Higher Symptom Severity Research Articles

Microsocial analysis of dyadic interactions with toddlers and mothers with borderline personality disorder

Borderline personality disorder (BPD) is known for disruptions in mother-child interaction, but possible underlying patterns of micro-behavior are barely understood. This is the first study examining behavioral dyadic synchrony—the coordinated and reciprocal adaptation of behavior—and regulation on a micro-level and relating it to macro-behavior in mothers with BPD and their toddlers. Twenty-five mothers with BPD and 29 healthy mothers participated with their 18- to 36-month-old toddlers in a frustration-inducing paradigm. Mother and toddler behavior was continuously micro-coded for gaze, affect, and vocalization. Synchrony, operationalized as the simultaneous engagement in social gaze and positive affect, and (co-)regulative behaviors and their contingencies were analyzed and associated with borderline symptom severity, the overall quality of interaction, and child internalizing and externalizing behavioral problems. Dyads with mothers with BPD showed significantly less synchrony compared to dyads with healthy mothers. Low synchrony was associated with high BPD symptom severity and low overall interaction quality. Dyads with BPD used the same amount of regulative behaviors as dyads with healthy mothers. Though both groups equally responded to children’s negative emotionality, mothers with BPD were less effective in drawing the dyad back into synchrony. For dyads with BPD, regulative behaviors were negatively associated with child externalizing behaviors. BPD symptomology may reduce the effectiveness of mothers’ attempts to attune to their child’s needs. An emphasis on synchrony and regulative behaviors may be an important therapeutic target for parenting programs in mothers with BPD.

The Impact of Family Functioning on Help-Seeking Behavior and Symptom Severity in Obsessive-Compulsive Disorder.

Poor family functioning is associated with higher symptom severity in pediatric obsessive-compulsive disorder (OCD) and delayed help-seeking behavior in other forms of psychopathology. However, little is known about the impact of family functioning on help-seeking behavior and symptom severity in adults with OCD. The present study investigated the association between family functioning and both treatment delay and symptom severity in adults with obsessive-compulsive symptoms. Participants were 194 adults who self-identified as having OCD and completed an internet survey, including measures assessing family functioning, obsessive-compulsive symptom severity, help-seeking behavior, and depression symptom severity. Poorer family functioning was associated with higher obsessive-compulsive and depression symptom severity, after controlling for significant demographic variables. With respect to domains of family functioning, poorer general functioning, problem solving, communication skills, role functioning, affective involvement, and affective responsiveness were associated with higher obsessive-compulsive and depression symptom severity, after controlling for demographics. Poorer problem solving and communication were not significantly associated with treatment delay after controlling for demographics. Findings highlight the need for family intervention within the treatment framework for adult OCD and suggest targets ( e.g. , communication) to be addressed.

Associations of Nonmotor Symptom Burden, Activities of Daily Living, and Fear of Falling in Parkinson Disease.

BACKGROUND: Parkinson disease (PD), a neurodegenerative disease characterized by motor and nonmotor symptoms, can affect the daily activities of individuals. This study was conducted to determine nonmotor symptom burden in patients with PD and to reveal the relationship of nonmotor symptom burden with activities of daily living and fear of falling. METHODS: This cross-sectional and correlational study was carried out with 309 patients given a diagnosis of PD. The data were collected using a personal information form, the Non-Motor Symptoms Scale, the Katz Activities of Daily Living Scale, and the Fear of Falling Questionnaire. RESULTS: Whereas 70.2% of the patients had very high nonmotor symptom severity levels, 33.7% were semidependent or dependent in terms of performing their activities of daily living. The fear of falling was experienced by 32.7% of the patients. A statistically significant inverse relationship was found between the mean Non-Motor Symptoms Scale scores of the patients and their mean Katz Activities of Daily Living Scale and Fear of Falling Questionnaire scores (P < .05). Nonmotor symptom burden independently explained 66% of the total variance in the performance of activities of daily living and 69% of the total variance in fear of falling (P < .01). CONCLUSION: Nonmotor symptom burden in PD patients is a significant determinant for participation in activities of daily living and fear of falling. Nurses should approach patients with PD with a focus not only on assessing motor symptoms but also on assessing nonmotor symptoms.

