Structured Clinical Interview For DSM-IV Research Articles

The predictive value of cortisol in psychodynamic psychotherapy for social anxiety disorder: Extended results of the SOPHONET-Study

Psychotherapy is an effective treatment for anxiety disorders (AD), yet a vast majority of patients do not respond to therapy, necessitating the identification of predictors to enhance outcomes. Several studies have explored the relationship between stress response and treatment outcome, as a potential treatment mechanism. However, the latter remains under-researched in patients with social anxiety disorder (SAD). We studied N = 29 patients undergoing psychodynamic psychotherapy (PDT) within the SOPHONET-Study. Stress reactivity (i.e., area under the curve with respect to the increase; AUCi) was induced by a standardized psychosocial stressor (Trier Social Stress Test; TSST) and assessed by means of adrenocorticotropic hormone (ACTH), blood and salivary cortisol samples before (t1) treatment. Samples of these biomarkers were taken −1 min prior stress exposure and six more blood samples were collected post-TSST ( + 1, + 10, + 20, + 30, + 45, + 60 min.). The participants were diagnosed with SAD based on the Structured Clinical Interview for DSM-IV (SCID) and completed the Liebowitz Social Anxiety Scale as well as the Beck Depression Inventory before (t1) and after psychotherapy (t2). Pre-treatment stress reactivity significantly predicted changes in depression (salivary p < 0.001 and blood cortisol p = 0.001), as well as in avoidance behavior (blood cortisol p = 0.001). None of the biomarkers revealed significant results in fear or in the total LSAS-scores, except for ACTH with a trend finding (p = 0.06). Regarding therapy success, symptoms of social anxiety (p = 0.005) and depression (p < 0.001) were significantly reduced from pre (t1) to post-treatment (t2). Our study showed that stress reactivity pre-treatment may serve as a predictor of psychotherapy outcome. In this regard, alterations in stress response relate to changes in symptoms of social anxiety and depression after PDT. This implies that patients with chronic stress might benefit from a targeted interventions during psychotherapy, especially to manage fear in social contexts.

Validation of Machine Learning-Based Assessment of Major Depressive Disorder from Paralinguistic Speech Characteristics in Routine Care

New developments in machine learning-based analysis of speech can be hypothesized to facilitate the long-term monitoring of major depressive disorder (MDD) during and after treatment. To test this hypothesis, we collected 550 speech samples from telephone-based clinical interviews with 267 individuals in routine care. With this data, we trained and evaluated a machine learning system to identify the absence/presence of a MDD diagnosis (as assessed with the Structured Clinical Interview for DSM-IV) from paralinguistic speech characteristics. Our system classified diagnostic status of MDD with an accuracy of 66% (sensitivity: 70%, specificity: 62%). Permutation tests indicated that the machine learning system classified MDD significantly better than chance. However, deriving diagnoses from cut-off scores of common depression scales was superior to the machine learning system with an accuracy of 73% for the Hamilton Rating Scale for Depression (HRSD), 74% for the Quick Inventory of Depressive Symptomatology–Clinician version (QIDS-C), and 73% for the depression module of the Patient Health Questionnaire (PHQ-9). Moreover, training a machine learning system that incorporated both speech analysis and depression scales resulted in accuracies between 73 and 76%. Thus, while findings of the present study demonstrate that automated speech analysis shows the potential of identifying patterns of depressed speech, it does not substantially improve the validity of classifications from common depression scales. In conclusion, speech analysis may not yet be able to replace common depression scales in clinical practice, since it cannot yet provide the necessary accuracy in depression detection. This trial is registered with DRKS00023670.

