Denial of reproductive potential: a predictor of unperceived pregnancy in an Austrian neonaticide sample.

PURPOSE: This study aims to describe the phenomenon of unperceived pregnancy followed by neonaticide with a focus on the lack of awareness of reproductive potential in an Austrian sample. METHODS: An explorative comparative study of neonaticide cases with single and repeat perpetrators was conducted using nationwide register-based data from 1995 to 2017. A total number of 55 cases out of 66 were included in the analysis. A standardized coding sheet was used and calculations were performed. RESULTS: 48 women gave birth to 101 children, of which 55 were killed, 23 children lived out of home care and 23 lived with the perpetrator We found a higher fertility rate in both neonaticide perpetrators in the single (1,9) and the repeat group (4,25) in comparison to the general population (1,4). The use of contraception was only 31% among neonaticide perpetrators, deviating substantially from the general Austrian population age group (16-29yrs) which used contraception in 91%. The neonaticide perpetrators used an effective contraception method (pearl-index < 4) in only 2%, whereas 20% of the general population did so. The number of unperceived pregnancies was high in both groups (50/55) 91%. CONCLUSION: Future case reports and forensic evaluations should take reproductive behavior into account, as it may offer valuable insights into the events leading up to neonaticide. Our findings suggest that denial of reproductive potential often precedes unperceived pregnancies. In the Austrian cohort, women who experienced unperceived pregnancies resulting in unassisted births and subsequent neonaticide showed a low prevalence of contraceptive use. This is particularly noteworthy given that the primary motive for neonaticide is unwanted pregnancy.

Restorative justice in a case of traumatic birth following an unperceived pregnancy.

PURPOSE: Pregnancy can be denied or better "unperceived" by women in up to 1:300 pregnancies and poses the mother and her unborn at high risk when an unassisted birth follows. The importance of recognizing unperceived pregnancy and the risk of unassisted births for both mothers and their babies are described. METHODS: Description of a case of unperceived pregnancy and traumatic unassisted birth. RESULTS: A pregnant woman was not diagnosed in a clinic despite being at the verge of giving birth. She was turned away, was on her way to another hospital, and gave birth in a toilet in a dissociative state. The baby survived, but the mother was declared guilty of attempted manslaughter and received a 6-year prison sentence. The expertise of a perinatal psychiatrist reversed the verdict and the court apologized to the mother, now living with her son. CONCLUSIONS: This case shows the severe consequences when pregnancy and labor are not recognized by health professionals. The reversal of the original sentence is considered a pioneer case of restorative justice in the context of unperceived pregnancy and obstetric violence. Health providers and courts need to be informed by perinatal mental health professionals about the impact of unperceived pregnancy and obstetric violence.

Tetrahydrocannabinol in Pediatrics: Room for Improvement?

Introduction: The use of medical cannabis in pediatrics is not common in clinical practice, and there is a lack of prospective studies, especially in pediatric subpopulations. This study aimed to provide data on the off-label administration of tetrahydrocannabinol (∆9-THC) in a pediatric tertiary center in Austria. Methods: A retrospective data analysis was performed to assess the use of ∆9-THC at the Department of Pediatrics and Adolescent Medicine at the Comprehensive Center of Pediatrics (Medical University Vienna) from 2016 to 2018. The use of ∆9-THC in the Pediatric Department at the Medical University Vienna between 2016 and 2018 was analyzed using a retrospective design. Results: The most common diagnoses of patients receiving ∆9-THC were brain cancer and genetic diseases, including inborn metabolic disorders. The 32 patients who had received ∆9-THC had an arithmetic mean of 9.42 diagnoses and were treated with an arithmetic mean of 13.52 other drugs. Eleven of the 32 patients died by the end of the study period, indicating palliative use. Conclusion: The data shows that only severely ill patients were treated with ∆9-THC. A lack of information on the drug's indications, duration, and dosage was noticed in the files, which could represent problems for patient safety.

Cannabidiol treatment in an adolescent with multiple substance abuse, social anxiety and depression.

