Schizophrenia is often found in families with high rates of psychological illness. When one member of a family has schizophrenia, the chances of other members developing psychological problems, including schizophrenia and psychosis, increase. Some of the factors that are considered when analyzing risk for illness are family history, life stressors, trauma, and IQ. Each of these had a unique relationship with risk and schizophrenia.

In a recent study, Kim W. Verweij of the Department of Psychiatry at the University Medical Centre Utrecht in the Netherlands sought to explore the influence and evidence of IQ in families with schizophrenia. Using a sample 696 individuals with schizophrenia and their siblings (766), Verweij compared IQ scores to those of 517 individuals with no history of schizophrenia or psychiatric issues. Researchers collected data from all participants without schizophrenia and scored them separately. Those with schizophrenia also completed IQ tests and their results were analyzed independently.

The results showed that siblings of those with schizophrenia only had elevated IQs if they themselves had any history of mental health issues, or if other members of their family did. Those siblings who did not have a family history, excluding the member with schizophrenia, had average IQs compared to siblings with a robust family history. Verweij also found that the individuals with schizophrenia, who also had a family member with mental health issues, had higher IQ scores than the individuals with schizophrenia and no family history.

Verweij believes that this suggests a high familial influence on psychiatric impairment in the participants with family illness, while those without may be more influenced by external and variable factors, such as trauma, premature birth, or other stressors. Not only do these factors create a ripe environment for psychological impairment, but they also increase vulnerability for intellectual and cognitive disability.

This study provides much needed insight into the unique association between IQ and genetic predisposition for schizophrenia. Verweij added, “Since the association between IQ scores and family history of psychiatric disorder in siblings is not extensively investigated, more research is needed to further address this question.”

Reference:
Verweij, K.H.W., Derks, E.M., Genetic Risk and Outcome in Psychosis (GROUP) investigators (2013). The association between intelligence scores and family history of psychiatric disorder in schizophrenia patients, their siblings and healthy controls. PLoS ONE 8(10): e77215. doi:10.1371/journal.pone.0077215

Major depression (MDD) is known to affect numerous cognitive and behavioral domains. People with MDD often have pessimistic attitudes about future events and guilt over past events. They tend to isolate and withdraw, and choose to engage in activities that provide immediate reward over those that promise future enjoyment. This leads to impulsive and even risky behavior, like overeating and substance misuse.

Posttraumatic stress is an anxiety condition that has some similarities to MDD, but is unique in that risk/reward choices tend to be quite different. Understanding how people with MDD, PTSD, and MDD+PTSD value risks over rewards is an important area of clinical research and can provide insight into the behavioral and cognitive processes that take place in people with these mental health problems.

To get a closer look at the differences in decision making that occurs in these conditions, Jan B. Engelmann of the Department of Economics at the University of Zurich in Switzerland recently conducted risk/reward decision making experiments on 20 individuals. All had either MDD or MDD+PTSD. Engelmann compared their choices to those of 16 control (HC) participants.

The results showed that both MDD groups discounted long term rewards compared to controls. For gains, both MDD groups selected immediate versus long-term gains more than controls. However, when Engelmann looked at the subgroups of MDD participants, the findings revealed significant differences. The MDD only group demonstrated a preference for taking larger losses in the long term if it meant decreasing immediate losses. This was in contrast to the HC and MDD+PTSD groups, who chose smaller immediate losses over larger losses in the future.

Engelmann believes this difference in the MDD and MDD+PTSD group is due to anxiety. The PTSD group may be more willing to accept minimal losses today if it means avoiding larger losses later. This avoidant behavior is a symptom of anxiety and in the case of risk/reward may actually benefit individuals with respect to decision making.

For people with MDD+PTSD, although anxiety may decrease antidepressant efficacy, this negative consequence may be offset by the positive effect anxious symptoms appear to have on risk/reward processing. “Together,” added Engelmann, “These results inform future research investigating the underlying affective and cognitive processes, as well as related neural mechanisms, of the observed choice distortions in patients with MDD.”

