Nonpsychiatric Samples Research Articles

P187. Neurovascular and Neurostructural Correlates of Retinal Microvascular Caliber in Adolescents With Bipolar Disorder

While it is well established that vascular metrics are relevant to brain structure and function in adult non-psychiatric samples, little is known about this interface in youth. Retinal vessels comprise a well-established proxy of cerebral vessels, through which to assay the vascular-brain interface.

Psychological Resilience and Suicide Attempt in Patients With Bipolar Disorder: An Exploratory Study.

Patients with bipolar affective disorder (BPAD) have a suicide risk of up to 30 times higher than the general population. There is increasing interest in analyzing the effects of resilience in psychiatric diseases and its relationship to other factors such as suicide risk. The main objective of this study was to analyze the relationship between psychological resilience and suicide attempts, along with other relevant clinical and sociodemographic variables in euthymic patients with BPAD. Eighty six outpatients, more than 18 years old, mostly men (60.5%) with BPAD type 1, 2, mixed, and unspecified, in euthymic phase receiving antidepressant and/or euthimizing treatment, participated in the study. Sociodemographic and clinical variables were assessed by means of a questionnaire and psychological resilience by means of Connor-Davidson's 10-item Resilience Scale. Patients with previous autolytic attempts scored significantly lower in resilience than those who had not attempted suicide (T = 3.30; p ≤ .001; 20.61 ± 6.58 vs. 26.52 ± 7.29). Patients diagnosed with BPAD scored significantly lower than other samples of university participants, workers, and the unemployed. The number of depressive episodes experienced was negatively and significantly associated with resilience scores (r = -.28; p < .01). Patients diagnosed with BPAD who had made autolytic attempts had lower resilience scores than those who had not made them and lower scores than other general nonpsychiatric samples. The promotion of resilience in patients diagnosed with BPAD would facilitate a more adaptive and positive coping with the disease and their recovery process.

Repetitive Transcranial Magnetic Stimulation: A Potential Treatment for Obesity in Patients with Schizophrenia

Obesity is highly prevalent in patients with schizophrenia and, in association with metabolic syndrome, contributes to premature deaths of patients due to cardiovascular disease complications. Moreover, pharmacologic, and behavioral interventions have not stemmed the tide of obesity in schizophrenia. Therefore, novel effective interventions are urgently needed. Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy for inducing weight loss in obese non-psychiatric samples but this promising intervention has not been evaluated as a weight loss intervention in patients with schizophrenia. In this narrative review, we describe three brain mechanisms (hypothalamic inflammation, dysregulated mesocorticolimbic reward system, and impaired prefrontal cortex function) implicated in the pathogenesis and pathophysiology of obesity and emphasize how the three mechanisms have also been implicated in the neurobiology of schizophrenia. We then argue that, based on the three overlapping brain mechanisms in obesity and schizophrenia, rTMS would be effective as a weight loss intervention in patients with schizophrenia and comorbid obesity. We end this review by describing how deep TMS, relative to conventional TMS, could potentially result in larger effect size for weight loss. While this review is mainly conceptual and based on an extrapolation of findings from non-schizophrenia samples, our aim is to stimulate research in the use of rTMS for weight loss in patients with schizophrenia.

Universality and Normativity of the Attachment Theory in Non-Western Psychiatric and Non-Psychiatric Samples: Multiple Group Confirmatory Factor Analysis (CFA).

This study tests for the first time the validity of universality and normativity assumptions related to the attachment theory in a non-Western culture, using a novel design including psychiatric and non-psychiatric samples as part of a comprehensive exploratory and advanced confirmatory framework. Three attachment assessments were distributed to 212 psychiatric outpatients and 300 non-psychiatric samples in Yemen. The results of the fourteen approaches of exploratory factor analysis (EFA) produce a similar result and assertion that the psychiatric outpatients tend to explore attachment outcomes based on multi-methods, while the non-psychiatric samples suggest an attachment orientation based on multi-traits (self–other). The multiple group-confirmatory factor analysis (MG-CFA) demonstrates that the multi-method model fits the psychiatric samples better than the non-psychiatric samples. Equally, the MG-CFA suggests that the multi-traits model also fits the psychiatric samples better than the non-psychiatric samples. Implications of the results are discussed.

Health Control Beliefs and Attitude Toward Treatment in Psychiatric and Non-Psychiatric Clinical Samples.

