Are Treatments for Common Mental Disorders also Effective for Functional Symptoms & Disorder?

Research Paper Title

Are treatments for common mental disorders also effective for functional symptoms and disorder?

Background

To consider whether the many types of treatments for mental disorders – both those specifically targeting illness mechanisms and nonspecific elements – are also effective in treating functional symptoms and syndromes. The paper discusses the need for well-organised care that emphasizes early treatment and recognition of more complex problems in primary and secondary medical care.

Methods

Evidence from a wide range of research and clinical experience is used to identify and illustrate general themes.

Results

Despite a limited evidence base, it is clear that both specific and nonspecific interventions that are effective with mental disorders are also effective in treating functional complaints. They are also helpful in the management of maladaptive reactions to physical disorders. Delivery is most effective as stepped care.

Conclusions

There is a particular need for more evidence on the effectiveness of the nonspecific elements of treatment and of their most appropriate delivery by non-specialists in general medical settings.

Experience with a variety of treatment methods will enhance our understanding of psychological and other etiological variables and thereby influence the development of improved definitions in Diagnostic and Statistical Manual of Mental Disorders-5(th) Edition.

It is argued that a main focus of review of somatoform disorder should be the resolution of conceptual problems.

Reference

Mayou, R. (2020) Are treatments for common mental disorders also effective for functional symptoms and disorder? Psychosomatic Medicine. 69(9), pp.876-880. doi: 10.1097/PSY.0b013e31815b00a6.

Psychiatrists have Started the Process of Mapping Genetic Architecture of Mental Disorders

Research Paper Title

Psychiatrists begin to map genetic architecture of mental disorders.

Background

Mental illness affects one in six US adults, but scientists’ sense of the underlying biology of most psychiatric disorders remains nebulous.

That is frustrating for physicians treating the diseases, who must make diagnoses based on symptoms that may only appear sporadically.

Now, a large-scale analysis of postmortem brains is revealing distinctive molecular traces in people with mental illness.

An international team of researchers reports that five major psychiatric disorders have often overlapping patterns of gene activity, which furthermore vary in disease-specific – and sometimes counterintuitive – ways.

The findings, they say, might someday lead to diagnostic tests, and one has already inspired a clinical trial of a new way to treat overactive brain cells in autism.

Reference

Dengler, R. (2020) Psychiatrists begin to map genetic architecture of mental disorders. Neuroscience. 359(6376), pp.619. DOI: 10.1126/science.359.6376.619

Linking Brain Imagery, Brain Tumours, and Cognitive & Mental Disorders in Adults

Research Paper Title

Brain tumours, cognitive and mental disorders in adults.

Background

Cognitive and mental disorders are observed in 15-20% of brain tumours, and can be the first symptoms.

The severity of cognitive deficits varies from attention and reasoning disorders to major syndromes such as delirium, amnesic syndrome or dementia.

Mental disorders range from apathy, irritability to major depressive or psychotic symptoms.

Cognitive and mental disorders are related to many factors including the localisation and nature of the tumour, peritumoral and remote changes, and personal susceptibility.

The diagnosis of brain tumour is presently made by brain imagery, but the difficulty remains to determine when imagery is to be used in cognitive or mental disorders.

Reference

Derouesne, C. (2020) Brain tumors, cognitive and mental disorders in adults. Geriatrie et Psychologie Neuropsychiatrie du Vieillissement. 13(2), pp.187-194. doi: 10.1684/pnv.2015.0533.

Conditional Cash Transfers & Mental Health

Research Paper Title

The worse the better? Quantile treatment effects of a conditional cash transfer programme on mental health.

Background

Poor mental health is a pressing global health problem, with high prevalence among poor populations from low-income countries.

Existing studies of conditional cash transfer (CCT) effects on mental health have found positive effects.

However, there is a gap in the literature on population-wide effects of cash transfers on mental health and if and how these vary by the severity of mental illness.

Methods

The researchers use the Malawian Longitudinal Study of Family and Health containing 790 adult participants in the Malawi Incentive Programme, a year-long randomized controlled trial.

They estimate average and distributional quantile treatment effects and we examine how these effects vary by gender, HIV status and usage of the cash transfer.

Results

They find that the cash transfer improves mental health on average by 0.1 of a standard deviation.

The effect varies strongly along the mental health distribution, with a positive effect for individuals with worst mental health of about four times the size of the average effect.

These improvements in mental health are associated with increases in consumption expenditures and expenditures related to economic productivity.

Conclusions

Their results show that CCTs can improve adult mental health for the poor living in low-income countries, particularly those with the worst mental health.

Reference

Ohrnberger, J., Fichera, E., Sutton, M. & Anselmi, L. (2020) The worse the better? Quantile treatment effects of a conditional cash transfer programme on mental health. Health Policy and Planning. doi: 10.1093/heapol/czaa079. Online ahead of print.

What are the Challenges of Mental Healthcare during COVID-19?

Research Paper Title

Current and Future Challenges in the Delivery of Mental Healthcare during COVID-19.

