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PubMed ID: 21525167, A growing number of studies demonstrate high rates of subthreshold psychotic experiences, but there is considerable heterogeneity in rates due to study cohort and design factors, obscuring how prevalent psychotic experiences may or may not relate to rare psychotic disorders. In a representative general population sample (n 4011) in Izmir, Turkey, the full spectrum of expression of psychosis was categorized across 5 groups representing (1) absence of psychosis, (2) subclinical psychotic experiences, (3) low-impact psychotic symptoms, (4) high-impact psychotic symptoms, and (5) full-blown clinical psychotic disorder and analyzed for continuity and discontinuity in relation to (1) other symptom dimensions associated with psychotic disorder and (2) proxies of genetic and nongenetic etiology. Results were tested for linear and extralinear contrasts between clinical and nonclinical and between disorder and nondisorder expression of psychosis. Demographic variables, indexing premorbid social adjustment and socioeconomic status, impacted mostly linearly; proxy variables of genetic loading (more or more severely affected relatives) impacted in a positive extralinear fashion; environmental risk factors sometimes impacted linearly (urbanicity and childhood adversity) and sometimes extralinearly (cannabis), occasioning a disproportional shift in risk at the clinical disorder end of the spectrum. Affective symptoms were associated with a disproportionally higher risk below the disorder threshold, whereas a disproportionally higher risk above the threshold was associated with psychotic symptom load, negative symptoms, disorganization, and visible signs of mental illness. Liability associated with respectively affective and nonaffective symptom domains, in interaction with environmental risks, may operate by impacting differentially over a quasi-continuous extended psychosis phenotype in the population. © 2012 The Author.

WOS: 000310630300004, PubMed ID: 22717152, Background. Familial liability to both severe and common mental disorder predicts psychotic disorder and psychotic symptoms, and may be used as a proxy in models examining interaction between genetic risk and the environment at individual and contextual levels. Method. In a representative general population sample (n-4011) in Izmir, Turkey, the full spectrum of expression of psychosis representing (0) no symptoms, (1) subclinical psychotic experiences, (2) low-impact psychotic symptoms, (3) high-impact psychotic symptoms and (4) full-blown clinical psychotic disorder was assessed in relation to mental health problems in the family (proxy for familial liability) and the wider social environment. Quality of the wider social environment was assessed in an independent sample using contextual measures of informal social control, social disorganization, unemployment and low income, aggregated to the neighbourhood level. Results. The association between familial liability to severe mental illness and expression of psychosis spectrum was stronger in more deprived neighbourhoods [ e. g. this association increased from beta=0.33 (p=0.01) in low-unemployment neighbourhoods to beta-0.92 (p, Scientific and Technological Council of Turkey 1001 programmeTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [107S053]; Psychiatric Association of Turkey; European CommunityEuropean Community (EC) [HEALTH-F2-2009-241909], This work is part of the TurkSch project, funded by the Scientific and Technological Council of Turkey 1001 programme (project no. 107S053). Stage 2 of the TurkSch project was also funded by the Psychiatric Association of Turkey (award for research projects, 2008).; This study was supported by the European Community's Seventh Framework Program under grant agreement no. HEALTH-F2-2009-241909 (project EU-GEI).

