Course Of Symptoms Research Articles

Immune Response and Breakthrough Infection Risk After SARS-CoV-2 Vaccines in Patients with Hemoglobinopathy: A Single Center Experience

Background: Immune system impairment is frequently reported in patients affected by hemoglobinopathies due to various mechanisms, including iron accumulation, antigenic stimulation due to numerous transfusions, chronic hemolysis, and a general hyperinflammatory state. For these reasons, the antigenic immune response after a vaccine risks being ineffective. Methods: We evaluated the anti-spike IgG production after two doses of vaccine for SARS-CoV-2 in patients affected by hemoglobinopathies. Results: All 114 enrolled patients (100%) developed adequate antibody production, with a median value of serum IgG of 2184.4 BAU/mL (IQR 1127.4–3502.9). The amount of antibody was unrelated to any other clinical characteristics evaluated, including transfusion dependence or non-transfusion dependence, age, gender, disease type, ferritin, blood count, spleen status, and therapy with hydroxyurea or iron chelators (in all the cases p > 0.05). Moreover, 47 (41.2%) patients developed breakthrough SARS-CoV-2 infection during the first 2 years of follow-up after vaccination, all with a mildly symptomatic course, without requiring hospitalization or experiencing a significative drop in hemoglobin values, allowing for a slight delay in their transfusion regimen. Conclusion: Vaccination against COVID-19 is safe and effective for patients affected by hemoglobinopathies, ensuring adequate protection from severe infection.

The Role of Vietnamese Mourning Culture in Grief Symptomatology – A Study Protocol

Losing a loved one is a universal and inevitable part of life; however, the way that bereaved individuals grieve and cope with loss varies between cultures. Culturally bound symptoms of disordered grief often go unnoticed when assessed with Western-developed diagnostic tools. Additionally, culturally significant funerals and rituals to be carried out during the mourning period may serve an important role in defining the expression and presentation of grief. Funeral and mourning activities following the death of a family member in Viet Nam span over one year, consisting of rituals to be carried out forty-nine days, one hundred days, and one-year post-loss. No previous study has assessed the course of grief symptoms of Vietnamese bereaved throughout the mourning period using a culturally adapted scale. This paper describes the protocol for the research that aims to examine the possible protective and supportive role of traditions, rituals, and other ceremonies for bereaved individuals. The results are expected to reveal that participating in ritual activities predicts a better grief trajectory. These results would suggest the consideration of cultural contexts in the assessment and treatment of pathological grief. The project would not only contribute to the cross-cultural understanding of grief but also highlight the importance of local cultural practices in grief recovery.

Three-year course of clinical high-risk symptoms for psychosis in the community: a latent class analysis.

Clinical high-risk for psychosis (CHR-P) states exhibit diverse clinical presentations, prompting a shift towards broader outcome assessments beyond psychosis manifestation. To elucidate more uniform clinical profiles and their trajectories, we investigated CHR-P profiles in a community sample. Participants (N=829; baseline age: 16-40years) comprised individuals from a Swiss community sample who were followed up over roughly 3 years. latent class analysis was applied to CHR-P symptom data at baseline and follow-up, and classes were examined for demographic and clinical differences, as well as stability over time. Similar three-class solutions were yielded for both time points. Class 1 was mainly characterized by subtle, subjectively experienced disturbances in mental processes, including thinking, speech and perception (basic symptoms [BSs]). Class 2 was characterized by subthreshold positive psychotic symptoms (i.e., mild delusions or hallucinations) indicative of an ultra-high risk for psychosis. Class 3, the largest group (comprising over 90% of participants), exhibited the lowest probability of experiencing any psychosis-related symptoms (CHR-P symptoms). Classes 1 and 2 included more participants with functional impairment and psychiatric morbidity. Class 3 participants had a low probability of having functional deficits or mental disorders at both time points, suggesting that Class 3 was the healthiest group and that their mental health and functioning remained stable throughout the study period. While 91% of Baseline Class 3 participants remained in their class over time, most Baseline Classes 1 (74%) and Class 2 (88%) participants moved to Follow-up Class 3. Despite some temporal fluctuations, CHR-P symptoms within community samples cluster into distinct subgroups, reflecting varying levels of symptom severity and risk profiles. This clustering highlights the largely distinct nature of BSs and attenuated positive symptoms within the community. The association of Classes 1 and 2 with Axis-I disorders and functional deficits emphasizes the clinical significance of CHR-P symptoms. These findings highlight the need for personalized preventive measures targeting specific risk profiles in community-based populations.

