DSM-5 Symptom Research Articles

Characteristics and Prevalence of Posttraumatic Stress Disorder and Posttraumatic Stress Symptoms Among Adults with Hemophilia a and B

Background: Studies show that the prevalence of illness-induced Posttraumatic Stress Disorder (PTSD) ranges from 12-25%, but little is known about the prevalence of PTSD or Posttraumatic Stress Symptoms (PTSS) among adults with hemophilia. We hypothesized that persons with hemophilia (PWH) would be particularly at risk for PTSD and PTSS given their bleeding diathesis, bleeding disorder treatment and prophylaxis requirements, and history of viral contamination of their treatments. After experiencing a traumatic event, symptoms of PTSD include intrusive memories, avoidance of reminders of the traumatic event, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity. Aims:Determine the prevalence of PTSD and PTSS among PWH.Characterize the traumatic experiences of PWHs. Methods: Using REDCap, a self-administered survey tool was offered to all adult PWH aged 20+ at the time of their annual comprehensive visit to their Hemophilia Treatment Center (HTC). Three large academic HTCs (Boston Hemophilia Center, MA; Mount Sinai Hemophilia Center, NY; M Health Fairview Center for Bleeding and Clotting Disorders, MN) participated in the study. The tool for this study had two components: (i) Participant Characteristics was used to collect demographic information and specifics about participants’ hemophilia and comorbidities. Participants were also given the opportunity to provide a description of any hemophilia-related traumatic experience. The second component of the tool was the (ii) PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 (PCL-5): The PCL-5 is a validated, 20-item, self-report questionnaire that assesses the four DSM-5 symptom clusters of PTSD and their severity. In this study, it was used to screen for PTSS and/or provide a provisional diagnosis of PTSD based on their identified hemophilia-related trauma. Results: 178 participants were included in the analysis. Total scores on the PCL-5 ranged from 0-66 with a median of 8. 11.8% of participants (n=21) met criteria for a provisional PTSD diagnosis based on either PCL-5 score ≥ 31 or if the participant endorsed each PTSD symptom cluster. This included 6 participants (31.6%) with a self-reported established PTSD diagnosis. 101 participants (56.7%) identified a traumatic event related to living with hemophilia. The following themes of trauma emerged from their subjective trauma descriptions: non-infectious medical events, psychosocial, pain, hepatitis, and HIV/AIDS. 63 participants (35.4%) endorsed at least one Posttraumatic Stress Symptom (PTSS) by reporting a traumatic event and meeting clinical diagnostic criteria for at least one PTSD symptom cluster. Intrusion symptoms were experienced most frequently by participants (32%). A higher burden of PTSD symptomatology was significantly associated with lower education levels (p = 0.003), being unemployed (p = 0.003), having a history of previous hospitalization (p<0.001) and having two or more previously identified mental health disorders (p<0.001). Age (p = 0.18), sex (p = 0.14), comorbidities (p=0.16) and severity of hemophilia (p = 0.67) were not significantly associated with PTSD symptomatology or PTSS. Conclusion: PTSD and PTSS are commonly experienced by PWH regardless of disease severity and appear to exist at a higher rate than among the general population. These findings warrant the need for routine trauma screening, trauma informed care, and further investigation into trauma prevention. This research was supported by the 2021 National Hemophilia Foundation's Social Work Excellence Fellowship Award.

Toward an Integrative Perspective on the Person

Abstract. The Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) have been criticized frequently in recent years, with most critiques focusing on perceived limitations of diagnostic categories. These criticisms notwithstanding, the most promising approach to refining the diagnostic systems is not to replace the categorical model, but to expand the range of assessment methods that are used by clinicians to render diagnoses. This article presents an evidence-based framework for integrating interview and Rorschach data to enhance diagnostic precision, improve treatment planning, and provide a novel paradigm for studying the dynamics of psychopathology in clinical and community settings. Following a discussion of problems associated with monomethod assessment based on patient self-reports, the advantages of multimethod assessment in psychiatric diagnosis are described. A three-step approach to evidence-based multimethod diagnosis is outlined, emphasizing patients’ underlying dynamics, self-attributions, and expressed behaviors. The possibility of updating DSM and ICD symptom criteria to capture these three levels of patient functioning is discussed, strategies for exploring convergences and divergences between interview and Rorschach data are presented, and avenues for expanding the scope of Rorschach practice and research in the 21st century are described.

