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Biomedical subjects

M Rutter

Publications and source records attributed to M Rutter.

At least 73 records · Page 4Linked to original sources
PubMed1995

The Child and Adolescent Psychiatric Assessment (CAPA).

Great advances have been made during the last 20 years in the development of structured and semi-structured interviews for use with psychiatric patients. However, in the field of child and adolescent psychiatry there have been weaknesses in the specification and definition of both symptoms and the psychosocial impairments resulting from psychiatric disorder. Furthermore, most of the available interviews for use with children have been tied to a single diagnostic system (DSM-III, DSM-III-R, or ICD-9). This has meant that symptom coverage has been limited and nosological comparisons have been inhibited. The Child and Adolescent Psychiatric Assessment (CAPA) represents an attempt to remedy some of these shortcomings. This paper outlines the principles adopted in the CAPA to improve the standardization, reliability and meaningfulness of symptom and diagnostic ratings. The CAPA is an interviewer-based diagnostic interview with versions for use with children and their parents, focused on symptoms occurring during the preceding 3 month period, adapted for assessments in both clinical and epidemiological research.

Adolescent↗
PubMed1995

Behaviour problems in childhood and stressors in early adult life. I. A 20 year follow-up of London school children.

The research presented in this paper examined the relationship between the presence of childhood behaviour problems and the rate of life events and difficulties in early adult life. Data are presented from a 20 year follow-up study of a sample of inner London school children first studied when they were aged 10. The key finding was that emotional or behavioural disturbance in childhood was associated with a marked increase in the rate of severely negative events and difficulties some two decades later. This increase was only obtained for stressors with severe negative impact of the type shown in previous investigation to be associated with the onset of psychiatric disorder. Additional results demonstrated that this main finding could not be accounted for by stressors that were a result of adult psychiatric disorder, by the respondent's own behaviour, or by continuing association with the family of origin. The need for a lifespan developmental approach to the well-established stressor-illness is discussed.

Adolescent↗
PubMed1995

The Adult Personality Functioning Assessment (APFA): factors influencing agreement between subject and informant.

The Adult Personality Functioning Assessment (APFA) provides ratings of interpersonal and social role performance in six domains over substantial periods of time. Ratings based on subject and informant accounts using the APFA were compared. There was good agreement for estimates of levels of dysfunction, and moderate agreement for type of dysfunction. An anticipated under-reporting of difficulties by subjects was not found. The extent of personality dysfunction was predictive of whether a close informant was available; however, closeness of informant was not consistently associated with subject-informant agreement.

Adaptation, Psychological↗
PubMed1995

Localization of 102 exons to a 2.5 Mb region involved in Down syndrome.

Exon amplification has been applied to a 2.5 Mb region of chromosome 21 that has been associated with some features of Down syndrome (DS). Identification of the majority of genes from this region will facilitate the correlation of the over-expression of particular genes with specific phenotypes of DS. Over 100 gene fragments have been isolated from this 2.5 Mb segment. The exons have been characterized by sequence analysis, comparison with public databases and expansion to cDNA clones. Localization of the exons to chromosome 21 has been determined by hybridization to genomic Southern blots and to YAC and cosmid clones representing the region. This has resulted in a higher resolution physical map with a marker approximately every 25 kb. This integrated physical and transcript map will be valuable for fine mapping of DNA from individuals with partial aneuploidy of chromosome 21 as well as for assessing and ultimately generating a complete gene map of this segment of the genome.

Base Sequence↗
PubMed1995

Childhood disintegrative disorder: results of the DSM-IV autism field trial.

OBJECTIVE: This report is concerned with the classification of children in whom an "autistic-like" syndrome develops after some years of normal development. In DSM-IV the term "childhood disintegrative disorder" (CDD) is used to describe such cases. METHOD: Data collected as part of the international, multisite DSM-IV field trial for autism and related conditions were examined and cases that met DSM-IV criteria for CDD were identified. RESULTS: In 16 cases the clinician had given a CDD diagnosis; in an additional 10 cases criteria for the condition were met even though this diagnosis was not given by the clinician rating the case. CONCLUSIONS: The available data suggest that CDD cases can be differentiated from those with autism; these two groups appear to differ in important ways. The identification of cases of CDD may be of particular importance for research.

Adolescent↗
PubMed1995

Autism, mental retardation, multiple exostoses and short stature in a female with 46,X,t(X;8)(p22.13;q22.1).