The Relationship between High Fiber Diet and Severity of Premenstrual Syndrome Symptoms in Medical Students of Pelita Harapan University

&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;47.8% of women worldwide experience symptoms of premenstrual syndrome and 20% of women experience symptoms that are severe enough to interfere with daily activities. This occurs during the last 14 days of the menstrual cycle or luteal phase, and it is caused by hormonal fluctuations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study is going to be conducted to determine the relationship between high fiber diet and the severity of premenstrual syndrome in adolescents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;This study used a comparative analytic categorical study with two unpaired categories with a cross-sectional study design. The research sample is female students at the Faculty of Medicine, University of Pelita Harapan who met the inclusion criteria of at least 74 samples by judgmental sampling. Data were collected using a questionnaire in the form of a Premenstrual Symptom Scale, Esitimated Food Record and Perceived Stress Scale with the the chi-square method, and data analysis using SPSS 24.0.&lt;/p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 85 samples that matched the inclusion and exclusion criteria of this study. The majority of the sample came from the 2018 class (64.7%), 20 years old (61.2%), experiencing moderate stress (61.2%), and have normal body mass index (72.9%). Researcher found a p value of 0.309 (p&amp;gt; 0.05), which means that there is no significant relationship between a high-fiber diet and the severity of premenstrual syndrome symptoms.

Incidence, prevalence, and trajectories of suicidal ideation among clients enrolled in early intervention services for first episode psychosis in New York State.

Knowledge on how suicidal ideation (SI) varies following first episode psychosis (FEP) onset is scarce. We identified 1-year trajectories of SI and baseline predictors of emergent SI among all 1298 clients aged 16-30years enrolled between October 2013-December 2018 in OnTrackNY, a program providing early intervention services for FEP across New York State. Clinicians recorded baseline clinical and sociodemographic variables and quarterly assessments of SI over a one-year follow-up. We examined baseline correlates of baseline SI and of 1-year SI trajectory. Among clients not reporting baseline SI, we examined predictors of subsequent emergent SI. Baseline SI was reported by 349 (26.9%) clients and associated with schizoaffective disorder, previous self-injurious behavior, any alcohol or substance use, higher symptom severity, poorer social functioning, and Non-Hispanic White, Asian or Hispanic ethnoracial background. Two hundred and two (15.6% overall) clients stopped being suicidal within 6months of follow-up. Persistent SI was reported by 147 (11.3% overall) clients and, among clients not discharged before one year of follow-up, was associated with schizoaffective disorder, any alcohol use, being female, and being Hispanic or White Non-Hispanic. Among 949 (73.1%) clients not reporting baseline SI, subsequent emergent SI was reported by 139 (10.7% overall) and predicted at baseline by schizoaffective disorder, higher symptom severity, recent homelessness, and not being Hispanic. In conclusion, SI is highly prevalent and varies markedly over time among FEP early intervention clients. These results highlight the importance of ongoing assessment for SI among individuals experiencing FEP - even in the absence of baseline SI.

0632 The relationship of shift work disorder with depression, anxiety, and stress

Abstract Introduction Shift work-related circadian misalignment can adversely impact health and well-being. Shift workers often experience disturbances in mood and impairments in waking vigilance and cognitive performance. Shift workers also commonly experience disturbed sleep. Shift work disorder (SWD) is a circadian rhythm sleep disorder characterized by insomnia symptoms during the sleep episode and sleepiness during the wake episode, temporally associated with shift schedules. Here, we examined the association between SWD and mental health. Methods Participants were adults (18 y+) who engaged in non-standard work shifts (morning, evening, night, rotating, other). Data were collected via online survey, and included questions about demographics, job details, sleep, and mental health. Participants completed the validated SWD Questionnaire, assessing the presence and severity of symptoms, categorizing individuals as high or low risk for SWD based on International Classification of Sleep Disorders criteria. Participants completed the Depression, Anxiety, and Stress Scale-21 (DASS-21). Higher scores on each DASS-21 subscale indicate higher symptom severity. Linear regression was used to determine the relationship between the presence of SWD and depression, anxiety, and stress symptom scores, adjusting for age, gender, shift work type, self-reported work-day sleep duration, and alcohol use frequency. Results Sixty participants were included (60% female, mean age: 37 [SD: 12.2] y). High risk for SWD was seen in 55% of participants. Sleep duration was on average ~40 minutes shorter in those with vs. without SWD (5.61 [1.24] h vs. 6.31 [1.31] h, p=.037). Participants with SWD reported significantly higher depressive symptoms than those without (B=3.59, SE=1.52, 95% CI [0.54, 6.65], p=.022). SWD was not associated with anxiety, and was marginally associated with stress (B=2.48, SE=1.26, 95% CI [-0.06, 5.02], p=.055). Age was significantly associated with lower stress symptoms (B=-0.11, SE=0.05, 95% CI [-0.22, -0.01], p=.029). No other covariates were significantly associated with depression, anxiety, or stress (all other ps ≥.10). Conclusion SWD was common. Its presence was associated with higher severity of depression symptoms. Intervention approaches targeting underlying causes of SWD (e.g., strategic light-dark exposure and cognitive behavioral therapy for insomnia that is adapted for shift work) should be tested as methods to protect shift workers’ mental health. Support (if any)

