Mini Neuropsychiatric Interview Research Articles

54 The Differential Impact of Genetic Moderators on the Relationship Between Depression and Cognition

Objective:Depression has a well-established negative effect on cognitive functioning. Variations in the apolipoprotein e (APOE) and brain-derived neurotrophic factor (BDNF) genes likely contribute to this relationship. APOE4 and the BDNF Val66Met polymorphism are independently associated with late-life depression and cognitive dysfunction. The current study investigated the moderating effects of APOE4 and BDNFMet (i.e., the presence of the BDNF Val66Met polymorphism) on the relationship between depression and cognitive functioning in older adults.Participants and Methods:The sample included 103 older adults drawn from two clinical trials who were recruited from the VA Palo Alto Health Care System (VAPAHCS) and the Stanford/VA Alzheimer’s Disease Center. Depression was diagnosed using the Mini Neuropsychiatric Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). The presence of an APOE4 and BDNFMet allele were dichotomized (i.e., yes/no) and determined using venipuncture. A comprehensive neuropsychological battery was used to assess attention (RAVLT Trial 1, WAIS-IV DSF), processing speed (TMTA, SDMT, Stroop Word, Stroop Color), working memory (WAIS-IV DSB, DSS), visuospatial functioning (JLO), language (VNT), memory (RAVLT Delayed Recall, WMS-IV Logical Memory II), and executive function (TMTB, Stroop Color-Word). Separate moderation analyses were conducted with depression as the predictor and APOE4 or BDNFMet status as the moderator using the SPSS PROCESS macro v4.0. Age was a covariate for models with processing speed, memory, language, and executive function as outcome variables.Results:Participants were largely male (93%) and White (75%). Ten percent met criteria for depression, 26% were APOE4 carriers, and 32% were BDNFMet carriers. The overall model examining depression, APOE4, and memory was significant (p < .01, R2 = .14). Depression was associated with lower memory performance (p < .05), however, APOE4 was not a significant moderator (p > .05). Similarly, the overall model examining depression, APOE4, and language was also significant (p < .05, R2 = .10). While the direct effects of depression and APOE4 on language were nonsignificant (p > .05), there was a significant two-way interaction between APOE4 and depression (p = .03). The overall model with depression, BDNFMet, and memory was significant (p < .001, R2 = .18). While neither depression nor BDNFMet had significant direct effects on memory (p > .05), a two-way interaction emerged between depression and BDNFMet (p = .05). Simple slopes analyses were used to further investigate significant interactions. Depression, APOE4, and BDNFMet did not significantly impact attention, processing speed, working memory, visuospatial functioning, or executive function, and no significant interactions were noted among variables. BDNFMet had no direct impact on language.Conclusions:APOE4 and BDNFMet were found to differentially moderate the relationship between depression and cognition. Specifically, APOE4 carriers with depression had worse language performance compared to those who were healthy, depressed, or APOE4 carriers. BDNFMet carriers with depression performed worse on measures of memory compared to those who were healthy, depressed, or BDNFMet carriers. The treatment of depression in APOE4 and BDNFMet carriers may reduce associated cognitive impairments. Limitations and future implications are also discussed.

Live Z-Score Neurofeedback Training for PTSD: A Feasibility and Acceptability Study

Individuals with traumatic experiences may develop symptoms of post-traumatic stress disorder (PTSD) and co-morbid disorders, such as anxiety disorders, major depression, and substance use disorder. Although exposure therapy is considered the “gold standard” for the treatment of PTSD, dropout rates and patient distress are relatively high. One promising approach is live Z-score neurofeedback (ZNF) training, but clinical evidence is sparse. Thus, the current study aimed to evaluate the feasibility and acceptability of ZNF training among individuals with PTSD. After undergoing a diagnostic interview utilizing the MINI Neuropsychiatric Interview, nine patients with PTSD (7 females; mean age = 20.75 [SD = 2.38]) completed ten ZNF sessions, lasting 20 min each, and the PCL-5 at pre- and post-treatment. Over the course of the study, only a few minor study disruptions, adverse events, and patient complaints were reported, and participants rated high on feasibility and acceptability. Results from repeated measures ANOVAs suggest significant improvements in overall PTSD symptoms. Although these findings need to be replicated in larger samples with active control groups, the current study provides support that ZNF is a safe, acceptable, and potentially effective treatment for PTSD.

A Study on assessment of the severity and the prevalence of Anxiety, Depression and Quality of Life in caregivers of patients with cancer.

