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Maddox SA, Ponomareva OY, Zaleski CE, Chen MX, Vella KR, Hollenberg AN, Klengel C, Ressler KJ. Evidence for thyroid hormone regulation of amygdala-dependent fear-relevant memory and plasticity. Mol Psychiatry 2024:10.1038/s41380-024-02679-2. [PMID: 39039155 DOI: 10.1038/s41380-024-02679-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 07/08/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024]
Abstract
The amygdala is an established site for fear memory formation, and clinical studies suggest involvement of hormone signaling cascades in development of trauma-related disorders. While an association of thyroid hormone (TH) status and mood disorders is established, the related brain-based mechanisms and the role of TH in anxiety disorders are unknown. Here we examine the role that TH receptor (TR, a nuclear transcriptional repressor when unbound and a transcriptional activator when bound to TH) may have in mediating the initial formation of fear memories in the amygdala. We identified mRNA levels of TR and other TH pathway regulatory genes, including thyrotropin-releasing hormone (Trh), transthyretin (Ttr), thyrotropin-releasing hormone receptor (Trhr), type 2 iodothyronine deiodinase (Dio2), mediator complex subunit 12 (Med12/Trap230) and retinoid X receptor gamma (Rxrg) to be altered in the amygdala following Pavlovian fear conditioning. Using TH agonist and antagonist infusion into the amygdala, we demonstrated that this pathway is both necessary and sufficient for fear memory consolidation. Inhibition of TH signaling with the TR antagonist 1-850 decreased fear memory consolidation; while activation of TR with T3 (triiodothyronine) resulted in increased memory formation. Using a systemic hypothyroid mouse model, we found that intra-amygdala infusions of T3 were sufficient to rescue deficits in fear memory. Finally, we demonstrated that T3 was sufficient to activate TR-specific gene pathways in the amygdala. These findings on the role of activity-dependent TR modulation support a model in which local TH is a critical regulator of fear memory-related plasticity in the amygdala.
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Affiliation(s)
- Stephanie A Maddox
- Neurobiology of Fear Laboratory, Basic Neuroscience Division, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Olga Y Ponomareva
- Neurobiology of Fear Laboratory, Basic Neuroscience Division, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Cole E Zaleski
- Neurobiology of Fear Laboratory, Basic Neuroscience Division, McLean Hospital, Belmont, MA, USA
- Northeastern University, Boston, MA, USA
| | - Michelle X Chen
- Neurobiology of Fear Laboratory, Basic Neuroscience Division, McLean Hospital, Belmont, MA, USA
- University of Iowa, Iowa City, IA, USA
| | - Kristen R Vella
- Joan and Sanford I. Weill Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, New York, NY, USA
- Weill Center for Metabolic Health, Weill Cornell Medicine, New York, NY, USA
| | - Anthony N Hollenberg
- Joan and Sanford I. Weill Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, New York, NY, USA
- Weill Center for Metabolic Health, Weill Cornell Medicine, New York, NY, USA
| | - Claudia Klengel
- Neurobiology of Fear Laboratory, Basic Neuroscience Division, McLean Hospital, Belmont, MA, USA
| | - Kerry J Ressler
- Neurobiology of Fear Laboratory, Basic Neuroscience Division, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Coldevin M, Brænden A, Zeiner P, Øyen AS, Melinder A, Stubberud J. Disruptive Mood Dysregulation Disorder in a Norwegian Clinical Child Population. Clin Child Psychol Psychiatry 2024; 29:393-406. [PMID: 37208899 DOI: 10.1177/13591045231176928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Disruptive Mood Dysregulation Disorder was included in DSM-5 to accommodate new research addressing aspects of emotional dysregulation in children suffering from disruptive behavior problems. Despite growing interest in Disruptive Mood Dysregulation Disorder, few studies have looked at prevalence rates in European clinical populations. The primary objective of this study was to examine the prevalence and characteristics associated with Disruptive Mood Dysregulation Disorder in a Norwegian clinical sample. METHODS The present study assessed children 6-12 years of age referred to a mental health clinic for evaluation and treatment (N = 218, Mage = 9.6, 60.4% boys) and compared those who did and did not meet Disruptive Mood Dysregulation Disorder diagnostic criteria. Diagnoses were determined using K-SADS-PL 2013. Associated difficulties at home and in school were measured by Achenbach Systems of Empirically Based Assessment battery. RESULTS In this clinical sample, 24% met the diagnostic criteria for Disruptive Mood Dysregulation Disorder. Children with Disruptive Mood Dysregulation Disorder were more likely than those without Disruptive Mood Dysregulation Disorder to be male (77% vs. 55%, p = .008), be living in poverty, have multiple mental health diagnoses (79% vs. 53%, p = .001), and have lower global functioning levels as measured by Children's Global Assessment Scale (range 0-100, M = 47, SD = 8.5 vs. M = 57, SD = 11.4, p=<.001). Finally, parents and teachers of children with Disruptive Mood Dysregulation Disorder reported lower overall competence and adaptive functioning, and higher total symptom load than children with other diagnoses. CONCLUSION Disruptive Mood Dysregulation Disorder is highly prevalent in a Norwegian clinical sample and displays a high symptom load. Our results are in accordance with similar studies. Consistent findings across the world may support Disruptive Mood Dysregulation Disorder as a valid diagnostic category.
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Affiliation(s)
- Marit Coldevin
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Astrid Brænden
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway
| | - Pål Zeiner
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne-Siri Øyen
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Annika Melinder
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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Chen XD, Wei JX, Wang HY, Peng YY, Tang C, Ding Y, Li S, Long ZY, Lu XM, Wang YT. Effects and mechanisms of salidroside on the behavior of SPS-induced PTSD rats. Neuropharmacology 2023; 240:109728. [PMID: 37742716 DOI: 10.1016/j.neuropharm.2023.109728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/13/2023] [Accepted: 09/22/2023] [Indexed: 09/26/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a complex mental disorder, closely associated with stress and traumatic events. Salidroside (Sal) has been reported to possess neuroprotective effects. However, the behavioral effects and mechanisms of Sal on PTSD remain unknown. In this study, we utilized a rat model of PTSD induced by single prolonged stress (SPS) and administered Sal intraperitoneally (25, 50, 75 mg/kg/d) for 14 days. We then examined the behavioral effects and underlying mechanisms of Sal on SPS-induced PTSD rats. Our findings demonstrated that Sal alleviated anxiety-like behavior and spatial learning and memory impairment in SPS-induced PTSD rats. Furthermore, Sal treatment preserved the histomorphology of the hippocampal region. It was observed that Sal protected against hippocampal neuronal apoptosis in PTSD rats by reducing the number of TUNEL-positive cells and modulating apoptosis-related proteins (Bcl-2 and Bax). Additionally, Sal inhibited the activation of the NF-κB/iNOS/COX-2 signaling pathway in the hippocampus of PTSD rats, thereby suppressing the release of inflammatory factors (TNF-α and IL-1β) and the activation of microglia. Notably, Sal increased the expression of synapse-associated proteins PSD95 and Synapsin I in the hippocampus, while also enhancing dendritic density in the region. In conclusion, our results demonstrated that Sal could attenuate SPS-induced PTSD-like behaviors by inhibiting hippocampal neuronal apoptosis, enhancing hippocampal synaptic plasticity, and reducing neuroinflammatory responses. These findings may provide a foundation for the potential clinical application of Sal in the treatment of PTSD.
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Affiliation(s)
- Xing-Dong Chen
- State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University, Chongqing, 400042, China; College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Jing-Xiang Wei
- College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Hai-Yan Wang
- State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Yu-Yuan Peng
- College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Can Tang
- College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Yang Ding
- College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China
| | - Sen Li
- State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Zai-Yun Long
- State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Xiu-Min Lu
- College of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054, China.
| | - Yong-Tang Wang
- State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Erhardt A, Gelbrich G, Klinger-König J, Streit F, Kleineidam L, Riedel-Heller SG, Schmidt B, Schmiedek F, Wagner M, Grabe HJ, Rietschel M, Berger K, Deckert J. Generalised anxiety and panic symptoms in the German National Cohort (NAKO). World J Biol Psychiatry 2023; 24:881-896. [PMID: 34842503 DOI: 10.1080/15622975.2021.2011409] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Anxiety disorders (AD) are common in the general population, leading to high emotional distress and disability. The German National Cohort (NAKO) is a population-based mega-cohort study, examining participants in 16 German regions. The present study includes data of the first 101,667 participants and investigates the frequency and severity of generalised anxiety symptoms and panic attacks (PA). METHODS The Generalised Anxiety Disorder Symptoms Scale (GAD-7) and the first part of the Patient Health Questionnaire Panic Disorder (PHQ-PD) were filled out by NAKO participants (93,002). We examined the correlation of GAD-7 and PHQ-PD with demographic variables, stress (PHQ-Stress), depression (PHQ-9) and childhood trauma (CTS). RESULTS The total proportion of prior lifetime diagnoses of AD in the NAKO cohort reached 7.8%. Panic attacks were reported by 6.0% and possible/probable current GAD symptoms in 5.2% of the examined participants. Higher anxiety severity was associated with female sex, lower education level, German as a foreign language and younger age as well as high perceived stress and depression. CONCLUSIONS Clinically relevant GAD symptoms as well as panic attacks are frequent in the NAKO and are associated with sociodemographic factors, and high anxiety symptoms are accompanied by pronounced stress and depression levels.
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Affiliation(s)
- Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Wuerzburg, Germany
- Clinical Trial Centre Wuerzburg, University Hospital Würzburg, Wuerzburg, Germany
| | | | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Germany
| | - Florian Schmiedek
- Leibniz-Institute for Research and Information in Education, University of Frankfurt, Germany
- Institute of Psychology, Goethe University, Frankfurt am Main, Germany
- Centre for Mind, Brain and Behaviour, University of Marburg and Justus Liebig University Giessen, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Klaus Berger
- Institute of Epidemiology & Social Medicine, University of Muenster, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
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Altwaijri Y, Al-Habeeb A, Al-Subaie A, Bruffaerts R, Bilal L, Hyder S, Naseem MT, Alghanim AJ. Dual burden of chronic physical conditions and mental disorders: Findings from the Saudi National Mental Health Survey. Front Public Health 2023; 11:1238326. [PMID: 38089017 PMCID: PMC10715453 DOI: 10.3389/fpubh.2023.1238326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Comorbidities of mental disorders and chronic physical conditions are a common medical burden reported among Western countries. National estimates of such comorbidities among the general population of Arab countries like Saudi Arabia are unknown. This study examined the prevalence of lifetime chronic physical conditions among the Saudi general population with DSM-IV 12-month mental disorders, and the associations with disability in the Kingdom of Saudi Arabia (KSA). Methods The Saudi National Mental Health Survey, a cross-sectional household study - part of the World Mental Health (WMH) Survey Consortium - was conducted between 2013-2016 in the KSA, with 4,001 Saudi citizens aged 15-65 (response rate 61%). The World Health Organization Composite International Diagnostic Interview 3.0 was used to assess prevalence of lifetime chronic physical conditions and 12-month mental disorders; disability was measured in terms of days out of role. Results The prevalence of any comorbid 12-month mental disorder among those with chronic physical conditions was 24%. Major depressive disorder, social phobia, and adult separation anxiety disorder were the most common comorbid mental disorders across all chronic physical conditions. Gender, education, income, urbanicity, region, and employment were associated with the presence of any chronic physical condition. Respondents with mental / physical comorbidities had 2.97 days out of role (on average) in the last 30 days. Conclusion Comorbidities of mental disorders and chronic physical conditions are common among Saudis. National efforts are needed to increase awareness of such comorbidities among the general population, and develop prevention and treatment services tailored to the needs of individuals at-risk for comorbidities.
