Diagnostic And Statistical Manual Research Articles

Role of Personality and Psychiatric Disorders in the Perception of Pain.

Although previous studies have shown that psychiatric and personality disorders are more prevalent in chronic pain than in pain-free groups, few studies have investigated the prevalence of personality disorders (PerDs) in patients with chronic pain with and without a psychiatric comorbidity. The aim of the present study was therefore designed to investigate the burden of PerDson the prevalence and perception of chronic pain in patients with and without psychiatric comorbidity. 232 patients from the Gift Institute for Integrative Medicine in Pisa, Italy, of which n = 161 (69.4%) were patients with chronic pain, were administered the SCID II for personality disorders and MINI for DSM IV-TR criteria. Both psychiatric and personality disorders were more prevalent in the chronic pain group than in the pain-free group (χ2 = 5.9, p = .015, φ = .16; χ2 = 7.2, p = .007, φ = .18). Cluster A and C PerDs were more prevalent in patients with chronic pain than in subjects without pain (χ2 = 8.1, p = .004, φ = .19; χ2 = 4.7, p = .030, φ = .14, respectively). Unlike Cluster C PerDs, however, Cluster A PerDs were more prevalent in the absence of psychiatric comorbidity (χ2 = 5.0, p = .024, φ = .29), and by themselves worsened the pain perceived. An appropriate PerD diagnosis can be helpful in the treatment of patients with chronic pain.

Multiple Complement Pathway-related Proteins Might Regulate Immunopathogenesis of Major Depressive Disorder

Exacerbated inflammatory pathway has emerged as a predominant etiological construct of major depressive disorder (MDD). Innate immune molecules like complement proteins induce inflammatory responses and also regulate key neurobiological processes. However, there is a dearth of literature on the impact of critical complement proteins in MDD. Herein, plasma profiling of seven complement proteins was carried out to obtain a better insight into the role of the complement pathway in MDD. Plasma levels of C1q, C3, C3b/iC3b, C4, Factor B, Factor H, and properdin were assayed in 22 patients with MDD and 27 healthy controls by multiplex suspension assay. The patients with MDD were diagnosed as per DSM IV-TR. Hamilton Depression Rating Scale (HAM-D), Montgomery Depression Rating Scale and Clinical Global Improvement were used for clinical assessments of the patients. The plasma levels of these complement proteins were also correlated with various clinical scores and phenotypes of MDD. The patients with MDD and healthy controls did not differ in terms of age and gender (p > 0.1). The patients with MDD had a mean duration of illness of around 3 years, with average number of depressive episodes being 6 and the mean HAM-D score was 19. Of the seven complement components, the plasma levels of C1q, Factor B, and Factor H (p ≤ 0.05) were significantly elevated in MDD patients compared to healthy controls. However, the plasma levels of these complement proteins were not found to correlate with the clinical profile of MDD patients. Both Factor B and Factor H are crucial in the induction and regulation of the alternative pathway of complement activation. The alternative pathway also plays a critical role in inflammation. These findings suggest an important role of the alternative complement pathway in immuno-inflammation in MDD.

Clinician and patient perspectives on the ontology of mental disorder: a qualitative study.

