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Background: Patient-reported outcomes (PROs) can promote person-centered biopsychosocial health care by measuring outcomes that matter to patients, including functioning and well-being. Data support feasibility and acceptability of PRO administration as part of routine clinical care, but less is known about its effects on population health, including detection of unmet healthcare needs. Our objectives were to examine differences in rates of clinically significant depression across sociodemographic groups and clinical settings from universal depression screens in a large health system, estimate the number of patients with untreated depression detected by screenings, and examine associations between biopsychosocial PROs—physical, psychological, and social health.Methods: We analyzed data from over 200,000 adult patients who completed depression screens—either PROMIS (Patient Reported Outcomes Measurement Information System) or PHQ-2/9—as part of routine outpatient care.Results: Depression screens were positive in 14.2% of the sample, with more positive screens among younger vs. older adults, women vs. men, non-White vs. White, and Hispanics vs. non-Hispanics. These same sociodemographic indicators, as well as completing screening in primary care (vs. specialty care) were also associated with greater likelihood of detected depression in the medical record.Discussion: Universal screening for depression symptoms throughout a large health system appears acceptable and has the potential to detect depression in diverse patient populations outside of behavioral health. Expanded delivery of PROs to include physical and social health as well as depression should be explored to develop a clinically-relevant model for addressing patients' biopsychosocial needs in an integrated fashion across the health system.

The presented study aims to explore the relationship between quality of life after myocardial infarction and factors such as temperamental traits, stress coping, and posttraumatic stress disorder (PTSD) symptoms. Ninety-six participants, including 51 females and 45 males aged 24–85 years, who have survived ST-elevation myocardial infarction were asked to complete the Formal Characteristics of Behavior—Temperament Inventory, Coping Inventory for Stressful Situations, PTSD Inventory, and Quality of Life SF-36 questionnaire. According to the obtained results, a lower level of briskness and sensory sensitivity, as well as a higher level of perseverance and endurance, correlates with a higher level of emotion-oriented coping, whereas a higher level of perseverance, endurance, and activity correlates with a higher level of avoidant-distracted coping. Moreover, a higher level of briskness and activity is correlated with a higher level of avoidant-social coping. A higher level of emotion-oriented and avoidant-distracted coping is, in turn, associated with a higher intensity of PTSD symptoms, whereas a higher level of avoidant-social coping correlates with lower intensity of PTSD symptoms. Furthermore, a higher level of avoidant-distracted coping is correlated to a better physical quality of life, whereas higher levels of endurance and activity are associated with a better emotional quality of life. Also, the more severe the PTSD symptoms, the lower quality of life in general. Contrastingly, higher sensory sensitivity and briskness correlate with better quality of life. The meaning of other temperamental traits, however, is more ambiguous. Nevertheless, the findings support the model of psychological processes in which the subsequent stages are temperament, coping, PTSD, and quality of life.

Background: The Depression Anxiety Stress Scales (DASS) are designed to identify quickly and differentiate between the symptoms of depression and anxiety in the non-clinical population. Different versions (original and short) were validated in many cultures. Nevertheless, there are no data of factorial validity of the different versions of this scale in Polish culture. Thus, the aim of this study was to evaluate the factor structure using confirmatory factor analysis (CFA) and internal consistency of DASS-42 (original version) and two short versions (DASS-21 items and DASS-12 items) in the Polish population.Methods: The DASS-42 was administered to a non-clinical sample, broadly representative of the general Polish adult population (n = 1,021) in terms of demographic variables. The DASS-21 and DASS-12 version used in this study comprise seven and four items from each of the following corresponding three subscales of the Polish version of DASS-42.Results: There were two models that fitted best for DASS-42: (a) modified three correlated factors (depression, anxiety, and stress) with cross-loadings and (b) second order (general factor of psychological distress) and three factors with cross-loadings. There were also two models that fitted best for DASS-21 and DASS-12: (a) modified three correlated factors (depression, anxiety, and stress) and (b) second order (general factor of psychological distress) and three factors.Conclusions: All three versions of DASS appear to have an acceptable factorial structure. However, the shorter versions (DASS-21 and DASS-12) may be more feasible to use in general medical practice and also be less burdensome to participants.

The urgency to understand the long-term neuropsychiatric sequala of COVID-19, a part of the Post-Acute COVID-19 Syndrome (PACS), is expanding as millions of infected individuals experience new unexplained symptoms related to mood, anxiety, insomnia, headache, pain, and more. Much research on PACS involves cross sectional surveys which limits ability to understand the dynamic trajectory of this emerging phenomenon. In this secondary analysis, we analyzed data from a 4-week observational digital phenotyping study using the mindLAMP app for 695 college students with elevated stress who specified if they were exposed to COVID-19. Students also completed a biweekly survey of clinical assessments to obtain active data. Additionally, passive data streams like GPS, accelerometer, and screen state were extracted from phone sensors and through features the group built. Three hundred and eighty-second number participants successfully specified their COVID-19 exposure and completed the biweekly survey. From active smartphone data, we found significantly higher scores for the Prodromal Questionnaire (PQ) and the Pittsburgh Sleep Quality Index (PSQI) for students reporting exposure to COVID-19 compared to those who were not (ps < 0.05). Additionally, we found significantly decreased sleep duration as captured from the smartphone via passive data for the COVID-19 exposed group (p < 0.05). No significant differences were detected for other surveys or passive sensors. Smartphones can capture both self-reported symptoms and behavioral changes related to PACS. Our results around changes in sleep highlight how digital phenotyping methods can be used in a scalable and accessible manner toward better capturing the evolving phenomena of PACS. The present study further provides a foundation for future research to implement improving digital phenotyping methods.

This study focuses on identifying COVID-19 related exposure, stress, and mental health concerns in the larger Charlotte, North Carolina region, an area with many low-income and under resourced communities. A community-academic partnership conducted a regional COVID-19 needs assessment. Low-income adults (N = 156) completed an online-administered survey of demographic information, COVID-19 exposure, stress, coping-related factors, and mental health. Frequency data showed that common COVID-19 related stressors included job exposure, lost job/income, and increased home responsibilities. Frequency data further showed elevated screening risk rates for mental health concerns were observed for post-traumatic stress (83.3%), depression (52.2%), problematic drinking (50.0%), generalized anxiety (43.0%), and suicide (40.4%). Bivariate correlation and multivariate regression models identified robust mental health risk factors including COVID-19 related stress affecting close persons, fear/worry reaction to the pandemic, and use of venting as a coping strategy; protective factors included active coping and problem-focused coping beliefs. Findings are discussed with respect to informing regional public health efforts during the pandemic.

AimsTo explore changes in alcohol purchase and consumption during the first few months of the Covid-19 pandemic, and assess associations between increased alcohol purchase/use and socioeconomic and environmental factors.DesignSecondary data from a cross-sectional online survey conducted from 17 April to 25 June 2020.SettingThirty-eight countries from all continents of the world.ParticipantsA total of 37,206 adults (mean age:36.7, SD:14.8, 77% female) reporting alcohol purchasing and drinking habit before and during the pandemic.MeasurementsChanges in alcohol stock-up and frequency of alcohol use during the pandemic and increased alcohol stock-up and use were stratified by gender, age, education, household structure, working status, income loss, psychological distress, and country based on alcohol consumption per capita. The associations between increased alcohol stock-up/use and living with children, working from home, income loss and distress were examined using multivariate logistic regression, controlling for demographic factors.FindingsThe majority of respondents reported no change in their alcohol purchasing and drinking habits during the early pandemic period. Increased drinking was reported by 20.2% of respondents, while 17.6% reported decreased alcohol use. More than half (53.3%) of respondents experienced psychological distress, with one in five (20.7%) having severe distress. Female gender, being aged under 50, higher educational attainment, living with children, working from home, and psychological distress were all independently associated with increased alcohol drinking during lockdown. Limitations of the study were the non-representative sample, the data collection early in the pandemic, and the non-standard measurement of alcohol consumption.ConclusionIncreased psychological distress among people during the early pandemic period, resulted in increased alcohol consumption, especially among women with children working from home during lockdown.

