The downward spiral of mental disorders and educational attainment: a systematic review on early school leaving.

BACKGROUND: Most psychiatric disorders present symptom patterns that cause severe impairment on the emotional, cognitive and social level. Thus, adolescents who suffer from a mental disorder risk finding themselves in a downward spiral caused by the reciprocal association of psychological symptoms and negative school experiences that may culminate in early school leaving. In addition to previous collective work that mainly focused on school refusing behaviour among children and was presented as an expert's opinion, the following systematic review fills the knowledge gap by providing a structured overview of the bidirectional association between mental health and secondary school dropout based on a sound methodology and with a particular focus on mediating factors. METHODS: Four electronic databases were searched from January 1990 until June 2014. Selected references were assessed for study details, main results, mediating factors and methodological limitations. Standardized risk of bias assessment was conducted. RESULTS: Mood and anxiety disorders seemed to have a less consequential direct effect on early school leaving than substance use and disruptive behaviour disorders. The association between externalizing disorders and educational attainment was even stronger when the disorder occurred early in life. On the other hand, internalizing disorders were reported to develop as a consequence of school dropout. Only few studies had addressed gender differences, with discrepant results. Socio-economic background, academic achievement and family support were identified as significant mediating factors of the association between mental disorders and subsequent educational attainment. CONCLUSIONS: Findings suggested a strong association between mental health and education, in both directions. However, most studies focused on mediating factors that could not be targeted by intervention programs.

Psychosocial risk and protective factors of secondary school dropout in Luxembourg: the protocol of an exploratory case-control study.

BACKGROUND: In Luxembourg, the extensive phenomenon of school dropout is a prime policy concern in the light of individual, social and economic consequences. Although the authorities report an overall decrease of the national dropout rate, the proportion of early school leavers who remain without any specific occupation is still alarming. Therefore, this study intends a shift of focus from system-inherent to individual factors, including mental health and family correlates, to provide a more comprehensive analysis of the dropout phenomenon. METHODS/DESIGN: The objectives of this study are to investigate the type and prevalence of psychiatric disorders among school dropouts and to compare the findings with those by a matched control group of regularly enrolled students. Furthermore, family variables and socioeconomic status will be analysed, as they are factors likely to interfere with both educational attainment and mental health. A trained psychologist will use structured interviews and self-report forms to investigate for mental health issues, information on schooling, socioeconomic situation and family life. Controls will be matched for gender, age, school type and educational grade. DISCUSSION: As school dropouts face a serious risk of long term professional and social marginalization, there is an evident need for action. Identifying psychosocial risk and protective factors of school dropout will deliver solid insight on how to conceive public health strategies for young people who may need a more customized support to carry out their academic potential. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01354236.

Developing the World Health Organization Disability Assessment Schedule 2.0.

OBJECTIVE: To describe the development of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for measuring functioning and disability in accordance with the International Classification of Functioning, Disability and Health. WHODAS 2.0 is a standard metric for ensuring scientific comparability across different populations. METHODS: A series of studies was carried out globally. Over 65,000 respondents drawn from the general population and from specific patient populations were interviewed by trained interviewers who applied the WHODAS 2.0 (with 36 items in its full version and 12 items in a shortened version). FINDINGS: The WHODAS 2.0 was found to have high internal consistency (Cronbach's alpha, α: 0.86), a stable factor structure; high test-retest reliability (intraclass correlation coefficient: 0.98); good concurrent validity in patient classification when compared with other recognized disability measurement instruments; conformity to Rasch scaling properties across populations, and good responsiveness (i.e. sensitivity to change). Effect sizes ranged from 0.44 to 1.38 for different health interventions targeting various health conditions. CONCLUSION: The WHODAS 2.0 meets the need for a robust instrument that can be easily administered to measure the impact of health conditions, monitor the effectiveness of interventions and estimate the burden of both mental and physical disorders across different populations.

The 'European Alliance Against Depression (EAAD)': a multifaceted, community-based action programme against depression and suicidality.

Action programmes fostering partnerships and bringing together regional and national authorities to promote the care of depressed patients are urgently needed. In 2001 the 'Nuremberg Alliance Against Depression' was initiated as a community-based model project within the large-scale 'German Research Network on Depression and Suicidality' (Kompetenznetz 'Depression, Suizidalität'). The 'Nuremberg Alliance Against Depression' was an action programme, conducted in the city of Nuremberg (500,000 inhabitants) in 2001/2002, addressing four intervention levels (Hegerl et al. Psychol Med 2006;36:1225). Based on the positive results of the Nuremberg project (a significant reduction of suicidal behaviour by more than 20%) 18 international partners representing 16 different European countries established the 'European Alliance Against Depression' (EAAD) in 2004. Based on the four-level approach of the Nuremberg project, all regional partners initiated respective regional intervention programmes addressing depression and suicidality. Evaluation of the activities takes place on regional and international levels. This paper gives a brief overview of the background for and experiences with the EAAD. It describes the components of the programme, provides the rationale for the intervention and outlines the current status of the project. The aim of the paper is to disseminate information about the programme's potential to reduce suicidal behaviour and to provide examples of how European community-based 'best practice' models for improving the care of depressed patients and suicidal persons can be implemented using a bottom-up approach. EAAD is mentioned by the European commission as a best practice example within the Green Paper 'Improving the mental health of the population: Towards a strategy on mental health for the European Union' (European Commission 2005).

