Severe Symptoms Research Articles

Avoidant/Restrictive Food Intake Disorder (ARFID) Symptoms in Adolescent Patients With Disorders of Gut-Brain Interaction.

Disorders of gut-brain interaction (DGBI) and avoidant/restrictive food intake disorder (ARFID) share clinical characteristics. However, research on the prevalence of ARFID symptoms in youth with DGBI and the clinical presentation of DGBI youth with varying levels of ARFID symptoms is limited. In this cross-sectional observational study, 38 adolescents (range 12-17 years; 71% female) with a diagnosed DGBI receiving treatment at a pediatric gastroenterology clinic and a primary caregiver completed the Nine Item ARFID Screen (NIAS). Gastrointestinal (GI), psychiatric, quality of life (QOL), and weight/growth outcomes were assessed via youth- and caregiver-reported questionnaires, anthropometrics, and a water load test. ARFID symptoms were characterized, and their associations with GI, psychiatric symptoms, QOL, and weight/growth outcomes were analyzed. Clinically significant ARFID symptoms were reported by 42% of youth and 55% of caregivers. ARFID symptoms were associated with more severe GI and psychiatric symptoms, lower QOL, and clinically significant weight loss or faltering growth. While associations became non-significant after false discovery rate correction, the effect sizes were medium to large, clearly demonstrating meaningful associations. Agreements between youth and caregiver NIAS reports were good to excellent. ARFID symptoms are common in adolescents with DGBI and associated with clinical severity. Further elucidating this common co-morbidity and developing guidelines for effective co-management are priorities.

Manual Therapy for Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors: The MANTLE Nonrandomized Clinical Trial.

Late radiation-associated dysphagia (RAD) after head and neck cancer (HNC) treatment is challenging and commonly treatment refractory, with fibrosis stiffening connective tissues and compressing peripheral nerve tracts, contributing to diminished strength and possibly denervation of swallowing muscles. Manual therapy (MT), while common for cancer-related pain and other indications, remains largely unstudied for fibrosis-related late RAD. To determine the feasibility and safety of MT, estimate effect size and durability of MT for associated improvements in cervical range of motion (CROM), and examine functional outcomes after MT in survivors of HNC with fibrosis-related late RAD. This nonrandomized clinical trial, Manual Therapy for Fibrosis-Related Late Effect (MANTLE) Dysphagia in Head and Neck Cancer Survivors, is a prospective, single-institution, pilot, single-arm supportive care trial conducted at a National Comprehensive Cancer Network-designated academic comprehensive cancer center. Participants were adult survivors of HNC who were disease free at 2 or more years after curative-intent radiotherapy with grade 2 or higher fibrosis (per Common Terminology Criteria for Adverse Events version 4.0) and grade 2 or higher dysphagia (per video fluoroscopy Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]). Data were collected June 2018 to July 2021 and analyzed November 2022 to November 2024. MANTLE included 10 hourly MT sessions by lymphedema-certified speech-language pathologists over 6 weeks with a home exercise program. During the subsequent 6-week washout period, participants implemented only the home exercise program, without clinician MT. Primary end points were feasibility (per therapy completion rate, with a 75% target) and safety. Secondary end points included functional outcomes per CROM, dysphagia severity (per DIGEST), maximum interincisal opening (MIO), and validated participant-reported outcomes (PROs). Among 24 survivors of HNC (20 male [83.3%]; median [range] age, 68 [53-80] years), there was a median (range) of 8.9 (2.4-30.2) years after curative-intent radiotherapy. A total of 22 participants (91.7%) completed the 10 prescribed therapy sessions, and 1 participant experienced a severe adverse event. Secondary end points improved among participants who completed the therapy: MIO (r = 0.76; 95% CI, 0.66 to 0.94) and all 6 planes of CROM (eg, cervical extension: r = 0.86; 95% CI, 0.83 to 0.93) improved, with large effect sizes from baseline to after MT. Large to moderate effect sizes were achieved in symptom measures per PROs (eg, lymphedema-fibrosis symptom severity after MT: r = 0.74; 95% CI, 0.63 to 0.99). However, effect sizes were small to moderate or null in uncompensated swallowing outcome measures (eg, MD Anderson Dysphagia Inventory composite score from baseline to after MT: r = 0.38; 95% CI, 0.07 to 0.73). This study found that MT was safe and feasible in long-term survivors of HNC with late RAD and was associated with several functional, physical, and psychosocial gains. This trial may offer insight into next directions to optimize swallowing outcomes by integrating MT into a comprehensive rehabilitation program. ClinicalTrials.gov Identifier: NCT03612531.