Morphological, Molecular and Genomic Identification and Characterisation of Monilinia fructicola in Prunus persica from Portugal

In Portugal, the Cova da Beira region is well-known for the production of Prunus spp. and is considered the main peach production area in the country. In the spring of 2021 and 2022, field surveys in peach and nectarine orchards showed symptoms of decline such as cankers, gummosis, dry branches, abortion of flowers, mummified fruits and the partial or total death of some plants. Brown rot is caused by three species of the genus Monilinia, M. fructigena, M. laxa and M. fructicola, the last is an OEPP/EPPO A2 quarantine organism on peach trees. Brown rot disease had previously been described in the Cova da Beira region, however, the recent high mortality and severity of symptoms raised doubts as to the species involved. Symptomatic plant material was collected from thirteen orchards and used for fungal isolation and molecular detection according to the OEPP/EPPO standard. M. fructicola was confirmed morphologically and molecularly in two orchards, and molecularly (duplex real-time PCR) detected in two others. Whole genome sequencing using Oxford Nanopore MinION was also carried out to confirm the identification. Pathogenicity tests were performed on peach, nectarine and sweet cherry fruit according to Koch’s postulates. Based on all the results obtained, we report the first detection of M. fructicola in P. persica in Portugal.

Factors associated with long-term gastrointestinal symptoms in colorectal cancer survivors in the women's health initiatives (WHI study).

Colorectal cancer (CRC) survivors often experience long-term symptoms after cancer treatments. But gastrointestinal (GI) symptom experiences are under-investigated in CRC survivors. We described persistent GI symptoms after cancer treatments in female CRC survivors and assessed GI symptoms' risk and life-impact factors. A cross-sectional study utilized data from the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study that recruited postmenopausal women. Correlation analyses and multivariable linear regression models were used. CRC survivors after cancer treatments were included (N = 413, mean age 71.2 years old, mean time since diagnosis = 8.1 years). 81% of CRC survivors experienced persistent GI symptoms. Bloating/gas was the most prevalent (54.2%± 0.88) and severe GI symptom, followed by constipation (44.1%±1.06), diarrhea (33.4%±0.76), and abdominal/pelvic pain (28.6%±0.62). Significant risk factors for GI symptoms include time since cancer diagnosis (<5 years), advanced cancer stage, high psychological distress, poor dietary habits, and low physical activity. Fatigue and sleep disturbance were the most significant risk factors for long-term GI symptoms (β = 0.21, t = 3.557; β = 0.20, t = 3.336, respectively, Ps < .001). High severity of GI symptoms was positively associated with poor quality of life (QOL), increased daily life interferences (social and physical functions), and low body image satisfaction (Ps < .001). Women CRC survivors experience a high GI symptom burden, highlighting the need to inform policy and improve the QOL of cancer survivors. Our findings will aid in identifying those more vulnerable to symptoms, and inform future survivorship care interventions (i.e., community-based cancer symptom management) by considering multiple risk factors (e.g., psychological distress).

