Self-rated Symptoms Research Articles

The three-year outcome of emotional symptoms in clinically referred youth with ADHD and their relationship to neuropsychological functions

BackgroundFurther knowledge is needed regarding long-term outcome of emotional symptoms, and the interplay between these symptoms and neuropsychological functioning in youth with attention deficit hyperactivity disorder (ADHD).ObjectiveWe aimed to explore the effect of performance-based neurocognitive functions and parent-rated behavioral executive functioning (EF) on self-rated and parent-rated internalizing symptoms longitudinally in clinically referred youth with ADHD (n = 137; mean age = 12.4 years). We also aimed to examine the change in self-rated emotional symptoms in the ADHD group and a Control group (n = 59; mean age = 11.9 years).MethodAt baseline, and three years later, parents completed rating scales of their child’s ADHD symptoms (Swanson Nolan Pelham Scale, Version IV – SNAP-IV), emotional symptoms (Five To Fifteen Questionnaire, Strengths, and Difficulties Questionnaire), and EF (Behavior Rating Inventory of Executive Function). At the same time, the child completed self-report measures of Anxiety, Depression, and Anger Inventories (the Beck Youth Inventories) and neurocognitive measures (Conner’s Continuous Performance Test, Version II (CPT-II), Working Memory and Processing Speed composites (Wechsler Intelligence Scales). Statistical analyses were linear and logistic mixed models.ResultsUsing longitudinal data, parent- and self-ratings of emotional symptoms were associated with parent-ratings of EF behavior in youth with ADHD. Plan/organizing deficits were associated with Anxiety and Anger over and above other metacognitive subscales, while Emotional Control was related to Anger over and above other behavior regulation subscales. In the ADHD group, Anger symptoms improved across measuring points. When controlling for age, Anxiety, and Depression symptoms were largely stable in both groups, however at higher levels in the ADHD group. The differences in anxiety and depression symptoms across groups decreased over time.ConclusionsThe current study emphasizes the importance of identification, monitoring, and treatment of emotional symptoms, and behavioral aspects of EF in youth with ADHD.

Fecal microbiota transplantation is associated with improved aspects of mental health of patients with recurrent Clostridioides difficile infections

• FMT is associated with improvements in self-rated health and depressive symptoms. • Mental health improvement after FMT is larger in patients with history of depression. • Mental health improvement was largely independent of the immediate success of FMT. The microbiota of the gut contributes to human mental health through the gut-brain axis. Treatment with fecal microbiota transplantation (FMT) offers the opportunity to explore the effects of modification of the microbiota on mental health in patients with a perturbed gut microbiota after multiple recurrent Clostridioides difficile infections (rCDI). Symptoms of anxiety and depression, as well as self-rated health, happiness and dispositional optimism were assessed pre-FMT ( n = 49), and post-FMT at 4 ( n = 49) and 26 weeks ( n = 34) in 49 rCDI patients, treated with FMT using feces from healthy donors. Patients had a mean age of 68.4 years, and 67.3% were female. Improvements of self-rated health ( p < 0.001) and a decrease in severity of depression ( p < 0.001) and anxiety symptoms ( p = 0.045) were observed 4 weeks after FMT. These improvements persisted until week 26. No changes were found for happiness and dispositional optimism. The improvement of mental health was statistically independent of the immediate success of FMT, though the number of patients who developed a relapse within 2 months after FMT was low. Observational study without a control group. FMT was associated with significant improvements of severity of depression and anxiety symptoms, which persisted until 6 months after FMT. Future larger studies should answer the question whether these effects are associated with clinical recovery, or whether they are partly mediated through gut microbiota changes on psychological wellbeing.

Outcomes of psychiatric interviews and self-rated symptom scales in people on sick leave for common mental disorders: an observational study

ObjectivesTo investigate the correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Secondary aims were to investigate length of sick leave by diagnoses on sick...

