Mental health of parents of children with autism spectrum disorder during COVID-19 pandemic: A systematic review

BACKGROUND

Children diagnosed with autism spectrum disorder (ASD) may have great difficulties when their routines change, and this may affect the psychological well-being of their parents. For this reason, it is important to examine studies that address the mental health of parents in order to adapt to the coronavirus disease 2019 (COVID-19) pandemic.

AIM

To determine the mental health status of parents with children diagnosed with ASD in the COVID-19 pandemic.

METHODS

The study, which is a systematic review, was conducted between December 15, 2020 and December 30, 2020 by scanning articles in English. The Scopus, Science Direct, PubMed, Cochrane, Web of Science, and Google Scholar databases were used for scanning. The keywords COVID-19 AND ("autism" OR "autistic" OR "autism spectrum disorder") AND parent AND ("mental health" OR "anxiety" OR "stress") were used in the search process. The inclusion criteria in the study were findings regarding the mental health of parents with children diagnosed with ASD in the COVID-19 pandemic, addressing their anxiety and stress situations, being a research article, and accessing the full text of the article.

RESULTS

In the study, a total of 6389 articles were reached, and the full texts of 173 articles were evaluated for eligibility. After the articles excluded by the full-text search were eliminated, 12 studies involving 7105 parents were included in the analysis. The findings obtained from the articles containing data on mental health in the COVID-19 pandemic of parents with children with autism spectrum disorder were discussed in three groups. These were findings on the experiences of parents with children with ASD in the COVID-19 pandemic regarding the areas where parents with children with ASD need support in the COVID-19 pandemic and methods of coping with the COVID-19 pandemic for parents with children with ASD. In the systematic review, it was determined that the anxiety and stress of the parents increased, they needed more support compared to the pre-pandemic period, and they had difficulty coping.

CONCLUSION

In this systematic review, it was concluded that the COVID-19 pandemic negatively affected the mental health of the parents of children with ASD.

Risk factors for antenatal depression: A review

Depression is the most prevalent mental disorder in pregnancy, and yet it is less studied than postpartum depression despite the consequences it may have on both the pregnant woman and her offspring. Therefore, it would be important to know which risk factors may favour the appearance of antenatal depression in order to carry out appropriate prevention interventions. The aim of the present review was to identify the main risk factors of antenatal depression. We searched in databases PubMed and PsycINFO for articles published about the factors associated with antenatal depression from January 2010 through December 2020. The literature review identified three main groups of antenatal depression risk factors: sociodemographic, obstetric, and psychological. First, among the sociodemographic variables, the low level of studies and the economic income clearly stood out from the rest. Then, not having planned the pregnancy was the main obstetric variable, and finally, the main psychological risk factors were having a history of psychological disorders and/or depression as well as presenting anxiety, stress, and/or low social support during pregnancy. This review shows that the antenatal depression is affected by multiple factors. Most can be identified at the beginning of the pregnancy, and some are risk factors potentially modifiable through appropriate interventions, such as psychological factors. For this reason, it is important to carry out a good screening for depression during pregnancy and consequently, be able to prevent its appearance or treat it if necessary.

Selective serotonin reuptake inhibitors and risk reduction for cardiovascular disease in patients with schizophrenia: A controversial but promising approach

Patients with schizophrenia (SCZ) are at high risk of cardiovascular disease (CVD) due to an inherited predisposition, a sedentary life style and the use of antipsychotic medications. Several approaches have been taken to minimize this risk but results continue to be unsatisfactory. A potential alternative is prescribing selective serotonin reuptake inhibitors (SSRIs). SSRIs decrease platelet aggregation and reduce the risk of coronary heart disease in patients with depression. We therefore aim to investigate whether there is evidence that supports the use of SSRIs to reduce the risk for CVD in SCZ. A review of the literature revealed five published reports relating to the impact of SSRIs on CV risk in SCZ. Three trials assessed the influence on metabolic parameters of fluvoxamine when combined with clozapine. Two of those studies found improvements with fluvoxamine. Of the other two reports, one indicates SSRIs as a group caused minimal but statistically significant increments in total cholesterol, low-density lipoprotein and triglyceride. The second report suggests that when SSRIs are combined with antipsychotics, the metabolic impact depends on the antipsychotic prescribed. While there are promising results, no conclusions can be made currently on whether SSRIs increase or decrease CV risk in SCZ. Further studies are needed to resolve this matter.

How do serotonergic psychedelics treat depression: The potential role of neuroplasticity

Depression is a common mental disorder and one of the leading causes of disability around the world. Monoaminergic antidepressants often take weeks to months to work and are not effective for all patients. This has led to a search for a better understanding of the pathogenesis of depression as well as to the development of novel antidepressants. One such novel antidepressant is ketamine, which has demonstrated both clinically promising results and contributed to new explanatory models of depression, including the potential role of neuroplasticity in depression. Early clinical trials are now showing promising results of serotonergic psychedelics for depression; however, their mechanism of action remains poorly understood. This paper seeks to review the effect of depression, classic antidepressants, ketamine, and serotonergic psychedelics on markers of neuroplasticity at a cellular, molecular, electrophysiological, functional, structural, and psychological level to explore the potential role that neuroplasticity plays in the treatment response of serotonergic psychedelics.

Psychological predictors of bipolarity in panic disorder

BACKGROUND

Panic disorders frequently occur with affective disorders, particularly bipolar disorder. Patients with panic disorder and bipolar disorder are more likely to present with severe symptoms, such as high rates of suicidal behavior, poor symptomatic and functional recovery, and poor drug responses.

AIM

To investigate the psychological characteristics of panic disorder patients related to bipolarity.

METHODS

A total of 254 patients (136 men and 118 women, mean age = 33.48 ± 3.2 years) who were diagnosed with panic disorder were included in the study. Panic disorder with bipolarity (BP+) was defined as a score of ≥ 7 on the Korean version of the Mood Disorder Questionnaire (K-MDQ), and a score lower than 7 was considered as a panic disorder without bipolarity (BP-). Self-report questionnaires were analyzed to examine their association with bipolarity. Psychological tests used in the study were the Mood Disorder Questionnaire (MDQ), Panic Disorder Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Temperament and Character Inventory (TCI), and Minnesota Multiphasic Personality Inventory (MMPI). Statistical analyses were performed to evaluate the correlation between bipolarity of panic disorder patients and various psychological test results indicative of psychological characteristics.

RESULTS

Patients with a K-MDQ score of 7 or more were considered to have a history of manic or hypomanic episodes (BP+ group, n = 128), while patients with K-MDQ scores below 7 were defined as those without bipolarity (BP- group, n = 126). The BP+ group were more likely to be unmarried (single 56.2% vs 44.4%, P = 0.008) and younger (30.78 ± 0.59 vs 37.11 ± 3.21, P < 0.001). Additionally, the BP+ group had significantly higher scores on psychological assessment scales, such as the hypochondriasis, psychopathic deviate, masculinity-femininity, psychasthenia, schizophrenia, and hypomania (Ma) in MMPI, and novelty seeking, harm avoidance and self-transcendence in TCI, and STAI (state and trait) compared to the BP- group. In logistic regression analysis, depression in MMPI, self-directedness in TCI, and age were negatively associated with MDQ score, meanwhile, Ma in MMPI and STAI (trait) were positively associated with MDQ score.

CONCLUSION

The result of this study suggests that almost 50% of patients with panic disorder are likely to have hypomanic or manic symptoms, and certain psychological factors are associated bipolarity in panic disorder.

COVID-19 impact on high school student’s education and mental health: A cohort survey in China

BACKGROUND

The ongoing coronavirus disease 2019 (COVID-19) pandemic and the universal implementation of control measures are fundamentally affecting every aspect of our society and daily lives.

AIM

To evaluate the prevalence of post-traumatic stress disorder symptoms and their associated factors as well as the effects and attitudes towards online education in Chinese high school students.

METHODS

A total of 883 students were included. The first, second and third-year students of a high school in Lanzhou, Gansu province of China were invited to participate in this study. They were requested to involve their parents to complete the survey together. A detailed questionnaire of 65 questions was designed and divided into five sections. The survey was anonymously conducted via WeChat, a Chinese multipurpose messaging, social media and mobile payment app.

RESULTS

Overall, 32.94% of students experienced post-traumatic stress disorder due to the COVID-19 epidemic. The majority of students (60.82%) felt that online education was not (10.76%) or less effective (50.06%) in terms of gaining knowledge and improving practical and communications skills. Correlation analysis revealed that the class level, residential background and whether living with parents were significantly linked with the effectiveness and satisfaction of the online education system. Of the final year students, 74.2% said that the COVID-19 outbreak has negatively affected their preparation for the college entrance exam, and 68% of students felt that this outbreak increased psychological pressure for their college entrance examination preparation. In case of having COVID-19 symptoms during the exam, 50.7%, 13.3%, and 10.2% would notify the proctor, teacher and parents, respectively.

CONCLUSION

We found a high prevalence rate of post-traumatic stress disorder symptoms in high school students. Thus, our results call for urgent attention from both government and schools to implement effective interventions to cope with the psychological effects and the disturbance of education by COVID-19 on children.

Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders

Mental health symptoms secondary to trauma exposure and substance use disorders (SUDs) co-occur frequently in both clinical and community samples. The possibility of a shared aetiology remains an important question in translational neuroscience. Advancements in genetics, basic science, and neuroimaging have led to an improved understanding of the neural basis of these disorders, their frequent comorbidity and high rates of relapse remain a clinical challenge. This project aimed to conduct a review of the field's current understanding regarding the neural circuitry underlying posttraumatic stress disorder and SUD. A comprehensive review was conducted of available published literature regarding the shared neurobiology of these disorders, and is summarized in detail, including evidence from both animal and clinical studies. Upon summarizing the relevant literature, this review puts forth a hypothesis related to their shared neurobiology within the context of fear processing and reward cues. It provides an overview of brain reward circuitry and its relation to the neurobiology, symptomology, and phenomenology of trauma and substance use. This review provides clinical insights and implications of the proposed theory, including the potential development of novel pharmacological and therapeutic treatments to address this shared neurobiology. Limitations and extensions of this theory are discussed to provide future directions and insights for this shared phenomena.

Current global research landscape on COVID-19 and depressive disorders: Bibliometric and visualization analysis

BACKGROUND

Coronavirus disease 2019 (COVID-19) has affected daily life globally dramatically over the last year. The impact of the COVID-19 epidemic on mental health is expected to be immense and likely to be long-lasting, raising a range of global problems that need to be addressed accordingly.

AIM

To analyze the Scopus-based depression research and COVID-19, explain the advancement of research nowadays, and comment on the possible hotspots of depression research and COVID-19 to obtain a more global perspective.

METHODS

In this report, bibliometric analysis and visualization are used to explain COVID-19's global research status on depression and provide researchers with a guide to identify future research directions. Relevant studies on depression and COVID-19 were retrieved from the Scopus database. Visualization maps were produced using the VOSviewer software, including research collaboration.

RESULTS

At the time of data collection (November 18, 2020), 77217 documents were released by Scopus to COVID-19 in all areas of research. By limiting the search to depression and COVID-19 (January 2020 up until November 18, 2020), there are 1274 published articles on depression and COVID-19 in the Scopus. The great majority of which are original articles (n = 1049, 82.34%), followed by 118 review articles (9.26%), 66 letters (5.18%). The United States had the highest number of publications at 282 (22.14%), followed by China (19.07%) at 243 and Italy at 121 (9.5%). The major two clusters are signified by mental health outcomes among the general population and mental health outcomes among health care workers.

CONCLUSION

The evidence from this study found that many articles focused on mental health outcomes among the general population and health care workers. With adequate psychological support offered by the government or community agencies, mental health in various communities should be put within the local and global public health agenda. This changing situation involves the scientific community's collaborative efforts to contribute to population monitoring during quarantine and COVID-19 outbreaks and to examine the short- and long-term adverse effects on psychological well-being.

Intimate partner violence: A loop of abuse, depression and victimization

Intimate partner violence has been recognized as a serious public health issue. Exposure to violence contributes to the genesis of, and exacerbates, mental health conditions, and existing mental health problems increase vulnerability to partner violence, a loop that imprisons victims and perpetuates the abuse. A recently described phenomenon is when male violence against females occurs within intimate relationships during youth, and it is termed adolescent or teen dating violence. In this narrative review, factors associated with intimate partner violence and consequences of exposure of children to parental domestic violence are discussed, along with possible intensification of violence against women with the spread of coronavirus disease 2019 pandemic and subsequent lockdown. Intervention programs with a multicomponent approach involving many health care settings and research have a pivotal role in developing additional strategies for addressing violence and to provide tailored interventions to victims. Prevention policy with a particular attention on healthy child and adolescent development is mandatory in the struggle against all forms of violence.

COVID-19 knowledge, risk perception, and information sources among Chinese population

BACKGROUND

Measures for effective control of the coronavirus disease 2019 (COVID-19) pandemic include identifying the causal organisms, applying appropriate therapies, and developing vaccines, as well as improving understanding among the general public.

AIM

To evaluate the knowledge, awareness, perception, and response of the general public to COVID-19 in China.

METHODS

A detailed questionnaire comprising 47 questions designed in both English and Chinese was developed. The survey was conducted via WeChat, a multipurpose messaging, social media, and mobile payment app that is widely used by the Chinese population. In total, 1006 participants responded, and most of them were from different provinces of mainland China.

RESULTS

Overall, this comprehensive survey revealed that the general public in China is highly aware of the basic information concerning COVID-19 and its precautions. Interestingly, more respondents (99.3%) were aware of the term severe acute respiratory syndrome (SARS) than COVID-19 (97.2%) and Middle East respiratory syndrome (MERS) (73.4%). Among them, 2.4%, 1.6%, and 0.9% said that they or their family members or friends were affected by COVID-19, SARS, and MERS, respectively. The majority of the respondents (91.2%) indicated that knowledge about COVID-19 was received mainly from WeChat, followed by TV (89%), friends (76.1%), and QQ (a Chinese instant messaging software service) (57.7%).

CONCLUSION

The general public in China is highly aware of COVID-19 and the necessary precautions. Unexpectedly, 2.8% of the participants were unaware of the current epidemic. The remaining information gaps highlight the necessity of further enhancing awareness and preparedness.

Use of cognitive event-related potentials in the management of psychiatric disorders: Towards an individual follow-up and multi-component clinical approach

Relapse prevention remains a major challenge in psychiatry, thus indicating that the established treatment methods combining psychotherapy with neuropharmacological interventions are not entirely effective. In recent years, several intervention strategies have been devised that are aimed at improving psychiatric treatment by providing a complementary set of add-on tools that can be used by clinicians to improve current patient assessment. Among these, cognitive event-related potentials (ERPs) have been indexed as valuable biomarkers of the pathophysiological mechanisms of various mental illnesses. However, despite decades of research, their clinical utility is still controversial and a matter of debate. In this opinion review, I present the main arguments supporting the use of cognitive ERPs in the management of psychiatric disorders, stressing why it is currently still not the case despite the vast number of ERP studies to date. I also propose a clinically-oriented suitable way in which this technique could — in my opinion — be effectively incorporated into individual patient care by promotion of the use of individual ERP test-retest sessions and the use of a multi-component approach.

Uncertainty following an inconclusive result from the BRCA1/2 genetic test: A review about psychological outcomes

BACKGROUND

An inconclusive result from BRCA1/2 genetic testing indicates that a genetic variant of uncertain significance is detected. This case constitutes the majority of genetic test results, but studies specifically addressing the psychological adjustment of people with inconclusive results are scarce.

AIM

To examine psychological outcomes of receiving an uninformative BRCA1/2 test result.

METHODS

PubMed, PsychInfo, and Cochrane Central Register of Controlled Trials were screened for studies focusing on distress, anxiety, and depression levels in individuals with inconclusive genetic test results. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.

RESULTS

Studies on psychological outcomes of inconclusive BRCA1/2 focused on general and specific distress, anxiety, and depression. Overall, they produced mixed results. These inconsistent findings are probably due to the uncertainty caused by this type of result, that may also influence the decisions of individuals about surveillance and prophylactic options, reducing their compliance. In addition, this review highlights specific risk and protective factors that affect psychological adjustment in individuals with an inconclusive genetic testing result.

CONCLUSION

Individuals with inconclusive genetic test results need specific educational programs and support to better understand the meaning of their results in order to be able to make decisions about surveillance and prophylactic options.

Implications from translational cross-validation of clinical assessment tools for diagnosis and treatment in psychiatry

Traditional therapeutic methods in psychiatry, such as psychopharmacology and psychotherapy help many people suffering from mental disorders, but in the long-term prove to be effective in a relatively small proportion of those affected. Therapeutically, resistant forms of mental disorders such as schizophrenia, major depressive disorder, and bipolar disorder lead to persistent distress and dysfunction in personal, social, and professional aspects. In an effort to address these problems, the translational approach in neuroscience has initiated the inclusion of novel or modified unconventional diagnostic and therapeutic techniques with promising results. For instance, neuroimaging data sets from multiple modalities provide insight into the nature of pathophysiological mechanisms such as disruptions of connectivity, integration, and segregation of neural networks, focusing on the treatment of mental disorders through instrumental biomedical methods such as electro-convulsive therapy (ECT), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS). These methodologies have yielded promising results that have yet to be understood and improved to enhance the prognosis of the severe and persistent psychotic and affective disorders. The current review is focused on the translational approach in the management of schizophrenia and mood disorders, as well as the adaptation of new transdisciplinary diagnostic tools such as neuroimaging with concurrently administered psychopathological questionnaires and integration of the results into the therapeutic framework using various advanced instrumental biomedical tools such as ECT, TMS, tDCS and DBS.

Use of technology and social media in dementia care: Current and future directions

As the population across the globe continues to dramatically increase, the prevalence of cognitive impairment and dementia will inevitably increase as well, placing increasing burden on families and health care systems. Technological advancements over the past decade provide potential benefit in not only relieving caregiver burden of caring for a loved one with dementia, but also enables individuals with dementia to age in place. Technological devices have served to improve functioning, tracking and mobility. Similarly, smartphones, tablets and the ubiquitous world wide web have facilitated the dissemination of health information to previously hard to reach populations largely through use of various social media platforms. In this review, we discuss the current and future uses of technology via devices and social media to promote healthy aging in individuals with dementia, and also limitations and challenges to consider in the future.

Chronic serotonin syndrome: A retrospective study

BACKGROUND

Serotonin syndrome (SS) is an underdiagnosed drug-induced clinical syndrome resulting from the excess intrasynaptic concentration of serotonin. Very limited information is available about chronic SS.

AIM

To evaluate the epidemiological, clinical, and other aspects of the insidious onset SS.

METHODS

We retrospectively evaluated 14 consecutive adult patients (> 18 years) who had complaints for more than 6 wk at the time of consultation and met the Hunter criteria for SS.

