Semi-structured Diagnostic Interview Research Articles

Structured clinical interview for diagnosing obsessive-compulsive spectrum disorders.

BackgroundThere are several established structured diagnostic interviews that cover common mental disorders seen in general psychiatry clinics. The administration of more focused diagnostic interviews may be useful in specialty clinics, such as OCD clinics. A semi-structured clinician-administered interview for obsessive-compulsive spectrum disorders (SCID-OCSD) was developed and adapted for DSM-5/ICD-11 obsessive-compulsive and related disorders as well as other putative obsessive-compulsive spectrum conditions. ObjectiveTo introduce a semi-structured diagnostic interview for in-depth assessment of obsessive-compulsive spectrum disorders (OCSDs), and to report on its implementation in adults with primary OCD attending an OCD-specialized unit. MethodsPatients with primary OCD were interviewed using the SCID-OCSD. The SCID-OCSD assesses disorders drawn from several diagnostic categories that share some core features of obsessive-compulsive phenomenology and that are often comorbid in OCD (e.g., obsessive-compulsive related disorders, impulse-control disorders, and a spectrum of compulsive-impulsive conditions such as tics, eating disorders, non-suicidal self-injury, and behavioral addictions. Participants had to be at least moderately symptomatic on the Yale-Brown Obsessive-Compulsive Severity scale (YBOCS, i.e., a total score ≥ 14) to be included in the current study. ResultsOne hundred and one adult patients with current OCD (n = 101, 37 men and 64 women), took part in the study. Forty-two participants (n = 42) had OCD and one or more current or past comorbid OCSDs, with excoriation (skin-picking) disorder (n = 16) and body dysmorphic disorder (n = 14) being the most common. Nine (n = 9) participants reported a history of non-suicidal self-injury, and 6 participants reported a history of comorbid tics. ConclusionsIn OCD clinics, the SCID-OCSD may help diagnose the full range of putative OCSDs, and so facilitate treatment planning and research on these conditions.

Fear of negative evaluation and intolerance of uncertainty: Assessing potential internalizing correlates of eating disorder-related clinical impairment and differences across diagnostic presentations

The Hierarchical Taxonomy of Internalizing Dimensions for Eating Disorders model positions eating disorder (ED) symptoms on an internalizing dimension alongside anxiety and mood symptoms. Symptom dimensions falling under the internalizing subfactors of distress (e.g., social anxiety) and fear/avoidance (e.g., panic, compulsions, checking) may differentially guide treatment. We examined relations between fear of negative evaluation and intolerance of uncertainty (core features of social anxiety and obsessive-compulsive disorder, respectively) and ED-related impairment and potential diagnostic differences. We hypothesized that: (a) fear of negative evaluation and intolerance of uncertainty would be related to ED-related impairment, (b) the relation between fear of negative evaluation and impairment would be strongest among individuals with “binge-eating syndromes” (i.e., bulimia nervosa [BN], binge-eating disorder [BED]), and (c) the relation between intolerance of uncertainty and impairment would be strongest among individuals with “weight-phobic syndromes” (i.e., anorexia nervosa [AN], BN, atypical AN). Participants (N = 236) included children/adolescents and adults evaluated for outpatient ED treatment. Participants completed questionnaires and semi-structured diagnostic interviews. Greater fear of negative evaluation and greater intolerance of uncertainty were related to greater clinical impairment, and the strength of these relations depended on ED diagnosis. Fear of negative evaluation was related to impairment among individuals with AN and atypical AN, and intolerance of uncertainty was related to impairment for individuals with AN, BN, and atypical AN. We identified fear of negative evaluation and intolerance of uncertainty as correlates of clinical impairment, highlighting the potential utility of developing treatments to target these internalizing constructs, especially for individuals with weight-phobic syndromes.

