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Most of the existing prediction models for COVID-19 lack validation, are inadequately reported or are at high risk of bias, a reason which has led to discourage their use. Few existing models have the potential to be extensively used by healthcare providers in low-resource settings since many require laboratory and imaging predictors. Therefore, we sought to develop and validate a multivariable prediction model of death in Mexican patients with COVID-19, by using demographic and patient history predictors. We conducted a national retrospective cohort study in two different sets of patients from the Mexican COVID-19 Epidemiologic Surveillance Study. Patients with a positive reverse transcription-polymerase chain reaction for SARS-CoV-2 and complete unduplicated data were eligible. In total, 83 779 patients were included to develop the scoring system through a multivariable Cox regression model; 100 000, to validate the model. Eight predictors (age, sex, diabetes, chronic obstructive pulmonary disease, immunosuppression, hypertension, obesity and chronic kidney disease) were included in the scoring system called PH-Covid19 (range of values: −2 to 25 points). The predictive model has a discrimination of death of 0.8 (95% confidence interval (CI) 0.796–0.804). The PH-Covid19 scoring system was developed and validated in Mexican patients to aid clinicians to stratify patients with COVID-19 at risk of fatal outcomes, allowing for better and efficient use of resources.
Methane (CH4) is a greenhouse gas (GHG) produced and released by eructation to the atmosphere in large volumes by ruminants. Enteric CH4 contributes significantly to global GHG emissions arising from animal agriculture. It has been contended that tropical grasses produce higher emissions of enteric CH4 than temperate grasses, when they are fed to ruminants. A number of experiments have been performed in respiration chambers and head-boxes to assess the enteric CH4 mitigation potential of foliage and pods of tropical plants, as well as nitrates (NO3−) and vegetable oils in practical rations for cattle. On the basis of individual determinations of enteric CH4 carried out in respiration chambers, the average CH4 yield for cattle fed low-quality tropical grasses (>70% ration DM) was 17.0 g CH4/kg DM intake. Results showed that when foliage and ground pods of tropical trees and shrubs were incorporated in cattle rations, methane yield (g CH4/kg DM intake) was decreased by 10% to 25%, depending on plant species and level of intake of the ration. Incorporation of nitrates and vegetable oils in the ration decreased enteric CH4 yield by ∼6% to ∼20%, respectively. Condensed tannins, saponins and starch contained in foliages, pods and seeds of tropical trees and shrubs, as well as nitrates and vegetable oils, can be fed to cattle to mitigate enteric CH4 emissions under smallholder conditions. Strategies for enteric CH4 mitigation in cattle grazing low-quality tropical forages can effectively increase productivity while decreasing enteric CH4 emissions in absolute terms and per unit of product (e.g. meat, milk), thus reducing the contribution of ruminants to GHG emissions and therefore to climate change.
There is often a need to locate the same cellular structure of interest in light and electron microscopy, which can be a difficult task. Here we present a method that uses only commercially available reagents and standard epi-fluorescence and transmission electron microscopy (TEM) technology to make correlative light and electron microscopy (CLEM) available to a large group of researchers without specialized CLEM hardware. This was achieved by seeding cells on photo-etched gridded cover slips and staining the protein to be localized with a secondary antibody coupled to both a fluorophore and 10 nm gold. The presence of the grid allowed for the alignment of light microscopy images with TEM images and the double-labeled antibody revealed co-localization of the fluorophore with gold particles.
Constitutive heterochromatin typically exhibits low gene density and is commonly found adjacent or close to the nuclear periphery, in contrast to transcriptionally active genes concentrated in the innermost nuclear region. In Triatoma infestans cells, conspicuous constitutive heterochromatin forms deeply stained structures named chromocenters. However, to the best of our knowledge, no information exists regarding whether these chromocenters acquire a precise topology in the cell nuclei or whether their 18S rDNA, which is important for ribosome function, faces the nuclear center preferentially. In this work, the spatial distribution of fluorescent Feulgen-stained chromocenters and the distribution of their 18S rDNA was analyzed in Malpighian tubule cells of T. infestans using confocal microscopy. The chromocenters were shown to be spatially positioned relatively close to the nuclear periphery, though not adjacent to it. The variable distance between the chromocenters and the nuclear periphery suggests mobility of these bodies within the cell nuclei. The distribution of 18S rDNA at the edge of the chromocenters was not found to face the nuclear interior exclusively. Because the genome regions containing 18S rDNA in the chromocenters also face the nuclear periphery, the proximity of the chromocenters to this nuclear region is not assumed to be associated with overall gene silencing.