Improvement in symptom severity, asthma control, and quality of life in pediatric patients with seasonal allergic rhinitis

Objectives: To evaluate the allergic rhinitis (AR) symptoms, asthma control, and quality of life (QoL) outcomes following treatment in children with seasonal allergic rhinitis (SAR), with and without asthma. Methods: Children diagnosed with SAR and presenting during the pollen season were included in the study. Symptom severity of SAR was assessed using the Total Nasal Symptom Score (TNSS), Total Ocular Symptom Score (TOSS), and Visual Analog Scale (VAS). Asthma control was measured using the Childhood Asthma Control Test (C-ACT), Asthma Control Test (ACT), and CARATkids. Quality of life (QoL) was evaluated using the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire. Data were collected at admission, the first month, and the second month of treatment. Results: Fifty-five children aged 5-16 years with SAR were evaluated of whom twenty three (42%) had asthma. Sensitivities to grass, tree, and weed allergens were observed in 74.5%, 50.9%, and 80% of patients, respectively. During the study period, TNSS, TOSS, and VAS scores significantly decreased (P<0.05 for all). Significant improvements were also observed in CARATkids, C-ACT and ACT scores among SAR patients with asthma (P<0.05 for all). All domains of QoL score showed significant improvement (P<0.001 for all), and positively correlated with TNSS, TOSS, and VAS scores. In SAR patients with asthma, ACT and C-ACT scores demonstrated a positive correlation with QoL scores, while CARATkids scores showed a negative correlation. Conclusions: Treatment for SAR in children significantly reduces symptom severity, improves asthma control, and enhances QoL. Effective management of SAR is crucial for alleviating the disease burden and improving patients' overall well-being.

“Vulnerability can breed strength”: The role of borderline personality disorder severity in movement synchrony among patients with major depressive disorder

Objective: Patients with Major depressive disorder (MDD) and a comorbid Borderline personality disorder (BPD) show a poorer prognosis for MDD compared to patients without BPD. Little is known about the therapeutic processes underlying this prognosis. The goal of the present study was to investigate whether patients with more severe BPD symptoms experience less strengthening in patient-therapist movement synchrony (MS) throughout treatment, and whether less strengthening in MS is associated with less effective sessions. Method: Ninety-five patients participating in a randomized control trial were assessed for BPD (N = 9) using the Structured Interview for DSM-IV Personality. 1367 video-taped sessions were analyzed for MS using Motion Energy Analysis. Session effectiveness was evaluated following each session using a one-item scale taken from the Helping Skills Measure. Multilevel models were used to assess whether BPD severity predicted MS throughout treatment, and whether MS predicted session effectiveness. Results: Patients with more severe BPD symptoms experienced greater strengthening in MS throughout treatment. Less MS strengthening was associated with less session effectiveness. Conclusion: These findings indicate unique therapeutic processes that characterize individuals with more severe BPD symptoms. Shedding light on these unique processes has the potential to contribute to the personalization of MDD treatment for patients with BPD.

