DSM-IV Criteria Research Articles

Cardiovascular Disease Risk Scores and Incident Dementia and Cognitive Decline in Older Men and Women

Introduction: Risk factors for cardiovascular disease (CVD) also increase the risk of dementia. However, whether commonly used CVD risk scores are associated with dementia risk in older adults who do not have a history of CVD, and potential gender differences in this association, remains unclear. The aim of this study was to determine whether CVD risk scores are prospectively associated with cognitive decline and dementia in initially healthy older men and women. Methods: A total of19,114 participants from a prospective cohort of individuals aged 65+ years without known CVD or dementia were recruited. The atherosclerotic cardiovascular disease risk score (ASCVDRS), Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP), and the Framingham risk score (FRS) were calculated at baseline. Risk of dementia (according to DSM-IV criteria) and cognitive decline (defined as a >1.5 standard deviation decline in global cognition, episodic memory, psychomotor speed, or verbal fluency from the previous year) were assessed using hazard ratio. Results: Over a median follow-up of 6.4 years, 850 individuals developed dementia and 4,352 cognitive decline. Men and women in the highest ASCVDRS tertile had a 41% (95% CI 1.08, 1.85) and 45% (1.11, 1.89) increased risk of dementia compared to the lowest tertile, respectively. Likewise, men and women in the highest SCORE2-OP tertile had a 64% (1.24, 2.16) and 60% (1.22, 2.11) increased risk of dementia compared to the lowest tertile, respectively. Findings were similar, but the risk was slightly lesser when examining risk of cognitive decline for both ASCVDRS and SCORE2-OP. However, FRS was only associated with the risk of cognitive decline among women (highest vs. lowest tertiles: 1.13 [1.01–1.26]). Conclusion: These findings suggest the utility of the ASCVDRS and SCORE2-OP in clinical practice, to not only assess future risk of CVD, but also as potential early indicators of cognitive impairment, even in relatively healthy older men and women.

Children with Down syndrome who experience developmental skill loss, characterization, and phenomenology: A case series.

Loss of previously acquired developmental skills in children with Down syndrome (DS) is not a well characterized phenomenon. We identified 20 confirmed cases of childhood-onset skill loss for descriptive analysis. Eligible participants were recruited from a specialty clinic for persons with DS at a large medical center. Age and gender-matched participants also with DS but without skill loss were used as a comparison group. Case and control participants were between 3 and 14 years (mean 7.6 yr) at the time of evaluation. Loss of previously acquired communication, social-communication, and play skills was experienced by all cases, as well as new-onset or intensification of pre-existing maladaptive behaviors. The Aberrant Behavior Checklist (ABC)-community was helpful in distinguishing group differences in maladaptive behavior among cases and controls. All cases met DSMIV criteria for autism. Developmental skill loss associated with autism is an extreme example of within-group phenotypic variability and needs to be the focus of further research.

Expressed emotion and early treatment response in family-based treatment for adolescent anorexia nervosa

ABSTRACT This study examined the effect of pre-treatment levels of parental expressed emotion (EE) on early treatment response for adolescent anorexia nervosa (AN). Data were collected from 121 adolescents, ages 12–18, who met DSM-IV criteria for AN excluding the amenorrhea criterion, and their parents. Participants were randomized to family-based treatment (FBT) or adolescent-focused therapy (AFT). To examine the effects of different thresholds of EE, we used two different levels of EE in analyses. Results demonstrated that adolescents who had at least one parent with elevated EE indicated by a lower threshold (i.e. even mild levels) at baseline were less likely to achieve an early treatment response, suggesting that EE might interfere with treatment success from the start of treatment. When high EE was defined by a higher threshold, these effects were no longer significant, regardless of treatment type (FBT or AFT). These findings suggest that adolescents with AN may be more sensitive to EE than other mental illnesses, such that lower thresholds of EE impact the speed with which they are able to reduce symptoms and gain weight in treatment. It may be necessary to target parental EE prior to or early in treatment or pivot to parent-focused treatment to change the trajectory of treatment response. Future research is needed to explore ways parental EE can be reduced.

