Diagnostic And Statistical Manual Of Mental Disorders-IV Research Articles

Prevalence of and optimal screening tool for postpartum depression in a community-based population in China

BackgroundPostpartum depression (PPD) is an important public health problem worldwide. China is planning to launch PPD screening in community settings, but there are questions on the community prevalence of PPD and validated screening tools. MethodsWe sought to recruit all eligible new mothers during postnatal home visits in two districts of Changsha, China, and after informed consent, screened them for PPD using three self-administered questionnaires—the Edinburgh Postpartum Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), and Whooley Questions for Depression Screening. Video structured diagnostic interviews were performed online according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) by qualified specialists who were blinded to screening results. Optimal screening was determined based on the acceptability of scales and diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). ResultsOut of 3004 eligible women, 2730 (90.9 %) completed the screening questionnaires. Among those screened, the video structured diagnostic interview was administered to 1862 (68.2 %) and 62 (3.3 %) were diagnosed with a current depressive condition. The optimal screening approach involved combining Whooley Questions (at least one “yes”) with EPDS (cutoff >10) in series, with sensitivity of 0.76 (95 % CI 0.63 to 0.85), specificity of 0.93 (0.92 to 0.94), PPV of 0.28 (0.21 to 0.36) and NPV of 0.99 (0.98 to 1.00). LimitationsDue to the regional sample and exclusion of mothers with telephone contact rather than home visits, our findings may not be fully generalizable to the entire population. ConclusionsThe prevalence of PPD among women in this sample was substantially lower than those reported in previous studies in China, the majority of which used screen positivity in measuring prevalence. Combining Whooley Questions with EPDS in series is the most optimal screening approach in this population, though this would still result in a high number of false positives at current prevalence.

54 The Differential Impact of Genetic Moderators on the Relationship Between Depression and Cognition

Objective:Depression has a well-established negative effect on cognitive functioning. Variations in the apolipoprotein e (APOE) and brain-derived neurotrophic factor (BDNF) genes likely contribute to this relationship. APOE4 and the BDNF Val66Met polymorphism are independently associated with late-life depression and cognitive dysfunction. The current study investigated the moderating effects of APOE4 and BDNFMet (i.e., the presence of the BDNF Val66Met polymorphism) on the relationship between depression and cognitive functioning in older adults.Participants and Methods:The sample included 103 older adults drawn from two clinical trials who were recruited from the VA Palo Alto Health Care System (VAPAHCS) and the Stanford/VA Alzheimer’s Disease Center. Depression was diagnosed using the Mini Neuropsychiatric Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). The presence of an APOE4 and BDNFMet allele were dichotomized (i.e., yes/no) and determined using venipuncture. A comprehensive neuropsychological battery was used to assess attention (RAVLT Trial 1, WAIS-IV DSF), processing speed (TMTA, SDMT, Stroop Word, Stroop Color), working memory (WAIS-IV DSB, DSS), visuospatial functioning (JLO), language (VNT), memory (RAVLT Delayed Recall, WMS-IV Logical Memory II), and executive function (TMTB, Stroop Color-Word). Separate moderation analyses were conducted with depression as the predictor and APOE4 or BDNFMet status as the moderator using the SPSS PROCESS macro v4.0. Age was a covariate for models with processing speed, memory, language, and executive function as outcome variables.Results:Participants were largely male (93%) and White (75%). Ten percent met criteria for depression, 26% were APOE4 carriers, and 32% were BDNFMet carriers. The overall model examining depression, APOE4, and memory was significant (p < .01, R2 = .14). Depression was associated with lower memory performance (p < .05), however, APOE4 was not a significant moderator (p > .05). Similarly, the overall model examining depression, APOE4, and language was also significant (p < .05, R2 = .10). While the direct effects of depression and APOE4 on language were nonsignificant (p > .05), there was a significant two-way interaction between APOE4 and depression (p = .03). The overall model with depression, BDNFMet, and memory was significant (p < .001, R2 = .18). While neither depression nor BDNFMet had significant direct effects on memory (p > .05), a two-way interaction emerged between depression and BDNFMet (p = .05). Simple slopes analyses were used to further investigate significant interactions. Depression, APOE4, and BDNFMet did not significantly impact attention, processing speed, working memory, visuospatial functioning, or executive function, and no significant interactions were noted among variables. BDNFMet had no direct impact on language.Conclusions:APOE4 and BDNFMet were found to differentially moderate the relationship between depression and cognition. Specifically, APOE4 carriers with depression had worse language performance compared to those who were healthy, depressed, or APOE4 carriers. BDNFMet carriers with depression performed worse on measures of memory compared to those who were healthy, depressed, or BDNFMet carriers. The treatment of depression in APOE4 and BDNFMet carriers may reduce associated cognitive impairments. Limitations and future implications are also discussed.

