DSM-5 Diagnostic Criteria Research Articles

0393 Durability of treatment effects for a stepped-care model integrating digital therapy for insomnia

Abstract Introduction A stepped-care model going from digital cognitive behavioral therapy for insomnia (dCBT-I) to clinician-led CBT-I (fCBT-I) has been shown to be acutely effective. However, the sustainability of the effects over longer periods of time has not yet been examined. This study tested the durability of treatment effects of this stepped-care approach two years following the end of treatment. Methods 1018 individuals with insomnia (DSM-5 diagnostic criteria) were randomized into two conditions at step 1: dCBT-I (N=613), or an online sleep education control (N=624). Participants in the dCBT-I condition who did not remit (ISI>9) were further randomized to either face-to-face CBT-I (N=103) or sleep education (N=104). Insomnia remission and treatment gains at 2-year follow-up were compared across treatment conditions. Results Among step-1 non-remitters, odds of insomnia remission for those who stepped-up to fCBT-I was almost three times higher (60% in remission) than those who received the step-2 control (33% in remission), OR = 2.95, 95% CI [1.3, 6.7]. Odds of remission was not significantly different between those who remitted at step-1 (64% in remission at year 2) and those who received fCBT-I, OR = 3.53, 95% CI [1.7, 7.5]. The treatment gains were higher in the fCBT-I group (9.6 point improvement from baseline) compared to those who remitted at step-1 (7.7 point improvement from baseline) (Cohen’s d = 0.44). Conclusion Preliminary evidence indicate that the treatment effects of this stepped-care model are durable two years after treatment. Support (if any) Support for this study was provided from the National Institute of Mental Health R56MH115150 and R01MH122636 awarded to Dr. Christopher Drake.

Chronic Posttraumatic Stress Disorder: A Prolonged Nightmare of Aftershocks

This article is an overview of chronic posttraumatic stress disorder incorporating its etiology, treatments, certain controversies, and recommendations for future development. Based on the diagnostic criteria of DSM-5 and ICD-10 and the research and summary of previous literature. This paper summarizes the etiology of chronic posttraumatic stress disorder under the theoretical models of five schools (including the biological, psychodynamic, cognitive/information processing model, behavioral model, and current etiological conceptualization based on anxiety disorders). Their influence and application, the current commonly used treatment methods and their effectiveness, the current controversies regarding the definition and treatment of chronic PTSD, and recommendations for future research. Overall, based on previous theoretical research and practical treatment, this paper discusses chronic posttraumatic stress disorder from different perspectives and puts forward the existing problems in current research, thus not only offering readers a relatively comprehensive understanding of chronic traumatic stress disorder but also having multiple orientations of summarizing historical research and facing the future.

Rate of Overlap between ICD-11 Gaming Disorder and DSM-5 Internet Gaming Disorder along with Turkish Reliability of the Gaming Disorder Scale for Adolescents (GADIS-A)

Introduction: The main aims of the current study were (i) to explore the overlap between Internet gaming disorder (IGD) and gaming disorder (GD) diagnoses, (ii) to identify clinical characteristics in clinical settings, and (iii) to measure psychometric properties of the Gaming Disorder Scale for Adolescents (GADIS-A). Methods: 222 adolescents who were followed up within a tertiary-care mental health hospital, were included (IGD/GD group [n = 111], clinical comparison group [n = 90], healthy controls [n = 21]). The tools used were the GADIS-A, Internet Gaming Disorder Scale – Short-Form, The Difficulties in Emotion Regulation Scale (DERS-36), Children’s Global Assessment Scale, and a semistructured interview for DSM-5 diagnoses. Results: The overlap rate of IGD and GD is 73%. Comorbid ADHD diagnoses were more commonly found in the IGD group compared to the clinical comparison group. Patients who met GD and IGD diagnoses revealed higher scores in DERS-36. Turkish GADIS-A Item-total score correlation coefficients were between 0.627 and 0.860. In the sample, there was a high level of correlation between the number of DSM-5 and ICD-11 diagnostic criteria met and GADIS-A scale scores. The Cronbach’s alphas if item deleted ranged between 0.942 and 0.954. In addition, treatment refusal was more frequent in the IGD group than in the clinical comparison group. Conclusion: The GADIS-A had good to excellent psychometric properties in Turkish adolescents. Despite having a stricter diagnostic criterion, GD overlapped with IGD in a clinical population.

