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Is There a Link between Elevated Spindle Oscillatory Frequency in PTSD & Sleep Continuity?

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Research Paper Title

Increased Oscillatory Frequency of Sleep Spindles in Combat-Exposed Veteran Men with Post-Traumatic Stress Disorder.

Background

Sleep disturbances are core symptoms of post-traumatic stress disorder (PTSD), but reliable sleep markers of PTSD have yet to be identified.

Sleep spindles are important brain waves associated with sleep protection and sleep-dependent memory consolidation.

The present study tested whether sleep spindles are altered in individuals with PTSD and whether the findings are reproducible across nights and sub-samples of the study.

Methods

Seventy-eight combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive nights of high-density EEG recordings in a laboratory.

The researchers identified slow (10-13 Hz) and fast (13-16 Hz) sleep spindles during N2 and N3 sleep stages and performed topographical analyses of spindle parameters (amplitude, duration, oscillatory frequency, and density) on both nights.

To assess reproducibility, we used the first 47 consecutive participants (18 with PTSD) for initial discovery and the remaining 31 participants (13 with PTSD) for replication assessment.

Results

In the discovery analysis, compared to non-PTSD participants, PTSD participants exhibited:

  1. Higher slow-spindle oscillatory frequency over the antero-frontal regions on both nights; and
  2. Higher fast-spindle oscillatory frequency over the centro-parietal regions on the second night.

The first finding was preserved in the replication analysis.

The researchers found no significant group differences in the amplitude, duration, or density of slow or fast spindles.

Conclusions

The elevated spindle oscillatory frequency in PTSD may indicate a deficient sensory-gating mechanism responsible for preserving sleep continuity.

The findings, if independently validated, may assist in the development of sleep-focused PTSD diagnostics and interventions.

Reference

Wang, C., Laxminarayan, S., Ramakrishnan, S., Dovzhenok, A., Cashmere, J.D., Germain, A. & Reifman, J. (2020) Increased Oscillatory Frequency of Sleep Spindles in Combat-Exposed Veteran Men with Post-Traumatic Stress Disorder. Sleep. pii: zsaa064. doi: 10.1093/sleep/zsaa064. [Epub ahead of print].

Preparation for Life…

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“How has your field of study changed in the time you have been working in it?

We understand a lot more about how many mental health problems originate in early life. Experience in pregnancy sends a kind of weather report to the fetus to give it indicators of how life might be and to begin the process of preparation for that life. That is extraordinary and there is still a huge amount to learn.”

Reference

Ramchandani, P. (2020) The Back Pages: Q&A. New Scientist. 11 January 2020, pp.56.

Does Comorbid GAD & Back Pain and GAD & Migraine have an Association with Non-Medical Opioid Use?

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Research Paper Title

An Examination of Comorbid Generalized Anxiety Disorder and Chronic Pain on Substance Misuse in a Canadian Population-Based Survey.

Background

Chronic pain and generalised anxiety disorder (GAD) are co-occurring, and both conditions are independently associated with substance misuse. However, limited research has examined the impact of comorbid GAD and chronic pain on substance misuse.

The aim of this article was to examine the associations between comorbid GAD and chronic pain conditions compared to GAD only with non-medical opioid use, drug abuse/dependence, and alcohol abuse/dependence in a Canadian, population-based sample.

Methods

Data came from the 2012 Canadian Community Health Survey-Mental Health (N = 25,113).

Multiple logistic regressions assessed the associations between comorbid GAD and chronic pain conditions (migraine, back pain, and arthritis) on substance misuse.

Results

Comorbid GAD + back pain and GAD + migraine were associated with increased odds of nonmedical opioid use compared to GAD only. However, the relationship was no longer significant after controlling for additional chronic pain conditions.

No significant relationship was found between GAD + chronic pain conditions with drug or alcohol abuse/dependence.

Conclusions

Comorbid GAD + back pain and GAD + migraine have a unique association with non-medical opioid use in Canadians compared to GAD only, and chronic pain multi-morbidity may be driving this relationship.

