Non-psychotic Disorders Research Articles

Clinical-psychopathological and psychometric features of maladaptive disorders which are a characteristic of students who have experienced psycho-emotional stress

The purpose of this study is to discover the most relevant psychopathological features of maladaptive disorders arising under the influence of psycho-emotional stress in the student community and associated with consequences of military conflict, and identify potential diagnostic and treatment-rehabilitation measures for improving effectiveness of their primary, secondary and tertiary prevention in future. The study was conducted in 4 stages on the basis of an adapted questionnaire and a set of psychometric methods, involving 249 adult students (over 18 years), including a group of respondents at greatest risk – and namely students who are internally displaced persons and students children of anti-terrorist operation participants. The studies have shown a decrease in psychological well-being, the predominance of leading psychopathological symptoms of anxiety, lack of interest in life, lack of motivation, loss of vital energy, feelings of hopelessness, suicidal thoughts, somatic symptoms in the form of disorders of the cardiovascular, gastrointestinal systems, higher medium severity levels of asthenic manifestations; worse than the general indicator of quality of life among the respondents of the main group. Inverse correlation between a high level of state anxiety (r= -0.6) and trait anxiety (r= -0.45) and a low level of mental well-being has been proved. The obtained results can be used to substantiate and continue transformation of the system of social and medical support in health care, in particular when developing measures aimed at preventing development of non-psychotic mental disorders among students in Ukraine, which will optimize human resources and further health improvement of student youths.

Advanced in Vitro Safety Assessment of Herbal Medicines for the Treatment of Non-Psychotic Mental Disorders in Pregnancy.

When confronted with non-psychotic mental disorders, pregnant women often refrain from using synthetic drugs and resort to herbal medicines such as St. John’s wort, California poppy, valerian, lavender, and hops. Nevertheless, these herbal medicines have not yet been officially approved in pregnancy due to lack of safety data. Using a variety of in vitro methods (determination of cytotoxicity, apoptosis induction, genotoxicity, effects on metabolic properties, and inhibition/induction of differentiation) in a commonly used placental cell line (BeWo b30), we were previously able to show that extracts from these plants are likely to be safe at the usual clinical doses. In the present work, we wanted to extend our safety assessment of these herbal medicines by 1) looking for possible effects on gene expression and 2) using the same in vitro methods to characterize effects of selected phytochemicals that might conceivably lead to safety issues. Proteomics results were promising, as none of the five extracts significantly affected protein expression by up- or down-regulation. Protopine (contained in California poppy), valerenic acid (in valerian), and linalool (in lavender) were inconspicuous in all experiments and showed no adverse effects. Hyperforin and hypericin (two constituents of St. John’s wort) and valtrate (typical for valerian) were the most obvious phytochemicals with respect to cytotoxic and apoptotic effects. A decrease in cell viability was evident with hypericin (≥1 µM) and valtrate (≥10 µM), whereas hyperforin (≥3 µM), hypericin (30 µM) and valtrate (≥10 µM) induced cell apoptosis. None of the tested phytochemicals resulted in genotoxic effects at concentrations of 0.1 and 1 µM and thus are not DNA damaging. No decrease in glucose consumption or lactate production was observed under the influence of the phytochemicals, except for valtrate (at all concentrations). No compound affected cell differentiation, except for hyperforin (≥1 µM), which had an inhibitory effect. This study suggests that extracts from St. John’s wort, California poppy, valerian, lavender, and hops are likely to be safe during pregnancy. High plasma concentrations of some relevant compounds—hyperforin and hypericin from St. John’s wort and valtrate from valerian—deserve special attention, however.

Clinical, psychopathological and pathopsychological features of non-psychotic mental disorders in persons who suffered from combat actions (combatants, volunteers and internally displaced persons)

