Current Symptom Severity Research Articles

Self-reported symptom severity, general health, and impairment in post-acute phases of COVID-19: retrospective cohort study of Swedish public employees

This study aimed to examine current symptom severity and general health in a sample of primarily non-hospitalized persons with polymerase chain reaction (PCR) confirmed COVID-19 in comparison to PCR negative controls. During the first quarter of 2021, we conducted an online survey among public employees in West Sweden, with a valid COVID-19 test result. The survey assessed past-month severity of 28 symptoms and signs, self-rated health, the WHO Disability Assessment Schedule (WHODAS) 2.0 and illness severity at the time of test. We linked participants’ responses to their SARS-CoV-2 PCR tests results. We compared COVID-19 positive and negative participants using univariable and multivariable regression analyses. Out of 56,221 invited, 14,222 (25.3%) responded, with a response rate of 50% among SARS-CoV-2 positive individuals. Analysis included 10,194 participants (86.4% women, mean age 45 years) who tested positive 4–12 weeks (N = 1425; subacute) and > 12 weeks (N = 1584; postcovid) prior to the survey, and 7185 PCR negative participants who did not believe that they had had COVID-19. Symptoms were highly prevalent in all groups, with worst symptoms in subacute phase participants, followed by postcovid phase and PCR negative participants. The most specific symptom for COVID-19 was loss of smell or taste. Both WHODAS 2.0 score and self-rated health were worst in subacute participants, and modestly worse in postcovid participants than in negative controls. Female gender, older age and acute illness severity had larger effects on self-rated health and WHODAS 2.0 score in PCR positive participants than in PCR negative. Studies with longer follow-up are needed to determine the long-term improvement after COVID-19.

Sex-based variations of prefrontal structure and longitudinal symptoms in pediatric posttraumatic stress disorder.

Pediatric posttraumatic stress disorder (pPTSD) is more than three times as likely to develop in trauma-exposed female youth than males. Despite the staggering sex differences in the prevalence rates of pPTSD and symptom expression, relatively little is known about the underlying biomarkers of these sex-based variations in pPTSD as compared to typically development. The Youth PTSD study recruited 97 youth, ages of 7 and 18, to undergo comprehensive clinical assessments and T1-weighted MRI to evaluate the extent to which sex can explain PTSD-related variations in brain structure. Whole-brain VBM as well as whole-brain estimates of cortical thickness and surface area were analyzed to identify group-by-sex interactions. Finally, we tested whether current or future symptom severity was predictive of regions exhibiting sex-based variations. Clinically, females with PTSD were significantly more likely to report exposure to and higher severity of interpersonal violence and symptoms of hyperarousal. Sex and PTSD status were predictive of gray matter across the lateral prefrontal cortex (PFC), including the ventrolateral PFC and frontal pole, where increased volume and surface area was found in PTSD females as compared to PTSD males. Interestingly, the ventrolateral prefrontal cortex and frontal pole were negatively predictive of symptoms 1 year later in only males with PTSD. Together, these results establish that youth with PTSD exhibit sex-based variations in clinical and trauma characteristics and prefrontal cortical structure relative to normative development. This work demonstrates the importance of examining the role that sex may play in the behavioral and neurobiological presentation of pPTSD.

Clinical correlates of women endorsing premenstrual suicidal ideation: a cross-sectional study

BackgroundPrevalence of premenstrual syndrome (PMS) may be as high as 13-18%, but it remains under-recognized and is associated with increased suicidal ideation (SI), plans, and attempts in epidemiological studies. The present study reports on women endorsing premenstrual SI (PMSI) and characterizes this at-risk group and its clinical correlates.MethodsA cross-sectional study assessed demographics, anxiety and depression severity, psychiatric diagnoses, menstrual symptoms, SI, and trauma in adult women at a major medical center over 11 months.ResultsThree hundred two women were assessed. Of 153 participants endorsing premenstrual symptoms, 41 (27%) reported new or worsening concurrent premenstrual passive or active SI. Women who reported PMSI were significantly more likely to be single, unemployed, and childless as well as significantly more likely to report interference from premenstrual symptoms, histories of psychiatric hospitalization, adverse childhood events, suicide attempts, and current and past depression and anxiety compared to women without PMSI. The final regression model indicated the most significant predictors of PMSI were history of a depression diagnosis, severity of current depressive symptoms, and having experienced 3 or more childhood adverse events.ConclusionNearly one-third of women reporting premenstrual symptoms endorsed concurrent SI, a clinically valuable demonstration of the importance of this predictable cyclic risk factor.

