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Is Anxiety in People with Rheumatoid Arthritis Associated with Increased Disease Activity & Worse Quality of Life?

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Research Paper Title

The association between anxiety and disease activity and quality of life in rheumatoid arthritis: a systematic review and meta-analysis.

Background

In people with rheumatoid arthritis (RA), mental health problems are common, but often not recognized or treated, contributing to increased morbidity and mortality.

Most studies examining the impact of mental health problems in RA have focused on depression.

The researchers aimed to determine the association between anxiety, and disease activity and quality of life (QoL) in people with RA.

Methods

A systematic review and meta-analysis were performed. A protocol was registered with PROSPERO (CRD2-17062580).

Databases (Web of Science, PsycINFO, CINAHL, Embase, Medline) were searched for studies examining the association between anxiety and disease activity and QoL, in adults with RA, from inception to February 2019.

Primary outcome measures were DAS28 and SF-36.

Eligibility screening and data extraction were completed by two reviewers.

Disagreements were resolved by discussion or a third reviewer.

Quality assessment was carried out using the Newcastle-Ottawa Scale.

Results

From 7712 unique citations, 60 articles were assessed for eligibility.

The final review included 20 studies involving 7452 people with RA (14 cross-sectional, 6 cohort).

Eleven examined disease activity, 6 reported QoL outcome measures and 3 included both.

Anxiety was associated with increased disease activity and worse QoL.

Meta-analysis showed anxiety to be correlated with increased DAS28 scores (r = 0.23, CI 0.14, 0.31) and reduced physical (r = - 0.39, CI - 0.57, - 0.20) and mental QoL (- 0.50, CI - 0.57, - 0.43).

Conclusions

Anxiety in people with RA is associated with increased disease activity and worse QoL.

Improved recognition and management of comorbid anxiety may help to improve outcomes for people with RA.

Key Points:

  • This is the first systematic review and meta-analysis to examine the relationship between anxiety and disease activity and QoL in people with RA.
  • Anxiety was associated with higher disease activity both cross-sectionally and at up to 12-month follow-up.
  • Anxiety may have a more significant impact on disease activity in early RA, highlighting the importance of early recognition and management of co-morbid anxiety.
  • People with anxiety had poorer self-reported physical and mental QoL, although there was some heterogeneity in study findings, particularly for physical QoL (I2 = 78.5%).

Reference

Machin, A.R., Babatunde, O., Haththotuwa, R., Scott, I. Blagojevic-Bucknall, M., Corp, N., Chew-Graham, C.A. & Hider, S.L. (2020) The association between anxiety and disease activity and quality of life in rheumatoid arthritis: a systematic review and meta-analysis. Clinical Rheumatology. doi: 10.1007/s10067-019-04900-y. [Epub ahead of print].

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

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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?

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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.

What Psychiatric Inpatients Needs when Approaching Discharge?

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Research Paper Title

Identifying profiles of need among psychiatric inpatients approaching discharge in New York City: a latent class analysis.

Background

Understanding the needs of individuals transitioning to the community following a psychiatric hospitalisation can inform community service planning.

This study is among the first to examine the needs of a sample of psychiatric inpatients approaching discharge in a large urban area in the USA.

Methods

Representative data were drawn from 1129 acutely hospitalised psychiatric inpatients from eight New York City hospitals.

Descriptive statistics were used to estimate patient needs at discharge across nine domains: housing, employment, income, transportation, education, time use, social support, and help accessing medical and mental health care.

Latent class analysis (LCA) was applied to identify subgroups of patients based on needs profiles.

Multinomial logistic regression was used to investigate socio-demographic associations with class membership.

Results

Respondents were most likely to have needs related to income (50.7%), housing (49.2%), and employment (48.7%).

Results from the LCA suggested a five class solution of patient needs:

  • Three domain-specific classes whose members endorsed needs for ‘housing and employment’ (22.5%), ‘social support and time use’ (15.0%) and ‘access to care’ (6.4%); and
  • Two classes where overall member needs were high (‘high needs,’18.4%) or low (‘low needs,’ 37.7%) across all needs.

Compared to the ‘low needs’ class, members of the ‘high needs’ class had significantly greater odds of being black or Latino, male, uninsured, and parents of a child under 18 years.