Perinatal anxiety disorders screening study: a study protocol

BackgroundThe anxiety and their related disorders (AD) are the most common of all mental health conditions, and affect approximately 20% of pregnant and postpartum people. They are associated with significant distress and life interference for sufferers, as well as negative consequences for fetal and infant development. At present, little if any routine screening for prenatal AD is being conducted and data regarding the most effective tools to screen for these disorders is lacking. The majority of screening studies suffer from methodological difficulties which undermine the confidence needed to recommend measures for population distribution. The primary purpose of this research is to identify the most accurate self-report tool(s) to screen for perinatal AD.MethodsA large, prospective cohort of pregnant people (N = 1,000) is being recruited proportionally across health service delivery regions in British Columbia (BC). The screening accuracy of a broad range of perinatal AD self-report measures are being assessed using gold standard methodology. Consenting individuals are administered online questionnaires followed by a semi-structured diagnostic interview between 16- and 36-weeks’ gestation, and again between 6 and 20 weeks postpartum. Questionnaires include all screening measures, measures of sleep and unpaid family work, and questions pertaining to demographic and reproductive history, COVID-19, gender role burden, and mental health treatment utilization. Interviews assess all current anxiety disorders, as well as obsessive–compulsive disorder, and posttraumatic stress disorder.DiscussionThis research is in response to an urgent demand for accurate perinatal AD screening tools based on high quality evidence. AD among perinatal people often go unidentified and untreated, resulting in continued suffering and life impairment. Findings from this research will inform healthcare providers, policymakers, and scientists, about the most effective approach to screening for anxiety and related disorders in pregnancy in the postpartum period.

Social zeitgeber and sleep loss as risk factors for suicide in American Indian adolescents.

American Indians / Alaska Natives (AI/AN) bear a high burden of suicide, the reasons for which are not completely understood, and rates can vary by tribal group and location. This article aims to identify circumstances reported by a community group of American Indian adolescent participants to be associated with their depression and/or suicide. American Indian adolescents (n = 360) were recruited from contiguous reservations and were assessed with a semi-structured diagnostic interview. Twenty percent of the adolescents reported suicidal thoughts (ideation, plans), an additional 8% reported a history of suicide attempts, and three deaths due to suicide were reported. Suicidal behaviors and major depressive disorder (MDD) co-occurred and were more common among female adolescents. The distressing events that adolescents most often reported were: death in the family, family disruption, peer relationship problems, and school problems. All of these events were significantly associated with suicidal behaviors, however those with suicidal acts were more likely to report death in the family. Those with MDD but no suicidal behaviors were more likely to report disruptions in the family. Disruptions in falling asleep were also associated with suicidal behaviors and having experienced a death in the family. Disruptions in important relationships, particularly through death or divorce, may be interpreted as a loss or disruption in "social zeitgebers" that may in turn disturb biological rhythms, such as sleep, thus potentially increase the risk for MDD and/or suicide. Prevention programs aimed at ameliorating the impact of disruptions in important relationships may potentially reduce suicidal behaviors in AI/AN adolescents.

High psychological stress levels related to delivery can increase the occurrence of postpartum mental disorders.

The study sought to explore the relationship between high psychological stress levels related to delivery and postpartum mental disorders. A total of 284 parturients were included in the study from July 2021 to January 2022. The stress level at 1 month postpartum was assessed by the Impact of Event Scale-Revised (IES-R). Parturients with an IES-R score ≤ 9 were included in the low psychological stress level group, and those with an IES-R score > 9 were included in the high psychological stress level group. The Edinburgh Postnatal Depression Scale (EPDS), Union Physio-Psycho-Social Assessment Questionnaire (UPPSAQ-70), Symptom Checklist-90 (SCL-90) and Mini-International Neuropsychiatric Interview (M.I.N.I.) were conducted at 42 ± 7 days postpartum to assess the mental health of parturients.The parturients' mental health after birth was assessed by the EPDS, UPPSAQ-70, and SCL-90. Semi-structured diagnostic interviews were conducted at 42 ± 7 days postpartum by using the M.I.N.I. The incidence rate of postpartum mental disorders was 20.42% (58/284), the incidence rates of postpartum depression, anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder were 17.96% (51/284), 11.97% (34/284), 4.58% (13/284) and 1.41% (4/284), respectively, and the comorbidity rate was 58.62% (34/58). A history of mental disorders and pregnancy complications were risk factors for postpartum depression (p = 0.028, p = 0.040, respectively); a history of mental disorders, a lack of physical exercise, partner violence and pregnancy complications were risk factors for postpartum anxiety disorders (p = 0.003, p = 0.007, p = 0.031, p = 0.048, respectively); and the delivery of female infants was a risk factor for postpartum obsessive-compulsive disorder (p = 0.022).The risk of postpartum depression, anxiety disorders and obsessive-compulsive disorder was 9.125 times (95% CI = 3.900 ~ 21.349, p < 0.01), 7.310 times (95% CI = 2.588 ~ 20.649, p < 0.01) and 6.259 times (95% CI = 1.347 ~ 29.093, p < 0.01) higher in postpartum women with high psychological stress levels related to delivery than in those with low psychological stress levels, respectively. The incidence of postpartum mental disorders is high and has a positive correlation with the level of psychological stress. This may lead to a new perspective of the effect of psychological stress on postpartum mental disorders and attract more attention to other mental disorders in addition to postpartum depression.