Gambling disorder in minority ethnic groups

BackgroundAlthough the data on racial/ethnic associations with gambling disorder are limited, studies suggest that ethnicity may have associations with both symptom severity and psychosocial impairment linked to gambling disorder. Based on the current literature, we hypothesized that there would be a difference in gambling symptom severity, and co-occurring disorders, as a function of racial-ethnic group. Methods475 adults (mean age = 47.6 (±11.6) years; 54.3 % females) with gambling disorder who had participated in clinical trials on pharmacotherapy or psychotherapy were included. Participants were assessed for gambling severity, comorbidities, health issues, quality of life and psychosocial functioning. Participants who self-identified as Black, Asian or Minority Ethnic (BAME) were compared to those who self-identified as white Caucasian (non-BAME). Significance was defined as p < 0.01. ResultsThe BAME group had significantly earlier age of first gambling. The two groups did not differ significantly in terms of age when gambling first became problematic, disability, current gambling disorder symptom severity, previous suicide attempt(s), quality of life, percent of salary in past year lost to gambling, or likelihood of having received treatment for gambling disorder in the past, nor in terms of having used Gamblers Anonymous. ConclusionsThese data show that having gambling disorder and being from a minority racial-ethnic group was associated with significantly earlier age at first gambling, in clinical trial settings. Future work should further examine differences in the clinical features of gambling disorder in different minority groups in larger sample sizes, ideally also longitudinally, across a range of settings. Identification of the reasons/mechanisms for differences in earlier age of first gambling may lead to new public health and treatment targets to minimize gambling harms.

Intensive Outpatient Treatment of Pediatric Rumination Syndrome in the Era of Telemedicine.

We have had success treating children with severe rumination syndrome using a multidisciplinary intensive outpatient program (IOP) involving multiple treatment sessions daily. During the coronavirus disease 2019 (COVID-19) pandemic, we temporarily transitioned care to telemedicine. The objective of this study is to compare outcomes of patients with rumination syndrome who completed IOP treatment in person versus by telemedicine. We performed a retrospective review of patients diagnosed with rumination syndrome who participated in IOP treatment from 2018 to 2020. Similar treatment sessions were performed involving medical and behavioral techniques provided by a multidisciplinary team during telemedicine visits. Families/patients were asked to complete a survey outlining their child's current rumination symptom severity and review the IOP. We included 34 patients (79% F, median age 15 years, range 7-19 years) who completed IOP treatment. Twenty-six patients (76%) were treated in person and 8 patients (24%) by telemedicine. For patients treated in person, 76% (19/25) had improvement in symptoms while 16% (4/25) had complete resolution of symptoms. For patients treated by telemedicine, 88% (7/8) had improvement in their symptoms. There were no significant differences between groups in likelihood of improvement. Overall, 78% (18/23) preferred in person therapy while 17% (4/23) did not have a preference. All 18 of the in-person cohort who completed follow-up surveys preferred in-person management. Multidisciplinary intensive outpatient treatment for children and adolescents with severe rumination syndrome is effective. Although telemedicine may be an alternative to in person therapy, majority of families prefer in person visits.

RORA rs8042149 polymorphism moderates the association between PTSD symptom severity and transverse temporal gyrus thickness in Han Chinese adults who lost their only child

