APOE Genotype, ApoE Plasma Levels, Lipid Metabolism, and Cognition in Monozygotic Twins with, at Risk of, and without Affective Disorders

Background: Lipids influence brain function and mental health. Understanding the role of apolipoproteins in affective disorders could provide valuable insights and potentially pave the way for novel therapeutic approaches. Methods: We examined the apolipoprotein E genotype and ApoE-levels, lipid profiles, and the correlation with cognition in 204 monozygotic (MZ) twins with unipolar or bipolar disorder in remission or partial remission (affected, AT), their unaffected co-twins (high-risk, HR), and twins with no personal or family history of affective disorder (low-risk, LR). Results: The APOE genotype was not associated with affective disorders. No significant group differences in ApoE levels were found between the three risk groups. Post hoc analysis group-wise comparisons showed higher ApoE levels in the AT than HR twins and in the concordant AT twin pairs relative to the discordant twin pairs. Within the discordant twin pairs, higher ApoE levels were observed in the affected twins (AT = 39.4 mg/L vs. HR = 36.8 mg/L, p = 0.037). Limitations: The present study could benefit from a larger sample size. We did not assess dietary habits. Conclusions: The results did not support our main hypothesis. However, exploratory post hoc analysis suggests a role for plasma ApoE and triglycerides in affective disorders. Future research is needed.

Treating neuropathic pain and comorbid affective disorders: Preclinical and clinical evidence

INTRODUCTION

Neuropathic pain (NP) significantly impacts quality of life and often coexists with affective disorders such as anxiety and depression. Addressing both NP and its psychiatric manifestations requires a comprehensive understanding of therapeutic options. This study aimed to review the main pharmacological and non-pharmacological treatments for NP and comorbid affective disorders to describe their mechanisms of action and how they are commonly used in clinical practice.

METHODS

A review was conducted across five electronic databases, focusing on pharmacological and non-pharmacological treatments for NP and its associated affective disorders. The following combination of Mesh and title/abstract keywords were used: "neuropathic pain," "affective disorders," "depression," "anxiety," "treatment," and "therapy." Both animal and human studies were included to discuss the underlying therapeutic mechanisms of these interventions.

RESULTS

Pharmacological interventions, including antidepressants, anticonvulsants, and opioids, modulate neural synaptic transmission to alleviate NP. Topical agents, such as capsaicin, lidocaine patches, and botulinum toxin A, offer localized relief by desensitizing pain pathways. Some of these drugs, especially antidepressants, also treat comorbid affective disorders. Non-pharmacological techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and photobiomodulation therapy, modulate cortical activity and have shown promise for NP and mood disorders.

CONCLUSIONS

The interconnection between NP and comorbid affective disorders necessitates holistic therapeutic strategies. Some pharmacological treatments can be used for both conditions, and non-pharmacological interventions have emerged as promising complementary approaches. Future research should explore novel molecular pathways to enhance treatment options for these interrelated conditions.

Weakened effective connectivity between salience network and default mode network during resting state in adolescent depression

Adolescent major depressive disorder (MDD) is associated with altered resting-state connectivity between the default mode network (DMN) and the salience network (SN), which are involved in self-referential processing and detecting and filtering salient stimuli, respectively. Using spectral dynamical causal modelling, we investigated the effective connectivity and input sensitivity between key nodes of these networks in 30 adolescents with MDD and 32 healthy controls while undergoing resting-state fMRI. We found that the DMN received weaker inhibition from the SN and that the medial prefrontal cortex and the anterior cingulate cortex showed reduced self-inhibition in MDD, making them more prone to external influences. Moreover, we found that selective serotonin reuptake inhibitor (SSRI) intake was associated with decreased and increased self-inhibition of the SN and DMN, respectively, in patients. Our findings suggest that adolescent MDD is characterized by a hierarchical imbalance between the DMN and the SN, which could affect the integration of emotional and self-related information. We propose that SSRIs may help restore network function by modulating excitatory/inhibitory balance in the DMN and the SN. Our study highlights the potential of prefrontal-amygdala interactions as a biomarker and a therapeutic target for adolescent depression.

Network analysis of neuropsychiatric, cognitive, and functional complications of stroke: implications for novel treatment targets

AIM

Recovery from stroke is adversely affected by neuropsychiatric complications, cognitive impairment, and functional disability. Better knowledge of their mutual relationships is required to inform effective interventions. Network theory enables the conceptualization of symptoms and impairments as dynamic and mutually interacting systems. We aimed to identify interactions of poststroke complications using network analysis in diverse stroke samples.

METHODS

Data from 2185 patients were sourced from member studies of STROKOG (Stroke and Cognition Consortium), an international collaboration of stroke studies. Networks were generated for each cohort, whereby nodes represented neuropsychiatric symptoms, cognitive deficits, and disabilities on activities of daily living. Edges characterized associations between them. Centrality measures were used to identify hub items.

RESULTS

Across cohorts, a single network of interrelated poststroke complications emerged. Networks exhibited dissociable depression, apathy, fatigue, cognitive impairment, and functional disability modules. Worry was the most central symptom across cohorts, irrespective of the depression scale used. Items relating to activities of daily living were also highly central nodes. Follow-up analysis in two studies revealed that individuals who worried had more densely connected networks than those free of worry (CASPER [Cognition and Affect after Stroke: Prospective Evaluation of Risks] study: S = 9.72, P = 0.038; SSS [Sydney Stroke Study]: S = 13.56, P = 0.069).

CONCLUSION

Neuropsychiatric symptoms are highly interconnected with cognitive deficits and functional disabilities resulting from stroke. Given their central position and high level of connectedness, worry and activities of daily living have the potential to drive multimorbidity and mutual reinforcement between domains of poststroke complications. Targeting these factors early after stroke may have benefits that extend to other complications, leading to better stroke outcomes.

The development of type 2 diabetes management in people with severe mental illness in the Capital Region of Denmark from 2001 to 2015

BACKGROUND

Type 2 diabetes (T2D) treatment has changed markedly within the last decades. We aimed to explore whether people with severe mental illness (SMI) have followed the same changes in T2D treatment as those without SMI, as multiple studies suggest that people with SMI receive suboptimal care for somatic disorders.

METHODS

In this registry-based annual cohort study, we explored the T2D treatment from 2001 to 2015 provided in general practices of the Greater Copenhagen area. We stratified the T2D cohorts by their pre-existing SMI status. T2D was defined based on elevated glycated hemoglobin (≥48 mmol/mol) or glucose (≥11 mmol/L) using data from the Copenhagen Primary Care Laboratory Database. Individuals with schizophrenia spectrum disorders (ICD-10 F20-29) or affective disorders (bipolar disorder or unipolar depression, ICD-10 F30-33) were identified based on hospital-acquired diagnoses made within 5 years before January 1 each year for people with prevalent T2D or 5 years before meeting our T2D definition for incident patients. For comparison, we defined a non-SMI group, including people who did not have a hospital-acquired diagnosis of schizophrenia spectrum disorders, affective disorders, or personality disorders. For each calendar year, we assembled cohorts of people with T2D with or without SMI. We used Poisson regression to calculate the rates per 100 person-years of having at least one biochemical test (glycated hemoglobin, low-density lipoprotein cholesterol, estimated glomerular filtration rate, and urine albumin-creatinine ratio), having poor control of these biochemical results, taking glucose-lowering or cardiovascular medications, or experiencing a clinical outcome, including all-cause mortality and cardiovascular mortality. Three outcomes (cardiovascular events, cardiovascular mortality, and all-cause mortality) were additionally examined and adjusted for age and sex in a post hoc analysis.

RESULTS

From 2001 to 2015, 66,914 individuals were identified as having T2D. In 2015, 1.5% of the study population had schizophrenia spectrum disorder and 1.4% had an affective disorder. The number of people who used biochemical tests or had poor biochemical risk factor control was essentially unrelated to SMI status. One exception was that fewer LDL cholesterol tests were done on people with affective disorders and schizophrenia spectrum disorders at the beginning of the study period compared to people in the non-SMI group. This difference gradually diminished and was almost nonexistent by 2011. There was also a slightly slower rise in UACR test rates in the SMI groups compared to other people with T2D during the period. Throughout the study period, all groups changed their use of medications in similar ways: more metformin, less sulfonylurea, more lipid-lowering drugs, and more ACEi/ARBs. However, people with schizophrenia disorder consistently used fewer cardiovascular medications. Cardiovascular events were more common in the affective disorder group compared to the non-SMI group from 2009 to 2015 (rate ratio 2015 : 1.36 [95% CI 1.18-1.57]). After adjustment for age and sex, all-cause mortality was significantly higher among people with a schizophrenia spectrum disorder each year from 2003 to 2015 compared to the non-SMI group (rate ratio 2015 : 1.99 [95% CI 1.26-3.12]).