Amaç: Bir genel toplum örnekleminde psikotik belirtilerin görüldüğü 12 DSM-IV bozukluğunun yaşamboyu yaygınlıklarını saptamak amaçlanmıştır. Yöntem: Çok katmanlı kümeli bir örnekleme yöntemiyle İzmir kent merkezinde yer alan dokuz ilçe ve 302 mahalleden saptanan haneler Kasım 2007-Ekim 2008 arasında ziyaret edildi. Her hanede rastgele örnekleme yöntemiyle seçilen 15-64 yaş arası bir kişiyle görüşme yapıldı. Temel tarama aracı olarak Uluslararası Bileşik Tanı Görüşmesi 2.1 kullanıldı. Olası olguları saptamak için farklı basamaklardan oluşan sistematik bir tarama yapıldı. Olası olgu olarak tanımlanan kişiler DSM-IV İçin Yapılandırılmış Klinik Görüşme ile yeniden değerlendirildi. Klinik değerlendirme yapılamayanların tanıları bildirdikleri kayıtlara ve/veya yakınlarına ulaşılarak ya da tarama sonucuna göre netleştirildi. Bulgular: Toplam 4011 kişi olası psikotik bozukluklar için tarandı. 449 kişi olası olgu olarak tanımlandı. Olası olgulardan 277’sine klinik değerlendirme uygulandı. Görüşülemeyen 172 kişinin tanısı kayıtlar aracılığıyla ya da yapılan ilk taramaya göre netleştirildi. Psikotik belirtilerin görüldüğü 12 DSM-IV bozukluğunun yaşamboyu toplam yaygınlığı %2.62 olarak saptandı. Her bir bozukluğun yaygınlık tahminleri ise şizofreni için %0.74, şizoaffektif bozukluk için %0.20, şizofreniform bozukluk için %0.05, sanrısal bozukluk için %0.10, kısa psikotik bozukluk için %0.12, psikotik bulgulu depresyon için %0.55, bipolar I bozukluk için %0.37, madde kullanımına bağlı psikotik bozukluk için %0.20 ve tıbbi duruma bağlı psikotik bozukluk için %0.07 idi. Sonuç: Psikotik belirtilerin belirleyici olduğu psikiyatrik bozuklukların yaşamboyu yaygınlığı Türkiye’de daha önce bildirilen oranlardan daha yüksektir. %2.5’i aşan yaygınlıklarıyla bu bozukluklar önde gelen halk sağlığı sorunlarından bir tanesini oluşturmaktadır., Objective: To estimate the lifetime prevalence of 12 DSM-IV disorders with psychotic symptoms in a general population survey. Method: Addresses were contacted in a multistage clustered area probability sampling frame of administrative neighbourhoods and households, covering 9 districts and 302 neighbourhoods in the Izmir metropolitan area between November 2007 and October 2008. One household member aged between 15 and 64 years and available to complete the interview was randomly selected using a withinhousehold sampling method. The primary screening instrument was the Composite International Diagnostic Interview 2.1. A systematic screening procedure was implemented to detect probable cases with any psychotic disorder. Those selected by the screens were re-interviewed with the Structured Clinical Interview for DSM-IV. Diagnoses of individuals who were not available for re-interview were made by combining screening information with case register diagnoses and/or the telephone interviews with relatives or spouse. Results: A total of 4011 individuals were screened for disorders with psychotic symptoms. After screening, 499 respondents were selected as a probable case. 277 of screen positive respondents were available for clinical reappraisal. Initial screening interviews and additional material were used for best estimate diagnoses of the remaining 172 respondents. Total lifetime prevalence of 12 DSM-IV disorders with psychotic symptoms was 2.62%. Lifetime prevalence of each disorder separately were as follows: 0.74% for schizophrenia, 0.20% for schizoaffective disorder, 0.05% for schizophreniform disorder, 0.10% for delusional disorder, 0.12% for brief psychotic disorder, 0.55% for major depressive disorder with psychotic features, 0.37% for bipolar I disorder, 0.20% for substance induced psychotic disorder, and 0.07% for psychotic disorders due to a general medical condition. Conclusion: Total lifetime prevalence of disorders with psychotic symptoms is higher than any previously reported estimates in Turkey; with a prevalence of approximately 2.5%, these disorders can be considered a major public health concern.

Past analyses examining the relationship between genetic variation in the 5, 10-methylenetetrahydrofolate reductase (MTHFR) gene and psychiatric disorders have provided mixed and largely inconclusive findings. MTHFR is involved in the one-carbon metabolic pathway which is essential for DNA biosynthesis and the epigenetic process of DNA methylation. We conducted a meta-analysis of all published case-control studies investigating associations between two common MTHFR single nucleotide polymorphisms (SNPs), MTHFR C677T (sample size 29,502) and A1298C (sample size 7934), and the major psychiatric disorders (i) schizophrenia (SZ), (ii) bipolar disorder (BPD), and (iii) unipolar depressive disorder (UDD). In order to examine possible shared genetic vulnerability, we also tested for associations between MTHFR and all of these major psychiatric disorders (SZ, BPD and UDD) combined. MTHFR C677T was significantly associated with all of the combined psychiatric disorders (SZ, BPD and UDD); random effects odds ratio (OR) = 1.26 for TT versus CC genotype carriers; confidence interval (CI) 1.09-1.46); meta-regression did not suggest moderating effects of psychiatric diagnosis, sex, ethnic group or year of publication. Although MTHFR A1298C was not significantly associated with the combination of major psychiatric disorders, nor with SZ, there was evidence for diagnostic moderation indicating a significant association with BPD (random effects OR = 2.03 for AA versus CC genotype carriers, CI: 1.07-3.86). Meta-analysis on UDD was not possible due to the small number of studies available. This study provides evidence for shared genetic vulnerability for SZ. BPD and UDD mediated by MTHFR 677TT genotype, which is in line with epigenetic involvement in the pathophysiology of these psychiatric disorders.

Objective: To examine whether mindfulness-based cognitive therapy (MBCT) increases momentary positive emotions and the ability to make use of natural rewards in daily life. Method: Adults with a life-time history of depression and current residual depressive symptoms (mean age = 43.9 years, SD = 9.6; 75% female; all Caucasian) were randomized to MBCT (n = 64) or waitlist control (CONTROL; n = 66) in a parallel, open-label, randomized controlled trial. The Experience Sampling Method was used to measure momentary positive emotions as well as appraisal of pleasant activities in daily life during 6 days before and after the intervention. Residual depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (Hamilton, 1960). Results: MBCT compared to CONTROL was associated with significant increases in appraisals of positive emotion (b* = .39) and activity pleasantness (b* = .22) as well as enhanced ability to boost momentary positive emotions by engaging in pleasant activities (b* = .08; all ps < .005). Associations remained significant when corrected for reductions in depressive symptoms or for reductions in negative emotion, rumination, and worry. In the MBCT condition, increases in positive emotion variables were associated with reduction of residual depressive symptoms (all ps < .05). Conclusions: MBCT is associated with increased experience of momentary positive emotions as well as greater appreciation of, and enhanced responsiveness to, pleasant daily-life activities. These changes were unlikely to be pure epiphenomena of decreased depression and, given the role of positive emotions in resilience against depression, may contribute to the protective effects of MBCT against depressive relapse. ispartof: Journal of Consulting and Clinical Psychology vol:79 issue:5 pages:618-28 ispartof: location:United States status: published

