Physical exercise in attention deficit hyperactivity disorder - evidence and implications for the treatment of borderline personality disorder

The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial

BACKGROUND

Although clinical guidelines prioritize the treatment of depression and anxiety in young persons, there is accumulating evidence that the presence of symptoms of borderline personality disorder (BPD) is associated with the limited effectiveness of these standard treatments. These findings stress the need for interventions addressing early-stage BPD in young people with presenting symptoms of anxiety and depressive disorders. The aim of this study is to investigate the (cost-)effectiveness of an early intervention programme for BPD (MBT-early) compared to first-choice psychological treatment for depression and anxiety according to Dutch treatment guidelines (CBT), in adolescents with either depression, anxiety, or both, in combination with early-stage BPD.

METHODS

This study is a multi-centre randomized controlled trial. A total of 132 adolescents, presenting with either depression, anxiety, or both and significant BPD features will be randomized to either MBT-early or CBT. The severity of BPD, symptoms of depression and anxiety, personality, social and academic functioning, and quality of life will be assessed at baseline, end of treatment, and at 12-, 18-, and 24-month follow-up, along with medical costs and costs of productivity losses for cost-effectiveness analyses.

DISCUSSION

This study will provide an empirical evaluation of the potential surplus value of early intervention in young people for whom treatment oriented at common mental disorders like anxiety and depression may be insufficient given their underlying personality problems.

TRIAL REGISTRATION

Netherlands Trial Register, NL9569. Registered on June 15, 2021.

Alternative Treatments to Pharmacological Therapy in Pediatric Populations With Attention-Deficit/Hyperactivity Disorder (ADHD): A Scoping Review

In recent years, there has been an increase in the prevalence of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), a cognitive and behavioral disorder in which individuals present with inattention and impulsivity, in the pediatric population. With an increase in diagnoses, there is also increasing concern regarding overdiagnosis and overtreatment with medications for ADHD. The objective of this study was to map out and compile the recent literature pertaining to alternative therapies (e.g., physical activity, diet, mindfulness, and computer-based interventions) for children and adolescents diagnosed with ADHD in an attempt to reduce or replace the use of pharmacological therapy. This scoping review searched articles from multiple databases (PubMed, ScienceDirect, Web of Science, Directory of Open Access Journals, Scopus, and CINAHL). Using search terms "children with ADHD," "alternative treatment," and "cognitive behavioral therapy," articles were identified that were specific to the research question. The inclusion criteria were patients under the age of 18 with a previous diagnosis of ADHD, no other comorbid illnesses, alternative treatments, and was limited to studies published between 2012 and 2022. After removing duplicates, screening for eligibility criteria, and conducting a critical appraisal of the articles, 16 articles were retained for the final review. The main alternative therapeutic domains that emerged were (1) physical activity, (2) diet, (3) mindfulness, (4) computer-based interventions, and (5) miscellaneous interventions. Seven articles assessed the effect of physical activity on executive and cognitive function in children and adolescents with ADHD. Most findings showed improvement with increased physical activity. Two articles explored the effect of diet on the improvement of ADHD symptoms and reported a positive impact. The two articles that evaluated the effects of mindfulness on ADHD symptoms reported a reduction in ADHD symptoms. Two studies evaluated the use of computer-based interventions as an adjunct treatment in children and adolescents with ADHD; improvements in symptoms were reported. One study each evaluated interventions based on music and nerve stimulation. These showed an improvement in attention, memory, and executive function. With the increasing prevalence of ADHD diagnosis in children and adolescents, alternative and/or adjunctive treatments may be a viable and valuable alternative to pharmaceutical interventions. The findings from this review suggest that multiple non-pharmacological interventions effectively reduce symptoms of ADHD in children and adolescents, including diet, exercise, mindfulness, computer-based interventions, music, and nerve stimulation. While there are implications for alternatives to be used in the future, more research is warranted using larger samples with controlled trials.

