Psychiatric Treatment Outcome Research Articles

71. Psychiatric Prescription Patterns and Treatment Outcomes in 3q29 Deletion Syndrome

71. Psychiatric Prescription Patterns and Treatment Outcomes in 3q29 Deletion Syndrome

Frontoparietal beta event characteristics are associated with early life stress and psychiatric symptoms in adults

Recent work has found that the presence of transient, oscillatory burst-like events, particularly within the beta band (15–29 Hz), is more closely tied to disease state and behavior across species than traditional electroencephalography (EEG) power metrics. This study sought to examine whether features of beta events over frontoparietal electrodes were associated with early life stress (ELS) and the related clinical presentation. Eighteen adults with documented ELS (n = 18; ELS + ) and eighteen adults without documented ELS (n = 18; ELS-) completed eyes-closed resting state EEG as part of their participation in a larger childhood stress study. The rate, power, duration, and frequency span of transient oscillatory events were calculated within the beta band at five frontoparietal electrodes. ELS variables were positively associated with beta event rate at Fp2 and beta event duration at Pz, in that greater ELS was associated with higher resting rates and longer durations. These beta event characteristics were used to successfully distinguish between ELS + and ELS- groups. In an independent clinical dataset (n = 25), beta event power at Pz was positively correlated with ELS. Beta events deserve ongoing investigation as a potential disease marker of ELS and subsequent psychiatric treatment outcomes.

Real-world depression, anxiety and safety outcomes of intramuscular ketamine treatment: a retrospective descriptive cohort study

BackgroundKetamine has emerged as a promising pharmacotherapy for depression and other mental illnesses, and the intramuscular (IM) administration of ketamine is now offered at many North American outpatient psychiatric clinics. However, a characterization of the outpatient population receiving IM ketamine treatment and an evaluation of the real-world depression, anxiety, and safety outcomes of long-term psychiatric IM ketamine treatment has not been reported. This study aimed to evaluate the clinical characteristics, treatment patterns, clinical outcomes, and adverse events of patients receiving IM ketamine treatment.MethodsPatient data from the electronic health records of a private outpatient psychiatric clinic network in the United States were collected and analyzed retrospectively. Adults with any psychiatric diagnosis who received ketamine treatment only by IM administration from January 2018 to June 2021 were included. A total of 452 patients were included in the cohort.ResultsPatients receiving IM ketamine treatment had a mean of 2.8 (SD 1.4) psychiatric diagnoses. 420 (93%) patients had a diagnosis of major depressive disorder, 243 (54%) patients had a diagnosis of generalized anxiety disorder, and 126 (28%) patients had a diagnosis of post-traumatic stress disorder. Patients received a median of 4 (range 1–48) IM ketamine treatments. Median depression scores (PHQ-9) improved 38% from 16.0 (IQR 11.3–21.8) at baseline to 10.0 (IQR 6.0–15.0) at last treatment (p < .001). Median anxiety scores (GAD-7) improved 50% from 14.0 (IQR 8.0–17.0) at baseline to 7.0 (IQR 4.3–11.8) at last treatment (p < .001). With maintenance ketamine treatments, average improvements in depression (PHQ-9) and anxiety (GAD-7) scores of at least 4.7 and 4.9 points were maintained for over 7 months. An adverse event occurred during 59 of 2532 treatments (2.3%).ConclusionsIM ketamine is being utilized to treat psychiatric outpatients with multiple mental illnesses not limited to depression. Average depression and anxiety levels significantly improve throughout IM ketamine treatment and do not regress to baseline during patients’ maintenance treatment phase. Prospective studies are recommended to confirm the long-term effectiveness and safety of IM ketamine.

2.103 A Multi-Site Study to Compare the Outcomes of Psychiatric Treatment of Suicidal Adolescents in Different Treatment Settings During the Pandemic

Suicide is a leading cause of death for adolescents in the United States. The mental health community needs to explore alternative treatments for suicidal patients, including crisis outpatient clinics and telehealth services. The objectives of this study include evaluating the safety (SA1) and effectiveness (SA2) of telehealth Crisis Intervention Services (CIS) and in-person Outpatient Crisis Intervention Clinics (OCICs) relative to the current standard of care, inpatient treatment. A secondary aim (SA3) seeks to assess the patient and parent treatment satisfaction in all 3 groups.