In this report, we present a case of a 16,9-year-old patient with multiple substance use disorder (cannabis, MDMA, cocaine, ecstacy), severe depression, social phobia and narcissistic personality disorder.We administered Cannabidiol (CBD) capsules in different dosages (starting dosage 100 mg up to 600 mg over 8 weeks) after unsuccessful treatment with antidepressants.CBD was a safe and well tolerated medication for this patient. Upon treatment with CBD and cessation of the antidepressant medication, the patient improved regarding depressive as well as anxiety symptoms including simple phobias and symptoms of paranoia and dissociation. Furthermore, the patient quit abusing illegal drugs including THC without showing withdrawal symptoms. This is the first report of CBD medication in a patient with multiple substance use disorder with a positive outcome.Until today it is not clear if CBD holds promise as a therapeutic option in substance use disorder as RCTs are lacking, but in this single case the substance seems to work in various domains.

Repeated neonaticide: differences and similarities to single neonaticide events.

This study aims to identify differences between single and repeat perpetrators of filicide by using register-based data. The study used register-based, comprehensive, nationwide data from both Austria and Finland. The current study covers 23 perpetrators, 20 single and 3 repeat perpetrators, with a total of 28 victims. All victims had a maximum age of 24 h and all perpetrators were women. Every third victim of neonaticide was a victim of a repeat case. The repeat perpetrators were older; had a higher number of children over their lifespan, some of whom lived with them; were more likely to live within established family structures; had higher levels of education and employment; had a higher proportion of personality disorders; and were more likely to identify stress factors during pregnancy. One unexpected finding was low levels of awareness about pregnancy within the perpetrator's circle remain a risk factor, especially for repeat perpetrators. Arguably, the quality of interpersonal relationships these women have may be affected by their own mental health issues and life experience and vice versa.

Foetal abuse.

Pregnancy and motherhood are often presented as natural and unproblematic for women. The fact that there are some women who engage in violent behaviour towards their unborn child suggests that motherhood is not as unproblematic as we are led to believe. This paper presents six previously unpublished cases of foetal abuse that is physical assaults on the foetus by the mothers themselves, and examines how the prevailing myth of the good mother might be further endangering mothers and their unborn children. So far, the research suggests there are some common, possibly co-occurring, features that might be an antecedent to foetal abuse: unplanned pregnancies, prior mental health issues in the mother, trauma, pregnancy denial up to 20 weeks or until birth, and ideation of harm correlated to in utero movements.

[Language development in children with migration background and parental reading to children]. / Sprachentwicklung bei Kindern mit Migrationshintergrund und elterliches Vorlesen.

Introduction: The majority of children with a migration background suffer from language deficits in one or both languages. The aim of our study was to describe the patterns of language acquisition in children with Turkish background in Austria and to find factors which influence these Patterns. Method: Fifty-two children at the age of 5 to 6 years and their parents were assessed. Inclusion criteria for parents were Turkish migration background and use of Turkish at home. Inclusion criteria for children: no hearing impairment, no blindness, no chronic disease, average cognitive development, born in Austria, and attending a kindergarten. Language competence was measured with Havas 5. Parents were administered a questionnaire about socio-demographics and their child centered literacy orientation (CCLO). Results: There was a significant difference between language patterns in Turkish and German. Moreover, language competence was higher in both Turkish and German, the more parents tended to read to their children in Turkish. Discussion: Children acquired a grammatically correct but simple Turkish, while their competence in German was reduced. Reading to the children seems to stimulate language development not only of their natural language, but also of German. Conclusion: Early literacy in migrant languages should be integrated in training programs.

Predictors of longer-term outcome in the Vienna omega-3 high-risk study.

Longer-term data on ω-3 polyunsaturated fatty acids (PUFA) for prevention of psychosis in (ultra high risk) UHR individuals have initially shown promising results. This analysis aimed to assess clinical predictors of longer-term outcome in UHR individuals treated with ω-3 PUFAs versus placebo. Data derived from an RCT in 81 UHR individuals treated with ω-3 PUFAs versus placebo for 12weeks and follow-up assessment after a median of 6.7years. Baseline GAF, baseline PANSS global score, pre-to-post-intervention change in EPA (Eicosapentaenoic acid) level were significant predictors of transition to psychosis, PANSS negative score and baseline MADRS reached trend-levels. In the final multivariate Cox regression analysis change in EPA levels remained the only significant predictor. Taking into account all other significant predictors, changes in EPA levels were found to be the single most significant predictor for transition to psychosis in a longer term observation of UHR individuals.

