Acute Psychological Distress Research Articles

Self-efficacy, Effort, and Performance Perceptions Enhance Psychological Responses to Strength Training in National Collegiate Athletic Association Division I Athletes.

Biscardi, LM, Miller, AD, Andre, MJ, and Stroiney, DA. Self-efficacy, effort, and performance perceptions enhance psychological responses to strength training in National Collegiate Athletic Association Division I athletes. J Strength Cond Res 38(5): 898-905, 2024-This study examined the effect of self-efficacy, effort, and perceived performance on positive well-being (PWB) and psychological distress (PD) following high-intensity resistance training sessions in collegiate student-athletes. An observational field study design was used to collect data before and after resistance training sessions in a 4-week preseason strength training block. A multilevel model assessed day-level and person-level variance in acute PWB and PD. Interaction terms were also tested at the day level. Alpha was set at 0.05. Within a 4-week training block, training session intensity did not predict changes in acute psychological responses. After controlling for an athlete's preexercise psychological state, higher self-efficacy, daily effort, and perceived performance predicted higher PWB and lower PD following training (p < 0.05). Self-efficacy moderated the relationships of daily effort and performance with PD (p < 0.05). When athletes experienced lower self-efficacy, producing a higher effort and perceiving better performance reduced the negative psychological response. These findings highlight the important mediating role of cognitive variables in the acute psychological response to high-intensity resistance training. Coaches should identify and mitigate low cognitive states to facilitate a positive psychological response to resistance training. This strategy promotes a positive psychological response without altering training prescription.

Psychological distress and coping strategies of hospital nurses during covid-19 pandemic in Greece

IntroductionHospital nurses have played a crucial role during the covid-19 pandemic. Research demonstrates the extent to which nurses were experiencing acute stress and psychological distress during the waves of the pandemic.ObjectivesThe purpose of this study was to assess the psychological distress (stress, depression, and anxiety) of nurses working in public hospitals in Greece during the covid-19 pandemic, to identify their coping strategies, and to explore the eventual sociodemographic and work environmental influence on distress and the coping strategies.MethodsSample consisted of 317 nurses working in public hospitals. A self-report online questionnaire was used for data collection. The first part of the questionnaire comprised the Depression, Anxiety, and Stress Scale (DASS-21), the second part included the Greek version of the Ways of Coping questionnaire (WAYS), the third part the Oslo Social Support Scale (OSSS-3), and the fourth part included participants’ sociodemographic data. Analyses were conducted using SPSS statistical software (version 26.0).Results18.4% of participants presented severe depression, 39.9% very severe anxiety, and 22.5% very severe stress. Significantly lower levels of depression, anxiety, and stress were experienced by those who slept more than 5 hours a day, compared to those who slept up to 5 hours. Participants who were infected with the coronavirus had significantly higher levels of depression, anxiety, and stress. Additionally, participants who received moderate/high social support experienced overall less anxiety, stress, and depression than those who received low social support. Finally, the more they sought social support to deal with their problems and the more they avoided stressful situations, the higher the levels of depression, anxiety, and stress.ConclusionsA staff care protocol must be applied by every hospital, including rest breaks and night-shift naps, psychosocial support for those who get infected by SARS-CoV-2 and their families, peer support (groups and mentoring), and coping skills trainings.Disclosure of InterestNone Declared

Non-adaptive cognitive emotion regulation mediates the relationship between disease uncertainty and acute stress disorder in patients with ischaemic stroke.

