Review Article
Richard von Krafft-Ebing's views on the etiology of major psychiatric illness
- E. J. Engstrom, K. S. Kendler
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- Published online by Cambridge University Press:
- 15 August 2012, pp. 1345-1352
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While best known in the anglophonic world for his work on sexual deviations and his advocacy for degeneration theory, Richard Krafft-Ebing (RKE) (1840–1902) was a major figure in late-19th century European psychiatry and author of the most widely read German psychiatric textbook of that era. With the goal of (re-)introducing his work to an anglophonic audience, we review and provide an historical context for RKE's etiologic theory of major psychiatric illness. RKE saw psychiatric disorders as multifactorial, arising from two sets of etiologic factors: predisposing and exciting. Exciting causes were either psychological or physical, while predisposing causes were either general (e.g. sex, occupation, age) or individual-specific. Three major individual-specific risk factors were of particular importance: heredity, personality and education/rearing. Hereditary factors were typically the most important but were usually non-specific in their effect with the forms of psychiatric illness often differing in close relatives. He emphasized the importance of the ‘neuropathic personality,’ which rendered affected individuals sensitive to the pathogenic effects of various exciting influences. Poor rearing could also substantially increase risk for major mental illness. RKE saw the influences of hereditary and rearing factors on psychiatric illness as often mediated through a neuropathic personality. While RKE believed in degeneration theory and emphasized the potential etiologic importance of masturbation in psychiatric illness, his clinical writings were otherwise characterized by a broad-minded and sensible approach that lacked the narrowness of the strongly brain-based or psychoanalytic psychiatric schools which were very influential during and shortly after his life.
Estimating remission from untreated major depression: a systematic review and meta-analysis
- H. A. Whiteford, M. G. Harris, G. McKeon, A. Baxter, C. Pennell, J. J. Barendregt, J. Wang
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- 10 August 2012, pp. 1569-1585
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Background
Few studies have examined spontaneous remission from major depression. This study investigated the proportion of prevalent cases of untreated major depression that will remit without treatment in a year, and whether remission rates vary by disorder severity.
MethodWait-list controlled trials and observational cohort studies published up to 2010 with data describing remission from untreated depression at ⩽2-year follow-up were identified. Remission was defined as rescinded diagnoses or below threshold scores on standardized symptom measures. Nineteen studies were included in a regression model predicting the probability of 12-month remission from untreated depression, using logit transformed remission proportion as the dependent variable. Covariates included age, gender, study type and diagnostic measure.
ResultsWait-listed compared to primary-care samples, studies with longer follow-up duration and older adult compared to adult samples were associated with lower probability of remission. Child and adolescent samples were associated with higher probability of remission. Based on adult samples recruited from primary-care settings, the model estimated that 23% of prevalent cases of untreated depression will remit within 3 months, 32% within 6 months and 53% within 12 months.
ConclusionsIt is undesirable to expect 100% treatment coverage for depression, given many will remit before access to services is feasible. Data were drawn from consenting wait-list and primary-care samples, which potentially over-represented mild-to-moderate cases of depression. Considering reported rates of spontaneous remission, a short untreated period seems defensible for this subpopulation, where judged appropriate by the clinician. Conclusions may not apply to individuals with more severe depression.
Editorial
Service users as collaborators in mental health research: less stick, more carrot
- K. Staley, T. Kabir, G. Szmukler
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- Published online by Cambridge University Press:
- 31 July 2012, pp. 1121-1125
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Involving service users in research improves its quality and relevance. Many research organizations funding and supporting research now ask researchers about involvement as part of their application process. Some researchers are facing challenges in taking forward involvement as the research infrastructure is not always facilitative. Researchers need greater reward and recognition for carrying out good quality involvement to encourage more effective processes.
Review Article
Foetal origins of depression? A systematic review and meta-analysis of low birth weight and later depression
- W. Wojcik, W. Lee, I. Colman, R. Hardy, M. Hotopf
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- Published online by Cambridge University Press:
- 13 April 2012, pp. 1-12
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Background
The foetal origins hypothesis suggests an association between low birth weight and later depression, yet evidence supporting this association has been inconsistent.