Post-stress mental disorders caused by military operations in the east of Ukraine are becoming one of the most important internal barriers during adaptation to peaceful life. Due to the accumulation of new stresses associated with social maladaptation on this substrate. We conducted a comprehensive survey of 299 patients with non-psychotic mental disorders, both sexes (mean age — 30.6 ± 4.7 years). The first study group consisted of 96 servicemen of the Armed Forces of Ukraine who were directly involved in hostilities in the Joint Forces Operation zone (66 men and 30 women); group II — 98 volunteers whose activities are related to the support of the soldiers in the Joint Forces Operation zone (44 men and 54 women); group III — 105 internally displaced persons (52 men and 53 women). The clinical structure of post-stress disorders in the examined patients was presented by: posttraumatic stress disorder (F43.1); adjustment disorders (prolonged anxietydepressive reaction) (F43.21); anxiety disorders: generalized anxiety disorder (F41.1); panic disorder (F41.0). The data obtained during the study formed basis for the development of a comprehensive personalized program for the correction of non-psychotic mental disorders and rehabilitation of combat stress victims with the differentiated use of psychopharmacotherapy, psychotherapy and psychoeducation.

Evaluation of the factor structure of the Russian version of PID-5-BF

IntroductionTraditional categorical classifications of personality disorders (PD) have been criticized for insufficient structural and cross-cultural validity. In the DSM-5 Section III, alternative model of the PDs (AMPD), the maladaptive personality traits are divided into five domains: negative affect, detachment, antagonism, disinhibition and psychoticism. The Personality Inventory for DSM-5 Brief Form (PID-5-BF) is a 25-item self-report questionnaire that measures the severity of each of these five domains. To date, no questionnaires assessing pathological personality traits following the AMPD have been validated in Russia.ObjectivesThis study aimed to investigate the factor structure of the Russian version of PID-5-BF.MethodsFive hundred and 86 (female - 505 (86,2%), age - 18–77 years (M - 28.2, SD - 11.5)) consecutive inpatients with non-psychotic mental disorders were assessed with the Russian language version of the PID-5-BF. Exploratory structural equation modelling (ESEM) with Robust Diagonally Weighted Least Squares method of extraction and Robust Equamax rotation was performed in Factor v 11.04.02.ResultsThe results of the ESEM analysis showed good fit of the five-factor model (CFI - 0.982; TLI - 0.971; RMSEA (95% CI) - 0.036 (0.01-0.05). Most of the items had the highest factor loadings on their mother domains. However, two items showed weak loadings on their designated factors (<0.4), and attention seeking item had a primary load to (low) detachment instead of antagonism.ConclusionsThe PID-5-BF was found to be a valid and reliable tool for the evaluation of the AMPD trait domainDisclosureNo significant relationships.

Comorbidity Between Recent Diagnosis of Type 2 Diabetes and Non-Psychotic Psychiatric Disorders: Metabolic Characteristics and Clinical Correlates.

PurposeTo describe the metabolic status and clinical characteristics associated with NPPD in patients with less than five years of T2D diagnosis and explore the role of age in the presentation of psychiatric comorbidities.Patients and MethodsThis was a cross-sectional study of subjects who attended a comprehensive care program. Patients were assessed using the Mini-International Neuropsychiatric Interview, and clinical and metabolic characteristics were registered. Multivariate logistic regression analyses were conducted to identify risk and protective factors for psychiatric disorders. We performed an analysis to further explore age’s influence on our results.ResultsWe included 1953 patients, and 40.1% had any psychiatric disorder. Younger age, female sex, and personal psychiatric history were associated with NPPD. The use of insulin was reported as a protective factor for eating disorders. Body mass index was associated with any psychiatric disorders and eating disorders. The analysis of age reported that patients younger than 45 years had the worst metabolic parameters and increased odds for NPPD, while patients older than 65 years had the best metabolic measures and decreased odds for psychiatric comorbidity.ConclusionNPPD were frequent comorbidities in our sample; younger age, female sex, and personal psychiatric history were the most important factors associated with psychiatric comorbidities. Younger subjects experience a higher risk for psychiatric disorders and worst metabolic control.