BackgroundThe G allele in retinoid-related orphan receptor alpha (RORA, rs8042149) gene is associated with post-traumatic stress disorder (PTSD) diagnosis and more severe symptoms, reported in the first genome-wide association study of PTSD and subsequent replication studies. Although recent MRI studies identified brain structural deficits in RORA rs8042149 risk G allele carriers, the neural mechanism underlying RORA–related brain structural changes in PTSD remains poorly understood. MethodsThis study included 227 Han Chinese adults who lost their only child. Cortical thickness and subcortical volume were extracted using FreeSurfer, and PTSD severity was assessed using the Clinician-Administered PTSD Scale. Hierarchical linear regression was used to assess the interaction effect between RORA genotypes (T/T, G/T, and G/G) and PTSD severity on cortical and subcortical structures. ResultsSignificant genotype × PTSD symptom severity interaction effects were found for bilateral transverse temporal gyrus thickness. For individuals with the homozygous T/T genotype, current PTSD symptom severity was positively associated with bilateral transverse temporal gyrus thickness. For individuals with heterozygous G/T genotype, current PTSD symptom severity was negatively associated with the left transverse temporal gyrus thickness. No significant main or interaction effects were found in any subcortical regions. LimitationCross-sectional design of this study. ConclusionThese findings suggest that the non-risk T/T genotype – but not the risk G allele carriers – has a potentially protective or compensatory role on temporal gyrus thickness in adults who lost their only child. These results highlight the moderation effect of RORA polymorphism on the relationship between PTSD symptom severity and cortical structural changes.

Impaired verbal memory function is related to anterior cingulate glutamate levels in schizophrenia: findings from the STRATA study

Impaired cognition is associated with lower quality of life and poor outcomes in schizophrenia. Brain glutamate may contribute to both clinical outcomes and cognition, but these relationships are not well-understood. We studied a multicentre cohort of 85 participants with non-affective psychosis using proton magnetic resonance spectroscopy. Glutamate neurometabolites were measured in the anterior cingulate cortex (ACC). Cognition was assessed using the Brief Assessment for Cognition in Schizophrenia (BACS). Patients were categorised as antipsychotic responders or non-responders based on treatment history and current symptom severity. Inverted U-shaped associations between glutamate or Glx (glutamate + glutamine) with BACS subscale and total scores were examined with regression analyses. We then tested for an interaction effect of the antipsychotic response group on the relationship between glutamate and cognition. ACC glutamate and Glx had a positive linear association with verbal memory after adjusting for age, sex and chlorpromazine equivalent dose (glutamate, β = 3.73, 95% CI = 1.26–6.20, P = 0.004; Glx, β = 3.38, 95% CI = 0.84–5.91, P = 0.01). This association did not differ between good and poor antipsychotic response groups. ACC glutamate was also positively associated with total BACS score (β = 3.12, 95% CI = 0.01–6.23, P = 0.046), but this was not significant after controlling for antipsychotic dose. Lower glutamatergic metabolites in the ACC were associated with worse verbal memory, and this relationship was independent of antipsychotic response. Further research on relationships between glutamate and cognition in antipsychotic responsive and non-responsive illness could aid the stratification of patient groups for targeted treatment interventions.

Psychotherapy employed additionally to Psychopharmacotherapy is not related to Better Treatment Outcome in Major Depressive Disorder

IntroductionAlthough numerous effective antidepressant (AD) strategies are available for the treatment of major depressive disorder (MDD), many patients do not achieve satisfactory treatment response.ObjectivesThe aims of the present European, cross-sectional, multicenter, naturalistic study were (1) to determine the proportion of patients suffering from primary MDD who received additional psychotherapy to their ongoing psychopharmacotherapy and (2) to identify the associated socio-demographic and clinical patterns.MethodsPatients receiving both treatments were compared to those lacking concomitant additional psychotherapy that was manual-driven psychotherapy (MDP) in all cases.ResultsWhile 68.8% of a total of 1279 MDD patients received exclusively psychopharmacotherapy, 31.2% underwent a psychopharmacotherapy-MDP combination. The latter patient population was rather younger, higher educated, employed, exhibited an earlier mean age of MDD onset, lower severity of current depressive symptoms with lower odds of suicidality and higher rates of melancholic features, and comorbid asthma and migraine, and was generally treated with lower daily doses of their first-line ADs. Whereas agomelatine was more commonly dispensed in these patients, selective serotonin reuptake inhibitors were more often prescribed in MDD patients lacking additional MDP. No significant between-group differences were detected in terms of treatment outcome.ConclusionsThe fact that the employment of additional MDP was not related to better treatment outcome in MDD represents our major and clinically most relevant finding. Generally, MDP was employed in a minority of our patients who experienced rather beneficial socio-demographic and clinical characteristics. This might reflect an inferior accessibility of these psychotherapeutic techniques for patients who are more severely ill and less socio-economically privileged.DisclosureReferences Bartova L, Fugger G, Dold M, Swoboda MMM, Zohar J, Mendlewicz J, Souery D, Montgomery S, Fabbri C, Serretti A, Kasper S. Combining psychopharmacotherapy and psychotherapy is not associated with better treatment outcome in major depressive disor

