Psychiatric Domains Research Articles

Evaluating the psychosocial status of BC children and youth during the COVID-19 pandemic: A MyHEARTSMAP cross-sectional study.

Understanding the psychosocial status of children and adolescents during the COVID-19 pandemic is vital to the appropriate and adequate allocation of social supports and mental health resources. This study evaluates the burden of mental health concerns and the impact of demographic factors while tracking mental health service recommendations to inform community service needs. MyHEARTSMAP is a digital self-assessment mental health evaluation completed by children and their guardian throughout British Columbia between August 2020 to July 2021. Severity of mental health concerns was evaluated across psychiatric, social, functioning, and youth health domains. Proportional odds modelling evaluated the impact of demographic factors on severity. Recommendations for support services were provided based on the evaluation. We recruited 541 families who completed 424 psychosocial assessments on individual children. Some degree of difficulty across the psychiatric, social, or functional domains was reported for more than half of children and adolescents. Older youth and those not attending any formal school or education program were more likely to report greater psychiatric difficulty. Girls experienced greater social concerns, and children attending full-time school at-home were more likely to identify difficulty within the youth health domain but were not more likely to have psychiatric difficulties. Considerations to access community mental health service were triggered in the majority (74%) of cases. Psychosocial concerns are highly prevalent amongst children and adolescents during the COVID-19 pandemic. Based on identified needs of this cohort, additional community health supports are required, particularly for higher risk groups.

Associations Between Psychiatric Symptoms and Cognitive Impairment in Post-Acute Sequelae of COVID

Introduction: Post-acute sequelae of COVID (PASC) is an emerging postviral syndrome affecting patients who have recovered from acute COVID infection. Symptoms can affect many different organ systems, including the CNS. Neuropsychiatric complications are common in PASC, affecting roughly 1 in 3 patients who recover from COVID. The present study aims to investigate relationships between depressive, anxious, somatic, and general psychiatric symptom burden and cognitive impairment in PASC.
 Methods: Patients were recruited from the Parkview Post-COVID Clinic (PPCC) from April 2021 to March 2022. Patients were deemed eligible if data were available for both Brief Symptomatic Inventory (BSI) and BrainCheck scores. Eligible patients were divided into low or normal cognitive function based on BrainCheck guidelines, and differences in psychiatric symptom severity were assessed via Mann-Whitney U testing. Strength and direction of associations were determined using Pearson’s correlation coefficient. A smaller subset of patients was analyzed for differences in PASC symptom severity based on Omicron or Delta infection.
 Results: Generalized cognitive and mental flexibility complaints were associated with more severe psychiatric symptom burden in all domains measured by BSI (p = 0.003 and p = 0.01, respectively). Impaired attention was not related to any psychiatric symptom domain (p > 0.05). Impaired memory was related to more severe symptom burden in all psychiatric domains except depression (immediate recall p = 0.015; delayed recall p = 0.015).
 Conclusion: General cognitive and mental flexibility complaints can be used to prompt clinical suspicion of concurrent psychiatric symptoms. Complaints regarding attention are not linked to any psychiatric symptom domain. Complaints regarding memory can also provide impetus for investigating concurrent psychiatric symptoms, excluding depression. These associations can be used to facilitate earlier diagnosis and treatment of cognitive impairment and psychiatric illness in the context of PASC.

Post-intensive Care Syndrome in a Heterogeneous Pediatric Population.

