Poor Psychosocial Functioning Research Articles

QOL-09. SyMon-SAYS: A symptom monitoring and reporting program for children with cancer

Unrelieved symptom burden due to cancer treatments can lead to poor psychosocial functioning and decreased health-related quality of life (HRQOL) for patients and their families. Barriers at the patient, healthcare provider and system levels can contribute to poor symptom management. Funded by the US National Cancer Institute, we have developed the Symptom Monitoring & Systematic Assessment and Reporting System in Young Survivors (SyMon-SAYS) program. SyMon-SAYS is a technology-based program with the potential to minimize symptom management barriers by routinely collecting and interpreting patient-reported outcomes in pediatric oncology ambulatory settings in a manner that is efficient, actionable by clinicians, supports engagement of patients and families with their health and care, and improves clinical processes and outcomes. This is a single institution modified waitlist control 16-week randomized trial of 200 children (ages 8-17) with cancer and their parents/guardians. Participants in the intervention phase will complete a symptom checklist weekly via the electronic health record patient portal. Scores exceeding a pre-defined threshold will trigger an alert to the treatment team, which will review the report and take appropriate actions. Participants will complete a separate battery of questionnaires assessing HRQOL at baseline and weeks 8 and 16. The recruitment is in progress. As of today, we have recruited 57 patients/parents. 29 completed 16-week study (15 intervention & 14 wait-list). Preliminary results showed SyMon-SAYS system was easy (92%) and convenient (85%) to use. Parents were satisfied (74.1%) with the SyMon-SAYS program. Comparing to the waitlist control, intervention group parents reported significantly less concerns on not having enough time to discuss their child’s symptoms with treating clinicians (p=0.0022), and disagreed that it is not necessary to treat their child’s symptoms as they will go away (p=0.04). We anticipate completing the recruitment by the end of 2023.

Assessing Serum Brain Derived Neurotrophic Factor and Matrix MetalloProteinase-9 Levels and Their Correlation With Neurocognitive and Psychosocial Functioning in Bipolar Disorder-I in Remission: A Case-Control Study

Aims1.To determine the association between serum BDNF, serum MMP-9 and cognitive function test in BD-1 patients in remission and to compare with controls.2.To assess the current psychosocial functioning of BD-I patients in remission and their correlates.MethodsSingle center case control study.Cases were BD-I patients in Remission (n = 60) and controls (n = 60) were age and gender matched healthy persons. The diagnosis of BD-1 was confirmed using Structured Clinical Interview For DSM-IV-Tr Axis I Disorders –Research Version along with clinical record. Age group between18–60 years, in remission for at least 2 months [scoring ≤ 8 on the Hamilton Depression Rating Scale, and ≤ 6 on Young Mania Rating Scale] were included. Those with significant head injury, neurological disorder, substance use disorder, Diabetes/Hypertension and premorbid IQ < 70 were excluded.Control group were excluded if their first degree relative had any psychiatric illness as elicited using Family Interview for Genetic Studies scale (FIGS).Cognitive functioning was assessed using Addenbrooke's Cognitive Examination version III (ACE-III) and Trail making test A and B (TMT A and TMT B). Current psychosocial functioning was assessed with Functioning assessment short test (FAST).Five ml blood sample was taken for estimation of serum BDNF and MMP-9 levels by ELISA.Chi-square test used to compare categorical variables. Mann-Whitney U test for continuous variables. Spearman's correlation - evaluate the relationship between scores on the cognitive function tests and serum levels of BDNF and MMP-9, within the group of patients with BD-I.ResultsWith regards to cognitive functioning, compared to controls, cases performed significantly poor in domains of Memory (Z = −3.435, p = 0.001), Processing speed (z=−2.667, p = 0.008), and Executive functioning (Z= −4.084, p = 0.000).No statistical difference in levels of serum BDNF and MMP-9 between patients and controls were found.While BDNF serum levels were not associated with cognitive or psychosocial functioning, there were significant relation between serum MMP-9 and the various domains of FAST scale and total FAST score (rho = 0.447, p < 0.001).BD-I patients exhibited poor psychosocial functioning compared to controls even in euthymic state (U = 702.00, p < 0.000).ConclusionPatients with BD-I display poor performance in memory, executive function and psychosocial functioning even during euthymic state compared to controls.Serum BDNF and MMP-9 levels comparable to the healthy controls during remission- pointing towards them as state markers rather than trait.Need for routine evaluation of cognitive function during follow-up visits and focus on target deficits for rehabilitation for better recovery and improving the quality of life of BD patients.