RESULTS

The mean age was 41.1 years (range: 21-61 years), with a male preponderance (64%). Although tremors were observed in all patients, this was a presenting complaint in only 43% of patients. Generalized body pain, insomnia, and restlessness were common presenting features (50% each). Other common clinical features were stiffness of the limbs (43%), diaphoresis (43%), gait disturbances (36%), bowel disturbances (36%), dizziness (29%), sexual dysfunctions (21%), incoordination (14%), and fatigue (14%) The mean duration of symptoms before the diagnosis of SS was 13.5 ± 5.8 wk (range: 6-24 wk). Amitriptyline was the most common drug (n = 6, 43%), followed by tramadol (n = 5, 36%) and sodium valproate (n = 5, 36%). All patients received cyproheptadine, a 5- hydroxytryptamine2A antagonist, as treatment and noted an excellent response over the course of 4-14 d.

CONCLUSION

This study represents the largest study on chronic SS. We suggest that patients receiving serotonergic drugs should be physically examined for the presence of SS upon the development of new symptoms.

Contemplative sciences: A future beyond mindfulness

Mindfulness is a psychological technique based on Eastern meditative practices that was developed in the late 1970s by Kabat-Zinn at the University of Massachusetts. Initially, there was a debate over whether it should be considered a scientific technique or labelled as part of the "new wave" practices. Today, mindfulness is omnipresent in modern societies but has suffered from merchandising and banalization, which has been strongly criticized. Despite some limitations regarding methodological aspects of mindfulness research, it is considered effective for treating many physical and psychological disorders, and even it is recommended in clinical guidelines such the British National Institute for Health and Care Excellence. During the last 2500 years, mindfulness practices have moved from Northern India across most of Asia, but their mixing with Western science and culture at the end of the 20th century is considered a key event in recent history. For the first time in human history, due to globalization, the wisdom of all contemplative traditions can be shared with all human beings and assessed by science. Mindfulness practices, yoga included, are giving birth to a new field of knowledge, contemplative sciences, which go beyond mindfulness and is devoted to helping humanity to reach higher levels of happiness and mental peace.

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population. In this narrative review, we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients: People of diverse ethnic background and color, children with disabilities, sexual and gender minorities, pregnant women, mature adults, and those patients living in urban and rural communities. The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression, anxiety and posttraumatic stress disorder symptoms. Those psychiatric patients who are ethnic minorities display barriers to care, including collective trauma and structural racism. Sexual and gender minorities with mental illness face discrimination and limited access to treatment. Pregnant women with psychiatric diagnoses show higher exposure to domestic violence. Children with disabilities face a higher risk of worsening behavior. Mature adults with psychiatric problems show depression due to social isolation. Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities, which face limited access to telehealth services. We suggest that social programs that decrease discrimination, enhance communal resilience, and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.

Effectiveness of digital psychotherapeutic intervention among perinatal women: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The perinatal period is a challenging time of substantial emotional, physiological, social, and relational changes. Depression, anxiety, and stress symptoms are common, and co-exist in the perinatal period. Digital technology continues to grow at an unprecedented pace with wide application, including psychotherapeutic intervention. A growing number of meta-analyses supported the application of digital psychotherapeutic intervention across different populations, but relatively few meta- and meta-regression analyses have concentrated on perinatal women.

AIM

To evaluate the effectiveness of digital psychotherapeutic intervention on improving psychological outcomes among perinatal women and identify its essential features.

METHODS

Randomized controlled trials (RCTs) were obtained from eight databases, including Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, Scopus, PsycINFO, PubMed, Web of Science, and ProQuest Dissertation and Theses from inception up until November 24, 2020. Comprehensive Meta-analysis 3.0 software was used to conduct meta- and meta-regression analyses. The Cochrane risk-of-bias tool and the Grading of the Recommendation, Assessment, Development, and Evaluation system were adopted to assess the individual and overall qualities of the evidence, respectively.

RESULTS

A total of 25 RCTs that included 3239 women were identified. Meta-analyses revealed that intervention significantly improved depression (Hedges's g = 0.49), anxiety (g = 0.25), and stress (g = 0.47) symptoms compared to the control. Subgroup analyses demonstrated that a website platform with ≥ eight therapist-guided sessions using the theoretical principle of cognitive behavioral therapy was more effective than other treatments in improving depression symptoms in postnatal women. Meta-regression analyses observed that the age of perinatal women and the type of psychotherapy also had statistically significant effects on depression symptoms. Egger's regression asymmetry tests suggested that no publication biases occurred, but the overall quality of the evidence was very low.

CONCLUSION

This review suggests that digital psychotherapeutic intervention may be a potential solution to reduce psychological problems in perinatal women. Further high-quality RCTs with large sample sizes are needed.

Rapid commentary: Ethical implications for clinical trialists and patients associated with COVID-19 research

Pandemics disrupt clinical trials worldwide, with lasting effects on research. It can severely impact clinical trialists ability to conduct safe and ethically uncompromised trials. Hence, the mounting pressure results in ethically and morally distressing decisions faced by clinical trial professionals during pandemic situations. Whilst clinical trialists attempt to think about preparedness and responses during a pandemic, the need to have an ethical framework that has real-world applicability is imperative. Pandemics are a challenging time for all, however, the safety and access to support for clinical trialists and patients within clinical trials should be at the forefront for their organisations and the government.

Using eye movements in the dot-probe paradigm to investigate attention bias in illness anxiety disorder

BACKGROUND

Illness anxiety disorder (IAD) is a common, distressing, and debilitating condition with the key feature being a persistent conviction of the possibility of having one or more serious or progressive physical disorders. Because eye movements are guided by visual-spatial attention, eye-tracking technology is a comparatively direct, continuous measure of attention direction and speed when stimuli are oriented. Researchers have tried to identify selective visual attention biases by tracking eye movements within dot-probe paradigms because dot-probe paradigm can distinguish these attentional biases more clearly.

AIM

To examine the association between IAD and biased processing of illness-related information.

METHODS

A case-control study design was used to record eye movements of individuals with IAD and healthy controls while participants viewed a set of pictures from four categories (illness-related, socially threatening, positive, and neutral images). Biases in initial orienting were assessed from the location of the initial shift in gaze, and biases in the maintenance of attention were assessed from the duration of gaze that was initially fixated on the picture per image category.

RESULTS

The eye movement of the participants in the IAD group was characterized by an avoidance bias in initial orienting to illness-related pictures. There was no evidence of individuals with IAD spending significantly more time viewing illness-related images compared with other images. Patients with IAD had an attention bias at the early stage and overall attentional avoidance. In addition, this study found that patients with significant anxiety symptoms showed attention bias in the late stages of attention processing.

CONCLUSION

Illness-related information processing biases appear to be a robust feature of IAD and may have an important role in explaining the etiology and maintenance of the disorder.

Exorcising memories of internalised stigma: The demons of lived experience

Public stigma and self-stigma impact negatively on the lives of people with mental health issues. Many people in society stereotype and discriminate against people with mental ill-health, and often this negative process of marginalisation is internalised by people with lived experiences. Thus, this negative internalisation leads to the development of self-stigma. In this article, I reflect on my own experiences of shame and self-stigma as a person with mental ill-health socially bullied by peers from my community and social groups. I present a personal narrative of both public and self-stigmatisation which I hope will enable me to exorcise memories of internalised stigma, which are encountered as my demons of lived experience. Using reflexivity, a process used widely in health and social care fields, I consider how social bullying shattered my fragile confidence, self-esteem, and self-efficacy in the early days of my recovery; the impact of associative stigma on family members is also explored. Following this, the potential to empower people who experience shame and stigma is explored alongside effective anti-stigma processes which challenge discrimination. I connect the concept of recovery with the notion of empowerment, both of which emphasise the importance of agency and self-efficacy for people with mental ill-health. Finally, I consider how the concepts of empowerment and recovery can challenge both the public stigma held by peers in the community and the self-stigma of those with lived experiences.

Sleep problems in children and adolescents following traumatic life events

Rates of childhood trauma exposure are extremely high, with approximately 70% of children and adolescents experiencing at least one traumatic event. Among the most common non-specific consequences of stress and trauma are disruptions of sleep. Sleep problems, such as shorter sleep duration, difficulty falling asleep, frequent awakenings, nightmares, sleepless nights, and early-morning wakefulness appear to have a higher prevalence among children and adolescents following traumatic events. This review will illustrate the role of sleep problems in traumatized children and adolescents, and emphasize the need to consider a wide range of etiological mechanisms for these symptoms. However, the relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research. Moreover, in view of the adverse consequences of long-term disrupted sleep on mental health outcomes following trauma, the need to effectively address sleep disturbances in traumatized children and adolescents is crucial.

Psychic euosmia among obsessive-compulsive personality disorder patients: A case control study

BACKGROUND

Psychic euosmia (PE) has been described as a supposed psychological predisposition for which pleasant smells elicit an immediate sense of pleasure, order and calmness in obsessive-compulsive personality disorder (OCPD). In this study we tried to verify the interpretation that PE is the counterpart of disgust that has been associated to contamination and moral purity. Disgust and morality are significantly associated in people with obsessive-compulsive personality traits. We expected that OCPD patients would experience higher levels of PE.

AIM

To investigate the PE frequency in OCPD patients and healthy controls (HC) and to evaluate the relationship between PE and disgust.