Parenting styles and health in mid- and late life: evidence from the China health and retirement longitudinal study

BackgroundsThe impact of relationships in early childhood may be long-lasting and reaching to mid to late life. Limited studies have investigated the associations between parenting style and different aspects of well-being beyond adolescence. The current study aims to examine the association between parenting styles and multiple dimensions of functioning in mid-and later-life adults.MethodsWe used data from China Health and Retirement Longitudinal Study (CHARLS). Generalized Estimating Equation (GEE) was applied to examine the association between retrospective parenting styles/behaviors in childhood and health outcome.ResultsCompared with authoritative style, authoritarian style predicted worse self-rated health (coefficient = − 0.13, P < 0.001), cognitive function (− 0.23, P < 0.05) and depressive symptom (0.87, P < 0.001). Paternal affection was associated with more health outcome in mid- and late life than maternal affection. Only paternal affection was a significant predictor of mid- and late life health among male adults, while both paternal and maternal affection were strong predictors among female adults. Authoritative style was associated more positive health outcomes in mid- and late life among adults with literate parents than those with illiterate parents.ConclusionThis study provides evidence for the link between parenting behaviors in early life stage and physical and psychological functioning in mid- to late adulthood. Authoritative style, and the memory of parental affection, particularly from father and educated parents, could have long-lasting positive influence on children’s physical and mental well-being, which further support the life-course perspective on human development.

A Latent Class Analysis on Symptoms of Prolonged Grief, Post-Traumatic Stress, and Depression Following the Loss of a Loved One.

BackgroundThe loss of a significant other can lead to variety of responses, including prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. The aim of this study was to replicate and extend previous research that indicated that three subgroups of bereaved individuals can be distinguished based one similar post-loss symptom profiles using latent class analysis (LCA). The second aim was to examine whether sociodemographic and loss-related characteristics as well as the extent of meaning making were related to classes with more pervasive psychopathology.MethodsTelephone-based interviews with 433 Dutch and German speaking persons who had lost a significant other at last 6 months earlier were conducted. Self-rated PGD, PTSD, and depression symptoms were assessed. LCA was conducted and correlates of class-membership were examined using the 3step approach.ResultsThe LCA resulted in three distinct classes: a no symptoms class (47%), a moderate PGD, low depression/PTSD class (32%), and a high PGD, moderate depression/PTSD class (21%). A multivariate analysis indicated that female gender, a shorter time since loss, an unexpected loss and less meaning made to a loss were significantly associated with membership to the moderate PGD, low depression/PTSD and high PGD, moderate depression/PTSD class compared to membership to the no symptom class. Losing a child or spouse, a shorter time since loss, and having made less meaning to the loss further distinguished between the high PGD, moderate depression/PTSD symptom class and the moderate PGD, low depression/PTSD class.DiscussionWe found that the majority of individuals coped well in response to their loss since the no symptom class was the largest class. Post-loss symptoms could be categorized into classes marked by different intensity of symptoms, rather than qualitatively different symptom patterns. The findings indicate that perceiving the loss as more unexpected, finding less meaning in the loss, and loss-related factors, such as the recentness of a loss and the loss of a partner or child, were related to class membership more consistently than sociodemographic factors.

Latent classes of sleep quality and related predictors in older adults: A person-centered approach

ObjectivesThis research identified latent classes of sleep quality on the basis of the Pittsburgh Sleep Quality Index (PSQI) among older Chinese adults and investigated whether some influencing factors are associated with these classes. MethodsA total of 1047 older adults were involved in this study. Self-reported questionnaires were used to measure the levels of sleep quality, background variables (demographic factors, socioeconomic status, and life satisfaction), health status (self-rated health, depressive symptoms, and anxiety), social resources (perceived friends’ support and family affective involvement), and psychological resources (sense of coherence and hope). ResultsLatent class analysis revealed four latent classes, namely, poor sleep quality (17.6%), inadequate sleep (13.8%), disturbed sleep (18.2%), and good sleep quality (50.4%) in older adults. Multinomial logistic regression analyses suggested that some of the background variables, all three health-related factors, and all four personal resources predicted group membership. Specifically, age, gender, self-rated health, and hope were significant factors that could predict the membership of all classes. ConclusionThis study revealed four groups of sleep quality and its related predictors in older adults. Our results provided information for tailored interventions that can promote older adults’ sleep quality and prevent a worsened sleep quality unprecedented situation.

