Jim Os

Impact of Birth Weight and Genetic Liability on Psychopathology in Children of Bipolar Parents

OBJECTIVEnTo test different models for ways in which birth weight and familial loading influence the risk for psychopathology in bipolar offspring.nnnMETHODnDSM-IV diagnoses of 140 bipolar offspring (12-21 years of age) were assessed with the K-SADS-PL. Parents were interviewed using the Family History-Research Diagnostic Criteria to determine familial loading of mood and substance use disorders. Parents reported the birth weight of their offspring. Age- and sex-adjusted hazard ratios were calculated.nnnRESULTSnLow birth weight was associated with mood and non-mood disorders in bipolar offspring (hazard ratio = 0.6, confidence interval = 0.4-0.8), even after controlling for familial loading of unipolar disorder, bipolar disorder, or substance use disorder. There were no significant interactions between birth weight and familial loading of unipolar disorder, familial loading of bipolar disorder, and familial loading of substance use disorder.nnnCONCLUSIONSnBirth weight is associated with mood as well as non-mood disorders. This association is independent from the association of familial loading of mood and substance use disorder with mood- and non-mood disorders in bipolar offspring.

T115. REASONING BIAS, WORKING MEMORY PERFORMANCE, AND A TRANSDIAGNOSTIC PHENOTYPE OF AFFECTIVE DISTURBANCES AND PSYCHOTIC EXPERIENCES IN THE GENERAL POPULATION

Abstract Background There is robust evidence that reasoning biases such as a tendency of jumping to conclusions (JTC) as well as cognitive deficits are associated with psychosis, but evidence on their association with affective disturbances remains inconclusive. Recent findings also suggest a transdiagnostic phenotype of co-occurring affective disturbances and psychotic experiences. This study aimed to investigate whether JTC bias and decreased working memory performance are associated with the co-occurrence of affective disturbances, psychotic experiences (PEs), and psychosis-related help-seeking behaviour (HS) in the general population. Methods The second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). Trained interviewers administered the Composite International Diagnostic Interview (CIDI) at three time points in a representative general population sample, with N=4.596 individuals who completed all assessments. The beads task and digit-span task were completed to assess JTC bias and working memory performance, respectively. CIDI was used to measure affective disturbances (i.e. depression, anxiety, mania) and an add-on instrument to measure PEs and HS. Results We found that, compared to individuals with neither affective disturbances nor PEs, JTC bias was more likely to be present in individuals with co-occurring affective disturbances, PEs, and HS (moderate psychosis [1–2 PEs]: relative risk ratio [RRR]=1.23, 95% CI 1.03 – 1.48, p=0.023; high psychosis [3 or more PEs or HS]: RRR=1.66, 95% CI 1.26 – 2.19, p<0.001) in models adjusted for socio-demographic characteristics and socio-environmental factors. However, when we additionally adjusted for working memory performance this association was attenuated (moderate psychosis: RRR=1.17, 95% CI 0.98 – 1.41, p=0.088; high psychosis: RRR=1.57, 95% CI 1.19 – 2.08, p=0.002). In line with previous findings, there was no evidence that JTC bias was more likely to occur in individuals with sole presence of affective disturbances (RRR=1.03, 95% CI 0.94–1.13, p=0.492). Further, there was some evidence of a dose-response relationship, as JTC bias was progressively more likely to occur in individuals with affective disturbances as the level of PEs increased or HS was reported (high vs. moderate psychosis: p=0.052). In contrast, compared to individuals with neither affective disturbances nor PEs, a decreased working memory performance was evident in all groups (i.e., affective disturbances only: RRR=0.94, 95% CI 0.90–0.98, p=0.006; PEs only: RRR=0.79, 95% CI 0.69–0.91, p=0.001; co-occurring affective disturbances and moderate psychosis: RRR=0.83, 95% CI 0.75–0.91, p<0.001; co-occurring affective disturbances and high psychosis: RRR=0.76, 95% CI 0.65–0.89, p=0.001). Discussion Our findings suggest that JTC bias and decreased working memory performance may contribute to a transdiagnostic phenotype of co-occurring affective disturbances and PEs. Further, findings support the notion that JTC bias may be specifically associated with psychosis, including in those presenting a transdiagnostic phenotype, while a lowered working memory performance may represent a more broadly distributed vulnerability factor across various symptom domains. Overall, results point to the need to further investigate whether established mechanism and risk factors, described to be involved in the development and maintenance of psychosis, extend to transdiagnostic phenotypes to further corroborate proposed aetiological models and overcome shortcomings of focussing only on specific domains of mental health.