Background: Caregivers plays a role in caring of the cancer patients. They may experience psychological problems such as depression, anxiety which in turn results in decrease in the quality of life. Such people cannot effectively fulfill their role as a caregiver which in turn affects the overall treatment outcome of cancer patients. Aims: The study was done for the purpose of assessesment of the depression and anxiety prevalence in caregivers and to determine the quality of the life in caregivers. Methodology: It was a cross sectional study conducted in caregivers of cancer patients. A total of 100 subjects were recruited in to the study. They were administered with socio-demographic proforma, MINI neuropsychiatric interview to detect the presence of depression and anxiety. Montgomery asberg depression rating scale to assess the severity of depression, Hamilton anxiety rating scale to assess the severity of anxiety and the caregiver quality of life index –cancer for the assessment of the quality of life in the subjects. Data analysis was done with appropriate tests. Results: The study subjects showed that the majority of the caregivers had severe depression (41%), followed by moderate depression in 34% and mild depression in 25% of the subjects. The anxiety rating scale showed that 69%of subjects had severe anxiety, followed mild anxiety (18%) and moderate anxiety in 13% of the subjects. High scores on depression and anxiety rating scales decreases the scores on the caregiver quality of life scale. Conclusions: Majority of the study subjects showed higher rates of anxiety, depression and decreased quality of life.

Sensitivity and specificity of self-reported psychiatric diagnoses amongst patients treated for opioid use disorder

BackgroundPatients with opioid use disorder (OUD) frequently present with comorbid psychiatric illnesses which have significant implications for their treatment outcomes. Notably, these are often identified by self-report. Our study examined the sensitivity and specificity of self-reported psychiatric diagnoses against a structured diagnostic interview in a cohort of patients receiving outpatient pharmacological treatment for OUD.MethodsUsing cross-sectional data from adults receiving outpatient opioid agonist treatment for OUD in clinics across Ontario, Canada, we compared participants’ self-reported psychiatric diagnoses with those identified by the Mini Neuropsychiatric Interview (MINI) Version 6.0 administered at the time of study entry. Sensitivity and specificity were calculated for self-report of psychiatric diagnoses.ResultsAmongst a sample of 683 participants, 24% (n = 162) reported having a comorbid psychiatric disorder. Only 104 of these 162 individuals (64%) reporting a comorbidity met criteria for a psychiatric disorder as per the MINI; meanwhile, 304 (75%) participants who self-reported no psychiatric comorbidity were in fact identified to meet MINI criteria for a psychiatric disorder. The sensitivity and specificity for any self-reported psychiatric diagnoses were 25.5% (95% CI 21.3, 30.0) and 78.9% (95% CI 73.6, 83.6), respectively.ConclusionsOur findings raise questions about the utility of self-reported psychiatric comorbidity in patients with OUD, particularly in the context of low sensitivity of self-reported diagnoses. Several factors may contribute to this including remittance and relapse of some psychiatric illnesses, underdiagnosis, and the challenge of differentiating psychiatric and substance-induced disorders. These findings highlight that other methods should be considered in order to identify comorbid psychiatric disorders in patients with OUD.

Quality of Marital Relationship and Sexual Interaction in Couples With Sexual Dysfunction: An Exploratory Study From India

Background: Sexual dysfunction and marital intimacy and quality are found to have a reciprocal relationship. Examining this relationship in couples seeking help for sexual dysfunctions in the cultural context of India is worthwhile. Aim: This study aims to explore the nature of sexual functioning, sexual interaction, sexual communication, and marital intimacy and quality in couples with sexual dysfunction. Further, relationship between the above variables is also examined. Methods: A cross-sectional, single-group exploratory design was adopted. A sample of 155 married heterosexual individuals, with a clinical diagnosis of sexual dysfunction in either of the spouses, was included in the study. The tools used included MINI neuropsychiatric interview, Marital Quality Scale, Marital Intimacy Questionnaire, Dyadic Sexual Communication Scale, and Sexual Interaction Inventory. Results: Erectile dysfunction and premature ejaculation in men and hypoactive sexual desire disorder in women were the most common sexual dysfunctions. Majority of the sample were young adults. About 82% of the sample had moderate-to-severe levels of marital distress. Mood disorder was the most common psychiatric disorder reported in the sample. High levels of intimacy problems were seen with no significant gender differences in the overall marital quality or intimacy. Difficulty in the overall sexual interactions was found; however, higher levels of dissatisfaction with the frequency of sex and lower self-acceptance was reported by men compared to women. Significant interrelationships were found between marital quality and intimacy, sexual interaction, and sexual communication. Conclusions: Sexual dysfunctions and marital distress are closely related. Sexual interaction and sexual communication play a significant role in marital quality and intimacy.

