Managing Your Own Mood Lability: Use of Mood Stabilizers and Antipsychotics in Pregnancy

Identifying Trends in Posttraumatic Stress Disorder Symptoms, Type of Trauma, and Associated Features: A Latent Class Analysis

The aim of the study was to identify salient groupings of trauma survivors based on Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 posttraumatic stress disorder symptomatology. Latent class analysis was used in 365 outpatient mental health trauma survivors. We identified six classes with two spectra-prominent avoidance and negative alterations in cognitions/mood (NACM)-and a resilient class (a plurality). Sexual assaults were more common among avoidance-prominent classes, and suicide attempts and tobacco problems were more common among NACM-prominent classes. Previous studies have found classes differentiated by numbing, but this is the first since numbing was subsumed by DSM-5's NACM. Our findings suggest that avoidance and numbing are distinct symptoms (consistent with DSM-5) but indicate that current nosology may miss individuals with high numbing and low avoidance despite their distinct suicide risks.

Risk and protective factors for the mental health of displaced Ukrainian families in the Netherlands: study protocol of a 4-year longitudinal study

BACKGROUND

Over 6 million people have fled their homes in response to the full-scale invasion of Russian armed forces into Ukraine and are forcibly displaced since the start on 4 February 2022. Refugees, both adults and children, have a high risk of developing mental health disorders, in particular post-traumatic stress disorder, depression and anxiety disorders. Research into the mental health of Ukrainian families and their needs is urgently needed. The primary aim of this study is to increase our understanding of the consequences of potentially traumatic events for the mental health of parents and children. This may inform the development of mental health and psychosocial support interventions which can be readily implemented in the family context.

METHODS AND ANALYSIS

We will conduct a four-wave longitudinal online survey study among Ukrainian families displaced to the Netherlands. This study is a part of the Nadiya data collection, intended to assess the mental health responses of Ukrainian refugee families to the stress of war, forced migration, family separation and adaptation to new circumstances in their hosting country. Participants are assessed at four time points, approximately 6 months apart. Data collection for T1 started in May 2023. We aim to recruit a total of n=1500 participants at T1, of which n=1000 adults (18 years and older) and n=500 children (8-11 years) and teenagers (12-17 years). To investigate symptom profiles and associated risk and protective factors among parents and children, we will use latent class growth modelling.

ETHICS AND DISSEMINATION

The data collection procedure has been approved by the Ethical Committee of the Faculty of Social Sciences of Utrecht University. Data will be deposited, stored and shared using Utrecht University's institutional research data repository Yoda. This research project is part of the Global Collaboration on Traumatic Stress; all authors are affiliated with this network. The findings will be published in peer-reviewed, open access journals and further disseminated through conference presentations, news updates at the project website and on the websites of the Dutch Society for Traumatic Stress Studies (www.ntvp.nl), and the European Society of Traumatic Stress Studies, as well as through media contributions.

TRIAL REGISTRATION NUMBER

The current study was registered on 26 March 2024 on The Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/9FP7U.

Associations between overprotective parenting style and academic anxiety among Chinese high school students

BACKGROUND

Increasing attention has been paid to the effect of overprotective parenting style, which is prevalent in China, on academic anxiety among high school students. The present study aims to clarify the intrinsic dynamic mechanism and explore gender heterogeneity in this relationship. We also analyze the mediating roles of self-concept and positive coping style, and identify intervention programs for academic anxiety and psychological disorders from these dynamic connections.

METHODS

Data were analyzed using a stratified whole-cluster random sampling method from a sample of 2,286 high school students aged 14-19 years in three regions of China: Shanxi (n = 784), Hebei (n = 675), and Henan (n = 827). Pearson correlation, ordinary least squares (OLS) regression analysis, path analysis, and Fisher's permutation test (FPT) were used to examine the effects of overprotective parenting style on high school students' academic anxiety.

