Update on Mental Health of Infants and Children of Parents Affected With Mental Health Issues

This paper highlights the most recent publications, in the field of psychiatry, on offspring of patients with psychiatric illnesses such as schizophrenia and bipolar disorder, and then summarizes what we know about the progeny of adults with mood disorders, the most prevalent of parental disorders. Studies examining personality disorders and contextual factors such as stress and trauma are examined with a focus on the crucial question of development and attachment status in children. Findings converge to reveal that offspring of parents (generally mothers) with most major psychiatric disorders present a higher risk for all mental disorders, and a wide range of disorders are also found in children, adolescent, and finally adult offspring of mothers with mood and anxiety disorders. Developmental psychopathology and infant and child psychiatry have focused on early relationship formation through social interaction and attachment patterns as pathways affected by vulnerability or resilience factors. First year of life longitudinal studies following mothers and infants has shown that maternal psychopathology is positively correlated with higher risk of attachment issues. It would seem that pathology appears when adaptation to real-life contexts becomes difficult in association with an accumulation of negative individual characteristics and environmental circumstances. We suggest that in order to move forward psychiatry should embrace a developmental cascade model, which posits a cumulative pathway for the emergence of psychopathology in the developing child. We propose that we have sufficient knowledge today to start implementing multilevel approaches to enhance the health and mental health of the next generation.     

Relations entre le Big Five Inventory français et le manuel diagnostique des troubles mentaux dans un échantillon clinique français

The Big Five Inventory (BFI) was designed to provide researchers and clinicians with an efficient measure of individual differences on the so-called Big Five factors of normal personality: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness to Experience. The present article has two objectives: a) to introduce the BFI-Français, a French language version of the BFI; and b) to use the BFI-Français to study the relations between normal personality traits and the DSM classification of psychiatric disorders. Three French samples (161 medical students, 200 hospital employees, 106 psychiatric inpatients) completed the 44-item BFI-Français. DSM-IV diagnoses were made for each inpatient. The psychometric data obtained from the combined French samples were compared to US and Spanish samples. Means, standard deviations, internal consistency reliabilities, and factor structure were similar in all samples; thus, the BFI-Français provides an efficient, psychometrically sound way to measure the five personality factors in French samples. As expected, scores on the BFI-Français were related systematically to DSM diagnoses on both Axis I and II. Findings were consistent with the recent literature; since past research has relied primarily on Anglo-American and non-clinical samples, the present findings contribute importantly to establishing the generality of the links between personality traits and DSM.     

Psychometric properties of an informant personality questionnaire (the HAP) in a sample of older adults in the Netherlands and Belgium

In geriatric psychiatry, informant reports are often important due to cognitive problems and related impaired insight and judgment. Informant questionnaires to identify personality traits among older adults are sparse. The Dutch informant personality questionnaire (the HAP) is especially developed to address this need. The objective of this study is the psychometric evaluation of the HAP among older adults in the Netherlands and Belgium. We investigated the internal consistency, gender differences, the test–retest and inter-rater reliability, the factorial structure, and the concurrent validity. Informants completed the HAP ratings of nursing home residents (n?=?385) and elderly psychiatric patients (n?=?204). The internal consistency of the scales is good. Medium gender differences on three scales were found in the population Psychiatry. The inter-rater and test–retest reliability are good to excellent. There are significant similarities between a number of HAP scales and dimensions of the Big Five. The congruence between the factor structures in both samples is very high. We labeled the three factors externalizing/antagonistic, internalizing/neurotic, and compulsive. The HAP meets the need for validated and reliable informant instruments for personality assessment among older adults in geriatric psychiatry. The content scales of the questionnaire address traits of the premorbid personality. Therefore, the HAP might be useful for personality assessment and selecting treatment options in mental healthcare and can be applied in scientific research in the area of personality aspects in late life.     

Prevalence and severity of mental health-related disability and relationship to diagnosis.