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Affiliation(s)
- Yasmin Altwaijri
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulhameed Al-Habeeb
- National Center for Mental Health Promotion, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdullah Al-Subaie
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Psychiatry, Edrak Medical Center, Riyadh, Saudi Arabia
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Lisa Bilal
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sanaa Hyder
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Talal Naseem
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Garcia D, Kazemitabar M, Asgarabad MH. The 18-item Swedish version of Ryff's psychological wellbeing scale: psychometric properties based on classical test theory and item response theory. Front Psychol 2023; 14:1208300. [PMID: 37854148 PMCID: PMC10580072 DOI: 10.3389/fpsyg.2023.1208300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/24/2023] [Indexed: 10/20/2023] Open
Abstract
Background Psychological wellbeing is conceptualized as the full engagement and optimal performance in existential challenges of life. Our understanding of psychological wellbeing is important for us humans to survive, adapt, and thrive during the challenges of the 21st century. Hence, the measurement of psychological wellbeing is one cornerstone for the identification and treatment of both mental illness and health promotion. In this context, Ryff operationalized psychological wellbeing as a six-dimensional model of human characteristics: self-acceptance, positive relations with others, environmental mastery, personal growth, autonomy, and purpose in life. Ryff's Psychological Wellbeing Scale has been developed and translated into different versions. Here, we examine and describe the psychometric properties of the 18-item Swedish version of Ryff's Psychological Wellbeing Scale using both Classical Test Theory (CTT) and Item Response Theory (IRT). Methods The data used in the present study was earlier published elsewhere and consists of 768 participants (279 women and 489 men). In addition to the 18-item version of the scale, participants answered the Temporal Satisfaction with Life Scale, the Positive Affect Negative Affect Schedule, and the Background and Health Questionnaire. We examined, the 18-item version's factor structure using different models and its relationship with subjective wellbeing, sociodemographic factors (e.g., education level, gender, age), lifestyle habits (i.e., smoking, frequency of doing exercise, and exercise intensity), and health issues (i.e., pain and sleeping problems). We also analyzed measurement invariance with regard to gender. Moreover, as an addition to the existing literature, we analyzed the properties of the 18 items using Graded Response Model (GRM). Results Although the original six-factor structure showed a good fit, both CTT and IRT indicated that a five-factor model, without the purpose in life subscale, provided a better fit. The results supported the internal consistency and concurrent validity of the 18-item Swedish version. Moreover, invariance testing showed similar measurement precision by the scale across gender. Finally, we found several items, especially the purpose in life's item "I live life one day at a time and do not really think about the future," that might need revision or modification in order to improve measurement. Conclusion A five-factor solution is a valid and reliable measure for the assessment of psychological wellbeing in the general Swedish population. With some modifications, the scale might achieve enough accuracy to measure the more appropriate and correct six-dimensional theoretical framework as detailed by Ryff. Fortunately, Ryff's original version contains 20 items per subscale and should therefore act as a perfect pool of items in this endeavor.
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Affiliation(s)
- Danilo Garcia
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
- Promotion of Health and Innovation (PHI) Lab, International Network for Well-Being, Linköping, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
- Department of Psychology, Lund University, Lund, Sweden
| | - Maryam Kazemitabar
- Yale School of Medicine, Yale University, New Haven, CT, United States
- VA Connecticut Healthcare System, West Haven, CT, United States
- Promotion of Health and Innovation (PHI) Lab, International Network for Well-Being, New Haven, CT, United States
| | - Mojtaba Habibi Asgarabad
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Positive Youth Development Lab, Human Development and Family Sciences, Texas Tech University, Lubbock, TX, United States
- Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
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Mohammadi S, Seyedmirzaei H, Salehi MA, Jahanshahi A, Zakavi SS, Dehghani Firouzabadi F, Yousem DM. Brain-based Sex Differences in Depression: A Systematic Review of Neuroimaging Studies. Brain Imaging Behav 2023; 17:541-569. [PMID: 37058182 PMCID: PMC10102695 DOI: 10.1007/s11682-023-00772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
Major depressive disorder (MDD) is a common psychiatric illness with a wide range of symptoms such as mood decline, loss of interest, and feelings of guilt and worthlessness. Women develop depression more often than men, and the diagnostic criteria for depression mainly rely on female patients' symptoms. By contrast, male depression usually manifests as anger attacks, aggression, substance use, and risk-taking behaviors. Various studies have focused on the neuroimaging findings in psychiatric disorders for a better understanding of their underlying mechanisms. With this review, we aimed to summarize the existing literature on the neuroimaging findings in depression, separated by male and female subjects. A search was conducted on PubMed and Scopus for magnetic resonance imaging (MRI), functional MRI (fMRI), and diffusion tensor imaging (DTI) studies of depression. After screening the search results, 15 MRI, 12 fMRI, and 4 DTI studies were included. Sex differences were mainly reflected in the following regions: 1) total brain, hippocampus, amygdala, habenula, anterior cingulate cortex, and corpus callosum volumes, 2) frontal and temporal gyri functions, along with functions of the caudate nucleus and prefrontal cortex, and 3) frontal fasciculi and frontal projections of corpus callosum microstructural alterations. Our review faces limitations such as small sample sizes and heterogeneity in populations and modalities. But in conclusion, it reflects the possible roles of sex-based hormonal and social factors in the depression pathophysiology.
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Affiliation(s)
- Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Seyedmirzaei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Interdisciplinary Neuroscience Research Program (INRP), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Jahanshahi
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyed Sina Zakavi
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, MD, USA.
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Bryant RA, McFarlane AC, Silove D, O'Donnell ML, Forbes D, Creamer M. The Lingering Impact of Resolved PTSD on Subsequent Functioning. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:290-295. [PMID: 37404963 PMCID: PMC10316210 DOI: 10.1176/appi.focus.23021016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
This study investigated whether impairment persists after posttraumatic stress disorder (PTSD) has resolved. Traumatically injured patients (N = 1,035) were assessed during hospital admission and at 3 (85%) and 12 months (73%). Quality of life prior to traumatic injury was measured with the World Health Organization Quality of Life-BREF during hospitalization and at each subsequent assessment. PTSD was assessed using the Clinician-Administered PTSD Scale at 3 and 12 months. After controlling for preinjury functioning, current pain, and comorbid depression, patients whose PTSD symptoms had resolved by 12 months were more likely to have poorer quality of life in psychological (OR = 3.51), physical (OR = 10.17), social (OR = 4.54), and environmental (OR = 8.83) domains than those who never developed PTSD. These data provide initial evidence that PTSD can result in lingering effects on functional capacity even after remission of symptoms. Reprinted from Clin Psychol Sci 2016; 4:493-498, with permission from Sage. Copyright © 2016.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
| | - Alexander C McFarlane
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
| | - Derrick Silove
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
| | - Meaghan L O'Donnell
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
| | - David Forbes
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
| | - Mark Creamer
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
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Schouten MJE, ten Have M, Tuithof M, de Graaf R, Dekker JJM, Goudriaan AE, Blankers M. Alcohol use as a predictor of the course of major depressive disorder: a prospective population-based study. Epidemiol Psychiatr Sci 2023; 32:e14. [PMID: 36847267 PMCID: PMC9971850 DOI: 10.1017/s2045796023000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
AIMS There are indications that problematic alcohol use may negatively impact the course of major depressive disorder (MDD). However, most studies on alcohol use and adverse MDD outcomes are conducted amongst MDD populations with (severe) alcohol use disorder in psychiatric treatment settings. Therefore, it remains unclear whether these results can be generalised to the general population. In light of this, we examined the longitudinal relationship between alcohol use and MDD persistence after a 3-year follow-up amongst people with MDD from the general population. METHODS Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric epidemiological prospective study comprising four waves amongst the adult Dutch general population (n = 6.646). The study sample (n = 642) consisted of those with 12-month MDD who participated at the follow-up wave. The outcome was 12-month MDD persistence after the 3-year follow-up, which was assessed via the Composite International Diagnostic Interview version 3.0. Weekly alcohol consumption was operationalised as non-drinking (0 drinks), low-risk drinking (⩽7 drinks; reference), at-risk drinking (women 8-13 drinks, men 8-20 drinks) and high-risk drinking (women ⩾14, men ⩾21 drinks). We performed univariate and multiple logistic regression analyses, which were adjusted for various socio-demographic and health-related factors. RESULTS The majority (67.4%) of the MDD sample were female, while the mean age was 47.1 years. Amongst these, 23.8% were non-drinkers, 52.0% were low-risk drinkers and 14.3% and 9.4% were at-risk and high-risk drinkers, respectively. Around one-quarter of the sample (23.6%) met the criteria for a persistent MDD after 3-year follow-up. No statistically significant association was found between alcohol use and MDD persistence, either for the crude model or the adjusted models. In comparison to low-risk drinking, the full adjusted model showed no statistically significant associations between MDD persistence and non-drinking (odds ratio (OR) = 1.15, p = 0.620), at-risk drinking (OR = 1.25, p = 0.423), or high-risk drinking (OR = 0.74, p = 0.501). CONCLUSIONS Contrary to our expectations, our findings showed that alcohol use was not a predictor of MDD persistence after 3-year follow-up amongst people with MDD from the general population.
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Affiliation(s)
- Maria J. E. Schouten
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, the Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands, Amsterdam Public Health research institute, Amsterdam, the Netherlands
- Author for correspondence: Maria J. E. Schouten, E-mail:
| | - Margreet ten Have
- Trimbos Institute – Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Marlous Tuithof
- Trimbos Institute – Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Ron de Graaf
- Trimbos Institute – Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Jack J. M. Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, the Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Anna E. Goudriaan
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, the Netherlands
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, and Amsterdam Institute for Addiction Research, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, the Netherlands
- Trimbos Institute – Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, and Amsterdam Institute for Addiction Research, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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10
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Rakofsky JJ. What Might Not Be Learned in 4 Years of Psychiatry Residency Training. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:115-116. [PMID: 35648378 DOI: 10.1007/s40596-022-01664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
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11
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Poluektov MG, Akarachkova ES, Dovgan EV, Kotova OV, Demidova TY, Klimenko AA, Kokorin VA, Ostroumova OD, Ostroumova TM. [Management of patients with insomnia and polymorbidity: expert consensus]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:49-57. [PMID: 37275998 DOI: 10.17116/jnevro202312305249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sleep disorders are becoming increasingly important due to the high comorbidity with other diseases and a significant impact on the patient's quality of life. Insomnia is the most common sleep disorder both in the general population and in patients with multimorbid pathology. Its prevalence in the general population is 6-15%, while in patients with somatic diseases it increases up to 20-40% and can reach 90% in patients with comorbid mental disorders. Another problem is the development of drug-induced insomnia. Insomnia has negative impact on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and a worse quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so it is extremely important to identify and correct these disorders in the early stages, therefore recommendations for the diagnosis of insomnia in polymorbid patients are proposed. Modern methods of treating acute and chronic insomnia and features of insomnia treatment in polymorbid patients are also discussed.
