PTSD as a mediator of the relationship between trauma and psychotic experiences.

BACKGROUND: Traumatic experiences are associated with a higher risk of psychotic illnesses, but little is known about potentially modifiable mechanisms underlying this relationship. This study aims to examine whether post-traumatic stress disorder (PTSD) symptoms mediate the relationship between trauma and psychotic experiences (PEs). METHODS: We used data from the Avon Longitudinal Study of Parents and Children to examine whether: PTSD symptoms mediate the relationships between (a) childhood trauma and adolescent PEs (study of adolescent PEs; n = 2952), and (b) childhood/adolescent trauma and PEs in early adulthood (study of adult PEs; n = 2492). We examined associations between variables using logistic regression, and mediation using the parametric g-computation formula. RESULTS: Exposure to trauma was associated with increased odds of PEs (adolescent PEs: ORadjusted 1.48, 95% CI 1.23-1.78; adult PEs: ORadjusted 1.57, 95% CI 1.25-1.98) and PTSD symptoms (adolescent PTSD: ORadjusted 1.59, 95% CI 1.31-1.93; adult PTSD: ORadjusted 1.50, 95% CI 1.36-1.65). The association between PTSD symptoms and PE was stronger in adolescence (ORadjusted 4.63, 95% CI 2.34-9.17) than in adulthood (ORadjusted 1.62, 95% CI 0.80-3.25). There was some evidence that PTSD symptoms mediated the relationship between childhood trauma and adolescent PEs (proportion mediated 14%), though evidence of mediation was weaker for adult PEs (proportion mediated 8%). CONCLUSIONS: These findings are consistent with the hypothesis that PTSD symptoms partly mediate the association between trauma exposure and PEs. Targeting PTSD symptoms might help prevent the onset of psychotic outcomes.

Spirometric lung function in school-age children: effect of intrauterine growth retardation and catch-up growth.

RATIONALE: Few studies have investigated childhood respiratory outcomes of intrauterine growth retardation (IUGR), and it is unclear if catch-up growth in these children influences lung function. OBJECTIVES: We determined if lung function differed in 8- to 9-year-old children born at term with or without growth retardation, and, in the growth-retarded group, if lung function differed between those who did and those who did not show weight catch up. METHODS: Caucasian singleton births of 37 weeks or longer gestation from the Avon Longitudinal Study of Parents and Children (n = 14,062) who had lung spirometry at 8-9 years of age were included (n = 5,770). MEASUREMENTS AND MAIN RESULTS: Infants with gestation-appropriate birthweight (n = 3,462) had significantly better lung function at 8-9 years of age than those with IUGR (i.e., birthweight <10th centile [n = 576] [SD differences and confidence intervals adjusted for sex, gestation, maternal smoking during pregnancy, and social class: FEV(1), -0.198 (-0.294 to -0.102), FVC, -0.131 (-0.227 to -0.036), forced midexpiratory flow between 25 and 75% of vital capacity -0.149 (-0.246 to -0.053)]). Both groups had similar respiratory symptoms. All spirometry measurements were higher in children with IUGR who had weight catch-up growth (n = 430) than in those without (n = 146), although the differences were not statistically significant. Both groups remained significantly lower than control subjects. Growth-retarded asymmetric and symmetric children had similar lung function. CONCLUSIONS: IUGR is associated with poorer lung function at 8-9 years of age compared with control children. Although the differences were not statistically significant, spirometry was higher in children who showed weight catch-up growth, but remained significantly lower than the control children.

Activating Iron Based Materials for Overall Electrochemical Water Splitting via the Incorporation of Noble Metals.

Although the presence of iron in mixed metal oxide based catalysts has shown significant performance improvement in the oxygen evolution reaction (OER), iron oxides themselves demonstrate much poorer activity. In this study, we investigate improving the performance of iron catalysts via surface decoration with gold or platinum for not only the OER but also the hydrogen evolution reaction (HER) for overall water splitting in an alkaline electrolyte. Two types of iron catalysts were synthesised, iron nanocubes and iron oxide via electrochemical deposition methods which were decorated with either Au or Pt via galvanic replacement. It was found that the presence of Au significantly enhanced the OER performance of iron oxide and the HER performance of iron nanocubes. The presence of Pt resulted in moderate improvement in the OER but significant improvement for the HER but did not surpass the performance of gold decorated iron nanocubes. This indicates that the speciation of the iron catalyst and the decorating metal was important for tuning the activity to the OER and the HER. For the OER, the formation of iron oxide/Au interfaces was determined to be an important component for high activity whereas the metallic nature of metal decorated iron nanocubes was important for the HER. Therefore, iron based catalysts can be modified to demonstrate bifunctional behaviour for overall water splitting via the inclusion of gold nanoparticles.

Alcohol consumption and internalising disorders in young adults of ALSPAC: a population-based study.