CONCLUSION

Persons with schizophrenia or affective disorders demonstrated the same treatment changes for T2D as those without SMI in general practice. The lower use of most types of cardiovascular medications among people with schizophrenia disorders indicates potential undertreatment of hypertension and dyslipidemia and remains throughout the study period. Cardiovascular events were most common among people with affective disorders, but this was not reflected in a higher proportion using cardiovascular preventive medications. This knowledge should be considered in the management of this vulnerable patient group.

SARS-CoV-2 and Adolescent Psychiatric Emergencies at the Tübingen University Hospital: Analyzing Trends, Diagnoses, and Contributing Factors

Psychiatric emergencies have increased in recent decades, particularly with the onset of the SARS-CoV-2 pandemic, and far too little is known about the backgrounds of these emergencies. In this study, we investigated the extent to which the number of psychiatric emergencies changed during and in the aftermath of the SARS-CoV-2 pandemic at the Child and Adolescent Psychiatry (CAP) Tübingen. We considered age and psychiatric diagnoses. Additionally, we evaluated the backgrounds of the emergencies. We applied a mixed- (quantitative and qualitative) methods approach to data on emergency presentations at the CAP Tübingen from the pre-SARS-CoV-2 pandemic period (October 2019-January 2020) to Restriction Phase 1 (October 2020-January 2021), Restriction Phase 2 (October 2021-January 2022), and endemic phase (October 2022-January 2023). The total number of emergencies and those with eating disorders and affective disorders increased, while obsessive-compulsive disorders, expansive disorders and anxiety disorders decreased. The patients presenting in the pre-SARS-CoV-2 pandemic period were younger than those in the subsequent periods. We content-coded the reasons behind the emergency presentations. We also identified four areas of stressors and personality characteristics associated with the emergency presentations. In light of the increasing number of psychiatric emergencies, the long-term aim should be to meet the growing demands and create options for prevention.

Distress Symptoms of Old Age and Mild Cognitive Impairment are Two Distinct Dimensions in Older Adults Without Major Depression

Background

Studies in old adults showed bidirectional interconnections between amnestic mild cognitive impairment (aMCI) and affective symptoms and that adverse childhood experiences (ACE) may affect both factors. Nevertheless, these associations may be confined to older adults with clinical depression.

Aim

To delineate the relationship between clinical symptoms of aMCI and affective symptoms in older adults without major depression (MDD) or dysfunctions in activities of daily living (ADL).

Methods

This case-control study recruited 61 participants with aMCI (diagnosed using Petersen's criteria) and 59 older adults without aMCI and excluded subjects with MDD and ADL dysfunctions.

Results

We uncovered 2 distinct dimensions, namely distress symptoms of old age (DSOA), comprising affective symptoms, perceived stress and neuroticism, and mild cognitive dysfunctions, comprising episodic memory test scores, the total Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. A large part of the variance (37.9%) in DSOA scores was explained by ACE, negative life events (health and financial problems), a subjective feeling of cognitive decline, and education (all positively). ACE and NLE have a highly significant impact on the DSOA score and are not associated with aMCI or its severity. Cluster analysis showed that the diagnosis of aMCI is overinclusive because some subjects with DSOA symptoms may be incorrectly classified as aMCI.

Conclusion

The clinical impact is that clinicians should carefully screen older adults for DSOA after excluding MDD. DSOA might be misinterpreted as aMCI.

Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records

BACKGROUND

There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research.

AIMS

This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery-Åsberg Depression Rating Scale (MADRS-6).

METHOD

A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation.

RESULTS

The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set.

CONCLUSIONS

The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.

How do we make progress in phenotyping patients with LUT such as OAB and underactive detrusor, including using urine markers and microbiome data, in order to personalize therapy? ICI-RS 2023: Part 1

INTRODUCTION

Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction.

OBJECTIVES

The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment.

METHODS

A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment.

RESULTS AND CONCLUSIONS

The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract symptoms, such as OAB and UAB. The intricate interplay between the lower urinary tract and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.

[Features of the clinical picture of affective disorders in women during the menopausal transition and early postmenopause]

OBJECTIVE

To determine the clinical and psychopathological features of affective disorders in women in the perimenopausal and early postmenopausal periods.

MATERIAL AND METHODS

The study included 90 female patients receiving inpatient psychiatric care for affective disorders, among them 41 patients were perimenopausal (group 1) and 49 were early postmenopausal (group 2). Clinical and psychopathological, psychometric (the Hospital Anxiety and Depression Scale - HADS, the Hamilton Depression and Anxiety Scales - HAM-D and HAM-A, the Hypomania Checklist-32 - HCL-32, the Bipolarity Index (BI), the Insomnia Severity Index - ISI, the Pittsburgh Sleep Quality Index - PSQI) and statistical methods were used.

RESULTS

Symptoms of atypical (63.4%) and anxious (87.8%) depression predominated among perimenopausal patients, and melancholic depression (59.2%) prevailed in early postmenopause. Patients in group 1 had higher anxiety scores on HADS and HAM-A compared to group 2 (p=0.003 and p=0.01). At the same time, early postmenopausal women had higher depression scores on the HADS and HAM-D (p=0.001). ISI and PSQI scores in postmenopause were significantly higher than in perimenopause (p=0.001 and p=0.009).

CONCLUSION

The clinical features of affective disorders as well as severity and nature of the accompanying sleep disturbances vary depending on the stage of menopause, which must be considered when prescribing additional methods for examination and treatment of these disorders.

Brooding and neuroticism are strongly interrelated manifestations of the phenome of depression

Introduction

We found that neuroticism may be identified as a subclinical manifestation of the phenome of depression, comprising depressive and anxiety symptoms, and suicidal behaviors. Rumination is positively associated with depression and neuroticism and may mediate the effects of neuroticism on depression. This study aimed to determine whether rumination or its components, including brooding or reflection, mediate the effects of neuroticism on depression or, alternatively, whether both neuroticism and rumination are manifestations of the phenome of depression.

Methods

This study recruited 74 depressed subjects and 44 healthy controls. The depression group was split into groups with high versus low brooding scores. We used partial least squares (PLS) to examine mediation effects.

Results

We found that brooding and reflection scores are significantly higher in depressed patients than in controls. Patients with higher brooding scores have increased severity of depression, anxiety, insomnia, neuroticism, and current suicidal ideation as compared with patients with lower brooding scores and controls. There is a strong positive association between rumination, and neuroticism, depression, anxiety, and lifetime and current suicidal behaviors. PLS analysis shows that brooding does not mediate the effects of neuroticism on the depression phenome because no discriminant validity could be established between neuroticism and brooding, or between neuroticism and brooding and the depression phenome. We were able to extract one validated latent vector from brooding and neuroticism, insomnia, depression, anxiety, and current suicidal behaviors.

Conclusion

Overall, this study supports the theory that rumination and neuroticism are reflective manifestations of the phenome of depression.

Applications of dialectical behavioural therapy in the perinatal period: A scoping review

Psychological distress is the most common complication of pregnancy. High-risk concerns can include severe emotion dysregulation, suicidality and self-injury, and health risk behaviours, which bear substantial consequences for caregivers and families. Yet, effective, comprehensive interventions for high-risk caregivers have received limited attention. Dialectical behaviour therapy (DBT) is a frontline treatment for such concerns. Accordingly, we conducted a scoping review on the implementation of DBT in the perinatal period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Seven studies were identified; study designs included case studies and single-arm pilot trials. Most studies used DBT-informed protocols with significant adaptations, few included multiple components of DBT (i.e. skills group, individual therapy, phone coaching and consultation team), and none met criteria for adherent delivery of all four modes of DBT treatment. Findings suggest DBT-informed interventions may be successfully implemented to treat a range of perinatal mental health symptoms, including borderline personality disorder, depression, anxiety, and post-traumatic stress, and to promote emotion regulation and positive parenting behaviours. While results provide preliminary support for perinatal DBT, this literature is scant and empirical rigour considerably lacking. Clinical implications and future directions are outlined to aid researchers and providers in addressing the ongoing perinatal mental health crisis and developing sorely needed interventions to address the needs of high-risk caregivers.