Tracking the course of depressive and anxiety symptoms across adolescence (the CATS study): a population-based cohort study in Australia

Adolescent mental health appears to be in crisis, yet few studies have comprehensively charted the course of common mental disorders (CMDs; depression and anxiety) across this key life stage. We aimed to describe the course of CMD symptoms in adolescence by summarising annual prevalence, cumulative incidence, and course for depression and anxiety, both separately and as comorbid CMDs, by sex assigned at birth in a contemporary Australian cohort. The Child to Adult Transition Study (CATS) was established in 2012 to form a representative cohort of adolescents in Melbourne, VIC, Australia. 43 schools were recruited using a stratified sampling approach, and all 2289 students aged 8-9 years were invited to participate. 1239 (54·1%) students obtained parental written informed consent and were followed up annually from 2012 to 2019 for a total of ten waves. Data from waves 3-10 (ages 10 to 18 years) were used for the current study and analysed to describe the course of symptoms of CMDs across adolescence. Primary measures of interest were clinically relevant depressive symptoms, clinically relevant anxiety symptoms, and any CMD (clinically relevant depressive or anxiety symptoms) at waves 3-10. A secondary measure of interest was comorbid CMDs (concurrent reporting of clinically significant anxiety and depressive symptoms) at waves 3-10. Depressive symptoms in the past 2 weeks were self-reported using the 13-item validated Short Mood and Feelings Questionnaire (SMFQ) at each wave, with a threshold score of 12 or more indicating clinically relevant symptoms. Anxiety symptoms in the past two weeks were self-reported using an 8-item shortened version of the Spence Children's Anxiety Scale (SCAS) at each wave, with a threshold score of 11 or higher indicating clinically relevant symptoms. The course of CMDs was described using annual prevalence, cumulative incidence for depression and anxiety, separately and combined. Missing data were handled via multiple imputation. An author with lived experience was involved in the research and writing process. Of the 1239 adolescents who participated in the study, 667 (53·8%) were female and 572 (46·2%) were male. 769 (62·1%) of 1239 were classified as socioeconomically advantaged, 675 (66·4%) of the 1016 with available data had a mother whose highest level of education was vocational or tertiary, and 579 (70·7%) of the 819 participants with ethnicity data identified as Anglo-Celtic or European. Overall, incidence of any clinically significant CMD symptoms during adolescence was 74% (95% CI 70-77; 84% [81-88] for females and 61% [55-66] for males). Independently, incidences of clinically significant depressive symptoms and anxiety symptoms were 65% (62-68) and 58% (55-62), respectively. Incidence of comorbid CMD was 48% (45-52). The estimated mean ages of first report in adolescence for both sexes were 14·1 years (95% CI 13·9-14·4) and 13·6 years (3·3-13·9) for depressive and anxiety symptoms, respectively. Of those who reached the threshold score for any CMD between ages 10 and 18 years, over half had a chronic (three or more waves) course (depression 54% [49-60]; anxiety 52% [47-58]), and a third met criteria for full remission at any subsequent wave (depression 30% [25-35]; anxiety 33% [27-39]). Females were consistently estimated to have a worse course of adolescent CMDs compared with males (eg, 64% [58-70] of females had a chronic course of depressive symptoms vs 37% [26-48] of males). In this contemporary multi-wave cohort study, almost three-quarters of adolescents reported CMD symptoms. The likelihood of chronicity of CMD symptoms (ie, recurrence) was high. Universal responses are urgently required to address this considerable public health problem. National Health and Medical Research Council of Australia and the Royal Children's Hospital Foundation.

Trajectory of depressive symptoms in a longitudinal stroke cohort.

