Psychiatric Diagnosis Research Articles

The hierarchical taxonomy of psychopathology and the search for neurobiological substrates of mental illness: A systematic review and roadmap for future research.

Understanding the neurobiological mechanisms involved in psychopathology has been hindered by the limitations of categorical nosologies. The Hierarchical Taxonomy of Psychopathology (HiTOP) is an alternative dimensional system for characterizing psychopathology, derived from quantitative studies of covariation among diagnoses and symptoms. HiTOP provides more promising targets for clinical neuroscience than traditional psychiatric diagnoses and can facilitate cumulative integration of existing research. We systematically reviewed 164 human neuroimaging studies with sample sizes of 194 or greater that have investigated dimensions of psychopathology classified within HiTOP. Replicated results were identified for constructs at five different levels of the hierarchy, including the overarching p-factor, the externalizing superspectrum, the thought disorder and internalizing spectra, the distress subfactor, and the depression symptom dimension. Our review highlights the potential of dimensional clinical neuroscience research and the usefulness of HiTOP while also suggesting limitations of existing work in this relatively young field. We discuss how HiTOP can be integrated synergistically with neuroscience-oriented, transdiagnostic frameworks developed by the National Institutes of Health, including the Research Domain Criteria, Addictions Neuroclinical Assessment, and the National Institute on Drug Abuse's Phenotyping Assessment Battery, and how researchers can use HiTOP to accelerate clinical neuroscience research in humans and other species. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Is epistemic injustice a worthy application to mental health nurse education?

This paper explores the philosophical concept of epistemic injustice and contends its significance and relevance to mental health nurse education and clinical practice. The term epistemic injustice may be unfamiliar to mental health nurses, yet the effects are readily visible in the dismissing, silencing, and doubting of service users' knowledge, testimony, and interpretation. Existing professional values and clinical standards lack depth and critical exploration pertaining to epistemology and associated ethical concerns. Despite central tenets of person-centred care and valuing the service users' voice, epistemic injustice continues to occur. Epistemic injustice cannot be summed up merely by asking nurses to listen to service users. This represents an oversimplification of epistemology, ignoring the complexities of social influence and knowledge exchanges. Epistemic injustice brings something new and innovative to the nursing curriculum and fits within the principles of heutagogy. It encourages deep reflexivity surrounding the ethical issues of power inequalities and intersectionality. Inclusion in mental health nursing education allows for the social and political powers of psychiatric diagnosis as a form of silencing and stigma to be examined. Practical application is made to mental health nursing education and practice with epistemological values and ethical reflexive prompts. These can be utilised by educators and lecturers for pre-registration mental health nurse education, post-registration, and continued professional development.

Associations Between Self-Reported Cocaine Use Patterns and Cocaine and Its Metabolites in Hair: Implications for Clinical and Forensic Practices.

In forensic toxicology, it has been debated if hair testing allows an estimation of the intensity of cocaine use-an assumption that may have risen because self-reports in a forensic setting are of uncertain validity per se. We therefore investigated the relationship between self-reported cocaine use and cocaine hair concentrations (including its main metabolites benzoylecgonine and norcocaine) in chronic cocaine users voluntary participating in psychiatric study settings. Additionally, we tested whether hair testing can distinguish between individuals with and without a diagnosis of cocaine dependency. Cocaine users (N = 195) from three independent experimental studies reported their average powder cocaine consumption in g/week over the last 3-4 months in an interview and provided a 3- to 4-cm hair sample assayed with liquid chromatography tandem-mass spectrometry. Moreover, study participants were assessed with the Structured Clinical Interview (SCID-IV) for psychiatric diagnoses. Using linear regression models, we found a robust correlation between cocainetotal (sum of cocaine and metabolites) hair concentration and self-reported cocaine use in g/week (rcocainetotal = 0.47, p < 0.001), indicating that 1000 pg/mg cocainetotal corresponded to a use of 0.80 g/week (confidence interval [95%]: 0.56-1.07 g/week). In logistic regression models, cocainetotal hair concentration predicted cocaine dependency with a sensitivity of 0.79 and a specificity of 0.65 (threshold 0.5), suggesting its acceptable capacity to distinguish dependent from non-dependent cocaine users. The findings may have significant implications for forensic and clinical practices, encouraging the use of hair analysis as a potential tool for monitoring cocaine use and dependence.

