Major Psychiatric Illness Research Articles

The Impact of Socially Stigmatized Preexisting Conditions on Outcomes After Injury

BackgroundSocially stigmatized preexisting conditions (SSPECs), including alcohol use disorder (AUD), drug use disorder (DUD), and major psychiatric illness, may lead to provider minimization of patient symptoms and have been associated with negative outcomes. However, the impact of SSPECs on failure to rescue (FTR) has not been evaluated. We hypothesized that SSPEC patients would have increased probability of complications, mortality, and FTR. Materials and methodsWe performed a retrospective analysis of the 2015 National Trauma Data Bank, including patients aged ≥18 y and excluding burn victims, patients with Injury Severity Score <9, and non-SSPEC patients with drug or alcohol withdrawal. We defined SSPECs using the National Trauma Data Bank's comorbidity recording codes for AUD, DUD, and major psychiatric illnesses. We built multivariable logistic regression models to determine the relationships between SSPECs and complications, mortality, and FTR. ResultsWe included 365,801 patients (62% male, 76% White, median age 56 y [interquartile range 35-74], median Injury Severity Score 10 [interquartile range 9-17]). After adjusting for patient and injury characteristics, SSPEC patients were more likely to have complications (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.70-1.79), less likely to die (OR 0.43, CI 0.38-0.48), and less likely to have FTR (OR 0.34, CI 0.26-0.43). SSPEC patients had a significantly higher complication rate (12.4% versus 7.2%; P < 0.001). After excluding drug or alcohol withdrawal, the complication rate remained significantly higher for SSPEC patients (9.3% versus 7.2%; P < 0.001). ConclusionsAlthough SSPEC patients have lower odds of mortality and FTR, they are at higher probability of complications after injury. Further investigation into the causality behind the higher complications despite lower mortality and FTR is warranted.

Psychiatric Comorbidity and Outcomes After Left Ventricular Assist Device Implantation for End-Stage Heart Failure

BackgroundPsychiatric comorbidities play a key role in patient selection for left ventricular assist devices (LVADs), but their impact on clinical outcomes is unknown. ObjectivesThe goal of this study was to examine the clinical impact of psychiatric illness on outcomes in patients receiving LVADs for end-stage heart failure (HF). MethodsThe study identified adults in the Interagency Registry for Mechanically Assisted Circulatory Support with psychiatric comorbidities (history of alcohol abuse, drug use, narcotic dependence, depression, and other major psychiatric diagnoses) receiving continuous-flow LVADs from 2008 to 2017. Demographic characteristics, survival, adverse events, and quality of life scores were compared for patients with and without each psychiatric comorbidity. ResultsOver the study period, the prevalence of psychiatric comorbidities was low: alcohol abuse, n = 1,093 (5.5%); drug use, n = 1,077 (5.4%); narcotic dependence, n = 96 (0.5%); depression, n = 401 (2.0%); and other major psychiatric illnesses, n = 265 (1.4%). Narcotic dependence (adjusted hazard ratio: 1.9; 95% confidence interval: 1.2 to 3.0; p = 0.004) and other major psychiatric illnesses (adjusted hazard ratio: 1.4; 95% confidence interval: 1.0 to 1.9; p = 0.02) were associated with increased risk of mortality, whereas alcohol abuse, drug use, and depression were not. All comorbidities except narcotic dependence were associated with increased risk of rehospitalization and device-related infection (both p < 0.05). Kansas City Cardiomyopathy Questionnaire scores were lower from 6 to 24 months’ post-implantation among patients with psychiatric comorbidities (p < 0.05). ConclusionsDespite a low prevalence of psychiatric comorbidities among LVAD recipients, these conditions were associated with mortality risk, adverse events, and poorer quality of life. Further study is needed to understand how specific psychiatric conditions affect outcomes and how to best manage this vulnerable patient population.

