Level Of General Functioning Research Articles

The Home Learning Environment of Primary School Children with Down Syndrome and those with Williams Syndrome.

Background and aims: Research on typically developing (TD) populations has shown that the home learning environment plays a significant role in cognitive development and learning, but very little is known about the home learning environment of children with Down syndrome (DS) or children with Williams syndrome (WS). The present study examined and compared, for the first time, the home learning environment of children diagnosed with DS and children diagnosed with WS to investigate whether different cognitive profiles were reflected in their home literacy and number experiences. Methods and procedures: Quantitative and qualitative data were collected through a web-based survey from 58 parents and one foster parent of primary school children with DS (n = 35) and WS (n = 24) mostly based in the UK. The survey targeted the children’s general level of functioning and academic skills; type, format, and frequency of home learning activities; parents’ expectations for their child’s academic outcomes; parents’ attitudes towards literacy and mathematics; children’s interest towards mathematics; and the use of technology to support home learning activities. Outcomes and results: Our results showed that, overall, the home learning environment of children with DS and children with WS were similar but changed based on the child’s cognitive profile. Comparative analyses showed that parents of children with DS engaged more often in activities supporting counting than parents of children with WS, despite both groups reporting difficulties with this skill. Moreover, our results indicated that literacy-based activities occurred more often than mathematics-based activities and that the home numeracy environment was characterized by activities supporting different mathematical skills such as counting, arithmetic, and numeracy. Parents in both groups engaged with their child in both formal and informal literacy and mathematics-based activities, but informal activities occurred more often when supporting counting and number recognition skills. Conclusions and implications: The current study provides evidence that the home learning environment of children with DS and children with WS include different literacy- and mathematics-based activities and that the home learning environment changes on the basis of the child’s strengths and weaknesses. The findings are discussed in relation to previous studies and the impact on parental interventions.

Unravelling a couple in conflict: Undiagnosed obstructive sleep apnea

IntroductionObstructive sleep apnea impacts quality of sleep and leads to sleep deprivation with consequences on level of general functioning and interpersonal relationships besides the known contribution to cardio and cerebrovascular disorders and sexual dysfunction. Most adults sleep with a partner and sleep disorders may also disrupt the partner´s sleep, yet surprisingly obstructive sleep apnea, even when such is the case, goes frequently undiagnosed.ObjectivesTo reflect on a clinical case that presents apparently as just another couple in conflict but in fact when unravelled leads to a diagnosis of obstructive sleep apnea that may have significant contribution to the conflict.MethodsUnravelling what was at the core of a couple in conflict.ResultsA heterosexual couple in their late thities present in serious conflict with each other. Both are depressed and anxious, sleeping badly, with intimacy issues and having trouble dealing with work obligations and household chores. After continued squabbling, some self-reflection but mostly other blaming, a thread released by the female partner leads to sleep evaluation of the male partner with a resulting diagnosis of obstructive sleep apnea and subsequent treatment. And the couple relationship got better…ConclusionsObstructive sleep apnea is frequent in the general population and more often than not undiagnosed but may be even more frequent in patients seeking mental health services. A sleep history is an important part of evaluation of patients who present with anxiety, depressive, sexual function and/or cognitive complaints and relationship issues. Interviewing intimate partners may provide essential clues to the possibility of existing sleep disorders.DisclosureNo significant relationships.

Executive functioning in psychiatric patients with deliberate self-harm, as compared with a psychiatric and a healthy comparison group

ABSTRACT Introduction: Deliberate self-harm (DSH) is a common symptom in psychiatric disorders. It is a cross-diagnostic symptom, although it has mainly been associated with borderline personality disorder (BPD). Research has suggested an association between DSH and deficits in executive functioning. The main aim of the current study was to assess three specific aspects of executive functioning (EF) (working memory, inhibition and cognitive flexibility) among psychiatric patients with DSH, compared to a clinical and a healthy comparison group. Methods: Thirty psychiatric patients with DSH, 29 psychiatric patients without DSH and 29 healthy individuals were assessed with regard to psychiatric illness, self-harming behavior, EF, general cognitive functioning level and measures of psychopathology. The results were analyzed by means of ANOVA, regression analysis, Chi-square, and correlation analysis. Results: The patients with DSH showed deficits in cognitive flexibility and inhibition as compared to healthy individuals. In addition, the patients with DSH had greater deficits in cognitive flexibility than the patients without DSH; this effect was independent of concurrent severity of depressive symptoms but not independent of borderline symptomatology. Conclusion: Psychiatric patients with DSH may have deficits in cognitive flexibility as compared to both the healthy and clinical comparison groups. The results partly differ from previous related studies in the field. It is unclear to which extent the deficits in cognitive flexibility are due to other factors. More research is needed to understand the implications of such deficits, and if the results could be used for adapting treatment services and strategies. Future studies should include more similar comparison groups.