The Interrelationship of Benefit Finding, Stigma, and Suicide Risk Among Patients with Schizophrenia and Their Caregivers: A Six-Month Follow-Up Study

Objective: This study aimed to assess the dyadic dynamics of benefit finding, stigma, and suicide risk on the depression severity of individuals with schizophrenia and their caregivers. Methods: We prospectively recruited a total of 72 individuals with schizophrenia and 72 caregivers of individuals with schizophrenia from a medical center in Taiwan between August 2022 and July 2023. Patients with schizophrenia and their caregivers were assessed using the Taiwanese Depression Questionnaire, Benefit Finding Scale, Explanatory Model Interview Catalogue, Suicide Assessment Scale, and Mini International Neuropsychiatric Interview. Results: The most prevalent psychiatric diagnoses in the caregivers were depressive disorders (29.2%). Using structural equation modeling, we found that patients’ suicidal risk (β = 0.45, p &lt; 0.001) may contribute to the severity of depression in individuals with schizophrenia. We also found that caregivers’ BF degree (β = −0.25, p &lt; 0.01) and suicidal risk (β = 0.64, p &lt; 0.001) may contribute to the severity of depression in the caregivers of individuals with schizophrenia. Furthermore, we found that caregivers’ suicidal risk (β = 0.28, p &lt; 0.05) and caregivers’ stigma (β = −0.31, p &lt; 0.01) level may contribute to the severity of depression in individuals with schizophrenia. Discussion: Clinicians should actively manage caregivers’ stigma and provide positive reinforcement for caregivers’ BF, as this may help reduce depression in both caregivers and individuals with schizophrenia. Additionally, assessing suicide risk in both groups is essential for preventing suicides among individuals with schizophrenia and caregivers alike.

Update on the Neurobiology of Borderline Personality Disorder: A Review of Structural, Resting-State and Task-Based Brain Imaging Studies.

This review summarizes recent advances in research on the neurobiology of borderline personality disorder (BPD) according to structural brain imaging investigations and resting-state and task-based functional brain activation studies. Extending established findings on differences in regional brain volumes and cortical thickness between BPD and healthy controls, recent research illuminates shared and distinct brain structural characteristics compared to other psychiatric diagnoses, and uncovers relations of these brain structures with transdiagnostic symptoms and clinical features. Resting-state functional brain imaging studies reveal disruptions among adolescents and adults with BPD in frontolimbic and default-mode networks, which primarily underlie affect regulation and self-referential processes, respectively. Recent task-based functional brain imaging research builds on existing neurobiological understanding of emotion and cognition in BPD by revealing novel intersections with interpersonal- and stress-related processes. Studies of psychological and pharmacological interventions suggest possible effects on neural regions underlying emotion processing and behavioral control.

1.O. Scientific session: Trans &amp; Gender-Diverse Individuals’ Mental &amp; Behavioral Health Risks &amp; Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

The introduction of the concept of anxiety into China: a thematic historical study

IntroductionThis article presents a thematic historical study on the introduction of “anxiety” to modern China. Based on seminal research conducted previously by European scholars on histories of psychological and psychiatric concepts, this article reviews the itinerary of “anxiety” to China by using multiple types of textual evidence. Alongside a detailed description of how “anxiety” was translated and introduced, a comparison between the notions of “anxiety” in Traditional Chinese Medicine (TCM) and Western psychoanalytic approaches was made. The processes of how “depression” and “anxiety” were introduced to China were also compared.Materials and methodsThree types of textual evidence were meticulously analyzed. First, lexicographical works published since the 19th century were examined to trace the initial introduction and observe the standardized translation of “anxiety” in Chinese. Second, newspaper and periodical articles were analyzed to understand how knowledge of “anxiety” was communicated to the general public. Third, the evolution of psychological and psychiatric terminologies was observed through medical books.ResultsIt was found that “anxiety” was initially translated into various Chinese terms, with “jiaolyu” eventually emerging as the standardized term after 1949. The textual evidence showed that “anxiety” began to be acknowledged as a disease concept in the early 20th century, though it was not formally recognized as a diagnostic category until the late 20th century. This article also highlights the differences between the Western psychoanalytic view on anxiety and the Chinese folk conception of it.Discussion and conclusionsIt was observed that the introduction processes of depression and anxiety to China were similar, though their conceptual histories in the West showed much difference. The fading of neurasthenia marked a new era of psychiatric development in China, characterized by an enhanced specificity in the classification of mental disorders, which was never observed in the discourse about “xin feng,” a corresponding TCM notion of “anxiety.” The article also underscores the need for further exploration of corresponding TCM concepts of “anxiety” and the assimilation of Western psychiatric concepts in China.