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Affiliation(s)
- M G Poluektov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - E S Akarachkova
- International society «Stress under control», Moscow, Russia
| | - E V Dovgan
- Smolensk Regional Clinical Hospital, Smolensk, Russia
| | - O V Kotova
- International society «Stress under control», Moscow, Russia
- Peoples' Friendship University of Russia, Moscow, Russia
| | - T Yu Demidova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A A Klimenko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V A Kokorin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O D Ostroumova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - T M Ostroumova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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12
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Onaemo VN, Fawehinmi TO, D’Arcy C. Risk of suicide ideation in comorbid substance use disorder and major depression. PLoS One 2022; 17:e0265287. [PMID: 36477246 PMCID: PMC9728854 DOI: 10.1371/journal.pone.0265287] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Suicidal behaviour is commonly associated with major depression (MD) and substance use disorders (SUDs). However, there is a paucity of research on risk for suicide ideation among individuals with comorbid SUDs and MD in the general population. OBJECTIVES This study investigated the associated risk of suicide ideation in comorbid SUDs-cannabis use disorder (CUD), alcohol use disorder (AUD), drug use disorder (DUD) with major depressive episode (MDE) in a nationally representative sample. METHODS Multilevel logistic regression models were used to analyze the 2012 Canadian Community Health Survey- Mental Health (CCHS-MH) data. This is a cross-sectional survey of nationally representative samples of Canadians (n = 25,113) aged 15 years and older residing in the ten Canadian provinces between January and December 2012. Diagnoses of MDE, AUD, DUD, and CUD were based on a modified WHO-CIDI, derived from DSM-IV diagnostic criteria. RESULTS Comorbidity was found to be the strongest predictor of suicide ideation. Compared to those with no diagnosis of either a SUD or MDE, individuals with a comorbid diagnosis of AUD with MDE, CUD with MDE, or DUD with MDE were 9, 11 and 16 times more likely to have 12-month suicide ideation respectively. A diagnosis of MDE was a significant predictor of 12-month suicide ideation with about a 7-fold increased risk compared with individuals not diagnosed with either MDE or a SUD. CONCLUSION Suicide is a preventable public health issue. Our study found a significantly increased risk of suicide ideation among persons who have comorbid SUD with MD. Effective integration of mental health and addictions services could mitigate the risk of suicide and contribute to better outcomes.
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Affiliation(s)
- Vivian N. Onaemo
- Division of Public Health and Preventive Medicine, Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- * E-mail:
| | | | - Carl D’Arcy
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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13
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McMurray KMJ, Sah R. Neuroimmune mechanisms in fear and panic pathophysiology. Front Psychiatry 2022; 13:1015349. [PMID: 36523875 PMCID: PMC9745203 DOI: 10.3389/fpsyt.2022.1015349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022] Open
Abstract
Panic disorder (PD) is unique among anxiety disorders in that the emotional symptoms (e.g., fear and anxiety) associated with panic are strongly linked to body sensations indicative of threats to physiological homeostasis. For example, panic attacks often present with feelings of suffocation that evoke hyperventilation, breathlessness, or air hunger. Due to the somatic underpinnings of PD, a major focus has been placed on interoceptive signaling and it is recognized that dysfunctional body-to-brain communication pathways promote the initiation and maintenance of PD symptomatology. While body-to-brain signaling can occur via several pathways, immune and humoral pathways play an important role in communicating bodily physiological state to the brain. Accumulating evidence suggests that neuroimmune mediators play a role in fear and panic-associated disorders, although this has not been systematically investigated. Currently, our understanding of the role of immune mechanisms in the etiology and maintenance of PD remains limited. In the current review, we attempt to summarize findings that support a role of immune dysregulation in PD symptomology. We compile evidence from human studies and panic-relevant rodent paradigms that indicate a role of systemic and brain immune signaling in the regulation of fear and panic-relevant behavior and physiology. Specifically, we discuss how immune signaling can contribute to maladaptive body-to-brain communication and conditioned fear that are relevant to spontaneous and conditioned symptoms of PD and identify putative avenues warranting future investigation.
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Affiliation(s)
- Katherine M. J. McMurray
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, United States
- Veterans Affairs Medical Center, Cincinnati, OH, United States
| | - Renu Sah
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, United States
- Veterans Affairs Medical Center, Cincinnati, OH, United States
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14
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Relationship Between Self-Reported Concomitant Depressive and Anxiety Symptoms and the Post-Concussion Symptoms Scale (PCSS). J Int Neuropsychol Soc 2022; 28:1064-1074. [PMID: 34895377 DOI: 10.1017/s135561772100134x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The current study explored how affective disturbances, particularly concomitant anxiety and depressive symptoms, impact baseline symptom self-reporting on the Post-Concussion Symptoms Scale (PCSS) in college athletes. METHODS Athletes were separated into four groups (Healthy Control (HC) (n = 581), Depression Only (n = 136), Anxiety Only (n = 54), Concomitant Depression/Anxiety (n = 62)) based on their anxiety and depression scores. Groups were compared on Total PCSS Score as well as 5 PCSS Symptom Cluster scores (Cognitive, Physical, Affective, Sleep, and Headache). RESULTS The three affective groups reported significantly greater symptomatology than HCs, with the Concomitant group showing the highest symptomatology scores across all clusters. The depressive symptoms only group also reported significantly elevated symptomatology, compared to HCs, on every symptom cluster except headache. The anxiety symptoms only group differed from HCs on only the cognitive symptoms cluster. Additionally, the Concomitant group reported significantly increased PCSS symptomatology, in terms of total scores and all 5 symptom clusters, compared to the depressive symptoms only and anxiety symptoms only groups. CONCLUSIONS Our findings suggest that athletes experiencing concomitant depressive/anxiety symptoms report significantly greater levels of symptomatology across all 5 PCSS symptom clusters compared to HCs. Further, results suggest that athletes experiencing concomitant affective disturbance tend to report greater symptomatology than those with only one affective disturbance. These findings are important because, despite the absence of concussion, the concomitant group demonstrated significantly elevated symptomatology at baseline. Thus, future comparisons with post-concussion data should account for this increased symptomatology, as test results may be skewed by affective disturbances at baseline.
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15
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Gupta S, Rozatkar AR, Chaudhary P, KK A, Vullanki SS, Kachhawaha G. Profiles of the Patients and Their Referral Patterns Visiting the Psychiatry Clinic of a General Hospital Setting Located in a Mental Health Resource Deficient Region of India: A Retrospective Observational Study. J Neurosci Rural Pract 2022; 13:453-461. [PMID: 35946028 PMCID: PMC9357508 DOI: 10.1055/s-0042-1749455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objectives
Treatment for mental health problems is determined by cultural, health infrastructure, and illness-related factors. Literature is sparse from India, particularly from the mental health resources-deficient regions of the country such as central India. Therefore, the current study is aimed at assessing the profile of the patients visiting the psychiatry outpatient facility (OPF) of a tertiary-care general hospital setting (GHS), their referral patterns, and their determinants.
Materials and Methods
A retrospective chart review of the newly registered individuals (October 2019 to March 2020) in the psychiatry OPF of the GHS from Central India was used in the study. Data (sociodemographic profiles, illness characteristics, and referral patterns) were extracted as per the standard guidelines.
Statistical Analysis
Descriptive statistics were used to represent sociodemographic, illness-, and past treatment-related characteristics of the participants. Chi-squared test was used to compare the referral characteristics of the two groups (self-referred patients vs. those referred by others, dependent variable) with regard to characteristics of the patients (independent variables).
Results
A total of 418 individuals were registered in the clinic. Most individuals suffered from the neurotic, stress-related, and somatoform group of disorders (
n
= 231, 39.5%). More than halves were self-referred; most were referred from the internal medicine and allied departments. Being male, having at least graduate degree (χ
2
df(1) = 4.25 to 6.79,
p
< 0.05), suffering from organic mental-, psychotic-, and recurrent affective-disorders, and positive family history (χ
2
df(1) = 4.91 to 21.76,
p
< 0.05 to <0.001) along with first treatment attempt or previous treatment from the traditional healers, and absence of co-occurring medical illness were associated with self-referral (vs. referred by others) (χ
2
df(1) = 4.64 to 17.6,
p
< 0.05 to <0.001).
Conclusions
GHS has a characteristic referral pattern. The referral patterns of the patients for various psychiatric problems are determined by their sociodemographic, illness, and cultural characteristics; particularly, poor mental health literacy (among the patients-caregivers), stigma related to mental disorders, and unavailability of the mental health services act as major determinants. Sensitizing the patients-caregivers and health-care professionals concerning this could facilitate an early engagement with the psychiatric treatment. Future research needs to explore this phenomenon in greater detail, maybe by qualitative methods.
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Affiliation(s)
- Snehil Gupta
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Abhijit R. Rozatkar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Pooja Chaudhary
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Adhil KK
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Sai Sreeja Vullanki
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal, Madhya Pradesh, India
| | - Gaurav Kachhawaha
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal, Madhya Pradesh, India
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16
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Kim S, Lee J, Boone D. Protective and Risk Factors at the Intersection of Chronic Pain, Depression, Anxiety, and Somatic Amplification: A Latent Profile Approach. J Pain Res 2022; 15:1107-1121. [PMID: 35450061 PMCID: PMC9018014 DOI: 10.2147/jpr.s340382] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Research indicates a complex nexus between chronic pain, depression, anxiety, and somatic amplification (PDAS) symptoms, marked by high rates of co-morbidity and mutually maintaining mechanisms. Although recent frameworks have attempted to explain co-occurrence rates of pain and other comorbid disorders, the interrelations between PDAS and their impacts on pain outcomes have not been adequately examined with a person-centered approach. Using nationally representative data, this study assessed the heterogeneity in PDAS symptomatology and examined links among risk and protective factors in different profiles. Methods Data were derived from 1027 participants in the National Survey of Midlife Development in the United States (MIDUS) who completed telephone interviews or self-report measures that assessed PDAS, various sources of social supports (family, friends, spouses/partners, religion, coworkers, and supervisors), and the number of healthcare visits. Results We found heterogeneity in symptom severity rather than symptom type across classes over time. Regardless of comorbidity severity, people reported similar levels of somatic symptoms, which may help clinicians more effectively diagnose comorbidity issues among chronic pain patients. As PDAS symptomatology increased by group, the perceived levels of social support decreased. Membership in a higher symptom severity class was associated with being female, younger age, and an increase in medical, but not mental health visits. Limitations Limitations included the use of a cross-sectional design, reliance on self-report measures, and a sample largely comprised of Whites. Conclusion PDAS co-occurs across classes, which may relate to shared risk and protective factors. This study lays the foundation to investigate similar questions for overlapping symptoms that occur during the same period, which would shed light on whether—among middle to older age adults—these disorders are attributable to a common mechanism and if they may inform transdiagnostic treatments.
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Affiliation(s)
- ShinYe Kim
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
- Correspondence: ShinYe Kim Email
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, Texas Tech University, Lubbock, TX, USA
| | - Dianna Boone
- Center for Behavioral Health, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
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17
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Abdin E, Chong SA, Vaingankar JA, Shafie S, Seah D, Chan CT, Ma S, James L, Heng D, Subramaniam M. Changes in the prevalence of comorbidity of mental and physical disorders in Singapore between 2010 and 2016. Singapore Med J 2022; 63:196-202. [PMID: 32798362 PMCID: PMC9251260 DOI: 10.11622/smedj.2020124] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016. METHODS We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses. RESULTS The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status. CONCLUSION The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.
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Affiliation(s)
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore
| | - Darren Seah
- Family Medicine Department, National Healthcare Group Polyclinics, Singapore
| | - Chun Ting Chan
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
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18
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Riley ED, Delucchi K, Rubin S, Weiser SD, Vijayaraghavan M, Lynch K, Tsoh JY. Ongoing tobacco use in women who experience homelessness and unstable housing: A prospective study to inform tobacco cessation interventions and policies. Addict Behav 2022; 125:107125. [PMID: 34673360 DOI: 10.1016/j.addbeh.2021.107125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/30/2021] [Accepted: 09/23/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Tobacco use is common in people who experience homelessness. However, despite biological differences in use by sex and lower quit rates in women, research in homeless and unstably housed (HUH) women is sparse. We identified correlates of use specific to this population, with the goal of informing tobacco cessation programs tailored for HUH women. METHODS We conducted a prospective study among HUH women recruited from San Francisco homeless shelters, street encampments, free meal programs and low-income hotels. Between June 2016 and January 2019, study participants completed six monthly interviews to examine factors associated with tobacco use, defined as urinary cotinine >10 pg/mL or self-reported prior 30-day use. RESULTS Among 245 participants, 40% were Black, the median age was 53, 75% currently used tobacco and 89% had ≥one 24-hour quit attempt in the prior year. Tobacco use was more common in women with PTSD (66% vs. 48%) and depression (54% vs. 35%) compared to women without these conditions. Adjusted odds of tobacco use decreased significantly with increasing age (OR/5 yrs: 0.81; 95% CI:0.68, 0.96) and increased with an increasing number of additional substances used (OR: 2.52; 95% CI: 1.88, 3.39). CONCLUSION Outside of a treatment setting and within a community-recruited sample population composed of HUH women, the number of additional substances used is a primary correlate of ongoing tobacco use. Tailored cessation interventions that prioritize the issue of multiple substance use, and public health policies that allocate funding to address it, may increase tobacco cessation in this population.
