Does attachment theory offer new resources to the treatment of schizoaffective patients?

This paper focused on considering schizoaffective disorder in the light of Attachment Theory: a case of intensive psychotherapy with a patient with a schizoaffective disorder was presented. In this case, Attachment Theory provided a useful framework for understanding the patient as well for her treatment. The core of the treatment was to build a strong therapeutic alliance in which compliance with medication and elaboration of psychological processes could be achieved. This paper could contribute to opening the discussion about the relationship between schizoaffective disorder and Attachment Theory.     

Genetic risk factors for schizophrenia associate with sleep spindle activity in healthy adolescents

Schizophrenia has been associated with disturbed sleep, even before the onset of the disorder, and also in non‐schizophrenic first‐order relatives. This may point to an underlying genetic influence. Here we examine whether weighted polygenic risk scores (PRS) for schizophrenia are associated with sleep spindle activity in healthy adolescents. Our sample comes from a community‐based cohort of 157 non‐schizophrenic adolescents (57% girls) having both genetic data and an overnight sleep EEG measurement available. Based on a recent genome‐wide association study, we calculated PRS for schizophrenia across the whole genome. We also calculated PRS for the CACNA1l gene region, which has been associated with both schizophrenia and sleep spindle formation. We performed an overnight sleep EEG at the homes of the participants. Stage two sleep spindles were detected using an automated algorithm. Sleep spindle amplitude, duration, intensity and density were measured separately for central and frontal derivations and for fast (13–16 Hz) and slow (10–13 Hz) spindles. PRS for schizophrenia was associated with higher fast spindle amplitude (p = 0.04), density (p = 0.006) and intensity (p = 0.04) at the central derivation, and PRS in the CACNA1l region associated with higher slow spindle amplitude (p = 0.01), duration (p = 0.03) and intensity (p = 0.002) at the central derivation. A positive association between genetic variants for schizophrenia and sleep spindle activity among healthy adolescents supports a view that sleep spindles and schizophrenia share similar genetic pathways. This study suggests that altered sleep spindle activity might serve as an endophenotype of schizophrenia.     

Long-term outcome of patients who receive ketamine during research.

BACKGROUND: To comprehend the pathophysiology of schizophrenia and to facilitate drug discovery, animal and human models of schizophrenia are necessary. Ketamine, a noncompetitive N-methyl-D-aspartate antagonist, has been used to probe glutamatergic function in normal and schizophrenic volunteers. These studies and others have provided data consistent with a putative involvement of a glutamatergic dysfunction in the pathophysiology of schizophrenia; however, these studies have also raised concerns about the distress inflicted on patients, the potential for adverse events, and the serious long-term effects that could possibly be induced by symptom-simulating action. METHODS: For all patient volunteers (n = 30) who participated in these studies, we reviewed the acute safety during and in the immediate postketamine administration. Patients available for long-term follow-up (n = 25) were matched to a group of patients (n = 25) who participated in research but did not receive ketamine. We compared their long-term outcome in terms of psychopathology, the need for psychiatric care, and the amount of antipsychotic medication required for optimal therapeutic response. RESULTS: There were no serious adverse events in more than 90 ketamine interviews. Distress to patients was minimal, which is shown by the lack of anxiety ratings. Over a mean follow-up period of 8 months, we found no differences between patients who did and did not receive ketamine on any measures of psychopathology, psychiatric care, or the amount of antipsychotic medication.CONCLUSIONS: In a controlled environment and paying close attention to subject safety features, administering subanesthetic doses of ketamine causes no adverse events and little distress to schizophrenic volunteers. This study strongly indicates that administering ketamine does not change any aspect of the course of schizophrenic illness.     

Short‐term longitudinal changes in adult dental fear

This study aimed to evaluate (i) longitudinal fluctuations and considerable changes in adult fear at five data‐collection points during a 2.5‐yr period and (ii) the stability of symptoms of depression in dental fear‐change groups. Pilot data from the FinnBrain Birth Cohort study, of 254 families expecting a baby, were used. Data‐collection points (DCPs) were: 18–20 and 32–34 gestational weeks; and 3, 12, and 24 months after delivery. At baseline, 119 women and 85 men completed the Modified Dental Anxiety Scale (MDAS) questionnaire. At all DCPs, 57 (48%) women and 35 (41%) men completed MDAS. Depression was measured using the Edinburgh Postnatal Depression Scale. Changes in MDAS were analyzed using general linear modelling for repeated measures. Stability of dental fear was assessed using dichotomized MDAS scores. Dental fear among women decreased statistically significantly in late pregnancy and increased thereafter. Among men, dental fear tended to increase in late pregnancy and decreased afterwards. Depression scores varied in high and fluctuating fear groups but the differences diminished towards the last DCP. Dental fear among adults experiencing a major life event does not seem to be stable. Clinicians should take this into account. The mechanisms behind these changes need further research.