5-year incidence of suicide-risk in youth: A gradient tree boosting and SHAP study

BackgroundMachine learning methods for suicidal behavior so far have failed to be implemented as a prediction tool. In order to use the capabilities of machine learning to model complex phenomenon, we assessed the predictors of suicide risk using state-of-the-art model explanation methods. MethodsProspective cohort study including a community sample of 1,560 young adults aged between 18 and 24. The first wave took place between 2007 and 2009, and the second wave took place between 2012 and 2014. Sociodemographic and clinical characteristics were assessed at baseline. Incidence of suicide risk at five-years of follow-up was the main outcome. The outcome was assessed using the Mini Neuropsychiatric Interview (MINI) at both waves. ResultsThe risk factors for the incidence of suicide risk at follow-up were: female sex, lower socioeconomic status, older age, not studying, presence of common mental disorder symptoms, and poor quality of life. The interaction between overall health and socioeconomic status in relation to suicide risk was also captured and shows a shift from protection to risk by socioeconomic status as overall health increases. LimitationsProximal factors associated with the incidence of suicide risk were not assessed. ConclusionsOur findings indicate that factors related to poor quality of life, not studying, and common mental disorder symptoms of young adults are already in place prior to suicide risk. Most factors present critical non-linear patterns that were identified. These findings are clinically relevant because they can help clinicians to early detect suicide risk.

Prevalence and factors associated with depressive illness in patients with tuberculosis in Mulago hospital, Kampala- Uganda: A cross sectional study

BackgroundDepression is a major cause of the global disease burden and globally affects 350–400 million persons making it the largest contributor to years lived with disability. Among of patients with chronic physical illnesses like tuberculosis, depression affects up to 25–33% of individuals. There are limited studies on the comorbidity of depressive illness and tuberculosis in the Ugandan setting. Our aim was to determine the prevalence and factors associated with depressive illness in patients with tuberculosis in Mulago Hospital, Uganda. MethodsThis was a cross sectional study involving 308 consecutively sampled participants aged 18 years and above diagnosed with tuberculosis attending the tuberculosis clinic in Mulago Hospital, Uganda. Consecutive sampling was done for a sample size of 308 participants. Participants had the following instruments administered to them; the Socio-demographic questionnaire, the Mini Neuropsychiatric Interview (MINI) to diagnose depressive illness and the Patient Health Questionnaire- 9 to rate the severity of depression. Data was entered using Epi-Data. Descriptive, bivariate and multivariate analyses were done with the Statistical Package for Social Sciences (SPSS). Resultsthe prevalence of depressive illness was 23.7% (95% confidence interval 19.3–28.9). Depressive illness was independently associated with low education level (AOR = 0.39, 95%CI = 0.21–0.72, p = 0.003), being in the intensive phase of TB treatment (AOR = 2.34, 95%CI = (1.27–4.33), p = 0.007) and family history of depressive illness (AOR = 5.42, 95%CI = 2.02–14.54, p = 0.001). On the PHQ, 60.3% had moderate to severe depression. ConclusionDepressive illnesses should be screened and managed among patients with TB. RecommendationDepression should be routinely screened and managed among patients with Tuberculosis.

Paranoia and Suicidality: A Cross-Sectional Study in the General Population

Paranoia and suicidality seem to be common traits expressing in the general population to varying degrees. This study aims to explore the association between both and to identify determinants of comorbidity. We interviewed a representative sample of the population in Andalusia (n = 4507) and assessed paranoia and suicidality utilizing the Spanish Green’s Paranoid Thoughts Scale (S-GPTS) and the suicidality section of the MINI Neuropsychiatric Interview, respectively. We gathered data on socio-demographics, personality, substance abuse, social support, and environmental distress. We found that paranoia and suicidality were rather common with 6.4% (95% CI: 5.7–7.12) of the sample admitting to some (vs. none) level of suicidality. We also found a robust association between paranoia and suicidality, independent of age and sex (F:298.2; p =.0001; Eta2: .065); 0.5% (95% CI: 0.32–0.76) of the sample (n = 21) presented combinedly high levels of paranoia and some suicidality risk and were considered as having paranoia-suicidality comorbidity (PSC). We identified factors associating with PSC, including poor social support, childhood maltreatment, threatening life-events and increasing personality disorder, and nicotine dependence scores. Paranoia and suicidality are common traits in the general population and their comorbidity seems to associate with low social support, environmental adversity and disordered personality. Suicidality and paranoia are common traits present dimensionally in a representative nonclinical sample. Paranoia strongly and independently associates with suicidality risk in a large population-based study. Paranoia and suicidality comorbidity may be commonly determined by poor social support, disordered personality, previous childhood maltreatment, and exposure to threatening life-events.

