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Strike LT, Hansell NK, Chuang KH, Miller JL, de Zubicaray GI, Thompson PM, McMahon KL, Wright MJ. The Queensland Twin Adolescent Brain Project, a longitudinal study of adolescent brain development. Sci Data 2023; 10:195. [PMID: 37031232 PMCID: PMC10082846 DOI: 10.1038/s41597-023-02038-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 02/22/2023] [Indexed: 04/10/2023] Open
Abstract
We describe the Queensland Twin Adolescent Brain (QTAB) dataset and provide a detailed methodology and technical validation to facilitate data usage. The QTAB dataset comprises multimodal neuroimaging, as well as cognitive and mental health data collected in adolescent twins over two sessions (session 1: N = 422, age 9-14 years; session 2: N = 304, 10-16 years). The MRI protocol consisted of T1-weighted (MP2RAGE), T2-weighted, FLAIR, high-resolution TSE, SWI, resting-state fMRI, DWI, and ASL scans. Two fMRI tasks were added in session 2: an emotional conflict task and a passive movie-watching task. Outside of the scanner, we assessed cognitive function using standardised tests. We also obtained self-reports of symptoms for anxiety and depression, perceived stress, sleepiness, pubertal development measures, and risk and protective factors. We additionally collected several biological samples for genomic and metagenomic analysis. The QTAB project was established to promote health-related research in adolescence.
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Affiliation(s)
- Lachlan T Strike
- The University of Queensland, Queensland Brain Institute, Brisbane, QLD 4072, Australia.
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia.
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, QLD, 4006, Brisbane, Australia.
| | - Narelle K Hansell
- The University of Queensland, Queensland Brain Institute, Brisbane, QLD 4072, Australia
| | - Kai-Hsiang Chuang
- The University of Queensland, Queensland Brain Institute, Brisbane, QLD 4072, Australia
- The University of Queensland, Centre for Advanced Imaging, Brisbane, QLD 4072, Australia
| | - Jessica L Miller
- The University of Queensland, Queensland Brain Institute, Brisbane, QLD 4072, Australia
| | - Greig I de Zubicaray
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Margaret J Wright
- The University of Queensland, Queensland Brain Institute, Brisbane, QLD 4072, Australia
- The University of Queensland, Centre for Advanced Imaging, Brisbane, QLD 4072, Australia
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2
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Sandler CX, Cvejic E, Valencia BM, Li H, Hickie IB, Lloyd AR. Predictors of Chronic Fatigue Syndrome and Mood Disturbance After Acute Infection. Front Neurol 2022; 13:935442. [PMID: 35959390 PMCID: PMC9359311 DOI: 10.3389/fneur.2022.935442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Prospective cohort studies following individuals from acute infections have documented a prevalent post-infective fatigue state meeting diagnostic criteria for chronic fatigue syndrome (CFS) – that is, a post-infective fatigue syndrome (PIFS). The Dubbo Infection Outcomes Study (DIOS) was a prospective cohort following individuals from acute infection with Epstein-Barr virus (EBV), Ross River virus (RRV), or Q fever through to assessment of caseness for CFS designated by physician and psychiatrist assessments at 6 months. Previous studies in DIOS have revealed that functional genetic polymorphisms in both immunological (pro- and anti-inflammatory cytokines) and neurological (the purinergic receptor, P2X7) genes are associated with both the severity of the acute infection and subsequent prolonged illness. Principal components analysis was applied to self-report data from DIOS to describe the severity and course of both the overall illness and concurrent mood disturbance. Associations between demographics and acute infection characteristics, with prolonged illness course as well as the PIFS outcome were examined using multivariable statistics. Genetic haplotype-driven functional variations in the neuropeptide Y (NPY) gene previously shown to be associated with brain responses to stress, and to trait anxiety were also examined as predictors. The sample included 484 subjects (51% female, median age 32, IQR 19–44), of whom 90 (19%) met diagnostic criteria for CFS at 6 months. Participants with greater overall illness severity and concurrent mood disturbance in the acute illness had a more prolonged illness severity (HR = 0.39, 95% CI: 0.34–0.46, p < 0.001) and mood disturbance (HR = 0.36, 95% CI: 0.30–0.42, p < 0.001), respectively. Baseline illness severity and RRV infection were associated with delayed recovery. Female gender and mood disturbance in the acute illness were associated with prolonged mood disturbance. Logistic regression showed that the odds of an individual being diagnosed with PIFS increased with greater baseline illness severity (OR = 2.24, 95% CI: 1.71–2.94, p < 0.001). There was no association between the NPY haplotypes with overall illness severity or mood disturbance either during the acute illness phase or with prolonged illness (p > 0.05). Severe acute infective illnesses predicted prolonged illness, prolonged mood disturbance and PIFS. These factors may facilitate early intervention to manage both PIFS and mood disturbances.
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Affiliation(s)
- Carolina X. Sandler
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
- Sport and Exercise Science, School of Health Science, Western Sydney University, Sydney, NSW, Australia
- Menzies Health Institute Queensland, Griffith University Brisbane, Queensland, QLD, Australia
| | - Erin Cvejic
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, NSW, Australia
| | - Braulio M. Valencia
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
| | - Hui Li
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
| | - Ian B. Hickie
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
| | - Andrew R. Lloyd
- Laboratory Viral Immunology Systems Program, Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
- *Correspondence: Andrew R. Lloyd
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Tsikandilakis M, Yu Z, Kausel L, Boncompte G, Lanfranco RC, Oxner M, Bali P, Urale Leong P, Qing M, Paterakis G, Caci S, Milbank A, Mevel PA, Carmel D, Madan C, Derrfuss J, Chapman P. "There Is No (Where a) Face Like Home": Recognition and Appraisal Responses to Masked Facial Dialects of Emotion in Four Different National Cultures. Perception 2021; 50:1027-1055. [PMID: 34806492 DOI: 10.1177/03010066211055983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The theory of universal emotions suggests that certain emotions such as fear, anger, disgust, sadness, surprise and happiness can be encountered cross-culturally. These emotions are expressed using specific facial movements that enable human communication. More recently, theoretical and empirical models have been used to propose that universal emotions could be expressed via discretely different facial movements in different cultures due to the non-convergent social evolution that takes place in different geographical areas. This has prompted the consideration that own-culture emotional faces have distinct evolutionary important sociobiological value and can be processed automatically, and without conscious awareness. In this paper, we tested this hypothesis using backward masking. We showed, in two different experiments per country of origin, to participants in Britain, Chile, New Zealand and Singapore, backward masked own and other-culture emotional faces. We assessed detection and recognition performance, and self-reports for emotionality and familiarity. We presented thorough cross-cultural experimental evidence that when using Bayesian assessment of non-parametric receiver operating characteristics and hit-versus-miss detection and recognition response analyses, masked faces showing own cultural dialects of emotion were rated higher for emotionality and familiarity compared to other-culture emotional faces and that this effect involved conscious awareness.
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Affiliation(s)
- Myron Tsikandilakis
- School of Psychology, University of Nottingham.,Medical School, Faculty of Medicine and Health Sciences, 6123University of Nottingham
| | - Zhaoliang Yu
- Department of Psychology, National University of Singapore.,Department of Psychology, Wuhan University, China
| | - Leonie Kausel
- School of Medicine, Pontificia Universidad Católica de Chile.,School of Psychology, Pontificia Universidad Católica de Chile
| | - Gonzalo Boncompte
- Universidad del Desarrollo, Centro de Investigación en Complejidad Social.,School of Psychology, Pontificia Universidad Católica de Chile
| | - Renzo C Lanfranco
- Department of Psychology, The University of Edinburgh.,Department of Neuroscience, Karolinska Institutet
| | - Matt Oxner
- School of Psychology, The University of Auckland.,University of Leipzig, Institute of Psychology
| | | | | | - Man Qing
- Department of Psychology, National University of Singapore
| | | | | | | | | | - David Carmel
- Victoria University of Wellington, School of Psychology
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Darley DR, Dore GJ, Byrne AL, Plit ML, Brew BJ, Kelleher A, Matthews GV. Limited recovery from post-acute sequelae of SARS-CoV-2 at 8 months in a prospective cohort. ERJ Open Res 2021; 7:00384-2021. [PMID: 34725634 PMCID: PMC8504133 DOI: 10.1183/23120541.00384-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Global attention is gradually turning to focus on the problem of prolonged illness following acute coronavirus disease 2019 (COVID-19), commonly termed “Long COVID” or post-acute sequelae of SARS-CoV-2 infection (PASC). While an increasing number of reports now recognise this condition, accurate characterisation of its prevalence, clinical features and natural history is complicated by choice of denominator population, lack of case definition and marked self-selection bias. Nevertheless, a picture is emerging of a syndrome characterised predominantly by fatigue, dyspnoea, chest tightness and “brain fog” present in around 10–30% of individuals at 2–3 months post-acute infection and affecting both those with initial severe illness and those in whom acute infection was mild [1–3]. In a longitudinal cohort, a significant proportion of patients had persistent symptoms 8 months after initial #COVID19 infection. There was no significant improvement in symptoms or health-related quality of life between 4- and 8-month assessments.https://bit.ly/2Wtb7IX
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Affiliation(s)
- David Ross Darley
- Dept of Thoracic Medicine, St Vincent's Hospital Darlinghurst, Sydney, Australia.,UNSW Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Gregory John Dore
- Dept of Infectious Diseases, St Vincent's Hospital Darlinghurst, Sydney, Australia.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Anthony Luke Byrne
- Dept of Thoracic Medicine, St Vincent's Hospital Darlinghurst, Sydney, Australia.,UNSW Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Marshall Lawrence Plit
- Dept of Thoracic Medicine, St Vincent's Hospital Darlinghurst, Sydney, Australia.,UNSW Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Bruce James Brew
- UNSW Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia.,Dept of Neurology and Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, Sydney Australia
| | - Anthony Kelleher
- Kirby Institute, University of New South Wales, Sydney, Australia.,Dept of Immunology, St Vincent's Hospital Darlinghurst, Sydney, Australia
| | - Gail Veronica Matthews
- Dept of Infectious Diseases, St Vincent's Hospital Darlinghurst, Sydney, Australia.,Kirby Institute, University of New South Wales, Sydney, Australia
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McBride KE, Steffens D, Lambert T, Glozier N, Roberts R, Solomon MJ. Acceptability and face validity of two mental health screening tools for use in the routine surgical setting. BMC Psychol 2021; 9:171. [PMID: 34717771 PMCID: PMC8556895 DOI: 10.1186/s40359-021-00672-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/21/2021] [Indexed: 12/05/2022] Open
Abstract
Background Preoperative assessment of mental health rarely occurs within routine surgery. Any screening tool selected to form part of this process must be deemed practical, acceptable and valid by clinicians and consumers alike. This study aims to assess the acceptability and face validity of two existing mental health screening tools to select one for further development and use in the routine surgical setting. Methods A survey of clinicians and consumers was conducted from October 2020 to March 2021 at a tertiary hospital in Sydney, Australia. Using a Likert scale (1–5, lowest to highest rating), the clinicians evaluated four domains for acceptability and two for validity (six overall) and the consumers four domains for acceptability and one for validity (five overall) on the preoperative use of the amended Kessler Psychological Distress Scale (K10) and the Somatic and Psychological Health Report-12 (SPHERE-12). Consensus was achieved through a rating of 4 or 5 being given by 70% or more of participants with domains able to remain unchanged. Free text responses were analysed into themes. Results A total of 73 participants (51 clinicians; 22 consumers) were included. The K10 received consensus scores (≥ 70%) in four out of six domains for clinicians (4/4 acceptability; 0/2 validity), and all five domains for consumers (4/4 acceptability; 1/1 validity). The SPHERE-12 received consensus scores (≥ 70%) in three domains for clinicians (3/4 acceptability; 0/2 validity), and three domains for consumers (3/4 acceptability; 0/1 validity). Six qualitative themes were described including (1) amendments to tool structure and language; (2) scale response options; (3) difficulty with somatic questions; (4) practicality and familiarity with K10; (5) challenges for specific patient cohorts and (6) timing considerations for patients. Conclusion Adequate acceptability was established for the K10. However further development is required to strengthen its validity for this specific surgical cohort and purpose. Future research to determine the feasibility and acceptability of implementing and using the K10 in the routine surgical setting is now needed. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00672-w.
