Category: Mental Health

Is there Evidence of Cognitive Impairment in Psychosis Risk Syndrome Children & Adolescents?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Neuropsychological profile of children and adolescents with psychosis risk syndrome: the CAPRIS study.

Background

Neuropsychological underperformance is well described in young adults at clinical high risk for psychosis, but the literature is scarce on the cognitive profile of at-risk children and adolescents.

The aim of this study is to describe the neuropsychological profile of a child and adolescent sample of patients with psychosis risk syndrome (PRS; also known as Attenuated Psychosis Syndrome) compared to healthy controls and to analyse associations between attenuated psychotic symptoms and cognitive impairment.

Methods

Cross-sectional baseline data analysis from a longitudinal, naturalistic, case-control, two-site study is presented.

Eighty-one help-seeking subjects with PRS and 39 healthy controls (HC) aged between 10 and 17 years of age were recruited.

PRS was defined by:

  • Positive or negative attenuated symptoms;
  • Brief Limited Intermittent Psychotic Symptoms (BLIPS);
  • Genetic risk (first- or second-degree relative); or
  • Schizotypal personality disorder plus impairment in functioning.

A neuropsychological battery was administered to assess:

  • General intelligence;
  • Verbal and visual memory;
  • Visuospatial abilities;
  • Speed processing;
  • Attention; and
  • Executive functions.

Results

The PRS group showed lower general neuropsychological performance scores at a multivariate level and lower scores than controls in general intelligence and executive functions.

Lower scores on executive function and poorer attention were associated with high scores of positive attenuated psychotic symptoms.

No association with attenuated negative symptoms was found.

Conclusions

This study provides evidence of cognitive impairment in PRS children and adolescents and shows a relationship between greater cognitive impairment in executive functions and attention tasks and severe attenuated positive symptoms.

However, longitudinal studies are needed to clarify the nature of cognitive impairment as a possible vulnerability marker.

Reference

Tor, J., Dolz, M., Sintes-Estevez, A., de la Serna, E., Puig, O., Muñoz-Samons, D., Pardo, M., Rodríguez-Pascual, M., Sugranyes, G., Sánchez-Gistau, V. & Baeza, I. (2020) Neuropsychological profile of children and adolescents with psychosis risk syndrome: the CAPRIS study. European Child & Adolescent Psychiatry. doi: 10.1007/s00787-019-01459-6. [Epub ahead of print].

What Impact does Motivational Dispositions have on Mood Symptoms & Emotional Regulation?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Psychopathological Correlates and Emotion Regulation as Mediators of Approach and Avoidance Motivation in a Chinese Military Sample.

Background

Approach and avoidance motivation have been thoroughly studied in common mental disorders, which are prevalent in the military context.

Approach/avoidance motivational dispositions underlie emotion responses and are thought to influence emotion dysregulation.

However, studies on the mediating role of emotion regulation (ER) between motivational dispositions and mental disorders have been insufficient.

The researchers examined the psychopathological correlates of motivational dispositions and explored the mediating role of ER.

Methods

The Behavioural Inhibition System and Behavioural Activation System (BIS/BAS) scales and measures of mood disorders (depression, anxiety, OCD, and PTSD) were administered to a nonclinical sample of 3,146 Chinese military service members.

The Emotion Regulation Questionnaire for Army men (ERQ-A) (Chinese version) was used to measure ER styles.

They examined the reliability and construct validity of the BIS/BAS scales.

Approach/avoidance motivations were correlated with symptoms of mood disorders.

Mediation analysis was conducted to confirm the mediating role of ER between motivation and mood disorders.

Results

The results showed acceptable internal reliability and construct validity of the BIS/BAS scales. Gender (female), family status (single-parent family), and social relationships (having fewer good friends) were significant predictors of high BIS sensitivity.

More years of education, an older age, being an only child and being in a single-parent family all significantly predicted high BAS sensitivity.

The BIS/BAS scales were predictive of various DSM-V-based mental disorders (depression, anxiety, OCD, and PTSD).