Assessing alexithymia in adults with acquired brain injury: Psychometric properties of the Perth Alexithymia Questionnaire

BackgroundAlexithymia is a multidimensional personality trait comprised of difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking. The assessment of alexithymia in people with acquired brain injury (ABI) is of clinical interest because alexithymia is linked to poor psychosocial functioning and community reintegration after ABI. To date, alexithymia measures have not been psychometrically investigated/validated in an ABI sample, restricting confident empirical work in this area. We aimed to fill this gap by assessing the psychometric properties of the Perth Alexithymia Questionnaire (PAQ) in adults with ABI and determining whether the alexithymia construct manifests similarly in ABI samples compared to the general community. MethodsThe PAQ and Depression Anxiety Stress Scales-21 were administered to an ABI sample (N = 350) and a community sample (N = 1012). Factor structure, measurement invariance, internal consistency reliability, and concurrent/discriminant validity were explored. ResultsOur confirmatory factor analysis of the PAQ supported the intended five-factor correlated model as the best solution, where items loaded well onto the five intended subscales. This factor structure was invariant across ABI and community samples. Good reliability and concurrent and discriminant validity were also established. LimitationsThe PAQ is a self-report measure and may be impacted by insight deficits known to occur after ABI. ConclusionOur data suggests that the PAQ has good validity and reliability as a measure of alexithymia. The latent structure of alexithymia manifests similarly in ABI and community samples. This study provides the first psychometric foundation for confident assessment of alexithymia in ABI.

Prevention of common mental disorders among women in the perinatal period: a critical mixed-methods review and meta-analysis.

Perinatal depression and anxiety account for a high burden of perinatal morbidity and poor psychosocial functioning. There is a growing interest among mental health professionals, to devise interventions to prevent this condition. This review synthesizes evidence for the effectiveness of psychological and psychosocial interventions aimed at the prevention of perinatal depression and anxiety. We also explore qualitative evidence to understand the acceptability and feasibility of these interventions. Using a mixed-methods approach, data from a total of 21 studies were collated to inform the evidence for preventive interventions for perinatal depression and anxiety. Based on their theoretical orientations, these interventions were described by authors as cognitive-behavioral (n = 7); psychoeducational (n = 6); mindfulness (n = 2); and interpersonal psychotherapy (n = 2). These also included psychosocial approaches such as social support (n = 1) and multicomponent interventions (n = 3). For depressive symptoms, these interventions yielded moderate to strong effect sizes in favor of the intervention group [standardized mean difference (SMD) = -0.59; 95% confidence interval (CI) -0.95 to -0.23]. For anxiety symptoms, a strong effect size was estimated in favor of the intervention group (SMD = -1.43, 95% CI -2.22 to -0.65). Preventive interventions significantly reduce the severity of perinatal depressive and anxiety symptoms. These interventions are also acceptable and feasible in many settings.

Impact of Personality Features and Interpersonal Problems on Anxiety Among Older Adults

Introduction: Anxiety is a significant mental health problem among older adults and is associated with multiple other mental disorders, poor psychosocial functioning, and reduced quality of life. Personality traits and disorders, along with interpersonal problems, may play a significant role in anxiety, but these relationships are not well understood among older adults. This study examined relationships between anxiety with normative personality traits, personality disorder (PD) features, and interpersonal problems. Method: Community-dwelling older adults (N = 130) completed the Geriatric Anxiety Scale (GAS), Coolidge Axis Two Inventory (CATI), Big Five Inventory-2 (BFI-2), and Circumplex Scales of Interpersonal Problems (CSIP). Results: Anxiety was positively correlated with 13 of 14 CATI PD scales, ranging from .23 (Narcissistic) to .61 (Depressive). Regarding normative personality, anxiety was associated with Agreeableness (-.23), Conscientiousness (-.30), Extraversion (-.31), and Negative Emotionality (.56). Regarding interpersonal problems, anxiety was positively related to all eight CSIP scales: Self-Sacrificing (.30), Domineering (.31), Exploitable (.40), Intrusive (.41), Self-centered (.47), Nonassertive (.50), Socially Inhibited (.60), and Distant/Cold (.62). Regression analyses indicated that PD features accounted for the most variance in anxiety (53%), followed by interpersonal problems, (46%) and normative personality traits (33%). Discussion: Anxiety appears to be meaningfully associated with PD features, several aspects of normative personality, and interpersonal problems, suggesting that these variables may play a role in the development of anxiety, or vice versa. Our findings especially speak to the growing awareness of the deleterious impact of PD features on clinical syndromes in later life, as evidenced by strong comorbidities with anxiety.