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Affiliation(s)
- Kate E McBride
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, PO Box M157, Sydney, NSW, Australia. .,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Daniel Steffens
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Surgical Outcomes Research Centre (SOuRCe), Sydney, NSW, Australia
| | - Tim Lambert
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,ccCHiP, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Nick Glozier
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Rachael Roberts
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, PO Box M157, Sydney, NSW, Australia
| | - Michael J Solomon
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, PO Box M157, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Surgical Outcomes Research Centre (SOuRCe), Sydney, NSW, Australia
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6
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Mitchell BL, Thorp JG, Wu Y, Campos AI, Nyholt DR, Gordon SD, Whiteman DC, Olsen CM, Hickie IB, Martin NG, Medland SE, Wray NR, Byrne EM. Polygenic Risk Scores Derived From Varying Definitions of Depression and Risk of Depression. JAMA Psychiatry 2021; 78:1152-1160. [PMID: 34379077 PMCID: PMC8358814 DOI: 10.1001/jamapsychiatry.2021.1988] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Genetic studies with broad definitions of depression may not capture genetic risk specific to major depressive disorder (MDD), raising questions about how depression should be operationalized in future genetic studies. OBJECTIVE To use a large, well-phenotyped single study of MDD to investigate how different definitions of depression used in genetic studies are associated with estimation of MDD and phenotypes of MDD, using polygenic risk scores (PRSs). DESIGN, SETTING, AND PARTICIPANTS In this case-control polygenic risk score analysis, patients meeting diagnostic criteria for a diagnosis of MDD were drawn from the Australian Genetics of Depression Study, a cross-sectional, population-based study of depression, and controls and patients with self-reported depression were drawn from QSkin, a population-based cohort study. Data analyzed herein were collected before September 2018, and data analysis was conducted from September 10, 2020, to January 27, 2021. MAIN OUTCOME AND MEASURES Polygenic risk scores generated from genome-wide association studies using different definitions of depression were evaluated for estimation of MDD in and within individuals with MDD for an association with age at onset, adverse childhood experiences, comorbid psychiatric and somatic disorders, and current physical and mental health. RESULTS Participants included 12 106 (71% female; mean age, 42.3 years; range, 18-88 years) patients meeting criteria for MDD and 12 621 (55% female; mean age, 60.9 years; range, 43-87 years) control participants with no history of psychiatric disorders. The effect size of the PRS was proportional to the discovery sample size, with the largest study having the largest effect size with the odds ratio for MDD (1.75; 95% CI, 1.73-1.77) per SD of PRS and the PRS derived from ICD-10 codes documented in hospitalization records in a population health cohort having the lowest odds ratio (1.14; 95% CI, 1.12-1.16). When accounting for differences in sample size, the PRS from a genome-wide association study of patients meeting diagnostic criteria for MDD and control participants was the best estimator of MDD, but not in those with self-reported depression, and associations with higher odds ratios with childhood adverse experiences and measures of somatic distress. CONCLUSIONS AND RELEVANCE These findings suggest that increasing sample sizes, regardless of the depth of phenotyping, may be most informative for estimating risk of depression. The next generation of genome-wide association studies should, like the Australian Genetics of Depression Study, have both large sample sizes and extensive phenotyping to capture genetic risk factors for MDD not identified by other definitions of depression.
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Affiliation(s)
- Brittany L. Mitchell
- QIMR Berghofer Medical Research Institute, Brisbane, Australia,School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jackson G. Thorp
- QIMR Berghofer Medical Research Institute, Brisbane, Australia,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Yeda Wu
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Adrian I. Campos
- QIMR Berghofer Medical Research Institute, Brisbane, Australia,Faculty of Medicine, The University of Queensland, Brisbane, Australia,School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Dale R. Nyholt
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia,Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, Australia
| | - Scott D. Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | | | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Naomi R. Wray
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia,Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Enda M. Byrne
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia,Child Health Research Centre, The University of Queensland, Brisbane, Australia
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7
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Cameron B, Webber K, Li H, Bennett B, Boyle F, de Souza P, Wilcken N, Lynch J, Friedlander M, Goldstein D, Lloyd A. Genetic associations of fatigue and other symptoms following breast cancer treatment: A prospective study. Brain Behav Immun Health 2021; 10:100189. [PMID: 34589724 PMCID: PMC8474532 DOI: 10.1016/j.bbih.2020.100189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background Cancer-related fatigue, mood disturbances, pain and cognitive disturbance are common after adjuvant cancer therapy, but vary considerably between individuals despite common disease features and treatment exposures. A genetic basis for this variability was explored in a prospective cohort. Methods Physical and psychological health of women were assessed prospectively following therapy for early stage breast cancer with self-report questionnaires. Participation in a genetic association sub-study was offered. Indices for the key symptom domains of fatigue, pain, depression, anxiety, and neurocognitive difficulties were empirically derived by principal components analysis from end-treatment questionnaires, and then applied longitudinally. Genetic associations were sought with functional single nucleotide polymorphisms (SNPs) in pro- and anti-inflammatory cytokine genes - tumour necrosis factor (TNF)-α (−308 GG), interferon (IFN)-ɣ (+874 TA), interleukin (IL)-10 (1082 GA and −592 CA), IL-6 (−174 GC), IL-1β (−511 GA). Results Questionnaire data was available for 210 participants, of whom 111 participated in the genetic sub-study. As expected, symptom domain scores generally improved over several months following treatment completion. Tumour and adjuvant treatment related factors were unassociated with either severity or duration of the individual symptom domains, but severity of symptoms at end-treatment was strongly associated with duration for each domain (all p < 0.05). In multivariable analyses, risk genotypes were independently associated with: fatigue with IL-6 -174 GG/GC and IL-10 -1082 GG; depression and anxiety with IL-10 -1082 AA; neurocognitive disturbance: TNF-α −308 GG; depression IL-1β (all p < 0.05). The identified SNPs also had cumulative effects in prolonging the time to recovery from the associated symptom domain. Conclusions Genetic factors contribute to the severity and duration of common symptom domains after cancer therapy. Common symptoms following breast cancer treatment can be grouped into symptom domains. Symptom domains are useful to describe patterns and trajectories of symptoms following breast cancer treatment. Cytokine gene polymorphisms are associated with the severity and duration of symptom domains following cancer treatment. The symptom severity at final treatment predicts the duration of symptoms.
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Affiliation(s)
- B. Cameron
- The Kirby Institute, UNSW, Sydney, Australia
- Corresponding author. The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - K. Webber
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | - H. Li
- The Kirby Institute, UNSW, Sydney, Australia
| | - B.K. Bennett
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | - F. Boyle
- Patricia Ritchie Cancer Care Centre, Mater Hospital, Sydney, Australia
| | - P. de Souza
- Southside Cancer Care Centre, St George Hospital, Sydney, Australia
| | - N. Wilcken
- Westmead Hospital Cancer Care Centre, Sydney, Australia
| | - J. Lynch
- St George Hospital, Sydney, Australia
| | - M. Friedlander
- Prince of Wales Hospital Cancer Centre, Sydney, Australia
| | - D. Goldstein
- The Kirby Institute, UNSW, Sydney, Australia
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | - A.R. Lloyd
- The Kirby Institute, UNSW, Sydney, Australia
- Prince of Wales Hospital Clinical School, Sydney, Australia
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Scott J, Crouse JJ, Ho N, Carpenter J, Martin N, Medland S, Parker R, Byrne E, Couvy-Duchesne B, Mitchell B, Merikangas K, Gillespie NA, Hickie I. Can network analysis of self-reported psychopathology shed light on the core phenomenology of bipolar disorders in adolescents and young adults? Bipolar Disord 2021; 23:584-594. [PMID: 33638252 PMCID: PMC8387492 DOI: 10.1111/bdi.13067] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/13/2021] [Accepted: 02/21/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Network analysis is increasingly applied to psychopathology research. We used it to examine the core phenomenology of emerging bipolar disorder (BD I and II) and 'at risk' presentations (major depression with a family history of BD). METHODOLOGY The study sample comprised a community cohort of 1867 twin and nontwin siblings (57% female; mean age ~26) who had completed self-report ratings of (i) depression-like, hypomanic-like and psychotic-like experiences; (ii) family history of BD; and (iii) were assessed for mood and psychotic syndromes using the Composite International Diagnostic Interview (CIDI). Symptom networks were compared for recent onset BD versus other cohort members and then for individuals at risk of BD (depression with/without a family history of BD). RESULTS The four key symptoms that differentiated recent onset BD from other cohort members were: anergia, psychomotor speed, hypersomnia and (less) loss of confidence. The four key symptoms that differentiated individuals at high risk of BD from unipolar depression were anergia, psychomotor speed, impaired concentration and hopelessness. However, the latter network was less stable and more error prone. CONCLUSIONS We are encouraged by the overlaps between our findings and those from two recent publications reporting network analyses of BD psychopathology, especially as the studies recruited from different populations and employed different network models. However, the advantages of applying network analysis to youth mental health cohorts (which include many individuals with multimorbidity) must be weighed against the disadvantages including basic issues such as judgements regarding the selection of items for inclusion in network models.
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Affiliation(s)
- Jan Scott
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Nicholas Ho
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Joanne Carpenter
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Nicholas Martin
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Sarah Medland
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Richard Parker
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Enda Byrne
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Baptiste Couvy-Duchesne
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Australia
- Paris Brain Institute, INRIA ARAMIS lab, Paris, France
| | - Brittany Mitchell
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- School of Biomedical Science and Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Kathleen Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, USA
| | - Nathan A. Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond VA, USA
| | - Ian Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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9
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Scott J, Crouse JJ, Ho N, Iorfino F, Martin N, Parker R, McGrath J, Gillespie NA, Medland S, Hickie IB. Early expressions of psychopathology and risk associated with trans-diagnostic transition to mood and psychotic disorders in adolescents and young adults. PLoS One 2021; 16:e0252550. [PMID: 34086749 PMCID: PMC8177455 DOI: 10.1371/journal.pone.0252550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The heterogeneity and comorbidity of major mental disorders presenting in adolescents and young adults has fostered calls for trans-diagnostic research. This study examines early expressions of psychopathology and risk and trans-diagnostic caseness in a community cohort of twins and non-twin siblings. METHODS Using data from the Brisbane Longitudinal Twin Study, we estimated median number of self-rated psychiatric symptoms, prevalence of subthreshold syndromes, family history of mood and/or psychotic disorders, and likelihood of subsequent trans-diagnostic caseness (individuals meeting diagnostic criteria for mood and/or psychotic syndromes). Next, we used cross-validated Chi-Square Automatic Interaction Detector (CHAID) analyses to identify the nature and relative importance of individual self-rated symptoms that predicted trans-diagnostic caseness. We examined the positive and negative predictive values (PPV; NPV) and accuracy of all classifications (Area under the Curve and 95% confidence intervals: AUC; 95% CI). RESULTS Of 1815 participants (Female 1050, 58%; mean age 26.40), more than one in four met caseness criteria for a mood and/or psychotic disorder. Examination of individual factors indicated that the AUC was highest for subthreshold syndromes, followed by family history then self-rated psychiatric symptoms, and that NPV always exceeded PPV for caseness. In contrast, the CHAID analysis (adjusted for age, sex, twin status) generated a classification tree comprising six trans-diagnostic symptoms. Whilst the contribution of two symptoms (need for sleep; physical activity) to the model was more difficult to interpret, CHAID analysis indicated that four self-rated symptoms (sadness; feeling overwhelmed; impaired concentration; paranoia) offered the best discrimination between cases and non-cases. These four symptoms showed different associations with family history status. CONCLUSIONS The findings need replication in independent cohorts. However, the use of CHAID might provide a means of identifying specific subsets of trans-diagnostic symptoms representing clinical phenotypes that predict transition to caseness in individuals at risk of onset of major mental disorders.
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Affiliation(s)
- Jan Scott
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
- * E-mail:
| | - Jacob J. Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Nicholas Ho
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Nicholas Martin
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Richard Parker
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - John McGrath
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Nathan A. Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Sarah Medland
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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10
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Crouse JJ, Ho N, Scott J, Martin NG, Couvy-Duchesne B, Hermens DF, Parker R, Gillespie NA, Medland SE, Hickie IB. Days out of role and somatic, anxious-depressive, hypo-manic, and psychotic-like symptom dimensions in a community sample of young adults. Transl Psychiatry 2021; 11:285. [PMID: 33986245 PMCID: PMC8119948 DOI: 10.1038/s41398-021-01390-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/25/2021] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
Improving our understanding of the causes of functional impairment in young people is a major global challenge. Here, we investigated the relationships between self-reported days out of role and the total quantity and different patterns of self-reported somatic, anxious-depressive, psychotic-like, and hypomanic symptoms in a community-based cohort of young adults. We examined self-ratings of 23 symptoms ranging across the four dimensions and days out of role in >1900 young adult twins and non-twin siblings participating in the "19Up" wave of the Brisbane Longitudinal Twin Study. Adjusted prevalence ratios (APR) and 95% confidence intervals (95% CI) quantified associations between impairment and different symptom patterns. Three individual symptoms showed significant associations with days out of role, with the largest association for impaired concentration. When impairment was assessed according to each symptom dimension, there was a clear stepwise relationship between the total number of somatic symptoms and the likelihood of impairment, while individuals reporting ≥4 anxious-depressive symptoms or five hypomanic symptoms had greater likelihood of reporting days out of role. Furthermore, there was a stepwise relationship between the total number of undifferentiated symptoms and the likelihood of reporting days out of role. There was some suggestion of differences in the magnitude and significance of associations when the cohort was stratified according to sex, but not for age or twin status. Our findings reinforce the development of early intervention mental health frameworks and, if confirmed, support the need to consider interventions for subthreshold and/or undifferentiated syndromes for reducing disability among young people.
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Affiliation(s)
- Jacob J Crouse
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia.
| | - Nicholas Ho
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Jan Scott
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
- Diderot University, Paris, France
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Baptiste Couvy-Duchesne
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- ARAMIS Laboratory, Paris Brain Institute, Paris, France
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Australia
| | - Richard Parker
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Virginia, USA
| | - Sarah E Medland
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Ian B Hickie
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
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11
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Structural brain network topology underpinning ADHD and response to methylphenidate treatment. Transl Psychiatry 2021; 11:150. [PMID: 33654073 PMCID: PMC7925571 DOI: 10.1038/s41398-021-01278-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 02/03/2023] Open
Abstract
Behavioural disturbances in attention deficit hyperactivity disorder (ADHD) are thought to be due to dysfunction of spatially distributed, interconnected neural systems. While there is a fast-growing literature on functional dysconnectivity in ADHD, far less is known about the structural architecture underpinning these disturbances and how it may contribute to ADHD symptomology and treatment prognosis. We applied graph theoretical analyses on diffusion MRI tractography data to produce quantitative measures of global network organisation and local efficiency of network nodes. Support vector machines (SVMs) were used for comparison of multivariate graph measures of 37 children and adolescents with ADHD relative to 26 age and gender matched typically developing children (TDC). We also explored associations between graph measures and functionally-relevant outcomes such as symptom severity and prediction of methylphenidate (MPH) treatment response. We found that multivariate patterns of reduced local efficiency, predominantly in subcortical regions (SC), were able to distinguish between ADHD and TDC groups with 76% accuracy. For treatment prognosis, higher global efficiency, higher local efficiency of the right supramarginal gyrus and multivariate patterns of increased local efficiency across multiple networks at baseline also predicted greater symptom reduction after 6 weeks of MPH treatment. Our findings demonstrate that graph measures of structural topology provide valuable diagnostic and prognostic markers of ADHD, which may aid in mechanistic understanding of this complex disorder.