Premenstrual Disorders (PMS and PMDD) Incidence, and its Predictors in Iranian Medical University Students; An Exploratory Cross Sectional Study

Introduction: Premenstrual disorders are a wide range of physical, behavioral, and psychological symptoms which emergence before menstruation and in the first initial days of menstruation which repeat in several cycle. This study aimed to evaluate the Premenstrual syndrome (PMS) and Premenstrual dysphoric disorder (PMDD) incidence and its related factors among Iranian medical students. Materials and Methods: In a is cross sectional study 264 students of Qom university of Medical Sciences were selected by stratified proportional to size and simple random sampling method. Demographic form, Premenstrual Symptoms Screening Tool (PSST) and Daily Record of Severity of Problems (DRSP) questionnaires were used for data collection and evaluation of subjects for PMS and PMMD according to the DSM-IV criteria. Data analysis conducted using SPSS version 20 (SPSS Inc., Chicago, IL, USA) by Chi square, independent t-test and multivariable logistic regression. P value lower 0.05 was considered as significant. Results: The mean age of subjects was 21.05±2.20 years and 102 students (38.6%) were diagnosed as PMS that 8% (21 subjects) were labeled as PMMD. Decreased interest in daily activities (60.6%), depressed mood (60.2%), fatigue/lack of energy (52.3%), physical symptoms and difficulty concentrating (51.1%) were the most common PMS symptoms. Bivariate analysis showed that BMI, marital status, chronic disease history, and continuous use of medication have significant relationship with PMS morbidity. Marriage 2.1 (OR=2.1, 95% CI: 1.12-4.42) and stress in the last 3 months (OR=2.38, 95% CI: 1.23-4.63) were two most important predictors of PMS in medical students based on multivariate logistic regression. Conclusion: Decreasing the students stress, especially in students with chronic disease history that have continuous medication consumption could be effective factors for control the PMS symptoms. Moreover, educational stress beside higher familial stress in married students due to socioeconomic and cultural factors, are the related predictive determinants of PMS. Change in life style by rest taking and enough sleeping, and counseling could be help the affected subjects.

Association of plasma high-density lipoprotein cholesterol level with risk of incident dementia: a cohort study of healthy older adults

Recent studies have reported associations between high plasma high-density lipoprotein cholesterol (HDL-C) levels and risk of all-cause mortality, age-related macular degeneration, sepsis and fractures, but associations with dementia risk remain unclear. To determine whether high plasma HDL-C levels are associated with increased incident dementia risk in initially-healthy older people. We conducted a post-hoc analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial; a double-blind, randomized, placebo-controlled trial of daily low-dose aspirin in healthy older people. ASPREE recruited 16,703 participants aged ≥70 years (from Australia) and 2411 participants aged ≥65 years (from the US) between 2010 and 2014. Participants had no diagnosed cardiovascular disease, dementia, physical disability, or life-threatening illness at enrolment and were cognitively healthy (3MS score ≥78). All-cause dementia was a primary trial endpoint, and determined by DSM-IV criteria. Cox regression was used to examine hazard ratios between HDL-C categories <40mg/dL, 40-60mg/dL (reference category), 60-80mg/dL, and >80mg/dL and dementia. Restricted cubic spline curves were used to determine nonlinear associations. Data analysis was performed from October 2022 to January 2023. Of the 18,668 participants, 850 (4.6%) cases of incident dementia were recorded over 6.3 (SD 1.8) years. Participants with high HDL-C (>80mg/dL) had a 27% higher risk of dementia (HR 1.27, 95% CI 1.03, 1.58). Age stratified analyses demonstrated that the risk of incident dementia was higher in participants ≥75 years compared to participants <75 years (HR 1.42, 95% CI 1.10, 1.83 vs HR 1.02, 95% CI 0.68, 1.51). Associations remained significant after adjusting for covariates including age, sex, country of enrolment, daily exercise, education, alcohol consumption, weight change over time, non-HDL-C, HDL-C-PRS, and APOE genotype. In a population of initially-healthy older adults aged ≥75 years, high HDL-C levels were associated with increased risk of all-cause dementia. National Institutes of Health, USA; National Health and Medical Research Council Australia; Monash University (Melbourne, VIC, Australia); and the Victorian Cancer Agency (Australia).

The Joint Effect of Body Mass Index and Serum Lipid Levels on Incident Dementia among Community-Dwelling Older Adults.