During epidemic outbreaks, hospitalized patients, especially those with cerebrovascular disease, were identified as a vulnerable group suffering from acute stress disorder (ASD) and consequent psychological distress. For stroke patients, not only will they suffer from physical illness, but the uncertainty of illness caused by sudden illness may also cause patients to experience different degrees of ASD. Relevant studies have shown that the impact of ASD on individuals may vary according to age, gender, disease characteristics, individual personality, treatment methods, income level, family support, cognitive psychology and other factors. However, non-adaptive cognitive emotion regulation plays a crucial role in influencing individual psychological states. At present, the risk factors of ASD after stroke and the mechanism between illness uncertainty and cognitive emotion regulation are not fully understood. Therefore, we focus on exploring the predictive effects of general demographic and disease-related characteristics, maladaptive cognitive emotion regulation, and illness uncertainty on ASD after stroke, and make hypotheses. When a disease acts on the body, the patient will have the corresponding cognition of the disease, and ASD will appear at the same time. Then the maladaptive cognitive emotion regulation as an important mediating variable can aggravate the level of acute stress disorder and be verified. We used a cross-sectional design, which can be used to investigate the distribution of a disease or health condition and its related factors in a specific population at a specific time, so as to describe the distribution of the disease or health condition and its relationship with related factors. A total of 256 hospitalized patients with ischemic stroke were enrolled, including 145 males and 111 females, aged from 26 to 90 years, with a mean age of (64.71 ± 12.20) years. All patients completed and returned a self-report questionnaire that included demographic information, illness uncertainty, cognitive emotion regulation, and ASD. We then compared the differences in general demographic data, illness uncertainty, and maladaptive cognitive emotion regulation in acute stress disorders. The majority of hospitalized stroke patients (67.6%) developed ASD due to the COVID-19 pandemic and were therefore at risk for PTSD. More than one third (39.1%) of stroke survivors also suffered from severe psychological distress. More specifically, younger stroke patients are more likely to experience ASD than older patients. Although higher illness uncertainty scores indicate more severe ASD, adaptive cognitive emotion regulation was a protective factor. Given that individuals with ASD are susceptible to PTSD, it is critical to follow up hospitalized patients with ischemic stroke for screening for PTSD and referral to appropriate psychological services. Maladaptive cognitive emotion regulation can increase the impact of uncertainty on the traumatic experience of stroke patients. Therefore, health care institutions should increase their efforts to provide psychosocial support services to hospitalized patients and make continuous efforts to screen for symptoms of trauma and psychological distress in hospitalized stroke patients.

Neurologic Injury-Related Predisposing Factors of Post-Traumatic Stress Disorder: A Critical Examination.

The present review aimed to identify the means through which neurologic injury can predispose individuals to Post-Traumatic Stress Disorder (PTSD). In recent years, comprehensive studies have helped to clarify which structures in the central nervous system can lead to distinct PTSD symptoms-namely, dissociative reactions or flashbacks-when damaged. Our review narrowed its focus to three common neurologic injuries, traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and stroke. We found that in each of the three cases, individuals may be at an increased risk of developing PTSD symptoms. Beyond discussing the potential mechanisms by which neurotrauma may lead to PTSD, we summarized our current understanding of the pathophysiology of the disorder and discussed predicted associations between the limbic system and PTSD. In particular, the effect of noradrenergic neuromodulatory signaling on the hypothalamic pituitary adrenal (HPA) axis as it pertains to fear memory recall needs to be further explored to better understand its effects on limbic structures in PTSD patients. At present, altered limbic activity can be found in both neurotrauma and PTSD patients, suggesting a potential causative link. Particularly, changes in the function of the limbic system may be associated with characteristic symptoms of PTSD such as intrusive memories and acute psychological distress. Despite evidence demonstrating the correlation between neurotrauma and PTSD, a lack of PTSD prognosis exists in TBI, SAH, and stroke patients who could benefit from early treatment. It should be noted that PTSD symptoms often compound with pre-existing issues, further deteriorating health outcomes for these patients. It is ultimately our goal to clarify the relationship between neurotrauma and PTSD so that earlier diagnoses and appropriate treatment are observed in clinic.

Thematic Analysis of Psychosocial Stressors and Adaptive Coping Strategies Among Informal Caregivers of Patients Surviving ICU Admission for Coma.

Family caregivers of patients with severe acute brain injury (SABI) admitted to intensive care units (ICUs) with coma experience heightened emotional distress stemming from simultaneous stressors. Stress and coping frameworks can inform psychosocial intervention development by elucidating common challenges and ways of navigating such experiences but have yet to be employed with this population. The present study therefore sought to use a stress and coping framework to characterize the stressors and coping behaviors of family caregivers of patients with SABI hospitalized in ICUs and recovering after coma. Our qualitative study recruited a convenience sample from 14 US neuroscience ICUs. Participants were family caregivers of patients who were admitted with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, traumatic brain injury, or hypoxic-ischemic encephalopathy; had experienced a comatose state for > 24h; and completed or were scheduled for tracheostomy and/or gastrostomy tube placement. Participants were recruited < 7days after transfer out of the neuroscience ICU. We conducted live online video interviews from May 2021 to January 2022. One semistructured interview per participant was recorded and subsequently transcribed. Recruitment was stopped when thematic saturation was reached. We deductively derived two domains using a stress and coping framework to guide thematic analysis. Within each domain, we inductively derived themes to comprehensively characterize caregivers' experiences. We interviewed 30 caregivers. We identified 18 themes within the two theory-driven domains, including ten themes describing practical, social, and emotional stressors experienced by caregivers and eight themes describing the psychological and behavioral coping strategies that caregivers attempted to enact. Nearly all caregivers described using avoidance or distraction as an initial coping strategy to manage overwhelming emotions. Caregivers also expressed awareness of more adaptive strategies (e.g., cultivation of positive emotions, acceptance, self-education, and soliciting social and medical support) but had challenges employing them because of their heightened emotional distress. In response to substantial stressors, family caregivers of patients with SABI attempted to enact various psychological and behavioral coping strategies. They described avoidance and distraction as less helpful than other coping strategies but had difficulty engaging in alternative strategies because of their emotional distress. These findings can directly inform the development of additional resources to mitigate the long-term impact of acute psychological distress among this caregiver population.

