ABSTRACT
The 22q11.2 deletion syndrome (22q11.2DS) is associated with high psychiatric morbidity. However, large phenotypic heterogeneity hampers early detection of 22q11.2DS individuals at highest risk. Here, we investigated whether individuals with 22q11.2DS can be subdivided into clinically relevant subgroups based on their severity of cognitive impairments and whether such subgroups differ in polygenic risk. Using a cross-sectional design, we examined the number of lifetime psychiatric diagnoses and polygenic risk scores for schizophrenia in an unselected nationwide biobank cohort of individuals with 22q11.2DS (n = 183). Approximately 35% of this sample, aged 10-30 years, had a history with one or more psychiatric diagnosis. In a representative nested subgroup of 28 children and youth, we performed additional comprehensive cognitive evaluation and assessed psychiatric symptoms. Unsupervised hierarchical cluster analysis was performed to divide the subgroup of 22q11.2DS individuals, based on their performance on the cognitive testing battery. This produced two groups that did not differ in mean age or gender composition, but were characterized by low cognitive (LF) and high cognitive (HF) functional levels. The LF group, which had significantly lower global cognitive functioning scores, also displayed higher negative symptom scores; whereas, the HF group displayed lower rate of current psychiatric disorders than the LF group and the reminder of the biobank cohort. The polygenic risk score for schizophrenia was insignificantly lower for the low functioning group than for the high functioning group, after adjustment. Cognitive functioning may provide useful information on psychiatric risk.
ABSTRACT
BACKGROUND: Few studies have explored associations between adaptive functioning and cognition in adolescents with early-onset schizophrenia spectrum disorders (EOS). METHODS: Adaptive functioning, cognition, positive, negative, and general symptoms were characterized in adolescents with EOS and healthy controls. A modified scale of negative, respectively, general symptoms was used. Bivariate analyses identified correlates of adaptive functioning to be included in multivariate analysis. RESULTS: Adolescents with EOS showed significant impairments of social- and neurocognitive functions (-0.86 < Cohen´s ds < -0.58) and adaptive functioning (Cohen´s d = -2.23). Visual memory, verbal working memory, processing speed, reaction time, social cognition, and modified negative and general symptoms correlated significantly with adaptive functioning. The multiple regression analysis revealed only verbal working memory as uniquely associated with adaptive functioning (explaining 22.7 % of its variance). Verbal working memory also associated significantly with adaptive functioning in the context of the nonsignificant modified negative and the significant modified general symptoms dimension. CONCLUSIONS: Adolescents with first-episode EOS had large impairments in adaptive functioning and moderate to large cognitive deficits. Verbal working memory was an important associate to concurrent adaptive functioning and may be a treatment target for trials to improve cognitive and adaptive functioning in adolescents with EOS.
ABSTRACT
OBJECTIVE: The home environment provided by the caregivers of a child is an influential single factor for development and well-being. We aimed to compare the quality of the home environment of children at familial high risk of schizophrenia or bipolar disorder with population-based controls. METHODS: Danish nationwide registers were used to retrieve a cohort of 522 7-year-old children of parents diagnosed with schizophrenia (N = 202), bipolar disorder (N = 120) or none of these diagnoses (N = 200). The home environment was assessed using the Middle Childhood-Home Observation for Measurement of the Environment Inventory (MC-HOME Inventory). RESULTS: The proportion of children living in home environments that were evaluated not to meet the needs of a 7-year-old child was significantly larger in the two familial high-risk groups. This was true for 21% of the children with familial predisposition for schizophrenia and 7% of children with familial disposition for bipolar disorder. CONCLUSION: Children born to parents diagnosed with schizophrenia and to a lesser extent bipolar disorder are at an increased risk of growing up in a home environment with an insufficient level of stimulation and support. Identifying families with inadequate home environments is a necessary step towards specialized help and support to at-risk families.