Relationships of walking activity with depressed mood and suicidal ideation among the middle-aged Korean population: a nationwide cross-sectional study

Introduction

The suicide rate of middle-aged adults has increased rapidly, which is a significant public health concern. A depressed mood and suicidal ideation are significant risk factors for suicide, and non-pharmacological interventions such as exercise therapy have been suggested as potential treatments. Walking is a feasible and accessible form of exercise therapy for middle-aged adults.

Methods

We conducted a study based on the Seventh Korea National Health and Nutrition Examination Survey (2016-2018) data of 6,886 general middle-aged adults in South Korea to investigate the relationships of walking exercise with depressed mood and suicidal ideation. Multiple logistic regression analysis was used to adjust for confounding variables. Sampling weights were applied to obtain estimates for the general Korean population.

Results

Participants who walked ≥5 days per week had a significantly lower odds ratio (OR) for depressed mood [OR = 0.625, 95% confidence interval (CI): 0.424-0.921, p = 0.018] and suicidal ideation (OR = 0.252, 95% CI: 0.125-0.507, p < 0.001) compared to those who never walked, regardless of the duration of exercise. The same results were obtained for males after stratifying the data by sex and suicidal ideation was associated with walking in females.

Conclusion

Regular walking exercise was associated with diminished mental health problems in middle-aged adults. Light walks may serve as a useful starting point for patients with serious mental health issues, such as suicidal ideation.

Microtemporal Dynamics of Dietary Intake, Physical Activity, and Impulsivity in Adult Attention-Deficit/Hyperactivity Disorder: Ecological Momentary Assessment Study Within Nutritional Psychiatry

BACKGROUND

Increasing attention is being paid to lifestyle factors, such as nutrition and physical activity (PA), as potential complementary treatment options in attention-deficit/hyperactivity disorder (ADHD). Previous research indicates that sugar and saturated fat intake may be linked to increased impulsivity, a core symptom of ADHD, whereas protein intake and PA may be related to reduced impulsivity. However, most studies rely on cross-sectional data that lack microtemporal resolution and ecological validity, wherefore questions of microtemporal dynamics (eg, is the consumption of foods high in sugar associated with increased impulsivity within minutes or hours?) remain largely unanswered. Ecological momentary assessment (EMA) has the potential to bridge this gap.

OBJECTIVE

This study is the first to apply EMA to assess microtemporal associations among macronutrient intake, PA, and state impulsivity in the daily life of adults with and without ADHD.

METHODS

Over a 3-day period, participants reported state impulsivity 8 times per day (signal-contingent), recorded food and drink intake (event-contingent), and wore an accelerometer. Multilevel 2-part models were used to study the association among macronutrient intake, PA, and the probability to be impulsive as well as the intensity of impulsivity (ADHD: n=36; control: n=137).

RESULTS

No association between macronutrient intake and state impulsivity was found. PA was not related to the intensity of impulsivity but to a higher probability to be impulsive (ADHD: β=-.09, 95% CI -0.14 to -0.04; control: β=-.03, 95% CI -0.05 to -0.01). No evidence was found that the combined intake of saturated fat and sugar amplified the increase in state impulsivity and that PA alleviated the positive association between sugar or fat intake and state impulsivity.

CONCLUSIONS

Important methodological considerations are discussed that can contribute to the optimization of future EMA protocols. EMA research in the emerging field of nutritional psychiatry is still in its infancy; however, EMA is a highly promising and innovative approach as it offers insights into the microtemporal dynamics of psychiatric symptomology, dietary intake, and PA in daily life.

On the Importance of Mental Health in STEM

From homework to exams to proposal deadlines, STEM academia bears many stressors for students, faculty, and administrators. The increasing prevalence of burnout as an occupational phenomenon, along with anxiety, depression, and other mental illnesses in the STEM community is an alarming sign that help is needed. We describe common mental illnesses, identify risk factors, and outline symptoms. We intend to provide guidance on how some people can cope with stressors while also giving advice for those who wish to help their suffering friends, colleagues, or peers. We hope to spark more conversation about this important topic that may affect us all-while also encouraging those who suffer (or have suffered) to share their stories and serve as role models for those who feel they cannot speak.