MethodWe systematically reviewed evidence for an association between low birth weight and adult depression or psychological distress in the general population by meta-analysis. We searched EMBASE, Medline, PsycINFO and ISI Web of Science for studies reporting observational data with low birth weight as the exposure and self- or clinician-rated depression or psychological distress measures as an outcome. Selective studies of exposures such as famine or outcomes such as severe illness only were excluded. Altogether,1454 studies were screened for relevance, 26 were included in the qualitative synthesis, 18 were included in the meta-analysis. A random effects meta-analysis method was used to obtain a pooled estimate of effect size.
ResultsThe odds of depression or psychological distress was greater for those of low birth weight (<2500 g) compared to those of normal birth weight (>2500 g) or greater [odds ratio (OR) 1.15, 95% confidence intervals (CI) 1.00–1.32]. However, this association became non-significant after trim-and-fill correction for publication bias (OR 1.08, 95% CI 0.92–1.27). Using meta-regression, no differences in effect size were observed by gender, outcome measure of depression or psychological distress, or whether the effect size was adjusted for possible confounders.
ConclusionsWe found evidence to support a weak association between low birth weight and later depression or psychological distress, which may be due to publication bias. It remains possible that the association may vary according to severity of symptoms or other factors.
Cognitive impairment in euthymic major depressive disorder: a meta-analysis
- E. Bora, B. J. Harrison, M. Yücel, C. Pantelis
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- Published online by Cambridge University Press:
- 26 October 2012, pp. 2017-2026
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Background
There is evidence to suggest that cognitive deficits might persist beyond the acute stages of illness in major depressive disorder (MDD). However, the findings are somewhat inconsistent across the individual studies conducted to date. Our aim was to conduct a systematic review and meta-analysis of existing studies that have examined cognition in euthymic MDD patients.
MethodFollowing a systematic search across several publication databases, meta-analyses were conducted for 27 empirical studies that compared euthymic adult MDD patients (895 participants) and healthy controls (997 participants) across a range of cognitive domains. The influence of demographic variables and confounding factors, including age of onset and recurrent episodes, was examined.
ResultsCompared with healthy controls, euthymic MDD patients were characterized by significantly poorer cognitive functions. However, the magnitude of observed deficits, with the exception of inhibitory control, were generally modest when late-onset cases were excuded. Late-onset cases demonstrated significantly more pronounced deficits in verbal memory, speed of information processing and some executive functions.
ConclusionsCognitive deficits, especially poor response inhibition, are likely to be persistent features, at least of some forms, of adult-onset MDD. More studies are necessary to examine cognitive dysfunction in remitted psychotic, melancholic and bipolar spectrum MDD. Cognitive deficits overall appear to be more common among patients with late-onset depression, supporting the theories suggesting that possible vascular and neurodegenerative factors play a role in a substantial number of these patients.
Childhood adversity in schizophrenia: a systematic meta-analysis
- S. L. Matheson, A. M. Shepherd, R. M. Pinchbeck, K. R. Laurens, V. J. Carr
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- 30 April 2012, pp. 225-238
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Background
Childhood adversity is a putative risk factor for schizophrenia, although evidence supporting this suggestion is inconsistent and controversial. The aim of this review was to pool and quality assess the current evidence pertaining to childhood adversity in people with schizophrenia compared to other psychiatric disorders and to non-psychiatric controls.
MethodIncluded were case-control, cohort and cross-sectional studies. Medline, EMBASE and PsycINFO databases were searched. Study reporting was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and pooled evidence quality was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
ResultsTwenty-five studies met inclusion criteria. Moderate to high quality evidence suggests increased rates of childhood adversity in schizophrenia compared to controls [odds ratio (OR) 3.60, p < 0.00001]. Increased childhood adversity was also reported in schizophrenia compared to anxiety disorders (OR 2.54, p = 0.007), although the effect was not significant in the subgroup analysis of five studies assessing only sexual abuse. No differences in rates of childhood adversity were found between schizophrenia and affective psychosis, depression and personality disorders whereas decreased rates of childhood adversity were found in schizophrenia relative to dissociative disorders and post-traumatic stress disorder (OR 0.03, p < 0.0001).
ConclusionsThis is the first meta-analysis to report a medium to large effect of childhood adversity in people with schizophrenia and to assess specificity for schizophrenia. Further research is required that incorporates longitudinal design and other potentially causal variables to assess additive and/or interactive effects.