OBJECTIVE: Psychiatric disability has been defined largely from measures that focus on serious mental illness. This practice may have led to substantial underestimation of the total impact of mental disorders on community health. In this study a generic measure of mental health-related disability was used to examine disabilities attributable to various common mental disorders. METHODS: Data were drawn from the Australian National Survey of Mental Health and Wellbeing, a household survey of 10,641 adults that assessed participants for 14 DSM-IV disorders with use of the Composite International Diagnostic Interview. Screening instruments were used to identify likely cases of ICD-10 personality disorder, neurasthenia (an undifferentiated somatoform disorder), and psychosis. Mental health disability was assessed with the Medical Outcomes Study 12-item Short Form (SF-12) mental health summary scale, which was administered to all participants. RESULTS: Disability was significantly greater among participants with a current psychiatric diagnosis, and disability varied by type of disorder. Diagnosis remained a strong predictor of disability after sociodemographic factors and physical illness were controlled for. Disorders found to be independently associated with disability were depression, panic disorder, agoraphobia, social phobia, generalized anxiety disorder, alcohol dependence, and drug dependence. CONCLUSIONS: Substantial proportions of persons with mental disorders that are not usually classified as major mental disorders reported moderate and severe disability. A generic measure of mental health-related disability was able to detect variations in disability among persons with different diagnoses. Although such a measure is not as sensitive as a disorder-specific measure developed for use in psychiatric populations, it can facilitate comparison of disability across common mental disorders.     

Social psychiatry and sociology of mental health: a view on their past and future relevance.

The origins of social psychiatry can be traced to the age of enlightenment and to the effects of the industrial revolution. Social psychiatry deals with social factors associated with psychiatric morbidity, social effects of mental illness, psycho-social disorders and social approaches to psychiatric care. Since the end of World War II up to the early seventies it has been claimed that social psychiatry should concentrate on the fight against war, poverty, racial discrimination, urban decay and all other social ills affecting people's mental health, and that the psychiatrist should be responsible for the mental health of the society. In contrast, sociology of mental health questioned the expertise of the psychiatrist and the very existence of mental illness, claiming that it covers deviant behaviour rejected by the society. The paper refutes this approach indicating that not the existence but the perception and presentation of psychiatric illness are socially determined. Acknowledging the contribution of sociology and social sciences to psychiatry, it is suggested that the heroic period of social psychiatry and the iconoclastic approach of sociology of mental health are over. However, social psychiatry, enriched by the use of epidemiological methods, has still much to offer to the daily practice of psychiatry.     

Lessons From Geriatric Psychiatry in the Long Term Care Setting

Of all long term care settings, the nursing home has served as the most productive laboratory for the study of the mental health problems of late life. Lessons from geriatric psychiatry research and practice in the nursing home have relevance to general psychiatry and to other health care settings, informing us about (a) psychiatric disorders in medically ill and disabled populations; (b) subsyndromes and subtypes of depression; (c) behavioral disturbances in patients with brain injury; (d) the effects of government regulation and education on mental health care; and (e) essential roles for psychiatrists in changing health care systems. Selected areas of knowledge based on geriatric psychiatry research and experience in long term care are reviewed in this paper, and their applications for the field of psychiatry in general are explored.     

The future of cultural psychiatry: an international perspective.

Cultural psychiatry has evolved along 3 lines: 1) cross-cultural comparative studies of psychiatric disorders and traditional healing; 2) efforts to respond to the mental health needs of culturally diverse populations that include indigenous peoples, immigrants, and refugees; and 3) the ethnographic study of psychiatry itself as the product of a specific cultural history. These studies make it clear that culture is fundamental both to the causes and course of psychopathology and also to the effectiveness of systems of healing. The provision of mental health services in multicultural societies has followed different models that reflect their specific histories of migration and ideologies of citizenship. Globalization has influenced psychiatry through socioeconomic effects on the prevalence and course of mental disorders, changing notions of ethnocultural identity, and the production of psychiatric knowledge. A cultural perspective can help clinicians and researchers become aware of the hidden assumptions and limitations of current psychiatric theory and practice and can identify new approaches appropriate for treating the increasingly diverse populations seen in psychiatric services around the world.     

