Clinical Version Research Articles

Does alexithymia, independent of depressive and anxiety disorders, correlate with the severity of somatic manifestations among patients with medically unexplained physical symptoms?

Background: Medically unexplained physical symptoms (MUPS) are highly prevalent, frequently co-occurring with psychiatric symptoms such as depression, alexithymia, and anxiety. Objective: To evaluate the relation between depression, anxiety, and alexithymia and severity of somatic symptoms in patients with MUPS. Method: This is a cross-sectional study conducted on 196 patients suffering from MUPS. The patients were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. The Patient Health Questionnaire (PHQ-15), (PHQ-9), Generalized Anxiety Disorder (GAD-7), Structured Clinical Interview for DSM-IV Axis I Disorders Clinician Version (SCID-I-CV), and Toronto Alexithymia Scale (TAS-20) were employed to assess somatic severity, depression, anxiety, major mental disorders, and alexithymia in the sample of patients. Results: The results of the study indicate that GAD-7 and PHQ-9 scores had a positive correlation with PHQ-15 ( p < 0.05) in multivariate regression. In contrast, TAS-20 was not independently correlated with PHQ-15. Adding TAS-20 to GAD-7 and PHQ-9 in the equation of the regression model enhances the predictive capacity of the model ( p < 001). Conclusion: The results of the study indicate that only anxiety and depressive symptoms, but not alexithymia, were associated independently with MUPS severity.

The Apathy Evaluation Scale (AES-C): Psychometric Properties and Invariance of Italian Version in Mild Cognitive Impairment and Alzheimer's Disease.

Apathy is a neuropsychiatric symptom observed in different neurological and psychiatric disorders. Although apathy is considered a symptom, it has been recently reconsidered as a syndrome characterised by three dimensions: cognitive symptoms, affective symptoms and behavioural symptoms. Recent studies have shown that apathy can be considered as a prodromal symptom of Alzheimer’s disease (AD), but also an indicator of the transition from mild cognitive impairment to AD. According to this scenario, an early detection of apathy in subjects with Mild Cognitive Impairment (MCI) and Mild AD can be a valid psychometric strategy to improve an early diagnosis and promote a prompt intervention. The Apathy Evaluation Scale is a validated tool composed of 18 items that assess and quantify emotional, behavioural and cognitive aspects of apathy. The aim of this study is to assess the specific reliability and validity of the Italian version of the Apathy Evaluation Scale—Clinician Version (AES-C) to detect apathy both in amnestic MCI and mild AD patients. In the present paper, we therefore examined the psychometric properties and the invariance of the Italian Version of the AES-C conducted on a sample composed of an experimental group of amnestic MCI and AD patients (N = 107) and a control group (N = 107) constituted by Age- and Sex-matched healthy controls. Results confirm the goodness of the scale. Confirmatory factory analysis confirmed that the AES-C Italian Version presents the same stability of one second-order factor and three first-order factors identified in the original version, and all items are predicted by a single general factor. Moreover, the scale was found to be invariant across both populations. Moreover, reliability and discriminant analysis showed good values. We found in the experimental group a negative correlation between the AES-C and Frontal Assessment Battery (FAB) (rs = −0.21, p < 0.001) and Mini Mental State Examination (MMSE) (rs = −0.04, p < 0.001), while a positive correlation was found between the AES-C and Hamilton psychiatric Rating scale for Depression (HAM-D) scores (rs = 0.58, p < 0.001) Overall, our data demonstrated the validity of the Italian version of the AES-C for the assessment of apathy both in MCI and in AD patients.

An Exploratory Study on Cross-Cultural Differences in Facial Emotion Recognition Between Adults From Malaysia and Australia.

