History Of Serious Mental Illness Research Articles

Impact of post-release community mental health and disability support on reincarceration for prisoners with intellectual disability and serious mental illness in NSW, Australia.

Prisoners with an intellectual disability are overrepresented in custody and more likely to reoffend and be reincarcerated compared with the general prison population. Although prisoners with intellectual disability have many of the same risk factors for recidivism as the general prison population, the high rates of mental illness experienced by this group are key drivers of recidivism. We aimed to assess the impact of provision of post-release disability and community mental health support on rates of reincarceration in a cohort with identified intellectual disability and serious mental illness diagnosis. We conducted a historical cohort study using linked administrative data-sets, including data on hospital admissions, community mental health, disability support and corrections custody in New South Wales, Australia (n = 484). To assess the time to return to adult custody, we used survival analysis on multiple failure-time data. Over the median follow-up period of 7.4 years, 73.7% (357) received community mental health support, 19.8% (96) received disability support and 18.6% (85) received a combination of supports during a post-release period from prison. Lower hazards of reincarceration in a post-release period were associated with receipt of community mental health support (hazard ratio [HR] = 0.58, CI 0.49-0.69, P < 0.001), or a combination of community mental health and disability support (HR = 0.46, CI 0.34-0.61, P < 0.001). High rates of reincarceration for prisoners with intellectual disability and history of serious mental illness may be modifiable by provision of appropriate mental health and disability supports.

'Trials and Tribulations': The Ambivalent Influence of Temporary Accommodation on Mental Health Recovery in Chronically Homeless Adults.

Relatively few studies have explicitly examined whether and how shelter-type, temporary or emergency accommodation shapes homeless clients' personal (mental health) recovery. A transatlantic phenomenological qualitative study was conducted to examine the influence of those services on personal recovery. Eighteen chronically homeless adults with a history of serious mental illness were recruited from several temporary accommodation services in New York City (NYC), U.S., and Glasgow, Scotland. Participants completed repeat in-depth interviews and a novel one-week multimedia mobile phone diary. The interpretative phenomenological analysis (IPA) produced three overarching group experiential themes: 'everything was just starting to fall into place'; 'caught in a trap'; and 'trials and tribulations'. Collectively, the findings underscore the duality of influence of temporary accommodation on recovery. Those ambiguous spaces confronted participants with existential uncertainty, volatility and chronic boredom, but also proffered opportunities for envisioning and enacting recovery. Embarking on recovery while residing in temporary accommodation is possible, even for those enduring chronic life adversity. However, it is contingent upon enabling socio-material, affective and relational resources. Implications are discussed for theorising recovery as a contextually embedded, relational phenomenon, and for providing recovery-oriented support across the housing continuum.

Principal component regression analysis of familial psychiatric histories and suicide risk factors among adults with opioid use disorder

This study explores familial psychiatric risk factors that are closely linked to suicide risk among patients with opioid use disorder (OUD) as measured by the Family History Assessment Module (FHAM). Data was derived from adults diagnosed with OUD (N = 389). To analyze the covariance between the 11 items of the FHAM, principal component analysis was applied to infer principal components (PC) scores. Log-binominal regression was conducted to quantify the associations between PC scores and mental health symptoms (e.g., lifetime suicidal attempt, P30D suicidal ideation, depression, and anxiety). Analyses revealed that the first 3 three PCs could account for 56% of the total variance of the FHAM items within the data. Family history of substance misuse (PC1) was positively associated with lifetime suicide attempts and severe anxiety. Family history of serious mental illness (PC2) and of suicidal behavior (PC3) were not significantly associated with any outcomes. Our findings suggest current suicide risk is associated with an array of familial psychiatric issues among people with OUD. However, family history of suicide attempts and death by suicide has less bearing on current suicide risk in OUD patients whereas family history of substance use confers significant risk. Findings underscore suicide-related preventive interventions as necessary components of treatment plans among people with OUD, who commonly report family histories of substance misuse.