METHODS

A single-center, case-control study was conducted in an outpatient service for obsessive-compulsive and related disorders. The sample consisted of 129 subjects: 45 OCPD patients and 84 HC. In both groups we submitted the Disgust Scale Revised (DS-R) and the self-report Structured Clinical Interview for DSM-5 Screening Personality Questionnaire to which we added an additional yes or no question to investigate the presence of PE. In order to verify differences between groups, t-test was employed for continuous variables and ² test for categorical variable; odds ratio was employed to analyze group differences in the PE survey. Correlation was explored with Pearson r correlations.

RESULTS

No differences were observed between groups in gender composition or education. A slight significant difference was found in mean age (t = 1.988; P = 0.049). The present study revealed significantly higher proportions of PE among OCPD patients when compared to HC (OR: 5.3, 2.28-12.46). Patients with OCPD were more likely to report PE (n = 36; 80%) whereas a much lower proportion endorsed PE in the HC group (n = 36; 42.9%). Interestingly, no differences were observed between groups in mean score for the Disgust Scale. There was also no difference between the two groups in any of the Disgust Scale Revised subscales. Moreover, no significant correlations were observed in the OCPD group between PE and Disgust Scale Revised subscales.

CONCLUSION

Results suggested that PE might be part of the clinical spectrum of OCPD, and it does not reflect the counterpart of disgust. This could also indicate that this phenomenon is a manifestation of orderliness or incompleteness. Further studies will need to be undertaken to better understand PE and its significance in OCPD.

Selective ablation of type 3 adenylyl cyclase in somatostatin-positive interneurons produces anxiety- and depression-like behaviors in mice

BACKGROUND

Major depressive disorder (MDD) is a highly disabling psychiatric syndrome associated with deficits of specific subpopulations of cortical GABAergic interneurons; however, the underlying molecular mechanism remains unknown. Type 3 adenylyl cyclase (ADCY3, AC3), which is important for neuronal excitability, has been implicated in MDD in a genome-wide association study in humans. Moreover, a study reported that ablation of AC3 in mice caused similar symptoms as MDD patients.

AIM

To determine if disruption of the AC3 gene in different subtypes of GABAergic interneurons of mice causes depression-like behaviors.

METHODS

Using immunohistochemistry, we investigated the expression of AC3 in two major subtypes GABAergic interneurons: Somatostatin-positive (SST⁺) and parvalbumin-positive (PV⁺) neurons. Genetic manipulations were used to selectively disrupt AC3 expression in SST⁺ or PV⁺ interneurons. A series of behavior tests including rotarod test, open field test (OFT), elevated plus maze test (EPM), forced swimming test (FST), and tail suspension test (TST) were used to evaluate the motor ability, anxiety- and depression- like behaviors, respectively.

RESULTS

Our results indicate that approximately 90.41% of SST⁺ and 91.22% of PV⁺ interneurons express AC3. After ablation of AC3 in SST⁺ interneurons, the mice spent comparable time in the center area in OFT, but significantly less time in the open arms and low frequency of entries to the open arms in EPM. Furthermore, these mice showed prolonged immobility in FST and more freezing in TST. However, there were no significant changes in these behaviors after specific disruption of AC3 in PV⁺ interneurons.

CONCLUSION

This study indicates that ablation of AC3 in SST⁺ interneurons of mice increases anxiety- and depression-like behaviors in mice, supporting the general hypothesis that decreased AC3 activity may play a role in human depression.

How to construct neuroscience-informed psychiatric classification? Towards nomothetic networks psychiatry

Psychiatry remains in a permanent state of crisis, which fragmented psychiatry from the field of medicine. The crisis in psychiatry is evidenced by the many different competing approaches to psychiatric illness including psychodynamic, biological, molecular, pan-omics, precision, cognitive and phenomenological psychiatry, folk psychology, mind-brain dualism, descriptive psychopathology, and postpsychiatry. The current "gold standard" Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases taxonomies of mood disorders and schizophrenia are unreliable and preclude to employ a deductive reasoning approach. Therefore, it is not surprising that mood disorders and schizophrenia research was unable to revise the conventional classifications and did not provide more adequate therapeutic approaches. The aim of this paper is to explain the new nomothetic network psychiatry (NNP) approach, which uses machine learning methods to build data-driven causal models of mental illness by assembling risk-resilience, adverse outcome pathways (AOP), cognitome, brainome, staging, symptomatome, and phenomenome latent scores in a causal model. The latter may be trained, tested and validated with Partial Least Squares analysis. This approach not only allows to compute pathway-phenotypes or biosignatures, but also to construct reliable and replicable nomothetic networks, which are, therefore, generalizable as disease models. After integrating the validated feature vectors into a well-fitting nomothetic network, clustering analysis may be applied on the latent variable scores of the R/R, AOP, cognitome, brainome, and phenome latent vectors. This pattern recognition method may expose new (transdiagnostic) classes of patients which if cross-validated in independent samples may constitute new (transdiagnostic) nosological categories.

What gets in the way of social engagement in schizophrenia?

BACKGROUND

Social engagement-important for health and well-being-can be difficult for people with schizophrenia. Past research indicates that despite expressing interest in social interactions, people with schizophrenia report spending less time with others and feeling lonely. Social motivations and barriers may play an important role for understanding social engagement in schizophrenia.

AIM

To investigate how people with schizophrenia describe factors that impede and promote social engagement.

METHODS

We interviewed a community sample of people with (n = 35) and without (n = 27) schizophrenia or schizoaffective disorder about their social interactions with friends and family over the past week and planned social activities for the coming week. We reviewed the interview transcripts and developed a novel coding system to capture whether interactions occurred, who had initiated the contact, and frequency of reported social barriers (i.e., internal, conflict-based, logistical) and social motivations (i.e., instrumental, affiliative, obligation-based). We also assessed symptoms and functioning.

RESULTS

People with schizophrenia were less likely than people without schizophrenia to have spent time with friends [t (51.04) = 2.09, P = 0.042, d = 0.51)], but not family. People with schizophrenia reported more social barriers than people without schizophrenia [F (1, 60) = 10.55, P = 0.002, ηp2 = 0.15)] but did not differ in reported social motivations. Specifically, people with schizophrenia reported more internal [t (45.75) = 3.40, P = 0.001, d = 0.83)] and conflict-based [t (40.11) = 3.03, P = 0.004, d = 0.73)] barriers than people without schizophrenia. Social barriers and motivations were related to real-world social functioning for people with schizophrenia, such that more barriers were associated with more difficulty in close relationships (r = -0.37, P = 0.027) and more motivations were associated with better community functioning (r = 0.38, P = 0.024).

CONCLUSION

These findings highlight the importance of assessing first person accounts of social barriers and motivations to better understand social engagement in schizophrenia.

Identification of key genes involved in post-traumatic stress disorder: Evidence from bioinformatics analysis

BACKGROUND

Post-traumatic stress disorder (PTSD) is a serious stress-related disorder.

AIM

To identify the key genes and pathways to uncover the potential mechanisms of PTSD using bioinformatics methods.

METHODS

Gene expression profiles were obtained from the Gene Expression Omnibus database. The differentially expressed genes (DEGs) were identified by using GEO2R. Gene functional annotation and pathway enrichment were then conducted. The gene-pathway network was constructed with Cytoscape software. Quantitative real-time polymerase chain reaction (qRT-PCR) analysis was applied for validation, and text mining by Coremine Medical was used to confirm the connections among genes and pathways.

RESULTS

We identified 973 DEGs including 358 upregulated genes and 615 downregulated genes in PTSD. A group of centrality hub genes and significantly enriched pathways (MAPK, Ras, and ErbB signaling pathways) were identified by using gene functional assignment and enrichment analyses. Six genes (KRAS, EGFR, NFKB1, FGF12, PRKCA, and RAF1) were selected to validate using qRT-PCR. The results of text mining further confirmed the correlation among hub genes and the enriched pathways. It indicated that these altered genes displayed functional roles in PTSD via these pathways, which might serve as key signatures in the pathogenesis of PTSD.

CONCLUSION

The current study identified a panel of candidate genes and important pathways, which might help us deepen our understanding of the underlying mechanism of PTSD at the molecular level. However, further studies are warranted to discover the critical regulatory mechanism of these genes via relevant pathways in PTSD.

Testing the hypothesis of subtypes of nonadherence in schizophrenia and schizoaffective disorder: A prospective study

BACKGROUND

Nonadherence is a major problem in the treatment of psychotic disorders. It has been hypothesized that nonadherent patients with schizophrenia are not a homogeneous population and subtypes of nonadherence might exist, but this hypothesis has not been specifically tested.

AIM

To test the hypothesis of subtypes of nonadherence in schizophrenia and schizoaffective disorder.

METHODS

This prospective study included 110 consecutively admitted patients diagnosed with schizophrenia or schizoaffective disorder. Assessments were performed at baseline and at 6 mo follow-up after discharge. Sociodemographic, clinical, psychopathological and treatment-related variables were evaluated. Adherence was defined as the concurrence of adherence to antipsychotic treatment and outpatient follow-up during the six-month period. Adherence to antipsychotic treatment was defined as the concurrence of objective and subjective adherence. Sixty-four patients (58%) fulfilled nonadherence criteria at the end of the follow-up period and were categorized according to their subtype of nonadherence.

RESULTS

In nonadherent patients (n = 64), 32 (50%) fulfilled criteria of intentional nonadherence, and 32 (50%) of unintentional nonadherence (UNA). Unintentional nonadherent patients, as compared to intentional nonadherent patients, are characterized by older age, lower educational level, worse cognitive and negative symptoms, greater severity, worse knowledge of their treatment regimen, greater prevalence of supervision of the treatment, lower number of prior hospitalizations and greater use of nonpsychiatric treatment, anticholinergics and hypnotics. Low educational level (OR = 26.1; 95%CI: 2.819-241), worse treatment knowledge at six months (OR per unit = 0.904; 95%CI: 0.853-0.957) and nonpsychiatric treatment at six months (OR = 15.8; 95%CI: 1.790-139) were independently associated to UNA.