Reference:
Engelmann, J.B., Maciuba, B., Vaughan, C., Paulus, M.P., Dunlop, B.W. (2013). Posttraumatic stress disorder increases sensitivity to long term losses among patients with major depressive disorder. PLoS ONE 8(10): e78292. doi:10.1371/journal.pone.0078292

The personality traits of neuroticism, agreeableness, openness, extraversion, and conscientiousness, known as the “big five,” have been studied at length in relation to nearly every psychological condition. Several of the big five traits have been linked to suicide, but only in the presence of other comorbid conditions or only when viewed through a limited lens.

To get a more comprehensive picture of how these personality traits affect the risk of suicide in the general population, Victor Bluml of the Department of Psychoanalysis and Psychotherapy at the Medical University of Vienna in Austria recently conducted a study involving community participants. Bluml assessed 2,555 adults for measures of past, present, and potential suicidality as well as for the big five. He controlled for other risk factors such as anxiety, depression, PTSD, and socioeconomic status.

The results revealed that specific big five traits influenced risk for suicide for men differently than for women. For women, Bluml discovered that high levels of openness and neuroticism increased suicide risk. For men, low levels of conscientiousness and extraversion elevated the risk of suicide.

Bluml believes that neuroticism, which is a risk factor for depression, could increase depressive symptoms in women, making them more vulnerable to maladaptive coping and impulsivity. This could explain the link between neuroticism and suicidality in women. However, women are more likely to have nonfatal suicide attempts than men.

When Bluml looked at the big five scores for the male participants, he found that there was no direct association between openness or neuroticism and suicide. But extraversion, which is associated with positive affect, was found to be linked to suicide risk when scores were low. Likewise, low scores on conscientiousness, which directly impacts hopefulness, were also shown to be predictive of suicidality for males. Bluml also found that these trends persisted even when other factors such as anxiety, unemployment and stress were considered.

These results clearly show how specific personality factors impact suicide uniquely for each gender. Bluml also added, “Different personality dimensions are significantly associated with suicide-related behaviors even when adjusting for other known risk factors of suicidality.”

Reference:
Blüml, V., Kapusta, N.D., Doering, S., Brähler, E., Wagner, B., et al. (2013). Personality factors and suicide risk in a representative sample of the German general population. PLoS ONE 8(10): e76646. doi:10.1371/journal.pone.0076646

The most common way to assess the outcome of therapy is to gather information relating to well-being, functionality, and problems that brought someone to therapy, and to do this both at the beginning of therapy and again at the conclusion of therapy. This allows a therapist, and the person attending therapy, to see the progress they have made and determine what areas may still need to be addressed in the future. Unfortunately, this outcome measure is rarely accurate, because a large number of people who receive cognitive therapy or talk therapies drop out prior to therapy conclusion.

Therefore, Slawomir Czachowski of the College of Medicine at the Nicolaus Copernicus University in Poland recently led a study utilizing a revised outcome tool. Czachowski altered the Psychological Outcome Profiles (PSYCHLOPS) tool to include questions pertaining to problems that could arise during therapy, not just those that were present when therapy began. Further, Czachowski repeatedly administered the revised PSYCHLOPS throughout the therapy process to gauge progress along the way.

Using a sample of 238 clients, Czachowski administered pre-therapy, during therapy, and post-therapy surveys. A total of 135 people completed all three assessments. The results revealed that those who experienced valid change increased from 56% to 81%. This suggests that the revised PSYCHLOPS method captured more accurate data than the traditional delivery method, or more change occurred because PSYCHLOPS was repeatedly administered.

Czachowski also discovered that 60% of the completers reported new problems during therapy. However, these problems were not more severe than any that they presented with and the level of change that occurred with respect to these new problems was equal to that that occurred for the prior existing problems.  In fact, completers were more likely to have new problems arise during therapy, or at least admit them, than those who did not complete therapy.

Another interesting finding was that during therapy PSYCHLOPS allowed Czachowski to recognize that non-completers had the lowest PSYCHLOPS scores before and during. This could help therapists identify and take steps to help those most at risk for early drop out. In sum, these results support intermittent PSYCHLOPS to measure therapeutic outcome. “A large proportion of outcome data is lost when outcome measures depend upon completed end of therapy questionnaires,” said Czachowski. “The use of a during-therapy measure increases data capture.”

