Hair cortisol concentrations in pregnant women with bipolar, depressive, or schizophrenic spectrum disorders.

PURPOSE: Maternal cortisol levels in pregnancy may support the growth of or adversely affect fetal organs, including the brain. While moderate cortisol levels are essential for fetal development, excessive or prolonged elevations may have negative health consequences for both the mother and the offspring. Little is known about predictors of altered hypothalamic-pituitary-adrenal (HPA) axis activity during pregnancy. This study examined maternal hair cortisol concentration (HCC) in the 3rd trimester of pregnancy in relation to severe psychopathology. METHODS: Hair samples were collected from 69 women, 32 with a lifetime diagnosis of severe mental disorders (bipolar I or II disorder, moderate or severe depressive disorder, schizophrenic spectrum disorder), and 37 non-clinical controls. Hair samples were collected during the 3rd trimester, and liquid chromatography tandem mass spectrometry was used for cortisol assessment. Psychiatric diagnosis and current level of symptomatic functioning were assessed using the structured clinical interview from the DSM-5 and the global assessment of functioning scale. RESULTS: Women with a lifetime diagnosis of severe mental illness had significantly elevated HCC compared to controls. Poorer current symptomatic functioning was also significantly associated with elevated HCC in pregnancy. CONCLUSIONS: The implications of alterations in HCC on both maternal and infant health need further study.

The longitudinal association of combined regulatory problems in infancy and mental health outcome in early childhood: a systematic review.

Co-occurring regulatory problems in infancy, RPs, including excessive crying, feeding-eating and sleeping, have been found associated with mental health problems in school ages. Still, an overview is needed on trajectories of co-occurring or combined RPs, and mental health problems in early childhood. The aim of this review is to systematically review the literature on longitudinal community-based studies of combined RPs measuring mental health outcomes in early childhood. Following the PRISMA guideline, we systematically reviewed the literature published 2000-2020, in which combined RPs are assessed in infancy, and mental health is examined using standardised measures at ages 1-7 years. The search was performed in four databases MEDLINE, EMBASE, PsycINFO and Scopus. A protocol is published on PROSPERO. Based on 1978 screened articles, 42 papers were screened for eligibility, of which six were included, comprising data on two or more RPs investigated among a total of 20,675 children. Assessment of risk of bias in the studies showed overall good quality in five of the six papers. The literature reviewed suggests that combined RPs in infancy are early markers of mental health problems during early childhood, and highlights that community studies exploring the longitudinal associations of combined RP and mental health problems in preschool and early school age are still scarce. Overall, the review points to the need of research into preventive intervention targeting early manifestations of childhood dysregulation, such as RPs.

Mental and pediatric disorders among children 0-6 years of parents with severe mental illness.

OBJECTIVE: Parental severe mental illness (SMI) increases the lifetime risk of mental and pediatric disorders in the offspring but little is known about specific disorders during early childhood. The primary aim was to investigate the incidence of mental and pediatric disorders among children 0-6 years old exposed to parental SMI, and secondarily to investigate the distribution of disorders on specific child age. METHODS: A nationwide, register-based cohort study of 1,477,185 children born in Denmark between 1994.01.01 and 2016.12.31. Incidence rate ratios were calculated using Poisson regression analysis for any and specific mental and pediatric disorders. RESULTS: IRR for any psychiatric disorder was elevated by a factor 2-5 among SMI offspring. Maternal schizophrenia resulted in the highest IRR = 5.23 (4.80-5.69) of any child psychiatric disorder. The risk of anxiety/OCD and attachment disorder among offspring exposed to parental, and in particular maternal, SMI was markedly raised with IRRs for anxiety/OCD between 7.59 and 17.02 and attachment disorders between 6.26 and 15.40. IRRs of mental disorders were highest at age 0-1 year and declined with age. IRR for any pediatric disorder was also elevated with IRRs between 1.01 and 1.28. Disorders of the digestive system and ill-defined symptoms were associated with the highest IRRs. Maternal (vs. paternal) SMI was associated with higher IRRs. IRRs declined slightly with child age. CONCLUSION: Children exposed to parental SMI are at increased risk of mental and pediatric disorders during early childhood, particularly anxiety/OCD and attachment disorders. If associations are estimates of a modifiable causal relationship, our results indicate a need for early intervention to promote mental and pediatric health among SMI offspring.

Morbidity and Mortality in the Children and Young Adult Offspring of Parents With Schizophrenia or Affective Disorders-A Nationwide Register-Based Cohort Study in 2 Million Individuals.

