Diagnosis Of Mood Disorder Research Articles

Psychiatric hospitalizations among adolescents during the pandemic in Italy: a retrospective study.

The COVID-19 pandemic has negatively impacted child and adolescent mental health. The study outcome was the evaluation of the pandemic impact on adolescents' hospitalizations in an acute psychiatric ward. With an observational and retrospective design,we collected selected variables among adolescents hospitalized in an acute psychiatric ward from 01/07/2017 to 30/06/2022. Data were statistically processed. Our sample consisted of 118minors with an average age of 15.7±1.2 SD, mostly represented by females (61 %) and Italians (60.2 %), who made 204 hospitalizations inthe study period. The admissions by years drastically decreased in 2020 concomitantly with the lockdown and increased in the first half of 2022. The admission rate was higher in winter and spring, except in 2020 when all admissions decreased (p=0.000). Females more frequently were hospitalized for suicidal behavior and acute anxiety (p=0.000) and were discharged with acute stress reactions, eating disorders, and mood disorder diagnoses (p=0.000). Differently, males more frequently were hospitalized for aggressive behavior (p=0.000) and discharged with ADHD diagnosis (p=0.000). At multiple linear regression, the duration of hospitalization (dependent variable) was negatively associated with "the pandemic period" (p=0.017) and "absent aggressive behavior" (p=0.003), and positively with "autism" diagnosis (p=0.000). We highlighted the more stressful impact of COVID-19 pandemic on female adolescents, who required more frequently psychiatric hospitalizations due to suicidal behavior, anxiety and mood disorders.

Unlocking the potential of wearable device wear time to enhance postpartum depression screening and detection.

Postpartum depression (PPD) is a mood disorder affecting one in seven women after childbirth that is often under-screened and under-detected. If not diagnosed and treated, PPD is associated with long-term developmental challenges in the child and maternal morbidity. Wearable technologies, such as smartwatches and fitness trackers (e.g., Fitbit), offer continuous and longitudinal digital phenotyping for mood disorder diagnosis and monitoring, with device wear time being an important yet understudied aspect. Using the All of Us Research Program (AoURP) dataset, we assessed the percentage of days women with PPD wore Fitbit devices across pre-pregnancy, pregnancy, postpartum, and PPD periods, as determined by electronic health records. Wear time was compared in women with and without PPD using linear regression models. Results showed a strong trend that women in the PPD cohort wore their Fitbits more those without PPD during the postpartum (PPD: mean=72.9%, SE=13.8%; non-PPD: mean=58.9%, SE=12.2%, P -value=0.09) and PPD time periods (PPD: mean=70.7%, SE=14.5%; non-PPD: mean=55.6%, SE=12.9%, P -value=0.08). We hypothesize this may be attributed to hypervigilance, given the common co-occurrence of anxiety symptoms among women with PPD. Future studies should assess the link between PPD, hypervigilance, and wear time patterns. We envision that device wear patterns with digital biomarkers like sleep and physical activity could enhance early PPD detection using machine learning by alerting clinicians to potential concerns facilitating timely screenings, which may have implications for other mental health disorders.

The relationship between prodromal symptom levels and affective temperament features and emotional dysregulation in patients diagnosed with bipolar disorder and their first-degree relatives: A controlled study

