Prevalence and determinants of minor psychiatric disorder in Turkish immigrants living in the Netherlands

Background The aim of this study was to assess the prevalence of and risk and protective factors for minor psychiatric disorder in a general population sample of Turkish immigrants living in the Netherlands. Methods Minor psychiatric disorder was assessed with the 28-item version of the General Health Questionnaire. Demographic, immigration, social and support, and stress related variables were assessed with the Turkish Immigrant Assessment Questionnaire. The study sample was a randomly selected sample of 262 male and 523 female Turkish immigrants. Results Of all immigrants, 33.4 % experience minor psychiatric disorder with more females (36.1 %) than males (27.9 %) with disorder. For males, unemployment is a strong risk factor, whereas for females the burden of additional tasks (physical illness and inclusion of family members) in the household increases the risk for psychiatric disorder. For both males and females, however, the quality of the relationship with their partner in addition to enduring stresses around housing and finances are associated with elevated risks. Conclusions The incidence of minor psychiatric disorder in this sample of Turkish immigrants living in the Netherlands is higher than the incidence normally found in general population samples. The expression of somatic complaints around ‘tightness’ should alert physicians to further explore symptoms of minor psychiatric disorder and to examine sources of distress stemming from the partner relationship, the family, work and from poor housing and financial conditions. Accepted: 22 November 2001     

Obsessive-compulsive disorder and acquired toxoplasmosis in two children

Two children presenting symptoms of obsessive-compulsive disorder (OCD) and with acquired toxoplasmosis are described and the possibility of a previously rarely reported association between OCD and acquired toxoplasmosis is discussed. Case 1 is a 14-year-old boy with Tourette syndrome (TS), attention deficit hyperactivity disorder (ADHD) in partial remission and a three-year history of OCD referred to our department due to an acute deterioration of obsessive-compulsive (OC) symptoms. Case 2 is an 11-year-old boy referred to our department because of a two-year history of OCD. The OC symptoms were observed immediately following an infection. In both cases laboratory tests confirmed the diagnosis of acquired toxoplasmosis. The pharmacological therapy of T.gondi infection without any psychopharmacological treatment caused remission or significant improvement regarding OC symptoms. Accepted: 6 March 2001     

DSM-IV Conduct Disorder symptoms in adolescents as markers of registered criminality

A nationwide sample of 1,079 Norwegian adolescent psychiatric in-patients, 581 males and 498 females, were followed up after 11–33 (mean 23.2) years. On the basis of detailed records from index hospitalisation they were re-diagnosed and retrospectively scored on 14 of the 15 behaviour items listed as diagnostic criteria for conduct disorder in DSM-IV. The patient list was linked to the national criminal registry, and 48 % were found to have a criminal record. The ability of the 14 behaviour items to identify overall and specific kinds of registered criminality was investigated. In males, “stealing” was the strongest marker for overall and violent crime. “Having forced someone into sexual activity” was a strong marker for later sex offences. In females, “running away from home” was strongly associated with overall and violent registered criminality. ROC curves were constructed to test the sensitivity and specificity of the sum of conduct disorder behaviour items fulfilled in the identification of individuals with registered criminality. The area under the curve was 0.81 (95 % c. i. = 0.78–0.85) in males and 0.75 (95 % c. i. = 0.71–0.80) in females. A cut-off at 3 criteria fulfilled seemed optimal in males and somewhat high in females. Accepted: 17 May 2001     

Sociodemographic and clinical characteristics of patients with conversion disorder in Eastern Turkey

Background: Conversion disorder (CD) is a common disease and its importance still continues in Turkey and particularly in Eastern Turkey. The aim of this study is to examine sociodemographic and clinical characteristics of CD. Method: Among 198 consecutive patients having CD diagnosed by structured DSM-III-R clinical interview, the psychosocial characteristics of the patients were clinically investigated. Results: The most common subtype of CD was non-epileptic seizure (NES) (41.4 %). The psychosocial stress factors were found in the initiation or at the last episode of the disorder (88.9 %). The most prominent problem related with primary support group was traumatic event (37.9 %) followed by problems associated with migration and related economical problems which are the most important problems of the study area. The incidence of depressive disorders was high in patients with CD, and the histrionic personality disorder was the most prominent personality pathology among the patients. Direct referral to psychiatry clinics appeared to be low (12.1 %). Conclusion: Our findings have shown that traumatic events may have an important role in the occurrence, severity and duration of CD, and most of the patients seek help from religious healers. The study has also revealed that lower education level and socioeconomic and sociocultural problems may play a role in the occurrence of the disorder as well as regarding its course. Accepted: 13 August 2002 Correspondence to Murat Kuloglu, MD     