A longitudinal study on depression and anxiety in college students during the first 106-days of the lengthy Argentinean quarantine for the COVID-19 pandemic

BACKGROUND

The Argentinean quarantine is among the strictest and longest quarantines in the world. To determine if a worsening pattern on mental health would emerge with a prolonged quarantine duration, a longitudinal analysis pertaining to the lengthy mandatory Argentinean quarantine was conducted.

AIM

To examine depression and anxiety changes in college students, as a function of quarantine duration, demographic and health-related factors, during successive time cuts of the lengthy mandatory quarantine in Argentina.

METHODS

We used a longitudinal design, N = 1492 college students. For the first measurement, successive samplings were carried out across quarantine sub-periods of up to 106-days duration. The follow-up was one month later.

RESULTS

Particularly women, young, and having a history of mental disorder and suicidal behavior, were more depressed and anxious under mandatory restrictive quarantine conditions. Repeated measures of both depression and anxiety scores remained constantly high during the more restrictive quarantine sub-periods of up to 13 and 53-days duration, and decreased during the less restrictive quarantine sub-period of up to 106-days duration, but with small effect sizes (0.10-0.08).

CONCLUSIONS

Restrictive quarantine has negative effects on mental health outcomes. Partial spontaneous remissions of depression and anxiety symptoms may be expected with further quarantine relaxations.

Oral Health-Related Quality of Life in Adult Patients with Depression or Attention Deficit Hyperactivity Disorder (ADHD)

The aim of this cross-sectional study was the evaluation of the oral health-related quality of life (OHRQoL) in patients with depression or attention-deficit/hyperactivity disorder (ADHD) in comparison with a group of mentally healthy individuals. Patients from the Department of Psychiatry and Psychotherapy, University of Leipzig, Germany, were recruited. A healthy comparison group (HC) was recruited from the Department of Cariology, Endodontology and Periodontology. The OHRQoL was assessed using the Oral Health Impact Profile G14 (OHIP G14). Furthermore, a questionnaire regarding oral hygiene behaviour was applied. A total of 141 patients with depression or ADHD (depression n = 94, ADHD n = 47) and 145 HC individuals with a balanced age and gender distribution were surveyed. OHIP G14 median scores were significantly higher in the overall psychiatric patient group compared to HC (5.00 vs. 0.00, p < 0.001). This was also found for the four dimensions of OHIP G14 (p < 0.001). The OHIP G14 sum score of patients with depression and ADHD was comparable (5.00 vs. 6.50, p = 0.302). A significant association among psychiatric patients between smoking, gum bleeding, professional tooth cleaning, oral health education, interdental cleaning, and elevated OHIP scores was found (p < 0.001). In conclusion, patients with depression and adults with ADHD show a reduced OHRQoL. A contradictory association between oral hygiene/oral health behaviour and OHRQoL supports the hypothesis of a changed perception of oral conditions in patients with mental diseases. Interdisciplinary collaboration between psychiatric specialists and dentists should be fostered.

Interleukin-1β and TNF-α are elevated in the amygdala of adult rats prenatally exposed to ethanol

Affective disorders, including anxiety and depression, developed in adult offspring of the mothers who consumed alcohol during pregnancy could be associated with an imbalance in neuroimmune factors in the amygdala (corpus amygdaloideum) resulted in impaired emotional stimulus processing. The aim of this study was to compare the content of cytokines TNF-α, IL-1α, IL-1β, IL-10, and IL-17 in the amygdala of adult female rats exposed to alcohol in utero and control rats. Cytokine levels were evaluated using a multiplex immunoassay system; mRNA expression was investigated using a real-time reverse transcription-polymerase chain reaction (RT-qPCR) assay. Prenatal alcohol exposure led to the increase in the content of TNF-α and IL-1β without significant changes in the mRNA expression level. Our data suggest that ethanol exposure to the fetus during pregnancy can result in long-term alterations in the content of the key neuroinflammatory factors in the amygdala, which in turn can be a risk factor for affective disorders in the adulthood.

Using polygenic risk scores to investigate the evolution of smoking and mental health outcomes in UK biobank participants

OBJECTIVE

Mendelian randomization studies report a bi-directional relation between cigarette smoking and mental disorders, yet from a clinical standpoint, mental disorders are the focus of treatment. Here, we used an event history framework to understand their evolution in the life course. Our objective was to estimate the relative contribution of genetic predispositions and self-reported smoking status (never, former, and present smoker) to hospitalizations for major depression, bipolar disorder, and schizophrenia.

METHODS

We calculated polygenic risk scores (PRS) for ever smoking, pack-years of smoking as a proportion of adult life, and neuroticism in 337,140 UK Biobank participants of white British ancestry. These PRS and self-reported smoking status were entered as explanatory variables in survival models for hospitalization.

RESULTS

The estimated single nucleotide polymorphisms heritabilities (h2 ) were 23%, 5.7%, and 5.7% for pack-years, ever smoking, and neuroticism respectively. PRS pack-years and PRS neuroticism were associated with higher hospitalization risk for mental disorders in all smoking status groups. The hazard for mental health hospitalization was higher in both previous (HR: 1.50, CI: 1.35-1.67) and current (HR: 3.58, 2.97-4.31) compared to never smokers, after adjusting for confounders.

CONCLUSION

Since genetic liabilities for smoking and neuroticism are fixed at conception and smoking initiation generally started before age 20, our results show that preventing smoking in adolescents probably prevents the development of mental disorders.

Patient Perceptions of In Vivo Versus Virtual Reality Exposures for the Treatment of Anxiety Disorders: Cross-Sectional Survey Study

BACKGROUND

Psychotherapy, and particularly exposure therapy, has been proven to be an effective treatment for many anxiety disorders, including social and specific phobias, as well as posttraumatic stress disorders. Currently, exposures are underused and mostly delivered in vivo. Virtual reality exposure therapy (VRET) offers a more flexible delivery mechanism that has the potential to address some of the implementation barriers of in vivo exposures while retaining effectiveness. Yet, there is little evidence on how patients perceive different exposure therapy methods.

OBJECTIVE

This study aims to explore the perceptions of individuals with anxiety disorders toward in vivo and VRET. Our findings can inform therapists about the degree of patient interest in both methods while exploring the demand for VRET as an alternative and novel treatment approach.

METHODS

Web-based survey assessing the (1) interest in, (2) willingness to use, (3) comfort with, (4) enthusiasm toward, and (5) perceived effectiveness of exposure therapy when delivered in vivo and through VR. Participants included individuals with specific phobia, social phobia, posttraumatic stress disorder, or acute stress disorder or reaction. Participants were presented with educational videos about in vivo and VRET and asked to provide their perceptions quantitatively and qualitatively through a rated scale and free-text responses.

RESULTS

In total, 184 surveys were completed and analyzed, in which 82% (n=151) of participants reported being willing to receive in vivo exposures and 90.2% (n=166) reported willingness to receive VRET. Participants reported higher interest in, comfort with, enthusiasm toward, and perceived effectiveness of VRET compared to in vivo. Most reported in vivo concerns were linked to (1) increased anxiety, (2) feelings of embarrassment or shame, and (3) exacerbation of current condition. Most reported VRET concerns were linked to (1) risk of side effects including increased anxiety, (2) efficacy uncertainty, and (3) health insurance coverage. The most frequently mentioned VRET benefits include (1) privacy, (2) safety, (3) the ability to control exposures, (4) comfort, (5) the absence of real-life consequences, (6) effectiveness, and (7) customizability to a wider variety of exposures.

CONCLUSIONS

On average, our participants expressed positive perceptions toward exposure therapy, with slightly more positive perceptions of VRET over in vivo exposures. Despite valid personal concerns and some misconceptions, our findings emphasize that VRET provides an opportunity to get much-needed therapy to patients in ways that are more acceptable and less concerning.

