Important Areas Of Functioning Research Articles

Exploring sub-threshold food addiction in adult patients with severe obesity: a cross-sectional analysis

Background Most studies on Food Addiction (FA) used the strict classical diagnosis approach without quantifying sub-threshold symptoms (i.e. uncontrolled/excessive food intake, negative affect, craving, tolerance, withdrawal, and continued use despite harm) nor indicating where they stand on the “three-stage addiction cycle” modeling the transition from substance use to addiction. Objectives (1) to estimate the proportion of clinically significant episodes of distress/impairment in severely obese patients without FA, and (2) to assess their associations with FA symptoms at the subthreshold level. Methods The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) assesses 11 symptoms (diagnostic criteria) plus clinically significant impairment and distress (clinical significance criterion). We used this tool to diagnose FA (≥ 2 criteria plus clinical significance) in adult patients with severe obesity, but included only those below the threshold in the analyses. Demographics, clinical features, and obesity complications were collected. Results Only 18% of the 192 participants (women n = 148, 77.1%; mean age: 43.0 ± 13.2) reported a total absence of FA symptoms, while one in four reported recurrent episodes of clinically significant distress (24%) or impairment (25%) in social, occupational, or other important areas of functioning. The most common recurrent symptoms were first-stage symptoms (binge/intoxication), while second- (withdrawal/negative affect) and third-stage (preoccupation/anticipation) symptoms affected nearly one patient in five for tolerance and craving, and one in ten for withdrawal. In multivariate analysis, impairment was positively related to withdrawal and tolerance, while distress was positively related to failure in role obligations. Conclusion Many patients with severe obesity experience recurrent episodes of FA symptoms at the subthreshold level. Prospective studies will examine whether these symptoms may play a causal role in symptoms progression toward a full-blown FA and obesity outcomes.

Protocol for a Single-Arm Feasibility Study of Photobiomodulation for Fatigue, Depression, and Pain in Inflammatory Bowel Disease.

There are limited treatment options for mental health comorbidities associated with Inflammatory Bowel Disease (IBD), although they have been shown to negatively affect the course of IBD and multiple important areas of functioning. Photobiomodulation (PBM) is a new therapeutic intervention using laser-generated low-powered light therapy that has shown early promise in alleviating fatigue, depression, and pain in chronic illness. This prospective, single-arm pilot study aims to assess the feasibility and efficacy of PBM in the treatment of fatigue, depression, and pain in youth with IBD. We will recruit 28 young adults with IBD who will receive PBM in addition to treatment as usual. The primary outcome will be fatigue, while secondary outcomes will include depression, pain, quality of life, inflammatory markers, alterations in microbiome composition, physical activity, and functioning. Outcome measures will be assessed at baseline, after a 10-week control period (pre-PBM), at 20 weeks (post-PBM), and at 30 weeks. Feasibility will be assessed by attendance, recruitment rates, and participants' views of PBM. Mixed-effects linear regression modelling will be used to assess the PBM effect on continuous outcomes (fatigue, depression, anxiety and stress scores, and inflammation levels). The study will provide preliminary indicators of PBM feasibility and efficacy in IBD.

Characterization of a population of transgender individuals and their perceived negative mental health and life experiences