T12. VITAMIN D STATUS AND PSYCHOTIC DISORDER: ASSOCIATIONS WITH CLINICAL VARIABLES AND RISK FACTORS

Abstract Background The association between schizophrenia and decreased vitamin D levels is well documented. Low maternal and postnatal vitamin D levels suggest a possible etiological mechanism. Vitamin D deficiency in patients diagnosed with schizophrenia is presumably (also) the result of disease-related factors. Furthermore, certain demographic risk factors such as urbanicity may be associated with vitamin D. Methods In a large study population of 347 patients with psychotic disorder and 282 controls, associations between vitamin D levels in blood and clinical variables and risk factors were investigated. Regression analyses were conducted correcting for gender, age, ethnicity, body mass index (BMI), smoking and sampling season. Group × symptomatology and group × urbanicity interactions were investigated. Both current urbanicity and urbanicity at birth were assessed. Results Vitamin D concentrations were significantly lower in patients (B= -8.05; 95% confidence interval (CI) -13.68 to -2.42; p=0.005). There were (trend) significant interactions between group and vitamin D for symptomatology (positive symptoms: χ2=2.81 and p=0.094; negative symptoms: χ2=5.63 and p=0.018). A small but significant effect was detected: higher vitamin D concentration was associated with lower positive (B= -0.02; 95% CI -0.04 to 0.00; p=0.049) and negative symptom levels (B= -0.03; 95% CI -0.05 to -0.01; p=0.008) in patients. The group × current urbanicity interaction was not significant. However, the group × urbanicity at birth was significant when corrected for current urbanicity (χ2=11.26 and p=0.001). Discussion Vitamin D levels in patients with psychotic disorder were lower than in controls, with an interaction between group and urbanicity at birth. In the patient group, symptom levels were lower when vitamin D concentration was higher.

F4. LINKING LIFE EVENTS WITH NEGATIVE AFFECT AND PSYCHOTIC EXPERIENCES IN DAILY LIVES OF YOUTH: STRESS SENSITIVITY AS A PUTATIVE MECHANISM?

Abstract Background Negative life events are associated with a range of mental disorders, including psychosis. However, evidence on underlying mechanisms remain scarce. The current study aimed to investigate whether life events (e.g. intrusive threat, experience of loss, illness) impact on the sensitivity towards stress in daily lives of youth. Methods The Experience Sampling Method was used to measure momentary stress (i.e. event-related, activity-related, social), negative affect, and psychotic experiences in a sample of 42 help-seeking adolescents and young adults (service user), 17 siblings, and 40 comparison subjects (controls). Life events during lifetime and the previous year as well as depressive, anxiety, and psychotic symptoms were assessed. Results Stress sensitivity, that is, the associations between momentary stress and (i) negative affect and (ii) psychotic experiences, was modified by lifetime and previous negative life events in service users. While there was strong evidence for increased negative affect and psychotic experiences in service users when high vs. low levels of lifetime exposure to negative life events were compared a pattern of resilience was evident in controls with no marked differences in the magnitude of associations comparing high vs. low exposure levels. However, in controls, exposure to life events during the previous year were also found to impact on the stress sensitivity in daily life. Less consistent findings were observed in siblings. Discussion Our findings point to the importance of time that has passed between exposure to and impact of life events on stress sensitivity: while the detrimental effects may attenuate in controls over time, service users appeared to be at greater risk of negative long-term effects. Thus, stress sensitivity may constitute an important risk and resilience mechanism through which adverse life events impact on mental health in youth. Targeting stress sensitivity in daily life through ecological momentary interventions, potentially with stronger effects shortly after stress exposure, may represent a promising novel therapeutic approach.

