Psychiatric Diagnostic Categories Research Articles

Explosive Outbursts at School.

Explosive outbursts (EO) by students are an intensely distressing experience for that student as well as for all school staff and students present during the outburst. These EO are characterized by rapid escalations, usually far out of proportion to precipitating events, may include significant verbal and/or physical aggression, require intensive staff intervention, are often difficult for the student to process, and are typically recurrent. These explosions cross multiple psychiatric and educational diagnostic categories and require diverse interventions to address behavioral, emotional, impulsive, and sensory components. Interventions for each stage of an EO can be used to deescalate these events.

Characterizing transdiagnostic premorbid biotypes can help progress in selective prevention in psychiatry.

Characterizing transdiagnostic premorbid biotypes can help progress in selective prevention in psychiatry.

Diagnostic Moderators of the Risk-Recidivism Relationship for Offenders with Mental Illness.

Recent research suggests that early onset of criminality is a potential marker for a subgroup of offenders with mental illness (OMI) for whom general risk/need factors are more relevant. The present study examines whether the presence of certain psychiatric diagnostic categories (i.e., Psychotic Disorders, Mood Disorders, Personality Disorders, Substance use Disorders) moderates the prediction of arrest outcomes using Level of Service Inventory-Revised (LSI-R) total scores in an archival sample of N = 179 OMI probationers. Moderator analyses demonstrated that LSI-R total scores predicted arrest outcomes significantly better for those with a diagnosis of Personality Disorder using path and survival analytic methods. Hierarchical regressions using LSI-R subscales as predictors revealed lower pro-criminal Attitudes for Mood Disordered participants, while more severe Criminal History and Family/Marital problems characterized those diagnosed with Personality Disorders. This study adds to the developing literature on subgroups of OMI for whom general risk/need factors are particularly important and highlights personality disturbance as another potential characterizing feature.

Child Sexual Abuse and Risk of Revictimization: Impact of Child Demographics, Sexual Abuse Characteristics, and Psychiatric Disorders.

Approximately half of child sexual abuse (CSA) victims report sexual revictimization later in life; however, there is limited rigorous evidence concerning factors contributing to sexual and nonsexual forms of revictimization. This article investigates the relationships between CSA and a range of revictimization experiences. It also examines the role of other individual-level factors (demographics, CSA characteristics, psychiatric disorders) in the risk of revictimization. The study compares data from a prospective-longitudinal study of 2,759 Australian children (<17 years old) alleged to have experienced contact-CSA between 1964 and 1995, and a comparison group matched on sex and age. In each case, CSA was deemed likely to have occurred according to expert forensic medical opinion. Abused children and comparisons were followed to age 35 years on average, and their lifetime official crime victimization histories and public mental health service records were extracted from statewide population-level administrative databases. Relative to comparisons, CSA victims experienced significantly higher rates of revictimization, with marked elevations in odds for interpersonal revictimization (i.e., sexual assault, physical assault, threats of violence, and stalking). The CSA-physical assault relationship was moderated by sex, with a stronger association for female victims. Among CSA victims, victim sex, age at index abuse, and several psychiatric diagnostic categories were independently associated with revictimization risk, with different patterns of vulnerability emerging depending on the nature of revictimization. Overall, CSA victims are vulnerable to a range of revictimization experiences later in life. Findings have implications for the identification of particular groups of sexually abused children at heightened risk for revictimization and the role mental health services may play in mitigating risk.

Mortality among male forensic and non-forensic psychiatric patients: matched cohort study of rates, predictors and causes-of-death