Introduction Gender dysphoria (GD) is characterized by a marked incongruence between one’s experienced/expressed gender and gender assigned at birth, associated with clinically significant distress or impairment in important areas of functioning. Persons with GD are a population with specific healthcare needs. In our hospital, psychiatric assessment of these individuals started in 2008. Objectives Characterization of a population of transgender individuals and their perceived negative mental health and life experiences. Methods Since the beginning of evaluations of transgender individuals in our hospital, from 2008 to 2022, they were asked to freely elaborate their “life story”: a report of the most relevant events in their lives, related to their condition. We retrospectively analyzed the content of the reports that were sent and associated with the clinical files. Results We collected the data of 104 individuals. The gender attributed at birth consisted of 74 (71.2%) females and 30 (28.8%) males. As for the gender identity, the sample consisted of 73 (70.2%) males, 28 (26.9%) females, 2 (1.9%) nonbinary and 1 (1%) person didn’t identify with any of the existent denominations. The medium age in October of 2022 was 27.4 (minimum 18, maximum 60, SD 7.3). The age at first evaluation at consult was 23.6 (minimum 15, maximum 56, SD 7.2). 99 (95.2%) individuals mentioned symptoms of gender non-conformity beginning in childhood, and of those who mentioned their adolescence (n=43, 41.3%), all expressed feelings of anguish relating to their changing bodies. The medium age of recognition of their condition was 17.2 (minimum 11, maximum 30, SD 4.3). Of those who recall their first contact with health practitioners regarding their symptoms (n=31, 29.8%), 32.3% admitted they didn’t feel they were helped. Of those who mentioned early relationships with family and carers (n=65, 62,5%), 35.4% reveal dysfunctional relationships and 79% mention gender expectations from their families. Similarly, 42 (40.4%) individuals reveal experiences of victimization and bullying because of their gender nonconformity. 53 (60.2%) described symptoms of a likely comorbid psychiatric illness throughout their life, particularly depressive symptoms, anxious symptoms, suicide attempts and non-suicidal self-injury. Conclusions GD has gained more attention in the recent years, and the scientific community has now developed a more accurate set of criteria for the recognition of this condition. The findings in our study are in accordance with these criteria. Unfortunately, much of the suffering this condition entails is also associated with distress related to stigma and societal gender expectations, and that was evident in this investigation. Disclosure of Interest None Declared

What’s new on the treatment of pedophilia and hebephilia?

IntroductionParaphilias constitute a set of psychiatric conditions that are often chronic and require a combination of treatment approaches, such as pharmacotherapy and psychotherapy. Sexual interest toward prepubescents and pubescents (pedophilia and hebephilia) is frequently identified in criminal settings, within numerous child sexual abuse and child pornography offenses. The high prevalence rates and negative consequences of these acts, causing distress in multiple important areas of health and functioning, reveal the importance of preventing these offenses as a clinical and social matter. Secondary prevention programs, which provide treatment and support for those with paraphilia disorders before sexually abusive behaviors and legal system involvement, show as ethically and socially necessary.ObjectivesWe aim to discuss and bring insights into the knowledge on pedophilia and hebephilia treatments and prevention programs, in the fields of psychotherapy as well as pharmacologic strategies.MethodsWe present a non-systematic review of the updated literature on this subject from the data found on the PubMed and PsycInfo databases.ResultsPreliminary results of recent works show that at-risk individuals with paraphilia disorders are often willing to seek treatment without external pressure from the legal system, and report benefits from early treatments. Most studies found that gonadotropin-releasing hormone agonists reduce the risk of child sexual abuse in men with pedophilia. An injectable form has shown to lower this risk 2 weeks after the initial injection, suggesting its use as a rapid-onset treatment option. Cyproterone acetate and medroxyprogesterone acetate are other anti-androgen drugs that inhibit hypersexual behavior, with important side effects to be considered. The combination of androgen deprivation treatment and psychotherapy has a greater effect on preventing fantasies, urges, and behaviours in paraphilic patients. Cognitive-behavioural psychotherapy shows the best results and should soon be initiated in all patients. Biomolecular studies revealed that serotonin and prolactin inhibit sexual arousal, being SSRIs used as first treatment in younger patients, particularly in less severe cases.ConclusionsEvidence-based treatments from randomized clinical trials for paedophilic and hebephilic disorders are lacking. These current numbers reveal the need for widespread implementation of primary and secondary prevention initiatives, that go beyond the prevention of a repeated offense. There is a need for further research using controlled, randomized trials to examine the effectiveness of sexual offender treatment including psychotherapeutic and pharmacologic interventions. The development of more specific, more effective, and better-tolerated medications for these disorders should be recognized as a program worthy of greater support from government and pharmaceutical industry sources.Disclosure of InterestNone Declared

Perfectionism in theory and research

Purpose The purpose of the present article is to systematize knowledge about perfectionism - the relatively stable tendency to set unrealistic expectations for oneself or others. The article reviews studies conducted in recent years and presents the evolution of views on the development and importance of perfectionism for individual adjustment. Theses Knowledge about perfectionism is constantly expanding, which makes it necessary to describe the history of the study of this phenomenon, the evolution of ways of thinking, and the theoretical models that have emerged over the past decades. There are relatively few publications on this subject in the Polish literature, and the presented article aims to at least partially fill this gap. We present the results of a study on the relationship between perfectionism and important areas of human functioning, such as health, work and interpersonal relations, and point out factors associated with the development of this characteristic. We also present the most popular measures of perfectionism. Conclusion Perfectionism, initially viewed as an unambiguously negative disposition and treated as a predictor of psychopathology, in light of studies conducted in recent years should be treated as a complex personality characteristic that manifests itself manifests itself in different manner, including positive and adaptive ones.