Conclusions

Patients have unique profiles of need that are significantly associated with the socio-demographic characteristics.

These findings may help practitioners and policymakers improve mental health services.

Reference

McDonald, K.L., Hoenig, J.M. & Norman, C.C. (2020) Identifying profiles of need among psychiatric inpatients approaching discharge in New York City: a latent class analysis. Social Psychiatry and Psychiatric Epidemiology. doi: 10.1007/s00127-019-01817-4. [Epub ahead of print].

Linking Risk of Suicidal Behaviour with Mental Disorders & Work Disability

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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

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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

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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

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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.

Education: Text-based Coaching Protocols for Digital Mental Health Interventions

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Research Paper Title

Guidance on defining the scope and development of text-based coaching protocols for digital mental health interventions.

Background

A body of literature suggests that the provision of human support improves both adherence to and clinical outcomes for digital mental health interventions.

While multiple models of providing human support, or coaching, to support digital mental health interventions have been introduced, specific guidance on how to develop coaching protocols has been lacking.

In this Education Piece, the authors provide guidance on developing coaching protocols for text-based communication in digital mental health interventions.

Researchers and practitioners who are tasked with developing coaching protocols are prompted to consider the scope of coaching for the intervention, the selection and training of coaches, specific coaching techniques, how to structure communication with clients and how to monitor adherence to guidelines, and quality of coaching.

Their goal is to advance thinking about the provision of human support in digital mental health interventions to inform stronger, more engaging, and effective intervention designs.

Reference

Lattie, E.G., Graham, A.K., Hadjistavropoulos, H.D., Dear, B.F., Titov, N. & Mohr, D.C. (2019) Guidance on defining the scope and development of text-based coaching protocols for digital mental health interventions. Digital Health. doi: 10.1177/2055207619896145. eCollection 2019 Jan-Dec.

Review of Physical Health Monitoring after Rapid Tranquilisation for Acute Behavioural Disturbance

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Research Paper Title

Physical health monitoring after rapid tranquillisation: clinical practice in UK mental health services.

Background

The researchers aimed to assess the quality of physical health monitoring following rapid tranquillisation (RT) for acute behavioural disturbance in UK mental health services.

Methods

The Prescribing Observatory for Mental Health (POMH-UK) initiated an audit-based quality improvement programme addressing the pharmacological treatment of acute behavioural disturbance in mental health services in the UK.

Results

Data relating to a total of 2454 episodes of RT were submitted by 66 mental health services.

Post-RT physical health monitoring did not reach the minimum recommended level in 1933 (79%) episodes.

Patients were more likely to be monitored (OR 1.78, 95% CI 1.39-2.29, p < 0.001) if there was actual or threatened self-harm, and less likely to be monitored if the episode occurred in the evening (OR 0.79, 95% CI 0.62-1.0, p < 0.001) or overnight (OR 0.57, 95% CI 0.44-0.75, p < 0.001).

Risk factors such as recent substance use, RT resulting in the patient falling asleep, or receiving high-dose antipsychotic medication on the day of the episode, did not predict whether or not the minimum recommended level of post-RT monitoring was documented.

Conclusions

The minimum recommended level of physical health monitoring was reported for only one in five RT episodes.

The findings also suggest a lack of targeting of at-risk patients for post-RT monitoring.

Possible explanations are that clinicians consider such monitoring too demanding to implement in routine clinical practice or not appropriate in every clinical situation.

For example, physical health measures requiring direct contact with a patient may be difficult to undertake, or counter-productive, if RT has failed.

These findings prompt speculation that post-RT monitoring practice would be improved by the implementation of guidance that integrated and refined the currently separate systems for undertaking and recording physical health observations post-RT, determining nursing observation schedules and detecting acute deterioration in physical health.

The effectiveness and clinical utility of such an approach would be worth testing.

Reference

Paton, C., Adams, C.E., Dye, S., Delgado, O., Okocha, C. & Barnes, T.R.E. (2019) Physical health monitoring after rapid tranquillisation: clinical practice in UK mental health services. Therapeutic Advances in Psychopharmacology. doi: 10.1177/2045125319895839. eCollection 2019.