Educational achievement and health during adolescence in second generation immigrants in Sweden

Abstract Background Over the last decades, immigration have increased markedly in Sweden. Educational achievement is essential for successful integration; however, second generation immigrants have been shown to lag behind. There is a complex intertwinement between educational attainment and health outcomes. Thus, schooling is crucial in terms of integration but also from a public health perspective. We aim to compare school performance and health in children of immigrant parents and children of parents born in Sweden. Methods In this population-based cohort study, 1723 children were followed from birth to age 20. Of these 246 (14.3%) had at least one parent born abroad. Logistic regression was performed controlling for gender, language spoken at home and sociodemographic data obtained at 3 months, 3-, 12- and 20 years. Outcome measures were school performance at age 12 (n = 984), grades from compulsory and upper secondary school (n = 1668) and register data on psychiatric diagnoses (n = 737). Self-response questionnaires on general health, long term health problems and psychiatric conditions were administered at age 20 (n = 731). Results There were no differences in reading (p = 0.676) or mathematics (p = 0.324) at age 12, eligibility to upper secondary school (p = 0.298) or university (p = 0.232) between second generation immigrants and children of native-born parents. No differences in frequency of psychiatric diagnoses (p = 0.112), presence of long-term health problems (p = 0.267) or self-reported health (p = 0.595) were shown. Conclusions The results indicate that young adults born in Sweden in the middle of the 1990’s with immigrant parents perform similarly in school compared to children of parents born in Sweden. They are not at increased risk for mental illness, long-term health conditions and report their general health equivalently to children of native-born. The comprehensive school system and child health programs used in Sweden are likely important factors to promote education and health. Key messages • In a birth-cohort of children followed into early adulthood, no difference in educational achievement or health was shown between second generation immigrants and children of parents born in Sweden. • International comparative studies are needed to highlight the importance of underlying structural and socio-cultural factors.

Psychosomatic complaints at age 15-16 and subsequent depression and anxiety disorders

Abstract Background In recent years, the prevalence of self-reported mental health issues such as psychosomatic complaints has risen among adolescents in several countries, including Sweden. Despite this trend, a gap in the understanding remains regarding the implications of these complaints, including their ability to predict more severe mental health conditions. Depression and anxiety represent common mental health disorders among youth today, significantly affecting daily functioning. In light of this, the current study aims to investigate the association between self-reported psychosomatic complaints at age 15-16 and the likelihood of being diagnosed with depression or anxiety by age 20. Methods Data was drawn from Futura01, a cohort study of Swedish adolescents who attended grade 9 in 2017 (n = 5,225). Information on psychiatric diagnoses was obtained from the Swedish National Patient Register. Psychosomatic complaints were captured through self-reported frequencies of headache, stomach ache, and difficulties falling asleep, which were aggregated into an index (ranging from 3-15). Covariates included sex, parental education, parental country of birth, family type, and prior diagnoses of ADHD, depression, and anxiety. Binary logistic regression analyses were performed. Results The findings show that higher levels of psychosomatic complaints at age 15-16 were prospectively associated with increased odds of being diagnosed with depression (OR = 1.28, 95% CI 1.22-1.34) as well as anxiety (OR = 1.30, 95% CI 1.25-1.35) by age 20, even after adjusting for prior diagnoses and other covariates. Conclusions This study highlights the potential for psychosomatic complaints during adolescence to act as early indicators of future mental health disorders. Recognising the importance of these complaints and implementing public health interventions targeting mental health issues among youth could help improve mental health outcomes in late adolescence and young adulthood. Key messages • Adolescents reporting frequent psychosomatic complaints at age 15-16 were more likely to receive subsequent specialised care due to a depression or anxiety diagnosis in a Swedish sample. • Interventions directed at youth experiencing frequent psychosomatic complaints may have a beneficial impact on their future mental health outcomes.