BackgroundThe frequency of developing psychiatric symptoms is higher in the first-degree relatives of bipolar patients compared to the healthy population. This study aims to determine the possible diagnosis of bipolarity by revealing the bipolar prodromal features, temperament changes, and emotional disregulation in the first-degree relatives of bipolar patients and their interrelationships. MethodsA total of 150 patients, including bipolar disorder patients, their first-degree relatives, and a healthy control group, aged 18–65 who met the study inclusion criteria, were included in the study. Sociodemographic data form, Bipolar Prodromal Symptom Scale (BPSS), Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire (TEMPS-A), and Difficulty in Emotion Regulation Scale (DERS) were administered to all participants. ResultsSignificant differences were found between the BPSS, TEMPS-A, and DERS total and subscale scores of the bipolar patient group, first-degree relatives, and healthy control group (p < 0.001). There were significant differences in BPSS frequency and severity subscale scores, TEMPS-A hyperthymic and cyclothymic subscale scores, and DERS strategy, goal-oriented, and awareness subscale scores between patients and their first-degree relatives (p < 0.001). Additionally, all scale scores of the patient relatives were significantly different from the healthy control group (p < 0.001). A significant relationship was found between the prodromal scores and temperament scores of the patient relatives, and between the temperament scores and DERS scores (p < 0.001). ConclusionIt has been observed that the severity and frequency of bipolar prodromal symptoms, temperament changes, and difficulty in mood regulation are higher in bipolar patients and their first-degree relatives compared to the healthy population. Differences were found in hyperthymic and cyclothymic temperament features and difficulty in mood regulation scores between bipolar patients and their first-degree relatives. Patient relatives showed significant changes in all parameters compared to the healthy group. The severity of bipolar prodromal symptoms in patient relatives was associated with cyclothymic and anxious temperament features, while the frequency of bipolar symptoms was associated with anxious temperament. Relationships were found between some temperament and mood regulation difficulty sub-scores. In light of these findings, evaluating clinical variables such as the frequency and severity of prodromal symptoms, temperament features, and difficulty in mood regulation in the first-degree relatives of bipolar patients may be an appropriate approach for diagnosing mood disorders.

Understanding experiences of non-physical maltreatment in childhood in Canada: What is the relationship with suicidal ideation and mental health disorders?

Physical and sexual childhood abuse are associated with suicidal ideation and mental health disorders. However, less is known about non-physical types of maltreatment. This study examined associations between non-physical types of child maltreatment (e.g., emotional abuse, interpersonal aggression, exposure to physical intimate partner violence, emotional and physical neglect) and suicidal ideation, and mental health disorders. Data from the 2018 Survey of Safety in Public and Private Spaces were used to estimate the proportion of individuals 15 years and older in Canada who experienced non-physical maltreatment during childhood. Multivariable regression analyses were used to examine associations between five types of non-physical child maltreatment and suicidal ideation, and mental health disorders. Overall, interpersonal aggression was the most common (45.7%), followed by emotional abuse (40.4%) and emotional neglect (20.0%). Individuals who experienced any type of non-physical maltreatment in childhood had a higher probability of lifetime suicidal ideation than those who never experienced the maltreatment examined. Mood disorder diagnoses were more likely among those who experienced emotional abuse, interpersonal aggression, and emotional neglect than among those who never experienced these types of maltreatment. Compared with those who never experienced the maltreatment examined, individuals who experienced emotional abuse, interpersonal aggression, emotional neglect, or physical neglect were more likely to be diagnosed with an anxiety disorder. Diagnoses of post-traumatic stress disorder were more likely among those who experienced emotional and physical neglect than among those who never experienced these types of maltreatment. Non-physical child maltreatment is associated with suicidal ideation and mental health disorders. The findings highlight the importance of including non-physical types of child maltreatment on population-based surveys to differentiate associations with mental health outcomes to better align interventions and policies.

Psychiatric follow-up and repeated hospital presentation of DSH: A national study on young adults

IntroductionPsychiatric care following discharge from general hospital treatment of deliberate self-harm (DSH) is important to reduce patients´ risk of relapse. Whether such follow-up is associated with DSH repetition in young adults is not sufficiently understood. This study examined the association between psychiatric service attendance within seven days of discharge and repeated hospital-presented DSH within 3, 6, and 12 months in patients aged 18–35 years. MethodsIncident episodes of hospital-presented DSH from 2010 to 2017 were identified from the Norwegian Patient Register. Those already psychiatrically admitted or who died during the general hospital or in the seven days after discharge were excluded. Psychiatric service attendance was categorized as ‘no attendance’, ‘outpatient attendance’, and ‘inpatient admissions.’ The association between psychiatric service attendance and subsequent DSH repetition was examined with an Inverse Probability of Treatment Weighted logistic regression model. ResultsOf the 11,308 patients identified, 17.3 % had a psychiatric outpatient attendance, and 19.9 % had an inpatient admission. Outpatient attendance was not associated with a reduced risk of repeated DSH and inpatient admissions were associated with an increased risk in certain subgroups, notably patients: aged 18–24 years; without a recorded mood disorder diagnosis; or no history of hospital-treated DSH. LimitationsOur data did not contain all relevant confounders. Unmeasured confounding is therefore likely to influence the results. ConclusionAlthough no conclusions regarding treatment effectiveness can be drawn from these findings, the study highlights that patients with the most severe psychiatric symptoms and at the highest risk of DSH relapse received follow-up.