Psychiatry may face an "identity crisis" regarding its very foundations. The lack of consensus regarding the theoretical grounds of psychiatry as a discipline has its epicenter in the discussion about the Diagnostic and Statistical Manual (DSM). A growing number of academics considers the manual broken and a growing number of patients voice concern. Despite the huge body of critique, 90% of Randomized Trials are based on DSM definitions of mental disorder. Therefore, the question regarding the ontology of mental disorder remains: what is a mental disorder, exactly? We aim to identify ontologies that live among patients and clinicians, evaluate the degree of consistency and coherence between clinician and patient views and contribute to the establishment of a novel ontological paradigm of mental disorder that is aligned with patients' and clinicians' perspectives. Eighty participants (clinicians/patients/clinicians with lived experience) were interviewed using a semi-structured interview, exploring their ideas on the ontology of mental disorder. This question was approached from different angles which led to comprising the interview schedule into different topics: "concept of disorder," "representation by DSM," "what is treated," "what is recovered," and "the right outcome measure." Interviews were transcribed and analyzed using inductive Thematic Analysis. From all subthemes and main themes, a typology was constructed in which six, not necessarily mutually exclusive, ontological domains were identified: mental disorder as (1) disease, (2) functional impairment, (3) loss of adaptation, (4) existential problem, (5) highly subjective phenomenon, and (6) deviation from social norms. Common ground for the sample groups was that mental disorder is about functional impairment. Although about a fourth of sample clinicians holds an ontological concept of disease, only a small percentage of patients and none of the clinicians with lived experience adhered to an ontological concept of disease. The sample clinicians most often understand mental disorder to be a highly subjective phenomenon, and individuals with lived experience (patients and clinicians) most often understand mental (dis)order to be adaptational in nature: an (im)balance of burden in relation to strengths, skills, and recourses. The ontological palette is more diverse than what is taught about mental disorder in dominant scientific and educational discourse. There is a need to diversify the current, dominant ontology and make room for other ontologies. Investment is required in the development, elaboration and coming of age of these alternative ontologies, allowing them to reach their full potential and act as drivers of a landscape of promising novel scientific and clinical approaches.

Multi-study evaluation of neuroimaging-based prediction of medication class in mood disorders

Clinicians often face a dilemma in diagnosing bipolar disorder patients with complex symptoms who spend more time in a depressive state than a manic state. The current gold standard for such diagnosis, the Diagnostic and Statistical Manual (DSM), is not objectively grounded in pathophysiology. In such complex cases, relying solely on the DSM may result in misdiagnosis as major depressive disorder (MDD). A biologically-based classification algorithm that can accurately predict treatment response may help patients suffering from mood disorders. Here we used an algorithm to do so using neuroimaging data. We used the neuromark framework to learn a kernel function for support vector machine (SVM) on multiple feature subspaces. The neuromark framework achieves up to 95.45% accuracy, 0.90 sensitivity, and 0.92 specificity in predicting antidepressant (AD) vs. mood stabilizer (MS) response in patients. We incorporated two additional datasets to evaluate the generalizability of our approach. The trained algorithm achieved up to 89% accuracy, 0.88 sensitivity, and 0.89 specificity in predicting the DSM-based diagnosis on these datasets. We also translated the model to distinguish responders to treatment from nonresponders with up to 70% accuracy. This approach reveals multiple salient biomarkers of medication-class of response within mood disorders.

A Suicide-Specific Diagnosis – The Case For

A Suicide-Specific Diagnosis – The Case For

Insomnia nosology: a systematic review and critical appraisal of historical diagnostic categories and current phenotypes.

Insomnia nosology has significantly evolved since the Diagnostic and Statistical Manual (DSM)-III-R first distinguished between 'primary' and 'secondary' insomnia. Prior International Classification of Sleep Disorders (ICSD) nosology 'split' diagnostic phenotypes to address insomnia's heterogeneity and the DSM nosology 'lumped' them into primary insomnia, while both systems assumed causality for insomnia secondary to health conditions. In this systematic review, we discuss the historical phenotypes in prior insomnia nosology, present findings for currently proposed insomnia phenotypes based on more robust approaches, and critically appraise the most relevant ones. Electronic databases PsychINFO, PubMED, Web of Science, and references of eligible articles, were accessed to find diagnostic manuals, literature on insomnia phenotypes, including systematic reviews or meta-analysis, and assessments of the reliability or validity of insomnia diagnoses, identifying 184 articles. The data show that previous insomnia diagnoses lacked reliability and validity, leading current DSM-5-TR and ICSD-3 nosology to 'lump' phenotypes into a single diagnosis comorbid with health conditions. However, at least two new, robust insomnia phenotyping approaches were identified. One approach is multidimensional-multimethod and provides evidence for self-reported insomnia with objective short versus normal sleep duration linked to clinically relevant outcomes, while the other is multidimensional and provides evidence for two to five clusters (phenotypes) based on self-reported trait, state, and/or life-history data. Some approaches still need replication to better support whether their findings identify true phenotypes or simply different patterns of symptomatology. Regardless, these phenotyping efforts aim at improving insomnia nosology both as a classification system and as a mechanism to guide treatment.

