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Ben Thabet J, Turki M, Mezghani M, Guermazi A, Mâalej M, Charfi N, Maalej M. Prevalence of the generalized anxiety disorder in Tunisia: A study of 707 primary care outpatients. Int J Psychiatry Med 2024:912174241263235. [PMID: 38898013 DOI: 10.1177/00912174241263235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE This study examined the prevalence and correlates of generalized anxiety disorder (GAD) among primary care outpatients. METHOD A multicenter, cross-sectional study was conducted that included 707 primary care outpatients being seen at 20 primary healthcare centers in Tunis and Sfax, Tunisia. The Mini International Neuropsychiatric Interview was used to identify a diagnosis of GAD. The Beck Depression Inventory was used to assess depressive symptom severity, and the Sheehan Disability Scale (SDS) was used to measure functional impairment. RESULTS The prevalence of GAD was 11%. GAD was positively correlated with female gender (P = .005), family history of psychiatric disorder (P < .001), personal history of suicide attempt (P = .019), and depressive symptoms (P < .001). Based on the SDS, severe to very severe functional limitations were reported at work, in social life, and family life (56.4%, 60.2%, and 73.1%, respectively) among GAD patients. CONCLUSION This study indicated a relatively high prevalence of GAD among primary care patients in Tunisia. Risk factors were also determined that may help to identify these patients. This information may help primary care physicians recognize this diagnosis and provide timely referrals to mental health professionals to prevent complications and preserve quality of life.
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Affiliation(s)
- Jihene Ben Thabet
- Psychiatry "C" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Mariem Turki
- Psychiatry "B" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Molka Mezghani
- Psychiatry Department, Razi Psychiatric Hospital, University of Tunis, Tunisia
| | - Asma Guermazi
- Psychiatry "C" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Mohamed Mâalej
- Psychiatry "C" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nada Charfi
- Psychiatry "C" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Manel Maalej
- Psychiatry "C" Department, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Couto TA, Gao F, Lak DC, Yuan Z. Combined EEG-tDCS approach in resting state to reduce comorbid anxiety and depressive symptoms in affective disorders: A sham-controlled pilot study. IBRO Neurosci Rep 2024; 16:571-581. [PMID: 38764542 PMCID: PMC11101867 DOI: 10.1016/j.ibneur.2024.04.007] [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: 10/30/2023] [Revised: 04/19/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024] Open
Abstract
Continuous challenges have been imposed on mental health science by Anxiety and Depression disorders as the most prevalent and debilitating psychiatric conditions worldwide. Pharmacologic and cognitive behavioral therapies, either alone or in combination, have been considered as the first-line therapies, however, resistant symptomatology is prevalent in comorbid conditions with symptoms remaining after interventions. The demand for new therapeutic solutions has given space to the development of non-invasive brain stimulation techniques (NIBS), and the transmagnetic direct current stimulation (tDCS) has been reported as a safe and well-tolerated technique for the treatment of several mental health conditions, including Anxiety and Depression disorders. Relying on quantitative electroencephalography(qEEG)- tDCS approach, the current study aims to inspect the effect of tDCS intervention on patients who suffer from anxiety-depression comorbidity, in particular, the impact of tDCS intervention on qEEG spectral power activity and resting-state connectivity organization during eyes closed and eyes open protocols. QEEG data were acquired from eight patients suffering from moderate to severe anxiety-depression comorbid symptoms along with poor coping skills to manage stress and negative affect. Twelve control subjects allocated in the control group exhibiting low to moderate symptoms in both anxiety and depression conditions went also through the qEEG data acquisition. In addition, a sham-controlled study was conducted, and the patient group went through resting-state qEEG-tDCS neuromodulation once a week for ten weeks. Various-stage qEEG recordings were performed to inspect the efficacy of tDCS treatment during the modulation of brain regions involved in the regulation of affective responses. Our results demonstrated that after tDCS neuromodulation, the patients' groups exhibited decreased absolute power abnormalities over the left anterior cingulate cortex and reduced abnormal activity in the alpha band over posterior regions; improved functional connectivity indexes; decreased anxiety and depressive scores while positive affect score was improved. Besides the promising improvements, our study did not find a significant tDCS effect on perceived stress and negative affect scores. Consistently, significant differences in absolute spectral power over the left anterior cingulate cortex were detected among the patient group, as compared to the controls, as expected. Therefore, our study offers preliminary data to understand the neuroplasticity changes that potentially result from the manipulation of cortical excitability during affective regulation protocols followed by the consequent decrease of comorbid anxiety and depressive symptomatology. The pilot study was followed by prospective registration with ChiCTR2200062142.
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Affiliation(s)
- Tania A. Couto
- Faculty of Health Sciences. Centre for Cognitive and Brain Sciences. University of Macau, Taipa 999078, Macau, Special Administrative region of China
- Brain, Language and Computation Laboratory. University Research Facility in Behavioural and Systems Neuroscience. The Hong Kong Polytechnic University, Hong Kong Special Administrative Region of China
| | - Fei Gao
- Faculty of Health Sciences. Centre for Cognitive and Brain Sciences. University of Macau, Taipa 999078, Macau, Special Administrative region of China
- Fudan University, Shanghai, China
| | - Davis C. Lak
- Alpha Positive Limited, Central, 999077, Hong Kong Special Administrative Region of China
- Department of Psychology. The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Zhen Yuan
- Faculty of Health Sciences. Centre for Cognitive and Brain Sciences. University of Macau, Taipa 999078, Macau, Special Administrative region of China
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Hauch D, Elklit A. The psychological consequences of stalking: cross-sectional findings in a sample of Danish help-seeking stalking victims. Eur J Psychotraumatol 2023; 14:1-16. [PMID: 38018419 PMCID: PMC10990443 DOI: 10.1080/20008066.2023.2281749] [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] [Received: 12/02/2022] [Accepted: 10/23/2023] [Indexed: 11/30/2023] Open
Abstract
Background: The experience of stalking presents a threat to the mental and physical health and wellbeing of victims. Although some studies have explored the impact of stalking on victims, few have gone into detail about specific mental health outcomes and their association with various types of stalking behaviour.Objective: To investigate the psychological consequences among Danish help-seeking victims of stalking who have contacted and received help through the Danish Stalking Center (DSC).Methods: We used survey-data from stalking victims who sought and received help from the DSC during 2015-2020 (N = 591). Descriptive statistics, correlation analysis, T-tests, and hierarchical logistic regression analysis were used to examine psychological distress symptoms and the relationship between psychopathological symptoms and stalking behaviour characteristics.Results: Victims reported considerable levels of stalking and psychological distress. Almost 80% of victims reported symptom levels indicative of a diagnosable disorder of PTSD, depression, or anxiety. T-test shoved that following behaviour had the greatest effect size for PTSD-symptoms (t(575) = -5.81, p < .01, d = -.58), anxiety (t(576) = -4.21, p < .01, d = -.42), and somatization (t(572) = -4.29, p < .01, d = -.43). Hierarchical logistic regression analysis showed that stalking victims who experienced following had significantly higher odds of experiencing symptoms of PTSD (OR 2.869; 95% CI, [1.641-5.016]) and anxiety (OR 2.274; 95% CI [1.265; 4.090]).Conclusion: Being stalked is associated with substantial PTSD-, affective and trauma-related symptoms and psychological distress in general. Together with the strikingly high levels of psychopathology and the particularly grave effects of being followed, it is indicated that stalking is a special type of trauma with many negative and harmful effects. Hence, further research into how to properly help stalking victims through preventive interventions and treatment is needed.
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Affiliation(s)
- Didde Hauch
- Danish National Center of Psychotraumatology, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Danish Stalking Center, Copenhagen, Denmark
| | - Ask Elklit
- Danish National Center of Psychotraumatology, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Flannery MK, Falkenstein MJ, Boyd M, Haaga DAF. Untroubled Pullers: An Examination of Nonclinical Hair-Pulling. J Obsessive Compuls Relat Disord 2023; 38:100821. [PMID: 37485310 PMCID: PMC10358351 DOI: 10.1016/j.jocrd.2023.100821] [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] [Indexed: 07/25/2023]
Abstract
Nonclinical hair-pulling is much more prevalent than hair pulling associated with a diagnosis of trichotillomania (TTM). However, little is known about nonclinical pulling. The purpose of this exploratory research was to begin characterizing a subset of nonclinical hair pullers we refer to as "untroubled pullers," people who engage in recurrent, noncosmetic hair-pulling without associated distress or impairment. In a secondary analysis of two studies conducted online, untroubled pullers reported significantly lower symptom severity than did those diagnosed with TTM. The Big Five personality dimensions did not differentiate the groups in Study 1, but untroubled pullers endorsed significantly less disability, focused and automatic pulling, social anxiety, perceived risk in intimacy, and perfectionism in Study 2. These findings remained significant after controlling for symptom severity. Age and race resulted in mixed findings between the two studies, but no differences arose in other demographics. These findings suggest that symptom severity may not sufficiently explain differences in associated distress and impairment. Future studies are needed on how other constructs related to distress and impairment interact with hair-pulling behavior to provide insight into when pulling is associated with clinically significant distress or impairment.
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Affiliation(s)
- Meghan K. Flannery
- Department of Psychology, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016-8062
| | - Martha J. Falkenstein
- McLean Hospital OCD Institute/Harvard Medical School, 115 Mill Street, Mail Stop #207, Belmont, MA 02478
| | - Megan Boyd
- Department of Psychology, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016-8062
| | - David A. F. Haaga
- Department of Psychology, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016-8062
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Tornivuori A, Kronström K, Aromaa M, Salanterä S, Karukivi M. Accessible mental well-being intervention for adolescents in school settings: a single-group intervention study using a pretest-post-test design. Child Adolesc Psychiatry Ment Health 2023; 17:28. [PMID: 36805796 PMCID: PMC9940674 DOI: 10.1186/s13034-023-00576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND A growing number of adolescents seek treatment for mental health problems, a circumstance that stresses the importance of implementing accessible treatment options. This study evaluates the impacts of brief, mental well-being intervention for adolescents in a school environment. As mental health interventions are often targeted at specific disorders, we sought a comprehensive approach to reach adolescents with a range of mental health symptoms. METHODS Single-group intervention study with a pretest-posttest design was utilized and conducted in lower, upper secondary, and vocational schools on adolescents ages 12-18 who sought medical attention for mental health symptoms. The cut-off point for inclusion was ≥ 14, for the Young Persons Clinical Outcomes for routine Evaluation (YP-CORE) measurement. The intervention included six face-to-face visits implemented by psychiatric nurses who received a 3-day training course. The impacts were evaluated after 6 weeks (n = 87) and again at 6 months (n = 68) and assessed using the YP-CORE, Beck Depression Inventory (BDI-II) and Overall Anxiety Severity and Impairment Scale (OASIS). RESULTS The participants reported significant levels of mental distress at baseline with a YP-CORE mean score = 21.48, a BDI-II mean score = 23.60, OASIS mean score = 10.98. Post-intervention results at 6 weeks for the primary outcome YP-CORE showed a significant (p < .001) mean score decrease of - 3.82, a medium effect size d = .627. For participants attending upper secondary and vocational schools the YP-CORE scores changed significantly from baseline to 6-weeks (p = .005) and from baseline to 6-months (p < .001). Long-term outcomes at 6-months showed a - 1.14 decrease (p = non-significant), effect size d = .175. After the 6-week intervention, 12% of the participants were assessed as not requiring additional visits. CONCLUSIONS This easily accessible intervention in a school setting indicated improvement for those participants with mild to moderate mental disorder symptoms and attending upper secondary and vocational schools. After the 6-week intervention, significant positive effects were observed. Participants reported substantial levels of mental distress at the baseline, which could contribute to the decline of symptoms and need for extended care during the 6 months follow-up. Trial registration Retrospectively registered with Clinicaltrials.gov identifier NCT05356949.