Prevalence of Brugada ECG pattern in psychiatric patients: a longitudinal prospective cohort of 550 patients

Abstract Background Brugada syndrome (BrS) is an inherited disorder with autosomal dominant transmission, which occurs predominantly in males in the third to fourth decade of life with resting syncope, nocturnal agonic breathing, major ventricular arrhythmias and sudden death. Arrhythmic complications can occur spontaneously or following exposure to triggers such as fever, or certain categories of medications, including psychiatric drugs. Aim of the study To evaluate the prevalence of Brugada ECG pattern in psychiatric patients. Methods from January 2023 to Decembre 2023, 550 consecutive patients who were admitted to the psychiatric department of our university hospital were enrolled. For each patient, electrocardiographic and anamnestic data including psychiatric diagnosis, current drug therapy and family history were collected. Results Twenty-one out of five-hundred and fifty patients (3.8%) presented with a Brugada ECG pattern. Mean age was 42±6 years and seventeen out of twenty-one patients (81%) were male. Two patients exhibited a Spontaneous type 1 Brugada ECG pattern meanwhile nineteen patients had a Brugada type 2 or 3 ECG pattern. When compared to the general population, those with Brugada ECG had longer P wave duration (110±7 vs 103±13 msec p&amp;lt;0.01) and longer QRS duration (97±14 vs 89±12 msec p=0.04). Evaluating psychiatric disorders, patients with Brugada ECG had high prevalence of mood disorders (10 out of 21, 47%). Other disorders were schizophrenia (3 out of 21, 14%), cognitive retardation (5 out of 21, 23%), and attention disorder (1 out of 21, 5%). Moreover 4 patients were drug addicted. Only 5 out of 21 (24%) patients had a family history of psychiatric and neurological disorders. Conclusions Brugada ECG pattern has a prevalence of 3.8% in a large cohort of psychiatric patients. Mood disorders was the most common diagnosis in this cohort. Large prospective registries are needed to evaluate the clinical feature and potential clinical implication of this findings.

Gender identity differences in age of first mental health diagnosis: A population-based study of childhood and adolescence

Abstract Introduction Gender minority (GM; i.e., trans, non-binary, and other gender diverse) individuals have an increased risk of mental health disorders, but few studies have explored disparities using population-based samples or the age of onset of this risk. Objectives The aim of the current study was to identify the age at which the gender identity disparity in physician-assessed psychiatric diagnosis and treatment for common mental health disorders can be first identified in a population-based sample linked to national health care registries. Methods All individuals aged 16 to 25 (n = 18,793) participating in the nationwide probability-based Swedish National Public Health Survey in 2018, 2020, or 2021 were included in the analyses. This sample could be linked to mental health care treatment history data in nationally comprehensive health care registries starting at age 8 years old. Results Individuals reporting a GM identity in adulthood were seven times more likely to having been diagnosed with depression and/or anxiety and about five times more likely to having been diagnosed with a neurodevelopmental disorder during childhood or adolescence compared to individuals with a cisgender identity. GM individuals’ increased likelihood of being diagnosed with depression and/or anxiety was significantly elevated from age 13, while their neurodevelopmental disorder diagnosis risk was significantly elevated from age 10, compared to cisgender individuals. Conclusions The results from this study are the first population-based evidence to show that GM individuals are more likely to be diagnosed and treated for mental health disorders early during childhood and adolescence compared to cisgender individuals. The early emergence of this increased risk requires further inquiry into causes of these early disparities. It also suggests a potential benefit of interventions that facilitate social belonging and inclusion and reduce stressors related to societal expectations of gender.