Recent trends in the study of specific phobias.

PURPOSE OF REVIEW: Specific phobias are prevalent and often disabling anxiety disorders. The present review examines relevant investigations that have been published during the last 2 years on major aspects of this group of disorders. RECENT FINDINGS: Recent studies have come mainly from epidemiology, brain imagery and cognitive-behavioral therapy, including virtual reality exposure therapy. SUMMARY: Studies published in the last 2 years confirm the high prevalence of specific phobias in the general population and provide new insights into the mechanisms underlying the fear reaction after exposure to a phobic stimulus.

[Day care hospital in psychiatry: diversity or specificity?]. / L'Hôpital de jour en psychiatrie: diversité ou spécificité?

Day Care Hospitals represent efficient structures for the treatment of various psychatric disorders through a large variety of medical care. In the litterature, multiple terms are used to define the various models of Day Care Hospitals, according to their use, their orientation and their therapeutic programmes. Our aim in this study is to compare, through a search on "Medline", the various existing models of Day Care Hospitals in France and in Belgium. Thereafter, the "specific" model which exists at the Centre Hospitalier du Luxembourg will be described. Two main types of Day Care Hospitals are described in the litterature: the "classical" type, with mainly a support fuction, resides on the downstream side of hospitalisation and the "specific" type, with a care function for a short duration, resides on its upstream side. The model developed at the Centre Hospitalier du Luxembourg is upstream the hospital. From our study, it is concluded that, rather of being an inconvenience, the large number of existing Day Care Hospitals, which differ by various specificities, represent excellent complementary opportunities for the current care of mental diseases.

Combined pharmacotherapy and cognitive-behavioural therapy for anxiety disorders.

PURPOSE OF REVIEW: Both pharmacotherapy and cognitive-behavioural therapy are effective treatments for anxiety disorders. The present editorial reviews the current status of combination treatments with a focus on randomized controlled trials, meta-analyses and reviews that have been published in the past 3 years. RECENT FINDINGS: Recent studies on treatments combining pharmacotherapy and cognitive-behavioural therapy for anxiety disorders have found little benefit for combination therapies versus monotherapies. New investigations have explored the potential benefits of sequential treatments versus the concomitant ones as well as the use of cognitive enhancers as adjuncts to psychotherapy. SUMMARY: Uncertainty exists as to whether the combination of cognitive-behavioural therapy and pharmacotherapy in the treatment of anxiety disorders is associated with greater overall efficacy than with either treatment when given alone. New ways for combining the two types of treatments are being investigated.

Self-help Internet interventions for mental disorders.

PURPOSE OF REVIEW: In recent years a considerable number of publications has appeared on various aspects of Internet interventions for mental health care. The purpose of the present article is to review the current scientific status of Internet interventions for the treatment of mental disorders. RECENT FINDINGS: Randomized controlled studies on the use Internet interventions for the treatment of mental disorders are still scarce. Most studies in the field have been on Internet interventions for the treatment of depressive disorders and anxiety disorders, using cognitive behavioural therapy. In addition, a few studies have been published on the use of Internet interventions in the treatment of substance use disorders (smoking, problem drinking), insomnia and tinnitus. SUMMARY: Recent studies provide provisional evidence that Internet interventions may be a promising tool for the treatment of some mental disorders.

Economic impact of crisis intervention in emergency psychiatry: a naturalistic study.

OBJECTIVE: This is a naturalistic study comparing the outcomes of all emergency psychiatric interventions in the Hospital Center of Luxembourg during two periods of six months each, before and after the introduction of a crisis intervention program. The aim of the study was to investigate the clinical and economic impact of crisis intervention on psychiatric emergency admissions. METHODS: All subjects admitted to the emergency psychiatric unit during the two study periods were considered for participation. Data were collected retrospectively and comparisons were made between patients before (September 1, 2001 to February 28, 2002) and after (September 1, 2002 to February 28, 2003) crisis intervention programs were established. RESULTS: A comparison between the two patient groups demonstrated a significant decrease in the rate of voluntary hospitalizations after crisis intervention, and a significant increase in the number of patients with subsequent outpatient consultations. The cost increase due to ambulatory follow-ups was widely compensated for by the cost decrease due to hospitalization avoidance. CONCLUSIONS: These preliminary findings suggest that crisis intervention leads to a shift from hospitalization to outpatient psychotherapeutic management in emergency psychiatric services, which has a significant economic impact.

