Remission Of Disorder Research Articles

Efficacy of brief cognitive behavior therapy in improving symptoms, functioning, and adherence to treatment in patients with bipolar disorder in remission: A randomized control study

Background: Residual symptoms in individuals with bipolar disorder (BD) in remission are common, and they contribute to significant functional impairment and distress. The incomplete efficacy of pharmacological treatments and improvements in psychotherapeutic approaches has led to renewed interest in psychotherapy for this disorder. However, there are fewer studies addressing the same. Aim: The study aims to examine brief CBT (cognitive behavior therapy) in addressing the residual symptoms in BD. Method: A two-group randomized control design with multiple assessments (pre, post, and 3-month follow-up) was adopted. The sample consisted of 30 patients each in the intervention and Treatment As Usual (TAU) groups selected from the outpatient services of a tertiary mental health hospital. The variables studied were interepisodic symtpoms, functioning, and adherence to treatment using the tools of Beck Depression Inventory-II, Young Mania Rating Scale, and Beck Anxiety Inventory. The intervention group received a brief integrated CBT of 8–10 sessions conducted weekly over 2–3 months. The TAU group received treatment as usual and brief weekly telephonic contact. Results: A significant difference was seen across the time points between the groups on all the variables. Significant changes in within group scores was noted in the intervention group on depressive and anxiety symptoms, medication adherence, and dysfunctional attitudes compared to the TAU group. However, there was no significant change in the functioning in both the groups. Larger within group effect sizes for anxiety, dysfunctional attitudes and emotion regulation, medium effect sizes for depression, and quality of life and small effect sizes for manic symptoms and medication adherence were found in the intervention group. Depression severity had a significant moderating effect on therapy outcomes. Conclusion: The study shows effectiveness of brief CBT in reducing residual symptoms in the patients with BD. A longer-term follow-up would validate the findings.

Relationship between duration of undiagnosed illness, clinical features and cognitive impairment in bipolar disorder

Purpose: It is believed that a delay in the diagnosis of bipolar disorder may adversely affect the clinical course and outcome. This study aimed to investigate the relationship between diagnostic delay and clinical variables, as well as neurocognitive and social cognitive disorders Materials and methods: Eighty-four patients with bipolar disorder in remission were included in the study. Participants were evaluated using a neuropsychological battery that assessed verbal memory and learning, visual memory and learning, verbal fluency, attention, processing speed, executive functions, working memory, and social cognition. Results: The duration of undiagnosed illness was longer in patients with bipolar II disorder, those without psychotic features, those with at least one suicide attempt, those whose first episode was depressive, and those currently on antidepressants. A significant positive correlation was found between the duration of undiagnosed illness and scores on the Controlled Oral Word Association Test, total number of episodes, hypomanic episodes, depressive episodes, and their respective durations. Conversely, a significant negative correlation was found between the duration of undiagnosed illness and both the number and duration of manic episodes. Conclusion: We found that a delay in diagnosis and treatment was associated with more recurrences in bipolar disorder, an increased number of depressive episodes, and at least one lifetime suicide attempt. However, the association between extended periods of untreated illness and poor clinical and functional outcomes did not align with cognitive impairment.

Toxoplasma gondii IgG serointensity and cognitive function in bipolar disorder

BackgroundAlongside affective episodes, cognitive dysfunction is a core symptom of bipolar disorder. The intracellular parasite T. gondii has been positively associated with both, the diagnosis of bipolar disorder and poorer cognitive performance, across diagnostic boundaries. This study aims to investigate the association between T. gondii seropositivity, serointensity, and cognitive function in an euthymic sample of bipolar disorder.MethodsA total of 76 participants with bipolar disorder in remission were tested for T. gondii-specific IgG and IgM antibodies and for cognitive performance using neuropsychological test battery. Cognitive parameters were categorized into three cognitive domains (attention and processing speed, verbal memory, and executive function). Statistical analysis of associations between continuous indicators of cognitive function as dependent variables in relationship to T. gondii, included multivariate analyses of co-variance for seropositivity, and partial correlations with IgG serointensity in IgG seropositives. All analyses were controlled for age and premorbid IQ.ResultsIn seropositives (n = 27), verbal memory showed significant inverse partial correlations with IgG antibody levels (short delay free recall (r=–0.539, p = 0.005), long delay free recall (r=–0.423, p = 0.035), and immediate recall sum trial 1–5 (r=–0.399, p = 0.048)). Cognitive function did not differ between IgG seropositive and seronegative individuals in any of the cognitive domains (F (3,70) = 0.327, p = 0.806, n = 76). IgM positives (n = 7) were too few to be analyzed.ConclusionsThis investigation is the first to show an association between T. gondii IgG serointensity and memory function in a well-diagnosed bipolar disorder sample. It adds to the existing literature on associations between latent T. gondii infection and cognition in bipolar disorder, while further research is needed to confirm and expand our findings, eliminate potential sources of bias, and establish cause-effect relationships.

