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Smith SA, Han Le G, Teopiz KM, Kwan ATH, Rhee TG, Ho RC, Wu J, Cao B, Ceban F, McIntyre RS. Effects of Cannabidiol and Δ 9-Tetrahydrocannabinol on Cytochrome P450 Enzymes: A Systematic Review. Drug Metab Rev 2024:1-20. [PMID: 38655747 DOI: 10.1080/03602532.2024.2346767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
Due to legal, political, and cultural changes, the use of cannabis has rapidly increased in recent years. Research has demonstrated that the cannabinoids cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) inhibit and induce cytochrome P450 (CYP450) enzymes. The objective of this review is to evaluate the effect of CBD and THC on the activity of CYP450 enzymes and the implications for drug-drug interactions (DDIs) with psychotropic agents that are CYP substrates. A systematic search was conducted using PubMed, Scopus, Scientific Electronic Library Online (SciELO) and PsychINFO. Search terms included 'cannabidiol', 'tetrahydrocannabinol and 'cytochrome P450'. A total of seven studies evaluating the interaction of THC and CBD with CYP450 enzymes and psychotropic drugs were included. Both preclinical and clinical studies were included.Results from the included studies indicate that both CBD and THC inhibit several CYP450 enzymes including, but not limited to, CYP1A2, CYP3C19, and CYP2B6. While there are a few known CYP450 enzymes that are induced by THC and CBD, the induction of CYP450 enzymes is an understudied area of research and lacks clinical data. The inhibitory effects observed by CBD and THC on CYP450 enzymes vary in magnitude and may decrease the metabolism of psychotropic agents, changes in plasma levels of psychotropic medications, and increase adverse effects. Our findings clearly present interactions between THC and CBD and several CYP450 enzymes, providing clinicians evidence of a high risk of DDIs for patients who consume both cannabis and psychotropic medication. However, more clinical research is necessary before results are applied to clinical settings.
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Affiliation(s)
- Sarah Ann Smith
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Gia Han Le
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Angela T H Kwan
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Jie Wu
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing 400715, P. R. China
| | - Felicia Ceban
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Ceban F, Kulzhabayeva D, Rodrigues NB, Di Vincenzo JD, Gill H, Subramaniapillai M, Lui LMW, Cao B, Mansur RB, Ho RC, Burke MJ, Rhee TG, Rosenblat JD, McIntyre RS. Corrigendum to "COVID-19 vaccination for the prevention and treatment of long COVID: A systematic review and meta-analysis" [Brain Behav. Immun. 111 (2023) 211-229]. Brain Behav Immun 2024; 115:758. [PMID: 37806865 PMCID: PMC11021210 DOI: 10.1016/j.bbi.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Affiliation(s)
- Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
| | - Dana Kulzhabayeva
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Joshua D Di Vincenzo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
| | - Leanna M W Lui
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, China
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
| | - Matthew J Burke
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Neurology, Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
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Teh WL, Liu J, Chandwani N, Lee YW, Tor PC, Subramaniam M, Ho RC. Emotional urgency predicts bipolar symptoms, severity, and suicide attempt better than non-emotional impulsivity: a cross-sectional study. Front Psychol 2023; 14:1277655. [PMID: 38106393 PMCID: PMC10722176 DOI: 10.3389/fpsyg.2023.1277655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Emotional urgency is an emotion-based subdimension of trait impulsivity that is more clinically relevant to psychopathology and disorders of emotion dysfunction than non-emotional subdimensions (i.e., lack of perseverance, sensation seeking, lack of premeditation). However, few studies have examined the relative effects of emotional urgency in bipolar disorder. This cross-sectional study aimed to establish the clinical relevance of emotional urgency in bipolar disorders by (1) explicating clinically relevant correlates of emotional urgency and (2) comparing its effects against non-emotional impulsivity subdimensions. Methods and results A total of 150 individuals with bipolar disorder were recruited between October 2021 and January 2023. Zero-order correlations found that emotional urgency had the greatest effect on bipolar symptoms (r = 0.37 to 0.44). Multiple two-step hierarchical regression models showed that (1) positive urgency predicted past manic symptomology and dysfunction severity (b = 1.94, p < 0.001 and 0.35 p < 0.05, respectively), (2) negative urgency predicted current depression severity, and (3) non-emotional facets of impulsivity had smaller effects on bipolar symptoms and dysfunction by contrast, and were non-significant factors in the final step of all regression models (b < 0.30, ns); Those who had a history of attempted suicide had significantly greater levels of emotional urgency (Cohen's d = -0.63). Discussion Notwithstanding the study's limitations, our findings expand status quo knowledge beyond the perennial relationship between non-emotion-based impulsivity and bipolar disorder and its implications.
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Affiliation(s)
- Wen Lin Teh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute of Mental Health, Singapore, Singapore
| | - Jianlin Liu
- Institute of Mental Health, Singapore, Singapore
| | | | - Yu Wei Lee
- Institute of Mental Health, Singapore, Singapore
| | | | | | - Roger C. Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
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Meshkat S, Teopiz KM, Di Vincenzo JD, Bailey JB, Rosenblat JD, Ho RC, Rhee TG, Ceban F, Kwan ATH, Cao B, McIntyre RS. Clinical efficacy and safety of Zuranolone (SAGE-217) in individuals with major depressive disorder. J Affect Disord 2023; 340:893-898. [PMID: 37557991 DOI: 10.1016/j.jad.2023.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/16/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
Major depressive disorder (MDD) is a common mental disorder with a high rate of morbidity and mortality. Dysfunctional signaling of gamma-aminobutyric acid (GABA) has been implicated in some studies in the etiology of MDD. Zuranolone (SAGE-217) is a novel, oral neuroactive steroid and an investigational positive allosteric modulator of synaptic and extrasynaptic GABAA receptors. Herein, we aimed to evaluate the efficacy and safety of Zuranolone in individuals with MDD. We reviewed seven studies including 1662 participants with MDD. Zuranolone was investigated as an oral, once-daily, 14-day treatment course. The results of our synthesis indicate that the antidepressant effects of Zuranolone are rapid, clinically meaningful, and replicated across multiple randomized clinical trials. In addition to replicated efficacy, Zuranolone is associated with an acceptable level of treatment-emergent adverse events and discontinuation without serious adverse events. It is believed that Zuranolone's antidepressant effects arise from its ability to enhance inhibitory GABAergic signaling by increasing synaptic and extrasynaptic GABAA activity and regulation of GABAA receptor expression. Taken together, preliminary evidence suggests the potential for antidepressant effects of Zuranolone. Zuranolone has been approved by FDA for postpartum depression, and is showing efficacy in major depressive disorder. Future research vistas should seek to determine the durability of this treatment approach as well as its effects on domain-specific outcomes (e.g., anhedonia, circadian rhythm, arousal systems) along with application in other diagnostic entities (e.g., bipolar depression).
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Affiliation(s)
- Shakila Meshkat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Joshua D Di Vincenzo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Julia B Bailey
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Angela T H Kwan
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Faculty of Medicine, Ottawa University, Ottawa, Ontario, Canada
| | - Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, Chongqing 400715, PR China
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
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Husain SF, Chiang SK, Vasu AA, Goh CP, McIntyre RS, Tang TB, Tran BX, Dang THT, Nguyen TT, Ho RC, Ho CS. Functional Near-Infrared Spectroscopy of English-Speaking Adults With Attention-Deficit/Hyperactivity Disorder During a Verbal Fluency Task. J Atten Disord 2023; 27:1448-1459. [PMID: 37341192 DOI: 10.1177/10870547231180111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Functional near-infrared spectroscopy (fNIRS) provides direct and quantitative assessment of cortical hemodynamic response. It has been used to identify neurophysiological alterations in medication-naïve adults with attention-deficit/hyperactivity disorder (ADHD). Hence, this study aimed to distinguish both medication-naïve and medicated adults with ADHD from healthy controls (HC). METHOD 75 HCs, 75 medication-naïve, and 45 medicated patients took part in this study. fNIRS signals during a verbal fluency task (VFT) were acquired using a 52-channel system and relative oxy-hemoglobin changes in the prefrontal cortex were quantified. RESULTS Prefrontal cortex hemodynamic response was lower in patients than HCs (p ≤ ≤.001). Medication-naïve and medicated patients did not differ in hemodynamic response or symptom severity (p > .05). fNIRS measurements were not associated with any clinical variables (p > .05). 75.8% patients and 76% HCs were correctly classified using hemodynamic response. CONCLUSION fNIRS may be a potential diagnostic tool for adult ADHD. These findings need to be replicated in larger validation studies.
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Affiliation(s)
| | | | | | | | - Roger S McIntyre
- University Health Network, Toronto, ON, Canada
- University of Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Tong Boon Tang
- University Teknologi PETRONAS, Seri Iskandar, Perak Darul Ridzuan, Malaysia
| | - Bach X Tran
- Hanoi Medical University, Dong Da, Vietnam
- Johns Hopkins University, Baltimore, MD, USA
| | - Trang H T Dang
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Tham T Nguyen
- Duy Tan University, Da Nang, Vietnam
- Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Roger C Ho
- National University of Singapore, Singapore
| | - Cyrus S Ho
- National University of Singapore, Singapore
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Olszewska-Guizzo A, Russo A, Roberts AC, Kühn S, Marques B, Tawil N, Ho RC. Editorial: Cities and mental health. Front Psychiatry 2023; 14:1263305. [PMID: 37599878 PMCID: PMC10436606 DOI: 10.3389/fpsyt.2023.1263305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
| | - Alessio Russo
- School of Arts, University of Gloucestershire, Cheltenham, United Kingdom
| | | | - Simone Kühn
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bruno Marques
- Faculty of Architecture and Design Innovation, Victoria University of Wellington, Wellington, New Zealand
| | - Nour Tawil
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Roger C Ho
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
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Ceban F, Kulzhabayeva D, Rodrigues NB, Di Vincenzo JD, Gill H, Subramaniapillai M, Lui LMW, Cao B, Mansur RB, Ho RC, Burke MJ, Rhee TG, Rosenblat JD, McIntyre RS. COVID-19 vaccination for the prevention and treatment of long COVID: A systematic review and meta-analysis. Brain Behav Immun 2023; 111:211-229. [PMID: 36990297 PMCID: PMC10067136 DOI: 10.1016/j.bbi.2023.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
Empirical evidence addressing the association between SARS-CoV-2 vaccination and long COVID would guide public health priorities and inform personal health decisions. Herein, the co-primary objectives are to determine the differential risk of long COVID in vaccinated versus unvaccinated patients, and the trajectory of long COVID following vaccination. Of 2775 articles identified via systematic search, 17 were included, and 6 were meta-analyzed. Meta-analytic results determined that at least one vaccine dose was associated with a protective effect against long COVID (OR 0.539, 95% CI 0.295-0.987, p = 0.045, N = 257 817). Qualitative analysis revealed that trajectories of pre-existing long COVID following vaccination were mixed, with most patients reporting no changes. The evidence herein supports SARS-CoV-2 vaccination for the prevention of long COVID, and recommends long COVID patients adhere to standard SARS-CoV-2 vaccination schedules.
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Affiliation(s)
- Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
| | - Dana Kulzhabayeva
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Joshua D Di Vincenzo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
| | - Leanna M W Lui
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, China
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
| | - Matthew J Burke
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Neurology, Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
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Husain SF, Wang N, McIntyre RS, Tran BX, Nguyen TP, Vu LG, Vu GT, Ho RC, Ho CS. Functional near-infrared spectroscopy of medical students answering various item types. Front Psychol 2023; 14:1178753. [PMID: 37377693 PMCID: PMC10291186 DOI: 10.3389/fpsyg.2023.1178753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Background Traditionally, the effect of assessment item types including true/false questions (TFQs), multiple-choice questions (MCQs), short answer questions (SAQs), and case scenario questions (CSQs) is examined through psychometric qualities or student interviews. However, brain activity while answering such questions or items remains unknown. Functional near-infrared spectroscopy (fNIRS) can be used to safely measure cerebral cortex hemodynamic response during various tasks. Hence, this fNIRS study aimed to determine differences in frontotemporal cortex activity as medical students answered TFQs, MCQs, SAQs, and CSQs. Methods In total, 24 medical students (13 males and 11 females) were recruited in this study during their mid-psychiatry posting. Oxy-hemoglobin and deoxy-hemoglobin levels in the frontal and temporal regions were measured with a 52-channel fNIRS system. Participants answered 9-18 trials under each of the four types of tasks that were based on their psychiatry curriculum during fNIRS measurements. The area under the oxy-hemoglobin curve (AUC) for each participant and each item type was derived. Repeated measures ANOVA with post-hoc Bonferroni-corrected pairwise comparisons were used to determine differences in oxy-hemoglobin AUC between TFQs, MCQs, SAQs, and CSQs. Results Oxy-hemoglobin AUC was highest during the CSQs, followed by SAQs, MCQs, and TFQs in both the frontal and temporal regions. Statistically significant differences between different types of items were observed in oxy-hemoglobin AUC of the frontal region (p ≤ 0.001). Oxy-hemoglobin AUC in the frontal region was significantly higher during the CSQs than TFQ (p = 0.005) and during the SAQ than TFQ (p = 0.025). Although the percentage of correct responses was significantly lower in MCQ than in the other item types, there was no correlation between the percentage of correct response and oxy-hemoglobin AUC in both regions for all four item types (p > 0.05). Conclusion CSQs and SAQs elicited greater hemodynamic response than MCQs and TFQs in the prefrontal cortex of medical students. This suggests that more cognitive skills may be required to answer CSQs and SAQs.