Subject(s)
Bipolar Disorder/diagnosis , House Calls/statistics & numerical data , Parents/psychology , Schizophrenia/diagnosis , Bipolar Disorder/psychology , Caregivers/psychology , Child , Child of Impaired Parents/psychology , Child of Impaired Parents/statistics & numerical data , Cohort Studies , Cross-Sectional Studies , Denmark/epidemiology , Female , Humans , Male , Registries , Risk AssessmentABSTRACT
BACKGROUND: Schizophrenia and attention-deficit/hyperactivity disorder (ADHD) are developmental disorders with shared clinical characteristics such as cognitive impairments and impulsivity. Impulsivity is a core feature of ADHD and an important factor in aggression, violence, and substance use in schizophrenia. Based on the hypothesis that schizophrenia and ADHD represent a continuum of neurodevelopmental impairments, the aim was to identify overlapping and disease specific forms of impulsivity. METHODS: Adolescents between 12 and 17 years of age were assessed with the Schedule for Affective Disorders and Schizophrenia for School-aged Children - Present and Lifetime Version. Subjects with early-onset, first-episode schizophrenia spectrum disorders (EOS) (N = 29) or ADHD (N = 29) and healthy controls (N = 45) were compared on two performance measures (Information Sampling Task, Stop Signal Task) and a subjective personality trait measure of impulsivity (Barratt Impulsiveness Scale, Version 11 (BIS-11)). RESULTS: Significantly increased reflection impulsivity was observed in ADHD but not in the EOS group. No significant response inhibition deficits (stop signal reaction time) were found in the two clinical groups. The ADHD and the EOS group showed significantly increased motor, attentional, and non-planning subtraits of impulsivity. CONCLUSIONS: Impaired pre-decisional information gathering appeared to be specific for ADHD while the information gathering was not significantly reduced in subjects with EOS. Neither the ADHD nor EOS group showed impaired response inhibition but shared increased personality subtraits of attentional, non-planning, and motor impulsivity although the latter was significantly more pronounced in ADHD. These increased subtraits of impulsivity may reflect diagnostic non-specific neurodevelopmental impairments in ADHD and EOS in adolescence.
Subject(s)
Attention Deficit Disorder with Hyperactivity/psychology , Attention , Impulsive Behavior , Schizophrenia/complications , Schizophrenic Psychology , Adolescent , Case-Control Studies , Denmark , Female , Humans , Male , Multivariate Analysis , Neuropsychological Tests , Personality/physiology , Reaction Time , Severity of Illness IndexABSTRACT
The sensory gating deficits in schizophrenia have been theorized to associate with increased distractibility. We explore the potential associations between sensory and sensorimotor gating and subjective and objective indices of distraction in healthy subjects. Forty healthy males were assessed with the P50 suppression and pre-pulse inhibition of the startle reflex (PPI) paradigms. Additionally, a neurocognitive test battery was administered in a cross-over design: with/without auditory distraction. Significant effects of distraction were found in response inhibition, and verbal working memory and attention. Parameters from the PPI and P50 suppression paradigms were significantly associated with the distractor effects on strategy formation, cognitive inhibition and flexibility, visual short-term memory, and the level of subjective distraction. Subjectively reported distraction was significantly associated with verbal working memory and attention as well as executive and supervisory processes. Sensory and sensorimotor gating efficiency do not reflect the effect of distraction across executive and attention functions i.e. we did not observe a generalized distractor effect. Gating only related to the effect of distraction on strategy formation, cognitive inhibition and flexibility, as well as visual short term memory. Future studies should investigate if gating deficits affect the distractibility of the same specific cognitive functions in patients with schizophrenia.
Subject(s)
Attention/physiology , Cognition Disorders/psychology , Inhibition, Psychological , Memory, Short-Term/physiology , Sensory Gating/physiology , Acoustic Stimulation/methods , Adult , Cognition , Cognition Disorders/physiopathology , Cross-Over Studies , Evoked Potentials/physiology , Healthy Volunteers , Humans , Male , Mental Status and Dementia Tests , Prepulse Inhibition , Reflex, Startle/physiologyABSTRACT
BACKGROUND: Deficient mismatch negativity (MMN) has been proposed as a candidate biomarker in schizophrenia and may therefore be potentially useful in early identification and intervention in early onset psychosis. In this study we explored whether deficits in the automatic orienting and reorienting responses, measured as MMN and P3a amplitude, are present in young adolescents with first-episode psychosis (FEP) and whether findings are specific to psychosis compared to young adolescents with attention deficit hyperactivity disorder (ADHD). METHOD: MMN and P3a amplitude were assessed in young adolescents (age 12-17 years) with either FEP (N = 27) or ADHD (N = 28) and age- and gender-matched healthy controls (N = 43). The MMN paradigm consisted of a four-tone auditory oddball task with deviant stimuli based on frequency, duration and their combination. RESULTS: Significantly less MMN was found in patients with psychosis compared to healthy controls in response to frequency and duration deviants. MMN amplitudes in the group of patients with ADHD were not significantly different from patients with psychosis or healthy controls. No significant group differences were found on P3a amplitude. CONCLUSION: Young adolescents with FEP showed impaired MMN compared to healthy controls while intermediate and overlapping levels of MMN were observed in adolescents with ADHD. The findings suggest that young FEP patients already exhibit pre-attentive deficits that are characteristic of schizophrenia albeit expressed on a continuum shared with other neuropsychiatric disorders.
