%). High-risk and interventional studies were the predictors for both screen failures and dropouts, but pharmaceutical industry-funded studies and healthy participants were predictors for only screen failures. Conclusion: Risk, funding, study design, and nature of participants are important to be considered while planning studies to minimize screen failures and dropouts.
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Affiliation(s)
- Debdipta Bose
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Shruti Saha
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Unnati Saxena
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Harshad Kesari
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Urmila M Thatte
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nithya J Gogtay
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Lawrence PJ, Creswell C, Cooper PJ, Murray L. The role of maternal anxiety disorder subtype, parenting and infant stable temperamental inhibition in child anxiety: a prospective longitudinal study. J Child Psychol Psychiatry 2020; 61:779-788. [PMID: 31916250 DOI: 10.1111/jcpp.13187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) aggregates in families. To elucidate intergenerational transmission of risk, we examined whether childhood SAD and symptoms of anxiety were prospectively predicted by stable infant temperamental inhibition, maternal SAD, maternal generalized anxiety disorder (GAD) and maternal parenting behaviours. METHODS We conducted a longitudinal study beginning prenatally with follow-up at 4, 10, 14 and 58 months postnatally. Mothers were assessed for anxiety disorders prenatally and assigned to one of three groups: SAD (n = 67), GAD (n = 56) and nonanxious controls (n = 94). We assessed infant temperamental inhibition at 4 and 14 months, maternal parenting behaviours at 10 and 58 months, and child anxiety disorders and symptoms at 58 months. RESULTS Child SAD at 58 months was predicted by prenatal maternal SAD (OR = 23.76, 95% CI = 1.15-60.37), but not by prenatal maternal GAD (OR = 7.44, 95% CI = 0.32-124.49), stable temperamental inhibition or maternal behaviours. Child anxiety symptoms at 58 months were predicted specifically by maternal SAD (but not GAD), and also by concurrent maternal intrusiveness. Stable temperamental inhibition moderated the association between 10-month maternal encouragement and 58-month child anxiety symptoms. CONCLUSIONS We found evidence for specificity of risk for child SAD and anxiety symptoms from maternal SAD compared to maternal GAD. Childhood anxiety symptoms were also predicted by an interaction between a lack of maternal encouragement in infancy and stable temperamental inhibition, as well as concurrent maternal intrusiveness. The findings have clinical implications for targeted prevention of child anxiety.
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Affiliation(s)
- Peter J Lawrence
- School of Psychology, University of Southampton, Southampton, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Peter J Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Lynne Murray
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Parry P, Allison S, Bastiampillai T. Debate: Bipolar disorder: extremely rare before puberty and antipsychotics cause serious harms - a commentary on Van Meter et al. (2019). Child Adolesc Ment Health 2019; 24:92-94. [PMID: 32677224 DOI: 10.1111/camh.12306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/28/2022]
Abstract
'Paediatric bipolar disorder' (PBD) remains controversial; because it is based on the hypothesis that bipolar disorder (BD) often begins in childhood with atypical forms of mania. A meta-analysis of 12 epidemiological surveys found a high prevalence of PBD among children and adolescents worldwide (1.8%), however, our study of the measurement issues (Child and Adolescent Mental Health, 23, 2018, 14) found that PBD rates were lower than claimed. Our findings are consistent with the developmental trajectory of BD, as described by most longitudinal studies of high-risk offspring. BD is extremely rare in childhood with nearly all index manic/hypomanic episodes being in midadolescence or later. Treatment for BD should not commence until the first well-defined manic/hypomanic episode, because children and younger adolescents are extremely sensitive to the side effects of second-generation antipsychotics including weight gain, metabolic syndrome, extrapyramidal side effects and the risk of cerebral atrophy, as observed in studies of juvenile animals.
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Affiliation(s)
- Peter Parry
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Children's Health Queensland Clinical Unit, School of Clinical Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Abstract
The rise in pediatric bipolar disorder (PBD) prevalence rates and the related treatment regimen has an impact on a whole generation of severely affected young children. In Europe, we also see these emotional dysregulated children with a broad range of explosive disruptive behavior. However, classification within the bipolar disorder spectrum is rare. Why are these prepubertal children diagnosed with mania and how does this fit with the findings from bipolar offspring studies? Impact of methods of assessment, recruitment, and parental diagnoses are discussed.
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Affiliation(s)
- Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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