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1.
BMC Psychiatry ; 21(1): 602, 2021 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-34856968

RESUMO

BACKGROUND: Functional recovery of patients with clinical and subclinical psychosis is associated with clinical, neuropsychological and developmental factors. Less is known about how these factors predict functional outcomes in the same models. We investigated functional outcomes and their predictors in patients with first-episode psychosis (FEP) or a confirmed or nonconfirmed clinical high risk of psychosis (CHR-P vs. CHR-N). METHODS: Altogether, 130 patients with FEP, 60 patients with CHR-P and 47 patients with CHR-N were recruited and extensively examined at baseline (T0) and 9 (T1) and 18 (T2) months later. Global Assessment of Functioning (GAF) at T0, T1 and T2 and psychotic, depression, and anxiety symptoms at T1 and T2 were assessed. Functional outcomes were predicted using multivariate repeated ANOVA. RESULTS: During follow-up, the GAF score improved significantly in patients with FEP and CHR-P but not in patients with CHR-N. A single marital status, low basic education level, poor work situation, disorganization symptoms, perceptual deficits, and poor premorbid adjustment in patients with FEP, disorganization symptoms and poor premorbid adjustment in patients with CHR-P, and a low basic education level, poor work situation and general symptoms in patients with CHR-N predicted poor functional outcomes. Psychotic symptoms at T1 in patients with FEP and psychotic and depression symptoms at T1 and anxiety symptoms at T2 in patients with CHR-P were associated with poor functioning. CONCLUSIONS: In patients with FEP and CHR-P, poor premorbid adjustment and disorganization symptomatology are common predictors of the functional outcome, while a low education level and poor work situation predict worse functional outcomes in patients with FEP and CHR-N. Interventions aimed at improving the ability to work and study are most important in improving the functioning of patients with clinical or subclinical psychosis.


Assuntos
Transtornos Psicóticos , Ansiedade , Humanos , Transtornos Psicóticos/diagnóstico
2.
J Ment Health ; 29(4): 376-384, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30675805

RESUMO

Background: Childhood adversities and trauma (CAT) are associated with adult mental disorders. Nevertheless, although CAT of different domains mostly co-occurs, and co-morbidity is common, the associations between CAT and mental disorders, when taking these interrelations into account, are not well known.Aims: We aimed to study differential associations between the five core domains of CAT and current axis-I disorders, taking into consideration their interrelations.Methods: Four hundred and fifteen outpatients attending adult primary (n = 255) and psychiatric care (n = 160) were assessed with the Trauma and Distress Scale (TADS) and the Mini International Neuropsychiatric Interview (MINI). Associations between CAT core domains and diagnostic categories were examined by path analyses.Results: At least some infrequent experience of CAT (83.6%), mostly of neglect, and current mental disorders (49.4%), mostly depression, was frequent, as were co-morbidities and co-occurrence of CAT domains. Considering these interrelations in a path model of excellent fit, physical abuse predicted depressive, manic, psychotic and anxiety disorders, whereas emotional neglect predicted depressive, anxiety and substance misuse disorders.Conclusions: Of all five CAT core domains, physical abuse and emotional neglect had the strongest association with adult psychiatric disorders and might have transmitted earlier reported main effects of other CAT domains onto mental disorders.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Transtornos Mentais/psicologia , Abuso Físico/psicologia , Adulto , Feminino , Humanos , Masculino , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença
3.
Nord J Psychiatry ; 73(2): 125-131, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30856038

