Symptoms Of Varying Severity Research Articles

Impact of Long COVID symptoms on individuals in Hong Kong: Implications for occupational therapy practices

Introduction: From occupational therapy perspective, this study investigates the nature and impact of Long COVID symptoms on individuals in Hong Kong according to their gender, age, and occupation and to understand their treatment needs Method: A total of 193 participants with an acute COVID-19 episode 3 months ago and having recovered from it who were experiencing subjective symptoms of Long COVID were recruited through snowball sampling from local COVID-19 support groups and healthcare facilities to participate in a cross-sectional design via an online survey assessing their symptoms and the impact on daily activities, and exploring their treatment preferences. Findings: Respiratory, systemic, sleep, and cognitive symptoms were found to be the most prevalent, with significant variations in symptom severity and impact on daily life across different age and occupational status groups. The treatment preference was quite strongly inclined to traditional Chinese medicine. Conclusion: This study has uncovered the critical and yet recognized roles of occupational therapy in managing Long COVID impact by identifying the potential gaps of occupational therapy in its management and calling for advocating promotion in the community and interdisciplinary collaboration with traditional Chinese medicine. Implications about occupational therapy management and the healthcare policies for tailoring treatment programs are discussed.

The effect of health education on symptom severity in patients with fibromyalgia: a systematic review and meta-analysis.

Fibromyalgia (FM) is a complex chronic disorder characterized by widespread pain as the primary symptom. To evaluate the effect of health education on the severity of various symptoms in patients with FM, seven databases were searched from inception to August 2024 to identify randomized controlled trials evaluating the effects of health education for FM. The primary outcome was overall symptom severity, and the secondary outcomes were pain, depression, anxiety, sleep quality, fatigue, physical function and self-efficacy. The Cochrane Risk-of-Bias tool for randomized trials and the Grading of Recommendations, Assessment, Development, and Evaluations were used to assess the quality of the included studies and the certainty of evidence, respectively. Treatment effects were estimated by calculating Hedges' g and the corresponding 95% confidence intervals. Meta-analysis included a total of 13 trials. The results revealed that health education significantly reduced overall symptom severity, depression and anxiety and increased sleep quality and physical function among patients with FM (all P values < 0.05). However, no significant effects were observed on pain, fatigue and self-efficacy. Health education may be a beneficial intervention for FM patients, particularly for mitigating symptom severity. Health-care providers should implement health education interventions to empower patients to effectively manage their symptoms.

Disease burden among patients with Arginase 1 deficiency and their caregivers: A multinational, cross-sectional survey.

Arginase 1 deficiency (ARG1-D) is an ultrarare, metabolic disease which may cause spastic paraplegia, cognitive deficiency, seizures, and ultimately severe disability. The aim of this study was to assess disease burden in ARG1-D by performing a cross-sectional survey of patients with ARG1-D and their caregivers in four European countries (France, Portugal, Spain, and the United Kingdom). Patients were enrolled at participating clinics and data were collected using a web-based questionnaire. The findings indicate that there is a significant share of patients who experience severe cognitive and mobility impairment but also that there is a considerable variance in symptom severity among patients. Disease management was mostly in line with treatment guidelines and self-reported adherence to treatment was reported to be high among a majority although following diet restrictions was perceived as difficult. However, despite this, since a large share of patients experienced severe cognitive and mobility impairment an unmet need among this patient population is suggested. The introduction of disease-modifying therapies and early identification and diagnosis may help alleviate the disease burden associated with ARG1-D in the future.

Individuals with anxiety and depression use atypical decision strategies in an uncertain world.