While culture and depression influence the way in which humans process emotion, these two areas of investigation are rarely combined. Therefore, the aim of this study was to investigate the difference in facial emotion recognition among Malaysian Malays and Australians with a European heritage with and without depression. A total of 88 participants took part in this study (Malays n = 47, Australians n = 41). All participants were screened using The Structured Clinical Interview for DSM-5 Clinician Version (SCID-5-CV) to assess the Major Depressive Disorder (MDD) diagnosis and they also completed the Beck Depression Inventory (BDI). This study consisted of the facial emotion recognition (FER) task whereby the participants were asked to look at facial images and determine the emotion depicted by each of the facial expressions. It was found that depression status and cultural group did not significantly influence overall FER accuracy. Malaysian participants without MDD and Australian participants with MDD performed quicker as compared to Australian participants without MDD on the FER task. Also, Malaysian participants more accurately recognized fear as compared to Australian participants. Future studies can focus on the extent of the influence and other aspects of culture and participant condition on facial emotion recognition.

Risk of Depression among Early Onset Type 2 Diabetes Mellitus Patients

Methodology: Biochemically confirmed type 2 diabetes mellitus (T2DM) patients (n = 1,114) were recruited from the outpatient department of 2 tertiary care hospitals in Dhaka, Bangladesh. Face-to-face interview was conducted using a semi-structured questionnaire containing sociodemographic parameters and relevant information about depression and diabetes. Biochemical test results and treatment-related information were taken from patients’ records. The Hospital Anxiety and Depression Scale (HADS) was used to screen all patients for psychiatric manifestation. Those diagnosed by HADS were subsequently reassessed using structured clinical interview for DSM-5 Disorders – Clinician Version. T2DM diagnosed at age <40 years were considered as early onset T2DM. Association between age of onset category and depression was assessed using multivariable mixed-effect logistic regression adjusting for random variation of the area of residence and plausible confounders. Results: Around a third of the participants (32.5%) were diagnosed with T2DM before the age of 40 years. Early onset T2DM patients were found to have 57% increase in the risk of developing depression (OR 1.57; 95% CI 1.13–2.28; p = 0.011) in comparison to those with usual onset T2DM (≥40 years). Among other factors a positive family history for diabetes (OR 1.33; 95% CI 1.03–1.78; p = 0.038), poor glycemic control (OR 1.31; 95% CI 1.03–1.68; p = 0.028), presence of 1, or more diabetic complications (OR 1.37; 95% CI 1.03–1.78; p = 0.011) also showed increased risk of depression. Conclusion: Early onset T2DM patients are at greater risk of developing depression. The finding is likely to help in setting preventive strategies aiming to reduce the presence of concomitant depression symptoms among diabetes.

Association of angiotensin-converting enzyme gene polymorphism and clinical characteristics in Egyptian patients with major depressive disorder

Objectives Depression is one of the leading causes of disability and suicide worldwide. It has strong genetic etiopathogenesis, especially that related to angiotensin-converting enzyme (ACE) gene polymorphism. Therefore, this research tackled the relation between genetic variants of ACE polymorphism and symptomatology profile of major depression.Patients and methods A total of 42 patients diagnosed with depression matched with 39 controls underwent Structured Clinical Interview for the DSM-IV Axis I diagnosis clinician version, Structured Clinical Interview for the DSM-IV Axis I diagnosis-nonpatient edition, Hamilton Depression Rating Scale, real-time PCR for genotyping, and serum cortisol level assay.Results ACE I/D gene polymorphism was significantly higher in patients with major depression (45.2%) compared with the control group (25.6%). Patients with I/D polymorphism showed longer duration of illness; greater severity; higher number of episodes and rate of hospitalization; higher tendency to be prescribed serotonin/norepinephrine reuptake inhibitors and to receive electroconvulsive therapy; higher scores of core depressive symptoms, such as guilt feeling, inability to work, and suicidal ideation; and higher serum cortisol level than the other genotype groups.Conclusion Our findings support the notion that ACE I/D polymorphism affects major depression severity and symptomatology imprint.