A young adult female with multiple exostoses, short stature, autism, mental retardation and 46,X,t(X;8)(p22.13;q22.1) is described. Although the clinical features and translocation breakpoints raise the possibility of a number of specific conditions, the constellation of problems is not consistent with any previously reported genetic syndrome. It is argued that her clinical disorder is likely due to the chromosomal abnormality and that further detailed molecular genetic investigation may shed light on the genetic basis to various components of her phenotype including the autism.

Abnormalities, Multiple↗
PubMed1995

Clinical implications of attachment concepts: retrospect and prospect.

The key features of attachment theory are summarized and the unresolved questions considered in terms of a behavioural control system, measurement of attachment security, qualities of attachment, the role of temperament, transformation of a dyadic quality into an individual characteristic, internal working models, manifestations of attachment post infancy, how one relationship affects another relationship, boundaries of attachment, associations with later functioning, the role of parenting qualities and patterns of caregiving, adaptive value of secure attachment, and disorders of attachment. The clinical implications are discussed in terms of: the need to reject the traditional psychoanalytic theories of development, the patterns of residential care for children, the provision of child care, the assessment of parenting, the effects of parental divorce and family break-up, "maternal bonding" to infants, psychotherapy and disorders of attachment.

Child↗
PubMed1995

Relationships between mental disorders in childhood and adulthood.

Research findings on continuities and discontinuities in psychopathology between childhood and adult life are reviewed with respect to major depressive disorders, anxiety states, obsessional conditions, anorexia nervosa, conduct disorders, hyperkinetic disorders, autism, specific developmental disorders of language and schizophrenia. The findings are used to consider both the conceptual issues and possible mediating mechanisms.

Adult↗
PubMed1995

A 15-20 year follow-up of adult psychiatric patients. Psychiatric disorder and social functioning.

BACKGROUND: An exploratory study was undertaken of the importance of personality disorder in predicting the long-term outcome for both episodic disorders and social functioning. METHOD: In 1966-67, a representative series of patients with children, free of episodic illness for at least one year, was sampled from the Camberwell Psychiatric Register and systematically assessed over a four-year period, using measures of known reliability and validity. Psychiatric disorder was measured using a PSE-compatible instrument. The follow-up after 15-20 years used the PSE and a systematic assessment of social functioning. RESULTS: Overall outcomes were similar across diagnoses, but an initial categorical diagnosis of personality disorder predicted much poorer outcomes on psychiatric and social measures for patients with unipolar depressive disorders than for those with other diagnoses. CONCLUSIONS: The findings indicate the importance for prognosis of including a systematic assessment of personality disorder in the clinical assessment of patients with depressive disorder.

Adolescent↗
PubMed1995

Latent-class analysis of recurrence risks for complex phenotypes with selection and measurement error: a twin and family history study of autism.

The use of the family history method to examine the pattern of recurrence risks for complex disorders such as autism is not straightforward. Problems such as uncertain phenotypic definition, unreliable measurement with increased error rates for more distant relatives, and selection due to reduced fertility all complicate the estimation of risk ratios. Using data from a recent family history study of autism, and a similar study of twins, this paper shows how a latent-class approach can be used to tackle these problems. New findings are presented supporting a multiple-locus model of inheritance, with three loci giving the best fit.

Autistic Disorder↗
PubMed1994

Psychiatric genetics: research challenges and pathways forward.

Lessons from past psychiatric genetic research, together with key issues in psychiatry requiring genetic investigation, are reviewed in order to consider the implications for the ways forward. It is argued that traditional quantitative genetics needs to use a combination of twin, adoptee, and family strategies, to examine continuities and discontinuities in psychopathology between childhood and adult life, to compare dimensions and categories, to employ adequate conceptualization and measurement of disorders, to use statistical techniques based on latent constructs, to use biological trait indicators where possible, to examine risk factors as well as diseases, to include good measures of postulated environmental risk variables, to study the interplay between genes and environment, and to study the key assumptions underlying genetic strategies. Molecular cytogenetics needs to consider both the general and specific psychopathological risks associated with chromosome abnormalities and to examine the mechanism involved, to examine the role of submicroscopic chromosomal deletions and of mitochondrial disorders, and to investigate the mechanisms involved in trinucleotide repeat amplifications that take place during intergenerational transmission. Molecular genetics needs to make greater use of smaller pedigrees in view of the concerns over phenotypic definition and genetic heterogeneity in very large extended dense pedigrees, to use sib-pair designs in view of the likelihood that most psychiatric disorder will prove to be multifactorial, to combine association strategies with linkage analyses, to pay careful attention to the definition of phenotypes in probands, to remain in close touch with other branches of biological psychiatry, and to make effective use of collaboration between centers. To date, transgenic models have had a rather limited application in psychiatry but, despite their difficulties, they are likely to provide an underpinning for gene therapy in disorders where that seems feasible.