A novel screening instrument for the assessment of autism in German language: validation of the German version of the RAADS-R, the RADS-R.

The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) demonstrated excellent results in its original study, with a sensitivity of 97% and a specificity of 100% (Ritvo et al. in J Autism Dev Disord 41:1076-1089, 2011). As a result, it was included in the National Institute for Health and Care Excellence (NICE) guidelines (Recommendations | Autism spectrum disorder in adults: diagnosis and management | Guidance | NICE, 2022). The questionnaire includes 80 questions across four subcategories (language, social relatedness, circumscribed interests, sensory motor). So far, the subcategory sensory motor has not been addressed in most available instruments, despite being part of the diagnostic criteria specified in DSM-5 (Falkai et al., in Diagnostisches Und Statistisches Manual Psychischer Störungen DSM-5. Hogrefe, 2015) and ICD-11 (ICD-11 for Mortality and Morbidity Statistics, 2022). In our validation study, we tested a translated German version of the questionnaire in 299 individuals (110 persons with ASD according to ICD-10 F84.0, F84.5, 64 persons with an primary mental disorders (PMD), 125 persons with no disorders). To enhance the practical use of the instrument in clinical everyday practice, the questionnaire was completed by the participants without the presence of a clinician-unlike the original study. Psychiatric diagnoses were established following the highest standards, and psychometric properties were calculated using established protocols. The German version of the RADS-R yielded very good results, with a high sensitivity of 92.5% and a high specificity of 93.6%. The area under the curve (AUC = 0.976), indicates a high quality and discriminatory power of RADS-R. Furthermore, the ROC curve analysis showed that the optimal threshold to distinguish between the ASD and non-ASD groups in the German version of the RAADS-R is a score of 81. In comparison to the RADS-R, the co-administered instruments Social Responsiveness Scale (SRS), Autism Spectrum Quotient (AQ), and Empathy Quotient (EQ) each showed slightly better specificity but worse sensitivity in this sample.The study included individuals already diagnosed with ASD according to ICD-10 (F84.0, F84.5), with or without an primarymental disorders, preventing us from identifying the influence of comorbidities on the RADS-R results. In addition, a self-report questionnaire has generally only limited objectivity and may allow for false representation of the symptoms. The RADS-R compares well with other questionnaires and can provide valuable additional information. It could turn out to be a helpful diagnostic tool for patients in Germany. We propose naming the German version RADS-R (Ritvo Autism Diagnostic Scale - rRevised) to reflect the change in terminology.

Symptom profile in suicide attempters during the COVID-19 pandemic: Relationships with suicide outcomes.

Suicidal behavior constitutes a multi-cause phenomenon that may also be present in people without a mental disorder. This study aims to analyze suicidal behavior outcomes in a sample of attempters, from a symptom-based approach. The sample comprised 673 patients (72% female; M=40.9years) who attended a hospital emergency department due to a suicide attempt. A wide range of clinical factors (e.g., psychopathology symptoms, psychiatric diagnoses, impulsivity, acquired capability), was administered within 15days after the index attempt. Nine psychopathology domains were explored to identify the profile of symptoms, using latent profile analysis. The relationship between the profile membership and suicide outcome (i.e., intensity of suicidal ideation, number of suicide behaviors, and medical injury derived from index attempt) was also studied, using linear and logistic regression. Three psychopathology profiles were identified: high-symptom profile (45.02% of participants), moderate-symptom profile (42.50%), and low-symptom profile (12.48%). High-symptom profile members were more likely to show higher risk of non-suicidal self-injury, acquired capability for suicide, and more severe suicide behavior and ideation. On the other hand, a more severe physical injury was associated with low-symptom profile membership in comparison to membership from the other profiles (OR<0.45, p<.05). A symptom-based approach may be useful to monitor patients and determine the risk of attempt repetition in the future and potential medical injury, and to optimize prevention and intervention strategies.

Psychopathology, psychopathy, body management, and undoing in youthful parricide offenders.