To describe the objectives and design of a multistage study on the prevalence and risk factors of mental health problems, in particular psychotic disorders and psychotic symptoms, by assessing a probabilistic sample of household residents in the Izmir Metropolitan Area, aged 15-64 years.The study included three different observation frames. In the first stage, of which methodology is in the focus of this paper, the primary screening instrument was the Composite International Diagnostic Interview 2.1, which assesses lifetime and/or last one year occurrence of several DSM-IV disorders. Second, a parallel survey of social capital of administrative wards was conducted in the same neighbourhoods. Third, a nested-case control study was performed to study effects of genetic and environmental risk factors on wide psychosis phenotype.A total of 4011 males and females were contacted through a multistage clustered area probability sample of administrative neighbourhoods and households, covering 9 districts and 302 neighbourhoods. The response rate for the first stage was 76.5% in 5242 eligible households. Respondents were interviewed at home in 2008 for the screening of included mental health problems. The screened disorders were mood disorders (last 1 year), schizophrenia and other non-affective psychotic disorders (lifetime), and dependence and abuse of psychoactive substances (lifetime).Although cross-sectional in nature, the TürkSch has a unique study design and yields data of high quality. This enables study of the prevalence, risk and higher-order interactions underlying ill-health in the Turkish population, with a specific focus on psychosis.

Background Auditory hallucinations are common in adolescents. However, it has been suggested that not the presence of low-grade psychotic experiences per se, but rather the level of persistence and associated clinical complications over time may lead to psychotic illness. The current paper investigated, in a large representative sample of adolescents, to what degree hallucinations persist, and whether persistence of hallucinations increases the risk of developing secondary delusional ideation and affective dysregulation. Methods Data were derived from a general health screening of all 1912 adolescents living in the Maastricht area. Baseline assessment was in the second grade of secondary school (T0) and follow-up occurred 2 years later (T1). Questions included the psychosis screening questions ( Poulton et al., 2000 ), the SDQ assessing general psychopathology and a question assessing depression. Results Five percent of adolescents reported hallucinations at T0 and 27% of these hallucinations were still present 2 years later. Hallucinations at T0 were associated with increased levels of depressed mood and general psychopathology at T1, and the degree of persistence of hallucinations was associated with a progressively greater risk for T1 delusional ideation as well as increased levels of follow-up depressed mood and general psychopathology. Conclusion Although hallucinations in adolescents are a common and mainly transitory phenomenon, the persistence rate over time is far from negligible, and associated with clinical deterioration.

Background Effectiveness of services for patients diagnosed with severe mental illness (SMI) may improve when treatment plans are needs based. A regional Cumulative Needs for Care Monitor (CNCM) introduced diagnostic and evaluative tools, allowing clinicians to explicitly assess patients' needs and negotiate treatment with the patient. We hypothesized that this would change care consumption patterns. Methods Psychiatric Case Registers (PCR) register all in-patient and out-patient care in the region. We matched patients in the South-Limburg PCR, where CNCM was in place, with patients from the PCR in the North of the Netherlands (NN), where no CNCM was available. Matching was accomplished using propensity scoring including, amongst others, total care consumption and out-patient care consumption. Date of the CNCM assessment was copied to the matched controls as a hypothetical index date had the CNCM been in place in NN. The difference in care consumption after and before this date (after minus before) was analysed. Results Compared with the control region, out-patient care consumption in the CNCM region was significantly higher after the CNCM index date regardless of treatment status at baseline (new, new episode, persistent), whereas a decrease in in-patient care consumption could not be shown. Conclusions Monitoring patients may result in different patterns of care by flexibly adjusting level of out-patient care in response to early signs of clinical deterioration.

OBJECTIVE To describe the objectives and design of a multistage study on the prevalence and risk factors of mental health problems, in particular psychotic disorders and psychotic symptoms, by assessing a probabilistic sample of household residents in the Izmir Metropolitan Area, aged 15-64 years. METHOD The study included three different observation frames. In the first stage, of which methodology is in the focus of this paper, the primary screening instrument was the Composite International Diagnostic Interview 2.1, which assesses lifetime and/or last one year occurrence of several DSM-IV disorders. Second, a parallel survey of social capital of administrative wards was conducted in the same neighbourhoods. Third, a nested-case control study was performed to study effects of genetic and environmental risk factors on wide psychosis phenotype. RESULTS A total of 4011 males and females were contacted through a multistage clustered area probability sample of administrative neighbourhoods and households, covering 9 districts and 302 neighbourhoods. The response rate for the first stage was 76.5% in 5242 eligible households. Respondents were interviewed at home in 2008 for the screening of included mental health problems. The screened disorders were mood disorders (last 1 year), schizophrenia and other non-affective psychotic disorders (lifetime), and dependence and abuse of psychoactive substances (lifetime). CONCLUSION Although cross-sectional in nature, the TurkSch has a unique study design and yields data of high quality. This enables study of the prevalence, risk and higher-order interactions underlying ill-health in the Turkish population, with a specific focus on psychosis.