Psychodermatological Disorders in Patients With Primary Psychiatric Conditions: Cross-Sectional Study

BACKGROUND

Psychodermatological disorders (PDs) and their associations with mental health problems are one of the most frequent research themes in dermatology outpatient settings. Surprisingly, very few studies have been conducted to evaluate PDs among patients with primary psychiatric conditions. As such, the relationship between preexisting psychiatric conditions and comorbid PDs is underrepresented in the literature.

OBJECTIVE

This study examined the prevalence and distribution of PDs among adults with primary psychiatric conditions and determined their association with underlying psychiatric diagnoses.

METHODS

We conducted a cross-sectional analysis at a tertiary health care facility in southwestern Nigeria. Comorbid PDs were identified and classified using preexisting classification systems. A bivariate analysis was conducted to determine the association between PDs and underlying psychiatric conditions. The level of statistical significance was set at P<.05.

RESULTS

The study included 107 patients with mental health disorders, of whom 64 (59.8%) were female. The mean age of the patients was 40.73 (SD 13.08) years. A total of 75 (75/107, 70%) patients had at least one comorbid PD. The prevalence of PDs was highest in patients with affective disorders (15/20, 75%) and least in those with schizophrenia (45/66, 68%). PDs associated with delusions or hallucinations and somatoform symptoms were 9 and 13 times more frequent in patients with anxiety disorders compared to those with other psychiatric conditions (P=.01; odds ratio [OR] 9.88, 95% CI 1.67-58.34 and P=.003; OR 13.13, 95% CI 2.34-73.65), respectively. In contrast, patients with schizophrenia were significantly less likely to be diagnosed with dermatoses resulting from delusions or hallucinations (P=.002; OR 0.04, 95% CI 0.00-0.75). A weak but significant negative association was also found between psychophysiological PDs and anxiety disorders (ϕ=-0.236; P=.02).

CONCLUSIONS

This study provides important insights into the overwhelming burden of psychodermatological conditions in patients with mental health disorders and specific associations with underlying psychiatric diagnosis.

Associations between sleep complaints, suicidal ideation and depressive symptoms among adolescents and young adults in Greece

Depression prevalence increases significantly during adolescence/early adulthood. Depression in youth may present suicidal ideation, while suicide represents the leading cause of death in this age group. Moreover, adolescents/young adults frequently report sleep complaints that may partially be due to depressive symptoms. Studies on the associations between depression, sleep complaints and suicidality in this age group are limited. We aimed to examine associations between depressive symptoms, sleep complaints and suicidal ideation in a large (n = 2771), representative sample of adolescents (age: 15-17 years, n = 512) and young adults (age: 18-24 years, n = 2259) from the general population in Greece. A telephone structured questionnaire was administered. Depressive symptoms were assessed using the modified Patient Health-7 questionnaire score, while presence of suicidal ideation and sleep complaints were assessed using the ninth and third question of Patient Health-9 questionnaire, respectively. Mediation logistic regression analysis revealed significant direct paths from depressive symptoms to sleep complaints (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.19-1.24; OR 1.21, 95% CI 1.18-1.24) and suicidal ideation (OR 1.18, 95% CI 1.14-1.22; OR 1.18, 95% CI 1.14-1.22), as well as sleep complaints and suicidal ideation (OR 1.82, 95% CI 1.32-2.50; OR 1.91, 95% CI 1.33-2.76) in the total group and in young adults, respectively, but not among adolescents. Moreover, we detected a significant indirect effect of depressive symptoms on suicidal ideation mediated by sleep complaints (18.8%) in young adults. These findings support the hypothesis that treatment of sleep disturbances among youth with depression may independently further reduce suicidal risk.

Acute Psychosis and Mania: An Uncommon Complication of Dengue Fever

Dengue fever is primarily known as a mosquito-borne viral infection that causes a range of physical symptoms, ranging from myalgia to bleeding tendencies. However, there is growing recognition of its potential to trigger psychiatric manifestations, although such cases remain relatively rare. We report a case of acute dengue fever in a 25-year-old male who developed mania and psychotic symptoms after one week of infection. A comprehensive diagnostic workup, including laboratory tests, including cerebrospinal fluid analysis, and neuroimaging, confirmed the absence of organic causes for his psychiatric symptoms, except for his prior exposure to the dengue virus. The patient was initiated on mood stabilizers and antipsychotic medications, leading to a gradual improvement in his mental health.

When practice does not make a perfect - paradoxical learning curve in schizophrenia and bipolar disorder revealed by different serial reaction time task variants

Introduction

Our previous studies identified a paradoxical implicit motor learning curve in schizophrenia (SZ) and bipolar disorder (BD) patients. This study aimed to verify whether those previously observed deficits may be captured by a new version of the ambidextrous serial reaction time task (SRTT), prepared for use in the MRI.

Methods

This study involved 186 participants. A total of 97 participants (33 BD, 33 SZ, and 31 healthy controls, HCs) completed the original, unlimited time response variant of SRTT. A total of 90 individuals (30 BD, 30 SZ, and 30 HCs) underwent a newer, limited response time version of this procedure.

Results

There was no significant difference in terms of implicit motor learning indices between both limited and unlimited response time SRTT. Compared to HCs, SZ, and BD patients presented decreased indices of implicit motor learning. Both clinical groups showed a paradoxical learning pattern that differed significantly from the HCs. Moreover, in the SZ group, the pattern depended on the hand performing SRTT.

Discussion

The limited response time SRTT variant allowed us to replicate the findings of disrupted implicit motor learning in SZ and BD. The use of this paradigm in further neuroimaging studies may help to determine the neuronal underpinnings of this cognitive dysfunction in the abovementioned clinical groups.

Progressive grey matter alterations in bipolar disorder across the life span - A systematic review

OBJECTIVES

To elucidate the relationship between the course of bipolar disorder (BD) and structural brain changes across the life span, we conducted a systematic review of longitudinal imaging studies in adolescent and adult BD patients.

METHODS

Eleven studies with 329 BD patients and 277 controls met our PICOS criteria (participants, intervention, comparison, outcome and study design): BD diagnosis based on DSM criteria, natural course of disease, comparison of grey matter changes in BD individuals over ≥1-year interval between scans.

RESULTS

The selected studies yielded heterogeneous findings, partly due to varying patient characteristics, data acquisition and statistical models. Mood episodes were associated with greater grey matter loss in frontal brain regions over time. Brain volume decreased or remained stable in adolescent patients, whereas it increased in healthy adolescents. Adult BD patients showed increased cortical thinning and brain structural decline. In particular, disease onset in adolescence was associated with amygdala volume reduction, which was not reported in adult BD.

CONCLUSIONS

The evidence collected suggests that the progression of BD impairs adolescent brain development and accelerates structural brain decline across the lifespan. Age-specific changes in amygdala volume in adolescent BD suggest that reduced amygdala volume is a correlate of early onset BD. Clarifying the role of BD in brain development across the lifespan promises a deeper understanding of the progression of BD patients through different developmental episodes.

Longitudinal Digital Mood Charting in Bipolar Disorder: Experiences with ChronoRecord Over 20 Years

INTRODUCTION

Longitudinal study is an essential methodology for understanding disease trajectories, treatment effects, symptom changes, and long-term outcomes of affective disorders. Daily self-charting of mood and other illness-related variables is a commonly recommended intervention. With the widespread acceptance of home computers in the early 2000s, automated tools were developed for patient mood charting, such as ChronoRecord, a software validated by patients with bipolar disorder. The purpose of this study was to summarize the daily mood, sleep, and medication data collected with ChronoRecord, and highlight some of the key research findings. Lessons learned from implementing a computerized tool for patient self-reporting are also discussed.

METHODS

After a brief training session, ChronoRecord software for daily mood charting was installed on a home computer and used by 609 patients with affective disorders.

RESULTS

The mean age of the patients was 40.3±11.8 years, a mean age of onset was 22±11.2 years, and 71.4% were female. Patients were euthymic for 70.8% of days, 15.1% had mild depression, 6.6% had severe depression, 6.6% had hypomania, and 0.8% had mania. Among all mood groups, 22.4% took 1-2 medications, 37.2% took 3-4 medications, 25.7 took 5-6 medications, 11.6% took 7-8 medications, and 3.1% took >8 medications.