The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies

Background Exercise for post-traumatic stress disorder (PTSD) is a potentially effective adjunct to psychotherapy. However, the biopsychosocial mechanisms of exercise are not well understood. This co-produced living systematic review synthesizes evidence from human and non-human studies. Methods We Included controlled human and non-human studies involving searches of multiple electronic databases (until 31.10.23). Records were screened, extracted, assessed for risk of bias, and reconciled by two independent reviewers. The primary outcome for human studies was PTSD symptom severity, while outcomes of interest for non-human studies included freezing behaviour, fear memory, fear generalization, startle response, and locomotion. Data were synthesised with random-effects meta-analysis. Results Eleven human studies met the eligibility criteria. Overall, exercise was not associated with symptom severity improvement compared to control (standardized mean difference [SMD] -0.08, 95% confidence interval [CI] -0.24 to 0.07; 8 studies, one at low risk of bias). High-intensity exercise reduced PTSD symptoms scores more than moderate-intensity exercise. There was insufficient data to examine the effects of exercise on functional impairment, PTSD symptom clusters, and PTSD remission. Only three studies, all at high risk of bias, examined mechanisms of exercise with inconclusive results. Exercise was associated with improvement in all behavioural outcomes, including locomotor activity (SMD 1.30, 95% CI 0.74 to 1.87, 14 studies), and changes in several neurobiological markers, including increase in brain-derived neurotrophic factor (SMD 1.79, 95% CI 0.56 to 3.01). Conclusions While non-human studies provide compelling evidence for the beneficial effects of exercise, human trials do not. Evidence from non-human studies suggest that exercise might increase the levels of brain-derived neurotrophic factor, enhance cognitive appraisal, and improve perceived exertion. Overall, the paucity of data on the effectiveness of exercise in PTSD and mechanisms of action underscore the need for rigorous trials. Registration The protocol was registered with PROSPERO (ID:453615; 22.08.2023).

The Relations Between Sensory Modulation, Hyper Arousability and Psychopathology in Adolescents with Anxiety Disorders

Background: Sensory modulation may play a significant role in psychiatric conditions, including anxiety, and explain arousability levels, behavioral disorders, and functional deficits. Yet, studies about sensory modulation in adolescents with anxiety disorders are scarce. Purpose: To profile the prevalence of sensory modulation difficulties (SMDs) in adolescents with anxiety and examine their relations to arousability and psychopathology. The study compared adolescents with anxiety disorders to healthy controls using physiological measures and self-reports that reflect daily life scenarios. Then, the study examined the relationship between SMDs, arousability, and psychopathological severity in the study group. Method: Participants were 106 adolescents, aged 10.5–18 years and their parents. The study group included 44 participants diagnosed with anxiety disorder by psychiatrists. The control group included 62 healthy participants matched by age and gender to the study group. Parents completed the demographic questionnaire and the Child Behavior Checklist (CBCL). The adolescents completed The Revised Children’s Manifest Anxiety Scale (RCMAS) and the Adolescent/Adult Sensory Profile (AASP) and underwent the electrodermal activity (EDA) and pulse rate tests while listening to extreme sensory stimuli of auditory startles. Results: Based on AASP, the study group had a higher prevalence of SMDs expressed in lower sensory seeking, difficulties in registering sensory stimuli, and higher sensory sensitivity and avoidance. The study group presented higher arousability while listening to the startles as manifested in higher heart rate and EDA responses. The physiological results correlated with SMD levels measured by the AASP self-reports. SMDs correlated with psychopathological severity. Conclusions: SMDs may characterize adolescents with anxiety disorders and impact their arousability, symptoms severity, and daily functioning. Therefore, sensory modulation should be evaluated using both self-reports (to reflect implications in real life from patients’ own voices) along with objective measures to explain daily behaviors by underlying physiological mechanisms. This may focus intervention towards better health, function, and development.

Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels.

Endovascular treatment (EVT) of stroke with large-vessel occlusion is known to be safe and effective. The effect of EVT for occlusion of medium or distal vessels is unclear. We randomly assigned participants with an isolated occlusion of medium or distal vessels (occlusion of the nondominant or codominant M2 segment of the middle cerebral artery [MCA]; the M3 or M4 segment of the MCA; the A1, A2, or A3 segment of the anterior cerebral artery; or the P1, P2, or P3 segment of the posterior cerebral artery) to receive EVT plus best medical treatment or best medical treatment alone within 24 hours after the participant was last seen to be well. The primary outcome was the level of disability at 90 days, as assessed with the modified Rankin scale score. A total of 543 participants (women, 44%; median age, 77 years) were included in the analysis: 271 were assigned to receive EVT plus best medical treatment and 272 to receive best medical treatment alone. The median score on the National Institutes of Health Stroke Scale (range, 0 to 42, with higher scores indicating more severe symptoms) at admission was 6 (interquartile range, 5 to 9). Intravenous thrombolysis was given to 65.4% of the participants. The predominant occlusion locations were the M2 segment (in 44.0% of the participants), M3 segment (in 26.9%), P2 segment (in 13.4%), and P1 segment (in 5.5%). In the comparison between EVT plus best medical treatment and best medical treatment alone, no significant difference in the distribution of modified Rankin scale scores was observed at 90 days (common odds ratio for improvement in the score, 0.90; 95% confidence interval, 0.67 to 1.22; P = 0.50). All-cause mortality was similar in the two groups (15.5% with EVT plus best medical treatment and 14.0% with best medical treatment alone), as was the incidence of symptomatic intracranial hemorrhage (5.9% and 2.6%, respectively). In persons with stroke with occlusion of medium or distal vessels, EVT did not result in a lower level of disability or a lower incidence of death than best medical treatment alone. (Funded by the Swiss National Science Foundation and others; DISTAL ClinicalTrials.gov number, NCT05029414.).

