Impaired Social Functioning Research Articles

Epidemiology, diagnostics and treatment of attention deficit-hyperactivity disorder (ADHD) in advanced age

Current studies demonstrate acomparably high prevalence of attention deficit-hyperactivity disorder (ADHD) in advanced age. Older people affected by ADHD suffer from asevere burden of psychiatric and somatic comorbidities as well as substantial impairment of social functioning and subjective well-being. The diagnostic differentiation from neurodegenerative diseases is particularly difficult in this age group. This narrative review summarizes the current knowledge about the epidemiology of ADHD in advanced age and possible relationships between ADHD and the risk for neurodegeneration. Furthermore, recommendations for diagnostics and treatment options of ADHD in advanced age are presented.

When healers get wounded! Moral injury in healthcare providers during the COVID-19 pandemic in Pakistan.

Moral injury (MI) is a multi-faceted and multidimensional phenomenon. Occupational MI has been studied mainly among military personnel and first responders and is linked to mental health problems. MI encompasses negative moral emotions such as shame, guilt, and anger leading to distress, and impairment in social and occupational functioning. The COVID-19 pandemic predisposed healthcare providers to moral dilemmas, potentially morally injurious events (PMIEs), and MI. We aimed to assess the prevalence and predictors of MI in healthcare providers during the COVID-19 pandemic in Pakistan. This cross-sectional study was conducted in July-October 2021 among physician/clinician staff working at teaching hospitals in Lahore. The Moral Injury Symptoms Scale-Health Professionals (MISS-HP) was used to collect data. SPSS 26 was used for data analysis applying Wilcoxon Mann-Whitney U and Kruskal-Wallis tests on non-normally distributed data at α = 0.05. Predictors of MI were ascertained through Binary Logistic Regression analysis. Four hundred and twenty physicians responded to the questionnaires. The Median (IQR) MI scores were 37(28-47). Guilt, moral concerns, and shame were higher-scoring MI dimensions. 40.8% (n = 171) suffered from clinically significant distress and impaired functioning while 14.3% (n = 60) from severe distress. Gender, department, and history of psychiatric illness predicted higher levels of distress which were 1.9 times higher in females than males and 2.5 times higher with a history of psychiatric illness. Working on the front lines did not predict MI. Our findings highlight the substantial burden of MI in our sample during COVID-19, having implications for healthcare providers' well-being, healthcare quality, and service delivery. This calls for concerted efforts from all stakeholders to better prepare for future disasters through effective human-resource policies, pre-trauma exposure soft-skills training, effective teamwork and communication strategies; self-stewardship and resilience modules, and mental health support for healthcare providers. The dimensional construct of MI may vary across cultures; hence we recommend further cross-cultural research on MI in healthcare providers, particularly in the context of public health disasters.

Mentalisation in multiple sclerosis: The role of mentalisation in anxiety and depression

Background: Multiple sclerosis(MS) is a chronic inflammatory disease and is characterised by impairment in cognitive and social functioning during the course of the disease. Mentalisation is of great importance in social functioning as it is the ability to understand oneself and others. Mentalisation disorders constitute a risk for psychiatric diseases. In our study, mentalisation skills and their relationship with anxiety and depression symptoms were investigated in MS patients.
 Method: 31 consecutive MS patients were included in the study. Sociodemographic form, Beck depression inventory, Beck anxiety inventory, and mentalisation scale were administered to the participants. Mentalisation was considered in three sub-dimensions: self-based mentalisation (MentS-S), others-based mentalisation (MentS-O) and motivation to mentalise (MentS-M).
 Result: Patients with Anxiety have significantly lower MentS-O scores. MentS-S scores of those with depression were found to be significantly lower and MentS-O scores were found to be higher. While positive moderate correlation was found between MentS-S dimension and depression is, negative moderate correlation was found between MentS-M and MentS-O dimensions
 Conclusion: Mental skills are impaired in patients with Ms. This impairment appears in different sub-dimensions in patients with anxiety and depression. Differences in mentalisation skills are particularly associated with depression.