Risky Sexual Behavior and Its Association With Attention-Deficit Hyperactivity Disorder, Stressful Life Events, and Other Psychiatric Correlates Among Women in Sex Work

Introduction: Numerous psychiatric disorders are known to be associated with risky sexual behavior (RSB). Depression or substance use is known to be higher in those who are in sex work. Recent literature has also described the association between attention-deficit hyperactivity disorder (ADHD) and RSB. However, the association between ADHD and RSB among women in sex work (WSW) is relatively unknown. In this background, this study was conducted to study the prevalence of ADHD and associated psychiatric correlates among WSW and also to study the prevalence of RSB in this population. Methodology: A sample of 96 women who were in sex work and consented to be the part of the study were recruited. They were later administered Adult ADHD Self-Report Scale to screen for adult ADHD symptoms, Wender Utah Rating Scale to retrospectively look into a childhood diagnosis of ADHD, MINI neuropsychiatric interview for DSM 4-TR psychiatric diagnoses, HIV Risk Behavior Scale to study RSB, Beck’s Depression Inventory to quantify depression, and Presumptive Stressful Life Events Scale to quantify the presence of stressful life events. Results: The prevalence of Adult ADHD in the sample was 32.20 % (n = 31). Individuals with ADHD had a higher prevalence of RSB ( P = .02), comorbid depression ( P = .04), presence of stressful life events ( P = .001), and a higher prevalence of sexually transmitted infections ( P = .03). Conclusion: The prevalence of ADHD is high among WSW (32%). Risky sexual behavior in this population could be probably due to higher prevalence of associated psychiatric conditions including depression, higher presence of stressful life events, and ADHD, the association which is less understood. There is a need to replicate these findings in larger samples to study ADHD and its relationship with risky sexual behavior among WSW.

Validity of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adult primary care users in Bucaramanga, Colombia

The patient health questionnaire-9 (PHQ-9) is one of the most widely used self-report instruments in primary care. There is no criterion validity of the PHQ-9 in Colombia. The objective was to validate the PHQ-9 as a screening tool in primary care. A cross-sectional, scale criterion validity study was performed using as reference criterion the mini neuropsychiatric interview (MINI) in male and female adult users of primary care centres. We calculated the internal consistency and convergent and criterion validity of the PHQ-9 by analysing the receiver operating characteristics (ROC) and the area under the curve (AUC). We analysed 243 participants; 184 (75.7%) were female. The average age was 34.05 (median of 31 and SD=12.47). Cronbach's α was 0.80 and McDonald's ω was 0.81. Spearman's Rho was 0.64 for HADS-D (P<0.010) and 0.70 for PHQ-2 (P<0.010). The AUC was 0.92 (95% CI 0.880–0.963). The optimal cut-off point of PHQ-9 was ≥7: sensitivity of 90.38 (95% CI: 81.41–99.36); specificity of 81.68 (95% CI: 75.93–87.42); PPV 57.32 (95% CI: 46.00–68.63); NPV 96.89 (95% CI: 93.90–99.88); Youden index 0.72 (95% CI: 0.62–0.82); LR+ 4.93 (95% CI: 3.61–6.74); LR− 0.12 (95% CI: 0.005–0.270). In sum, the Colombian version of PHQ-9 is a valid and reliable instrument for depression screening in primary care in Bucaramanga, with a cut-off point ≥7.

Psychiatric Disorders and Mild Cognitive Impairment in Older Veterans With Subjective Memory Complaints