Effects of DSM-5 Betel-Quid-Related Symptoms, Pathological Behaviors, and Use Disorder on Oral Squamous Cell Carcinoma Risk.

Simple SummaryThis is the first study using psychometrics to investigate the association of the DSM-5 betel-quid (BQ)-related symptoms, pathological behaviors, and BQ use disorder (BUD) severity with the risk of oral squamous cell carcinoma (OSCC). This study presents data demonstrating that the symptoms of unsuccessful cutdown of BQ consumption, neglecting major roles, social or interpersonal problems, abandoning or limiting activities, hazardous use, and continued use despite awareness of the dangers were associated with the risk of OSCC. Pathological behavior of risky BQ use enhanced OSCC risk in chewers with moderate-to-severe BUD. BQ chewing is a major risk factor for oral cavity cancers; however, the risk can be mitigated by reducing pathological use. Our study indicates that targeting BUD and establishing a BUD-based strategy is a promising new direction for the prevention of OSCC.The neuroactive alkaloids in betel quid (BQ) can induce BQ addiction. We conducted a case–control study to investigate the effects of BQ-associated DSM-5 symptoms, pathological behaviors, and BQ use disorder (BUD) on oral squamous cell carcinoma (OSCC) risk. A total of 233 patients with newly diagnosed and histopathologically confirmed OSCC and 301 sex- and age-matched controls were included. BQ-related DSM-5 symptoms in the 12 months prior to disease onset were used to measure psychiatric characteristics and BUD. Compared with nonchewers, chewers with the symptoms of unsuccessful cutdown of BQ consumption, neglecting major roles, social or interpersonal problems, abandoning or limiting activities, hazardous use, and continued use despite the awareness of the dangers had a 54.8-, 49.3-, 49.9-, 40.4-, 86.2-, and 42.9-fold higher risk of developing OSCC, respectively. Mild-to-moderate and severe BUD were, respectively, associated with a 8.2–8.5- and 42.3-fold higher OSCC risk, compared with BQ nonuse. Risky BQ use of pathological behavior was associated with a 12.5-fold higher OSCC risk in chewers with no BUD or mild BUD and a 65.0-fold higher risk in chewers with moderate-to-severe BUD (p for risk heterogeneity between the two BUD groups, 0.041). In conclusion, BQ-associated DSM-5 symptoms, pathological behaviors, and BUD severity are associated with the impact of BQ chewing on OSCC development. The pathological behavior of risky BQ use enhances OSCC risk in chewers with moderate-to-severe BUD. Preventing BUD in new BQ users and treating BUD in chewers who already have the disorder are two priorities in areas where BQ chewing is prevalent.

Impulsivity may be a risk factor in the transition from recreational to problem gaming

Several factors of trait impulsivity were analysed to determine which may contribute towards potentially disordered gaming, as measured by the DSM-5 and ICD-11 criteria. Three-hundred and seventy-two adults, sourced from a convenient sample (prolific.co) and a targeted gaming forum sample (Reddit and Facebook), completed an online survey hosted at Qualtrics.com. Three-hundred and twenty-eight participants continued onto a Go/No-Go reaction time task hosted at Pavlovia.org to measure inhibitory control. Demographic information was collected alongside impulsivity measures (BIS-11, UPPS-P, and 27-MCQ) and dichotomous DSM-5 and ICD-11 gaming disorder symptoms. Impulsivity was found to relate to gaming at both an recreational and potentially disordered level, however negative and positive urgency and delay discounting appear to be associated with the highest symptom counts and may be potential factors in the transition between recreational and disordered gaming.