Background

The USA is in the midst of the COVID-19 pandemic.

The researchers assess the impact of COVID-19 on psychiatric symptoms in healthcare workers, those with psychiatric comorbidities, and the general population.

They highlight the challenges ahead and discuss the increased relevance of telepsychiatry.

Methods

The researchers analysed all available literature available as of 25 March 2020, on PubMed, Ovid Medline, and PsychInfo.

They utilised the MeSH term “covid AND (psychiatry OR mental health)” and included all articles.

Duplicates were removed resulting in 32 articles, of which 19 are cited. Four additional references are included to examine suicide data. During the review process, an additional 7 articles were identified which are also included.

Results

Frontline healthcare workers are currently experiencing increased psychiatric symptoms and this is more severe in females and nurses. Non-frontline healthcare workers, as well as the general population, are experiencing vicarious traumatisation.

People with psychiatric comorbidities, and the general population, face increased psychiatric symptom burden. Migrant workers, the elderly, children, and the homeless may be disproportionately impacted. Suicide rates may be impacted.

Conclusions

The COVID-19 pandemic has resulted in a severe disruption to the delivery of mental healthcare.

Psychiatric facilities are facing unprecedented disruptions in care provision as they struggle to manage an infected population with comorbid psychiatric symptoms.

Telepsychiatry is a flawed but reasonable solution to increase the availability of mental healthcare during COVID-19.

Reference

Gautam, M., Thakrar, A., Akinyemi, E. & Mahr, G. (2020) Current and Future Challenges in the Delivery of Mental Healthcare during COVID-19. SN Comprehensive Clinical Medicine. 1-6. doi: 10.1007/s42399-020-00348-3. Online ahead of print.

Identifying Qualitatively Distinct PTSD Symptom Typologies

Research Paper Title

Identifying PTSD Symptom Typologies: A Latent Class Analysis.

Background

Posttraumatic stress disorder (PTSD) is characterised by re-experiencing, avoidance, negative alterations in cognition and mood, and arousal symptoms per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

While numerous symptom combinations are possible to meet diagnostic criteria, simplification of this heterogeneity of symptom presentations may have clinical utility.

Methods

In a nationally representative sample of American adults with lifetime DSM-5 PTSD diagnoses from the third wave of the National Epidemiologic Survey on Alcohol and Related Conditions (n = 2,365), the researchers used Latent Class Analysis (LCA) to identify qualitatively distinct PTSD symptom typologies.

Subsequently, they used linear and logistic regressions to identify demographic, trauma-related, and psychiatric characteristics associated with membership in each class.

Results

In contrast to prior LCAs with DSM-IV-TR diagnostic criteria, fit indices for the present analyses of DSM-5 PTSD revealed a four-class solution to the data:

  1. Dysphoric (23.8%);
  2. Threat-Reactivity (26.1%);
  3. High Symptom (33.7%); and
  4. Low Symptom (16.3%).

Exploratory analyses revealed distinctions between classes in socioeconomic impairment, trauma exposure, comorbid diagnoses, and demographic characteristics.

Conclusions

Although the study is limited by its cross-sectional design (preventing analysis of temporal associations or causal pathways between covariates and latent classes), findings may support efforts to develop personalised medicine approaches to PTSD diagnosis and treatment.

Reference

Campbell, S.B., Trachik, B., Goldberg, S. & Simpson, T.L. (2020) Identifying PTSD Symptom Typologies: A Latent Class Analysis. Psychiatry Research. 285:112779. doi: 10.1016/j.psychres.2020.112779. Epub 2020 Jan 23.

Can Adverse Childhood Experiences have an Affect on Mental Health Outcomes through Disrupted Sleep?

Research Paper Title

Sleep disturbance mediates the association of adverse childhood experiences with mental health symptoms and functional impairment in US soldiers.

Background

Adverse childhood experiences (ACEs) can have long-term impacts on a person’s mental health, which extend into adulthood.

There is a high prevalence of ACEs among service members.

Further, service members also report frequently experiencing disrupted sleep.

Methods

The researchers hypothesised that disrupted sleep may serve a mechanistic function connecting ACEs to functional impairment and poorer mental health.

Results

In a cross-sectional sample (n = 759), the researchers found evidence for an indirect effect of ACEs on mental health outcomes through disrupted sleep.

In a different sample using two time-points (n = 410), they found evidence for an indirect effect of ACEs on changes in mental health outcomes and functional impairment during a reset period, through changes in disrupted sleep during the same period.

Conclusions

Implications, limitations and future research directions are discussed.

Reference

Conway, M.A., Cabrera, O.A., Clarke-Walper, K., Dretsch, M.N., Holzinger, J.B., Riviere, L.A. & Quartana, P.J. (2020) Sleep disturbance mediates the association of adverse childhood experiences with mental health symptoms and functional impairment in US soldiers. Journal of Sleep Research. e13026. doi: 10.1111/jsr.13026. [Epub ahead of print].

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

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.

