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Rasmussen AR, Handest P, Vollmer-Larsen A, Parnas J. Pseudoneurotic Symptoms in the Schizophrenia Spectrum: A Longitudinal Study of Their Relation to Psychopathology and Clinical Outcomes. Schizophr Bull 2024:sbad185. [PMID: 38227579 DOI: 10.1093/schbul/sbad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND AND HYPOTHESIS Nonpsychotic symptoms (depression, anxiety, obsessions, etc.) are frequent in schizophrenia-spectrum disorders and are usually conceptualized as comorbidity or transdiagnostic symptoms. However, in twentieth century foundational psychopathological literature, many nonpsychotic symptoms with specific phenomenology (here termed pseudoneurotic symptoms) were considered relatively typical of schizophrenia. In this prospective study, we investigated potential associations of pseudoneurotic symptoms with diagnostic status, functional outcome as well as psychopathological dimensions of schizophrenia. STUDY DESIGN First-admitted patients (N = 121) diagnosed with non-affective psychosis, schizotypal disorder, or other mental illness were examined at initial hospitalization and 5 years later with a comprehensive assessment of psychopathology. Informed by the literature, we constructed scales targeting pseudoneurotic symptoms and other, more general, nonpsychotic symptoms. STUDY RESULTS Pseudoneurotic symptoms aggregated in schizophrenia-spectrum groups compared to other mental illnesses and occurred at similar levels at baseline and follow-up. They longitudinally predicted poorer social and occupational functioning in schizophrenia-spectrum patients over a 5-year-period but not transition to schizophrenia-spectrum disorders from other mental illnesses. Finally, the level of pseudoneurotic symptoms correlated with disorder of basic self at both assessments and with positive and negative symptoms at follow-up. The scale targeting general nonpsychotic symptoms did not show this pattern of associations. CONCLUSIONS The study supports that a group of nonpsychotic symptoms, ie, pseudoneurotic symptoms, are associated with schizophrenia-spectrum disorders and linked with temporally stable psychopathology, particularly disorder of the basic self. Their prospective association with social and occupational functioning needs replication.
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Affiliation(s)
- Andreas Rosén Rasmussen
- Mental Health Center Amager, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Josef Parnas
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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Uher R, Pavlova B, Radua J, Provenzani U, Najafi S, Fortea L, Ortuño M, Nazarova A, Perroud N, Palaniyappan L, Domschke K, Cortese S, Arnold PD, Austin JC, Vanyukov MM, Weissman MM, Young AH, Hillegers MH, Danese A, Nordentoft M, Murray RM, Fusar‐Poli P. Transdiagnostic risk of mental disorders in offspring of affected parents: a meta-analysis of family high-risk and registry studies. World Psychiatry 2023; 22:433-448. [PMID: 37713573 PMCID: PMC10503921 DOI: 10.1002/wps.21147] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
The offspring of parents with mental disorders are at increased risk for developing mental disorders themselves. The risk to offspring may extend transdiagnostically to disorders other than those present in the parents. The literature on this topic is vast but mixed. To inform targeted prevention and genetic counseling, we performed a comprehensive, PRISMA 2020-compliant meta-analysis. We systematically searched the literature published up to September 2022 to retrieve original family high-risk and registry studies reporting on the risk of mental disorders in offspring of parents with any type of mental disorder. We performed random-effects meta-analyses of the relative risk (risk ratio, RR) and absolute risk (lifetime, up to the age at assessment) of mental disorders, defined according to the ICD or DSM. Cumulative incidence by offspring age was determined using meta-analytic Kaplan-Meier curves. We measured heterogeneity with the I2 statistic, and risk of bias with the Quality In Prognosis Studies (QUIPS) tool. Sensitivity analyses addressed the impact of study design (family high-risk vs. registry) and specific vs. transdiagnostic risks. Transdiagnosticity was appraised with the TRANSD criteria. We identified 211 independent studies that reported data on 3,172,115 offspring of parents with psychotic, bipolar, depressive, disruptive, attention-deficit/hyperactivity, anxiety, substance use, eating, obsessive-compulsive, and borderline personality disorders, and 20,428,575 control offspring. The RR and lifetime risk of developing any mental disorder were 3.0 and 55% in offspring of parents with anxiety disorders; 2.6 and 17% in offspring of those with psychosis; 2.1 and 55% in offspring of those with bipolar disorder; 1.9 and 51% in offspring of those with depressive disorders; and 1.5 and 38% in offspring of those with substance use disorders. The offspring's RR and lifetime risk of developing the same mental disorder diagnosed in their parent were 8.4 and 32% for attention-deficit/hyperactivity disorder; 5.8 and 8% for psychosis; 5.1 and 5% for bipolar disorder; 2.8 and 9% for substance use disorders; 2.3 and 14% for depressive disorders; 2.3 and 1% for eating disorders; and 2.2 and 31% for anxiety disorders. There were 37 significant transdiagnostic associations between parental mental disorders and the RR of developing a different mental disorder in the offspring. In offspring of parents with psychosis, bipolar and depressive disorder, the risk of the same disorder onset emerged at 16, 5 and 6 years, and cumulated to 3%, 19% and 24% by age 18; and to 8%, 36% and 46% by age 28. Heterogeneity ranged from 0 to 0.98, and 96% of studies were at high risk of bias. Sensitivity analyses restricted to prospective family high-risk studies confirmed the pattern of findings with similar RR, but with greater absolute risks compared to analyses of all study types. This study demonstrates at a global, meta-analytic level that offspring of affected parents have strongly elevated RR and lifetime risk of developing any mental disorder as well as the same mental disorder diagnosed in the parent. The transdiagnostic risks suggest that offspring of parents with a range of mental disorders should be considered as candidates for targeted primary prevention.
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Affiliation(s)
- Rudolf Uher
- Dalhousie UniversityDepartment of PsychiatryHalifaxNSCanada
- Nova Scotia Health AuthorityHalifaxNSCanada
| | - Barbara Pavlova
- Dalhousie UniversityDepartment of PsychiatryHalifaxNSCanada
- Nova Scotia Health AuthorityHalifaxNSCanada
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Instituto de Salud Carlos IIIUniversity of BarcelonaBarcelonaSpain
| | - Umberto Provenzani
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Sara Najafi
- Dalhousie UniversityDepartment of PsychiatryHalifaxNSCanada
- Nova Scotia Health AuthorityHalifaxNSCanada
| | - Lydia Fortea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Instituto de Salud Carlos IIIUniversity of BarcelonaBarcelonaSpain
| | - Maria Ortuño
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Instituto de Salud Carlos IIIUniversity of BarcelonaBarcelonaSpain
| | - Anna Nazarova
- Dalhousie UniversityDepartment of PsychiatryHalifaxNSCanada
- Nova Scotia Health AuthorityHalifaxNSCanada
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of PsychiatryUniversity Hospitals of GenevaGenevaSwitzerland
- Department of PsychiatryUniversity of GenevaGenevaSwitzerland
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of PsychiatryMcGill UniversityMontrealQBCanada
- Robarts Research InstituteWestern UniversityLondonONCanada
- Department of Medical BiophysicsWestern UniversityLondonONCanada
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Samuele Cortese
- School of Psychology, and Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- Solent NHS TrustSouthamptonUK
- Division of Psychiatry and Applied PsychologyUniversity of NottinghamNottinghamUK
- Hassenfeld Children's Hospital at NYU LangoneNew YorkNYUSA
| | - Paul D. Arnold
- Mathison Centre for Mental Health Research & EducationUniversity of CalgaryCalgaryALCanada
| | - Jehannine C. Austin
- Departments of Psychiatry and Medical GeneticsUniversity of British ColumbiaVancouverBCCanada
| | - Michael M. Vanyukov
- Departments of Pharmaceutical Sciences, Psychiatry, and Human GeneticsUniversity of PittsburghPittsburghPAUSA
| | - Myrna M. Weissman
- Department of Psychiatry, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA
- Division of Translational EpidemiologyNew York State Psychiatric InstituteNew YorkNYUSA
- Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Allan H. Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | - Manon H.J. Hillegers
- Department of Child and Adolescent Psychiatry/PsychologyErasmus University Medical Center, Sophia Children's HospitalRotterdamThe Netherlands
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre and Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- National and Specialist CAMHS Clinic for Trauma, Anxiety, and DepressionSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health, Mental Health ServicesCapital Region of DenmarkCopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Paolo Fusar‐Poli
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Early Psychosis: Intervention and Clinical‐detection (EPIC) lab, Department of Psychosis StudiesKing's College LondonLondonUK
- Outreach and Support in South‐London (OASIS) NHS Foundation Trust, South London and Maudsley NHS Foundation TrustLondonUK
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3
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Rasmussen AR, Zandersen M, Nordgaard J, Sandsten KE, Parnas J. Pseudoneurotic symptoms in the schizophrenia spectrum: An empirical study. Schizophr Res 2022; 250:164-171. [PMID: 36423441 DOI: 10.1016/j.schres.2022.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Nonpsychotic symptoms (depression, anxiety, obsessions etc.) are frequent in schizophrenia-spectrum disorders. Twentieth century foundational psychopathological literature claimed that certain nonpsychotic symptoms (here termed pseudoneurotic symptoms) are relatively closely linked with the schizophrenia-spectrum, despite descriptive overlap with symptoms of other diagnoses. In this study, we investigated the association of pseudoneurotic and other nonpsychotic symptoms with the schizophrenia-spectrum as well as a hypothesis about an association of pseudoneurotic symptoms with disorder of basic self. METHODS The sample (N = 226) comprised patients with non-affective psychosis (N = 119), schizotypal personality disorder (N = 51) and other mental illness (N = 56), who were examined with a comprehensive assessment of lifetime psychopathology. Informed by the literature, we constructed scales targeting pseudoneurotic symptoms and other, more general, nonpsychotic symptoms. RESULTS Pseudoneurotic symptoms aggregated significantly in schizophrenia-spectrum disorders with an Area under the receiver operating characteristic curve of 0.84 (SE 0.03) for classifying patients with schizophrenia-spectrum disorders versus other mental illness. Patients with non-affective psychosis scored slightly, but significantly, higher on the scale targeting general nonpsychotic symptomatology than the other groups. In multiple regression analysis, pseudoneurotic symptoms were predicted by general nonpsychotic symptoms, disorders of basic self, and negative symptoms but not positive symptoms. CONCLUSION The study supports that certain neurotic-like symptoms with specific descriptive features (pseudoneurotic symptoms) are associated with schizophrenia-spectrum disorders. It suggests that pseudoneurotic symptoms are linked with temporally stable schizophrenia psychopathology (disorder of basic self and negative symptoms).