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Affiliation(s)
- Syeda Fabeha Husain
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nixi Wang
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Bach X. Tran
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Thao Phuong Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Linh Gia Vu
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Roger C. Ho
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cyrus S. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Harris KM, Wang L, Mu GM, Lu Y, So C, Zhang W, Ma J, Liu K, Wang W, Zhang MWB, Ho RC. Measuring the suicidal mind: The 'open source' Suicidality Scale, for adolescents and adults. PLoS One 2023; 18:e0282009. [PMID: 36821531 PMCID: PMC9949661 DOI: 10.1371/journal.pone.0282009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
Clinicians are expected to provide accurate and useful mental health assessments, sometimes in emergency settings. The most urgent challenge may be in calculating suicide risk. Unfortunately, existing instruments often fail to meet requirements. To address this situation, we used a sustainable scale development approach to create a publicly available Suicidality Scale (SS). Following a critical review of current measures, community input, and panel discussions, an international item pool survey included 5,115 English-speaking participants aged 13-82 years. Revisions were tested with two follow-up cross-sectional surveys (Ns = 814 and 626). Pool items and SS versions were critically examined through item response theory, hierarchical cluster, factor and bifactor analyses, resulting in a unidimensional eight-item scale. Psychometric properties were high (loadings > .77; discrimination > 2.2; test-retest r = .87; internal consistency, ω = .96). Invariance checks were satisfied for age, gender, ethnicity, rural/urban residence, first language, self-reported psychiatric diagnosis and suicide attempt history. The SS showed stronger psychometric properties, and significant differences in bivariate associations with depressive symptoms, compared with included suicide measures. The 'open source' Suicidality Scale represents a significant step forward in accurate assessment for people aged 13+, and diverse populations. This study provides an example of sustainable scale development utilizing community input, emphasis on strong psychometric evidence from diverse samples, and a free-to-use license allowing instrument revisions. These methods can be used to develop a wide variety of psychosocial instruments that can benefit clinicians, researchers, and the public.
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Affiliation(s)
- Keith M. Harris
- School of Psychology, Charles Sturt University, Bathurst, New South Wales, Australia
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
- * E-mail:
| | - Lu Wang
- School of Environmental and Life Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Guanglun M. Mu
- Education Futures, University of South Australia, Adelaide, South Australia, Australia
| | - Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China
| | | | - Wei Zhang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Jing Ma
- School of Politics and Public Administration, Zhengzhou University, Zhengzhou, Henan, China
| | - Kefei Liu
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Wei Wang
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Melvyn Wei-bin Zhang
- Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore, Singapore
| | - Roger C. Ho
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
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10
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Meshkat S, Ho RC, Cao B, Teopiz KM, Rosenblat JD, Rhee TG, Di Vincenzo JD, Ceban F, Jawad MY, McIntyre RS. Biomarkers of ketamine's antidepressant effect: An umbrella review. J Affect Disord 2023; 323:598-606. [PMID: 36521662 DOI: 10.1016/j.jad.2022.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
Ketamine is a NMDA receptor antagonist that has a rapid acting antidepressant effect with high efficacy in treatment-resistant patients. Ketamine is a beneficial antidepressant for many individuals with depression, but not all of the patients respond, and some even exhibit symptom deterioration. The discovery of repeatable and mechanistically relevant biomarkers would address a major gap in treatment response prediction. Numerous potential peripheral biomarkers have been reported, but their current utility is unclear. We conducted an umbrella review to evaluate the biomarkers of ketamine's antidepressant effect in individuals with depression. PubMed and copus were searched using terms appropriate to each area of research, from their inception until July 2022. Five systematic reviews and meta analyses including 108 studies with 4912 participants were included. Blood-based and neuroimaging biomarkers were investigated. The results of this review indicate that ketamine can produce an anti-inflammatory effect and decrease at least one inflammatory marker following administration. Data from neuroimaging studies demonstrated that the cingulate cortex is the key locus of ketamine's action. The majority of the blood-based, neuroimaging, and neurophysiological investigations reviewed herein indicate ketamine induced normalization of major depressive disorder pathogenesis via synaptic plasticity and functional connectivity. Currently, no biomarker/biosignature is sufficiently validated for clinical utility, but several are promising. Now that ketamine is more widely available, biomarker discovery and replication should be attempted in larger, real-world populations.
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Affiliation(s)
- Shakila Meshkat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, PR China
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Taeho Greg Rhee
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Joshua D Di Vincenzo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Muhammad Youshay Jawad
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
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11
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Gillissie ES, Le GH, Rhee TG, Cao B, Rosenblat JD, Mansur RB, Ho RC, McIntyre RS. Evaluating Anhedonia as a risk factor in suicidality: A meta-analysis. J Psychiatr Res 2023; 158:209-215. [PMID: 36603315 DOI: 10.1016/j.jpsychires.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/11/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Previous studies have evaluated the relationship between anhedonia and suicidality; however, to our knowledge, there has been no quantitative synthesis evaluating the foregoing association to date. Herein, this meta-analysis aims to provide a quantitative synthesis of the extant literature reporting on the association between levels of anhedonia across all dimensions (e.g., anticipatory, consummatory) amongst individuals endorsing suicidality. Online databases (i.e., PubMed, PsycINFO, Google Scholar) were searched from inception to 13 June 2022. Studies which assessed an aspect of suicidality (i.e., ideation, attempts) and a validated anhedonia scale were included. The risk of bias was assessed using the ROBINS-1 tool, and the quality of the sources was evaluated using GRADE criteria. The results of the studies were quantitatively synthesized using Pearson's r effect sizes via a random-effects meta-analysis. A total of 20 studies and 11,212 individuals were included in the final quantitative synthesis. Overall, results indicate that anhedonia has a significant and moderate correlation with suicidality in general and psychiatric populations (r = 0.31, p < 0.001 and r = 0.32, p < 0.001 respectively). Sub-analysis suggests a larger effect of anticipatory and consummatory interpersonal anhedonia (r = 0.40, p < 0.001). The identification of increased levels of anhedonia in individuals with suicidality indicates that anhedonia may be a core risk factor for suicidal ideation and behaviours. Future studies should endeavour to develop a comprehensive risk assessment encompassing all domains of anhedonia which can be utilized in a primary care setting as a potential prevention strategy for suicidal behaviours and outcomes.
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Affiliation(s)
- Emily S Gillissie
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gia Han Le
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Taeho Greg Rhee
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA; VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, PR China
| | - Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore; Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 117599, Singapore
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
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12
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Tan YQ, Wang Z, Yap QV, Chan YH, Ho RC, Hamid ARAH, Landaluce-Olavarria A, Pellino G, Gauhar V, Chand M, Wroclawski ML, Hameed BZ, Ling SKK, Sengupta S, Gallo G, Chiu PKF, Tanidir Y, Tallada MPV, Garcia BN, Colleoni R, Abiddin ZAZ, Campi R, Esperto F, Carrion D, Elterman D, Chung ASJ, Ng ACF, Moschini M, Rivas JG, Mayol J, Teoh JYC, Chiong E. Psychological Health of Surgeons in a Time of COVID-19: A Global Survey. Ann Surg 2023; 277:50-56. [PMID: 33491983 PMCID: PMC9762613 DOI: 10.1097/sla.0000000000004775] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the degree of psychological impact among surgical providers during the COVID-19 pandemic. SUMMARY OF BACKGROUND DATA The COVID-19 pandemic has extensively impacted global healthcare systems. We hypothesized that the degree of psychological impact would be higher for surgical providers deployed for COVID-19 work, certain surgical specialties, and for those who knew of someone diagnosed with, or who died, of COVID-19. METHODS We conducted a global web-based survey to investigate the psychological impact of COVID-19. The primary outcomes were the depression anxiety stress scale-21 and Impact of Event Scale-Revised scores. RESULTS A total of 4283 participants from 101 countries responded. 32.8%, 30.8%, 25.9%, and 24.0% screened positive for depression, anxiety, stress, and PTSD respectively. Respondents who knew someone who died of COVID-19 were more likely to screen positive for depression, anxiety, stress, and PTSD (OR 1.3, 1.6, 1.4, 1.7 respectively, all P < 0.05). Respondents who knew of someone diagnosed with COVID-19 were more likely to screen positive for depression, stress, and PTSD (OR 1.2, 1.2, and 1.3 respectively, all P < 0.05). Surgical specialties that operated in the head and neck region had higher psychological distress among its surgeons. Deployment for COVID- 19-related work was not associated with increased psychological distress. CONCLUSIONS The COVID-19 pandemic may have a mental health legacy outlasting its course. The long-term impact of this ongoing traumatic event underscores the importance of longitudinal mental health care for healthcare personnel, with particular attention to those who know of someone diagnosed with, or who died of COVID-19.
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Affiliation(s)
- Yi Quan Tan
- Department of Urology, National University Hospital, National University, Health System, Singapore
| | - Ziting Wang
- Department of Urology, National University Hospital, National University, Health System, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger C Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | | | | | - Gianluca Pellino
- Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Luigi Vanvitelli University of Campania, Caserta, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Manish Chand
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil; BP-a Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Bm Zeeshan Hameed
- Department of Urology, Kasturba Medical, College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Samuel Ka-Kin Ling
- Department of Orthopedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Shomik Sengupta
- Eastern Health and Monash University Eastern Health Clinical School, Box Hill, VIC, Australia
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Peter Ka-Fung Chiu
- SH Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Yiloren Tanidir
- Department of Urology, Marmara University Research and Training Hospital, Istanbul, Turkey
| | | | | | - Ramiro Colleoni
- Escola Paulista de Medicina - Universidade Federal de Sa˜o Paulo, Sa˜o Paulo, Brazil
| | | | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Roma, Italy
| | - Diego Carrion
- Servicio de Urologi´a, Hospital Universitario La Paz, Madrid, Spain
| | - Dean Elterman
- Division of Urology, University Health Network, Department of Surgery, University of Toronto, Canada
| | - Amanda Shu Jun Chung
- Macquarie University Hospital and Royal North Shore Hospital, Department of Urology, Sydney, New South Wales, Australia
| | - Anthony Chi Fai Ng
- SH Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Marco Moschini
- Department of Urology- Luzerner Kantonsspital- Luzern, CH, Switzerland
| | - Juan Gomez Rivas
- Servicio de Urologi´a, Hospital Universitario La Paz, Madrid, Spain
| | - Julio Mayol
- Instituto de Investigacio´n Sanitaria San Carlos, Hospital Clinico San Carlos, Madrid, Spain
| | - Jeremy Yuen-Chun Teoh
- SH Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Edmund Chiong
- Department of Urology, National University Hospital, National University, Health System, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
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13
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Lu Y, Jin X, Feng LW, Tang CSK, Neo M, Ho RC. Effects of illness perception on negative emotions and fatigue in chronic rheumatic diseases: Rumination as a possible mediator. World J Clin Cases 2022; 10:12515-12531. [PMID: 36579115 PMCID: PMC9791537 DOI: 10.12998/wjcc.v10.i34.12515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/06/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Illness perception has long been hypothesized to be linked to psychological well-b eing in patients with rheumatic diseases, although substantial evidence is lacking, and the contribution of ruminative coping style to this relationship is unclear.
AIM To investigate the roles of illness perception and rumination in predicting fatigue and negative emotions in patients with chronic rheumatic diseases.
METHODS Illness perception, rumination, fatigue and negative emotions (i.e. depression, anxiety and stress) were assessed by the Illness Perception Questionnaire-Revised, Stress Reactive Rumination Scale, Multidimensional Assessment of Fatigue, and the Depression, Anxiety and Stress Scale respectively. Multivariate regression analysis, the Sobel test, and the bootstrap were used to identify the mediating effect of rumination.
