Background: Traditional psychosocial treatments have been adapted for use with individuals with bipolar affective disorders due to the limited prophylactic nature of pharmacotherapy and the recognition of the role of psychosocial factors in the course of this disorder. Psychosocial interventions that include a prodromal monitoring and management component have been empirically shown to be an effective adjunct to medication for the treatment of bipolar disorder. Aims: There is a deficit of quantitative research that examines the impact of individualrelated (e.g. age, self-efficacy), disorder-related (e.g. time since diagnosis, experience of prodromal symptoms) and treatment-related (e.g. level of psychosocial input) factors on individuals’ ability to manage this disorder via the use of prodromal monitoring. The current research aimed to investigate factors that are associated with the identification and management of prodromal symptoms. Method: Participants completed five self-report measures in order to provide information on their experience of prodromal symptoms, current mood state, general self-efficacy, view of social support from significant others, and demographic and clinical-related variables. The data were collected from 101 participants, 58 of whom were female. The sample consisted of individuals with a diagnosis of bipolar disorder type I and II. Results: Univariate and bivariate analyses were used to explore the relationship between individual, disorder, and treatment-related variables associated with participants’ experience of bipolar disorder. Variables that were significantly associated with participants’ perception of their ability to identify and manage prodromes were further investigated using ordinal logistic regression analyses. The results indicated that general self-efficacy and prodromal-specific help from significant others were associated with an increase in participants’ perception of their ability to identify manic and depressive prodromal symptoms. General self-efficacy was also associated with participants’ view of their ability to manage cognitive and behavioural prodromes. Experience of prodromal symptoms (e.g. consistency of symptoms experienced, type of prodrome experienced) was associated the participants’ perception of their ability to identify and manage prodromes. In general, disorder-related variables (e.g. time since diagnosis, mood state, diagnosis type, and number of episodes experienced) were not significantly associated with the participants’ view of their ability to identify and manage prodromal symptoms. Individual-related variables such as gender and age, however, were associated with prodromal identification. Conclusion: The results indicated the need to consider constructs such as general selfefficacy and experience of prodromal symptoms (e.g. consistency of symptoms, types of prodromes experienced, and ability to recognise prodromes when they first present) when helping patients to learn how to identify and manage prodromal symptoms. In addition gender differences and the role of help from significant others were highlighted as variables that should be considered when using prodromal monitoring approaches with patients with bipolar disorder. Limitations of the research are reviewed in relation to the methodology used. Clinical implications and directions for future research are considered.

ABSTRACT Heart disease is the number one killer of American women regardless of age or race. Women still face disparity in the assessment and recognition of heart disease. One key element that contributes to this delay is a prodromal symptom presentation that may impede quick assessment and streamline treatment for cardiovascular events. The aims of this project, using best evidence and initial testing with data from Arizona Health Sciences Center Clinical Research Data Warehouse, is to construct a women's Cardiac Prodromal Symptoms Recognition Assessment List to increase early recognition of cardiovascular etiology, resulting in earlier diagnostics and treatment. A literature review was completed to determine a list of current cardiac prodromal symptoms in women. Symptom data was mined from the clinical research data warehouse and compared to the symptom list. The project results support that prodromal symptoms are valid as identifiers of women experiencing a cardiac event. The literature review identified ten prodromal symptoms; Chest Pain/Discomfort, Shortness of Breath, Fatigue, Arm/Shoulder Pain, Weakness, Nausea/Indigestion, Back Pain, Jaw Pain, Sleep Disturbance and Dizziness/Syncope that are consistent in the literature. The Clinical Research Data Warehouse (CRDW) clinical elements did match the literature prodromal symptoms list with the additional elements of edema defined as a physical finding and depression defined as a risk factor. Application of the literature review and mined clinical data provide an opportunity to explore a clinical issue such as cardiac prodromal symptoms recognition for women and to assist providers in rapid identification and treatment initiation for women experiencing cardiac events.