P01.10.B EMOTION RECOGNITION IN PATIENTS WITH LOW-GRADE GLIOMA: THE RELATIONSHIP WITH TUMOR LOCATION AND TUMOR VOLUME

Abstract BACKGROUND Patients with low-grade gliomas (LGG), generally function well at the time of diagnosis and have a favourable prognosis. However, LGG can have impact on cognitive functioning of patients. To date, little is known about social cognition (SC) in patients with LGG. Social cognitive functions allow the processing of complex social information, with as important element the ability to recognize other people’s emotional expressions. Inaccurate recognition or misinterpretation of emotional facial expressions can lead to impairments in social functioning, which can have adverse effects on quality of life. Therefore, the aim of the present study was to investigate emotion recognition in patients with LGG and the relationship with tumor location and tumor volume. MATERIAL AND METHODS 125 patients with IDH mutated astrocytoma and oligodendroglioma grade 2 and 3, were matched with 169 healthy controls (HC). Tumor location and volume were evaluated pre-radiotherapy based on MRI scans. As a parameter for LGG volume the clinical radiotherapy target volume was used. SC was measured with a test for emotion recognition, i.e. the Facial Expressions of Emotion Stimuli and Tests (FEEST), after surgery. Descriptive statistics and between-group comparisons were performed. RESULTS On a group level, patients with LGG performed significantly lower on the FEEST total score compared to HC. Also, compared to norm data used in clinical practice, 32.8% of the patients showed an impaired performance. Larger LGG volume was significantly associated (p < 0.001) with poorer performance on emotion recognition. However, no direct association between LGG location (frontal, temporal, parietal) and emotion recognition was found. CONCLUSION In patients with LGG, impaired emotion recognition is often present before start of radiotherapy, and is related to larger LGG volume but not to location. Because of the relatively favourable prognosis of patients with LGG, maintaining quality of life is of high importance. Therefore, a thorough neuropsychological examination, including measurements for SC, is necessary to inform patients with LGG about possible changes in SC, and offer appropriate psychoeducation and care.

Total and individual PBC-40 scores are reliable for the assessment of health-related quality of life in Greek patients with primary biliary cholangitis.

Primary biliary cholangitis (PBC) has been long associated with impairment of various aspects of health-related quality of life (HRQoL) with substantial differences among populations. This study evaluated for the first-time the HRQoL in Greek PBC patients in conjunction with clinical and laboratory parameters of patients. We analyzed prospectively collected data regarding the HRQoL by using the PBC-40 and SF-36 questionnaires in 374 Greek PBC patients and 131 age- and sex-matched non-PBC controls. The PBC-40 questionnaire is a reliable tool for HRQoL assessment in Greek PBC patients (Cronbach's α > 0.7 for all domains). Implementation of PBC-40 and SF-36 demonstrated significant impairment of HRQoL in Greek PBC patients compared to controls (P < 0.001 for all comparisons). Emotional dysfunction, social impairment, and fatigue (100%, 80.5% and 78%, respectively) were amongst those with the highest, while cognitive dysfunction (32%) with the least impact on quality of life. Fatigue was associated with female sex (P = 0.02), longer disease duration (P = 0.01), presence of cirrhosis (P = 0.02) and positivity for PBC-specific ANA (P < 0.05), while social dysfunction with increased age (P < 0.001), longer disease duration (P < 0.001) and presence of cirrhosis (P = 0.004). Living in urban areas was linked to impaired social function (P = 0.04), cognition (P = 0.02), fatigue (P = 0.04) and increased total PBC-40 score (P = 0.01). Implementation of PBC-40 and SF-36 revealed impaired HRQoL in Greek PBC patients with fatigue, social and emotional dysfunction exerting the highest impact. However, total, and individual PBC-40 scores were lower than that reported in studies from Northern/Central Europe and Canada. Deranged HRQoL was associated with severity of liver disease and presence of PBC-specific ANA.

