OBJECTIVE:To examine factors increasing the risk for onset and persistence of subthreshold mania and depression.METHOD:In a prospective cohort community study, the association between risk factors [a family history of mood disorders, trauma, substance use, attention-deficit/hyperactivity disorder (ADHD) and temperamental/personality traits] and onset of manic/depressive symptoms was determined in 705 adolescents. The interaction between baseline risk factors and baseline symptoms in predicting 8-year follow-up symptoms was used to model the impact of risk factors on persistence.RESULTS:Onset of manic symptoms was associated with cannabis use and novelty seeking (NS), but NS predicted a transitory course. Onset of depressive symptoms was associated with a family history of depression. ADHD and harm avoidance (HA) were associated with persistence of depressive symptoms, while trauma and a family history of depression predicted a transitory course.CONCLUSION:Different risk factors may operate during onset and persistence of subthreshold mania and depression. The differential associations found for mania and depression dimensions suggest partly different underlying mechanisms.

BackgroundReported rates of bipolar syndromes are highly variable between studies because of age differences, differences in diagnostic criteria, or restriction of sampling to clinical contacts.MethodIn 1395 adolescents aged 14–17 years, DSM-IV (hypo)manic episodes (manic and hypomanic episodes combined), use of mental health care, and five ordinal subcategories representing the underlying continuous score of (hypo)manic symptoms (‘mania symptom scale’) were measured at baseline and approximately 1.5, 4 and 10 years later using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI).ResultsIncidence rates (IRs) of both (hypo)manic episodes and (hypo)manic symptoms (at least one DSM-IV core symptom) were far higher (714/105 person-years and 1720/105 person-years respectively) than traditional estimates. In addition, the risk of developing (hypo)manic episodes was very low after the age of 21 years [hazard ratio (HR) 0.031, 95% confidence interval (CI) 0.0050–0.19], independent of childhood disorders such as attention deficit hyperactivity disorder (ADHD). Most individuals with hypomanic and manic episodes were never in care (87% and 62% respectively) and not presenting co-morbid depressive episodes (69% and 60% respectively). The probability of mental health care increased linearly with the number of symptoms on the mania symptom scale. The incidence of the bipolar categories, in particular at the level of clinical morbidity, was strongly associated with previous childhood disorders and male sex.ConclusionsThis study showed, for the first time, that experiencing (hypo)manic symptoms is a common adolescent phenomenon that infrequently predicts mental health care use. The findings suggest that the onset of bipolar disorder can be elucidated by studying the pathway from non-pathological behavioural expression to dysfunction and need for care.

BACKGROUND:Early substance use (SU) in adolescence is known to be associated with an elevated risk of developing substance use disorders (SUD); it remains unclear though whether early SU is associated with more rapid transitions to SUD.OBJECTIVE:To examine the risk and speed of transition from first SU (alcohol, nicotine, cannabis) to SUD as a function of age of first use.METHODS:N=3021 community subjects aged 14-24 years at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI.RESULTS:(1) The conditional probability of substance-specific SU-SUD transition was the greatest for nicotine (36.0%) and the least for cannabis (18.3% for abuse, 6.2% for dependence) with alcohol in between (25.3% for abuse; 11.2% for dependence). (2) In addition to confirming early SU as a risk factor for SUD we find: (3) higher age of onset of any SU to be associated with faster transitions to SUD, except for cannabis dependence. (4) Transitions from first cannabis use (CU) to cannabis use disorders (CUD) occurred faster than for alcohol and nicotine. (5) Use of other substances co-occurred with risk and speed of transitions to specific SUDs.CONCLUSION:Type of substance and concurrent use of other drugs are of importance for the association between age of first use and the speed of transitions to substance use disorders. Given that further research will identify moderators and mediators affecting these differential associations, these findings may have important implications for designing early and targeted interventions to prevent disorder progression.

