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Suicidal behavior is influenced by a multitude of factors, making prediction and prevention of suicide attempts (SA) a challenge. A useful tool to uncover underlying pathophysiology or propose new therapy approaches are biomarkers, especially within the context of point-of-care tests. Heart rate variability (HRV) is a well-established biomarker of mental health, and measures the activity of the sympathetic and parasympathetic nervous system (PNS). Previous studies reported a correlation between lower PNS activity and suicidality. However, most studies involved participants from a healthy population, patients without history of suicide attempts, or patients with a single diagnosis. 52 in-patients with a recent suicide attempt (6 months), and 43 controls without history of SA or psychiatric diagnoses confirmed study participation. The included patients age ranged between 18 and 65 years, 65% had psychiatric comorbidities. Patients with dementia, cognitive impairments, acute psychosis, chronic non suicidal self-harming behavior, or current electroconvulsive therapy were excluded. A 15-min resting state electrocardiography was recorded with two bipolar electrodes attached to the right and left insides of the wrists. The multiple regression analyses showed lower parasympathetic, and higher sympathetic activity in patients compared to controls. Partial correlation found a positive trend result between self-reported suicidality and the very low frequency band. ROC curve analysis revealed an acceptable to excellent clinical accuracy of HRV parameters. Therefore, HRV parameters could be reliable discriminative biomarkers between in-patients with a recent SA and healthy controls. One limitation is the lack of a control group consisting of in-patients without life-time suicidal ideation or attempts.

ADHD is the most common neurodevelopmental disorder presenting to child and adolescent mental health, paediatric, and primary care services. Timely and effective interventions to address core ADHD symptoms and co-occurring problems are a high priority for healthcare and society more widely. While much research has reported on the benefits and adverse effects of different interventions for ADHD, these individual research reports and the reviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent and difficult to interpret. We have summarized the current evidence and identified several methodological issues and gaps in the current evidence that we believe are important for clinicians to consider when evaluating the evidence and making treatment decisions. These include understanding potential impact of bias such as inadequate blinding and selection bias on study outcomes; the relative lack of high-quality data comparing different treatments and assessing long-term effectiveness, adverse effects and safety for both pharmacological and non-pharmacological treatments; and the problems associated with observational studies, including those based on large national registries and comparing treatments with each other. We highlight key similarities across current international clinical guidelines and discuss the reasons for divergence where these occur. We discuss the integration of these different perspective into a framework for person/family-centered evidence-based practice approach to care that aims to achieve optimal outcomes that prioritize individual strengths and impairments, as well as the personal treatment targets of children and their families. Finally, we consider how access to care for this common and impairing disorder can be improved in different healthcare systems., European Child & Adolescent Psychiatry, 32 (8), ISSN:1435-165X, ISSN:1018-8827

Zusammenfassung: Das Hauptziel des vorliegenden Beitrags ist eine kritische Reflexion der Situation von Studierenden mit neurokognitiven Beeinträchtigungen in Hinblick auf deren Partizipation im universitären Setting. Nach einer kurzen Erläuterung der aktuellen universitätsrechtlichen Rahmenbedingungen in Deutschland, Österreich und der Schweiz werden (i) am Beispiel von Aufmerksamkeitsstörungen und spezifischen Lernstörungen charakteristische Schwierigkeiten von betroffenen Studierenden beim Studium anhand von Fallvignetten dargestellt und (ii) Ziele in Hinblick auf eine gelingende Partizipation und Chancengleichheit für Studierende mit Beeinträchtigungen skizziert. Anhand eines tentativen Rahmenmodells zur Förderung der Partizipation diskutieren wir die Notwendigkeit differenzierter universitätsinterner und -externer struktureller Rahmenbedingungen, die zusätzlich zu den bereits bestehenden – aber nicht ausreichenden – universitätsinternen Maßnahmen wie dem Nachteilsausgleich implementiert werden sollten.