Pedophilia-Social Shame at present

Presently in the society main pathetic and cruel news is sexual harassment as well as molestation towards children, girls,women even old age people also. By keeping this concept to make people aware have taken this initiation to put lighton a very interesting topic i.e. Pedophilia. Pedophilia is a type of illness in conventional usage, a psychosexual disorder,commonly affecting adults, manifested by sexual interest in preteen children or attempts to engage in sexual acts withprepubescent children. The word pedophilia originates from the Greek παῖς, παιδός (paîs, paidós) means “child”, andφιλία (philía), “friendly love” or “friendship”. The term paedophilia erotica was thought up in an 1886 article by theViennese psychiatrist Richard von Krafft-Ebing. According to the Diagnostic and Statistical Manual of Mental Disorders,fourth edition text revised the fantasies, sexual urges or behaviors must cause clinically significant distress or impairmentin social, occupational or other important areas of daily functioning. Some psychological treatment ways for treating thisdisease are Cognitive-behavioral Therapy (CBT), Psychodynamic Therapy, Neurobiological Interventions etc.

Grief Impairment Scale: A biopsychosocial measure of grief-related functional impairment

Though most mourners are resilient, a minority of the bereaved experience disabling grief accompanied by clinically significant impairment in important areas of functioning. Although impairment measures exist, they have notable limitations in the context of bereavement. Therefore, the objective of this study was to develop and evaluate the Grief Impairment Scale (GIS), which was designed to identify the impact of grief on biopsychosocial functioning. The resulting 5-item scale, which was based on 363 adults who are struggling with grief, demonstrated solid reliability, factorial validity, and convergent and divergent validity with correlations with measures of impairment, prolonged grief, and psychological distress. The GIS also measures grief-related functioning equivalently across demographic groups and satisfactorily discriminates between persons with and without impairment using an optimized cut score of ≥ 9 (79% sensitivity and 74% specificity). These results provide preliminary support for the GIS as a flexible tool for clinical research and practice.

Cultural and biological factors in body dysmorphic disorder in East Asia.

Body dysmorphic disorder (BDD) can cause severe distress and impairment in many important areas of functioning. Although BDD has been well studied in Western populations, there is limited information on BDD in other cultures. In this review, we discuss the prevalence and presentation of BDD in East Asian countries and the significance of conducting further research in this particular group.

Subtyping treatment-seeking gaming disorder patients

Background and aimsGaming Disorder (GD) is characterized by a pattern of persistent and uncontrolled gaming behavior that causes a marked impairment in important areas of functioning. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the existence of different subtypes within clinical samples, in order to tailor treatment. This study explored the existence of different profiles of patients seeking treatment for GD through a data-driven approach. MethodsThe sample included n = 107 patients receiving treatment for GD (92% men and 8% women) ranging between 14 and 60 years old (mean age = 24.1, SD = 10). A two-step clustering analysis approach explored the existence of different underlying GD profiles based on a broad set of indicators, including sociodemographic features, clinical course of the condition (e.g., onset or evolution), psychopathological symptoms, and personality traits. ResultsTwo GD profiles emerged. The first cluster grouped together patients who presented with a lower psychological impact (n = 72, 66.1%), whereas the second cluster comprised patients with a higher psychological impact (n = 35, 32.7%). Cluster comparisons revealed that those patients presenting the higher impact were older, with a later onset of pathological gaming patterns, and more pronounced psychopathological symptoms and dysfunctional personality profiles. ConclusionsGD severity is influenced by specific demographic, clinical, and psychopathological factors. The identification of two separate profiles provides empirical evidence that contributes to the conceptualization of this disorder, as well as to the development of reliable and valid screening tools and effective intervention plans focused on the precise characteristics of the treatment-seeking patients.