Owning & Managing a Business Can be Hazardous to your Mental Health

1.0 Introduction

Owning and Managing a Business Can be Hazardous to your Mental Health.

This article provides an overview of business ownership in the context of mental health.

If you are one of the millions of small and medium business owners around the globe, you probably have a good idea of how tough (and sometimes lonely) it can be at the top of the business – and how owning and managing your own business can be hazardous to your mental health.

It is well-known that our mental health can deteriorate, for a variety of reasons, and, if left unchecked, can lead to mental health problems.

Although depression and anxiety are likely to be the most common issues an owner faces, it is important to remember that mental health symptoms and conditions come in many forms.

2.0 Why Be a Business Owner?

Many of us are drawn to small business because working for others provides its own stresses, for example, the feeling of lost control as others make decisions we may feel unable to influence.

Being a business owner offers a level of freedom and control that we may be unable to achieve as an employee.

3.0 Factors Affecting Mental Health in Owners

Although the symptoms of mental health conditions can be similar between people, the triggers can be very different.

There are a number of factors that could lead to a deterioration in a business owner’s mental health, including:

  • Excessive stress;
  • A toxic work environment;
  • Poor leadership;
  • Uncertainty;
  • Long hours;
  • A lack of sleep; and
  • So on.

These can lead to burnout which, in turn, can lead to mental health conditions such as anxiety and depression.

Increased competition in your particular market or industry means added pressure to perform and stand out from the crowd, as well as potentially making it more difficult to be financially successful. Business costs may also be rising, possibly faster than your ability to increase sales and revenue – meaning the bottom line is impacted, aka less profit.

Using a contemporaneous example, the business uncertainty surrounding Brexit, especially for export-orientated businesses, can have a profound impact on business planning and sales generation.

4.0 A Blur between Personal, Family & Work

Small business ownership, especially, can be tough because there are few support structures for owners.

As an owner, you are responsible for everything and the lines between personal and family pressures and work are blurred or even non-existent.

Finally, the financial pressures are very real, as it is the owner’s money at stake not a large company’s money.

5.0 I’m In Control!

Business owners may be reluctant to seek, ask or talk about any mental health issues they may be facing due to the need to be perceived as having everything under control.

This means that business owners can, effectively, end up in rather stressful jobs.

With this in mind, most employees will be unaware of the stress attached to owning a business and how challenging cashflow, for example, can be. When margins are tight, paying wages can be extremely stressful. There are real life examples where owners have paid staff wages through their credit cards or overdrafts to ensure their employees get paid – mainly due to a feeling of guilt and not wanting to let them down. It can be stressful knowing that your employee’s family relies on the wage you are paying their loved one.

There is also the stress on marriages, especially if a couple is in business together.

6.0 The Value of Mentors

Other business owners understand what you, as a business owner, are going through. They understand the impact that long hours, for example, can have on the owner’s well-being and their families.

A business mentor can assist by helping the owner find ways of being more effective with their time, among other things.

7.0 Addressing Mental Health Issues

It is imperative that you do not do nothing.

There are a number of things owners can do, at both at an individual and organisational level:

  • Know the risks to mental health and well-being in your business.
    • What are the triggers?
  • Talk about mental health and well-being.
    • This helps to normalise it.
  • Leaders in your business need to be on board.
    • They must send the message to all staff that the business takes mental health seriously.
    • Role model what good mental health looks like and what we do when someone needs our help.
  • Get some education around mental health.
    • The reason that myths and fear exist is because of lack of awareness and knowledge.
    • There are workshops, coaches and even online courses now which help plug this knowledge gap.
  • Have the conversation with your people.
    • Not saying anything to someone who is struggling is not the way to go.
    • Simply asking “Are you OK?” is a really good start and shows the person that you have noticed and do care.
  • Sleep, nutrition, relationships and exercise all correlate with mental health, so check in on your people to see how they are going with these areas.
    • For example, if someone tells you that they have not been sleeping for two months, that is going to take its toll and something needs to be done.
  • Know who to go to.
    • Have an accessible list of contacts that you can call on for a range of different mental health and well-being matters.

It is important to seek support from someone who:

  • Has received appropriate training;
  • Is a registered practitioner; and
  • Has frequent supervision.

8.0 Pursing Good Mental Health

In the pursuit of good mental health, it is important to:

  • Understand our stressors;
  • Name our stressors;
  • Admit they exist; and
  • Aim to avoid them.

If our stressors cannot be avoided, we should attempt to better manage them.

Finally, when possible, it is important as a business owner to make time and take personal care of yourself.

Suicide in Older Adults: A Critical Problem

Research Paper Title

Suicide in Older Adults.

Abstract

Suicide in older adults is a critical problem that nurses and other health professionals need to address. Evidence-based interventions for prevention of late-life suicide are urgently needed, as well as increased availability of health care professionals with knowledge and skills to recognise suicide risks and intervene to provide effective care for this vulnerable population.

Reference

Sorrell, J.M. (2020) Suicide in Older Adults. Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.17-20. doi: 10.3928/02793695-20191218-04.