Amaç: İzmir büyükşehir bölgesi hanelerinde yaşayan 15-64 yaş arası bireylerden oluşan bir örneklemde psikotik bozukluklar ve belirtiler başta olmak üzere akıl sağlığı sorunlarının yaygınlığını, risk etkenlerini değerlendiren çok aşamalı bir araştırmanın amaçlarını ve yöntemini tanımlamak. Yöntem: Araştırma üç aşama içermektedir. Yöntemi bu makalenin ana konusu olan ilk aşamada, temel tarama aracı olarak birçok DSM-IV bozukluğunun yaşam boyu ve son bir yıl yaygınlığını değerlendiren Uluslararası Bileşik Tanı Görüşmesi 2.1 kullanılmıştır. İkinci olarak, aynı yerleşim birimlerinde mahallelerin sosyal sermayesini değerlendiren paralel bir araştırma yürütülmüştür. Üçüncü olarak, genetik ve çevresel risk etkenlerini araştırmak için kesitsel araştırmanın içine yerleştirilmiş bir olgu-kontrol çalışması gerçekleştirilmiştir. Bulgular: Toplam 4011 erkek ve kadından oluşan, 9 ilçede ve 302 idari mahallede yer alan haneleri temsil eden çok katmanlı kümeli bir örneklem ile görüşülmüştür. İlk aşamanın katılım oranı, görüşme yapılabilecek 5242 hanede %76,5’dir ve katılımcılarla 2008 yılında evlerinde görüşme yapılmıştır. Duygudurum bozuklukları (son 1 yıl), şizofreni ve diğer psikotik bozukluklar (yaşam boyu) ve psikoaktif madde kullanımı ve bağımlılığı (yaşam boyu) taranmıştır. Sonuç: Kesitsel olmasına rağmen TürkSch’ın araştırma deseni özgündür ve yüksek kaliteli bir verinin elde edilmesini sağlamıştır. Bu da araştırmanın, akıl sağlığı hastalıklarının Türkiye nüfusundaki yaygınlığını, risklerini ve daha üst seviyedeki etkileşim özelliklerini psikoza odaklı olarak incelenmesine olanak vermiştir., Objective: To describe the objectives and design of a multistage study on the prevalence and risk factors of mental health problems, in particular psychotic disorders and psychotic symptoms, by assessing a probabilistic sample of household residents in the Izmir Metropolitan Area, aged 15-64 years. Method: The study included three different observation frames. In the first stage, of which methodology is in the focus of this paper, the primary screening instrument was the Composite International Diagnostic Interview 2.1, which assesses lifetime and/or last one year occurrence of several DSM-IV disorders. Second, a parallel survey of social capital of administrative wards was conducted in the same neighbourhoods. Third, a nested-case control study was performed to study effects of genetic and environmental risk factors on wide psychosis phenotype. Results: A total of 4011 males and females were contacted through a multistage clustered area probability sample of administrative neighbourhoods and households, covering 9 districts and 302 neighbourhoods. The response rate for the first stage was 76.5% in 5242 eligible households. Respondents were interviewed at home in 2008 for the screening of included mental health problems. The screened disorders were mood disorders (last 1 year), schizophrenia and other non-affective psychotic disorders (lifetime), and dependence and abuse of psychoactive substances (lifetime). Conclusion: Although cross-sectional in nature, the TürkSch has a unique study design and yields data of high quality. This enables study of the prevalence, risk and higher-order interactions underlying illhealth in the Turkish population, with a specific focus on psychosis.

Background The etiology of schizophrenia is thought to involve differential—likely genetically mediated—sensitivity to environmental exposures. However, examination of differential sensitivity in models of psychopathologic constructs is subject to bias because psychopathology itself may distort exposure assessment. The use of neuroimaging phenotypes, conversely, may provide unbiased evidence for differential sensitivity to environmental exposures. This study examined the impact of two environmental exposures associated with both schizophrenia and magnetic resonance imaging (MRI) cerebral alterations in models of cerebral cortical thickness. Methods T1-weighted MRI scans were acquired from 88 patients with schizophrenia, 98 healthy siblings at higher than average genetic risk for schizophrenia, and 87 control subjects. Freesurfer software was used to measure cortical thickness for 68 brain regions. Associations between 1) cortical thickness and 2) cannabis use and developmental trauma were examined. Results A significant group × developmental trauma interaction (χ 2 = 9.65, p = .01), as well as a significant group × cannabis interaction (χ 2 = 6.04, p = .05) was apparent, indicating differential sensitivity of the patient group, which displayed stronger reductions of cortical thickness for both exposures. A similar pattern was found in the sibling–control comparison for cannabis. For developmental trauma, siblings did not differ from control subjects, displaying an increase in cortical thickness with higher levels of trauma. Conclusions The findings suggest that schizophrenia and its genetic liability are associated with differential cerebral cortical sensitivity to developmental environmental exposures such as cannabis. Gene–environment interactions may underlie some of the brain alterations observed in patients with schizophrenia and their relatives.

