Silvana Fennig

Insight in first-admission psychotic patients

BACKGROUND The prevalence of insight was examined longitudinally in psychotic patients with schizophrenia (n = 86), bipolar disorder (n = 52), major depressive disorder (n = 35) and other psychoses (n = 16). METHOD Before discharge and at 6-month follow-up, insight in first-admission patients from 10 facilities in Suffolk County, New York was rated as part of a modified Hamilton Depression Scale. RESULTS Initially, 80% of depressives but approximately half with other diagnoses manifested insight. At follow-up, most patients demonstrated insight except for the schizophrenic patients. After controlling for diagnosis, significant correlates of baseline insight were being married, hospitalized in a community or academic facility, intelligence and negative symptoms. At follow-up, after controlling for diagnosis and baseline insight, prior treatment was predictive. This finding held for schizophrenic patients separately. CONCLUSION Lack of insight is more prevalent in schizophrenia and improves over time. The components of prior treatment leading to better insight should be explored.

Self-criticism is a key predictor of eating disorder dimensions among inpatient adolescent females.

OBJECTIVE Although the unipolar depression-eating disorder comorbidity is adequately documented, examination of the role of depressive personality styles in eating disorders is relatively scarce. METHOD Associations between depressive symptoms, depressive risk and resilience (i.e., dependency, self-criticism, and sense of efficacy), and eating disorder symptoms (as measured by the Eating Disorder Inventory-2) were examinedin inpatient adolescent females (N = 81). RESULTS Self-criticism emerged as independent, robust, and strong predictor of eating disorder symptoms. CONCLUSION Patients self-criticism should be targeted in psychotherapy and might serve as an obstacle for successful inpatient treatment. The role of self-derogation in eating disorders should be examined further.

Suicidal behavior and depression in adolescents with eating disorders

Background: Eating disorders are associated with an increased risk of suicide. Aim of the study: To examine suicidal behavior and depression in adolescents with eating disorders, and to identify risk factors associated with suicidal ideation and attempted suicide. Methods: Forty-six Israeli adolescent girls with anorexia nervosa or bulimia nervosa completed a self-report battery at the time of assessment or treatment. Suicide attempts and suicidal ideation were investigated in relation to clinical (e.g. body mass index, purging) and psychological (e.g. body dissatisfaction) features of the eating disorders, as well as depression. Twenty-four percent of the subjects had attempted suicide, and 65% reported suicidal thoughts. Fifty-eight percent were moderately to severely depressed. Findings: The risk of attempted suicide was associated with depression, a history of sexual abuse and longer duration of illness, but it was moderated by hospital treatment. Suicidal ideation was related only to depression. Conclusions: The results of this study emphasize the importance of treating aggressively depression in adolescents with eating disorders. Depression seems to amplify illness severity. Currently, strategies for treating eating disorders focus more on the eating disorder behaviors and less on depression. We suggest investing more resources in detecting and treating the co-morbid depression.

Haplotype analysis of the COMT-ARVCF gene region in israeli anorexia nervosa family trios

Anorexia nervosa (AN) is a severe and complex psychiatric disorder with a significant genetic contribution. Previously, we found an association between AN and the 158Val/Met polymorphism of the catechol‐O‐methyltransferase (COMT) gene in a family‐based study of 51 Israeli AN trios. In the present study, we extended the original sample to include 85 family trios [66 AN restricting (AN‐R) and 19 bingeing/purging (AN‐BP) subtype] and performed a family‐based transmission disequilibrium test (TDT) analysis for five SNPs in the COMT and two in the adjacent ARVCF gene. Association was found between AN‐R and several SNPs in the COMT‐ARVCF region including the 158Val/Met polymorphism. TDT analysis of 5‐SNP haplotypes in AN‐R trios revealed an overall statistically significant transmission disequilibrium (P < 0.001). Specifically, haplotype B [COMT‐186C‐408G‐472G(158Val)‐ARVCF‐659C(220Pro)‐524T(175Val)] was preferentially transmitted (P < 0.001) from parents of AN‐R patients to their affected daughters, while haplotype A [COMT‐186T‐408C‐472A(158Met)‐ARVCF‐659T(220Leu)‐524C(175Ala)] was preferentially (P = 0.01) not transmitted. Haplotype B was associated with increased risk (RR 3.38; 0.95CI 1.98–6.43) while haplotype A exhibited a protective effect (RR 0.40; 0.95CI 0.21–0.70) for AN‐R. Preferential transmission of the risk alleles and haplotypes from the parents was mostly contributed by the fathers. No significant transmission disequilibrium of alleles or haplotypes was found for AN‐BP trios. The risk and protective haplotypes may carry molecular variations in the COMT gene or its vicinity that are relevant to the pathophysiology of restrictive anorexia nervosa in the Israeli‐Jewish population.

The impact of comorbid depressive and anxiety disorders on severity of anorexia nervosa in adolescent girls.

Abstract We examined the impact of comorbid depression and anxiety disorders on the severity of anorexia nervosa (AN) in adolescent girls. Adolescent girls with AN (N = 88) were divided into one group with and another group without comorbid disorders, and selected subjective and objective measures of illness severity were compared between the two groups. The comorbid group had significantly higher scores than the noncomorbid group for all four subscales and total scores of the Eating Disorders Examination as well as for all Eating Disorders Inventory–2 subscales, except for bulimia. The comorbid group also had significantly more suicide attempts and hospitalizations compared with the noncomorbid group. There were no significant group differences for the lowest ever body mass index, duration of AN symptoms, and age at AN onset. Our findings suggest that AN with comorbid depression and anxiety disorder is a more severe clinical variant of the disorder, especially with respect to severity of psychological symptoms and suicide risk.