Die vorliegende Studie geht der Frage nach, ob das Auftreten einer Weißkittelhypertonie (WKH) mit den gleichen psychischen Faktoren assoziiert ist, wie das Auftreten einer essentiellen Hypertonie (HYP). Dies wurde bei 65 WKHkern (58% Frauen; 42,3±15,7 Jahre) sowie 130 HYPkern (53% Frauen; 54,3±13,2 Jahre) im Vergleich zu 104 Normotonikern (NO; 76% Frauen; 35,3±15,3 Jahre) analysiert. Als psychische Konstrukte wurden untersucht. Ärger (STAXI), Typ D (DS 14), Angst und Depressivität (HADS), Hypochondrie (IAS); Soziale Ängste (SIAS, SPS); Unsicherheitsintoleranz (IUS); Behavioral Inhibition (RSRI) und das Vorliegen psychischer Störungen (DIA-X). In multinomial logistischen Regressionen (univariat) unter Kontrolle von Alter und Geschlecht ist eine WKH im Vergleich zu NO signifikant assoziiert mit: Sozialer Phobie (Exp(B)=4,39; p=,025), SIAS (Exp(B)=1,04; p=,008) und Trait-Anger (Exp(B)=1,09; p=,040). Eine HYP ist im Vergleich zu NO ebenfalls assoziiert mit Trait-Anger (Exp(B)=1,14; p=,002) aber auch mit allgemeiner Ängstlichkeit (Exp(B)=1,10; p=,038). WKH und HYP lassen sich mittels der untersuchten Konstrukte nicht differenzieren. Das Auftreten einer WKH ist demnach mit dem Vorliegen sozialer Ängste assoziiert, die beim Arztkontakt aktiviert werden und über die sympatische Aktivierung zu einer Blutdruckerhöhung führen. Hierbei wäre zu untersuchen, ob der temperamentsbedingte Ärger das Bindeglied zur Entwicklung einer HYP bei einer Subgruppe von WKH darstellt.

To examine the familial liability of panic disorder (PD) and agoraphobia (AG) in a community sample, namely the effect of parental PD and AG on the offspring's risk to develop either or both conditions in adolescence or adulthood. A representative community sample of N=3,021 adolescents and young adults aged 14-24 years at baseline was followed up over a period of 10 years in up to four waves. Family information was assessed by either direct interviews with at least one parent or by using subjects' family history information at either wave (N=3,014). Diagnoses and selected symptoms were assessed in both, parents and subjects, by using a standardized diagnostic interview (DSM-IV M-CIDI) with its respective family history module. (1) Parental panic attacks (PA), PD, and AG were all shown to be associated with an increased risk of offspring to also develop PA, PD, and AG. (2) Associations of parental PD were present irrespective of parental AG, whereas parental AG without PD was not associated with an increased offspring risk. (3) Outcome risk was particularly elevated in offspring of parents with PD+AG. (4) Parental PD or AG was not associated with an earlier age of onset of any syndrome in the offspring. We confirmed and expanded previous results from clinical samples that comorbid PD and AG aggregate in families. AG without PD is not familial, but it might enhance the familial transmission of PD.

The application of neoliberal policies that began to spread all over the world and Turkey at least since 1980s as it is commonly accepted. The latest applications of the neoliberal policies mainly observed in the service sector and especially in the health sector. After the year 2000, the important reforms in health sector has been applied by the Ministry of Health in Turkey like “privatization”, “autonomy”, “decentralization”, “family medicine” and “general health insurance” implementations. These research aims to find out how these implementations of the neoliberal policies in health sector affect the treatment costs of the patients in public research and training hospitals in Istanbul, Turkey, which represent 60% of the hospitals in Istanbul. Document analysis has been applied in order to figure out the effect. There is time limitation in the research due to the time limitations and difficulties in reaching the old documents. This study is valid for the years 2000 and 2007, and 2003 is accepted as the turning point since the implementations of the neoliberal policies in health care industry in Turkey has been put into practice at the time. The treatment services given in public hospitals and the changes in these services and in treatment expenses were analyzed from the 7253 invoices of the patients that were treated at Lütfi Kırdar Educational and Research Hospital and Sisli Etfal Educational and Research Hospital. The invoices of the patients were separated into: laboratory, drugs, medical materials, radiologic studies and general services, and respectively into: price, procedure numbers, costs per procedure, and the percentage of each costs in the invoices for two periods as the years 2000-2003 (first/ pre-implementation period) and 2004-2007 (second/ post-implementation period). The expenses were separated into price, procedure numbers, costs per procedure, and the percentage of each cost in total, and the two periods were compared to observe whether there is a difference pre-implementation and post-implementation periods of the neoliberal policies in the health sector.

Cannabis use (CU) and disorders (CUD) are highly prevalent among adolescents and young adults. We aim to identify clinically meaningful latent classes of users of cannabis and other illegal substances with distinct problem profiles.N = 3021 community subjects aged 14–24 at baseline were followed-up over a period ranging up to 10 years. Substance use (SU) and disorders (SUD) were assessed with the DSM-IV/M-CIDI. Latent class analysis (LCA) was conducted with a subset of N = 1089 subjects with repeated illegal SU. The variables entered in the LCA were CU-related problems, CUD, other SUD, and other mental disorders.Four latent classes were identified: “Unproblematic CU” (class 1: 59.2%), “Primary alcohol use disorders” (class 2: 14.4%), “Delinquent cannabis/alcohol DSM-IV-abuse” (class 3: 17.9%), “CUD with multiple problems” (class 4: 8.5%). Range and level of CU-related problems were highest in classes 3 and 4. Comorbidity with other mental disorders was highest in classes 2 and 4. The probability of alcohol disorders and unmet treatment needs was considerable in classes 2–4.While the majority of subjects with repeated illegal SU did not experience notable problems over the 10-year period, a large minority (40.8%) experienced problematic outcomes, distinguished by clinically meaningful profiles. The data underline the need for specifically tailored interventions for adolescents with problematic CU and highlight the potentially important role of alcohol and other mental disorders.

