Psychiatric Outcomes Research Articles

Neuroplasticity Alterations Induced by Isotretinoin use in RARA Gene Polymorphism is Associated with Increased Risk of Depression and Suicidal Ideation in Patients with Vitamin D Deficiency: A Systematic Review and Meta-Analysis

Rationale: Isotretinoin is widely used for severe acne treatment, but concerns have emerged regarding its potential association with depression and suicidal ideation. Previous studies have produced mixed findings, necessitating a comprehensive evaluation of the evidence. This systematic review and meta-analysis aim to clarify the association between isotretinoin use and the onset of depression or suicidal ideation, focusing on genetic predispositions, particularly in patients with vitamin D deficiency. Objectives: This review assesses the risk of depression and suicidal ideation in patients treated with isotretinoin for severe acne compared to those not using isotretinoin. A secondary focus is placed on identifying specific genetic factors, such as polymorphisms in the RARA and LEP genes, that may predispose patients to these psychiatric side effects. Eligibility Criteria: Randomized controlled trials (RCTs), cohort studies, and case-control studies comparing isotretinoin users to non-users were included. Exclusion criteria included studies that lacked a comparator group or did not report psychiatric outcomes (depression or suicidal ideation). Outcomes: The primary outcome was the incidence of depression or suicidal ideation among isotretinoin users compared to non-users. Secondary outcomes examined the influence of genetic polymorphisms, specifically in the RARA and LEP genes, on the risk of developing psychiatric side effects. Risk of Bias: Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. The overall quality of the included studies was moderate to high. Synthesis Methods: A random-effects meta-analysis was performed to pool odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic, and sensitivity analyses were conducted to ensure the robustness of the findings. Included Studies: Fifteen studies were included, comprising 3 randomized controlled trials, 7 cohort studies, and 5 case-control studies, with a total of 8,000 isotretinoin users and 10,000 non-users. The studies were conducted in diverse clinical settings with a follow-up range of 6 months to 5 years. Synthesis of Results: The pooled analysis demonstrated a significant association between isotretinoin use and an increased risk of depression (OR: 1.3, 95% CI: 1.1–1.5, p < 0.05). Specific genetic polymorphisms, particularly in the RARA and LEP genes, were identified as potential risk factors for developing depression among isotretinoin users, particularly in patients with concurrent vitamin D deficiency. Conclusions: Isotretinoin use is associated with an increased risk of depression, particularly in individuals with specific genetic polymorphisms such as RARA and LEP. Clinicians should consider conduct precision medicine genetic testing testing for these polymorphisms before initiating isotretinoin treatment and closely monitor patients for psychiatric alterations, mood changes, especially those with with vitamin D deficiency or genetic predisposition to depression

Medical Psychiatric Challenges in the Treatment of Obsessive-Compulsive Disorder and Eating Disorders

This paper examines the intricate relationship between Obsessive-Compulsive Disorder (OCD) and eating disorders (EDs), focusing on their diagnostic criteria, comorbidity, shared characteristics, and the profound medical and psychiatric complications that arise from these conditions. OCD is characterized by intrusive obsessions and compulsions that significantly impact daily functioning, while EDs, including Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder, involve severe disturbances in eating behaviors and body image. These disorders often co-occur, with up to 41% of individuals with EDs also suffering from OCD. The shared symptoms, such as obsessions, compulsions, avoidance behaviors, and perfectionism, highlight the complex interplay between OCD and EDs, complicating diagnosis and treatment. The medical complications associated with this comorbidity are severe and varied, affecting multiple organ systems. Gastrointestinal issues, proctological problems, oral health deterioration, cardiological dysfunction, electrolyte imbalances, kidney disorders, and hormonal dysregulation are common. Additionally, sleep disorders are prevalent, further exacerbating both psychiatric and physical health outcomes. Effective treatment requires a holistic approach that addresses the unique needs of each individual, with integrated care involving specialists across medical and mental health fields. This comprehensive approach is crucial to mitigating the devastating impact of OCD and EDs, improving overall well-being and quality of life for affected individuals.

