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

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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.

Documentary: No Body’s Perfect (2016)

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Introduction

International fashion photographer Rankin and artist Alison Lapper explore how the explosion of digital photography, social media and selfie culture has affected people’s sense of identity.

Rankin and Alison challenge four individuals who all hate the camera for a variety of reasons to be photographed up-close to investigate different perceptions of self-worth, image and beauty.

Outline

In this documentary for BBC Four, disabled artist Alison Lapper and internationally renowned photographer Rankin tackle contemporary attitudes to beauty and identity through the medium of photography.

Alison and Rankin will meet four fascinating people who do not conform to traditional notions of beauty, or who hate being photographed, and invite them to step in front of Rankin’s camera. Each person will reveal their incredible life story and their own personal struggle with their sense of identity. Through hearing these stories and capturing them in Rankin’s studio, Alison and Rankin will explore how the explosion of digital media over the past decade, from social media to selfies, has presented new challenges to our self-image.

Each contributor has a different challenge to tackle: from an amputee who for 30 years has never come to terms with his body image, to a woman with alopecia who struggles to leave the house without full make up and a wig on, to the person whose Body Dysmorphic Disorder means they will never allow their photo to be taken.

Alison Lapper, who was born with no arms and shortened legs, knew from a young age that she was happiest without prosthetics. Partly as a result of her work through photographic media she grew to accept her body as it was born, and to feel proud and confident with her own image. Alison’s image is now well-known as a subject of sculpture, painting and photography.

By inviting these four contributors to Rankin’s studio to confront their own image in front of the camera, Alison and Rankin hope that each person will discover a new sense of self. Rankin’s intimate, beautiful and striking portraits have the potential to give each person a sense of pride and self-worth, demonstrating photography’s unique power to positively affect how we feel about ourselves in the digital world.

Production & Filming Details

  • Presenter(s): Rankin and Alison Lapper.
  • Director(s): Ian Denyer.
  • Producer(s): Ben Weston and Shola Sittabey.
  • Production: BBC.
  • Distributor(s): BBC.
  • Original Network: BBC Four.
  • Release Date: 10 November 2016.
  • Running Time: 60 minutes.
  • Country: UK.
  • Language: English.

YouTube Link

Workplace Injury: Musculoskeletal Conditions & Mental Illness

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Research Paper Title

Prevalence of serious mental illness and mental health service use after a workplace injury: a longitudinal study of workers’ compensation claimants in Victoria, Australia.

Background

Serious mental illness is common among those who have experienced a physical workplace injury, yet little is known about mental health service use in this population.

This study aims to estimate the proportion of the workplace musculoskeletal injury population experiencing a mental illness, the proportion who access mental health services through the workers’ compensation system and the factors associated with likelihood of accessing services.

Methods

A longitudinal cohort study was conducted with a random sample of 615 workers’ compensation claimants followed over three survey waves between June 2014 and July 2015.

The primary outcome was receiving any type of mental health service use during this period, as determined by linking survey responses to administrative compensation system records for the 18 months after initial interview.

Results

Of 181 (29.4%) participants who met the case definition for a serious mental illness at one or more of the three interviews, 75 (41.4%) accessed a mental health service during the 18-month observation period.

Older age (OR=0.96, 95% CI 0.93 to 0.99) and achieving sustained return to work (OR=0.27, 95% CI 0.11 to 0.69) were associated with reduced odds of mental health service use.

Although not significant, being born in Australia was associated with an increased odds of service use (OR=2.23, 95% CI 0.97 to 5.10).

Conclusions

The proportion of injured workers with musculoskeletal conditions experiencing mental illness is high, yet the proportion receiving mental health services is low.

More work is needed to explore factors associated with mental health service use in this population, including the effect of returning to work.

Reference

Orchard, C., Carnide, N., Mustard, C. & Smith, P.M. (2020) Prevalence of serious mental illness and mental health service use after a workplace injury: a longitudinal study of workers’ compensation claimants in Victoria, Australia. Occupational and Environmental Medicine. pii: oemed-2019-105995. doi: 10.1136/oemed-2019-105995. [Epub ahead of print].

CNS Endothelium: Respiratory & Affective Disorders associated with Vascular Diseases

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Research Paper Title

Impaired endothelium-mediated cerebrovascular reactivity promotes anxiety and respiration disorders in mice.

