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There is an ongoing necessity to match clinical interventions with the multidimensional needs of young people. A key step toward better service planning and the design of optimal models of care is to use multidimensional assessment to understand the clinical needs of those presenting to primary mental health care. 1284 people aged 12–25 years presenting to primary youth mental health services completed an online assessment at service entry. Latent class analysis was conducted for seven scales assessing anxiety, depression, psychosis, mania, functioning (indexed by Work and Social Adjustment Scale), and suicidality. A three-class solution was identified as the optimal solution. Class 1 (n = 305, 23.75%), an early illness stage group, had low and mixed symptomatology with limited functional impairment, class 2 (n = 353, 27.49%) was made up of older persons with established depression and functional impairment, and class 3 (n = 626, 48.75%) had very high and complex needs, with functional impairment, suicidality, and at-risk mental states (psychosis or mania). Additional differentiating characteristics included psychological distress, circadian disturbances, social support, mental health history, eating disorder behaviours, and symptoms of post-traumatic stress disorder. A large proportion of help-seeking young people present with symptoms and functional impairment that may exceed the levels of care available from basic primary care or brief intervention services. These subgroups highlight the importance of multidimensional assessments to determine appropriate service pathways and care options. • Youth seeking mental health care completed a digital multidimensional assessment. • Latent class analysis revealed three distinct groups of young people. • Almost half had very high and complex needs, with suicidality and poor functioning. • Approximately one in four were seeking care at an early stage of illness. • Identifying subgroups may determine appropriate service pathways and care options. [ABSTRACT FROM AUTHOR]

• Clinicopathological evidence is outlined for a clinical phenotype: 'circadian depression.' • Phenotype is associated with circadian, cardiometabolic, and inflammatory markers. • Identification and validation of this phenotype may guide circadian-specific interventions. Major mood syndromes are among the most common and disabling mental disorders. However, a lack of clear delineation of their underlying pathophysiological mechanisms is a major barrier to prevention and optimised treatments. Dysfunction of the 24-h circadian system is a candidate mechanism that has genetic, behavioural, and neurobiological links to mood syndromes. Here, we outline evidence for a new clinical phenotype, which we have called 'circadian depression'. We propose that key clinical characteristics of circadian depression include disrupted 24-h sleep-wake cycles, reduced motor activity, low subjective energy, and weight gain. The illness course includes early age-of-onset, phenomena suggestive of bipolarity (defined by bidirectional associations between objective motor and subjective energy/mood states), poor response to conventional antidepressant medications, and concurrent cardiometabolic and inflammatory disturbances. Identifying this phenotype could be clinically valuable, as circadian-targeted strategies show promise for reducing depressive symptoms and stabilising illness course. Further investigation of underlying circadian disturbances in mood syndromes is needed to evaluate the clinical utility of this phenotype and guide the optimal use of circadian-targeted interventions. [ABSTRACT FROM AUTHOR]

• Vaccine acceptance in the Amish decreased in the last decade, similar to the general population. • More conservative Amish sects were less likely to accept vaccines. • Parents of special needs children were more likely to vaccinate than parents of healthy children. • Fathers and bishops are potential key targets for vaccine education in the Amish. • The Amish are less likely to accept a COVID-19 vaccine than the general population. The Holmes County Amish have low vaccination rates, an increasingly diverse population, and have an increased incidence of certain inherited diseases. The objectives were to evaluate; the rate and influences of vaccine hesitancy compared to a decade ago, vaccination patterns between Amish affiliations, vaccine practices of Amish special needs children, and the Amish's acceptance of a COVID-19 vaccine. Study design. In April of 2020, a survey assessing vaccination patterns and beliefs were mailed to 1000 Amish families, including ultra-conservative Amish sects and special needs families. The response rate was 39%. Among 391 respondents, 59% did not vaccinate their children, compared to only 14% that refused all vaccinations reported by Wenger et al in the same community only a decade ago. The ultra-conservative Amish rejected vaccines more often. Amish special needs children were more likely to receive vaccines than healthy Amish children. 75% responded they would reject a COVID-19 vaccine. Fear of adverse effects was the most common reason to reject vaccines. Families that accepted vaccines were more likely to cite a healthcare worker as the primary influence to vaccinate. Wives were more likely to cite their spouse as the primary influence to vaccinate. Families that rejected vaccines were more likely to state their bishop was the most influential person on vaccination. The Holmes County Amish have decreasing vaccine acceptance. Efforts to improve vaccination will require a targeted focus on the primary influences and beliefs of sub-populations within the Amish. Physician advocacy, peer mentorship, father-directed education, and close partnership with Church leadership will be needed to limit vaccine-preventable disease. The Amish may be at risk for low uptake of a COVID-19 vaccine. [ABSTRACT FROM AUTHOR]