Study of socio-demographic factors and comorbidities in children with attention deficit hyperactivity disorder admitted in a tertiary care centre

Background: Objectives of the study were to study the socio-demographic factors and co-morbidities in Indian children with attention-deficit/hyperactivity disorder (ADHD). Methods: A prospective observational study of 2 years duration at the pediatrics department, Rural tertiary care center in Tamil Nadu, using diagnostic and statistical manual 5 (DSM-5) criteria-based questionnaires. Results: 60 children met the diagnosis of ADHD. M: F ratio was 3.6:1. The mean age was 8.2 years. A majority of the children belonged to lower socio-economic classes and were first-born children. Most children were brought up in nuclear families. A history of delayed speech and language development was commonly seen in these children. The combined type of ADHD was the most common. At least two co-morbid diagnoses were seen in most of the children, and anxiety disorder was the most common co-morbid diagnosis. Conclusions: Knowledge about their sociodemographic profile and other co-morbid conditions that are associated with ADHD is necessary to the fully understand the magnitude of the problem and to the plan effective therapy for them.

Giftedness as Disorder: Examining the Dimensionality of the Debate

Determining what must be included in a common description for what constitutes disorder is a crucial task for resolving the debate over whether giftedness is a disorder, and if ethics/responsibility demands its inclusion in the Diagnostic and Statistical Manual (DSM). Without a clear and agreed-upon definition of what constitutes a disorder, it is difficult to make meaningful comparisons between different conditions or to assess the relative costs and benefits of including certain conditions in future DSM editions. Moreover, it is important to establish clear criteria for what constitutes a disorder non-illness (DNI) and disorder underlying-illness (DUNI) as spectral in the context of mental health, education, and intelligence research, drawing on the insights and expertise of researchers, clinicians—including the gifted. By doing so, we can promote a more productive and evidence-based conversation around the inclusion of giftedness in the DSM and whether giftedness demands heightened, and just attention, which would invigorate the perspectives of social inclusion and social acceptance thereby. Using thematic analysis to evaluate arguments has contributed to the suggestion that a resolution to this argument already exists.

Characteristics and symptomatology of major depressive disorder with atypical features from symptom to syndromal level

ObjectiveTo explore clinical characteristics and symptomatology of major depressive disorder (MDD) with atypical features based on DSM criteria or only reversed vegetative symptoms. MethodA total of 3187 patients who met DSM-IV TR criteria for MDD were enrolled. Demographics and symptomatology covering multiple symptom domains were assessed and compared between three groups of cases: those who met DSM criteria for atypical specifier (the DAD group), those who had at least one reversed vegetative symptoms (hypersomnia or hyperphagia) (the SAD group) without meeting DSM atypical specifier criteria, and those without any reversed vegetative symptoms (the NAD group). ResultsThe DAD and SAD group accounted for 4.4% and 14.4% of the participants, respectively. The DAD cases were characterized by a highest proportion of hospitalizations, longest duration of current episode and worst quality of life. The DAD and SAD cases were more likely to adopt unhealthy behaviors (smoking and alcohol drinking). Most depressive symptoms related to higher illness severity and treatment resistance were more frequent in the DAD cases, followed by the SAD cases, and least frequent in the NAD cases. LimitationsA cross-sectional design and a non-validated questionnaire were used. ConclusionsThe findings support the role of DSM defined atypical depression as a valid MDD subtype and provide evidence for clinical utility of the simplified approach of defining atypical features based on only reversed vegetative symptoms. This has implications for illness screening, public health, suicide prevention and better treatment planning for depressed individuals with atypical features even below syndromal level.