Knowledge of the trajectory of post-stroke depression is important to identify high-risk patients, develop precise management programs and enhance prognosis. We aimed to characterise the course of depressive symptoms within the first year post-stroke and to evaluate associations with time. Depressive symptoms were measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) within the first week, and at 3 and 12 months post-stroke. Scores were dichotomised into symptoms 'present' (MADRS ≥ 7) or 'absent' (MADRS < 7). The course of depressive symptoms within individuals was mapped and categorised using a trajectory diagram. The association between time and the presence of depressive symptoms was investigated using random effects logistic regression. Logistic regression was also used to assess the likelihood of participants having depressive symptoms later, given their status at earlier time points. Of 142 ischaemic stroke survivors included for analysis, almost half (47.9%) experienced a change in depressive symptom status over time. Depressive symptoms were common at each timepoint (35-43%), although an association between time and frequency of depressive symptoms was not evident. Stroke survivors with depressive symptoms at 3 months were more likely to have depressive symptoms at 12 months, compared to those without symptoms at 3 months. Our findings provide evidence for a dynamic trajectory of depressive symptoms in individuals in the first year post-stroke. The importance of repeated screening for depression is highlighted, though most necessary at 3 months post-stroke.

Negative memory bias predicts change in psychiatric problems in a naturalistic psychiatric patient sample

Self-referential negative memory bias contributes to depression and other psychiatric disorders. Co-morbidity between these disorders is highly common in clinical practice, but transdiagnostic predictors like negative memory bias are not well understood yet. Therefore, the present study aimed to investigate the predictive value of negative memory bias for long-term change in broad psychiatric problems. In a naturalistic psychiatric patient sample (N = 202), using a prospective design, we examined the predictive value of negative memory bias (Self-Referent Encoding Task, SRET) for change in psychiatric problems (Outcome Questionnaire-45, OQ-45) after one, two, three, and four years. More negative memory bias predicted more psychiatric problems three and four years later, even when controlling for baseline psychiatric problems and depression. Memory bias might be a transdiagnostic predictor of change in psychiatric problems. Including such neuropsychological measures in diagnostics and symptom course prediction may improve psychological interventions.

Gastric electrostimulation in refractory gastroparesis: results of a explorative observational study

High-frequency electrical stimulation therapy (gastric electrical stimulation, GES) is a treatment option for gastroparesis of various genesis. The best indication and prognostic parameters have not yet been conclusively determined.Retrospective analysis of all gastroparesis patients implanted with a GES device between 2011 and 2020. Clinical response was measured before and after implantation using a validated Gastroparesis Cardinal Symptom Index (GCSI) (maximum score: 5, minimum score: 0). Other study endpoints included: subjective symptom course (no improvement, partial improvement, or severe improvement) and change in gastroparesis medication.A GES device was implanted in 42 patients (16 M: 26 F, mean age 45 years). The etiology of gastroparesis was diabetic (n=23), idiopathic (n=10) or postoperative (n=9). Eleven patients (26%) had undergone one or more invasive treatments before. GCSI score of the total group was 3.23 preoperatively. The median follow-up time was 12 months. In the overall group, significant improvement in GCSI score was found 3, 6, 9, and 12 months postoperatively-regardless of indication. In multivariate analysis, disease duration of >30 months was associated with a significantly decreased GCSI score at 12 months (p<0.001). Approximately 40% of patients were able to discontinue or significantly reduce gastroparesis medication. At the end of follow-up, 81% of patients reported partial or major improvement in symptoms. During the follow-up period, three patients (7%) died.Gastric electrical neurostimulation is an effective and safe option for refractory gastroparesis-regardless of the underlying disease.

Peculiarities of somatotype components and indicators of the component composition of body weight in ukrainian men and women with various forms of urticaria