Background In this study, we aimed to measure the incidence of post-intensive care syndrome among children (PICS-p) who received critical care treatment in our hospital and evaluate patient characteristics and critical care interventions associated with the development of PICS-p. Methodology We conducted a retrospective cohort review ofall surviving pediatric patients admitted to an urban, academic, tertiary intensive care unit betweenJuly 2017 and June 2018. Based on the existing literature on PICS, we excluded children whose length of stay in the pediatric intensive care unit (PICU) was less than four days. We collected demographic data, clinical data, and data related to outcomes in our study cohort. We defined PICS-p a priori as a change in the Functional Status Scale (FSS) score of three or greater between pre-admission and discharge. Using Student's t-tests and Wilcoxon rank-sum tests, we compared outcomes among those with PICS-p versus those without PICS-p. Results Of the 183 patients, 36 (19.6%) were diagnosed with PICS in our study. Aside from pre-admission FSS (7 vs. 8), analysis of the two groups revealed no statistically significant difference before or at the time of admission. Upon admission to the PICU, statistically significant differences between the PICS and no PICS groups were noted in the hospital length of stay (33.5 days vs. 14.7 days), ventilation-free days (8.3 days vs. 5.2 days), and the number of procedural interventions (2.6 vs. 1). Conclusions Utilizing the FSS to determine PICS is a viable method to standardize the measurement of functional outcomes for critically ill children. In our single-center, retrospective review, nearly one out of five pediatric patients developed PICS with associated factors that included a decreased pre-hospital FSS score, increased hospital length of stay, fewer ventilation-free days, and increased number of procedural interventions. Significant opportunities exist regarding the social and psychiatric domains of PICS-p.

Comorbidities in newly diagnosed epilepsy: Pre-existing health conditions are common and complex across age groups

ObjectivesPeople with epilepsy have a higher prevalence of medical and psychiatric comorbidities compared to the general population. Comorbidities are associated with poor epilepsy outcomes, and there have been recommendations for screening and early identification to improve clinical management. Data from ‘First Seizure Clinics’ (FSCs) with expert epileptological review can inform about disorders already present at the point of diagnosis of epilepsy or unprovoked seizures. Here, we aimed to describe pre-existing conditions with a focus on psychiatric, substance use, cardiac, neurological, and cancer health domains. MethodsWe included 1383 adults who received a new diagnosis of epilepsy or unprovoked seizures at Austin Hospital (AH) or Royal Melbourne Hospital (RMH) (Australia) FSCs from 2000 to 2010. Data were audited from FSC records, primarily detailed interviews undertaken by epileptologists. Logistic regression examined age distribution and other risk factors. ResultsThe median age at FSC presentation was 37 years (IQR 26–53, range 18–94). Pre-existing conditions were reported by 40 %; from 32 % in the youngest group (18–30 years) to 53 % in the oldest (65+ years). Psychiatric (18 %) and substance use (16 %) disorders were most common, with higher prevalence among patients 18 to 65 years of age compared to those older than 65 years (p < 0.001). Cardiac, neurological, or cancer conditions were reported by 3–6 %, most often amongst those older than 65 years (p < 0.01). Eight percent (n = 112) reported disorders in >1 health domain. The commonest combination was a psychiatric condition with substance use disorder. Of the sixty-two patients reporting this combination, 61 were ≤65 years of age. ConclusionsPre-existing health conditions are present in a substantial proportion of patients diagnosed with epilepsy or unprovoked seizures. Disorders are highest amongst elders, but one-third of younger adults also reported positive histories. These are predominantly psychiatric and/or substance use disorders, conditions strongly associated with poor outcomes in the general population. These findings inform post-diagnosis planning and management, as well as research examining post-diagnostic outcomes and associations between comorbidities and epilepsy.

Psychological and psychiatric characterization of various groups of drugs users

Aim. We aimed to assess the differences among various groups of drugs users, especially in the psychiatric and psychological domains. Materials and Methods. A retrospective study was carried out in collaboration with C.E.T.T.T `St. Stelian` Institute from Bucharest. There were analyzed the medical records of 604 hospitalized patients with heroin or polydrug addiction. Results. Significant differences in diagnosis at submission among groups were outlined (personality and behavior disorders, p-value = .04298, psychotic disorders, p-value = .004274, schizophrenia, p-value = .000141) as well as significant differences among psychiatric parameters: perception (legal highs, opiates), attention (cannabis), consciousness (legal highs), thinking (legal highs), and, instinctive life (legal highs). Conclusions. Personality and behavioral disorders have been particularly linked to opiate use, the psychotic disorder was related to cannabis and legal highs intake, while schizophrenia was related to legal highs intake.

Effectiveness of Artificial Intelligence Methods in Personalized Aggression Risk Prediction within Inpatient Psychiatric Treatment Settings-A Systematic Review.