Cumulative Effect of Psychosis and Aging on Cognitive Function in Patients Diagnosed With Schizophrenia Spectrum Disorders: A Cognitive Domain Approach.

Schizophrenia spectrum disorders are characterized by cognitive decline, which is evident even in the prodromal phase. Aging is a complex gradual procedure that affects, among other organs, the central nervous system, resulting in age-related cognitive decline. The objective of this study is to assess the cognitive function of patients diagnosed with psychotic disorders, in comparison with healthy controls, along the age spectrum. Sixty patients diagnosed with schizophrenia spectrum disorders in remission, 20-59 years old, and 60 healthy controls, matched by age and educational level, from the region of Thessaly in Central Greece, were evaluated, with respect to their cognitive performance, using the Greek version of the Montreal Cognitive Assessment (MoCA). Correlations between age and MoCA total and cognitive domains' scores, as well as statistical analysis of variance (ANOVA) and t-test among age groups, were performed using Statistical Product and Service Solutions (SPSS, version 23; IBM SPSS Statistics for Windows, Armonk, NY). The MoCA score was negatively correlated with age, both in the patients' group (p<0.001) and in the control group (p=0.001).A significant statistical difference in mean MoCA scores between patients and healthy controls was observed, not only in the total sample (p<0.001) but also in all age groups (20-29: p=0.006, 40-49: p=0.024, 50-59: p<0.001), except for age group 30-39 (30-39: p=0.356).Statistically significant differences were also found between patients and healthy controls in the total sample, regarding specific cognitive domains, in the visuospatial and executive function domain (p=0.01), attention domain (p<0.001), language domain (p<0.001), and orientation domain (p<0.005). Interestingly, different deterioration patterns in cognitive domains were observed in each age group. Specifically,in the age group 20-29, statistically significant differences were found between patients and healthy controls in the language domain (p<0.014) and orientation domain (p<0.041). No difference was found in the age group 30-39, while statistically significant differences were found between patients and healthy controls in the age group 40-49 inthe attention domain (p<0.001) and language domain (p<0.001). Finally, in the age group 50-59, such differences were found in the visuospatial and executive function domain (p=0.041), attention domain (p=0.006), and language domain (p=0.001).Statistically significant cognitive decline occurs in a shorter period in the patients' group, suggesting an accelerated cognitive decline in psychotic patients after middle age. Age-related cognitive decline in psychotic patients occurs at an accelerated rate in relation to the control sample, with age-specific cognitive domain decline patterns, due to the cumulative effect of aging and psychosis on cognition. Further, larger, multicenter research should focus on establishing these results and designing relevant procognitive interventions.

Monitoring momentary subjective well-being and psychotic experiences during antipsychotic dose reduction: Two single-case time series experience sampling method pilot study.