Neuronal networks of depression: Pushing the limits of brain stimulation technology

Neuronal networks of depression: Pushing the limits of brain stimulation technology A team of researchers at the University of Freiburg and Delft University of Technology have joined forces to explore a new focused ultrasound technology to tap into the Neuronal Networks of Depression. Major Depressive Disorder (MDD, or “depression”) is not a single disorder but a syndrome: a spectrum of associated behavioral symptoms that are defined (and re-defined with time) in the Diagnostic and Statistical Manual (DSM) of Mental Disorders, American Psychiatric Association. Key symptoms are anhedonia and hopelessness. Clinical depression is diagnosed if the person experiences five or more of the nine symptoms during a continuous 2 week period, with at least one of the symptoms being either reduced motivation or anhedonia (DSM-5 American Psychiatric Association, 2013). Given the nine main symptoms, the pairing with one of the two essential traits, the bi-directionality of many symptoms (increase or decrease), or their sub-symptoms, there are several hundred different individual symptom profiles possible that would qualify for depression diagnosis (Fried & Nesse, 2015).

Renewed call to improve approaches for developing fetal alcohol spectrum disorder diagnostic criteria: Commentary on "Comparison of three systems for the diagnosis of fetal alcohol spectrum disorders in a community sample".

Renewed call to improve approaches for developing fetal alcohol spectrum disorder diagnostic criteria: Commentary on "Comparison of three systems for the diagnosis of fetal alcohol spectrum disorders in a community sample".

A cross-sectional survey on prevalence of Shayyamutra(Nocturnal enuresis) in children

Background: Shayyamutra (Nocturnal enuresis) is a condition of spontaneous passage of urine to wet the clothes and beddings while asleep in the night time. Enuresis is common in school-aged children. It significantly affects a child's psychology. In India, bed wetting is under-recognised and thought to disappear with advancing age. Objective:This cross-sectional survey is done to estimate the prevalence of Shayyamutra in children which is underreported. Materials and Methods: Healthy children of 5-10 years studying in various schools in and around Anchepalya and Kumabalgodu, Bengaluru attending Kaumarabhritya out Patient Department of Shri Dharmasthala Manjunatheshwara Institute of Ayurveda and Hospital (SDMIAH) were screened under parental assent/consent using Diagnostic and Statistical Manual (DSM)-5criteria for diagnosis of enuresis using structured case report format. Results: Among 613 children aged between 5 to 10 years screened 82 children (13.37 %) had Shayyamutra. Female preponderance (57.31%) was seen as against males (42.68%). 30 children (36.58%) had daily once enuresis, 14 children (17.07%) had enuresis twice or more daily, 21 children (25.6%) passed twice a week, 17 children (20.73%) reported once-a-week episodes of bedwetting. 9 children (10.97%) had poor bladder control and 6 (07.31%) were using one to two diapers in 24 hours. 15.85 % were constipated and 2 of them had occasional encopresis. 13.41% were watching television late at night. 52 (63.41%) children were easily awakened from sleep, 21 children (28.04 %) were hard to awake, and 7 children (8.53%) had disturbed sleep due to bedwetting. Conclusion: Shayyamutra is a common problem in children. Prevalence of Shayyamutra was 13.37 % with female preponderance.

Prevalence of Mood Disorders and Associated Factors at the Time of the COVID-19 Pandemic: Potocol for a Community Survey in La Manouba Governorate, Tunisia.