On the problem of the catatonic disorders taxonomy

IntroductionIn accordance with the systematics of modern international clinical guidelines (DSM-V, ICD-11), catatonia is qualified as a transnosological formation, which boundaries expandes by including non-psychotic movement disorders (hysterical, affective, negative, etc.). This study presents the psychopathological systematics of movement disorders, based on a new dimensional model of catatonia.Objectives60 patients with an established diagnosis of schizophrenia or SSD (F20, F21, F25.01, F25.11, F25.21, F25.22), catatonic disorders in the structure of which persist throughout the course of the disease or determine the clinical picture of phases.MethodsClinical, psychometric (BFCRS, SANS, SAPS, HADS), statistic.ResultsThree catatonic syndromes (S.) have been identified. 1. S. of stereotypical catatonia - presented by the mechanism of affiliation with negative symptoms (R between BFCRS Total Score (TS) and Avolition-Apathy SANS – 0,875): tendency to stereotypical activity; general, increasing slowness (SANS avolition-apathy -2,9±0,5; BFCRS TS – 11,1±0,2). 2. S. of parakinetic catatonia - includes paroxysms formes by the mechanism of mental automatism (with the loss of motor acts voluntary effect ) (R BFCRS TS/Persecutory Delusions SAPS– 0,764): irregular polymorphic movement disorders of hyperkinetic and akinetic types, impulsive actions, akinesias (Persecutory Delusions - 2,3±0,4; BFCRS – 19,5±2,3). 3. Affective - catatonic S. - including both the lightest (at the level of recurrent depression) variants of affective-catatonic phases (R BFCRS TS/HADS – 0,732; BFCRS – 5,1±0,4; HADS -15,1±2,4), and more severe affective-catatonic states based on schizoaffective psychoses (R BFCRS TS/SAPS TS– 0,783; BFCRS – 15,3±2,1; SAPS – 3,1±0,2).ConclusionsCatatonia is not a single dimension, represented by heterogeneous movement disorders, differing both in the mechanism of formation and in the psychopathological structure.DisclosureNo significant relationships.

Psychopathological and clinical-typological aspects of youth chronic endogenous depression

IntroductionYouth ontogenesis contributes significantly to depressive disorders, causing pronounced atypia, a high level of comorbid pathology. A long-term depressive state lead can to persistent, adverse consequences.ObjectivesTo study the clinical, psychopathological and psychometric features of youth chronic endogenous depression (UCED).Methods62 patients of the age 16-25 were examined clinically and psychopathologically; the patients were first hospitalized from 2017 to 2020 for a chronic depressive state with non-psychotic mental disorders (ICD-10: F31, F32, F33, F34, F21 keys) lasting more than two years. Psychometric assessment was done by HDRS, SOPS, and SANS.ResultsUCED are characterized by a pronounced atypia with a predominance of symptoms for negative affectivity with apathy, anhedonia, physical and mental asthenia, depressive devitalization. In contrast with non-chronic youth depressions, cognitive disorders, motor inhibition, a large proportion of comorbid pathology are presented in the chronic ones. Depending on the prevalence of additional psychopathological disorders, 2 types were distinguished: Type I – depression with a clear-cut affective psychopathological structure (54.8%, 34 patients); Type II - depression with the symptoms of other than affective registers (45.2%, 28 patients). Psychometric assessment on the HDRS scale, in the sub-scale “negative symptoms” of the SOPS scale, in the sub-scale “anhedonia-associality” of the SANS scale showed a greater severity of psychopathological symptoms in type II depression (p<0.05).ConclusionsThe obtained data confirm the differences between UCED and non-chronic youth depressions and demonstrate the aggravating effect of symptoms of the non-affective spectrum on the severity of UCED and the level of negative affectivity.DisclosureNo significant relationships.

Radiation-associated cerebroophtalmic effects

IntroductionWe proposed to consider the brain and eye as a target of ionizing radiation exposure. Prevention of potential radiation-associated cerebroophtalmic effects are crucial for successful long-term space missions; interventional radiology; medical, occupational and accidental irradiationObjectivesDetermination of radiation-associated cerebroophtalmic effects in the long term after irradiation in adulthood and in utero.MethodsNeuropsychiatric, ophtalmological, neurophysiological and neuropsychological assessment of irradiated in adulthood (57 Chernobyl accident clean-up workers, liquidators), 52 persons exposed in utero as a result of the Chernobyl accident, comparison group (51 combatants of the Antiterrorist operation in Donbass), and 53 healthy people.ResultsRadiation-associated cerebroophthalmic pathology is characterized by high neuropsychiatric and ophthalmic comorbidity, which increases in proportion to the radiation dose, and is mainly represented by chronic vascular and degenerative diseases of the brain and retina, mild cognitive impairment (after irradiation in adulthood), as well as disorders of the autonomic nervous system; non-psychotic organic mental disorders; neurotic, stress-related and somatoform disorders; vascular and dystrophic processes in the retina (after in utero exposure). Characteristic of both radiological scenarios remains intellectual disharmony due to a decrease in the verbal IQ. The delay and attenuation of cerebral visual afferentation processing were observed in prenatally exposed.ConclusionsRadiation-associated cerebroophtalmic effects in the long term after irradiation in adulthood and in utero could be mainly classified as a “small vessel disease of the brain and eye” of vascular-degenerative nature and possible latent demyelination after irradiation in utero.DisclosureNo significant relationships.

