Validity, reliability, and psychometric properties of a computerized, cognitive assessment test (Cognivue®)

BACKGROUND

Cognitive issues such as Alzheimer’s disease and other dementias confer a substantial negative impact. Problems relating to sensitivity, subjectivity, and inherent bias can limit the usefulness of many traditional methods of assessing cognitive impairment.

AIM

To determine cut-off scores for classification of cognitive impairment, and assess Cognivue^® safety and efficacy in a large validation study.

METHODS

Adults (age 55-95 years) at risk for age-related cognitive decline or dementia were invited via posters and email to participate in two cohort studies conducted at various outpatient clinics and assisted- and independent-living facilities. In the cut-off score determination study (n = 92), optimization analyses by positive percent agreement (PPA) and negative percent agreement (NPA), and by accuracy and error bias were conducted. In the clinical validation study (n = 401), regression, rank linear regression, and factor analyses were conducted. Participants in the clinical validation study also completed other neuropsychological tests.

RESULTS

For the cut-off score determination study, 92 participants completed St. Louis University Mental Status (SLUMS, reference standard) and Cognivue^® tests. Analyses showed that SLUMS cut-off scores of < 21 (impairment) and > 26 (no impairment) corresponded to Cognivue^® scores of 54.5 (NPA = 0.92; PPA = 0.64) and 78.5 (NPA = 0.5; PPA = 0.79), respectively. Therefore, conservatively, Cognivue^® scores of 55-64 corresponded to impairment, and 74-79 to no impairment. For the clinical validation study, 401 participants completed ≥ 1 testing session, and 358 completed 2 sessions 1-2 wk apart. Cognivue^® classification scores were validated, demonstrating good agreement with SLUMS scores (weighted κ 0.57; 95%CI: 0.50-0.63). Reliability analyses showed similar scores across repeated testing for Cognivue^® (R² = 0.81; r = 0.90) and SLUMS (R² = 0.67; r = 0.82). Psychometric validity of Cognivue^® was demonstrated vs. traditional neuropsychological tests. Scores were most closely correlated with measures of verbal processing, manual dexterity/speed, visual contrast sensitivity, visuospatial/executive function, and speed/sequencing.

CONCLUSION

Cognivue^® scores ≤ 50 avoid misclassification of impairment, and scores ≥ 75 avoid misclassification of unimpairment. The validation study demonstrates good agreement between Cognivue^® and SLUMS; superior reliability; and good psychometric validity.

Do adjunctive art therapies reduce symptomatology in schizophrenia? A meta-analysis

BACKGROUND

Art therapies are advocated by national bodies, such as the United Kingdom’s National Institute for Health and Care Excellence, to alleviate the negative symptoms associated with schizophrenia. The last decade has however, seen several new larger well-controlled trials published suggesting an update is timely.

AIM

To asses randomised controlled trials (RCT) of art therapies for reducing the symptoms of schizophrenia – particularly negative symptoms.

METHODS

Searches of PubMed and Scopus were conducted until May 2019 for RCTs examining the impact of art therapies on psychosis (positive, negative and total) symptoms in people diagnosed with schizophrenia. Study quality was assessed using the Cochrane risk of bias tool. Random effects meta-analyses were used to derive overall effect sizes. Moderator analyses were conducted using both meta-regression and categorical comparisons.

RESULTS

We identified 133 articles, of which 9 RCTs involving 948 participants (475 assigned to art therapies and 473 controls) met our inclusion criteria. Using random effects models, we calculated pooled effect sizes (Hedges g) for end-of-trial symptomatic outcomes. Effect sizes both for total symptoms [g = -0.27, 95% confidence interval (CI) -0.60 to 0.05, k = 6] and for positive symptoms (g = -0.10, 95%CI -0.35 to 0.15, k = 6) were non-significant; however, we did find significant reduction of negative symptoms (g = -0.42, 95%CI -0.70 to -0.14, k = 9). Meta-regression revealed that negative symptom reduction was larger in trials with a greater proportion of women and in trials with younger patients. Crucially, the negative symptom reduction following art therapies was limited to lower quality trials and did not emerge in trials that used blind assessment of outcomes.

CONCLUSION

This review presents a comprehensive meta-analysis of art therapies in schizophrenia in terms of both studies included and participant numbers. We found that art therapies did not significantly reduce total or positive symptoms. A "small" therapeutic effect was found for negative symptoms, but we show that the effect is not present in blind trials and may be subject to publication bias.

Outcomes of administrative involuntary hospitalization: A national retrospective cohort study in Japan

BACKGROUND

Treatment for offenders with mental disorders is a key concern in public mental health. Provision of adequate psychiatric treatment is important for the offender and their community. An approach used in Japan to address this issue is administrative involuntary hospitalization. Under this scheme, a person at risk for harming themselves or others because of a mental disorder can be involuntarily hospitalized in a designated psychiatric hospital. However, this scheme does not include tracking of these patients after discharge. Although some data for administrative involuntary hospitalizations are available, it remains unclear what happens to these patients after discharge.

AIM

To evaluate follow-up of patients under administrative involuntary hospitalization after discharge and obtain data for later comparisons with outcomes.

METHODS

We used a retrospective design and conducted a national survey of administrative involuntary hospitalizations. Questionnaires were distributed to 939 facilities across Japan. The questionnaire collected data for selected involuntary hospitalization cases in the hospital on June 30, 2010 (census date), and the prognoses of each patient on a specified date in 2011 and 2012. We also asked about the treatment provided to each patient. We stratified patients by prognosis (good or poor), and used logistic regression analysis to examine the relationship between treatment and prognosis.

RESULTS

We received completed questionnaires from 292 facilities (response rate 31.1%); 105 facilities had no relevant patients. Our analysis included data for 394 patients with valid data. Official statistics indicated 1503 patients were under administrative involuntary hospitalization as at June 30, 2012, meaning the capture rate was 27.2%. Approximately a fourth (104/394) at 1 year, and a third (137/294) at 2 years after the census had unknown prognosis. Treatment content included multi-disciplinary team meetings (78.2% of patients), counseling by public workers (59.9%), and discussion with external specialists (32.5%). Overall, 116 patients were categorized as having a good prognosis at 1 year, and 168 had a poor prognosis. At the 2-year point, 102 patients had a good prognosis and 150 had a poor prognosis. “Discussion with external specialists” was positively associated with a good prognosis at both 1 year (P = 0.016) and 2 years (P = 0.036).

CONCLUSION

We found that facilities in Japan currently have limited ability to track the prognoses of patients who were hospitalized involuntarily. Discussion with external specialists is associated with a good prognosis.

Dissociation and disasters: A systematic review

BACKGROUND

Dissociation, which is defined as the failure to associate consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior into an integrated whole, has long been assumed to be generated by trauma. If dissociation is a product of trauma exposure, then dissociation would be a major mental health outcome observed in studies of disaster survivors. Although some studies have examined dissociation in disasters, no systematic literature reviews have been conducted to date on the topic.

AIM

To systematically evaluate the literature on the association between disaster and dissociation to determine the prevalence and incidence of dissociation after exposure to disaster and further examine their relationship.

METHODS

EMBASE, Medline, and PsychINFO were searched from inception to January 1, 2019 to identify studies examining dissociative disorders or symptoms related to a disaster in adult or child disaster survivors and disaster responders. Studies of military conflicts and war, articles not in English, and those with samples of 30 or more participants were excluded. Search terms used were “disaster*” and dissociation (“dissociat*,” “multiple personality,” “fugue,” “psychogenic amnesia,” “derealization,” and “depersonalization”). Reference lists of identified articles were scrutinized to identify studies for additional articles.

RESULTS

The final number of articles in the review was 53, including 36 articles with samples of adults aged 18 and above, 5 of children/adolescents under age 18, and 12 of disaster workers. Included articles studied several types of disasters that occurred between 1989 and 2017, more than one-third (38%) from the United States. Only two studies had a primary aim to investigate dissociation in relation to disaster and none reported data on dissociative disorders. All of the studies used self-report symptom scales; none used structured interviews providing full diagnostic assessment of dissociative disorders or other psychopathology. Several studies mixed exposed and unexposed samples or did not differentiate outcomes between exposure groups. Studies examining associations between dissociation and disaster exposure have been inconclusive. The majority (75%) of the studies compared dissociation with posttraumatic stress, with inconsistent findings. Dissociation was found to be associated with a wide range of other psychiatric disorders, symptoms, and negative emotional, cognitive, and functional states.