Background

Carbon dioxide (CO2), the major product of metabolism, has a strong impact on cerebral blood vessels, a phenomenon known as cerebrovascular reactivity.

Several vascular risk factors such as hypertension or diabetes dampen this response, making cerebrovascular reactivity a useful diagnostic marker for incipient vascular pathology, but its functional relevance, if any, is still unclear.

Here, the researchers found that GPR4, an endothelial H+ receptor, and endothelial Gαq/11 proteins mediate the CO2/H+ effect on cerebrovascular reactivity in mice. CO2/H+ leads to constriction of vessels in the brainstem area that controls respiration.

The consequential washout of CO2, if cerebrovascular reactivity is impaired, reduces respiration.

In contrast, CO2 dilates vessels in other brain areas such as the amygdala. Hence, an impaired cerebrovascular reactivity amplifies the CO2 effect on anxiety.

Even at atmospheric CO2 concentrations, impaired cerebrovascular reactivity caused longer apneic episodes and more anxiety, indicating that cerebrovascular reactivity is essential for normal brain function.

The site-specific reactivity of vessels to CO2 is reflected by regional differences in their gene expression and the release of vasoactive factors from endothelial cells.

This data suggests the central nervous system (CNS) endothelium as a target to treat respiratory and affective disorders associated with vascular diseases.

Reference

Wenzel, J., Hansen, C.E., Bettoni, C., Vogt, M.A., Lembrich, B., Natsagdorj, R., Huber, G., Brands, J., Schmidt, K., Assmann, J.C., Stölting, I., Saar, K., Sedlacik, J., Fiehler, J., Ludewig, P., Wegmann, M., Feller, N., Richter, M., Müller-Fielitz, H., Walther, T., König, G.M., Kostenis, E., Raasch, W., Hübner, N., Gass, P., Offermanns, S., de Wit, C., Wagner, C.A. & Schwaninger, M. (2020) Impaired endothelium-mediated cerebrovascular reactivity promotes anxiety and respiration disorders in mice. Proceedings of the National Academy of Sciences of the United States of America. 117(3), pp.1753-1761. doi: 10.1073/pnas.1907467117. Epub 2020 Jan 2.

Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Paediatric Somatic Symptom and Related Disorders

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Research Paper Title

Taking the Pain out of Somatisation: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Paediatric Somatic Symptom and Related Disorders.

Background

The diagnostic category of somatic symptom and related disorders (SSRDs), although common, is often poorly recognized and suboptimally managed in inpatient pediatric care.

Little literature exists to address SSRDs in the inpatient paediatric setting.

The purpose of the study was to characterise current SSRD practice, identify problem areas in workflow, and develop a standardised approach to inpatient evaluation and management at a tertiary care academic children’s hospital.

Methods

A multidisciplinary group identified patients with SSRD admitted between May 2012 and October 2014.

A retrospective chart review on a convenience sample was performed to identify population characteristics and current practice.

Lean methodology was used to define current state practice and future state intervention.

These methods were used to guide identification of problem areas, which informed protocol, a clinical practice guideline, and resource development.

Results

Thirty-six patients aged 8 to 17 years met inclusion criteria for chart review.

Most patients presented with either neurological or pain-related complaints.

The mean length of stay was 5.44 days (SD = 6.3), with few patients receiving a mental health consultation within 24 hours of hospitalisation.

Patients averaged 5.8 medical and/or psychiatric diagnoses on discharge (SD = 5.2), and two-thirds did not have an SSRD diagnosis.

Half of patients had co-morbid psychiatric diagnoses, whereas one-quarter were discharged with no mental health follow-up.

Conclusions

In this study, the researchers describe the process and content development of a single-site institutional protocol, clinical practice guideline, and resources for the evaluation and management of paediatric SSRDs.

This study may serve as a model for similar standardisation of SSRD care in other inpatient paediatric medical settings.

Reference

Kullgren, K.A., Shefler, A., Malas, N., Monroe, K., Leber, S.M., Sroufe, N., El Sakr, A., Pomeranz, E., O’Brien, E. & Mychaliska, K.P. (2020) Taking the Pain out of Somatization: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Pediatric Somatic Symptom and Related Disorders. Hospital Paediatrics. 10(2), pp.105-113. doi: 10.1542/hpeds.2019-0141. Epub 2020 Jan 2.

Analysis of Voluntary vs Involuntary Admissions

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Research Paper Title

Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis.