This study aimed to explore the joint effect of body mass index (BMI) and serum lipids levels on incident dementia. We prospectively followed up with 1,627 dementia-free community residents aged ≥60 for 5.7 years on average. At baseline, weight, and height were measured, and total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were detected in serum. Demographic characteristics were collected through questionnaires. Dementia was based on consensus diagnosis of neurologists and neuropsychologists using DSM-IV criteria. Additive Cox proportional model was used to assess the exposure-response relationship between BMI and serum lipid levels and dementia risk. Interactions and further classifications of BMI and serum lipid levels were further presented by bivariate surface models and decision-tree models. The joint effects of TC with BMI, TG with BMI, and LDL-C with BMI on the risk of incident dementia shared a similar pattern, different from their independent exposure-response curves. The joint effect of HDL-C with BMI showed an S-surface but without statistical significance. Participants with TC<5.4 mmol/L and BMI<21 kg/m2 (Hazard Ratio(HR) 1.93, 95% Confidence Interval (CI) 1.05-3.53), TC<5.4 mmol/L and BMI≥21 kg/m2 (HR 1.73, 95% CI 1.09-2.72), and TC≥5.4 mmol/L and BMI<21 kg/m2 (HR 4.02, 95% CI 2.10-7.71) were identified to have the increased risk of incident dementia compared to those with TC≥5.4 mmol/L and BMI≥21 kg/m2. Participants with TG<1.7 mmol/L and BMI<21 kg/m2 had an increased risk of incident dementia compared to those with TG≥1.7 mmol/L and BMI≥21 kg/m2 (HR 1.98, 95%CI 1.17-3.3). Participants with LDL-C≥3.3 mmol/L and BMI<21 kg/m2 were identified to have an increased risk of incident dementia compared to those with LDL-C≥3.3 mmol/L and BMI≥21 kg/m2 (HR 3.33, 95%CI 1.64-6.78). Our study showed that low BMI combined with low or high levels of serum lipids may increase the risk of dementia among older adults. This finding suggests the potential impacts of these two metabolic indexes on the risk of dementia.

Can a History of Childhood Trauma Impact the Effectiveness of Treatment in Individuals with Alcohol Use Disorders? A 2.5- and 5-Year Follow-up

AbstractExperienced childhood trauma (CT) is prevalent in individuals with alcohol use disorders (AUDs). Few studies examine how experienced CT affects alcohol-treatment outcome. This study accordingly investigates whether experienced CT independently affects treatment outcome 2.5- and 5-years post-treatment, controlling for other significant variables, such as self-efficacy, self-directedness, and mental health. Participants (n = 349) with AUDs (without severe psychiatric comorbidity or drug dependence) were recruited from three alcohol-treatment settings and followed up 2.5- and 5 years after treatment initiation. The group with experienced CT had more mental health problems, less self-efficacy, and less self-directedness. Multiple and logistic regressions were conducted using the outcome variables total number of DSM-IV criteria and abstinence. The results indicated that CT did not independently affect treatment outcome. Individuals with AUDs and experienced CT benefitted the same from alcohol treatment as those without such experience; however, studies should also examine groups with AUD and psychiatric comorbidity.

SAT655 Modifying Effects Of Dash Diet On Food Addiction Two Years After Sleeve Gastrostomy: A Randomized Controlled Clinical Trial