Comparison between only Child and Child with Siblings on Adjustment and Personality

A sibling relationship is likely to be the most lasting in our lives. It has an important role not only in the family life but also influences our adjustment and wellbeing in social circumstances. However, in the face of failing fertility and increases in divorce, the number of children growing up without other children in the household has increased as families have become smaller. The term adjustment refers to the degree to which an individual’s personality functions effectively in the world of people. Personality refers to the unique and relatively stable qualities that characterize a person’s responses to life situations over a period of time. The aim of the research was to compare the level of adjustment and personality in only child and child with siblings. For this purpose, a sample of 100 adolescents (50 only child and 50 sibling child) was taken. NEO-FFI and Adjustment Inventory for College students were used as tools. The results indicate that sibling child are more adjusted than only child and also there are significant differences on the dimensions of neuroticism, extraversion and openness to experiences. Since the results show that adjustment is comparatively low in only child, it indicates that being an only child is a disadvantage in itself as they are always over pampered, and given undivided love which in turn leads to some form of maladjustment in important areas of functioning. Also, since sibling child are high on neuroticism, extraversion and openness to experiences, it indicates that how having a sibling affects the overall development of an individual which have a crucial role to play in how an individual perceive and interact with others, and how open he/she is to new ideas and experiences.

Trastorno dismórfico corporal del adolescente

El Trastorno Dismórfico Corporal (TDC) es un trastorno caracterizado por la preocupación por defectos físicos corporales no existentes, o apenas perceptibles, que generan un gran malestar psicológico o un deterioro en el funcionamiento de la persona que lo padece. La prevalencia de este trastorno oscila entre el 1,7 y 2,5% en la población general, siendo las dos terceras partes de los casos de inicio en la adolescencia. Existen diferencias significativas a la hora de clasificar este trastorno. Mientras que la CIE-10 lo hace dentro de los trastornos somatomorfos, el DSM-5 y la futura CIE-11 lo clasifican dentro del Trastorno obsesivo compulsivo (TOC) y Trastornos relacionados. Así mismo, a nivel clínico, pueden surgir dudas diagnósticas con los trastornos psicóticos o con los trastornos de la conducta alimentaria. Presentamos el caso de una paciente de 16 años, cuya sintomatología planteaba los interrogantes previamente descritos, decantándonos finalmente por el diagnóstico de TDC en la forma en que lo hacen el DSM-5 y la futura CIE-11 (TOC y trastorno relacionados), siendo tratada como tal y evolucionando de forma favorable. Este artículo tiene dos objetivos principales. En primer lugar, actualizar al lector en el novedoso cambio nosológico del TDC en la CIE-11, que se aproxima cada vez más a la orientación americana, siendo ésta la que hemos usado como referente para nuestro trabajo. En segundo lugar, profundizar en el diagnóstico diferencial de esta entidad, ya que no resulta una tarea sencilla y prueba de ello es el cambio clasificatorio anteriormente mencionado.

Post-Traumatic Stress Disorder and Associated Factors Among Traumatic Patients Attended in Four Government Hospitals, West Ethiopia

Background: Posttraumatic Stress Disorder is exposure to actual or threatened death that leads to negative alterations in cognitions and mood, and marked change in arousal and reactivity. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Patients’ quality of life decreases in almost every dimension after severe trauma. Objective: This study aims to assess the prevalence of post-traumatic stress disorder and its associated factors among fifteen years and above aged patients with traumatic history for more than one month who attended four government hospitals in East Wollega Zone, West Ethiopia. Methods: An institutional based cross-sectional study was employed using an interviewer-administered questionnaire. Post-trauma stress disorder symptoms scale was employed to assess the prevalence of post-trauma stress disorder and its associated factors among fifteen years and above aged patients. Study populations were those who had a history of a traumatic injury and attended four government hospitals in East Wollega Zone, West Ethiopia, for more than one month. Study participants were, consecutively, recruited from January to February 2018. Results: One hundred ninety-three traumatic patients participated in this study. Male participants accounted for 119 (61.7%) and 82 (42.5%) of respondents aged between 15-26 years. The prevalence of Posttraumatic Stress Disorder in this study was 33 (17.1%). Female traumatic patients were 2.727 times more likely to develop post-traumatic stress disorder than male respondents (AOR= 2.727, 95% CI: 0.431-4.227). Similarly, participants who were found to be involved in substance abuse were 1.65 times (AOR= 1.65, 95% CI: 0.926-2.782) more likely to develop post-traumatic stress disorder than their counterparts. Also, daily laborers were 4.05 times (AOR= 4.05, 95% CI: 0.89-8.76) more likely to develop post-traumatic stress disorder than government employees. Conclusion: The prevalence of post-traumatic stress disorder, in this study, was 17.1%. Psychological counseling services offered to female patients, daily laborers, and substance abusers can benefit them as they were significantly associated with the post-traumatic stress disorder.

