Abstract: PURPOSE: Generally, immigrant status and male sex are separately documented to increase the risk of schizophrenia; although population-based risk trends by sex and immigration over time have not been examined. This study aims to examine the extent to which immigration acts as a risk factor for schizophrenia, delineated by origin, sex and year, using national population-based data over 15 years. METHOD: Data on all first psychiatric admissions from 1978 to 1992 (n = 10,892) from the National Psychiatric Hospitalization Case Registry of the State of Israel were merged with aggregate national data from the Israeli Central Bureau of Statistics. RESULTS: Compared to native-born Israelis, people who migrated prior to the age of 15 (n = 2,335) were at a greater risk of schizophrenia (n = 8,557; RR = 1.6, 95% CI = 1.53; 1.68), particularly those from Far Eastern (RR = 2.43, 95% CI = 1.91; 3.1) and Caribbean and South American (RR = 1.94, 95% CI = 1.51; 2.51) countries. Aggregate risk was higher among female than male immigrants and over the 15-year study immigration-related risk declined across the sexes. CONCLUSION: The current findings replicate past research showing that immigrants, particularly from a social minority, as suggested by the social defeat-hypothesis, are at an increased risk of schizophrenia, and extend past findings to show that risk at least in Israel has decreased with time irrespective of sex.
Abstract: PURPOSE: This study examined the extent to which parental SES and ethnic affiliation during adolescence are associated with Center for Epidemiologic Studies Depression Scale (CES-D) scores compatible with depression during adulthood. METHODS: The data were extracted from the US National Longitudinal Survey of Youth (NLSY79) conducted in 1979 on several ethnic groups (African-Americans, Hispanics and Others). These data included paternal socio-economic status (SES) when respondents (N = 8,331) were on average aged 18. The CES-D was re-administered 27Â years later to assess the presence of depression. RESULTS: Adjusted for age, binary logistic regression modeling showed that parental low SES increased the risk of CES-D of scores compatible with depression across ethnic groups for both genders. A gradient was observed of an increased likelihood of depression scores with lower parental SES levels: among African-American respondents, depression scores were highest at the lowest parental SES levels (ORÂ =Â 3.25, 95% CI 2.19-4.84) and the risk dropped at medium (ORÂ =Â 3.00, 95% CI 1.96-4.59), and highest SES levels (ORÂ =Â 1.85, 95% CI 1.12-3.07). An analogous pattern was generally found for each ethnic group. CONCLUSIONS: Low parental SES during adolescence significantly increases the likelihood of CES-D scores compatible with depression during adulthood across US ethnic groups and in both genders.
Abstract: The Health Belief Model states that medication adherence is primarily determined by beliefs (i.e., perceptions of: adherence costs and benefits, susceptibility, and outcome severity), yet little is known regarding the model's longitudinal utility.
Abstract: The adequacy of the Positive and Negative Syndrome Scale (PANSS) items in measuring symptom severity in schizophrenia was examined using Item Response Theory (IRT). Baseline PANSS assessments were analyzed from two multi-center clinical trials of antipsychotic medication in chronic schizophrenia (n=1872). Generally, the results showed that the PANSS (a) item ratings discriminated symptom severity best for the negative symptoms; (b) has an excess of "Severe" and "Extremely severe" rating options; and (c) assessments are more reliable at medium than very low or high levels of symptom severity. Analysis also showed that the detection of statistically and non-statistically significant differences in treatment were highly similar for the original and IRT-modified PANSS. In clinical trials of chronic schizophrenia, the PANSS appears to require the following modifications: fewer rating options, adjustment of 'Lack of judgment and insight', and improved severe symptom assessment.
Abstract: The extent of heterogeneity in antipsychotic treatment response for over extended period is unclear. This study aimed to quantify treatment response trajectories and their characteristics up to 2 years in recent-onset psychosis.
Abstract: To extend the early treatment response literature, this article aims to quantify the extent of heterogeneity and describe the characteristics of treatment response trajectories in schizophrenia.