Neurocognitive functions in siblings of patients with bipolar disorder

ObjectivesSome studies suggest that there are deficits in neurocognitive functions in the euthymic phase of bipolar disorder and healthy relatives of patients with bipolar disorder and that these neurocognitive disorders may be the endophenotype for bipolar disorder. This study aimed to evaluate the neurocognitive functions of unaffected siblings of patients with bipolar disorder compared with the healthy controls. MethodsThe study included the unaffected siblings of patients with bipolar disorder (n = 75) and healthy volunteers without a family history of bipolar disorder (n = 50). The Structured Clinical Interview for DSM-IV (SCID-I) was administered to each individual to investigate the diagnosis of Axis-I psychiatric disorders according to DSM-IV. The Judgment of Line Orientation Test, the Auditory Verbal Learning Test, the Serial Digit Learning Test, the Stroop Color Word Test, and the Trail Making Test were used to evaluate neurocognitive functions. ResultsOur study found no difference between the groups regarding processing speed, set-shifting, and mental flexibility. However, unaffected siblings of patients with bipolar disorder had significantly worse performance than healthy controls in verbal learning and memory, response inhibition, and visuospatial function. ConclusionsThis study suggests that visuospatial function, response inhibition, verbal learning, and memory may be endophenotypic markers for bipolar disorder.

Intimate partner violence across pregnancy and the postpartum and the relationship to depression and perinatal wellbeing: findings from a pregnancy cohort study.

To compare the prevalence of emotional and physical intimate partner violence (IPV) across pregnancy and the first year postpartum in those with and without clinical depression and assess the association between maternal childhood trauma, current stressful life events and depression and IPV over the perinatal period. Data were obtained from 505 pregnant women from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a cohort study with data collected across pregnancy until 12 months postpartum. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) with repeat measurement of perinatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). Trauma was measured using the Childhood Trauma Questionnaire, and experiences of physical and emotional intimate partner violence using items in the Stressful Life Events Scale. Women experiencing IPV across the perinatal period were significantly more likely to score over 13 on the EPDS (p < .001) at each timepoint in pregnancy and the postpartum and physical IPV was associated with clinical depression. Further, a history of childhood trauma and current additional stressful life events were significantly associated with reporting current IPV in the perinatal period. This study confirmed the risk factors of childhood trauma and current stressful life events for reporting experiences of IPV in the perinatal period. Furthermore, women experiencing IPV reported higher depressive symptoms, providing evidence supporting the value of assessing those women who screen higher on the EPDS for IPV. Together these findings also support trauma informed care across pregnancy and the postpartum.

Clinical characteristics of probands with obsessive-compulsive disorder from simplex and multiplex families

Genetic and non-genetic factors contribute to obsessive-compulsive disorder (OCD), with strong evidence of familial clustering. Genomic studies in psychiatry have used the concepts of families that are "simplex" (one affected) versus "multiplex" (multiple affected). Our study compares demographic and clinical data from OCD probands in simplex and multiplex families to uncover potential differences. We analyzed 994 OCD probands (501 multiplex, 493 simplex) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC). Clinicians administered the Structured Clinical Interview for DSM-IV (SCID-IV) to diagnose, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to assess severity, and Dimensional Yale–Brown Obsessive-Compulsive Scale (DY-BOCS) to assess symptom dimensionality. Demographics, clinical history, and family data were collected. Compared to simplex probands, multiplex probands had earlier onset, higher sexual/religious and hoarding dimensions severity, increased comorbidity with other obsessive-compulsive-related disorders (OCRD), and higher family history of psychiatric disorders. These comparisons provide the first insights into demographic and clinical differences between Latin American simplex and multiplex families with OCD. Distinct clinical patterns may suggest diverse genetic and environmental influences. Further research is needed to clarify these differences, which have implications for symptom monitoring and management.

Personality characteristics, not clinical symptoms, are associated with anhedonia in a community sample: A preliminary investigation