Schizotypal personality disorder in clinical obsessive-compulsive disorder samples: a brief overview.

Obsessive-compulsive disorder (OCD) is a chronic and disabling mental disorder characterized by the presence of obsessions and/or compulsions that cause major distress and impair important areas of functioning. About 9 out of 10 patients with OCD have comorbid psychiatric diagnoses. A high proportion of clinically diagnosed OCD patients fulfill diagnostic criteria of a schizophrenia spectrum disorder, to the point that significant evidence in the literature supports the existence and the clinical relevance of a schizo-obsessive spectrum of disorders, including schizotypal personality disorder (SPD) with OCD (schizotypal OCD). In this paper, we provide a brief but comprehensive analysis of the literature on the clinical coexistence between OCD and SPD. The clinical validity of the so-called schizotypal OCD is analyzed through a comprehensive investigation of the relationship between SPD features and obsessive-compulsive phenomena in clinical OCD samples. This review describes the potential connections between OCD and SPD on the epidemiological, sociodemographic, psychopathological, and clinical levels. SPD is commonly observed in OCD patients: about 10% of OCD patients have a full categorical diagnosis of SPD. Early clinical identification of SPD features-and, more generally, of psychotic features and personality disorders-in OCD patients is strongly recommended. In fact, a proper and early diagnosis with early treatment may have benefits for prognosis. However, although schizotypal OCD seems to have clinical and predictive validity, further neurobiological and genetic studies on etiological specificity are warranted.

Occurrence and clinical characteristics of Compulsive Sexual Behavior Disorder (CSBD): A cluster analysis in two independent community samples.

Background and aimsCompulsive Sexual Behavior Disorder (CSBD) is characterized by a persistent failure to control intense and recurrent sexual impulses, urges, and/or thoughts, resulting in repetitive sexual behavior that causes a marked impairment in important areas of functioning. Despite its recent inclusion in the forthcoming ICD-11, concerns regarding its assessment, diagnosis, prevalence or clinical characteristics remain. The purpose of this study was to identify participants displaying CSBD through a novel data-driven approach in two independent samples and outline their sociodemographic, sexual, and clinical profile.MethodsSample 1 included 1,581 university students (females = 56.9%; Mage = 20.58) whereas sample 2 comprised 1,318 community members (females = 43.6%; Mage = 32.37). First, we developed a new composite index to assess the whole range of CSBD symptoms based on three previously validated scales. Based on this new composite index, we subsequently identified individuals with CSBD through a cluster analytic approach.ResultsThe estimated occurrence of CSBD was 10.12% in sample 1 and 7.81% in sample 2. Participants with CSBD were mostly heterosexual males, younger than respondents without CSBD, reported higher levels of sexual sensation seeking and erotophilia, an increased offline and especially online sexual activity, more depressive and anxious symptoms, and poorer self-esteem.ConclusionsThis research provides further evidence on the occurrence of CSBD based on an alternative data-driven approach, as well as a detailed and nuanced description of the sociodemographic, sexual, and clinical profile of adults with this condition. Clinical implications derived from these findings are discussed in detail.

Body dysmorphic disorder (dysmorphophobia / dysmorphomania): literature review

A literature review regarding body dysmorphic disorder. Analysis of Russian and foreign bibliographic sources. Dysmorphophobia (body dysmorphic disorder, dysmorphomania) is a psychopathological disorder with ideas of imaginary or exaggerated personal physical inferiority. In the general population it occurs in more than 2 %. Criteria for dysmorphophobia diagnosis are the following: excessive preoccupation with any imaginary or insignificant defect in appearance; preoccupation with a clinically significant disorder or impairment in social, occupational or other important areas of functioning; the clinical picture is not explained by another mental disorder. A unique approach to the diagnosis of dysmorphophobia has not been developed yet; clinical, pathopsychological and anamnestic methods are used as well as special questionnaires. Treatment includes drug and psychotherapeutic approaches. The disease is usually chronic, only 9 % of patients manage to achieve stable remission and only 21 % partial. Narrow specialists are not always acquainted with dysmorphophobia; it leads to an incorrect diagnosis and treatment. It is necessary to improve methods for the timely detection and correction of this form of mental pathology in order to prevent severe personal and social consequences of the disease.