Abstract: Little is known about the extent of heterogeneity of symptomatology in treated early-onset psychosis. The current study aims to quantify the extent of heterogeneity in trajectories of treated symptom severity in early-episode psychosis and their antecedents.
Abstract: This study aims to examine competing explanations of the relationship between religious and political ideology commitment with posttraumatic growth.
Abstract: This study presents the psychometric properties of the Strengths and Difficulties Questionnaire - Hebrew version (SDQ-H), used in the Israel Survey on Mental Health among Adolescents (ISMEHA). The SDQ-H was administered to a representative sample of 611 adolescents and their mothers. Structural validity was evaluated by exploratory and confirmatory factor analysis and the Development and Well-Being Assessment (DAWBA) inventory was used as "gold standard" to test convergent and discriminant validity. Internal consistency and normative scores were established. Agreement was found with the original factor structure, except for the Peer problem scale. Concurrent and discriminant validity varied from fair to very good for most scales. Total Difficulties scores showed better discriminant validity for the adolescents' than the mothers' report for internalizing disorders, and the opposite for externalizing disorders. Internal consistency for the Total Difficulties was 0.77 and for the Hyperactivity scale it was 0.73. It was lower for the other scales, particularly for the Peer problems scale. The findings suggest reasonable psychometric properties of the SDQ-H. Comparisons with other translated SDQ versions are presented.
Abstract: Meta-analysis was conducted to examine dropout predictors and differences between SSRIs and placebo in randomized clinical trials (RCTs) of PTSD. Studies systematically located were SSRI versus placebo double blind RCTs of PTSD DSM diagnosis published between 1991 and 2008. Fourteen RCTs (n = 2815) met the inclusion criteria with an average duration of 10.8 weeks. Dropout rates were: 331 of 1111 (29.8%) among placebo arm and 513 of 1704 (30.3%) among SSRI participants. Random effects modeling showed that the dropout rates of SSRIs and placebo did not differ (OR = 1.05, 95% CI = 0.82-1.34), although favored SSRIs among civilian traumas (OR = 2.52, 95% CI = 1.11-5.7). Mixed effects modeling showed dropout was predicted by mixed trauma in the placebo arms, and duration and mean dose across treatments. With the exception of civilian trauma, SSRIs dropout rates were slightly lower than those of placebo. Formulae are available to guide the prediction of dropout.
Abstract: This article examined suicide attempt rates at first psychiatric hospitalization and risk factors for subsequent suicide attempts over the early course of schizophrenia in national population-based data. Data were extracted from the National Psychiatric Hospitalization Case Registry of the State of Israel that contains all first psychiatric admissions with schizophrenia 1989-1992 and were followed up to 1996 (N=2293). Attempted suicide rates were: 8.5% (n=196) at the time of first psychiatric hospitalization and 6.6% (n=151) over the follow-up period of 4 to 7 years. Of those with a suicide attempt at first admission, 31.6% (n=62) made a subsequent suicide attempt during the follow-up period (OR=10.44, 95% CIs=7.22 to 15.09). Risk profiles were derived using recursive partitioning to predict sub-groups at risk of a subsequent suicide attempt. Those characterized by an attempt at the time of first admission were college educated, female and not married (45.9% (17/37), OR=13.46, 95% CIs=6.89 to 26.3). The risk profiles together correctly classified 90.7% (137/151) of subsequent suicide attempts. Suicide attempts at first admission and premorbid years of education have long-term prognostic utility and risk profiles are available.