Widespread white matter aberration is associated with the severity of apathy in amnestic Mild Cognitive Impairment: Tract-based spatial statistics analysis

Apathy is recognized as a prevalent behavioral symptom of amnestic Mild Cognitive Impairment (aMCI). In aMCI, apathy is associated with an increased risk and increases the risk of progression to Alzheimer’s Disease (AD). Previous DTI study in aMCI showed that apathy has been associated with white matter alterations in the cingulum, middle and inferior longitudinal fasciculus, fornix, and uncinate fasciculus. However, the underlying white matter correlates associated with apathy in aMCI are still unclear. We investigated this relationship using whole-brain diffusion tensor imaging (DTI). Twenty-nine aMCI patients and 20 matched cognitively healthy controls were included. Apathy severity was assessed using the Apathy Evaluation Scale Clinician version. We applied the tract-based spatial statistics analyses to DTI parameters: fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity to investigate changes in white matter pathways associated with the severity of apathy. No significant difference was found in any of the DTI parameters between aMCI and the control group. In aMCI, higher severity of apathy was associated with lower FA in various white matter pathways including the left anterior part of inferior fronto-occipital fasciculus/uncinate fasciculus, genu and body of the corpus callosum, superior and anterior corona radiata, anterior thalamic radiation of both hemispheres and in the right superior longitudinal fasciculus/anterior segment of arcuate fasciculus (p < .05, TFCE-corrected) after controlling for age, gender and GDS non-apathy. A trend association was observed in the right posterior corona radiata and corticospinal tract/internal capsule, and bilateral forceps minor (p < .065, TFCE-corrected). In conclusion, in aMCI, severity of apathy is associated with aberrant white matter integrity in widely distributed pathways, within and between hemispheres.

Ready to Go Home? Assessment of Shared Mental Models of the Patient and Discharging Team Regarding Readiness for Hospital Discharge.

A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. Determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments. We surveyed interprofessional discharging teams and each team's patient at time of hospital discharge using validated tools to capture their SMMs. Discharge events (N = 64) from a single hospital consisting of the patient and their team (nurse, coordinator, physician). Clinician and patient versions of the validated Readiness for Hospital Discharge Scales/Short Form (RHDS/SF). We measured team convergence by comparing the individual clinicians' scores on the RHDS/SF, and we measured team-patient convergence as the absolute difference between the Patient-RHDS/SF score and the team average score on the Clinician-RHDS/SF. Discharging teams assessed patients as having high readiness for hospital discharge (mean score, 8.5 out of 10; SD, 0.91). The majority of teams had convergent SMMs with high to very high interrater agreement on discharge readiness (mean r*wg(J), 0.90; SD, 0.10). However, team-patient SMM convergence was low: Teams overestimated the patient's self-assessment of readiness for discharge in 48.4% of events. We found that teams reporting higher-quality teamwork (P = .004) and bachelor's level-trained nurses (P < .001) had more convergent SMMs with the patient. Measuring discharge teams' SMM of patient discharge readiness may represent an innovative assessment tool and potential lever to improve the quality of care transitions.

Apathy and white matter integrity in amnestic mild cognitive impairment: A whole brain analysis with tract‐based spatial statistics

