Binia Roth

Defining subjects at risk for psychosis : A comparison of two approaches

The ability to detect individuals at high risk for developing schizophrenia before they express the disease will lead to targeted early intervention. It has been proposed that subjects at risk share a core deficit with people who already have schizophrenia. This includes cognitive impairment, affective symptoms, social isolation and decline in social functioning. In a sample of 104 help-seeking patients from a specialised outpatient clinic we investigated how well two different sets of criteria define the at-risk group and capture this core deficit. One set of criteria is the well-established ultra high-risk model of McGlashan et al. [McGlashan 2001 (SIPS) McGlashan, T. H., Miller, T. J., Woods, S. W., et al. (2001) Structured Interview for Prodromal Syndromes (Version 3.0, unpublished manuscript). New Haven, Connecticut: PRIME Research Clinic, Yale School of Medicine.]; the other criteria were those defined by Cornblatt et al. [Cornblatt, B., Lencz, T., Smith, C.W., Correll, C.U., Auther, A., Nakayama, E., 2003. The schizophrenia prodrome revisited: a neurodevelopmental perspective. Schizophr. Bull. 29, 633-651.]. There was considerable overlap in the two sets of criteria. However, when the basic symptoms of Klosterkötter [Klosterkötter, J., Hellmich, M., Steinmeyer, E.M., Schultze-Lutter, F., 2001a. Diagnosing schizophrenia in the initial prodromal phase. Arch. Gen. Psychiatry, 58, 158-164.] were included in the McGlashan et al. model, a more narrow and homogeneous group was defined.

Randomized controlled comparison of two cognitive behavioral therapies for obese children : mother versus mother-child cognitive behavioral therapy

Background: Parent-child treatments have been shown to be superior to child-focused treatments of childhood obesity. Yet until now, the comparative effectiveness of parent-only and parent-child approaches has been little studied. Method: Fifty-six obese children and their families were randomly assigned to a 16-session cognitive behavioral therapy (CBT) for the parents only or for a combined treatment of parents and children. Children’s percent overweight, the body mass index of their mothers, and behavioral and psychological problems of children and mothers were assessed. Results: Both treatments reduced children’s percent overweight significantly and equally by 6-month follow-up. Also both treatments provided similar results in reducing general behavior problems (externalizing and internalizing behavior problems), global and social anxiety, and depression. Conclusions: Our results point to a comparable efficacy of the two treatments. Further, psychological well-being of both mothers and children can be improved in a CBT for obese children and their parents. Future studies should focus on finding ways to improve the adherence of families to long-term treatment of obesity in childhood.

Cognitive functioning in at-risk mental states for psychosis and 2-year clinical outcome

BACKGROUND Cognitive impairment is prevalent in at-risk mental states (ARMS) for psychosis. METHOD We studied cognitive functioning at baseline in ARMS individuals and investigated its power to predict ARMS persistence and remission at 2-year follow-up. RESULTS 196 patients were recruited. At baseline the ARMS population included 26 subjects meeting basic symptom (BS) criteria and 73 subjects fulfilling ultra-high risk (UHR) criteria. Two control groups were defined: 48 patients in a first episode of psychosis (FE), and 49 help-seeking patient controls (PCO). In 144 patients follow-up data were obtained. The 2-year risk of conversion to psychosis was 20%. Remission from an initial UHR state occurred in two thirds of the follow-up sample. UHR patients that converted to psychosis or did not remit during the follow-up (UHR(n-rem)) showed similar impairment in global cognitive functioning at baseline as the FE group, whereas global cognitive functioning in UHR patients with subsequent remission (UHR(rem)) approximated performances of the BS and PCO groups. UHR(n-rem) and UHR(rem) patients differed significantly on immediate verbal memory, but showed similarly impaired executive functions. Normal immediate verbal memory uniquely predicted remission from an at-risk state with a positive predictive value of 82%. CONCLUSIONS Cognitive deficits are a characteristic feature of true ARMS patients. Verbal memory function appears critical in determining outcome.