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19
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Brown JL, Cochran G, Bryan MA, Charron E, Winhusen TJ. Associations between elevated depressive symptoms and substance use, prescription opioid misuse, overdose history, pain, and general health among community pharmacy patients prescribed opioids. Subst Abus 2022; 43:1110-1115. [PMID: 35499399 PMCID: PMC9487888 DOI: 10.1080/08897077.2022.2060450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Individuals with pain prescribed opioids experience high rates of comorbid depression. The aim of this study was to characterize pain, substance use, and health status as a function of depressive symptom level in individuals filling an opioid prescription at a community pharmacy. Methods: Participants (N = 1268) filling an opioid prescription enrolled in a study validating a prescription drug monitoring metric completed an online survey assessing sociodemographics, depressive symptoms, substance use, prescription opioid misuse, overdose history, general health, and pain severity and interference. Results: Approximately one-fifth (19.3%) had a positive depression screen result. In covariate-adjusted logistic regression analyses, individuals with a positive depression screen result were more likely to have moderate/high substance use risk scores for prescription opioids (adjusted odds ratio [AOR] = 2.06; 95% confidence interval [CI], 1.51-2.79); street opioids (AOR = 7.18; 95% CI, 2.57-20.01); cannabis (AOR = 2.00; 95% CI, 1.34-3.00); cocaine (AOR = 3.46; 95% CI, 1.46-8.22); tobacco (AOR = 1.59; 95% CI, 1.18-2.15); methamphetamine (AOR = 7.59; 95% CI, 2.58-22.35); prescription stimulants (AOR = 2.95; 95% CI, 1.59-5.49); and sedatives (AOR = 3.41; 95% CI, 2.43-4.79). Individuals with a positive depression screen were more likely to misuse prescription opioids (AOR = 3.46; 95% CI, 2.33-5.15), experience a prior overdose (AOR = 2.69; 95% CI, 1.76-4.11), report poorer general health (AOR = 0.25, 95% CI, 0.18-0.35), and report moderate/severe pain severity (AOR = 4.36, 95% CI, 2.80-6.77) and interference (AOR = 6.47, 95% CI, 4.08-10.26). Conclusions: Individuals prescribed opioids with heightened depression were more likely to report other substance use, prescription opioid misuse, prior overdose, greater pain, and poorer health.
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Affiliation(s)
- Jennifer L. Brown
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gerald Cochran
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - M. Aryana Bryan
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Elizabeth Charron
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - T. John Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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20
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Vaccarino AL, Beaton D, Black SE, Blier P, Farzan F, Finger E, Foster JA, Freedman M, Frey BN, Gilbert Evans S, Ho K, Javadi M, Kennedy SH, Lam RW, Lang AE, Lasalandra B, Latour S, Masellis M, Milev RV, Müller DJ, Munoz DP, Parikh SV, Placenza F, Rotzinger S, Soares CN, Sparks A, Strother SC, Swartz RH, Tan B, Tartaglia MC, Taylor VH, Theriault E, Turecki G, Uher R, Zinman L, Evans KR. Common Data Elements to Facilitate Sharing and Re-use of Participant-Level Data: Assessment of Psychiatric Comorbidity Across Brain Disorders. Front Psychiatry 2022; 13:816465. [PMID: 35197877 PMCID: PMC8859302 DOI: 10.3389/fpsyt.2022.816465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022] Open
Abstract
The Ontario Brain Institute's "Brain-CODE" is a large-scale informatics platform designed to support the collection, storage and integration of diverse types of data across several brain disorders as a means to understand underlying causes of brain dysfunction and developing novel approaches to treatment. By providing access to aggregated datasets on participants with and without different brain disorders, Brain-CODE will facilitate analyses both within and across diseases and cover multiple brain disorders and a wide array of data, including clinical, neuroimaging, and molecular. To help achieve these goals, consensus methodology was used to identify a set of core demographic and clinical variables that should be routinely collected across all participating programs. Establishment of Common Data Elements within Brain-CODE is critical to enable a high degree of consistency in data collection across studies and thus optimize the ability of investigators to analyze pooled participant-level data within and across brain disorders. Results are also presented using selected common data elements pooled across three studies to better understand psychiatric comorbidity in neurological disease (Alzheimer's disease/amnesic mild cognitive impairment, amyotrophic lateral sclerosis, cerebrovascular disease, frontotemporal dementia, and Parkinson's disease).
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Affiliation(s)
| | - Derek Beaton
- Data Science and Advanced Analytics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Dr. Sandra Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Pierre Blier
- Mood Disorders Research Unit, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Farnak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Jane A Foster
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Morris Freedman
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | | | - Keith Ho
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
| | | | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, ON, Canada
| | | | | | - Mario Masellis
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care, Kingston, ON, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Franca Placenza
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | | | - Stephen C Strother
- Indoc Research, Toronto, ON, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Research Program, Dr. Sandra Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases University of Toronto, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Gustavo Turecki
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Lorne Zinman
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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21
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Schick MR, Nalven T, Thomas ED, Weiss NH, Spillane NS. Depression and alcohol use in American Indian adolescents: The influence of family factors. Alcohol Clin Exp Res 2022; 46:141-151. [PMID: 35076972 PMCID: PMC8988920 DOI: 10.1111/acer.14748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Rates of both depression and alcohol use are disproportionately higher among American Indian (AI) adolescents than adolescents in the general population. The co-occurrence of depression and alcohol use is common and clinically relevant given their reciprocal negative influences on outcomes. Family factors may be especially relevant because they could have a buffering effect on this relationship due to the importance of kinship and community in AI communities. The current study examines the roles of family warmth and parental monitoring in the association between depressive symptoms and alcohol use in a large, nationally representative sample of AI adolescents. METHODS Data were collected from 3498 AI 7th to 12th graders (47.8% female) residing on or near a reservation during the period 2009 to 2013. Participants reported on their depressive symptoms, family factors, and alcohol use. RESULTS There was a small, but statistically significant positive association between depressive symptoms and alcohol use (r = 0.11, p < 0.001). Greater depressive symptoms were associated with significantly less perceived family warmth (β = -0.09, 95% CI [-0.13, -0.06]), which was associated with significantly greater alcohol use (β = -0.39, 95% CI [-0.55, -0.23]). Family warmth significantly accounted for the association between depressive symptoms and alcohol use at high (β = 0.04, SE = 0.02, 95% CI [0.004, 0.09]), but not low, levels of parental monitoring (β = 0.02, SE = 0.02, 95% CI [-0.002, 0.06]). CONCLUSIONS Results of the present study suggest that developing culturally sensitive prevention and treatment approaches focusing on increasing both family warmth and parental monitoring are important to address the co-occurrence of depression and alcohol misuse among AI adolescents.
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Affiliation(s)
- Melissa R. Schick
- Department of Psychology University of Rhode Island Kingston Rhode Island USA
| | - Tessa Nalven
- Department of Psychology University of Rhode Island Kingston Rhode Island USA
| | - Emmanuel D. Thomas
- Department of Psychology University of Rhode Island Kingston Rhode Island USA
| | - Nicole H. Weiss
- Department of Psychology University of Rhode Island Kingston Rhode Island USA
| | - Nichea S. Spillane
- Department of Psychology University of Rhode Island Kingston Rhode Island USA
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22
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Yao M. Relationships Between Childhood Health Experience and Depression Among Older People: Evidence From China. Front Psychol 2021; 12:744865. [PMID: 34925148 PMCID: PMC8678407 DOI: 10.3389/fpsyg.2021.744865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
The assessment of childhood health experience helps to identify the risk of depression among older people. Poor childhood experience is generally associated with depression in adulthood. However, whether such association can be extended to older people' life remains unclear. The history of parental mental health was obtained from 2014 CHARLS Wave 3 (Life History Survey) data while other data from 2011 CHARLS Wave 1 baseline data. The study involves 4,306 respondents. The depression was assessed by the Chinese version of Center for Epidemiologic Studies Depression scales (CES-D) using logistic regression model. More than 40% of older people suffered from depression, 25% of whom experienced poor childhood self-reported health. Nearly 20% of their mothers and more than 10% of their fathers had a history of poor mental health. Poor childhood health experiences have shown to be associated with higher odds of depression (good self-reported health OR: 0.732, p = 0.000, 95% CI: 0.633-0.847; poor mother's mental health OR: 1.391, p = 0.001, 95% CI: 1.138-1.699; poor father's mental health OR: 1.457, p = 0.003, 95% CI: 1.141-1.862). There is a high rate of depression among the older adults in China. In China, older people with poor childhood health experiences are more likely to suffer from depression.
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Affiliation(s)
- Min Yao
- School of Marxism, Dalian University of Technology, Dalian, China
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23
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‘You’d think they’d know’: social epistemology and informal carers of mental health service users. SOCIAL THEORY & HEALTH 2021. [DOI: 10.1057/s41285-021-00172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Abramovitz LM, Lutgendorf MA, Bukowinski AT, Gumbs GR, Conlin AMS, Hall C. Posttraumatic Stress Disorder in a Cohort of Pregnant Active Duty U.S. Military Servicewomen. J Trauma Stress 2021; 34:586-595. [PMID: 33544939 DOI: 10.1002/jts.22656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 01/04/2023]
Abstract
The present study aimed to describe the demographic and occupational characteristics, comorbidities, and psychotropic medication receipt associated with posttraumatic stress disorder (PTSD) diagnosis during pregnancy among a sample of active duty U.S. military servicewomen. Data from the U.S. Department of Defense Birth and Infant Health Research program were used to identify pregnancies in active duty servicewomen from 2007 through 2014. Demographic and occupational data were linked with electronic medical and pharmacy records to capture mental health diagnoses and medication receipt dates. Cases of PTSD were identified by the presence of ICD-9-CM Diagnostic Code 309.81 on maternal records from 1 year before the date of the last menstrual period through the end of pregnancy. Of 134,244 identified pregnancies among active duty servicewomen, 2,240 (1.7%) met the case criteria for PTSD. Women with a PTSD diagnosis compared to those without a PTSD diagnosis were more likely to be White non-Hispanic (51.3% vs. 47.4%), unmarried (33.3% vs. 28.2%), in the Army (49.6% vs. 35.8%) or Marine Corps (10.9% vs. 8.0%), in a service and supply occupation (18.2% vs. 13.6%), and to have a junior enlisted rank (56.3% vs. 50.1%) and have been previously deployed (51.2% vs. 39.6%), RRs = 1.15-1.75. Among PTSD cases, the most common mental health comorbidities were depressive disorder (60.9%), adjustment disorder (43.4%), and anxiety disorder (39.3%). During pregnancy, 44.2% of PTSD cases and 7.2% of noncases received psychotropic medications. Demographic and occupational characteristics, comorbidities, and psychotropic medication use differed substantially among PTSD cases and noncases in this large records-based study.