CONCLUSION

Differentiated subtypes of nonadherence according to intentionality seem to exist in patients with schizophrenia and schizoaffective disorder. Our findings suggest the need for differentiated approach, both in future research and in clinical practice.

Best early-onset Parkinson dementia predictor using ensemble learning among Parkinson's symptoms, rapid eye movement sleep disorder, and neuropsychological profile

BACKGROUND

Despite the frequent progression from Parkinson’s disease (PD) to Parkinson’s disease dementia (PDD), the basis to diagnose early-onset Parkinson dementia (EOPD) in the early stage is still insufficient.

AIM

To explore the prediction accuracy of sociodemographic factors, Parkinson's motor symptoms, Parkinson’s non-motor symptoms, and rapid eye movement sleep disorder for diagnosing EOPD using PD multicenter registry data.

METHODS

This study analyzed 342 Parkinson patients (66 EOPD patients and 276 PD patients with normal cognition), younger than 65 years. An EOPD prediction model was developed using a random forest algorithm and the accuracy of the developed model was compared with the naive Bayesian model and discriminant analysis.

RESULTS

The overall accuracy of the random forest was 89.5%, and was higher than that of discriminant analysis (78.3%) and that of the naive Bayesian model (85.8%). In the random forest model, the Korean Mini Mental State Examination (K-MMSE) score, Korean Montreal Cognitive Assessment (K-MoCA), sum of boxes in Clinical Dementia Rating (CDR), global score of CDR, motor score of Untitled Parkinson’s Disease Rating (UPDRS), and Korean Instrumental Activities of Daily Living (K-IADL) score were confirmed as the major variables with high weight for EOPD prediction. Among them, the K-MMSE score was the most important factor in the final model.

CONCLUSION

It was found that Parkinson-related motor symptoms (e.g., motor score of UPDRS) and instrumental daily performance (e.g., K-IADL score) in addition to cognitive screening indicators (e.g., K-MMSE score and K-MoCA score) were predictors with high accuracy in EOPD prediction.

Effects of smartphone-based interventions and monitoring on bipolar disorder: A systematic review and meta-analysis

BACKGROUND

Recently, there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder (BD). However, their efficacy for BD remains unclear.

AIM

To compare the effect of smartphone-based interventions and monitoring with control methods in treating patients with BD.

METHODS

A systematic literature search was performed on PubMed, Embase, Clinical trials, psycINFO, Web of Science, and Cochrane Library. Randomized clinical trials (RCTs) or single-group trials in which smartphone-based interventions and monitoring were compared with control methods or baseline in patients with symptoms of BD were included. Data were synthesized using a random-effects or a fixed-effects model to analyze the effects of psychological interventions and monitoring delivered via smartphone on psychiatric symptoms in patients with BD. The primary outcome measures were set for mania and depression symptoms. Subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms.

RESULTS

We identified ten articles, including seven RCTs (985 participants) and three single-group trials (169 participants). Analysis of the between-group study showed that smartphone-based interventions were effective in reducing manic [g = -0.19, 95% confidence interval (CI): -0.33 to -0.04, P = 0.01] and depressive (g = -0.28, 95%CI: -0.55 to -0.01, P < 0.05) symptoms. In within-group analysis, smartphone-based interventions significantly reduced manic (g = 0.17, 95%CI: 0.04 to 0.30, P < 0.01) and depressive (g = 0.48, 95%CI: 0.18 to 0.78) symptoms compared to the baseline. Nevertheless, smartphone-based monitoring systems significantly reduced manic (g = 0.27, 95%CI: 0.02 to 0.51, P < 0.05) but not depressive symptoms. Subgroup analysis indicated that the interventions with psychoeducation had positive effects on depressive (g = -0.62, 95%CI: -0.81 to -0.43, P < 0.01) and manic (g = -0.24, 95%CI: -0.43 to -0.06, P = 0.01) symptoms compared to the controlled conditions, while the interventions without psychoeducation did not (P > 0.05). The contacts between therapists and patients that contributed to the implementation of psychological therapy reduced depression symptoms (g = -0.47, 95%CI: -0.75 to -0.18, P = 0.01).

CONCLUSION

Smartphone-based interventions and monitoring have a significant positive impact on depressive and manic symptoms of BD patients in between-group and within-group analysis.

Mechanisms of repetitive transcranial magnetic stimulation for anti-depression: Evidence from preclinical studies

This review summarizes the anti-depressant mechanisms of repetitive transcranial magnetic stimulation in preclinical studies, including anti-inflammatory effects mediated by activation of nuclear factor-E2-related factor 2 signaling pathway, anti-oxidative stress effects, enhancement of synaptic plasticity and neurogenesis via activation of the endocannabinoid system and brain derived neurotrophic factor signaling pathway, increasing the content of monoamine neurotransmitters via inhibition of Sirtuin 1/monoamine oxidase A signaling pathway, and reducing the activity of the hypothalamic-pituitary-adrenocortical axis. We also discuss the shortcomings of transcranial magnetic stimulation in preclinical studies such as inaccurate positioning, shallow depth of stimulation, and difficulty in elucidating the neural circuit mechanism up- and down-stream of the stimulation target brain region.

Development of a depression in Parkinson's disease prediction model using machine learning

BACKGROUND

It is important to diagnose depression in Parkinson’s disease (DPD) as soon as possible and identify the predictors of depression to improve quality of life in Parkinson’s disease (PD) patients.

AIM

To develop a model for predicting DPD based on the support vector machine, while considering sociodemographic factors, health habits, Parkinson's symptoms, sleep behavior disorders, and neuropsychiatric indicators as predictors and provide baseline data for identifying DPD.

METHODS

This study analyzed 223 of 335 patients who were 60 years or older with PD. Depression was measured using the 30 items of the Geriatric Depression Scale, and the explanatory variables included PD-related motor signs, rapid eye movement sleep behavior disorders, and neuropsychological tests. The support vector machine was used to develop a DPD prediction model.

RESULTS

When the effects of PD motor symptoms were compared using “functional weight”, late motor complications (occurrence of levodopa-induced dyskinesia) were the most influential risk factors for Parkinson's symptoms.

CONCLUSION

It is necessary to develop customized screening tests that can detect DPD in the early stage and continuously monitor high-risk groups based on the factors related to DPD derived from this predictive model in order to maintain the emotional health of PD patients.

Alcohol and drug use disorders in adult attention-deficit/hyperactivity disorder: Prevalence and associations with attention-deficit/hyperactivity disorder symptom severity and emotional dysregulation

BACKGROUND

High risk of alcohol and drug use disorders in people with attention-deficit/hyperactivity disorder (ADHD) calls for exploratory research of relationships with clinical features of ADHD.

AIM

To estimate prevalence of alcohol/drug use disorders and associations with ADHD symptom severity and emotional dysregulation, in adults with ADHD.

METHODS

This observational cross-sectional clinical study consisted of patients admitted to a private psychiatric outpatient clinic in Oslo, Norway (2014-2018). Five-hundred and fifty-eight eligible patients diagnosed with ADHD (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria) agreed to participate. Alcohol and drug use disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI). Dependence and abuse were merged into “use” disorder as in MINI version 7.0/DSM-5. Questions were related both to lifetime and the past 12-mo. ADHD severity was assessed by the Adult ADHD Self Report Scale (ASRS). Subdivisions of the ASRS questionnaire as inattentive items and hyperactive/impulsivity items were recorded separately. Emotional dysregulation was assessed by the eight-item version of Barkley’s Current Behavior Scale - Self Report.

RESULTS

The 12-mo prevalence was 5.3% for alcohol use disorder and 13.7% for drug use disorder. The lifetime prevalence was 12.0% for alcohol use disorder and 27.7% for drug use disorder. Men had higher rates of both alcohol use disorder and drug use disorder compared to women. The prevalence of drug use disorder was more than twice that of alcohol use disorder for both sexes. The drugs most participants reported having used were (in descending order): Amphetamine (19.1%), cannabis (17.1%), cocaine or ecstasy (7.4%), benzodiazepines (7.4%), and heroin or other opioids (2.9%). Lifetime drug use disorder was significantly associated with both hyperactivity-impulsivity symptoms and emotional dysregulation symptom severity. Lifetime alcohol use disorder, on the other hand, was not significantly associated with ADHD symptoms or emotional dysregulation when adjusted for gender and age.

CONCLUSION

Patients with ADHD have a high lifetime prevalence of drug use disorder, which is associated with higher levels of hyperactivity-impulsivity symptoms and emotional dysregulation.

Delirium, insulin-like growth factor I, growth hormone in older inpatients

BACKGROUND

Delirium is a common disorder in elderly medical inpatients with serious adverse outcomes and is characterized by sudden onset, disturbance in attention, awareness, consciousness and cognition, and often with behavioural disturbances. Central to understanding delirium, is understanding mechanisms by which body and brain wellbeing are linked and in particular how brain responses to bodily homeostatic stress is mediated. A number of studies have investigated the relationship between insulin-like growth factor I (IGF-I) and delirium in medically ill hospitalised patients with conflicting results. However, none have investigated growth hormone (GH) which is related to IGF-I via negative feedback.

AIM

To investigate the relationship between serum levels of IGF-I and GH, and the occurrence of delirium.

