scholarly journals Early childhood social communication deficits in youth at clinical high-risk for psychosis: Associations with functioning and risk

2019 ◽  
Vol 32 (2) ◽  
pp. 559-572 ◽  
Author(s):  
K. Juston Osborne ◽  
Teresa Vargas ◽  
Vijay A. Mittal
Keyword(s):  
Early Childhood ◽  
Social Interaction ◽  
High Risk ◽  
Social Communication ◽  
Eye Gaze ◽  
Clinical High Risk ◽  
Communication Deficits ◽  
Increased Risk ◽  
Reciprocal Social Interaction ◽  
Critical Developmental Period

AbstractEffective social functioning requires a broad range of social communication skills that are impaired in psychosis populations. However, little is known about early childhood (4- to 5-year period) social communication during the premorbid (pre-illness) stage of psychosis. The present study utilized retrospective parent reports to examine total early childhood social communication deficits, as well as deficits in two distinct domains, reciprocal social interaction (social smiling/eye gaze) and communication (social chat/gesture), in youth at clinical high-risk (CHR) for psychosis (ages 13–21; 37.2% female). Furthermore, associations between early childhood social communication and CHR youth's current functioning (social, academic/work), symptoms (positive/negative), and risk for conversion to psychosis were examined. Compared to healthy controls, CHR individuals had greater deficits in total and communication-specific early childhood social communication. Early childhood total, communication, and reciprocal social interaction deficits were associated with worse current functioning and greater current negative symptom severity (amotivation/anhedonia) in CHR youth. Early childhood total and reciprocal social interaction deficits were also associated with increased risk for conversion. These findings inform the field's understanding of the etiology and pathophysiology of psychosis by extending the current developmental literature on premorbid deficits in psychosis populations to specific domains of social behavior in a critical developmental period.

scholarly journals S154. TOBACCO SMOKING AND CLINICAL HIGH RISK: A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EVIDENCE

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S94-S95
Author(s):  
Andrea De Micheli ◽  
Albertine van Lawick van Pabst ◽  
Enass Yossef ◽  
Philip McGuire ◽  
Paolo Fusar-Poli
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Physical Health ◽  
Tobacco Use ◽  
Citation Index ◽  
Meta Analysis ◽  
Assessment Tools ◽  
Clinical High Risk ◽  
Increased Risk ◽  
Russian Science Citation Index

Abstract Background There is converging evidence that youths at clinical high risk (CHR) are not only likely to develop the first episode of psychosis but also to develop poor physical outcomes. Some physical health risk factors - such as smoking - have been shown to increase the probability of a frank onset of psychosis in those at risk. A meta-analysis conducted in psychotic patients confirmed that daily tobacco use is associated with an increased risk of psychosis. A significant association between any attenuated psychotic symptoms (that characterize CHR state) and cigarette smoking has been recently shown in a study conducted in South London. Nowadays, it is not completely clear how these findings would translate to the CHR population but a better understanding of how physical health parameters could affect psychopathological outcomes could be beneficial for these vulnerable clinical populations. To shed light on the percentage of smokers in CHR populations, an updated systematic review and meta-analysis of the literature has been carried out. Our main aim was to test whether the probability of being a smoker was higher in the CHR subjects or in the control group. Methods The literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We systematically scrutinized from literature inception to 2019 the following on-line databases: Web of Science Core Collection, BIOSIS Citation Index, KCL-Korean Journal Database, MEDLINE, Russian Science Citation Index, SCiELO Citation Index. We have considered all the relevant studies reporting the smoking status in CHR subjects and in control groups. We used the odds ratio (OR) as effect size measure and data were pooled using a random effect approach. Results Preliminary data show that CHR individuals were more likely to use tobacco that matched healthy controls. Specifically, the overall OR of 2.016 (p<.001 95%CI=1.476–2.749) indicated a higher likelihood that CHR individuals would use tobacco compared to controls. Heterogeneity was not significant (I²=30.193 p=0.11). The visual inspection of funnel plots did not reveal a clear suggestion for publication bias and the Egger’s test was non-significant (p=0.10). Discussion Our systematic review and meta-analysis suggest that is crucial to investigate physical health outcomes such as tobacco use as part of clinical practice in CHR services. Unfortunately, current CHR assessment tools are entirely based on the measurement of psychopathological features and do not include an assessment of these parameters on a regular basis.

scholarly journals Behavioural and psychological characteristics in Pitt-Hopkins syndrome: a comparison with Angelman and Cornelia de Lange syndromes