Відновлення функціонування ветеранів з ПТСР та легкою черепно-мозковою травмою після 8-тижневого комплексного втручання Смашна О.Є.

Background. Significant numbers of veterans with mild traumatic brain injury (TBI) and/or post-traumatic stress disorder (PTSD), usually co-morbid, have functional impairments in various areas of life, which significantly complicate the process of their readaptation and resocialization. They experience significant persistent limitations in daily life, including problems with occupational, family, social activities, and self-care due to a combination of emotional, cognitive, and behavioral impairments that should be targets of intervention, including transcranial stimulation and psychotherapy. Aims. To investigate the effectiveness of a complex intervention, namely the combination of a psychotherapy program with transcranial direct current electrical stimulation (tDCS) in the treatment of patients with PTSD and mTBI by assessing their level of functioning. Methods. Examination data of 329 veterans from three clinical groups were analyzed: individuals with PTSD (n=109), mild TBI (n = 112), and with comorbid PTSD+TBI (n=108). All patients received standard therapy as well as psychotherapeutic intervention (a combination of psychoeducation with elements of motivational interviewing and acceptance and commitment therapy for PTSD (ACT) and transcranial direct current electrical stimulation (tDCS). According to the WHODAS 2.0 scale, the level of functioning was determined in six domains: cognition (CW); mobility (MW); self-care ( SW); relationships (RW); daytime activity (LW); social activity (PW); general level of functioning (WHO). A rank correlation was also determined between individual criteria of the CAPS-5 scale and domains of the WHODAS 2.0 test. Results. In patients of all clinical groups, the most pronounced disorders were in the cognitive sphere (CW), the sphere of relationships (RW), social (PW), and daytime activity (LW). The combination of PTSD and TBI was associated with more significant and persistent cognitive impairment, as well as reduced daytime activity. In the majority of respondents, the indicators of all scales of the WHODAS 2.0 methodology at the second examination were significantly lower than at first, which indicated the effectiveness of the therapy. The state of the cognitive sphere turned out to be essential for the effective psychotherapeutic effect on patients both within the PTSD group and with CCM. The connection of separate domains of WHODAS 2.0 with pathological symptoms of PTSD determines the recommendations to increase the duration of the therapeutic program specifically for the group of PTSD. Conclusions. Impairment of functioning in persons with PTSD, TBI, and the combination of these painful conditions is closely related to the presence and expressiveness of PTSD symptoms, which provides the possibility of differentiated targeted therapy for certain clinical groups of patients.

Determinants of caregiver satisfaction with child neurodevelopmental assessment in neuropaediatric clinics

BackgroundIn addition to patient evaluations, caregiver evaluations and experiences are important indicators of the quality of health services. The aim of this study was to examine determinants of caregiver satisfaction with and perceived benefit of child neurodevelopmental assessment in neuropaediatric clinics.MethodsThe study was conducted among caregivers of children and adolescents aged 4–18 years (N = 330) referred for neurodevelopmental assessment in two neuropaediatric clinics in the specialised health service in Northern Norway. The Generic Short Patient Experiences Questionnaire (GS-PEQ) for child psychiatric outpatient patients was distributed to caregivers immediately following the assessment, and two of its items were used as measurements of caregiver satisfaction with and perceived benefit of the assessment.ResultsCaregiver satisfaction with the assessment was correlated with a better general level of function in the child, higher socioeconomic status, Norwegian mother tongue, referral from a specialist, and the respondent being a woman. Higher perceived benefit of the assessment was correlated with higher socioeconomic status, Norwegian mother tongue, and younger age of the child. Regression analysis revealed that caregivers’ perception that the assessment was suited to their child’s situation and that there was good cooperation with other public services (e.g., primary care and social/educational services) seemed more fundamental to caregiver satisfaction with neuropaediatric clinics’ services than any background variable. Younger age of the child, in addition to caregivers’ perception that the assessment was suited to their child and receiving sufficient information about the child’s diagnosis/afflictions, were essential to the perceived benefit of the assessment.ConclusionsCaregiver satisfaction with child neurodevelopmental assessment in neuropaediatric clinics partly depends on variables not related to the assessment experience per se. An assessment that was suited to the child, good cooperation with other public services such as primary health care and social/educational services, and giving sufficient information about the child’s diagnosis are essential to an overall positive caregiver evaluation of neurodevelopmental assessments.