Previous studies on reinforcement learning have identified three prominent phenomena: (1) individuals with anxiety or depression exhibit a reduced learning rate compared to healthy subjects; (2) learning rates may increase or decrease in environments with rapidly changing (i.e. volatile) or stable feedback conditions, a phenomenon termed learning rate adaptation; and (3) reduced learning rate adaptation is associated with several psychiatric disorders. In other words, multiple learning rate parameters are needed to account for behavioral differences across participant populations and volatility contexts in this flexible learning rate (FLR) model. Here, we propose an alternative explanation, suggesting that behavioral variation across participant populations and volatile contexts arises from the use of mixed decision strategies. To test this hypothesis, we constructed a mixture-of-strategies (MOS) model and used it to analyze the behaviors of 54 healthy controls and 32 patients with anxiety and depression in volatile reversal learning tasks. Compared to the FLR model, the MOS model can reproduce the three classic phenomena by using a single set of strategy preference parameters without introducing any learning rate differences. In addition, the MOS model can successfully account for several novel behavioral patterns that cannot be explained by the FLR model. Preferences for different strategies also predict individual variations in symptom severity. These findings underscore the importance of considering mixed strategy use in human learning and decision-making and suggest atypical strategy preference as a potential mechanism for learning deficits in psychiatric disorders.

Individuals with anxiety and depression use atypical decision strategies in an uncertain world

Previous studies on reinforcement learning have identified three prominent phenomena: (1) individuals with anxiety or depression exhibit a reduced learning rate compared to healthy subjects; (2) learning rates may increase or decrease in environments with rapidly changing (i.e. volatile) or stable feedback conditions, a phenomenon termed learning rate adaptation; and (3) reduced learning rate adaptation is associated with several psychiatric disorders. In other words, multiple learning rate parameters are needed to account for behavioral differences across participant populations and volatility contexts in this flexible learning rate (FLR) model. Here, we propose an alternative explanation, suggesting that behavioral variation across participant populations and volatile contexts arises from the use of mixed decision strategies. To test this hypothesis, we constructed a mixture-of-strategies (MOS) model and used it to analyze the behaviors of 54 healthy controls and 32 patients with anxiety and depression in volatile reversal learning tasks. Compared to the FLR model, the MOS model can reproduce the three classic phenomena by using a single set of strategy preference parameters without introducing any learning rate differences. In addition, the MOS model can successfully account for several novel behavioral patterns that cannot be explained by the FLR model. Preferences for different strategies also predict individual variations in symptom severity. These findings underscore the importance of considering mixed strategy use in human learning and decision-making and suggest atypical strategy preference as a potential mechanism for learning deficits in psychiatric disorders.

Relationships between depression, anxiety, and motivation in the real-world: Effects of physical activity and screentime.

Mood and anxiety disorders are highly prevalent and comorbid worldwide, with variability in symptom severity that fluctuates over time. Digital phenotyping, a growing field that aims to characterize clinical, cognitive and behavioral features via personal digital devices, enables continuous quantification of symptom severity in the real world, and in real-time. In this study, N=114 individuals with a mood or anxiety disorder (MA) or healthy controls (HC) were enrolled and completed 30-days of ecological momentary assessments (EMA) of symptom severity. Novel real-world measures of anxiety, distress and depression were developed based on the established Mood and Anxiety Symptom Questionnaire (MASQ). The full MASQ was also completed in the laboratory (in-lab). Additional EMA measures related to extrinsic and intrinsic motivation, and passive activity data were also collected over the same 30-days. Mixed-effects models adjusting for time and individual tested the association between real-world symptom severity EMA and the corresponding full MASQ sub-scores. A graph theory neural network model (DEPNA) was applied to all data to estimate symptom interactions. There was overall good adherence over 30-days (MA=69.5%, HC=71.2% completion), with no group difference (t(58)=0.874, p=0.386). Real-world measures of anxiety/distress/depression were associated with their corresponding MASQ measure within the MA group (t's > 2.33, p's < 0.024). Physical activity (steps) was negatively associated with real-world distress and depression (IRRs > 0.93, p's ≤ 0.05). Both intrinsic and extrinsic motivation were negatively associated with real-world distress/depression (IRR's > 0.82, p's < 0.001). DEPNA revealed that both extrinsic and intrinsic motivation significantly influenced other symptom severity measures to a greater extent in the MA group compared to the HC group (extrinsic/intrinsic motivation: t(46) = 2.62, p < 0.02, q FDR < 0.05, Cohen's d = 0.76; t(46) = 2.69, p < 0.01, q FDR < 0.05, Cohen's d = 0.78 respectively), and that intrinsic motivation significantly influenced steps (t(46) = 3.24, p < 0.003, q FDR < 0.05, Cohen's d = 0.94). Novel real-world measures of anxiety, distress and depression significantly related to their corresponding established in-lab measures of these symptom domains in individuals with mood and anxiety disorders. Novel, exploratory measures of extrinsic and intrinsic motivation also significantly related to real-world mood and anxiety symptoms and had the greatest influencing degree on patients' overall symptom profile. This suggests that measures of cognitive constructs related to drive and activity may be useful in characterizing phenotypes in the real-world.