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Affiliation(s)
- Andreas Rosén Rasmussen
- Mental Health Center Amager, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Maja Zandersen
- Mental Health Center Glostrup, Broendbyoestervej, University of Copenhagen, Broendby, Denmark; Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Julie Nordgaard
- Mental Health Center Amager, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karl Erik Sandsten
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Josef Parnas
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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4
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Sandsten KE, Zahavi D, Parnas J. Disorder of Selfhood in Schizophrenia: A Symptom or a Gestalt? Psychopathology 2022; 55:273-281. [PMID: 35350027 PMCID: PMC9533449 DOI: 10.1159/000524100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/12/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The concept of schizophrenia (SCZ) was originally associated with a disorder of formal strata of the self. During the last two decades, empirical studies have demonstrated a selective hyper-aggregation of self-disorders in the SCZ spectrum. As with other scientific research areas, the role of self-disturbances in SCZ has been up for debate in various disciplines including cognitive sciences, philosophy of mind, and psychopathology. Several philosophical papers have used the psychopathological phenomena of "thought insertion" as an alleged example of a complete loss of minimal selfhood. In the field of psychopathology, it has been claimed that self-disorders may comprise a transdiagnostic phenotype. Common to these approaches is the underlying assumption that self-disorders reflect well-delineated and isolated symptoms akin to the notion of symptom in the medical model. The aim of this paper was to argue that the clinical manifestation of self-disturbances is to be seen as aspects of a Gestalt of disturbed experiential selfhood. METHODS Seven videotaped interviews of patients with SCZ who were emblematic of very diverse symptomatological constellations were selected and jointly watched and discussed by the authors, who reached a consensus assessment. The interviews were semi-structured and narrative in nature in order to obtain faithful self-descriptions according to the standards of phenomenologically oriented interviews. For the purpose of this article, we chose 4 videos from which excerpts were verbatim transcribed and translated from Danish into English. RESULTS The patients describe unique combinations of various psychopathological phenomena such as diminished sense of embodied self-presence, loss of ego boundaries, diminished sense of self, alienation and objectification of the experiential processes, mirror-phenomena, and Schneiderian passivity phenomena. DISCUSSION Through an interweaving of the four vignettes and their subsequent psychopathological discussions, we argue that the invariant commonality across the different symptomatic expressions in these patients resides in a Gestalt of pervasive disturbance of self-experience. From a phenomenological perspective, these self-disturbances target a basic structure of phenomenal consciousness, namely, the first-person givenness of experience. We conclude that self-disorders reflect a trait-instability in the most basic structures of consciousness in SCZ and that its clinical manifestations are to be seen as aspects of a particular Gestalt rather than appearing as separate and well-delineated symptoms.
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Affiliation(s)
- Karl Erik Sandsten
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Dan Zahavi
- Department of Communication, Center of Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Josef Parnas
- Department of Communication, Center of Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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5
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De la Serna E, Ilzarbe D, Sugranyes G, Baeza I, Moreno D, Rodríguez-Toscano E, Espliego A, Ayora M, Romero S, Sánchez-Gistau V, Castro-Fornieles J. Lifetime psychopathology in child and adolescent offspring of parents diagnosed with schizophrenia or bipolar disorder: a 2-year follow-up study. Eur Child Adolesc Psychiatry 2021; 30:117-129. [PMID: 32146538 DOI: 10.1007/s00787-020-01500-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
Having one parent diagnosed with a severe mental disorder is considered one of the main risk factors for developing that disorder in adulthood, and it also increases the risk of a wide range of mental disorders in the offspring. The aim of this study is to compare the prevalence of several psychopathological diagnoses, the presence of prodromal symptoms, and global functioning in offspring of parents with schizophrenia or bipolar disorder and in offspring of controls at baseline and 2-year follow-up. This study included 41 offspring of parents with schizophrenia, 90 offspring of parents with bipolar disorder, and 107 offspring of controls (mean age 11.7 ± 3.2 at baseline and 13.9 ± 3.2 at follow-up). The prevalence of psychopathology and comorbidity was higher in offspring of parents with schizophrenia and offspring of parents with bipolar disorder than in offspring of controls at baseline and at 2-year follow-up. Interestingly, mood disorders were more prevalent in offspring of parents with bipolar disorder and disruptive disorders were more prevalent in offspring of parents with schizophrenia. Prodromal symptoms were more frequent in offspring of parents with schizophrenia than in offspring of controls, while the offspring of parents with bipolar disorder showed an intermediate pattern. Finally, global functioning was lower in the offspring of parents with schizophrenia than the offspring of parents with bipolar disorder and the offspring of controls. Screening patients' children is clinically relevant, since, as a group, they have an elevated risk of developing a psychiatric disorder and of experiencing their first symptoms during childhood and adolescence.
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Affiliation(s)
- E De la Serna
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| | - D Ilzarbe
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, C/ Villarroel, 170, 08036, Barcelona, Spain
| | - G Sugranyes
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, C/ Villarroel, 170, 08036, Barcelona, Spain.,Institut D´Investigació Biomèdica August Pi I Sunyer, IDIBAPS, Barcelona, Spain
| | - I Baeza
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, C/ Villarroel, 170, 08036, Barcelona, Spain.,Institut D´Investigació Biomèdica August Pi I Sunyer, IDIBAPS, Barcelona, Spain.,Department of Psychiatry and Clinical Psychology, University of Barcelona, Barcelona, Spain
| | - D Moreno
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - E Rodríguez-Toscano
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - A Espliego
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - M Ayora
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - S Romero
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, C/ Villarroel, 170, 08036, Barcelona, Spain.,Institut D´Investigació Biomèdica August Pi I Sunyer, IDIBAPS, Barcelona, Spain
| | - V Sánchez-Gistau
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Early Intervention Psychosis Service, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira I Virgili, Reus, Spain
| | - J Castro-Fornieles
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, C/ Villarroel, 170, 08036, Barcelona, Spain.,Institut D´Investigació Biomèdica August Pi I Sunyer, IDIBAPS, Barcelona, Spain.,Department of Psychiatry and Clinical Psychology, University of Barcelona, Barcelona, Spain
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6
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Rasmussen AR, Raballo A, Preti A, Sæbye D, Parnas J. Anomalies of Imagination, Self-Disorders, and Schizophrenia Spectrum Psychopathology: A Network Analysis. Front Psychiatry 2021; 12:808009. [PMID: 35111092 PMCID: PMC8801416 DOI: 10.3389/fpsyt.2021.808009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anomalies of imagination encompass disturbances of the basic experiential structure of fantasies and imagery that can be explored in a semi-structured way with the Examination of Anomalous Fantasy and Imagination (EAFI). We aimed (1) to examine the distribution of anomalies of imagination among different diagnostic groups and a group of healthy controls, and (2) to examine their relation with disorders of basic self, perceptual disturbances and canonical state psychopathology of the schizophrenia-spectrum (positive, negative and general symptoms). METHODS The 81 participants included patients with schizophrenia or other non-affective psychosis (N = 32), schizotypal personality disorder (N = 15) or other mental illness (N = 16) and healthy controls (N = 18). The assessment encompassed EAFI, Examination of Anomalous Self-Experience (EASE), parts of Bonn Scale for the Assessment of Basic Symptoms (BSABS) and Positive and Negative Syndrome Scale (PANSS). For network analysis, the associations of EAFI with the other psychopathological variables were tested by Pearson's correlation coefficient and graphically represented using multidimensional clustering. Comparisons between correlations in the network were tested with Steiger's test. RESULTS Anomalies of imagination aggregated significantly in schizophrenia-spectrum disorders compared to other mental illness and healthy controls with no difference between schizophrenia and schizotypal disorder. In the network analysis, anomalies of imagination were closely inter-connected with self-disorders. Although, the anomalies of imagination correlated moderately with perceptual disturbance and positive, negative and general state symptomatology, these dimensions aggregated separately and relatively distant in the network. CONCLUSIONS The results support that anomalies of imagination are highly characteristic of schizophrenia-spectrum disorders and closely related to self-disorders.
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Affiliation(s)
- Andreas Rosén Rasmussen
- Mental Health Center Amager, University of Copenhagen, Copenhagen, Denmark.,Mental Health Center Glostrup, University of Copenhagen, Broendby, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Raballo
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Ditte Sæbye
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Josef Parnas
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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7
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Zandersen M, Parnas J. Exploring schizophrenia spectrum psychopathology in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:969-978. [PMID: 31289925 PMCID: PMC7599140 DOI: 10.1007/s00406-019-01039-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022]
Abstract
We have previously argued that the current borderline personality disorder (BPD) diagnosis is over-inclusive and clinically and conceptually impossible to distinguish from the schizophrenia spectrum disorders. This study involves 30 patients clinically diagnosed with BPD as their main diagnosis by three BPD dedicated outpatient treatment facilities in Denmark. The patients underwent a careful and time-consuming psychiatric evaluation involving several senior level clinical psychiatrists and researchers and a comprehensive battery of psychopathological scales. The study found that the vast majority of patients (67% in DSM-5 and 77% in ICD-10) in fact met the criteria for a schizophrenia spectrum disorder, i.e., schizophrenia (20%) or schizotypal (personality) disorder (SPD). The schizophrenia spectrum group scored significantly higher on the level of disorders of core self as measured by the Examination of Anomalous Self-Experiences Scale (EASE). The BPD criterion of "identity disturbance" was significantly correlated with the mean total score of EASE. These findings are discussed in the light of changes from prototypical to polythetic diagnostic systems. We argue that the original prototypes/gestalts informing the creation of BPD and SPD have gone into oblivion during the evolution of polythetic criteria.
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Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendbyoestervej 160, 2605, Broendby, Denmark.
| | - Josef Parnas
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendbyoestervej 160, 2605, Broendby, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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8
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Kendler KS, Ohlsson H, Bacanu S, Sundquist J, Sundquist K. The risk for drug abuse, alcohol use disorder, and psychosocial dysfunction in offspring from high-density pedigrees: its moderation by personal, family, and community factors. Mol Psychiatry 2020; 25:1777-1786. [PMID: 29930388 PMCID: PMC6309530 DOI: 10.1038/s41380-018-0111-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/15/2018] [Accepted: 05/14/2018] [Indexed: 11/09/2022]
Abstract
Previous high-risk family designs in psychiatry have focused largely on offspring of affected parents. We take a pedigree-based approach and examine the social, psychological, and psychiatric features of offspring from extended pedigrees selected for high-densities of alcohol use disorder (AUD) or drug abuse (DA). We identified, from the Swedish population, 665,715 pedigrees containing a mean of 17.9 parents, aunts/uncles, grandparents, and cousins of a core full-sibship we term the pedigree offspring. We then derived 13 empirical classes of these pedigrees based on the density of cases of AUD and DA. High rates of AUD or DA in the pedigrees were associated in the offspring with lower levels of school achievement, educational attainment, and resilience, and higher rates of psychiatric illness, neighborhood deprivation, unemployment, social welfare, early retirement, and criminal convictions. Effect sizes were large in the offspring of the highest density pedigrees and were stronger in high-density DA than in high-density AUD pedigrees. Sensitivity to the pathogenic effects of membership in these high-risk sibships was substantially attenuated by high levels of school attainment and resilience, female sex, and absence of parental divorce. Offspring of pedigrees with a high density of AUD or DA are multiply disadvantaged and typically suffer from educational difficulties, social deprivation, socio-economic dysfunction, personality problems, and elevated rates of both psychiatric disorders and externalizing syndromes. Despite these difficulties, personal strengths, including improved school achievement and resilience, and an intact parental marriage can substantially buffer these adverse effects and might form a basis for prevention efforts.