Plasma levels of S100B and neurofilament light chain protein in stress-related mental disorders

The pathophysiological changes underlying stress-related mental disorders remain unclear. However, research suggests that alterations in astrocytes and neurons may be involved. This study examined potential peripheral markers of such alterations, including S100B and neurofilament light chain (NF-L). We compared plasma levels of S100B and NF-L in patients with chronic stress-induced exhaustion disorder (SED), patients with major depressive disorder (MDD), and healthy controls. We also investigated whether levels of S100B and NF-L correlated with levels of astrocyte-derived extracellular vesicles (EVs that indicate astrocyte activation or apoptosis) and with symptom severity. Only women had measurable levels of S100B. Women with SED had higher plasma levels of S100B than women with MDD (P < 0.001) and healthy controls (P < 0.001). Self-rated symptoms of cognitive failures were positively correlated with levels of S100B (rs = 0.434, P = 0.005) as were depressive symptoms (rs = 0.319, P < 0.001). Plasma levels of astrocyte-derived EVs were correlated with levels of S100B (rs = 0.464, P < 0.001). Plasma levels of NF-L did not differ between the groups and were not correlated with symptom severity or EV levels. Thus, long-term stress without sufficient recovery and SED may be associated with raised plasma levels of S100B, which may be evidence of pathophysiological changes in astrocytes. The findings also support the hypothesis that plasma levels of S100B are associated with cognitive dysfunction.

Perceived healthcare discrimination and well-being among older adults in the United States and Brazil

Despite well-documented evidence illustrating the relationship between discrimination and health, less is known about the influence of unfair treatment when receiving medical care. Moreover, our current knowledge of cross-national and racial variations in healthcare discrimination is limited in aging populations. This article addresses these gaps using two harmonized data sets of aging populations to clarify the relationship between healthcare discrimination and health in the United States and Brazil. We use nationally representative, harmonized data from the Health and Retirement Study in the United States and the Brazilian Longitudinal Study of Aging to examine and compare perceived discrimination in the healthcare setting and its relationship to self-rated health, depression diagnosis, and depressive symptoms across national contexts. Using Poisson regression models and population attributable risk percent estimates, we found that aging adults reporting healthcare discrimination were at higher risk of poor self-rated health, diagnosed depression, and depressive symptoms. Our results also suggest that reducing perceived healthcare discrimination may contribute to improved self-rated health and mental well-being in later life across racialized societies. In two comparative settings, we highlight the differential impact of healthcare discrimination on self-rated health and depression. We describe the implications of our study's findings for national public health strategies focused on eliminating discrimination in the healthcare setting, particularly among aging countries.

Effects of two types of exercise training on psychological well-being, sleep and physical fitness in patients with high-grade glioma (WHO III and IV)

BackgroundThere is evidence that regular exercise training has the potential to improve psychological well-being among cancer survivors. However, limited findings are available for individuals with high-grade glioma (HGG; WHO grade III and IV) after neurosurgery and undergoing radiochemotherapy. Given this, endurance and strengths training were employed to investigate their impact on symptoms of depression, feelings of stress and anxiety, fatigue, insomnia, and physical fitness, compared to an active control condition. MethodsA total of 29 patients (M = 52.07, SD = 12.45, 55.2% women) participated in this randomized controlled trial (RCT). After neurosurgical treatment and during adjuvant radiotherapy and chemotherapy or combined radiochemotherapy, patients were randomly assigned to the following conditions: Endurance training (n = 10); strengths training (n = 11); active control condition (n = 8). At baseline, three weeks and six weeks later at the end of the study physical fitness was objectively measured with a 6-min walk test (6MWT) and a handgrip test. Participants completed a series of questionnaires covering sociodemographic information, symptoms of depression, stress, anxiety, fatigue, and insomnia. Further, experts rated participants’ severity of symptoms of depression. ResultsOver time and compared to the strengths and active control condition, self-rated symptoms of depression, state and trait anxiety, stress and insomnia decreased in the endurance condition. Over time and compared to the endurance and active control condition, no changes on symptoms of depression, anxiety, stress, or insomnia were observed in the strengths condition. Over time and compared to the endurance and strengths condition, symptoms of depression (self-ratings), stress, insomnia and fatigue decreased in the active control condition. Fatigue increased in both exercising conditions. Over time and irrespective from the study condition, physical fitness did neither improve nor decrease. ConclusionsThe pattern of results suggests that endurance training and an active control condition improved dimensions of depression, stress, and anxiety, while mere strengths training appeared to neither improve, nor decrease dimensions of psychological functioning. Further, exercise interventions did not change physical fitness, but increased fatigue. Overall, endurance training and an active control condition appeared to favorably impact on psychological well-being among patients with high-grade glioma after neurosurgery and undergoing radiochemotherapy.