20 years of daily hospital for non-psychotic disorders, organisational structure and treatment modalities

IntroductionAnxiety and depressive disorders are among the most prevalent psychiatric disorders, yet there aren’t many studies adressing treatment modalities in daily hospitals.ObjectivesThe aim of our study is to present organisational structure and treatment modalities in Daily hospital for non-psychotic disorders in University Psychiatric Clinic “Sveti Ivan“, Zagreb, Croatia.MethodsAll patients in Daily Hospital attend 6 months programme. The treatment programme consists of psychodynamic group psychotherapy, cognitive-behavioral therapy, occupational therapy, antistress and mindfulness workshops, psychoeducational workshops, cinema therapy and sociotherapy. Along with clinical follow-up, all the patients are given sociodemographic questionnaire designed for our programme, World Health Organisation Quality of Life Questionnaire (WHOQoL BREF) and The Depression, Anxiety and Stress Scale 21 (DASS-21).ResultsAt discharge moderate to significant improvement was observed in different aspects of functioning among most of the participants, verified by clinical follow-up as well as by results obtained through questionnaires.ConclusionsOur data show that patients with anxiety and depressive disorders can be efffectively treated by such comprehensive treatment approach.DisclosureNo significant relationships.

Internal picture of the disease and medical-psychological support as a component of clinical pediatrics in psychosomatic diseases in children

The aim of the work is to systematize current data on the peculiarities of the internal picture of the disease and the need for medical and psychological support of psychosomatic illnesses in children with different types of responses to the disease. The article is devoted to studying the internal picture of the condition as an integral part of the internal picture of health in pediatric practice. Types of patients' attitudes to the disease are considered. The types of disease responses from the standpoint of medical psychology are given. The typology of psychological response to the disease or personality types (harmonious, indifferent, hyperpathic, hypopathic, labile) in diseases of the gastrointestinal tract in children is described. Peculiarities of non-psychotic mental disorders in young children have been identified. It is noted that the development of differential programs of psychological support, taking into account the typology of psychological response to the disease, will accelerate the process of recovery and rehabilitation of patients. Conclusions. Increasing professional competence in an internal picture of the disease will improve communication links in the chain "health worker - sick child - parents". The timely organization of medical and psychological support at all levels of medical care for psychosomatic diseases in children will help prevent and reduce the incidence of neurotic and neurosis-like mental and behavioral disorders.

FEATURES OF CLINICAL ANAMNESTIC PSYCHIATRIC EXAMINATION OF THE STUDENTS OF HIGHER EDUCATIONAL ESTABLISHMENTS

A brief description of the work. It is generally accepted that the student period is themost favorable for the manifestation and development of mental illness, mainly of anon-psychotic level. This determines the relevance of the search for new forms of timelydiagnosis of non-psychotic mental disorders (NPD) amoung young people.The aim of the study – to conduct clinical and anamnestic psychiatric examination ofstudents of higher educational establishments (HEE) in order to determine its role in thecomplex modern diagnosis of non-psychotic mental disorders in this contingent.Material and methods. In compliance with the principles of bioethics and deontology, acomprehensive examination of 1235 students was carried out. Such methods were applied:clinical, clinical-psychopathological, clinical-epidemiological, clinical-anamnestic,experimental-psychological and statistical methods.Results.The students reliably more often consider that they have a good state of their ownhealth 37.69% (group II) and 17.03% (group I), and 21.77% (group I) and 4.68% (groupII) felt unsatisfactory. ) (p <0.05). For the rest of the indicators, regarding the frequencyof visits to doctors, head injuries, colds, somatic diseases, no significant discrepancieswere found in both groups (p> 0.05). Most students of the main group assessed theirhealth as satisfactory 61.20%, and there were no significant differences between men andwomen 65.98% and 59.09%, respectively (p> 0.05).Conclusions. Consequently, as a result of the clinical and anamnestic study of universitystudents, a positive effect of psychoeduction and screening examination on the attitudeof the surveyed to their own health status has been established as a result of the clinicaland anamnestic study of the university students, that ultimately increases the efficiency ofearly diagnosis of NPD.

Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET): Protocol for a Cross-sectional Comorbidity Study From a Research Domain Criteria Perspective.

It is widely acknowledged that comorbidity between psychiatric disorders is common. Shared and diverse underpinnings of psychiatric disorders cannot be systematically understood based on symptom-based categories of mental disorders, which map poorly onto pathophysiological mechanisms. In the Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET) study, we make use of current concepts of comorbidity that transcend the current diagnostic categories. We test this approach to psychiatric problems in patients with frequently occurring psychiatric disorders and their comorbidities (excluding psychosis). The main aim of the MIND-SET project is to determine the shared and specific mechanisms of neurodevelopmental and stress-related psychiatric disorders at different observational levels. This is an observational cross-sectional study. Data from different observational levels as defined in the Research Domain Criteria (genetics, physiology, neuropsychology, system-level neuroimaging, behavior, self-report, and experimental neurocognitive paradigms) are collected over four time points. Included are adult (aged ≥18 years), nonpsychotic, psychiatric patients with a clinical diagnosis of a stress-related disorder (mood disorder, anxiety disorder, or substance use disorder) or a neurodevelopmental disorder (autism spectrum disorder or attention-deficit/hyperactivity disorder). Individuals with no current or past psychiatric diagnosis are included as neurotypical controls. Data collection started in June 2016 with the aim to include a total of 650 patients and 150 neurotypical controls by 2021. The data collection procedure includes online questionnaires and three subsequent sessions with (1) standardized clinical examination, physical examination, and blood sampling; (2) psychological constructs, neuropsychological tests, and biological marker sampling; and (3) neuroimaging measures. We aim to include a total of 650 patients and 150 neurotypical control participants in the time period between 2016 and 2022. In October 2021, we are at 95% of our target. The MIND-SET study enables us to investigate the mechanistic underpinnings of nonpsychotic psychiatric disorders transdiagnostically. We will identify both shared and disorder-specific markers at different observational levels that can be used as targets for future diagnostic and treatment approaches.

Effectiveness of group metacognitive training and cognitive-behavioural therapy in a transdiagnostic manner for young patients with psychotic and non-psychotic disorders.

To investigate group metacognitive training and cognitive-behavioural therapy (MCT/CBT) prospectively in a young population with various psychiatric disorders, including psychotic and mood disorders. This was a prospective study to investigate the effectiveness of group MCT/CBT on quality of life, psychotic symptoms, depression, self-esteem, perceived stress, social function and social cognition. The objective measures included the Positive and Negative Syndrome Scale (PANSS), clinical global impression (CGI), personal and social performance scale for social functioning, a computerized continuous performance test for sustained attention and a computerized emotional recognition test for social cognition. Self-report measures administered included the Subjective Well-being under Neuroleptics for quality of life, Ambiguous Intentions Hostility Questionnaire for suspiciousness, Drug Attitude Inventory, Beck Depression Inventory, Perceived Stress Scale, Brief Resilience Scale, Rosenberg Self-esteem Scale and visual analogue scale for the EQ-5D. Among 110 young patients with early psychosis and mood disorders who participated, 82 (74.5%) completed the study. Social functioning, quality of life, self-esteem, resilience, depression, suspiciousness, social cognition, sustained attention and scores on the PANSS and CGI improved significantly after completing group MCT/CBT. Perceived stress, resilience and suspiciousness improved significantly only in participants with a non-psychotic disorder. Improvements in subjective well-being of the participants were associated with increases in self-esteem and resilience and decreases in depression and perceived stress. Our study showed that group transdiagnostic MCT/CBT for young patients with mental illness improved subjective wellbeing, self-esteem, resilience, social cognition and social functioning and significantly diminished suspiciousness, perceived stress and depression.