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Affiliation(s)
- Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Silviu Bacanu
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
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9
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Metsänen M, Wahlberg KE, Saarento O, Hakko H, Tarvainen T, Koistinen P, Tienari P. Stability of Thought Disorder Index among high-risk and low-risk adoptees in the Finnish adoptive family study of schizophrenia. Eur Psychiatry 2020; 20:35-40. [PMID: 15642441 DOI: 10.1016/j.eurpsy.2004.09.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Accepted: 09/14/2004] [Indexed: 11/28/2022] Open
Abstract
AbstractThe aim of the study was to evaluate whether thought disorders are stable, trait-like features specific to subjects who have a genetic liability to schizophrenia or a psychiatric disorder. The thought disorders of adoptees genetically at high risk (HR) or low risk (LR) for schizophrenia from the Finnish adoptive family study of schizophrenia were evaluated twice at a mean interval of 11 years, using the sum of the Thought Disorder Index (TDI) scores on the Rorschach (TDR). At the initial assessment, the mean TDR scores of women were significantly higher than those of men, while no association between genetic risk and psychiatric status or their interactions with the TDR scores at baseline were found. The main finding was that the initial TDR scores statistically significantly predicted the TDR scores at follow-up, thus indicating the stability of thought disorder over time. However, neither genetic or psychiatric status nor gender or any interaction between these variables associated with TDR at follow-up.
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Affiliation(s)
- M Metsänen
- Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland.
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10
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LE L, R K, B M, Mj G. Risk of schizophrenia in relatives of individuals affected by schizophrenia: A meta-analysis. Psychiatry Res 2020; 286:112852. [PMID: 32065982 DOI: 10.1016/j.psychres.2020.112852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 12/31/2022]
Abstract
A meta-analysis was conducted to estimate schizophrenia incidence in first-degree relatives (FDRs) of probands diagnosed with schizophrenia. The aim was to inform future schizophrenia research and improve accuracy of risk communication to patients. Schizophrenia risk in FDRs with 1 or 2 probands with schizophrenia was investigated by conducting a systematic review of cohort and case-control studies with the following criteria: published between 1977 and 2018; reported odds ratios (OR), relative risk (RR) or sufficient raw data to calculate OR or RR; used appropriate diagnostic criteria; and reported systematic proband recruitment and ascertainment of relatives. Studies were obtained via EMBASE and MEDLINE electronic database searches. From an initial 5755 articles, 19 met the inclusion criteria. Mean effect sizes across studies were estimated using random effects methods. Estimates for schizophrenia risk were OR = 7.69 (95% CI 5.11-11.56) for FDRs of one proband with schizophrenia compared to healthy control probands, increasing to OR = 11.11 (95% CI = 1.45-85.02) for FDRs with two probands with schizophrenia. These findings support the existing literature suggesting significant genetic liability for schizophrenia. The results can be used to educate individuals with a family history of schizophrenia about their risk.
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Affiliation(s)
- Lo LE
- Psychosocial Research Group, Prince of Wales Clinical School, Sydney, NSW, Australia
| | - Kaur R
- Psychosocial Research Group, Prince of Wales Clinical School, Sydney, NSW, Australia
| | - Meiser B
- Psychosocial Research Group, Prince of Wales Clinical School, Sydney, NSW, Australia.
| | - Green Mj
- School of Psychiatry, University of New South Wales, NSW 2052, Australia; Neuroscience Research Australia, Sydney, NSW 2031, Australia
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11
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Koren D, Tzivoni Y, Schalit L, Adres M, Reznik N, Apter A, Parnas J. Basic self-disorders in adolescence predict schizophrenia spectrum disorders in young adulthood: A 7-year follow-up study among non-psychotic help-seeking adolescents. Schizophr Res 2020; 216:97-103. [PMID: 31889574 DOI: 10.1016/j.schres.2019.12.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND GOALS Recent studies indicate that basic self-disorder (SD) is a core clinical phenotype of schizophrenia and its spectrum. The goal of the present study was to test the degree to which SD characterizes the pre-onset phase of schizophrenia-spectrum disorders (SSD). A secondary goal was to replicate previous findings regarding the long-term stability of SD. METHOD To accomplish these goals, the long-term association of SD in adolescence with SSD seven years later was examined in a sample of 39 non-psychotic, help-seeking adolescents. SD was assessed with the Examination of Anomalous Self-Experience (EASE), and presence of schizophrenia-spectrum and other co-morbid illnesses in young adulthood was assessed with the Operational Criteria+ (OPCRIT+) checklist for psychotic and affective disorders. RESULTS Nine (23.1%) of the 39 participants were diagnosed as suffering from SSD (three Schizophrenia, three non-organic and non-affective psychotic disorder, and three schizotypal disorder) in young adulthood. A diagnosis of SSD in young adulthood was significantly predicted by SD, but not by prodromal symptoms in adolescence. The correlation between the EASE total score at adolescence and young adulthood was moderate and significant (r = 0.64, p < .001). CONCLUSIONS These results provide first long-term prospective support, in a sample not enriched for risk for psychosis, for the possibility that SD is a clinical marker of risk for SSD. Also, they provide additional support for the longitudinal persistence of SD over time.
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Affiliation(s)
- Danny Koren
- Psychology Department, University of Haifa, Haifa 31905, Israel; Psychiatry Division, Rambam Medical Center, Haifa, Israel.
| | - Yair Tzivoni
- Psychology Department, University of Haifa, Haifa 31905, Israel
| | - Liat Schalit
- Psychology Department, University of Haifa, Haifa 31905, Israel
| | - Merav Adres
- Psychology Department, University of Haifa, Haifa 31905, Israel
| | - Noa Reznik
- Psychology Department, University of Haifa, Haifa 31905, Israel
| | - Alan Apter
- Psychological Medicine Department, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Josef Parnas
- Psychiatric Center Glostrup, University of Copenhagen, Denmark; Center for Subjectivity Research, Faculty of Humanities, University of Copenhagen, Denmark
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12
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Rasmussen AR, Nordgaard J, Parnas J. Schizophrenia-spectrum psychopathology in obsessive-compulsive disorder: an empirical study. Eur Arch Psychiatry Clin Neurosci 2020; 270:993-1002. [PMID: 31129700 PMCID: PMC7599137 DOI: 10.1007/s00406-019-01022-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/15/2019] [Indexed: 12/29/2022]
Abstract
The differential diagnosis of obsessive-compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession ('with resistance') and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clinician. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizophrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive-compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.
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Affiliation(s)
- Andreas Rosén Rasmussen
- Mental Health Center Glostrup, University of Copenhagen, Broendbyostervej 160, 2605, Broendby, Denmark.
| | - Julie Nordgaard
- grid.5254.60000 0001 0674 042XMental Health Center Amager, University of Copenhagen, Gl. Kongevej 33, 1610 Copenhagen V, Denmark
| | - Josef Parnas
- grid.5254.60000 0001 0674 042XMental Health Center Glostrup, University of Copenhagen, Broendbyostervej 160, 2605 Broendby, Denmark ,grid.5254.60000 0001 0674 042XCenter for Subjectivity Research, University of Copenhagen, Karen Blixens Plads 8, 2300 Copenhagen S, Denmark
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13
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Moldovan R, McGhee KA, Coviello D, Hamang A, Inglis A, Ingvoldstad Malmgren C, Johansson-Soller M, Laurino M, Meiser B, Murphy L, Paneque M, Papsuev O, Pawlak J, Rovira Moreno E, Serra-Juhe C, Shkedi-Rafid S, Laing N, Voelckel MA, Watson M, Austin JC. Psychiatric genetic counseling: A mapping exercise. Am J Med Genet B Neuropsychiatr Genet 2019; 180:523-532. [PMID: 31222934 DOI: 10.1002/ajmg.b.32735] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 03/12/2019] [Accepted: 04/19/2019] [Indexed: 11/08/2022]
Abstract
Psychiatric genetic counseling (PGC) is gradually developing globally, with countries in various stages of development. In some, PGC is established as a service or as part of research projects while in others, it is just emerging as a concept. In this article, we describe the current global landscape of this genetic counseling specialty and this field's professional development. Drawing on information provided by expert representatives from 16 countries, we highlight the following: (a) current understanding of PGC; (b) availability of services for patients; (c) availability of training; (d) healthcare system disparities and cultural differences impacting practice; and (e) anticipated challenges going forward.
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Affiliation(s)
- Ramona Moldovan
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania.,Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, United Kingdom.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kevin A McGhee
- Faculty of Science and Technology, Bournemouth University, Poole, United Kingdom
| | - Domenico Coviello
- IRCCS Istituto Giannina Gaslini, Research Institute and Children Hospital, Genova, Italy
| | - Anniken Hamang
- Department of Medical Genetics, St. Olavs Hospital, Trondheim University Hospital
| | - Angela Inglis
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotta Ingvoldstad Malmgren
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Mercy Laurino
- College of Medicine, Department of Pediatrics, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Lauren Murphy
- University of Texas Genetic Counseling Program, UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Milena Paneque
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,CGPP - Centre for Predictive and Preventive Genetics, Institute for Molecular and Cell Biology (IBMC), Universidade do Porto, Porto, Portugal
| | - Oleg Papsuev
- Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Joanna Pawlak
- Department of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Eulàlia Rovira Moreno
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain.,Department of Clinical and Molecular Genetics, Hospital Vall d'Hebron, Barcelona, Spain
| | - Clara Serra-Juhe
- Department of Clinical and Molecular Genetics, Hospital Vall d'Hebron, Barcelona, Spain.,Medicine Genetics, VHIR, Barcelona, Spain
| | - Shiri Shkedi-Rafid
- Department of Genetics and Metabolic Diseases, Hadassah Medical Center, The Faculty of Medicine, The Hebrew University, Jerusalem
| | - Nakita Laing
- Division of Human Genetics, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | - Melanie Watson
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, Southampton, United Kingdom
| | - Jehannine C Austin
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Valle R, Perales A. Self-disorders in Early Stages of the Schizophrenia Spectrum. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2019; 48:244-251. [PMID: 31779875 DOI: 10.1016/j.rcp.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/04/2018] [Accepted: 02/08/2018] [Indexed: 06/10/2023]
Abstract
The pathogenic nucleus of schizophrenia has varied according to the different eras and influences of distinguished clinical researchers. Self-disorders have also been recognised to be at the heart of this disorder, although they have seldom been studied due to their subjective nature. Recently, due to the growing interest in the study of the early stages of schizophrenia, the study of self-disorders has been resumed. The self-disorders in schizophrenia model, developed by Sass and Parnas, proposes that in this disorder the person suffers loss of the first-person perspective and experiences hyperreflexibility, diminished self-affection and disturbance of the field of awareness. Therefore, the person experiences feelings of strangeness about him/herself, difficulty in understanding the common sense of things and difficulty interacting with his/her environment. Based on this model, self-disorder evaluation instruments have been developed and empirical studies have been conducted to evaluate people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in prepsychotic stages and that their manifestation may predict the transition to schizophrenia spectrum disorders. These results have important clinical implications as they enable people in the early stages of the disorder to be identified and create the opportunity to apply early therapeutic interventions.