COPING WITH DEATH ANXIETY AND AWARENESS: EXPERIENCE WITH COVID-19 PATIENTS IN NEW YORK

Introduction: The global challenge that the Covid-19 pandemic represented for humanity, included local experiences and encounters from which helpful lessons may be drawn.&#x0D; Objectives: The primary objective was to assess and document death anxiety and death awareness among hospitalized intensive care unit (ICU) patients diagnosed with COVID-19 in a community-based teaching hospital. The secondary one was to reflect on mental health clinicians’ therapeutic styles and skills when caring for patients in critical care settings.&#x0D; Methods: A series of hospitalized ICU patients diagnosed with COVID-19 at the height of the pandemic in New York City were evaluated in this study. Patients’ psychological distress symptoms, death awareness, and death anxiety were measured using the Revised Death Anxiety Scale. Seventeen COVID-19 positive patients with various comorbidities who had been admitted to the ICU at Staten Island University Hospital were compared with seventeen COVID-19 negative patients with various comorbidities who had been seen and evaluated on the same ward over the same time period. The Revised Death Anxiety Scale (25 items) was used on all subjects by the deployed psychiatrists. The clinicians’ experiences as recorded through diaries during this time were examined and reflected on.&#x0D; Results: Out of seventeen COVID-19 positive patients who participated in this case series, eleven responded with heigh death anxiety scores as compared to the seventeen COVID-19 negative patients in which only three subjects were observed to have high scores. From the very beginning, the COVID-19 pandemic brought to the forefront massive challenges for both psychiatrists and patients. These challenges immediately affected rapport-building, often leading to an atmosphere of trust, but also exposing patients to additional distress. Prior to furthering and facilitating therapeutic dialogue, psychiatrists had to “anesthetize the therapeutic situation,” decrease the arousal level and be attentive throughout the encounter. This attentiveness had to be individually organized and modulated as patients displayed different personality styles, with variations in their internal world and severity of medical condition. In due course, individual patterns of reactions were observed such as fantasies concerning isolation and separation, contrasting attachment styles, need for punishment and guilt feelings and activation of panic and helplessness. The latter was particularly challenging as both patient and physician could become easily trapped in feeling helpless and confused, with strong interpersonal and relational overlays. Compassionate gestures and sensibility in connectedness conveyed vitality and much needed hope.&#x0D; Discussion and Conclusions: Although death anxiety and death awareness seemed overwhelmingly prevalent among the COVID-19 positive patients in comparison to COVID-19 negative patients, differences have been observed in terms of being age-specific, having multiple comorbidities compounding on COVID-19 positive status (e.g., obesity and COPD). In general, the acute psychological distress of patients improved with medical treatment and when stabilized they were moved out of the ICU. Patients with high scores who had a COVID-19 positive status tended to have increased stay in the ICU. Future studies should assess the long-term consequences of COVID-19 on patients’ general mental health and particularly death awareness and death anxiety. Additionally, health systems may use similar studies to understand the labor and costs borne by mental health clinicians as well as other clinicians working in such settings. In terms of medical education and liaison work, such research may inform training of clinicians in internal medicine, critical care, and mental health.

Predictors of suicidal ideation severity among treatment-seeking young people with major depressive disorder: The role of state and trait anxiety.