Personality disorders: the impact of severity on societal costs.

Personality disorders (PDs) are associated with high levels of societal costs. However, previous research has found limited or no evidence of unique contributions of individual PD categories on the overall level of societal costs. Recent research supports the validity of PD as a dimensional construct, and PD severity may be a better predictor of societal costs than specific PD categories. The aim of this study was to explore if PD severity could predict the level of societal costs among treatment-seeking patients with PDs, while controlling for the impact of comorbid mental health and substance use disorders. Four different severity indicators were explored: the number of PDs, the total number of PD criteria, the number of BPD criteria, and the Level of Personality Functioning Scale (LPFS) from the alternative model in DSM-5. Participants (n = 798/794) were retrieved from the quality register of the Norwegian Network for Personality Disorders for the period 2017-2020. Societal costs were assessed using a structured interview covering the six-month period prior to assessment. Diagnoses and diagnostic criteria were determined using a semi-structured diagnostic interview (SCID-5-PD and M.I.N.I), and the LPFS was assessed by the LPFS-Brief Form 2.0 (LPFS-BF 2.0) questionnaire. Statistics included multiple regression analyses. None of the severity indicators were significant predictors of overall societal costs among treatment-seeking patients, and effect sizes were small.

Comparing mental health semi-structured diagnostic interviews and symptom checklists to predict poor life outcomes: an 8-year cohort study from childhood to young adulthood in Brazil

Semi-structured diagnostic interviews and symptom checklists present similar internal reliability. We aim to investigate whether they differ in predicting poor life outcomes in the transition from childhood to young adulthood. For this longitudinal study, we used data from the Brazilian High Risk Cohort Study for Childhood Mental Health Conditions. Eligible participants were aged 6-14 years on the day of study enrolment (January to February, 2010) and were enrolled in public schools by a biological parent in Porto Alegre and São Paulo, Brazil. 2511 young people and their caregivers were assessed at baseline in 2010-11, and 1917 were assessed 8 years later (2018-19; 76·3% retention). Clinical thresholds were derived using semi-structured parent-report interview based on the Diagnostic and Statistical Manual of Mental Disorders, according to the Developmental and Well-being Assessment (DAWBA), and clinical scores as defined by the Child Behavior Checklist (CBCL; T-score ≥70 considered positive caseness). At 8 years, participants were assessed for a composite life-threatening outcome (a composite of death, suicide attempts, severe self-harm, psychiatric inpatient admission, or emergency department visits) and a composite poor life chances outcome (a composite of any criminal conviction, substance misuse, or school dropout). We evaluated the accuracy of DAWBA and CBCL to predict these outcomes. Logistic regression models were adjusted for age, sex, race or ethnicity, study site, and socioeconomic class. DAWBA and CBCL had similar sensitivity, specificity, predictive values, and test accuracy for both composite outcomes and their components. Any mental health problem, as classified by DAWBA and CBCL, was independently associated with the composite life-threatening outcome (DAWBA adjusted odds ratio 1·62, 95% CI 1·20-2·18; CBCL 1·66, 1·19-2·30), but only CBCL independently predicted poor life chances (1·56, 1·19-2·04). Participants classified by both approaches did not have higher odds of the life-threatening outcome when compared with participants classified by DAWBA or CBCL alone, nor for the poor life chances outcome when compared with those classified by CBCL alone. Classifying children and adolescents based on a semi-structured diagnostic interview was not statistically different to symptom checklist in terms of test accuracy and predictive validity for relevant life outcomes. Classification based on symptom checklist might be a valid alternative to costly and time-consuming methods to identify young people at risk for poor life outcomes. Conselho Nacional de Desenvolvimento Científico e Tecnológico; Fundação de Amparo à Pesquisa do Estado de São Paulo; and Medical Research Council, European Research Council. For the Portuguese translation of the abstract see Supplementary Materials section.

