Pathways from maternal depressive symptoms to adolescent depressive symptoms: the unique contribution of irritability symptoms

- Background: The authors tested three possible pathways linking prenatal maternal depressive symptoms to adolescent depressive symptoms. These pathways went through childhood Irritability Symptoms, Anxiety/Depressive Symptoms or Conduct Problems.\ud - Method: Data were collected from 3,963 mother–child pairs participating in the Avon Longitudinal Study of Parents and Children. Measures include maternal depressive symptoms (pre- and postnatal); toddler temperament (2 years); childhood (7–13 years) irritability symptoms, anxiety/depressive symptoms, conduct problems, and adolescent depressive symptoms (16 years).\ud - Results: Irritability Symptoms: This pathway linked sequentially – prenatal maternal depressive symptoms, toddler temperament (high perceived intensity and low perceived adaptability), childhood irritability symptoms, and adolescent depressive symptoms. Anxiety/Depressive symptoms: This pathway linked sequentially – prenatal maternal depressive symptoms, toddler temperament (negative perceived mood), childhood anxiety/depressive symptoms, and adolescent depressive symptoms. Childhood conduct problems were not associated with adolescent depressive symptoms, above and beyond irritability symptoms and anxiety/depressive symptoms.\ud - Conclusions: Results suggest evidence for two distinct developmental pathways to adolescent depressive symptoms that involve specific early and midchildhood features

Mood lability and psychopathology in youth

Background. Mood lability is a concept widely used. However, data on its prevalence and morbid associations are scarce. We sought to establish the occurrence and importance of mood lability in a large community sample of cildren and adolescents by testing a priori hypotheses.Method. Cross-sectional data were taken from a national mental health survey including 5326 subjects aged 8-79 years in the UK. The outcomes were prevalence and characteristics of mood lability and its associations with psychopathology and overall impairment.Results. Mood lability occurred in more than 5% of the population of children and adolescents, both by parent and self-report. Mood lability was strongly associated with a wide range of psychopathology and was linked to significant impairment even in the absence of psychiatric disorders. Mood lability was particularly strongly associated with co-morbidity between internalizing and externalizing disorders, even when adjusting for the association with individual disorders. The pattern of results did not change after excluding youth with bipolar disorder or with episodes of elated mood.Conclusions. Clinically significant mood lability is relatively common in the community. Our findings indicate that mood lability is not a mere consequence of other psychopathology in that it is associated with significant impairment even in the absence of psychiatric diagnoses. Moreover, the pattern of association of mood lability with co-morbidity suggests that it could be a risk factor shared by both internalizing and externalizing disorders. Our data point to the need for greater awareness of mood lability and its implications for treatment

About breaking barriers, the risk paradox, and other twists

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Age-Related Effects on Self-Focused Attention Across Adolescence and the Relationship With Symptoms of Body Dysmorphia, Social Anxiety and Depression

INTRODUCTION: Adolescence is a critical period for the development of several emotional disorders, including body dysmorphic disorder (BDD), social anxiety disorder (SAD) and depression. It has been suggested that this may be partly due to developmental changes in self-referential processing, including self-focused attention (SFA). However, to date little is known about normative changes in self-focused attention across adolescence. This study investigated age-related effects on SFA during adolescence, and its relationship with symptoms of BDD, SAD and depression. METHODS: A sample of 638 adolescents aged 11-18 years (53% male) were recruited through government-funded secondary school students in the United Kingdom and completed validated self-reported measures of SFA, BDD, SAD and depression. RESULTS: Age was positively associated with SFA, and with symptoms of BDD, SAD and depression. The associations of age with SFA, SAD and depression were, on average, greater in females, although this age by sex interaction effect only reached statistical significance for BDD symptoms. SFA fully mediated the effect of age on SAD symptoms, and partially mediated age effects on symptoms of BDD and depression. CONCLUSIONS: The current findings indicate that self-focused attention increases during adolescence. Moreover, findings provide support for the notion that increased self-focused attention may partly account for the rise in symptoms of BDD, SAD and depression during this developmental period. Future research should seek to establish the direction of effects between self-focused attention and symptoms using longitudinal designs

Epidemiology of Body Dysmorphic Disorder and Appearance Preoccupation in Youth: Prevalence, Comorbidity and Psychosocial Impairment

OBJECTIVE: Little is known about how common and impairing body dysmorphic disorder (BDD) is in the general population of youth. We evaluated the prevalence, comorbidity, and psychosocial impairment associated with BDD and more broadly defined appearance preoccupation in young people. METHOD: Data were drawn from the 2017 Mental Health of Children and Young People in England survey. BDD and psychiatric comorbidity were assessed in individuals 5 to 19 years of age (N = 7,654) according to DSM-5 criteria, using a clinician-rated standardized diagnostic assessment. Psychosocial impairment was measured with a quantitative scale and was indexed by reported self-harm and suicide attempts, as well as service use, assessed using structured interviews. RESULTS: The point prevalence of BDD was 1.0% (95% CI = 0.8%-1.3%). BDD was significantly more common among adolescents than children (1.9 vs 0.1%; OR = 22.5, p < .001), and among female than male participants (1.8% vs 0.3%; OR = 7.3, p < .001). Approximately 70% of young people with BDD had psychiatric comorbidity, most commonly internalizing disorders. BDD was associated with self- and parent-reported psychosocial impairment, self-harm and suicide attempts, and service utilization. Appearance preoccupation was more common than full-syndrome BDD, but showed similar age and sex effects, patterns of comorbidity, and associated impairment. CONCLUSION: BDD and appearance preoccupation are relatively common, especially among adolescent girls, and are associated with substantial co-occurring psychopathology, impairment, and risk. Improved screening is needed to increase detection and diagnosis of BDD, and to facilitate access to evidence-based treatment. STUDY PREREGISTRATION INFORMATION: The epidemiology of body dysmorphic disorder the youth: prevalence, comorbidity and psychosocial impact; https://osf.io/g83j

Editorial Perspective: When is a ‘small effect’ actually large and impactful?