Abstract Disclosure: S. Ariyanfar: None. M. Tabesh: None. M. Noormohammadi: None. S. Razeghi Jahromi: None. E. Rashidbeigi: None. In morbid obese individuals, bariatric surgery is considered an effective intervention due to failure of non-surgical weight management strategies. Sleeve gastrostomy (LSG) accounts for over half of bariatric surgeries. The prevalence of weight regains is 76% over 2-6 years after LSG due to binge eating disorder and food addiction. In our previous study, one-fifth of patients with LSG fulfilled the criteria for food addiction (FA). Various dietary patterns have been studied for their potential benefits in controlling FA in non-surgical weight loss programs. Among them, DASH diet attracted our attention, because, besides its effect on FA, the nature of this diet fully addresses other prevalent complications of patients with morbid obesity who undergoes LSG more than two years ago, i.e., vascular problems and gut microbiota changes. To study the effect of the DASH diet on food addiction after LSG we recruited 100 individuals with LSG two years prior to the study who had mild to moderate FA according to DSM-IV criteria and Yale Food Addiction Scale (YFAS) and weight regain of more than 25% of excess weight loss. Participants were randomly assigned to a calorie-restricted DASH diet (1000-1200 calories, containing 2-3 servings of whole grain, 3-4 servings of vegetables, 3 servings of fruit, 2 servings of skim or low-fat dairy products, 1-2 servings of meat, poultry, and fish, 3 servings of nuts, seeds, and legumes, 2 servings of oil) or a calorie-restricted diet (1000-1200 calories, 3-4 servings of whole grain, 3-4 servings of vegetables, 2 servings of fruit, 2 servings of skim or low-fat dairy products, 2-3 servings of meat, poultry, and fish, 1 serving of nuts, seeds, and legumes, 2 servings of oil, and 1 serving of sugar.) for 16 weeks. Food addiction, serum levels of FBS and insulin were assessed. No significant differences in calorie and macronutrient intake, BMI, amount of excess weight before surgery, physical activity level, depression, anxiety level, and YFAS mean were observed between to studied groups After 16 weeks, individuals in DASH diet group reported a significant reduction in YFAS (from3.64±0.63 to 2.66±0.63, P.Value &amp;lt; 0.001), also Insulin levels and FBS decreased from 12.22±3.13 to 10.12±2.3 mcU/ml (P.Value&amp;lt; 0.001) and from 91.92±8.9 to 86.98±6.8 mg/dl (P.Value&amp;lt; 0.001), respectively. A significant reduction of insulin (13.21±2.97 to11.15±2.18 mcU/ml, P.Vaue&amp;lt; 0.001) and FBS level (92.31±7.5 to 87.63±5.9 mg/dl) was observed among controls. A significantly higher reduction of insulin levels in DASH group was noticed at the endpoint (P.Value: 0.026). It could be concluded that adherence to DASH diet, 2 years after SLG, can combat food addiction by modifying serum insulin levels. Presentation: Saturday, June 17, 2023

Tobacco and Illicit Drug Use and Drug Use Disorders Among Employees of Businesses Affected by the 9/11 Attacks on the World Trade Center in New York City

Objective To study the New York City area population after the September 11, 2001, 9/11 attacks, focusing on tobacco and drug use and drug use disorders. An abundance of research has identified the important mental health sequelae stemming from exposure to disasters, especially vulnerability to the development of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). There also is a body of literature on the association of disaster exposure with alcohol use/misuse, but far less research on tobacco and other drug use/disorders. Methods A terrorism-affected sample (N = 379) was assessed nearly 3 years after the attacks using structured diagnostic interviews, providing predisaster and postdisaster prevalence and incidence of tobacco and drug use, changes in tobacco and drug use, and predisaster and postdisaster prevalence and incidence of drug use disorders in relation to the 9/11 attacks. DSM-IV criteria were fully assessed using structured diagnostic interviews for psychiatric disorders including PTSD, MDD, panic disorder, generalized anxiety disorder, and alcohol and drug use disorders. Results Tobacco use did not increase significantly, and no predictors of increased tobacco use could be found for any subgroups, including disaster trauma exposures. Drug use (largely cannabis) increased initially but decreased by 3 years after the attacks. Drug use disorders, which were associated with other psychiatric disorders, were rare and primarily began prior to 9/11. Conclusions The overall lack of increase of tobacco use or predictors of increased use found after the disaster and the low rates of new drug use disorders suggest that universal screening for increased tobacco use and new drug use disorders by clinicians may have very low yield. Regardless, postdisaster settings provide suitable circumstances for general discussions about self-care including concern for increased tobacco use, avoiding drug use, and guidance on healthier means of managing stress than through substances. Additionally, because existing tobacco and drug use are endemic in populations, the postdisaster setting can serve as a reminder for clinicians to assess these problems generally and provide appropriate referrals when needed. Postdisaster circumstances offer opportunities to disseminate and promote public health messages and address issues of substance use and misuse.

Body Dysmorphic Disorder and Self-esteem in Adolescents and Young Adults with Acne Vulgaris.