Associations of High-Sensitivity C-Reactive Protein and Interleukin-6 with Depression in a Sample of Italian Adolescents During COVID-19 Pandemic

IntroductionMany studies highlighted the role of inflammation in the pathogenesis of depression, although not for every patient nor for every symptom. It is widely shared that stressors can increase inflammation and lead to depressive symptoms. Little is known about the symptom-specificity of the inflammation-depression link in adolescence, which we aimed to explore. The single symptom analysis is a core feature of the recent network approach to depression, supposing that psychiatric disorders consist of co-occurring symptoms and their tendency to cause each other.Patients and MethodsWe recruited 52 adolescents diagnosed with a Depressive Disorder during the COVID-19 stressful period. We used regression analysis to measure associations between high sensitivity C-Reactive Protein (hs-CRP) and Interleukin-6 (IL-6) and depressive symptoms assessed by the Children’s Depression Inventory 2 (CDI 2). For the study of symptom specificity, we selected 13 items from the CDI 2 Self Report corresponding with the DSM-5 diagnostic criteria for Major Depressive Disorder and we coded them as dichotomous variables to perform a regression analysis.ResultsWe found that a higher CDI 2-Parent Version total score was significantly predicted by higher hs-CRP (coefficient 3.393; p 0.0128) and IL-6 (coefficient 3.128; p 0.0398). The endorsement of the symptom self-hatred, measuring the DSM-5 symptom “feelings of worthlessness”, was significantly predicted by hs-CRP (OR 10.97; 95% CI 1.29–93.08; p 0.0282).ConclusionA novel symptom-specificity emerged, with hs-CRP significantly predicting the endorsement of the symptom self-hatred, recognized as a core feature of adolescent depression, following the network theory. We considered it a possible phenotypic expression of one depression endophenotype previously causally linked to inflammation. Due to the limited sample size, these preliminary findings require confirmation with future research focusing on the relationship between inflammation and self-hatred and other central nodes of the depression network, representing an opportunity for targeting interventions on crucial symptoms.

Effectiveness of New Maternal Mental Health Service ‘Thrive’ in the Treatment of PTSD Symptoms Arising From Birth Trauma and Perinatal Loss

AimsThe NHS Long-Term Plan includes the perinatal mental health objective: by 2023/24 ‘Maternal Mental Health Services’ will be available across the country to provide psychological therapy for those who experience mental health difficulties directly arising from birth trauma and or/perinatal loss. We achieved early implementer status via application to NHS England and, using transformation funding received, ‘Thrive’ was piloted in East Kent. A gap in service provision was identified: some existing primary care services provide intervention for this cohort, however some people remain in psychological distress but do not meet the criteria for specialist perinatal mental health secondary care services; these secondary care services are not commissioned to support those who have experienced perinatal loss. Thrive is co-delivered by a mental health trust and acute healthcare trust; NICE recommended psychological interventions are provided by Psychological Therapists, Specialist Mental Health Midwives and a Peer Support Worker. The aim of this project was to evaluate the effectiveness of the Thrive pilot in reducing PTSD symptomology whilst also collating feedback from patients, their families and healthcare staff across the maternity system, in order to adapt the service offer for full county rollout.Methods40 people who received care from Thrive from 11th January 2021 to 31st December 2021 were included in this evaluation.Data were collected retrospectively at the end of each period of care via:Clinical outcomes measures (quantitative): •PCL-5: a 20-item self-report measure assessing the 20 DSM-5 symptoms of PTSD.•CORE-34: a universal method of establishing well-being and risk.•HoNOS (Health of the Nation Outcomes Scales): a measure of the health and social functioning of people with severe mental illness.Patient Satisfaction Survey (qualitative).Results•100% of patients improved following Thrive intervention: PCL-5 (significant change = a reduction in score by 10–20 points has been met) / CORE-34 (clinically significant change =score above 10 initially and below 10 after intervention).•Clinical improvement: HoNOS = 100% of patients improved following Thrive intervention.ConclusionEvaluation has evidenced the effectiveness of Thrive in successfully treating those with PTSD symptomology arising from their maternity experience. Post-treatment measures indicate that the level of trauma symptomology and the impact of psychological distress on the functioning of patients who have received intervention from Thrive has reduced to a sub-clinical level in all cases.