METHODS

Prospective, longitudinal, observational study. Consecutive elderly inpatients (aged 70+), were assessed twice weekly with Montreal cognitive assessment (MoCA), Confusion assessment method (CAM), Acute Physiology and Chronic Health Evaluation II. Delirium was defined using CAM. Previous history of dementia was evaluated with the Informant Questionnaire on Cognitive Decline in the Elderly. IGF-I and GH levels were estimated with the ELISA method. Generalized estimating equations (GEE) model was applied for the first five assessments to analyze those longitudinal data.

RESULTS

The sample consisted of 198 participants (mean age 80.63 ± 6.81; range 70-97). Of these 92 (46.5%) were females. Eighty six (43.4%) were identified with a history of dementia. Incident or prevalent delirium during hospitalisation was identified with CAM in 40 participants (20.2%). Evaluation of missing values with Little's MCAR test indicated that they were missing completely at random (MCAR χ² = 12.24, u: 9, P = 0.20). Using GEE for the analysis we found that low MoCA scores, low levels of IGF-I and high levels of GH were significantly associated with any delirium (prevalence, incident, or fluctuating , during the study period (Wald χ² = 12.231; u: 1, P < 0.001, Wald χ² = 7.196, u: 1, P = 0.007, Wald χ² = 6.210; : u: 1, P = 0.013 respectively).

CONCLUSION

The results show that low levels of IGF-I, high levels of GH and low scores in cognition are independently associated with the occurrence of any delirium during the hospitalisation of medically ill older people. The results of the study supports the hypothesis that deficits in the immunoreactivity of the brain (low cerebral reserve) may be associated with delirium.

Serum levels of chemokines in adolescents with major depression treated with fluoxetine

BACKGROUND

Major depressive disorder (MDD) is a global health issue that affects 350 million people of all ages. Although between 2% and 5.6% of affected individuals are adolescents, research on young patients is limited. The inflammatory response contributes to the onset of depression, and in adult MDD patients, symptom severity has been linked to chemokine levels.

AIM

To determine the differences in circulatory levels of chemokines in healthy volunteers (HVs) and adolescents with MDD, and assess the changes induced by fluoxetine consume.

METHODS

The 22 adolescents with MDD were monitored during the first 8 wk of clinical follow-up and clinical psychiatric evaluation was done using the Hamilton depresión rating scale (HDRS). The serum levels of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein (MIP)-1α, MIP-1β, interleukin (IL)-8, interferon gamma-induced protein (IP)-10, and eotaxin were measured in patients and HVs.

RESULTS

In all cases, significant differences were detected in circulating chemokine levels between patients before treatment and HVs (P < 0.0001). All chemokines decreased at 4 wk, but only MCP-1 and IL-8 significantly differed (P < 0.05) between 0 wk and 4 wk. In the patients, all chemokines rose to their initial concentrations by 8 wk vs 0 wk, but only IP-10 did so significantly (P < 0.05). All patients experienced a significant decrease in HDRS scores at 4 wk (P < 0.0001) and 8 wk (P < 0.0001) compared with 0 wk.

CONCLUSION

Despite the consumption of fluoxetine, patients had significantly higher chemokine levels, even after considering the improvement in HDRS score. The high levels of eotaxin, IP-10, and IL-8 partially explain certain aspects that are affected in MDD such as cognition, memory, and learning.

Dietary modification in the treatment of schizophrenia spectrum disorders: A systematic review

BACKGROUND

Schizophrenia spectrum disorders impact functioning, reduce quality of life and increase the risk of physical illness and premature mortality. Nutritional intervention studies aimed at decreasing body weight have demonstrated efficacy in improving metabolic outcomes; however, few studies have explored the impact of interventions designed to modify diet on mental health outcomes.

AIM

To synthesize the existing experimental studies of adjunctive diet modification as an intervention in the treatment of psychotic disorders, analyze findings related to effectiveness and safety, highlight knowledge gaps and limitations, and set forward recommendations for future research studies.

METHODS

An extensive a priori search strategy was developed and the databases Embase, Embase Classic, Ovid MEDLINE were searched. Screening and data extraction were completed in duplicate. Studies included in this analysis were experimental studies of an adjunctive dietary intervention (overall dietary pattern or education on dietary change) for treatment of schizophrenia spectrum disorders. No restrictions were placed on control groups or blinding. The studies were required to report a mental health outcome.

RESULTS

Twenty-five clinical trials were identified, along with two additional protocols and two meta-analyses. Nineteen of the clinical trials reported improvement in one or more mental health domain including psychosis symptoms, cognition, and quality of life. A high level of heterogeneity was found with respect to patient population, intervention, and study design. All of the studies included lifestyle or psychosocial components in addition to dietary modification. The nutrition advice provided to participants was poorly described overall and compliance was not assessed. The studies that showed benefit tended to have a smaller sample size and were less likely to be randomized but were more likely to use a group delivery intervention.

CONCLUSION

Further research assessing effectiveness and efficacy of clearly reported dietary interventions is warranted, especially those using rigorous methodology, modifying diet in isolation and assessing participant compliance.

Pimavanserin for the treatment of psychosis in Alzheimer’s disease: A literature review

BACKGROUND

Alzheimer’s disease (AD) is among the most prevalent forms of dementia in the world and neuropathological studies suggest similar high prevalence of mixed (AD + vascular) dementias. Approximately 25%-50% of individuals with AD develop psychosis sometime during their illness. The presence of psychosis in AD worsens outcomes. Currently there are no United States Food and Drug Administration (FDA) approved medications for the treatment of psychosis in AD. Pimavanserin, a novel atypical antipsychotic medication, was approved by the FDA for the treatment of hallucinations and delusions associated with Parkinson disease psychosis and is currently in clinical trials for the treatment of psychosis in AD.

AIM

To evaluate the existing literature regarding the use of pimavanserin for treating psychosis among individuals with AD.

METHODS

A literature review of clinical studies of pimavanserin treatment for psychosis in individuals with AD was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Trials were identified by systematically searching PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2019. The 5-point Jadad scoring system was used to assess the methodologic quality of the randomized placebo-controlled trials.

RESULTS

A total of 499 citations were retrieved and pooled in EndNote and de-duplicated to 258 citations. This set was uploaded to Covidence for screening. Two separate screeners (Srinivasan S and Tampi RR) evaluated the titles, abstracts, and full text of eligible articles. Of the identified 258 abstracts, 98 articles underwent full text review and 2 publications from 1 randomized controlled trial (RCT) were included in the final analysis. The quality of evidence was assessed to be of good methodologic quality, scoring 4 out of 5 using the 5-point Jadad questionnaire with the Jadad Scoring calculation. This systematic review found only one RCT that evaluated the use of pimavanserin for the treatment of psychosis among individuals with AD. This phase 2 trial resulted in two publications, the second of which was a subgroup analysis from the original study. The evidence from these two publications showed that pimavanserin improves psychotic symptoms among individuals with AD when compared to placebo at week 6.

CONCLUSION

Pimavanserin may be a pharmacologic consideration for the treatment for psychosis in AD. Additional RCTs are needed to assess the evidence of effectiveness before pimavanserin is considered a standard treatment.

Comparison of three administration modes for establishing a zebrafish seizure model induced by N-Methyl-D-aspartic acid

BACKGROUND

Epilepsy is a complex neurological disorder characterized by recurrent, unprovoked seizures resulting from the sudden abnormal discharge of brain neurons. It leads to transient brain dysfunction, manifested by abnormal physical movements and consciousness. It can occur at any age, affecting approximately 65 million worldwide, one third of which are still estimated to suffer from refractory seizures. There is an urgent need for further establishment of seizure models in animals, which provides an approach to model epilepsy and could be used to identify novel anti-epileptic therapeutics in the future.

AIM

To compare three administration modes for establishing a seizure model caused by N-Methyl-D-aspartic acid (NMDA) in zebrafish.

METHODS

Three administration routes of NMDA, including immersion, intravitreal injection and intraperitoneal injection, were compared with regard to their effects on inducing seizure-like behaviors in adult zebrafish. We evaluated neurotoxicity by observing behavioral changes in zebrafish and graded those behaviors with a seizure score. In addition, the protective effects of MK-801 (Dizocilpine) and natural active constituent resveratrol against NMDA-induced alterations were studied.

RESULTS

The three NMDA-administration methods triggered different patterns of the epileptic process in adult zebrafish. Seizure scores were increased after increasing NMDA concentration regardless of the mode of administration. However, the curve of immersion continuously rose to a high plateau (after 50 min), while the curves of intravitreal injection and intraperitoneal injection showed a spike in the early stage (10-20 min) followed by a steady decrease in seizure scores. Furthermore, pretreatment with resveratrol and MK-801 significantly delayed seizure onset time and lowered seizure scores.

CONCLUSION

By comparing the three methods of administration, intravitreal injection of NMDA was the most suitable for establishing an acute epileptic model in zebrafish. Thus, intraperitoneal injection in zebrafish can be applied to simulate diseases such as epilepsy. In addition, NMDA immersion may be an appropriate method to induce persistent seizures. Moreover, MK-801 and resveratrol showed strong anti-epileptic effects; thus, both of them may be clinically valuable treatments for epilepsy.

Visual impairment and depression: Age-specific prevalence, associations with vision loss, and relation to life satisfaction

BACKGROUND

To our knowledge, no study has obtained specific estimates of depression for young and middle-aged adults with visual impairment (VI). As estimates of depression varies across age groups in the general population, it is of interest to examine whether the same applies to adults with low vision or blindness.

