Carol Fitzpatrick

Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies

BACKGROUND Epidemiological research has shown that hallucinations and delusions, the classic symptoms of psychosis, are far more prevalent in the population than actual psychotic disorder. These symptoms are especially prevalent in childhood and adolescence. Longitudinal research has demonstrated that psychotic symptoms in adolescence increase the risk of psychotic disorder in adulthood. There has been a lack of research, however, on the immediate clinicopathological significance of psychotic symptoms in adolescence. AIMS To investigate the relationship between psychotic symptoms and non-psychotic psychopathology in community samples of adolescents in terms of prevalence, co-occurring disorders, comorbid (multiple) psychopathology and variation across early v. middle adolescence. METHOD Data from four population studies were used: two early adolescence studies (ages 11-13 years) and two mid-adolescence studies (ages 13-16 years). Studies 1 and 2 involved school-based surveys of 2243 children aged 11-16 years for psychotic symptoms and for emotional and behavioural symptoms of psychopathology. Studies 3 and 4 involved in-depth diagnostic interview assessments of psychotic symptoms and lifetime psychiatric disorders in community samples of 423 children aged 11-15 years. RESULTS Younger adolescents had a higher prevalence (21-23%) of psychotic symptoms than older adolescents (7%). In both age groups the majority of adolescents who reported psychotic symptoms had at least one diagnosable non-psychotic psychiatric disorder, although associations with psychopathology increased with age: nearly 80% of the mid-adolescence sample who reported psychotic symptoms had at least one diagnosis, compared with 57% of the early adolescence sample. Adolescents who reported psychotic symptoms were at particularly high risk of having multiple co-occurring diagnoses. CONCLUSIONS Psychotic symptoms are important risk markers for a wide range of non-psychotic psychopathological disorders, in particular for severe psychopathology characterised by multiple co-occurring diagnoses. These symptoms should be carefully assessed in all patients.

Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence.

BACKGROUND Adolescent cannabis use has been shown in many studies to increase the risk of later psychosis. Childhood trauma is associated with both substance misuse and risk for psychosis. In this study our aim was to investigate whether there is a significant interaction between cannabis use and childhood trauma in increasing the risk for experiencing psychotic symptoms during adolescence. METHOD Psychiatric interviews using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) semi-structured instrument were carried out with 211 adolescents aged between 12 and 15 years and their parents as part of a population-based study. The interview enquired about early traumatic events, cannabis use and psychiatric symptoms in adolescence. RESULTS In separate analyses both cannabis use and childhood trauma were significantly associated with risk of experiencing psychotic symptoms. However, the presence of both childhood trauma and early cannabis use significantly increased the risk for psychotic symptoms beyond the risk posed by either risk factor alone, indicating that there was a greater than additive interaction between childhood trauma and cannabis use. CONCLUSION Our finding of a greater than additive interaction between childhood trauma and cannabis use may have implications for the identification of individuals at high risk of experiencing psychotic symptoms. For example, measures to actively discourage or intensively treat cannabis use in children and adolescents who have experienced abuse may help to prevent the development of psychosis in this vulnerable group. Our findings require replication in larger samples to confirm this interaction effect.

Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning.

BACKGROUND Recent community-based research has suggested that psychotic experiences act as markers of severity of psychopathology. There has, however, been a lack of clinic-based research. We wished to investigate, in a clinical sample of adolescents referred to a state-funded mental health service, the prevalence of (attenuated or frank) psychotic experiences and the relationship with (i) affective, anxiety and behavioural disorders, (ii) multimorbid psychopathology, (iii) global functioning, and (iv) suicidal behaviour. METHOD The investigation was a clinical case-clinical control study using semi-structured research diagnostic psychiatric assessments in 108 patients newly referred to state adolescent mental health services. RESULTS Psychotic experiences were prevalent in a wide range of (non-psychotic) disorders but were strong markers of risk in particular for multimorbid psychopathology (Z = 3.44, p = 0.001). Young people with psychopathology who reported psychotic experiences demonstrated significantly poorer socio-occupational functioning than young people with psychopathology who did not report psychotic experiences, which was not explained by multimorbidity. Psychotic experiences were strong markers of risk for suicidal behaviour. Stratified analyses showed that there was a greatly increased odds of suicide attempts in patients with a major depressive disorder [odds ratio (OR) 8.89, 95% confidence interval (CI) 1.59-49.83], anxiety disorder (OR 15.4, 95% CI 1.85-127.94) or behavioural disorder (OR 3.13, 95% CI 1.11-8.79) who also had psychotic experiences compared with patients who did not report psychotic experiences. CONCLUSIONS Psychotic experiences (attenuated or frank) are an important but under-recognized marker of risk for severe psychopathology, including multimorbidity, poor functioning and suicidal behaviour in young people who present to mental health services.

Mobile Phone Mood Charting for Adolescents

Mobile phones may provide a useful and engaging platform for supporting therapeutic services working with adolescents. This paper examines the potential benefits of the mobile phone for self-charting moods in comparison to existing methods in current practice. The paper describes a mobile phone application designed by the authors which allows adolescents to record moods on their personal mobile phones. The authors propose that a personal mobile device is more suitable for adolescents than other devices. A pilot study with a non-clinical adolescent group in schools comparing a mobile and a paper diary is presented, along with discussion and analysis of the results. The main finding of the study was that compliance was significantly higher on mobile phones than paper, and the task was not found to be any more difficult to complete using mobile phones than with paper charts. A number of salient issues requiring further research are also identified.