Refugees are often exposed to a variety of stressors and traumatic events, posing a significant risk for the development of mental disorders. Young refugees may be particularly at risk because adverse life events affect identity formation, a developmental task that is typically expected in adolescence and emerging adulthood. Trauma and cultural changes may alter identity development, potentially leading to identity diffusion, a core concept of personality disorders. However, previous research on personality pathology among refugees is scarce. In this study, we examine identity development and maladaptive personality traits in young refugees and migrants. Refugees from 22 countries of origin were recruited in a German reception center (n = 120) and a group of adults with a migration background in first- or second generation was obtained via web-based recruitment (n = 281). Identity development was measured using the Assessment of Identity Development in Adolescence – Short Form. Maladaptive personality traits were assessed with the Personality Inventory for DSM-5-Brief Form. Group differences between refugees and migrants regarding identity development and trait expression were investigated using t-tests. The relationship between the two measures and their corresponding subscales was examined by means of correlation analyses. Refugees reported significantly higher levels of identity diffusion, negative affectivity, detachment, antagonism, and disinhibition compared to migrants. No significant differences were found for psychoticism. Correlation analyses revealed low to moderate positive associations between identity diffusion and maladaptive trait expression. Possible implications for early phase of resettlement, preventive psychiatric care and further research questions are discussed.

Background: This study examines the interaction between a history of binge drinking (BD), alone or with cannabis consumption, and the effects of acute alcohol exposure on immediate visual memory (IVM) (faces memory task, scenes memory task and IVM-IQ) in adolescents of both sexes.Method: Two hundred and ninety adolescents, grouped into refrainers, binge drinkers and subjects with a history of simultaneous BD/Cannabis co-use, received a risk dose of alcohol or a control drink.Results: Consumption Pattern (refrainers vs. binge drinkers vs. BD/Cannabis consumers) was not significant, while Treatment (acute alcohol vs. control drink) was significant in both sexes. Also, male binge drinkers' performance in the faces memory task was poorer than that of refrainers and BD/Cannabis consumers who consumed the control drink. BD/Cannabis consumers performed this task as capably as refrainers. In women, binge drinkers performed better than refrainers in scene memory and IVM-IQ tests when given alcohol, and binge drinkers performed worse than refrainers after consuming the control drink.Conclusions: Acute alcohol consumption worsens IVM. Cannabis exerts a buffering effect in men. A cognitive tolerance effect is observed in women. Exposure during adolescence to alcohol, alone or with cannabis, can trigger different cognitive effects in men and women that could endure into adulthood.

Background and Objectives: Opioid agonist pharmacotherapies are effective in the treatment of opioid use disorder (OUD) but concurrent stimulant use is common and can lead to relapse and treatment drop out. Contingency management in combination with opioid agonist pharmacotherapy has broad beneficial effects in polysubstance users, including promoting drug abstinence and treatment retention, but clinic-based implementation can be burdensome. The present study was conducted to evaluate a contingency management intervention delivered via a smartphone-smartcard platform in OUD patients who had concurrent stimulant use disorder.Methods: Retrospective comparison of (n = 124) patients; half received the contingency management intervention and half were matched controls. Drug use and clinic attendance outcomes over four consecutive 30-day periods were analyzed with regression.Results: The intervention group showed consistently higher rates of drug abstinence and clinic attendance which were significant at the latter two timepoints.Discussion: Smartphone-smartcard platforms can facilitate dissemination of contingency management by surmounting or obviating key barriers to adoption. They appear to be convenient for all stakeholders, are easy to use, and facilitate high-fidelity implementation. Delivering contingency management via a smartphone-smartcard platform produces effects consistent with those observed when the intervention is delivered with substantially costlier and more burdensome in-person procedures.

Marijuana (Cannabissp.) is among the most recurred controlled substances in the world, and there is a growing tendency to legalize its possession and use; however, the genotoxic effects of marijuana remain under debate. A clear definition of marijuana's genotoxic effects remains obscure by the simultaneous consumption of tobacco and other recreational substances. In order to assess the genotoxic effects of marijuana and to prevent the bias caused by the use of substances other than cannabis, we recruited marijuana users that were sub-divided into three categories: (1) users of marijuana-only (M), (2) users of marijuana and tobacco (M+T), and (3) users of marijuana plus other recreative substances or illicit drugs (M+O), all the groups were compared against a non-user control group. We quantified DNA damage by detection of γH2AX levels and quantification of micronuclei (MN), one of the best-established methods for measuring chromosomal DNA damage. We found increased levels of γH2AX in peripheral blood lymphocytes from the M and M+T groups, and increased levels of MNs in cultures from M+T group. Our results suggest a DNA damage increment for M and M+T groups but the extent of chromosomal damage (revealed here by the presence of MNs and NBuds) might be related to the compounds found in tobacco. We also observed an elevated nuclear division index in all marijuana users in comparison to the control group suggesting a cytostatic dysregulation caused by cannabis use. Our study is the first in Mexico to assess the genotoxicity of marijuana in mono-users and in combination with other illicit drugs.

Background: People experiencing homelessness face significant medical and psychiatric illness, yet few studies have characterized the effects of multimorbidity within this population. This study aimed to (a) delineate unique groups of individuals based on medical, psychiatric, and substance use disorder profiles, and (b) compare clinical outcomes across groups.Methods: We extracted administrative data from a health system electronic health record for adults referred to the Durham Homeless Care Transitions program from July 2016 to June 2020. We used latent class analysis to estimate classes in this cohort based on clinically important medical, psychiatric and substance use disorder diagnoses and compared health care utilization, overdose, and mortality at 12 months after referral.Results: We included 497 patients in the study and found 5 distinct groups: “low morbidity” (referent), “high comorbidity,” “high tri-morbidity,” “high alcohol use,” and “high medical illness.” All groups had greater number of admissions, longer mean duration of admissions, and more ED visits in the 12 months after referral compared to the “low morbidity” group. The “high medical illness” group had greater mortality 12 months after referral compared to the “low morbidity” group (OR, 2.53, 1.03–6.16; 95% CI, 1.03–6.16; p = 0.04). The “high comorbidity” group (OR, 5.23; 95% CI, 1.57–17.39; p < 0.007) and “high tri-morbidity” group (OR, 4.20; 95% CI, 1.26–14.01; p < 0.02) had greater 12-month drug overdose risk after referral compared to the referent group.Conclusions: These data suggest that distinct groups of people experiencing homelessness are affected differently by comorbidities, thus health care programs for this population should address their risk factors accordingly.

Introduction: Suicide is a major public health problem but factors determining suicide risk are still unclear. Studies in this field in Bulgaria are limited, especially on a regional level.Methods: By a cross-sectional design, we accessed the medical records of all psychiatric patients committed suicide over a 10-year period (2009–2018) in one major administrative region of Bulgaria. A statistical analysis was performed of the association between age of suicide as an indirect yet measurable expression of the underlying suicidal diathesis and a number of socio-demographic and clinical characteristics.Results: Seventy-seven of 281 suicides (28%) had psychiatric records. Most common diagnoses were mood disorders (44%), followed by schizophrenia (27%), anxiety disorders (10%), substance use disorders (9%) and organic conditions (8%). Male gender, single/divorced marital status, early illness onset, co-occurring substance misuse and lower educational attainment (for patients aged below 70) were significantly associated with earlier age of suicide whereas past suicide attempts and psychiatric hospitalizations, comorbid somatic conditions and unemployment showed insignificant association. Substantial proportion of patients (60%) had contacted psychiatric service in the year preceding suicide, with nearly half of these encounters being within 30 days of the accident.Conclusion: Severe mental disorders are major suicide risk factor with additional contribution of certain socio-demographic and illness-related characteristics. Monitoring for suicidality must be constant in chronic psychiatric patients. Registration of suicide cases in Bulgaria needs improvement in terms of information concerning mental health. More studies with larger samples and longitudinal design are needed to further elucidate distal and proximal suicide risk factors.