This study of 21 youthful parricide offenders (YPOs) ages 11-21 examined the relationship between psychopathology, level of psychopathy, and crime scene behaviors, particularly two forms of "body management": (1) "body movement" and (2) "body alteration." Undoing, a form of body alteration reflecting psychological rather than practical needs, for example, to lessen guilt or symbolically reverse the killing, was present in one-third of the sample. The sample shared common characteristics with juvenile parricide offenders overall in that most of them killed one parent, were victims of chronic child abuse, had one or more psychiatric diagnoses (PTSD was most prevalent), used a firearm, and committed the killings at the family home. Unexpectedly, YPOs who were child abuse victims were not more likely to engage in undoing behaviors than non-abused youth, and over half of the youth with undoing behaviors had elevated psychopathy levels. Three-quarters of youth who moved victim bodies following the murders had elevated psychopathy levels. Similarly, all three youth who transported bodies away from the crime scene had elevated psychopathy levels and conduct disorder. None of the youth with psychotic symptoms engaged in undoing behaviors, altered victim bodies, moved bodies either within or away from the home, or had an elevated degree of psychopathy; they also most often killed using bladed weapons, whereas the nonpsychotic youth usually used firearms. Studies examining the influence of mental illness and psychopathy level on parricidal behaviors by youth are scarce, and to our knowledge this is the largest study to date investigating this area.

Oral and Long-acting Injectable Aripiprazole in Severe Mental Illness and Substance Use Disorder Comorbidity: An Updated Systematic Review.

Co-occurrence of substance use disorders is frequent in patients with mental health disorders is a condition known as "dual diagnosis". The use of substances worsens the prognosis and lowers the quality of life of psychiatric patients. It also increases the risk of hospitalization and suicide rate. To assess the effects of aripiprazole therapy on substance use and other psychiatric outcomes in dually diagnosed patients. We performed a systematic review conducted on 3 databases PUBMED, SCOPUS, and Web of Science, selecting original studies and analyzing the impact of aripiprazole therapy on dually diagnosed patients. Six hundred and fifty-five articles were founded and, after removing duplicates (n = 274) and applying the exclusion criteria, 12 articles were included in our systematic review. 12 studies were included, among which 6 were Randomized Controlled Trials. The Most frequent psychiatric diagnosis were schizoaffective disorders, schizophrenia, and bipolar disorders. Alcohol and cocaine use disorders were the most used substances. Eleven studies showed a clinical improvement after aripiprazole treatment. 8 studies evaluated craving and found a significant reduction after treatment with aripiprazole. No definitive conclusions can be drawn on substance usage and maintenance of abstinence. The present findings suggest aripiprazole may be associated with reducing substance craving and improving depression, psychosis, and schizoaffective disorders in dually diagnosed patients.

Psycho-Socio-Demographic Risk Factors of Self-injurious Behaviors in Iranian Females Inmates: A Case-Control Study

Background: Self-injurious behavior or self-harm among inmates is a common phenomenon. However, no study has yet been conducted in Iran regarding self-harm in female inmates. Objectives: The present study aimed to investigate the psycho-socio-demographic risk factors associated with non-suicidal self-harm in Iranian female inmates. Patients and Methods: Participants in this case-control study were 306 female inmates in Tehran, who were randomly selected and divided into two groups: (1) 88 individuals who scored 5 or higher on the Sansone Self-harm Inventory (SHI), and (2) 88 individuals randomly selected from the 218 inmates who did not self-harm as the comparison group. The participants completed a researcher-designed questionnaire, SHI, and the Difficulties in Emotion Regulation Scale. The data were analyzed using logistic regression analysis in SPSS version 16. Results: Logistic regression analysis revealed that marital status (B = 1.438, P = 0.002), arrest history (B = 1.295, P = 0.005), substance abuse (B = 1.198, P = 0.011), psychiatric diagnoses (B = 1.126, P = 0.018), parental divorce (B = 1.280, P = 0.005), and difficulties in emotion regulation (B = 0.027, P = 0.022) were significant predictors of self-harm in inmates. Although there was a difference in the addiction rates of parents between those with self-harm and those without, this variable did not predict self-harm in female inmates (B = 0.488, P = 0.307). Conclusions: The results of this study underscore the importance of family-based preventive interventions to prevent self-harm behaviors among female inmates.