The present survey aims to assess the overall mood disorder prevalence and identify associated socio-demographic and clinical factors in a Tunisian community sample, with special attention to the COVID-19 pandemic. Mood disorders are one of the leading causes of all non-fatal burdens of disease, with depression being at the top of the list. The COVID-19 pandemic may have increased the prevalence of mood disorders, especially in Low and Middle-income countries (LMICs) and in vulnerable populations. 1/ Assess point and lifetime prevalence of depressive and bipolar disorders as well as subthreshold bipolarity in a representative population sample of La Manouba governorate and assess treatment patterns for these disorders; 2/Study socio-demographic and clinical correlates of mood disorders 3/ Assess the association between mood disorders and quality of life 4/ Study the impact of the COVID-pandemic on the prevalence of mood disorders 5/ Assess coping mechanisms to the COVID-pandemic and whether these mechanisms moderate the appearance of mood disorders or symptoms since the beginning of the pandemic. This is a household cross-sectional observational survey to be conducted in La Manouba Governorate in a sample of 4540 randomly selected individuals aged ≥ 15 years. Data collection will be carried out by trained interviewers with clinical experience, through face-to-face interviews and the use of the computer assisted personal interviewing approach (CAPI). The following assessment tools are administered. Structured clinical Interview for DSM IV-TR (Mood disorder section and Screening questions on Anxiety), Mood Disorder Questionnaire (MDQ), Suicide Behaviors Questionnaire-Revised (SBQ), 12-item Short Form Survey (SF-12), the Brief-COPE, and a questionnaire about a headache. In addition, socio-demographic and clinical data will be collected. This will be one of the very few household surveys in a general population sample to assess mental health problems and COVID-19-related variables since the beginning of the pandemic. Through this research, we aim to obtain an epidemiological profile of mood disorders in Tunisia and an estimation of the impact of the COVID-19 pandemic on their prevalence. Results should contribute to improving mental health care in Tunisia.

Mechanism-based groups of children with ADHD are associated with distinct domains of impairment

Person-oriented analyses are commonly used to identify subgroups of children with mental health conditions in the hopes that they will meaningfully inform the taxonomy, assessment, and treatment of psychological disorder. However, whether these data-driven groups are demonstrably better at predicting important aspects of adaptive functioning than standard DSM taxonomy has not been established. Using Attention-Deficit-Hyperactivity-Disorder (ADHD) as a model condition, we utilized dimensions of personality and cognitive ability to identify person-centered profiles of school-aged children (N=246) and evaluated the association of these profiles with critical areas of adaptive functioning. A single profile (“Conscientious”) represented non-ADHD controls and was characterized by faster drift rate and higher executive functioning scores. Three profiles (“Disagreeable,” “Negative Emotionality,” and “Extraverted”) were identified for children with ADHD. Drift rate, but not executive functioning, distinguished among ADHD profiles, which were also distinctly associated with comorbid externalizing and internalizing psychopathology, social skills, and academic achievement. In contrast, the Diagnostic and Statistical Manual (DSM) presentations were not informative and showed similar patterns of impairment across domains. Person-centered profiles of children with ADHD are associated with distinct adaptive functioning deficits and may be useful in informing clinical practice.

PERIOD3 (PER3) VNTR Variant Associated with Seasonal Pattern and Family History in Bipolar Disorder.

Dysregulation of circadian rhythms has been thought to be associated with psychiatric disorders such as bipolar disorder (BD) and depression. We aimed to evaluate the relationship between clinical specifiers of BD, mainly seasonal pattern (SP), and the variable number tandem repeat (VNTR) variant of the PERIOD3 (PER3) gene (rs57875989) in BD patients by comparing genotype distributions with healthy controls considering clinical parameters. A sample of 98 BD patients and 97 healthy volunteers were included in the study. The Clinical Interview for DSM-IV Axis-I Disorders (SCID-I) was administered to all participants. The patients were evaluated with some scales (Sociodemographic and Clinical Data Form, The Young Mania Rating Scale (YMRS), the Hamilton Depression Rating Scale (HAM-D), and The Clinical Global Impression Scale (CGI)) in terms of clinical features and symptom severity. Blood samples were obtained from participants to isolate their DNA. PCR-RFLP was used to determine the PER3 gene variant. The PER3 genotype (4/4, 4/5, 5/5) distribution of BD was found to be significantly different from the control group. There was a statistically significant difference in the PER3 genotype distribution between BD patients with SP and BD patients without SP. Again, the PER3 allele (4, 5) distributions of BD patients with the SP were statistically different from the control group. The BD patients' PER3 genotype distributions with a family history of BD were significantly different from the BD patients without family history or control group. It was found that the VNTR variant of the PER3 gene (rs57875989) may be associated with the SP and family history of BD as well as the BD itself. Further studies with the VNTR variant of the PER3 gene (rs57875989) in different ethnic populations are also required to determine these polymorphisms' exact role in BD.