Body dysmorphic disorder is a mental health disorder characterized by a preoccupation with a perceived flaw, which is commonly seen among dermatology patients. The objective of this study was to determine the frequency of body dysmorphic disorder and assess self-esteem among a clinical sample of adolescents and young adults being managed for acne vulgaris. A total of 105 patients, age range 13-24 years, receiving acne treatment at 1 of 2 dermatology outpatient clinic were included. A self-report questionnaire was used, which included a body dysmorphic disorder screening tool (based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria) and the Rosenberg Self-Esteem Scale (RSES). Acne was graded with the Cook's acne grading scale. Out of 105 adolescents and young adults visiting a dermatologist due to acne, 13 (12.4%) screened positive for body dysmorphic disorder (95% confidence interval (95% CI) 6.8-20.2%). Patients with body dysmorphic disorder were more likely to have female gender (p = 0.020) and had lower self-esteem (RSES 15.8 vs 20.5, respectively, p = 0.013) compared with patients without body dysmorphic disorder. No differences were found in the frequency of body dysmorphic disorder with DSM-IV or DSM-5 criteria. This is the first study to report on the frequency of body dysmorphic disorder and self-esteem in adolescents and young adults with acne. Ultimately, more awareness of body dysmorphic disorder among adolescents and young adults presenting with dermatological disorders could lead to more rapid recognition and referral to psychiatric units.

Depression in Children with Epilepsy in a Teaching Hospital South/South Nigeria

Background: Epilepsy affects over 50 million in the world with a life time prevalence of 7.6%. It is the commonest paediatric neurological disorder and about 80% of these children live in the developing countries. Depression is the most common psychiatric comorbid condition in children with epilepsy.&#x0D; Objective: To investigate the prevalence of depression among children aged 9-18yr with epilepsy and evaluate factors associated with depression.&#x0D; Methods: 380 children with epilepsy were interviewed using researcher designed questionnaire, the clinical version of DICA-IV in a 2nd stage design, after having been screened with CES-DC. The study was descriptive with psychometric evaluation. Data obtained were analysed using SPSS version 22.0. p-values&lt;0.05 were statistically significant.&#x0D; Results: Using the CES-DC with a cut- off point of 15 and above, 117 (30.8%) of the respondents had significant scores for depression. All the 117 who were interviewed with DICA-IV met the DSM-IV criteria for major depression with 40 (10.5%) of them currently very depressed requiring urgent attention. Sociodemographic factors of; sex revealed that males were more depressed than females p=0.000, OR: 0.86, Age showed 9-11yr with a strong association p=0.001, OR:1.91. Marital status- Divorced or separated parents showed a higher association p=0.01 OR:2.233. Children with longer duration of illness had a strong association p=0,025, OR:1.203 and the more frequent the seizures, the stronger the association p=0.001, OR:1,411.&#x0D; Conclusion: There is relativelhjy high prevalence of depression in children with epilepsy in Port Harcourt. More health education is needed to provide a comprehensive care.

Validation of Two Diagnostic Assessments for Opioid and Stimulant Use Disorder for Use by Non-Clinicians.

The United States is in the fourth wave of the opioid epidemic marked by the increase in fentanyl and co-occurring stimulant use related overdose deaths. Measures are needed to quickly diagnose opioid and stimulant use disorders, yet current traditional diagnostic assessments pose barriers to providing rapid diagnoses. This study aimed to (1) validate an updated version of the Rapid Opioid Dependence Screen (RODS) from DSM-IV criteria for opioid dependence to the now DSM-5 moderate-to-severe opioid use disorder, the Rapid Opioid Use Disorder Assessment (ROUDA); and (2) create and validate the Rapid Stimulant Use Disorder Assessment to DSM-5 stimulant use disorder (RSUDA) when compared to the substance use disorder module from the DSM-5 version of the Mini International Neuropsychiatric Interview. One-hundred and fifty adults completed study assessments, 122 reported opioid misuse and 140 reported stimulant misuse within their lifetime. The ROUDA had a sensitivity of 82.5% (95% confidence interval [CI]75.7, 89.2), specificity of 100.0% (95% CI: 100, 100), and strong internal consistency α=0.94. The RSUDA had similarly high sensitivity (83.8%, 95% CI: 77.7, 89.9), specificity (91.4%, 95% CI: 86.8, 96.1), and internal consistency α=0.87. The ROUDA and RSUDA are efficient and valid measures that can be administered in various settings by non-clinical staff to rapidly diagnose opioid and stimulant use disorders and allow for immediate treatment and harm reduction interventions. The ROUDA and RSUDA are efficient and valid measures that can be administered by non-clinicians to rapidly diagnose opioid and stimulant use disorders.

Ventricular Electrocardiographic Signatures Associated with Dementia and Plasma Alzheimer's Disease Biomarkers in Older Adults: A Population-Based Study.

