Risk Of Severe Mental Illness Research Articles

293. Two-Year Trajectories of Anhedonia in Adolescents at Transdiagnostic Risk for Severe Mental Illness: Association With Clinical Symptoms and Brain-Symptom Links

293. Two-Year Trajectories of Anhedonia in Adolescents at Transdiagnostic Risk for Severe Mental Illness: Association With Clinical Symptoms and Brain-Symptom Links

Comparison of early risk factors between healthy siblings and subjects with schizophrenia and bipolar disorder.

The following work aims to compare the types and magnitude of risk events in patients with Schizophrenia and Bipolar Disorder and each of those groups with of a group of healthy siblings, exploring differences and similarities of the two psychotic disorders. Retrospective interviews were conducted with 20 families to investigate maternal and obstetric health, social support and the presence of early trauma for the affected family members and healthy siblings. Mothers were interviewed with the Prenatal Psychosocial Profile and each family participant was assessed with the Early Trauma Inventory, Screening Questionnaire of the Genomic Psychiatry Cohort and the Diagnostic Interview for Psychosis and Affective Disorders. Obstetric and gestational history, pregnancy weight changes and early trauma were associated with offspring's mental illness, including statistically significant findings for complications of pregnancy, pregnancy weight changes, general trauma, physical punishment and emotional abuse. These findings highlight the different risk factor exposures that occur within a family, which may increase the risk for severe mental illness.

Debate: The prevention of psychosis in child and adolescent mental health services.

Psychopathological conditions in adolescence and young adulthood often result from an altered neurodevelopment already phenotypically expressed in childhood. Child and adolescent mental health services are ideally placed to intercept in the developmental trajectories of younger adolescents and contribute to the early detection of a risk for psychosis, as proposed by Salazar de Pablo and Arango (2023, Child and Adolescent Mental Health), opening a debate to which we contribute. The early detection of a specific risk for psychosis and of a broader risk for severe mental illness requires an understanding of the clinical staging of psychosis, neurodevelopmental antecedents of severe mental illness and of heterotypic trajectories between childhood phenotypes and adult disorders.

Anhedonia in adolescents at transdiagnostic familial risk for severe mental illness: Clustering by symptoms and mechanisms of association with behavior

BackgroundAnhedonia is a transdiagnostic symptom of severe mental illness (SMI) and emerges during adolescence. Possible subphenotypes and neural mechanisms of anhedonia in adolescents at risk for SMI are understudied. MethodsAdolescents at familial risk for SMI (N = 81) completed anhedonia (e.g., consummatory, anticipatory, social), demographic, and clinical measures and one year prior, a subsample (N = 46) completed fMRI scanning during a monetary reward task. Profiles were identified using k-means clustering of anhedonia type and differences in demographics, suicidal ideation, impulsivity, and emotional processes were examined. Moderation analyses were conducted to investigate whether levels of brain activation of reward regions moderated the relationships between anhedonia type and behaviors. ResultsTwo-clusters emerged: a high anhedonia profile (high-anhedonia), characterized by high levels of all types of anhedonia, (N = 32) and a low anhedonia profile (low-anhedonia), characterized by low levels of anhedonia types (N = 49). Adolescents in the high-anhedonia profile reported more suicidal ideation and negative affect, and less positive affect and desire for emotional closeness than low-anhedonia profile. Furthermore, more suicidal ideation, less positive affect, and less desire for emotional closeness differentiated the familial high-risk, high-anhedonia profile adolescents from the familial high-risk, low-anhedonia profile adolescents. Across anhedonia profiles, moderation analyses revealed that adolescents with high dmPFC neural activation in response to reward had positive relationships between social, anticipatory, and consummatory anhedonia and suicidal ideation. LimitationsSmall subsample with fMRI data. ConclusionProfiles of anhedonia emerge transdiagnostically and vary on clinical features. Anhedonia severity and activation in frontostriatal reward areas have value for clinically important outcomes such as suicidal ideation.