A multi-level intervention to reduce the stigma of substance use and criminal involvement: a pilot feasibility trial protocol

BACKGROUND

Stigma associated with substance use and criminal involvement is pervasive and creates a barrier to evidence-based addiction care within the criminal legal system. Research has yet to examine a multi-level stigma intervention which targets the intersection of these stigmas among both criminal legal staff and legally-involved clients.

METHODS

This paper presents the protocol for a non-randomized trial of a multi-level stigma intervention called Combatting Stigma to Aid Reentry and Recovery (CSTARR) that involves two interventions: (1) training for criminal legal staff to address public stigma and (2) group-based acceptance and commitment therapy to address self-stigma among legally-involved adults enrolled in substance use treatment. Staff and client participants are engaged with a program called the Tennessee Recovery Oriented Compliance Strategy in 6 East Tennessee counties. This study examines the feasibility, acceptability, and preliminary effectiveness of CSTARR using a type 1 hybrid implementation/effectiveness trial with pre to post follow-up.

DISCUSSION

Stigma must be addressed in the criminal legal system to facilitate the uptake of evidence-based addiction care. This study is the first to evaluate a stigma intervention designed for the criminal legal setting and results will be used to inform a larger, randomized controlled trial. The rationale for this study, research design and measures, as well as potential implications for the field are described.

TRIAL REGISTRATION

This clinical trial is registered at clinicaltrials.gov with the identifier NCT05152342. Registered 11/5/2021 at https://register.

CLINICALTRIALS

gov/prs/app/action/SelectProtocol?sid=S000BIN8&selectaction=Edit&uid=U0005X4C&ts=2&cx=-u3wsbx .

The efficacy of cognitive-motor rehabilitation on cognitive functions and behavioral symptoms of attention deficit/hyperactivity disorder (ADHD) children: Specification of near-transfer and far-transfer effects in comparison to medication

BACKGROUND AND AIM

This study aimed to investigate and compare the efficacy of cognitive-motor rehabilitation (CMR) with methylphenidate on cognitive functions and behavioral symptoms of children with attention deficit/hyperactivity disorder (ADHD) and specified the near-transfer and far-transfer effects.

MATERIALS AND METHODS

The research was semiexperimental with posttest and follow-up assessments, in a single-blind design. Forty-eight boys with ADHD, aged 9-12, were selected conveniently regarding the inclusion/exclusion criteria, matched base on severity and Intelligence quotient (IQ) and were randomly assigned to CMR (n = 16), methylphenidate medication (MED, n = 16), and placebo CMR groups (PCMR, n = 16). CMR and PCMR received 20 3-h training sessions, and the MED group received 20 or 30 mg/day methylphenidate. Tower of London (TOL), Swanson, Nolan, and Pelham, Version IV Scale (SNAP-IV), Wechsler's digit span and mathematic subscales, dictation test, and restricted academic situation scale (RASS) were completed at posttest and follow-up. The data were analyzed by repeated measures multivariate analysis of variance.

RESULTS

CMR outperformed PCMR on forward digit span, backward digit span, ToL score at both posttest, and follow-up (P < 0.05). CMR scored lower than MED on ADHD-PI and ADHD-C at both posttest and follow-up (P < 0.05). Moreover, CMR outperformed MED on dictation at both assessment phases (P < 0.01) and RASS at the follow-up phase (P < 0.05). CMR outperformed PCMR on mathematics at post-test (P = 0.038) and also, in dictation and RASS, at both post-test (P < 0.001) and follow-up (P < 0.05).

CONCLUSION

CMR Improves near-transfer cognitive functions and behavior symptoms of ADHD as much as MED, but only CMR has more generalizable and endurable improvement on complex Efs and academic performance (far-transfer effects).

"It's not you, it's me": identity disturbance as the main contributor to interpersonal problems in pathological narcissism

BACKGROUND

Core impairments in self and other functioning typify individuals with personality disorder. While interpersonal dysfunction is a known element of narcissistic disorders, empirical research investigating intrapersonal elements is lacking. The aim of this study was to investigate the internal representations of individuals with grandiose and vulnerable features, as manifested through their attachment styles, and the specific role of identity disturbance in explaining the relationship between pathological narcissism and maladaptive interpersonal functioning.