Anhedonia is a salient transdiagnostic psychiatric symptom associated with increased illness severity and chronicity. Anhedonia is also present to varying degrees in non-clinical cohorts. Here, we sought to examine factors influencing expression of anhedonia. Participants (N = 335) were recruited through the Nathan Kline Institute-Rockland Sample, an initiative to deeply phenotype a large community sample across the lifespan. Utilizing a data-driven approach, we evaluated associations between anhedonia severity, indexed by Snaith-Hamilton Pleasure Scale (SHAPS), and 20 physical, developmental, and clinical measures, including Structured Clinical Interview for DSM-IV, Beck Depression Inventory, State-Trait Anxiety Inventory, NEO Five-Factor Inventory-3 (NEO–FFI–3), BMI, Hemoglobin A1C, and demography. Using a bootstrapped AIC-based backward selection algorithm, seven variables were retained in the final model: NEO–FFI–3 agreeableness, extraversion, and openness to experience; BMI; sex; ethnicity; and race. Though median SHAPS scores were greater in participants with psychiatric diagnoses (18.5) than those without (17.0) (U = 12238.5, z = 2.473, p = 0.013), diagnosis and symptom measures were not retained as significant predictors in the final robust linear model. Participants scoring higher on agreeableness, extraversion, and openness to experience reported significantly lower anhedonia. These results demonstrate personality as a mild-to-moderate but significant driver of differences in experiencing pleasure in a community sample.

Preliminary validation of the Klenico diagnostic software self-report module through comparison with the diagnostic gold standard in an outpatient routine clinical sample

ABSTRACT Background Inaccuracy in current diagnostic procedures for mental disorders can lead to misdiagnosis and increase the burden on the healthcare system. Therefore, Klenico, a diagnostic software designed to support comprehensive and efficient clinical diagnostic procedures that is easy to apply in everyday clinical practice, was developed. This study aimed to take the first step toward validating the Klenico self-report module. Methods Data of 115 patients from a German psychotherapeutic outpatient clinic were included in this study. Criterion validity was tested by comparing Klenico with the diagnoses based on the structured clinical interview for DSM-IV (SCID). Construct validity was investigated by comparing Klenico with commonly used self-reporting questionnaires. Results The results showed that most of the Klenico disorder domains were able to differentiate between corresponding diagnoses and other diagnoses, confirming criterion validity. Construct validity was demonstrated by high correlations with the compared convergent questionnaire scales and non-significant or low correlations with most of the divergent scales. Conclusions These preliminary results demonstrate the psychometric properties of the Klenico self-report module and imply that the Klenico system has high potential to improve the accuracy of diagnostic procedures in everyday clinical practice.

Expression of ANK3 moderates the association between childhood trauma and affective traits in severe mental disorders

Exposure to early life trauma increases the risk of psychopathology later in life. Here we investigated if ANK3 mRNA levels influence the relationship between childhood trauma experiences and clinical characteristics in mental disorders. A sample of 174 patients with bipolar disorder and 291 patients with schizophrenia spectrum disorder were included. Patients were diagnosed using the Structured Clinical Interview for DSM-IV, and childhood trauma was assessed using the childhood trauma questionnaire. Age at illness onset and number of psychotic and affective episodes were assessed from interview and medical records. Current depressive symptoms were measured using the calgary depression scale for schizophrenia and the inventory for depressive symptomatology. ANK3 expression was analyzed in whole blood using the Illumina HumanHT-12 v4 Expression BeadChip. Analyses were carried out with the Process adjusted for confounders. Within the total sample, patients with both high ANK3 expression and with the most severe childhood sexual abuse had more manic/hypomanic episodes and an earlier age at onset of the first episode. ANK3 mRNA levels also moderated the relationship between emotional neglect and manic/hypomanic episodes. Our results suggest that ANK3 expression levels moderate the association between specific types of childhood trauma and affective traits in mental disorders.

A Cross-Sectional Study on Outcomes of Hospitalization in Patients with Borderline Personality Disorder After Six Months