Knowledge of genetic predisposition to future illness and disability creates uncertainties that shape and influence life decisions about reproduction, career, health behavior, and the need for care. Current research has not yet identified the meaning of the experience of feeling uncertain among intimate partners of persons who have received genetic information pertaining to future health status. The purpose of this phenomenological study was to understand the meaning of uncertainty as a lived experienced among intimate partners of persons who have tested positive for a mutation in the gene causing Huntington disease (HD) but have not yet been clinically diagnosed with HD. The specific aims were to create a rich, vivid description of uncertainty as experienced by this population and to present these findings within an existential phenomenological perspective. Using van Manen's hermeneutic-phenomenological methodology, experiential descriptions from 10 intimate partners of persons in the prodromal phase of HD were obtained. Thematic aspects of the lived experience of uncertainty were uncovered and isolated; essential themes were determined; and linguistic transformations were composed. The analysis revealed four essential themes, indicating that the meaning of the lived experience of uncertainty was 1) an intangible reality characterized by 2) anticipating with ebbing and flowing disquietude while feeling 3) a weighty pull to dwell upon, towards inner turmoil and 4) a subdued presence with freeing possibilities. The implications of these findings are that nurses need to ensure adequate opportunity is created in which the meaning of the lived experience of uncertainty can be ascertained and explored among persons who are on the cusp of the inevitable but not yet graspable. Continued research is needed to further address the implications of being situated in this potentially fracturing phase of the disease trajectory and to determine appropriate interventions.

La maladie d'Alzheimer reste en 2012 un véritable problème de santé publique. Cette pathologie neurodégénérative est au coeur des nombreux projets de recherche scientifique dans des aspects physiopathologiques, neuropsychologique, d'imagerie ou thérapeutiques tant chez l'animal que chez l'homme. Les neurosciences tentent depuis plusieurs décennies de comprendre les mécanismes de son origine et de son évolution, afin d'arriver à freiner le plus précocement possible les atteintes cognitives, comportementales et la perte d'autonomie qui en découlent. Grâce à de nombreux progrès technologiques, en particulier en neuroimagerie, cliniciens et chercheurs disposent d'un panel d'outils de plus en plus performants pour aider au diagnostic et étendre nos connaissances sur la maladie. Dans une première partie, nous verrons comment, à l'aide de l'utilisation combinée de marqueurs cliniques, anatomiques, et biologiques, il nous est possible de mieux caractériser une population de patients atteints de maladie d'Alzheimer prodromale dans les formes sporadiques, et comment ceux-ci nous permettent d'avancer dans la compréhension des processus physiopathologiques à l'origine de la maladie. Nous aborderons ensuite dans une seconde partie le versant génétique de la maladie d'Alzheimer, au travers de deux cas cliniques. Enfin, nous verrons comment, par le biais d'une étude sur le traitement de l'information visuelle, nous pouvons tenter de mieux caractériser certains dysfonctionnements cérébraux impliquant des régions atteintes précocement dans la maladie d'Alzheimer, et ce dans le but d'une meilleure connaissance des réseaux neuronaux atteints.

Background: Mexican-American women are a burgeoning population and are at increased risk for heart disease. However, there are no studies published yet describing acute myocardial infarction (AMI) symptoms unique to this Hispanic subgroup. Aims: Guided by vulnerability theory, the aims were to describe Mexican-American women's perceptions of the AMI symptom experience and to measure their self-reported acute and prodromal MI symptoms. Methods: A convenience sample of eight Mexican-American women mean age 63 years (range 41-78 years) with recent AMI from the U.S.-Mexico border region participated in a semi-structured interview and completed the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS). Qualitative description was used to analyze codes from interview data and descriptive statistics to analyze the MAPMISS responses. Results: Mexican-American women's symptom experience was incongruent with what they knew to be symptoms of a heart attack. They attributed AMI symptoms to non-cardiac causes and did not think they were having an MI. Women self-managed symptoms and delayed seeking health care until symptoms became severe. "Asphyxiatia" (asphyxiating) and "menos fuerza" (less strength) were the most commonly described symptoms in the interviews. On the MAPMISS, Mexican-American women reported a mean of 11.25 (range 5-22) acute and 8.75 (range 0-17) prodromal symptoms. Sleep disturbance and weakness and nausea were the most frequently reported prodromal and acute symptoms, respectively, as measured by MAPMISS. Prodromal leg pain was reported with more frequency than prodromal general chest pain. Conclusions: Delays in seeking health services by Mexican-American women in the U.S.-Mexico border region reflect (1) the difference in their actual MI symptoms compared to preconceived ideas of a heart attack, (2) different terms used to describe their MI symptoms, and (3) not initiating healthcare services themselves. These findings can be used to inform Mexican-American women and healthcare providers in the U.S.-Mexico border region about the unique experiences of Mexican-American women. The findings that participants were not able to recognize or attribute their AMI symptoms suggest that heart health education should be tailored to Mexican-American women and targeted to Mexican-American families and communities.