A Comparison of Neurocognitive Functions in Adults Diagnosed With Obsessive Compulsive Disorder and Healthy Volunteers

The aim of the study was to evaluation of neuropsychological areas to determine whether or not there were cognitive differences and whether the impairment was in a specific form in obsessive-compulsive disorder (OCD) patients compared to healthy control subjects. The sample comprised 30 patients aged 16-65 years diagnosed with OCD, and a control group of 30 age and gender-matched healthy volunteers. According to the DSM diagnostic criteria, various neurocognitive tests were applied to the patients diagnosed with OCD. A statistically significant difference was determined between the two groups in respect of the WCST scores. No statistically significant difference was determined between the groups in respect of the Forward, Reverse, or total Digit Span Test values. WAIS-R; The results of this test were determined as a mean of 43.1 ± 15.4 in the OCD group and 56.2 ± 6.8 in the control group, and the difference between the groups was statistically significant. When the groups were examined in terms of interference errors, the value of 2.2 ± 2.8 in the OCD group was determined to be statistically significantly greater than the 0.8 ± 0.8 value of the control group. A statistically significant difference was determined between the groups in respect of the mean words counted with perseverance by the OCD group (1.7 ± 2.1) and the control group (0.6 ± 0.8). It can be said that combining cognitive function impairments specific to OCD with neuroimaging studies would be useful in understanding OCD symptoms in more detail. Thus, new treatment strategies could be developed.

Chromosomal Microarray in Patients with Non-Syndromic Autism Spectrum Disorders in the Clinical Routine of a Tertiary Hospital

Autism spectrum disorders (ASD) comprise a group of neurodevelopmental disorders (NDD) characterized by deficits in communication and social interaction, as well as repetitive and restrictive behaviors, etc. The genetic implications of ASD have been widely documented, and numerous genes have been associated with it. The use of chromosomal microarray analysis (CMA) has proven to be a rapid and effective method for detecting both small and large deletions and duplications associated with ASD. In this article, we present the implementation of CMA as a first-tier test in our clinical laboratory for patients with primary ASD over a prospective period of four years. The cohort was composed of 212 individuals over 3 years of age, who met DSM-5 diagnostic criteria for ASD. The use of a customized array-CGH (comparative genomic hybridization) design (KaryoArray®) found 99 individuals (45.20%) with copy number variants (CNVs); 34 of them carried deletions (34.34%) and 65 duplications (65.65%). A total of 28 of 212 patients had pathogenic or likely pathogenic CNVs, representing approximately 13% of the cohort. In turn, 28 out of 212 (approximately 12%) had variants of uncertain clinical significance (VUS). Our findings involve clinically significant CNVs, known to cause ASD (syndromic and non-syndromic), and other CNVs previously related to other comorbidities such as epilepsy or intellectual disability (ID). Lastly, we observed new rearrangements that will enhance the information available and the collection of genes associated with this disorder. Our data also highlight that CMA could be very useful in diagnosing patients with essential/primary autism, and demonstrate the existence of substantial genetic and clinical heterogeneity in non-syndromic ASD individuals, underscoring the continued challenge for genetic laboratories in terms of its molecular diagnosis.

A male mouse model of WIN 55,212-2 self-administration to study cannabinoid addiction.

We have established for the first time a mouse model of cannabinoid addiction using WIN 55,212-2 intravenous self-administration (0.0125mg/kg/infusion) in C57Bl/6J mice. This model allows to evaluate the addiction criteria by grouping them into 1) persistence of response during a period of non-availability of the drug, 2) motivation for WIN 55,212-2 with a progressive ratio, and 3) compulsivity when the reward is associated with a punishment such as an electric foot-shock, in agreement with the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5). This model also allows to measure two parameters that have been related with the DSM-5 diagnostic criteria of craving, resistance to extinction and reinstatement, and two phenotypic traits suggested as predisposing factors, impulsivity and sensitivity to reward. We found that 35.6% of mice developed the criteria of cannabinoid addiction, allowing to differentiate between resilient and vulnerable mice. Therefore, we have established a novel and reliable model to study the neurobiological correlates underlying the resilience or vulnerability to develop cannabinoid addiction. This model included the chemogenetic inhibition of neuronal activity in the medial prefrontal cortex to the nucleus accumbens pathway to assess the neurobiological substrate of cannabinoid addiction. This model will shed light on the neurobiological substrate underlying cannabinoid addiction.