Usefulness of the CAPE-P15 for detecting people at ultra-high risk for psychosis: Psychometric properties and cut-off values.

A need for a brief, easy to complete self-report questionnaire to detect people at ultra-high risk for psychosis (UHR) in busy clinical settings has been recognised. Our aim was to explore whether the Community Assessment of Psychic Experiences - Positive 15-items Scale (CAPE-P15) could be used as a screening tool to identify people at UHR in a clinical setting. Our objectives were to confirm the CAPE-P15 factorial structure as well as its reliability and determine cut-off values for the detection of such individuals using the Comprehensive Assessment of At-Risk Mental States (CAARMS), a commonly used clinical interview for the detection of UHR. 165 participants aged between 13 and 18 referred to the General Hospital of Vienna were included in the analysis. 50.9% of the sample were "CAARMS-positive" and 49.1% "CAARMS-negative". The Youden method determined CAPE-P15 cut-off values for UHR detection of 1.47 for both frequency of and distress associated with psychotic experiences. The cut-off value of 1.47 for frequency showed sensitivity of 77%, specificity of 58%, a positive predictive value of 66% and a negative predictive value of 71%; whilst for distress it showed sensitivity of 73%, specificity of 63%, a positive predictive value of 69% and a negative predictive value of 66%. Good reliability and the previously suggested three-correlated factor model as well as an alternative bi-factor model of the CAPE-P15 were confirmed. The CAPE-P15 seems to be a promising screening tool for identifying people who might be at UHR in busy clinical settings.

Relationship between Erythrocyte Fatty Acid Composition and Psychopathology in the Vienna Omega-3 Study.

This study investigated the relationship between erythrocyte membrane fatty acid (FA) levels and the severity of symptoms of individuals at ultra-high risk (UHR) for psychosis. Subjects of the present study consisted of 80 neuroleptic-naïve UHR patients. Partial correlation coefficients were calculated between baseline erythrocyte membrane FA levels, measured by gas chromatography, and scores on the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning Scale, and Montgomery-Asberg Depression Rating Scale (MADRS) after controlling for age, sex, smoking and cannabis use. Subjects were divided into three groups according to the predominance of positive or negative symptoms based on PANSS subscale scores; membrane FA levels in the three groups were then compared. More severe negative symptoms measured by PANSS were negatively correlated with two saturated FAs (myristic and margaric acids), one ω-9 monounsaturated FA (MUFA; nervonic acid), and one ω-3 polyunsaturated FA (PUFA; docosapentaenoic acid), and were positively correlated with two ω-9 MUFAs (eicosenoic and erucic acids) and two ω-6 PUFAs (γ-linolenic and docosadienoic acids). More severe positive symptoms measured by PANSS were correlated only with nervonic acid. No associations were observed between FAs and MADRS scores. In subjects with predominant negative symptoms, the sum of the ω-9 MUFAs and the ω-6:ω-3 FA ratio were both significantly higher than in those with predominant positive symptoms, whereas the sum of ω-3 PUFAs was significantly lower. In conclusion, abnormalities in FA metabolism may contribute to the neurobiology of psychopathology in UHR individuals. In particular, membrane FA alterations may play a role in negative symptoms, which are primary psychopathological manifestations of schizophrenia-related disability.

Niacin Skin Sensitivity Is Increased in Adolescents at Ultra-High Risk for Psychosis.