0091 Sleep as a Mediator of the Relationship Between Exercise and Self-Reported Cognitive Function

Abstract Introduction Insufficient sleep and sedentary behavior are associated with cognitive decline. How sleep and physical activity interact to influence cognition is not fully understood. This study sought to examine whether self-reported sleep and exercise impact subjective cognitive complaints across adulthood. Methods Self-report questionnaire data from 2,744 adults (μ=56.18 yrs/old; 63.8% F; μ=16.36 yrs/edu) in the University of California Irvine Consent-to-Contact Registry were analyzed. Multiple regression models, analysis of covariance, and ordinary least squares path analysis were conducted to investigate relationships among the Cognitive Function Instrument (CFI), Medical Outcome Study Sleep Scale (MOS-SS) Subscales, and exercise frequency. All models adjusted for education, sex, age, BMI, medical comorbidities, depression, cancer diagnosis, and antidepressant usage. Individuals taking medications known to affect sleep or with a diagnosis major psychiatric illness were excluded from analyses. Results All MOS-SS Subscales significantly predicted CFI score (all p&amp;lt;0.001). Individuals who exercise &amp;gt;3times/week had significantly lower scores on the CFI (p&amp;lt;0.05), Sleep Problems Index I &amp; II (both p&amp;lt;0.05), Somnolence Subscale (p&amp;lt;0.01), and higher scores on the Sleep Adequacy Subscale (p=0.001). Mediation analyses revealed that all subscales, aside from the Sleep Disturbance Subscale, mediated the relationship between exercise frequency and CFI Score (Bootstrapped CI’s did not include zero). Conclusion More self-reported sleep disturbance and greater daytime sleepiness are associated with more subjective cognitive complaints. Individuals who exercise more frequently report lower daytime sleepiness and higher quality sleep. The effects of exercise frequency on cognitive complaints appear to be mediated by the impact of exercise on sleep. These results suggest that sleep health may be a crucial consideration when evaluating outcomes of exercise-based therapies aimed at delaying the onset of cognitive impairment. Support The C2C registry was made possible by a donation from HCP, Inc. and is supported by NIA AG016573 and NCATS UL1 TR001414.

M171. THE GENE-SHARING RELATIONSHIP OF SCHIZOPHRENIA WITH OTHER MENTAL OR SYSTEMIC DISORDERS: A DISEASE-SIMILARITY NETWORK ANALYSIS FOCUSED ON EGOCENTRIC NETWORK

BackgroundSchizophrenia is an archetypal example that a psychiatric illness may not merely be a mental or a brain disorder but rather a systemic illness. It can be glimpsed from a wide range of biomarkers that span all the imaginable body systems, and from higher co-morbidity with other systemic illnesses. However, quantitative analysis of schizophrenia’s relationship with other diseases are not yet satisfactory. Genome-wide association studies have identified more than hundreds of genetic loci associated with schizophrenia. In turn, these loci are associated with a wide variety of other diseases. From this gene-disease relationship, a bipartite network can be built which, after appropriate projection, could help to map a complex disease-similarity network. In case of schizophrenia, it would reveal the position of schizophrenia among the broader categories of systemic illnesses.MethodsDisGeNET is a discovery platform which contains one of the largest collections of gene-disease association data. The major source of the integrated data is the automatized curation from MEDLINE abstract. Therefore, it contains the timestamp of reported gene-disease association. Gene-disease-timestamp (year of publication) triplet was fed into a Neo4J graph database platform. From this, disease-disease relationships with shared gene count and Jaccard similarity score was extracted. The network structure of level 1.5 egocentric network centered upon schizophrenia was inspected. Louvain community detection algorithm was applied to expose underlying group structure among the 1st order alters. For comparison, similar ego-networks centered upon several major psychiatric illnesses were also inspected. Finally, the yearly variation of Jaccard score which reflected the accumulation of research data were monitored.ResultsThe diseases which showed the highest Jaccard score (j) were bipolar disorder (j=0.203) and depressive disorder (j=0.190) as expected. Other diseases with meaningful similarity could be grouped into three communities: 1) psychiatric illness including bipolar/depressive disorder, 2) a variety of malignancies including neuroblastoma (j=0.083), stomach cancer (j=0.070) and pancreatic cancer (j=0.065) 3) other systemic illnesses including multiple sclerosis (j=0.088), metabolic syndrome (j=0.076), myocardial infarction (j=0.073), rheumatoid arthritis (j=0.070), lupus erythematosus (0.056). The gene-sharing relationship with systemic illnesses (malignancies and other) began to be revealed after 2005. Since then, more and more evidences were accumulated to solidify the schizophrenia’s link with systemic illnesses.DiscussionRecently, a couple of large-scale epidemiological studies verified the significant correlation between prevalence of schizophrenia and cancer/autoimmune disorders. The present study results may augment these epidemiological data and thus strongly support the concept of schizophrenia as a systemic illness. Gene-sharing and its reflection in prevalence data would indicate deeper link at the level of pathogenesis with systemic illnesses. Recently, many authors contemplated the possible link between schizophrenia and cancer in terms of cell cycle regulation and control of apoptosis. Likewise, others suspected immunological disturbance as the fundamental mechanism of schizophrenia. In this vein, the need for extending the concept of mental disorders as a focused manifestation of systemic illness seems gaining impetus.