Depressive symptomatology in Brazil: perspectives of statistical and psychometrics analyses of the PHQ-9 at four time-points (2020–2023) in the COVID-19 pandemic

The present research assessed the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) through an examination of its internal structure, invariance analysis, and standardization. Social distribution analyses of the measure were conducted using linear and binomial logistic regression. The sample consisted of 10,069 adults from all 27 states in Brazil. The data were obtained through four collections across different years of the COVID-19 pandemic (2020, 2021, 2022, and 2023), using independent samples. Confirmatory Factor Analysis (CFA) indicated that the measure is unidimensional with satisfactory fit indices. The model was invariant in relation to the variables investigated at four different levels (configural, metric, scalar, and strict). The standardization supported hypothetical cut scores indicating the severity of depressive symptoms, categorized as very low (0 to 6), low (7 to 13), moderate (14 to 19), high (20 to 23), and very high (≥ 24). We found that sex/gender, skin color/ethnicity, age, education level, and year of the pandemic were predictors of depressive symptoms in the adjusted linear regression analysis. The logistic regression showed variables with higher chances for a positive screening diagnosis of depression, with adjusted Odds Ratio as follows: years 2021 (ORadj = 1.275) and 2023 (ORadj = 1.409), women (ORadj = 1.900), Pardos individuals (ORadj = 1.252), education up to high school (ORadj = 1.272), being a northeast region resident (ORadj = 2.127), and younger people (ORadj = 1.716). The findings of this study indicate the suitability of the PHQ-9 for assessing depression in the population and recommend its use for monitoring depressive symptoms in the coming years in Brazil. Clinical implications include developing interventions to address the psychological impact of this and any future health crises.

Caregiver assessment of socioemotional functioning in people living with neurodegenerative disease (Part 2): Concurrent validity and test-retest reliability of a new measure.

Care recipients with neurodegenerative disease can have socioemotional impairments that are challenging for their caregivers. We examine the concurrent and incremental validity of a novel informant-rated measure of care recipient functioning, the Caregiver Assessment of Socioemotional Functioning (CASEF), by examining links with clinician-rated behavioral problems, neuropsychiatric symptoms, and disease severity, as well as caregivers' reported burden and relationship quality. We also examine test-retest reliability of the CASEF. Informal caregivers (N=177) of individuals with neurodegenerative disease reported on their care recipients' socioemotional functioning and completed structured interviews with clinicians to assess care recipients' disease severity and neuropsychiatric symptoms. Care recipients' behavioral symptoms were evaluated with clinician rating scales. Another sample of caregivers (N=61) repeated the CASEF four to six months following an initial administration. CASEF subscales evidenced concurrent validity with other measures of care recipients' socioemotional functioning, disease severity, neuropsychiatric symptoms, and behavioral symptoms. CASEF subscales also evidenced incremental validity by accounting for significant additional variance in caregiver burden and relationship quality after accounting for care recipients' neuropsychiatric and behavioral symptoms. Finally, CASEF subscales demonstrated adequate to excellent test-retest reliability. Findings highlight the validity and reliability of the CASEF. Coupled with findings from Part 1 of this series (which established CASEF's construct validity), these findings support using the CASEF in clinical and research settings to assess changes in care recipient socioemotional functioning over time and to examine links between care recipient socioemotional changes and caregiver burden, health, and well-being.

