Mental disorders in offspring of parents with bipolar and major depressive disorders

Vandeleur C, Rothen S, Gholam‐Rezaee M, Castelao E, Vidal S, Favre S, Ferrero F, Halfon O, Fumeaux P, Merikangas KR, Aubry J‐M, Burstein M, Preisig M. Mental disorders in offspring of parents with bipolar and major depressive disorders. Bipolar Disord 2012: 14: 641–653. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objectives: There is limited information on the specificity of associations between parental bipolar disorder (BPD) and major depressive disorder (MDD) and the risk of psychopathology in offspring. The chief aim of the present study was to investigate the association between mood disorder subtypes in the two parents and mental disorders in the offspring. Methods: A total of 376 offspring (aged 6.0–17.9 years; mean = 11.5 years) of 72 patients with BPD (139 offspring), 56 patients with MDD (110 offspring), and 66 controls (127 offspring) participated in a family study conducted in two university hospital centers in Switzerland. Probands, offspring, and biological co‐parents were interviewed by psychologists blind to proband diagnoses, using a semi‐structured diagnostic interview. Results: Rates of mood and anxiety disorders were elevated among offspring of BPD probands (34.5% any mood; 42.5% any anxiety) and MDD probands (25.5% any mood; 44.6% any anxiety) as compared to those of controls (12.6% any mood; 22.8% any anxiety). Moreover, recurrent MDD was more frequent among offspring of BPD probands (7.9%) than those of controls (1.6%). Parental concordance for bipolar spectrum disorders was associated with a further elevation in the rates of mood disorders in offspring (64.3% both parents versus 27.2% one parent). Conclusions: These findings provide unique information on the broad manifestations of parental mood disorders in their offspring. The earlier onset and increased risk of recurrent MDD in the offspring of parents with BPD compared to those of controls suggests that the episodicity characterizing BPD may emerge in childhood and adolescence.     

Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort

BACKGROUND: Little information is available about older deliberate self-harm (DSH) patients and their outcome. METHODS: This study is a prospective investigation and follow-up of 730 consecutive patients (459 females and 271 males) aged 60 years and over who presented to a general hospital following DSH over a 20-year period, 1978-1997. Outcome has been examined in terms of repetition of DSH, and deaths by the end of 2000 identified through official death registers. RESULTS: DSH involved self-poisoning in 88.6% of cases, 49.3% of the overdoses including paracetamol (acetaminophen), 24.0% minor tranquillizers, and 15.9% antidepressants. Nearly three-quarters of episodes involved high suicidal intent. Common problems preceding DSH were physical illness (46.1%), social isolation (33.5%), relationship problems with family (29.4%) or partner (25.9%), and bereavement or loss (16.7%). Repetition of DSH occurred in 15.3% of cases, 8.2% in the first year following DSH. By the end of 2000, 432/661 (65.4%) of traced patients had died. There were 30 suicides and open verdicts, which were 49 times and 33 times more frequent respectively than expected from general population death rates. Prior DSH before initial presentation was the main risk factor for suicide, with some evidence of high suicide intent being another factor. There were also excess deaths due to several types of physical disorder. CONCLUSIONS: DSH in older people is closely related to suicide, both in terms of suicidal intent and risk of eventual suicide, especially when DSH is repeated. The range of problems experienced by older DSH patients requires extensive and multidisciplinary clinical interventions.     

Cross‐modal pattern of brain activations associated with the processing of self‐ and significant other's name

Previous neuroimaging studies have shown that the patterns of brain activity during the processing of personally relevant names (e.g., own name, friend's name, partner's name, etc.) and the names of famous people (e.g., celebrities) are different. However, it is not known how the activity in this network is influenced by the modality of the presented stimuli. In this fMRI study, we investigated the pattern of brain activations during the recognition of aurally and visually presented full names of the subject, a significant other, a famous person and unknown individuals. In both modalities, we found that the processing of self‐name and the significant other's name was associated with increased activation in the medial prefrontal cortex (MPFC). Acoustic presentations of these names also activated bilateral inferior frontal gyri (IFG). This pattern of results supports the role of MPFC in the processing of personally relevant information, irrespective of their modality. Hum Brain Mapp 34:2069–2077, 2013. © 2011 Wiley Periodicals, Inc.     

Association between deliberate self-harm-related Internet searches and the mental states and lifetime suicidal behaviors of Japanese young adults

This study aimed to clarify the association between the experience of searching for deliberate self‐harm (DSH)‐related Internet content and the mental states and lifetime suicidal behaviors of Japanese young adults (n = 1000) using an online questionnaire. The results were assessed using χ² and t‐tests, which revealed that the experience of DSH‐related Internet searches may be significantly associated with lifetime suicidal behaviors (including DSH), suicidal ideation, and tendencies towards depression/anxiety. We discussed the possibility of using search engines to increase the motivation of Japanese young adults who deliberately harmed themselves with regard to seeking help.     