SERIOUS MENTAL ILLNESS EXACERBATION POST-BEREAVEMENT: A POPULATION-BASED STUDY OF PARTNERS AND ADULT CHILDREN

Abstract The death of a family member may trigger exacerbations among individuals with serious mental illness (SMI). We hypothesized that bereavement would be associated with SMI exacerbations among bereaved partners and adult children diagnosed with SMI. Using linked population-based registries in Denmark, we identified partners and adult children diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, and major depression in the five years preceding the family member’s death. Generalized estimating equations were used to estimate the odds of SMI exacerbation two years after decedent death. Partners had increased odds of SMI exacerbation at 3 months into bereavement compared to 9-12 months prior to partners’ death (AOR=1.43, [1.13-1.81]). Children with a history of SMI had lower odds of SMI exacerbation in the second year of bereavement. Sociodemographic characteristics and co-occurring alcohol and substance abuse disorders were associated with higher odds of SMI exacerbations. These findings have implications for targeted bereavement support.

Serious Mental Illness Exacerbation Post-Bereavement: A Population-Based Study of Partners and Adult Children.

PurposeThe death of a close family member is commonly accompanied by intense grief, stress, and loss of social support. We hypothesized that recent bereavement would be associated with an increase in symptom exacerbations among adults with serious mental illness (SMI) whose partners or parents had died.Patients and MethodsAdults whose partners and parents had died in Denmark between January 1, 2010, and June 30, 2016, were identified using linked population-based registries. History of SMI was defined as having a diagnosis of schizophrenia and schizoaffective disorders, major depression, and bipolar disorder in the five years preceding their family member’s death in the Danish Psychiatric Central Research Register using International Classification of Diseases-10 codes. The odds of SMI exacerbation (ie, attempt or completion of suicide or psychiatric hospitalization) among partners and children in the first two years after death in 3-month intervals were estimated with generalized estimating equations.Results12.8% of partners and 15.0% of adult children with a history of SMI experienced any SMI exacerbation two years after bereavement. Among bereaved partners, older age (80+ years) was associated with a lower risk of experiencing an SMI exacerbation compared with partners aged 18–49 years (ORadj=0.29, [0.18–0.45]). Partners with a history of SMI had significantly increased odds of SMI exacerbations three months after their partners’ death compared to prior to their partners’ death (ORadj = 1.43, [1.13–1.81]). There was no evidence that adult children with SMI experience increased SMI exacerbations after the death of their parents compared to prior to death.ConclusionAdults with a history of SMI whose partners had died are at increased risk for an SMI exacerbation post bereavement. Additional bereavement resources and support should be provided to those with a history of SMI, especially in the period immediately after death.