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12
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Valencia BM, Cvejic E, Vollmer-Conna U, Hickie IB, Wakefield D, Li H, Pedergnana V, Rodrigo C, Lloyd AR. The severity of the pathogen-induced acute sickness response is affected by polymorphisms in genes of the NLRP3 inflammasome pathway. Brain Behav Immun 2021; 93:186-193. [PMID: 33434563 PMCID: PMC7794598 DOI: 10.1016/j.bbi.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 12/27/2022] Open
Abstract
The acute sickness response (ASR) is a stereotyped set of symptoms including fatigue, pain, and disturbed mood, which are present in most acute infections. The immunological mechanisms of the ASR are conserved, with variations in severity determined partly by the pathogen, but also by polymorphisms in host genes. The ASR was characterised in three different serologically-confirmed acute infections in Caucasians (n = 484) across four symptom domains or endophenotypes (termed 'Fatigue', 'Musculoskeletal pain', 'Mood disturbance', and 'Acute sickness'). Correlations were sought with functional single nucleotide polymorphisms in the NLRP3 inflammasone pathway and severity of the endophenotypes. Individuals with severe Fatigue, Musculoskeletal pain, or Mood endophenotypes were more likely to have prior episodes of significant fatigue (11.4 vs. 3.8%, p = 0.07), pain (14.3 vs. 1.2%, p = 0.001), or Mood disturbance (13 vs 1%, p=0.001), suggesting trait characteristics. The high functioning allele of the rs35829419 SNP in NLRP3 was more common in those with severe Fatigue (OR = 13.3, 95% CI: 1.7-104), particularly in a dominant inheritance pattern (OR = 13.4, 95% CI: 1.8-586.3). In a multivariable analysis assuming dominant inheritance, both rs35829419 and the rs4848306 SNP in Interleukin(IL)-1β, were independently associated with severe Fatigue (OR = 29.6, 95% CI: 2.6-330.9 and OR = 13, 95% CI: 2.7-61.8, respectively). The severity of fatigue in acute infection is influenced by genetic polymorphisms in NLRP3 and IL-1β.
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Affiliation(s)
- Braulio M. Valencia
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Erin Cvejic
- The University of Sydney, School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27), Fisher Rd, NSW 2006, Australia,Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Ute Vollmer-Conna
- Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, 94 Mallett St, Camperdown, NSW 2050, Australia
| | - Denis Wakefield
- School of Medical Sciences, UNSW Sydney, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Hui Li
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Vincent Pedergnana
- Laboratoire MIVEGEC, Institut de recherche pour le développement, 39 Avenue Charles Flahault, 34090 Montpellier, France
| | - Chaturaka Rodrigo
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia,School of Medical Sciences, UNSW Sydney, Wallace Wurth Building, High St, Kensington, NSW 2052, Australia
| | - Andrew R. Lloyd
- Kirby Institute, The University of New South Wales, Sydney (UNSW Sydney), Wallace Wurth Building, High St, Kensington, NSW 2052, Australia,Corresponding author at: Viral Immunology Systems Program, Kirby Institute, UNSW Sydney, 2052, Australia
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13
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Tickell AM, Rohleder C, Garland A, Song YJC, Carpenter JS, Harel K, Parker L, Hickie IB, Scott E. Protocol for a young adult mental health (Uspace) cohort: personalising multidimensional care in young people admitted to hospital. BMJ Open 2021; 11:e038787. [PMID: 33431486 PMCID: PMC7802707 DOI: 10.1136/bmjopen-2020-038787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Currently, the literature on personalised and measurement-based mental healthcare is inadequate with major gaps in the development and evaluation of 21st century service models. Clinical presentations of mental ill health in young people are heterogeneous, and clinical and functional outcomes are often suboptimal. Thus, treatments provided in a person-centred and responsive fashion are critical to meet the unique needs of young people and improve individual outcomes. Personalised care also requires concurrent assessment of factors relating to outcomes and underlying neurobiology. This study builds on a completed feasibility study and will be the first to incorporate clinical, cognitive, circadian, metabolic and hormonal profiling with personalised and measurement-based care in a cohort of young people admitted to hospital. METHODS AND ANALYSIS This prospective, transdiagnostic, observational study will be offered to all young people between the ages of 16 and 30 years admitted to the inpatient unit of the participating centre. In total, 400 participants will be recruited. On admission to hospital, young people will undergo clinical and diagnostic assessment, cognitive testing, self-report questionnaires, metabolic and hormonal data collection, and anthropomorphic measurements. Participants will wear an actigraphy watch for at least 1 week during admission to measure circadian patterns and sleep-wake cycles. A feedback session between clinician and participant will occur after clinical and other laboratory assessments to tailor individual treatment plans, explain the ongoing process of measurement-based care, and provide participant and family education. Associations between cognitive impairments, disturbed sleep-wake behaviours, circadian rhythms, clinical symptoms and functional impairments will be evaluated to improve the understanding of parameters affecting clinical outcomes. ETHICS AND DISSEMINATION This study protocol was approved by the Human Research Ethics Committees of the University of Sydney (HREC USYD 2015/867) and St Vincent's Hospital (HREC SVH 17/045). This study will be published on completion in a peer-reviewed journal.
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Affiliation(s)
- Ashleigh M Tickell
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Cathrin Rohleder
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Garland
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Kate Harel
- Young Adult Mental Health Unit, St Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
| | - Lisa Parker
- Young Adult Mental Health Unit, St Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Scott
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Young Adult Mental Health Unit, St Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
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14
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Wigman JTW, Pijnenborg GHM, Bruggeman R, Vos M, Wessels A, Oosterholt I, Nauta M, Stelwagen R, Otto L, Wester A, Wunderink L, Sportel E, Boonstra N. Onset and transition of and recovery from adverse development: Study methodology. Early Interv Psychiatry 2020; 14:568-576. [PMID: 31691504 PMCID: PMC7496076 DOI: 10.1111/eip.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/07/2019] [Accepted: 09/24/2019] [Indexed: 01/26/2023]
Abstract
AIM Early intervention programs for first-episode psychosis have led to the awareness that the period before onset of a first episode is important in light of early intervention. This has induced a focus on the so-called 'at risk mental state' (ARMS). Individuals with ARMS are at increased risk for later psychotic disorder, but also for other psychiatric disorders as well as poor psychosocial functioning. Thus, adequate detection and treatment of ARMS is essential. METHODS Since 2018, screening for and treatment of ARMS is recommended standard care in the Netherlands. Implementation is still ongoing. We initiated a naturalistic long-term cohort study of ARMS individuals, the onset and transition of and recovery from adverse development (OnTheROAD) study, with the aim to monitor course and outcome of symptoms and psychosocial functioning over time, as well as patterns of comorbidity and associations with factors of risk and resilience. To this end, participants complete a broad battery of instruments at baseline and yearly follow-up assessments up to 3 years. Outcome is defined in terms of symptom severity level, functioning and quality of life. In particular, we aim to investigate the impact of negative symptoms as part of the ARMS concept. Results from this study can aid in refining the existing ARMS criteria, understanding the developmental course of ARMS and investigating the hypothesized pluripotentiality in outcome of ARMS. New knowledge may inform the further development of specialized early interventions. RESULTS AND CONCLUSIONS In this article, we describe the rationale, outline and set-up of OnTheROAD.
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Affiliation(s)
- Johanna T W Wigman
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Gerdina H M Pijnenborg
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Department of Psychology, University of Groningen, Groningen, The Netherlands.,GGZ (Mental Health Organization) Drenthe, Assen, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Maarten Vos
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Anita Wessels
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Mediant Mental Health Organization, Enschede, The Netherlands
| | - Inez Oosterholt
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Dimence Mental Health Organization, Deventer, The Netherlands
| | - Maaike Nauta
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Department of Psychology, University of Groningen, Groningen, The Netherlands.,Accare Youth Mental Health Organization, Groningen, The Netherlands
| | - Renee Stelwagen
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Lana Otto
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Anniek Wester
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Lex Wunderink
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Mental Health Organization Friesland, Leeuwarden, The Netherlands
| | - Esther Sportel
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,GGZ (Mental Health Organization) Drenthe, Assen, The Netherlands
| | - Nynke Boonstra
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Mental Health Organization Friesland, Leeuwarden, The Netherlands
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15
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Ospina-Pinillos L, Davenport TA, Navarro-Mancilla AA, Cheng VWS, Cardozo Alarcón AC, Rangel AM, Rueda-Jaimes GE, Gomez-Restrepo C, Hickie IB. Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies. JMIR Ment Health 2020; 7:e15914. [PMID: 32027313 PMCID: PMC7055810 DOI: 10.2196/15914] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. OBJECTIVE Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). METHODS This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions. RESULTS A total of 2 co-design workshops were held with 18 users-young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions-young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. CONCLUSIONS The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C-a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.
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Affiliation(s)
- Laura Ospina-Pinillos
- Brain and Mind Centre, Sydney, The University of Sydney, Sydney, Australia.,Department of Psychiatry and Mental Health, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Tracey A Davenport
- Brain and Mind Centre, Sydney, The University of Sydney, Sydney, Australia
| | | | | | | | - Andres M Rangel
- E-Health Living Lab, Faculty of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - German Eduardo Rueda-Jaimes
- Neuropsychiatry Research Group, Universidad Autonoma de Bucaramanga, Bucaramanga, Colombia.,Mental Health Department, Faculty of Health Sciences, Universidad Autonoma de Bucaramanga, Bucarmanaga, Colombia
| | - Carlos Gomez-Restrepo
- Department of Psychiatry and Mental Health, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Ian B Hickie
- Brain and Mind Centre, Sydney, The University of Sydney, Sydney, Australia
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16
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Fatt SJ, Beilharz JE, Joubert M, Wilson C, Lloyd AR, Vollmer-Conna U, Cvejic E. Parasympathetic activity is reduced during slow-wave sleep, but not resting wakefulness, in patients with chronic fatigue syndrome. J Clin Sleep Med 2019; 16:19-28. [PMID: 31957647 DOI: 10.5664/jcsm.8114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Physiological dearousal characterized by an increase in parasympathetic nervous system activity is important for good-quality sleep. Previous research shows that nocturnal parasympathetic activity (reflected by heart rate variability [HRV]) is diminished in individuals with chronic fatigue syndrome (CFS), suggesting hypervigilant sleep. This study investigated differences in nocturnal autonomic activity across sleep stages and explored the association of parasympathetic activity with sleep quality and self-reported physical and psychological wellbeing in individuals with CFS. METHODS Twenty-four patients with medically diagnosed CFS, and 24 matched healthy control individuals participated. Electroencephalography and HRV were recorded during sleep in participants' homes using a minimally invasive ambulatory device. Questionnaires were used to measure self-reported wellbeing and sleep quality. RESULTS Sleep architecture in patients with CFS differed from that of control participants in slower sleep onset, more awakenings, and a larger proportion of time spent in slow-wave sleep (SWS). Linear mixed-model analyses controlling for age revealed that HRV reflecting parasympathetic activity (normalized high frequency power) was reduced in patients with CFS compared to control participants, particularly during deeper stages of sleep. Poorer self-reported wellbeing and sleep quality was associated with reduced parasympathetic signaling during deeper sleep, but not during wake before sleep, rapid eye movement sleep, or with the proportion of time spent in SWS. CONCLUSIONS Autonomic hypervigilance during the deeper, recuperative stages of sleep is associated with poor quality sleep and self-reported wellbeing. Causal links need to be confirmed but provide potential intervention opportunities for the core symptom of unrefreshing sleep in CFS.
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Affiliation(s)
- Scott J Fatt
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Jessica E Beilharz
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Michael Joubert
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Chloe Wilson
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Andrew R Lloyd
- Viral Immunology Systems Program, The Kirby Institute, University of New South Wales Sydney, New South Wales, Australia
| | - Uté Vollmer-Conna
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Erin Cvejic
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia.,The University of Sydney, School of Public Health, Faculty of Medicine and Health, New South Wales, Australia
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17
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Tsikandilakis M, Kausel L, Boncompte G, Yu Z, Oxner M, Lanfranco R, Bali P, Urale P, Peirce J, López V, Tong EMW, William H, Carmel D, Derrfuss J, Chapman P. “There Is NoFaceLike Home”: Ratings for Cultural Familiarity to Own and Other FacialDialectsof Emotion With and Without Conscious Awareness in a British Sample. Perception 2019; 48:918-947. [DOI: 10.1177/0301006619867865] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Myron Tsikandilakis
- School of Psychology, University of Nottingham, UK; Medical School, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Leonie Kausel
- Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Boncompte
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Zhaoliang Yu
- Department of Psychology, National University of Singapore, Singapore
| | - Matt Oxner
- School of Psychology, The University of Auckland, New Zealand
| | - Renzo Lanfranco
- Department of Psychology, The University of Edinburgh, UK; Department of Psychiatry and Mental Health, University Psychiatric Clinic, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Poutasi Urale
- School of Psychology, The University of Auckland, New Zealand
| | | | - Vladimir López
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Hayward William
- School of Psychology, The University of Auckland, New Zealand; School of Psychology, University of Hong Kong, Hong Kong
| | - David Carmel
- Department of Psychology, The University of Edinburgh, UK
| | - Jan Derrfuss
- School of Psychology, University of Nottingham, UK
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18
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Ospina-Pinillos L, Davenport T, Mendoza Diaz A, Navarro-Mancilla A, Scott EM, Hickie IB. Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study. J Med Internet Res 2019; 21:e14127. [PMID: 31376271 PMCID: PMC6696860 DOI: 10.2196/14127] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022] Open
Abstract
Background The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically diverse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students. Objective We used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC; (2) inform the development of the MHeC-S alpha prototype; (3) test the usability of the MHeC-S alpha prototype; (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment; and (5) collect information to inform its beta prototype. Methods A research and development cycle included several participatory design phases: co-design workshops; knowledge translation; language translation and cultural adaptation; and rapid prototyping and user testing of the MHeC-S alpha prototype. Results We held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random sample of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86; P<.001) and content (kappa=.92; P<.001) and substantial agreement for the user interface (kappa=.785; P<.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype’s 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking. Conclusions Through a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries.