Psychiatric disorders pose a unique risk for Alzheimer’s disease (AD). Prior research indicates psychiatric disorders in MCI increase AD vulnerability. Less research has been done to understand how psychiatric disorders may affect the development of MCI. Understanding these potentially modifiable risk factors is important as they may represent a potential target of intervention for secondary prevention of AD. The present study examines the relationship between psychiatric disorders and amnestic MCI (aMCI) in a sample of Veterans with subjective memory complaints. The sample included 150 older adults with subjective memory complaints (90% male, age = 70.6±8.2). aMCI diagnosis was based upon performance on the delayed recall trials of the Rey Auditory Verbal Learning Test and Logical Memory II of the Wechsler Memory Scale-4th edition. Psychiatric disorders (e.g., Mood Disorders, Anxiety Disorders, and Substance Use Disorders) were assessed using the Mini Neuropsychiatric Interview for DSM-IV. Logistic regression modeling demonstrated that diagnosis of anxiety disorders, but not mood or substance use disorders, was significantly associated with aMCI status. Specifically, older adults with an anxiety disorder were less likely to have aMCI than those older adults without an anxiety disorder. Additional analyses revealed that within those with aMCI (n=107), persons with a psychiatric disorder were significantly younger than those without a psychiatric disorder by an average of 6 years. These findings support prior research on the complex relationship of anxiety and cognitive impairment as well as suggest that those with psychiatric disorders may be at risk for developing aMCI at younger ages.

A-013 The Impact of Anxiety and Depressive Disorders on Late-Life Cognitive Functioning

Abstract Objective Research indicates that the presence of psychiatric disorders is predictive of cognitive performance and increases the risk of developing dementia. Some have found that psychiatric disorders decrease cognitive performance while others have found that they increase cognitive performance. The purpose of the present study is to further investigate the relationship between psychiatric disorders and cognitive performance in older Veterans. Method The convenience sample included 216 older Veterans who were screened at the VA Palo Alto Health Care System (94% male, age = 71.8 ± 8.3). Psychiatric disorders (e.g., mood and anxiety disorders) were assessed using the Mini Neuropsychiatric Interview for DSM-IV. Domains of cognitive performance (e.g., Learning and Memory, Executive Function, Processing Speed, Attention, Visuospatial Ability, and Language) were measured using a comprehensive neuropsychological assessment battery. Results Results indicated that 25% of the sample had depression (n = 56) and 16% had anxiety (n = 34). Psychiatric diagnoses largely had no effect on executive function, processing speed, or language. Age was found to moderate the association between depression and learning and memory, though there were no main effects for depression on learning and memory. Anxiety was significantly associated with learning and memory performance, and age was found to further moderate that relationship. Age also moderated the association between depression and attention, though no main effects for depression were seen in the model. Anxiety had no effect on attention. Conclusions Age and psychiatric diagnoses interact to differentially impact cognitive functioning in late life. These findings support prior research on the complex relationship between psychiatric disorders and late-life cognitive impairment.

The Unhappy Mental Health Triad: Comorbid Severe Mental Illnesses, Personality Disorders, and Substance Use Disorders in Prison Populations.

BackgroundInformation on the comorbidity of mental health problems in prison populations is scarce. The aim of the present study was to assess the prevalence of comorbidities at intake to prison between three diagnostic groups: severe mental illnesses (SMIs), personality disorders (PDs), and substance use disorders (SUDs). The co-occurrence of those disorders in prison populations may require the integration of differential treatment approaches and novel treatment trials.MethodsA consecutive sample of N = 427 (229 male and 198 female) individuals committed to imprisonment in Santiago de Chile was assessed with the Mini Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV (module for borderline personality disorders) on arrival at prison. Diagnoses were a priori grouped as SMI including psychosis, bipolar disorder and major depression, PD including borderline and antisocial PD and SUD including alcohol and drug abuse or dependence. Sex stratified multivariate binary logistic regression analyses were conducted to assess sociodemographic, criminal and treatment characteristics of individuals with at least one diagnosis from each of the three diagnostic groups.ResultsThe triad of SMI, PD, and SUD was present in n = 138 (32.3%; 95% IC: 28.0–36.9) study participants, n = 105 (45.9%; 95% CI: 39.4–52.4) of the men and n = 33 (16.7%; 95% CI: 12.1–22.6) of the women. Among those with the disorder triad, n = 129 (30.2%; 95% CI: 26.0–34.8) had major depression, PD and SUD; n = 54 (12.6%; 95% CI: 9.8–16.2) had psychosis, PD and SUD. The disorder triad was more common in men (OR = 4.86; 95% IC: 2.63–8.95), younger age (OR = 0.94; 95% CI: 0.91–0.97), and participants with lower educational levels (OR = 1.69; 95% CI: 1.01–2.82). The disorder triad was significantly associated with previous incarcerations (OR 2.60; 95% CI: 1.55–4.34) and histories of psychiatric hospitalizations (OR 2.82; 95% CI: 1.27–6.28).DiscussionThe complex triad of disorders from different diagnostic groups is common in prison populations, especially among young men. Successful treatment interventions may have the potential to break a cycle of repeat institutionalization in prisons and psychiatric institutions.