AbstractBackgroundApathy is one of the most prevalent neuropsychiatric symptoms in amnestic mild cognitive impairment (aMCI) and is associated with an increased risk for progression to Alzheimer’s Disease (AD). Previous diffusion tensor imaging (DTI) studies in AD have shown that apathy is associated with changes in the cingulum, corpus callosum and uncinate fasciculus (Hahn et al., 2013; Kim et al., 2011). However, the underlying white matter (WM) correlates of apathy in aMCI are still unclear. Therefore, we aimed to investigate the association between the severity of apathy and white matter integrity in aMCI using diffusion tensor imaging (DTI) and tract‐based spatial statistics (TBSS).MethodTwenty‐nine aMCI patients and 20 cognitively healthy controls were included. Apathy severity was assessed with the Apathy Evaluation Scale Clinician version (AES‐C). Depressive symptoms were assessed using the Geriatric Depression Scale (GDS). We calculated a sub‐score of the GDS (i.e. GDS non‐apathy) which excluded apathy‐related items (Adams et al., 2004). We applied whole‐brain TBSS analyses to all DTI parameters: i.e. fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD), investigating which WM areas were associated with apathy severity. Age, gender, MMSE, and GDS non‐apathy were used as covariates. Significance was set to p&lt; .05, corrected for multiple comparisons using Threshold‐Free Cluster Enhancement (TFCE).ResultThere was no statistical difference between groups on age, gender, education level, MMSE, and AES‐C scores. Group comparison TBSS analyses showed that the aMCI group did not differ in any of the DTI parameters compared to the control group. Within the aMCI group, significant inverse associations were observed between AES‐C scores and FA values in the bilateral genu and body of the corpus callosum, anterior and superior corona radiata, anterior thalamic radiation, anterior part of inferior frontooccipital fasciculus, and the right forceps minor, superior longitudinal fasciculus/arcuate fasciculus anterior segment, corticospinal tract/internal capsule (pTFCE&lt; .05). A similar pattern was observed in the combined group of aMCI and controls (pTFCE&lt; .025).ConclusionThere was no significant WM integrity difference between aMCI and control groups. Our findings point to reduced integrity in widely distributed WM pathways being related to apathy severity, regardless of aMCI diagnosis.

Occurrence, sociodemographic, and clinical correlates of eating disorders among a sample of secondary school students in Egypt

BackgroundEating disorders are common in adolescents. Data on occurrence rates, sociodemographic correlates, and risk factors in Egyptian population are needed along with better screening tools to inform future research and service development. We aimed to estimate the occurrence of eating disorders in a representative sample of Egyptian adolescent students and to examine the sociodemographic and clinical risk factors associated with eating disorders. So, a multistage random selection of 407 adolescent students from public and private secondary schools in Eastern Tanta, Egypt, was carried out. All participants were subjected to screening using the Eating Attitude Test (EAT) and the eating disorders section of the clinician version of the Structured Clinical Interview for DSM-IV axis-I disordersResultsOccurrence estimates of anorexia nervosa and bulimia nervosa were 6.1% and 3.2%, respectively. Being female, overweight (BMI = 25–29.9 kg/m2), low self-esteem, and high body shape preoccupation were significantly associated with eating disorders risk among adolescents.ConclusionsEating disorders are prevalent in the general adolescent population. The unmet treatment needs in the adolescent population place these disorders as important public health concerns.

Maternal psychosocial predictors of pacifier use in a mother-infant interaction task: An observational study from the MPEWS pregnancy cohort

The prevalence of pacifier use is high but when it occurs outside of the recommended sleep context, it becomes more controversial. Using 211 mother-infant dyads recorded as part of the Mercy Pregnancy and Emotional Wellbeing Study, we examined the maternal psychosocial predictors of pacifier use within an interaction task (i.e., ten minutes face-to-face followed by 30-minutes unstructured play). Predictors included maternal emotional availability measured with the Emotional Availability Scales; depression measured by the Structured Clinical Interview for the DSM-IV-TR Clinician Version; and maternal history of childhood trauma measured by the Childhood Trauma Questionnaire. An unadjusted odds ratio demonstrated that women classified as non-emotionally available to their infants were three-and-a-half-times more likely to use a pacifier. Multivariate logistic regression including all maternal psychosocial predictors demonstrated that even when adjusting for cessation of breastfeeding, maternal emotional availability remained the only significant predictor of pacifier use. This is the first time that predictors of pacifier use have been examined with a sample of clinically depressed women, as well as women with childhood trauma history. The results provide preliminary evidence that women who are not emotionally available might be more likely to rely on a pacifier during mother-infant interaction.