Stressful life events play a role in the pathogenesis of major depressive disorder (MDD) and many patients with MDD were exposed to developmental stress due to adverse childhood experiences (ACE). Furthermore, dysregulation of the autonomic nervous system and higher incidence of cardiovascular disease are found in MDD. In MDD, and independently in individuals with ACE, abnormalities in heart rate variability (HRV) have been reported. While these are often confounded, we systematically investigated them with a study which included MDD patients with/without ACE as well as healthy individuals with/without ACE. With this study, we investigated the influence of noradrenergic stimulation on HRV reactivity in unmedicated participants in a randomized, double-blind, repeated measures design. Our sample consisted of men and women with MDD and ACE (n = 25), MDD without ACE (n = 24), healthy participants with ACE (n = 27), and without ACE (n = 48). Participants received a 10 mg single dose of the alpha-2 antagonist yohimbine that increases noradrenergic activity or placebo on 2 separate days, with ECG recordings before and after drug administration at defined intervals. We found lower basal HRV in MDD and ACE: patients with MDD had reduced RMSSD whereas participants with ACE had lower LF-HRV. Contrary to our hypothesis, there was no effect of yohimbine. With this study, we were able to replicate previous findings on HRV differences in MDD and ACE. From the null effect of yohimbine, we conclude that the yohimbine-induced sympathetic activation is not a significant driver of HRV in MDD and ACE.

Introduction:Military members and Veterans are at risk of developing combat-related, treatment-resistant posttraumatic stress disorder (TR-PTSD) and moral injury (MI). Conventional trauma-focused therapies (TFTs) have shown limited success. Novel interventions including Multi-modal Motion-assisted Memory Desensitization and Reconsolidation therapy (3MDR) may prove successful in treating TR-PTSD.Objective:To qualitatively study the experiences of Canadian military members and Veterans with TR-PTSD who received the 3MDR intervention.Methods:This study explored qualitative data from a larger mixed-method waitlist control trial testing the efficacy of 3MDR in military members and veterans. Qualitative data were recorded and collected from 3MDR sessions, session debriefings and follow-up interviews up to 6 months post-intervention; the data were then thematically analyzed.Results:Three themes emerged from the data: (1) the participants' experiences with 3MDR; (2) perceived outcomes of 3MDR; and (3) keys to successful 3MDR treatment. Participants expressed that 3MDR provided an immersive environment, active engagement and empowerment. The role of the therapist as a coach and “fireteam partner” supports the participants' control over their therapy. The multi-modal nature of 3MDR, combining treadmill-walking toward self-selected trauma imagery with components of multiple conventional TFTs, was key to helping participants engage with and attribute new meaning to the memory of the traumatic experience.Discussion:Preliminary thematic analysis of participant experiences of 3MDR indicate that 3MDR has potential as an effective intervention for combat-related TR-PTSD, with significant functional, well-being and relational improvements reported post-intervention.Conclusion:Military members and Veterans are at risk of developing TR-PTSD, with worse outcomes than in civilians. Further research is needed into 3MDR and its use with other trauma-affected populations.

Some first investigations have focused on the consequences of the COVID-19 pandemic for the general mental health after its outbreak in 2020. According to multiple self-reporting surveys, symptoms of stress, anxiety, and depression have risen worldwide. Even some studies based on health care records start to be published, providing more objective and statistically reliable results. Additionally, concerns have been raised, to what extend the access to mental health care has been compromised by the COVID-19 outbreak. The aim of this study was to detect changes in prescription trends of common psychotropic medications in the Swedish region of Scania. The monthly dispensed amounts of selected pharmaceuticals were compared from January 2018 until January 2021, regarding the prescription trends before and after the outbreak of COVID-19. Using an interrupted time series analysis for each medication, no general trend changes were observed. On the one hand, a possible deterioration of the general mental health could not be confirmed by these results. On the other hand, the access to mental health care did not seem to be impaired by the pandemic. When interpreting findings related to the COVID-19 pandemic, regional differences and country-specific approaches for coping with the pandemic should be considered. The Swedish population, for instance, never experienced a full “lock-down” and within Sweden the time point of the outbreak waves differed regionally. In general, the effects of the COVID-19 outbreak on mental health are still unclear and need to be investigated further in an international comparison.

Aim: This qualitative study examined the experiences of families with Multi-Family Therapy (MFT) provided by the Early Psychosis Intervention Programme (EPIP) in Singapore. The MFT was piloted over a period of 2 years and findings from this study were used to further refine the MFT to better meet the needs of Singaporean families in the service.Methods: Families who completed the MFT were invited to participate in the study. Nine clients and ten carers who consented to participate in the study were allocated to two client and two carer Focus Group Discussions (FGDs) respectively. A semi-structured interview schedule was used to facilitate the discussions. The FGDs were audio recorded, transcribed, and anonymised. The data was analysed using thematic analysis.Results: Four main themes emerged from the analysis: (1) therapeutic processes of MFT, (2) positive changes in family relationships, (3) improvements in coping with psychosis, and (4) suggestions for improvement in MFT. The families suggested some structural changes to the MFT, and more carers than clients would prefer therapists to offer more expert advice.Conclusions: Findings suggest that a Western-based MFT can be adapted to work with Singaporean families. This study sheds light on the therapeutic processes that may be related to the changes in family relationships and coping with psychosis. In addition, it suggests that therapists taking an expert and authoritative approach may not fit with the needs of younger generations in Singapore. It advocates for therapists to take a flexible and fluid stance to work with Singaporean families.

Multichannel near-infrared spectroscopy (NIRS), including 52-channel NIRS (52ch-NIRS), has been used increasingly to capture hemodynamic changes in the brain because of its safety, low cost, portability, and high temporal resolution. However, optode caps might cause pain and motion artifacts if worn for extended periods of time because of the weight of the cables and the pressure of the optodes on the scalp. Recently, a small NIRS apparatus called compact NIRS (cNIRS) has been developed, and uses only a few flexible sensors. Because this device is expected to be more suitable than 52ch-NIRS in the clinical practice for patients with children or psychiatric conditions, we tested whether the two systems were clinically comparable. Specifically, we evaluated the correlation between patterns of hemodynamic changes generated by 52ch-NIRS and cNIRS in the frontopolar region. We scanned 14 healthy adults with 52ch-NIRS and cNIRS, and measured activation patterns of oxygenated-hemoglobin [oxy-Hb] and deoxygenated-hemoglobin [deoxy-Hb] in the frontal pole while they performed a verbal fluency task. We performed detailed temporal domain comparisons of time-course patterns between the two NIRS-based signals. We found that 52ch-NIRS and cNIRS showed significant correlations in [oxy-Hb] and [deoxy-Hb] time-course changes in numerous channels. Our findings indicate that cNIRS and 52ch-NIRS capture similar task-dependent hemodynamic changes due to metabolic demand, which supports the validity of cNIRS measurement techniques. Therefore, this small device has a strong potential for clinical application with infants and children, as well as for use in the rehabilitation or treatment of patients with psychiatric disorders using biofeedback. ispartof: FRONTIERS IN PSYCHIATRY vol:12 ispartof: location:Switzerland status: published

Reducing criminal legal system involvement requires an understanding of the factors that promote repeat offending (i. e., recidivism), and the dissemination of relevant interventions to those most likely to benefit. A growing body of research has established common recidivism risk factors for persons with serious psychiatric disorder diagnoses. However, research to date has not examined the degree to which these risks apply to those with serious psychiatric disorders with and without co-occurring substance use disorders. To clarify what risk and need factors are greatest and for whom, this cross-sectional study drew from an original dataset containing data on 14 social and economic, psychological, and criminal risk areas for a cohort of people on probation (n = 4,809). Linear regression models indicated that, compared to those without a serious psychiatric disorder, people on probation with a serious psychiatric disorder are at greater risk in a minority of areas and those areas are mostly social and economic in nature. Meanwhile, those withco-occurring disorders are at relatively high risk across almost all areas. The results from this study suggest that justice involved persons with serious psychiatric disorders will benefit from interventions that increase social support and economic well-being and that interventions that broadly reduce risk among people with co-occurring serious psychiatric and substance use disorders will likely yield meaningful reductions in system involvement. Ultimately, understanding and intervening upon risk for recidivism among persons with serious psychiatric disorders requires differentiating between those with and without co-occurring substance use disorders.