Psychiatric comorbidity and hospitalization outcomes for AMI in portuguese public hospitals

Abstract Background Severe mental health disorders directly affect quality of life but may also indirectly relate to physical diseases and their prognosis. We test this hypothesis for the specific case of acute myocardial infarction (AMI), postulating a longer in-patient stay and an excess in-hospital mortality among patients suffering psychiatric comorbidities (PC). Methods A retrospective observational study was conducted using secondary data from public Portuguese hospitals, for all patients with a primary diagnosis of AMI (12,213 patients aged 18-80, for the years 2017-18). We used linear and logistic regression to model length of stay (LoS) and in-hospital mortality, respectively. Having at least one psychiatric comorbidity was the explanatory variable, and models were adjusted for age, sex, and the Charlson Comorbidity Index. Results The prevalence of PC was 12.95%. The in-hospital mortality rate was significantly higher in the group with PC (4.43%, OR = 1.372, 95%CI=1.041-1.784), than in the group without PC (3,38%). Stays were significantly longer among those with PC (mean=7.69 days), compared to those without PC (mean=6.87 days; adjusted β-coefficient=0.098, 95%CI=0.056-0.141). Conclusions Patients with AMI and comorbid mental disorders have poorer hospitalization outcomes than those without PC. This emphasizes the importance of promoting effective management strategies for comorbid psychiatric disorder, for instance, by improving the integration of mental health care in general hospitals, and empowering healthcare professionals to recognize and manage patients with PC. Key messages • Psychiatric comorbidity is related to longer inpatient stays and higher mortality risk among patients with AMI. • Efforts to integrate mental health care in general hospitals should be maintained.

Advancing ketamine in the treatment hierarchy for refractory depression.

Evidence indicates that ketamine is highly effective, has a lower side effect profile and is better tolerated compared to many augmentation strategies for refractory depression. This, combined with data on psychiatric treatment outcome mediators, suggests that earlier intervention with ketamine could improve outcomes for patients suffering from refractory depression.

Oral and Long-acting Injectable Aripiprazole in Severe Mental Illness and Substance Use Disorder Comorbidity: An Updated Systematic Review.

Co-occurrence of substance use disorders is frequent in patients with mental health disorders is a condition known as "dual diagnosis". The use of substances worsens the prognosis and lowers the quality of life of psychiatric patients. It also increases the risk of hospitalization and suicide rate. To assess the effects of aripiprazole therapy on substance use and other psychiatric outcomes in dually diagnosed patients. We performed a systematic review conducted on 3 databases PUBMED, SCOPUS, and Web of Science, selecting original studies and analyzing the impact of aripiprazole therapy on dually diagnosed patients. Six hundred and fifty-five articles were founded and, after removing duplicates (n = 274) and applying the exclusion criteria, 12 articles were included in our systematic review. 12 studies were included, among which 6 were Randomized Controlled Trials. The Most frequent psychiatric diagnosis were schizoaffective disorders, schizophrenia, and bipolar disorders. Alcohol and cocaine use disorders were the most used substances. Eleven studies showed a clinical improvement after aripiprazole treatment. 8 studies evaluated craving and found a significant reduction after treatment with aripiprazole. No definitive conclusions can be drawn on substance usage and maintenance of abstinence. The present findings suggest aripiprazole may be associated with reducing substance craving and improving depression, psychosis, and schizoaffective disorders in dually diagnosed patients.

Assessing emergency physicians' competency gaps in caring for acute psychiatric emergencies: a comparative analysis of self-perceived confidence and performance against training program expectations