1 The Influence of Depression and Anxiety on Working Memory in Children with ADHD

Objective:Previous research has explored the performance of working memory in children with ADHD and individual co-occurring disorders, finding that internalizing disorders such as depression and anxiety, both independently negatively impact working memory performance (Saarinen, Fontell, Vuontela, Carlson, &amp; Aronen, 2015; Kofler, Rapport, Bolden, Sarver, Raiker, &amp; Alderson, 2011; Skogan, Zeiner, Egeland, Rohrer-Baumgartner, Urnes, Reichborn-Kjennerud &amp; Aase, 2013). However, there is limited research on the impact of co-occurring depression and anxiety on working memory, which are common in children with ADHD. When depression is present, parts of the prefrontal cortex regions are hypoactive and therefore lead to impairment in executive functioning abilities (Snyder, 2013). In regard to anxiety, previous literature (Moran, 2016) has found that anxious arousal competes with processes located in the prefrontal cortex leaving limited neural resources for executive functioning skills (Moran, 2016). The current study will evaluate the influences of depression and anxiety on working memory in children with ADHD.Participants and Methods:Participants were from an archived data set, which included 849 individual children ages 7-15 years old and their biological parents, recruited between 2009 and 2015. The 849 children included 76 sibling pairs. Families were part of an ongoing longitudinal study. The children completed a computerized version of a spatial working memory task identical to the spatial span task from CANTAB (De Luca et al., 2003). In regard to verbal working memory, children completed Digit Span from the WISC-IV, including both forward and backward conditions. Depression was measured by the Children’s Depression Inventory, 2nd edition (Kovac, 2004) and anxiety was measured by the Multidimensional Anxiety Scale for Children, 2nd edition (MASC-2) (March, 2012). ADHD was measured by having the parents and teachers complete two questionnaires: the ADHD rating scale (ADHD-RS; DuPaul et al. 1998), the Connor’s Rating Scale, 3rd edition (CRS-R, Connors 2003), and an in person semi-structured diagnostic interview (Kiddie Schedule for Affective Disorders and Schizophrenia -KSADS, Kaufman et al. 1997). A best estimate DSM-IV ADHD (American Psychiatric Association [APA], 1994) diagnosis was established by a multidisciplinary diagnostic team (ADHD diagnosis agreement kappa = .88). On cases where consensus was not achieved, they were excluded from the participant pool, and this became the clinical referred control group for the study.Results:The results indicated that children with ADHD and a co-occurring diagnosis of depression experience more difficulties with working memory abilities than those who do not have a co-occurring diagnosis of depression. Additionally, depression has a greater impact on verbal working memory in children with ADHD than anxiety does alone. This study also found that there were no significant gender differences between children with ADHD who identify as males and females on verbal or visual working memory tasks.Conclusions:The findings of this study indicate the importance of addressing depressive symptoms in children with ADHD. With a holistic understanding of working memory deficits in children with ADHD as well as potential gender differences, caretakers and providers can integrate more effective intervention plans to help mitigate significant working memory deficits.

Screening Accuracy of the Parent-Report Preschool Strengths and Difficulties Questionnaire in Primary Care

ObjectiveTo evaluate the screening test accuracy and reliability of the parent-report preschool Strengths and Difficulties Questionnaire (P-SDQ) in primary care settings. MethodsChildren 24 to 48 months were recruited at scheduled primary care visits in Toronto, Canada. Parents completed the P-SDQ at baseline, 2, and 12 weeks. At 12 weeks, parents were invited to a semistructured diagnostic phone interview, the Preschool Age Psychiatric Assessment (PAPA). Criterion validity between baseline P-SDQ scores (Total Difficulties Score [TDS], internalizing and externalizing subscale) and Diagnostic and Statistical Manual, 5th edition diagnoses on PAPA was evaluated using area under the curve (AUC) and calculating screening test properties (sensitivity and specificity). Test-retest reliability at baseline and 2 weeks was evaluated using intraclass correlation coefficient. ResultsA total of 183 children were enrolled, mean age 39.3 (SD 7.4) months, 46.4% male, 120 (66%) completed P-SDQ at 2 weeks, 107 (58%) completed PAPA at 12 weeks. Of those with a PAPA, 26 (24%) had any psychiatric diagnosis, 17 (16%) had internalizing disorders and 4 (4%) had externalizing disorders. TDS identified any diagnosis with AUC = 0.67 (95% confidence intervals (CI): 0.55, 0.79); internalizing subscale identified internalizing disorders with AUC = 0.61 (95% CI: 0.47, 0.74); externalizing subscale identified externalizing disorders with AUC = 0.77 (95% CI: 0.60, 0.94). Sensitivity and specificity, and test-retest reliability were satisfactory for TDS and externalizing subscale, and less satisfactory for the internalizing subscale. ConclusionsThe externalizing subscale has sufficient accuracy and reliability to identify children aged 2 to 4 years at risk for attention deficit/hyperactivity disorder and disruptive behavior disorders in primary care.