0688 Insomnia Symptom Severity Predicts Greater Alcohol Use During the COVID-19 Pandemic: A Longitudinal Study

IntroductionIndividual stress levels undeniably increased following the start of the COVID-19 pandemic. Not surprisingly, sleep problems, including insomnia, have intensified during the pandemic due to the increase in overall stress levels. The impact that greater insomnia has had on other health outcomes, for example problematic drinking, has yet to be examined. Therefore, the aim of the present study was to assess whether greater insomnia symptom severity predicted future alcohol use patterns (i.e., frequency and severity).MethodsThe study used data from a nationwide sample of 2,979 who were surveyed at two different points during the COVID-19 pandemic (T1 = initial months after the start of the pandemic [April – June 2020]; T2 = 10-12 months later). Of those, 1,971 adults (mean age = 46.0 years; 80% women) reported having had an alcoholic beverage during the past 3 months and were included in the subsequent analyses. Insomnia symptom severity was assessed at both time points using the Insomnia Severity Index (ISI). Self-reported alcohol frequency (i.e., days per week) and severity (i.e., drinks per day) were assessed at T2.ResultsAt T2, participants reported drinking alcoholic beverages (mean ± standard deviation) 2.7 ± 2.1 days during a typical week and drinking 1.8 ± 1.1 alcoholic beverages on days they did drink. According to results from separate multiple regression analyses, where T1 ISI scores were entered as the independent variable and alcohol frequency and severity were entered as the dependent variables, total ISI scores at T1 were associated with less frequent (β = -0.075, p = .001) but more severe drinking patterns (β = .088, p < .001). These associations remained significant while controlling for current insomnia symptom severity.ConclusionBaseline insomnia symptom severity was a predictor of future alcohol use patterns. Specifically, people with greater insomnia at T1 reported, on average, less frequent drinking (i.e., fewer days per week), yet greater consumption on days that they did drink alcohol. These data highlight the importance of assessing the impact that insomnia has had (and continues to have) on other behavioral health outcomes during the ongoing pandemic.Support (If Any)K23HL141581 (PI: Vargas); R25HL10544 (PI: Jean-Louis); K24AG055602 (PI: Perlis)

Circulating inflammatory markers, cell-free mitochondrial DNA, cortisol, endocannabinoids, and N-acylethanolamines in female depressed outpatients

Objectives Major depressive disorder (MDD) involves peripheral low-grade pro-inflammatory activity. This multi-biomarker case-control study characterises the proinflammatory status in MDD beyond C-reactive protein (CRP) and Interleukin (IL)-6 levels through investigating concomitant alterations of immunoregulatory biomolecules. Methods In 20 female MDD patients and 24 non-depressed women, circulating levels of CRP, IL-6, cortisol, selected endocannabinoids (ECs; anandamide [AEA], 2-arachidonylglycerol [2-AG]), and N-acylethanolamines (NAEs), as well as circulating cell-free mitochondrial DNA (ccf-mtDNA) were measured. Results We found higher serum CRP and plasma AEA levels in MDD and a positive association of CRP and AEA levels with current depressive symptoms. Blood levels of cortisol, ccf-mtDNA, 2-AG, and NAEs did depend on MDD diagnosis nor correlated with the severity of current depressive symptoms. CRP correlated positively with AEA, and AEA showed positive associations with 2-AG and NAE levels. Conclusions In this study, female MDD outpatients with mild to moderate disorder severity did not substantially differ from non-depressed controls in the resting levels of multiple immunoregulatory markers in peripheral blood. Instead of investigating resting levels, future research on the role of inflammatory activity in MDD should focus on investigating the reactivity of pathways modulating the immune system upon exposure to physical and psychosocial stressors.

Perceptions of Symptom Duration are Associated With Emotional Distress and Functioning in Adolescents With Protracted Concussion Recovery.

