The Role of Cognitive Control and Rumination in Predicting Depression among Adolescents with Internalizing Disorders.

BACKGROUND: Given the high prevalence of internalizing disorders among adolescents, it is necessary to define the factors affecting the development and course of psychopathology. Nolen Hoeksema demonstrated the effect of rumination on the development of various forms of psychopathology in adults, while recent data suggest that cognitive control may be a factor underlying this relationship. The aim of this study is to investigate the relation between cognitive control impairments and symptoms of depression through rumination in adolescents suffering from internalizing psychiatric disorders. SUBJECTS AND METHODS: The study included 100 adolescents of both genders diagnosed with internalizing psychiatric disorders at the Unit for Child and Adolescent Psychiatry at University Hospital Center Osijek. During psychodiagnostic assessment, subjects completed Youth self report, CANTAB Intra-dimensional/extra-dimensional (IED) task, The Ruminative Response Scale, and Beck Depression Inventory-II. RESULTS: The results indicate a clinically significant level of internalizing symptoms and a clinically and subclinically high level of depressive symptoms. The results also show a high positive correlation between internalizing symptoms, rumination, and depressive symptoms, as well as a positive correlation between female gender and internalizing symptoms, rumination, and depressive symptoms. Significant predictors of depression are female gender and rumination while cognitive control has not been detected as a significant predictor. CONCLUSION: The results of the study emphasize the importance of rumination in the prediction of depressive symptoms in internalizing psychiatric disorders among adolescents and, accordingly, the importance of rumination as a clinical variable in terms of implications in the prevention and treatment of internalizing psychopathology.

Ethics of the early intervention in the treatment of schizophrenia.

When second generation antipsychotics were introduced in the mid 1990-s they offered the possibility of early psychopharmacological interventions in the treatment of schizophrenia. The idea applying antipsychotics in the prodromal phase of schizophrenia today is an realistic option. However ethical dilemmas about offering antipsychotics to the adolescents with at risk mental states, of whom only a few are real prodromes of schizophrenia remain for clinicians. In the literature about the ethics of the early interventions in psychiatry there are still many ethical questions which call for caution because of the low predictive value of at risk mental states, of which only 40% turn out to be a real prodrome of schizophrenia. These ethical questions can be addressed in three categories: - how to best identify who should receive early pharmacological intervention? - what this intervention should consist of? - how to evaluate treatment efficacy in the absence of illness base rates in the adolescents with a real prodrome of schizophrenia? Besides, arguing against the concept of early psychopharmacological interventions in the adolescent population are the fact of the unknown effect of antipsychotics on the developing brain as well as negative effects of stigma on those adolescents who receive them. The authors in the article analyse these ethical questions and take the side of those clinicians who think that caution and careful ethical judgment are needed before the prescribing of antipsychotics to adolescents with at risk mental states.