The dynamic interactions of PTSD symptoms in daily life

Background: Intensive longitudinal assessments such as experience sampling methodology (ESM)/ecological momentary assessment (EMA) are data collection methods in which participants are prompted to provide data at least once a day over a particular time period on symptoms, emotions, and behaviours, often using mobile technology. In recent years, there has been a rise in ESM/EMA studies in the traumatic stress field (Greene et al., 2018; Chun, 2016; Kleindienst et al., 2017). ESM/EMA approaches enable researchers to ask and answer questions that are not typically possible using traditional methods, such as: How variable is PTSD symptomatology in daily life? Which symptoms and behaviours predict other symptoms and behaviours a few hours later? What is the real-time effect of environmental stressors on mental health? What are the temporal dynamics of symptoms during treatment? (Greene, Gelkopf, Fried, Robinaugh, & Lapid Pickman, 2020; Hoffart, Langkaas, Øktedalen, & Johnson, 2019). Objectives: The objective of the current study was to investigate the dynamic interactions of traumatic symptoms during and after stress exposure using a prospective multi-wave ESM/EMA design. Methods: In this study, 182 Israeli civilians exposed to rocket fire, including 86 with a history of serious mental illness, completed assessments twice daily for 30 days via mobile phone during the Israel-Gaza 2014 conflict (July-August). Three ESM/EMA follow up bursts were conducted 1.5, 3.5, and nearly 6 years later. Respondents completed ESM versions of the PTSD checklist for DSM-5 (PCL-5), the Patient Health Questionnaire – 9 (PHQ-9), and other questions relating to dissociation, perceived threat, social support, and stress exposure. A series of analyses were conducted using R, Mplus and SPSS, including dynamic network analyses, dynamic structural equation models (DSEM), and multilevel mediation analyses. Results: In the peritraumatic phase, dynamic network analyses found that arousal symptoms predicted other PTSD symptoms, as well as negative affect. A multilevel mediation model showed that perceived threat mediated the relationship between stress exposure and traumatic stress symptoms (Lapid Pickman, Greene, & Gelkop, 2017). In the posttraumatic phase (3.5 year follow up), a DSEM found dynamic associations between PTSD and depression symptoms, with elevations in PTSD symptoms predicting elevations in depression symptoms 12 hours later, but not vice versa. Conclusions: ESM/EMA approaches can provide novel insights into the complex and dynamic interactions of PTSD symptoms in daily life, both those that are part of the core PTSD symptomatology, and also with comorbid phenomena, such as perceived threat, negative affect, and depression.

Is it depression or is it bipolar depression?

This review is intended to guide primary care providers in differentiating patients with bipolar depression from those with unipolar depression and inform patient management. Up to 64% of clinical encounters for depression occur in primary care, with misdiagnosis of bipolar depression common in both primary care and psychiatry. Although bipolar disorder is characterized by manic, hypomanic, and depressive episodes, the most common and debilitating symptomatic presentation is depression. Misdiagnosis as unipolar depression is common, often resulting in mistreatment with an unopposed monoamine antidepressant. Antidepressants are often ineffective for treating bipolar depression and may cause detrimental consequences such as treatment-emergent hypomania/mania, rapid cycling, or increased suicidality. Factors that are suggestive of bipolar disorder versus unipolar depression include early-onset depression, frequent depressive episodes, family history of serious mental illness, hypomania/mania symptoms within the depressive episode, and nonresponse to antidepressants. Comorbid medical (e.g., cardiovascular disease, hypertension, obesity) and psychiatric (e.g., attention-deficit/hyperactivity disorder, anxiety disorder, personality disorders, and substance use disorder) conditions are common and contribute to premature mortality for patients with bipolar disorder compared with the general public. Cariprazine, fluoxetine/olanzapine, lurasidone, and quetiapine are approved to treat bipolar depression; only cariprazine and quetiapine are approved to treat both bipolar mania and depression. Primary care providers who can differentiate presenting symptoms of bipolar depression from unipolar depression and offer appropriate treatment options will optimize patient care in clinical practice. Relevant information for this review was identified through a multistep literature search of PubMed using the terms bipolar depression/bipolar disorder plus other relevant terms.

A social history of serious mental illness.

Despite medical, technological, and humanitarian advances, the criminalization of those with serious mental illness continues. This is not an isolated phenomenon. The benefits of treatment reform and innovation are difficult to maintain or sometimes outright harmful. Across time and geography, the care of those with serious mental illness tends towards maltreatment, be it criminalization or other forms of harm. We present a social history of serious mental illness, along with the idea that the treatment of serious mental illness is a Sisyphean task-perpetually pushing a boulder up a hill, only for it to roll down and start again. The history is provided as a basis for deeper reflection of treatment, and treatment reform, of those with serious mental illnesses.