Problems of technical exploitation and ecological safety of hydrotechnical facilities of irrigation systems

In this work, we analyzed and studied the Ukrainian typical hydrotechnical structures of the ameliorative complex on soil materials. On the examples of such objects in Dnipropetrovsk oblast, we carried out research and determined the technical condition of the transporting (main irrigation canals) and regulating (retention ponds) hydrotechnical structures (HTS). The main factors and the reasons for the negative engineering-geological processes occurring in those structures and affecting the ecological balance of adjacent territories were determined. The study revealed that the long period of exploitation and absence of corresponding technical care have led to significant losses of irrigation water from the canals and retention ponds. Due to the systemic absence and low use of monitoring researchers, we have proposed the use of prompt and low-cost methods and means of technical diagnostics. The article presents the possibility of using a complex of geophysical methods of natural impulse magnetic field of the Earth and vertical electrical sounding for the purposes of technical diagnostics. The possibility of recording plots and parameters of zones of seepage deformations in the body and at the base of the structures was visually determined and instrumentally proven. This allows identifying the amounts of technical and material resources, stages and order of implementation of repair-restoration works. It was determined that share of the damaged zones accounts for 20 to 35% of the total length of the hydrotechnical structures dependingon their type and parameters of the constructions. In such conditions, the estimated losses of water equal 17-22% of the total amount of the delivery. The surveys showed that further operation of HC poses an ecological threat because of significant worsening of quality of water resources. The article presents disturbing dynamics of change in the irrigated areas involving the danger of secondary salinization, sodification, alkalinization, and toxification as a result of watering. We indicated threatening changes in the structures of the areas irrigated with low-quality water, which, according to various indicators of danger, increased by 1.4 times regarding threat of secondary salinization and by 2 times regarding threat of sodification. We proposed and substantiated approaches to improving the general technical and technological level of functioning of ameliorative structures in the context of maintaining ecological balance and economic practicability of their further use, based on the principles of systemic optimization of complex technical-natural ecosystems.

Clinical Correlates of the NR3C1 Gene Methylation at Various Stages of Psychosis.

BackgroundDysregulation of epigenetic processes might account for alterations of the hypothalamic-pituitary-adrenal axis observed in patients with schizophrenia. Therefore, in this study, we aimed to investigate methylation of the glucocorticoid receptor (NR3C1) gene in patients with schizophrenia-spectrum disorders, individuals at familial high risk of schizophrenia (FHR-P), and healthy controls with respect to clinical manifestation and a history of psychosocial stressors.MethodsWe recruited 40 first-episode psychosis patients, 45 acutely relapsed schizophrenia (SCZ-AR) patients, 39 FHR-P individuals, and 56 healthy controls. The level of methylation at 9 CpG sites of the NR3C1 gene was determined using pyrosequencing.ResultsThe level of NR3C1 methylation was significantly lower in first-episode psychosis patients and significantly higher in SCZ-AR patients compared with other subgroups of participants. Individuals with FHR-P and healthy controls had similar levels of NR3C1 methylation. A history of adverse childhood experiences was associated with significantly lower NR3C1 methylation in all subgroups of participants. Higher methylation of the NR3C1 gene was related to worse performance of attention and immediate memory as well as lower level of general functioning in patients with psychosis.ConclusionsPatients with schizophrenia-spectrum disorders show altered levels of NR3C1 methylation that are significantly lower in first-episode psychosis patients and significantly higher in SCZ-AR patients. Higher methylation of the NR3C1 gene might be related to cognitive impairment observed in this clinical population. The association between a history of adverse childhood experiences and lower NR3C1 methylation is not specific to patients with psychosis. Longitudinal studies are needed to establish causal mechanisms underlying these observations.