Patient-reported exposures and outcomes link the gut-brain axis and inflammatory pathways to specific symptoms of severe mental illness

We developed a “gut-brain-axis questionnaire” (GBAQ) to obtain standardized person-specific “review of systems” data for microbiome-gut-brain-axis studies. Individual items were compared to PANSS symptom measures using dimensional, transdiagnostic and traditional categorical approaches. MethodForty psychotic participants, independent of diagnoses, and 42 without psychosis (18 nonpsychotic affective disorders, 24 healthy controls) completed the GBAQ and underwent research diagnostic and symptom assessments. The PANSS scales and its dysphoric mood, autistic preoccupation and activation factors were computed. ResultsTransdiagnostic analyses robustly linked psychosis severity to constipation (p<.001), and Negative (p=.045) and General Psychopathology scores (p=.016) with bowel hypomotility. Activation factor scores predicted numbers of psychiatric (p=.009) and medical conditions (p=.003), BMI (p=.003), skin (p<.001) and other conditions. Categorical analyses comparing psychotic, nonpsychotic and control groups revealed behavioral differences: cigarette smoking (p=.013), alcohol use (p=.007), diet (p's <.05), exercise (p<.001). All subjects accurately self-reported their diagnosis. ConclusionsThe GBAQ is a promising tool. Transdiagnostic analyses associated psychotic symptoms to gut hypomotility, indicative of low gut vagal tone, consistent with reduced cardiovagal activity in psychosis. Activation, similar to delirium symptoms, predicted medical comorbidity and systemic inflammatory conditions. Group level comparisons only showed behavioral differences. Underpinnings of psychiatric disorders may include reduced gut vagal function, producing psychosis, and systemic inflammation, impacting risks for psychotic and nonpsychotic conditions.

Different patterns of white matter microstructural alterations between psychotic and non-psychotic bipolar disorder.

This study aimed to investigate alterations in white matter (WM) microstructure in patients with psychotic and non-psychotic bipolar disorder (PBD and NPBD, respectively). We used 3T-magnetic resonance imaging to examine 29 PBD, 23 NPBD, and 65 healthy control (HC) subjects. Using tract-based spatial statistics for diffusion tensor imaging data, we compared fractional anisotropy (FA) and mean diffusion (MD) pairwise among the PBD, NPBD, and HC groups. We found several WM areas of decreased FA or increased MD in the PBD and NPBD groups compared to HC. PBD showed widespread FA decreases in the corpus callosum as well as the bilateral internal capsule and fornix. However, NPBD showed local FA decreases in a part of the corpus callosum body as well as in limited regions within the left cerebral hemisphere, including the anterior and posterior corona radiata and the cingulum. In addition, both PBD and NPBD shared widespread MD increases across the posterior corona radiata, cingulum, and sagittal stratum. These findings suggest that widespread WM microstructural alterations might be a common neuroanatomical characteristic of bipolar disorder, regardless of being psychotic or non-psychotic. Particularly, PBD might involve extensive inter-and intra-hemispheric WM connectivity disruptions.

Plasma lipid alterations in young adults with psychotic experiences: A study from the Avon Longitudinal Study of Parents and Children cohort

BackgroundPsychotic experiences (PEs) are associated with an increased risk of future psychotic and non-psychotic mental disorders. The identification of biomarkers of PEs may provide insights regarding the underlying pathophysiology. MethodsThe current study applied targeted lipidomic approaches to compare plasma lipid profiles in participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort who did (n = 206) or did not (n = 206) have PEs when aged approximately 24 years. ResultsIn total, 202 lipids including 8 lipid classes were measured by using ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS). Eight lipid clusters were generated. Thirteen individual lipids were nominally significantly higher in the PEs group compared to the control group. After correction for multiple comparisons, 9 lipids comprising 3 lysophosphatidylcholines (LPCs), 2 phosphatidylcholines (PCs) and 4 triacylglycerols (TGs) remained significant. In addition, PEs cases had increased levels of TGs and LPCs with a low double bond count. ConclusionsThese findings indicate plasma lipidomic abnormalities in individuals experiencing PEs. The lipidomic profile measures could aid our understanding of the underlying pathophysiological mechanisms.