Outpatient Prescriptions for Insomnia Medications During the First Year Following Combat-Related Amputations.

Sleep-related disorders are associated with pain, fatigue, and deficits in cognitive performance, which may interfere with successful rehabilitation. The study objectives were to (1) quantify outpatient prescriptions for insomnia medications during the first year following combat-related amputations, (2) examine longitudinal changes in prescriptions for insomnia medications, and (3) analyze patient characteristics associated with prescriptions for insomnia medications. This was a retrospective study of DoD casualty records from the Expeditionary Medical Encounter Dataset and prescriptions for outpatient medications from the Pharmacy Data Transaction Service. Patients were a total of 1,651 U.S. service members who sustained major limb amputations in Operations Iraqi and Enduring Freedom from 2001 through 2017 and had outpatient prescriptions for any medication during the first year postinjury. Prescriptions for medications recommended for insomnia were low-dose antidepressants, anxiolytic sedatives, benzodiazepines, melatonin receptor agonist, and low-dose quetiapine. These prescription medications were analyzed by medication type, postinjury time, and patient characteristics during the first year postinjury. During the first year postinjury, 78% of patients (1,291 of 1,651) had outpatient prescriptions for insomnia medications, primarily anxiolytic sedative drugs (e.g., zolpidem), averaging a total of 86 prescription days (median = 66). The prevalence of these prescriptions declined substantially during the first year, from 57% of patients during the first quarter to 28% during the fourth quarter postinjury. In univariate analyses, multiple patient characteristics, including high Injury Severity Score, continued opioid and non-opioid analgesic prescriptions, and diagnoses of chronic pain, mood disorder, and posttraumatic stress disorder, were significantly associated with higher prevalence and duration of outpatient prescriptions for insomnia medications. The present results indicate a high prevalence of outpatient prescriptions for insomnia medications following combat-related amputations, a prevalence that is substantially higher than previously reported among active duty personnel. These findings can inform DVA/DoD guidelines for amputation care and insomnia among military subpopulations. The results highlight the need for more research on the treatment of insomnia during early postinjury rehabilitation among patients who sustained serious combat injuries.

Benzodiazepine use for anxiety disorders is associated with increased long-term risk of mood and substance use disorders: A large-scale retrospective cohort study

BackgroundBenzodiazepines (BZDs) are widely prescribed for anxiety disorders. However, the long-term implications on mental health remain uncertain, especially the potential association between chronic BZD use and subsequent diagnosis of mood and substance use disorders (SUDs). MethodWe conducted a 5-year retrospective cohort study by analyzing the TriNetX database, a real-time electronic medical record network. The study population was defined as patients aged 18–65 with anxiety disorders (ICD-10-CM: F40-F48). We employed propensity score matching to pair a BZD-exposed cohort (≥12 BZD prescriptions) with a BZD-unexposed control cohort. The outcomes were defined as depressive disorders, bipolar disorders, and SUDs. We employed Kaplan-Meier analyses to assess the survival probability over five years following diagnosis and BZD exposure; log-rank test to obtain the hazard ratio (HR) with 95 % confidence interval (CI). ResultsWe identified and matched 76,137 patients in the study and control cohorts. Compared to the control cohort, the BZD-exposed group exhibited significantly higher risks of being diagnosed with depressive disorders (HR, 2.64; 95 % CI, 2.59–2.68), bipolar disorders (HR, 4.39; 95 % CI, 4.15–4.64), overall substance use disorders (HR, 3.00; 95 % CI, 2.92–3.08), alcohol use disorder (HR, 3.38; 95 % CI, 3.20–3.57), stimulant use disorder (HR, 3.24; 95 % CI, 2.95, 3.55), cannabis use disorder (HR, 2.93; 95 % CI, 2.75–3.11), inhalant use disorder (HR, 4.14; 95 % CI, 3.38–5.06), and nicotine use disorder (HR, 2.72; 95 % CI, 2.63–2.81). ConclusionOur findings demonstrate a concerning association between BZD use and an increased risk of being diagnosed with various mood disorders and SUDs.

