Outcome Of Psychiatric Disorders Research Articles

Heterogeneity as a Marker of Brain Function and Treatment Outcomes in Psychiatric Disorders

Heterogeneity as a Marker of Brain Function and Treatment Outcomes in Psychiatric Disorders

Biomarker Variability, Severity of CORADS and Impact of Psychotropic Medications on Course and Outcome of Neuropsychiatric Sequalae of COVID-19 ICU Patients: A Preliminary Observation from South India

IntroductionThere is growing evidence of neuropsychiatric presentations in patients of COVID-19, but literature is scarce on laboratory, clinical and radiological markers as well as impact of psychotropic medications during the course of hospitalization in critically ill patients.ObjectivesThe primary outcome measure was variability of clinical biomarkers and CORADS scores with severity of COVID-19 infections and the impact of psychotropic medications like risperidone and aripiprazole.MethodsWe screened 430 ICU patients admitted to our tertiary care hospitals, out of whom 67 were diagnosed positively with definitive neuropsychiatric sequalae and receive psychotropic interventions during their hospital stay. We compared their D-dimer levels, C-reactive proteins, serum ferritin levels, serum procalcitonin and Vitamin D levels and further analyzed CORADS severity score with psychiatric severity and outcome.ResultsThe mean age of the patients was 42.38 years, majority (44.8%) of them belonged to 21-34 years with slight (52.2%) male preponderance and none of them were more than 60 years. We observed a 43.3% were having organic mood disorder and 37.3% of individual had significant history of alcohol dependence while hypertension and diabetes mellitus were noted in 34.3% and 29.9% respectively. Only D-dimer levels were found to be significant and positively associated with outcome of psychiatric disorders (p<0.05), accounting for 41% of covariance on linear regression analysis.ConclusionsOur study has found significant association of elevated levels of D-dimer variability but not the other laboratory biomarkers among various neuropsychiatric comorbid sequalae in ICU admitted COVID 19 patients. This particular observation might have potential for serum D-dimer levels to be possibly used as an early biomarker to screen or suspect for comorbid neuropsychiatric presentations.Disclosure of InterestNone Declared

Serotonin Transporter Genetic Variation and Antidepressant Response and Tolerability: A Systematic Review and Meta-Analysis.

Antidepressants are used to treat several psychiatric disorders; however, a large proportion of patients do not respond to their first antidepressant therapy and often experience adverse drug reactions (ADR). A common insertion–deletion polymorphism in the promoter region (5-HTTLPR) of the serotonin transporter (SLC6A4) gene has been frequently investigated for its association with antidepressant outcomes. Here, we performed a systematic review and meta-analysis to assess 5-HTTLPR associations with antidepressants: (1) response in psychiatric disorders other than major depressive disorder (MDD) and (2) tolerability across all psychiatric disorders. Literature searches were performed up to January 2021, yielding 82 studies that met inclusion criteria, and 16 of these studies were included in the meta-analyses. Carriers of the 5-HTTLPR LL or LS genotypes were more likely to respond to antidepressant therapy, compared to the SS carriers in the total and European ancestry-only study populations. Long (L) allele carriers taking selective serotonin reuptake inhibitors (SSRIs) reported fewer ADRs relative to short/short (SS) carriers. European L carriers taking SSRIs had lower ADR rates than S carriers. These results suggest the 5-HTTLPR polymorphism may serve as a marker for antidepressant outcomes in psychiatric disorders and may be particularly relevant to SSRI treatment among individuals of European descent.

Rapid improvement of psychiatric stigmata after IFN-free treatment in HCV patients with and without cryoglobulinemic vasculitis