Vicarious heterosexism-based stress induces alcohol, nicotine, and cannabis craving and negative affect among sexual minority young adults: An experimental study

PurposeSexual minority young adults are at increased risk for hazardous drinking and alcohol use disorder compared to heterosexual adults. Heterosexism-based stressors contribute and often explain inequities in alcohol outcomes. However, the extant research primarily relies on correlational designs, and often neglects the importance of alcohol craving, despite its foundational role in addiction. Leveraging a novel experimental mood induction paradigm, this study examined the effects of exposure to vicarious heterosexism-based stress on alcohol craving and negative affect among sexual minority young adults who drink heavily. We also examined its effects on cannabis and nicotine craving among participants who used cannabis and nicotine, respectively. Lastly, we examined moderating factors that could influence the impact of exposure to heterosexism-based stress on alcohol craving. MethodsParticipants were 101 heavy drinking sexual minority young adults, ages 20–35 (M = 26.46 years old; SD = 3.49), recruited from the community (51.5% female sex assigned at birth; 76.3% cisgender; 51.5% plurisexual; and 42.6% racial and ethnic minorities). They completed three mood induction trials counterbalanced over three visits on different days: heterosexism stress, general stress, and neutral. Structured interviews assessed criteria for DSM-5 alcohol use disorder (AUD) and substance use, and self-report measures assessed lifetime traumatic stressors. ResultsMost participants met criteria for past-year AUD (74.7%). Exposure to heterosexism stress produced more negative affect and substance craving than the neutral mood induction, even while controlling for demographic variables and lifetime exposure to traumatic and heterosexism stressors. Exposure to heterosexism-based stress had large effects on alcohol craving among participants who had greater drinking to cope motives and heterosexism-specific rejection sensitivity, whereas the effects were small for those who had lower drinking to cope motives and heterosexism-specific rejection sensitivity. Demographic, lifetime stress, prior alcohol use, and AUD symptom severity variables were not significant moderators. Greater substance craving induced by heterosexism-based stress in the laboratory was associated with greater recent and current substance use. ConclusionsThis study findings show that vicarious exposure to heterosexism elicits negative mood and alcohol, cannabis, and nicotine craving among sexual minority young adults who engaged in heavy drinking. The effects for alcohol craving were largest among those who endorse high levels of drinking to cope motives and heterosexism-based rejection sensitivity. These findings have implications for oppression-based stress and motivational models of addiction.

Treacher Collins syndrome: current and emerging treatment options

Treacher Collins syndrome is a rare congenital disorder characterized by bilateral craniofacial malformations, including mandibular and zygomatic hypoplasia, cleft palate, and eye anomalies, resulting in significant variability in symptom severity. The syndrome, with an incidence of approximately 1 in 50,000 births, is primarily caused by mutations in the TCOF1 gene and less frequently by mutations in POLR1C and POLR1D genes, disrupting ribosome biogenesis crucial for craniofacial development. Clinical manifestations encompass diverse craniofacial, auditory, and skeletal abnormalities, often leading to airway complications and hearing loss. Management involves a multidisciplinary approach, combining surgical interventions such as mandibular distraction osteogenesis and orthognathic surgeries with advanced imaging techniques for precise planning. Hearing loss is managed with bone conduction aids and cochlear implants, although outcomes may vary due to associated anomalies. Genetic testing aids in diagnosis and family planning decisions, while emerging therapies like genome editing and regenerative medicine show promise for future treatments. Despite challenges in long-term management and relapse rates in surgical corrections, ongoing research aims to enhance therapeutic efficacy and patient outcomes, emphasizing the need for tailored treatment strategies addressing both functional and aesthetic aspects.