Objective: The worldwide pandemic of coronavirus disease (COVID-19) has caused significant public health burdens and psychological dysfunctions. In this challenging time, adolescents require special care. The Persian version of the Obsession with COVID-19 Scale (OCS) for adolescents was developed to screen for dysfunctional obsession associated with the coronavirus during the global pandemic. The structure and internal consistency of the OCS were established.Design and Measures: Although there are different language versions of the OCS, this is the first study to validate the psychometric properties of the OCS in Iranian adolescents. Seven hundred and nine students (369 girls) participated in the study. Demographic questions and the OCS were administered.Results: The findings provided support for the existence of a unidimensional structure that met the criteria for configural, metric, and full scalar invariance across gender (girls and boys), inhabitancy (urban and rural), and infection experience (infected and non-infected). The OCS is short and highly reliable measurement. However, further research is necessary to establish the validity of the scale in Iranian population.Conclusions: The development of such valid scales is an essential part of both research and practice during times of crisis, like a global pandemic. Diagnosis of pandemic related to obsessive thoughts in adolescents is needed as the COVID-19 pandemic is still ongoing and as experts point out, it can be expected that the effects of the pandemic will be observed in the coming years. The Persian version makes it possible to conduct international comparative research on the anxiety related to the COVID-19 pandemic.

Background: Physical activity significantly improves mental illness symptoms and physical health for people living with mental illness. Mental health services do not routinely provide their consumers with access to exercise professionals for physical activity engagement. Barriers exist to integrating physical activity as part of standard care including staff culture, finance, and resources. This study examines the feasibility of newly established exercise physiology clinic within a mental health service in Sydney, Australia.Methods: A single site, open trial was conducted in a community centre within a large mental health district. A meeting room was converted into a part-time exercise physiology clinic where individualised physical activity interventions were delivered by an accredited exercise physiologist. Outcome measures including BMI, cardiovascular fitness, and self-reported physical activity were collected.Results: A total of 84 mental health consumers (17% of eligible consumers within the mental health service) participated in the clinic on average for one exercise session weekly. Moderate-to-vigorous physical activity significantly increased and sedentary time significantly decreased (p < 0.001).Conclusions: Exercise physiology clinics are feasible within mental health services and should be incorporated as part of standard care.

Background: Multiple prenatal factors have been associated with autism spectrum disorder (ASD) risk. However, current data about the association between antimicrobial use during pregnancy and ASD is limited.Methods: A nested matched case-control study of children with ASD (cases), and children without ASD or other psychiatric or genetic disorders (controls). We compared the use of antimicrobial therapy during the 3 months before conception or during pregnancy between mothers of cases and controls and used multivariate conditional logistic regression models to assess the independent association between maternal use of antimicrobials during pregnancy and the risk of ASD in their offspring.Results: More than half of the mothers in the study (54.1%) used antimicrobial drugs during the 3 months before conception or during pregnancy. Rates of antimicrobial use were lower for mothers of children with ASD compared to mothers of controls (49.0 vs. 55.1%, respectively; p = 0.02), especially during the third trimester of pregnancy (18.8 vs. 22.9%, respectively; p = 0.03), and for the use of penicillins (15.7 vs. 19.7%, respectively; p = 0.06). These case–control differences suggest that antimicrobial administration during pregnancy was associated with a reduced risk of ASD in the offspring (aOR = 0.75, 95% CI = 0.61–0.92). Interestingly, this association was seen only among Jewish but not for the Bedouin mothers (aOR = 0.62, 95% CI = 0.48–0.79 and aOR = 1.21, 95% CI = 0.82–1.79).Conclusions: The reduced risk of ASD associated with prenatal antimicrobials use only in the Jewish population suggest the involvement of other ethnic differences in healthcare services utilization in this association.

The potency of the synthetic opioid fentanyl and its increased clinical availability has led to the rapid escalation of use in the general population, increased recreational exposure, and subsequently opioid-related overdoses. The wide-spread use of fentanyl has, consequently, increased the incidence of in utero exposure to the drug, but the long-term effects of this type of developmental exposure are not yet understood. Opioid use has also been linked to reduced mitochondrial copy number in blood in clinical populations, but the link between this peripheral biomarker and genetic or functional changes in reward-related brain circuitry is still unclear. Additionally, mitochondrial-related gene expression in reward-related brain regions has not been examined in the context of fentanyl exposure, despite the growing literature demonstrating drugs of abuse impact mitochondrial function, which subsequently impacts neuronal signaling. The current study uses exposure to fentanyl via dam access to fentanyl drinking water during gestation and lactation as a model for developmental drug exposure. This perinatal drug-exposure is sufficient to impact mitochondrial copy number in circulating blood leukocytes, as well as mitochondrial-related gene expression in the nucleus accumbens (NAc), a reward-related brain structure, in a sex-dependent manner in adolescent offspring. Specific NAc gene expression is correlated with both blood mitochondrial copy number and with anxiety related behaviors dependent on developmental exposure to fentanyl and sex. These data indicate that developmental fentanyl exposure impacts mitochondrial function in both the brain and body in ways that can impact neuronal signaling and may prime the brain for altered reward-related behavior in adolescence and later into adulthood.

Person-centered care approaches continue to evolve in long-term care (LTC). At the same time, these settings have faced increased challenges due to a more diverse and complex population, including persons with intellectual and developmental disabilities (IDD) and serious mental illness (SMI). This study examined the mental, social, and physical wellbeing of residents with different diagnoses, within a person-centered care model. It was hypothesized that individual wellbeing would be comparable among all residents, regardless of primary diagnosis. The study cohort was drawn from all admissions to long-term care facilities in the USA from 2011 to 2013. Data are based on admission, 3 and 6 month follow-up Minimum Data Set (MDS) 3.0 assessments. The groups examined included: schizophrenia, other psychotic disorders, IDD, dementia, and all others (i.e., none of the above diagnoses). The wellbeing outcomes were depression (mental), pain (physical), and behaviors (social). All residents experienced improvements in pain and depression, though the group without the examined diagnoses experienced the greatest gains. Behaviors were most prevalent among those with psychotic disorders; though marked improvements were noted over time. Improvement also was noted among persons with dementia. Behavior worsened over time for the three other groups. In particular, those with IDD experienced the highest level of worsening at 3-month follow-up, and continued to worsen. The results suggest person-centered care in US nursing homes provides the necessary foundation to promote mental and physical wellbeing in persons with complex needs, but less so for social wellbeing.

Background: Communication between healthcare providers and patients with persistent somatic symptoms (PSS) is frequently hampered by mutual misunderstanding and dissatisfaction.Methods: We developed an online, interprofessional course to teach healthcare providers the knowledge, skills, and attitude they need to diagnose and treat PSS in a patient-centered manner based on the biopsychosocial model. The course consisted of six modules of 45–60 min. Each module contained different types of assignments, based on six cases: videos, discussion boards, reading assignments, polls, and quizzes. For this study, we included (1) medical residents, following the course as part of their residency training, and (2) healthcare providers (general practitioners, medical specialists, physiotherapists, nurses, and psychologists), following the course as continuing vocational training. Throughout the course, participants were asked to fill out online surveys, enquiring about their learning gains and satisfaction with the course.Results: The biopsychosocial approach was integrated across the modules and teached health care workers about recent insights on biological, psychological and social aspects of PSS. In total, 801 participants with a wide variety in clinical experience started the course; the largest groups of professionals were general practitioners (N = 400), physiotherapists (N = 124) and mental healthcare workers (N = 53). At the start of the course, 22% of the participants rated their level of knowledge on PSS as adequate. At the end of the course, 359 participants completed the evaluation questionnaires. Of this group, 81% rated their level of knowledge on PSS as adequate and 86% felt that following the course increased their competencies in communicating with patients with PSS (N = 359). On a scale from 1 to 10, participants gave the course a mean grade of 7.8 points. Accordingly, 85% stated that they would recommend the course to a colleague.Conclusion: Our course developed in a co-design process involving multiple stakeholders can be implemented, is being used, and is positively evaluated by professionals across a variety of health care settings.

Background: Although the relevant underlying biological mechanisms are still lacking, mental disorders have been closely associated with several metabolic abnormalities including high rates of obesity and metabolic syndrome especially in vulnerable populations. Therefore, the current study aims to examine how metabolic parameters increase the risk for developing mood disorders in individuals stratified by gender and age.Methods: In a routine physical examination, 319 healthy participants were recruited and assigned to six different groups according to age (young adults: 25–34 Y, middle age: 35–49 Y, and older age: 50–65 Y) in both males and females. A linear regression and bivariate correlation analysis were used to analyze the relationship between mood health outcomes measured by the Kessler 10 Psychological Distress Scale (K10) and the metabolic function.Results: The results demonstrated that there was a significant association between K10 scores and metabolic parameters, including Body Mass Index (BMI), total-, LDL-cholesterol, and triglyceride. Furthermore, poor mental health (higher K10 scores) was observed in individuals with increased BMI, total-, LDL-cholesterol, and triglyceride levels particularly in middle-aged women relative to other groups.Limitations: This is a cross-sectional study with a small sample size and lacks longitudinal follow-up evidence and preventive interventions and therefore could not provide the causal inference of metabolic pathophysiology on the increased sensitivity to mental disorders.Conclusions: The potential association suggests that targeting of the metabolic parameters might give us a better understanding of the underlying mechanisms of psychiatric diseases and provide preventive strategies and potential treatment for those with metabolic disturbances especially in middle-aged females.