Psychiatric comorbidity and treatment outcomes in patients with opioid use disorder: Results from a multisite trial of buprenorphine-naloxone and methadone

BackgroundIndividuals treated for opioid use disorder (OUD) have high rates of psychiatric disorders potentially diminishing treatment outcomes. We examined long-term treatment experiences and outcomes by type of psychiatric disorder among participants who participated in the Starting Treatment with Agonist Replacement Therapies (START) study and its follow-up study. MethodsWe categorized the 593 participants who completed the Mini-International Neuropsychiatric Interview (MINI) during the START follow-up study into four mutually exclusive groups to indicate current psychiatric diagnosis: 1) bipolar disorder (BPD; n = 51), 2) major depressive disorder (MDD; n = 85), 3) anxiety disorder (AXD; n = 121), and 4) no comorbid mental disorder (NMD; n = 336). We compared participants’ baseline characteristics and treatment outcomes. ResultsGroups with mental disorders had worse substance use outcomes and poorer psychosocial functioning than the NMD group. Participants with BPD had significantly more self-reported days using opioids (Mean: 8.6 for BPD vs. 3.4 days for NMD, p < 0.01) and heroin (Mean: 6.4 for BPD vs. 2.0 for MDD, 3.1 days for NMD, p < 0.05) in the 30 days prior to the final interview. Compared to patients without mental disorders, patients with MDD spent more time engaged with OUD pharmacotherapy during the ∼16-month period between MINI and final interview (mean: 71.6 % vs. 50.6 %; p < 0.001). ConclusionsOur results show that treatment outcomes in individuals with OUD vary by psychiatric comorbidity groups, which supports the need for mental health assessment and treatment for psychiatric conditions in the context of pharmacotherapy for patients with OUD.

Psychosocial functioning in integrated treatment of co-occurring posttraumatic stress disorder and alcohol use disorder

Co-occurring posttraumatic stress disorder and alcohol use disorder (PTSD/AUD) is associated with poorer psychosocial functioning than either disorder alone; however, it is unclear if psychosocial functioning improves in treatment for PTSD/AUD. This study examined if psychosocial functioning improved in integrated treatments for PTSD/AUD, and if changes in PTSD severity and percentage heavy drinking days (PHDD) during treatment were associated with functioning outcomes. 119 veterans with PTSD/AUD randomized to receive either Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure or Seeking Safety completed measures of functioning (Medical Outcomes Survey SF-36), PTSD (Clinician Administered PTSD Scale for DSM-5), and alcohol use (Timeline Follow-Back) at baseline, posttreatment, 3- and 6-month follow-ups. Our findings suggest that psychosocial functioning improved to a statistically significant degree with no significant differences between conditions. Reductions in PTSD severity during treatment were associated with psychosocial functioning improvements, whereas reductions in PHDD were associated with improvement in role impairment at posttreatment. Although psychosocial functioning improves to a statistically significant degree in interventions designed to treat PTSD/AUD, these improvements do not represent clinically meaningful improvements in patients’ abilities to navigate important roles. Findings underscore the need to study how to best treat psychosocial functioning impairment in PTSD/AUD.

Social cognition and major depressive disorder: impact on psychosocial function and therapeutic opportunities

AimsThis poster aims to examine the impact of social cognitive deficits on psychosocial functioning in depressed patients, as well as summarise the utility of various evidence-based therapeutic interventions employed to target these deficits. The stated hypotheses were twofold: (1) that social cognitive impairment in major depressive disorder will correlate with poorer psychosocial functioning; and (2) that these deficits will respond to existing anti-depressant therapies.BackgroundSocial cognition is an important adaptive trait that incorporates the identification, perception and interpretation of socially relevant information from the external world. It is frequently affected in major depressive disorder such that depressed patienMethodA review of the existing literature was performed in order to test the stated hypotheses. Pertinent sources were identified via the MEDLINE, EMBASE, PsycINFO, PubMed, Scopus and Google Scholar databases. A total of 107 studies met inclusion criteria for review.ResultImpaired social cognitive performance in depressed patients correlated with poorer psychosocial functioning across the key domains of general cognitive functioning and quality of life. Many current anti-depressant therapies were found to have a normalising effect on the social cognitive abilities of depressed subjects, both at a neural and functional level. Anti-depressant medications, in particular citalopram and reboxetine, appeared to correct facial affect recognition deficits, while a psychotherapeutic approach demonstrated improvements in theory of mind and negative interpretive bias. Data relating to other common treatments, such as electroconvulsive therapy, are limited.ConclusionThe impact and treatment of social cognitive deficits in major depressive disorder is an important emerging field. The social cognitive deficits evident in depressed patients are sometimes subtle, but afford a significant functional impact. Additionally, it appears these impairments are at least partially reversible using anti-depressants or psychotherapy.