Genetic Heterogeneity↗
PubMed1994

Survival models for developmental genetic data: age of onset of puberty and antisocial behavior in twins.

The use of survival analysis for developmental genetic data is discussed. The main requirements for models based on the decomposition of frailty distributions into shared and unshared components are outlined for the simple case of twins. Extending the earlier work of Clayton, Oakes, and Hougaard, among others, three forms of hazard model are presented, all of which can be applied to pedigree data with flexible baseline hazards without the use of numerical integration. The first two models use an additive decomposition of frailty, with either gamma or positive stable law distributed (PSL) components. The third model previously described by Hougaard involves a multiplicative PSL decomposition. The models are applied to data on the onset of puberty in male twins and illustrate the importance of correct specification of the baseline hazard for correct inference about genetic effects. The difficulty of assessing model specification using information only on the margins is also noted. Overall, the new model with additive PSL components appeared to fit these data best. A second application illustrates the use of a time-varying covariate in examining the impact of puberty on the onset of conduct disorder symptomotology.

Adolescent↗
PubMed1994

A simple method for censored age-of-onset data subject to recall bias: mothers' reports of age of puberty in male twins.

Genetic analysis of variation in age of onset of development milestones or psychopathological behaviors has been little researched, owing largely to the computational difficulty of dealing with "censored" observations. Censored observations arise when the only information on individuals is that they have reached a particular age but without onset having occurred. This paper shows how models can be simply fitted to such data using programs that can perform genetic analysis of categorical data by maximum likelihood. The method is illustrated using the program Mx with data on maternal report of the onset of puberty in twin sons from the Virginia Twin Study of Adolescent Behavioral Development. Frequently, data on age of onset is collected by retrospective recall. This can pose a variety of measurement problems. Suggestions are made for models that account for some of these problems or are robust to their presence. Substantial evidence for "telescoping" of onset dates is found for the puberty data. If left unaccounted for, these effects can artifactually inflate estimates of common environment effects.

Adolescent↗
PubMed1994

Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders.

Describes the Autism Diagnostic Interview-Revised (ADI-R), a revision of the Autism Diagnostic Interview, a semistructured, investigator-based interview for caregivers of children and adults for whom autism or pervasive developmental disorders is a possible diagnosis. The revised interview has been reorganized, shortened, modified to be appropriate for children with mental ages from about 18 months into adulthood and linked to ICD-10 and DSM-IV criteria. Psychometric data are presented for a sample of preschool children.

Algorithms↗
PubMed1994

Beyond longitudinal data: causes, consequences, changes, and continuity.

Longitudinal data have very important advantages for both measurement and the testing of causal hypotheses on the causes or course of psychopathology, but cross-sectional studies should usually be used first. The investigation of causes needs to encompass the several different types of causal question. The study of within-individual change constitutes a most important research strategy to test causal hypotheses, but it is not the only approach. Their testing requires specification of possible mechanisms, together with attention to the differential impact of risk experiences, of the possible role of person-environment interactions and protective mechanisms. This article addresses several strategies needed in using longitudinal data to test cause-and-effect relationships, including natural experiments, testing of competing hypotheses on mechanisms, study of reversal effects, multiple replications in different circumstances, use of designs to dissociate possible mechanisms, testing for dose-response relationships, examination of effect-specificity, considering biological plausibility, and assessing the strength of effects.

Cross-Sectional Studies↗
PubMed1994

Autism and known medical conditions: myth and substance.

There is general agreement that autism has an organic basis but there is less agreement on the frequency with which it is associated with known medical conditions. The evidence in the literature on the latter point is reviewed and it is concluded that the rate of known medical conditions in autism is probably about 10%; however the rate appears to be higher in cases of autism associated with profound mental retardation and in cases of atypical autism.

Autistic Disorder↗
PubMed1994

Adult outcomes of childhood and adolescent depression. III. Links with suicidal behaviours.

This study followed up into adulthood a group of child psychiatric patients suffering from depressive disorders and a closely matched nondepressed child psychiatric control group. Depression in childhood was a strong predictor of attempted suicide in adulthood. This predictive power was not due to the association between childhood depression and other childhood risk factors such as conduct disorder or suicidality. Rather, it seemed mostly to reside in the association between depression in childhood and major depression in adult life. These findings suggest that the pathways from childhood psychopathology to adult outcomes can be complex, and depend crucially on what happens later.

Adolescent↗