Aggression risk assessments are vital to prevent injuries and morbidities amongst patients and staff in psychiatric settings. More recent studies have harnessed artificial intelligence (AI) methods such as machine learning algorithms to determine factors associated with aggression in psychiatric treatment settings. In this review, using Cooper’s five-stage review framework, we aimed to evaluate the: (1) predictive accuracy, and (2) clinical variables associated with AI-based aggression risk prediction amongst psychiatric inpatients. Databases including PubMed, Cochrane, Scopus, PsycINFO, CINAHL were searched for relevant articles until April 2022. The eight included studies were independently evaluated using critical appraisal tools for systematic review developed by Joanna Briggs Institute. Most of the studies (87.5%) examined health records in predicting aggression and reported acceptable to excellent accuracy with specific machine learning algorithms employed (area under curve range 0.75–0.87). No particular machine learning algorithm outperformed the others consistently across studies (area under curve range 0.61–0.87). Relevant factors identified with aggression related to demographic and social profile, past aggression, forensic history, other psychiatric history, psychopathology, challenging behaviors and management domains. The limited extant studies have highlighted a potential role for the use of AI methods to clarify factors associated with aggression in psychiatric inpatient treatment settings.

The Carriers: What the Fragile X Gene Reveals About Family, Heredity, and Scientific Discovery.

Back to table of contents Previous article Book ReviewsFull AccessThe Carriers: What the Fragile X Gene Reveals About Family, Heredity, and Scientific DiscoveryJames A. Bourgeois, O.D., M.D.James A. BourgeoisSearch for more papers by this author, O.D., M.D.Published Online:22 Aug 2022https://doi.org/10.1176/appi.neuropsych.22010008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by Anne Skomorowsky, M.D. New York, Columbia University Press, 2022, 280 pages.In The Carriers, Dr. Anne Skomorowsky—a consultation-liaison psychiatrist, clinical instructor in psychiatry at the New York University (NYU) Grossman School of Medicine and attending psychiatrist at NYU Langone Hospital—offers us a thorough, sensitive, and provocative account of the lives of patients with the premutation, or carrier state, of fragile X disorders—many clustered in families of multiple fragile X–affected individuals. In this relatively slim volume, the author offers a concise yet thoroughly informative account of the genetic and clinical history of the ascertainment of fragile X syndrome, a critical distinction between fragile X syndrome and its carrier state, detailed and poignant narratives of many affected patients, and the evolution of the diagnosis, classification, and clinical research paradigm into this important condition.Fragile X–related conditions are of great interest to both psychiatrists and neurologists in that there may be manifestations in both the psychiatric and neurologic symptom and syndrome domains. Indeed, so many patients suffer in both domains that we really ought to consider these conditions as prototypical “neuropsychiatric” disorders, similar in conceptual inclusion to multiple sclerosis and Parkinson’s disease.Whereas full-spectrum fragile X syndrome is generally better known and usually manifests in childhood with various degrees of cognitive and behavioral impairment (though the spectrum of illness ranges from the subtle to the severely impairing), Dr. Skomorowsky focuses her book on the carrier or premutation states. The book’s thesis is that for most patients the carrier-state illness is not just a milder version of fragile X syndrome, but is a distinct, separate illness with different genetic deficits, pathophysiology, and multisystemic clinical manifestations, which have been ascertained only in the past 20 years. Additional chapters address the history of ascertainment of genetically caused intellectual disability, the ultimately successful search for the fragile X gene, and the evolution of fragile X disorders clinical research.One fascinating aspect of assessing clinical illness in carriers, particularly psychiatric comorbid illness, is that many carriers are actively involved in raising one or more full-spectrum fragile X children, such that the axiomatic (yet, critically, incomplete) assumption of clinicians is often that the stresses of raising affected children are the genesis of the carriers’ often significant psychiatric comorbidity. Dr. Skomorowsky persuasively shows, by citations of literature, interviews with many fragile X researchers, and her own interviews with affected patients, that the psychiatric comorbidity in carriers is primarily part of the phenotype of the carrier premutation state itself. Carriers need empathic clinical care on this basis alone.The book emphasizes the multigenerational nature of the carrier/premutation conditions. Although young adult females who carry the premutation are prone to ovarian dysfunction, other systemic manifestations, anxiety and depressive disorders, and problems with social behavior, middle-aged and older male carriers (the grandfathers of full-mutation fragile X children and fathers of the adult female carriers) are at risk for an often debilitating fragile X–associated tremor-ataxia syndrome (FXTAS, acronym pronounced “fax-tass”), which is a mixed movement disorder and dementia syndrome that can lead to significant debility. One of the many instructive ironies in fragile X research is that FXTAS was initially described by the noted fragile X clinical researcher Randi Hagerman, M.D., making FXTAS perhaps the only adult degenerative dementia syndrome discovered by a pediatrician. In many cases, young adult carriers are “pulled two ways” between attending to their own impaired children and assisting their progressively ill fathers, all while managing their own, often clinically impairing, symptoms.Throughout the text, Dr. Skomorowsky highlights the need for an empathic approach, the need for physician-patient alliance, and an appreciation of the coping strategies exhibited by fragile X carrier patients while they manage their own variable symptoms in the broader context of affected family members. As clinical and basic sciences advance apace, it is both inevitable and desirable that additional neuropsychiatric illnesses will be discovered to have a genetic and molecular basis. The recent experience with fragile X premutation carrier states illustrates this magnificently. Psychiatrists curious about genetically determined psychiatric illness—which should be all of us—will find this book a valuable introduction to the world of fragile X illnesses and of patients coping with them.Central Texas Division, Baylor Scott & White Health, Dallas; Department of Medical Education, College of Medicine, Texas A&M University Health Science Center, Temple.Send correspondence to Dr. Bourgeois ([email protected]).Dr. Bourgeois reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited byNone Volume 35Issue 1 Winter 2023Pages 102-102 Metrics KeywordsDementiaGeneticsPDF download History Received 10 January 2022 Accepted 15 April 2022 Published online 22 August 2022 Published in print 1 January 2023