Internalized stigma mediates the relation between psychosis-risk symptoms and subjective quality of life in a help-seeking sample

Subjective quality of life can be compromised in individuals with psychosis-risk symptoms, with poorer quality of life being associated with worse functioning and later transition to psychosis. Individuals who experience psychosis-related symptoms also tend to endorse more internalized (or self-) mental health stigma when compared to controls, potentially contributing to delays in seeking treatment and increased duration of untreated psychosis, as well as interfering with treatment engagement and retention in those already receiving care. Despite these findings, and the growing recognition for prevention in earlier phases of psychotic illness, few studies have examined the relation between psychosis-risk symptoms, internalized stigma, and subjective quality of life in a younger, help-seeking sample. The present study examined whether internalized stigma mediates the relation between psychosis-risk symptoms and subjective quality of life in a transdiagnostic sample of youth (M age = 17.93, SD = 2.90) at clinical high-risk for psychosis (CHR), with early psychosis, or with non-psychotic disorders (N = 72). Psychosis-risk symptom severity was assessed using the Structured Interview for Psychosis-Risk Syndromes (SIPS). Internalized stigma was assessed using the Internalized Stigma of Mental Illness Inventory (ISMI), and subjective quality of life was assessed using the Youth Quality of Life Instrument – Short Form (YQOL-SF). Internalized stigma fully mediated the relation between psychosis-risk symptoms and subjective quality of life across the full sample (p < .05, f2 = 0.06). Findings suggest that internalized stigma may be an important target in efforts to improve quality of life for individuals in early stages of psychosis.

Factors associated with antipsychotic use in non-psychotic depressed patients: results from a clinical multicenter survey

BackgroundThe combination of antipsychotics is not well studied among non-psychotic major depressive disorder (MDD). This study aims to explore the antipsychotics use in this population and its associated factors.MethodsThis cross-sectional and multi-site study was conducted in 11 sites of China. one Thousand five hundred three eligible MDD patients after 8–12 weeks of antidepressant treatment were included consecutively. A structured questionnaire was used to obtain socio-demographic data and medical histories. The Chinese version of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR), the Patient Health Questionnaire-15 (PHQ-15) and the Sheehan Disability Scale (SDS) were used for patient self-rating. Logistic regression model was used to explore the associated factors that could potentially be influential for the use antipsychotic augmentation.ResultsOverall, quetiapine (43.4%) was the most commonly used as an adjunct to antidepressants, followed by olanzapine (38.8%). And antipsychotics were commonly combined with escitalopram (23.1%), venlafaxine (21.7%), sertraline (14.8%). The factors influencing the combination of antipsychotics in non-psychotic depressed patients included service setting (OR = 0.444; p < 0.001; 95%CI = 0.338–0.583), comorbidity of physical illness (OR = 1.704; p < 0.001; 95%CI = 1.274–2.278), PHQ level (OR = 0.680; p < 0.001; 95%CI = 0.548–0.844), SDS level (OR = 1.627; p < 0.001; 95%CI = 1.371–1.930) and antidepressants co-treatment (OR = 2.606; p < 0.001; 95%CI = 1.949–3.485).ConclusionsAntipsychotics use is common among non-psychotic MDD patient. Service setting, comorbidity of physical illness, somatic symptoms, social functioning and engagement, and antidepressants co-treatment could be the factors associated with the antipsychotics use in MDD patients.

Peer support for discharge from inpatient mental health care versus care as usual in England (ENRICH): a parallel, two-group, individually randomised controlled trial

