Subclinical hallucinations in adolescent outpatients: an outcome study.

OBJECTIVE: We assessed the continued prevalence at one year and association with clinical variables of subclinical hallucinations ascertained at baseline in a cohort of adolescent outpatients referred to a specialized early psychosis service. We further assessed the prevalence of psychiatric disorders in adolescents presenting subclinical hallucinations. METHOD: 84 adolescent patients were sampled from a longitudinal, prospective study that assesses the course of clinical and neuropsychological measures in patients identified as at high clinical risk for psychosis. Subclinical hallucinations were measured using the Scale of Prodromal Symptoms (SOPS) with its companion interview manual (Structured Interview for Prodromal Symptoms, SIPS) [Miller, T.J., McGlashan, T.H., Woods, S.W., Stein, K., Driesen, N., Corcoran, C.M., Hoffman, R., Davidson, L., 1999. Symptom assessment in schizophrenic prodromal states. Psychiatr. Q. 70, 273-287; McGlashan, T.H., Miller, T.J., Woods, S.W., Rosen, J.L., Hoffman, R.E., Davidson, L., 2001. Structured Interview for Prodromal Syndromes (Version 3.0, unpublished manuscript). PRIME Research Clinic, Yale School of Medicine New Haven, Connecticut. ], and the Schizophrenia Proneness Instrument -Adult Version (SPI-A) [Schultze-Lutter, F., Addington, J., Ruhrmann, S., Klosterkötter, J., 2007. Schizophrenia Proneness Instrument (SPI-A). Giovanni Fioriti, Rome, Italy]. At one-year follow-up, only patients reporting subclinical hallucinations at initial assessment were studied. RESULTS: Full remission of subclinical hallucinations occurred in over half and at least partial remission in two thirds of these patients at one-year follow-up. Mood disorders were present in 62.5% of adolescents with subclinical hallucinations at initial assessment. SOPS measures for depression, deficient attention and for unusual/delusional thought were significantly associated with subclinical hallucinations at baseline. However, sustained experience of subclinical hallucinations at one-year follow-up was only predicted by the global level of functioning at baseline, while cannabis abuse, psychiatric and psychopharmacological treatment were not predictors. CONCLUSIONS: Subclinical hallucinations occur across a wide range of mental states in adolescents and show high rates of remission. Our results warrant that the clinical meaning of such phenomena needs to be carefully weighed against the specific developmental phenomena in this particular age range.

[The mental status of overweight children]. / Die psychische Befindlichkeit übergewichtiger Kinder.

OBJECTIVE: Numerous studies based on parent questionnaires reveal that obese children are subject to both physical and psychosocial strains. Children are not included as informants in the assessment procedure, and there is a lack of clinical interview studies assessing DSM-IV-based diagnoses in overweight children. METHODS: Emotional and behavioural problems of treatment seeking obese children (N = 59; aged 8-12-years) attending a mental health service were assessed by means of clinical interviews (Kinder-DIPS) that included child and parent reports. In addition, Child Behavior Checklist (CBCL) data (N = 55) available for this clinical sample were compared with data of a representative sample of normal-weight children (N = 1,080). Furthermore, CBCL data of the clinical subsample of 10-12 year-old overweight children (N = 34) were compared with data of a subsample of 10-12 year-old overweight children (N = 33) and of the subsample of normal-weight (N = 386) children from a representative population, both matched by sex. RESULTS: 23 children (39%) met full criteria for a psychiatric disorder according to DSM-IV, and 19 (34.5%), nearly one third, suffered from Binge Eating Disorder (BED). The overweight clinical sample and their normal weight peers differed significantly on 6 of the 8 primary syndrome scales, on the internalizing and the externalizing scores, and on the total problem score of the CBCL. The overweight children in the clinical sample scored significantly higher than the overweight children in the representative sample on the subscale measuring social problems and the total score, with BMI accounting for the difference in total score. Within the representative sample, overweight 10-12 year-old children scored significantly higher than their normal weight peers on two scales measuring delinquency and social problems. CONCLUSION: A third of the obese children had mental disorders and behaviour problems. This finding applies to clinically referred obese children and, to a much lesser degree, to nonclinical obese subgroups in the normal population. Clinically obese children constitute a patient group that is in urgent need of multimodal treatment. As a consequence, a major change in treatment and prevention of childhood obesity is warranted, i.e., from the mere treatment of eating and activity behaviours to the inclusion of treatment of co-morbid mental disorder and prevention of chronification.

Randomized controlled comparison of two cognitive behavioral therapies for obese children: mother versus mother-child cognitive behavioral therapy.