Diagnostic efficiency and psychometric properties of CBCL DSM-oriented scales in a large sample of Chinese school-attending students aged 5–16

BackgroundChildren and adolescents are vulnerable to various psychiatric disorders during the critical phase of individual development. In China, the child behavior checklist (CBCL) is a widely employed psychometric questionnaire for assessing children and adolescents. However, further validation of the psychometric properties and diagnostic effectiveness of the CBCL DSM-oriented scales is necessary. These scales were developed based on DSM diagnosis and require evaluation using a substantial sample of Chinese individuals. MethodsThis study involved the analysis of a substantial dataset consisting of 72,109 samples collected from five provinces in China. Data was gathered using the CBCL (Parent Rating Scale), and rigorous assessments of reliability and validity were conducted. The mini-international neuropsychiatric interview for children and adolescents (MINI-KID) and the diagnostic and statistical manual of mental disorders-IV (DSM-IV) interview were employed to diagnose the participants. To ensure the accuracy of the diagnoses, receiver operating characteristic curve (ROC curves) were utilized, and the Youden Index was calculated to determine the appropriate diagnostic cut-off point for each specific target diagnosis. ResultsThe study included a total sample of 72,109 cases, out of which 19,782 cases underwent MINI-KID assessment and structured or semi-structured interviews based on DSM-IV to clarify the diagnosis. Reliability and validity analyses showed that the reliability of the subscales and total scales was good, except for Anxiety Problems. The Cronbach's alpha for the CBCL DSM-oriented scales was 0.92. In addition, the validity of all scales was good (CFI = 0.80). For the sample with a clear diagnosis, all five subscales of the CBCL DSM-oriented scales showed fair diagnostic efficiency for the target diagnosis. Among them, the area under curves (AUC) of Mood disorder, Anxiety, Attention deficit and hyperactivity disorder (ADHD), Oppositional defiant disorder (ODD) and Conduct disorder (CD) are 0.80, 0.74, 0.75, 0.74, 0.74. Among the three sample groups, the highest diagnostic efficiency was found in Affective Problems to Mania. The diagnostic cut-off point for each subscale on target diagnoses was clearly defined. ConclusionOverall, the reliability, validity and diagnostic efficiency of CBCL DSM-oriented scales in Chinese children and adolescents were within acceptable limits. In addition, we used ROC curves and cut-off points to predict the cut-off values of common child and adolescent psychiatric disorders mentioned in the CBCL DSM-oriented scales. This provides an important reference for the clinical application of the CBCL DSM-oriented scales in Chinese samples.

Does Screening for Bipolar Disorders Identify a "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS)? A Heuristic Working Hypothesis.

The aim of this paper is to verify if people with a positive score on the Mood Disorder Questionnaire (MDQ) without comorbidity of mood disorders showed a worse level of Health-related Quality of life (HRQol) compared to a control-matched sample of MDQ negatives, identifying a specific syndrome. This is a case-control study based on a database from a community survey. Cases: MDQ-positive without mood disorders; Controls: MDQ negatives matched by sex, age, and psychiatric diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria. Tools: MDQ, the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS) semi-structured interview for psychiatric diagnosis, and the Health Survey Short Form (SF-12) for measuring HRQol. People scoring positive on the MDQ without a diagnosis of mood disorders showed significantly lower scores on the SF-12 compared to people of the same age and of the same sex with an equal diagnosis of psychiatric disorders not related to mood disorders (35.21 ± 6.30 vs. 41.48 ± 3.39, p < 0.0001). In the debate whether a positive score on the MDQ selects an area of "malaise" due to the presence of disorders differing from Bipolar Disorders, or if a positive score on the MDQ may be considered a "subthreshold" form of bipolar disorder in people who may later develop bipolar disorder, a third hypothesis can be advanced, i.e., that a positive score on the MDQ identifies a specific "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS), characterized by a considerable amount of suffering and not attributable to other disorders, and which might represent a trigger for the previously mentioned disorders with which a positive score on the MDQ is associated, probably including, in severe conditions, bipolar disorder.