RESUMO

BACKGROUND: In addition to psychiatric disorders, childhood adversities may increase the risk of suicidal behavior. In previous studies, the effects of clinical co-morbidity and overlap of childhood adversities has rarely been taken into account. AIM: The study aims to search associations of psychiatric diagnoses and childhood adversities and trauma (CAT) with suicide risk. METHODS: Altogether 415 adult patients attending primary and psychiatric outpatient care filled in the Trauma and Distress Scale, including assessment of five core CAT domains (emotional, physical and sexual abuse, and emotional and physical neglect). The study patients' current psychiatric disorders and suicide risk were assessed by the Mini International Neuropsychiatric Interview. RESULTS: Age, poor perceived health, poor social support, current psychiatric treatment, all psychiatric disorders, except hypomania, emotional and physical abuse, and emotional neglect did associate significantly with suicide risk. Number of psychiatric disorders and CAT domains had dose-dependent effects on suicide risk. In multivariate analysis, current psychiatric treatment, current and life-time major depression, social phobia, alcohol, and drug dependency, as well as emotional abuse had direct associations with suicide risk. In females, manic disorders and drug dependence, and in males, dysthymia, social phobia, and emotional abuse associated with suicide risk. CONCLUSIONS: Psychiatric disorders and most CAT domains associate with suicide risk. However, when the effect of co-morbidity and overlap of CAT domains is controlled, major depression, social phobia, alcohol, and drug dependency and emotional abuse seem to increase the risk of suicide. The risk profile varies between the genders.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/psicologia , Transtornos Mentais/psicologia , Ideação Suicida , Suicídio/psicologia , Adulto , Criança , Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/tendências , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Suicídio/tendências
4.
Soc Psychiatry Psychiatr Epidemiol ; 51(2): 247-57, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26643940

RESUMO

BACKGROUND: The link between depression and paranoia has long been discussed in psychiatric literature. Because the causality of this association is difficult to study in patients with full-blown psychosis, we aimed to investigate how clinical depression relates to the presence and occurrence of paranoid symptoms in clinical high-risk (CHR) patients. METHODS: In all, 245 young help-seeking CHR patients were assessed for suspiciousness and paranoid symptoms with the structured interview for prodromal syndromes at baseline, 9- and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood adversities by the Trauma and Distress Scale, trait-like suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressiveness by the Positive and Negative Syndrome Scale. RESULTS: At baseline, 54.3% of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 and 24.4%. Depressive, obsessive-compulsive and somatoform disorders, emotional and sexual abuse, and anxiety and suspiciousness associated with paranoid symptoms. In multivariate modelling, depressive and obsessive-compulsive disorders, sexual abuse, and anxiety predicted persistence of paranoid symptoms. CONCLUSION: Depressive disorder was one of the major clinical factors predicting persistence of paranoid symptoms in CHR patients. In addition, obsessive-compulsive disorder, childhood sexual abuse, and anxiety associated with paranoia. Effective pharmacological and psychotherapeutic treatment of these disorders and anxiety may reduce paranoid symptoms in CHR patients.


Assuntos
Transtorno Depressivo/epidemiologia , Transtornos Paranoides/diagnóstico , Transtornos Paranoides/epidemiologia , Transtornos Psicóticos/epidemiologia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Entrevista Psicológica , Masculino , Inventário de Personalidade , Escalas de Graduação Psiquiátrica , Medição de Risco , Fatores de Risco , Adulto Jovem
5.
Duodecim ; 131(22): 2117-24, 2015.
Artigo em Fi | MEDLINE | ID: mdl-26749905

RESUMO

Psychoses are associated with problems in the development and maturation of the central nervous system and disturbances of brain connectivity. In all likelihood, their etiology is heterogenous. The susceptibility to and onset of psychosis result from the combined effect of the genome, biological and social risk factors of the early environment and the negative social experiences in childhood and adolescence. Among the neurobiological factors of psychoses, the best characterized is sensitization of the dopamine system in patients affected with schizophrenia, leading to misinterpretation of external stimuli. Psychoses are also associated with alterations in the immune system and metabolism the significance of which in the etiology of the disease is under vigorous research.


Assuntos
Transtornos Psicóticos/etiologia , Suscetibilidade a Doenças , Humanos , Transtornos Psicóticos/metabolismo , Transtornos Psicóticos/fisiopatologia , Fatores de Risco
6.
Soc Psychiatry Psychiatr Epidemiol ; 48(2): 303-11, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22797132

