Outcome Of Psychiatric Patients Research Articles

High state boredom vastly affects psychiatric inpatients and predicts their treatment duration

Boredom is a ubiquitous, aversive human experience typically elicited by low information and monotony. Boredom can occur either as a transient mental state that prompts individuals to adapt their behavior to avoid monotony or as a temporally stable trait, describing a chronic susceptibility to feeling bored. Increased trait boredom was found to correlate with various psychopathologies and indicators of mental burden. However, the role of state boredom in psychopathological conditions and its implications for psychiatric treatment remain elusive. Here, we address this issue by investigating state boredom and trait boredom in a cohort of psychiatric inpatients and a healthy control cohort. We find that in both groups, state boredom, even more than trait boredom, shows remarkable associations with psychopathology. In the inpatient group, state boredom is implicated broadly in multiple mental disorders and shows an association with treatment in closed psychiatric wards. Furthermore, through statistical modeling, we find that high-state boredom during inpatient therapy is predictive of a longer therapy duration. Thus, we show that state boredom constitutes an indicator of mild and severe psychopathology in different mental disorders, affecting the outcome of psychiatric patients. Potential therapeutic interventions are discussed, aiming to enhance information flow in the brain in order to alleviate boredom in clinical settings.

Clinical characteristics and outcomes of patients with mental illnesses who attempted suicide by drug overdose: A retrospective analysis of 109 cases.

Individuals with mental illnesses are exposed to an increased risk of suicide. In this study, we aimed to investigate the clinical characteristics and outcome of psychiatric patients who attempted suicide by drug overdose and required emergency care. A retrospective study was carried out in the Department of Emergency, the First Affiliated Hospital, Zhejiang University School of Medicine. Electronic medical records of psychiatric patients who were hospitalized due to suicide attempts from March 2019 to February 2022, with a discharge diagnosis of drug overdose were reviewed. Suicide-related data of patients were collected, including suicide month, time from suicide to admission, type of drugs, the number of tablets taken, as well as demographic and clinical profiles (e.g., gender, age, marital status, profession, physical comorbidities, and diagnosis of mental illness). In the results, half of the patients were young people, female patients accounted for a higher proportion (72.5%), and the incidence of suicide was higher in winter than other seasons. Among the 109 psychiatric patients, 60 patients (55.0%) had a history of major depressive disorder, and 86 patients (78.9%) committed suicide with various psychotropic drugs, among which anxiolytics were the most commonly used drugs. Thirty-seven patients (33.9%) experienced severe physical complications caused by drug overdose, with lung infections being the most common. The clinical outcome of most patients was favorable following emergent treatment, while 2 patients (1.8%) older than 80 failed to survive. A better understanding of psychiatric patients referred to emergency care due to suicide by drug overdose helps to improve the clinical management and prognosis of patients.

Association between continuity of care and treatment outcomes in psychiatric patients in Germany: a prospective cohort study

BackgroundContinuity of care is considered an important treatment aspect of psychiatric disorders, as it often involves long-lasting or recurrent episodes with psychosocial treatment aspects. We investigated in two psychiatric hospitals in Germany whether the positive effects of relational continuity of care on symptom severity, social functioning, and quality of life, which have been demonstrated in different countries, can also be achieved in German psychiatric care.MethodsProspective cohort study with a 20-months observation period comparing 158 patients with higher and 165 Patients with lower degree of continuity of care of two psychiatric hospitals. Patients were surveyed at three points in time (10 and 20 months after baseline) using validated questionnaires (CGI Clinical Global Impression rating scales, GAF Global Assessment of Functioning scale, EQ-VAS Euro Quality of Life) and patient clinical record data. Statistical analyses with analyses of variance with repeated measurements of 162 patients for the association between the patient- (EQ-VAS) or observer-rated (CGI, GAF) outcome measures and continuity of care as between-subject factor controlling for age, sex, migration background, main psychiatric diagnosis group, duration of disease, and hospital as independent variables.ResultsHigher continuity of care reduced significantly the symptom severity with a medium effect size (p 0.036, eta 0.064) and increased significantly social functioning with a medium effect size (p 0.023, eta 0.076) and quality of life but not significantly and with only a small effect size (p 0.092, eta 0.022). The analyses of variance suggest a time-independent effect of continuity of care. The duration of psychiatric disease, a migration background, and the hospital affected the outcome measures independent of continuity of care.ConclusionOur results support continuity of care as a favorable clinical aspect in psychiatric patient treatment and encourage mental health care services to consider health service delivery structures that increase continuity of care in the psychiatric patient treatment course. In psychiatric health care services research patients’ motives as well as methodological reasons for non-participation remain considerable potential sources for bias.Trial registrationThis prospective cohort study was not registered as a clinical intervention study because no intervention was part of the study, neither on the patient level nor the system level.

