Psykoosille altis potilas

Vuosina 2001–2006 toteutettiin ensimmäinen eurooppalainen psykoosiriskin tunnistamiseen ja psykoosin ennustamiseen kohdistuva monikeskustutkimus EPOS European Prediction of Psychosis Study), johon osallistuivat Kölnin, Turun, Amsterdamin ja Birminghamin yliopistot. Turun tutkimusryhmässä seulottiin 772 psykiatrisen avohoidon potilasta. Perusteellisemmin tutkittiin 55 psykoosiriskissä olevaa ja 25 ei-psykoosiriskissä olevaa 16–35-vuotiasta potilasta, joita seurattiin 9 ja 18 kuukautta. Lisäksi tutkittiin 30 sukupuolen ja iän suhteen kaltaistettua väestöverrokkia. Uuden psykiatrisen avohoidon aloittaneista potilaista 26 prosentilla ilmeni psykoosialttiuteen viittaavia oireita ja 15 prosentilla arvioitiin olevan ajankohtainen psykoosiriski. Psykoosiriskissä olleiden potilaiden sairastumista edeltänyt psykososiaalinen kehitys oli ollut heikompaa kuin vertailuryhmillä. Riskipotilailla oli enemmän traumaattisia lapsuudenkokemuksia ja ennen tutkimukseen tuloa he olivat kokeneet rasittavampia elämänmuutoksia kuin vertailuryhmät. Riskipotilailla oli enemmän poikkeavia persoonallisuuden piirteitä ja psykiatrisia häiriöitä kuin potilasverrokeilla. Perustutkimuksen aikaan riskipotilaiden elämänlaatu ja toimintakyky olivat heikommat kuin potilasverrokeilla. Riskipotilaat olivat hakeutuneet hoitoon keskimäärin noin kolme vuotta ennen tutkimukseen tuloa. Sekä ennen perustutkimusta että sen jälkeen riskipotilaat käyttivät enemmän terveydenhuollon palveluita kuin potilasverrokit. Seuranta-aikana kuusi riskipotilasta (10,9 %) sairastui psykoosiin. Psykoosiin sairastuneet käyttivät enemmän hoitopalveluita ja heidän hoitokustannuksensa olivat suuremmat kuin niillä riskipotilailla, jotka eivät sairastuneet psykoosiin. Psykoosien varhaistunnistamista tulisi kehittää varsinkin perusterveydenhuollon tasolla ja psykoosiriskissä olevien potilaiden hoitoa tehostaa.8,00 euro

Longitudinal brain morphology in anti-NMDA receptor encephalitis: a case report with controls

BackgroundAnti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is a severe autoimmune condition, which typically affects young females. The long-term clinical consequences and brain morphology changes after anti-NMDAR encephalitis are not well known.Case presentationWe present clinical and neuroimaging follow-up data on a 25-year female patient with typically presenting anti-NMDAR encephalitis. Longitudinal analyses of brain morphology were done using 3T structural magnetic resonance imaging (sMRI) and Freesurfer analysis at the time of diagnosis and after symptomatic remission. The presented case attained good functional recovery after standard immunoglobulin-corticosteroid treatment but elevated serum NMDAR antibody levels persisted. The patient had no symptomatic relapses during a 3-year clinical follow-up. In the baseline brain sMRI scan there were no marked volume changes. However, a follow-up sMRI after 9months indicated clear volume reductions in frontal cortical regions compared to matched controls with identical sMRI scans.ConclusionsThis case report of anti-NMDAR encephalitis suggests that despite clinical recovery long-term brain morphological changes can develop in the frontal cortex. Longer clinical and imaging follow-up studies are needed to see whether these frontocortical alterations are fully reversible and if not, can they result in trait vulnerabilities for e.g. neuropsychiatric disorders.</p

Psychometric properties of the Trauma and Distress Scale, TADS, in an adult community sample in Finland

