Duration of breast feeding and attention-deficit/hyperactivity disorder in United States preschool-aged children.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by difficulties sustaining attention and controlling hyperactivity and impulsive behavior. Population-based studies concerning the association between breast-feeding duration and ADHD among preschool-aged children in the United States (U.S.) have been sparse. AIMS: To determine whether there is an association between the duration of breast feeding and ADHD in U.S. children aged 2-5 years. METHODS AND PROCEDURES: We used nationally representative data from the 2016, 2017, and 2018 National Survey of Children's Health (NSCH) to examine the association between breast-feeding duration and ADHD in U.S. preschool-aged children. Sample characteristics were compared using Rao-Scott chi-square test, and adjusted prevalence odds ratios and 95 % confidence intervals were estimated using unconditional logistic regression. OUTCOMES AND RESULTS: Of the 20,453 children eligible for our study, 1.5 % had received a diagnosis of ADHD and 77.5 % were reported to have been fed human milk as infants. Prevalence odds of ADHD were 57 % lower among children fed human milk for 6-12 months compared to children never fed human milk after controlling for potential confounders. Among children with durations of breast feeding lasting less than 6 months or lasting 12 months or longer, prevalence odds of ADHD were not significantly lower than the comparison group, children who were never fed human milk, after controlling for potential confounders. CONCLUSIONS AND IMPLICATIONS: We noted an inverse association between breast feeding durations of 6-12 months and parent-reported diagnosis of ADHD in preschool-aged children in the U.S. Future studies should use longitudinal designs to examine ADHD and duration of breast-feeding measures.

Latent factor modeling of four schizotypy dimensions with theory of mind and empathy.

Preliminary evidence suggests that theory of mind and empathy relate differentially to factors of schizotypy. The current study assessed 686 undergraduate students and used structural equation modeling to examine links between a four-factor model of schizotypy with performance on measures of theory of mind (Reading the Mind in the Eyes Test [MIE]) and empathy (Interpersonal Reactivity Index [IRI]). Schizotypy was assessed using three self-report measures which were simultaneously entered into the model. Results revealed that the Negative factor of schizotypy showed a negative relationship with the Empathy factor, which was primarily driven by the Empathic Concern subscale of the IRI and the No Close Friends and Constricted Affect subscales of the Schizotypal Personality Questionnaire. These findings are consistent with a growing body of literature suggesting a relatively specific relationship between negative schizotypy and empathy, and are consistent with several previous studies that found no relationship between MIE performance and schizotypy.

Developmental mechanisms in the prodrome to psychosis.

Psychotic disorders continue to be among the most disabling and scientifically challenging of all mental illnesses. Accumulating research findings suggest that the etiologic processes underlying the development of these disorders are more complex than had previously been assumed. At the same time, this complexity has revealed a wider range of potential options for preventive intervention, both psychosocial and biological. In part, these opportunities result from our increased understanding of the dynamic and multifaceted nature of the neurodevelopmental mechanisms involved in the disease process, as well as the evidence that many of these entail processes that are malleable. In this article, we review the burgeoning research literature on the prodrome to psychosis, based on studies of individuals who meet clinical high risk criteria. This literature has examined a range of factors, including cognitive, genetic, psychosocial, and neurobiological. We then turn to a discussion of some contemporary models of the etiology of psychosis that emphasize the prodromal period. These models encompass the origins of vulnerability in fetal development, as well as postnatal stress, the immune response, and neuromaturational processes in adolescent brain development that appear to go awry during the prodrome to psychosis. Then, informed by these neurodevelopmental models of etiology, we turn to the application of new research paradigms that will address critical issues in future investigations. It is expected that these studies will play a major role in setting the stage for clinical trials aimed at preventive intervention.

The development of psychotic disorders in adolescence: a potential role for hormones.