CONCLUSION

The daily mood charting tool is a useful tool for increasing patient involvement in their care, providing detailed patient data to the physician, and increasing understanding of the course of illness. Longitudinal data from patient mood charting was helpful in both clinical and research settings.

Metabolic Syndrome in Affective Disorders: Associations with Dark Triad Personality Traits

Previous research has focused on the relationship between affective disorders (AD) and metabolic syndrome (MetS). Aside from biological and lifestyle factors, personality traits were identified as influencing aspects. In particular, the Dark Triad personality traits (DT; Machiavellianism, narcissism, psychopathy) were connected to both AD and worse somatic health, thus possibly resulting in MetS. This observational study aimed to investigate the associations between DT and anthropometric parameters and differences in the DT traits concerning the presence of MetS in individuals with AD. A total of 112 individuals (females = 59, males = 51, diverse = 2, Mage = 47.5, SDage = 11.5) with AD filled out the Short Dark Triad questionnaire. Body Mass Index (BMI) and MetS criteria, including blood pressure, waist circumference, lipid, and glucose levels, were assessed. For Machiavellianism, a positive association with BMI (r = 0.29, p < 0.05) and a negative association with systolic blood pressure (r = -0.23, p < 0.05) were found. No relationship between the overall MetS and DT score (r = 0.08, p = 0.409) was observed. The results were limited by the lack of a control group and the cross-sectional study design, which does not allow for the determination of causality. Machiavellianism was associated with a higher BMI and lower systolic blood pressure, indicating a deteriorating health effect of this trait. Possibly, the higher prevalence of MetS in AD stems from aspects such as lifestyle or medication intake, which might also be influenced by DT. Further research is needed to disentangle underlying mechanisms.

Empowerment group therapy for refugees with affective disorders: results of a multicenter randomized controlled trial

BACKGROUND

Against the background of missing culturally sensitive mental health care services for refugees, we developed a group intervention (Empowerment) for refugees at level 3 within the stratified Stepped and Collaborative Care Model of the project Mental Health in Refugees and Asylum Seekers (MEHIRA). We aim to evaluate the effectiveness of the Empowerment group intervention with its focus on psychoeducation, stress management, and emotion regulation strategies in a culturally sensitive context for refugees with affective disorders compared to treatment-as-usual (TAU).

METHOD

At level 3 of the MEHIRA project, 149 refugees and asylum seekers with clinically relevant depressive symptoms were randomized to the Empowerment group intervention or TAU. Treatment comprised 16 therapy sessions conducted over 12 weeks. Effects were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery-Åsberg Depression Rating Scale (MÅDRS). Further scales included assessed emotional distress, self-efficacy, resilience, and quality of life.

RESULTS

Intention-to-treat analyses show significant cross-level interactions on both self-rated depressive symptoms (PHQ-9; F(1,147) = 13.32, p < 0.001) and clinician-rated depressive symptoms (MÅDRS; F(1,147) = 6.91, p = 0.01), indicating an improvement in depressive symptoms from baseline to post-intervention in the treatment group compared to the control group. The effect sizes for both scales were moderate (d = 0.68, 95% CI 0.21-1.15 for PHQ-9 and d = 0.51, 95% CI 0.04-0.99 for MÅDRS).

CONCLUSION

In the MEHIRA project comparing an SCCM approach versus TAU, the Empowerment group intervention at level 3 showed effectiveness for refugees with moderately severe depressive symptoms.

Shared sorrow, shared costs: cost-effectiveness analysis of the Empowerment group therapy approach to treat affective disorders in refugee populations

BACKGROUND

Refugees and asylum seekers (RAS) in Germany need tailored and resource-oriented mental healthcare interventions.

AIMS

To evaluate the cost-effectiveness of group psychotherapy for RAS with moderate depressive symptoms.

METHOD

This is a post hoc cost-effectiveness analysis of Empowerment group psychotherapy that was embedded in a stratified stepped and collaborative care model (SCCM) from the multicentre randomised controlled MEHIRA trial. One hundred and forty-nine participants were randomly assigned to SCCM or treatment as usual (TAU) and underwent Empowerment (i.e. level 3 of the SCCM for adults) or TAU. Effects were measured with the nine-item Patient Health Questionnaire (PHQ-9) and quality adjusted life-years (QALY) post-intervention. Health service and intervention costs were measured. Incremental cost-effectiveness ratios (ICER) were estimated and net monetary benefit (NMB) regressions with 95% confidence intervals were performed. Cost-effectiveness was ascertained for different values of willingness to pay (WTP) using cost-effectiveness acceptability curves for probable scenarios. Trial registration number: NCT03109028 on ClinicalTrials.gov.

RESULTS

Health service use costs were significantly lower for Empowerment than TAU after 1 year. Intervention costs were on average €409.6. Empowerment led to a significant change in PHQ-9 scores but not QALY. Bootstrapped mean ICER indicated cost-effectiveness according to PHQ-9 and varied considerably for QALY in the base case. NMB for a unit reduction in PHQ-9 score at WTP of €0 was €354.3 (€978.5 to -€269.9). Results were confirmed for different scenarios and varying WTP thresholds.

CONCLUSIONS

The Empowerment intervention was cost-effective in refugees with moderate depressive symptoms regarding the clinical outcome and led to a reduction in direct healthcare consumption. Concerning QALYs, there was a lack of confidence that Empowerment differed from TAU.

Longitudinal associations between psychiatric comorbidity and the severity of gambling disorder: Results from a 36-month follow-up study of clients in Bavarian outpatient addiction care

Background and aims

Individuals with gambling disorder (GD) often suffer from psychiatric comorbidities. Previous studies demonstrated greater severity of GD among gamblers with psychiatric comorbidities. However, evidence on the association between psychiatric comorbidity and course of GD severity during and after outpatient treatment is sparse. This study analyses data from a longitudinal one-armed cohort study on outpatient addiction care clients over three years.

Methods

We investigated the course of GD severity using data from 123 clients in 28 outpatient addiction care facilities in Bavaria using generalized estimation equations (GEE). We applied time* interaction analyses to examine different development profiles in participants with and without (1) affective disorders, or (2) anxiety disorders, and (3) to account for the co-occurrence of both.

Results

All participants benefitted from outpatient gambling treatment. Improvement in GD severity was poorer in participants with anxiety disorders compared to participants without anxiety disorders. The co-occurrence of affective and anxiety disorders was linked to a less favourable course of GD than the presence of affective disorders alone. However, the combined occurrence of both disorders was more favourable than the presence of anxiety disorders alone.

Discussion and conclusions

Our study suggests that clients with GD, with and without psychiatric comorbidities, benefit from outpatient gambling care. Psychiatric comorbidity, especially comorbid anxiety disorders, seems to be negatively associated with the course of GD within outpatient gambling care. Addressing psychiatric comorbidity within the treatment of GD and offering individualised help are required to meet the needs of this clientele.

The Role of COVID-19-Associated Fear, Stress and Level of Social Support in Development of Suicidality in Patients Diagnosed with Affective and Stress-Induced Psychiatric Disorders during the COVID-19 Pandemic-A Comparative Analysis

Only a few studies seem to address suicidality as an effect of the COVID-19 pandemic in persons previously affected by psychiatric disorders. The relationship between fear and stress caused by the COVID-19 pandemic and the level of social support and suicidality in patients diagnosed with affective and stress-induced psychiatric disorders prior to the onset of the COVID-19 pandemic were investigated. This study was observational and involved 100 participants. The examined period was from April 2020 to April 2022. The Fear of COVID-19 Scale (FCV-19S), the Oslo Social Support Scale 3 (OSSS-3) and general psychiatric interviews were used to obtain data. A statistically significant relationship between the impact of COVID-19-related distress on the occurrence of suicidality and the year of the pandemic χ²(2, N = 100) = 8.347, p = 0.015 was observed. No statistically significant correlation was found between suicidal behavior, stress intensity, fear and the score on the social support scale (p > 0.05). Fear related to the COVID-19 pandemic can only be seen as a contributor to suicidality. Overall, social support does not always act protectively. Previously stressful experiences such as wars, poverty and natural disasters seem to play a significant role in the resilience to each new public health crisis.

Air Pollution and Perinatal Mental Health: A Comprehensive Overview

BACKGROUND

The aim of the present study was to summarise the available data about the link between air pollution exposure and the new-onset and severity of psychiatric disorders in pregnant women during the perinatal period.