Network Analysis of DSM Symptoms of Substance Use Disorders and Frequently Co-Occurring Mental Disorders in Patients with Substance Use Disorder Who Seek Treatment.

Background: Substance use disorders (SUD) often co-occur with other psychiatric conditions. Research on SUD and comorbid disorders generally flows from a categorical diagnostic or dimensional latent variable perspective, where symptoms are viewed as independent indicators of an underlying disorder. In contrast, the current study took a network analysis perspective to examine the relationships between DSM symptoms of SUD, ADHD, conduct disorder (CD), depression (MDD), and borderline personality disorder (BPD). In addition, we explored possible gender differences in the network structures of these symptoms. Method: In a sample of 722 adult treatment-seeking patients with SUD from the International ADHD in Substance Use Disorders Prevalence Study (IASP) we estimated the network structure for 41 symptoms of SUD, ADHD, CD, MDD, and BPD. We described the structure of symptom networks and their characteristics for the total sample, and we compared the symptom networks for males and females. Results: Network analyses identified seven clusters of symptoms, largely corresponding with the DSM diagnostic categories. There were some connections between clusters, mainly between some hyperactivity symptoms and CD and depressive symptoms. ADHD hyperactivity was most central in the symptom network. Invariance tests revealed no significant gender differences in the structure of symptom networks. Conclusions: The current findings support the categorical DSM classification of mental disorders in treatment-seeking patients with SUD. Future network analyses should include a broader range of symptoms and prospectively explore changes in the symptoms network of patients during treatment.

Anhedonia and Substance Use Disorders by Type, Severity, and With Mental Health Disorders.

Anhedonia can accompany substance use disorders (SUDs); its severity may vary by substance type, severity of SUD symptoms, or psychiatric comorbidity. The goal of this study was to clarify the contribution of each. Data were from participants aged 18 to 65 years in the National Epidemiologic Survey on Alcohol and Related Conditions III (n = 30,999; 51% women), a cross-sectional, nationally representative sample reporting lifetime DSM-5 symptoms and lifetime anhedonia. We used logistic regression to test how anhedonia was associated with specific SUDs and psychiatric disorders in respondents with one lifetime diagnosis. We used latent class analysis to assess the association of anhedonia with patterns of comorbidity in all respondents. Opioid use disorder (OUD) had the greatest odds of anhedonia relative to other SUDs (ORs [95% CIs]): mild alcohol use disorder (AUD) ( 3.33 [1.74, 6.38]), moderate/severe AUD ( 2.73 [1.41, 5.30]), and cannabis use disorder ( 3.21 [1.43, 7.19]), though not significantly greater than stimulant use disorder ( 2.44 [.88, 6.73]). Anhedonia was more likely in mood disorders and posttraumatic stress disorder (PTSD) than in any SUD, except for PTSD versus OUD (OR [95% CIs] = .98 [.47, 2.02]). In latent class analysis analyses, the poly disorder class, which included SUDs and other diagnoses, had greater odds of anhedonia than the Poly SUD (ORs [95% CIs] = 1.62 [1.25, 2.09] and AUD 2.89 [2.40, 3.48]) classes. People with OUD or a lifetime history of mood disorder or PTSD may be most likely to present to SUD treatment with anhedonia.