A history of the DSM-5 scientific review committee
- K. S. Kendler
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- Published online by Cambridge University Press:
- 03 July 2013, pp. 1793-1800
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This article describes the history of the Scientific Review Committee (SRC) for DSM-5 and reviews its background, procedures and deliberative processes, and conceptual/philosophical framework. The results of its work and the most important and contentious issues that arose in its efforts are reviewed. The central role of the SRC was to provide external review for all proposals for diagnostic change in DSM-5, evaluate them on their level of empirical support using objectively structured rules of evidence agreed upon in advance and make appropriate recommendations to the leadership of the American Psychiatric Association. While the creation of the SRC necessitated a great deal of additional work on the part of the SRC, the workgroups and the DSM-5 Task Force, the SRC succeeded in increasing the focus on empirical standards for nosologic change and providing a greater degree of consistency and objectivity in the DSM review process. The article concludes with recommendations, based on lessons learned, for similar efforts that might be included in future iterations of our psychiatric nosology.
Externalizing biases and hallucinations in source-monitoring, self-monitoring and signal detection studies: a meta-analytic review
- M. L. Brookwell, R. P. Bentall, F. Varese
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- Published online by Cambridge University Press:
- 02 January 2013, pp. 2465-2475
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Background
Cognitive models have postulated that auditory hallucinations arise from the misattribution of internally generated cognitive events to external sources. Several experimental paradigms have been developed to assess this externalizing bias in clinical and non-clinical hallucination-prone samples, including source-monitoring, verbal self-monitoring and auditory signal detection tasks. This meta-analysis aims to synthesize the wealth of empirical findings from these experimental studies.
MethodA database search was carried out for reports between January 1985 and March 2012. Additional studies were retrieved by contacting authors and screening references of eligible reports. Studies were considered eligible if they compared either (i) hallucinating and non-hallucinating patients with comparable diagnoses, or (ii) non-clinical hallucination-prone and non-prone participants using source-monitoring, verbal self-monitoring or signal detection tasks, or used correlational analyses to estimate comparable effects.
ResultsThe analysis included 15 clinical (240 hallucinating patients and 249 non-hallucinating patients) and nine non-clinical studies (171 hallucination-prone and 177 non-prone participants; 57 participants in a correlation study). Moderate-to-large summary effects were observed in both the clinical and analogue samples. Robust and significant effects were observed in source-monitoring and signal detection studies, but not in self-monitoring studies, possibly due to the small numbers of eligible studies in this subgroup. The use of emotionally valenced stimuli led to effects of similar magnitude to the use of neutral stimuli.
ConclusionsThe findings suggest that externalizing biases are important cognitive underpinnings of hallucinatory experiences. Clinical interventions targeting these biases should be explored as possible treatments for clients with distressing voices.
Cortisol and depression: three questions for psychiatry
- J. Herbert
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- 08 May 2012, pp. 449-469
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Background
Cortisol plays a multifaceted role in major depression disorder (MDD). Diurnal rhythms are disturbed, there is increased resistance to the feedback action of glucocorticoids, excess cortisol may induce MDD, basal levels may be higher and the post-awakening cortisol surge accentuated in those at risk for MDD. Does this suggest new avenues for studying MDD or its clinical management?
MethodThe relevant literature was reviewed.
ResultsCortisol contributes to genetic variants for the risk for MDD and the way that environmental events amplify risk. The corticoids' influence begins prenatally, but continues into adulthood. The impact of cortisol at each phase depends not only on its interaction with other factors, such as psychological traits and genetic variants, but also on events that have, or have not, occurred previously.
ConclusionsThis review suggests that the time is now right for serious consideration of the role of cortisol in a clinical context. Estimates of cortisol levels and the shape of the diurnal rhythm might well guide the understanding of subtypes of MDD and yield additional indicators for optimal treatment. Patients with disturbed cortisol rhythms might benefit from restitution of those rhythms; they may be distinct from those with more generally elevated levels, who might benefit from cortisol blockade. Higher levels of cortisol are a risk for subsequent depression. Should manipulation of cortisol or its receptors be considered as a preventive measure for some of those at very high risk of future MDD, or to reduce other cortisol-related consequences such as long-term cognitive decline?