MATERIALS AND METHODS

We selected articles published until June 2022 on PubMed and the Web of Science. Pollutants included were PM_2.5 (particulate matter 2.5 micrometres and smaller), PM₁₀ (particulate matter 10 micrometres and smaller), NO₂ (nitrogen dioxide), O₃ (ozone), SO₂ (sulphur dioxide), CO (carbon monoxide), PBDEs (polybrominated diphenyl ethers), PFAS (per- and polyfluoroalkyl substances), lead, and cadmium. The perinatal period was considered as the time of pregnancy until one year after childbirth.

RESULTS

Nine studies were included; most of them evaluated the association between exposure to air pollutants and the onset of Postpartum Depression (PPD). Two studies showed an association between, respectively, only PM_2.5 and both PM_2.5 and NO₂ exposure and PPD onset 12 months after childbirth, while another study found a significant association between NO₂ exposure and PPD occurrence 6 months after childbirth. PBDE blood levels were associated with more severe depressive symptoms. Lastly, one study observed a link between stressful symptoms and exposure to PM_2.5, PM₁₀ during pregnancy.

CONCLUSION

More comprehensive and uniform studies are required to make a roadmap for future interventions, given the growing relevance of issues such pollution and mental health, particularly during the perinatal period.

The Cytokine, Chemokine, and Growth Factor Network of Prenatal Depression

BACKGROUND

Neuro-immune pathways are engaged in antenatal and postpartum depression.

AIMS

To determine if immune profiles influence the severity of prenatal depression above and beyond the effects of adverse childhood experiences (ACE), premenstrual syndrome (PMS), and current psychological stressors.

METHODS

Using the Bio-Plex Pro human cytokine 27-plex test kit, we assayed M1 macrophage, T helper (Th)-1, Th-2, Th-17, growth factor, chemokine, and T cell growth immune profiles as well as indicators of the immune inflammatory response system (IRS) and compensatory immunoregulatory system (CIRS) in 120 pregnant females in the early (<16 weeks) and late (>24 weeks) pregnancy. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess severity of antenatal depression.

RESULTS

Cluster analyses showed that the combined effects of ACE, relationship dissatisfaction, unwanted pregnancy, PMS, and upregulated M1, Th-1, Th-2, and IRS immune profiles and the ensuing early depressive symptoms shape a stress-immune-depression phenotypic class. Elevated IL-4, IL-6, IL-8, IL-12p70, IL-15, IL-17, and GM-CSF are the cytokines associated with this phenotypic class. All immune profiles (except CIRS) were significantly associated with the early EPDS score, independent of the effects of psychological variables and PMS. There was a shift in immune profiles from early to late pregnancy, with an increase in the IRS/CIRS ratio. The late EPDS score was predicted by the early EPDS score, adverse experiences, and immune profiles, mainly the Th-2 and Th-17 phenotypes.

CONCLUSIONS

Activated immune phenotypes contribute to early and late perinatal depressive symptoms above and beyond the effects of psychological stressors and PMS.

Factors associated with early and late response to electroconvulsive therapy

OBJECTIVE

Electroconvulsive therapy (ECT) is an effective treatment for severe depressive symptoms, yet more research is needed to examine predictors of treatment response, and factors associated with response in patients not initially improving with treatment. This study reports factors associated with time to response (early vs. late) to ECT in a real-world setting.

METHODS

This was a retrospective, single-center cohort study of patients endorsing moderate to severe depressive symptoms using the Quick Inventory of Depressive Symptomatology (QIDS; QIDS>10). Response was defined as 50% or greater decrease in QIDS score from baseline. We used logistic regression to predict response at treatment #5 (early response) as well as after treatment #5 (late response) and followed patients through ECT discontinuation or through treatment #20.

RESULTS

Of the 1699 patients included in this study, 555 patients (32.7%) responded to ECT treatment at treatment #5 and 397 (23.4%) responded after treatment #5. Among patients who did not respond by treatment #5, those who switched to brief pulse width ECT from ultrabrief pulse ECT had increased odds of response after treatment #5 compared with patients only receiving ultrabrief pulse (aOR = 1.55, 95% CI: 1.16-2.07). Additionally, patients with less improvement in QIDS from baseline to treatment #5 had decreased odds of response after treatment #5 (aOR = 0.97, 95% CI = 0.97-0.98).

CONCLUSION

Among depressed patients treated with ECT, response occurred in 56.0% of patients by treatment #20. Patient receiving ultrabrief pulse ECT at baseline and who did not respond by treatment #5 had greater odds of subsequent response if switched to brief pulse ECT than if continued with ultrabrief pulse.

The impact of treatment resistance on outcome and course of electroconvulsive therapy in major depressive disorder

INTRODUCTION

Major depressive disorder (MDD) is a common psychiatric disorder. Despite several treatment options, a subgroup of patients will not respond to the commonly used antidepressant treatments and thus express treatment resistance (TRD). TRD can be quantified with the Dutch Measure for Treatment Resistance in Depression (DM-TRD). Electroconvulsive therapy (ECT) is an effective treatment for MDD, also in TRD. Yet, the position of ECT as "treatment-of-last-resort" may decrease the likelihood of beneficial outcome. Our aim was to investigate the association between treatment resistance and outcome and course of ECT.

METHODS

We performed a retrospective, multicenter cohort study with 440 patients of which data was retrieved from patient records as collected in the Dutch ECT Cohort database. Linear and logistic regression models were used to explore the association between level of treatment resistance and outcome of ECT. Median split was used to explore the differences between high and low level of TRD and course of treatment.

RESULTS

A higher DM-TRD score was associated with significantly smaller reduction of depression symptoms (R²  = 0.160; β = -2.968; p < 0.001) and lower chance of response (OR = 0.821 [95 CI: 0.760-0.888]; β = -0.197; p < 0.001). Low level TRD patients underwent fewer ECT sessions (mean 13 ± 6 SD vs. 16 ± 7 SD; p < 0.001) and fewer switches from right unilateral tot bifrontotemporal electrode placement (29% vs. 40%; p = 0.032).

CONCLUSION

Reserving ECT as "treatment-of-last-resort" in the treatment algorithm for MDD seems questionable, because in our study lower level of treatment resistance predicted more beneficial ECT-outcome. Moreover, providing ECT in less treatment resistant patients showed fewer needed ECT-sessions and less switches to BL electrode placement, which may decrease the risk for cognitive side-effects.

A Psychometric Study of the Perinatal Assessment of Maternal Affectivity (PAMA) for the Screening of Perinatal Affective Disorders in Mothers

Recently, empirical evidence from perinatal studies has led researchers to pay more attention to fathers. The need to evaluate male suffering led at first to using the same screening tools developed for mothers. However, these instruments present validity concerns with fathers, and today the need to assume a gender-based perspective is clear. The Perinatal Assessment of Paternal Affectivity (PAPA) is a self-reported questionnaire for the screening of a variety of psychological and behavioral dimensions related to affectivity as experienced by fathers during the perinatal period. In the present study, the psychometric properties of the maternal version of the scale (Perinatal Assessment of Maternal Affectivity; PAMA) were examined. The study, based on 225 mothers and their partners (n = 215), used a cross-sectional design with a single assessment at the third trimester of pregnancy. Results indicated a one-factor structure for a seven-item version of the PAMA, which showed adequate internal consistency reliability and was associated in the expected direction with other clinically relevant variables (depression, psychological distress, perceived stress and dyadic adjustment). The findings suggest the usefulness of developing gender sensitive screening tools for the detection of perinatal affective disorders.

Loneliness, affective disorders, suicidal ideation, and the use of psychoactive substances in a sample of adolescents during the COVID-19 pandemic: A cross-sectional study

PROBLEM

The global coronavirus (COVID-19) pandemic has been challenging for adolescents. Indeed, with the closure of schools and social centers and reduction of extracurricular activities, increased social isolation has compounded difficulties in and with school performance, loneliness, and social networking. Increased risk of mental health problems, substance abuse, affective disorders, suicidal ideation, and suicide has been reported in adolescents.

