The significance of at-risk symptoms for psychosis in children and adolescents

The early detection and treatment of people at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. Currently, the 2 most broadly used sets of at-risk criteria, that is, ultra-high risk (UHR) and basic symptom criteria, were developed mainly in adult samples. We review the data regarding the presence and relevance of at-risk symptoms for psychosis in children and adolescents. The few existing studies suggest that attenuated psychotic symptoms (APS) and brief limited intermittent psychotic symptoms (BLIPS) do have some clinical relevance in young adolescents from the general population. Nevertheless, their differentiation from atypical psychotic symptoms or an emerging schizotypal personality disorder, as well as their stability and predictive accuracy for psychosis, are still unclear. Further, standard interviews for UHR criteria do not define a minimum age for the assessment of APS and BLIPS or guidelines as to when and how to include information from parents. APS and basic symptoms may be predictive of conversion to psychosis in help-seeking young adolescents. Nevertheless, the rate and timing, and thus the required observation time, need further study. Moreover, no study has yet addressed the issue of how to treat children and adolescents presenting with at-risk symptoms and criteria. Further research is urgently needed to examine if current at-risk criteria and approaches have to be tailored to the special needs of children and adolescents. A preliminary rationale for how to deal with at-risk symptoms for psychosis in clinical practice is provided.

[Pathways-to-Care for First-Episode psychotic patients--an overview of international studies]

A longer duration of untreated psychosis (DUP) as well as of untreated illness (DUI) was found to be associated with a negative course of psychosis. Thus, increasing efforts are made to reduce the DUP and provide adequate treatment as early as possible. But, in order to overcome obstacles to early help-seeking, these have to be identified first. Thus, an overview on initial help-seeking behaviour and predictors of DUP is given. Across 25 identified studies, the DUP, at about one year on average, is still unfavourably long and includes on average of three help-seeking contacts prior to the initiation of adequate treatment. Since negative factors in pathways-to-care involve features on all relevant levels (patient, social environment and health-care system), an optimisation of pathways-to-care will require the integration of services and continuous awareness programmes targeting the general population and mental health-care professionals.

Inkonsistenz und psychische Gesundheit: eine Metaanalyse

Consistency within the psychological processes is accepted as a precondition for efficient functioning and good health. Inconsistency in contrast impairs meeting the requirements of environment and therefore impairs the satisfaction of human needs. It is also seen as a stressor and having the potential to increase the vulnerability for mental disorders (Grawe, 1998, 2004). Incongruence is a form of Inconsistency, describing the divergency between the perception of reality and the goals of a person. Discordance as a second form of Inconsistency is the amount of conflict between goals, wishes and motives. According to the Consistency Theory of Grawe, these two forms of Inconsistency together with avoidance goals and satisfaction of human needs play an important role at the emergence and the maintenance of mental disorders, as well as for the wellbeing of humans. This study includes a short overview of the conceptions of Inconsistency in the psychological literature and a metaanalysis about the interrelations between forms of Inconsistency and characteristics of health and disease. The results support mostly the assumptions of Consistency Theory. Almost all forms of Inconsistency are associated with characteristics of subjective wellbeing, health and disease. One has to take into consideration, that most of the results come from correlational studies with only one measuring time. It is therefore not possible to distinguish between cause and effect.

[Erectile dysfunction in depression and under treatment with antidepressants -- current treatment options]

Erectile dysfunction (ED) is a common problem in the general population, but also a symptom of both treated and untreated depression. As a side effect of antidepressant medication, erectile dysfunction appears to be one of the principal reasons for discontinuing antidepressant treatment. Avoiding or switching antidepressants is problematic, as this may lead to an increase in depressive symptoms. Our review shows that oral phosphodiesterase inhibitors are an option in treating both ED resulting from depression and from antidepressant medication.