Current status of virtual reality exposure therapy in anxiety disorders: editorial review.

PURPOSE OF REVIEW: In recent years, a considerable number of publications have appeared on different aspects of virtual reality exposure therapy in the treatment of anxiety disorders. The purpose of the present article is to review the evidence that has emerged to support the potential of this therapy in the treatment of anxiety disorders. RECENT FINDINGS: Case histories and open comparative studies, as well as randomized controlled studies, have been published on the use of virtual reality exposure therapy in the treatment of anxiety disorders. Most studies in the field have been on specific phobias, in particular on fear of flying, acrophobia, fear of driving, claustrophobia and fear of spiders. In addition, several studies have been published on the use of virtual reality exposure therapy for social anxiety disorders, posttraumatic stress disorder and panic disorder with or without agoraphobia. SUMMARY: Recent studies provide evidence that virtual reality exposure therapy is a promising tool for the treatment of several anxiety disorders.

New fields of research in posttraumatic stress disorder: brain imaging.

PURPOSE OF REVIEW: This paper reviews the most recent literature on brain imaging research in posttraumatic stress disorder. Neuroimagery identifies several cerebral modifications occurring after a significant psychological trauma, and it contributes to a better understanding of the pathophysiology of posttraumatic stress disorder. A systematic search of the literature in English, French, German and Dutch from January 2003 to August 2004 was performed on MEDLINE. References cited in all trials were searched iteratively to identify missing studies. RECENT FINDINGS: There appears to be a consensus in brain imaging findings concerning posttraumatic stress disorder: a diminished volume of the hippocampus uni- or bilateral (on the structural level) and a hyper-reactivity in the amygdala, with a lowered activation in the anterior cingular cortex (at the functional level). These findings are in agreement with several neurological and psychological studies suggesting that hyper-reactivity in the amygdala corresponds to a constellation of symptoms of anxiety in posttraumatic stress disorder, while the lowered activation of the prefrontal and the anterior cingular cortex could reflect slower extinction of a conditioned emotional response. SUMMARY: These neuroimaging findings could contribute to a better understanding of posttraumatic stress disorder. The integration of neurobiological, social and psychological findings may lead to an improved approach to the pathophysiology of posttraumatic stress disorder and perhaps to the development of new pharmacological treatment. Future studies could integrate the disparate findings among numerous biological systems and propose an integrative structural, functional and endocrinological model.

[The impact of crisis intervention on the management of patients with personality disorder]. / L'impact de l'intervention de crise sur la prise en charge des patients présentant un trouble de personnalité.

The aim of this study was to investigate in psychiatric emergency unit at Hospital Center of Luxembourg the impact of crisis intervention on the management of patients with personality disorder. There were included in this study all the patients with the diagnosis of personality disorder (axis II, criteria DSM IV), even the reason for emergency consultation was related to a disorder diagnosed on the axis I (criteria DSM IV). Data were retrospectively collected to compare patients examined in the psychiatric emergency unit during five months, from 1st September 2001 to 31st January 2002, with those examined from 1st September 2002 to 31st January 2003 and able to benefit from a crisis intervention. The results show a significant reduction of voluntary hospitalizations and a significant increase of the number of patients with more than five outpatient consultations, after the introduction of crisis interventions. The theoretical frame of our psychotherapeutic interventions is briefly exposed. The results of this study emphasize the importance of crisis interventions in psychiatry for improving the management of patients with a personality disorder.

Too few or too many? Reactions to removing versus retaining specific personality disorders in DSM-5.

PURPOSE OF REVIEW: The present review examines the decision of the DSM-5 Personality and Personality Disorders Working Group to retain or to remove specific personality disorders included in DSM-IV-TR and presents the reactions elicited by the decision and published between 10 February 2010 and 30 September 2012. RECENT FINDINGS: In the first draft of Chapter P (Personality disorders), posted on the DSM-5 Internet site on 10 February 2010, the DSM-5 Personality and Personality Disorders Working Group proposed to remove paranoid, schizoid, histrionic, dependent and narcissistic personality disorders from the classification. A revised version of the draft, posted on the Internet in June 2011, reinstated narcissistic personality disorder but not the four remaining types that had been slated for removal. Underlying the decision of the Work Group for retaining versus removing specific personality disorder types are arguments concerning the clinical utility and validity of each type. The arguments provided by the Work Group have not been accepted unanimously by other personality disorder experts. SUMMARY: DSM-5 will retain six out of the 10 personality disorder types listed in DSM-IV-TR while removing the remaining four types. Reactions to the decision and to the arguments presented for doing so have been mixed.

