Mood Disturbance Research Articles

I know why the caged bird sings: Distress tolerant individuals show greater resting state connectivity between ventromedial prefrontal cortex and right amygdala as a function of higher vagal tone

BackgroundIntolerance to psychological distress is associated with various forms of psychopathology, ranging from addiction to mood disturbance. The capacity to withstand aversive affective states is often explained by individual differences in cardiovagal tone as well as resting state connectivity of the ventromedial prefrontal cortex (vmPFC), a region involved in the regulation of emotions and cardio-autonomic tone. However, it is unclear which brain regions involved in distress tolerance show greater resting state functional connectivity (rsFC) as a function of resting heart rate variability (HRV). MethodsOne-hundred and twenty-six adults, aged 20 to 83.5 years, were selected from a lifespan cohort at the Nathan Kline Institute-Rockland Sample. Participants' distress tolerance levels were assessed based upon performance on the Behavioral Indicator of Resiliency to Distress (BIRD) task. Artifact-free resting-state functional brain scans collected during separate sessions were used. While inside the scanner, a pulse oximeter was used to record beat-to-beat intervals to derive high-frequency heart rate variability (HF-HRV). The relationship between HF-HRV and vmPFC to whole brain functional connectivity was compared between distress tolerant (BIRD completers) and distress intolerant (BIRD non-completers). ResultsGroups did not differ in their history of psychiatric diagnosis. Higher resting HF-HRV was associated with longer total time spent on the BIRD task for the entire sample (r = 0.255, p = 0.004). After controlling for age, gender, body mass index, head motion, and gray matter volume. Distress tolerant individuals showed greater rsFC (p < 0.005 (uncorrected), k = 20) between the vmPFC and default-mode network (DMN) hubs including posterior cingulate cortex/precuneus, medial temporal lobes, and the parahippocampal cortex. As a function of higher resting HF-HRV greater vmPFC connectivity was observed with sub-threshold regions in the right amygdala and left anterior prefrontal cortex, with the former passing small volume correction, in distress tolerant versus distress intolerant individuals. ConclusionIn a lifespan sample of community-dwelling adults, distress tolerant individuals showed greater vmPFC connectivity with anterior and posterior hubs of the DMN compared to distress intolerant individuals. As a function of greater HF-HRV, distress tolerant individuals evidenced greater vmPFC with salience and executive control network hubs. These findings are consistent with deficits in neural resource allocation within a triple network resting amongst persons exhibiting behavioral intolerance to psychological distress.

Mood disturbance and tau pathology in older women at risk for Alzheimer’s disease

AbstractBackgroundNeuropsychiatric symptoms, particularly depression, have been associated with Alzheimer’s disease (AD) biomarkers in individuals on the AD continuum. Although mood changes are a clinical manifestation of AD, research examining how the spectrum of common mood symptoms relates to AD biomarkers is limited. We examined the association between mood disturbance and tau pathology measured with positron emission tomography (PET) in older women at risk for AD and particular mood domains driving any associations.MethodParticipants included 18 women (Mage = 71.5, SDage = 3.3 years) with higher AD genetic risk (polygenetic hazard score ≥50th percentile) and mild impairment on the Montreal Cognitive Assessment who had completed the Profile of Mood States (POMS) questionnaire and a PET Scan as part of a larger research study. Those with formal psychiatric or neurodegenerative diagnoses were excluded. The POMS assessed six mood subcategories. The Total Mood Disturbance (TMD) was calculated as the sum of Tension, Depression, Anger, Fatigue, and Confusion subscores, minus the Vigor subscore. Tau standardized uptake value ratio (SUVR) were calculated for each Braak region of interest (ROI) (i.e., Braak 1‐2: transentorhinal stage, Braak 3‐4: limbic stage, and Braak 5‐6: isocortical stage). Linear regression models were conducted with TMD as the predictor and each Braak‐derived ROI as the outcome while controlling for age. Significant relationships were further probed by repeating analyses with each POMS subcategory as the predictor.ResultHigher POMS TMD scores significantly predicted higher tau‐PET SUVRs in Braak 1‐2 (β = 0.73, p&lt;0.01), Braak 3‐4 (β = 0.88, p&lt;0.001), and Braak 5‐6 (β = 0.72, p&lt;0.01) (Figure 1). Further analysis showed that the Tension subscore significantly predicted tau‐PET in all three regions (Figure 2) and Confusion significantly predicted tau‐PET in Braak 1‐2 and Braak 5‐6 (Figure 3).ConclusionMood disturbance was consistently associated with higher tau across all Braak regions in older women with higher AD risk. These relationships were strongest when reflecting the combination of mood symptoms, but tension may have a stronger influence than other subcategories. Longitudinal research should be done to assess the directionality of this relationship and to explore whether treatments for mood symptoms may have protective effects on Alzheimer’s pathogenesis before diagnosis.

Endocannabinoid and psychological responses to acute resistance exercise in trained and untrained adults.