RESUMO

PURPOSE: In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus of recent studies. Their broader outcome has received less attention. We studied psychosocial state and outcome in CHR patients. METHODS: In the European Prediction of Psychosis Study, 244 young help-seeking CHR patients were assessed with the Strauss and Carpenter Prognostic Scale (SCPS) at baseline, and 149 (61.1%) of them were assessed for the second time at the 18-month follow-up. The followed patients were classified into poor and good outcome groups. RESULTS: Female gender, ever-married/cohabitating relationship, and good working/studying situation were associated with good baseline SCPS scores. During follow-up, patients' SCPS scores improved significantly. Good follow-up SCPS scores were predicted by higher level of education, good working/studying status at baseline, and white ethnicity. One-third of the followed CHR patients had poor global outcome. Poor working/studying situation and lower level of education were associated with poor global outcome. Transition to psychosis was associated with baseline, but not with follow-up SCPS scores or with global outcome. CONCLUSION: The majority of CHR patients experience good short-term recovery, but one-third have poor psychosocial outcome. Good working situation is the major indicator of good outcome, while low level of education and non-white ethnicity seem to be associated with poor outcome. Transition to psychosis has little effect on psychosocial outcome in CHR patients. In treating CHR patients, clinicians should focus their attention on a broader outcome, and not only on preventing transition to psychosis.


Assuntos
Avaliação de Resultados em Cuidados de Saúde , Transtornos Psicóticos/epidemiologia , Qualidade de Vida/psicologia , Apoio Social , Adolescente , Adulto , Análise de Variância , Feminino , Seguimentos , Humanos , Masculino , Análise Multivariada , Pacientes/psicologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Adulto Jovem
7.
Nord J Psychiatry ; 67(5): 298-304, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23216246

RESUMO

BACKGROUND: Psychosis and other psychiatric disorders are often preceded by prodromal symptoms. There are few community-based studies on symptom predictors of severe mental problems in healthy people. AIMS: We aimed to study how a new self-reported screen for prodromal symptoms (PROD) predicts onset of all psychotropic and antipsychotic medication in healthy draftees. METHODS: In a prospective follow-up study, 2330 18-year-old Finnish draftees who at call-up in 1999 completed the PROD comprising 21 symptom items divided into positive, negative and general symptom categories were prospectively followed for 6 years. First purchases of any psychotropic and antipsychotic drugs separately between 2000 and 2005 were used as an indicator of the onset of psychiatric disorder and predicted by PROD symptoms in Cox regression analysis. RESULTS: A majority of the PROD items significantly predicted the first purchases of any psychotropic and of antipsychotic drugs, separately. Positive, negative and general symptoms predicted purchases of any psychotropic medication, while negative and general symptoms predicted purchases of antipsychotic drugs. General symptoms, in particular anxiety, had a strong independent association with onset of psychotropic medication. CONCLUSIONS: In young healthy men, self-reported sub-clinical psychic symptoms predict onset of psychiatric disorders requiring psychotropic, including antipsychotic, medication.


Assuntos
Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Sintomas Prodrômicos , Adolescente , Seguimentos , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Militares , Estudos Prospectivos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Psicotrópicos/uso terapêutico , Autorrelato , Inquéritos e Questionários , Adulto Jovem
8.
Early Interv Psychiatry ; 17(7): 692-701, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36218312

RESUMO

BACKGROUND: Several psychological symptoms in adolescence associate with later development of psychosis. However, it is unclear which symptoms specifically predict psychotic disorders rather than psychiatric disorders in general. We conducted a prospective study comparing how specific adolescent psychotic-like symptoms, predicted psychotic and non-psychotic hospital-treated psychiatric disorders in the population-based Northern Finland Birth Cohort 1986 (NFBC1986). METHODS: At age 15-16 years, 6632 members of the NFBC1986 completed the PROD-screen questionnaire. New hospital-treated mental disorders of the NFBC1986 participants were detected between age 17 and 30 years from the Finnish Care Register for Health Care. Multiple covariates were used in the analysis. RESULTS: During the follow-up, 1.1% of the participants developed a psychotic and 3.2% a non-psychotic psychiatric disorder. Three symptoms were specifically associated with onset of psychosis compared to non-psychotic psychiatric disorders: 'Difficulty in controlling one's speech, behaviour or facial expression while communicating' (adjusted OR 4.00; 95% CI 1.66-9.92), 'Difficulties in understanding written text or heard speech' (OR 2.25; 1.12-4.51), and 'Difficulty or uncertainty in making contact with other people' (OR 2.20; 1.03-4.67). Of these, the first one remained statistically significant after Bonferroni correction for multiple comparisons. CONCLUSION: To our knowledge, this is the first general-population-based prospective study exploring psychiatric symptoms predicting the onset of hospital-treated first-episode psychosis in comparison to non-psychotic disorders. We found three symptoms related with difficulties in social interaction which predicted onset of psychosis. This is a novel finding and should be replicated.


