Measures Of Symptom Severity Research Articles

Development and validation of a questionnaire to measure the severity of pain, functional limitations, and reduction of sports ability for german-speaking patients with osteochondral lesions of the ankle (OCLA-G)

BackgroundThere is no patient-reported functional scale specific for osteochondral lesion of the ankle (OCLA). Therefore, the objectives of this study were to develop a questionnaire that measures symptom severity, function, and sports capacity in patients with osteochondral lesions of the ankle and to determine the psychometric properties of the tool in German language (OCLA-G).MethodsThe OCLA-G questionnaire was developed according to the COSMIN guidelines. Scalable items were generated from a literature search, based on an evaluation of 71 own OCLA patients, and from expert opinions. Following a twofold item reduction the questionnaire underwent explorative data analysis and principal component analysis. Validity and reliability were analysed in four groups of participants (40 patients with OCLA, 40 patients with other foot and ankle injuries, 40 asymptomatic athletes serving as a population at risk, and 40 asymptomatic persons playing sports not at risk). The minimum age for participation in the study was set at 18 years. The mean age was 39.3 ± 15.1 years.ResultsThe final OCLA-G questionnaire consists of eight and five questions to mirror activities of daily life (ADL) and sports, respectively. Excellent internal consistency (Cronbach’s α = 0.950 for the ADL subscore and 0.965 for the sport subscale, respectively) was found. Spearman’s rank correlation coefficients for test-retest reliability were 0.992 for the ADL subscore and 0.999 for the sport subscale (p < 0.001). The results of the exploratory and confirmatory factor analyses indicated that item difficulty was between 23.4 and 62.8. The Pearson correlation for the OCLA subscales ADL and sport was 0.853 (p < 0.001). Construct validity as tested against the SF-12 questionnaire subscales (Physical and Mental component scale) were r = -0.164 to -0.663 (p < 0.05). Statistically, there was no ADL and sport OCLA mean score difference between OCLA patients and patients with other foot and ankle injuries (p = 0.993 and 0.179, respectively), but both groups differed from the uninjured control groups (p < 0.001). There were no ceiling or floor effects.ConclusionsThe OCLA-G was successfully developed as the first patient reported and injury specific outcome scale to measure the impact of OCLA induced symptoms on activities of daily living and sport. This study provides evidence for the reliability and validity of the OCLA-G assessing patients with OCLA.Trial registrationThe registration trial number is DRKS00009401 on DRKS. ‘Retrospectively registered’. Date of registration: 10/12/2015.

What Is Unspecified Functional Bowel Disorder? A Commonly Seen, Rarely Recognized, and Poorly Understood Diagnosis.

Unspecified functional bowel disorder (FBD-U) is a Rome IV diagnosis of exclusion and occurs when patients report bowel symptoms but do not meet the criteria for other functional bowel disorders (FBD; irritable bowel syndrome [IBS], functional constipation [FC], functional diarrhea [FDr], or functional bloating). Previous research suggests that FBD-U is as/more common than IBS. One thousand five hundred one patients at a single-center tertiary care center completed an electronic survey. Study questionnaires included Rome IV Diagnostic Questionnaires, anxiety, depression, sleep, health care utilization, and bowel symptom severity measures. Eight hundred thirteen patients met Rome IV criteria for a FBD and 194 patients (13.1%) met criteria for FBD-U, representing the second most common FBD after IBS. Severity of abdominal pain, constipation, and diarrhea were lower in FBD-U compared with other FBD, whereas health care utilization was similar among the groups. Scores on measures of anxiety, depression, and sleep disturbances were similar in FBD-U compared with FC and FDr but were less severe than IBS. Between 25% and 50% of patients with FBD-U did not meet Rome IV criteria for other FBD due to timing of onset of the target symptom (e.g., constipation for FC, diarrhea for FDr, and abdominal pain for IBS). FBD-U, by Rome IV criteria, is highly prevalent in clinical settings. These patients are not represented in mechanistic studies or clinical trials for not having met Rome IV criteria for other FBD. Making future Rome criteria less stringent would minimize the number fulfilling criteria for FBD-U and maximize the true representation of FBD in clinical trials.

