Course Of Psychiatric Disorders Research Articles

Evaluating the association of vitamin D3, parathyroid hormone, and C-reactive protein serum levels in patients with an acute psychotic episode: a cross-sectional study in tertiary centre in Iran

BackgroundThe high impact of vitamin D on brain development and its relationship with inflammatory markers in the clinical course of psychiatric disorders have compelled researchers to investigate the potential association between vitamin D levels, C-reactive protein (CRP) levels, and the incidence of mental disorders. In the present study, we aimed to compare the serum levels of vitamin D and its related markers, including calcium, phosphorus, and parathyroid hormone (PTH), along with CRP, in 3 groups of patients with acute psychotic episodes, including schizophrenia, bipolar disorder, and methamphetamine-induced psychosis, with a standard control group of the Iranian population.MethodsThis descriptive cross-sectional study was conducted at a psychiatric hospital in Tehran, Iran, and involved a total of 185 subjects. The subjects included four groups: acute phase of schizophrenia (n = 49), acute manic episodes of bipolar disorder (n = 43), methamphetamine-induced psychotic disorder (n = 46), and control group (n = 47). Among 138 patients in acute psychotic episodes, 33 patients were in their first episode of psychosis, while 105 patients were in acute exacerbation of their chronic psychotic disorders. The Brief Psychiatric Rating Scale (BPRS) was measured by an expert attending psychiatrist for all patients. Then, serum levels of calcium, phosphorus, parathormone, vitamin D, and CRP were assessed in all study groups.ResultsAmong our 185 study subjects, it was observed that individuals with higher education levels and those who were married had a lower prevalence of mental disorders. In all patient groups, the serum levels of CRP were significantly higher, and PTH levels were significantly lower than in the control group (p < 0.001). The serum levels of calcium, phosphorus, and vitamin D were not statistically significantly different between the patient and control groups of the study. In chronic psychotic patients, CRP levels were significantly higher (p < 0.031), and vitamin D levels were significantly lower (p < 0.044) compared to first-episode psychotic patients.ConclusionThis study suggests that CRP levels are significantly higher and PHT level is significantly lower in acute psychotic patients. Moreover, vitamin D levels were significantly lower in chronic psychotic patients compared to first-episode psychotic patients.

Sex and cell-specific gene expression in corticolimbic brain regions associated with psychiatric disorders revealed by bulk and single-nuclei RNA sequencing

There are sex-specific differences in the prevalence, symptomology and course of psychiatric disorders. However, preclinical models have primarily used males, such that the molecular mechanisms underlying sex-specific differences in psychiatric disorders are not well established. In this study, we compared transcriptome-wide gene expression profiles in male and female rats within the corticolimbic system, including the cingulate cortex, nucleus accumbens medial shell (NAcS), ventral dentate gyrus and the basolateral amygdala (n=22-24 per group/region). We found over 3000 differentially expressed genes (DEGs) in the NAcS between males and females. Of these DEGs in the NAcS, 303 showed sex-dependent conservation DEGs in humans and were significantly enriched for gene ontology terms related to blood vessel morphogenesis and regulation of cell migration. Single nuclei RNA sequencing in the NAcS of male and female rats identified widespread sex-dependent expression, with genes upregulated in females showing a notable enrichment for synaptic function. Female upregulated genes in astrocytes, Drd3+MSNs and oligodendrocyte were also enriched in several psychiatric genome-wide association studies (GWAS). Our data provide comprehensive evidence of sex- and cell-specific molecular profiles in the NAcS. Importantly these differences associate with anxiety, bipolar disorder, schizophrenia, and cross-disorder, suggesting an intrinsic molecular basis for sex-based differences in psychiatric disorders that strongly implicates the NAcS. This work was supported by funding from the Hope for Depression Research Foundation (MJM).

Surgical treatment methods in the course of psychiatric disorders: Deep brain stimulation-Novel insights and indications.