Assuntos
Coorte de Nascimento , Transtornos Psicóticos , Humanos , Adolescente , Adulto Jovem , Adulto , Finlândia/epidemiologia , Estudos Prospectivos , Sintomas Prodrômicos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia
9.
Soc Psychiatry Psychiatr Epidemiol ; 46(1): 17-27, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19907910

RESUMO

OBJECTIVE: Our aim was to study the association between psychotic-like symptoms and inattention/hyperactivity symptoms in a general adolescent population. SUBJECTS AND METHODS: The sample is based on a population-based prospective mother-child birth cohort, the Northern Finland Birth Cohort 1986. In the 15-16-year follow-up survey, the adolescents completed the Youth Self-Report questionnaire as well as the PROD-Screen questionnaire that addressed prodromal symptoms of psychosis. Meanwhile, their parents assessed inattention and hyperactive symptoms of their offspring by completing the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors questionnaire (N = 5,318). The cross-sectional associations between psychotic-like symptoms and inattention/hyperactivity symptoms were studied with logistic regression models. RESULTS: The association between negative psychotic-like symptoms and inattention symptoms, especially the dreamy type of inattention symptoms (e.g., difficulties in organizing tasks, losing things, being forgetful), was statistically significant for both genders. Psychotic-like symptoms, however, were not associated with hyperactivity symptoms. CONCLUSIONS: The present findings demonstrate that an association between psychotic-like symptoms and attentional dysfunction, which has been found in clinical samples, is also present in a general adolescent population.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estudos de Coortes , Estudos Transversais/estatística & dados numéricos , Coleta de Dados , Feminino , Finlândia/epidemiologia , Seguimentos , Nível de Saúde , Humanos , Classificação Internacional de Doenças/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pais/psicologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Transtornos Psicóticos/epidemiologia , Autorrelato , Inquéritos e Questionários
10.
Br J Psychiatry ; 197(4): 278-84, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20884950

RESUMO

BACKGROUND: Decline in social functioning occurs in individuals who later develop psychosis. AIMS: To investigate whether baseline differences in disability are present in those who do and those who do not make a transition to psychosis in a group clinically at high risk and whether disability is a risk factor for transition. METHOD: Prospective multicentre, naturalistic field study with an 18-month follow-up period on 245 help-seeking individuals clinically at high risk. Disability was assessed with the Disability Assessment Schedule of the World Health Organization (WHODAS-II). RESULTS: At baseline, the transition group displayed significantly greater difficulties in making new friends (z = -3.40, P = 0.001), maintaining a friendship (z =-3.00, P = 0.003), dealing with people they do not know (z =-2.28, P = 0.023) and joining community activities (z =-2.0, P = 0.05) compared with the non-transition group. In Cox regression, difficulties in getting along with people significantly contributed to the prediction of transition to psychosis in our sample (ß = 0.569, s.e. = 0.184, Wald = 9.548, P = 0.002, hazard ratio (HR) = 1.767, 95% CI 1.238-2.550). CONCLUSIONS: Certain domains of social disability might contribute to the prediction of psychosis in a sample clinically at high risk.