Clinical and genotypic analysis in determining dystonia non-motor phenotypic heterogeneity: a UK Biobank study

The spectrum of non-motor symptoms in dystonia remains unclear. Using UK Biobank data, we analysed clinical phenotypic and genetic information in the largest dystonia cohort reported to date. Case–control comparison of dystonia and matched control cohort was undertaken to identify domains (psychiatric, pain, sleep and cognition) of increased symptom burden in dystonia. Whole exome data were used to determine the rate and likely pathogenicity of variants in Mendelian inherited dystonia causing genes and linked to clinical data. Within the dystonia cohort, phenotypic and genetic single-nucleotide polymorphism (SNP) data were combined in a mixed model analysis to derive genetically informed phenotypic axes. A total of 1572 individuals with dystonia were identified, including cervical dystonia (n = 775), blepharospasm (n = 131), tremor (n = 488) and dystonia, unspecified (n = 154) groups. Phenotypic patterns highlighted a predominance of psychiatric symptoms (anxiety and depression), excess pain and sleep disturbance. Cognitive impairment was limited to prospective memory and fluid intelligence. Whole exome sequencing identified 798 loss of function variants in dystonia-linked genes, 67 missense variants (MPC > 3) and 305 other forms of non-synonymous variants (including inframe deletion, inframe insertion, stop loss and start loss variants). A single loss of function variant (ANO3) was identified in the dystonia cohort. Combined SNP and clinical data identified multiple genetically informed phenotypic axes with predominance of psychiatric, pain and sleep non-motor domains. An excess of psychiatric, pain and sleep symptoms were evident across all forms of dystonia. Combination with genetic data highlights phenotypic subgroups consistent with the heterogeneity observed in clinical practice.

Impact of Hoarding and Obsessive-Compulsive Disorder Symptomatology on Quality of Life and Their Interaction With Depression Symptomatology.