CONCLUSION

The studies reviewed had serious methodological limitations including problems with measurement of psychopathology, sampling, and generation of unwarranted conclusions, precluding conclusions that dissociation is an established outcome of disaster.

Substance use disorders among older adults: A review of randomized controlled pharmacotherapy trials

Substance use disorders (SUDs) are a growing problem among older adults. Acamprosate, disulfiram, and naltrexone are United States Food and Drug Administration (referred to as FDA) approved for the treatment of alcohol use disorder, and buprenorphine is approved for the treatment of opiate use disorder among adults. However, the data on the use of these medications for the treatment of SUDs among older adults are unclear from randomized controlled trials (referred to as RCTs). A review of the literature indicates that there are only two RCTs that evaluated the use of pharmacologic agents for SUDs among older adults (≥ 50 years). One trial evaluated the use of naltrexone when compared to placebo for the treatment of alcohol use disorder among individuals, 50-70 years in age. The other trial evaluated the use of naltrexone or placebo as adjuncts with sertraline in the treatment of alcohol use disorder among individuals older than 55 years in age. Both trials indicated that the use of naltrexone reduced the rates of relapse among older adults with alcohol use disorder. However, we did not identify any RCTs that studied the use of buprenorphine, acamprosate, or disulfiram for SUDs among older adults. Based on available evidence, it would be safe to conclude that limited data indicate some efficacy for naltrexone in the treatment of alcohol use disorder among older adults. However, data from controlled trials on the use of other medications that are FDA approved for the treatment of SUDs among younger adults are nonexistent among older adults with SUDs.

Medical student depression and its correlates across three international medical schools

BACKGROUND

Medical students have high rates of depression, anxiety, and burnout that have been found to affect their empathy, professional behaviors, and performance as a physician. While studies have examined predictors for burnout and depression in the United States (US), no study, to our knowledge, has compared depression in medical students cross-culturally, or has attempted to examine the effect of factors influencing rates including burnout, exercise, stress, unmet mental health needs, and region.

AIM

To examine rates of depression in three international cohorts of medical students, and determine variables that may explain these differences.

METHODS

Convenience samples of medical students from three countries (US, China, and a Middle Eastern country whose name remains anonymous per request from the school) were surveyed in this observational study. Using the Patient Health Questionnaire-2 (PHQ-2) and a modified Maslach Burnout Inventory, depression and burnout were examined among medical students from the three cohorts (n = 473). Chi-square test and analysis of variance were used to examine differences in demographics, behavioral, and psychological variables across these three schools to identify potentially confounding descriptive characteristics. Analysis of covariance compared depression and the emotional exhaustion component of burnout identified through Principal Component Analysis across countries. Multiple linear regression was used to analyze the impact of demographic, behavioral, and psychological variables on screening positive for depression.

RESULTS

Medical students from the Middle Eastern country had the highest rates of positive depression screens (41.1%), defined as a PHQ-2 score of ≥ 3, followed by China (14.1 %), and then the US (3.8%). More students in the Middle Eastern school had unmet mental health needs (50.8%) than at the medical school in China (34.8%) or the school in the US (32.8%) (Pearson chi-square significance < 0.05). Thus, PHQ-2 scores were adjusted for unmet mental health needs; however, the Middle Eastern country continued to have the highest depression. Adjusting for PHQ-2 score, medical students from the US scored the highest on emotional exhaustion (a measure of burnout). Demographic variables did not significantly predict medical student depression; however, lack of exercise, unmet mental health needs, stress, and emotional exhaustion predicted nearly half of depression in these cohorts. In comparison to the US, coming from the Middle Eastern country and China predicted higher levels of depression.

CONCLUSION

Depression rates differ in three international cohorts of medical students. Measured factors contributed to some observed differences. Identifying site-specific prevention and intervention strategies in medical student mental health is warranted.

Problematic Internet use in drug addicts under treatment in public rehab centers

BACKGROUND

Problematic Internet use (PIU) or Internet addiction has been recognized to be a behavioral addiction characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding computer use and Internet access that leads to impairment or distress resembling substance abuse.

AIM

To investigate the prevalence and characteristics of Internet use and abuse in a group of drug addicts from Southern Italy, by means of a specific questionnaire [“Questionario sull’Utilizzo delle Nuove Tecnologie” (QUNT)].

METHODS

All subjects (183) were heavy smokers, almost 50% of them used heroin and/or opioid compounds, 30% alcohol, 10% cannabis, 8% cocaine, and 5% were polydrug users. Almost 10% of the individuals were also suffering from gambling disorder.

RESULTS

The time spent online was more than 4 hours a day in the total sample, with a slight prevalence in male subjects. Cocaine and cannabis users spent more than 6 hours online, significantly more than opioid and alcohol abusers. Distribution of the QUNT factors was not different in both sexes. Cocaine users showed higher scores at the “loss of control”, “pornography addiction”, and “addiction to social networks” factors, for the stimulant effect of this substance. Moreover, 15 out of the total 17 cocaine users were pathological gamblers. Positive and statistically significant relationships were observed between some QUNT factors and body mass index.

CONCLUSION

These findings indicate that PIU is less severe in subjects taking sedative substances, such as heroin/opioids and alcohol, than in subjects taking stimulants. Alternatively, it may be used as a “stimulant” trigger in cocaine and cannabis users. Flattening effect of abuse drugs was noted on possible sex-related differences in QUNT items. We observed a sort of “protective” effect of a love relationship and/or living together with a partner, as those engaged subjects showed lower scores on different items than single subjects or those living alone. The relationship between time spent online (and related sedentary lifestyle) and body mass index would suggest that Internet use might be a contributing factor to increasing weight gain and obesity amongst adolescents and young adults worldwide. Our findings also highlighted the specific vulnerability of drug addicts who use stimulants, rather than sedative compounds, to other kinds of behavioral addictions, such as gambling disorder.

Evidence for using pimavanserin for the treatment of Parkinson's disease psychosis

The aim of this editorial is to evaluate the evidence for using pimavanserin for the treatment of Parkinson's disease psychosis (PDP) from randomized controlled trials (RCTs). We only identified two published trials that evaluated the use of pimavanserin among individuals with PDP. Both studies found that pimavanserin improved psychotic symptoms among individuals with PDP when compared to placebo. Pimavanserin was fairly well tolerated in both studies and did not appear to cause significant sedation or worsen motor symptoms among individuals with PDP. However, given the limited data, additional confirmatory studies are required before pimavanserin can be considered as a first line agent for the treatment of psychotic symptoms among individuals with PD.

Parenting preschoolers with autism: Socioeconomic influences on wellbeing and sense of competence

BACKGROUND

Previous research suggests that parents raising a child with autism experience higher levels of psychological distress than parents of typically developing children and parents of children with other developmental disorders. Little is known, however, about the intersection between the effects of socioeconomic status (SES) on the wellbeing and sense of parental competency of parents of pre-schoolers with autism and how it relates to child symptom severity.

AIM

To examine the relationship between their child’s symptom severity, SES, as measured by neighbourhood advantage and occupational status, on the psychological wellbeing and perceived parenting competence among parents of preschoolers with autism.

METHODS

Parents of 117 preschool-aged children with a diagnosis of autism spectrum disorder (ASD), 107 mothers and 54 fathers, completed questionnaires about their child’s symptoms of ASD and functioning, their own perceptions of their wellbeing and parental competence on entry to an early intervention program in Sydney, Australia. Parents also provided demographic information pertaining to their occupation, level of education attained and address (postcode). All children were also assessed for their severity of symptoms using the Autism Diagnostic Observation Schedule. The Australian Socioeconomic Index of occupational status as a measure of familial SES and the Index of Relative Socio-economic Advantage and Disadvantage as a measure of neighbourhood advantage were used to examine the impact of SES on parental sense of competence and wellbeing.

RESULTS

Compared to normative populations, both mothers and fathers in our sample reported significantly higher levels of parenting sense of efficacy but lower levels of interest in the parenting role. Mothers also displayed higher levels of satisfaction. Both mothers and fathers displayed higher levels of depression than normative populations with mothers also reporting greater levels of stress and anxiety. Child symptom severity was associated with maternal parenting competency with these relationships amplified among mothers with higher familial SES and who lived in areas of greater neighbourhood advantage. Increased adaptive functioning was associated with better maternal wellbeing, particularly among mothers who lived in areas of greater neighbourhood advantage. Contrastingly, paternal parenting competence was generally not influenced by child adaptive functioning or symptom severity, although for those in higher familial SES brackets, children’s symptom severity and maladaptive symptoms were negatively related to paternal sense of parenting efficacy. There was a trend towards moderate relationships between lower familial SES and greater depression, stress and anxiety among fathers, but no relationship with their child’s ASD symptom severity or functioning.