History of Serious Mental Illness Is a Predictor of Morbidity and Mortality in Cardiac Surgery

Serious mental illness (SMI), defined as a mental disorder causing functional impairment, affects 9.8 million Americans. SMI correlates with earlier onset, more extensive cardiac disease, and reduced life expectancy by 25 years. The impact of SMI on patients undergoing cardiac surgery has not been extensively studied. We hypothesized that patients with SMI have worse cardiac surgery outcomes. Using our institution's Society of Thoracic Surgeons database of 16,781 cardiac operations (2002-2017),a total of 1445 (8.7%) patients with SMI were identified and stratified into anxiety, mood disorders, andpsychosis. The risk-adjusted impact on morbidity and mortality were evaluated using multivariable regression. Patients with SMI were more often female patients, were younger, and had more comorbid disease. SMI patients were more likely to have had previous cardiac surgery and require urgent or emergent procedures (both P < .05). Among specific SMI diagnoses, patients with psychosis had worse outcomes compared with the general population, with higher operative mortality (9.1% vs 4.2%; P= .001), major morbidity (30.4% vs 15.8%; P < .0001), and cost ($50,211 vs $38,820; P < .001). After multivariable risk adjustment, SMI and psychosis remained independently associated with composite mortality and major morbidity (odds ratio, 1.21; P= .012; and odds ratio, 1.68; P= .003, respectively). SMI is independently associated with morbidity and mortality after cardiac surgery. SMI patients, especially the subset with psychosis, are complicated, high-risk, and resource-consuming. Refined strategies to reduce postoperative complications and improve care coordination are necessary in this population.

Aberrant limbic brain structures in young individuals at risk for mental illness.

Alterations in limbic structures may be present before the onset of serious mental illness, but whether subfield-specific limbic brain changes parallel stages in clinical risk is unknown. To address this gap, we compared the hippocampus, amygdala, and thalamus subfield-specific volumes in adolescents at various stages of risk for mental illness. MRI scans were obtained from 182 participants (aged 12-25 years) from the Canadian Psychiatric Risk and Outcome study. The sample comprised of four groups: asymptomatic youth at risk due to family history of mental illness (Stage 0, n = 32); youth with early symptoms of distress (Stage 1a, n = 41); youth with subthreshold psychotic symptoms (Stage 1b, n = 72); and healthy comparison participants with no family history of serious mental illness (n = 37). Analyses included between-group comparisons of brain measurements and correlational analyses that aimed to identify significant associations between neuroimaging and clinical measurements. A machine-learning technique examined the discriminative properties of the clinical staging model. Subfield-specific limbic volume deficits were detected at every stage of risk for mental illness. A machine-learning classifier identified volume deficits within the body of the hippocampus, left amygdala nuclei, and medial-lateral nuclei of the thalamus that were most informative in differentiating between risk stages. Aberrant subfield-specific changes within the limbic system may serve as biological evidence to support transdiagnostic clinical staging in mental illness. Differential patterns of volume deficits characterize those at risk for mental illness and may be indicative of a risk-stage progression.

Couples becoming parents: Trajectories for psychological distress and buffering effects of social support

Background: Becoming a parent is a time of both joy and stress. Associations between exposure to postnatal depression and negative child outcomes underscore the importance of understanding trajectories and correlates of perinatal depression and anxiety. Methods: In a study of 438 expectant couples (from the UK, USA and Netherlands) tracked across four time-points (third trimester, 4, 14 and 24 months), we used dyadic latent growth curve modeling (LGCM) of self-reported symptoms of anxiety and depression (CES-D, GHQ, STAI) to investigate the affective impact of becoming a parent. Results: Confirmatory factor analyses of anxious-depressive symptoms revealed a single latent factor with measurement invariance across time and parent. Dyadic LGCM intercepts showed greater prenatal problems in mothers compared with fathers. LGCM slopes revealed stable maternal problems but worsening paternal problems. Both intercepts and slopes showed significant within-couple associations. Controlling for prenatal salivary cortisol levels and perinatal couple relationship quality, support from friends attenuated mothers’ psychological distress and support from family reduced fathers’ psychological distress across the transition to parenthood. Limitations: Our sample was low risk (i.e., predominantly well-educated and affluent and no history of serious mental illness), limiting the generalizability of findings. In addition, the inverse association between psychological distress and social support may, in part, reflect the use of self-report for both measures. Conclusions: The international dyadic longitudinal design strengthens conclusions regarding variation in trajectories of psychological distress in both mothers and fathers. Crucially, social support appears pivotal in enabling new parents to flourish.

