Claudia M. Klier

Long-Chain -3 Fatty Acids for Indicated Prevention of Psychotic Disorders A Randomized, Placebo-Controlled Trial

CONTEXT The use of antipsychotic medication for the prevention of psychotic disorders is controversial. Long-chain omega-3 (omega-3) polyunsaturated fatty acids (PUFAs) may be beneficial in a range of psychiatric conditions, including schizophrenia. Given that omega-3 PUFAs are generally beneficial to health and without clinically relevant adverse effects, their preventive use in psychosis merits investigation. OBJECTIVE To determine whether omega-3 PUFAs reduce the rate of progression to first-episode psychotic disorder in adolescents and young adults aged 13 to 25 years with subthreshold psychosis. DESIGN Randomized, double-blind, placebo-controlled trial conducted between 2004 and 2007. SETTING Psychosis detection unit of a large public hospital in Vienna, Austria. PARTICIPANTS Eighty-one individuals at ultra-high risk of psychotic disorder. INTERVENTIONS A 12-week intervention period of 1.2-g/d omega-3 PUFA or placebo was followed by a 40-week monitoring period; the total study period was 12 months. MAIN OUTCOME MEASURES The primary outcome measure was transition to psychotic disorder. Secondary outcomes included symptomatic and functional changes. The ratio of omega-6 to omega-3 fatty acids in erythrocytes was used to index pretreatment vs posttreatment fatty acid composition. RESULTS Seventy-six of 81 participants (93.8%) completed the intervention. By studys end (12 months), 2 of 41 individuals (4.9%) in the omega-3 group and 11 of 40 (27.5%) in the placebo group had transitioned to psychotic disorder (P = .007). The difference between the groups in the cumulative risk of progression to full-threshold psychosis was 22.6% (95% confidence interval, 4.8-40.4). omega-3 Polyunsaturated fatty acids also significantly reduced positive symptoms (P = .01), negative symptoms (P = .02), and general symptoms (P = .01) and improved functioning (P = .002) compared with placebo. The incidence of adverse effects did not differ between the treatment groups. CONCLUSIONS Long-chain omega-3 PUFAs reduce the risk of progression to psychotic disorder and may offer a safe and efficacious strategy for indicated prevention in young people with subthreshold psychotic states. Trial Registration clinicaltrials.gov Identifier: NCT00396643.

Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders?

Objective: The utility of several self‐report symptom inventories were examined for detecting postpartum depression (MDD) and anxiety disorders (AD).

Minor depressive disorder in the context of miscarriage

BACKGROUND Although minor depressive disorder is of considerable clinical and public health importance, it has received limited research attention relative to major depressive disorder. This study examines the incidence rate and relative risk for minor depressive disorder following miscarriage. METHODS Using a cohort design we tested whether miscarrying women are at increased risk for an episode of minor depression (diagnosed based on research criteria proposed in Appendix B of DSM-IV) in the 6 months following loss. The miscarriage cohort consisted of women attending a medical center for spontaneous abortion (n=229); the comparison group was a population-based cohort of women drawn from the community (n=230). RESULTS Among miscarrying women, 5.2% experienced an episode of minor depression, compared with 1.0% of community women. The overall relative risk for an episode of minor depression for miscarrying women was 5.2 (95% confidence interval, 1.2-23.6). Relative risk did not vary by length of gestation at the time of loss or attitude toward the pregnancy. The majority of episodes in miscarrying women began within 1 month following loss. LIMITATIONS Minor depression was relatively rare in both study cohorts. The resulting limits on statistical power reduced our ability to identify factors, such as sociodemographic or reproductive history variables that might moderate the effect of miscarriage on risk for minor depression. CONCLUSIONS These results, in the context of prior work showing increased risks of major depression and depressive symptoms following miscarriage, lend some support to the conceptualization of minor depressive disorder as part of a continuum of symptom severity. Miscarrying women should be evaluated for depression at their follow-up medical visits.

Correlation between serum testosterone levels and peripartal mood states

Background. We conducted a prospective study at the Department of Obstetrics and Gynecology, University Hospital of Vienna to investigate associations between serum testosterone levels and maternal peripartal mood states.