S169. THE IMPACT OF PSYCHOSIS IN ADOLESCENT-ONSET BIPOLAR DISORDER: A STRUCTURAL MRI STUDY

BackgroundBipolar Disorder (BD) is a major psychiatric illness defined by episodic mood changes, which in approximately 50% of cases is associated with psychotic features. Over the past decades, a large amount of research has identified brain structural and functional alterations in patients with this mental disorder. Some findings have been found to be specific to patients with psychotic symptoms, raising suggestions that this could represent a biological subtype of the disorder. Recent interest has been addressed to Early-Onset Bipolar Disorder (EOBD, onset prior to age 18). Latest reviews in EOBD samples have pointed to abnormalities in the frontal lobe and limbic structures, with some inconsistencies in the reported results possibly caused by differences in the methodology. In addition, no study so far has examined the neural structural correlates of psychotic symptoms in adolescent-onset bipolar disorder (AOBD).The aim of the present study is to examine the impact of psychosis on the neurobiological architecture in a sample of patients with AOBD. To our knowledge, this is the first study comparing gray matter structure between AOBD patients with or without psychotic features.MethodsWe conducted a cross-sectional study collecting T1-weighted structural magnetic resonance neuroimaging (3T-MRI) data in patients diagnosed with Bipolar Disorder type I or II between 12 and 19 years old (N=46, mean age (SD)=15.89 (1.94), gender=52.2% females). All patients were recruited from child and adolescent mental health services of the Hospital Clinic of Barcelona, Spain. Diagnoses were confirmed with a semi-structured clinical interview (Kiddie-Sads present and lifetime version) by child and adolescent psychiatrists.Images were pre-processed employing FreeSurfer 5.3.0, and data corresponding to Cortical Thickness (CTH) and Subcortical Volumes (SCV) was obtained. Groups were compared according to whether patients had experienced psychotic symptoms at any point during their illness: Non-Psychotic Bipolar Disorder (NPSBD, N=25) and Psychotic Bipolar Disorder (PSBD, N=21). No differences in age (t=0.498, p=0.621) or sex (χ2=0.001, p=0.979). Group effects in relation to both CT and SCV were examined with a general linear model. The main effect of group on CTH and SCV, was performed for the whole brain, performing a correction for multiple comparisons (Montecarlo correction, threshold = 0.05).ResultsBetween-group analyses showed smaller CTH in a cluster in the left medial orbitofrontal cortex (cluster size= 1142.58 mm2) in PSBD relative to NPSBD (x, y, z: 25.63, 89.61, -42.74; p=0.002). In addition, we observed a smaller right hippocampus volume (p=0.025) in PSBD relative to NPSBD. No other statistically significant differences were obtained.DiscussionPSBD showed smaller cortical thickness in the left medial orbitofrontal cortex, as well as a volumetric reduction in the right hippocampal volume. Similar results have been reported in a study comparing adolescent patients with psychotic BD and healthy controls. These results add evidence about the role of these two structures in the genesis of psychotic symptoms in a population diagnosed with AOBD. Interestingly, one study has reported a surface area decreased of the orbitofrontal cortex in adolescent patients with a non-bipolar psychotic disorder, which suggests that they may be a common substrate to psychotic symptoms during adolescence regardless of co-occurring affective symptoms.In summary, this study points to the existence of a distinct biological nature between bipolar patients according to psychotic symptoms, underpinned by a different neurobiological architecture. Future research should focus on replication and on examining the clinical value of this finding.

