Psychopathological Outcomes Research Articles

Understanding maladaptive daydreaming from the attachment framework: The intertwining roles of parental care, unresolved attachment, depression/anxiety and obsessive-compulsive symptoms.

Maladaptive Daydreaming (MD) is an excessive absorption in vivid fantasies interfering with individuals' daily functioning, which has been associated with adverse psychological outcomes and adult attachment insecurities. However, no study to date has addressed the relationships between MD, parental care, unresolved attachment, and psychological symptoms (depression/anxiety and obsessive-compulsive disorder; OCD) in a sample of young adults. In this study, 1295 young adults (401 males) completed an online survey including the Parental Bonding Instrument, Maladaptive Daydreaming Scale, Adult Unresolved Attachment Questionnaire, and the DSM-5 Level 1 Cross-Cutting Symptom Measure. The results evidenced the differential contribution of maternal and paternal care on individuals' psychological symptoms; whilst higher maternal care was negatively related to OCD symptoms, higher paternal care was negatively linked to depression/anxiety symptoms. A relationship between unresolved attachment, MD and psychopathological symptoms emerged; specifically, MD mediated the relationships between unresolved attachment and depression/anxiety and OCD symptoms. Overall, paternal and maternal care may have distinct roles in predicting individuals' psychopathological outcomes. In the presence of unresolved attachment, MD may represent a dissociative response that allows individuals to deal with negative experiences through psychopathological symptoms. Understanding the specific pathways that lead to different psychopathological outcomes could have important implications in developing preventive clinical interventions.

Prevalence of neurocognitive deficits in patients with first-episode schizophrenia in an African sample and its relationship with dimensions of psychopathology and psychosocial outcome

BackgroundCurrent evidence supports the idea that neurocognitive deficits (NCD) constitute a core dimension of schizophrenia. Studies on longitudinal changes in neurocognition among neuroleptic-naive first-episode schizophrenia (FES) from Africa are uncommon. We aimed to highlight the prevalence of, and changes in NCD among FES on naturalistic treatment follow-up for 8 weeks, and the relationship with psychopathological and psychosocial outcomes.MethodsConsecutive FES and Healthy Control (HC) were recruited. Diagnosis of schizophrenia was based on ICD-10 criteria. The HC (n = 86) consisted of nursing students in the same facility, recruited purposely to match the cases in age and gender. After the baseline assessment, 82 FES were followed up 4-weekly for changes in NCD, psychopathological and psychosocial ratings for a period of 8 weeks, using the 3 alternate forms of the Screen for Cognitive Impairment in Psychiatry (SCIP), the Wisconsin Card Test, the Mini Mental State Examination, as well as the Brief Psychiatric Rating Scale, the WHO Disability Assessment Scale, and the Global Assessment of Functioning scale. The control group was tested only once, and their scores were utilized for comparison with the patients’ scores only at week 8. The prevalence of neurocognitive deficits in the two groups was described using percentages and 95% confidence interval. Predictors of cognitive function was determined using multivariate linear regression.ResultsThe prevalence of any NCD among FES at 8 weeks and HC was 62.9% (95% CI: 51.5%, 74.2%) and 1.2% (95% CI: 0.0%, 6.6%), respectively. With treatment, there was a significant improvement in cognitive function at each interval of follow-up. At week 8, the prevalence of any NCD among patients in remission was 55.1%. Total SCIP scores at week 8 had significant inverse moderate relationship with the dimensions of psychopathology. Conversely, total SCIP score was strongly positively correlated with functioning (rhos= 0.71, p < 0.001) at week 8. At week 8, the baseline predictors of total SCIP score were, duration of untreated psychosis (β = -0.33, p = 0.01, variance = 19.8%), negative symptoms (β = -0.35, p = 0.03, variance = 4.9%) and positive symptoms (β = -0.43, p = 0.01, variance = 4.8%).ConclusionThe high prevalence of NCD when patients were in remission indicates that they are enduring and merit consideration as a domain of psychopathology.

MENTAL HEALTH OUTCOMES IN COVID-19 SURVIVORS: ROLE OF CLINICAL PREDICTORS.

