Psychiatry research communications最新文献

Increased delay discounting is evident in bipolar disorder, though there is minimal research on the factors that impact delay discounting in this population. We evaluated neurocognitive correlates of delay discounting among relatively euthymic participants with bipolar disorder (N ​= ​76) with (n ​= ​31) and without (n ​= ​45) past-year substance use disorders. There were no significant differences in the mean delay discounting value between the bipolar disorder group and the comorbid bipolar disorder and past-year substance use disorders group (p ​= ​.082, Cohen's d ​= ​0.41). Using multiple regression, we evaluated the most important predictors of the delay discounting value. Impairments in executive functioning (per number of categories completed on the Wisconsin Card Sorting Test) and visuospatial construction (per the Rey-Osterrieth Complex Figure Test Copy Raw Score), as well as decreased years of education (all ps ​< ​.05), offered the best neurocognitive characterization of increased delay discounting in this sample.

Background

Schizophrenia is a severe, chronic, neuropsychiatric disorder, with a complex, yet to be elucidated aetiology. The altered connectivity responsible for the wide range of symptoms in schizophrenia, stemming from genetic, metabolic, as well as environmental factors, has had researchers focusing on the identification of more and more “players” carrying certain specificity for the disease. One of these factors is the brain-derived neurotrophic factor (BDNF) - the most abundant growth factor in the central nervous system (CNS) and most frequently researched. Here, we set to explore the evidence pertaining to a correlational change in serum BDNF levels while individuals with schizophrenia undergo a non-pharmacological/psychotherapeutic intervention.

Methods

We performed a systematic search of studies evaluating BDNF changes as a result of psychotherapeutic interventions in schizophrenia, in four databases: APA PsycInfo, Pubmed, Medline and EBSCO. The keywords “schizophrenia”, “psychotherapy OR psychosocial”, and “BDNF OR brain-derived neurotrophic factor” were searched for on all databases.

Results

The search yielded 46 titles and abstracts, of which 10 met the criteria for inclusion. The interventions consisted in neurofeedback, auditory training, cognitive remediation and lifestyle changes and behaviour therapy, as well as exercise. Serum BDNF levels were assessed systematically, showing significant increases as a result of the interventions in all studies, except three, where other changes are discussed.

Conclusions

The studies discussed in this review support, overall, the idea of an increase in BDNF levels, as well as cognitive and clinical improvements secondary to non-pharmacological interventions. Several limitations and future directions are discussed.

This study explored the pathophysiology of bipolar disorder (BD) and schizophrenia (SZ) by examining the associations between the two disorders and single nucleotide polymorphisms (SNPs) involved in the dopamine signaling system. This was a case-controlled, exploratory, and multicenter study. A total of 1048 patients with BD (495 male; mean age, 49.6 ​± ​15.0 years), 2106 patients with SZ (1159 male, 49.6 ​± ​15.0 years), and 2240 healthy controls (HCs) (917 male, 42.3 ​± ​14.2 years) were included, and all the volunteers were Japanese. SNPs at tyrosine hydroxylase rs10770141 ​C-824T, catechol-O-methyltransferase rs4680 ​G/A(Val158Met), dopamine receptor D2 gene (DRD2) rs1799732 -141C Ins/Del, and DRD2/ANKK1 (Taq1A) rs1800497 ​C/T were examined. Binomial logistic regression analyses were performed to analyze the four SNPs, age, and sex. C allele and heterozygous CT in Taq1A were associated with an increased risk of BD. A comparison of the BD and HC groups revealed a significant association between heterozygous CT in Taq1A and BD in female participants. Heterozygous CT in Taq1A showed a significant association with BD as compared to SZ. DRD2 Taq1A polymorphism (CT heterozygotes) is associated with a high risk of BD in the Japanese population, particularly in females. DRD2 genetic predisposition in the dopamine signaling system and sex-specific factors may be associated with the pathophysiology of BD.

Obsessive-compulsive disorder (OCD) affects 1–2% of children and is associated with functional impairment and diminished quality of life. Several treatments are efficacious: cognitive behavioral therapy (CBT) with exposure and response prevention, serotonin reuptake inhibitor (SRI) monotherapy, and combined treatment (SRI ​+ ​CBT). Expert clinician-informed practice parameters suggest that youth with mild to moderate OCD should be treated initially with CBT yet SRIs are frequently employed as the first-line intervention or in combination with psychotherapy in applied practice. Empirical data to guide SRI discontinuation in pediatric OCD are very limited. This study, Promoting OCD Wellness and Resiliency (POWER), aims to address this gap through a two phase, double-blinded, placebo-controlled, randomized controlled non-inferiority trial with the purpose of evaluating whether youth with OCD on an SRI can discontinue their medication after successful CBT augmentation and maintain wellness for a period of 24 weeks during which they receive maintenance CBT that models standard-of-care. In this paper we describe the rationale and methodological design of the POWER study.

The COVID-19 pandemic has presented many stressors for parents. This study was conducted to examine treatment preferences and barriers to care amidst COVID-19. Parents (N ​= ​95) completed self-report measures. Education was provided on interventions (e.g., individual therapy, medication), and acceptability assessed. Elevated stress and distress were observed. Parents indicated interest in services for parenting concerns, stress, anxiety, and depression. Individual therapy and telehealth were highly acceptable, while medication and group therapy were less accepted. Findings highlight the need for specific supports among parents amidst the pandemic. Factors that influence treatment preference warrant further attention. Implications for healthcare service delivery are discussed.