Reference:
Czachowski, S., Seed, P., Schofield, P., Ashworth, M. (2011). Measuring psychological change during cognitive behaviour therapy in primary care: A Polish study using ‘PSYCHLOPS’ (Psychological Outcome Profiles). PLoS ONE 6(12): e27378. doi:10.1371/journal.pone.0027378

Attention deficit hyperactivity (ADHD) is characterized by cognitive disorganization, low attention, and impaired focus. Among the many symptoms and behaviors associated with ADHD are excess energy and externalizing behavior. Research has shown that as children with ADHD mature, their symptoms often decrease.

However, some children also exhibit signs of conduct disorder and personality problems, which exacerbate and perpetuate symptoms. This combination of psychological conditions can lead to violent behavior in some individuals. But does ADHD itself cause violent behavior?

That was the question posed by Rafael A. Gonzalez of the Forensic Psychiatry Research Unit at the University of London as the subject of a recent study. Gonzalez and his colleagues wanted to determine if ADHD by itself was linked directly to violent behavior in adults. And if so, what aspects of ADHD were most influential on violence?

To answer this question, Gonzalez reviewed responses from over 7,300 adults in the general population, using the Adult Self-Report Scale for ADHD. He also asked about violence, recurrence of violence acts, level of violence, and other comorbid issues. Gonzalez found that ADHD alone was only slightly predictive of violence. More specifically, the hyperactive behavior linked with ADHD, not the inattentive aspect, was the impetus for violence.

When Gonzalez examined levels of ADHD in relation to levels of violence, he discovered that the mild and moderate symptoms of ADHD were most closely related to repeated violent perpetration. However, severe ADHD was only associated with violence in the context of comorbidity. The most common conditions that appeared to be responsible for violent behavior in the adults with severe ADHD were personality problems, anxiety, and substance abuse.

“We thereby conclude that repetitive violence among persons with severe ADHD is associated with multiple forms of coexisting psychopathology but not ADHD,” said Gonzalez. Therefore, it is imperative that people with ADHD and co-existing psychological problems address the issues that could make them more susceptible to violent behavior. Future research should address the most effective ways to accomplish this.

Reference:
González, R.A., Kallis, C., Coid, J.W. (2013). Adult attention deficit hyperactivity disorder and violence in the population of England: Does comorbidity matter? PLoS ONE 8(9): e75575. doi:10.1371/journal.pone.0075575

Spontaneous remission refers to the achievement of subclinical levels of physical or psychological symptoms of a specific condition without the aid of psychological, medical, or pharmacological treatment. In depression, spontaneous remission has been the topic of recent research, with an emphasis on the role and necessity of treatment. Some research has suggested that intervention is not necessary to achieve remission in all cases, while other research has underscored the importance of mental health treatment for depression.

To explore this issue further, Harvey A. Whiteford of the Policy and Evaluation Group at the Queensland Centre for Mental Health Research in Australia recently conducted an analysis on 19 existing studies to determine the rate of spontaneous remission in untreated major depression. Whiteford found looked at adults, children, and elderly individuals with depression that were waitlisted or who served as controls in clinical studies. He evaluated remission based on symptom severity over a one year period.

The results revealed that 23% of adults will experience remission of depression without treatment in three months, 32% in six months and 53% in a year. Whiteford found that children and adolescents were more likely to achieve remission without treatment than adults. They also achieved remission sooner than adults did during the 12-month period.

When symptom severity was examined, it was revealed that individuals with severe symptoms were 25% less likely to remit than those with only mild symptoms of depression. Factors that affect symptom severity, along with personal treatment preferences and barriers to treatment, could also affect remission and choice to treat. Although not explored in this study, these factors should be examined in future work.

The findings presented here provide new direction for clinicians working with depressed clients. The results support a wait and see approach for treating some cases of depression, and in particular, cases with mild and moderate symptoms. Doing so could make critical resources more available to high risk clients.

Whiteford added, “Resources should be directed towards those with greatest need, for example those experiencing more severe depression and those whose symptoms are likely to persist or reoccur.” These findings are novel and because this research is a relatively new avenue of exploration, these results should be further validated before suggestions are fully implemented in clinical settings.

