Lifetime psychopathology in child and adolescent offspring of parents diagnosed with schizophrenia or bipolar disorder: a 2-year follow-up study.

Having one parent diagnosed with a severe mental disorder is considered one of the main risk factors for developing that disorder in adulthood, and it also increases the risk of a wide range of mental disorders in the offspring. The aim of this study is to compare the prevalence of several psychopathological diagnoses, the presence of prodromal symptoms, and global functioning in offspring of parents with schizophrenia or bipolar disorder and in offspring of controls at baseline and 2-year follow-up. This study included 41 offspring of parents with schizophrenia, 90 offspring of parents with bipolar disorder, and 107 offspring of controls (mean age 11.7 ± 3.2 at baseline and 13.9 ± 3.2 at follow-up). The prevalence of psychopathology and comorbidity was higher in offspring of parents with schizophrenia and offspring of parents with bipolar disorder than in offspring of controls at baseline and at 2-year follow-up. Interestingly, mood disorders were more prevalent in offspring of parents with bipolar disorder and disruptive disorders were more prevalent in offspring of parents with schizophrenia. Prodromal symptoms were more frequent in offspring of parents with schizophrenia than in offspring of controls, while the offspring of parents with bipolar disorder showed an intermediate pattern. Finally, global functioning was lower in the offspring of parents with schizophrenia than the offspring of parents with bipolar disorder and the offspring of controls. Screening patients' children is clinically relevant, since, as a group, they have an elevated risk of developing a psychiatric disorder and of experiencing their first symptoms during childhood and adolescence.

Spanish adaptation and validation of the Brief Negative Symptoms Scale.

Negative symptoms prevalent in schizophrenia are associated with poor outcome. Developing new instruments to identify new treatments was highlighted at the NIMH-MATRICS Consensus Development Conference on Negative Symptoms. The new Brief Negative Symptoms scale (BNSS) demonstrated strong psychometric properties, but there is a need for validating it in non-English languages. A multi-center study was conducted to validate the Spanish version of the BNSS (BNSS-Sp) in 20 schizophrenia patients, following the original BNSS validation methodology. We found strong inter-rater, test-retest and internal consistency properties (for the total BNSS-Sp, intraclass correlation coefficient=0.97, Pearson's correlation coefficient r=0.95 (p<0.001), Cronbach's alpha=0.98).

Evidence of diagnostic specificity in the neural correlates of facial affect processing in bipolar disorder and schizophrenia: a meta-analysis of functional imaging studies.

BACKGROUND: Schizophrenia (SZ) and bipolar disorder (BD) may overlap in etiology and phenomenology but differ with regard to emotional processing. We used facial affect as a probe for emotional processing to determine whether there are diagnosis-related differences between SZ and BD in the function of the underlying neural circuitry. METHOD: Functional magnetic resonance imaging (fMRI) studies published up to 30 April 2012 investigating facial affect processing in patients with SZ or BD were identified through computerized and manual literature searches. Activation foci from 29 studies encompassing 483 healthy individuals, 268 patients with SZ and 267 patients with BD were subjected to voxel-based quantitative meta-analysis using activation likelihood estimation (ALE). RESULTS: Compared to healthy individuals, when emotional facial stimuli were contrasted to neutral stimuli, patients with BD showed overactivation within the parahippocampus/amygdala and thalamus and reduced engagement within the ventrolateral prefrontal cortex (PFC) whereas patients with SZ showed underactivation throughout the entire facial affect processing network and increased activation in visual processing regions within the cuneus. Patients with BD showed greater thalamic engagement compared to patients with SZ; in the reverse comparison, patients with SZ showed greater engagement in posterior associative visual cortices. CONCLUSIONS: During facial affect processing, patients with BD show overactivation in subcortical regions and underactivation in prefrontal regions of the facial affect processing network, consistent with the notion of reduced emotional regulation. By contrast, overactivation within visual processing regions coupled with reduced engagement of facial affect processing regions points to abnormal visual integration as the core underlying deficit in SZ.

Neuropsychological development in the child and adolescent offspring of patients diagnosed with schizophrenia or bipolar disorder: A two-year follow-up comparative study.