Προδρομικές και αναδρομικές μελέτες έχουν κατά το παρελθόν αναδείξει ένα ευρύ φάσμα προδρόμων συμπτωμάτων. Ωστόσο η σχέση των προδρόμων αυτών συμπτωμάτων με αυτά της ενεργού ψύχωσης δεν έχει διερευνηθεί επαρκώς. Σε 73 νοσηλευθέντες ασθενείς με σχιζοφρένεια στο πρώτο ή το δεύτερο ψυχωτικό επεισόδιο και με διάρκεια νόσου ≤ 3 έτη (DSM-IV-TR, Axis I διάγνωση), μετρήθηκε η βαρύτητα του επεισοδίου με τη χρήση της Κλίμακας για το Αρνητικό και το Θετικό σύνδρομο (PANSS), εντός 5 ημερών από τη έναρξη του επεισοδίου. Αναζητήθηκαν επίσης αναδρομικά τα πρόδρομα συμπτώματα της νόσου. Η ανάλυση με κατά βήματα παλινδρόμηση έδειξε ότι 8 πρόδρομα συμπτώματα έφεραν αυξημένο κίνδυνο για υψηλή τιμή PANSS (ολική ή/και υποκλίμακες ), ανεξάρτητα του φύλου, ενώ ένα σύμπτωμα συσχετίστηκε με ήπια ψυχοπαθολογία. Ωστόσο τα αρνητικά και τα θετικά-αποδιοργανωτικά πρόδρομα συμπτώματα δεν συσχετίζονταν με τα αντίστοιχα συστατικά της PANSS. Παρόμοια ευρήματα παρατηρήθηκαν στους μη παρανοϊκούς ασθενείς, ενώ στους παρανοϊκούς μόνο 2 μη ειδικά πρόδρομα συμπτώματα συσχετίστηκαν με υψηλή ψυχοπαθολογία. Επίσης υπήρξαν σημαντικές συσχετίσεις ανάμεσα στον αριθμό των προδρόμων συμπτωμάτων και στα σκορ της PANSS (ολικής κλίμακας, θετικής και γενικής υποκλίμακας) στους ασθενείς με μη παρανοϊκό υπότυπο όχι όμως και στους ασθενείς με παρανοϊκό υπότυπο. Συμπερασματικά αρκετά πρόδρομα συμπτώματα, αλλά και ο αριθμός των συμπτωμάτων της πρόδρομης φάσης σχετίζεται με τη σοβαρότητα της ψυχοπαθολογίας της ενεργού ψύχωσης. Στους μη παρανοϊκούς ασθενείς υπάρχει συνέχεια στη μετάβαση από την προψυχωτική στη ψυχωτική φάση, ενώ στους παρανοϊκούς η μετάβαση αυτή διακόπτεται. / Both retrospective and prospective studies have identified a broad spectrum of ‘‘prodromal’’ symptoms, but their relationship to those of frank psycho¬sis remains largely unexplored. In 73 successive hospitalized schizophrenia patients in the first or second psychotic episode and with duration of illness ≤ 3years from the onset of psychosis were made DSM-IV-TR, Axis I, diagnoses. Also, within the first 5 days from the psychotic episode’s onset, symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). Patients were interviewed for the presence of ‘‘prodromal’’ symptoms retrospectively. Stepwise regression analyses showed that 8 prodromal symptoms carried an increased risk for high total PANSS and the components of the PANSS scores, independently of gender; one symptom was associated with mild psychopathology. However, the categories of negative and positive-disorganization prodromal symptoms were not associated with the corresponding PANSS components. Similar findings were observed in the nonpa¬ranoid patients, whereas in the paranoid only 2 nonspecific symptoms were associated with high PANSS psychopathology. Also, there were significant associations between number of prodromal symptoms and total PANSS and the subscales positive and general scores in the patients with the nonparanoid subtypes, but there were not such associations in those with the paranoid. In conclusion several prodromal symptoms as well as the number of symptoms are associated with the severity of the psychopathology of frank psychosis. In the nonpa¬ranoid subtypes there is a continuance in the transition from the prepsychotic to the psychotic stage, whereas in the paranoid the transition appears to be disrupted.