Psychological factors in symptom severity and quality of life in Raynaud's phenomenon.

Despite emotional stress being recognised as a key trigger for Raynaud's phenomenon episodes, research in the area is still in its infancy. This study investigated the role of psychological factors relating to symptom severity and quality of life, and differences between Raynaud's types (primary and secondary) to further inform the development of intervention in this field. A cross-sectional design was used. Two hundred and ten adults with Raynaud's completed an online questionnaire measuring stress, anxiety, depression, anxiety sensitivity, beliefs about emotions, symptom severity and quality of life. Primary and secondary Raynaud's groups differed in anxiety (p < .004), symptom severity (p < .001) and quality of life (p < .001). Stepwise multiple regressions indicated anxiety and Raynaud's type explained 23% variance in hand symptom severity (p < .001); anxiety, Raynaud's type and anxiety sensitivity explained 29% variance in symptom severity (global impact, p < .001); depression, Raynaud's type and anxiety sensitivity explained 32% variance in quality of life (p < .001). Results highlight the importance of psychological factors in Raynaud's phenomenon, indicating possible targets for treatment. Interventions such as cognitive behavioural therapy, which target both physical and psychological wellbeing, bear some promise as an adjuvant therapy for this group.

Fibroblast-like synoviocytes orchestrate daily rhythmic inflammation in arthritis.

Rheumatoid arthritis is a chronic inflammatory disease that shows characteristic diurnal variation in symptom severity, where joint resident fibroblast-like synoviocytes (FLS) act as important mediators of arthritis pathology. We investigate the role of FLS circadian clock function in directing rhythmic joint inflammation in a murine model of inflammatory arthritis. We demonstrate FLS time-of-day-dependent gene expression is attenuated in arthritic joints, except for a subset of disease-modifying genes. The deletion of essential clock gene Bmal1 in FLS reduced susceptibility to collagen-induced arthritis but did not impact symptomatic severity in affected mice. Notably, FLS Bmal1 deletion resulted in loss of diurnal expression of disease-modulating genes across the joint, and elevated production of MMP3, a prognostic marker of joint damage in inflammatory arthritis. This work identifies the FLS circadian clock as an influential driver of daily oscillations in joint inflammation, and a potential regulator of destructive pathology in chronic inflammatory arthritis.

Effect of a 12-week remote exercising program (ExIOnc) on quality of life and symptoms of older patients with cancer in Brazil.

1623 Background: Leading organizations, including ASCO, recommend physical activity for patients with cancer. However, numerous barriers hinder patients from maintaining regular physical activity, particularly among older adults, who have lower participation in exercise programs. This study aims to evaluate the effects of a 12-week supervised remote exercise program on the health-related quality of life (HRQOL) of older patients with cancer (aged ≥65) undergoing treatment in Brazil. Methods: This was a single-arm pilot study evaluating a remote physical activity program which combined supervised and remote exercise. Eligible patients were contacted through WhatsApp for the initial assessment and received guidance on weekly exercises. The Vedius platform was employed to demonstrate proper home exercise techniques. The prescribed regimen consisted of 3-5 hours per week (4-6 days a week), encompassing both resistance and aerobic exercise. Outcome measures included overall HRQOL (FACT-G, scale 0-108) and symptom assessment (ESAS). Assessments were conducted at baseline and after 12 weeks. Descriptive statistics were calculated, and linear mixed models were employed to analyze changes from before to after the intervention. Results: Out of 46 approached patients, 41 patients were enrolled, with a median age of 70 years (range 65-88). Of the participants, 56.1% were female, 70.7% were white, and 58.2% were married, with 53.5% holding a college degree. The most common cancer types were breast (26.8%), genitourinary (22.0%), and lung (17.1%), all diagnosed at advanced stages. A significant improvement was observed in overall HRQOL (MT1=83.2 to MT2=94.4, P=0.001). Improvements were also seen in the severity of various symptoms, including pain (MT1=1.6 to MT2=0.7, P=0.001), fatigue (MT1=3.8 to MT2=1.3, P=0.001), nausea (MT1=0.8 to MT2=0.2, P=0.01), depression (MT1=2.6 to MT2=0.8, P=0.001), anxiety (MT1=3.2 to MT2=1.2, P=0.001), drowsiness (MT1=1.8 to MT2=0.4, P=0.001), and appetite (MT1=2.2 to MT2=0.6, P=0.001). Conclusions: This study demonstrates a positive impact of a 12-week remote physical activity program on HRQOL and symptom management for older patients with cancer, and set the stage for future randomized trials. Despite the challenges posed by cancer treatment, incorporating such programs into patient care could be an effective strategy to enhance overall well-being and mitigate treatment-related symptoms.