Post-traumatic stress disorder and association with low birth weight in displaced population following conflict in Malakand division, Pakistan: a case control study

BackgroundThe northern part of the province of Khyber Pakhtunkhwa in Pakistan experienced armed conflict since September 2007 till the autumn of 2011. Conflict involved widespread insurgency activity and military intervention including in 2009 internally displacing the 2.5 million people of the valley of Swat to live in camps, with relatives, or in rented accommodation across the region for approximately 4 months. It was during this period the current study was conducted to determine whether Post-Traumatic Stress Disorder in pregnant women was independently associated with Low Birth Weight (LBW) in an area affected by conflict and militancy.MethodsA case control study was conducted in tertiary care hospitals of district Peshawar, Khyber Pakhtunkhwa. Two hundred twenty-five cases (neonates with birth weight < 2.5 kg) and 225 controls (neonates with birth weight of > 2.5 kg) were enrolled within 24 h of delivery. Post-Traumatic Stress Disorder was assessed through the MINI Neuropsychiatric Interview 5.0, a validated questionnaire along with the birth weight of the newborn. Maternal anthropometry, anemia and other sociodemographic details were also obtained during data collection. Data was analyzed using statistical package (STATA version 14). Logistic regression analysis of the association between LBW and all variables collected with a p-value of < 0.25 on uni-variate analysis were entered.ResultsA total of 450 newborn and mother pairs participated in the study with 225 cases and 225 controls. On univariate analysis factors significantly associated with LBW include: less than 5 years of paternal schooling and PTSD. On logistic regression, PTSD was independently associated with low birth weight in the presence of other factors like maternal/paternal schooling, gravida, history of preterm, BMI of the mother and maternal anemia.ConclusionPTSD was found to be independently associated with LBW. In light of the current findings and other similar literature, intervention programs should be considered for pregnant women exposed to traumatic events.

Validez del Cuestionario de salud del paciente-9 (PHQ-9) para cribado de depresión en adultos usuarios de Atención Primaria en Bucaramanga, Colombia

The patient health questionnaire-9 (PHQ-9) is one of the most widely used self-report instruments in primary care. There is no criterion validity of the PHQ-9 in Colombia. The objective was to validate the PHQ-9 as a screening tool in primary care. A cross-sectional, scale criterion validity study was performed using as reference criterion the mini neuropsychiatric interview (MINI) in male and female adult users of primary care centres. We calculated the internal consistency and convergent and criterion validity of the PHQ-9 by analysing the receiver operating characteristics (ROC) and the area under the curve (AUC). We analysed 243 participants; 184 (75.7%) were female. The average age was 34.05 (median of 31 and SD = 12.47). Cronbach's α was 0.80 and McDonald's ω was 0.81. Spearman's Rho was 0.64 for HADS-D (P <0.010) and 0.70 for PHQ-2 (P <0.010). The AUC was 0.92 (95% CI 0.880-0.963). The optimal cut-off point of PHQ-9 was ≥7: sensitivity of 90.38 (95% CI: 81.41-99.36); specificity of 81.68 (95% CI: 75.93-87.42); PPV 57.32 (95% CI: 46.00-68.63); NPV 96.89 (95% CI: 93.90-99.88); Youden index 0.72 (95% CI: 0.62-0.82); LR+ 4.93 (95% CI: 3.61-6.74); LR– 0.12 (95% CI: 0.005-0.270). In sum, the Colombian version of PHQ-9 is a valid and reliable instrument for depression screening in primary care in Bucaramanga, with a cut-off point ≥7.

Spatial working memory, not IQ or executive function, discriminates early psychosis and clinically vulnerable creative individuals.

While associations between creativity and psychopathology have been well researched, the specific cognitive processes that distinguish highly creative from those with psychopathology warrant further investigation. This study will examine whether IQ, executive function, cognitive inhibition or spatial working memory differentiate individuals with early psychosis, clinically vulnerable creative individuals, creative controls and non-creative controls. The study sample consisted of 110 participants: early psychosis (n = 21); clinically vulnerable creative controls (n = 25); creative controls (n = 30) and non-creative control (n = 34). The Diagnostic Interview for Psychosis assessed early psychosis participants and the Mini Neuropsychiatric Interview was used to screen for psychopathology in the remaining groups. Several cognitive tests were administered: IQ, neurocognitive measures of executive function and spatial working memory. Creativity was assessed using the Torrance Test of Creativity and Creative Achievement Questionnaire. A measure of vividness of mental imagery was also given. Across all cognitive tests, spatial working memory differentiated the early psychosis group from both creative and non-creative control groups. Spatial working memory predicted group membership but vivid imagery was a better predictor of creative achievement. The early psychosis, clinically vulnerable creative and creative groups all recorded significantly higher results on creative achievement and creative cognition compared to non-creative controls. Our results provide further support for spatial working memory as an early neuro-cognitive marker for early psychosis. Spatial working memory, rather than IQ or executive function, may also be an early protective factor for clinically vulnerable young creative individuals.