Depression and suicidal ideation are closely intertwined. Yet, among young people with depression, the specific factors that contribute to changes in suicidal ideation over time are uncertain. Factors other than depressive symptom severity, such as comorbid psychopathology and personality traits, might be important contributors. Our aim was to identify contributors to fluctuations in suicidal ideation severity over a 12-week period in young people with major depressive disorder receiving cognitive behavioural therapy. Data were drawn from two 12-week randomised, placebo-controlled treatment trials. Participants (N = 283) were 15-25 years old, with moderate to severe major depressive disorder. The primary outcome measure was the Suicidal Ideation Questionnaire, administered at baseline and weeks 4, 8 and 12. A series of linear mixed models was conducted to examine the relationship between Suicidal Ideation Questionnaire score and demographic characteristics, comorbid psychopathology, personality traits and alcohol use. Depression and anxiety symptom severity, and trait anxiety, independently predicted higher suicidal ideation, after adjusting for the effects of time, demographics, affective instability, non-suicidal self-injury and alcohol use. Both state and trait anxiety are important longitudinal correlates of suicidal ideation in depressed young people receiving cognitive behavioural therapy, independent of depression severity. Reducing acute psychological distress, through reducing depression and anxiety symptom severity, is important, but interventions aimed at treating trait anxiety could also potentially be an effective intervention approach for suicidal ideation in young people with depression.

ASSOCIATION BETWEEN SYMPTOM SEVERITY AND INTENSITY OF ACUTE PSYCHOLOGICAL DISTRESS IN NEWLY DIAGNOSED PATIENTS WITH CHRONIC RHINITIS AND CHRONIC RHINOSINUSITIS.

Chronic rhinitis and rhinosinusitis (CR and CRS) can lead to impairment of the health-related quality of life (HRQL) with higher psychological perceived distress, resulting in disease worsening and poor treatment outcomes. W aimed to evaluate the potential association between disease severity and HRQL impairment with the perceived acute psychological distress in newly diagnosed CR/CRS patients. This single-center cross-sectional study included otherwise healthy consecutive adults with newly diagnosed CR/CRS (European position paper on rhinosinusitis and nasal polyp criteria and International Consensus Statement on Allergy and Rhinology - Allergic Rhinitis criteria or non-allergic rhinitis), who were evaluated for CR/CRS symptom severity and HRQL (Sino Nasal Outcome Test 22 [SNOT-22], visual analog scale [VAS]) and acute perceived distress (Perceived Stress Scale [PSS]). Principal component analysis (SNOT-22 items, VAS) identified 6 components as CR/CRS severity indicators, i.e,, poor sleep, wakes-up tired, nasopharynx, obstruction, torment and rhinorrhea, which were evaluated for association with PSS score. Of the 63 included patients (20 men, age median 38, range 19-75 years), 27 suffered from CR and 36 from CRS. Upon adjustment for age and sex, higher total SNOT-22 (geometric means ratio [GMR]=1.04, 95% CI 1.01-1.06), higher "torment" (GMR=1.13, 1.04-1.24), higher "poor sleep" (GMR=1.11, 1.02-1.21) and higher "wakes-up tired" (GMR=1.11, 1.01-1.21) scores were each associated with a higher PSS score, overall and consistently in CR and CRS patients. In conclusion, more severe CR/CRS is associated with greater perceived psychological distress already at earlier stages of the disease. Paying attention to patient level of distress and anxiety over time may enable better understanding of the connection between exacerbations, symptom severity and psychological burden of the disease.

Predictors of Self-Harm Types in Members of Online Communities: Age As a Moderating Variable.

Deliberate self-harm includes direct and indirect behaviors that cause harm to the body. Various manifestations of such behavior (e.g., non-suicidal self-injuries) are prevalent in adolescent and youth populations, and they often serve as precursors of subsequent suicidal behavior. The interpersonal dynamics that lead to self-harm behavior remain understudied. Interpersonal sensitivity, defined as an anticipation of criticism and fear of rejection in one's relationships with other people, may become one such factor. The present study was conducted to investigate the relationship between interpersonal sensitivity, psychopathological symptoms, and types of self-harm. The sample (n=804, 17-35 years, M=23.3±4.6 years) was recruited in online communities. A survey developed by the authors was used to measure the types of self-harm. Other measures included the Interpersonal Sensitivity Measure and Symptom Checklist-90-R. It was discovered that superficial self-injuries could be related to more severe types of self-harm, destructive for the body on the whole (e.g., risk-taking, deprivation, fasting, substance abuse). Fear of rejection and psychopathological symptoms emerged as predictors of both superficial self-injuries and self-destructive behavior. Although younger respondents (17-19 years old) were more likely to inflict on themselves superficial self-injuries, those who scored high on fear of rejection were more likely to report more severe self-destructive behavior. Acute psychological distress elevated this risk for both younger and older participants (27-35 years old). The results of the study point at the important role the dynamics of interpersonal relationships plays in perpetuating self-harm.