32 Major Psychiatric Illness and Drug Dependence Both Influence Burn Outcomes, but Not in the Same Way

Abstract Introduction Studies of trauma patients indicated that as many as 17% of patients have major mental illness. The prevalence of mental illness in burns is not well known, but is thought to be similar to that seen in trauma. In this study we aim to examine the effect of mental health on outcomes following burns less than 20% total body surface area (%TBSA). We hypothesize that mental illness is associated with longer length of stay (LOS), length of stay per % TBSA (LOS/TBSA), and number of readmissions. Methods Following IRB approval, a 2-year (2016–2018) retrospective chart review was conducted of burn patients with burns less than 20% admitted to the burn center. Data collected include: age, sex, % TBSA, LOS, LOS/TBSA, discharge disposition, mortality, presence of mental health diagnoses (Drug Dependence, and Major Psychiatric Illness). Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables was conducted. Values expressed as mean ± standard deviation. Results A total of 961 patients with a mean age of 46.2±17.4 years, 717 men and 244 women, were analyzed. Mean total body surface area burn (TBSA) was 6.72±5.5%, and 6.14% had inhalation injury. In this study population 27.6% had drug dependence, and 15.4% had major psychiatric illness. The mean length of stay was 11.4±16.7 days, and 12 patients (1.25%) died. In examining the effects of major psychiatric illness, there was no difference in age (46.4 vs. 46.2 years, p=0.87), no difference in %TBSA (6.30% vs. 6.77%, p=0.328). Length of stay (LOS) (15.2 vs. 10.7 days, p=0.0009) and LOS/TBSA (4.03 vs. 2.90 days, p = 0.03) were increased in patients with major psychiatric illness. There was no difference in the rate of readmissions (8.11% vs. 6.56%, p=0.49). In examining the effects of drug dependence, patients were younger (40.4 vs. 48.4 years, p&amp;lt; 0.0001), suffered a larger %TBSA (7.70% vs. 6.31%, p=0.0008), and had a longer length of stay (13.7 vs. 10.5 days, p=0.04). There were no differences in LOS/TBSA (2.94 vs. 3.12 days, p = 0.66), and rate of readmissions (6.04% vs. 7.09%, p=0.56). Conclusions In burns &amp;lt; 20% TBSA, both major psychiatric illness and drug dependence influence patient’s outcomes. Major psychiatric illness does not affect burn size but does increase length of stay. Drug dependence leads to larger burn size which secondarily increases length of stay. Based on these increases in length of stay, it is likely that hospital costs are also higher for these patients. Further work must be done to mitigate the effects of mental illness on burn outcomes, even in small burns. Applicability of Research to Practice Many burn patients have mental health problems. These can influence their recovery from burn injury. We should work to minimize the effects of their mental illness on their outcomes.

Self-Inflicted Gun Violence Injuries Epidemic in the United States: A Closer Look at the Nation's Well-Being

Gun-related injuries are a hotly debated sociopolitical topic in the United States. Annually, more than 33 million Americans seek heathcare services for mental health issues. These conditions are the leading cause of combined disability and death among women and the second highest among men. Our study's main objective was to identify cases of self-inflicted penetrating firearm injuries with reported pre-existing psychiatric conditions as defined in the 2013-2016 National Trauma Data Standard. The 2013-2016 Research Data Sets (RDSs) were reviewed. Cases were identified using the ICD-9 external cause codes 955-955.4, and ICD 10th Edition Clinical Modification external cause codes X72-X74. Odds ratios were calculated, and categorical data were analyzed by using the chi-squared test, with significance defined as P < 0.05. The 2013-2016 Research Data Set consists of 3,577,168 reported cases, with 15,535 observations of self-inflicted penetrating firearms injuries. Of those patients, 18.4 per cent had major psychiatric illnesses, 7.5 per cent had alcohol use disorder, 6.4 per cent had drug use disorder, and 0.6 per cent had dementia. An upward trend in the proportion of patients with major psychiatric illnesses was observed, from 15.5 per cent in 2013 to 18.6 per cent in 2016, peaking in 2015 at 20.9 per cent. Nearly one in three self-inflicted penetrating firearm injuries in the United States is associated with pre-existing behavioral health conditions. Advances in understanding the behavioral and social determinants leading to these conditions, and strategies to improve the diagnosis of mental illness and access to mental health care are required.

Rehabilitation needs of patients with schizophrenia attending the general hospital psychiatric unit of a tertiary care hospital in South India.

Context:Schizophrenia is a major psychiatric illness that is stressful for both patients and their families. Along with clinical improvement with medications, psychosocial rehabilitation is an essential part of treatment to improve functioning and quality of life.Aims:This study aims to assess the rehabilitation needs of patients with schizophrenia and to identify the association of these needs with demographic and clinical variables.Settings and Design:A cross-sectional descriptive design was used. The study was conducted in a general hospital psychiatric unit (GHPU) of a tertiary care teaching hospital.Subjects and Methods:The sample included 770 subjects (385 patients and 385 caregivers). A standardized self-administered questionnaire, the Rehabilitation Needs Assessment Schedule was used to assess the patients' rehabilitation needs.Statistical Analysis Used:Categorical variables were expressed as frequencies and percentages. Continuous variables were expressed in terms of mean with standard deviation or median with an interquartile range. The association between different rehabilitation needs was analyzed using the Chi-square test or Fisher's exact test.Results:The most common requirement was skill training rehabilitation needs (93.8%), followed by psychosocial modification rehabilitation needs (88%) and help for family members (87%). There were significant associations (P < 0.05) between age at onset of illness with employment, current living status with overall needs, and help needed by the family.Conclusion:The study found that 76.9% of the patients required help in at least one rehabilitation domain. The findings of the study have implications in planning and implementing rehabilitation programs.