RESULTS

There was a significant positive predictive effect between overprotective parenting style and high school students' academic anxiety ( β = 0.848, t = 144.855, p < 0.001). Students' self-concept was significantly and positively correlated with positive coping style ( β = 0.418, t = 20.720, p < 0.001) and served as mediators in this relationship. Additionally, overprotective parenting style may indirectly alleviate academic anxiety through these mediating factors. Gender variations were also revealed: female students (0.338) showed more negative effects of an overprotective parenting style on academic anxiety compared to male students (0.269).

CONCLUSION

The findings of this study indicate that overprotective parenting style increases the risk of academic anxiety among Chinese high school students. However, this effect is partially mediated by students' self-concept and positive coping style. Therefore, schools and educational policymakers should consider the interrelationships and interactions when designing intervention strategies for adolescents' academic anxiety and psychological disorders. The objective is to effectively decrease the occurrence of adverse behavioral outcomes among adolescents.

Anxiety, depression, working from home and health-related behaviours during COVID-19: Structural equation modelling and serial mediation of associations with angina, heart attacks and stroke

Based on the vulnerability-stress model and coping theory, this study of 1920 people in Scotland investigated how sex, age, occupational factors, anxiety, depression and maladaptive coping behaviours are associated with cardiovascular health. Structural equation modelling and serial Sobel mediation tests were conducted. Anxiety was associated with past arrhythmia, whereas depression was associated with past heart attacks, stroke and angina. Females reported more anxiety, past arrhythmia, confectionary and alcohol consumption, whereas males had more heart attacks. Confectionary consumption was associated with past arrhythmia, and alcohol consumption was associated with past heart attacks. Being older was associated with depression, past stroke, arrhythmia and alcohol consumption. Being younger was associated with anxiety and smoking. Depression and smoking mediated the relationship between type of working and cardiovascular health history, potentially because of socioeconomic factors. Clinicians can use these results to advise clients about cardiovascular risks associated with anxiety, depression, demographics and health-related coping behaviours.

Supporting caregivers of children living with disability in a humanitarian context: realist-informed evaluation of the 'Mighty Children' programme in Afghanistan

INTRODUCTION

To ensure that humanitarian action is disability-inclusive, evidence is needed to understand how different strategies to support children living with disabilities and their families can work in these settings. Evidence from other contexts suggests support groups can improve caregiver quality of life (QOL). This study reports an evaluation of the 'Mighty Children' programme a participatory educational support group programme for caregivers of children living with disability in Kabul province, Afghanistan.

METHODS

We conducted a mixed-methods realist-informed before-and-after study to measure change in caregiver-reported QOL and explore how and for whom the programme worked, and in what contexts. Female caregivers of children with any disability were recruited through clinics in urban Kabul (n=3) and rural Paghman district (n=3). We collected quantitative data on QOL pre/post programme using the Paediatric Quality of Life Inventory Family Impact Module (PedsQL-FIM). Qualitative data were collected through facilitator and participant focus groups postprogramme.

RESULTS

118 caregivers participated in two cohorts (November 2020, February 2021). Caregivers expressed a significant increase in QOL from baseline to programme completion (t(125)=-10.7, p≤0.0001). Participation in cohort 2 was associated with the greatest PedsQL-FIM change.Qualitative data revealed positive changes postprogramme in five key areas: caregiver mindset, parenting practices, disability-inclusive behaviours, psychological well-being and child functioning. These changes were seen as both outcomes and mechanisms influencing the primary outcome of QOL. Mechanisms that mediated these changes included increased knowledge of disability and the core acceptance and commitment therapy components of mindfulness and acceptance.

CONCLUSION

The Mighty Children caregiver support programme for children living with disability in Afghanistan was associated with improved caregiver QOL. Further studies are warranted to explore pathways to scale, sustainability and potential application in other settings.