METHODS

This cross-sectional study assesses the association between loneliness, depression, anxiety, suicidal ideation, the use of social networks, and school achievement in a sample of Italian adolescents during the COVID-19 pandemic. This study also explores emotional dysregulation through the association between affective disorders (depression and anxiety), substance use, and social networks. The sample comprises adolescents in the first and second grades of high school during the pandemic; participants received an email explaining the purpose of the e-research. Data were collected using the Strengths and Difficulties Questionnaire, the Achenbach System of Empirically Based Assessment, and the Loneliness Scale.

FINDINGS

A total of 505 adolescents completed the web survey. Data revealed that students experienced difficulties with loneliness, problems with school achievement, and extracurricular activities. The mean scores for depression and anxiety were close to the borderline range. A total of 14.3% of adolescents intentionally harmed themselves or attempted suicide.

CONCLUSIONS

This study raises concerns about the impacts of the pandemic on adolescents that require the attention of adult reference figures who deal with adolescents, such as parents, teachers, and healthcare professionals. Results indicate the necessity of providing early interventions aimed at the prevention of psychopathologies and the promotion of adolescent mental health due to the pandemic.

Bipolar spectrum in prostate cancer patients and its role in stress related symptoms

BACKGROUND

Studies show significant co-occurrence of bipolar disorder and prostate cancer, as well as the presence of shared genes associated with both diseases. Our aim was to evaluate whether prostate cancer patients present bipolar spectrum symptoms and to establish their possible associations with stress related symptoms during diagnosis and the course of the cancer therapy.

METHODS

200 participants were enrolled to this study: 100 prostate cancer patients and 100 healthy males. Bipolar spectrum symptoms were measured with the use of Mood Disorder Questionnaire and Hypomania Checklist-32 (HCL-32). Stress related symptoms were rated with The Impact of Events Scale-Revised (IES-R), Perceived Stress Scale-10 (PSS-10) and Generalised Self-Efficacy Scale (GSES).

RESULTS

In comparison to healthy controls group, prostate cancer patients have shown higher HCL-32 scores. Mood Disorder Questionnaire measures were associated with more severe stress related to prostate cancer diagnosis and treatment reflected by higher scores of IES-R and its subscales (Avoidance, Intrusions and Hyperarousal). Mood Disorder Questionnaire, HCL-32, PSS-10, IES-R and GSES measures were not associated with clinical characteristics of prostate cancer severity.

LIMITATIONS

Cross-sectional study model precluded identification of causal relationship among variables. Bipolar spectrum symptoms and stress related measures were based on auto-questionnaires.

CONCLUSIONS

To our best knowledge, this is the first study evaluating bipolar spectrum symptoms in prostate cancer patients. We have shown that this clinical group presents increased bipolarity traits compared to healthy individuals. Moreover, bipolar spectrum symptoms were associated with more severe stress related to the prostate cancer diagnosis and its treatment, reflected in avoidance, hyperarousal, and intrusions.

Low rate of performance validity failures among individuals with bipolar disorder

OBJECTIVE

Assessing performance validity is imperative in both clinical and research contexts as data interpretation presupposes adequate participation from examinees. Performance validity tests (PVTs) are utilized to identify instances in which results cannot be interpreted at face value. This study explored the hit rates for two frequently used PVTs in a research sample of individuals with and without histories of bipolar disorder (BD).

METHOD

As part of an ongoing longitudinal study of individuals with BD, we examined the performance of 736 individuals with BD and 255 individuals with no history of mental health disorder on the Test of Memory Malingering (TOMM) and the California Verbal Learning Test forced choice trial (CVLT-FC) at three time points.

RESULTS

Undiagnosed individuals demonstrated 100% pass rate on PVTs and individuals with BD passed over 98% of the time. A mixed effects model adjusting for relevant demographic variables revealed no significant difference in TOMM scores between the groups, a = .07, SE = .07, p = .31. On the CVLT-FC, no clinically significant differences were observed (ps < .001).

CONCLUSIONS

Perfect PVT scores were obtained by the majority of individuals, with no differences in failure rates between groups. The tests have approximately >98% specificity in BD and 100% specificity among non-diagnosed individuals. Further, nearly 90% of individuals with BD obtained perfect scores on both measures, a trend observed at each time point.

Defense mechanisms in affective disorders - the state of the art

Defense mechanisms are unconscious, automatic processes that allow us to cope with tension and stress. They play a significant role in maintaining mental health, but the use of some of them, especially immature ones which strongly distort reality, can be associated with psychopathological symptoms. Multiple studies show a relationship between immature defensive styles and mood disorders. Individuals with depressive and bipolar affective disorders use more immature mechanisms compared to non-clinical control groups. At the same time, they rely less on mature, adaptive defense mechanisms. Immature defense mechanisms may negatively affect the course and effectiveness of treatment, while improvements toward the use of more mature defenses due to psychotherapy and other treatment interventions are observed. Estimation of the maturity level of defense mechanisms may prove useful in the diagnostic process, especially in differentiating depressive disorders from anxiety disorders, differentiating between subtypes of mood disorders and in assessing the risk of suicidal behavior. Enhancing mature defense mechanisms and reducing reliance on immature ones may improve the overall functioning of patients with mood disorders and contribute to reducing the severity of psychopathological symptoms.

Effectiveness of health literacy interventions on anxious and depressive symptomatology in primary health care: A systematic review and meta-analysis

Background

Affective disorders are a debilitating and very prevalent problem throughout the world. Often these are associated with the onset of comorbidities or a consequence of chronic diseases. Anxiety and depression are associated with poor social and personal relationships, compromised health. We aimed to synthesize evidence from studies measuring the impact of a health literacy (HL) intervention on the improvement of affective disorders.

Methods

For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, Web of Science, Ibecs, Cuiden, Scielo, Science Direct and Dialnet for exclusively randomized controlled trial studies (RCTs) published between 1 Jan 2011, and 31 May 2022. The search terms employed were "health literacy," "health knowledge," "anxiety," "anxiety disorder," "depression," "depressive disorder," and "adult." The risk of bias assessment was performed using the Cochrane Collaboration Revised Risk of Bias tool (RoB2). We conducted random-effects meta-analyses and explored heterogeneity using meta-regression and a stratified survey.

Results

Of 2,863 citations found through the initial screening, 350 records were screened by the title and abstract for their themes and relevance. Finally, nine studies complied with the inclusion criteria for the meta-analysis. 66.66% of studies (n = 6) were rated as having a low risk of bias and 33.33% (n = 3) were judged to raise some concerns. The health literacy interventions were associated with -1.378 reduction in depression and anxiety questionnaires scores [95% CI (-1.850, -0.906)]. Low mood disorder scores are associated with better mental health and wellbeing.

Conclusion

Our findings demonstrate that an HL intervention in relation to the symptoms associated with affective disorders improves the emotional state of patients in PHC, with a moderately positive effect in reducing depression and anxiety.

Dopamine D3/D2 Receptor Ligands Based on Cariprazine for the Treatment of Psychostimulant Use Disorders That May Be Dual Diagnosed with Affective Disorders

Highly selective dopamine D3 receptor (D3R) partial agonists/antagonists have been developed for the treatment of psychostimulant use disorders (PSUD). However, none have reached the clinic due to insufficient potency/efficacy or potential cardiotoxicity. Cariprazine, an FDA-approved drug for the treatment of schizophrenia and bipolar disorder, is a high-affinity D3R partial agonist (Ki = 0.22 nM) with 3.6-fold selectivity over the homologous dopamine D2 receptor (D2R). We hypothesized that compounds that are moderately D3R/D2R-selective partial agonists/antagonists may be effective for the treatment of PSUD. By systematically modifying the parent molecule, we discovered partial agonists/antagonists, as measured in bioluminescence resonance energy transfer (BRET)-based assays, with high D3R affinities (Ki = 0.14-50 nM) and moderate selectivity (<100-fold) over D2R. Cariprazine and two lead analogues, 13a and 13e, decreased cocaine self-administration (FR2; 1-10 mg/kg, i.p.) in rats, suggesting that partial agonists/antagonists with modest D3R/D2R selectivity may be effective in treating PSUD and potentially comorbidities with other affective disorders.

Antidepressant and antipsychotic treatment of Psychotic Major Depression in a British mental healthcare setting

BACKGROUND

Evidence from treatment trials shows that the most effective pharmacological treatment for Psychotic Major Depression (PMD) is combined antidepressant and antipsychotic pharmacotherapy.