Assuntos
Atividades Cotidianas/psicologia , Pessoas com Deficiência/psicologia , Relações Interpessoais , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Inquéritos e Questionários , Adolescente , Adulto , Criança , Progressão da Doença , Diagnóstico Precoce , Europa (Continente) , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Esquizofrenia/epidemiologia , Participação Social/psicologia , Adulto Jovem
11.
Psychiatry Res ; 179(2): 151-6, 2010 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-20483480

RESUMO

This study was designed to assess cognitive functioning in a clinical sample of adolescents with heterogeneous psychiatric diagnoses, with a specific focus on patients at clinical high risk (CHR) for psychosis. The sample comprised 22 patients identified at CHR for psychosis, 67 psychotic and 187 non-psychotic, non-CHR patients. Neuropsychological assessment was conducted as part of the clinical examination and treatment, including Wechsler Intelligence Scale for Children (WISC)-III and/or Wechsler Adult Intelligence Scale (WAIS)-III measures of verbal comprehension, perceptual organisation, working memory and processing speed, Wisconsin Card Sorting Test (WCST) measures of executive function, and the Rorschach Comprehensive System measures of perceptual and thinking accuracy. Patients at CHR for psychosis did not significantly differ from other patient groups in terms of intellectual or executive functions. The Rorschach Perceptual Thinking Index (PTI) distinguished patients at CHR for psychosis from those diagnosed as having non-psychotic disorders, but not from those diagnosed as psychotic. Our results suggest perceptual and thought disturbance as an important indicator of vulnerability to psychosis.


Assuntos
Transtornos Mentais , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Pensamento/fisiologia , Adolescente , Análise de Variância , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Feminino , Humanos , Testes de Inteligência , Masculino , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/complicações , Risco , Adulto Jovem
12.
Eur Psychiatry ; 24(4): 233-8, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19201166

RESUMO

AIM: Risk of psychosis is defined by the presence of positive psychotic-like symptoms, by subtle self-perceived cognitive and perceptual deficiencies, or by decreased functioning with familial risk of psychosis. We studied the associations of psychiatric outpatients' self-reported functioning and interpersonal relationships with vulnerability to and risk of psychosis. METHODS: A total of 790 young patients attending psychiatric outpatient care completed the PROD screen [Heinimaa M, Salokangas RKR, Ristkari T, Plathin M, Huttunen J, Ilonen T, et al. PROD-screen - a screen for prodromal symptoms of psychosis. Int J Meth Psychiatr Res 2003;12:92-04.], including questions on functioning, interpersonal relationships and subtle specific (psychotic-like) and non-specific symptoms. Vulnerability to psychosis was assessed employing the patient's written descriptions of specific symptoms. Of the patients vulnerable to psychosis, those at current risk of psychosis were assessed using the Bonn Scale for Assessment of Basic Symptoms [Schultze-Lutter F, Klosterkötter J. Bonn scale for assessment of basic symptoms - prediction list, BSABS-P. Cologne: University of Cologne; 2002] and the Structured Interview for Positive symptoms [Miller TJ, McGlashan TH, Rosen JL, Somjee L, Markovich PJ, Stein K, et al. Prospective diagnosis of the initial prodrome for schizophrenia based on the structured interview for prodromal syndromes: preliminary evidence of interrater reliability and predictive validity. Am J Psychiatry 2002;159:863-65.]. RESULTS: In all, 219 patients vulnerable to and 55 patients at current risk of psychosis were identified. Vulnerability to psychosis was associated with all items of functioning and interpersonal relationships. Current risk of psychosis, however, was associated only with the subjectively reported negative attitude of others. Negative attitude of others was also associated with feelings of reference at both vulnerability and risk levels. CONCLUSION: The subjective experience of negative attitude of others towards oneself may be an early indicator of psychotic development.


Assuntos
Atitude Frente a Saúde , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Percepção Social , Inquéritos e Questionários , Adolescente , Adulto , Assistência Ambulatorial , Diagnóstico Precoce , Feminino , Humanos , Relações Interpessoais , Masculino , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Fatores de Risco , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Autoimagem , Ajustamento Social
13.
Early Interv Psychiatry ; 13(4): 935-942, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30033690