Intimate Partner Sexual Violence, Gender, and Psychological Distress Among Northern Irish University Students

While substantial prevalence rates of intimate partner sexual violence (IPSV) have been found among university students for decades in North America, there is a specific gap in published studies on this issue in the United Kingdom and Ireland. The present analysis used data from a larger survey study of students in one Northern Irish university. The analyses reported here were used to examine relationships among IPSV victims, gender (males and females only), unhealthy alcohol use, and psychological distress among university students (n = 654) since the age of 16 and during the previous year. The results of this study are consistent with previous research indicating that women (n = 248) experience IPSV more often than men (n = 37; 50% vs. 23%, respectively). Nonetheless, IPSV is experienced by both men and women with statistically significant associations with alcohol use, posttraumatic stress, depression, and generalized anxiety compared with those who did not report any IPSV experience.

Systematic review of machine learning in PTSD studies for automated diagnosis evaluation

Post-traumatic stress disorder (PTSD) is frequently underdiagnosed due to its clinical and biological heterogeneity. Worldwide, many people face barriers to accessing accurate and timely diagnoses. Machine learning (ML) techniques have been utilized for early assessments and outcome prediction to address these challenges. This paper aims to conduct a systematic review to investigate if ML is a promising approach for PTSD diagnosis. In this review, statistical methods were employed to synthesize the outcomes of the included research and provide guidance on critical considerations for ML task implementation. These included (a) selection of the most appropriate ML model for the available dataset, (b) identification of optimal ML features based on the chosen diagnostic method, (c) determination of appropriate sample size based on the distribution of the data, and (d) implementation of suitable validation tools to assess the performance of the selected ML models. We screened 3186 studies and included 41 articles based on eligibility criteria in the final synthesis. Here we report that the analysis of the included studies highlights the potential of artificial intelligence (AI) in PTSD diagnosis. However, implementing AI-based diagnostic systems in real clinical settings requires addressing several limitations, including appropriate regulation, ethical considerations, and protection of patient privacy.

A New Player in Depression: MiRNAs as Modulators of Altered Synaptic Plasticity

Depression is a psychiatric disorder that presents with a persistent depressed mood as the main clinical feature and is accompanied by cognitive impairment. Changes in neuroplasticity and neurogenesis greatly affect depression. Without genetic changes, epigenetic mechanisms have been shown to function by regulating gene expression during the body’s adaptation to stress. Studies in recent years have shown that as important regulatory factors in epigenetic mechanisms, microRNAs (miRNAs) play important roles in the development and progression of depression through the regulation of protein expression. Herein, we review the mechanisms of miRNA-mediated neuroplasticity in depression and discus synaptic structural plasticity, synaptic functional plasticity, and neurogenesis. Furthermore, we found that miRNAs regulate neuroplasticity through several signalling pathways to affect cognitive functions. However, these pathways do not work independently. Therefore, we try to identify synergistic correlations between miRNAs and multiple signalling pathways to broaden the potential pathogenesis of depression. In addition, in the future, dual-function miRNAs (protection/injury) are promising candidate biomarkers for the diagnosis of depression, and their regulated genes can potentially be used as target genes for the treatment of depression.

Sleep and Mental Health Issues in Current and Former Athletes: A Mini Review

Sleep and mental health are important aspects of human health that work concurrently. However, sleep and mental health disorders are often overlooked and undiagnosed in sport due to the negative stigma associated with them. Evidence suggests that athletes are disproportionately affected by mental health issues and sleep problems. Internal and external pressures contribute to psychological distress. Variable competition times, travel and stress are detrimental to sleep quality. Retirement from sport can deteriorate sleep and psychological wellbeing, particularly for those who retired involuntarily and identify strongly with their athletic role. When untreated, these issues can manifest into a range of clinical disorders. This is concerning, not only for compromised athletic performance, but for general health and wellbeing beyond sport. Previous research has focussed on sleep and health independently among currently competing, or former, athletes. To date, no research has comprehensively assessed and compared sleep complaints and mental health issues between these two cohorts. Moreover, research has failed to obtain data across a variety of different competition levels, sports, and genders, leaving the current scope of the literature narrow. Comorbid conditions (e.g., concussion history, obesity), ex-college athletes, and mental health has been the focus of existing literature post-retirement. Future research would benefit from employing both quantitative and qualitative methodologies to comprehensively assess the prevalence and severity of sleep and mental health disorders across current and retired athletes. Research outcomes would inform education strategies, safeguarding athletes from these issues by reducing negative stigmas associated with help-seeking in sport and ultimately increase self-guided treatment.