The use of the ADI-R as a diagnostic tool in the differential diagnosis of children with infantile autism and children with a receptive language disorder

Children with infantile autism and children with a specific receptive language disorder often show similar behavioural problems, making the differentiation between these two diagnostic categories difficult. The purpose of this study is to evaluate the usefulness of parental information in the differential diagnosis of the two types of disorders mentioned above. Sixteen children with a receptive language disorder and 11 children with infantile autism participated in the study. All children had normal non-verbal IQs. The ADI-R (Autism Diagnostic Interview-Revised) was performed with all children. The results showed that the ADI-R items reflecting behavioural features at pre-school age (age range 4–5 years) were better suited to differentiate the groups than the items reflecting behavioural features at the time of the investigation (mean age: 9 years). The items on the dimension “Reciprocal social interaction” and “Communication and language” discriminated the groups better than the items of the dimension “Restricted interests”. According to the ICD-10 algorithm of the ADI-R one child with autism and one child with a receptive language disorder were falsely classified. These false classifications were mainly due to a distorted parental perception of the child's behaviour. The ADI-R is a useful tool in the differential diagnosis of developmental disorders. Accepted: 27 April 2001     

Further evidence for a low body weight in male children and adolescents with Asperger's disorder

The study explores the common clinical impression and previously reported finding by Hebebrand et al. (7) of reduced body weight in male children and adolescents with Asperger's disorder (AD). Body weight and height of 36 consecutively admitted male patients with AD were retrospectively assessed for the calculation of body mass indices (BMI, kg/m²). The BMIs were transformed to percentile ranks and plotted into BMI-centiles representative for the German population. In addition, comorbid psychopathology was assessed to explore a possible relationship between associated psychopathology and body weight. The mean BMI-centile of all patients was 34.7 ± 31.8 and, thus, differed significantly from the mean centile of an age- and gender-matched psychiatric control group, which was 52.7 ± 28.3. Thirteen patients had a BMI below the 10th centile and five even below the third. Three of the latter presented with disturbed eating behaviour. Altogether four patients showed disturbed eating behaviour. They had a significantly lower mean BMI-centile than the rest of the group. The BMI-centiles of patients with other additional psychopathology did not differ significantly from the mean percentile of the whole cohort. The results clearly show an increased risk for underweight and disturbed eating behaviour in patients with Asperger's disorder which should be evaluated in further studies. Accepted: 26 January 1999     

Evaluation of neuromotor deficits in children with autism and children with a specific speech and language disorder

Several studies have described problems in motor functions in children with autism and children with a specific speech and language disorder. The purpose of this study was to identify neuromotor deficits in these neurodevelopmentally impaired children. A standardised neurological examination was performed in 11 children with childhood autism, 11 children with an expressive language disorder, 11 children with a receptive language disorder and 11 control children. The children were matched for age and non-verbal IQ, not for gender. All children had a non-verbal IQ above 85. The neurological examination procedure allowed for a qualitative and quantitative assessment of five specific neurological subsystems: fine and gross motor functions, balance, coordination and oral motor functions. The high-functioning children with autism and the children with a specific language disorder (expressive or receptive) had more motor problems than the control children on most neurological subsystems. There were few statistically significant differences between the three groups of developmentally impaired children. The frequent co-occurrence of verbal and non-verbal, in particular neuromotor, deficits in developmentally impaired children put an additional burden on the development of these children and should be diagnosed as early as possible. Accepted: 8 May 2002 The research was funded by grant AM 63/4–2 of the Deutsche Forschungsgemeinschaft. Correspondence to Dr. M. Noterdaeme     

Diagnostic assessment of communicative and interactive behaviours in children with autism and receptive language disorder

 Children with autism and children with a severe specific receptive language disorder both show clear deficits in communicative language skills and in social relationships. In this study the usefulness of the Autism Diagnostic Observation Schedule (ADOS) in the differential diagnosis between these two groups of developmentally impaired children is assessed. 11 children with early infantile autism and 20 children with a specific receptive language disorder participated in the study. 18 children with an expressive language disorder were used as a control group. The ADOS was individually administered to all children by the same examiner. The results showed that on most of the ADOS measures the autistic children were clearly more deviant than the language impaired children. There were no significant differences between the two groups of language impaired children. Eight out of 11 autistic children reached the defined cut-off values on the measures “language and communication” and “social interaction” of the ADOS algorithm, whereas only three autistic children did so on the measure “stereotyped behaviour”. None of the language-impaired children reached the cut-off values on more than one measure. The ADOS allowed for good assessment of certain types of behaviour. However, to confirm the diagnosis of infantile autism, additional information from parents is required. Accepted: 15 February 2000     