First report of Brugmansia latent virus on Angel’s Trumpet (Brugmansia sp.) in Florida, USA

Angel’s trumpet (Brugmansia sp.) is a perennial shrub that is widely propagated as an ornamental and landscape plant around the world. In November 2022, Brugmansia sp. leaves with severe mosaic symptoms were collected from a nursery in Duval County, Florida, USA and sent to the Florida Department of Agriculture and Consumer Services Division of Plant Industry for pathogen identification. Based on serology, reverse-transcription PCR, and sequencing, the virus was identified as Brugmansia latent virus (BrLV). To our knowledge, this is the first report of BrLV in Florida from any host.

The cognitive model of negative symptoms: a systematic review and meta-analysis of the dysfunctional belief systems associated with negative symptoms in schizophrenia spectrum disorders.

The hypothesized cognitive model of negative symptoms, proposed nearly twenty years ago, is the most prevalent psychological framework for conceptualizing negative symptoms in schizophrenia spectrum disorders (SSDs). The aim of this study was to comprehensively validate the model for the first time, specifically by quantifying the relationships between negative symptom severity and all related dysfunctional beliefs. A systematic search was conducted using MEDLINE and PsychINFO, supplemented by manual reviews of reference lists and Google Scholar. Eligible studies were peer-reviewed with data on the direct cross-sectional association between negative symptoms and at least one relevant dysfunctional belief in SSD patients. Screening and data extraction were completed by independent reviewers. Random-effects meta-analyses were performed to pool effect size estimates of z-transformed Pearson's r correlations. Moderators of these relationships, as well as subset analyses for negative symptom domains and measurement instruments, were also assessed. Significant effects emerged for the relationships between negative symptoms and defeatist performance beliefs (k=38, n=2808), r=0.23 (95% CI, 0.18-0.27), asocial beliefs (k=8, n=578), r=0.21 (95% CI, 0.12-0.28), low expectancies for success (k=55, n=5664), r=-0.21 (95% CI, -0.15 - -0.26), low expectancies for pleasure (k=5, n=249), r=-0.19 (95% CI, -0.06 - -0.31), and internalized stigma (k=81, n=9766), r=0.17 (95% CI, 0.12-0.22), but not perception of limited resources (k=10, n=463), r=0.08 (95% CI, -0.13 - 0.27). This meta-analysis provides support for the cognitive model of negative symptoms. The identification of specific dysfunctional beliefs associated with negative symptoms is essential for the development of precision-based cognitive-behavioral interventions.

Understanding the misophonic experience: a mixed method study

Misophonia is a poorly understood condition in which intense distress is experienced in response to mostly orofacial stimuli. To better understand why specifically anger and disgust seem to characterize this distress, we investigated meanings conveyed by misophonic trigger stimuli in two studies. Study 1 explored these meanings and emotions in two small focus groups (n = 3, n = 5) of misophonia sufferers. Four meaning—themes were generated based using reflexive thematic analysis: “intrusion,” “violation,” “offense,” and “lack of autonomy.” Also, four emotional reaction themes were constructed: “anger/defensive rage,” “disgust,” “fear,” and “safety behaviors.” Study 2 aimed to corroborate the findings of Study 1 in a large, independent sample. To this end, misophonia symptom severity was assessed in 431 young adults using the Amsterdam Misophonia Scale (A-Miso-S). Participants rated the extent to which the meanings and reactions identified in Study 1 matched their experiences with prototypical misophonic trigger stimuli. The meanings showed a positive, moderate correlation with misophonia symptom severity and accounted for 35.15% of the variance in A-Miso-S scores. An exploratory factor analysis identified two factors explaining 50% of the variance in the meanings and reactions. Factor 1, “Avoidance of intrusive/disgusting stimuli” had high and unique loadings on avoidance, intrusion, and disgust. Factor 2, “Autonomy/Violation,” had high and unique loadings on violation, lack of autonomy, offense, and defensive rage. These findings suggest that the meanings of intrusion, violation, and lack of autonomy are inherent to the misophonic experience, with potential implications for treatment strategies.

Deconstructing the nature of emotion regulation impairments at the identification, selection, and implementation stages in individuals at clinical high-risk for psychosis.