Background It was hypothesised that the introduction of tools that allow clinicians to assess patients' needs and to negotiate treatment (Cumulative Needs for Care Monitor; CNCM), would be associated with global outcome improvements in patients diagnosed with severe mental illness. Methods The CNCM was introduced in one region in South Limburg (the Netherlands) in 1998 (REGION-1998) and in the rest of South Limburg in 2004 (REGION-2004). By comparing these two regions, changes after the introduction of the CNCM could be assessed (between-region comparison). In addition, a pre-post within-patient comparison was conducted in both regions. Results The within-patient comparison revealed that global outcomes of psychopathology and impairment improved in the first 3-5 years after the introduction of the CNCM. The between-region comparison revealed an improvement in global psychopathology but not in global impairment in REGION-2004 after 2004, while there was no such improvement in REGION-1998. Conclusion Systematic clinical monitoring of individual severe mental illness patients, in combination with provision of feedback, is associated with global improvement in psychopathology. More research is needed to determine the degree to which this association reflects a causal effect.

Children with either underweight or overweight may be at risk for mental health problems and require mental health service use. The present study investigated the relationship between weight status and psychosocial dysfunctioning in children of two different age groups (5-6 and 13-14 years).Using height and weight measurements collected during routine medical examinations of all children in a circumscribed geographical region, measures of underweight and overweight were calculated in young children (aged 5-6 years; n=797) and in adolescents (13-14 years; n=614). In addition, parent-reported questionnaires (young children) and adolescent-reported questionnaires (adolescents), including the Strengths and Difficulties Questionnaire (SDQ), provided information on psychopathology subscales including emotional symptoms, conduct problems, hyperactivity-inattention, peer problems and prosocial behaviour.Few associations were apparent after controlling for confounding variables. Young children who were underweight (but not severely underweight) less frequently displayed conduct problems, while adolescents who were overweight or obese reported more peer problems and less prosocial behaviour than did children of normal weight. Children who were underweight and children who were overweight did not score higher on any of the other psychopathology scales than did children of normal weight in either age group.Our findings suggest that the domains of weight problems and psychopathology do not display strong associations. However, there are indications that some areas of psychopathology may be differentially associated with weight problems. Further longitudinal research is warranted.

A useful way of operationalising treatment effects in routine outcome assessment data may be to assess the rate at which unmet needs at time point t change to met needs at time point t + 1. Data were obtained from the local Cumulative Needs for Care Register (CNCR), a cumulative data set of needs (Camberwell Assessment of Need), psychopathology, well being and functioning of psychiatric patients living both inside and outside the hospital, in a circumscribed geographical area. In the group of relatively new patients, the number of met needs (sum score) increased over time. Higher unmet needs sum score predicted higher met needs at time point t + 1. Unmet needs in the areas of accommodation, household skills, self-care, safety to others (in new patients only), alcohol, drugs, money and benefits were associated with met needs on these items at time point t + 1, but there was no such association for occupation/daytime activities, psychotic symptoms, psychological distress and self-harm. Treatment outcomes in psychiatric practice can be usefully tracked and quantified using the rate of change from unmet to met needs. Needs in the area of the ability to live independently may represent outcomes that are more sensitive to treatment effects than needs in the realm of psychopathology and daytime activities.

The present editorial discusses whether socioeconomic status of the individual and of the neighbourhood could be important in prevalence, treatment and prevention of psychiatric morbidity. Previous research showed that patients diagnosed with mental disorders are concentrated in socioeconomically disadvantaged areas. This could be the result of (1) an association between individual socioeconomic status and mental health, (2) an association between neighbourhood socioeconomic status and mental health, or (3) social selection. Research disentangling associations between individual and neighbourhood socioeconomic status on the one hand and mental health outcomes on the other, reported that neighbourhood socioeconomic disadvantage was associated with individual mental health over and above individual-level socioeconomic status, indicating deleterious effects for all inhabitants both poor and affluent. In conclusion, subjective mental health outcomes showed stronger evidence for an effect of neighbourhood socioeconomic status than research focussing on treated incidence. Within the group of patients, however, service use was higher in patients living in disadvantaged neighbourhoods. Social capital was identified as one of the mechanisms whereby neighbourhood socioeconomic disadvantage may become associated with observed reductions in mental health. After controlling for individual socioeconomic status, there is evidence for an association between neighbourhood socioeconomic status and objective as well as subjective mental health in adults. Evidence for such an association in young children is even stronger.

Background: Accumulating evidence suggests that experiences of trauma and victimization during childhood are associated with an increased risk to develop clinical and subclinical psychosis in adulthood. A recent cross-sectional study showed a significant association between trauma and psychotic experiences in adolescents. The current study aimed to extend these findings by investigating the longitudinal effects of negative life experiences on the risk for subclinical psychotic symptoms 2 years later in an adolescent general community sample. Methods: Data were derived from the standard health screenings of the Youth Health Care Divisions of the Public Health Services, in the South of the Netherlands. A total of 1129 adolescents filled out a self-report questionnaire at age 13/14 years and 2 years later (15/16 years), assessing psychotic experiences, as well as experiences of being bullied, sexual trauma, and negative life events. Results: Logistic regression analyses revealed that sexual trauma increased the risk for psychotic symptoms 2 years later. Life events contributed to the risk for psychosis over time and psychosis in turn gave rise to new life events. No significant association with bullying was found after controlling for confounders. Conclusion: The results provide further evidence for an association between childhood environment and psychosis in the crucial developmental period of early adolescence. Early and later psychological stress, if severe, may impact on the risk for psychosis in adolescence through mechanisms of person–environment interaction and correlation.