Personality and subjective age: Evidence from six samples.

Subjective age is associated with health-related outcomes across adulthood. The present study examined the cross-sectional and longitudinal associations between personality traits and subjective age. Participants (N > 31,000) were from the Midlife in the United States Study (MIDUS), the Health and Retirement Study (HRS), the National Health and Aging Study (NHATS), the Wisconsin Longitudinal Study Graduate (WLSG) and Siblings (WLSS) samples, and the English Longitudinal Study of Aging (ELSA). Demographic factors, personality traits, and subjective age were assessed at baseline. Subjective age was assessed again in the MIDUS, the HRS, and the NHATS, 4 to almost 20 years later. Across the samples and a meta-analysis, higher neuroticism was related to an older subjective age, whereas higher extraversion, openness, agreeableness, and conscientiousness were associated with a younger subjective age. Self-rated health, physical activity, chronic conditions, and depressive symptoms partially mediated these relationships. There was little evidence that chronological age moderated these associations. Multilevel longitudinal analyses found similar associations with the intercept and weak evidence for an association with the slope in the opposite of the expected direction: Lower neuroticism and higher extraversion, agreeableness, and conscientiousness were related to feeling relatively older over time. The present study provides replicable evidence that personality is related to subjective age. It extends existing conceptualization of subjective age as a biopsychosocial marker of aging by showing that how old or young individuals feel partly reflects personality traits. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Heterogeneity of posttraumatic stress symptoms in bereaved children and adolescents: Exploring subgroups and possible risk factors

Bereaved youths are at risk of developing posttraumatic stress (PTS), but there are large individual differences in presentation and severity of PTS symptoms among bereaved youths. The study sought to identify subgroups based on the distribution of self-rated loss-related PTS symptoms in a sample of 264 bereaved youths (aged 7–18). Based on latent class analysis, we identified three subgroups: no disturbance (37.9%), intermediate disturbance (39.0%) and pervasive disturbance (23.1%). Subgroups differed in PTS severity and symptom configuration. Specifically, avoidance was relatively more pronounced in bereaved youth with no and intermediate PTS disturbance, whereas emotional numbing was relatively more pronounced in bereaved youth with intermediate and pervasive PTS disturbance. Associations between subgroup membership, emotional stability and demographic and loss-related variables were also examined. Multinomial logistic regression indicated that youths in the pervasive disturbance subgroup reported lower emotional stability than youths in the no disturbance subgroup. Other variables were unrelated to subgroup membership. The study highlights the importance of considering the heterogeneity in PTS symptomatology in the diagnoses and treatment of loss-related traumatic stress in bereaved youth. Moreover, it underscores the need for further research on possible risk and protective factors involved in the maintenance and development of this traumatic stress.

Modeling the impact of financial hardship and age on self-rated health and depressive symptoms pre/post the great recession

Stressful life events such as a recession, could be devastating on a macro and micro level. Although there have been a number of articles written examining the health effects of the recession, little is known about age differences in the relationship between financial stressors and health pre and post the 2008 recession. Using the Health and Retirement study, we investigated the relationship between two forms of financial hardships, mental and physical health among middle aged (N = 4403) and older adults) (N = 2709). Our findings indicate that with regard to financial hardships experienced pre/post recessionary periods there are differences by age. Specifically, older adults tend to report having less financial hardship than their younger counterparts. Additionally, reduced medication use due to costs was a significant predictor of poor self-rated health among middle aged participants compared to older adults. These results highlight the selective impact of recessions on certain age groups. They also suggests that economic recessions may also produce short-term procyclical health effects. Future research should focus on the relationship between other sources of financial hardship among middle-aged and older adults pre/post-recession at shorter time intervals.