Effectiveness of forensic outpatients' psychiatric treatment and recidivism rates: A comparison study

It was previously shown that forensic outpatient psychiatric treatment lowers recidivism and improves mental health. However, there is no data specifically from Switzerland, a fact that has been repeatedly criticized by local policymakers in the course of healthcare planning. The present study aimed to describe two groups of mentally ill offenders referred to a Swiss forensic outpatient clinic, namely those accepted for treatment and those who were left untreated because their treatment was rejected. The recidivism rates of the two groups were then compared, to determine whether differences in recidivism rates between the two groups might be related to socio-demographic characteristics and mental health. Finally, improvements regarding general functional level and severity of psychopathology were evaluated over the course of time. A total of n = 131 mentally ill offenders were studied. After an average time at risk of 42.6 months, our preliminary results show that 18% of those accepted for treatment relapsed into delinquent activities, while 38% of the rejected offenders did so. We found no sociodemographic variable that differentiated between reoffenders in the two samples. Likewise, the prevalence of personality disorders was similar in the two groups. Regarding comorbidity, the combination of any substance abuse disorder and any personality disorder was more prevalent in the treated sample. Over the course of therapy, the treated group showed improvements regarding their general functional level and the severity of their psychopathology. This is the first study to explore the effects of therapeutic outpatient treatment of mentally ill offenders on Swiss recidivism rates.

Impact of metabolic syndrome and clinical features on functioning in patients with bipolar disorder: a cross-sectional study.

Objective:The metabolic syndrome (MS) is highly prevalent among patients with bipolar disorder (BD), and may affect progression, functioning, and comorbid conditions in BD. The aim of this study was to investigate the effect of clinical variables and MS on overall functioning and specific areas of functioning in patients with BD.Methods:A total of 210 participants (140 participants with BD I and BD II in remission and 70 non-psychiatric control subjects) were included. The investigators administered the Young Mania Rating Scale (YMRS), the Bipolar Depression Rating Scale (BDRS), the Global Assessment of Functioning Scale (GAF), and the Bipolar Disorder Functioning Scale (BDFS). The participants completed the Beck Depression Scale (BDS) and the Beck Anxiety Scale (BAS). MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Hierarchical regression analysis was used to investigate potential correlations of comorbid MS with clinical variables and level of functioning.Results:Level of functioning did not differ between patients with and without MS. However, there were significant correlations between the level of functioning subscales and the number of depressive episodes (p = 0.033), level of general functioning (p = 0.012), duration of illness (p = 0.012), BDS (p = 0.005), BDRS (p = 0.021), BAS total scores (p = 0.021), number of hypomanic episodes (p = 0.022), number of hospitalizations (p = 0.003), employment status (p = 0.032), and diagnosis of BD I (p = 0.007) and BD II (p = 0.044).Conclusion:Our findings suggest that clinical variables had a greater effect on functioning than MS in BD patients.

The Global Assessment of School Functioning (GASF): Criterion validity and interrater reliability

AbstractThe Global Assessment of School Functioning (GASF) provides a robust estimate of a student's overall level of functioning within the school environment. It is intended to capture a global metric reflecting academic, social and general behavioral functioning within the school. It is a modification of the Global Assessment of Functioning and reflects functioning across academics, interpersonal relationships, school behavior, and school participation. It was developed to allow school personnel a means to communicate the general level of student functioning without reverting to specific issues or immediate concerns. This paper reports on the scale's criterion validity and interrater reliability. Confirmations of the scale structure and descriptors were obtained using subject matter experts, who confirmed descriptor's criterion validity. Vignettes were developed and then rated by 64 educators to establish interrater reliability. Strong intraclass correlations (ICC) were obtained supporting the GASF reliability (single measure absolute agreement ICC = 0.998, 95th percentile confidence interval = 0.994 to 1.00). With appropriate use, this tool has value for all school personnel as a general indicator of student functioning and as a point of student reference in school team considerations. Anecdotal evidence indicates it can be used for overall progress monitoring as well.

