RESUMO
BACKGROUND: Both maternal and, separately, paternal mental illness are associated with diminished academic attainment among children. However, the differential impacts of diagnostic type and degree of parental burden (e.g. one v. both parents affected) on these functional outcomes are unknown. METHODS: Using the Swedish national patient (NPR) and multi-generation (MGR) registers, 2 226 451 children (1 290 157 parental pairs), born 1 January 1973-31 December 1997, were followed through 31 December 2013. Diagnostic status of all cohort members was defined for eleven psychiatric disorders, and families classed by exposure: (1) parents affected with any disorder, (2) parents affected with a disorder group (e.g. neuropsychiatric disorders), and (3) parents affected with a specific disorder (e.g. ADHD). Pairs were further defined as 'unaffected,' 'single-affected,', or 'dual-affected.' Among offspring, the study evaluated fulfillment of four academic milestones, from compulsory (primary) school through University (college). Sensitivity analyses considered the impact of child's own mental health, as well as parental education, on main effects. RESULTS: Marked reductions in the odds of achievement were observed, emerging at the earliest levels of schooling for both single-affected [adjusted odds ratio (aOR), 0.50; 95% CI 0.49-0.51] and dual-affected (aOR 0.29, 95% CI 0.28-0.30) pairs and persisting thereafter [aOR range (single), 0.52-0.65; aOR range (dual), 0.30-0.40]. This pattern was repeated for analyses within diagnosis/diagnostic group. Main results were robust to adjustment for offspring mental health and parent education level. CONCLUSIONS: Parental mental illness is associated with profound reductions in educational attainment in the subsequent generation, with children from dual-affected families at uniquely high risk.
Assuntos
Transtornos Mentais , Masculino , Criança , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pais/psicologia , Escolaridade , Pai , Saúde MentalRESUMO
Tourette syndrome (TS) is a highly heritable neuropsychiatric disorder with complex patterns of genetic inheritance. Recent genetic findings in TS have highlighted both numerous common variants with small effects and a few rare variants with moderate or large effects. Here we searched for genetic causes of TS in a large, densely-affected British pedigree using a systematic genomic approach. This pedigree spans six generations and includes 122 members, 85 of whom were individually interviewed, and 53 of whom were diagnosed as "cases" (consisting of 28 with definite or probable TS, 20 with chronic multiple tics [CMT], and five with obsessive-compulsive behaviors [OCB]). A total of 66 DNA samples were available (25 TS, 15 CMT, 4 OCB cases, and 22 unaffecteds) and all were genotyped using a dense single nucleotide polymorphism (SNP) array to identify shared segments, copy number variants (CNVs), and to calculate genetic risk scores. Eight cases were also whole genome sequenced to test whether any rare variants were shared identical by descent. While we did not identify any notable CNVs, single nucleotide variants, indels or repeat expansions of near-Mendelian effect, the most distinctive feature of this family proved to be an unusually high load of common risk alleles for TS. We found that cases within this family carried a higher load of TS common variant risk similar to that previously found in unrelated TS cases. Thus far, the strongest evidence from genetic data for contribution to TS risk in this family comes from multiple common risk variants rather than one or a few variants of strong effect.
Assuntos
Transtornos de Tique , Síndrome de Tourette , Humanos , Linhagem , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco , Síndrome de Tourette/genéticaRESUMO
BACKGROUND: Hoarding disorder is typified by persistent difficulties discarding possessions, resulting in significant clutter that obstructs the individual's living environment and produces considerable functional impairment. The prevalence of hoarding disorder, as defined in DSM-5, is currently unknown. AIMS: To provide a prevalence estimate specific to DSM-5 hoarding disorder and to delineate the demographic, behavioural and health features that characterise individuals with the disorder. METHOD: We conducted a two-wave epidemiological study of 1698 adult individuals, originally recruited via the South East London Community Health (SELCoH) study. Participants screening positively for hoarding difficulties in wave 1, and who agreed to be re-contacted for wave 2 (n = 99), underwent in-home psychiatric interviews and completed a battery of self-report questionnaires. Current DSM-5 diagnoses were made via consensus diagnostic procedure. RESULTS: In total, 19 individuals met DSM-5 criteria for hoarding disorder at the time of interview, corresponding to a weighted prevalence of 1.5% (95% CI 0.7-2.2). Those with hoarding disorder were older and more often unmarried (67%). Members of this group were also more likely to be impaired by a current physical health condition (52.6%) or comorbid mental disorder (58%), and to claim benefits as a result of these issues (47.4%). Individuals with hoarding disorder were also more likely to report lifetime use of mental health services, although access in the past year was less frequent. CONCLUSIONS: With a lower-bound prevalence of approximately 1.5%, hoarding disorder presents as a condition that affects people of both genders and is associated with substantial adversity.