Postoperative Pain Management Strategies and Delirium After Transapical Aortic Valve Replacement: A Randomized Controlled Trial

This study was designed to compare 2 different perioperative analgesia strategies with respect to the incidence of postoperative delirium after a transapical approach for transcatheter aortic valve replacement (TAVR). The authors hypothesized that perioperative thoracic paravertebral analgesia with a local anesthetic would decrease opioid consumption and in turn reduce the incidence of postoperative delirium when compared with systemic opioid-based analgesia after a transapical TAVR procedure. Prospective, randomized controlled clinical trial. Tertiary referral center, university hospital. The study comprised 44 patients undergoing a transapical TAVR procedure. Patients with a history of serious mental illness, delirium, and severe dementia and/or patients with contraindications to regional anesthesia were excluded. Patients were randomly assigned to either the paravertebral group (perioperative continuous thoracic paravertebral block with local anesthetic) or the patient-controlled analgesia group (systemically administered opioids) using a computer-generated randomization code in blocks of four patients. Assessment of postoperative delirium was performed by trained research staff using the confusion assessment method for intensive care unit preoperatively and postoperatively every 12 hours or more often if needed according to the patient's condition during the first 7 postoperative days or until discharge. Pain was assessed with a 10 cm Visual Analog Scale pain score system during the 48 hours postoperatively. The sedation level was assessed using the Sedation Agitation Scale during the same period. Overall postoperative delirium was detected in 12/44 (27%) patients, with 7/22 (32%) in the patient-controlled analgesia and 5/22 (23%) in the paravertebral groups, respectively (p = 0.73). Both groups were similar with respect to demographic data, preoperative medications, and comorbidities. Paravertebral analgesia was associated with an opioid-sparing effect during surgery and during the 48-hour postoperative period. Sedation and pain scores were similar between the 2 groups. In addition, paravertebral analgesia was associated with earlier extubation times; however, the overall morbidity and mortality were similar between the 2 groups. Paravertebral analgesia in patients undergoing transapical TAVR procedures appears to have an opioid-sparing effect. However, it did not translate into a statistically significant decrease in the rate of postoperative delirium.

Relapse in the first three months postpartum in women with history of serious mental illness

BackgroundRelapse of serious mental illness (psychotic and bipolar disorders; SMI) in the postpartum period is potentially devastating for mother and baby. There is limited evidence on whether medication in the perinatal period is protective against postpartum relapse for women with SMI particularly non-affective psychoses. We aimed to investigate risk factors for postpartum relapse, particularly the potential prophylactic effects of medication. MethodsUsing an anonymised resource of comprehensive electronic secondary mental health care records linked with maternity data, women with history of SMI who gave birth from 2007 to 2011 were identified.Relapse was defined as admission to acute care in the first 3 months postpartum. Women who were exposed to regular medication were compared with women who were unexposed. Data were analysed by pregnancy using random effects models to account for repeated measures in women who had more than one pregnancy in the study period. ResultsThere were 452 full term pregnancies, of which 128 (28.3%) were associated with relapse in the first 3 months postpartum, with recent relapse an independent predictor (aOR; 95% CI:1.30–2.27). There was no evidence of a prophylactic effect of medication (crude OR = 0.65; 0.34–1.25) (aOR = 0.99; 0.54–1.83), in women with non-affective or affective psychoses (interaction test p = 0.453). ConclusionsRecent relapse increases the risk of relapse in the postpartum period so women with severe illnesses with a recent history of relapse should be warned pre-conception about the high risk of relapse.The lack of evidence of a protective impact of medication prophylaxis may reflect confounding by indication.

Treatment History of Youth At-Risk for Serious Mental Illness.