To evaluate perceptions about recovery duration (e.g., "my symptoms will last a long time", "my symptoms will be permanent rather than temporary") and its associations with emotional distress and functioning in children and adolescents with a slower post-concussive recovery. Participants (N = 49, 69% girls, 11-17 years old, M = 15.8 years old, SD = 1.8) were recruited from a concussion clinic on average 7.7 months after injury (SD = 2.5). Measures included the Illness Perception Questionnaire Revised (perceived duration of symptoms only) to evaluate recovery expectations, the Health and Behavior Inventory (self and parent reports) to evaluate current post-concussive symptoms (cognitive and somatic symptoms), the emotional distress subscale of the Strengths and Difficulties Questionnaire (SDQ-self-report), and the emotional functioning subscale of the Pediatric Quality of Life Questionnaire (PedsQL-self-report). Regression analyses (linear models with all covariates entered at once) suggested that greater expectations for symptom persistence were significantly associated with higher emotional distress on both SDQ and PedsQL subscales, after controlling for post-concussive symptom severity and other confounds. Emotional distress/functioning was not associated with perceptions of symptom duration reported by parents, severity of post-concussive symptoms (self- and parent reports), age, number of concussions, time since injury, or a history of mental health concern or diagnosis (parent-reported). This study suggests that pessimistic attitudes for recovery duration may be more strongly associated with emotional distress than current post-concussive symptom severity or a history of mental health concern or diagnosis.

The association between subjective memory complaints and objective memory performance in older adults with mood disorders

<h3>Introduction</h3> The relationship between subjective memory complaints (SMCs) and objective memory performance is not always clear-cut, which in turn can complicate the assessment of potential memory decline in older adults. Although previous research suggests that the presence of certain state-related factors, including mood and anxiety symptoms, are associated with higher SMCs, whether these factors play a mediating or moderating role in the relationship between SMCs and objective memory performance isn't as clear. In addition, scant research has explored this relationship in older adults with mood disorders. This is an important target of investigation, as accounting for mood state is critical when interpreting the clinical significance of one's SMCs and objective test performance. Thus, the current study aimed to (1) investigate the relationship between SMCs and concurrent performance on memory testing in older adults with mood disorders compared to healthy controls (HCs), and (2) determine if the relationship between SMCs and objective memory performance varies as a function of depression and/or anxiety symptom severity within the mood disorder group. <h3>Methods</h3> We conducted multilevel regression analyses of cross-sectional data from a total of 36 older adults (aged 56-89) who were enrolled in the Geriatric Mood Disorders Database study at McLean Hospital. Our sample included 21 older adults with major mood disorders (depressive and bipolar spectrum disorders) and 15 older adults without any psychiatric diagnoses (HCs). All participants completed self-report scales that assessed current mood/anxiety symptom severity (Geriatric Depression Scale, GDS; Geriatric Anxiety Scale, GAS-2) and subjective memory concerns (Multifactorial Memory Questionnaire, MMQ), as well as objective memory testing using the California Verbal Learning Test (CVLT-II). Aim 1 analyses used group (HCs vs mood), SMCs (total MMQ score), and their interaction term (group x SMCs) as predictors, with three CVLT-II metrics representing memory encoding/registration, retrieval, and storage/retention as outcome variables. Aim 2 analyses were performed within the mood group only and used SMCs (total scores from the MMQ), GDS/GAS-2, and their interaction term (SMCs x GDS and SMCs x GAS-2, respectively) as predictors, with the same CVLT-II scores as outcome variables. All analyses included age and sex as covariates. <h3>Results</h3> Mood group and control group did not significantly differ (p > 0.05) in participant's age, sex, race/ethnicity, SMCs, and three categories of objective memory testing (memory encoding/registration, retrieval, and storage/retention). As expected, the groups did differ significantly in mean severity of depressive and anxiety symptoms. For aim 1, the results from regression analyses indicated that SMCs did not significantly predict memory encoding/registration (Β = .332, <i>p</i> = .16), memory retrieval (Β = .063, <i>p</i> = .40), and memory storage/retention (Β = .189, <i>p</i> = .231). Moreover, being in a mood vs. control group did not significantly moderate any of the association between SMCs and objective memory performances (i.e., memory encoding/registration (Β = -.32, <i>p</i> = .231); retrieval (Β = -.055, <i>p</i> =.514); and storage/retention (Β =-.187, <i>p</i> = .295). For aim 2, results suggested that, within the mood disorder group, the severity of depressive symptoms did not significantly moderate the association between SMCs and each of the objective memory performance variables: encoding/registration (Β = .022, <i>p</i> =.272); retrieval (Β = .007, <i>p</i> =.336); and storage/retention (Β = .02, <i>p=</i>.212). Additionally, results demonstrated that severity of anxiety symptoms was not a significant moderator for the association between SMCs and memory performance within older adults with mood disorders (i.e., Β =.003, <i>p</i> =.583 for encoding/registration; Β = .002, <i>p</i> =.454 for retrieval; and Β = .007, <i>p=</i>.261 for storage/retention). <h3>Conclusions</h3> The current results indicate that the association between SMCs and concurrent objective memory performance did not differ between healthy older adults and those with major mood disorders. In addition, the strength of this association did not vary as a function of current depression or anxiety symptom severity within the mood disorder group. Collectively, these findings suggest that, amongst older adults, neither the presence of an endogenous mood disorder nor the severity of active depression/anxiety symptoms impacts the subjective appraisal of memory functioning in relation to objective performance on concurrent memory testing. Further, those with mood disorders did not differ significantly from HCs in their subjective appraisal of memory concerns. These findings are surprising, as prior literature suggests that those with more severe mood symptoms also have higher SMCs. Our analysis is limited by a small sample size, and further investigations should be conducted with larger samples to confirm the strength of these findings. <h3>This research was funded by</h3> This study is funded by the Rogers Family Foundation.