Background: The mortality of forensic psychiatric (FP) patients compared to non-forensic psychiatric (non-FP) patients has been sparsely examined. Methods: We conducted a matched cohort study and compared Danish male FP patients (n = 490) who underwent pre-trial forensic psychiatric assessment (FPA) 1980–1992 and were subsequently sentenced to psychiatric treatment with matched (on year of birth, marital status, and municipality of residence) male non-FP patients (n = 490) and male general population controls (n = 1716). FP and non-FP patients were also matched on major psychiatric diagnostic categories. To determine mortality and identify potential predictors of mortality, we linked nationwide register data (demographics, education, employment, psychiatric admission pattern and diagnoses, cause of death) to study cohorts. Average follow-up time was 19 years from FPA assessment/sampling until death/censoring or 31 December 2010 and risk factors were studied/controlled with Cox proportional hazard analysis. Results: Overall, psychiatric patients had significantly higher mortality compared to matched general population controls (medium to large effects). Among patients, 44% (213) of FP vs. 36% (178) of matched non-FP patients died during follow-up (p = 0.02). When we used Cox regression modeling to control for potential risk factors; age, education, immigrant background, employed/studying at index, length of psychiatric inpatient stay/year, and ever being diagnosed with substance use disorder (SUD), FP patient status was no longer significantly associated with increased mortality, whereas SUD and longer inpatient time per year were independently associated with increased mortality. Discussion: This study suggests that SUD and longer inpatient time per year are independent risk factors for increased mortality in psychiatric patients.

Relative importance of symptoms, cognition, and other multilevel variables for psychiatric disease classifications by machine learning

This study used machine-learning algorithms to make unbiased estimates of the relative importance of various multilevel data for classifying cases with schizophrenia (n = 60), schizoaffective disorder (n = 19), bipolar disorder (n = 20), unipolar depression (n = 14), and healthy controls (n = 51) into psychiatric diagnostic categories. The Random Forest machine learning algorithm, which showed best efficacy (92.9% SD: 0.06), was used to generate variable importance ranking of positive, negative, and general psychopathology symptoms, cognitive indexes, global assessment of function (GAF), and parental ages at birth for sorting participants into diagnostic categories. Symptoms were ranked most influential for separating cases from healthy controls, followed by cognition and maternal age. To separate schizophrenia/schizoaffective disorder from bipolar/unipolar depression, GAF was most influential, followed by cognition and paternal age. For classifying schizophrenia from all other psychiatric disorders, low GAF and paternal age were similarly important, followed by cognition, psychopathology and maternal age. Controls misclassified as schizophrenia cases showed lower nonverbal abilities, mild negative and general psychopathology symptoms, and younger maternal or older paternal age. The importance of symptoms for classification of cases and lower GAF for diagnosing schizophrenia, notably more important and distinct from cognition and symptoms, concurs with current practices. The high importance of parental ages is noteworthy and merits further study.

Rapid brain responses to affective pictures indicate dimensions of trauma-related psychopathology in adolescents.

A variety of mental disorders are related to deviant brain activity, but these neural alterations do not validate psychiatric diagnostic categories. High symptom overlap and variable symptom patterns encourage a dimensional approach. Following the logic of the Research Domain Criteria (RDoC), we investigated trauma survivors for symptom clusters that might be associated with characteristics of ERPs, in particular with the early posterior negativity (EPN) elicited during affective picture processing. In rapid serial visual presentation, 90 adolescents (40 male/50 female, age M = 15.0 ± 2.5 years) who had been exposed to varying amounts of traumatic stress passively viewed a stream of high‐arousing positive and low‐arousing neutral pictures taken from the International Affective Picture System (IAPS). Using standardized interviews, symptoms of trauma‐related mental disorders were assessed (including those for PTSD, depression, borderline personality disorder, and behavioral problems). A principal component analysis was performed to derive potential dimensions of psychopathology. Multiple regression analysis confirmed a factor comprising problems concentrating, sleeping difficulties, and mistrust as a predictor of a larger EPN difference between high‐arousing positive and low‐arousing neutral IAPS pictures (β = 0.19, p < 0.05). Sex predicted the magnitude of the EPN (β = 0.45, p < 0.001). Male adolescents displayed a stronger EPN suppression than female adolescents. The result suggests that problems concentrating, sleeping difficulties, and mistrust seem to be trans‐diagnostic elements related to diminished early emotional discrimination represented by the EPN. Furthermore, our findings indicate that the EPN in response to emotional processing is modulated by sex.