My Silence Says It All: A Case Report and Literature Review of Catatonia in First Episode Psychosis

Background: Catatonia is a severe psychomotor syndrome associated with various psychiatric disorders and medical conditions. While it is associated with multiple conditions, it is studied most in psychiatric patients. In Schizophrenia, for eg, rates have been found in the range of 1% to 50%. It can present as a symptom cluster of psychomotor and behavioral symptoms such as automatism, negativism, mutism, waxy flexibility, echolalia amongst others. Motor symptoms including catatonia can be seen in psychosis, but little literature exists specifically on first episode psychosis (FEP) presenting with the specific motor cluster of catatonia. Materials and Methods: In our poster, we will present a case of catatonia in FEP and will also review existing literature which alludes to the topic. Case Report: Mr. X is a 24-year-old male without prior medical or psychiatric history who presented to the emergency room in a catatonic state, with immobility, mutism, staring, catalepsy, rigidity, withdrawal and negativism. He was admitted for medical management and subsequently required transfer to inpatient psychiatry. On the psychiatric unit, even after resolution of catatonia, patient continued to elicit delusional thoughts, internal preoccupation and paranoid ideation. As of date of submission, he is still on the inpatient unit. Discussion: Studies have alluded to motor symptoms being present in first episode psychosis, although significant epidemiological information was unable to be found in the literature. Cuesta et al studied 100 antipsychotic-naive FEP patients undertaking extensive motor evaluation including symptoms of catatonia but also parkinsonism, dyskinesia, akathisia and neurological soft signs. Patients were followed up over the course of months and years to track how motor symptoms correlated with disease outcomes. It was observed that early catatonic signs and dyskinesia at drug-naive state were significantly associated with poor long-term psychosocial functioning. Having more data about motor signs, specifically catatonia in psychosis has implications for treatment. Benzodiazepine and Electroconvulsive Therapy (ECT) are first line treatments, however antipsychotic medication remains an area to be studied regarding risk versus benefits for alleviating psychotic symptoms, while possibly increasing the risk for Neuroleptic Malignant Syndrome (NMS). The data is also unclear on first or second generation antipsychotics, with conflicting reports showing efficacy and detrimental side effects for both classes. Conclusion: Further research into the etiology of catatonia is warranted as well as its relationship with other motor symptoms and action of neurotransmitters (GABA, Serotonin, Dopamine). This will have treatment implications as current first line treatment includes benzodiazepines and ECT; Treatment with antipsychotics remains controversial, with evidence supporting and negating its efficacy and possibility for inducing Neuroleptic Malignant Syndrome (NMS).

Uptrend in Distress and Psychiatric Symptomatology in Pregnant Women During the Coronavirus Disease 2019 Pandemic

(Acta Obstet Gynecol Scand. 2020;99:848–855) It is well established that psychological distress in pregnancy is associated with a range of negative outcomes, including delivery at an earlier gestational age, lower neonatal birthweight, and poor maternal psychosocial functioning. Expectant mothers of all social classes and educational levels can experience antenatal psychological distress, and the COVID-19 pandemic has introduced additional stress to people around the world. Most obstetric research on COVID-19 has focused on respiratory issues rather than mental health implications. This study aimed to provide data on any increase in prenatal psychological distress symptoms caused by the COVID-19 pandemic. As a secondary objective, the study aimed to identify which subgroup of women would be particularly vulnerable.

Impact of tobacco and illicit drug use in the care of adolescent and young adults with sarcoma.

