Influence of the typology and timing of childhood trauma in psychoticism.

PURPOSE: Child maltreatment (CM) is associated with psychosis; however little is known about the frequency, type, and timing of abuse in the personality pathology domain of psychoticism (PSY) in the DSM-5. The purpose of this study was to analyze childhood trauma typology and frequency according to gender and to identify sensitive periods of susceptibility to CM in women with high PSY. METHODS: The Maltreatment and Abuse Chronology Exposure (MACE) scale was used to evaluate the frequency, severity and timing of each type of maltreatment. The full sample consisted of 83 participants with different psychiatric diagnoses. Psychoticism was assessed with the DSM-5 Personality Inventory (PID-5). To identify the differences in CM exposure between the PSY+ (high psychoticism) and PSY- (low psychoticism) groups, the Mann-Whitney U test, the chi square test and random forest (RF) test were used. RESULTS: Comparing PSY + and PSY-, revealed gender differences in the impact of abuse, with highly frequent and severe types of abuse, in women. In women, PSY + and PSY-, were differentiated especially in non-verbal emotional abuse, peer physical bullying and parental verbal abuse. Several periods with a major peak at age seven followed by peaks at age 17 and 12 years old were identified. CONCLUSION: Increased exposure to CM occurs in women with PSY+. A sensitivity to CM exposure during early childhood and late adolescence could be a risk factor for psychoticism in women.

Males and females with first episode psychosis present distinct profiles of social cognition and metacognition.

Deficits in social cognition and metacognition impact the course of psychosis. Sex differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive, and metacognitive assessment. Subsequent latent profile analysis split by sex yielded two clusters common to both sexes (a Homogeneous group, 53% and 79.3%, and an Indecisive group, 18.3% and 8.6% of males and females, respectively), a specific male profile characterized by presenting jumping to conclusions (28.7%) and a specific female profile characterized by cognitive biases (12.1%). Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had lower self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider sex when planning interventions.

Persons with first episode psychosis have distinct profiles of social cognition and metacognition.

Subjects with first-episode psychosis experience substantial deficits in social cognition and metacognition. Although previous studies have investigated the role of profiles of individuals in social cognition and metacognition in chronic schizophrenia, profiling subjects with first-episode psychosis in both domains remains to be investigated. We used latent profile analysis to derive profiles of the abilities in 174 persons with first-episode psychosis using the Beck's Cognitive Insight Scale, the Faces Test, the Hinting Task, the Internal, Personal and Situational Attributions Questionnaire, and the Beads Task. Participants received a clinical assessment and a neuropsychological assessment. The best-fitting model was selected according to the Bayesian information criterion (BIC). We assessed the importance of the variables via a classification tree (CART). We derived three clusters with distinct profiles. The first profile (33.3%) comprised individuals with low social cognition. The second profile (60.9%) comprised individuals that had more proneness to present jumping to conclusions. The third profile (5.7%) presented a heterogeneous profile of metacognitive deficits. Persons with lower social cognition presented worse clinical and neuropsychological features than cluster 2 and cluster 3. Cluster 3 presented significantly worst functioning. Our results suggest that individuals with FEP present distinct profiles that concur with specific clinical, neuropsychological, and functional challenges. Each subgroup may benefit from different interventions.

The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study.

Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck's personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01-1.06; and OR, 1.03; 95%CI 1.01-1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11-1.26), personal psychiatric history (OR 2.1; 95%CI 1.33-3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12-3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.

Free thyroxine levels are associated with cognitive changes in individuals with a first episode of psychosis: A prospective 1-year follow-up study.

The results of previous cross-sectional studies suggest that free thyroxine (FT4) levels are associated with cognitive abilities (particularly attention/vigilance) during the early stages of psychosis. We aimed to explore whether hypothalamic-pituitary-thyroid hormones predict cognitive changes in a 1-year longitudinal study following first episodes of psychosis (FEP). We studied 36 FEP patients and a control group of 50 healthy subjects (HS). Plasma levels of thyroid-stimulating hormone (TSH) and FT4 were measured. Cognitive assessment was performed with the MATRICS Cognitive Consensus Cognitive Battery (MCCB). FEP patients were assessed twice (baseline and after 1year), whereas HS were assessed only once. We compared cognitive changes at 1year between three groups based on baseline FT4 levels: 1) lowest quartile (Q1, FT4<1.16ng/dL); 2) medium quartiles (Q2-Q3, FT4 1.16-1.54ng/dL); and 3) highest quartile (Q4, FT4>1.54ng/dL). No differences in TSH or FT4 levels were found between HS and FEP patients. All participants had FT4 levels within the normal range. HS outperformed FEP patients in all cognitive tasks. In relation to the relationship between FT4 levels and cognitive changes, a U-shaped pattern was observed: FEP patients from the middle quartiles (Q2-Q3) improved in attention/vigilance, whereas both extreme quartiles (Q1 and Q4) showed a worsening in this cognitive domain over time. Patients with lower FT4 (Q1) showed poorer baseline attention; therefore, lower baseline FT4 levels predicted a poorer prognosis in terms of attention performance. Our study suggests that baseline FT4 levels are associated with changes in attention and vigilance performance over one year in FEP patients.