Annotation. The study of the relationship between urticaria and somatotype is relevant, since the peculiarities of body structure can play an important role in the susceptibility to this disease and influence its course and severity of symptoms. The study of such correlations can help in the improvement of approaches to diagnosis and individualization of treatment, taking into account the anthropometric characteristics of patients. This can not only improve treatment outcomes, but also reduce recurrence rates and improve the quality of life of patients with urticaria. The purpose of the work is to establish the peculiarities and gender differences of the components of the somatotype, the frequency of the distribution of somatotypes according to the Heath-Carter method, and indicators of the component composition of body weight in Ukrainian men and women with acute and chronic urticaria of a mild and severe course. The components of the somatotype, the frequency of the distribution of somatotypes according to the Heath-Carter method, and indicators of the component composition of body weight were determined in 40 Ukrainian men and 40 young Ukrainian women with acute (AU) and chronic (CU) urticaria of mild (MU) and severe (SU) of the course. As a control group, the corresponding indicators of 82 practically healthy men and 101 practically healthy women of a similar age group were used, which were taken from the data bank of the research center of the National Pirogov Memorial Medical University, Vinnytsya. Statistical analysis was carried out in the license package “Statistica 6.0” using non-parametric estimation methods. When comparing somatotype components, the frequency of distribution of somatotypes according to the Heath-Carter method, and indicators of the component composition of body weight between patients with urticaria and practically healthy Ukrainian men or women, the following reliable or trends of differences were established: in all groups of sick men and women, higher values of muscle body weight component according to Matiegka (in men by 17.21-34.60 %, in women by 19.99-52.31 %) and the American Institute of Nutrition (in men by 20.33-31.86 %, in women by 23.81-75.20 %); only in sick men – higher values of the mesomorphic component of the somatotype (in patients with AU/SU and CU/MU by 15.70-27.96 %) and the bone component of body mass (in patients with AU/SU by 11.26 %), as well as lower values of the ectomorphic component somatotype (in patients with AU/MU, AU/SU and CU/MU by 31.25-41.80 %); only in female patients are higher values of the mesomorphic component of the somatotype (in patients with AU/MU and CU/MU by 56.00-58.34 %), the bone component of body mass (in patients with AU/MU by 8.80 %), the frequency of mesomorphic (in patients with AU/MU by 37.30 %) and the frequency of endo-mesomorphic somatotypes (in patients with CU/SU by 28.20 %), as well as lower values of the ectomorphic component of the somatotype (in patients with AU/MU, CU/MU and CU/SU by 39.88-46.90 %) and the fat component of body weight (in patients with AU/SU by 17.51 %). Only isolated differences were found when comparing these indicators between men and women with urticaria (more pronounced). The following manifestations of sexual dimorphism were established between the respective groups of male and female patients with urticaria: significantly higher values or a tendency towards higher values in male patients of the mesomorphic component of the somatotype (in patients with AU/SU by 26.57 %), the muscle component of body weight according to Matiegka and AIN (in patients with AU/SU CU/SU by 22.27-56.65 %), bone component of body weight (in milestone groups of patients by 18.98-59.65 %), fat component of body weight (in patients with AU/SU by 22.01 %), frequency of mesomorphic somatotype (50.00 % in patients with CU/SU); as well as trends towards higher values in women with CU/SU of the endo-mesomorphic frequency (by 40.00 %) and in AU/SU patients with the frequency of the average intermediate somatotype (by 30.00 %).

Associations Between Clinical Manifestations of SARS-CoV-2 Infection and HLA Alleles in a Caucasian Population: A Molecular HLA Typing Study.

Background and Objectives: Severe COVID-19 still constitutes an important health problem. Taking into account the crucial role of HLA in immune reactions, evaluation of the impact of HLA on COVID-19 risk and clinical course seemed necessary, as the already available data are inconsistent. The aim of the present study was to compare the HLA profiles of patients with symptomatic SARS-CoV-2 infection and a healthy control group, as well as to compare HLA allele frequencies in patients with severe and non-severe courses of COVID-19. Materials and Methods: HLA classes were genotyped using a next-generation sequencing method in 2322 persons, including 2217 healthy hematopoietic stem cell potential donors and 105 patients with symptomatic COVID-19. Results: Symptomatic course of SARS-CoV-2 infection appeared to be associated with the presence of HLA-A*30:01, B*44:02, B*52:01, C*05:01, C*17:01, and DRB1*11:02, while HLA-C*07:04 and DQB1*03:03 seem to play a protective role. Moreover, we demonstrated that the severe symptomatic course of COVID-19 can be associated with the presence of HLA-B*08:01, C*04:01, DRB1*03:01, and DQB1*03:01, while HLA-DRB1*08:01 appeared to be protective against severe COVID-19 disease. Conclusions: Identification of alleles that are potentially associated with symptomatic SARS-CoV-2 infection as well as the severe course of COVID-19 broadens the knowledge on the genetic background of COVID-19 course and can constitute an important step in the development of personalized medicine.