This article is part of a Special Issue "Puberty and Adolescence". The notion that adolescence is characterized by dramatic changes in behavior, and often by emotional upheaval, is widespread and longstanding in popular western culture. In recent decades, this notion has gained increasing support from empirical research showing that the peri- and post-pubertal developmental stages are associated with a significant rise in the rate of psychiatric symptoms and syndromes. As a result, interest in adolescent development has burgeoned among researchers focused on the origins of schizophrenia and other psychotic disorders. Two factors have fueled this trend: 1) increasing evidence from longitudinal research that adolescence is the modal period for the emergence of "prodromal" manifestations, or precursors of psychotic symptoms, and 2) the rapidly accumulating scientific findings on brain structural and functional changes occurring during adolescence and young adulthood. Further, gonadal and adrenal hormones are beginning to play a more prominent role in conceptualizations of adolescent brain development, as well as in the origins of psychiatric symptoms during this period (Walker and Bollini, 2002; Walker et al., 2008). In this paper, we begin by providing an overview of the nature and course of psychotic disorders during adolescence/young adulthood. We then turn to the role of hormones in modulating normal brain development, and the potential role they might play in the abnormal brain changes that characterize youth at clinical high-risk (CHR) for psychosis. The activational and organizational effects of hormones are explored, with a focus on how hormone-induced changes might be linked with neuropathological processes in the emergence of psychosis.

The prodrome and clinical risk for psychotic disorders.

The psychosis prodrome offers great promise for identifying neural mechanisms involved in psychotic disorders and offers an opportunity to implement empirical interventions to delay, and ultimately ameliorate, illness onset. This article summarizes the literature on individuals in the putatively prodromal phase of psychosis/deemed at clinical high risk (CHR) for psychosis onset. Standardized measurement and manifestation of the CHR syndromes are discussed, followed by empirical findings that highlight the psychological deficits and biological abnormalities seen in CHR syndromes and psychotic disorders. Current controversies surrounding the diagnosis of CHR syndromes and issues related to the treatment of CHR individuals are also presented.

Social distance and stigma toward individuals with schizophrenia: findings in an urban, African-American community sample.

Because schizophrenia is arguably among the most stigmatized health conditions, research assessing correlates of stigma is essential. This study examined factors associated with stigma in predominantly Protestant, low-income, urban African Americans in the Southeastern United States. A survey was distributed to 282 patrons of an inner-city food court/farmers' market. Associations were assessed between two measures of stigma--an adapted version of the Social Distance Scale (SDS) and a Semantic Differential Measure (SDM) of attributes such as dangerousness, dirtiness, and worthlessness--and several key variables addressing sociodemographic characteristics and exposure to/familiarity with mental illnesses. Independent predictors of scores on the two measures were identified using linear regression modeling. Higher stigma (as measured by the SDM) was predicted by a family history of psychiatric treatment, whereas lower stigma (as indicated by the SDS) was predicted by personal psychiatric treatment history and higher annual income. The results suggest special considerations when working with disenfranchised populations, especially family members of individuals with mental illnesses, in treatment settings.

Life and treatment goals of individuals hospitalized for first-episode nonaffective psychosis.

First-episode psychosis typically emerges during late adolescence or young adulthood, interrupting achievement of crucial educational, occupational, and social milestones. Recovery-oriented approaches to treatment may be particularly applicable to this critical phase of the illness, but more research is needed on the life and treatment goals of individuals at this stage. Open-ended questions were used to elicit life and treatment goals from a sample of 100 people hospitalized for first-episode psychosis in an urban, public-sector setting in the southeastern United States. Employment, education, relationships, housing, health, and transportation were the most frequently stated life goals. When asked about treatment goals, participants' responses included wanting medication management, reducing troubling symptoms, a desire to simply be well, engaging in counseling, and attending to their physical health. In response to queries about specific services, most indicated a desire for both vocational and educational services, as well as assistance with symptoms and drug abuse. These findings are interpreted and discussed in light of emerging or recently advanced treatment paradigms-recovery and empowerment, shared decision-making, community and social reintegration, and phase-specific psychosocial treatment. Integration of these paradigms would likely promote recovery-oriented tailoring of early psychosocial interventions, such as supported employment and supported education, for first-episode psychosis.

Associations among perceptual anomalies, social anxiety, and paranoia in a college student sample.

Recent evidence suggests that normal-range paranoid ideation may be particularly likely to develop in individuals disposed to both social anxiety and perceptual anomalies. This study was designed to test the hypothesis that among college students in an unselected sample, social anxiety and experience of perceptual anomalies would not only each independently predict the experience of self-reported paranoid ideation, but would also interact to predict paranoid patterns of thought. A diverse sample of 644 students completed a large battery of self-report measures, as well as the five-factor Paranoia/Suspiciousness Questionnaire (PSQ). We conducted hierarchical multiple regression analyses predicting scores on each PSQ factor from responses on measures of social anxiety, perceptual aberration, and the interaction between the two constructs. Current general negative affect was covaried in all analyses. We found that both social anxiety and perceptual aberrations, along with negative affect, predicted multiple dimensions of paranoia as measured by the PSQ; the two constructs did not, however, interact significantly to predict any dimensions. Our findings suggest that perceptual aberration and anxiety may contribute to normal-range paranoid ideation in an additive rather than an interactive manner.

Patient-level predictors and clinical correlates of duration of untreated psychosis among hospitalized first-episode patients.

OBJECTIVE: Duration of untreated psychosis (DUP) has been associated with poor early course outcomes of nonaffective psychotic disorders; however, less is known about predictors of DUP. This study examined patient-level predictors of DUP and clinical correlates of both DUP and duration of untreated illness (DUI), both of which have been implicated as prognostic indicators. METHOD: Participants included 109 first-episode patients hospitalized in 3 public-sector inpatient psychiatric units serving an urban, socially disadvantaged, predominantly African American community. DUP, DUI, and a number of clinical and psychosocial variables were measured using standardized methods. Patients were diagnosed with schizophrenia and related psychotic disorders according to the Structured Clinical Interview for DSM-IV Axis I Disorders. RESULTS: The median DUP and DUI were 22.3 and 129.9 weeks, respectively. Survival analyses revealed that, at any given time point, patients not living with family members were, on average, about 1.5 times as likely to be hospitalized as those living with family when controlling for mode of onset of psychosis. Patients not living in poverty were, on average, about 1.6 times as likely to be hospitalized as those living in poverty when controlling for mode. A greater burden of negative symptoms was associated with longer DUP (r = 0.23, P = .02), and poorer insight was associated with longer DUI (r = -0.24, P = .01). Longer DUP and DUI were associated with diverse adverse clinical characteristics, such as greater impairment in global functioning, poorer social functioning, and more psychosocial problems. CONCLUSIONS: There is a need for early intervention efforts to be directed to families (and their loved ones who live with them with emerging psychotic disorders or frank untreated psychotic syndromes), particularly families facing major socioeconomic challenges.

Prevalence and psychosocial correlates of prior incarcerations in an urban, predominantly African-American sample of hospitalized patients with first-episode psychosis.

High rates of incarceration and criminal justice system recidivism among individuals with serious mental illnesses have long been topics of concern, but few studies have examined rates of prior incarceration at the point of first treatment contact. In a sample of 109 urban, low-income, predominantly African-American patients hospitalized for first-episode psychosis, 57.8 percent reported a history of incarceration. Among those who reported having ever been incarcerated, 58.1 percent had more than one past incarceration, and the mean number of incarcerations was 2.9 ± 3.4. Patients with a history of incarceration had completed fewer years of education, had poorer late-adolescence premorbid academic functioning, reported an earlier age at initiation of cannabis use, and were more likely to have cannabis and alcohol dependence or abuse. Incarceration was also associated with a greater number of psychosocial problems and more severe general psychopathology symptoms. These findings of excessively high rates of past incarceration among urban, predominantly African-American, first-episode psychosis patients, along with the associations between past incarceration and diverse adverse psychosocial and clinical characteristics, serve as a call to action for researchers in early psychosis, program developers, policy-makers, and clinical and forensic psychiatrists.

Cluster A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence.