BACKGROUND: Most studies provide evidence that the skin flush response to nicotinic acid (niacin) stimulation is impaired in schizophrenia. However, only little is known about niacin sensitivity in the ultra-high risk (UHR) phase of psychotic disorders. METHODS: We compared visual ratings of niacin sensitivity between adolescents at UHR for psychosis according to the one year transition outcome (UHR-T n = 11; UHR-NT n = 55) with healthy controls (HC n = 25) and first episode schizophrenia patients (FEP n = 25) treated with atypical antipsychotics. RESULTS: Contrary to our hypothesis niacin sensitivity of the entire UHR group was not attenuated, but significantly increased compared to the HC group, whereas no difference could be found between the UHR-T and UHR-NT groups. As expected, niacin sensitivity of FEP was attenuated compared to HC group. In UHR individuals niacin sensitivity was inversely correlated with omega-6 and -9 fatty acids (FA), but positively correlated with phospholipase A2 (inPLA2) activity, a marker of membrane lipid repair/remodelling. CONCLUSIONS: Increased niacin sensitivity in UHR states likely indicates an impaired balance of eicosanoids and omega-6/-9 FA at a membrane level. Our findings suggest that the emergence of psychosis is associated with an increased mobilisation of eicosanoids prior to the transition to psychosis possibly reflecting a "pro-inflammatory state", whereas thereafter eicosanoid mobilisation seems to be attenuated. Potential treatment implications for the UHR state should be further investigated.

Anonymous birth law saves babies--optimization, sustainability and public awareness.

The aims of this study are to assess the impact of Austria's anonymous birth law from the time relevant statistical records are available and to evaluate the use of hatches versus anonymous hospital delivery. This study is a complete census of police-reported neonaticides (1975-2012) as well as anonymous births including baby hatches in Austria during 2002-2012. The time trends of neonaticide rates, anonymous births and baby hatches were analysed by means of Poisson and logistic regression model. Predicted and observed rates were derived and compared using a Bayesian Poisson regression model. Predicted numbers of neonaticides for the period of the active awareness campaign, 2002-2004, were more than three times larger than the observed number (p = 0.0067). Of the 365 women who benefitted from this legislation, only 11.5% chose to put their babies in a baby hatch. Since the law was introduced, a significant decreasing tendency of numbers of anonymous births (p = 047) was observed, while there was significant increase of neonaticide rates (p = 0.0001). The implementation of the anonymous delivery law is associated with a decrease in the number of police-reported neonaticides. The subsequent significantly decreasing numbers of anonymous births with an accompanying increase of neonaticides represents additional evidence for the effectiveness of the measure.

Correlates of electroencephalographic resting states and erythrocyte membrane docosahexaenoic and eicosapentaenoic acid levels in individuals at ultra-high risk of psychosis.

OBJECTIVE: Abnormal levels of polyunsaturated fatty acids (PUFAs) have been reported in individuals suffering from schizophrenia. The main aim of the present study was to investigate the relationship between erythrocyte membrane fatty acid levels and resting-state brain activity occurring in individuals at ultra-high risk (UHR) of psychosis. METHOD: The association between erythrocyte membrane fatty acids levels and resting-state brain activity and its value in predicting psychosis was examined in 72 UHR individuals. RESULTS: In the frontal area, the activity in the fast frequency band Beta2 was positively associated with docosahexaenoic acid (DHA) levels (R = 0.321, P = 0.017), and in the fronto-central area, Beta2 activity showed a positive correlation with eicosapentaenoic acid (EPA) levels (R = 0.305, P = 0.009), regardless of psychosis transition status. Conversely, the slow frequency band Theta was significantly negatively associated with EPA levels in the parieto-occipital region (R = -0.251, P = 0.033. Results also showed that Alpha power was negatively correlated with DHA levels in UHR individuals who did not transition to psychosis, while this correlation was not present in individuals who later transitioned. CONCLUSION: Our results suggest that individuals at UHR for psychosis who have higher basal omega-3 fatty acids levels present with resting EEG features associated with better states of alertness and vigilance. Furthermore, the improvement in the Alpha synchrony observed along with increased DHA levels in participants who did not transition to psychosis is disturbed in those who did transition. However, these interesting results are limited by the small sample size and low statistical power of the study.

Effects of omega-3 PUFA on the vitamin E and glutathione antioxidant defense system in individuals at ultra-high risk of psychosis.