ObjectiveHepatitis C virus (HCV) causes neuropsychiatric disorders and quality of life impairment, especially in patients with cryoglobulinemic vasculitis (CV). Direct acting antivirals (DAAs) are effective in most extrahepatic HCV diseases, but limited information exists regarding the outcome of psychiatric disorders in patients with and without CV, after therapy. We aimed to evaluate psychiatric outcomes, in HCV-patients with and without CV, before and after successful DAA therapy.MethodsWe prospectively studied DAA-treated HCV-patients, stratified into presence (CV) or absence of CV (NON-CV). Four psychometric scales were administered to assess depression (HAM-D and MADRS), anxiety (HAM-A), and mania (MRS). Short-Form-36 questionnaires evaluated quality of life.ResultsSeventy-six patients were recruited, and 47 CV and 29 NON-CV were treated with antivirals. At baseline, depression and anxiety, from mild to severe, were frequently shown, with the most advanced cases in thee CV group; no patients achieved the scores for mania. A significant improvement emerged for all the psychometric scales in the entire population and in the subgroups, after viral eradication even in the short-term outcome. The Short-Form-36 summary components showed benefits.ConclusionsAfter HCV eradication, the depression and anxiety scores significantly improved and severity grade generally lowered. DAA-positive effects on mental disorders should be considered part of the therapy outcome, being beneficial especially in CV patients who usually have worse baseline mental scores.Key Points• HCV frequently causes psychiatric disorders and an often-invalidating autoimmune/lymphoproliferative disease called cryoglobulinemic vasculitis.• The new direct acting antivirals (DAAs) are very effective and well tolerated by HCV-patients.• This study shows DAA-induced benefits on depression and anxiety in HCV-patients that are especially evident in CV patients who usually have worse baseline mental scores.• DAA-induced benefits are observed in the short-term post-therapy follow-up, in contrast with data previously obtained in HCV patients treated with IFN-based anti-HCV therapy.

Prediction of functional outcomes of schizophrenia with genetic biomarkers using a bagging ensemble machine learning method with feature selection

Genetic variants such as single nucleotide polymorphisms (SNPs) have been suggested as potential molecular biomarkers to predict the functional outcome of psychiatric disorders. To assess the schizophrenia’ functional outcomes such as Quality of Life Scale (QLS) and the Global Assessment of Functioning (GAF), we leveraged a bagging ensemble machine learning method with a feature selection algorithm resulting from the analysis of 11 SNPs (AKT1 rs1130233, COMT rs4680, DISC1 rs821616, DRD3 rs6280, G72 rs1421292, G72 rs2391191, 5-HT2A rs6311, MET rs2237717, MET rs41735, MET rs42336, and TPH2 rs4570625) of 302 schizophrenia patients in the Taiwanese population. We compared our bagging ensemble machine learning algorithm with other state-of-the-art models such as linear regression, support vector machine, multilayer feedforward neural networks, and random forests. The analysis reported that the bagging ensemble algorithm with feature selection outperformed other predictive algorithms to forecast the QLS functional outcome of schizophrenia by using the G72 rs2391191 and MET rs2237717 SNPs. Furthermore, the bagging ensemble algorithm with feature selection surpassed other predictive algorithms to forecast the GAF functional outcome of schizophrenia by using the AKT1 rs1130233 SNP. The study suggests that the bagging ensemble machine learning algorithm with feature selection might present an applicable approach to provide software tools for forecasting the functional outcomes of schizophrenia using molecular biomarkers.

Erratum: Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review.

Mediterranean Diet (MD) is currently considered one of the most healthy dietary models worldwide. It is generally based on the daily intake of fruit and vegetables, whole grains, legumes, nuts, fish, white meats, and olive oil. It may also include moderate consumption of fermented dairy products, a low intake of red meat, and red/white wine during the main course. Even if the effect of MD on cancer prevention as well as on human metabolic and cardiovascular balance has been discussed, including the quality of life of the exposed population, the putative effects on mental health are still not properly investigated. This narrative review reports on some emerging pieces of evidence on the possible impact of MD on general health and the outcome of psychiatric disorders (e.g., major depression, anxiety) and encourages further studies to test the benefits of healthy food selection on the health of the general population.

Elevated peripheral inflammation is associated with attenuated striatal reward anticipation in major depressive disorder