Defeatist Beliefs and Schizotypy in Adolescents and Emerging Adults

Defeatist beliefs involved overgeneralized negative beliefs regarding the ability to successfully perform tasks and accomplish goals. These cognitive errors have been shown to affect one’s ability to accurately assess and react in social situations and serve as hallmarks of many mood disorders. These negative beliefs also exist at high rates in adults with schizophrenia spectrum diagnoses. There is evidence for these beliefs existing during prodromal periods in young adults at-risk for psychosis, especially if they exhibit motivational or interpersonal difficulties (negative symptoms). However, there is little known about when these beliefs first emerge and whether they predate clinical disorder during earlier life stages where only subclinical presentations of risk (schizotypy) may be present. To address this research gap and help to inform cognitive-behavioral interventions targeting defeatist belief structures, we investigated the relations between defeatist beliefs and schizotypy in a sample of adolescents and emerging adults. Participants were 86 high school students (ages 14-17) and 270 college students (ages 18-22). Participants completed a 30-minute, self-report survey on defeatist beliefs and schizotypy. Our analyses found little difference in mean or standard deviation in defeatist beliefs or schizotypy between our two samples, with a robust positive association (r=0.46) when the samples where aggregated. These findings suggests that defeatist beliefs correspond with subclinical risk more-or-less on a continuum during this wider period of life potentially helping to understand variability in symptom severity. Future research is needed to clarify the nature of this relationship and to inform future interventions. Our finding suggests that cognitive behavioral approaches, which are well suited to target and modify defeatist beliefs, could serve a preventative role in the risk for future psychosis in at-risk adolescents and emerging adults.

ANK3 rs10994336 and ZNF804A rs7597593 polymorphisms: genetic interaction for emotional and behavioral symptoms of alcohol withdrawal syndrome

ObjectiveAlcohol withdrawal syndrome (AWS) is a complex condition associated with alcohol use disorder (AUD), characterized by significant variations in symptom severity among patients. The psychological and emotional symptoms accompanying AWS significantly contribute to withdrawal distress and relapse risk. Despite the importance of neural adaptation processes in AWS, limited genetic investigations have been conducted. This study primarily focuses on exploring the single and interaction effects of single-nucleotide polymorphisms in the ANK3 and ZNF804A genes on anxiety and aggression severity manifested in AWS. By examining genetic associations with withdrawal-related psychopathology, we ultimately aim to advance understanding the genetic underpinnings that modulate AWS severity.MethodsThe study involved 449 male patients diagnosed with alcohol use disorder. The Self-Rating Anxiety Scale (SAS) and Buss-Perry Aggression Questionnaire (BPAQ) were used to assess emotional and behavioral symptoms related to AWS. Genomic DNA was extracted from peripheral blood, and genotyping was performed using PCR.ResultsSingle-gene analysis revealed that naturally occurring allelic variants in ANK3 rs10994336 (CC homozygous vs. T allele carriers) were associated with mood and behavioral symptoms related to AWS. Furthermore, the interaction between ANK3 and ZNF804A was significantly associated with the severity of psychiatric symptoms related to AWS, as indicated by MANOVA. Two-way ANOVA further demonstrated a significant interaction effect between ANK3 rs10994336 and ZNF804A rs7597593 on anxiety, physical aggression, verbal aggression, anger, and hostility. Hierarchical regression analyses confirmed these findings. Additionally, simple effects analysis and multiple comparisons revealed that carriers of the ANK3 rs10994336 T allele experienced more severe AWS, while the ZNF804A rs7597593 T allele appeared to provide protection against the risk associated with the ANK3 rs10994336 mutation.ConclusionThis study highlights the gene-gene interaction between ANK3 and ZNF804A, which plays a crucial role in modulating emotional and behavioral symptoms related to AWS. The ANK3 rs10994336 T allele is identified as a risk allele, while the ZNF804A rs7597593 T allele offers protection against the risk associated with the ANK3 rs10994336 mutation. These findings provide initial support for gene-gene interactions as an explanation for psychiatric risk, offering valuable insights into the pathophysiological mechanisms involved in AWS.