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Alice Watkins ◽  
Stacey Bissell ◽  
Jo Moss ◽  
Chris Oliver ◽  
Jill Clayton-Smith ◽  
...  
Keyword(s):  
Social Interaction ◽  
Social Communication ◽  
Neurodevelopmental Disorder ◽  
Autism Spectrum ◽  
Sensory Profile ◽  
Psychological Characteristics ◽  
Genetic Syndrome ◽  
Reciprocal Social Interaction ◽  
Cornelia De Lange ◽  
Challenging Behaviours

Abstract Background Pitt-Hopkins syndrome (PTHS) is a genetic neurodevelopmental disorder associated with intellectual disability. Although the genetic mechanisms underlying the disorder have been identified, description of its behavioural phenotype is in its infancy. In this study, reported behavioural and psychological characteristics of individuals with PTHS were investigated in comparison with the reported behaviour of age-matched individuals with Angelman syndrome (AS) and Cornelia de Lange syndrome (CdLS). Methods Questionnaire data were collected from parents/caregivers of individuals with PTHS (n = 24), assessing behaviours associated with autism spectrum disorder (ASD), sociability, mood, repetitive behaviour, sensory processing, challenging behaviours and overactivity and impulsivity. For most measures, data were compared to data for people with AS (n = 24) and CdLS (n = 24) individually matched by adaptive ability, age and sex. Results Individuals with PTHS evidenced significantly higher levels of difficulties with social communication and reciprocal social interaction than individuals with AS, with 21 of 22 participants with PTHS meeting criteria indicative of ASD on a screening instrument. Individuals with PTHS were reported to be less sociable with familiar and unfamiliar people than individuals with AS, but more sociable with unfamiliar people than individuals with CdLS. Data also suggested areas of atypicality in sensory experiences. Challenging behaviours were reported frequently in PTHS, with self-injury (70.8%) occurring at significantly higher rates than in AS (41.7%) and aggression (54.2%) occurring at significantly higher rates than in CdLS (25%). Individuals with PTHS also evidenced lower reported mood than individuals with AS. Conclusions Behaviours which may be characteristic of PTHS include those associated with ASD, including deficits in social communication and reciprocal social interaction. High rates of aggression and self-injurious behaviour compared to other genetic syndrome groups are of potential clinical significance and warrant further investigation. An atypical sensory profile may also be evident in PTHS. The specific aetiology of and relationships between different behavioural and psychological atypicalities in PTHS, and effective clinical management of these, present potential topics for future research.

Clinical High Risk Symptoms and Criteria in the Community: Prevalence, Clinical Significance and Risk Factors for Their Occurrence

2017 ◽  
Vol 41 (S1) ◽  
pp. S226-S226
Author(s):  
F. Schultze-Lutter ◽  
C. Michel ◽  
B.G. Schimmelmann ◽  
S. Ruhrmann
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Clinical Relevance ◽  
Clinical Samples ◽  
Clinical High Risk ◽  
Basic Symptoms ◽  
Developmental Models ◽  
Increased Risk ◽  
Ultra High Risk ◽  
Competing Interest

IntroductionIn clinical samples, symptomatic ultra-high risk (UHR) criteria and the basic symptom criterion “cognitive disturbances” perform well in predicting psychosis, and best when both approaches are combined.ObjectiveHowever, little-to-nothing is known about clinical high risk (CHR) and their constituent symptoms in the community.AimsWe studied the prevalence, clinical relevance, and moderators of CHR criteria and symptoms in the community.MethodRegression analyses involved 2683 community participants (age 16–40 years; response rate: 63.4%). Semi-structured telephone interviews were performed by well-trained psychologists.ResultsLifetime and current CHR symptoms were reported by 21.1% and 13.8% of interviewees. Frequency of symptoms was mostly low, only 2.4% met any CHR criterion. A stepwise relationship underlay the association of the two types of CHR symptoms and criteria with the presence of mental disorders and functional deficits, with odds ratios being highest (7.4–31.8) when UHR and basic symptoms occurred together. Report of a family history of mental disorder generally increased risk for CHR symptoms. While younger age increased risk for basic symptoms, lifetime substance misuse and trauma increased risk for UHR symptoms.ConclusionsPrevalence of CHR criteria was within the to-be-expected range from prevalence rates of psychoses. Clinical relevance of both CHR symptoms and criteria increased in a stepwise manner from basic symptoms via UHR symptoms to their combined presence, reinforcing the clinical utility of their combined use. The risk factors selectively associated with basic and UHR symptoms support developmental models relating basic symptoms to neurobiological and UHR symptoms to psychological factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals O10.5. CLINICAL HIGH RISK (CHR) CRITERIA IN CHILDREN AND ADOLESCENTS NOT SUSPECTED TO DEVELOP PSYCHOSIS: NO TRANSDIAGNOSTIC SEVERITY MARKER OF MENTAL HEALTH PROBLEMS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S26-S26
Author(s):  
Frauke Schultze-Lutter ◽  
Chantal Michel ◽  
Benno G Schimmelmann ◽  
Maurizia Franscini ◽  
Nina Traber-Walker ◽  
...  
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Children And Adolescents ◽  
Mental Health Problems ◽  
Community Sample ◽  
Structured Interview ◽  
Clinical High Risk ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Increased Risk