RESUMO

AIM: Depression and suicidal ideation (SUI) and behaviour are more prevalent in females than males, and common in clinical high-risk (CHR) patients. Childhood adversities and trauma (CAT) are associated with adult depression and SUI. The role of gender as a moderator and depression as a mediator for the effect of CAT on SUI has not been explored in CHR patients. METHODS: In all, 245 young help-seeking CHR patients were assessed for SUI (thoughts of killing themselves) with the Beck Depression Inventory at baseline, 9-month and 18-month follow-ups. At baseline, clinical depression was assessed by the Structured Clinical Interview for DSM-IV (SCID-I), and CAT by the Trauma and Distress Scale (TADS) which includes the five domains of emotional, physical and sexual abuse, emotional and physical neglect. RESULTS: CAT total and all domains except physical neglect predicted SUI over the study period. The effect of CAT on SUI was mediated via clinical depression and concurrent depression symptoms differently for females and males. In females, the effect of emotional abuse and neglect on SUI was mediated via baseline depression. In males, emotional and physical abuse had a direct effect on SUI, and the effect of sexual abuse and emotional neglect was partly mediated via concurrent depression symptoms. CONCLUSIONS: For CHR females, the effect of CAT on adult SUI is mediated via depression, while for males, CAT and its domains have mainly direct effects in maintaining SUI. These gender differences should be taken into account when treating CHR patients with SUI.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Experiências Adversas da Infância , Maus-Tratos Infantis/psicologia , Transtorno Depressivo/psicologia , Transtornos Psicóticos/psicologia , Ideação Suicida , Adolescente , Adulto , Criança , Maus-Tratos Infantis/diagnóstico , Transtorno Depressivo/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Fatores de Risco , Fatores Sexuais , Adulto Jovem
14.
Schizophr Res ; 199: 346-352, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29661524

RESUMO

OBJECTIVE: To investigate the impact of expressed emotion (EE) on the risk of developing the first psychotic episode (FEP). METHOD: The European Prediction of Psychosis Study (EPOS) investigated 245 patients who were at clinical high risk (CHR) of psychosis. The predictive value of EE alone and as a part of the multivariate EPOS model was evaluated. RESULTS: "Perceived irritability", a domain of the Level of Expressed Emotion Scale (LEE), was found to be predictive for the First Psychotic Episode (FEP), even as an individual variable. Furthermore, it was selected in the multivariate EPOS prediction model, thereby replacing two of the original predictor variables. This led to an improved revised version that enabled the identification of three significantly different risk classes with a hazard rate of up to 0.911. CONCLUSIONS: CHR subjects who perceive the most important person in their individual social environment to be limited in their stress coping skills had a higher risk of conversion to the first psychotic episode. The importance of this risk factor was further demonstrated by an improvement of risk estimation in the original EPOS predictor model. Perceiving a reference person as stress-prone and thus potentially unreliable might amplify self-experienced uncertainty and anxiety, which are often associated with the prodromal phase. Such an enforcement of stress-related processes could promote a conversion to psychosis.


Assuntos
Emoções Manifestas , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Feminino , Humanos , Masculino , Modelos Psicológicos , Análise Multivariada , Sintomas Prodrômicos , Prognóstico , Modelos de Riscos Proporcionais , Risco , Adulto Jovem
15.
Schizophr Bull ; 33(3): 715-26, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17483100

RESUMO

The prodrome of psychosis has become a target for early identification and for treatments that address both symptoms and risk for future psychosis. Interest and activity in this realm is now worldwide. Clinical trials with rigorous methodology have only just begun, making treatment guidelines premature. Despite the sparse evidence base, treatments are currently applied to patients in the new prodromal clinics, usually treatments developed for established psychosis and modified for the prodromal phase. This communication will describe representative samplings of how treatment-seeking prodromal patients are currently recruited and treated in prodromal clinics worldwide. Recruitment includes how prodromal patients are sought, initially evaluated, apprised of their high-risk status, and informed of the risks and benefits of prodromal treatments and how their mental state is monitored over time. The treatment modalities offered (and described) include engagement, supportive therapy, case management, stress management, cognitive behavioral treatment, family-based treatment, antipsychotic pharmacotherapy, and non-antipsychotic pharmacotherapy. References for details are noted.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Seleção de Pacientes , Esquizofrenia/prevenção & controle , Psicologia do Esquizofrênico , Transtorno da Personalidade Esquizotípica/terapia , Administração de Caso , Ensaios Clínicos como Assunto , Terapia Combinada , Comparação Transcultural , Diagnóstico Precoce , Humanos , Consentimento Livre e Esclarecido , Avaliação de Processos e Resultados em Cuidados de Saúde , Gestão de Riscos , Esquizofrenia/diagnóstico , Transtorno da Personalidade Esquizotípica/diagnóstico
16.
Psychiatry Res ; 150(3): 255-63, 2007 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-17331590