Dialysis vintage is associated with a high prevalence and severity of unpleasant symptoms in patients on hemodialysis

Background The burden of physical and emotional symptoms caused by somatic illness is present in most dialysis patients. However, it’s unclear how symptom burden varies among patients with different dialysis vintages. We sought to examine differences in the prevalence and severity of unpleasant symptoms in hemodialysis patients with diverse dialysis vintage cohorts. Methods This cross-sectional study included patients on maintenance hemodialysis at the Second Hospital of Anhui Medical University. We used the Dialysis Symptom Index (DSI) to determine the associated unpleasant symptoms, which is a validated survey to assess symptom burden/severity (higher scores indicate more severe symptoms), over June 2022 – September 2022. Results We studied 146 patients: 35 (24%) had a dialysis vintage of ≤12 months (group 1) and 111 (76%) had a dialysis vintage of >12 months (group 2). Concerning Group 1 patients, the prevalence and severity of unpleasant symptoms were significantly higher in Group 2, the most common individual symptoms included feeling tired or lack of energy and trouble falling asleep (i.e., 75–85% of patients in each group), with dialysis vintage being an independent influencing factor (adjusted OR, 0.19; 95% CI, 0.16 to 0.23). Lower hemoglobin levels, iron stores, and dialysis adequacy levels are correlated with longer dialysis vintage. Conclusion We observed a high prevalence of unpleasant symptoms and symptom clusters in a diverse dialysis vintages hemodialysis cohort. Further studies are needed to accurately and routinely define the symptom burden of chronic patients with chronic kidney disease (CKD).

Factors associated with psychiatric outcomes and coping in Long COVID

The relationship between Long COVID (LC) and psychiatric outcomes, as well as factors associated with presence and absence of these, has so far been insufficiently studied. Here we evaluated psychiatric symptoms and coping among patients with LC and patients recovered from COVID-19 who participated in a large international survey. Given increased rates of psychiatric illness with chronic medical conditions and known immune-inflammatory contributors to psychiatric disease, we hypothesized that a subset, but not the entirety, of LC respondents may have comorbid psychopathology. A substantial minority of both groups experienced suicidality, depression and anxiety symptoms, with these symptoms being more common in the LC group. LC respondents used more adaptive coping styles. Psychiatric outcomes in LC were associated with younger age, greater reductions in overall health, higher symptom severity, limitations to physical capability, lower income, financial hardship, psychiatric history, employment impact, male sex, men and non-binary gender, and negative experiences with medical professionals, family, friends, partners and employers. In a large international survey, a minority subset of individuals with Long COVID experienced greater psychiatric symptom severity that was associated with greater reductions in overall health and other specific outcomes.

Exploring maladaptive cognitions and behaviors as perpetuating factors in patients with persistent somatic symptoms: a longitudinal study

ObjectiveMaladaptive cognitions and behaviors may influence symptoms and impairment in patients with persistent somatic symptoms (PSS). Aims of this study were to examine: (i) whether maladaptive cognitions and behaviors are associated with symptom severity and functional health over time; (ii) if these associations are the result of changes within individuals over time or of differences between individuals; (iii) directions of changes within individuals over time. MethodsLongitudinal data of a heterogeneous sample of patients with PSS were analyzed (n = 322 patients enrolled in the PROSPECTS cohort study). Cognitive and behavioral responses to symptoms (CBRQ), symptom severity (PHQ-15) and physical and mental functioning (RAND-36 PCS and MCS) were assessed seven times over a five-year period (0, 6 months, 1, 2, 3, 4, 5 year). Longitudinal mixed model and hybrid model analysis with and without time-lag were applied. ResultsMaladaptive cognitions and behaviors were associated with more severe symptoms and reduced physical and mental functioning over time. Both changes within individuals over time and differences between individuals were associated with higher symptom severity and reduced physical and mental functioning. The between-subject component was about twice the effect size of the within-subject component. Changes in several specific maladaptive cognitions and behaviors were associated with more severe symptoms and reduced physical and mental functioning later in time and vice versa. ConclusionThis study shows that maladaptive cognitions and behaviors are associated with symptom severity and reduced physical and mental functioning over time in patients with PSS.