The current study examined the influence of pubertal development stage on depression and its psychosocial mechanisms in a non-clinical population of 502 adolescents (244 boys and 258 girls) in China, graded 5 to 8. Results indicated that (1) pubertal development was positively correlated with depression, negative physical self and interpersonal stress. (2) There is a significant gender by pubertal development interaction on the measure of academic self-concept, which is accounted for by decreased academic self in boys but not in girls as a function of pubertal development. (3) Mediation analyses show that increased depression in late compared to pre- puberty is partly mediated by the enhancement of negative physical self and interpersonal stress. These findings suggest that the late stage of puberty is coupled by a higher risk of depression in adolescents partly through increased negative physical self and interpersonal stress.

Background: Resilience is proven as a protective factor against the development of psychiatric disorders, and it has gained clinical relevance in the development and progression of cardiovascular pathology. The authors performed a longitudinal study on patients with implantable cardioverter defibrillator (ICD) with the primary aim to highlight the possible existence of a correlation between individual resilience capacity, depressive and anxiety symptoms, and quality of life in terms of outcomes. The secondary aim was to analyze the differences between patients with major cardiac events in the follow-up and patients without cardiac events with respect to the previous variables.Materials and Methods: A total of 80 patients enrolled in the Cardiology Unit were evaluated at T0 and during the follow-up through the following scales: the 14-item Resilience Scale (RS-14), the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life-Brief Version (WHOQOL-Bref).Results: A significant linear correlation between resilience and all the areas of quality of life at T0, T1, and T2 emerged. A negative correlation between resilience and anxiety and depressive symptoms emerged, as well as between depression and anxiety and quality of life. Patients with cardiac events during the follow up have shown a worse quality of life and the onset of anxiety-depressive symptoms over time, without changes to the resilience scores. Patients without cardiac events showed an increasing trend in resilience scores.Discussion: Given the speed and simplicity of use of the RS-14 scale, it seems promising to further investigate the real clinical usefulness of this instrument in the cardiology field.

Background: The Covid-19 pandemic and related measures represent an enormous burden on mental health. The aim of this study was to investigate longitudinal changes in psychological distress, loneliness, boredom, and resilience over the course of the pandemic and to examine the associations between resilience and extraversion at baseline (summer 2020) and psychological distress, loneliness, and boredom at 5-month-follow-up.Methods: Residents of Tyrol (≥18a) completed an online survey on psychological distress, loneliness, boredom, resilience, and extraversion by using the Brief-Symptom-Checklist, the Three-Item Loneliness Scale, the Multidimensional State Boredom Scale-Short Form (MSBS-SF), the Resilience Scale, and the Extraversion subscale of the Big Five Inventory.Results: Of the 961 baseline participants, 384 took part in the follow-up survey. The percentage of study participants with striking psychological distress remained the same. Similarly, resilience did not change from baseline to follow-up, whereas the number of those experiencing moderate loneliness increased significantly. In contrast, at follow-up, severe loneliness was detected in significantly less people. Boredom decreased significantly over time. A moderate negative association was detected between baseline resilience and psychological distress, loneliness, and boredom at follow-up, and a weak but still significant negative association between extraversion and these outcomes.Discussion: These findings indicate that a subset of the general population consistently suffers from high levels of psychological distress and point to the protective effects of resilience and extraversion in this context. They reemphasize the importance of prevention and mitigation strategies to address these public health problems.

Background: Psychosocial stress negatively affects the clinical course of bipolar disorder. Studies primarily focused on adults with bipolar disorder suggest the impact of stress is progressive, i.e., stress response sensitizes with age. Neural mechanisms underlying stress sensitization are unknown. As stress-related mechanisms contribute to alcohol/substance use disorders, variation in stress response in youth with bipolar disorder may contribute to development of co-occurring alcohol/substance use disorders. This study investigated relations between psychosocial stress, amygdala reactivity, and alcohol and cannabis use in youth with bipolar disorder, compared to typically developing youth.Methods: Forty-two adolescents/young adults [19 with bipolar disorder, 23 typically developing, 71% female, agemean ± SD = 21 ± 2 years] completed the Perceived Stress Scale (PSS), Daily Drinking Questionnaire modified for heaviest drinking week, and a modified Montreal Imaging Stress functional MRI Task. Amygdala activation was measured for both the control and stress conditions. Main effects of group, condition, total PSS, and their interactions on amygdala activation were modeled. Relationships between amygdala response to acute stress with recent alcohol/cannabis use were investigated.Results: Greater perceived stress related to increased right amygdala activation in response to the stress, compared to control, condition in bipolar disorder, but not in typically developing youth (group × condition × PSS interaction, p = 0.02). Greater amygdala reactivity to acute stress correlated with greater quantity and frequency of alcohol use and frequency of cannabis use in bipolar disorder.Conclusion: Recent perceived stress is associated with changes in amygdala activation during acute stress with amygdala reactivity related to alcohol/cannabis use in youth with bipolar disorder.

Altered risk-taking propensity is an important determinant of functional impairment in bipolar disorder. However, prior studies primarily assessed patients with chronic illness, and risk-taking has not been evaluated in the early illness course. This study investigated risk-taking behavior in 39 euthymic early-stage bipolar disorder patients aged 16–40 years who were treated within 3 years from their first-episode mania with psychotic features and 36 demographically-matched healthy controls using the Balloon Analog Risk Task (BART), a well-validated risk-taking performance-based paradigm requiring participants to make responses for cumulative gain at increasing risk of loss. Relationships of risk-taking indices with symptoms, self-reported impulsivity, cognitive functions, and treatment characteristics were also assessed. Our results showed that patients exhibited significantly lower adjusted scores (i.e., average balloon pumps in unexploded trials) (p = 0.001), lower explosion rate (p = 0.007) and lower cumulative scores (p = 0.003) than controls on BART, indicating their suboptimal risk-taking performance with increased propensity for risk aversion. Risk-taking indices were not correlated with any symptom dimensions, self-reported impulsivity, cognitive functions or antipsychotic dose. No significant difference was observed between patients with and without antipsychotic medications on self-reported impulsivity or any of the BART performance indices. This is the first study to examine risk-taking behavior in early-stage bipolar disorder with history of psychosis and indicates that patients displayed altered risk-taking with increased risk aversion compared with controls. Further research is needed to clarify longitudinal trajectory of risk-taking propensity and its relationships with psychosis and functional outcome in the early stage of bipolar disorder.

Adolescence is often a period of turmoil. The COVID-19 pandemic has increased adolescents' difficulty due to mental health consequences that may affect their developmental milestones. This study constructed and empirically tested a theoretical model of three predictive factors (cyberbullying, abuse, and screen time) and stress as the mediating factor in adolescent non-suicidal self-injury (NSSI). Structural equation model (SEM) analysis was applied to investigate stress as a mediating factor in the relationship between adolescent NSSI and cyberbullying, abuse, and screen time. This cross-sectional study used a “crowdsourcing” sample collection method to recruit 464 adolescents aged 11–17 years who were administered a questionnaire comprising scales on cyberbullying, abuse, screen time, stress, and NSSI. All scales had construct reliabilities ranging from 0.759 to 0.958. SEM statistical analysis was performed using Lisrel version 8.8 (Scientific Software International, USA) for Windows (Microsoft Corporation, Redmond, WA, USA). The mean (± SD) age of the cohort was 14.61 ± 1.65 years, and consisted of 66.7% females. Secondary high school was the highest educational background (58%). The study found that cyberbullying and abuse were direct positive predictors (critical t-value for the path > 1.96; p < 0.05) of adolescent NSSI; however, screen time did not have any direct relationship. Furthermore, stress was a significant full mediating factor of screen time and a partial mediating factor of cyberbullying and abuse in the relationship with adolescent NSSI (critical t-value of the path = 5.27; p < 0.05). Cyberbullying, screen time, and abuse with the mediating effect of stress could explain 48% of the variance in adolescent NSSI (R2 = 0.48). Adolescent mental health prevention and promotion programs need to be redesigned during the current COVID-19 pandemic to manage their stress and minimize the mental health consequences of cyberbullying, abuse, and inappropriately increased screen time.