Atypical antipsychotics are actually the first-line treatment in schizophrenia. Obsessive–compulsive symptoms (OCS) are common in patients suffering from schizophrenia and seem to worsen prognosis. Whilst atypical antipsychotics can be a useful augmentation strategy in refractory Obsessive Compulsive Disorder (OCD), their efficacy in case of comorbid obsessive compulsive symptoms in schizophrenia remains unclear.
Aims:
The purpose of this literature review was to examine the relationships between atypical antipsychotics, Obsessive Compulsive Symptoms (OCS) in schizophrenia.
Method:
A systematic MEDLINE database was run using the following key-words: atypical antipsychotics, obsessive compulsive symptoms and schizophrenia (27 articles).
Results:
Clozapine, risperidone,olanzapine and quietiapine may induce or exacerbate OCS in patients with schizophrenia due to their anti-serotoninergic properties. There was no study with ziprazidone,aripiprazole nor amisulpiride. For schizophrenic patients with comorbid OCS, the first line strategy appears to be combination therapy with clomipramine or an Selective Serotoninergic Reuptake Inhibitors (SSRIs)(fluvoxamine, sertraline, fluoxétine) and an atypical antipsychotic. Moreover, in these cases, cognitive behavioural therapy should also be considered.
Conclusions:
Obsessive Compulsive symptoms and schizophrenia are an ongoing matter of debate in terms of comorbidity or constitution of a specific "schizo-obsessive" subtype. Nevertheless, according to the worsening prognosis of this phenomenon, combination therapy (atypical antipsychotics and SSRIs) remains the most relevant therapeutic approach. Moreover, cognitive behavioural therapy studies in this area are required.
It has frequently been suggested that low self-esteem and low self-worth are closely related to psychological and emotional problems, particularly depression. In a retrospective study of “prodromal” symptoms of obsessive-compulsive disorder (OCD), Fava et al. (1996) noted that low self-esteem was one of a number of symptoms (including depression) reported as preceding the onset of OCD. Low self-esteem could also have the effect of predisposing people to the development of psychological problems regardless of type as a general vulnerability factor.
In a preliminary investigation of the link between self-esteem and obsessional problems, patients with OCD (n = 34) were compared with patients with social phobia (n = 29), diagnosed according to DSM IV. Standardized measures of self-esteem and clinical symptomatology were also administered: the Beck Depression Inventory (BDI), the Assertiveness Schedule of Rathus, the State Trait Inventory Anxiety, Yale Brown Obsessive Compulsive Scale (Y-BOCS) and Self-Esteem Inventory of Coopersmith (SEI).
Results:
Indicated that the OCD group differed significantly from the social phobia group on generalized self-esteem assessments (p<0.001). Both groups showed a lower self-esteem but there was some evidence of OCD specific effects; depressive cognitions altered significantly self-esteem in OCD patients (p<0.001). Obsessionals were more likely than anxious controls to link their self-worth to other people and their relationships. They also regarded the possibility of causing harm as likely to result in other people making extreme negative and critical judgements of them. The implications for future research and for treatment of OCD are discussed.
Pica is an eating disorder characterized by eating of nonnutritive materials. It has been reported in different population, from certain ethnic groups, children, pregnant woman or organic disorders (eg. mineral deficiency) to psychiatric patients, including psychotic.
Objectives
To describe a patient who ingest nonfood substances and its relationship with delusions.
Methods
X is a 26 year-old male with Paranoid Schizophrenia who came into the psychiatric emergency service because of an acute exacerbation of his mental illness, presenting auditory hallucinations and delusional mysticism. Draws our attention the presence of an aberrant eating behavior ingesting animals, lime, earth and leaves. The patient was hospitalized in the Impatient Psychiatric Unit for examination and treatment.
Results
Several medical tests were performed and the only finding was an idiopathic eosinophilia, considered secondary to pica. He referred that the ingested items provided him from energy and better sight, as an explanation for his eating behavior. No suicidal ideation was objectified. Neuroleptic treatment was prescribed and behavioral and psychotic symptoms improved progressively.