Sympathetic and blood pressure reactivity to acute stress in young adults with major depressive disorder: the influence of depressive symptomatology

Major depressive disorder (MDD) is episodic in nature, highly recurrent, and associated with increased cardiovascular disease (CVD) risk. Sympathetic overactivation in response to acute stress may contribute to MDD-CVD comorbidity. However, few studies have investigated acute sympathetic stress reactivity in young adults with MDD or considered the potential influence of depressive symptom severity on these responses. We hypothesized that 1) acute stress-induced increases in muscle sympathetic nerve activity (MSNA) and blood pressure (BP) would be greater in young adults with MDD (unmedicated) compared to healthy non-depressed adults (HA) and 2) the magnitude of responsiveness would be graded in relation to symptom severity. Twenty-nine HA (22±5 yrs; 17 female) and 40 adults with MDD having mild-to-moderately severe depressive symptoms (23±6 yrs; 32 female) participated. Adults with MDD were also subclassified as having either low (l-MDD, n=25) or high symptom severity (h-MDD, n=15). MSNA (microneurography) and beat-to-beat BP (photoplethysmography) were measured at rest and during the cold pressor test (CPT) and the Stroop color word test (SCWT). There were no group differences in either resting MSNA (17±9 HA vs. 14±6 bursts/min MDD, p=0.39) or mean arterial pressure (MAP; 86±6 HA vs. 84±5 mmHg MDD, p=0.25). The CPT elicited increases in MSNA and MAP (both p&lt;0.01), but the magnitude was not different between groups (MSNA: Δ24±12 HA vs. Δ19±9 bursts/min MDD, p=0.22; MAP: Δ24±8 HA vs. Δ23±9 mmHg MDD, p=0.45). The SCWT also elicited increases in MAP (p&lt;0.01) that were not different between groups (Δ10±7 HA vs Δ10±6 mmHg MDD; p=0.76). Surprisingly, the SCWT failed to cause increases in MSNA (p&gt;0.05), which also did not differ between groups (Δ-2±7 HA vs. Δ-2±8 bursts/min MDD, p=0.92). When further classifying adults with MDD into symptom severity subgroups, there likewise were no differences in MSNA reactivity to either acute stressor (both p&gt;0.05). Interestingly, adults with h-MDD exhibited greater increases in MAP than adults with l-MDD during the CPT (Δ28±9 h-MDD vs. Δ20±8 mmHg l-MDD, p&lt;0.01) but not during the SCWT (Δ9±4 h-MDD vs. Δ11±7 mmHg l-MDD, p=0.63). Contrary to our hypothesis, these data demonstrate that neither acute stress-induced sympathetic activation nor the ensuing increase in BP are exaggerated in young adults with MDD. However, the severity of active depressive symptomatology may influence BP reactivity to generalized stress stimuli, thereby influencing CVD risk profiles. NIH R21MH123928 and R00 HL133414 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Self-efficacy trajectories of individuals newly diagnosed with multiple sclerosis.

The first year following a new multiple sclerosis (MS) diagnosis may be a critical time for individuals as they learn to manage their disease. Effective self-management of MS likely requires healthy self-efficacy levels, yet little is known about self-efficacy in the postdiagnosis period. This study aims to improve our understanding of self-efficacy in individuals newly diagnosed with MS by examining self-efficacy trajectories and identifying patient characteristics associated with trajectories in the first postdiagnosis year. Newly diagnosed adults with MS/clinically isolated syndrome (CIS) (N = 230) completed a battery of questionnaires, including the University of Washington Self-Efficacy Scale, at 1, 2, 3, 6, 9, and 12 months, postdiagnosis. Sankey diagrams characterized self-efficacy trajectories and a multiple regression model tested patient characteristics as predictors of self-efficacy change scores. Mean self-efficacy T-scores ranged from 50.79 to 52.04 (SD = 9.40 and 10.12, respectively) across the postdiagnosis year. MS diagnosis (vs. CIS), higher disability levels, and higher MS symptom severity were associated with lower self-efficacy levels at baseline. Baseline symptom severity predicted change in self-efficacy levels from baseline to month 12 (B = -0.05, p = .030). Self-efficacy remains relatively stable in the first year following a MS diagnosis, though high symptom severity is associated with decreased self-efficacy at 12-months postdiagnosis. Clinical characteristics (e.g., MS diagnosis, disability level) also appear to play a role in setting the course of self-efficacy in this postdiagnosis year. Timely interventions that enhance self-efficacy and/or improve certain clinical characteristics may promote healthy self-management of MS that carries forward in disease course. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Poor Insight in Obsessive-Compulsive Disorder as a Multifaceted Phenomenon: Evidence From Brain Activation During Symptom Provocation