Subject(s)
Attention Deficit Disorder with Hyperactivity/physiopathology , Auditory Perception/physiology , Event-Related Potentials, P300/physiology , Evoked Potentials, Auditory/physiology , Psychotic Disorders/physiopathology , Adolescent , Child , Electroencephalography , Female , Humans , MaleABSTRACT
OBJECTIVE: Neurocognition is known to impact functioning in individuals at ultrahigh risk (UHR) for psychosis, but studies investigating potential mediators of this relationship are scarce. Building on evidence from schizophrenia spectrum disorders, the study tested whether negative symptoms and social skills act as mediators between neurocognition and functional outcome in UHR individuals. METHODS: Ultrahigh risk participants (N = 84) underwent neurocognitive testing using the Brief Assessment of Cognition in Schizophrenia. Social skills and negative symptoms were assessed using the High-Risk Social Challenge task and the Scale for the Assessment of Negative Symptoms respectively. Four instruments were used to assess overall functioning, and one instrument assessed quality of life encompassing social functioning. RESULTS: The cross-sectional analyses revealed that neurocognition was related to the measures of functioning. Negative symptoms mediated the relationship between neurocognition and four of the five measures of functioning. We did not find social skills to mediate between neurocognition and functioning. CONCLUSION: Negative symptoms appear to mediate the relationship between neurocognition and functional outcome in UHR individuals, but the finding needs to be confirmed and extended to longitudinal studies. This underscores the importance of focusing on both neurocognition and negative symptoms when aiming at improving the functional outcome of UHR individuals.
Subject(s)
Cognition Disorders/complications , Psychotic Disorders/psychology , Social Behavior Disorders/complications , Adult , Cognition Disorders/psychology , Cross-Sectional Studies , Female , Humans , Longitudinal Studies , Male , Neuropsychological Tests , Psychiatric Status Rating Scales , Psychotic Disorders/physiopathology , Quality of Life , Risk Factors , Social Behavior , Social Behavior Disorders/psychology , Young AdultABSTRACT
BACKGROUND: Identification of the early signs of schizophrenia would be a major achievement for the early intervention and prevention strategies in psychiatry. Social impairments are defining features of schizophrenia. Impairments of individual layers of social competencies are frequently described in individuals with 22q11.2 deletion syndrome (22q11.2DS), who have high risk of schizophrenia. It is unclear whether and to what extent social impairments associate with subclinical negative and positive symptoms in 22q11.2DS, and which layer of social impairments are more correlated with schizophrenia-related symptoms. The aims of this study were to conduct a comprehensive investigation of social impairments at three different levels (function, skill, and cognition) and their interrelationship and to determine to what degree the social impairments correlate to subclinical levels of negative and positive symptoms, respectively, in a young cohort of 22q11.2DS not diagnosed with schizophrenia. METHODS: The level of social impairment was addressed using questionnaires and objective measures of social functioning (The Adaptive Behavior Assessment System), skills (Social Responsiveness Scale), and cognition (The Awareness of Social Inference Test and CANTAB Emotional Recognition Task), and the presence of subclinical symptoms of schizophrenia were evaluated using the Structured Interview for Prodromal Syndromes in a cross-sectional case-control study of 29 cases and 29 controls, aged 12 to 25 years. Association between social impairment and negative and positive symptoms levels was examined in cases only. RESULTS: Subjects with 22q11.2DS were highly impaired in social function, social skills, and social cognition (p ≤ 6.2 × 10-9) relative to control peers and presented with more negative (p = 5.8 × 10-11) and positive (p = 7.5 × 10-4) symptoms. In particular, social functional and skill levels were highly associated with notably subclinical negative symptoms levels. CONCLUSIONS: This study shows strong correlations between levels of social impairments and subclinical negative and positive symptoms. However, longitudinal studies are required to show if social impairments represent early disease manifestations. If parental or self-reporting suggests severe social impairment, it should advocate for clinical awareness not only to social deficits per se but also of potential subclinical psychosis symptoms.