Personalized dose optimization is desirable to improve subjective well-being and support rehabilitation. Therefore, N = 1 trials investigating tools to self-manage functional outcomes during dose optimization are necessary. The aim of this pilot study was to determine in two N = 1 trials whether an experience sampling method (ESM) smartphone app could be used to monitor and detect changes in subjective well-being and psychotic experiences during and after dose reduction. Two participants with a psychotic disorder in remission underwent gradual dose reduction under a longitudinal self-monitoring paradigm, accompanied by regular clinical monitoring by the attending physician. Subjective well-being was monitored with an (ESM) app through momentary affective experience (positive and negative affect) and physical well-being (tiredness, feeling unwell, and pain). Momentary psychotic experiences were assessed with four items. Time-series linear regression models were used to detect changes in reduction phases compared to baseline. Whereas significant improvements in subjective well-being and psychotic experiences during dose reduction were detected in one participant, the opposite was demonstrated for the other participant, showing worsened subjective well-being and increased psychotic experiences in the reduction phase compared to baseline. Self-monitoring with an ESM smartphone app offers a tool for detecting changes in subjective well-being and psychotic experiences during antipsychotic dose reduction. In this way, ESM may increase an individual's sense of control and empowerment. It may further facilitate dose optimization and shared decision-making at an individual level, which is required considering the high heterogeneity in psychotic disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Manic Residual Symptoms Also Deserve Attention: A Symptom Network Analysis of Residual Symptoms in Bipolar Disorder.

Lots of patients with bipolar disorder (BD) continue to have residual symptoms after treatment in their remission, BD exhibits intricate characteristics and transformation patterns in its residual symptoms, residual symptoms of different polarities and degrees can mix with and transform to each other. There is a need for further investigation of BD as a comprehensive multivariate disease system. The current research lacks network analyses focusing on BD's residual and subsyndromal symptoms. 242 patients were included with bipolar disorder in remission. We compared demographic data and differences in symptoms between populations with and without residual symptoms using t-tests and chi-square tests, with FDR applied for multiple comparison correction. Logistic regression was used to identify influencing factors for residual symptoms. Symptom networks were compared by network analysis to analyze the relationships between different types of residual symptoms. Depressive residual symptoms (N=111) were more common than manic residual symptoms (n=29) in the patients included. The comparison between two groups with and without residual symptoms shows no difference in demographic data and medical history information. The main influencing factors related to residual symptoms were time from diagnosis to first treatment (OR=0.88), the first(OR=1.51) and second (OR=17.1)factors of the Mood Disorder Questionnaire (MDQ), the Quick Inventory of Depressive Symptomatology Self-Report (QIDS)(OR=5.28), the psychological(OR=0.68) and environment (OR=1.53) subscale of the World Health Organization Quality of Life Short Form (WHOQOL-BREF). There was a significant difference in network structure between the groups with and without residual symptoms (network invariance difference=0.4, p =0.025). At the same time, there was no significant difference between the groups with and without depressive residual symptoms. However, the symptom network in patients with depressive residual symptoms is more loosely structured than in those without, with symptoms exhibiting weaker interconnections. When there is no depressive or manic residual symptom, it can still form a symptom network and cause an impact on social function. This study underscores the complexity of bipolar disorder's residual symptoms. Although it primarily manifests as loosely structured depressive residual symptoms, manic residual symptoms should not be ignored. Future research should explore network-based interventions targeting specific symptom clusters or connections to improve residual symptom management and patient outcomes.

The sexual functions of male patients suffering from affective disorders.

This study aimed to outline the picture of the sexual functions of male patients with affective disorders as an important part of their lives. The sample consisted of 57 male patients diagnosed with mood disorders in remission. They were interviewed for demographic and clinical data, asked to fill in number of self-descriptive questionnaires' Sexual Function of Man (SFM/K), the Montgomery-Åsberg Depression Scale (MADRS) and Young Mania Scale (YMRS), and the Alcohol Use Disorders Identification Test (AUDIT). Lower levels of sexual functioning were experienced by patients who had suffered from affective disorder for a longer time, and who had a diagnosis of recurrent depressive disorder (F33), in comparison with patients with bipolar disorder (F31). The most common sexual dysfunction was premature ejaculation, while the rarest was erectile dysfunction. An occurrence of any sexual disorder at least once in the past was reported by 66% of all patients. Participants did not have problems with alcohol usage. A worse quality of sexual functioning was associated with a longer history of affective disorder. Sexual dysfunction can be affected by even the most minor depressive and manic-depressive components. The tools used excluded non-heterosexual patients. Further research based on bigger samples is required.

Hemiplegic Migraines Exacerbated using an Injectable GLP-1 Agonist for Weight Loss.