Maternal Eating Disorders, Body Mass Index, and Offspring Psychiatric Diagnoses

Maternal nutrition is essential in fetal development; thus, disordered eating may influence this process and contribute to the development of offspring psychiatric disorders. To investigate the association of maternal eating disorders and prepregnancy body mass index (BMI) with offspring psychiatric diagnoses. This population-based cohort study used Finnish national registers to assess all live births from January 1, 2004, through December 31, 2014, with follow-up until December 31, 2021. The data analyses were conducted from September 1, 2023, to September 30, 2024. Maternal eating disorder and prepregnancy BMI. Primary outcomes were 9 neurodevelopmental and psychiatric offspring diagnoses. Cox proportional hazards modeling adjusted for potential risk factors in the development of the outcome disorders was applied in 2 models. Secondary analyses were stratified for adverse birth outcomes (prematurity, small size for gestational age, and low Apgar score) or comorbid offspring eating disorders. Categories of BMI (calculated as weight in kilograms divided by height in meters squared) included underweight (BMI <18.5), normal weight (18.5-24.9), overweight (25.0-29.9), obesity (30.0-34.9), and severe obesity (≥35.0). The mean (SD) age of 392 098 included mothers was 30.15 (5.38) years, 42 590 mothers (10.86%) were born outside of Finland, 6273 mothers (1.60%) had a history of an eating disorder, 23 114 mothers (5.89%) had prepregnancy underweight, and 208 335 (53.13%) mothers had overweight or obesity. Among 649 956 included offspring, 332 359 (51.14%) were male, and 106 777 (16.43%) had received a neurodevelopmental or psychiatric diagnosis. Maternal eating disorders, prepregnancy underweight, and overweight or obesity were associated with most of the studied mental diagnoses in offspring, even after adjusting for potential covariates. The largest effect sizes were observed for maternal eating disorders not otherwise specified in association with offspring sleep disorders (hazard ratio [HR], 3.34 [95% CI, 2.39-4.67]) and social functioning and tic disorders (HR, 2.79 [95% CI, 2.21-3.52]), while for maternal severe prepregnancy obesity, offspring intellectual disabilities (HR, 2.04 [95% CI, 1.83-2.28]) had the largest effect size. Adverse birth outcomes further increased the risk of offspring having other feeding disturbances of childhood and infancy (eg, HR, 4.53 [95% CI, 2.97-6.89] for maternal eating disorders) and attention-deficit/hyperactivity disorder and conduct disorder (eg, HR, 2.27 [95% CI, 1.74-2.96] for maternal anorexia nervosa). In this population-based cohort study including 392 098 mothers and 649 956 offspring, offspring from mothers with an eating disorder history or prepregnancy BMI outside normal weight were at higher risk of psychiatric disorders. The results differed somewhat between the 2 exposures with regard to which offspring diagnoses had associations, and effect sizes were typically larger for maternal eating disorders vs BMI. These findings suggest a need to consider these 2 exposures clinically to help prevent offspring mental illness.

Prodromal Phase of Idiopathic Generalized Epilepsy: A Register-Based Case Control Study.