Objective: Remission criteria for schizophrenia have been proposed, consisting of a time criterion and a symptomatic remission criterion. With longitudinal data of a representative patient group (N=317; median follow-up: 1,132 days), validity of the symptomatic remission criterion was investigated. Method: In a group of 145 patients meeting the symptomatic remission criterion at baseline and a group of 172 patients not meeting it at baseline, change over time in remission status was examined in relation to change in various functional outcomes. Results: In both groups, change over time with the symptomatic remission criterion was associated with substantial changes in unmet needs, Global Assessment of Functioning scale scores, satisfaction with services and, to a lesser extent, quality of life. Changing the symptomatic remission criterion to include depression and suicidality did not affect the results. Conclusions: The proposed symptomatic remission criterion has clinical validity and represents the righ...

Background Neighbourhood socioeconomic disadvantage and social capital have been associated with adolescent well-being, but the majority of studies were cross-sectional, and the time window over which the neighbourhood may impact on development is unknown. Therefore, the contribution of the neighbourhood environment to adolescents' quality of life and the course of these effects during the period of transition from childhood to early adolescence was examined. Methods A cohort of adolescents living in Maastricht (The Netherlands), with a mean age of 11.2 years at baseline and of 13.5 years at follow-up was followed. Adolescents who responded both at baseline and at follow-up were included in the analysis (n = 475). Multilevel regression analyses estimated neighbourhood effects while controlling for individual-level effects. Neighbourhood-level socioeconomic and social capital variables, individual-level confounders, and baseline values of the outcome measures were included in the models. Results None of the neighbourhood factors was associated with changes in general health or mental health over the two-year period. However, two-year exposure to greater disparity between individual level socioeconomic status on the one hand and neighbourhood level of socioeconomic status on the other (e.g. high socioeconomic status adolescents living in deprived neighbourhoods and vice versa) negatively impacted on self-esteem and satisfaction. Conclusion The neighbourhood environment per se does not contribute to change in quality of life during the transition to early adolescence. However, adolescents living in families whose socioeconomic status deviates from the mean level of neighbourhood socioeconomic deprivation may be negatively affected.

To study, in a geographically defined area, associations between the neighbourhood social environment and individual socioeconomic status on the one hand, and treated incidence of schizophrenia and level of subsequent service use on the other. A combined data set of (i) patients with a case register diagnosis of schizophrenia and (ii) population controls was subjected to multilevel analyses, including neighbourhood exposures (neighbourhood socioeconomic disadvantage and social capital) and individual level confounders. Separate analyses were conducted for inpatient and outpatient psychiatric service consumption as indexed by the case register. Neighbourhood socioeconomic disadvantage and neighbourhood social capital did not impact on the treated incidence of schizophrenia, but quantity of inpatient service consumption was higher in neighbourhoods with higher level of social control (i.e. where it is more likely that neighbours intervene in neighbourhood-threatening situations). In addition, most indicators of lower individual socioeconomic status were associated with higher treated incidence, while treated incidence was lower when individual educational status was low. Residents of high social control neighbourhoods may seek greater levels of resolution of psychiatric disorder in patient-residents, and by consequence may induce greater levels of inpatient service consumption in patients diagnosed with schizophrenia. Individual-level indicators of social disadvantage are associated with higher risk of treated psychotic disorder, with the exception of lower educational status, which may confer a lower probability of treatment given the presence of psychotic disorder.

The comorbidity bias predicts that if disease definition is based on observations of patients in the hospital, spurious comorbidity of psychopathological dimensions that increase the probability of hospital admission will be included in the disease concept, whereas comorbid dimensions that are not associated with admission will be excluded. The direction of any dimensional comorbidity bias in psychotic illness was assessed in a longitudinal analysis of the psychopathology of patients assessed both inside and outside the hospital.Four hundred and eighty patients with broadly defined psychotic disorders were assessed between one and nine times (median two times) over a 5-year period with, amongst others, the Brief Psychiatric Rating Scale. Dimensional comorbidities between positive symptoms, negative symptoms, depression/anxiety, and manic excitement were compared, in addition to their associations with current and future admission status.Higher levels of psychopathology in all symptom domains were associated with both current and future hospital admissions. Associations between the positive, negative, and manic symptom domains were higher for patients in the hospital than for patients outside the hospital, in particular, between positive symptoms and manic excitement (beta=0.28, p0.001). However, associations between depression and other symptom domains were higher in out-patients as compared to in-patients (positive symptoms and depression, beta=-0.26; p0.002).The current analyses suggest that, to the extent that disease concepts of psychosis do not take into account effects of dimensional comorbidity biases occasioned by differential psychopathology according to treatment setting, "florid" psychotic psychopathology may be overrepresented, whereas depressive symptoms may be spuriously excluded.

Objective: Previous studies associating neighbourhood context with mental health service use typically included limited sets of confounders. Method: A data set including patients registered in a Case Register and population controls was subjected to multilevel analyses, including neighbourhood exposures and individual level confounders. In addition, days of care consumption of patients was addressed. Results: The association between socioeconomic deprivation and social capital on the one hand and mental health service use rates on the other could be attributed to individual level differences. However, number of days of service consumption was higher in neighbourhoods with more informal social control. In residentially stable neighbourhoods only, socioeconomic deprivation was associated with lower levels of service consumption. Conclusion: Higher levels of social control may induce patients to remain in contact with mental health services. Furthermore, higher levels of deprivation in neighbourhoods with little population mobility may result in reduced expectations of recovery and/or increased tolerance.