Background and aims: We aimed to create a basic set of definitions and relationships for identity-related constructs, as part of the Addiction Ontology and E-Cigarette Ontology projects, that could be used by researchers with diverse theoretical positions and so facilitate evidence synthesis and interoperability. Methods: We reviewed the use of identity-related constructs in psychological and social sciences and how these have been applied to addiction with a focus on nicotine and tobacco research. We then used an iterative process of adaptation and review to arrive at a basic set of identity-related classes with labels, definitions and relationships that could provide a common framework for research. Results: We propose that identity be used to refer to ‘a cognitive representation by a person or group of themselves’, with self-identity referring to an individual’s identity and group identity referring to an identity held by a social group. Identities can then be classified at any level of granularity based on the content of the representations (e.g., tobacco smoker identity, cigarette smoker identity, vaper identity). We propose distinguishing identity from self-appraisal in order to capture the distinction between the representation of oneself (e.g., as an ex-smoker) and a) the importance and b) the positive or negative evaluation that we attach to what is represented. We label an identity that is appraised as enduring as a core identity, related to strong identity due to the appraisal as important. Identities that are appraised positively or negatively involve positive self-appraisal and negative self-appraisal respectively. This allows us to create ‘logically defined classes’ of identity by combining them (e.g., positive core cigarette smoker identity to refer to a cigarette smoker self-identity that is both positive and important). We refer to the totality of self-identities of a person as a composite self-identity. Conclusions: An ontology of identity constructs may assist in improving clarity when discussing theories and evidence relating to this construct in addiction research.

There have been renewed calls to use phenomenology in psychiatry to improve knowledge about causation, diagnostics, and treatment of mental health conditions. A phenomenological approach aims to elucidate the subjective experiences of mental health, which its advocates claim have been largely neglected by current diagnostic frameworks in psychiatry (eg, DSM-5). The consequence of neglecting rich phenomenological information is a comparatively more constrained approach to theory development, empirical research, and care programmes. Although calls for more phenomenology in psychiatry have been met with enthusiasm, there is still relatively little information on how to practically facilitate this integration. In this Personal View, we argue that phenomenological approaches need a shared semantic framework to drive their innovative potential, thus enabling consistent data capture, exchange, and interoperability with current mental health data and informatics approaches (eg, the Research Domain Criteria project). We show how an applied ontology of phenomenological psychopathology offers a suitable method to address these challenges.