BackgroundThe increasing trend of patients with mental health conditions seeking emergency care is a global phenomenon. Numerous studies have emphasized the importance of emergency physicians' ability to recognize and manage psychiatric emergencies, both for patient well-being and societal safety nets. With the growing demand for emergency care related to mental health conditions, it is crucial to assess whether emergency physicians possess sufficient confidence and capabilities to adapt to these changes. Against this backdrop, our study aimed to explore the factors influencing emergency physicians' management of acute psychiatric emergencies and to critically evaluate whether current training programs adequately align with societal expectations for psychiatric emergency care.MethodsA cross-sectional survey, disseminated online by the Taiwan Society of Emergency Medicine, targeted 936 attending physicians and 449 residents in 43 Resident Review Committee approved training hospitals in winter 2021. The questionnaire covered participant demographics, skill requirements, and confidence in managing acute psychiatric patients independently. Statistical analyses included descriptive statistics, chi-square tests, medians (IQRs), and Wilcoxon rank-sum tests.ResultsOut of 229 participants, 63.8% were attending physicians, and 81.7% were affiliated with medical centers. Psychiatrists led 69.9% of emergency psychiatric training curricula, and 66.8% reported that their clinical psychiatric training outcomes were assessed by psychiatrists. Clinical seniority, training hospital level, and the average number of patients with an acute psychiatric presentation seen in a daily shift influenced physicians' self-reported confidence in managing acute psychiatric patients independently. Medical center training improved capability in managing psychiatric emergencies in the elderly, while encountering a higher average number of patients with an acute psychiatric presentation seen in a daily EM shift was associated with better performance, especially in managing specific populations.ConclusionsOur nationwide study highlights how clinical seniority, training hospital level, and patient volume per shift influence emergency physicians' confidence in managing acute psychiatric patients. However, there remains room for improvement, particularly in addressing the needs of specific patient populations. These findings underscore the importance of refining training curricula to bridge these gaps and enhance the quality of psychiatric emergency patient care.

Psychiatric and functional correlates of stigma associated with cognitive impairment in schizophrenia

Schizophrenia is the most strongly stigmatized psychiatric diagnosis, with negative stereotypes including assumptions of incompetence and inability to recover. Individuals with cognitive impairment associated with schizophrenia (CIAS) have reported stigma experiences, suggesting that CIAS carries stigma in addition to the stigma associated with schizophrenia as a diagnostic label. While research has established that mental illness stigma more generally is linked with poor psychiatric and functional outcomes, no research has explored correlates of CIAS stigma. This study evaluated cognitive, psychiatric, and functional correlates of CIAS stigma among 54 individuals with schizophrenia spectrum disorders participating in a cognitive remediation trial. Participants with greater estimated cognitive decline reported higher levels of CIAS stigma experiences. Participants who reported higher levels of CIAS stigma also scored higher on a measure of depressive symptom severity. No significant associations were found between CIAS stigma and positive and negative psychosis symptoms or general psychopathology ratings. CIAS stigma was not associated with performance-based functional capacity or ratings of community functioning. Findings suggest that CIAS stigma is linked with the degree of cognitive decline and depressive symptom severity among individuals with schizophrenia spectrum disorders. Additional research is needed to elucidate directionality and the relationship between CIAS stigma and functioning outcomes.

Extracting social support and social isolation information from clinical psychiatry notes: comparing a rule-based natural language processing system and a large language model.

Social support (SS) and social isolation (SI) are social determinants of health (SDOH) associated with psychiatric outcomes. In electronic health records (EHRs), individual-level SS/SI is typically documented in narrative clinical notes rather than as structured coded data. Natural language processing (NLP) algorithms can automate the otherwise labor-intensive process of extraction of such information. Psychiatric encounter notes from Mount Sinai Health System (MSHS, n = 300) and Weill Cornell Medicine (WCM, n = 225) were annotated to create a gold-standard corpus. A rule-based system (RBS) involving lexicons and a large language model (LLM) using FLAN-T5-XL were developed to identify mentions of SS and SI and their subcategories (eg, social network, instrumental support, and loneliness). For extracting SS/SI, the RBS obtained higher macroaveraged F1-scores than the LLM at both MSHS (0.89 versus 0.65) and WCM (0.85 versus 0.82). For extracting the subcategories, the RBS also outperformed the LLM at both MSHS (0.90 versus 0.62) and WCM (0.82 versus 0.81). Unexpectedly, the RBS outperformed the LLMs across all metrics. An intensive review demonstrates that this finding is due to the divergent approach taken by the RBS and LLM. The RBS was designed and refined to follow the same specific rules as the gold-standard annotations. Conversely, the LLM was more inclusive with categorization and conformed to common English-language understanding. Both approaches offer advantages, although additional replication studies are warranted.