Background

Voluntary admission rates of schizophrenia vary widely across studies.

In order to make the topic be informed by evidence, it is important to have accurate estimates.

This meta-analysis examined the worldwide prevalence of voluntary admissions for patients with schizophrenia.

Methods

PubMed, EMBASE, PsycINFO, the Cochrane Library, Web of Science and Medline databases were systematically searched, from their commencement date until 19th November 2018.

Meta-analysis of included studies was performed using the random-effects model.

Results

Thirty-five studies with 134,100 schizophrenia patients were included.

The overall voluntary admission rate of schizophrenia was 61.9 % (95 %CI: 52.3 %-70.7 %), while the involuntary rate was 43.0 % (95 %CI: 34.8 %-51.7 %).

Subgroup analyses revealed that patients in Europe had significantly higher voluntary admission rates, while their North American counterparts were more likely admitted involuntarily.

Papers published prior to 2008 reported higher involuntary admission rates.

Meta-regression analyses showed that higher male percentage and higher study quality were significantly associated with higher voluntary admission rate.

Conclusions

Although the worldwide prevalence of voluntary admissions was higher than that of involuntary admissions, the latter was common for schizophrenia.

With the continuing liberalisation of mental health laws broadening community-based psychiatric services, the rate of voluntary psychiatric admissions is expected to further increase over time.

Reference

Yang, Y., Li, W., Lok, K.I., Zhang, Q., Hong, L., Ungvari, G.S., Bressington, D.T., Cheung, T. & Xiang, Y.T. (2019) Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis. Asian Journal of Psychiatry. 48:101902. doi: 10.1016/j.ajp.2019.101902. [Epub ahead of print].

Do Individuals who are Suicidal have Unusual Patterns of Brain Activity?

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Individuals who are suicidal seem to have unusual patterns of brain activity.

The differences are not big enough to identify those who may try to kill themselves, however, the researchers hope it will provide them with more information about what may be happening in terms of brain mechanisms (Schmaal et al., 2019).

The finding comes from a review of 131 brain-scan studies, comprising more than 12,000 people. The study looked to see whether there are distinctive patterns of brain activity in those who had made suicide attempts or had been thinking about suicide.

Most of these studies compared individuals with a certain mental health condition, such as depression, who had a history of suicidal behaviour, with a similar group with that condition who had not become suicidal, or with individuals without mental health problems.

The researchers found that two brain networks appear to function differently:

  • The first of these involves areas at the front of the head known as the medial and lateral ventral prefrontal cortex and their connections to regions involved in emotion. This may lead to difficulties regulating emotions.
  • A second involves regions known as the dorsal prefrontal cortex and inferior frontal gyrus system, which play a role in decision making.

However, the differences in these networks may just reflect that individuals who are suicidal are in more distress, rather than indicating specific thoughts of suicide.

Reference

Wilson, C. (2019) Suicidal Behaviour Linked to Two Brain Networks. New Scientist. 07 December 2019, pp.16.

Schmaal, L>, van Harmelen, A-L., Chatzi, V., Lippard, E.T.C., Toenders, Y.J., Averill, L.A., Mazure, C.M. & Plumberg, H.P. (2019) Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies. Molecular Psychiatry. 25, pp.408-427. https://www.nature.com/articles/s41380-019-0587-x

Did you know that Mental Health Sites Share User Data with Ad Firms?

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Mental health websites are sharing user data with advertisers, including the results of tests for depression.

This means that individuals seeking information or help for mental health conditions can be targeted with adverts while they may be vulnerable.

Researchers, from Privacy International based in London, looked at 136 of the most popular websites in the UK, France and Germany that provide resources and information about mental health conditions.

The researchers found that 76% of the websites contained third party marketing trackers. These collect information about a user and can track them as they browse other sites.

This can be combined into a detailed profile.

Many of the pages had trackers from Google, Facebook and Amazon and shared information with data brokers – firms that aggregate information and sell individual profiles to other organisations – and advertising companies.

Commentators state that it is currently (almost) impossible to seek information and help about depression without advertisers knowing.

Knowing who is depressed and when allows advertisers to target people when they are at their most vulnerable.

Advertisers target users based on their personal data, such as their IP address and location, and the site they visit. Some sites also have real-time bidding, where information, including a page’s content and URL, is used to instantaneously show a relevant ad on the page.