The Netherlands Mental Health Survey and Incidence Study-3 (NEMESIS-3): Objectives, methods and baseline characteristics of the sample.

NEMESIS-3 (Netherlands Mental Health Survey and Incidence Study-3) is a psychiatric epidemiological cohort study of the Dutch general population that replicates and expands on two previous NEMESIS-studies conducted in 1996-1999 and 2007-2018 respectively. The main aims of NEMESIS-3 are to provide up-to-date information on the prevalence, incidence, course and consequences of mental disorders, their risk indicators, and to study the relevant time trends. This paper gives an overview of the objectives and methods of NEMESIS-3, especially of the recently completed first wave, and describes the sample characteristics. NEMESIS-3 is based on a multistage, stratified random sampling of individuals aged 18-75years. Face-to-face interviews were laptop computer-assisted and held at the respondent's home. A slightly modified Composite International Diagnostic Interview (CIDI) version 3.0 was used to assess both Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and DSM-5 mental disorders. Two follow-up waves are planned three and sixyears after baseline. In the first wave, performed from November 2019 to March 2022, 6194 individuals were interviewed: 1576 respondents before and 4618 respondents during the COVID-19 pandemic. The average interview duration was 91min and the response rate was 54.6%. The sample consisted of 50.4% women and had a mean age of 47.9years. The sample was reasonable nationally representative, although some sociodemographic groups were somewhat underrepresented. Despite the COVID-19 restrictions, we were able to build a large and comprehensive dataset of good quality, permitting us to investigate the latest trends in mental health status, various new topics related to mental health, and the extent to which the pandemic has had an effect on the population's mental health.

Transcranial Sonography as a Diagnostic Tool for Depressive Disorders.

Transcranial sonography (TCS) is an available and noninvasive neuroimaging method that has been found to reduce the echogenicity of the brainstem raphe (BR) in patients with depression. Applying the criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), we performed a meta-analysis of the diagnostic accuracy of TCS. A systematic search was conducted in PubMed, EMBASE, The Cochrane Library, and Web of Science. The databases were searched from inception to December 2021. The quality of the included literature was assessed using the QUADAS-2. Heterogeneity analysis was performed. A summary receiver operating characteristic (SROC) curve was generated to evaluate the diagnostic accuracy of TCS. We included 12 studies with 809 patients. The pooled sensitivity was 0.66 (95% confidence interval [CI]: 0.61-0.71), and the specificity was 0.84 (95% CI: 0.80-0.87). The combined positive likelihood ratio (LR) was 3.84 (95% CI: 2.68-5.51), the negative LR was 0.41 (95% CI: 0.29-0.57), and the diagnostic odds ratio (DOR) was 11.45 (95% CI: 5.57-23.02). The area under the curve (AUC) of the plotted SROC curve was 0.86 (95% CI: 0.83-0.89). The meta-regression and subgroup analyses found no source of heterogeneity. TCS has high potential and efficacy in diagnosing depression and may be a reasonable test to perform clinically for the assessment of depression.

White matter characteristics in the early and late stages of bipolar disorder: A diffusion tensor imaging study

BackgroundBipolar disorder (BD) is characterized by recurrent mood episodes that may progress over time. Staging models may be used to follow the long-term course of BD. BD is associated with microstructural changes in white matter (WM). This study aims to compare the WM integrity within patients groups who are in different stages of BD and healthy controls and investigate whether WM integrity changes may be a biomarker that can be used in the clinical staging of BD. MethodsThe study sample included euthymic 54 patients diagnosed with BD according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and 27 healthy volunteers. Early-stage patients (n = 26) were determined as patients who have not had any mood episodes after the first manic episode, and late-stage patients (n = 28) determined as patients with recurrent mood episodes. MRI was performed using a 1.5 Tesla MR system and DTI sequences were acquired. ResultsRegion of interest (ROI) analyses showed that late-stage patients had significantly reduced fractional anisotropy (FA) in the right sagittal stratum and genu of the corpus callosum compared with healthy controls and early-stage patients. Regression models show that corpus callosum genu and right sagittal stratum FA values are predictive for the late-stage patient group. LimitationsThere are some limitations of the ROI method. The cross-sectional design is another limitation of this study. ConclusionsWM integrity of corpus callosum genu and right sagittal stratum may be a biomarker for clinical staging of BD. Identifying stage-specific biomarkers may help us predict the neuroprogressive course of BD. Longitudinal studies would be required to detect stage-specific biomarkers.