Introduction: There is an increased risk of adverse metabolic effects of some modern antipsychotic drugs, and concern that long-acting, injected preparations of them may increase such risk. We now report on clinical and metabolic outcomes in patient-subjects diagnosed with affective and non-affective psychotic disorders following exposure to psychoeducation on metabolic risks of modern antipsychotics followed by treatment with long-acting atypical injected antipsychotics over 6-months.Materials and Methods: 85 psychotic disorder outpatients (42 affective [AP]; 43 non-affective [NAP]) at the University of Foggia were treated with long-acting, injected, second-generation antipsychotics in association with a set of psychoeducational sessions concerning general health and potential effects of antipsychotic drug treatments. They were evaluated at baseline and six months.Results: Initially, NAP subjects reported higher ratings of positive and negative symptoms than AP subjects, were more likely to receive risperidone or paliperidone, with higher CPZ-eq doses of antipsychotics (294.0 ± 77.8 vs. 229.3 ± 95.8 mg/day), and shorter QTc electrocardiographic recovery intervals. During the 6-month follow-up, ratings of treatment-adherence improved through overall (+8.75%), and symptom-ratings decreased (−7.57%) as did Body-Mass Index (−2.40%; all p ≤ 0.001). Moreover, serum levels of fasting glucose, hemoglobin glycosylation, cholesterol and prolactin concentrations all decreased, with little difference between subjects with AP vs. NAP.Discussion and Conclusions: A psychoeducational program was associated with consistent improvement in psychotic symptoms and several metabolic and physiological measures, as well as with treatment-adherence during six months of treatment with long-acting, injected, second-generation antipsychotics, in association with both affective and non-affective psychotic disorders.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication deficits and restricted interests and behaviors which begin very early in life. In about a quarter of cases, the symptoms emerge about 18–24 months after a period of normal development, a phenomenon commonly described as early regression. However, marked functional decline can also occur in persons with autism after a relatively stable childhood. As opposed to early regression, which occurs in normally developing children, late regression occurs typically in adolescents with an established diagnosis of autism. Apart from their occasional mention in the literature, these individuals have not been examined systematically. This Brief Report describes the presentation, comorbidity and short-term outcome of 20 persons with ASD who developed late regression. The mean age of onset of regression was 13 years. One of the earliest symptoms was an increase in obsessive slowing and compulsive rituals. Other symptoms included motor abnormalities, aggression and mood disturbance. The most common comorbid disorder was catatonia occurring in 17 patients. Despite treatment with several modalities, the outcome was often suboptimal. These findings suggest that catatonia is a common cause of late regression in persons with autism. Clinical and research implications are discussed.

Over 10 million individuals pass through U.S. detention centers on an annual basis, with nearly two-thirds meeting criteria for drug dependence/abuse. Despite proven efficacy, treatment with medications for opioid use disorder (MOUD) is underutilized in jail settings—a gap that could be addressed using telemedicine. Here we describe a new program of telemedicine-based clinical provision of new/continuing buprenorphine treatment for individuals detained in a rural jail. Implementation objectives were completed between January and August 2020, and patient encounters were conducted between August 2020 and February 2021. We established (i) telemedicine hardware/software capability; (ii) a screening process; (iii) buprenorphine administration methods; (iv) necessary medical release procedures; (v) telemedicine encounter coordination and medication prescription procedures; and (vi) a research platform. Seven incarcerated patients have been treated, two of whom were referred from community treatment. Patients were mostly male (71%), non-Hispanic White (86%), and averaged 33 years old. All patients tested positive for an opioid upon intake and began/continued buprenorphine treatment in the jail. Average time to first MOUD appointment was 9 days and patients were maintained in treatment an average 21 days. Referrals for continuing community treatment were offered to all patients prior to discharge. We report successful implementation of telemedicine MOUD in a rural detention center, with treatment engagement and initiation occurring prior to the high-risk period of discharge. The fact that this program was launched during the height of the pandemic highlights the flexibility of telemedicine-based buprenorphine treatment. Challenges and obstacles to implementation of buprenorphine treatment in a correctional system are discussed.

Aims: We aimed to determine whether there has been a change in the number of suicides occurring in three Australian states overall, and in age and sex subgroups, since the COVID-19 pandemic began, and to see if certain risk factors for suicide have become more prominent as likely underlying contributing factors for suicide.Method: Using real-time data from three state-based suicide registers, we ran multiple unadjusted and adjusted interrupted time series analyses to see if trends in monthly suicide counts changed after the pandemic began and whether there had been an increase in suicides where relationship breakdown, financial stressors, unemployment and homelessness were recorded.Results: Compared with the period before COVID-19, during the COVID-19 period there was no change in the number of suicides overall, or in any stratum-specific estimates except one. The exception was an increase in the number of young males who died by suicide in the COVID-19 period (adjusted RR 1.89 [95% CI 1.11–3.23]).The unadjusted analysis showed significant differences in suicide in the context of unemployment and relationship breakdown during the COVID-19 compared to the pre-COVID-19 period. Analysis showed an increase in the number of suicides occurring in the context of unemployment in the COVID-19 period (unadjusted RR 1.53 [95% CI 1.18–1.96]). In contrast, there was a decrease in the number of suicides occurring in the context of relationship breakdown in the COVID-19 period (unadjusted RR 0.82 [95% CI 0.67–0.99]). However, no significant changes were identified when the models were adjusted for possible over-dispersion, seasonality and non-linear trend.Conclusion: Although our analysis found no evidence of an overall increase in suicides after the pandemic began, the picture is complex. The identified increase in suicide in young men indicates that the impact of the pandemic is likely unevenly distributed across populations. The increase in suicides in the context of unemployment reinforces the vital need for mitigation measures during COVID-19, and for ongoing monitoring of suicide as the pandemic continues.

Alexithymia is a trait composed of difficulties identifying feelings (DIF), difficulties describing feelings (DDF), and externally orientated thinking (EOT). It is an important transdiagnostic risk factor for psychosomatic disorders and other types of emotion-based psychopathologies, and can reduce the efficacy of some treatment approaches. Alexithymia assessments are therefore important in psychiatric and research settings. The Perth Alexithymia Questionnaire (PAQ) was recently developed to enable more comprehensive alexithymia assessments, however, its psychometric properties need further examination and it is so far only available in English. In this study, we sought to address this by translating the PAQ into Spanish and testing its psychometric properties in an adult sample from Chile (N = 370). Confirmatory factor analyses found the PAQ to have a theoretically congruent factor structure, supporting the contemporary status of alexithymia as a multifaceted construct and the PAQ's capacity to assess the DIF, DDF, and EOT facets of alexithymia across negative and positive emotions. All subscale and composite scores had high internal consistency reliability, and demonstrated good concurrent and discriminant validity. The PAQ therefore appears to provide a robust and detailed alexithymia profile. This Spanish version should help to enable more comprehensive cross-cultural research into alexithymia and its role in and psychological disorders.

Background: Methamphetamine use is a rapidly increasing cause of morbidity and mortality. Pregnant women and new parents who consume methamphetamine are at high risk since they seldom seek health services despite having multiple needs. We addressed this care gap by implementing an easily accessible program that pools resources from psychiatric, obstetric, and pediatric departments as well as community and government agencies. Method: This real-life observational study evaluated an integrated care program in 27 expecting parents and 57 parents of minors. The outcome criteria were treatment retention, psychosocial functioning, and abstinence. We compared participant demographics according to outcome and applied ordinal logistic regression to predict treatment success. Results: Patients received integrated care for almost 7 months on average. Nearly half achieved stable abstinence and functional recovery. Only one pregnant woman dropped out before a care plan could be implemented, and all women who gave birth during treatment completed it successfully. Three-fourths of patients had psychiatric comorbidities. Patients with depressive disorders were almost 5 times less likely to succeed with treatment. Attention-deficit hyperactivity disorder (ADHD) was diagnosed in nearly 30% of patients who dropped out of a care plan, which was about 4 times more often than in the successful outcome group. Conclusion: Our program engaged pregnant women and parents in treatment and helped them recover from methamphetamine-related mental disorders. Management of comorbid ADHD and depression should be an integral part of care initiatives to counter the methamphetamine crisis that affects parents and children across the globe.