Background: Borderline Personality Disorder (BPD) is a serious psychiatric disorder that is characterized by unstable affect, mood, behavior, object relations, and self-image. In this study, a 6-month follow-up was performed to evaluate the outcomes of hospitalization in terms of symptoms severity, suicidal attempts, self-harm behaviors, substance use, and anger expression.&#x0D; Methods: This cross-sectional study was performed on 60 patients hospitalized with BPD in Iran Psychiatric Hospital in the first 6 months of 2018. Demographic information of patients was collected at the time of admission. Patients were assessed by initial psychiatric evaluations with the Structured Clinical Interview for DSM-IV [Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-2)], the Borderline Evaluation of Severity over Time (BEST), the Spielberger’s state-trait anger expression inventory and Depression Anxiety Stress Scale (DASS). Medical comorbidities, self-harm and suicide ideations and attempts, high-risk behaviors, and substance use disorders were also assessed and recorded. Three months after discharge, the patients were reassessed by BEST questionnaire and after 6 months, they were reassessed using DASS, BEST, SCID-2, and Spielberger’s state-trait anger expression inventory.&#x0D; Results: The repeated measures analysis of changes in quantitative variables including the scores of the severity of symptoms in BEST, DASS, and Spielberger tools showed that the scores of DASS decreased significantly during the study (p=0.020), while no significant change was observed in the scores of Spielberger and BEST inventory.&#x0D; Conclusion: In patients with BPD, hospitalization was correlated with reduced depression, anxiety, and stress 6 months after discharge. Regular follow-ups along with regular patient visits can form an effective therapeutic relationship with the patients and help to improve monitoring of their drug usage, self-harming acts, and suicidal thoughts.

Epigenome-wide analysis identifies methylome profiles linked to obsessive-compulsive disorder, disease severity, and treatment response.

Obsessive-compulsive disorder (OCD) is a prevalent mental disorder affecting ~2-3% of the population. This disorder involves genetic and, possibly, epigenetic risk factors. The dynamic nature of epigenetics also presents a promising avenue for identifying biomarkers associated with symptom severity, clinical progression, and treatment response in OCD. We, therefore, conducted a comprehensive case-control investigation using Illumina MethylationEPIC BeadChip, encompassing 185 OCD patients and 199 controls recruited from two distinct sites in Germany. Rigorous clinical assessments were performed by trained raters employing the Structured Clinical Interview for DSM-IV (SCID-I). We performed a robust two-step epigenome-wide association study that led to the identification of 305 differentially methylated CpG positions. Next, we validated these findings by pinpointing the optimal set of CpGs that could effectively classify individuals into their respective groups. This approach identified a subset comprising 12 CpGs that overlapped with the 305 CpGs identified in our EWAS. These 12 CpGs are close to or in genes associated with the sweet-compulsive brain hypothesis which proposes that aberrant dopaminergic transmission in the striatum may impair insulin signaling sensitivity among OCD patients. We replicated three of the 12 CpGs signals from a recent independent study conducted on the Han Chinese population, underscoring also the cross-cultural relevance of our findings. In conclusion, our study further supports the involvement of epigenetic mechanisms in the pathogenesis of OCD. By elucidating the underlying molecular alterations associated with OCD, our study contributes to advancing our understanding of this complex disorder and may ultimately improve clinical outcomes for affected individuals.

Identifying the DSM-5 mixed features specifier in depressed patients: A comparison of measures

BackgroundA commonly used measure to assess mixed features in depressed patients is the Young Mania Rating Scale (YMRS), which only partially aligns with the DSM-5 criteria. Different algorithms on the YMRS have been used to approximate the DSM-5 mixed features criteria. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the agreement and validity of different approaches towards assessing the mixed features specifier. MethodsThree hundred nine depressed psychiatric patients were interviewed with the Structured Clinical Interview for DSM-IV, the DSM-5 Mixed Features Specifier Interview (DMSI) and the YMRS. Seven definitions of mixed features were examined, two based on the DMSI and five from the YMRS. ResultsThe prevalence of mixed features varied 8-fold amongst the 7 definitions. The level of agreement between the YMRS definitions and the DMSI was poor. For each definition, mixed features were significantly more common in patients with bipolar disorder than major depressive disorder. A family history of bipolar disorder was significantly associated with the DMSI assessment of mixed features but none of the YMRS approaches. LimitationsThe ratings on the measures were not independent of each other. The sample size was too small to compare the patients with bipolar I and bipolar II disorder. ConclusionsWhile there was evidence of validity for both the DSM-5 and YMRS approaches towards identifying mixed features, the 2 approaches are not interchangeable. The algorithm on the YMRS used to classify patients has a significant impact on prevalence.