RESUMO

Patients with psychosis have been found to suffer from physical illnesses more commonly than the general population. In this report, self-reported physical ill health and its correlates among subjects with and without vulnerability to psychosis in a sample of first-degree relatives, help-seekers and controls were investigated. Perceived physical health was statistically significantly poorer among subjects with minor symptoms on the Structured Interview for Prodromal Symptoms and those vulnerable to psychosis than among those without symptoms measured by 13 somatoform symptom sum scores of the Symptom Checklist-90. Those at current risk of psychosis had a significantly higher mean sum score on the 13 somatic items (mean=21.1) than others (mean=9.6). Having physical symptoms or a self-reported physician-diagnosed illness was significantly associated with vulnerability to psychosis (odds ratio=3.05). The subjects with a mood disorder (odds ratio=4.33) had significantly more commonly physician-diagnosed illnesses than those who had no diagnosis or any other diagnosis. Physical ill health seems to be common among those vulnerable to psychosis.


Assuntos
Nível de Saúde , Transtornos Psicóticos/psicologia , Adulto , Atitude Frente a Saúde , Feminino , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/epidemiologia
17.
Early Interv Psychiatry ; 10(2): 129-36, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24861468

RESUMO

AIM: In the recent literature, there has been growing interest in assessment methods for detecting increased risk of developing psychosis. Self-report methods are popular but may lead to different results compared to clinical interviews. METHODS: The difference in psychosis risk scores was tested between self-reported psychosis risk symptoms (PROD-SR) and self-reported symptoms additionally confirmed by interview (PROD-SR + I). The symptom categories were derived from 12 common psychosis risk symptoms included in the PROD screening instrument. The data were collected by questionnaires and interviews conducted with 395 adolescents (mean age 15.3 years) in an early intervention and detection team, JERI, at Helsinki University Central Hospital, Finland. RESULTS: The results show a significant difference between the PROD-SR risk symptom sum scores and the PROD-SR + I risk symptom sum scores (N = 395; Z = -15.123; P < 0.001). In an item-by-item analysis, the item 'Disorders in connection with hearing' had the strongest kappa value (0.827) agreement between an interviewed and self-report psychosis risk item. Agreement in most items remained between slight and substantial (kappa values from 0.082 to 0.649). CONCLUSIONS: The results suggest that there is a significant difference between psychosis risk symptom responses collected by self-report and self-report responses which are additionally confirmed by interview. Auditory disorders are the most reliably reported item with self-report.


Assuntos
Doenças Auditivas Centrais/diagnóstico , Diagnóstico Precoce , Entrevista Psicológica , Transtornos Psicóticos/diagnóstico , Autorrelato , Adolescente , Doenças Auditivas Centrais/complicações , Criança , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/complicações , Fatores de Risco , Avaliação de Sintomas , Adulto Jovem
18.
J Affect Disord ; 206: 109-114, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27472412

RESUMO

BACKGROUND: Genetic studies imply a shared genetic etiology between bipolar disorder (BD) and migraine. Epidemiological studies have demonstrated elevated comorbidity between these disorders, but haven't controlled for parental psychopathology. No previous nationally representative studies exist on familial clustering of BD and migraine. This study examines the association between parental and comorbid migraine and BD, controlling for potential confounders. METHODS: We identified 1861 cases aged ≤25 years, 3643 matched controls, and their parents from Finnish national registers. Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) and two-sided significance limits of p<0.05. RESULTS: Parental migraine, controlling for parental BD, was associated with offspring BD diagnosed at age ≥18 years (OR 1.52, 95%CI: 1.08-2.14). Associations between BD and comorbid migraine persisted following adjustment for parental BD and parental migraine in all subjects (OR=2.46, 95% CI: 1.76-3.42), both age groups of BD-diagnosis (<18 years,≥18 years) and both sexes. LIMITATIONS: The diagnoses were register-based, not directly ascertained. CONCLUSIONS: This study indicates that parental migraine, even in the absence of parental BD, is a risk factor for offspring BD. Thus, a genetic link between BD and migraine could potentially explain some of the elevated comorbidity between these disorders. However, BD shows a stronger association with comorbid migraine than with parental migraine, suggesting that much of the elevated comorbidity is related to non-genetic factors. Increased understanding of mechanisms underlying the comorbidity of BD and migraine is important since it is associated with poorer health-related outcomes compared with BD alone.