Assuntos
Nível de Saúde , Transtorno de Acumulação/epidemiologia , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Coleta de Dados/métodos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Entrevista Psicológica , Londres/epidemiologia , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Autorrelato , Índice de Gravidade de Doença , Fatores Socioeconômicos , Adulto JovemRESUMO
BACKGROUND: Clutter impeding the normal use of living spaces is a landmark feature of hoarding disorder (HD) but can also be present in other conditions. The assessment of clutter ideally requires home visits, although such assessments are sometimes not feasible. This study examined whether photographs from patients' homes can assist in the diagnostic process. METHODS: Thirty-two professionals with experience with hoarding cases were shown pictures from the inside of 10 houses and asked to decide whether the house belonged to a person with HD, a person with obsessive compulsive disorder (OCD), or a healthy collector. Participants also rated different features of the room appearing in each picture (overall amount of possessions, tidiness, functionality, number of different classes of items, and cleanliness). RESULTS: Sensitivity for the HD and collectors' pictures was high, whereas sensitivity for the OCD pictures was substantially lower. Specificity was high for all groups. Rooms belonging to HD individuals were rated as significantly more cluttered, more untidy, less functional, containing a higher number of different classes of items, and being less clean than the rooms from the remaining groups. CONCLUSIONS: Photographs may be used to assist clinicians in determining the presence of clinically significant levels of clutter in the event a home visit is not feasible. Although differential diagnosis will usually not be possible from photographs alone, examination of certain characteristics of the environment might provide useful diagnostic clues. Combined with a thorough psychopathological interview, the use of photographs may increase the clinician's confidence in the diagnosis of HD.
Assuntos
Transtorno de Acumulação/diagnóstico , Fotografação/métodos , Visita Domiciliar , Habitação , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: A new diagnostic category called Hoarding Disorder (HD) has been proposed for inclusion in DSM-5. It is paramount that this addition does not result in an over-pathologization of normative behavior. Collectors constitute a valid population within which to test the diagnostic boundaries of HD. The current study explored the features that differentiate pathological hoarding from normative collecting. METHODS: Participants were 29 individuals with a diagnosis of HD and 20 individuals who self-identified as collectors who enrolled in the London Field Trial for HD. A series of semi-structured interviews (often in the participants' homes) were conducted, including a detailed assessment of the typical elements of the collecting process. Participants also completed a battery of self-report questionnaires. RESULTS: Collectors were more likely than those with HD to be male, partnered, and free of psychiatric conditions or medication. Like those with HD, collectors reported the acquisition of, attachment to, and reluctance to discarding objects. However, the resulting clutter and impairment were minimal in this group and ultimately insufficient to garner an HD diagnosis. Collectors were, additionally, more focused in their acquisitions (e.g., confining their accumulations to a narrow range of items), more selective (e.g., planning and purchasing only pre-determined items), more likely to organize their possessions and less likely to accumulate in an excessive manner. CONCLUSIONS: There are important quantitative and qualitative differences between HD and normative collecting. For this reason, collectors are unlikely to be inappropriately pathologized by the introduction of HD.