Structural connectivity of an interoception network in schizophrenia

Interoception refers to the processing, integration, and interpretation of bodily signals by the brain. Interoception is key to not only basic survival, but also motivational and affective functioning. There is emerging evidence suggesting altered interoception in schizophrenia, but few studies have explored potential neural underpinnings. The current study aims to investigate the anatomical connectivity of a previously identified interoception network in individuals with schizophrenia, and the relationship between network structural connectivity and both emotional functioning and clinical symptoms. Thirty-five participants with schizophrenia (SZ) and 36 healthy control participants (HC) underwent diffusion tensor imaging (DTI) and performed tasks measuring emotional functioning. Probabilistic tractography was used to identify white matter tracts connecting key hubs in an interoception network. Microstructural integrity of these tracts was compared across groups and correlated with measures of emotional functioning and symptom severity. Compared with HC, SZ exhibited altered structural connectivity in the interoception network. In HC, the structural connectivity of the network was significantly correlated with emotion recognition, supporting a link between the interoception network and emotional functioning. However, this correlation was much weaker in SZ. These findings suggest that altered interoception may have implications for illness mechanisms of schizophrenia, especially in relation to emotional deficits.

Amateur choir singers - Does good vocal health matter?

Many amateur singers enjoy singing in choirs. They are likely to lack the training and expertise of professional singers and this may have an impact on their vocal health. To assess the experiences of amateur singers, their use of warm-up and cool-down sessions, their vocal health, their sources of help and advice and their reactions to receiving a diagnosis and treatment. A questionnaire was sent to amateur choir singers. Quantitative data on their use of warm-up and cool-down activities were collected and the singers rated how frequently they experienced adverse voice symptoms after singing. Qualitative data were collected from singers who had sought advice about their voice and from those who had received a diagnosis and treatment. Most choirs used warm-up sessions but few used cool-down. Singers who participated in choir warm-ups experienced significantly less vocal symptoms. Individual warm-ups were ineffective. Singers who had previously had a diagnosis continued to have significantly higher symptom scores. A quarter of the singers who had neither sought help nor had a diagnosis had high scores. Singers appeared uncertain about who to consult for help. Those who saw a speech and language therapist were much more likely to receive a diagnosis and treatment either by the therapist or by referral to an ear, nose and throat specialist. Those receiving treatment were mainly positive about it and likely to complete a course of therapy. Warm-up sessions performed by choirs are helpful in avoiding voice symptoms and are recommended. The presence of singers who are unaware of potential damage to their voices is a concern. A simple rating system, as used in this research, may act to alert them to the dangers. Choir leaders could be more active in advising singers and refer them to professionals where necessary. Speech and language therapists appear more sensitive to their problems and could be a first point of contact. What isalreadyknownonthissubject Poor vocal health may occur in amateur singers and lead to voice disorders which will reduce the demonstrated benefits of regular singing. They may be less aware than professional singers of potential hazards and may not know how to sing in a way that ensures good vocal health. There has been less research on the extent of voice problems in amateurs or of the actions they may take to resolve the vocal difficulties they encounter. What this paper adds to the existing knowledge This survey demonstrates that choir warm-ups were effective in helping to avoid common symptoms associated with voice problems. A large minority of singers who had not sought help for voice problems had high symptom scores on our assessment. Singers frequently turned to a singing teacher for help. Those who consulted a speech and language therapist were much more likely to be referred for further investigation and treatment. What are the potential or actual clinical implications of this work? We present a simple subjective measure of symptom severity which succeeds in distinguishing between singers who warm up their voices and those who do not and between singers who have received a past diagnosis and those who have not. There are a number of indications in this research that amateur singers are unsure if they need help and are uncertain who can offer it. In these circumstances the use of a simple measure of the severity of vocal abuse may be useful.

Development and psychometric evidence of the Chinese Version of the Theory of Mind Inventory-2 (ToMI-2) in children with autism spectrum disorder

BackgroundTheory of mind (ToM) is an important social cognitive ability of humans to understand the mental states of themselves and others. Children with autism spectrum disorder (ASD) are believed to have impaired ToM. In this study, for application in Chinese children with ASD in clinical and research settings, the Chinese Version of the Theory of Mind Inventory-2 (ToMI-2-C) was developed with cultural adaptations. The psychometric properties of ToMI-2-C were then evaluated in Chinese children with ASD. MethodsThe ToMI-2-C was developed and culturally adapted through a standard translation process: forward translation, back-translation, synthesis, expert validation and content validity, and a pilot study. A total of 166 children with ASD and 54 children with typical development, all aged 3–12 years, were then assessed with the ToMI-2-C and with measures of symptom severity, social adaptive behavior skills, and verbal ability. ResultsThe ToMI-2-C was found to have high internal consistency (Cronbach’s α = 0.965) and good test–retest reliability (Intraclass correlation coefficient = 0.88), convergent validity (r = − 0.436 to 0.591, all p < 0.001), and discriminative validity (t = 8.172, p < 0.01; Cohen's d = 1.57; area-under-the-curve = 0.87) for differentiating children with ASD and those with typical development. ConclusionsThe empirical results show that the ToMI-2-C could be a useful measure for clinicians and researchers to reliably and validly evaluate the daily performance of ToM in children with ASD.