Abstract Diffusion tensor imaging (DTI) has been utilized to index white matter (WM) integrity in the major psychiatric disorders. However, the findings within and across such disorders have been mixed. Given this, transdiagnostic sampling with data-driven statistical approaches may lead to new and better insights about the clinical and functional factors associated with WM abnormalities. Thus, we undertook a cross-sectional DTI study of 401 young adult (18–30 years old) outpatients with a major psychiatric (depressive, bipolar, psychotic, or anxiety) disorder and 61 healthy controls. Participants also completed self-report questionnaires and underwent neuropsychological assessment. Fractional anisotropy (FA) as well as axial (AD) and radial (RD) diffusivity was determined via a whole brain voxel-wise approach (tract-based spatial statistics). Hierarchical cluster analysis was performed on FA scores in patients only, obtained from 20 major WM tracts (that is, association, projection and commissural fibers). The three cluster groups derived were distinguished by having consistently increased or decreased FA scores across all tracts. Compared to controls, the largest cluster (N = 177) showed significantly increased FA in 55% of tracts, the second cluster (N = 169) demonstrated decreased FA (in 90% of tracts) and the final cluster (N = 55) exhibited the most increased FA (in 95% of tracts). Importantly, the distribution of primary diagnosis did not significantly differ among the three clusters. Furthermore, the clusters showed comparable functional, clinical and neuropsychological measures, with the exception of alcohol use, medication status and verbal fluency. Overall, this study provides evidence that among young adults with a major psychiatric disorder there are subgroups with either abnormally high or low FA and that either pattern is associated with suboptimal functioning. Importantly, these neuroimaging-based subgroups appear despite diagnostic and clinical factors, suggesting differential treatment strategies are warranted. Highlights • Cluster analytic study of white matter profiles in early psychiatric disorders • Three clusters identified all showed abnormal fractional anisotropy. • Abnormally high or low fractional anisotropy was associated with poor functioning. • Clusters tended not to differ across diagnostic, clinical and functional factors. • Outcomes provide new hypotheses regarding categorization and treatment strategies. [ABSTRACT FROM AUTHOR]

While disturbances of the sleep-wake cycle are common in people with affective disorders, the characteristics of these disturbances differ greatly between individuals. This heterogeneity is likely to reflect multiple underlying pathophysiologies, with different perturbations in circadian systems contributing to the variation in sleep-wake cycle disturbances. Such disturbances may be particularly relevant in adolescents and young adults with affective disorders as circadian rhythms undergo considerable change during this key developmental period. This study aimed to identify profiles of sleep-wake disturbance in young people with affective disorders and investigate associations with biological circadian rhythms. Fifty young people with affective disorders and 19 control participants (aged 16–31 years) underwent actigraphy monitoring for approximately two weeks to derive sleep-wake cycle parameters, and completed an in-laboratory assessment including evening dim-light saliva collection for melatonin assay and overnight continuous core body temperature measurement. Cluster analysis based on sleep-wake cycle parameters identified three distinct patient groups, characterised by ‘delayed sleep-wake’, ‘disrupted sleep’, and ‘long sleep’ respectively. The ‘delayed sleep-wake’ group had both delayed melatonin onset and core temperature nadir; whereas the other two cluster groups did not differ from controls on these circadian markers. The three groups did not differ on clinical characteristics. These results provide evidence that only some types of sleep-wake disturbance in young people with affective disorders are associated with fundamental circadian perturbations. Consequently, interventions targeting endogenous circadian rhythms to promote a phase shift may be particularly relevant in youth with affective disorders presenting with delayed sleep-wake cycles. [ABSTRACT FROM AUTHOR]

Abstract: For many young people, binge drinking is the most common form of alcohol misuse, particularly in those with a depressive disorder. Nonetheless, relatively little is known about the effects that the combination of depression and binge drinking has on neuropsychological outcomes. This study aimed to determine whether binge drinkers with depression show more pronounced neuropsychological dysfunction compared to their peers with depression alone or binge drinking alone. Neuropsychological testing was conducted on help-seeking young people (18–30 years) recently diagnosed with a depressive disorder and classified as either ‘binge drinkers’ (n=43) or ‘non-bingers’ (n=48). Two healthy control groups (i.e. binge drinkers, n=24 and non-bingers, n=21) were additionally recruited and also underwent the same testing. Qualitatively, binge-drinking patients with depression performed consistently below controls, depression alone, or binge drinking alone. In keeping with our hypotheses, visual learning and memory was significantly reduced in depressed binge drinkers, whereas mental flexibility was reduced at a trend level. There were no significant differences in neuropsychological performance in depressed alone or binge drinking alone individuals compared to controls. The findings suggest that when treating young people with a depressive disorder, strategies targeting binge drinking may contribute to preventing potential neurobiological changes underlying poorer long-term clinical outcomes. [Copyright &y& Elsevier]