P 50 The safety and feasibility of deep transcranial magnetic stimulation in patients with Parkinson syndromes and medical refractory symptoms: a retrospective analysis

Introduction: Deep transcranial magnetic stimulation (dTMS) is a relatively novel, non-invasive therapeutic tool whereby magnetic fields are utilized to assert neuromodulatory effects in targeted brain area. The aim of the current study was to investigate the safety and feasibility of dTMS as an add-on treatment for patients with Parkinson syndromes in a retrospective manner. Hypotheses included if the application is safe and not associated with severe adverse reactions; if dTMS can successfully be applied to patients regardless of their diagnosis, age, impairment profile and symptom severity; and to assess the potential short- term effects of this application on patients‘ self- related symptom severity as well as on motor and cognitive and emotional functions. Patients and Methods: Multifaceted patient data of patients with different parkinson syndroms (PD, atypical) (N = 21) were analyzed to examine adverse effects (AEs) as well as short-term effects of the dTMS treatment on patients‘ self-rated symptom severity and on motor, cognitive, and emotional functions obtained in neuropsychological tests and questionnaires. Results: We found dTMS to be safe and generally well tolerated with headache as the most common AE. A large variation was apparent in the rate (50%) and severity ratings ( M = 5.4, SD = 2.6) of the reported AEs, which was not related to the examined patient characteristics nor stimulation parameters. The explorative analysis of the short-term effects revealed a significant decrease in the self-rated main motor symptom severity that were recorded at each stimulation session ( t (18) = -2.06, p = .027), which was more pronounced in PD patients. There were no correlations between the changes in main symptom severity and different stimulation parameters in our sample. Interestingly, older patients reported larger decreases in symptom severity. No significant effect of dTMS could be found on cognition. Depression scores improved, but failed significance. Conclusion: DTMS can be safely administered to patients with Parkinson syndromes with medical refractory symptoms. Moreover, treatment with dTMS can lead to a subjective decrease in the self-rated main symptom severity especially in PD patients.

Health and self-perceived barriers to internet use among older migrants: a population-based study

BackgroundIn older adults, including those with a migrant background, ill health is associated with less internet use. However, it is not known what are the specific self-perceived barriers to internet use among older migrants with different health conditions. The aim of this study was to investigate the associations between different health conditions and self-perceived barriers to internet use among older migrants.MethodsWe used the Care, Health and Ageing of Russian-speaking Minority in Finland (CHARM) study, which is a nationally representative survey of community-dwelling Russian-speaking adults aged ≥50 years living in Finland (N=1082, 57% men, mean age 63.2 years, standard deviation 8.4 years, response rate 36%). Postal survey data were collected in 2019. Health indicators were self-rated health (SRH), depressive symptoms, cognitive functioning, and doctor-diagnosed conditions. Linear regression analyses were used to investigate the associations between health indicators and a summary scale consisting of the following barriers of internet use: (1) internet use is too complicated and hard to learn; (2) having concerns about safety issues; (3) internet use is too expensive; (4) physical limitations hinder the internet use; (5) memory problems hinder the internet use. In addition, the two most commonly reported barriers (the first two) were examined separately using logistic regression analyses. The analyses were adjusted for age, sex, education, marital status, local language proficiency, and income support, and the health conditions, and were performed with weights accounting for the survey design and non-response.ResultsAfter adjustments, spine/back problems (b=0.13; p=0.049), depressive symptoms (b=0.40; p=0.007), and problems in learning new things (b=0.60; p<0.0005) were associated with higher level of overall barriers to internet use. In addition, a number of health conditions were associated with individual barriers, albeit some health conditions appeared protective.ConclusionsIn general, older migrants with declining health experience more barriers to internet use than their counterparts with better health. To provide better access to healthcare for older adults, including older migrants, rapidly changing devices, software and apps need to be modified and adapted for those with specific health-related needs.

Effects of a community-based chronic disease self-management programme on chronic disease patients in Singapore.