Although there is accumulating evidence on the potential influencing factors of medication adherence, the knowledge about patients' attitudes and beliefs toward treatment is only partly utilized in adherence-improving strategies. Several internal and external factors determining adherence have been described regarding many chronic somatic diseases but in recent research, insight on psychiatric patients has been exclusively lacking. As a result, there is a scarcity of effective adherence-improving interventions. Identification of any specific differences or similarities between the attitudes toward treatment of psychiatric and non-psychiatric patients would help to support adherent behavior.We recruited 189 participants from four departments of general psychiatry (GEN PSYCH, n = 106), addictology (ADDICT, n = 42) and somatic diseases (NON PSYCH, n = 41). The Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) was performed to assess the patients' attitude toward drug treatment, perceived health locus of control, and psychological reactance.The most robust difference of the PHBQT scores occurred between the GEN PSYCH and ADDICT subgroups. ADDICT patients scored significantly higher on the internal and external health locus of control and on the Psychological Reactance subscale as well. While GEN PSYCH subjects provided higher scores on the Positive Aspect of Medication compared to ADDICT persons. Interestingly, the only difference between the GEN PSYCH and NON-PSYCH groups was the more pronounced mistrust in physicians in the case of psychiatric patients.Our data suggest that mistrust toward medication does not differ in psychiatric and non-psychiatric samples, while the acceptance of the doctor's competency may be stronger in the non-psychiatric sample. The analysis of these factors provides information which could help us better understand this important issue and to develop more efficient interventions for improving adherence.

Efficacy of Polyunsaturated Fatty Acids (PUFAs) on Impulsive Behaviours and Aggressiveness in Psychiatric Disorders.

It is the focus of increasing interest to investigate the effects of long-chain n-3 and long-chain n-6 polyunsaturated fatty acids (LC n-3 PUFAs; LC n-6 PUFAs) on psychiatric symptoms in a transdiagnostic perspective. There is some evidence that low levels of LC n-3 PUFAs and a higher ratio of LC n-6 to LC n-3 PUFAs in plasma and blood cells are associated with aggressive and impulsive behaviours. Therefore, implementation of LC n-3 PUFAs may produce positive effects on hostility, aggression, and impulsivity in both psychiatric and non-psychiatric samples across different stages of life. A possible mechanism of action of LC n-3 PUFAs in conditions characterized by a high level of impulsivity and aggression is due to the effect of these compounds on the serotonin system and membrane stability. Studies that evaluated the effects of LC n-3 PUFAs on impulsivity and aggressiveness indicated that addition of rather low doses of these agents to antipsychotic treatment might reduce agitation and violent behaviours in psychosis, attention deficit hyperactivity disorder, personality disorders, and impulsive control and conduct disorders. The present review is aimed at examining and discussing available data from recent trials on this topic.

Biocueing and ambulatory biofeedback to enhance emotion regulation: A review of studies investigating non-psychiatric and psychiatric populations

Over the last years, biofeedback applications are increasingly used to enhance interoceptive awareness and self-regulation, in psychiatry and beyond. These applications are used to strengthen emotion regulation skills by home training (ambulatory biofeedback) and real-time support in everyday life stressful situations (biocueing). Unfortunately, knowledge about the feasibility and effectivity of these applications is still scarce. Therefore, a systematic literature search was performed. In total, 30 studies (4 biocueing, 26 ambulatory biofeedback) were reviewed; 21 of these studies were conducted in non-psychiatric samples and 9 studies in psychiatric samples. Study characteristics, biofeedback characteristics, effectivity and feasibility outcomes were extracted. Despite the rapid advances in wearable technology, only a few biocueing studies were found. In the majority of the studies significant positive effects were found on self-reported (stress-related) psychological measures. Significant improvements on physiological measures were also reported, though these measures were used less frequently. Feasibility of the applications was often reported as sufficient, though not adequately assessed in most studies. Taken into account the small sample sizes and the limited quality of the majority of the studies in this recently emerging field, biocueing and ambulatory biofeedback interventions showed promising results. Future research is expected to be focusing on biocueing as a just-in-time adaptive intervention. To establish this research field, closer cooperation between research groups, use of more rigorous as well as individually tailored research designs and more valid feasibility and effectivity assessment are recommended.