Abstract Background Compared to adults, children and adolescents of the community more frequently report clinical high risk of psychosis (CHR) criteria. Yet, little is known about the prevalence of CHR criteria in clinical children and adolescents’ samples. Thus, we studied the prevalence of CHR criteria and symptoms in 8- to 17-year-old inpatients with disorders that have been associated with greater odds to develop psychosis in adulthood, i.e., attention-deficit hyperactivity disorder, social and specific phobia, and obsessive-compulsive disorder, eating disorders and Asperger’s disorder. Methods As part of the multicenter naturalistic Bi-national Evaluation of At-Risk Symptoms in children and adolescents (BEARS-Kid) study, 8- to 17-year-olds of the community (N=235) and 8- to 17-year-old inpatients with any one of the above main diagnoses who were not suspected to be at increased risk of psychosis (N=306) were examined for CHR symptoms and criteria with the Schizophrenia Proneness Instrument, Child & Youth version and with the Structured Interview for Psychosis-Risk Syndromes. Results At 6.4%, the prevalence rate of CHR criteria in the community sample did not significantly differ from the 8.2%-rate in the inpatient sample. CHR criteria and symptoms were generally associated with age but not with group membership. Discussion This indicates that, irrespective of their mental health status, children and adolescents present more frequently with CHR criteria compared to young adults of the community for whom a 2.4%-rate of CHR criteria had earlier been reported. Furthermore, these findings contradict assumptions that CHR criteria might be diagnostically puripotential or merely severity markers of mental illness. Yet, more research into these symptoms and their cause and meaning in children and adolescents is needed to understand their significance in this age group and to detect factors that convey their clinical relevance in adulthood.

Soziale Ängste im klinischen Hochrisikostadium für Psychosen

2018 ◽  
Vol 87 (05) ◽  
pp. 284-297
Author(s):  
Theresa Katharina Haidl ◽  
Marlene Rosen ◽  
Stephan Ruhrmann ◽  
Joachim Klosterkötter
Keyword(s):  
Social Interaction ◽  
High Risk ◽  
Anxiety Scale ◽  
Clinical High Risk ◽  
Soziale Phobie ◽  
Soziale Angststörung

ZusammenfassungIn den letzten Jahren wird zunehmend über die Komorbidität von schizophrenen Störungen mit Angsterkrankungen berichtet. So wurde bei Patienten mit einer Störung aus dem Schizophrenie-Spektrum in 38,3 % eine Angsterkrankung und darunter mit 14,9 % am häufigsten eine soziale Phobie (SP) gefunden. Gerade sozialer Angst kommt bei Patienten mit Psychose eine besondere Bedeutung zu, weil sie sich oft mit Depressivität verbindet und zur Entstehung von psychosozialen Behinderungen beitragen kann. Auch im Hochrisikostadium für Psychosen („Clinical High- Risk State for Psychosis“, HRP) treten Angsterkrankungen bereits gehäuft auf. Daher stellen sich die Fragen, ob auch hier die soziale Angststörung dominiert und welche Bedeutung dies für die Arbeit in den Früherkennungs- und Präventivzentren hätte. Um diese Fragen zu klären, gibt diese Arbeit erstmals einen systematischen Überblick über alle bisher publizierten Untersuchungen zu sozialen Ängste im klinischen HRP.Insgesamt wurden 124 Studien eingeschlossen. Nach der aussagekräftigsten dieser Arbeiten kamen Angsterkrankungen bei den HRP-Probanden mit knapp 51 % hochsignifikant häufiger als bei Kontrollpersonen mit nur knapp 4 % vor. Die SP dominierte und war mit einer Prävalenz 14,4 % gegenüber nur 0,36 % bei den Kontrollpersonen fast genauso häufig vertreten, wie man sie unter den Angststörungen im Schizophrenie-Spektrum (14,9 %) gefunden hat. Der in 9 Studien mit Hilfe der Social Interaction and Anxiety Scale (SIAS) ermittelte Ausprägungsgrad sozialer Ängstlichkeit (SÄ) lag im Mittel bei den HRP Gruppen nahezu genauso hoch (SIAS-Score = 34,4; SD = 6,11) wie bei den bereits an einer Psychose erkrankten Patienten (SIAS-Score = 35,0; SD = 9,56) und hob sich deutlich von den Werten für Angehörige von Psychosekranken (SIAS-Score = 22,1; SD = 8,7) und Kontrollen (SIAS Score =  14,6; SD = 7,28) ab. Der Ausprägungsgrad der SÄ stand zwar mit der für das HRP maßgeblichen attenuierten psychotischen Symptomatik im Zusammenhang, ließ aber keine Vorhersagekraft für den Übergang in die psychotische Erstmanifestation erkennen. Die psychosozialen Funktionsverluste im HRP scheinen zudem nicht nur mit der SÄ, sondern auch mit den ebenfalls häufigen komorbiden depressiven Störungen in Verbindung zu stehen. Ferner konnte eine Studie zeigen, dass es erfolgversprechend ist, die SÄ im HRP durch neu entwickelte spezialisierte kognitive Verhaltenstherapien anzugehen.