Results emphasise the need for screening for substance misuse and prescription access in the context of GAD and comorbid chronic pain.

Reference

Bilevicius, E., Sommer, J.L., Keough, M.T. & El-Gabalawy, R. (2020) An Examination of Comorbid Generalized Anxiety Disorder and Chronic Pain on Substance Misuse in a Canadian Population-Based Survey. Canadian Journal of Psychiatry. doi: 10.1177/0706743719895340. [Epub ahead of print].

Foster Care, Mental Health, & Primary Care Visits

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Research Paper Title

A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid.

Background

The purpose of this study was to compare the utilisation of primary care services and presence of mental health disorder diagnoses among children in foster care to children on Medicaid not in foster care in a large health system.

Methods

The data for this study were analysed from a clinical database of a multi-practice paediatric health system in Houston, Texas.

The sample included more than 95 000 children covered by Medicaid who had at least one primary care visit during the 2-year study period.

Results and Conclusions

The results of the study demonstrated that children not in foster care had a greater number of primary care visits and the odds of having >3 visits were significantly lower for children in foster care with a mental health disorder diagnosis.

Additionally, more than a quarter of children in foster care had a diagnosis of a mental health disorder, compared with 15% of children not in foster care.

Reference

Keefe, R.J., Van Horne, B.S., Cain, C.M., Budolfson, K., Thompson, R. & Greeley, C.S. (2020) A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid. Clinical Pediatrics. 59(3), pp.252-258. doi: 10.1177/0009922819898182. Epub 2020 Jan 3.

Do we need Evidence-based Rehabilitation Programmes to Facilitate Community Integration & Functional Recovery?

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Research Paper Title

Addressing Severe Mental Illness Rehabilitation in Colombia, Costa Rica, and Peru.

Background

Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalisation and community-based care.

This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru.

Methods

The authors conducted a thematic analysis by using public records and semi-structured interviews with stakeholders.

The authors found evidence of supported employment programmes for vulnerable populations, including people with disabilities, but found that the programmes did not include people with severe mental illnesses.

Results

Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services:

  1. Rigid labour markets;
  2. Insufficient advocacy;
  3. Public subsidies that create conflicting incentives;
  4. Lack of deinstitutionalised models; and
  5. Lack of reimbursement for evidence-based psychiatric rehabilitation interventions.

Conclusions

Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programmes to facilitate community integration and functional recovery.

Because these countries have other supported employment programmes for people with non-psychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.

Reference

Cubillos, L., Muñoz, J., Caballero, J., Mendoza, M., Pulido, A., Carpio, K., Udutha, A.K., Botero, C., Borrero, E., Rodríguez, D., Cutipe, Y., Emeny, R., Schifferdecker, K. & Torrey, W.C. (2020) Addressing Severe Mental Illness Rehabilitation in Colombia, Costa Rica, and Peru. Psychiatric Services (Washington, D.C.). 71(4):378-384. doi: 10.1176/appi.ps.201900306. Epub 2020 Jan 3.

Should Hospital Psychiatry Complement Community Psychiatry?

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Research Paper Title

The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes?

Background

Community-based psychiatric services are essential to mental health. For decades, researchers, advocates, and policy makers have presumed that expanding the supply of these services hinges on reducing the supply of hospital-based care.

Cross-national data from the World Health Organisation call this presumption into question.

Community and hospital psychiatry appear to be complements, not substitutes.

Reference

Perera, I.M. (2020) The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes? Psychiatric Services (Washington, D.C.). doi: 10.1176/appi.ps.201900086. [Epub ahead of print].

Can We Use Smartphones in the Assessment & Prediction of Mental Health?

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Research Paper Title

Digital phenotyping for assessment and prediction of mental health outcomes: a scoping review protocol.

Background

Rapid advancements in technology and the ubiquity of personal mobile digital devices have brought forth innovative methods of acquiring healthcare data.

