Speurtocht naar de voorboden van een psychose bij jongeren
ABSTRACT Samenvatting In dit artikel wordt aan de hand van het voorbeeld psychose allereerst het concept staging uitgelegd.Vervolgens wordt in een casusbespreking een voorbeeld van behandeling van subklinische psychotische symptomen en gebleken risicosymptomen voor een eerste psychose, besproken. Behandeling met cognitieve gedragstherapie, zoals in deze casus wordt op dit moment onderzocht op de positieve effectiviteit ervan op het beloop van subklinische psychotische klachten. De groep patiënten met een verhoogd risico op een psychose zit vaak in de adolescentiefase, wat inhoudt dat rekening gehouden dient te worden met ontwikkelingsniveau, hetgeen uitgelegd wordt.
Abstract In this article we discuss the concept of staging of illness in relation to psychosis. In early detection of subclinical psychotic symptoms mostly a milder treatment like cognitive behavior therapy is sufficient; currently the effect of cognitive behavioral therapy on delaying or even preventing a psychosis is evaluated. Patients with an at risk mental state are mostly adolescents: this taking the developmental phase into account.
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ABSTRACT: The aim of this study was to investigate when social consequences in schizophrenia emerge, and what conditions give rise to the social disadvantage evident in people suffering from schizophrenia. Early course in schizophrenia was studied in a population-based sample of 232 first illness-episode cases retrospectively from onset to first admission, and in a representative subsample of 115 patients prospectively at six cross-sections over a period of 5 years. Data on non-specific and negative symptomatology and social development was compared with data from an age- and sex-matched control group drawn from the normal population. In total, 73% of the patients showed a prodromal phase of several years. First signs were depressive and negative symptoms. In 57% of cases social disability emerged 2 to 4 years before first admission. Social consequences depended on the level of social development at onset. An early onset involved social stagnation, and a late onset was associated with social decline. Men's poorer social outcome was determined by their lower level of social development at onset and socially adverse illness behaviour. The 5-year symptom-related course showed no gender difference. At 81% the lifetime prevalence of depressive mood until first admission was several times higher in schizophrenics than in healthy controls. Early depression predicted a lower subsequent score for affective flattening. Suicide indicators were predicted by lack of self-confidence and feelings of guilt early in the illness. Taking into account a prodromal phase of several years on average before first hospital admission, early detection, case identification and intervention are urgently needed. The intervention must be targeted at syndromes such as early depression, negative symptoms and certain forms of cognitive and social impairment.Acta Psychiatrica Scandinavica 09/1999; 100(2):105-18. DOI:10.1111/j.1600-0447.1999.tb10831.x · 5.61 Impact Factor
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ABSTRACT: Previous twin studies have supported a genetic contribution to the major categories of psychotic disorders, but few of these have employed operational diagnostic criteria, and no such study has been based on a sample that included the full range of functional psychotic disorders. A total of 224 twin probands (106 monozygotic, 118 dizygotic) with a same-sex co-twin and a lifetime history of psychosis was ascertained from the service-based Maudsley Twin Register in London, England. Research Diagnostic Criteria psychotic diagnoses were made on a lifetime-ever basis. Main-lifetime diagnoses of DSM-III-R and International Statistical Classification of Diseases, 10th Revision schizophrenia were also made. Probandwise concordance rates and correlations in liability were calculated, and biometrical model fitting applied. A substantial genetic contribution to variance in liability was confirmed for the major diagnostic categories except Research Diagnostic Criteria depressive psychosis and unspecified functional psychosis, where familial transmission was confirmed, but the relative contribution of genetic and common environmental factors was unclear. Heritability estimates for Research Diagnostic Criteria schizophrenia, schizoaffective disorder, mania, DSM-III-R schizophrenia, and International Statistical Classification of Diseases, 10th Revision schizophrenia were all between 82% and 85%. None of the estimates differed significantly from any other. Heritability estimates for schizophrenia, schizoaffective disorder, and mania were substantial and similar. Population morbid risk estimates were inferred rather than directly measured, but the results were very similar to those from studies where morbid risks were directly estimated.Archives of General Psychiatry 03/1999; 56(2):162-8. DOI:10.1001/archpsyc.56.2.162 · 14.48 Impact Factor
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ABSTRACT: The current study examined the relationship between the family environment and symptoms and functioning over time in a group of adolescents and young adults at clinical high risk for psychosis (N=63). The current study compared the ability of interview-based versus self-report ratings of the family environment to predict the severity of prodromal symptoms and functioning over time. The family environmental factors were measured by interviewer ratings of the Camberwell Family Interview (CFI), self-report questionnaires surveying the patient's perceptions of criticism and warmth, and parent reported perceptions of their own level of criticism and warmth. Patients living in a critical family environment, as measured by the CFI at baseline, exhibited significantly worse positive symptoms at a 6-month follow-up, relative to patients living in a low-key family environment. In terms of protective effects, warmth and an optimal level of family involvement interacted such that the two jointly predicted improved functioning at the 6-month follow-up. Overall, both interview-based and self-report ratings of the family environment were predictive of symptoms and functioning at follow-up; however patient's self-report ratings of criticism had stronger predictive power. These results suggest that the family environment should be a specific target of treatment for individuals at risk for psychosis.Schizophrenia Research 02/2010; 118(1-3):69-75. DOI:10.1016/j.schres.2010.01.017 · 3.92 Impact Factor