Background: Parkinson’s disease (PD) is a neurodegenerative disorder that causes distinct motor impairments (i.e., resting tremor, bradykinesia, rigidity, postural instability) and affects approximately one percent of the global population over the age of 60 years. Currently, there is no cure and diagnosis remain challenging due to the lack of well validated biomarkers. Prodromal PD is a phase that predates the onset of motor symptoms but includes brain changes and nonmotor symptoms, such as rapid eye movement sleep behaviour disorder (RBD) and hyposmia. Diffusion tensor imaging (DTI) provides non-invasively acquired metrics of microstructural changes in white matter and subcortical tissue and has potential as a biomarker for PD. To date, most DTI studies have focused on the clinical phase of PD. Investigating potential biomarkers in the prodromal phase of the disease is key for early diagnosis and treatment. This study had two primary objectives: (1) to investigate how white matter microstructure changes in different phases of PD progression, and (2) to investigate how sleep and motor symptoms relate to white matter microstructure in different phases of PD. Methods: All study data were downloaded from the Parkinson’s Progression Markers Initiative database. Subjects included 21 heathy controls (mean age=68.17±4.69; 6 female), 20 individuals with prodromal PD (14 with RBD and 6 with hyposmia) (mean age=67.95±5.90; 6 female), and 17 individuals with clinical PD (mean age=67.69±5.97; 6 female) (at baseline and one-year later). Tract based spatial statistics were used to determine between group differences in fractional anisotropy (FA) and mean diffusivity (MD) at the whole brain level and in a region of interest (ROI), the substantia nigra. The relationship between sleep or motor symptoms and DTI metrics were investigated within each group. Results: There were no differences between the groups in age, education level, or cognitive scores. Clinical PD had significantly higher motor symptoms than healthy controls or prodromal PD, and this significantly increased from baseline to one-year later. Between group comparisons showed increased MD (reflecting increased neurodegeneration) in prodromal PD relative to clinical PD (both at baseline and one-year later), while there were no group differences between either prodromal or clinical PD and healthy controls at the whole brain level or within the ROI. Increased motor symptoms were associated with neurodegeneration (i.e., decreased FA and increased MD) for healthy controls, while increased sleep symptoms were associated with decreased MD for clinical PD. Conclusion: This was the first to study of white matter microstructure differences in a mixed prodromal PD group relative to clinical PD. The detected early brain changes may support an RBD subtype of PD with overall different pattern of neurodegeneration. However, these results are preliminary and future studies must be conducted to clarify and expand upon the microstructural differences between prodromal and clinical PD, ideally with longitudinal follow-up. / Graduate / 2019-07-27

Background: Subjective cognitive decline (SCD; self-perceived decrements in cognitive functioning in spite of objective cognitive performance within the normal range) subtle cognitive decline (subtle CD; objective sub-clinical decrements in cognitive functioning), and APOE 4 genotype have each been identified as potential risk factors for Alzheimer’s and other pathological cognitive decline in later life. However, despite considerable research attention, our accrued knowledge of potential dementia risk factors has failed to coalesce into a reliable screening measure or assessment method at the earliest preclinical stages of decline. A key issue undermining this effort is the challenge of discriminating older adults experiencing age-normative cognitive changes and complaints from those with dementia risk-relevant concerns and experiences. This, in turn, may result from a fractured field that emphasizes some sources of information (e.g., cognitive test performance) at the expense of others