Optimization of Early Diagnosis of Glucose Metabolism Impairment for Patients Receiving Antipsychotic Medications at the Outpatient Psychiatric Clinic of the University Teaching Hospital, Lusaka, Zambia

Introduction: Patients using antipsychotic drugs are more likely than the general population to suffer glucose metabolism dysfunctions. Patients who take antipsychotic drugs, particularly second-generation antipsychotics, are four times more likely to develop overweight, obesity, and diabetes type 2. Failing to recognize these metabolic issues puts an individual at risk of developing cardio-metabolic and others disorders that potentially worsen psychiatric problems. For controlling and enhancing potential psychiatric treatment outcomes, early diagnosis and treatment of glucose metabolism dysfunction are crucial. Objective: To optimize the early diagnosis of glucose metabolism impairments in patients with psychiatric disorders treated with antipsychotic medications. Methodology: This is a descriptive cross-sectional study that was conducted at the outpatient psychiatric clinic of the University Teaching Hospital (Lusaka, Zambia). A systematic sampling method was applied to all patients who were receiving antipsychotic drugs. All participants were checked for their weight, height, Body Mass Index (BMI), waist circumference, random, and fasting blood glucose levels respectively. The results were analyzed by using SPSS software (version 20), while Fisher’s exact test was used to determine the relationship between categorical variables. Results: The proportion of individuals with impaired fasting blood glucose levels found in this study was 11.1% and that of individuals with diabetes was 10.0% respectively which is higher compared to the general population. Patients who were receiving second-generation antipsychotics showed a slightly higher proportion of impaired fasting blood glucose levels compared to those on conventional antipsychotic medications. Conclusion: The glucose metabolism deficit in patients with psychotic disorders was found to be high. Patients of both sexes had an equal chance of developing the problem, though females had a higher proportion as compared to males, and it is not time-dependent. Older patients showed a higher proportion of impaired fasting blood glucose levels compared to younger ones. It is recommended that basic screening measures of glucose metabolism parameters that are simple and cost-effective, like checking weight, BMI, waist circumferences, and regular checking of blood glucose levels, be routine practice in all psychiatric settings before starting antipsychotic medications.

P131. Moment-To-Moment Brain Signal Variability Reliably Predicts Psychiatric Treatment Outcome

Månsson et al., Biological Psychiatry, In press:

Periodontal status and the efficacy of the first-line treatment of major depressive disorder.

ObjectivesThe efficacy of treatment of major depressive disorder (MDD) is not satisfactory. Systemic inflammation may play an important role in MDD pathogenesis and treatment outcomes. Periodontal disease is the systemic inflammatory condition. Its prevalence may be as high as 45%. We aimed to assess the association of periodontal status with the outcome of 3‐month first‐line treatment of MDD with selective serotonin reuptake inhibitors.Material and MethodsWe performed the prospective cohort study during 2018/2019 at Psychiatric Hospital “Sveti Ivan,” Croatia, on a consecutive sample of 43 patients. The outcome was the MDD symptoms severity measured using the Hamilton Depression Rating Scale‐17. The periodontal status was indicated by the clinical attachment loss (CAL).ResultsBaseline periodontal status had a nonlinear significant and clinically relevant association with the MDD treatment outcome (R 2 change of the quadratic term = 0.12; p = 0.027). In patients with good baseline periodontal status the severity of MDD symptoms was significantly improved. When the value of CAL was ≥4.44 mm, indicating the worse periodontal status, further increase in baseline CAL was associated with the worsening of MDD treatment outcomes independently of the baseline depression severity and 14 sociodemographic and clinical predictors of treatment outcome.ConclusionsPeriodontal healthcare is accessible, and should be utilize in an integrative, multidisciplinary approach not only for the sake of psychiatric patients' quality of life and prevention of periodontal disease, but for the sake of the outcomes of psychiatric treatment as well.

