Gennaro Catone

Bullying victimisation and risk of psychotic phenomena: analyses of British national survey data

BACKGROUND Being bullied is an aversive experience with short-term and long-term consequences, and is incorporated in biopsychosocial models of psychosis. We used the 2000 and the 2007 British Adult Psychiatric Morbidity Surveys to test the hypothesis that bullying is associated with individual psychotic phenomena and with psychosis, and predicts the later emergence of persecutory ideation and hallucinations. METHODS We analysed two nationally representative surveys of individuals aged 16 years or older in Great Britain (2000) and England (2007). Respondents were presented with a card listing stressful events to identify experiences of bullying over the entire lifespan. We assessed associations with the dependent variables persecutory ideation, auditory and visual hallucinations, and diagnosis of probable psychosis. All analyses were controlled for sociodemographic confounders, intelligence quotient (IQ), and other traumas. FINDINGS We used data for 8580 respondents from 2000 and 7403 from 2007. Bullying was associated with presence of persecutory ideation and hallucinations, remaining so after adjustment for sociodemographic factors, IQ, other traumas, and childhood sexual abuse. Bullying was associated with a diagnosis of probable psychosis. If reported at baseline, bullying predicted emergence and maintenance of persecutory ideation and hallucinations during 18 months of follow-up in the 2000 survey. Controlling for other traumas and childhood sexual abuse did not affect the association between bullying and psychotic symptoms, but reduced the significance of the association with diagnosis of probable psychosis. Bullying was most strongly associated with the presence of concurrent persecutory ideation and hallucinations. INTERPRETATION Bullying victimisation increases the risk of individual psychotic symptoms and of a diagnosis of probable psychosis. Early detection of bullying and use of treatments oriented towards its psychological consequences might ameliorate the course of psychosis. FUNDING None.

Antipsychotic-Induced Dyslipidemia Treated with Omega 3 Fatty Acid Supplement in an 11-Year-Old Psychotic Child: A 1-Year Follow-up

Antipsychotic-induced weight gain and dyslipidemia are hard-to-fight threats that can arise during treatment with second generation antipsychotic drugs (De Hert et al. 2011). The youth population is probably at higher risk than adults for antipsychotic-induced metabolic adverse events, because they are more likely drug naı̈ve (Correll et al. 2009; Roy et al. 2010, De Hert et al. 2011). The concern about metabolic complications in youth derives from evidence that metabolic abnormalities and weight gain during childhood strongly predict obesity, metabolic syndrome, hypertension, cardiovascular morbidity, sleep apnea, osteoarthritis, and malignancy risk in adulthood (De Hert et al. 2011; Maayan and Correll 2011). The mechanism of action that lead to metabolic abnormalities is still poorly understood (Roerig et al. 2011), as is what to do to prevent or to treat these adverse events. Guidelines published in 2009 and in August 2011 suggest strictly monitoring patients receiving atypical antipsychotics (De Hert et al. 2009; Ho et al. 2011). Common strategies currently implemented to moderate weight gain and other metabolic changes consist in encouraging a healthy lifestyle and switching to a lower metabolic impact drug (Correll et al. 2011; De Hert et al. 2011). Concomitant metformin administration is used in adults, but data regarding children and adolescents are limited (Newall et al. 2012). Many other psychopharmacological interventions have been suggested, but, although promising, none of those drugs have been demonstrated to be able to entirely reverse weight gain or reduce cholesterol and triglycerides (TG) (Maayan et al. 2010). Omega 3 fatty acids are becoming more frequently used in all fields of medicine, including child psychiatry (e.g., Gabbay et al. 2012). Use of well-timed controls of bleeding time are encouraged, but, generally, omega 3 use is considered safe (Emsley et al. 2008). In general medicine, the effects on lowering triglyceride levels are described, as well as small evidences of reducing obesity and metabolic syndrome symptoms (Balk et al. 2006; Buckley and Howe 2010; Poudyal et al. 2011). The use of omega 3 in antipsychotic-induced metabolic syndrome is only suggested, but no controlled or naturalistic studies are known by authors at the time of this report. An urgent need for evidence-based strategies to reduce metabolic symptoms in children and adolescents taking antipsychotic drugs is an opinion shared among experts (Correll et al. 2009; De Hert et al. 2011; Maayan and Correll 2011).

Using Directed Acyclic Graphs in Epidemiological Research in Psychosis: An Analysis of the Role of Bullying in Psychosis.