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Affiliation(s)
- Anna Tornivuori
- Department of Nursing Science, University of Turku, Turku, Finland.
| | - Kim Kronström
- Department of Adolescent Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Aromaa
- Outpatient Clinic for Children and Adolescents, Turku University Hospital, Turku, Finland
- Outpatient Clinic for Children and Adolescents, Turku University Hospital, Turku, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Administration, Turku, Finland
| | - Max Karukivi
- Department of Adolescent Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
- Psychiatric Care Division, Satakunta Hospital District, Pori, Finland
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Peterson AL, Blount TH, Foa EB, Brown LA, McLean CP, Mintz J, Schobitz RP, DeBeer BR, Mignogna J, Fina BA, Evans WR, Synett S, Hall-Clark BN, Rentz TO, Schrader C, Yarvis JS, Dondanville KA, Hansen H, Jacoby VM, Lara-Ruiz J, Straud CL, Hale WJ, Shah D, Koch LM, Gerwell KM, Young-McCaughan S, Litz BT, Meyer EC, Blankenship AE, Williamson DE, Roache JD, Javors MA, Sharrieff AFM, Niles BL, Keane TM. Massed vs Intensive Outpatient Prolonged Exposure for Combat-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2249422. [PMID: 36602803 PMCID: PMC9856757 DOI: 10.1001/jamanetworkopen.2022.49422] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Improved, efficient, and acceptable treatments are needed for combat-related posttraumatic stress disorder (PTSD). OBJECTIVE To determine the efficacy of 2 compressed prolonged exposure (PE) therapy outpatient treatments for combat-related PTSD. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted among military personnel and veterans at 4 sites in Texas from 2017 to 2019. Assessors were blinded to conditions. Data were analyzed from November 2020 to October 2022. INTERVENTIONS The interventions were massed-PE, which included 15 therapy sessions of 90 minutes each over 3 weeks, vs intensive outpatient program PE (IOP-PE), which included 15 full-day therapy sessions over 3 weeks with 8 treatment augmentations. The IOP-PE intervention was hypothesized to be superior to massed-PE. MAIN OUTCOMES AND MEASURES Coprimary outcomes included the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5) administered at baseline and posttreatment follow-ups. Measures ranged from 0 to 80, with higher scores indicating greater severity. Diagnostic remission and reliable change were secondary outcomes. RESULTS Among 319 military personnel and veterans screened, 234 were randomized (mean [SD] age, 39.20 [7.72] years; 182 [78%] male participants), with 117 participants randomized to IOP-PE and 117 participants randomized to massed-PE. A total of 61 participants (26%) were African American, 58 participants (25%) were Hispanic, and 102 participants (44%) were White; 151 participants (65%) were married. Linear mixed-effects models found that CAPS-5 scores decreased in both treatment groups at the 1-month follow-up (IOP-PE: mean difference, -13.85 [95% CI, -16.47 to -11.23]; P < .001; massed-PE: mean difference, -14.13 [95% CI, -16.63 to -11.62]; P < .001). CAPS-5 change scores differed from 1- to 6-month follow-ups (mean difference, 4.44 [95% CI, 0.89 to 8.01]; P = .02). PTSD symptoms increased in massed-PE participants during follow-up (mean difference, 3.21 [95% CI, 0.65 to 5.77]; P = .01), whereas IOP-PE participants maintained treatment gains (mean difference, 1.23 [95% CI, -3.72 to 1.27]; P = .33). PCL-5 scores decreased in both groups from baseline to 1-month follow-up (IOP-PE: mean difference, -21.81 [95% CI, -25.57 to -18.04]; P < .001; massed-PE: mean difference, -19.96 [95% CI, -23.56 to -16.35]; P < .001) and were maintained at 6 months (IOP-PE: mean change, -0.21 [95% CI, -3.47 to 3.06]; P = .90; massed-PE: mean change, 3.02 [95% CI, -0.36 to 6.40]; P = .08). Both groups had notable PTSD diagnostic remission at posttreatment (IOP-PE: 48% [95% CI, 36% to 61%] of participants; massed-PE: 62% [95% CI, 51% to 73%] of participants), which was maintained at 6 months (IOP-PE: 53% [95% CI, 40% to 66%] of participants; massed-PE: 52% [95% CI, 38% to 66%] of participants). Most participants demonstrated reliable change on the CAPS-5 (61% [95% CI, 52% to 69%] of participants) and the PCL-5 (74% [95% CI, 66% to 81%] of participants) at the 1-month follow-up. CONCLUSIONS AND RELEVANCE These findings suggest that PE can be adapted into compressed treatment formats that effectively reduce PTSD symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03529435.
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Affiliation(s)
- Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
- Department of Psychology, University of Texas at San Antonio, San Antonio
| | - Tabatha H. Blount
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Edna B. Foa
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Lily A. Brown
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Carmen P. McLean
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Richard P. Schobitz
- Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas
| | - Bryann R. DeBeer
- VISN-17 Center of Excellence for Returning War Veterans, Central Texas Veterans Health Care System, Waco
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Aurora, Colorado
| | - Joseph Mignogna
- VISN-17 Center of Excellence for Returning War Veterans, Central Texas Veterans Health Care System, Waco
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Aurora, Colorado
| | - Brooke A. Fina
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Wyatt R. Evans
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Samantha Synett
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
- VISN-17 Center of Excellence for Returning War Veterans, Central Texas Veterans Health Care System, Waco
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Aurora, Colorado
| | - Brittany N. Hall-Clark
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Timothy O. Rentz
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
| | - Christian Schrader
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Jeffrey S. Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
- School of Social Work, Tulane University, New Orleans, Louisiana
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Hunter Hansen
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Vanessa M. Jacoby
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Jose Lara-Ruiz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
- Department of Psychology, University of Texas at San Antonio, San Antonio
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
- Department of Psychology, University of Texas at San Antonio, San Antonio
| | - Willie J. Hale
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
- Department of Psychology, University of Texas at San Antonio, San Antonio
| | - Dhiya Shah
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
| | - Lauren M. Koch
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Kelsi M. Gerwell
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
| | - Brett T. Litz
- Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston
- Department of Psychological and Brain Sciences, School of Arts and Sciences, Boston University, Boston, Massachusetts
| | - Eric C. Meyer
- VISN-17 Center of Excellence for Returning War Veterans, Central Texas Veterans Health Care System, Waco
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Abby E. Blankenship
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Douglas E. Williamson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Durham VA Health Care System, Durham, North Carolina
| | - John D. Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
| | - Martin A. Javors
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio
| | - Allah-Fard M. Sharrieff
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas
- Department of Homeland Security, Miami, Florida
| | - Barbara L. Niles
- Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
| | - Terence M. Keane
- Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
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Ketvel L, Keltikangas-Järvinen L, Pahkala K, Juonala M, Ahola-Olli A, Lehtimäki T, Viikari J, Raitakari O, Rovio S, Saarinen A. Stress-Related Exhaustion, Polygenic Cognitive Potential, and Cognitive Test Performance - A General Population Study. COGNITIVE THERAPY AND RESEARCH 2023; 47:155-167. [PMID: 36945257 PMCID: PMC10023621 DOI: 10.1007/s10608-023-10354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/06/2023]
Abstract
Background We investigated whether stress-related exhaustion (chronic or short-term, and co-occurring with depression or not) is related to cognitive performance and whether polygenic cognitive potential modifies these associations. Methods The participants were from the Young Finns Study (N = 541-1273). Stress-related exhaustion was assessed using the Maastricht Questionnaire, depressive symptoms with the Beck Depression Inventory, and cognitive performance with subtests of the Cambridge Neuropsychological Test Automated Battery, measuring visuospatial learning, reaction time, sustained attention, and executive function. Cognitive performance and depression were assessed in 2011, and exhaustion in 2001, 2007, and 2011. A polygenic score for cognitive potential was calculated based on a GWAS on intelligence. Results High stress-related exhaustion, especially chronic, was associated with slower reaction time. Only clinical levels of depression were related to slower reaction time. Polygenic cognitive potential did not modify these associations. There were no differences in cognitive performance between individuals with co-occurring exhaustion and depression vs. those with only either condition. Conclusion Stress-related exhaustion, especially if chronic, seems to relate to slower reactions. Co-occurring exhaustion and depression may not have additive effects on cognitive performance. High polygenic cognitive potential may not protect from or predispose to harmful effects of exhaustion or depression on reaction time. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10354-z.
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Affiliation(s)
- Laila Ketvel
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, 00014 Helsinki, Finland
| | - Liisa Keltikangas-Järvinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, 00014 Helsinki, Finland
| | - Katja Pahkala
- Research Centre for Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Department of Medicine, Division of Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Ari Ahola-Olli
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center, Fimlab Laboratories, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jorma Viikari
- Department of Medicine, Division of Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Olli Raitakari
- Research Centre for Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Suvi Rovio
- Research Centre for Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
| | - Aino Saarinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, 00014 Helsinki, Finland
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Hada A, Minatani M, Wakamatsu M, Kitamura T. Disability during Early Pregnancy: Using the Sheehan Disability Scale during the First Trimester in Japan. Healthcare (Basel) 2022; 10:healthcare10122514. [PMID: 36554038 PMCID: PMC9777738 DOI: 10.3390/healthcare10122514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Many pregnant women experience impairments in social, occupational, or other important functioning. Aim: This study aimed to confirm measurement and structural invariance of the Sheehan Disability Scale (SDS) and its validity during early pregnancy. Design: Longitudinal study with two observations. Methods: Questionnaires were distributed to pregnant women attending antenatal clinics at gestational weeks 10-13. Of 382 respondents, 129 responded to the SDS again 1 week later. Results: Confirmatory factor analysis shows good fit with the data: χ2/df = 0, comparative fit index (CFI) = 1.000, standardized root mean square residual (SRMR) = 0, and root mean square error of approximation (RMSEA) = 0.718. There is acceptable configural, measurement, and structural invariance of the factor structure between primiparas and multiparas as well as between two observation occasions. The Pregnancy-Unique Quantification of Emesis and Nausea, Patient Health Questionnaire-9, and Insomnia Severity Index subscales explain 47% of the variance in SDS scores. Conclusion: Perinatal health care professionals should pay more attention to the difficulties and disabilities that pregnant women face.
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Affiliation(s)
- Ayako Hada
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan
- Kitamura KOKORO Clinic Mental Health, Tokyo 151-0063, Japan
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
| | - Mariko Minatani
- Life Value Creation Unit, NTT DATA Institute of Management Consulting, Inc., Tokyo 102-0093, Japan
| | - Mikiyo Wakamatsu
- Department of Reproductive Health Care Nursing, Kagoshima University Faculty of Medicine School of Health Sciences, Kagoshima 890-8544, Japan
| | - Toshinori Kitamura
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan
- Kitamura KOKORO Clinic Mental Health, Tokyo 151-0063, Japan
- T. and F. Kitamura Foundation for Studies and Skill Advancement in Mental Health, Tokyo 151-0063, Japan
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
- Correspondence:
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9
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Siegel-Ramsay JE, Wu B, Bond M, Spelber D, Chiang KS, Lanza di Scalea T, Collier S, Smith T, Nunez L, Fuller E, Strakowski SM, Lippard E, Almeida JR. Subjective cognitive impairment and its relationship to sleep impairment, anxiety severity, and depressive symptoms in individuals with bipolar disorder. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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10
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Bruhn M, Laugesen H, Kromann-Larsen M, Trevino CS, Eplov L, Hjorthøj C, Carlsson J. The effect of an integrated care intervention of multidisciplinary mental health treatment and employment services for trauma-affected refugees: study protocol for a randomised controlled trial. Trials 2022; 23:859. [PMID: 36209104 PMCID: PMC9547630 DOI: 10.1186/s13063-022-06774-z] [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: 09/05/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background The complexity of past trauma and ongoing post-migration stressors challenges the existing mental health treatment for trauma-affected refugees. Therefore, interventions are needed to accommodate these complex challenges in mental health treatment. This study examines the effect of an add-on integrated care intervention compared to treatment as usual (TAU) for trauma-affected refugees in a randomised controlled trial (RCT). Methods The study is carried out at a Danish outpatient clinic and will include 197 treatment-seeking refugees with post-traumatic stress disorder (PTSD) who are unemployed and affiliated with municipal employment services. Mental health TAU comprises 10 sessions with a medical doctor (pharmacological treatment and psychoeducation) and 16–20 sessions with a psychologist (manual-based cognitive behavioural therapy) for a period of 8 to 12 months. The add-on intervention strengthens coordination between mental health treatment and employment interventions with three cross-sectoral collaborative meetings during the mental health treatment. The integrated care intervention draws attention to the bidirectional impact of mental health problems and post-migration stressors and focuses on cross-sectoral shared plans. The primary outcome is functioning, measured by WHODAS 2.0, the interviewer-administered 12-item version, with secondary outcomes measuring quality of life, mental health symptoms, and post-migration stressors. Discussion The RCT is novel in intervention design for trauma-affected refugees and will bring forward new perspectives and knowledge of integrated care interventions for trauma-affected refugees. The integrated care intervention is expected to reduce post-migration stressors that negatively affect the treatment of trauma-related mental health problems, thereby improving preconditions for enhanced treatment outcomes. The intervention builds on existing practices in the Danish healthcare and employment sectors, which ensures high scalability and sustainability for future practices. Trial registration ClinicalTrials.gov Identifier: NCT04244864, registered 28 January 2020. Protocol version: 17 September 2022, version 2. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06774-z.
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Affiliation(s)
- Maja Bruhn
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark.
| | - Henriette Laugesen
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Matilde Kromann-Larsen
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Cathrine Selnes Trevino
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Lene Eplov
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Gentofte, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Gentofte, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Zamar AC, Kouimtsidis C, Lulsegged A, Roberts R, Koutsomitros T, Stahl D. A New Treatment Protocol of Combined High-Dose Levothyroxine and Repetitive Transcranial Magnetic Stimulation for the Treatment of Rapid-Cycling Bipolar Spectrum Disorders: A Cohort Evaluation of 55 Patients. J Clin Med 2022; 11:jcm11195830. [PMID: 36233698 PMCID: PMC9572106 DOI: 10.3390/jcm11195830] [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: 07/20/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Bipolar spectrum disorders (BSD) are highly disabling, with rapid cycling being treatment resistant. High-dose levothyroxine (HDT) has been reported to be effective. Diagnosis is associated with mutations in thyroid-activating enzymes and cerebral transporter protein carrier. Repetitive transcranial magnetic stimulation (rTMS) has neuroplastic effects. Methods: We report data on 55 severely symptomatic patients with rapid-cycling BSD treated with a combination protocol of HDT and rTMS. Of the patients, 31 patients (56.4%) were female and 40 (72.7%) had at least one additional diagnosis. Results: Patients were evaluated at three monthly intervals after acute treatment. Remission was measured using the Sheehan Disability Scale (SDS). The average number of medications prescribed was 1.8, with 32 patients (58.2%) needing only levothyroxine. The average dose of levothyroxine was 303.7 mcg (50 mcg−1000 mcg). A total of 53 patients were in remission (96.4%), with an average duration of 2.0 years. The SDS scores decreased significantly (Cohen’s d = 2.61 (95% C.I. 1.81 to 2.83, p < 0.001). One patient had reversible side effects. A total of 52 (94.3%) patients had Deiodinase 1 and 2 (DiO1/DiO2) or SLCO1C1 protein carrier gene mutations. Conclusion: The data support the safety and acceptability of combined HDT/rTMS. Patients achieved long remissions with substantial improvements in quality of life.