Application of thermoplastic elastomer (TPE) bolus in postmastectomy radiotherapy

PurposeTo assess the planned dose, in vivo dosimetry, acute skin toxicity, pain, and distress using Thermoplastic Elastomer (TPE) bolus for postmastectomy radiotherapy (PMRT). Material and methodsThirty-two PMRT patients with TPE bolus (17 patients for 25 fractions, 15 patients for the first 20 fractions) were selected for the study. The acute skin toxicity, pain, and psychological distress were assessed from the first treatment week to the fourth week after the end of treatment. At the first treatment, the MOSFET was used in vivo dosimetry measurement. ResultsIn vivo dosimetry with the bolus, the dose deviation ranged from −6.22% to −1.56% for 5 points. The presence of grade 1 and 2 skin toxicity reached its peak (70.0% and 13.3%) in the sixth week. Two patients (6.6%) with 25 fractions bolus experienced moist desquamation in the fifth and seventh week, with pain score 2 and 3, and interruptions of 3 and 5 days, respectively. The incidence of pain score 1, 2, and 3 peaked in the fifth (33.3%), fourth (33.3%), and seventh (10.0%) week. No patients experienced grade 3 skin toxicity and severe pain. One patient had significant anxiety, and two patients had significant depression. ConclusionThe TPE bolus can accurately fit skin and improve the surface dose to more than 90%. Twenty fractions with TPE bolus had similar skin toxicity and pain to those without bolus and did not increase patients' distress and clinical workload, compared with the literature's data, which is an alternative to the 3D printing bolus for PMRT.

Association of pain, analgesic, psychological, and socioeconomic factors with sub-acute pain after childbirth: A prospective cohort study

Study objectiveTo determine if acute postpartum pain, psychological distress, socioeconomic factors, and labor analgesia were associated with sub-acute pain after childbirth (SAPC; pain starting after childbirth and lasting between four weeks to three months). DesignProspective cohort study, from pre-conception to post-partum three months. SettingSingapore's major public maternity institution. PatientsWe included women planning to conceive within a year. We excluded women who were pregnant, taking chemotherapy or psychotropic medications, had diabetes mellitus, received assisted fertility interventions or contraception, did not conceive after 12 months, with multiple pregnancies, or who developed obstetric complications. InterventionsNone. MeasurementsWe investigated the relationship between average pain score during the three days after childbirth (primary exposure) and incidence of SAPC at postpartum three months (primary outcome). Secondarily, psychological distress at pre-conception (Beck Depression Inventory (BDI), Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), General Health Questionnaire-12 (GHQ-12), Life Experiences Survey (LES)) and second trimester of pregnancy (BDI, EPDS, STAI, PSS, Pregnancy Experience Scale (PES)) were assessed. Baseline maternal and socioeconomic characteristics, labor analgesia, maternal and neonatal outcomes were also collected accordingly. Main resultsOf 317 women who met the study criteria, 30 (9.5%) developed SAPC. Higher average pain score during the three days after childbirth (adjusted odds ratio (aOR) 1.46, 95% CI 1.17 to 1.82, p = 0.001), use of meperidine for labor analgesia (aOR 4.23, 95% CI 1.03 to 17.43, p = 0.046), higher pre-conception GHQ-12 score (aOR 1.14, 95% CI 1.03 to 1.27, p = 0.013), and lack of employment with income during pregnancy (aOR 9.62, 95% CI 3.07 to 30.30, p < 0.001) were independently associated with SAPC, with area under the curve (AUC) of 0.837. ConclusionsHigher acute postpartum pain scores, use of meperidine for labor analgesia, poorer pre-conception general psychological health, and lack of employment with income during pregnancy are associated with SAPC.

Culture-Bound Psychopathology or Supernatural Reality? A West African Case Study of Psychotherapeutic Strategies for Improving the Welfare of Patients in Spiritual Crisis

ABSTRACT Certain aspects of Vodoun, Benin’s primary indigenous religious tradition, have been perceived by some of that nation’s Christian believers as a menacing occult reality. Many Christians report states of acute psychological distress due to fears of the forces of Vodoun. This study analyzes the strategies employed by applied psychotherapeutic science professionals to diagnose and treat such cases, with an eye toward presenting a framework for the possible amelioration of clinical outcomes in comparable instances elsewhere.