Higher schizotypy predicts better metabolic profile in unaffected siblings of patients with schizophrenia

RationaleType 2 diabetes (T2D) is more frequent in schizophrenia (Sz) than in the general population. This association is partly accounted for by shared susceptibility genetic variants.ObjectiveWe tested the hypotheses that a genetic predisposition to Sz would be associated with higher likelihood of insulin resistance (IR), and that IR would be predicted by subthreshold psychosis phenotypes.MethodsUnaffected siblings of Sz patients (nu2009=u2009101) were compared with a nonclinical sample (nu2009=u2009305) in terms of IR, schizotypy (SzTy), and a behavioural experiment of “jumping to conclusions”. The measures, respectively, were the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Structured Interview for Schizotypy-Revised (SIS-R), and the Beads Task (BT). The likelihood of IR was examined in multiple regression models that included sociodemographic, metabolic, and cognitive parameters alongside group status, SIS-R scores, and BT performance.ResultsInsulin resistance was less frequent in siblings (31.7%) compared to controls (43.3%) (pu2009<u20090.05), and negatively associated with SzTy, as compared among the tertile groups for the latter (pu2009<u20090.001). The regression model that examined all relevant parameters included the tSzTy tertiles, TG and HDL-C levels, and BMI, as significant predictors of IR. Lack of IR was predicted by the highest as compared to the lowest SzTy tertile [OR (95%CI): 0.43 (0.21–0.85), pu2009=u20090.015].ConclusionHigher dopaminergic activity may contribute to both schizotypal features and a favourable metabolic profile in the same individual. This is compatible with dopamine’s regulatory role in glucose metabolism via indirect central actions and a direct action on pancreatic insulin secretion. The relationship between dopaminergic activity and metabolic profile in Sz must be examined in longitudinal studies with younger unaffected siblings.

Wat betekent ‘hulp nodig hebben’ voor psychische klachten?

Wil men de zorg betaalbaar houden en enigszins bewaken dat het aanbod in de pas loopt met de zorgbehoefte van de bevolking, dan lijkt reflectie op zijn plaats.

Voordelen, beperkingen en risico’s van ehealth

Wetenschappelijk onderzoek en jarenlange praktijkervaring hebben verschillende voordelen van eHealth ten opzichte van reguliere face-to-facebehandeling aan het licht gebracht. Let wel, het is zeker niet zo dat al deze voordelen meteen optreden zodra een client, organisatie of behandelaar met eHealth gaat werken (vaak met digitalisering van het bestaande aanbod). Om de potentiele voordelen maximaal te benutten is meer nodig. Een goed werkende en geintegreerde technologie ligt uiteraard voor de hand, maar het is vooral van belang dat hulpverleners en clienten samenwerken vanuit een gedeelde onderliggende theorie en werkwijze, die gebaseerd is op positieve gezondheid en de drie domeinen van herstel.

Wat is een hulpverlener? naar een multideskundig perspectief

We hebben het nog niet over de hulpverlener gehad, toch een niet onbelangrijke schakel in het geheel. De hulpverlener is met name belangrijk omdat hij meerdere rollen heeft die zich niet altijd lineair tot elkaar verhouden. Maar ongeacht de rol waarin de ggz-hulpverlener zich bevindt, een belangrijke – zo niet de belangrijkste – functie is het scheppen van een therapeutische relatie. Althans als we de ‘evidence’ volgen en als de ggz-omgeving het toelaat.

Uitkomst die ertoe doet: de psychische gezondheid van de wijk

Wanneer heeft de zorg in de regio zijn doelstelling behaald? Uitkomstmeting is een belangrijke factor in de verantwoording van de zorg en de sturing van verandering. Op dit ogenblik wordt de uitkomst landelijk geregeld op basis van de voor- en nameting van bijvoorbeeld de ernst van symptomen van mensen in zorg.

Wat Is Dat Eigenlijk, Goede GGZ?

Vrijwel ieder land heeft een gezondheidszorgvoorziening voor mensen met psychische klachten. Blijkbaar is daar universeel behoefte aan.