entirely (e.g., self-reported experiences). In light of this, a mixed-methods approach integrating the various methods of enquiry and sources of data may be appropriate at this juncture. Sample and data collection: n=65 healthy community-dwelling older adults from Victoria, BC, Canada completed a brief neuropsychological assessment, participated in interviews related to their first-hand experiences of aging and cognitive change, and provided saliva samples for the purposes of genotype analysis. Chapter 1: This chapter presents a systematic review authored by the Principal Investigator and several Supervisory Committee Members prior to the commencement of this dissertation. This paper presents the current evidence regarding the relationship between SCD and APOE 4 genotype. It is included in this dissertation to contextualize our analysis and overall findings. Chapter 2: This chapter provides an overview of the methods and materials used for the subsequent dissertation studies. Chapter 3: The objective of this investigation was to identify specific psychosocial and demographic predictors of SCD and subtle CD and, by extension, to determine whether these two variables may reflect similar underlying factors. Our findings determined that the predictors for SCD and subtle CD were entirely separable. Moreover, SCD and subtle CD were not found to be related. Chapter 4: This study explored which commonly endorsed qualitative experiences correspond with SCD and subtle CD. Commonly endorsed qualitative experiences were categorized according to commonality and clinical convention. MANOVA and Mann-Whitney U analyses were performed to determine the association of SCD and subtle CD with categories of experience controlling for other demographic and psychosocial factors. Executive functioning declines and related compensatory strategies were strongly associated with both SCD and subtle CD – challenging the traditionally memory-centric focus of the majority of dementia risk research. Conclusions: As a first step, this work provides evidence that SCD may not relate to early sub-clinical objective cognitive declines. Further, executive functioning – and not episodic memory – may be a key area to explore when determining early risk-predicting cognitive declines. Overall, this work presents the potential utility of more qualitatively-oriented research to inform the development of comprehensive and multimodal risk assessment approaches. Caveats, limitations, clinical implications, and future directions are discussed. / Graduate / 2021-07-31

O objetivo central desta tese de doutorado foi investigar as características clínicas de sintomas obsessivo-compulsivos (SOC), como fenômeno intermediário entre o desenvolvimento normal e o transtorno obsessivo-compulsivo (TOC), em uma ampla amostra comunitária (não-clínica) composta por crianças em idade escolar (6 a 12 anos) e seus familiares biológicos. Para tal, determinou-se a prevalência e a distribuição sociodemográfica dos SOC descrevendo sua fenomenologia caracterizada a partir de dimensões de SOC, agregação familiar, associação com outras comorbidades psiquiátricas e outras variáveis de comprometimento clínico (ex: fatores de risco, problemas sociais, escolares e de comportamento). Dividimos o presente estudo em duas etapas. Na Etapa I, o objeto de estudo foram 9.937 crianças de 6 a 12 anos regularmente matriculadas em escolas públicas (crianças-index) e seus familiares biológicos (n total=29.459). Nesta etapa utilizou-se a Family History Screening (FHS), escala de rastreamento para sintomas psiquiátricos internacionalmente validada, e um módulo adicional com sete itens para identificar quatro dimensões de SOC (\"Agressão/ sexual/ religiosa\"; \"arranjo/ simetria\"; \"contaminação/ lavagem\" e colecionismo\"). Nessa primeira etapa obtivemos dados sobre 9.937 crianças-index (podendo ser irmãos entre si), 3.305 irmãos biológicos (13 a 18 anos) e 16.218 pais. As mães biológicas foram informantes em 88% das entrevistas. Os SOC estiveram presentes em 19.4% da amostra total, sendo 14,7% das crianças-index; 15,6% dos irmãos; 34,6% das mães