The association of depression and anxiety symptoms to three different types of activities of daily living in persons with and without HIV

ABSTRACT Mood disorders are highly prevalent in people living with HIV (PLWH) and represent a potential contributor to functional impairment in activities of daily living. We aimed to determine if (1) Anxiety and depression symptoms were independently associated with impairments in basic self-care, role functioning, and social functioning and (2) PLWH differentially experienced impairments due to mood symptoms compared to those without HIV. Data for this study were obtained from 150 individuals (87 PLWH, 61% male, mean age = 44) via a cross-sectional study on alcohol and HIV-associated brain dysfunction. The Beck Anxiety Inventory (BAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess anxiety and depressive symptoms. Higher anxiety symptoms were associated with role functioning impairment, while higher depressive and anxiety symptoms were each associated with social functioning impairment. As depressive symptoms increased, PLWH were 3x more likely to have impairments in role functioning compared to those without HIV. HIV status did not interact with mood symptoms to affect basic self-care or social functioning. Overall, mood symptoms are associated with different types of functional impairment, and improved management of mood symptoms could lead to improved role and social functioning.

Integrating Cognitive-Behavioral Therapy With Compassion-Focused Therapy for the Treatment of Social Anxiety Disorder: An Evidence-Based Case Study

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for social anxiety disorder that has been found to elicit significant changes in process-based mechanisms (e.g., emotion regulation strategies), which subsequently lead to reductions in social anxiety and associated functional impairment; however, CBT may be less effective for socially anxious individuals experiencing high self-criticism and low self-compassion. Compassion-focused therapy (CFT) has been used to address these tendencies in socially anxious individuals, but research in this area is limited. The present case study examined changes in social anxiety symptoms, self-compassion, emotion regulation strategies, and functional impairment throughout the course of treatment with a young, Chinese American woman using a novel integration of CBT and CFT for social anxiety disorder. The client experienced significant reductions in social anxiety and functional impairment across treatment, which was accompanied by reductions in fear and avoidance ratings for feared social scenarios. Significant mechanistic changes were also observed, including decreases in maladaptive emotion regulation strategies (i.e., suppression, rumination) and increases in self-compassion and adaptive emotion regulation strategies (i.e., expressive engagement, cognitive reappraisal). Findings support the efficacy of integrating compassion-focused strategies with CBT for social anxiety for a young adult with prominent tendencies of self-criticism and low self-compassion.

Behavioral and psychiatric correlates of brain responses to social feedback.

Maladaptive responses to peer acceptance and rejection arise in numerous psychiatric disorders in adolescence; yet, homogeneity and heterogeneity across disorders suggest common and unique mechanisms of impaired social function. We tested the hypothesis that social feedback is processed similarly to other forms of feedback (e.g., monetary) by examining the correspondence between the brain's response to social acceptance and rejection and behavioral performance on a separate reward and loss task. We also examined the relationship between these brain responses and depression and social anxiety severity. The sample consisted of one hundred and thirteen 16-21-year olds who received virtual peer acceptance/rejection feedback in an event-related potential (ERP) task. We used temporospatial principal component analysis and identified a component consistent with the reward positivity (RewP) or feedback negativity (FN). RewP to social acceptance was not significantly related to reward bias or the FN to social rejection related to loss avoidance. The relationship between RewP and depression severity, while nonsignificant, was of a similar magnitude to prior studies. Exploratory analyses yielded a significant relationship between lower socioeconomic status (SES) and blunted RewP and between lower SES and heightened loss avoidance and blunted reward bias. These findings build on prior work to improve our understanding of the function of the brain's response to social feedback, while also suggesting a pathway for further study, whereby poverty leads to depression via social and reward learning mechanisms.