Quality of Life of Children and Adolescents Undergoing Hematopoietic Stem Cell Transplantation Is Negatively Affected by Psychological Distress Experienced by Their Parents: A Case for Pediatric Palliative Care (RP410)

•State the elements and trajectory of distress for parents caring for children and adolescents undergoing hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor (CAR) T-cell therapy.•Examine the impact of parent distress on symptoms and quality of life (QoL) experienced by children and adolescents undergoing HSCT or CAR T-cell therapy. Hematopoietic stem cell transplantation (HSCT) is curative for children with life-threatening conditions but can result in compromised quality of life (QoL). Parents provide extensive care for their children and can experience distress, yet the association between parent and child outcomes has not been sufficiently investigated. To examine the impact of parent distress on QoL among children undergoing HSCT or chimeric-antigen receptor (CAR) T cell therapy. This multisite study employed a longitudinal, repeated measures design. English or Spanish-speaking children ages 2-18 years, with any diagnosis, and planned HSCT or CAR therapy were eligible. Beck Anxiety and Depression Inventories, the Perceived Stress Scale and the PROMIS Sleep and Fatigue Short Forms were administered to parents pre-HSCT/CAR, and day+30, +60, +90 post-HSCT/CAR. The PedsQL Cancer Module was administered to children (parent-proxy for younger children) at corresponding timepoints. Descriptive statistics and longitudinal parallel process (type of effect modeling) analyses were used to explore relationships between parent distress (a single factor consisting of sleep, fatigue, anxiety, depression and stress) and child outcomes. To date, 139 child/parent dyads (278 participants) were enrolled across 4 sites. Child mean age was 8.3 years (SD=4.9), 57% were male, primarily with an underlying diagnosis of malignancy (68.9%). Most parents were mothers (79.1%), mean age of 38.9 years (SD=8.1). Parent anxiety, depression and stress scores were higher than normative means generated from non-psychiatric samples. A significant inverse relationship between parent distress and child QoL was found at baseline and over time post-HSCT. When parent distress was higher at baseline, child QoL was lower. When parent distress increased over time, child QoL decreased. Findings suggest that parents experience heightened distress during the acute phase of their child's HSCT or CAR therapy, and this may impact their child's QoL.