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Affiliation(s)
- Laura Ospina-Pinillos
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Department of Psychiatry and Mental Health, Pontifical Javeriana University, Bogota, Colombia
| | - Tracey Davenport
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Antonio Mendoza Diaz
- School of Psychiatry, Department of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Elizabeth M Scott
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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19
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Tsikandilakis M, Bali P, Chapman P. Beauty Is in the Eye of the Beholder: The Appraisal of Facial Attractiveness and Its Relation to Conscious Awareness. Perception 2018; 48:72-92. [DOI: 10.1177/0301006618813035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous research suggests that facial attractiveness relies on features such as symmetry, averageness and above-average sexual dimorphic characteristics. Due to the evolutionary and sociobiological value of these characteristics, it has been suggested that attractiveness can be processed in the absence of conscious awareness. This raises the possibility that attractiveness can also be appraised without conscious awareness. In this study, we addressed this hypothesis. We presented neutral and emotional faces that were rated high, medium and low for attractiveness during a pilot experimental stage. We presented these faces for 33.33 ms with backwards masking to a black and white pattern for 116.67 ms and measured face-detection and emotion-discrimination performance, and attractiveness ratings. We found that high-attractiveness faces were detected and discriminated more accurately and rated higher for attractiveness compared with other appearance types. A Bayesian analysis of signal detection performance indicated that faces were not processed significantly at-chance. Further assessment revealed that correct detection (hits) of a presented face was a necessary condition for reporting higher ratings for high-attractiveness faces. These findings suggest that the appraisal of attractiveness requires conscious awareness.
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Affiliation(s)
- Myron Tsikandilakis
- School of Psychology, University of Nottingham, UK; Medical School, Faculty of Medicine and Health Sciences, University of Nottingham, UK
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20
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Ospina-Pinillos L, Davenport T, Iorfino F, Tickell A, Cross S, Scott EM, Hickie IB. Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study. J Med Internet Res 2018; 20:e259. [PMID: 30201602 PMCID: PMC6231849 DOI: 10.2196/jmir.9966] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
Background Globally there is increasing recognition that new strategies are required to reduce disability due to common mental health problems. As 75% of mental health and substance use disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, new and innovative technologies show promise in augmenting traditional clinic-based services. Objective The aim of this study was to test new and innovative technologies to assess clinical stage in early intervention youth mental health services using a prototypic online system known as the Mental Health eClinic (MHeC). Methods The online assessment within the MHeC was compared directly against traditional clinician assessment within 2 Sydney-based youth-specific mental health services (headspace Camperdown and headspace Campbelltown). A total of 204 young people were recruited to the study. Eligible participants completed both face-to-face and online assessments, which were randomly allocated and counterbalanced at a 1-to-3 ratio. These assessments were (1) a traditional 45- to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician and (2) an approximate 60-minute online assessment (including a self-report Web-based survey, immediate dashboard of results, and a video visit with a clinician). All assessments were completed within a 2-week timeframe from initial presentation. Results Of the 72 participants who completed the study, 71% (51/72) were female and the mean age was 20.4 years (aged 16 to 25 years); 68% (49/72) of participants were recruited from headspace Camperdown and the remaining 32% (23/72) from headspace Campbelltown. Interrater agreement of participants’ stage, as determined after face-to-face assessment or online assessment, demonstrated fair agreement (kappa=.39, P<.001) with concordance in 68% of cases (49/72). Among the discordant cases, those who were allocated to a higher stage by online raters were more likely to report a past history of mental health disorders (P=.001), previous suicide planning (P=.002), and current cannabis misuse (P=.03) compared to those allocated to a lower stage. Conclusions The MHeC presents a new and innovative method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connected with traditional clinical services and assist in providing the right care at the right time.
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Affiliation(s)
| | - Tracey Davenport
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Ashleigh Tickell
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Shane Cross
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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21
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A Breukelaar I, Williams LM, Antees C, Grieve SM, Foster SL, Gomes L, Korgaonkar MS. Cognitive ability is associated with changes in the functional organization of the cognitive control brain network. Hum Brain Mapp 2018; 39:5028-5038. [PMID: 30136345 DOI: 10.1002/hbm.24342] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 01/25/2023] Open
Abstract
Cognitive control is one of the most important skills in day-to-day social and intellectual functioning but we are yet to understand the neural basis of the group of behaviors required to carry this out. Here, we probed changes over time in the brain network associated with cognitive control (the dorsolateral prefrontal cortex, the dorsal posterior parietal cortex, and the dorsal anterior cingulate cortex) using both behavioral assays and functional brain imaging during a selective working memory task in 69 healthy participants within the age range 18-38 years (mean: 25, SD: ±6), assessed twice, 2 years apart. We aimed to explore the relationship of changing network activation and connectivity with behavioral tasks associated with cognitive control in this otherwise neurodevelopmentally stable group. We found that increased connectivity between frontoparietal cognitive control network regions during the working memory task was associated with improved memory and executive functions over the 2-year period and that this association was not impacted by age, gender, or baseline performance. These results provide evidence that changes in the functional organization of the cognitive control brain network occur despite the absence of neurodevelopment, aging or targeted cognitive training effects, and could modulate cognitive performance in early to mid-adulthood. Understanding how and why this change is occurring could provide insights into the mechanisms through which cognitive control ability is cultivated over time. This could aid in the development of interventions in cases where cognitive control is impaired.
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Affiliation(s)
- Isabella A Breukelaar
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
| | - Leanne M Williams
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia.,Psychiatry and Behavioral Sciences, Stanford University, Stanford, California.,VA Palo Alto (Sierra-Pacific MIRECC), Palo Alto, California
| | - Cassandra Antees
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
| | - Stuart M Grieve
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia.,Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre and Sydney Medical School, University of Sydney, New South Wales, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sheryl L Foster
- Department of Radiology, Westmead Hospital, Westmead, New South Wales, Australia.,Faculty of Health Science, The Discipline of Medical Radiation Sciences, The University of Sydney, New South Wales, Australia
| | - Lavier Gomes
- Department of Radiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia.,Discipline of Psychiatry, Sydney Medical School, Westmead, Sydney, Australia
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22
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Personalised relaxation practice to improve sleep and functioning in patients with chronic fatigue syndrome and depression: study protocol for a randomised controlled trial. Trials 2018; 19:371. [PMID: 29996933 PMCID: PMC6042263 DOI: 10.1186/s13063-018-2763-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/25/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) and major depressive disorder (MDD) are both debilitating but heterogeneous conditions sharing core features of fatigue, unrefreshing sleep, and impaired functioning. The aetiology of these conditions is not fully understood, and 'best-practice' treatments are only moderately effective in relieving symptoms. Unrecognised individual differences in the response to such treatments are likely to underlie poor treatment outcomes. METHODS/DESIGN We are undertaking a two-group, parallel, randomised controlled trial (RCT) comparing the effects of a personalised relaxation intervention on sleep quality, daytime symptoms, and functioning in patients with CFS (n = 64) and MDD (n = 64). Following identification of the method that best enhances autonomic responding (such as heart rate variability), participants randomised to the active intervention will practise their recommended method nightly for 4 weeks. All participants will keep a sleep diary and monitor symptoms during the trial period, and they will complete two face-to-face assessments, one at baseline and one at 4 weeks, and a further online assessment to evaluate lasting effects of the intervention at 2 months. Assessments include self-report measures of sleep, wellbeing, and function and monitoring of autonomic responses at rest, in response to the relaxation method and during nocturnal sleep. Treatment outcomes will be analysed using linear mixed modelling. DISCUSSION This is the first RCT examining the effects of a personalised relaxation intervention, pre-tested to maximise the autonomic relaxation response, in patients with unrefreshing sleep and fatigue attributed to CFS or MDD. Detailed monitoring of sleep quality and symptoms will enable sensitive detection of improvements in the core symptoms of these debilitating conditions. In addition, repeated monitoring of autonomic functioning can elucidate mechanisms underlying potential benefits. The findings have translational potential, informing novel, personalised symptom management techniques for these conditions, with the potential for better clinical outcomes. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR), ACTRN12616001671459 . Registered on 5 December 2016.
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23
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Couvy-Duchesne B, O’Callaghan V, Parker R, Mills N, Kirk KM, Scott J, Vinkhuyzen A, Hermens DF, Lind PA, Davenport TA, Burns JM, Connell M, Zietsch BP, Scott J, Wright MJ, Medland SE, McGrath J, Martin NG, Hickie IB, Gillespie NA. Nineteen and Up study (19Up): understanding pathways to mental health disorders in young Australian twins. BMJ Open 2018; 8:e018959. [PMID: 29550775 PMCID: PMC5875659 DOI: 10.1136/bmjopen-2017-018959] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The Nineteen and Up study (19Up) assessed a range of mental health and behavioural problems and associated risk factors in a genetically informative Australian cohort of young adult twins and their non-twin siblings. As such, 19Up enables detailed investigation of genetic and environmental pathways to mental illness and substance misuse within the Brisbane Longitudinal Twin Sample (BLTS). PARTICIPANTS Twins and their non-twin siblings from Queensland, Australia; mostly from European ancestry. Data were collected between 2009 and 2016 on 2773 participants (age range 18-38, 57.8% female, 372 complete monozygotic pairs, 493 dizygotic pairs, 640 non-twin siblings, 403 singleton twins). FINDINGS TO DATE A structured clinical assessment (Composite International Diagnostic Interview) was used to collect lifetime prevalence of diagnostic statistical manual (4th edition) (DSM-IV) diagnoses of major depressive disorder, (hypo)mania, social anxiety, cannabis use disorder, alcohol use disorder, panic disorder and psychotic symptoms. Here, we further describe the comorbidities and ages of onset for these mental disorders. Notably, two-thirds of the sample reported one or more lifetime mental disorder.In addition, the 19Up study assessed general health, drug use, work activity, education level, personality, migraine/headaches, suicidal thoughts, attention deficit hyperactivity disorder (ADHD) symptomatology, sleep-wake patterns, romantic preferences, friendships, familial environment, stress, anorexia and bulimia as well as baldness, acne, asthma, endometriosis, joint flexibility and internet use.The overlap with previous waves of the BLTS means that 84% of the 19Up participants are genotyped, 36% imaged using multimodal MRI and most have been assessed for psychological symptoms at up to four time points. Furthermore, IQ is available for 57%, parental report of ADHD symptomatology for 100% and electroencephalography for 30%. FUTURE PLANS The 19Up study complements a phenotypically rich, longitudinal collection of environmental and psychological risk factors. Future publications will explore hypotheses related to disease onset and development across the waves of the cohort. A follow-up study at 25+years is ongoing.
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Affiliation(s)
- Baptiste Couvy-Duchesne
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Victoria O’Callaghan
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Richard Parker
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Natalie Mills
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Katherine M Kirk
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jan Scott
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Anna Vinkhuyzen
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Penelope A Lind
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Tracey A Davenport
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Jane M Burns
- Young and Well CRC, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Connell
- UQCCR, The University of Queensland, Brisbane, Queensland, Australia
| | - Brendan P Zietsch
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - James Scott
- UQCCR, The University of Queensland, Brisbane, Queensland, Australia
| | - Margaret J Wright
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - John McGrath
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nathan A Gillespie
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
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24
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Tsikandilakis M, Chapman P. Skin Conductance Responses to Masked Emotional Faces Are Modulated by Hit Rate but Not Signal Detection Theory Adjustments for Subjective Differences in the Detection Threshold. Perception 2018; 47:432-450. [DOI: 10.1177/0301006618760738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The biological preparedness model suggests that survival-related visual cues elicit physiological changes without awareness to enable us to respond to our environment. Previous studies have reported some evidence for this effect. In the current article, we argue that this evidence is subject to methodological confounds. These include the use of a universal masked presentation threshold, the employment of hit rates (HRs) to measure meta-awareness, and the assertion of overall guess-level target detection using nonsignificance. In the current report, we address these issues and test whether masked emotional faces can elicit changes in physiology. We present participants with subjectively adjusted masked angry, fearful, happy, and neutral faces using HRs and signal detection theory. We assess detection performance using a strict Bayesian criterion for meta-awareness. Our findings reveal that HR adjustments in the detection threshold allow higher skin conductance responses to happy, fearful, and angry faces, but that this effect could not be reported by the same participants when the adjustments were made using signal detection measures. Combined these findings suggest that very brief biologically relevant stimuli can elicit physiological changes but cast doubt to the extent that this effect can occur in response to truly unconscious emotional faces.