Conclusions
The etiology of pica is unknown. Schizophrenic motivation for deliberate foreign body ingestion is a poorly understood phenomenon. In the case presented, the ingestions seems to be secondary to delusional beliefs that these objects contains properties that the patient lacks, not obeying to suicidal behavior and objectifying parallel remission of the pica and delusional activity. Further research is needed to clarify the etiology and mechanisms of this disorder, as it can lead to serious medical consequences (eg. metal poisoning, parasitosis, intestinal obstruction).
Apropos of a case we show that antidepressant drugs may cause a switch phenomenon in patients diagnosed with a psychiatric illness other than bipolar disorder.
Objective
To describe a case of antidepressant-induced mania in a patient with obsessive compulsive disorder (OCD).
Methods
X is an 18 year-old male who presented obsession with books and compulsive reading. He went to the psychiatric consultation and initiated treatment with sertraline 25mg. 24 hours later he began with soliloquies, restlessness, verbosity, increased performance of activities without purpose and persistent insomnia.
Results
After the antidepressant was removed, the manic symptoms disappeared and the patient remained euthymic. Treatment with risperidone 1 mg was established and the obsessions and compulsions partially improved.
Conclusions
This case raises the hypothesis of a possible comorbidity between OCD and bipolar disorder.
Huntington's disease (HD) is a genetic disorder characterized by movement disturbances, psychiatric symptoms, and cognitive impairment resulting in a subcortical dementia. It is an autosomal dominant neurodegenerative disease with almost complete penetrance. An increased number of CAG repeats in the 5’ region of the IT15 gene on chromosome 4 is believed to be the responsible mutation. CAG expansion beyond 35 repeats is associated with the expression of HD.
Objective:
A description of the psychiatric symptoms of Huntington's disease through a possible case.
Methods and results:
A 28 year-old, female, was admitted for injury and grandeur delusions, suspicion an mania that had started in the last two weeks. Grandmother and great grandmother diagnosed with Huntington's disease. Transcranial magnetic resonance seemed to show a descent on the peak of the N-Acetylaspartate neuronal marker. Genetic test shower 27 repeats of the CAG, that is, intermediate risk. Olanzapine was started up to 20 mg per day and carbamazepine was started up to 600 mg per day. She had a progressive clinical improvement and in one month was discharged.
Conclusions:
The diagnosis of HD is based upon presence of the typical clinical features and a family history of the disease. with the availability of genetic molecular testing, all suspected HD cases can be easily confirmed.
In our case report, because of the medium-risk, genetic advice will be necessary, due to the probability of transmiting the illness onto the descendants, as well as a follow-up to predict its reappearing.
The use of long-acting injectable antipsychotics is useful in patients with low therapeutic compliance.
Objective
To present the demographic and clinical data of a case series in which long-acting injectable aripiprazole has been prescribed in an ambulatory Mental Health Center.
Methods
Systematic review of the related literature and clinical history of patients in which long-acting injectable aripiprazole had been prescribed from January to March 2015 in a Mental Health Center.
Results
We found 10 patients, whose diagnosis were schizophrenia (4), non-specified psychosis (2), personality disorder (1), bipolar disorder (1), schizoaffective disorder (2), of whom 7 were men and 3 women, with a mean age of 43.8 years old. The mean of years since diagnosis was 15.1 years. In 7 patients, we found concomitant treatment with another antipsychotic agent (low dose quetiapine in all of them); antidepressants in 1 patient, benzodiazepines in 6; mood stabiliser in 5 and biperidene in 1. In relation to previous antipsychotic drugs, we found: aripiprazole 15 mg/day oral (4); long-acting injectable paliperdidone 150 mg/28 days (2) paliperdone 6 mg/day oral (1); combination of paliperidone 6 mg/day oral plus olanzapine 5 mg/day oral (1). Only 4 patients had used long-acting injectable drugs previously in their lifetime. The reason of having initiated treatment with long-acting injectable aripiprazole was sexual disturbance (3); lack of compliance (4); clinical inestability (2) and motor side effects (1).
Conclusions
In our series, we can observe a chronic patient profile, predominantly men with diagnosis of psychotic spectrum.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Often find it difficult diagnostic approach to patients with symptoms that could correspond to several clinical entities. This requires making a correct differential diagnosis to enable a better understanding and addressing the disease in an individualized way.
Objective
Describe pathogenetic factors of paranoid schizophrenia highlighting their relationship with drug consumption.