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Affiliation(s)
- Lisa M Abramovitz
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Monica A Lutgendorf
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, California, USA
| | - Anna T Bukowinski
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Gia R Gumbs
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Ava Marie S Conlin
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Clinton Hall
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
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25
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Schouten MJE, Dekker JJM, de Bruijn TQ, Ebert DD, Koomen LM, Kosterman SLA, Riper H, Schaub MP, Goudriaan AE, Blankers M. Effectiveness of a digital alcohol moderation intervention as an add-on to depression treatment for young adults: study protocol of a multicentre pragmatic randomized controlled trial. BMC Psychiatry 2021; 21:265. [PMID: 34022840 PMCID: PMC8140318 DOI: 10.1186/s12888-021-03222-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depressive disorders and problematic drinking often co-occur, also among young adults. These co-occurring conditions are associated with various negative health outcomes compared to both conditions alone. Early intervention by addressing alcohol use and depressive symptoms simultaneously in the same treatment might improve both conditions. However, evidence on the (cost-) effectiveness of digital combined depression and alcohol interventions for young adults is currently insufficient. We therefore developed an add-on digital alcohol moderation adherence-focussed guided intervention to complement treatment as usual (TAU) for depressive disorders. The digital intervention is a web-app, including 6 modules based on motivational interviewing and cognitive behavioural therapy. This study aims to evaluate the (cost-)effectiveness of a digital alcohol moderation intervention + TAU compared to TAU on alcohol and depression outcomes among young adults with co-occurring depressive disorders and problematic alcohol use. METHODS One hundred fifty-six participants, aged 18-35 years, with problematic alcohol use and a diagnosed depressive disorder will participate in a pragmatic multicentre two-arm randomized controlled trial. Problematic alcohol use is operationalised as scoring ≥5 for women and ≥ 8 for men on the Alcohol Use Disorder Identification Test (AUDIT). Participants will be randomized to either the experimental group (digital alcohol intervention + TAU) or control group (TAU only). Participants will be recruited at three Dutch mental health care centres and through social media. Assessments take place at baseline and after 3, 6 and 12 months post-randomization. The primary outcome is treatment response at 6-month follow-up, operationalized as a composite score that combines alcohol use and depression measures and indicates whether treatment has been successful or not. Secondary outcomes are depressive symptoms and alcohol use (i.e. number of weekly standard drinks and AUDIT score). An economic evaluation will be conducted alongside the trial. DISCUSSION This study evaluates the (cost-) effectiveness of an add-on digital alcohol moderation intervention for young adults who are in treatment for depressive disorders. If proven effective, the digital intervention could be implemented in mental health care and improve treatment for people with co-occurring depressive disorders and problematic alcohol use. TRIAL REGISTRATION Pre-registered on October 29, 2019 in The Netherlands Trial Register ( NL8122 ).
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Affiliation(s)
- Maria J E Schouten
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Tamara Q de Bruijn
- Department of Prevention, Jellinek, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - David D Ebert
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisanne M Koomen
- Arkin BasisGGZ, Arkin Mental Health Care, Roetersstraat 210, Amsterdam, The Netherlands
| | - Sjoerd L A Kosterman
- Department of Outpatient Treatment of Common Mental Health Disorders, PuntP, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Research Unit for Telepsychiatry and e-Mental Health, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Anna E Goudriaan
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Addiction Research and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Addiction Research and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Trimbos Institute-The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Hyporesponsivity to mu-opioid receptor agonism in the Wistar-Kyoto rat model of altered nociceptive responding associated with negative affective state. Pain 2021; 162:405-420. [PMID: 32826755 DOI: 10.1097/j.pain.0000000000002039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Chronic pain is often comorbid with anxiety and depression, altering the level of perceived pain, which negatively affects therapeutic outcomes. The role of the endogenous mu-opioid receptor (MOP) system in pain-negative affect interactions and the influence of genetic background thereon are poorly understood. The inbred Wistar-Kyoto (WKY) rat, which mimics aspects of anxiety and depression, displays increased sensitivity (hyperalgesia) to noxious stimuli, compared with Sprague-Dawley (SD) rats. Here, we report that WKY rats are hyporesponsive to the antinociceptive effects of systemically administered MOP agonist morphine in the hot plate and formalin tests, compared with SD counterparts. Equivalent plasma morphine levels in the 2 rat strains suggested that these differences in morphine sensitivity were unlikely to be due to strain-related differences in morphine pharmacokinetics. Although MOP expression in the ventrolateral periaqueductal gray (vlPAG) did not differ between WKY and SD rats, the vlPAG was identified as a key locus for the hyporesponsivity to MOP agonism in WKY rats in the formalin test. Moreover, morphine-induced effects on c-Fos (a marker of neuronal activity) in regions downstream of the vlPAG, namely, the rostral ventromedial medulla and lumbar spinal dorsal horn, were blunted in the WKY rats. Together, these findings suggest that a deficit in the MOP-induced recruitment of the descending inhibitory pain pathway may underlie hyperalgesia to noxious inflammatory pain in the WKY rat strain genetically predisposed to negative affect.
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Yao F, Zheng M, Wang X, Ji S, Li S, Xu G, Zheng Z. Patient activation level and its associated factors in adults with chronic pain: A cross-sectional survey. Medicine (Baltimore) 2021; 100:e25929. [PMID: 34106661 PMCID: PMC8133271 DOI: 10.1097/md.0000000000025929] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 04/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: Patients’ capacity to manage their own health can be graded by levels of activation. Highly activated patients tend to have better health outcomes. However, little is known about the activation levels of chronic pain patients in China. This study aimed to identify: (1).. the activation levels within this population; and (2).. demographic and pain factors associated with the level of activation. METHODS: In this cross-sectional survey, patients completed a sociodemographic questionnaire, Brief Pain Inventory and Patient Activation Measure (PAM) 13. Patient activation was measured and categorized into Levels 1–4. Its associations with sociodemographic, patient-reported diseases and pain variables were explored using Wilcoxon rank sum test and Kruskal-Wallis H test. RESULTS: Of 338 patients, 84 were excluded. Of the 254 remaining, 51.6% of patients were at lower activation levels (PAM Levels 1 and 2). Higher activation levels (PAM Levels 3 and 4) were recorded in patients with younger age (P = .00005), higher education (P = .0018), non-laboring occupations (P = .0239), and fewer co-morbidities (P = .00615). Intensities of the worst pain (P = .000627), average pain (P = .0213), and current pain (P = .0353), as well as the impact of pain on relationships with others (P = 0.00529), mood (P = .00391), sleep (P = .0132), and interest in life (P = .0248), were negatively correlated with activation levels. CONCLUSION: Half of the chronic pain patients in this population displayed lower activation levels. Older age, less education, manual labor, more co-morbidities, more intense pain and greater impact of pain on life were associated with lower activation levels. Pain education programs need to target the individual's PAM level. REGISTRATION: This trial was registered in Chinese Clinical Trial Registry. Number: ChiECRCT-20180170
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Affiliation(s)
- Fengzhen Yao
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Man Zheng
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Xiaoqing Wang
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Shujuan Ji
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Sha Li
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Gang Xu
- Department of Anesthesiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
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28
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Abasi I, Pourshahbaz A, Mohammadkhani P, Dolatshahi B, Moradveisi L, Mennin DS. Emotion regulation therapy for social anxiety disorder: a single case series study. Behav Cogn Psychother 2021; 49:1-15. [PMID: 33952371 DOI: 10.1017/s1352465821000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite the vast majority of evidence indicating the efficacy of traditional and recent cognitive behaviour therapy (CBT) therapies in treating social anxiety disorder (SAD), some individuals with SAD do not improve by these interventions, particularly when co-morbidity is present. AIMS It is not clear how emotion regulation therapy (ERT) can improve SAD co-morbid with symptoms of generalized anxiety disorder (GAD) and depression. This study investigated this gap. METHOD Treatment efficacy was assessed using a single case series methodology. Four clients with SAD co-occurring with GAD and depression symptoms received a 16-session version of ERT in weekly individual sessions. During the treatment, self-report measures and clinician ratings were used to assess the symptom intensity, model-related variables, and quality of life, work and social adjustment of participants every other week throughout the treatment. Follow-up was also conducted at 1, 2 and 3 months after treatment. Data were analysed using visual analysis, effect size (Cohen's d) and percentage of improvement. RESULTS SAD clients with depression and GAD symptoms demonstrated statistically and clinically significant improvements in symptom severity, quality of life, work, social adjustment and model-related measures (i.e. negative emotionality/safety motivation, emotion regulation strategies). The improvements were largely maintained during the follow-up period and increased for some variables. CONCLUSION These findings showed preliminary evidence for the role of emotion dysregulation and motivational factors in the aetiology and maintenance of SAD and the efficacy of ERT in the treatment of co-morbid SAD.
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Affiliation(s)
- Imaneh Abasi
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Current Affiliation: Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Pourshahbaz
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Parvaneh Mohammadkhani
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrouz Dolatshahi
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Latif Moradveisi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Douglas S Mennin
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, United States of America
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29
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Jang S, Shin WC, Song MK, Han HS, Lee MC, Ro DH. Which orally administered antithrombotic agent is most effective for preventing venous thromboembolism after total knee arthroplasty? A propensity score-matching analysis. Knee Surg Relat Res 2021; 33:10. [PMID: 33743830 PMCID: PMC7981904 DOI: 10.1186/s43019-021-00093-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023] Open
Abstract
Purpose Even today, total knee arthroplasty (TKA) is associated with venous thromboembolism (VTE). The purpose of our study is to report the incidence of postoperative VTE and to compare the efficacy of commonly used orally administered antithrombotic agents. Materials and methods Seven hundred ad ninety-nine patients who underwent primary TKA were retrospectively reviewed. The patients were prescribed one of three antithrombotic agents: aspirin (n = 168), rivaroxaban (n = 117), or apixaban (n = 514). Before surgery, patient demographics and risk factors were matched via propensity scoring. After surgery, all three groups took the agent for 7 days and underwent ultrasonography to check for VTE. Results The overall incidence of postoperative VTE was 15.4% (123/799). Only one patient developed symptomatic VTE. Female sex and staged bilateral TKA were risk factors for postoperative VTE. The postoperative VTE rates in the aspirin, rivaroxaban, and apixaban groups were 16.2%, 6.0%, and 17.1%, respectively, significantly lower in the rivaroxaban group (p < 0.02). The majority of VTEs in all three groups were calf-vein thromboses. Conclusions All agents showed enough efficacy as antithrombotic agents. Considering that aspirin is inexpensive, aspirin is a cost-effective option for preventing postoperative VTE.
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Affiliation(s)
- Seonpyo Jang
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Woo Cheol Shin
- Seoul National University College of Medicine, Seoul, South Korea
| | - Min Ku Song
- Department of Orthopedic Surgery, Jounachim Hospital, Guri, South Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea. .,Seoul National University College of Medicine, Seoul, South Korea.
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Høstmælingen A, Ulvenes P, Nissen-Lie HA, Eielsen M, Wampold BE. Do self-criticism and somatic symptoms play a key role in chronic depression? Exploring the factor structure of Beck depression inventory-II in a sample of chronically depressed inpatients. J Affect Disord 2021; 283:317-324. [PMID: 33578344 DOI: 10.1016/j.jad.2021.01.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/06/2021] [Accepted: 01/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The factor structure of depression differs for different sub-samples. The purpose of this study was to explore the factor structure of Beck Depression Inventory-II in patients with chronic depression presenting for inpatient treatment. METHODS Using exploratory structural equation modeling (ESEM), we explored whether a two-factor solution or a bifactor solution provided best model fit for a sample of 377 patients. For the best fitting model stability was assessed with tests for invariance across primary diagnosis (persistent depressive disorder v. recurrent major depressive disorder), and presence of comorbidity. RESULTS A bifactor solution with one general factor and two specific factors provided best model fit. Invariance analyses provided support for measurement invariance and stability of the factor solution. LIMITATIONS The naturalistic study design implies some uncertainty regarding possible systematic differences between the patients on demographic and clinical characteristics. CONCLUSION The factor structure in our sample was best explained by a general depression factor, one specific factor pertaining to self-criticism, and one consisting of the somatic items fatigue, disturbance of sleep, and appetite. Clinicians could benefit from paying special attention to the subfactors identified, as these findings may have implications for treatment choice for patients with chronic depression.