The well-being of children at familial risk of severe mental illness: an overlooked yet crucial prevention and early intervention opportunity

The well-being of children at familial risk of severe mental illness: an overlooked yet crucial prevention and early intervention opportunity

174. Anhedonia in Adolescents at Transdiagnostic Familial Risk for Severe Mental Illness: Clustering by Symptoms and Mechanisms of Association With Behavior

174. Anhedonia in Adolescents at Transdiagnostic Familial Risk for Severe Mental Illness: Clustering by Symptoms and Mechanisms of Association With Behavior

Dynamic contributions of socioeconomic status to mental health with the resettlement process among refugees

Socioeconomic status (SES) is shown to be associated with refugees’ mental health, but few studies have considered that these associations may vary over time. This study aimed to examine the dynamic contributions of SES to refugees’ mental health during resettlement. We used five waves of data from a cohort study in Australia; 2399 refugees completed the interview in Wave 1, and the remaining waves had 2009, 1894, 1929, and 1881 participants, respectively. SES, high risk of severe mental illness (HR-SMI), and post-traumatic stress disorder (PTSD) were assessed in each wave. Weighted multilevel regression models were performed, and analyses were stratified by sex. For both sexes, financial hardships were consistently positively associated with HR-SMI and PTSD across all five waves. However, time or sex differences were more pronounced for associations between other SES factors and mental health. For males, there were negative associations of current paid jobs with HR-SMI and PTSD in Waves 3–5. For females, the current paid job was negatively associated with HR-SMI only in Wave 5. Our findings highlight the dynamic associations and sex differences between SES and refugees’ mental health. We recommend interventions focusing on increasing employment opportunities, particularly for male refugees in the later resettlement stages.

Detecting individuals with severe mental illness using artificial intelligence applied to magnetic resonance imaging.

Identifying individuals at risk for severe mental illness (SMI) is crucial for prevention and early intervention strategies. While MRI shows potential for case identification even before illness onset, no practical model for mental health risk monitoring has been developed. This study aims to develop an initial version of an efficient and practical model for mental health screening among at-risk populations. A deep learning model known as Multiple Instance Learning (MIL) was adopted to train and test a SMI detection model with clinical MRI scans of 14,915 patients with SMI (age 32.98±12.01 years, 9102 women) and 4538 healthy controls (age 40.60±10.95 years, 2424 women) in the primary dataset. Validation analysis was conducted in an independent dataset with 290 patients (age 28.08±10.95 years, 169 women) and 310 healthy participants (age 33.55±11.09 years, 165 women). Another three machine learning models of ResNet, DenseNet and EfficientNet were used for comparison. We also recruited 148 individuals receiving high-stress medical school education to characterize the potential real-world utility of the MIL model in detecting risk of mental illness. Similar performance of successful differentiation of individuals with SMI and healthy controls was observed for the MIL model (AUC: 0.82) and other models (ResNet, DenseNet, EfficientNet, 0.83, 0.81, and 0.80 respectively). MIL had better generalization in the validation test than other models (AUC: 0.82 vs 0.59, 0.66 and 0.59), and less drop-off in performance from 3.0T to 1.5T scanners. The MIL model did better in predicting clinician ratings of distress than self-ratings with questionnaires (84% vs 22%) in the medical student sample. Brain regions that contributed to SMI identification were mainly neocortical, including right precuneus, bilateral temporal regions, left precentral/postcentral gyrus, bilateral medial prefrontal cortex and right cerebellum. Our digital model based on brief clinical MRI protocols identified individual SMI patients with good accuracy and high sensitivity, suggesting that with incremental improvements the approach may offer potentially useful aid for early identification and intervention to prevent illness onset in vulnerable at-risk populations. This study was supported by the National Natural Science Foundation of China, National Key Technologies R&D Program of China, and Sichuan Science and Technology Program.

Mental health and associated risk factors of Puerto Rico Post-Hurricane María.

Mental health disorders have an increased prevalence in communities that experienced devastating natural disasters. Maria, a category 5 hurricane, struck Puerto Rico on September 20, 2017, weakening the island's power grid, destroying buildings and homes, and limiting access to water, food, and health care services. This study characterized sociodemographic and behavioral variables and their association with mental health outcomes in the aftermath of Hurricane Maria. A sample of 998 Puerto Ricans affected by Hurricane Maria was surveyed between December 2017 and September 2018. Participants completed a 5-tool questionnaire: Post-Hurricane Distress Scale, Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder (GAD) 7, and Post-Traumatic Stress Disorder checklist for DSM-V. The associations of sociodemographic variables and risk factors with mental health disorder risk outcomes were analyzed using logistic regression analysis. Most respondents reported experiencing hurricane-related stressors. Urban respondents reported a higher incidence of exposure to stressors when compared to rural respondents. Low income (OR = 3.66; 95% CI = 1.34-11.400; p < 0.05) and level of education (OR = 4.38; 95% CI = 1.20-15.800; p < 0.05) were associated with increased risk for severe mental illness (SMI), while being employed was correlated with lower risk for GAD (OR = 0.48; 95% CI = 0.275-0.811; p < 0.01) and lower risk for SIM (OR = 0.68; 95% CI = 0.483-0.952; p < 0.05). Abuse of prescribed narcotics was associated with an increased risk for depression (OR = 2.94; 95% CI = 1.101-7.721; p < 0.05), while illicit drug use was associated with increased risk for GAD (OR = 6.56; 95% CI = 1.414-39.54; p < 0.05). Findings underline the necessity for implementing a post-natural disaster response plan to address mental health with community-based social interventions.