Hoarding disorder (HD) is a psychiatric condition characterized by difficulty discarding items and accumulation of clutter. Although studies have established the negative impact of HD and compulsive hoarding behavior, fewer have examined the impact on quality of life (QoL) of hoarding behavior independent of obsessive–compulsive disorder (OCD). Moreover, specific aspects of QoL such as success in work/academics or satisfaction with interpersonal relationships have not been well-investigated. In this study, we examined, in a sample of 2100 adult participants obtained from Amazon Mechanical Turk, the relationships between hoarding, OCD, and depression symptomatology and four QoL domains (success, enrichment, environment, and family) derived from a factor analysis of the Quality of Life Inventory (QoLI). We performed linear regressions to examine associations between psychiatric symptomatology and QoL domains and then conducted mediation analyses to investigate the role of depressive symptomatology in the identified relationships. We found that while hoarding and obsessive–compulsive symptoms were both negatively associated with QoL, they were associated with different domains [hoarding was significantly associated (p < 0.05) with total QoL and all domains and uniquely associated with environment and family QoL compared to obsessive–compulsive symptoms], whereas obsessive–compulsive symptoms were only significantly associated with total, success, and enrichment QoL. However, when depressive symptoms were included in the model, hoarding no longer accounted for significant variance in the total, environment, or family QoL domains (p > 0.05), and was less strongly associated with success or enrichment. Mediation analyses confirmed the role of depression as a complete mediator of hoarding’s effect on total, environment, and family QoL, and as a partial mediator of hoarding’s effect on success and enrichment QoL. Further examination of the relationship between hoarding symptoms and QoL in those with mild, moderate, and severe depression indicated that in those with more severe depression, hoarding was associated with improved QoL, indicating a possible buffering or compensatory effect. The findings suggest a differential impact of hoarding and obsessive–compulsive symptoms on QoL and emphasize the importance of considering co-morbid depressive symptoms in designing more targeted interventions. Future studies should continue to investigate these complex relationships, given the high co-morbidity of hoarding and depression.

P575. A Scalable Platform for Integrated Multi-Modal Neuroimaging Data Processing and Analysis Across Psychiatric Studies

A key opportunity for psychiatry is combining neuroimaging datasets to map neural-behavioral variation across psychiatric domains. To map stable, replicable neuro-behavioral relationships, data across different studies and acquisition parameters must be processed and analyzed in a standardized manner. However, there are no field-wide standards for preprocessing and analytic techniques, leading to methodology-specific pipelines, inconsistent choices across researchers, and irreproducible results.

Repeat Closed-Head Injury in Male Rats Impairs Attention but Causes Heterogeneous Outcomes in Multiple Measures of Impulsivity and Glial Pathology.

Repetitive mild traumatic brain injury, or concussion, can lead to the development of long-term psychiatric impairments. However, modeling these deficits is challenging in animal models and necessitates sophisticated behavioral approaches. The current set of studies were designed to evaluate whether a rubberized versus metal impact tip would cause functional deficits, the number of injuries required to generate such deficits, and whether different psychiatric domains would be affected. Across two studies, male rats were trained in either the 5-choice serial reaction time task (5CSRT; Experiment 1) to assess attention and motor impulsivity or concurrently on the 5CSRT and the delay discounting task (Experiment 2) to also assess choice impulsivity. After behavior was stable, brain injuries were delivered with the Closed-head Injury Model of Engineered Rotational Acceleration (CHIMERA) either once per week or twice per week (Experiment 1) or just once per week (Experiment 2). Astrocyte and microglia pathology was also assayed in relevant regions of interest. CHIMERA injury caused attentional deficits across both experiments, but only increased motor impulsivity in Experiment 1. Surprisingly, choice impulsivity was actually reduced on the Delay Discounting Task after repeat injuries. However, subsequent analyses suggested potential visual issues which could alter interpretation of these and attentional data. Subtle changes in glial pathology immediately after the injury (Experiment 1) were attenuated after 4 weeks recovery (Experiment 2). Given the heterogenous findings between experiments, additional research is needed to determine the root causes of psychiatric disturbances which may arise as a results of repeated brain injuries.