Predicting criminal and violent outcomes in psychiatry: a meta-analysis of diagnostic accuracy

Although reducing criminal outcomes in individuals with mental illness have long been a priority for governments worldwide, there is still a lack of objective and highly accurate tools that can predict these events at an individual level. Predictive machine learning models may provide a unique opportunity to identify those at the highest risk of criminal activity and facilitate personalized rehabilitation strategies. Therefore, this systematic review and meta-analysis aims to describe the diagnostic accuracy of studies using machine learning techniques to predict criminal and violent outcomes in psychiatry. We performed meta-analyses using the mada, meta, and dmetatools packages in R to predict criminal and violent outcomes in psychiatric patients (n = 2428) (Registration Number: CRD42019127169) by searching PubMed, Scopus, and Web of Science for articles published in any language up to April 2022. Twenty studies were included in the systematic review. Overall, studies used single-nucleotide polymorphisms, text analysis, psychometric scales, hospital records, and resting-state regional cerebral blood flow to build predictive models. Of the studies described in the systematic review, nine were included in the present meta-analysis. The area under the curve (AUC) for predicting violent and criminal outcomes in psychiatry was 0.816 (95% Confidence Interval (CI): 70.57–88.15), with a partial AUC of 0.773, and average sensitivity of 73.33% (95% CI: 64.09–79.63), and average specificity of 72.90% (95% CI: 63.98–79.66), respectively. Furthermore, the pooled accuracy across models was 71.45% (95% CI: 60.88–83.86), with a tau squared (τ2) of 0.0424 (95% CI: 0.0184–0.1553). Based on available evidence, we suggest that prospective models include evidence-based risk factors identified in prior actuarial models. Moreover, there is a need for a greater emphasis on identifying biological features and incorporating novel variables which have not been explored in prior literature. Furthermore, available models remain preliminary, and prospective validation with independent datasets, and across cultures, will be required prior to clinical implementation. Nonetheless, predictive machine learning models hold promise in providing clinicians and researchers with actionable tools to improve how we prevent, detect, or intervene in relevant crime and violent-related outcomes in psychiatry.

1.5 The Relationship Between Sleep Architecture and Emotional Inhibition Processing in Adolescents Hospitalized During a Suicidal Crisis

Suicide is the second leading cause of death for adolescents worldwide. Research has shown that adolescents in a suicidal crisis may exhibit both sleep disturbances and impairments in cognitive inhibition. Poor sleep quality has been linked to worse clinical outcomes in psychiatric patients. Furthermore, difficulties with inhibitory control have been proposed to increase susceptibility to suicidality by altering one’s ability to inhibit intrusive suicidal thoughts. In fact, a previous study has shown that suicidal adolescents exhibited lower neural resources mobilized by inhibition processing compared to healthy adolescents.

Long-term neurological and psychiatric outcomes in patients with aromatic l-amino acid decarboxylase deficiency

Introductionl-amino acid decarboxylase deficiency (AADCD) is an ultrarare autosomal recessive defect of biogenic amine synthesis that presents with early-onset encephalopathy progressing to severe neurological impairment and intellectual disability. We aimed to explore neurocognitive and behavioral profiles associated with AADCD and possible factors predicting outcome in more detail. MethodsNine AADCD patients (23.2 ± 10.3 years; range 8–40) underwent systematic clinical and neuropsychological assessment. Diagnostic levels of CSF 5-hydroxyindolacetic acid (5-HIAA) and homovanillic acid (HVA), and DDC genotype (as ascertained by American College of Medical Genetics and Genomics grading) were included in the data analysis. ResultsAll AADCD patients were affected by intellectual disability and psychiatric disorders. Movement disorders included parkinsonism-dystonia, dysarthria, and oculogyric crises. CSF 5-HIAA and HVA levels at diagnosis had a significant influence on adaptive behavior and executive function performance. Patients homozygous for DDC pathogenetic variants showed lower CSF 5-HIAA and HVA levels and higher Unified Parkinson's Disease Rating Scale scores. The disease showed a self-limiting clinical course with partial improvement under pharmacological treatment (B6 and dopamine mimetic drugs). ConclusionsPatients with AADCD suffer from neuropsychological and psychopathological impairment, which may be improved but not reversed under the present therapeutic approach. However, cognitive functioning should be specifically examined in order to avoid its underestimation on the basis of movement disorder severity. Genotype and biogenic amine level at diagnosis have an important prognostic value.