e 12,1% dos pais. A presença dos SOC foi associada ao sexo masculino e aumento da idade em crianças e adolescentes. Houve agregação familiar das dimensões de SOC nas famílias, sendo que a dimensão de \"contaminação/ lavagem\" foi a mais familiar (OR: 1,44; IC 95% 1,23-1,67; p < 0,001). Crianças-index com SOC apresentaram maior frequência de outros sintomas psiquiátricos, bem como maior comprometimento escolar, social e busca por tratamentos prévios. As principais limitações desta etapa incluem entrevista indireta (by proxy) e utilização de um instrumento ainda não validado para triagem de dimensões de SOC. Na Etapa II, o objeto de estudo foi uma sub-amostra da Etapa I e foram coletados dados de 2.512 crianças-index [média de idade: 8,86 anos (DP: 1,84); 44,59% sexo feminino], com um rigoroso e abrangente protocolo de avaliação clínica, incluindo diagnósticos de transtornos mentais pela DSM-IV/ DAWBA (Development and Well-Being Assessment), padrões específicos de comportamento pelo CBCL (Child Behavior Checklist), fatores de risco, comprometimento escolar, social e tratamentos prévios. A amostra foi dividida em grupos TOC (n=77; 3,07%), SOC (n=488; 19,43%) e controles (n=1.947; 77,5%), que foram comparados em relação às suas características fenotípicas. Não houve diferenças significativas de sexo, idade e classificação socioeconômica entre os três grupos estudados. O grupo TOC apresentou, mais frequentemente, obsessões ou compulsões em geral, obsessões de contaminação, compulsões de lavagem, repetição e colecionismo. Os grupos TOC e SOC foram semelhantes em relação às frequências de obsessões de agressão e compulsões de simetria, verificação e contagem. Em relação às comorbidades pelo DAWBA, o grupo TOC apresentou mais frequentemente transtornos de humor (agrupados), transtorno de ansiedade de separação, transtorno de ansiedade generalizada, transtorno de déficit de atenção e hiperatividade, e transtornos disruptivos (agrupados), quando comparado aos grupos SOC e controles. Os grupos TOC e SOC apresentaram prevalências semelhantes de fobia social, transtornos ansiosos (agrupados), transtorno de oposição e desafio, transtorno de tiques e transtornos alimentares, com prevalência superior àquela encontrada entre controles. Fatores de risco perinatais e abuso físico ou sexual foram significativamente mais frequentes no grupo TOC, em relação a SOC e controles. O grupo SOC exibiu padrão intermediário entre TOC (maior pontuação) e controles (menor pontuação) em relação aos escores totais e às dimensões de problemas de comportamento \"internalizantes\", \"externalizantes\" e sociais da CBCL. O grupo SOC revelou o mesmo padrão encontrado no grupo TOC acerca de vulnerabilidade social, problemas escolares (repetência, expulsão ou abandono), comprometimento funcional, comportamento delinquente e busca por tratamentos prévios. A principal limitação dessa etapa foi a adaptação dos critérios do DAWBA para a DSM-IV, para se estabelecer o diagnóstico de TOC na infância e adolescência. Portanto, este estudo transversal sugere que os SOC são um fenômeno relativamente frequente (aproximadamente 15 a 20%) em escolares de 6 a 12 anos e, sua prevalência se assemelha àquela descrita em adolescentes e adultos. Os dados desta tese fornecem evidências adicionais de que há um contínuo psicopatológico e de impacto clínico entre SOC e TOC o que é importante, não apenas para aprimorar a compreensão da natureza do TOC, mas para estabelecer estratégias de tratamento e prevenção / The present thesis investigated the clinical characteristics of obsessive-compulsive symptoms (OCS), as an intermediate phenomenon between normal development and obsessive-compulsive disorder (OCD) by assessing an extensive community (non- clinical) sample of schoolchildren (6-12 years) and their biological relatives. We determined the prevalence and sociodemographic status of OCS, describing its phenomenology characterized from OCS dimensions, familial aggregation, association with other psychiatric comorbidities, and other variables of clinical impairment (e.g.: risk factors , social, school and behavior problems). The