Club Drugs and Psychiatric Outcomes: A Descriptive Case Series from Spain

Background: illegal drugs significantly contribute to global health issues, with health complications often occurring not only in regular users with Substance Use Disorders (SUDs) but also in first-time and occasional users. Methods: this study examines five clinical cases from a public hospital in Ibiza, Spain, where patients presented with acute psychiatric symptoms due to recreational drug use. Results: Contrary to previous studies on SUDs, our patients typically had higher education levels and stable employment. Most of them used multiple substances, with cannabis, cocaine, and alcohol being the most frequently used. There was also a common occurrence of consuming drugs with uncertain contents. Upon admission, typical symptoms included aggression, hallucinations, mood swings, and disorientation in time and space. Conclusions: Our findings underscore the significant mental health risks posed by illicit drugs, even for individuals with no prior psychiatric history. Factors like the drug’s potency, frequency and amount of use, past mental health issues, personality traits, and previous traumatic experiences might influence the onset of these symptoms.

Altered Gut Microbiota Patterns in Young Children with Recent Maltreatment Exposure

Background: The brain and the intestinal microbiota are highly interconnected and especially vulnerable to disruptions in early life. Emerging evidence indicates that psychosocial adversity detrimentally impacts the intestinal microbiota, affecting both physical and mental health. This study aims to investigate the gut microbiome in young children in the immediate aftermath of maltreatment exposure. Methods: Maltreatment exposure was assessed in 88 children (ages 3–7) using the Maternal Interview for the Classification of Maltreatment [MICM]. Children were allocated to three groups according to the number of experienced maltreatment categories: no maltreatment, low maltreatment, and high maltreatment exposures. Stool samples were collected and analyzed by 16S rRNA sequencing. Results: Children subjected to high maltreatment exposure exhibited lower alpha diversity in comparison to those with both no and low maltreatment exposure (Simpson Index, Tukey post hoc, p = 0.059 and p = 0.007, respectively). No significant distinctions in beta diversity were identified. High maltreatment exposure was associated with the enrichment of several genera from the class Clostridia (Clostridium, Intestinibacter, Howardella and Butyrivibrio) and the depletion of the genus Phocaeicola (class Bacteriodia). Conclusions: Severe maltreatment exposure is associated with alterations in the gut microbiota of young children. Longitudinal trajectories of intestinal microbiota composition in the context of maltreatment may reveal important insights related to psychiatric and somatic health outcomes.

Association of concussion history with psychiatric symptoms, limbic system structure, and kynurenine pathway metabolites in healthy, collegiate-aged athletes

Psychiatric outcomes are commonly observed in individuals with repeated concussions, though their underlying mechanism is unknown. One potential mechanism linking concussion with psychiatric symptoms is inflammation-induced activation of the kynurenine pathway, which is thought to play a role in the pathogenesis of mood disorders. Here, we investigated the association of prior concussion with multiple psychiatric-related outcomes in otherwise healthy male and female collegiate-aged athletes (N = 212) with varying histories of concussion recruited from the community. Specially, we tested the hypotheses that concussion history is associated with worse psychiatric symptoms, limbic system structural abnormalities (hippocampal volume, white matter microstructure assessed using neurite orientation dispersion and density imaging; NODDI), and elevations in kynurenine pathway (KP) metabolites (e.g., Quinolinic acid; QuinA). Given known sex-effects on concussion risk and recovery, psychiatric outcomes, and the kynurenine pathway, the moderating effect of sex was considered for all analyses. More concussions were associated with greater depression, anxiety, and anhedonia symptoms in female athletes (ps ≤ 0.005) and greater depression symptoms in male athletes (p = 0.011). More concussions were associated with smaller bilateral hippocampal tail (ps < 0.010) and left hippocampal body (p < 0.001) volumes across male and female athletes. Prior concussion was also associated with elevations in the orientation dispersion index (ODI) and lower intracellular volume fraction in several white matter tracts including the in uncinate fasciculus, cingulum-gyrus, and forceps major and minor, with evidence of female-specific associations in select regions. Regarding serum KP metabolites, more concussions were associated with elevated QuinA in females and lower tryptophan in males (ps ≤ 0.010). Finally, serum levels of QuinA were associated with elevated ODI (male and female athletes) and worse anxiety symptoms (females only), while higher ODI in female athletes and smaller hippocampal volumes in male athletes were associated with more severe anxiety and depression symptoms (ps ≤ 0.05). These data suggest that cumulative concussion is associated with psychiatric symptoms and limbic system structure in healthy athletes, with increased susceptibility to these effects in female athletes. Moreover, the associations of outcomes with serum KP metabolites highlight the KP as one potential molecular pathway underlying these observations.