Eveningness and Impulsivity in Euthymic Mood States Adversely Affect the Quality of Life of Major Depression and Bipolar Disorder Patients

Objective: Chronotype and impulsivity are important features to be examined in mood disorder patients; these characteristics precede mood disorder onset and persist between mood episodes. Moreover, quality of life is an important outcome in psychiatric patients. This study investigated the interaction between these features and its effect on mood disorder patient’s quality of life.Methods: Early-onset major depressive disorder (MDD), bipolar disorder I (BD I), and bipolar disorder II (BD II) patients were recruited. Excluding 18 patients who were missing data on main variables and 5 patients who were classified as severely ill, a total of 472 euthymic patients (MDD=167, BD I=133, BD II= 172) were assessed on their chronotype, trait impulsivity, and quality of life using self-reports.Results: Both impulsivity and eveningness were negatively associated with quality of life. Regression results showed that there was a significant interaction effect between eveningness and impulsivity on quality of life. This indicates that the higher the level of impulsivity in mood disorder patients, the negative effect of eveningness on quality of life increased.Conclusion: The current study suggests that examination of impulsive personality in relation to chronotype may be important in further understanding the effects of these features on mood disorder patients’ lives.

A meta-analysis on the prevalence of anxiety and depression in patients with unruptured intracranial aneurysms: exposing critical treatment gaps

Unruptured intracranial aneurysms (UIAs) are a significant cause of anxiety and depression. Though the annual rupture rate is relatively low, ensuing mortality and morbidity may be high. Most published studies have focused on functional outcomes; however, limited studies have explored and reported on psychiatric outcomes, which are equally important. We aimed to review existing data on anxiety and depression in patients with UIAs. We systematically searched the databases of Pubmed, Cochrane, Scopus, EBSCOHOST, and ClinicalTrials.gov for studies that reported on anxiety and depression in patients with UIAs. Where available, we also reported data on aneurysm characteristics, treatment modalities, and functional outcomes of these populations. We performed a meta-analysis of proportions by random-effects modeling to compute the prevalence of anxiety and depression in patients with UIAs. Eighteen studies reporting a total of 1413 patients with UIAs were included in the systematic review. The mean age was 57.8 (range 27-79); 64% of whom were female. Random-effect modeling analysis showed an overall estimated prevalence of 28% [95% CI: 0.17-0.42] for anxiety and 21% [95% CI: 0.13-0.33] for depression among patients with UIAs. No significant difference was found in the prevalence of these conditions between treated vs untreated aneurysms. Our review highlights the heterogeneity of data from existing studies and the lack of standardized methodologies in determining psychiatric outcomes in patients with UIAs. It was also limited by the small sample sizes and patient counseling bias in the included studies. Larger, well-designed epidemiologic studies on patients with UIA should include more representative samples, assess for predictors of psychological outcomes, and explore the most optimal psychiatric assessment tools.

Psychiatric Outcomes in ICU Patients With Family Visitation: A Population-Based Retrospective Cohort Study