Moment-to-Moment Brain Signal Variability Reliably Predicts Psychiatric Treatment Outcome

BackgroundBiomarkers of psychiatric treatment response remain elusive. Functional magnetic resonance imaging (fMRI) has shown promise, but low reliability has limited the utility of typical fMRI measures (e.g., average brain signal) as harbingers of treatment success. Notably, although historically considered a source of noise, temporal brain signal variability continues to gain momentum as a sensitive and reliable indicator of individual differences in neural efficacy, yet has not been examined in relation to psychiatric treatment outcomes. MethodsA total of 45 patients with social anxiety disorder were scanned twice (11 weeks apart) using simple task-based and resting-state fMRI to capture moment-to-moment neural variability. After fMRI test-retest, patients underwent a 9-week cognitive behavioral therapy. Multivariate modeling and reliability-based cross-validation were used to perform brain-based prediction of treatment outcomes. ResultsTask-based brain signal variability was the strongest contributor in a treatment outcome prediction model (total rACTUAL,PREDICTED = 0.77), outperforming self-reports, resting-state neural variability, and standard mean-based measures of neural activity. Notably, task-based brain signal variability showed excellent test-retest reliability (intraclass correlation coefficient = 0.80), even with a task length less than 3 minutes long. ConclusionsRather than a source of undesirable noise, moment-to-moment fMRI signal variability may instead serve as a highly reliable and efficient prognostic indicator of clinical outcome.

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

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

Do outcomes of psychiatric hospital treatment differ for migrants and non-migrants?

PurposeProviding effective treatment for immigrants is an increasing challenge for mental health services across Europe. Yet, little is known as to whether current practice is associated with different outcomes in migrant and non-migrant patients. We compared outcomes of inpatient psychiatric treatment for migrants and non-migrants in a sample from five European countries.MethodsPatients with psychotic disorders, affective disorders or anxiety/somatisation disorders admitted to routine psychiatric inpatient treatment were assessed in hospitals in Belgium, Germany, Italy, Poland and the United Kingdom. Treatment outcomes were satisfaction with care during hospitalisation, length of stay, readmission to hospital (any and, specifically, involuntary re-hospitalisation), as well as untoward incidents in a 1-year follow-up period. Outcomes were compared between patients born inside (non-migrants) and outside (migrants) the country of treatment, through mixed regression models.ResultsAcross all sites, 985 migrant patients and 6298 non-migrant patients were included. After accounting for the influence of confounding patient characteristics, migrants reported significantly lower treatment satisfaction, but there were no significant differences for length of stay and re-hospitalisations, in general and involuntary ones. Migrants had a lower rate of suicide attempts, but there was no significant difference in other types of untoward incidents in the year following the index admission.ConclusionThe study suggests that migrants are less satisfied with their hospital treatment, there is no evidence that routine inpatient care as currently provided results overall in poorer objective outcomes for migrants than in non-migrant populations.

Autistic Personality Traits and Treatment Outcome for Alcohol Use Disorders.

The importance of personality traits for the outcome of psychiatric treatment, including treatment for alcohol use disorder (AUD), has been widely acknowledged. Also, research on autism spectrum disorders has evolved in recent years, emphasizing that the behavioral traits within these neuropsychiatric disorders exist on a dimension both within and outside the boundaries of psychopathology. In the present study, the relationship between personality traits associated with autistic functioning and level of alcohol use among patients before and after concluded AUD treatment was investigated. The participants (n = 165, diagnosed with AUD) were part of a longitudinal project on AUD treatment. Data from personality questionnaires (Structured Clinical Interview of Personality Disorders II and Temperament and Character Inventory) were used to assess autistic personality traits (APTs) based on behavior within Wing's triad, which were related to background and treatment outcome. The chosen APT items illustrated a personality functioning with an emphasis on social interaction and rigidity. Only certain included questions were indicative of still having a problematic drinking pattern 2.5 years after treatment entry, which adhered to phobic, obsessive-compulsive, and schizoid personality traits, as well as rigidity/stubbornness. Albeit with modest influence, the degree of APTs was associated with heavier drinking at treatment entry, and symptoms relating to social interaction and rigidity were associated with still having a problematic drinking pattern 2.5 years after treatment entry. A higher degree of such traits may result in having problems taking advice from others and establishing treatment alliance, important parts of treatment efficacy, making assessment of such traits relevant to clinicians.