Evaluating Compulsive‐Like Drug‐Taking Using Signaled and Unsignaled Footshock Procedures in Male and Female Rats Self‐Administering MDPV

A subset of rats that self‐administer synthetic cathinones, such as 3,4‐methylenedioxypyrovalerone (MDPV), develop high levels of drug intake and patterns of responding similar to the compulsive, binge‐like patterns of cathinone (e.g., “bath salts”) use reported in humans. Though high‐responder rats exhibit some behaviors thought to be related to substance use disorder, the effects of punished responding in these rats were unknown. These studies evaluated whether (1) high‐responder rats were less sensitive to footshock‐punished responding than low‐responder rats using both unsignaled and signaled footshock procedures; (2) whether sensitivity to footshock was dependent on the self‐administered dose of MDPV. Inhibition curves for unsignaled footshock (0.05‐0.9 mA, increasing across sessions) were evaluated in forty adult Sprague Dawley rats self‐administering 0.01, 0.032, and 0.1 mg/kg/infusion MDPV under a FR5 schedule of reinforcement; footshocks were paired with ~50% of drug infusions. Rats were then trained on a signaled footshock procedure, in which a change in stimulus conditions signaled that the next infusion would be paired with a footshock (intensities individualized to each rat’s IC50). Rats could avoid this footshock by withholding responding for 30‐sec. After rats learned the signaled shock procedure, inhibition curves were generated using a range of footshock intensities (0.05‐0.9 mA). High‐ and low‐responder rats were similarly sensitive to unsignaled punishment by footshock (mean IC50s‐ high‐responders: 0.30mA; low‐responders: 0.36mA). However, high‐responder rats (mean: 45mA) received significantly more total current than low‐responder rats (mean: 18mA). Compared to low‐responder rats, high‐responder rats respond more in the presence of the signal indicating impending shock and avoid a smaller proportion of shocks. This suggests high‐responder rats may be less able to adapt their behavior in response to a stimulus associated with punishment. These studies suggest that the high levels of drug‐taking observed in the high‐responder rats reflects a compulsive‐like pattern of responding, which may be related to continued use despite adverse consequence, a DSM symptom of substance use disorder.

Feasibility and Acceptability of Group-Facilitated Prolonged Exposure Therapy for PTSD in VA Residential Rehabilitation Treatment Programs

Prolonged Exposure therapy (PE) is a first-line treatment for posttraumatic stress disorder (PTSD); however, few VA patients receive this treatment. One of the barriers to PE receipt is that it is only available in an individual (one-on-one) format, whereas many VA mental health clinics provide the majority of their psychotherapy services in group format. In particular, PTSD residential rehabilitation treatment programs (RRTPs) offer most programming in group format. Consequently, strategies are needed to improve the scalability of PE by adapting it to fit the delivery setting. The current study was designed to pilot test a group-facilitated format of PE in RRTPs. Thirty-nine Veterans who were engaged in care in the PTSD RRTP at a Midwestern VA were recruited to participate in a Group-facilitated PE protocol. Participants engaged in twelve 90-minute sessions of Group PE over the course of 6 weeks, plus six 60-minute individual sessions for imaginal exposure. Group treatment followed the PE model and consisted of psychoeducation, treatment rationale, and in vivo exposure to reduce trauma-related avoidance and thereby improve PTSD symptoms. PTSD symptoms were measured via the PTSD Checklist for DSM-5 (PCL-5) and depression symptoms were measured via the Patient Health Questionnaire (PHQ-9) at baseline, endpoint (6 weeks), and at 2-month follow-up. Thirty-nine individuals initiated Group-facilitated PE and 34 completed treatment. The average number of group sessions attended was 11 out of 12. Acceptability ratings were high. Mean change (improvement) in the intent-to-treat sample at 2-month follow-up was 20.0 points on the PCL-5 (CI 18.1, 21.9; Cohen’s d = 1.1) and 4.8 points on the PHQ-9 (CI 4.1, 5.5, d = .8). These results suggest that adapted evidence-based interventions for PTSD can improve treatment access and efficiency for the RRTP setting. A group-based approach has the potential to improve the scalability of PTSD treatment by reducing required resources. A fully powered trial is now needed to test the effectiveness of Group-facilitated PE in the RRTP setting.

Worsening sleep quality across the lifespan and persistent sleep disturbances in persons with opioid use disorder.