AIM

This study investigates the use of antidepressant and antipsychotic treatment for PMD in clinical practice and examines how treatment profiles correlate with demographic and clinical symptoms.

METHOD

Anonymised electronic health records of 2,837 individuals with PMD were followed up for 12-months post-diagnosis in a historic open cohort design. The use of antidepressants and antipsychotics, alone or in combination, were described using frequency statistics. Demographic and clinical characteristics associated with each treatment were assessed using logistic regression analyses.

RESULTS

Antidepressant and antipsychotic combination pharmacotherapy was the most used treatment for PMD with 69.9% users, compared to antidepressant monotherapy (10.9%) and antipsychotic monotherapy (10.3%). The remaining 8.9% of individuals did not receive antidepressant or antipsychotic treatment. The presence of delusions was strongly associated with the use of antipsychotics, both alone (odds ratio =3.99, 95% confidence intervals = 2.72-5.83, p<.001) and in combination with antidepressants (OR = 2.7, 95% CI = 2.09-3.67, p<.001), rather than antidepressant treatment alone.

CONCLUSIONS

Combined antidepressant and antipsychotic pharmacotherapy is the most common treatment of PMD in clinical practice, showing that clinical practice is in line with evidence from treatment research.

Contribution of the μ-opioid receptor system to affective disorders in temporal lobe epilepsy: A bidirectional relationship?

OBJECTIVE

Affective disorders are frequent comorbidities of temporal lobe epilepsy (TLE). The endogenous opioid system has been implicated in both epilepsy and affective disorders, and may play a significant role in their bidirectional relationship. In this cross-sectional study, we investigated the association between μ-opioid receptor binding and affective disorders in patients with TLE.

METHODS

Nine patients with TLE and depression/anxiety underwent ¹¹ C-carfentanil positron emission tomography (CFN PET) and neuropsychiatric assessment, including the Hospital Anxiety and Depression Scale and the Positive and Negative Affect Schedule. The normalized CFN PET scans were compared with those of 26 age-matched healthy controls. Correlation analyses with affective symptoms were performed by region of interest-based analysis focusing on the limbic circuit and orbitofrontal cortex.

RESULTS

We observed widely reduced CFN binding potential (BP) in bilateral frontal lobes and striata in patients with TLE compared to healthy controls. In the TLE group, more severe anxiety and negative affect were associated with decreased CFN BP in the posterior cingulate gyrus.

SIGNIFICANCE

In patients with TLE, interictally reduced binding in the opioid system was associated with higher levels of anxiety and negative affect. We speculate that seizure-related agonist-driven desensitization and downregulation of opioid receptors could be a potential underlying pathomechanism.

The Genetic Side of the Mood: A Scientometric Review of the Genetic Basis of Mood Disorders

Mood disorders are highly heritable psychiatric disorders. Over the years, many genetic polymorphisms have been identified to pose a higher risk for the development of mood disorders. To overview the literature on the genetics of mood disorders, a scientometric analysis was performed on a sample of 5342 documents downloaded from Scopus. The most active countries and the most impactful documents in the field were identified. Furthermore, a total of 13 main thematic clusters emerged in the literature. From the qualitative inspection of clusters, it emerged that the research interest moved from a monogenic to a polygenic risk framework. Researchers have moved from the study of single genes in the early 1990s to conducting genome-wide association studies around 2015. In this way, genetic overlaps between mood disorders and other psychiatric conditions emerged too. Furthermore, around the 2010s, the interaction between genes and environmental factors emerged as pivotal in understanding the risk for mood disorders. The inspection of thematic clusters provides a valuable insight into the past and recent trends of research in the genetics of mood disorders and sheds light onto future lines of research.

Mimicry and affective disorders

Mimicry, the spontaneous imitation of an interaction partner, is an important part of everyday communication, as it has been shown to foster relationships and increase closeness. People with affective disorders often have problems in their interpersonal lives. In this review, we pursue the question if these problems are linked to differences in mimicry behavior. First, we summarize existing evidence on mimicry, depression and mood. Then, based on five theories differing in their core assumptions regarding mechanisms and functionality of mimicry, we derive suggestions on how mimicry might affect people suffering from bipolar disorders, dysthymia or depression. Depending on each theory, a different understanding of affective disorders and mimicry arises, and we show how the evidence fit in with the suggested theories. Previous studies on affective disorders have focused on mimicry behavior of participants watching photos, computer-generated images, or short video sequences. This review sheds light on the fact that evidence on mimicry needs to be broadened systematically for people with affective disorders in interactional settings. Mimicry represents a novel and important yet underestimated source for diagnostic, intervention and evaluation processes in affective disorders.

[Hypersomnia in mental disorders]

Hypersomnia is a group of diseases that share the main symptom - excessive daytime sleepiness, not caused by disturbances in nocturnal sleep or circadian rhythms. Excessive daytime sleepiness is present in 15.6% of adults in the world, a Russian study showed a prevalence of 39.2%. It is associated with a wide range of comorbidities, including obesity and mental disorders, on the other hand, the presence of hypersomnia increases the likelihood of mental illness. People with hypersomnia are more likely to take medications, have a decreased quality of life, spend more health care resources, and more often receive social benefits. The heritability is estimated to be about 40% for sleep duration and 17% for excessive daytime sleepiness. Hypersomnia in mental disorders is secondary. It most often occurs in patients with depression or bipolar disorder. To assess the severity of daytime sleepiness, self-observation and objective methods, including the multiple sleep latency test, actigraphy, polysomnography, are used. In the differential diagnosis of hypersomnia in psychiatric disorders, it is necessary to make a differential diagnosis with hypersomnia caused by taking medications or other substances and insufficient sleep syndrome. The etiology of prolonged sleep in psychiatric disorders is complex, and includes biological and psychological causes. The relationship between self-reported hypersomnia and sleep actually obtained is still unclear. Results of daily polysomnography show a significant increase in time in bed during the day and night (clinophilia). Therapy of hypersomniac syndromes should be done taking into account the etiology of the disease. In cases of secondary nature, the main efforts should be directed to the treatment of the underlying mental disorder causing somnolence.

[Gender characteristics of anxiety disorders]

Anxiety and depression are an extremely significant issue of the modern society. According to the epidemiological data, the development of various affective syndromes shows gender-related differences. For example, clinically significant anxiety occurs 2.5 times more often in women than in men. Anxiety disorders in women are characterized by less favorable course, a tendency to relapses and chronification, and also by poor clinical response to therapy. Taking gender differences into account, a significant role of reproductive hormones may be assumed in development of both affective disorders and the features of the course of the disease. In this review we discuss various effects of testosterone, estrogens that can influence development risks of anxiety and depression, as well as possibly influence therapeutic choices.

[Structure and dynamics of depressive disorders in patients with a new coronavirus infection]

OBJECTIVE

To analyze the dynamics of depressive disorders in patients who underwent COVID-19.

MATERIAL AND METHODS

The study included female patients (n=30) with mean age 35.4±3.0 years, who received inpatient treatment of depressive spectrum symptoms in accordance with ICD-10 rubrics F31-F34 and who have undergone COVID-19 (U04.9, U07.1, U07.2). Clinical-psychopathological and statistical methods were used.

RESULTS

Among all patients, who underwent inpatient treatment for affective disorders, the most common symptoms were: low mood (96.7%), anxiety (83.3%), decreased interest in daily activities (40%), loss of appetite (36.7%). In patients who have had depressive symptoms before COVID-19, an increase in the number of affective spectrum symptoms (suicidal thoughts - 83.3%), as well as in asthenic manifestations in the form of increased fatigue (60%), sleep disorders (73.3%), feelings of fatigue, weakness (60%), emotional lability (40%).

CONCLUSION

In patients with depressive disorders who underwent COVID-19, hypothymia is most often accompanied by anxiety, suicidal thoughts, as well as asthenic manifestations in the form of fatigue, sleep disturbances, and emotional lability. An increase in the number of asthenic spectrum symptoms in patients with depressive disorders may indicate a possible link between COVID-19 and affective pathology. The impact of coronavirus infection on the structure and dynamics of depressive disorders requires further study, taking into account the severity of affective symptoms, the impact of psychopharmacotherapy, and the severity of the infectious disease.