The widespread adoption of Glucagon-like peptide-1 (GLP-1) receptor agonists for the treatment of obesity and diabetes has raised concerns about their potential adverse effects, including the induction of depression and suicide ideation. We report on a male patient in his early 50s with a complex medical history, including adult Attention-Deficit/Hyperactive Disorder, narcolepsy with cataplexy, and major depressive disorder in remission, who experienced exacerbated hemiplegic migraines after initiating treatment with an injectable GLP-1 agonist (Saxenda) for weight loss. Despite a previous history of experiencing hemiplegic migraines once or twice a year, the patient reported daily occurrences of migraines, many of which were hemiplegic, during the 60 days of GLP-1 agonist treatment. The migraines abated only upon discontinuation of the medication. This case underscores the need to carefully consider patient history and potential genetic predispositions when prescribing GLP-1 agonists, highlighting the complex interactions between these medications, existing comorbidities, and the dopaminergic and calcitonin gene-related peptide pathways. Our findings suggest that GLP-1 agonists, while beneficial for some, may pose significant risks for patients with specific genetic backgrounds or neurological conditions, calling for personalized approaches to treatment and increased awareness of potential adverse effects.

APOE Genotype, ApoE Plasma Levels, Lipid Metabolism, and Cognition in Monozygotic Twins with, at Risk of, and without Affective Disorders.

Background: Lipids influence brain function and mental health. Understanding the role of apolipoproteins in affective disorders could provide valuable insights and potentially pave the way for novel therapeutic approaches. Methods: We examined the apolipoprotein E genotype and ApoE-levels, lipid profiles, and the correlation with cognition in 204 monozygotic (MZ) twins with unipolar or bipolar disorder in remission or partial remission (affected, AT), their unaffected co-twins (high-risk, HR), and twins with no personal or family history of affective disorder (low-risk, LR). Results: The APOE genotype was not associated with affective disorders. No significant group differences in ApoE levels were found between the three risk groups. Post hoc analysis group-wise comparisons showed higher ApoE levels in the AT than HR twins and in the concordant AT twin pairs relative to the discordant twin pairs. Within the discordant twin pairs, higher ApoE levels were observed in the affected twins (AT = 39.4 mg/L vs. HR = 36.8 mg/L, p = 0.037). Limitations: The present study could benefit from a larger sample size. We did not assess dietary habits. Conclusions: The results did not support our main hypothesis. However, exploratory post hoc analysis suggests a role for plasma ApoE and triglycerides in affective disorders. Future research is needed.

A Comparative Study of Internalized Stigma in Patients with Schizophrenia and Bipolar Affective Disorder in Remission

Background: Internalized stigma experienced by individuals with schizophrenia and bipolar affective disorder dramatically affects their overall quality of life. While several studies have explored this topic, there remains a scarcity of research comparing internalized stigma across both these illnesses. We investigated and compared how internalized stigma is associated with different socio-demographic factors among individuals diagnosed with schizophrenia and bipolar affective disorder in remission. Aim: To carry out a comparative study of the internalized stigma experienced by patients with schizophrenia and bipolar affective disorder in remission. Materials and Methods: A total of 106 patients with schizophrenia and 53 with bipolar affective disorder (BPAD) in remission underwent assessment using the Internalized Stigma of Mental Illness Scale (ISMIS), Positive and Negative Syndrome Scale (PANSS), and Young Mania Rating Scale (YMRS). Results: The study revealed that internalized stigma was significantly more ( p value = .0001) in patients with schizophrenia (84.84 ± 6.02) compared to those with BPAD (78.55 ± 6.07). Further analysis of the ISMIS domains revealed significant correlations between internalized stigma and stereotype endorsement ( p value = .005), stigma resistance ( p value = .009), social withdrawal ( p value = .0001), and alienation ( p value = .0001). Conclusion: The study suggests that individuals with schizophrenia experience higher levels of internalized stigma in comparison to those with BPAD.

Predicting risk of dementia among the elderly with major depressive disorder in remission: A prospective study.