BackgroundPoor insight in obsessive-compulsive disorder (OCD) is associated with higher symptom severity, more comorbidities, and worse response to treatment. This study aimed to elucidate underlying mechanisms of poor insight in OCD by exploring its neurobiological correlates. MethodsUsing a symptom provocation task during functional magnetic resonance imaging, we compared brain activation of patients with poor insight (n = 19; 14 female, 5 male), good/fair insight (n = 63; 31 female, 32 male), and healthy control participants (n = 42; 22 female, 20 male) using a Bayesian region-of-interest and a general linear model whole-brain approach. Insight was assessed using the Overvalued Ideas Scale. ResultsCompared with patients with good/fair insight and healthy control participants, patients with OCD and poor insight showed widespread lower task-related activation in frontal areas (subgenual anterior cingulate cortex, ventromedial prefrontal cortex, dorsolateral prefrontal cortex, ventrolateral prefrontal cortex, supplementary motor area, precentral gyrus), parietal areas (posterior parietal cortex, precuneus), and the middle temporal gyrus and insula. Results were not driven by interindividual differences in OCD symptom severity, medication usage, age of disorder onset, or state distress levels. ConclusionsDuring symptom provocation, patients with OCD and poor insight show altered activation in brain circuits that are involved in emotional processing, sensory processing, and cognitive control. Future research should focus on longitudinal correlates of insight and/or use tasks that probe emotional and sensory processing and cognitive control.

Health-related quality of life among patients with treated alcohol use disorders, schizophreniform disorders or affective disorders and the influence of flexible and integrative psychiatric care models in Germany (PsychCare).

Flexible and integrated treatment options (FIT) have been established in German psychiatric hospitals to enhance continuous and patient-centered treatment for patients with mental disorders. We hypothesized that patients with experience in FIT treatment showed higher health-related quality of life (HRQoL) and comparable symptom severity compared with patients treated as usual (TAU). Further, we expected that some sub-dimensions of HRQoL determined HRQoL results clearer than others, while certain factors influenced HRQoL and symptom severity stronger in the FIT compared to the TAU group. In addition, we hypothesized that HRQoL is correlated with symptom severity. We undertook a controlled, prospective, multicenter cohort study (PsychCare) conducted in 18 psychiatric hospitals in Germany, using the questionnaires Quality of Well Being Self-Administered (QWB-SA) (HRQoL) and Symptom-Checklist-K-9 (SCL-K-9) (symptom severity) at recruitment (measurement I) and 15 months later (measurement II). We assessed overall HRQoL (measured in health utility weights (HUW) and symptom severity score for patients from FIT and TAU treatment. We investigated the QWB-SA dimensions and separated the results by diagnosis. We used beta regressions to estimate the effect of multiple co-variates on both outcomes. To investigate the correlation between HRQoL and symptom severity, we used Pearson correlation. During measurement I, 1,150 patients were recruited; while 359 patients participated during measurement II. FIT patients reported higher HUWs at measurement I compared to TAU patients (0.530 vs. 0.481, p = 0.003) and comparable HUWs at measurement II (0.581 vs. 0.586, p = 0.584). Symptom severity was comparable between both groups (I: 21.4 vs. 21.1, p = 0.936; II: 18.8 vs. 19.8, p = 0.122). We found lowest HRQoL and highest symptom severity in participants with affective disorders. HRQoL increased and symptom severity decreased over time in both groups. The QWB-SA dimension acute and chronic symptoms was associated with highest detriments in HRQoL. We identified risk/protective factors that were associated with lower quality of life and higher symptom severity in both groups. We confirmed that HRQoL was negatively associated with symptom severity. Health-related quality of life (during hospital treatment) was higher among patients treated in FIT hospitals compared to patients in routine care, while symptom severity was comparable between both groups.