A real-world data analysis of Clinical Global Impression-Severity (CGI-S) as a transdiagnostic predictor of psychiatric hospitalisation

IntroductionPreventing psychiatric admissions holds benefits for patients as well as healthcare systems. The Clinical Global Impression-Severity (CGI-S) scale is a 7-point measurement of symptom severity, independent of diagnosis, which has shown capability of predicting risk of hospitalisation in schizophrenia. Due to its routine use in clinical practice and ease of administration, it may have potential as a transdiagnostic predictor of hospitalisation.ObjectivesTo investigate whether early trajectories of CGI-S scores predict risk of hospitalisation over a 6 month-follow-up period.MethodsA retrospective cohort study was conducted, analysing Electronic Health Record (EHR) data from the NeuroBlu Database (Patel et al. BMJ Open 2022;12:e057227). Patients were included if they had a psychiatric diagnosis and at least 5 recorded CGI-S scores within a 2-month period, defined as the ‘index’ period. The relationship between early CGI-S trajectories and risk of hospitalisation was investigated using Cox regression. The analysis was adjusted for age, gender, race, number of years in education, and psychiatric diagnosis. Early CGI-S trajectories were estimated as clinical severity (defined as the mean CGI-S score during the index period) and clinical instability (defined as a generalised Root Mean Squared Subsequent Differences of all CGI-S scores recorded during the index period). The primary outcome was time to psychiatric hospitalisation up to 6 months following the index period. Patients who had been hospitalised before or within the index period were excluded.ResultsA total of 36,914 patients were included (mean [SD] age: 29.7 [17.5] years; 57.3% female). Clinical instability (hazard ratio: 1.09, 95% CI 1.07-1.10, p&lt;0.001) and severity (hazard ratio: 1.11, 95% CI 1.09-1.12, p&lt;0.001) independently predicted risk of hospitalisation. These associations were consistent across all psychiatric diagnoses. Patients in the top 50% of severity and/or instability were at a 45% increased risk of hospitalisation compared to those in the bottom 50% (Figure 1).Image:ConclusionsEarly CGI-S trajectories reflecting clinical severity and instability independently predict risk of hospitalisation across diagnoses. This risk was compounded when instability and severity were present together. These results have translation potential in predicting individuals who are at high risk of hospitalisation and could benefit from preventative strategies to mitigate this risk.Disclosure of InterestE. Palmer Employee of: Holmusk, M. Taquet Consultant of: Holmusk, K. Griffiths Employee of: Holmusk, S. Ker Employee of: Holmusk, C. Liman Employee of: Holmusk, S. N. Wee Employee of: Holmusk, S. Kollins Employee of: Holmusk, R. Patel Grant / Research support from: National Institute of Health Research (NIHR301690); Medical Research Council (MR/S003118/1); Academy of Medical Sciences (SGL015/1020); Janssen, Employee of: Holmusk

Psychometric evaluation of the German version of the Yale-Brown Obsessive- Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS)

The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) is a clinician-administered interview to assess symptom severity in individuals with a BDD diagnosis. It has been translated into German and disseminated into research and practice. However, the psychometric properties of the German version have not been thoroughly evaluated. Therefore, we investigated its psychometric properties, factor structure and provided normative data. Our study included a large pooled sample comprising 350 outpatients with a BDD diagnosis (mean age = 30.35 years, SD = 10.15; gender: 70.6% female, 28.9% male, 0.6% unspecified). Psychometric data supported a good internal consistency of the BDD-YBOCS total score (α = 0.81, ω = 0.86) and an excellent interrater-reliability (ICC = 0.96). The BDD-YBOCS correlated moderately with other measures of BDD symptom severity. Confirmatory factor analysis favored a two-factor structure representing obsessions versus compulsions over a one-factor structure, with the quality of the proposed two-factor structure still being poor. Normative data indicated that BDD-YBOCS scores between 21 and 34 can be considered as typical range in an outpatient sample with a wide range of BDD symptom severity. In conclusion, the German BDD-YBOCS is a brief and psychometrically supported clinician-rated instrument for the measurement of BDD severity.