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Affiliation(s)
- Antonis C. Zamar
- The London Psychiatry Centre, London W1G 7HG, UK
- Correspondence: ; Tel.: +44-2075804224
| | - Christos Kouimtsidis
- The London Psychiatry Centre, London W1G 7HG, UK
- Imperial College, London SW7 2BX, UK
| | | | | | - Theodoros Koutsomitros
- Greek rTMS Clinic, Medical Psychotherapeutic Centre (ΙΨΚ), 546 24 Thessaloniki, Greece
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Daniel Stahl
- Statistics Kings College, Strand, London WC2R 2LS, UK
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12
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Yamada F, Kataoka Y, Minatani M, Hada A, Wakamatsu M, Kitamura T. The NVP QOL Questionnaire: Psychometric properties of the self-report measure of health-related quality of life for nausea and vomiting during pregnancy. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e21. [PMID: 38868696 PMCID: PMC11114323 DOI: 10.1002/pcn5.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/10/2022] [Accepted: 05/24/2022] [Indexed: 06/14/2024]
Abstract
Aim The Nausea and Vomiting of Pregnancy Quality of Life (NVP QOL) Questionnaire is a self-report measure of health-related QOL for nausea and vomiting during pregnancy. This study determines the best fitting factor structure for the NVP QOL Questionnaire and explores its measurement invariance in terms of observation time and parity. Methods A test-retest study of pregnant women was conducted at Gestational Weeks (GWs) 10-13 (T1: N = 381) and 1 week later (T2: n = 128) at one hospital and five clinics with the NVP QOL and the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE). Exploratory and confirmatory factor analyses were performed to compare different factor structure models and evaluate measurement invariance of the best fitting model between two time points and between primiparas and multiparas. Concurrent validity of the NVP QOL was clarified by correlations with the PUQE, Sheehan Disability Scale, and other scales. Results The one-factor model had the best fit. This factor structure model was acceptable up to the factor invariance level for two time points and up to the factor mean level for primiparas versus multiparas. Correlations between NVP QOL, PUQE, and Sheehan Disability Scale scores were strong. Women with higher NVP QOL scores were more likely to lose weight, have lower daily fluid intake, have reduced fluid and food intake since pregnancy began, and receive outpatient or inpatient treatment. Conclusion The one-factor structure and measurement invariance of the NVP QOL at different times and parities were demonstrated, suggesting that the NVP QOL can be used to evaluate primiparas and multiparas in a longitudinal study.
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Affiliation(s)
- Fukiko Yamada
- Kitamura Institute of Mental Health TokyoTokyoJapan
- Department of Women's Health and MidwiferySt. Luke's International UniversityTokyoJapan
| | - Yaeko Kataoka
- Department of Women's Health and MidwiferySt. Luke's International UniversityTokyoJapan
| | - Mariko Minatani
- Kitamura Institute of Mental Health TokyoTokyoJapan
- Life Value Creation UnitNTT DATA Institute of Management Consulting Inc.TokyoJapan
| | - Ayako Hada
- Kitamura Institute of Mental Health TokyoTokyoJapan
- Department of Community Mental Health and Law, National Center of Neurology and PsychiatryNational Institute of Mental HealthTokyoJapan
| | - Mikiyo Wakamatsu
- Department of Reproductive Health Care Nursing, School of Health Sciences, Faculty of MedicineKagoshima UniversityKagoshimaJapan
| | - Toshinori Kitamura
- Kitamura Institute of Mental Health TokyoTokyoJapan
- Kitamura KOKORO Clinic Mental HealthTokyoJapan
- T. and F. Kitamura Foundation for Studies and Skill Advancement in Mental HealthTokyoJapan
- Department of Psychiatry, Graduate School of MedicineNagoya UniversityNagoyaJapan
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13
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Takarangi MKT, Moeck EK, Peters J, Stirling NSJ. Posttraumatic stress disorder symptom severity and functional impairment in the education domain. J Anxiety Disord 2022; 88:102573. [PMID: 35525074 DOI: 10.1016/j.janxdis.2022.102573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/21/2022] [Accepted: 04/20/2022] [Indexed: 12/12/2022]
Abstract
To comprehensively understand and treat Posttraumatic Stress Disorder (PTSD), we need to accurately assess how PTSD symptoms affect people's daily functioning (e.g., in work, study, and relationships). However, the predominant use of self-report functional impairment measures-which are not validated against observable behavior-limits our understanding of this issue. To address this gap, we examined the relationship between posttraumatic stress (PTS) symptoms (including symptom clusters) and subjective and objective measures of functional impairment in the education domain. University students completed online self-report measures of educational impairment, PTS symptoms, intelligence and childhood trauma. We accessed participants' average grades at the end of the semester in which they participated. After controlling for IQ and childhood trauma, increased PTS symptoms were associated with both higher subjective educational impairment and lower Grade Point Average; this relationship was strongest for subjective global ratings of educational impairment, compared to educational impairment assessed according to specific examples. Our results suggest conceptual overlap between symptoms and impairment, and point to the benefit of using both objective and subjective modes of assessing impairment.
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Affiliation(s)
| | - Ella K Moeck
- Flinders University, Australia; University of Melbourne, Australia
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14
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Persson Asplund R, Asplund S, von Buxhoeveden H, Delby H, Eriksson K, Svenning Gerhardsson M, Palm J, Skyttberg T, Torstensson J, Ljótsson B, Carlbring P, Andersson G. Work-focused versus generic internet-based interventions for employees with stress-related disorders: A randomized controlled trial (Preprint). J Med Internet Res 2022; 25:e34446. [PMID: 37097739 PMCID: PMC10170369 DOI: 10.2196/34446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/22/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In recent decades, stress-related disorders have received more attention, with an increasing prevalence, especially within the working population. The internet provides new options for broad dissemination, and a growing body of evidence suggests that web-based interventions for stress might be effective. However, few studies have examined the efficacy of interventions in clinical samples and work-related outcomes. OBJECTIVE The aim of this study was to evaluate the efficacy of an internet-based cognitive behavioral intervention for stress-related disorders integrating work-related aspects (work-focused and internet-based cognitive behavioral therapy [W-iCBT]), compared with a generic internet-based cognitive behavioral therapy (iCBT) group and a waitlist control (WLC) group. METHODS In this trial, 182 employees, mainly employed in the health care, IT, or educational sector, who fulfilled the criteria for a stress-related disorder, were randomized to a 10-week W-iCBT (n=61, 33.5%), generic iCBT (n=61, 33.5%), or WLC (n=60, 33%). Self-rated questionnaires on perceived stress, burnout, exhaustion, and other mental health- and work-related outcomes were administered before and after the treatment and at 6- and 12-month follow-ups. RESULTS Compared with the WLC group, participants of the W-iCBT and iCBT groups showed an equal and significant reduction in the primary outcome (Shirom-Melamed Burnout Questionnaire [SMBQ]) from pretreatment to posttreatment assessment (Cohen d=1.00 and 0.83, respectively) and at the 6-month follow-up (Cohen d=0.74 and 0.74, respectively). Significant moderate-to-large effect sizes were also found in the secondary health- and work-related outcomes. The W-iCBT was the only group that exhibited significant effects on work ability and short-term sickness absence. Short-term sickness absence was 445 days lower than the WLC group and 324 days lower than the iCBT intervention group. However, no significant differences were found in terms of work experience or long-term sick leave. CONCLUSIONS The work-focused and generic iCBT interventions proved to be superior compared with the control condition in reducing chronic stress and several other mental health-related symptoms. Interestingly, effects on work ability and short-term sickness absence were only seen between the W-iCBT intervention and the WLC groups. These preliminary results are promising, indicating that treatments that include work aspects may have the potential to accelerate recovery and reduce short-term sickness absence because of stress-related disorders. TRIAL REGISTRATION ClinicalTrials.gov NCT05240495; https://clinicaltrials.gov/ct2/show/NCT05240495 (retrospectively registered).
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Affiliation(s)
- Robert Persson Asplund
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Sofia Asplund
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Helene von Buxhoeveden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hanna Delby
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Karin Eriksson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Joachim Palm
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Thea Skyttberg
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Julia Torstensson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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15
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Gumport NB, Harvey AG. Memory and learning for sleep and circadian treatment in serious mental illness treated in a community mental health setting. Behav Res Ther 2022; 149:104029. [PMID: 34995953 PMCID: PMC10883147 DOI: 10.1016/j.brat.2021.104029] [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: 11/04/2020] [Revised: 11/30/2021] [Accepted: 12/28/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Existing research has demonstrated that patient memory and learning of treatment contents are poor and poorer learning is associated with worse treatment outcome. Most prior studies have included individuals from only a single diagnostic group, offer limited data on possible contributors to poor memory and learning, and have included small samples recruited in university settings. This study sought to describe patient recall of treatment contents, describe patient learning of treatment contents, examine contributors to patient recall and learning of treatment contents, and examine the association of patient recall and learning of treatment contents with treatment outcome. METHODS Adults with serious mental illness and sleep and circadian dysfunction (N = 99) received the Transdiagnostic Intervention for Sleep and Circadian Dysfunction in a community mental health setting. Measures of recall, learning, age, years of education, symptom severity, and treatment outcome were collected at post-treatment and 6-month follow-up. RESULTS Recall and learning were poor, fewer years of education was associated with worse recall and learning, and recall and learning were not associated with treatment outcome. CONCLUSIONS The findings offer evidence that poor patient memory for, and learning of, treatment contents extends to community settings and are transdiagnostic concerns.
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16
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Niu X, Dembek C, Fan Q, Mao Y, Divino V, Burch S, Tocco M. The impact of lurasidone on functioning and indirect costs in adults with bipolar depression: a post-hoc analysis. J Med Econ 2022; 25:152-159. [PMID: 35037813 DOI: 10.1080/13696998.2022.2030147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this post-hoc analysis was to assess the impact of lurasidone monotherapy on functional impairment, productivity, and associated indirect costs in patients with bipolar depression. METHODS Data were analyzed from a 6-week randomized, double-blind (DB; NCT00868699), placebo-controlled trial of lurasidone monotherapy and a 6-month open label extension (OLE; NCT00868959) study. Patients with bipolar depression who completed the 6-week DB trial were subsequently enrolled in the OLE. Analysis of the OLE was limited to patients who either continued lurasidone (LUR-LUR) or switched from placebo to lurasidone monotherapy (PBO-LUR). The Sheehan Disability Scale (SDS), which measures functional impairment and productivity, was collected at DB baseline, DB week 6/OLE baseline, OLE month 3, and OLE month 6. Annual indirect costs were calculated based on days lost or unproductive from work/school due to symptoms. Effect sizes (ES) in functioning and days lost/unproductive were reported for the DB trial and mean changes for the OLE. RESULTS A total of 485 patients were enrolled in the DB trial (lurasidone: n = 323; placebo: n = 162) and 316 were in the lurasidone monotherapy group during the OLE (LUR-LUR: n = 210; PBO-LUR: n = 106). In the DB trial, improvements in functioning (work: ES = 0.36, p = .0071; social: ES = 0.55, p < .0001; family: ES = 0.50, p < .0001) were significantly greater for lurasidone compared to placebo. Reductions in days lost (ES = 0.33, p = .0050) and unproductive (ES = 0.45, p = .0001) were significantly higher for lurasidone vs. placebo. This resulted in a greater reduction in indirect costs for lurasidone vs. placebo (least squares mean (standard error) = -$32,322 ($2,100) vs. -$20,091 ($2,838)). Improvements in functioning and productivity were sustained during the 6-month OLE for both LUR-LUR and PBO-LUR. CONCLUSIONS Lurasidone monotherapy for the treatment of bipolar depression significantly improved functioning and reduced indirect costs vs. placebo at week 6. Significant improvements in functioning and productivity were sustained for 6 months for both LUR-LUR and PBO-LUR.
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Affiliation(s)
- Xiaoli Niu
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | - Qi Fan
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Yongcai Mao
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | - Steven Burch
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Split-Belt Training but Not Cerebellar Anodal tDCS Improves Stability Control and Reduces Risk of Fall in Patients with Multiple Sclerosis. Brain Sci 2021; 12:brainsci12010063. [PMID: 35053807 PMCID: PMC8773736 DOI: 10.3390/brainsci12010063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
The objective of this study was to examine the therapeutic potential of multiple sessions of training on a split-belt treadmill (SBT) combined with cerebellar anodal transcranial direct current stimulation (tDCS) on gait and balance in People with Multiple Sclerosis (PwMS). Twenty-two PwMS received six sessions of anodal (PwMSreal, n = 12) or sham (PwMSsham, n = 10) tDCS to the cerebellum prior to performing the locomotor adaptation task on the SBT. To evaluate the effect of the intervention, functional gait assessment (FGA) scores and distance walked in 2 min (2MWT) were measured at the baseline (T0), day 6 (T5), and at the 4-week follow up (T6). Locomotor performance and changes of motor outcomes were similar in PwMSreal and PwMSsham independently from tDCS mode applied to the cerebellum (anodal vs. sham, on FGA, p = 0.23; and 2MWT, p = 0.49). When the data were pooled across the groups to investigate the effects of multiple sessions of SBT training alone, significant improvement of gait and balance was found on T5 and T6, respectively, relative to baseline (FGA, p < 0.001 for both time points). The FGA change at T6 was significantly higher than at T5 (p = 0.01) underlining a long-lasting improvement. An improvement of the distance walked during the 2MWT was also observed on T5 and T6 relative to T0 (p = 0.002). Multiple sessions of SBT training resulted in a lasting improvement of gait stability and endurance, thus potentially reducing the risk of fall as measured by FGA and 2MWT. Application of cerebellar tDCS during SBT walking had no additional effect on locomotor outcomes.