Assessing the Impact of COVID-19 on Pregnancy and Maternal Outcomes: A Slovak National Study

Background: The COVID-19 pandemic highlighted the global challenge of inadequate data on SARS-CoV-2’s effects on pregnant women and their infants. In response, Slovakia, along with other countries, launched a nationwide study to assess the incidence, characteristics, and outcomes of SARS-CoV-2 infection during pregnancy. Methods: We conducted a national observational descriptive study of SARS-CoV-2 positive cases among pregnant women from the pandemic’s onset to its conclusion. In collaboration with the Public Health Office of the Slovak Republic, we identified 1184 pregnant women who tested positive for SARS-CoV-2 and contacted them for participation. Results: Among the 240 participating SARS-CoV-2-positive pregnant women, 13 required hospitalizations, with an increased need for intensive care and respiratory support. However, the absolute risk of poor outcomes remained low. Higher maternal age and infection during the third trimester emerged as key risk factors for hospitalization. A symptomatic course was dominant, with fatigue (70%), headache (58%), and fever (56%) as the leading symptoms. While maternal and neonatal outcomes were generally favourable, a slight increase in caesarean sections and preterm births suggests an indirect impact on maternity care. Vaccination during pregnancy correlated with reduced symptoms and no hospitalizations. Elevated CRP levels were common among infected women, while ultrasound findings remained normal. Conclusions: This study offers a multi-dimensional view of pregnancy during the pandemic, capturing both the mother’s personal concerns and the objective insights from prenatal and labour care settings. The findings suggest that most pregnant women with SARS-CoV-2 experience mild to moderate illness, offering reassurance to clinicians about generally favourable maternal and neonatal outcomes while underscoring the need for vigilance in rare severe cases.

Duration, course and caregiver burden of croup in children: two observational cohorts

ObjectivesAlthough croup is a common respiratory illness, there is little published regarding symptom course. We aimed to assess symptom progression and caregiver burden, and whether age, sex or season and...

Affective Aspects of Religiousness and 6-Year Course of Depressive Symptoms in Aged Dutch Citizens.

In prospective studies on religiousness and depressive symptoms, it remains unclear whether religiousness is a predictor or parallels the fluctuating course of depressive symptoms. The current study focuses on several affective aspects of religiousness in their associations over time with late life depressive symptoms. As part of the population-based Longitudinal Aging Study Amsterdam, a subsample of 222 respondents (mean age 76.3 years) completed up to three postal questionnaires with 3-year intervals. The questionnaires included the Center for Epidemiologic Studies Depression scale and subscales of the Questionnaire God Representations and the Brief Religious Coping scale. Analyses were performed using mixed model analysis and logistic regression. Positive feelings toward God were associated with fewer depressive symptoms over time. Anxiety toward God, discontent about God, and negative religious coping predicted more depressive symptoms over time (between-subject effects) but also tended to run parallel to the course of depressive symptoms (within-subject effects).

Changes Over Time in Masseter Muscle Activity, Symptoms of Discomfort, Stress Level and Salivary Flow Rate Following Intra-Oesophageal Acid Infusion.

Intra-oesophageal acid stimulation increases masseter muscle activity. However, the infusion speeds used in previous studies are significantly slow, with minimal acid volume (30 mL over 30 min). Additionally, it is unclear how masseter muscle activity, symptoms of discomfort, stress levels and saliva quantity change over time. The time course of masseter muscle activity, heartburn and discomfort symptoms, salivary cortisol concentration to assess stress, autonomic nervous system (ANS) activity and saliva quantity under the influence of intra-oesophageal acid infusion were evaluated at a faster injection rate and larger volume than in previous studies. Ten healthy adults underwent polygraphic monitoring, consisting of electromyography of the masseter muscle and electrocardiography during intra-oesophageal acid infusion (10 mL/min, 10 min). Symptoms of heartburn and discomfort were assessed using the visual analogue scale (VAS), and saliva quantity was measured. Friedman's test was used for multiple comparisons. Masseter muscle activity, VAS scores for heartburn and discomfort, as well as saliva quantity during the 10-min acid infusion, increased significantly compared with that before acid infusion (p < 0.001, 0.001, 0.019 and 0.047, respectively) and decreased 10 and 20 min after acid infusion (p = 0.004, 0.004 and 0.007, respectively). No significant changes were observed in the salivary cortisol concentration or ANS activity. Intra-oesophageal acid infusion stimulated symptoms of heartburn and discomfort and increased masseter muscle activity and saliva production, which may not be related to psychological stress.