Current status of knowledge on public-speaking anxiety.

PURPOSE OF REVIEW: This review examines the current knowledge on public-speaking anxiety, that is, the fear of speaking in front of others. This article summarizes the findings from previous review articles and describes new research findings on basic science aspects, prevalence rates, classification, and treatment that have been published between August 2008 and August 2011. RECENT FINDINGS: Recent findings highlight the major aspects of psychological and physiological reactivity to public speaking in individuals who are afraid to speak in front of others, confirm high prevalence rates of the disorder, contribute to identifying the disorder as a possibly distinct subtype of social anxiety disorder (SAD), and give support to the efficacy of treatment programs using virtual reality exposure and Internet-based self-help. SUMMARY: Public-speaking anxiety is a highly prevalent disorder, leading to excessive psychological and physiological reactivity. It is present in a majority of individuals with SAD and there is substantial evidence that it may be a distinct subtype of SAD. It is amenable to treatment including, in particular, new technologies such as exposure to virtual environments and the use of cognitive-behavioral self-help programs delivered on the Internet.

Gray matter volume decreases in elderly patients with schizophrenia: a voxel-based morphometry study.

BACKGROUND: Aged patients (>50 years old) with residual schizophrenic symptoms differ from young patients. They represent a subpopulation with a more unfavorable Kraepelinian course and have an increased risk (up to 30%) for dementia of unknown origin. However, our current understanding of age-related brain changes in schizophrenia is derived from studies that included less than 17% of patients who were older than 50 years of age. This study investigated the anatomical distribution of gray matter (GM) brain deficits in aged patients with ongoing schizophrenia. METHODS: Voxel-based morphometry was applied to 3D-T1 magnetic resonance images obtained from 27 aged patients with schizophrenia (mean age of 60 years) and 40 age-matched normal controls. RESULTS: Older patients with schizophrenia showed a bilateral reduction of GM volume in the thalamus, the prefrontal cortex, and in a large posterior region centered on the occipito-temporo-parietal junction. Only the latter region showed accelerated GM volume loss with increasing age. None of these results could be accounted for by institutionalization, antipsychotic medication, or cognitive scores. CONCLUSIONS: This study replicated most common findings in patients with schizophrenia with regard to thalamic and frontal GM deficits. However, it uncovered an unexpected large region of GM atrophy in the posterior tertiary cortices. The latter observation may be specific to this aged and chronically symptomatic subpopulation, as atrophy in this region is rarely reported in younger patients and is accelerated with age.

Assessment of body-image perception and attitudes in obesity.

PURPOSE OF REVIEW: To examine techniques that have been used to assess various aspects of body-image perception and body-image attitudes in obesity. It summarizes findings from previous review articles and reports on new research findings that have been published between August 2007 and August 2010. RECENT FINDINGS: Body-image perception and attitudes in obesity have been assessed using questionnaires, figural drawing scales and computer morphing or adjustment programs. Most of these techniques have been developed to assess body image in eating disorders and as such are not specific to the assessment of body image in obesity. SUMMARY: Body-image perception and body-image attitudes are commonly assessed in research studies on obesity. However, currently available assessment instruments have not been developed specifically for use in obese populations and not all have been validated in these populations. Researchers should be careful in selecting assessment instruments that are appropriate for use in obesity.

Current psychological assessment practices in obesity surgery programs: what to assess and why.

PURPOSE OF REVIEW: The present editorial review examines current psychological assessment practices in obesity surgery programs, reasons for making such assessments and data obtained prior to surgery and during follow-up. It summarizes findings from previous review articles and reports on new research findings that have been published between August 2006 and August 2009. RECENT FINDINGS: Patients with morbid obesity applying for weight loss are commonly administered extensive psychiatric and psychological assessment prior to surgery. Although the value of psychopathological factors for predicting weight loss and mental health after surgery remains controversial, the presence of psychopathology should be taken into account in the presurgery as well as in the postsurgery management of patients undergoing weight-loss surgery. SUMMARY: Morbid obesity is associated with high rates of psychopathology, including depression, anxiety, eating disorders, abnormal personality traits and personality disorders. There is a decrease in psychopathology after obesity surgery in many, though not all, individuals. There is some evidence for poorer postsurgery outcome in individuals with significant presurgery psychopathology, but there is a clear need for more substantial information with regard to reliable psychological predictors of weight loss and mental health after surgery. Whatever the predictive value of psychopathology prior to surgery, it is essential to detect patients in need of psychiatric and/or psychological support after surgery.