The COVID-19 pandemic had a major worldwide impact resulting in more than 7 million deaths due to COVID-19. Mental health issues, including anxiety, depression, and post-traumatic stress disorder (PTSD) have been observed in COVID-19 survivors worldwide. This study aimed to investigate the psychological impact of COVID-19 survivors three months after discharge from hospital and examine associated risk factors. 186 COVID-19 patients were assessed at baseline and three months after hospital discharge using questionnaires for depression, anxiety, insomnia, and post-traumatic stress symptoms (PTSD). Medical data, including comorbidities, complications, and psychiatric history, were collected, and analyzed. The study found a prevalence of PTSD, anxiety, and depression symptoms of 14%, 14% and 10.8% respectively three months after hospital discharge. Female gender was a risk factor for PTSD (OR 4.54), depression (OR 3.55) and anxiety (OR 3.06). Patients with psychiatric history were at higher risk of depression (OR 8.46) and anxiety (OR 4.00) but not of PTSD. No association was found with other clinical variables including inflammation markers. The prevalence of psychopathological outcomes in COVID-19 survivors in this study was increased compared to the general population and in line with previous research. Female gender and psychiatric history increased the risk of anxiety and depression. The absence of correlation between inflammation or other clinical variables and psychopathological outcome measures is discussed in comparison with prior research. More research is needed to understand these associations and the long-term effects of COVID-19 on mental health.

The Interaction of Polygenic Susceptibility to Stress and Childhood Adversity Dimensions Predicts Longitudinal Trajectories of Stress-Sensitivity.

Stress-sensitivity (SS) is considered a psychobiological trait possibly resulting from the interaction of genetic and environmental factors (GxE). This study examined whether the interaction of SS-related genetic markers with interview-based dimensions of childhood adversity predicted longitudinal trajectories of low versus high SS. Participants were nonclinically-ascertained young adults comprising normative and elevated scores on schizotypy. SS trajectories were defined in a previous report based on three prospective assessments (23.5, 25, 28 years-old) of both retrospective (Perceived Stress Scale; PSS) and momentary (Experience Sampling Methodology; ESM) stress ratings. A total of n=177 and n=165 participants with PSS and ESM stress-sensitivity trajectories, respectively, as well as genetic data, were included in the study. GxE effects between a SS Polygenic Risk Score (PRS-SS) and a Genetic Risk Score of the Hypothalamic Pituitary Adrenal axis (GRS-HPA) with childhood adversity dimensions (Intrafamilial Adversity, Threat and Deprivation) on SS trajectories were examined. Threat was the most consistent predictor of persistently high SS. PRS-SS moderated the association of Threat with high-PSS. GRS-HPA moderated the effects of all adversity dimensions on high-PSS. The interaction of PRS-SS with Deprivation and GRS-HPA with Intrafamilial Adversity predicted trajectories of momentary social stress, but the effects were driven by those with lower genetic susceptibility. Genetic-HPA-axis moderates the effects of all adversity dimensions on persistent SS trajectories, as well as PRS-SS and Threat, particularly for retrospective stress measure. The findings highlight the complex interplay between GxE factors and suggest that PSS may better capture SS trait. Including biologically-meaningful GRS indexing SS and adversity dimensions in future studies using comprehensive stress measures would enhance our knowledge on high SS susceptibility and its relationship with diverse psychopathological outcomes.

Anxiety, depression and acromegaly: a systematic review.

scientific literature highlights risk factors linked to the onset of psychopathology in different medical pathological contexts. Acromegaly is a rare condition, particularly noteworthy due to the associated clinical psychological features. This research aimed at understanding the main psychopathological outcomes related to acromegaly, with particular emphasis to anxiety and depression. In January 2024, in line with PRISMA guidelines, a systematic search based on PubMed, Scopus, Web of Science and PsycInfo was conducted to detect studies considering anxiety, depression and alexithymia in patients suffering from acromegaly. The Keywords used for the search phase were "Acromegaly" AND "Depression" OR "Anxiety" OR "Alexithymia". Fifty-five studies were eligible. Anxiety and depression were significantly present in patients with acromegaly, with prevalence rates variable based on disease status and psycho-diagnostic instruments. None of the included studies reported alexithymia in patients with acromegaly. No significant difference was found regarding anxiety and depressive symptoms in patients with acromegaly in comparison with patients suffering from different pituitary diseases and chronic conditions. Anxiety and depression were associated with lower perceived HR-QoL, presence of comorbidity, joint issues, delayed diagnosis, disease duration and body image concerns. Anxiety and depression may be encountered in patients with acromegaly, impacting HR-QoL and the course of the disease. This systematic review suggests that a deeper evaluation of clinical psychological features in patients suffering from acromegaly is needed. Particularly, the early detection of clinical psychological symptoms may lead to multi-integrate interventions promoting individuals' well-being and a better HR-QoL.