A STUDY TO ASSESS DEPRESSION, ANXIETY AND ALCOHOL USE AMONG MEN WITH ERECTILE DYSFUNCTION AND PREMATURE EJACULATION

Objectives- To assess prevalence of and compare sociodemographic and clinical variables of depression, anxiety and alcohol use amongst men with (ED) Erectile dysfunction, (PME) Premature ejaculation and both. This cros Methods- s-sectional study was conducted at B.J Medical college and civil hospital, Ahmedabad. Sample of 100 males having either ED or PME or both, were taken from the Government civil hospital,Ahmedabad. Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and Alcohol Use Disorders Identication Test (AUDIT) were primary screening tools and Diagnostic and Statistical Manual-5(DSM-5) was primary diagnostic tool. SPSS Statistics, version 20 was used.Chi-square test and Fisher's exact test were used to nd signicant statistical differences. Most men among Resultsall three groups of disorders were > 30 years,married, uneducated, worked in jobs that were below the clerical level and with monthly income <19,758/-.Overall, depression was found in 37 out of 100(37%), anxiety in 20 out of 100(20%) and alcohol use in 13 out of 100(13%) men. Anxiety was more prevalent(statistically signicant) in married males in PME and Mixed groups, and in men working above clerical work in ED and PME groups. Most men with ED, PME or both were >30 years old,married, uneducated, worked in j Conclusion- obs that were below clerical level and with monthly income <19,758/-. Both depression and anxiety were more prevalent in men with psychosexual disorders, which was higher than national prevalence, while alcohol use was found to be less than national prevalence.

Post-traumatic stress disorder as a nosological unit: Difficulties of the past and challenges of the future

Introduction. The impact of traumatic experiences has always been a part of human life. According to Judith Herman, an American psychotherapist, and professor at Harvard Medical School, "traumatic events overload a person's usual strategies for adapting to life, his usual security systems that give a sense of control, connection, and meaning." Also, traumatic events, for the most part, contain close personal contact with violence and death and pose a threat to life or physical integrity. For almost one year of the war, Ukrainian society faced a large number of negative phenomena capable of causing severe psychological trauma: disruption of the usual lifestyle, loss of family friends, and property, lack of many vital needs for a person, forced migration, uncertainty, a constant threat for health and life, etc. The purpose of the study was to analysis of scientific and literary data reflecting the history of the formation of the concept of "post-traumatic stress disorder" as a nosological unit, as well as the peculiarities of its manifestation and prevalence, diagnostic criteria. Materials and methods: A systematic search was conducted in the main electronic medical databases, such as PubMed, Scopus, Web of Science, Google Scholar, and processed publications that studied the history of the formation of "post-traumatic stress disorder" as a nosological unit, the features of its manifestation and prevalence. diagnostic criteria. Eligible studies were identified using keywords: post-traumatic stress disorder, psychotraumatology, trauma, physioneurosis, history of medicine. All types of articles were reviewed, including original studies, systematic reviews, and meta-analyses. Review and discussion: For a long time, there was a stigmatization of combat-related disorders in society. The path to the development of PTSD as a psychiatric diagnosis is long and thorny. After the World War II, there was an urgent need to introduce a standard unified nomenclature that would enable doctors from all over the world to have a common language for discussing the psychopathology of this disorder, establishing a diagnosis and determining disability. Over 60 years, starting in 1952, when the American Psychiatric Association (APA) introduced the concept of "brutal stress reaction" in its first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I) and up to 2013 (DSM-5) formation of post-traumatic stress disorder as a nosological unit was taking place. Conclusions: Despite the non-acceptance, stigmatization, indifference and other difficulties, PTSD finally achieved official status in the recognized list of diagnoses

Surveillance of ADHD Among Children in the United States: Validity and Reliability of Parent Report of Provider Diagnosis