Methods
Review of the clinical history of a patient admitted to acute ward of the Hospital General Universitario of Valencia.
Results
A case of a 30-year-old man, whose income is motivated by persistent and structured autolytic ideation occurs. It presents positive symptoms for several years and amotivational syndrome ago. It has a history of cannabis, cocaine and alcohol since he was thirteen and remains abstinent for more than six months ago. Differential diagnosis arises between amotivational toxic syndrome, reactive depressive symptoms to the disease and negative symptoms for chronic psychotic process. Finally diagnosed with paranoid schizophrenia and is included in the program of first psychotic episodes.
Today the productive symptoms disappeared and remain negative though with less intensity achieving an improvement in overall activity.
Conclusions
Consumption of toxic influences the development of a chronic psychotic process that may appear years later, becoming a etiological and maintainer factor, not only if its consumption continue, but other effects that occur long term amotivational syndrome and worsening prognosis.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A clinical case is presented. The reason for admission was for behavioral disturbances and agitation piscomotriz episode in the street: she had gone to a library to “denounce” the police for entering the subway without paying several times. The patient was very distraught because she was heavily guarded (someone had tapped her phone, entered her house, changed objects place, she was chased down the street…). In the psychopathological examination revealed the sphere of language, her speech was fluid, with pressured speech, full of details, with loss of thread and highlighted the presence of neologisms and grammatical errors (changes of subject and predicate…) and changes some letters by others in the same word. She often used sayings incorrectly and, when you are exploring about this fact, objectively presenting alteration in abstract thinking. In addition, it presents self-references on television. The diagnostic impression was chronic psychotic process of years of evolution. In this case, it was decided to administer intramuscular antipsychotic treatment because she was not aware of the disease but presenting good tolerability profile because, otherwise, leave the track and also a good social functioning was sought. Currently, she continues in mental health, she has not reported new crisis and a progressive scan objective improvement in the organization of thought and speech, leaving the psychotic symptoms.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The aim of this work is to study the efficacy of loxapine inhalation powder on agitated patients in a psychiatric inpatient unit.
Methods
Nineteen patients sample, with an average age of 39.4 years old, diagnosed with schizophrenia, bipolar disorder or schizoaffective disorder. Patients inhaled loxapine 10 mg, using the staccato system, when they suffered a psychomotor agitation. The clinical efficacy was measured as a change from baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) and in the Young Mania Rating Scale (YMRS) one hour after the administration of loxapine.
Results
A mean of 9.8 points reduction (22.6 at baseline and 12.7 one hour after the administration) was found on the PANSS-EC (t-test, P < .001) and 68.4% of the patients were considered responders as they obtained a reduction of at least 40% of the basal score. On 10 of the total of the agitated patients showed an improvement of the psychomotor excitement, and this allowed the clinicians to remove the physical restraint; on 6 of the agitated patients the physical restraint could be avoided during the whole treatment; and 3 of the patients experienced a reduction of the excitement. The reduction on PANNS-EC on the latest group was not statistically significant (t-test, P = .121).
Conclusions
Inhaled loxapine was a non-invasive, rapid and effective alternative treatment for acute agitation in a psychiatric inpatient unit. It resulted more effective on mild and moderate cases; not been significantly effective on the severe cases of agitation.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Non-attendance at initial appointments is an important problem in outpatient settings and has consequences, such as decreased efficient use of resources and delayed attention to patients who attend their visits, and that compromises quality of care.
Objectives
To identify and describe the characteristics of patients who do not attend the first appointment in an adult outpatient mental health center, located in Barcelona.
Method
Retrospective study. The sample was made up from all patients who had a first appointment during 2014 in our outpatient mental health centre. Socio-demographic and clinical data (type of first appointment, reason for consultation, origin of derivation, priority, history of mental health problems) were described. The results were analyzed using the SPSS statistical package.
Results
A total of 272 patients were included. Twenty-six per cent did not attend their first appointment; with mean age 39.75 years and 51.4% were male. Most frequent problems were anxiety (41.7%), depression (26.4%) and psycosis and behavioural problems (11.2%). The origin was primary care (83.3%), social services (4.2%) and emergencies (2.8%). Most of them were not preferent or urgent (86.1%). The 51.4% of non-attendees had history or psychiatric problems and 13.9% nowadays are patients of our mental health centre.