Sustainable Development and Innovations- How They Work Together?

Purpose: The main purpose of the paper is the elaboration and verification of a comprehensive proposal for measuring the results achieved by selected global economies in the area of sustainable development and innovation. Approach/Methodology/Design: To compare the results obtained by EU countries the multi-criteria taxonomy methods were used. The basis of empirical research are the indicators used by the European Commission to monitor the progress in the implementation of the Strategy for Sustainable Development – Agenda 2030 and the indicators used to assess the level of innovation published in European Innovation Scoreboard. Findings: The results of the research can be divided into two parts. In the first one the rankings of EU countries were built separately for each analyzed dimension of sustainable development and the area describing the level of innovation. In the second one the values of taxonomic measures of development were used to divide EU countries into groups characterized by similarity within all considered areas of sustainability. As a result, typological groups were obtained that differed both in number and composition. Practical Implications: The presented results are important for individual countries as well as for organisations as EU, in which internal cohesion is one of the strategic development goals. The results can also used to assess the effects of implementing the assumptions of the Green Deal strategy, currently being developed in the EU. Originality/Value: The added value of the paper is the research findings focused on the assessment of development of EU countries in two most important areas of functioning. In the literature, these areas are usually considered separately. In the paper, the authors decided to compare the results in these two areas analysed together and treat them as one of the important development directions of EU countries.

Psychiatric comorbidity in compulsive sexual behavior disorder (CSBD)

Compulsive Sexual Behavior Disorder (CSBD) is characterized by a persistent failure to control intense and recurrent sexual impulses, urges, and/or thoughts, resulting in repetitive sexual behavior that causes a marked impairment in important areas of functioning. Data collected from clinical populations suggest that CSBD frequently co-occurs with other Axis I and II psychiatric disorders; however, studies conducted so far suffer from methodological shortcomings that prevent the determination of accurate psychiatric comorbidity rates (e.g., small sample sizes, reliance on non-reliable assessment methods in the estimation of comorbidity or the non-inclusion of healthy individuals to compare prevalence rates). The purpose of this study was to explore psychiatric comorbidity in a sample of individuals with and without CSBD. The study sample comprised 383 participants distributed into two groups through a cluster analyses: 315 participants without CSBD (non-CSBD) and 68 qualifying as sexually compulsives (CSBD). Participants were assessed for co-occurring Axis I and II clinical conditions using structured clinical interviews for the DSM-IV (SCID-I and II). The majority of CSBD participants (91.2%) met the criteria for at least one Axis I disorder, compared to 66% in non-CSBD participants. CSBD participants were more likely to report an increased prevalence of alcohol dependence (16.2%), alcohol abuse (44%), major depressive disorder (39.7%), bulimia nervosa (5.9%), adjustment disorders (20.6%), and other substances –mainly cannabis and cocaine– abuse or dependence (22.1%). Concerning Axis II, prevalence of borderline personality disorder was significantly higher in CSBD participants (5.9%). As expected, prevalence of different psychiatric conditions was significantly increased among sexually compulsive participants, revealing comorbidity patterns with important implications in the conceptualization, assessment, and treatment of patients with CSBD.

Prevalence of Major Depression Among Cancer Patients: Single Center Tertiary Care Hospital Experience from Lahore, Pakistan