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25
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Lingual Gyrus Surface Area Is Associated with Anxiety-Depression Severity in Young Adults: A Genetic Clustering Approach. eNeuro 2018; 5:eN-NWR-0153-17. [PMID: 29354681 PMCID: PMC5773884 DOI: 10.1523/eneuro.0153-17.2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/21/2017] [Accepted: 12/25/2017] [Indexed: 11/21/2022] Open
Abstract
Here we aimed to identify cortical endophenotypes for anxiety-depression. Our data-driven approach used vertex-wise genetic correlations (estimated from a twin sample: 157 monozygotic and 194 dizygotic twin pairs) to parcellate cortical thickness (CT) and surface area (SA) into genetically homogeneous regions (Chen et al., 2013). In an overlapping twin and sibling sample (n = 834; aged 15–29, 66% female), in those with anxiety-depression Somatic and Psychological Health Report (SPHERE) scores (Hickie et al., 2001) above median, we found a reduction of SA in an occipito-temporal cluster, which comprised part of the right lingual, fusiform and parahippocampal gyrii. A similar reduction was observed in the Human Connectome Project (HCP) sample (n = 890, age 22–37, 56.5% female) in those with Adult Self Report (ASR) DSM-oriented scores (Achenbach et al., 2005) in the 25–95% quantiles. A post hoc vertex-wise analysis identified the right lingual and, to a lesser extent the fusiform gyrus. Overall, the surface reduction explained by the anxiety-depression scores was modest (r = −0.10, 3rd order spline, and r = −0.040, 1st order spline in the HCP). The discordant results in the top 5% of the anxiety-depression scores may be explained by differences in recruitment between the studies. However, we could not conclude whether this cortical region was an endophenotype for anxiety-depression as the genetic correlations did not reach significance, which we attribute to the modest effect size (post hoc statistical power <10%).
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26
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Rietschel L, Streit F, Zhu G, McAloney K, Frank J, Couvy-Duchesne B, Witt SH, Binz TM, McGrath J, Hickie IB, Hansell NK, Wright MJ, Gillespie NA, Forstner AJ, Schulze TG, Wüst S, Nöthen MM, Baumgartner MR, Walker BR, Crawford AA, Colodro-Conde L, Medland SE, Martin NG, Rietschel M. Hair Cortisol in Twins: Heritability and Genetic Overlap with Psychological Variables and Stress-System Genes. Sci Rep 2017; 7:15351. [PMID: 29127340 PMCID: PMC5703444 DOI: 10.1038/s41598-017-11852-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/30/2017] [Indexed: 12/19/2022] Open
Abstract
Hair cortisol concentration (HCC) is a promising measure of long-term hypothalamus-pituitary-adrenal (HPA) axis activity. Previous research has suggested an association between HCC and psychological variables, and initial studies of inter-individual variance in HCC have implicated genetic factors. However, whether HCC and psychological variables share genetic risk factors remains unclear. The aims of the present twin study were to: (i) assess the heritability of HCC; (ii) estimate the phenotypic and genetic correlation between HPA axis activity and the psychological variables perceived stress, depressive symptoms, and neuroticism; using formal genetic twin models and molecular genetic methods, i.e. polygenic risk scores (PRS). HCC was measured in 671 adolescents and young adults. These included 115 monozygotic and 183 dizygotic twin-pairs. For 432 subjects PRS scores for plasma cortisol, major depression, and neuroticism were calculated using data from large genome wide association studies. The twin model revealed a heritability for HCC of 72%. No significant phenotypic or genetic correlation was found between HCC and the three psychological variables of interest. PRS did not explain variance in HCC. The present data suggest that HCC is highly heritable. However, the data do not support a strong biological link between HCC and any of the investigated psychological variables.
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Affiliation(s)
- Liz Rietschel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Research Department, University of Bern, Bern, Switzerland.
- SRH University Heidelberg, Academy for Psychotherapy, Heidelberg, Germany.
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Gu Zhu
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Kerrie McAloney
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Baptiste Couvy-Duchesne
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tina M Binz
- Zurich Institute of Forensic Medicine, Centre for Forensic Hair Analysis, University of Zurich, Zurich, Switzerland
| | - John McGrath
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Narelle K Hansell
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Nathan A Gillespie
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life & Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Thomas G Schulze
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, USA
- Institute of Psychiatric Phenomics and Genomics (IPPG), Medical Center of the University of Munich, Campus Innenstadt, Munich, DE, Germany
- Human Genetics Branch, NIMH Division of Intramural Research Programs, Bethesda, USA
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Goettingen, DE, Germany
| | - Stefan Wüst
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Institute of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Life & Brain Center, Department of Genomics, University of Bonn, Bonn, Germany
| | - Markus R Baumgartner
- Zurich Institute of Forensic Medicine, Centre for Forensic Hair Analysis, University of Zurich, Zurich, Switzerland
| | - Brian R Walker
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew A Crawford
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Lucía Colodro-Conde
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Sarah E Medland
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Nicholas G Martin
- Genetics & Computational Biology Department, QIMR Berghofer Medical Research, Brisbane, Australia
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Yu T, Korgaonkar MS, Grieve SM. Gray Matter Atrophy in the Cerebellum-Evidence of Increased Vulnerability of the Crus and Vermis with Advancing Age. THE CEREBELLUM 2017; 16:388-397. [PMID: 27395405 DOI: 10.1007/s12311-016-0813-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined patterns of cerebellar volumetric gray matter (GM) loss across the adult lifespan in a large cross-sectional sample. Four hundred and seventy-nine healthy participants (age range: 7-86 years) were drawn from the Brain Resource International Database who provided T1-weighted MRI scans. The spatially unbiased infratentorial template (SUIT) toolbox in SPM8 was used for normalisation of the cerebellum structures. Global volumetric and voxel-based morphometry analyses were performed to evaluate age-associated trends and gender-specific age-patterns. Global cerebellar GM shows a cross-sectional reduction with advancing age of 2.5 % per decade-approximately half the rate seen in the whole brain. The male cerebellum is larger with a lower percentage of GM, however, after controlling for total brain volume, no gender difference was detected. Analysis of age-related changes in GM volume revealed large bilateral clusters involving the vermis and cerebellar crus where regional loss occurred at nearly twice the average cerebellar rate. No gender-specific patterns were detected. These data confirm that regionally specific GM loss occurs in the cerebellum with age, and form a solid base for further investigation to find functional correlates for this global and focal loss.
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Affiliation(s)
- Teresa Yu
- The Brain Dynamics Centre, Westmead Millennium Institute and Sydney Medical School, Sydney, NSW, Australia
| | - Mayuresh S Korgaonkar
- The Brain Dynamics Centre, Westmead Millennium Institute and Sydney Medical School, Sydney, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Westmead Hospital, Sydney, NSW, Australia.,Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre and Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Stuart M Grieve
- The Brain Dynamics Centre, Westmead Millennium Institute and Sydney Medical School, Sydney, NSW, Australia. .,Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre and Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia. .,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, 2006, Australia.
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Couvy-Duchesne B, Davenport TA, Martin NG, Wright MJ, Hickie IB. Validation and psychometric properties of the Somatic and Psychological HEalth REport (SPHERE) in a young Australian-based population sample using non-parametric item response theory. BMC Psychiatry 2017; 17:279. [PMID: 28764680 PMCID: PMC5540428 DOI: 10.1186/s12888-017-1420-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Somatic and Psychological HEalth REport (SPHERE) is a 34-item self-report questionnaire that assesses symptoms of mental distress and persistent fatigue. As it was developed as a screening instrument for use mainly in primary care-based clinical settings, its validity and psychometric properties have not been studied extensively in population-based samples. METHODS We used non-parametric Item Response Theory to assess scale validity and item properties of the SPHERE-34 scales, collected through four waves of the Brisbane Longitudinal Twin Study (N = 1707, mean age = 12, 51% females; N = 1273, mean age = 14, 50% females; N = 1513, mean age = 16, 54% females, N = 1263, mean age = 18, 56% females). We estimated the heritability of the new scores, their genetic correlation, and their predictive ability in a sub-sample (N = 1993) who completed the Composite International Diagnostic Interview. RESULTS After excluding items most responsible for noise, sex or wave bias, the SPHERE-34 questionnaire was reduced to 21 items (SPHERE-21), comprising a 14-item scale for anxiety-depression and a 10-item scale for chronic fatigue (3 items overlapping). These new scores showed high internal consistency (alpha > 0.78), moderate three months reliability (ICC = 0.47-0.58) and item scalability (Hi > 0.23), and were positively correlated (phenotypic correlations r = 0.57-0.70; rG = 0.77-1.00). Heritability estimates ranged from 0.27 to 0.51. In addition, both scores were associated with later DSM-IV diagnoses of MDD, social anxiety and alcohol dependence (OR in 1.23-1.47). Finally, a post-hoc comparison showed that several psychometric properties of the SPHERE-21 were similar to those of the Beck Depression Inventory. CONCLUSIONS The scales of SPHERE-21 measure valid and comparable constructs across sex and age groups (from 9 to 28 years). SPHERE-21 scores are heritable, genetically correlated and show good predictive ability of mental health in an Australian-based population sample of young people.
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Affiliation(s)
- Baptiste Couvy-Duchesne
- Queensland Brain Institute, the University of Queensland, Brisbane, Australia. .,Centre for Advanced Imaging, the University of Queensland, Brisbane, Australia. .,Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Tracey A. Davenport
- 0000 0004 1936 834Xgrid.1013.3Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Nicholas G. Martin
- 0000 0001 2294 1395grid.1049.cGenetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Margaret J. Wright
- 0000 0000 9320 7537grid.1003.2Queensland Brain Institute, the University of Queensland, Brisbane, Australia
| | - Ian B. Hickie
- 0000 0004 1936 834Xgrid.1013.3Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Iorfino F, Davenport TA, Ospina-Pinillos L, Hermens DF, Cross S, Burns J, Hickie IB. Using New and Emerging Technologies to Identify and Respond to Suicidality Among Help-Seeking Young People: A Cross-Sectional Study. J Med Internet Res 2017; 19:e247. [PMID: 28701290 PMCID: PMC5529742 DOI: 10.2196/jmir.7897] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Suicidal thoughts are common among young people presenting to face-to-face and online mental health services. The early detection and rapid response to these suicidal thoughts and other suicidal behaviors is a priority for suicide prevention and early intervention efforts internationally. Establishing how best to use new and emerging technologies to facilitate person-centered systematic assessment and early intervention for suicidality is crucial to these efforts. OBJECTIVE The aim of this study was to examine the use of a suicidality escalation protocol to respond to suicidality among help-seeking young people. METHODS A total of 232 young people in the age range of 16-25 years were recruited from either a primary mental health care service or online in the community. Each young person used the Synergy Online System and completed an initial clinical assessment online before their face-to-face or online clinical appointment. A suicidality escalation protocol was used to identify and respond to current and previous suicidal thoughts and behaviors. RESULTS A total of 153 young people (66%, 153/232) reported some degree of suicidality and were provided with a real-time alert online. Further levels of escalation (email or phone contact and clinical review) were initiated for the 35 young people (15%, 35/232) reporting high suicidality. Higher levels of psychological distress (P<.001) and a current alcohol or substance use problem (P=.02) predicted any level of suicidality compared with no suicidality. Furthermore, predictors of high suicidality compared with low suicidality were higher levels of psychological distress (P=.01), psychosis-like symptoms in the last 12 months (P=.01), a previous mental health problem (P=.01), and a history of suicide planning or attempts (P=.001). CONCLUSIONS This study demonstrates the use of new and emerging technologies to facilitate the systematic assessment and detection of help-seeking young people presenting with suicidality. This protocol empowered the young person by suggesting pathways to care that were based on their current needs. The protocol also enabled an appropriate and timely response from service providers for young people reporting high suicidality that was associated with additional comorbid issues, including psychosis-like symptoms, and a history of suicide plans and attempts.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | | | - Daniel F Hermens
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Shane Cross
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Jane Burns
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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30
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Kozlowska K, Griffiths KR, Foster SL, Linton J, Williams LM, Korgaonkar MS. Grey matter abnormalities in children and adolescents with functional neurological symptom disorder. NEUROIMAGE-CLINICAL 2017; 15:306-314. [PMID: 28560155 PMCID: PMC5440356 DOI: 10.1016/j.nicl.2017.04.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/28/2017] [Accepted: 04/12/2017] [Indexed: 11/18/2022]
Abstract
Objective Functional neurological symptom disorder refers to the presence of neurological symptoms not explained by neurological disease. Although this disorder is presumed to reflect abnormal function of the brain, recent studies in adults show neuroanatomical abnormalities in brain structure. These structural brain abnormalities have been presumed to reflect long-term adaptations to the disorder, and it is unknown whether child and adolescent patients, with illness that is typically of shorter duration, show similar deficits or have normal brain structure. Method High-resolution, three-dimensional T1-weighted magnetic resonance images (MRIs) were acquired in 25 patients (aged 10–18 years) and 24 healthy controls. Structure was quantified in terms of grey matter volume using voxel-based morphometry. Post hoc, we examined whether regions of structural difference related to a measure of motor readiness to emotional signals and to clinical measures of illness duration, illness severity, and anxiety/depression. Results Patients showed greater volumes in the left supplementary motor area (SMA) and right superior temporal gyrus (STG) and dorsomedial prefrontal cortex (DMPFC) (corrected p < 0.05). Previous studies of adult patients have also reported alterations of the SMA. Greater SMA volumes correlated with faster reaction times in identifying emotions but not with clinical measures. Conclusions The SMA, STG, and DMPFC are known to be involved in the perception of emotion and the modulation of motor responses. These larger volumes may reflect the early expression of an experience-dependent plasticity process associated with increased vigilance to others' emotional states and enhanced motor readiness to organize self-protectively in the context of the long-standing relational stress that is characteristic of this disorder. We used high-resolution MRI to investigate brain structure in children presenting with acute functional neurological symptom disorder (FND). Patients had multiple antecedent stressors, a long-standing history of relational stress and at-risk attachment strategies. Patients had greater volumes in the SMA—where motor-, cognitive-, and emotion-processing signals interact to influence motor function. FND may involve experience-dependent changes in brain structure alongside experience-dependent changes in brain function.