RESULTS All five subscales of illness perception, including perceived illness identity, chronicity, cyclical nature, consequences and coherence of illness, were significantly associated with fatigue and negative emotions. In mediational analysis, rumination was found to mediate three components of illness perception (the identity, cyclical nature and consequences of illness) and negative emotions/fatigue.
CONCLUSION Perceived identity, cyclical nature, and consequences of illness are significantly associated with fatigue and negative emotions in patients with chronic rheumatic diseases and these associations are mediated by rumination. Our findings suggest that psychological intervention should target rumination to improve physical and emotional well-being of patients with chronic rheumatic diseases.
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Affiliation(s)
- Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Xia Jin
- The Third Hospital of Jinan, Jinan 250132, Shandong Province, China
| | - Li-Wei Feng
- College of Education for the Future, Beijing Normal University, Zhuhai 519087, Guangdong Province, China
| | - CSK Tang
- Department of Obstetrics and Gynecology, National University of Singapore, The Chinese University of Hong Kong, Singapore 117570, Singapore
| | - Michelle Neo
- Department of Psychological Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Roger C Ho
- Department of Psychological Medicine, National University of Singapore, Singapore 119228, Singapore
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14
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Lau SSS, Ho CCY, Pang RCK, Su S, Kwok H, Fung SF, Ho RC. Measurement of burnout during the prolonged pandemic in the Chinese zero-COVID context: COVID-19 burnout views scale. Front Public Health 2022; 10:1039450. [PMID: 36438233 PMCID: PMC9686433 DOI: 10.3389/fpubh.2022.1039450] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
Burnout is an important public health issue at times of the COVID-19 pandemic. Current measures which focus on work-based burnout have limitations in length and/or relevance. When stepping into the post-pandemic as a new Norm Era, the burnout scale for the general population is urgently needed to fill the gap. This study aimed to develop a COVID-19 Burnout Views Scale (COVID-19 BVS) to measure burnout views of the general public in a Chinese context and examine its psychometric properties. A multiphase approach including literature review, expert consultation, and pilot testing was adopted in developing the scale. The scale was administered to a sample of 1,078 of the general public in Hong Kong with an average age of 34.45 years (SD = 12.47). Exploratory and Confirmatory Factor Analyses suggested a 5-item unidimensional model of COVID-19 BVS. The CFA results indicated that the COVID-19 BVS had a good model fit, as χ2 (10.054)/5 = 2.01, SRMR = 0.010, CFI = 0.998, RMSEA = 0.031. Five items were maintained in EFA with high internal consistency in terms of Cronbach's α of 0.845 and McDonald's ω coefficient of 0.87, and the corrected item-to-total correlations of 0.512 to 0.789 are way above the acceptable range. The KMO values of 0.841 and Bartlett's Test of Sphericity (p < 0.01) verified the normal distribution of the EFA and the adequacy of the EFA sampling. The analyses suggest that the COVID-19 BVS is a promising tool for assessing burnout views on the impacts of the epidemic on the Chinese general populations.
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Affiliation(s)
- Sam S. S. Lau
- Research Centre for Environment and Human Health, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China,Multidisciplinary Research Centre, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China,College of International Education, Hong Kong Baptist University, Hong Kong, China,Institute of Bioresources and Agriculture, Hong Kong Baptist University, Hong Kong, China,*Correspondence: Sam S. S. Lau
| | - Cherry C. Y. Ho
- Research Centre for Environment and Human Health, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China,Multidisciplinary Research Centre, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China,Division of Nursing Education, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China
| | - Rebecca C. K. Pang
- Research Centre for Environment and Human Health, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China,Multidisciplinary Research Centre, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China,Division of Nursing Education, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China
| | - Susan Su
- Research Centre for Environment and Human Health, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China,Multidisciplinary Research Centre, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China,College of International Education, Hong Kong Baptist University, Hong Kong, China
| | - Heather Kwok
- Research Centre for Environment and Human Health, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China,Multidisciplinary Research Centre, School of Continuing Education, Hong Kong Baptist University, Hong Kong, China,College of International Education, Hong Kong Baptist University, Hong Kong, China
| | - Sai-fu Fung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Roger C. Ho
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
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15
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Meshkat S, Rosenblat JD, Ho RC, Rhee TG, Cao B, Ceban F, Danayan K, Chisamore N, Vincenzo JDD, McIntyre RS. Ketamine use in pediatric depression: A systematic review. Psychiatry Res 2022; 317:114911. [PMID: 37732856 DOI: 10.1016/j.psychres.2022.114911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022]
Abstract
Pediatric depression is a common psychiatric disorder that is associated with significant morbidity and mortality. Ketamine is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist with demonstrated antidepressant effects in the adult population, however, the efficacy and safety of ketamine for the treatment of pediatric depression remains poorly understood. Electronic databases were searched from inception to June 2022 to identify relevant articles. Six articles involving 46 participants with a mean age of 15.7 years were included in this systematic review. Out of six articles, three were case reports, one was a randomized clinical trial (RCT) and two were open-label trials. All studies used 0.5 mg/kg intravenous ketamine except for one, which used 2-7 micrograms/kg. Ketamine was significantly associated with reduced depressive symptoms without severe adverse events. Taken together, the results of these studies demonstrated the potential role of ketamine for treating pediatric depression. Several important limitations were identified, most notably the small sample sizes of the component studies, and that all studies administered intravenous ketamine. Further studies with larger sample sizes and different administration modalities are needed to better determine the efficacy and safety of ketamine in pediatric depression.
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Affiliation(s)
- Shakila Meshkat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Braxia Health, Braxia Scientific Corp, Mississauga, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Taeho Greg Rhee
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA; VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, PR China
| | - Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Kevork Danayan
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Noah Chisamore
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Joshua D Di Vincenzo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Braxia Health, Braxia Scientific Corp, Mississauga, ON, Canada.
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16
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Tan MK, Chia EC, McIntyre RS, Ho RC. The impact of COVID-19 pandemic on loss and grief. Ann Acad Med Singap 2022. [DOI: 10.47102/annals-acadmedsg.2022335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Affiliation(s)
- Marcus K Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eik-Chao Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation (BCDF), Toronto, Canada
| | - Roger C Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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17
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Lim GY, Tam WW, Lu Y, Ho CS, Zhang MW, Ho RC. Author Correction: Prevalence of Depression in the Community from 30 Countries between 1994 and 2014. Sci Rep 2022; 12:14856. [PMID: 36050349 PMCID: PMC9436937 DOI: 10.1038/s41598-022-19021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Wilson W Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yanxia Lu
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China.
| | - Cyrus S Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Melvyn W Zhang
- National Addiction Management Service, Institute of Mental Health, Singapore, Singapore
| | - Roger C Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
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18
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Gillissie ES, Krupski JR, Jawad MY, Lui LMW, Di Vencenzo JD, Teopiz KM, Cao B, Phan L, Mansur RB, Kwan ATH, Gill H, Ho RC, McIntyre RS. Evaluating cognitive function in unaffected relatives of individuals with bipolar disorders: A meta-analysis. J Psychiatr Res 2022; 152:289-295. [PMID: 35763918 DOI: 10.1016/j.jpsychires.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Available studies have evaluated cognition in the unaffected relatives of bipolar disorder patients; however, to our knowledge, there has been no quantitative analysis evaluating the foregoing association. Herein, this meta-analysis aims to provide a quantitative synthesis of the extant literature reporting on the association between performance in cognitive domains (i.e., executive function, attention, learning and memory or global cognition) amongst unaffected individuals of probands with bipolar disorders. METHODS Online databases (i.e., PubMed, PsycINFO) and Google Scholar were searched from inception to 20 September 2021. Studies with unaffected, first-degree relatives of individuals with DSM-IV or DSM-5 defined bipolar disorders were included. The risk of bias was assessed using the ROBINS-1 tool, and the quality of the sources was evaluated using GRADE criteria. The results of the studies were quantitatively synthesized using Cohen's d effect sizes via a random-effects meta-analytic approach on JASP. RESULTS A total of 15 studies were included in the final review. Overall, results indicate that cognitive performance across all domains is moderately impaired in unaffected relatives of individuals with bipolar disorders (d = 0.488). Sub-analysis suggests there is a higher level of impairment in executive functioning (d = 0.612). DISCUSSION The identification of cognitive deficits in unaffected relatives of probands with bipolar disorders indicates that cognitive impairment is endophenotypic and a core disturbance in persons with bipolar disorders; future studies should endeavour to target cognition as a potential pre-emptive and prevention strategy of bipolar disorders.
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Affiliation(s)
- Emily S Gillissie
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jillian R Krupski
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Muhammad Youshay Jawad
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Leanna M W Lui
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Joshua D Di Vencenzo
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Kayla M Teopiz
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, PR China
| | - Lee Phan
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Angela Tian Hui Kwan
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Mental Health University Institute, Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Hartej Gill
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
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19
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Affiliation(s)
- Fushun Wang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Jiongjiong Yang
- Department of Psychology, Beijing University, Beijing, China
| | - Fang Pan
- Department of Psychology, Shandong University, Jinan, China
| | - Roger C Ho
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health Center, Temple, TX, United States
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20
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Wang W, Ho RC. Editorial: Brain Activity Patterns During Dreams. Front Neurosci 2022; 16:802778. [PMID: 35620673 PMCID: PMC9127960 DOI: 10.3389/fnins.2022.802778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wei Wang
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- *Correspondence: Wei Wang
| | - Roger C. Ho
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
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21
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Toh EYJ, Ng JSP, McIntyre RS, Tran BX, Ho RC, Ho CSH, Tam WWS. Repetitive Transcranial Magnetic Stimulation for Fibromyalgia: An Updated Systematic Review and Meta-Analysis. Psychosom Med 2022; 84:400-409. [PMID: 35100184 DOI: 10.1097/psy.0000000000001062] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Meta-analysis was performed to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in fibromyalgia on the domains of pain, depression, anxiety and quality of life. METHOD Publications were searched with the keywords "repetitive transcranial magnetic stimulation" and "fibromyalgia" for randomized controlled trials that compare rTMS with sham stimulation for treating pain, depression, anxiety, and quality of life. Trials available until April 2021 were searched through PubMed, Scopus, Web of Science, and Cochrane Controlled Trials Register. The postintervention scores after 4 weeks for pain, depression, anxiety, and quality of life were extracted to compare the effects of rTMS and sham. Subgroup analysis was conducted based on the stimulation site. RESULTS From 265 screened articles, 11 eligible randomized controlled trials involving 303 patients were included. The results show that rTMS is more effective than sham stimulation in improving pain (standardized mean difference [SMD] = -0.35; 95% confidence interval [CI] = -0.62 to -0.08; p = .01) and quality of life (SMD = -0.51; 95% CI = -0.78 to -0.23; p = .0003). It is not more effective than sham stimulation for depression, and anxiety. After sensitivity analysis, subgroup analysis revealed that primary motor cortex stimulation was more effective than sham for improving pain (SMD = -0.57; 95% CI = -0.91 to -0.23; p = <0.01). Neither dorsolateral prefrontal cortex nor primary motor cortex stimulation was more effective than sham in improving depression and anxiety. CONCLUSIONS rTMS is more effective than sham in improving pain and quality of life, but it does not demonstrate reduction in depression or anxiety.
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Affiliation(s)
- Ezekiel Y J Toh
- From the Department of Psychological Medicine (Toh, Ng, R. Ho, C. Ho), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Mood Disorders Psychopharmacology Unit (McIntyre), University Health Network, University of Toronto, Toronto, Canada; Bloomberg School of Public Health (Tran), Johns Hopkins University, Baltimore, Maryland; Institute for Preventive Medicine and Public Health (Tran), Hanoi Medical University, Hanoi, Vietnam; Institute of Health Innovation and Technology (iHealthtech) (R. Ho) and Alice Lee School of Nursing (Tam), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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22
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Liu YK, Ling S, Lui LMW, Ceban F, Vinberg M, Kessing LV, Ho RC, Rhee TG, Gill H, Cao B, Mansur RB, Lee Y, Rosenblat J, Teopiz KM, McIntyre RS. Prevalence of type 2 diabetes mellitus, impaired fasting glucose, general obesity, and abdominal obesity in patients with bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2022; 300:449-461. [PMID: 34965395 DOI: 10.1016/j.jad.2021.12.110] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The study herein aimed to assess the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), as well as general and abdominal obesity in patients with bipolar disorder (BD). We also compared the prevalence of T2DM and general obesity in patients with BD with age- and gender-matched healthy controls. METHODS A systematic search of Embase, Medline, PubMed, and APA PsycArticles was conducted from inception to June 2021 without language restrictions. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) modified for case-control studies. RESULTS A total of forty-nine studies were included in this analysis. The pooled prevalence of T2DM was 9.6% (95% CI, 7.3-12.2%). Patients with BD had a nearly 1.6 times greater risk of developing T2DM compared to their age- and gender-matched controls (RR=1.57, 95% CI 1.36-1.81, p<0.001). In the present analysis, IFG is defined as a fasting plasma glucose (FPG) ≥ 100 mg/dL (FPG≥100) with a prevalence of 22.4% (95% CI, 16.7-28.7%), or as an FPG equal to or greater than 110 mg/d (FPG≥110) with a prevalence of 14.8% (95% CI, 10.8-19.3%). The prevalence of general obesity (BMI≥30 kg/m2) was 29.0% (95% CI, 22.8-35.6%); the risk of obesity was almost twice the rate reported in patients with BD compared to controls (RR=1.67, 95% CI 1.32-2.12, p<0.001). We also observed that more than half of the BD participants had abdominal obesity (i.e., prevalence of 51.1%; 95% CI, 45.0-57.3%). LIMITATIONS A significant degree of heterogeneity was detected. Sources of heterogeneity included differences in study designs, inclusion criteria, measurement tools, and data analysis methods. CONCLUSION Bipolar disorder is associated with a higher prevalence of T2DM, IFG, general obesity, and abdominal obesity. Type 2 diabetes mellitus and obesity are significantly more prevalent in patients with BD than in their age- and gender-matched controls. STUDY REGISTRATION CRD42021258431.