BACKGROUND: Parent-child treatments have been shown to be superior to child-focused treatments of childhood obesity. Yet until now, the comparative effectiveness of parent-only and parent-child approaches has been little studied. METHOD: Fifty-six obese children and their families were randomly assigned to a 16-session cognitive behavioral therapy (CBT) for the parents only or for a combined treatment of parents and children. Children's percent overweight, the body mass index of their mothers, and behavioral and psychological problems of children and mothers were assessed. RESULTS: Both treatments reduced children's percent overweight significantly and equally by 6-month follow-up. Also both treatments provided similar results in reducing general behavior problems (externalizing and internalizing behavior problems), global and social anxiety, and depression. CONCLUSIONS: Our results point to a comparable efficacy of the two treatments. Further, psychological well-being of both mothers and children can be improved in a CBT for obese children and their parents. Future studies should focus on finding ways to improve the adherence of families to long-term treatment of obesity in childhood.

Cognitive functioning in the schizophrenia prodrome.

In the last decade, there has been an increasing interest in cognitive alterations during the early course of schizophrenia. From a clinical perspective, a better understanding of cognitive functioning in putative at-risk states for schizophrenia is essential for developing optimal early intervention models. Two approaches have more recently been combined to assess the entire course of the initial schizophrenia prodrome: the predictive "basic symptom at-risk" (BS) and the ultra high-risk (UHR) criteria. Basic symptoms are considered to be present during the entire disease progression, including the initial prodrome, while the onset of symptoms captured by the UHR criteria expresses further disease progression toward frank psychosis. The present study investigated the cognitive functioning in 93 subjects who met either BS or UHR criteria and thus were assumed to be at different points on the putative trajectory to psychosis. We compared them with 43 patients with a first episode of psychosis and to 49 help-seeking patient controls. All groups performed significantly below normative values. Both at-risk groups performed at intermediate levels between the first-episode (FE) group and normative values. The UHR group demonstrated intermediate performance between the FE and BS groups. Overall, auditory working memory, verbal fluency/processing speed, and declarative verbal memory were impaired the most. Our results suggest that cognitive impairments may still be modest in the early stages of the initial schizophrenia prodrome and thus support current efforts to intervene in the early course of impending schizophrenia because early intervention may prevent or delay the onset of frank psychosis and thus prevent further cognitive damage.

Developing services for the early detection of psychosis: a critical consideration of the current state of the art.

Recent research has attempted to improve the identification of individuals at-risk of developing schizophrenia to permit targeted early prevention. Two sets of criteria, one characterized by a subgroup of 'basic symptoms' [Klosterkötter, Hellmich, Steinmeyer, Schultze-Lutter (2001) Arch Gen Psychiat 58:158-164] and one by the ultra high-risk model [Miller, McGlashan, Woods, Stein, Driesen, Corcoran, Hoffman, Davidson (1999) Psychiatr Q 70:273-287; Yung, McGorry, McFarlane, Jackson, Patton, Rakkar (1996) Schizophr Bull 22:283-303], have been associated with positive predictive values for later schizophrenia. This paper is a critical discussion of these predictive values. In the first part, the paper demonstrates that the predictive values of at-risk criteria are mediated by a strong enrichment effect and depend considerably on the structure of early detection systems. Further, it shows that these predictive values do not apply to the general population level, where subclinical psychosis shows high prevalence and incidence rates, and that these values may be less predictive in adolescents. In the second part, the paper discusses the need for specific sensitization on several levels of an early detection system and proposes a selected overview of prototypical models already applied in this field.

Defining subjects at risk for psychosis: a comparison of two approaches.

The ability to detect individuals at high risk for developing schizophrenia before they express the disease will lead to targeted early intervention. It has been proposed that subjects at risk share a core deficit with people who already have schizophrenia. This includes cognitive impairment, affective symptoms, social isolation and decline in social functioning. In a sample of 104 help-seeking patients from a specialised outpatient clinic we investigated how well two different sets of criteria define the at-risk group and capture this core deficit. One set of criteria is the well-established ultra high-risk model of McGlashan et al. [McGlashan 2001 (SIPS) McGlashan, T. H., Miller, T. J., Woods, S. W., et al. (2001) Structured Interview for Prodromal Syndromes (Version 3.0, unpublished manuscript). New Haven, Connecticut: PRIME Research Clinic, Yale School of Medicine.]; the other criteria were those defined by Cornblatt et al. [Cornblatt, B., Lencz, T., Smith, C.W., Correll, C.U., Auther, A., Nakayama, E., 2003. The schizophrenia prodrome revisited: a neurodevelopmental perspective. Schizophr. Bull. 29, 633-651.]. There was considerable overlap in the two sets of criteria. However, when the basic symptoms of Klosterkötter [Klosterkötter, J., Hellmich, M., Steinmeyer, E.M., Schultze-Lutter, F., 2001a. Diagnosing schizophrenia in the initial prodromal phase. Arch. Gen. Psychiatry, 58, 158-164.] were included in the McGlashan et al. model, a more narrow and homogeneous group was defined.