Experiencing traumatic events across the lifespan has long been identified as an etiologic factor in the development or worsening of personality disorder (PD) symptoms. However, knowledge about relationships between trauma and PDs among older adults is limited. In particular, no research has been conducted examining these relationships in later life according to alternative, dimensional models of PDs (i.e., Alternative Model of Personality Disorders; AMPD). The purpose of the study was to examine relationships between the AMPD's two diagnostic constructs (Criterion A: personality functioning and Criterion B: pathological personality traits) with post-traumatic stress (PTS) symptoms, the developmental timing of first experiencing trauma, and cumulative trauma exposure among an older adult sample. Older adults aged 65 years and older (n ​= ​185) completed questionnaires assessing trauma history, PTS symptoms, and the AMPD's two diagnostic constructs. Correlations, hierarchical regressions, and MANCOVA models were computed. Overall, correlational and MANCOVA results suggest that cumulative trauma exposure was more strongly related to AMPD personality pathology than the developmental timing of first experiencing trauma. Further, correlations and regressions suggest that Criterion A's Identity construct was most related to PTS symptoms, with more limited relationships with cumulative trauma exposure and the developmental timing of trauma. Criterion B's Psychoticism and Detachment domains were most strongly related to both PTS symptoms and cumulative trauma exposure. These findings represent the intrapersonally and interpersonally disruptive nature of experiencing trauma and demonstrate that relationships with personality pathology meaningfully persist into older adulthood.

Background

Depression is a risk factor for opioid use disorder (OUD). Addressing the dual care needs of patients with co-morbid Major Depressive disorder (MDD) and OUD is vital in improving clinical outcomes among this patient population. The aim of this study is to assess the impact of MDD on the hospital length of stay (LOS) of adults admitted with primary diagnosis of OUD.

Methods

We used the Nationwide Inpatient Sample (NIS) from January 1, 2016–December 31, 2019. We conducted univariate and multivariate analyses to determine association between MDD and hospital LOS among hospitalizations with OUD.

Results

6.9% of hospitalizations with OUD had a comorbid diagnosis of MDD. The association of MDD with longer LOS persisted after adjusting for age, sex, race, type of insurance and severity of illness (OR 2.86, 95% CI 2.69–3.04). Major and extreme severity of illness scores had 2.0- and 4.2-times higher odds for longer hospital LOS compared to milder severity of illness scores.

Conclusions

Comorbid diagnosis of MDD is an independent risk factor of longer hospital LOS among hospitalizations with OUD. Treatment modalities which coordinate mental health conditions and substance use therapies are needed for more effective outcomes including reducing long hospital stays, relapse and enhancing recovery.

We report here a pilot trial that mainly aimed to assess the endogenous secretion of oxytocin (OXT) in patients with Borderline personality disorder (BPD) and healthy controls. It is the first trial with BPD using salivary OXT and studying its reactivity in a natural setting and an experimental stress task. Compared to controls, patients with BPD showed lower variation of OXT in the natural setting and lower OXT reactivity during the stress task, contrasting to higher perceived stress and anger states. We confirm the feasibility of the protocol. Our results encourage the implementation of a larger trial to address specific hypotheses.

Different forms of childhood maltreatment are known to be significant risk factors for psychosis. However, the strength of this relationship is frequently contested due to different findings between studies, partly because of variations in the conceptualizations and assessments of childhood trauma. The objective of the current study was to explore the convergent validity of two childhood trauma instruments, the Brief Betrayal Trauma Survey (BBTS) and the Childhood Trauma Questionnaire short-form (CTQ-SF), in a sample of first-episode psychosis (FEP) participants. This was a cross-sectional study where participants from a Danish early psychosis service (OPUS) were recruited over a 2-year period. Ninety-nine participants were assessed with both instruments, and reports of childhood emotional, physical, and sexual abuse were compared. There were significantly differing reports of childhood trauma in all domains, with higher reports of childhood abuse in the CTQ than in the BBTS. Findings suggest previous heterogeneous results in studies exploring the association between childhood trauma and psychosis could partly be due to different assessments of trauma. Future studies wishing to explore this association should aim to use a common conceptualization of childhood trauma in their assessments.

The COVID-19 pandemic impacted emotional well-being due to safety concerns, grief, employment impacts, and social interaction limitations. Face-to-face mental health treatment restrictions were especially impactful to veterans who often gain social enrichment from Veterans Health Administration (VHA) care. We present results from a novel group-based telehealth intervention, VA Caring for Our Nation's Needs Electronically during the COVID-19 Transition (VA CONNECT), which integrates skills training and social support to develop a COVID-19 Safety & Resilience Plan. Veterans (n ​= ​29) experiencing COVID-related stress participated in an open trial of this 10-session, manualized group VHA telehealth intervention. We examined whether COVID-19-related stress, adjustment disorder symptoms, and loneliness decreased, and coping strategy use increased after participation in VA CONNECT. Between baseline and two-month follow-up, participants reported a significant reduction in perceived stress and adjustment disorder symptoms, and an increase in planning coping skills use. Significant changes were not observed in loneliness or other specific coping strategies. Findings may support the utility of VA CONNECT as an intervention for pandemic-related stress and improving certain coping skills. Future research should explore group-based telehealth interventions like VA CONNECT with other populations within and outside of the VA, which have value during major disruptions to face-to-face mental healthcare access.