Transient patterns of advanced brain ageing in female adolescents with anorexia nervosa.

Anorexia nervosa is a psychiatric disorder characterised by undernutrition, significantly low body weight and large, although possibly transient, reductions in brain structure. Advanced brain ageing tracks accelerated age-related changes in brain morphology that have been linked to psychopathology and adverse clinical outcomes. The aim of the current case-control study was to characterise cross-sectional and longitudinal patterns of advanced brain age in acute anorexia nervosa and during the recovery process. Measures of grey- and white-matter-based brain age were obtained from T1-weighted magnetic resonance imaging scans of 129 acutely underweight female anorexia nervosa patients (of which 95 were assessed both at baseline and after approximately 3 months of nutritional therapy), 39 recovered patients and 167 healthy female controls, aged 12-23 years. The difference between chronological age and grey- or white-matter-based brain age was calculated to indicate brain-predicted age difference (BrainAGEGM and BrainAGEWM). Acute anorexia nervosa patients at baseline, but not recovered patients, showed a higher BrainAGEGM of 1.79 years (95% CI [1.45, 2.13]) compared to healthy controls. However, the difference was largely reduced for BrainAGEWM. After partial weight restoration, BrainAGEGM decreased substantially (beta = -1.69; CI [-1.93, -1.46]). BrainAGEs were unrelated to symptom severity or depression, but larger weight gain predicted larger normalisation of BrainAGEGM in the longitudinal patient sample (beta = -0.65; CI [-0.75, -0.54]). Our findings suggest that in patients with anorexia nervosa, undernutrition is an important predictor of advanced grey-matter-based brain age, which itself might be transient in nature and largely undetectable after weight recovery.

Neural mechanisms of reward processing in preadolescent irritability: Insights from the ABCD study

Elevated youth irritability is characterized by increased proneness to frustration relative to peers when rewards are blocked, and is a transdiagnostic symptom that predicts multiple forms of psychopathology and poorer socioeconomic outcomes in adulthood. Although mechanistic models propose that irritability is the result of aberrant reward-related brain function, youth irritability as it relates to multiple components of reward processes, including reward anticipation, gain, and loss, has yet to be examined in large, population-based samples. Data from the Adolescent Brain and Cognitive Development (ABCD) baseline sample (N = 5923) was used to examine associations between youth irritability (measured by parent-report) and reward-related brain activation and connectivity in a large, preadolescent sample. Preadolescents (M age = 9.96 years, SD = 0.63) performed the Monetary Incentive Delay task during functional MRI acquisition. In the task, during the anticipation period, participants were informed of the upcoming trial type (win money, lose money, no money at stake) and waited to hit a target; during the feedback period, participants were informed of their success. Whole brain and region of interest (ROI) analyses evaluated task conditions in relation to irritability level. Preadolescents with higher compared to lower levels of irritability demonstrated blunted prefrontal cortex activation in the anticipation period and exaggerated striatum-prefrontal connectivity differences among reward conditions during the feedback period. These effects persisted after adjusting for co-occurring anxiety, depression, and attention-deficit/hyperactivity disorder symptoms. These findings provide evidence for the role of reward salience in pathophysiological models of youth irritability, suggesting a mechanism that may contribute to exaggerated behavioral responses.

Developmental mechanisms linking deprivation and threat to psychopathology and school outcomes.