Examining racial differences in community integration between black and white homeless veterans

Black Americans are overrepresented in Veteran and non-Veteran homeless populations. Community integration remains a problem for many Veterans after they obtain housing, and Black Veterans may encounter additional difficulties due to systemic racism. However, no prior study has specifically examined whether there are racial differences in community integration; similarly, no study has considered racial differences in psychosocial correlates of community integration in homeless Veterans. Knowledge of these factors could inform the development of culturally congruent rehabilitative interventions for Black Veterans. Semi-structured clinical interviews were administered to Black (N = 99) and White (N = 49) homeless Veterans to examine relations among psychiatric symptoms, motivation, and community integration domains (e.g., social integration, work productivity, and independent living). There were no significant racial differences in independent living or work productivity. Black Veterans had better social integration with family compared to White Veterans. In addition, psychiatric symptoms were more strongly correlated with social integration for Black than White Veterans. The association between motivation and work productivity was also stronger for Black Veterans. Recovery-oriented interventions could harness family connections and better target psychiatric symptoms to improve community integration for Black Veterans. Work productivity may improve from interventions aimed at enhancing motivation for Black Veterans.

Engaging Older Veterans With Serious Mental Illness in Physical Activity: In-Person, Remote, and Hybrid Models

Older adults with serious mental illness (SMI) have complex care needs across medical, psychiatric, cognitive, and social domains. This growing population exhibits high levels of medical comorbidity and sedentariness. Innovative interventions that promote holistic recovery for this group are needed, especially in the context of the COVID-19 pandemic. Peer Education on Exercise for Recovery (PEER) is a peer coaching intervention, delivered by VA Peer Specialists (Veterans with lived experience of mental illness), to promote exercise and physical activity among older adults with SMI. This paper will present on three different models of PEER: fully in-person, fully remote, and a hybrid model with both in-person and remote elements. Preliminary data indicates that PEER is (1) engaging and well-liked, (2) associated with greater sustained increases in physical activity compared to an active control, and (3) can lead to sustained physical activity increases that are resilient to situational constraints such as physical distancing.

The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention Among Health Care Workers and First Responders

BackgroundThe COVID-19 pandemic has greatly affected front-line health care workers (HCW) and first responders (FR). The specific components of COVID-19 related occupational stressors (CROS) associated with psychiatric symptoms and reduced occupational functioning or retention remain poorly understood.ObjectivesExamine the relationships between total and factored CROS, psychiatric symptoms, and occupational outcomes.DesignObservational, self-report, single time-point online assessment.ParticipantsA total of 510 US HCW (N = 301) and FR (N = 200) with occupational duties affected by the COVID-19 pandemic.Main Outcomes and MeasuresCROS were assessed using a custom 17-item questionnaire. Post-traumatic stress disorder (PTSD), depression, insomnia, and generalized anxiety symptoms were assessed using the PTSD Checklist-5 (PCL5), Patient Health Questionnaire-9 (PHQ9), Insomnia Severity Index (ISI), and General Anxiety Disorder-7 (GAD7). Respondents’ likelihood of leaving current field and occupational functioning were assessed with 2-item PROMIS subscales. Relationships were modeled using multivariable regression. Open-ended responses were coded using rapid template analysis.ResultsCROS total scores correlated significantly with all four psychiatric symptom domains (R’s = .42–.53), likelihood of leaving one’s current occupation (R = .18), and trouble doing usual work (R = .28), all p’s < .001. Half of HCW indicated a decreased likelihood of staying in their current occupation as a result of the pandemic. CROS were fit to a 3-factor model consisting of risk, demoralization, and volume factors. All CROS factors were associated with psychiatric symptom burden, but demoralization was most prominently associated with psychiatric symptoms and negative occupational outcomes. Among psychiatric symptoms, PTSD symptoms were most strongly associated with negative occupational outcomes. Open-ended statements emphasized lack of protection and support, increased occupational demands, and emotional impact of work duties.Conclusions and RelevanceThese results demonstrate potentially treatable psychiatric symptoms in HCW and FR experiencing CROS, impacting both wellbeing and the health care system. Mitigating CROS, particularly by addressing factors driving demoralization, may improve HCW and FR mental health, occupational functioning, and retention.