Deep brain stimulation (DBS) is a relatively dated treatment procedure that emerged in the late 1980s. Nonetheless, numerous studies are being carried out to examine its influence on the human brain and develop new treatment indications. This systematic review aims to summarize the current state of knowledge referring to DBS, investigate novel insights into its indications, and discuss the technical aspects and rationale behind DBS application. In particular, we sought to subject to scrutiny the application of DBS specifically in anorexia nervosa (AN), various addiction types, depression, and obsessive-compulsive disorders (OCDs). The method is supposed to offer promising results, especially in pharmacologically resistant forms of the upper-mentioned psychiatric disorders. Moreover, further insight has been provided into the historical notions of the method and differences in the surgical approach in specific disease entities. Furthermore, we mark the possible influence of comorbidities on treatment results. Our review consists of articles and studies found on PubMed, Google Scholar, Cochrane, and Scopus, which were then analyzed with scrutiny in the identification process, including the most resourceful ones. After methodological quality and risk of bias assessment, a total of 53 studies were included. To this date, DBS's usefulness in the treatment of AN, OCDs, depression, and addictions has been proven, despite an ongoing debate concerning the technical aspects and parameters when applying DBS. To the best of our knowledge, we have not found any paper that would recapitulate the current state of DBS in the context of psychiatric disorders with an addition of technical insights.

Somatoform disorders and expressed emotions in the family: Results from a cross-sectional observational study to evaluate a novel relationship

Background: Expressed emotions (EEs) in the family affect the presentation and course of psychiatric disorders. Somatoform disorders with their psychosocial origins may be caused or perpetuated by family dynamics like EEs. Aims: The study aimed to assess the prevalence, type, and levels of EEs in the families of patients with somatoform disorders. Methods: One hundred and six adult patients with somatoform disorders (F45; ICD-10) and their family member were recruited for the study. Patients with any comorbid medical or psychiatric disorder and substance use disorders (except tobacco dependence) or subjects living alone were excluded from the study. The study participants were assessed for somatoform disorders and EEs using a sociodemographic proforma, Mini-International Neuropsychiatric Interview structured interview, Patient Health Questionnaire-15 (PHQ-15), Family Emotional Involvement and Criticism Scale, and perceived criticism measure (PCM). Final analysis was done using statistical tests including Chi-square test, Fisher’s exact test, Student’s t-test, Pearson’s correlation coefficient, and univariate and multiple regression analysis. P ≤ 0.05 was considered to denote statistical significance. Results: The most common somatoform disorder in the sample was somatization disorder (33%) followed by persistent somatoform pain disorder (18.87%) and undifferentiated somatoform disorder (15.09%). Age (P = 0.007), married status (c2 = 6.752, P = 0.034), and a diagnosis of hypochondriacal disorder and somatization disorder (c2 = 14.613, P = 0.023) were significantly associated with perceived criticism (P < 0.05), while emotional overinvolvement (EOI) was high in subjects with somatoform autonomic dysfunction disorder (21.75) (P < 0.05). Significant positive correlation was seen between PCM and PHQ15 (severity measure) scores (r = 0.209; P = 0.032). Conclusions: Moderate level of EEs were found in the families of patients with somatoform disorders with the association being significant for criticism in hypochondriacal and somatization disorders and for EOI in somatoform autonomic dysfunction disorders. The hypothesis needs further study with follow-up and stronger statistical models to establish causation.

The Neurobiology of Childhood Trauma - Aldosterone and Blood Pressure Changes in a Community Sample

Childhood trauma is an important risk factor for onset and course of psychiatric disorders and particularly major depression. Recently, the renin-angiotensin-aldosterone system, one of the core stress hormone systems, has been demonstrated to be modified by childhood trauma.

