The etiology of anorexia nervosa (AN) remains difficult to understand, and even harder to predict. Identifying possible risk factors is therefore crucial. Recent literature has suggested that...Show moreThe etiology of anorexia nervosa (AN) remains difficult to understand, and even harder to predict. Identifying possible risk factors is therefore crucial. Recent literature has suggested that impaired set-shifting (SS) in the anorexic population might play a role as an endophenotype, meaning it might make individuals more susceptible to developing this disorder. It has been established that SS abilities are impaired in adults with AN, but it is unclear whether this is also the case for younger age groups. In this study we aimed to get a better understanding of the possible SS impairment in adolescents with AN. We examined differences in SS abilities between female adolescents with AN and HC (N=72; AN=45, HC=27), between the ages of 12-21 years old (M=15.83, SD=2.08) using a MANOVA, and looked at the influence of food-related stimuli, activity-related stimuli, and neutral stimuli on SS abilities within both groups through ANCOVAs. We examined whether poor SS abilities are associated with low BMI, poor body image, and restrictive eating behaviors using multiple regression analyses, with age, AN subtype and intelligence level as covariates. We found no significant difference in SS abilities between the participants with AN and healthy controls (p=.20). Participants with AN performed significantly worse on the SS task with activity-related stimuli as compared to the food-related (p=.015) and neutral stimuli (p<.001). HC participants did not show a difference in performance between the three SS tasks (p=.17). We did not find a significant association between SS abilities and low BMI (p=.78), poor body image (p=.233) and restrictive behaviors (p=.197). Based on our findings, poor SS abilities do not seem to be associated with adolescent AN, but more research should be done into this topic to strengthen these results. Future research must additionally focus on finding alternative measures that can be understood as risk factors, and actively seek out new approaches that can be used in the prevention of this disorder.Show less
Background. Children with Tuberous Sclerosis Complex (TSC) are at a high risk for an intellectual impairment and experiencing psychiatric symptoms. Internalizing problems, such as anxiety and a...Show moreBackground. Children with Tuberous Sclerosis Complex (TSC) are at a high risk for an intellectual impairment and experiencing psychiatric symptoms. Internalizing problems, such as anxiety and a depressed mood, are among the most prevalent reported psychiatric symptoms in patients with TSC. These problems often precede more severe psychopathology, especially when they remain unrecognized. Despite this, research on this subject is still remarkably scarce, especially in children. A factor that seems to be positively associated with internalizing problems is intellectual ability. A major research question that arises is whether more internalizing problems are related to higher intelligence levels in children with TSC, which was examined in the current study. As TSC1 is related to less (severe) intellectual impairments compared to TSC2, a differentiation was made between these mutation types. Additionally, we explored whether internalizing problems increased with age, as would be consistent with findings in the general population. Methods. To test these hypotheses, internalizing problem scores (a parental report on the child behavior checklist) and intellectual ability (using different age- and range-appropriate intelligence and developmental tests) in a non-selected sample of children with TSC (N = 95, Age (Mean (SD) = 10.46 (4.25), 46.3% female, 28.5% TSC1) were assessed. To examine the association between internalizing problems and intellectual ability, several hierarchical regression analyses were performed. Externalizing problems, age, sex and the number of prescribed anti-epileptic drugs were included as control variables. For the exploratory hypothesis, this study tracked symptom severity over two follow-up visits in a subset of our patient population, using several paired sample t-tests. To additionally check whether internalizing problems became more severe in (early) adolescence we selected 15 children (66.7% female) for the childhood/adolescence subgroup. Within these groups, sex- and mutation related differences were also considered. Results. A significant model was found (F = 10.53, p <.001) in which externalizing problems (B = .55, p <.001) and age (B = .28, p <.005) were positively associated with internalizing problems. However, intelligence levels were found to have no influence. Furthermore, internalizing problems tend to increase with age (p <.001). Between childhood and adolescence, this increase was predominantly observed in girls (p = .03). Boys did not seem to experience more internalizing problems during this transition period. Lastly, a trend was found in which only a mutation on the TSC2 gene was associated with more internalizing problems over time (p <.005). Conclusion. This study could not confirm an association between internalizing problems and intelligence. However, our results indicated that internalizing problems increased with age, especially in girls. Since these behaviors contribute to the burden of the disease, it is of great importance that all involved professionals are sensitive to internalizing problems. A regular and thorough evaluation of internalizing problems should therefore always be part of the psychiatric assessment.Show less