Identification and prevalence of factors associated with the outcome of psychiatric treatment of youths who refuse to attend school

Objectives To assess the prevalence and investigate factors associated with resumption of school attendance by youths who have previously refused to go to school. Methods Between 2012-2018, a retrospective cross-sectional study measured the baseline situation and outcomes after 3 months of treatment at one tertiary child and adolescent psychiatric service of youths who refused to attend school. Sociodemographic, clinical and family characteristics as well as school environment characteristics and child behavior were used to identify possible correlations with short-term outcomes of youths who had refused to attend school. Results A total of 111 patients age 5-18 displayed a refusal to attend school. Of those, 71 patients who could be followed up for at least 3 months were examined. Of those 71 patients, 22 (31%) resumed regular school attendance and 21 patients (29.6%) resumed attending school occasionally. All subjects had been diagnosed with a psychiatric disorder at baseline, and 32.4% had been diagnosed with at least two psychiatric disorders. Multiple logistic regression revealed that younger age below 14.58 years (p = 0.003), having siblings (p = 0.014), living with biological parents (p = 0.018) and having had negative interactions with teachers or learning (p = 0.029) correlated with favorable outcomes. Conclusions Youth who refuse to attend school have a high incidence of psychiatric disorders. Short-term outcomes of psychiatric treatment are fair. Outcomes of treatment of psychiatric disorders are associated with four factors: age, having siblings, living with biological parents, and having had negative interactions with teachers or learning. However, other outcomes eg., emotional/behavioral symptoms, self-efficacy, social adjustment, well-being of the patient/family and global assessment of functioning should also be considered.

Psychanalyse et pharmacopsychologie

ObjectiveAlthough it is easy to portray psychoanalysis and psychopharmacology as separate and contradictory approaches of the psychic phenomena, the aim of this paper is to highlight that the two disciplines have shared a common historical context, some epistemological traits, and even some theoretical alliance at their very beginnings and during the 20th century. MethodsIn order to achieve this objective, the article re-examines through an historical perspective both Emil Kraepelin's very first experimental project of a genuine “pharmacopsychology”, and Sigmund Freud's invention of “metapsychology”, which were formed almost simultaneously. Through an in-depth analysis of the main texts in the Freudian and the Kraepelinian corpus (some of which have not been translated into French), we analyze the theoretical frameworks of the two so-called “fathers” of modern psychiatry, as well as their complex interactions. This leads to explore, as a second step, why Freud himself envisioned with hopeful optimism the coming era of psychopharmacology, and why psychoanalysis initially expressed a positive attitude towards the burgeoning influence of pharmacological psychiatry. ResultsStrikingly, before the shift in our field from the subjectivity-oriented psychiatry to the more scientific model of the biological psychiatry, metapsychology and pharmacopsychology have grown side by side, with many unintended mutual synergies. This is especially true during the 1950s, when psychoanalysts had come to dominate the whole psychiatric field at the same time as psychopharmacology had begun its revival, thanks to the chlorpromazine discovery. The historical examination of this symbiotic relationship existing for a limited time between the two fields leads to understand how and why they interacted together, both from a practical and theoretical points of view. DiscussionAlthough some psychoanalysts simply acknowledged that the new pharmacological medications were indispensable for helping difficult patients make use of psychotherapy, and advocated therefore the integration of psychological and biological treatment modalities, many others intended to offer in addition some psychoanalytic hypothesis for the pharmacological effects, and proposed the metapsychology as a useful explanatory tool for examination of drug effects upon the psychic apparatus. More interestingly, psychoanalytical framework has also contributed to highlight the many oft-neglected clues that speak powerfully to the influence of psychological and interpersonal factors in psychopharmacology. Because the pure pharmacology of drugs can hardly account for all the clinically observable effects, psychoanalysts have invited to acknowledge some extra-pharmacological factors, like the nature of the patient's relationship to the physician and their attitude toward the drug that may play a crucial role in psychiatric treatment outcome. ConclusionsMany interactions encourage a breaking down of barriers, in order to emphasize the psychology of psychopharmacology, and to specify the therapeutic effects that are connected with the use of psychotropic drugs beyond their pharmacologic specificity. Further research needs today to be done – related to patients’ expectancies, treatment preferences, drugs’ prescientific representations, etiological beliefs, and their positive or adverse effects on therapeutic alliance and outcomes – to better understand how nonpharmacologic aspects of medications play a crucial role in psychiatric treatment. This could help to clarify the modalities of the psychological and biological treatments association.

