Validation of the Chinese version of Community Assessment of Psychic Experiences (CAPE) in an adolescent general population.

The Community Assessment of Psychic Experiences (CAPE) is a popular 42-item self-report assessment of psychosis proneness (PP) that has been widely-translated. However, there is as yet no validation of CAPE in non-Western languages. Here, we validated a Chinese translation of CAPE ("CAPE-C") in a young Chinese community sample. Factor analyses were employed in a sample of 660 individuals (mean age=18.63) to identify a culturally-sensitive factor structure for CAPE-C (Study 1). Since confirmatory factor analysis (CFA) suggested that CAPE-C did not follow the original factor structure, exploratory factor analysis and follow-up CFA were employed to establish an alternative structure, resulting in a 15-item "CAPE-C15" which retained a three-factor structure tapping positive, negative and depressive symptoms. To demonstrate the specificity of CAPE-C15 as a measure of PP, we conducted regression analyses to examine associations between CAPE-C15 dimensions and other measures of psychotic and depressive symptoms (Study 2). Results confirmed that CAPE-C15 dimensions showed specific associations with relevant symptom dimensions of other measures, but not with irrelevant ones. Finally, to aid interpretation of CAPE-C15 scores, Receiver Operating Characteristic analysis was conducted to establish a cut-off score that could indicate test-takers' need for clinical attention (Study 3). We found that a cut-off score of 8.18 on CAPE-C15 positive and negative symptom frequency and distress scores distinguished individuals whose PP was within normal ranges from those at psychometric high-risk (sensitivity: 78.6%; specificity: 77.7%). CAPE-C15 will likely prove relevant to researchers and healthcare providers who serve Chinese-speaking adolescents and young adults.

The unmet concerns of twins with special needs: diagnostic challenges and service recommendations.

The quality of services provided to families of twins with special needs [SPNs] was examined in a US-based study. Participants included 30 parents with monozygotic (n=8) or dizygotic (n=22) twin pairs. Parents completed questionnaires containing quantitative and qualitative components addressing the circumstances and challenges surrounding their twins' diagnoses. Areas of unmet concerns included contact withother parents, respite care and grief counseling. Beneficial services included early interventions (e.g., occupational and physical therapy). Several resources were identified as not providing sufficient benefit (e.g., inadequate state resources). These findings underline the need to improve methods by which knowledge and support are disseminated to parents regarding diagnostic information and service availability. Practitioner and service recommendations are provided.

First trimester risk assessment for trisomy 21 in twin pregnancies combining nuchal translucency and first trimester biochemical markers.

OBJECTIVE: The aim is to describe the performance of first-trimester combined risk assessment in twin pregnancies. METHODS: Maternal serum free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein A (PAPP-A) were determined at 8 to 12 weeks and fetal nuchal translucency (NT) was measured at 11 to 13+6 weeks. The individual risk was estimated for each fetus using the combined test in dichorionic twins. In monochorionic twins, the mean risk assessment of the two fetuses was used. An invasive diagnostic procedure was offered when the risk was ≥ 1 : 270 in either one of the fetuses. RESULTS: From February 2007 to June 2011, 447 twin pregnancies were enrolled in this study. There were 402 (89.9%) dichorionic and 45 (10.1%) monochorionic twins. In dichorionic twins, mean crown-rump length (CRL) was 63.9 mm; median NT multiples of the median (MoM) was 0.97; median Β-hCG was MoM 1.74; median PAPP-A was 1.72. In monochorionic twins, mean CRL was 61.9 mm; median NT MoM was 0. 98; median Β-hCG MoM was 1.44; and median PAPP-A was 1.51. Two pregnancies with Down syndrome were detected by first trimester screening, both in dichorionic twins. The false positive rate was 5.7% (95% confidence interval 4.1-7.3) and 4.4% (95% confidence interval 0.1-8.8%) in dichorionic and monochorionic twins, respectively. CONCLUSIONS: The combined test in twins appears to be a good method for Down syndrome screening with a high detection rate and an acceptable false-positive rate.

A comparison of the construct validity of two alternative approaches to the assessment of psychopathy in the community.