Cognitive impairment and change are a focus of research into late-life depression. The aims of this 5-year prospective study were (1) to observe cognitive status change; (2) to investigate the rate and risk ratio of dementia or cognitive decline; and (3) to examine the cognitive domain predictors for conversion to dementia within 5years among a clinical cohort with remitted major depressive disorder (MDD). The study cohort included 130 elderly persons with late-life remitted MDD and 100 normal controls. Comprehensive neuropsychological tests were conducted to determine cognitive domain status. Diagnoses of mild cognitive impairment (MCI) and dementia were made at baseline and at a follow-up visit at the 5-year point. In total, 98 cases and 55 normal controls completed the 5-year follow-up assessment. Of the study cohort with late-life remitted MDD, 28.6% had MCI and 25.5% developed dementia within 5years. Patients with late-life remitted MDD had an approximate 3 times higher risk of subsequent cognitive decline as compared with the normal controls. Information-processing speed (p=0.009) and memory (p=0.041) could predict subsequent progression to dementia within 5years among patients with MDD. This study demonstrated that compared with the general elderly population, elderly patients with depression have more significant impairment in cognitive function after 5years. Further, we found that in depressed patients, deficits in information-processing speed and memory domains were highly suggestive of progression to dementia within 5years.

Relationships Among Demographic Factors, Stigma, Social Support, and Self-Management in Individuals With Bipolar Disorder in Remission.

The current cross-sectional study aimed to investigate the extent to which demographic characteristics, stigma, and social support impact the self-management abilities of individuals with bipolar disorder in remission. Participants (N = 114) completed a demographic questionnaire, Self-Stigma Scale-Short Form, Social Support Rating Scale, and Self-Management Scale for Patients With Bipolar Disorder. Mean scores were 60.65 (SD = 10.42) for self-management, 35.76 (SD = 7.14) for social support, and 21.38 (SD = 5.06) for stigma. In the univariate analysis, age, educational level, method of payment for care, illness duration, and number of hospitalizations demonstrated significant associations with self-management (p < 0.05). Correlation analysis revealed a positive correlation between self-management and social support (r = 0.574, p < 0.01) and negative correlations between self-management and stigma (r = -0.489, p < 0.01) and stigma and social support (r = -0.476, p < 0.01). Multiple linear regression analysis included number of hospitalizations (β = -3.818), social support (β = 0.436), literacy (β = 2.132), and stigma (β = -0.397). Individuals in remission from bipolar disorder exhibit moderate levels of self-management. Follow-up interventions should prioritize enhancing social support and addressing stigma to promote improved self-management and overall well-being. [Journal of Psychosocial Nursing and Mental Health Services, 62(7), 26-35.].