e18657 Background: Despite adolescent and young adults (AYAs) representing the patient population most likely to initiate and use tobacco and illicit drugs, studies of their impact have thus far focused on older cancer patients or those in survivorship. As sarcomas often serve as a model for AYA care and are associated with poor psychosocial function, frequent delays in diagnosis, and outcomes related to chemotherapy dose density, we sought to understand the impact of tobacco and illicit drug use on diagnosis, chemotherapy delays and dose reductions, and no-show rates in AYAs with sarcoma. Methods: Retrospective chart review was performed on adult AYA patients (18-39 years) with sarcoma seen at least once in 2019 at the University of Wisconsin, identifying documentation of tobacco, marijuana, and other illicit drug use and comparing to pre-identified cancer outcomes including days from symptom onset to tissue diagnosis (with delay defined as &gt; 120 days from symptoms to diagnosis), chemotherapy delays &gt; 1 week and dose reductions, and appointment no-show rates. Current substance use was defined as use following cancer diagnosis. Results: We identified 46 AYAs with sarcoma, with documented tobacco use in 20% as current (9/46), 13% as former (6/46) and 67% as none (31/46). Marijuana and illicit drug use were less frequent at 17% (8/46) and 7% (3/46) respectively. Delayed diagnoses were more common in patients with current tobacco use (6/9, 67%) as compared with former or non-smokers (12/37, 32%, p = 0.12) and were seen in all patients with illicit drug use (3/3, 100%), as compared with only 35% without illicit drug use (15/43, p = 0.05). Of the 24 patients who received chemotherapy, chemotherapy delays and dose reductions were more common in current tobacco users at 86% (6/7) and 29% (2/7) respectively, as compared with patients with former or no tobacco use at 71% (12/17) and 18% (3/17) respectively. Chemotherapy dose reductions were also more common in patients with illicit drug use (2/3, 67%) versus no illicit drug use (3/21, 14%, p = 0.10). Appointment no-show rates were higher in current tobacco users versus former or non-smokers, with 44% (4/9) versus 27% (10/37) with a no-show rate &gt; 5%. In patients with documented substance use, oncology providers documented 93% of tobacco use (14/15) but only 38% marijuana use (3/8) and 33% illicit drug use (1/3) and no oncology providers documented a cessation plan. Conclusions: Current tobacco and illicit drug use in AYAs with sarcoma were associated with delays in diagnosis, increased chemotherapy delays and dose reductions, and higher no-show rates, highlighting modifiable risk factors. Even more strikingly, oncology providers had low rates of documentation of marijuana and illicit drug use in AYAs and no documentation of plans for cessation, highlighting a lost opportunity and the need for more standardized substance use assessment and evidence-based cessation interventions for AYAs with cancer.

625 The association between circadian rhythms and psychosocial functioning in children with attention deficit hyperactivity disorder

Abstract Introduction Circadian rhythm disturbances, including delayed circadian rhythm and increased motor activity, are commonly seen in attention-deficit hyperactivity disorder (ADHD). Previous research suggested a link between circadian rhythm disturbances and poor psychosocial functioning in children, but such a relationship has not been examined in children with ADHD. This study aimed at examining the association between circadian-related parameters and psychosocial functioning in children with ADHD. Methods Seventy-nine children with ADHD were recruited into this study (age range: 6–12 years, 75.9% male). They were assessed by parent-report questionnaires on sleep problems (Children’s Sleep Habits Questionnaire, CSHQ), ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour Scale, SWAN), and psychosocial functioning (Strengths and Difficulties Questionnaire, SDQ). Actigraphic data collected for seven consecutive days were analyzed using parametric and nonparametric methods. The relationship between circadian parameters and psychosocial functioning was analyzed using multiple regression while controlling for age, sex, ADHD medication, total sleep time, and CSHQ total score. Results Later acrophase was significantly associated with higher scores on SDQ emotional problems (St. β = 0.30, p = 0.03) and SWAN inattention subscale (St. β = 0.27, p = 0.043). Lower relative amplitude was associated with higher scores on SDQ hyperactivity symptoms (St. β = -0.29, p = 0.045) and SDQ total difficulties (St. β = -0.31, p = 0.036). Higher levels of mean activity level during the least active 5-h period (L5) were related to higher scores on SDQ peer problems (St. β = 0.38, p = 0.021), SDQ internalizing problems (St. β = 0.38, p = 0.020) and SDQ total difficulties (St. β = 0.33, p = 0.036). Later onset of L5 was associated with increased SDQ emotional problems (St. β = 0.26, p = 0.046). Conclusion Circadian rest-activity rhythm disturbances (delayed phase, blunted rest-activity rhythms, higher level of nocturnal activity, and later onset of nocturnal rest) were associated with poor psychosocial functioning in children with ADHD. Further longitudinal studies are needed to examine the effects of circadian disruption on psychosocial functioning in children with ADHD. Support (if any) This work was supported by the Health and Medical Research Fund (Project No.: 30160604).