The Essential Network (TEN): engagement and mental health insights from a digital mental health assessment tool for Australian health professionals during COVID-19

BackgroundHealth professionals are at risk of poor mental health outcomes due to the COVID-19 pandemic. The Essential Network (TEN) is a blended care mental health support service for Australian health professionals, funded by the Australian Federal Department of Health. TEN comprises both digital and face-to-face components. We examined completed digital mental health assessments (Digital Mental Health Check-Up) to understand usage of TEN and the demographics and mental health of users.MethodsA total of 9889 completed assessments from a community sample of help-seeking health professionals who engaged with the Digital Mental Health Check-Up between May 2020 and December 2021 were examined. Users had the option to complete the Distress Questionnaire (DQ-5), Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7), Oldenburg Burnout Inventory (OLBI-16), Work and Social Adjustment Scale (WSAS), Post-traumatic Stress Disorder Checklist (PCL-5), as well as provide demographic information on their gender, age, and profession.ResultsUsers were mostly women (85.7%) aged between 25 and 54 (73.7%). Nursing was the most reported profession (32.6%), followed by allied health (27.5%) and doctors (21.9%). Notably, 8.1% of users reported being in medical administration roles. Mental health measures were poor across all measures and professions and worse than would be expected from the general population. Disengagement (92.5%) from burnout and impaired social and occupational functioning (75%) were also notably high. Use of the DQ-5 as a screening tool in the Digital Mental Health Check-Up was confirmed through correlation with clinically significance scoring on all other measures and increased likelihood of opting to complete other optional measures following clinically significant scoring on the DQ-5.ConclusionsThe present study indicates good usage of the TEN digital components among Australian health professionals, with use across all professional categories. While self-selection bias is inherent in the sample, mental health measures were notably poor – particularly for burnout. Such findings highlight the continued need to provide mental health support to health professionals both during and after the eventual resolution of the COVID-19 pandemic, as well as to develop better support for health professionals experiencing burnout.

Short Report on Effectiveness of an Autistic-Delivered Peer Support Program: Preliminary Results.

There is little research on the effectiveness of autistic peer-delivered services. This study examines early outcomes associated with the Community Autism Peer Specialist program (CAPS), which was created in partnership with autistic individuals and is delivered by autistic adults who have received training in the delivery of peer support services to enhance the community functioning of autistic youth and adults. A single group pre-test/post-test design was used to examine early outcomes in the areas of independent living needs, social functioning, service engagement, and quality of life. A total of 23 individuals with autism aged 14-41 years were included in the study. Reductions were found in social functioning impairments and unmet needs after three months in the program. Participants also reported greater engagement in mental health services and activities that promote wellness compared with before the program. This study suggests that peer support services delivered by autistic peers may be an effective intervention approach for autistic youth and adults. Future studies with a more rigorous study design (e.g., randomized controlled trials), a larger sample size, and longer-term outcome measurements are needed to further investigate the effectiveness of CAPS and similar autistic-delivered services.

Older Adult Mental Health: A Student-Led Project to Reduce Stigma Among Residents Living in a Publicly Supported Housing

Twenty percent of older adults report having a concern about their mental health. Mental health concerns lead to impairments in physical, mental, and social functioning and complicate the management of chronic illness. These concerns are widely underrecognized and often untreated or under-treated in community-dwelling older adults. A 6-week student-led mental health promotion initiative for older adults living in publicly supported housing was developed. The initiative included student-led weekly “mood” screenings which aimed to destigmatize mental illness and educational sessions teaching the older adults how to use iPads and access the internet and Wi-Fi. The goal of the project was to have residents engage in telehealth visits that promote mental health and improve quality of life. Ungirded by the RE-AIM framework, the initiative focused on achieving Reach by ensuring participants had sufficient knowledge and skill in using the telehealth technology and were not encumbered by mental illness stigma. The project sample of older adults living in publicly supported housing self-reported minimal depressive symptoms and demonstrated stigma toward seeking help for mental illness. Cultural implications contribute to these findings. To have a program with good Reach as delineated in the RE-AIM model, it must recognize facilitators and barriers. Integrating affordability, cultural congruency, and a social connection to community in its design together with the utilization of students during implementation may promote mental health and mitigate some of the negative health consequences.