This study examined the effects of acute resistance exercise on circulating endocannabinoid (eCB) and mood responses in trained and untrained healthy adults. Thirty-two healthy adults (22.1 ± 2.9 years) were recruited from trained (reporting resistance exercise at least twice per week for ≥ previous three months) and untrained (performing no resistance exercise for ≥ previous three months) groups. Participants (13 male, 19 female) completed three sets of resistance exercise (16 repetitions at 50% 1-repetition max, 12 repetitions at 70% 1-repetition max, 8 repetitions at 80% 1-repetition max). Resistance machines targeted the legs, chest, back, and abdominal muscles. Mood states, affect, and circulating eCB concentrations were evaluated before and after resistance exercise. There were significant decreases in AEA, PEA, and OEA levels following acute resistance exercise (p <0.05; ds = -0.39, -0.48, -0.65, respectively), with no significant group differences or group by time interactions. 2-AG did not change significantly. Positive affect increased significantly following resistance exercise (p = 0.009), while negative affect decreased (p <0.001). Depressive symptoms, anger, confusion, and total mood disturbance decreased significantly (p <0.05), while vigor increased significantly following resistance exercise (p = 0.005). There were no significant group differences or group by time interactions for any psychological outcomes. These results indicate that acute resistance exercise may reduce eCB and related lipid concentrations, which is opposite to the increase in lipids typically observed with acute aerobic exercise. Furthermore, psychological improvements occur after resistance exercise regardless of decreases in eCBs, supporting the notion that psychological changes with exercise likely occur through a wide variety of biological and environmental mechanisms.

Evaluation of Antidepressant Activity of Leaf Extract of Curculigo orchioides Gaertn in mice

Depression is mood disturbances that causes a continuous feeling of unhappiness, changes in behavior, unable to concentrate and loss of interest. Chronic exposure to stressful events plays very important role in the etiology of depression. Curculigoorchioides is a medicinally important plant that is used widely in ayurvedic system of medicine and Chinese traditional systems. The present study was undertaken to evaluate the antidepressant activity of the Curculigoorchioides leaf extract in mice exposed to acute stress in different behavioural models like forced swimming test, tail suspension test, 5-Hydroxy Tryptamine (5-HTP) induced head twitches. The effect of the extract on brain lipid peroxidation was also assessed by invitro estimation of malondialdehyde levels. After the oral administration of leaf extract of Curculigoorchioides at the dose of 100, 200 and 400mg/kg to the mice antidepressant activity was compared with the standarddrug imipramine (10mg/kg). The Curculigoorchioides leaf extract showed significant reduction in immobility time and increased number of 5-Hydroxy Tryptamine induced head twitchesin dose-dependent manner. Significant antidepressant activity of Curculigoorchioides leaf extract was observed at the dose of 100mg/kg which was evident by the reduced duration of immobility in forced swimming and tail suspension test. Extract treatedgroups showed reduced brain lipid peroxidation indicated by decrease in malondialdehyde content. Hence Curculigoorchioidesleaf extract possess antidepressant activity.

Isatuximab Rescue for Inadequate Response to Lenalidomide and Dexamethasone in Transplant Ineligible Patients with Newly Diagnosed Multiple Myeloma: Primary Analysis of the Phase II Iril Study of the Australian Myeloma Research Consortium (AMaRC 18-02)