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Affiliation(s)
- Yuhan Karida Liu
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Susan Ling
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Leanna M W Lui
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Maj Vinberg
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Lars Vedel Kessing
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, PR China
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Joshua Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kayla M Teopiz
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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23
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Ceban F, Ling S, Lui LM, Lee Y, Gill H, Teopiz KM, Rodrigues NB, Subramaniapillai M, Di Vincenzo JD, Cao B, Lin K, Mansur RB, Ho RC, Rosenblat JD, Miskowiak KW, Vinberg M, Maletic V, McIntyre RS. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis. Brain Behav Immun 2022; 101:93-135. [PMID: 34973396 PMCID: PMC8715665 DOI: 10.1016/j.bbi.2021.12.020] [Citation(s) in RCA: 505] [Impact Index Per Article: 252.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/08/2021] [Accepted: 12/24/2021] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE COVID-19 is associated with clinically significant symptoms despite resolution of the acute infection (i.e., post-COVID-19 syndrome). Fatigue and cognitive impairment are amongst the most common and debilitating symptoms of post-COVID-19 syndrome. OBJECTIVE To quantify the proportion of individuals experiencing fatigue and cognitive impairment 12 or more weeks following COVID-19 diagnosis, and to characterize the inflammatory correlates and functional consequences of post-COVID-19 syndrome. DATA SOURCES Systematic searches were conducted without language restrictions from database inception to June 8, 2021 on PubMed/MEDLINE, The Cochrane Library, PsycInfo, Embase, Web of Science, Google/Google Scholar, and select reference lists. STUDY SELECTION Primary research articles which evaluated individuals at least 12 weeks after confirmed COVID-19 diagnosis and specifically reported on fatigue, cognitive impairment, inflammatory parameters, and/or functional outcomes were selected. DATA EXTRACTION & SYNTHESIS Two reviewers independently extracted published summary data and assessed methodological quality and risk of bias. A meta-analysis of proportions was conducted to pool Freeman-Tukey double arcsine transformed proportions using the random-effects restricted maximum-likelihood model. MAIN OUTCOMES & MEASURES The co-primary outcomes were the proportions of individuals reporting fatigue and cognitive impairment, respectively, 12 or more weeks following COVID-19 infection. The secondary outcomes were inflammatory correlates and functional consequences associated with post-COVID-19 syndrome. RESULTS The literature search yielded 10,979 studies, and 81 studies were selected for inclusion. The fatigue meta-analysis comprised 68 studies, the cognitive impairment meta-analysis comprised 43 studies, and 48 studies were included in the narrative synthesis. Meta-analysis revealed that the proportion of individuals experiencing fatigue 12 or more weeks following COVID-19 diagnosis was 0.32 (95% CI, 0.27, 0.37; p < 0.001; n = 25,268; I2 = 99.1%). The proportion of individuals exhibiting cognitive impairment was 0.22 (95% CI, 0.17, 0.28; p < 0.001; n = 13,232; I2 = 98.0). Moreover, narrative synthesis revealed elevations in proinflammatory markers and considerable functional impairment in a subset of individuals. CONCLUSIONS & RELEVANCE A significant proportion of individuals experience persistent fatigue and/or cognitive impairment following resolution of acute COVID-19. The frequency and debilitating nature of the foregoing symptoms provides the impetus to characterize the underlying neurobiological substrates and how to best treat these phenomena. STUDY REGISTRATION PROSPERO (CRD42021256965).
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Affiliation(s)
- Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada,Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Susan Ling
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada,Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Leanna M.W. Lui
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada,Braxia Health, Mississauga, ON, Canada
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Kayla M. Teopiz
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Nelson B. Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | | | - Joshua D. Di Vincenzo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada,Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, China
| | - Kangguang Lin
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China,Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
| | - Rodrigo B. Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger C. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Joshua D. Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada,Department of Pharmacology, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kamilla W. Miskowiak
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark,Mental Health Services, Capital Region of Denmark, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maj Vinberg
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark,Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Vladimir Maletic
- Department of Psychiatry, University of South Carolina, Greenville, SC, USA
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada,Brain and Cognition Discovery Foundation, Toronto, ON, Canada,Braxia Health, Mississauga, ON, Canada,Department of Pharmacology, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Corresponding author at: University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON M5T 2S8, Canada
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24
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Ho RC, Tran BX, McIntyre RS. The relationship between major depressive disorder and employment status. Ann Acad Med Singap 2022; 51:69-70. [PMID: 35224601 DOI: 10.47102/annals-acadmedsg.20229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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25
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Lim ICZY, Tam WWS, Chudzicka-Czupała A, McIntyre RS, Teopiz KM, Ho RC, Ho CSH. Prevalence of depression, anxiety and post-traumatic stress in war- and conflict-afflicted areas: A meta-analysis. Front Psychiatry 2022; 13:978703. [PMID: 36186881 PMCID: PMC9524230 DOI: 10.3389/fpsyt.2022.978703] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the rise of fragility, conflict and violence (FCV), understanding the prevalence and risk factors associated with mental disorders is beneficial to direct aid to vulnerable groups. To better understand mental disorders depending on the population and the timeframe, we performed a systematic review to investigate the aggregate prevalence of depression, anxiety and post-traumatic stress symptoms among both civilian and military population exposed to war. METHODS We used MEDLINE (PubMed), Web of Science, PsycINFO, and Embase to identify studies published from inception or 1-Jan, 1945 (whichever earlier), to 31-May, 2022, to reporting on the prevalence of depression, anxiety and post-traumatic stress symptoms using structured clinical interviews and validated questionnaires as well as variables known to be associated with prevalence to perform meta-regression. We then used random-effects bivariate meta-analysis models to estimate the aggregate prevalence rate. RESULTS The aggregate prevalence of depression, anxiety and post-traumatic stress during times of conflict or war were 28.9, 30.7, and 23.5%, respectively. Our results indicate a significant difference in the levels of depression and anxiety, but not post-traumatic stress, between the civilian group and the military group respectively (depression 34.7 vs 21.1%, p < 0.001; anxiety 38.6 vs 16.2%, p < 0.001; post-traumatic stress: 25.7 vs 21.3%, p = 0.256). The aggregate prevalence of depression during the wars was 38.7% (95% CI: 30.0-48.3, I 2 = 98.1%), while the aggregate prevalence of depression post-wars was 29.1% (95% CI: 24.7-33.9, I 2 = 99.2%). The aggregate prevalence of anxiety during the wars was 43.4% (95% CI: 27.5-60.7, I 2 = 98.6%), while the aggregate prevalence of anxiety post-wars was 30.3% (95% CI: 24.5-36.9, I 2 = 99.2%). The subgroup analysis showed significant difference in prevalence of depression, and anxiety between the civilians and military group (p < 0.001). CONCLUSION The aggregate prevalence of depression, anxiety and post-traumatic stress in populations experiencing FCV are 28.9, 30.7, and 23.5%, respectively. There is a significant difference in prevalence of depression and anxiety between civilians and the military personnels. Our results show that there is a significant difference in the prevalence of depression and anxiety among individuals in areas affected by FCV during the wars compared to after the wars. Overall, these results highlight that mental health in times of conflict is a public health issue that cannot be ignored, and that appropriate aid made available to at risk populations can reduce the prevalence of psychiatric symptoms during time of FCV. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=337486, Identifier 337486.
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Affiliation(s)
- Isis Claire Z Y Lim
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wilson W S Tam
- Alice Lee School of Nursing, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Braxia Scientific Corp., Toronto, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, National University Health System, Singapore, Singapore
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26
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Husain SF, McIntyre RS, Tang TB, Abd Latif MH, Tran BX, Linh VG, Thao TPN, Ho CS, Ho RC. Functional near-infrared spectroscopy during the verbal fluency task of English-Speaking adults with mood disorders: A preliminary study. J Clin Neurosci 2021; 94:94-101. [PMID: 34863469 DOI: 10.1016/j.jocn.2021.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/10/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023]
Abstract
Functional near-infrared spectroscopy (fNIRS) provides a direct and objective assessment of cerebral cortex function. It may be used to determine neurophysiological differences between psychiatric disorders with overlapping symptoms, such as major depressive disorder (MDD) and bipolar disorder (BD). Therefore, this preliminary study aimed to compare fNIRS signals during the verbal fluency task (VFT) of English-speaking healthy controls (HC), patients with MDD and patients with BD. Fifteen HCs, 15 patients with MDD and 15 patients with BD were recruited. Groups were matched for age, gender, ethnicity and education. Relative oxy-haemoglobin and deoxy-haemoglobin changes in the frontotemporal cortex was monitored with a 52-channel fNIRS system. Integral values of the frontal and temporal regions were derived as a measure cortical haemodynamic response magnitude. Both patient groups had lower frontal and temporal region integral values than HCs, and patients with MDD had lower frontal region integral value than patients with BD. Moreover, patients could be differentiated from HCs using the frontal and temporal integral values, and patient groups could be differentiated using the frontal region integral values. VFT performance, clinical history and symptom severity were not associated with integral values. These results suggest that prefrontal cortex haemodynamic dysfunction occurs in mood disorders, and it is more extensive in MDD than BD. The fNIRS-VFT paradigm may be a potential tool for differentiating MDD from BD in clinical settings, and these findings need to be verified in a larger sample of English-speaking patients with mood disorders.