ABSTRACT
BACKGROUND. In addition to the well-known medical consequences of overweight, severe obesity may also constitute a safety problem on board a ship in case of an emergency. The purpose of this study was to determine the current extent of the problem of overweight among Danish seafarers and fishermen and to follow-up the situation since a previous survey. The aim was to identify the main target groups and determine the need for continuous intervention. MATERIAL AND METHODS. Data on height and weight were obtained from the mandatory health examinations of seafarers and fishermen. A total of 2,101 seafarers were included in the study. Body Mass Index (BMI) was calculated for each individual seafarer. Data from two other surveys were used as reference. RESULTS. A total of 1,379 (66%) of all tested subjects were overweight. Among the male officers and ratings, the relative risk of being overweight was 1.33 (1.25-1.38) and 1.30 (1.22-1.38), respectively. The relative risk for fishermen was 1.45 (1.25-1.66) and for maritime students and trainees 1.44 (1.25-1.66). The female seafarers had a relative risk of being overweight of 1.42 (1.23-1.65). There were a statistical significantly increased number of overweight merchant seafarers since 2001/2002. DISCUSSION. The study shows that Danish merchant seafarers have a major and significantly increasing overweight problem. Among fishermen, overweight was even more frequent. Overweight constitutes a threat not only to their health, but also to their career at sea. The larger than expected incidence of overweight among new employees in the industry provides particular cause for concern. The causes of the problem are complex and interventions need to be broad.
Subject(s)
Fisheries , Health Status , Obesity/epidemiology , Occupational Diseases/epidemiology , Ships , Adult , Body Mass Index , Comorbidity , Denmark , Female , Health Behavior , Humans , Male , Naval Medicine , Obesity/diagnosis , Obesity/prevention & control , Occupational Diseases/diagnosis , Occupational Diseases/prevention & control , Risk Factors , Sex Distribution , Young AdultABSTRACT
BACKGROUND: Upper limb disorders (ULDs) are common, and so are the difficulties in specific diagnoses of these disorders. Prior studies have shed light on the nerves in the diagnostic approach beside disorders related to muscles, tendons and joints (MCDs). OBJECTIVE: The study aimed to compare the distribution of upper limb disorders, and the vibration perception threshold (VPT) in different diagnostic groups according to 1) A-criteria: the SALTSA consensus criteria, including MCDs and four peripheral neuropathies, and 2) B-criteria: including MCDs and 10 different neuropathy diagnoses--re-defined in an attempt to refine diagnostic criteria of peripheral neuropathy in respect of different MCDs; and further to discuss the impact of the presented criteria. METHODS: 161 patients--recruited from 21 general practitioners--were examined by the same examiner according to the two sets of diagnostic criteria. VPT measurements were conducted in all patients. RESULTS: Three patients did not fulfill the criteria of any ULD diagnosis. A/B criteria were fulfilled for 181/183 upper limbs, respectively, out of which 29.3%/163.3% were neuropathy diagnoses alone, 23.8%/10.9% MCD alone, and 46.9%/25.7% were categorized as neuropathy in combination with MCD diagnoses. The overall agreement on presence of neuropathy was high (75%), but on focal level there was a large discrepancy. According to the A-criteria, patients with symptoms located at wrist and shoulder were primarily defined with wrist diagnoses, and only few had concomitant shoulder diagnoses. In contrast, the B-criteria primarily defined neuropathy located at the shoulder, often concomitantly with neuropathy of the radial and the median nerve at the elbow, but seldom at the wrist level. In MCDs defined by both sets of criteria--Rotator cuff syndrome and medial/lateral epicondylitis--the A-criteria defined more MCDs than the B-criteria, the B diagnoses typically constituted only a part of the A diagnoses and additionally defined neuropathy. The B-criteria showed more significant VPT findings than the A-criteria concerning the discrimination between limbs with and contralateral limbs without diagnoses as well as between diagnostic groups with and without neuropathy. CONCLUSIONS: The VPT findings suggest the B-criteria to be superior to A-criteria for differentiating between patients with and without neuropathy. This study shows that neuropathy is extensive in ULDs when specific diagnostic criteria are used. Additionally it suggests the importance of a critical revision of the current diagnostic criteria of upper limb neuropathy, and the differential diagnoses concerning the MCDs. Management and prevention is highly dependent on correct diagnoses.