Assuntos
Transtorno de Acumulação/diagnóstico , Passatempos , Adulto , Idoso , Análise de Variância , Estudos de Casos e Controles , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Transtorno de Acumulação/psicologia , Passatempos/psicologia , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
A reluctance to discard items, leading to severely cluttered living spaces, is the landmark feature of hoarding disorder (HD). Many, but not all, individuals with HD also excessively acquire, buy or even steal items that they do not need and for which no space is available. In DSM-5, "excessive acquisition" can be coded as a specifier of HD. Despite their consistent co-occurrence, the question of whether excessive acquisition and difficulties discarding possessions share a common etiology remains unanswered. The current study sought to flesh out this relationship by examining the extent of shared genetic and environmental influences on the association between excessive acquisition and difficulties discarding in a community sample of adult, female twins. A total of 5,022 female twins (2,529 pairs; mean age = 55.5 years) completed a self-report measure of hoarding symptoms, including items assessing excessive acquisition and difficulties discarding. The data were analyzed using bivariate twin modeling methods in the statistical program Mx. As expected, we found a strong phenotypic correlation (0.63) between excessive acquisition and difficulty discarding items. Both traits were moderately heritable. The genetic correlation between the traits was estimated to be 0.77 (95% CI: 0.69-0.85), indicating a substantial but imperfect genetic overlap. The non-shared environmental correlation (0.50 [95% CI: 0.42-0.57]), though lower, was also significant. The findings demonstrate a substantial genetic, and more modest environmental, etiological overlap between the excessive acquisition of possessions and difficulties discarding them, providing a possible explanation for their frequent co-occurrence in HD. However, given that the etiological overlap is not perfect, unique etiological influences, particularly environmental, on each phenotype seem plausible.
Assuntos
Predisposição Genética para Doença , Transtorno de Acumulação/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Londres , Pessoa de Meia-Idade , Sistema de Registros , Gêmeos Dizigóticos , Gêmeos Monozigóticos , Adulto JovemRESUMO
BACKGROUND: Nonrandom mating has been shown for psychiatric diagnoses, with hypothesized-but not quantified-implications for offspring liability. This national cohort study enumerated the incidence of major psychiatric disorders among the offspring of parent pairs affected with schizophrenia (SCZ) and/or bipolar disorder (BIP) (i.e., dual-affected pairs). METHODS: Participants were all Swedish residents alive or born between 1968 and 2013 (n = 4,255,196 unique pairs and 8,343,951 offspring). Offspring with dual-affected, single-affected, and unaffected parents were followed (1973-2013) for incidence of broad psychiatric disorders. Primary outcomes included hazard ratio (HR) and cumulative incidence for SCZ and BIP in the offspring. Additional outcomes included any neuropsychiatric, anxiety, depressive, personality, or substance use disorders. Cumulative incidences of SCZ and BIP were used to inform heritability models for these disorders. RESULTS: Hazards were highest within disorder (e.g., offspring of dual-SCZ pairs had sharply raised hazards for SCZ [HR = 55.3]); however, they were significantly raised for all diagnoses (HR range = 2.89-11.84). Incidences were significantly higher for the majority of outcomes, with 43.4% to 48.5% diagnosed with "any" disorder over follow-up. Risks were retained, with modest attenuations, for the offspring of heterotypic pairs. The estimated heritability of liability for SCZ (h2 = 0.62, 95% confidence interval = 0.55-0.70) and BIP (h2 = 0.52, 95% confidence interval = 0.46-0.58) did not differ significantly from estimates derived from single-affected parents. CONCLUSIONS: Risks for a broad spectrum of psychiatric diagnoses are significantly raised in the offspring of dual-affected parents, in line with expectations from a polygenic model of liability to disease risk. How these risks may contribute to population maintenance of these disorders is considered.