Effects of Big Five,HEXACO, and Dark Triad on Counterproductive Work Behaviors: A Meta-Analysis

Purpose: This study investigates the effects of Big Five, HEXACO, and Dark Triad personality traits on counterproductive work behaviors (CWBs), and examines the moderating effects of countries where the studies were carried out, gender rate of samples, and scales used to measure personalities. Method: Following the rules of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we include 74 empirical studies published between 2007 and September 2022 with 83 samples and 394 correlations. Studies are selected from both English databases such as Web of Science and Chinese databases such as CNKI. The meta-analysis and metaregression analysis were both performed using the Comprehensive Meta-Analysis (CMA) program, version 3.7. Results: Although emotionality is irrelevant to CWBs, other Big Five, HEXACO, and Dark Triad personality factors are all significant predictors of CWBs. The effect of Dark Triad (ρ = 0.412) is stronger than that of Big Five (ρ = −0.176) and HEXACO (ρ = −0.221). Gender negatively moderates the positive relationship between Dark Triad traits (total and subdimensions) and CWBs. The moderating effects of countries and scales are only significant for very few personalities. Conclusion: Personality traits are important antecedents of CWBs, and gender ratio plays a role as moderator for some personality traits. We propose that organizations should pay more attention to the mental health of employees and future studies could investigate other types of characteristics and moderators.     

Are there future psychiatrists among medical students in Croatia? The role of premedical and medical factors on career choice in psychiatry

Abstract

Despite the high prevalence of mental disorders, a worldwide shortage of psychiatrists exists. Moreover, the number of students interested in choosing psychiatry as their future profession is low and psychiatry is frequently regarded as one of the least wanted medical specializations. We report the findings of a cross-sectional quantitative survey of final year Croatian medical students as part of the International Survey of Student Career Choice in Psychiatry (ISoSCCiP). The questionnaire consisted of three sections: socio-demographic factors, psychiatric education during medical school, and attitudes and personality characteristics. Out of 200 students, 122 completed the questionnaire (response rate 61%). The overall student evaluation of the compulsory psychiatry curriculum was ‘average’. Significantly higher ratings were reported by students who attended special psychiatry teaching modules, or felt more involved in the teaching of the subject. Poor evaluation of medical school psychiatric education significantly increased the likelihood of not choosing psychiatry as a future career. The choice of psychiatry was also predicted by attitudes towards psychiatry and by personal characteristics. In conclusion, student ratings of medical school psychiatric education and involvement in teaching appear to influence choice towards psychiatry. Addressing these issues may increase the number of students motivated to pursue psychiatry as their future career choice.     

Race-ethnicity and the prevalence and co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol and drug use disorders and Axis I and II disorders: United States, 2001 to 2002

The objective of this study was to compare the current prevalence and co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol and drug use disorders and mood, anxiety, and personality disorders among whites, blacks, Native Americans, Asians, and Hispanics in a large representative sample of the US population. Striking mental health disparities were observed in the prevalences of psychiatric disorders, especially among Native Americans. Disparities in psychiatric comorbidity differed from those associated with prevalence. Most significantly, the association between alcohol disorders and personality disorders was significantly greater among Asians relative to whites, blacks, and Native Americans, despite lower prevalences of these disorders among Asians. Taken together, the results of this study highlight the need of future studies that help unravel the risk factors underlying the disparities in both prevalence and comorbidity of psychiatric disorders observed among race-ethnic groups in the United States.     

An overview of anxiety disorders

Anxiety disorders are more prevalent than any other mental health problem in the United States. Afflicted persons are often untreated or are treated only by a primary care physician without psychiatric consultation. However, based on current knowledge of the biological and psychological factors involved in these disorders, psychiatry has defined effective treatment that integrates education, psychotherapy, and psychopharmacology. After reviewing current research on possible mechanisms of anxiety, the authors discuss therapeutic interventions and recommend ways to choose appropriate treatment modalities for anxiety-disordered patients.     