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Affiliation(s)
| | - Pål Ulvenes
- Department of Psychology, University of Oslo and Modum Bad Research Institute
| | | | - Mikkel Eielsen
- Department of Medicine, University of Oslo and Modum Bad Research Institute
| | - Bruce E Wampold
- University of Wisconsin-Madison and Modum Bad Research Institute
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Schouten MJE, Christ C, Dekker JJM, Riper H, Goudriaan AE, Blankers M. Digital Interventions for People With Co-Occurring Depression and Problematic Alcohol Use: A Systematic Review and Meta-Analysis. Alcohol Alcohol 2021; 57:113-124. [PMID: 33588432 PMCID: PMC8753780 DOI: 10.1093/alcalc/agaa147] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Aims This systematic review and meta-analysis assessed the effectiveness of digital interventions addressing depressive symptoms and alcohol use simultaneously among people with co-occurring depression and problematic alcohol use. Methods Seven databases were searched for trials evaluating digital interventions aimed at depression and alcohol use. Random-effects meta-analyses were conducted to pool effects on depressive symptoms and alcohol use up to 3-month and 6-month follow-up. Overall quality for every outcome was assessed with GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results The pooled effect of digital interventions compared to their comparators was in favour of digital interventions. Small but significant effects on depressive symptoms at 3-month follow-up were found (g = 0.34, 95% confidence interval (CI): 0.06–0.62, P = 0.02, k = 6) and non-significant effects at 6-month follow-up (g = 0.29, 95% CI: −0.16 to 0.73, P = 0.15, k = 5). For alcohol use, the pooled effect of digital interventions was small and non-significant at 3-month follow-up (g = 0.14, 95% CI: −0.02 to 0.30, P = 0.07, k = 6) and significant at 6-month follow-up (g = 0.14, 95% CI: 0.07–0.20, P = 0.005, k = 5). Sensitivity analysis indicated the latter finding to be sensitive to statistical estimator choice. Quality of evidence was moderate, except for depressive symptoms at 6-month follow-up for which it was low. Conclusion Based on the literature, digital interventions are effective in reducing depressive symptoms at 3-month follow-up and alcohol use at 6-month follow-up among people with comorbid depression and problematic alcohol use. More high-quality trials are needed to confirm the current findings.
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Affiliation(s)
- Maria J E Schouten
- Department of Research, Arkin Mental Health Care, 1033 NN Amsterdam, The Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands
| | - Carolien Christ
- Department of Research, Arkin Mental Health Care, 1033 NN Amsterdam, The Netherlands.,Department of Psychiatry, Department of Research and Innovation, VU University Medical Centre, GGZ InGeest Specialized Mental Health Care, Amsterdam Public Health research institute, 1081 HV Amsterdam, The Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, 1033 NN Amsterdam, The Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands.,Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health research institute, 1081 HV Amsterdam, The Netherlands.,Research Unit for Telepsychiatry and e-Mental Health, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark.,University of Turku, Faculty of Medicine, 20500 Turku, Finland
| | - Anna E Goudriaan
- Department of Research, Arkin Mental Health Care, 1033 NN Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Addiction Research and Amsterdam Public Health research institute, 1105 AZ Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, 1033 NN Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Addiction Research and Amsterdam Public Health research institute, 1105 AZ Amsterdam, The Netherlands.,Trimbos Institute- The Netherlands Institute of Mental Health and Addiction, 3500 AS Utrecht, The Netherlands
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Experiences of falling and depression: Results from the Korean Longitudinal Study of Ageing. J Affect Disord 2021; 281:174-182. [PMID: 33321383 DOI: 10.1016/j.jad.2020.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/08/2020] [Accepted: 12/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study estimates the association between fall experiences during the last two years and risk of depression. METHODS Data from 9,355 subjects of the Korean Longitudinal Study of Ageing from 2006 to 2016 were included with baseline at 2006. To analyze the association between fall experiences during the last two years and depression, a generalized estimating equation (GEE) model and chi-square tests were used. RESULTS At baseline 2006, the odds ratio (OR) of depressive symptoms in those with fall experiences was 1.36 times higher (p < .0001) than those with non-fall experience. In those 64 years or younger and 65 years or older, the OR of depressive symptoms in fall experience was 1.45 times higher (p =0.003) and 1.34 times higher (p =0.000) than those with non-fall experience, respectively. In males and females, the OR of depressive symptoms in those with fall experience was 1.47 times higher (p 0.008) and 1.34 times higher (p =0.000) than those with non-fall experience, respectively. CONCLUSION Fall experiences during the last two years are associated with depressive symptoms. Therefore, self-reported screening for fall experiences might aid in population-based prevention strategies for depressive symptoms.
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Socio-ecological predictors of mental health outcomes among healthcare workers during the COVID-19 pandemic in the United States. PLoS One 2021; 16:e0246602. [PMID: 33544761 PMCID: PMC7864435 DOI: 10.1371/journal.pone.0246602] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background Healthcare workers are at increased risk of adverse mental health outcomes during the COVID-19 pandemic. Studies are warranted that examine socio-ecological factors associated with these outcomes to inform interventions that support healthcare workers during future disease outbreaks. Methods We conducted an online cross-sectional study of healthcare workers during May 2020 to assess the socio-ecological predictors of mental health outcomes during the COVID-19 pandemic. We assessed factors at four socio-ecological levels: individual (e.g., gender), interpersonal (e.g., social support), institutional (e.g., personal protective equipment availability), and community (e.g., healthcare worker stigma). The Personal Health Questionnaire-9, Generalized Anxiety Disorder-7, Primary Care Post-Traumatic Stress Disorder, and Alcohol Use Disorders Identification Test-Concise scales assessed probable major depression (MD), generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and alcohol use disorder (AUD), respectively. Multivariable logistic regression models were used to assess unadjusted and adjusted associations between socio-ecological factors and mental health outcomes. Results Of the 1,092 participants, 72.0% were female, 51.9% were frontline workers, and the mean age was 40.4 years (standard deviation = 11.5). Based on cut-off scores, 13.9%, 15.6%, 22.8%, and 42.8% had probable MD, GAD, PTSD, and AUD, respectively. In the multivariable adjusted models, needing more social support was associated with significantly higher odds of probable MD, GAD, PTSD, and AUD. The significance of other factors varied across the outcomes. For example, at the individual level, female gender was associated with probable PTSD. At the institutional level, lower team cohesion was associated with probable PTSD, and difficulty following hospital policies with probable MD. At the community level, higher healthcare worker stigma was associated with probable PTSD and AUD, decreased satisfaction with the national government response with probable GAD, and higher media exposure with probable GAD and PTSD. Conclusions These findings can inform targeted interventions that promote healthcare workers’ psychological resilience during disease outbreaks.
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Travaglini LE, Kuykendall L, Bennett ME, Abel EA, Lucksted A. Relationships between chronic pain and mood symptoms among veterans with bipolar disorder. J Affect Disord 2020; 277:765-771. [PMID: 33065815 DOI: 10.1016/j.jad.2020.08.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 07/13/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic pain is highly prevalent among individuals with mood disorders. While much is known about the relationship between pain and unipolar depression, little is known about pain experiences among people with bipolar disorder. This pilot study addresses this gap by examining pain and its relationship to mood and functioning in a sample of US military veterans with bipolar disorder. METHODS Qualitative interviews were conducted with 15 veterans with bipolar disorder and chronic pain who were recruited from outpatient services within a Veterans Affairs medical center. RESULTS Veterans reported a bidirectional relationship between pain and bipolar depression. When discussing manic episodes, individuals' experiences varied between notable reductions in pain (usually in euphoric states), increases in pain (usually in angry/irritable states), and feeling disconnected from pain. Many reported that increased activity when manic contributed to worse pain after an episode. Veterans clearly articulated how these connections negatively affected their functioning and quality of life. LIMITATIONS This was a small, retrospective study that included a non-random sample of veteran participants from one VA medical center. All veterans were engaged in outpatient mental health care, so the majority reported that their mood has been well-stabilized through medications and/or psychotherapy. CONCLUSIONS Chronic pain experiences appear to be related to depressive and manic mood states and significantly affects functioning and quality of life in Veterans with bipolar disorder. This study highlights the need to assess chronic pain among veterans with bipolar disorder, as changes in mood could have significant implications for functioning and pain management.
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Affiliation(s)
- Letitia E Travaglini
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States.
| | - Lorrianne Kuykendall
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States
| | - Melanie E Bennett
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Erica A Abel
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, West Haven, CT 06516, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, United States
| | - Alicia Lucksted
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States
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A framework for indirect elicitation of the public health impact of gambling problems. BMC Public Health 2020; 20:1717. [PMID: 33198709 PMCID: PMC7670710 DOI: 10.1186/s12889-020-09813-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Gambling problems are increasingly understood as a health-related condition, with harms from excessive time and money expenditure contributing to significant population morbidity. In many countries, the prevalence of gambling problems is known with some precision. However, the true severity of gambling problems in terms of their impact on health and wellbeing is the subject of ongoing debate. We firstly review recent research that has attempted to estimate harm from gambling, including studies that estimate disability weights using direct elicitation. Limitations of prior approaches are discussed, most notably potential inflation due to non-independent comorbidity with other substance use and mental health conditions, and potential biases in the subjective attribution of morbidity to gambling. An alternative indirect elicitation approach is outlined, and a conceptual framework for its application to gambling is provided. Significant risk factors for propensity to develop gambling problems are enumerated, and relative risks for comorbidities are calculated from recent meta-analyses and reviews. Indirect elicitation provides a promising alternative framework for assessing the causal link between gambling problems and morbidity. This approach requires implementation of propensity score matching to estimate the counterfactual, and demands high quality information of risk factors and comorbid conditions, in order to estimate the unique contribution of gambling problems. Gambling harm is best understood as a decrement to health utility. However, achieving consensus on the severity of gambling problems requires triangulation of results from multiple methodologies. Indirect elicitation with propensity score matching and accounting for comorbidities would provide an important step towards full integration of gambling within a public health paradigm.
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Levine JA, Gius BK, Boghdadi G, Connors GJ, Maisto SA, Schlauch RC. Reductions in Drinking Predict Increased Distress: Between- and Within-Person Associations between Alcohol Use and Psychological Distress During and Following Treatment. Alcohol Clin Exp Res 2020; 44:2326-2335. [PMID: 32945567 DOI: 10.1111/acer.14462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/07/2020] [Accepted: 09/07/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND As the nature of the association between alcohol use disorder (AUD) and other disorders is not well understood, the ways in which psychological distress changes during the course of treatment for AUD are relatively unknown. Existing literatures posit 2 competing hypotheses such that treatment for AUD concurrently decreases alcohol use and psychological distress or treatment for AUD decreases alcohol use and increases psychological distress. The current study examined the ways in which psychological distress changed as a function of treatment for AUD, including the relationship between psychological distress and drinking behaviors. METHODS Secondary data analysis was conducted on an existing clinical trial dataset that investigated the effect of cognitive-behavioral therapy and therapeutic alliance feedback on AUDs. Specifically, data collected at baseline, posttreatment, 3-month, 6-month, 9-month, and 12-month follow-up assessments were examined. RESULTS Results indicated decreases in heavy drinking days, increases in percentage of days abstinent, and decreases in overall psychological distress. Findings also revealed that changes in psychological distress did not predict changes in drinking at the next time interval; however, decreases in drinking predicted higher psychological distress at the next assessment. Further, average levels of psychological distress were positively associated with rates of drinking. CONCLUSIONS The current study provides some insight into how psychological distress changes during the course of treatment for AUD, including the relationship between changes in drinking and such symptoms. Future research should continue to explore these relationships, including the ways in which treatment efforts can address what may be seen as paradoxical effects.