BackgroundMajor depressive disorder (MDD) is the leading cause of years lived with disability worldwide, and up to 40% of individuals with MDD do not respond to current treatments. Studies suggest that peripheral inflammation plays an important role in the striatal mesolimbic dopamine pathway and corticostriatal reward circuitry in MDD. Although MDD patients show blunted striatal responses to reward, the link between degree of inflammation and attenuation of reward processing is unclear. We investigated whether MDD patients with elevated peripheral inflammation exhibit attenuated reward responses to enhance our understanding of MDD pathophysiology and develop more effective treatments for current non-responders. MethodsMDD subjects varying on serum C-reactive protein (CRP) concentrations (MDD-High CRP, >3 mg/L, n = 44; MDD-Low CRP, <3 mg/L, n = 44) and healthy comparisons (HC, n = 44) completed a monetary incentive delay (MID) task and provided blood samples to measure inflammation-related markers. MDD-High and MDD-Low were propensity score-matched on age, sex, body mass index (BMI), smoking status, exercise and MID task head motion. Percent change in blood oxygen level-dependent (BOLD) signal during anticipation of wins and losses was extracted from bilateral nucleus accumbens, dorsal caudate and dorsolateral putamen regions of interest (ROIs). A linear mixed-effects model was used to test group (MDD-High, MDD-Low and HC), condition (large-win, small-win and no win), and their interaction for these ROIs as well as whole-brain voxelwise data. Analyses also tested group differences in inflammatory mediators. Correlations were used to explore the relationship between inflammatory mediators and brain regions showing differences between MDD-High and MDD-Low. ResultsMDD-High exhibited: (a) lower BOLD signal change in dorsal caudate, thalamus, left insula and left precuneus during anticipation of small wins than MDD-Low; and (b) higher serum soluble intercellular adhesion molecule 1 (sICAM-1) and interleukin 6 (IL-6) concentrations than MDD-Low and HC. MDD as a whole, regardless of CRP-based inflammation, exhibited: (a) lower precuneus BOLD signal change to large wins than HC; and (b) higher Interleukin 1 receptor antagonist (IL-1ra), macrophage-derived chemokine (MDC) and macrophage inflammatory protein-1 alpha (MIP-1α) concentrations than HC. Higher serum sICAM-1 concentrations were associated with lower caudate BOLD signal change to small wins only within the MDD-High group. ConclusionWithin MDD patients, high inflammation (CRP, sICAM-1) was linked to reduced striatal activation recruited to discriminate intermediate reward magnitudes. These findings support an association between levels of peripheral inflammation and the degree of reward-related activation in individuals with MDD. Registration of clinical trialsThe ClinicalTrials.gov identifier for the clinical protocol associated with data published in this current paper is NCT02450240, “Latent Structure of Multi-level Assessments and Predictors of Outcomes in Psychiatric Disorders.”

Long-acting Injectable vs. Oral Antipsychotics: Adherence, Persistence and Switching over three Years of Real-life Analysis.

Persistence and adherence to treatment are considered efficacy outcomes in psychiatric disorders. One of the best ways to improve these values in patients with psychiatric disorders is to prefer Long-Acting Injectable (LAI) drugs to oral AP. The objective of this study is to evaluate adherence, persistence and switching of antipsychotics and compare in real life long-acting with oral formulations. This pharmacological, observational, retrospective and non-interventional study involved all patients of the ASL of Pescara treated in the front-line with AP in the period between January 2011 and February 2019. Adherence was measured using the ratio between the received daily dose and prescribed daily dose. Persistence to treatment with antipsychotics was calculated as the daily difference between the beginning and end of treatment. We examined 840 patients treated with aripiprazole, 130 patients treated with paliperidone and 925 patients treated with risperidone. Adherence was significantly better in long-acting formulations with values of 0.89 (aripiprazole) and 0.82 (paliperidone and risperidone) than in oral formulations with values of 0.78, 0.70 and 0.58, respectively (p> 0.999, p= 0.0091, p=< 0.0001). Threeyear persistence curves relating to three study drugs did not show a statistically significant difference (p = 0.3314). Persistence curves based on formulation have not shown a statistically significant difference (p= 0, 4658, p=0, 4794, p=0, 2199 for ariprazolo, paliperidone and risperidone, respectively). 7% of patients were treated with aripiprazole, 12% of patients were treated with risperidone and 28% of patients were treated with paliperidone switched therapy. In all the drugs of present study, adherence values were better in LAI than in OA, whereas no statistically significant difference was found in persistence values.

Investigation of human plasma depletome from patients with schizophrenia

The proteome of blood plasma is an interesting source of biomarkers and a potential way to improve treatment outcomes in psychiatric disorders. Respire that, its wide dynamic concentration range makes reducing its complexity necessary. Thus, in proteomic studies, a few of the most abundant proteins are depleted and normally discarded. This high-abundance fraction, called the depletome, however, is a source of potential biomarkers due to nonspecific bindings with low abundance proteins. In this work, we aimed to characterize the high-abundance fraction using a shotgun mass spectrometry approach. These proteins show the importance of studying depletome proteins in the quest for biomarkers.

Expressed Emotion Research in India: A Narrative Review.