This study compared the validity of 2 different self-report approaches to the assessment of psychopathy in nonforensic samples: the Psychopathy Resemblance Index (PRI), derived from a measure of normal personality functioning, and the Self-Report Psychopathy Scale (SRP), developed specifically to assess the maladaptive traits associated with psychopathy. In 2 adult samples (n (1) = 260, n(2) = 250), the PRI and the SRP were positively correlated with each other and with measures of maladaptive personality traits related to Machiavellianism and narcissism. However, unlike the SRP, the PRI was independent of trait empathy and general psychopathology and was positively associated with trait emotional intelligence. These results suggest that the PRI captures a more adaptive variant of psychopathy than does the SRP.

A time-lagged momentary assessment study on daily life physical activity and affect.

OBJECTIVE: Novel study designs using within-subject methodology and frequent and prospective measurements are required to unravel direction of causality and dynamic processes of behavior over time. The current study examined the effects of physical activity on affective state. A primary and within-study replication sample was derived from twin pairs. METHODS: Female twins (n = 504) participated in an experience sampling method study at baseline. Positive and negative affective changes were examined before and following daily life increases in physical activity. Neuroticism was measured at baseline and depressive symptoms were assessed at baseline and at each of four follow-up assessments. Diagnoses, derived by Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Health-IV axis I disorders, (A. P. A., 1994) were obtained at baseline. RESULTS: A significant increase in positive affect (PA) following the moment of increase in physical activity was replicated across both samples up to 180 min after physical activity. There was no effect of physical activity on negative affect (NA). Across the two samples, a history of fulfilling diagnostic criteria for depression at least once moderated the effect of physical activity on PA, in that the effect was lost more rapidly. CONCLUSIONS: The study supports a causal effect of physical activity on PA. However, people with past experience of clinical depression may benefit less from the PA-inducing effect of physical activity. These findings have implications for the use of physical exercise in clinical practice.

Prenatal screening for and diagnosis of aneuploidy in twin pregnancies.

OBJECTIVE: To provide a Canadian consensus document with recommendations on prenatal screening for and diagnosis of fetal aneuploidy (e.g., Down syndrome and trisomy 18) in twin pregnancies. OPTIONS: The process of prenatal screening and diagnosis in twin pregnancies is complex. This document reviews the options available to pregnant women and the challenges specific to screening and diagnosis in a twin pregnancy. OUTCOMES: Clinicians will be better informed about the accuracy of different screening options in twin pregnancies and about techniques of invasive prenatal diagnosis in twins. EVIDENCE: PubMed and Cochrane Database were searched for relevant English and French language articles published between 1985 and 2010, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis, twin gestation). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS: There is a need for specific guidelines for prenatal screening and diagnosis in twins. These guidelines should assist health care providers in the approach to this aspect of prenatal care of women with twin pregnancies. SUMMARY STATEMENTS 1. Fetal nuchal translucency combined with maternal age is an acceptable first trimester screening test for aneuploidies in twin pregnancies. (II-2) 2. First trimester serum screening combined with nuchal translucency may be considered in twin pregnancies. It provides some improvement over the performance of screening by nuchal translucency and maternal age by decreasing the false-positive rate. (II-3) 3. Integrated screening with nuchal translucency plus first and second trimester serum screening is an option in twin pregnancies. Further prospective studies are required in this area, since it has not been validated in prospective studies in twins. (III) 4. Non-directive counselling is essential when invasive testing is offered. (III) 5. When chorionic villus sampling is performed in non-monochorionic multiple pregnancies, a combination of transabdominal and transcervical approaches or a transabdominal only approach appears to provide the best results to minimize the likelihood of sampling errors. (II-2) Recommendations 1. All pregnant women in Canada, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies. In addition, they should be offered a second trimester ultrasound for dating, assessment of fetal anatomy, and detection of multiples. (I-A) 2. Counselling must be non-directive and must respect a woman's right to accept or decline any or all of the testing or options offered at any point in the process. (III-A) 3. When non-invasive prenatal screening for aneuploidy is available, maternal age alone should not be an indication for invasive prenatal diagnosis in a twin pregnancy. (II-2A) If non-invasive prenatal screening is not available, invasive prenatal diagnosis in twins should be offered to women aged 35 and over. (II-2B) 4. Chorionicity has a major impact on the prenatal screening process and should be determined by ultrasound in the first trimester of all twin pregnancies. (II-2A) 5. When screening is done by nuchal translucency and maternal age, a pregnancy-specific risk should be calculated in monochorionic twins. In dichorionic twins, a fetus-specific risk should be calculated. (II-3C) 6. During amniocentesis, both amniotic sacs should be sampled in monochorionic twin pregnancies, unless monochorionicity is confirmed before 14 weeks and the fetuses appear concordant for growth and anatomy. (II-2B) 7. Prior to invasive testing or in the context of twins discordant for an abnormality, selective reduction should be discussed and made available to those requesting the procedure after appropriate counselling. (III-B) 8. Monitoring for disseminated intravascular coagulopathy is not indicated in dichorionic twin pregnancies undergoing selective reduction. (II-2B).