There has been growing scientific evidence in recent years that schizophrenia and bipolar disorder share clinical, cognitive, neuroimaging and genetic characteristics. This overlap might also be present in their offspring, who have an increased risk of developing both disorders. Comparing the characteristics of these samples may have important implications for understanding etiological processes. This study aimed to assess the development of cognitive functions over two years in a sample of child and adolescent offspring of patients diagnosed with schizophrenia (SZoff) or bipolar disorder (BDoff), comparing them with a community control group (CCoff). METHODS: 90 BDoff, 41 SZoff and 107 CCoff aged between 6 and 17 years were included at baseline. At the two-year follow-up, 84.9% of the sample was re-assessed (78 BDoff, 32 SZoff and 92 CCoff). All subjects were assessed with a comprehensive neuropsychological test battery at baseline and at the two-year follow-up to evaluate: intelligence quotient, working memory, processing speed, verbal memory and learning, visual memory, executive functions and sustained attention. RESULTS: Processing speed, verbal memory and executive functions showed different developmental patterns among the SZoff, BDoff and CCoff groups. The SZoff group maintained baseline performances in the three variables over time, while the BDoff group presented improved processing speed and executive functioning and the CCoff group showed improvements in verbal memory and executive functions at follow-up. CONCLUSIONS: These findings suggest that the development of some cognitive functions might differ between child and adolescent SZoff and BDoff, indicating different trajectories during neurodevelopment.

Atypical depression is associated with suicide attempt in bipolar disorder.

OBJECTIVE: There is a dearth of research focusing on factors associated with suicide attempts. High rates of atypical depression have been reported in studies including unipolar and bipolar II patients. In this study, the association between suicide attempt and atypical depression, in addition to other major risk factors, was evaluated in 390 bipolar I and II out-patients. METHOD: Variables were defined according to DSM-IV criteria, and assessed with a Structured Interview for DSM-IV (axis I and II). History of suicide attempt was obtained through interviews with patients and relatives. Attempters and non-attempters were compared using univariate and multivariate analysis. RESULTS: Attempters showed significantly higher rates of atypical depression, family history of completed suicide, depression at index episode and cluster B personality disorder. CONCLUSION: Our results highlight the relevance of atypical depression in bipolar disorder. A more accurate identification of potential attempters may contribute to the development of effective preventive treatment strategies.

Common and distinct neural correlates of facial emotion processing in social anxiety disorder and Williams syndrome: A systematic review and voxel-based meta-analysis of functional resonance imaging studies.

BACKGROUND: Social Anxiety Disorder (SAD) and Williams-Beuren Syndrome (WS) are two conditions which seem to be at opposite ends in the continuum of social fear but show compromised abilities in some overlapping areas, including some social interactions, gaze contact and processing of facial emotional cues. The increase in the number of neuroimaging studies has greatly expanded our knowledge of the neural bases of facial emotion processing in both conditions. However, to date, SAD and WS have not been compared. METHODS: We conducted a systematic review of functional magnetic resonance imaging (fMRI) studies comparing SAD and WS cases to healthy control participants (HC) using facial emotion processing paradigms. Two researchers conducted comprehensive PubMed/Medline searches to identify all fMRI studies of facial emotion processing in SAD and WS. The following search key-words were used: "emotion processing"; "facial emotion"; "social anxiety"; "social phobia"; "Williams syndrome"; "neuroimaging"; "functional magnetic resonance"; "fMRI" and their combinations, as well as terms specifying individual facial emotions. We extracted spatial coordinates from each study and conducted two separate voxel-wise activation likelihood estimation meta-analyses, one for SAD and one for WS. RESULTS: Twenty-two studies met the inclusion criteria: 17 studies of SAD and five of WS. We found evidence for both common and distinct patterns of neural activation. Limbic engagement was common to SAD and WS during facial emotion processing, although we observed opposite patterns of activation for each disorder. Compared to HC, SAD cases showed hyperactivation of the amygdala, the parahippocampal gyrus and the globus pallidus. Compared to controls, participants with WS showed hypoactivation of these regions. Differential activation in a number of regions specific to either condition was also identified: SAD cases exhibited greater activation of the insula, putamen, the superior temporal gyrus, medial frontal regions and the cuneus, while WS subjects showed decreased activation in the inferior region of the parietal lobule. CONCLUSIONS: The identification of limbic structures as a shared correlate and the patterns of activation observed for each condition may reflect the aberrant patterns of facial emotion processing that the two conditions share, and may contribute to explaining part of the underlying neural substrate of exaggerated/diminished fear responses to social cues that characterize SAD and WS respectively. We believe that insights from WS and the inclusion of this syndrome as a control group in future experimental studies may improve our understanding of the neural correlates of social fear in general, and of SAD in particular.

HPA-axis function, symptoms, and medication exposure in youths at clinical high risk for psychosis.