Psychotic disorders are characterized by emotion regulation abnormalities that predict greater symptom severity and poor functional outcomes. However, it is unclear whether these abnormalities also occur in individuals at clinically high risk for psychosis (CHR). The current study used ecological momentary assessment (EMA) to address this question and examined the nature of abnormalities at three stages of emotion regulation (identification, selection, implementation). Participants included 120 CHR and 59 CN who completed 1week of EMA surveys evaluating emotional experience, emotion regulation, context, and symptoms. Multi-level models examined concurrent and time-lagged effects. CHR evidenced elevated state negative affect and abnormalities at all three stages of emotion regulation. At the identification stage (i.e., determining the need to regulate), regulatory attempts were made too frequently and with too much effort at low levels of negative affect and not frequently enough and with insufficient effort at high levels of negative affect. Selection stage abnormalities (i.e., choosing the exact strategy to attempt based on context) were characterized by increased frequency of selecting individual strategies and greater polyregulation (i.e., use of multiple strategies concurrently). Implementation stage (i.e., executing the selected strategy) abnormalities were indicated by being less effective at decreasing the intensity of negative affect from time t to t+1. It is not only heightened stress reactivity that confers risk for psychosis, but also abnormalities in applying emotion regulation strategies to control the stress response. The profile of abnormalities observed in CHR is similar to schizophrenia, suggesting treatment targets that transcend phases of psychotic illness.

Navigating the Complexity of Psychotic Disorders: A Systematic Review of EEG Microstates and Machine Learning

EEG microstates are brief, stable topographical configurations of brain activity that provide insights into alterations in brain function and connectivity. Anomalies in microstates are associated with different neuropsychiatric conditions, especially schizophrenia. Recent advances in both EEG techniques and machine learning point to the potential role of microstates as diagnostic markers for psychotic disorders. This systematic review aims to gather current knowledge on machine learning applied to EEG microstate analysis in psychotic disorders. Following PRISMA guidelines, we searched Scopus, PubMed, and Scholar databases, including 10 studies. Overall results show that EEG microstates can be used to accurately classify diagnoses within the psychosis spectrum, across all stages, outperforming models based on conventional EEG measures, with a prominent role of microstate D. One study also suggests that microstate anomalies may be directly linked to symptom severity. Integrating EEG microstates with machine learning shows promise in improving our understanding of psychotic disorders and developing more precise diagnostic tools.

Adherence to customized vestibular rehabilitation therapy: influencing factors and clinical implications in vestibulopathy

ObjectiveCustomized vestibular rehabilitation therapy (CVRT) is an effective treatment approach for various vestibular disorders. However, low adherence significantly limits its efficacy, and factors influencing adherence remain underexplored. This study aimed to identify factors affecting adherence to CVRT across major vestibulopathy categories, including acute unilateral vestibular hypofunction (AUVH), chronic unilateral vestibular hypofunction (CUVH), and bilateral vestibular hypofunction (BVH).MethodsA retrospective analysis of 90 patients who were prescribed four sessions of CVRT and underwent the therapy was conducted. Patients were classified as adherent (≥3 sessions) or non-adherent (≤2 sessions). Demographic characteristics, baseline questionnaire scores, and vestibular function test (VFT) results were compared. Change in questionnaire scores and VFT results before and after CVRT, as well as mid-treatment follow-up questionnaire scores were analyzed.ResultsAdherence rates were highest in CUVH (86.7%) and lowest in BVH (46.2%). Among patients with AUVH, poor functional reach test scores were significantly associated with lower adherence (p = 0.045). In the CUVH category, patients with mild dizziness in the initial questionnaire were non-adherent (p = 0.019). CVRT improved subjective dizziness symptoms and VFT parameters, with the greatest gains observed in AUVH. However, no significant differences in symptom improvement were found between adherent and non-adherent patients. Patients whose symptoms improved rapidly to a mild degree after starting the CVRT were more likely to be non-adherent, with this tendency being especially pronounced in those with AUVH.ConclusionAdherence to CVRT varies by vestibulopathy category and is influenced by baseline symptom severity. Tailoring CVRT strategies based on individual clinical profiles may enhance adherence and optimize therapeutic outcomes.