Prevalence of suicidal ideation and suicide attempts among refugees: a meta-analysis

BACKGROUND

Suicidal ideation and attempts are one of the most serious mental health problems affecting refugees. Risk factors such as mental disorders, low socio-economic status, and stressful life events all contribute to making refugees a high-risk group. For this reason, this meta-analysis aims to investigate the prevalence of suicidal ideation and attempts among refugees in non-clinical populations.

METHOD

We searched PubMed, Web of Science, PubPsych, and PsycInfo for articles reporting (period) prevalence rates of suicidal ideation and attempts. Inclusion criteria were the population of refugees or asylum seekers (aged 16 years and older), assessment of the prevalence of suicidal ideation and attempts in empirical studies in cross-sectional or longitudinal settings, written in English, and published by August 2020. Exclusion criteria were defined as a population of immigrants who have lived in the host country for a long time, studies that examined children and adolescents younger than 16 years, and research in clinical samples. Overall prevalence rates were calculated using Rstudio.

RESULTS

Of 294 matches, 11 publications met the inclusion criteria. The overall period prevalence of suicidal ideation was 20.5% (CI: 0.11-0.32, I2 = 98%, n = 8), 22.3% (CI: 0.10-0.38, I2 = 97%, n = 5) for women, and 27.7% for men (CI: 0.14-0.45, I2 = 93%, n = 3). Suicide attempts had an overall prevalence of 0.57% (CI: 0.00-0.02, I2 = 81%, n = 4).

CONCLUSION

There is a great lack of epidemiological studies on suicidal ideation and attempts among refugees. The high prevalence of suicidal ideation indicates the existence of heavy psychological burden among this population. The prevalence of suicide attempts is similar to that in non-refugee populations. Because of the large heterogeneity between studies, the pooled prevalence estimates must be interpreted with caution. The results underline the need for systematic and standardized assessment and treatment of suicidal ideation and attempts.

Ethical and sociocultural challenges in managing dead bodies during epidemics and natural disasters

Background

Catastrophic natural disasters and epidemics claim thousands of lives and have severe and lasting consequences, accompanied by human suffering. The Ebola epidemic of 2014–2016 and the current COVID-19 pandemic have revealed some of the practical and ethical complexities relating to the management of dead bodies. While frontline staff are tasked with saving lives, managing the bodies of those who die remains an under-resourced and overlooked issue, with numerous ethical and practical problems globally.

Methods

This scoping review of literature examines the management of dead bodies during epidemics and natural disasters. 82 articles were reviewed, of which only a small number were empirical studies focusing on ethical or sociocultural issues that emerge in the management of dead bodies.

Results

We have identified a wide range of ethical and sociocultural challenges, such as ensuring dignity for the deceased while protecting the living, honouring the cultural and religious rituals surrounding death, alleviating the suffering that accompanies grieving for the survivors and mitigating inequalities of resource allocation. It was revealed that several ethical and sociocultural issues arise at all stages of body management: notification, retrieving, identification, storage and burial of dead bodies.

Conclusion

While practical issues with managing dead bodies have been discussed in the global health literature and the ethical and sociocultural facets of handling the dead have been recognised, they are nonetheless not given adequate attention. Further research is needed to ensure care for the dead in epidemics and that natural disasters are informed by ethical best practice.