Background: The core clinical feature of posttraumatic stress disorder (PTSD) is recurrent re-experiencing in form of intrusive memories. While a great number of biological processes are regulated by sleep and internal biological clocks, the effect of 24-hour biological cycles, named circadian rhythm, has not been investigated in the context of intrusive memories. Objective: Here we examined effects of time of day on frequency and characteristics of intrusive re-experiencing. Methods: Fifty trauma survivors reported intrusive memories for 7 consecutive days using ecological momentary assessment in their daily life. We investigated (i) time-of-day dependent effects on frequency and distribution of intrusive re-experiencing in the overall sample as well as in PTSD versus non-PTSD and (ii) time-of-day dependent effects on the memory characteristics intrusiveness, vividness, nowness and fear. Results: Intrusive memories showed a curvilinear pattern that peaked at 2pm. Intrusive memories in the PTSD group showed a constant level of intrusive re-experiencing in the afternoon and evening, whereas a descending slope was present in the non-PTSD group. In PTSD, intrusive memories might thus be experienced in a more time-scattered fashion throughout the day, indicating chronodisruption. Intrusion characteristics did not follow this pattern. Conclusion: Although preliminary and based on a small sample size, these findings contribute to a better understanding of the everyday occurrence and characteristics of intrusive memories, and point to the added value of examining time-dependent effects, which can directly inform prevention and intervention science. Influencia circadiana en la re-experimentación intrusiva en la vida diaria de los sobrevivientes de trauma Antecedentes: La característica clínica central del trastorno de estrés postraumático (TEPT) es la re-experimentación recurrente en forma de recuerdos intrusivos. Si bien un gran número de procesos biológicos están regulados por el sueño y los relojes biológicos internos, el efecto de los ciclos biológicos de 24 horas, llamado ritmo circadiano, no ha sido investigado en el contexto de los recuerdos intrusivos. Objetivo: Aquí examinamos los efectos de la hora del día sobre la frecuencia y características de la re-experimentación intrusiva. Métodos: Cincuenta sobrevivientes de trauma reportaron recuerdos intrusivos por 7 días consecutivos usando la evaluación ecológica momentánea en su vida diaria. Investigamos (i) los efectos dependientes de la hora del día sobre la frecuencia y distribución de los recuerdos intrusivos en la muestra general, así como en TEPT versus no TEPT y (ii) los efectos dependien- tes de la hora del día sobre las características de la intrusividad de los recuerdos, vividez, momento presente y miedo. Resultados: Los recuerdos intrusivos mostraron un patrón curvilíneo que alcanzaba su punto máximo a las 2 pm. Los recuerdos intrusivos en el grupo con TEPT mostraron un nivel constante de re-experimentación intrusiva en la tarde y la noche, mientras que en el grupo sin TEPT se observó una pendiente descendiente. En el TEPT, los recuerdos intrusivos pueden experimen- tarse en una manera más dispersa en el tiempo a lo largo del día, lo que indica cronodisrupción. Las características de intrusión no siguieron este patrón. Conclusión: Aunque son preliminares y se basan en un tamaño de muestra pequeño, estos hallazgos contribuyen a una mayor comprensión de la ocurrencia cotidiana y las características de los recuerdos intrusivos y apuntan al valor agregado de examinar sus efectos dependientes del tiempo, que pueden informar directamente a la ciencia de la prevención e intervención. 昼夜节律对创伤幸存者日常生活中闯入性再体验的影响 背景: 创伤后应激障碍(PTSD)的核心临床特征是以闯入性记忆的形式反复再体验。虽然大量 的生物过程受睡眠和内部生物钟的调节,尚未在闯入性记忆的背景下研究 24 小时生物周期 (称为昼夜节律)的影响。 目的: 这里我们考查了一天时间对闯入性再体验频率和特征的影响。 方法 : 50 名创伤幸存者在日常生活中使用生态瞬时评估连续 7 天报告了闯入性记忆。我们 研究了 (i)对整个样本以及 PTSD 与非 PTSD 对比组中闯入性再体验的频率和分布的每日时间 依赖影响,以及 (ii) 对记忆特征闯入性、生动性、当下性和恐惧的每日时间依赖影响。 结果: 闯入性记忆呈现出一种在下午 2 点达到峰值的曲线模式。PTSD组的闯入性记忆在下 午和晚上表现出恒定水平的闯入性再体验,而非PTSD组则呈现下降趋势。因此,在 PTSD 组 中,闯入性记忆可能会在一天中以更分散的方式体验,这表明时间中断。闯入特征没有遵循这 种模式。 结论: 虽然是初步研究并且基于小样本量,这些发现有助于更好了解闯入性记忆的日常发生 和特征,并指出考查其时间依赖效应的附加价值,可以直接为预防和干预提供信息科学。

Introduction: Fast and minimally invasive approaches for early diagnosis of Alzheimer's disease (AD) are highly anticipated. Evidence of adaptive immune cells responding to cerebral β-amyloidosis has raised the question of whether immune markers could be used as proxies for β-amyloid accumulation in the brain. Methods: Here, we apply multidimensional mass-cytometry combined with unbiased machine-learning techniques to immunophenotype peripheral blood mononuclear cells from a total of 251 participants in cross-sectional and longitudinal studies. Results: We show that increases in antigen-experienced adaptive immune cells in the blood, particularly CD45RA-reactivated T effector memory (TEMRA) cells, are associated with early accumulation of brain β-amyloid and with changes in plasma AD biomarkers in still cognitively healthy subjects. Discussion: Our results suggest that preclinical AD pathology is linked to systemic alterations of the adaptive immune system. These immunophenotype changes may help identify and develop novel diagnostic tools for early AD assessment and better understand clinical outcomes., Alzheimer's & Dementia: The Journal of the Alzheimer's Association, ISSN:1552-5279, ISSN:1552-5260