Smartphones can capture vast amounts of data both passively through inbuilt sensors or connected devices and actively via user engagement.

This scoping review aims to evaluate evidence to date on the use of passive digital sensing/phenotyping in assessment and prediction of mental health.

Methods

The methodological framework proposed by Arksey and O’Malley will be used to conduct the review following the five-step process.

A three-step search strategy will be used:

  1. Initial limited search of online databases namely, MEDLINE for literature on digital phenotyping or sensing for key terms;
  2. Comprehensive literature search using all identified keywords, across all relevant electronic databases: IEEE Xplore, MEDLINE, the Cochrane Database of Systematic Reviews, PubMed, the ACM Digital Library and Web of Science Core Collection (Science Citation Index Expanded and Social Sciences Citation Index), Scopus; and
  3. Snowballing approach using the reference and citing lists of all identified key conceptual papers and primary studies.

Data will be charted and sorted using a thematic analysis approach.

Findings

The findings from this systematic scoping review will be reported at scientific meetings and published in a peer-reviewed journal.

Reference

Spinazze, P., Rykov, Y., Bottle, A. & Car, J. (2019) Digital phenotyping for assessment and prediction of mental health outcomes: a scoping review protocol. BMJ Open. 9(12):e032255. doi: 10.1136/bmjopen-2019-032255.

Are Studies into Severe Mental Illness Robust Enough?

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Research Paper Title

Multidimensional impact of severe mental illness on family members: systematic review.

Background

The impact of severe mental illnesses (SMIs) is not limited to the person with the illness but extends to their family members and the community where the patient comes from.

In this review, the researchers systematically analyse the available evidence of impacts of SMI on family members, including parents, grandparents, siblings, spouses and children.

Methods

PubMed, PsycINFO, Embase and Global Index Medicus were searched from the inception of each database up to 9 November 2019. They also did manual searches of grey literature.

The researchers included studies that assessed the impacts of SMI on any family member. They excluded studies in admitted clinics and acute wards to rule out the acute effect of hospitalisation.

Two reviewers extracted data independently using the Cochrane handbook guideline for systematic reviews and agreed on the final inclusion of identified studies.

The quality of the included studies was assessed using effective public health practice project quality assessment tool for quantitative studies. The review protocol was registered in the PROSPERO database.

Results

The researchers screened a total of 12,107 duplicate free articles and included 39 articles in the review.

The multidimensional impact of SMI included physical health problems (sleeplessness, headache and extreme tiredness.), psychological difficulties (depression and other psychological problems) and socioeconomic drift (less likely to marry and higher divorce rate and greater food insecurity).

Impacts on children included higher mortality, poor school performance and nutritional problems. However, the quality of one in five studies was considered weak.

Conclusions

The review indicated a high level of multidimensional impact across multiple generations.

The serious nature of the impact calls for interventions to address the multi-dimensional and multi-generational impact of SMI, particularly in low/middle-income countries.

Given the relatively high number of studies rated methodologically weak, more robust studies are indicated.

Reference

Fekadu, W., Mihiretu, A., Craig, T.K.J. & Fekadu, A. (2019) Multidimensional impact of severe mental illness on family members: systematic review. BMJ Open. 9(12):e032391. doi: 10.1136/bmjopen-2019-032391.

PTSD & Korean War Veterans

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Research Paper Title

Aging and Trauma: Post Traumatic Stress Disorder Among Korean War Veterans.

Background

Having experienced posttraumatic stress disorder 30 years prior to its recognition as a formal disorder, Korean War veterans are now an ageing population that requires unique clinical management.

The Korean War lasted from 25 June 1950 through 27 July 1953. Although many veterans of the Korean War experienced traumas during extremely stressful combat conditions. However, they would not have been diagnosed with post-traumatic stress disorder (PTSD) at the time because the latter did not exist as a formal diagnosis until the publication of the third edition of the Diagnostic and Statistical Manual (DSM) in 1980. Prior to 1980, psychiatric syndromes resulting from war and combat exposure where known by numerous other terms including shell shock, chronic traumatic war neurosis, and combat fatigue/combat exhaustion. Military psychiatrists attended to combat fatigue during the course of the Korean War, but as was true of World War I and II, the focus was on returning soldiers to duty. Combat fatigue was generally viewed as a transient condition.