Mehrsprachiges Aufwachsen und Sprachentwicklungsstörungen. Eine Übersichtsarbeit

Multilingual children and language impairment Abstract. For many children with a migration background, difficulties acquiring their second language skills influences their educational success. Because of the wide range of languages and their varieties, which are not described linguistically in detail, development of reliable and valid assessment procedures is hindered. This results in a diagnostic dilemma, as children who have problems learning their second language, along with many other reasons, have to be distinguished from children suffering from a specific language impairment (SLI). Children with migration background may show linguistic profiles which superficially resemble those of children with SLI. The current paper constitutes a selective review of relevant literature and offers suggestions for meeting those respective challenges. It is assumed that the prevalence for clinically relevant language disorder is the same in multilingual as in monolingual children. Also, multilingual children like monolingual children can show subtle cognitive weaknesses. The relevance of language disorder in psychiatrically ill multilingual and monolingual children is well known and has to be considered in the context of a comprehensive assessment. For those children with a migration background who face more pronounced problems acquiring their second language skills, language assessment in their mother tongue is essential.

Sprachentwicklung bei Kindern mit Migrationshintergrund und elterliches Vorlesen

Introduction The majority of children with a migration background suffer from language deficits in one or both languages. The aim of our study was to describe the patterns of language acquisition in children with Turkish background in Austria and to find factors which influence these Patterns. Method Fifty-two children at the age of 5 to 6 years and their parents were assessed. Inclusion criteria for parents were Turkish migration background and use of Turkish at home. Inclusion criteria for children: no hearing impairment, no blindness, no chronic disease, average cognitive development, born in Austria, and attending a kindergarten. Language competence was measured with Havas 5. Parents were administered a questionnaire about socio-demographics and their child centered literacy orientation (CCLO). Results There was a significant difference between language patterns in Turkish and German. Moreover, language competence was higher in both Turkish and German, the more parents tended to read to their children in Turkish. Discussion Children acquired a grammatically correct but simple Turkish, while their competence in German was reduced. Reading to the children seems to stimulate language development not only of their natural language, but also of German. Conclusion Early literacy in migrant languages should be integrated in training programs.

Psychopharmaka bei Kindern – Heilung oder Verkleidung?

Das Reizthema Psychopharmaka hat in der Kinderpsychiatrie ganz besondere Brisanz. Bei einer insgesamt schwachen Datenlage und Evidenz, sowie dem allgegenwärtigen Off-Label Einsatz von Medikamenten bewegt sich die Kinderpsychiatrie auf äußerst dünnem Eis. Vor diesem Hintergrund gewinnen nicht-pharmakologische Interventionen an besonderem Stellenwert und stellen heute in beinahe allen Anwendungsgebieten die Erstlinienbehandlung dar. Für Psychiatrie & Psychotherapie analysierten Doz. Dr. Claudia Klier, Sonnenpark Neusiedlersee, Podersdorf, Prim. Dr. Rainer Fliedl, Landesklinikum Thermenregion Mödling und Prof. Dr. Brigitte Hackenberg, Universitätsklinik für Kinder- und Jugendheilkunde, AKH Wien den Stellenwert von Psychopharmaka bei Kindern und Jugendlichen.

Die pharmakologische Therapie von postpartalen Depressionen

Die Verordnung von Psychopharmaka wahrend der Stillzeit kann nicht generell abgelehnt werden. Ein korperlich gesunder Saugling nimmt bei den via Muttermilch aufgenommenen trizyklischen Antidepressiva und den selektiven Serotonin-Wiederaufnahmehemmern in aller Regel keinen Schaden. Eine verallgemeinernde Aussage im Sinne einer volligen Unbedenklichkeit dieser Antidepressiva fur Sauglinge ist aber nicht moglich. Dies entspricht medikamentosen Therapien uberhaupt, auch in allen anderen Situationen — man kann nie generell sagen, dass eine Therapie in jedem Falle unschadlich ist.