The Chronic Disease Self-Management Programme (CDSMP) is a small-group intervention attended by people with chronic diseases and aims to promote self-efficacy and improve health. We adopted this programme to improve population health in the Western region of Singapore. This study aimed to evaluate the association of the CDSMP with various health outcomes for people with chronic disease living in the community. Validated instruments were used to measure various health outcomes. Participants completed baseline questionnaires before the programme. Post-intervention questionnaires were administered 6 months after programme. Primary outcome measures include self-efficacy and self-rated health status while secondary outcomes include several other self-management behaviours and healthcare utilisation. 461 participants attended the baseline questionnaire and 265 participants returned for the post-intervention questionnaire from November 2014 to August 2020. Post intervention, participants had statistically significant improvement in self-efficacy, self-rated health score, self-management behaviours and symptoms. The proportion of participants with depression and medication adherence also improved. There were no statistically significant changes in cognitive symptom management and healthcare utilisation. CDSMP in the community can improve health outcomes and should be standard care for people with chronic disease. It can be an effective way for sustainable chronic disease management in Singapore.

Examining the Reciprocity Between Perceived Discrimination and Health: A Longitudinal Perspective.

This study aims to fill two interrelated knowledge gaps in the extant literature on the association between perceived discrimination and health. First, potential selection bias associated with pre-existing health conditions has rarely been rigorously tested in empirical studies. Second, whether there is a reciprocal relationship between perceived discrimination and health has been underexplored. Using longitudinal data from the Americans' Changing Lives data, waves 3 to 5 (N=1,058), we test the reciprocity between perceived discrimination and health with a formal mediation analysis technique. We also use the Heckman correction to adjust for the potential selection bias associated with attrition. Our analysis indicates that perceived discrimination is associated with poor self-rated health and depressive symptoms even when previous health conditions are considered. Furthermore, net of other confounders, there is a reciprocal relationship between perceived discrimination and depressive symptoms. However, this reciprocity does not hold for self-rated health. These findings indicate that there is a vicious circle between perceived discrimination and mental health. That is, poor mental health may lead to perceived discrimination, and heightened perceived discrimination may subsequently increase depressive symptoms. Sensitivity tests suggest that this reciprocity may vary by gender and race.

Effect of Medical Marijuana Card Ownership on Pain, Insomnia, and Affective Disorder Symptoms in Adults

Despite the legalization and widespread use of cannabis products for a variety of medical concerns in the US, there is not yet a strong clinical literature to support such use. The risks and benefits of obtaining a medical marijuana card for common clinical outcomes are largely unknown. To evaluate the effect of obtaining a medical marijuana card on target clinical and cannabis use disorder (CUD) symptoms in adults with a chief concern of chronic pain, insomnia, or anxiety or depressive symptoms. This pragmatic, single-site, single-blind randomized clinical trial was conducted in the Greater Boston area from July 1, 2017, to July 31, 2020. Participants were adults aged 18 to 65 years with a chief concern of pain, insomnia, or anxiety or depressive symptoms. Participants were randomized 2:1 to either the immediate card acquisition group (n = 105) or the delayed card acquisition group (n = 81). Randomization was stratified by chief concern, age, and sex. The statistical analysis followed an evaluable population approach. The immediate card acquisition group was allowed to obtain a medical marijuana card immediately after randomization. The delayed card acquisition group was asked to wait 12 weeks before obtaining a medical marijuana card. All participants could choose cannabis products from a dispensary, the dose, and the frequency of use. Participants could continue their usual medical or psychiatric care. Primary outcomes were changes in CUD symptoms, anxiety and depressive symptoms, pain severity, and insomnia symptoms during the trial. A logistic regression model was used to estimate the odds ratio (OR) for CUD diagnosis, and linear models were used for continuous outcomes to estimate the mean difference (MD) in symptom scores. A total of 186 participants (mean [SD] age 37.2 [14.4] years; 122 women [65.6%]) were randomized and included in the analyses. Compared with the delayed card acquisition group, the immediate card acquisition group had more CUD symptoms (MD, 0.28; 95% CI, 0.15-0.40; P < .001); fewer self-rated insomnia symptoms (MD, -2.90; 95% CI, -4.31 to -1.51; P < .001); and reported no significant changes in pain severity or anxiety or depressive symptoms. Participants in the immediate card acquisition group also had a higher incidence of CUD during the intervention (17.1% [n = 18] in the immediate card acquisition group vs 8.6% [n = 7] in the delayed card acquisition group; adjusted odds ratio, 2.88; 95% CI, 1.17-7.07; P = .02), particularly those with a chief concern of anxiety or depressive symptoms. This randomized clinical trial found that immediate acquisition of a medical marijuana card led to a higher incidence and severity of CUD; resulted in no significant improvement in pain, anxiety, or depressive symptoms; and improved self-rating of insomnia symptoms. Further investigation of the benefits of medical marijuana card ownership for insomnia and the risk of CUD are needed, particularly for individuals with anxiety or depressive symptoms. ClinicalTrials.gov Identifier: NCT03224468.