Immersion exacerbated the impact of BAS/BIS sensitivities on depressive/PTSD symptoms, while reinterpretation and talking out alleviated the impact of BAS/BIS sensitivities on these symptoms.

Conclusions

Motivational dispositions have an impact on mood symptoms under specific conditions.

ER strategies (immersion, reinterpretation, and talking out) were shown to be partial mediators between approach/avoidance motivation and mood disorders.

These findings highlight the importance of ER in altering the impact of motivational dispositions on mood disorders and as a promising target of psychotherapies.

Reference

Wang, X., Zhang, R., Chen, X., Liu, K., Wang, L., Zhang, J., Liu, X. & Feng, Z. (2019) Psychopathological Correlates and Emotion Regulation as Mediators of Approach and Avoidance Motivation in a Chinese Military Sample. Frontiers in Psychiatry. 10:149. doi: 10.3389/fpsyt.2019.00149. eCollection 2019.

Linking Risk of Suicidal Behaviour with Mental Disorders & Work Disability

Published on by Andrew MarshallLeave a comment

Research Paper Title

Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?

Background

Among potential pathways to suicidal behavior in individuals with mental disorders (MD), work disability (WD) may play an important role.

The Researchers examined the role of WD in the relationship between MD and suicidal behaviour in Swedish-born individuals and refugees.

Methods

The study cohort consisted of 4,195,058 individuals aged 16-64, residing in Sweden in 2004-2005, whereof 163,160 refugees were followed during 2006-2013 with respect to suicidal behaviour.

Risk estimates were calculated as hazard ratios (HR) with 95% confidence intervals (CI).

The reference groups comprised individuals with neither MD nor WD.

WD factors (sickness absence (SA) and disability pension (DP)) were explored as potential modifiers and mediators.

Results

In both Swedish-born and refugees, SA and DP were associated with an elevated risk of suicide attempt regardless of MD. In refugees, HRs for suicide attempt in long-term SA ranged from 2.96 (95% CI: 2.14-4.09) (no MD) to 6.23 (95% CI: 3.21-12.08) (MD).

Similar associations were observed in Swedish-born. Elevated suicide attempt risks were also observed in DP.

In Swedish-born individuals, there was a synergy effect between MD, and SA and DP regarding suicidal behaviour.

Both SA and DP were found to mediate the studied associations in Swedish-born, but not in refugees.

Conclusions

There is an effect modification and a mediating effect between mental disorders and WD for subsequent suicidal behaviour in Swedish-born individuals.

Also for refugees without MD, WD is a risk factor for subsequent suicidal behaviour.

Particularly for Swedish-born individuals with MD, information on WD is vital in a clinical suicide risk assessment.

Reference

Björkenstam, E., Helgesson, M., Amin, R., Lange, T. & Mittendorfer-Rutz, E. (2020) Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability? Social Psychiatry and Psychiatric Epidemiology. doi: 10.1007/s00127-019-01824-5. [Epub ahead of print].

Occupational Stress: Mental Health Professionals & Stigma

Published on by Andrew MarshallLeave a comment

Research Paper Title

Development of a measure of stigma towards occupational stress for mental health professionals.

Background

Stigma is a common barrier to mental health professionals (MHPs) seeking help for occupational stress and burnout, although there is a lack of psychometrically sound tools to measure this construct.

The current study aimed to develop and validate a scale (the Mental Health Professional Stigma Scale; MHPSS) for this purpose.

Methods

The MHPSS and related measures were completed by 221 Australian MHPs via online survey, with a sub-sample completing the MHPSS again 2 weeks after initial completion.

Results

Exploratory factor analysis revealed a four-factor solution, comprising of 13 items and accounting for 50.16% of variance.

Factors were:

  • Perceived Other Stigma;
  • Perceived Structural Stigma;
  • Personal Stigma; and
  • Self stigma.

The internal consistency, test-retest reliability, and validity of the scale were supported.

Conclusions

The MHPSS has utility to capture stigmatising attitudes and beliefs related to occupational stress and burnout among MHPs.

It may be used to assist in the development and evaluation of initiatives to reduce stigma and increase help-seeking among MHPs.