Abstract: Advanced paternal age has been suggested as a risk factor for autism, but empirical evidence is mixed. This study examines whether the association between paternal age and autism in the offspring (1) persists controlling for documented autism risk factors, including family psychiatric history, perinatal conditions, infant characteristics and demographic variables; (2) may be explained by familial traits associated with the autism phenotype, or confounding by parity; and (3) is consistent across epidemiological studies. Multiple study methods were adopted. First, a Swedish 10-year birth cohort (N=1 075 588) was established. Linkage to the National Patient Register ascertained all autism cases (N=883). Second, 660 families identified within the birth cohort had siblings discordant for autism. Finally, meta-analysis included population-based epidemiological studies. In the birth cohort, autism risk increased monotonically with increasing paternal age. Offspring of men aged 50 years were 2.2 times (95% confidence interval: 1.26-3.88: P=0.006) more likely to have autism than offspring of men aged 29 years, after controlling for maternal age and documented risk factors for autism. Within-family analysis of discordant siblings showed that affected siblings had older paternal age, adjusting for maternal age and parity (P<0.0001). Meta-analysis demonstrated advancing paternal age association with increased risk of autism across studies. These findings provide the strongest evidence to date that advanced paternal age is a risk factor for autism in the offspring. Possible biological mechanisms include de novo aberration and mutations or epigenetic alterations associated with aging.Molecular Psychiatry advance online publication, 30 November 2010; doi:10.1038/mp.2010.121.
Abstract: This article examines how premorbid years of education and age of onset relate to the course of schizophrenia in a population-based cohort. All first and subsequent cases who were hospitalized with schizophrenia (1988-92, followed up until 1996) and completed their formal education at least 1 year before hospitalization (n=2135) were extracted from the Israeli National Psychiatric Hospitalization Registry. Results, based on hierarchical moderated regression models showed that age of onset predicted the course with greater consistency and magnitude than years of education. Years of education predicted the age of first hospitalization among males. Years of education and age of first hospitalization significantly interacted to predict the length of first stay and average number of days hospitalized over the course for males. The interaction showed that for males less education predicted poorer hospitalization outcomes if an earlier onset occurred. Together, the results suggest that less educated, early onset males are at higher risk of a poorer course.
Abstract: To extend the literature the present study aims to examine the interrelationships between resilience (defined by a lack of posttraumatic stress disorder following trauma) and posttraumatic growth. Two studies were conducted of Israeli: (a) adolescents exposed to terror (N = 2908), and (b) citizens and army personnel following the second Lebanon War (N = 588). Across studies the results showed that high levels of resilience were associated with the lowest posttraumatic growth scores. The results imply that although growth and resilience are both salutogenic constructs they are inversely related. The theoretical and clinical implications of these findings are discussed.
Abstract: This study examined the extent to which the contingencies risk framework (consisting of dispositional, historical, contextual, and clinical domains) predicted detected recidivism (i.e., arrest or conviction). Secondary data were extracted on 413 prisoners who underwent a psychiatric evaluation, were assessed on the risk domains, and followed up over 20 years. There were 273 (66.1%) cases of recidivism for serious offenses (e.g., assaults). Criminal career outcomes examined included: years to and the incidence of recidivism. Statistics showed that chance classification of the incidence of recidivism was 21% more accurate for the recursive partitioning than the bilinear model. These results are consistent with the contingencies risk framework, support its use over linear models, and highlight its predictive utility.
Abstract: Social and intellectual premorbid functioning are generally estimated retrospectively, and related to clinical or hospitalization outcomes in schizophrenia. Yet the relationship between premorbid functioning assessed prior to psychiatric hospitalization and postmorbid functional outcomes has not been examined.
Abstract: Dropout is often used as an outcome measure in clinical trials of antipsychotic medication. Previous research is inconclusive regarding (a) differences in dropout rates between first- and second-generation antipsychotic medications and (b) how trial design features reduce dropout. Meta-analysis of randomized controlled trials (RCTs) of antipsychotic medication was conducted to compare dropout rates for first- and second-generation antipsychotic drugs and to examine how a broad range of design features effect dropout. Ninety-three RCTs that met inclusion criteria were located (n = 26 686). Meta-analytic random effects models showed that dropout was higher for first- than second-generation drugs (odds ratio = 1.49, 95% confidence interval: 1.31-1.66). This advantage persisted after removing study arms with excessively high dosages, in flexible dose studies, studies of patients with symptom exacerbation, nonresponder patients, inpatients, and outpatients. Mixed effects models for meta-analysis were used to identify design features that effected dropout and develop formulae to derive expected dropout rates based on trial design features, and these assigned a pivotal role to duration. Collectively, dropout rates are lower for second- than first-generation antipsychotic drugs and appear to be partly explained by trial design features thus providing direction for future trial design.