LONELINESS, AGE, CARDIOVASCULAR AND METABOLIC HEALTH IN SCHIZOPHRENIA

Introduction Loneliness is common in schizophrenia with prevalence estimates as high as 80% among people with schizophrenia. Recent studies among non-psychiatric samples have indicated deleterious effects of loneliness on physical health and mortality, including increased risk of hypertension, central obesity, metabolic syndrome, coronary heart disease, stroke, and other cardiovascular disorders. The all-cause mortality risk of loneliness is double that from obesity and equivalent to that from smoking ¾ of a pack of cigarettes per day. However, despite the increased risk for loneliness and cardiovascular problems in schizophrenia, these associations have not been examined directly in previous studies of people with schizophrenia. This study aims to explore the relationship of loneliness and age with cardiovascular and metabolic markers of physical health among participants with schizophrenia in comparison to non-psychiatric comparison (NC) participants. Methods The third edition of the University of California, Los Angeles Loneliness Scale (UCLA-3) was administered to 53 participants with schizophrenia, as diagnosed by DSM IV criteria, and 32 NC participants. Sociodemographic and clinical characteristics such as age, education, gender, duration of illness, and antipsychotic use were measured. Participants were also evaluated in terms of severity of psychopathology (positive, negative, depressive, and anxiety symptoms) using standard clinical symptom rating scales. Metabolic and cardiovascular health markers including LDL, HDL, total cholesterol, triglycerides, homeostatic model assessment of insulin resistance (HOMA-IR), systolic and diastolic blood pressure, fasting glucose, as well as waist circumference, body mass index were also collected. The Framingham 10-year Cardiovascular risk score was also calculated. This data was drawn from a larger ongoing study of aging in schizophrenia. We included only those participants with complete data for all of the above measures in the present analyses. Differences between the two groups on continuous variables were evaluated with independent t-tests; differences on categorical variables were evaluated with Pearson's Chi-square. Within each group, we also employed hierarchical multiple regression analyses to evaluate the association of loneliness with each health marker, while adjusting for gender and age. We also examined interactions between age and loneliness. (Given that loneliness is associated with an increased risk of mortality, the presence or absence of the latter could indicate potential survivor biases in the sample.) Results Participants with schizophrenia had a mean age of 51.41 (SD 11.03), with 20(37.7%) females, and 28 (52.8%) non-Caucasians. The NC participants had a mean age of 51.52 (SD 9.98), with 19 (59.4%) females, and 20 (62.5%) non- Caucasians. Relative to the NC group, participants with schizophrenia had worse loneliness, as well as worse positive, negative, depressive and anxiety symptoms. The also had fewer years of education, higher 10- year risk of cardiovascular disease, and were more likely to meet criteria for metabolic syndrome. Among the NC group, multivariate analyses indicated no association of loneliness with of any of the physical health measures, although the association of loneliness with total cholesterol suggested a non-trivial amount of shared variance (R2= 0.85, p= .086). Within the schizophrenia group, loneliness was associated with worse triglyceride levels; there was no age*loneliness interactions for most variables, suggesting the association was similar across age levels. However, there were significant loneliness x age interactions for cholesterol, t = -2.40, p = .021, R2 = .102, and LDL levels, t = -2.67, p = .011, R2 = .129. Specifically, loneliness was associated with worse cholesterol levels among individuals 1 SD below the mean in age (i.e., age 40.39), t= 2.30, p= .020, and better LDL levels among individuals 1 SD above the mean age (i.e., age 62.45), t= -2.037, p= .047. Conclusions Given the small sample size (particularly among NCs), and the exploratory nature of the present analyses, findings must be interpreted with caution until replicated in larger independent samples. However, the overall pattern of findings within the schizophrenia group is intriguing in suggesting a possible link between loneliness and blood lipid levels. There have been some GWAS studies suggesting an overlap in polygenic risk scores for cholesterol and loneliness. The differential effects of loneliness on cholesterol measures among older versus younger patients must be interpreted with particular caution, but if replicated could indicate those people with schizophrenia who survive to older age have a protective factor moderating the association of loneliness and cholesterol levels. The latter warrants further prospective research among older and younger people with schizophrenia. This research was funded by: Support provided by National Institute of Mental Health (NIMH) grant 5R01 MH094151-04 (Jeste), the NIMH T32 Geriatric Mental Health Program MH019934 (PI: Jeste), and UC San Diego's Stein Institute for Research on Aging (Director: Jeste).

Six Years of Research on the National Institute of Mental Health's Research Domain Criteria (RDoC) Initiative: A Systematic Review.

Six years have passed since the National Institute of Mental Health (NIMH) in the United States launched the Research Domain Criteria (RDoC) initiative. The RDoC introduces a framework for research on the biology of mental illness that integrates research findings across multiple levels of information. The framework outlines constructs that represent specific quantifiable dimensions of behavior (e.g., responses to acute threat, cognitive control) and corresponding units of analysis that can be used to study the constructs, beginning at the levels of genes, molecules, cells, circuits and physiology, and moving up to behaviors and self-reports. In this systematic review, a literature search was conducted to synthesize empirical research published since the proposal of the framework that incorporated the RDoC. Forty-eight peer-reviewed scholarly articles met eligibility criteria for the review. Studies differed according to whether they analyzed RDoC constructs and units of analysis within vs. between clinically-diagnosed and non-psychiatric samples. The most commonly studied constructs were subsumed within the domains of Negative Valence Systems, Positive Valence Systems and Cognitive Systems, providing initial results which primarily connected genetics, brain circuits and physiology research findings with behavior and self-reports. Prospects for future research adopting the RDoC matrix and utilizing a dimensional approach to studying the biology of mental illness are discussed.

Cigarette smoking is associated with thinner cingulate and insular cortices in patients with severe mental illness.