Using language in social media posts to study the network dynamics of depression longitudinally

Network theory of mental illness posits that causal interactions between symptoms give rise to mental health disorders. Increasing evidence suggests that depression network connectivity may be a risk factor for transitioning and sustaining a depressive state. Here we analysed social media (Twitter) data from 946 participants who retrospectively self-reported the dates of any depressive episodes in the past 12 months and current depressive symptom severity. We construct personalised, within-subject, networks based on depression-related linguistic features. We show an association existed between current depression severity and 8 out of 9 text features examined. Individuals with greater depression severity had higher overall network connectivity between depression-relevant linguistic features than those with lesser severity. We observed within-subject changes in overall network connectivity associated with the dates of a self-reported depressive episode. The connectivity within personalized networks of depression-associated linguistic features may change dynamically with changes in current depression symptoms.

Depressive symptoms in youth with ADHD: the role of impairments in cognitive emotion regulation

Youth with attention-deficit/hyperactivity disorder (ADHD) are at increased risk to develop co-morbid depression. Identifying factors that contribute to depression risk may allow early intervention and prevention. Poor emotion regulation, which is common in adolescents, is a candidate risk factor. Impaired cognitive emotion regulation is a fundamental characteristic of depression and depression risk in the general population. However, little is known about cognitive emotion regulation in youth with ADHD and its link to depression and depression risk. Using explicit and implicit measures, this study assessed cognitive emotion regulation in youth with ADHD (N = 40) compared to demographically matched healthy controls (N = 40) and determined the association with depressive symptomatology. As explicit measure, we assessed the use of cognitive emotion regulation strategies via self-report. As implicit measure, performance in an ambiguous cue-conditioning task was assessed as indicator of affective bias in the processing of information. Compared to controls, patients reported more frequent use of maladaptive (i.e., self-blame, catastrophizing, and rumination) and less frequent use of adaptive (i.e., positive reappraisal) emotion regulation strategies. This pattern was associated with the severity of current depressive symptoms in patients. In the implicit measure of cognitive bias, there was no significant difference in response of patients and controls and no association with depression. Our findings point to depression-related alterations in the use of cognitive emotion regulation strategies in youth with ADHD. The study suggests those alterations as a candidate risk factor for ADHD-depression comorbidity that may be used for risk assessment and prevention strategies.