Lack of family visitation in the ICU can have long-term consequences on patients in the ICU after discharge. The effect of family visitation on the incidence of patient psychiatric disorders is unknown. What is the association between family visitation in the ICU and incidence of psychiatric outcomes in patients in the ICU 1 year after hospital discharge? This study assessed a population-based retrospective cohort of adult patients admitted to the ICU from January 1, 2014, through May 30, 2017, surviving to hospital discharge with ICU length of stay of≥ 3days. To be eligible, patients needed to have minimum of 5 years of administrative data before ICU admission and a minimum of 1 year of follow-up data after hospital discharge. An internally validated algorithm that interpreted natural language in health records determined patients with or without in-person family (ie, relatives, friends) visitation during ICU stay. The primary outcome was risk of an incidence of psychiatric disorder (composite outcome), including anxiety, depressive, trauma- and stressor-related, psychotic, and substance use disorders, identified using coding algorithms for administrative databases. Propensity scores were used in inverse probability weighted logistic regression models, and average treatment effects were converted to risk ratios (RRs) with 95%CIs. Secondary outcomes were incidences of diagnoses by type of psychiatric disorder. We included 14,344 patients with (96%[n= 13,771]) and without (4.0%[n= 573]) in-person family visitation who survived hospital discharge. More than one-third of patients received a diagnosis of any psychiatric disorder within 1 year after discharge (34.9%; 95%CI, 34.1%-35.6%). Patients most often received diagnoses of anxiety disorders (17.5%; 95%CI, 16.9%-18.1%) and depressive disorders (17.2%; 95%CI, 16.6%-17.9%). After inverse probability weighting of 13,731 patients, in-person family visitation was associated with a lower risk of received a diagnosis of any incident psychiatric disorder within 1 year after discharge (RR, 0.79; 95%CI, 0.68-0.92). ICU family visitation is associated with a decreased risk of psychiatric disorders in critically ill patients up to 1 year after hospital discharge.

Berberine, a Herbal Metabolite in the Metabolic Syndrome: The Risk Factors, Course, and Consequences of the Disease.

In recent years, the health of patients exposed to the consequences of the metabolic syndrome still requires the search for new solutions, and plant nutraceuticals are currently being intensively investigated. Berberine is a plant alkaloid possessing scientifically determined mechanisms of the prevention of the development of atherosclerosis, type 2 diabetes, and obesity, as well as cardiovascular complications and cancer. It positively contributes to elevated levels of fasting, postprandial blood glucose, and glycosylated hemoglobin, while decreasing insulin resistance. It stimulates glycolysis, improving insulin secretion, and inhibits gluconeogenesis and adipogenesis in the liver; by reducing insulin resistance, berberine also improves ovulation. The anti-obesity action of berberine has been also well-documented. Berberine acts as an anti-sclerotic, lowering the LDL and testosterone levels. The alkaloid exhibits an anti-inflammatory property by stalling the expression of cyclooxygenase 2 (COX-2) and prostaglandin E2. Berberine is neuroprotective and acts as an antidepressive. However, the outcomes in psychiatric patients are nonspecific, as it has been shown that berberine improves metabolic parameters in schizophrenic patients, acting as an adjuvant during antipsychotic treatment. Berberine acts as an anticancer option by inducing apoptosis, the cell cycle arrest, influencing MAPK (mitogen-activated protein kinase), and influencing transcription regulation. The inhibition of carcinogenesis is also combined with lipid metabolism.

Social determinants of health in male forensic patients admitted at a tertiary psychiatric hospital in South Africa.

Social factors are increasingly being used to determine health outcomes. The concept of social determinants of health has been used to shape policies that address disparities. There is a paucity of such studies in the forensic setting. This study aimed to use social determinants of health to identify social factors that are associated with being a male forensic patient. The study was a retrospective two-group (forensic and non-forensic) comparison clinical record review. Association was identified through independent and multivariate statistical analysis. The study sample comprised of 296 patients, 56.4% (n = 167) of which were non-forensic. The majority of the sample was black African, 50 years and older, single, unemployed and had attended main-stream schooling. Race (p < .01), employment status (p < .02), not completing high school (p < .01), previous imprisonment (p < .01), drug use (p < .01) and not being on medication prior to admission (p < .01) were significantly associated with being a forensic patient. Multivariate logistic regression analyses also confirmed these associations. Social determinants of health ought to be targeted to improve health outcomes of psychiatric patients. Collaborations between mental health, public health, law and policy makers as well as non-/governmental agencies may lead to change. Human rights of individuals with mental illness may thus be enhanced in the long run.

Psychosocial Profiles of Patients Admitted to Psychiatric Emergency Services: Results from the Signature Biobank Project.