Assuntos
Transtorno Bipolar , Filho de Pais com Deficiência , Esquizofrenia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/genética , Estudos de Coortes , Humanos , Esquizofrenia/epidemiologia , Esquizofrenia/genética , Suécia/epidemiologiaRESUMO
Though problematic hoarding is believed to be a universal human behavior, investigations of clinically-defined hoarding disorder (HD) have been confined almost exclusively to Western countries. The current investigation sought to describe and directly compare the features of individuals meeting diagnostic criteria for HD across four distinct cultural settings. Participants were 82 individuals meeting DSM-5 diagnostic criteria for HD, recruited and assessed by trained clinicians at one of four project sites: London, Barcelona, Fukuoka, and Rio de Janeiro. A series of semi-structured interviews and self-report scales were administered, including assessments of socio-demographic characteristics, psychiatric comorbidity, and severity of hoarding and related features. Results indicate that the severity and core features of HD, as well as the cognitions and behaviors commonly associated with this condition, are largely stable across cultures. However, some differences in patient demographics-in particular age, marital status, and clinical expression-as well as comorbid psychiatric features also emerged. These findings confirm that HD, as defined in DSM-5, exists and presents with similar phenomenology across the studied cultures. Future, more fine-grained, research will be needed to study the features of the disorder in additional cultures (e.g., non-industrialized nations) and to evaluate the impact of these cultural aspects on the design of interventions for the disorder.
Assuntos
Comparação Transcultural , Transtorno de Acumulação/etnologia , Adulto , Idoso , Brasil/etnologia , Feminino , Humanos , Japão/etnologia , Masculino , Pessoa de Meia-Idade , Espanha/etnologia , Reino Unido/etnologiaRESUMO
IMPORTANCE: Psychiatric disorders are heritable, polygenic traits, which often share risk alleles and for which nonrandom mating has been suggested. However, despite the potential etiological implications, the scale of nonrandom mating within and across major psychiatric conditions remains unclear. OBJECTIVE: To quantify the nature and extent of nonrandom mating within and across a broad range of psychiatric conditions at the population level. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort using Swedish population registers. Participants were all Swedish residents with a psychiatric diagnosis of interest (attention-deficit/hyperactivity disorder, autism spectrum disorder, schizophrenia, bipolar disorder, major depression, generalized anxiety disorder, agoraphobia, social phobia, obsessive-compulsive disorder, anorexia, or substance abuse), along with their mates. Individuals with select nonpsychiatric disorders (Crohn's disease, type 1 and type 2 diabetes mellitus, multiple sclerosis, or rheumatoid arthritis) were included for comparison. General population samples were also derived and matched 1:5 with each case proband. Inpatient and outpatient diagnostic data were derived from the Swedish National Patient Register (1973-2009), with analyses conducted between June 2014 and May 2015. MAIN OUTCOMES AND MEASURES: Correlation in the diagnostic status of mates both within and across disorders. Conditional logistic regression was used to quantify the odds of each diagnosis in the mates of cases relative to matched population controls. RESULTS: Across cohorts, data corresponded to 707â¯263 unique case individuals, with women constituting 45.7% of the full population. Positive correlations in diagnostic status were evident between mates. Within-disorder correlations were marginally higher (range, 0.11-0.48) than cross-disorder correlations (range, 0.01-0.42). Relative to matched populations, the odds of psychiatric case probands having an affected mate were significantly elevated. Differences in the magnitude of observed relationships were apparent by disorder (odds ratio range, 0.8-11.4). The number of comorbidities in a case proband was associated with the proportion of affected mates. These relationships were not apparent or weaker in magnitude among nonpsychiatric conditions (correlation range, -0.03 to 0.17). CONCLUSIONS AND RELEVANCE: Nonrandom mating is evident in psychiatric populations both within specific disorders and across the spectrum of psychiatric conditions. This phenomenon may hold important implications for how we understand the familial transmission of these disorders and for psychiatric genetic research.
Assuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/genética , Cônjuges/psicologia , Adulto , Idoso , Estudos de Coortes , Fatores de Confusão Epidemiológicos , Feminino , Pesquisa em Genética , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Estudos de Amostragem , Comportamento Sexual , Suécia/epidemiologiaRESUMO
The extent to which clinicians adhere to international guidelines for the pharmacological management of obsessive-compulsive disorder (OCD) is unknown. We aimed to comprehensively map the patterns of prescription of psychotropic drugs for OCD patients (adults and children) at the Swedish national level and to compare these prescription patterns to best-practice recommendations in international guidelines. We linked the Swedish National Patient Register and the Swedish Prescribed Drug Register, which includes a record for all medications prescribed and dispensed in Sweden since July 2005. Of all active OCD cases in the Swedish National Patient Register between July 1st, 2005, and December 31st 2008 (N=10,523), 85% received at least one psychotropic drug. Most of the medicated adults and children with OCD (88%) received serotonin reuptake inhibitors (SRIs). Of all adults and children prescribed SRIs, 16% received sub-optimal doses. An additional 12% of all medicated patients were prescribed drugs that never included an SRI. Approximately 75% of the patients on SRIs received additional drugs (67% anxiolytics/hypnotics, 27% antipsychotics, 17% serotonin and norepinephrine reuptake inhibitors, 24% other antidepressants). Twelve percent of all medicated patients were at least 'regular' users, and 3% 'heavy' users of benzodiazepines. We also observed important variations in prescription practices according to patient's gender, age, and comorbidity status. We conclude that a substantial number of OCD patients might benefit from changes in their prescriptions. Dissemination of best-practice prescription guidelines for OCD is a major educational goal for the future. Monitoring of these prescription patterns over time is warranted.
Assuntos
Uso de Medicamentos/estatística & dados numéricos , Fidelidade a Diretrizes , Transtornos Mentais/epidemiologia , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Adulto , Fatores Etários , Criança , Estudos de Coortes , Comorbidade , Quimioterapia Combinada/estatística & dados numéricos , Feminino , Humanos , Masculino , Sistema de Registros , Fatores Sexuais , Suécia/epidemiologia , Resultado do TratamentoRESUMO
BACKGROUND: Hoarding Disorder (HD), a new diagnostic entity in DSM-5, is associated with substantial functional impairment and family frustration but data from well-characterized samples is lacking. METHOD: Participants were 37 individuals meeting DSM-5 criteria for HD, 55 relatives of individuals meeting criteria for HD, and comparison groups of 51 self-identified collectors and 25 relatives of collectors. All participants completed a clinician-administered diagnostic interview for HD and an online battery of standardized measures of health, well-being, and impairment. RESULTS: Substantial functional impairment was found for both HD individuals and their relatives. HD relatives reported significantly greater carer burden and accommodation of hoarding behaviors than relatives of collectors. Perceived level of squalor, co-habiting with, and increasing age of the HD individual were significant predictors of carer burden and functional impairment in the relatives. LIMITATIONS: The use of self-identified HD individuals may have produced a bias towards participants with relatively good insight. Subjective biases in self-reported symptoms cannot be ruled out, although the use of informant-report data provided some independent validation. CONCLUSIONS: HD is associated with substantial functional impairment for both sufferers and their relatives. The level of carer burden experienced by HD relatives was comparable to or greater than that reported in the literature by relatives of individuals with dementia. The findings indicate that relatives of individuals with HD may benefit from increased support and suggest that it may be beneficial to involve family members in the treatment of HD.
Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Família/psicologia , Transtorno de Acumulação/psicologia , Atividades Cotidianas , Adulto , Cuidadores/estatística & dados numéricos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Nível de Saúde , Transtorno de Acumulação/diagnóstico , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , AutorrelatoRESUMO
A new diagnosis termed Hoarding Disorder has been proposed for inclusion in the upcoming DSM-5 to cover the majority of cases where severe hoarding occurs in the absence of, or independently from other mental disorders. Much effort has been directed to ensuring that the proposed criteria discriminate Hoarding Disorder from other mental disorders, particularly those historically associated with hoarding (e.g. OCD, OCPD). Considerably less attention, however, has been paid to addressing the suitability of the proposed criteria for effectively differentiating pathological hoarding from normative collecting behavior. This is crucial in order to avoid false positives or the overpathologization of this widespread human activity. Collecting behavior mirrors many of the core features of hoarding (e.g. the acquisition of and emotional attachment to a potentially large number of objects), is highly prevalent and is generally considered a normative form of object amassment; as such, it represents a valid population with which to explore the diagnostic boundaries of Hoarding Disorder. Examination of the collecting literature, within the context of the hoarding diagnostic criteria, indicates that, for the majority of collectors, a diagnosis of Hoarding Disorder is likely to be effectively ruled out. For a minority of 'extreme' collectors, a diagnosis may potentially be adequate. This review highlights the similarities and differences between hoarding and collecting and offers suggestions for further research in this group.