Background:Expressed emotion (EE) is detrimental to patients with schizophrenia, mood disorders, eating disorders and many other psychiatric and neurological disorders. However, majority of the EE literature is generated from the west, and the results of those studies may have limited application in Indian setting. Hence, we conducted this review with the main aim of understanding EE research in India and its potential role in the course and outcome of psychiatric disorders and other chronic illnesses.Methods:Using keywords, we performed searches of electronic databases (PubMed, IndMed, PsychInfo, Science-Direct and Google Scholar) and internet sources and a manual search in the bibliography of the retrieved articles to identify potential original research articles on EE in India.Results:As per the selection criteria, 19 reports of 16 studies were included and reviewed. The sample size of the EE studies ranged from 20 to 200, and majority of the studies were conducted in psychosis/schizophrenia, followed by obsessive compulsive disorder and epilepsy. Although high EE was found in most of the studies, the impact of EE on illness outcome is not well explored and only two studies examined the relationship between EE and relapse.Discussion and Conclusion:There is a dearth of studies on EE, especially its relationship with relapse or clinical outcomes in the Indian context. We recommend more studies in these areas which may be helpful for clinical decisions and advancement of context knowledge in EE.

Slow-wave sleep predicts long-term social functioning in severe mental illness.

Sleep’s relevance for long-term social functioning in psychiatric disorders has been widely overlooked so far. Here, we investigate social functioning in a transdiagnostic sample of 31 patients with severe mental illness, namely schizophrenia (n = 15) or major depression (n = 16), in relation to their polysomnographic sleep characteristics 6 (± 2.4) years earlier. In addition, cognitive performance at follow-up and clinical characteristics (i.e., severity of disorder-related symptoms and number of hospitalizations between baseline and follow-up) are assessed. Multiple regression analysis results in a model with slow-wave sleep (SWS) and number of hospitalizations as significant predictors accounting for 50% (R2 = 0.507; p <0.001) of the variance in social functioning. SWS remains a significant predictor of long-term social functioning throughout a series of refining analyses which also identify baseline functioning as an additional significant predictor, whereas diagnosis is non-significant. Also, the effect of SWS on social functioning is not mediated by number of hospitalizations as assessed by a bootstrapped mediation analysis. We thus conclude that duration of slow-wave sleep is a powerful predictor of long-term social outcome in psychiatric disorders. Also, we discuss the relevance of verbal memory, symptom severity, and diagnostic category for social functioning. Future studies should test this finding by using a prospective design, a bigger sample, optimized predictor variables, and a more diverse set of diagnoses. Moreover, it should be explored whether or not treating sleep disturbances in psychiatric illnesses independently improves long-term social functioning.

S204. NUTRITIONAL DEFICIENCIES AND CLINICAL CORRELATES IN FIRST-EPISODE PSYCHOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

BackgroundDiet is increasingly recognised as a modifiable factor influencing the onset and outcomes of psychiatric disorders. Previous meta-analyses of blood nutrient levels in schizophrenia have already shown significant reductions in various individual vitamins/minerals. However, studies to date have largely focused on individual nutrients, and only considered nutrient status in patients with long-term schizophrenia. Meta-analytic evaluation of the evidence for nutrient deficits in first-episode psychosis (FEP) is completely absent. Therefore, we conducted a systematic review of all published studies comparing blood levels of vitamins and/or mineral in FEP to healthy control samples; and applied meta-analytic techniques to determine the prevalence and extent of deficiencies across the full spectrum of nutrients examined in this population to date.MethodsWe searched electronic databases from inception to July 2017 for all studies examining blood levels (i.e. serum, plasma or whole blood) of nutrient levels in people with FEP compared to healthy controls. Our systematic search identified 28 eligible studies, examining blood levels of 16 different nutrients (six vitamins, ten dietary minerals) across 2,612 individuals: 1,221 patients with FEP and 1,391 control subjects. Random effects meta-analyses compared nutrient levels in FEP to healthy controls. Clinical correlates of nutritional status in patient samples were systematically reviewed.ResultsRandom effects meta-analyses found that people with FEP had large, significant reductions in blood levels of vitamin B9 (i.e. folate) compared to healthy controls(N=6, n=827, g=-0.624, 95% C.I.=-1.176 to -0.072, p=0.027). Significant reductions were also found for vitamin D (N=7, n=906, g=-1.055, 95% C.I.=-1.99 to -0.119, p=0.027) and, among fewer studies, vitamin C (N=2, n=96, g=-2.207, 95% C.I.=-3.71 to -0.71, p=0.004). No differences were found for other vitamins or minerals. Systematic synthesis of clinical correlates showed that reductions in both folate and vitamin D held significant relationships with greater psychiatric symptoms in FEP.DiscussionThis is the first meta-analysis to examine the prevalence, extent and clinical correlates of nutritional deficiencies in FEP to date. The deficits in vitamin D and folate which have previously been observed in long-term schizophrenia appear to exist from illness onset, even prior to antipsychotic treatment, and are associated with more severe symptoms. The extent and importance of these deficiencies suggests that routine screening for vitamin D and folate deficiencies should be considered in early intervention services. Furthermore, since our previous meta-analyses have shown that high-dose b-vitamin supplementation can reduce symptoms in long-term schizophrenia, this should now be investigated in FEP. The potential physical and psychological benefits of vitamin D supplementation in early psychosis should also be explored. However, further research is needed to establish casual and mechanistic relationships between vitamin deficiencies, poor diet and the onset and outcomes of psychotic disorders.

