Risk of schizophrenia in character disordered patients

Inpatients from the Chestnut Lodge follow-up study diagnosed with character disorder were studied to predict future schizophrenic decompensation. Individually, three DSM-III criteria for schizotypal personality disorder predicted schizophrenia at long-term follow-up: magical thinking, suspiciousness or paranoid ideation, and social isolation. Additionally, lower IQ, poorer premorbid quality of work, and transient delusional experiences were predictive. No borderline personality disorder criterion was predictive. This suggests that schizotypal but not borderline personality disorder belongs in the schizophrenic spectrum. Within schizotypal personality disorder, criteria from both familial and clinical traditions appear to be dimensions of vulnerability to psychosis.     

Stigma in families of individuals in early stages of psychotic illness: family stigma and early psychosis

Aim: Stigma is pervasive among families of individuals with psychotic disorders and includes both general and ‘associative’ stigma – that is, the process by which a person is stigmatized by virtue of association with another stigmatized individual. These forms of stigma may present a barrier to help seeking. However, little is known about stigma in the early stages of evolving psychotic disorder. Methods: Family members of 11 individuals at clinical high risk and of nine patients with recent‐onset psychosis were evaluated for generalized and associative stigma using the Opinions about Mental Illness (modified) and the Family Experiences Interview Schedule. Results: In this small study, the level of stigma was low, as families endorsed many supportive statements, forexample, patients should be encouraged to vote, patients want to work, mental illness should be protected legally as a disability and parity should exist in insurance coverage. Families also endorsed that both talking and a belief in God and prayer can help someone get better. Only ethnic minority families of individuals with recent‐onset psychosis endorsed a sense of shame and need to conceal the patient's illness. Conclusions: This preliminary study suggests that family stigma is low in the early stages of psychotic disorder, a finding that requires further investigation in a larger and more representative sample. This may be an opportune time to engage young people and families, so as to reduce duration of untreated illness. Ethnic differences in stigma, if replicated, highlight the need for cultural sensitivity in engaging individuals and their families in treatment.     

Primary cilia in osteoarthritic chondrocytes: from chondrons to clusters.

Osteoarthritis (OA) is a common joint disease characterized by articular cartilage degeneration. The etiology of OA is unknown. Because several previous studies have shown that primary cilia play critical roles in joint development, this study examined the incidence and morphology of primary cilia in chondrocytes during joint degeneration in a naturally occurring bovine model of OA. Primary cilia were detected using antibodies to acetylated alpha-tubulin in normal cartilage as well as in mild and severe OA tissue. In normal cartilage, cilia number and length were lowest in the superficial zone and increased with distance from the articular surface. In OA tissue, the incidence and length of cilia increased at the eroding articulating surface, resulting in an overall increased proportion of cilia. This is the first study to show that primary cilia are present on chondrocytes throughout OA progression and that the overall percentage of ciliated cells within the degenerating cartilage increases with OA severity.     

Physical ill health and risk of psychosis

Patients with psychosis have been found to suffer from physical illnesses more commonly than the general population. In this report, self-reported physical ill health and its correlates among subjects with and without vulnerability to psychosis in a sample of first-degree relatives, help-seekers and controls were investigated. Perceived physical health was statistically significantly poorer among subjects with minor symptoms on the Structured Interview for Prodromal Symptoms and those vulnerable to psychosis than among those without symptoms measured by 13 somatoform symptom sum scores of the Symptom Checklist-90. Those at current risk of psychosis had a significantly higher mean sum score on the 13 somatic items (mean=21.1) than others (mean=9.6). Having physical symptoms or a self-reported physician-diagnosed illness was significantly associated with vulnerability to psychosis (odds ratio=3.05). The subjects with a mood disorder (odds ratio=4.33) had significantly more commonly physician-diagnosed illnesses than those who had no diagnosis or any other diagnosis. Physical ill health seems to be common among those vulnerable to psychosis.     

Recruitment and treatment practices for help-seeking "prodromal" patients

The prodrome of psychosis has become a target for early identification and for treatments that address both symptoms and risk for future psychosis. Interest and activity in this realm is now worldwide. Clinical trials with rigorous methodology have only just begun, making treatment guidelines premature. Despite the sparse evidence base, treatments are currently applied to patients in the new prodromal clinics, usually treatments developed for established psychosis and modified for the prodromal phase. This communication will describe representative samplings of how treatment-seeking prodromal patients are currently recruited and treated in prodromal clinics worldwide. Recruitment includes how prodromal patients are sought, initially evaluated, apprised of their high-risk status, and informed of the risks and benefits of prodromal treatments and how their mental state is monitored over time. The treatment modalities offered (and described) include engagement, supportive therapy, case management, stress management, cognitive behavioral treatment, family-based treatment, antipsychotic pharmacotherapy, and non-antipsychotic pharmacotherapy. References for details are noted.     

The DSM-IV version of schizophrenia may be harmful to patients' health

The DSM-III, III-R and DSM-IV diagnostic systems required deterioration (functional loss) and duration (6 months) in the diagnosis of schizophrenia. These criteria made schizophrenia exceptional to an otherwise phenomenologically-based nosology, but their inclusion represented an effort to disentangle the diagnosis of schizophrenia from considerable historical baggage. Newer findings about the efforts of early detection and intervention in schizophrenia, however, are now calling into question the validity, utility and even the safety of these decisions. This communication will review the original reasons for including deterioration and duration as criteria. It will then argue that these reasons are now obsolete and potentially anti-therapeutic, and that a revised set of cross-sectional phenomenologic criteria for schizophrenia need to be utilized as soon as possible.