Clinical characteristics of anti-N-methyl-d-aspartate receptor encephalitis in patients with a long-term history of mental disorders

BackgroundAnti-N-methyl-d-aspartate (NMDA) receptor encephalitis is an autoimmune disorder characterized by complex neuropsychiatric syndromes during disease onset. Although this disease has been well documented in the last decade, clinical characteristics of anti-NMDA receptor encephalitis in patients with long-term diagnostic history of mental disorders remain unclear.MethodsHere, we reviewed and analyzed series of anti-NMDA receptor encephalitis patients with a long-term medical history of psychiatric disorders through a review of literature using PubMed, web of science and Embase database. In addition, we described a patient of anti-NMDA receptor encephalitis with a long-term history of major depressive disorder.ResultsA total of 14 patients with anti-NMDA receptor encephalitis and a long-term history of mental disorders were included in our study. We found that most patients were adult (92.9%) and female (78.6%). These patients often first visited a psychiatric department (71.43%). The mean disease course of psychiatric disorders was more than 9 years. Speech impairment (71.4%), abnormal behaviors (64.3%), and catatonia (64.3%) were the most common clinical symptoms. Most patients (85.7%) had a satisfactory prognosis after immunotherapy.ConclusionAnti-NMDA receptor encephalitis in individuals with mental disorders is an underestimated condition, yet it presents complex clinical symptoms. Mental and behavioral impairments are more frequently observed in newly diagnosed anti-NMDA receptor encephalitis patients with a long-term history of mental disorders than those without mental illness. A diagnosis of anti-NMDA receptor encephalitis should be considered when patients with mental illness show sudden fluctuations in psychiatric symptoms.

Relationships between childhood trauma and dissociative, psychotic symptoms in patients with schizophrenia: a case–control study

BackgroundChildhood trauma (CT) is an important risk factor in the emergence and clinical course of psychiatric disorders. In the latest literature, an association exists between CT and patients with schizophrenia....

The neurobiology of childhood trauma - aldosterone and blood pressure changes in a community sample

Objective: Childhood trauma is an important risk factor for onset and course of psychiatric disorders and particularly major depression. Recently, the renin-angiotensin-aldosterone system, one of the core stress hormone systems, has been demonstrated to be modified by childhood trauma. Methods: Childhood trauma was obtained using the Childhood Trauma Questionnaire (CTQ) in a community-dwelling sample (N = 2038). Plasma concentrations of renin and aldosterone were measured in subjects with childhood trauma (CT; N = 385) vs. subjects without this experience (NoCT; N = 1,653). Multivariable linear regression models were calculated to assess the associations between CTQ, systolic and diastolic blood pressure, renin and aldosterone concentrations and the ratio of aldosterone and systolic blood pressure (A/SBP). Results: CT subjects demonstrated higher plasma aldosterone (A) concentrations, a lower systolic and diastolic blood pressure and a higher A/SBP. In addition, both aldosterone concentrations as well as A/SBP correlated with the severity of childhood trauma. These findings could not be attributed to differences in concomitant medication. Conclusions: In conclusion, childhood trauma was associated with neurobiological markers, which may impact the risk for psychiatric disorders, primarily major depression. The altered A/SBP ratio points to a desensitization of peripheral mineralocorticoid receptor function, which may be a target for therapeutic interventions.

Trapped: rigidity in psychiatric disorders

In the past decades, it has been shown to be difficult to predict the course of psychiatric disorders, because the mechanisms underlying their development and recovery process remain poorly understood. 1 Dalgleish T Black M Johnston D Bevan A Transdiagnostic approaches to mental health problems: current status and future directions. J Consult Clin Psychol. 2020; 88: 179-195 Crossref PubMed Scopus (82) Google Scholar These difficulties have been attributed to the fact that previous research was mostly performed from a categorical, diagnostic label point of view and on a single level (ie, psychological or biological), typically on the basis of static measures with low ecological validity. 1 Dalgleish T Black M Johnston D Bevan A Transdiagnostic approaches to mental health problems: current status and future directions. J Consult Clin Psychol. 2020; 88: 179-195 Crossref PubMed Scopus (82) Google Scholar To improve the prediction of course of illness, we propose to adopt a transdiagnostic, cross-level, mechanistic approach informed by clinical observations on rigidity in psychiatric patients.