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Affiliation(s)
- Rubén Valle
- Centro de Investigación en Epidemiología Clínica y Medicina Basada en Evidencias, Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Perú; Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú; DEIDAE de Adultos y Adultos Mayores, Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi, Lima, Perú.
| | - Alberto Perales
- Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú; Instituto de Ética en Salud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
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15
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Messent P. Test of time: 'Out of the mainstream - helping the children of parents with a mental illness'. Clin Child Psychol Psychiatry 2019; 24:712-716. [PMID: 30658536 DOI: 10.1177/1359104518822674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Myllyaho T, Siira V, Wahlberg KE, Hakko H, Läksy K, Roisko R, Niemelä M, Räsänen S. Interaction of genetic vulnerability to schizophrenia and family functioning in adopted-away offspring of mothers with schizophrenia. Psychiatry Res 2019; 278:205-212. [PMID: 31226546 DOI: 10.1016/j.psychres.2019.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association of family functioning to psychiatric disorders of adoptees with and without genetic vulnerability to schizophrenia. METHODS The data is based on the Finnish Adoptive Family Study of Schizophrenia. The study sample consisted of 346 adoptive families, of which 175 adoptees had high (HR) and 171 low (LR) genetic risk for schizophrenia. DSM-III-R was used for diagnostic criteria. Family functioning was assessed using the Global Family Ratings. Childhood adversities covered early parental divorce and death occurring before 18 years of age of the adoptees. RESULTS Approximately two thirds of the adoptees had lived in families with mildly dysfunctional processes (30%) or dysfunctional processes (28.4%). An increased likelihood for psychiatric disorders of the adoptees was related to dysfunctional family processes both in HR (OR = 4.8, 95% CI 2-11.4) and LR (OR = 2.6, 95% CI 1.1-6.3) adoptees, but not to early parental death or divorce. CONCLUSIONS The risk for psychiatric disorders was increased for adoptees in families with dysfunctional processes, especially for those adoptees with genetic vulnerability to schizophrenia. These results emphasize the importance of policies and practices that aim to strengthen and support family functioning.
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Affiliation(s)
- Toni Myllyaho
- Faculty of Medicine, Department of Psychiatry, University of Oulu, P.O. Box 5000, Oulu 90014, Finland.
| | - Virva Siira
- Faculty of Education, University of Oulu, P.O. Box 2000, Oulu 90014, Finland.
| | - Karl-Erik Wahlberg
- Faculty of Medicine, Department of Psychiatry, University of Oulu, P.O. Box 5000, Oulu 90014, Finland
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, Oulu 90029, Finland
| | - Kristian Läksy
- Social Security Institute of Finland (SSI), Helsinki, Finland
| | - Riikka Roisko
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, Oulu 90029, Finland
| | - Mika Niemelä
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, Oulu 90029, Finland; Department of Medicine, Center for Life Course Health Research, University of Oulu, P.O. Box 5000, Oulu 90014, Finland
| | - Sami Räsänen
- Department of Psychiatry, Oulu University Hospital, P.O. Box 26, Oulu 90029, Finland
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17
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Parnas J, Sandsten KE, Vestergaard CH, Nordgaard J. Schizophrenia and Bipolar Illness in the Relatives of University Scientists: An Epidemiological Report on the Creativity-Psychopathology Relationship. Front Psychiatry 2019; 10:175. [PMID: 31001153 PMCID: PMC6454109 DOI: 10.3389/fpsyt.2019.00175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/11/2019] [Indexed: 11/13/2022] Open
Abstract
A potential link between creativity and mental illness has been a longstanding topic for human studies and empirical research. The major problem is defining creativity and establishing its measurable indicators. A few high-quality epidemiological studies have been undertaken and point to a link between creativity and vulnerability to mental illness. Demonstrating such a shared vulnerability could expand our understanding of mental illnesses and open up new avenues of empirical research. In this epidemiological study, we defined scientists (academics) at the universities as individuals assumed to exhibit "more creativity" than the background population. In a register coupling with a population of 588,532 people, we examined successful university academics' first- and second-degree relatives for diagnosed mental disorders and compared those figures with controls from the background population controlling for educational level. The relatives of the academics had significantly increased risk of suffering from schizophrenia or bipolar disorder. For bipolar disorder, it is perhaps temperamental features and high energy levels that contribute to this association. In the case of schizophrenia, the mediating bridge may involve an amplification of human tendency to question the obvious and "taken-for-granted." Creativity and an increased risk for mental disorders seem to be linked by a shared vulnerability that is not manifested by clinical mental disorders in the academics.
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Affiliation(s)
- Josef Parnas
- Mental Health Center Glostrup, Broendby, Denmark.,Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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18
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Cès A, Falissard B, Glangeaud-Freudenthal NMC, Sutter-Dallay AL, Gressier F. Pregnancy in women with psychotic disorders: risk factors associated with mother-baby separation. Arch Womens Ment Health 2018; 21:699-706. [PMID: 29728866 DOI: 10.1007/s00737-018-0848-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
Pregnancy in women suffering from psychotic disorders is becoming more common. However, this psychiatric disorder is linked to the highest risk of early mother and child separation. The aim of this study was to evaluate risk factors associated with these separations. In an observational, naturalist, and multicentric study, 320 women suffering from a psychotic disorder and jointly hospitalized with their child in one of the sixteen mother-baby units (MBUs) in France and Belgium between 2001 and 2010 were assessed for risk factors associated with mother-child separation. Eighty-seven (27.2%) mothers were separated from their infant at discharge from MBUs. Early separation was linked to the placement of the mother herself in an institution in childhood (OR 4.44; CI 95% 1.12-18.69), to the mother being single (OR 3.84; CI 95% 1.38-11.44), to early hospitalization of the baby in neonatology (OR 2.88; CI 95% 1.27-6.59), and to maternal psychiatric decompensation during pregnancy (OR 2.60; CI 95% 1.15-6.20), independently from maternal neglectful behaviors. Low family/social support showed a trend towards association with separation (OR 2.17; CI 95% 0.91-5.42). This study shows that separation is mostly linked to mothers' environmental and interactive past and current history, to the child's health, and to maternal mental health decompensation. The identification of these factors is essential to implement antenatal prevention and social programs for these women. Further studies should focus on the long-term development of children of schizophrenic mothers, whether or not they have been placed, in order to help clarifying the impact of the risk factors.
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Affiliation(s)
- Agathe Cès
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Univ Paris Sud, Bicêtre University Hospital, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Bruno Falissard
- Department of Biostatistics, Maison de Solenn, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, 97 Bld de Port-Royal, 75679, Paris Cedex 14, France
| | - Nine M C Glangeaud-Freudenthal
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris Descartes University, Paris, France
| | - Anne-Laure Sutter-Dallay
- Research Center Inserm 1219, Bordeaux Population Health Bordeaux University, University Department of Adult Psychiatry, Charles-Perrens Hospital, 33000, Bordeaux, France
| | - Florence Gressier
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Univ Paris Sud, Bicêtre University Hospital, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. .,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178, Bicêtre University Hospital, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
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19
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Revsbech R, Mortensen EL, Nordgaard J, Jansson LB, Saebye D, Flensborg-Madsen T, Cutting J, Parnas J. Exploring social cognition in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2017; 267:611-619. [PMID: 27838738 DOI: 10.1007/s00406-016-0745-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/28/2016] [Indexed: 11/25/2022]
Abstract
The aim of the study was to compare social cognition between groups of patients diagnosed with schizophrenia and healthy controls and to replicate two previous studies using tests of social cognition that may be particularly sensitive to social cognitive deficits in schizophrenia. Thirty-eight first-admitted patients with schizophrenia and 38 healthy controls solved 11 "imaginary conversation (i.e., theory of mind)" items, 10 "psychological understanding" items, and 10 "practical understanding" items. Statistical tests were made of unadjusted and adjusted group differences in models adjusting for intelligence and neuropsychological test performance. Healthy controls performed better than patients on all types of social cognitive tests, particularly on "psychological understanding." However, after adjusting for intelligence and neuropsychological test performance, all group differences became nonsignificant. When intelligence and global cognitive functioning is taken into account, schizophrenia patients and healthy controls perform similarly on social cognitive tests.
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Affiliation(s)
- R Revsbech
- The Psychiatric Research Unit, Psychiatric Center Hvidovre, University Hospital Copenhagen, Brondby, Denmark. .,Department for Forensic Psychiatry, Psychiatric Center Sct. Hans, Roskilde, Denmark.
| | - E L Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - J Nordgaard
- Early Psychosis Intervention Center, University Hospital Copenhagen, Roskilde, Denmark
| | - L B Jansson
- The Psychiatric Research Unit, Psychiatric Center Hvidovre, University Hospital Copenhagen, Brondby, Denmark
| | - D Saebye
- The Capital Region, Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - T Flensborg-Madsen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - J Cutting
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - J Parnas
- The Psychiatric Research Unit, Psychiatric Center Hvidovre, University Hospital Copenhagen, Brondby, Denmark.,Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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20
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Parnas J, Møller P, Kircher T, Thalbitzer J, Jansson L, Handest P, Zahavi D, Karakuła-Juchnowicz H, Morylowska-Topolska J, Juchnowicz D. EASE: Examination of Anomalous Self-Experience. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
StreszczenieSkala EASE jest listą objawów do częściowo ustrukturalizowanego fenomenologicznego badania subiektywnych lub empirycznych nieprawidłowości (anomalii), które można uznać za zaburzenia podstawowej, „minimalnej” samoświadomości. EASE opracowana została na podstawie samoopisów otrzymanych od pacjentów chorujących na zaburzenia ze spektrum schizofrenii. Skala ma duże znaczenie dla opisu, diagnozy oraz diagnozy różnicowej zaburzeń ze spektrum schizofrenii. Prezentowana wersja zawiera istotne szczegółowe kwestie dotyczące zbierania wywiadu oraz opisy objawów psychopatologicznych (Podręcznik), arkusz wyników (Aneks A), listę pozostałych pozycji Skali stosowanych w czasie wywiadu (Aneks B) oraz porównawczą listę pozycji EASE/BSABS (Bonner Skala für die Beurteilung von Basissymptomen, Bońska Skala do Oceny Objawów Podstawowych) (Aneks C).
