87 research outputs found

    Psychotic disorders in the Lundby population 1947-1997: Incidence, life-time prevalence and predictors related to personality and behaviour

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    The aims were to analyze the first incidence, age-at-onset, prevalence and personality related predictors of psychotic disorders in the Lundby population (n=3563) – a community population followed through four waves of field study 1947-1997. Case ascertainment included interviews, registers, case notes and key informants. Consensus diagnoses of mental illness were assessed according to a classification adapted to the Lundby Study, but in 1972-1997 also according to the DSM-IV. Mental illness 1947-1972 was rediagnosed according to the DSM-IV. Follow-ups were feasible in the majority of subjects; 99% in 1947-1972 and 94% in 1972-1997. The incidence rate was higher in males than in females for ‘substance-induced psychoses’. The incidence rates of the other psychoses did not differ between the sexes. The male mean age-at-onset was lower than that for females for ‘psychotic disorder due to a general medical condition’, ‘nonaffective psychoses’ and ‘schizophrenia’. Males and females had different incidences by age patterns for ‘nonaffective psychoses’, ‘schizophrenia’ and ‘other nonaffective psychoses’. The period prevalence 1947-1997 was higher in males than in females for ‘substance-induced psychoses’. For the other psychoses the period prevalences did not differ between the sexes. The lifetime prevalence in 1997 was higher in males than in females for the general group including any psychotic or bipolar disorder. For the specific psychoses the lifetime prevalences in 1997 did not differ significantly between the sexes. The influence of constructed dichotomous predictor variables related to premorbid personality traits in the subjects on time to occurrence of ‘functional psychosis’ and ‘schizophrenia’, respectively, was assessed by Cox regression. In multivariate and/or univariate models the predictors nervous-tense, down-semidepressed, blunt-deteriorated, paranoid-schizotypal, sensitive-frail, easily hurt and tired-distracted were associated with ‘functional psychosis’. When ‘schizophrenia’ was analyzed separately, nervous-tense remained significant and abnormal-antisocial reached significance. The findings suggest similar overall risks in males and females to contract psychosis during the life course, but with putative disorder delaying mechanisms in females and/or different aetiologies in males and females. Certain personality traits – related to anxiety-proneness, affective/cognitive blunting, poor concentration, personality cluster-A like traits and interpersonal sensitivity – may be associated with general psychosis vulnerability. Limitations: changing sample representativeness, small sample size, attrition, recall bias, changing data sources, inter-rater reliability and changing diagnostic systems during the study

    Metacognition, Social Cognition, and Mentalizing In Psychosis: Are These Distinct Constructs When It Comes To Subjective Experience Or Are We Just Splitting Hairs?

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    Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised – as often occurs in psychosis – results in the loss of persons’ sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches

    Non-Psychiatric Hospitalization For Patients With Psychotic Disorders: A Mixed-Methods Study

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    Patients with psychotic disorders face a multitude of medical health disparities in addition to psychological symptoms. They have a higher medical disease burden than the general population and are more likely to have a non-psychiatric hospitalization. In the hospital, these patients have an increased risk of adverse events, readmission and extended length-of-stay. Working with a Health Equity lens and the Quality Health Outcomes Model, we reviewed the literature on adverse events during medical-surgical hospitalizations for these patients and identified differences at the patient, provider and system levels between these patients and the general population. Next, a mixed methods, exploratory sequential study was conducted to: 1) explore the experience of patients with psychotic disorders hospitalized on medical-surgical unit; 2) examine patient characteristics and care processes associated with length-of-stay (primary outcome), adverse events and readmissions (secondary outcomes), among patients with psychotic disorders during non-psychiatric hospitalizations; and 3) integrate qualitative and quantitative data to contextualize factors associated with hospital outcomes among patients with psychotic disorders during non-psychiatric hospitalizations. For Phase 1, interviews were conducted with twenty patients with psychotic disorders on medical-surgical units. Five themes were developed through thematic analysis: 1) managing through hard times, 2) ignored and treated unfairly, 3) actively involved in health, 4) appreciation of caring providers and 5) violence: expected and experienced. In Phase 2, information from these interviews guided variable selection for an analysis of patient hospital records. A general linear model was conducted to examine length-of-stay’s relationship with patient characteristics and care processes. Of patient characteristics, only medical comorbidities were significantly related to length-of-stay. Certain processes of care highlighted by patients from the qualitative sample were found to be associated with length-of-stay like physical restraints (64% longer), psychiatrist consult (20% longer) and outpatient appointment in the previous six months (10% shorter). Results suggest specific patient characteristics and care processes are highly related to length-of-stay and that many of these were important to the patients in the qualitative portion. The use of mixed methods research for hospital outcomes research in this population creates valuable information for educational and clinical settings to improve care for patients with psychotic disorders