Age-related effect on language control and executive control in bilingual and monolingual speakers: Behavioral and electrophysiological evidence

Research suggests that bilingual language control and executive control (EC) have similar mechanisms and share common brain networks. Managing two languages presumably reinforces these networks and enhances the level of general executive functioning in bilinguals. Despite a huge amount of research, there is not yet any consensus on the nature of the potential bilingual advantage. The overall purpose of the present research was thus to gain insights into the influence of bilingualism on executive functions, by exploring aging-related changes. The domain-general tasks approach consisted in comparing young and older bilinguals with their monolingual peers on tasks that were deliberately chosen to assess different aspects of inhibition (Stroop, Antisaccade, and Stop Signal tasks) and cognitive flexibility (Berg Card Sorting Test, Trail Making Test and verbal fluency). Our goal was to ascertain whether bilinguals outperform monolinguals, and whether this advantage is greater for older bilinguals. Results provided some evidence of a bilingual advantage in verbal tasks involving language processing, such as verbal fluency and the Stroop test, but did not support the hypothesis of a general executive advantage, as bilinguals and monolinguals did not differ on nonlinguistic executive tasks. The language switch task approach consisted in studying the performance of young and older bilinguals on picture naming while switching between their dominant and nondominant languages, and comparing their performance with monolingual speakers in an equivalent switching paradigm. The effects of aging on mixing and switch costs were investigating by analyzing behavioral and event-related potential (ERP) data. Results of these tasks did not reveal any effect of aging on mixing cost in bilinguals. Furthermore, ERP data pointed to a degree of flexibility in older bilinguals, who were able to allocate resources according to task difficulty. Taken together, our results suggest that a bilingual advantage is only observed in language-based tasks.

SCREENING ANALYSIS OF PSYCHOSOCIAL FUNCTIONING OF PRIMARY PUPILS AT SCHOOL

Currently, research on possible psychological and socio-psychological problems of children and adolescents during the period of their education is becoming increasingly important. Extensive use of short screening tests-questionnaires allows to identify possible deviations in the psychosocial functioning of ordinary children and adolescents, children with somatic diseases, victims of violence. The aim of the study was to increase the effectiveness of determining psychosocial dysfunction in children of primary school age by analyzing the results of a screening study. Using «Pediatric Symptom Checklist» methodology, including child (Y-PSC) and parent (PSC) versions in Ukrainian adaptation, 263 primary schoolchildren and 228 parents were examined by filling out a paper version or an online version. Statistical processing of the data was performed using t-test and one-way analysis of variance in a licensed SPSS Statistic v.20 software suite. With the help of adapted version of the methodology, it was determined that general average level of psychosocial functioning of primary pupils, according to Y-PSC, was exceeding the established norm, particularly during 2nd and 3rd study years; this fact can be the evidence of some stress in mechanisms of psychosocial adaptation during that period. According to the child version, critically high indicators were observed in 12.9% of cases – by attention subscale, in 33.1% – by internalization subscale, in 21.7% – by externalization subscale. According to parent version (PSC), critically high indicators were observed in 18.9% of cases – by attention subscale, in 7.9% – by internalization subscale, and in 32.9% – by externalization subscale. By one-way analysis of variance, it has been established that psychosocial state is affected by sex, grade and method of survey. For example, attention and externalization subscale indicators were higher in online data. In girls, there was a higher level of internalization, while in boys, veraciously – of externalization, according to both parent and child versions. Indicators by attention and externalization subscale have been significantly higher in first-graders, while the level of internalization – in students of 2nd and 3rd grade. Therefore, obtained results can be utilized as groundwork for further study of various age groups of schoolchildren and adolescents. Additionally, dynamic observation of risk group children while employing psychologists, primarily school psychologists, for support, psychological interventions, and psychoeducational programs, can produce certain reasonable activities for overcoming and deactualization of present deviations at a prenosological level.