From Affective Science to Psychiatric Disorder: Ontology as a Semantic Bridge

Advances in emotion and affective science have yet to translate routinely into psychiatric research and practice. This is unfortunate since emotion and affect are fundamental components of many psychiatric conditions. Rectifying this lack of interdisciplinary integration could thus be a potential avenue for improving psychiatric diagnosis and treatment. In this contribution, we propose and discuss an ontological framework for explicitly capturing the complex interrelations between affective entities and psychiatric disorders, in order to facilitate mapping and integration between affective science and psychiatric diagnostics. We build on and enhance the categorisation of emotion, affect and mood within the previously developed Emotion Ontology, and that of psychiatric disorders in the Mental Disease Ontology. This effort further draws on developments in formal ontology regarding the distinction between normal and abnormal in order to formalize the interconnections. This operational semantic framework is relevant for applications including clarifying psychiatric diagnostic categories, clinical information systems, and the integration and translation of research results across disciplines.

Institutionalised otherness: Patients references to psychiatric diagnostic categories

Diagnosis is integral part of the way medicine organises illness: it is important for identifying treatment options, predicting outcomes and providing an explanatory framework for clinicians. Previous research has shown that during a medical visit not only the clinician but also patients provide explanations for the causes of their symptoms and health problems. Patients’ lifeworld explanations are often differentiated from the diagnostic explanations provided by clinicians. However, while previous conversation analytic research has elaborated the ways in which diagnostic and lifeworld explanations are interactionally structured in somatic medicine, there is little research on how these explanations are organised in psychiatry.Psychiatric diagnosis is particularly interesting because in mental disorders illness itself is not determined by any objective measurement. Understanding of the patient's problem is constructed in interaction between the patient and clinician. The focus of this research will be patients' references to diagnosis in psychiatry and the functions of these references.The findings are based on conversation analysis of 29 audio-recorded diagnostic interviews in a psychiatric outpatient clinic. Our results demonstrate that patients can utilise diagnostic categories in several ways: disavowing a category to distance their symptoms from it, accounting for their life experiences being rooted in psychiatric illnesses and explaining their illnesses as being caused by certain life experiences. We argue that these explanations are important in patients' face-work – in constructing and maintaining a coherent and meaningful view of the patient's self.

F137. INFECTIONS OF THE CENTRAL NERVOUS SYSTEM AS A RISK FACTOR FOR MENTAL DISORDERS AND COGNITIVE IMPAIRMENT: A NATIONWIDE REGISTER-BASED STUDY

BackgroundInfections and inflammatory diseases have long been suggested as risk factors for cognitive decline and mental disorders, most notably schizophrenia and affective disorders. However, largescale studies have been lacking. This study aims to investigate the association between specific CNS-infections and the risk of developing mental disorders, and whether the causal agent of the CNS-infection has an effect on the association. Furthermore, this study will investigate the possible effect of CNS-infections on cognition in the largest study to date.MethodsWe will utilize the unique personal registration number to link nationwide Danish registers in order to identify all individuals born in Denmark between January 1, 1977, and December 31, 2010, with follow-up from birth. We will investigate the association between CNS-infections with the risk of 1) developing mental disorders and 2) affected cognition (defined as the highest completed level of education, completion of the 9th grade and grade average score at the end of the 9th grade). Further analyses will estimate the risk within every psychiatric diagnostic category based on the International Classification of Diseases, 10th edition (ICD-10), e.g. organic mental disorders (ICD-10: F00-09), substance abuse disorders (ICD-10: F10-19) and schizophrenia spectrum disorders (ICD-10: F20-29). The risk related to the different pathogens causing the CNS-infection will also be investigated. Data will be analysed using survival analysis to approximate relative risks estimated by Poisson regression, and will be adjusted for age, sex, calendar year, first-born status, parental history of mental disorders and educational level of the parents.ResultsAll analyses are expected to be completed no later than February 2018 and ready to be presented at the conference in April 2018.DiscussionThis population-based cohort study will be the largest to date investigating the association between CNS-infections and mental disorders, and whether there’s a difference in risk depending on the pathogen responsible for the CNS-infection. Additionally, it will be one of the largest studies investigating the effect of CNS-infections on cognition. It will add important knowledge to our understanding of the association between CNS-infections and mental disorders, and between CNS-infections and cognition.