Maladaptive mood repair predicts suicidal behaviors among young adults with depression histories

BackgroundAs the rates of suicidal behaviors continue to rise, research is needed that can facilitate prevention. The present study therefore examined whether a modifiable process, dysfunctional regulation of sadness (maladaptive mood repair), predicts a range of suicidal behaviors and if its impact is affected by risk and protective factors. MethodsYoung adults with histories of childhood-onset mood disorder (COMD) (n = 173) or no histories of major psychiatric illness (controls, n = 96) were followed for approximately 3 years. Self-rated questionnaires and psychiatric evaluations were administered at study entry (T1) and across the follow-up (T2) and clinicians assessed the DSM-range of non-fatal suicidal behaviors. We hypothesized that the impact of depression on suicidal behaviors was mediated by dysfunctional regulation of sadness. ResultsAt T1, 90% of the COMD group had histories of various suicidal behaviors; 63% had past suicide attempts. During follow-up, 40% exhibited suicidal behaviors; 7% reported suicide attempts. Controlling for prior suicidal behaviors, T1 maladaptive mood repair predicted suicidal behavior during the follow-up and differentiated recurrent thoughts of death from other forms of suicidality. Protective and risk factors lost their predictive power in the presence of maladaptive mood repair. LimitationsFew control cases exhibited suicidal behavior during the follow-up and the high inter-correlations among several key variables constrained the models that could be fitted. ConclusionsPrograms to prevent suicidal behavior among high-risk individuals should include maladaptive mood repair as an intervention target. Further research is needed on whether recurrent thoughts of death constitute a valid index of suicidality.

Serum folate levels in bipolar disorder: a systematic review and meta-analysis

BackgroundBipolar disorder (BD) is a major psychiatric illness, however its physiopathology is unclear. The role of folate in the physiopathology of BD is controversial. We conducted this systematic review and meta-analysis to investigate the effect of folate in BD patients.MethodsWe performed a thorough literature study of the PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov databases until December 21st, 2018. Random effects meta-analysis was conducted.ResultsSix articles involving 481 patients with BD and 760 controls were included. The meta-analysis results suggested that serum folate levels in the patients with BD were significantly lower than those in the controls (Hedges’ g = − 0.211, 95% confidence interval = − 0.391 to − 0.031, p = 0.021).ConclusionThe current meta-analysis show it might be association between lower serum folate levels and patient with BD. However, we could not distinguish the potentially confounding effects of mood states on the folate levels. Further prospective studies including subjects with different mood states and possible physiopathology are warranted to investigate the association between folate deficiency and the etiology of BD.

Reduced density of oligodendrocytes and oligodendrocyte clusters in the caudate nucleus in major psychiatric illnesses

Functional dysconnectivity in schizophrenia and affective disorders may be associated with myelin and oligodendrocyte abnormalities. Altered network integration involving the caudate nucleus (CN) and metabolic abnormalities in fronto-striatal-thalamic white matter tracts have been reported in schizophrenia and impaired patterns of cortico-caudate functional connectivity have been found in both bipolar disorder (BPD) and schizophrenia compared to healthy controls. Postmortem studies have found ultrastructural dystrophy and degeneration of oligodendrocytes and dysmyelination in the CN in schizophrenia and BPD. We aimed to test the hypothesis that oligodendrocyte density may be reduced in the CN in major psychiatric disorders and may thereby form the cellular basis for the functional dysconnectivity observed in these disorders. Optical disector was used to estimate the numerical density (Nv) of oligodendrocytes and oligodendrocyte clusters (OLC) in the CN of cases with schizophrenia, BPD and major depressive disorder (MDD) and in normal controls (15 cases per group). A significant reduction in the Nv of oligodendrocytes was found in schizophrenia and BPD as compared to the control group (p < 0.05), and the Nv of OLC was significantly lowered in schizophrenia and BPD compared to controls (p < 0.05). There were no significant differences between MDD and control groups. The Nv of OLC was significantly decreased in the left hemisphere in schizophrenia as compared to the left hemisphere of the control group (−52%, p < 0.01). The data indicates that a decreased density of oligodendrocytes and OLC could contribute to the altered functional connectivity of the CN in subjects with severe mental illnesses.