Reference

Clough, B.A., Hill, M., Delaney, M. & Casey, L.M. (2020) Development of a measure of stigma towards occupational stress for mental health professionals. Social Psychiatry and Psychiatric Epidemiology. doi: 10.1007/s00127-019-01820-9. [Epub ahead of print].

Clozapine & Motivation for Food

Published on by Andrew MarshallLeave a comment

Research Paper Title

Clozapine reliably increases the motivation for food: parsing the role of the 5-HT2c and H1 receptors.

Background

Although clozapine is effective in treating schizophrenia, it is associated with adverse side effects including weight gain and metabolic syndrome.

Despite this, the role of clozapine on feeding behaviour and food intake has not been thoroughly characterised.

Clozapine has a broad pharmacological profile, with affinities for several neurotransmitter receptors, including serotonin (5-hydroxytriptamine, 5-HT) and histamine.

Given that the serotonin 5-HT2C receptor and histaminergic H1 receptor are involved in aspects of feeding behaviour, the effect of clozapine on feeding may be linked to its action at these receptors.

Methods

The researchers assessed, in rats, the effect of acute and subchronic administration of clozapine on responding for food under a progressive ratio (PR) schedule under conditions of food restriction and satiety.

They also examined the effect of antagonists of the serotonin 5-HT2C and histaminergic H1 receptors on the same schedule.

Results

Clozapine reliably increased responding for food, even when rats had ad libitum access to food.

The effect of clozapine on responding for food was reproduced by combined (but not individual) antagonism of the serotonin 5-HT2C and histaminergic H1 receptors.

Conclusions

These findings show that clozapine enhances the motivation to work for food, that this effect is stable over repeated testing, and is independent of hunger state of the animal.

This effect may relate to a combined action of clozapine at the serotonin 5-HT2C and histaminergic H1 receptors.

Reference

Abela, A.R., Ji, X.D., Li, Z., Lê, A.D. & Fletcher, P.J. (2020) Clozapine reliably increases the motivation for food: parsing the role of the 5-HT2c and H1 receptors. Psychopharmacology (Berl). doi: 10.1007/s00213-019-05425-7. [Epub ahead of print].

Mental Health: Exercise & Osteoarthritis in Older People

Published on by Andrew MarshallLeave a comment

Research Paper Title

A Study on the Physical Activities, Mental Health, and Health-Related Quality of Life of Osteoarthritis Patients.

Background

The purpose of this study was to investigate the physical activities, mental health, and health-related quality of life (HRQOL) of osteoarthritis patients.

Methods

This study was conducted using data from the first year of the 7th Korea National Health and Nutritional Examination Survey.

There were 8,150 participants included in the survey, and 665 participants had been diagnosed with osteoarthritis.

This study analysed the measurements of physical activities, depression, and HRQOL in participants with osteoarthritis.

Results

The mean age of the participants was 67 ± 9.9 years and 83.1% were female.

Participants rarely engaged in work-related physical activity, and engaged in leisure-related physical activities infrequently.

Most of the participants (85.9%) did not do regular exercise, but 1/3 of the participants walked for over 10 minutes a day.

“Pain/discomfort” had the least impact upon HRQOL, and among the depression subcategories, “difficult to sleep and tiredness” had the most impact.

Multiple logistic regression analysis showed that an adverse HRQOL score was statistically significantly associated with “location changes/physical activities” (p < 0. 01), “depression” (p < 0.001) and “age” (p < 0.001).

Conclusions

Exercise programmes should be in place which are manageable in everyday life for the elderly (> 65 years).

Changes in daily routine so that patients become more active, should be supported by the family and community, together with assistance in managing psychological problems such as depression.

Reference

Kim, D.J. (2019) A Study on the Physical Activities, Mental Health, and Health-Related Quality of Life of Osteoarthritis Patients. Osong Public Health and Research Perspectives. 10(6), pp.368-375. doi: 10.24171/j.phrp.2019.10.6.07.

Can a New Blood Test Help Identify Troops & Veterans with PTSD?

