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Velthorst E, Nieman DH, Klaassen RMC, Becker HE, Dingemans PM, Linszen DH, de Haan L. Three year course of clinical symptomatology in young people at ultra high risk for transition to psychosis. The investigation into the course of ultra high risk (UHR) symptomatology of those patients who eventually do not meet the psychosis-threshold criteria within the 3-year timeframe of the study. The course of UHR symptoms, GAF score and employment status was investigated in 57 patients who did not make a transition to psychosis and who were examined within the Dutch Prediction of Psychosis Study in Amsterdam, the Netherlands. At the 3- year follow-up, 75% of the patients who did not make a transition to psychosis had remitted from UHR status. With a Generalized Estimation Equation Model it was shown that this group recovered from positive ( F = 52.7, P < 0.0001), negative ( F = 24.3, P < 0.0001), disorganization ( F = 14.4, P < 0.0001) and general symptoms ( F = 25.0, P < 0.0001) within the timeframe of the study. In addition, the level of global functioning and likelihood of having a job and/or education significantly improved. The largest improvements occurred within the first year. UHR symptoms did not re-occur after improvement. With the current UHR criteria, a large percentage of the included subjects appear to have transitory complaints and dysfunctioning. A refinement of the UHR criteria may diminish the chance of including 'false positives' in future UHR studies. [ABSTRACT FROM AUTHOR]

Background. Cognitive impairment is considered to be a core characteristic of schizophrenia. The relationship between psychosis and cognitive deterioration, however, remains unclear. This longitudinal study investigated the neuropsychological functioning of patients before and after their first psychotic episode. Cognitive functioning of participants who later developed a psychosis was compared to that of people at ultra-high risk (UHR) for psychosis who did not develop psychosis at follow-up and healthy controls. Method. Participants were 41 persons at UHR for psychosis (the UHR group), of whom 17 developed psychosis between the first and second assessment. Seventeen healthy controls were included in the study. Cognitive performance was assessed at intake (T0) and again after 18 months (T1). The areas of cognitive functioning assessed include verbal memory and learning, visuospatial working memory, executive function, sustained attention and motor speed. Results. The transition group did not perform significantly worse at the second assessment than at the first on any of the outcome measures. The UHR group performed better on a verbal learning and memory test at T1 compared to T0. At T0, the control group scored significantly better than the UHR group and the transition group on the verbal learning and memory test and the verbal fluency test. Conclusions. The results indicate that no cognitive deterioration occurs during the first psychotic episode. Problems in verbal memory may be present before the first episode of psychosis. [ABSTRACT FROM AUTHOR]

The article reprints the article "Managerial Careers," published in the periodical "Sociologia Neerlandica." The article discusses key issues and developments relevant to improving the managerial career in the Netherlands by adopting a more professional approach towards the job. The research is based on an examination of managerial careers in a number of large and medium-sized Dutch enterprises. During the past few years, in the Netherlands, the managers of both large and small concerns are now more favorably disposed toward research, perhaps for the very good reason that it seems to offer an opportunity for solving some of the problems encountered in enterprise management. When talking on the promotion age, 36% of the sample of top managers were promoted to the highest level of their present enterprise at the age of 45 or older, and 8% at the age of 54 or older. While 48% of the top managers and 22% of the middle managers in an American enterprise had taken 15 years or longer in the same employment to reach that level. The manager or prospective manager, the 'organization man,' who is rigidly oriented toward his own particular enterprise and who, either because of his own attitude or of the attitude of those around him, cannot conceive of a future for himself elsewhere, is not an immutable figure.

Background: The comparison of high-risk populations with different developmental pathways to psychosis may lend more insight into the heterogeneity of the manifestation of the psychotic syndrome, and possible differing etiological pathways., Aim: To compare high-risk traits and symptoms in two populations at risk for psychosis, i.e. (1) help-seeking adolescents presenting with prodromal symptoms meeting the criteria for At Risk Mental State (ARMS), and (2) adolescents with Multiple Complex Developmental Disorder (MCDD), a PDD-NOS subtype characterized by severe, early childhood-onset deficits in affect regulation, anxieties, disturbed social relationships, and thought disorder., Method: 80 ARMS- and 32 MCDD-adolescents (12-18 years) were compared on prodromal symptoms (Structured Interview of Prodromal Symptoms, and Bonn Scale for the Assessment of Basic Symptoms-Prediction list), and autism traits (Social Communication Questionnaire). In addition, both high-risk groups were compared with 82 healthy controls on schizotypal traits (Schizotypal Personality Questionnaire-Revised)., Results: Although the high-risk groups clearly differed in early developmental and treatment histories as well as autism traits, they did not differ with regard to schizotypal traits and basic symptoms, as well as disorganized and general prodromal symptoms. There were, however, group differences in positive and negative prodromal symptoms. Interestingly, 78% of the adolescents with MCDD met criteria for ARMS., Conclusion: These findings suggest that children diagnosed with MCDD are at high risk for developing psychosis later in life, and support the notion that there are different developmental pathways to psychosis. Follow-up research is needed to compare the rates of transition to psychosis in both high-risk groups.

In an ideal typical way the cohorts 1920 and 1930 are sketched. In economical and social respects these cohorts illustrate the emergence of new social inequalities and social tension. The cohorts fit into a hypothesized pattern of four generations, that is characteristic for the Netherlands at this time. At last some social and scientific perspectives of the greying of the Netherlands are considered.

In order to create health services that effectively respond to the changing picture of health, governments should try to anticipate the health needs for the future. The scenarios for the elderly that are briefly discussed in this paper are approximations of developments that are largely autonomous if considered from the position of the individuals and organizations responsible for policies on health and health services. The three contextual scenarios developed are based on the forecasts, explorations and speculations to be found in the literature and also on the outcome of discussions with groups of experts in the fields of medical, biological and technological research and practice. The following variables have been incorporated in the study preparing the scenarios: demographic developments, the health status of the elderly, health services for the elderly, developments in medical, biological and technological fields, and societal developments, both economic and social. These scenarios provide policy makers with a learning environment in which they can test the strategies that are considered to answer the questions that they face, and evaluate the particular circumstances in which these strategies might be feasible.