    Psychiatric and physical comorbidity in adults with autism spectrum disorder

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    Autism spectrum disorder (ASD) is a highly impairing neurodevelopmental condition, manifesting in childhood and continuing into adult life. Comorbid psychiatric and physical illness lends considerable increased mortality to the condition. An increased awareness of comorbid conditions in adults with normal IQ ASD could improve diagnostic formulation, facilitate targeted treatments and improve psychosocial outcomes. This study examines the prevalence of comorbid psychiatric and physical illness in 413 adults with normal IQ ASD, attending a tertiary referral neurodevelopmental clinic in South London, to determine if rates of comorbid illness would be greater than rates reported in the general population. This study noted autism spectrum disorder in 70% of participants, with a male-to-female ratio of 2.8:1. Milder forms of ASD were recorded for 88%. Participants with autism spectrum disorder were more likely to be single, unemployed and living in the company of others. Seventy-six percent suffered from a comorbid Axis I illness and 2% suffered from a comorbid Axis II condition. Anxiety spectrum disorders were the most common comorbid psychiatric illness, followed by attention deficit hyperactivity disorder, mood disorders and deliberate self-harm. Psychosis, substance-use disorder, eating disorder and tic disorder were rarely diagnosed. Participants with Asperger’s syndrome were statistically more likely to be diagnosed with a comorbid psychiatric illness, most commonly obsessive compulsive disorder. Eighty-four percent of participants had a history of physical illness, most frequently asthma followed by head injury. Sleep difficulties and eating disturbance were notably high at 42% and 25% respectively. Adults with normal IQ autism spectrum disorder suffer higher rates of physical and psychiatric morbidity, display a poorer ability to engage with treatment and have a lower chance of recovery compared to the general population. Increased awareness and a high degree of diagnostic skill to identify those with the disorder should be promoted among physicians and psychiatrists

    A Potential Role For Sap97 In Psychiatric Disorders

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    The goal of this dissertation is to further understand the genetic architecture of neuropsychiatric disorders, such as autism spectrum disorder (ASD) and schizophrenia (SCZ). We attempt to understand the functional significance of the gene synapse associated protein of 97KDa (SAP97) and identify a novel role for SAP97 in the etiology of neuropsychiatric disorders. SAP97 belongs to a family of scaffolding proteins, the membrane-associated guanylate kinases (MAGUKs), that are highly enriched in the postsynaptic density of synapses and play an important role in organizing protein complexes necessary for synaptic development and plasticity. Large-scale genetic studies have implicated MAGUKs in neuropsychiatric disorders such as intellectual disability, ASD, and SCZ, but knock-out mice have been impossible to study because the Sap97 null mice die soon after birth due to a craniofacial defect. In Chapter 2, we studied the transcriptomic and behavioral consequences of a viable, brain-specific conditional knockout of Sap97 (SAP97-cKO). RNA sequencing (RNAseq) from hippocampi from control and SAP97-cKO male animals identified 67 differentially expressed transcripts, which were specifically enriched for SCZ-related genes. Subjecting SAP97-cKO mice to a battery of behavioral tests revealed a subtle anxiety-like phenotype present in both male and female SAP97-cKO animals, as well as a mild male-specific cognitive deficit and female-specific motor learning deficit. Collectively, this work suggests that loss of Sap97 alters behavior, and may contribute to some of the endophenotypes present in SCZ. In Chapter 3, we discuss how the SAP97-cKO mouse may serve as a novel model system for interrogating aspects of the cellular and molecular defects underlying SCZ and other related neuropsychiatric disorders

    Mentalizing the Self in Adolescence and its Links with Schizotypal Trait Expression

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    Contemporary research suggests that clinical psychosis is distally linked with schizotypal trait expression and more proximally with the breakdown of psychological processes pertaining to mentalizing. Although previous findings are suggestive of a relationship between trait-vulnerability for psychosis and mentalizing difficulties, they involve adult participants either within or beyond the critical period of illness onset. To date, little is known about the process of mentalizing during the critical developmental period of adolescence or its associations with schizotypal trait dimensions. In a series of empirical studies, the current thesis used novel experimental tasks and self-report measures in samples of typically-developing young people to: (1) examine the nature of associations linking schizotypal trait dimensions in adolescence to disruptions in mentalizing processes involving both the understanding of the self and others; (2) further understand the processes that sustain self-awareness during adolescence by examining the effects that age, cognitive effort and emotional valence may exert on self- and reality-monitoring performance; and (3) prospectively assess the nature of the relation between mentalizing processes sustaining self- (self-monitoring) and other-awareness (ToM) from adolescence to young adulthood. Overall, the findings of the current thesis provide novel data suggesting that he expression of schizotypal traits that impede interpersonal communication with others in adolescence are associated with difficulties in self and other understanding. Regarding the development of psychological processes sustaining self-awareness, current data suggest that although both self- and reality-monitoring abilities may be established in pre-adolescent development, reality-monitoring capacities for emotionally-charged material may undergo further elaboration from adolescence to young adulthood. In addition, the data of the current thesis suggest that increased cognitive effort and emotional valence during memory encoding may respectively lead to self- and reality-monitoring confusions. Finally, the findings of the current thesis suggest that different types of self-monitoring misattributions in adolescence can prospectively predict specific patterns of ToM dysfunction at 5-year follow-up
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