Individuals with opioid use disorder (OUD) may experience worsening sleep quality over time, and a subset of individuals may have sleep disturbances that precede opioid use and do not resolve following abstinence. The purpose of the present study was to (1) collect retrospective reports of sleep across the lifespan and (2) identify characteristics associated with persistent sleep disturbance and changes in sleep quality in persons with OUD. Adults with OUD (n = 154) completed a cross-sectional study assessing current and past sleep disturbance, opioid use history, and chronic pain. Repeated-measures analysis of variance was used to examine changes in retrospectively reported sleep quality, and whether changes varied by screening positive for insomnia and/or chronic pain. Multivariate linear regression analyses were used to identify additional correlates of persistent sleep disturbance. Participants reported that their sleep quality declined over their lifespan. Changes in reported sleep over time varied based on whether the individual screened positive for co-occurring insomnia and/or chronic pain. In regression analyses, female sex (β = 0.16, P = .042), a greater number of treatment episodes (β = 0.20, P = .024), and positive screens for chronic pain (β = 0.19, P = .018) and insomnia (β=0.22, P = .013) were associated with self-reported persistent sleep disturbance. Only a portion of participants who screened positive for sleep disorders had received a formal diagnosis. OUD treatment providers should routinely screen for co-occurring sleep disturbance and chronic pain. Interventions that treat co-occurring OUD, sleep disturbance, and chronic pain are needed. Ellis JD, Mayo JL, Gamaldo CE, Finan PH, Huhn AS. Worsening sleep quality across the lifespan and persistent sleep disturbances in persons with opioid use disorder. J Clin Sleep Med. 2022;18(2):587-595.

Association between Neuroticism and Premenstrual Affective/Psychological Symptomatology.

Neuroticism and premenstrual conditions share pleiotropic loci and are strongly associated. It is presently not known which DSM-5 symptoms of premenstrual syndrome/premenstrual mood disorder are associated with neuroticism. We enrolled 45 study participants to provide prospective daily ratings of affective ("depression", "anxiety, "anger", "mood swings") and psychological ("low interest", "feeling overwhelmed", and "difficulty concentrating") symptoms across two-three menstrual cycles (128 total cycles). Generalized additive modeling (gam function in R) was implemented to model the relationships between neuroticism and the premenstrual increase in symptomatology. Significance level was adjusted using the False Discovery Rate method and models were adjusted for current age and age of menarche. Results of the association analysis revealed that "low interest" (p ≤ 0.05) and "difficulty concentrating" (p ≤ 0.001) were significantly associated with neuroticism. None of the remaining symptoms reached statistical significance. The late luteal phase of the menstrual cycle is characterized by complex symptomatology, reflecting a physiological milieu of numerous biological processes. By identifying co-expression between neuroticism and specific premenstrual symptomatology, the present study improves our understanding of the premenstrual conditions and provides a platform for individualized treatment developments.

Network Analysis-Based Disentanglement of the Symptom Heterogeneity in Asian Patients with Schizophrenia: Findings from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics.

The symptom heterogeneity of schizophrenia is consistent with Wittgenstein’s analogy of a language game. From the perspective of precision medicine, this study aimed to estimate the symptom presentation and identify the psychonectome in Asian patients, using data obtained from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics. We constructed a network structure of the Brief Psychiatric Rating Scale (BPRS) items in 1438 Asian patients with schizophrenia. Furthermore, all the BPRS items were considered to be an ordered categorical variable ranging in value from 1–7. Motor retardation was situated most centrally within the BPRS network structure, followed by depressive mood and unusual thought content. Contrastingly, hallucinatory behavior was situated least centrally within the network structure. Using a community detection algorithm, the BPRS items were organized into positive, negative, and general symptom clusters. Overall, DSM symptoms were not more central than non-DSM symptoms within the symptom network of Asian patients with schizophrenia. Thus, motor retardation, which results from the unmet needs associated with current antipsychotic medications for schizophrenia, may be a tailored treatment target for Asian patients with schizophrenia. Based on these findings, targeting non-dopamine systems (glutamate, γ-aminobutyric acid) may represent an effective strategy with respect to precision medicine for psychosis.