Cluster A personality disorders (PD), including schizotypal personality disorder (SPD), paranoid personality disorder (PPD), and schizoid PD, are marked by odd and eccentric behaviors, and are grouped together because of common patterns in symptomatology as well as shared genetic and environmental risk factors. The DSM-IV-TR describes personality disorders as representing stable and enduring patterns of maladaptive traits, and much of what is understood about Cluster A personality disorders in particular stems from research with adult populations. Less in known about these disorders in children and adolescents, and controversy remains regarding diagnosis of personality disorders in general in youth. The current paper reviews the available research on Cluster A personality disorders in childhood and adolescence; specifically, we discuss differentiating between the three disorders and distinguishing them from other syndromes, measuring Cluster A disorders in youth, and the nature and course of these disorders throughout childhood and adolescence. We also present recent longitudinal data from a sample of adolescents diagnosed with Cluster A personality disorders from our research laboratory, and suggest directions for future research in this important but understudied area.

Beliefs about causes of schizophrenia among urban African American community members.

The public's causal attributions of schizophrenia have far-reaching effects on the community and affected individuals. This study investigated causal beliefs within a community of predominantly Protestant, low-income, urban, African Americans in the southeastern United States. Two hundred eighty-two patrons of an inner-city food court/farmers' market participated in a self-administered survey assessing causal beliefs through a 30-item survey and self-reported causal opinions. Associations were assessed between causal attributions of schizophrenia and sociodemographic characteristics and exposure/familiarity variables. Certain sociodemographic variables, as well as key exposure/familiarity variables, predicted the nature of one's causal beliefs. The most common causal opinions reported included substance abuse, negative life events, and "mental illness." Findings from a subsample administered an exploratory multiple-choice question investigating understanding of causation revealed that the public may not fully understand the nature of causation. Although this study suggests potential determinants of causal beliefs held by community members, further research examining the public's conception of causation would enhance interpretation of studies on such beliefs.

Characteristics of the retrospectively assessed prodromal period in hospitalized patients with first-episode nonaffective psychosis: findings from a socially disadvantaged, low-income, predominantly African American population.

OBJECTIVE: Because many heterogeneous symptoms and substantial psychosocial impairment develop during the prodrome of nonaffective psychosis, it is imperative to further characterize the prodrome, both retrospectively and prospectively. This study describes the prodromal period of 109 hospitalized first-episode patients from an urban, socially disadvantaged, predominantly African American population. METHOD: Detailed data were gathered using established measures. Diagnoses of psychotic disorders were determined with the Structured Clinical Interview for DSM-IV Axis I Disorders. The prodromal period was described, exploratory factor analysis was conducted to assess the latent structure of 14 prodromal features, and patients with and without a retrospectively determined prodrome were compared on a number of sociodemographic and clinical variables. RESULTS: Some 76 patients (69.7%) had an identifiable prodrome, and the median duration of the prodrome was 107.7 weeks. The most prevalent prodromal features were deterioration in role function (65.8%), suspiciousness (63.2%), social withdrawal (60.5%), and trouble with thinking (57.9%). Factor analysis revealed 3 factors, termed depressive/deficit, subthreshold positive, and brief, intermittent psychotic symptoms, which were highly consistent with recently described prodromal syndromes in prospective research efforts. Patients without an identifiable prodrome had higher mean social functioning scores-in social engagement, prosocial, and employment domains-compared to those with an identifiable prodrome. Only 11 participants (14.5%) had sought professional help during the prodrome. CONCLUSIONS: Given the highly variable duration and phenomenology of the prodrome, and the fact that relatively few individuals in this sample had sought professional help during their prodromal period, further research is needed to inform efforts aimed at identification of and intervention during the prodromal period of nonaffective psychosis.

Social functioning in urban, predominantly African American, socially disadvantaged patients with first-episode nonaffective psychosis.