Early-onset Tourette syndrome with reversible autistic behaviour: a dysmaturational disorder

Early-onset Tourette syndrome comorbid with reversible autistic behaviour is described in twelve young males. After a normal gestation, delivery and first-year development, regression set in between the age of one and two with loss of various abilities and the emergence of autistic behaviour. At this time, or slightly later, they showed multiple motor and vocal tics, simple and complex: the latter could also be traced to most of their parents. Following an intervention based on intense cuddling, motor activation and paedagogic guidance, these children's abilities rapidly improved, reaching at follow-up a normal or borderline intellectual functioning and with the disappearance of their initial autistic behaviour. At follow-up tics were present in all, usually with the features of a full-blown Tourette syndrome, often comorbid with ADHD, and in some cases with OCD. Accepted: 6 June 2001     

Repetitive behaviors in autistic disorder

Introduction: Repetitive behaviors are common in autistic disorder, as in other developmental disabilities. Behaviors as diverse as stereotypies, cognitive inflexibility, and a need for sameness are grouped together under DSM IV classification, even though they are diverse in phenomenology, underlying neural circuitry, and possible clinical significance. In order to better define repetitive behaviors, we studied the relationship between such behaviors and chronological age, developmental level, estimated IQ, presumed mood state, severity of illness, as well as behavior reactivity to environmental stimuli, in a group of 121 consecutive autistic children, aged 2–4 and 7–11 years. Results: Younger autistic children displayed more motor and sensory repetitive behaviors. Older children had more complex behaviors. Children with higher IQ scores, likewise, demonstrated more complex repetitive behaviors. Most motor behaviors and self injury showed features of reactivity. Conclusions: Certain “repetitive” activities may not represent core features of autistic disorder and may be equivalent to normal motor and cognitive behaviors, as seen during typical development. Accepted: 28 August 2002 Correspondence to Mark T. Palermo, MD     

Causal explanations of distress and general practitioners' assessments of common mental disorder among Punjabi and English attendees

Background: The literature on the primary care assessment of mental distress among Indian sub-continent origin patients suggests frequent presentations to general practitioner, but rarely for recognisable psychiatric disorders. This study investigates whether cultural variations in patients' causal explanatory models account for cultural variations in the assessment of non-psychotic mental disorders in primary care. Methods In a two-phase survey, 272 Punjabi and 269 English subjects were screened. The second phase was completed by 209 and 180 subjects, respectively. Causal explanatory models were elicited as explanations of two vignette scenarios. One of these emphasised a somatic presentation and the other anxiety symptoms. Psychiatric disorder was assessed by GPs on a Likert scale and by a psychiatrist on the Clinical Interview Schedule. Results Punjabis more commonly expressed medical/somatic and religious beliefs. General practitioners were more likely to assess any subject giving psychological explanations to vignette A and English subjects giving religious explanations to vignette B as having a significant psychiatric disorder. Where medical/somatic explanations of distress were most prevalent in response to the somatic vignette, psychological, religious and work explanations were less prevalent among Punjabis but not among English subjects. Causal explanations did not fully explain cultural differences in assessments. Conclusions General practitioners' assessments and causal explanations are related and influenced by culture, but causal explanations do not fully explain cultural differences in assessments. Accepted: 18 September 2001     

Dimensional measures of psychopathology. The probability of being classified with a psychiatric disorder using empirically derived symptom scales

Objectives: We sought to develop a ranking scheme that assigns a probability of having one of four psychiatric disorders to children based on their scores on a symptom scale. We then estimated the impact of each scale symptom on the prevalence of the disorder in the population. Method: Logistic regressions were specified for ADHD, ODD, depressive, and conduct disorders using all the individual symptoms in the pertinent scale as predictors. Individual fitted values from the regression function then served as a probability scale measure. We combined the prevalence and influence of each scale symptom to calculate its overall impact on the prevalence of the disorder. Results: Probability distributions had a wide range of values and discriminated between cases and non-cases. Those having a disorder were consistently associated with higher probabilities in the scale. The estimated probability corresponds to the empiric prevalence of the diagnosis in a group of persons sharing the same estimated probabilities. Symptoms varied on their impact on the prevalence of the disorder. Conclusions: We recommend the estimated probability of the disorder based on the empirically defined scales as dimensional measures that complement prevalence of the disorder. Different symptoms are identified as targets for screening when selection is based on their impact on the prevalence of the disorder than when selection is based on the strength of the association with the disorder. We recommend using a common nosology with different classification schemes; the categorical definition of the disorder, the probability of having the disorder, and the impact of each symptom in the prevalence. Different measures serve different purposes. Accepted: 5 April 2002 Correspondence to Maritza Rubio-Stipec     