PHARMACOLOGY IN SCHIZOPHRENIA

Background: Schizophrenia is a chronic debilitating major psychiatric illness which is characterized by a decreased ability to understand reality, strange speech and abnormal behavior.&#x0D; Aims: To find out pharmacological patterns in schizophrenic patients.&#x0D; Materials &amp; Methods: The present observational cross-sectional study involved prescription of 150 schizophrenic patients and was conducted in the outpatient department (OPD) of tertiary care hospital, Jammu over a period of two months. Data like name, number, combination of drugs etc of psychotropic medications were collected&#x0D; Results: Average number of drugs per prescription was 2.26. Among prescribed antipsychotics, 87.9% were atypical antipsychotic drugs. Single antipsychotic was used in 57.3% patients whereas combination of antipsychotics were used in 42.7% patients. Olanzapine was the most commonly used antipsychotic drug and was prescribed in 72.7% patients. Benzodiazepines were the most commonly used comedications and were prescribed in 62% patients.&#x0D; Conclusion: From present study, it has been concluded that atypical antipsychotic drugs were the most frequently prescribed among schizophrenic patients. The most common medication to be used was olanzapine whereas the most common comedications used along with antipsychotics were benzodiazepines.&#x0D; Keywords: Antipsychotics, Olanzapine, Schizophrenia.

Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial.

This randomized, placebo-controlled, crossover, and double-blind trial aimed to examine the possible effects of four weeks L-theanine administration on stress-related symptoms and cognitive functions in healthy adults. Participants were 30 individuals (nine men and 21 women; age: 48.3 ± 11.9 years) who had no major psychiatric illness. L-theanine (200 mg/day) or placebo tablets were randomly and blindly assigned for four-week administration. For stress-related symptoms, Self-rating Depression Scale, State-Trait Anxiety Inventory-trait, and Pittsburgh Sleep Quality Index (PSQI) scores decreased after L-theanine administration (p = 0.019, 0.006, and 0.013, respectively). The PSQI subscale scores for sleep latency, sleep disturbance, and use of sleep medication reduced after L-theanine administration, compared to the placebo administration (all p < 0.05). For cognitive functions, verbal fluency and executive function scores improved after L-theanine administration (p = 0.001 and 0.031, respectively). Stratified analyses revealed that scores for verbal fluency (p = 0.002), especially letter fluency (p = 0.002), increased after L-theanine administration, compared to the placebo administration, in individuals who were sub-grouped into the lower half by the median split based on the mean pretreatment scores. Our findings suggest that L-theanine has the potential to promote mental health in the general population with stress-related ailments and cognitive impairments.

Using text mining to extract depressive symptoms and to validate the diagnosis of major depressive disorder from electronic health records

BackgroundMany studies have used Taiwan's National Health Insurance Research database (NHIRD) to conduct psychiatric research. However, the accuracy of the diagnostic codes for psychiatric disorders in NHIRD is not validated, and the symptom profiles are not available either. This study aimed to evaluate the accuracy of diagnostic codes and use text mining to extract symptom profile and functional impairment from electronic health records (EHRs) to overcome the above research limitations. MethodsA total of 500 discharge notes were randomly selected from a medical center's database. Three annotators reviewed the notes to establish gold standards. The accuracy of diagnostic codes for major psychiatric illness was evaluated. Text mining approaches were applied to extract depressive symptoms and function profiles and to identify patients with major depressive disorder. ResultsThe accuracy of the diagnostic code for major depressive disorder, schizophrenia, and dementia was acceptable but that of bipolar disorder and minor depression was less satisfactory. The performance of text mining approach to recognize depressive symptoms is satisfactory; however, the recall for functional impairment is lower resulting in lower F-scores of 0.774–0.753. Using the text mining approach to identify major depressive disorder, the recall was 0.85 but precision was only 0.69. ConclusionsThe accuracy of the diagnostic code for major depressive disorder in discharge notes was generally acceptable. This finding supports the utilization of psychiatric diagnoses in claims databases. The application of text mining to EHRs might help in overcoming current limitations in research using claims databases.

Interactions between psychiatric and physical disorders and their effects on the risks of suicide: a nested case-control study.