Subclinical hallucinations in adolescent outpatients: An outcome study

OBJECTIVE We assessed the continued prevalence at one year and association with clinical variables of subclinical hallucinations ascertained at baseline in a cohort of adolescent outpatients referred to a specialized early psychosis service. We further assessed the prevalence of psychiatric disorders in adolescents presenting subclinical hallucinations. METHOD 84 adolescent patients were sampled from a longitudinal, prospective study that assesses the course of clinical and neuropsychological measures in patients identified as at high clinical risk for psychosis. Subclinical hallucinations were measured using the Scale of Prodromal Symptoms (SOPS) with its companion interview manual (Structured Interview for Prodromal Symptoms, SIPS) [Miller, T.J., McGlashan, T.H., Woods, S.W., Stein, K., Driesen, N., Corcoran, C.M., Hoffman, R., Davidson, L., 1999. Symptom assessment in schizophrenic prodromal states. Psychiatr. Q. 70, 273-287; McGlashan, T.H., Miller, T.J., Woods, S.W., Rosen, J.L., Hoffman, R.E., Davidson, L., 2001. Structured Interview for Prodromal Syndromes (Version 3.0, unpublished manuscript). PRIME Research Clinic, Yale School of Medicine New Haven, Connecticut. ], and the Schizophrenia Proneness Instrument -Adult Version (SPI-A) [Schultze-Lutter, F., Addington, J., Ruhrmann, S., Klosterkötter, J., 2007. Schizophrenia Proneness Instrument (SPI-A). Giovanni Fioriti, Rome, Italy]. At one-year follow-up, only patients reporting subclinical hallucinations at initial assessment were studied. RESULTS Full remission of subclinical hallucinations occurred in over half and at least partial remission in two thirds of these patients at one-year follow-up. Mood disorders were present in 62.5% of adolescents with subclinical hallucinations at initial assessment. SOPS measures for depression, deficient attention and for unusual/delusional thought were significantly associated with subclinical hallucinations at baseline. However, sustained experience of subclinical hallucinations at one-year follow-up was only predicted by the global level of functioning at baseline, while cannabis abuse, psychiatric and psychopharmacological treatment were not predictors. CONCLUSIONS Subclinical hallucinations occur across a wide range of mental states in adolescents and show high rates of remission. Our results warrant that the clinical meaning of such phenomena needs to be carefully weighed against the specific developmental phenomena in this particular age range.

Die psychische Befindlichkeit übergewichtiger Kinder

OBJECTIVE: Numerous studies based on parent questionnaires reveal that obese children are subject to both physical and psychosocial strains. Children are not included as informants in the assessment procedure, and there is a lack of clinical interview studies assessing DSM-IV-based diagnoses in overweight children. METHODS: Emotional and behavioural problems of treatment seeking obese children (N = 59; aged 8-12-years) attending a mental health service were assessed by means of clinical interviews (Kinder-DIPS) that included child and parent reports. In addition, Child Behavior Checklist (CBCL) data (N = 55) available for this clinical sample were compared with data of a representative sample of normal-weight children (N = 1,080). Furthermore, CBCL data of the clinical subsample of 10-12 year-old overweight children (N = 34) were compared with data of a subsample of 10-12 year-old overweight children (N = 33) and of the subsample of normal-weight (N = 386) children from a representative population, both matched by sex. RESULTS: 23 children (39%) met full criteria for a psychiatric disorder according to DSM-IV, and 19 (34.5%), nearly one third, suffered from Binge Eating Disorder (BED). The overweight clinical sample and their normal weight peers differed significantly on 6 of the 8 primary syndrome scales, on the internalizing and the externalizing scores, and on the total problem score of the CBCL. The overweight children in the clinical sample scored significantly higher than the overweight children in the representative sample on the subscale measuring social problems and the total score, with BMI accounting for the difference in total score. Within the representative sample, overweight 10-12 year-old children scored significantly higher than their normal weight peers on two scales measuring delinquency and social problems. CONCLUSION: A third of the obese children had mental disorders and behaviour problems. This finding applies to clinically referred obese children and, to a much lesser degree, to nonclinical obese subgroups in the normal population. Clinically obese children constitute a patient group that is in urgent need of multimodal treatment. As a consequence, a major change in treatment and prevention of childhood obesity is warranted, i.e., from the mere treatment of eating and activity behaviours to the inclusion of treatment of co-morbid mental disorder and prevention of chronification.OBJECTIVE Numerous studies based on parent questionnaires reveal that obese children are subject to both physical and psychosocial strains. Children are not included as informants in the assessment procedure, and there is a lack of clinical interview studies assessing DSM-IV-based diagnoses in overweight children. METHODS Emotional and behavioural problems of treatment seeking obese children (N = 59; aged 8-12-years) attending a mental health service were assessed by means of clinical interviews (Kinder-DIPS) that included child and parent reports. In addition, Child Behavior Checklist (CBCL) data (N = 55) available for this clinical sample were compared with data of a representative sample of normal-weight children (N = 1,080). Furthermore, CBCL data of the clinical subsample of 10-12 year-old overweight children (N = 34) were compared with data of a subsample of 10-12 year-old overweight children (N = 33) and of the subsample of normal-weight (N = 386) children from a representative population, both matched by sex. RESULTS 23 children (39%) met full criteria for a psychiatric disorder according to DSM-IV, and 19 (34.5%), nearly one third, suffered from Binge Eating Disorder (BED). The overweight clinical sample and their normal weight peers differed significantly on 6 of the 8 primary syndrome scales, on the internalizing and the externalizing scores, and on the total problem score of the CBCL. The overweight children in the clinical sample scored significantly higher than the overweight children in the representative sample on the subscale measuring social problems and the total score, with BMI accounting for the difference in total score. Within the representative sample, overweight 10-12 year-old children scored significantly higher than their normal weight peers on two scales measuring delinquency and social problems. CONCLUSION A third of the obese children had mental disorders and behaviour problems. This finding applies to clinically referred obese children and, to a much lesser degree, to nonclinical obese subgroups in the normal population. Clinically obese children constitute a patient group that is in urgent need of multimodal treatment. As a consequence, a major change in treatment and prevention of childhood obesity is warranted, i.e., from the mere treatment of eating and activity behaviours to the inclusion of treatment of co-morbid mental disorder and prevention of chronification.