Urban-rural differences in the occurrence of female depressive disorder in Europe

Background: In an earlier paper of the European multi-centre ODIN study (Ayuso-Mateos et al. 2001) we found remarkable urban preponderance in comparison to the corresponding rural site in the female prevalence of depressive disorder in the UK and Ireland. The aim of this paper is to analyse the possible reasons for this finding. Method: A representative sample of 12,702 people aged between 18 and 64 residing in specified urban and rural areas were screened by the Beck Depression Inventory (BDI) for depressive disorder in four European countries (Finland, Ireland, Norway and the UK). Those over cut-off (BDI score < 12) and a 5 % random sample of those under cut-off underwent diagnostic interview including the SCAN version 2.0, and completed a battery of additional research instruments. Results: The estimated 1-month prevalence of depressive disorder according to ICD-10 was 9 % in the total ODIN sample. A large between-country variation was found in female urban prevalence, with Ireland (Dublin) and the UK (Liverpool) having a remarkably high rate. The women in these same countries showed a significant urban/rural difference, whereas in men and in the total sample this difference was non-significant. Logistic regression analysis including some selected risk factors of depression showed still higher risk of depressive disorder both in Dublin and Liverpool compared with the Finnish urban site (Turku), which had the lowest urban prevalence. In addition, also such factors as lack of confidant and having difficulties in getting practical help from neighbours were important predictors of depressive disorder. Similarly, when analysing the different countries separately, the significance of the urban/rural difference in women remained for Ireland and the UK, indicating that the other risk factors studied could not totally explain the difference. Conclusions: ODIN is the first European study on occurrence of depressive disorder in both urban and rural settings allowing closer analysis of the urban/rural differences. The most striking result was the large urban/rural difference in women in the two countries from the British Isles which could not be totally explained by the socio-demographic factors included in this study. Accepted: 20 November 2002 RID="*" ID="*"Andres Arriaga, Lourdes Aznar, Trygve Borve, Alfonso de la Calle, Maria Carnicero, Emma del Castillo, Graham Dunn, Mette Finne, Fiona Ford, Clare Hayes, Andres Herran, Ann Horgan, Fiona Johnstone, Nicola Jones, Tarja Koffert, Marja Lehtil?, Catherine McDonagh, Christine Murphy, Anne Navra, Teija Nummelin, Armando Oviedo, Helen Page, Helena Rasi-Hakala and Britta Sohlman Correspondence to Ville Lehtinen     

Posttraumatic stress disorder in children after the military operation "Anfal" in Iraqi Kurdistan

 Five years after the military operation “Anfal” in Iraqi Kurdistan, 45 families were randomly selected among the survivors in two displacement camps. The Posttraumatic Stress Symptoms for Children (PTSS-C) and the Harvard Trauma Questionnaire (HTQ) were administered to the oldest child and the caregiver in each family, respectively. Posttraumatic stress disorder (PTSD) was reported in 87% of children and 60% of their caregivers. While childhood PTSD was only significantly predicted by child trauma score and the duration of captivity, it was neither predicted by maternal PTSD nor did it disappear after the reunion with the PTSD-free father. However, the small sample size makes the results hypotheses rather than conclusive. Accepted: 17 April 2000     

Epidemiology and prognosis of specific disorders of language and scholastic skills

 Data from a prospective longitudinal study on the development of children born at biological and psychosocial risk were utilised to examine language and learning abilities of 320 children at ages 4.5 and 8 years. Following the research criteria of the ICD-10, specific developmental disorders of speech and language and specific developmental disorders of scholastic skills were diagnosed. Data were also provided for a clinical and general low achievement group according to less stringent criteria. Frequencies in the risk population were low for specific disorders (ICD-10) (0.6%–3.7% depending on age and type of disorder). Higher frequencies were found when a clinical definition (0.6%–13.6%) or overall low achievement score (0.6%–18.6%) was chosen. The impact of well-documented organic and psychosocial risks was analysed. Organic risk affected language abilities at 4.5 years of age but neither language nor learning abilities at 8 years of age. Psychosocial aspects of a child's environment proved to be associated with both specific language and learning abilities. Stability of language disorders, association between language and reading/spelling disorders as well as gender effects were investigated. Accepted: 17 December 1999     