Abstract Modern psychiatric epidemiology researches complex interactions between multiple variables in large datasets. This creates difficulties for causal inference. We argue for the use of probabilistic models represented by directed acyclic graphs (DAGs). These capture the dependence structure of multiple variables and, used appropriately, allow more robust conclusions about the direction of causation. We analyzed British national survey data to assess putative mediators of the association between bullying victimization and persecutory ideation. We compared results using DAGs and the Karlson–Holm–Breen (KHB) logistic regression commands in STATA. We analyzed data from the 2007 English National Survey of Psychiatric Morbidity, using the equivalent 2000 survey in an instant replication. Additional details of methods and results are provided in the supplementary material. DAG analysis revealed a richer structure of relationships than could be inferred using the KHB logistic regression commands. Thus, bullying had direct effects on worry, persecutory ideation, mood instability, and drug use. Depression, sleep and anxiety lay downstream, and therefore did not mediate the link between bullying and persecutory ideation. Mediation by worry and mood instability could not be definitively ascertained. Bullying led to hallucinations indirectly, via persecutory ideation and depression. DAG analysis of the 2000 dataset suggested the technique generates stable results. While causality cannot be fully determined from cross-sectional data, DAGs indicate the relationships providing the best fit. They thereby advance investigation of the complex interactions seen in psychiatry, including the mechanisms underpinning psychiatric symptoms. It may consequently be used to optimize the choice of intervention targets.

Subject at Risk for Eating Disorders: Study of a Population of Children Aged between 8 and 13 Years

Subject at Risk for Eating Disorders: Study of a Population of Children Aged between 8 and 13 Years Background: early onset eating disorders (EOED) are increasing. Epidemiological studies provided that the overall prevalence is estimated at around 10% in the school population. The present study aims to evaluate those at risk for EOED in a population of students from Campania Region, Italy and to identify some correlated factors associated with the disorder (BMI, age, gender, sport/activities involvement, meal-time characteristics). Method: sample consisted of the students of the primary and secondary schools in six municipalities near the city of Caserta (Campania-Italy). Children eating attitude test-26 (Ch-EAT-26) has been used to collect data on eating disorder behaviors and attitudes. Results: 137 subjects, 61 female and 76 male composed the sample. Mean age was 115,38 months (SD: 10,4). Mean BMI was 20 (SD: 5). The means score at the ChEAT was 13.25 (SD: 9) and 30 children exceeded the clinical cut-off score (>20). There was no correlation between ChEAT score and BMI and age. Sport/activities outside the school and key figure for the child at meal time were significantly different between the clinical and non-clinical group (Ch-EAT score). Conclusion: data showed that our sample had a higher risk for EOED compared to the overall prevalence. Dance and physical exercise were confirmed such as risk factors for eating disorders. Finally according to the results of our research, the presence of the mother at the meal- time may be a protective factor for the risk of developing and eating disorder in childhood.

Conduct disorders and psychopathy in children and adolescents: aetiology, clinical presentation and treatment strategies of callous-unemotional traits

Conduct Disorder (CD) is a psychiatric diagnosis characterized by a repetitive and persistent pattern of behaviour in which the basic rights of others and major age-appropriate social norms or rules are violated. Callous Unemotional (CU) traits are a meaningful specifier in subtyping CD for more severe antisocial and aggressive behaviours in adult psychopathology; they represent the affective dimension of adult psychopathy, but they can be also detected in childhood and adolescence. The CU traits include lack of empathy, sense of guilt and shallow emotion, and their characterization in youth can improve our diagnostic, prognostic and therapeutic abilities. A strong genetic liability, in interaction with parenting and relevant environmental factors, can lead to elevated levels of CU traits in children. We pointed out that CU traits can be detected in early childhood, may remain stable along the adolescence, but a decrease following intensive and specialized treatment is possible. We here provide a narrative review of the available evidences on CU traits in three main domains: aetiology (encompassing genetic liability and environmental risk factors), presentation (early signs and longitudinal trajectories) and treatments.

Psychiatric and neuropsychological issues in Marfan syndrome: A critical review of the literature.

The cooccurrence of Marfan syndrome and psychiatric disorders has been reported for many years. Furthermore, neuropsychological deficits have been shown to be associated with Marfan syndrome. The aim of the present article is to summarize findings from the sparse studies and case reports available. The results hold clinical and therapeutic implications and suggest that psychological and neuropsychological domains in Marfan syndrome patients should be carefully assessed. In particular, some patients may require specific rehabilitation programs. On this basis, a multidisciplinary approach to Marfan syndrome treatment seems mandatory.

Putative mechanisms of action and clinical use of lithium in children and adolescents: a critical review

Background: Lithium is a first-line treatment for bipolar disorder in adults, but its mechanism of action is still far from clear. Furthermore, evidences of its use in pediatric populations are sparse, not only for bipolar disorders, but also for other possible indications. Objectives: To provide a synthesis of published data on the possible mechanisms of action of lithium, as well as on its use in pediatric samples, including pharmacokinetics, efficacy, and safety data. Methods: Clinical trials in pediatric samples with at least one standardized measure of efficacy/effectiveness were included in this review. We considered: i) randomized and open label trials, ii) combination studies iii) augmentation studies iv) case series including at least 5 patients. Results: Different and non-alternative mechanisms of action can explain the clinical efficacy of lithium. Clinical studies in pediatric samples suggest that lithium is effective in managing manic symptoms/episodes of bipolar disorder, both in the acute phase and as maintenance strategy. Efficacy on depressive symptoms/phases of bipolar disorder is much less clear, while studies do not support its use in unipolar depression and severe mood dysregulation. Conversely, it may be effective on aggression in the context of conduct disorder. Other possible indications, with limited published evidence, are the acute attacks in Kleine-Levin syndrome, behavioral symptoms of X-fragile syndrome, and the management of clozapine- or chemotherapy- induced neutropenia. Generally, lithium resulted relatively safe. Conclusions: Lithium seems an effective and well-tolerated medication in pediatric bipolar disorder and aggression, while further evidences are needed for other clinical indications.