Impulsivity in Depression: Its Relation to Suicidality.

Impulsivity is an important risk for suicidality, which is common in patients with major depressive disorder (MDD). The goal of this study was to examine multiple facets of impulsivity in depressed patients compared with healthy controls and to assess their relationship to suicidality. Outpatients diagnosed with MDD using the Structured Clinical Interview for DSM-IV were recruited. Two groups were constituted as "MDD in remission" (n=32) and "MDD" (n=71). The "healthy control" group (n=30) consisted of individuals who had never been diagnosed with any psychiatric disorder. Impulsivity was assessed with the Barratt Impulsivity Scale (BIS), a self-rating measure, and with the following behavioral tasks: Go/No-go Task, Iowa Gambling Task, and Balloon Analogue Risk Task. The scores of the 3 groups (n=133) were compared to evaluate the effect of MDD. The scores were also analyzed and compared in the patients in the 2 MDD groups (n=103) with respect to their current and lifetime suicidality. There was no difference in the 3 groups in task scores, but nonplanning BIS was correlated with the severity of depressive symptoms. Patients with suicidal ideation (SI) had higher BIS total and attention impulsivity scores and more commission errors on the Go/No-go Task, reflecting failure in response inhibition, compared with the patients without SI. Failure to show differences in impulsivity-related tasks suggests that there might be no relationship between the state of depression and impulsivity. However, these findings confirm that there is an association between SI and response inhibition and the attention facet of impulsivity in depression.

Episodic Memory in Obsessive-Compulsive Disorder: Comparison with Healthy Controls

Background: Obsessive-compulsive disorder is identified by intrusive thoughts and related compulsive behaviors. Memory complaints are controversial among obsessive-compulsive disorder patients. Objectives: The present study compared verbal, visual, episodic, and semantic memory between obsessive-compulsive disorder patients and healthy controls. Methods: This is a case-control study. The participants included 31 newly diagnosed obsessive-compulsive disorder outpatients and 30 healthy controls. The patients were selected using targeted sampling from Emam Reza Polyclinic, affiliated with blinded for peer review. They responded to a demographic checklist, structured clinical interview for DSM-IV (SCID-I), verbal and visual episodic memory from the Wechsler Memory Scale-Revised (WMS-R), and autobiographical memory interview (AMI). Results: The results indicated that patients with obsessive-compulsive disorder compared with the controls had lower scores in visual (P = 0.0001), verbal (P = 0.006), semantic (P = 0.3), and episodic memory (P = 0.001). Conclusions: All types of memory which were evaluated in the present study were impaired in obsessive-compulsive disorder. Memory impairment might explain the psychiatric symptoms of the disorder.

Does method matter? Assessing the validity and clinical utility of structured diagnostic interviews among a clinical sample of first-admitted patients with psychosis: A replication study.

Increasingly, diagnostic assessments in clinical practice are made using structured diagnostic interviews or self-rating scales imported into clinical practice from research studies and big-scale surveys. Although structured diagnostic interviews have been shown to be highly reliable in research, the use of such method in clinical contexts are more questionable. In fact the validity and clinical utility of such methods in naturalistic contexts have rarely been evaluated. In this study we report on a replication study of Nordgaard et al (22) Assessing the diagnostic validity of a structured psychiatric interview in a first-admission hospital sample. World Psychiatry, 11 (3): 181-185. The study sample comprises 55 first-admitted inpatients to a treatment facility specializing in the assessment and treatment of patients with psychotic disorders. We found poor agreement between diagnoses generated by Structured Clinical Interview for DSM-IV and Best-estimate consensus diagnoses (κ value 0.21). We identified over-reliance on self-report, vulnerability to response set in dissimulating patients, and a strong diagnosis and comorbidity focus, as possible reasons for misdiagnosis with the SCID. We conclude that structured diagnostic interviews performed by mental health professionals without solid psychopathological knowledge and experience are not recommendable for clinical practice.

Nightmares: An Independent Risk Factor for Cardiovascular Disease?