Reliability and validity of a child-specific cross-cultural instrument for assessing posttraumatic stress disorder

 The Posttraumatic Stress Symptoms in Children (PTSS-C) was developed as a cross-cultural semi-structured interview to diagnose posttraumatic stress disorder (PTSD) and to identify PTSD-non-related posttraumatic stress symptoms in children after various traumatic experiences. The psychometric properties were studied in two different child populations in Iraqi Kurdistan (the survivors of the military operation “Anfal”, and the orphans), in a sample of Kurdistanian refugee children in Sweden, and in a comparison sample of Swedish children. The instrument yielded satisfactory internal consistency, high interrater agreement, and excellent validity on cross-validation with the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI) and the Diagnostic Interview for Children and Adolescents (DICA) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Accepted: 14 March 2000     

Validating the Ontario Child Health Scale in a UK population

The Ontario Child Health Scale (OCHS) was one of the first scales to seek to assess a broad range of formally defined psychiatric disorders using a checklist format. The performance of the teacher version of this instrument is reported in a UK population of children attending a special educational provision for emotionally and behaviourally disordered (EBD) pupils. Against DSM-IV criteria the instrument proved to have retained its convergent and discriminant validity, although it was somewhat less effective in detecting internalising disorders and discriminating oppositional defiance from other behavioural disorders. Overall the results confirm the usefulness of this instrument as a screening tool in a UK population. Accepted: 8 March 1999     

Case report: autistic disorder and chromosomal abnormality 46, XX duplication (4) p12-p13

 We report an 18-year-old female with a diagnosis of DSM-IV Autistic Disorder and moderate to severe mental retardation who was discovered to have a previously undescribed chromosomal abnormality 46, XX, duplication (4) p12–p13. We discuss her history and diagnosis, noting that the co-occurrence of her diagnoses have not previously been documented. The report adds to the literature supporting the argument that individuals with autistic spectrum disorders should be re-examined for chromosomal abnormalities. Accepted: 17 April 2000     

Iatrogenic depression in the elderly. Results from a community-based study in the Netherlands

Background The aim of this study was to investigate the association between the use of medication and depression in the elderly. Method A cross-sectional population-based study was conducted. Associations between the use of medication and depression are corrected for eight other etiological correlates of depression. The sample consisted of 2646 elderly people living in 11 municipalities in the Netherlands. Subjects were taken from the Longitudinal Aging Study Amsterdam, a 10-year longitudinal study on predictors and consequences of changes in well-being and autonomy in the older population. Associations are expressed in odds ratios (95 % Confidence Intervals) between the use of (groups of) medication and depression. Results are adjusted for age, sex, urbanicity, socioeconomic status, physical health, social and interpersonal support, comorbidity with other psychiatric disease and personality. The Population Attributable Risk percentage was calculated for selected groups of medication. Results After correction for competing risk factors of depression, 22 individual medications and nine groups of medications had unique associations with depression. Conclusions The use of depressogenic medication is an independent etiological factor in the pathogenesis of depression. Accepted: 25 April 2002     

No increase in long-term risk for nicotine use disorders after treatment with methylphenidate in children with attention-deficit/hyperactivity disorder (ADHD): evidence from a non-randomised retrospective study

Summary Objective. To evaluate long-term effects of methylphenidate (MPH) treatment in ADHD children on the development of nicotine use disorders (SUD-N). Methods. Multisite retrospective non-randomised longitudinal study with 215 ADHD children (diagnosis at 9.2 years of age; reassessment for SUD-N at 21.9 years of age) strictly parallel allocated to MPH treated (n = 106) and drug naive (n = 109) children. Results. There was no difference between the groups with respect to frequency (84% MPH; 89% non-MPH; χ² = 1.6; p = 0.21) and age of onset for first cigarette smoking (log rank 1.68; p = 0.19). Continuous smoking was reached by 51% (MPH) and 61% (non-MPH) of the patients. Survival analyses revealed a small and nominally significant delay in age of onset for continuous smoking in the MPH-group (log rank = 3.85; p = 0.049). Nicotine dependency was reached by 20% (MPH) and 27% (non-MPH). Age of onset does not differ between groups (log rank = 2.24; p = 0.13). Discussion. Limited evidence due to the non-randomised nature of the study is given that MPH does not induce SUD-N. The data suggests there may be a beneficial effect of MPH on delay of onset for continuous nicotine consumption in ADHD patients. Correspondence: Michael Huss, Head of Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany