Reliability and Comparability of Psychosis Patients’ Retrospective Reports of Childhood Abuse

An increasing number of studies are demonstrating an association between childhood abuse and psychosis. However, the majority of these rely on retrospective self-reports in adulthood that may be unduly influenced by current psychopathology. We therefore set out to explore the reliability and comparability of first-presentation psychosis patients’ reports of childhood abuse. Psychosis case subjects were drawn from the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) epidemiological study and completed the Childhood Experience of Care and Abuse Questionnaire to elicit abusive experiences that occurred prior to 16 years of age. High levels of concurrent validity were demonstrated with the Parental Bonding Instrument (antipathy: r_s = 0.350–0.737, P < .001; neglect: r_s = 0.688–0.715, P < .001), and good convergent validity was shown with clinical case notes (sexual abuse: κ = 0.526, P < .001; physical abuse: κ = 0.394, P < .001). Psychosis patients’ reports were also reasonably stable over a 7-year period (sexual abuse: κ = 0.590, P < .01; physical abuse: κ = 0.634, P < .001; antipathy: κ = 0.492, P < .01; neglect: κ = 0.432, P < .05). Additionally, their reports of childhood abuse were not associated with current severity of psychotic symptoms (sexual abuse: U = 1768.5, P = .998; physical abuse: U = 2167.5, P = .815; antipathy: U = 2216.5, P = .988; neglect: U = 1906.0, P = .835) or depressed mood (sexual abuse: χ² = 0.634, P = .277; physical abuse: χ² = 0.159, P = .419; antipathy: χ² = 0.868, P = .229; neglect: χ² = 0.639, P = .274). These findings provide justification for the use in future studies of retrospective reports of childhood abuse obtained from individuals with psychotic disorders.     

Do Child Abuse and Maltreatment Increase Risk of Schizophrenia?

Introduction

IntroductionaaAlthough childhood abuse is a recognised risk factor for depression, post-traumatic stress disorder, and substance misuse, its role in the aetiology of psychotic disorder remained controversial. This is in part because the putative effect of childhood trauma on psychosis has been mostly evaluated by small, cross sectional, uncontrolled studies that raised methodological issues.

Methods

Papers concerning the association between childhood trauma and psychotic disorders (to November, 2011) were identified using a comprehensive search of PubMed, Psychinfo, and Scopus and analysing reference list of relevant papers. A narrative synthesis was used to summarise results.

Results

An association between childhood abuse and psychotic symptoms was consistently reported by large cross sectional surveys with an effect ranging from 1.7 to 15. However, we cannot conclude that the relationship is causal as lack of longitudinal studies prevent us from fully excluding alternative explanations such as reverse causality. Gender, cannabis use, and depressive and post-traumatic stress disorder symptoms appear to moderate the effect of childhood trauma on psychotic disorders. However, specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated.

Conclusion

Although the association between childhood abuse and psychosis has been replicated, the etiological role of such early adversity has yet to be fully clarified. So far none of the studies reported support the hypothesis that childhood abuse is either sufficient or necessary to develop a psychotic disorder. It seems likely that any effect of childhood abuse on schizophrenia needs to be understood in terms of genetic susceptibility and interaction with other environmental risk factors.     

Abuse of vulnerable people with dementia by their carers: can we identify those most at risk?

OBJECTIVE: We wanted to explore possible associations between characteristics of carers, dementia sufferers and the caring situation and the presence of abuse that was acknowledged by carers. METHODS: Eighty-two carers of dementia sufferers were interviewed in their homes about three types of abuse (verbal abuse, physical abuse and neglect) using a structured questionnaire. RESULTS: Fifty-two percent (n = 43) carers admitted to having carried out some form of abuse. Verbal abuse was the most common form (n = 42, 51%), while 20% (n = 16) of carers admitted to physical abuse and 4% (n = 3) to neglect abuse. Significant associations were found between verbal abuse and psychological ill health in the carer and behavioural problems in the dementia sufferer. Physical abuse was significantly associated with higher levels of self-reported good health by the carer. High expressed emotion measured in carers was highly correlated with all types of abuse. CONCLUSION: It is possible to identify situations where people with dementia may be at high risk of abuse from their carers. Any effective intervention strategy should address psychological health problems in the carer, behavioural problems in the dementia sufferer and a strategy to manage high levels of expressed emotion in these situations.     

“Sex,Lies and Videotapes”: Gathering and Assessing Evidence of Child Abuse in Family Law Cases

Determining the veracity of allegations of child abuse raised in post-separation parenting disputes is difficult, because family courts in Australia do not have their own investigatory power or capacity. They rely on evidence brought before them from State/Territory child protection authorities, police, and other experts who may have interviewed and assessed the child/family. This article describes the gap between Commonwealth and State/Territory responsibilities and mechanisms, and data from a recent evaluation of an innovative program designed to bridge this jurisdictional gap: the Family Court of Australia's “Magellan” case-management model. The views of judges and other key stakeholders from the Family Court and intersecting agencies are presented about the evidence that is put forward in family law disputes in which child sexual abuse or serious physical abuse is alleged. It is important to ensure children's best interests are served, even when it is difficult to adduce evidence and distil truth.     

Private and Public Ownership in Outpatient Substance Abuse Treatment: Do We Have a Two-Tiered System?

As investor-owned organizations increase their presence in the mental health care sector, questions emerge regarding the effects of ownership type on service delivery. One important question is whether ownership is related to patient access to care for persons requiring treatment for substance abuse problems. Using data from a 1995 national survey of outpatient substance abuse treatment units, the authors investigate whether there are differences in measures of patient access to care among investor-owned, not-for-profit, and public provider organizations. Results indicate investor-owned units cater to and serve a clientele that differs from that of not-for-profit and public units, suggesting the presence of a two-tiered system of substance abuse treatment.     

Longitudinal Development of Mother–Infant Interaction During the First Year of Life Among Mothers with Substance Abuse and Psychiatric Problems and Their Infants

The quality of mother–infant interaction during the first year may be hampered by maternal substance abuse and co-existing non-optimal factors such as psychiatric problems and difficult relational experiences. In the present study three groups of women were recruited during pregnancy: One group with substance abuse problems from residential treatment centers (n = 28), a second group from psychiatric outpatient treatment centers (n = 22), and a third group from well-baby clinics (n = 30). Four maternal optimality indexes were assessed (substance abuse, psychiatric problems, relational experiences and SES). Mother–infant interaction was observed at 3 and 12 months. The substance abuse group showed the most disturbed mother–infant interaction at 12 months. Low maternal optimality as well as impairments in maternal affective involvement at 3 months influenced negatively both on infant and dyadic affective behavior in interaction at 12 months. Long-term interventions are needed to promote affective reciprocity among mother–baby pairs with low optimality.     

Are there Distinctive Trajectory Groups in Substance Abuse Remission over 10 years? An Application of the Group-Based Modeling Approach

This paper introduces to mental health services and evaluation researchers a method for analyzing longitudinal data: a group-based modeling approach for applied research. We present the basic formulations of the model and illustrate its application by analyzing the 10-year longitudinal data on substance abuse remission from the New Hampshire Dual Disorders Study. The basic features of the approach are: identifying latent groups with distinctive trajectories, estimating the proportion of the population in each group, linking individual-level covariates to group membership, assigning individuals to different groups, and creating group profiles based on posterior probabilities. We also discuss cautions and the controversies surrounding this approach. The major findings include four groups with distinct trajectories of remission from substance abuse.

Trajectories of brain development: point of vulnerability or window of opportunity?

Brain development is a remarkable process. Progenitor cells are born, differentiate, and migrate to their final locations. Axons and dendrites branch and form important synaptic connections that set the stage for encoding information potentially for the rest of life. In the mammalian brain, synapses and receptors within most regions are overproduced and eliminated by as much as 50% during two phases of life: immediately before birth and during the transitions from childhood, adolescence, to adulthood. This process results in different critical and sensitive periods of brain development. Since Hebb (1949) first postulated that the strengthening of synaptic elements occurs through functional validation, researchers have applied this approach to understanding the sculpting of the immature brain. In this manner, the brain becomes wired to match the needs of the environment. Extensions of this hypothesis posit that exposure to both positive and negative elements before adolescence can imprint on the final adult topography in a manner that differs from exposure to the same elements after adolescence. This review endeavors to provide an overview of key components of mammalian brain development while simultaneously providing a framework for how perturbations during these changes uniquely impinge on the final outcome.     

'Theory of Mind' I: a theory of knowledge?

Objective: 'Theory of mind' is a cognitive notion introduced by Simon Baron-Cohen and colleagues to explain certain deficits in autistic disorders. It has, however, been extended beyond this, and applied more broadly. It proposes a means of knowing the mind of others, and suggests that this means fails in autism. The epistemological basis of 'theory of mind' will be examined critically, not just in terms of its endeavour as a theory of knowledge, but also in regard to the principles that underlie it. Conclusions: The proponents of 'theory of mind' eschew the rich field of psychological and phenomenological research, privileging only the biological sciences into which they endeavour to place their theorizations. In doing this, they fail to recognize the epistemological problems involved. This leads to the theory remaining hamstrung by the very Cartesian ontological problems that it seeks to avoid. For some, 'theory of mind' is but an artefact of the cognitive approach that it employs. It is argued that these difficulties are compounded by the failure of 'theory of mind' to take account of the place of language in the interpersonal encounters it attempts to describe.     

Disruption of cellular transport: a common cause of neurodegeneration?

In many cases, the clinical manifestations of inherited neurodegenerative disorders appear after decades of normal function, which suggests that neurons may die through cumulative damage. Several genes that cause these diseases have been identified in recent years, but no common pathogenetic mechanism has been found. However, the most recent studies have begun to implicate the same mechanism in a range of neurodegenerative diseases, particularly those that involve motor neurons. The results of these studies suggest that the morphology and energy requirements of neurons make them particularly susceptible to the disruption of cellular transport systems.     

Severe Myoclonic Epilepsy of Infancy: Extended Spectrum of GEFS+?

PURPOSE: Severe myoclonic epilepsy of infancy (SMEI) is an intractable epilepsy of early childhood of unknown etiology. It is often associated with a family history of seizure disorders, but epilepsy phenotypes have not been well described. We sought to characterize the seizure phenotypes of relatives to better understand to the genetic basis of SMEI. METHODS: Probands with SMEI were identified, and systematic family studies were performed. Epilepsy syndromes were characterized in affected family members. RESULTS: Twelve probands with SMEI were identified. Eleven of the 12 probands with SMEI had a family history of seizures, and the twelfth was the result of a consanguineous marriage. We found that 16.7% of full siblings and 8.3% of parents had definite seizures. A total of 39 affected family members was identified. The most common phenotype was febrile seizures in 14, febrile seizures plus in seven, partial epilepsy in two, and there were single individuals with SMEI, myoclonic-astatic epilepsy, Lennox-Gastaut syndrome, and 13 cases with unclassified or unconfirmed seizures. CONCLUSIONS: The family history of seizures in SMEI is in keeping with the spectrum of seizure phenotypes seen in generalized epilepsy with febrile seizures plus (GEFS+). Our findings suggest that SMEI is the most severe phenotype in the GEFS+ spectrum.     

Subtypes of social phobia: Are they of any use?

This study investigated the existence of DSM-IV social phobia subtype models in the community. Data came from the Dresden Predictor Study of a representative sample of 1877 German women (aged 18-24 years) who completed a diagnostic interview and filled out various self-report questionnaires. The number of feared social situations was distributed continuously without a clear-cut for delineation of subtypes and significantly increased functional impairment, comorbidity, subjective need for psychotherapy, seeking psychotherapeutic help and dysfunctional attitudes, and decreased social support and mental health. Subtype models based on the number (1, 2-4 and >4) and type ('formal speaking fear' versus 'other fears') of social fear did not have extra value above the continuum model of social phobia. The heterogeneity within social phobia has to be seen as a continuum of severity of social phobia, with a greater number of feared situations associated with more functional, social and psychological disability.