Coping strategies and postpartum depressive symptoms: A structural equation modelling approach.

BACKGROUND: Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks. METHODS: A total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression. RESULTS: Passive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism. CONCLUSIONS: Early identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.

A haplotype of glycogen synthase kinase 3ß is associated with early onset of unipolar major depression.

Recent findings suggest that glycogen synthase kinase 3ß (GSK3ß) may play a role in the pathophysiology and treatment of mood disorders. Various genetic studies have shown the association of GSK3ß polymorphisms with different mood disorder phenotypes. We hypothesized that genetic variants in the GSK3ß gene could partially underlie the susceptibility to mood disorders. We performed a genetic case-control study of 440 psychiatrically screened control subjects and 445 mood disorder patients [256 unipolar major depressive disorder (MDD) and 189 bipolar disorder (BD)]. We genotyped a set of 11 single nucleotide polymorphisms (SNPs) and determined the relative frequency of a known copy number variant (CNV) overlapping the GSK3ß by quantitative real-time polymerase chain reaction (PCR). We found no evidence of association with MDD or BD diagnosis, and we further investigated the age at onset (AAO) of the disorder and severity of depressive index episode. We found that rs334555, located in intron 1 of GSK3ß, was nominally associated with an earlier AAO of the disease in MDD (P = 0.001). We also identified a haplotype containing three SNPs (rs334555, rs119258668 and rs11927974) associated with AAO of the disorder (permutated P = 0.0025). We detected variability for the CNV, but we could not detect differences between patients and controls for any of the explored phenotypes. This study presents further evidence of the contribution of GSK3ß to mood disorders, implicating a specific SNP and a haplotype with an earlier onset of the disorder in a group of well-characterized patients with unipolar MDD. Further replication studies in patients with the same phenotypic characteristics should confirm the results reported here.

Association of common copy number variants at the glutathione S-transferase genes and rare novel genomic changes with schizophrenia.

Copy number variants (CNVs) are a substantial source of human genetic diversity, influencing the variable susceptibility to multifactorial disorders. Schizophrenia is a complex illness thought to be caused by a number of genetic and environmental effects, few of which have been clearly defined. Recent reports have found several low prevalent CNVs associated with the disease. We have used a multiplex ligation-dependent probe amplification-based (MLPA) method to target 140 previously reported and putatively relevant gene-containing CNV regions in 654 schizophrenic patients and 604 controls for association studies. Most genotyped CNVs (95%) showed very low (<1%) population frequency. A few novel rare variants were only present in patients suggesting a possible pathogenic involvement, including 1.39 Mb overlapping duplications at 22q11.23 found in two unrelated patients, and duplications of the somatostatin receptor 5 gene (SSTR5) at 16p13.3 in three unrelated patients. Furthermore, among the few relatively common CNVs observed in patients and controls, the combined analysis of gene copy number genotypes at two glutathione S-transferase (GST) genes, GSTM1 (glutathione S-transferase mu 1) (1p13.3) and GSTT2 (glutathione S-transferase theta 2) (22q11.23), showed a statistically significant association of non-null genotypes at both loci with an additive effect for increased vulnerability to schizophrenia (odds ratio of 1.92; P=0.0008). Our data provide complementary evidences for low prevalent, but highly penetrant chromosomal variants associated with schizophrenia, as well as for common CNVs that may act as susceptibility factors by disturbing glutathione metabolism.

Mood changes after delivery: role of the serotonin transporter gene.

BACKGROUND: Polymorphic variations in the serotonin transporter gene (5-HTT) moderate the depressogenic effects of tryptophan depletion. After childbirth there is a sharp reduction in brain tryptophan availability, thus polymorphic variations in 5-HTT may play a similar role in the post-partum period. AIMS: To study the role of 5-HTT polymorphic variations in mood changes after delivery. METHOD: One thousand, eight hundred and four depression-free Spanish women were studied post-partum. We evaluated depressive symptoms at 2-3 days, 8 weeks and 32 weeks post-partum. We used diagnostic interview to confirm major depression for all probable cases. Based on two polymorphisms of 5-HTT (5-HTTLPR and STin2 VNTR), three genotype combinations were created to reflect different levels of 5-HTT expression. RESULTS: One hundred and seventy-three women (12.7%) experienced major depression during the 32-week post-partum period. Depressive symptoms were associated with the high-expression 5-HTT genotypes in a dose-response fashion at 8 weeks post-partum, but not at 32 weeks. CONCLUSIONS: High-expression 5-HTT genotypes may render women more vulnerable to depressive symptoms after childbirth.