Evidence has emerged that altered ventricular electrocardiogram profiles are associated with dementia, but the neuropathological mechanisms underlying their associations are poorly understood. To investigate the interrelationships of ventricular electrocardiogram profiles with dementia and plasma Alzheimer's disease (AD) biomarkers among older adults. This population-based cross-sectional study included 5,153 participants (age ≥65 years; 57.3% women) living in rural communities in China; of these, 1,281 had data on plasma amyloid-β (Aβ)40, Aβ42, total-tau, and neurofilament light chain (NfL) protein. The QT, QTc, JT, JTc, QRS intervals, and QRS axis were derived from the 10-second electrocardiogram recording. The DSM-IV criteria were followed for clinical diagnosis of dementia, the NIA-AA criteria for AD, and the NINDS-AIREN criteria for vascular dementia (VaD). Data were analyzed using general linear models, multinomial logistic models, and restricted cubic splines. Of the 5,153 participants, 299 (5.8%) were diagnosed with dementia, including 194 with AD and 94 with VaD. Prolonged QT, QTc, JT, and JTc intervals were significantly associated with all-cause dementia, AD, and VaD (p < 0.05). Left QRS axis deviation was significantly associated with all-cause dementia and VaD (p < 0.01). In the subsample of plasma biomarkers (n = 1,281), prolonged QT, JT, and JTc intervals were significantly associated with a lower Aβ42/Aβ40 ratio and higher plasma NfL concentrations (p < 0.05). Alterations in ventricular repolarization and depolarization are independently associated with all-cause dementia, AD, VaD, and AD plasma biomarkers in older adults (age ≥65 years). Ventricular electrocardiogram parameters may be valuable clinical markers for dementia and the underlying AD pathologies and neurodegeneration.

Sex differences in the symptom network structure of depression: Findings from a nationwide sample of the Spanish adult population

BackgroundSex differences in the prevalence and clinical features of depression have been widely described. However, some authors argue that categorical diagnostic systems do not adequately capture the complexity of depression. The aim of this study was to examine sex differences in the symptom network structure of depressive symptoms among individuals with a major depressive episode. MethodsThe study sample consisted of 510 participants (age 62.17 ± 14.43, 71.96 % women) from a nationwide study of the Spanish non-institutionalised adult population (Edad con Salud). To estimate the presence of a 12-month major depressive episode according to DSM-IV criteria, participants were administered an adapted version of the Composite International Diagnostic Interview (CIDI 3.0). A network analysis was carried out to determine possible interrelationships between different depressive symptoms by sex. ResultsMen and women showed a similar overall structure and network strength. However, sex-specific variations emerged in relation to individual symptom associations and symptom centrality. Specifically, for individual symptom associations “loss of confidence” and “suicide attempts” were more strongly related in women, and “suicidal ideation” and “impaired thinking” in men. For symptom centrality, “anxiety” played a central role in men's symptomatology, whereas “hopelessness”, “loss of confidence”, “distress” and “slowness of movement” were the most central symptoms in the women's group. LimitationsReliance on cross-sectional data precludes us from determining the direction and temporality of the association between different symptoms. ConclusionsThis study suggests that specific symptoms should be prioritised in the prevention, diagnosis assessment and treatment of depressed patients based on sex.

The impact of body mass index on the clinical features of bipolar disorder: A STEP-BD study.

The effects of body mass index (BMI) on the core symptoms of bipolar disorder (BD) and its implications for disease trajectory are largely unexplored. To examine whether BMI impacted hospitalization rate, medical and psychiatric comorbidities, and core symptom domains such as depression and suicidality in BD. Participants (15 years and older) were 2790 BD outpatients enrolled in the longitudinal STEP-BD study; all met DSM-IV criteria for BD-I, BD-II, cyclothymia, BD NOS, or schizoaffective disorder, bipolar subtype. BMI, demographic information, psychiatric and medical comorbidities, and other clinical variables such as bipolarity index, history of electroconvulsive therapy (ECT), and history of suicide attempts were collected at baseline. Longitudinal changes in Montgomery-Åsberg Depression Rating Scale (MADRS) score, Young Mania Rating Scale (YMRS) score, and hospitalizations during the study were also assessed. Depending on the variable of interest, odds-ratios, regression analyses, factor analyses, and graph analyses were applied. A robust increase in psychiatric and medical comorbidities was observed, particularly for baseline BMIs >35. A significant relationship was noted between higher BMI and history of suicide attempts, and individuals with BMIs >40 had the highest prevalence of suicide attempts. Obese and overweight individuals had a higher bipolarity index (a questionnaire measuring disease severity) and were more likely to have received ECT. Higher BMIs correlated with worsening trajectory of core depression symptoms and with worsening lassitude and inability to feel. In BD participants, elevated BMI was associated with worsening clinical features, including higher rates of suicidality, comorbidities, and core depression symptoms.