Psychiatric services for children in India

Mental hygiene deals essentially with the promotion of mental health among all people in general as well as with the prevention and early treatment of neuroses, psychoses, character and personality disorders, and other types of maladjustment of adults and children. It concerns itself with the main objective of bringing about greater happiness, efficiency, and ability to get along with others. Mental hygiene is a composite science based on principles drawn from psychology, psychiatry, child development, education, sociology, anthropology, biology, and medicine. Child psychiatric services are not only useful for treatment of psychiatric disorders but are an endeavor in the field of mental hygiene.     

Psychiatric services for children in India

Mental hygiene deals essentially with the promotion of mental health among all people in general as well as with the prevention and early treatment of neuroses, psychoses, character and personality disorders, and other types of maladjustment of adults and children. It concerns itself with the main objective of bringing about greater happiness, efficiency, and ability to get along with others. Mental hygiene is a composite science based on principles drawn from psychology, psychiatry, child development, education, sociology, anthropology, biology, and medicine. Child psychiatric services are not only useful for treatment of psychiatric disorders but are an endeavor in the field of mental hygiene.     

Mental illness--problems with definition, diagnosis and legal regulations

The analysis of literature and events in psychiatry in the course of past centurie show that the term mental illness even though it had played a positive role in the development of knowledge of psychic disorders and the place of psychiatry as part of clinical medicine has become an anachronic term in time. Because its content and form were never precisely defined, it began to serve as a means of hiding the lack of knowledge of the causes of mental disorders It was abused against its initial aim, e.g. used to 'label' persons whose behaviour did not fit socially accepted conventions. At times it caused a permanent exclusion of those persons. These circumstanc es were a means of giving up on the term mental illness in the modern diagnostic-classification systems of psychic disorders (DSM-IV, ICD-10). Retaining of the term mental illness, and its derivatives menatlly ill, a mentally ill person are anchronisms in the Polish legislation, which can be a cause of serious misunderstanings and abuse. The author believes that these terms should disappear from the Polish legislation and the mental health act. They should be replaced by terms adequate for legal regulations but also be compliant with modern psychiatric terminology.     

Microbes and mental health: Can the microbiome help explain clinical heterogeneity in psychiatry?

Trillions of microbes cover the surfaces of our bodies and inhabit our gastrointestinal tract. In the past decade, research efforts examining the role of the microbiome in mental health have moved to the forefront of neuroscience and psychiatry. Based on a foundation of animal studies demonstrating the vital role for microbiota-brain communication in brain development, behavior, and brain function over the life span, clinical studies have started to consider the microbiome in psychiatric disorders. The composition, diversity and function of commensal microbes is influenced by genetic, lifestyle, and environmental factors. This review provides an overview of the factors contributing to individual differences in the microbiome, reviews recent work in psychiatric disorders, and considers what is needed to advance a better understanding of how the microbiome impacts mental health which may help us understand the heterogeneity observed in clinical psychiatric populations.     

Risk factors for suicide: a questionnaire survey by psychiatrists in Fukuoka Prefecture]

In our previous study, we demonstrated a preliminary questionnaire survey to psychiatrists from university hospitals, psychiatric hospitals, psychiatric clinics, and departments of psychiatry in general hospitals in Fukuoka Prefecture. In that study, 324 psychiatric patients who committed suicide between January 1, 1998 and December 31, 2001 were ascertained. In the present study, we have recruited matched control patients from the same clinics/hospitals and further demonstrated a secondary questionnaire survey to the psychiatrists in order to reveal the various risk factors for suicide suggested by the literature. Associations between completed suicide and possible risk factors were examined in 192 completed suicide psychiatric patients and 356 non-suicidal psychiatric patients (controls). Significant association was found for history of admission to psychiatric hospitals, history of suicide attempts, history of substance abuse, cluster B personality disorders, and hopelessness in our sample. In male samples, history of suicide attempts, cluster B personality disorders, recent loss, and hopelessness were significantly associated with suicide. In females, history of admission to psychiatric hospitals, history of suicide attempts, and hopelessness were significant.     