Negative life events are associated with risk of mental illness among Japanese university students

Negative life events are associated with risk of mental illness among Japanese university students

Insulin resistance and lipid levels in the middle-aged offspring of parents with severe mental illness

BackgroundType 2 diabetes and dyslipidemias co-occur frequently with severe mental illnesses (SMI). However, less is known about serum insulin and lipid levels and prevalence of Insulin Resistance (IR) in offspring with familial risk for SMI. MethodThe Northern Finland Birth Cohort 1966 consists of 12,068 mothers, 11,068 fathers, and 12,231 children from the two northernmost provinces in Finland. At age 46 they participated in clinical examination including measurements of glucose, lipids, and IR and answered a questionnaire including information about their nutrition and physical activity. The information on parental SMI was obtained from the Hospital Discharge Register. Parents with SMI were those who had been treated in hospital for any psychiatric disorder during 1969–1982 (ICD-8 codes 290–315). The final study group included 334 (7.3 %) offspring who had a parent with SMI and 4249 (92.7 %) offspring in the comparison group. ResultsWe did not find increased risk for disturbances in lipid levels, insulin levels, or IR levels between the study group (offspring of either parent with SMI) compared with the comparison group. All offspring, especially female offspring of either parent with SMI, had an increased risk for higher glucose levels and waist circumference. The results remained the same after excluding offspring with SMI. ConclusionOur findings suggest that offspring of parents with SMI, especially female offspring, have partly increased risk for disturbances in cardiometabolic risk factors. Disturbances in glucose metabolism may have an effect via familial risk of severe mental illness.

Twin pregnancy and severe maternal mental illness: a Canadian population-based cohort study.

Twin pregnancy is a risk factor for postpartum depression and anxiety. Whether this translates into a higher risk of severe maternal mental illness in the short-term or long-term is unknown. This study was a population-based retrospective cohort study, using linked health administrative databases for the entire province of Ontario, Canada. Included were primiparas aged 15-50years with a twin vs. singleton hospital livebirth, between January 1, 2003, and March 31, 2019. Propensity-score inverse probability of treatment weights accounted for potential confounding. The primary outcome of severe mental illness comprised a composite of an emergency department visit or hospitalization for mental illness or self-injury, or death by suicide, assessed in the first year after birth, and in long-term follow-up, up to 17years thereafter. Fifteen thousand twenty-four twin and 796,804 (15,022 weighted) singleton births were included, with a mean (IQR) duration of follow-up of 9 (5-13) years. After weighting, the mean (SD) maternal age was 31.3 (5.5) years. In the first 365days postpartum, severe mental illness occurred at rates of 10.5 and 8.7 per 1000 person-years in twin and singleton mothers, respectively, corresponding to a hazard ratio (HR) of 1.21 (95% CI 1.07-1.47). From 366days onward, the corresponding figures were 5.9 and 6.1 per 1000 person-years (HR 0.96, 95% CI 0.89-1.04). Individuals with a twin birth appear to experience an increased risk for severe mental illness in the first year postpartum, but not thereafter. This suggests a potential need for targeted counselling and mental health services for mothers within the first year after birth.

Developing a clinical decision tool based on electroretinogram to monitor the risk of severe mental illness

BackgroundWe have shown that electroretinograms can discriminate between patients with severe mental illness (SMI) and healthy controls in previous studies. We now intend to enhance the development and clinical utility of ERG as a biological tool to monitor the risk of SMI.MethodologyA sample of 301 SMI patients (bipolar disorder or schizophrenia) and 200 controls was first split into a training (N = 401) and testing dataset (N = 100). A logistic regression using ERG was modeled in the training data, while external validation and discriminative ability were assessed in the testing data. A decision curve analysis was used to test clinical usefulness. Moreover, the identification of thresholds of uncertainty based on the two-graph ROC and the interval of uncertainty was used to enhance prediction.ResultsThe discriminative assessment of the ERG showed very high sensitivity (91%) and specificity (89%) after considering uncertainty levels. Furthermore, for prediction probabilities ranging from 0.14 to 0.95 in the testing data, the net benefit of using our ERG model to decide whether to intervene or not exceeded that of never or always intervening.ConclusionThe ERG predicted SMI risk with a high level of accuracy when uncertainty was accounted for. This study further supports the potential of ERG to become a useful clinical decision tool to decide the course of action for subjects at risk of SMI. However, further investigation is still needed in longitudinal studies to assess the external validity of the instrument.