Pain syndrome, “dropped head” and myasthenia gravis: a case report and literature review

The objective of the study is to present a description of the first domestic clinical observation of the painful dropped head syndrome in a patient with myasthenia gravis (MG).Materials and Methods. Clinical, laboratory and instrumental data were analyzed over the course of MG symptoms with late onset in combination with thymoma, manifesting with pain and weakness in the neck extensors.Results. The characteristic and unique features of diagnostics and treatment of MG developed in a 59-year-old patient associated with antecollis and significant pain syndrome, initially considered as manifestations of osteochondrosis, are observed in comparison with the literature data. The information on the occurrence, demographic origin, association with the type of receptor targets, thymus pathology and reversibility of these disorders in MG is systematized, and the importance of addressing the concepts of pain in MG is emphasized. The positive effect of ipidacrine in the symptomatic treatment of MG in a patient with marked cholinergic manifestations induced by conventional anticholinergic agents (AA) therapy is confirmed.Conclusions. MG can cause axial muscle impairment leading to the phenomenon of “dropped head” and the development of pain syndrome atypical for the classical course of the disease. Pathogenetic treatment of seropositive MG in most cases leads to the elimination of its clinical manifestations, including pain. In some cases, the use of the reversible AA ipidacrine is an additional advantage in the therapy of such conditions, taking into account its concomitant proven efficacy as an adjuvant analgesic.

Two-year trajectories of anhedonia in adolescents at transdiagnostic risk for severe mental illness: Association with clinical symptoms and brain-symptom links.

Anhedonia emerges during adolescence and is characteristic of severe mental illness (SMI). To understand how anhedonia emerges, changes with time, and relates with other symptoms, there is a need to understand patterns of this symptom's course reflecting change or stability-and associations with clinical symptoms and neural reward circuitry in adolescents at risk of SMI. In total, 113 adolescents at low or high familial risk of developing SMI completed clinical measures at up to five time points across 2 years and functional magnetic resonance imaging scanning during a guessing reward task at baseline. Growth curve analysis was used to determine the trajectory of anhedonia across 2 years, including different phases (consummatory and anticipatory) and their association with clinical features (risk status, average suicidal ideation, and average depression across time) and neural activation in response to rewards (ventral striatum and dorsal medial prefrontal cortex). The findings revealed anhedonia decreased across 2 years. Furthermore, lower depression severity was associated with decreases in anhedonia across 2 years. There were no interactions between neural reward activation and anhedonia slopes in predicting clinical features. Exploratory analyses examining latent classes revealed three trajectory classes of anhedonia across phases. While preliminary, in the low and decreasing consummatory anhedonia trajectory class, there was a positive association between neural activation of the right ventral striatum in response to rewards and depression. Certain patterns of anhedonia development could confer risk or resilience for specific types of psychopathologies. The results are preliminary but do highlight the complexity and heterogeneity in anhedonia development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Posttraumatic cognitions about the self are associated with depression symptoms in veterans endorsing a history of assaultive military sexual trauma.

Depressive symptoms are a commonly observed yet understudied mental health sequalae of military sexual trauma (MST). Prior research supports the relationship between negative posttraumatic cognitions (NPCs) and the onset and course of trauma symptoms more broadly. We hypothesized that NPCs would be associated with depression symptoms in veterans endorsing a history of MST, specifically assaultive type MST. Our clinical sample included veterans presenting for treatment related to assaultive MST (N = 158; 70.9% female, 65.2% White, 27.8% Black). Participants completed self-report measures of posttraumatic stress disorder (PTSD), depression, and NPCs during intake at a Veteran's Affairs specialty trauma clinic. Linear regressions were used to analyze the association between NPCs and depression symptoms controlling for PTSD symptom severity. PTSD severity and NPCs about the self were significantly associated with depression symptoms, explaining 46% of the variance severity, F(4, 153) = 33.16, R² = .46, p < .001. These findings newly demonstrate a relationship between NPCs about the self and depression in veterans with a history of MST. Clinicians may benefit from incorporating cognitive interventions into preexisting depression treatments to directly address NPCs in this population. Future study is needed to determine how these results may extend to other forms of MST or trauma types. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring the Relationship Between Prolonged Grief and Borderline Personality Symptoms.