Magnetic resonance imaging (MRI) studies show reduced cortical thickness in patients with schizophrenia and bipolar disorder. These subtle brain abnormalities may provide insight into illness mechanisms. However, environmental and lifestyle-related factors, such as cigarette smoking, may contribute to brain structure changes. Cigarette smoking is highly prevalent in patients with severe mental illness. In nonpsychiatric samples, smoking has been associated with reduced thickness in the anterior (ACC) and posterior cingulate cortices, the insular cortex (INS), the dorsolateral prefrontal cortex and the orbitofrontal cortex. We examined MRI scans from patients with schizophrenia, other psychotic disorders or bipolar disorder and healthy controls using FreeSurfer. We included 506 patients (49% smokers) and 237 controls (20% smokers) in our study. We found reduced cortical thickness in the left rostral ACC and the left INS in smoking patients compared with nonsmoking patients, but this difference was not found among healthy controls. No dose-response relationship was found between amount of smoking and cortical thickness in these regions. Among patients, maps of thickness along the whole cortical surface revealed reduced insular thickness but no effects in other regions. Among healthy controls, similar analyses revealed increased age-related cortical thinning in the left occipital lobe among smokers compared with nonsmokers. The causal direction could not be determined owing to the cross-sectional design and lack of detailed data on smoking addiction and smoking history. The effect of cigarette smoking should be considered in MRI studies of patients with severe mental illness.

Cognitive Remediation for Psychotic and Affective Disorders

Cognitive impairment has long been recognized as a symptom of schizophrenia, affective, and psychotic disorders. Until relatively recently, most research has focused on the severity, type, and course of impairment. As is reviewed in this series by Dr Alice M Saperstein and Dr Matthew M Kurtz,1 we have learned that cognitive deficits are evident in most people with schizophrenia and schizoaffective disorders, evident even in the prodromal phase but seem to worsen around the time of first episode, and stable for many years, even as positive symptoms, such as hallucinations and delusions, wax and wane. Dr Christopher R Bowie, Ms Maya Gupta, and Ms Katherine Holshausen2 report in this series that cognitive symptoms in the affective disorders appear to be more state related, though more than 60% of people with bipolar disorder (BD) continue to manifest cognitive dysfunction, even when clinically stable. Most studies comparing people with schizophrenia to nonpsychiatric samples find that cognitive test scores are on average 1.3 to 2.0 standard deviations below the mean, which means that 91% to 98% of the general population score higher. These deficits put patients at a considerable disadvantage when seeking employment and more generally facing the challenges of independent, productive living. Repeatedly, the research indicates that cognitive deficits are associated with functional outcome. It is for this reason that there is tremendous interest in finding ways to treat cognitive dysfunction.In this In Review are 2 papers that provide an overview of the behavioural approaches that have been developed to address cognitive dysfunction in the psychotic and affective disorders. Dr Saperstein and Dr Kurtz1 focus on cognitive remediation (CR) for schizophrenia, while Dr Bowie and colleagues2 address how CR is being used to treat people with psychotic and nonpsychotic affective disorders. We learn from these 2 papers that the field of psychology is at a crossroads. No longer is there debate about whether people with schizophrenia can learn, or if cognitive skills are malleable. The research overwhelmingly supports the efficacy of CR for schizophrenia and schizoaffective disorder-when it is done in the context of a psychiatric rehabilitation model. The evidence base for using CR for people with nonpsychotic affective disorders is relatively smaller; nevertheless, CR for mood disorders is emerging as an effective nonpharmacological treatment option for improving cognitive performance in people with major depressive disorder and BD. Further, CR impacts not only cognition but also, as intended, it helps to improve psychosocial functioning and reduce disability.Having established that cognitive deficits do respond to behavioural interventions, researchers are now tackling how to enhance the ability of CR to improve cognition, how to promote the transfer of cognitive gains to real-world functioning, and develop personalized treatments that are easily disseminated with fidelity. A tension has emerged as these issues are addressed. While there is tremendous enthusiasm for harnessing emerging knowledge about neuroplasticity to engineer more effective and efficient computer-based treatments, there is, simultaneously, a groundswell of support for integrating humanistic psychiatric rehabilitation principles into CR approaches to enhance functional outcomes. At their most extreme, these tensions emerge as camps.1 One side, fuelled by the technology industry, advocates a medical model approach that uses US Food and Drug Administration-approved computer devices that dose cognitive exercises like medications. The other side, fuelled by person-centred advocacy, emphasizes psychotherapeutic approaches to address the many factors (for example, beliefs, motivation, and emotions) that promote transfer of learning to real-world behaviours.The first large multisite study of CR in schizophrenia4 chose the model of dosed, device-based computer exercises to test the effectiveness of CR, and the results failed to replicate the promising findings from a single-site trial of device-based CR. …

The Perceived Stress Scale: Evaluating Configural, Metric and Scalar Invariance across Mental Health Status and Gender

The Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, Journal of Health and Social Behavior, 24: 385–396, 1983) and its derivatives are among the most commonly used self-report measures of subjective global stress. Several factorial models of the PSS have been proposed; however, which of these structures reliably measures individuals with mental illness remains unclear. Moreover, despite the detection of gender differences in perceived stress, factorial invariance between genders has not yet been tested with the PSS. Confirmatory factor analysis evaluating six prevailing factorial models of the PSS among a large sample of psychiatric patients and a matched community sample supported a two-factor model. Multiple group analysis established configural, metric and scalar invariance of this model across gender, but only configural invariance across samples differing by mental health status. Implications are that gender differences can be cautiously interpreted as true mean differences rather than artifacts of measurement bias; however, mean perceived stress factor scores should not be compared directly across psychiatric and non-psychiatric samples.

Implications of Weight-Based Stigma and Self-Bias on Quality of Life Among Individuals With Schizophrenia

Obesity has been associated with significant stigma and weight-related self-bias in community and clinical studies, but these issues have not been studied among individuals with schizophrenia. A consecutive series of 70 obese individuals with schizophrenia or schizoaffective disorder underwent assessment for perceptions of weight-based stigmatization, self-directed weight bias, negative affect, medication compliance, and quality of life. The levels of weight-based stigmatization and self-bias were compared with levels reported for nonpsychiatric overweight/obese samples. Weight measures were unrelated to stigma, self-bias, affect, and quality of life. Weight-based stigmatization was lower than published levels for nonpsychiatric samples, whereas levels of weight-based self-bias did not differ. After controlling for negative affect, weight-based self-bias predicted an additional 11% of the variance in the quality of life measure. Individuals with schizophrenia and schizoaffective disorder reported weight-based self-bias to the same extent as nonpsychiatric samples despite reporting less weight stigma. Weight-based self-bias was associated with poorer quality of life after controlling for negative affect.

Surgical treatment of morbid obesity among patients with bipolar disorder: a research agenda

Persons with bipolar disorder (BD) have an increased risk of obesity and associated diseases. Success of current behavioral treatment for obesity in patients with BD is inadequate. Existing literature on bariatric surgery outcomes in populations with BD were reviewed, and needed areas of research were identified. Knowledge about bariatric surgery outcomes among patients with BD is limited. Available evidence indicates that bariatric surgery is a uniquely effective intervention for achieving and sustaining significant weight loss and improving metabolic parameters. Notwithstanding the benefits of bariatric surgery in nonpsychiatric samples, individuals with BD (and other serious and persistent mental illnesses) have decreased access to this intervention. Areas of needed research include: (1) current practice patterns; (2) metabolic course after bariatric surgery; (3) psychiatric course after bariatric surgery; and (4) mechanisms of psychiatric effect. The considerable hazards posed by obesity in BD, as measured by illness complexity and premature mortality, provide the basis for hypothesizing that bariatric surgery may prevent and improve morbidity in this patient population. In addition to physical health benefits, bariatric surgery may exert a robust and favorable effect on the course and outcome of BD and reduce obesity-associated morbidity, the most frequent cause of premature mortality in this patient population.

Von Economo neuron density in the anterior cingulate cortex is reduced in early onset schizophrenia

The anterior cingulate cortex (ACC) represents a phylogenetically ancient region of the mammalian brain that has undergone recent adaptive changes in humans. It contains a large spindle-shaped cell type, referred to as von Economo neuron (VEN) that has been shown to be involved in the pathophysiology of various neuropsychiatric disorders. Schizophrenia is a group of disorders that is, in part, characterised by a disruption of neuronal migration in early ontogeny and presumably secondary degeneration after the first psychotic episode in some patients. Accordingly, we tested the hypothesis that the density of VENs is reduced in a neurodevelopmental subtype of schizophrenia, which we defined by an early onset of the disorder. The density of VENs was estimated in layer Vb of Brodmann's area 24 in 20 subjects diagnosed with schizophrenia. The results were compared with 19 specimens from patients with bipolar disorder as a clinical control and 22 non-psychiatric samples. The density of VENs did not differ between the three groups. However, the VEN density in the right ACC correlated with the age at onset, and inversely with the duration of the illness in schizophrenia, but not in bipolar disorder. Thus, patients with early onset schizophrenia (and longer duration of illness) had a reduced VEN density. Age, sex, postmortem interval, brain weight, and cortical thickness had no significant impact on the results. These findings suggest that VENs in the ACC are involved in neurodevelopmental and perhaps neurodegenerative processes specific to schizophrenia.