Parental mentalizing as a key resource for difficult transitions

ABSTRACTThis commentary on Ruiz et al.’s study focuses on the relevance of parental mentalizing for child development within a transactional framework. This view takes into account what kind of challenges in the parent, in the infant, or in the interaction have effects on child development and if this mediated by parental mentalizing. Differences between maternal and paternal mentalizing seem unrelated to the general level of reflective functioning but strongly influenced by social roles of parents. However, more sophisticated measures of mentalizing are needed to better understand subtle problems with regard to a dimensional and multifaceted model of mentalizing as well as interactional processes. To master the transition to parenthood in challenging circumstances such as preterm birth, it would be especially valuable to know if one parent’s lower mentalizing can be counterbalanced by higher mentalizing in the other parent.

Cognition and physical functioning in patients with schizophrenia: any role for vitamin D?

ABSTRACT Aim: The study’s objective was to evaluate the relationship between vitamin D (VD) levels and cognitive performance in patients with schizophrenia. Methods: A cross-sectional study, conducted between March and July 2016, recruited 196 patients with schizophrenia. The Brief Cognitive Rating Scale (BCRS) and the Morningside Rehabilitation Status Scale (MRSS) were used to measure the severity of cognitive impairment and the level of general functioning in psychiatric patients. Lower scores for both scales indicate a better cognition and functioning respectively. Vitamin D levels of participants were divided into four groups: severe VD deficiency (<10 ng/ml), VD deficiency (10–20 ng/ml), VD insufficiency (20–30 ng/ml), VD sufficiency (>30 ng/ml). Relationships between VD level and cognition and functioning were assessed by analyses of covariance and hierarchical multiple regression, adjusted for age, gender, marital status, education level, sun exposure, physical activity and monthly income. Results: Severe VD deficiency was found in 22 patients with schizophrenia (11.3%), while 45.6% of patients had VD deficiency. Severe VD deficiency was significantly associated with an increase in MRSS score after adjusting for covariates (Beta = 2.44), however, no significant association was found with the BCRS score. Conclusion: These findings suggest that severe VD deficiency in patients with schizophrenia might be associated with low general functioning but could not influence cognitive function.

Effectiveness of the Group Psychoeducation Program in Bipolar Disorder

Objective: The aim of this study was to assess effectiveness of the group psychoeducation program in euthymic bipolar disorder. Method: Sixty patients with bipolar disorder followed at the Psychiatry Outpatient Clinic of Diskapi Yildirim Beyazit Training and Research Hospital were enrolled into the study. The patients were randomly divided into two groups, 30 patients were followed with medical treatment while 30 patients participated in a group psychoeducation program along with medical therapy. The program consisted of sixteen weekly sessions and each session lasted 90 minutes. Hamilton Depression Scale, Young Mania Rating Scale, Bipolar Functional Scale, Global Assessment of Functioning Scale, Morisky Treatment Adherence Scale and The Scale for the Assessment of Insight scales were applied to the patients. Non-parametric Mann Whitney-U and Wilcoxon tests were used to assess effectiveness of the group psychoeducation program. Findings: There was no significant change in depression and mania scores with the adminsitration of group psychoeducation, however, those included in group psychoeducation showed a significant increase in general functioning level, insight, and treatment adherence. In addition, psychoeducation program improved stigmatization, introversion, and daily functioning scores. Depression and mania scores were significantly higher at the 16th week compared to at baseline in the patients not applied group psychoeducation. Group psychoeducation program increased initiative and occupational functionality in this study. Conclusion: Group psychoeducation program increased the functionality and insight of the patients in this study. The administration of psychosocial interventions in clinical practice might improve the functionality of patients with bipolar disorder. Structured prospective studies are needed to evaluate the short and long-term effects of psychosocial interventions in bipolar disorder.