Parent-child agreement on children's psychopathology and the impact of parental depression.

Parental depression increases children's risk of mental illness and may simultaneously impair the detection of children's symptoms. Here we investigate the nature of parent-child agreement of children's psychopathology in children of parents with current (cMD) versus remitted (rMD) major depression. Baseline data from 100 parent-child dyads including healthy children aged 8-17 (M=11.89, SD=2.83) and their parents with a history of depression were analysed. The presence of sub-clinical psychopathology (yes/no) in children was assessed using semi-structured diagnostic interviews with child and parent (K-DIPS). Self- (YSR) and parent-report (CBCL) questionnaires were used to measure the severity of symptoms. Parent-child agreement was calculated using Chi-square tests and Cohen's kappa respectively. We compared whether agreement differed between children of parents with cMD (n=52) versus rMD (n=48). In the interviews parents more frequently reported sub-clinical child psychopathology than the children themselves (χ2 1,100 =4.63, p<0.001, d=0.59). This pattern characterised parents with cMD (χ2 1,52 =7.99, p=0.005; κ=0.582) but not rMD (χ2 1,48 =000, p=0.686; κ=-0.010), a difference which was statistically significant (z=3.14, p<0.001, d=0.66). Since agreement between parents and children about the severity of children's symptoms was particularly poor in families where parents were currently depressed, parental mental illness should be taken into account when assessing youth psychopathology.

Cyber-Victimization /Bullying Among Turkish Adolescents with Attention Deficit Hyperactivity Disorder

ABSTRACT Cyberbullying is a form of deviant behavior, acknowledged as a worldwide mental health issue. Few studies have investigated cyberbullying among youth with attention-deficit hyperactivity disorder (ADHD), a population susceptible to bullying, and associated factors. In this study, we aimed to explore frequency and related factors of cybervictimization/bullying among adolescents with ADHD. We included 92 clinically referred adolescents (14.37 ± 1.78 years) with ADHD. Revised Cyberbullying Inventory and a semi-structured diagnostic interview were used to assess cybervictimization/bullying and psychiatric disorders respectively. 38% of participants (n = 35) were defined as cybervictims and 35.9% (n = 33) as cyberbullies. The symptoms of anxiety and problematic internet use were more severe, and social phobia was more frequent among cybervictims than non-cybervictims. Cybervictimization was associated with being overweight, having generalized anxiety disorder and online gaming. Parent-rated inattention, hyperactivity, and defiant behaviors were significantly more severe and internet addiction scores were higher in cyberbullies compared to non-cyberbullies. Cyberbullying was associated with having generalized anxiety disorder, more severe problematic internet use, and downloading programs. Per our study, a major component of clinical assessment must include questions related to social experiences on the internet. This recommendation is especially valid for adolescents with ADHD with anxiety disorders, high body mass index, and online gamers.

A comparison of linguistic patterns between individuals with current major depressive disorder, past major depressive disorder, and controls in a virtual, psychiatric research interview

Major Depressive Disorder (MDD) is a leading health burden worldwide. Previous research has demonstrated that linguistic analysis of depressed individuals’ written and oral speech has potential as a diagnostic and monitoring biomarker. We sought to determine if the semantic content of speech differs between individuals with current MDD, past MDD, and controls. We recruited 53 volunteers for a simulated telehealth psychiatric intake interview. The sample included 14 individuals with current MDD, 21 with past MDD, and 18controls, all confirmed using a semi-structured diagnostic interview. The manually-transcribed interview transcripts were analyzed utilizing the LIWC-22 dictionary and statistical tests were applied to identify differences in the linguistic patterns between each clinical categorization. When comparing depressed subjects (either current or past) versus controls, significant differences were found for emotional tone, total function words, auxiliary verbs, negative tone, negative emotion, anxiety, sadness, attention, and visual. Individuals with past MDD only differed from those with current MDD in use of analytical thinking and auxiliary verbs. These results indicate that LIWC categories could differentiate current or past depressed subjects from controls, but fewer differences emerged when comparing current and past MDD. Further prospective studies with larger sample sizes are needed to confirm these findings.