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Affiliation(s)
- Kasia Kozlowska
- The Children's Hospital at Westmead, Psychological Medicine, Locked Bag 4001, Westmead, NSW 2145, Australia; The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
| | - Kristi R Griffiths
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
| | - Sheryl L Foster
- The University of Sydney, Sydney, Australia; Westmead Hospital Radiology Department, Darcy Rd, Westmead, NSW 2145, Australia.
| | - James Linton
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia.
| | - Leanne M Williams
- Psychiatry and Behavioral Sciences, Stanford University, VA Palo Alto (Sierra-Pacific MIRECC) 401 Quarry Rd, United States.
| | - Mayuresh S Korgaonkar
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
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Bergin ART, Hovey E, Lloyd A, Marx G, Parente P, Rapke T, de Souza P. Docetaxel-related fatigue in men with metastatic prostate cancer: a descriptive analysis. Support Care Cancer 2017; 25:2871-2879. [PMID: 28429147 DOI: 10.1007/s00520-017-3706-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 04/10/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Fatigue is a prevalent and debilitating side effect of docetaxel chemotherapy in metastatic prostate cancer. A better understanding of the kinetics and nature of docetaxel-related fatigue may provide a framework for intervention. METHODS This secondary analysis was performed using the MOTIF database, from a phase III, randomised, double-blind, placebo-controlled study of modafinil (200 mg/day for 15 days) for docetaxel-related fatigue in men with metastatic prostate cancer [1]. The pattern of fatigue was analysed using the MDASI (MD Anderson Symptom Inventory) score. The impact of modafinil, cumulative docetaxel exposure, age and smoking status on fatigue kinetics were explored. Fatigue-related symptoms were assessed using the SOMA6 (fatigue and related symptoms) subset of the SPHERE (Somatic and Psychological Health Report). Mood was tracked using the short form 36 health survey questionnaire (SF-36). RESULTS Across four docetaxel cycles, fatigue scores were higher in the first week and decreased over weeks two and three. Whilst men randomised to modafinil had reduced fatigue scores, cumulative docetaxel had little impact. Younger men (55-68 years) had significantly reduced fatigue scores, whereas current and ex-smokers had higher scores. There was no significant change in mood status or haemoglobin across treatment cycles. Men described both 'somnolence' and 'muscle fatigue' contributing significantly to their symptom complex. CONCLUSIONS Assessment and management of docetaxel-related fatigue remains an important challenge. Given the complex, multifactorial nature of fatigue, identification through structured interview and interventions targeted to specific 'at risk' groups may be the most beneficial. Understanding the temporal pattern (kinetics) and nature of fatigue is critical to guide this process.
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Affiliation(s)
- A R T Bergin
- Eastern Health, Box Hill Hospital, 8 Arnold St, Box Hill, Victoria, Australia.
| | - E Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Barker St, Randwick, New South Wales, Australia.,University of New South Wales, Kensington, New South Wales, Australia
| | - A Lloyd
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Barker St, Randwick, New South Wales, Australia.,University of New South Wales, Kensington, New South Wales, Australia.,Inflammation and Infection Research Centre (IIRC), School of Medical Sciences and National Centre for Cancer Survivorship (NCCS), Randwick, New South Wales, Australia
| | - G Marx
- Sydney Adventist Hospital Clinical Trials Unit & Integrated Cancer Centre, 185 Fox Valley Rd, Wahroonga, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - P Parente
- Eastern Health, Box Hill Hospital, 8 Arnold St, Box Hill, Victoria, Australia.,Eastern Health, Monash University Clinical School, 5 Arnold St, Box Hill, Victoria, Australia
| | - T Rapke
- Sanofi Aventis, Sydney, New South Wales, Australia
| | - P de Souza
- Liverpool Hospital, Goulburn Street, Liverpool, New South Wales, Australia.,Western Sydney University, Penrith, New South Wales, Australia
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32
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Griffiths KR, Grieve SM, Kohn MR, Clarke S, Williams LM, Korgaonkar MS. Altered gray matter organization in children and adolescents with ADHD: a structural covariance connectome study. Transl Psychiatry 2016; 6:e947. [PMID: 27824356 PMCID: PMC5314130 DOI: 10.1038/tp.2016.219] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/25/2016] [Accepted: 09/20/2016] [Indexed: 01/28/2023] Open
Abstract
Although multiple studies have reported structural deficits in multiple brain regions in attention-deficit hyperactivity disorder (ADHD), we do not yet know if these deficits reflect a more systematic disruption to the anatomical organization of large-scale brain networks. Here we used a graph theoretical approach to quantify anatomical organization in children and adolescents with ADHD. We generated anatomical networks based on covariance of gray matter volumes from 92 regions across the brain in children and adolescents with ADHD (n=34) and age- and sex-matched healthy controls (n=28). Using graph theory, we computed metrics that characterize both the global organization of anatomical networks (interconnectivity (clustering), integration (path length) and balance of global integration and localized segregation (small-worldness)) and their local nodal measures (participation (degree) and interaction (betweenness) within a network). Relative to Controls, ADHD participants exhibited altered global organization reflected in more clustering or network segregation. Locally, nodal degree and betweenness were increased in the subcortical amygdalae in ADHD, but reduced in cortical nodes in the anterior cingulate, posterior cingulate, mid temporal pole and rolandic operculum. In ADHD, anatomical networks were disrupted and reflected an emphasis on subcortical local connections centered around the amygdala, at the expense of cortical organization. Brains of children and adolescents with ADHD may be anatomically configured to respond impulsively to the automatic significance of stimulus input without having the neural organization to regulate and inhibit these responses. These findings provide a novel addition to our current understanding of the ADHD connectome.
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Affiliation(s)
- K R Griffiths
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead Sydney, NSW, Australia
| | - S M Grieve
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead Sydney, NSW, Australia,Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - M R Kohn
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead Sydney, NSW, Australia,Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, NSW, Australia,Centre for Research into Adolescents' Health (CRASH), Sydney, NSW, Australia
| | - S Clarke
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead Sydney, NSW, Australia,Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, NSW, Australia,Centre for Research into Adolescents' Health (CRASH), Sydney, NSW, Australia
| | - L M Williams
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Department of Sierra-Pacific MIRECC, VA Palo Alto Health Care System, Palo Alto, CA, USA,Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA. E-mail:
| | - M S Korgaonkar
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead Sydney, NSW, Australia,Discipline of Psychiatry, Sydney Medical School, Westmead, Sydney, NSW, Australia
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Keech A, Vollmer-Conna U, Barry BK, Lloyd AR. Gene Expression in Response to Exercise in Patients with Chronic Fatigue Syndrome: A Pilot Study. Front Physiol 2016; 7:421. [PMID: 27713703 PMCID: PMC5031769 DOI: 10.3389/fphys.2016.00421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/06/2016] [Indexed: 12/17/2022] Open
Abstract
Chronic fatigue syndrome (CFS) is a debilitating disorder of unknown pathogenesis, characterized by fatigue, which is exacerbated after minimal exercise. We examined the effect of a single bout of aerobic exercise on leucocyte mRNA expression of genes putatively linked to exaggerated afferent signaling as an under-pinning of the fatigue state. A carefully-characterized sample of patients with CFS (N = 10) and healthy matched control participants (N = 12) were included. Participant ratings of fatigue and other symptoms, as well as blood samples, were obtained at baseline, and five other time-points up to 72 h after 25 min of moderate-intensity cycling exercise. Leucocyte mRNA of 19 metabolite-sensing, adrenergic, immune, and neurotransmission genes was examined using quantitative polymerase chain reaction. Patients with CFS reported substantial fatigue, functional impairment, and poor sleep at baseline (all p < 0.02), and exercise immediately induced worsened patients' fatigue (effect size, ES = 1.17). There were no significant changes in gene expression after exercise and patients did not differ from control participants at any time point. Higher levels of expression of ficolin (FCN1) and a purinergic receptor (P2RX4) in patients with CFS were found when all time points were combined. Patients with CFS did not show significant exercise-induced changes in leucocyte mRNA of 19 metabolite-sensing, adrenergic, immune and neurotransmission genes despite a prominent exacerbation of fatigue.
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Affiliation(s)
- Andrew Keech
- School of Medical Sciences, University of New South Wales Sydney, NSW, Australia
| | - Ute Vollmer-Conna
- School of Psychiatry, University of New South Wales Sydney, NSW, Australia
| | - Benjamin K Barry
- School of Medical Sciences, University of New South WalesSydney, NSW, Australia; Neuroscience Research AustraliaSydney, NSW, Australia
| | - Andrew R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales Sydney, NSW, Australia
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Murdock KW, Wang XS, Shi Q, Cleeland CS, Fagundes CP, Vernon SD. The utility of patient-reported outcome measures among patients with myalgic encephalomyelitis/chronic fatigue syndrome. Qual Life Res 2016; 26:913-921. [PMID: 27600520 DOI: 10.1007/s11136-016-1406-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 02/01/2023]
Abstract
PURPOSE Debilitating fatigue is a core symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); however, the utility of patient-reported symptom outcome measures of fatigue for ME/CFS patients is problematic due to ceiling effects and issues with reliability and validity. We sought to evaluate the performance of three patient-reported symptom measures in a sample of ME/CFS patients and matched controls. METHODS Two hundred and forty ME/CFS patients and 88 age, sex, race, and zip code matched controls participated in the study. Participants completed the Multidimensional Fatigue Inventory-20, DePaul Symptom Questionnaire, and RAND SF-36. RESULTS The general and physical fatigue subscales on Multidimensional Fatigue Inventory-20, as well as the role of physical health on the RAND SF-36, demonstrated questionable or unacceptable internal consistency and problematic ceiling effects. The DePaul Symptom Questionnaire demonstrated excellent internal reliability, and less than 5 % of participants were at the ceiling on each subscale. The post-exertional malaise subscale on the DePaul Symptom Questionnaire demonstrated excellent clinical utility as it was able to differentiate between ME/CFS patients and controls (OR 1.23, p < .001) and predicted ceiling effects on other patient-reported outcome subscales. A score of 20 on the post-exertional malaise subscale of the DePaul Symptom Questionnaire optimally differentiated between patients and controls. CONCLUSIONS Significant ceiling effects and concerns with reliability and validity were observed among Multidimensional Fatigue Inventory-20 and RAND SF-36 subscales for ME/CFS patients. The DePaul Symptom Questionnaire addresses a number of concerns typically identified when using patient-reported outcome measures with ME/CFS patients; however, an improved multidimensional patient-reported outcome tool for measuring ME/CFS-related symptoms is warranted.
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Affiliation(s)
- Kyle W Murdock
- Department of Psychology, Rice University, Houston, TX, USA
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1450, Houston, TX, 77030, USA.
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1450, Houston, TX, 77030, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1450, Houston, TX, 77030, USA
| | - Christopher P Fagundes
- Department of Psychology, Rice University, Houston, TX, USA.,Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1450, Houston, TX, 77030, USA
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Meier MH, Gillespie NA, Hansell NK, Hewitt AW, Hickie IB, Lu Y, McGrath J, MacGregor S, Medland SE, Sun C, Wong TY, Wright MJ, Zhu G, Martin NG, Mackey DA. Retinal microvessels reflect familial vulnerability to psychotic symptoms: A comparison of twins discordant for psychotic symptoms and controls. Schizophr Res 2015; 164:47-52. [PMID: 25694186 PMCID: PMC4409503 DOI: 10.1016/j.schres.2015.01.045] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 11/29/2022]
Abstract
Mounting evidence suggests that individuals with schizophrenia have an underlying vulnerability to cardiovascular disease, and a recent study suggested that this vulnerability might be reflected in the retinal microvasculature. The purpose of this study was to test the hypothesis that the retinal microvessels reflect familial vulnerability to psychotic symptoms. Participants were 531 adolescent and young adult twins who took part in the Brisbane Longitudinal Twin Study and the Twins Eye Study in Tasmania. The twins had photographs taken of their retina when they were adolescents or young adults (M age=20.6 years), and retinal vessel diameter was assessed using computer software. The twins completed an assessment of psychosis symptoms approximately six years later. We compared retinal venular diameters of individuals with one or more symptoms of psychosis (n=45), their unaffected co-twins (n=24), and controls (n=462). Individuals with one or more symptoms of psychosis had wider venules (standardized mean=0.29) than controls (standardized mean=-0.04; p=.03), and unaffected co-twins had venular diameters that were intermediate (standardized mean=0.13) between the two groups, suggesting that wide venules may represent a proxy marker of familial vulnerability to psychosis symptoms. Consistent with previous work, there were no differences in arteriolar diameter between individuals with and without symptoms of psychosis. Findings suggest that wide retinal venules may serve as a proxy marker of familial liability to psychosis symptoms. The pathophysiological mechanisms linking psychosis and cardiovascular disease may be operative from early in life, possibly at the level of the microvasculature.