CONCLUSION

SES differentially impacts wellbeing and sense of parenting competence and its relationship to the impact of child symptoms for mothers and fathers of preschoolers with autism.

Electroconvulsive therapy: 80 years old and still going strong

Electroconvulsive therapy (ECT), which is among the oldest and most controversial treatments in the field of psychiatry, has its 80^th birthday this year. In this brief historical overview, the discovery of the therapeutic effects of convulsive therapy by Laszló Meduna, and the circumstances that motivated Ugo Cerletti and Lucio Bini to use electricity as a means of seizure induction are described. Meduna’s original theory about the antagonism between epilepsy and schizophrenia has been replaced by hypotheses on the mechanism of action of ECT. The position of ECT in modern psychiatry is also discussed with special attention to its most important clinical indications, including catatonia, and pre- and postpartum affective and psychotic states that are responsive to ECT and in which ECT may even be lifesaving. Adverse effects and comparison of ECT with recently developed brain stimulation methods are also reviewed. The negative media portrayal of ECT and its earlier misuse may have contributed to its negative professional and public perceptions indicated repeatedly in attitude surveys. This negative attitude has played an important role in the decreasing use of ECT in the developed world and a reduction in access to ECT, which constitutes a violation of psychiatric patients’ right to an effective treatment.

Comorbidity of bipolar and anxiety disorders: An overview of trends in research

Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder (BD), but it also adversely impacts the course, outcome, and treatment of BD. The present review provides an overview of the current trends in research on comorbid anxiety and BDs based on prior reviews and meta-analyses (n = 103), epidemiological surveys, and large-scale clinical studies. The results reiterated the fact that at least half of those with BD are likely to develop an anxiety disorder in their lifetimes and a third of them will manifest an anxiety disorder at any point of time. All types of anxiety disorders were equally common in BD. However, there was a wide variation in rates across different sources, with most of this discrepancy being accounted for by methodological differences between reports. Comorbid anxiety disorders negatively impacted the presentation and course of BD. This unfavourable clinical profile led to poorer outcome and functioning and impeded treatment of BD. Despite the extensive body of research there was paucity of data on aetiology and treatment of anxiety disorder comorbidity in BD. Nevertheless, the substantial burden and unique characteristics of this comorbidity has important clinical and research implications.

Treatment alliance and adherence in bipolar disorder

The clinician patient relationship lies at the core of psychiatric practice and delivery of mental health care services. The concept of treatment alliance in psychiatry has its origins in psychotherapy, but has also been influenced by several other constructs such as patient-centred care (PCC) and shared decision-making (SDM). Similarly, there has been a shift in conceptualization of treatment-adherence in psychiatric disorders including bipolar disorder (BD) from illness-centred and clinician-centred approaches to patient-centred ones. Moreover, the traditional compliance based models are being replaced by those based on concordance between clinicians and patients. Newer theories of adherence in BD place considerable emphasis on patient related factors and the clinician patient alliance is considered to be one of the principal determinants of treatment-adherence in BD. Likewise, current notions of treatment alliance in BD also stress the importance of equal and collaborative relationships, sensitivity to patients' viewpoints, sharing of knowledge, and mutual responsibility and agreement regarding decisions related to treatment. Accumulated evidence from quantitative research, descriptive accounts, qualitative studies and trials of psychosocial interventions indicates that efficacious treatment alliances have a positive influence on adherence in BD. Then again, research on the alliance-adherence link in BD lags behind the existing literature on the subject in other medical and psychiatric conditions in terms of the size and quality of the evidence, the consistency of its findings and clarity about underlying processes mediating this link. Nevertheless, the elements of an effective alliance which could have a positive impact on adherence in BD are reasonably clear and include PCC, collaborative relationships, SDM, open communication, trust, support, and stability and continuity of the relationship. Therefore, clinicians involved in the care of BD would do well to follow these principles and improve their interpersonal and communication skills in order to build productive alliances with their patients. This could go a long way in confronting the ubiquitous problem of non-adherence in BD. The role of future research in firmly establishing the alliance-adherence connection and uncovering the processes underlying this association will also be vital in devising effective ways to manage non-adherence in BD.

Women who suffer from schizophrenia: Critical issues

Many brain diseases, including schizophrenia, affect men and women unequally - either more or less frequently, or at different times in the life cycle, or to varied degrees of severity. With updates from recent findings, this paper reviews the work of my research group over the last 40 years and underscores issues that remain critical to the optimal care of women with schizophrenia, issues that overlap with, but are not identical to, the cares and concerns of men with the same diagnosis. Clinicians need to be alert not only to the overarching needs of diagnostic groups, but also to the often unique needs of women and men.

Role of rumination in the relationship between metacognition and shyness

AIM

To explore the association between metacognitive beliefs, rumination and shyness in a non-clinical sample of adults.

METHODS

One hundred and three healthy subjects from the general population were enrolled in the study. Shyness was evaluated using the Revised Cheek and Buss Shyness Scale, rumination was assessed using the Ruminative Response Scale, metacognition was evaluated using the Meta-Cognitions Questionnaire 30, and anxiety levels were measured using the State Trait Anxiety Inventory form Y. Correlation analyses, mediation models and 95% bias-corrected and accelerated (BCaCI) bootstrapped analyses were performed. Mediation analyses were adjusted for sex and anxiety.

RESULTS

Shyness, rumination and metacognition were significantly correlated (P < 0.05). The relationship between metacognition and shyness was fully mediated by rumination (Indirect effect: 0.20; 95% BCaCI: 0.08-0.33).

CONCLUSION

These findings suggest an association between metacognition and shyness. Rumination mediated the relationship between metacognition and shyness, suggesting that rumination could be a cognitive strategy for shy people. Future research should explore the relationship between these constructs in more depth.

Antidepressant foods: An evidence-based nutrient profiling system for depression

AIM

To investigate which foods are the most nutrient dense sources of nutrients demonstrated by the scientific literature to play a role in the prevention and promotion of recovery from depressive disorders.

METHODS

A systematic literature review was conducted to derive a list of Antidepressant Nutrients from the 34 nutrients known to be essential for humans using level of evidence criteria. Nutritional data was extracted for a subset of foods with a high content of at least 1 Antidepressant Nutrient using a USDA database. These foods were analyzed for Antidepressant Nutrient density resulting in an Antidepressant Food Score (AFS). Plant and animal foods were analyzed separately.

RESULTS

Twelve Antidepressant Nutrients relate to the prevention and treatment of depressive disorders: Folate, iron, long-chain omega-3 fatty acids (EPA and DHA), magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc. The highest scoring foods were bivalves such as oysters and mussels, various seafoods, and organ meats for animal foods. The highest scoring plant foods were leafy greens, lettuces, peppers, and cruciferous vegetables.

CONCLUSION

The AFS is based on a nutrient profiling system devised to identify foods with the highest nutrient density of nutrients with clinical evidence to support their role in depressive disorders. This list of foods and food categories with the highest density of the 12 Antidepressant Nutrients, the Antidepressant Foods, should be considered by researchers in the design of future intervention studies and clinicians as dietary options to support prevention and recovery from depression disorders.

Psycho-emotional content of illness narrative master plots for people with chronic illness: Implications for assessment

Illness narratives are stories of illness told by patients with chronic illness. One way of studying illness narratives is by considering illness narrative master plots. An examination of illness narrative master plots has revealed the importance of psycho-emotional information contained within the story that is told. There is a need for research to capture this information in order to better understand how common stories and experiences of illness can be understood and used to aid the mental well-being of individuals with chronic illness. The current editorial provides a suggestion of how this is possible. This editorial identifies that stories can be “mapped” graphically by combining emotional responses to the illness experience with psychological responses of the illness experience relating to hope and psychological adaptation. Clinicians and researchers should consider the evidence presented within this editorial as: (1) A possible solution for documenting the mental well-being of individuals with chronic illness; and (2) As a tool that can be used to consider changes in mental well-being following an intervention. Further research using this tool will likely provide insights into how illness narrative master plots are associated together and change across the course of a chronic illness. This is particularly important for illness narrative master plots that are difficult to tell or that are illustrative of a decline in mental well-being.