Mental healthcare use and severe psychiatric diagnoses in adult survivors of childhood cancer: A population-based study using health services data.

10565 Background: Though physical late effects in childhood cancer survivors are well documented, their risk for adverse mental health outcomes is less clear; existing evidence is contradictory. Health services data offer an objective method for measuring population-based mental health outcomes. Methods: Using a provincial registry with detailed patient, disease, treatment, and outcome data, we assembled a cohort of all five-year survivors of childhood cancer diagnosed before age 18 years and treated in an Ontario pediatric cancer centre between 1987-2008. Patients were linked to population-based healthcare data capturing inpatient, outpatient, and emergency department (ED) visits. The primary outcome was the rate of mental healthcare visits (primary care, psychiatrist, ED or hospital). Secondary outcomes included the time to a severe mental health event (ED visit, hospitalization, or suicide) both overall and by psychiatric diagnostic categories. Outcomes were compared between survivors and matched controls using recurrent event and survival analyses, and predictors of adverse outcomes modeled. Results: When compared to 20,269 controls, 4,117 survivors had a significantly higher rate of mental health visits [47.1 vs. 36.1 visits/100 person years; adjusted relative rate (RR) 1.3, 95% confidence interval (CI) 1.2-1.5]. Higher rates of visits were associated with female gender (RR 1.4, CI 1.1-1.7; p = 0.008) and adolescent age at diagnosis (RR 2.0, CI 1.3-3.0; p = 0.004). Cancer type, treatment intensity or treatments targeting the central nervous system were not significant predictors. The hazard of a severe mental health event did not differ between survivors and controls. Though rare in both groups, survivors were at increased risk of a severe event due to a psychotic disorder (HR 1.8, CI 1.1-2.8; p &lt; 0.05). Conclusions: Childhood cancer survivors experience higher rates of mental health visits than the general population, but are no more likely to experience a severe mental health event. Their risk is not attributable to a specific diagnosis or aspect of treatment. An increased risk of severe psychotic disorders requires confirmation in other cohorts.

Symptom profile of catatonia in children and adolescents admitted to psychiatry inpatient unit.

To study the symptom profile of catatonia in children and adolescents. Treatment records of all the inpatients aged (≤19 years) were reviewed for the period January 2005 to January 2017. Patients with catatonia (diagnosed as having at least two symptoms as per the Bush Francis Catatonia Rating scale) were included. During the study period, data was available for 52 children and adolescent. The mean age of the sample was 16.8 years (SD=2.0; range 9-19). Males (N=28; 53.8%) outnumbered females. The most common primary psychiatric diagnostic category was that of psychotic disorders (N=26; 78.8%). One-sixth (N=8; 15.4%) were diagnosed with organic illnesses like epilepsy and systemic lupus erythematosus. Affective disorders accounted for only one-tenth (N=5; 9.6%) of cases, with mania being more common presentation than depression. Very few patients were diagnosed with pervasive developmental disorder (N=2). The common signs and symptoms noted were mutism (90.4%) followed by immobility/stupor (75%), staring (71.2%), negativism (57.7%), rigidity (55.8%) and posturing (53.8%). The mean BFCRS score was 13.73 (SD - 7.6; range 3-20). Overall there was no significant difference in the prevalence of various signs and symptoms of catatonia between those with psychotic disorders, affective disorders and those with catatonia due to organic causes. In only half of the patients catatonia responded to lorazepam and other half required electroconvulsive therapy. The most common symptoms of catatonia in children and adolescent are mutism, immobility/stupor, staring, posturing, negativism and rigidity. The most common underlying psychiatric diagnosis is that of schizophrenia.