The Effect of Acupuncture Combined with Aerobic Exercise for Coronary Heart Disease as Cardiac Rehabilitation.

Background The mortality of coronary heart disease continues to rise. Cardiac rehabilitation intervenes the risk factors of cardiovascular disease, improves cardiopulmonary function, maintains healthy psychology, improves the quality of life of patients, and reduces cardiovascular mortality. Objective To explore the effect of acupuncture combined with aerobic exercise on cardiopulmonary exercise ability, blood lipid, fatty acid oxidation, and psychology in patients with coronary heart disease. Methods Sixty patients with coronary heart disease from February 2018 to October 2020 were randomly divided into two groups: the control group and experimental group. The control group was given an exercise prescription, and the experimental group was given acupuncture combined with an exercise prescription. Before and after the intervention, the cardiopulmonary exercise test, blood lipid, carnitine acyltransferase (CACT), the Self-Rating Somatic Symptom Scale (SSS), the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) of the two groups were compared. Results The PHQ-9 score was better in the experimental group than in the control group. In both groups, after the intervention, the peak oxygen uptake and anaerobic threshold were increased, and blood lipid and PHQ-9 scores were decreased. In the experimental group, the carbon dioxide metabolic equivalent was decreased, CACT was increased, and SSS and GAD-7 scores were decreased, with statistical difference (P < 0.05). Conclusion Acupuncture combined with aerobic exercise can improve the cardiopulmonary exercise ability, increase fatty acid oxidation, decrease blood lipid, and ameliorate anxiety and depression symptoms of patients with coronary heart disease as cardiac rehabilitation.

Extended-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults.