Background: A significant proportion of transplant ineligible, treatment-naïve multiple myeloma (NDMM, TNE) patients (pts) do not proceed to second line anti-MM therapy. Given depth of response to initial therapy correlates with overall survival (OS), a deep remission should be the target for this often elderly and frail cohort of pts. Additionally, current risk-stratification models utilizing predictive biomarkers, cytogenetics, FISH, and molecular profile cannot reliably identify patients with functional high-risk MM who respond sub optimally [i.e., &amp;lt; partial response (PR)]to standard first line therapy. IRIL is a phase II, multicentre, response-adapted study examining treatment rescue/intensification with isatuximab (Isa), an anti-CD38 monoclonal antibody, for functional high-risk pts, defined as those not achieving pre-defined target responses to lenalidomide and dexamethasone (Rd). Method: TNE NDMM pts meeting IMWG criteria for treatment were eligible for enrolment. Pts commenced treatment with lenalidomide [R; 25mg D1-D21 of a 28-day cycle (c)] and dexamethasone [d; 40mg (20mg for those aged ³75 years) PO weekly]. Isa (10mg/kg IV weekly for c1, then fortnightly) was added for failure to achieve pre-defined target responses [³PR after 4c, ³VGPR after 6c, or ³CR after 9c of Rd] or progressive disease (PD) within the first 9c Rd and was continued until PD or consent withdrawal. The primary endpoint was the achievement of PR or better after an additional 6c of Isa-Rd in pts who progressed during the first 4c of Rd or did not achieve a PR after 4c of Rd (i.e., the functional high-risk subgroup). A dual-criteria, Bayesian Proof-of-Concept (PoC) design was implemented requiring an observed rate of PR (or better) after 6c Isa-Rd of ≥ 50% with a posterior probability that the true rate exceeds 37.7% of &amp;gt;95%. The protocol allowed the trial management committee (TMC) to halt accrual at the first demonstration of PoC. The secondary endpoints were achievement of VGPR or CR after an additional 6c Isa-Rd in pts failing to meet these milestones after 6 or 9c Rd, progression free survival (PFS), OS and safety. This is a report of a per-protocol specified interim analysis of the primary endpoint. Results: From June 2019 until April 2023, 68 pts [52% male, median age 78.2 years (range 65.5-91.9), R-ISS Stage I (n=11), Stage II (n=37), Stage III (n=10)] were enrolled (67 commenced treatment with Rd). At the first interim analysis, both Bayesian PoC criteria were met with the observed PR rate after up to 6 additional cycles of Isa-Rd of 73.3% with a posterior probability that the true rate exceeded 37.7%, greater than 95% (Table 1). Given PoC was demonstrated and the SARS-CoV-2 pandemic-related slower than expected accrual, the TMC terminated study recruitment. At the most recent sweep in June 2023 (Figure 1), 14/15 rescued pts have achieved a PR or better (9/15 VGPR or CR), 4 deaths have been reported (1 each of disease-related, cardiac event, trauma, cause unknown) while 8/15 pts remain on treatment. With an estimated median potential follow-up of 28 months, a preliminary estimate of PFS at 24-months is 73.3% (median PFS not reached). The safety profile for the combination Isa-Rd is similar to previously reported. 14/15 pts had any grade (Gr) adverse event (AE) reported, while 73% pts had at least 1 ³ Gr 3 AE (10 pts with Gr 3, 1 pt with Gr 4). The most common ³ Gr 3 AE were neutropenia (40%), fever (13.3%), back pain (13.3%) and mood disturbance (13.3%). Conclusion: A response-adapted approach to treatment of TNE NDMM pts with Isa rescue upon disease progression or failure to meet a target response to Rd is safe and effective. Isa rescue improves depth of response after 6 additional cycles of therapy in 73% of functionally high-risk patients. The study was closed to recruitment early due to demonstration of PoC of a response-adapted treatment strategy. There were no new safety signals observed from the Isa-Rd combination. Reports on secondary endpoints will be presented, 12 months following the last Isa rescued patient's 6 th cycle of IsaRd. This study is supported by BMS/Celgene (funding), Sanofi/Genzyme (provision of Isatuximab), The Victorian Cancer Agency (funding) and the Victorian Epigenetics Group (funding).

Circadian Reinforcement Therapy in Combination With Electronic Self-Monitoring to Facilitate a Safe Postdischarge Period for Patients With Major Depression: Randomized Controlled Trial.

Patients with major depression exhibit circadian disturbance of sleep and mood, and when they are discharged from inpatient wards, this disturbance poses a risk of relapse. We developed a circadian reinforcement therapy (CRT) intervention to facilitate the transition from the inpatient ward to the home for these patients. CRT focuses on increasing the zeitgeber strength for the circadian clock through social contact, physical activity, diet, daylight exposure, and sleep timing. In this study, we aimed to prevent the worsening of depression after discharge by using CRT, supported by an electronic self-monitoring system, to advance and stabilize sleep and improve mood. The primary outcome, which was assessed by a blinded rater, was the change in the Hamilton Depression Rating Scale scores from baseline to the end point. Participants were contacted while in the inpatient ward and randomized 1:1 to the CRT or the treatment-as-usual (TAU) group. For 4 weeks, participants in both groups electronically self-monitored their daily mood, physical activity, sleep, and medication using the Monsenso Daybuilder (MDB) system. The MDB allowed investigators and participants to simultaneously view a graphical display of registrations. An investigator phoned all participants weekly to coinspect data entry. In the CRT group, participants were additionally phoned between the scheduled calls if specific predefined trigger points for mood and sleep were observed during the daily inspection. Participants in the CRT group were provided with specialized CRT psychoeducation sessions immediately after inclusion, focusing on increasing the zeitgeber input to the circadian system; a PowerPoint presentation was presented; paper-based informative materials and leaflets were reviewed with the participants; and the CRT principles were used during all telephone consultations. In the TAU group, phone calls focused on data entry in the MDB system. When discharged, all patients were treated at a specialized affective disorders service. Overall, 103 participants were included. Participants in the CRT group had a significantly larger reduction in Hamilton Depression Scale score (P=.04) than those in the TAU group. The self-monitored MDB data showed significantly improved evening mood (P=.02) and sleep quality (P=.04), earlier sleep onset (P=.009), and longer sleep duration (P=.005) in the CRT group than in the TAU group. The day-to-day variability of the daily and evening mood, sleep offset, sleep onset, and sleep quality were significantly lower in the CRT group (all P<.001) than in the TAU group. The user evaluation was positive for the CRT method and the MDB system. We found significantly lower depression levels and improved sleep quality in the CRT group than in the TAU group. We also found significantly lower day-to-day variability in daily sleep, mood parameters, and activity parameters in the CRT group than in the TAU group. The delivery of the CRT intervention should be further refined and tested. ClinicalTrials.gov NCT02679768; https://clinicaltrials.gov/study/NCT02679768. RR2-10.1186/s12888-019-2101-z.