Association between Regular Use of Analgesics before Cancer Diagnosis and Occurrence of Mood Disorders.

We aimed to determine the relationship between the use of analgesics prescribed for pain management and the onset and progression of mood disorders using a large-scale cohort database. We calculated hazard ratios (HR) with 95% confidence intervals (CI) for patient risk of developing mood disorders based on age, income, health-related variables, disease history, Charlson comorbidity index, and analgesics prescription behavior (Models 1-3). Additionally, we determined the risk of mood disorder occurrence by age group (Model 4) using a proportional hazards regression model. The age- and income-adjusted HR (Model 1) was 1.8275. The age-, income-, BMI-, and physical-activity-adjusted HR (Model 2) was 1.882. The fully adjusted HR (Model 3) was 1.698. Compared with no analgesic use, nonregular use (HR = 1.386) and regular use (HR = 1.698) was associated with a higher risk of mood disorders. Among patients older than 50 years, those who participated in physical activity (less than five days) had a lower risk of mood disorders than those who did not. This suggests that it may be useful for preventing mood disorders in older cancer survivors. A high risk of comorbidities and regular use of analgesics are risk factors for developing mood disorders. Therefore, our results suggest that cancer survivors with a high risk of comorbidities and a history of regular analgesic use should undergo careful psychiatric consultation.

Examining the association of familial and social stress, trauma, and support on mood, anxiety, and behavioral symptoms and diagnoses in youth at risk for bipolar disorder and controls

IntroductionYouth with a family history of bipolar disorder (At-Risk) have a higher risk of developing psychiatric disorders and experiencing environmental stressors than youth without such family history (Control). We studied the differential associations of familial and environmental factors on developing psychiatric diagnoses and symptoms, in At-Risk and Control youth. MethodsAt-Risk and Control youth (N = 466, ages 9–22) were systematically assessed for severity of symptoms, psychiatric diagnoses, and self-reported measures of stress and social support. We tested the association of family history and measures of stress or support with symptom severity and diagnoses. ResultsAt-Risk youth had higher symptom severity scores and were more frequently diagnosed with psychiatric disorders (all p values < 0.001). When predicting mood symptom severity, family history had an interaction effect with stressful life events (p < 0.001) and number of distinct traumatic events (p = 0.001). In multivariate models, At-Risk status predicted anxiety disorders (OR = 2.7, CI 1.3–5.4, p = 0.005) and anxiety severity (Coefficient = 0.4, CI 0.2–0.7, p < 0.001) but not mood or behavioral disorder diagnoses or severity. LimitationsMeasures of stress and social support were based on self-report. Not all participants had passed through the period of risk for developing the outcomes under study and the follow up period was variable. We could not fully study the differential impact of physical or sexual abuse due to low frequency of occurrence in controls. ConclusionAt-Risk youth exhibit more severe mood symptoms compared to Controls when exposed to similar levels of stress or trauma. At-Risk youth are also more prone to develop anxiety which may be a precursor for bipolar disorder.

Mental Health Service Use Before First Diagnosis of a Psychotic Disorder.