Objectives:Patients admitted to psychiatric emergency services (PES) are highly heterogenous. New tools based on a transdiagnosis approach could help attending psychiatrists in their evaluation process and treatment planning. The goals of this study were to: (1) identify profiles of symptoms based on self-reported, dimensional outcomes in psychiatric patients upon their admission to PES, (2) link these profiles to developmental variables, that is, history of childhood abuse (CA) and trajectories of externalizing behaviours (EB), and (3) test whether this link between developmental variables and profiles was moderated by sex.Methods:In total, 402 patients were randomly selected from the Signature Biobank, a database of measures collected from patients admitted to the emergency of a psychiatric hospital. A comparison group of 92 healthy participants was also recruited from the community. Symptoms of anxiety, depression, alcohol and drug abuse, impulsivity, and psychosis as well as CA and EB were assessed using self-reported questionnaires. Symptom profiles were identified using cluster analysis. Prediction of profile membership by sex, CA, and EB was tested using structural equation modelling.Results:Among patients, four profiles were identified: (1) low level of symptoms on all outcomes, (2) high psychotic symptoms, (3) high anxio-depressive symptoms, and (4) elevated substance abuse and high levels of symptoms on all scales. An indirect effect of CA was found through EB trajectories: patients who experienced the most severe form of CA were more likely to develop chronic EB from childhood to adulthood, which in turn predicted membership to the most severe psychopathology profile. This indirect effect was not moderated by sex.Conclusion:Our results suggest that a transdiagnostic approach allows to highlight distinct clinical portraits of patients admitted to PES. Importantly, developmental factors were predictive of specific profiles. Such transdiagnostic approach is a first step towards precision medicine, which could lead to develop targeted interventions.

COMPARISON OF TWO WIDELY USED ATYPICAL ANTIPSYCHOTICS OLANZAPINE VERSUS RISPERIDONE IN TERMS OF METABOLIC OUTCOMES

Objective: To compare the metabolic outcomes in psychiatric patients treated with Olanzapine and Risperidone.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: The study was conducted at Armed Forces Institute of Mental Health, Rawalpindi,from Aug 2016 to Jan 2017.&#x0D; Methodology: In this study 114 newly diagnosed psychiatric patients taking atypical anti-psychotics were selected and placed randomly into two groups i.e. group A (Olanzapine) andgroup B (Risperidone), 57 patients each. Patients of either gender, 20 to 60 years’ age, clinically diagnosed new cases having psychiatric illness using DSMV were selected consecutively. Baseline and six months’ end study data were collected and compared.&#x0D; Results: Total 14 out of 109 (5 patients lost follow up) patients developed metabolic syndrome. Among these 10(18.18%) were in group A while 4 (7.41%) were in group B. Patients receiving Olanzapine were 2.58 times moreprone to develop metabolic syndrome compared to the Risperidone receiving [RR= 2.58 {C.I. 0.85009, 7.62703}].Weight gain (p-value = 0.0048), increased Waist circumference (p-value = 0.00867) and elevated Blood Pressure (pvalue = 0.0563) were seen more significantly with use of Olanzapine.&#x0D; Conclusion: Olanzapine although associated with good efficacy but indeed with more serious and long-term side effects like impaired blood glucose tolerance, dyslipidemia and increase weight. Psychiatrist must screen and continuously monitor such patients.

Mental Disorders and Risk of Covid-19 Related Mortality, Hospitalization and Intensive Care Unit Admission: A Systematic Review and Meta-Analysis