Life events and suicidality in adolescents with schizophrenia

ObjectiveSuicide is the leading cause of premature death in patients with schizophrenia. Studies have shown a weaker association between suicidal behavior and stressful life events in schizophrenic than in nonschizophrenic subjects. The aim of the present study was to further investigate the complicated relationship of suicide attempts and life events in adolescent schizophrenic patients.MethodsForty adolescents with a diagnosis of schizophrenia, including 20 who had attempted suicide and 20 who had not, were compared with 20 age-matched subjects with no psychiatric history. The instruments used for the assessment were the Life Events Checklist, the Suicidal Risk Scale, the Sexual Abuse in Childhood Questionnaire, and the Beck Depression Inventory.ResultsControl subjects reported fewer life events in general, and fewer negative events, events of sexual abuse, and events associated with impaired family functioning than the schizophrenic patients. Within the schizophrenic group, the suicidal patients reported fewer life events than the nonsuicidal patients, but there was no difference between the groups in the number of negative or sexual-abuse events. However, the proportion of negative life events out of total life events was higher in the suicidal group, and their perceived impact was stronger. Levels of depression and suicidality were higher in the suicidal schizophrenic patients than in the nonsuicidal patients.ConclusionsIn adolescent patients with schizophrenia, suicidal behavior is associated less with the number of life events and more with their perception of the events as negative and the impact of these events on the individual.

CAG repeat polymorphism within the KCNN3 gene is a significant contributor to susceptibility to anorexia nervosa: A case-control study of female patients and several ethnic groups in the Israeli Jewish population

The human small‐conductance Ca2+‐activated potassium channel gene KCNN3 has been involved in mechanisms underlying neuronal function and plasticity. A multiallelic CAG repeat polymorphism within the KCNN3 has been associated with schizophrenia and bipolar disorder. We have previously reported in a family‐based study that longer CAG repeats are preferentially transmitted to patients with anorexia nervosa (AN). The present study extends the analysis of KCNN3 allele distribution to a larger series of AN female patients and control groups, incorporating information on ethnicity and co‐morbidities associated with AN. The data analysis is presented while considering separately the two alleles of each individual, namely a minor (shorter) and a major (longer) allele. This study has found that the KCNN3 allele distribution in the general Israeli population does not differ significantly in at least four Jewish ethnic groups of Ashkenazi, North African, Iraqi, and Yemenite origin. These have been used as control groups in a matched case‐control analysis that has demonstrated a significant over‐representation of KCNN3 alleles with longer CAG repeats among AN patients (P < 0.001 for the major allele and P = 0.035 for allele sum). Under dichotomization, a significantly higher prevalence of the L allele (>19 repeats) has been observed among AN patients (P < 0.001). While considering AN and co‐morbid phenotypes, a tendency towards longer (L) alleles has been observed in the subset of patients with obsessive‐compulsive disorder (OCD) co‐morbidity. These findings further implicate KCNN3 as a significant contributor to predisposition to AN.

Diagnostic delays and dilemmas: Management of affected patients in the psychiatric inpatient unit of a general children's hospital

We present the role of the medical-psychiatric unit in the management of children and adolescents with somatic symptoms in whom diagnosis remains uncertain or delayed, which can lead to severe impairment in the childs normal development and functioning and cause anger and hostility in the families. We describe two patients, one with cyclic vomiting syndrome, considered a medical disorder, and the other with conversion disorder, considered a psychiatric disorder. Both patients had had multiple ER admissions and outpatient visits with elaborate and expensive diagnostic workups. On admission to our unit, a coherent and integrated treatment plan was finally formulated and successfully implemented. We discuss the advantage of the medical-psychiatric unit for simultaneous medical and psychosocial intervention early in the development of symptoms and signs. The units need to be ready and able to cope with a wide range of medical and psychiatric disorders with different levels of gravity.

Inpatient treatment has no impact on the core thoughts and perceptions in adolescents with anorexia nervosa

Examine changes in core perceptions and thoughts during the weight restoration phase of inpatient treatment for adolescents with anorexia nervosa.

Subjective versus objective measures of tic severity in Tourette syndrome – The influence of environment

The objective of this study was to examine the influence of environmental challenges on tic expression by subjective and objective measures. The study group consisted of 41 children aged 6-18 years (M=10.15, SD=2.73) with a primary diagnosis of Tourette syndrome. Subjective measures included the Functional Assessment Interview developed for this study and three standard validated instruments. The objective measure was a video-recording of the patients in five daily-life situations: watching television, doing homework, being alone, receiving attention when ticcing, and talking to a stranger. In addition, the effect of premonitory urges on assessment of tic expression was evaluated. The associations between the subjective and objective measures of tic expression were moderate to low. A significantly higher number of tics were observed in the television situation, and a significantly lower number in the alone situation, compared to the other situations. Higher levels of premonitory urge were associated with greater awareness of objectively measured tic expression. In conclusion, tic expression is significantly influenced by the environment. Subjective measures of tic expression may be misleading. These results have implications for refining the clinical assessment of tics, improving research methodology, and developing new therapeutic strategies.