Reference:
Whiteford, H. A., et al. (2013). Estimating remission from untreated major depression: A systematic review and meta-analysis. Psychological Medicine 43.8 (2013): 1569-85. ProQuest. Web.

Negative self-views and self-appraisals are commonly associated with depressive symptoms. Individuals with major depression, as well as those with depression related to bipolar, often experience low self-esteem, feelings of worthlessness, and overall negative self-concept while in their depressive states. In contrast to these feelings, high levels of self-esteem, goal attainment, and motivation are often evident preceding or during manic episodes.

But according to the results of a new study led by Hana Pavlickova of the School of Psychology at the University of Wales Bangor, negative self-beliefs can also predict manic episodes in people with bipolar. Pavlickova theorized that the comorbidity of both positive and negative affect might exist during periods of no symptoms and also during periods when symptoms were present. Understanding how this overlap affects each mood state could help determine when manic or depressive episodes might occur and also could provide opportunities for intervention prior to those episodes.

For her study, Pavlickova evaluated 253 participants with bipolar several times over the course of 18 months. She looked at depressive and manic symptoms and how self-esteem, self-appraisals, internalization, externalization, and other behaviors influenced the symptoms.

The results revealed that self-esteem was most strongly associated with both mood states. In particular, low self-esteem was linked to depression and high self-esteem to mania. However, negative self-esteem, although highly predictive of depressive symptoms, also indirectly predicted manic episodes. Pavlickova discovered that although cross-sectional data indicated a direct association between negative self-esteem and depression, longitudinally, negative self-esteem was weakly but clearly associated with mania.

She explains this finding by suggesting that individuals with bipolar may overcompensate for feelings of negative self-worth by actively avoiding any depressive emotions and engaging in high levels of externalizing, which could provoke manic behaviors and symptoms. These results are novel in that they demonstrate the overlapping relationship of negative self-evaluations in bipolar. Pavlickova added, “In terms of clinical implications, the findings accentuate the importance of the therapeutic management of negative self-concept shared by both depression and mania in bipolar disorder.”

Reference:
Pavlickova, H., et al. (2013). Symptom-specific self-referential cognitive processes in bipolar disorder: A longitudinal analysis. Psychological Medicine 43.9 (2013): 1895-907. ProQuest. Web.

Schizophrenia is often diagnosed after someone has a psychotic episode. When someone who has had a psychotic episode initially seeks treatment, however, he or she may have had a prolonged duration of untreated psychosis (DUP). This period of time has been theorized to significantly impact later symptom severity and even progression, prognosis, and outcome.

Surprisingly, even though this theory has been introduced and explored, few studies have looked at the relationship between DUP and symptoms via a long-term follow-up. Therefore, Dr. Wing Chung Chang of the Department of Psychiatry at the University of Hong Kong in China recently led a study examining the long-term effects of DUP on executive function in a sample of 93 adults with schizophrenia.

The participants ranged in age between 18 and 55, and were evaluated extensively when they first presented for treatment for psychosis. They were followed up with several other assessments over the course of the next three years. Chang measured executive functions and looked at various aspects of cognitive function and memory.

The results revealed that when compared to nonpsychotic control participants, the participants with psychosis had large deficits in areas of memory. Chang found that visual memory was especially impaired in the participants with psychosis and that verbal memory continued to experience deficits over the three-year period. Additionally, the length of DUP was directly predictive of symptom severity and outcome at three years.

Chang believes this study supports other research that demonstrates a link between DUP and illness outcome. The longer an individual experiences psychosis, the more likely they are to have a worse illness trajectory, more severe symptoms, and more impairment to cognitive capacities. Chang said, “Our findings provided further supportive evidence that delayed treatment to first-episode psychosis is associated with poorer cognitive and clinical outcomes.”

In sum, this study extends existing research into this topic by demonstrating the long-term negative effects of psychosis on cognitive function, especially verbal memory. Future work could fortify this area of research by extending the study duration even further and by examining particular shifts in cognitive deficits and how they relate to DUP.