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Affiliation(s)
- Jacob A Levine
- From the, Department of Psychology, (JAL, BKG, GB, RCS), University of South Florida, Tampa, Florida, USA
| | - Becky K Gius
- From the, Department of Psychology, (JAL, BKG, GB, RCS), University of South Florida, Tampa, Florida, USA
| | - George Boghdadi
- From the, Department of Psychology, (JAL, BKG, GB, RCS), University of South Florida, Tampa, Florida, USA
| | - Gerard J Connors
- Research Institute on Addictions, (GJC), University at Buffalo, Buffalo, New York, USA
| | - Stephen A Maisto
- Department of Psychology, (SAM), Syracuse University, Syracuse, New York, USA
| | - Robert C Schlauch
- From the, Department of Psychology, (JAL, BKG, GB, RCS), University of South Florida, Tampa, Florida, USA
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Olmert T, Cooper JD, Han SYS, Barton-Owen G, Farrag L, Bell E, Friend LV, Ozcan S, Rustogi N, Preece RL, Eljasz P, Tomasik J, Cowell D, Bahn S. A Combined Digital and Biomarker Diagnostic Aid for Mood Disorders (the Delta Trial): Protocol for an Observational Study. JMIR Res Protoc 2020; 9:e18453. [PMID: 32773373 PMCID: PMC7445599 DOI: 10.2196/18453] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background Mood disorders affect hundreds of millions of people worldwide, imposing a substantial medical and economic burden. Existing diagnostic methods for mood disorders often result in a delay until accurate diagnosis, exacerbating the challenges of these disorders. Advances in digital tools for psychiatry and understanding the biological basis of mood disorders offer the potential for novel diagnostic methods that facilitate early and accurate diagnosis of patients. Objective The Delta Trial was launched to develop an algorithm-based diagnostic aid combining symptom data and proteomic biomarkers to reduce the misdiagnosis of bipolar disorder (BD) as a major depressive disorder (MDD) and achieve more accurate and earlier MDD diagnosis. Methods Participants for this ethically approved trial were recruited through the internet, mainly through Facebook advertising. Participants were then screened for eligibility, consented to participate, and completed an adaptive digital questionnaire that was designed and created for the trial on a purpose-built digital platform. A subset of these participants was selected to provide dried blood spot (DBS) samples and undertake a World Health Organization World Mental Health Composite International Diagnostic Interview (CIDI). Inclusion and exclusion criteria were chosen to maximize the safety of a trial population that was both relevant to the trial objectives and generalizable. To provide statistical power and validation sets for the primary and secondary objectives, 840 participants were required to complete the digital questionnaire, submit DBS samples, and undertake a CIDI. Results The Delta Trial is now complete. More than 3200 participants completed the digital questionnaire, 924 of whom also submitted DBS samples and a CIDI, whereas a total of 1780 participants completed a 6-month follow-up questionnaire and 1542 completed a 12-month follow-up questionnaire. The analysis of the trial data is now underway. Conclusions If a diagnostic aid is able to improve the diagnosis of BD and MDD, it may enable earlier treatment for patients with mood disorders. International Registered Report Identifier (IRRID) DERR1-10.2196/18453
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Affiliation(s)
- Tony Olmert
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Jason D Cooper
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Sung Yeon Sarah Han
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | | | | | | | | | - Sureyya Ozcan
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Nitin Rustogi
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Rhian L Preece
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Pawel Eljasz
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | | | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
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Depression level, not pain severity, is associated with smoked medical marijuana dosage among chronic pain patients. J Psychosom Res 2020; 135:110130. [PMID: 32417435 DOI: 10.1016/j.jpsychores.2020.110130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of medical marijuana (MM) for the treatment of chronic pain is rapidly growing in the United States and Europe; however there is concern regarding the specificity of its therapeutic effects and the motivation underlying its use. While research indicates that among chronic pain prescribed opioids, depression has been associated with increased opioid dosage (regardless of pain levels), the extent to which depression and pain each contribute to MM dose among chronic pain patients is yet unknown. METHODS This cross-sectional study included 209 chronic pain patients prescribed smoked MM, in flower or other plant form, with no concurrent opioid treatment. Ordinal regression analyses were performed in order to explore the unique contribution of mean pain level (1-10 scale), depression severity (measured by the Patient Health Questionnaire (PHQ-9)) and anxiety severity (measured by the Generalized Anxiety Disorder scale (GAD-7)) to doses of MM, while taking into account additional sociodemographic and clinical factors. RESULTS Individuals with mild depression and those with moderate to severe depression were at significantly increased odds for using higher doses of MM in grams per month(Adjusted Odds Ratio(AOR) = 2.06,95% Confidence Interval(CI) = 1.05-4.01, and AOR = 5.95,95% CI = 1.97-17.98, respectively) compared to those without depression. In addition, individuals with mild depression were at significantly increased odds for smoking more MM joints daily(AOR = 2.07, 95% CI = 1.01-4.23) compared to individuals without depression. Mean levels of pain or anxiety severity were not significantly associated with either dose measures. CONCLUSIONS Depression and MM dose are highly correlated and should be concurrently addressed during chronic pain treatment.
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Kapadia M, Desai M, Parikh R. Fractures in the framework: limitations of classification systems in psychiatry
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 22:17-26. [PMID: 32699502 PMCID: PMC7365290 DOI: 10.31887/dcns.2020.22.1/rparikh] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article examines the limitations of existing classification systems from the
historical, cultural, political, and legal perspectives. It covers the evolution of
classification systems with particular emphasis on the DSM and
ICD systems. While pointing out the inherent Western bias in these
systems, it highlights the potential of misuse of these systems to subserve other
agendas. It raises concerns about the reliability, validity, comorbidity, and
heterogeneity within diagnostic categories of contemporary classification systems.
Finally, it postulates future directions in alternative methods of diagnosis and
classification factoring in advances in artificial intelligence, machine learning,
genetic testing, and brain imaging. In conclusion, it emphasizes the need to go beyond
the limitations inherent in classifications systems to provide more relevant diagnoses
and effective treatments.
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Affiliation(s)
- Munira Kapadia
- Department of Psychiatry, Jaslok Hospital & Research Centre, Mumbai, India
| | - Maherra Desai
- Department of Psychiatry, Jaslok Hospital & Research Centre, Mumbai, India
| | - Rajesh Parikh
- Department of Psychiatry, Jaslok Hospital & Research Centre, Mumbai, India
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Hamwey MK, Gargano LM, Friedman LG, Leon LF, Petrsoric LJ, Brackbill RM. Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4344. [PMID: 32560511 PMCID: PMC7344905 DOI: 10.3390/ijerph17124344] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
Abstract
Prior reviews of 9/11-related post-traumatic stress disorder (PTSD) have not focused on the civilian survivors most directly exposed to the attacks. Survivors include those individuals who were occupants of buildings in or near the World Trade Center (WTC) towers, those whose primary residence or workplace was in the vicinity, and persons who were on the street passing through the area. This review reports published information on the prevalence of and risk factors for PTSD, as well as comorbidities associated with PTSD among 9/11 survivors. Articles selected for inclusion met the following criteria: (1) full-length, original peer-reviewed empirical articles; (2) published in English from 2002-2019; (3) collected data from persons directly exposed; (4) adult populations; and (5) focused on non-rescue or recovery workers (i.e., survivors). Data were extracted with focus on study design, sample size, time frame of data collection post-9/11, PTSD assessment instrument, and PTSD prevalence, risk factors, and comorbidities. Our review identified the use of cross-sectional and longitudinal designs, finding multiple direct comorbidities with PTSD, as well as the prevalence and persistence of PTSD. Future research would benefit from incorporating more mixed methods designs, and exploring the mediating mechanisms and protective factors of the known associations of PTSD among the 9/11 survivor population.
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Affiliation(s)
| | | | | | | | | | - Robert M. Brackbill
- World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (M.K.H.); (L.M.G.); (L.G.F.); (L.F.L.); (L.J.P.)
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Arruda MA, Arruda R, Guidetti V, Bigal ME. ADHD Is Comorbid to Migraine in Childhood: A Population-Based Study. J Atten Disord 2020; 24:990-1001. [PMID: 28587507 DOI: 10.1177/1087054717710767] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Recurrent headaches and ADHD are prevalent in the pediatric population. Herein, we assess if ADHD is comorbid to headaches overall, to headache subtypes (e.g., migraine), and to headache frequency. Method: Informed consent and analyzable data were obtained for 5,671 children aged 5 to 12 years (65.9% of the target sample). Parents and teachers were interviewed using validated questionnaires based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). Relative risks were modeled using univariate and multivariate analyses. Results: As contrasted to nonheadache controls, the prevalence of ADHD was significantly higher in children with migraine (p < .001) but not in those with tension-type headaches. In children with migraine, risk of ADHD increased as a function of headache frequency (p < .05). Conclusion: Migraine and frequent migraine are comorbid to ADHD. Future studies should focus on the impact of the association on the burden to the children and their families.
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Pini S, Abelli M, Gesi C, Lari L, Cardini A, Di Paolo L, Felice F, Di Stefano R, Mazzotta G, Oligeri C, Bovenzi F, Borelli L, Bertoli D, Michi P, Muccignat A, Micchi J, Balbarini A. Frequency and clinical correlates of bipolar features in acute coronary syndrome patients. Eur Psychiatry 2020; 29:253-8. [DOI: 10.1016/j.eurpsy.2013.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 06/24/2013] [Accepted: 06/30/2013] [Indexed: 01/01/2023] Open
Abstract
AbstractBackground:Depression and acute coronary syndrome (ACS) are both extremely prevalent diseases. Studies aimed at evaluating whether depression is an independent risk factor for cardiac events provided no definitive results. In most of these studies, depression has been broadly defined with no differentiation between unipolar (MDD) versus bipolar forms (BD). The aim of this study was to evaluate the frequency of DSM-IV BD (bipolar I and bipolar II subtypes, cyclothymia), as well as temperamental or isolated bipolar features in a sample of 171 patients hospitalized for ACS. We also explored whether these psychopathological conditions were associated with some clinical characteristics of ACS.Methods:Patients with ACS admitted to three neighboring Cardiac Intensive Care Units (CICUs) in a 12-month continuative period of time were eligible for inclusion if they met the criteria for either acute myocardial infarct with or without ST-segment elevation or unstable angina, verified by standard ACS criteria. All patients underwent standardized cardiological and psychopathological evaluations.Results:Of the 171 ACS patients enrolled, 37 patients (21.7%) were found to have a DSM-IV mood disorder. Of these, 20 (11.7%) had bipolar type I or type II or cyclothymia, while 17 (10%) were the cases of MDD. Rapid mood switches ranged from 11% of ACS patients with no mood disorders, to 47% of those with MDD to 55% of those with BD. Linear regression analysis showed that a diagnosis of BD (p = .023), but not that of MDD (p = .721), was associated with a significant younger age at the index episode of ACS. A history of previous coronary events was more frequent in ACS patients with BD than in those with MDD.Conclusions:Our data indicate that bipolar features and diagnosis are frequent in ACS patients. Bipolar disorder has a negative impact on cardiac symptomatology. Further research in this area is warranted.