Psychiatric outcomes among COVID-19 egyptian patients at ain shams university quarantine hospitals: A cross-sectional study

BackgroundPsychological repercussions resulting from coronavirus disease 2019 (COVID-19) have been encountered, such as anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD). The study aimed to assess the frequency and severity of PTSD, depression, and anxiety in a sample of Egyptian patients with COVID-19 infection and analyze potential risk factors. The current study is a descriptive cross-sectional, hospital-based study, conducted from August 2020 to June 2021. The sample was selected from patients diagnosed with COVID-19 infection at Ain Shams University hospitals (outpatient clinics and inpatient units). Patients underwent a COVID severity criteria scoring system, structured clinical interview for DSM-IV (SCID-I), PTSD checklist–Civilian Version (PCLC), Beck depression inventory, and Taylor’s manifest anxiety scale.ResultsPTSD was observed in 79.29% of the study sample, 61.43% had depression, and 18.57% had anxiety. The severity of COVID-19 infection was significantly associated with PTSD severity mean scores (P value = 0.027). Furthermore, a significant relationship was observed between the severity of depression and COVID-19 infection severity (P value = 0.028). The number of comorbid medical risk factors demonstrated significance to PTSD severity (P value = 0.014).ConclusionA significant portion of the study’s patients experienced psychiatric consequences following COVID-19 infection, with 79.29% developing PTSD, 61.43% suffering from depression, and 18.57% experiencing anxiety. Various factors, such as the presence of chronic medical illnesses and the number of co-morbid medical risk factors, were observed to contribute to these psychiatric outcomes. Therefore, comprehensive psychiatric assessment and management in COVID-19 patients especially with severe forms of the disease and hospitalized patients are mandatory.

Postpartum Psychiatric Outcomes and Sick Leave After Discontinuing SSRI or SNRI in Pregnancy