Single men seeking adoption

It was once impossible anywhere in the world for single adults to adopt children, and this is still the case in many jurisdictions. Elsewhere, however, single adults are now being actively recruited primarily because they are more willing than are married couples to adopt older or disabled children or to adopt across racial or other barriers. This is true for single men as well as for single women, but single men seeking to adopt continue to be widely viewed with skepticism and are reportedly often judged to be inappropriate parents. This paper reviews the sparse fostering and adoption literature on single heterosexual males and addresses the evident ambivalence with which parenting by single men is held among both child and adult mental health professionals. The paper also discusses the parenting styles of mothers and fathers, the ways that the central nervous system in both sexes has been found to respond to parenthood, the similarity of outcomes between single male and single female parenting, and the availability in North America of support and training for foster and adoptive single parents. The paper concludes that, in general, single men have as much to offer an adopted child as do single women and that seeming discrimination against them by childcare agencies requires investigation.

Psychic euosmia and obsessive compulsive personality disorder

Patients with obsessive compulsive personality disorder (OCPD) often refer to a prompt mood improvement upon encountering good scents in general, or fresh laundry borax on their clothes, pillows or home settings. The Authors propose the new term psychic euosmia in the mean of an overstated psychological predisposition for a real pleasant smell that elicits an immediate sense of pleasure, order and calm. The prompt reactions to a pleasant odor might be explained by the involvement of rhinencephalon and its proximity to mood-related limbic circuits, which bypass the cognitive awareness. Cleanliness may not preclude a subject to enjoy a good smell, even if we are representing smells that resemble freshness, in other words order. A potentially even more important argument is given by the continuum of personality disorders and their variability. Not all personality characteristics led to disturbed behaviors. In evolutionary perspectives having the ability to differentiate between unpleasant and pleasant odors should have made the difference in surviving. On the other hand, psychic euosmia could be considered a normal reaction, but in our clinical experience it is over-represented among OCPD subjects with marked orderliness and disgust. Therefore, detecting psychic euosmia might vicariously confirm the relevance of disgust as a cognitive driver of OCPD. Hereby we support research to characterize psychic euosmia as a feature of orderliness and cleanliness for OCPD.

Successful treatment of nightmares may reduce psychotic symptoms in schizophrenia

Nightmares occur more frequently in patients with schizophrenia than they do in the general population. Nightmares are profoundly distressing and may exacerbate daytime psychotic symptoms and undermine day-to-day function. Clinicians do not often ask about nightmares in the context of psychotic illness and patients may underreport them or, if nightmares are reported, they may be disregarded; it may be assumed that they will disappear with antipsychotic medication and that they do not, therefore, require separate intervention. This is a missed opportunity because Image Rehearsal Therapy, among other psychological and pharmacological interventions, has proven effective for nightmares in non-schizophrenia populations and should be considered at an early stage of psychotic illness as an important adjunct to standard treatment. There is active ongoing research in this field, which will undoubtedly benefit patients with schizophrenia in the future.

Drinking plain water is associated with decreased risk of depression and anxiety in adults: Results from a large cross-sectional study

AIM

To investigate the relation between plain water drinking and risk of depression and anxiety among a large sample of Iranian adults.

METHODS

A total of 3327 Iranian general adults were included in this cross-sectional study. Validated Iranian version of the Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Water consumption was assessed by asking about the number of glasses of water that consumed daily. Water consumption was categorized into < 2, 2-5, and ≥ 5 glasses of water/d.

RESULTS

In the crude model, the lowest level of water drinking (< 2 glasses/d) compared with reference group (≥ 5 glasses/d) doubled the risk of depression and anxiety (P < 0.0001). After adjusting potential confounders, this inverse link remained significant for depression (OR: 1.79; 95%CI: 1.32, 2.42; P < 0.0001), but not for anxiety (OR: 1.49; 95%CI: 0.98, 2.25; P = 0.109). In stratified analyses by sex, after controlling for potential confounders, water drinking < 2 glasses/d was associated with 73% and 54% increment in the risk of depression in men and women, respectively (P < 0.05), whilst no significant association was observed for anxiety either in men or in women.

CONCLUSION

We found inverse associations between plain water consumption and depression. Also, these findings showed a tended risky association, but not statistically significant, between lower levels of water consumption and anxiety. These findings warrant evaluation in prospective and clinical trials studies to establish the plausible role of water in mental health status.

Glutamate transporters, EAAT1 and EAAT2, are potentially important in the pathophysiology and treatment of schizophrenia and affective disorders

Glutamate is the predominant excitatory neurotransmitter in the human brain and it has been shown that prolonged activation of the glutamatergic system leads to nerve damage and cell death. Following release from the pre-synaptic neuron and synaptic transmission, glutamate is either taken up into the pre-synaptic neuron or neighbouring glia by transmembrane glutamate transporters. Excitatory amino acid transporter (EAAT) 1 and EAAT2 are Na⁺-dependant glutamate transporters expressed predominantly in glia cells of the central nervous system. As the most abundant glutamate transporters, their primary role is to modulate levels of glutamatergic excitability and prevent spill over of glutamate beyond the synapse. This role is facilitated through the binding and transportation of glutamate into astrocytes and microglia. The function of EAAT1 and EAAT2 is heavily regulated at the levels of gene expression, post-transcriptional splicing, glycosylation states and cell-surface trafficking of the protein. Both glutamatergic dysfunction and glial dysfunction have been proposed to be involved in psychiatric disorder. This review will present an overview of the roles that EAAT1 and EAAT2 play in modulating glutamatergic activity in the human brain, and mount an argument that these two transporters could be involved in the aetiologies of schizophrenia and affective disorders as well as represent potential drug targets for novel therapies for those disorders.

Melatonin in drug addiction and addiction management: Exploring an evolving multidimensional relationship

Melatonin is a pleiotropic signalling molecule that regulates several physiological functions, and synchronises biological rhythms. Recent evidences are beginning to reveal that a dysregulation of endogenous melatonin rhythm or action may play a larger role in the aetiology and behavioural expression of drug addiction, than was previously considered. Also, the findings from a number of animal studies suggest that exogenous melatonin supplementation and therapeutic manipulation of melatonin/melatonin receptor interactions may be beneficial in the management of behavioural manifestations of drug addiction. However, repeated exogenous melatonin administration may cause a disruption of its endogenous rhythm and be associated with potential drawbacks that might limit its usefulness. In this review, we examine the roles of melatonin and its receptors in addictive behaviours; discussing how our understanding of melatonin’s modulatory effects on the brain rewards system and crucial neurotransmitters such as dopamine has evolved over the years. Possible indications(s) for melatonergic agents in addiction management, and how manipulations of the endogenous melatonin system may be of benefit are also discussed. Finally, the potential impediments to application of melatonin in the management of addictive behaviours are considered.

Repeatability of two-dimensional chemical shift imaging multivoxel proton magnetic resonance spectroscopy for measuring human cerebral choline-containing compounds

AIM

To investigate the repeatability of proton magnetic resonance spectroscopy in the in vivo measurement of human cerebral levels of choline-containing compounds (Cho).

METHODS

Two consecutive scans were carried out in six healthy resting subjects at a magnetic field strength of 1.5 T. On each occasion, neurospectroscopy data were collected from 64 voxels using the same 2D chemical shift imaging (CSI) sequence. The data were analyzed in the same way, using the same software, to obtain the values for each voxel of the ratio of Cho to creatine. The Wilcoxon related-samples signed-rank test, coefficient of variation (CV), repeatability coefficient (RC), and intraclass correlation coefficient (ICC) were used to assess the repeatability.

RESULTS

The CV ranged from 2.75% to 33.99%, while the minimum RC was 5.68%. There was excellent reproducibility, as judged by significant ICC values, in 26 voxels. Just three voxels showed significant differences according to the Wilcoxon related-samples signed-rank test.

CONCLUSION

It is therefore concluded that when CSI multivoxel proton neurospectroscopy is used to measure cerebral choline-containing compounds at 1.5 T, the reproducibility is highly acceptable.

Bullying among people with visual impairment: Prevalence, associated factors and relationship to self-efficacy and life satisfaction

AIM

To examine associated factors of bullying and to determine associations between bullying and psychosocial outcomes among individuals with visual impairments (VI).