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Tolin DF, Frost RO, Steketee G, Muroff J. Cognitive Behavioral Therapy For Hoarding Disorder: A Meta-Analysis. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:468-476. [PMID: 35747301 PMCID: PMC9063573 DOI: 10.1176/appi.focus.19403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/24/2014] [Accepted: 09/27/2014] [Indexed: 06/15/2023]
Abstract
(Appeared originally in Depression and Anxiety 2015; 32:158-166).
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Affiliation(s)
- David F Tolin
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Psychology, Smith College, Northampton, Massachusetts; School of Social Work, Boston University, Boston, Massachusetts
| | - Randy O Frost
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Psychology, Smith College, Northampton, Massachusetts; School of Social Work, Boston University, Boston, Massachusetts
| | - Gail Steketee
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Psychology, Smith College, Northampton, Massachusetts; School of Social Work, Boston University, Boston, Massachusetts
| | - Jordana Muroff
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Psychology, Smith College, Northampton, Massachusetts; School of Social Work, Boston University, Boston, Massachusetts
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19
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Midhage R, Hermansson L, Söderberg P, Tungström S, Nordenskjöld A, Svanborg C, Ginsberg Y, Ramklint M. Psychometric evaluation of the Swedish self-rated 36-item version of WHODAS 2.0 for use in psychiatric populations - using classical test theory. Nord J Psychiatry 2021; 75:494-501. [PMID: 33969799 DOI: 10.1080/08039488.2021.1897162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM The aim of this study was to evaluate the reliability and validity of the Swedish version of the self-rated 36-item WHODAS 2.0 in patients from Swedish psychiatric outpatient settings, using classical test theory. METHODS The 36-item WHODAS 2.0, together with the Sheehan Disability Scale (SDS), was filled in by a sample of 780 participating psychiatric patients: 512 (65.6%) women, 263 (33.7%) men, and 5 (0.6%) who did not report any sex. RESULTS The internal consistency, measured by Cronbach's alpha, for the different domains of functioning were between 0.70 and 0.94, and interpreted as good. The confirmatory factor analysis (CFA) revealed two levels: the first level consisted of a general disability factor, while the second level consisted of the six domains of the scale, respectively. The model had borderline fit. There was a significant correlation between WHODAS 2.0 36-item and SDS (n = 395). The WHODAS 2.0 differed significantly between diagnostic groups. CONCLUSION The present study demonstrates that the Swedish self-rated 36-item version of WHODAS 2.0, within a psychiatric outpatient population, showed good reliability and convergent validity. We conclude that the self-rated 36-item Swedish version of WHODAS 2.0 can be used for valid interpretations of disability in patients with psychiatric health conditions.
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Affiliation(s)
- Robin Midhage
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Liselotte Hermansson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Per Söderberg
- Department of Psychiatric Research and Development, Säter, Sweden
| | - Stefan Tungström
- Department of Psychiatric Research and Development, Säter, Sweden
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Cecilia Svanborg
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Ginsberg
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,The National Board of Health and Welfare, Stockholm, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Soler CT, Vadlin S, Olofsdotter S, Ramklint M, Sonnby K, Nilsson K. Psychometric evaluation of the Swedish Child Sheehan Disability Scale in adolescent psychiatric patients. Scand J Child Adolesc Psychiatr Psychol 2021; 9:137-146. [PMID: 34239817 PMCID: PMC8254144 DOI: 10.21307/sjcapp-2021-015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Assessment of disability is part of the psychiatric diagnostic process, and validated scales are needed for the assessment of functioning. The Swedish translations of the Child Sheehan Disability Scale (CSDS) for adolescents and parents (CSDS-P) have been adapted for use in psychiatric settings. Objective: The purpose of the study was to explore the psychometric properties of the Swedish CSDS and the CSDS-P among adolescent psychiatric patients. Method: Patients (n = 107) were assessed with the CSDS, the Strengths and Difficulties Questionnaire (SDQ adolescent), and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) diagnostic interview. Their parents participated in the interview and completed the CSDS-P and SDQ parent. Results: Internal consistency was α =.813 for the CSDS (three items) and α =.842 for the CSDS-P (five items). For both scales, principal component analyses showed one component. The correlations between the total scores of the CSDS and CSDS-P in relation to a general K-SADS-PL symptom summation index were rs = .332, p < .001 and rs = .237, p = .014, respectively. Correlations with the total K-SADS function summation index were rs < .300 for both. The correlation between the CSDS and the total difficulties score on the SDQ was rs = .433, p < .001. Conclusions: The Swedish translations of the CSDS and CSDS-P had similar psychometric properties to Whiteside's CSDS and the Adult Sheehan Disability Scale. Concurrent validity and correlation between the CSDS and CSDS-P were weak.
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Affiliation(s)
- Catalina Tores Soler
- Center for Clinical Research, Uppsala University, Västmanlands County Hospital, Uppsala, Sweden
| | - Sofia Vadlin
- Center for Clinical Research, Uppsala University, Västmanlands County Hospital, Uppsala, Sweden
| | - Susanne Olofsdotter
- Center for Clinical Research, Uppsala University, Västmanlands County Hospital, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden
| | - Karin Sonnby
- Center for Clinical Research, Uppsala University, Västmanlands County Hospital, Uppsala, Sweden
| | - Kent Nilsson
- Center for Clinical Research, Uppsala University, Västmanlands County Hospital, Uppsala, Sweden
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21
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Wolf NM, Løkkegaard SS, Elklit A. Psychological Distress and Attachment Insecurity of Stalked Mothers. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:6487-6511. [PMID: 30569786 DOI: 10.1177/0886260518819883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is a lack of research about intimate partner stalking when victim and stalker have children together. The aim of the current study was to provide knowledge about the mental health status and attachment patterns of mothers stalked by the father of one or more of their children. One hundred ninety six Danish women, recruited via a closed social network for stalked mothers, completed an anonymous online questionnaire concerning their experiences of violence during and after the relationship with the stalker, relationship characteristics, attachment patterns, and psychological distress. Results indicated high exposure to psychological maltreatment during the victim-stalker relationship, harassing and violent stalking behaviors after relationship termination, and high levels of functional disabilities, PTSD (posttraumatic stress disorder), other trauma-related, affective, and somatization symptoms. Furthermore, the women retrospectively reported an increase in attachment insecurity from the time before their relationship with the stalker to the time of study participation (after they experienced relationship violence and/or stalking). Stalking behaviors uniquely contributed to the explanation of the mothers' psychological distress above the effects of relationship violence. Moreover, attachment insecurity appeared to be the strongest predictor of psychological distress. Having children together with their stalker captures women in an ongoing situation of threat and interpersonal traumatization that differs from other forms of stalking in many respects. The present study is the first drawing attention to the experiences and suffering of stalked mothers, a particularly vulnerable group of stalking victims.
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Affiliation(s)
- Nele Marie Wolf
- University of Southern Denmark, Odense, Denmark
- Center of Psychotraumatology, Alexianer Krefeld GmbH, Cologne, Germany
| | | | - Ask Elklit
- University of Southern Denmark, Odense, Denmark
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22
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Studart-Bottó P, Bezerra-Filho S, Sarmento S, Miranda-Scippa Â. Social support in patients with bipolar disorder and differing ages at onset. Clin Psychol Psychother 2021; 29:351-359. [PMID: 34128280 DOI: 10.1002/cpp.2617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The main purpose of this study was to evaluate the association between age at onset and social support in outpatients with bipolar disorder who were in the recovery phase. We also investigated the association between age at onset and disability. METHODS A total of 180 bipolar disorder I outpatients, of whom 50 had early onset with age at onset ≤18 years old, 108 had middle onset with age at onset between 19 and 39 years old, and 22 had late onset with age at onset ≥40 years old, were assessed with the Medical Outcomes Study Social Support Scale and Sheehan Disability Scale. RESULTS The early onset group had lower tangible social support, longer length of illness, more childless participants, lower income and more suicide attempters than the late onset group. CONCLUSIONS Early onset seems to have inferior outcomes in tangible social support than late onset, but this trend should be considered as a starting point for future studies.
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Affiliation(s)
- Paula Studart-Bottó
- Mood and Anxiety Disorders Program (CETHA), University Hospital, Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | - Severino Bezerra-Filho
- Mood and Anxiety Disorders Program (CETHA), University Hospital, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Stella Sarmento
- Mood and Anxiety Disorders Program (CETHA), University Hospital, Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | - Ângela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), University Hospital, Federal University of Bahia (UFBA), Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil.,Department of Neurosciences and Mental Health, Medical School, UFBA, Salvador, Brazil
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23
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Micic G, Lovato N, Ferguson SA, Burgess HJ, Lack L. Circadian tau differences and rhythm associations in delayed sleep-wake phase disorder and sighted non-24-hour sleep-wake rhythm disorder. Sleep 2021; 44:5867108. [PMID: 32619243 DOI: 10.1093/sleep/zsaa132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/19/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES We investigated biological and behavioral rhythm period lengths (i.e. taus) of delayed sleep-wake phase disorder (DSWPD) and non-24-hour sleep-wake rhythm disorder (N24SWD). Based on circadian phase timing (temperature and dim light melatonin onset), DSWPD participants were dichotomized into a circadian-delayed and a circadian non-delayed group to investigate etiological differences. METHODS Participants with DSWPD (n = 26, 17 m, age: 21.85 ± 4.97 years), full-sighted N24SWD (n = 4, 3 m, age: 25.75 ± 4.99 years) and 18 controls (10 m, age: 23.72 ± 5.10 years) participated in an 80-h modified constant routine. An ultradian protocol of 1-h "days" in dim light, controlled conditions alternated 20-min sleep/dark periods with 40-min enforced wakefulness/light. Subjective sleepiness ratings were recorded prior to every sleep/dark opportunity and median reaction time (vigilance) was measured hourly. Obtained sleep (sleep propensity) was derived from 20-min sleep/dark opportunities to quantify hourly objective sleepiness. Hourly core body temperature was recorded, and salivary melatonin assayed to measure endogenous circadian rhythms. Rhythm data were curved using the two-component cosine model. RESULTS Patients with DSWPD and N24SWD had significantly longer melatonin and temperature taus compared to controls. Circadian non-delayed DSWPD had normally timed temperature and melatonin rhythms but were typically sleeping at relatively late circadian phases compared to those with circadian-delayed DSWPD. CONCLUSIONS People with DSWPD and N24SWD exhibit significantly longer biological circadian rhythm period lengths compared to controls. Approximately half of those diagnosed with DSWPD do not have abnormally delayed circadian rhythm timings suggesting abnormal phase relationship between biological rhythms and behavioral sleep period or potentially conditioned sleep-onset insomnia.
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Affiliation(s)
- Gorica Micic
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - Nicole Lovato
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Adelaide, South Australia
| | - Helen J Burgess
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Leon Lack
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia.,College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia
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Yee KS, Pokrzywinski R, Hareendran A, Shaffer S, Sheehan DV. Evaluating functional disability in clinical trials of lisdexamfetamine dimesylate in binge eating disorder using the Sheehan Disability Scale. Int J Methods Psychiatr Res 2021; 30:e1849. [PMID: 32841462 PMCID: PMC7992284 DOI: 10.1002/mpr.1849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/28/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study examined Sheehan Disability Scale (SDS) performance in binge eating disorder (BED) and explored relationships between SDS and BED outcomes using data from three placebo-controlled lisdexamfetamine (LDX) studies (two short-term, dose-optimized studies and one double-blind, randomized-withdrawal study) in adults with Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR)-defined BED. METHODS Analyses evaluated the psychometric properties of the SDS. RESULTS Confirmatory factor analysis supported a unidimensional total score in the short-term studies, with internal consistency (Cronbach's α) being 0.878. Total score exhibited good construct validity, with moderate and statistically significant correlations observed with Yale-Brown Obsessive Compulsive Scale modified for binge eating, Binge Eating Scale (BES), and EuroQol Group 5-Dimension 5-Level health status index scores. Known-groups validity analysis for the short-term studies demonstrated a significantly lower total score at end of study in participants considered "not ill" versus "ill" based on Clinical Global Impressions-Severity scores. SDS total score changes in the short-term studies were greater in responders than nonresponders based on binge eating abstinence or BES score. In the randomized-withdrawal study, SDS scores increased relative to baseline to a greater extent in participants randomized to placebo than LDX. CONCLUSIONS These analyses support the reliability, validity, and responsiveness to change of the SDS in individuals with BED.
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Affiliation(s)
- Karen S Yee
- Shire, a Member of the Takeda Group of Companies, Cambridge, Massachusetts, USA
| | | | | | | | - David V Sheehan
- University of South Florida College of Medicine, Tampa, Florida, USA
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25
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Liao Z, You C, Chen Y, Zhang J, Ding L. Psychometric properties of the Chinese version of the family accommodation scale for obsessive-compulsive disorder interviewer-rated. Compr Psychiatry 2021; 105:152220. [PMID: 33348295 DOI: 10.1016/j.comppsych.2020.152220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Family accommodation (FA) in obsessive-compulsive disorder (OCD) means that the relatives of patients are involved in, help or facilitate patients' ritual behaviors and avoidance, which is a frequent occurrence and underresearched phenomenon in China. Recent studies have suggested that FA is adversely associated with treatment response, contradictory to the goal of cognitive behavior therapy, a contributor to the maintenance of symptoms and increased symptom severity, and associated with low levels of family and social functioning. There is increasing interest and focus on establishing a family-based intervention for OCD treatment based on the inclusion of relatives by decreasing FA. The present study explored the psychometric properties of the Chinese version of the Family Accommodation Scale for OCD Interviewer-Rated (FAS-IR). METHOD A total of 109 patients with OCD and 91 primary relatives were assessed in corresponding patient and family measures, and the FAS-IR was administered to relatives by trained interviewers. RESULTS More than 90% of the relatives accommodated patients' symptoms with at least one kind of FA behavior over the previous week, and the incidence of extreme or everyday routines was as high as 59.3%. Exploratory factor analysis demonstrated two-factor structure for the whole scale, including (1) modification and facilitation, and (2) participation. Cronbach's alpha was 0.798 for the whole scale, and the interrater and test-retest reliability coefficients were 0.835 (95%CI: 0.603-0.937) and 0.882 (95%CI: 0.685-0.959), respectively. Convergent validity was supported in exploring FA and was associated with symptom severity, level of functional impairment and family functioning related to OCD. The FA was not significantly correlated with depressive symptoms rated by the patients, as evidence of acceptable divergent validity. There was no significant difference in FA total score based on patient gender, patient age, or relationship with patients. CONCLUSIONS The Chinese version of the FAS-IR demonstrated excellent psychometric properties for assessing the degree of FA, suggesting that it is a useful and valuable instrument in clinical and research settings.