Background The juvenile justice system in the USA adjudicates over seven hundred thousand youth in the USA annually with significant behavioral offenses. This study aimed to test the effect of juvenile justice involvement on adult criminal outcomes. Methods Analyses were based on a prospective, population-based study of 1420 children followed up to eight times during childhood (ages 9–16; 6674 observations) about juvenile justice involvement in the late 1990 and early 2000s. Participants were followed up years later to assess adult criminality, using self-report and official records. A propensity score (i.e. inverse probability) weighting approach was used that approximated an experimental design by balancing potentially confounding characteristics between children with v. without juvenile justice involvement. Results Between-groups differences on variables that elicit a juvenile justice referral (e.g. violence, property offenses, status offenses, and substance misuse) were attenuated after applying propensity-based inverse probability weights. Participants with a history of juvenile justice involvement were more likely to have later official and violent felony charges, and to self-report police contact and spending time in jail (ORs from 2.5 to 3.3). Residential juvenile justice involvement was associated with the highest risk of both, later official criminal records and self-reported criminality (ORs from 5.1 to 14.5). Sensitivity analyses suggest that our findings are likely robust to potential unobserved confounders. Conclusions Juvenile justice involvement was associated with increased risk of adult criminality, with residential services associated with highest risk. Juvenile justice involvement may catalyze rather than deter from adult offending.

Objective: Anxiety and pain during medical procedures may have adverse short and long-term consequences. We summarize the effectiveness of hospital clown interventions, as compared with medication, the presence of a parent, standard care, and other non-pharmacological distraction interventions on anxiety and pain in minors undergoing medical procedures. Method: Randomized trials were identified in PsycINFO, MEDLINE, Embase, Scopus and CINAHL, and previous reviews. Screening of titles and abstracts and full-texts, data extraction and risk of bias assessment was done by two independent reviewers. We conducted random-effects network and pairwise meta-analyses based on a frequentist framework. Results: Our analyses with 28 studies showed significantly lower anxiety scores in clowning and other distraction interventions as compared with the presence of parents. No differences were observed between clowning, medication, and other distraction interventions. Clowning interventions were superior to standard care in our main analyses, but non-significant in some of the sensitivity analyses. Furthermore, clowning led to significantly lower pain as compared with presence of parents and standard care. No differences were observed between clowning interventions and the other comparators. For both outcomes, large between study heterogeneity was present but no significant inconsistency between designs. Risk of bias was mainly high and accordingly the certainty of evidence is considered moderate to low. Conclusions: We found no significant difference between medication, other non-medical distraction interventions and hospital clown interventions. Hospital clowns and other distraction interventions were more effective in reducing anxiety and pain in children undergoing medical procedures than the presence of parents alone. In order to allow for better insights regarding the comparative effectiveness of clowning interventions future trials should include detailed descriptions about the clowning intervention itself and the comparator.

Rule-violating behaviour in the form of substance misuse has been studied primarily within the context of prison settings, but not in forensic psychiatric settings.Our aim was to explore factors that are associated with substance misuse during hospitalisation in patients among those patients in a Swiss forensic psychiatric inpatient unit who were suffering from a disorder along the schizophrenia spectrum.From a database of demographic, clinical and offending data on all residents at any time between 1982 and 2016 in the forensic psychiatric hospital in Zurich, 364 cases fulfilled diagnostic criteria for schizophrenia or a schizophrenia-like illness and formed our sample. Any confirmed use of alcohol or illicit substances during admission (yes/no) was the dependent variable. Its relationship to all 507 other variables was explored by machine learning. To counteract overfitting, data were divided into training and validation set. The best model from the training set was tested on the validation set.Substance use as a secure hospital inpatient was unusual (15, 14%). Prior substance use disorder accounted for so much of the variance (AUC 0.92) that it was noted but excluded from further models. In the resulting model of best fit, variables related to rule breaking, younger age overall and at onset of schizophrenia and nature of offending behaviour, substance misuse as a minor and having records of complications in prior psychiatric treatment were associated with substance misuse during hospitalisation, as was length of inpatient treatment. In the initial model the AUC was 0.92. Even after removal of substance use disorder from the final model, performance indicators were meaningful with a balanced accuracy of 67.95, an AUC of 0.735, a sensitivity of 81.48% and a specificity of 57.58%.Substance misuse in secure forensic psychiatric hospitals is unusual but worthy of clinical and research consideration because of its association with other rule violations and longer hospitalisation. More knowledge is needed about effective interventions and rehabilitation for this group.