Background: Mental disorders may represent a risk factor for severe COVID-19. This study evaluated the risk of COVID-19 mortality, hospitalization, and intensive care unit (ICU) admission in patients with pre-existing mental disorders or exposure to psychopharmacological treatments. Methods: In this PRISMA-compliant systematic review and meta-analysis (PROSPERO-CRD42021233984), we searched Web of Science, PsycINFO, Cochrane, PubMed, and Ovid/PsycINFO databases through March 5, 2021 for studies reporting data on COVID-19 outcomes in psychiatric patients compared to controls. Risk of COVID-19 mortality was defined as the primary outcome, with hospitalization and ICU admission as secondary outcomes. We modeled random-effects meta-analyses to estimate crude (OR) and adjusted (aOR) odds ratios for these three outcomes. Heterogeneity was assessed using the I2 statistic, publication bias was tested with Egger regression and visual inspection of funnel plots. Newcastle Ottawa Scale was used to explore study quality. We estimated effect sizes associated with any pre-existing mental disorder as well as specific categories of mental disorders (psychotic disorders, mood disorders, substance use disorders, anxiety disorders, intellectual disabilities and developmental disorders), and exposure to psychopharmacological drug classes (antidepressants, antipsychotics, and anxiolytics). Severe mental illness was compared with other mental disorders. We also conducted subgroup analyses and meta-regressions to assess the effects of baseline COVID-19 treatment setting, patient age, country, pandemic phase, quality assessment score and adjustment for confounders. Findings: A total of 32 studies were included in the systematic review and 23 in the meta-analysis, representing 658,702 patients with COVID-19 (41,944 with mental disorders). The presence of any mental disorder was associated with increased risk of COVID-19 mortality (Crude OR 1·99, 95% CI 1·56-2·54; aOR 1·34, 95% CI 1·15-1·56). This association was confirmed in psychotic disorders (Crude OR 2·11, 95% CI 1·47-3·03; aOR 1·77, 95% CI 1·34-2·33), and mood disorders (Crude OR 1·98, 95% CI 1·48-2·64; aOR 1·44, 95% CI 1·14-1·82). An increased mortality risk with substance use disorders (Crude OR 1·76, 95% CI 1·30- 2·38; aOR 1·12, 95% CI 0·89-1·39) and intellectual disabilities and developmental disorders (Crude OR 1·47, 95% CI 1·08-2·01) was only established in unadjusted estimates. We detected no effect for anxiety disorders (Crude OR 1·06, 95% CI 0·75-1·51; aOR 1·01, 95% CI 0·76-1·34). COVID-19 mortality was also associated with exposure to antipsychotics (Crude OR 3·71, 95% CI 1·74-7·91; aOR 2·43, 95% CI 1·81-3·25) and anxiolytics (Crude OR 2·58, 95% CI 1·22-5·44; aOR 1·47, 95% CI 1·15-1·88), but with antidepressant exposure only in unadjusted models (Crude OR 2·23, 95% CI 1·06-4·71; aOR 1·18, 95% CI 0·93-1·50). Overall, mental disorders were consistently associated with increased risk of hospitalization (Crude OR: 2·24, 95% CI 1·70-2·94; aOR: 1·77, 95% CI 1·29-2·42), but not ICU admission (Crude OR 1·71, 95% CI 1-2·93; aOR 1·26, 95% CI 0·78-2·05). Increased rates of hospital and ICU admission were found in substance use disorders (Hospitalization - Crude OR: 2·66, 95% CI 1·79-3·95; aOR: 1·87, 95% CI 1·16-3·03; ICU - Crude OR 2·59, 95% CI 1·54-4·38) and for unadjusted estimates in mood disorders (Hospitalization Crude OR 2·26, 95% CI 1·33-3·86; aOR 1·26, 95% CI 0·64-2·50; ICU - Crude OR 2·39, 95% CI 1·15-5·00; aOR 1·13, 95% CI 0·70-1·84). Psychotic disorders were not associated with an increased risk of hospitalization (Crude OR 1·68, 95% CI 0·86-3·29; aOR: 1·34, 95% CI 0·61-2·94), and even showed a decreased risk of ICU admission in adjusted estimates (Crude OR 0·77, 95% CI 0·42- 1·42; aOR 0·75, 95% CI 0·62-0·91). Adjusted effect sizes were significantly higher for mortality (p=0·005) and lower for ICU admission (pInterpretation: Pre-existing mental disorders, in particular psychotic and mood disorders, as well as exposure to antipsychotics and anxiolytics, were associated with COVID-19 mortality. Substance use disorders were associated with COVID-19 hospitalization. These findings support the need for targeted approaches for the management and prevention of COVID-19 in patients with mental disorders. Funding: NoneDeclaration of Interest: LDP reports grants from Boehringer-Ingelheim and Janssen R&D, outside the submitted work. PFP reports grants from Lundbeck, personal fees from Angelini, personal fees from Menarini, non-financial support from Boehringer Ingelheim, outside the submitted work. BV, FB, AB, RT, ML, MEB, IB, PFP and LDP are members of the ECNP Immunopsychiatry Thematic Working Group. All other authors have nothing to disclose.