Subject(s)
Arm , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/etiology , Nervous System Diseases/complications , Occupational Diseases/diagnosis , Occupational Diseases/etiology , Physical Examination/methods , Physical Examination/standards , Adolescent , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
This study aims to identify risk factors and their prevalence in long-term sickness absence. The study is designed as a case-referent study which comprises 481 participants who have experienced a sickness absence lasting >10 weeks and a reference group of 1326 individuals in active employment. Multivariate analysis identified the following significant risk factors for men: (i) age >50 years [odds ratio (OR) = 2.4]; (ii) short period of education (OR = 2.3); (iii) unemployment within the last 3 years (OR = 1.7); (iv) heavy-duty work (OR = 2.1); (v) monotonous, repetitive work (OR = 1.7); (vi) lack of job satisfaction (OR = 2.1); and (vii) much back pain during the last 3 years (OR = 2.1). The following risk factors were identified for women: (i) leaving school without graduation (OR = 2.6); (ii) unemployment within the last 3 years (OR = 1.5); (iii) heavy-duty work (OR = 2.8); (iv) lack of influence on own job situation (OR = 2.1); and (v) much back pain within the last 3 years (OR = 1.8). It is concluded that the identification of working environment risk factors constitutes a case for improvement of the working environment which may be instrumental in reducing long-term sickness absence.
Subject(s)
Sick Leave/statistics & numerical data , Absenteeism , Adolescent , Adult , Aged , Bias , Case-Control Studies , Denmark/epidemiology , Female , Humans , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Regression Analysis , Risk Factors , Sex Factors , Surveys and QuestionnairesABSTRACT
Based on clinical experiences and a review of the literature we describe venepuncture of blood donors complicated by an affection of the peripheral nerves secondary to an arterial or venous lesion. Such complications are rare but potentially disabling and should be known in blood banks and clinical departments to which these patients are referred. Blood donors should be offered optimal and early diagnostics, which appear to be a prerequisite for treatment of donors complaining of pain of neuropathic character extending beyond the puncture site. Recognition of the complication opens options for prevention.
Subject(s)
Elbow/innervation , Nerve Compression Syndromes/etiology , Peripheral Nerve Injuries , Phlebotomy/adverse effects , Blood Donors , Humans , Medical Illustration , Nerve Compression Syndromes/prevention & control , Nerve Compression Syndromes/therapy , Pain/etiology , Pain/physiopathology , Pain/prevention & control , Risk FactorsABSTRACT
Four blood donors with persistent pain and dysfunction of the upper extremity after venepuncture are presented. Physical examinations identified median nerve-affections in all and additionally a varying involvement of other nerves in the elbow region. Such complications appear to have developed following to a vascular lesion. They are rare but potentially disabling and should be known in blood banks and clinical departments to which these patients are referred.
Subject(s)
Elbow/innervation , Nerve Compression Syndromes/etiology , Pain/etiology , Peripheral Nerve Injuries , Phlebotomy/adverse effects , Adult , Blood Donors , Female , Humans , Male , Median Nerve/injuries , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/therapy , Pain/diagnosis , Pain/physiopathology , Peripheral Nerves/physiopathology , Radial Nerve/injuries , Ulnar Nerve/injuriesABSTRACT
A case of a 35 year-old female nurse without atopic disposition is presented. For one year (1990-1991), she worked in an emergency room, applying synthetic casts containing MDI 0-3 times daily. She developed rhinitis, itchy eyes and nightly wheezing, during employment in the emergency room, with subsequent serious asthma attacks in 1992 and 1996. Just before the last attack, the patient's husband had used insulation foam containing MDI. A specific bronchial provocation test was performed with MDI-based synthetic cast material. The patient developed an asthma attack after seven hours, with a 48% drop in FEV1, suggesting that MDI is the causative agent.