Efficacy of Transcendental Meditation to Reduce Stress Among Health Care Workers

Health care workers (HCWs) have been experiencing substantial stress and burnout, and evidence-based mitigation strategies are needed. Transcendental Meditation (TM) is a mantra meditation practice with potential efficacy in reducing stress. To assess the efficacy of TM practice in reducing stress among HCWs over a 3-month period. This single-center open-label randomized clinical trial was conducted among HCWs at an academic medical center from November 19, 2020, to August 31, 2021. Inclusion criteria comprised a score of 6 points or greater on the Subjective Units of Distress Scale and an increase of 5% or greater in baseline heart rate or an increase of 33% or greater in galvanic skin response after exposure to a stressful script. Exclusion criteria included the use of antipsychotic or β blocker medications, current suicidal ideation, or previous TM training. Of 213 HCWs who participated in prescreening, 95 attended in-person visits, resulting in 80 eligible participants who were randomized to receive a TM intervention (TM group) or usual treatment (control group). The TM group practiced TM for 20 minutes twice daily over a 3-month period. The control group received usual treatment, which consisted of access to wellness resources. The primary outcome was change in acute psychological distress measured by the Global Severity Index. Secondary outcomes included changes in burnout (measured by the Maslach Burnout Inventory), insomnia (measured by the Insomnia Severity Index), and anxiety (measured by the Generalized Anxiety Disorder-7 scale). Among 80 participants, 66 (82.5%) were women, with a mean (SD) age of 40 (11) years. One participant (1.3%) was American Indian or Alaska Native, 5 (6.3%) were Asian, 12 (15.0%) were Black, 59 (73.8%) were White, and 3 (3.8%) were of unknown or unreported race; 4 participants (5.0%) were Hispanic, and 76 (95.0%) were non-Hispanic. A total of 41 participants were randomized to the TM group, and 39 were randomized to the control group. Participants in the TM group did not show a statistically significant decrease in psychological distress on the Global Severity Index compared with those in the control group (-5.6 points vs -3.8 points; between-group difference, -1.8 points; 95% CI, -4.2 to 0.6 points; P = .13). Compared with the control group, the TM group had significantly greater reductions in the secondary end points of emotional exhaustion (Maslach Burnout Inventory subscore: -8.0 points vs -2.6 points; between-group difference, -5.4 points; 95% CI, -9.2 to -1.6 points; P = .006), insomnia (Insomnia Severity Scale score: -4.1 points vs -1.9 points; between-group difference, -2.2 points; 95% CI, -4.4 to 0 points; P = .05), and anxiety (Generalized Anxiety Disorder-7 score: -3.1 points vs -0.9 points; between-group difference, -2.2 points; 95% CI, -3.8 to -0.5; P = .01) at 3 months. A total of 38 participants (92.7%) in the TM group adhered to home practice. In this randomized clinical trial, TM practice among HCWs over a 3-month period did not result in a statistically significant reduction in the primary outcome of acute psychological distress compared with usual treatment but significantly improved the secondary outcomes of burnout, anxiety, and insomnia. These findings suggest that TM may be a safe and effective strategy to alleviate chronic stress among HCWs. ClinicalTrials.gov identifier: NCT04632368.

Clinical MRI morphological analysis of functional seizures compared to seizure-naïve and psychiatric controls

PurposeFunctional seizures (FS), also known as psychogenic nonepileptic seizures (PNES), are physical manifestations of acute or chronic psychological distress. Functional and structural neuroimaging have identified objective signs of this disorder. We evaluated whether magnetic resonance imaging (MRI) morphometry differed between patients with FS and clinically relevant comparison populations. MethodsQuality-screened clinical-grade MRIs were acquired from 666 patients from 2006 to 2020. Morphometric features were quantified with FreeSurfer v6. Mixed-effects linear regression compared the volume, thickness, and surface area within 201 regions-of-interest for 90 patients with FS, compared to seizure-naïve patients with depression (n = 243), anxiety (n = 68), and obsessive–compulsive disorder (OCD, n = 41), respectively, and to other seizure-naïve controls with similar quality MRIs, accounting for the influence of multiple confounds including depression and anxiety based on chart review. These comparison populations were obtained through review of clinical records plus research studies obtained on similar scanners. ResultsAfter Bonferroni–Holm correction, patients with FS compared with seizure-naïve controls exhibited thinner bilateral superior temporal cortex (left 0.053 mm, p = 0.014; right 0.071 mm, p = 0.00006), thicker left lateral occipital cortex (0.052 mm, p = 0.0035), and greater left cerebellar white-matter volume (1085 mm3, p = 0.0065). These findings were not accounted for by lower MRI quality in patients with FS. ConclusionsThese results reinforce prior indications of structural neuroimaging correlates of FS and, in particular, distinguish brain morphology in FS from that in depression, anxiety, and OCD. Future work may entail comparisons with other psychiatric disorders including bipolar and schizophrenia, as well as exploration of brain structural heterogeneity within FS.