The grasp reflex in patients with idiopathic normal pressure hydrocephalus

ObjectiveTo investigate the prevalence and intensity of grasp reflexes and to examine changes in these reflexes after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).MethodsWe enrolled 147 patients with probable iNPH. A standard procedure was used to determine the presence of grasp reflexes, and the intensity of these reflexes was assessed using a four-category classification. Clinical rating scales and their correlation with grasp reflexes were also evaluated. Grasp reflexes were reassessed in 72 patients 1 year after surgery.ResultsWe found that approximately 50.3% of patients with iNPH exhibited a positive grasp reflex. Among these patients, 69% exhibited bilateral positivity, while the remaining patients showed unilateral positivity. Furthermore, the intensity of the grasp reflex was significantly correlated with the severity of gait and with cognitive, urinary, motor, and behavioural symptoms. Surgical interventions led to a reduction (41.7%) or maintenance (30.6%) of the reflex intensity in 72.3% of iNPH patients. The changes in reflex intensity showed significant positive correlations with changes in the number of steps of the Timed Up and Go test and Trail Making Test-A scores but not with changes in total scores on the iNPH Grading Scale.ConclusionThis retrospective study identified grasp reflexes as a highly prevalent phenomenon in patients with iNPH. These reflexes can assist in evaluating the severity of various symptoms, including cognitive, gait, urinary, motor and emotional symptoms.

The Long COVID Symptoms and Severity Score: Development, Validation, and Application

ObjectivesThe primary focus of this research is the proposition of a methodological framework for the clinical application of the long COVID symptoms and severity score (LC-SSS). This tool is not just a self-reported assessment instrument developed and validated but serves as a standardized, quantifiable means to monitor the diverse and persistent symptoms frequently observed in individuals with long COVID. MethodsA 3-stage process was used to develop, validate, and establish scoring standards for the LC-SSS. Validation measures included correlations with other patient-reported measures, confirmatory factor analysis, Cronbach’s α for internal consistency, and test-retest reliability. Scoring standards were determined using K-means clustering, with comparative assessments made against hierarchical clustering and the Gaussian Mixture Model. ResultsThe LC-SSS showed correlations with EuroQol 5-Dimension 5-Level (rs = −0.55), EuroQol visual analog scale (rs = −0.368), Patient Health Questionnaire-9 (rs = 0.538), Beck Anxiety Inventory (rs = 0.689), and Insomnia Severity Index (rs = 0.516), confirming its construct validity. Structural validity was good with a comparative fit index of 0.969, with Cronbach’s α of 0.93 indicating excellent internal consistency. Test-retest reliability was also satisfactory (intraclass correlation coefficient 0.732). K-means clustering identified 3 distinct severity categories in individuals living with long COVID, providing a basis for personalized treatment strategies. ConclusionsThe LC-SSS provides a robust and valid tool for assessing long COVID. The severity categories established via K-means clustering demonstrate significant variation in symptom severity, informing personalized treatment and improving care quality for patients with long COVID.

Isolating unique variance in mental health outcomes attributable to personality variables and childhood emotional abuse.