Nutrition, Exercise, and Stress Management for Treatment and Prevention of Psychiatric Disorders. A Narrative Review Psychoneuroendocrineimmunology-Based

Psychoneuroendocrineimmunology (PNEI) brings together knowledge acquired since the 1930s from endocrinology, immunology, neuroscience, and psychology. With PNEI, a model of research and interpretation of health and disease is emerging, which sees the human body as a structured and interconnected unit, where the psychological and biological systems are mutually coordinated. In the PNEI view, many factors could influence mental health, with the endocrine system involved in mediating the effects of environmental stress on mental health and inflammation in the onset and course of psychiatric disorders as a result of individual and collective conditions and behaviors. Among these, nutrition is one way by which the environment impacts physiology: indeed, many pieces of research showed that several elements (e.g., probiotics, fish oil, zinc) have a positive effect on mental disorders thus being potentially augmentation agents in treatment. Still, physical activity can moderate depressive symptoms, while prolonged stress increases the risk of psychopathology. Taken together, the PNEI-based approach may inform prevention and treatment strategies, also in the field of mental health care.

Staging is not enough: Restoring complexity to the course of psychiatric disorders.

Staging is not enough: Restoring complexity to the course of psychiatric disorders.

Sleep Interventions in the Treatment of Schizophrenia and Bipolar Disorder.

Due to the effects of sleep on the central nervous system, it is thought that sleep disorders have a special importance in the onset, course and treatment of psychiatric diseases. Although the negative effects of sleep problems on the occurrence, recurrence and clinical course of psychiatric disorders are well known, it is reported that clinicians do not spend enough time for sleep problems in practice. This may be related to the fact that patients underreport their complaints for various reasons, insufficient examination time, and clinicians’ lack of knowledge about the importance of the subject. Pharmacotherapy, psychological and behavioral interventions are options among the therapeutic approaches to sleep problems. But, it seems that clinicians tend to prefer pharmacological approaches for the treatment of sleep problems. However, it is important to choose the appropriate treatment option with considering the method preferred by the patients, who already use many and high doses of pharmacological agents, the nature of the psychiatric disorder and the sleep problem. In this context, chronotherapeutic approaches such as bright light, sleep deprivation, interpersonal relations and social rhythm therapy, and cognitive behavioral therapy techniques adapted for patients with bipolar disorder can be used in the treatment of suitable patients. In this article, the current literature about sleep-related problems observed in patients with schizophrenia and bipolar disorder is reviewed comprehensively with presenting clinical phenotypes and treatment approaches.

Neuroprogression in post-traumatic stress disorder: a systematic review.

Introduction Neuroprogression has been proposed as the pathological rewiring of the brain that takes place in parallel with clinical and neurocognitive deterioration in the course of psychiatric disorders. This study aims to review the biological underpinnings and clinical outcomes related to neuroprogression in post-traumatic stress disorder (PTSD).Methods We performed a systematic review by searching PubMed, Embase, and Web of Science for articles published between January 1, 1960, and January 6, 2020. Inclusion criteria were met when articles assessed brain changes, neurocognition, functioning, inflammation, oxidative stress, and neurotrophins in patients with PTSD. Narrative review articles, case reports, and preclinical studies were excluded.Results A total of 965 abstracts were identified and 15 articles were included in our systematic review. It seems that for a subset of patients whose symptoms worsen or are maintained at a high intensity there is a progressive change in the frontal lobe, especially the prefrontal cortex, and worsening of both neurocognition (verbal memory and facial recognition) and functioning (physical, psychological, social and environmental).Conclusion Although current findings associate progressive reduction in frontal lobe size with neurocognitive impairment, further research is needed to characterize PTSD as a neuroprogressive disorder.

Psychiatric morbidity, somatic comorbidity and substance use in an adolescent psychiatric population at 3-year follow-up