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Affiliation(s)
- Syeda Fabeha Husain
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Tong-Boon Tang
- Centre for Intelligent Signal and Imaging Research (CISIR), University Teknologi PETRONAS, 32610 Seri Iskandar, Perak Darul Ridzuan, Malaysia
| | - Muhamad Hafiz Abd Latif
- Centre for Intelligent Signal and Imaging Research (CISIR), University Teknologi PETRONAS, 32610 Seri Iskandar, Perak Darul Ridzuan, Malaysia
| | - Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Vu Gia Linh
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Viet Nam; Faculty of Medicine, Duy Tan University, Da Nang 550000, Viet Nam
| | - Thi Phuong Nguyen Thao
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Viet Nam; Faculty of Medicine, Duy Tan University, Da Nang 550000, Viet Nam
| | - Cyrus S Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Roger C Ho
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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27
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McIntyre RS, Lipsitz O, Lui LMW, Rodrigues NB, Gill H, Nasri F, Ling R, Teopiz KM, Ho RC, Subramaniapillai M, Kratiuk K, Mansur RB, Jones BDM, Lee Y, Rosenblat JD. The meaningful change threshold as measured by the 16-item quick inventory of depressive symptomatology in adults with treatment-resistant major depressive and bipolar disorder receiving intravenous ketamine. J Affect Disord 2021; 294:592-596. [PMID: 34332360 DOI: 10.1016/j.jad.2021.07.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/22/2021] [Accepted: 07/11/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE .To identify a meaningful change threshold (MCT) in depression outcomes in adults with treatment-resistant major depressive disorder (MDD) or bipolar disorder (BD) receiving intravenous ketamine treatment at a community-based mood disorders center. METHOD .A triangular approach integrating both anchor-based and distributive methods was used to identify meaningful change on the patient-reported Quick Inventory for Depressive Symptoms Self-Report 16-Item (QIDS-SR16) as associated with the Patient Global Impression - Severity (PGI-S). Both the QIDS-SR16 and the PGI-S are self-report measures, and were collected at five timepoints (timepoints were approximately 2-7 days apart). RESULTS .A total of 297 adults with treatment-resistant depression (TRD) as part of either DSM-5-defined MDD or BD were included. The MCT for the QIDS-SR16 revealed that a mean improvement of 3.38 points from baseline was comparable to a 1-point improvement on the PGI-S. Together with an examination of the probability density function, a 3.5-point change is a reasonable MCT (i.e., 1-point PGI-S improvement) for the QIDS-SR16. A 2-point symptomatic improvement on the QIDS-SR16 was associated with no change on the PGI-S. CONCLUSION .A 3.5-point reduction in the QIDS-SR16 represents a MCT based on the PGI-S for adults with treatment-resistant MDD or BD receiving intravenous ketamine treatment at a community-based mood disorders center. These findings are limited by the post-hoc nature of this analysis and open-label case-series design. Measurement-based care decisions by patients, providers and clinicians, as well as cost/reimbursement decisions should include consideration of meaningful change along with conventional objective outcomes.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
| | - Orly Lipsitz
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Leanna M W Lui
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Flora Nasri
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada
| | - Rui Ling
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada
| | - Kayla M Teopiz
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Clinical Immunology, Poznan University of Medical Sciences, Poznan, Poland
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Brett D M Jones
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Ceban F, Nogo D, Carvalho IP, Lee Y, Nasri F, Xiong J, Lui LMW, Subramaniapillai M, Gill H, Liu RN, Joseph P, Teopiz KM, Cao B, Mansur RB, Lin K, Rosenblat JD, Ho RC, McIntyre RS. Association Between Mood Disorders and Risk of COVID-19 Infection, Hospitalization, and Death: A Systematic Review and Meta-analysis. JAMA Psychiatry 2021; 78:1079-1091. [PMID: 34319365 PMCID: PMC8319830 DOI: 10.1001/jamapsychiatry.2021.1818] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Preexisting noncommunicable diseases (eg, diabetes) increase the risk of COVID-19 infection, hospitalization, and death. Mood disorders are associated with impaired immune function and social determinants that increase the risk of COVID-19. Determining whether preexisting mood disorders represent a risk of COVID-19 would inform public health priorities. OBJECTIVE To assess whether preexisting mood disorders are associated with a higher risk of COVID-19 susceptibility, hospitalization, severe complications, and death. DATA SOURCES Systematic searches were conducted for studies reporting data on COVID-19 outcomes in populations with and without mood disorders on PubMed/MEDLINE, The Cochrane Library, PsycInfo, Embase, Web of Science, Google/Google Scholar, LitCovid, and select reference lists. The search timeline was from database inception to February 1, 2021. STUDY SELECTION Primary research articles that reported quantitative COVID-19 outcome data in persons with mood disorders vs persons without mood disorders of any age, sex, and nationality were selected. Of 1950 articles identified through this search strategy, 21 studies were included in the analysis. DATA EXTRACTION AND SYNTHESIS The modified Newcastle-Ottawa Scale was used to assess methodological quality and risk of bias of component studies. Reported adjusted odds ratios (ORs) were pooled with unadjusted ORs calculated from summary data to generate 4 random-effects summary ORs, each corresponding to a primary outcome. MAIN OUTCOMES AND MEASURES The 4 a priori primary outcomes were COVID-19 susceptibility, COVID-19 hospitalization, COVID-19 severe events, and COVID-19 death. The hypothesis was formulated before study search. Outcome measures between individuals with and without mood disorders were compared. RESULTS This review included 21 studies that involved more than 91 million individuals. Significantly higher odds of COVID-19 hospitalization (OR, 1.31; 95% CI, 1.12-1.53; P = .001; n = 26 554 397) and death (OR, 1.51; 95% CI, 1.34-1.69; P < .001; n = 25 808 660) were found in persons with preexisting mood disorders compared with those without mood disorders. There was no association between mood disorders and COVID-19 susceptibility (OR, 1.27; 95% CI, 0.73-2.19; n = 65 514 469) or severe events (OR, 0.94; 95% CI, 0.87-1.03; n = 83 240). Visual inspection of the composite funnel plot for asymmetry indicated the presence of publication bias; however, the Egger regression intercept test result was not statistically significant. CONCLUSIONS AND RELEVANCE The results of this systematic review and meta-analysis examining the association between preexisting mood disorders and COVID-19 outcomes suggest that individuals with preexisting mood disorders are at higher risk of COVID-19 hospitalization and death and should be categorized as an at-risk group on the basis of a preexisting condition.
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Affiliation(s)
- Felicia Ceban
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada,Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Danica Nogo
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Isidro P. Carvalho
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Flora Nasri
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Jiaqi Xiong
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Leanna M. W. Lui
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada,Braxia Health, Mississauga, Ontario, Canada
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada,Braxia Health, Mississauga, Ontario, Canada
| | - Rene N. Liu
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Prianca Joseph
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Kayla M. Teopiz
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Bing Cao
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
| | - Rodrigo B. Mansur
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kangguang Lin
- Department of Affective Disorders, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China,Laboratory of Emotion and Cognition, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
| | - Joshua D. Rosenblat
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada,Braxia Health, Mississauga, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger C. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Institute for Health Innovation and Technology, National University of Singapore, Singapore
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada,Braxia Health, Mississauga, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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29
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Ng J, Rosenblat JD, Lui LMW, Teopiz KM, Lee Y, Lipsitz O, Mansur RB, Rodrigues NB, Nasri F, Gill H, Cha DS, Subramaniapillai M, Ho RC, Cao B, McIntyre RS. Efficacy of ketamine and esketamine on functional outcomes in treatment-resistant depression: A systematic review. J Affect Disord 2021; 293:285-294. [PMID: 34225208 DOI: 10.1016/j.jad.2021.06.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/26/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In recent years, ketamine and esketamine treatment have demonstrated rapid antidepressant effects in adults with treatment-resistant depression (TRD). Hitherto, relatively few studies have reported the effect of ketamine/esketamine treatment on functional outcomes (e.g., psychosocial functioning, workplace functioning). Herein, we review and synthesize extant literature reporting functional outcomes with ketamine/esketamine treatment in adults with TRD. METHODS A systematic review of clinical studies reporting subjective or objective ratings of general functioning as primary or secondary outcomes was performed. RESULTS Four randomized-controlled trials, one open-label clinical study and one case series reported on the efficacy of ketamine/esketamine on subjective measures of general functioning. Overall, mixed results were reported with respect to the effect across disparate functional measures (e.g., Sheehan Disability Scale [SDS]) using ketamine/esketamine. A single study demonstrated a significant decrease (i.e., improvement) in SDS total scores in TRD with esketamine treatment; most studies, however, did not report on functional outcomes and have functional outcomes as a (co)-primary outcome measure. LIMITATIONS Clinical studies that were included evaluated work- or social-related disability as a secondary outcome using subjective rating scales. CONCLUSION Functional outcomes in adults with TRD receiving ketamine/esketamine was insufficiently characterized. Available evidence indicates that improvements in general psychosocial functioning is apparent. The association, if any, between symptomatic improvement and functional improvement in TRD, as well as the temporality to improve functioning, are future research vistas.
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Affiliation(s)
- Jason Ng
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (CRTCE), Mississauga, ON, Canada
| | - Leanna M W Lui
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Kayla M Teopiz
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Orly Lipsitz
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Flora Nasri
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Hartej Gill
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Danielle S Cha
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | | | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Bing Cao
- Key Laboratory of Cognition and Personality (SWU), Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, P. R. China
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (CRTCE), Mississauga, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Canada; University of Toronto, Toronto, ON, Canada.
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30
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Chan NA, Zhang Z, Yin G, Li Z, Ho RC. Update on hypnotherapy for psychiatrists. BJPsych advances 2021. [DOI: 10.1192/bja.2021.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Although hypnosis has played a part in psychotherapy for a long time, it is not yet seen as an evidence-based therapy and is absent from many practice guidelines when it comes to the treatment of psychiatric disorders. At present, the applications and methods of hypnotherapy are poorly understood and other methods of psychotherapy tend to be favoured. This review article aims to introduce the role of hypnotherapy and its application for certain common psychiatric presentations, as well as examine its efficacy by summarising recent evidence from high-quality outcome studies and meta-analyses.
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31
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Lipsitz O, Di Vincenzo JD, Rodrigues NB, Cha DS, Lee Y, Greenberg D, Teopiz KM, Ho RC, Cao B, Lin K, Subramaniapillai M, Flint AJ, Kratiuk K, McIntyre RS, Rosenblat JD. Safety, Tolerability, and Real-World Effectiveness of Intravenous Ketamine in Older Adults With Treatment-Resistant Depression: A Case Series. Am J Geriatr Psychiatry 2021; 29:899-913. [PMID: 33478865 DOI: 10.1016/j.jagp.2020.12.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the safety, tolerability, and effectiveness of repeated doses of intravenous (IV) ketamine in older adults (i.e., ≥60 years of age) with treatment-resistant depression. METHOD In this case series, fifty-three older adults (Mage = 67, SD = 6; 57% female [n = 30]) received 4 IV ketamine infusions, administered over 1-2 weeks. Effectiveness of IV ketamine was measured using the Quick Inventory for Depressive Symptomatology-Self Report 16 (QIDS-SR16) approximately 2 days after infusions 1-3, and 1-2 weeks after infusion 4. Safety was measured as hemodynamic changes before, during, immediately after, and 20 minutes after each infusion. Tolerability was assessed via systematic reporting of treatment-emergent adverse events during and after each infusion, in addition to symptoms of dissociation measured using the Clinician Administered Dissociative States Scale. Partial response (25%-50% symptomatic improvement from baseline), response (≥50% symptomatic improvement from baseline), clinically significant improvements (≥25% symptomatic improvement from baseline), and remission rates (QIDS-SR16 ≤5) were also calculated. RESULTS Participants reported significant decreases in depressive symptoms (i.e., as measured by the QIDS-SR16) with repeated ketamine infusions (F(4, 92) = 7.412, p <0.001). The mean QIDS-SR16 score was 17.12 (SD = 5.33) at baseline and decreased to 12.52 (SD = 5.79) following 4 infusions. After 4 infusions, 31% (n = 8) of participants partially responded to IV ketamine, 27% (n = 7) responded, 58% (n = 15) experienced clinically significant improvements, and 10% (n = 3) met remission criteria. Thirty-six participants (69%) experienced treatment-emergent hypertension during at least 1 infusion, and 10 (19%) required intervention with an antihypertensive. Drowsiness was the most commonly reported adverse event (50% of infusions; n = 73). CONCLUSION Ketamine was associated with transient treatment-emergent hypertension. Response and remission rates were comparable to those reported in general adult samples. Findings are limited by the open-label, chart review nature of this study.
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Affiliation(s)
- Orly Lipsitz
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - Joshua D Di Vincenzo
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto (JDV, RSM), Toronto, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; School of Medicine, Faculty of Medicine, University of Queensland (DSC), Brisbane, QLD, Australia
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - David Greenberg
- Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - Kayla M Teopiz
- Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore (RCH), Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore (RCH), Singapore
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University (BC), Chongqing, 400715, PR China
| | - Kangguang Lin
- Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University (KL), Guangzhou, China; Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University (KL), Guangzhou, China
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto (AJF, RSM, JDR), Toronto, ON, Canada; Centre for Mental Health, University Health Network (AJF), Toronto, ON, Canada
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada; Department of Clinical Immunology, Poznan University of Medical Sciences, Poznan, Poland
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada; Department of Psychiatry, University of Toronto (AJF, RSM, JDR), Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto (JDV, RSM), Toronto, ON, Canada.
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network (OL, JDV, NBR, DSC, YL, MS, RSM, JDR), Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence (OL, NBR, YL, DG, KMT, MS, KK RSM, JDR), Mississauga, ON, Canada; Department of Psychiatry, University of Toronto (AJF, RSM, JDR), Toronto, ON, Canada
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32
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Ceban F, Rosenblat JD, Kratiuk K, Lee Y, Rodrigues NB, Gill H, Subramaniapillai M, Nasri F, Lui LMW, Lipsitz O, Kumar A, Lee JG, Chau EH, Cao B, Lin K, Ho RC, Mansur RB, Swainson J, McIntyre RS. Prevention and Management of Common Adverse Effects of Ketamine and Esketamine in Patients with Mood Disorders. CNS Drugs 2021; 35:925-934. [PMID: 34363603 DOI: 10.1007/s40263-021-00846-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 01/22/2023]
Abstract
The emerging roles of ketamine and esketamine as effective rapid-acting antidepressants hold promise for patients suffering from treatment-resistant depression and/or major depressive disorder with suicidality. Practitioner familiarity with common tolerability/safety concerns along with pragmatic prevention and management strategies are needed to reduce patient burden and improve the acceptability and accessibility of these treatments. The most common treatment-emergent adverse events associated with ketamine/esketamine are dissociation, anxiety, nausea, increased blood pressure, and headache. The majority of side effects are mild, transient, dose dependent, and attenuate with subsequent treatments. Patient selection, baseline physical and psychiatric assessments, and an appropriate setting are critical first steps in the prevention and mitigation of adverse events. Patient education and supportive interventions play central roles in the prevention and management of select adverse events. Severe and/or clinically significant adverse effects may necessitate the judicious use of adjunctive medications. Moreover, practitioners must remain vigilant to the potential for abuse liability and long-term adverse events, for which there are insufficient data. This article succinctly reviews common treatment-emergent adverse events of ketamine and esketamine within the context of mood disorders, and provides practical suggestions for prevention and management at point-of-care.