University students are at high risk for anxiety and depression. Our main objective was to tease apart variance in symptom severity that was uniquely attributable to four associated variables that are frequently confounded: exposure to childhood emotional abuse, alexithymia, sensory processing sensitivity (SPS), and anxiety sensitivity (AS). University students (N = 410) completed an online survey designed to measure our four key study variables along with several other potentially relevant variables including sex, physical activity levels, and perceived COVID-19 impacts. Over half of the participants reported moderate to extremely severe symptoms of anxiety and depression. Females reported stronger signs of SPS and AS and were more likely than males to have increased their moderate/vigorous exercise since the pandemic began. After controlling for the other variables, the best predictors of perceived COVID-19 impacts were SPS, childhood emotional abuse, and current levels of physical activity. Whereas all three personality variables and childhood emotional abuse emerged as significant predictors of both depression and anxiety, neither COVID-19 impacts nor physical activity levels accounted for unique variance in either model. Unexpectedly, male sex emerged as an additional risk factor for depression, raising the possibility that males experience unique stressors and societal pressures that increase their risk of depression. These findings help to clarify the links between childhood emotional abuse, personality traits implicated in emotional awareness and self-regulation, and mental health. They may have important implications for the development and implementation of individualized treatments for common mental disorders.

Prescriptive factors for intensive home treatment in acute psychiatry: a secondary analysis of a randomised controlled trial

BackgroundIntensive home treatment (IHT) aims to prevent psychiatric hospitalisation. Although this intervention is well tested, it is still unknown for whom this intervention works best. Therefore, this study aims to explore prescriptive factors that moderate the effect of IHT compared to care as usual (CAU) on symptom severity.MethodsUsing data from a randomised controlled trial, 198 participants that experience an exacerbation of acute psychiatric symptoms were included in this secondary analysis. In order to maximise clinical relevance, generally available environmental and clinical baseline factors were included as tentative moderators: age, gender, employment status, domestic situation, psychiatric disorders, psychological symptoms, psychosocial functioning, alcohol and other substance use. The outcome variable symptom severity was measured using the Brief Psychiatric Rating Scale (BPRS) and collected at 26 and 52 weeks post-randomisation. Multiple regression analysis was used to examine which participants’ characteristics moderate the effect of IHT on the total BPRS score.ResultsOur results suggest that being employed (B = 0.28, SE = 0.13, 95% CI = 0.03–0.53, p = 0.03) at baseline seems to have a moderation effect, which result in lower symptom severity scores at 26 weeks follow-up for patients who received IHT. This effect was not found at 52 weeks.ConclusionsOn the basis of the number of factors tested, there is no evidence for robust outcome moderators of the effect of IHT versus CAU. Our conclusion is therefore that IHT can be offered to a diverse target population with comparable clinical results.Trial registrationThis trial is registered (date of registration: 2016-11-23) at the international clinical trials registry platform (NTR6151).

Clinical features that predict the mortality risk in older patients with Omicron pneumonia: the MLWAP score.

In December 2022, the Chinese suffered widespread Omicron of SARS-CoV-2 with variable symptom severity and outcome. We wanted to develop a scoring model to predict the mortality risk of older Omicron pneumonia patients by analyzing admission data. We enrolled 227 Omicron pneumonia patients aged 60years and older, admitted to our hospital from December 15, 2022, to January 16, 2023, and divided them randomly into a 70% training set and a 30% test set. The former were used to identify predictors and develop a model, the latter to verify the model, using the area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow goodness-of-fit test, a calibration curve to test its performance and comparing it to the existing scores. The MLWAP score was calculated based on a multivariate logistic regression model to predict mortality with a weighted score that included immunosuppression, lactate ≥ 2.4, white blood cell count ≥ 6.70 × 109/L, age ≥ 77years, and PaO2/FiO2≤211. The AUC for the model in the training and test sets was 0.852 (95% CI, 0.792-0.912) and 0.875 (95% CI, 0.789-0.961), respectively. The calibration curves showed a good fit. We grouped the risk scores into low (score 0-7 points), medium (8-10 points), and high (11-13 points). This model had a sensitivity of 0.849, specificity of 0.714, and better predictive ability than the CURB-65 and PSI scores (AUROC = 0.859 vs. 0.788 vs. 0.801, respectively). The MLWAP-mortality score may help clinicians to stratify hospitalized older Omicron pneumonia patients into relevant risk categories, rationally allocate medical resources, and reduce the mortality.