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Affiliation(s)
| | - Nathan A. Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond,VA, USA,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Alex W. Hewitt
- Centre for Eye Research Australia (CERA), University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia,Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Ian B. Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Yi Lu
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - John McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia,Queensland Brain Institute, University of Queensland, St Lucia, Australia
| | | | | | - Cong Sun
- Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Tien Y. Wong
- Singapore Eye Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| | | | - Gu Zhu
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - David A. Mackey
- Centre for Eye Research Australia (CERA), University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia,Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
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Abstract
OBJECTIVE Previous longitudinal studies suggest that depression and anxiety are associated with risk for cardiovascular disease. The aim of the present study was to test whether an association between depression and anxiety symptoms and retinal vessel caliber, an indicator of subclinical cardiovascular risk, is apparent as early as adolescence and young adulthood. METHODS Participants were 865 adolescents and young adults who participated in the Brisbane Longitudinal Twin Study and the Twin Eye Study in Tasmania. Participants completed an assessment of depression/anxiety symptoms (the Somatic and Psychological Health Report) when they were 16.5 years old (mean age), and they underwent retinal imaging, on average, 2.5 years later (range, 2 years before to 7 years after the depression/anxiety assessment). Retinal vessel caliber was assessed using computer software. RESULTS Depression and anxiety symptoms were associated with wider retinal arteriolar caliber in this sample of adolescents and young adults (β = 0.09, p = .016), even after adjusting for other cardiovascular risk factors (β = 0.08, p = .025). Multiple regression analyses revealed that affective symptoms of depression/anxiety were associated with retinal vessel caliber independently of somatic symptoms. CONCLUSIONS Depression and anxiety symptoms are associated with measurable signs in the retinal microvasculature in early life, suggesting that pathological microvascular mechanisms linking depression/anxiety and cardiovascular disease may be operative from a young age.
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The Brisbane Longitudinal Twin Study: Pathways to Cannabis Use, Abuse, and Dependence project-current status, preliminary results, and future directions. Twin Res Hum Genet 2012. [PMID: 23187020 DOI: 10.1017/thg.2012.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We describe the data being collected from the Brisbane Longitudinal Twin Study in Australia as part of the US National Institute on Drug Abuse (NIDA)-funded project, Pathways to Cannabis Use, Abuse and Dependence. The history, recruitment, assessment, and retention of twin families in this project are described in detail, along with preliminary findings and plans for future research. The goal of this NIDA project is to make a significant contribution to the discovery of quantitative trait loci influencing cannabis use disorders. Although the focus is cannabis use, abuse, and dependence in young adults, measures of comorbid illicit drug use disorders are also being collected. In addition, a variety of internalizing and externalizing disorders are being assessed, funded by support from the Australian National Health and Medical Research Council. Because these same twins have participated in numerous twin studies since 1992, future plans will include linking different phenotypes to investigate relationships between drug use, psychiatric disorders, and psychological phenotypes within cross-sectional and longitudinal or developmental frameworks.
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Beaumont A, Burton AR, Lemon J, Bennett BK, Lloyd A, Vollmer-Conna U. Reduced cardiac vagal modulation impacts on cognitive performance in chronic fatigue syndrome. PLoS One 2012; 7:e49518. [PMID: 23166694 PMCID: PMC3498107 DOI: 10.1371/journal.pone.0049518] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 10/09/2012] [Indexed: 01/16/2023] Open
Abstract
Background Cognitive difficulties and autonomic dysfunction have been reported separately in patients with chronic fatigue syndrome (CFS). A role for heart rate variability (HRV) in cognitive flexibility has been demonstrated in healthy individuals, but this relationship has not as yet been examined in CFS. The objective of this study was to examine the relationship between HRV and cognitive performance in patients with CFS. Methods Participants were 30 patients with CFS and 40 healthy controls; the groups were matched for age, sex, education, body mass index, and hours of moderate exercise/week. Questionnaires were used to obtain relevant medical and demographic information, and assess current symptoms and functional impairment. Electrocardiograms, perceived fatigue/effort and performance data were recorded during cognitive tasks. Between–group differences in autonomic reactivity and associations with cognitive performance were analysed. Results Patients with CFS showed no deficits in performance accuracy, but were significantly slower than healthy controls. CFS was further characterized by low and unresponsive HRV; greater heart rate (HR) reactivity and prolonged HR-recovery after cognitive challenge. Fatigue levels, perceived effort and distress did not affect cognitive performance. HRV was consistently associated with performance indices and significantly predicted variance in cognitive outcomes. Conclusions These findings reveal for the first time an association between reduced cardiac vagal tone and cognitive impairment in CFS and confirm previous reports of diminished vagal activity.
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Affiliation(s)
- Alison Beaumont
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Alexander R. Burton
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Jim Lemon
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara K. Bennett
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Andrew Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Uté Vollmer-Conna
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
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Comorbid externalising behaviour in AD/HD: evidence for a distinct pathological entity in adolescence. PLoS One 2012; 7:e41407. [PMID: 22984398 PMCID: PMC3440414 DOI: 10.1371/journal.pone.0041407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 06/22/2012] [Indexed: 11/20/2022] Open
Abstract
While the profiling of subtypes of Attention Deficit Hyperactivity Disorder (AD/HD) have been the subject of considerable scrutiny, both psychometrically and psychophysiologically, little attention has been paid to the effect of diagnoses comorbid with AD/HD on such profiles. This is despite the greater than 80% prevalence of comorbidity under the DSM-IV-TR diagnostic definitions. Here we investigate the event related potential (ERP) and psychometric profiles of Controls, AD/HD, and comorbid AD/HD (particularly AD/HD+ODD/CD) groups on six neurocognitive tasks thought to probe the constructs of selective and sustained attention, response inhibition and executive function. Data from 29 parameters extracted from a child group (age range 6 to 12; 52 Controls and 64 AD/HD) and from an adolescent group (age range 13 to 17; 79 Controls and 88 AD/HD) were reduced via a Principal Components Analysis, the 6 significant eigenvectors then used as determinants of cluster membership via a Two-Step Cluster Analysis. Two clusters were found in the analysis of the adolescent age group - a cluster dominated by Control and AD/HD participants without comorbidity, while the second cluster was dominated by AD/HD participants with externalising comorbidity (largely oppositional defiant/conduct disorder ODD/CD). A similar segregation within the child age group was not found. Further analysis of these objectively determined clusters in terms of their clinical diagnoses indicates a significant effect of ODD/CD comorbidity on a concurrent AD/HD diagnosis. We conclude that comorbid externalising behaviour in AD/HD constitutes a distinct pathological entity in adolescence.
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Williams LM, Cooper NJ, Wisniewski SR, Gatt JM, Koslow SH, Kulkarni J, Devarney S, Gordon E, John Rush A. Sensitivity, specificity, and predictive power of the "Brief Risk-resilience Index for SCreening," a brief pan-diagnostic web screen for emotional health. Brain Behav 2012; 2:576-89. [PMID: 23139903 PMCID: PMC3489810 DOI: 10.1002/brb3.76] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 05/02/2012] [Accepted: 05/16/2012] [Indexed: 11/11/2022] Open
Abstract
Few standardized tools are available for time-efficient screening of emotional health status across diagnostic categories, especially in primary care. We evaluated the 45-question Brief Risk-resilience Index for SCreening (BRISC) and the 15-question mini-BRISC in identifying poor emotional health and coping capacity across a range of diagnostic groups - compared with a detailed clinical assessment - in a large sample of adult outpatients. Participants 18-60 years of age (n = 1079) recruited from 12 medical research and clinical sites completed the computerized assessments. Three index scores were derived from the full BRISC and the mini-BRISC: one for risk (negativity-positivity bias) and two for coping (resilience and social capacity). Summed answers were converted to standardized z-scores. BRISC scores were compared with detailed health assessment and diagnostic interview (for current psychiatric, psychological, and neurological conditions) by clinicians at each site according to diagnostic criteria. Clinicians were blinded to BRISC scores. Clinical assessment stratified participants as having "clinical" (n = 435) or "healthy" (n = 644) diagnostic status. Receiver operating characteristic analyses showed that a z-score threshold of -1.57 on the full BRISC index of emotional health provided an optimal classification of "clinical" versus "healthy" status (sensitivity: 81.2%, specificity: 92.7%, positive predictive power: 80.2%, and negative predictive power: 93.1%). Comparable findings were revealed for the mini-BRISC. Negativity-positivity bias index scores contributed the most to prediction. The negativity-positivity index of emotional health was most sensitive to classifying major depressive disorder (100%), posttraumatic stress disorder (95.8%), and panic disorder (88.7%). The BRISC and mini-BRISC both offer a brief, clinically useful screen to identify individuals at risk of disorders characterized by poor emotion regulation, from those with good emotional health and coping.
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Affiliation(s)
- Leanne M Williams
- BRAINnet Foundation 71 Stephenson Street, Suite 400, San Francisco, California, 94105 ; University of Sydney Medical School and Westmead Millennium Institute Sydney, New South Wales, 2145, Australia
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Predictors of mental health service utilisation in a non-treatment seeking epidemiological sample of Australian adults. Community Ment Health J 2012; 48:511-21. [PMID: 21994023 DOI: 10.1007/s10597-011-9439-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 09/24/2011] [Indexed: 11/27/2022]
Abstract
This study sought to replicate Parslow and Jorm's (Aust N Z J Psychiatry 34(6): 997-1008, 2000) research on need, enabling and predisposing factors as predictors of mental health service use, with the addition of childhood trauma as a predisposing factor. It utilised a non-treatment seeking epidemiological sample of Australian adults (N = 822) to examine 25 variables covering psychiatric disorder, socio-demographics, physical health problems, and childhood trauma as predictors of mental health visits to general practitioners (GP's), mental health specialists and non-mental health specialists. A consistent multivariate predictor of mental health visits to all types of professionals was psychological distress. Presence of an affective disorder, age, and number of health problems were additional predictors of visiting a GP. Being female, divorced, and exposure to childhood trauma predicted use of a mental health specialist, while rural living was associated with lower use of these services. Results highlight the importance of general psychological distress and need factors in seeking help for mental health, and reinforce the lifelong disadvantage arising from adverse childhood experiences and the need to address these issues in adult mental health services.
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Piraino B, Vollmer-Conna U, Lloyd A. Genetic associations of fatigue and other symptom domains of the acute sickness response to infection. Brain Behav Immun 2012; 26:552-8. [PMID: 22227623 PMCID: PMC7127134 DOI: 10.1016/j.bbi.2011.12.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 12/02/2011] [Accepted: 12/19/2011] [Indexed: 01/24/2023] Open
Abstract
The acute sickness response to infection is a conserved set of changes in physiology and behaviour, featuring fever, fatigue, musculo-skeletal pain, disturbed mood, and cognitive difficulties. The manifestations differ somewhat between individuals, including those infected with pathogens which do not have genetic variability--suggesting host determinants. Principal components analysis (PCA) was applied to acute phase, self-report symptom data from subjects in the Dubbo Infection Outcomes Study (n=296) to empirically derive indices of fatigue, pain, neurocognitive difficulties, and mood disturbance, as well as overall illness severity. Associations were sought with functional single nucleotide polymorphisms (SNPs) in the cytokine genes, interleukin (IL)-6, tumour necrosis factor (TNF)-α, interferon (IFN)-γ, and IL-10. The summed individual symptom indices correlated with overall severity and also with functional status. The relative contribution of individual symptom domains to the overall illness was stable over time within subjects, but varied between subjects with the same infection. The T allele of the IFN-γ +874 T/A SNP was associated with increased fatigue (p=0.0003; OR: 3.3). The C allele of the IL-10 -592 C/A SNP exerted a protective effect on neurocognitive difficulties (p=0.017; OR: 0.52); while the A allele for the IL-10 -592 SNP was associated with increased mood disturbance (p=0.044; OR: 1.83), as was the G allele of the IL-6 -174 G/C SNP (p=0.051; OR: 1.83). The acute sickness response has discrete symptom domains including fatigue, which have unique genetic associations. These data provide novel insights into the pathophysiology of fatigue states.
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Affiliation(s)
- B. Piraino
- Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales, Australia
| | | | - A.R. Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales, Australia,Corresponding author. Address: Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales, Sydney 2052, Australia. Tel.: +61 02 9385 2534; fax: +61 02 9385 1514.
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Kemp AH, Quintana DS, Felmingham KL, Matthews S, Jelinek HF. Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: implications for cardiovascular risk. PLoS One 2012; 7:e30777. [PMID: 22355326 PMCID: PMC3280258 DOI: 10.1371/journal.pone.0030777] [Citation(s) in RCA: 274] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/26/2011] [Indexed: 12/02/2022] Open
Abstract
CONTEXT There is evidence that heart rate variability (HRV) is reduced in major depressive disorder (MDD), although there is debate about whether this effect is caused by medication or the disorder per se. MDD is associated with a two to fourfold increase in the risk of cardiac mortality, and HRV is a robust predictor of cardiac mortality; determining a direct link between HRV and not only MDD, but common comorbid anxiety disorders, will point to psychiatric indicators for cardiovascular risk reduction. OBJECTIVE To determine in physically healthy, unmedicated patients whether (1) HRV is reduced in MDD relative to controls, and (2) HRV reductions are driven by MDD alone, comorbid generalized anxiety disorder (GAD, characterized by anxious anticipation), or comorbid panic and posttraumatic stress disorders (PD/PTSD, characterized by anxious arousal). DESIGN, SETTING, AND PATIENTS A case-control study in 2006 and 2007 on 73 MDD patients, including 24 without anxiety comorbidity, 24 with GAD, and 14 with PD/PTSD. Seventy-three MDD and 94 healthy age- and sex-matched control participants were recruited from the general community. Participants had no history of drug addiction, alcoholism, brain injury, loss of consciousness, stroke, neurological disorder, or serious medical conditions. There were no significant differences between the four groups in age, gender, BMI, or alcohol use. MAIN OUTCOME MEASURES HRV was calculated from electrocardiography under a standardized short-term resting state condition. RESULTS HRV was reduced in MDD relative to controls, an effect associated with a medium effect size. MDD participants with comorbid generalized anxiety disorder displayed the greatest reductions in HRV relative to controls, an effect associated with a large effect size. CONCLUSIONS Unmedicated, physically healthy MDD patients with and without comorbid anxiety had reduced HRV. Those with comorbid GAD showed the greatest reductions. Implications for cardiovascular risk reduction strategies in otherwise healthy patients with psychiatric illness are discussed.