Background: For a better understanding of the evolution of addictive disorders and the timely initiation of early intervention and prevention, we have to learn when and how quickly the critical transitions from first substance use (SU) to regular use and from first SU and regular SU to abuse and dependence occur. Little data are currently available on the transitions to substance use disorders (SUDs) across the spectrum of legal and illegal drugs taking into account gender differences. It is the aim of this paper to describe the high density incidence and transition periods of SU and SUD for alcohol, nicotine, cannabis and other illicit drugs for young males and females.Methods: A sample of (N = 3021) community subjects aged 14-24 at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI. Results: Ages 10-16 are the high risk period for first alcohol and nicotine use (up to 38% of subjects start before age 14). Onset of illegal SU occurs later. Substantial proportions of transitions to regular SU and SUD occur in the first three years after SU onset. Only few gender differences were found for time patterns of SU/SUD incidence and transition.Conclusion: Except for alcohol the time windows for targeted intervention to prevent progression to malignant patterns in adolescence are critically small, leaving little time for targeted intervention to prevent transition. The fast transitions to abuse and dependence in adolescence may be indicative for the increased vulnerability to substance effects in this time period. Basic research on the determinants of transitions should thus target this period in adolescence. Copyright (C) 2008 John Wiley & Sons, Ltd.

Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) are highly comorbid (Collimore et al., 2010). Trauma may present a shared environmental factor contributing to the development of comorbidity; however, existent research has been hampered by use of restrictive samples and limitations in the range of traumas investigated. The current study examines the relationship between a broad range of potentially traumatic events and the comorbidity between PTSD and SAD using Wave 2 of the National Epidemiological Survey of Alcohol and Related Conditions (n=34,653). Multiple logistic regressions and cross-tabulations were used to evaluate differences in the prevalence of potentially traumatic events among those who met criteria for comorbid PTSD-SAD compared to those with PTSD without SAD and SAD without PTSD. Those in the comorbid PTSD-SAD group were significantly more likely than those in the PTSD without SAD or SAD without PTSD groups to report experiencing specific types of assaultive violence, childhood maltreatment, and other shocking events. Associations between comorbidity and childhood maltreatment were significant for females only. Individuals diagnosed with comorbid PTSD-SAD are more likely than those diagnosed with either disorder alone to report exposure to specific types of traumatic events within their lifetime.

Accessible online at: www.karger.com/ver Fax +49 761 4 52 07 14 E-mail Information@Karger.de www.karger.com Aber eigentlich sind gesundheitsbezogene Ängste genauso realistisch wie viele andere Ängste, z.B. soziale. «Health Anxiety» fängt den Kern des Problems viel besser ein. Auch für einen Arzt ist es doch viel leichter, mit einem Patienten über eine nachvollziehbare gesundheitsbezogene Angst zu sprechen, als ihn davon zu überzeugen, er sei Hypochonder!

It has repeatedly been found that early-life traumatic events may contribute to metabolic dysregulation. Therefore, the aim of this study was to investigate the association between the history of childhood trauma and cardiovascular risk factors in first-episode schizophrenia (FES) patients.The history of childhood trauma was assessed using the Early Trauma Inventory Self Report — Short Form (ETISR-SF) in 83 FES patients. Based on the ETISR-SF, patients were divided into those with positive and negative history of childhood trauma: FES(+) and FES(−) patients. Serum levels of fasting glucose lipids, homocysteine, vitamin B12 and folate, as well as anthropometric parameters and resting systolic and diastolic blood pressure (SBP and DBP) were measured.The history of childhood trauma was associated with higher low-density lipoprotein (LDL) levels, SBP and DBP after covarying for age, gender, body mass index, education and chlorpromazine equivalent. There were significant correlations between scores of distinct ETISR-SF subscales and LDL, high-density lipoprotein, SBP, DBP and the number of metabolic syndrome criteria.Results of this study indicate that traumatic events during childhood might be related to higher resting blood pressure and higher LDL levels in adult FES patients.