Emotion regulation in 7‐year‐old children with familial high risk for schizophrenia or bipolar disorder compared to controls – The Danish High Risk and Resilience Study – VIA 7, a population‐based cohort study

Emotion regulation is a predictor of overall life outcome. Problems of emotion regulation are associated with multiple psychiatric disorders and could be a potential treatment target for improving well-being and functioning. Children at familial high risk of severe mental illness have a markedly increased risk of various psychopathology and constitute a group at significant risk of emotion regulation problems. Investigations of emotion regulation in children at familial high risk of severe mental illness are sparse. We applied an instrument for assessing emotion regulation, the Tangram Emotion Coding Manual (TEC-M), to a population-based cohort of 522 7-year-old children born to parents diagnosed with either schizophrenia or bipolar disorder and matched controls. The TEC-M is an ecologically valid, clinician-rated observational test measure of spontaneous emotion regulation. We aimed to compare emotion regulation between risk groups and to investigate associations between emotion regulation and psychopathology and daily life functioning, and between emotion regulation and an acknowledged questionnaire-based dysregulation profile. In this early developmental phase, we found no between group differences in emotion regulation. We found a significant but weak negative association between emotion regulation and both child psychopathology and the presence of a dysregulation profile on the Child Behavior Checklist and a weak positive association between emotion regulation and current level of functioning. These findings contribute to the understanding of emotion regulation in familial high-risk children and further studies of emotion regulation in children at familial high risk of severe mental illness are warranted.

Social Connectedness in Schizotypy: The Role of Cognitive and Affective Empathy.

Social connectedness is increasingly understood to be a resilience factor that moderates vulnerability to poor physical and mental health. This study examines cognitive and affective processes that support normal socialization and social connectedness, and the impact of schizotypy, in well-functioning college students. In this study, a total of 824 college students completed a series of self-report questionnaires, and structural equation modeling was then employed to identify relationships between cognitive and affective empathy, alexithymia, distress tolerance, social connectedness, and schizotypy. Schizotypy is a trait-like condition, presumed to be genetic in origin, associated with the risk for schizophrenia. Like schizophrenia, schizotypy is thought to have three distinct dimensions or categories, termed positive, negative, and disorganized. Results indicate that the respective dimensions of schizotypy have different pathways to social connectedness, through both direct and indirect effects. Positive schizotypy exerts a counterintuitive positive influence on social connectedness, mediated by positive effects on cognitive empathy, but this is obscured by the high correlations between the schizotypal dimensions and the strong negative influences on empathy and social connectedness of the negative and disorganized dimensions, unless all those intercorrelations are taken into account. Overall, the pathways identified by structural equation modeling strongly support the role of empathy in mediating the impact of schizotypy on social connectedness. Implications for the etiology of social impairments in schizotypy, and for interventions to enhance social connectedness to improve quality of life and reduce health disparities in people at risk for severe mental illness, are discussed.

Twin pregnancy and severe maternal mental illness: A Canadian population-based retrospective cohort study

Twin pregnancy is a risk factor for early postpartum depression and anxiety. Whether this translates into a higher risk of severe maternal mental illness is unknown. The objective of this study was to compare women with a twin vs. singleton birth, and their risk of severe mental illness in the first year after birth, as well as starting from 1 year after birth.

56.4 STRATEGIES THAT THE NATIONAL TRAINING AND TECHNICAL ASSISTANCE CENTER FOR CHILD, YOUTH, AND FAMILY MENTAL HEALTH (NTTAC) EMPLOYS TO IMPLEMENT A MORE EFFECTIVE SYSTEM OF CARE PROGRAM