Psychological Distress, Pain and Insurance Claims Negatively Affect Long-Term Health-Related Quality of Life After Road Traffic Injuries.

ObjectiveA prospective cohort study to investigate how injury and early post-injury psychosocial factors influence health outcomes 12 months after road traffic injury.MethodsResidents of New South Wales, Australia, with road traffic injury in the period 2013–16 were recruited. Explanatory factors were evaluated for outcomes over 12 months using 12-Item Short Form Survey (SF-12) Physical and Mental Component Scores (PCS and MCS). Path models and mediation analysis were used to examine the effect of injury severity and explanatory factors.ResultsSF-12 PCS and MCS outcomes were poorer among participants with baseline psychological distress, for all injury severities (β coefficients –3.3 to –9.3, p < 0.0001). Baseline pain and psychological distress, and baseline PCS and MCS were each involved in indirect effects of injury severity on 12-month PCS and MCS. Injury severity, baseline PCS and MCS, and baseline psychological distress were also associated with the likelihood of a compulsory third-party insurance claim, and claiming was negatively associated with 12-month PCS and MCS outcomes (beta coefficients –0.22 and –0.14, respectively, for both, p < 0.01).ConclusionBaseline factors, including pain, psychological distress and lodging a compulsory third-party insurance claim, negatively impact long-term physical and mental health status following road traffic injury, emphasizing the importance of early screening and intervention.Trial registrationAustralia New Zealand Clinical trial registry identification number: ACTRN12613000889752.LAY ABSTRACTRoad traffic injury (RTI) can lead to adverse long-term physical and mental health outcomes. This study followed participants with RTI for 12 months to assess the effects of acute post-injury psychological distress and physical and mental health outcomes. For physical health outcomes, greater severity of injury leads directly to a more restricted physical state; pain and psychological distress soon after injury also contribute to negative physical outcomes for participants experiencing more severe injuries. For mental health outcomes, injury severity has no direct effect on worsening mental state; mental state and psychological distress soon after injury leads to worsening outcomes for participants experiencing more severe injury. Individuals with higher psychological distress or pain were more likely to lodge a motor vehicle insurance claim. These people had subsequently poorer 12-month physical and mental health outcomes. It is essential to understand how early screening and interventions for psychological distress and pain can affect recovery.

The Use of Virtual Reality for Managing Psychological Distress in Adolescents: Systematic Review.

Acute and chronic psychological distress are prevalent during adolescence and can have negative impacts on adolescents in all life domains. The aim of this systematic review was to appraise the use of virtual reality (VR) interventions to manage symptoms of psychological distress symptoms among adolescents. MEDLINE, PubMed, PsycINFO, and Scopus databases were searched up to June 2020. Available citations were de-duplicated and screened by two authors using title and abstract information. A total of 301 articles were retained for full-text evaluation next to eligibility criteria. Empirical studies of all designs and comparator groups were included if these appraised the impact of an immersive VR intervention on any standardized measure indicative of psychological distress in an adolescent sample. Data were extracted into a standardized coding sheet. Results were tabulated and discussed with a narrative synthesis due to the heterogeneity between studies. A total of seven studies met inclusion criteria. There were four randomized controlled trials and three uncontrolled pilot studies on new VR interventions. Distress-related issues included: state-anxiety, venepuncture, risk taking, public speaking anxiety, social anxiety disorder, sexual victimization, and chemotherapy administration. All studies reported significant changes on outcome measures after VR treatment. Six studies reported small-to-large reductions in symptoms. The average attrition rate was 3.6 percent during the active VR treatment phase. Treatment acceptability was high in the studies that assessed user engagement factors. The VR technology can provide a safe, rapidly efficacious, and acceptable treatment modality for managing psychological distress in several key adolescent populations.

Discussion Guide for the Ernst Article.

Discussion Guide for the Ernst Article.