Premature Mortality Among Patients Recently Discharged From Their First Inpatient Psychiatric Treatment

Nationwide cohorts provide sufficient statistical power for examining premature, cause-specific mortality in patients recently discharged from inpatient psychiatric services. To investigate premature mortality in a nationwide cohort of patients recently discharged from inpatient psychiatric treatment at ages 15 to 44 years. This single-cohort design included all persons born in Denmark (N = 1 683 385) between January 1, 1967, and December 31, 1996. Exactly 48 599 of these Danish residents were discharged from an inpatient psychiatric unit or ward on or after their 15th birthday, which took place during this study's observation period from January 1, 1982, through December 31, 2011. This group of patients was followed up beginning on their 15th birthday until their death, emigration, or December 31, 2011, whichever came first. Individuals discharged from inpatient psychiatric care at least once before their 15th birthday (n = 5882) were excluded from the study. All data were obtained from the Danish Civil Registration System, Psychiatric Central Research Register, and Register of Causes of Death. Data analysis took place between February 1, 2016, and December 10, 2016. Incidence rates and incidence rate ratios (IRRs) for all-cause mortality and for an array of unnatural and natural causes of death among patients recently discharged from an inpatient psychiatric unit vs persons not admitted to a psychiatric facility. Primary analysis considered risk within the year of first discharge. Of the 48 599 discharged patients who were included in the study, 25 006 (51.4%) were female, 35 660 (73.4%) were aged 15 to 29 years, and 33 995 (70.0%) had a length of stay of 30 days or less. Compared with persons not admitted, patients discharged had an elevated risk for all-cause mortality within 1 year (IRR, 16.2; 95% CI, 14.5-18.0). The relative risk for unnatural death (IRR, 25.0; 95% CI, 22.0-28.4) was much higher than for natural death (IRR, 8.6; 95% CI, 7.0-10.7). The highest IRR found was for suicide at 66.9 (95% CI, 56.4-79.4), followed by alcohol-related death at 42.0 (95% CI, 26.6-66.1). Among the psychiatric diagnostic categories assessed, psychoactive substance abuse conferred the highest risk for all-cause mortality (IRR, 24.8; 95% CI, 21.0-29.4). Across the array of cause-specific outcomes examined, risk of premature death during the first year after discharge was markedly higher than the risk of death beyond the first year of discharge. Clinicians may help protect patients after discharge by serving as a liaison between primary and secondary health services to ensure they are receiving holistic care. Early intervention programs for drug and alcohol misuse could substantially decrease the greatly elevated mortality risk among these patients.

Reading related white matter structures in adolescents are influenced more by dysregulation of emotion than behavior

Mood disorders and behavioral are broad psychiatric diagnostic categories that have different symptoms and neurobiological mechanisms, but share some neurocognitive similarities, one of which is an elevated risk for reading deficit. Our aim was to determine the influence of mood versus behavioral dysregulation on reading ability and neural correlates supporting these skills in youth, using diffusion tensor imaging in 11- to 17-year-old children and youths with mood disorders or behavioral disorders and age-matched healthy controls. The three groups differed only in phonological processing and passage comprehension. Youth with mood disorders scored higher on the phonological test but had lower comprehension scores than children with behavioral disorders and controls; control participants scored the highest. Correlations between fractional anisotropy and phonological processing in the left Arcuate Fasciculus showed a significant difference between groups and were strongest in behavioral disorders, intermediate in mood disorders, and lowest in controls. Correlations between these measures in the left Inferior Longitudinal Fasciculus were significantly greater than in controls for mood but not for behavioral disorders. Youth with mood disorders share a deficit in the executive-limbic pathway (Arcuate Fasciculus) with behavioral-disordered youth, suggesting reduced capacity for engaging frontal regions for phonological processing or passage comprehension tasks and increased reliance on the ventral tract (e.g., the Inferior Longitudinal Fasciculus). The low passage comprehension scores in mood disorder may result from engaging the left hemisphere. Neural pathways for reading differ mainly in executive-limbic circuitry. This new insight may aid clinicians in providing appropriate intervention for each disorder.