The aim was to describe treatment history including medications, psychosocial therapy and hospital visits of participants in the Canadian Psychiatric Risk and Outcomes Study (PROCAN). PROCAN is a 2-site study of 243 youth/young adults aged 12 to 25 y, categorized into 4 groups: healthy controls ( n = 42), stage 0 (non-help seeking, asymptomatic with risk mainly family history of serious mental illness (SMI); n = 41), stage 1a (distress disorders; n = 52) and stage 1b (attenuated syndromes; n = 108). Participants were interviewed regarding lifetime and current treatments, including medications, psychosocial therapies and hospital visits. The number receiving baseline medications differed significantly across groups ( P < 0.001): 0% healthy controls, 14.6% stage 0, 32.7% stage 1a and 34.3% stage 1b. Further, 26.9% and 49.1% of stage 1a and stage 1b participants received psychosocial therapy at baseline, indicative of statistically significant differences among the groups ( P < 0.001). Similar results were observed for lifetime treatment history; stage 1b participants had the highest frequency of lifetime treatment. Medications started in adulthood (>18 y of age) were the most common for initiation of treatment compared to childhood (0 to 12 y) and adolescence (13 to 17 y) for stage 1a and 1b participants. Lifetime mental health hospital visits differed significantly across groups ( P < 0.001) and were most common in stage 1b participants (29.6%) followed by stage 1a (13.5%), stage 0 (4.9%) and healthy controls (2.4%). We found that treatment history for participants in the PROCAN study differed among the at-risk groups. Future initiatives focused on determining the effects of treatment history on SMI are warranted.

Predictors of severe relapse in pregnant women with psychotic or bipolar disorders

Pregnancy in women with severe mental illness is associated with adverse outcomes for mother and infant. There are limited data on prevalence and predictors of relapse in pregnancy. A historical cohort study using anonymised comprehensive electronic health records from secondary mental health care linked with national maternity data was carried out. Women with a history of serious mental illness who were pregnant (2007–2011), and in remission at the start of pregnancy, were studied; severe relapse was defined as admission to acute care or self-harm. Predictors of relapse were analysed using random effects logistic regression to account for repeated measures in women with more than one pregnancy in the study period. In 454 pregnancies (389 women) there were 58 (24%) relapses in women with non-affective psychoses and 25 (12%) in women with affective psychotic or bipolar disorders. Independent predictors of relapse included non-affective psychosis (adjusted OR = 2.03; 95% CI = 1.16–3.54), number of recent admissions (1.37; 1.03–1.84), recent self-harm (2.24; 1.15–4.34), substance use (2.15; 1.13–4.08), smoking (2.52; 1.26–5.02) and non-white ethnicity (black ethnicity: 2.37; 1.23-4.57, mixed/other ethnicity: 2.94; 1.32-6.56). Women on no regular medication throughout first trimester were also at greater risk of relapse in pregnancy (1.99; 1.05–3.75). There was no interaction between severity of illness and medication status as relapse predictors. Therefore, women with non-affective psychosis and higher number of recent acute admissions are at significant risk of severe relapse in pregnancy. Continuation of medication in women with severe mental illness who become pregnant may be protective.

Patient-Reported Symptoms Over 48 Weeks Among Participants in Randomized, Double-Blind, Phase III Non-inferiority Trials of Adults with HIV on Co-formulated Bictegravir, Emtricitabine, and Tenofovir Alafenamide versus Co-formulated Abacavir, Dolutegravir, and Lamivudine