Assuntos
Transtorno Bipolar/epidemiologia , Filho de Pais com Deficiência/estatística & dados numéricos , Transtornos de Enxaqueca/epidemiologia , Sistema de Registros , Adolescente , Adulto , Comorbidade , Feminino , Finlândia/epidemiologia , Humanos , Armazenamento e Recuperação da Informação , Modelos Logísticos , Masculino , Razão de Chances , Pais , Fatores de Risco , Adulto Jovem
19.
Eur J Psychotraumatol ; 7: 30062, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27032511

RESUMO

BACKGROUND: There is increasing evidence that a history of childhood abuse and neglect is not uncommon among individuals who experience mental disorder and that childhood trauma experiences are associated with adult psychopathology. Although several interview and self-report instruments for retrospective trauma assessment have been developed, many focus on sexual abuse (SexAb) rather than on multiple types of trauma or adversity. METHODS: Within the European Prediction of Psychosis Study, the Trauma and Distress Scale (TADS) was developed as a new self-report assessment of multiple types of childhood trauma and distressing experiences. The TADS includes 43 items and, following previous measures including the Childhood Trauma Questionnaire, focuses on five core domains: emotional neglect (EmoNeg), emotional abuse (EmoAb), physical neglect (PhyNeg), physical abuse (PhyAb), and SexAb.This study explores the psychometric properties of the TADS (internal consistency and concurrent validity) in 692 participants drawn from the general population who completed a mailed questionnaire, including the TADS, a depression self-report and questions on help-seeking for mental health problems. Inter-method reliability was examined in a random sample of 100 responders who were reassessed in telephone interviews. RESULTS: After minor revisions of PhyNeg and PhyAb, internal consistencies were good for TADS totals and the domain raw score sums. Intra-class coefficients for TADS total score and the five revised core domains were all good to excellent when compared to the interviewed TADS as a gold standard. In the concurrent validity analyses, the total TADS and its all core domains were significantly associated with depression and help-seeking for mental problems as proxy measures for traumatisation. In addition, robust cutoffs for the total TADS and its domains were calculated. CONCLUSIONS: Our results suggest the TADS as a valid, reliable, and clinically useful instrument for assessing retrospectively reported childhood traumatisation.

20.
Schizophr Res ; 75(2-3): 439-46, 2005 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-15885535

RESUMO

BACKGROUND: The psychopathology that manifests during the prodromal phase of first-episode psychosis is varied. Little is known about the clinical diagnoses of subjects with so-called prodromal or psychotic-like symptoms. METHOD: Samples of psychotic patients, first-degree relatives (FDRs) of psychotic, or severely ill patients, treatment-seeking patients, and a random community sample (in all 157 subjects) were assessed by the Structured Interview for Prodromal Symptoms (SIPS) and the SCID-I. Vulnerability to psychosis (VTP) was defined by severity of positive symptoms reported in the SIPS interview and associated with lifetime SCID-I diagnoses. RESULTS: The number of lifetime diagnoses received increased linearly as the SIPS symptoms approached more psychotic-like phenomena. All VTP subjects received on average 2.5, and currently prodromal subjects 2.9 lifetime SCID-I diagnoses, while the corresponding figure for non-VTP subjects was 0.7 (p<0.0001). Mood disorders and comorbid anxiety disorders were particularly common. CONCLUSION: Vulnerability to psychosis seems to be associated with a high number of lifetime Axis-I diagnoses. Occurrence of anxiety disorders is remarkable, and most VTP subjects can be diagnosed with a lifetime mood disorder. VTP subjects require careful assessment of mood and anxiety symptoms and adequate treatment for their multiple disorders.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Adulto , Demografia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos Psicóticos/psicologia
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