Societal costs of personality disorders among treatment-seeking patients in Norway: the relative contribution of specific DSM-5 categories.

Personality disorders (PDs) are associated with high levels of societal costs, regardless of whether a single PD or a broad range of PDs have been studied. However, research on the relative contribution of specific PD-types on societal costs is limited. The aim of this study was to explore the possible contributions of the individual DSM-5 categories of PDs on the level of societal costs and its components (health service costs and productivity loss), while controlling for the impact of comorbid mental health and substance use disorders on these outcomes. Participants (n = 798) were retrieved from the quality register of the Norwegian Network for Personality Disorders-a collaboration of PD-treatment units within specialist mental health services. The patients were referred to treatment in the time-period 2017-2020. Costs were assessed using a structured interview covering the 6-month period prior to assessment. Diagnoses were determined by semi-structured diagnostic interviews (SCID-5-PD and M.I.N.I.). Statistics included multiple regression analyses. The main result was that no specific PD had a unique contribution to the high level ofsocietal costsgenerally found among treatment-seeking patients with PDs. Borderline PD (BPD) was the only PD with significantly higher health service costs than the other PDs, while BPD, avoidant PD, and unspecified PD were independently associated with enhanced productivity loss. The differential cost-effects of specific PDs on the cost componentswere small. Several comorbid mental health and substance use disorders were significant contributors to costs, irrespective of PD status. The results underscore the importance of developing and implementing effective treatments for a broader range of PDs, to reduce the high levels of societal costs associated with all PDs.

Facing Eating Disorder Fears: An Open Trial Adapting Prolonged Exposure to the Treatment of Eating Disorders

Eating disorders (EDs) are maintained by core fears, which lead to avoidance behaviors, such as food avoidance or compensatory behaviors. Previously tested exposure-based treatments for EDs have generally focused on proximal outcomes (e.g., food), rather than addressing core fears (e.g., fear of weight gain and its consequences). The current study tested the feasibility and initial clinical efficacy of 10 sessions of imaginal and in vivo exposure for core ED fears (termed “Facing Eating Disorder Fears”), mainly fear of weight gain and its associated consequences. Participants were 36 adults with anorexia nervosa (AN), bulimia nervosa, or other specified feeding and eating disorders determined by semistructured diagnostic interviews. ED symptoms, fears, and body mass index (BMI) were assessed at pretreatment, posttreatment, and 1-month follow-up. Treatment involved 10 sessions of imaginal and in vivo exposure to ED fears in combination with in vivo exposures to feared and avoided situations as homework. ED symptoms and fears decreased from pre- to posttreatment and at 1-month follow-up. BMI increased significantly from pre- to posttreatment, particularly for those with AN. Effect sizes ranged from small to very large. ED symptoms and fears decreased and BMI increased following exposure. Increases in BMI occurred without any direct intervention on eating, suggesting that weight gain can be achieved without a specific focus on food during ED treatment. Facing Eating Disorder Fears may be a feasible stand-alone intervention for EDs. Future research must test comparative efficacy through randomized controlled trials.

Associations between psychiatric comorbid disorders and executive dysfunctions in hypocretin-1 deficient pediatric narcolepsy type1