BackgroundIntegrase strand transfer inhibitors (INSTIs) are recommended for first-line antiretroviral therapy in combination with two nucleos(t)ide reverse transcriptase inhibitors. Co-formulated bictegravir, emtricitabine, and tenofovir alafenamide (B/F/TAF), a novel, INSTI-based regimen, is currently approved in the US and EU for the treatment of HIV-1 infection and recommended as first-line treatment in current guidelines. In our current analysis, we aimed to determine changes in patient-reported symptoms over time among HIV-1-infected adults who initiated or switched to B/F/TAF versus another INSTI-based regimen, co-formulated abacavir, dolutegravir, and lamivudine (ABC/DTG/3TC).MethodsA planned secondary analysis of patient-reported outcomes was conducted for two double-blind, randomized, phase III studies in HIV-1-infected adults comparing B/F/TAF with ABC/DTG/3TC: one in treatment-naïve individuals (GS-US-380-1489, ClinicalTrials.gov NCT02607930) and the other in virologically suppressed participants (GS-US-380-1844, ClinicalTrials.gov NCT02603120). In both studies, the HIV symptoms distress module (HIV-SI) was administered at baseline (BL) and weeks 4, 12, and 48. Responses to each of the 20 items were dichotomized as bothersome or not bothersome. Treatment differences were assessed using unadjusted and adjusted logistic regression models (adjusted for BL HIV-SI count, age, sex, BL Veterans Aging Cohort Study [VACS] Index, medical history of serious mental illness, BL Short Form [SF]-36 Physical Component Summary [PCS], BL SF-36 Mental Component Summary [MCS], and, for virologically suppressed participants only, years since HIV diagnosis). We conducted longitudinal modeling of bothersome symptoms using a generalized mixed model including treatment, time, time-by-treatment, and additional covariates from the adjusted logistic regression model as described above. The Pittsburgh Sleep Quality Index (PSQI) was administered at the same frequency as the HIV-SI, and the total score was dichotomized as good or poor sleep quality. Similar models to those used for HIV-SI were applied, using BL sleep quality and BL SF-36 MCS as covariates. Statistical significance was assessed using p < 0.05.ResultsAcross both studies, bothersome symptoms were reported by fewer participants on B/F/TAF than those on ABC/DTG/3TC. In treatment-naïve adults, fatigue/loss of energy, nausea/vomiting, dizzy/lightheadedness, and difficulty sleeping were reported significantly less with B/F/TAF at two or more time points. Fatigue and nausea were also significantly less common for those receiving B/F/TAF in longitudinal models. In virologically suppressed participants, nausea/vomiting, sad/down/depressed, nervous/anxious, and poor sleep quality (from the PSQI) were reported significantly less with B/F/TAF at two or more time points, as well as in longitudinal models.ConclusionsB/F/TAF was associated with lower prevalence of bothersome symptoms than ABC/DTG/3TC in both treatment-naïve and virologically suppressed adults.Electronic supplementary materialThe online version of this article (10.1007/s40271-018-0322-8) contains supplementary material, which is available to authorized users.

HIV Risk, Substance Use, and Personality Characteristics among Adults with History of Serious Mental Illness

ABSTRACTThe present study examined the relationship between characteristics associated with personality disorders, substance use, and HIV risk among adults with a history of serious mental illness. Participants included 103 adults with antisocial or borderline personality disorder, serious mental illness, and recent HIV risk behavior. The sample was predominately male (64%), diverse (42% African American and 13% Hispanic), and homeless/marginally housed (76%). In order to examine the relationship between personality characteristics and risk we constructed a risk index comprising key symptoms of antisocial and borderline personality disorders, namely; impulsivity, affective instability, and disregard for safety of self/others. Contrary to our primary hypotheses, risk index scores did not predict HIV risk behavior and substance abuse did not mediate this risk. Exploratory analyses did reveal that women engaged in significantly more risk behaviors than their male counterparts and that risk scores were a significant predictor of total sex acts for women but not men. In addition, increased emotional dysregulation was a significant predictor of condomless sex acts for women but not men. Finally, recent alcohol use and increased impulsivity was associated with more condomless oral sex for men and women. These results suggest the relationship among serious mental illness, personality disorder, substance abuse, and gender is complex and merits further study.