Ulcerative Colitis-Symptom Questionnaire: Valid for Use in Adults with Moderately to Severely Active Ulcerative Colitis

BackgroundDue to wide-ranging impacts of Ulcerative Colitis (UC), regulatory authorities emphasize the importance of including validated patient-reported symptom severity measures in clinical trials.AimTo describe the development and validation of the Ulcerative Colitis-Symptom Questionnaire (UC-SQ).MethodsThe UC-SQ was developed in a qualitative study involving a targeted literature review, semi-structured concept elicitation interviews, and combined concept elicitation/cognitive interviews. Measurement properties, including item-level analyses, factor structure, reliability, validity, responsiveness, and clinically meaningful change were evaluated using data from a phase 2b, randomized trial in adults with UC (N = 113).ResultsFourteen symptom concepts were elicited across 22 interviews, with saturation at the fifth interview. Twenty-two items were unmodified as cognitive interview participants interpreted underlying concepts correctly. Instructions were clear and items were relevant, with appropriate response options and recall periods. Reduction to 17 items was completed prior to psychometric testing. Two items (joint pain/constipation) did not contribute to reliability in initial testing and were included as non-scored items. The 15-item UC-SQ showed evidence of internal consistency (α = 0.86) and test–retest reliability (intraclass correlation coefficient = 0.88). The UC-SQ discriminated by disease severity as defined by Mayo and Inflammatory Bowel Disease Questionnaire scores (p < 0.0001). Convergent validity was supported by strong correlations with criterion measures. The UC-SQ was responsive in patients indicating change in other measures. A 10-point decrease from baseline indicated within-patient meaningful improvement.ConclusionsThe UC-SQ is reliable, valid and responsive, with a 10-point improvement estimating within-patient clinically meaningful improvement. The tool is fit-for-purpose as a key endpoint in pivotal UC trials.

Psychosocial Factors in Chronic Wound Patients

Background/Objective: Chronic wound (CW) represents a major burden on the individual patients who are typically challenged with many underlying health related complications. Stress is now recognized as a universal premorbid factor associated with many risk factors of various chronic diseases. This study utilized socio-demographic data of CW patients and analyzed it against salivary cortisol, a known marker of psychosocial stress.&#x0D; Methods: CW patients were recruited under IRB approved protocol of Indiana University (ClinicalTrials.gov Identifier# NCT03793062). Morning saliva samples were analyzed from 11 patients with CW (56.4±2.8 years). The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) assessment were used as screening tools as well as measures of symptom severity for depression (PHQ-9) and different types of anxiety (GAD-7). Human salivary cortisol was measured by ELISA.&#x0D; Results: The salivary cortisol concentration for CW patients were as follows: those with minimal depression (PHQ-9 score ≤4) had 2.2±0.5 ng/mL; those affected by moderate severe depression (PHQ-9 score &gt;4) showed 1.3±0.3 ng/mL; those with minimal anxiety (GAD-7 score ≤4) was 1.8±0.5 ng/mL; and those with mild to severe anxiety (GAD-7 score &gt;4) had 1.6±0.3 ng/mL. Comparison across race showed that the African American CW patients had higher (2.8±0.5 ng/mL) salivary cortisol levels compared to white CW patients (1.5±0.3 ng/mL).&#x0D; Conclusion and Impact: These preliminary study results indicated that although higher scales of depression and anxiety do not seem to increase salivary cortisol, it is likely that African American CW patients are subject to higher psychosocial stress compared to Caucasian CW patients. The study of a larger sample size is warranted.