MSF Paediatric Days: a step forward in operationalising 'Humanitarian Paediatrics'

Around the world, one in four children live in a country affected by conflict, political insecurity and disaster. Healthcare in humanitarian and fragile settings is challenging and complex to provide, particularly for children. Furthermore, there is a distinct lack of medical literature from humanitarian settings to guide best practice in such specific and resource-limited contexts. In light of these challenges, Médecins Sans Frontières (MSF), an international medical humanitarian organisation, created the MSF Paediatric Days with the aim of uniting field staff, policymakers and academia to exchange ideas, align efforts, inspire and share frontline research and experiences to advance humanitarian paediatric and neonatal care. This 2-day event takes place regularly since 2016. The fourth edition of the MSF Paediatric Days in April 2021 covered five main topics: essential newborn care, community-based models of care, paediatric tuberculosis, antimicrobial resistance in neonatal and paediatric care and the collateral damage of COVID-19 on child health. In addition, eight virtual stands from internal MSF initiatives and external MSF collaborating partners were available, and 49 poster communications and five inspiring short talks referred to as 'PAEDTalks' were presented. In conclusion, the MSF Paediatric Days serves as a unique forum to advance knowledge on humanitarian paediatrics and creates opportunities for individual and collective learning, as well as networking spaces for interaction and exchange of ideas.

Experiences of psychotherapists working with refugees in Germany: a qualitative study

BACKGROUND

Despite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group. Although substantial efforts in understanding the complexity of cross-cultural psychotherapy - which in the context of this study we use to refer to therapy with client and therapist of different cultural backgrounds - have been made, there remains a dearth of research exploring barriers for effective cross-cultural psychotherapy. This study aimed at narrowing this gap in knowledge by exploring major challenges encountered by psychotherapists in cross-cultural psychotherapy and strategies which have proven useful in overcoming such challenges.

METHODS

We employed a qualitative study design, conducting semi-structured in-depth interviews with 10 purposely selected psychotherapists working with refugees in Germany. Respondents were from varying theoretical background and had varying levels of experience. Data were analyzed using a thematic approach, following a mix of deductive and inductive coding.

RESULTS

Respondents reported three main challenges in their cross-cultural practice: different or unrealistic expectations of clients towards what psychotherapy would offer them; challenges grounded in different illness explanatory models; and communication challenges. In dealing with these challenges, respondents recommended psychoeducation to overcome issues related to problematic expectations towards psychotherapy; "imagining the real", identifying "counter magic" and other client-appropriate resources to deal with issues related to clients' foreign illness attributions; and translators in dealing with communication barriers, though the latter not univocally.

CONCLUSIONS

Results show that psychotherapy with refugees can be very successful, at least from the psychotherapist perspective, but also poses significant challenges. Our findings underline the importance of developing, testing, and institutionalizing structured and structural approaches to training psychotherapists in cross-cultural therapy at scale, to accommodate the rising mental health care need of refugees as a client group.

Improving the mental wellbeing of Arabic speaking refugees: an evaluation of a mental health promotion program

BACKGROUND

Refugee populations have particularly high rates of mental health problems, including Posttraumatic Stress Disorder (PTSD) and depression. However, uptake of mental health care may be low even when severe depression and PTSD symptoms are present in individuals following resettlement. This is likely due, at least in part, to cultural influences on refugees' knowledge and beliefs about mental health problems and their treatment. We sought to provide preliminary evidence for the effectiveness of a culturally tailored mental health promotion program for Arabic-speaking refugees.

METHODS

A total of 33 Arabic-speaking refugees resettled in South Western Sydney were recruited and completed intervention which consisted of weekly three-hour sessions for 4 weeks delivered in Arabic. Key aspects of mental health literacy, help-seeking intentions and levels of general psychological distress were assessed, by means of a self-report survey, pre-intervention, (immediately) post-intervention and 3 months following intervention.