Characterizing mental health service use trajectories preceding diagnosis of a psychotic disorder may help identify individuals at highest risk and in which settings they are at highest risk. To examine mental health service use and diagnostic trajectories before first diagnosis of psychotic disorder and identify utilization and diagnostic patterns. This population-based, retrospective cohort study used linked provincial health administrative data. The sample included individuals aged 15 to 29 years diagnosed with a psychotic disorder in Ontario, Canada, between April 1, 2012, and March 31, 2018. These individuals were matched to individuals with a diagnosis of a mood disorder. Data were analyzed from November 2018 to November 2019. The main outcomes were rates, timing, and setting of mental health-related service use and associated diagnoses in the 3 years before the index disorder among individuals first diagnosed with a psychotic disorder compared with those first diagnosed with a mood disorder. A total of 10 501 individuals with a first diagnosis of psychotic disorder were identified (mean [SD] age, 21.55 [3.83] years; 72.1% male). A total of 72.2% of individuals had at least 1 mental health service visit during the 3 years before their first psychotic disorder diagnosis, which was significantly more than matched controls with a first mood disorder diagnosis (66.8%) (odds ratio [OR], 1.34; 95% CI, 1.26-1.42). Compared with individuals diagnosed with a mood disorder, individuals diagnosed with a psychotic disorder were significantly more likely to have had mental health-related hospital admissions (OR, 3.98; 95% CI, 3.43-4.62) and emergency department visits (OR, 2.27; 95% CI, 2.12-2.43) in the preceding 3 years. Those with psychotic disorders were more likely to have had prior diagnoses of substance use disorders (OR, 2.57; 95% CI, 2.35-2.81), other disorders (personality disorders, developmental disorders) (OR, 1.75; 95% CI, 1.61-1.90), and self-harm (OR, 1.64; 95% CI, 1.36-1.98) in the past 3 years compared with those diagnosed with mood disorders. This study found that in the 3 years prior to an index diagnosis, individuals with a first diagnosis of psychotic disorder had higher rates of mental health service use, particularly emergency department visits and hospitalizations, compared with individuals with a first diagnosis of a mood disorder. Individuals with psychotic disorders also had a greater number of premorbid diagnoses. Differences in health service utilization patterns between those with a first psychotic disorder diagnosis vs a first mood disorder diagnosis suggest distinct premorbid trajectories that could be useful for next steps in prediction and prevention research.

A Preliminary Study of Brain Developmental Features of Bipolar Disorder Familial Risk and Subthreshold Symptoms

BackgroundRisk for bipolar disorder (BD) is increased among individuals with a family history or subthreshold mood symptoms. However, the brain structural developments associated with these BD risks remain unknown. MethodsThis longitudinal cohort study examined the brain gray matter volume (GMV) developmental features of familial and symptomatic risks for BD and their associations with participants’ global function levels. We recruited unaffected BD offspring with (n = 26, 14 female, mean ± SD age = 14.9 ± 2.9 years) or without (n = 35, 19 female, age = 15.3 ± 2.7 years) subthreshold manic or depressive symptoms and unaffected non-BD offspring with (n = 49, 30 female, age = 14.5 ± 2.2 years) or without (n = 68, 37 female, age = 15.0 ± 2.3 years) symptoms. The offspring had no mood disorder diagnosis prior to the study. The average follow-up duration was 2.63 ± 1.63 years. ResultsAt baseline, we found significant interactive effects of familial risk and subthreshold symptoms that indicated that the symptomatic offspring exhibited markedly large GMV in the brain affective and cognitive circuitries. During follow-up, the combined group of BD offspring (symptomatic and nonsymptomatic) displayed a more accelerated GMV decrease than BD nonoffspring in the hippocampus and anterior cingulate cortex. In contrast, the combined group of symptomatic participants (offspring and nonoffspring) displayed a slower GMV decrease than nonsymptomatic participants in the ventromedial prefrontal cortex. Larger GMV at baseline and accelerated GMV decrease during follow-up prospectively and longitudinally predicted positive global function changes. All results survived multiple testing correction. ConclusionsThese findings indicated that familial and symptomatic risks of BD are associated with distinct brain structural developments and unraveled key brain developmental features of particularly vulnerable high-risk individuals to subsequent functional deterioration.

Sex Differences in Diagnosis and Treatment Timing of Comorbid Depression/Anxiety and Disease Subtypes in Patients With ADHD: A Database Study

Objective: Our study examined the impact of sex, ADHD subtype, and comorbid illnesses (depression/anxiety) on the timing of diagnosis and treatment for ADHD. Method: To analyze ADHD patients, four health databases were used to assess subtype, comorbid mood, and antidepressant or anxiolytic drug exposure. Analyses were stratified by sex and age. Standardized mean differences measured intergroup differences. Results: Females with ADHD were identified at older ages and had higher rates of depression and anxiety diagnoses and treatments before and after their initial ADHD diagnosis. Predominantly inattentive ADHD patients were diagnosed later and more likely to receive mood disorder diagnosis and treatment than hyperactive impulsive ADHD patients. Conclusions: Results suggest a more complex ADHD presentation in females, potentially causing late diagnosis and delayed treatment.

How to Solve Clinical Challenges in Mood Disorders; Machine Learning Approaches Using Electrophysiological Markers.