Published on by Andrew MarshallLeave a comment

Medical professionals could potentially one day identify veterans with post-traumatic stress disorder (PTSD) through a quick blood test instead of complex psychological tests, thanks to new research from the
US Army and outside biometrics experts.

The study, which appeared in the journal Molecular Psychiatry, found a set of 27 blood markers which helped identify patients suffering from PTSD.

Researchers said the findings support past hypotheses that the disorder “affects not just the brain, but the entire body.”

In a statement, US Army Medical Research Systems Biology Chief Scientist Marti Jett said those markers “will continue to be refined and adapted for commercialisation” in coming years.

Researchers are hopeful blood tests can lead not only to more accurate diagnoses but also earlier ones, perhaps indicating signs of problems even before PTSD has fully manifested.

Senior study author Dr. Charles Marmar, chair of the Department of Psychiatry at the New York University School of Medicine, said a blood test could indicate signs of PTSD that veterans are unaware of or deliberately hiding out of fear surrounding the stigma of the diagnosis. It could also more quickly eliminate PTSD as a potential problem for patients with unclear medical issues.

“This is an attempt to take the field of psychiatry from the subjective to the objective,” he said. “It’s a way to start a new conversation about how to find the invisible wounds of war.”

But the study has limits. No women were among the veterans tracked for the research, and no civilians were included. Marmar said creating a simple, inexpensive blood test for widespread use to help diagnose PTSD is likely still years away. But he still lauded the findings as an important medical breakthrough for health experts looking for ways to more accurately track troops’ health.

Defence Department and Veterans Affairs researchers have estimated that as many as 25% of individuals who served in combat zones in Iraq or Afghanistan may suffer from PTSD, marked by uncontrolled anxiety, confusion or anger.

Officials have spent years trying to break down the stigma surrounding the diagnosis, which many service members fear could render them undeployable or otherwise unfit for duty because of the non-physical nature of the symptoms.

The study, the culmination of six years of work, tracked blood samples from 165 veterans, half of whom suffer from PTSD following deployments into war zones.

Scientists studied their medical histories and biochemistry, trimming down the list of potential identifying characteristics in their blood from more
than 1 million to less than 30.

In subsequent tests with other patients, the final set of blood markers showed a 77% accuracy rate in helping identify PTSD. Marmar said that is more than enough for a potential screening test, where medical professionals can follow up with more in-depth
examinations to diagnose the illness.

Past studies have hinted at blood markers as a potential indicator of PTSD, but researchers in the new study which included the Harvard John A. Paulson School of Engineering and Applied Sciences and the US Army Medical Research and Development Command said this is the first time a coherent set of measures has been developed.

Jett said that any screening tool that comes from the research would be used before and after deployments, and treatment for those issues would be provided based on military medical standards.

The full study is available on the journal’s website @ https://www.nature.com/articles/s41380-019-0496-z.

Psychotraumatology: What Have We Learned?

Published on by Andrew MarshallLeave a comment

Research Paper Title

A decennial review of psychotraumatology: what did we learn and where are we going?

Background

On 06 December 2019 the reviewers started the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma.

This editorial is part of a special issue/collection celebrating the 10 years anniversary of the journal where the reviewers will acknowledge some of their most impactful articles of the past decade.

In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline.

These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience.

The reviewers address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help them to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions

  1. Where did we stand in 2010?
  2. What did we learn in the past 10 years?
  3. What are our knowledge gaps?

The reviewers conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.

Reference

Olff, M., Amstadter, A., Armour, C., Birkeland, M.S., Bui, E., Cloitre, M., Ehlers, A., Ford, J.D., Greene, T., Hansen, M., Lanius, R., Roberts, N., Rosner, R. & Thoresen, S. (2019) A decennial review of psychotraumatology: what did we learn and where are we going? European Journal of Psychotraumatology. 10(1):1672948. doi: 10.1080/20008198.2019.1672948. eCollection 2019.

Clinical Characteristics of OCD in Children & Adolescents: Developing vs Developed Countries

Published on by Andrew MarshallLeave a comment

Research Paper Title

Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India.