Decades of evidence have elucidated associations between early adversity and risk for negative outcomes. However, traditional conceptualizations of the biologic embedding of adversity ignore neuroscientific principles which emphasize developmental plasticity. Dimensional models suggest that separate dimensions of experiences shape behavioral development differentially. We hypothesized that deprivation would be associated with higher psychopathology and lower academic achievement through executive function and effortful control, while threat would do so through observed, and parent reported emotional reactivity. In this longitudinal study of 206 mother-child dyads, we test these theories across the first 7 years of life. Threat was measured by the presence of domestic violence, and deprivation by the lack of cognitive stimulation within the parent-child interaction. We used path analyses to test associations between deprivation and threat with psychopathology and school outcomes through cognition and emotional reactivity. We show that children who experienced more deprivation showed poor academic achievement through difficulties with executive function, while children who experienced more threat had higher levels of psychopathology through increased emotional reactivity. These observations are consistent with work in adolescence and reflect how unique adverse experiences have differential effects on children's behavior and subsequently long-term outcomes.

Differences and similarities between children and adolescent exposed to interpersonal traumas with and without Intellectual Disability: An explorative study

BackgroundIndividuals with intellectual disability (ID) are more vulnerable to traumatic and stressful events, increasing their risk of developing post-traumatic stress disorder (PTSD). AimsThis study aimed to investigate differences in psychopathology, post-traumatic symptoms, and adaptive functioning in a sample of Italian children and adolescents with and without ID. It also sought to determine whether the type of interpersonal trauma was associated with distinct psychopathological outcomes. Methods and proceduresSixty-six children and adolescents exposed to interpersonal trauma (physical/sexual abuse, domestic violence, and neglect), were selected and divided into two groups based on the presence or absence of ID. Assessment consisted of structured parent interviews and parent-reported questionnaires. For each scale, comparisons between subtests were performed. Outcomes and resultsChildren and adolescents with ID were more likely to exhibit more severe post-traumatic symptoms, anxiety issues, social problems, and poorer adaptive functioning, with the exception of the practical domain, which appeared to be equally impaired in both groups. In terms of interpersonal trauma typology, exposure to physical/sexual abuse and domestic violence led to greater post-traumatic symptoms compared to neglect. Conclusion and implicationsInterpersonal trauma significantly affects children and adolescents, with or without ID, highlighting the need for tailored treatments for both groups.

Association of Childhood Sexual Abuse with Adolescent's Psychopathology: A Systematic Review and Meta-Analysis.

Childhood Sexual Abuse (CSA) poses a significant risk to mental health, especially among adolescents. This systematic review and meta-analysis investigates the association between CSA and adolescent psychopathology. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we conducted an extensive search across multiple databases, including PubMed, Scopus, PsycINFO, Science Direct, Embase, and ProQuest, resulting in 27,207 observational studies. From this pool, 87 studies (n: 189,393) were included in the qualitative synthesis and 78 studies were included in meta-analysis, discussing CSA and adolescent's psychopathology Random effect model with Cohen's d values were used to analyze data. To assess publication bias, funnel plots, Egger's regression test, and the fill and trim method were employed, with no significant bias found. The results indicated a positive correlation between CSA and adolescent psychopathology, for example, depression, anxiety, PTSD, suicidal ideation, nonsuicidal self-injury, anger, substance use, and sexrelated behaviors (Pooled association: 0.13-0.25, 95% CI [0.04, 0.28]). Subgroup analysis showed the strongest association in clinical samples. Furthermore, the moderator analysis suggested minimal influence of study-level variables, as well as men showing higher levels of anger and suicidal ideation. The positive correlation between CSA and psychopathological outcomes highlights the detrimental effects of CSA on adolescents' mental health. To mitigate these effects, increased awareness, prevention efforts, and targeted interventions are essential.

“You’re Ugly and Bad!“: a path analysis of the interplay between self-criticism, alexithymia, and specific symptoms

AbstractSelf-criticism is a transdiagnostic factor of significant clinical relevance. Research has studied its detrimental role on mental health without discriminating how this differs based on individual psychological functioning. Furthermore, little research has considered the lack of emotional awareness as an essential competence that contributes to dysfunctional self-critical processes and, consequently, to psychopathological outcomes. The objective of the study was to investigate how different forms of self-criticism are associated with specific symptoms, considering social anxiety, obsessive-compulsive, and eating disorder symptoms. Furthermore, we wanted to explore the role of alexithymia in this relationship. The sample comprised 564 subjects (M = 35.12, SD = 12.8), 389 females and 175 males. Participants completed online questionnaires to investigate levels of self-criticism, alexithymia, and specific symptoms. Hierarchical regression and path analyses showed that aspects of self-criticism have different importance in psychopathological features. Furthermore, the subscales of alexithymia differently mediate the relationship between self-criticism and symptomatological features, depending on the type of feature considered (social anxiety, eating or obsessive-compulsive). In light of the results, since self-criticism is a contributing factor to the onset and maintenance of many mental disorders, it becomes important to distinguish its specific characteristics and how they are linked to the disorders. A better understanding of these processes would help to prepare more targeted interventions.