METHODS

A sample of 270 university students completed the Brief Pathological Narcissism Inventory (B-PNI), the Severity Indices of Personality Problems (SIPP), the Relationship Questionnaire (RQ), and the Inventory of Interpersonal Problems (IIP-32).

RESULTS

Both vulnerable and grandiose narcissism were positively associated with both fearful and preoccupied attachment, and negatively associated with secure attachment, whilst grandiose narcissism was also positively associated with dismissive attachment. Furthermore, unstable representations of self, poor self-reflective functioning, and low sense of purpose fully mediated the relationship between interpersonal problems and grandiose narcissism while partially mediating the relationship between interpersonal problems and vulnerable narcissism.

CONCLUSIONS

Overall, our findings suggest that for individuals presenting with narcissistic features, capacity for adaptive interpersonal functioning is grounded by deficits in identity integration. Implications of these findings are discussed.

Neuroplasticity to autophagy cross-talk in a therapeutic effect of physical exercises and irisin in ADHD

Adaptive neuroplasticity is a pivotal mechanism for healthy brain development and maintenance, as well as its restoration in disease- and age-associated decline. Management of mental disorders such as attention deficit hyperactivity disorder (ADHD) needs interventions stimulating adaptive neuroplasticity, beyond conventional psychopharmacological treatments. Physical exercises are proposed for the management of ADHD, and also depression and aging because of evoked brain neuroplasticity. Recent progress in understanding the mechanisms of muscle-brain cross-talk pinpoints the role of the myokine irisin in the mediation of pro-cognitive and antidepressant activity of physical exercises. In this review, we discuss how irisin, which is released in the periphery as well as derived from brain cells, may interact with the mechanisms of cellular autophagy to provide protein recycling and regulation of brain-derived neurotrophic factor (BDNF) signaling via glia-mediated control of BDNF maturation, and, therefore, support neuroplasticity. We propose that the neuroplasticity associated with physical exercises is mediated in part by irisin-triggered autophagy. Since the recent findings give objectives to consider autophagy-stimulating intervention as a prerequisite for successful therapy of psychiatric disorders, irisin appears as a prototypic molecule that can activate autophagy with therapeutic goals.

Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention

BACKGROUND

Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties.

METHODS

This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability.

RESULTS

The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%.

CONCLUSIONS

The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.

Integrating lived experience into clinical practice: a case study of young peer providers in pediatric rehabilitation

PURPOSE

Youth Facilitators (YFs) are peer service providers (SPs) with childhood-onset disabilities working in pediatric rehabilitation teams. This study explored the YF role focusing on what work YFs do, the perceived facilitators and challenges pertinent to the role integration process, and the evolution of the role over the study period.

METHODS

A longitudinal, qualitative case study approach was used to gather data over a total period of 14 months through interviews, focus groups, workload logs, and observations. Data were analyzed using the method of thematic analysis.

RESULTS

Two YFs, 23 SPs and two managers participated in the study. YFs' work included independent consultation, resource provision, referral making, and program co-facilitation. Analysis produced two contrasting themes. When viewed as a representative of clients, YFs were considered bringing client perspectives to care, adding credibility to clinical services, and empowering clients and families through role modeling. However, when viewed as a professional SP, their expertise was questioned due to role unclarity, limited generalizability of lived experience, and organizational limitations.

CONCLUSIONS

Training tailored to local care contexts and organizational supports are needed to transform YFs' experiential knowledge into experiential expertise. We propose strategies for optimal integration of peer providers into clinical care teams.Implications for rehabilitationAs peer service providers with lived experience of disabilities, Youth Facilitators (YFs) have the potential to benefit pediatric rehabilitation services by facilitating empowerment in clients and families as they navigate through life transitions.The YF scope of practice and training should be adapted to fit with individual clinical teams and local care contexts to help YFs establish their experiential expertise in interdisciplinary teams.Establishing YF's core competencies (e.g., advocacy, coaching, and boundary setting skills) can help transform their experiential knowledge into experiential expertise.