Psychosocial Problems on Adolescents with Thalassemia Major: A Systematic Scoping Review

Disease and treatment of thalassemia major that are carried out for life can cause physical and psychological problems in sufferers. Adolescents with thalassemia major will experience disturbances at a stage of development that is undergoing dynamic changes. Nurses, as health workers who provide holistic services, need to know what psychosocial problems may arise in adolescents with thalassemia major. This study aims to describe psychosocial problems in adolescents with thalassemia major. This study uses a scoping review design by searching English literature through the CINAHL, PubMed, and Scopus databases. The keywords used are psychosocial problems, thalassemia major, and adolescence. The criteria for the article in this study where the patient was a teenager with thalassemia, open access full text, and the time setting was the last 10 years (2013-2022). We found 9 articles discussing psychosocial problems in adolescents with thalassemia. Psychosocial problems that arise in the form of disturbances in several functions, namely physical, emotional, social, and school functions. Psychosocial disorders that occur in adolescents with thalassemia cause disturbances at the stage of adolescent development. Psychosocial problems that occur in adolescents with thalassemia include impaired physical, emotional, social, and school functions.&#x0D; Keywords: adolescence, psychosocial problems, thalassemia major

Development of social functioning in preadolescent children at familial high-risk of schizophrenia or bipolar disorder – a 4-year follow-up study from age 7 to 11

Social functioning is a major indicator of psychosis risk and evidence is lacking regarding social functioning development during preadolescence in children at familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP). We aimed to investigate development of social functioning from age 7 to 11 in children at FHR-SZ or FHR-BP compared with population-based controls. At 4-year follow-up, 179 children at FHR-SZ (mean age 12.0 y, SD 0.3), 105 children at FHR-BP (mean age 11.9 y, SD 0.2), and 181 controls (mean age 11.9 y, SD 0.2) participated. We used the Vineland-II to measure social functioning. Development of social functioning was non-significantly different across groups on the Socialization Composite score as well as the subscales Interpersonal Relations, Play and Leisure, and Coping Skills. At 4-year follow-up, children at FHR-SZ demonstrated impaired social functioning, whereas children at FHR-BP displayed social functioning comparable to controls except from impaired coping skills. From age 7 to 11, the maturational pace of social functioning in children at FHR-SZ and FHR-BP is parallel to that of controls. Children at FHR-SZ show stable social functioning deficits, whereas children at FHR-BP show normal social functioning except from emergence of discretely impaired coping skills at age 11.

Automatically annotated motion tracking identifies a distinct social behavioral profile following chronic social defeat stress

Severe stress exposure increases the risk of stress-related disorders such as major depressive disorder (MDD). An essential characteristic of MDD is the impairment of social functioning and lack of social motivation. Chronic social defeat stress is an established animal model for MDD research, which induces a cascade of physiological and behavioral changes. Current markerless pose estimation tools allow for more complex and naturalistic behavioral tests. Here, we introduce the open-source tool DeepOF to investigate the individual and social behavioral profile in mice by providing supervised and unsupervised pipelines using DeepLabCut-annotated pose estimation data. Applying this tool to chronic social defeat in male mice, the DeepOF supervised and unsupervised pipelines detect a distinct stress-induced social behavioral pattern, which was particularly observed at the beginning of a novel social encounter and fades with time due to habituation. In addition, while the classical social avoidance task does identify the stress-induced social behavioral differences, both DeepOF behavioral pipelines provide a clearer and more detailed profile. Moreover, DeepOF aims to facilitate reproducibility and unification of behavioral classification by providing an open-source tool, which can advance the study of rodent individual and social behavior, thereby enabling biological insights and, for example, subsequent drug development for psychiatric disorders.