What happened matters: Trauma type and cumulative trauma exposure in refugee youth psychopathology.

Trauma exposure-a contributor to psychological risk for refugee youth-is typically assessed using cumulative indices; however, recent findings indicate that trauma type may better predict psychological outcomes. This study investigated the utility of two methods of classifying trauma exposure-cumulative trauma and exposure to specific types of trauma (i.e., trauma subtypes)-in predicting the severity of symptoms related to posttraumatic stress disorder (PTSD) and anxiety for refugee youth. 96 Syrian and Iraqi youth resettled as refugees in the United States self-reported trauma exposure and psychological symptoms. Multiple regression was used to assess the variance in symptom severity explained by specific trauma subtypes (i.e., victimization, death threat, and accidental/injury) as compared to cumulative trauma scores. Multiple regression models predicting PTSD revealed cumulative trauma (b = 0.07; p = .004) and death threat trauma (b = 0.16; p = .001) as significant predictors of PTSD symptom severity; notably, death threat trauma was the only subtype associated with PTSD and explained more variance than cumulative trauma scores (10.3% and 8.4%, respectively). Cumulative trauma, but no specific trauma subtype, was associated with anxiety (b = .03; p = .043); however, this relation did not survive correction for multiple comparisons. Focused trauma assessment-particularly consideration of death threat trauma and cumulative trauma exposures-may be useful in evaluating the risk of PTSD symptoms in refugee youth, whereas symptoms related to anxiety may be driven by other factors. These findings can be leveraged toward focused identification of youth at highest risk for PTSD symptoms, to improve prevention and early intervention efforts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Clinical severity in Parkinson's disease is determined by decline in cortical compensation.

Dopaminergic dysfunction in the basal ganglia, particularly in the posterior putamen, is often viewed as the primary pathological mechanism behind motor slowing (i.e. bradykinesia) in Parkinson's disease. However, striatal dopamine loss fails to account for interindividual differences in motor phenotype and rate of decline, implying that the expression of motor symptoms depends on additional mechanisms, some of which may be compensatory in nature. Building on observations of increased motor-related activity in the parieto-premotor cortex of Parkinson patients, we tested the hypothesis that interindividual differences in clinical severity are determined by compensatory cortical mechanisms and not just by basal ganglia dysfunction. Using functional MRI, we measured variability in motor- and selection-related brain activity during a visuomotor task in 353 patients with Parkinson's disease (≤5 years disease duration) and 60 healthy controls. In this task, we manipulated action selection demand by varying the number of possible actions that individuals could choose from. Clinical variability was characterized in two ways. First, patients were categorized into three previously validated, discrete clinical subtypes that are hypothesized to reflect distinct routes of α-synuclein propagation: diffuse-malignant (n = 42), intermediate (n = 128) or mild motor-predominant (n = 150). Second, we used the scores of bradykinesia severity and cognitive performance across the entire sample as continuous measures. Patients showed motor slowing (longer response times) and reduced motor-related activity in the basal ganglia compared with controls. However, basal ganglia activity did not differ between clinical subtypes and was not associated with clinical scores. This indicates a limited role for striatal dysfunction in shaping interindividual differences in clinical severity. Consistent with our hypothesis, we observed enhanced action selection-related activity in the parieto-premotor cortex of patients with a mild-motor predominant subtype, both compared to patients with a diffuse-malignant subtype and controls. Furthermore, increased parieto-premotor activity was related to lower bradykinesia severity and better cognitive performance, which points to a compensatory role. We conclude that parieto-premotor compensation, rather than basal ganglia dysfunction, shapes interindividual variability in symptom severity in Parkinson's disease. Future interventions may focus on maintaining and enhancing compensatory cortical mechanisms, rather than only attempting to normalize basal ganglia dysfunction.