580 Psychosocial Functioning Mediates Parental Depression and Sleep Behaviors in Children with Autism Spectrum Disorder

Abstract Introduction Parents who have been diagnosed with depression often report that their children have poor sleep behaviors. This relationship may occur because the children of parents with depression are more likely experience poor psychosocial functioning, which can negatively impact their sleep. Children with Autism Spectrum Disorder (ASD) are particularly at risk for sleep difficulties, and it is important to better understand these relationships as scant to no research has been done which investigates parental depression, child psychosocial functioning, and child sleep among children with ASD. The current study examined whether parental perception of their child’s psychosocial functioning mediated the relationship between parental depression and their child’s sleep behaviors. Methods The sample (N=36) consisted of parents (81% female) reporting on their children aged 6–12 (M=8.56, SD = 1.86; 75% male). All children were diagnosed with ASD and had sleep complaints as reported by their parents. Children and their parents were recruited because they expressed interest in a behavioral treatment sleep study and these data come from the baseline data collection associated with that study. Measures included Sleep Behaviors factor from the Child Sleep Health Questionnaire (CSHQ), the Pediatric Symptom Checklist (PSC), and a question asking if the parent had been diagnosed with depression. Results Analyses were conducting using AMOS 27.0. Child psychosocial functioning significantly mediated (β = .12) the relation between parental depression and child sleep behavior. Parents who had been diagnosed with depression were more likely to report greater child psychosocial difficulties (β =.39, p = .01) and child psychosocial difficulties were associated with a greater likelihood of the child having worse sleep behavior (β =.32, p = .04). The direct effect between parental depression and child sleep behavior was not significant. Conclusion These results indicate that child psychosocial functioning may help to explain the connection between diagnosed parental depression and poor child sleep behavior among children with ASD. This suggests that psychosocial functioning may be an important aspect to target in sleep interventions, particularly for children with ASD. Support (if any) University of Missouri Research Board Grant (McCrae, PI); United States Department of Defense USAMRAA Autism Research Program (McCrae, PI; CTA AR190047).

Internet-based cognitive assessment tool: Sensitivity and validity of a new online cognition screening tool for patients with bipolar disorder

BackgroundThe International Society for Bipolar Disorders Targeting Cognition Task Force recommends the Screen for Cognitive Impairment in Psychiatry (SCIP) to screen for cognitive impairment in bipolar disorder. However, SCIP must be administered by a healthcare professional, which is often impossible due to time and resource constraints. Web-based, self-administered cognition screening tools may enable assessment and monitoring of patients’ cognition at a much larger scale to a reduced cost. For this purpose, we developed the Internet-Based Cognitive Assessment Tool (ICAT) as a modified web-based version of SCIP. This study aimed to investigate the sensitivity and validity of ICAT for cognition assessment in bipolar disorder. MethodThirty-five patients with bipolar disorder in full or partial remission and 35 healthy controls completed ICAT on a computer, the standard paper-and-pencil SCIP and a subjective cognition questionnaire and were rated for mood symptoms and functioning at the Copenhagen Affective Disorders Research Centre. ResultsPatients displayed cognitive impairments compared to controls on the ICAT (t (61)=3.67, p<.001, d=0.93). There was a strong correlation between ICAT and SCIP Total Scores (r(61)=.72, p<.000) and moderate to strong correlations on subtest scores (r=.48-.63, ps<.001). Across all participants, lower ICAT scores correlated with more subjective cognitive complaints (r(59)=-.43, p<.001) and poorer psychosocial functioning (r(62)=-.47, p<.001). ConclusionICAT is a sensitive and valid web-based tool for cognition assessment in patients with bipolar disorder. This highlights ICAT as a novel web-based cognition screening tool that is feasible for largescale assessment and monitoring of cognition in the clinical management of bipolar disorder.

Chronic difficulties are associated with poorer psychosocial functioning in the first year post-diagnosis in epithelial ovarian cancer patients.

Ovarian cancer is characterized by poor prognosis, high levels of distress, disturbed sleep, and compromised quality of life (QOL). Although life stressors have been shown to significantly impact physical and psychological health in cancer populations, no studies have used a high-resolution stress assessment to differentiate effects of acute versus chronic stressors among women with ovarian cancer. We addressed this issue in the present prospective longitudinal study by examining how acute and chronic stress exposure in the year pre-diagnosis relate to depressive symptoms, sleep quality, and QOL over the first year post-diagnosis in women with ovarian cancer. One hundred thirty-seven women completed the Life Events and Difficulties Schedule within a month of initial treatment for suspected ovarian cancer. Depressive symptoms, sleep, and QOL were measured pre-treatment, at six months, and one-year post-diagnosis. Mixed models were used to examine associations of acute and chronic stress pre-diagnosis with (a) change in psychosocial outcomes over the first year post-diagnosis and (b) levels of psychosocial outcomes across all time points. Both the number and severity of chronic difficulties (but not acute life events) were related to significantly greater depression, and poorer sleep quality and QOL, across all time-points. In contrast, these stress indices were unrelated to changes in psychosocial functioning over time. Chronic but not acute stress exposure predicted average levels of depression, sleep, and QOL in the first year post-diagnosis among women with ovarian cancer. Assessing stressors and designing interventions for reducing stress may thus be beneficial for ovarian cancer patients.