Associations were examined between neighbourhood income inequality and neighbourhood socioeconomic deprivation on the one hand and (mental) health related quality of life (QoL) on the other, in Maastricht, the Netherlands. Three different data sources were used: 1) neighbourhood socioeconomic indicators, 2) house prices per postal code area aggregated to an inequality measure at neighbourhood level, and 3) individual data measured in a family cohort study. Maastricht families with children aged approximately 11 years received questionnaires including the parents’ QoL and family socioeconomic status (response rate: 60%). Multilevel analyses were conducted using neighbourhood level, family level, and individual level data. Income inequality at neighbourhood level was not associated with QoL, whereas socioeconomic deprivation was associated with environment-related QoL. The relative income hypothesis, according to which it is the contrast in deprivation rather than the absolute level of deprivation that influences health outcomes, does not hold at the neighbourhood level. Income inequality may only have an effect in larger areas containing sufficient socioeconomic contrast.

We conducted a cross-national study to examine the association between neighbourhood socioeconomic deprivation, social capital and child health in two countries and multiple ethnic groups. For our analysis we used data from (1) the Project on Human Development in Chicago Neighborhoods (PHDCN), USA and (2) the Maastricht Quality of Life study (MQoL), the Netherlands. Both the PHDCN and the MQoL collected data on objective neighbourhood socioeconomic deprivation, subjective neighbourhood social capital (i.e. informal social control, ISC, social cohesion and trust, SC&T), and children's perceived health. For the present analyses, 11- and 12-year olds were selected. Multilevel analyses were conducted using both neighbourhood level and individual-level data. Lower socioeconomic deprivation scores and higher levels of ISC as well as SC&T were associated with higher levels of children's perceived health, in both Maastricht and the Chicago Hispanic subsample, but not in the Chicago non-Hispanic samples. The results suggest that associations between the wider social environment and health outcomes vary across different populations and cross-national contexts.

We examined associations between neighbourhood socioeconomic deprivation and health-related quality of life, and estimated the mediating effects of individual-level lifestyle, housing, and perception of the neighbourhood environment. Two different data sources were used: 1) neighbourhood- level objective socioeconomic indicators, and 2) individual-level questionnaires from a community survey (response rate: 48%) to assess quality of life, neighbourhood perceptions, housing variables, and lifestyle. Multilevel analyses were conducted using both neighbourhood-level and individual-level data. Neighbourhood-level socioeconomic deprivation was associated with two aspects of individual-level quality of life: mental health and perceived health. Individual-level neighbourhood perceptions regarding social cohesion mediated these associations. Lifestyle also had mediating effects. Neighbourhood socioeconomic deprivation variables may impact on the individual through cognitive mechanisms that are associated with appraisal of the wider social environment.

There is accumulating evidence that the shared social environment at the neighbourhood level exerts significant effects on health over and above individual level variables. The aim of this study was to assess the interactive influence of neighbourhood measures of socioeconomic deprivation and social capital (i. e. informal social control, social cohesion and trust) on children’s mental health service use, independent of individual level confounders. Two different data sources were used: 1) individual socioeconomic measures, derived from a case-control study in which case/control status indicated mental health service use or not, and 2) neighbourhood measures of socioeconomic deprivation and social capital. The data were subjected to multilevel logistic regression analysis. Children living in more deprived neighbourhoods run a higher risk of coming into contact with mental health care services. The social capital variables (informal social control and social cohesion and trust) did not exert main effects, but strong trust and social cohesion between citizens in the neighbourhood mitigated the risk-increasing effect of socioeconomic deprivation on children’s mental health service use. The deleterious effects of socioeconomic deprivation on mental health service use in children are sensitive to the context of cohesion and trust in neighbourhoods. Effects of deprivation on children’s mental health cannot be interpreted without taking into account the context of social capital.

INTRODUCTION: Antipsychotics (AP) induce weight gain. However, reviews and meta-analyses generally are restricted to second generation antipsychotics (SGA) and do not stratify for duration of AP use. It is hypothesised that patients gain more weight if duration of AP use is longer. METHOD: A meta-analysis was conducted of clinical trials of AP that reported weight change. Outcome measures were body weight change, change in BMI and clinically relevant weight change (7% weight gain or loss). Duration of AP-use was stratified as follows: ≤6 weeks, 6-16 weeks, 16-38 weeks and >38 weeks. Forest plots stratified by AP as well as by duration of use were generated and results were summarised in figures. RESULTS: 307 articles met inclusion criteria. The majority were AP switch studies. Almost all AP showed a degree of weight gain after prolonged use, except for amisulpride, aripiprazole and ziprasidone, for which prolonged exposure resulted in negligible weight change. The level of weight gain per AP varied from discrete to severe. Contrary to expectations, switch of AP did not result in weight loss for amisulpride, aripiprazole or ziprasidone. In AP-naive patients, weight gain was much more pronounced for all AP. CONCLUSION: Given prolonged exposure, virtually all AP are associated with weight gain. The rational of switching AP to achieve weight reduction may be overrated. In AP-naive patients, weight gain is more pronounced.