The role of maternal postmigration living difficulties in intergenerational trauma transmission among asylum-seeker mother-child dyads: Exploring complex posttraumatic stress disorder as a mechanism.

Among forcibly displaced people, maternal trauma and stress have been implicated in poor child socioemotional outcomes via intergenerational trauma transmission. This study explored the role of maternal postmigration living difficulties (PMLD) in the pathway linking maternal trauma, trauma-related psychopathology, and child socioemotional outcomes among mother-child dyads seeking asylum in a high-risk urban setting. Participants were East African (Eritrean) mothers (N = 127) of preschool-aged children seeking asylum in Israel. Using moderated mediation analysis, we tested whether and how PMLD may moderate the mediating role of current maternal International Classification of Diseases, 11th revision (ICD-11) posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder disturbances in self-organization (DSO) symptoms between past maternal trauma exposure and current postdisplacement child internalizing and externalizing difficulties. Children's direct exposure to adverse life experiences was controlled for. Maternal PTSD symptoms mediated the association between past maternal trauma exposure and child internalizing difficulties, but not externalizing difficulties, across all levels of current maternal PMLD. However, maternal DSO symptoms mediated internalizing and externalizing child outcomes, but only among mothers reporting high levels of current PMLD. This study provides novel evidence that PMLD may amplify the toxicity of past maternal trauma exposure for poor child socioemotional outcomes via ICD-11 DSO symptoms. The intergenerational transmission pathway via the narrower fear-based ICD-11 PTSD, however, is independent of the degree of maternal PMLD. Findings suggest that policies designed to buffer intergenerational trauma transmission among forcibly displaced people may need to consider the toxicity of PMLD as well as enable mothers to heal from PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Lisdexamfetamine maintenance treatment for binge-eating disorder following successful treatments: randomized double-blind placebo-controlled trial.

Controlled research examining maintenance treatments for responders to acute interventions for binge-eating disorder (BED) is limited. This study tested efficacy of lisdexamfetamine (LDX) maintenance treatment amongst acute responders. This prospective randomized double-blind placebo-controlled single-site trial, conducted March 2019 to September 2023, tested LDX as maintenance treatment for responders to acute treatments with LDX-alone or with cognitive-behavioral therapy (CBT + LDX) for BED with obesity. Sixty-one (83.6% women, mean age 44.3, mean BMI 36.1 kg/m2) acute responders were randomized to LDX (N = 32) or placebo (N = 29) for 12 weeks; 95.1% completed posttreatment assessments. Mixed-models and generalized-estimating equations comparing maintenance LDX v. placebo included main/interactive effects of acute (LDX or CBT + LDX) treatments to examine their predictive/moderating effects. Relapse rates (to diagnosis-level binge-eating frequency) following maintenance treatments were 10.0% (N = 3/30) for LDX and 17.9% (N = 5/28) for placebo; intention-to-treat binge-eating remission rates were 59.4% (N = 19/32) and 65.5% (N = 19/29), respectively. Maintenance LDX and placebo did not differ significantly in binge-eating but differed in weight-loss and eating-disorder psychopathology. Maintenance LDX was associated with significant weight-loss (-2.3%) whereas placebo had significant weight-gain (+2.2%); LDX and placebo differed significantly in weight-change throughout treatment and at posttreatment. Eating-disorder psychopathology remained unchanged with LDX but increased significantly with placebo. Acute treatments did not significantly predict/moderate maintenance-treatment outcomes. Adults with BED/obesity who respond to acute lisdexamfetamine treatment (regardless of additionally receiving CBT) had good maintenance during subsequent 12-weeks. Maintenance lisdexamfetamine, relative to placebo, did not provide further benefit for binge-eating but was associated with significantly better eating-disorder psychopathology outcomes and greater weight-loss.