Exercise as an Adjuvant Treatment of Schizophrenia: A Review.

Schizophrenia is achronic debilitating condition associated with impaired social functioning, memory, and executive functioning. To date, we are still unsure about the exact etiology of schizophrenia, but there are many factors, such asgenetics, diminished hippocampal volume, and imbalance ofneurotransmitters, that lead to the pathogenies of the disease.Antipsychotics arethe most effective treatment option for schizophrenia so far, yetthey are associated with a wide array of side effects, ranging from extrapyramidal side effects to conditions, such as metabolic syndrome. Exercise has been shown to increase neural connections in the brain, which can improve cognition and memory. This literature review focuses on the signs and symptoms of schizophrenia, its treatment options, and how exercise can help with some of the symptoms of schizophrenia, especially the negative symptoms that are least effectively treated by antipsychotics.

Examining associations, moderators and mediators between childhood maltreatment, social functioning, and social cognition in psychotic disorders: a systematic review and meta-analysis.

Childhood maltreatment (CM) has been related to social functioning and social cognition impairment in people with psychotic disorders (PD); however, evidence across different CM subtypes and social domains remains less clear. We conducted a systematic review and meta-analysis to quantify associations between CM, overall and its different subtypes (physical/emotional/sexual abuse, physical/emotional neglect), and domains of social functioning and social cognition in adults with PD. We also examined moderators and mediators of these associations. A PRISMA-compliant systematic search was performed on 24 November 2022 (PROSPERO CRD42020175244). Fifty-three studies (N = 13 635 individuals with PD) were included in qualitative synthesis, of which 51 studies (N = 13 260) with 125 effects sizes were pooled in meta-analyses. We found that CM was negatively associated with global social functioning and interpersonal relations, and positively associated with aggressive behaviour, but unrelated to independent living or occupational functioning. There was no meta-analytic evidence of associations between CM and social cognition. Meta-regression analyses did not identify any consistent moderation pattern. Narrative synthesis identified sex and timing of CM as potential moderators, and depressive symptoms and maladaptive personality traits as possible mediators between CM and social outcomes. Associations were of small magnitude and limited number of studies assessing CM subtypes and social cognition are available. Nevertheless, adults with PD are at risk of social functioning problems after CM exposure, an effect observed across multiple CM subtypes, social domains, diagnoses and illness stages. Maltreated adults with PD may thus benefit from trauma-related and psychosocial interventions targeting social relationships and functioning.

The Mediating Effect of Social Functioning on the Relationship between Catastrophizing and Pain among Patients with Chronic Low Back Pain.

Pain catastrophizing can be characterized as an interpersonal form of coping used to elicit support or empathy from others. Despite intentions of increasing support, catastrophizing can impair social functioning. While considerable work has addressed the relationship between catastrophizing and pain, limited empirical work has examined this relationship within a social context. First, we examined the role of catastrophizing as a potential contributor to group differences (cLBP vs. pain-free controls) in social functioning. Then, we conducted a follow-up, exploratory analysis to examine the relationships between catastrophizing, social functioning, and pain within the subgroup of participants with cLBP. In this observational study, participants with cLBP (N = 62) and pain-free controls (N = 79) completed validated measures of pain, social functioning, and pain catastrophizing. A mediation analysis was conducted to examine whether catastrophizing mediated group differneces (cLBP vs. controls) in social functioning. A follow-up, exploratory mediation analysis then tested whether social functioning mediated the association between catastrophizing and pain within the subgroup of cLBP participants. Participants with cLBP reported higher levels of pain, impaired social functioning, and higher catastrophizing compared to pain-free controls. Catastrophizing partially mediated the group difference in impaired social functioning. Additionally, social functioning mediated the association between higher catastrophizing and greater pain within the subgroup of cLBP participants. We showed that impaired social functioning was driving the relationship between higher pain catastrophizing and worse pain among participants with cLBP. Interventions, such as cognitive behavioral therapy, should address catastrophizing in individuals with cLBP, while simultaneously improving social functioning.