Exposure to Olfactory Alcohol Cues During Non-rapid Eye Movement Sleep Did Not Decrease Craving in Patients With Alcohol Dependence

Background and ObjectivesCue exposure therapy (CET) has been used to reduce alcohol use, but the effect of CET during sleep on alcohol dependence (AD) is unclear. The present study examined the effect of repeated exposure to an olfactory stimulus during non-rapid eye movement (NREM) sleep on cue reactivity and craving in patients with AD.MethodsThirty-five patients with AD were enrolled according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). All the subjects were randomly assigned to the experimental or control group. The experimental group was exposed to alcohol odor for 10 min during NREM sleep. The other group (controls) was exposed to water [control stimulus (CtrS)] for 10 min during NREM sleep. Demographic, alcohol-related, and clinical characteristics were collected at baseline. A cue-reactivity test was conducted before and after exposure to evaluate the effect of memory manipulation on acute response to an alcohol stimulus.ResultsThere were no significant time × group interactions according to the visual analog scale (VAS) score of craving intensity, skin conductance response (SCR), systolic blood pressure (SBP), and diastolic blood pressure (DBP; all p > 0.05). Two-way ANOVA showed significant main effects of time on SCR [F(1,33) = 4.453, p = 0.043], SBP [F(1,33) = 14.532, p = 0.001], DBP [F(1,33) = 8.327, p = 0.007], Craving-VAS [F(1,33) = 1.997, p = 0.167] in two groups.ConclusionExposure to olfactory alcohol cues during NREM sleep had no significant effect on alcohol craving in subjects with AD during hospitalization.

Generation and characterization of human-derived iPSC lines from one pair of dizygotic twins discordant for schizophrenia

Schizophrenia (SCZ) is a debilitating neurodevelopmental disorder with a high heritability. In this study, peripheral blood mononuclear cells (PBMCs) were donated by a pair of dizygotic twins. The female was clinically diagnosed as SCZ by Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria, and her unaffected male sibling was healthy control. Induced pluripotent stem cells (iPSCs) were established using Episomal vectors carrying reprograming factors OCT4, SOX2, NANOG, LIN28, c-MYC, KLF4, and SV40LT. These lines with normal karyotype highly expressed pluripotency markers and are capable to differentiate into derivatives of three germ layers. Both lines are negative of mycoplasma.

Higher baseline serum adiponectin predicts better treatment remission in patients with generalized anxiety disorder treated with escitalopram.

Generalized anxiety disorder (GAD) is partly attibuted to the dysregulation of nuero-inflammation which can be mediated by adiponectin. We conducted this study was to explore the characteristics of peripheral adiponectin and its role in predicting treatment outcome in patients with generalized anxiety disorder (GAD) treated by escitalopram or venlafaxine. A total of 70 untreated GAD inpatients who met the diagnosis criteria of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) were enrolled and randomly selected for treatment with escitalopram (n=36) or venlafaxine (n=34) for 8 weeks. The serum adiponectin level of GAD and healthy controls (HCs) was measured by enzyme-linked immunosorbent assay (ELISA) before treatment. Hamilton Anxiety Rating Scale (HAM-A) assessment was conducted at baseline and at 1, 2, 4, and 8 weeks after treatment respectively. Serum adiponectin levels were compared between GAD patients and HCs, as well as between remission and nonremission cases; the correlation between baseline adiponectin level and HAM-A reduction rate were also analyzed. The serum adiponectin levels were higher in GAD patients compared to HCs (t=2.304; P=0.023), the serum adiponectin levels were higher in remission cases compared to nonremission cases (t=2.255, P=0.027), and the receiver operating characteristic (ROC) area in predicting treatment remission was 0.652±0.066 (P=0.029). The correlation between baseline adiponectin level and HAM-A reduction rate of GAD cases treated with escitalopram and venlafaxine in the endpoint was 0.362 (P=0.030) and -0.026 (P=0.883), respectively, and the ROC area of baseline adiponectin level in predicting treatment remission was 0.72±0.086 (P=0.024) and 0.473±0.102 (P=0.469), respectively. Peripheral adiponectin is upregulated in GAD, and it seems higher baseline adiponectin level predicts a better treatment remission treated by escitalopram but not with venlafaxine, which suggests adiponectin maybe a potential key biomarker in Chinese GAD.