Diagnostic Reliability and Validity of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) Chinese Version

The Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) is a polydiagnostic instrument for substance use and psychiatric disorders. We translated the SSADDA English version into Chinese (SSADDA-Chinese) and report here our examination of the diagnostic reliability and validity of DSM-IV substance dependence (SD) diagnoses in a Mandarin-speaking sample in Taiwan. We recruited 125 subjects who underwent an assessment of lifetime SD diagnoses using both the SSADDA-Chinese and the Structured Clinical Interview for DSM-IV, Clinician Version (SCID-Chinese). Thirty-one subjects were retested with the SSADDA-Chinese. Cohen’s κ statistic, which measures chance-corrected agreement, was used to measure the test-retest reliability and concurrent validity of the individual SD diagnoses. There was a high degree of concordance between SD diagnoses made using the SSADDA-Chinese and the SCID-Chinese, including those for dependence on alcohol (κ = 0.83), ketamine (κ = 0.97), methamphetamine (κ = 0.93), and opioids (κ = 0.95). The test-retest reliability of dependence diagnoses for ketamine (κ = 0.95), methamphetamine (κ = 0.80), and opioids (κ = 1.00) obtained using the SSADDA-Chinese was excellent, while that for alcohol dependence (κ = 0.63) and nicotine dependence (κ = 0.65) was good. We conclude that the SSADDA-Chinese is a reliable and valid instrument for the diagnosis of major SD traits in Mandarin-speaking populations.

\u201cEstablishing the criterion validity of the interRAI Check-Up Self-Report instrument\u201d

BackgroundLow and middle-income countries have growing older populations and could benefit from the use of multi-domain geriatric assessments in overcoming the challenge of providing quality health services to older persons. This paper reports on the outcomes of a study carried out in Cape Town, South Africa on the validity of the interRAI Check-Up Self-Report instrument, a multi-domain assessment instrument designed to screen older persons in primary health settings. This is the first criterion validity study of the instrument. The instrument is designed to identify specific health problems and needs, including psychosocial or cognition problems and issues related to functional decline. The interRAI Check-Up Self-Report is designed to be compatible with the clinician administered instruments in the interRAI suite of assessments, but the validity of the instrument against clinician ratings has not yet been established. We therefore sought to establish whether community health workers, rather than trained healthcare professionals could reliably administer the self-report instrument to older persons.MethodsWe evaluated the criterion validity of the self-report instrument through comparison to assessments completed by a clinician assessor. A total of 112 participants, aged 60 or older were recruited from 7 seniors clubs in Khayelitsha, Cape Town. Each participant was assessed by one of two previously untrained, non-healthcare personnel using the Check-Up Self-report version and again by a trained assessor using the clinician version of the interRAI Check-Up within 48 h. Our analyses focused on the degree of agreement between the self-reported and clinician-rated versions of the Check-Up based on the simple or weighted kappa values for the two types of ratings. Binary variables used simple kappas, and ordinal variables with three or more levels were examined using weighted kappas with Fleiss-Cohen weights.ResultsBased on Cohen’s Kappa values, we were able to establish that high levels of agreement existed between clinical assessors and lay interviewers, indicating that the instrument can be validly administered by community health workers without formal healthcare training. 13% of items had kappa values ranging between 0.10 and 0.39; 51% of items had kappa values between 0.4 and 0.69; and 36% of items had values of between 0.70 and 1.00.ConclusionOur findings indicate that there is potential for the Check-Up Self-Report instrument to be implemented in under-resourced health systems such as South Africa’s.