Prediction of vocational participation and global role functioning in help-seeking young adults, from neurocognitive, demographic and clinical variables

BackgroundThe purpose of this study was to investigate neurocognitive, demographic and clinical correlates of vocational participation among a sample of young help-seeking adults. MethodsYoung people (18–25 years) accessing an early intervention youth health service participated. The Global Functioning: Role scale and level of vocational participation, participant characteristics (age, gender, socioeconomic background and family history of serious mental illness), distress, psychotic-like experiences, substance use, and mental health diagnoses were recorded. The Cambridge Neuropsychological Testing Automated Battery was used to assess sustained attention, visual memory and executive function. ResultsOf the 107 participants, 33 (31%) were not working or studying and 52 (49%) had a diagnosis of affective disorder. Impairments in neurocognitive tests were evidenced in attention shift, sustained attention target sensitivity, impulsivity and spatial working memory errors. Univariate analyses indicated that information processing and target impulsivity were associated with both vocational participation and global functioning, and that spatial working memory strategy was also associated with vocational participation. After controlling for significant demographic and clinical predictors, strategy formation remained a significant correlate of vocational participation (coefficient (95%CI) = −0.08 (−0.17, −0.01)), but no neurocognitive measures remained significant in the multivariate prediction of global functioning. LimitationsNeurocognitive outcomes were assessed at a single time point, factors such as fluctuations in motivation could impact on test results. ConclusionsInterventions targeting work and education participation should consider the capacity of vulnerable young people to develop appropriate plans for role success and provide support accordingly. The study also emphasised the importance of high school completion and avoidance of cannabis use, especially in males.

Deaths From Unintentional Injury, Homicide, and Suicide During or Within 1 Year of Pregnancy in Philadelphia.

To understand the effect of unintentional injuries (e.g., drug overdose), suicide, and homicide on pregnancy-associated death (death during or within 1 year of pregnancy). We analyzed all cases of pregnancy-associated death among Philadelphia, Pennsylvania, residents from 2010 to 2014, examining cause of death, contributing factors, and history of health care use. Approximately half (49%; 42 of 85) of pregnancy-associated deaths were from unintentional injuries (n = 31), homicide (n = 8), or suicide (n = 3); drug overdose was the leading cause (n = 18). Substance use was noted during or around events leading to death in 46% (31 of 67) of nonoverdose deaths. A history of serious mental illness was noted in 39% (32 of 82) of nonsuicide deaths. History of intimate partner violence (IPV) was documented in 19% (15 of 77) of nonhomicide deaths. Regardless of cause of death, approximately half of all decedents had an unscheduled hospital visit documented within a month of death. Unintentional injury, homicide, and suicide contribute to many deaths among pregnant and recently pregnant women. Interventions focused on substance use, mental health, and IPV may reduce pregnancy-associated and pregnancy-related deaths.

Neglect and hereditary risk: Their relative contribution to schizophrenia with negative symptomatology.

There is evidence that genetic and environmental stressors contribute to the genesis of schizophrenia. However, the relevant impact of each factor remains unclear. We tested for an interactive effect between childhood neglect and family history of serious mental illness. Data were further analyzed for a possible connection to type of schizophrenic symptoms. Data for the study are taken from the medical records of 641 patients with schizophrenia from a large state hospital in the northeastern United States. Clinical assessments were divided into positive and negative symptomatology through application of the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Positive and Negative Syndrome Scale (PANSS). Detailed information about childhood neglect and family history of serious mental illness was obtained through Social Service Assessment interviews at intake and during hospital stay. Among clients with no family history of mental illness, childhood neglect does not meaningfully affect the risk of negative versus positive schizophrenia. For clients with such history, on the other hand, neglect significantly raises the risk of schizophrenia with negative symptomatology. Our central finding is that risk for negative symptoms of schizophrenia are elevated by childhood neglect combined with a history of serious mental illness within the family. This is the only report to combine schizophrenic symptoms, familial risk and childhood neglect to date. Implications for primary prevention and treatment are discussed.