Background: Anorexia nervosa (AN) is a debilitating psychiatric disorder characterized by disturbed self-image resulting in dieting and losing weight. AN can be subdivided into the restricting (AN...Show moreBackground: Anorexia nervosa (AN) is a debilitating psychiatric disorder characterized by disturbed self-image resulting in dieting and losing weight. AN can be subdivided into the restricting (AN-r) and the binge-eating/purging type (AN-bp). The comorbidity of psychiatric disorders in AN is high. Previous literature mainly focused on comorbidity in AN adults whereas the onset of AN is often during adolescence. Our study investigated (severity of) depression, anxiety (social phobia and generalized anxiety disorder (GAD)) and obsessive-compulsive disorder (OCD) in AN female adolescents and subtypes and differences in these symptoms at baseline and after one year follow-up. Methods: The current study is the largest longitudinal, first-onset AN, case-control study in the Netherlands (N=121) with identical procedures at baseline and follow-up. The study included 56 AN and 65 healthy control (HC) female adolescents aged between 12 and 22 years. AN adolescents received treatment as usual between baseline and follow-up. The MINI International Neuropsychiatric Interview was used to examine the presence of psychiatric disorders. The Beck Depression InventoryII, the Screen for Child Anxiety Related Emotional Disorders and the (Children’s) Yale-Brown Obsessive Compulsive Scale measured severity of depressive, anxiety and obsessive and compulsive symptoms respectively. Group differences in prevalence and severity of psychiatric disorders were examined using chi-square tests and a MANCOVA test respectively. Changes over time were investigated using a one-way repeated measures ANCOVA. Results: The Pearson chi-square (χ 2 (1, n = 92) = 17.47, p ≤ .001) and Fisher’s exact test (χ 2 (1, n = 67) = 7.05, p = .011) showed higher prevalence of depression and social phobia respectively at baseline in AN (41% and 14%) compared to HCs (14% and 2%). There were no differences at baseline in prevalence of GAD and OCD between the groups. The Fisher’s exact test showed no differences in prevalence of the aforementioned psychiatric disorders between AN-bp and AN-r. The Pillai’s Trace test (F(3,46) = 20.73, p = .000, Pillia’s trace = .58, partial eta squared = .58) showed more severe depressive, anxiety and obsessive and compulsive symptoms at baseline in AN compared to HCs. Lastly, the Wilcoxon Matched-Pairs Test showed no differences in AN in the aforementioned symptoms over time. Conclusion: Depression, social phobia and depressive, anxiety and obsessive and compulsive symptoms were more prevalent at baseline in AN adolescents compared to HCs. Research into comorbidity in subtypes of AN adolescents is needed since our study included a small subtype sample size. Moreover, treatment should focus on reducing the prevalence of social phobia and depression and severity of depressive symptoms.Show less
Introduction: Executive functioning [EF] and intelligence are likely to be impaired in people with psychotic disorders. There are two different ways of assessing executive functioning, performance...Show moreIntroduction: Executive functioning [EF] and intelligence are likely to be impaired in people with psychotic disorders. There are two different ways of assessing executive functioning, performance-based or self-report measures. Even though both ways claim to measure the same construct, research in people with psychotic disorders shows that there is hardly any correlation between the two. Objective: Therefore, the goal of this study was to use an exploratory correlational design to investigate the association between performance-based and self-report measures in a more elaborate manner by using structural equation modelling [SEM], which may allow for a different view on the assessment of EF. Method: The study consisted of 236 psychotic patients, 65.6% were male. The mean age was 40.7 (SD = 12.1) and 41.1% of the sample were diagnosed with schizophrenia. All of the participants currently received treatment for either a first episode psychosis or a psychotic disorder. The performance-based measures in this study were the screener for intellectual and learning disabilities and tower of London, whereas the self-report measures consisted of the Behaviour Rating Inventory of Executive Function - Adult version indexes, metacognition index and behaviour regulation index. In order to see whether the different forms of testing do or do not show coherence with each other, structural equation modelling was used. Additionally, typologies were created to gain more insight into the prevalence of EF functioning of psychotic patients. These typologies were based on the used measures. Results: Results on the SEM showed that performance-based and self-report measures of EF do not show coherence (χ2(2) = 3.800, p = .150). The typologies revealed that psychotic individuals in this study scored more frequently within normal ranges rather than in clinically impaired ranges of the chosen measures. Conclusion: The typologies that were created in this study are novel within the field and provide an indication for future research. It is important to use both performance-based as well as self-report measures when assessing EF in order to get the full picture. Gaining more insight in EF might result in better mental healthcare which may allow patients to leave mental healthcare sooner.Show less
