We investigated whether psychosis risk symptoms predicted psychiatric service use using seven-year register follow-up data.
Our sample included 715 adolescents aged 15-18, referred to psychiatric care for the first time. Psychosis risk symptoms were assessed with the Prodromal Questionnaire (PQ) at the beginning of the treatment. We assessed the power of the overall PQ as well as its positive, negative, general, and disorganized psychosis risk symptom factors in predicting prolonged service use. Baseline psychiatric diagnoses (grouped into 7 categories) were controlled for. Based on both inpatient and outpatient psychiatric treatment after baseline, adolescents were divided into three groups of brief, intermittent, and persistent service use.
Stronger symptoms on any PQ factor as well as the presence of a mood disorder predicted prolonged service use. All of the PQ factors remained significant predictors when adjusted for baseline mood disorder and multimorbidity.
In a prospective follow-up of a large sample using comprehensive mental health records, our findings indicate that assessing psychosis risk symptoms in clinical adolescent settings at the beginning of treatment could predict long-term need for care beyond diagnostic information. Our findings replicate the previous findings that positive psychosis risk symptoms are unspecific markers of severity of psychopathology. Also psychosis risk symptoms of the negative, disorganization, and general clusters are approximately as strongly associated with prolonged psychiatric service use in the upcoming years.
Dysfunction in affect regulation is a prominent feature that grossly impairs behavioural and interpersonal domains of experience and underlies a great deal of the psychopathology in borderline personality disorder (BPD). However, no study has yet been published that evaluates the psychometric properties of the translated Danish version of self-report measures sensitive to the different aspects and dimensions of dysfunction in affect regulation prevalent in BPD.
This study comprised a group of women diagnosed with BPD (n = 29) and a comparison group of healthy subjects (n = 29) who reported psychopathology and levels of affective instability, aggression, impulsivity and alexithymia by self-report measures.
Our results demonstrated that women with BPD have significant psychopathology and report significantly higher levels of dysfunction in separate components of affect regulation by self-report measures than the comparison group of healthy subjects. Our results also provided partial support for the psychometric appropriateness and clinical relevance of the translated Danish version of affect regulation measures.
The normative reference range indicated by our results makes the measures useful as a practical assessment tool.
Factors that predicted the outcome of drug treatment (alprazolam or imipramine) of panic disorder were studied in a sample of 123 Scandinavian patients participating in a multicenter placebo-controlled 8-week trial. The attrition rate was 95% for alprazolam, 73% for imipramine and 46% for placebo. For the intention-to-treat and 3-week-completer samples, drugs and anxiety symptoms at baseline were the best predictors of improvement on the Global Improvement Scale and on symptom scales focusing on panic attacks, phobic behavior and anticipatory anxiety. For completers of the 8-week trial, only baseline scores predicted outcome. Generally, more severe symptoms at baseline predicted a worse outcome. A subsample of patients had a marked placebo response. Avoidance, sex, age, childhood psychopathology and previous treatment experience had no or only a weak impact on the outcome. The relationship between panic disorder and mood disorder is presented elsewhere.
To study the specific features of the epileptic syndrome after present-day gunshot cranial wounds (GCW), as well as risk factors of its occurrence, 56 victims were examined prospectively (within at least a year after their admission). The epileptic syndrome developed in 18 (32.1%) patients within 1 to 15 months following GCW; there were prevalent generalized convulsive (in 13 of the 18 patients) and focal (in 12 of the 18 ones) seizures. One type of seizures was noted in 7 patients, two or three ones were in 11. The polymorphism of seizures and a disparity of their psychopathological structure to the side of brain lesion were typical for left-handers. As compared to other patients, epileptics were more commonly found to have: 1) frontoparietal lesion; 2) multiple bony defects of the vault of the skull; 3) enlargement of the lateral ventricle of the brain on CT scans; 4) primary coma for > 2 hours and other depressed consciousness syndromes for > 1 day; 5) signs of left-handedness. The findings suggest that there is a need for studies of the functional asymmetry of the brain to gain a better insight into the problem.