Life Course Models of Child Maltreatment: Effects on General Psychopathology Outcomes in a Longitudinal Sample.

The study compared life course models (LCM; accumulation, recency, and sensitive period) of child maltreatment and general psychopathology in a large, national longitudinal data set of 1354 youth ages birth-16years (657 boys, 53.2% Black, 59.7% <$40K caregiver income). Previous research has supported the accumulation and recency models, albeit with shorter or fewer time periods of outcome measurement. We extend this work by modeling the impact of combined abuse and neglect allegations on a general psychopathology factor (dysregulation profile). Cross-sectional structural equation models were constructed using LCMs and tested across two-year periods from 4-16years old and compared using Akaike Information Criterion weights. The recency variable generally explained the greatest proportion of variance in psychopathology. Notably, maltreatment more proximal to the time of outcome measurement had the strongest effect, suggesting that more recent maltreatment may have stronger effects on general psychopathology. These results lend support to a recency effect of maltreatment on psychopathology outcomes, although substantive overlaps with the accumulation model are noted.

Circadian lighting effect for inpatients with schizophrenia: A prospective cohort study.

In schizophrenia, nonspecific lighting likely causes sleep timing disturbances, leading to distress and poorer clinical status. However, the effect of exposure to circadian lighting on psychopathology outcome in schizophrenia remains unknown. Hence, this study aimed to develop such an intervention and investigate its impact on schizophrenia. Twenty schizophrenia patients at a psychiatric nursing institute were monitored over 10weeks, with assessments using the Brief Psychiatric Rating Scale (BPRS) and Mini-Mental State Examination (MMSE) conducted at baseline, weeks 3 (T1), 7 (T2), and 10 (T3). Circadian lighting significantly improved BPRS scores between T1-T2 (p<.05) and T1-T3 (p<.001), with affectivity scores also showing significant enhancements postintervention. Notably, female participants exhibited substantial improvements in BPRS scores from T1 to T3 (p<.01), while male participants demonstrated significant gains in MMSE scores from T1 to T2 (p<.01). Circadian lighting presents a promising intervention for improving psychiatric outcomes in schizophrenia, with distinct benefits observed across different psychopathological aspects and genders. These findings underscore the potential of lighting chronotherapy in psychiatric clinical practice and warrant further exploration in related research.

How sexual objectification marks the brain: fMRI evidence of self-objectification and its harmful emotional consequences

Female Sexual Objectification refers to perceiving and treating women based on their body appearance. This phenomenon may serve as a precursor for dysfunctional behaviors, particularly among females prone to self-objectification and experiencing shame emotions. Understanding this challenging trajectory by disclosing its neural consequences may be crucial for comprehending extreme psychopathological outcomes. However, investigations in this sense are still scarce. The present study explores the neural correlates of female participants' experiences of being objectified and their relationship with self-objectification, emotional responses and individual dispositions in self-esteem, emotion regulation abilities and self-conscious emotion proneness. To this aim, 25 female participants underwent an fMRI experimental session while they were exposed to interpersonal encounters with objectifying or non-objectifying men. Participants’ experienced emotions and levels of attention shifted toward their bodies (self-objectification) was reported after each interaction. The results revealed increased brain activity in objectifying contexts, impacting cortical (frontal, occipital and temporal cortex) and subcortical regions (thalamus, and hippocampus) involved in visual, emotion, and social processing. Remarkably, the inferior temporal gyrus emerged as a crucial neural hub associated in opposite ways with self-esteem and the self-conscious emotion of shame, highlighting its role in self-referential processing during social dynamics. This study points out the importance of adopting a neuroscientific perspective for a deeper understanding of sexual objectification, and to shed light on its possible neural consequences.

When, Why and How to Re-challenge Clozapine in Schizophrenia Following Myocarditis.