Moving in together, marriage, and motherhood: A follow up study of relationships in psychiatric patients with personality disorders

Personality disorders (PDs) are related to poor psychosocial function, including fewer relationships with friends and romantic partners. One-hundred eighty-six psychiatric patients were included in a study cohort in 2002-2003. In 2017, data regarding living arrangements and marital status between 2003 and 2016 were collected for these participants and from a matched control group. Data on birth of first child during the study period were collected for women. The former patients were divided into two groups based on occurrence of PD or not. Groups were compared with each other and with the controls. The proportion of participants with PD who lived together with someone did not increase at the same rate as in the other groups. PD was associated with a reduced likelihood of getting married during the study period. Women in the PD group had children to a lower extent than females in the other groups. Personality disorder was associated with an increased likelihood of living alone and being unmarried. Female participants with PD had a decreased likelihood of having children compared with controls. © 2021 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.

Neurocognitive functions in persistent negative symptoms following a first episode of psychosis

Negative symptoms are present at the onset of psychosis and their persistence is significantly associated with poor psychosocial functioning and lower quality of life. Persistent negative symptoms (PNS) may be idiopathic or secondary to other factors such as depression, positive symptoms, and medication side-effects. Several studies have examined neurocognitive functions in early psychosis patients with PNS relative to non-PNS, but have not systematically controlled for secondary PNS (sPNS). The latter may have a distinct neurocognitive profile that could obscure differences between PNS and non-PNS. Using a large (n = 425) sample, we examined neurocognitive functions in PNS, sPNS, and non-PNS and hypothesized that PNS would be associated with greater impairments relative to non-PNS. Following admission to an early intervention program, a neurocognitive battery was administered after at least 3 months of treatment, and symptom data collected during a subsequent 6-month period were used to classify patients as PNS, sPNS and non-PNS. At month 12, both PNS and sPNS groups had significantly lower level of functioning relative to the non-PNS group but the sPNS group experienced higher levels of depressive and positive symptoms and were on a higher dose of antipsychotics. Relative to non-PNS, PNS patients exhibited significant impairments in verbal memory and working memory, whereas sPNS patients exhibited a trend towards greater impairments in verbal memory. This study confirms that the presence of PNS or sPNS negatively influences functioning with more selective cognitive impairments found in PNS, providing evidence that these groups of patients could benefit from different personalised interventions.

Relationship of Subjective Cognitive Impairment with Psychosocial Function and Relapse of Depressive Symptoms in Patients with Major Depressive Disorder: Analysis of Longitudinal Data from PERFORM-J.

BackgroundAccumulating evidence suggests the presence of cognitive impairment in patients with major depressive disorder (MDD), which affects their psychosocial function and quality of life (QoL). PERFORM-J (Prospective Epidemiological Research on Functioning Outcomes Related to MDD in Japan) is an observational, multicenter study to assess longitudinal changes in depressive symptoms, psychomotor speed, subjective cognitive function, and psychosocial function.MethodsFive hundred and eighteen Japanese outpatients with MDD initiating new antidepressant monotherapy (first-line or switch from previous drug) as part of their routine medical care participated in this study. Assessments at baseline and over the 6-month observation period included physician-rated depression severity (Montgomery–Åsberg Depression Rating Scale), psychomotor speed (Digit Symbol Substitution Test; DSST), subjective cognition (Perceived Deficits Questionnaire–Depression), psychosocial function (Sheehan Disability Scale), and QoL (EuroQol-5 Dimension-5 Level).ResultsAntidepressant treatment for 6 months improved depressive symptoms and subjective cognitive impairment (cognitive complaints), whereas psychomotor speed remained impaired (ie, DSST total score was >1 standard deviation below the norm) in 35.6% of patients at 6 months. Impairment of subjective cognition, but not psychomotor speed at month 2 was associated with poor psychosocial function and QoL at 6 months. There was a trend for higher relapse rates at 6 months in patients with greater subjective cognitive impairment at 2 months.ConclusionThese findings highlight the importance of evaluating cognitive difficulties to predict long-term outcomes in patients with MDD. Early intervention for cognitive complaints may decrease the relapse rate, which warrants further study.