Background Mental health-related stigma is a global public health concern and a major barrier to seeking care. In this study, we explored the role of stigma as a barrier to scaling up mental health services in primary health care (PHC) centres in Lebanon. We focused on the experiences of Healthcare Providers (HCPs) providing services to patients with mental health conditions (MHCs), the views of policy makers, and the perceptions of stigma or discrimination among individuals with MHCs. This study was conducted as part of INDIGO-PRIMARY, a larger multinational stigma reduction programme. Methods Semi-structured qualitative interviews (n = 45) were carried out with policy makers (n = 3), PHC management (n = 4), PHC staff (n = 24), and service users (SUs) (n = 14) between August 2018 and September 2019. These interviews explored mental health knowledge, attitudes and behaviour of staff, challenges of providing treatment, and patient outcomes. All interviews were coded using NVivo and a thematic coding framework. Results The results of this study are presented under three themes: (1) stigma at PHC level, (2) stigma outside PHC centres, and (3) structural stigma. SUs did not testify to discrimination from HCPs but did describe stigmatising behaviour from their families. Interestingly, at the PHC level, stigma reporting differed among staff according to a power gradient. Nurses and social workers did not explicitly report incidents of stigma but described patients with MHCs as uncooperative, underscoring their internalized negative views on mental health. General practitioners and directors were more outspoken than nurses regarding the challenges faced with mental health patients. Mental health professionals revealed that HCPs still hold implicitly negative views towards patients with MHCs however their attitude has improved recently. Our analysis highlights five layers of stigma affecting SUs. Conclusion This qualitative study reveals that stigma was still a key concern that affects patients with MHC. SUs reported experiencing overt stigmatising behaviour in the community but less explicit discrimination in a PHC setting. Our findings emphasise the importance of (1) combatting structural stigma through legal reform, (2) addressing interpersonal stigma, (3) committing PHC management to deliver high quality mental health integrated services, and (4) reducing intrapersonal stigma by building public empathy.

Background and aimsProblem gambling and tobacco use are highly comorbid among adults. However, there are few treatment frameworks that target both gambling and tobacco use simultaneously (i.e., an integrated approach), while also being accessible and evidence-based. The aim of this two-arm open label RCT was to examine the efficacy of an integrated online treatment for problem gambling and tobacco use.MethodsA sample of 209 participants (Mage = 37.66, SD = 13.81; 62.2% female) from North America were randomized into one of two treatment conditions (integrated [n = 91] or gambling only [n = 118]) that lasted for eight weeks and consisted of seven online modules. Participants completed assessments at baseline, after treatment completion, and at 24-week follow-up.ResultsWhile a priori planned generalized linear mixed models showed no condition differences on primary (gambling days, money spent, time spent) and secondary outcomes, both conditions did appear to significantly reduce problem gambling and smoking behaviours over time. Post hoc analyses showed that reductions in smoking and gambling craving were correlated with reductions in days spent gambling, as well as with gambling disorder symptoms. Relatively high (versus low) nicotine replacement therapy use was associated with greater reductions in gambling behaviours in the integrated treatment condition.Discussion and conclusionsWhile our open label RCT does not support a clear benefit of integrated treatment, findings suggest that changes in smoking and gambling were correlated over time, regardless of treatment condition, suggesting that more research on mechanisms of smoking outcomes in the context of gambling treatment may be relevant.