72 Lesion Location and Differing Symptom Presentation in Two Arachnoid Cyst Cases

Objective:Arachnoid cysts are fluid-filled sacs thought to be a developmental abnormality which form as a result of splitting or duplication of the arachnoid membrane. In most cases, arachnoid cysts are congenital and asymptomatic throughout an individual’s life. Rarely, arachnoid cysts develop because of head injury, intraventricular hemorrhage of prematurity, presence of a tumor, infection or surgery on the brain. Intracranial cysts are typically incidental brain imaging findings and most commonly located in the middle fossa, the suprasellar region, and the posterior fossa. In cases where the cyst enlarges significantly individuals may experience symptoms of increased intracranial pressure, mass effects, seizures, nausea and vomiting, focal neurological deficits, or hydrocephalus. This presentation compares the differing symptom presentation of two individuals with medically confirmed arachnoid cysts -- one in the middle cranial fossa region (Patient A) and the other in the posterior cranial fossa region (Patient B).Participants and Methods:The 2 patients were referred to a private practice neuropsychological clinic for neuropsychological assessment. Patient A was a 39-year-old, right-handed, married Syrian male with 12 years if education, unemployed at the time of testing. Changes in cognition, behavior and personality were reported for Patient A approximately two years after a known cerebrovascular accident. Patient B was a 48-year-old, left-handed married Caucasian male with 16 years of education, on disability due to his medical condition. Patient B reported severe memory impairment, speech and language deficits, variable attention, executive dysfunction, impaired gait with falls, emotional dysregulation, and sleep difficulties. He was diagnosed with bipolar disorder and alcohol use disorder in remission for 9 years.Results:Neuropsychological testing results for Patient A were not valid, due to initiation difficulties, paranoia about the testing and consequent limited engagement in the process. Predominant symptoms were consistent with negative symptoms of schizophrenia, (i.e., avolition, abulia, and diminished emotional expression); no positive symptoms were observed or reported. His speech was limited -he lacked spontaneous speech and only responded to direct questions. His informant completed a measure assessing pre/post changes in frontal systems and there were significant increases in apathy and executive dysfunction reported. Neuropsychological results collected from Patient B revealed mild to severe impairment of aspects of executive functioning, memory, processing speed, visual attention, expressive language, and manual dexterity bilaterally and manual motor strength - more consistent with subcortical neurological disease. Self-report and informant data revealed significant difficulties with functional abilities, pre/post changes in frontal systems (apathy, disinhibition, and executive dysfunction), sleep efficiency and daytime fatigue, and psychological distress (anxiety and depressive symptoms).Conclusions:The presenting case analysis illustrates the importance of neuropsychology in identifying and tracking the nature of symptoms associated with neuroimaging confirmed arachnoid cysts. This case analysis is unique as it highlights the complexities of differing symptom phenotypes of the same condition due to location of the cyst. Surgical intervention usually through draining the cyst directly or implantation of a shunt is typically recommended for symptomatic patients and that course of treatment was suggested to both patients. Treatment recommendations geared to target psychosocial and functional difficulties should also be considered.

A blended module (STAIRS) to promote functional and personal recovery in patients with a major depressive disorder in remission: study protocol of a concurrent mixed methods randomized controlled trial

BackgroundDespite the availability of a wide variety of evidence-based treatments for major depressive disorder (MDD), many patients still experience impairments in their lives after remission. Programs are needed that effectively support patients in coping with these impairments. The program Storytelling and Training to Advance Individual Recovery Skills (STAIRS) was developed to address this need and combines the use of peer contact, expert-by-experience guidance, family support and professional blended care. The aim of the planned study is (1) to assess the efficacy of the STAIRS program in patients with remitted MDD, (2) to investigate patients’ subjective experiences with STAIRS, and (3) to evaluate the program’s cost-effectiveness.MethodsA concurrent mixed-methods randomized controlled trial design will be used. Patients aged between 18 and 65 years with remitted MDD (N = 140) will be randomized to either a group receiving care as usual (CAU) + the STAIRS-program or a control group receiving CAU + some basic psychoeducation. Quantitative efficacy data on functional and personal recovery and associated aspects will be collected using self-report questionnaires at the start of the intervention, immediately following the intervention, and at the six-month follow-up. Insights into patients’ experiences on perceived effects and the way in which different program elements contribute to this effect, as well as the usability and acceptability of the program, will be gained by conducting qualitative interviews with patients from the experimental group, who are selected using maximum variation sampling. Finally, data on healthcare resource use, productivity loss and quality of life will be collected and analysed to assess the cost-effectiveness and cost-utility of the STAIRS-program.DiscussionWell-designed recovery-oriented programs for patients suffering from MDD are scarce. If efficacy and cost-effectiveness are demonstrated with this study and patients experience the STAIRS program as usable and acceptable, this program can be a valuable addition to CAU. The qualitative interviews may give insights into what works for whom, which can be used to promote implementation.Trial registrationThis trial was registered at ClinicalTrials.gov on 1 July 2021, registration number NCT05440812.

Disability, quality of life enjoyment and satisfaction of patients with bipolar affective disorder in remission