The association between serum homocysteine and depression: A systematic review and meta-analysis of observational studies.

Hyperhomocysteinaemia is known to interfere with neurological functions; however, there is a controversy regarding the relationship between homocysteine and depression. Science Direct, MEDLINE and ISI Web of Science were searched to find relevant articles, published up to August 2020. Studies were included if they compared homocysteine levels in healthy subjects with subjects with depression. Also, articles that reported the association between hyperhomocysteinaemia and risk of depression were included. Odds ratios of depression and means of homocysteine were used to ascertain the overall effect size. Homocysteine level was higher in subjects with depression in comparison with healthy controls (weight mean difference=2.53µmol/L, 95% confidence interval: 1.77, 3.30), and the depression diagnostic tool was a source of heterogeneity. Homocysteine level was significantly higher in subjects with depression in studies that used Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), Geriatric Depression Scale (GDS), Zung Self-Rating Depression Scale (ZDRS) and Beck Depression Index II (BDI-II) as depression diagnostic tools. Also, participants with hyperhomocysteinaemia had a higher chance of depression (Pooled risk=1.34, 95% confidence interval: 1.19, 1.52), where the depression diagnostic tool was a source of heterogeneity. In contrast to ZDRS and Patient Health Questionnaire (PHQ) subgroups, hyperhomocysteinaemia yielded a significantly higher risk of depression in DSM-IV, GDS and 'other' subgroups. Homocysteinemia level is higher in individuals with depression. However, the depression diagnostic tool used is instrumental in influencing their association, and thus, future studies should focus on the tools for depression assessment.

Relationship between circadian rhythm related brain dysfunction and bipolar disorder

To investigate the changes of functional connectivity (FC) in the suprachiasmatic nucleus (SCN) of patients with bipolar disorder and perform a cluster analysis of patients with bipolar disorder based on FC. The study recruited 138 patients with bipolar disorder (BD) diagnosed according to the 4th edition of Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) and 150 healthy control subjects. All the participants underwent resting-state functional magnetic resonance brain scans. DPARSF software was used to generate the FC diagram of the SCN. Based on the FC data, principal components analysis (PCA) and k-means in scikit-learn 0.20.1 were used for cluster analysis of the patients with bipolar disorder. Compared with the healthy controls, the patients showed enhanced functional connections between the SCN and the paraventricular nucleus and between the SCN and the dorsomedial hypothalamus nucleus. Based on these FC values, the optimal cluster of unsupervised k-means machine learning for bipolar disorder was 2, and the Silhouette coefficient was 0.49. Patients with bipolar disorder have changes in the FC of the SCN, and the FC of the rhythm pathway can divide bipolar disorder into two subtypes, suggesting that biological rhythm is one of the potential biomarkers of bipolar disorder.

Prednisolone versus placebo addition in the treatment of patients with recent-onset psychotic disorder: a trial design