study was divided in two phases. In phase I, 9,937 children (aged 6 to 12 years) enrolled in regular public schools (index-children) and their biological relatives (overall n = 29,459) were assessed. In this phase, we used the Family History Screening (FHS), an internationally validated instrument developed for psychiatric symptoms assessment. An additional seven-item module to identify four OCS dimensions (\"aggressive/ sexual/ religious\"; \"symmetry/ arranging\", \"contamination/ cleaning\" and \"hoarding \") was also used. In the first phase data on 9,937 index-children (may be siblings to each other), 3,305 biological siblings (13-18 years) and 16,218 parents were obtained. The biological mothers were informants in 88 % of the interviews. OCS were present in 19.4 % of the total sample, 14.7 % of index-children, 15.6 % of siblings, 34.6 % of mothers and 12.1 % of parents. The presence of OCS was associated with male gender and increasing age in children and adolescents. Familial aggregation of OCS dimensions was found; the \"contamination/ cleaning\" was the most familial dimension (OR: 1.44; 95% IC 1.23 to 1.67; p < 0.001). OCS were associated with higher frequency of other psychiatric symptoms as well as greater rates of social/ school problems and searching for previous treatments. The main limitations of this phase include by proxy interviews and use of an instrument for assessing OCS dimensions not yet validated. In phase II, a sub-sample (n=2,512) of phase I index-children [mean age: 8.86 (PD: 1.84); 44.59% female] was submitted to a rigorous and comprehensive clinical evaluation protocol, including structural diagnoses of mental disorders DSM-IV/ DAWBA (Development and Well-Being Assessment), specific behavioral patterns from CBCL (Child Behavior Checklist), risk factors, school/ social problems and searching for previous treatments. The sample was divided in three groups: OCD (n = 77; 3.07 %), OCS (N=488; 19.43 %) and controls (n=1,947; 77.5 %), compared according to their clinical features. There were no significant age/ gender and socio-economic status differences between groups. OCD group presented higher rates of overall obsessions and compulsions, contamination obsessions, cleaning and repetition compulsions and \"hoarding\". OCD and OCS groups showed similar prevalence rates of aggressive, symmetry, checking and counting symptoms. Regarding DAWBA comorbidities, OCD group showed increased prevalence of mood disorders (as a group), separation anxiety disorder, generalized anxiety disorder, attention deficit hyperactivity disorder, and disruptive disorders (as a group) compared to OCS and control groups. OCD and OCS groups showed similar prevalences of social phobia, anxiety disorders (as a group), oppositional defiant disorder, tic disorders and eating disorders, showing higher prevalence than controls. Perinatal risk factors and physical or sexual abuse were significantly more frequent in the OCD group in comparison to OCS and control groups. The OCS group exhibited intermediate pattern between OCD (higher scores) and controls (lower scores) concerning total and \"internalizing\", \"externalizing\" and social dimensions scores of the CBCL. The OCS group showed the same pattern found in the OCD group concerning social vulnerability, school problems (failure, expulsion or dropout), functional impairment, delinquent behavior, and searching for previous treatments. The main limitation of this phase was the adaptation of the DAWBA criteria for DSM -IV diagnosis for pediatric OCD. Therefore, this cross-sectional study suggests that OCS is fairly frequent in schoolchildren 6-12 years (about 15 to 20%) and its prevalence is similar to that described in adolescents and adults. Data from this thesis provide further evidence that there is a psychopathological and clinical impact continuum between OCS and OCD, which is important not only to enhance the understanding of the nature of OCD but to develop treatment and prevention strategies