Clozapine-induced myocarditis (CIM) is among the most important adverse events limiting the use of clozapine as the most effective treatment for schizophrenia. CIM necessitates the immediate termination of clozapine, often resulting in its permanent discontinuation with considerable detrimental effects on patients' psychopathology and long-term outcome. Consequently, a clozapine re-challenge after CIM is increasingly regarded as a viable alternative, with published reports indicating a success rate of approximately 60%. However, published cases of re-challenges after CIM remain limited. Here, we provide a narrative review of the current state of research regarding the epidemiology, pathophysiology, risk factors, diagnosis and clinical management of CIM as well as a synthesis of current recommendations for re-challenging patients after CIM. This includes a step-by-step guide for this crucial procedure based on the current evidence regarding the pathophysiology and risk factors for CIM. Slow dose titration regimes and addressing risk factors including concomitant valproate and olanzapine are crucial both to prevent CIM and to ensure a safe and successful re-challenge. Furthermore, we discuss the utility of C-reactive protein, troponin, N-terminal-pro hormone and brain natriuretic peptide, therapeutic drug-monitoring and cardiac magnetic resonance imaging for CIM screening and diagnosis as well as for post-CIM re-challenges.

Use and consequences of exercise tracking technology on exercise psychopathology and mental health outcomes in adolescents

ABSTRACT Exercise tracking technology use is associated with exercise psychopathology in adolescents; however, research is yet to identify components of such technology that can predict maladaptive exercise at this age. This research assessed the relationship between exercise tracking technology use and exercise psychopathology in adolescents. Development of a new measure of exercise tracking behaviours/attitudes was also conducted. Adolescents (N = 327; aged 12–15, mean = 13.64 years (SD = .95); n = 168 girls) participated in this multi-phase study. Following factor analysis to develop and validate the new measure, relationships between exercise tracking behaviours/attitudes and compulsive exercise were explored. Key components of such technology (e.g. pressure to achieve exercise-related goals) were significantly associated with higher compulsive exercise in adolescents. However, using technology to simply monitor their own exercise behaviours was significantly associated with positive exercise and mental wellbeing outcomes. Prospective research should assess how exercise tracking can predict exercise psychopathology changes and mental wellbeing throughout adolescent development.

Protocol-based assessment and management of first episode psychosis: Comparison of short and medium-term outcomes in psychopathology, quality of life, functioning and family burden across two sites in India

BackgroundStandard assessment and management protocols exist for first episode psychosis (FEP) in high income countries. Due to cultural and resource differences, these need to be modified for application in low-and middle-income countries. AimsTo assess the applicability of standard assessment and management protocols across two cohorts of FEP patients in North and South India by examining trajectories of psychopathology, functioning, quality of life and family burden in both. MethodFEP patients at two sites (108 at AIIMS, North India, and 115 at SCARF, South India) were assessed using structured instruments at baseline, 3, 6 and 12 months. Standard management protocols consisted of treatment with antipsychotics and psychoeducation for patients and their families. Generalised estimating equation (GEE) modelling was carried out to test for changes in outcomes both across and between sites at follow-up. ResultsThere was an overall significant improvement in both cohorts for psychopathology and other outcome measures. The trajectories of improvement differed between the two sites with steeper improvement in non-affective psychosis in the first three months at SCARF, and affective symptoms in the first three months at AIIMS. The reduction in family burden and improvement in quality of life were greater at AIIMS than at SCARF during the first three months. ConclusionsDespite variations in cultural contexts and norms, it is possible to implement FEP standard assessment and management protocols in North and South India. Preliminary findings indicate that FEP services lead to significant improvements in psychopathology, functioning, quality of life, and family burden within these contexts.

Theory of Mind: A Brief Review of Candidate Genes.

Deficits in theory of mind (ToM), known as the ability to understand the other's mind, have been associated with several psychopathological outcomes. The present systematic review aims to summarize the results of genetic studies that investigated gene polymorphisms associated with mentalization performance tasks in children and adults. The systematic review was carried out following PRISMA guidelines, and the literature search was conducted in PubMed and EBSCOhost using the following keywords: 'theory of mind, mentalizing, mindreading' and 'gene, genetic basis'. Nineteen studies met the eligibility criteria for inclusion. Most of the literature focused on the role of DRD4, DAT1, OXTR, OXT, COMT, ZNF804A, AVP, AVPR, SCL6A4, EFHC2, MAO-A, and the family of GTF2I genes in influencing ToM. However, controversial results emerged in sustaining the link between specific genetic polymorphisms and mentalization abilities in children and adults. Available data show heterogeneous outcomes, with studies reporting an association between the same family genes in subjects of the same age and other studies reporting no correlation. This does not allow us to draw any solid conclusions but paves the way for exploring genes involved in ToM tasks.