142 Mental Health Emergency Department Visits: 24 Hours and Counting, Characteristics Associated With Prolonged Length of Stay

Mental health visits, including substance abuse and psychiatric illness, continue to be among the most common and expensive presentations to emergency departments (ED). Acutely ill ED patients await psychiatric evaluation and disposition for times ranging from hours to more than 10 days. Our objective is to examine the relationship of psychiatric diagnostic categories with ED disposition and length of stay. We performed a retrospective analysis of all mental health ED visits using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001-2011. Patients with any one of the three recorded International Classification of Disease; Ninth Revision (ICD-9) diagnostic codes indicative of substance abuse or primary psychiatric diagnosis were included. Dual diagnosis was defined as ICD-9 codes with both substance abuse and psychiatric diagnosis. Psychosis, self-harm, and bipolar disorder were categorized as severe disease according to convention. Disposition was categorized as: discharge, admission and transfer. Length of stay was defined as time of ED arrival to disposition (min) and categorized into time periods of >6, >12, >24 hours. We examined demographic, and visit-level factors associated with increased ED length of stay using chi-square tests for categorical variables, and f-tests of means for continuous variables. Of the more than 65 million ED mental health visits, substance abuse (41%), depression (23%) and anxiety (26%) comprised the majority of diagnoses. Dual diagnosis and multiple psychiatric diagnoses accounted for 9 and 10% of patients. While patients with anxiety were infrequently admitted (8.3%) or transferred (3.7%), the majority of patients with severe mental illness, required either admission or transfer. Of patients with psychosis, 34% were admitted and 24%, transferred; of patients with self-harm, 33% were admitted and 29% transferred; of patients with bipolar disorder, 29% were admitted and 40% transferred. Regardless of disposition, patients with bipolar disorder, psychosis, dual diagnosis, multiple psychiatric diagnoses and depression had increased odds of >24 hour length of stay respectively (OR 3.7, (95% CI 1.5-9.4); 2.9, (2.1-3.8); OR 2.4, (1.7-3.2); OR 1.8, (1.2-2.8) respectively. When length of stay was analyzed by disposition status, we found that even for patients discharged with these diagnoses, similarly increased lengths of stay> 24 hour were observed (data not shown.) We found that ED mental health patients with more severe disorders had increased rates of admission and transfer and longer lengths of stay overall. Our finding that the most seriously ill patients had increased odds of ED lengths of stay > 24 hours, even when ultimately discharged, demonstrates unacceptable conditions, in which patients are held and do not receive essential psychiatric care. Further investigation of the systems affecting these patients including, placement of involuntary holds, availability of ED psychiatric consultants or outpatient resources, would delineate potential intervention points for the care of these vulnerable patients.

Disability and Functioning of Patients Who Use Psychiatric Hospital Emergency Services.

First, to compare the level of disability and functioning of patients who access psychiatric emergency services by diagnosis and service use frequency. Second, to compare patients who access psychiatric emergency services to the general population in terms of demographics and the level of disability and functioning. Data from 420 patients were obtained by time-based sampling from August 2011 to February 2012 in the emergency department of a psychiatric hospital that provides services to adolescents and adults. The 2011 and 2012 Centre for Addiction and Mental Health Monitor surveys were used as a representative adult general population sample. Disability and functioning were measured using the World Health Organization Disability Assessment Schedule (WHODAS). Variation in WHODAS scores among psychiatric emergency patients was observed within but not between diagnostic categories and within frequency of use of these services categories. Psychiatric emergency patients had a mean WHODAS score of 38.0, significantly higher (P < .001) than the mean score of 5.0 for the general population; however, there was overlap in the distribution of WHODAS scores. Compared to the general population, psychiatric emergency patients were more likely to be men, younger in age, never married, and unemployed or a student. Psychiatric emergency patients are demographically different when compared to the general population. Furthermore, since disability and functioning are highly variable within but not between psychiatric diagnostic categories, data on disability and functioning should be collected for psychiatric emergency patients, in addition to diagnosis data, to more accurately align patients with the appropriate intensity of services.

Post-Partum Psychosis: Cultural Issue and Therapeutic Barriers and Regional Therapists

Catatonia is a state that a person who is awake does not respond to any external stimuli. The term cultural bound syndrome refers to anyone who has recurrences, locality-specific patterns of aberrant behavior and experiences that appear to fall outside conventional Western psychiatric diagnostic categories. In this case we are presenting a young woman who had given birth, and it was followed by an acute and extreme stressor. She suffered from severe anxiety and the symptoms of catatonia.