Functional and molecular characterization of suicidality factors using phenotypic and genome-wide data

Genome-wide association studies (GWAS) of suicidal thoughts and behaviors support the existence of genetic contributions. Continuous measures of psychiatric disorder symptom severity can sometimes model polygenic risk better than binarized definitions. We compared two severity measures of suicidal thoughts and behaviors at the molecular and functional levels using genome-wide data. We used summary association data from GWAS of four traits analyzed in 122,935 individuals of European ancestry: thought life was not worth living (TLNWL), thoughts of self-harm, actual self-harm, and attempted suicide. A new trait for suicidal thoughts and behaviors was constructed first, phenotypically, by aggregating the previous four traits (termed “suicidality”) and second, genetically, by using genomic structural equation modeling (gSEM; termed S-factor). Suicidality and S-factor were compared using SNP-heritability (h2) estimates, genetic correlation (rg), partitioned h2, effect size distribution, transcriptomic correlations (ρGE) in the brain, and cross-population polygenic scoring (PGS). The S-factor had good model fit (χ2 = 0.21, AIC = 16.21, CFI = 1.00, SRMR = 0.024). Suicidality (h2 = 7.6%) had higher h2 than the S-factor (h2 = 2.54, Pdiff = 4.78 × 10−13). Although the S-factor had a larger number of non-null susceptibility loci (πc = 0.010), these loci had small effect sizes compared to those influencing suicidality (πc = 0.005, Pdiff = 0.045). The h2 of both traits was enriched for conserved biological pathways. The rg and ρGE support highly overlapping genetic and transcriptomic features between suicidality and the S-factor. PGS using European-ancestry SNP effect sizes strongly associated with TLNWL in Admixed Americans: Nagelkerke’s R2 = 8.56%, P = 0.009 (PGSsuicidality) and Nagelkerke’s R2 = 7.48%, P = 0.045 (PGSS-factor). An aggregate suicidality phenotype was statistically more heritable than the S-factor across all analyses and may be more informative for future genetic study designs interested in common genetic factors among different suicide related phenotypes.

Measuring Psychosis: A Review of Widely Used Clinical Outcome Assessments in Clinical Trials

Accurate diagnosis and assessment of symptoms is essential to the appropriate treatment and management of individuals with psychotic disorders. It also plays a pivotal role in research, ensuring that enrolled subjects meet study-specific inclusion requirements and that their progress is accurately tracked throughout the study. Clinical outcome assessments are standardized instruments designed specifically to measure symptoms and their impact on a patient’s life and functioning. These instruments can be used to diagnose, categorize, and track symptom severity, and to measure the functional impact of disease on a patient’s quality of life. Clinical outcome assessments play a pivotal role in advancing our understanding and treatment of schizophrenia and other psychotic disorders, providing the ability to evaluate the safety and efficacy of emerging treatments and interventions. In this review article we provide an overview of the most widely used clinical outcome assessments in schizophrenia and other psychotic disorders research with a focus on clinical trials, and delve into the specific instruments commonly used to diagnose, measure symptom severity, and assess cognitive ability. A brief description of each instrument and its role in clinical outcome assessment is provided, along with advantages and limitations in implementation. Additionally, the clinician’s perspective on the administration and scoring of these scales is included, where relevant. The goal is to familiarize new clinicians and researchers with the available assessment tools, highlighting the advantages, limitations, and any other relevant information that can aid in the selection of the appropriate measurement tools for their patients and studies. Finally, we briefly discuss our view on the future of clinical outcome assessments in schizophrenia and other psychotic disorders research and clinical trials

IMPROVEMENTS AFTER PATIENT-SPECIFIC ADAPTIVE DYNAMIC CYCLING IN PARKINSON'S DISEASE

https://youtu.be/k9T32ExGuPw BACKGROUND Parkinson's disease (PD) is a progressive neurological disorder characterized by symptoms of bradykinesia, tremor, and muscle rigidity. Previous studies have shown that high cadence dynamic cycling promotes significant improvement in PD motor symptoms. This improvement is attributed to a higher entropy (variability) of cadence during dynamic cycling. However, it is not clear how entropy of cadence and level of effort can be utilized to develop individualized exercise prescriptions for individuals with PD, as well as how patient specific adaptive dynamic cycling impacts motor function and mobility in individuals with PD. Therefore, the purpose of this study was to develop an individualized exercise paradigm by manipulating entropy of cadence and level of effort and also examine the effects on motor function and mobility in PD. METHODS/DESIGN 11 individuals diagnosed with idiopathic PD were randomized into either the patient-specific adaptive dynamic cycling (PSADC) or an active control (AC) group. The dynamic cycle resistance settings were optimized for each individual in the PSADC group, while settings remained constant in the AC group. Each group completed 12 sessions over the course of 4 weeks. Motor function and mobility were measured at baseline and after 12 exercise sessions using the clinical and Kinesia One Unified Parkinson's Disease Rating Scale Motor III (UPDRS Motor III) and the Timed Up and Go (TUG). The UPDRS Motor III is the gold standard measurement of PD symptom severity. TUG is a mobility assessment that is highly correlated to overall functional mobility. Outcome measures were compared using repeated measures ANOVA, as well as paired samples and independent samples t-tests. RESULTS Individuals in the PSADC group saw significant improvements UPDRS Motor III score (Pre: 43.33, Post: 36.67; p=0.040), Kinesia One UPDRS Motor III score (Pre: 25.142, Post 23.833; p = 0.017), and TUG completion time (Pre: 12.37s, Post: 9.99s; p=0.036) from baseline to follow up. Individuals in the AC group did not significantly improve motor function (Pre: 28.60, Post: 29.60) or mobility (Pre: 11.23s, Post: 10.85s). CONCLUSIONS PSADC is associated with significant improvements in motor function and mobility in individuals with PD. Future studies will consider developing machine learning or artificial intelligence algorithms to provide accurate and valid exercise prescriptions to be utilized in the clinical rehabilitation for individuals with PD.