Differentiating between the diagnoses of mood disorders and other psychiatric disorders, and predicting treatment response in depression has long been a concern for clinicians. Machine learning (ML) is one part of artificial intelligence that focuses on instructing computers to mimic the cognitive abilities of the human brain through training. This study will review the research on the use of ML techniques to differentiate diagnoses and predict treatment responses in mood disorders based on electroencephalography (EEG) data. There have been several attempts to differentiate between the diagnoses of bipolar disorder and major depressive disorder , mood disorders, and other psychiatric disorders using ML techniques found on EEG markers. Previous studies have shown that accuracy varies depending on which EEG markers are used, the sample size, and the ML technique. Also, precise and improved ML approaches can be developed by adapting the various feature selection and validation methods that reflect each disease's characteristics. Although ML faces some limitations and challenges in solving for consistent and improved accuracy in the diagnosis and treatment of mood disorders, it has a great potential to understand mood disorders better and provide valuable tools to personalize both identification and treatment.

Prospective prediction of anxiety onset in the Canadian longitudinal study on aging (CLSA): A machine learning study

BackgroundAnxiety disorders are among the most common mental health disorders in the middle aged and older population. Because older individuals are more likely to have multiple comorbidities or increased frailty, the impact of anxiety disorders on their overall well-being is exacerbated. Early identification of anxiety disorders using machine learning (ML) can potentially mitigate the adverse consequences associated with these disorders. MethodsWe applied ML to the data from the Canadian Longitudinal Study on Aging (CLSA) to predict the onset of anxiety disorders approximately three years in the future. We used Shapley value-based methods to determine the top factor for prediction. We also investigated whether anxiety onset can be predicted by baseline depression-related predictors alone. ResultsOur model was able to predict anxiety onset accurately (Area under the Receiver Operating Characteristic Curve or AUC = 0.814 ± 0.016 (mean ± standard deviation), balanced accuracy = 0.741 ± 0.016, sensitivity = 0.743 ± 0.033, and specificity = 0.738 ± 0.010). The top predictive factors included prior depression or mood disorder diagnosis, high frailty, anxious personality, and low emotional stability. Depression and mood disorders are well known comorbidity of anxiety; however a prior depression or mood disorder diagnosis could not predict anxiety onset without other factors. LimitationWhile our findings underscore the importance of a prior depression diagnosis in predicting anxiety, they also highlight that it alone is inadequate, signifying the necessity to incorporate additional predictors for improved prediction accuracy. ConclusionOur study showcases promising prospects for using machine learning to develop personalized prediction models for anxiety onset in middle-aged and older adults using easy-to-access survey data.

P2X7 receptor: a potential target for treating comorbid anxiety and depression.

In clinical practice, depression and anxiety frequently coexist, and they are both comorbid with somatic diseases. The P2X7R is an adenosine 5'-triphosphate (ATP)-gated non-selective cation channel that is widely expressed in immune-related cells. Under conditions of stress, chronic pain, and comorbid chronic physical illness, P2X7R activation in glial cells leads to neuroinflammation. This could contribute to the development of anxiety and depression-related emotional disturbances. Previous studies have shown that the P2X7 receptor (P2X7R) plays an important role in the pathogenesis of both anxiety and depression. Thus, the P2X7R may play a role in the comorbidity of anxiety and depression. Positron emission tomography can be used to assess the degree and location of neuroinflammation by monitoring functional and expression-related changes in P2X7R, which can facilitate clinical diagnoses and guide the treatment of patients with anxiety and depression. Moreover, single nucleotide polymorphisms (SNPs) in the P2X7R gene are associated with susceptibility to different types of psychiatric disorders. Thus, evaluating the SNPs of the P2X7R gene could enable personalized mood disorder diagnoses and treatments. If the P2X7R were set as a therapeutic target, selective P2X7R antagonists may modulate P2X7R function, thereby altering the balance of intra- and extra-cellular ATP. This could have therapeutic implications for treating anxiety and depression, as well as for pain management. According to in vitro and in vivo studies, the P2X7R plays an important role in anxiety and depression. In this review, we consider the potential of the P2X7R as a therapeutic target for comorbid anxiety and depression, and discuss the potential diagnostic and therapeutic value of this receptor.

Factors Associated with Confirmed and Unconfirmed Autism Spectrum Disorder Diagnosis in Children Volunteering for Research.