The self-efficacy in distress tolerance scale (SE-DT): a psychometric evaluation

BACKGROUND

Skills training is believed to be essential in dialectical behavior therapy (DBT) and is also offered as a standalone intervention. There is a need to better understand each skills module's separate contribution to treatment outcomes. Several assessment instruments are available, but none of them provides specific information about patients' perceived ability to use skills promoting distress tolerance. The aim of the present study was to develop and evaluate the psychometric properties of a Swedish adaptation of the General Self-Efficacy scale (GSE) for skills use in distress tolerance - the Self-Efficacy in Distress Tolerance scale (SE-DT).

METHODS

Cross-sectional and longitudinal data were gathered in a non-clinical (NC) community sample (n = 407) and a clinical psychiatric (CP) sample (n = 46). Participants in the NC sample were asked to complete a set of 19 self-report instruments, including the SE-DT, and 45 participants repeated the assessment after 2 weeks. The patients in the CP sample filled out a subset of eight instruments; twenty patients repeated the assessment after completing a treatment intervention including mindfulness skills and distress tolerance skills or emotion regulation skills.

RESULTS

The analyses showed that the SE-DT is unidimensional with high internal consistency (Cronbach's alpha = .92) and good test-retest reliability (intraclass correlation = .74). The SE-DT also showed good convergent and divergent validity, demonstrating positive correlations with general self-efficacy and self-compassion, and negative correlations with difficulties in emotion regulation, psychiatric symptoms, and borderline symptoms. The SE-DT showed sensitivity to change, when pre- and post-treatment assessments were compared (Cohen's d = 0.82).

DISCUSSION

This is preliminary evidence that the SE-DT has adequate to good psychometric properties, supporting the use of a total sum score. The results indicate that the SE-DT can adequately measure the construct of self-efficacy with regard to dealing with distress and emotional crises. The instrument enables continued investigation of standalone skills training and the specific contribution of distress tolerance skills to treatment outcomes in DBT. Further studies are needed to investigate whether these results are valid in other populations. In addition, the field would benefit from a common definition of distress tolerance.

Are physical activity and nutrition linked to personality disorders? Health habits and personality disorders: A scoping review

Individuals with personality disorders (PDs) have a decreased life expectancy compared with the general population in part due to physical illnesses. Many hypotheses have been suggested to explain those physical illnesses such as hormone imbalance, medication, lack of physical activity, and unhealthy diet. However, little is known about the relation between lifestyle and PDs. The purpose of this scoping review is to regroup the available information on this topic. We searched the literature up to February 2021 using four databases and found 21 articles analyzing the relation between lifestyle and PDs in observational studies including 153,081 participants from diverse populations going from general population to adults in psychiatric care. Most studies used measures of lifestyle as control variables or did not use lifestyle variables at all. Moreover, the instruments used to measure lifestyle variables lacked precision at best. Two studies demonstrated a relation between early malnutrition and further development of PDs, but those results may be influenced by confounding variables and cannot indicate a clear link between nutrition and personality disorder. The lack of solid evidence we observed is surprising, considering the multiple benefits individuals with PDs could get from a healthy lifestyle. More studies are needed to thoroughly analyze the impact of lifestyle on PDs and vice versa.

Multimodal treatment efficacy differs in dependence of core symptom profiles in adult Attention-Deficit/Hyperactivity Disorder: An analysis of the randomized controlled COMPAS trial