Previous studies, which included predominantly Caucasian populations, examined psychiatric and physical illness and associated suicide risk. We used a nationwide database to reassess the findings in an Asian population, and also analyzed the influence of different onset timing of psychiatric and physical illness and the suicide risk. We included 55,630 suicide cases aged 20-110 years. Using an incidence density sampling approach, we selected 222,520 controls matched by age, sex, and residence area from 2000 to 2012. We included most major psychiatric and physical illnesses defined by ICD-9-CM codes with anatomical classifications. By using conditional logistic regression models with adjustment of covariates, such as patients' marital status and education levels, we found that patients with psychiatric illness had higher suicide risk (adjusted IRR, 7.72; 95% CI: 7.35-8.09) compared with those with neither physical nor psychiatric illness and the risk increased substantially in patients with both psychiatric and physical illnesses (adjusted IRR, 18.35; 95% CI: 16.40-20.86). Specifically, we found the suicide risk was relatively higher (adjusted IRR, 1.28; 95% CI: 1.10-1.40) when psychiatric disorders occurred before physical illness compared with the other way around. The findings warrant attention to high suicide risk and preventive treatments in patients with both psychiatric and physical illnesses.

Pain Trajectories and Predictors: A 7-Year Longitudinal Study of Women With Vulvodynia

IntroductionA significant proportion of women report a reduction of symptoms over time—even without treatment—yet the natural progression of vulvodynia and which factors may explain decrease vs persistence of pain remain unclear. AimTo identify subgroups of pain trajectories in women with vulvodynia and to predict these different trajectories by treatments undertaken, pain characteristics, and psychosocial factors. MethodsData on pain intensity, treatments undertaken, pain characteristics, and psychosocial factors were collected 3 times over a 7-year period from 173 women who screened positive for vulvodynia. Latent class growth analysis was conducted to identify homogeneous subgroups with distinct pain trajectories. A multivariate binomial logistic regression was used to examine whether treatments, pain characteristics, and psychosocial factors predicted these trajectories. Main Outcome MeasureThe main outcome was pain intensity (0–10), measured at 3 time points with the numerical rating scale. Results2 pain trajectories were identified: 1 where pain persisted (28.9%), and 1 where pain decreased over time (71.1%). Whether a treatment had been undertaken was not predictive of the course of pain over time. Women who were older at first pain onset, had pain at another location than the entrance of the vagina, and reported more anxiety were more likely to have a persistent pain trajectory relative to the decreased pain trajectory. Clinical ImplicationsFindings suggest that the evolution of pain differs among women with vulvodynia depending on pain characteristics and anxiety. Strengths & LimitationsStrengths of the study include the 7-year longitudinal design to examine the natural history of provoked vestibulodynia and the inclusion of biopsychosocial factors as predictors of pain trajectories. However, women with major medical and psychiatric illnesses or deep dyspareunia were not included, and, thus, these factors could not be examined as predictors. ConclusionAssessing baseline characteristics associated with different pain trajectories during medical visits could have positive implications for the management of vulvodynia.Pâquet M, Vaillancourt-Morel M-P, Jodouin J-F, et al. Pain Trajectories and Predictors: A 7-Year Longitudinal Study of Women With Vulvodynia. J Sex Med 2019;16:1606–1614.

Drug Utilization pattern of psychotropic medicines in tertiary care centre of Bastar Region, Chhattisgarh, India

Background: With the changing lifestyle, the incidence of psychiatric illness is increasing day by day. And the mental illnesses not only affect the social and personal life but also adds additional economic burden affecting quality of life of the person. So, proper diagnosis and management of psychiatric illnesses is utmost important. So, keeping this in mind, the present study has been conducted to evaluate drug utilization pattern of psychotropic medicines in tertiary care centre of Bastar region.Methods: After obtaining approval from Institutional Ethics Committee, present study was conducted in 237 patients for a period of 3 months from February 2019 to April 2019. The data of patients attending psychiatry OPD was collected in a structured case record form. The data were analysed using graph pad prism version 6.0.Results: Out of total 237 patients, males 136(57.38%) outnumbered females 101 (42.62%). The major psychiatric illness reported was schizophrenia (45.99%) followed by bipolar affective disorder (16%) and generalized anxiety disorder (14.35%). Average number of psychotropic drugs per prescription was 1.74±1.02. The percentage of drugs prescribed from state Essential drug List (EDL) was 93.05%.Conclusions: Overall, the principles of rational prescribing was tried to be maintained, as polypharmacy has been avoided and most of the drugs were prescribed from the state EDL. The use of generic drugs should be increased to make prescriptions more rational and to cut down the cost of the therapy which may be helpful in increasing the quality of life of the patients.

Association between Sleep Disturbances and Medial Temporal Lobe Volume in Older Adults with Mild Cognitive Impairment Free of Lifetime History of Depression.