Examining the role of emotion dysregulation in the association between obsessive compulsive symptom severity and suicide risk

Obsessive-compulsive disorder (OCD) has been found to be associated with increased risk for suicidal thoughts and behaviors. However, little research has explored factors that may account for the OCD-suicide link. One factor that holds promise in this regard is emotion dysregulation given its previously demonstrated association with obsessive-compulsive (OC) symptom severity and suicide risk. Therefore, the goal of this study was to examine whether emotion dysregulation accounts for the association between OC symptom severity and suicide risk. A sample of 109 adults (60.6% female, mean age = 39.85) seeking treatment at an anxiety disorders clinic completed a variety of self-report measures of OC symptom severity, emotion dysregulation, and recent (past two weeks) suicide risk upon intake into the clinic. As expected, emotion dysregulation accounted for the association between OC symptom severity and recent suicide risk. This result remained when anxiety symptom severity was included as a covariate. Results suggest that emotion dysregulation may be an important target for intervention in reducing suicide risk among individuals experiencing OC symptoms.

High dose intravenous vitamin C for lyme disease: a safety and tolerability study with an exploratory assessment of treatment efficacy.

Lyme disease is the most common vector-borne disease in the United States with an estimated 476,000 new cases per year. Delays in diagnosis and treatment are common and there is a lack of consensus on the antibiotic therapy protocols to ensure successful outcomes. Much of this discord is due to the observation that more than 50 percent of people treated with conventional antibiotic protocols, which have changed little in the last 30 years, report persistent and/or recurring symptoms within 6 months of completing treatment. Labeled as chronic Lyme or post-treatment Lyme disease, it is a syndrome that afflicts more than 2 million people in the United States and can have a devastating impact on both quality of life and socioeconomic capacity. Despite these known treatment failures, the research community has lacked the funding necessary to advance our understanding of this syndrome or to explore innovative options to improve success. In this regard, complementary and alternative therapies, which are generally not patentable and have little potential for producing large economic gain, are generally disregarded in favor of new designer drugs or old reworked protocols. Intravenous vitamin C is one such example that has research validated effectiveness for a wide range of clinical conditions ranging from infection to cancer care. Achieving serum levels much higher than could be obtained orally, high dose intravenous vitamin C has the capacity to generate a concentration of intracellular peroxide that exerts both cytotoxic and immune stimulating effects. Unfortunately, these high doses of intravenous vitamin C have never been evaluated to establish safety and tolerability in Lyme positive patients. This study’s primary aim is to examine this question with the unique additions of DMSO and calcium EDTA into the formula to enhance tissue penetration and address biofilm formation respectively, both of which are known barriers to antibiotic success. The secondary aim of the study is to determine whether subjects gain relief from Lyme-associated symptoms by tracking changes in both the PROMIS-29 and the Horowitz-Lyme-MSIDS questionnaires. The exploratory objective is to assess changes in Lyme specific labs including the standard immunoblot and the T-cell based Elispot as well as the CD57+ lymphocyte immune marker. Administered at a 75-gram dose twice weekly over 12 weeks, high dose intravenous vitamin C was shown to be both well tolerated and safe. The secondary and exploratory aims of the study provide insight into the potential efficacy of this protocol, as both subjective measures of symptom severity and objective assessment of Lyme biomarkers showed marked improvement. Ultimately, this study paves the way for future research using high dose intravenous vitamin C in Lyme patents either as a stand-alone treatment or in synergy with other therapies. It is this author’s hope that employing an integrative medical approach such as this will eventually see chronic Lyme disease as a rare rather than common occurrence.