Distinct and opposite profiles of connectivity during self‐reference task and rest in youth at clinical high risk for psychosis

Self‐reference is impaired in psychotic disorders such as schizophrenia, associated with disability, and closely related to characteristic patterns of aberrant brain connectivity. However, at present, it is unclear whether self‐reference is impacted in pathogenesis of the disorder. Alterations in connectivity during a self‐reference task or resting‐state in the psychosis risk (i.e., prodromal) period may yield important clues for biomarker development, as well as for novel treatment targets. This study examined a task‐based and resting‐state functional magnetic resonance imaging in individuals at clinical high risk (CHR) for psychosis (n = 22) and healthy control unaffected peers (n = 20). The self‐reference task comprised three task conditions where subjects were asked if an adjective was relevant to themselves (self), a designated other individual (other), or to evaluate the word's spelling (letter). Connectivity analyses examined medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC), regions commonly found in conjunction analyses of self‐reference, during both the self‐reference task and rest. In task connectivity analyses, CHR individuals exhibited decreased mPFC–PCC connectivity when compared to controls. In resting‐state analyses, CHR participants showed greater mPFC–PCC connectivity. Taken together, results suggest that psychosis‐like alterations in mPFC–PCC connectivity is present prior to psychosis onset across both task and rest.     

Temporal integration as “common currency” of brain and self‐scale‐free activity in resting‐state EEG correlates with temporal delay effects on self‐relatedness

The self is a multifaceted phenomenon that integrates information and experience across multiple time scales. How temporal integration on the psychological level of the self is related to temporal integration on the neuronal level remains unclear. To investigate temporal integration on the psychological level, we modified a well‐established self‐matching paradigm by inserting temporal delays. On the neuronal level, we indexed temporal integration in resting‐state EEG by two related measures of scale‐free dynamics, the power law exponent and autocorrelation window. We hypothesized that the previously established self‐prioritization effect, measured as decreased response times or increased accuracy for self‐related stimuli, would change with the insertion of different temporal delays between the paired stimuli, and that these changes would be related to temporal integration on the neuronal level. We found a significant self‐prioritization effect on accuracy in all conditions with delays, indicating stronger temporal integration of self‐related stimuli. Further, we observed a relationship between temporal integration on psychological and neuronal levels: higher degrees of neuronal integration, that is, higher power‐law exponent and longer autocorrelation window, during resting‐state EEG were related to a stronger increase in the self‐prioritization effect across longer temporal delays. We conclude that temporal integration on the neuronal level serves as a template for temporal integration of the self on the psychological level. Temporal integration can thus be conceived as the “common currency” of neuronal and psychological levels of self.     

Effects of diisopentyl phthalate exposure during gestation and lactation on hormone‐dependent behaviours and hormone receptor expression in rats

Phthalates are found in different plastic materials, such as packaging, toys and medical devices. Some of these compounds are endocrine disruptors, comprising substances that are able to induce multiple hormonal disturbances and downstream developmental effects, including the disruption of androgen‐dependent differentiation of the male reproductive tract and changes in pathways that regulate hormone‐dependent behaviours. In a previous study, metabolites of diisopentyl phthalate (DiPeP), a potent anti‐androgenic phthalate, were found in the urine of Brazilian pregnant women. Therefore, the present study aimed to evaluate the effects of DiPeP exposure during critical developmental periods on behaviours controlled by sex hormones in rats. Pregnant Wistar rats were treated with DiPeP (1, 10 or 100 mg kg day^‐1) or canola oil by oral gavage between gestational day 10 and post‐natal day (PND) 21. Male offspring were tested in a behavioural battery, including the elevated plus maze task, play behaviour, partner preference and sexual behaviour. After the behavioural tests, the hypothalamus and pituitary of these animals were removed on PND 60‐65 and PND 145‐160 to quantify gene expression for aromatase, androgen receptor (Ar) and oestrogen receptors α (Esr1) and β (Esr2). Male rats exposed to 1 and 10 mg kg day^‐1 DiPeP displayed no preference for the female stimulus rat in the partner preference test and 1 mg kg day^‐1 DiPeP rats also showed a significant increase in mount and penetration latencies when mated with receptive females. A decrease in pituitary Esr1 expression was observed in all DiPeP treated groups regardless of age. A reduction in hypothalamic Esr1 expression in rats exposed to 10 mg kg day^‐1 DiPeP was also observed. No significant changes were found with respect to Ar, Esr2 and aromatase expression in the hypothalamus. These results suggest that DiPeP exposure during critical windows of development in rats may induce changes in behaviours related to mating and the sexual motivation of males.     

Paradigms and parallels: A commentary on the transformation of the self East and West

Ways of gaining enhanced self understanding have developed in every culture. A modern way of referring to this understanding is insight, defined as the individual's understanding of associations between past and present, typical relationship patterns and their vicissitudes, emotional experiences, and psychological symptoms. This paper explores the similarities and differences among the approaches developed in Europe, the United States, and Asia. An example of evolving changes in psychoanalytic theory and practice in the United States, embodied in the body of work called “self psychology” is described as an illustration of how “western” approaches may be incorporating wisdom from “eastern” practice.     