Contraception and thrombophilia

2009 ◽  
Vol 29 (02) ◽  
pp. 193-196 ◽  
Author(s):  
H. Rott ◽  
A. Kruempel ◽  
G. Kappert ◽  
U. Nowak-Göttl ◽  
S. Halimeh
Keyword(s):  
Chronic Illness ◽  
High Risk ◽  
Children And Adolescents ◽  
Hormonal Contraception ◽  
Hormonal Contraceptives ◽  
Thromboembolic Events ◽  
Contraceptive Methods ◽  
Secondary Complications ◽  
Increased Risk ◽  
Coagulation Proteins

SummaryThe risk of thromboembolic events (TE) is increased by acquired or inherited thrombo -philias (IT). We know that some hormonal contraceptives also increase the risk of thrombosis, thus, the use of such contraceptives are discussed as contraindications in women with IT. TEs are infrequent events in children and adolescents and in the majority of cases are associated with secondary complications from underlying chronic illness. Although adolescents are not typically considered to be at high-risk for TE, this cohort is frequently using hormonal contraception, leading to an increased risk in cases with unknown IT. The risk of TE with pregnancy alone is higher than associated with combined hormonal contra -ception. Progestin-only methods have not been found to increase the risk of TE with only moderate changes of coagulation proteins compared to normal reference values. Conclusion: Thrombophilic women are good candidates for progestin-only contraceptive methods.

Markers of Hypercoagulability in Patients with Hemophilia B Given Repeated, Large Doses of Factor IX Concentrates during and after Surgery

1994 ◽  
Vol 71 (06) ◽  
pp. 737-740 ◽  
Author(s):  
E Santagostino ◽  
P M Mannucci ◽  
A Gringeri ◽  
G Tagariello ◽  
F Baudo ◽  
...  
Keyword(s):  
High Risk ◽  
Ex Vivo ◽  
Factor Ix ◽  
Hemophilia B ◽  
Coagulation System ◽  
Prolonged Treatment ◽  
Orthopedic Procedures ◽  
Factor X ◽  
Prothrombin Complex Concentrates ◽  
Increased Risk

SummaryPurer factor IX (FIX) concentrates have been produced for the treatment of hemophilia B in the attempt to reduce the risk of thrombotic complications associated with the use of prothrombin complex concentrates. To evaluate ex vivo whether or not FIX concentrates activate the coagulation system in conditions associated with a high risk for thrombosis, we measured markers of hypercoagulability in 10 patients with hemophilia B who underwent surgery, mainly orthopedic procedures, covered by multiple concentrate infusions (40-80 U/kg/day). Postinfusion plasma levels of prothrombin fragment 1+2 and factor X activation peptide did not differ significantly from the presurgical levels, neither before nor after each concentrate dose. Therefore, it appears that prolonged treatment of patients with hemophilia B undergoing high risk surgical procedures with high doses of FIX concentrate does not cause systemic activation of coagulation. This suggests that purified FIX concentrates are preferable to prothrombin complex concentrates for conditions associated with an increased risk of thrombosis.

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