Correlates of aggressive behavior in the moroccan context

IntroductionViolence among the mentally ill population has long been a subject of stigma, and controversy. Clinicians’ ability to assess the violent potential is still limited.ObjectivesThe objective of this work is to identify the positively correlated indicators of aggressive behavior in patients admitted to hospital emergency departments.MethodsIt is a retrospective and descriptive paper based on the records of patients admitted to the emergency department of Arrazi University Psychiatric Hospital in Salé during a one-month period.The psychiatric diagnosis was formulated using the DSM-5 diagnostic criteria and Violent behavior was assessed using the Modified Overt Aggression Scale (MOAS). The existence of aggressive behavior was defined by a MOAS score ≥3.We used SPSS 15 to analyse resultsResultsSixty-five case files were selected during the study month. The average age was 35.3 (19;64).The mean of our sample MOAS aggression scale score was 31.5 [0; 79] and 90% of patients had a score ≥ 3 (image 1)Among the 65 admissions, heteroaggressive risk was the most frequent reason for hospitalization (N=53), followed by psychomotor excitement. IMAGE 2Statistical analysis revealed a significant association between high MOAS scores and substance use, history of suicide attempt, educational level and socioeconomic levelImage:Image 2:ConclusionsIn the current research, the prevalence of aggressive behavior was high among these patients, which may be due to the conditions of psychiatric hospitalization in our region, which is often reserved for the most serious and dangerous patients.Disclosure of InterestNone Declared

A rare case of trauma related dissociative identity disorder

IntroductionDissociative identity disorder (DID) is a debilitating and controversial psychiatric disorder with a lifetime prevalence estimated around 1,5%. It remains underdiagnosed despite recognition in international classification of mental disorders. In fact, based on the DSM-5 criteria, DID is characterised by two or more distinct personality states that coincide, with fluctuating consciousness and changing access to autobiographical memory. The aetiology of DID has long been debated with recent neuroimaging evidence supporting the trauma model of this condition.ObjectivesThe aim of this presentation is to describe the case of a young female diagnosed with DID related to childhood trauma.MethodsWe also conducted a literature review in order to discuss the aetiology of the disorder. The following keywords were searched through the pubmed website: dissociative identity disorder, trauma, aetiology.ResultsWe report the case of a 20 years old female with no past medical, nor psychiatric history. However, she had a family history of an uncle and an aunt with chronic psychosis. Her father died when she was 8, thus she lived with her mother and her brother and two sisters. She was a brilliant student and started engineering studies. She has no particular personality trait. She was raised within a strict religious family with little time dedicated to leisure activities. Importantly, since the age of 10, she was exposed to her mother’s religious extremist and threatening discourses, related to death and “grave’s torture” and comprising many cultural beliefs. She seeks for psychiatric care complaining of “soliloquy” that became remarkable by her relatives. On psychiatric evaluation she presented daily fluctuating consciousness during at least one hour, in which she switches identity toward the daughter of a famous singer. This alter was having pleasant activity with her mother and was singing and hanging out most of the time. No particular triggers were identified. The trouble started by the age of 14 then worsened gradually and became an unvoluntary phenomenon with significant distress. She had no depressive nor psychotic nor anxiety or obsessive symptoms. Her sleep and appetite were not disturbed. She met DSM-5 diagnostic criteria for DID and was referred to a trained psychiatrist for adequate psychotherapy management.ConclusionsWe exposed a rare case of a young student complaining of soliloquy since the age of 14 that was diagnosed with DID subsequent to a particular childhood trauma which consisted in exposure to threatening religious and cultural beliefs about life after death told by her mother. This unique case emphasises the trauma model of DID, where the nature of the trauma influences the clinical expression of DID. Given the recent neuroimaging evidence, DID can be framed as a chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress.Disclosure of InterestNone Declared

Special Report: Bipolar Disorder II—Frequently Neglected, Misdiagnosed

Special Report: Bipolar Disorder II—Frequently Neglected, Misdiagnosed

Mixed Features in Bipolar Disorder: assessing symptoms profiles and their relation with DSM-5 criteria