Bipolar affective disorders (BPAD) can lead to impaired quality of life (QOL) through intense personal suffering and disrupted familial, social and occupational functioning.Self‐report of QOL in patients with BPAD is likely to be influenced by ‘mood bias’ or cognitive distortions regarding self‐concept and functioning. Improving the QOL of patients with BPAD is one of the valued goals of treatment. This study is undertaken with the aim to evaluate quality of life and disability in patients with BPAD in remission. Patients diagnosed with BPAD, currently in remission were taken as subjects for the study. HAM-D and YMRS were applied to assess depression and mania, respectively. Fifty patients who were in remission were included and Quality of Life Enjoyment and Satisfaction Questionnaire – short form (Q-LES-Q-SF) and IDEAS were applied to evaluate quality of life and disability, respectively. Mean age of the sample was 42±3.55 years. Of the total sample, 29 (58%) were males, and 21 (42%) were females. Statistically significant association was found between number of years spent ill and quality of life (p&amp;#60;0.05), and between number of years spent ill and disability (p&amp;#60;0.05). Short/just significant association was also found between quality of life and disability (p&amp;#60;0.05). No association was found between age at onset of illness and quality of life.Taken together, our results have indicated that many patients with BPAD in remission have significant disability and poorer QOL. There is a need to develop interventions to reduce the disability thereby enhancing the QOL.

Pre-existing Opioid Use Worsens Outcomes in Patients With Diverticulitis.

Background and objective Diverticulitis occurs in 10-25% of patients with diverticulosis. Although opioids can decrease bowel motility, there is scarce data on the effect of chronic opioid use on the outcomes of diverticulitis. In this study, we aimed to explore the outcomes of diverticulitis in patients with pre-existing opioid use. Methods Data between 2008 and 2014 from the National Inpatient Sample (NIS) database was extracted using the International Classification of Diseases, 9th Revision (ICD-9) codes. Univariate and multivariate analyses were used to generate odds ratios (OR). Elixhauser Comorbidity Index (ECI) scores predicting mortality and readmission were calculated based on weighted scores from 29 different comorbidities. Scores were compared between the two groups using univariate analysis.Inclusion criteria included patients with a primary diagnosis of diverticulitis. Exclusion criteria included patients less than 18 years of age, and a diagnosis of opioid use disorder in remission. Studied outcomes included inpatient mortality, complications (including perforation, bleeding, sepsis event, ileus, abscess, obstruction, and fistula), length of hospital stay, and total costs. Results A total of 151,708 patients with diverticulitis and no active opioid use and 2,980 patients with diverticulitis and active opioid use were hospitalized in the United States from 2008 to 2014. Opioid users had a higher OR for bleeding, sepsis, obstruction, and fistula formation. Opioid users had a lower risk of developing abscesses. They had longer lengths of stay, higher total hospital charges, and higher Elixhauser readmission scores. Conclusion Hospitalized diverticulitis patients with comorbid opioid use are at an elevated risk of in-hospital mortality and sepsis. This could be attributed to complications from injection drug use predisposing opioid users to these risk factors. Outpatient providers caring for patients with diverticulosis should consider screening their patients for opioid use and try offering themmedication-assisted treatment to reduce their risk of poor outcomes.

Internalized Stigma, Self-Esteem, Loneliness, and Suicide Probability in Patients with Alcohol Use Disorder in Remission

Objective: It was aimed to investigate internalized stigma, self-esteem, suicide probability, and loneliness in patients with alcohol use disorder (AUD) in remission. Methods: Fifty patients diagnosed with AUD according to DSM-5 diagnostic criteria and 50 healthy volunteers were included in the study. The Structured Clinical Interview for DSM-5 (SCID-5), Suicide Probability Scale (SPS), Rosenberg Self-Esteem Scale (RSS), and University of California Los Angeles Loneliness Scale (UCLA-LS) were administered to all participants. In addition, Internalized Stigma of Mental Illness Scale (ISMIS) was applied to the AUD group. Results: UCLA-LS scores were found to be significantly higher in the AUD group than the control group (p=0.014). RSS scores were found to be significantly lower in the AUD group compared to the control group (p=0.019). The SPS total score and all subscale scores were similar in the AUD group and healthy controls (for all; p&gt;0.05). In the AUD group, as ISMIS scores increased, SPS scores and UCLA-LS scores increased (respectively; p=0.022, p=0.003), while as UCLA-LS scores increased, SPS scores increased and RSS scores decreased (respectively; p=0.005, p=0.001). In the regression analysis, loneliness predicts the probability of suicide in AUD patients. Conclusion: It can be said that even if AUD patients are in remission, they have lower self-esteem and higher levels of loneliness, and the probability of suicide is not different from healthy controls. In addition, it can be said that as internalized stigma increases in AUD patients, the level of loneliness and the possibility of suicide increase.