PSYCHIATRIC DISORDER AMONG BOYS WITH DUCHENNE MUSCULAR DYSTROPHY

The prevalence of psychiatric disorder in 23 boys with Duchenne muscular dystrophy was assessed and compared to a matched control group. Dysthymic disorder and major depressive disorder occurred significantly more often among DMD boys than controls. Older boys with DMD were at greater risk of depressive disorder than younger boys. Possible aetiological factors and approaches to management are discussed.

The relationship between bullying, depression and suicidal thoughts/behaviour in Irish adolescents

OBJECTIVES This study examined the prevalence of depressive symptoms, including suicidal ideation/behaviour, among bullied and non-bullied young people. METHODS Participants were 209 students, 97 male and 112 female, attending eight urban post-primary schools and aged between 12 and 15 years. Participants were interviewed using the Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version, the Hopelessness Scale for Children, the Scale for Suicide Ideation, and the Suicide Intent Scale. RESULTS Data were analysed using a series of non-parametric comparison tests. Being a victim of bullying was found to be significantly associated with depression (χ2 = 10.986; df = 1; p = 0.001) and suicidal ideation (χ2 = 5.811; df = 1; p = 0.022). Results also indicated that victims were more likely to have reported a suicide attempt (χ2 = 5.995; df = 1; p = 0.022). Finally, those bullied were significantly more likely to have been referred to psychiatric services (χ2 = 6.661; df = 1;p = 0.011). CONCLUSIONS These findings suggest that the issue of bullying needs to be re-addressed within Irish schools, with particular emphasis placed on further investigation into the psychological consequences thereof.

Competencies and problems of Irish children and adolescents

Abstract This study set out to investigate the behavioural and emotional problems and competencies of Irish children and adolescents using Achenbachs Child Behaviour Checklist (CBCL) and Youth Self Report (YSR). The Child Behaviour Checklist was completed by parents of 481 Irish school children aged 7–9 years and 13–15 years, and the Youth Self Report was completed by 240 adolescents. The schools were selected to represent a wide social and cultural spread. Irish young people of all ages scored significantly lower than their American counterparts on measures of competence, whether rated by themselves or their parents. The parents of the 7–9 year olds rated their children as having significantly lower total problem scores than their American counterparts, but for 13–15 year olds there were no differences in total problem scores between the Irish and American samples, whether rated by parents or the adolescents themselves. Total problem scores and externalizing scores increased with age on the CBCL and the YSR, a pattern in which Irish young people differed from those in most other cultures. Despite differences in sampling and methodology, the Irish results are similar in many respects to those seen in a number of other European studies.

A controlled clinical evaluation of the parents plus children's programme: a video-based programme for parents of children aged 6 to 11 with behavioural and developmental problems.

This article describes the development and the clinic-based evaluation of the Parents Plus Children’s Programme (PPCP), a group-based video-modelling-assisted programme for parents of children aged 6 to 11 referred to a Child Mental Health Service with significant behavioural problems both with and without associated developmental difficulties. In evaluating the programme, a sequential block design was used to assign 74 parents of children referred to the service to the PPCP group (n = 42) or the Treatment as Usual (TAU) Comparison Group (n = 32). Assessment took place before and immediately following the 8-week intervention for both groups and at 5-month follow-up for the PPCP Group. Compared to the TAU Group postprogramme, the PPCP Group displayed significant reductions in total difficulties and conduct problems as measured by the Strengths and Difficulties Questionnaire, decreased parental stress, increased parental confidence and significant improvements in parent-defined problems and goals. These positive changes were maintained at 5-month follow-up for the PPCP group, in addition to further significant improvements in peer problems and prosocial behaviour. The analysis also suggests that the programme is more effective for parents of children with behavioural problems only, than for those with associated developmental difficulties. The strengths and limitations of the study are discussed, as well as the difficulties of conducting practice-based research.

Evaluation of a Group Treatment Programme for Parents of Children with Behavioural Disorders

This study set out to evaluate the use of a video based parent training programme (The Webster-Stratton Programme) in the management of children referred to child mental health services for treatment of behaviour problems. Following diagnostic assessment children were assigned to one of two groups: parents of both groups completed the parenting programme and, in addition, in the second group the child received an intervention appropriate to his/her clinical presentation. The waiting list control group waited 3 months prior to allocation to either treatment group. Standardised rating scales were administered pre-treatment, post-treatment and at 6-month follow-up to both treatment groups, and at an interval of 3 months to the control group. Improvement was significantly greater in both the treatment groups than in the control group. Parenting training programmes are an effective intervention in the management of clinic-referred children with behaviour disorders.

CULTURAL DIFFERENCES IN FAMILY COMMUNICATION ABOUT DUCHENNE MUSCULAR DYSTROPHY

This study compared the patterns of communication and use of professional support systems of Irish and American families with sons with Duchenne muscular dystrophy (DMD). Structured interviews were used with the parents of 34 Irish boys and 21 American boys attending the muscular dystrophy services of Central Remedial Clinic, Dublin, and Childrens Hospital, Boston. A matched control group was interviewed in each culture to compare use of professional support systems. Difficulties in communicating about DMD with their spouses and with their affected sons were reported by significantly more Irish parents than by their American counterparts. More Irish parents had never spoken about DMD with their affected sons. American DMD families reported significantly more contact with professional support systems than did the Irish families. Factors which may contribute to these cultural differences are discussed.