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are consistently reported to be discontinued by approximately half of pregnant women. Little is known about how this may be associated with postpartum psychiatric health. To investigate associations of SSRI or SNRI discontinuation in pregnant women with depression or anxiety and psychiatric health and sick leave absence after childbirth. This population-based cohort study was conducted between 2006 and 2019 using data from Swedish population-based registers. Pregnant women with a filled prescription of an SSRI or SNRI in the 90 days before pregnancy without recorded comorbid or severe psychiatric conditions were included. Analyses were performed in November 2023. K-means for longitudinal data was used to cluster trajectories of SSRI and SNRI use during pregnancy, resulting in 2 trajectory groups based on the number of days covered, defined as continued and discontinued use groups. The primary outcome was psychiatric-related hospitalizations by 90 days after childbirth. Secondary outcomes included psychiatric-related outpatient visits, self-harm and suicide, and any-cause mortality by 90 days after childbirth and all outcomes plus sick leave absence by 1.5 years after childbirth. Among 27 773 pregnant women (17 241 aged ≥30 years [62.1%] at childbirth), 13 184 women (47.5%) had discontinued SSRI or SNRI use and 14 589 individuals (52.5%) had continued use. Individuals in the discontinued compared with continued use group were younger (5588 women [42.4%] vs 4944 women [33.9%] aged <30 years), less educated (4281 women [32.5%] vs 5821 women [39.9%] who completed postsecondary education or above), and more likely to have smoked in early pregnancy (1445 individuals [11.0%] vs 1180 individuals [8.1%]), been born in a non-Nordic country (1641 individuals [12.4%] vs 975 individuals [6.7%]), and used anxiolytics (1301 individuals [9.9%] vs 1119 individuals [7.7%]) and hypnotics and sedatives (1609 individuals [12.2%] vs 1510 individuals [10.4%]). Psychiatric-related hospitalizations occurred in 49 individuals (0.4%) in the discontinued vs 59 individuals (0.5%) in the continued use group in the 90 days after childbirth, with an adjusted hazard ratio (aHR) of 1.28 (95% CI, 0.85-1.91), while at 1.5 years after childbirth, the aHR was 0.81 (95% CI, 0.66-1.00). Lower hazard rates for psychiatric-related outpatient visits in the discontinued vs continued use group at 90 days (aHR, 0.59; 95% CI, 0.53-0.66) and 1.5 years (aHR, 0.60; 95% CI, 0.57-0.64) after childbirth were found. No difference in sick leave absence was found; however, individuals who discontinued had fewer days of sick leave by 1.5 years after childbirth than those who continued (mean [SD], 44.6 [70.6] days vs 53.1 [82.3] days). In this study, approximately half of pregnant women discontinued SSRIs or SNRIs, and discontinuation during pregnancy was not associated with adverse psychiatric-related outcomes, including hospitalizations, outpatient visits, suicidal behavior, or sick leave absence in the 90 days or 1.5 years after childbirth.

Impact of COVID-19 on Psychiatric Patients: The Role of Vaccination, Comorbidities, and Biomarkers in Clinical Outcomes

Background/Objectives: The COVID-19 pandemic has posed significant challenges, particularly for individuals residing in psychiatric facilities. This study aims to investigate the impact of COVID-19 on psychiatric patients, focusing on factors such as their vaccination status, comorbidities, medication regimens, and biomarkers like C-reactive protein (CRP) and ferritin. Methods: This retrospective study analyzed 100 patients with confirmed SARS-CoV-2 infections admitted to the private psychiatric clinic “Asclepius of Upper Volos” from March 2020 to March 2023. The data collected included sociodemographic characteristics, vaccination status, symptom severity, medication regimens, and levels of CRP and ferritin. Statistical analyses using IBM SPSS Statistics version 29 included Pearson’s chi-square tests, Student’s t-tests, and a survival time analysis via the log-rank test to assess associations between clinical characteristics and outcomes. Results: Among the participants, 64% were female and 74% received two doses of the COVID-19 vaccine. The majority experienced mild symptoms, with a survival rate of 74%. Statistically significant findings include a higher survival rate among vaccinated individuals (98.6%) versus unvaccinated individuals (1.4%, p &lt; 0.001). Comorbidities like chronic obstructive pulmonary disease (COPD), coronary artery disease, and renal failure were associated with severe symptoms and higher mortality rates. Higher ferritin levels were significantly associated with poorer outcomes, with survivors having a mean ferritin level of 246.2 (SD = 150.3) compared to the 416.9 (SD = 215.9) seen in non-survivors (p &lt; 0.001). Similarly, mean CRP levels were lower in survivors (1.58, SD = 1.96) than in non-survivors (3.46, SD = 2.92), with a p-value of 0.002. Conclusions: The findings underscore the importance of tailored health protocols and continued support for this vulnerable population. Enhanced strategies for managing comorbidities and utilizing biomarkers can aid in better predicting and improving psychiatric patient outcomes.

Comment on: Psychiatric outcomes among survivors of COVID-19

We read with interest the article titled “Six-month psychiatric outcomes among survivors of COVID-19” published in Cukurova Medical Journal by Poyraz et al.. This study showed that anxiety, depression and sleep disorders improved over time, but symptoms continued in severe disease. COVID-19 can affect all organs in the body. Therefore, these processes can be prevented with early diagnosis and treatment. Smoking can couse chronic diseases. Additionally, smoking is one of the most important triggers of anxiety and depression. No information about smoking was found in the study. Obesity can couse sleep disorders. Were the patients body mass indexes checked?