Conclusions
It is important to develop mechanisms that can reduce the incidence of first non-attended appointments. In our case, most of them are attended by primary care so we can establish better communication with our colleagues and try to contact to the patients prior to the date of the appointment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Several risk factors make older adults more prone to psychosis. The persistent growth in the elderly population makes important the necessity of accurate diagnosis of psychosis, since this population has special features especially regarding to the pharmacotherapy and side effects.
Objectives
To review the medical literature related to late-life psychosis.
Methods
Medline search and ulterior review of the related literature.
Results
Reinhard et al. [1] highlight the fact that up to 60% of patients with late onset psychosis have a secondary psychosis, including: metabolic (electrolite abnormalities, vitamines defficiency…); infections (meningitides, encephalitides…); neurological (dementia, epilepsy…); endocrine (hypoglycemia…); and intoxication. Colijn et al. [2] describe the epidemiological and clinical features of the following disorders: schizophrenia (0.3% lifetime prevalence > 65 years); delusional disorder (0.18% lifetime prevalence); psychotic depression (0.35% lifetime prevalence); schizoaffective disorder (0.32% lifetime prevalence); Alzheimer disease (41.1% prevalence of psychotic symptoms); Parkinson's disease (43% prevalence of psychotic symptoms); Parkinson's disease dementia (89% prevalence of visual hallucinations); Lewy body dementia (up to 78% prevalence of hallucinations) and vascular dementia (variable estimates of psychotic symptoms). Recommendations for treatment include risperidone, olanzapine, quetiapine, aripiprazole, clozapine, donepezil and rivastigmine.
Conclusions
Differential diagnosis is tremendously important in elderly people, as late-life psychosis can be a manifestation of organic disturbances. Mental disorders such as schizophrenia or psychotic depression may have different manifestations in comparison with early onset psychosis.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The induced delusional disorder or folie à deux, is a rare condition characterized by psychotic symptoms at least in two individuals in close association.
Objectives
We report a case of shared psychotic disorder between mother and daughter. We briefly review both classical and current literature.
Methods
We summarized the results from articles identified via MEDLINE/PubMed using “induced delusional/shared psychotic disorder” as keywords. We report a case of a woman who develops psychotic symptoms characterized by delusions of persecution. Her daughter started, during the first high school grade with referring sexual threats and having delusions of persecution lived by her mother like a fact. They have very symbiotic relationship. Seven years later, the mother has required hospitalization for chronic delusions.
Results
The term folie à deux was first coined by Lasègue and Falret, they assume the transmission of delusions was possible when an individual dominated the other and existed relative isolation. Recent studies found no significant differences in age and sex, although described higher comorbidity with other psychiatric diseases. Relative to treatment, separation by itself is insufficient; an effective neuroleptic treatment is required.
Conclusions
Our case meets criteria for shared psychotic disorder. The daughter, with a ruling attitude who dominates the relationship, was the inducer. The mother showed no resistance in accepting delusions and remains them active after separation. This leads us to consider the possible predisposition to psychotic illness by both patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Traditionally, cannabis is associated with antiemetic action after acute consumption. However, in 2004 the cannabinoid hyperemesis as paradoxical effect of chronic users, after years of exposure described.
Objectives
Description of the cannabinoid hyperemesis.
Method
OLOGYA case is presented.
Results
Clinical case of a woman who repeatedly comes to the emergency service because of abdominal, nausea and vomiting pain.
This is cyclical and hardly controllable. The gastroenterology service studied in depth with negative results. She was followed up by mental health borderline personality disorder and she consumed cannabis at an early age, 20–30 joints daily.
When she reaches abstinence in short periods, ceases digestive discomfort. However, aprece digestive symptoms with each relapse. The present case showed improvement with cessation of cannabis so it probably was the cannabinoid hyperemesis syndrome.