Telephone-Based, Clinician-Guided Self-Help Cognitive Behavioral Therapy for Depression in Parkinson's Disease (dPD): The Responder Cases of "Alice" and "Carl," and the Nonresponder Cases of "Ethan" and "Gary"

Roseanne Dobkin and her colleagues (e.g., Dobkin, Interian, Durland, Gara, &amp; Menza, 2018) have developed a 10-session, individual cognitive-behavioral treatment (CBT) program for treating depression in individuals with Parkinson’s disease (dPD). The program has been found to yield statistically and clinically significant success in both uncontrolled group trial designs and randomized clinical trials—originally in a face-to-face version, and then in a telehealth version, using telephone therapy sessions and guided self-help materials for patients. This latter version is herein called "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short. Applying Fishman, Messer, Edwards, and Dattilio’s (2017) "case studies within psychotherapy trials" methodological model, the present research was designed to complement the group research findings by my conducting systematic, pragmatic case studies (Fishman, 2013) with four patients representative of those in the telehealth studies, given the names of "Alice" (and her caregiver husband "Bob"); "Carl" (and his caregiver wife "Doris"); "Ethan" (and his caregiver wife, "Fay"); and "Gary" (and his caregiver mother, not named). Specifically, Alice and Carl were representative of those patients in the group studies with positive, responsive outcomes; and Ethan and Gary were representative of those patients in the group studies with negative, nonresponsive outcomes. Each case combines (a) quantitative data, comprised of demographic information, psychiatric diagnostic data, neurocognitive data, caregiver distress, and treatment outcome measures; and (b) qualitative data, consisting of recordings of the telephone therapy sessions, my treatment notes, my observations as the therapist, and systematic, post-treatment "Exit Interviews" I conducted with each of the patients and their caregivers about their therapy experience. Each of the four case studies aims (a) to provide a detailed, thickly described portrait of the TH-GSH-dPD treatment process; and (b) to explore the presence and influence of barriers and facilitators of treatment in an idiographic context. Regarding point (b), the following variables that cut across the case studies are explored as appearing to be particularly impactful: patients’ worldviews, patients’ cognitive functioning, caregiver involvement, and homework adherence.

M124. ASSOCIATION OF CHRONIC PHYSICAL MULTIMORBIDITY WITH THE EFFICACY OF TREATMENT IN DIFFERENT SCHIZOPHRENIA SPECTRUM DISORDERS

BackgroundPatients with schizophrenia spectrum disorders (SSD) have higher prevalence of chronic physical illness (CPI) and a substantially reduced life expectancy compared with the general population. Despite the increasing amount of research in this area, the effect on psychiatric treatment outcome is still not clear. Some research reported significant associations between several CPIs and different SSD treatment outcomes, whereas the remaining study did not. The objective of the current study is to assess differences in the association of the number of CPI with the overall number of psychiatric rehospitalization in specific SSD diagnosis.MethodsWe conducted a cross-sectional study of 354 patients diagnosed with SSD (ICD10): 135 schizophrenia, 71 acute and transient psychotic disorder, 57 schizoaffective disorder, 68 unspecified unorganic psychosis, 23 other (persistent delusional disorder, schizotypal disorder). The primary outcome was the association of the number of CPI with the number of psychiatric rehospitalization since the diagnosis, as the surrogate outcome for the treatment success, adjusted for the time from diagnosis, age, and gender of participants.ResultsMean number of CPI adjusted for the time from diagnosis, age, and gender was not significantly nor clinically relevantly different between particular SSD diagnosis (F(5,345)=0.70; p=0.620). It was 1.7 in schizophrenia, 1.5 in acute and transient psychotic disorder, 1.4 in schizoaffective disorder, 1.8 in unspecified unorganic psychosis, 1.0 in persistent delusional disorder and 1.9 in schizotypal disorder. The mean number of CPI adjusted for the same three potential confounders was significantly different between particular SSD diagnosis (F(5,345)=2.78; p=0.018). It was 6.7 in schizophrenia, 3.8 in acute and transient psychotic disorder, 7.3 in schizoaffective disorder, 4.8 in unspecified unorganic psychosis. However, the association of the number of CPI with the psychiatric rehospitalizations, adjusted for the previously stated three confounders, was significant and clinically relevant only in participants diagnosed with schizophrenia. In these participants, an increase of one CPI was associated with the 2.3 (95% CI 1.2 to 3.5) more psychiatric rehospitalizations (p<0.001). In participants diagnosed with other specific SSD the association of the number of CPI was not significantly associated with the number of psychiatric rehospitalizations. Moreover, on this particular sample level, it was negative, meaning that more CPI was associated with the lower number of psychiatric rehospitalization in all other SSD except in the case of unspecified nonorganic psychosis.DiscussionIn this cross-sectional study, we observed that the hypothesis of the effect of the number of CPI on the SSD treatment outcomes is valid only in the case of schizophrenia. Further research is needed to clarify whether additional psychological distress is related to the additional burden of multimorbidity.

