A preliminary investigation of schematic beliefs and unusual experiences in children

Background In cognitive models of adult psychosis, schematic beliefs about the self and others are important vulnerability and maintaining factors, and are therefore targets for psychological interventions. Schematic beliefs have not previously been investigated in children with distressing unusual, or psychotic-like, experiences (UEDs). The aim of this study was firstly to investigate whether a measure of schematic beliefs, originally designed for adults with psychosis, was suitable for children; and secondly, to examine the association of childhood schematic beliefs with internalising and externalising problems and with UEDs. Method Sixty-seven children aged 8–14 years, with emotional and behavioural difficulties, completed measures of UEDs, internalising (depression and anxiety), and externalising (conduct and hyperactivity-inattention) problems, together with the Brief Core Schema Scales (BCSS). Results The BCSS was readily completed by participants, and scale psychometric properties were good. Children tended to view themselves and others positively. Internalising and externalising problems and UEDs were all associated with negative schematic beliefs; effect sizes were small to medium. Conclusions Schematic beliefs in young people can be measured using the BCSS, and negative schematic beliefs are associated with childhood psychopathology and with UEDs. Schematic beliefs may therefore form a useful target in psychological interventions for young people with UEDs

Prevalence and consequences of noncardiac incidental findings on preprocedural imaging in the workup for transcatheter aortic valve implantation, renal sympathetic denervation, or MitraClip implantation

Background: Dedicated data on the prevalence of incidental findings (IF) stratified according to overall clinical relevance and their subsequent correlation to outcome are lacking. The aim of the present study was to describe the prevalence and consequences of noncardiac IF on computed tomography or magnetic resonance imaging in the workup for interventional cardiovascular procedures. Methods: A total of 916 patients underwent preprocedural computed tomography or magnetic resonance imaging in the workup for transcatheter aortic valve implantation (TAVI), renal sympathetic denervation (RDN), or MitraClip implantation. Results: IF were found in 395 of 916 patients (43.1%), with an average of 1.8 IF per patient. Classifying the IF resulted in 155 patients with minor, 171 patients with moderate, and 69 patients with major IF. The intended procedure was delayed or canceled in only 15 of 916 (1.6%) of the patients because of the presence of potential malignant IF. In patients that did undergo the intended procedure (n = 774), the presence of a moderate or major IF (23.8%) did not impact 1-year mortality compared to no or minor IF (adjusted HR 0.90, 95% CI 0.56-1.44, P value =.65). These findings were consistent among patients referred for TAVI, RDN, or MitraClip. Conclusions: IF are frequent in patients referred for cardiovascular procedures. IF did not result in a delay or cancellation of the intended procedure in the vast majority of cases, irrespective of their clinical relevance. The presence of a major or moderate IF did not significantly impact 1-year mortality

Reading and numeracy attainment of children reported to child protection services: A population record linkage study controlling for other adversities

Background: Maltreated children are at risk of poor educational outcomes, but also experience greater individual, family, and neighbourhood adversities that may obscure an understanding of relationships between child protection involvement and educational attainment. Objective: To examine associations between child protection involvement and 3rd- and 5th-grade reading and numeracy attainment, while controlling multiple other adversities. Participants and Setting Participants were 56,860 Australian children and their parents from the New South Wales Child Development Study with linked multi-agency records. Methods: Multinomial logistic regressions examined associations between level of child protection involvement (Out-Of-Home Care [OOHC] placement; substantiated Risk Of Significant Harm [ROSH]; unsubstantiated ROSH; non-ROSH; and no child protection report) and standardised tests of 3rd- and 5th-grade reading and numeracy. Fully adjusted models controlled demographic, pregnancy, birth, and parental factors, and early (kindergarten) developmental vulnerabilities on literacy and numeracy, and other developmental domains (social, emotional, physical, communication). Results: All children with child protection reports were more likely to attain below average, and less likely to attain above average, 3rd- and 5th-grade reading and numeracy, including children with reports below the ROSH threshold. Children with substantiated ROSH reports who were not removed into care demonstrated the worst educational attainment, with some evidence of protective effects for children in OOHC. Conclusions: A cross-agency response to supporting educational attainment for all children reported to child protection services is required, including targeted services for children in OOHC or with substantiated ROSH reports, and referral of vulnerable families (unsubstantiated and non-ROSH cases) to secondary service organisations (intermediate intervention).Kristin R.Laurens, Fahkrul Islam, Maina Kariuki, Felicity Harris, Marilyn Chilvers ... Sally A.Brinkman ... et al

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.Peer reviewe

Improved hemodynamic activity in first episode psychotic patients with atypical neuroleptic treatment: A six week test-retest event-related fMRI study

One of the most replicated findings in the neurobiology of schizophrenia is abnormal event-related potentials to auditory oddball stimuli, suggesting abnormality in attention and memory processes. Recently, we used event-related fMRI to elucidate the abnormal neural architecture underlying target detection in chronic patients with schizophrenia. Compared with control participants, deficits were observed in the lateral frontal cortex, thalamus, superior temporal gyrus, cingulate, and parietal lobes. Here we present the results from a group of first-episode psychotic patients. As in the chronic medicated patients, diffuse hemodynamic abnormalities were observed in the first episode patients in multiple cortical and subcortical sites. Following six weeks treatment with atypical neuroleptics, first episode patients showed improvement in neural function, manifest as significantly larger hemodynamic responses to target stimuli in bilateral amygdala, hippocampus, dorsolateral prefrontal cortex, supramarginal gyrus and in the posterior cingulate. These data are consistent with the hypothesis that schizophrenia is characterized by a widespread pathological process affecting many cerebral areas. The data also suggest atypical neuroleptics improve neural function at diverse cerebral sites