Influence of Socio-Demographic Factors on Perceived Stress in Outpatients with Depression and Anxiety in Remission During the COVID-19 Pandemic

Abstract Objective: The study aimed at identifying the influence of socio-demographic factors on perceived stress during the first and the second “waves” of the COVID-19 pandemic among patients with depression and anxiety in remission compared to controls. Method: The study was designed as case-control, cross-sectional and non-interventional, and included 60 outpatients with depressive and anxiety disorders in remission and 60 controls with or without family history of affective disorder. A self-assessment scale (Perceived Stress Scale, PSS-10) was used to evaluate perceived stress. The remission was objectified by the Clinical Global Impression scale (CGI-S ≤ 2) and a questionnaire about the socio-demographic features and clinical characteristics of the disorders was completed. Results: By using multiple logistic regression, it was found that the diagnostic category and/or the relevant family history did not predict higher levels of perceived stress during the COVID-19 pandemic (p &gt; 0.05). Females were associated with higher risk of moderate or high stress (OR = 2.613, p = 0.017), as well as those working from home during the pandemic (OR = 4.00, p = 0.026). Conclusions: Addressing the COVID-19 effects on mental health in a biopsychosocial manner, the study shows the impact of socio-demographic factors such as gender and work environment in times of a psychosocial crisis. The lack of differences in stress perception by the patients in remission and healthy controls implicates the importance of adequate maintenance treatment and easy access to mental health services in times of crisis.

Quality of life and disability: a study on bipolar disorder patients in remission

Background: Throughout the world bipolar disorder is one of the leading causes of mental disability. But there are only few literature studies found on quality of life (QoL) and disability of patients with bipolar disorder. The study aims to assess inter-relationship between QoL and disability of patients with bipolar I disorder in remission and to assess the pathways of help seeking behaviors by the family members of bipolar I disorder patients.Methods: This study involves non-experimental research design with purposive sampling method. A total of 62 participants from clinical group (outpatient department of mental health institute (Centre of excellence), S. C. B. medical college) and 48 participants from matched healthy control group included. World health organization quality of life assessment (WHO-QoL) Bref Odia version and WHO disability assessment schedule (WHO DAS) 2.0 used.Results: Statistically significant differences (p&lt;0.05) were found in all the four domains of QoL. Statistically significant differences (p&lt;0.05) were found in cognition, mobility, life activity and participation in society domains of WHO DAS. There were significant negative correlations found in different domains of QoL and disability. A majority of family members consulted mental health professionals directly as the first modality of treatment.Conclusions: Both the QoL and mental disability burden are equally affected in chronic suffers of bipolar I disorder, which requires mental health intervention at earliest as possible.

Psychological resilience and related influencing factors in patients diagnosed with major depressive disorder in remission: A cross-sectional study.

AIM: Psychological resilience is closely related to recurrence of depression. There are few previous studies on the influencing factors of psychological resilience in patients diagnosed with major depressive disorder in remission (MDDR). Here, we investigated the current status of resilience in patients diagnosed with MDDR and its influencing factors. A descriptive cross-sectional study was conducted from June 2019 to April 2021. One hundred and forty-two patients diagnosed with MDDR were recruited from the Department of Psychiatry and Psychology of the General Hospital of Northern Theater Command. Demographic information, social support, well-being, self-efficacy and psychological resilience were collected using self-reported questionnaires. The psychological resilience of MDDR patients was lower than that of the healthy Chinese adults in China. Multiple logistic regression analysis showed that education, personal monthly income, social support, well-being and self-efficacy were associated with psychological resilience. Receiver operating characteristic (ROC) curve analysis further confirmed that social support, well-being and self-efficacy were associated with psychological resilience. The psychological resilience of MDDR patients was lower than that of the general population in China. The education levels, personal monthly income, social support, well-being and self-efficacy were influencing factors of psychological resilience. According to the factors affecting the psychological resilience of patients diagnosed with MDDR, targeted clinical nursing is helpful to prevent the recurrence of depression.