Impact of adverse childhood experiences on risk for internalizing psychiatric disorders in youth at clinical high-risk for psychosis

IntroductionResearch has established that adverse childhood experiences (ACEs) confer risk for psychiatric diagnoses, and that protective factors moderate this association. Investigation into the effect of protective factors in the relationship between ACEs and internalizing disorders (e.g., depression, anxiety) is limited in high-risk groups. The present study investigated the relationship between ACEs and risk for internalizing disorders in youth at clinical high risk for psychosis (CHR-P) and tests the hypothesis that protective factors moderate this relationship. Methods688 participants aged 12–30 (M = 18; SD = 4.05) meeting criteria for CHR-P were administered measures of child adversity, protective factors (SAVRY), and diagnostic assessment (SCID- 5). Logistic regression tested whether ACEs predicted internalizing disorders. Moderation regression analyses determined whether these associations were weaker in the presence of protective factors. Results & ConclusionsHigher levels of ACEs predicted history of depressive disorder (β = 0.26(1.30), p < .001), self-harm/suicide attempts (β = 0.34(1.40), p < .001), and substance use (β = 0.14(1.15), p = .04). Childhood sexual abuse (β = 0.77(2.15), p = .001), emotional neglect (β = 0.38(1.46), p = .05), and psychological abuse (β = 0.42(1.52), p = .04), predicted self- harm/suicide attempts. Sexual abuse (β = 1.00 (2.72), p = .001), and emotional neglect (β = 0.53(1.71), p = .011), were also linked to depressive disorder. There was no association between ACEs and anxiety disorder, and no moderation effect of protective factors in the relationship between ACEs and psychiatric outcomes. These findings add nuance to a growing literature linking ACEs to psychopathology and highlight the importance of investigation into the mechanisms that may buffer this relationship.

Virtual Versus In-Person Follow-up After a Psychiatric Emergency Visit: A Population-Based Cohort Study: Suivi virtuel opposé à en personne après une visite à l’urgence psychiatrique : une étude de cohorte dans la population

Objective With increased utilization of virtual care in mental health, examining its appropriateness in various clinical scenarios is warranted. This study aimed to compare the risk of adverse psychiatric outcomes following virtual versus in-person mental health follow-up care after a psychiatric emergency department (ED) visit. Methods Using population-based health administrative data in Ontario (2021), we identified 28,232 adults discharged from a psychiatric ED visit who had a follow-up mental health visit within 14 days postdischarge. We compared those whose first follow-up visit was virtual (telephone or video) versus in-person on their risk for experiencing either a repeat psychiatric ED visit, psychiatric hospitalization, intentional self-injury, or suicide in the 15–90 days post-ED visit. Cox proportional hazard models generated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), adjusted for age, income quintile, psychiatric hospitalization, and intentional self-injury in the 2 years prior to ED visit. We stratified by sex and diagnosis at index ED visits based on the International Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) coding. Results About 65% ( n = 18,354) of first follow-up visits were virtual, while 35% ( n = 9,878) were in-person. About 13.9% and 14.6% of the virtual and in-person groups, respectively, experienced the composite outcome, corresponding to incidence rates of 60.9 versus 74.2 per 1000 person-years (aHR 0.95, 95% CI 0.89 to 1.01). Results were similar for individual elements of the composite outcome, when stratifying by sex and index psychiatric diagnosis, when varying exposure (7 days) and outcome periods (60 and 30 days), and comparing “only” virtual versus “any” in-person follow-up during the 14-day follow-up. Conclusions and Relevance These results support virtual care as a modality to increase access to follow-up after an acute care psychiatric encounter across a wide range of diagnoses. Prospective trials to discern whether this is due to the comparable efficacy of virtual and in-person care, or due solely to appropriate patient selection may be warranted.