Knowledge is scarce on the course of psychiatric disorders in adolescence. We aimed to assess changes in the frequency of psychiatric disorders, somatic disorders, pain, and substance use in a clinical psychiatric cohort from adolescence to young adulthood. This study is part of the Health Survey in Department of Children and Youth, St. Olavs Hospital, Norway. At age 13–18 years, 717 (43.5% of eligible) participated in the first study visit (T1) in 2009–2011, 549 were reassessed 3 years later with telephone interview (T2), and 464 had diagnostic evaluation at both time points. Data included: ICD-10 diagnoses (T1), DSM-IV diagnoses (T2), self-reported pain and substance use (T1 and T2). The overall rate of psychiatric disorders decreased (T1 vs. T2: 94.8% vs. 72.2%, p < 0.001); while, an increased rate of anxiety disorders was marked among girls (37.5% vs. 55.9%, p < 0.001), with accompanying raised frequencies of psychiatric comorbidity (14.1% vs. 42.6%, p < 0.001), somatic comorbidity (9.4% vs. 19.5%, p = 0.001), chronic pain (31.6% vs. 49.4%, p < 0.001), smoking, alcohol use and trying illicit drugs. Chronic pain, smoking and trying illicit drugs were associated with persisting psychiatric disorders, with highest risk differences for girls (RD = 25.4%, p = 0.002, RD = 15.6%, p = 0.008, RD = 18.0%, p = 0.001, respectively). Three out of four adolescents still had a psychiatric disorder after 3 years. Unlike boys, girls had an increasing rate of anxiety disorders and comorbidities. Chronic pain, smoking and trying illicit drugs were associated with persisting psychiatric disorders. Despite methodological limitations, these findings emphasize the importance of early targeted intervention for adolescents with psychiatric disorders.

Increasing the Clinical Psychiatric Knowledge Base About Pathogenic Copy Number Variation.

Specific copy number variants (CNVs) have been robustly associated with intellectual disability, autism, and schizophrenia. Most of the literature focus has been on documenting the existence of these phenomena. There are few data to guide therapeutic choices for these “orphan” diseases. We call for systematic and longitudinal case reports which, if carefully conducted, may provide crucial initial knowledge to guide therapeutics. We provide a step-by-step overview, a tailored set of consensus criteria for high-quality case reports, and a specific set of learning resources.

Childhood Maltreatment and Perceived Stress in Individuals with Concurrent Psychiatric Disorders

ABSTRACTPerceived stress plays an important role in the development and course of psychiatric disorders and early dropout from treatment. This study examined the effect of different types of childhood maltreatment on the current perceived stress level of patients with concurrent substance use and psychiatric disorders. One hundred patients (25% females) were recruited from a residential center for treatment of concurrent substance use and psychiatric disorders and assessed for the histories of childhood maltreatment and level of perceived stress. Results indicated that all types of childhood maltreatment (emotional and physical neglect, and emotional, physical and sexual abuse) were associated with elevated levels of perceived stress regardless of demographic characteristics, diagnoses of psychiatric disorders, and length of stay in the center. Findings support the need for additional targeted interventions for managing perceived stress and improving emotional regulation and coping skills in psychiatric patients with childhood maltreatment histories.

Neurofilament light chain as a blood biomarker to differentiate psychiatric disorders from behavioural variant frontotemporal dementia

The overlapping symptoms of behavioural variant frontotemporal dementia (bvFTD) and primary psychiatric disorders (such as depressive disorder, schizophrenia spectrum, and bipolar disorder) present a challenge for the differential diagnosis of bvFTD in middle and older-aged people. Neurofilaments are cytoskeletal proteins in the neurons, and several studies have reported elevated levels of neurofilament light chain (NfL) in cerebrospinal fluid of neurodegenerative as well as psychiatric disorders. The study aims to determine the utility of serum NfL levels as a biomarker to differentiate between bvFTD and psychiatric disorder. In our study, we investigated the levels of NfL in the serum of schizophrenia (n = 11), depression (n = 28), bipolar (n = 11), bvFTD (n = 20) patients and controls (n = 27) by single molecule array (Simoa) technology. The schizophrenia, depression and bipolar patients did not show significant changes in serum NfL levels in comparison to the control group (p > 0.99). The serum NfL levels were significantly elevated in bvFTD patients in comparison to the control cohort (p < 0.0001), depression (p < 0.0001), schizophrenia (p < 0.0002) and bipolar patients (p < 0.0083). We propose serum NfL as a biomarker to differentiate bvFTD from psychiatric disorders and to rule out neurodegeneration in the course of psychiatric disorders.