The Effects of Emotional Labor and Workplace Violence on the Somatic Symptoms of Customer Service Employees in Department Stores

Purpose: This study was aimed to explore the effects of emotional labor and workplace violence on the somatic symptoms of customer service employees in department stores. Methods: Data from a total of 218 subjects were collected from July 21, 2021 to August 10, 2021, using a self-report questionnaire. The data were analyzed using descriptive statistics, X2-test, and logistic regression. Results: Among 4 sub-scales of workplace violence, a factor affecting the possibility of the moderate or high severity of somatic symptoms was found to be a risk group in "Experience of psychological and sexual violence from customer” (OR: 2.94). On the other hand, emotional labor did not show a statistically significant effect. In addition, education level, monthly income, subjective health status, and working hours per week were also factors affecting somatic symptoms. Conclusion: In order to reduce the somatic symptoms of customer service employees in department stores, it is necessary to raise the awareness of employers and customers first, and follow-up research is necessary on the development of strategy and systems for the establishment of active and diverse protective devices to protect workers at the organizational level.

Clinical characteristics associated with relapse 2 years after electroconvulsive therapy for major depression.

High relapse rates are observed after electroconvulsive therapy (ECT) for major depression. Identifying patients who are at increased risk for relapse to intensify their treatment regimen post-ECT might reduce relapse rates. We aimed to determine clinical characteristics that are associated with relapse within 2 years after successful ECT. Patients who remitted to ECT in a randomised controlled trial comparing adjuvant nortriptyline and placebo during a course of bilateral ECT were followed-up prospectively for 1 year with open-label nortriptyline (Dutch Trial Register NTR5579). Second-year follow-up data were collected retrospectively. Thirty-four patients were included in this follow-up cohort. To examine the association between clinical characteristics and the risk of relapse, unadjusted hazard ratios (HRs) were calculated. At 2 years post-ECT, the overall relapse rate was 50%, and the HRs for relapse in patients with psychotic features, a higher severity of depression, and medication resistance prior to ECT were 0.33 (CI 0.12-0.89; p = 0.029), 0.88 (CI 0.80-0.98; p = 0.014), and 4.48 (CI 1.28-15.73, p = 0.019), respectively. No effect was found for age, sex or episode duration on the relapse rate. Depressed patients with psychotic features, with higher symptom severity and without medication resistance prior to ECT have a significantly decreased risk of relapse after successful ECT. A sustained remission rate of 50% over 2 years in patients with severe major depression who were treated with nortriptyline monotherapy after successful ECT is encouraging.

An Unsupervised Machine Learning Approach to Evaluating the Association of Symptom Clusters With Adverse Outcomes Among Older Adults With Advanced Cancer

Older adults with advanced cancer who have high pretreatment symptom severity often experience adverse events during cancer treatments. Unsupervised machine learning may help stratify patients into different risk groups. To evaluate whether clusters identified from baseline patient-reported symptom severity were associated with adverse outcomes. This secondary analysis of the Geriatric Assessment Intervention for Reducing Toxicity in Older Patients With Advanced Cancer (GAP70+) Trial (2014-2019) included patients who completed the National Cancer Institute Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) before starting a new cancer treatment regimen and received care at community oncology sites across the United States. An unsupervised machine learning algorithm (k-means with Euclidean distance) clustered patients based on similarities of baseline symptom severities. Clustering variables included severity items of 24 PRO-CTCAE symptoms (range, 0-4; corresponding to none, mild, moderate, severe, and very severe). Total severity score was calculated as the sum of 24 items (range, 0-96). Whether the clusters were associated with unplanned hospitalization, death, and toxic effects was then examined. Analyses were conducted in January and February 2022. Symptom severity. Unplanned hospitalization over 3 months (primary), all-cause mortality over 1 year, and any clinician-rated grade 3 to 5 toxic effect over 3 months. Of 718 enrolled patients, 706 completed baseline PRO-CTCAE and were included (mean [SD] age, 77.2 [5.5] years, 401 [56.8%] male patients; 51 [7.2%] Black and 619 [87.8%] non-Hispanic White patients; 245 [34.7%] with gastrointestinal cancer; 175 [24.8%] with lung cancer; mean [SD] impaired Geriatric Assessment domains, 4.5 [1.6]). The algorithm classified 310 (43.9%), 295 (41.8%), and 101 (14.3%) into low-, medium-, and high-severity clusters (within-cluster mean [SD] severity scores: low, 6.3 [3.4]; moderate, 16.6 [4.3]; high, 29.8 [7.8]; P < .001). Controlling for sociodemographic variables, clinical factors, study group, and practice site, compared with patients in the low-severity cluster, those in the moderate-severity cluster were more likely to experience hospitalization (risk ratio, 1.36; 95% CI, 1.01-1.84; P = .046). Moderate- and high-severity clusters were associated with a higher risk of death (moderate: hazard ratio, 1.31; 95% CI, 1.01-1.69; P = .04; high: hazard ratio, 2.00; 95% CI, 1.43-2.78; P < .001), but not toxic effects. In this study, unsupervised machine learning partitioned patients into distinct symptom severity clusters; patients with higher pretreatment severity were more likely to experience hospitalization and death. ClinicalTrials.gov Identifier: NCT02054741.