BackgroundThe symptom severity of a substantial group of schizophrenia patients (30–40%) does not improve through pharmacotherapy with antipsychotic medication, indicating a clear need for new treatment options to improve schizophrenia outcome. Meta-analyses, genetic studies, randomized controlled trials, and post-mortem studies suggest that immune dysregulation plays a role in the pathophysiology of schizophrenia. Some anti-inflammatory drugs have shown beneficial effects on the symptom severity of schizophrenia patients. Corticosteroids are effective in various chronic inflammatory and autoimmune disorders. Prednisolone, a potent glucocorticosteroid, has minor mineral-corticosteroid potencies and can adequately pass the blood–brain barrier and its side effects and safety profile are well known. Therefore, the effect of prednisolone can be studied as a proof of concept for immune modulation as a treatment for schizophrenia.Methods/designIn total, 90 subjects aged 18–70 years and diagnosed with schizophrenia, schizoaffective disorder, or schizophreniform disorder (Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) 295.x) or psychosis not otherwise specified (NOS; 298.9) will be included. The time interval between the onset of psychosis and study entry should not exceed 7 years. Patients will be randomized 1:1 to either prednisolone or placebo daily for a period of 6 weeks in addition to a stable dose of antipsychotic medication. Study medication will be initiated at 40 mg for 3 days, after which it will be tapered down within 6 weeks after initiation, following inflammatory bowel diseases treatment guidelines. Primary outcome is change in symptom severity, expressed as change in total score on the Positive and Negative Symptom Scale (PANSS) from baseline to end of treatment. Cognitive functioning (measured through the Brief Assessment of Cognition in Schizophrenia (BACS)) and change in Global Assessment Functioning (GAF) and depressive symptoms as measured with the Calgary Depression Scale for Schizophrenia (CDS) will be assessed, in addition to various immunological biomarkers. Secondary outcomes are a 4- and 6-month follow-up assessment of PANSS, BACS, and GAF scores and immunological biomarkers. Additionally, a subgroup of patients will be included in the magnetic resonance imaging (MRI) part of the study where MR spectroscopy and structural, functional, and diffusion MRI will be conducted.DiscussionIt is expected that prednisolone addition to current antipsychotic medication use will reduce symptom severity and will improve cognition when compared to placebo.Trial registrationClinicalTrials.gov, NCT02949232 and NCT03340909. Registered 31 October 2016 and 14 November 2017. EudraCT-number 2014–000520-14 and 2017–000163-32.

Efficacy and Safety of Quetiapine for Pediatric Bipolar Depression: A Systematic Review of Randomized Clinical Trials.

Quetiapine is a second-generation antipsychotic (SGA) approved by the Food and Drug Administration (FDA) for the treatment of schizophrenia, mania, and aggression in children and adolescents. It is also commonly used as an off-label medication to treat children and adolescents with bipolar depression, although the FDA has not approved quetiapine for this purpose. We conducted a systematic review of randomized clinical trials (RCTs) using the MEDLINE database and included two studies that met our inclusion criteria. Both RCTs were eight-week short-term studies that involved patients of 10-18 years of age with a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of bipolar disorder, depressed type. The mean difference in the Children's Depression Rating Scale-Revised (CDRS-R) score and the response and remission rates in the quetiapine group were not statistically significant when compared to the placebo group. A high placebo response rate proved that quetiapine was no better than the placebo in treating pediatric bipolar depression. Quetiapine proved to be a relatively safe drug with the most common side effects being headache, somnolence, gastric upset, and weight gain. There was a significant increase in triglyceride levels, but no other metabolic effects were reported. This calls for future studies with larger sample sizes and improved methodology to explore the efficacy of quetiapine and other SGAs for the management of pediatric bipolar depression.

Childhood trauma is associated with poorer social functioning in severe mental disorders both during an active illness phase and in remission

BackgroundImpaired social functioning is a core feature of schizophrenia spectrum (SZS) and bipolar spectrum disorders (BDS). Childhood traumatic events are more frequent in SZS and BDS than in healthy individuals (HC), and could represent a cumulative risk for reduced social functioning beyond experiencing ongoing clinical symptoms. MethodsThe study comprised 1039 individuals (SZS [n = 348]; BDS [n = 262], and HC [n = 429]). Childhood trauma and level of social functioning was assessed by the Childhood Trauma Questionnaire (CTQ) and the Social Functioning Scale (SFS), respectively. Diagnosis was obtained by the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). ResultsPatients had poorer social functioning (F = 819.18, p ˂ 0.001, Cohen's d = 0.44) and reported more childhood trauma experiences than HC (X2 = 289.0, p < .001) than HC. Patients with at least one moderate to severe trauma had poorer social functioning than patients without childhood trauma (F = 8.16, p = .004, Cohen's d = 0.17). Within the patients, a cumulative relationship was observed in that more severe childhood trauma was associated with lower social functioning (F = 2.65, p = .02, Cohen's d = 0.20). No significant associations were observed for having at least one moderate to severe trauma or cumulative traumas on social functioning in the HC. Follow-up analysis showed that patients in remission childhood trauma also had poorer social functioning. ConclusionPatients who reported childhood trauma experiences had poorer social functioning both during an active illness phase and in remission.