Interference With Wound Healing

To the Editor: Individuals with borderline personality disorder (BPD) are characterized by their persistent engagement in various self-destructive behaviors. While common self-destructive behaviors include self-mutilation (eg, cutting, hitting, scratching oneself) and suicide attempts, we have found in a number of empirical studies that some patients with BPD also intentionally prevent wounds from healing. In this study, which combines data from several smaller research projects that we have conducted, we compare the prevalence of interference with wound healing among patients with BPD from psychiatric versus nonpsychiatric (ie, internal medicine, bariatric surgery, family medicine, buprenorphine) treatment settings. Method. Participants consisted of 771 females and 269 males (N = 1,040), both from psychiatric settings (all from 1 inpatient site, n = 441)1–4 and from various medical settings (ie, internal medicine, all from the same site (references 5–9 and R.A.S.; L. Gebauer, MD; T. Moussa, MD; et al, unpublished manuscript, 2007), n = 332; bariatric medicine, from 1 site,10 n = 121; family medicine, from 1 site, n = 3411; buprenorphine treatment, from 1 site,12 n = 112), who participated in 1 of 13 separate research projects. The descriptions of these individual samples can be found in the original reports for each (references 1–12 and R.A.S.; L. Gebauer, MD; T. Moussa, MD; et al, unpublished manuscript, 2007). In all of these individual studies, participants completed 1 of 2 versions of the borderline personality scale of the Personality Diagnostic Questionnaire (PDQ), either the PDQ-R13 or the PDQ-4,14 as well as the Self-Harm Inventory (SHI).15 We used the borderline personality scale of each PDQ version to diagnose borderline personality symptomatology (BPS) in participants. The borderline personality scale of the PDQ is a true/false self-report measure that consists of the diagnostic criteria for borderline personality that are listed in the DSM (ie, PDQ-R, DSM-III-R; PDQ-4, DSM-IV). Various versions of the PDQ have been confirmed as useful screening tools for borderline personality in both clinical16,17 and nonclinical samples,18 including the use of the free-standing borderline scale.19 After dividing the subsamples according to BPS status, we examined participants' responses to 1 item on the SHI, which is a 22-item self-report measure of self-harm behavior—“Have you ever intentionally, or on purpose…prevented wounds from healing?” Results. In the psychiatric samples (n = 441),1–4 325 respondents (73.7%) exceeded the PDQ cut-off score for BPS. Compared to psychiatric respondents who did not exceed the PDQ cut-off score (n = 116), the BPS group was significantly more likely to endorse “prevented wounds from healing” (16.9% vs 9.5%, t1,439 = 2.16, P < .05). In the various medical samples (n = 599),5–13 169 respondents (28.2%) exceeded the PDQ cut-off score for BPS. Compared to respondents who did not exceed the PDQ cut-off score (n = 430), the BPS group was significantly more likely to endorse “prevented wounds from healing” (13.0% vs 1.6%, t1,597 = 4.29, P < .001). In the internal medicine–only samples (n = 332),5–10 78 respondents (23.5%) exceeded the PDQ cut-off score for BPS. Compared to respondents who did not exceed the PDQ cut-off score (n = 254), the BPS group was significantly more likely to endorse “prevented wounds from healing” (12.8% vs 2.0%, t1,330 = 2.78, P < .01). We next considered only those respondents who exceeded the PDQ cut-off score for BPS. Such respondents from psychiatric samples were no more likely to have endorsed “prevented wounds from healing” (16.9%) when compared to respondents from either various medical samples (13.0%, t1,492 = 1.17, P < .15) or internal medicine–only samples (12.8%, t1,401 = 0.95, P < .20). These data indicate several important findings. First, among patients with BPS, whether in psychiatric or medical settings, a similar proportion report preventing wounds from healing (13%–17%). In other words, the prevention of wound healing does not appear to be more common in medical settings. Second, in a psychiatric setting, preventing wounds from healing does not appear to be particularly specific to BPS. Indeed, there may be patients with other types of psychiatric disorders that wash out the specificity of this relationship (eg, obsessive-compulsive disorder, schizophrenia, other personality disorders). In contrast, in a medical setting, the relationship between preventing wounds from healing and BPS is far more specific. Therefore, this behavior in a primary care setting is highly likely to be associated with BPS. This study has a number of potential limitations, including the self-report nature of all data, the use of 2 versions of the PDQ, various nonpsychiatric samples, and the consolidation of multiple samples for analysis. However, it is the only study that we are aware of that has examined in broad psychiatric and medical samples the relationship between BPS and the prevention of wound healing.