O8.2. VALIDATION OF A COMPUTERIZED ADAPTIVE TESTING TOOL FOR PSYCHOSIS: THE CAT-PSYCHOSIS BATTERY

BackgroundTime constraints limit the use of measurement-based approaches in the routine clinical management of schizophrenia. Computerized Adaptive Testing (CAT) uses computational algorithms (item response theory - IRT) to match individual subjects with only the most relevant questions for them, reducing administration time and increasing measurement efficiency and scalability. This study aimed to test the psychometric properties of the newly developed CAT-Psychosis battery, both self-administered and rater-administered versions.MethodsPatients rated themselves with the self-administered CAT-Psychosis which yields a current psychotic severity score. The CAT-Psychosis is based on a multidimensional extension of traditional IRT-based CAT that is suitable for complex traits and disorders such as psychosis. Two different raters independently conducted the rater-administered CAT-Psychosis to test inter-rater reliability (IRR). The Brief Psychiatric Rating Scale (BPRS) was administered to test convergent validity. Subjects were re-tested within 7 days to assess test-retest reliability. Generalized linear mixed models and Pearson product moment correlation coefficients were used to test for correlations between individual ratings and average CAT-Psychosis severity scores respectively and the BPRS. Intraclass correlation coefficients (ICCs) were used to test for reliability. Generalized linear and non-linear (logistic) mixed models were used to estimate diagnostic discrimination capacity (lifetime ratings) and to estimate diagnostic sensitivity, specificity and area under the ROC curve with 10-fold cross validation.Results135 subjects with psychosis and 25 healthy controls were included in the study. Mean age of the sample was 33.1 years, standard deviation (SD)=12.2years; 62% were males. No significant differences were detected between groups (p=0.9064 and p=0.2684 respectively). Mean length of assessment was 7 minutes and 9 seconds (SD: 5:04min) for the clinician-administered version and 1 minute and 49 seconds (SD: 1:35min) for the self-administered version, averaging 11.4 and 12.6 questions each. Convergent validity against BPRS was moderate for both rater-administered (r=0.65 (0.55–0.73); Marginal Maximum Likelihood Estimation (MMLE)=0.052, Standard Error (SE)=0.005, p<0.00001) and self-administered (r=0.66; MMLE=0.057, SE=0.005, p<0.00001) versions. Clinician version’s IRR was strong (ICC=0.67 (Confidence Interval (CI): 0.51–0.80)), and test-retest reliability was strong for both self-report (ICC=0.83 (CI: 0.76–0.87) and clinician (ICC=0.87 (CI: 0.75–0.94) version. The CAT-Psychosis clinician version was able to discriminate psychosis vs. healthy controls (Area Under the ROC Curve (AUC)=0.96 (CI: 0.90–0.97)). CAT-Psychosis self-report yielded similar results (AUC= 0.85 (CI: 0.77–0.88)).DiscussionCAT-Psychosis provides valid severity ratings that mirror BPRS total scores, even as a self-report, yielding a dramatic reduction in administration time, while maintaining reliable psychometric properties. Furthermore, CAT-Psychosis, both clinician and self-report versions, is able to reliably discriminate psychotic patients based on a lifetime diagnosis from healthy controls after a brief assessment of current symptomatology.

The problematic use of social networking sites associates with elevated symptoms in patients with major depressive disorder.

Although excessive use of social networking site (SNS) is related to undesired effects on healthy individual's psychological well-being, there is a huge gap in studies performed with individuals who suffer from various mental disorders. The main goal of this study is to examine the association between problematic utilization of SNSs and depressive symptoms across patients diagnosed with major depressive disorder (MDD). 111 patients diagnosed with MDD (diagnoses confirmed via the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5/CV)) and 108 healthy controls (HCs) were recruited for the study. Montgomery-Asberg Depression Rating Scale (MADRS) and Bergen Social Media Addiction Scale (BSMAS) were administered by both MDD and HC groups. Group comparisons were estimated with multivariate analysis of covariance (MANCOVA) analyses. To identify the relationship between SNS addiction and depressive symptoms, the Pearson correlations were performed, and finally, we computed the multiple linear regression analyses to determine whether SNS addiction predicts depressive symptoms. The results revealed that MDD group is more addicted to SNS relative to HC. In addition, depressive symptoms were significantly predicted by 'relapse' subdimension and the overall score of SNS addiction in the MDD group. Our study illustrated the detrimental effects of excessive SNSs usage on depressive symptoms in MDD particularly for the individuals in 'relapse' state of SNS addiction. The mental health workers should consider the usage patterns of SNSs in patients diagnosed with MDD during their clinical observation and management.

Depressive and anxiety disorders among single mothers in Dhaka.