Several websites with questionnaires about depression stored users’ answers and shared them with third parties.

When the researchers first analysed the UK’s National Health Service (NHS) website in September 2019, they found that a mood self-assessment quiz shared individual answers, test scores and the test URL with Adobe for analysis purposes. However, the NHS website has since updated its privacy policy so users now need to manually opt in to be tracked.

The researchers also found that doctissimo.fr, one of France’s most popular health websites, sent unique user identifiers and answers to a data collection firm. They basically send all of an individuals answers to the test to a third party that is named nowhere on their website, and nowhere in their privacy policy. A perfect example of abusing someone’s confidence.”

Under the European Union’s General Data Protection Regulation (GDPR), websites and apps are required to obtain consent before tracking users.

Data relating to physical or mental health is considered a “special category” and can only be processed with explicit consent or for relevant other reasons.

Reference

Lu, D. (2019) Mental Health Sites Share User Data with Ad Firms. New Scientist. 07 December 2019, pp.9.

Analysing Voluntary Admission Rates for Patients with Schizophrenia

Published on by Andrew MarshallLeave a comment

Research Paper Title

Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis.

Background

Voluntary admission rates of schizophrenia vary widely across studies. In order to make the topic be informed by evidence, it is important to have accurate estimates. This meta-analysis examined the worldwide prevalence of voluntary admissions for patients with schizophrenia.

Methods

PubMed, EMBASE, PsycINFO, the Cochrane Library, Web of Science and Medline databases were systematically searched, from their commencement date until 19th November 2018. Meta-analysis of included studies was performed using the random-effects model.

Results

Thirty-five studies with 134,100 schizophrenia patients were included. The overall voluntary admission rate of schizophrenia was 61.9 % (95 %CI: 52.3 %-70.7 %), while the involuntary rate was 43.0 % (95 %CI: 34.8 %-51.7 %).

Subgroup analyses revealed that patients in Europe had significantly higher voluntary admission rates, while their North American counterparts were more likely admitted involuntarily.

Papers published prior to 2008 reported higher involuntary admission rates. Meta-regression analyses showed that higher male percentage and higher study quality were significantly associated with higher voluntary admission rate.

Conclusions

Although the worldwide prevalence of voluntary admissions was higher than that of involuntary admissions, the latter was common for schizophrenia.

With the continuing liberalisation of mental health laws broadening community-based psychiatric services, the rate of voluntary psychiatric admissions is expected to further increase over time.

Reference

Yang, Y., Li, W., Lok, K.I., Zhang, Q., Hong, L., Ungvari, G.S., Bressington, D.T., Cheung, T. & Xiang, Y.T. (2019) Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis. Asian Journal of Psychiatry. 48:101902. doi: 10.1016/j.ajp.2019.101902. [Epub ahead of print].

Are Mental Health Apps Worthwhile?

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Among the hundreds of thousands of apps available for health and fitness, among many others, millions of us have downloaded mental health apps for everything from breathing exercises to guided meditation.

However, a recent analysis now suggests that almost everyone gives up on such apps in just two weeks.

Amit Baumel (2019), at the University of Haifa in Israel and his colleagues, analysed the use of 93 popular mental health apps.

The data suggests that, after 15 days, more than 94% of users had stopped opening their apps.

Baumel and colleagues only studied apps that are available in English and that have been installed at least 10,000 times via the Google Play store.

App use differed depending on the kind of support provided.

On any given day, just over 4% of individuals who have downloaded mindfulness or meditation apps will use them. However this figure is 17% among those who have installed peer-support apps, which enable individuals to talk to someone who may be experiencing similar issues.

The team did not reveal which apps were included in the analysis, but the findings raise questions over how useful mental health apps are.

It is currently unknown how often an individual needs to use such apps for them to be effective.

Baumel and colleagues study confirms what the clinical community has known for a long time: a lot of individuals abandon these apps.

However, it should be noted that a low engagement rate does not necessarily mean mental health apps do not work – it could be an indication of how curious we are about these apps, and how easy it is to download them.

References

Baumel, A., Muench, F., Edan, S. & Kane, J.M. (2019) Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis. Journal of Medical Internet Research. 21(9), e14567. https://www.jmir.org/2019/9/e14567/.

New Scientist. (2019) People Quickly Abandon Mental Health Apps. New Scientist. 16 November 2019, pp.14.