AIM

To estimate depression prevalence and its association with VI-related characteristics and life satisfaction in adults with VI.

METHODS

A telephone-based cross-sectional survey was conducted between January and May 2017 in an age-stratified sample of adults who were members of the Norwegian Association of the Blind and Partially Sighted. Participants were asked questions about their sociodemographic characteristics, VI characteristics, and life satisfaction. Depression was measured with the Patient Health Questionnaire. The diagnostic scoring algorithm was used to calculate the point prevalence of depression (i.e., major depression and other depressive disorders) across categories of gender and age (years: 18-35, 36-50, 51-65, ≥ 66). The associations were estimated using regression models.

RESULTS

Overall, 736 adults participated in the study (response rate: 61%). The prevalence estimates of depression varied across different age groups, ranging from 11.1%-22.8% in women and 9.4%-16.5% in men, with the highest rates for the two youngest age groups. Results from the multivariable models including sociodemographic and VI-related variables showed that losing vision late in life [Prevalence ratio (PR), 1.76, 95%CI: 1.11, 2.79] and having other impairments (PR: 1.88, 95%CI: 1.32, 2.67) were associated with higher rates of depression, whereas older age was associated with lower rates (PR: 0.83, 95%CI: 0.74, 0.93). Additionally, participants who were depressed had lower life satisfaction than those who were not depressed (adjusted β: -2.36, 95%CI: -2.75, -1.98).

CONCLUSION

Our findings suggest that depression in adults with VI, and especially among young and middle-aged adults, warrants greater attention by user organisations, clinicians, and healthcare authorities.

Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications

A spectrum of neuropsychiatric disorders is a common complication from stroke. Neuropsychiatric disorders after stroke have negative effects on functional recovery, increasing the rate of mortality and disability of stroke survivors. Given the vital significance of maintaining physical and mental health in stroke patients, neuropsychiatric issues after stroke have raised concerns by clinicians and researchers. This mini-review focuses on the most common non-cognitive functional neuropsychiatric disorders seen after stroke, including depressive disorders, anxiety disorders, post-traumatic stress disorder, psychosis, and psychotic disorders. For each condition, the clinical performance, epidemiology, identification of the therapeutic implication, and strategies are reviewed and discussed; the main opinions and perspectives presented here are based on the latest controlled studies, meta-analysis, or updated systematic reviews. In the absence of data from controlled studies, consensus recommendations were provided accordingly.

Neuroendocrine, epigenetic, and intergenerational effects of general anesthetics

The progress of modern medicine would be impossible without the use of general anesthetics (GAs). Despite advancements in refining anesthesia approaches, the effects of GAs are not fully reversible upon GA withdrawal. Neurocognitive deficiencies attributed to GA exposure may persist in neonates or endure for weeks to years in the elderly. Human studies on the mechanisms of the long-term adverse effects of GAs are needed to improve the safety of general anesthesia but they are hampered not only by ethical limitations specific to human research, but also by a lack of specific biological markers that can be used in human studies to safely and objectively study such effects. The latter can primarily be attributed to an insufficient understanding of the full range of the biological effects induced by GAs and the molecular mechanisms mediating such effects even in rodents, which are far more extensively studied than any other species. Our most recent experimental findings in rodents suggest that GAs may adversely affect many more people than is currently anticipated. Specifically, we have shown that anesthesia with the commonly used GA sevoflurane induces in exposed animals not only neuroendocrine abnormalities (somatic effects), but also epigenetic reprogramming of germ cells (germ cell effects). The latter may pass the neurobehavioral effects of parental sevoflurane exposure to the offspring, who may be affected even at levels of anesthesia that are not harmful to the exposed parents. The large number of patients who require general anesthesia, the even larger number of their future unexposed offspring whose health may be affected, and a growing number of neurodevelopmental disorders of unknown etiology underscore the translational importance of investigating the intergenerational effects of GAs. In this mini review, we discuss emerging experimental findings on neuroendocrine, epigenetic, and intergenerational effects of GAs.

Effects of age and sex on clinical high-risk for psychosis in the community

BACKGROUND

Recent reports of both heightened prevalence rates and limited clinical relevance of clinical high-risk (CHR) criteria and their relevant symptoms in children and adolescents indicate an important role of neurodevelopment in the early detection of psychoses. Furthermore, sex effects in CHR symptoms have been reported, though studies were inconclusive. As sex also impacts on neurodevelopment, we expected that sex might have an additional contribution to age in the prevalence and clinical relevance of CHR symptoms and criteria.

AIM

To investigate age and sex effects on CHR criteria and symptoms and their association with psychosocial impairment and mental disorder.

METHODS

In this cross-sectional cohort study, n = 2916 8- to 40-year-olds, randomly drawn from the population register of the Swiss canton Bern, were assessed in semi-structured interviews by phone or face-to-face for CHR symptoms and criteria using the Structured Interview for Psychosis-Risk Syndromes and the Schizophrenia Proneness Instrument in its child and youth, and adult version, respectively. Furthermore, social and occupational functioning and DSM-IV axis I disorders were assessed. Simple and interaction effects of age and sex on CHR symptoms and criteria, and interaction effects of age, sex, and CHR symptoms and criteria on presentation of functional impairment and of non-psychotic disorder were investigated using logistic regression analyses.

RESULTS

Altogether, 542 (18.6%) participants reported any CHR symptom; of these, 261 (9.0%) participants reported any one of the 11 criteria relevant cognitive and perceptual basic symptoms, and 381 (13.1%) any one of the five attenuated or transient psychotic symptoms (attenuated psychotic symptoms/brief intermittent psychotic symptoms). Fewer participants met any one of the CHR criteria (n = 82, 2.8%) or any one of the three recently recommended CHR criteria (n = 38, 1.3%). Both age and sex were significantly (P < 0.05) associated with CHR symptoms and criteria, mostly by younger age and female sex. Though slightly differing between symptom groups, age thresholds were detected around the turn from adolescence to adulthood; they were highest for cognitive basic symptoms and CHR criteria. With the exception of the infrequent speech disorganization attenuated psychotic symptom, the interaction of age with CHR symptoms and criteria predicted functional impairment; whereas, independent of each other, sex and CHR symptoms mostly predicted mental disorders.

CONCLUSION

Age and sex differentially impact on CHR symptoms and criteria; these differences may support better understanding of causal pathways. Thus, future CHR studies should consider effects of sex and age.

Abdominal pain related to adulterated opium: An emerging issue in drug addicts

Lead may contaminate opium, heroin and illicit opiates and is particularly observed in Iran. Lead, a natural heavy metal is able to interfere with several organ functions after ingestion or inhalation. Lead poisoning manifestations are non-specific and thus lead poisoning remains difficult to diagnose. Among the manifestations, abdominal pain is almost the most frequent symptom causing patients to seek medical care. In patients with a history of opium addiction presenting with moderate-to-severe abdominal pain, lack of diagnosis of lead toxicity may thus result in time-consuming and unnecessary medical work-ups that can end up in invasive surgery. This paper aims to briefly review abdominal pain as an emergency issue and the leading symptom of lead poisoning that brings most of the patients to healthcare facilities. All published adult cases and case series of opium addicts admitted with abdominal pain due to lead-adulterated opium consumption have been reviewed. A trend of increasing numbers of lead poisoning cases has recently emerged among opium addicts in Iran. Due to the non-specific manifestations and hazardous effects, psychiatrists and emergency physicians should consider lead poisoning in patients with a past or present history of opium addiction referred for acute abdominal pain, particularly in case of colicky abdominal pain.

Risk factors for depression in patients with chronic obstructive pulmonary disease

BACKGROUND

The prevalence of depression in patients with chronic obstructive pulmonary disease (COPD) ranges from 10% to 42%, but the diagnosis of depression in patients with COPD is often unrecognized and untreated. Unrecognized depression has major implications for compliance with medical treatment, prolonged lengths of stay, increased frequency of hospital admissions, and increased consultations with primary care physicians. Many studies have attempted to identify risk factors for progression, prognosis and response to therapy in patients with depression. However, few studies have examined the risk factors for depression in patients with COPD, and some results remain controversial.

AIM

To identify the potential risk factors to define patients with COPD who are at “high risk” of depression.

METHODS

The clinical data of 293 patients with COPD were reviewed from January 2017 to December 2018. The correlations between demographics, clinical characteristics and depression were analyzed. The risk factors for depression in patients with COPD were identified by multivariate logistic regression analysis. The cutoff value, sensitivity and specificity of the independent correlation factors were calculated with a receiver operating characteristic curve.

RESULTS

Of the 293 patients included, 65 (22.18%) individuals were identified to have depression. Significant differences were detected between patients with and without depression in terms of body mass index (BMI), forced expiratory volume in 1 s (FEV1), and COPD assessment test (CAT) score (all P < 0.05). Low BMI, low FEV1, and high CAT were independent risk factors for depression in patients with COPD and the cutoff values of BMI, FEV1, and CAT scores were 21.373 kg/m², 0.855 L and 12.5, respectively.

CONCLUSION

Low BMI, low FEV1, and high CAT score were identified as independent risk factors for depression in patients with COPD.