METHODS

We conducted an age-stratified cross-sectional survey of adults with VI who were recruited from the Norwegian Association of the Blind and Partially Sighted. Data were collected through structural telephone interviews in the period between February and May, 2017. Linear regression models were used to examine factors related to bullying and associations of bullying with self-efficacy and life satisfaction.

RESULTS

A total of 736 individuals were interviewed. The lifetime and 6-mo prevalence of bullying was 41.7% and 8.2%, respectively. The majority of bullied participants reported VI-specific bullying (65.1%). Victimization of bullying was associated with young age, early onset-age of VI, and having other impairments. Participants who reported bullying had lower levels of self-efficacy [Adjusted relative risk (ARR): 0.40, 95% confidence interval (CI): 0.19-0.85] and life satisfaction (ARR: 0.68, 95%CI: 0.51-0.91).

CONCLUSION

Bullying is highly prevalent among individuals with VI. Our findings suggest that interventions to reduce bullying may be beneficial for improving the well-being and life quality of people with VI.

Factors associated with tobacco, alcohol, and other drug use among youth living in West Central Mexico

AIM

To determine the prevalence of drug and substance abuse among high school students in Jalisco and its association with the severity of health, behavior and psychosocial problems in order to provide evidence for possible prevention and treatment needs.

METHODS

A multi-stage random sample of Jalisco high school students was given a paper-and-pencil survey based upon an adapted version of the drug use screening inventory (DUSI) (n = 24699; n = 2832). The DUSI showed adequate psychometric characteristics in this population. The statistical analyses accommodated the complex survey design with attention to unequal probability of selection and clustering of participants within schools and regions.

RESULTS

An estimated 44% of the students had smoked tobacco, one in five students was a current smoker, and one in four students used to smoke but had not smoked for one year or more. By contrast, 6.8% of the students reported having used marijuana, cocaine, or both. Behavioral problems, deviant peer affiliation, and troubled families were independently associated with drug use. One in two students who used tobacco or alcohol had used these drugs in the past year (46% and 54%, respectively), and one in four students who used marijuana or cocaine in their lifetime had used those drugs in the past year (28% in both cases).

CONCLUSION

The rates of cocaine use as well as the proportion of current users were higher than expected among high school students and indicate changing patterns of drug use in Mexico. These results corroborate that the general trend of drug use by youth in Mexico is increasing. Results from this study help us better understand the needs of at-risk youth and the need for new treatment and prevention strategies.

Promoting recovery from severe mental illness: Implications from research on metacognition and metacognitive reflection and insight therapy

Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed with the serious mental illness must feel ownership of their recovery. This raises the issue of how mental health services should systematically promote recovery. This paper explores the practical implications for research on metacognition in schizophrenia for this issue. First, we present the integrated model of metacognition, which defines metacognition as the spectrum of activities which allow individual to have available to themselves an integrated sense of self and others as they appraise and respond to the unique challenges they face. Second, we present research suggesting that many with schizophrenia experience deficits in metacognition and that those deficits compromise individuals’ abilities to manage their lives and mental health challenges. Third, we discuss a form of psychotherapy inspired by this research, Metacognitive Reflection and Insight Therapy which assists individuals to recapture the ability to form integrated ideas about themselves and others and so direct their own recovery. The need for recovery oriented interventions to focus on process and on patient’s purposes, assess metacognition and consider the intersubjective contexts in which this occurres is discussed.

Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?

Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases, 11^th version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder (BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities’ biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.

Audit of physical health monitoring in children and adolescents receiving antipsychotics in neurodevelopmental clinics in Northumberland

AIM

To ascertain performance against the standards set by National Institute for Clinical Excellence (NICE) guidelines on physical health monitoring of thirty children and adolescents prescribed antipsychotics in neurodevelopmental clinics in Northumberland and identifying areas for improvement in practice.

METHODS

The audit involved a review of recorded documentation pertaining to physical health monitoring in patient electronic records pertaining to children and adolescents attending neurodevelopmental clinics in Northumberland prescribed antipsychotics. Clients were also contacted by telephone if relevant documentation could not be identified or retrieved to confirm the details. 32 case notes were perused of which 2 were excluded as they had refused to have venepuncture which was documented in the electronic records.

RESULTS

The overall audit results demonstrated partial compliance with NICE guidelines on physical health monitoring in children and adolescents prescribed antipsychotics. Bi-annual recording of height, weight, blood pressure, pulse rate and review of side effects was completed in 100% of subjects. However, annual monitoring for blood tests including liver function, renal function full blood count as well as biannual monitoring of serum prolactin, serum lipid profile was completed only in 56% of subjects. Comparative baseline characteristics between the two groups (compliant and non-compliant with guidelines) found no differences based on any socio-demographic or clinical variables. However, the proportion of patients in the group compliant to guidelines was higher in the age group of 12-17 years as compared to < 12 years (70.58% vs 38.46%), though not statistically significant (χ² = 1.236; P = 0.24).

CONCLUSION

Development of tailored and specific guidelines for physical health monitoring in children and adolescents prescribed antipsychotics taking into consideration clinical effectiveness and safety profile is likely to improve adherence rates.

Effect of educational intervention on attitudes toward the concept of criminal responsibility

AIM

To evaluate the effect of educational intervention on individuals’ knowledge of and attitudes toward forensic mental health.

METHODS

We conducted a questionnaire regarding attitudes toward various ideas about forensic mental health. The respondents attended a 1-h seminar regarding forensic mental health after answering the questionnaire. On completion of the seminar, the respondents answered another questionnaire containing many of the same questions as contained in the pre-seminar questionnaire.

RESULTS

A total of 86 individuals attended the seminar, and 78 responded to the questionnaire. Only 13 (18.8%) participants were supportive of the concept of criminal responsibility initially, and there was a statistically significant increase in those who became more supportive after the seminar, with 22 (33%) being supportive after the seminar (Wilcoxon signed-rank test, P < 0.001). Logistic regression analysis revealed that participants who were skeptical about forensic mental systems and those with fewer opportunities to see media reports regarding psychiatry were likely to become supportive of criminal responsibility after the intervention.

CONCLUSION

These results suggest that public attitudes toward criminal responsibility and mental health can be influenced via educational interventions.

Catatonia as a putative nosological entity: A historical sketch

Kahlbaum was the first to propose catatonia as a separate disease following the example of general paresis of the insane, which served as a model for establishing a nosological entity. However, Kahlbaum was uncertain about the nosological position of catatonia and considered it a syndrome, or “a temporary stage or a part of a complex picture of various disease forms”. Until recently, the issue of catatonia as a separate diagnostic category was not entertained, mainly due to a misinterpretation of Kraepelin’s influential views on catatonia as a subtype of schizophrenia. Kraepelin concluded that patients presenting with persistent catatonic symptoms, which he called “genuine catatonic morbid symptoms”, particularly including negativism, bizarre mannerisms, and stereotypes, had a poor prognosis similar to those of paranoid and hebephrenic presentations. Accordingly, catatonia was classified as a subtype of dementia praecox/schizophrenia. Despite Kraepelin’s influence on psychiatric nosology throughout the 20^th century, there have only been isolated attempts to describe and classify catatonia outside of the Kraepelinian system. For example, the Wernicke-Kleist-Leonhard school attempted to comprehensively elucidate the complexities of psychomotor disturbances associated with major psychoses. However, the Leonhardian categories have never been subjected to the scrutiny of modern investigations. The first three editions of the DSM included the narrow and simplified version of Kraepelin’s catatonia concept. Recent developments in catatonia research are reflected in DSM-5, which includes three diagnostic categories: Catatonic Disorder due to Another Medical Condition, Catatonia Associated with another Mental Disorder (Catatonia Specifier), and Unspecified Catatonia. Additionally, the traditional category of catatonic schizophrenia has been deleted. The Unspecified Catatonia category could encourage research exploring catatonia as an independent diagnostic entity.

Taking care of suicidal patients with new technologies and reaching-out means in the post-discharge period

Suicide is a global public health problem with over one million people dying by suicide each year worldwide. Research efforts have focused on developing and testing novel suicide prevention strategies employing recent technological advances. In order to provide a review regarding the role of new technologies (e.g., postcards/letters, text messages, crisis cards, telephone contacts, online interventions) in suicide prevention, we searched PubMed, ScienceDirect, ResearchGate, and Crisis to identify all papers in English from 1977 to 2016. Our results indicated that brief contact interventions show promise in reducing the number of episodes of repeated self-harm and/or suicide attempts following discharge from the Emergency Department or psychiatric units. Innovative methods of contact (e.g., text messages) are easily implemented by clinicians and received by patients in the period of post discharge and have been shown to be beneficial. However, more research employing randomized clinical trials investigating the potential benefits of these novel suicide prevention methods is warranted. Future researchers should continue improving and testing new technologies in the prevention of suicide.