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Affiliation(s)
- Zhenhua Liao
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Ciping You
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China
| | - Ying Chen
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China
| | - Jinli Zhang
- Department of Psychiatry Rehabilitation Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Lijun Ding
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China.
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26
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Chen K, Barnes-Horowitz N, Treanor M, Sun M, Young KS, Craske MG. Virtual Reality Reward Training for Anhedonia: A Pilot Study. Front Psychol 2021; 11:613617. [PMID: 33488482 PMCID: PMC7817899 DOI: 10.3389/fpsyg.2020.613617] [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] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/04/2020] [Indexed: 02/01/2023] Open
Abstract
Anhedonia is a risk factor for suicide and poor treatment response in depressed individuals. Most evidence-based psychological therapies target symptoms of heightened negative affect (e.g., negative inferential style) instead of deficits in positive affect (e.g., attenuated reward response) and typically show little benefit for anhedonia. Viewing positive scenes through virtual reality (VR) has been shown to increase positive affect and holds great promise for addressing anhedonic symptoms. In this pilot study, six participants with clinically significant depression completed 13 sessions of exposure to positive scenes in a controlled VR environment. Significant decreases were found in self-reported anhedonia, depression, anxiety, and impairments in functioning from baseline to 1-month follow-up. Negative affect decreased over all 13 sessions, and positive affect increased over sessions 8-13. Results suggest that positive experiences in VR may be a novel avenue for the treatment of anhedonia in depressed individuals.
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Affiliation(s)
- Kelly Chen
- Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Nora Barnes-Horowitz
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Treanor
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Sun
- Department of Psychology, Dartmouth College, Hanover, NH, United States
| | - Katherine S. Young
- Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
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Tremain H, Fletcher K, Scott J, McEnery C, Berk M, Murray G. The influence of stage of illness on functional outcomes after psychological treatment in bipolar disorder: A systematic review. Bipolar Disord 2020; 22:666-692. [PMID: 32621794 DOI: 10.1111/bdi.12974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to advance understanding of stage of illness in bipolar disorder (BD), by interrogating the literature for evidence of an influence of stage of illness on functional (ie non-symptom) outcomes following psychosocial intervention. METHODS A systematic literature search following PRISMA guidelines was conducted to identify empirical studies of psychosocial interventions for established BD. To investigate stage as a predictor of three functional outcomes (general/social functioning, cognitive functioning and quality of life [QoL]), study samples were dichotomised into earlier and later stage using proxy measures identified in existing staging models. Findings were integrated using data-based convergent synthesis. RESULTS A total of 88 analyses from 62 studies were identified. Synthesis across studies suggested that psychosocial intervention was more likely to be effective for general functioning outcomes earlier in the course of established BD. No stage-related differences were found for cognitive or QoL outcomes. Exploratory investigations found some evidence of an interaction between specific intervention type and stage of illness in predicting outcomes. CONCLUSIONS A novel systematic review provided preliminary evidence that benefits general/social functioning may be more pronounced in earlier versus later stages of established BD. The review also generated hypotheses about a potential three-way interaction, whereby specific psychosocial interventions may be best placed to target functional outcomes in earlier versus later stage BD. The strength of conclusions is limited by the overall low-quality and significant heterogeneity of studies. Further research is urgently required to understand the impact of illness stage on the effectiveness of psychosocial interventions.
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Affiliation(s)
- Hailey Tremain
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia
| | - Kathryn Fletcher
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia
| | - Jan Scott
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia.,Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Carla McEnery
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Vic, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Vic, Australia.,The Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Parkville, Vic, Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia
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Cheung HN, Chan SWY, Williams JM. Validation of Chinese Multidimensional Depression Assessment Scale (MDAS) in Inner Mongolia pregnant women and risk factors of antenatal depression in Inner Mongolia in the era of one-child policy. PLoS One 2020; 15:e0227944. [PMID: 32196492 PMCID: PMC7083312 DOI: 10.1371/journal.pone.0227944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pregnancy involves physiological changes in reproductive and endocrine systems, and social role changes that can increase the risk of mental health problems. In China, greater emphasis has been given to postpartum depression and its negative impact on infant development. This study examined depression in pregnant women in Inner Mongolia, who are under the influence of cultural values of collectivism and social factors specific to China. Chinese society adheres firmly to traditional values, while market reform, birth-control policy, together with high parental investment in childcare and rearing construct a unique and sometimes unfavorable environment for Chinese women that may influence their depression expression. THE AIMS OF THIS STUDY ARE TWOFOLD First, it validated the Chinese Multidimensional Depression Assessment Scale (MDAS), a holistic self-report questionnaire measuring depression severity in four domains of depression-emotional, somatic, cognitive and interpersonal in pregnant women in Inner Mongolia; second, it examined the influences of demographic characteristics (including age, education and employment), pregnancy characteristics (week of gestation, first pregnancy), self-esteem, social support, social activity, work stress, and work-family balance on depression. METHODS A total of 234 pregnant women, mostly in their third trimester, were recruited in an antenatal hospital in Inner Mongolia and self-reported questionnaires were completed. RESULTS Using Confirmatory factor analysis (CFA), MDAS gave rise to a best-fit four-factor model corresponding to each subscale when it was first developed. MDAS also reported high Cronbach's alpha (0.96) and good convergent validity. Using hierarchical multiple linear regressions with significant demographic variables controlled for, self-esteem, work-family conflict, and social support were found to be significant predictors for depression. CONCLUSIONS MDAS is a valid scale to be used with Chinese pregnant women, especially in more collectivistic geographical areas. Risk factors specific to the Chinese context add insights to the experience of antenatal depression in China and contribute to understanding depression in from a global mental health perspective.
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Affiliation(s)
- Ho Nam Cheung
- Department of Social Sciences, School of Arts and Social Sciences, The Open University of Hong Kong, Hong Kong, China
| | - Stella W. Y. Chan
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Joanne M. Williams
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
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30
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Nordbrandt MS, Sonne C, Mortensen EL, Carlsson J. Trauma-affected refugees treated with basic body awareness therapy or mixed physical activity as augmentation to treatment as usual-A pragmatic randomised controlled trial. PLoS One 2020; 15:e0230300. [PMID: 32163509 PMCID: PMC7067472 DOI: 10.1371/journal.pone.0230300] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 02/25/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The prevalence of post-traumatic stress disorder (PTSD) is estimated to be as high as 30% among refugees. The coexistence of prevalent chronic pain is believed to maintain symptoms of PTSD and add complexity to the condition. Despite this, little evidence exists on how to treat PTSD and comorbid conditions best in trauma-affected refugees. AIM The aim of the present study was to investigate if adding either BBAT or mixed physical activity to the treatment as usual (TAU) for trauma-affected refugees with PTSD would increase the treatment effect compared to TAU alone. METHOD Randomised controlled trial, 3-armed parallel group superiority study, conducted at Competence Centre for Transcultural Psychiatry, Denmark. Participants were adult trauma-affected refugees with PTSD. Allocation ratio was 1:1:1, stratified for PTSD severity and gender. An open-label design was applied due to the nature of the intervention. Participants were randomised to receive either individual basic body awareness therapy (group B) or individual mixed physical activity (group M) one hour/week for 20 weeks plus TAU, or TAU only (group C). The primary outcome was PTSD severity measured by Harvard Trauma Questionnaire (HTQ). Trial registration: ClinicalTrials.gov, NCT01955538. RESULTS Of the 338 patients included (C/B/M = 110/114/114), 318 patients were eligible for intention-to-treat analysis (C/B/M = 104/105/109). On the primary outcome, intention-to-treat as well as per-protocol analyses showed small but significant improvement on scores from pre- to post-treatment in all three groups but with no significant difference in improvement between groups. CONCLUSIONS The findings do not provide evidence that either BBAT or mixed physical activity as add-on treatment bring significantly larger improvement on symptoms of PTSD compared to TAU alone for adult, trauma-affected refugees. There is a need for studies on potential subpopulations of trauma-affected refugees who could benefit from physical activity as a part of their treatment.
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Affiliation(s)
- Maja Sticker Nordbrandt
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Sonne
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Mills L, Lintzeris N, Bruno R, Montebello M, Dunlop A, Deacon RM, Copeland J, Jefferies M, Rivas C, Mammen K. Validation of the Australian Treatment Outcomes Profile for use in clients with cannabis dependence. Drug Alcohol Rev 2020; 39:356-364. [DOI: 10.1111/dar.13050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Llewellyn Mills
- Drug and Alcohol ServicesSouth Eastern Sydney Local Health District Sydney Australia
- Discipline of Addiction Medicine, Faculty Medicine and HealthUniversity of Sydney Sydney Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network Sydney Australia
| | - Nicholas Lintzeris
- Drug and Alcohol ServicesSouth Eastern Sydney Local Health District Sydney Australia
- Discipline of Addiction Medicine, Faculty Medicine and HealthUniversity of Sydney Sydney Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network Sydney Australia
| | - Raimondo Bruno
- School of MedicineUniversity of Tasmania Hobart Australia
| | - Mark Montebello
- Discipline of Addiction Medicine, Faculty Medicine and HealthUniversity of Sydney Sydney Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network Sydney Australia
- Drug and Alcohol ServicesNorth Sydney Local Health District Sydney Australia
- National Drug and Alcohol Research CentreUNSW Sydney Sydney Australia
| | - Adrian Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network Sydney Australia
- National Drug and Alcohol Research CentreUNSW Sydney Sydney Australia
- Drug and Alcohol ServicesHunter New England Local Health District Newcastle Australia
- Hunter Medical Research InstituteUniversity of Newcastle Newcastle Australia
| | - Rachel M. Deacon
- Drug and Alcohol ServicesSouth Eastern Sydney Local Health District Sydney Australia
- Discipline of Addiction Medicine, Faculty Medicine and HealthUniversity of Sydney Sydney Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network Sydney Australia
| | - Jan Copeland
- Mind and Neuroscience Thompson InstituteUniversity of the Sunshine Coast Sunshine Coast Australia
| | - Meryem Jefferies
- NSW Drug and Alcohol Clinical Research and Improvement Network Sydney Australia
- Drug HealthWestern Sydney Local Health District Sydney Australia
| | - Consuelo Rivas
- Drug and Alcohol ServicesSouth Eastern Sydney Local Health District Sydney Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network Sydney Australia
| | - Kristie Mammen
- Drug and Alcohol ServicesSouth Eastern Sydney Local Health District Sydney Australia
- NSW Drug and Alcohol Clinical Research and Improvement Network Sydney Australia
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García-Jiménez J, Gutiérrez-Rojas L, Jiménez-Fernández S, González-Domenech PJ, Carretero MD, Gurpegui M. Features Associated With Depressive Predominant Polarity and Early Illness Onset in Patients With Bipolar Disorder. Front Psychiatry 2020; 11:584501. [PMID: 33304285 PMCID: PMC7701086 DOI: 10.3389/fpsyt.2020.584501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/15/2020] [Indexed: 12/19/2022] Open
Abstract
Objective: The aim of this study is to determine the prevalence of three possible diagnostic specifiers, namely predominant polarity (PP) throughout illness, polarity of the first episode and early age at onset, in a sample of bipolar disorder (BD) patients and their association with important socio-demographic, clinical and course-of-illness variables. Methods: A retrospective and naturalistic study on 108 BD outpatients, who were classified according to the PP, polarity of the first episode and early age at onset (≤ 20 years) [vs. late (>20 years)] and were characterized by their demographics, clinical data, functionality and social support, among others features. After bivariate analyses, those variables showing certain association (P value < 0.25) with the three dependent variables were entered in logistic regression backward selection procedures to identify the variables independently associated with the PP, polarity of the first episode and early age at onset. Results: The sample consisted of 75 women ad 33 men, 74% with type I BD and 26% with type II. Around 70% had depressive PP, onset with a depressive episode and onset after age 20. Depressive PP was independently associated with depressive onset, higher score on the CGI severity scale and work disability. Onset with depressive episode was associated with type II BD, longer diagnostic delay and higher score on family disability. Early age at onset (≤ 20 years) was associate with younger age, longer diagnostic delay, presence of ever psychotic symptoms, current use of antipsychotic drugs and higher social support score. Conclusions: The results of this study show that BD patients with depressive PP, onset with depression and early age at onset may represent greater severity, because they are frequently associated with variables that worsen the prognosis. Our findings match up with the conclusions of two systematic reviews and we also include a disability factor (at family and work) that has not been previously reported. This work contributes to the use of polarity and age at onset in BD patients, as it can become a useful instrument in the prognostic and therapeutic applications.