Link between psychiatric symptoms and cognition

Researchers have found both positive and negative associations between mental symptom severity and general cognition. Prior studies showed mixed findings. But this study, by noting that the associations were nonlinear, reconciled those prior studies, which assumed that symptom severity tracked with cognitive ability. In fact, the association between cognition and symptoms may be the opposite in low vs. high symptom severity samples. The study shows that it's necessary to use clinical information in studies of cognitive impairment. Because mental illnesses are a leading cause of disability, and cognitive impairments often play a role across psychiatric disorders. The researchers wanted to determine if the association between general cognition and mental health symptoms diverges at different symptom severities in children. For the study, researchers used the ongoing Adolescent Brain and Cognitive Development (ABCD) study to assess 5175 children at ages 9 to 11 years. They evaluated aggregate cognitive test scores (general cognition) in relation to total and subscale‐specific symptoms reported from the Child Behavioral Checklist. Linear models showed differing associations between general cognition and mental health symptoms, depending on the range of symptom severities queried. Nonlinear models confirm that internalizing symptoms were significantly positively associated with cognition at low symptom burdens and significantly negatively associated with cognition at more severe symptoms. [Pines, A., Tozzi, L., Bertrand, C., et al. (2024, Dec). Psychiatric symptoms, cognition, and symptom severity in children. JAMA Psychiatry, 81(12), 1236–1245. https://doi.org/10.1001/jamapsychiatry.2024.2399.]

Outcomes of endovascular thrombectomy in patients with cerebral venous thrombosis: A cohort study of 325 patients.

Cerebral venous thrombosis (CVT) is a rare condition that presents with significant treatment challenges and has traditionally been managed with anticoagulation. However, for patients who fail anticoagulation or present with severe symptoms, endovascular thrombectomy (EVT) has emerged as a favorable treatment modality. This study examines the outcomes, complications, and comorbidities associated with EVT in patients with CVT. A query of the 2015-2019 National (Nationwide) Inpatient Sample was performed for patients admitted to hospitals with ICD-10 diagnosis codes for CVT and ICD-10 procedure codes for usage of EVT. Demographic information, baseline comorbidities, complications, and discharge dispositions were compared between patients who underwent EVT and those who were managed medically. A total of 36,005 patients diagnosed with CVT were identified from 2015(Q4) to 2019. Of these patients, 325 (0.9%) received EVT. Patients who underwent EVT were older (<0.001), more likely to be female (p = 0.016), and had higher rates of diabetes mellitus (p = 0.012), hypertension (p < 0.001), and obesity (p < 0.001). These patients also presented with more severe neurological symptoms, including higher National Institutes of Health Stroke Scale scores (p < 0.001), coma (p < 0.001), and cerebral edema (p < 0.001). Patients undergoing EVT had a higher incidence of in-hospital mortality (p = 0.007) and were less likely to be discharged routinely (p < 0.001). This study found that patients with CVT who underwent EVT were older, more likely to be female, and presented with more severe neurological conditions. After controlling for severity, EVT in patients with CVT was associated with significant risks, including higher rates of complications and inpatient mortality. Although EVT is associated with significant risks, the findings of this study suggest that its outcomes may reflect the severity of the underlying condition rather than the procedure itself. Careful patient selection and individualized management strategies are essential for optimizing outcomes in this high-risk population.

Identifying neurobiological heterogeneity in clinical high-risk psychosis: a data-driven biotyping approach using resting-state functional connectivity