Prior work has established associations between post-traumatic stress disorder (PTSD), disrupted sleep, and cardiovascular disease (CVD), but few studies have examined health correlates of nightmares beyond risks conferred by PTSD. This study examined associations between nightmares and CVD in military veterans. Participants were veterans (N=3468; 77% male) serving since September 11, 2001, aged 38 years (SD=10.4); approximately 30% were diagnosed with PTSD. Nightmare frequency and severity was assessed using the Davidson Trauma Scale (DTS). Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study Self-report Medical Questionnaire. Mental health disorders were established using the Structured Clinical Interview for DSM-IV. The sample was stratified by the presence or absence of PTSD. Within-group associations between nightmare frequency and severity and self-reported CVD conditions, adjusting for age, sex, race, current smoking, depression, and sleep duration. Frequent and severe nightmares during the past week were endorsed by 32% and 35% of participants, respectively. Those endorsing nightmares that were frequent, severe, and the combination thereof were more likely to also evidence high blood pressure (ORs 1.42, OR 1.56, and OR 1.47, respectively) and heart problems (OR 1.43, OR 1.48, and OR 1.59, respectively) after adjusting for PTSD diagnosis and other covariates. Nightmare frequency and severity among veterans are associated with cardiovascular conditions, even after controlling for PTSD diagnosis. Study findings suggest that nightmares may be an independent risk factor for CVD. Additional research is needed to validate these findings using confirmed diagnoses and explore potential mechanisms.

Chemsex, HIV, and Psychiatric Diagnosis in Gay or Bisexual Men in Hong Kong

Background: Psychotropic substance use, for chemsex in particular, is common in gay or bisexual men (GBM) with HIV infection. This case-control study examined the association between Axis I psychiatric disorders and active psychotropic substance use, and identified factors affecting the prevalence of psychiatric disorders in HIV-infected GBM. Methods: Participants were 62 HIV-infected self-identified GBM who reported psychotropic substance use in the past 1 year (cases), and 55 HIV-infected self-identified GBM without psychotropic substance use in the past 1 year and had negative toxicology tests at recruitment (controls). The Chinese-bilingual Structured Clinical Interview for DSM-IV (Axis I, Patient version) was followed to establish the psychiatric diagnoses. Socio-demographic data, level of social support, HIV-related data, and pattern of psychotropic substance use were collected. Results: Cases had lower level of social support, more depressive disorders (AOR 3.4, 95% CI 1.3-8.7, p=0.01) and psychotic disorders (AOR 7.2, 95% CI 1.2-41, p=0.03) but not anxiety disorders. Significant difference in the prevalence of psychiatric disorders was only evident for disorders with onset after HIV diagnosis. Methamphetamine dependence, weekly methamphetamine use for 2 years or more, using methamphetamine beyond chemsex, duration of HIV diagnosis were significant predictors for psychiatric disorders in the cases. Conclusion: Active psychotropic substance use in HIV-infected gay or bisexual men was associated with an overall 3-fold increase in Axis I psychiatric disorders. Coordinated efforts from HIV, psychiatric and substance use services are needed to prevent harms arising from chemsex and to identify those in need and facilitate treatment access.

The therapeutic effect of the extracts of Lavandula angustifolia and Dracocephalum ruyschiana besides sertraline on patients with mild to moderate depression: A double-blind controlled trial

BackgroundDepression is one of the most common psychiatric disorders in today's society. The therapeutic effects of Lavandula angustifolia Mill. (Lamiaceae) (L. angustifolia) and Dracocephalum ruyschiana L. (Lamiaceae) (D. ruyschiana) have been demonstrated in the treatment of several disorders. ObjectivesThe present study aimed to evaluate the therapeutic effect of L. angustifolia and D. ruyschiana extracts on patients with mild to moderate depression under treatment with sertraline. MethodsThis study was experimental with a pretest-posttest control group design. Seventy individuals with major depressive disorder were randomly allocated into two groups. The first group received a dose of 100 mg sertraline tablet per day with placebo syrup three times a day. The second group was treated with the same dose of sertraline plus the herbal syrup containing two units of the extract of L. angustifolia and one unit of the D. ruyschiana three times a day. The unit dose was the same as defined in traditional medicine. Data were collected using the Structured Clinical Interview for DSM-IV (SCID-IV) and Beck Depression Inventory (BDI) and analyzed using appropriate statistical methods. ResultsThe mean scores for depression by BDI in the two groups were not significantly different before the intervention (P > 0.05). Six weeks after the intervention the mean scores of depression in the experimental group were significantly lower than in the control group (P = 0.02). ConclusionsSimultaneous use of L. angustifolia and D. ruyschiana extracts alongside sertraline has beneficial effects in decreasing depression and confers a promising herbal medication in treating such patients.

