Mood Instability and Psychosis: Analyses of British National Survey Data

Background: We used British national survey data to test specific hypotheses that mood instability (1) is associated with psychosis and individual psychotic phenomena, (2) predicts the later emergence of auditory hallucinations and paranoid ideation, and (3) mediates the link between child sexual abuse and psychosis. Methods: We analyzed data from the 2000 and 2007 UK national surveys of psychiatric morbidity (N = 8580 and 7403, respectively). The 2000 survey included an 18-month follow-up of a subsample (N = 2406). Mood instability was assessed from the Structured Clinical Interview for DSM-IV Axis II (SCID-II) questionnaire. Our dependent variables comprised auditory hallucinations, paranoid ideation, the presence of psychosis overall, and a 15-item paranoia scale. Results: Mood instability was strongly associated in cross-sectional analyses with psychosis (2000: OR: 7.5; 95% CI: I 4.1–13.8; 2007: OR: 21.4; CI: 9.7–41.2), paranoid ideation (2000: OR: 4.7; CI: 4.1–5.4; 2007: OR: 5.7; CI: 4.9–6.7), auditory hallucinations (2000: OR: 3.4; CI: 2.6–4.4; 2007: OR 3.5; CI: 2.7–4.7), and paranoia total score (2000: Coefficient: 3.6; CI: 3.3–3.9), remaining so after adjustment for current mood state. Baseline mood instability significantly predicted 18-month inceptions of paranoid ideation (OR: 2.3; CI: 1.6–3.3) and of auditory hallucinations (OR: 2.6; CI: 1.5–4.4). Finally, it mediated a third of the total association of child sexual abuse with psychosis and persecutory ideation and a quarter of that with auditory hallucinations. Conclusions: Mood instability is a prominent feature of psychotic experience and may have a role in its genesis. Targeting mood instability could lead to innovative treatments for psychosis.Key words: epidemiology, psychopathology, paranoia, auditory hallucination, child sexual abuse     

Auditory tasks for assessment of sensory function and affective prosody in schizophrenia

Schizophrenia patients exhibit impairments in auditory-based social cognition, indicated by deficits in detection of prosody, such as affective prosody and basic pitch perception. However, little is known about the psychometric properties of behavioral tests used to assess these functions. The goal of this paper is to characterize the properties of prosody and pitch perception tasks and to investigate whether they can be shortened. The pitch perception test evaluated is a tone-matching task developed by Javitt and colleagues (J-TMT). The prosody test evaluated is the auditory emotion recognition task developed by Juslin and Laukka (JL-AER). The sample includes 124 schizophrenia patients (SZ) and 131 healthy controls (HC). Properties, including facility and discrimination, of each item were assessed. Effects of item characteristics (e.g., emotion) were also evaluated. Shortened versions of the tests are proposed based on facility, discrimination, and/or ability of item characteristics to discriminate between patients and controls. Test–retest reliability is high for patients and controls for both the original and short forms of the J-TMT and JL-AER. Thus, the original as well as short forms of the J-TMT and JL-AER are suggested for inclusion in clinical trials of social cognitive and perceptual treatments. The development of short forms further increases the utility of these auditory tasks in clinical trials and clinical practice. The large SZ vs. HC differences reported here also highlight the profound nature of auditory deficits and a need for remediation.     

Psychometric properties of the Creole Haitian version of the Resilience Scale amongst child and adolescent survivors of the 2010 earthquake

Resilience is defined as the capacity of human beings to deal with and adapt to adversity, suffering, tragedy or other traumatic event. This study aims to investigate psychometric properties and the underlying structure of the Creole version of the RS among children and adolescents survivors to the 2010 Haitian earthquake. A total of 872 children and adolescents exposed to the earthquake with an average age of 14.91 (SD = 1.94) completed the Creole version of RS, the Impact Event Scale-Revised, the Children Depression Inventory and the Social Support Questionnaire-6. The current validity of RS and the internal consistency were investigated; sex, age, religion and others socio-demographic variables differences were also analysed. Cronbach’s alpha coefficient for the RS was .77; the split-half coefficient was .72. The goodness-of-fit for the 5-factor model presents the best adjusted indices. The total resilience score was correlated positively with social support (r = .42, p < .01). Mean score of the RS was 131.46 (SD = 21.01). No significant differences were observed about sex, age and residential municipality. The results showed that the Haitian Creole version of RS is a valid and reliable measure in assessing resilience for the children and adolescent survivors to the 2010’s earthquake.     