This six-month prospective study of 326 patients with substance use disorders assessed rates of depression and anxiety symptoms among patients entering addiction treatment and examined the effects of concurrent psychiatric symptoms on indicators of addiction treatment outcome.
Initial assessments included semistructured clinical interviews, the Addiction Severity Index (ASI), the Beck Depression Inventory (BDI), and the Symptom Checklist 90-Revised (SCL90-R). Patients were reassessed at six months to determine treatment outcome (abstinence status and duration of continuous abstinence).
A majority of the sample (63 percent) had significant psychiatric symptoms at intake: 15 percent (N=49) presented with depressive symptoms, 16 percent (N=53) with anxiety symptoms, and 32 percent (N=105) with combined depressive and anxiety symptoms. Forty percent of patients who presented with combined depression and anxiety symptoms were abstinent at six months. These patients fared worse than those who were less symptomatic at intake, including those who presented with depression symptoms alone; in the latter group, 73 percent were abstinent at six months. The hierarchical regression models accounted for 22 percent of the variance in the duration of continuous abstinence, 26 percent of the variance in the frequency of drug use at six months, and 39 percent of the variance in abstinence status at six months. Key predictor variables included days in treatment, primary drug of abuse, frequency of drug use, and report of concurrent depression or anxiety symptoms at intake.
Concurrent depression or anxiety symptoms at intake had a small but significant predictive effect on addiction treatment outcome over and above factors that are clearly known to influence outcome (length of stay in treatment and initial addiction severity).
In an epidemiological survey of mentally retarded children of the school age the psychopathy-like syndrome was found in 16% of cases which accounted for one-third of all complicated forms of oligophrenia. Elevated affective excitability was the most common of all psychopathy-like disorders, followed by the syndrome of home leaving and tramping, the aggressive-sadistic syndrome, and mental instability. Other variants were observed far less frequently. Thirty per cent of the children presented a combination of various manifestations of the studied syndrome. Specific features of the syndromal structure were found to be correlated with the sex and age of children and degree of mental insufficiency. The correlation with antisocial behaviour was also determined. Although the diagnosis of mental retardation and transfer of such children to specialized schools were made earlier than in other groups of oligophrenic children, 4.9% of them continued their education in ordinary schools (i.e. in conditions inadequate for such children) which contributed to aggravation of their social disadaptation.
Forty-one panic disorder patients receiving placebo were investigated in a double-blind comparison of alprazolam, imipramine and placebo in panic disorder. A significantly higher drop-out rate was found in the placebo group than in the active treatment groups, but placebo response was found in 34% of the patients, defined as reduction of panic attacks to zero, and in 23%, defined as a score of greater than or equal to 8 on the Physician Global Improvement Scale (0-10 points). Several predictors of response to placebo were found. The responders had fewer panic attacks than the nonresponders at baseline. They also reported less psychopathology and were less help-seeking than the nonresponders. The implications for psychopathology and possible response to psychotherapy among responders and nonresponders are discussed. It is hypothesized that the responders show more signs of realistic processing of internal and external stimuli and fewer signs of subjective distress than the nonresponders. Responders will therefore probably be more responsive to psychotherapy than nonresponders.
Reviews conclude that childhood and adolescence sexual, physical, emotional abuse and emotional and physical neglect are all risk factors for psychosis. However, studies suggest only some adversities are associated with psychosis. Dose-response effects of several adversities on risk of psychosis have not been consistently found. The current study aimed to explore adversity specificity and dose-response effects of adversities on risk of psychosis.
Participants were 101 persons with first-episode psychosis (FEP) diagnosed with ICD-10 F20 - F29 (except F21) and 101 non-clinical control persons matched by gender, age and parents' socio-economic status. Assessment included the Childhood Trauma Questionnaire and parts of the Childhood Experience of Care and Abuse Questionnaire.
Eighty-nine percent of the FEP group reported one or more adversities compared to 37% of the control group. Childhood and adolescent sexual, physical, emotional abuse, and physical and emotional neglect, separation and institutionalization were about four to 17 times higher for the FEP group (all p