Exploring Social Bonds and Well-Being in Young Adults during and beyond the COVID-19 Pandemic.

Young adults, aged between 17 and 25 years, experienced a strong impact on both their mental health and well-being due to COVID-19. Indeed, they were simultaneously faced with the normative tasks of their age and stressors associated with the long-lasting COVID-19 pandemic. This study offers further insights into the perceptions of the well-being (stress, anxiety, and depression) and social bonds in young Italian adults during and after the COVID-19 pandemic. The first survey was conducted between December and February 2021 (i.e., during the second wave in Italy) and included a total sample of 347 participants. The second survey took place between April and May 2022 (i.e., at the end of the health emergency in Italy) and consisted of a total sample of 313 participants. T-tests, correlations, and linear regressions were performed. Overall, our findings showed an increased mood disturbance was positively correlated with having contracted COVID-19 and negatively associated with social connectedness. Furthermore, social assurance was found to negatively predict mood disorders during COVID-19. While numerous studies have focused on mental health, there has been limited exploration of protective factors, which could represent a different perspective that emphasizes individuals' resources rather than their vulnerabilities.

Rationale and design of a randomized clinical trial evaluating the efficacy of mechanical neuroprotection in reducing the risk of silent brain infarcts associated with percutaneous left atrial appendage closure: study protocol for a LAAC-SBI trial

BackgroundLeft atrial appendage closure (LAAC) procedures prevent cardioembolic stroke in patients with atrial fibrillation who have contraindications to oral anticoagulant medications. However, these procedures carry certain risks of peri-procedural complications. One such complication is silent brain infarcts (SBI), which can lead to cognitive impairment and mood disturbances. The implementation of mechanical neuroprotection systems during LAAC procedures may reduce the risk of SBI and associated cognitive and mood disorders.MethodsThe LAAC-SBI trial is a prospective, multicenter, randomized, and double-blind interventional study. The study aims to enroll a total of 240 patients, with 120 patients allocated to each group. The study group will evaluate the use of the Sentinel CPS during LAAC, while the control group will undergo LAAC procedures without the Sentinel CPS. The primary endpoint of the study is the number of new SBIs or stroke foci detected by diffusion-weighted magnetic resonance imaging (DW MRI). Secondary endpoints include deterioration of cognitive function, development of dementia syndrome, and occurrence of depressive disorders. These endpoints will be assessed using questionnaire tools such as the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Controlled Oral Word Association Test (COWAT), and Hospital Anxiety and Depression Scale (HADS). The observational period for patients in the study is 2 years.DiscussionIf the study demonstrates a favorable outcome with reduced incidence of SBI and improved cognitive and mood outcomes in patients receiving cerebral protection devices during LAAC, it will have significant implications for clinical management standards. This would support the use of neuroprotection devices not only for LAAC but also in procedures such as atrial fibrillation ablation or transcatheter mitral valve interventions, where the risk of embolic events and subsequent brain injury may also be present.Trial registrationClinicalTrials.gov NCT05369195. Registration on 11.05.2022.

Omega-3 in the Subjective Betterment of Mood and Sleep Disturbances Induced by Hormone Therapy in Women with Breast Cancer: A Pilot, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

Omega-3 in the Subjective Betterment of Mood and Sleep Disturbances Induced by Hormone Therapy in Women with Breast Cancer: A Pilot, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

Enhanced low-gamma band power in the hippocampus and prefrontal cortex in a rat model of depression is reversed by orexin-1 receptor antagonism

The hippocampal-prefrontal cortex network dynamics is reported to be involved in various cognitive functions and in different mood disturbances including depression. It has been suggested that blocking orexin-1 receptors can be beneficial in depression. The purpose of this study is to determine whether orexin-1 receptor antagonists have an impact on changes in brain oscillations in the hippocampus and prefrontal cortex in a rat model of depression. Forty-eight male Wistar rats were divided into six experimental groups: control, chronic mild stress (CMS), acute SB-334867, a selective orexin-1 receptor antagonist, treated rats (SB), chronic SB-treated (CSB), CMS+SB, and CMS+CSB. Two stainless steel recording electrodes were placed in the coordinates of the hippocampus (HPC) and the prefrontal cortex (PFC). After behavioral verification of the model, local field potentials were recorded at 1 kHz sampling frequency. The absolute power of different frequency bands was obtained using the Fast Fourier Transform (FFT) function, and the power spectral density (PSD) of each frequency band was calculated for each animal. In the CMS- treated animals, the low-gamma band power increased both in the HPC and PFC (p ≤ 0.05), which were reversed by chronic SB-334867 treatment (p ≤ 0.05). The alterations in theta, and high-gamma band power were not significant in CMS treated rats, while acute and chronic SB-334867 treatment diminished the theta and high-gamma band power (p ≤ 0.05), respectively. The hippocampal-prefrontal coherence decreased in the delta (p ≤ 0.01), theta (p ≤ 0.01), and alpha (p ≤ 0.05) band range of the CMS exposed rats. It is concluded that CMS boosts the low-gamma band power, which is reversed by CSB treatment. The low-frequency band coherence is attenuated after CMS treatment.