Physical frailty and the risk of major depressive disorder: The Irish Longitudinal Study on Ageing

Although frailty is a well-established risk factor for adverse health outcomes in later life, little is known about the role of physical frailty on the development of incident major depressive disorder (MDD). The purpose of this study was to determine whether frailty is an important and independent predictor of incident major depressive disorder (MDD) in elderly people without probable depression at baseline. Of the 3671 older individuals from the population-based Irish Longitudinal Study on Ageing, we classified participants as non-frail (0), pre-frail (1–2), and frail (3–5) at baseline according to the five criteria of the physical frailty phenotype. The World Health Organization Composite International Diagnostic Interview Short-Form was used to assess whether respondents fulfilled the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for MDD over a 4-year follow-up. After adjusting for demographic factors, living arrangements, health behaviors, common chronic diseases including hypertension, diabetes, cancer, lung disease, heart problems, and stroke, those classified as pre-frail (HR = 1.40, 95%CI = 1.14–1.73) and frail (HR = 2.20, 95%CI = 1.23–3.92) presented a higher risk to develop incident MDD over the 4-year follow-up compared to non-frail participants. Shrinking and exhaustion, as physical frailty components, were individually predictive of onset of MDD. The present study supports a significant role of physical frailty as a predictor of incident MDD in older adults. It is necessary to identify groups with a high vulnerability for MDD according to easily identifiable frailty criteria, and to delay or prevent at least in part, some of the negative health outcomes related to this disorder.

The potential role of clock genes in children attention-deficit/hyperactivity disorder

BackgroundAttention deficit/ hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder and is thought to be associated with circadian system. MethodsWe performed a pathway-based study to test individual single nucleotide polymorphisms (SNPs) and the overall evidence of genetic polymorphisms involved in the circadian pathway in association with children ADHD susceptibility among a Chinese population. A community-based case–control study was conducted among Chinese children, and 168 ADHD patients and 233 controls were recruited using a combination diagnosis based on the diagnostic and statistical manual of mental disorders iv (DSM-IV) ADHD rating scale, Swanson, Nolan, and Pelham rating scale (SNAP-IV) rating scale, and semi-structured clinical interview. ResultsThe results of single-loci analyses identified that PER1 rs2518023 and ARNTL2 rs2306074 were nominally association with ADHD susceptibility (P < 0.05). Next, we applied multifactor dimensionality reduction (MDR), and classification and regression tree (CART) analyses to explore high-order gene–gene interactions among the functional SNPs to ADHD risks. The results indicated that interactions among the PER1 rs2518023, ARNTL2 rs2306074 and NR1D1 rs939347 were associated with the risk of ADHD in children. Individuals carrying the combination genotypes of the PER1 rs2518023 GG or GT, ARNTL2 rs2306074 TC or TT and NR1D1 rs939347 GA or AA displayed a significantly higher risk for ADHD than who carry the PER1 rs2518023 TT and CRY2 rs2292910 CA/CC genotypes (adjusted OR = 4.37, 95% CI = 2.16–8.85, P < 0.001). ConclusionsThese findings revealed the importance of genetic variations related to the circadian clock system to the susceptibility of children ADHD.

Transgenerational effects of the genocide against the Tutsi in Rwanda: A post-traumatic stress disorder symptom domain analysis