RESULTS

Of the 33 participants that completed the intervention, 31 completed the immediate post-intervention survey and 29 completed the 3 months follow-up survey. Improvements in most aspects of mental health literacy assessed were found immediately post-intervention and at follow-up, although only changes relating to stigmatising attitudes were statistically significant. Additionally, a statistically significant decrease in participants' levels of general psychological distress was observed immediately following the intervention, and this decrease was sustained at follow-up.

CONCLUSION

While further research employing a more rigorous study design and larger sample size will be needed, results of this initial trial suggest that a culturally tailored mental health promotion program targeting key aspects of mental health literacy can improve the mental health of Arabic-speaking refugees resettled in a Western nation.

Development of a Cascade of Care for responding to the opioid epidemic

Amid worsening opioid overdose death rates, the nation continues to face a persistent addiction treatment gap limiting access to quality care for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and extended-release naltrexone) have high quality evidence demonstrating reductions in drug use and overdose events, but most individuals with OUD do not receive them. The development of a unified public health framework, such as a Cascade of Care, could improve system level practice and treatment outcomes. In response to feedback from many stakeholders over the past year, we have expanded upon the OUD treatment cascade, first published in 2017, with additional attention to prevention stages and both individual-level and population-based services to better inform efforts at the state and federal level. The proposed cascade framework has attracted considerable interest from federal agencies including the Centers for Disease Control and Prevention (CDC) and National Institute on Drug Abuse (NIDA) along with policy-makers nationwide. We have reviewed recent literature and evidence-based interventions related to prevention, identification, and treatment of individuals with OUD and modeled updated figures from the 2016 National Survey on Drug Use and Health. Many currently employed interventions (prescriber guidelines, prescription monitoring programs, naloxone rescue) address prevention of OUD or downstream complications but not treatment of the underlying disorder itself. An OUD Cascade of Care framework could help structure local and national efforts to combat the opioid epidemic by identifying key targets, interventions, and quality indicators across populations and settings to achieve these ends. Improved data collection and reporting methodology will be imperative.

The translation of age-related body composition findings from rodents to humans

The objective of this review is to highlight changes in body composition in rodent models as a result of healthy aging in order to enhance translational research. Aging is associated with alterations in body composition, particularly fat mass and fat-free mass, which may be accompanied by adverse health effects, especially nearing middle age to old age. In humans, it is generally understood that fat mass tends to increase while fat-free mass concurrently declines with aging. However, the effect of aging on body composition in rodent models is less well studied, and how these changes compare and contrast with observations in humans has not yet been fully elucidated. Though, it appears as though the constituent-level alterations occur in humans and rodents at different life phases thereby having a potential effect on the outcomes of basic biomedical research. Though highly strain-dependent, this review suggests that FM changes begin at a much earlier life phase in rodents than in humans. Conversely, FFM appears to increase throughout middle age and into old age in rodents, whereas middle age is associated with the initiation the subsequent decline of FFM in humans. Given the essentiality of rodent models in basic biomedical research, careful consideration of these differences in age-related BC findings is imperative when the research is aimed for human translation.

A factor analytic investigation of DSM-5 PTSD symptoms in a culturally diverse sample of refugees resettled in Australia

Background

Refugees and asylum-seekers are often exposed to multiple types of potentially traumatic events (PTEs) and report elevated rates of psychological disorders, including posttraumatic stress disorder (PTSD). Considering this, refugee populations merit continued research in the field of traumatic stress to better understand the psychological impact of these experiences. The symptom structure of PTSD underwent a major revision in the recent formulation in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and this reformulation has yet to be comprehensively investigated in the context of PTSD arising from traumatic events experienced by refugees. The current study assessed the construct validity of the DSM-5 PTSD structure in a refugee sample from a variety of cultural backgrounds alongside four alternate models commonly identified in western populations, namely the four-factor Dysphoria model, the five-factor Dysphoric Arousal model, and the six-factor Anhedonia and Externalising Behaviours models.