Introduction There is a large mortality gap between patients with a non-affective psychotic disorder (NAPD) and the general population. Objectives To assess whether mortality risks vary for different death causes according to duration since diagnosis and age in a large sample of NAPD patients. Aims To get insight into the risk of specific death causes along the treatment trajectory, important for interventions that are tailored to the patients' risk profile. Methods Data of NAPD patients (n=12,580) from three Dutch psychiatric registers were linked to the registers of Statistics Netherlands and compared to personally matched controls (n=124,143). Death rates were analysed by duration since the date of diagnosis of the (matched) patient and age using Poisson regression. Results Among patients, the rates of all-cause death decreased with longer duration. This was explained by lower suicide rates. E.g., among those aged 40-60 years, the rate ratios (RRs) of suicide during 2-5 and >5 years compared to the early years after diagnosis were 0.52 and 0.46 (P=0.002). Compared with controls, patients experienced higher rates of natural death causes during all stages and in all age categories: RRs 2.35-5.04, P Conclusions The high risk of natural death causes among NAPD patients is not (only) an effect of accumulating risks induced by the chronic nature of the disorder and/or antipsychotic treatment, but is already present during the early stages of the treatment and at young age.

Introduction In the Netherlands, there is an increased incidence of non-affective psychotic disorders (NAPD) among first- and second-generation migrants from Turkey, Morocco, Surinam and the Netherlands Antilles. Objectives/aims The purpose of this population-based study was to compare the risk of suicide in Dutch natives and immigrants with or without NAPD. We examined the influence of NAPD, ethnicity and history of migration (first or second generation). Methods Cases of NAPD (n = 12,580) from three Dutch psychiatric registers were linked to the cause of death register of Statistics Netherlands and compared to matched controls (n = 124,547) from the population register, who had no such diagnosis. Hazard ratios (HRs) of suicide were estimated and adjusted for age and gender by Cox regression analysis. Results The presence of NAPD was strongly associated with suicide risk in each ethnic group. However, for most ethnic minority groups the HRs were somewhat lower than among Dutch natives, for whom the HR was 30.4 (95%; 22.8–40.7). A closer examination revealed that suicide risk was influenced by history of migration. While the risk for immigrants of the first generation, diagnosed with NAPD, was significantly lower than that for native Dutch patients (HR = 0.44; 95% CI: 0.27–0.72), the risk for those of the second generation was similar to that for the Dutch (HR = 0.81; 95% CI: 0.48–1.38). The same pattern was found among first- and second-generation immigrants not diagnosed with NAPD. Conclusion Immigrants of the first generation appear to be protected against suicide, whereas this protection is waning among those of the second generation.

Background Current cognitive models of positive symptoms of psychosis suggest a mechanism of defective self-monitoring that may be relevant for (i) expression of psychosis at the clinical and subclinical level and (ii) transmission of risk for psychosis. Method The study included 41 patients with psychosis, 39 non-psychotic first-degree relatives, 39 subjects from the general population with a high level of positive psychotic experiences, and 52 healthy controls with an average level of positive psychotic experiences. All subjects performed a speech attribution task in which single adjectives with a complimentary or derogatory meaning were presented to them on a computer screen; subjects had to read aloud and determine the source (self/other/uncertain) of the words they heard. In some of the trials, participants' speech was distorted, in others they heard someone else's voice (alien feedback condition) that could also be distorted. Results No large or significant differences in errors in the speech attribution task were found between the four groups in any of the conditions. Conclusions Contrary to previous work using this paradigm, this study found no evidence that either expression of psychosis or risk for psychosis was associated with impairment in self-monitoring.

McKenzie et al ( [2002][1]) reported that social capital in the neighbourhood may be beneficial for health and mental health in adults. We have reported associations between neighbourhood social capital and mental health service use in children ( [Van der Linden et al , 2003][2]). We wished to

Background ACT is an effective community treatment but causes discontinuity of care between acutely ill and currently stable patient groups. The Dutch variant of ACT, FACT, combines both intensive ACT treatment and care for patients requiring less intensive care at one time point yet likely to need ACT in the future. It may be hypothesised that this case mix is not beneficial for patients requiring intensive care, as other patient groups may "dilute" care provision. The effectiveness of FACT was compared with standard care, with a particular focus on possible moderating effects of patient characteristics within the case mix in FACT. Methods In 2002, three FACT teams were implemented in a Dutch region in which a cumulative routine outcome measurement system was in place. Patients receiving FACT were compared with patients receiving standard treatment, matched on "baseline" symptom severity and age, using propensity score matching. Outcome was the probability of being in symptomatic remission of psychotic symptoms. Results The probability of symptomatic remission was higher for SMI patients receiving FACT than for controls receiving standard treatment, but only when there was an unmet need for care with respect to psychotic symptoms (OR = 6.70, p = 0.002; 95% CI = 1.97 – 22.7). Conclusion Compared to standard care, FACT was more rather than less effective, but only when a need for care with respect to psychotic symptoms is present. This suggests that there is no adverse effect of using broader patient mixes in providing continuity of care for all patients with severe mental illness in a defined geographical area.