Editorial
Criteria of validity in experimental psychopathology: application to models of anxiety and depression
- B. Vervliet, F. Raes
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- Published online by Cambridge University Press:
- 12 November 2012, pp. 2241-2244
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The modeling of abnormal behavior in ‘normal’ subjects (often animals) has a long history in pharmacological research for the screening of novel drug compounds. Systematic criteria have been outlined in that literature to estimate the external validity of a model, that is to estimate how closely the model is linked to the disorder of interest. Experimental psychopathology (EPP) also uses behavioral models to study the psychological processes that underlie abnormal behavior. Although EPP researchers may occasionally feel uneasy about the validity of the model that they use, the issue has not received direct attention in this literature. Here, we review the criteria of validity as set out in pharmacology research (face, predictive and construct validity) and discuss their relevance for EPP research. Furthermore, we propose diagnostic validity as an additional criterion of external validity that is relevant to EPP research. We evaluate two models for the study of anxiety and depression, and show that they have good face, diagnostic and construct validity. However, EPP research generally lacks direct tests of predictive validity. We conclude that combined evaluations of predictive, diagnostic and construct validity provide a sound basis to infer the external validity of behavioral models in EPP research.
Review Article
The current state of play on the molecular genetics of depression
- S. Cohen-Woods, I. W. Craig, P. McGuffin
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- Published online by Cambridge University Press:
- 12 June 2012, pp. 673-687
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Background
It has been well established that both genes and non-shared environment contribute substantially to the underlying aetiology of major depressive disorder (MDD). A comprehensive overview of genetic research in MDD is presented.
MethodPapers were retrieved from PubMed up to December 2011, using many keywords including: depression, major depressive disorder, genetics, rare variants, gene–environment, whole genome, epigenetics, and specific candidate genes and variants. These were combined in a variety of permutations.
ResultsLinkage studies have yielded some promising chromosomal regions in MDD. However, there is a continued lack of consistency in association studies, in both candidate gene and genome-wide association studies (GWAS). Numerous factors may account for variable results including the use of different diagnostic approaches, small samples in early studies, population stratification, epigenetic phenomena, copy number variation (CNV), rare variation, and phenotypic and allelic heterogeneity. The conflicting results are also probably, in part, a consequence of environmental factors not being considered or controlled for.
ConclusionsEach research group has to identify what issues their sample may best address. We suggest that, where possible, more emphasis should be placed on the environment in molecular behavioural genetics to identify individuals at environmental high risk in addition to genetic high risk. Sequencing should be used to identify rare and alternative variation that may act as a risk factor, and a systems biology approach including gene–gene interactions and pathway analyses would be advantageous. GWAS may require even larger samples with reliably defined (sub)phenotypes.
Global prevalence of anxiety disorders: a systematic review and meta-regression
- A. J. Baxter, K. M. Scott, T. Vos, H. A. Whiteford
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- Published online by Cambridge University Press:
- 10 July 2012, pp. 897-910
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Background
The literature describing the global prevalence of anxiety disorders is highly variable. A systematic review and meta-regression were undertaken to estimate the prevalence of anxiety disorders and to identify factors that may influence these estimates. The findings will inform the new Global Burden of Disease study.
MethodA systematic review identified prevalence studies of anxiety disorders published between 1980 and 2009. Electronic databases, reference lists, review articles and monographs were searched and experts then contacted to identify missing studies. Substantive and methodological factors associated with inter-study variability were identified through meta-regression analyses and the global prevalence of anxiety disorders was calculated adjusting for study methodology.
ResultsThe prevalence of anxiety disorders was obtained from 87 studies across 44 countries. Estimates of current prevalence ranged between 0.9% and 28.3% and past-year prevalence between 2.4% and 29.8%. Substantive factors including gender, age, culture, conflict and economic status, and urbanicity accounted for the greatest proportion of variability. Methodological factors in the final multivariate model (prevalence period, number of disorders and diagnostic instrument) explained an additional 13% of variance between studies. The global current prevalence of anxiety disorders adjusted for methodological differences was 7.3% (4.8–10.9%) and ranged from 5.3% (3.5–8.1%) in African cultures to 10.4% (7.0–15.5%) in Euro/Anglo cultures.
ConclusionsAnxiety disorders are common and the substantive and methodological factors identified here explain much of the variability in prevalence estimates. Specific attention should be paid to cultural differences in responses to survey instruments for anxiety disorders.
Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature
- A. J. Ferrari, A. J. Somerville, A. J. Baxter, R. Norman, S. B. Patten, T. Vos, H. A. Whiteford
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- Published online by Cambridge University Press:
- 25 July 2012, pp. 471-481
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Background
Summarizing the epidemiology of major depressive disorder (MDD) at a global level is complicated by significant heterogeneity in the data. The aim of this study is to present a global summary of the prevalence and incidence of MDD, accounting for sources of bias, and dealing with heterogeneity. Findings are informing MDD burden quantification in the Global Burden of Disease (GBD) 2010 Study.
MethodA systematic review of prevalence and incidence of MDD was undertaken. Electronic databases Medline, PsycINFO and EMBASE were searched. Community-representative studies adhering to suitable diagnostic nomenclature were included. A meta-regression was conducted to explore sources of heterogeneity in prevalence and guide the stratification of data in a meta-analysis.
ResultsThe literature search identified 116 prevalence and four incidence studies. Prevalence period, sex, year of study, depression subtype, survey instrument, age and region were significant determinants of prevalence, explaining 57.7% of the variability between studies. The global point prevalence of MDD, adjusting for methodological differences, was 4.7% (4.4–5.0%). The pooled annual incidence was 3.0% (2.4–3.8%), clearly at odds with the pooled prevalence estimates and the previously reported average duration of 30 weeks for an episode of MDD.
ConclusionsOur findings provide a comprehensive and up-to-date profile of the prevalence of MDD globally. Region and study methodology influenced the prevalence of MDD. This needs to be considered in the GBD 2010 study and in investigations into the ecological determinants of MDD. Good-quality estimates from low-/middle-income countries were sparse. More accurate data on incidence are also required.
Original Articles
The duration and timing of maternal depression as a moderator of the relationship between dependent interpersonal stress, contextual risk and early child dysregulation
- E. D. Barker
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- Published online by Cambridge University Press:
- 06 November 2012, pp. 1587-1596
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Background
Risk factors that are associated with depression in the mother also negatively affect the child. This research sought to extend current knowledge by examining the duration and timing of maternal depression as a moderator of: (1) the impact of dependent interpersonal stress (DIS), such as partner conflict or low social support, and contextual risk (e.g. poverty) on child dysregulation; and (2) continuity in early child dysregulation.
MethodMother–child pairs (n = 12 152) who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC) were examined between pregnancy and age 4 years. Data on maternal depression were collected five times between pregnancy and 33 months postpartum; on DIS and contextual risk three times between pregnancy and 33 months; and on child dysregulation at age 2 and 4 years.
ResultsLongitudinal latent class analysis identified a class of mothers (10%) who evinced a chronic level of depression between pregnancy and 33 months. For chronic-depressed versus non-depressed mothers, the results indicate that: (1) DIS predicted higher child dysregulation if experienced between pregnancy and age 2; (2) contextual risk had a differential effect on child dysregulation if experienced during pregnancy; and (3) children had higher continuity in dysregulation between age 2 and age 4.
ConclusionsAssessing the impact of the timing and duration of maternal depression, and different types of co-occurring risk factors, on child well-being is important. Maternal depression and associated DIS, in comparison to contextual risk, may be more responsive to intervention.
Review Article
Neurocognitive phenomics: examining the genetic basis of cognitive abilities
- G. Donohoe, I. J. Deary, D. C. Glahn, A. K. Malhotra, K. E. Burdick
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- 30 November 2012, pp. 2027-2036
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Cognitive deficits are core to the disability associated with many psychiatric disorders. Both variation in cognition and psychiatric risk show substantial heritability, with overlapping genetic variants contributing to both. Unsurprisingly, therefore, these fields have been mutually beneficial: just as cognitive studies of psychiatric risk variants may identify genes involved in cognition, so too can genome-wide studies based on cognitive phenotypes lead to genes relevant to psychiatric aetiology. The purpose of this review is to consider the main issues involved in the phenotypic characterization of cognition, and to describe the challenges associated with the transition to genome-wide approaches. We conclude by describing the approaches currently being taken by the international consortia involving many investigators in the field internationally (e.g. Cognitive Genomics Consortium; COGENT) to overcome these challenges.