Methods

A total of 246 refugees settled in Australia were assessed using the Harvard Trauma Questionnaire, to measure exposure to potentially traumatic events (PTEs), and the Posttraumatic Diagnostic Scale, to assess symptoms of PTSD based on DSM-5 criteria. All measures were translated into Arabic, Farsi or Tamil using rigorous translation procedures, or provided in English.

Results

Findings from five confirmatory factor analyses (CFAs) revealed that all models demonstrated acceptable model fit. However, an examination of relative fit revealed that the DSM-5 model provided the poorest fit overall for our sample. Instead, we found preliminary evidence in support of the six-factor Anhedonia model, comprising the symptom clusters of re-experiencing, avoidance, negative affect, anhedonia, dysphoric arousal and anxious arousal, as the superior model for our data.

Conclusions

Our findings offer preliminary support for the applicability of the Anhedonia model to a culturally diverse refugee sample, and contribute to a growing body of studies which indicate that the DSM-5 model may not best represent the symptom structure of PTSD found across non-western conflict-affected populations.

Acrylamide acute neurotoxicity in adult zebrafish

Acute exposure to acrylamide (ACR), a type-2 alkene, may lead to a ataxia, skeletal muscles weakness and numbness of the extremities in human and laboratory animals. In the present manuscript, ACR acute neurotoxicity has been characterized in adult zebrafish, a vertebrate model increasingly used in human neuropharmacology and toxicology research. At behavioral level, ACR-treated animals exhibited “depression-like” phenotype comorbid with anxiety behavior. At transcriptional level, ACR induced down-regulation of regeneration-associated genes and up-regulation of oligodendrocytes and reactive astrocytes markers, altering also the expression of genes involved in the presynaptic vesicle cycling. ACR induced also significant changes in zebrafish brain proteome and formed adducts with selected cysteine residues of specific proteins, some of them essential for the presynaptic function. Finally, the metabolomics analysis shows a depletion in the monoamine neurotransmitters, consistent with the comorbid depression and anxiety disorder, in the brain of the exposed fish.

Genetic association of HCRTR2, ADH4 and CLOCK genes with cluster headache: a Chinese population-based case-control study

Background

Cluster headache (CH), a rare primary headache disorder, is currently thought to be a genetic susceptibility which play a role in CH susceptibility. A large numbers of genetic association studies have confirmed that the HCRTR2 (Hypocretin Receptor 2) SNP rs2653349, and the ADH4 (Alcohol Dehydrogenase 4) SNP rs1126671 and rs1800759 polymorphisms are linked to CH. In addition, the CLOCK (Circadian Locomotor Output Cycles Kaput) gene is becoming a research hotspot for CH due to encoding a transcription factor that serves as a basic driving force for circadian rhythm in humans. The purpose of this study was to evaluate the association between CH and the HCRTR2, ADH4 and CLOCK genes in a Chinese CH case–control sample.

Methods

We genotyped polymorphisms of nine single nucleotide polymorphisms (SNPs) in the HCRTR2, ADH4 and CLOCK genes to perform an association study on a Chinese Han CH case-control sample (112 patients and 192 controls),using Sequenom MALDI-TOF mass spectrometry iPLEX platform. The frequencies and distributions of genotypes and haplotypes were statistically compared between the case and control groups to identify associations with CH. The effects of SNPs on CH were further investigated by multiple logistic regression.

Results

The frequency of the HCRTR2 SNP rs3800539 GA genotype was significantly higher in cases than in controls (48.2% vs.37.0%). The GA genotypes was associated with a higher CH risk (OR = 1.483, 95% CI: 0.564-3.387, p = 0.038), however, after Bonferroni correction, the association lost statistical significance. Haplotype analysis of the HCRTR2 SNPs showed that among eight haplotypes, only H1-GTGGGG was linked to a reduced CH risk (44.7% vs. 53.1%, OR = 0.689, 95% CI =0.491~0.966, p = 0.030). No significant association of ADH4, CLOCK SNPs with CH was statistically detected in the present study.