IntroductionMixed states, the co-occurrence of manic and depressive symptoms, were recognized and described from the time of antiquity. DSM-5 first, and DSM-5-TR after, introduced the ‘’mixed features’’ specifier, defined by the presence of at least three non-overlapping opposite-pole symptoms during a syndromic depressive, hypomanic, or manic episode. Various manifestations, including irritability, distractibility, anxiety, psychomotor agitation, were excluded from the specifier, since they can occur during both depressive and hypo/manic episodes and other mental illnesses.ObjectivesThe objective of this study was to evaluate the phenomenology and prevalence of mixed states among bipolar disorder (BD) patients. We first assessed the frequency of specific features during different mood states. Then, we estimated the prevalence of mixed states by applying DSM-5 criteria, comparing it qualitatively with the one detected from psychometric questionnaires.MethodsIn a naturalistic study, 903 adult outpatients with BD participating in the Stanley Foundation Bipolar Network were followed longitudinally across 14,213 visits for 7 years. The scores at the Inventory of Depressive Symptomatology–Clinician-Rated Version (IDS-C) and at the Young Mania Rating Scale (YMRS), administered at each visit, were used to define the mood episode and to assess the frequency of specific symptoms. In addition, we applied DSM-5 criteria for “with mixed features” to our sample, to examine a DSM-5-based construct.ResultsSpecific symptomatic profiles differentiate mixed states from pure ones (Figure 1 and 2). Mainly, a higher prevalence of irritability was found during mixed episodes, both depressive and hypo/manic, compared to pure depression (0.60 vs. 1.20, p < 0,001) and hypo/mania (0.82 vs. 1.54, p < 0,001), as reported at the 6th item of IDS-C.Figure 1. Individual YMRS items scores in visits with pure depression, mixed depression, pure hypo/mania and mixed hypo/mania.Figure 2. Individual IDS-C items scores in visits with pure depression, mixed depression, pure hypo/mania and mixed hypo/mania.Image:Image 2:ConclusionsPreliminary results of the present study showed that symptoms like irritability are strongly prevalent during mixed states. Moreover, the DSM-5 diagnostic criteria for “with mixed features” specifier for any of the mood episodes detected lower rates of mixed states, hence this criteria may yield inadequate sensitivity in recognizing patients suffering from such conditions.Disclosure of InterestNone Declared

A COMPARISON OF EIDETIC IMAGE THERAPY WITH COGNITIVE BEHAVIOR THERAPY FOR TREATING DEPRESSIVE AND ANXIETY DISORDERS IN ADULTS: A RANDOMIZED CONTROLLED TRIAL

Background & Objectives: Depression and anxiety are common mental health disorders around the world. This study aims to examine efficacy of eidetic image therapy in comparison to cognitive behavior therapy for treating depressive and anxiety disorders, and to compare the patients' dropout ratio in these therapies.
 Methods: This was a randomized controlled trial conducted from January through June 2021 in psychiatry department of Sir Ganga Ram hospital Lahore. Using DSM-5 diagnostic criteria, 60 adult patients with depressive and anxiety disorders were recruited and were randomly and equally assigned to experimental (eidetic image therapy) and control (cognitive behavior therapy) groups. These participants received respective therapies and followed. Beck Depression Inventory and Beck Anxiety Inventory were used at baseline and after conducting five therapy sessions. Paired t-test was used to compare the mean difference and p-value of <0.05 was considered statistically significant.
 Results: Descriptive analysis demonstrated a major difference in dropout numbers of eidetic image therapy (9; 30 %) and cognitive behavior therapy (25; 83 %). The efficacy of both interventions was statistically incomparable due to this excessive number of dropouts in control group. However, eidetic image therapy showed a significant difference (p<0.001) in pre and post therapy ratings; each patient exhibited a marked decline in depression/anxiety symptoms after taking 5 sessions.
 Conclusion: Eidetic imagery is a promising therapeutic utility for depressive and anxiety disorders. Cognitive behavior therapy is also an effective treatment methodology but this narrative is based on analysis of few cases.

The Effect of Drug Use, Body Mass Index and Blood Pressure on Oxidative Stress Levels in Children and Adolescents with Attention Deficit and Hyperactivity Disorder.