Idiopathic generalized epilepsy (IGE) is associated with distinct behavioral traits, symptoms of frontal lobe dysfunction, and psychiatric comorbidity. Whether psychiatric symptoms are part of the IGE endophenotype or secondary to the burden of chronic disease is unknown. In this study, we aimed at describing the sequence of appearance of psychiatric and epilepsy symptoms in patients with IGE. Inclusion criteria for this cohort study were diagnosis of IGE with age at diagnosis at 10-25 years. We created 2 mutually exclusive cohorts, 1 based on ICD-10 codes in Danish registers with a first IGE diagnosis from January 1, 2005, to December 31, 2018, and a second patient cohort treated at Odense University Hospital and the Danish Epilepsy Centre in the same period. Each case was matched with 10 age-matched, sex-matched, and geography-matched normal population controls from the Danish registers. We compared social status, health care utilization, and psychiatric diagnoses between the groups in the 5 years preceding epilepsy diagnosis, at diagnosis, and at the end of the study period using the Wilcoxon rank-sum test and confirmatory logistic regression models. We identified 1,009 patients for the register-based cohort (55.1% female; mean age at diagnosis [SD]: 15.9 [±3.8] years) and 402 patients for the hospital-based cohort (56.2% female; mean age at diagnosis [SD]: 18.3 [±7.4] years) and matched them to 10,090 and 4,020 controls, respectively. IGE cohorts and controls did not differ at birth. In the 5 years before their IGE diagnosis, register patients had an increasing number of contacts with hospitals (mean visits [SD]: cases: 8.3 [±5.6], controls: 6.6 [±4.5]) and their general practitioners (mean visits [SD]: cases: 48.7 [±26.3], controls: 45.3 [±24.5]) and received more prescriptions for psychiatric medications (prescriptions: cases: 4.2%, controls: 2.5%, p = 0.003) compared with controls. Patients had a higher rate of psychiatric comorbidity (comorbidity: cases: 26.5%, controls: 17.8%, p < 0.0001) at the end of the study than controls. Data were similar in the hospital-based cohort. Our data suggest a prodromal phase of IGE detectable approximately 5 years before the first seizure characterized by increased health care utilization and greater use of prescription medicine for psychiatric symptoms.

Characteristics of Individuals Losing Autism Diagnosis: A Comparative Study With Typically Developing and Autism Spectrum Disorder Individuals.

This study aims to reveal the characteristics of individuals who have lost an autism spectrum disorder (ASD) diagnosis and to evaluate their current psychiatric diagnoses. Additionally, the study aims to compare individuals who have lost ASD with typically developing (TD) individuals and those with ASD in terms of current psychopathology, functionality and sociodemographic and clinical variables. The study included a total of 85 participants aged between 5 and 18, comprising 30 individuals who no longer meet the criteria for ASD (loss of autism diagnosis or LAD), 32 individuals with ASD and 23 TD individuals. While the sociodemographic data form and Childhood Autism Rating Scale (CARS) were completed by the clinician, the Autism Behavior Checklist (ABC) and Social Responsiveness Scale (SRS) were completed by the parents. It was found that the LAD group acquired speaking skills earlier, started special education sooner, received preschool education and physical exercise support for a longer duration and exhibited higher mental capacity and lower symptom severity compared to the ASD group. Moreover, 80% of the LAD group had at least one DSM-5 diagnosis. Scores on the ABC and SRS indicated a significant difference, with ASD > LAD > TD. Even if ASD regresses, individuals may still experience residual difficulties and remain at risk for other psychopathologies. Therefore, it is crucial to maintain monitoring and support processes.

Psychiatric co-morbidities and feasibility of an online psychiatric screening measure in children and adolescents with the Fontan circulation.

Guidelines recommend screening for psychiatric co-morbidities in patients with congenital heart defects alongside cardiac outpatient follow-ups. These recommendations are not implemented in Denmark. This study aimed to investigate the psychiatric co-morbidities in children and adolescents with Fontan circulation in Denmark and to evaluate the feasibility of an online screening measure for psychiatric disorders. Children, adolescents, and their families answered the Development and Well-Being Assessment questionnaire and a questionnaire about received help online. Development and Well-Being Assessment ratings present psychiatric diagnoses in accordance with ICD-10 and DSM-5. Parent-reported received psychiatric help is also presented. Feasibility data are reported as participation rate (completed Development and Well-Being Assessments) and parental/adolescent acceptability from the feasibility questionnaire. The participation rate was 27%. Of the participating children and adolescents, 53% (ICD-10)/59% (DSM-5) met full diagnostic criteria for at least one psychiatric diagnosis. Of these, 50% had not received any psychiatric or psychological help. Only 12% of participants had an a priori psychiatric diagnosis. We found that a large proportion of children and adolescents with Fontan circulation are underdiagnosed and undertreated for psychiatric disorders. The results from our study emphasise the need for psychiatric screening in this patient group. Development and Well-Being Assessment may be too comprehensive for online electronic screening in children and adolescents with CHD.