Axe I,Axe II ou Troubles mentaux et Troubles de la personnalité

Objectives

Since the publication of the third edition of the American classification the Diagnostic and Statistical Manual of mental disorders (DSM-III), psychiatric clinical syndromes and personality disorders appear in two distinct axes, axis I and II. In the fifth revision of the manual (DSM-5), published in May 2013, this distinction no longer exists and personality disorders now appear among other mental disorders. The aim of this paper is to try to pinpoint the clinical and epistemological stakes therein.

Method

The particular interest of this distinction was to attract the attention of the practitioners on the personality of the patients, independently of their psychiatric diagnoses. However today, its scientific justification appears insufficient. Numerous arguments are in favour of a continuity between the two axes and the nosographical reorganisation of anxiety, depression and personality disorders. This clarification summarises the principle tendencies that have emerged over the past ten years regarding the classification of personality disorders, with increasing dissatisfaction with the traditional categorical model and a growing interest in a dimensional perspective. These tendencies are illustrated by the recommendations drawn up by the DSM-5 task force on personality and personality disorders.

Results

The criticisms of the scientific world regarding theses recommendations have been strong. This article summarises the main arguments developed here and there, and the evolution of the task force's reflections up to the final decisions that were published in December 2012. No real consensus exists on the best dimensional model to be retained; even if the system most studied is, without doubt, the five-factor model, known as the ‘Big Five’.

Discussion

This system was studied above all in psychology, and its applicability to psychopathology, which could obviously be envisaged, requires adjustments and further validation studies before being finally adopted.

Conclusion

The return to a single axis perspective for personality disorders also justifies in depth reflection on the limits of normality and on the general definition of a mental disorder that has never been the subject of a true consensus in our profession.     

Bihemispheric gunshot wounds: survival and long-term neuropsychological follow-up of three siblings

Purpose

Penetrating gunshot wounds to the head (GSWH) have notoriously poor outcomes with extremely high mortality. Long-term follow-up data of affected children is scant in the medical literature. This report summarizes clinical presentation, management, and long-term outcomes from three children who survived “execution style” frontal, bihemispheric gunshot wounds with no or minimal surgical intervention.

Methods

A retrospective chart review of available medical records and outcomes from standardized, validated psychological instruments was undertaken, summarized, and evaluated.

Results

Despite bihemispheric injuries in each patient, no patient required operative intervention. Each child survived without readily evident neurologic impairment; however, the extent of impaired executive function varied widely, and severe disinhibition remains profoundly disabling in one survivor.

Conclusions

Bihemispheric penetrating gunshot injuries are not uniformly fatal and can occasionally be associated with long-term favorable survival; however, impaired executive function has significant potential to be profoundly disabling in these injuries.     

Persecutory delusions and psychological well-being

Social Psychiatry and Psychiatric Epidemiology - Persecutory delusions are one of the key problems seen in psychotic conditions. The aim of the study was to assess for the first time the levels of...     

Stat3 mediates LIF‐induced protection of astrocytes against toxic ROS by upregulating the UPC2 mRNA pool

Reactive oxygen species (ROS) have been implicated in various types of CNS damage, including stroke. We used a cultured astrocyte model to explore mechanisms of survival of CNS cells following ROS damage. We found that pretreatment with leukemia inhibitory factor (LIF) preserves astrocytes exposed to toxic levels of t‐BHP by inhibiting an increase in intracellular ROS following t‐BHP treatment. Astrocytes lacking functional Stat3 did not benefit from the pro‐survival or antioxidant effects of LIF. Inhibition of mitochondrial uncoupling protein 2 (UCP2) using a chemical inhibitor or siRNA abrogates the prosurvival effects of LIF, indicating a critical role for UCP2 in modulation of mitochondrial ROS production in survival following ROS exposure. LIF treatment of astrocytes results in increased UCP2 mRNA that is accompanied by an increase in Stat3 binding to the UCP2 promoter region. Although treatment with LIF alone did not increase UCP2 protein, a combination of LIF treatment and ROS stress led to increased UCP2 protein levels. We conclude that LIF protects astrocytes from ROS‐induced death by increasing UCP2 mRNA, allowing cells to respond to ROS stress by rapidly producing UCP2 protein that ultimately decreases endogenous mitochondrial ROS production. GLIA 2014;62:159–170