INTRODUCTION: Depression and harmful alcohol consumption contribute significantly to the global health burden, but in young adults, this relationship is under-researched and conflicted. The aim of this study was to determine the sex-based prevalence and the association between internalising disorders such as depression and alcohol use disorders. METHOD: Using the Avon Longitudinal Study of Parents and Children, we assessed the sex-specific prevalence of International Classification of Diseases,Tenth Revision diagnosed generalised anxiety disorder (GAD), depression and fear-based anxieties (FBA) at 24 years (n=3572). We examined the association between internalising disorders and alcohol consumption using the Alcohol Use Disorder Identification Test for Consumption 5+ threshold and Diagnostic and Statistical Manual on Mental Disorders defined criteria for alcohol dependence. RESULTS: Women reported more GAD (11.6% vs 6.5%), depression (13.4% vs 6.9%) and FBA (1.3% vs 0.5%) than men (p<0.001). Harmful drinking, after adjustment for sex and socioeconomic status, was associated with a higher prevalence of depression (OR 1.8, 95% CI 1.3 to 2.4, p<0.001), anxiety (OR 1.4, 95% CI 1.0 to 2.0, p<0.001) and FBA (OR 2.4, 95% CI 1.04 to 5.56, p=0.009) compared with lower-risk drinkers. In contrast, hazardous drinking was associated with a lower prevalence of GAD (OR 0.69, 95% CI 0.54 to 0.88) and depression (OR 0.68, 95% CI 0.54 to 0.86) compared with lower-risk drinkers. CONCLUSIONS: Young adults in the UK who drink harmfully are more likely to have depression and other internalising disorders. Further research should test whether there is a J-shaped relationship between alcohol consumption and mental health in young people and whether this varies across the life course.

'There's the record, closed and final': Rough for Theatre II as Psychiatric Encounter.

A co-authored collaboration between a theatre practitioner and a clinical psychiatrist, this paper will examine Rough for Theatre II (RFTII) and Beckett's demonstration of the way records are used to understand the human subject. Using Beckett's play to explore interdisciplinary issues of embodiment and diagnosis, the authors will present a dialogue that makes use of the 'best sources' in precisely the same manner as the play's protagonists. One of those sources will be Beckett himself, as Heron will locate the play in its theatrical context through reflections upon his own practice (with Fail Better Productions, UK) as well as recent studies such as Beckett, Technology and the Body (Maude 2009) and Performing Embodiment in Samuel Beckett's Drama (McMullan 2010); another source will be the philosopher Wilhelm Windleband, whose 1901 History of Philosophy was read and noted upon by Beckett in the 1930s, as Broome will introduce a philosophical and psychiatric context to the exchange. Windelband is now a neglected figure in philosophy; but as one of the key figures of Neo-Kantianism in the late 19(th) century, his work was an important impetus to that of Rickert, Weber and Heidegger. Specifically, Windelband gives us the distinction between idiographic and nomothetic understanding of individuals, an approach that is of relevance to the psychiatric encounter. This academic dialogue will consider tensions between subjectivity and objectivity in clinical and performance practice, while examining Beckett's analysis of the use of case notes and relating them back to Windelband's ideas on the understanding of others. The dialogue took place in 2011 at the University of Warwick, and has since been edited by the authors.

Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression.

OBJECTIVE: To examine the hypothesis that the effects of postnatal depression on children's behavioral/emotional problems are explained by antenatal maternal mood. METHOD: The current study investigated this hypothesis in the Avon Longitudinal Study of Parents and Children, a prospective, community-based study that has followed a cohort of women since pregnancy (n = 7,144) who delivered their baby between April 1, 1991, and December 31, 1992. Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period. Children's behavioral/emotional problems were assessed by parent report at age 4 years. RESULTS: After controlling for smoking, alcohol use, birth weight for gestational age, maternal age, child sex, and socioeconomic status, postnatal depression at 8 weeks (OR = 2.27 [1.55-3.31]) and 8 months (OR = 1.68 [1.12-2.54]) was associated with children's behavioral/emotional problems. Subsequent analyses that included antenatal maternal mood indicated that antenatal anxiety in late pregnancy and not antenatal depression was also independently associated with behavioral/emotional problems at age 4 (OR = 1.72 [1.14-2.59]); 8 week postnatal depression remained a significant predictor after antenatal maternal mood was statistically controlled for (OR = 1.56 [1.04-2.32]). CONCLUSIONS: Antenatal anxiety and postnatal depression represent separate risks for behavioral/emotional problems in children and act in an additive manner.

The course of anxiety and depression through pregnancy and the postpartum in a community sample.

BACKGROUND: Postnatal and antenatal depression are a focus of considerable clinical and research attention, but little is known about the patterns of anxiety across this period. METHODS: Self-reported anxiety and depression were assessed at 18 and 32 weeks gestation and 8 weeks and 8 months postnatally in a prospective longitudinal study of a community sample of women in England (n=8323). RESULTS: The majority of cases of postnatal depression were preceded by antenatal depression; similarly, postnatal anxiety was preceded by antenatal anxiety. Despite the stability of anxiety and depression across this period, there was a mean decrease in both anxiety and depression. Finally, antenatal anxiety predicted postnatal depression at 8 weeks and 8 months, even after controlling for antenatal depression (OR=3.22, p<0.001). LIMITATIONS: Data were based on self-report only and there was evidence of selective attrition. CONCLUSION: The findings confirm that antenatal anxiety occurs frequently, overlaps with depression and increases the likelihood of postnatal depression.