Test-retest reliability of fMRI-measured brain activity during decision making under risk

Neural correlates of decision making under risk are being increasingly utilized as biomarkers of risk for substance abuse and other psychiatric disorders, treatment outcomes, and brain development. This research relies on the basic assumption that fMRI measures of decision making represent stable, trait-like individual differences. However, reliability needs to be established for each individual construct. Here we assessed long-term test-retest reliability (TRR) of regional brain activations related to decision making under risk using the Balloon Analogue Risk Taking task (BART) and identified regions with good TRRs and familial influences, an important prerequisite for the use of fMRI measures in genetic studies. A secondary goal was to examine the factors potentially affecting fMRI TRRs in one particular risk task, including the magnitude of neural activation, data analytical approaches, different methods of defining boundaries of a region, and participant motion. For the average BOLD response, reliabilities ranged across brain regions from poor to good (ICCs of 0 to 0.8, with a mean ICC of 0.17) and highest reliabilities were observed for parietal, occipital, and temporal regions. Among the regions that were of a priori theoretical importance due to their reported associations with decision making, the activation of left anterior insula and right caudate during the decision period showed the highest reliabilities (ICCs of 0.54 and 0.63, respectively). Among the regions with highest reliabilities, the right fusiform, right rostral anterior cingulate and left superior parietal regions also showed high familiality as indicated by intrapair monozygotic twin correlations (ranging from 0.66 to 0.69). Overall, regions identified by modeling the average BOLD response to a specific event type (rather than its modulation by a parametric regressor), regions including significantly activated vertices (compared to a whole parcel), and regions with greater magnitude of task-related activations showed greater reliabilities. Participant motion had a moderate negative effect on TRR. Regions activated during decision period rather than outcome period of risky decisions showed the greatest TRR and familiality. Regions with reliable activations can be utilized as neural markers of individual differences or endophenotypes in future clinical neuroscience and genetic studies of risk-taking.

The gut microbiota is associated with psychiatric symptom severity and treatment outcome among individuals with serious mental illness

BackgroundEmerging evidence implicates the gut microbiota in central nervous system functioning via its effects on inflammation, the hypothalamic-pituitary axis, and/or neurotransmission. Our understanding of the cellular underpinnings of the brain-gut relationship is based almost exclusively on animal models with some small-scale human studies. This study examined the relationship between the gut microbiota and psychiatric symptom severity and treatment response among inpatients with serious mental illness. MethodWe collected data from adult inpatients (N = 111). Measures of diagnoses, suicide severity, trauma, depression, and anxiety were collected shortly after admission, while self-collected fecal swabs were collected early in the course of hospitalization and processed using 16S rRNA gene sequencing and whole genome shotgun sequencing methods. ResultsResults indicate that depression and anxiety severity shortly after admission were negatively associated with bacterial richness and alpha diversity. Additional analyses revealed a number of bacterial taxa associated with depression and anxiety severity. Gut microbiota richness and alpha diversity early in the course of hospitalization was a significant predictor of depression remission at discharge. ConclusionsThis study is among the first to demonstrate a gut microbiota relationship with symptom severity among psychiatric inpatients as well as a relationship to remission of depression post-treatment. These findings are consistent with animal models and limited human studies as well as with the broader literature implicating inflammation in the pathophysiology of depression. These findings offer the foundation for further studies of novel therapeutic approaches to the treatment, prevention of, or recurrence of serious mental illness.