A test of self-medication hypothesis for drug use in homeless persons: the role of severe mental illness

ABSTRACT The purpose of this study was to test the self-medication hypothesis of drug use in a sample of homeless persons. A serial mediation model was tested to examine the effects of recent victimization on trauma-related symptom severity, and the effects of trauma-related symptom severity on severity of severe mental illness (SMI) symptoms, and finally the effects of severity of SMI symptoms on illicit drug use. The final sample for the study included 164 participants who were assessed prospectively at both baseline and 6-month post-baseline. It was hypothesized that SMI would mediate the pathways for self-medication. Structural Equations Modelling analyses revealed that current trauma-related symptom severity mediated the relationship between recent victimization and severity of SMI symptoms. Furthermore, SMI symptom severity mediated the relationship between current trauma-related symptom severity, and illicit drug use providing indirect support for the self-medication hypothesis. The findings underscore the importance of assessing and providing for trauma-informed care to persons with SMI seeking services for co-occurring substance use disorders.

Depressive symptom screening and endorsement of psychosis risk-related experiences in a diverse adolescent and young adult outpatient clinic in the US

BackgroundEarly identification and intervention is a gold standard for psychotic disorders, for which delays in care can have serious consequences. Screening for psychosis in primary care may circumvent barriers related to stigma and facilitate shorter pathways to care. Yet, there is debate regarding the benefit-risk balance for psychosis screening in general adolescent populations. MethodsPrimary care patients of an adolescent/young adult medical clinic in the US ages 14–21 self-administered surveys assessing age, sex, receipt of psychotherapy, and occurrence, frequency (1–5), and distress (0–3) for 23 psychosis risk (PR) symptoms, including 6 general/nonspecific items and 17 psychosis-specific items. Participants also completed the 9-item Patient Health Questionnaire (PHQ-9); scores of ≥10 suggested clinically significant depressive symptoms. Analyses characterized PR symptoms and examined associations of PR symptom distress with current therapy and depressive symptom severity. ResultsOf 212 patients who completed the survey, 75% endorsed ≥1 PR symptom and 27% rated ≥3 on distress for psychosis-specific items. Those with high PHQ-9 scores reported higher PR distress overall (t = −6.1, df = 52.3, p < 0.001) but not on psychosis-specific items such as hallucinations and suspiciousness. One in 9 participants reported heightened PR distress without being in therapy or having high depressive symptoms. ConclusionsMost adolescents in this primary care sample endorsed symptoms associated with PR. Distress related to these symptoms was less common but occurred even in the absence of depressive symptoms. PR screening only in youth with high depressive symptom screens or in mental health care may miss youth needing further assessment for psychosis.

Hair glucocorticoids are associated with childhood adversity, depressive symptoms and reduced global and lobar grey matter in Generation Scotland

Hypothalamic–pituitary–adrenal (HPA) axis dysregulation has been commonly reported in major depressive disorder (MDD), but with considerable heterogeneity of results; potentially due to the predominant use of acute measures of an inherently variable/phasic system. Chronic longer-term measures of HPA-axis activity have yet to be systematically examined in MDD, particularly in relation to brain phenotypes, and in the context of early-life/contemporaneous stress. Here, we utilise a temporally stable measure of cumulative HPA-axis function (hair glucocorticoids) to investigate associations between cortisol, cortisone and total glucocorticoids with concurrent measures of (i) lifetime-MDD case/control status and current symptom severity, (ii) early/current-life stress and (iii) structural neuroimaging phenotypes, in N = 993 individuals from Generation Scotland (mean age = 59.1 yrs). Increased levels of hair cortisol were significantly associated with reduced global and lobar brain volumes with reductions in the frontal, temporal and cingulate regions (βrange = −0.057 to −0.104, all PFDR < 0.05). Increased levels of hair cortisone were significantly associated with MDD (lifetime-MDD status, current symptoms, and severity; βrange = 0.071 to 0.115, all PFDR = < 0.05), with early-life adversity (β = 0.083, P = 0.017), and with reduced global and regional brain volumes (global: β = −0.059, P = 0.043; nucleus accumbens: β = −0.075, PFDR = 0.044). Associations with total glucocorticoids followed a similar pattern to the cortisol findings. In this large community-based sample, elevated glucocorticoids were significantly associated with MDD, with early, but not later-life stress, and with reduced global and regional brain phenotypes. These findings provide important foundations for future mechanistic studies to formally explore causal relationships between early adversity, chronic rather than acute measures of glucocorticoids, and neurobiological associations relevant to the aetiology of MDD.