Psychological processes underlying delusional thinking in late-onset psychosis: a preliminary investigation

BACKGROUND AND AIMS: It has been suggested that delusions may serve as a defence against negative self-representations. The present study investigated general psychological well-being and evidence for defensive emotional processes among people with late-onset psychosis. METHOD: The performance and responses of older people with late-onset psychosis (n = 13), older people with depression (n = 15), and age-matched healthy controls (n = 15) were compared in a cross-sectional design. Participants rated their own levels of depression and self-esteem, and completed an emotional Stroop task to establish whether there was evidence of implicit depression in the absence of explicit acknowledgement. Participants rated themselves on a number of personal attributes in relation to two life stages to generate discrepancies in 'actual', 'ideal' and 'other' self-concepts, and completed measures of their perceptions of current and past psychological well-being. RESULTS: People with late-onset psychosis showed no evidence of overt depression or low-self esteem. All three groups showed an attentional bias to depression-related and age-related words, although response times overall were faster for controls. The psychosis group showed no discrepancies between either their past or their current 'actual' and 'other' self-concepts, suggesting that they do not have more negative views about how others see them. CONCLUSIONS: Evidence from this study does not support the application of the 'delusion-as-defence' model to late-onset psychosis, but methodological constraints must be borne in mind when interpreting the findings.     

Cancer risk from diagnostic radiology in a deliberate self‐harm patient

Norelli LJ, Coates AD, Kovasznay BM. Cancer risk from diagnostic radiology in a deliberate self‐harm patient. Objective: Patients who engage in recurrent deliberate self‐harm (DSH) behaviours have increased morbidity and mortality and use emergency services more than others. Unrecognized iatrogenic injury may play a role. Specifically, we call attention to the potential danger of cumulative radiation exposure. Method: Case presentation and discussion. Results: A 29‐year‐old woman with multiple episodes of deliberate foreign body ingestion received over 400 diagnostic radiology examinations during a 12 year period. The patient’s calculated total radiation dose reached an average of 20.5 mSv per year, a dose comparable to atomic bomb survivors and nuclear industry workers, populations in which there is a significant excess cancer risk. Conclusion: Patients with recurrent self‐injurious behaviours, frequent users of healthcare services who often undergo repeated medical assessment and treatment, are likely at higher risk for iatrogenic adverse events. Multiple diagnostic radiology examinations have recently come under scrutiny for causing increased lifetime risk of cancer. Healthcare providers, in particular psychiatrists and emergency department physicians, should consider the cumulative risks of radiological procedures when assessing and treating patients with DSH.     

Trichotillomania and skin-picking: a phenomenological comparison

Although trichotillomania and pathological skin-picking are both characterized by repetitive self-injurious stereotypic behaviors, the former is classified as an impulse control disorder, while the latter is not given a specific diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) [APA, 1994]. There are, however, few empirical data on phenomenological similarities and differences between these disorders. Patients with trichotillomania and pathological skin-picking were compared in terms of several demographic (age, gender), clinical (comorbid axis I and II disorders), and personality variables. Trichotillomania and pathological skin-picking were very similar in demographics, psychiatric comorbidity, and personality dimensions. Dissociative symptoms may be more common in trichotillomania than in pathological skin-picking. These data support the concept of phenomenological overlap between trichotillomania and pathological skin-picking. Future work to assess the implications of overlap for clinical evaluation and intervention in the two conditions may be useful.     

The temporal signature of self: Temporal measures of resting‐state EEG predict self‐consciousness

The self is the core of our mental life. Previous investigations have demonstrated a strong neural overlap between self‐related activity and resting state activity. This suggests that information about self‐relatedness is encoded in our brain's spontaneous activity. The exact neuronal mechanisms of such “rest‐self containment,” however, remain unclear. The present EEG study investigated temporal measures of resting state EEG to relate them to self‐consciousness. This was obtained with the self‐consciousness scale (SCS) which measures Private, Public, and Social dimensions of self. We demonstrate positive correlations between Private self‐consciousness and three temporal measures of resting state activity: scale‐free activity as indexed by the power‐law exponent (PLE), the auto‐correlation window (ACW), and modulation index (MI). Specifically, higher PLE, longer ACW, and stronger MI were related to higher degrees of Private self‐consciousness. Finally, conducting eLORETA for spatial tomography, we found significant correlation of Private self‐consciousness with activity in cortical midline structures such as the perigenual anterior cingulate cortex and posterior cingulate cortex. These results were reinforced with a data‐driven analysis; a machine learning algorithm accurately predicted an individual as having a “high” or “low” Private self‐consciousness score based on these measures of the brain's spatiotemporal structure. In conclusion, our results demonstrate that Private self‐consciousness is related to the temporal structure of resting state activity as featured by temporal nestedness (PLE), temporal continuity (ACW), and temporal integration (MI). Our results support the hypothesis that self‐related information is temporally contained in the brain's resting state. “Rest‐self containment” can thus be featured by a temporal signature.