Bullying victimization, psychosocial functioning, and protective factors: Comparing African American heterosexual and sexual minority adolescents in Chicago's Southside.

African American heterosexual and sexual minority (SM) adolescents report widespread bullying victimization (BV), which is associated with poorer psychosocial functioning. However, studies examining potential protective factors that moderate this association are limited. Using data from a cross-sectional study conducted in Chicago, we examined the association between BV and psychosocial functioning among a sample of heterosexual (n = 475) and SM (n = 105) African American adolescents and examined whether four empirically-supported protective factors moderated these associations. Among SM adolescents, having close parents was protective against psychosomatic symptoms for those who reported high BV and having caring teachers was protective against substance use for those who reported both high and low BV. Among heterosexual adolescents, having close parents was protective against substance use for those who reported high BV but having high neighborhood support exacerbated the risk of developing psychosomatic symptoms for those who reported high BV. Implications for school and parental-based interventions are discussed.

First-rank symptoms in Bipolar disorder: A case report.

Despite their description as characteristic symptoms of schizophrenia, first-rank symptoms (FRS) are also seen in other conditions.[1] The prevalence of FRS was 70% in schizophrenia, 29% in psychotic bipolar disorder, and 18% in psychotic depression.[2] Manic hyperactivity may at times be confused with psychotic agitation and excitement. Amidst debate on the diagnostic utility of FRS, they continue to be relevant from prognostication and treatment planning point of view.[3] The presence of FRS in bipolar affective disorder (BPAD) may be predictor of poor short-term outcome and decompensating the course of illness.[4] BPAD patients with mania or mixed episodes are more likely to be females. Younger patients had a higher prevalence of FRS.[5] The presence of FRS in psychiatric illness is associated with poor long-term residential status and poorer psychosocial functioning.[6] We present a case of bipolar affective disorder who at presentation had florid psychotic symptoms with FRS. A 19-year-old female, BA LLB student, with no family history of psychiatric illness, premorbidly stable extrovert with past history of an insidious onset gradually progressive persistent and pervasive depressed mood, loss of interest and enjoyment, reduced concentration and attention, reduced self-esteem and self-confidence, disturbed sleep and diminished appetite in September 2019 remitted gradually without treatment over 3–4 months. She manifested in November 2020 with acute onset and progressive elevated and expansive mood, increased physical restlessness, and over-talkativeness. She was suspicious as she was unable to upload video on Instagram and believed that unknown people are jealous of her celebrity status and has hacking her mobile and network. General physical and systemic examinations were within normal limits. Mental status examination revealed her to be well-groomed, wearing colorful clothes with matching mask, and nail polish. She entered the chamber without seeking permission with air of confidence around her. She briskly shook the hand with examiner and sat on chair without asking as if in casual conversation. She was suspicious that the wall clock had monitoring device and there was someone behind the curtain. She was easily distractible by people entering the room. She was over-familiar, jocular, distractible, and had increased motor activity. She had elated affect, flight of ideas, delusion of grandiosity and persecution, intermittent auditory hallucination giving a running commentary on her action, ill sustained concentration, impaired judgment and insight, and decreased need for sleep and increased energy. Her hematological, biochemical parameters (including thyroid profile), and NCCT head were within normal limits. Young Mania Rating Scale score was 32/60, suggestive of moderate mania. Rorschach psychodiagnostic test revealed an increased number of responses, decreased initial and total reaction time, high number of color, sexual, and movement responses. New and additional responses in inquiry were suggestive of mania. She was provisionally diagnosed as a case of bipolar affective disorder, current episode manic with psychotic symptoms. She was started on tablet risperidone 2 mg/day and tablet lithium 900 mg/day. Psychoeducation about the illness and relapse prevention was taught to which she responded well. Schizophrenia is often difficult to diagnose, and it is important not to give a label of Schizophrenia to those who do not suffer from it.[7] In the index case, there was a diagnostic dilemma in view of the initial presentation with widespread persecutory delusions obscuring the disturbance of affect. The presence of FRS further complicated the clinical picture. However, history suggestive of a depressive episode which remitted without medications over 4 months compelled us to consider a diagnosis of BPAD with psychotic symptoms as more likely. She responded well to antipsychotic and mood stabilizer and supportive psychotherapy with improvement in mood, social and academic functioning. The index case underscores the importance of being aware of overlapping nature of symptoms in various psychiatric disorders, the need for close serial monitoring of patients for evolution of new symptoms of changing psychopathology and the utility of Rorschach psychodiagnostic test in difficult cases. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.