Significance of cross-cultural experience for young psychiatrists--learning from "The Joint Workshop for Psychiatric Residents of Korea and Japan"]

Korea and Japan are geographically very close, and a variety of cultural exchanges have taken place in recorded history. However, Korea and Japan have been enriched by the influence of Western cultures along with modernization, and mutual exchanges between the two countries have thus decreased in numerous fields including mental health and psychiatry. Prof. Masahisa Nishizono and Prof. Byun-Kun Min, who are leaders in the field of psychiatry in both Japan and Korea, have established "The Joint Workshop for Psychiatric Residents of Korea and Japan", which has been held alternately in Fukuoka or Seoul every summer since 2000. This Joint Workshop provides young psychiatrists with real experiences and many opportunities to learn about transcultural psychiatry regarding both countries. The participants are able to obtain a better mutual understanding of psychiatric epidemiology, recent developments in biological psychiatry while also learning about different concepts regarding the stigma of mental disorders. All participants could also increase their knowledge about the traditional culture and social changes related to the field of psychiatry in both countries. The workshop has helped to build friendship and mutual cooperation between both nations. Contemporary societies are continually becoming more and more diversified and complicated. For young psychiatrists who have to treat patients with modern difficulties and various complicated problems, such cross-cultural experiences may be useful for establishing potentially new and effective treatments for such patients. Psychiatrists and mental health experts have tried to reduce of stigma and discrimination against people with mental disorders, but even today such stigma and discrimination continues to strongly exist. The author thinks that such cross-cultural experiences by the psychiatrists themselves may help to reduce such notions. The author would like to explore the role of cross-cultural experiences in the field of psychiatry.     

The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients

BACKGROUND: In geriatric psychiatry assessment scales are often used in clinical praxis in the diagnostic work-up of mental disorders. AIM: To assess whether the state part of the STAI is useful as a case-finding instrument of mental disorders. MATERIALS AND METHOD: Data came from 70 non demented geriatric in-patients in stable clinical condition. Mean age was 83.3 years (range 64-96), and 74.3% were women. The 20-item STAI state instrument was used to measure current anxiety symptoms. Without knowledge of the score on STAI state a psychiatrist examined all patients and set diagnosis according to DSM-IV-TR criteria, but hierarchical rules were not used. Sensitivity, specificity, Likelihood ratio and accuracy were calculated for different cut-points of the mean sumscore on the STAI state. RESULTS: 15.7% of the participants suffered from a mental disorder: GAD = 1, mixed anxiety-depression = 5, depression = 1, dysthymic = 1, adjustment disorder (mixed anxiety-depression) = 1, and personality disorder = 1. The mean STAI sumscore in this group was 56.3 compared with 39.2 in the 59 patients without any psychiatric diagnosis. The optimal cut-off score on the STAI mean sumscore corresponding to the highest accuracy of 0.87 was 55/54 with sensitivity 0.82, specificity 0.88, and LR + 6.8. CONCLUSION: The STAI state scale is a useful instrument for detecting a variety of mental disorders in older people. Further studies should be carried out in different populations.     

Inpatient psychiatric treatment is not always effective in adolescent sample

Objective: Numerous studies confirm efficacy of psychiatric treatment as well as psychiatric placebo. The aim of the current study was the assessment of improvement rate and factors associated with treatment response in naturalistic group of adolescent inpatients.

Methods: Eighty two consecutive adolescent inpatients were recruited. Each patient at the admission and discharge was assessed with brief psychiatric rating scale (BPRS), eating attitude test (EAT-26), clinical global impression scale (CGI-S) and children global assessment scale (CGAS). Individual and family history was assessed by semi-structured interview. Patients, who improved in at least two interviewer-based scales (IMP, n?=?67) were compared to the rest (N-IMP, n?=?15). For statistical analysis STATISTICA package was used.

Results: The main difference between groups was ICD-10 diagnosis distribution: in the IMP group more anxiety-related disorders (F4), in the N-IMP group more personality disorders (F6). Other differences include history of paediatric hospitalisations and surgery (more in the N-IMP group). Most of the analysed factors did not differ between groups.

Conclusions: The inpatient treatment seems to be most effective in severe mental states and in anxiety-related disorders and least effective in personality disorders. Due to limited inpatient treatment efficacy we believe outpatients services are crucial in adolescent psychiatry.