Objective/BackgroundPsychiatric symptoms and cognitive deficits add significantly to impairment in academic achievement and quality of life in patients with narcolepsy. The primary aim of this study was to evaluate the prevalence of psychiatric disorders and executive dysfunctions, secondly to explore the association between psychiatric comorbidity, executive dysfunctions, subjective and objective sleep measures, and severity of cerebrospinal fluid (CSF) hypocretin-1 deficiency in pediatric narcolepsy type 1 (PNT1). Patients/MethodsCross-sectional study of 59 consecutively included PNT1 patients (age: 6-20 years; 34:25 girls: boys; 54/59 H1N1 (Pandemrix®)-vaccinated). Core narcolepsy symptoms including subjective sleepiness, polysomnography and multiple sleep latency test results, CSF hypocretin-1 levels, psychiatric disorders (by semistructured diagnostic interview Kaufmann Schedule for Affective Disorders and Schizophrenia Present and Lifetime version (KSADS)), and executive dysfunction (by Behavior Rating of Executive Function (BRIEF)) were assessed. Results52.5% of the patients had one or more psychiatric comorbid disorder, and 64.7% had executive dysfunction in a clinically relevant range, with no sex difference in prevalence, while older age was associated with poorer executive function (p=0.013). Having any psychiatric comorbid disorder was associated with poorer executive functions (p=0.001). CSF hypocretin-1 deficiency severity was significantly associated with presence of psychiatric comorbidity (p=0.022) and poorer executive functions (p=0.030), and poorer executive functions was associated with subjective sleepiness (p=0.009). ConclusionsThe high occurrence of, and association between, psychiatric comorbidity and executive dysfunction underlines the importance of close attention to both these comorbidities in clinical care of NT1.

A descriptive analysis of scoring patterns on clinically relevant questionnaires in 26 adults with diagnosed muscle dysmorphia.

Few studies have recruited adults with a formal diagnosis of muscle dysmorphia (MD), a psychological illness defined by preoccupation that one lacks muscularity and/or leanness, combined with significant functional impairment. This study presented descriptive statistics for a range of clinically relevant questionnaires in one of the largest samples of adults with confirmed diagnoses of MD. We recruited 29 adults who met diagnostic criteria for MD as determined by semi-structured diagnostic interviews and administered a battery of questionnaires assessing MD symptomology, compulsive exercise, and disordered eating. Descriptive statistics were calculated for both total and subscale scores for each questionnaire. Raincloud plots are included to show the distribution of total scores. Of the 29 participants, 26 completed all questionnaires. Mean scores were high across all questionnaires and broadly consistent with results in past studies that also recruited a clinical MD sample. Most participants scored above proposed clinical cut-off scores for questionnaires assessing compulsive exercise and disordered eating. This study adds to the small body of published questionnaire data in clinical MD samples. We stress that questionnaire scores should not be used alone to infer the presence of MD, but could be considered as a useful adjunct to a comprehensive clinical interview.

Relation of serum BDNF to major depression and exploration of mechanistic roles of serum BDNF in a study of vitamin D3 and omega-3 supplements for late-life depression prevention

This study: 1) examined cross-sectional and longitudinal relations of serum brain-derived neurotrophic factor (BDNF) to late-life depression (LLD); 2) tested effects of vitamin D3 and omega-3s on change in BDNF; 3) explored modifying or mediating roles of BDNF on effects of vitamin D3 and omega-3s for LLD. We selected 400 adults from a completed trial of vitamin D3 and omega-3 supplements for LLD prevention. BDNF was measured using an enzyme-linked immunosorbent assay. We administered semi-structured diagnostic interviews and Patient Health Questionnaire [PHQ]-9 to ascertain outcomes at baseline (depression caseness vs. non-caseness; PHQ-9) and at 2-year follow-up among baseline non-depressed individuals (incident vs. no incident MDD; change in PHQ-9). At baseline, while there were no significant differences in mean serum BDNF comparing depression cases and non-cases, being in the lowest vs. highest serum BDNF quartile was significantly associated with worse depressive symptoms. There were no significant longitudinal associations between serum BDNF and LLD. Neither supplement significantly affected change in BDNF; serum BDNF did not appear to modify or mediate treatment effects on LLD. In conclusion, we observed significant cross-sectional but not longitudinal associations between serum BDNF levels and LLD. Vitamin D3 or omega-3s did not alter serum BDNF over 2 years.