Biobehavioral assessment of the anxiety disorders: Current progress and future directions

It is difficult to accurately assess and differentially diagnose the anxiety disorders. The current system of assessment relies heavily on the subjective measures of client self-report, clinical observation, and clinical judgment. Fortunately, recent technological advances may enable practitioners to utilize objective, biobehavioral measures of assessment in a clinical setting. The current body of literature on two of these biobehavioral tools (eye-tracking and electrocardiogram devices) is promising, but more validation and standardization research is needed to maximize the utility of these devices. Eye-tracking devices are uniquely capable of providing data that can be used to differentially diagnose anxiety disorders from both other commonly comorbid and misdiagnosed disorders. Both eye-tracking and electrocardiogram devices are able to provide change-sensitive assessment information. This objective, real-time feedback can assist clinicians and researchers in assessing treatment efficacy and symptom fluctuation. Recently developed wearable and highly portable electrocardiogram devices, like the wearable fitness and behavior tracking devices used by many consumers, may be particularly suited for providing this feedback to clinicians. Utilizing these biobehavioral devices would supply an objective, dimensional component to the current categorical diagnostic assessment system. We posit that if adequate funding and attention are directed at this area of research, it could revolutionize diagnostic and on-going assessment practices and, in doing so, bring the field of diagnosis out of the 20th century.

Developmental psychopathology: A primer for clinical pediatrics

Developmental psychopathology (DP), broadly defined as the scientific discipline that has as its primary goal the integration of developmental science and psychopathology into a coherent approach to explanatory models for psychopathological development, has become the dominant approach in the past decade for understanding the origins of mental disorders among children and adolescents. Hence, it is incumbent upon those working in the field of clinical pediatrics to have at least a basic understanding of its core principles of DP. This article provided such an understanding (i.e., a primer) in an exposition of the four principles that are generally considered be core elements of with examples illustrative of each of the principles.

Transition to school for children with autism spectrum disorder: A systematic review

AIM

To identify factors that promote a positive start to school for children with autism spectrum disorder (ASD).

METHODS

Web of Science, MEDLINE, Scopus, and PsychINFO searches were conducted to identify literature published after 1991 and relevant to school transition processes in children with ASD. Twenty studies were deemed eligible for inclusion. These studies evaluated a range of factors including school readiness, parent and teacher perspectives on transition practices, characteristics of children with ASD that are associated with successful transition to school and the impact of school based intervention programs.

RESULTS

A review of these studies showed that children with ASD are less school ready emotionally than their peers and those children with ASD appear to have more externalising behaviours and self-regulation difficulties that affect their school engagement and their relationships with their teachers. There was a paucity of research looking at interventions targeting school readiness. However, school-based behavioural interventions appear to improve cognitive, language and daily living skills, but have less impact on socialisation and peer inclusion.

CONCLUSION

Children with ASD face more challenges transitioning to school, particularly with social interaction. Further development and implementation of specific school-based interventions is needed in order to assist children with autism to maximise their success in starting school.

Tattoos as a window to the psyche: How talking about skin art can inform psychiatric practice

Tattooing the skin as a means of personal expression is a ritualized practice that has been around for centuries across many different cultures. Accordingly, the symbolic meaning of tattoos has evolved over time and is highly individualized, from both the internal perspective of the wearer and the external perspective of an observer. Within modern Western societies through the 1970s, tattoos represented a cultural taboo, typically associated with those outside of the mainstream such as soldiers, incarcerated criminals, gang members, and others belonging to marginalized and counter-cultural groups. This paper aims to review the more recent epidemiology of tattoos in Western culture in order to establish that tattooing has become a mainstream phenomenon. We then review psychological and psychiatric aspects of tattoos, with a goal of revising outmoded stigmas about tattooing and helping clinicians working with tattooed patients to facilitate an exploration of the personal meaning of skin art and self-identity. We suggest that as a kind of augmentation of the physical exam, looking at and talking to patients about their tattoos can provide a valuable window into the psyche, informing clinical practice.

Cognitive correlates of neuroimaging abnormalities in the onset of schizophrenia: A case report

Increasing evidence shows that cognitive impairment and brain abnormalities can appear early in the first episodes of schizophrenia, but it is currently debated how brain changes can correlate with clinical presentation of schizophrenic patients. Of note, this report describes the case of a young schizophrenic male presenting parietal magnetic resonance/positron emission tomography abnormalities and cognitive impairment, documented by specific neuropsychological tests. In our knowledge only few studies have investigated if neuropsychological abnormalities could be concomitant with both structural and functional neuroimaging. This case shows that impairment in specific cognitive domains is associated with structural/functional brain abnormalities in the corresponding brain areas (frontal and parietal lobes), supporting the hypothesis of disconnectivity, involving a failure to integrate anatomical and functional pathways. Future research would define the role of cognitive impairment and neurodegeneration in psychiatric nosography and, in particular, their role in the early phases of illness and long-term outcome of schizophrenic patients.

Understanding the pathophysiology of postpartum psychosis: Challenges and new approaches

Postpartum psychosis is a severe psychiatric condition which affects 1-2 of every 1000 mothers shortly after childbirth. Whilst there is convincing evidence that the condition is precipitated by a complex combination of biological and environmental factors, as yet the pathophysiological mechanisms remain extremely poorly defined. Here, I critically review approaches that have been, or are being, employed to identify and characterise such mechanisms; I also review a recent animal model approach, and describe a novel biological risk model that it suggests. Clarification of biological risk mechanisms underlying disorder risk should permit the identification of relevant predictive biomarkers which will ensure that “at risk” subjects receive prompt clinical intervention if required.

Group psychological intervention for maternal depression: A nested qualitative study from Karachi, Pakistan

AIM

To understand the experience of maternal depression, the factors implicated in accessing health, and the acceptability of the psychosocial intervention.

METHODS

The participants were recruited from the paediatrics outpatient department of Civil Hospital Karachi, Pakistan. The study started in December 2009 and completed in December 2010. Women with maternal depression, aged 18-44 years with children aged 0-30 mo who had received nutritional supplements, and participated in the intervention programme [called Learning through Play (LTP) plus] were included in the study. Qualitative interviews were conducted with 8 participants before the intervention and 7 participants after the intervention. A semi structured topic guide was used to conduct the interviews.

RESULTS

Framework analysis procedures were used to analyse the qualitative data. Four themes emerged: (1) the women’s contextual environment: Interpersonal conflicts, lack of social support and financial issues being the major barriers in assessing healthcare; (2) women’s isolation and powerlessness within the environment: Sense of loneliness was identified as a restricting factor to access healthcare; (3) the impact of the intervention (LTP-Plus): Women felt “listened to” and seemed empowered; and (4) empowered transformed women within the same contextual environment: The facilitator provided a “gardening role” in nurturing the women resulting in a positive transformation within the same environment. The women’s homes seemed to be more happy homes and there was a positive change in their behaviour towards their children.

CONCLUSION

Findings informed the further development and testing of culturally-appropriate psychosocial intervention (LTP⁺) for addressing maternal depression.

Relation of binge eating disorder with impulsiveness in obese individuals

AIM

To investigate the levels of impulsiveness, and the relationship between the binge eating disorder (BED) and the levels of impulsiveness in obese individuals.

METHODS

Two hundred and forty-one obese patients who were included in the study and candidate for bariatric surgery (weight loss surgery) were clinically interviewed to identify the BED group, and patients were divided into two groups: Those with BED and those without BED. The comorbidity rate of groups was determined by using structured clinical interview for DSM-IV (SCID-I). A sociodemographic data form including the story of previous psychiatric treatment, structured clinical interview for DSM-IV (SCID-I), Beck Anxiety Inventory, Beck Depression Inventory (BDI) and Barratt Impulsiveness Scale-11 were applied to both of the groups.

RESULTS

In regard to 241 obese individuals included in the study, total score and score of attention subscale for BED (+) group were significantly high (P < 0.05). In addition, suicide attempt, story of psychiatric consultation, and score for BDI were again significantly high in the BED (+) group (P < 0.05).