Self-Reported Physical Inactivity and Mood Disturbances in End-Stage Kidney Disease (ESKD) Patients on Chronic Dialysis Treatment.

Physical inactivity and mood disturbances are key issues in individuals with end-stage kidney disease (ESKD) and may lead to poor clinical outcomes. We performed a pilot, observational study to explore the possible relationships between the self-reported level of physical activity (IPAQ) and the severity of mood disturbances (BDI score) in a cohort of 58 ESKD patients undergoing chronic hemodialysis (HD; n = 30) or peritoneal dialysis (PD; n = 28). Overall, ESKD patients were severely inactive (median METs: 590 [460-1850]) and the intensity of overall and walking physical activity was mostly low to moderate. HD individuals appeared less active than PD (METs 550 [250-1600] vs. 1080 [750-1730]; p = 0.003) and were also less prone to walking (METs 180 ± 90 vs. 320 ± 100; p = 0.01), while a barely statistical difference was noticed for the time spent sitting. ESKD individuals displayed a median BDI score of 17 [12-21], which indicated, on average, the presence of borderline depression, which was apparently more evident among HD individuals. A strong, inverse correlation was found between self-reported METs and BDI scores (R = -0.78; p < 0.0001), while such scores paralleled the time spent sitting during a weekday (R = 0.45; p = 0.0004) and a weekend day (R = 0.40; p = 0.002). In ESKD patients on chronic dialysis, physical inactivity and mood disturbances might be significantly inter-connected, thereby amplifying their relative impact on quality of life, dysautonomia and long-term outcomes. Future studies on larger populations are recommended to confirm these preliminary observations. Promoting strategies to improve fitness, along with greater attention to physiological aspects, should be incorporated into the clinical management of ESKD patients.

Characterization of the long-term effects of lethal total body irradiation followed by bone marrow transplantation on the brain of C57BL/6 mice

Purpose Total body irradiation (TBI) followed by bone marrow transplantation (BMT) is used in pre-clinical research to generate mouse chimeras that allow to study the function of a protein specifically on immune cells. Adverse consequences of irradiation on the juvenile body and brain are well described and include general fatigue, neuroinflammation, neurodegeneration and cognitive impairment. Yet, the long-term consequences of TBI/BMT performed on healthy adult mice have been poorly investigated. Material and Methods We developed a robust protocol to achieve near complete bone marrow replacement in mice using 2x550cGy TBI and evaluated the impact of the procedure on their general health, mood disturbances, memory, brain atrophy, neurogenesis, neuroinflammation and blood-brain barrier (BBB) permeability 2 and/or 16 months post-BMT. Results We found a persistent decrease in weight along with long-term impact on locomotion after TBI and BMT. Although the TBI/BMT procedure did not lead to anxiety- or depressive-like behavior 2- or 16-months post-BMT, long-term spatial memory of the irradiated mice was impaired. We also observed radiation-induced impaired neurogenesis and cortical microglia activation 2 months post-BMT. Moreover, higher levels of hippocampal IgG in aged BMT mice suggest an enhanced age-related increase in BBB permeability that could potentially contribute to the observed memory deficit. Conclusions Overall health of the mice did not seem to be majorly impacted by TBI followed by BMT during adulthood. Yet, TBI-induced alterations in the brain and behavior could lead to erroneous conclusions on the function of a protein on immune cells when comparing mouse chimeras with different genetic backgrounds that might display altered susceptibility to radiation-induced damage. Ultimately, the BMT model we here present could also be used to study the related long-term consequences of TBI and BMT seen in patients.

Comprehensive Outcome Assessment and Quality of Life Following Epilepsy Surgery.

Seizure freedom without deficits is the primary goal for epilepsy surgery. However, patients with medically refractory epilepsy commonly suffer from many co-morbidities related to mood, cognition, and sleep as well as social problems and resultant stigma. While epilepsy surgery literature does describe quality of life (QOL) and neuropsychological outcomes, there is a paucity of information on various common non-seizure outcomes, especially pertaining to mood, sleep, cognition, and social aspects. The objective of this study was to evaluate the role of various non-seizure parameters on post-epilepsy surgery QOL. Consecutive adult patients operated for refractory epilepsy at least 1 year prior to initiation of this study were included and classified as seizure-free (group 1) or non-seizure-free (group 2). QOL was assessed using the QOLIE-31 instrument; patients with a T score less than 40 were categorized as "poor QOL." Non-seizure parameters assessed were cognition, mood disturbances, social improvement, social stigma, and sleep disturbances. Categorization into "good" and "poor" outcome subgroups on each item was carried out by dichotomization of scores. Thirty-seven patients (16 F) [mean age 23.5 ± 5.6 years] were evaluated; 26 were seizure-free (group 1). In this group, impaired memory, lower language scores, depression, not having been employed, not receiving education prior to surgery, and experiencing social stigma were factors significantly associated with poor QOL. In group 2, all patients had poor QOL scores. Non-seizure factors related to common epilepsy co-morbidities and social issues are highly prevalent among seizure-free patients reporting poor QOL after epilepsy surgery.