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Affiliation(s)
- Jesús García-Jiménez
- Southern Mental Health Clinical Management Unit, Santa Ana Hospital, Motril, Spain
| | - Luis Gutiérrez-Rojas
- Department of Psychiatry, University of Granada, Granada, Spain.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Granada Mental Health Clinical Management Unit, Hospital Clínico San Cecilio, Granada, Spain
| | - Sara Jiménez-Fernández
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Child and Adolescent Mental Health Service, Jaén University Hospital Complex, Jaén, Spain
| | - Pablo José González-Domenech
- Department of Psychiatry, University of Granada, Granada, Spain.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
| | | | - Manuel Gurpegui
- Department of Psychiatry, University of Granada, Granada, Spain.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
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Fallon BA, Zubcevik N, Bennett C, Doshi S, Rebman AW, Kishon R, Moeller JR, Octavien NR, Aucott JN. The General Symptom Questionnaire-30 (GSQ-30): A Brief Measure of Multi-System Symptom Burden in Lyme Disease. Front Med (Lausanne) 2019; 6:283. [PMID: 31867334 PMCID: PMC6908481 DOI: 10.3389/fmed.2019.00283] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/19/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: The multi-system symptoms accompanying acute and post-treatment Lyme disease syndrome pose a challenge for time-limited assessment. The General Symptom Questionnaire (GSQ-30) was developed to fill the need for a brief patient-reported measure of multi-system symptom burden. In this study we assess the psychometric properties and sensitivity to change of the GSQ-30. Materials and Methods: 342 adult participants comprised 4 diagnostic groups: Lyme disease (post-treatment Lyme disease syndrome, n = 124; erythema migrans, n = 94); depression, n = 36; traumatic brain injury, n = 51; healthy, n = 37. Participants were recruited from clinical research facilities in Massachusetts, Maryland, and New York. Validation measures for the GSQ-30 included the Patient Health Questionnaire-4 for depression and anxiety, visual analog scales for fatigue and pain, the Sheehan Disability Scale for functional impairment, and one global health question. To assess sensitivity to change, 53 patients with erythema migrans completed the GSQ-30 before treatment and 6 months after 3 weeks of treatment with doxycycline. Results: The GSQ-30 demonstrated excellent internal consistency (Cronbach α = 0.95). The factor structure reflects four core domains: pain/fatigue, neuropsychiatric, neurologic, and viral-like symptoms. Symptom burden was significantly associated with depression (rs = 0.60), anxiety (rs = 0.55), pain (rs = 0.75), fatigue (rs = 0.77), functional impairment (rs = 0.79), and general health (rs = −0.58). The GSQ-30 detected significant change in symptom burden before and after antibiotic therapy; this change correlated with change in functional impairment. The GSQ-30 total score significantly differed for erythema migrans vs. three other groups (post-treatment Lyme disease syndrome, depression, healthy controls). The GSQ-30 total scores for traumatic brain injury and depression were not significantly different from post-treatment Lyme disease syndrome. Conclusions and Relevance: The GSQ-30 is a valid and reliable instrument to assess symptom burden among patients with acute and post-treatment Lyme disease syndrome and is sensitive in the detection of change after treatment among patients with erythema migrans. The GSQ-30 should prove useful in clinical and research settings to assess multi-system symptom burden and to monitor change over time. The GSQ-30 may also prove useful in future precision medicine studies as a clinical measure to correlate with disease-relevant biomarkers.
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Affiliation(s)
- Brian A Fallon
- Department of Psychiatry, Lyme and Tick-Borne Diseases Research Center, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Nevena Zubcevik
- Department of Physical Medicine and Rehabilitation, Dean Center for Tick borne Illness, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, United States
| | - Clair Bennett
- Department of Psychiatry, Lyme and Tick-Borne Diseases Research Center, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Shreya Doshi
- Department of Psychiatry, Lyme and Tick-Borne Diseases Research Center, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Alison W Rebman
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ronit Kishon
- Department of Psychiatry, Lyme and Tick-Borne Diseases Research Center, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - James R Moeller
- Department of Psychiatry, Lyme and Tick-Borne Diseases Research Center, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Nadlyne R Octavien
- Department of Physical Medicine and Rehabilitation, Dean Center for Tick borne Illness, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - John N Aucott
- Division of Rheumatology, Department of Medicine, Lyme Disease Research Center, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Chokka P, Bougie J, Rampakakis E, Proulx J. Assessment in Work Productivity and the Relationship with Cognitive Symptoms (AtWoRC): primary analysis from a Canadian open-label study of vortioxetine in patients with major depressive disorder (MDD). CNS Spectr 2019; 24:338-347. [PMID: 29792585 PMCID: PMC6676443 DOI: 10.1017/s1092852918000913] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/21/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The Assessment in Work Productivity and the Relationship with Cognitive Symptoms (AtWoRC) study aimed to assess the association between cognitive symptoms and work productivity in gainfully employed patients receiving vortioxetine for a major depressive episode (MDE). METHODS Patients diagnosed with major depressive disorder (MDD) and treated with vortioxetine independently of study enrollment were assessed over 52 weeks at visits that emulated a real-life setting. Patients were classified as those receiving vortioxetine as the first treatment for their current MDE (first treatment) or having shown inadequate response to a previous antidepressant (switch). The primary endpoint was the correlation between changes in patient-reported cognitive symptoms (20-item Perceived Deficits Questionnaire [PDQ-D-20]) and changes in work productivity loss (Work Limitations Questionnaire [WLQ]) at week 12. Additional assessments included changes in symptom and disease severity, cognitive performance, functioning, work loss, and safety. RESULTS In the week 12 primary analysis, 196 eligible patients at 26 Canadian sites were enrolled, received at least one treatment dose, and attended at least one postbaseline study visit. This analysis demonstrated a significant, strong correlation between PDQ-D-20 and WLQ productivity loss scores (r=0.634; p<0.001), and this correlation was significant in both first treatment and switch patients (p<0.001). A weaker correlation between Digit Symbol Substitution Test and WLQ scores was found (r=-0.244; p=0.003). CONCLUSION At 12 weeks, improvements in cognitive dysfunction were significantly associated with improvements in workplace productivity in patients with MDD, suggesting a role for vortioxetine in functional recovery in MDD.
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Affiliation(s)
- Pratap Chokka
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada
| | | | | | - Jean Proulx
- Lundbeck Canada Inc., Montreal, Quebec, Canada
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Tremain H, Fletcher K, Scott J, McEnery C, Berk M, Murray G. Does stage of illness influence recovery-focused outcomes after psychological treatment in bipolar disorder? A systematic review protocol. Syst Rev 2019; 8:125. [PMID: 31128591 PMCID: PMC6535183 DOI: 10.1186/s13643-019-1042-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 05/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is great interest in the possibility that 'stage of illness' moderates treatment outcomes in bipolar disorder (BD). Much remains unknown about the construct of stage of illness, but there is evidence that effectiveness of psychosocial interventions may depend on factors that are plausible proxy measures of stage of illness (e.g., number of episodes). To date, reviews of this data have focused solely on clinical outcomes (particularly symptoms and relapse rates), but a range of recovery-focused outcomes (including functioning, cognitive functioning, and quality of life) have been measured in individuals with established BD. The aim of the proposed systematic review is to synthesise existing evidence for plausible proxy measures of stage of illness as moderators of recovery-focused and functional outcomes in psychosocial treatment studies of BD. METHODS The proposed review will follow PRISMA guidelines; Scopus, PsychINFO, PubMed and Web of Science will be searched for empirical studies of psychosocial interventions used for established (clinical stages 2-4) BD; and findings will be summarised in a narrative synthesis of clinical stage of illness (operationalised in proxy measures identified in existing staging models) as a moderator of recovery-focused and functional outcomes of psychosocial interventions for established bipolar disorder. DISCUSSION This review will contribute to the literature by expanding upon previous reviews and potentially inform the psychosocial treatment of established BD. Implications include assisting clinicians, consumers and researchers to identify and select interventions most appropriate to recovery-focused goals based on individuals' clinical status. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016037868.
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Affiliation(s)
- Hailey Tremain
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, PO Box 218, John St Hawthorn VIC, Melbourne, 3122 Australia
| | - Kathryn Fletcher
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, PO Box 218, John St Hawthorn VIC, Melbourne, 3122 Australia
| | - Jan Scott
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, PO Box 218, John St Hawthorn VIC, Melbourne, 3122 Australia
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Carla McEnery
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, PO Box 218, John St Hawthorn VIC, Melbourne, 3122 Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- The Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Parkville, VIC Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, PO Box 218, John St Hawthorn VIC, Melbourne, 3122 Australia
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Chen M, Fitzgerald HM, Madera JJ, Tohen M. Functional outcome assessment in bipolar disorder: A systematic literature review. Bipolar Disord 2019; 21:194-214. [PMID: 30887632 PMCID: PMC6593429 DOI: 10.1111/bdi.12775] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Functional impairment is an important driver of disability in patients with bipolar disorder (BD) and can persist even when symptomatic remission has been achieved. The objectives of this systematic literature review were to identify studies that assessed functioning in patients with BD and describe the functional scales used and their implementation. METHODS A systematic literature review of English-language articles published between 2000 and 2017 reporting peer-reviewed, original research related to functional assessment in patients with BD was conducted. RESULTS A total of 40 articles met inclusion criteria. Twenty-four different functional scales were identified, including 13 clinician-rated scales, 7 self-reported scales, and 4 indices based on residential and vocational data. The Global Assessment of Functioning (GAF) and the Functional Assessment Short Test (FAST) were the most commonly used global and domain-specific scales, respectively. All other scales were used in ≤2 studies. Most studies used ≥1 domain-specific scale. The most common applications of functional scales in these studies were evaluations of the relationships between global or domain-specific psychosocial functioning and cognitive functioning (eg, executive function, attention, language, learning, memory) or clinical variables (eg, symptoms, duration of illness, number of hospitalizations, number of episodes). CONCLUSIONS The results of this review show growing interest in the assessment of functioning in patients with BD, with an emphasis on specific domains such as work/educational, social, family, and cognitive functioning and high utilization of the GAF and FAST scales in published literature.
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Affiliation(s)
- Maxine Chen
- Medical AffairsOtsuka Pharmaceutical Development & Commercialization, IncPrincetonNew Jersey
| | | | - Jessica J. Madera
- Medical AffairsOtsuka Pharmaceutical Development & Commercialization, IncPrincetonNew Jersey
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral SciencesUniversity of New MexicoAlbuquerqueNew Mexico
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Bonnín CDM, Reinares M, Martínez-Arán A, Jiménez E, Sánchez-Moreno J, Solé B, Montejo L, Vieta E. Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder. Int J Neuropsychopharmacol 2019; 22:467-477. [PMID: 31093646 PMCID: PMC6672628 DOI: 10.1093/ijnp/pyz018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022] Open
Abstract
People with bipolar disorder frequently experience persistent residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life. In the last decade, the treatment target in clinical and research settings has focused not only on clinical remission, but also on functional recovery and, more lately, in personal recovery, taking into account patients' well-being and quality of life. Hence, the trend in psychiatry and psychology is to treat bipolar disorder in an integrative and holistic manner. This literature review offers an overview regarding psychosocial functioning in bipolar disorder. First, a brief summary is provided regarding the definition of psychosocial functioning and the tools to measure it. Then, the most reported variables influencing the functional outcome in patients with bipolar disorder are listed. Thereafter, we include a section discussing therapies with proven efficacy at enhancing functional outcomes. Other possible therapies that could be useful to prevent functional decline and improve functioning are presented in another section. Finally, in the last part of this review, different interventions directed to improve patients' well-being, quality of life, and personal recovery are briefly described.
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Affiliation(s)
- Caterina del Mar Bonnín
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain,Correspondence: Anabel Martínez-Arán, PhD, Clinical Institute of Neuroscience. Hospital Clinic of Barcelona, Villarroel, 170. 08036 Barcelona, Catalonia ()
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jose Sánchez-Moreno
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Zheng J, Wang Z, Li E. The efficacy and safety of 10 mg/day vortioxetine compared to placebo for adult major depressive disorder: a meta-analysis. Afr Health Sci 2019; 19:1716-1726. [PMID: 31149002 PMCID: PMC6531944 DOI: 10.4314/ahs.v19i1.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is a growing interest in vortioxetine in major depressive disorder (MDD). OBJECTIVES This meta-analysis aimed to assess the efficacy and safety of 10 mg/day (mg/d) vortioxetine compared to placebo for MDD in adult. METHODS Eight randomly controlled trials (RCTs) about the treatment of 10 mg/d vortioxetine in adult patients with MDD were identified and 2354 patients were included in meta-analysis. RESULTS According to the results, 10 mg/d vortioxetine showed significant differences in response rates (OR=1.88, 95% CI=1.40-2.53, P<0.0001), remission rates (OR=1.54, 95% CI=1.27-1.86, P<0.00001), change from baseline in Montgomery-Asberg Depression Rating Scale (MADRS) total score (SMD=-3.50, 95%CI=-4.83 to -2.17, P<0.00001), clinical global Impression-Global Improvement (CGI-I) total score (SMD=-3.40, 95% CI=-4.69 to -2.11, P<0.00001), and change from baseline in Sheehan Disability Scale (SDS) total score (SMD=-2.09, 95% CI=-2.64 to -1.55, P<0.00001). But 10 mg/d vortioxetine was easier induced nausea (OR=4.18, 95% CI=3.21-5.44, P<0.00001) and constipation (OR=1.88, 95% CI=1.14 to 3.09, P=0.01). CONCLUSION 10 mg/d vortioxetine was more effective, but easily induced nausea and constipation when compared to placebo for MDD in adult.