BACKGROUND: Social functioning impairments develop and accumulate even prior to initial treatment-seeking for first-episode psychosis. This study, the first to examine social functioning in low-income, urban, predominantly African American first-episode patients: (1) assesses the internal consistency of Social Functioning Scale (SFS) subscales in this relatively unique sample; (2) identifies demographic and clinical variables that may be predictive of poor social functioning in this particular population; and (3) assesses changes in SFS scores in a subsample re-assessed six months after initial hospitalization. METHODS: 109 participants (age, 23.1+/-4.7years; 76.1% male; 89.9% African American) hospitalized for a first episode of nonaffective psychosis in an urban, public-sector setting were administered the SFS along with other clinical research instruments. 34 (31.2%) returned for a follow-up clinical research assessment six months after baseline assessment. Associations between the variables of interest were analyzed utilizing independent samples Student's t-tests and Pearson correlations. RESULTS: Associations were observed between social functioning domains and negative symptoms (r=-.21--.32, p<.05), depressive symptoms (r=-.20--.23, p<.05), and general psychopathology symptoms (r=-.23--.24, p<.05). No significant differences were found in SFS subscale scores between baseline and six-month follow-up. CONCLUSIONS: Deficits in social functioning are meaningfully related to several domains of symptoms, and such deficits may be relatively stable in the early course of psychotic disorders. Such findings may inform development of psychosocial interventions targeting social functioning in first-episode patients.

Prevalence and correlates of school drop-out prior to initial treatment of nonaffective psychosis: further evidence suggesting a need for supported education.

BACKGROUND: Because dropping out of high school (i.e., secondary education) contributes prominently to numerous social, economic, and health conditions, formal public health initiatives promoting population health and social justice, especially in at-risk populations, are increasingly encouraged to address high school drop-out. The relative dearth of research attention on school drop-out prior to first treatment contact in young adults with psychotic disorders indicates a need for investigation of the associations between school drop-out and illness-related variables so that interventions may be tailored appropriately to this unique population. METHODS: This study provides a descriptive characterization of the prevalence and correlates of high school drop-out in a sample of 109 patients hospitalized for the evaluation and treatment of a first episode of nonaffective psychosis. RESULTS: Findings from this urban, socially disadvantaged, predominantly African American sample indicate that school drop-out is a marker of diverse detrimental social problems in first-episode psychosis, and that further research is required to fully characterize the most appropriate interventions for such individuals. CONCLUSIONS: Future research might seek to intervene through an integrated treatment approach that incorporates supported education, symptom reduction and management, and comorbid substance use treatment in first-episode patients.

Health services determinants of the duration of untreated psychosis among African-American first-episode patients.

OBJECTIVE: The duration of untreated psychosis is associated with poor outcomes in multiple domains in the early course of nonaffective psychotic disorders, although relatively little is known about determinants of this critical period, particularly health services-level determinants. This study examined three hypothesized predictors of duration of untreated psychosis (lack of insurance, financial problems, and broader barriers) among urban, socioeconomically disadvantaged African Americans, while controlling for the effects of three patient-level predictors (mode of onset of psychosis, living with family versus alone or with others before hospitalization, and living above versus below the federally defined poverty level). METHODS: Analyses included data from 42 patient-family member dyads from a larger sample of 109 patients with a first episode of nonaffective psychosis. The duration of untreated psychosis and all other variables were measured in a rigorous, standardized fashion in a study designed specifically to examine determinants of treatment delay. Survival analyses and Cox regression assessed the effects of the independent predictors on time from onset of psychosis to hospital admission for initial evaluation and treatment. RESULTS: The median duration of untreated psychosis was 24.5 weeks. When the analyses controlled for the three patient-level covariates, patients without health insurance, with financial problems, or with barriers to seeking help had a significantly longer duration of untreated psychosis. CONCLUSIONS: Health services-related factors, such as lack of insurance, are predictive of longer treatment delay. Efforts to eliminate uninsurance and underinsurance, as well as minimize barriers to treatment, would be beneficial for improving the prognosis of young patients with emerging nonaffective psychotic disorders.

Association of pre-onset cannabis, alcohol, and tobacco use with age at onset of prodrome and age at onset of psychosis in first-episode patients.

