The detection of psychiatric illness by questionnaire

Objective: To review the research addressing the relationship of childhood trauma to psychosis and schizophrenia, and to discuss the theoretical and clinical implications.

Method:  Relevant studies and previous review papers were identified via computer literature searches.

Results:  Symptoms considered indicative of psychosis and schizophrenia, particularly hallucinations, are at least as strongly related to childhood abuse and neglect as many other mental health problems. Recent large-scale general population studies indicate the relationship is a causal one, with a dose-effect.

Conclusion:  Several psychological and biological mechanisms by which childhood trauma increases risk for psychosis merit attention. Integration of these different levels of analysis may stimulate a more genuinely integrated bio-psycho-social model of psychosis than currently prevails. Clinical implications include the need for staff training in asking about abuse and the need to offer appropriate psychosocial treatments to patients who have been abused or neglected as children. Prevention issues are also identified.

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Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications

http://www.waimh-vlaanderen.be/files/NeurBioRev2005_VandenberghetalRev.pdf

Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child : links and possible mechanisms. A review

Purpose of reviewTo briefly review results of the latest research on the contributions of depression, anxiety, and stress exposures in pregnancy to adverse maternal and child outcomes, and to direct attention to new findings on pregnancy anxiety, a potent maternal risk factor.Recent findingsAnxiety,

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Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice.

The effects of sex and hormonal status on the physiological response to acute psychosocial stress.

This review focuses on prenatal stress as a risk factor for psychopathology. Evidence from animal studies is summarized, and the relevance of prenatal stress models in animals for human studies is discussed. In the offspring of prenatally stressed animals, overactivity and impaired negative feedback regulation of the hypothalamic-pituitary-adrenal axis are consistent findings and may reflect a pathophysiological mechanism involved in the development of psychopathology. Reduced activity of the opioid GABA/benzodiazepine, serotonin, and dopamine systems and increased activity of the sympathico-adrenal system have been found as well. These alterations have been linked to a diverse spectrum of psychopathology. Therefore, the evidence supports the view that exposure to prenatal stress may result in a general susceptibility to psychopathology, rather than exerting a direct effect on a specific form of psychopathology.

Prenatal stress and risk for psychopathology: specific effects or induction of general susceptibility?

Prenatal stress and cognitive development and temperament in infants.

Background: In high-risk populations (e.g., adolescents, substance abusers), coping strategies in pregnancy have been studied. Avoidance of the stressful situation and aggressive coping are frequently used and related to postnatal depression and other negative outcomes. Little is known about coping strategies in nulliparous normal-risk pregnancy. Objective: To examine the factor structure of the 19-item Utrecht Coping List (UCL-19) in a sample of nulliparous normal-risk pregnant women and to explore the stability, change, and correlates of coping strategies throughout pregnancy. The associations between a particular coping strategy and the reported pregnancy complaints and experienced distress were examined. Methods: The UCL-19 was filled out and self-report data were collected about neuroticism, locus of control, depression, general anxiety, perceived stress, and physical pregnancy complaints in nulliparous women in early, mid-, and late pregnancy. Results: Confirmatory factor analysis on the UCL-19 revealed 2 coping strategies: emotion-focused coping and problem-focused coping. The factor structure of the UCL-19 had a good stability throughout pregnancy. Some changes in emotion-focused coping and problem-focused coping scores were found, although the absolute differences were rather small. High educational level and low internal locus of control predicted a high score on emotion-focused coping in the early period of pregnancy, F(2, 228) = 11.49, p < .005, R2 = .22. High educational level also predicted a high score on problem-focused coping in early pregnancy, F(1, 229) = 4.80, p < .05, R2 = .06. Emotion-focused coping was negatively and problem-focused coping was positively related to pregnancy complaints (r = -.23, p < .05 and r = .25, p < .005, respectively). Emotion-focused coping in early pregnancy and problem-focused coping in mid-pregnancy were negatively related to experienced distress in early and mid pregnancy, respectively (r = -.27, p < .0005 and r = -.18, p < .01).Conclusion: Two coping strategies were consistently found throughout pregnancy: emotion-focused coping and problem-focused coping. Coping in nulliparous normal-risk pregnancy is a process with small temporal variations. Emotion-focused coping was negatively related to the number of reported pregnancy complaints and to experienced distress.

Coping in normal pregnancy

Developmental aspects of behavioral organization were investigated in 29 healthy fetuses from 24-weeks gestation onwards: (a) short-term association between body (GM) and eye (EM) movements; (b) linkage of pairs of the three state variables [fetal heart rate pattern (FHRP), GM, and EM]; and (c) sequence of change of state variables during transitions. Linkage and sequence were also studied in complicated pregnancies. Short-term association between GM and EM was well established after 28 weeks. Linkage of state variables improved considerably after 32-34 weeks. FHRP was the first variable to change during synchronized transitions from 1F to 2F between 28-39 weeks, and the last variable during 2F to 1F transitions between 32-39 weeks. Although clear developmental patterns could be recognized, the interfetal variability was such that identification of the abnormal fetus is still difficult. Only transitions were significantly different in growth-restricted fetuses, as they showed no specific sequence of change. Assessing the temporal organization of fetal behavior seems, therefore, until now, not of great clinical value. (C) 1999 John Wiley & Sons, Inc.

Temporal organization of fetal behavior from 24-weeks gestation onwards in normal and complicated pregnancies.

Our objective was to investigate the longitudinal development of incidence parameters of fetal body movements to define normal reference ranges, to relate them to episodes of fetal heart rate patterns A and B, and to determine the intrafetal consistency for these parameters. Twenty-nine fetuses were studied longitudinally from 24 wk of gestation. Fetal body movements and heart rate were recorded at fortnightly intervals between 24 and 36 wk of gestation and weekly from 36 wk of gestation. Data were analyzed using multilevel analysis. Reference ranges were constructed for the percentage of observation time that movements were present, the number of movement bursts per hour, the mean burst duration, and the median onset-onset interval. The median percentage incidence of fetal body movements decreased from 17% at 24 wk to about 7% near term. The developmental course was the same during active episodes. Body movements also decreased during episodes of relative quiescence, in the course of pregnancy. Intrafetal variance was on average 40-80% of the total range of the four movement parameters. Normal reference ranges were developed for incidence parameters of fetal body movements from 24 wk of gestation onward. The overall decline in the incidence of movements during pregnancy appeared to be a developmental phenomenon and not due to progressively increasing episodes of fetal quiescence. Individual fetuses showed a degree of consistency in the percentage incidence of body movements, but intra- and interfetal variances were generally high, resulting in wide ranges.

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Edu J. H. Mulder

Papers

Prenatal stress and risk for psychopathology: specific effects or induction of general susceptibility?

Prenatal stress and cognitive development and temperament in infants.

Coping in normal pregnancy

Temporal organization of fetal behavior from 24-weeks gestation onwards in normal and complicated pregnancies.

Longitudinal study of fetal body movements: nomograms, intrafetal consistency, and relationship with episodes of heart rate patterns a and B.