Relationship of psychological stress with oral health status in commercial sex workers in Makassar City

&#x0D; Background : Depression can have a negative influence on dental health and increase the chance of engaging in high-risk sexual behavior. This study aims to determine the relationship between psychological stress with oral health status in commercial sex workers in Makassar&#x0D; &#x0D; &#x0D; Methods : This study is an analytic observational study using a cross-sectional design, was conducted in January 2022. The population in this study was 36 commercial sex workers in Makassar City, using total sampling technique. Exclusion criteria consisted of commercial sex workers who experienced cognitive impairment and commercial sex workers who did not complete the questionnaire. Psychological distress status was assessed using the General Health Questions (GHQ), and Depression syndrome using DSM-IV criteria. Oral health status was assessed using OHI-S and DMF-T. &#x0D; &#x0D; &#x0D; Results : Based on the OHI-S score, the sample had an average value of 5.45 ± 6.70, the DMF-T index, the sample had an average value of 7.76 ± 5.18, the mental health score for psychological pressure had an average of 20.72 ± 8.46 and depressive symptoms had an average of 10.52 ± 6.86.&#x0D; &#x0D; &#x0D; Discussion : This study found a significant relationship between psychological stress with oral health status in commercial sex workers in Makassar. Sex workers often feel they do not need oral health services and most of the pressure is always on sexually transmitted infections (STIs)&#x0D; &#x0D; &#x0D; Conclussion : There is a significant relationship between psychological distress and depressive symptoms, with oral health status in commercial sex workers in Makassar City.&#x0D;

Differential characteristics of bipolar I and II disorders: a retrospective, cross-sectional evaluation of clinical features, illness course, and response to treatment

BackgroundThe distinction between bipolar I and bipolar II disorder and its treatment implications have been a matter of ongoing debate. The aim of this study was to examine differences between patients with bipolar I and II disorders with particular emphasis on the early phases of the disorders.Methods808 subjects diagnosed with bipolar I (N = 587) or bipolar II disorder (N = 221) according to DSM-IV criteria were recruited between April 1994 and March 2022 from tertiary-level mood disorder clinics. Sociodemographic and clinical variables concerning psychiatric and medical comorbidities, family history, illness course, suicidal behavior, and response to treatment were compared between the bipolar disorder types.ResultsBipolar II disorder patients were more frequently women, older, married or widowed. Bipolar II disorder was associated with later “bipolar” presentation, higher age at first (hypo)mania and treatment, less frequent referral after a single episode, and more episodes before lithium treatment. A higher proportion of first-degree relatives of bipolar II patients were affected by major depression and anxiety disorders. The course of bipolar II disorder was typically characterized by depressive onset, early depressive episodes, multiple depressive recurrences, and depressive predominant polarity; less often by (hypo)mania or (hypo)mania-depression cycles at onset or during the early course. The lifetime clinical course was more frequently rated as chronic fluctuating than episodic. More patients with bipolar II disorder had a history of rapid cycling and/or high number of episodes. Mood stabilizers and antipsychotics were prescribed less frequently during the early course of bipolar II disorder, while antidepressants were more common. We found no differences in global functioning, lifetime suicide attempts, family history of suicide, age at onset of mood disorders and depressive episodes, and lithium response.ConclusionsDifferences between bipolar I and II disorders are not limited to the severity of (hypo)manic syndromes but include patterns of clinical course and family history. Caution in the use of potentially mood-destabilizing agents is warranted during the early course of bipolar II disorder.