Recent reports revealed that the number of single mothers has been increasing day by day in Dhaka city; however, their psychological problems have not been studied yet. We aimed to see the proportion of single mothers having depressive and anxiety disorders. This descriptive cross-sectional study was conducted under the supervision of the Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka from August 2016 to July 2017. A total of 156 single mothers from three social strata, namely, lower-, middle- and upper-class group were included purposively. Data were collected through face-to-face interviews using a semi-structured questionnaire consisting of demography and structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, axis-I disorders, clinician version (SCID-I-CV) which were analyzed by Statistical Package for the Social Sciences (SPSS) version 17. This study showed that the mean age of the single mothers was 34.8 ± 8.9 years. The overall 48.8% of single mothers had either depressive and/or anxiety disorders where 17.3% depressive disorder, 21.2% anxiety disorders and 10.3% had a dual diagnosis. Major depressive disorder and generalized anxiety disorder were the most common specific diagnosis. This study provided us a sound background knowledge regarding psychiatric disorders among single mothers. This study shows the need for larger research on this issue and early detection would help them to improve the quality of life.

TREATMENT PARAMETERS AND RATIONALE FOR THE USE OF ELECTROCONVULSIVE THERAPY FOR THE MANAGEMENT OF TREATMENT-REFRACTORY AGITATION IN ALZHEIMER'S DISEASE

TREATMENT PARAMETERS AND RATIONALE FOR THE USE OF ELECTROCONVULSIVE THERAPY FOR THE MANAGEMENT OF TREATMENT-REFRACTORY AGITATION IN ALZHEIMER'S DISEASE

Maternal depression and the emotional availability of mothers at six months postpartum: Findings from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) pregnancy cohort.

BackgroundExisting research suggests maternal depression may reduce the quality of early mother-infant interaction and this might increase our understanding of how maternal mental health impacts on child development outcomes. However, most studies recruit from community samples and few include both a diagnostic measure of maternal depression together with an observational measure of the quality of the mother-infant relationship. MethodsData was drawn from 210 women recruited in early pregnancy until 6 months postpartum within an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Those women who at six months postpartum were video recorded interacting with their infant for at least 40-minutes were included in this study, with the quality of those interactions assessed using the Emotional Availability Scales coding system. Depression was measured using the Structured Clinical Interview for the DSM-IV-TR Clinician Version and the Edinburgh Postnatal Depression Scale, and covariates included maternal age and education. ResultsWhilst results showed a small negative association between antenatal depressive symptoms in trimester one of pregnancy and maternal EA, there was no effect of maternal depression diagnosis or of maternal depressive symptoms in later pregnancy or postpartum. LimitationsThis study focuses exclusively on mothers and does not account for the role of partners. ConclusionsMaternal depression might have a smaller effect on maternal EA then some existing research implies, with that effect most prevalent in early pregnancy. Clinical intervention might not be necessary for all mother-infant dyads experiencing depressive symptomology, but instead be directed to those with additional risk factors.

Adaptation and the Psychometric Properties of Turkish version of the Structured Clinical Interview for the DSM-5-Personality Disorders - Clinician Version (SCID-5-PD/CV).

The aim of this study is to demonstrate the validity and reliability of the Categorical and Dimensional Psychometric Properties of the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) after its translation to the Turkish. The study was carried out with 102 volunteers from two university hospitals. The SCID interview was conducted by two experienced psychiatrists who interchanged positions as interviewer and observer; and completed the research forms without discussing the patient. The diagnostic agreement between the interviewers and the Kappa coefficient were calculated. Divergent and convergent validity analyses were carried out for diagnostic validity and the scores obtained from the self-report form as well as the dimensional evaluation scores were used in the statistical analyses. The group mean age for volunteers was 39.6±11.6 years and 66.7% consisted of females. The Kappa values for personality categories were 0.79 for avoidant personality structure, 0.64 for dependent personality structure, 0.81 for obsessive-compulsive personality structure, 0.76 for paranoid personality structure, 0.49 for schizotypal personality structure, 0.90 for histrionic personality structure, 0.66 for narcissistic personality structure, 0.89 for borderline personality structure and 0.71 for antisocial personality structure. Dimensional evaluation showed significant correlation with the diagnostic agreement between the interviewers and also with the scores of the self-report forms completed by the participants. The results demosntrated that the Turkish version of the Structured Clinical Interview for DSM-5 Personality Disorders (SCID- 5-PD-CV-TR) is valid and reliable.