Introduction: Major depressive disorder (MDD) often goes unrecognized in cancer patients. Some symptoms of major depression mimic signs and symptoms of malignancy due to which it often remains under-diagnosed. Depression has a contributing role in increasing the morbidity of cancer patients which if diagnosed and managed early in the treatment course can have a positive impact on cancer patients. This study focuses on determining the prevalence of major depression among cancer patients admitted in a tertiary care hospital in Lahore, Pakistan. Place & Duration: Mayo Hospital, Lahore. (March 01-30, 2019). Methods: After project approval and consent, a total of 187 patients were recruited in the study. Selection was made based on predefined criteria. Patients ranging between age group of 14-80 years in Mayo Hospital Lahore, Pakistan were included. Interviews were conducted through a pretested questionnaire based on DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) criteria. Data was analyzed with Stata version 13. Patients were considered to be having major depressive disorder if they fulfill DSM-5 criteria for MDD; they must have 5 or more out of following 9 symptoms for ≥2 weeks: low mood, sleep disturbance (insomnia/hypersomnia), loss of interest in daily activities (anhedonia), feelings of guilt, low energy, loss of concentration, appetite changes (increased or decreased), psychomotor agitation/retardation and suicidal ideation. Symptoms should cause significant distress or impairment in social, occupational or other important areas of normal functioning and should not be attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. The disturbance is not better explained by persistent psychiatric or psychotic disorders like schizophrenia, schizoaffective disorder, delusional disorder or other specified or unspecified schizophrenia spectrum and other psychotic disorders. Patients should not be currently on anti-depressants for any reason. Objectives: To determine the prevalence of major depression among cancer patients. Design: Cross-sectional study. Results: Out of 187 patients (171 in-patient, 16 outpatient), 116 (62%) were males and 71 (38%) were females with mean age of 44 years (SD±17.2). Descriptive analysis shows that 61 (33%) had hematological and 126 (67%) patients had non-hematological malignancies. 110 (59%) patients had low mood, 108 (57.7%) had insomnia, 77 (41%) lost interest in daily activities, 39 (21%) had feelings of guilt, 60 (32%) reported low energy, 13 (07%) were irritable, 120 (64%) noted decrease in appetite, 2 (1.0%) patients had suicidal ideation (not active). Seventy (37.4%) patients fulfilled the criteria to be clinically declared as suffering from major depression. Only 13 (7%) patients had prior knowledge of major depression. All variables showed positive correlation with MDD (ranging between +0.021 to +0.66) except hematological malignancies which were negatively correlated (-0.426). Regression analysis shows that patients having non-hematological malignancies were more likely to have MDD than hematological malignancies (Odds ratio [OR]: 25.07; 95% CI: 7.4-84.7; p<0.001). Stage 3 cancer patients had more odds to have MDD as compared to stage ≤2 (OR: 10.06; 95% CI: 1.17-85.7; p<0.01) and stage 4 cancer patients had even higher odds to be suffering from MDD in comparison to stage ≤2 (OR: 24.6; 95% CI: 2.8-214; p<0.01). Using PASS version 11; 95% CI, with 187 cancer patients, effect size of 0.502 with 1 df (degree of freedom), calculated power of this study is approximately 100%. The effect cells were calculated using cross table made between cancer classification and MDD (Table 2). Conclusion: Major depression is fairly prevalent but under recognized among cancer patients in Pakistani population. Patients having advanced non-hematological malignancies are more likely to have major depression as compared to other malignancy groups. Higher the cancer stage; higher the odds to have MDD. High clinical suspicion, appropriate questioning and psychiatry consultation should be routinely asked if there is high suspicion. Only few patients had the prior knowledge about depression so patients need to be screened and counseled regarding their symptoms and treatment should be tailored accordingly. Disclosures Anwer: In-Cyte: Speakers Bureau; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees.