Objectives: Neurocognitive functions might indicate specific pathways in developing attention deficit hyperactivity disorder (ADHD). We focus on reward-related dysfunctions and analyze whether reward-related inhibitory control (RRIC), approach motivation, and autonomic reactivity to reward-related stimuli are linked to developing ADHD, while accounting for comorbid symptoms of oppositional defiant disorder (ODD), and callous-unemotional (CU) traits. Methods: A sample of 198 preschool children (115 boys; age: m = 58, s = 6 months) was re-assessed at age 8 years (m = 101.4, s = 3.6 months). ADHD diagnosis was made by clinical interviews. We measured ODD symptoms and CU traits using a multi-informant approach, RRIC (Snack-Delay task, Gift-Bag task) and approach tendency using neuropsychological tasks, and autonomic reactivity via indices of electrodermal activity (EDA). Results: Low RRIC and low autonomic reactivity were uniquely associated with ADHD, while longitudinal and cross-sectional links between approach motivation and ADHD were completely explained by comorbid ODD and CU symptoms. Conclusion: High approach motivation indicated developing ADHD with ODD and CU problems, while low RRIC and low reward-related autonomic reactivity were linked to developing pure ADHD. The results are in line with models on neurocognitive subtypes in externalizing disorders.

Introduction:The coronavirus (COVID-19) pandemic has resulted in substantial changes to the normalcy of daily life. Research conducted in Western Europe point to elevated levels of depression, rumination and worry as well psychological burden. These in turn impact the capacity of individuals to adhere to lockdown measures and health-protective behaviours. Investigations of these pandemic-related mental health constructs in the Middle East appears sparse. Moreover, there is an immense need to investigate the potential for simple strategies that might be used by individuals whilst in lockdown to combat the onset of mental health difficulties. Regular physical exercise may prove valuable in this regard.Objective:To investigate the potential mediational role of engagement in physical exercise on the association between depression and psychological burden related to COVID-19.Method:A sample of 1,322 participants (mage= 19.50 years, SD = 1.54) completed measures of depression and psychological burden related to COVID-19 and self-reported their frequency of physical exercise. Data were collected between February and May 2021 in Egypt and the United Arab Emirates.Results:Analyses revealed statistically significant associations between depression and psychological burden as well as between elevated depression and reduced physical exercise. Mediation analyses in which the potential mediational role of physical exercise was examined were not significant.Conclusions:Depression and psychological burden related to the pandemic appear to be prevalent in these Middle Eastern locations. Whilst physical exercise appears to be beneficial in combating depression, it does not appear to be a sufficient strategy for impeding the experience of psychological burden. Investigation of the contribution of additional strategies is required.

Purpose: Women who carry an FMR1 premutation (PM) can experience two well-established PM-associated disorders: fragile X-associated primary ovarian insufficiency (FXPOI, affects ~20–30% carriers) and fragile X-associated tremor-ataxia syndrome (FXTAS, affects ~6–15% carriers); however, emerging evidence indicates that some of these women experience complex health profiles beyond FXPOI and FXTAS.Methods: In an effort to better understand predictors for these comorbid conditions, we collected self-reported medical histories on 413 women who carry an FMR1 PM.Results: There were 22 health conditions reported by at least 9% of women. In an exploratory analysis, 12 variables were tested in logistic regression models for each comorbid condition, including demographic variables, environmental variables, PM-associated factors, and endorsement of depression and/or anxiety. More than half of the comorbid conditions studied were associated with women who self-reported having anxiety. Age, smoking, body mass index (BMI), and depression were also significant predictor variables for specific comorbid conditions.Conclusions: Age, smoking, and BMI were significantly associated with a subset of the comorbid conditions analyzed. Importantly, depression or anxiety were also significantly associated with many of the comorbid health conditions. This work highlights some of the modifiable factors associated with complex health profiles among women with an FMR1 PM.

Objective: This study aimed to compare the adaptability of the adapted version of Stress and Anxiety to Viral Epidemics-9 (SAVE-9) for public workers and the SAVE-6 scale and to validate them among public workers who are on the frontline of the coronavirus disease 2019 pandemic.Methods: A total of 300 public workers responded to the anonymous online survey during April 1–12, 2021. Principal component analysis was conducted with varimax rotation to explore the factor structure of this scale. Confirmatory factor analysis was also used to explore construct validity. Spearman correlation analysis of the scale with the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) was performed to explore the convergent validity. The cut-off score in accordance with the mild degree of generalized anxiety symptoms (GAD-7 score of 5) was defined using the receiver operating characteristic (ROC) analysis.Findings: The single-structure model of each scale (the adapted version of SAVE-9 and SAVE-6) was adopted based on the results of the parallel analysis. Because SAVE-6 showed good construct validity, but the adapted version of SAVE-9 did not, we adopted to apply the SAVE-6 scale to assess the anxiety response of public workers in response to the viral epidemic. SAVE-6 showed good internal consistency (Cronbach's alpha = 0.817; McDonald's Omega = 0.818) and good convergent validity with GAD-7 (rho = 0.417, p < 0.001) and PHQ-9 (rho = 0.317, p < 0.001) scale scores. The appropriate cut-off score for SAVE-6 was determined to be ≥ 16.Conclusion: The SAVE-6 scale, as compared to the public workers' version of SAVE-9, is a reliable and valid rating scale to assess the work-related stress and anxiety of public workers due to the viral epidemic.

In the present cyber age, Internet gaming disorder (IGD) and risky online behaviour are prevalent, and adolescents are especially vulnerable to such emergent problems. Few studies have explored the protective factors that mitigate harm caused by IGD and various common risky online behaviours. This study examined the prevalence of IGD and risky online behaviour, their hypothesised associations with depressive symptoms, and the beneficial role of psychological resilience as an underlying psychological mechanism. The participants included 1,099 Chinese junior secondary school students (33% boys, mean age = 13.5 years, age range = 10–17 years) who completed a battery of validated self-report questionnaires at their schools. The results revealed that 4% of the participants were at high risk of IGD and 6% were at an overall risk level of IGD. Depressive symptoms were positively associated with IGD and risky online behaviour, and psychological resilience mediated both of these associations. These results imply that clinicians and teachers should incorporate psychological resilience training into intervention approaches to mitigate IGD and risky online behaviour.

Hidradenitis Suppurativa (HS) is a chronic skin disease involving intimate and sensitive areas and affecting physical and mental health. We investigated the prevalence of sexual desire and functioning impairment, and their associations with quality of life, anxiety, depression, minor psychiatric disorders (MPD), and clinical features (e.g., disease severity) in 77 patients with HS who completed self-report measures and answered to questions assessing socio-demographic characteristics, lifestyle habits, and hindered sexuality due to HS. The majority of patients reported hindered sexuality, and poor sexual functioning, while showing good levels of dyadic and solitary sexual desire. No associations were found between clinical severity and sexuality measures. Multivariate analyses showed significant associations of sexual outcome measures with alcohol consumption, low Body Mass Index, family history of HS, and severe skin symptoms. Moreover, we found that the presence of negative psychological factors (i.e., MPD, anxiety, poor mental status) increased the risk of sexual impairment. These findings underline the important role of psychological and sexual aspects in HS patients and suggest that physicians should consider the effect of disease burden on patients' sexual health.

Anxiety is a common perinatal disorder that can cause severe adverse consequences. This study (a) assesses the prevalence of maternal postnatal anxious symptomatology, and (b) analyses its association with demographic and socioeconomic variables as well as obstetric and other psychosocial variables. The assessment included 307 mothers aged ≥18 years with a biological baby aged ≤ 52 weeks and from seven Italian healthcare centres, evaluated using a Psychosocial and Clinical Assessment Form (also covering demographic and socioeconomic factors), and the state scale of the State-Trait Anxiety Inventory. We found an overall prevalence of self-reported postnatal anxious symptoms of 34.2%. More specifically, the prevalence was 34.5% at 1–24 weeks postpartum, and 30.8% at >24 weeks postpartum. No associations between postnatal anxious symptoms and demographic or socioeconomic variables were observed. As regards the other variables, the findings indicated antenatal depression or anxiety, parity, and current psychological support from the partner as having the strongest relationships.