Type D personality traits in patients with schizophrenia and their relationship with clinical parameters

Objective: The aim of this study was investigate to type D personality traits of in schizophrenia patients and the relationship between personality and clinical parameters. Methods: The study included 100 patients with schizo-phrenia who were aged between 18-65, inpatient or outpatient follow-up, and 92 healthy controls matched for sociodemographic data. To all participants; Sociodemographic data form, Type D personality scale (DS-14), Schizo-phrenia Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS) were applied. Results: The comparison of the groups showed a significant difference in DS-14, negative affectivity and social inhibition. In the results of Pearson’s correlation analysis of schizophrenia patients; the DS-14 negative affectivity subscale and PANSS positive symptom subscale, general functioning level and CDSS scores were inversely related. While DS-14 social inhibition and PANSS all subscales were negatively correlated. Discussion: The results of our study; it was found that patients with schizophrenia had higher D-type characteristics and those with D-type personality had poorer functionality. It was found that type D personality traits were higher rates in patients with additional medical illnesses, psychiatric disorders requiring family treatment, smokers and those with old psychiatric hospitalizations. In order to improve the functionality of patients with schizophrenia, it may be beneficial to evaluate personality traits in addition to pharmacotherapy.

CCSchool: a multicentre, prospective study on improving continuum of care in children and adolescents with mental health problems associated with school problems in Germany

BackgroundMost psychiatric disorders in childhood and adolescence cause impairment in academic performance. Early interventions in school are thought to reduce the burden of disorder and prevent chronicity of disorder, while a delay in reachable help may result in more severe symptoms upon first time presentation, often then causing upon first-time presentation immediate need of inpatient care.MethodsThe study aims at reducing hospitalization rates and increasing social participation and quality of life among children and adolescents by establishing collaborations between schools, mental health care services and youth welfare services. CCSchool offers children and adolescents, aged six to 18 years, who present with psychiatric problems associated to school problems, a standardized screening and diagnostic procedure as well as treatment in school if necessary. Students can participate in CCSchool in three federal states of Germany if they a) show symptoms vindicating a mental health diagnosis, b) present with confirmed school problems and c) have a level of general functioning below 70 on the children global assessment of Functioning (C-GAF). Intervention takes place in three steps: module A (expected n = 901, according to power calculation) with standardized diagnostic procedures; module B (expected n = 428) implies a school-based assessment followed by a first intervention; module C (expected n = 103) offering school-based interventions with either four to six sessions (basic, 80% of patients) or eight to 12 sessions (intensive, 20% of patients).Primary aim is to evaluate the effectiveness of CCSchool, in reducing the need of hospitalization in children with mental health problems. The analyses will be conducted by an independent institute using mainly data collected from patients and their caregivers during study participation. Additionally, claims data from statutory health insurances will be analysed. Relevant confounders will be controlled in all analyses.DiscussionEvaluation may show if CCSchool can prevent hospitalizations, enhance social participation and improve quality of life of children and adolescents with mental health problems by providing early accessible interventions in the school setting.Trial registrationDeutsches Register Klinischer Studien, Trial registration number: DRKS00014838, registered on 6th of June 2018.

Distinct Patterns of Atypical Functional Connectivity in Lower-Functioning Autism

BackgroundFunctional magnetic resonance imaging research on autism spectrum disorders (ASDs) has been largely limited to individuals with near-average intelligence. Although cognitive impairment is common in ASDs, functional network connectivity in this population remains poorly understood. Specifically, it remains unknown whether lower-functioning individuals exhibit exacerbated connectivity abnormalities similar to those previously detected in higher-functioning samples or specific divergent patterns of connectivity. MethodsResting-state functional magnetic resonance imaging data from 88 children (44 ASD, 44 typically developing; average age: 11 years) were included. Based on IQ, individuals with ASDs were assigned to either a lower-functioning group (mean IQ = 77 ± 6) or a higher-functioning group (mean IQ = 123 ± 8). Two typically developing comparison groups were matched to these groups on head motion, handedness, and age. Seeds in the medial prefrontal cortex, posterior cingulate cortex, posterior superior temporal sulcus, insula, and amygdala were used to contrast whole-brain functional connectivity across groups. ResultsLower-functioning ASD participants (compared with higher-functioning ASD participants) showed significant underconnectivity within the default mode network and the ventral visual stream. Higher-functioning ASD participants (compared with matched typically developing participants) showed significantly decreased anticorrelations among default mode, salience, and task-positive regions. Effect sizes of detected differences were large (Cohen’s d > 1.46). ConclusionsLower- and higher-functioning individuals with ASDs demonstrated distinct patterns of atypical connectivity. Findings suggest a gross pattern of predominantly reduced network integration in lower-functioning ASDs (affecting default mode and visual networks) and predominantly reduced network segregation in higher-functioning ASDs. Results indicate the need for stratification by general functional level in studies of functional connectivity in ASDs.