Characterizing a psychiatric symptom dimension related to deficits in goal-directed control.

Prominent theories suggest that compulsive behaviors, characteristic of obsessive-compulsive disorder and addiction, are driven by shared deficits in goal-directed control, which confers vulnerability for developing rigid habits. However, recent studies have shown that deficient goal-directed control accompanies several disorders, including those without an obvious compulsive element. Reasoning that this lack of clinical specificity might reflect broader issues with psychiatric diagnostic categories, we investigated whether a dimensional approach would better delineate the clinical manifestations of goal-directed deficits. Using large-scale online assessment of psychiatric symptoms and neurocognitive performance in two independent general-population samples, we found that deficits in goal-directed control were most strongly associated with a symptom dimension comprising compulsive behavior and intrusive thought. This association was highly specific when compared to other non-compulsive aspects of psychopathology. These data showcase a powerful new methodology and highlight the potential of a dimensional, biologically-grounded approach to psychiatry research.

Correlates of nicotine withdrawal severity in smokers during a smoke-free psychiatric hospitalization

Psychiatric hospitals are increasingly adopting smoke-free policies. Tobacco use is common among persons with mental illness, and nicotine withdrawal (NW), which includes symptoms of depression, anxiety, anger/irritability, and sleep disturbance, may confound psychiatric assessment and treatment in the inpatient setting. This study aimed to characterize NW and correlates of NW severity in a sample of smokers hospitalized for treatment of mental illness in California. Participants (N=754) were enrolled between 2009 and 2013, and averaged 17 (SD=10) cigarettes/day prior to hospitalization. Though most (70%) received nicotine replacement therapy (NRT) during hospitalization, a majority (65%) reported experiencing moderate to severe NW. In a general linear regression model, NW symptoms were more severe for women, African American patients, and polysubstance abusers. Though invariant by psychiatric diagnostic category, greater NW was associated with more severe overall psychopathology and greater cigarette dependence. The full model explained 46% of the total variation in NW symptom severity (F [19, 470]=23.03 p<0.001). A minority of participants (13%) refused NRT during hospitalization. Those who refused NRT reported milder cigarette dependence and stated no prior use of NRT. Among smokers hospitalized for mental illness, NW severity appears multidetermined, related to cigarette dependence, demographic variables, psychiatric symptom severity, and other substance use. Assessment and treatment of NW in the psychiatric hospital is clinically warranted and with extra attention to groups that may be more vulnerable or naïve to cessation pharmacotherapy.

SNAP-25a/b Isoform Levels in Human Brain Dorsolateral Prefrontal Cortex and Anterior Cingulate Cortex

SNAP-25 is a neurotransmitter vesicular docking protein which has been associated with brain disorders such as attention deficit hyperactivity disorder, bipolar disorder and schizophrenia. In this project, we were interested if clinical factors are associated with differential SNAP-25 expression. We examined the SNAP-25 isoform mRNA and protein levels in postmortem cortex Brodmann's area 9 (BA9) and BA24 (n = 29). Subjects were divided by psychiatric diagnosis, clinical variables including mood state in the last week of life and lifetime impulsiveness. We found affected subjects with a diagnosis of alcohol use disorder (AUD) had a lower level of SNAP-25b BA24 protein compared to those without AUD. Hispanic subjects had lower levels of SNAP-25a, b and BA9 mRNA than Anglo-American subjects. Subjects who smoked had a total pan (total) SNAP-25 BA9/BA24 ratio. Subjects in the group with a low level of anxious-psychotic symptoms had higher SNAP-25a BA24 mRNA compared to normal controls, and both the high and low symptoms groups had higher pan (total) SNAP-25 BA9/BA24 ratios than normal controls. These data expand our understanding of clinical factors associated with SNAP-25. They suggest that SNAP-25 total and isoform levels may be useful biomarkers beyond limited neurological and psychiatric diagnostic categories.