To explore the neurobiological heterogeneity within the Clinical High-Risk (CHR) for psychosis population, this study aimed to identify and characterize distinct neurobiological biotypes within CHR using features from resting-state functional networks. A total of 239 participants from the Shanghai At Risk for Psychosis (SHARP) program were enrolled, consisting of 151 CHR individuals and 88 matched healthy controls (HCs). Functional connectivity (FC) features that were correlated with symptom severity were subjected to the single-cell interpretation through multikernel learning (SIMLR) algorithm in order to identify latent homogeneous subgroups. The cognitive function, clinical symptoms, FC patterns, and correlation with neurotransmitter systems of biotype profiles were compared. Three distinct CHR biotypes were identified based on 646 significant ROI-ROI connectivity features, comprising 29.8%, 19.2%, and 51.0% of the CHR sample, respectively. Despite the absence of overall FC differences between CHR and HC groups, each CHR biotype demonstrated unique FC abnormalities. Biotype 1 displayed augmented somatomotor connection, Biotype 2 shown compromised working memory with heightened subcortical and network-specific connectivity, and Biotype 3, characterized by significant negative symptoms, revealed extensive connectivity reductions along with increased limbic-subcortical connectivity. The neurotransmitter correlates differed across biotypes. Biotype 2 revealed an inverse trend to Biotype 3, as increased neurotransmitter concentrations improved functional connectivity in Biotype 2 but reduced it in Biotype 3. The identification of CHR biotypes provides compelling evidence for the early manifestation of heterogeneity within the psychosis spectrum, suggesting that distinct pathophysiological mechanisms may underlie these subgroups.

Eye movement desensitisation and reprocessing for childbirth-related post-traumatic stress symptoms: effectiveness, duration and completion

Childbirth-related post-traumatic stress symptoms (CB-PTSS) occur in 12% of women and 3%–6% of mothers meet criteria for childbirth-related post-traumatic stress disorder (CB-PTSD). Eye Movement Desensitisation and Reprocessing (EMDR) therapy has shown promising results in this population. This study sought to assess the effectiveness of EMDR on CB-PTSS and CB-PTSD; to investigate the effect of EMDR duration on symptom reduction; to measure the EMDR completion rate; and to explore sample characteristics that may be associated with completion or effectiveness. A retrospective analysis was conducted of women (n = 34) who commenced EMDR for CB-PTSS or CB-PTSD in an Irish urban maternity hospital. Symptom severity was measured using the Posttraumatic Stress Disorder Checklist (PCL-5) pre- and post-EMDR. Pre-intervention, 64.7% (n = 22) of the sample met criteria for a provisional diagnosis of PTSD. The majority of women (61.8%) demonstrated a ≥ 10 point reduction on PCL-5 following EMDR. There was no correlation between reduction in PCL-5 score and number of EMDR sessions (r = −0.12, p = 0.504). The EMDR completion rate was 70.6%. Analyses did not identify any variables that were associated with EMDR completion or effectiveness. To our knowledge, this is the largest studied sample of women who have received EMDR for CB-PTSD or CB-PTSS. EMDR may be an effective intervention for CB-PTSS and CB-PTSD, even in women with a history of prior trauma, co-morbid mental health problems, or long-term symptoms. EMDR is easily-delivered with a low drop-out rate. Limitations include lack of a control group and long-term follow-up, and statistical analyses were limited by sample size.

Family Functioning and Parenting Styles in Adolescents Diagnosed with Trichotillomania.

This study aimed to compare the family functioning and parenting styles in adolescents with trichotillomania (TTM) and healthy controls and to assess the relationships between the family functioning, parenting styles, and clinical features of TTM, including the severity of TTM, duration of illness, and concomitant psychiatric symptoms. The study sample consisted of 100 adolescents aged 12-18 years, 50 patients with TTM, and 50 healthy controls. All participants completed a sociodemographic and clinical data form, the Massachusetts General Hospital Hairpulling Scale (MGH-HPS), the Revised Children's Anxiety and Depression Scale-Child Version (RCADS-CV), the Family Assessment Device (FAD), and the Perceived Parental Attitude Scale (PPAS). Results show that adolescents with TTM reported higher levels of comorbid anxiety and depression symptoms than healthy controls, and 64% of adolescents with TTM had at least one comorbid psychiatric disorder. Parents of adolescents with TTM also reported more significant impairment in the affective responsiveness, problem-solving, and general family functioning subscales of the FAD. Adolescents with TTM endorsed significantly more authoritarian perceptions of both parents on the PPAS. While the severity of hairpulling symptoms showed only a positive and significant relationship with the RCADS-CV total internalizing score, the duration of illness was positively and moderately correlated with the impairment in affective responsiveness, problem-solving, and general family functioning subscales of FAD. Finally, the RCADS-CV total internalizing score and the general functioning subscale of FAD were the most important predictors of TTM. The implications of family functioning and parenting styles, future targets for family-focused approaches in TTM, and study limitations are discussed.