Improving Pain Care Using Psychosocial Screening and Patient Education among Veterans

Pain education programming is considered one avenue of treatment for comorbid chronic pain and mental health disorders. The purpose of the current single group, longitudinal ex post facto study was to determine whether participation in a pain education program would decrease symptoms on psychiatric and functional disability domains using emerging screening measures. A sample of 90 Veterans participated in a pain education program at a Midwestern VA Medical Center between November 1, 2013 and October 31, 2014. The Pain Education School program is a comprehensive program that is open to all Veterans and introduces them to different modalities that deal with chronic pain available in the VA hospital. All participants completed pre- and post-education screening measures. Paired-samples t-tests were conducted to evaluate the impact of the pain education program on Veterans’ scores on these measures. The current study found a significant difference in depression (p=.005; d=.18), mobility (p=.000; d=.47), social participation (p=.001; d=.30), and total functional disability scores (p=.001; d=.30) upon completion of the program. The current study serves as a model of how to use emerging screening measures and education programming to enhance clinical practice and decision-making to better address Veterans’ needs.

3.5 BALANCING RISK AND BENEFIT IN MANAGING IRRITABILITY AND AGITATION IN AUTISM SPECTRUM DISORDER

This presentation aims to provide a systematic approach to the assessment of irritability and agitation symptoms in autism spectrum disorder (ASD) and to review the existing evidence for effective (and ineffective) treatments for irritability and agitation in ASD, highlighting both potential benefits and risks. A practice pathway, developed by expert consensus, for the assessment and management of irritability and problem behavior, will provide the organizing framework for the discussion. Systematic reviews and meta-analyses will provide an overview of the literature, with supplementation from individual randomized controlled trials. Clinical case examples will be used to highlight key concepts in assessment and treatment. Irritability and agitation are common but nonspecific outcomes of multiple underlying areas of difficulty, from pain to family conflict to communication difficulties. It is therefore critical to systematically evaluate potential contributions from the medical, psychiatric, psychosocial, communication, and behavioral domains for the individual patient. This multimodal assessment approach, combined with a careful evaluation of the severity and risk of the problem behavior, guides a multidisciplinary treatment approach. With regard to psychopharmacology in particular, the evidence of benefit for a medication must be carefully balanced with the potential risk that must be actively managed. Vignettes from clinical practice demonstrate the choice points for the use of particular behavioral and medication treatments in the management of irritability and agitation. Careful evaluation of irritability, agitation, and accompanying aggression in ASD requires integrating information across domains and settings. A systematic approach to assessment allows the child and adolescent psychiatrist or allied professional to consider each domain and develop an initial formulation that can be refined by response to intervention. Successful treatment will likewise require collaboration across disciplines, ranging from the management of medical problems to improving communication tools to optimizing behavioral management. In the real world, we must all balance risk and benefit to appropriately manage irritability and agitation in ASD.

Combined polygenic risk scores of different psychiatric traits predict general and specific psychopathology in childhood.

BackgroundPolygenic risk scores (PRSs) operationalize genetic propensity toward a particular mental disorder and hold promise as early predictors of psychopathology, but before a PRS can be used clinically, explanatory power must be increased and the specificity for a psychiatric domain established. To enable early detection, it is crucial to study these psychometric properties in childhood. We examined whether PRSs associate more with general or with specific psychopathology in school‐aged children. Additionally, we tested whether psychiatric PRSs can be combined into a multi‐PRS score for improved performance.MethodsWe computed 16 PRSs based on GWASs of psychiatric phenotypes, but also neuroticism and cognitive ability, in mostly adult populations. Study participants were 9,247 school‐aged children from three population‐based cohorts of the DREAM‐BIG consortium: ALSPAC (UK), The Generation R Study (Netherlands), and MAVAN (Canada). We associated each PRS with general and specific psychopathology factors, derived from a bifactor model based on self‐report and parental, teacher, and observer reports. After fitting each PRS in separate models, we also tested a multi‐PRS model, in which all PRSs are entered simultaneously as predictors of the general psychopathology factor.ResultsSeven PRSs were associated with the general psychopathology factor after multiple testing adjustment, two with specific externalizing and five with specific internalizing psychopathology. PRSs predicted general psychopathology independently of each other, with the exception of depression and depressive symptom PRSs. Most PRSs associated with a specific psychopathology domain, were also associated with general child psychopathology.ConclusionsThe results suggest that PRSs based on current GWASs of psychiatric phenotypes tend to be associated with general psychopathology, or both general and specific psychiatric domains, but not with one specific psychopathology domain only. Furthermore, PRSs can be combined to improve predictive ability. PRS users should therefore be conscious of nonspecificity and consider using multiple PRSs simultaneously, when predicting psychiatric disorders.