There is broad consensus that to improve the treatment of adult Attention-Deficit/Hyperactivity Disorder (ADHD), the various therapy options need to be tailored more precisely to the individual patient's needs and specific symptoms. This post-hoc analysis evaluates the multimodal effects of first-line medication (methylphenidate [MPH] vs placebo [PLB]) and psychotherapeutic (group psychotherapy [GPT] vs clinical management [CM]) treatments on the ADHD core symptoms inattention, hyperactivity and impulsivity. For the two-by-two factorial, observer-blinded, multicenter, randomized controlled Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS; ISRCTN54096201), 419 outpatients with ADHD were considered for analysis. ADHD symptoms were assessed by blind observer-rated and patient-rated Conners Adult ADHD Rating Scales before treatment (T1), 13 weeks (T2) and 26 weeks (T3) after T1, at treatment completion after 52 weeks (T4), and at follow-up (130 weeks, T5). MPH was superior to PLB in improving symptoms of inattention at almost all endpoints (observer-rated T2, T3, T4, T5; patient-rated T2, T3, T4), while a significant decrease in hyperactivity and impulsivity was at first found after 6 months of treatment. CM compared to GPT decreased inattention and impulsivity in the early treatment phase only (observer-rated T2, patient-rated T2, T3). In conclusion, while MPH seems to have a direct and sustained effect on inattention, premature medication discontinuation should particularly be avoided in patients with hyperactive-impulsive symptoms. Also, especially in high inattention and/or impulsivity presentations, initial individual patient management might be beneficial. Consequently, considering individual core symptom profiles may enhance the efficacy of treatments in adult ADHD.

Acute effect of physical exercise on negative affect in borderline personality disorder: A pilot study

Background

Physical exercise is an evidence-based treatment to reduce symptoms and negative affect in several psychiatric disorders, including depressive, anxiety, and psychotic disorders. However, the effect of physical exercise on negative affect in patients with borderline personality disorder (BPD) has not yet been investigated. In this pilot study, we tested the safety, acceptability, and potential acute effects on negative affect of a single session of aerobic physical exercise in adults with BPD.

Method

After completing a negative mood induction procedure, 28 adults with BPD were randomly assigned to a 20-minute single session of stationary bicycle or a control condition (emotionally neutral video).

Results

No adverse effects attributed to the physical exercise were reported and it was considered acceptable to patients. Following the negative mood induction, both conditions decreased the level of negative affect with a medium effect size but there was no significant difference between them.

Conclusion

The results suggest that a single 20-minute session of physical exercise does not produce a reduction of negative affect in BPD. Future research should consider the duration and intensities of physical exercise with the greatest potential to reduce negative affect both acutely and in a more prolonged manner in this patient group.

A systematic quality rating of available mobile health apps for borderline personality disorder

BACKGROUND

Mobile health apps (MHAs) may offer a mean to overcome treatment barriers in Borderline Personality Disorder (BPD) mental health care. However, MHAs for BPD on the market lack transparency and quality assessment.

METHODS

European app stores were systematically searched, and two independent trained reviewers extracted relevant MHAs. Employed methods and privacy and security details documentation of included MHAs were extracted. MHAs were then assessed and rated using the German version of the standardized Mobile Application Rating Scale (MARS-G). Mean values and standard deviations of all subscales (engagement, functionality, aesthetics, information, and therapeutic gain) and correlations with user ratings were calculated.

RESULTS

Of 2977 identified MHAs, 16 were included, showing average quality across the four main subscales (M = 3.25, SD = 0.68). Shortcomings were observed with regard to engagement (M = 2.87, SD = 0.99), potential therapeutic gain (M = 2.67, SD = 0.83), existing evidence base (25.0% of included MHAs were tested empirically), and documented privacy and security details. No significant correlations were found between user ratings and the overall total score of the MARS-G or MARS-G main subscales.

CONCLUSIONS

Available MHAs for BPD vary in quality and evidence on their efficacy, effectiveness, and possible adverse events is scarce. More substantial efforts to ensure the quality of MHAs available for patients and a focus on transparency, particularly regarding privacy and security documentation, are necessary.

A Qualitative Study of the Experience of Peer Workers in the Czech Republic

The study deals with the employment of people diagnosed with mental illness in the position of peer worker. The aim is to demonstrate through semi-structured interviews the involvement of peer workers in the social services for people diagnosed with mental illness and to identify the influences that affect the success of peer workers involvement in services. The results of the interviews were divided into two categories (Position Specifics, Ethical Aspects) and four subcategories (Professionalism, Risk Moments, Stigmatization, Shared Values) using the Coding Method. The individual subcategories were further subdivided in detail. The results show that the most negative influence on the successful involvement of peer workers is the unclear definition of the job role and responsibilities and further, from an ethical point of view, it is the fear of subsequent labelling (stigmatization) in the search for a new job. A positive ethical influence is the sharing of social values (hope, recovery, friendship, sharing, etc.), which supports the peer worker. The study could help anchor the role in practice and could be the basis for further research in human resources management, social work and management.