Conclusions
The cannabinoid hyperemesis is characterized by recurrent episodes of nausea, vomiting, abdominal pain, and chronic cannabis use. Temporary relief is achieved with hot baths. Ceases when abstinence is achieved. It is a clinical entity that does not have much information and requires further study.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
During three decades, only about 20 new drugs have been developed for malaria, tuberculosis and all neglected tropical diseases (NTDs). This critical situation was reached because NTDs represent only 10% of health research investments; however, they comprise about 90% of the global disease burden. Computational simulations applied in virtual screening (VS) strategies are very efficient tools to identify pharmacologically active compounds or new indications for drugs already administered for other diseases. One of the advantages of this approach is the low time-consuming and low-budget first stage, which filters for testing experimentally a group of candidate compounds with high chances of binding to the target and present trypanocidal activity. In this work, we review the most common VS strategies that have been used for the identification of new drugs with special emphasis on those applied to trypanosomiasis and leishmaniasis. Computational simulations based on the selected protein targets or their ligands are explained, including the method selection criteria, examples of successful VS campaigns applied to NTDs, a list of validated molecular targets for drug development and repositioned drugs for trypanosomatid-caused diseases. Thereby, here we present the state-of-the-art of VS and drug repurposing to conclude pointing out the future perspectives in the field.
The willow sawfly, Nematus oligospilus (Förster), is a pest in Salix commercial forests and has been reported worldwide. Female adults must recognize a suitable host plant to oviposit, since her offspring lack the ability to move to another host. We evaluated the effect of conspecific herbivory on the oviposition choices of N. oligospilus females by providing damaged (DP) and undamaged (UP) plants of Salix humboldtiana, a native willow from South America, as oviposition substrates. Local and systemic effects were studied. For the local treatment, a twig from the DP with damaged leaves was contrasted to a twig from a UP in dual choice experiments. For systemic treatment, a twig from the DP with intact leaves was contrasted to a twig from a UP. We estimated the use of olfactory and contact cues by comparing volatile emission of DP and UP, and by analysing the behaviour of the females during host recognition after landing on the leaf surface. In the context of the preference–performance hypothesis (PPH), we also tested if oviposition site selection maximizes offspring fitness by evaluating neonate hatching, larval performance and survival of larvae that were born and bred on either DP or UP. Our results demonstrate that previous conspecific herbivory on S. humboldtiana has a dramatic impact on female oviposition choices and offspring performance of the sawfly N. oligospilus. Females showed a marked preference for laying eggs on UP of S. humboldtiana. This preference was found for both local and systemic treatments. Volatile emission was quantitatively changed after conspecific damage suggesting that it could be related to N. oligospilus avoidance. In the dual choice preference experiments, the analysis of the behaviour of the females once landing on the leaf surface suggested the use of contact cues triggering egg laying on leaves from UP and avoidance of leaves from DP. Furthermore, 48 h of previous conspecific feeding was sufficient to dramatically impair neonate hatching, as well as larval development and survival, suggesting a rapid and effective reaction of the induced resistance mechanisms of the tree. In agreement with the PPH, these results support the idea that decisions made by colonizing females may result in optimal outcomes for their offspring in a barely studied insect model, and also opens the opportunity for studying tree-induced defences in the unexplored South American willow S. humboldtiana.
Children of parents with mental disorder face multiple challenges.
Aims
To summarise evidence about parental mental disorder and child physical health.
Method
We searched seven databases for cohort or case–control studies quantifying associations between parental mental disorders (substance use, psychotic, mood, anxiety, obsessive–compulsive, post-traumatic stress and eating) and offspring physical health. Studies were excluded if: they reported perinatal outcomes only (<28 days) or outcomes after age 18; they measured outcome prior to exposure; or the sample was drawn from diseased children. A meta-analysis was conducted. The protocol was registered on the PROSPERO database (CRD42017072620).
Results
Searches revealed 15 945 non-duplicated studies. Forty-one studies met our inclusion criteria: ten investigated accidents/injuries; eight asthma; three other atopic diseases; ten overweight/obesity; ten studied other illnesses (eight from low-and middle-income countries (LMICs)). Half of the studies investigated maternal perinatal mental health, 17% investigated paternal mental disorder and 87% examined maternal depression. Meta-analysis revealed significantly higher rates of injuries (OR = 1.15, 95% CI 1.04–1.26), asthma (OR = 1.26, 95% CI 1.12–1.41) and outcomes recorded in LMICs (malnutrition: OR = 2.55, 95% CI 1.74–3.73; diarrhoea: OR = 2.16, 95% CI 1.65–2.84). Evidence was inconclusive for obesity and other atopic disorders.
Conclusions
Children of parents with mental disorder have health disadvantages; however, the evidence base is limited to risks for offspring following postnatal depression in mothers and there is little focus on fathers in the literature. Understanding the physical health risks of these vulnerable children is vital to improving lives. Future work should focus on discovering mechanisms linking physical and mental health across generations.