Factors associated with not ready to stop using substances among adults with an unmet treatment need: findings from the National Survey of Drug Use and Health 2015-2019

ABSTRACT Background: A better understanding of factors associated with not ready to stop using substances may inform provider engagement with clients who have an unmet treatment need. Objectives: This study explores how treatment barriers, the number of SUD symptoms, and types of substances used are associated with not ready to stop using substances among adults with an unmet treatment need. Methods: The data came from the 2015–2019 National Survey on Drug Use and Health. Eligible adults met DSM-IV criteria for substance abuse and dependence and reported an unmet need for treatment. Among our sample (N = 1,017), a majority self-identified as male (weighted 59.3%). We employed multivariable logistic regression to examine individual-level factors associated with not being ready to stop using substances. Results: About 38% of the respondents reported that they were not ready to stop using substances. Reporting access barriers (aOR = 0.44, 95% CI: 0.29, 0.68) and attitudinal barriers (aOR = 0.47, 95% CI: 0.28, 0.80) was associated with a lower odds of not ready to stop using. Each additional increase in SUD symptoms was associated with 23% higher odds of not being ready to stop using (aOR = 1.22, 95% CI: 1.12, 1.34). Having a diagnosis of alcohol and/or marijuana abuse or dependence was associated with higher odds of not being ready to stop using when compared to respondents without these diagnoses (aOR = 2.13, 95% CI: 1.33, 3.40; aOR = 1.82 95% CI: 1.11, 2.99). Conclusion: Not ready to stop using substances may be impacted by the type of SUD, number of SUD symptoms, and certain barriers like access and attitude to care.

Adverse events in older adults and the risk of dementia and cognitive decline.

Increasing evidence suggests that stress could be a risk factor for dementia but this might vary by gender. This study investigated whether adverse life events were associated with cognitive decline and dementia in later-life, separately in men and women. Participants were 12,789 community-dwelling Australians aged ≥ 70 years. Ten common adverse events in later-life were self-reported. Cognitive decline was defined as a 1.5 SD decline from participants' baseline score in tests of global cognition, psychomotor speed, episodic memory, and executive functioning, which were assessed regularly over a maximum of 10.3 years. Dementia was diagnosed according to DSM-IV criteria. An increased risk of dementia was observed in participants who experienced the death of a spouse/partner (HR: 1.72, 95% CI: 1.17 - 2.52) and for individuals who experienced major financial problems (HR: 1.53, 95% CI: 1.05 - 2.23). The latter also increased the risk of cognitive decline in men specifically (HR: 1.43, 95% CI: 1.10 - 1.86). In contrast, some events for women were associated with a reduced risk of dementia (e.g. close family or friends lost their job/retired (HR: 0.62, 95% CI: 0.40-0.95)). Events including major money problems may result from prodromal dementia symptoms, thus reverse causation needs to be considered. Adverse life events may influence dementia risk in older adults, but associations vary depending on the nature of the event, and across genders. These findings support the need for early interventions in older people who have experienced adversities, particularly for the death of a loved one.

A smartphone-based support system coupled with a bluetooth breathalyzer in the treatment of alcohol dependence: A 12-week randomized controlled trial

BackgroundOur prior open trial showed the feasibility of a smartphone-based support system coupled with a Bluetooth breathalyzer (SoberDiary) in assisting recovery for patients with alcohol dependence (AD). In this 24-week follow-up study, we further explored the efficacy of supplementing SoberDiary to treatment as usual (TAU) over 12 weeks of intervention and whether the efficacy persisted in the post-intervention 12 weeks. Methods51 patients who met the DSM-IV criteria of AD were randomly assigned to the technological intervention group (TI group, receiving technology intervention of SoberDiary plus TAU, n = 25) or those receiving only TAU (TAU group, n = 26). After 12 weeks of intervention (Phase I), all participants were followed for another post-intervention 12 weeks (Phase II). We collected the drinking variables and psychological assessment data every 4 weeks (i.e., weeks 4, 8, 12, 16, 20, and 24). In addition, the cumulative abstinence days and retention rates were recorded. We used mixed-model analysis to compare the difference in outcomes between groups. ResultsIn Phase I or Phase II, we did not find differences in drinking variables, alcohol craving, depression, or anxiety severity between the two groups. However, the TI group showed greater self-efficacy for drinking refusal in Phase II than the TAU group. ConclusionsAlthough our system (SoberDiary) did not demonstrate benefits in drinking or emotional outcomes, we found the system holds promise to enhance self-efficacy on drinking refusal. Whether the benefit in promoting self-efficacy persists longer than 24 weeks requires further investigation.