Genetic and environmental influences on socio-emotional behavior in toddlers: an initial twin study of the infant-toddler social and emotional assessment.

BACKGROUND: Relatively little is known about the genetic architecture of childhood behavioral disorders in very young children. METHOD: In this study, parents completed the Infant-Toddler Social and Emotional Assessment, a questionnaire that assesses symptoms of childhood disorders, as well as socio-emotional competencies, for 822 twin pairs (49.3% female; age 17-48 months) participating in the Wisconsin Twin Project. Psychometric, rater bias, and sex-limitation models explored the role of genetic and environmental influences on (1) externalizing and internalizing behavior; (2) less commonly assessed behaviors pertaining to physical and emotional dysregulation, general competencies, social relatedness; and (3) infrequent behaviors such as those associated with pervasive developmental delays. RESULTS: Heritable influences accounted for the majority (56% or more) of variation in behavior that was commonly observed by both parents. The remaining variance was associated with non-shared environmental factors, with the exception of competency and atypical behavior, which were also influenced by shared environmental factors. In contrast, for most behaviors, the variation unique to mother and father ratings was split between variation due to shared environment or rater biases and to measurement error. Little evidence emerged for sex differences in the underlying causes of variation.

Epidemiology and course of anorexia nervosa in the community.

OBJECTIVE: Most previous studies of the prevalence, incidence, and outcome of anorexia nervosa have been limited to cases detected through the health care system, which may bias our understanding of the disorder's incidence and natural course. The authors sought to describe the onset and outcomes of anorexia nervosa in the general population. METHOD: Lifetime prevalences, incidence rates, and 5-year recovery rates of anorexia nervosa were calculated on the basis of data from 2,881 women from the 1975-1979 birth cohorts of Finnish twins. Women who screened positive for eating disorder symptoms (N=292), their screen-negative female co-twins (N=134), and 210 randomly selected screen-negative women were assessed for lifetime eating disorders by telephone by experienced clinicians. To assess outcomes after clinical recovery and to detect residua of illness, women who had recovered were compared with their unaffected co-twins and healthy unrelated women on multiple outcome measures. RESULTS: The lifetime prevalence of DSM-IV anorexia nervosa was 2.2%, and half of the cases had not been detected in the health care system. The incidence of anorexia nervosa in women between 15 and 19 years of age was 270 per 100,000 person-years. The 5-year clinical recovery rate was 66.8%. Outcomes did not differ between detected and undetected cases. After clinical recovery, the residua of illness steadily receded. By 5 years after clinical recovery, most probands had reached complete or nearly complete psychological recovery and closely resembled their unaffected co-twins and healthy women in weight and most psychological and social measures. CONCLUSIONS: The authors found a substantially higher lifetime prevalence and incidence of anorexia nervosa than reported in previous studies, most of which were based on treated cases. Most women recovered clinically within 5 years, and thereafter usually progressed toward full recovery.

[Paranoid schizophrenia in monozygotic twins--from caregiver to patient affected]. / Paranoide Schizophrenie bei eineiigen Zwillingen--vom Angehörigen zum Betroffenen.