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Affiliation(s)
- Josef Parnas
- Mental Health Center Glostrup , University Hospital , Copenhagen , Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
- Center for Subjectivity Research , University of Copenhagen , Copenhagen , Denmark
| | - Paul Møller
- Department of Mental Health Research and Development , Division of Mental Health and Addiction , Vestre Viken Hospital Trust, Drammen , Norway
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy , University of Marburg , Marburg , Germany
| | - Jørgen Thalbitzer
- Mental Health Center Glostrup , University Hospital , Copenhagen , Denmark
| | - Lennart Jansson
- Mental Health Center Glostrup , University Hospital , Copenhagen , Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Peter Handest
- Mental Health Center Nordsjaelland , Hilleroed , Denmark
| | - Dan Zahavi
- Center for Subjectivity Research , University of Copenhagen , Copenhagen , Denmark
- Department of Media, Communication and Cognition, Faculty of Humanities , University of Copenhagen , Copenhagen , Denmark
| | - Hanna Karakuła-Juchnowicz
- I Department of Psychiatry, Psychotherapy and Early Intervention , Medical University of Lublin , Poland
- Department of Clinical Neuroscience , Medical University of Lublin , Poland
| | | | - Dariusz Juchnowicz
- Department of Psychiatric Nursing , Medical University of Lublin , Poland
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21
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Moldovan R, Pintea S, Austin J. The Efficacy of Genetic Counseling for Psychiatric Disorders: a Meta-Analysis. J Genet Couns 2017; 26:1341-1347. [DOI: 10.1007/s10897-017-0113-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 05/18/2017] [Indexed: 12/27/2022]
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Nordgaard J, Handest P, Vollmer-Larsen A, Sæbye D, Pedersen JT, Parnas J. Temporal persistence of anomalous self-experience: A 5years follow-up. Schizophr Res 2017; 179:36-40. [PMID: 27720316 DOI: 10.1016/j.schres.2016.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/25/2016] [Accepted: 10/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The concept of self-disorders in schizophrenia has gained substantial interest and it has now been established empirically that self-disorders aggregate in schizophrenia-spectrum disorders but not in other mental disorders or in healthy controls. Yet, the issue of temporal persistence has not been addressed. AIM The aim of this study is to examine the temporal persistence of self-disorders. METHODS 96 first admission patients were thoroughly assessed for psychopathology including SD at baseline and again 5years later. We created a 25-item self-disorder scale which was used both at baseline and follow-up to assess self-disorders. The scale was a pre-cursor of the later published EASE-scale. Additionally, we examined the development of positive and negative syndromes and of the Global Assessment of Functioning (GAF). RESULTS There was a high correlation between self-disorders at baseline and at follow-up, and the majority of the items in self-disorders scale showed equal proportions between baseline and follow-up. CONCLUSION Self-disturbances showed a high level of persistence at 5-year follow-up.
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Affiliation(s)
- J Nordgaard
- Early Psychosis Intervention Center, Region Zealand, University of Copenhagen, Denmark; Institute of Clincal Medicine, University of Copenhagen, Denmark.
| | - P Handest
- Mental Health Centre North Zealand, University of Copenhagen, Denmark
| | - A Vollmer-Larsen
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - D Sæbye
- Clinic for Forensic Psychiatry, Copenhagen, Denmark
| | - J Thejlade Pedersen
- Mental Health Center Hvidovre, Copenhagen, University of Copenhagen, Denmark
| | - J Parnas
- Mental Health Center Hvidovre, Copenhagen, University of Copenhagen, Denmark; Center for Subjectivity Research, University of Copenhagen, Denmark
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Offspring of Parents with Schizophrenia: A Systematic Review of Developmental Features Across Childhood. Harv Rev Psychiatry 2016; 24:104-17. [PMID: 26954595 DOI: 10.1097/hrp.0000000000000076] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A significant body of longitudinal research has followed the offspring of parents with schizophrenia. This article presents a systematic review of 46 separate papers presenting the results of 18 longitudinal studies that have followed children who are at familial high risk of developing psychotic disorders. The studies suggest that these children do show distinct developmental patterns characterized by higher rates of obstetric complication, neurodevelopmental features such as motor and cognitive deficits, and distinctive social behavior. This review summarizes those findings according to child developmental stages. Twelve of the studies followed offspring into adulthood and examined psychiatric diagnoses. From 15% to 40% of children at familial high risk developed psychotic disorders in adulthood. Many also received other psychiatric diagnoses such as mood or anxiety disorders. This combination of results suggests that offspring of parents with schizophrenia are at high risk not just for schizophrenia but, more broadly, for poor developmental and general mental health outcomes. The clinical implications of the findings are discussed, as are new prognostic strategies and potential programs for selective prevention.
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Parnas J, Carter J, Nordgaard J. Premorbid self-disorders and lifetime diagnosis in the schizophrenia spectrum: a prospective high-risk study. Early Interv Psychiatry 2016; 10:45-53. [PMID: 24725282 DOI: 10.1111/eip.12140] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/28/2014] [Indexed: 11/29/2022]
Abstract
AIM The notion of a disordered self as a core disturbance of schizophrenia was proposed in many foundational texts. Recent studies, spurred by the development of the Examination of Anomalous Self-Experience (EASE), seem to indicate that self-disorders are a specific manifestation of schizophrenia vulnerability. Follow-up studies of help-seeking, prodromal and first-admission patients have demonstrated the utility of self-disorders for predicting later schizophrenia-spectrum disturbance. We wished to extend these findings by gauging the predictive value of self-disorders in a premorbid, non-clinical population at high risk for schizophrenia. METHODS Children from the Copenhagen High-Risk Project with high-genetic risk for schizophrenia (N = 212) were assessed premorbidly (average age = 15), and diagnostically re-evaluated after 10 and 25 years. Since the EASE was not available at the time of premorbid assessment, we hypothesized that a proxy scale drawn from the Minnesota Multiphasic Personality Inventory (MMPI) could distinguish those who later developed a schizophrenia-spectrum disorder (N = 68) from those who remained healthy (N = 64). The Self-Disorder Scale comprised 32 items whose content suggested an aspect of self-disorder as measured by the EASE. RESULTS Premorbid Self-Disorder Scale scores significantly predicted lifetime schizophrenia-spectrum diagnosis in the high-risk cohort. Although there was considerable item overlap between the new scale and an existing MMPI scale (psychoticism), the overlap did not account for the Self-Disorder Scale's predictive efficacy. CONCLUSION The results support the notion of self-disorders as a core vulnerability feature in schizophrenia, detectable premorbidly in those developing later schizophrenia-spectrum disorders.
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Affiliation(s)
- Josef Parnas
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Center Hvidovre, University of Copenhagen, Hvidovre, Denmark
| | - John Carter
- Horizon Consumer Science, Glendale, California, USA
| | - Julie Nordgaard
- Psychiatric Center Hvidovre, University of Copenhagen, Hvidovre, Denmark
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Linkage and whole genome sequencing identify a locus on 6q25-26 for formal thought disorder and implicate MEF2A regulation. Schizophr Res 2015; 169:441-446. [PMID: 26421691 DOI: 10.1016/j.schres.2015.08.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/27/2015] [Accepted: 08/27/2015] [Indexed: 11/24/2022]
Abstract
Formal thought disorder is a major feature of schizophrenia and other psychotic disorders. It is heritable, found in healthy relatives of patients with schizophrenia and other mental disorders but knowledge of specific genetic factors is lacking. The aim of this study was to search for biologically relevant high-risk variants. Formal thought disorder was assessed in participants in the Copenhagen Schizophrenia Linkage Study (N=236), a unique high-risk family study comprised of six large pedigrees. Microsatellite linkage analysis of formal thought disorder was performed and subsequent haplotype analysis of the implicated region using phased microsatellite and SNP genotypes. Whole genome sequencing (N=3) was used in the attempt to identify causative variants in the linkage region. Linkage analysis of formal thought disorder resulted in a single peak at chromosome 6(q26-q27) centred on marker D6S1277, with a maximum LOD score of 4.0. Phasing and fine mapping of the linkage peak identified a 5.5Mb haplotype (chr6:162242322-167753547, hg18) in 31 individuals, all belonging to the same pedigree sharing the haplotype from a common ancestor. The haplotype segregated with increased total thought disorder index score (P=4.9 × 10(-5)) and qualitatively severe forms of thought disturbances. Whole genome sequencing identified a novel nucleotide deletion (chr6:164377205 AG>A, hg18) predicted to disrupt the potential binding of the transcription factor MEF2A. The MEF2A binding site is located between two genes previously reported to associate with schizophrenia, QKI (HGNC:21100) and PDE10A (HGNC:8772). The findings are consistent with MEF2A deregulation conferring risk of formal thought disorder.
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Revsbech R, Mortensen EL, Owen G, Nordgaard J, Jansson L, Sæbye D, Flensborg-Madsen T, Parnas J. Exploring rationality in schizophrenia. BJPsych Open 2015; 1:98-103. [PMID: 27703730 PMCID: PMC4998928 DOI: 10.1192/bjpo.bp.115.000224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 07/11/2015] [Accepted: 08/19/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Empirical studies of rationality (syllogisms) in patients with schizophrenia have obtained different results. One study found that patients reason more logically if the syllogism is presented through an unusual content. AIMS To explore syllogism-based rationality in schizophrenia. METHOD Thirty-eight first-admitted patients with schizophrenia and 38 healthy controls solved 29 syllogisms that varied in presentation content (ordinary v. unusual) and validity (valid v. invalid). Statistical tests were made of unadjusted and adjusted group differences in models adjusting for intelligence and neuropsychological test performance. RESULTS Controls outperformed patients on all syllogism types, but the difference between the two groups was only significant for valid syllogisms presented with unusual content. However, when adjusting for intelligence and neuropsychological test performance, all group differences became non-significant. CONCLUSIONS When taking intelligence and neuropsychological performance into account, patients with schizophrenia and controls perform similarly on syllogism tests of rationality. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Rasmus Revsbech
- , MSc, PhD, Psychiatric Center Hvidovre & Glostrup Forensic Psychiatric Department, University of Copenhagen, Denmark
| | - Erik Lykke Mortensen
- , MSc, Department of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
| | - Gareth Owen
- , BSc, PhD, MBBS, MRCPsych, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Weston Education Centre, UK
| | - Julie Nordgaard
- , MD, PhD, Department of Psychiatric Research, Region Zealand, Denmark
| | | | - Ditte Sæbye
- , MSc, Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark
| | - Trine Flensborg-Madsen
- , MSc, PhD, Unit of Medical Psychology, Institute of Public Health, University of Copenhagen, Denmark
| | - Josef Parnas
- , MD, Dr Med, Psychiatric Center Hvidovre, Center for Subjectivity Research, University of Copenhagen, Denmark
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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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Abstract
INTRODUCTION Self-disorders (SD) have been described as a core feature of schizophrenia both in classical and recent psychopathological literature. However, the specificity of SD for the schizophrenia spectrum disorders has never been demonstrated in a diagnostically heterogeneous sample, nor has the concurrent validity of SD been examined. AIM (1) To examine the specificity of Examination of Anomalous Self-Experiences (EASE) measured SD to the schizophrenia spectrum disorder in first contact inpatients, (2) to explore the internal consistency and factorial structure of the EASE, (3) to assess the concurrent validity of SD by exploring correlations between SD and the canonical psychopathological dimensions of schizophrenia, (4) to explore relations of SD to intelligence, sociodemographic, and extrinsic illness characteristics. METHODS A total of 100 consecutive first admission patients underwent a comprehensive psychopathological examination and an assessment of SD with the EASE scale. The diagnostic distribution of the EASE scores was tested with ANOVA, whereas the relations between the EASE scores and other symptomatic dimensions of schizophrenia were tested with Spearman's rho. A potential factorial structure and the internal consistency of the EASE scale were also examined. RESULTS SD aggregated significantly in the schizophrenia spectrum disorders, with no differences between schizophrenia and schizotypal disorders. EASE scores correlated moderately with canonical psychopathological dimensions of schizophrenia. Factor analysis of the EASE disclosed only one factor and the internal consistency of the EASE was excellent. CONCLUSIONS SD aggregate selectively in the schizophrenia spectrum disorders, with similar levels in schizophrenia and schizotypy. The study lends validity to the view of SD as an experiential vulnerability phenotype of the schizophrenia spectrum disorders.