BACKGROUND: The offspring of parents with severe mental illness (SMI) are at higher risk of mortality and of developing certain somatic diseases. However, across the full spectrum of somatic illness, there remains a gap in knowledge regarding morbidity. METHODS: We conducted a register-based nationwide cohort study of all 2 000 694 individuals born in Denmark between 1982 and 2012. Maximum age of offspring at follow-up was 30 years. Information on parents' psychiatric diagnoses of schizophrenia, bipolar disorder, and unipolar depression was retrieved from the Psychiatric Central Register. We estimated incidence rate ratio (IRR), cumulative incidence percentage and mortality rate ratio of first hospital contact for a broad spectrum of somatic illnesses according to the International Statistical Classification of Diseases and Related Health Problems. Analyses were adjusted for important confounders. RESULTS: Offspring of individuals with SMI had higher risk of somatic hospital contacts IRR: 1.17 (95% CI: 1.16-1.18) with maternal depression being associated with the highest IRR (1.22, 95% CI: 1.20-1.24). Offspring of parents with SMI had higher risk within most broad diagnostic categories with highest IRRs for unclassified somatic diagnoses, infections and endocrine diseases ranging from 1.27 (95% CI: 1.25-1.28) to 1.26 (95% CI: 1.23-1.29) (all P < .0001). Morbidity was particularly increased in children aged 0-7 years. The mortality rate ratio associated with parental SMI was 1.31 (95% CI: 1.21-1.41) with excess mortality mainly due to unnatural causes. CONCLUSION: Our findings indicate that offspring of parents with SMI experienced increased mortality and somatic morbidity warranting heightened vigilance and support for this population.

Antenatal caregiving representations among expectant mothers with severe mental illness: a cross-sectional study.

Objective: The study explores predictors of antenatal caregiving representations among mothers with a history of severe mental illness (SMI). Background: Attachment research has demonstrated that multifactorial assessment of antenatal caregiving representations predicts later maternal behaviour and child attachment. However, the field lacks research among clinical groups. Knowledge of factors influencing caregiving representations during pregnancy can contribute to our understanding of caregiving risk among SMI-mothers and inform intervention decisions. Method: The current study is a cross-sectional subsample of the WARM study. Participants were 65 Danish or Scottish pregnant women with a history of either schizophrenia, bipolar disorder, moderate-severe depression, or non-clinical controls. Caregiving representations, adverse childhood experiences, social support and current symptom severity were assessed during pregnancy. Results: Symptom severity was associated with more non-optimal caregiving representations expecting less parental enjoyment, more difficulties separating from the child, and more feelings of caregiving helplessness. Lack of social support and adverse childhood experiences served as independent predictors of caregiving representations. Parental mental illness during own childhood predicted role reversed expectations. Conclusion: Antenatal caregiving representations can be assessed with a time-efficient self-report measure that assesses caregiving as a multidimensional construct. Prenatal treatment planning should target individual difficulties in undertaking transformation of the caregiving system.

Mother-infant interaction in schizophrenia: transmitting risk or resilience? A systematic review of the literature.

PURPOSE: The parent-infant relationship is an important context for identifying very early risk and resilience factors and targets for the development of preventative interventions. The aim of this study was to systematically review studies investigating the early caregiver-infant relationship and attachment in offspring of parents with schizophrenia. METHODS: We searched computerized databases for relevant articles investigating the relationship between early caregiver-infant relationship and outcomes for offspring of a caregiver with a diagnosis of schizophrenia. Studies were assessed for risk of bias. RESULTS: We identified 27 studies derived from 10 cohorts, comprising 208 women diagnosed with schizophrenia, 71 with other psychoses, 203 women with depression, 59 women with mania/bipolar disorder, 40 with personality disorder, 8 with unspecified mental disorders and 119 non-psychiatric controls. There was some evidence to support disturbances in maternal behaviour amongst those with a diagnosis of schizophrenia and there was more limited evidence of disturbances in infant behaviour and mutuality of interaction. CONCLUSIONS: Further research should investigate both sources of resilience and risk in the development of offspring of parents with a diagnosis of schizophrenia and psychosis. Given the lack of specificity observed in this review, these studies should also include maternal affective disorders including depressive and bipolar disorders.

Anomalous self-experience in adolescents at risk of psychosis. Clinical and conceptual elucidation.

BACKGROUND: In research and clinical settings, there is a growing interest in the prodromal state of psychosis. The condition is usually operationalized by the presence of weak positive symptoms. Some studies also point to disorders of self-awareness as a core characteristic of the schizophrenia spectrum detectable before the onset of psychosis. Combining the 2 approaches is a pragmatic solution to the investigation of the role of anomalous self-experience in developing psychosis. METHODS: This clinical report describes disorders of self-experience in a small sample of 11 subjects fulfilling the Criteria of Prodromal Syndromes. All subjects were interviewed using the symptom checklist Examination of Anomalous Self-Experience. Through in-depth analysis of cases, interview excerpts have been selected for the purpose of illustrating the phenomena of anomalous self-experience. RESULTS: Disorders of self-experience were found in all subjects who fulfilled the prodromal criteria. There was, however, a difference in the kind and numbers of single features. Examples of disorders of self-experience which differ from the attenuated positive symptoms are illustrated by selected interview excerpts. CONCLUSIONS: Anomalous self-experience should be further investigated in subjects at risk of psychosis and in a broader clinical population. The concept of anomalous self-experience should be further elaborated theoretically as well as empirically.