OBJECTIVE: The aim of this case study is to show how a monozygotic twin perceives the schizophrenic disorder of his twin brother and how these experiences affect his own handling and coping after the beginning of his own schizophrenic disorder. PATIENT: A 46-year-old patient with a first episode of schizophrenia who took care of his twin brother with a disease history of 25 years of schizophrenia. RESULTS: In this case the little knowledge the patient had of his schizophrenic disorder and his lasting lack accessing his illness in the context of a defensive mechanism were striking. Concurrently, the patient overestimated his loading capacity. CONCLUSIONS: A long time of caregiving of a schizophrenic twin brother does not necessarily facilitate the coping with a schizophrenic illness of one's own. Defensive mechanisms could inhibit the implementation of constructive coping strategies with the illness.

Anaesthetic management of thoracopagus twins with complex cyanotic heart disease for cardiac assessment: special considerations related to ventilation and cross-circulation.

We describe the anaesthetic management of a pair of thoracopagus twins of 14 months of age undergoing complex cardiac evaluation. Synchronous ventilation of the twins, needed for the ECG-gated magnetic resonance imaging-angiography, was achieved through a Carlens (Y) adaptor during procedures and transport. The complex logistical implications are obvious. We also describe the first use of bispectral index monitor for detection of cross-circulation in conjoint twins.

Screening for aneuploidy in twin pregnancies: maternal age- and race-specific risk assessment between 9-14 weeks.

The aim of this study was to calculate the risk for aneuploidy in twin pregnancies between 9-14 weeks utilizing maternal age, race and dizygotic twinning rates. Using previously published risks for aneuploidy in singletons and twins at the time of amniocentesis and at term, we calculated new risk estimates for twins at 9-14 weeks gestation or at the time of chorionic villus sampling. Using these tables, the risk for trisomy 21 in at least one fetus of a twin gestation in a 32-year-old at 9-14 weeks is 1/285 for Whites and for African-Americans. This is equivalent to the risk for trisomy 21 (1/265) in a 35-year-old woman with a singleton at the same gestational age. The risks for trisomies 18 and 13 also follow similar trends. In counseling women with twin pregnancies at the time of first trimester nuchal translucency screening or chorionic villus sampling, it should be noted that the maternal age-related risk for aneuploidy for a 32-year-old is equivalent to that of a 35-year-old woman with a singleton gestation.

Three-dimensional sonoembryology.

Three-dimensional (3D) ultrasound plays an important role in obstetrics, predominantly for assessing fetal anatomy. Presenting volume data in a standard anatomic orientation valuably assists both ultrasonographers and pregnant patients to recognize the anatomy more readily. Three-dimensional ultrasound is advantageous in studying normal embryonic and/or fetal development, as well as providing information for families at risk for specific congenital anomalies by confirming normality. This method offers advantages in assessing the embryo in the first trimester due to its ability to obtain multiplanar images through endovaginal volume acquisition. Rotation allows the systematic review of anatomic structures and early detection of fetal anomalies. Three-dimensional ultrasound imaging in vivo compliments pathologic and histologic evaluation of the developing embryo, giving rise to a new term: 3D sonoembryology. Rapid technological development will allow real-time 3D ultrasound to provide improved and expanded patient care on the one side, and increased knowledge of developmental anatomy on the other.

Genetics and developmental psychopathology: 1. Phenotypic assessment in the Virginia Twin Study of Adolescent Behavioral Development.