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Affiliation(s)
- Julie Nordgaard
- Psychiatric Center Hvidovre, University of Copenhagen, Broendbyoestervej 160, 2605 Broendby, Denmark;
| | - Josef Parnas
- Psychiatric Center Hvidovre, University of Copenhagen, Broendbyoestervej 160, 2605 Broendby, Denmark; Center for Subjectivity Research Center, University of Copenhagen, Njalsgade 140, 2300 Copenhagen, Denmark
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Abstract
After over 100 years of research without clarifying the aetiology of schizophrenia, a look at the current state of knowledge in epidemiology, genetics, precursors, psychopathology, and outcome seems worthwhile. The disease concept, created by Kraepelin and modified by Bleuler, has a varied history. Today, schizophrenia is considered a polygenic disorder with onset in early adulthood, characterized by irregular psychotic episodes and functional impairment, but incident cases occur at all ages with marked differences in symptoms and social outcome. Men’s and women’s lifetime risk is nearly the same. At young age, women fall ill a few years later and less severely than men, men more rarely and less severely later in life. The underlying protective effect of oestrogen is antagonized by genetic load. The illness course is heterogeneous and depressive mood the most frequent symptom. Depression and schizophrenia are functionally associated, and affective and nonaffective psychoses do not split neatly. Most social consequences occur at the prodromal stage. Neither schizophrenia as such nor its main symptom dimensions regularly show pronounced deterioration over time. Schizophrenia is neither a residual state of a neurodevelopmental disorder nor a progressing neurodegenerative process. It reflects multifactorial CNS instability, which leads to cognitive deficits and symptom exacerbations.
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Abstract
This article explores the phenomenological and empirical rediscovery of anomalous self-experience as a core feature of the schizophrenia spectrum disorders and presents the current status of research in this field. Historically, a disordered self was considered to be a constitutive phenotype of schizophrenia. Although the notion of a disordered self has continued to appear occasionally over the years-mainly in the phenomenologically or psychodynamically oriented literature-this notion was usually considered as a theoretical construct rather than as referring to concretely lived anomalous experiences. Empirical research on the disorders of self-experience in schizophrenia can be traced back to the US-Denmark psychopathological collaboration in the well-known adoption and high-risk studies, which aimed at identifying trait or phenotypic vulnerability features. This research was later followed by clinical work with first-admission schizophrenia patients. We offer clinical descriptions of anomalous self-experience and outline the phenomenological structures of subjectivity that are needed for grasping the nature of these anomalous experiential phenomena. What appears to underlie these experiences is an instability of the first-person perspective that threatens the basic experience of being a self-coinciding, embodied, demarcated, and persisting subject of awareness. We summarize a series of empirical studies targeting self-experience in schizophrenia performed prior to and after the construction of a phenomenologically oriented psychometric instrument for assessing anomalies of self-experience, the Examination of Anomalous Self-Experience (EASE). These empirical studies support the classic clinical intuition that anomalous self-experiences form a central phenotype of schizophrenia. Implications for diagnosis and research are briefly discussed.
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Rasic D, Hajek T, Alda M, Uher R. Risk of mental illness in offspring of parents with schizophrenia, bipolar disorder, and major depressive disorder: a meta-analysis of family high-risk studies. Schizophr Bull 2014; 40:28-38. [PMID: 23960245 PMCID: PMC3885302 DOI: 10.1093/schbul/sbt114] [Citation(s) in RCA: 436] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Offspring of parents with severe mental illness (SMI; schizophrenia, bipolar disorder, major depressive disorder) are at an increased risk of developing mental illness. We aimed to quantify the risk of mental disorders in offspring and determine whether increased risk extends beyond the disorder present in the parent. METHOD Meta-analyses of absolute and relative rates of mental disorders in offspring of parents with schizophrenia, bipolar disorder, or depression in family high-risk studies published by December 2012. RESULTS We included 33 studies with 3863 offspring of parents with SMI and 3158 control offspring. Offspring of parents with SMI had a 32% probability of developing SMI (95% CI: 24%-42%) by adulthood (age >20). This risk was more than twice that of control offspring (risk ratio [RR] 2.52; 95% CI 2.08-3.06, P < .001). High-risk offspring had a significantly increased rate of the disorder present in the parent (RR = 3.59; 95% CI: 2.57-5.02, P < .001) and of other types of SMI (RR = 1.92; 95% CI: 1.48-2.49, P < .001). The risk of mood disorders was significantly increased among offspring of parents with schizophrenia (RR = 1.62; 95% CI: 1.02-2.58; P = .042). The risk of schizophrenia was significantly increased in offspring of parents with bipolar disorder (RR = 6.42; 95% CI: 2.20-18.78, P < .001) but not among offspring of parents with depression (RR = 1.71; 95% CI: 0.19-15.16, P = .631). CONCLUSIONS Offspring of parents with SMI are at increased risk for a range of psychiatric disorders and one third of them may develop a SMI by early adulthood.
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Affiliation(s)
- Daniel Rasic
- *To whom correspondence should be addressed; Department of Psychiatry, Canada Research Chair in Early Intervention in Psychiatry, Dalhousie University, 5909 Veterans' Memorial Lane, Room 3089, Abbie J. Lane Memorial Building, Halifax, Nova Scotia B3H 2E2, Canada; fax: 902-473-4877, e-mail:
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia B3H 2E2, Canada;,Department of Psychiatry and Medical Psychology, Prague Psychiatric Center, Charles University, Prague, Czech Republic
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia B3H 2E2, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia B3H 2E2, Canada;,MRC Social, Genetic and Developmental Psychiatry Centre at the Institute of Psychiatry, King’s College London, UK,*To whom correspondence should be addressed; Department of Psychiatry, Canada Research Chair in Early Intervention in Psychiatry, Dalhousie University, 5909 Veterans’ Memorial Lane, Room 3089, Abbie J. Lane Memorial Building, Halifax, Nova Scotia B3H 2E2, Canada; fax: 902-473-4877, e-mail:
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Abstract
Paranoid personality disorder (PPD) is currently included in DSM-IV's "odd cluster" or "cluster A." In the present article, the authors review available information pertaining to the psychometric properties of PPD, as derived from the relevant literature and from databases of personality disorder study groups. There is comparatively little published evidence for the reliability and validity of PPD, and researchers by and large have tended not to study the disorder, either because of investigators' difficulty recruiting individuals with PPD into research studies, or (as seems more likely) because the trait-paranoia from which many psychiatric patients suffer has seemed better explained by other DSM-IV disorders on Axis I and/or Axis II than by PPD. Given the scant empirical evidence on PPD, it seems reasonable to remove it as an independent diagnosis from the next edition of DSM, and instead to encourage clinicians to code trait-paranoia using a dimensional approach.
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Hart SJ, Bizzell J, McMahon MA, Gu H, Perkins DO, Belger A. Altered fronto-limbic activity in children and adolescents with familial high risk for schizophrenia. Psychiatry Res 2013; 212:19-27. [PMID: 23482245 PMCID: PMC3604031 DOI: 10.1016/j.pscychresns.2012.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 11/27/2012] [Accepted: 12/19/2012] [Indexed: 12/13/2022]
Abstract
Early symptoms of schizophrenia tend to emerge during adolescence, hich is a critical period for development of executive and emotional processing. While individuals with familial high risk (FHR) for schizophrenia may show cognitive and emotional changes, the neural mechanisms underlying the development of these changes remain unclear. The goal of this study was to identify functional differences in fronto-striato-limbic regions in children with FHR. Functional magnetic resonance imaging (MRI) data were collected from 21 children with a first-degree family member with schizophrenia and 21 controls without FHR. Participants performed an emotional oddball task requiring both selective attention and suppression of task-irrelevant emotional information. During selective attention, the group with FHR showed enhanced activation in the inferior frontal gyrus and caudate, with decreases in middle frontal gyrus and insular activation. The FHR group also showed greater age-related recruitment of anterior cingulate, temporal and occipital cortical areas during selective attention. During emotional processing, the FHR group showed decreased anterior cingulate activation, with decreased age-related recruitment of inferior frontal, parietal and occipital areas. The results suggest that FHR for schizophrenia may be associated with abnormal hyperactivation and hypoactivation of the neural circuitry engaged during executive and emotional processing and with age-related changes in neural recruitment during adolescence.
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Affiliation(s)
- Sarah J Hart
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
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Parnas J, Møller P, Kircher T, Thalbitzer J, Jansson L, Handest P, Zahavi D, Cermolacce M, Bovet P. EASE : Évaluation des Anomalies de l’Expérience de Soi#. Encephale 2012; 38 Suppl 3:S121-45. [DOI: 10.1016/s0013-7006(12)70090-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Schizoid personality disorder (ScPD) is one of the "odd cluster" or "cluster A" personality disorders in DSM-IV. In the present article, the authors review information pertaining to the psychometric characteristics of ScPD as gleaned from a search of relevant publications as well as from databases of personality disorder study groups. Comparatively little evidence exists for the validity and reliability of ScPD as a separate, multifaceted personality disorder. Some authors, moreover, have contended that the group of patients termed "schizoid" actually fall into two distinct groups--an "affect constricted" group, who might better be subsumed within schizotypal personality disorder, and a "seclusive" group, who might better be subsumed within avoidant personality disorder. The research-based justification for retaining ScPD as an independent diagnosis is sufficiently sparse for it to seem reasonable to remove ScPD from the list of personality disorders in DSM-V, and instead to invite clinicians to code for schizoid traits using a dimensional model.