Conclusions

Association between HCRTR2, ADH4,CLOCK gene polymorphisms and CH was not significant in the present study, however, haplotype analysis indicated H1-GTGGGG was linked to a reduced CH risk.

Electronic supplementary material

The online version of this article (10.1186/s10194-017-0831-1) contains supplementary material, which is available to authorized users.

Thoughts and Considerations of Women With Bipolar Disorder About Family Planning and Pregnancy: A Qualitative Study

BACKGROUND

Women with bipolar disorder have an increased risk of relapse during pregnancy and the postpartum period, and they often express broad concerns about family planning.

OBJECTIVE

To explore the thoughts and considerations of women of childbearing age with bipolar disorder, about family planning and pregnancy.

DESIGN

A qualitative study was conducted: 15 women with bipolar I disorder were individually interviewed. Content analysis was applied.

RESULTS

Women worried about heritability of bipolar disorder, medication issues, and risk of relapse during pregnancy. They mentioned their fear to be incompetent as a mother during future mood episodes. Support of partner, family/friends, and professionals was mentioned as essential.

CONCLUSIONS

Family planning is an essential topic in the treatment of every woman with bipolar disorder of childbearing age. These women expect early consultation with professionals for support, and specific information about heritability of the illness and use of medication during and after pregnancy.

Valproic Acid in Women and Girls of Childbearing Age

PURPOSE OF REVIEW

The aim of this paper is to evaluate recent literature on valproic acid (VPA) in women and girls of childbearing age and to emphasize new findings.

RECENT FINDINGS

Recent research confirms VPAs teratogenicity and risk of hormone disruption. VPA exposure in utero increases the risk for a variety of major congenital malformations (MCMs), reduced IQ and behavioral problems. In girls and women, VPA increases the risk of hormone abnormalities, obesity, and polycystic ovarian syndrome (PCOS). Despite guidelines recommending caution, VPA use continues to be prescribed to reproductive-aged women and girls. Despite significant and well-documented risk, adherence to guidelines in VPA use in reproductive-aged girls and women remains low.

[Peripartum management plan for patients with mental illnesses : Strategies to reduce the risk of postpartum relapse]

BACKGROUND

Transition to parenthood is challenging but for women with a history of recurrent psychiatric disorders becoming a mother has a number of additional issues. Women with a history of mood disorders or psychoses are at increased risk for exacerbation in the vulnerable postpartum period and fear the potential risk of medication during pregnancy for the unborn child as much as they fear a relapse. In these difficult situations women and their families seek advice and support from mental health providers and obstetricians.

METHODS AND RESULTS

Based on the treatment of 420 mentally ill women with a desire to have children and pregnancy and prospective documentation of 196 pregnancies over the last 10 years (2006-2016) the authors developed the Bonn concept of peripartum management (BKPM). The plan was designed to reduce the incidence and severity of postpartum relapses in women suffering from psychiatric disorders. Factors to be considered include antenatal and postpartum medication as well as reduction of stress and stimuli, sleep preservation, social support and help from the partner in caring for the baby. Of the 196 women in the BKPM only 4.6 % (n = 9) experienced a severe postpartum relapse with hospitalization. Additionally, the informed consent discussion with patient and partner as part of the peripartum management plan showed positive effects on how women and their families experienced autonomy and safety during pregnancy and postpartum.

DISCUSSION

Careful planning and monitoring with a structured perinatal management plan can reduce the risk of relapse in the perinatal period and thus support women with a history of mental disorder in the transition to motherhood. Therefore, the management concept employed in Bonn contributes to the major goal of current peripartum psychiatric care in developing effective prevention strategies for women at high risk.