T102. AN INVESTIGATION OF SCHIZOPHRENIA-BIPOLAR SUBGROUPS WITH GENETIC AND PROGNOSTIC VALIDATION

BackgroundSeparation of individuals into schizophrenia and bipolar diagnoses has long been questioned, with some suggesting that the classification impairs the understanding of etiology, the accuracy of prognoses, and treatment selection. In this study, we employed unbiased statistical techniques to identify subgroups of individuals with chronic illness using a large array of variables commonly evaluated at the bedside. We then validated the resulting groups by investigating age of onset, schizophrenia polygenic risk scores (PRS), and functional outcomes at a 1-year follow-up period. Our hypothesis was that transdiagnostic subgroups would be stratified based on illness onset whereby individuals with earlier onset would have higher genetic risk loading and poorer functional outcomes.MethodsParticipants were selected from a longitudinal, naturalistic, multi-site project (PsyCourse) designed to investigate psychiatric illness course and outcomes. A total of 329 participants (age(SD)=45.7(12.6); 54% female; years of illness duration(SD) = 13.7(10.3)) with a DSM-IV diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder were assessed from 17 centers at baseline and 1-year follow-up periods. A clinical battery measuring sociodemographic, illness history, symptoms, cognition, and personality questionnaires (199 variables) was used to subgroup individuals. A non-negative factor analytic consensus clustering MATLAB toolbox was created based on previous methodological work in oncology. PRS were generated using widely used strategies, and differences between resulting subgroups were investigated with MANCOVA controlling for ancestry effects. Differences in functional outcomes were investigated with repeated measures ANOVA.ResultsA 4-subgroup solution was robustly defined as the optimal solution using resampling techniques and cluster validity indices. Diagnoses were mixed in two subgroups, but predominantly bipolar or schizophrenia in the other two. All subgroups had equal illness durations (p>0.05), but the age of onset showed a decreasing trend with the earliest age being linked to two subgroups: a mixed bipolar-schizophrenia group with intermediate levels of general functioning and in a schizophrenia group with low levels of functioning (p<0.001). PRS scores were significantly increased in the early-onset, mixed bipolar-schizophrenia subgroup (p=0.007, uncorrected) and in the schizophrenia group (p=0.025, uncorrected). Prognoses differed between the four groups (p=0.003), with the greatest increases in functional outcomes in a late-onset mixed diagnostic subgroup (p=0.006) and in the schizophrenia group (p=0.002).DiscussionFour subgroups were detected and our hypothesis was supported by a relationship between earlier illness onset and higher schizophrenia genetic risk loading. While one of the subgroups with an earlier onset mostly consisted of individuals with schizophrenia, the other subgroup was diagnostically mixed. Our results tentatively suggest that transdiagnostic clustering may identify subgroups that could be effectively used to understand etiology and prognoses. Future research will investigate the possibility of differential treatment effects in these subgroups.

Integrated, Family-based, Partial Hospital Treatment for Complex Pediatric Illness.

This paper describes a unique treatment program for complex pediatric illness. The Hasbro Children's Partial Hospital Program uses a family systems orientation, integrated care, and a partial hospital setting to treat children with a wide range of pediatric illnesses that have failed outpatient and inpatient treatments. We have treated more than 2000 children with at least 80 different ICD-9 diagnoses. The multidisciplinary treatment team functions as a meta-family for children and their families who present with illness and family beliefs that impede successful outcomes with standard care. The three features: family systems orientation, integrated care, and partial hospital setting, hopefully interact to create an environment that helps families expand and modify their explanatory models regarding participating in effective medical care. The goal of treatment is for both children and their parents to feel empowered to take control of the illness. Parents completing standardized measures at intake describe their children and families as experiencing significant emotional distress, low levels of general family functioning, and poor quality of life. Although the children are described as having distinct behavioral differences, the families are described as responding to the experience of a seriously ill child in similar ways. A treatment program that addresses the noncategorical aspects of how families respond to illness while addressing the specific diseases of the children can allow children and their families to respond favorably to treatment.