Relationship between Childhood Adversities, Emotion Dysregulation and Cognitive Processes in Bipolar Disorder and Recurrent Depressive Disorder

Cognitive development is susceptible to environmental distress, leading to cognitive distortions. Cognitive distortions may affect clinical course of psychiatric disorders. We aimed to assess whether childhood maltreatment and emotion dysregulation impair automatic thoughts (ATs) and meta-cognitions (MCs) in Bipolar Disorder (BD) and Major Depressive Disorder - Recurrent (MDB-RE) in this study. 85 patients with BD, 81 MDD-RE in remission and 86 healthy participants were enrolled. Automatic Thoughts Scale (ATS), Metacognition Questionnaire (MCQ-30), Childhood Trauma Questionnaire (CTQ- 28), Difficulties in Emotion Regulation Strategies Scale (DERS) were the measures used. ATs were determined by CTQ physical abuse (β=0.34, p<0.01), DERS goals (β=-0.37, p<0.01), impulse (β=0.53, p<0.01) and non-accept (β=0.23, p<0.05) subscales in BD (F=21.08, p<0.01) and CTQ emotional neglect (β=0.22, p<0.05), DERS strategies (β=0.39, p<0.05) in MDD-RE (F=9.97, p<0.05). MCs were predicted by sexual abuse (β=0.46, p<0.01) in BD (F=4.88, p<0.01), and emotional abuse (B=-0.30, p<0.05) in MDD-RE (F= 7.02, p<0.01). These results suggest that emotion dysregulation and childhood adversities are associated with cognitive processes such as MCs and ATs in MDD-RE and BD. Cognitive processes can cause various clinical manifestations and emotion dysregulation and childhood traumas should be considered as psychopathological components that can affect the course of mood disorders via various components. Further follow-up studies and larger samples are needed to better understand the effects of these components.

Blood pressure recovery to social stress in parentally bereaved and non-bereaved youths

ObjectiveTo examine differences in blood pressure response and recovery in a sample of bereaved and non-bereaved youths during an acute stress task conducted 5 years after time of parental death. MethodsOne-hundred and ninety-two (n = 192) bereaved and non-bereaved offspring (ages 11–29) participated in an adaptation of the Trier Social Stress Task (TSST) 5-years after the time of parental death. Blood pressure measurements were collected before, during, and after the laboratory stress protocol. Mixed models for repeated measures were used to analyze the effects of bereavement status and course of psychiatric disorder in the 5-year period after parental death in both offspring and caregivers on blood pressure response; linear regression was used to examine these associations with blood pressure recovery. ResultsAlthough there were no differences across groups in diastolic (DBP) or systolic blood pressure (SBP) response to stress, bereaved offspring demonstrated less SBP recovery to the TSST as compared to non-bereaved offspring. A significant interaction between bereavement status and race, and a marginally significant interaction between bereavement status and sex indicated poor SBP recovery for parentally bereaved racial/ethnic minority offspring as compared to parentally bereaved Caucasian offspring, and for parentally bereaved males compared to parentally bereaved females. ConclusionsParentally bereaved youths demonstrate blood pressure response to social stress tasks similar to that of non-bereaved youths, but parentally bereaved ethnic/racial minority youths and parentally bereaved males evidence a less complete recovery from the effects of stress. The health consequences of poor blood pressure recovery in bereaved youths are discussed.

Accurate recording of personality disorder in clinical practice.

SummaryDisturbances of personality are recorded very poorly in official statistics, but there are signs that this is changing. For many years, personality disorder has been either regarded as a secondary diagnosis that can be forgotten in the presence of another mental disorder, or avoided as the diagnosis gives the impression of untreatability or stigma. What is now abundantly clear is that under-diagnosis of personality disorder represents a disservice to patients and practitioners. It prevents a proper understanding of the longitudinal course of psychiatric disorder and an appreciation of some of the positive aspects of abnormal personality that can be used in treatment. We must no longer bury personality disorder, ostrich-like, in the diagnostic sand. It is there for the asking and needs to be embraced honestly and without fear if we are to improve the management of psychiatric patients.Declaration of interestNone.