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Affiliation(s)
- Felicia Ceban
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Braxia Health, Mississauga, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | | | - Yena Lee
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Braxia Health, Mississauga, ON, Canada
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Braxia Health, Mississauga, ON, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Braxia Health, Mississauga, ON, Canada
| | - Flora Nasri
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Leanna M W Lui
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Orly Lipsitz
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Braxia Health, Mississauga, ON, Canada
| | | | - Jung Goo Lee
- Department of Psychiatry, College of Medicine, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.,Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea.,Department of Health Science and Technology, Graduate School, Inje University, Busan, Republic of Korea
| | | | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, People's Republic of China
| | - Kangguang Lin
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, People's Republic of China.,Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jennifer Swainson
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada. .,Braxia Health, Mississauga, ON, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
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33
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McIntyre RS, Lipsitz O, Lui LMW, Rodrigues NB, Lee Y, Ho RC, Subramaniapillai M, Gill H, Cha DS, Lin K, Teopiz KM, Nasri F, Mansur RB, Kratiuk K, Rosenblat JD. Does pre-treatment functioning influence response to intravenous ketamine in adults with treatment-resistant depression? J Affect Disord 2021; 292:714-719. [PMID: 34161889 DOI: 10.1016/j.jad.2021.05.090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/27/2021] [Accepted: 05/31/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The efficacy of monoamine-based antidepressants in adults with major depressive disorder (MDD) is attenuated in persons with greater pre-treatment functional impairment. Herein, we investigated whether pre-treatment functioning in outpatients with treatment-resistant depression (TRD) moderates response to intravenous (IV) ketamine. METHODS Adults (N= 326; Mage = 45) with DSM-5-defined MDD or bipolar disorder and TRD received repeat-dose IV ketamine at a community-based clinic. Function was evaluated with the Sheehan Disability Scale (SDS), using total scores as well as scores on the subdomains of workplace/school, social life, and family life/home responsibilities. The primary dependent measure was change in depressive symptoms from pre-treatment to post-infusion 4, as measured by the Quick Inventory for Depressive Symptomatology-Self Report-16. RESULTS Total functional disability, as well as the subdomains of social life and family life/home responsibilities, significantly moderated response to IV ketamine (p = .003; p = .008; p = .008). Follow-up simple slopes analyses indicated a significant improvement in depressive symptoms across the functional domain spectrum (ps < .001). Above average functional disability (i.e., 1 SD > mean functional impairment within the sample) was associated with a greater change in depressive symptoms. Workplace function did not significantly moderate response to IV ketamine (p = .307), suggesting that individuals with significantly impaired workplace functioning may expect a similar response to ketamine as those with less workplace impairment. CONCLUSIONS Symptomatic benefit with IV ketamine was observed in patients with TRD and significant pre-treatment functional impairment. The foregoing result has implications for mechanism of action, cost-effectiveness, and patient selection in adults with TRD receiving IV ketamine.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
| | - Orly Lipsitz
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Leanna M W Lui
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Mehala Subramaniapillai
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Hartej Gill
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Danielle S Cha
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Kangguang Lin
- Department of Affective Disorder, the Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China; Laboratory of Emotion and Cognition, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
| | - Kayla M Teopiz
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Flora Nasri
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Physical Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Dong Y, Yeo MC, Tham XC, Danuaji R, Nguyen TH, Sharma AK, Rn K, Pv M, Tai MLS, Ahmad A, Tan BY, Ho RC, Chua MCH, Sharma VK. Investigating Psychological Differences between Nurses and Other Healthcare Workers from Asia-Pacific Region during the Early Phase of the Coronavirus Disease 2019 (COVID-19): A Machine Learning Approach (Preprint). JMIR Nurs 2021; 5:e32647. [PMID: 35648464 PMCID: PMC9162133 DOI: 10.2196/32647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background As the COVID-19 pandemic evolves, challenges in frontline work continue to impose a significant psychological impact on nurses. However, there is a lack of data on how nurses fared compared to other health care workers in the Asia-Pacific region. Objective This study aims to investigate (1) the psychological outcome characteristics of nurses in different Asia-Pacific countries and (2) psychological differences between nurses, doctors, and nonmedical health care workers. Methods Exploratory data analysis and visualization were conducted on the data collected through surveys. A machine learning modeling approach was adopted to further discern the key psychological characteristics differentiating nurses from other health care workers. Decision tree–based machine learning models (Light Gradient Boosting Machine, GradientBoost, and RandomForest) were built to predict whether a set of psychological distress characteristics (ie, depression, anxiety, stress, intrusion, avoidance, and hyperarousal) belong to a nurse. Shapley Additive Explanation (SHAP) values were extracted to identify the prominent characteristics of each of these models. The common prominent characteristic among these models is akin to the most distinctive psychological characteristic that differentiates nurses from other health care workers. Results Nurses had relatively higher percentages of having normal or unchanged psychological distress symptoms relative to other health care workers (n=233-260 [86.0%-95.9%] vs n=187-199 [74.8%-91.7%]). Among those without psychological symptoms, nurses constituted a higher proportion than doctors and nonmedical health care workers (n=194 [40.2%], n=142 [29.5%], and n=146 [30.3%], respectively). Nurses in Vietnam showed the highest level of depression, stress, intrusion, avoidance, and hyperarousal symptoms compared to those in Singapore, Malaysia, and Indonesia. Nurses in Singapore had the highest level of anxiety. In addition, nurses had the lowest level of stress, which is the most distinctive psychological outcome characteristic derived from machine learning models, compared to other health care workers. Data for India were excluded from the analysis due to the differing psychological response pattern observed in nurses in India. A large number of female nurses emigrating from South India could not have psychologically coped well without the support from family members while living alone in other states. Conclusions Nurses were least psychologically affected compared to doctors and other health care workers. Different contexts, cultures, and points in the pandemic curve may have contributed to differing patterns of psychological outcomes amongst nurses in various Asia-Pacific countries. It is important that all health care workers practice self-care and render peer support to bolster psychological resilience for effective coping. In addition, this study also demonstrated the potential use of decision tree–based machine learning models and SHAP value plots in identifying contributing factors of sophisticated problems in the health care industry.
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Affiliation(s)
- YanHong Dong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mei Chun Yeo
- Institute of Systems Science, National University of Singapore, Singapore, Singapore
| | - Xiang Cong Tham
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rivan Danuaji
- Dr Moewardi Hospital Surakarta, Jawa Tengah, Indonesia
| | - Thang H Nguyen
- Cerebrovascular Disease Department, 115 People's Hospital, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Aftab Ahmad
- Department of Neurology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Benjamin Yq Tan
- Division of Neurology, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger C Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | | | - Vijay K Sharma
- Division of Neurology, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Tan LY, Yeo XY, Bae HG, Lee DPS, Ho RC, Kim JE, Jo DG, Jung S. Association of Gut Microbiome Dysbiosis with Neurodegeneration: Can Gut Microbe-Modifying Diet Prevent or Alleviate the Symptoms of Neurodegenerative Diseases? Life (Basel) 2021; 11:698. [PMID: 34357070 PMCID: PMC8305650 DOI: 10.3390/life11070698] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/11/2022] Open
Abstract
The central nervous system was classically perceived as anatomically and functionally independent from the other visceral organs. But in recent decades, compelling evidence has led the scientific community to place a greater emphasis on the role of gut microbes on the brain. Pathological observations and early gastrointestinal symptoms highlighted that gut dysbiosis likely precedes the onset of cognitive deficits in Alzheimer's disease (AD) and Parkinson's disease (PD) patients. The delicate balance in the number and functions of pathogenic microbes and alternative probiotic populations is critical in the modulation of systemic inflammation and neuronal health. However, there is limited success in restoring healthy microbial biodiversity in AD and PD patients with general probiotics interventions and fecal microbial therapies. Fortunately, the gut microflora is susceptible to long-term extrinsic influences such as lifestyle and dietary choices, providing opportunities for treatment through comparatively individual-specific control of human behavior. In this review, we examine the impact of restrictive diets on the gut microbiome populations associated with AD and PD. The overall evidence presented supports that gut dysbiosis is a plausible prelude to disease onset, and early dietary interventions are likely beneficial for the prevention and treatment of progressive neurodegenerative diseases.
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Affiliation(s)
- Li Yang Tan
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore 138667, Singapore; (L.Y.T.); (X.Y.Y.)
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
| | - Xin Yi Yeo
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore 138667, Singapore; (L.Y.T.); (X.Y.Y.)
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
| | - Han-Gyu Bae
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea;
| | - Delia Pei Shan Lee
- Department of Food Science and Technology, Faculty of Science, National University of Singapore, Singapore 117542, Singapore;
| | - Roger C. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore, Singapore 117599, Singapore
| | - Jung Eun Kim
- Department of Food Science and Technology, Faculty of Science, National University of Singapore, Singapore 117542, Singapore;
| | - Dong-Gyu Jo
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea;
| | - Sangyong Jung
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore 138667, Singapore; (L.Y.T.); (X.Y.Y.)
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore
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Chew NWS, Cheong C, Kong G, Phua K, Ngiam JN, Tan BYQ, Wang B, Hao F, Tan W, Han X, Tran BX, Hoang MT, Pham HQ, Vu GT, Chen Y, Danuaji R, Rn K, Pv M, Talati K, Ho CS, Sharma AK, Ho RC, Sharma VK. An Asia-Pacific study on healthcare workers' perceptions of, and willingness to receive, the COVID-19 vaccination. Int J Infect Dis 2021; 106:52-60. [PMID: 33781902 PMCID: PMC7997703 DOI: 10.1016/j.ijid.2021.03.069] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE In the fight against COVID-19, vaccination is vital in achieving herd immunity. Many Asian countries are starting to vaccinate frontline workers; however, expedited vaccine development has led to hesitancy among the general population. We evaluated the willingness of healthcare workers to receive the COVID-19 vaccine. METHODS From 12 to 21 December 2020, we recruited 1720 healthcare workers from 6 countries: China, India, Indonesia, Singapore, Vietnam and Bhutan. The self-administrated survey collected information on willingness to vaccinate, perception of COVID-19, vaccine concerns, COVID-19 risk profile, stigma, pro-socialness scale, and trust in health authorities. RESULTS More than 95% of the healthcare workers surveyed were willing to vaccinate. These respondents were more likely to perceive the pandemic as severe, consider the vaccine safe, have less financial concerns, less stigmatization regarding the vaccine, higher pro-socialness mindset and trust in health authorities. A high perceived pandemic risk index, low vaccine harm index and high pro-socialness index were independent predictors in multivariable analysis. CONCLUSIONS The majority of healthcare workers in Asia are willing to receive COVID-19 vaccination. Perceived COVID-19 susceptibility, low potential risk of vaccine harm and pro-socialness are the main drivers. These findings may help formulate vaccination strategies in other countries.