Background: Perinatal Depression (PD) is a widespread disabling condition that is hypothesized to be associated with abnormalities in circadian rhythms and neuropeptide release including oxytocin (OXT).Methods: Fourty-four pregnant women (28 with PD, and 16 controls) were evaluated through the Edinburgh Postnatal Depression Scale (EPDS), the State/Trait Anxiety Inventory Form Y (STAI-Y), and the Prenatal Attachment Inventory (PAI). A blood sample was collected from all participants, and OXT plasma levels, DNA methylation of clock genes, as well as of FOXp3 and HERV-W were measured. Linear regression analyses were performed to assess the effect of oxytocin on the methylation of selected genes. Continuous ordinal regression models was further applied to see if the score of rating scales was associated to gene methylation, adjusting for oxytocin-methylation interaction.Results: OXT plasma levels were positively associated with CRY1 methylation. Women with higher OXT plasma levels showed an association between higher degree of CRY2 methylation (thus, reduced expression) and lower EPDS (OR = 0.21; P = 0.043) and STAI-S scores (OR = 6.96; P = 0.019). Finally, with high OXT levels, hypermethylation of CRY1 was associated to higher scores on the PAI (OR = 2.74; P = 0.029) while higher methylation of HERV-W related to lower PAI scores (OR = 0.273; P = 0.019).Conclusion: Our results suggest a possible protective role played by oxytocin in the development of PD by promoting a favorable methylation profile characterized by reduced expression of CRY1 and CRY2. Moreover, oxytocin strengthens the association between maternal prenatal attachment with a favorable pattern of methylation of clock genes and HERV-W, which is essential for pregnancy outcomes.

Objective: Early intervention in patients with first episode psychosis (FEP) can improve cognitive abilities, with both short- and long-term benefits. In this paper, we describe the implementation and review of cognitive remediation training (CRT) in an Asian FEP population. The outcomes of the training are also evaluated and discussed.Methods: This naturalistic paper describes in detail the real-life implementation and conduct of CRT in an early psychosis intervention service. One hundred and nine patients with FEP underwent a 24-session CRT programme, using Cogpack and Neuropsychological Educational Approach to Remediation. The program is evaluated with pre- and post-CRT assessment scores which included Montreal Cognitive Assessment and Brief Assessment of Cognition in Schizophrenia. The rates of improvement on these cognitive assessments were evaluated using paired t-tests, with statistical significance set at p ≤ 0.05.Results: Of the 109 patients who underwent CRT, a total of 92 (84.4%) completed all 24 sessions. Paired t-tests between pre- and post-CRT assessments scores revealed that participants significantly improved on majority of the measures, including verbal memory, digit sequencing, and symbol coding.Conclusion: As with other cognitive remediation programmes, CRT has shown to improve cognitive functioning in patients with FEP. The results support the use of CRT in an Asian context and may serve as guidance for the implementation of similar training programmes in other Asian early psychosis intervention services.

Introduction: Many individuals with obsessive-compulsive disorder (OCD) delay seeking help, leading to greater illness severity, additional comorbidity, and increased functional impairment. Patterns of help-seeking for OCD have however not yet been described in South Africa, a low-and middle-income country with many health service challenges. Using the health belief model as a conceptual framework, study aims were to identify predictors of and barriers to help-seeking among South Africans with OCD.Methods: Fifty adults with OCD completed an online survey to assess (1) socio-demographic characteristics, (2) OCD symptom severity, (3) treatment barriers, (4) perceived treatment benefits, (5) self-efficacy, and (6) help-seeking intention. Multiple linear regression analysis was used to establish predictors of help-seeking intention. Descriptive statistics were used to determine the most endorsed help-seeking barriers.Results: 42.6% of the variance in help-seeking intention was explained by the investigated constructs (R2 = 0.426, F = 4.45 and p < 0.01). Perceived treatment benefits were the only significant predictor of help-seeking intention (B = 1.37, t = 5.16, and p < 0.01). More than a third (36%) of the sample endorsed wanting to handle the problem independently as a significant barrier, followed by treatment concerns (26%), affordability (22%), and shame (20%).Conclusion: An innovative analysis of help-seeking patterns suggested that perceived treatment benefits were the only significant predictor of help-seeking intention among South African adults with OCD. Psychoeducation and mental health literacy programmes may be useful in increasing public appreciation of the benefits of OCD treatment, and in mitigating key help-seeking barriers.

Objective: To examine how psychiatrists think about and modulate non-specific factors (e.g., hope, expectations) in clinical practice.Methods: U.S. psychiatrists were recruited for two studies assessing attitudes and behaviors related to non-specific factors. Study 1 entailed remote qualitative focus groups (k = 7) with n = 26 participants (36.0% female). Study 2 was a quantitative survey with n = 346 respondents (34.0% female) designed to assess the generalizability of focus group findings.Results: Four themes were identified in Study 1 that were used to inform the survey (Study 2): (1) Expectations (2) Hope, (3) Placebo Effect, and (4) Aesthetic Features. Nearly all surveyed psychiatrists (92.2%) considered patient expectations at least “most of the time” when interacting with a patient. Focus groups revealed that psychiatrists often attempt to balance optimism and realism to improve outcomes. A majority of survey respondents believed office design and physician attire could at least somewhat influence expectations (72.5 and 77.3%, respectively) and even outcomes (51.5 and 58.7%, respectively). Focus group psychiatrists described how physical features may be used as therapeutic tools.Conclusions: Psychiatrists are highly mindful of patient expectations. Although there is variability in the perceived importance of expectations, hope, the placebo effect, and aesthetic features, many utilize these factors in clinical practice.

Introduction: Popular media coverage of psychedelics use, growing research into this class of compounds for psychiatry and decriminalization initiatives, are transforming the public perception of psychedelics. However, little is known about levels of knowledge and psychedelic mushroom (PM) use among American adults.Methods: We examined PM use and various measures of health status, quality of life, and self-reported mental health outcome measures obtained through a national on-line, cross-sectional survey of adults with a demographic composition representative of the US adult population by region, gender, age, and race (weighted N = 251,297,495) from November 2020–March 2021.Results: General mental health and well-being were popular reasons for PM use (63.6%), although use for medically-diagnosed (31.8%) and self-diagnosed (19.0%) conditions was also common. PM users reported more depression and anxiety as reflected in higher GAD-7 and PHQ-9 scores. Factors predictive of PM use included being male [OR 1.54 95%CI 1.09–2.15] and having higher Charlson Comorbidity Index scores [OR 1.42; 95%CI 1.22–1.65]. Self-reported PM use was less likely among participants with health insurance [OR = 0.50 (0.35–0.72)], increased age [OR = 0.92 (0.90–0.93)] and, relative to those living in the west US census region, living in the northeast [OR = 0.27 (0.15–0.50)], midwest [OR = 0.34 (0.20–0.56)], and south [OR = 0.38 (0.26–0.55)].Discussion and Conclusions: A significant number of Americans are already “self-medicating” with PM and as growing positive media coverage of psychedelics drives public interest in the health benefits of PM, this number will increase. The association between PM use and poor mental health requires further research to inform policy.

The COVID-19 pandemic has a multifaceted impact on mental health due to ill health, restrictions and lockdowns, and loss of employment and institutional support. COVID-19 may disproportionally impact families with special educational needs and disabilities (SEND) due to the already higher prevalence of mental health conditions in children with SEND and their parents. Therefore, it is essential to determine the short-term impact of the pandemic on the mental health of families with SEND in order to identify their ongoing health support needs. The current study aims to examine the anxiety level and concerns of children with SEND and their parents living in China. The sample consisted of 271 parents of children with SEND aged between 6 and 17 years (Mage = 8.37; SDage = 2.76). Parents completed an online survey between 10 April to 8 June 2020. Both child and parental anxiety levels and various concerns increased after the initial wave of COVID-19 when compared with retrospective pre-COVID-19 levels. Parental anxiety and concern levels were significantly higher for those living in rural areas compared to urban areas. In addition, parental and child anxiety and concern levels were significantly correlated with each other. Parental anxiety at the lowest level made a unique and significant statistical contribution to children's anxiety levels. The implications of the study findings are discussed.