Onset of Postural Instability in Parkinson's Disease Depends on Age rather than Disease Duration.

Postural instability and falls are considered a major factor of impaired quality of life in patients with advanced Parkinson's disease (PD). The knowledge of the time at which postural instability occurs will help to provide the evidence required to introduce fall-prevention strategies at the right time in PD. To investigate whether postural instability of patients with different age at disease onset is associated with age or with disease duration of PD. Patients diagnosed with sporadic PD between 1991 and 2017 and postural instability (according to the International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III, item 3.12 postural instability) were included, with strict inclusion criteria including regular follow-ups, agreement on data use, and exclusion of comorbidities affecting the free stand. Applying these strict inclusion criteria, we included 106 patients. Those younger than 50 years at PD onset took significantly longer to develop postural instability (n = 23 patients, median: 18.4 years) compared with patients with later onset of PD (50-70 years, n = 66, median: 14.2 years, p < 0.001; and >70 years, n = 17, median: 5.7 years, p < 0.001, Kruskal-Wallis test followed by Dunn's multiple comparisons test). There was no association between total MDS-UPDRS III (as a measure of motor symptom severity) at onset of postural instability. In PD, postural instability is primarily associated with the age of the patient and not with disease duration.

Rasch Analysis of the Behavioral Assessment Screening Tool for Adolescents with Mild Traumatic Brain Injury

<h3>Research Objectives</h3> To provide psychometric evidence for the Behavioral Assessment Screening Tool for Adolescents (BAST-A) using Rasch analysis according to the RULER guidelines. <h3>Design</h3> Measurement Development. <h3>Setting</h3> Community. <h3>Participants</h3> Adolescents ages 12-17 with a documented concussion (n=107). <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> The Behavioral Assessment Screening Tool for Adolescents (BAST-A),3,4 adapted from the BAST for adults,5,6 is a 59-item measure of neurobehavioral functioning. The measure captures severity of symptoms in three domains: Negative Affect and Fatigue, Executive and Social Function, and Risk Behaviors. <h3>Results</h3> Each of the BAST-A subscales met criteria for unidimensionality. There were 5 misfitting items for Negative Affect and Fatigue and 1 misfitting item for both Executive and Social Function and Risk Behaviors. However, upon removal of these items, the average domain measures and standard errors did not improve so the items were retained. Item difficulty (i.e., a measure of symptom severity) also displayed a range across subscales (-1.14 to 2.11 logits). In this sample of adolescents with concussion, less severe symptoms were more commonly endorsed for each of the subscales. However, risk behaviors were endorsed the least. The Executive and Social Function subscale displayed appropriate targeting, but the Negative Affect and Fatigue and Risk Behaviors subscales had higher domain values (-1.06 and -3.38) indicating that more items need to be added to capture different severity levels. <h3>Conclusions</h3> The BAST-A displayed adequate psychometric properties for this sample according to RULER guidelines for the Negative Affect and Fatigue and Executive and Social Function subscales but not the Risk Behaviors subscale. Future work should include adolescents with traumatic brain injury (TBI) of various severity levels and causes of injury as this sample consisted of mostly sports concussion. <h3>Author(s) Disclosures</h3> The authors report no conflicts of interest.

Pediatric anxiety and daily fine particulate matter: A longitudinal study.

Daily variations in ambient fine particulate matter (PM2.5) could contribute to the morbidity of anxiety disorders in children and adolescents, but has not yet been studied longitudinally at a daily level. We tested this association using repeated weekly measures of anxiety symptom severity in a group of 23 adolescents with generalized anxiety disorder. After estimating ambient PM2.5 concentrations using a validated model, we found that increased concentrations were significantly associated with increased anxiety symptom severity and frequency two, three, and four days later. PM2.5 may be a novel, modifiable exposure that could inform population level interventions to decrease psychiatric morbidity.