Original Articles
Anxiety is related to Alzheimer cerebrospinal fluid markers in subjects with mild cognitive impairment
- I. H. G. B. Ramakers, F. R. J. Verhey, P. Scheltens, H. Hampel, H. Soininen, P. Aalten, M. Olde Rikkert, M. M. Verbeek, L. Spiru, K. Blennow, J. Q. Trojanowski, L. M. Shaw, P. J. Visser, the Alzheimer's Disease Neuroimaging Initiative and DESCRIPA Investigators
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- 07 September 2012, pp. 911-920
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Background
Anxiety, apathy and depression are common in subjects with mild cognitive impairment (MCI) and may herald Alzheimer's disease (AD). We investigated whether these symptoms correlated with cerebrospinal fluid (CSF) markers for AD in subjects with MCI.
MethodSubjects with MCI (n=268) were selected from the ‘Development of screening guidelines and criteria for pre-dementia Alzheimer's disease’ (DESCRIPA) and Alzheimer's Disease Neuroimaging Initiative (ADNI) studies. We measured amyloid β(1-42) protein (Aβ42) and total tau (t-tau) in CSF. Neuropsychiatric symptoms were measured with the Neuropsychiatric Inventory.
ResultsDepressive symptoms were reported by 55 subjects (21%), anxiety by 35 subjects (13%) and apathy by 49 subjects (18%). The presence of anxiety was associated with abnormal CSF Aβ42 [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.6–3.3] and t-tau (OR 2.6, 95% CI 1.9–3.6) concentrations and with the combination of abnormal concentrations of both Aβ42 and t-tau (OR 3.1, 95% CI 2.0–4.7). The presence of agitation and irritability was associated with abnormal concentrations of Aβ42 (agitation: OR 1.6, 95% CI 1.1–2.3; irritability: OR 2.2, 95% CI 1.5–3.3). Symptoms of depression and apathy were not related to any of the CSF markers.
ConclusionsIn subjects with MCI, symptoms of anxiety, agitation and irritability may reflect underlying AD pathology, whereas symptoms of depression and apathy do not.
Editorial
Withdrawing interferon-α from psychiatric patients: clinical care or unjustifiable stigma?
- A. Spennati, C. M. Pariante
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- Published online by Cambridge University Press:
- 14 September 2012, pp. 1127-1132
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IFN-α is an effective therapy for chronic viral hepatitis C and today still represents an effective first-line treatment. Unfortunately, its use is associated with a number of side-effects, including psychiatric problems like depression, mania, psychosis, delirium and other cognitive disturbances. Clinicians have been concerned about the risks of worsening of pre-existent psychiatric disorders and of precipitating suicidal attempts in psychiatric patients. The presence of a mental illness is, therefore, often deemed to be a contraindication to the use of antiviral treatment. However, this amounts to stigmatization and discrimination, as it basically implies withholding a life-saving medical treatment because of a psychiatric diagnosis. Is this clinically and socially acceptable? With novel treatments now entering clinical practice as adjuvant to IFN-α, it is particularly important to make a statement now, to ensure that psychiatric patients are not left behind. The aim of this editorial is to critically discuss this notion, by reviewing the few studies (n = 14) that have indeed administered IFN-α to patients with a pre-existing psychiatric disorder. We find evidence that these patients have rates of treatment adherence and sustained virological response similar to those of non-psychiatric patients, and that their IFN-α-induced psychiatric symptoms respond successfully to clinical management. We conclude that there is no support to withdrawing IFN-α therapy from psychiatric patients.
Review Article
Prenatal maternal infection, neurodevelopment and adult schizophrenia: a systematic review of population-based studies
- G. M. Khandaker, J. Zimbron, G. Lewis, P. B. Jones
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- Published online by Cambridge University Press:
- 16 April 2012, pp. 239-257
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Background
Disruption of foetal development by prenatal maternal infection is consistent with a neurodevelopmental model of schizophrenia. Whether specific prenatal infections are involved, their timing and the mechanisms of any effect are all unknown. We addressed these questions through a systematic review of population-based studies.
MethodElectronic and manual searches and rigorous quality assessment yielded 21 studies that included an objective assessment of individual-level prenatal maternal infection and standardized psychotic diagnoses in adult offspring. Methodological differences between studies necessitated a descriptive review.