A systematic review of dialectical behavior therapy mobile apps for content and usability

BACKGROUND

The gap between treatment need and treatment availability is particularly wide for individuals seeking Dialectical Behavior Therapy (DBT), and mobile apps based on DBT may be useful in increasing access to care and augmenting in-person DBT. This review examines DBT based apps, with a specific focus on content quality and usability.

METHODS

All apps referring to DBT were identified in Google Play and iOS app stores and were systematically reviewed for app content and quality. The Mobile App Rating Scale (MARS) was used to evaluate app usability and engagement.

RESULTS

A total of 21 free to download apps were identified. The majority of apps (71%) included a component of skills training, five apps included a diary card feature. Most (76.19%) apps were designed to function without help from a therapist. The average user "star" rating was 4.39 out of 5. The mean overall MARS score was 3.41, with a range of 2.15 to 4.59, and 71.43% were considered minimally 'acceptable,' as defined by a score of 3 or higher. The average star rating was correlated with the total MARS score (r = .51, p = .02). Estimates of app usage differed substantially between popular and unpopular apps, with the three most popular apps accounting for 89.3% of monthly active users.

CONCLUSIONS

While the present study identified many usable and engaging apps in app stores designed based on DBT, there are limited apps for clinicians. DBT based mobile apps should be carefully developed and clinically evaluated.

The neurostructural and neurocognitive effects of physical activity: A potential benefit to promote eating disorder recovery

Accumulating evidence suggests that supervised and adapted physical activity provides cognitive benefits for individuals with eating disorders (EDs). The mechanisms underlying the benefits of physical activity are poorly understood. Addressing this knowledge gap may inform the appropriate integration of structured physical activity into eating disorders treatment and recovery. We draw attention to recent findings in the study of the impact of physical activity on the brain, and we describe the neurostructural and neurocognitive changes associated with physical activity observed in various clinical and nonclinical populations. Considering the identified impairment in brain volume- and/or neurocognitive function in various EDs, we propose that positive effects of physical activity may play a meaningful role in successful ED treatment. Accordingly, we outline research steps for closing the knowledge gap on how physical activity may aid in ED recovery, and emphasize the need to combine measures of cognitive and behavioral responses to physical activity, with technology capable of measuring changes in brain structure and/or function.

24-Hour Movement Behaviors and Internalizing and Externalizing Behaviors Among Youth

PURPOSE

The Canadian 24-Hour Movement Guidelines for Children and Youth (≥60 minutes of moderate-to-vigorous physical activity per day, ≤2 hours of recreational screen time per day, and 9-11 hours of sleep per night for 5-13 years old) are associated with better physical health, but less is known about how these behaviors are related to mental health. This study examined the association of meeting these guideline recommendations with internalizing and externalizing behaviors among youth.

METHODS

A large and broadly representative cross-sectional sample of 9- to 11-year-old U.S. youth (N = 11,875) from the Adolescent Brain and Cognitive Development study was analyzed. Internalizing and externalizing behaviors were measured using the Child Behaviour Checklist. Associations were examined using negative binomial regression adjusted for several confounders.

RESULTS

Compared to meeting none of the recommendations, meeting recommendations for screen time and sleep but not physical activity was associated with a lower prevalence ratio of total, internalizing, and externalizing behaviors. Meeting two or all three recommendations was more strongly associated with these outcomes than meeting one recommendation or none. The prevalence ratio of the group meeting all three recommendations was .77 (95% confidence interval [CI]: .68-.86) for total problem scores, .78 (95% CI: .68-.89) for internalizing problem scores, and .79 (95% CI: .68-.91) for externalizing problem scores.

CONCLUSIONS

Meeting the 24-hour movement guidelines was associated with a lower risk of internalizing and externalizing behaviors in youth. These associations were mainly explained by meeting the screen time and sleep duration recommendations.