Previous studies examining the link between neuropsychiatric symptoms (NPS) and biomarkers of Alzheimer's disease (AD) may be confounded by remitted or past history of psychiatric illness, which in itself is associated with AD biomarkers such as reduced medial temporal lobe (MTL) volume. We examined associations between mood and anxiety-related NPS and MTL in older adults with mild cognitive impairment (MCI) free of lifetime history of depression. We hypothesized an inverse relationship between NPS severity and MTL. Forty-two MCI participants without current or past history of depression or other major psychiatric illness were assessed using the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Correlation and regression analyses were performed between selected NPI-Q items and regional MTL volumes from structural magnetic resonance imaging. Sleep disturbances were inversely associated with several regional volumes within the MTL. Sleep disturbances remained significantly correlated with left hippocampal and amygdala volume following correction for multiple comparisons. In contrast, depression and anxiety were not correlated with MTL. The relationship between reduced MTL and sleep, but not with depressed or anxious states, in MCI free of lifetime history of depression, suggests a potential mechanism for sleep as a risk factor for AD. The current findings highlight the importance of accounting for remitted psychiatric conditions in studies of the link between NPS and AD biomarkers and support the need for further research on sleep as clinical biomarker of AD and target for AD prevention.

Exercise ameliorates deficits in neural microstructure in a Disc1 model of psychiatric illness

Recent studies have investigated the effectiveness of aerobic exercise to improve physical and mental health outcomes in schizophrenia; however, few have explicitly explored the impact of aerobic exercise on neural microstructure, which is hypothesized to mediate the behavioral changes observed. Neural microstructure is influenced by numerous genetic factors including DISC1, which is a major molecular scaffold protein that interacts with partners like GSK3β, NDEL1, and PDE4. DISC1 has been shown to play a role in neurogenesis, neuronal migration, neuronal maturation, and synaptic signaling. As with other genetic variants that present an increased risk for disease, mutations of the DISC1 gene have been implicated in the molecular intersection of schizophrenia and numerous other major psychiatric illnesses. This study investigated whether short-term exercise recovers deficits in neural microstructure in a novel genetic Disc1 svΔ2 rat model. Disc1 svΔ2 animals and age- and sex-matched controls were subjected to a treadmill exercise protocol. Subsequent ex-vivo diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) compared neural microstructure in regions of interest (ROI) between sedentary and exercise wild-type animals and between sedentary and exercise Disc1 svΔ2 animals. Short-term exercise uncovered no significant differences in neural microstructure between sedentary and exercise control animals but did lead to significant differences between sedentary and exercise Disc1 svΔ2 animals in neocortex, basal ganglia, corpus callosum, and external capsule, suggesting a positive benefit derived from a short-term exercise regimen. Our findings suggest that Disc1 svΔ2 animals are more sensitive to the effects of short-term exercise and highlight the ameliorating potential of positive treatment interventions such as exercise on neural microstructure in genetic backgrounds of psychiatric disease susceptibility.

Increased and Decreased Superficial White Matter Structural Connectivity in Schizophrenia and Bipolar Disorder.

Schizophrenia (SZ) and bipolar disorder (BD) are often conceptualized as "disconnection syndromes," with substantial evidence of abnormalities in deep white matter tracts, forming the substrates of long-range connectivity, seen in both disorders. However, the study of superficial white matter (SWM) U-shaped short-range tracts remained challenging until recently, although findings from postmortem studies suggest they are likely integral components of SZ and BD neuropathology. This diffusion weighted imaging (DWI) study aimed to investigate SWM microstructure in vivo in both SZ and BD for the first time. We performed whole brain tractography in 31 people with SZ, 32 people with BD and 54 controls using BrainVISA and Connectomist 2.0. Segmentation and labeling of SWM tracts were performed using a novel, comprehensive U-fiber atlas. Analysis of covariances yielded significant generalized fractional anisotropy (gFA) differences for 17 SWM bundles in frontal, parietal, and temporal cortices. Post hoc analyses showed gFA reductions in both patient groups as compared with controls in bundles connecting regions involved in language processing, mood regulation, working memory, and motor function (pars opercularis, insula, anterior cingulate, precentral gyrus). We also found increased gFA in SZ patients in areas overlapping the default mode network (inferior parietal, middle temporal, precuneus), supporting functional hyperconnectivity of this network evidenced in SZ. We thus illustrate that short U-fibers are vulnerable to the pathological processes in major psychiatric illnesses, encouraging improved understanding of their anatomy and function.