Objectively assessed sleep and physical activity in depression subtypes and its mediating role in their association with cardiovascular risk factors

The aims of this study were to investigate the associations of major depressive disorder (MDD) and its subtypes (atypical, melancholic, combined, unspecified) with actigraphy-derived measures of sleep, physical activity and circadian rhythms; and test the potentially mediating role of sleep, physical activity and circadian rhythms in the well-established associations of the atypical MDD subtype with Body Mass Index (BMI) and the metabolic syndrome (MeS). The sample consisted of 2317 participants recruited from an urban area, who underwent comprehensive somatic and psychiatric evaluations. MDD and its subtypes were assessed via semi-structured diagnostic interviews. Sleep, physical activity and circadian rhythms were measured using actigraphy. MDD and its subtypes were associated with several actigraphy-derived variables, including later sleep midpoint, low physical activity, low inter-daily stability and larger intra-individual variability of sleep duration and relative amplitude. Sleep midpoint and physical activity fulfilled criteria for partial mediation of the association between atypical MDD and BMI, and physical activity also for partial mediation of the association between atypical MDD and MeS. Our findings confirm associations of MDD and its atypical subtype with sleep and physical activity, which are likely to partially mediate the associations of atypical MDD with BMI and MeS, although most of these associations are not explained by sleep and activity variables. This highlights the need to consider atypical MDD, sleep and sedentary behavior as cardiovascular risk factors.

Pilot mental health during the COVID-19 pandemic: prevalence rates from semi-structured interviews, and associated vulnerability and protective factors.

Pilots are a unique occupational group who perform a specialised job and face significant stressors. Pilot mental health has received increased attention since Germanwings Flight 9525; however, this research has largely focused on general anxiety, depression, and suicide and relied on a questionnaire-based methodology. This approach is likely to miss various mental health issues that may affect pilot wellbeing, leaving the prevalence of mental health issues in aviation unclear. In addition, the COVID-19 pandemic is likely to have a particular impact on the mental health and wellbeing of pilots, who experienced the devastating effect of COVID-19 on the industry. In the present study, we conducted a comprehensive assessment of 73 commercial pilots during the COVID-19 pandemic, using the DIAMOND semi-structured diagnostic interview and explored possible associated vulnerability and protective factors, including life event stressors, personality, passion, lifestyle factors, and coping strategies. The COVID-19 pandemic had a significant impact on aviation during the time of this study, affecting 95% of participants. The diagnostic results revealed over one third of pilots had symptoms of a diagnoseable mental health disorder. Anxiety disorders were the most commonly found disorders, followed by Attention Deficit Hyperactivity Disorder (ADHD), Adjustment Disorder, and Depressive Disorders. Pilots' high life event scores placed them at an increased risk for the development of stress-related illness, though did not explain which pilots had mental health difficulties in this study. Regression analysis supported a diathesis-stress model for pilot mental health, with disagreeableness and obsessive passion contributing to pilots' development of mental health issues, and nutrition as the most important protective factor. This study, though limited to the COVID-19 pandemic, provides a valuable precedent for a more thorough assessment of pilot mental health, and contributes to the broader understanding of pilot mental health, including suggestions to target factors associated with the development of mental health issues.

Predictors of alcohol and substance use among people with post-traumatic stress disorder (PTSD): findings from the NESARC-III study

PurposeThe self-medication hypothesis suggests people may develop Alcohol Use Disorder (AUD) or Non-Alcohol Substance Use Disorder (NA-SUD) following PTSD as a maladaptive way of coping with PTSD symptoms. Given that an accumulation of trauma experiences and interpersonal trauma increase the likelihood and severity of PTSD, we sought to determine whether the number and type of traumas additionally predict AUD and NA-SUD following PTSD.MethodsWe analysed data from 36,309 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study (M = 45.63 years, SD = 17.53, 56.3% female) who were administered semi-structured diagnostic interviews of trauma exposure and PTSD, AUD and NA-SUD symptoms.ResultsIndividuals with PTSD were more likely to have an AUD or NA-SUD than those without PTSD. Endorsement of a greater number of traumas was associated with greater odds of having PTSD, AUD, or NA-SUD. Experience of interpersonal trauma was related to greater odds of having PTSD and subsequent AUD or NA-SUD than not experiencing interpersonal trauma. Multiple experiences of interpersonal trauma compared to one interpersonal trauma exposure also increased the odds of having PTSD followed by AUD or NA-SUD.ConclusionsInterpersonal trauma and multiple experiences of interpersonal trauma may result in individuals turning to alcohol and substances as a way to alleviate intolerable PTSD symptomology, aligning with the self-medication hypothesis. Our findings highlight the importance of ensuring services and support for interpersonal trauma survivors and for those who have experienced multiple traumas given their increased for unfavourable outcomes.