Abstract: Research based on pooling data from clinical trials suggests that it is possible to extrapolate from a CGI-S to a PANSS severity score and from the CGI-I to a PANSS percentage change score. This research has not been replicated nor examined in individual trials. This study aims to examine the feasibility of extrapolation from the CGI to the PANSS across and within 4 large clinical trials of antipsychotic medication.
Abstract: This study examined the relationship between legal status at the time of the first psychiatric hospitalization and hospitalization outcomes in a population-based cohort.
Abstract: To address gaps in the literature, this study examined the components of posttraumatic growth, and the relationship between growth and posttraumatic stress disorder (PTSD). Participants were from a pooled sample of 4,054 Israeli adolescents exposed to terror of whom 210 (5.5%) met criteria for PTSD. Measures included the Child Post-Traumatic Stress Reaction Index and Posttraumatic Growth Inventory. Principal components analysis showed two correlated components of outward and intrapersonal growth. Regression modeling showed that the relationship between the growth and PTSD measures was linear and curvilinear (inverted-U). These results replicated accounting for heterogeneity in PTSD, exposure and subsamples. Collectively, the results imply that posttraumatic growth in adolescence is characterized by two robust components, and is greatest at moderate posttraumatic stress levels.
Abstract: The Positive and Negative Syndrome Scale (PANSS) is a widely used instrument to measure severe psychopathology in schizophrenia. Recently, its widely accepted 5-factor solution is questioned using confirmatory factor analysis (CFA). This article examines the appropriateness of applying CFA to PANSS data and the dimensionality of the PANSS in a large sample of persons with chronic schizophrenia, schizophreniform disorder, and schizoaffective disorder.
Abstract: Schizophrenia may follow a course of amelioration, deterioration or stability. It is possible that deterioration at the aggregate level may be due to a sub-group of patients with a tendency to deteriorate.
Abstract: The Premorbid Adjustment Scale (PAS) is a widely used rating scale to assess premorbid functioning retrospectively. Despite its widespread use there is no published structured interview (SI) schedule and little is known about the reliability of the instrument.
Abstract: Despite suggestions that an earlier age of onset and being male confer to a poorer course of schizophrenia, evidence regarding when these effects are most salient appears to be ambiguous.
Abstract: This article provides a brief introduction to the history and applications of the class of data analytic techniques collectively known as Structural Equation Modeling (SEM). Using an example based on psychological factors thought to affect the likelihood of stuttering, we discuss the issues of specification, identification, and model fit and modification in SEM. We also address points relating to model specification strategies, item parceling, advanced modeling, and suggestions for reporting SEM analyses. It is noted that SEM techniques can contribute to the elucidation of the developmental pathways that lead to stuttering.
Abstract: In this article, we develop a revised short form of the original Eysenck Personality Profiler (EPP; H. J. Eysenck & Wilson, 1991). In addition, we address topics of broad theoretical importance such as the recurrent empirical finding of correlations between conceptually orthogonal personality dimensions and the possibility that gender differences in these dimensions are partly spurious. In Study 1 (N = 227), we demonstrate that the existing short form of the EPP (EPP-SF; H. J. Eysenck, Wilson, & Jackson, 1996) provides a poor fit to the data and we develop a revised well-fitting version. In Study 2, we retest this version on an independent new sample (N = 3,374) where it is again found to fit the data well. We show that most of the structural and measurement parameters of the revised EPP-SF are invariant across genders. Structured means analysis indicated a significant gender difference in Psychoticism, with men scoring higher than women, but no differences in Extraversion or Neuroticism. Our discussion focuses on issues concerning personality measurement and structure, including an examination of the role of confirmatory factor analysis in personality research.