Nutritional Deficiencies and Clinical Correlates in First-Episode Psychosis: A Systematic Review and Meta-analysis.

ObjectiveDiet is increasingly recognized as a potentially modifiable factor influencing the onset and outcomes of psychiatric disorders. Whereas, previous research has shown long-term schizophrenia is associated with various nutritional deficiencies, this meta-analysis aimed to determine the prevalence and extent of nutritional deficits in first-episode psychosis (FEP).MethodA search of electronic databases conducted in July 2017 identified 28 eligible studies, examining blood levels of 6 vitamins and 10 minerals across 2612 individuals: 1221 individuals with FEP and 1391 control subjects. Meta-analyses compared nutrient levels in FEP to nonpsychiatric controls. Clinical correlates of nutritional status in patient samples were systematically reviewed.ResultsSignificantly lower blood levels of folate (N = 6, n = 827, g = −0.624, 95% confidence interval [CI] = −1.176 to −0.072, P = .027) and vitamin D (N = 7, n = 906, g = −1.055, 95% CI = −1.99 to −0.119, P = .027) were found in FEP compared to healthy controls. Synthesis of clinical correlates found both folate and vitamin D held significant inverse relationships with psychiatric symptoms in FEP. There was also limited evidence for serum level reductions of vitamin C (N = 2, n = 96, g = −2.207, 95% CI = −3.71 to −0.71, P = .004). No differences were found for other vitamins or minerals.ConclusionsDeficits in vitamin D and folate previously observed in long-term schizophrenia appear to exist from illness onset, and are associated with worse symptomology. Further research must examine the direction and nature of these relationships (ie, mediator, moderator, or marker) with clinical status in FEP. Future trials assessing efficacy of nutrient supplementation in FEP samples should consider targeting and stratifying for baseline deficiency.

Treatment compliance and noncompliance in psychoses.

Background:Compliance or noncompliance with treatment significantly influences course and outcome of psychiatric disorders. While noncompliance has been extensively researched, compliance has received less attention. The current study was conducted to elicit reasons for compliance and noncompliance in patients having psychoses attending psychiatric clinics.Materials and Methods:A total of 196 compliant and 150 noncompliant patients were interviewed using self-designed tools to elicit sociodemographic data, details of illness, and treatment. Factors contributing to compliance and noncompliance were grouped under illness-related, clinician-related, medication-related, family-related, and economic-related domains and compared.Results:Compliance was significantly more in females and middle- and high-socioeconomic status patients. They had less substance use, high physical comorbidity, high attendance in the outpatient department, and better remission. Clinician-related, family-related, and medication-related domains were contributing more to compliance whereas illness-related and economic-related domains seemed to have more bearing on noncompliance.Conclusions:Compliance and noncompliance are determined multidimensionally. Domains related to clinician, family, and medications have to be reinforced to enhance compliance. Illness-related and economic domains have to be resolved to reduce noncompliance.

Long-Term Outcomes in Psychopathology Research: Rethinking the Scientific Agendaedited by Evelyn J. Bromet, Ph.D. New York, Oxford University Press, 2015, 360 pp., $89.95 (hardcover).

Long-Term Outcomes in Psychopathology Research: Rethinking the Scientific Agendaedited by Evelyn J. Bromet, Ph.D. New York, Oxford University Press, 2015, 360 pp., $89.95 (hardcover).