BIOPSYCHOSOCIAL RISK FACTORS ASSOCIATED WITH SUBOPTIMAL OUTCOMES FOLLOWING ACLR IN THE PEDIATRIC ATHLETE

Background:Anterior cruciate ligament reconstruction (ACLR) is associated with acute postoperative pain, decreased function, and psychological distress. Studies examining risk factors in pediatric populations following ACLR are limited; however, pediatric studies have found low socioeconomic status and fear of re-injury associated with poor outcomes.Hypothesis/Purpose:This study aims to expand the understanding of biopsychosocial risk factors for postoperative outcomes in pediatric ACLR populations.Methods:A retrospective review of patients that underwent ACLR at a pediatric sports medicine clinic from 5/12/17-5/15/19 was performed. Patients were included in the retrospective chart review if they were between the ages of 12 to 18 years, completed the ACSI-28, PROMIS Global Health 7+2 (PGH-7+2), Pedi-IKDC, and HSS Pedi-FABS, and underwent arthroscopic ACLR for a primary ACL lesion. Medical records were reviewed for demographic, sport involvement, injury, and treatment data collected at initial, pre-operative, first post-operative, one-year post-operative, and final post-operative visits.Results:107 patients (55F) with an average age of 15.69 years (range 12-18), meeting inclusion criteria were included in this review. Patients were cleared to return to sport (RTS) on average 350.23 days post-surgery.Both days between injury and surgery (109.65 days) and days between initial presentation and surgery (92.64 days) were found to be moderately correlated with RTS (r=0.478; p<0.001 and r=0.525; p<0.001, respectively).Between group comparisons were conducted comparing younger (<14yos) and older (≥14yos) patients. When looking at the PGH-7+2; the <14yos cohort reported significantly higher self-evaluation of health than the ≥14yos cohort (54.93 v 50.08; p=0.004). This younger cohort passed their functional test whereas older counterparts did not (n=13; 1 v 1.15; p=0.045).Patients who passed the functional test during their treatment course (i.e., through final follow-up) reported better pre-operative overall and physical health than those who ultimately failed (PGH-7+2Q1; 4.18 v 3.38, p=0.012; Q3; 4.03 v 3.15, p=0.002). Younger patients were more likely to pass the functional test (15.49 v 17.07 years, p=0.002).Lastly, a comparison between patients who did and did not reinjure their knee post-operatively was reviewed. Reinjured patients reported having increased levels of performance related worry pre-operatively (ACSI-28, FFW; 5.22 v 7.36, p=0.034).Conclusion:These findings suggest older athletes (≥14yos), those with lower perceived overall and physical health ratings, with performance related worry, and/or longer time between injury or initial presentation and surgery will need more pre-, peri-, and post-operative support and resources for optimal outcomes.

Healthcare staff well-being and use of support services during COVID-19: a UK perspective

BackgroundThe COVID-19 pandemic has drastically increased demands on healthcare workers (HCWs) leaving them vulnerable to acute psychological distress, burnout and post-traumatic stress. In response, supportive services in a central London...

Utilizing Employer Created Social Support Programs to Assist Frontline Nurses to Cope with the Psychological Symptoms of Trauma-Induced Stress and Burnout connected to Patient Death during the COVID-19 Healthcare Crisis in the United States

According to the latest epidemiological data from the National Center for Health Statistics, the total number of confirmed patient deaths at hospitals nationwide associated with COVID-19 between January 1st, 2020 and April 24th, 2021 has reached 569,771, a figure that continues to rise steadily each month, despite government efforts to vaccinate the nation's population against the disease (CDC tracker data updated, April 2021). Research shows that the effects of the COVID 19 crisis have had a devastating impact on the lives of thousands of health care workers and forced hospitals across the country to operate at maximum capacity, sometimes to the point of overload. Hospitals have given frontline staff, especially nurses, the primary responsibility for providing compassionate first-rate care to these critically ill patients in high-risk infectious disease settings. Nurses caring for patients with COVID 19 have witnessed a high volume of fatalities within a short space of time, which has resulted in severe adverse effects on their mental health. Frequent exposure to unmitigated loss of life on inpatient intensive care units and in emergency rooms nationwide triggered by the escalation of the COVID-19 pandemic is fast becoming a significant source of acute psychological and physical distress for a substantial number of nurses and other frontline service providers engaged in the battle to save the lives during this unprecedented time. A review of the results of studies cited in the nursing literature provides substantial evidence that demonstrates that nurses exposed to a high number of COVID-19 deaths daily are at increased risk for developing symptoms of psychopathology such as clinical depression, severe anxiety, and fatigue that can impair their job performance and lead to burnout (Maharaj et al., 2018, p. 61). The purpose of this article will be to examine the effectiveness of employer-created social support programs as an institutional resource to help frontline nurses deal with the psychological symptoms of trauma associated with patient death resulting from the COVID-19 healthcare crisis.