Background: There is increasing evidence that a history of childhood abuse and neglect is not uncommon among individuals who experience mental disorder and that childhood trauma experiences are associated with adult psychopathology. Although several interview and self-report instruments for retrospective trauma assessment have been developed, many focus on sexual abuse (SexAb) rather than on multiple types of trauma or adversity.Methods: Within the European Prediction of Psychosis Study, the Trauma and Distress Scale (TADS) was developed as a new self-report assessment of multiple types of childhood trauma and distressing experiences. The TADS includes 43 items and, following previous measures including the Childhood Trauma Questionnaire, focuses on five core domains: emotional neglect (EmoNeg), emotional abuse (EmoAb), physical neglect (PhyNeg), physical abuse (PhyAb), and SexAb. This study explores the psychometric properties of the TADS (internal consistency and concurrent validity) in 692 participants drawn from the general population who completed a mailed questionnaire, including the TADS, a depression self-report and questions on help-seeking for mental health problems. Inter-method reliability was examined in a random sample of 100 responders who were reassessed in telephone interviews.Results: After minor revisions of PhyNeg and PhyAb, internal consistencies were good for TADS totals and the domain raw score sums. Intra-class coefficients for TADS total score and the five revised core domains were all good to excellent when compared to the interviewed TADS as a gold standard. In the concurrent validity analyses, the total TADS and its all core domains were significantly associated with depression and help-seeking for mental problems as proxy measures for traumatisation. In addition, robust cutoffs for the total TADS and its domains were calculated.Conclusions: Our results suggest the TADS as a valid, reliable, and clinically useful instrument for assessing retrospectively reported childhood traumatisation

Childhood physical abuse and emotional neglect are specifically associated with adult mental disorders

Background: Childhood adversities and trauma (CAT) are associated with adult mental disorders. Nevertheless, although CAT of different domains mostly co-occurs, and co-morbidity is common, the associations between CAT and mental disorders, when taking these interrelations into account, are not well known.Aims: We aimed to study differential associations between the five core domains of CAT and current axis-I disorders, taking into consideration their interrelations.Methods: Four hundred and fifteen outpatients attending adult primary (n = 255) and psychiatric care (n = 160) were assessed with the Trauma and Distress Scale (TADS) and the Mini International Neuropsychiatric Interview (MINI). Associations between CAT core domains and diagnostic categories were examined by path analyses.Results: At least some infrequent experience of CAT (83.6%), mostly of neglect, and current mental disorders (49.4%), mostly depression, was frequent, as were co-morbidities and co-occurrence of CAT domains. Considering these interrelations in a path model of excellent fit, physical abuse predicted depressive, manic, psychotic and anxiety disorders, whereas emotional neglect predicted depressive, anxiety and substance misuse disorders.Conclusions: Of all five CAT core domains, physical abuse and emotional neglect had the strongest association with adult psychiatric disorders and might have transmitted earlier reported main effects of other CAT domains onto mental disorders.</p

General psychopathology links burden of recent life events and psychotic symptoms in a network approach

Recent life events have been implicated in the onset and progression of psychosis. However, psychological processes that account for the association are yet to be fully understood. Using a network approach, we aimed to identify pathways linking recent life events and symptoms observed in psychosis. Based on previous literature, we hypothesized that general symptoms would mediate between recent life events and psychotic symptoms. We analyzed baseline data of patients at clinical high risk for psychosis and with recent-onset psychosis (n = 547) from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. In a network analysis, we modeled links between the burden of recent life events and all individual symptoms of the Positive and Negative Syndrome Scale before and after controlling for childhood trauma. To investigate the longitudinal associations between burden of recent life events and symptoms, we analyzed multiwave panel data from seven timepoints up to month 18. Corroborating our hypothesis, burden of recent life events was connected to positive and negative symptoms through general psychopathology, specifically depression, guilt feelings, anxiety and tension, even after controlling for childhood trauma. Longitudinal modeling indicated that on average, burden of recent life events preceded general psychopathology in the individual. In line with the theory of an affective pathway to psychosis, recent life events may lead to psychotic symptoms via heightened emotional distress. Life events may be one driving force of unspecific, general psychopathology described as characteristic of early phases of the psychosis spectrum, offering promising avenues for interventions

Psychosis risk as a function of age at onset: A comparison between early- and late-onset psychosis in a general population sample

This paper proposes a partial-order semantics for a stochastic process algebra that supports general (non-memoryless) distributions and combines this with an approach to numerically analyse the first passage time of an event. Based on an adaptation of McMillan's complete finite prefix approach tailored to event structures and process algebra, finite representations are obtained for recursive processes. The behaviour between two events is now captured by a partial order that is mapped on a stochastic task graph, a structure amenable to numerical analysis. Our approach is supported by the (new) tool FOREST for generating the complete prefix and the (existing) tool PEPP for analysing the generated task graph. As a case study, the delay of the first resolution in the root contention phase of the IEEE 1394 serial bus protocol is analysed