SummaryBackgroundHigh numbers of patients discharged from psychiatric hospital care are readmitted within a year. Peer support for discharge has been suggested as an approach to reducing readmission post-discharge. Implementation has been called for in policy, however, evidence of effectiveness from large rigorous trials is missing. We aimed to establish whether peer support for discharge reduces readmissions in the year post-discharge.MethodsWe report a parallel, two-group, individually randomised, controlled superiority trial, with trial personnel masked to allocation. Patients were adult psychiatric inpatients (age ≥18 years) with at least one previous admission in the preceding 2 years, excluding those who had a diagnosis of any organic mental disorder, or a primary diagnosis of learning disability, an eating disorder, or drug or alcohol dependency, recruited from seven state-funded mental health services in England. Patients were randomly assigned (1:1) to the intervention (peer support plus care as usual) or control (care as usual) groups by an in-house, online randomisation service, stratified by site and diagnostic group (psychotic disorders, personality disorders, and other eligible non-psychotic disorders) with randomly permuted blocks of randomly varying length to conceal the allocation sequence and achieve the allocation ratio. The peer support group received manual-based, one-to-one peer support, focused on building individual strengths and engaging with activities in the community, beginning during the index admission and continuing for 4 months after discharge, plus care as usual. Care as usual consisted of follow-up by community mental health services within 7 days of discharge. The primary outcome was psychiatric readmission 12 months after discharge (number of patients readmitted at least once), analysed on an intention-to-treat basis. All patients were included in a safety analysis, excluding those who withdrew consent for use of their data. The trial is registered with the ISRCTN registry, ISRCTN10043328. The trial was complete at the time of reporting.FindingsBetween Dec 1, 2016, and Feb 8, 2019, 590 patients were recruited and randomly assigned, with 294 allocated to peer support (287 included in the analysis after withdrawals and loss to follow-up), and 296 to care as usual (291 in the analysis). Mean age was 39·7 years (SD 13·7; range 18–75). 306 patients were women, 267 were men, three were transgender, and two preferred not to say. 353 patients were White, 94 were Black, African, Caribbean, or Black British, 68 were Asian or Asian British, 48 were of mixed or multiple ethnic groups, and 13 were of other ethnic groups. In the peer support group, 136 (47%) of 287 patients were readmitted at least once within 12 months of discharge. 146 (50%) of 291 were readmitted in the care as usual group. The adjusted risk ratio of readmission was 0·97 (95% CI 0·82–1·14; p=0·68), and the adjusted odds ratio for readmission was 0·93 (95% CI 0·66–1·30; p=0·68). The unadjusted risk difference was 0·03 (95% CI –0·11 to 0·05; p=0·51) in favour of the peer support group. Serious adverse events were infrequent (67 events) and similar between groups (34 in the peer support group, 33 in the care as usual group). Threat to life (self-harm) was the most common serious adverse event (35 [52%] of 67 serious adverse events). 391 other adverse events were reported, with self-harm (not life threatening) the most common (189 [48%] of 391).InterpretationOne-to-one peer support for discharge from inpatient psychiatric care, plus care as usual, was not superior to care as usual alone in the 12 months after discharge. This definitive, high-quality trial addresses uncertainty in the evidence base and suggests that peer support should not be implemented to reduce readmission post-discharge for patients at risk of readmission. Further research needs to be done to improve engagement with peer support in high-need groups, and to explore differential effects of peer support for people from different ethnic communities.FundingUK National Institute for Health Research.

Sexual Dysfunction in Women with Nonpsychotic Disorders: A Cross-sectional Hospital-based Study.

Background:Sexual dysfunction among female psychiatric patients is zcommon and can be affected by various bio-psycho-social factors. The clinician’s or patient’s reluctance to actively inquire or spontaneously report these sexual difficulties creates a lacuna in our understanding of this association. This study aimed to assess the proportion of women with nonpsychotic psychiatric disorders reporting sexual dysfunction and evaluate its association with sociodemographic and clinical variables.Methods:This cross-sectional study conducted over six months included 113 women attending the psychiatry outpatient department of a tertiary care hospital. Sociodemographic and clinical variables, including diagnosis based on International Classification of Diseases 10th version (ICD 10) criteria, were assessed using a specially designed proforma. Sexual functioning was measured by Female Sexual Functioning Index (FSFI) and the Change in Sexual Functioning Questionnaire-Female Version (CSFQ-FV).Results:Sexual dysfunction was reported by 67.3% of patients. Among patients on psychotropics, 49% reported worsening of sexual dysfunction after treatment initiation. Sexual dysfunction was associated with increasing age (χ2 = 7.86, P = 0.04), lower educational qualification (χ2 =3.41, P = 0.04), skilled occupation (χ2 = 4.49, P = 0.03), lower socioeconomic status (χ2 = 4.27, P = 0.03) and presence of ongoing psychosocial stressor (χ2 = 4.49, P = 0.03).Conclusions:Difficulties in different domains of sexual functioning are prevalent among women with nonpsychotic disorders. Sociodemographic and relational factors, along with treatment status, can influence sexual dysfunction in these patients. Clinicians should be vigilant of this association and should plan treatment to enhance compliance and outcome.