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Affiliation(s)
- Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Clare Cheong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gwyneth Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kailun Phua
- Department of Medicine, National University Health System, Singapore
| | | | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Bokun Wang
- Science and Technology Promotion Bureau, Chongqing Liangjiang New Area Administration Committee, China
| | - Fengyi Hao
- The First People's Hospital of Chongqing Liang Jiang New Area, China
| | - Wanqiu Tan
- National University of Singapore (Chongqing) Research Institute, China
| | - Xiaofan Han
- The First People's Hospital of Chongqing Liang Jiang New Area, China
| | - Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Vietnam; Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Men Thi Hoang
- Institute for Global Health Innovations, Duy Tan University, Vietnam; Faculty of Medicine, Duy Tan University, Vietnam
| | - Hai Q Pham
- Institute for Global Health Innovations, Duy Tan University, Vietnam; Faculty of Medicine, Duy Tan University, Vietnam
| | - Giang T Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Vietnam
| | - Yang Chen
- Department of Medicine, Jigme Dorji Wangchuck National Referral Hospital, Khesar Gyalpo University of Medical Sciences, Thimphu, Bhutan
| | - Rivan Danuaji
- Dr Moewardi Hospital Surakarta, Jawa Tengah, Indonesia
| | | | | | | | - Cyrus S Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | | | - Roger C Ho
- Department of Psychological Medicine, National University of Singapore, Singapore; Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
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Husain SF, Ong SK, Cuizhen L, Tran B, Ho RC, Ho CS. Functional near-infrared spectroscopy during a decision-making task in patients with major depressive disorder. Aust N Z J Psychiatry 2021; 55:485-493. [PMID: 33300367 DOI: 10.1177/0004867420976856] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Patients with major depressive disorder tend to exhibit poorer decision-making capacity than the general population, but neurobiological evidence is lacking. Functional near-infrared spectroscopy monitors changes in oxy-haemoglobin concentration in the cerebral cortex. It may provide an objective assessment of neurophysiological responses during decision-making processes. Thus, this study investigated the effect of major depressive disorder diagnosis and severity on prefrontal cortex activity during the Iowa gambling task. METHODS Right-handed healthy controls (n = 25) and patients with major depressive disorder (n = 25) were matched for age, gender, ethnicity and years of education in this cross-sectional study. Functional near-infrared spectroscopy signals and the responses made during a computerised Iowa gambling task were recorded. In addition, demographics, clinical history and symptom severity were noted. RESULTS Compared to healthy controls, patients with major depressive disorder had reduced haemodynamic response in several cortical regions of the frontal lobe (Hedge's g range from 0.71 to 1.52; p values range from ⩽0.001 to 0.041). Among patients, mean oxy-haemoglobin declined with major depressive disorder severity in the right orbitofrontal cortex (Pearson's r = -0.423; p = 0.024). CONCLUSION Haemodynamic dysfunction of the prefrontal cortex during decision-making processes is associated with major depressive disorder diagnosis and severity. These neurophysiological alterations may have a role in the decision-making capacity of patients with major depressive disorder.
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Affiliation(s)
- Syeda F Husain
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Samantha K Ong
- Department of Psychological Medicine, National University Health System, Singapore
| | - Liu Cuizhen
- Department of Psychology, Faculty of Arts and Social Science, National University of Singapore, Singapore
| | - Bach Tran
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Roger C Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cyrus S Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Husain SF, Tang TB, Tam WW, Tran BX, Ho CS, Ho RC. Cortical haemodynamic response during the verbal fluency task in patients with bipolar disorder and borderline personality disorder: a preliminary functional near-infrared spectroscopy study. BMC Psychiatry 2021; 21:201. [PMID: 33879125 PMCID: PMC8056702 DOI: 10.1186/s12888-021-03195-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 04/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Functional near-infrared spectroscopy (fNIRS) is an emerging neuroimaging modality that provides a direct and quantitative assessment of cortical haemodynamic response during a cognitive task. It may be used to identify neurophysiological differences between psychiatric disorders with overlapping symptoms, such as bipolar disorder (BD) and borderline personality disorder (BPD). Hence, this preliminary study aimed to compare the cerebral haemodynamic function of healthy controls (HC), patients with BD and patients with BPD. METHODS Twenty-seven participants (9 HCs, 9 patients with BD and 9 patients with BPD) matched for age, gender, ethnicity and education were recruited. Relative oxy-haemoglobin and deoxy-haemoglobin changes in the frontotemporal cortex was monitored with a 52-channel fNIRS system during a verbal fluency task (VFT). VFT performance, clinical history and symptom severity were also noted. RESULTS Compared to HCs, both patient groups had lower mean oxy-haemoglobin in the frontotemporal cortex during the VFT. Moreover, mean oxy-haemoglobin in the left inferior frontal region is markedly lower in patients with BPD compared to patients with BD. Task performance, clinical history and symptom severity were not associated with mean oxy-haemoglobin levels. CONCLUSIONS Prefrontal cortex activity is disrupted in patients with BD and BPD, but it is more extensive in BPD. These results provide further neurophysiological evidence for the separation of BPD from the bipolar spectrum. fNIRS could be a potential tool for assessing the frontal lobe function of patients who present with symptoms that are common to BD and BPD.
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Affiliation(s)
- Syeda Fabeha Husain
- grid.4280.e0000 0001 2180 6431Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 117599 Singapore ,grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228 Singapore
| | - Tong-Boon Tang
- grid.444487.f0000 0004 0634 0540Centre for Intelligent Signal and Imaging Research (CISIR), University Teknologi PETRONAS, Darul Ridzuan, 32610 Seri Iskandar, Perak Malaysia
| | - Wilson W. Tam
- grid.4280.e0000 0001 2180 6431Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597 Singapore
| | - Bach X. Tran
- grid.21107.350000 0001 2171 9311Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205 USA ,grid.56046.310000 0004 0642 8489Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 116001 Vietnam ,grid.473736.20000 0004 4659 3737Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, 70000 Vietnam
| | - Cyrus S. Ho
- grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228 Singapore
| | - Roger C. Ho
- grid.4280.e0000 0001 2180 6431Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 117599 Singapore ,grid.4280.e0000 0001 2180 6431Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228 Singapore
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Ho RC, Tran BX, McIntyre RS. The impact of COVID-19 pandemic on global mental health: From the general public to healthcare workers. Ann Acad Med Singap 2021. [PMID: 33855314 DOI: 10.47102/annals-acadmedsg.202189] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Wang C, Tee M, Roy AE, Fardin MA, Srichokchatchawan W, Habib HA, Tran BX, Hussain S, Hoang MT, Le XT, Ma W, Pham HQ, Shirazi M, Taneepanichskul N, Tan Y, Tee C, Xu L, Xu Z, Vu GT, Zhou D, Koh BJ, McIntyre RS, Ho C, Ho RC, Kuruchittham V. The impact of COVID-19 pandemic on physical and mental health of Asians: A study of seven middle-income countries in Asia. PLoS One 2021; 16:e0246824. [PMID: 33571297 PMCID: PMC7877638 DOI: 10.1371/journal.pone.0246824] [Citation(s) in RCA: 222] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/27/2021] [Indexed: 01/02/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has impacted the economy, livelihood, and physical and mental well-being of people worldwide. This study aimed to compare the mental health status during the pandemic in the general population of seven middle income countries (MICs) in Asia (China, Iran, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). All the countries used the Impact of Event Scale–Revised (IES-R) and Depression, Anxiety and Stress Scale (DASS-21) to measure mental health. There were 4479 Asians completed the questionnaire with demographic characteristics, physical symptoms and health service utilization, contact history, knowledge and concern, precautionary measure, and rated their mental health with the IES-R and DASS-21. Descriptive statistics, One-Way analysis of variance (ANOVA), and linear regression were used to identify protective and risk factors associated with mental health parameters. There were significant differences in IES-R and DASS-21 scores between 7 MICs (p<0.05). Thailand had all the highest scores of IES-R, DASS-21 stress, anxiety, and depression scores whereas Vietnam had all the lowest scores. The risk factors for adverse mental health during the COVID-19 pandemic include age <30 years, high education background, single and separated status, discrimination by other countries and contact with people with COVID-19 (p<0.05). The protective factors for mental health include male gender, staying with children or more than 6 people in the same household, employment, confidence in doctors, high perceived likelihood of survival, and spending less time on health information (p<0.05). This comparative study among 7 MICs enhanced the understanding of metal health in the general population during the COVID-19 pandemic.
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Affiliation(s)
- Cuiyan Wang
- Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Michael Tee
- College of Medicine, University of the Philippines, Manila, Philippines
| | | | - Mohammad A. Fardin
- Department of Psychology, Zahedan Branch, Islamic Azad University, Zahedan, Iran
| | - Wandee Srichokchatchawan
- College of Public Health Sciences, Chulalongkorn University, a member of Thailand One Health University Network (THOHUN), Bangkok, Thailand
| | - Hina A. Habib
- Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan
| | - Bach X. Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Men T. Hoang
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Xuan T. Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Wenfang Ma
- Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Hai Q. Pham
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Mahmoud Shirazi
- Department of Psychology, University of Sistan and Baluchestan, Zahedan, Iran
| | - Nutta Taneepanichskul
- College of Public Health Sciences, Chulalongkorn University, a member of Thailand One Health University Network (THOHUN), Bangkok, Thailand
| | - Yilin Tan
- Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Cherica Tee
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Linkang Xu
- Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Ziqi Xu
- Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Giang T. Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Danqing Zhou
- Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal University, Huaibei, China
| | - Bernard J. Koh
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Cyrus Ho
- Department of Psychological Medicine, National University Health System, Singapore, Singapore
| | - Roger C. Ho
- Institute for Health Innovation and Technology (iHealthtech), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Vipat Kuruchittham
- Southeast Asia One Health University Network (SEAOHUN), Chiang Mai, Thailand
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Park C, Majeed A, Gill H, Tamura J, Ho RC, Mansur RB, Nasri F, Lee Y, Rosenblat JD, Wong E, McIntyre RS. The Effect of Loneliness on Distinct Health Outcomes: A Comprehensive Review and Meta-Analysis. Psychiatry Res 2020; 294:113514. [PMID: 33130511 DOI: 10.1016/j.psychres.2020.113514] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022]
Abstract
The primary objective was to evaluate the comparative effects of loneliness on multiple distinct health outcomes. The literature was qualitatively reviewed to identify loneliness risk factors, explore mechanisms, and discuss potential evidence-based interventions for targeting loneliness. 114 identified studies were systematically reviewed and analyzed to examine for associations between loneliness (as measured by the UCLA Loneliness or de Jong Gierveld Loneliness Scales) and one or more health outcome(s). Health outcomes were broadly defined to include measures of mental health (i.e., depression, anxiety, suicidality, general mental health), general health (i.e., overall self-rated health), well-being (i.e., quality of life, life satisfaction), physical health (i.e., functional disability), sleep, and cognition. Loneliness had medium to large effects on all health outcomes, with the largest effects on mental health and overall well-being; however, this result may have been confounded by the breadth of studies exploring the association between loneliness and mental health, as opposed to other health outcomes. A significant effect of gender on the association between loneliness and cognition (i.e., more pronounced in studies with a greater proportion of males) was also observed. The adequate training of health care providers to perceive and respond to loneliness among patients should be prioritized.
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Affiliation(s)
- Caroline Park
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Amna Majeed
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Tamura
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Flora Nasri
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Wong
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
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Tee ML, Tee CA, Anlacan JP, Aligam KJG, Reyes PWC, Kuruchittham V, Ho RC. Psychological impact of COVID-19 pandemic in the Philippines. J Affect Disord 2020; 277:379-391. [PMID: 32861839 PMCID: PMC7444468 DOI: 10.1016/j.jad.2020.08.043] [Citation(s) in RCA: 302] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The 2019 coronavirus disease (COVID-19) pandemic poses a threat to societies' mental health. This study examined the prevalence of psychiatric symptoms and identified the factors contributing to psychological impact in the Philippines. METHODS A total of 1879 completed online surveys were gathered from March 28-April 12, 2020. Collected data included socio-demographics, health status, contact history, COVID-19 knowledge and concerns, precautionary measures, information needs, the Depression, Anxiety and Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) ratings. RESULTS The IES-R mean score was 19.57 (SD=13.12) while the DASS-21 mean score was 25.94 (SD=20.59). In total, 16.3% of respondents rated the psychological impact of the outbreak as moderate-to-severe; 16.9% reported moderate-to-severe depressive symptoms; 28.8% had moderate-to-severe anxiety levels; and 13.4% had moderate-to-severe stress levels. Female gender; youth age; single status; students; specific symptoms; recent imposed quarantine; prolonged home-stay; and reports of poor health status, unnecessary worry, concerns for family members, and discrimination were significantly associated with greater psychological impact of the pandemic and higher levels of stress, anxiety and depression (p<0.05). Adequate health information, having grown-up children, perception of good health status and confidence in doctors' abilities were significantly associated with lesser psychological impact of the pandemic and lower levels of stress, anxiety and depression (p<0.05). LIMITATIONS An English online survey was used. CONCLUSION During the early phase of the pandemic in the Philippines, one-fourth of respondents reported moderate-to-severe anxiety and one-sixth reported moderate-to-severe depression and psychological impact. The factors identified can be used to devise effective psychological support strategies.
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Affiliation(s)
- Michael L Tee
- Department of Physiology, College of Medicine, University of the Philippines Manila, Taft Avenue, Manila 1000, Philippines; Philippine One Health University Network.
| | - Cherica A Tee
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Taft Avenue, Manila 1000, Philippines.
| | - Joseph P Anlacan
- Department of Psychiatry and Behavioral Medicine, College of Medicine, University of the Philippines Manila, Taft Avenue, Manila 1000, Philippines
| | - Katrina Joy G Aligam
- Department of Psychiatry and Behavioral Medicine, College of Medicine, University of the Philippines Manila, Taft Avenue, Manila 1000, Philippines
| | | | | | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge 119228, Singapore.