Tempering Madness: Emil Kraepelin’s Research on Affective Disorders

This essay examines some of the research practices and strategies that the German psychiatrist Emil Kraepelin (1856–1926) deployed in his efforts to account for the significance of emotions in psychiatric illnesses. After briefly surveying Kraepelin’s understanding of emotions and providing some historical context for his work in the late nineteenth century, it examines three different approaches that he took to studying emotions. First, it discusses his work in experimental psychology and his use of so-called artificial insanity to study affective disorders. It then turns to his clinical research, exploring his particular interest in the course and outcome of psychiatric disorders and then showing how those concerns related to his nosological delineation of manic depressive illness. Finally, it considers briefly how he attempted to expand his “clinical gaze,” turning it outward onto larger, nonhospitalized populations in an attempt to study subclinical forms of affect or temperaments. The article argues that the inadequacies and limitations of his own experimental and clinical research practices contributed to his evolving understanding of affective disorders. In particular, they led him to expand and differentiate his understanding of manic-depressive illness so as to take greater account of premorbid symptoms or temperaments.

Attitudes of Mental Health Workers Towards Early Interventions in Psychiatry

Early intervention (EI) is an effective strategy to improve outcomes of psychiatric disorders, but there is little evidence on mental health professionals' opinions on this approach. Hence, during conferences on this topic, we surveyed participants on the benefits, aims, and barriers to implementation of EI. Participants reported that the most important outcomes of EI were decreasing the risk of long-term social consequences, of severe psychopathological conditions, and chronicization. EI would primarily need to be implemented in the care of psychotic, eating, and mood disorders, whereas the main barriers to EI implementation were the lack of funding and of a prevention-oriented culture. Although these results might be biased by a generic attitude favoring EI, participants showed a very positive attitude towards EI and stated the need of a culture shift towards a more prevention-oriented model in a mental health setting.

Gyrification brain abnormalities as predictors of outcome in anorexia nervosa.

Gyrification brain abnormalities are considered a marker of early deviations from normal developmental trajectories and a putative predictor of poor outcome in psychiatric disorders. The aim of this study was to explore cortical folding morphology in patients with anorexia nervosa (AN). A MRI brain study was conducted on 38 patients with AN, 20 fully recovered patients, and 38 healthy women. Local gyrification was measured with procedures implemented in FreeSurfer. Vertex-wise comparisons were carried out to compare: (1) AN patients and healthy women; (2) patients with a full remission at a 3-year longitudinal follow-up assessment and patients who did not recover. AN patients exhibited significantly lower gyrification when compared with healthy controls. Patients with a poor 3-year outcome had significantly lower baseline gyrification when compared to both healthy women and patients with full recovery at follow-up, even after controlling for the effects of duration of illness and gray matter volume. No significant correlation has been found between gyrification, body mass index, amount of weight loss, onset age, and duration of illness. Brain gyrification significantly predicted outcome at follow-up even after controlling for the effects of duration of illness and other clinical prognostic factors. Although the role of starvation in determining our findings cannot be excluded, our study showed that brain gyrification might be a predictor of outcome in AN. Further studies are needed to understand if brain gyrification abnormalities are indices of early neurodevelopmental alterations, the consequence of starvation, or the interaction between both factors.

Association between social functioning and prefrontal hemodynamic responses in elderly adults

Social functioning has received widespread attention as one of the most important outcomes in psychiatric disorders and has been related to cognitive functioning and the underlying brain activity. Cognitive decline, however, appears not only in the psychiatric population but also in aged individuals. In our previous study, we demonstrated a significant relationship between social functioning and prefrontal cortex (PFC) activity in patients with depression. However, it has not been shown whether the above relationship could be extended to healthy populations. The purpose of the present study was to investigate a possible association between social functioning and prefrontal hemodynamic responses in healthy elderly adults by using a non-invasive and low-constraint functional neuroimaging technique, near-infrared spectroscopy (NIRS). Study subjects included 55 healthy, elderly volunteers. We measured hemodynamic responses over prefrontal cortical (PFC) areas during the verbal fluency task by using multi-channel NIRS and analyzed the relationship between task-associated hemodynamic responses and social functioning as measured by the social adaptation self-evaluation scale (SASS). A significant positive relationship was observed between the SASS total score and PFC activation. Our findings suggest that PFC activation is associated with social functioning in healthy elderly adults. Furthermore, hemodynamic responses assessed using non-invasive NIRS could be a useful biological marker of these characteristics.

Top of mind at APA meeting: Adherence, opioids, PTSD

The largest meeting for experts in psychiatric disorders, this month's 167th annual meeting of the American Psychiatric Association (APA) delivered information on several key issues related to managing patients with psychiatric disorders. Many important topics on the agenda are reviewed in this article: medication adherence (including how pharmacists can help), new antidepressants, opioid therapy, medical and recreational use of marijuana, management of posttraumatic stress disorder, and use of antipsychotics in vulnerable children.