ES15.03 Managing Sleep Difficulties and Cancer

This paper discusses evidence-based interventions for managing sleep difficulties in people with cancer. Insomnia is a common sleep problem in people with cancer. Insomnia refers to the difficulty of falling asleep, staying asleep and early morning awakenings. It causes distress or impairment in important areas of functioning, such as relationships and employment. It is estimated that between 30-60% of cancer survivors experience significant sleep disturbances that can persist for up to five years post treatment. Aside from greatly impacting on quality of life, poor sleep is associated with anxiety, depression, concentration and memory difficulties, higher rates of pain, increased use of sedatives and poorer work performance [1-3]. People with lung cancer are at an increased risk of experiencing sleep difficulties because of their generally older age, compromised respiratory function, increased disease burden and the impact of treatments [4]. Sleep difficulties also have economic and social impacts on the broader community, due to increased health system costs, productivity losses and wellbeing costs [5]. Cognitive Behaviour Therapy (CBT) is considered to be the first-line treatment for insomnia [6]. CBT targets dysfunctional attitudes, beliefs and habits that interfere with sleep. CBT for insomnia commences with a comprehensive assessment about the nature and duration of sleep complaints, the impact on daytime functioning, compensatory behaviours, the person's beliefs about sleep and any other biopsychosocial factors that might be impacting on sleep. Common screening tools used to assess the impact of sleep difficulties include the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Insomnia Rating Scale (PIRS). These tools are self-reporting and easy to administer. CBT for insomnia is a multi-component intervention and includes psychoeducation, sleep hygiene, stimulus control, sleep restriction, relaxation, cognitive strategies and relapse prevention strategies. It is usually delivered between four to eight session modules. CBT is effective in improving sleep disturbance, fatigue, pain and quality of life. The effects of CBT are durable, with benefits lasting up to three years post-treatment [7, 8]. CBT is suitable for most adults with insomnia, however, it works best with people who are motivated and have the cognitive capacity to learn and adopt CBT strategies. CBT can be effectively provided in group settings, individually, via telephone, video or online methods. Over three quarters of patients achieve remission or significant reduction of sleep disturbance after CBT treatment [9]. CBT has been found to be more effective than mindfulness, massage, exercise and acupuncture intervention. CBT has been found to be as effective as pharmacological intervention in the short-term and more beneficial than medication in the longer term. CBT is also more cost-effective than pharmacological or non-treatment of sleep difficulties [10]. Despite the benefits of CBT, access for people with cancer is limited due to lack specialist availability, cost and awareness of the benefit of CBT. To improve access to evidence-based interventions for people with cancer, stepped-care approaches (where face-to-face CBT is reserved for the most complex cases while less burdensome and less costly self-managed interventions are available for less complex cases) could help translate evidence into clinical practice. Sleep difficulties are highly prevalent in people with cancer, however, access to evidenced-based interventions are limited. Embedding evidence based-screening and CBT into routine care is essential to improving quality of life and care for people with cancer. 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Morin CM, Benca R. Chronic insomnia. Lancet (London, England). 2012;379(9821):1129-41 Arico D, Raggi A, Ferri R. Cognitive Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Review of the Literature. Frontiers in psychology. 2016;7:1162. Blom, K., Jernelöv, S., Rück, C., Lindefors, N., & Kaldo, V. (2016). Three-Year follow-up of insomnia and hypnotics after controlled internet treatment for insomnia. Sleep, 39(6), 1, 1267-1274. https://doi.org/10.5665/sleep.5850 Fiorentino L, McQuaid JR, Liu L, Natarajan L, He F, Cornejo M, et al. Individual cognitive behavioral therapy for insomnia in breast cancer survivors: a randomized controlled crossover pilot study. Nature and science of sleep. 2009;2010:1-8. Reynolds S, R. M. The Cost of Insomnia and the Benefit of Increased Access to Evidence-Based Treatment. Sleep Medicine Clinics,. 2017;12(1):39-46.

Six-Month Follow-up of the Families on Track Intervention Pilot Trial for Children With Fetal Alcohol Spectrum Disorders and Their Families.

When the primary disabilities associated with fetal alcohol spectrum disorders (FASD) are not well supported, individuals are at higher risk for mental health problems and other secondary conditions. The Families on Track (FOT) intervention was designed to prevent secondary conditions and improve family functioning in children with FASD. Promising results from a pilot study demonstrated positive effects on child and caregiver outcomes immediately following the intervention. The objective of this study was to examine the sustainability of these effects 6months postintervention. Thirty children (ages 4 to 8) with prenatal alcohol exposure and their caregivers were enrolled in the original study. Families were randomized to the FOT intervention or an active comparison group that provided comprehensive assessment and individualized feedback. The intervention integrated a positive parenting curriculum and a child skills group. Families were assessed at baseline, postintervention, and 6-month follow-up visits. Follow-up data were available for 24 families on child and caregiver outcomes. Data were analyzed using effect size calculations and analysis-of-variance techniques. Relative to the comparison group, intervention families showed continued gains in parenting efficacy and maintained prior improvements in FASD knowledge over the follow-up period. Although intervention families reported a decrease in their needs being met over the follow-up period, they continued to report their needs being met to greater extent than those in the comparison group. Consistent with postintervention outcomes, children in both groups exhibited similar decreases in child disruptive behavior 6months following the intervention. Unfortunately, positive gains seen at postintervention for child self-esteem and emotion regulation were attenuated at follow-up. This pilot study yielded promising effects on important areas of caregiver functioning. However, the intervention's impact on child functioning waned over time, suggesting the need for sustained or alternate child intervention.