AIM: Increased basal cortisol secretion has been associated with heightened clinical risk for psychosis, and among at-risk individuals, has been variably related to positive and mood symptoms, as well as clinical outcome. METHODS: Basal salivary cortisol secretion was assessed in 33 patients at clinical high risk (CHR) for psychosis (21 medication-free and 12 taking a serotonin reuptake inhibitor and/or atypical antipsychotic), and 13 healthy controls. Among the CHR patients, we also examined associations of basal salivary cortisol with symptoms (positive, negative, mood, stress sensitivity) and clinical outcome. RESULTS: Basal salivary cortisol secretion was significantly higher in CHR patients who were medication-free compared to CHR patients taking medications and to healthy controls. In this small cohort, basal salivary cortisol secretion was associated at trend level with stress sensitivity, and was not significantly related to other symptoms. CONCLUSIONS: Our finding of elevated basal cortisol secretion in CHR patients supports the premise that excess activation of the HPA axis and/or neuroendocrine abnormalities characterize the psychosis risk state for at least a subset of patients. Our findings further suggest that psychotropic medications may have a normalizing effect on HPA-axis dysfunction in CHR patients, which could potentially inform intervention strategies for the prodrome.

Déficit de ácido fólico y vitamina B12 en niños y adolescentes hospitalizados por un trastorno psiquiátrico / Folic acid and vitamin B12 deficit in children and adolescents hospitalized due to a psychiatric disorder

INTRODUCCIÓN: A pesar de que diferentes déficits nutricionales como el de ácido fólico se han asociado a la esquizofrenia y a otros trastornos psiquiátricos, se sabe poco sobre los posibles déficits de ácido fólico y vitamina B12 en niños y adolescentes con trastornos psiquiátricos. OBJETIVO: Describir los valores y posibles déficits de ácido fólico y vitamina B12 en niños y adolescentes hospitalizados por un trastorno psiquiátrico y comparar las posibles diferencias existentes según diagnóstico. MÉTODO: Se revisaron de forma retrospectiva las historias clínicas de los pacientes ingresados durante el 2015 en el Servicio de Psiquiatría y Psicología del Hospital Clinic de Barcelona. Se midieron los niveles de ácido fólico y vitamina B12 al ingreso, se registraron los datos sociodemográficos y la categoría diagnóstica, según criterios DSM-IV-TR. RESULTADOS: Se incluyeron 278 pacientes, de edad media: 14,8 años y 64% chicas. Los niveles medios de vitamina B12 fueron: 420.5±152.4 pg/ mL, significativamente menores en adolescentes que en niños y en chicos que en chicas. Se observaron diferencias significativas entre pacientes con un trastorno depresivo (381.3±107.5 pg/mL) vs. Trastornos de la conducta alimentaria (TCA) (523.1 ±229.6 pg/mL) (p = 0.002). La media de ácido fólico fue: 8±4.8 ng/mL, significativamente menor en adolescentes que en niños. Los pacientes con trastornos psicóticos (5,9±2.2ng/mL) presentaron niveles significativamente menores que los pacientes con TCA (8.1±3.6ng/mL) (p = 0.019). 11,2% de los pacientes tenían un déficit de uno o de ambos nutrientes. CONCLUSIONES: Alrededor de un 11% de la muestra presentaba un déficit de vitamina B12, de ácido fólico o de ambos, con diferencias significativas en algunas categorías diagnósticas. Sería interesante poder estudiar mejor estos déficits, debido a la importancia y posible repercusión clínica de los mismos en niños y adolescentes

INTRODUCTION: Despite different nutritional deficits such as folic acid have been associated with schizophrenia and other psychiatric disorders, little is known about the possible nutritional deficits in children and adolescents with psychiatric disorders. OBJECTIVE: To describe folic acid and vitamin B12 values and possible deficits of children and adolescents hospitalized due to psychiatric disorders and compared them between diagnostic categories. METHODS: We retrospectively reviewed the charts of patients hospitalized during 2015 in the Child and Adolescent Psychiatry and Psychology Department, Hospital Clínic in Barcelona, Spain. Levels of folic acid and vitamin B12 were registered as well as sociodemographic data and diagnostic category, according to DSM-IV-TR criteria. RESULTS: 278 patients were reviewed, mean age: 14.8 years, 64% females. Vitamin B12 mean value was 420.5±152.4 pg/mL, with significant lower levels in adolescent vs children and males vs females. We also found significant differences between patients with depressive (381.3±107.5 pg/mL) vs. eating disorders (523.1 ±229.6pg/mL) (p = 0.002). Folic acid mean value was 8±4.8 ng/mL, with significant lower levels in adolescents compared to children. Significant differences between patients with psychotic (5,9±2.2ng/mL) vs. eating disorders were also observed (8.1±3.6ng/mL) (p = 0.019). 11.2% patients had deficit of vitamin B12, folic acid or both. CONCLUSIONS: Around 11% of our sample had deficit of vitamin B12, folic acid or a combination of them, with some significant differences among diagnostic categories. It would be interesting to deeply study this issue due to the importance of these deficits in the paediatric population