The aim of this study was to determine the correlation between clinical variables such as body mass index, blood pressure, drug use and oxidative stress level in children and adolescents with attention deficit and hyperactivity disorder (ADHD). Total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), malondialdehyde (MDA) and superoxide dismutase (SOD) activity were measured in the serum of 51 patients (38 male, 13 female) diagnosed with ADHD according to DSM-5 diagnostic criteria and 32 control subjects (12 male, 20 female). The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version was applied to all participants. The mean TOS, OSI, MDA values were determined to be significantly higher (p < 0.001) and the mean SOD value was lower in the ADHD group (p < 0.001). Multivariate regression analysis indicated significantly lower SOD and diastolic blood pressure values and significantly higher MDA in the ADHD group compared to the control group (p < 0.01). Low SOD (sensitivity 90.2%, specificity 78.0%) and high MDA (sensitivity 86.3%, specificity 81.2%) were determined to be predictive parameters for diagnosing ADHD. In univariate analysis, the mean TOS, OSI and SOD values were higher in ADHD patients under medication, while the mean TAS was higher in patients not using medication (p < 0.01). Only TOS was significant in multivariate logistic regression analysis (p < 0.01). The results of this study demonstrate that impaired oxidative balance may play a role in the etiology of ADHD.

Implications of the Symptom-Level Overlap Among DSM Diagnoses for Dimensions of Psychopathology

Research on the patterns of covariation among mental disorders has proliferated, as summarized in the Hierarchical Taxonomy of Psychopathology (HiTOP). The aim of this brief descriptive study was to examine whether the repetition of symptoms among DSM-5 diagnoses is likely to be inflating the surface similarity of diagnoses in a way that artificially reinforces the dimensions that emerge when modelling patterns of disorder covariation or comorbidity. Specifically, the symptoms comprising the DSM-5 diagnostic criteria for all disorders covered by the HiTOP framework were examined for patterns of overlap that mirror the patterns of disorder covariation captured in HiTOP dimensions. I found that 358 pairs of the DSM-5 diagnoses covered by the HiTOP framework had one or more overlapping symptoms in their diagnostic criteria, and that a third (n = 130; 34%) of the unique constituent symptoms reinforced the higher-order structure of HiTOP through repetition within dimensions and/or between dimensions in the same superspectrum. By contrast, 86% of the possible pairs of diagnoses did not have any shared symptoms, and the majority of the symptoms (n = 222; 58%) did not influence the structure through repetition. Further, a fifth (n = 71; 19%) of the symptoms worked against the HiTOP structure by increasing the surface similarity of diagnoses under different subfactors, spectra, and superspectra. Overall, while patterns of symptom-level overlap do not appear strong enough to account for the emergence of HiTOP dimensions, these patterns do seem likely to inflate the similarity and consequent covariation of some DSM-5 diagnoses. Research on the statistical structure of psychopathology that uses DSM-5 diagnostic constructs should account for this potential source of bias.

Impact of alcohol use disorder severity on human immunodeficiency virus (HIV) viral suppression and CD4 count in three international cohorts of people with HIV.

Alcohol use has been linked to worse human immunodeficiency virus (HIV) immunologic/virologic outcomes, yet few studies have explored the effects of alcohol use disorder (AUD). This study assessed whether AUD severity is associated with HIV viral suppression and CD4 count in the three cohorts of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium. People with HIV (PWH) in Uganda (n= 301), Russia (n= 400), and Boston (n= 251), selected in-part based on their alcohol use, were included in analyses. Logistic and linear regressions were used to assess the cross-sectional associations between AUD severity (number of DSM-5 diagnostic criteria) and (1) HIV viral suppression, and (2) CD4 count (cells/mm3 ) adjusting for covariates. Analyses were conducted separately by site. The proportion of females was 51% (Uganda), 34% (Russia), and 33% (Boston); mean age (SD) was 40.7 (9.6), 38.6 (6.3), and 52.1 (10.5), respectively. All participants in Uganda and all but 27% in Russia and 5% in Boston were on antiretroviral therapy. In Uganda, 32% met criteria for AUD, 92% in Russia, and 43% in Boston. The mean (SD) number of AUD criteria was 1.6 (2.4) in Uganda, 5.6 (3.3) in Russia, and 2.4 (3.1) in Boston. Most participants had HIV viral suppression (Uganda 92%, Russia 57%, Boston 87%); median (IQR) CD4 count was 673 (506, 866), 351 (201, 542), and 591 (387, 881), respectively. In adjusted models, there were no associations between AUD severity and HIV viral suppression: adjusted odds ratios (AOR) (95%CI) per 1 additional AUD criterion in Uganda was 1.08 (0.87, 1.33); Russia 0.98 (0.92, 1.04); and Boston 0.95 (0.84, 1.08) or CD4 count: mean difference (95%CI) per 1 additional criterion: 5.78 (-7.47, 19.03), -3.23 (-10.91, 4.44), and -8.18 (-24.72, 8.35), respectively. In three cohorts of PWH, AUD severity was not associated with HIV viral suppression or CD4 count. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control.