OBJECTIVE: Several reports suggest that cannabis use is associated with an earlier age at onset of psychosis, although not all studies have operationalized cannabis use as occurring prior to onset of symptoms. This study addressed whether pre-onset cannabis use, alcohol use, and tobacco use are associated with an earlier age at onset of prodromal and psychotic symptoms. Effects of the progression of frequency of use were examined through time-dependent covariates in survival analyses. METHOD: First-episode patients (N=109) hospitalized in three public-sector inpatient psychiatric units underwent in-depth cross-sectional retrospective assessments. Prior substance use and ages at onset of prodromal and psychotic symptoms were determined by standardized methods, and analyses were conducted using Cox regression modeling. RESULTS: Whereas classifying participants according to maximum frequency of use prior to onset (none, ever, weekly, or daily) revealed no significant effects of cannabis or tobacco use on risk of onset, analysis of change in frequency of use prior to onset indicated that progression to daily cannabis and tobacco use was associated with an increased risk of onset of psychotic symptoms. Similar or even stronger effects were observed when onset of illness or prodromal symptoms was the outcome. A gender-by-daily-cannabis-use interaction was observed; progression to daily use resulted in a much larger increased relative risk of onset of psychosis in females than in males. CONCLUSIONS: Pre-onset cannabis use may hasten the onset of psychotic as well as prodromal symptoms. Age at onset is a key prognostic factor in schizophrenia, and discovering modifiable predictors of age at onset is crucial.

Associations between multiple dimensions of schizotypy and sociodemographic variables in a nonpsychiatric sample of young adults.

In several prior studies, self-reported schizotypy has been documented to vary by gender, age, race/ethnicity, and measures of social engagement. In this study, undergraduate students participated in an online survey, and data from 825 students were used to examine sociodemographic characteristics and past mental health treatment history as predictors of 6 schizotypy measures. History of mental health treatment was a significant independent predictor of paranoid, cognitive-perceptual, and interpersonal schizotypy; race, relationship status, and mental health treatment history were significant independent predictors of disorganized schizotypy; race was an independent significant predictor of perceptual aberrations; and race and gender were significant independent predictors of social anhedonia. These results suggest that basic demographics, relationship status, and history of mental health treatment may be important variables to consider in studies of schizotypy. Furthermore, differences across studies could be driven by race/ethnicity and cultural factors that may affect the reporting of unusual or distorted perceptions.

Family-level predictors and correlates of the duration of untreated psychosis in African American first-episode patients.

BACKGROUND: Little is known about how family-level factors are associated with duration of untreated psychosis (DUP), especially in ethnic/racial minority groups, such as African Americans. This study involved African American first-episode patients and their family members who initiated evaluation and treatment for them. It was hypothesized that a longer DUP would be predicted by family members' endorsement of: (1) less knowledge about schizophrenia, (2) greater perceptions of stigma, (3) lower levels of insight, (4) fewer family strengths, (5) more limited family coping capacity, and (6) lower levels of caregiver strain. METHODS: From a sample of 109 patients, 42 African American patients with family-level data were included. Cox proportional hazard models quantified associations between family-level predictors and DUP, and analyses controlled for effects of three previously determined patient-level predictors of DUP - mode of onset of psychosis, living with family members versus alone or with others, and living above versus below the federal poverty level. RESULTS: The median DUP was 24.5 weeks. Greater family strengths and a better family coping capacity were associated with a shorter DUP, whereas higher insight among informants and greater level of perceived caregiver strain were associated with a longer DUP. CONCLUSIONS: Whereas family strengths and coping likely account for a significant portion of variability in DUP, both insight and caregiver strain probably evolve as a consequence of DUP. Efforts to strengthen families and tap into existing strengths of families in specific cultural groups would likely enhance early treatment-seeking for psychotic disorders.

An examination of the factorial structure of the Schizotypal Personality Questionnaire-Brief (SPQ-B) among undergraduate students.

Cognitive-perceptual, interpersonal, and disorganized subscales of the Schizotypal Personality Questionnaire-Brief (SPQ-B), reflecting the three commonly used subscales of the full-version SPQ, have been used in a number of studies. However, the factorial validity of SPQ-B subscales remains to be clarified. Utilizing data from 825 undergraduate students, confirmatory factor analyses involving the 22 items of the SPQ-B were conducted. A significant chi(2) difference test favored the 3-factor over the 1-factor model and fit indices for the 3-factor model were generally satisfactory. However, several of the items may index more than one of the hypothesized factors, so the item-factor separation is not sharp. Thus, more research is needed on the factorial validity of the increasingly used SPQ-B subscales.