Prevalencia del trastorno bipolar y factores asociados en las parroquias rurales del cantón Cuenca

Introducción: El trastorno bipolar es una patología del estado de ánimo que se caracteriza por episodios que cambian entre manía y depresión; el objetivo del estudio fue conocer la prevalencia y factores asociados del trastorno bipolar en la población de las parroquias rurales del cantón Cuenca. Materiales y métodos: Se realizó un estudio de tipo transversal analítico. El universo estuvo conformado por 199.506 habitantes, a través de una muestra polietápica se evaluaron a 984 individuos de las parroquias El Valle, Tarqui y Checa. Se aplicó una entrevista sociodemográfica y el test MINI (Mini Entrevista Neuropsiquiátrica Internacional para adultos). Se incluyó personas de 18 años en adelante y se excluyó a individuos con alteraciones cognitivas y conductuales graves. Resultados: Se encontró que 32 personas presentaron trastorno bipolar actual que corresponde a una prevalencia del 3,30% de los cuales el 1,42%, se reportaron como trastorno único. Las personas que sufren manía actualmente representaron el 1,70% de la población; mientras que los que sufren hipomanía fueron el 1,50%. Se encontró un mayor porcentaje en el sexo femenino. El único factor asociado es el no convivir con una pareja, con un chi cuadrado de 11,60 (p: 0.00) con un OR de 2,20 (IC 1,39 – 3,50). No existe asociación con estructura y funcionalidad familiar, situación laboral, migración, edad y sexo. Se consideró como comorbilidades: ansiedad y dependencia-abuso de alcohol y sustancias. Conclusiones: El trastorno bipolar tiene una prevalencia del 3,30%. El principal factor asociado fue vivir sin una pareja.

Predictors of alcohol use transitions among drug-using youth presenting to an urban emergency department

BackgroundPrecipitants of alcohol use transitions can differ from generalized risk factors. We extend prior research by predicting transitions in alcohol use disorder (AUD) during adolescence and emerging adulthood.MethodsFrom 12/2009-9/2011, research assistants recruited 599 drug-using youth age 14–24 from Level-1 Emergency Department in Flint, Michigan. Youth were assessed at baseline and four biannual follow-ups, including a MINI Neuropsychiatric interview to diagnose AUD (abuse/dependence). We modeled AUD transitions using continuous time Markov Chains with transition probabilities modulated by validated measures of demographics, anxiety/depression symptoms, cannabis use, peer drinking, parental drinking, and violence exposure. Separate models were fit for underage (<21) and those of legal drinking age.ResultsWe observed 2,024 pairs of consecutive AUD states, including 264 transitions (119 No-AUD→AUD; 145 AUD→No-AUD); 194 (32.4%) individuals were diagnosed with AUD at ≥1 assessment. Among age 14–20, peer drinking increased AUD onset (No-AUD→AUD transition) rates (Hazard ratio—HR = 1.70; 95%CI: [1.13,2.54]), parental drinking lowered AUD remission (AUD→No-AUD transition) rates (HR = 0.53; 95%CI: [0.29,0.97]), and cannabis use severity both hastened AUD onset (HR = 1.18; 95%CI: [1.06,1.32]) and slowed AUD remission (HR = 0.85; 95%CI: [0.76,0.95]). Among age 21–24, anxiety/depression symptoms both increased AUD onset rates (HR = 1.35; 95%CI: [1.13,1.60]) and decreased AUD remission rates (HR = 0.74; 95%CI: [0.63,0.88]). Friend drinking hastened AUD onset (HR = 1.18, 95%CI: [1.05,1.33]), and slowed AUD remission (HR = 0.84; 95%CI: [0.75,0.95]). Community violence exposure slowed AUD remission (HR = 0.69, 95%CI: [0.48,0.99]). In both age groups, males had >2x the AUD onset rate of females, but there were no sex differences in AUD remission rates. Limitations, most notably that this study occurred at a single site, are discussed.ConclusionsSocial influences broadly predicted AUD transitions in both age groups. Transitions among younger youth were predicted by cannabis use, while those among older youth were predicted more by internalizing symptoms and stress exposure (e.g., community violence). Our results suggest age-specific AUD etiology, and contrasts between prevention and treatment strategies.

