117,549 research outputs found
Editorial Perspective: Rethinking child and adolescent mental health care after COVID-19
No full textWhile COVID-19 pandemic has allegedly passed its first peak in most western countries, health systems are progressively adapting to the ‘new normality’. In child and adolescent mental health services (CAMHS), such organizational envisioning is needed to cope with the foreseeable psychological effects of prolonged social isolation induced by nation-wide public health measures such as school closure. CAMHS need to ensure flexible responses to the psychopathological consequences of evolving societal dynamics, as dramatically actualized by the unexpected COVID-19 pandemic. This would imply (a) shifting the focus of intervention from symptom reduction and containment of acute crises in a comparatively small number of severe cases to a broader preventive strategy, guided by a gradient of increasing intensity and specificity of treatment; (b) promoting smooth access pathways into services and encouraging participation of families; (c) adopting a transdiagnostic staging model to capture the developmental fluctuations from subsyndromal to syndromal states and back, with related changes in the intensity of the need of care; and (d) implementing digital tools to encourage help-seeking and compliance by digitally native youth
Neural correlates of visuospatial working memory in the ‘at-risk mental state’
Full text linkBackground. Impaired spatial working memory (SWM) is a robust feature of schizophrenia and has been linked to
the risk of developing psychosis in people with an at-risk mental state (ARMS). We used functional magnetic
resonance imaging (fMRI) to examine the neural substrate of SWM in the ARMS and in patients who had just
developed schizophrenia.
Method. fMRI was used to study 17 patients with an ARMS, 10 patients with a first episode of psychosis and 15 agematched
healthy comparison subjects. The blood oxygen level-dependent (BOLD) response was measured while
subjects performed an object–location paired-associate memory task, with experimental manipulation of mnemonic
load.
Results. In all groups, increasing mnemonic load was associated with activation in the medial frontal and medial
posterior parietal cortex. Significant between-group differences in activation were evident in a cluster spanning the
medial frontal cortex and right precuneus, with the ARMS groups showing less activation than controls but greater
activation than first-episode psychosis (FEP) patients. These group differences were more evident at the most
demanding levels of the task than at the easy level. In all groups, task performance improved with repetition of the
conditions. However, there was a significant group difference in the response of the right precuneus across repeated
trials, with an attenuation of activation in controls but increased activation in FEP and little change in the ARMS.
Conclusions. Abnormal neural activity in the medial frontal cortex and posterior parietal cortex during an SWM task
may be a neural correlate of increased vulnerability to psychosis
Migration history, minorities status and risk of psychosis: An epidemiological explanation and a psychopathological insight
No full textObjectives A marked increased incidence of psychosis in migrants and ethnic minorities is a well established phenomenon. We aim to review data and insights arising from epidemiological and clinical/ psychopathological studies regarding the relationship between migration history, minority status and risk of psychosis in order to evaluate the experiences of migrants and minority ethnic groups in host societies. Method A qualitative literature review was conducted to identify population surveys, services based studies, and clinical and biological studies on the relationship between migration and/ or minority status and psychosis. Studies were identified by searching MEDLINE, PsychINFO and EMBASE. The search was supplemented by references provided by personal bibliographies of the investigators and by hand searching content pages of journals considered relevant to the topic. The search was run in June 2015. Results Risk differences related to minority groups vary in different countries. Socio-environmental risk factors faced by origin groups operate differently in the countries, depending on social experiences and available resources to cope with adversities. In addition, social factors can represent environmental risk factors because they might regulate gene expression. Facing severe or chronic social stress, such as isolation, low socio-economic status, late-life social adversities may result in long-term sometimes permanent alterations of the biological stress-response system, which can lead to the development of physical and mental illnesses. A number of studies have taken into account psychopathological and clinical features at psychosis onset and follow-up, and they do not support the suggestion that misdiagnosis can explain the high rates found in those populations. Conclusions Reviewed papers cover a period of more than 30 years and highlight that history of migration and minority status might both be important in increasing the risk of psychosis. Clinical studies reported that psychopathological differences and misdiagnosis cannot explain the excess of psychosis found in migrants and ethnic minorities. The excess of psychosis in migrant and ethnic minorities may be at least attenuated by several psychosocial interventions, targeted at social disadvantages and at most at-risk individuals and populations
Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis
No full textBackground: The current diagnostic system for subjects at enhanced clinical risk of psychosis allows concurrent comorbid diagnoses of anxiety and depressive disorders. Their impact on the presenting high-risk psychopathology, functioning, and transition outcomes has not been widely researched. Methods: In a large sample of subjects with an At-Risk Mental State (ARMS, n = 509), we estimated the prevalence of DSM/SCID anxiety or depressive disorders and their impact on psychopathology, functioning, and psychosis transition. A meta-analytical review of the literature complemented the analysis. Results: About 73% of ARMS subjects had a comorbid axis I diagnosis in addition to the "at-risk" signs and symptoms. About 40% of ARMS subjects had a comorbid diagnosis of depressive disorder while anxiety disorders were less frequent (8%). The meta-analysis conducted in 1683 high-risk subjects confirmed that baseline prevalence of comorbid depressive and anxiety disorders is respectively 41% and 15%. At a psychopathological level, comorbid diagnoses of anxiety or depression were associated with higher suicidality or self-harm behaviors, disorganized/odd/stigmatizing behavior, and avolition/apathy. Comorbid anxiety and depressive diagnoses were also associated with impaired global functioning but had no effect on risk of transition to frank psychosis. Meta-regression analyses confirmed no effect of baseline anxiety and/or depressive comorbid diagnoses on transition to psychosis. Conclusions: The ARMS patients are characterized by high prevalence of anxiety and depressive disorders in addition to their attenuated psychotic symptoms. These symptoms may reflect core emotional dysregulation processes and delusional mood in prodromal psychosis. Anxiety and depressive symptoms are likely to impact the ongoing psychopathology, the global functioning, and the overall longitudinal outcome of these patients. © 2012 The Author
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