Prolonged grief disorder (PGD) is a new diagnosis that is often mistaken for other psychopathologies. We report a case of PGD in a patient who screened positive for personality disorder. Both PGD and personality disorder symptoms were much improved after a course of prolonged grief disorder therapy. A bereaved woman in her mid-20s sought treatment for depression 9 months after the death of her father. Her depressive symptoms responded well to antidepressant medication and a brief course of interpersonal psychotherapy. However, prolonged grief symptoms persisted at a clinically significant level. Elements of her history, as well as her score of 9 out of 10 on the McLean Screening Instrument for Borderline Personality Disorder, indicated a possible diagnosis of borderline personality disorder. Yet, after completing a course of prolonged grief disorder therapy, both her grief and borderline symptoms were much reduced. This case raises the possibility of an association between prolonged grief and borderline symptoms. Disruption of attachment relationships provides a possible way of understanding this association. The case we present raises the possibility that prolonged grief disorder may better explain symptoms in some patients presenting with borderline personality disorder symptoms.

Worry differentially mediates posttraumatic cognition and posttraumatic stress symptom relationships among veterans seeking treatment associated with military sexual trauma.

Research has established negative posttraumatic cognitions (NPC) affect the development and course of posttraumatic stress symptoms (PTSS) following trauma exposure (L. A. Brown et al., 2019). Previous studies in civilian and combat veteran populations also suggest positive associations among worry, NPC (Beck et al., 2004; Bennett et al., 2009), and PTSS (Fergus & Bardeen, 2017). However, little research has investigated the prevalence of worry in veterans who have experienced military sexual trauma (MST), and no research has examined the role of worry in the relation between NPC and PTSS among veterans seeking treatment associated with MST. This project examined the prevalence of worry in a MST sample and whether worry mediated NPC-PTSS associations. Veterans (N = 91) seeking MST-related treatment presented to a Veterans Affairs Posttraumatic Stress Disorder specialty clinic for assessment and treatment recommendations. Veterans completed questionnaires assessing NPC, worry, and PTSS. Bootstrapped mediation analyses examined NPC-PTSS associations. Veterans reported similar levels of worry as nonveterans seeking treatment associated with generalized anxiety disorder. Mediation analyses showed worry significantly mediated NPC-PTSS relationships for beliefs about the world, self-blame, and coping competence but not for beliefs about the self or global NPC severity. Further, the degree of mediation differed by NPC type. Though a limitation of this study is the use of cross-sectional data, these results inform the use of clinical intervention strategies targeting worry in trauma-focused interventions and necessitate further research on whether trauma-focused interventions ameliorate co-occurring worry among veterans exposed to MST. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Understanding the transdiagnostic mechanisms underlying emerging psychopathology in adolescence: study protocol of a 1-year prospective epidemiological (EMERGE) study

IntroductionAdolescent mental health is a global public health challenge as most cases remain undetected and untreated, and consequently, have a high likelihood of persistence or recurrence. It is critical to...

Deprescribing Antidepressants in Children and Adolescents: A Systematic Review of Discontinuation Approaches, Cross-Titration, and Withdrawal Symptoms.

Background: Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are commonly used to treat depressive, anxiety, and obsessive-compulsive disorders in youth. Yet, data on discontinuing these medications, withdrawal symptoms, and strategies to switch between them are limited. Methods: We searched PubMed and ClinicalTrials.gov through June 1, 2024, to identify randomized controlled trials assessing antidepressant discontinuation in youth. We summarized pediatric pharmacokinetic data to inform tapering and cross-titration strategies for antidepressants and synthesized these data with reports of antidepressant withdrawal. Results: Our search identified 528 published articles, of which 28 were included. In addition, 19 records were obtained through other methods, with 14 included. The corpus of records included 13 randomized, double-blind, placebo-controlled trials (3026 patients), including SSRIs (K = 10), SNRIs (K = 4), andTCAs (K = 1), ranging from 4 to 35 weeks. Deprescribing antidepressants requires considering clinical status, treatment response, and, in cross-titration cases, the pharmacokinetics and pharmacodynamics of both medications. Antidepressant withdrawal symptoms are related to the pharmacokinetics of the medication, which vary across antidepressants and may include irritability, palpitations, anxiety, nausea, sweating, headaches, insomnia, paresthesia, and dizziness. These symptoms putatively involve changes in serotonin transporter expression and receptor sensitivity, impacting the serotonin, dopamine, and norepinephrine pathways. Conclusions: Although approaches to deprescribing antidepressants in pediatric patients are frequently empirically guided, accumulating data related to the course of relapse and withdrawal symptoms, as well as the pharmacokinetic and pharmacodynamic properties of medications, should inform these approaches. Recommendations within this review support data-informed discussions of deprescribing-including when and how-that are critically important in the clinician-family-patient relationship.