Although now octo- and nonagenarians, in 2019 there are 1.2 million living Korean War veterans in the US, representing 6.7% of all current veterans. Understanding their war experiences and the nature of their current and past presentation of PTSD is relevant not only in formal mental health settings, but in primary care settings, including home-based primary care, as well as community living centres, skilled nursing facilities and assisted living facilities. Older adults with PTSD often present with somatic concerns rather than spontaneously reporting mental health symptoms. Beyond the short-term clinical management of Korean War veterans with PTSD, consideration of their experiences also has long-term relevance for the appropriate treatment of other veteran cohorts as they age in coming decades.

The purpose of this article is to provide a clinically focused overview of PTSD in Korean War veterans, to help promote understanding of this often-forgotten group of veterans, and to foster optimised personalised care. This overview will include a description of the Korean War veteran population and the Korean War itself, the manifestations and identification of PTSD among Korean War veterans, and treatment approaches using evidence-based psychotherapies and pharmacotherapies. Finally, the researches provide recommendations for future research to address present empirical gaps in the understanding and treatment of Korean War veterans with PTSD.

Reference

Palmer, B.W., Friend, S., Huege, S., Mulvaney, M., Badawood, A., Almaghraby, A. & Lohr, J.B. (2019) Aging and Trauma: Post Traumatic Stress Disorder Among Korean War Veterans. Federal Practitioner. 36(12), pp.554-562.

Do Physical Comorbidities affect the Diagnosis of Depression & Anxiety?

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Research Paper Title

A systematic review and meta-analysis of the prevalence of common mental disorders in people with non-communicable diseases in Bangladesh, India, and Pakistan.

Background

The prevalence of mental and physical comorbidities is unknown in South Asia, as estimates of mental ill health in patients with non-communicable diseases (NCDs) have predominantly come from studies based in the United States, Europe and Australasia.

This systematic review and meta-analysis summarises evidence and provides pooled estimates of the prevalence of common mental disorders in adults with non-communicable diseases in South Asia.

Methods

The researchers included prevalence studies of depression and anxiety in adults with diabetes, cancer, cardiovascular disease, and chronic respiratory conditions in Bangladesh, India, and Pakistan, published from 1990 onwards in international and country-specific databases.

Results

Out of 96 included studies, 83 provided data for random effects meta-analyses.

The pooled prevalence of depression was 44% (95% confidence interval (CI) = 26 to 62) for patients with COPD, 40% (95% CI = 34 to 45) for diabetes, 39% (95% CI = 23 to 56) for stroke, 38% (95% CI = 32 to 45) for hypertension, and 37% (95% CI = 30 to 45) for cancer.

The pooled prevalence of anxiety based on 28 studies was 29% (95% CI = 22 to 36).

Many quality issues were identified in a critical appraisal of included studies, mostly relating to the sampling frame and selection process, the description of the methods and basic data, and the description of non-responders.

Conclusions

Depression and anxiety are prevalent and underdiagnosed in people with physical comorbidities in Bangladesh, India, and Pakistan.

Reference

Uphoff, E.P., Newbould, L., Walker, I., Ashraf, N., Chaturvedi, S., Kandasamy, A., Mazumdar, P., Meader, N., Naheed, A., Rana, R., Wright, J., Wright, J.M., Siddiqi, N., Churchill, R. & NIHR Global Health Research Group – IMPACT. (2019) A systematic review and meta-analysis of the prevalence of common mental disorders in people with non-communicable diseases in Bangladesh, India, and Pakistan. Journal of Global Health. 9(2):020417. doi: 10.7189/jogh.09.020417.