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Affiliation(s)
- Andrew H Kemp
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
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Webber K, Mok K, Bennett B, Lloyd AR, Friedlander M, Juraskova I, Goldstein D. If I am in the mood, I enjoy it: an exploration of cancer-related fatigue and sexual functioning in women with breast cancer. Oncologist 2011; 16:1333-44. [PMID: 21835897 DOI: 10.1634/theoncologist.2011-0100] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND We recently reported that cancer-related fatigue (CRF) after adjuvant breast cancer therapy was prevalent and disabling, but largely self-limiting within 12 months. The current paper describes sexual functioning (SF) and its relationship to CRF, mood disorder, and quality of life (QOL) over the first year after completion of adjuvant therapy. METHODS Women were recruited after surgery, but prior to commencing adjuvant treatment, for early-stage breast cancer. Self-reported validated questionnaires assessed SF, CRF, mood, menopausal symptoms, disability, and QOL at baseline, completion of therapy, and at 6 months and 12 months after treatment. RESULTS Of the 218 participants, 92 (42%) completed the SF measure (mean age, 50 years). They were significantly younger, more likely to be partnered, and less likely to be postmenopausal than nonresponders. At baseline, 40% reported problems with sexual interest and 60% reported problems with physical sexual function. SF scores declined across all domains at the end of treatment, then improved but remained below baseline at 12 months, with a significant temporal effect in the physical SF subscale and a trend for overall satisfaction. There were significant correlations between the SF and QOL domains (physical and emotional health, social functioning, and general health) as well as overall QOL. The presence of mood disorder, but not fatigue, demographic, or treatment variables, independently predicted worse overall sexual satisfaction. CONCLUSIONS Sexual dysfunction is common after breast cancer therapy and impacts QOL. Interventions should include identification and treatment of concomitant mood disorder.
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Affiliation(s)
- Kate Webber
- Department of Medical Oncology, Prince of Wales Hospital, High Street, Randwick, New South Wales 2031, Australia.
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Rahman K, Burton A, Galbraith S, Lloyd A, Vollmer-Conna U. Sleep-wake behavior in chronic fatigue syndrome. Sleep 2011; 34:671-8. [PMID: 21532961 DOI: 10.1093/sleep/34.5.671] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Disturbances of the internal biological clock manifest as fatigue, poor concentration, and sleep disturbances-symptoms reminiscent of chronic fatigue syndrome (CFS) and suggestive of a role for circadian rhythm disturbance in CFS. We examined circadian patterns of activity, sleep, and cortisol secretion in patients with CFS. DESIGN Case-control study, 5-day behavioral observation. SETTING Natural setting/home environment PARTICIPANTS 15 patients with CFS and 15 healthy subjects of similar age, sex, body mass index (BMI), and activity levels. INTERVENTIONS N/A. MEASUREMENTS Self-report questionnaires were used to obtain medical history and demographic information and to assess health behaviors, somatic and psychological symptoms, and sleep quality. An actiwatch accelerometer recorded activity and sleep patterns over 5 days with concurrent activity and symptom logs. Diurnal salivary cortisol secretion was measured. Additionally, overnight heart rate monitoring and pain sensitivity assessment was undertaken. RESULTS Ratings of symptoms, disability, sleep disturbance, and pain sensitivity were greater in patients with CFS. No between-group differences were found in the pattern or amount of sleep, activity, or cortisol secretion. Afternoon activity levels significantly increased evening fatigue in patients but not control subjects. Low nocturnal heart rate variability was identified as a biological correlate of unrefreshing sleep. CONCLUSIONS We found no evidence of circadian rhythm disturbance in CFS. However, the role of autonomic activity in the experience of unrefreshing sleep warrants further assessment. The activity symptom-relationship modelled here is of clinical significance in the approach to activity and symptom management in the treatment of CFS.
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Burton AR, Rahman K, Kadota Y, Lloyd A, Vollmer-Conna U. Reduced heart rate variability predicts poor sleep quality in a case-control study of chronic fatigue syndrome. Exp Brain Res 2010; 204:71-8. [PMID: 20502886 DOI: 10.1007/s00221-010-2296-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
Abstract
Parasympathetic function is important in the induction and maintenance of sleep. We examined whether nocturnal vagal modulation of heart rate is related to the poor sleep quality commonly reported in chronic fatigue syndrome (CFS). Heart rate (HR, as R-R intervals) was continuously monitored during sleep in 20 patients with CFS and 20 matched control subjects. Questionnaires assessed demographic information, symptoms, functional impairment, and subjective sleep quality. CFS was associated with more sleep problems in general and poorer subjective sleep quality on the study night (all p < 0.003), and reports of repeated awakening during the night were 7 times more likely compared to healthy subjects (p = 0.017). Time and frequency-domain parameters of HR variability during sleep were significantly lower in patients with CFS (all p < 0.006). Multiple regression analyses revealed that heart rate variability (HRV) parameters were the best predictors of subjective sleep measures. This study identified significant reductions in vagal modulation of heart rate during sleep in CFS. Low HRV strongly predicted sleep quality-suggesting a pervasive state of nocturnal sympathetic hypervigilance in CFS.
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Affiliation(s)
- A R Burton
- School of Psychiatry, University of NSW, Sydney, Australia
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Minton O, Stone P. How common is fatigue in disease-free breast cancer survivors? A systematic review of the literature. Breast Cancer Res Treat 2007; 112:5-13. [PMID: 18064565 DOI: 10.1007/s10549-007-9831-1] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 11/16/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is some debate in the literature as to whether fatigue persists in the long term in women who have completed adjuvant breast cancer treatment. METHODS A systematic review was conducted in order to characterise and quantify the phenomenon of post treatment fatigue (PTF). RESULTS There was a wide variation in the measures of fatigue used, duration of follow-up and type of comparison made. Overall 18 studies were identified with a follow-up period of between 4 months and 10 years. Fourteen studies demonstrated the presence of continued PTF and/or differences in fatigue levels compared to a reference population up to 5 years after treatment. One short-term study reported no increase in fatigue at 4 months. Three studies (with an average follow up period of longer than 5 years) did not identify overall quality of life differences in breast cancer survivors when compared with a reference population. However there were significant differences in measures of physical functioning and mental fatigue. CONCLUSION The authors conclude that there is good evidence of PTF occurring up to 5 years after completion of adjuvant therapy.
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Affiliation(s)
- O Minton
- Macmillan reader in palliative medicine, Division of mental health, St. Georges University of London, 6th floor Hunter Wing, Cranmer Terrace, London, SW17 ORE, UK.
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Hickie AM IB, Davenport TA, Luscombe GM, Rong Y, Hickie ML, Bell MI. The assessment of depression awareness and help-seeking behaviour: experiences with the International Depression Literacy Survey. BMC Psychiatry 2007; 7:48. [PMID: 17850674 PMCID: PMC2080627 DOI: 10.1186/1471-244x-7-48] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 09/13/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression causes substantial disease burden in both developed and developing countries. To reduce this burden, we need to promote understanding of depression as a major health condition. The International Depression Literacy Survey (IDLS) has been developed to assess understanding of depression in different cultural and health care settings. METHODS Four groups of Australian university students completed the survey: medical students in second (n = 103) and fourth (n = 82) years of a graduate course, ethnic Chinese students (n = 184) and general undergraduate students (n = 38). RESULTS Differences between the student groups were evident, with fourth year medical students demonstrating greater general health and depression literacy than second year medical students. Australian undergraduate students demonstrated better depression literacy than those from ethnic Chinese backgrounds. Ethnicity also influenced help seeking and treatment preferences (with more Chinese students being inclined to seek help from pharmacists), beliefs about discrimination and perceptions regarding stigma. CONCLUSION The IDLS does detect significant differences in understanding of depression among groups from different ethnic backgrounds and between those who differ in terms of prior health training. These preliminary results suggest that it may be well suited for use in a wider international context. Further investigation of the utility of the IDLS is required before these results could be extrapolated to other populations.
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Affiliation(s)
- Ian B Hickie AM
- Brain & Mind Research Institute, The University of Sydney, Sydney, Australia
| | - Tracey A Davenport
- Brain & Mind Research Institute, The University of Sydney, Sydney, Australia
| | - Georgina M Luscombe
- Brain & Mind Research Institute, The University of Sydney, Sydney, Australia
| | - Ye Rong
- Discipline of Psychological Medicine, The University of Sydney, Sydney, Australia
| | - Megan L Hickie
- Brain & Mind Research Institute, The University of Sydney, Sydney, Australia
| | - Morag I Bell
- Brain & Mind Research Institute, The University of Sydney, Sydney, Australia
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Goldstein D, Bennett B, Friedlander M, Davenport T, Hickie I, Lloyd A. Fatigue states after cancer treatment occur both in association with, and independent of, mood disorder: a longitudinal study. BMC Cancer 2006; 6:240. [PMID: 17026776 PMCID: PMC1613250 DOI: 10.1186/1471-2407-6-240] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 10/09/2006] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Persistent fatigue is recognised as one of the most common, ongoing symptoms reported by patients following cancer treatment and may have profound effects on the quality of life. However, recent cross-sectional studies also highlight the close relationship between cancer related fatigue (CRF) and diagnoses of depression or anxiety disorder. There is currently limited information about the relationships between these conditions over time. We sought to examine the longitudinal relationships between fatigue and mood disorder in women treated with adjuvant therapy for early stage breast cancer. METHODS Women who had recently completed adjuvant therapy for Stage I or II breast cancer (n = 212) were sent a questionnaire with established case thresholds for clinically-significant fatigue and psychological disorder, as well as a questionnaire assessing disability. Potentially relevant variables linked to fatigue states, including age, treatment modality, menopausal status, and hematological indices were recorded. The illness outcomes were assessed over 48 months of follow-up. RESULTS The 176 women who responded to the questionnaire (84%) had a mean age of 55 (range 24-83) years and had completed adjuvant treatment on average 10 (range 4.7-16.3) months previously. Radiotherapy had been administered, either alone (50% of women) or in combination with chemotherapy (36%). Responses from 87 women (48%) indicated a significant fatigue state (termed here post-cancer fatigue; PCF), and from 59 women (33%) responses indicated significant psychological distress. Thirty-four women (19%) were cases of fatigue alone (i.e. unaccompanied by psychological disorder), whereas 52 (30%) were cases of both disorders. Multivariate analysis did not reveal any association between demographic, clinical or laboratory variables, and caseness for PCF. Self-reported functional disability was significantly associated with fatigue. Follow-up at 24, 36 and 48 months revealed high rates of ongoing PCF in conjunction with psychological distress, despite falling rates of psychological distress alone and fatigue alone. CONCLUSION Post-cancer fatigue was prevalent and sustained on follow-up. Concurrent psychological disorder was evident in the majority, but not all, cases of PCF and tended to be sustained over time. Further prospective cohort studies to define the longitudinal co-morbid relationships between fatigue, mood disorder, and ongoing disability after cancer treatment are indicated.
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Affiliation(s)
- David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Barbara Bennett
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | | | - Tracey Davenport
- The Brain and Mind Research Institute, University of Sydney, Australia
| | - Ian Hickie
- The Brain and Mind Research Institute, University of Sydney, Australia
| | - Andrew Lloyd
- School of Medical Sciences, University of New South Wales, Sydney, Australia
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Hickie I, Davenport T, Wakefield D, Vollmer-Conna U, Cameron B, Vernon SD, Reeves WC, Lloyd A. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ 2006; 333:575. [PMID: 16950834 PMCID: PMC1569956 DOI: 10.1136/bmj.38933.585764.ae] [Citation(s) in RCA: 492] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2006] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To delineate the risk factors, symptom patterns, and longitudinal course of prolonged illnesses after a variety of acute infections. DESIGN Prospective cohort study following patients from the time of acute infection with Epstein-Barr virus (glandular fever), Coxiella burnetii (Q fever), or Ross River virus (epidemic polyarthritis). SETTING The region surrounding the township of Dubbo in rural Australia, encompassing a 200 km geographical radius and 104,400 residents. PARTICIPANTS 253 patients enrolled and followed at regular intervals over 12 months by self report, structured interview, and clinical assessment. OUTCOME MEASURES Detailed medical, psychiatric, and laboratory evaluations at six months to apply diagnostic criteria for chronic fatigue syndrome. Premorbid and intercurrent illness characteristics recorded to define risk factors for chronic fatigue syndrome. Self reported illness phenotypes compared between infective groups. RESULTS Prolonged illness characterised by disabling fatigue, musculoskeletal pain, neurocognitive difficulties, and mood disturbance was evident in 29 (12%) of 253 participants at six months, of whom 28 (11%) met the diagnostic criteria for chronic fatigue syndrome. This post-infective fatigue syndrome phenotype was stereotyped and occurred at a similar incidence after each infection. The syndrome was predicted largely by the severity of the acute illness rather than by demographic, psychological, or microbiological factors. CONCLUSIONS A relatively uniform post-infective fatigue syndrome persists in a significant minority of patients for six months or more after clinical infection with several different viral and non-viral micro-organisms. Post-infective fatigue syndrome is a valid illness model for investigating one pathophysiological pathway to chronic fatigue syndrome.
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Affiliation(s)
- Ian Hickie
- Brain and Mind Research Institute, Sydney University, Sydney, NSW 2050, Australia
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