New insights into prefrontal function in schizophrenia

Although many studies have reported diminished frontal lobe activation during cognitive tasks in schizophrenia, some studies have reported baseline frontal hyperactivity in acutely ill patients (Ebmeier et al, 1995). We employed fMRI to examine frontal activity in 8 first-episode patients and matched controls during the ™N-back∫ working memory task on two separate occasions. Patients were scanned for the first time while acutely psychotic and 6±8 weeks later after their symptoms remitted during antipsychotic treatment. During the acute state, patients exhibited significantly less activation in the 2-back condition relative to the 0-back condition, compared with healthy controls. Comparison with rest indicated that the reduced relative activation in patients was due to low activity during the 2-back condition together with abnormally high activation during the 0-back condition. After treatment, the frontal activation in the 2-back, relative to the 0-back condition, increased towards normal, due to normalization of the level of activity in the 0-back condition. However, the activity in the 2-back condition remained low. These findings suggest that the antipsychotic treatment is associated with reduction in aberrant frontal overactivity in the baseline state

Changes in distributed neural circuitry function in first episode schizophrenic patients during test-retest of a working memory task

We employed functional magnetic resonance imaging (fMRI) on two separate occasions (6-8 weeks apart) to investigate neurophysiological changes in acutely psychotic first episode schizophrenic patients and demographically matched controls during performance of the N-Back working memory task. The task consisted of 2-back (find letter identical to one presented two trial back), 0-back (find X), and Rest condition. By the time of the second scan, patients’ symptoms improved significantly with atypical antipsychotic treatment. The fMRI data were analyzed with the Statistical Parametric Mapping software (SPM99) using a random-effects model. In control subjects the analysis of 2-back vs. 0-back revealed significant activations in bilateral prefrontal cortex (PFC), parietal cortex, thalamus and cerebellum, whereas 0-back vs. Rest showed only limited activation. The same pattern was apparent during the second scan. In contrast, in acutely ill patients the analysis of 2-back vs. 0-back revealed very restricted activation, whereas 0-back vs. Rest showed widespread activations in bilateral PFC, parietal cortex, thalamus and cerebellum. This ‘‘shifted’’ pattern of activity with extensive activations during 0-back vs. Rest and a minimal increase from 0- back to 2-back normalized during the second scan, though not completely. While the function of right PFC, right thalamus and left cerebellum improved with treatment, implying a state-related phenomenon, the function of left PFC, left thalamus and right cerebellum remained disturbed, suggesting a trait-related nature of this deficit

Functional magnetic resonance imaging during sentence verification: A potential tool for assessment of neuro-correlates of delusional disorders

Schizophrenia is a heterogeneous disorder characterized by delusions, hallucinations, disorganized thinking, and cognitive deficits. Delusions are false beliefs that are firmly held in spite of evidence to the contrary. Functional magnetic resonance imaging is a noninvasive technique that allows investigators to assess brain function during specific thinking processes. To our knowledge, no studies have directly assessed brain function during the evaluation of delusional beliefs. In the present study, we compared the brain activity of normal healthy subjects that is associated with the evaluation of true versus false statements. fMRI images were acquired in nine subjects while they performed a task in which they were presented with, and required to validate or reject, a Ž series of true and false statements 30 of each, in total, in blocks . of five ; 50 of the sentences were autobiographical in content, and were derived from individual subject interviews held prior to scanning, while 10 sentences were A general knowledge B statements about the world. Results indicate that the right dorsal lateral Ž. prefrontal cortex RDLPFC is more active during the validation of true statements, as compared to during the negation of false statements. The RDLPFC is believed to be important to the integration of current perceptions and ideas with an individual’s existing knowledge and memories. In principle, such a procedure may be useful in the assessment of the neural correlates associated with delusional thinking. By directly assessing the evaluation of delusional beliefs, we hope to gain increased insight into the formation and maintenance of delusional thinking in schizophrenia

Developmental risk profiles for psychotic and affective disorders in offspring at age 5 years

Background and Aims: We used population record linkage (NSW Child Development Study; NSW-CDS) to determine developmental risk profiles at age 5 years for later psychotic and affective dis- orders, comprising vulnerabilities indexed by the Australian Early Development Census (AEDC). Of interest were shared and distinct features of risk profiles for children with parental diagnoses of schizophrenia (SZ), bipolar disorder (BD), affective disorders (AD), or a combination of SZ and BD (SZ/BD). Methods: Participants were 69,116 children with linked parental health records and AEDC data. Children with at least one parent with SZ (N = 885), BD (N = 517), AD (N = 4,536), or SZ/BD (N = 1186) were determined. Sets of AEDC indicators of vulnerability on physical, social, emotional, and language/cognitive domains that predicted membership of each risk group (relative to children without such parental history) were determined using multinomial logistic regressions. Results: Risk for SZ, BD, and AD comprised vulnerabilities in domains of general physical and social competencies, anxious and fearful behaviour, hyperactivity and inattention, and basic numeracy. The profile for SZ risk was distinguished from other groups by limited readiness to explore new things, while all vulnerability indicators for BD were shared with those for SZ and AD. Risk profiles for SZ/BD closely resembled that for AD; aggressive behaviours were common to both AD and SZ/BD, but did not emerge in risk profiles for SZ or BD alone. Conclusions: Developmental risk profiles for psychotic and affective disorders in early childhood share many features representing physical, social, emotional, and cognitive vulnerabilities, with implications for the early detection of risk for severe mental disorders