The Serum Brain-Derived Neurotrophic Factor Increases in Serotonin Reuptake Inhibitor Responders Patients with First-Episode, Drug-Naïve Major Depression

Brain-derived neurotrophic factor (BDNF) is a growth factor synthesized in the cell bodies of neurons and glia, which affects neuronal maturation, the survival of nervous system, and synaptic plasticity. BDNF play an important role in the pathophysiology of major depression (MD). The serum BDNF levels changed over time, or with the improvement in depressive symptoms. However, the change of serum BDNF during pharmacotherapy remains obscure in MDD. In particular, the changes in serum BDNF associated with pharmacotherapy have not yet been fully elucidated. The present study aimed to compare the changes in serum BDNF concentrations in first-episode, drug-naive patients with MD treated with antidepressants between treatment-response and treatment-nonresponse groups. The study included 35 inpatients and outpatients composed of 15 males and 20 females aged 36.7 ± 6.8 years at the Department of Psychiatry of our University Hospital. All patients met the DSM-5 diagnostic criteria for MD. The antidepressants administered included paroxetine, duloxetine, and escitalopram. Severity of depressive state was assessed using the 17-item HAMD before and 8 weeks after drug administration. Responders were defined as those whose total HAMD scores at 8 weeks had decreased by 50% or more compared to those before drug administration, while non-responders were those whose total HAMD scores had decreased by less than 50%. Here we showed that serum BDNF levels were not significantly different at any point between the two groups. The responder group, but not the non-responder group, showed statistically significant changes in serum BDNF 0 and serum BDNF 8. The results suggest that the changes of serum BDNF might differ between the two groups. The measurement of serum BDNF has the potential to be a useful predictor of pharmacotherapy in patients with first-episode, drug-naïve MD.

Impairment of GABA inhibition in insomnia disorders: Evidence from the peripheral blood system.

To explore the change characteristics and related factors of various indexes of GABAergic system in peripheral blood of patients with insomnia disorder. In this study, a total of 30 patients who met the DSM-5 diagnostic criteria for insomnia disorder and 30 normal controls were included. All subjects had a structured clinical interview with the Brief International Neuropsychiatric Disorder Interview, and PSQI was used to evaluate the sleep status of the subjects. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum γ-aminobutyric acid (GABA), and RT-PCR was used to detect GABAA receptor α1 and α2 subunit mRNA. All data were statistically analyzed using SPSS 23.0. Compared with the normal control group, the mRNA levels of GABAA receptor α1 and α2 subunits in the insomnia disorder group were significantly lower, but there was no significant difference in the serum GABA levels between the two groups. And in the insomnia disorder group, there was no significant correlation between the GABA levels and the mRNA expression levels of α1 and α2 subunits of GABAA receptors. Although no significant correlation was found between PSQI and serum levels of these two subunit mRNAs, its component factors sleep quality and sleep time were negatively correlated with GABAA receptor α1 subunit mRNA levels, and daytime function was inversely correlated with GABAA receptor α2 subunit mRNA levels. The inhibitory function of serum GABA in patients with insomnia may be impaired, and the decreased expression levels of GABAA receptor α1 and α2 subunit mRNA may become a reliable indicator of insomnia disorder.

Plasma tau and neurofilament light chain as biomarkers of Alzheimer's disease and their relation to cognitive functions.

Alzheimer's disease (AD) dementia is the most frequent cause of neurodegenerative dementia. The cognitive and behavioral symptoms associated with this disorder often have overlapping characteristics, potentially resulting in delayed diagnosis or misdiagnosis. This study aimed to assess the level of peripheral blood neurofilament light chain (NfL) and total tau (t-tau) protein in AD patients and investigate their relationship with cognitive impairment. The study included 80 participants of both sexes between the ages of 60 to 85 years. The participants were divided into two groups, consisting of 40 individuals in the control group (mean age 75±6.6 years) who had no cognitive or functional impairments and 40 AD patients (mean age 74.98±5.03 years). This study utilized the DSM-5 diagnostic criteria for major or mild neurocognitive disorder attributed to Alzheimer's disease (AD). The clinical and biochemical features of all participants were documented, and the Alzheimer's disease Assessment Scale cognitive subscale (ADAS-cog) scores were evaluated. Sandwich ELISA was employed to determine serum NfL and t-tau protein levels. The median serum NfL and t-tau protein levels in AD patients were significantly higher than those of the controls (47.84 pg/ml versus 17.66 pg/ml and 12.05 pg/ml versus 11.13 pg/ml, respectively). Age was positively correlated with NfL, t-tau levels, and ADAS-cog. Although elevated NfL and t-tau protein levels may play a role in disease progression, their diagnostic value for AD was limited.