Interrater-Reliabilität des Diagnostischen Interviews bei psychischen Störungen im Kindes- und Jugendalter (Kinder-DIPS)

OBJECTIVE This study investigates the interrater reliability of the «Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter» (Kinder-DIPS; Schneider, Unnewehr & Margraf, 2009) based on child and parent interviews. It further investigates differences in the interrater reliability depending on age or sex of the children. METHOD 48 certified interviewers conducted 264 parent and 213 child interviews in various inpatient, outpatient, and research settings. RESULTS There is a good interrater reliability for the parent and child interviews for the major diagnostic categories of conduct disorders, tic disorders, elimination disorders, mood disorders, eating disorders, sleeping disorders, the majority of the specific psychiatric disorders, and the exclusion of psychiatric disorders. Neither the sex nor the age of the children influenced interrater reliability. CONCLUSIONS The second and expanded Kinder-DIPS proves to be a reliable parent and child interview for the assessment of mental disorders in both outpatient and inpatient settings.

Developing services for the early detection of psychosis: a critical consideration of the current state of the art.

Recent research has attempted to improve the identification of individuals at-risk of developing schizophrenia to permit targeted early prevention. Two sets of criteria, one characterized by a subgroup of ‘basic symptoms’ [Klosterkötter, Hellmich, Steinmeyer, Schultze-Lutter (2001) Arch Gen Psychiat 58:158–164] and one by the ultra high-risk model [Miller, McGlashan, Woods, Stein, Driesen, Corcoran, Hoffman, Davidson (1999) Psychiatr Q 70:273–287; Yung, McGorry, McFarlane, Jackson, Patton, Rakkar (1996) Schizophr Bull 22:283–303], have been associated with positive predictive values for later schizophrenia. This paper is a critical discussion of these predictive values. In the first part, the paper demonstrates that the predictive values of at-risk criteria are mediated by a strong enrichment effect and depend considerably on the structure of early detection systems. Further, it shows that these predictive values do not apply to the general population level, where subclinical psychosis shows high prevalence and incidence rates, and that these values may be less predictive in adolescents. In the second part, the paper discusses the need for specific sensitization on several levels of an early detection system and proposes a selected overview of prototypical models already applied in this field.

Ambulante Behandlung der Adipositas im Kindes- und Jugendalter

Zusammenfassung: Fragestellung: Adipositas im Kindesalter ist ein zunehmendes Problem in Industrie- und immer mehr auch in Entwicklungslandern. Die Pravalenzraten steigen bis zu 15% in den USA und bis zu 10% in Europa. Der vorliegende Artikel gibt einen Uberblick uber die aktuelle Forschungslage sowie uber medizinische und psychosoziale Probleme, die mit kindlicher Adipositas verbunden sind. Es folgt eine umfassende Zusammenstellung und Beurteilung verschiedener Behandlungsmoglichkeiten, wobei detailliert auf die Behandlungsmerkmale und die Wirksamkeit von ambulanten Behandlungsansatzen bei kindlicher Adipositas eingegangen wird. Methode: Medline- und PsycINFO-Suche von 1966 bis 2003. Schlussfolgerungen: Die Aussagekraft und Generalisierbarkeit der Untersuchungsergebnisse wird insbesondere durch die begrenzte Vergleichbarkeit der Studien eingeschrankt. Implikationen zur Behandlung kindlicher und jugendlicher Adipositas und weiterer Forschung werden diskutiert.

Cenesthopathy in adolescence: an appraisal of diagnostic overlaps along the anxiety-hypochondriasis-psychosis spectrum.

OBJECTIVE To discuss the diagnostic validity of unusual bodily perceptions along the spectrum from age-specific, often transitory and normal, to pathological phenomena in adolescence to hypochondriasis and finally to psychosis. METHODS Critical literature review of the cornerstone diagnostic groups along the spectrum embracing anxiety and cenesthopathy in adolescence, hypochondriasis, and cenesthopathy and psychosis, followed by a discussion of the diagnostic overlaps along this spectrum. RESULTS The review highlights significant overlaps between the diagnostic cornerstones. It is apparent that adolescents with unusual bodily perceptions may conceptually qualify for more than one diagnostic group along the spectrum. To determine whether cenesthopathies in adolescence mirror emerging psychosis, a number of issues need to be considered, i.e. age and mode of onset, gender, level of functioning and drug use. The role of overvalued ideas at the border between hypochondriasis and psychosis must be considered. CONCLUSION As unusual bodily symptoms may in some instances meet formal psychosis risk criteria, a narrow understanding of these symptoms may lead to both inappropriate application of the new DSM-5 attenuated psychosis syndrome and of treatment selection. On the other hand, the possibility of a psychotic dimension of unusual bodily symptoms in adolescents must always be considered as most severe expression of the cenesthopathy spectrum.