CONCLUSION

In assessment of obese individuals, assessment of associated psychopathology such as impulsive characteristics and suicide attempt in addition to disrupted eating behaviors will allow to have a more extensive view.

Development of an instrument to measure patients’ attitudes towards involuntary hospitalization

AIM

To construct and assess the psychometric properties of an instrument to measure patients’ attitudes towards involuntary hospitalization.

METHODS

This is a two phase study. In the first phase, based on comprehensive literature review, a twenty one item scale to measure patients’ attitudes to involuntary admission was constructed. Forensic and inpatient Psychiatrists, patients’ advocates and legal experts (n = 15) were invited to participate in the validation process of the written instrument, by formally rating each item of the instrument for its relevancy in measuring patients’ attitudes to involuntary admission. In the second phase of the project, the instrument was administered to a sample of eighty consecutive patients, who were admitted involuntarily to an acute psychiatric unit of a teaching hospital. All patients completed the constructed attitudes towards involuntary admission scale, and the client satisfaction questionnaire.

RESULTS

Responses from psychiatry and advocacy experts provided evidence for face and content validity for the constructed instrument. The internal consistency reliability of the instrument is 0.84 (Chronbach’ alpha), factor analysis resulted in three correlated, and theoretically meaningful factors. There was evidence for content, convergent, and concurrent validity.

CONCLUSION

A reliable twenty one item instrument scale to measure patients’ attitudes to involuntary admission was developed. The developed instrument has high reliability, there is strong evidence for validity, and it takes ten minutes to complete.

Three-dimensional stereotactic surface projection in the statistical analysis of single photon emission computed tomography data for distinguishing between Alzheimer’s disease and depression

AIM

To evaluate usefulness of single photon emission computed tomography (SPECT) with three-dimensional stereotactic surface projection (3D-SSP) in distinguishing between Alzheimer’s disease (AD) and depression.

METHODS

We studied 43 patients who presented with both depressive symptoms and memory disturbance. Each subject was evaluated using the following: (1) the Minimal Mental State Examination; (2) the Hamilton Rating Scale for Depression; (3) Clinical Global Impression-Severity scale (CGI-S); and (4) SPECT imaging with 3D-SSP.

RESULTS

The MMSE scores correlated significantly with the maximum Z-scores of AD-associated regions. CGI-S scores correlated significantly with the maximum Z-scores of depression-associated regions. Factor analysis identified three significant factors. Of these, Factor 1 could be interpreted as favouring a tendency for AD, Factor 2 as favouring a tendency for pseudo-dementia, and Factor 3 as favouring a depressive tendency.

CONCLUSION

We investigated whether these patients could be categorized as types: Type A (true AD), Type B (pseudo-dementia), Type C (occult AD), and Type D (true depression). The factor scores in factor analysis supported the validity of this classification. Our results suggest that SPECT with 3D-SSP is highly useful for distinguishing between depression and depressed mood in the early stage of AD.

Childhood trauma and factors associated with depression among inpatients with cardiovascular disease

AIM

To identify factors associated with depressive symptoms among inpatients with cardiovascular disease (CVD).

METHODS

This is a cross-sectional study performed in a subsample of a large cross-sectional research that investigated affective disorders and suicide behaviour among inpatients hospitalized in non-surgical wards of the University Hospital of the Federal University of Minas Gerais from November 2013 to October 2015. Sociodemographic and clinical data were obtained through a structured interview and medical record review. Depression was assessed by the depression subscale of the Hospital Anxiety and Depression Scale, with scores ≥ 8 considered as positive screening for depression. We used the Fageström Test for Nicotine Dependence to characterize nicotine dependence. For assessing resilience and early-life trauma, we used the raw scores of the Wagnild and Young Resilience Scale and Childhood Trauma Questionnaire, respectively.

RESULTS

At endpoint, we included 137 subjects. Thirty-eight (27.7%) subjects presented depressive symptoms and nine (23.7%) of those were receiving antidepressant treatment during hospitalization. The female sex; a lower mean educational level; a greater prevalence of previous suicide attempts; a higher level of pain; a higher prevalence of family antecedents of mental disorders; a lower resilience score; and higher childhood trauma score were the factors significantly associated with screening positive for major depression (P < 0.05). Multivariate analysis demonstrated that the factors independently associated with the depressive symptoms were a higher childhood trauma severity (OR = 1.06; P = 0.004); moderate to severe nicotine dependence (OR = 8.58; P = 0.008); and the number of previous hospital admissions (OR = 1.11; P = 0.034). The obtained logistic model was considered valid, indicating that the three factors together distinguished between having or not depressive symptoms, and correctly classified 74.6% of individuals in the sample.

CONCLUSION

Our results demonstrate that inpatients presenting both CVD and a positive screening for depression are more prone to have antecedents of childhood trauma, nicotine dependence and a higher number of previous hospitalizations.

Attention-deficit/hyperactivity disorder and suicide: A systematic review

AIM

To investigate suicidality and attention-deficit/hyperactivity disorder (ADHD), this paper aims to systematically review the literature as an extension of previous reviews.

METHODS

We searched five databases (Ovid MEDLINE, Psychinfo, PubMed, Scopus, Web of Science) with two categories of search terms: (1) suicide; suicidal; suicide behavior; suicide attempt; suicidal thought; and (2) ADHD.

RESULTS

The search resulted 26 articles. There is a positive association between ADHD and suicidality in both sexes and in all age groups. Comorbid disorders mediate between suicidality and ADHD.

CONCLUSION

Recognizing ADHD, comorbid conditions and suicidality is important in prevention.

Neuroimaging studies of cognitive remediation in schizophrenia: A systematic and critical review

AIM

To examine the effects of cognitive remediation therapies on brain functioning through neuroimaging procedures in patients with schizophrenia.

METHODS

A systematic, computerised literature search was conducted in the PubMed/Medline and PsychInfo databases. The search was performed through February 2016 without any restrictions on language or publication date. The search was performed using the following search terms: [(“cogniti*” and “remediation” or “training” or “enhancement”) and (“fMRI” or “MRI” or “PET” or “SPECT”) and (schizophrenia or schiz*)]. The search was accompanied by a manual online search and a review of the references from each of the papers selected, and those papers fulfilling our inclusion criteria were also included.

RESULTS

A total of 101 studies were found, but only 18 of them fulfilled the inclusion criteria. These studies indicated that cognitive remediation improves brain activation in neuroimaging studies. The most commonly reported changes were those that involved the prefrontal and thalamic regions. Those findings are in agreement with the hypofrontality hypothesis, which proposes that frontal hypoactivation is the underlying mechanism of cognitive impairments in schizophrenia. Nonetheless, great heterogeneity among the studies was found. They presented different hypotheses, different results and different findings. The results of more recent studies interpreted cognitive recovery within broader frameworks, namely, as amelioration of the efficiency of different networks. Furthermore, advances in neuroimaging methodologies, such as the use of whole-brain analysis, tractography, graph analysis, and other sophisticated methodologies of data processing, might be conditioning the interpretation of results and generating new theoretical frameworks. Additionally, structural changes were described in both the grey and white matter, suggesting a neuroprotective effect of cognitive remediation. Cognitive, functional and structural improvements tended to be positively correlated.

CONCLUSION

Neuroimaging studies of cognitive remediation in patients with schizophrenia suggest a positive effect on brain functioning in terms of the functional reorganisation of neural networks.

Functional neuroanatomy in panic disorder: Status quo of the research

AIM

To provide an overview of the current research in the functional neuroanatomy of panic disorder.

METHODS

Panic disorder (PD) is a frequent psychiatric disease. Gorman et al (1989; 2000) proposed a comprehensive neuroanatomical model of PD, which suggested that fear- and anxiety-related responses are mediated by a so-called “fear network” which is centered in the amygdala and includes the hippocampus, thalamus, hypothalamus, periaqueductal gray region, locus coeruleus and other brainstem sites. We performed a systematic search by the electronic database PubMed. Thereby, the main focus was laid on recent neurofunctional, neurostructural, and neurochemical studies (from the period between January 2012 and April 2016). Within this frame, special attention was given to the emerging field of imaging genetics.