Opioid use disorder in two samples of the Lebanese population: scale validation and correlation with sleep and mood disorders.

The revised Opioid Risk Tool (ORT-OUD) is a brief, self-report scale designed to provide clinicians with a simple, validated method to screen for the risk of developing an Opioid Use Disorder (OUD) in patients without a prior history of substance abuse. This study aimed to translate and validate the Arabic version of ORT-OUD in the Lebanese population and assess its clinical validity in a sample of patients with OUD. This cross-sectional study in the Lebanese population used several validated scales to assess the risk of OUD, including the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Other tools evaluated chronotype and sleep and mood disturbances. Principal component analysis with Varimax rotation was applied to assess ORT-OUD construct validity. Convergent validity with the Arabic version of ASSIST was evaluated. The ORT-OUD criterion validity was then assessed in a clinical sample of patients with OUD. This study included 581 participants. The prevalence of the OUD risk in the Lebanese population using the ORT-OUD scale and the ASSIST-opioids scale was estimated at 14.5% and 6.54%, respectively. No items of the ORT-OUD were removed; all items converged over a solution of four factors with an eigenvalue > 1, explaining a total of 68.2% of the variance (Cronbach's alpha = 0.648). The correlation coefficients between the ORT-OUD total score and ASSIST subscales were as follows: ASSIST-opioids (r = 0.174; p = < 0.001), ASSIST-sedatives (r = 0.249; p < 0.001), and ASSIST-alcohol (r = 0.161; p = < 0.001). ORT-OUD clinical validation showed a correlation with ASSIST-opioids (r = 0.251; p = 0.093) and ASSIST-sedatives (r = 0.598; p < 0.001). Higher ORT-OUD scores were associated with a family and personal history of alcohol and substance consumption and higher insomnia and anxiety scores. This study is the first to validate the Arabic version of ORT-OUD in the Lebanese population, an essential step towards improving the detection and management of OUD in this population.

84 Utilizing the DSM-5 Cross Cutting Measure to Characterize the Neuropsychiatric Correlates of Subjective and Objective Cognition

Objective:Historically, psychiatric conditions and neurodegenerative diseases have been considered differential diagnoses in older adults with cognitive impairment. However, recent evidence has shown that neuropsychiatric symptoms may be prodromal for neurodegenerative disease. Subjective Cognitive Decline (SCD) is a potential marker for pre-clinical Alzheimer’s Disease (AD) that is frequently related to mood disturbances. Delineating the relationship between neuropsychiatric symptoms, SCD, and cognitive impairment will help to define both the independent and combined utility of SCD and neuropsychiatric symptoms as markers of preclinical AD. This abstract uses the DSM-5 Cross-Cutting Measure (DSM-5 CC), a novel comprehensive screening tool for psychiatric symptoms, to examine the relationship between objective and subjective measures of cognition as they relate to neuropsychiatric symptoms.Participants and Methods:27 community dwelling, cognitively diverse older adults (78% female, mean age 71.9 ± 7) were enrolled in the Concerns about Memory Problems (CAMP) study. Inclusion criteria included the expressed concern about memory functioning by participants on a 5-item screener, while exclusion criteria were defined as previous diagnosis of neurodegenerative diseases and/or major stroke. All participants completed neuropsychological testing and study surveys including the DSM-5 CC. Participants completed Level 1 and all Level 2 (L2) forms of the DSM-5 CC. Spearman two-tailed non-parametric correlations and independent samples t-tests were conducted to examine the relationship between the DSM-5 CC and the 5-item subjective cognition screener, as well as the DSM-5 CC and objective cognition results.Results:Subjective measures of cognition, as measured by answers to the 5-item screening measure, were significantly associated with DSM-5 CC measures. Question 1 on the SCD screener which asks, “Compared to others your age, do you have difficulty with memory or thinking abilities?” was associated with anger (p=.033) and depression (p=.018) L2 forms. Question 3, “Do any difficulties with memory or thinking abilities make it difficult for you to do things in daily life?)” was associated with the L2 forms for somatic symptoms (p=.016) and repetitive thoughts and behaviors (p&lt;.001). Objective measures of cognition from neuropsychological testing also correlated with DSM-5 CC sub-scores. Digits Backwards Length (DBL) correlated with DSM-5 CC Level 1 Sum (r= -.57, p=.002). DBL (r=-.59 p=.001) and Digits Backwards Total Correct (DBTC) (r=-.47, p=.013) associated with somatic symptoms L2 and sleep L2 (DBL: r=,-.45 p=.019; DBTC: r=-.39, p=.044). Category Naming (animals) was also associated with anxiety L2 (r=-.42, p=.030).Conclusions:Subjective and objective measures of cognition were each related to sub-scores of the DSM-5 CC. Interestingly, the associations were largely non-overlapping. These results highlight the importance of considering a wide range of neuropsychiatric symptoms in the assessment of SCD and cognitive impairment. Findings contribute to the growing body of literature suggesting that neuropsychiatric symptoms should be studied in conjunction with cognitive symptoms among older adults as co-occurring phenomena. Future directions will need to include longitudinal studies that can examine the prodromal nature of SCD and neuropsychiatric symptoms for Alzheimer’s and other neurodegenerative disorders.