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Huber-Mollema Y, Oort FJ, Lindhout D, Rodenburg R. Well-being of mothers with epilepsy with school-aged children. Epilepsy Behav 2020; 105:106966. [PMID: 32146338 DOI: 10.1016/j.yebeh.2020.106966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of the study was to examine different aspects of well-being in mothers with epilepsy with school-aged children. METHODS In an observational study, mothers, identified from the European Registry of Antiepileptic Drugs and Pregnancy database in the Netherlands, completed questions on epilepsy, the impact of epilepsy on daily functioning, quality of life, behavioral problems, and parenting stress. Descriptive analyses were performed to examine the prevalence of behavioral problems and the impact of epilepsy on different aspects of the mother's daily functioning and family life. We subsequently investigated which factors contributed most to the impact of maternal epilepsy using regression analyses. RESULTS One hundred fifty-six (46%) of the 342 invited mothers with epilepsy participated. The majority (89%) had low epilepsy severity, with well-controlled seizures. Internalizing problems within the borderline or clinical range were reported by 23% of the mothers. Behavioral problems were significantly correlated with epilepsy severity (r = 0.26, p = .002), impact of epilepsy on daily functioning (r = 0.32, p < .001), and quality of life (r = -0.52, p < 01). Quality of life was in general good (mean = 8, standard deviation [SD] = 1), with low impact of epilepsy. Epilepsy affected mostly maternal self-confidence, work, and general health. Mothers indicated to experience no to little impact of epilepsy on the relationship with their children, partner, or family. Regression analyses showed that epilepsy severity (1.0, 95% confidence interval [CI]: 0.4 to 1.6; p = .002) and quality of life (-1.3, CI: -2.3 to -0.4; p = .007) were significant contributors to the impact of epilepsy on daily functioning, while other factors (maternal education, family type, behavioral problems, and parenting stress) were nonsignificant. DISCUSSION The current study shows that mothers with epilepsy generally fared well. Epilepsy negatively impacted the lives of some mothers, though. As maternal well-being is of importance for mother-child interaction and child development, clinicians should be aware of the impact of epilepsy on maternal psychosocial outcomes and family life of women with epilepsy.
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Affiliation(s)
- Yfke Huber-Mollema
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Frans J Oort
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Dick Lindhout
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Department of Genetics, University Medical Center Utrecht, the Netherlands
| | - Roos Rodenburg
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, the Netherlands. H.-
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Riihimäki K, Sintonen H, Vuorilehto M, Jylhä P, Saarni S, Isometsä E. Health-related quality of life of primary care patients with depressive disorders. Eur Psychiatry 2020; 37:28-34. [DOI: 10.1016/j.eurpsy.2016.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/19/2016] [Accepted: 04/19/2016] [Indexed: 11/30/2022] Open
Abstract
AbstractBackgroundDepressive disorders are known to impair health-related quality of life (HRQoL) both in the short and long term. However, the determinants of long-term HRQoL outcomes in primary care patients with depressive disorders remain unclear.MethodsIn a primary care cohort study of patients with depressive disorders, 82% of 137 patients were prospectively followed up for five years. Psychiatric disorders were diagnosed with SCID-I/P and SCID-II interviews; clinical, psychosocial and socio-economic factors were investigated by rating scales and questionnaires plus medical and psychiatric records. HRQoL was measured with the generic 15D instrument at baseline and five years, and compared with an age-standardized general population sample (n = 3707) at five years.ResultsDepression affected the 15D total score and almost all dimensions at both time points. At the end of follow-up, HRQoL of patients in major depressive episode (MDE) was particularly low, and the association between severity of depression (Beck Depression Inventory [BDI]) and HRQoL was very strong (r = −0.804). The most significant predictors for change in HRQoL were changes in BDI and Beck Anxiety Inventory (BAI) scores. The mean 15D score of depressive primary care patients at five years was much worse than in the age-standardized general population, reaching normal range only among patients who were in clinical remission and had virtually no symptoms.ConclusionsAmong depressive primary care patients, presence of current depressive symptoms markedly reduces HRQoL, with symptoms of concurrent anxiety also having a marked impact. For HRQoL to normalize, current depressive and anxiety symptoms must be virtually absent.
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You DS, Ziadni MS, Gilam G, Darnall BD, Mackey SC. Evaluation of Candidate Items for Severe PTSD Screening for Patients With Chronic Pain: Pilot Data Analysis With the IRT Approach. Pain Pract 2020; 20:262-268. [PMID: 31646748 PMCID: PMC7083588 DOI: 10.1111/papr.12848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Post-traumatic stress disorder (PTSD) commonly co-occurs with chronic pain. Although PTSD symptoms are associated with negative health outcomes in patients with chronic pain, PTSD is typically under-detected and under-treated in outpatient pain settings. There is a need for rapid, brief screening tools to identify those at greatest risk for severe PTSD symptoms. To achieve that goal, our aim was to use item response theory (IRT) to identify the most informative PTSD symptoms characterizing severe PTSD in patients with chronic pain. METHODS Fifty-six patients (71% female, 61% White) with mixed etiology chronic pain completed the PTSD Checklist-Civilian Version (PCL-C) as part of their appointment with a pain psychologist at a tertiary outpatient pain clinic. We used an IRT approach to evaluate each item's discriminant (a) and severity (b) parameters. RESULTS Findings revealed that "feeling upset at reminders" (a = 3.67, b = 2.44) and "avoid thinking or talking about it" (a = 3.61, b = 2.17) as being highly discriminant for severe PTSD. CONCLUSIONS We identified 2 candidate items for a brief PTSD screener as they were associated with severe PTSD symptoms. These 2 items may provide clinical utility in outpatient pain treatment settings to identify those suffering from severe PTSD, enabling physicians to refer them to trauma-specific evaluation or therapy. Future research is needed to further validate and confirm these candidate PTSD items in a larger clinic sample. LAY SUMMARY The current study used the IRT approach to identify candidate items for a brief screener for severe PTSD. We examined 17 items of the PCL-C, and identified 2 items that were highly discriminant for severe PTSD. The 2 items were "feeling upset at reminders" and "avoid thinking or talking about it." These 2 items may provide clinical utility, since they may enable physicians to screen and make a referral for further assessment or treatment for PTSD.
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Affiliation(s)
- Dokyoung S You
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Gadi Gilam
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, U.S.A
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Meuret AE, Tunnell N, Roque A. Anxiety Disorders and Medical Comorbidity: Treatment Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:237-261. [PMID: 32002933 DOI: 10.1007/978-981-32-9705-0_15] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Natalie Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Andres Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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Burkhouse KL, Jagan Jimmy, Defelice N, Klumpp H, Ajilore O, Hosseini B, Fitzgerald KD, Monk CS, Phan KL. Nucleus accumbens volume as a predictor of anxiety symptom improvement following CBT and SSRI treatment in two independent samples. Neuropsychopharmacology 2020; 45:561-569. [PMID: 31756730 PMCID: PMC6969163 DOI: 10.1038/s41386-019-0575-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 12/18/2022]
Abstract
Structural variations of neural regions implicated in fear responses have been well documented in the pathophysiology of anxiety and may play an important role in treatment response. We examined whether gray matter volume of three neural regions supporting fear and avoidance responses [bilateral amygdala, nucleus accumbens (NAcc), and ventromedial prefrontal cortex (PFC)] predicted cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) treatment outcome in two independent samples of patients with anxiety disorders. Study 1 consisted of 81 adults with anxiety disorders and Study 2 included 55 children and adolescents with anxiety disorders. In both studies, patients completed baseline structural MRI scans and received either CBT or SSRI treatment. Clinician-rated interviews of anxiety symptoms were assessed at baseline and posttreatment. Among the adult sample, greater pre-treatment bilateral NAcc volume was associated with a greater reduction in clinician-rated anxiety symptoms pre-to-post CBT and SSRI treatment. Greater left NAcc volume also predicted greater decreases in clinician-rated anxiety symptoms pre-to-post CBT and SSRI treatment among youth with current anxiety. Across studies, results were similar across treatments, and findings were maintained when adjusting for patient's age, sex, and total intracranial brain volume. We found no evidence for baseline amygdala or ventromedial PFC volume serving as treatment predictors across the two samples. Together, these findings provide promising support for the role of NAcc volume as an objective marker of anxiety treatment improvement that spans across development. Future studies should clarify the specific mechanisms through which NAcc volume exerts its therapeutic effects.
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Affiliation(s)
- Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jagan Jimmy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Nicholas Defelice
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Bobby Hosseini
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Christopher S Monk
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
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Sex differences in incidence and psychiatric comorbidity for alcohol dependence in patients with panic disorder. Drug Alcohol Depend 2020; 207:107814. [PMID: 31887603 DOI: 10.1016/j.drugalcdep.2019.107814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/13/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sex differences in the development of alcohol dependence (AD) among patients with panic disorder (PD) remain unexplored. The study investigated sex as an effect modifier in the incidence of AD among patients with PD. METHOD We included 9480 patients with PD from the Taiwan National Health Insurance Research Database. A total of 169 patients (89 men and 80 women) developed incident AD during the follow-up period. Standardized incidence ratios (SIRs) were used to represent the relative risks of incident AD compared with the general population. Based on a nested case-control study design, 10 controls were selected for each case. Medical utilization and psychiatric comorbidity before diagnosing AD were analyzed using conditional logistic regression. RESULTS The SIR of incident AD was 3.36 for men and 6.29 for women. Women with PD and incident AD had more visits to the outpatient department than the controls did, whereas men exhibited no significant differences. Women with incident AD were more likely to comorbid with depressive disorder (adjusted risk ratio [aRR] = 2.94), personality disorder (aRR = 5.03), and sleep disorder (aRR = 1.72), whereas men with incident AD were more likely to comorbid with sleep disorder (aRR = 1.85) and other substance use disorders (aRR = 3.08). CONCLUSION Patients with PD have an additional risk of developing AD compared with the general population, and that risk is higher in women. Women and men exhibited dissimilar patterns of medical utilization and psychiatric comorbidity before developing AD. Sex differences should be taken into consideration when establishing preventive measures.
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Abstract
Objective: We reviewed important clinical aspects of bipolar depression, a progressive psychiatric condition that is commonly treated in primary care. Bipolar depression is associated with considerable burden of illness, high suicide risk, and greater morbidity and mortality than bipolar mania. Methods: We identified articles relevant to our narrative review using a multistep search of the literature and applying terms that were relevant to bipolar depression or bipolar disorder. Results: Bipolar depression accounts for the majority of time spent unwell for patients with bipolar disorder; high rates of morbidity and mortality arise from full symptomatic episodes and interepisode subsyndromal symptoms. Bipolar depression is an important contributor to long-term dysfunction for patients with bipolar disorder due to psychosocial impairment, loss of work productivity and high rates of substance abuse. Missed and delayed diagnosis is prevalent due to overlapping symptoms with unipolar depression and other diagnoses. Medical comorbidities (i.e. cardiovascular disease, hypertension, obesity, metabolic syndrome) and psychiatric comorbidities (i.e. anxiety disorder, personality disorder, eating disorder, attention-deficit/hyperactivity disorder) are common. Currently, only three treatments are FDA-approved for bipolar depression; monotherapy antidepressants are not a recommended treatment option. Conclusions: Bipolar disorder is common among primary care patients presenting with depression; it is often treated exclusively in primary care. Clinicians should be alert for symptoms of bipolar disorder in undiagnosed patients, know what symptoms probabilistically suggest bipolar versus unipolar depression, have expertise in providing ongoing treatment to diagnosed patients, and be knowledgeable about managing common medication-related side effects and comorbidities. Prompt and accurate diagnosis is critical.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network , Toronto , Canada
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Family Strain, Depression, and Somatic Amplification in Adults with Chronic Pain. Int J Behav Med 2019; 26:427-436. [DOI: 10.1007/s12529-019-09799-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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