Reporting of effect sizes is standard practice in psychology and psychiatry research. However, interpretation of these effect sizes can be meaningless or misleading – in particular, the evaluation of specific effect sizes as ‘small’, ‘medium’ and ‘large’ can be inaccurate depending on the research context. A real-world example of this is research into the mental health of children and young people during the COVID-19 pandemic. Evidence suggests that clinicians and services are struggling with increased demand, yet population studies looking at the difference in mental health before and during the pandemic report effect sizes that are deemed ‘small’. In this short review, we utilise simulations to demonstrate that a relatively small shift in mean scores on mental health measures can indicate a large shift in the number of cases of anxiety and depression when scaled up to an entire population. This shows that ‘small’ effect sizes can in some contexts be large and impactful

Capturing brain‐cognition relationship: Integrating task‐based fMRI across tasks markedly boosts prediction and test‐retest reliability

Capturing individual differences in cognition is central to human neuroscience. Yet our ability to estimate cognitive abilities via brain MRI is still poor in both prediction and reliability. Our study tested if this inability can be improved by integrating MRI signals across the whole brain and across modalities, including task-based functional MRI (tfMRI) of different tasks along with other non-task MRI modalities, such as structural MRI, resting-state functional connectivity. Using the Human Connectome Project (n = 873, 473 females, after quality control), we directly compared predictive models comprising different sets of MRI modalities (e.g., seven tasks vs. non-task modalities). We applied two approaches to integrate multimodal MRI, stacked vs. flat models, and implemented 16 combinations of machine-learning algorithms. The stacked model integrating all modalities via stacking Elastic Net provided the best prediction (r = 0.57), relatively to other models tested, as well as excellent test-retest reliability (ICC=∼.85) in capturing general cognitive abilities. Importantly, compared to the stacked model integrating across non-task modalities (r = 0.27), the stacked model integrating tfMRI across tasks led to significantly higher prediction (r = 0.56) while still providing excellent test-retest reliability (ICC=∼.83). The stacked model integrating tfMRI across tasks was driven by frontal and parietal areas and by tasks that are cognition-related (working-memory, relational processing, and language). This result is consistent with the parieto-frontal integration theory of intelligence. Accordingly, our results contradict the recently popular notion that tfMRI is not reliable enough to capture individual differences in cognition. Instead, our study suggests that tfMRI, when used appropriately (i.e., by drawing information across the whole brain and across tasks and by integrating with other modalities), provides predictive and reliable sources of information for individual differences in cognitive abilities, more so than non-task modalities

Diagnostic efficiency of the SDQ for Parents to identify ADHD in the UK: A ROC analysis.

arly, accurate identification of ADHD would improve outcomes while avoiding unnecessary medication exposure for non-ADHD youths, but is challenging, especially in primary care. The aim of this paper is to test the Strengths and Difficulties Questionnaire (SDQ) using a nationally representative sample to develop scoring weights for clinical use. The British Child and Adolescent Mental Health Survey (N = 18,232 youths 5–15 years old) included semi-structured interview DSM-IV diagnoses and parent-rated SDQ scores. Areas under the curve for SDQ subscales were good (0.81) to excellent (0.96) across sex and age groups. Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 21.3×. For discriminating ADHD from other diagnoses, accuracy was fair (&lt;0.70) to good (0.88); Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 4.47×. The SDQ is free, easy to score, and provides clinically meaningful changes in odds of ADHD that can guide clinical decision-making in an evidence-based medicine framework

Inflammatory CNS demyelination:histopathologic correlation with in vivo quantitative proton MR spectroscopy

BACKGROUND AND PURPOSE: The mechanisms behind the demyelination that is characteristic of multiple sclerosis (MS) are still poorly understood. The purpose of this study was to compare immunopathologic findings in demyelinating lesions of three patients with in vivo assessments obtained by quantitative proton MR spectroscopy (MRS).METHODS: Between four and seven stereotactic needle brain biopsies were performed in three young adults with diagnostically equivocal findings for MS. Axonal density, gliosis, blood brain–barrier breakdown, and demyelinating activity of lesions were determined. Combined MR/MRS studies were performed (T1-weighted fast low-angle shot and single-voxel stimulated-echo acquisition mode), and absolute metabolite levels were obtained with a user-independent fitting routine. Metabolite control values were obtained from a group of age-matched healthy volunteers (n=40, age range, 20–25 years old). Alterations of metabolite levels of control subjects were considered significant when exceeding two standard deviations.RESULTS: There were parallel decreases of N-acetylaspartate (21%–82%) and reductions of axonal density (44%–74%) in demyelinating plaques. Concomitant increases of choline (75%–152%) and myo-inositol (84%–160%) corresponded to glial proliferation. Elevated lactate was associated with inflammation.CONCLUSION: The present data suggest that in vivo MRS indicates key pathologic features of demyelinating lesions