Early life stress induced sex-specific changes in behavior is paralleled by altered locus coeruleus physiology in BALB/cJ mice

Adverse childhood experiences have been associated with many neurodevelopmental and affective disorders including attention deficit hyperactivity disorder and generalized anxiety disorder, with more exposures increasing negative risk. Sex and genetic background are biological variables involved in adverse psychiatric outcomes due to early life trauma. Females in general have an increased prevalence of stress-related psychopathologies beginning after adolescence, indicative of adolescence being a female-specific sensitive period. To understand the underlying neuronal mechanisms potentially responsible for this relationship between genetic background, sex, stress/trauma, and cognitive/affective behaviors, we assessed behavioral and neuronal changes in a novel animal model of early life stress exposure. Male and female BALB/cJ mice that express elevated basal anxiety-like behaviors and differences in monoamine signaling-associated genes, were exposed to an early life variable stress protocol that combined deprivation in early life with unpredictability in adolescence. Stress exposure produced hyperlocomotion and attention deficits (5-choice serial reaction time task) in male and female mice along with female-specific increased anxiety-like behavior. These behavioral changes were paralleled by reduced excitability of locus coeruleus (LC) neurons, due to resting membrane potential hyperpolarization in males and a female-specific increase in action potential delay time. These data describe a novel interaction between sex, genetic background, and early life stress that results in behavioral changes in clinically relevant domains and potential underlying mechanistic lasting changes in physiological properties of neurons in the LC.

Evaluating the distinct effects of body mass index at childhood and adulthood on adult major psychiatric disorders.

Children with high body mass index (BMI) are at heightened risk of developing health issues in adulthood, yet the causality between childhood BMI and adult psychiatric disorders remains unclear. Using a life course Mendelian randomization (MR) framework, we investigated the causal effects of childhood and adulthood BMI on adult psychiatric disorders, including Alzheimer's disease, anxiety, major depressive disorder, obsessive-compulsive disorder (OCD), and schizophrenia, using data from the Psychiatric Genomics Consortium and FinnGen study. Childhood BMI was significantly associated with an increased risk of schizophrenia, while adulthood BMI was associated with a decreased risk of OCD and schizophrenia. Multivariable MR analyses indicated a direct causal effect of childhood BMI on schizophrenia, independent of adulthood BMI and lifestyle factors. No evidence of causal associations was found between childhood BMI and other psychiatric outcomes. The sensitivity analyses yielded broadly consistent findings. These findings highlight the critical importance of early-life interventions to mitigate the long-term consequences of childhood adiposity.

Maternal dietary patterns and offspring behavioral problems.

Mental health problems often begin in early childhood and could predict psychiatric and behavioral outcomes. Prenatal factors such as maternal nutrition have an impact on neurodevelopment. This study aims to investigate the association between maternal dietary patterns and emotional and behavioral problems in 4-year-old children. Within a cohort of 205 mother-child pairs, three maternal dietary patterns were identified: 'Sweet and Superfluous', 'Fish and Vegetables' and 'Meat and Cereals'. Child behavior was evaluated by means of the Child Behavior Checklist 1.5-5 (CBCL 1.5-5), the Teacher's Report Form 1.5-5 (TRF 1.5-5), and the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P). Multivariable analysis determined associations between maternal dietary patterns and their children's behavior. Maternal adherence to the 'Sweet and Superfluous' pattern was positively associated with externalizing and depressive problems in children. The 'Meat and Cereals' pattern was linked to a higher risk for attention, hyperactivity and depressive problems as somatic complaints. Conversely, the 'Fish and Vegetables' pattern was associated with a reduced risk of hyperactivity problems. All these associations were more pronounced in girls than in boys. Maternal diet during pregnancy is associated with the emotional and behavioral development of children at 4 years of age. Previous research on prenatal dietary patterns and children's behavior is inconclusive. In our study, children of mothers who had higher intakes of sugar and processed foods during pregnancy were more likely to have emotional and behavioral problems at age 4, especially girls. A high-quality diet characterized by fish and vegetable consumption during pregnancy was associated with reduced anxiety and hyperactivity problems in girls. Our findings highlight the importance of prenatal nutrition for child neurodevelopment.