Background

Data from the Western countries suggest that obsessive-compulsive disorder (OCD) in children and adolescents is associated with male preponderance, comorbid neurodevelopmental disorders, and high family loading.

However, data are limited from the developing countries with respect to the demographic and clinical characteristics of OCD in children and adolescents.

To study the demographic and clinical characteristics of children and adolescents (age ≤18 years) with OCD.

Methods

This was a cross-sectional study, conducted in outpatient treatment setting, across six centres in India.

Methods

Participants were assessed using a semi-structured pro forma for sociodemographic information, clinical characteristics, the Children’s Yale Brown Obsessive Compulsive Scale (CYBOCS), Structured Clinical Interview for Diagnostic and Statistical Manual, 5th Edition Research Version, Children’s Depression Rating Scale, and Family Interview for Genetic Studies.

Results

The sample was largely male with a moderate illness severity. Nearly 75% of the sample had illness onset before the age of 14 years.

Aggressive, contamination-related obsessions and washing, checking, and repeating compulsions were the most common symptoms.

CYBOCS assessment revealed that >2/3rd of children and adolescents endorsed avoidance, pathological doubting, overvalued sense of responsibility, pervasive slowness, and indecisiveness.

Family history and comorbidity rates were low. OC-related disorders were present in about 10% of the sample.

Conclusions

This study suggests that the clinical characteristics of OCD in children and adolescents in developing countries differ on certain aspects as reported from developed countries.

Reference

Sharma, E., Tripathi, A., Grover, S., Avasthi, A., Dan, A., Srivastava, C., Goyal, N., Manohari, S.M. & Reddy, J. (2019) Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India. Indian Journal of Psychiatry. 61(6), pp.564-571. doi: 10.4103/psychiatry.IndianJPsychiatry_128_19.

Are Anti-neuronal Antibodies of Clinical Significance in Psychiatric Patients?

Published on by Andrew MarshallLeave a comment

Research Paper Title

A prospective three-year follow-up study on the clinical significance of anti-neuronal antibodies in acute psychiatric disorders.

Background

The clinical significance of anti-neuronal antibodies for psychiatric disorders is controversial.

The researchers investigated if a positive anti-neuronal antibody status at admission to acute psychiatric inpatient care was associated with a more severe neuropsychiatric phenotype and more frequent abnormalities during clinical work-up three years later.

Methods

Patients admitted to acute psychiatric inpatient care who tested positive for N-methyl-D-aspartate receptor (NMDAR), contactin-associated protein 2 (CASPR2) and/or glutamic acid decarboxylase 65 (GAD65) antibodies (n = 24) were age – and sex matched with antibody-negative patients (1:2) from the same cohort (n = 48).

All patients were invited to follow-up including psychometric testing (e.g. Symptom Checklist-90-Revised), serum and cerebrospinal fluid (CSF) sampling, EEG and 3 T brain MRI.

Twelve antibody-positive (ab+) and 26 antibody-negative (ab-) patients consented to follow-up.

Results

Ab+ patients had more severe symptoms of depression (p = 0.03), psychoticism (p = 0.04) and agitation (p = 0.001) compared to ab- patients.

There were no differences in CSF analysis (n = 6 ab+/12 ab-), EEG (n = 7 ab+/19 ab-) or brain MRI (n = 7 ab+/17 ab-) between the groups.

Conclusions

In conclusion, anti-neuronal ab+ status during index admission was associated with more severe symptoms of depression, psychoticism and agitation at three-year follow-up.

This supports the hypothesis that anti-neuronal antibodies may be of clinical significance in a subgroup of psychiatric patients.

Reference

Schou, M.B., Sæther, S.G., Drange, O.K., Brenner, E., Crespi, J., Eikenes, L., Mykland, M.S., Pintzka, C., Håberg, A.K., Sand, T., Vaaler, A. & Kondziella, D. (2019) A prospective three-year follow-up study on the clinical significance of anti-neuronal antibodies in acute psychiatric disorders. Scientific Reports. 10(1):35. doi: 10.1038/s41598-019-56934-6.