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Schultze-Lutter F, Klosterkötter J, Michel C, Winkler K, Ruhrmann S. Personality disorders and accentuations in at-risk persons with and without conversion to first-episode psychosis. Early Interv Psychiatry 2012; 6:389-98. [PMID: 22260339 DOI: 10.1111/j.1751-7893.2011.00324.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Cluster A personality disorders (PDs), particularly schizotypal PD, are considered a part of the schizophrenia spectrum and a risk factor of psychosis. The role of PDs and personality accentuations (PAs) in predicting conversion to psychosis was studied in patients symptomatically considered at risk, assuming a major role of the schizotypal subtype. METHODS PDs and PAs, assessed at baseline with a self-report questionnaire, were compared between risk-, gender- and age-matched at-risk patients with (n = 50) and without conversion to psychosis (n = 50). RESULTS Overall, Cluster A-PDs were the least frequent cluster (14%), and schizotypal PD was rare (7%). Yet, PDs in general were frequent (46%), especially Cluster B- (31%) and C-PDs (23%). Groups did not differ in frequencies of PDs, yet converters tended to have a higher expression of schizoid (P = 0.057) and Cluster A-PAs (P = 0.027). In regression analyses, schizoid PA was selected as sole but weak predictor of conversion (OR = 1.685; 95% CIs: 1.134/2.504). CONCLUSIONS Unexpectedly, schizotypal PD was infrequent and did not predict conversion. Conversion was best predicted by schizoid PA, indicating more severe, persistent social deficits already at baseline in later converters. This corresponds to premorbid social deficits reported for genetic high-risk children and low social functioning in at-risk patients later converting to psychosis. Further, PDs occurred frequently in at-risk patients irrespective of conversion. As psychopathology and personality relate closely to one another, this result highlights that, beyond the current narrow focus on schizotypal PD, personality-related factors should be considered more widely in the prevention of psychosis.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry, Research Department, Bern, Switzerland.
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NORDGAARD JULIE, REVSBECH RASMUS, SÆBYE DITTE, PARNAS JOSEF. Assessing the diagnostic validity of a structured psychiatric interview in a first-admission hospital sample. World Psychiatry 2012; 11:181-5. [PMID: 23024678 PMCID: PMC3449355 DOI: 10.1002/j.2051-5545.2012.tb00128.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The use of structured psychiatric interviews performed by non-clinicians is frequent for research purposes and is becoming increasingly common in clini-cal practice. The validity of such interviews has rarely been evaluated empirically. In this study of a sample of 100 diagnostically heterogeneous, first-admitted inpatients, the results of an assessment with the Structured Clinical Interview for DSM-IV (SCID), yielding a DSM-IV diagnosis and performed by a trained non-clinician, were compared with a consensus lifetime best diagnostic estimate (DSM-IV) by two experienced research clinicians, based on multiple sources of information, which included videotaped comprehensive semi-structured narrative interviews. The overall kappa agreement was 0.18. The sensitivity and specificity for the diagnosis of schizophrenia by SCID were 19% and 100%, respectively. It is concluded that structured interviews performed by non-clinicians are not recommendable for clinical work and should only be used in research with certain precautions. It is suggested that a revival of systematic theoretical and practical training in psychopathology is an obvious way forward in order to improve the validity and therapeutic utility of psychiatric diagnosis.
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Affiliation(s)
- JULIE NORDGAARD
- Psychiatric Center Hvidovre, University of
Copenhagen, Broendbyoestervej 160, 2605 Broendby
| | - RASMUS REVSBECH
- Psychiatric Center Hvidovre, University of
Copenhagen, Broendbyoestervej 160, 2605 Broendby
| | - DITTE SÆBYE
- Statistical Unit, Institute of Preventive Medicine,
University of Copenhagen
| | - JOSEF PARNAS
- Psychiatric Center Hvidovre, University of
Copenhagen, Broendbyoestervej 160, 2605 Broendby,Center for Subjectivity Research, University
of Copenhagen, Denmark
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The stability of severe thought disorders and mature thinking. Eur Psychiatry 2012; 27:350-7. [PMID: 21036555 DOI: 10.1016/j.eurpsy.2010.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 06/29/2010] [Accepted: 08/07/2010] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to investigate whether severe formal thought disorders and mature thinking are stable among adoptees (=187) drawn from the Finnish adoptive family study of schizophrenia. A group of 93 adoptees genetically at high risk (HR) and 94 at low risk (LR) for schizophrenia were assessed blindly and reliably using the Index of Primitive Thought (IPT) and the Index of Integration (IOI). Two assessments of the IPT and the IOI were performed with the mean interval of 11 years. Comparisons of the IPT and the IOI mean scores were conducted both at baseline and at follow-up between adoptees at low and high genetic risk, gender, and psychiatric status. The main result was that the IOI as well as the IPT of the adoptees at the initial assessment predicted the IOI and the IPT estimated at follow-up, thus indicating the stability of severe formal thought disorders and mature thinking over time. The stability of IOI or IPT was not related to genetic risk, gender or psychiatric status or their interactions.
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Examination of anomalous self-experience: initial study of the structure of self-disorders in schizophrenia spectrum. J Nerv Ment Dis 2012; 200:577-83. [PMID: 22759933 DOI: 10.1097/nmd.0b013e31825bfb41] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A growing body of evidence points to the clinical and heuristic value of anomalous subjective experiences (ASEs) for the characterization of schizophrenia spectrum vulnerability and early detection purposes. In particular, a subgroup of ASEs, entailing basic disorders of self-awareness (self-disorders [SDs]), has been shown to constitute a core feature of both clinically overt and latent (schizotaxic) spectrum phenotypes. However, a major limitation for the translational implementation of this research evidence has been a lack of assessment tools capable of encompassing the clinical richness of SDs. Here, we present the initial normative data and psychometric properties of a newly developed instrument (Examination of Anomalous Self-experience [EASE]), specifically designed to support the psychopathological exploration of SDs in both research and "real world" clinical settings. Our results support the clinical validity of the EASE as a tool for assessing anomalies of self-awareness (SDs) and lend credit to the translational potential of a phenomenological exploration of the subjective experience of vulnerability to schizophrenia.
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Pihkala H, Sandlund M, Cederström A. Initiating communication about parental mental illness in families: an issue of confidence and security. Int J Soc Psychiatry 2012; 58:258-65. [PMID: 21421639 DOI: 10.1177/0020764010392088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Beardslee's family intervention (FI) is a family-based intervention to prevent psychiatric problems for children of mentally ill parents. The parents' experiences are of importance in family-based interventions. METHOD Twenty five parents were interviewed about their experiences of FI. Data were analysed by qualitative methods. DISCUSSION Confidence and security in the professionals and in FI as a method were prerequisites for initiating communication about the parents' mental illness with the children. CONCLUSIONS FI provides a solid base for an alliance with the parents and might be a practicable method when parenthood and children are discussed with psychiatric patients.
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Affiliation(s)
- Heljä Pihkala
- Skellefteå Hospital, Psychiatric Clinic, Skellefteå, Sweden.
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41
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Lyons MJ, Huppert J, Toomey R, Harley R, Goldberg J, Eisen S, True W, Faraone SV, Tsuang MT. Lifetime prevalence of mood and anxiety disorders in twin pairs discordant for schizophrenia. ACTA ACUST UNITED AC 2012. [DOI: 10.1375/twin.3.1.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThere have been long questions about the relationship of schizophrenia to other mental disorders. Lifetime DSM-III-R diagnoses of mood and anxiety disorders in twins with clinically diagnosed schizophrenia (n = 24) and their non-affected co-twins (n = 24) were compared with twins from pairs without schizophrenia (n = 3327) using a sample from the Vietnam Era Twin Registry. Schizophrenic probands had significantly elevated rates of all included disorders (bipolar disorder, major depression, dysthymia, generalized anxiety disorder, panic disorder, and PTSD) compared with controls (P < 0.01). The odd ratios comparing co-twins of schizophrenic probands with controls was greater than three for every disorder, but did not attain statistical significance. A similar pattern was observed when analyses were restricted to only monozygotic twins (n = 12). Consistent with other studies, schizophrenics appeared to have higher rates of a range of mental disorders. Our results suggest that schizophrenia per se represents a risk factor for other psychiatric disorders, but the absence of significantly elevated risk among non-schizophrenic co-twins suggested that family environmental and/or genetic factors that contribute to risk of schizophrenia do not increase the risk of mood and anxiety disorders to the same extent that the risk of these other disorders is increased by the presence of schizophrenia. Twin Research (2000) 3, 28–32.
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Moore S, Kelleher E, Corvin A. The shock of the new: progress in schizophrenia genomics. Curr Genomics 2011; 12:516-24. [PMID: 22547958 PMCID: PMC3219846 DOI: 10.2174/138920211797904089] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 09/20/2011] [Accepted: 09/29/2011] [Indexed: 12/31/2022] Open
Abstract
A growing list of common and rare genetic risk variants are being implicated in schizophrenia susceptibility. As with other complex genetic disorders most of the variance in genetic risk is still to be attributed. What can be learned from progress to date? The available data challenges how we conceptualize schizophrenia and suggests strong aetiological links with other psychiatric and developmental disorders. With the identification of rare copy number risk variants implicating specific genes (e.g. VIPR2 and NRXN1) it is increasingly possible to investigate molecular aetiology in patient subgroups to establish whether schizophrenia represents one or many different disease processes. This review summarizes recent research progress and suggests how the tools of modern genomics and neuroscience can be applied to best understand this devastating disorder.
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Affiliation(s)
- Susan Moore
- Neuropsychiatric Genetics Research Group, Department of Psychiatry and Institute of Molecular Medicine, Trinity College, Dublin, Ireland
| | - Eric Kelleher
- Neuropsychiatric Genetics Research Group, Department of Psychiatry and Institute of Molecular Medicine, Trinity College, Dublin, Ireland
| | - Aiden Corvin
- Neuropsychiatric Genetics Research Group, Department of Psychiatry and Institute of Molecular Medicine, Trinity College, Dublin, Ireland
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PARNAS JOSEF, RABALLO ANDREA, HANDEST PETER, JANSSON LENNART, VOLLMER-LARSEN ANNE, SAEBYE DITTE. Self-experience in the early phases of schizophrenia: 5-year follow-up of the Copenhagen Prodromal Study. World Psychiatry 2011; 10:200-4. [PMID: 21991279 PMCID: PMC3188774 DOI: 10.1002/j.2051-5545.2011.tb00057.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Despite the avalanche of empirical data on prodromal/"at risk" conditions, the essential aspects of the vulnerability to the schizophrenia spectrum remain largely unaddressed. We report here the results of the Copenhagen Schizophrenia Prodromal Study, a prospective, observational study of first admission patients in putative state of beginning psychosis (N=151) with a follow-up length of 60 months. At follow-up, the rate of conversion to schizophrenia spectrum diagnosis was 37%, whereas the conversion rate from schizotypal disorder to schizophrenia was 25%. High levels of perplexity and self-disorders baseline scores yielded the best prediction of the subsequent development of schizophrenia spectrum disorders. Escalating transitions within the spectrum (i.e., from schizotypal disorder to schizophrenia) were not associated to any candidate psychopathological predictor.