Diagnostic accuracy of autism spectrum disorder (ASD) is crucial to track and characterize ASD, as well as to guide appropriate interventions at the individual level. However, under-diagnosis, over-diagnosis, and misdiagnosis of ASD are still prevalent. We describe 232 children (MAge = 10.71 years; 19% female) with community-based diagnoses of ASD referred for research participation. Extensive assessment procedures were employed to confirm ASD diagnosis before study inclusion. The sample was subsequently divided into two groups with either confirmed ASD diagnoses (ASD+) or unconfirmed/inaccurate diagnoses (ASD-). Clinical characteristics differentiating the groups were further analyzed. 47% of children with community-based ASD diagnoses did not meet ASD criteria by expert consensus. ASD + and ASD- groups did not differ in age, gender, ethnicity, or racial make-up. The ASD + group was more likely to have a history of early language delays compared to the ASD- group; however, no group differences in current functional language use were reported by caregivers. The ASD + group scored significantly higher on ADI-R scores and on the ADOS-2 algorithm composite scores and calibrated severity scores (CSSs). The ASD- group attained higher estimated IQ scores and higher rates of psychiatric disorders, including anxiety disorder, disruptive behavior, and mood disorder diagnoses. Broadly, caregiver questionnaires (SRS-2, CCC-2) did not differentiate groups. Increased reported psychiatric disorders in the ASD- group suggests psychiatric complexity may contribute to community misdiagnosis and possible overdiagnosis of ASD. Clinician-mediated tools (ADI-R, ADOS-2) differentiated ASD + versus ASD- groups, whereas caregiver-reported questionnaires did not.

Platelet Function in Mood Disorders: Interplay, Clinical Implications, and Future Perspectives – A Narrative Review

Abstract Mood disorders, encompassing major depressive disorder and bipolar disorder, present complex etiologies involving neuroanatomical, neurotransmitter, and inflammatory mechanisms. Recent research explores the role of platelets, traditionally associated with hemostasis, in the pathophysiology of mood disorders. We examine neuroanatomical insights, neurotransmitter dysregulation, and the link between inflammation and mood disorders, emphasizing the complex nature of mood disturbances. Emerging evidence of altered platelet function in mood disorders and the therapeutic potential of antiplatelet agents and serotonin reuptake inhibitors are discussed. While personalized medicine holds promise, further research is needed to fully comprehend this evolving field. This review offers comprehensive insights into mood disorder diagnosis, intervention, and pathophysiology. In this review, a comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science. The search focused on articles published from 2000 to 2023, using keywords like “platelet function,” “mood disorders,” and “neurotransmitter dysregulation.” We included studies that specifically investigated the role of platelets in mood disorders, encompassing various study designs and population demographics.

Differences between rural and urban residence in the detection and treatment of perinatal mood and anxiety disorders

BackgroundPerinatal mood and anxiety disorders are common, serious complications of pregnancy. Disparities exist by race and income in the prevalence and treatment of these conditions, and overall treatment rates remain low. Outside of pregnancy, a small body of literature suggests that rural residency may contribute to higher rates of depression for those who identify as women. Among more diverse populations, however, evidence suggests urban residency may be associated with higher rates of depression among women of color. It is not known whether these trends hold true for mood and anxiety disorders during pregnancy and postpartum. ObjectivesWe examined differences in the detection and treatment of perinatal mood and anxiety disorders by rural and urban residence and assessed if the observed differences varied by maternal race/ethnicity. Study DesignWe conducted a cross sectional study using linked Medicaid claims and birth certificate records from Oregon and South Carolina from 2016 to 2020. We identified perinatal mood and anxiety disorder diagnoses during the perinatal period (pregnancy and within 60 days postpartum) using International Classification of Disease 9/10 codes and enumerated receipt of pharmaco- and psychotherapy treatment using Medicaid claims. We used logistic regression models controlling for relevant clinical and sociodemographic characteristics to estimate associations between rural residence and mood disorder detection and treatment. ResultsAmong the 185,809 births in our sample, 27% of births (n=50,820) were to people who lived in rural areas and 73% (n=134,989) to those in urban areas. Prevalence of any perinatal mood and anxiety disorders diagnosis was higher for urban residents (19.5%) than for rural residents (18.0%, p<0.001). Overall treatment rates were low among people with a perinatal mood and anxiety disorder (42% (n=14,789)). In our adjusted models, those living in urban areas had higher odds of a perinatal mood and anxiety disorder diagnosis (aOR=1.059, 95% CI 1.059-1.059, p<0.001). We found a significant interaction between maternal race and rurality (p<0.001). When we stratified by race, we found that among those who identified as Black, the odds of a perinatal mood and anxiety disorder diagnosis were increased for urban residents (OR=1.188, 95% CI 1.188-1.188), whereas among those who identified as white there was no such increased odds (OR=1.027, 95% CI 0.843-1.252). ConclusionsWe saw small but meaningful differences between rural and urban residence in perinatal mood and anxiety disorder diagnosis rates. We detected an interaction between race and rural versus urban maternal residence that impacted the observed differences. By elucidating the intersection between race and other sociodemographic factors, we hope more targeted and meaningful investments can be made in the communities most at need.

