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Neurocognitive deficits and schizotypal features are elevated in first-degree relatives of schizophrenia patients. However, the co-aggregation of these indicators is not well known. Some studies have found that neurocognitive deficits and schizotypy increase in severity with the density of family history of schizophrenia. Therefore, we studied in affected families a) whether the status of Presumed Carrier (PC) of the genetic risk for schizophrenia is associated with higher levels of neurocognitive deficits and schizotypic features and b) the relationship between schizotypy and neurocognition.
From an ongoing Catalan Multicentric Family Study on Schizophrenia, 70 families were included in this analysis. 90 non-psychotic parents of schizophrenic patients (age 50.7/8.8; education 10.3/4.04; IQ 96.2/14.6) were defined as PC if they had at least one first (apart of offspring) or second degree relative with schizophrenia spectrum disorders (FIGS), resulting in 17 PC and 73 non-PC. Schizotypic features were assessed with the SCID-II and the SPQ-B. Working memory (WM), executive functioning, sustained attention, verbal fluency and logical memory were also assessed.
PC differed significantly from NPC on verbal working memory, even after controlling for IQ (d=0.8). They did not differ on any of the self-reported or interview measures of schizotypy. The negative schizotypic dimension was associated with more WCST-perseverative errors, and low scores in spatial-WM, verbal fluency and immediate/delayed logical memory.
A large association was found between verbal-WM and the familial background of schizophrenia. Only negative features were associated with some neurocognitive functions, supporting the view of multiple independent dimensions or a pleiotropic expression of risk.
The extent and causes of covariance between schizotypy and neurocognition is not well-known yet. Certain models conceive their association as necessary for the construct validity of schizotypy, whereas others view them as independently contributing to a multivariate endophenotype. It is also not clear whether those at increased genetic risk for schizophrenia present stronger covariance, reflecting an extra latent source of variance. We analysed their association within relatives of schizophrenia patients defined with FIGS as Presumed Carriers -PC- of the genetic risk for schizophrenia, Presumed Non Carriers -PNC-, and controls.
108 healthy relatives of schizophrenia patients and 72 healthy controls were assessed with the SCID-II and completed the SPQ-B. Neurocognitive assessment: Letter-Number Sequencing (LNS), WCST, CPT-IP, verbal fluency, and logical memory.
Partial correlations adjusting for age and education showed that within PC-relatives self-rated negative schizotypy was associated with lower LNS and CPT-IP; positive schizotypy was associated with CPT-IP, and disorganization with memory and failure to maintain set. Schizoid symptoms had an association with failure to maintain set (though not perseveration) and paranoid symptoms with memory. Within PNC-relatives, negative schizotypy was associated with lower verbal fluency and more perseverative errors. Within controls, positive schizotypy was associated with perseverative errors and both positive and negative dimensions were associated with verbal fluency.
Results indicate a wider array of covariation between relatives with presumed higher genetic liability. A consistent pattern of associations between psychotic-like dimensions and the brain functions tapped by neurocognitive tests did not emerge across groups.
Schizophrenia is a psychiatric disorder which involves chronic or recurrent psychosis and it is commonly associated with impairment in social and occupational functioning. Antipsychotic medications are a first-line treatment, however, most patients experience disabling impairment even after benefiting from antipsychotics, including positive and negative symptoms, cognitive deficits, poor social functioning and episodes of acute symptomatic relapse.
Systematic literature review in UpToDate and Pubmed.
To identify the most relevant intervention areas of systematic rehabilitation in schizophrenia.
45 years old schizophrenic male who admitted in a Medium Stay Psychiatry Unit with severe behavioural impairment and psychotic symptoms. At least 10 hospitalizations and pronounced disability in basic life skills despite optimal treatment. Poor insight and compliance, frequent relapses, co-morbid substance abuse and difficult family support. Clozapine was added to his treatment with improvement in psychotic symptoms. A multidisciplinary intervention was also done and he was discharged home with important improvement in social skills, better insight and familiar functioning
Despite following an adequate antipsychotic treatment, including Clozapine as the main medication in resistant schizophrenia, it is often partially effective with severe impairments in social and occupational functioning. Family-based interventions, cognitive behavioural therapy and social skills training, added to this medication seem to be essential in the systematic treatment of schizoprenia. It includes a multidisciplinary team and a specific length of time but it is based on the patient's status. Despite evidence of their efectiveness, the availability of these interventions varies widely, as does the availability of clinicians to provide them.
Children of patients with substance use disorders (SUD) are at high risk for mental disorders. The effects of specific SUD in both parents on the risk of psychopathology in offspring have hardly been studied.
To gain a better understanding of the morbid risk of these children.
To assess, 1) the associations between alcohol dependence (AD) or heroin dependence (HD) in patients and psychopathology in their children; 2) the morbid risk conferred by having a second parent with SUD.
The sample included 276 children aged from 6 to 17.9 years (mean age = 11.5): 23 children of 15 patients with HD, 101 offspring of 50 patients with AD, 152 children of 81 orthopedic patients (controls) and 158 biological co-parents of the children. Subjects were interviewed by psychologists blind to patient diagnoses, using a semi-structured diagnostic interview.
1) Children of HD or AD patients had largely elevated rates of recurrent major depressive disorder and children of HD patients were also at an increased risk for ADHD and SUD; 2) There were interactions between drug disorders and alcohol disorders in both parents to increase the risk of early SUD in offspring.
The early manifestations of mental disorders in children of SUD patients emphasize the need for prompt identification and treatment of these disorders. The involvement of co-parental disorders in the development of offspring psychopathology highlights the need to pay clinical attention not only to the patient, but also to the co-parent in order to optimize prevention in offspring.
Rapid industrialization and urbanization leads at first to secular rates of social mobility. Who benefits and how this occurs. The slow change to circular mobility and the blockages to social ascent are examined.
We study the “third power” and the expansion of voluntary organizations and NGOs in Brazil since 1985, when a major expansion occurred. How these national and international organizations work and their relation to society and the state.