Post-intensive Care Syndrome.

The increasing survival rate after discharge from the intensive care unit (ICU) has revealed long-term impairments in the cognitive, psychiatric, and physical domains among survivors. However, clinicians often fail to recognize this post-ICU syndrome (PICS) and its debilitating effects on family members (PICS-F). This study describes two cases of PICS to illustrate the different impairments that may occur in ICU survivors. The PICS risk factors for each domain and the interactions among risk factors are also described. In terms of diagnostic evaluation, limited evidence-based or validated tools are available to assist with screening for PICS. Clinicians should be aware to monitor for its symptoms on the basis of cognitive, psychiatric, and physical domains. The Montreal Cognitive Assessment is recommended to screen for cognition, as it has a high sensitivity and can evaluate executive function. Mood disorders should also be screened. For mobile patients, a 6-minute walk test should be performed. PICS can be prevented by applying the ABCDEF bundle ABCDEF bundle in ICU described in this paper. Finally, the family members of patients in the ICU should be involved in patient care and a tactful communication approach is required to reduce the risk of PICS-F.

Obsessive\u2013compulsive symptoms and information seeking during the Covid-19 pandemic

Increased mental-health symptoms as a reaction to stressful life events, such as the Covid-19 pandemic, are common. Critically, successful adaptation helps to reduce such symptoms to baseline, preventing long-term psychiatric disorders. It is thus important to understand whether and which psychiatric symptoms show transient elevations, and which persist long-term and become chronically heightened. At particular risk for the latter trajectory are symptom dimensions directly affected by the pandemic, such as obsessive–compulsive (OC) symptoms. In this longitudinal large-scale study (N = 406), we assessed how OC, anxiety and depression symptoms changed throughout the first pandemic wave in a sample of the general UK public. We further examined how these symptoms affected pandemic-related information seeking and adherence to governmental guidelines. We show that scores in all psychiatric domains were initially elevated, but showed distinct longitudinal change patterns. Depression scores decreased, and anxiety plateaued during the first pandemic wave, while OC symptoms further increased, even after the ease of Covid-19 restrictions. These OC symptoms were directly linked to Covid-related information seeking, which gave rise to higher adherence to government guidelines. This increase of OC symptoms in this non-clinical sample shows that the domain is disproportionately affected by the pandemic. We discuss the long-term impact of the Covid-19 pandemic on public mental health, which calls for continued close observation of symptom development.

Nursing staff's assessments of medication management process in the psychiatric and operative domains: A cross-sectional study after introduction of an electronic medication chart.

To describe nursing staff's assessments of medication management process in the psychiatric and operative domains after introduction of an electronic medication chart. The medication management process includes all structures and practices within the organisation that guide and support medication administration and related procedures. A cross-sectional survey. A Finnish version of the Medication Administration System - Nurses Assessment of Satisfaction (modified MAS-NAS) paper-based questionnaire was sent to all nursing staff (N=855) working in operative (n=498) and psychiatric (n=357) domains in one central hospital. Data were analysed using statistical methods. In total, 324 nursing staff members participated. More than half agreed that medication management is efficient (64%), safe for patients (76%), and that the current medication administration system provides the necessary medical treatment information (e.g. prescriptions by physicians, medication data) (64%). Respondents' overall satisfaction with medication management process was slightly above average on a scale from 1 to 10 (mean=6.2; SD=1.8; median=7, range 2-9). Respondents who used electronic medication chart reported higher overall satisfaction with medication management process (median=7, mean=6.1, SD=1.8 and range 2-9) than those not using it (median=6.5, mean=6.3, SD=1.6 and range 2-9). No statistically significant difference was found (U=8552.000, p=0.33). This study revealed several problems in the medication management process. The results can be used in developing the medication management process. Electronic medication chart should be used and developed further in terms of efficacy, safety and access. One year after the electronic medication chart was introduced, only half of the respondents had used it. That is why implementation of electronic systems or technological applications should be carefully considered as a whole.