Objective: To evaluate the appropriateness of parent-reported diagnosis of ADHD as a surveillance tool. Method: We assessed agreement over time and concordance of parent-reported diagnosis against Diagnostic and Statistical Manual (DSM)-based criteria. We compared concordance of diagnosis and DSM-based criteria by child characteristics, including treatment. Results: Among parents who reported their child had ADHD, 95.7% reported it again 2 years later. Comparing diagnosis with DSM-based criteria, specificity and negative predictive value were high, sensitivity was moderate, and positive predictive value was low. Most children with an ADHD diagnosis who did not meet DSM-based criteria met sub-threshold criteria or took medication for ADHD. Concordance differed by child characteristics and treatment. Conclusion: Parent-reported diagnosed ADHD is reliable over time. Although differences in parent-reported diagnosis and DSM-based criteria were noted, these may reflect children with milder symptoms or treated ADHD. Parent-report of child ADHD ever diagnosis may be a good single-item indicator for prevalence.

Prevalence of Mood Disorders and Associated Factors at the Time of the COVID-19 Pandemic: Protocol for a Community Survey in La Manouba Governorate, Tunisia

Aims: The present survey aims to assess the overall mood disorder prevalence and identify associated socio-demographic and clinical factors in a Tunisian community sample, with special attention to the COVID-19 pandemic. Background: Mood disorders are one of the leading causes of all non-fatal burden of disease, with depression being at the top of the list. The COVID-19 pandemic may have increased the prevalence of mood disorders, especially in Low and Middle income countries (LMICs) and in vulnerable populations. Objectives: 1. Assess point and lifetime prevalence of depressive and bipolar disorders as well as subthreshold bipolarity in a representative population sample of La Manouba governorate and assess treatment patterns for these disorders. 2. Study socio-demographic and clinical correlates of mood disorders 3. Assess the association between mood disorders and quality of life 4. Study the impact of the COVID-pandemic on the prevalence of mood disorders 5. Assess coping mechanisms to the COVID-pandemic and whether these mechanisms moderate the appearance of mood disorders or symptoms since the beginning of the pandemic Method: This is a household cross-sectional observational survey to be conducted in La Manouba Governorate in a sample of 4540 randomly selected individuals aged ≥ 15 years. Data collection will be carried out by trained interviewers with clinical experience, through face-to-face interviews and the use of the computer assisted personal interviewing approach (CAPI). The following assessment tools are administered: Result: Structured clinical Interview for DSM IV-TR (Mood disorder section and Screening questions on Anxiety), Mood Disorder Questionnaire (MDQ), Suicide Behaviors Questionnaire-Revised (SBQ), 12-item Short Form Survey (SF-12), the Brief-COPE, and a questionnaire about headache. In addition, socio-demographic and clinical data will be collected. Conclusion: This will be one of the very few household surveys in a general population sample to assess mental health problems and COVID-19 related variables since the beginning of the pandemic. Through this research, we aim to obtain an epidemiological profile of mood disorders in Tunisia, and an estimation of the impact of the COVID-19 pandemic on their prevalence. Results should contribute to improving mental health care in Tunisia.

Effect of insomnia in the major depressive disorder

BackgroundPeople with sleep problems are more likely to have mental disorders. This study aimed to assess the effect of insomnia on the prognosis of patients with major depressive disorder (MDD).MethodsWe divided the patients into three groups according to the Insomnia Severity Index (ISI) scores. In addition, we compared the results of the Hamilton Depression Scale (HAMD) and Symptom Checklist-90 (SCL-90) scores. We evaluated the effect of insomnia at the 2nd, 4th, and 8th-week follow-up on the prognosis of MDD.ResultsFifty-five patients between 19 and 58 years old, with a diagnosis of MDD via the Structured Clinical Interview for the Diagnostic and Statistical Manual-5 (DSM-5). The ISI scores of the moderate and severe group decreased significantly (P < 0.05) in the 2nd week compared to the baseline. The HAMD scores in all groups improved significantly in the 2nd week.ConclusionsThis study was inspired to assess insomnia as a comorbid disorder for patients with MDD, which may bring poor treatment consequences.