Attention deficit hyperactivity disorder (ADHD) is a psychiatric diagnosis increasingly used in adults. The recommended first-line pharmacological treatment is central nervous system (CNS) stimulants, such as methylphenidate, but uncertainty remains about its benefits and harms. To assess the beneficial and harmful effects of extended-release formulations of methylphenidate in adults diagnosed with ADHD. We searched CENTRAL, MEDLINE, Embase, nine other databases and four clinical trial registries up to February 2021. We searched 12 drug regulatory databases for clinical trial data up to 13 May 2020. In addition, we cross-referenced all available trial identifiers, handsearched reference lists, searched pharmaceutical company databases, and contacted trial authors. Randomised, double-blind, parallel-group trials comparing extended-release methylphenidate formulations at any dose versus placebo and other ADHD medications in adults diagnosed with ADHD. Two review authors independently extracted data. We assessed dichotomous outcomes as risk ratios (RRs), and rating scales and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs). We used the Cochrane risk of bias tool to assess risks of bias, and GRADE to assess the certainty of the evidence. We meta-analysed the data using a random-effects model. We assessed three design characteristics that may impair the trial results' 'generalisability'; exclusion of participants with psychiatric comorbidity; responder selection based on previous experience with CNS stimulants; and risk of withdrawal effects. Our prespecified primary outcomes were functional outcomes, self-rated ADHD symptoms, and serious adverse events. Our secondary outcomes included quality of life, ADHD symptoms rated by investigators and by peers such as family members, cardiovascular variables, severe psychiatric adverse events, and other adverse events. We included 24 trials (5066 participants), of which 21 reported outcome data for this review. We also identified one ongoing study. We included documents from six drug regulatory agencies covering eight trials. Twenty-one trials had an outpatient setting and three were conducted in prisons. They were primarily conducted in North America and Europe. The median participant age was 36 years. Twelve trials (76% of participants) were industry-sponsored, four (14% of participants) were publicly funded with industry involvement, seven (10% of participants) were publicly funded, and one had unclear funding. The median trial duration was eight weeks. One trial was rated at overall unclear risk of bias and 20 trials were rated at overall high risk of bias, primarily due to unclear blinding of participants and investigators, attrition bias, and selective outcome reporting. All trials were impaired in at least one of the three design characteristics related to 'generalisability'; for example, they excluded participants with psychiatric comorbidity such as depression or anxiety, or included participants only with a previous positive response to methylphenidate, or similar drugs. This may limit the trials' usefulness for clinical practice, as they may overestimate the benefits and underestimate the harms. Extended-release methylphenidate versus placebo (up to 26 weeks) For the primary outcomes, we found very low-certainty evidence that methylphenidate had no effect on 'days missed at work' at 13-week follow-up (mean difference (MD) -0.15 days, 95% confidence interval (CI) -2.11 to 1.81; 1 trial, 409 participants) or serious adverse events (risk ratio (RR) 1.43, CI 95% CI 0.85 to 2.43; 14 trials, 4078 participants), whereas methylphenidate improved self-rated ADHD symptoms (small-to-moderate effect; SMD -0.37, 95% CI -0.43 to -0.30; 16 trials, 3799 participants). For secondary outcomes, we found very low-certainty evidence that methylphenidate improved self-rated quality of life (small effect; SMD -0.15, 95% CI -0.25 to -0.05; 6 trials, 1888 participants), investigator-rated ADHD symptoms (small-to-moderate effect; SMD -0.42, 95% CI -0.49 to -0.36; 18 trials, 4183 participants), ADHD symptoms rated by peers such as family members (small-to-moderate effect; SMD -0.31, 95% CI -0.48 to -0.14; 3 trials, 1005 participants), and increased the risk of experiencing any adverse event (RR 1.27, 95% CI 1.19 to 1.37; 14 trials, 4214 participants). We rated the certainty of the evidence as 'very low' for all outcomes, primarily due to high risk of bias and 'indirectness of the evidence'. One trial (419 participants) had follow-up at 52 weeks and two trials (314 participants) included active comparators, hence long-term and comparative evidence is limited. We found very low-certainty evidence that extended-release methylphenidate compared to placebo improved ADHD symptoms (small-to-moderate effects) measured on rating scales reported by participants, investigators, and peers such as family members. Methylphenidate had no effect on 'days missed at work' or serious adverse events, the effect on quality of life was small, and it increased the risk of several adverse effects. We rated the certainty of the evidence as 'very low' for all outcomes, due to high risk of bias, short trial durations, and limitations to the generalisability of the results. The benefits and harms of extended-release methylphenidate therefore remain uncertain.

The Quantified Behavioural Test Plus (QbTest+) in adult ADHD

The Quantified Behavioural Test Plus (QbTest+) is widely used in clinical practice to assess patients with attention-deficit hyperactivity disorder (ADHD). This study mapped its behaviour in a group of adults with ADHD. Does it signal problems with impulsivity, attention and/or activity? To what extent are patients’ self-reported problems reflected in QbTest performance? Does Qb testing foretell the future, as reflected in the patients’ and clinicians’ judgements 4 years later? We here recorded the three QbTest+ cardinals–QbActivity, QbImpulsivity and QbInattention – in 67 consecutive ADHD patients diagnosed in adulthood. Among the 54 patients who medicated as usual on the day of testing, 35 (65%) scored above the clinical cut-off (Q-score ≥ 1.25) on at least one of the QbTest+ cardinals. Out of the 13 patients who suspended medication prior to the test, 11 (85%) scored above the clinical cut-off on at least one of the Qb-variables. There were modest associations between QbTest+ cardinals and symptom self-ratings [Brown ADD scale (BADDS); Adult Self-Report Scale (ASRS)]. Forty-one patients completed a second QbTest+ approximately 4 years after the first. Performance was improved on the follow-up test and fewer patients scored in the clinical range (34%). The scores on the QbInattention cardinal at baseline correlated positively with BADDS and ASRS self-ratings at the 4-year follow-up.