Adult ADHD: Underdiagnosis of a Treatable Condition.

Attention-deficit/hyperactivity disorder is a common neurodevelopmental disorder, well-characterized within the pediatric population and representing one of the most prevalent mental conditions among children and adolescents. Once diagnosed, pharmacologic and psychosocial therapies can reduce symptomatic expression and functional impairment. Traditionally thought to resolve by young adulthood, it is now recognized that ADHD persists into adulthood. Many of these individuals were never evaluated for ADHD as children and remain undiagnosed as adults, continuing to struggle with symptoms. It is common to develop compensatory strategies geared at mitigating the disruptive effects of ADHD. In this article, we provide an overview of adult ADHD, review changes to DSM-5 diagnostic criteria meant to facilitate diagnosis of ADHD during adulthood, and discuss various factors that serve as barriers to accurate detection of adult ADHD.

Child maltreatment exposure and adolescent nonsuicidal self-injury: the mediating roles of difficulty in emotion regulation and depressive symptoms

BackgroundAlthough child maltreatment (CM) experiences are recognized risk factors for nonsuicidal self-injury (NSSI), the mechanisms underlying this relationship remain unclear. The purpose of this study was to examine whether difficulty in emotion regulation (DER) and depressive symptoms mediate the relationship between child maltreatment experiences and NSSI severity, adjusting for demographic variables.MethodsThe participants were 224 adolescent inpatients recruited from a hospital in China (mean age 15.30 years, SD = 1.83; 78.6% females). Study measures included the Clinician-Rated Severity of Nonsuicidal Self-Injury (CRSNSSI), Childhood Trauma Questionnaire (CTQ-SF), Difficulties in Emotion Regulation Scale (DERS), and Patient Health Questionnaire-9 (PHQ-9). The hypothesized chain mediation model was tested using the structural equation model.ResultsA total of 146 (65.18%) adolescents reported engaging in NSSI during the past 12 months, and 103 (45.98%) participants met the DSM-5 diagnostic criteria for NSSI. Emotional neglect (48.1%) and emotional abuse (46.1%) had the highest prevalence, followed by physical neglect (43.1%) and physical abuse (24.1%), whereas sexual abuse (12.5%) was the least prevalent form of CM. Separately, both DER and depressive symptoms significantly mediated the association between CM and NSSI, with DER being the strongest mediator, with an indirect effect of 49.40% (p = 0.014). At the same time, we also proved a potential chain-mediated pathway of DER and depression in the relationship between CM and NSSI.ConclusionChild maltreatment seems to play a role in the aetiology of NSSI. DER and depressive symptoms both have a mediating role in the relationship between CM and NSSI. Importantly, DER seems to be a mediator with a stronger indirect effect compared to depressive symptoms.

Is abnormal metabolism in the olfactory bulb and amygdala associated with bipolar disorder?

Accumulated evidence has demonstrated abnormal amygdala activation in bipolar disorder (BD). The olfactory bulb (OB) has vigorous connections with the amygdala. Although odor-related functions of the OB decreased during the evolutionary process, we hypothesized that an evolved OB with increased activation in emotion regulation may be one of the main factors affecting amygdala functions in BD. Our aim was to investigate metabolism in the OB and amygdala in patients with BD. Twenty-six patients diagnosed with BD according to DSM-5 diagnostic criteria were included in this cross-sectional study. Metabolism in the OB and amygdala was assessed using fluorodeoxyglucose positron emission tomography/CT in patients with BD. The OB and amygdala metabolism was compared with the patients' Z scores. Both OB and amygdala metabolic activities were significantly higher than in the controls. A positive correlation was detected between right/left amygdala metabolism and right OB metabolism (p < 0.05, r:467 and r:662, respectively). This study increased our understanding of the etiopathogenesis of BD. In BD, the main cause of hypermetabolism in the amygdala may be increased metabolism in the OB. During evolution, the OB may have assumed a dominant role in emotional processing rather than olfactory functions.