Content analysis of insomnia questionnaires: A step to better evaluate the complex and multifaceted construct of insomnia disorder

Insomnia disorder is a mental disorder that includes various types of symptoms (e.g., insomnia initiating, worries, mood disturbances) and impairments (e.g., distress related to sleep alterations). Self-report questionnaires are the most common method for assessing insomnia but no systematic quantified analysis of their content and overlap has been carried out. We used content analysis and a visualization method to better identify the different types of clinical manifestations that are investigated by nine commonly used insomnia questionnaires for adults and the Jaccard index to quantify the degree to which they overlap. Content analysis found and visualized 16 different clinical manifestations classified into five dimensions (“Insomnia symptoms”, “Insomnia-related symptoms”, “Daytime symptoms”, “Insomnia-related impairments”, “Sleep behaviors”). The average Jaccard Index was 0.409 (moderate overlap in content). There is a lack of distinction between symptoms and impairments, and the assessment of sleep duration and hyperarousal symptoms remains overlooked. This preliminary analysis makes it possible to visualize the content of each of the nine questionnaires and to select the most appropriate questionnaire based on the issue to be addressed. Suggestions are made regarding the development of future questionnaires to better distinguish symptoms and impairments, and the different phenotypes of insomnia disorder.

Baseline Characteristics From a New Longitudinal Cohort of Patients With Noncancer Pain and Chronic Opioid Use in the United States

Retrospective cohort studies have consistently observed that long-term prescription opioid use is a risk factor for new major depressive episodes. However, prospective studies are needed to confirm these findings and establish evidence for causation. The Prescription Opioids and Depression Pathways cohort study is designed for this purpose. The present report describes the baseline sample and associations between participant characteristics and odds of daily versus nondaily opioid use. Second, we report associations between participant characteristics and odds of depression, dysthymia, anhedonia, and vital exhaustion. Patients with noncancer pain were eligible if they started a new period of prescription opioid use lasting 30 to 90 days. Participants were 54.8 (standard deviation ± 11.3) years of age, 57.3% female and 73% White race. Less than college education was more common among daily versus nondaily opioid users (32.4% vs 27.3%; P = .0008), as was back pain (64.2% vs 51.3%; P < .0001), any nonopioid substance use disorder (12.8% vs 4.8%; P < .0001), and current smoking (30.7% vs 18.4% P < .0001). High pain interference (50.9% vs 28.4%; P < .0001) was significantly associated with depression, as was having more pain sites (6.9 ± 3.6 vs 5.7 ± 3.6; P < .0001), and benzodiazepine comedication (38.2% vs 23.4%; P < .0001). High pain interference was significantly more common among those with anhedonia (46.8% vs 27.4%; P < .0001), and more pain sites (7.0 ± 3.7 vs 5.6 ± 3.6; P < .0001) were associated with anhedonia. Having more pain sites (7.9 ± 3.6 vs 5.5 ± 3.50; P < .0001) was associated with vital exhaustion, as was back pain (71.9% vs 56.8%; P = .0001) and benzodiazepine comedication (42.8% vs 22.8%; P < .0001). Patients using prescription opioids for noncancer pain have complex pain, psychiatric, and substance use disorder comorbidities. Longitudinal data will reveal whether long-term opioid therapy leads to depression or other mood disturbances such as anhedonia and vital exhaustion. PerspectiveThis study reports baseline characteristics of a new prospective, noncancer pain cohort study. Risk factors for adverse opioid outcomes were most common in those with depression and vital exhaustion and less common in dysthymia and anhedonia. Baseline data highlight the complexity of patients receiving long-term opioid therapy for noncancer pain.

Fibromyalgia in the Emergency Department: Perspective

Fibromyalgia is a complex musculoskeletal pain disorder, which requires a delicate approach in the emergency setting. Above all else, it is imperative on every clinician to ensure these patients are not suffering from a life-threatening condition. Fibromyalgia is often characterized by diffuse musculoskeletal pains secondary to pain dysregulation and central sensitization and often accompanied by fatigue, sleep and mood disturbances, and/or cognitive dysfunction

Association of Health Care Work With Anxiety and Depression During the COVID-19 Pandemic: Structural Topic Modeling Study