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Affiliation(s)
- Jiahuan Zheng
- Guangdong Provincial Key Laboratory of Biotechnology Candidate Drug Research, School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangdong, Guangzhou 510006
| | - Zhaoyu Wang
- Guangdong Provincial Key Laboratory of Biotechnology Candidate Drug Research, School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangdong, Guangzhou 510006
| | - Enli Li
- Guangdong Provincial Key Laboratory of Biotechnology Candidate Drug Research, School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangdong, Guangzhou 510006
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Toyoshima K, Kako Y, Toyomaki A, Shimizu Y, Tanaka T, Nakagawa S, Inoue T, Martinez-Aran A, Vieta E, Kusumi I. Associations between cognitive impairment and quality of life in euthymic bipolar patients. Psychiatry Res 2019; 271:510-515. [PMID: 30551083 DOI: 10.1016/j.psychres.2018.11.061] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/30/2018] [Indexed: 01/08/2023]
Abstract
During the euthymic state in bipolar disorder, cognitive functions often remain affected. Specifically, subjective and objective cognitive impairment might distinctly affect patients' quality of life (QoL); however, this question had not been examined previously in Japanese patients. Therefore, the current study investigated the associations between cognitive complaints, QoL, and objective cognitive functions. Forty patients in remission were recruited from the Hokkaido University Hospital, Sapporo, Japan and assessed with the translated version of the cognitive complaints in bipolar disorder rating assessment (COBRA), medical outcomes study 36-item short-form health survey version 2 (SF-36v2), and Sheehan disability scale (SDS). The Japanese adult reading scale, Wisconsin card sorting test, word fluency, continuous performance test, trail making test (TMT), auditory verbal learning, and Stroop test evaluated objective cognitive functions. Significant correlations were observed between the COBRA, SF-36v2, and SDS results, as well as the TMT scores. Overall, euthymic patients were aware of their cognitive dysfunction, which could be understood in relation to the decrease in satisfaction in their daily life. Therefore, even mild cognitive impairments can have ramifications for patients in the euthymic state of bipolar disorder.
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Affiliation(s)
- Kuniyoshi Toyoshima
- Department of Psychiatry, Wakkanai City Hospital, Wakkanai, Japan; Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Yuki Kako
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsuhito Toyomaki
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yusuke Shimizu
- Department of Psychiatry, Iwamizawa Municipal General Hospital, Iwamizawa, Japan
| | - Teruaki Tanaka
- Department of Psychiatry, KKR Sapporo Medical Center, Sapporo, Japan
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Anabel Martinez-Aran
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, Barcelona, 08036 Catalonia, Spain
| | - Eduard Vieta
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, Barcelona, 08036 Catalonia, Spain
| | - Ichiro Kusumi
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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40
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Toyoshima K, Inoue T, Masuya J, Ichiki M, Fujimura Y, Kusumi I. Evaluation Of Subjective Cognitive Function Using The Cognitive Complaints In Bipolar Disorder Rating Assessment (COBRA) In Japanese Adults. Neuropsychiatr Dis Treat 2019; 15:2981-2990. [PMID: 31695389 PMCID: PMC6804676 DOI: 10.2147/ndt.s218382] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To examine the relationship between depressive symptoms, subjective cognitive function, and quality of life in Japanese adults using the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA). PATIENTS AND METHODS We evaluated 585 adult community volunteers using the Patient Health Questionnaire-9 (PHQ-9) for evaluation of depressive symptoms and the COBRA for evaluation of subjective cognitive function. We additionally used the 8-item Short-Form Health Survey and the Sheehan Disability Scale to evaluate the quality of life (QoL). RESULTS Measures of subjective cognitive function were significantly correlated with depressive symptoms and QoL. Structural equation modeling demonstrated that depressive symptoms directly and indirectly decreased QoL via their effects on subjective cognitive dysfunction. Measures of depressive symptoms were more closely related to QoL than were measures of subjective cognitive function. LIMITATIONS Study participants were general adult population community volunteers and included healthy people; thus, these results may not be generalizable to patients with depression or bipolar disorder. In addition, the cross-sectional design of this study prevented the identification of causal relationships among the parameters. CONCLUSION Changes in subjective cognitive function may affect QoL via depressive symptoms. Evaluations of subjective cognitive function may help identify factors that reduce QoL.
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Affiliation(s)
- Kuniyoshi Toyoshima
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Jiro Masuya
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Masahiko Ichiki
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Yota Fujimura
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Kitchingman TA, Caputi P, Woodward A, Wilson CJ, Wilson I. The impact of their role on telephone crisis support workers' psychological wellbeing and functioning: Quantitative findings from a mixed methods investigation. PLoS One 2018; 13:e0207645. [PMID: 30566435 PMCID: PMC6300217 DOI: 10.1371/journal.pone.0207645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 11/05/2018] [Indexed: 12/26/2022] Open
Abstract
Research suggests that frequent empathic engagement with others in distress places helpers in registered professional roles (e.g. medical practitioners, psychologists) at risk of functional impairment related to symptoms of psychological distress, including the delivery of sub-optimal care to patients. Preliminary research suggests that telephone crisis support workers may also be impacted in a similar way. This repeated measures study is the first known research to examine telephone crisis support workers’ functional impairment related to symptoms of psychological distress before and after speaking with callers in crisis. A representative sample of telephone crisis support workers from Lifeline Australia participated by completing three surveys: 1) directly before; 2) directly after; and 3) one week after completing a shift on the national crisis line. Surveys included standardised measures of functional impairment, psychological distress, lived experience of mental health issues and suicide, motivations for volunteering, coping strategies and help-seeking. Categorical items were used to assess personal and shift-related factors. Repeated measures analyses of variance were used to identify changes in symptoms of psychological distress and impairment across time points. Structural equation modelling was used to test relationships within a hypothesised model of impairment. A significant proportion of participants reported functional impairment related to symptoms of psychological distress. Significant differences in functional impairment and symptoms of psychological distress were detected, and were associated with different mechanisms, across time points. An important outcome of this study is empirically-supported models which explain how telephone crisis support workers come to experience functional impairment in relation to their TCS role, as well as other work/study, home/family and social/leisure activities. Results warrant the deliberate development and/or modification of existing service strategies to optimise telephone crisis support workers’ psychological wellbeing and functioning, including by structuring the work environment and emphasising certain messages during training and supervision.
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Affiliation(s)
- Taneile Ashlea Kitchingman
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- * E-mail:
| | - Peter Caputi
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Alan Woodward
- Lifeline Australia, Canberra, Australian Capital Territory, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Coralie Joy Wilson
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ian Wilson
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Initiation and engagement as mechanisms for change caused by collaborative care in opioid and alcohol use disorders. Drug Alcohol Depend 2018; 192:67-73. [PMID: 30223190 PMCID: PMC6334843 DOI: 10.1016/j.drugalcdep.2018.07.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND To assess the mechanism by which a collaborative care (CC) intervention improves self-reported abstinence among primary care patients with opioid and alcohol use disorders (OAUD) compared to treatment as usual. METHODS Secondary data analysis of SUMMIT, a randomized controlled trial of CC for OAUD. Participants were 258 patients with OAUD receiving primary care at a multi-site Federally Qualified Health Center. Using a mediation analysis decomposition of a total effect into a mediated and a direct effect, we examined the effect of CC on abstinence at six months, attributable to the HEDIS treatment initiation and engagement measures for the total sample, for individuals with alcohol use disorders alone, and for those with a co-morbid opioid use disorder. RESULTS Although the CC intervention led to an increase in both initiation and engagement, among the full sample, only initiation mediated the effect of the intervention on abstinence (3.8%, CI=[0.4%, 8.3%]; 32% proportion of the total effect). In subgroup analyses, among individuals with comorbid alcohol and opioid use disorders, almost 100% of the total effect was mediated by engagement, but the effect was not significant. This was not observed among the alcohol use disorder only group. CONCLUSIONS Among primary care patients with OAUDs, treatment initiation partially mediated the effect of CC on abstinence at 6-months. The current study emphasizes the importance of primary care patients returning for a second substance-use related visit after identification. CC may work differently for people with co-morbid opioid use disorders vs. alcohol use disorders alone.
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Watkins KE, Ober A, McCullough C, Setodji C, Lamp K, Lind M, Hunter SB, Chan Osilla K. Predictors of treatment initiation for alcohol use disorders in primary care. Drug Alcohol Depend 2018; 191:56-62. [PMID: 30081338 PMCID: PMC6141324 DOI: 10.1016/j.drugalcdep.2018.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND We identified predictors of receiving treatment (brief therapy [BT] and/or extended-release injectable naltrexone [XR-NTX]) for the treatment of alcohol use disorders (AUDs) in primary care. We also examined the relationship between receiving BT and XR-NTX. METHODS Secondary data analysis of SUMMIT, a randomized controlled trial of collaborative care. Participants were 290 individuals with AUDs who reported no past 30-day opioid use and who were receiving primary care at a multi-site Federally Qualified Health Center. Bivariate and multivariate analyses examined predictors of BT and/or XR-NTX. RESULTS Thirty-two percent (N = 93) received either BT or XR-NTX, 28% (N = 82) received BT and 13% (N = 37) received XR-NTX; 9% (N = 26) received both BT and XR-NTX. Older age, white race, talking with a professional about alcohol use and having more negative consequences all predicted receipt of evidence-based treatment; being homeless was a negative predictor. The predictors of receiving BT included not being homeless and previously talking with a professional; the predictors of receiving XR-NTX included older age, white race and experiencing more negative consequences. In 80% of those who received both BT and XR-NTX, receipt of BT preceded XR-NTX. CONCLUSIONS Patient factors were important predictors of receiving primary-care based AUD treatment and differed by type of treatment received. Receiving BT was associated with subsequent use of XR-NTX and may be associated with a longer duration of XR-NTX treatment. Providers should consider these findings when considering ways to increase primary-care based AUD treatment.
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Affiliation(s)
| | - Allison Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | | | - Claude Setodji
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA.
| | - Karen Lamp
- Venice Family Clinic, 604 Rose Avenue, Venice, CA, 90291, USA.
| | - Mimi Lind
- Venice Family Clinic, 604 Rose Avenue, Venice, CA, 90291, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
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Peterson AL, Foa EB, Blount TH, McLean CP, Shah DV, Young-McCaughan S, Litz BT, Schobitz RP, Castillo DT, Rentz TO, Yarvis JS, Dondanville KA, Fina BA, Hall-Clark BN, Brown LA, DeBeer BR, Jacoby VM, Hancock AK, Williamson DE, Evans WR, Synett S, Straud C, Hansen HR, Meyer EC, Javors MA, Sharrieff AFM, Lara-Ruiz J, Koch LM, Roache JD, Mintz J, Keane TM. Intensive prolonged exposure therapy for combat-related posttraumatic stress disorder: Design and methodology of a randomized clinical trial. Contemp Clin Trials 2018; 72:126-136. [PMID: 30055335 DOI: 10.1016/j.cct.2018.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
Combat-related posttraumatic stress disorder (PTSD) is the most common psychological health condition in military service members and veterans who have deployed to the combat theater since September 11, 2001. One of the highest research priorities for the Department of Defense and the Department of Veterans Affairs is to develop and evaluate the most efficient and efficacious treatments possible for combat-related PTSD. However, the treatment of combat-related PTSD in military service members and veterans has been significantly more challenging than the treatment of PTSD in civilians. Randomized clinical trials have demonstrated large posttreatment effect sizes for PTSD in civilian populations. However, recent randomized clinical trials of service members and veterans have achieved lesser reductions in PTSD symptoms. These results suggest that combat-related PTSD is unique. Innovative approaches are needed to augment established evidence-based treatments with targeted interventions that address the distinctive elements of combat-related traumas. This paper describes the design, methodology, and protocol of a randomized clinical trial to compare two intensive prolonged exposure therapy treatments for combat-related PTSD in active duty military service members and veterans and that can be administered in an acceptable, efficient manner in this population. Both interventions include intensive daily treatment over a 3-week period and a number of treatment enhancements hypothesized to result in greater reductions in combat-related PTSD symptoms. The study is designed to advance the delivery of care for combat-related PTSD by developing and evaluating the most potent treatments possible to reduce PTSD symptomatology and improve psychological, social, and occupational functioning.
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Affiliation(s)
- Alan L Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA; University of Texas at San Antonio, San Antonio, TX, USA.
| | - Edna B Foa
- University of Pennsylvania, Philadelphia, PA, USA.
| | - Tabatha H Blount
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Carmen P McLean
- VA Palo Alto Health Care System, Menlo Park, CA, USA; Stanford University School of Medicine, Stanford, CA, USA.
| | - Dhiya V Shah
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | | | - Brett T Litz
- VA Boston Healthcare System, Boston, MA, USA; Boston University, Boston, MA, USA.
| | - Richard P Schobitz
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, USA.
| | - Diane T Castillo
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.
| | - Timothy O Rentz
- South Texas Veterans Health Care System, San Antonio, TX, USA.
| | | | | | - Brooke A Fina
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | | | - Lily A Brown
- University of Pennsylvania, Philadelphia, PA, USA.
| | - Bryann R DeBeer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.
| | - Vanessa M Jacoby
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Allison K Hancock
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Douglas E Williamson
- Duke University, Durham, NC, USA; Durham VA Health Care System, Durham, NC, USA.
| | - Wyatt R Evans
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Samantha Synett
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.
| | - Casey Straud
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Hunter R Hansen
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Eric C Meyer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.
| | - Martin A Javors
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | | | - Jose Lara-Ruiz
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; University of Texas at San Antonio, San Antonio, TX, USA.
| | - Lauren M Koch
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - John D Roache
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Terence M Keane
- VA Boston Healthcare System, Boston, MA, USA; Boston University, Boston, MA, USA.