Οι ασθενείς με σχιζοφρένεια βρίσκονται σε υψηλό κίνδυνο για αυτοκτονικό ιδεασμό, απόπειρες αυτοκτονίας, και επιτυχημένες απόπειρες. Παρ’ όλα αυτά, η αυτοκτονική συμπεριφορά κατά τη διάρκεια της πρόδρομης περιόδου της σχιζοφρένειας και μια πιθανή συσχέτιση μεταξύ της πρόδρομης αυτοκτονικής συμπεριφοράς και της αυτοκτονικότητας μετά την έναρξη της ενεργούς ψυχώσεως δεν είχε μελετηθεί. 106 συνεχόμενες εισαγωγές ασθενών με πρόσφατη έναρξη σχιζοφρένειας εκτιμήθηκαν αναδρομικά για πρόδρομα συμπτώματα και αυτοκτονικότητα κατά τη διάρκεια της πρόδρομης φάσης καθώς και μετά την έναρξη της ενεργούς ψυχώσεως. Επιπρόσθετα, 106 σταθμισμένοι μάρτυρες από το γενικό πληθυσμό εκτιμήθηκαν για αυτοκτονική συμπεριφορά κατά τη διάρκεια της ίδιας περιόδου με την πρόδρομη φάση του αντίστοιχου ασθενή. Αυτοκτονικός ιδεασμός και απόπειρες αυτοκτονίας κατά τη διάρκεια της πρόδρομης περιόδου βρέθηκαν στο 25.5% και 7.5% των ασθενών το οποίο είναι αντίστοιχα 3.8 φορές και 8 φορές πιο συχνό από ότι στους μάρτυρες. Οι ασθενείς με αυτοκτονική συμπεριφορά είχαν μεγαλύτερο αριθμό πρόδρομων συμπτωμάτων από ότι οι ασθενείς χωρίς αυτοκτονική συμπεριφορά. Η πρόδρομη καταθλιπτική διάθεση, η εκσεσημασμένη έκπτωση στη λειτουργικότητα, και το κάπνισμα καπνού βρέθηκαν να ασκούν ανεξάρτητη επίδραση στον αυτοκτονικό ιδεασμό, ενώ η καταθλιπτική διάθεση ήταν το πρόδρομο σύμπτωμα σημαντικά πιο συχνό στους ασθενείς με απόπειρες αυτοκτονίας. Οι απόπειρες αυτοκτονίας συσχετίστηκαν με πρώιμη έναρξη της πρόδρομης συμπτωματολογίας και της ενεργού ψυχώσεως. Όλοι οι ασθενείς με απόπειρα αυτοκτονίας στην πρόδρομη περίοδο ήταν καπνιστές. Ο αυτοκτονικός ιδεασμός κατά τη διάρκεια της πρόδρομης φάσης είχε ισχυρή συσχέτιση με την δια βίου αυτοκτονικότητα μετά την έναρξη της ενεργούς ψυχώσεως. Συμπερασματικά, η αυτοκτονική συμπεριφορά είναι αρκετά συχνή κατά τη διάρκεια της πρόδρομης περιόδου. Ο συνδυασμός καπνίσματος, καταθλιπτικής διάθεσης, έκπτωσης λειτουργικότητας, και ενός μεγάλου αριθμού προδρόμων συμπτωμάτων, ειδικά σε ασθενείς με πρώιμη έναρξη συμπτωματολογίας, συνεπάγεται σημαντικά αυξημένο κίνδυνο αυτοκτονικού ιδεασμού. Ιδιαίτερη προσοχή απαιτούν οι ασθενείς με αυτοκτονικό ιδεασμό κατά την πρόδρομη περίοδο μετά την έναρξη της ενεργούς ψυχώσεως διότι ο κίνδυνος απόπειρας αυτοκτονίας είναι υψηλός. / Patients with schizophrenia are at high risk for suicide ideation, attempts and completed suicide. However, suicidal behavior during the prodromal phase of schizophrenia and a possible association between prodromal suicidal behavior and suicidality after the onset of overt psychosis are not studied. 106 consecutively admitted schizophrenia patients with recent onset were evaluated retrospectively for prodromal symptoms and suicidality during the prodromal phase and after the onset of frank psychosis. Additionally, 106 matched control subjects from the general population were evaluated for suicidality during the same age period of the prodromal phase of the corresponding patient. Suicide ideation and attempt during the prodromal period were reported in 25.5% and 7.5% of the patients that is 3.8-fold and 8-fold greater than in the controls, respectively. Patients with suicidal behavior experienced a greater number of prodromal symptoms than those without. Prodromal depressive mood, marked impairment in role functioning, and tobacco smoking exerted an independent effect on suicide ideation, whereas depressive mood was the symptom significantly more frequent in patients with suicide attempt. Suicide attempts were associated with an earlier onset of prodromal symptoms and frank psychosis. All patients with prodromal suicide attempts were cigarette smokers. Suicide ideation during the prodromal phase was strongly associated with lifetime suicidality after the onset of frank psychosis. In conclusion suicidal behavior is quite common during the prodromal period. The association of smoking, depressive mood, impaired functioning, and a large number of prodromal symptoms, particularly in patients with an early onset of symptoma¬tology carries a substantially increased risk for suicide ideation. Particular care is needed in patients with prodromal suicide ideation after the onset of frank psychosis because the risk to attempt suicide is high.