Gender Differences in Gastroparesis

Delayed gastric emptying, known as gastroparesis, is a chronic disorder that disproportionately affects women over men. We reviewed studies focusing on female predominance of gastroparesis and various hypothesis for the development and presentation in such differences. Females are at a disadvantage for several factors, including physiologic delay at baseline, cyclic changes in sex hormones attributing to symptoms as well as dynamic results of gastric emptying tests, and interplay with nitric oxide dysfunction, linking it to functional gastrointestinal disorders, thus higher symptom severity, and a potential barrier to treatment response. Further studies need to be conducted to investigate gender differences in the development and presentation of gastroparesis, with the intent to develop and implement customized treatment for gender-specific variations in gastric delay.

Suicide Attempts in Panic Disorder: Clinical Effects on Treatment Response and Link to Fear of Cognitive Dyscontrol

IntroductionPanic disorders (PD) are associated with suicidality. The link between PD and suicide has been suggested to be depression; however, this remains controversial. Comprehensive research on the history of suicide attempts (SAs) in patients with PD is scarce.ObjectivesThis study investigated the characteristics and pharmacological short- and long-term treatment responses of patients with PD, with or without SAs. Moreover, a network analysis was conducted to investigate the central symptoms and their connection to suicidality among SA-related variables with and without SAs.MethodsWe investigated the characteristics of SAs in patients with PD using PD-related scales, magnetic resonance imaging, and network approaches. A total of 1151 subjects were enrolled, including 755 patients with PD (97 with SA and 658 without SA) and 396 healthy controls. Suicide and PD-related scales were also administered.ResultsOur results revealed that the scores of all symptom severities were significantly higher in the PD+SA group than in the PD-SA group. Multiple linear regression analysis revealed that short- and long-term pharmacological treatment responses were significantly poor in the PD+SA group. Network analysis showed that fear of cognitive dyscontrol (FCD) was the strongest central symptom among strength, expected influence (1 and 2 step), randomized shortest path betweenness, and eigenvector centrality measures in PD+SA, whereas depression was the central symptom in PD-SA.Table 1.Results of multiple regression analysis to predict treatment response for patients with panic disorder.Treatment responseat 8 weeks(n = 450)[R2 =0.19]Treatment responseat 6 month(n = 379)[R2 =0.20]Treatment responseat 1 year(n = 329)[R2 =0.22]Βp-valueβp-valueβp-valueGender0.100.150.140.090.080.39Age-0.060.440.040.620.010.94Baseline PDSS total score0.46&lt;0.001**0.48&lt;0.001**0.42&lt;0.001**Baseline BDI-II total score0.050.650.090.470.170.19Baseline PSWQ total score-0.070.47-0.110.29-0.180.09Baseline ASI-R total score-0.140.19-0.190.10-0.190.11Baseline ETISR-SF total score0.070.340.040.600.110.24A history of the suicide attempt-0.190.01*-0.200.02*-0.280.002*Note: Model p-values &lt;0.001.*p &lt; 0.05.**p &lt; 0.001.Abbreviations: PD, panic disorder; SA, suicide attempt; PDSS, Panic Disorder Severity Scale; BDI-II, Beck Depression Inventory-II; PSWQ, Penn State Worry Questionnaire; ASI-R, Anxiety Sensitivity Inventory-Revised; ETISR-SF, The Early Trauma Inventory Self Report-Short Form.Image:Image 2:Image 3:ConclusionsOur results suggest that SA history could be associated with high symptom severity and poor pharmacological treatment response in patients with PD and that FCD is the central symptom in the PD+SA network.Disclosure of InterestNone Declared