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Affiliation(s)
- JOSEF PARNAS
- Danish National Research Foundation: Center
for Subjectivity Research, University of Copenhagen, Njalsgade 140-142, DK-2300
Copenhagen S, Denmark,Mental Health Center Hvidovre, University of
Copenhagen, Denmark
| | - ANDREA RABALLO
- Danish National Research Foundation: Center
for Subjectivity Research, University of Copenhagen, Njalsgade 140-142, DK-2300
Copenhagen S, Denmark,Mental Health Center Hvidovre, University of
Copenhagen, Denmark,Department of Mental Health, Local Health Unit,
Reggio Emilia, Italy
| | - PETER HANDEST
- Mental Health Center Hvidovre, University of
Copenhagen, Denmark
| | - LENNART JANSSON
- Mental Health Center Hvidovre, University of
Copenhagen, Denmark
| | | | - DITTE SAEBYE
- Institute of Preventive Medicine, Copenhagen
Hospital Corporation, Copenhagen, Denmark
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Abstract
The identification of individuals carrying unexpressed genetic liability to schizophrenia is crucial for both etiological research and clinical risk stratification. Subclinical psychopathological features detectable in the nonpsychotic part of the schizophrenia spectrum could improve the delineation of informative vulnerability phenotypes. Inspired by Meehl's schizotaxia-schizotypy heuristic model, we tested anomalous subjective experiences (self-disorders, SDs) as a candidate vulnerability phenotype in a sample of nonpsychotic, genetically high-risk subjects. A total of 218 unaffected members of 6 extended multiplex families (assessed between 1989 and 1999 during the Copenhagen Schizophrenia Linkage Study) were stratified into 4 groups of increasing psychopathological expressivity: no mental illness (NMI), no mental illness with schizotypal traits (NMI-ST), personality disorders not fulfilling other personality disorders (OPDs), and schizotypal personality disorder (SPD). We tested the distribution of SDs among the subgroups, the effect of SDs on the risk of belonging to the different subgroups, and the effect of experimental grouping and concomitant psychopathology (ie, negative symptoms (NSs) and subpsychotic formal thought disorder [FTD]) on the chances of experiencing SDs. SDs distribution followed an incremental pattern from NMI to SPD. SDs were associated with a markedly increased risk of NMI-ST, OPDs, or SPD. The odds of SDs increased as a function of the diagnostic category assignment, independently of sociodemographics and concomitant subclinical psychopathology (NSs and FTD). The results support SDs as an expression of schizotaxic vulnerability and indicate a multidimensional model of schizotypy--characterized by SDs, NSs, FTD--as a promising heuristic construct to address liability phenotypes in genetically high-risk studies.
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Affiliation(s)
- Andrea Raballo
- Danish National Research Foundation: Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark.
| | - Josef Parnas
- Danish National Research Foundation: Center for Subjectivity Research,Department of Psychiatry, Psychiatric Center Hvidovre, University of Copenhagen, Copenhagen, Denmark
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45
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Tarbox SI, Pogue-Geile MF. A multivariate perspective on schizotypy and familial association with schizophrenia: a review. Clin Psychol Rev 2011; 31:1169-82. [PMID: 21855827 DOI: 10.1016/j.cpr.2011.07.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 06/29/2011] [Accepted: 07/12/2011] [Indexed: 10/18/2022]
Abstract
Although generally accepted that schizotypal personality disorder diagnosis is more prevalent among relatives of individuals with schizophrenia and may be associated with genetic liability to schizophrenia, it seems likely that this diagnosis is itself heterogeneous and thus perhaps not as useful in identifying genes that affect schizophrenia risk (i.e. endophenotypes) as it could be. In contrast, symptoms and dimensions of schizotypal personality disorder may be more etiologically homogeneous, and thus more useful in genetic studies. The current review evaluated and consolidated evidence to date regarding specific symptoms and dimensions of schizotypal personality disorder among non-psychotic relatives of schizophrenia patients. Comparisons were made with relatives of affective disorder patients and non-psychiatric controls. Findings indicate strong support for elevation of social-interpersonal schizotypal symptoms among relatives of schizophrenia patients versus other groups along with moderate specificity. Results suggest only a small elevation of cognitive-perceptual and disorganized symptoms in relatives of schizophrenia patients and results for disorganized symptoms were inconsistent across studies. Thus, evidence to date supports further investigation of genetic associations between symptoms of schizotypal personality disorder and schizophrenia, and suggests that social-interpersonal symptoms may be particularly promising in genetic analyses of schizophrenia.
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Affiliation(s)
- Sarah I Tarbox
- Department of Psychology, University of Pittsburgh, USA.
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Carter JW, Parnas J, Urfer-Parnas A, Watson J, Mednick SA. Intellectual functioning and the long-term course of schizophrenia-spectrum illness. Psychol Med 2011; 41:1223-1237. [PMID: 20860870 DOI: 10.1017/s0033291710001820] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recent neurodevelopmental models of schizophrenia, together with substantial evidence of neurocognitive dysfunction among people with schizophrenia, have led to a widespread view that general cognitive deficits are a central aspect of schizophrenic pathology. However, the temporal relationships between intellectual functioning and schizophrenia-spectrum illness remain unclear. METHOD Longitudinal data from the Copenhagen High-Risk Project (CHRP) were used to evaluate the importance of intellectual functioning in the prediction of diagnostic and functional outcomes associated with the schizophrenia spectrum. The effect of spectrum illness on intellectual and educational performance was also evaluated. The sample consisted of 311 Danish participants: 99 at low risk, 155 at high risk, and 57 at super-high risk for schizophrenia. Participants were given intellectual [Weschler's Intelligence Scale for Children (WISC)/Weschler's Adult Intelligence Scale (WAIS)] assessments at mean ages of 15 and 24 years, and diagnostic and functional assessments at mean ages 24 and 42 years. RESULTS Intellectual functioning was found to have no predictive relationship to later psychosis or spectrum personality, and minimal to no direct relationship to later measures of work/independent living, psychiatric treatment, and overall severity. No decline in intellectual functioning was associated with either psychosis or spectrum personality. CONCLUSIONS These largely negative findings are discussed in the light of strong predictive relationships existing between genetic risk, diagnosis and functional outcomes. The pattern of predictive relationships suggests that overall cognitive functioning may play less of a role in schizophrenia-spectrum pathology than is widely believed, at least among populations with an evident family history of schizophrenia.
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Affiliation(s)
- J W Carter
- Department of Psychology, University of West Georgia, Carrollton, GA, USA.
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47
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Abstract
Nonpsychotic anomalies of subjective experience were emphasized in both classic literature and phenomenological psychiatry as essential clinical features of schizophrenia. However, only in recent years, their topicality with respect to the construct validity of the concept of the schizophrenia spectrum has been explicitly acknowledged, mainly as a consequence of the increasing focus on early detection and prevention of psychosis. The current study tested the hypothesis of a specific aggregation of self-disorders (SDs, various anomalies of self-awareness) in schizophrenia-spectrum conditions, comparing different diagnostic groups; 305 subjects, previously assessed in the Copenhagen Schizophrenia Linkage Study, were grouped into 4 experimental samples, according to their Diagnostic and Statistical Manual of Mental Disorders (Third Edition Revised) main diagnosis: schizophrenia, (n = 29), schizotypal personality disorder (n = 61), other mental illness not belonging to the schizophrenia spectrum (n = 112), and no mental illness (n = 103). The effect of diagnostic grouping on the level of SDs was explored via general linear model and logistic regression. The diagnosis of schizophrenia and schizotypy predicted higher levels of SDs, and SDs scores were significantly different between spectrum and nonspectrum samples; the likelihood of experiencing SDs increased as well with the diagnostic severity. The findings support the assumption that SDs are a discriminant psychopathological feature of the schizophrenia spectrum and suggest their incorporation to strengthen its construct validity, with potential benefit for both early detection and pathogenetic research.
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Affiliation(s)
- Andrea Raballo
- Danish National Research Foundation: Center for Subjectivity Research, University of Copenhagen, Copenhagen S, Denmark.
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48
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Mason OJ, Beavan-Pearson J. Understanding the genesis of psychotic disorder: Issues in the prediction and prophylaxis of those at ultra-high risk. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 44:383-404. [PMID: 16238884 DOI: 10.1348/014466505x34615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Recent research is starting to identify individuals at an increased risk of developing a psychotic disorder. This review seeks to identify the 'state of the art' with respect to the clinical identification and treatment of individuals at 'ultra-high risk'. METHOD The research and clinical literature are reviewed with respect to a wide range of predictors relevant across development. RESULTS The review draws on evidence from childhood and adolescence to suggest that a range of biological, cognitive, personality, and social features are predictive of, but often not specific to, psychosis within the context of the diathesis-stress model. Much evidence supports the view that environmental stressors act in combination with vulnerability factors to increase risk of transition, often during late adolescence and early adulthood. CONCLUSIONS Recent clinical research has used both retrospective and prospective means of identifying individuals at ultra-high risk and has made substantial gains in predicting transition. The clinical implications of their identification are discussed in the context of current pharmacological and psychosocial treatment studies. However, significant unresolved clinical and ethical issues remain with both types of study.
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50
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Cheng H, Huang Y, Liu B, Liu Z. Familial aggregation of personality disorder: epidemiological evidence from high school students 18 years and older in Beijing, China. Compr Psychiatry 2010; 51:524-30. [PMID: 20728011 DOI: 10.1016/j.comppsych.2009.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 11/08/2009] [Accepted: 11/18/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There has been evidence from Western countries of the familial aggregation of personality disorder (PD) in clinical populations. Nonetheless, it is not clear if the results apply to nonclinical population or non-Western countries. The aim of this study is to provide evidence about the familial aggregation of PD using an epidemiological sample of high school students and their parents in Beijing, China. METHOD A sample of high school students (at least 18 years old) and their parents was drawn by stratified cluster sampling. Personality disorder in students was assessed via a two-stage approach, Personality Diagnostic Questionnaire (PDQ) as a screening tool and International Personality Disorder Examination as the diagnostic tool. Parents completed the PDQ. Univariate and multivariate analyses were used to address the familial aggregation of PD. RESULTS Students' PDQ scores were correlated with parents' PDQ scores. Parents of PD students scored higher in PDQ and were more likely to be PD cases than controls' parents (adjusted odds ratio, 6.4-18.8). LIMITATIONS Student controls and parents are only assessed by PDQ-4. CONCLUSION Obvious familial aggregation of PD was observed in this study. Psychiatrists may consider asking about family history when diagnosing PD.
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Affiliation(s)
- Hui Cheng
- Department of Preventive Medicine, School of Public Health, Peking University, Beijing 100083, China.
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