Prevalence of post-traumatic stress disorder and validity of the Impact of Events Scale – Revised in primary care in Zimbabwe, a non-war-affected African country

A critical step in research on the epidemiology of post-traumatic stress disorder (PTSD) in low-resource settings is the validation of brief self-reported psychometric tools available in the public domain, such as the Impact Event Scale - Revised (IES-R). We aimed to investigate the validity of the IES-R in a primary healthcare setting in Harare, Zimbabwe. We analysed data from a survey of 264 consecutively sampled adults (mean age 38 years; 78% female). We estimated the area under the receiver operating characteristic curve and sensitivity, specificity and likelihood ratios for different cut-off points of the IES-R, against a diagnosis of PTSD made using the Structured Clinical Interview for DSM-IV. We performed factor analysis to evaluate construct validity of the IES-R. The prevalence of PTSD was 23.9% (95% CI 18.9-29.5). The area under the curve for the IES-R was 0.90. At a cut-off of ≥47, the sensitivity of the IES-R to detect PTSD was 84.1 (95% CI 72.7-92.1) and specificity was 81.1 (95% CI 75.0-86.3). Positive and negative likelihood ratios were 4.45 and 0.20, respectively. Factor analysis revealed a two-factor solution, with both factors showing good internal consistency (Cronbach's factor-1 α = 0.95, factor-2 α = 0.76). In a post hoc analysis, we found the brief six-item IES-6 also performed well, with an area under the curve of 0.87 and optimal cut-off of 15. The IES-R and IES-6 had good psychometric properties and performed well for indicating possible PTSD, but at higher cut-off points than those recommended in the Global North.

The association between liver fibrosis and depression in patients after ischemic stroke

Background and objectiveLiver fibrosis has been considered a predictor of cardiovascular disease. This study aimed to evaluate whether the degree of liver fibrosis is related to post-stroke depression (PSD) at 3 months follow-up.MethodsWe prospectively and continuously enrolled patients with first-ever ischemic stroke from June 2020 to January 2022. Liver fibrosis was measured after admission by calculating the Fibrosis-4 index (FIB-4) and stratified into two categories (< 2.67 versus ≥ 2.67). Patients with a 17-item Hamilton Depression Scale score > 7 were further evaluated using the Chinese version of the structured clinical interview of DSM-IV, for diagnosing PSD at 3 months.ResultsA total of 326 patients (mean age 66.6 years, 51.5% male) were recruited for the study. As determined by the FIB-4 score, 80 (24.5%) patients had advanced liver fibrosis. During the follow-up, PSD was observed in 91 patients, which accounted for 27.9% (95% confidence interval [CI] 25.5%–30.5%) of the cohort.The prevalence of advanced liver fibrosis was higher in PSD patients than those without PSD (40.0% versus 24.0%; P = 0.006). After adjustment for covariates in the multivariate logistic analysis, advanced fibrosis was significantly associated with PSD (odds ratio [OR], 1.88; 95% CI, 1.03–3.42; P = 0.040). Similar results were found when the FIB-4 was analyzed as a continuous variable.ConclusionsThis study found that advanced liver fibrosis was associated with an increased risk of 3-month PSD. FIB-4 score may be valuable for screening depressive symptoms in ischemic stroke patients.

Postpartum-onset obsessive-compulsive disorder: A harbinger of bipolar disorder.

Postpartum-onset obsessive-compulsive disorder: A harbinger of bipolar disorder.