Childhood Sexual Abuse is Associated With Physical Illness Burden and Functioning in Psychiatric Patients 50 Years of Age and Older

To examine the association of childhood sexual abuse (CSA) with cumulative illness burden, physical function, and bodily pain (BP) in a sample of male and female psychiatric patients >or=50 years of age. Previous research on the health consequences of sexual abuse has focused on nonpsychiatric samples of younger-age adults, especially women. The health implications of abuse for mixed-gender samples of older psychiatric patients have not been explored. Participants were 163 patients with primary mood disorders. Sexual abuse histories were collected via patient self-report, as was BP. The measure of medical illness burden was based on chart review. Clinical interviewers rated physical function, using the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) scales. Linear and logistic regressions examined the association between CSA and health outcomes. As hypothesized, severe childhood sexual abuse was associated with higher cumulative medical illness burden, worse physical function, and greater BP. Comparisons of regression coefficients revealed that severe CSA's influence on illness burden is roughly comparable to the effects of adding 8 years of age. For ADL impairment and BP, the effects are comparable to adding 20 years of age. Strong relationships exist between CSA and medical illness burden, function, and pain among psychiatric patients >or=50 years of age. These relationships cannot be ascribed to shared method variance. Early detection of patients' abuse histories could inform targeted interventions to prevent or decelerate the progression of morbidity in this high-risk group.

P02-107 Children of psychiatric in-patients - prevalence, psychiatric symptoms and obstacles for professional support

Aims:Children of mentally ill parents are at high risk to develop psychiatric disorders. Psychiatric disorders often limit parenting skills and there are obstacles to accept professional help for the children. The study aimed to explore the prevalence of mentally ill parents in inpatient treatment, emotional and behavioural problems of their children, access to support for their children and obstacles for receiving support.Method:Inpatients of psychiatric hospitals of a county were examined by questionnaires (amongst other scales the Strengths and Difficulties Questionnaire (SDQ).Results:104 patients with children were detected, 81 patients with 165 children were enrolled. Most of the patients had more than one child and most of them had more than 3 prior inpatient treatments. Results in the SDQ indicated an up to fife fold increased number of children with emotional/behavioural problems compared to non-psychiatric samples. Even it 40% of the patients were dissatisfied with the care of their children during treatment, they seek seldom professional help. 51% have strong resentments against the youth welfare custodies. 55% quote that they cancelled or missed former inpatient treatments because of the inadequate nurturance of their children.Conclusion:Identification of children with need for professional support can be improved by using standardized questionnaires. Study results imply that psychiatrist should focus on parenthood of their patients and specialised offers of support are needed.

Dimensional Structure of the Frankfurt Complaint Questionnaire in a Sample of French Students

Background: The Frankfurt Complaint Questionnaire (FCQ) is a questionnaire designed to evaluate the subjective symptoms of schizophrenics. In schizophrenic samples, several validation studies of the FCQ using principal components analyses (PCA) have shown a one-factor solution. Aim: The aim of the present study was firstly to examine the factor structure and the psychometric properties of the FCQ in a sample of 399 students and secondly to explore the reliability of the FCQ-24, a 24-item subscale extracted from the FCQ. Method: PCA was done using several guidelines to select the number of factors. Results: PCA yielded one factor, and the values of the Cronbach alpha were 0.95 and 0.87 for FCQ and FCQ-24, respectively. Conclusions: These results firstly suggested an unidimensionality underlying FCQ items in nonpsychiatric samples and secondly confirmed the satisfactory reliability and validity of the FCQ and its subscale. Psychometric properties of the rating scales must be confirmed in other nonpsychiatric samples. Clinical relevance: As subjective symptoms allow to detect subjects prone to schizophrenia, it is important to use well-validated rating scales.