Participants will learn how the National Training and Technical Assistance Center for Child, Youth, and Family Mental Health (NTTAC) works with SAMHSA grantees and other communities to help develop systems of care. NTTAC is a partnership between 7 organizations with a history of serving the mental health workforce and systems of care nationwide. NTTAC is organized around 6 “Transformation Teams” that each provide trainings, technical assistance, and resources on a specific area of expertise. An array of learning events is offered at no cost to participants, including mental health professionals, primary care providers, peers, educators, systems leaders, and other youth-serving professionals. Jeff Bostic, MD, EdD, Clinical Director Lead for the Clinical Practice and Health Care Team, will explore how NTTAC partners with states, tribes, territories, and communities to help develop effective and efficient delivery systems that benefit children, youth, and young adults with behavioral health needs and their families. Participants will understand the role of NTTAC to provide innovative, responsive, and multimodal training and technical assistance (TTA) that supports systems-level change and the advancement of evidence-based, culturally responsive practice. They will learn how to access progressive learning opportunities to support different needs and audiences, ranging from intensive consultation to peer learning exchanges to multiday training events. Child and adolescent psychiatrists can access NTTAC to receive training, technical assistance, and resources to build or enhance system-of-care communities and serve young people with or at risk for severe mental illness or serious emotional disturbances.

The Psychological and Sleep-Related Impact of Coronavirus Disease 2019 (COVID-19): A Systematic Review

The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on mental health and sleeps quality that is unprecedented in the 21st century. This systematic review aimed to assess the psychological impact of COVID-19 and its effect on people’s sleep. Systematic searches were conducted via PubMed, ScienceDirect, and ProQuest from 2019 to August 2020, following PRISMA guidelines. Articles were selected based on eligibility criteria such as having a cross-sectional study design, assessing the general public’s mental health status or sleep problems, medical workers and non-medical workers during the COVID-19 pandemic, and using standardized and validated scales for measurement. The keywords: COVID-19 OR SARS-CoV-2 AND Mental health OR Psychological health AND General population OR General public AND sleep AND Impact of Coronavirus disease 2019. A total of 23 articles were selected after being assessed. During the period of the COVID-19 pandemic, medical workers were found to have psychological problems such as anxiety, depression, stress, PTSD, psychological distress, somatization symptoms, suicidal ideation, high risk of severe mental illness, worry, and insomnia. Non-medical workers experienced symptoms of depression. The general public experienced psychological problems: depression, anxiety, stress, bad mood, inability to stop thinking about COVID-19, panic, and experiencing sleep problems such as changing sleep patterns, sleep disturbances, sleep quality, difficulty with sleep initiation, and shortened sleep duration. The COVID-19 pandemic has been associated with psychological problems and sleep disorders for medical workers, non-medical workers, and the general public.

Increasing referrals to emergency department for psychiatric consultation and treatment among 50,056 adolescents and young adults: Predictors and implications.

To identify predictors and time trends over 10years of psychiatric consultation or treatment in adolescents and young adults referring to Emergency Department (ED). Real-world cohort data from 50,056 adolescents and young adults referring 105,596 times to ED between 2007 and 2016. We tested whether gender, age, triage code (red, yellow, green, white with decreasing severity), and referral modality predicted primary (psychiatric consultation) or secondary outcomes (anxiolytic treatment, sedative treatment, psychiatric admission), and whether these outcomes increased over the last 10years. Mean age was 19.57(SD=2.52), female percentage was 48.77%. Overall, 6.93% underwent psychiatric consultation, treatment, or admission. Among 2,547 adolescents and young adults undergoing a psychiatric consultation, 58.07% had either yellow or red triage code, and 47.2% were brought by ambulance. Female gender predicted psychiatric consultation and anxiolytic treatment, male gender predicted sedative treatment, suggesting gender differences in help-seeking behaviors. Older age predicted all outcomes. Severe triage presentation and being brought by ambulance increased the risk of primary and secondary outcomes. Psychiatric consultation (1.77% to 3.64%), anxiolytic (3.04% to 6.15%), or admission (0.40% to 0.98%) roughly doubled, and sedative (0.27% to 1.23%) treatment had a four-fold increase from 2007 to 2016. Among adolescents and young adults aged 15 to 24years old ED appears to be necessary for young help-seeking subjects given the severe presentations and the increasing number of adolescents referring to ED. More studies should assess whether ED might be helpful in detecting subjects with sub-threshold or early psychiatric symptoms, or at risk for severe mental illness.

Relationships between changes due to COVID-19 pandemic and the depressive and anxiety symptoms among mothers of infants and/or preschoolers: a prospective follow-up study from pre-COVID-19 Japan

ObjectivesMothers with young children are particularly vulnerable to the impacts of the lifestyle changes brought about by the COVID-19 pandemic. However, the association between such changes and maternal mental health...