Background: A number of studies have investigated transgenerational effects of parental post-traumatic stress disorder (PTSD) and its repercussions for offspring. Few studies however, have looked at this issue in the African context. Methods: The present study addresses this gap by utilizing a Pearson correlation matrix to investigate symptom severity within the three Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) PTSD symptom domains in mothers exposed to the genocide against the Tutsi in Rwanda (n=25) and offspring (n=25), and an ethnically matched set of controls (n=50) who were outside of Rwanda during the 1994 genocide. All mothers were pregnant with the offspring included in the study during the time of the genocide. Results: Total PTS score was significantly (p&lt;0.01) correlated with each of the three symptom domains at various strengths in both cases and controls. No significant differences in association of total PTS score and PTSD symptom domains were observed between exposed mothers and offspring, suggesting that each symptom domain contributed equivalently to both exposed mothers and offspring distress. In contrast, the re-experiencing symptom domain showed a significant difference in correlation to overall PTS score in non-exposed mothers compared to their offspring (p&lt;0.05), with mothers showing a significantly higher correlation. Furthermore, the correlation between avoidance/numbing symptoms to overall PTS was significantly different (p≤0.01) across exposed and non-exposed mothers. As a secondary analysis, we explored the relationship between DNA methylation in the glucocorticoid receptor (NR3C1) locus, an important stress modulating gene, and PTSD symptom domains, finding an association between DNA methylation and re-experiencing among genocide-exposed mothers that exceeded any other observed associations by approximately two-fold. Conclusions: This is the first report, to our knowledge, of a symptom-based analysis of transgenerational transmission of PTSD in sub-Saharan Africa. These findings can be leveraged to inform further mechanistic and treatment research for PTSD.

Comparative Efficacy of Structured Games and Behavioural Parent Training on Working Memory in Children with Attention Deficit Hyperactivity Disorder: A Pilot Study

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) may develop during the preschool years of the child and extend into adulthood. ADHD also leads to impaired Working Memory (WM) creating problems in various functions. Aim: To compare the effectiveness of behavioural parent training and structured games on WM of children with ADHD. Materials and Methods: This prospective interventional study was conducted in 18 schools of Ghaziabad City, Uttar Pradesh, India. Seventy subjects were selected based on Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria. Group A (n=35) received structured games and Group B (n=35) received Behavioural Parent Training (BPT). Seguin Form Board Test Time (SFBTT) was recorded as outcome on baseline and 5th week. Student’s paired and unpaired t-test was done. SPSS 22.0 version was the software used and p&lt;0.05 was considered as level of significance. Results: Analysed data showed significant results within structured games group with t=2.355, p&lt;0.05, and no significant result within BPT group with t=-0.776, p&gt;0.05. Between group comparison showed significant difference with t=-2.804, p&lt;0.05. Conclusion: Training of WM in form of structured games can be an effective method when compared to BPT in children with ADHD.

A transcranial sonography study of brainstem and its association with depression in idiopathic generalized epilepsy with tonic–clonic seizures

Brainstem raphe (BR) hypoechogenicity in transcranial sonography (TCS) has been depicted in patients with depression. But, up to date, the association of BR alterations in TCS with depression in patients with epilepsy has never been reported. This study was to investigate the possible role of BR examination via TCS in patients with idiopathic generalized epilepsy with tonic–clonic seizures (IGE-TCS) and depression. Forty-six patients with IGE-TCS and 45 healthy controls were recruited. Echogenicity of the caudate nuclei (CN), lentiform nuclei (LN), substantia nigra (SN), and BR and widths of the lateral ventricle (LV) frontal horns and the third ventricle (TV) were assessed via TCS. The determination of depression was based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), and depression severity measured by Chinese version Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E) and Beck Depression Inventory—II (BDI-II). The width of TV in patients with epilepsy was found significantly larger than that in healthy controls (p = 0.001), but there was no significant difference in TV width between patients with IGE-TCS with and without depression. There were no significant differences between patients with IGE-TCS and healthy controls in LV frontal horn width, as well as in SN, CN, LN, and BR echogenicity. Here, it seems that patients with IGE-TCS were detected with smaller SN echogenic area compared with controls though they had no statistical significance. Patients with IGE-TCS with hypoechogenic BR had significantly higher C-NDDI-E and BDI-II scores than those with normal BR signal, and most patients with IGE-TCS with depression exhibited hypoechogenic BR, but few patients with IGE-TCS without depression exhibited hypoechogenic BR. In conclusion, BR echogenic signal alterations in TCS can be a biomarker for depression in epilepsy, but it might not be associated with epilepsy itself. The alterations of SN echogenic area and TV width in TCS may reflect a potential role of SN and diencephalon structure in the pathogenesis of epilepsy, which needs to be further elucidated.