Ambiente familiar y emoción expresada en pacientes con esquizofrenia u otras psicosis y en sus familiares de primer grado / Family environment and expressed emotion in patients with schizophrenia or other psychoses and in their first-degree relatives

Introducción. Desde siempre se ha considerado la familia como un pilar fundamental en el desarrollo de la psiquehumana; y en relación con los trastornos mentales sabemos que ciertos aspectos del ambiente familiar modulan el curso de algunos de estos trastornos. El objetivo de este estudio es comparar la percepción del clima familiar entre pacientes esquizofrénicos y pacientes con otras psicosis entre sus familiares de primer grado y ver si el ambiente familiar guarda relación con la expresión del trastorno. Método. Se estudia a 112 sujetos: 41 pacientes, 41 familiares de primer grado y 30 controles. Los pacientes fueron diagnosticados dentro del grupo de las esquizofrenias (n=24) o del grupo de las psicosis no esquizofrénicas (n=17) sobre la base de los criterios DSM-IV mediante SCAN y se les aplicó la FES y la PANSS. Se utilizó la estadística descriptiva, la comparación de grupos y el estudio de correlaciones. Resultados. No se observan diferencias significativas al comparar la FES entre ambos grupos de pacientes ni entre pacientes y familiares, aunque sí se observa una tendencia en los pacientes a puntuar más alto que sus familiares en la mayoría de escalas y dimensiones. Se obtienen correlaciones positivas significativas al estudiar el grado de asociación de las escalas de la FES entre pacientes y familiares. Conclusiones. Aunque de manera no estadísticamente significativa, los pacientes con psicosis funcionales no esquizofrénicas presentan una percepción del ambiente familiar distinto que los pacientes esquizofrénicos y sus familiares: más conflictividad, más rigurosidad en las reglas y más necesidad de planificación. Niveles elevados de emoción expresada guardan relación con el predominio de la sintomatología positiva en pacientes psicóticos (AU)

Introduction. Family has always been considered a key milestone for the development of the human psyche. Furthermore, in relationship with mental disorders we know that certain aspects of family environment change the course of some of these disorders. This study has aimed to compare the family sestting perception of schizophrenic patients vs. other psychotic patients, their first-degree relatives and to see if the expression of the disorder is related with that perception. Method. The study included 112 subjects: 41 patients, 41 first-degree relatives and 30 normal controls. Patients were included in the group of as schizophrenic (n = 24) or non-schizophrenic psychosis (n = 17) following DSM-IV criteria diagnosis using the SCAN interview and were evaluated with the Family Environment Scale (FES) and PANSS. Descriptive analysis, group comparisons and correlation studies were used as statistical methods. Results. No statistically significant differences were found when comparing FES between both group of patients, nor between patients and relatives, although psychotic patients presented a tendency to score higher on almost all the FES scales and dimensions. We found significantly positive correlations between patients and their own relatives in the FES scales. Conclusions. Although not with statistical significance, non-schizophrenic psychotic patients and the irrelatives have a slightly different family environment perception than their schizophrenic counterparts: more conflictivity; more rule strictness and more planning needs. High levels of expressed emotion were related with a predominance of positive symptoms in psychotic patients (AU)

[Family environment and expressed emotion in patients with schizophrenia or other psychoses and in their first-degree relatives]. / Ambiente familiar y emoción expresada en pacientes con esquizofrenia u otras psicosis y en sus familiares de primer grado.

INTRODUCTION: Family has always been considered a key milestone for the development of the human psyche. Furthermore, in relationship with mental disorders we know that certain aspects of family environment change the course of some of these disorders. This study has aimed to compare the family setting perception of schizophrenic patients vs. other psychotic patients, their first-degree relatives and to see if the expression of the disorder is related with that perception. METHOD: The study included 112 subjects: 41 patients, 41 first-degree relatives and 30 normal controls. Patients were included in the group of as schizophrenic (n=24) or non-schizophrenic psychosis (n=17) following DSM-IV criteria diagnosis using the SCAN interview and were evaluated with the Family Environment Scale (FES) and PANSS. Descriptive analysis, group comparisons and correlation studies were used as statistical methods. RESULTS: No statistically significant differences were found when comparing FES between both group of patients, nor between patients and relatives, although psychotic patients presented a tendency to score higher on almost all the FES scales and dimensions. We found significantly positive correlations between patients and their own relatives in the FES scales. CONCLUSIONS: Although not with statistical significance, non-schizophrenic psychotic patients and their relatives have a slightly different family environment perception than their schizophrenic counterparts: more conflictivity; more rule strictness and more planning needs. High levels of expressed emotion were related with a predominance of positive symptoms in psychotic patients.