Evidence for using dextromethorphan-quinidine for the treatment of agitation in dementia

Behavioral and psychological symptoms including agitation are common in dementia, and are associated with decreased quality of life, increased risk of institutionalization, and greater patient and caregiver distress. Pharmacological agents used for management of behavioral and psychological symptoms of dementia are limited by their tolerability, prompting a need for identifying efficacious and safe pharmacological treatments for managing agitation in dementia. The combination of dextromethorphan and quinidine sulfate is approved for pseudobulbar affect, and may be effective in managing agitation in dementia. A review of literature found only one randomized controlled trial that evaluated the use of dextromethorphan-quinidine for the management of agitation in dementia when compared to placebo. Data from this trial demonstrated that dextromethorphan-quinidine decreased agitation in dementia, and was well tolerated. Although promising, further research is needed before dextromethorphan-quinidine combination can be accepted as a standard treatment for agitation in dementia.

Moderators and mediators of antipsychotic response in delusional disorder: Further steps are needed

Delusional disorder (DD) has been traditionally considered a relatively rare and treatment-resistant psychotic disorder. In the last decade, increasing attention has focused on therapeutic outcomes of individuals affected by this disorder. The aim of this paper is to provide a synthesis of the literature addressing two very important questions arising from DD research: (1) For which patients with DD do antipsychotic medications work best (the moderators of response); and (2) What variables best explain the relationship between such treatments and their effectiveness (the mediators of response). We searched PubMed and Google Scholar databases for English, German, French and Spanish language papers published since 2000. We also included a few classic earlier papers addressing this topic. Variables potentially moderating antipsychotic response in DD are gender, reproductive status, age, duration of illness, the presence of comorbidity (especially psychiatric comorbidity) and its treatment, brain structure, and genetics of neurochemical receptors and drug metabolizing enzymes. Antipsychotic and hormonal blood levels during treatment, as well as functional brain changes, are potential mediating variables. Some, but not all, patients with DD benefit from antipsychotic treatment. Understanding the circumstances under which treatment works best can serve to guide optimal management.

Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients

BACKGROUND

Efficient detection of delirium and comorbid delirium-dementia is a key diagnostic challenge. Development of new, efficient delirium-focused methods of cognitive assessment is a key challenge for improved detection of neurocognitive disorders in everyday clinical practice.

AIM

To compare the accuracy of two novel bedside tests of attention, vigilance and visuospatial function with conventional bedside cognitive tests in identifying delirium in older hospitalized patients.

METHODS

180 consecutive elderly medical inpatients (mean age 79.6 ± 7.2; 51% female) referred to a psychiatry for later life consultation-liaison service with delirium, dementia, comorbid delirium-dementia and cognitively intact controls. Participants were assessed cross-sectionally with conventional bedside cognitive tests [WORLD, Months Backward test (MBT), Spatial span, Vigilance A and B, Clock Drawing test and Interlocking Pentagons test] and two novel cognitive tests [Lighthouse test, Letter and Shape Drawing test (LSD)-4].

RESULTS

Neurocognitive diagnoses were delirium (n = 44), dementia (n = 30), comorbid delirium-dementia (n = 60) and no neurocognitive disorder (n = 46). All conventional tests had sensitivity of > 70% for delirium, with best overall accuracy for the Vigilance-B (78.3%), Vigilance-A (77.8%) and MBT (76.7%) tests. The sustained attention component of the Lighthouse test was the most distinguishing of delirium (sensitivity 84.6%; overall accuracy 75.6%). The LSD-4 had sensitivity of 74.0% and overall accuracy 74.4% for delirium identification. Combining tests allowed for enhanced sensitivity (> 90%) and overall accuracy (≥ 75%) with the highest overall accuracy for the combination of MBT-Vigilance A and the combined Vigilance A and B tests (both 78.3%). When analyses were repeated for those with dementia, there were similar findings with the MBT-Vigilance A the most accurate overall combination (80.0%). Combining the Lighthouse-SA with the LSD-4, a fail in either test had sensitivity for delirium of 91.4 with overall accuracy of 74.4%.

CONCLUSION

Bedside tests of attention, vigilance and visuospatial ability can help to distinguish neurocognitive disorders, including delirium, from other presentations. The Lighthouse test and the LSD-4 are novel tests with high accuracy for detecting delirium.

Diagnostic accuracy and clinical utility of non-English versions of Edinburgh Post-Natal Depression Scale for screening post-natal depression in India: A meta-analysis

BACKGROUND

The prevalence of post-natal depression (PND) is high in India, as it is in many other low to middle income countries. There is an urgent need to identify PND and treat the mother as early as possible. Among the many paper and pencil tests available to identify PND, the Edinburgh Postnatal Depression Scale (EPDS) is a widely used and validated measure in India. However, the summary diagnostic accuracy and clinical utility data are not available for this measure.

AIM

To establish summary data for the global diagnostic accuracy parameter as well as the clinical utility of the non-English versions of the EPDS in India.

METHODS

Two researchers independently searched the PubMed, EMBASE, MEDKNOW and IndMED databases for published papers, governmental publications, conference proceedings and grey literature from 2000-2018. Seven studies that evaluated the diagnostic accuracy of EPDS in five Indian languages against DSM/ICD were included in the final analysis. Two other investigators extracted the Participants’ details, Index measures, Comparative reference measures, and Outcomes of diagnostic accuracy data, and appraised the study quality using QUADS-2. Deek’s plots were used to evaluate publication bias. We used the area under the curve of the hierarchical summary area under the receiver operating characteristic curve, with the random effect model, to summarize the global diagnostic accuracy of EPDS. Using the 2 × 2 table, we calculated positive and negative likelihood ratios. From the likelihood ratios, the Fagan’s nomogram was built for evaluating clinical utility using the Bayesian approach. We calculated the 95% confidence interval (95%CI) whenever indicated. STATA (version 15) with MIDAS and METANDI modules were used.

RESULTS

There was no publication bias. The area under the curve for EPDS was 0.97 (95%CI: 0.95-0.98). The pre-test probability for the nomogram was 22%. For a positive likelihood ratio of 9, the positive post-test probability was 72% (95%CI: 68%, 76%) and for a negative LR of 0.08, the negative post-test probability was 2% (95%CI: 1%, 3%).

CONCLUSION

In this meta-analysis, we established the summary global diagnostic parameter and clinical utility of the non-English versions of the EPDS in India. This work demonstrates that these non-English versions are accurate in their diagnosis of PND and can help clinicians in their diagnostic reasoning.

Double-blind randomized controlled study of the efficacy, safety and tolerability of eszopiclone vs placebo for the treatment of patients with post-traumatic stress disorder and insomnia

BACKGROUND

Sleep disturbance is a core feature of post-traumatic stress disorder (PTSD). Given the relationship between sleep disturbance and PTSD, there has been a relative paucity of studies examining the potential therapeutic impact of using pharmacotherapy to target sleep disturbance in patients with PTSD. Eszopiclone (ESZ) is a non-benzodiazepine y-aminobutyric acid-A receptor agonist indicated for the treatment of sleep and may affect sleep in patients with PTSD.

AIM

To evaluate the efficacy of ESZ vs placebo (PBO) for patients with PTSD and insomnia.

METHODS

The study was a 12-wk, double blind, randomized controlled trial with 3 mg of ESZ (n = 13) or PBO (n = 12).

RESULTS

Patients in both arms experienced significant improvement in PTSD symptoms as assessed by the Clinician-Administered PTSD Scale for DSM-IV (CAPS): ESZ (t11 = -3.12, P = 0.005) and PBO (t11 = -3.5, P = 0.002) and by self-report with the Short PTSD Rating Interview (ESZ t11 = -3.38, P = 0.003 and PBO t11 = -4.48, P = 0.0005). There were no significant differences between treatments on the CAPS (t22 = -0.13, P = 0.70) or the Short PTSD Rating Interview (t22 = -0.58, P = 0.56). Similarly, both treated groups improved on sleep measures as assessed by the Pittsburgh Sleep Quality Index with PTSD Addendum (PSQI) and on total sleep time (TST) and sleep latency assessed by actigraphy with no significant differences between groups (PSQI t22 = -0.24, P = 0.81; total sleep time t10 = 0.13, P = 0.90 and sleep latency t10 = 0.68, P = 0.50). There was a significant correlation between improvement in sleep and overall improvement in PTSD as measured by change scores on the PSQI and CAPS, r(8) = 0.79, P = 0.01 for ESZ treated subjects, but not for those treated with PBO r(9) = 0.16, P = 0.69. Adverse events of ESZ were consistent with the known profile of the medication including dysgeusia (30%, mild), sedation (20%, mild) and headache (20%, moderate to severe).

CONCLUSION

Results do not support the hypothesis of a specific positive effect of ESZ compared to PBO for measures of PTSD and associated sleep disturbance.

Review of source-monitoring processes in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a severe mental illness characterized by persistent, intrusive and distressing obsessions and/or compulsions. Such symptoms have been conceptualized as resulting from a failure in source-monitoring processes, suggesting that patients with OCD fail to distinguish actions they perform from those they just imagine doing. In this study, we aimed to provide an updated and exhaustive review of the literature examining the relationship between source-monitoring and OCD. A systematic search in the literature through January 2019 allowed us to identify 13 relevant publications investigating source-monitoring abilities in patients with OCD or participants with subclinical compulsive symptoms. Most of the retrieved studies did not report any source-monitoring deficits in clinical and subclinical subjects compared with healthy volunteers. However, most of the studies reported that patients with OCD and subclinical subjects displayed reduced confidence in source-monitoring judgments or global cognitive confidence compared to controls. The present review highlighted some methodological and statistical limitations. Consequently, further studies are needed to explore source monitoring with regard to the subcategories of OCD symptoms (i.e., symmetry-ordering, contamination-washing, hoarding, aggressive obsession-checking, sexual-religious thoughts) and to clarify the relationship between source-monitoring subtypes (i.e., reality or internal source-monitoring) and confidence in these populations.