Physical Activity Improves Mental Health in Children and Adolescents Irrespective of the Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD)-A Multi-Wave Analysis Using Data from the KiGGS Study

Physical activity (PA) may have positive effects on mental health in children and adolescents. This post hoc study aimed to further investigate the relationship between different frequency levels of PA and general mental health as well as specific hyperactivity/inattention symptoms in children and adolescents.

METHODS

The analyses were based on data drawn from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study, a regularly conducted large-scale, epidemiological investigation of somatic and mental health of children and adolescents in Germany. Parents were asked about their children's attention deficit hyperactivity disorder (ADHD) records and answered questionnaires concerning any mental health problem behavior of the children and adolescents using the Strengths and Difficulties Questionnaire (SDQ). The overall problem score as well as the hyperactivity/inattention symptoms subscale (SDQ-H/I) were entered as outcomes in a regression model controlling for parental socio-economic status and participants' sex, age, and body mass index (BMI). Cross-sectional analyses were conducted at three time points of the KiGGS study (baseline, wave 1, and wave 2) using general linear models (GLM). This was performed for different age groups (4-5, 6-9, 10-17 years).

RESULTS

Significant negative relationships were found between PA and general mental health problems. For the relationship between PA and SDQ-H/I, different patterns emerged at the three time points. There was no interaction between PA frequency levels and diagnosis of ADHD (ADHD vs. non-ADHD controls) regarding the SDQ total score.

CONCLUSION

This study underlines the importance of a high frequency level of PA for a good mental health status among children and adolescents, irrespective of the diagnosis of ADHD.

Latent profiles of patients with borderline pathology based on the alternative DSM-5 model for personality disorders

BACKGROUND

There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological facets from Criterion B that define BPD in the AMPD can yield meaningful patient profiles.

METHODS

A total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5 Faceted Brief Form) self-reports were administered to measure elements and facets that define BPD in the AMPD model; these variables were used as indicators in a latent profile analysis (LPA).

RESULTS

The optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Moderate pathology with Impulsivity; (c) Moderate pathology with Identity problems and Depressivity; and (d) Severe pathology. Clinically meaningful distinctions emerged among profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity.

CONCLUSIONS

Profiles reflected both the "severity" and "style" components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B facets that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.

Predicting the number of article citations in the field of attention-deficit/hyperactivity disorder (ADHD) with the 100 top-cited articles since 2014: a bibliometric analysis

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children or early adolescents with an estimated worldwide prevalence of 7.2%. Numerous articles related to ADHD have been published in the literature. However, which articles had ultimate influence is still unknown, and what factors affect the number of article citations remains unclear as well. This bibliometric analysis (1) visualizes the prominent entities with 1 picture using the top 100 most-cited articles, and (2) investigates whether medical subject headings (i.e., MeSH terms) can be used in predicting article citations.

METHODS

By searching the PubMed Central^® (PMC) database, the top 100 most-cited abstracts relevant to ADHD since 2014 were downloaded. Citation rank analysis was performed to compare the dominant roles of article types and topic categories using the pyramid plot. Social network analysis (SNA) was performed to highlight prominent entities for providing a quick look at the study result. The authors examined the MeSH prediction effect on article citations using its correlation coefficients (CC).

RESULTS

The most frequent article types and topic categories were research support by institutes (56%) and epidemiology (28%). The most productive countries were the United States (42%), followed by the United Kingdom (13%), Germany (9%), and the Netherlands (9%). Most articles were published in the Journal of the American Academy of Child and Adolescent Psychiatry (15%) and JAMA Psychiatry (9%). MeSH terms were evident in prediction power on the number of article citations (correlation coefficient = 0.39; t = 4.1; n = 94; 6 articles were excluded because they do not have MeSH terms).

CONCLUSIONS

The breakthrough was made by developing 1 dashboard to display 100 top-cited articles on ADHD. MeSH terms can be used in predicting article citations on ADHD. These visualizations of the top 100 most-cited articles could be applied to future academic pursuits and other academic disciplines.