A prospective observational study of heroin users in Johannesburg, South Africa: Assessing psychiatric comorbidities and treatment outcomes

BackgroundDespite the rise in heroin use in sub Saharan-Africa opioid agonist maintenance treatment (OAMT) is still not state-funded in South Africa and many other African countries. In South Africa there has been little data published on the profile of heroin users and the outcomes of treatment for those who attend public treatment services. Methods300 heroin users from two state-funded rehabilitation centres in Johannesburg were studied at entry into rehabilitation and 3-months after treatment. Treatment consisted of inpatient detoxification and inpatient psychosocial rehabilitation. Structured interviews measured changes in drug use, psychopathology and criminality post rehabilitation. ResultsMost (65.7%) smoked heroin in combination with cannabis while 29.7% were injecting users. Almost half the sample (49.3%) had at least one mental illness. Of the 252 (84%) participants seen at 3-month follow-up, 6.3% were abstinent of all substances (excluding tobacco), 65.5% had continued heroin use (CHU) and the balance used other substances. At follow-up there were significant decreases in heroin use (p<0.0001) and criminality (p<0.0001). There were however significant increases in alcohol use (p<0.0001), crystalmetamphetamine use (p=0.032) and the prevalence of current episode of major depression (p<0.0001). Just 11.9% received formal psychosocial treatment after leaving rehabilitation. None were on OAMT and only three participants were on psychotropic medication. None were tested for Hepatitis C during the study period and the majority (53%) did not know their HIV status. ConclusionThere are significant gaps in current treatment services for heroin users in South Africa. Retention in treatment and assessment and management of psychiatric and non-psychiatric comorbidities is low. Services need to be more integrated and should also include the provision of OAMT.

Trajectories of self-reported sleep disturbance across inpatient psychiatric treatment predict clinical outcome in comorbid major depressive disorder and generalized anxiety disorder

BackgroundAs there has been a demonstrated link between sleep disturbance and suicide, the present study investigated the relationship between self-reported sleep disturbance during inpatient psychiatric treatment and clinical outcomes at discharge and six months post-discharge. MethodsParticipants were 2,970 adults receiving care in a long-term inpatient psychiatric hospital. Greater than 90% of inpatients reported at least mild sleep disturbance throughout treatment. Group-based trajectory modeling was used to determine patterns of sleep disturbance changes over time. ResultsParticipants fit into distinct categories based on their trajectories of sleep problems across treatment: No Sleep Problems (10.3% of participants, no sleep problems endorsed over the course of inpatient psychiatric treatment), Resolvers (sleep problems completely resolved over the course of inpatient psychiatric treatment; 10.6%), Non-Responders (did not respond to inpatient psychiatric treatment; 35.7%) and Responders (sleep problems decreased but did not fully resolve over the course of inpatient psychiatric treatment; 43.4%). Individuals with comorbid major depressive disorder and generalized anxiety disorder were significantly more likely to demonstrate higher rates of sleep disturbance throughout inpatient psychiatric treatment and their sleep problems did not respond to treatment as usual (Non-Responders). Further, patients in the Non-Responder group had significantly more suicidal ideation and worse clinical outcomes (higher anxiety, more disability, and lower well-being) at discharge and six months post-discharge, as well as were on more medication including hypnotics throughout treatment. ConclusionsFindings indicate the urgent need to design and implement inpatient psychiatry sleep protocols to not only improve sleep and clinical outcomes, but also reduce the risk for suicide post-discharge.

Clinical and sociodemographic Differences Between Patients with and without Migration Background in a Psychiatric Outpatient Service

A better understanding of specific sociodemographic and clinical factors in patients with migration background may help to significantly improve psychiatric treatment outcome of these patients. Therefore, we investigated these factors in a large sample of psychiatric outpatients. N = 423 psychiatric patients of a large outpatient service were assessed for sociodemographic variables as well as clinical variables including diagnosis, psychopharmacological treatment, treatment duration and current symptom load (SCL-14). We found significant differences between patients with and without migration background in terms of sociodemographic and clinical factors such as education, employment and main diagnose. Patients with migration background had a significantly higher current symptom load, especially for somatic symptoms. The data underline the large differences between patients with and without migration background regarding sociodemographic and clinical factors. These differences should be considered in psychiatric treatment of these patients.