Residual experiential symptoms mediate the effect of expressive symptoms over the social functioning in remitted schizophrenia.

Impairment in social functioning had been consistently found in remitted schizophrenia; yet, predictors of social dysfunction had been hardly explored and intervention trials had rarely included remitted schizophrenia. 60 subjects with schizophrenia (diagnosed based on DSM5), currently in remission (SAPS and SANS global rating ≤2, for a minimum period of 12 weeks) and 46 age and gender-matched healthy controls were recruited after obtaining informed consent. The socio-demographic details, illness characteristics, depressive symptoms, positive and negative symptoms [using Scale for assessment of positive symptoms (SAPS), and scale for assessment of negative symptoms (SANS)] were assessed. The Theory of Mind (ToM) score was derived from the ToM tasks of a culturally validated tool, Social Cognition Rating Tools in Indian Setting. The social functioning was assessed using Groningen social disabilities schedule II (GSDSSII). The mean SAPS summary and SANS summary scores were 3.01 ± 2.99 and 4.32 ± 2.94, respectively. The social functioning was significantly impaired in remitted schizophrenia when compared to healthy controls. In the hierarchical regression, experiential dimension (β =1.941, t = 6.097, P < 0.001), followed by expressive dimension predicted social functioning (explained 70.5% of variance) after controlling for confounders. On mediation analysis, the effect of expressive dimension over the social functioning was significantly mediated by experiential dimension (E = 1.1821, Boot SE = 0.2895, C.I: 0.6934 to 1.7862). The experiential dimension mediates the effect of expressive dimension over the social dysfunction in remitted schizophrenia. Future studies should focus on targeting the experiential dimension and thereby social functioning.

Тривога та порушення сну: можливості комбінованої фітотерапії

According to the WHO, the number of people suffering from anxiety disorders, sleep disorders, and depression is increasing every year, especially in low-income countries, where life expectancy is increasing dramatically, and with it the incidence of mental disorders [1, 2]. Anxiety disorders are the most common group of mental illnesses together with sleep disorders and astheno-neurotic syndrome [3]. Anxiety accompanies the course of many mental and somatic diseases [4]. It usually appears early in life, causes cumulative damage, and can contribute to depression, substance abuse, and other adverse outcomes [5]. Sleep disturbances and anxiety are frequent competing or synergistic symptoms. The onset and development of these conditions are often interrelated. In addition, these conditions often correlate with the appearance and course of other disorders - such as depression, dementia, and obsessive-compulsive disorder. Long-term, uncorrected disturbances of circadian rhythms lead to clinically significant distress and cause mental, physical, social, professional, educational, or other functional impairments [6].

Understanding Dissociative Identity Disorder: A Literature Review

Interest in dissociative identity disorder (DID) in psychiatry has increased rapidly although epidemiologically the cases of patients with DID are still rare, several studies exist trying to understand how DID might occur and the best therapeutic approach. Some of the symptoms of DID can also be found in non-clinical populations even though they are not directly related to the disorder. The findings of DID are often associated with other psychiatric disorders and can complicate the diagnosis. Various studies have tried to understand the case of DID either objectively or subjectively. Diagnosis of DID must be diagnosed by carefully experienced clinicians with clinical interviews with some proper tests that could help to identify various identities. Current DID therapy may be able to strengthen the identity of the patient’s control and prevent impaired social functioning of the patient. Many pharmacological and non-pharmacological treatments have been developed to improve symptoms of the disorder, but none of them have been effective due to the quality of the studies conducted. Further research is still needed on DID as a whole to assist in the correct diagnosis and therapy for DID patients.