Childhood maltreatment and cognitive functioning: the role of depression, parental education, and polygenic predisposition

Childhood maltreatment is associated with cognitive deficits that in turn have been predictive for therapeutic outcome in psychiatric patients. However, previous studies have either investigated maltreatment associations with single cognitive domains or failed to adequately control for confounders such as depression, socioeconomic environment, and genetic predisposition. We aimed to isolate the relationship between childhood maltreatment and dysfunction in diverse cognitive domains, while estimating the contribution of potential confounders to this relationship, and to investigate gene–environment interactions. We included 547 depressive disorder and 670 healthy control participants (mean age: 34.7 years, SD = 13.2). Cognitive functioning was assessed for the domains of working memory, executive functioning, processing speed, attention, memory, and verbal intelligence using neuropsychological tests. Childhood maltreatment and parental education were assessed using self-reports, and psychiatric diagnosis was based on DSM-IV criteria. Polygenic scores for depression and for educational attainment were calculated. Multivariate analysis of cognitive domains yielded significant associations with childhood maltreatment (η²p = 0.083, P < 0.001), depression (η²p = 0.097, P < 0.001), parental education (η²p = 0.085, P < 0.001), and polygenic scores for depression (η²p = 0.021, P = 0.005) and educational attainment (η²p = 0.031, P < 0.001). Each of these associations remained significant when including all of the predictors in one model. Univariate tests revealed that maltreatment was associated with poorer performance in all cognitive domains. Thus, environmental, psychopathological, and genetic risk factors each independently affect cognition. The insights of the current study may aid in estimating the potential impact of different loci of interventions for cognitive dysfunction. Future research should investigate if customized interventions, informed by individual risk profiles and related cognitive preconditions, might enhance response to therapeutic treatments.

Biomarkers in psychiatry: a clinician's viewpoint.

The dearth of biomarkers limits the precision of our research into pathogenesis of psychiatric disorders and has slowed down the development of new drugs. In clinical practice, it undermines the validity of psychiatric diagnoses and hampers the delivery of personalized treatment. The data quoted in this paper are gathered from a range of sources encompassing scientific and journalistic both in print and electronic. Availability of clinically useful biomarkers will improve the prognosis and outcome of psychiatric patients by helping in early diagnosis and delivery of individualized treatment. The cross-sectional and longitudinal observation of psychopathology is the bedrock of current clinical practice. Are psychiatric biomarkers advanced enough to supplant it? The need for biomarkers of psychiatric disorders has become more acute with the advent of new treatments which require precision and an individualized approach. Identification and deployment of intermediate phenotypes in classification, research and clinical practice of psychiatry.

Psychiatric Outcomes of Patients With Severe Agitation Following Administration of Prehospital Ketamine.

Ketamine is an emerging drug used in the management of undifferentiated, severe agitation in the prehospital setting. However, prior work has indicated that ketamine may exacerbate psychotic symptoms in patients with schizophrenia. The objective of this study was to describe psychiatric outcomes in patients who receive prehospital ketamine for severe agitation. This is a retrospective cohort study, conducted at two tertiary academic medical centers, utilizing chart review of patients requiring prehospital sedation for severe agitation from January 1, 2014, to June 30, 2016. Patients received either intramuscular (IM) versus intravenous (IV) ketamine or IM versus IV benzodiazepine. The primary outcome was psychiatric inpatient admission with secondary outcomes including ED psychiatric evaluation and nonpsychiatric inpatient admission. Generalized estimating equations and Fisher's exact tests were used to compare cohorts. During the study period, 141 patient encounters met inclusion with 59 (42%) receiving prehospital ketamine. There were no statistically significant differences between the ketamine and benzodiazepine cohorts for psychiatric inpatient admission (6.8% vs. 2.4%, difference= 4.3%, 95% CI= -2% to 12%, p=0.23) or ED psychiatric evaluation (8.6% vs. 15%, difference= -6.8%, 95% CI= -18% to 5%, p=0.23). Patients with schizophrenia who received ketamine did not require psychiatric inpatient admission (17% vs. 10%, difference= 6.7%, 95% CI= -46% to 79%, p=0.63) or ED psychiatric evaluation (17% vs. 50%, difference= -33%, 95% CI= -100% to 33%, p=0.55) significantly more than those who received benzodiazepines, although the subgroup was small (n=16). While there was no significant difference in the nonpsychiatric admission rate between the ketamine and benzodiazepine cohorts (35% vs. 51%, p=0.082), nonpsychiatric admissions in the benzodiazepine cohort were largely driven by intubation (63% vs. 3.8%, difference= 59%, 95% CI= 38% to 79%, p<0.001). Administration of prehospital ketamine for severe agitation was not associated with an increase in the rate of psychiatric evaluation in the emergency department or psychiatric inpatient admission when compared with benzodiazepine treatment, regardless of the patient's psychiatric history.