Psychological Stressor Of End Stage Chronic Kidney Disease Patients On Dialysis. A Battle For Life

Introduction Patients with chronic kidney disease (CKD) may choose to undergo dialysis. Factors that may have led patients to prescribe psychological interventions related to dialysis are poorly understood in the literature. The purpose of this study was to explore multi-level factors surrounding dialysis modalities such as Diagnosed Mood Disorders, Existential crises, Triggering events, Social support, and Distrust towards the process of dialysis.ObjectivesThe study aims to investigate the psychological battle of the client while going through the process of dialysis. The study reveals multiple mood disorders and existential crises leading to depression among chronic kidney disease patients. Therefore the study was conducted with the aim of providing a therapeutic guide line in future once the factors are investigated in detail.MethodsSemi-structured qualitative interviews were conducted in a dialysis clinic in Karachi where 19 participants participated in this qualitative study. The age ranges from 40-76. Initiating with informed consent followed by surveys assessing demographic and clinical information were administered to participants following their interviews.ResultsQualitative findings suggested that patients were dealing with Clinical Mood Disorders without being provided treatment. Moreover, the cohesive family support enabled them to continue with daily living activities; however, the patients with low support triggering adverse events in life lost their lives in follow-up sessions. Furthermore, nephrology care doesn’t seem sufficient as they are dealing with existential crises of hopelessness, regret, condemnation, and elevated death anxiety. In CKD the misinterpretation of dialysis by cognitively substituting it as End of life increased the clinical symptoms of Mood disorders. Thus the risk factors increase disturbing the quality of life.ConclusionsFindings point to broader factors affecting dialysis modalities with Mood disorders. The low social support and adverse triggering events precipitate the risk factors of dialysis treatment. Furthermore, distrust towards dialysis and existential crisis are recommended for therapeutic interventionsDisclosure of InterestNone Declared

Racial And Ethnic Inequities In Postpartum Depressive Symptoms, Diagnosis, And Care In 7 US Jurisdictions.

Understanding whether racial and ethnic inequities exist along the postpartum mental health care continuum is vital because inequitable identification of depression can lead to inequitable referral to and receipt of care. We aimed to expand on existing cross-sectional and single-state data documenting potential racial and ethnic disparities in postpartum depression care. Using early (from two to six months) and late (from twelve to fourteen months) postpartum survey data from seven US jurisdictions, we documented patterns of early postpartum depressive symptoms, perinatal mood and anxiety disorder (PMAD) diagnosis, and receipt of postpartum mental health care overall and by racial and ethnic identity. Of 4,542 people who delivered live births in 2020, 11.8percent reported early postpartum depressive symptoms. Among the sample with these symptoms, only 25.4percent reported receiving a PMAD diagnosis, and 52.8percent reported receiving some form of postpartum mental health care. There were no significant differences in diagnosis by race and ethnicity. Respondents identifying as Asian; Native Hawaiian or Pacific Islander; Southwest Asian, Middle Eastern, or North African; Hispanic; and non-Hispanic Black were significantly less likely than non-Hispanic White respondents to receive mental health care, demonstrating stark inequities in the management of postpartum depressive symptoms. Policies mandating and reimbursing universal postpartum depression screening, facilitating connection to care, reducing insurance coverage gaps, and enhancing clinician training in culturally responsive care may promote equitable postpartum mental health care.