Music therapy for anxiety disorders in adolescents and young adults: A systematic review

Purpose: The purpose of this systematic review is to examine the effectiveness of music therapy for adolescents and young adults with anxiety disorders. Methods: PRISMA guidelines were followed in performing this systematic review. Studies published in the last 25 years from September 1997 to September 2022 were identified through the use of the Medline, PsycInfo, PubMed, and Google Scholar databases, using the keywords: music* AND anxi*. Two authors independently conducted a focused analysis and reached a final consensus on six studies that met the specific selection criteria and passed the study quality checks. Results: All six studies included showed significant improvement as measured by anxiety symptom severity measures for adolescents and young adults receiving music therapy. Conclusion: While music therapy has shown to be promising as a stand-alone or adjunctive treatment for anxiety disorders in adolescents and young adults, more research is needed to establish music therapy as an effective treatment.

Positive, but not negative, treatment outcome expectancies mediate the relation between depressive symptoms and treatment-related pain reduction.

Previous research has shown that depression is associated with adverse recovery outcomes following work-related musculoskeletal injury. Treatment outcome expectancies have also been shown to predict recovery trajectories following musculoskeletal injury. The present study examined the role of positive and negative treatment outcome expectancies as mediators of the relation between depressive symptoms and treatment outcome for individuals receiving physical therapy for a musculoskeletal injury. The study sample consisted of 153 individuals who had sustained a work-related musculoskeletal injury to the back or neck within 6 months of enrolment. Participants completed self-report measures of depressive symptom severity, pain severity, and treatment outcome expectancies prior to treatment; pain severity was assessed again after 4 weeks of treatment. The results of this study were consistent with previous research showing significant relations between depressive symptom severity, pain severity and treatment outcome expectancies. Bootstrapping mediation analyses separately assessed the mediating roles of positive and negative treatment outcome expectancies on the relation between depressive symptoms and pain severity. Findings revealed that positive treatment outcome expectancies mediated the relation between depressive symptoms and pain severity, whereas negative treatment outcome expectancies did not. Discussion addresses potential pathways through which positive treatment outcome expectancies might influence pain outcomes. The findings suggest that intervention techniques aimed at increasing positive treatment outcome expectancies, rather than decreasing negative treatment outcome expectancies, might contribute to better recovery outcomes for individuals experiencing pain and depressive symptoms following a work-related musculoskeletal injury.

Toward a possible trauma subtype of functional neurological disorder: Impact on symptom severity and physical health.

As a group, individuals with functional neurological disorder (FND) report an approximately 3-fold increase in adverse life experiences (ALEs) compared to healthy controls. In patients with FND, studies have identified a positive correlation between symptom severity and the magnitude of ALEs. While not all individuals with FND report ALEs, such findings raise the possibility of a trauma-subtype of FND. This study investigated if patients with FND, with or without probable post-traumatic stress disorder (PTSD) and/or significant childhood maltreatment, differed in their symptom severity and physical health. Seventy-eight patients with FND were recruited (functional seizures, n = 34; functional movement disorder, n = 56). Participants completed self-report measures of symptom severity [Somatoform Dissociation Questionniare-20 (SDQ-20), Screening for Somatoform Disorders: Conversion Disorder subscale (SOMS:CD), Patient Health Questionniare-15 (PHQ-15)], physical health [Short Form Health Survey-36 (SF36-physical health)], childhood maltreatment [Childhood Trauma Questionnaire (CTQ)], and PTSD [PTSD Checklist-5 (PCL-5)]; a psychometric battery of other common predisposing vulnerabilities was also completed. To adjust for multiple comparisons, a Bonferroni correction was applied to all univariate analyses. Patients with FND and probable PTSD (n = 33) vs. those without probable PTSD (n = 43) had statistically significant increased scores on all symptom severity measures - as well as decreased physical health scores. In secondary post-hoc regression analyses, these findings remained significant adjusting for age, sex, race, college education, and: pathological dissociation; alexithymia; attachment styles; personality characteristics; resilience scores; functional seizures subtype; or moderate-to-severe childhood abuse and neglect scores; SOMS:CD and SDQ-20 findings also held adjusting for depression and anxiety scores. In a separate set of analyses, patients with FND and moderate-to-severe childhood abuse (n = 46) vs. those without moderate-to-severe childhood abuse (n = 32) showed statistically significant increased SDQ-20 and PHQ-15 scores; in post-hoc regressions, these findings held adjusting for demographic and other variables. Stratification by childhood neglect did not relate to symptom severity or physical health scores. This study provides support for a possible trauma-subtype of FND. Future research should investigate the neurobiological and treatment relevance of a FND trauma-subtype, as well as continuing to delineate clinical characteristics and mechanisms in individuals with FND that lack a history of ALEs.