Abstract: Background: Neuropsychological deficits in depression include difficulties with psychomotor speed, executive functions and memory. Some of these changes persist despite antidepressant treatment. While research in other areas of psychiatry has shown cognitive training techniques to be effective, only one study has evaluated this approach in depression. Methods: Sixteen patients (mean age=33.5years) with a lifetime diagnosis of major depressive disorder were administered a standardised battery of neuropsychological tests and allocated to treatment (n =8) or waitlist control (n =8) conditions. The treatment consisted of 10-weeks of twice weekly cognitive training using the Neuropsychological Educational Approach to Remediation. All participants were re-assessed after 10-weeks by interviewers blinded to group allocation. Results: Participants in the treatment condition demonstrated greater improvements on tests of memory encoding and memory retention than the waitlist control group. There were no observable benefits in terms of psychomotor speed or executive functions or in self-reported levels of disability. Affective symptoms also remained stable. Limitations: This study included a small sample of participants and treatment allocation was not randomised. Conclusions: Cognitive training in affective disorders improves memory performance. It may be an effective non-pharmacological treatment option for improving cognitive functions, which in turn, may improve psychosocial functioning and reduce disability. This study supports theories suggesting cognitive training may promote neuroplasticity. [Copyright &y& Elsevier]

Abstract: Background: Depression in older adults is associated with neuropsychological dysfunction, fronto-subcortical brain changes and sleep disturbance. Research suggests that adequate sleep is critical for many aspects of cognition including processing speed, verbal skills and memory. However, the association between sleep disturbance and neuropsychological functioning in depression has not been well evaluated. The current study therefore aimed to investigate these relationships. Methods: Forty-eight people (mean age=59.6, sd=8.2) meeting DSM-IV criteria for unipolar major depression were included for analysis. Neuropsychological assessment included assessment of processing speed, learning and memory, verbal fluency and executive functions. Early and late insomnia were defined by scores on the Hamilton Depression Rating Scale. Results: While early insomnia was related to depression severity and poorer global cognition, late insomnia was associated with later age of depression onset, depression severity, and poorer scores on tests of verbal fluency and memory. The associations between cognition and late insomnia were not accounted for by depression severity or age of onset of disorder. Limitations: This study was retrospective in nature, and did not include objective measures of sleep. Conclusions: This is the first known study to indicate that late insomnia in older people with major depression may be independently and aetiologically linked to neuropsychological performance, particularly verbal fluency and memory. It may also indicate underlying structural and neurochemical changes. Sleep and circadian disturbance may serve as a biomarker for ongoing cognitive decline and may be a potentially modifiable risk factor. [Copyright &y& Elsevier]

Abstract: Objectives: Selected structural and functional neuroimaging correlates of psychomotor slowing were examine in older persons with depression. Clinical, neuropsychological, magnetic resonance imaging (MRI) and single photon emission computerized tomography (SPECT) data were obtained for 32 persons with depression (mean age=55.5) and 17 controls (mean age = 55.4). Psychomotor slowing was measured by simple (SRT) and choice (CRT) reaction times. White matter lesions (WMLs) were visually rated and caudate nucleus regional cerebral blood flow (rCBF) was obtained through the co-registration of MRI and SPECT data. Two SPECT scans were performed (corresponding to the SRT and CRT tasks) and a percentage change score in rCBF (%rCBF) due to the increasing complexity of the second task was calculated. Persons with depression and controls did not differ with respect to %rCBF or frequency of WMLs. In persons with depression, reduced %rCBF was associated with slower CRT. For all subjects, WMLs predicted 14% of the variance in %rCBF. Although CRT was predicted by a combination of older age, WMLs and %rCBF, the diagnosis of depression still predicted a further 25% of the variance. Reduced %rCBF is associated with demonstrable psychomotor slowing and presence of WMLs. While psychomotor slowing is determined in part by subcortical changes, other cortical and illness-dependent factors are likely to be relevant. [Copyright &y& Elsevier]

Abstract: Background: Although the short allele of the serotonin transporter promoter polymorphism (5-HTT) has been linked to increased risk of major depression in early adult life, its relationships with late-life depression and to changes in subcortical nuclei remain unclear. Methods: 5-HTT genotypes (SS, SL, LL) were determined for 45 older persons with major depression (mean age=52.0, sd=12.8) and 16 healthy controls (mean age=55.8, sd=10.3). MRI-derived volumes of the amygdala, hippocampus, caudate and putamen were determined by reliable tracing techniques. Results: In those with depression, the short allele of 5-HTT was associated with smaller caudate nucleus volumes. Although hippocampal and amygdala volumes were smaller in those with depression as compared with control subjects, 5-HTT gene status did not predict this reduction in size. Limitations: The findings are limited by the number of clinical and control participants. Conclusions: Reduced caudate nucleus volume in older patients with major depression was associated with the short allele of the 5-HTT gene. This regional brain change may be a consequence of early developmental expression as well as later vascular or degenerative effects of this genotype. [Copyright &y& Elsevier]