Background Stressors for health care workers (HCWs) during the COVID-19 pandemic have been manifold, with high levels of depression and anxiety alongside gaps in care. Identifying the factors most tied to HCWs’ psychological challenges is crucial to addressing HCWs’ mental health needs effectively, now and for future large-scale events. Objective In this study, we used natural language processing methods to examine deidentified psychotherapy transcripts from telemedicine treatment during the initial wave of COVID-19 in the United States. Psychotherapy was delivered by licensed therapists while HCWs were managing increased clinical demands and elevated hospitalization rates, in addition to population-level social distancing measures and infection risks. Our goal was to identify specific concerns emerging in treatment for HCWs and to compare differences with matched non-HCW patients from the general population. Methods We conducted a case-control study with a sample of 820 HCWs and 820 non-HCW matched controls who received digitally delivered psychotherapy in 49 US states in the spring of 2020 during the first US wave of the COVID-19 pandemic. Depression was measured during the initial assessment using the Patient Health Questionnaire-9, and anxiety was measured using the General Anxiety Disorder-7 questionnaire. Structural topic models (STMs) were used to determine treatment topics from deidentified transcripts from the first 3 weeks of treatment. STM effect estimators were also used to examine topic prevalence in patients with moderate to severe anxiety and depression. Results The median treatment enrollment date was April 15, 2020 (IQR March 31 to April 27, 2020) for HCWs and April 19, 2020 (IQR April 5 to April 27, 2020) for matched controls. STM analysis of deidentified transcripts identified 4 treatment topics centered on health care and 5 on mental health for HCWs. For controls, 3 STM topics on pandemic-related disruptions and 5 on mental health were identified. Several STM treatment topics were significantly associated with moderate to severe anxiety and depression, including working on the hospital unit (topic prevalence 0.035, 95% CI 0.022-0.048; P&lt;.001), mood disturbances (prevalence 0.014, 95% CI 0.002-0.026; P=.03), and sleep disturbances (prevalence 0.016, 95% CI 0.002-0.030; P=.02). No significant associations emerged between pandemic-related topics and moderate to severe anxiety and depression for non-HCW controls. Conclusions The study provides large-scale quantitative evidence that during the initial wave of the COVID-19 pandemic, HCWs faced unique work-related challenges and stressors associated with anxiety and depression, which required dedicated treatment efforts. The study further demonstrates how natural language processing methods have the potential to surface clinically relevant markers of distress while preserving patient privacy.

A Study to Assess the Level of Knowledge Regarding Psychiatric Emergencies i.e., Deliberate Self-harm and Violence and Their Management Among Group D Workers Working in Swami Vivekananda Subharti University, Meerut

RESEARCH ABSTRACT BACKGROUND A psychiatric emergency is an acute disturbance of behavior, thought or mood of an individual which if untreated may lead to harm, either to an individual or to others in the environment. Thus, the definition of a psychiatric emergency differs from other medical emergencies in that the danger of harm to the society is also taken into account. Emergencies may be classified as major, where there is a danger to life either of an individual or to others in his environment or minor where there is no threat to life but causes severe incapacitation. STATEMENT OF PROBLEM “A study to assess the level of knowledge regarding psychiatric emergencies i.e., deliberate self-harm and violence and their management among Group D workers working in Swami Vivekanand Subharti University, Meerut”. OBJECTIVES OF THE STUDY 1. To assess the level of knowledge regarding psychiatric emergencies i.e. deliberate self-harm and violence and their management among Group D workers. 2. To find out the association between the knowledge of Group D workers with selected demographic variables. RESEARCH HYPOTHESIS H1: There will be no significant difference between the knowledge scores of Group D workers regarding management of psychiatric emergencies i.e., deliberate self-harm and violence. H2: There will be a significant association of knowledge scores of Group D workers regarding psychiatric emergencies i.e. deliberate self-harm and violence and selected demographic variables. MATERIAL AND METHOD The non- experimental descriptive research approach was adopted for this study and the non-probability purposive sampling technique adopted setting was Swami Vivekanand Subharti University, Meerut. A self-structured knowledge checklist was prepared to assess the level of knowledge regarding psychiatric emergencies i.e., deliberate self-harm and violence and their management among Group D workers working in SVSU, Meerut. Data was analyzed by descriptive statistics (Frequency, Mean, Standard Deviation, and Percentage) at inferential statistics Chi-square test wasused to find out the association and selected demographic variables values, the p Value 0.05 was accepted as statistically significant. RESULT Out of (160) majority of samples i.e. (16) 10% of them have good knowledge regarding psychiatric emergencies i.e., deliberate self-harm and violence and their management (121) 75.62% of them were have average knowledge and (23) 14.3% were have poor knowledge. the mean score of level of knowledge regarding psychiatric emergencies i.e., deliberate self-harm and violence and its management is (14.69) and SD (3.73) indicates that Group D workers working in selected university were having average knowledge regarding psychiatric emergencies i.e. deliberate selfharm and violence. This study shows that there is an association of knowledge score of Group D workers regarding psychiatric emergencies i.e. deliberate self-harm and violence with the selected demographic variables i.e. Gender. CONCLUSION The results revealed that the majority of Group D workers had average knowledge regarding psychiatric emergencies i.e., deliberate self-harm and violence and their management among Group D workers working in SVSU.