Sustained and selective attention deficits as vulnerability markers to psychosis.

The first descriptions of schizophrenia emphasized attention problems patients with schizophrenia have but recent results evidence that other psychotic disorders share them. We compared the performance in sustained and selective attention between psychotic patients (P), their healthy first degree relatives (R) and healthy volunteers (C) to prove whether these alterations could be an endophenotype of vulnerability to psychosis. We also compared the performance of schizophrenic patients (SZP) and that of patients with other functional psychoses (OP) in order to prove whether these alterations are specific of any psychotic disorder. Seventy-six P, 70 R and 39 C were included in the study. A selective attention index, comprising TMT A and B and Stroop Test, and a sustained attention index comprising the Continuous Performance Test were calculated. We conducted an univariant general linear model to compare three group performances in these indexes, with age, sex and years of education as a covariables. We found significant differences between the indexes when we compared P, R and C. No differences in performance were found between SZP and OP. Our data showed that sustained and selective attention alterations could be a vulnerability factor to psychotic disorders in general, but they were not specific of schizophrenia.

[The Scale for measure Control of Impulses Ramón y Cajal (ECIRyC). Development, validation and standardization]. / Escala de Control de los Impulsos Ramón y Cajal (ECIRyC). Desarrollo, validación y baremación.

INTRODUCTION: We are now seeing an increasing need of the measurement of impulsivity by clinicians and researchers due to the present prevalence of impulsivity control disorders. The authors develop and validate a new tool for measuring impulsivity: the Impulsive Control Scale Ramón y Cajal (ECIRyC) that has 20 items. MATERIAL AND METHODS: The first version of ECIRyC was applied to a sample recruited from general population. From their responses the scale was reduced to the present version and the construct validity coefficients and the alpha reliability of Cronbach were calculated. Also, the scores of the ECIRyC were standardized. RESULTS AND DISCUSSION: The Factor Analysis of the ECIRyC shows that there are five factors explaining 53% of the total variance obtained. This factorial structure is practically unidimensional. In the same way, the reliability of ECIRyC is high; obtaining the same score (0.85) with the Cronbach alpha intraclass correlation coefficient as with the two halves procedure plus the Spearman-Brown correction. The ECIRyC has proven to have a very good convergent validity with other foreign impulsivity measurement instruments. The ECIRyC scores, obtained with general population show a normal distribution which has permitted their standardization for applicating them both to large groups of people and to single individuals. All the initial validation data of the ECIRyC seem to show that it is a useful tool for the evaluation of impulsivity.

Escala de Control de los Impulsos 'Ramón y Cajal' (ECIRyC). Desarrollo, validación y baremación / The Scale for measure Control of Impulses 'Ramón y Cajal' (ECIRyC). Development, validation and standardization

Introducción. Actualmente se asiste a un incremento de las necesidades de medir la impulsividad, dada la prevalencia de los trastornos del control de los impulsos. Los autores desarrollan y validan un nuevo instrumento para medir la impulsividad: la Escala de Control de los Impulsos 'Ramón y Cajal' (ECIRyC) que contiene 20 ítems. Material y método. Se aplicó la versión inicial de la ECIRyC a una muestra extraída de la población general. Sobre esas respuestas se redujo la escala a su versión actual y se calcularon los coeficientes de validez de constructo y la fiabilidad alfa de Cronbach. También se utilizaron esas respuestas para estandarizar las puntuaciones en la ECIRyC. Resultados y discusión. El análisis factorial de la ECIRyC arroja la presencia de cinco factores que explican el 53 por ciento de la varianza total obtenida. Dicha estructura factorial es prácticamente unidimensional. Así mismo, la fiabilidad del ECIRyC es elevada; obteniendo el mismo valor (0,85) con el coeficiente de correlación intraclase alfa de Cronbach y con el procedimiento de las dos mitades más la corrección de Spearman-Brown. La ECIRyC ha demostrado tener una muy buena validez convergente con otras medidas foráneas de impulsividad. Las puntuaciones de la ECIRyC, obtenidas entre la población general, muestran una distribución normal que ha permitido estandarizarlas para su aplicación a grandes grupos y a sujetos individuales. Todos los datos iniciales de validación de la ECIRyC parecen mostrar un instrumento útil para evaluar la impulsividad (AU)