Adolescent depression beyond DSM definition: a network analysis

Calls for refining the understanding of depression beyond diagnostic criteria have been growing in recent years. We examined the prevalence and relevance of DSM and non-DSM depressive symptoms in two Brazilian school-based adolescent samples with two commonly used scales, the Patient Health Questionnaire (PHQ-A) and the Mood and Feelings Questionnaire (MFQ). We analyzed cross-sectional data from two similarly recruited samples of adolescents aged 14–16 years, as part of the Identifying Depression Early in Adolescence (IDEA) study in Brazil. We assessed dimensional depressive symptomatology using the PHQ-A in the first sample (n = 7720) and the MFQ in the second sample (n = 1070). We conducted network analyses to study symptom structure and centrality estimates of the two scales. Additionally, we compared centrality of items included (e.g., low mood, anhedonia) and not included in the DSM (e.g., low self-esteem, loneliness) in the MFQ. Sad mood and worthlessness items were the most central items in the network structure of the PHQ-A. In the MFQ sample, self-hatred and loneliness, two non-DSM features, were the most central items and DSM and non-DSM items in this scale formed a highly interconnected network of symptoms. Furthermore, analysis of the MFQ sample revealed DSM items not to be more frequent, severe or interconnected than non-DSM items, but rather part of a larger network of symptoms. A focus on symptoms might advance research on adolescent depression by enhancing our understanding of the disorder.

Longitudinal network model of the co-development of temperament, executive functioning, and psychopathology symptoms in youth with and without ADHD.

Attention Deficit Hyperactivity Disorder (ADHD) is a common, chronic, and impairing disorder, yet presentations of ADHD and clinical course are highly heterogeneous. Despite substantial research efforts, both (a) the secondary co-occurrence of ADHD and complicating additional clinical problems and (b) the developmental pathways leading toward or away from recovery through adolescence remain poorly understood. Resolving these requires accounting for transactional influences of a large number of features across development. Here, we applied a longitudinal cross-lagged panel network model to a multimodal, multilevel dataset in a well-characterized sample of 488 children (nADHD=296) to test Research Domain Criteria initiative-inspired hypotheses about transdiagnostic risk. Network features included DSM symptoms, trait-based ratings of emotional functioning (temperament), and performance-based measures of cognition. Results confirmed that ADHD symptom domains, temperamental Irritability, and Working Memory are independent transdiagnostic risk factors for psychopathology based on their direct associations with other features across time. ADHD symptoms and working memory each had direct, independent associations with depression. Results also demonstrated tightly linked co-development of ADHD symptoms and temperamental Irritability, consistent with the possibility that this type of anger dysregulation is a core feature that is co-expressed as part of the ADHD phenotype for some children.

Beyond DSM symptoms: Behavioral clues to diagnosing bipolar II disorder

Beyond DSM symptoms: Behavioral clues to diagnosing bipolar II disorder

Increased sugar-sweetened beverage use tendency in pregnancy positively associates with peripartum Edinburgh postpartum depression scores