BACKGROUND: Oxidative stress and impaired antioxidant defenses are reported in schizophrenia and are associated with disturbed neurodevelopment, brain structural alterations, glutamatergic imbalance, increased negative symptoms, and cognitive impairment. There is evidence that oxidative stress predates the onset of acute psychotic illness. Here, we investigate the effects of omega-3 PUFA on the vitamin E and glutathione antioxidant defense system (AODS). METHOD: In 64 help-seeking UHR-individuals (13-25 years of age), vitamin E levels and glutathione were investigated before and after 12 weeks of treatment with either 1.2g/d omega-3 (PUFA-E) or saturated fatty acids (SFA-E), with each condition also containing 30.4mg/d alpha-tocopherol to ensure absorption without additional oxidative risk. RESULTS: In multivariate tests, the effects on the AODS (alpha-tocopherol, total glutathione) were not significantly different (p=0.13, p=0.11, respectively) between treatment conditions. According to univariate findings, only PUFA-E caused a significant alpha-tocopherol increase, while PUFA-E and SFA-E caused a significant gamma- and delta-tocopherol decrease. Total glutathione (GSHt) was decreased by PUFA-E supplementation. CONCLUSION: Effects of the PUFA-E condition on the vitamin E and glutathione AODS could be mechanisms underlying its clinical effectiveness. In terms of the vitamin E protection system, PUFA-E seems to directly support the antioxidative defense at membrane level. The effect of PUFA-E on GSHt is not yet fully understood, but could reflect antioxidative effects, resulting in decreased demand for glutathione. It is still necessary to further clarify which type of PUFA/antioxidant combination, and in which dose, is effective at each stage of psychotic illness.

Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study.

Long-chain omega-3 polyunsaturated fatty acids (PUFAs) are essential for neural development and function. As key components of brain tissue, omega-3 PUFAs play critical roles in brain development and function, and a lack of these fatty acids has been implicated in a number of mental health conditions over the lifespan, including schizophrenia. We have previously shown that a 12-week intervention with omega-3 PUFAs reduced the risk of progression to psychotic disorder in young people with subthreshold psychotic states for a 12-month period compared with placebo. We have now completed a longer-term follow-up of this randomized, double-blind, placebo-controlled trial, at a median of 6.7 years. Here we show that brief intervention with omega-3 PUFAs reduced both the risk of progression to psychotic disorder and psychiatric morbidity in general in this study. The majority of the individuals from the omega-3 group did not show severe functional impairment and no longer experienced attenuated psychotic symptoms at follow-up.

Relationship between membrane fatty acids and cognitive symptoms and information processing in individuals at ultra-high risk for psychosis.

Cognitive symptoms and impairment are central to schizophrenia and often an early sign of this condition. The present study investigated biological correlates of cognitive symptoms and performance in individuals at ultra-high risk (UHR) for psychosis. The study sample comprised 80 neuroleptic-naïve UHR individuals aged 13-25 years. Associations among erythrocyte membrane fatty acid levels, measured by gas chromatography, and cognitive functioning were investigated in UHR patients. Subjects were divided into terciles based on their scores on the cognitive factor of the Positive and Negative Syndrome Scale. The Zahlen-Verbindungs Test (ZVT) (the number-combination test) was also used as a measure of information-processing speed. Exploratory analysis was conducted to investigate the relationship between membrane fatty acid levels with the size of the intracranial area (ICA), a neurodevelopmental measure relevant to schizophrenia, in half of subjects (n=40) using magnetic resonance imaging. The adjusted analysis revealed that omega-9 eicosenoic and erucic acid levels were significantly higher, but omega-3 docosahexaenoic acid levels were significantly lower, in the cognitively impaired than in the cognitively intact group. We found a significant negative association of eicosenoic, erucic, and gamma-linoleic acids with ZVT scores. A negative association between ICA and membrane levels of eicosenoic acid was also found. This is the first study to demonstrate the relationship between membrane fatty acids and cognitive function in neuroleptic-naïve subjects at UHR for psychosis. The study findings indicate that abnormalities in membrane fatty acids may be associated with the neurodevelopmental disruption associated with the cognitive impairments of individuals at UHR for psychosis.