Antenatal maternal anxiety is linked with atypical handedness in the child.

BACKGROUND: Animal studies have shown that prenatal stress is linked with altered laterality in the offspring. AIMS: The aim of this study was to test the hypothesis that antenatal maternal anxiety was associated with altered lateralisation in children, as demonstrated by mixed handedness. STUDY DESIGN AND SUBJECTS: We used the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective longitudinal study that has followed women since pregnancy. The final analysis included data on 7431 mother-child pairs. Maternal anxiety was measured at 18- and 32-week gestation and 8 weeks postnatally using a self-report inventory. Child handedness was assessed at 42 months using an established maternal report scale. Information on maternal and paternal handedness, as well as data on possible confounding variables such as obstetric and antenatal risks, were also assessed. RESULTS: Univariable analysis showed that antenatal anxiety at 18 weeks was associated with mixed-handedness in the child, OR=1.28 (95% CI 1.09-1.50, p<0.01). Although boys were more likely than girls to be mixed handed, the link with antenatal anxiety was similar. There was no significant association with antenatal anxiety at 32 weeks. Multivariable analyses indicated that maternal anxiety at 18 weeks of pregnancy predicted an increased likelihood of mixed-handedness in the child (OR=1.23, 95% CI 1.02-1.48, p<0.05), independently of parental handedness, obstetric and other antenatal risks, and postnatal anxiety. CONCLUSION: This result provides further evidence for a link between antenatal anxiety and fetal programming in humans.

Perinatal maternal life events and psychotic experiences in children at twelve years in a birth cohort study.

BACKGROUND: International studies indicate that the median prevalence of psychotic experiences in children is 7%. It has been proposed that environmental stress during pregnancy may affect the neurodevelopment of the foetus and lead to a vulnerability in the child to later stressors and psychopathology. AIM: In this study we explore the relationship between environmental stress during pregnancy and psychotic experiences in children in the general population at 12 years. METHODS: We analysed a birth cohort of 5038 children from the Avon Longitudinal Study of Parents and Children. Environmental stress was measured as life event exposure. Data on life events were collected on women during their pregnancy, whilst psychotic experiences in the offspring were assessed at age 12. RESULTS: There was a weak association between maternal exposure to life events and psychotic experiences at twelve years (crude OR 1.10 95% CI 1.02-1.18) per quartile of life event score. This association was not reduced after adjustment for socio-economic status, family history of schizophrenia, maternal education or birth weight but after adjustment for maternal anxiety and depression and smoking in early pregnancy there was no longer any evidence for an association (OR 1.01 95% CI 0.93-1.10). CONCLUSION: This study provides some evidence to suggest that stressful life events may affect child psychotic experiences through effects on maternal psychopathology, and possibly physiology, during pregnancy.

Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis.

BACKGROUND: Previous animal investigations link antenatal stress with a range of persistent behavioural abnormalities in the offspring. The current study examined if the effect was also found in humans through middle childhood. METHODS: The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, community-based study that has followed a cohort of women from pregnancy. Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period. Children's behavioural/emotional problems were assessed by parent report at age 47 and 81 months. Information on obstetric and psychosocial factors was obtained at several points in pregnancy and the postnatal period. RESULTS: Children whose mothers experienced high levels of anxiety in late pregnancy exhibited higher rates of behavioural/emotional problems at 81 months of age after controlling for obstetric risks, psychosocial disadvantage, and postnatal anxiety and depression (for girls, OR = 1.91, 95%CI = 1.26-2.89; for boys, OR = 2.16, 95%CI = 1.41-3.30). Furthermore, the effect at 81 months was comparable to what was previously obtained at 47 months, suggesting the kind of persistent effect proposed in the animal literature. CONCLUSIONS: There is evidence that antenatal stress/anxiety has a programming effect on the fetus which lasts at least until middle childhood.

Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children.

BACKGROUND: Animal experiments suggest that maternal stress and anxiety during pregnancy have long-term effects on the behaviour of the offspring. AIMS: To test the hypothesis that antenatal maternal anxiety predicts behavioural problems at age 4 years. METHOD: Data were collected on multiple antenatal and postnatal assessments of maternal anxiety and depression, antenatal and obstetric risks, psychosocial risks and children's behavioural/emotional problems (n=7448). RESULTS: Antenatal maternal anxiety predicted behavioural/emotional problems in boys (OR=2.14, 95% CI 1.48-3.10) and girls (OR=1.88, 95% CI 1.3-2.69) after accounting for covariates. When covarying maternal anxiety up to 33 months postnatally, antenatal anxiety continued to predict total problems in boys (OR=1.56, 95% CI 1.02-2.41) and girls (OR=1.51, 95% CI 1.22-2.81). CONCLUSIONS: There could be a direct effect of maternal mood on foetal brain development, which affects the behavioural development of the child.