Reference:
Chang, W. C., et al. (2013). Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: A 3-year prospective follow-up study. Psychological Medicine 43.9 (2013): 1883-93. ProQuest. Web.

The number of incarcerated individuals with mental health issues is disproportionately high. Not all people who commit an offense have psychological problems, but those that do often go without care prior to being introduced to the criminal justice system. Having a better understanding of the relationship between offending and mental health issues could help in the development of interventions and identification measures aimed at those most at risk for mental health issues and criminal offense behaviors.

To capture a more accurate picture of the prevalence of psychological problems among offenders, Vera A. Morgan of the School of Psychiatry and Clinical Neurosciences at the University of Western Australia recently led a study that analyzed data from a birth cohort spanning 15 years.

Morgan found that of those who were born during that time, over 116,000 had been arrested and over 40,000 had been registered as receiving psychiatric care. Of those who received psychiatric care, 32.1% were in the criminal justice system. The most common psychological issues in this group were substance abuse and schizophrenia. A combination of these two significantly increased the likelihood of being arrested.

When Morgan looked solely at arrest records, she found that over 11% had a psychological issue, 6.5% had substance abuse issues, and almost 2% had a diagnosis of schizophrenia. When she looked at other mental health issues, Morgan found that personality issues accounted for 35.9% of arrests, and 29.2% of all arrests were among people with psychological conditions other than substance misuse, schizophrenia, or personality issues. For many, being arrested led to their first contact with mental health services.

“Given a growing proportion of schizophrenia offenders being arrested prior to their first contact with psychiatric services, there are important implications for mental health and criminal justice policy and practice,” said Morgan. The development of programs designed to identify mental health issues prior to entering or at the threshold of the doorway into the criminal justice system should be explored in future work. Doing so has the potential to reach individuals most in need of mental health care and also to decrease the risk of offending by those with mental health issues, and in particular, substance abuse and schizophrenia.

Reference:
Morgan, V. A., et al. (2013). A whole-of-population study of the prevalence and patterns of criminal offending in people with schizophrenia and other mental illness. Psychological Medicine 43.9 (2013): 1869-80. ProQuest. Web.

Research on borderline personality (BPD) has explored various avenues in search of risk factors. But according to a recent study, some of the biggest risk factors for BPD may develop in the womb. Cornelia E. Schwarze of the Department of Psychiatry and Psychotherapy at the University Medical Center Mainz in Germany led the study that looked at the prenatal conditions of 100 individuals with BPD and compared them to 100 participants with no history of BPD.

Schwarze interviewed the mothers of the participants and reviewed prenatal and medical records. She looked at factors such as prenatal smoking, stress, family conflict, and medical problems. Schwarze also assessed environmental risk factors for the participants by evaluating levels of childhood adversity including maltreatment, neglect, physical and sexual abuse, emotional abuse, or other traumatic events.

The results revealed that the mothers of the BPD participants were more likely to have smoked during pregnancy when compared to the mothers of the 100 non-BPD control subjects. Additionally, the mothers of the participants with BPD also had higher rates of prenatal medical problems, stress, and conflict. Other risk factors that increased the likelihood of BPD were childhood sexual abuse and other childhood trauma. However, prenatal smoking and prenatal medical problems and stress had the strongest associations with BPD.

Exposure to prenatal smoke has been linked to impulsivity, identity issues, affective problems, and some borderline personality symptoms. The results of this study support existing research in this area. Schwarze also noted that medical problems that occur during pregnancy can have a significant impact on neurological development and specifically, on regions of the brain that affect emotional regulation. Although this should be explored further in future research, the strong link between prenatal medical problems and later BPD in children supports this as well.

Finally, prenatal stress, resulting from maternal stress during pregnancy, can be caused by a number of factors, including relationship problems, psychological issues, occupational conditions, or socioeconomic conditions, just to name a few. Each of these may also have a unique impact on the development of BPD or increased risk for BPD in unborn children. Schwarze added, “Future prospective longitudinal studies are essential to verify the impact of the observed potential prenatal risk factors.”

Reference:
Schwarze, C. E., et al. (2013). Prenatal adversity: a risk factor in borderline personality disorder? Psychological Medicine 43.6 (2013): 1279-91. ProQuest. Web.