Using directed acyclic graphs in Epidemiological research in psychosis

Abstract Modern psychiatric epidemiology researches complex interactions between multiple variables in large datasets. This creates difficulties for causal inference. We argue for the use of probabilistic models represented by directed acyclic graphs (DAGs). These capture the dependence structure of multiple variables and, used appropriately, allow more robust conclusions about the direction of causation. We analyzed British national survey data to assess putative mediators of the association between bullying victimization and persecutory ideation. We compared results using DAGs and the Karlson–Holm–Breen (KHB) logistic regression commands in STATA. We analyzed data from the 2007 English National Survey of Psychiatric Morbidity, using the equivalent 2000 survey in an instant replication. Additional details of methods and results are provided in the supplementary material. DAG analysis revealed a richer structure of relationships than could be inferred using the KHB logistic regression commands. Thus, bullying had direct effects on worry, persecutory ideation, mood instability, and drug use. Depression, sleep and anxiety lay downstream, and therefore did not mediate the link between bullying and persecutory ideation. Mediation by worry and mood instability could not be definitively ascertained. Bullying led to hallucinations indirectly, via persecutory ideation and depression. DAG analysis of the 2000 dataset suggested the technique generates stable results. While causality cannot be fully determined from cross-sectional data, DAGs indicate the relationships providing the best fit. They thereby advance investigation of the complex interactions seen in psychiatry, including the mechanisms underpinning psychiatric symptoms. It may consequently be used to optimize the choice of intervention targets.

Using directed acyclic graphs in Epidemiological research in psychosis: the role of bullying in psychosis

Abstract Modern psychiatric epidemiology researches complex interactions between multiple variables in large datasets. This creates difficulties for causal inference. We argue for the use of probabilistic models represented by directed acyclic graphs (DAGs). These capture the dependence structure of multiple variables and, used appropriately, allow more robust conclusions about the direction of causation. We analyzed British national survey data to assess putative mediators of the association between bullying victimization and persecutory ideation. We compared results using DAGs and the Karlson–Holm–Breen (KHB) logistic regression commands in STATA. We analyzed data from the 2007 English National Survey of Psychiatric Morbidity, using the equivalent 2000 survey in an instant replication. Additional details of methods and results are provided in the supplementary material. DAG analysis revealed a richer structure of relationships than could be inferred using the KHB logistic regression commands. Thus, bullying had direct effects on worry, persecutory ideation, mood instability, and drug use. Depression, sleep and anxiety lay downstream, and therefore did not mediate the link between bullying and persecutory ideation. Mediation by worry and mood instability could not be definitively ascertained. Bullying led to hallucinations indirectly, via persecutory ideation and depression. DAG analysis of the 2000 dataset suggested the technique generates stable results. While causality cannot be fully determined from cross-sectional data, DAGs indicate the relationships providing the best fit. They thereby advance investigation of the complex interactions seen in psychiatry, including the mechanisms underpinning psychiatric symptoms. It may consequently be used to optimize the choice of intervention targets.

Psychotic-like experiences in help-seeking adolescents: Dimensional exploration and association with different forms of bullying victimization - A developmental social psychiatry perspective.

Background: Psychotic-like experiences (PLEs) are common in the general population and increase the risk of psychotic disorders. Adolescents are a high-risk group of this condition. Stressful events, such as bullying, have a role in the onset of PLEs. This study has several aims: (1) to assess PLEs in adolescents seeking help from a Child and Adolescent Mental Health Service, (2) to assess the association of PLEs with specific bullying victimization and (3) to assess difference in PLEs and victimizations by sex and age. Methods: Participants were help-seeking (HS) adolescents initially screened for PLEs. They completed an assessment including characteristics of PLEs and bullying victimization. We paid particular attention to different kinds of PLEs and victimization. Results: In total, 50 PLE-positive adolescents screened from 324 HS adolescents (15.4%) constituted the sample. Paranoia and verbal bullying were the PLEs and form of victimization most represented, respectively. Verbal bullying was strongly associated with paranoia (odds ratio (OR): 4.40, confidence interval (CI): 2.8−5.9, p < .001). Results remained significant after controlling for confounder (socio-demographic, anxiety, depression and for the latter analysis also other forms of victimization). Furthermore, social manipulation showed a strong association of paranoia and physical bullying with grandiosity. Verbal bullying was also associated with psychotic negative symptoms, but controlling for emotional symptoms and other victimization led to a reduction in the effect. Men were more involved in physical victimization and experienced grandiosity; on the contrary, late adolescents were most involved in social victimization and negative psychotic symptoms Conclusion: PLEs are relevant in HS adolescents. Bullying victimization interacts with the onset of these phenomena. In particular, verbal bullying predicted paranoia onset significantly.