ResultsResults for prenatal maternal non-specific bacterial, respiratory or genital and reproductive infection differed between studies, which reported up to a two- to fivefold increased risk of schizophrenia. Evidence for herpes simplex virus type 2 (HSV-2) and Toxoplasma gondii was mixed; some studies reported up to a doubling of schizophrenia risk. Prenatal HSV-1 or cytomegalovirus (CMV) infections were not associated with increased risk. Exposure to influenza or other infections during early pregnancy may be more harmful than later exposure. Increased proinflammatory cytokines during pregnancy were also associated with risk. Prenatal infection was associated with structural and functional brain abnormalities relevant to schizophrenia.
ConclusionsPrenatal exposure to a range of infections and inflammatory responses may be associated with risk of adult schizophrenia. Larger samples, mediation and animal models should be used to investigate whether there is a ‘sensitive period’ during development, and the effects of prenatal infections on neurodevelopment. Inclusion of genetic and immunological information should help to elucidate to what extent genetic vulnerability to schizophrenia may be explained by vulnerability to infection.
Original Articles
Association between anxiety but not depressive disorders and leukocyte telomere length after 2 years of follow-up in a population-based sample
- P. W. Hoen, J. G. M. Rosmalen, R. A. Schoevers, J. Huzen, P. van der Harst, P. de Jonge
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- Published online by Cambridge University Press:
- 09 August 2012, pp. 689-697
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Background
Telomere length is considered an emerging marker of biological aging. Depression and anxiety are associated with excess mortality risk but the mechanisms remain obscure. Telomere length might be involved because it is associated with psychological distress and mortality. The aim of this study was to test whether anxiety and depressive disorders predict telomere length over time in a large population-based sample.
MethodAll analyses were performed in a longitudinal study in a general population cohort of 974 participants. The Composite International Diagnostic Interview (CIDI) was used to measure the presence of anxiety and depressive disorders. Telomere length was measured using monochrome multiplex polymerase chain reaction (PCR) at approximately 2 years of follow-up. We used linear multivariable regression models to evaluate the association between anxiety and depressive disorders and telomere length, adjusting for adverse life events, lifestyle factors, educational level and antidepressant use.
ResultsThe presence of anxiety disorders predicted shorter telomeres at follow-up (β = –0.073, t = –2.302, p = 0.022). This association was similar after controlling for adverse life events, lifestyle factors, educational level and antidepressant use (β = –0.077, t = –2.144, p = 0.032). No association was found between depressive disorders and shorter telomeres at follow-up (β = 0.010, t = 0.315, p = 0.753).
ConclusionsThis study found that anxiety disorders predicted shorter telomere length at follow-up in a general population cohort. The association was not explained by adverse life events, lifestyle factors, educational level and antidepressant use. How anxiety disorders might lead to accelerated telomere shortening and whether this might be a mediator explaining the excess mortality risk associated with anxiety deserve further investigation.
Invited Review
Update on the treatment of anorexia nervosa: review of clinical trials, practice guidelines and emerging interventions
- H. J. Watson, C. M. Bulik
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- Published online by Cambridge University Press:
- 10 December 2012, pp. 2477-2500
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Background
Anorexia nervosa is a potentially deadly psychiatric illness that develops predominantly in females around puberty but is increasingly being recognized as also affecting boys and men and women across the lifespan. The aim of this environmental scan is to provide an overview of best practices in anorexia nervosa treatment across the age spectrum.
MethodA triangulation approach was used. First, a detailed review of randomized controlled trials (RCTs) for anorexia nervosa published between 1980 and 2011 was conducted; second, clinical practice guidelines were consulted and reviewed; third, information about RCTs currently underway was sourced. This approach facilitated a comprehensive overview, which addressed the extant evidence base, recent advances in evidence and improvements in treatment, and future directions.
ResultsThe evidence base for the treatment of anorexia nervosa is advancing, albeit unevenly. Evidence points to the benefit of family-based treatment for youth. For adults no specific approach has shown superiority and, presently, a combination of renourishment and psychotherapy such as specialist supportive clinical management, cognitive behavioral therapy, or interpersonal psychotherapy is recommended. RCTs have neither sufficiently addressed the more complex treatment approaches seen in routine practice settings, such as multidisciplinary treatment or level of care, nor specifically investigated treatment in ethnically diverse populations. Methodological challenges that hinder progress in controlled research for anorexia nervosa are explained.
ConclusionsThe review highlights evidence-based and promising treatment modalities for anorexia nervosa and presents a triangulated analysis including controlled research, practice guidelines, and emerging treatments to inform and support clinical decision making.