The Role of Docosahexaenoic Acid (DHA) on Cognitive Functions in Psychiatric Disorders.

Cognitive impairment is strongly associated with functional outcomes in psychiatric patients. Involvement of n-3 long chain polyunsaturated fatty acid (n-3 LC-PUFA), in particular docosahexaenoic acid (DHA), in brain functions is largely documented. DHA is incorporated into membrane phospholipids as structural component, especially in the central nervous system where it also has important functional effects. The aim of this review is to investigate the relationship between DHA and cognitive function in relation to mental disorders. Results from few randomized controlled trials (RCTs) on the effects of DHA (alone or in combination) in psychotic, mood and neurodevelopmental disorders, respectively, suggest that no conclusive remarks can be drawn.

Spiritual struggles and mental health outcomes in a spiritually integrated inpatient program

BackgroundPersons contending with serious mental health difficulties often experience struggles with religious faith and/or spirituality that may also demand clinical attention. However, research has not examined the relative importance of specific forms of spiritual struggles in mental health status or treatment outcomes of psychiatric patients. MethodsFocusing on 217 adults who completed a spiritually integrated inpatient program, this study examined (1) which struggles in Exline et al.’s (2014) framework (Divine, Morality, Ultimate Meaning, Interpersonal, Demonic, and Doubting) represented the most salient indicators of major depressive disorder (MDD) symptomatology and positive mental health (PMH) and (2) whether alleviation of these struggles predicted improvements in patients’ mental health status over the treatment period. ResultsGreater severity of spiritual struggles was generally associated with worse MDD symptomatology and less PMH at intake and discharge. However, when weighing the role of varying forms of struggles, issues with ultimate meaning emerged as a salient indicator of mental health status at the two assessments as well as longitudinal changes in both MDD symptomatology and PMH. LimitationsThis sample was recruited from acute stabilization units in a single spiritually integrated behavioral health center with a general affiliation with Christianity. Hence, treatment periods were relatively brief in some cases and findings might not generalize to other psychiatric programs or settings. ConclusionsFindings highlight the utility of assessing prominent forms of spiritual distress for planning and delivering psychosocial interventions, particularly with respect to issues related to a perceived absence of ultimate meaning in life.

The same or different psychiatrists for in- and out-patient treatment? A multi-country natural experiment.

A core question in the debate about how to organise mental healthcare is whether in- and out-patient treatment should be provided by the same (personal continuity) or different psychiatrists (specialisation). The controversial debate drives costly organisational changes in several European countries, which have gone in opposing directions. The existing evidence is based on small and low-quality studies which tend to favour whatever the new experimental organisation is.We compared 1-year clinical outcomes of personal continuity and specialisation in routine care in a large scale study across five European countries. This is a 1-year prospective natural experiment conducted in Belgium, England, Germany, Italy and Poland. In all these countries, both personal continuity and specialisation exist in routine care. Eligible patients were admitted for psychiatric in-patient treatment (18 years of age), and clinically diagnosed with a psychotic, mood or anxiety/somatisation disorder.Outcomes were assessed 1 year after the index admission. The primary outcome was re-hospitalisation and analysed for the full sample and subgroups defined by country, and different socio-demographic and clinical criteria. Secondary outcomes were total number of inpatient days, involuntary re-admissions, adverse events and patients' social situation. Outcomes were compared through mixed regression models in intention-to-treat analyses. The study is registered (ISRCTN40256812). We consecutively recruited 7302 patients; 6369 (87.2%) were followed-up. No statistically significant differences were found in re-hospitalisation, neither overall (adjusted percentages: 38.9% in personal continuity, 37.1% in specialisation; odds ratio = 1.08; confidence interval 0.94-1.25; p = 0.28) nor for any of the considered subgroups. There were no significant differences in any of the secondary outcomes. Whether the same or different psychiatrists provide in- and out-patient treatment appears to have no substantial impact on patient outcomes over a 1-year period. Initiatives to improve long-term outcomes of psychiatric patients may focus on aspects other than the organisation of personal continuity v. specialisation.