The Relationship Between Cognitive Abilities and Trait Clinical Features in Patients With Borderline Personality Disorder

Very few studies have focused on the relationship between cognitive functions and clinical features in borderline personality disorder (BPD). Subjects with BPD and healthy controls were administered the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test A and B, and the Wisconsin Card Sorting Test. The Brief Symptom Inventory (BSI-53) was used to assess the severity of current symptoms. Attachment style was assessed with the Experiences in Close Relationship Questionnaire, identity integration with the Personality Structure Questionnaire, and other domains of personality dysfunction with the RUDE Scale for Personality Dysfunction. Patients with BPD performed significantly worse than healthy controls in all cognitive domains. Cognitive functions, particularly delayed memory and visuospatial abilities, displayed meaningful associations with trait-like clinical features, above the effect of global cognition and state psychopathology. These findings highlight the need to evaluate effects of cognitive rehabilitation on trait features among individuals with BPD.

Personality, symptom, and demographic correlates of perceived efficacy of selective serotonin reuptake inhibitor monotherapy among current users with low mood: A data-driven approach

BackgroundSelective serotonin reuptake inhibitors (SSRIs) are often the first-line treatment option for depressive symptoms, however their efficacy varies across patients. Identifying predictors of response to SSRIs could facilitate personalised treatment of depression and improve treatment outcomes. The aim of this study was to develop a data-driven formulation of demographic, personality, and symptom-level factors associated with subjective response to SSRI treatment. MethodsParticipants were recruited online and data were collected retrospectively through an extensive digital mental health questionnaire. Extreme gradient boosting classification with nested cross-validation was used to identify factors distinguishing between individuals with low (n=37) and high (n=111) perceived benefit from SSRI treatment. ResultsThe algorithm demonstrated a good predictive performance (test AUC=.88±.07). Positive affectivity was the strongest predictor of response to SSRIs and a major confounder of the remaining associations. After controlling for positive affectivity, as well as current wellbeing, severity of current depressive symptoms, and multicollinearity, only low positive affectivity, chronic pain, sleep problems, and unemployment remained significantly associated with diminished subjective response to SSRIs. LimitationsThis was an exploratory analysis of data collected at a single time point, for a study which had a different primary aim. Therefore, the results may not reflect causal relationships, and require validation in future prospective studies. Furthermore, the data were self-reported by internet users, which could affect integrity of the dataset and limit generalisability of the results. ConclusionsOur findings suggest that demographic, personality, and symptom data may offer a potential cost-effective and efficient framework for SSRI treatment outcome prediction.

Concussion Referral and Practice Patterns by Pediatric Emergency Medicine Providers.

Concussion is a commonly encountered diagnosis for pediatric emergency medicine (PEM) providers, yet little is known regarding referral patterns to specialists. Our goal was to assess PEM providers' referral patterns and current usage of standardized evaluation tools. This study was conducted as cross-sectional survey of PEM providers recruited from the American Academy of Pediatrics Section on Emergency Medicine Listserv. Surveys were distributed at 3 time points between December 1, 2020, and February 28, 2021, and included multiple choice, Likert scale, and free text questions. Descriptive statistics and bivariate analyses were used to describe the sample and compare responses between those with variable experience and confidence in concussion management. In total, 162 of 491 Listserv members (33.0%) completed the survey. The factors most often reported to assist in referral decisions were history of severe (92.6%) or multiple (90.7%) prior concussions, prolonged symptom duration (89.5%), and severity of current symptoms (84.6%). Most providers reported having large experience (63.0%) and confidence (54.9%) in managing concussion. Standardized symptom scales (8.0%), vestibular (11.7%) and balance assessments (13.0%), and prognostic tools (6.8%) were infrequently used. Most (64.2%) providers felt specialty referral was important. More than 80% reported high likelihood to use an accurate risk stratification tool to facilitate referral. Although most PEM providers reported significant experience and confidence in managing pediatric concussion, standardized assessment tools were infrequently used. Most were likely to use a risk stratification tool to assist in specialty referral. Future studies should assess the ability of targeted referral strategies to improve recovery for concussed youth.