Validation of the Zung self-rating depression scale (SDS) in older adults

Objective: The main objective of this study was to investigate the psychometric properties of the Zung Self-Rating Depression Scale (SDS) and evaluate screening parameters capability of the SDS with the Beck Depression Inventory (BDI-21) among the elderly population.Design: A population-based studySetting: CommunitySubjects: 520 adults, aged 72–73 years, living in the city of Oulu, Finland.Main outcome measures: The screening parameters of the SDS questions and BDI-21 for detecting severity of depression. The Mini Neuropsychiatric Interview for diagnosing major depression.Results: The optimal cut-off point for the SDS was 39. The sensitivity and specificity parameters for this cut-off point were 79.2% (95% CI 57.8–92.9) and 72.2% (95% CI 67.9–76.1), respectively. Positive and negative predictive values were 12.5% (95% CI 7.7–18.8) and 98.6% (95% CI 96.7–99.5), respectively. Moreover, there was no statistically significant difference in diagnostic accuracy indices of the cut-off points 39 and 40. In a receiver operating characteristic analysis, the area under the curve was 0.85 (95%CI 0.77–0.92) for the SDS total score and 0.89 (95% CI 0.83-0.96) for the BDI-21 (p = 0.137).Conclusion: Using the traditional cut-off point, the SDS was convenient for identifying clinically meaningful depressive symptoms in an elderly Finnish population when compared with the BDI-21 which is one of the most commonly used depression screening scales. The sensitivity and specificity of these two screening tools are comparable.Based on our study, the SDS is convenient for identifying clinically meaningful depressive symptoms among older adults at the community level.Key pointsThe widely used Zung Self-Rating Depression Scale (SDS) has not previously been validated among elderly people at the community level.The sensitivity and specificity of SDS (cut-off point 39) were 79.2% and 72.2%.The positive and negative predictive values for SDS were 12.5% and 98.6%.SDS is convenient for identifying major depression in an elderly population and regarding sensitivity and specificity comparable to BDI-21.

Oxidative Status in Bipolar Disorder (BD) and Its Correlation with Age, Gender and Body Mass Index (BMI)

Bipolar disorder (BD) is a chronic psychiatric illness which molecular foundations have yet to be elucidated. Oxidative stress appears to be a promising field of study to understand the formation of this disease in molecular level. The objective was to investigate the oxidative status of BD and its association with age, gender and body mass index (BMI). A cross-sectional study was conducted in a tertiary university hospital in Cheras, Malaysia on 55 patients with BD diagnosed using Mini Neuropsychiatric Interview (MINI). Peripheral markers of oxidative stress which include superoxide dismutase (SOD), glutathione peroxidise (GPx), catalase (CAT), malondialdehyde (MDA) and DNA damage were examined in subjects with BD (n=55) and compared to healthy controls (n=28). BD patients had significantly higher concentrations of MDA compared to healthy controls (p<0.001). Concentration of MDA was significantly higher in BD patients aged 40 and above compared to those aged 39 years and below (p<0.05). The concentration of MDA did not show significant difference between male and female BD patients, likewise between patients with BMI below and above 25. The percentage of normal DNA in healthy controls was significantly higher than that of BD patients (p<0.001), while percentage of mildly and severely damaged DNA in BD patients was significantly higher than that of healthy controls (mildly damaged: p<0.001; severely damaged: p<0.001). The severity of DNA damage in the BD patients was similar when compared between age, gender and BMI. SOD activity of BD patients was found to be comparable to that of healthy subjects as well as when compared between gender and age, but was significantly lower in subjects with BMI above 25 (p<0.05). CAT activity was significantly higher in BD patients compared to controls (p<0.001), while no significant difference was found when compared between gender, age and BMI. GPx activity did not show significant difference when compared between BD and healthy controls, gender, age and BMI. Multiple linear regression analysis showed that the percentage of normal DNA increases with age in BD patients (p<0.001), while the percentage of damaged DNA decreases with age (mildly damaged: p<0.002; severely damaged: p<0.001). Percentage of normal and damaged DNA are not significantly correlated with BMI, while all antioxidative enzymes (SOD, GPx, CAT) and MDA concentration did not show significant correlation with age and BMI. In conclusion, age and BMI are associated with the oxidative status of BD patients regardless of gender.