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Chew NWS, Ngiam JN, Tan BYQ, Tham SM, Tan CYS, Jing M, Sagayanathan R, Chen JT, Wong LYH, Ahmad A, Khan FA, Marmin M, Hassan FB, Sharon TML, Lim CH, Mohaini MIB, Danuaji R, Nguyen TH, Tsivgoulis G, Tsiodras S, Fragkou PC, Dimopoulou D, Sharma AK, Shah K, Patel B, Sharma S, Komalkumar RN, Meenakshi RV, Talati S, Teoh HL, Ho CS, Ho RC, Sharma VK. Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic. BJPsych Open 2020; 6:e116. [PMID: 33028449 PMCID: PMC7542327 DOI: 10.1192/bjo.2020.98] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers. AIMS In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes. METHOD From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country. RESULTS A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries. CONCLUSIONS This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
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Affiliation(s)
- Nicholas W S Chew
- Department of Medicine, National University Health System, Singapore
| | | | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore; and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore,Singapore
| | - Sai-Meng Tham
- Department of Medicine, National University Health System, Singapore
| | | | - Mingxue Jing
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | | | - Jin Tao Chen
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Lily Y H Wong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Aftab Ahmad
- Department of Neurology, Ng Teng Fong General Hospital, Singapore
| | - Faheem Ahmed Khan
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, Singapore
| | - Maznah Marmin
- Department of Neurology, Ng Teng Fong General Hospital, Singapore
| | | | | | | | | | | | - Thang H Nguyen
- Cerebrovascular Disease Department, 115 People's Hospital, Vietnam
| | - Georgios Tsivgoulis
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Sotirios Tsiodras
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Paraskevi C Fragkou
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Dimitra Dimopoulou
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | | | | | | | | | | | | | - Shikha Talati
- Department of Psychiatry, Geetanjali Medical College and Hospital, India
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore; and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cyrus S Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | - Roger C Ho
- Department of Psychological Medicine and Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore; and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Tee CA, Salido EO, Reyes PWC, Ho RC, Tee ML. Psychological State and Associated Factors During the 2019 Coronavirus Disease (COVID-19) Pandemic Among Filipinos with Rheumatoid Arthritis or Systemic Lupus Erythematosus. Open Access Rheumatol 2020; 12:215-222. [PMID: 33061689 PMCID: PMC7520098 DOI: 10.2147/oarrr.s269889] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are perceived to be more vulnerable to worse COVID-19 infection outcome. Furthermore, severe shortage in hydroxychloroquine supply was experienced. OBJECTIVE We presented the psychological responses of Filipino SLE and RA patients to the COVID-19 pandemic and shortage of hydroxychloroquine supply. METHODS A total of 512 completed online surveys from SLE and RA patients were gathered from May 19 to 26, 2020. The online survey collected data on socio-demographics, health status, contact history, health service utilization, use of hydroxychloroquine, COVID-19 knowledge and concerns, precautionary measures, information needs, the validated Impact of Events Scale-Revised (IES-R) and Depression, Anxiety and Stress Scales (DASS-21) ratings. RESULTS The psychological impact of COVID-19 outbreak was at least moderate in 20%. The mean IES-R score was higher among SLE (22.34, SD=14.39) than RA (18.85, SD=13.24) patients. Stress, anxiety and depression were moderate to severe in 12.3%, 38.7%, and 27.7% of respondents. The mean stress subscale score was 10.11 (SD=7.95), mean anxiety subscale score was 6.79 (SD=6.57) and mean depression subscale score was 9.03 (SD=8.77). The risk factors for adverse mental health during the COVID-19 pandemic include the presence of comorbidity of hypertension and asthma; being a healthcare worker; and presence of specific symptoms of myalgia, cough, breathing difficulty, dizziness and sore throat. The protective factors for mental health during the pandemic include satisfaction with available health information and wearing of face masks. CONCLUSION In the third month of the pandemic in the Philippines, 20% of the respondents with lupus and RA experienced moderate to severe psychological impact. There was moderate to severe anxiety in 38.7% and moderate to severe depression in 27%. Identification of factors that affect mental health in lupus and RA is useful in implementation of effective psychological support strategies.
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Affiliation(s)
- Cherica A Tee
- Department of Pediatrics, College of Medicine, University of the Philippines, Manila, Philippines
| | - Evelyn O Salido
- Department of Medicine, College of Medicine, University of the Philippines, Manila, Philippines
| | - Patrick Wincy C Reyes
- School of Statistics, University of the Philippines Diliman, Quezon City, Philippines
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
| | - Michael L Tee
- Department of Physiology, College of Medicine, University of the Philippines, Manila, Philippines
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Soh HL, Ho RC, Ho CS, Tam WW. Efficacy of digital cognitive behavioural therapy for insomnia: a meta-analysis of randomised controlled trials. Sleep Med 2020; 75:315-325. [PMID: 32950013 DOI: 10.1016/j.sleep.2020.08.020] [Citation(s) in RCA: 248] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/12/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Although cognitive behavioural therapy for insomnia (CBT-I) has been recommended the initial therapy for insomnia, its clinical usage remains limited due to the lack of therapists. Digital CBT-I (dCBT-I) can potentially circumvent this problem. This meta-analysis aims to evaluate the short-term and long-term efficacy of dCBT-I for adults with insomnia. METHODS Systematic search of PubMed, EMBASE, PsycINFO, and CENTRAL from inception till 5 March 2020 was conducted. Randomised controlled trials (RCTs) comparing dCBT-I with controls (wait-list/treatment-as-usual/online education) in adults with insomnia were eligible. The primary outcome was insomnia severity index (ISI) at post-intervention, short-term follow-up (ranging 4 weeks to 6 months) and 1-year follow-up. Mean differences were pooled using the random-effects model. RESULTS 94 articles were assessed full-text independently by two team members and 33 studies were included in this meta-analysis. 4719 and 4645 participants were randomised to dCBT-I and control respectively. dCBT-I significantly reduces ISI at post-intervention with mean difference -5.00 (95% CI -5.68 to -4.33, p < 0.0001) (I2 = 79%) compared to control. The improvements were sustained at short-term follow-up, -3.99 (95% CI -4.82 to -3.16, p < 0.0001) and 1-year follow-up, -3.48 (95% CI -4.21 to -2.76, p < 0.0001). Compared to dCBT-I, face-to-face CBT-I produced greater improvement in ISI, 3.07 (95% CI 1.18 to 4.95, p = 0.001). However, this was within the non-inferiority interval of 4 points on ISI. CONCLUSION This meta-analysis provides strong support for the effectiveness of dCBT-I in treating insomnia. dCBT-I has potential to revolutionise the delivery of CBT-I, improving the accessibility and availability of CBT-I content for insomnia patients worldwide.
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Affiliation(s)
- Hui Ling Soh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger C Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore.
| | - Cyrus S Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore; Department of Psychological Medicine, National University Health System, Singapore
| | - Wilson W Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH, Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore. Ann Intern Med 2020; 173:317-320. [PMID: 32251513 PMCID: PMC7143149 DOI: 10.7326/m20-1083] [Citation(s) in RCA: 705] [Impact Index Per Article: 176.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Benjamin Y Q Tan
- National University Health System and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (B.Y.T., L.L.Y., V.K.S.)
| | - Nicholas W S Chew
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Grace K H Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K.L.)
| | - Mingxue Jing
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Yihui Goh
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Leonard L L Yeo
- National University Health System and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (B.Y.T., L.L.Y., V.K.S.)
| | - Ka Zhang
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Howe-Keat Chin
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Aftab Ahmad
- Ng Teng Fong General Hospital, Singapore (A.A., F.A.K., G.N.S.)
| | | | | | - Bernard P L Chan
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Sibi Sunny
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Bharatendu Chandra
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Jonathan J Y Ong
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Prakash R Paliwal
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Lily Y H Wong
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Renarebecca Sagayanathan
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Jin Tao Chen
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Alison Ying Ying Ng
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Hock Luen Teoh
- National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)
| | - Cyrus S Ho
- National University of Singapore, Singapore (C.S.H.)
| | - Roger C Ho
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore (R.C.H.)
| | - Vijay K Sharma
- National University Health System and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (B.Y.T., L.L.Y., V.K.S.)
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Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, Yeo LLL, Ahmad A, Ahmed Khan F, Napolean Shanmugam G, Sharma AK, Komalkumar RN, Meenakshi PV, Shah K, Patel B, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH, Sagayanathan R, Chen JT, Ying Ng AY, Teoh HL, Tsivgoulis G, Ho CS, Ho RC, Sharma VK. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun 2020; 88:559-565. [PMID: 32330593 PMCID: PMC7172854 DOI: 10.1016/j.bbi.2020.04.049] [Citation(s) in RCA: 911] [Impact Index Per Article: 227.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers. METHODS Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated. RESULTS Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54-5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36-3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27-7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12-4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales. CONCLUSIONS Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.
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Affiliation(s)
- Nicholas W S Chew
- Department of Medicine, National University Health System, Singapore
| | - Grace K H Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Mingxue Jing
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | | | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Aftab Ahmad
- Department of Neurology, Ng Teng Fong General Hospital, Singapore
| | - Faheem Ahmed Khan
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, Singapore
| | | | - Arvind K Sharma
- Department of Neurology, Zydus Hospital and BJ Hospital, Ahmedabad, India
| | - R N Komalkumar
- Department of Neurology, Yashoda Hospital, Secunderabad, India
| | | | - Kenam Shah
- Department of Neurology, Zydus Hospital and BJ Hospital, Ahmedabad, India
| | - Bhargesh Patel
- Department of Neurology, Zydus Hospital and BJ Hospital, Ahmedabad, India
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Sibi Sunny
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Bharatendu Chandra
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Jonathan J Y Ong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Prakash R Paliwal
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Lily Y H Wong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | | | - Jin Tao Chen
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Alison Ying Ying Ng
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece and The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Cyrus S Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | - Roger C Ho
- Department of Psychological Medicine, National University of Singapore, Singapore; Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore.
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48
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Wang C, Shao X, Jia Y, Ho RC, Harris KM, Wang W. Peripherally Physiological Responses to External Emotions and Their Transitions in Bipolar I Disorder With and Without Hypersexuality. Arch Sex Behav 2020; 49:1345-1354. [PMID: 32133544 DOI: 10.1007/s10508-019-01615-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/28/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
Hypersexuality is associated with psychiatric disorders such as mania; however, it remains unclear whether bipolar I disorder with (BW) or without (BO) hypersexuality demonstrates different responses to external emotional stimuli and their transitions that were composed of pictures and sounds of same domain. In 21 BW patients, 20 BO patients, and 41 healthy volunteers, we administered polygraph tests (electrocardiogram, electromyogram, electrooculogram, and galvanic skin response) to measure transitions from a primer emotion (i.e., external disgust, erotica, fear, happiness, neutral, and sadness) to a noncongruent emotion (out of the remaining five) and to the primer emotion again (repeat-primer). We also evaluated participants' concurrent states of mania, hypomania, and depression. With neutral as the noncongruent emotion, the heart rate difference in BW was greater than in controls when responses to the primer erotica were subtracted from responses to the repeat-primer erotica, or when to the primer sadness were subtracted from the repeat-primer sadness. The difference of the masseter electromyographic activity in BW was lower than in BO and controls when responses to the noncongruent happiness were subtracted from responses to the repeat-primer neutral, and was lower than in BO when to the noncongruent neutral were subtracted from the repeat-primer erotica. The eyeball movement difference was greater in BW than in BO and controls when responses to the noncongruent sadness were subtracted from responses to the repeat-primer neutral. The heart rate difference when responses to the primer happiness were subtracted from responses to the noncongruent neutral was negatively correlated with mania in BO. BW and BO patients behaved differently to external emotions and their transitions, particularly regarding erotica and sadness, which might characterize unique pathophysiological processes of the two bipolar I disorder subtypes.
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Affiliation(s)
- Chu Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Xu Shao
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Yanli Jia
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Keith M Harris
- School of Psychology, Charles Sturt University, Port Macquarie, NSW, Australia
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China.
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.
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Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. IJERPH 2020. [DOI: 10.3390>10.3390/ijerph17051729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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Affiliation(s)
- Fushun Wang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Jiongjiong Yang
- Department of Psychology, Beijing University, Beijing, China
| | - Fang Pan
- Department of Psychology, Shandong University, Jinan, China
| | - Roger C Ho
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health Center, Temple, TX, United States.,Department of Surgery, Texas A&M University, Temple, TX, United States
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