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Ober AJ, Watkins KE, McCullough CM, Setodji CM, Osilla K, Hunter SB. Patient predictors of substance use disorder treatment initiation in primary care. J Subst Abuse Treat 2018; 90:64-72. [PMID: 29866385 PMCID: PMC6336395 DOI: 10.1016/j.jsat.2018.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Primary care clinics are opportune settings in which to deliver substance use disorder (SUD) treatment, but little is known about which patients initiate treatment in these settings. METHODS Using secondary data from a RCT that aimed to integrate SUD treatment into a federally qualified health center (FQHC) using an organizational readiness and collaborative care (CC) intervention, we examined patient-level predictors of initiation of evidence-based practices for opioid and/or alcohol use disorders (OAUDs): a brief behavioral treatment (BT) based on motivational interviewing and cognitive behavioral therapy and medication-assisted treatment (MAT) (extended-release injectable naltrexone (XR-NTX) for patients with an alcohol use disorder or opioid use disorder and buprenorphine/naloxone (BUP/NX) for patients with an opioid use disorder). Using the Andersen model of health care access, we tested bivariate and multivariate logistic regression models to assess associations between patient factors and initiation of BT and MAT. RESULTS Twenty-three percent of all participants (N = 392) received BT and 13% received MAT. In the multivariate model examining factors associated with initiation of BT, being of "other" or "multiple" races compared with being White (OR = 0.45, CI = 0.22, 0.92), being homeless (OR = 0.45, CI = 0.21, 0.97) and having been arrested within 90 days of baseline (OR = 0.21 CI = 0.63, 0.69) were associated with significantly lower odds of initiating BT. Greater self-stigma (OR = 1.60, CI = 1.06, 2.42), receiving MAT (OR = 5.52, CI = 2.34, 12.98), and having received the CC study intervention (OR = 12.95, CI = 5.91, 28.37) were associated with higher odds of initiating BT. In the multivariate model examining patient factors associated with initiating MAT, older age (OR = 1.07, CI = 1.03, 1.11), female gender (OR = 3.05, CI = 1.25, 7.46), having a diagnosis of heroin abuse or dependence (with or without alcohol abuse or dependence compared with have a diagnosis of alcohol dependence only (OR = 3.03, CI = 1.17, 7.86), and having received at least one session of BT (OR = 6.42, CI = 2.59, 15.94), were associated with higher odds of initiating MAT. CONCLUSIONS Individuals who initiate BT for OAUDs in a FQHC are less likely to be homeless and more likely to have greater self-stigma. Those who receive MAT are more likely to be of older age, female, and to have a diagnosis of heroin abuse or dependence, with or without concomitant alcohol abuse or dependence, rather than alcohol abuse or dependence alone. Receiving collaborative care (e.g., a warm handoff, and follow-up by a care coordinator) may be critical to initiating BT. Receiving at least one session of BT is associated with higher odds of receiving MAT, and receiving MAT is associated with higher odds of receiving BT. The Andersen model of health care access provides some insight into who initiates BT and MAT for OAUD treatment in FQHC-based primary care; further research is needed to explore system-level factors that may also influence treatment initiation.
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Affiliation(s)
- Allison J Ober
- RAND Corporation, 1776 Main Street Santa Monica, CA 90407, USA.
| | | | | | | | - Karen Osilla
- RAND Corporation, 1776 Main Street Santa Monica, CA 90407, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street Santa Monica, CA 90407, USA.
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Cepeda SL, McKay D, Schneider SC, La Buissonnière-Ariza V, Egberts JTNE, McIngvale E, Goodman WK, Storch EA. Politically-focused intrusive thoughts and associated ritualistic behaviors in a community sample. J Anxiety Disord 2018; 56:35-42. [PMID: 29631796 DOI: 10.1016/j.janxdis.2018.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 01/04/2023]
Abstract
A significant proportion of the U.S. population report increased stress attributed to the political climate following the controversial 2016 United States (U.S.) Presidential election. The political stressors paired with the growth in news consumption and social media-use could be a potential trigger for obsessive-compulsive-like symptoms specific to politics in some individuals. This study aimed to elucidate the rate of Politically-focused Intrusive Thoughts and associated Ritualistic Behaviors (PITRB), their demographic and clinical correlates, and the degree of association with political ideology. Survey data were collected using the crowdsourcing platform Mechanical Turk. A total of N = 484 individuals completed the survey. Measures of politically-focused intrusive thoughts and ritualistic behaviors, general obsessive-compulsive symptoms, depression, anxiety, anxiety control, worry, and disability were administered, as well as a measure of social and economic conservative affiliation. Results showed that a quarter of the sample (25.2%) had at least one PITRB more than once a day. PITRB was associated with all measures of psychopathology and disability. Finally, anxiety control moderated the relationship between PITRB and both anxiety and depression. No differences in psychopathology were found between major party affiliations. The findings suggest that politically-focused intrusive thoughts and ritualistic behaviors are associated with psychopathology domains in a manner comparable to general obsessive-compulsive symptoms.
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Affiliation(s)
- Sandra L Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Dean McKay
- Department of Psychology, Fordham University, Bronx, NY, United States
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | | | | | - Elizabeth McIngvale
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.
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Ociskova M, Prasko J, Vrbova K, Kasalova P, Holubova M, Grambal A, Machu K. Self-stigma and treatment effectiveness in patients with anxiety disorders - a mediation analysis. Neuropsychiatr Dis Treat 2018; 14:383-392. [PMID: 29416340 PMCID: PMC5790087 DOI: 10.2147/ndt.s152208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
GOAL The goal of this study was to explore the impact of self-stigma on the treatment outcomes in patients with anxiety disorders and to find possible mediators of this relationship. METHOD Two hundred and nine patients with anxiety disorders, who were hospitalized in a psychotherapeutic department, attended the study. The average age was 39.2±12.4 years; two-thirds were women. Most of the patients used a long-term medication. The participants underwent either cognitive behavioral therapy (CBT) or short psychodynamic therapy. The selection to the psychotherapy was not randomized. All individuals completed several scales - Beck Depression Inventory, the second edition (BDI-II), Beck Anxiety Inventory (BAI), Dissociative Experience Scale (DES), Sheehan Disability Scale (SDS), subjective Clinical Global Impression (subjCGI), and The Internalized Stigma of Mental Illness Scale (ISMI). A senior psychiatrist filled out the objective CGI (objCGI). RESULTS The patients significantly improved in the severity of anxiety (BAI), depression (BDI-II), and overall severity of the mental disorder (objCGI). The self-stigma predicted a lower change of the objCGI, but not a change of the anxiety and depressive symptoms severity. Anxiety, depressive symptoms, dissociation, and disability were assessed as possible mediators of the relationship between the self-stigma and the treatment change. None of them were significant. CONCLUSION Self-stigma lowers the effectiveness of the combined treatment of anxiety disorders. Future research should explore other possible mediators influencing this relationship.
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Affiliation(s)
- Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc
| | - Kristyna Vrbova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc
| | - Petra Kasalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc
| | - Michaela Holubova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc
| | - Ales Grambal
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc
| | - Klara Machu
- Department of Psychology, Faculty of Arts, University of Ostrava, Ostrava, The Czech Republic
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Wallhäusser-Franke E, D'Amelio R, Glauner A, Delb W, Servais JJ, Hörmann K, Repik I. Transition from Acute to Chronic Tinnitus: Predictors for the Development of Chronic Distressing Tinnitus. Front Neurol 2017; 8:605. [PMID: 29209267 PMCID: PMC5701924 DOI: 10.3389/fneur.2017.00605] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background Acute tinnitus and its transition to chronic tinnitus are poorly investigated, and factors associated with amelioration versus exacerbation are largely unknown. Aims of this study were to identify early predictors for the future development of tinnitus severity. Method Patients with tinnitus of no longer than 4 weeks presenting at an otolaryngologist filled out questionnaires at inclusion (T1), as well as 3 (T3), and 6 months (T4) after tinnitus onset. 6 weeks after onset, an interview was conducted over the phone (T2). An audiogram was taken at T1, perceived tinnitus loudness, and tinnitus-related distress were assessed separately and repeatedly together with oversensitivity to external sounds and the levels of depression and anxiety. Furthermore, coping strategies with illness were recorded. Results Complete remission until T4 was observed in 11% of the 47 participants, while voiced complaints at onset were stable in the majority. In the subgroup with a relevant level of depression at T1, tinnitus-related distress worsened in 30% until T4. For unilateral tinnitus, perceived loudness in the chronic condition correlated strongly with hearing loss at 2 kHz on the tinnitus ear, while a similar correlation was not found for tinnitus located to both ears or within the head. Conclusion Results suggest early manifestation of tinnitus complaints, and stress the importance of screening all patients presenting with acute tinnitus for levels of depression and tinnitus-related distress. Furthermore, hearing levels should be monitored, and use of hearing aids should be considered to reduce tinnitus loudness after having ascertained that sound sensitivity is within normal range.
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Affiliation(s)
- Elisabeth Wallhäusser-Franke
- Otorhinolaryngology, Phoniatrics and Audiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Roberto D'Amelio
- Department of Internal Medicine IV and Neurocenter, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Anna Glauner
- Otorhinolaryngology, Phoniatrics and Audiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang Delb
- Otorhinolaryngology, Phoniatrics and Audiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jérôme J Servais
- Otorhinolaryngology, University Medical Centre Mannheim, Mannheim, Germany
| | - Karl Hörmann
- Otorhinolaryngology, Phoniatrics and Audiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Otorhinolaryngology, University Medical Centre Mannheim, Mannheim, Germany
| | - Ines Repik
- Otorhinolaryngology, University Medical Centre Mannheim, Mannheim, Germany
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Sandahl H, Jennum P, Baandrup L, Poschmann IS, Carlsson J. Treatment of sleep disturbances in trauma-affected refugees: Study protocol for a randomised controlled trial. Trials 2017; 18:520. [PMID: 29110681 PMCID: PMC5674222 DOI: 10.1186/s13063-017-2260-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 10/13/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sleep disturbances are often referred to as a hallmark and as core symptoms of post-traumatic stress disorder (PTSD). Untreated sleep disturbances can contribute to the maintenance and exacerbation of PTSD symptoms, which may diminish treatment response and constitute a risk factor for poor treatment outcome. Controlled trials on treatment of sleep disturbances in refugees suffering from PTSD are scarce. The present study aims to examine sleep-enhancing treatment in refugees with PTSD. We aim to assess if add-on treatment with mianserin and/or Imagery Rehearsal Therapy (IRT) to treatment as usual (TAU) for PTSD improves sleep disturbances. We will study the relation between sleep disturbances, PTSD symptoms, psychosocial functioning and quality of life. METHODS The study is a randomised controlled superiority trial with a 2 × 2 factorial design. The study will include 230 trauma-affected refugees. The patients are randomised into four groups. All four groups receive TAU - an interdisciplinary treatment approach covering a period of 6-8 months with pharmacological treatment, physiotherapy, psychoeducation and manual-based cognitive behavioural therapy within a framework of weekly sessions with a physician, physiotherapist or psychologist. One group receives solely TAU, serving as a control group, while the three remaining groups are active-treatment groups receiving add-on treatment with either mianserin, IRT or a combination of both. Treatment outcome is evaluated using self-administered rating scales, observer ratings and actigraph measurements at baseline, during treatment and post treatment. The primary outcome is subjective sleep quality using the Pittsburgh Sleep Quality Index. Secondary outcome measures are objective sleep length, nightmares, PTSD severity, symptoms of depression and anxiety, pain, quality of life and psychosocial functioning. DISCUSSION This trial will be the first randomised controlled trial to examine sleep-enhancing treatment in trauma-affected refugees, as well as the first trial to investigate the effect of IRT and mianserin in this population. Therefore, this trial may optimise treatment recommendations for sleep disturbances in trauma-affected refugees. Based on our findings, we expect to discuss the effect of treatment, focussing on sleep disturbances. Furthermore, the results will provide new information regarding the association between sleep disturbances, PTSD symptoms, psychosocial functioning and quality of life in trauma-affected refugees. TRIAL REGISTRATION EudraCT registration under the name 'Treatment of sleep disturbances in trauma-affected refugees - a randomised controlled trial', registration number: 2015-004153-40 , registered on 13 November 2015. ClinicalTrials.gov, ID: NCT02761161. Registered on 27 April 2016.
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Affiliation(s)
- Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet – Glostrup, Copenhagen University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark
| | - Lone Baandrup
- Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Ida Sophie Poschmann
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
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A randomised, placebo-controlled trial of transcranial pulsed electromagnetic fields in patients with multiple chemical sensitivity. Acta Neuropsychiatr 2017; 29:267-277. [PMID: 27919300 DOI: 10.1017/neu.2016.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the efficacy of transcranially applied pulsed electromagnetic fields (PEMF) on functional impairments and symptom severity in multiple chemical sensitivity (MCS) patients. METHODS The study was conducted as a nationwide trial in Denmark using a randomised, parallel-group, double-blind and placebo-controlled design. Sample size was estimated at 40 participants. Eligibility criteria were age 18-75 years and fulfilment of the MCS case criteria. Participants received either PEMF or placebo PEMF (no stimulation) applied transcranially for 6 weeks. The primary outcome was the Life Impact Scale (LIS) of the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Secondary outcomes were the Symptom Severity Scale (SSS) and the Chemical Intolerance Scale of QEESI. RESULTS A total of 39 participants were randomised to PEMF or placebo treatment. No significant difference was observed on QEESI LIS between groups with a mean change score of -5.9 in the PEMF group compared with -1.5 in the placebo group (p=0.35, effect size=-0.31). However, a significant decrease was detected on QEESI SSS within and between groups with a mean change score of -11.3 in the PEMF group compared with -3.2 in the placebo group (p=0.03, effect size=-0.60). CONCLUSION PEMF treatment of 6 weeks showed no effect on functional impairments in MCS. However, a significant decrease in symptom severity was observed.
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