We introduce an overlapping cohort sequential longitudinal study of behavioral development and psychopathology in a representative sample of 1412 pairs of twins aged 8 through 16 years. Multiple phenotypic assessments involve a full psychiatric interview with each child and each parent, and supplementary parental, teacher, and child interview material and questionnaires. For the first wave of assessments, the numbers of reported DSM-III-R symptoms of Major Depressive Disorder (MDD), Separation Anxiety Disorder (SAD), Overanxious Disorder (OAD), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), and Attention Deficit Hyperactivity Disorder (ADHD), assessed through interviews, confirm patterns of age and sex trends found in other epidemiological samples, but underscore their dependence on whether the child or the parent is the informant. Correlations across domains for symptoms reported by the same informant are often as large as correlations across informants for the same domain of symptoms. Factor analyses of these symptom counts, taking account of informant view and unreliability of assessment, show the high degree of correlation between SAD and OAD, between MDD and OAD, and between CD and ODD. ADHD symptoms are relatively independent of the other domains, but show moderate correlations with CD, ODD, and MDD. Factorially derived dimensional questionnaire scales, based on child, parental, and teacher reports, show patterns of relationship to symptom counts consistent with both convergent and discriminant validity as indices of liability to clinical symptoms. Across informants, questionnaire scales provide as good a prediction of symptoms as do clinical interviews. Multitrait-multimethod confirmatory factor analysis reveals the patterns of relationship between symptoms of psychiatric disorder in children taking due account of informant and unique sources of variance. Gender differences are consistent within the correlated clusters of ODD/CD and MDD/SAD/OAD, although there are disorder-specific age trends. There are large informant-specific influences on the reporting of symptoms in clinical interviews. Dimensional questionnaire scales provide a useful source of additional information. In subsequent analyses of genetic and environmental etiology of childhood psychopathology we must expect that results may differ by informant and method of assessment. Multivariate and developmental analyses that explore the sources of these differences will shed new light on the relationship between genetic and environmentally influenced vulnerability and the manifestation of psychopathology in specific circumstances.

Prenatal prediction of neonatal growth status in twins using individualized growth assessment.

OBJECTIVE: To determine if the growth status at birth of twins can be predicted in the third trimester using the Prenatal Growth Assessment Score (PGAS). METHODS: The growth of 40 twin fetuses were studied with ultrasound from 14 weeks until delivery. Measurements of the head circumference (HC), abdominal circumference (AC), thigh circumference (ThC), femur diaphysis length (FDL), head cube (A), and abdominal cube (B) were made at 2 to 3 week intervals. Rossavik growth models for these parameters were determined from second trimester measurements. These models were used to define expected third trimester growth curves and birth characteristics. Comparisons of expected and actual third trimester measurements were used to calculate PGAS values after various time points (PGASAt) and after the last time point (PGASAT). Similar comparisons after birth were used to determine Growth Potential Realization Index (GPRI) values for HC, AC, ThC, weight (WT), and crown-heel length (CHL), with and without correction for decreased soft tissue deposition. These two sets of GPRI values were used to calculate two sets of Neonatal Growth Assessment Scores (NGASS, NGASTw). Using NGASS and NGASTw (as well as GPRI values in some cases), the twin neonates were classified as Normal (N), Decreased Soft Tissue Deposition, (DSTD), Intrauterine Growth Retardation (IUGR) and Macrosomia (M). RESULTS: At birth 22/40 (55%) were classified as N, 9/40 (22.5%) as DSTD, 6/40 (15.0%) as IUGR, and 3/40 (7.5%) as M. All -PGASAT values in the N group were greater than -0.40% with one exception (-PGASAT = -0.43%). All PGASAt values were above this same boundary except for one fetus. No differences were seen between the N and DSTD groups [mean -PGASAT (range): N, -0.12% (0% to -0.34%); DSTD, -0.10% (0% to -0.30%)]. The IUGR group had 4 fetuses with -PGASAT values between -0.65% and 2.79% and two with values of 0.0% and -0.12%. Growth retardation in the latter two was limited to a decrease in thigh soft tissue deposition. -PGASAt values in the first 4 fetuses were below -0.40% 1.6 to 9.5 weeks before delivery (mean: 6.1 weeks). Fetuses in group M had +PGASAT values of 0.0%, +1.8%, and +1.2%. PGASAt values were above +0.40% at 3.6 and 9.8 weeks before delivery in the latter two fetuses. CONCLUSIONS: These results support the concept that PGASAT and PGASAt values outside +/- 0.40% indicate either IUGR or macrosomia. Almost all fetuses with growth problems in the third trimester can be detected, on average, 6 weeks before delivery unless the growth abnormality is limited to decreased soft tissue deposition.