RESULTS

We noted that many neuroimaging studies have reinforced the role of the “fear network” regions in the pathophysiology of panic disorder. However, recent functional studies suggest abnormal activation mainly in an extended fear network comprising brainstem, anterior and midcingulate cortex (ACC and MCC), insula, and lateral as well as medial parts of the prefrontal cortex. Interestingly, differences in the amygdala activation were not as consistently reported as one would predict from the hypothesis of Gorman et al (2000). Indeed, amygdala hyperactivation seems to strongly depend on stimuli and experimental paradigms, sample heterogeneity and size, as well as on limitations of neuroimaging techniques. Advanced neurochemical studies have substantiated the major role of serotonergic, noradrenergic and glutamatergic neurotransmission in the pathophysiology of PD. However, alterations of GABAergic function in PD are still a matter of debate and also their specificity remains questionable. A promising new research approach is “imaging genetics”. Imaging genetic studies are designed to evaluate the impact of genetic variations (polymorphisms) on cerebral function in regions critical for PD. Most recently, imaging genetic studies have not only confirmed the importance of serotonergic and noradrenergic transmission in the etiology of PD but also indicated the significance of neuropeptide S receptor, CRH receptor, human TransMEMbrane protein (TMEM123D), and amiloride-sensitive cation channel 2 (ACCN2) genes.

CONCLUSION

In light of these findings it is conceivable that in the near future this research will lead to the development of clinically useful tools like predictive biomarkers or novel treatment options.

Identity and schizophrenia: Who do I want to be?

Many individuals with schizophrenia have occasional difficulty defining both to themselves and to others who they truly are. Perhaps for this reason they make attempts to change core aspects of themselves. These attempts may be delusional, but are too often unjustly dismissed as delusional before the potential value of the change is considered. Instead of facilitation, obstacles are placed in the way of hoped-for body modifications or changes of name or of religious faith. This paper discusses the various changes of identity sometimes undertaken by individuals with schizophrenia who may or may not be deluded. Ethical and clinical ramifications are discussed. The recommendation is made that, when clinicians respond to requests for help with identity change, safety needs to be the main consideration.

Consequences of bullying victimization in childhood and adolescence: A systematic review and meta-analysis

AIM

To identify health and psychosocial problems associated with bullying victimization and conduct a meta-analysis summarizing the causal evidence.

METHODS

A systematic review was conducted using PubMed, EMBASE, ERIC and PsycINFO electronic databases up to 28 February 2015. The study included published longitudinal and cross-sectional articles that examined health and psychosocial consequences of bullying victimization. All meta-analyses were based on quality-effects models. Evidence for causality was assessed using Bradford Hill criteria and the grading system developed by the World Cancer Research Fund.

RESULTS

Out of 317 articles assessed for eligibility, 165 satisfied the predetermined inclusion criteria for meta-analysis. Statistically significant associations were observed between bullying victimization and a wide range of adverse health and psychosocial problems. The evidence was strongest for causal associations between bullying victimization and mental health problems such as depression, anxiety, poor general health and suicidal ideation and behaviours. Probable causal associations existed between bullying victimization and tobacco and illicit drug use.

CONCLUSION

Strong evidence exists for a causal relationship between bullying victimization, mental health problems and substance use. Evidence also exists for associations between bullying victimization and other adverse health and psychosocial problems, however, there is insufficient evidence to conclude causality. The strong evidence that bullying victimization is causative of mental illness highlights the need for schools to implement effective interventions to address bullying behaviours.

Differences between British and Japanese perspectives on forensic mental health systems: A preliminary study

AIM

To clarify the differences in views on forensic mental health (FMH) systems between the United Kingdom and Japan.

METHODS

We conducted a series of semi-structured interviews with six leading forensic psychiatrists. Based on a discussion by the research team, we created an interview form. After we finished conducting all the interviews, we qualitatively analyzed their content.

RESULTS

In the United Kingdom the core domain of FMH was risk assessment and management; however, in Japan, the core domain of FMH was psychiatric testimony. In the United Kingdom, forensic psychiatrists were responsible for ensuring public safety, and psychopathy was identified as a disease but deemed as not suitable for medical treatment. On the other hand, in Japan, psychopathy was not considered a mental illness.

CONCLUSION

In conclusion, there are considerable differences between the United Kingdom and Japan with regard to the concepts of FMH. Some ideas taken from both cultures for better FMH practice were suggested.

Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia

AIM

To investigate health-care needs and their correlates among patients with remitted bipolar disorder (BD) compared to patients with remitted schizophrenia.

METHODS

Outpatients with BD (n = 150) and schizophrenia (n = 75) meeting clearly defined remission criteria were included in the study along with their relatives. Diagnostic ascertainment was carried out using the Mini International Neuropsychiatric Interview. Demographic and clinical details were recorded using structured formats. Residual symptoms were assessed using standardized scales. Health-care needs were assessed on two separate scales. The principal instrument employed to assess health-care needs was the Camberwell Assessment of Need-Research version (CAN-R). To further evaluate health-care needs we felt that an additional instrument, which was more relevant for Indian patients and treatment-settings and designed to cover those areas of needs not specifically covered by the CAN-R was required. This instrument with a structure and scoring pattern similar to the CAN-R was used for additional evaluation of needs. Patients’ level of functioning was assessed using the Global Assessment of Functioning Scale and their quality of life (QOL) using the World Health Organization Quality Of Life-BREF version in Hindi.

RESULTS

An average of 6-7 needs was reported by patients with BD as well as their relatives. Commonly reported needs were in the areas of economic and welfare needs, informational needs, social needs and the need for treatment. According to the CAN-R, both patients and relatives reported that more than 60% of the total needs were being met. However, over 90% of the needs covered by the additional evaluation were unmet according to patients and relatives. Needs in the areas of economic and welfare-benefits, information, company, daytime activities and physical health-care were largely unmet according to patients and relatives. Total, met and unmet needs were significantly higher for schizophrenia, but the most common types of needs were quite similar to BD. Relatives reported more needs than patients with certain differences in the types of needs reported. Level of patients’ functioning was the principal correlate of greater total and unmet needs in both groups. Significant associations were also obtained with residual symptoms and QOL.

CONCLUSION

The presence of unmet needs in remitted patients with BD was an additional marker of the enduring psychosocial impairment characteristic of the remitted phase of BD.

Influence of different second generation antipsychotics on the QTc interval: A pragmatic study

AIM

To investigate whether differential influence on the QTc interval exists among four second generation antipsychotics (SGAs) in psychosis.

METHODS

Data were drawn from a pragmatic, randomized head-to-head trial of the SGAs risperidone, olanzapine, quetiapine, and ziprasidone in acute admissions patients with psychosis, and with follow-up visits at discharge or maximally 6-9 wk, 3, 6, 12 and 24 mo. Electrocardiograms were recorded on all visits. To mimic clinical shared decision-making, the patients were randomized not to a single drug, but to a sequence of the SGAs under investigation. The first drug in the sequence defined the randomization group, but the patient and/or clinician could choose an SGA later in the sequence if prior negative experiences with the first one(s) in the sequence had occurred. The study focuses on the time of, and actual use of the SGAs under investigation, that is until treatment discontinuation or change, in order to capture the direct medication effects on the QTc interval. Secondary intention-to-treat (ITT) analyses were also performed.

RESULTS

A total of 173 patients, with even distribution among the treatment groups, underwent ECG assessments. About 70% were males and 43% had never used antipsychotic drugs before the study. The mean antipsychotic doses in milligrams per day with standard deviations (SD) were 3.4 (1.2) for risperidone, 13.9 (4.6) for olanzapine, 325.9 (185.8) for quetiapine, and 97.2 (42.8) for ziprasidone treated groups. The time until discontinuation of the antipsychotic drug used did not differ in a statistically significant way among the groups (Log-Rank test: P = 0.171). The maximum QTc interval recorded during follow-up was 462 ms. Based on linear mixed effects analyses, the QTc interval change per day with standard error was -0.0030 (0.0280) for risperidone; -0.0099 (0.0108) for olanzapine; -0.0027 (0.0170) for quetiapine, and -0.0081 (0.0229) for ziprasidone. There were no statistically significant differences among the groups in this regard. LME analyses based on ITT groups (the randomization groups), revealed almost identical slopes with -0.0063 (0.0160) for risperidone, -0.0130 (0.0126) for olanzapine, -0.0034 (0.0168) for quetiapine, and -0.0045 (0.0225) for ziprasidone.

CONCLUSION

None of the SGAs under investigation led to statistically significant QTc prolongation. No statistically significant differences among the SGAs were found.