The association among sugar sweetened beverages (SSB) consumption, addiction and depression in adults, children and adolescents is widely reported. Dieting patterns during pregnancy is complicated by maternal fetal concerns. Specifically, restrained use of SSB might be potentially a source of perinatal distress. The current study modified diagnostic criteria for Substance Use Disorder (SUD) in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), into SSB-specific questions to assess SSB use tendency. Edinburgh Postpartum Depression Scores (EPDS) is used to assess maternal distress during pregnancy. One hundred and ninety-six consecutive pregnant women receiving antenatal care at Kaohsiung Medical University Hospital were invited to participate in this study. In the first trimester, 46.6% of women had none or 1 DSM-5 symptom, 27.0% had 2–3 symptoms, while 26.4% had ≥ 4 symptoms. The mean numbers of DSM-5 symptoms in each trimester were found to be 2.5 ± 2.25, 2.6 ± 2.45, 2.4 ± 2.43 for the first, second and third trimester, respectively, p = 0.750. While EPDS score showed no difference among DSM-5 symptoms 0–1, 2–3 and ≥ 4 groups in the first trimester (8.1 ± 4.59, 8.4 ± 5.00, 8.8 ± 4.82, p = 0.343), women with ≥ 4 DSM-symptoms was found significantly higher EPDS scores than those with < 4 DSM-symptoms in the second (7.2 ± 4.81, 7.7 ± 4.98, 8.8 ± 4.33, p = 0.030) and third trimester (6.8 ± 5.00, 7.2 ± 4.63, 8.7 ± 5.24, p = 0.019). The relationship remained significant after adjusting for covariates including actual SSB amount consumed (adjusted β = 0.25 with 95% confident interval (CI) 0.04–0.45 and 0.21 with 95% CI 0.04–0.38 for the second and third trimesters, respectively). Overall, the study is the first to characterize the positive relationship between SSB use tendency and antenatal distress in pregnancy, independent of actual SSB amount consumed. The observational nature of the study design precludes inferences of its underlying socio-psychomotor mechanisms, although restrained SSB use in pregnancy is suspected to contribute. The novel employment of modified SSB-specific DSM-5 scores and EPDS in this setting is feasible and further validation is promising. With better understanding and awareness, pregnant women with increased SSB use tendency should be properly counseled with special attention to their mental state.

Adult ADHD Self-Report Scale Screener Ratings in College Students: Concurrent Validity and Test–Retest Reliability

The Adult ADHD Self-Report Scale screener is commonly used to determine if further evaluation of ADHD is required. However, despite use in college settings, the ASRS was not developed for this population, and limited relevant psychometric data exist. In this study, 190 college students completed the ASRS screener as well as a lengthier measure of the 18 DSM symptoms of ADHD. A subgroup ( n = 141) completed the ASRS twice, with at least 1 week in between measures. Concurrent validity of ASRS scores was substantial ( r = 0.73 with DSM inattentive symptoms and r = 0.57 with DSM hyperactive/impulsive symptoms) and test–retest reliability was adequate ( r = 0.69 with an average interval of 42 days). However, the sensitivity of the screener was only moderate (66%), and approximately one-fifth of the students changed screening status (positive vs. negative) across the time interval. Implications for future research and practice are discussed.

Exploratory and confirmatory factor analyses of the Arabic version of the Childhood Autism Rating Scale

The factor structure of the Arabic version of the Childhood Autism Rating Scale, Second Edition (CARS-2) was evaluated. The participants were 301 children, aged 2–12 years, who had been diagnosed with autism spectrum disorder (ASD) via the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Various diagnostic accuracy parameters for the CARS cutoff point were tested against the reference standard of the DSM-5. The Arabic version of the CARS-2 had high reliability, as measured by internal consistency (.79), inter-rater reliability (.65), and intraclass correlation coefficient (ICC) (.76). Construct validity was assessed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The results indicated that a three-factor solution was appropriate, with the first (Communications) and third (Senses and Physical) factors reflecting DSM-5 symptom domains. The CFA proved that the final model, derived from the EFA, yielded a 14-item, three-factor model that adequately fit the data. These findings support the continued relevance of the CARS-2 in ASD assessment.

Exploring Depressive Symptoms Among Healthcare Professionals and the General Population During the COVID-19 Pandemic in Brazil.

Our study aimed to examine the symptoms that might play a role in the co-occurrence of 9 DSM-5 symptom criteria of major depression among Brazil's adult population and healthcare professionals after three months of detecting the new coronavirus in Brazil. We estimated regularized Gaussian graphical models for both samples and compared the network structures. Depressed mood was the most central symptom in the general population network compared to the healthcare professional network. The findings revealed some individual symptoms showed a differential association between the general population and healthcare professionals. Those symptoms may be valuable targets for future research and treatment.