Exploring the Potential of a Questionnaire in Predicting Results of Nerve Conduction Studies in Patients with Suspected Carpal Tunnel Syndrome: Exploring a Clinician and Patient Complete Version

This evaluation of the Carpal Tunnel Questionnaire (CTQ) was designed to establish the validity and flexibility of its potential use both within a primary and secondary care setting. The questionnaire was originally designed to predict the positive and negative outcome of Nerve Conduction Studies (NCS) in those patients with suspected Carpal Tunnel Syndrome (CTS). Prior to being seen by the hand specialist patients who had been referred with suspected CTS where asked to complete the CTQ. These questionnaires were coded and filed by the clinic nurse. The hand specialist then completed the questionnaire with the patient preceding NCS. Questionnaires were scored subsequent to the appointment. Results for the hand specialist completed questionnaire showed an 80% specificity and 92% sensitivity regarding the ability of the CTQ to predict a positive NCS using a pre-determine cut-off score. The patient completed questionnaire showed a 70.67% specificity and 72% sensitivity. Using receiver operating characteristics a threshold score could be determined to achieve 100% sensitivity/specificity for both questionnaires. This questionnaire provides a useful addition in the assessment of patients with suspected carpal tunnel syndrome and could be used in a range of clinical settings although the scoring cut-off may need to be adapted depending on whether the questionnaire was completed by the clinician or patient. Using the questionnaire in a clinical setting would reduce the requirement for NCS by 60%, this would offer significant time and cost savings.

Apathy rating scores and β-amyloidopathy in patients with Parkinson disease at risk for cognitive decline.

To determine whether β-amyloidopathy correlates with apathy rating scores independently of mood changes and other neurodegenerative processes in Parkinson disease (PD). In this cross-sectional study, patients with PD (n = 64, 48 male and 16 female, mean age 69.2 ± 6.7 years, Hoehn & Yahr stage 2.7 ± 0.5, Montreal Cognitive Assessment score 25.3 ± 3.0) underwent [11C]Pittsburgh compound B β-amyloid, [11C]dihydrotetrabenazine vesicular monoamine transporter type 2 (VMAT2), and [11C]methyl 4 piperidinyl propionate acetylcholinesterase brain PET imaging and clinical assessments, including the Marin Apathy Evaluation Scale, Clinician Version. Patients were recruited on the basis of having at least 1 risk factor for PD dementia, but they were excluded if they had dementia. Mean apathy rating score was 25.4 ± 6.4, reflecting predominantly subclinical apathy. Apathy rating scale scores correlated with amyloid binding, cognitive, depressive, and anxiety scores but not significantly with age, duration of disease, striatal VMAT2, or cholinergic binding. Multiple regression analysis model (p < 0.0001) showed significant regressor effects for global β-amyloid burden (p = 0.0038) with significant covariate effects for global cognitive z scores (p = 0.028) and for anxiety (p = 0.038) but not with depressive scores. Voxel-based analysis showed robust correlation between apathy rating scale scores and β-amyloid binding in bilateral nuclei accumbens, inferior frontal, and cingulate cortices (family-wise error rate-corrected p < 0.005). Apathy is independently associated with β-amyloidopathy in patients with PD at risk of dementia. Regional brain findings are most robust for β-amyloidopathy in the nuclei accumbens, inferior frontal, and cingulate regions. Findings may provide an explanation for the often treatment-refractory nature of apathy in advancing PD despite optimized dopaminergic and antidepressant pharmacotherapy. NCT01565473.