Effective patient-provider communication is crucial to promote shared decision-making. However, it is unclear how to explain treatment changes to ensure patient acceptance, such as when transitioning from a bio-originator to a biosimilar. This review investigates communication strategies used to educate patients on transitioning to biosimilars and explores whether the willingness to transition and treatment persistence differs for the delivery (verbal or written) and the amount of information provided. MEDLINE, Embase, Scopus, and relevant conference databases were systematically searched. Communication strategies from 33 studies (88% observational cohort studies) published from 2012 to 2020 were synthesized and willingness to transition, persistence, and subjective adverse events explored. Patients only received information verbally in 11 studies. The remaining 22 studies also provided written information. Cost-saving was the main reason provided for the transition. Patients were most willing to transition when receiving written and verbal information (χ(2) = 5.83, p = .02) or written information that only addressed a few (3-5) concerns (χ(2) = 16.08, p .05). Few randomized controlled trials have been conducted. Available data shows more willingness to transition when patients received written and verbal information. Initial documents should contain basic information and consultations or telephone calls used to address concerns.

Zusammenfassung: Fragestellung: Die Patientenzufriedenheit ist ein etablierter Qualitätsindikator für medizinische Interventionen, welchen die Kostenträger im Gesundheitssystem zunehmend als Indikator heranziehen, um Unterschiede zwischen Kliniken sichtbar zu machen. Die Erfassung der Patientenzufriedenheit stellt die Kinder- und Jugendpsychiatrie/-psychotherapie (KJPP) vor besondere Herausforderungen (Entwicklungsstand, Rolle der Eltern). Die bestehenden Patientenzufriedenheitsinstrumente erwiesen sich als zu unspezifisch, um die verschiedenen Aspekte einer stationären KJPP-Behandlung abbilden zu können. Deshalb setzte sich eine Arbeitsgruppe im Auftrag der Schweizerischen Gesellschaft für Kinder und Jugendpsychiatrie (SGKJPP) zum Ziel, ein psychometrisches Instrument für die Patienten- und Elternzufriedenheit zu entwickeln, welches in den deutsch- und französischsprachigen Sprachregionen eingesetzt werden kann. Methodik: Die erste Anwendung und Überprüfung dieses Fragebogens in einer multizentrischen Pilotstudie mit einer Stichprobe von 174 Patientinnen und Patienten und 145 Eltern aus sechs Kliniken wird in diesem Artikel vorgestellt. Ergebnisse: Die Ergebnisse zeigen hervorragende Testgütekriterien des Instrumentariums (Cronbachs α = .93 bzw. α = .97 (Eltern-/Patientenversion). Die Fragebogenvarianten besitzen eine hohe konvergente Validität; die Korrelation zum Client Satisfaction Questionnaire (CSQ-8) beträgt p = .80 bzw. .83 (Patienten-, Elternurteil). Zudem differenzieren sie zwischen den einzelnen Kliniken. Die Korrelationen zwischen Patienten- und Elternurteil liegen bei moderaten p = .29 für den Gesamttest-Score und p = .39 für den CSQ-8. Schlussfolgerungen: Der Fragebogen eignet sich für die Beschreibung der Qualitätsentwicklung in der KJPP und kann als Standardverfahren für die Erfassung der Patientenzufriedenheit empfohlen werden.

Background: Ecological momentary assessment (EMA) has become a popular method of gathering information about participants as they go about their daily lives. However, participant non-compliance, especially non-random compliance, in EMA is a concern. Better knowledge of the moment-to-moment factors that predict prompt non-response can inform the design of strategies to mitigate it. Method: We used data from a general population young adult (n = 260) EMA study, ‘decades-to-minutes’ (D2M) and fitted dynamic structural equation models (DSEMs) to explore a range of candidate momentary predictors of missing the next prompt.Results: We found that higher levels of stress, overall negative affect, and the specific negative affective state of ‘upset’ at a given prompt predicted a greater likelihood of missing the next prompt. However, no other specific affective states, alcohol use, experiencing social provocations nor aggressive behaviour predicted missing the next prompt.Limitations: The primary limitation of the present study was a lack of information on predictors concurrent with missed prompts.Conclusions: Findings point to the potential value of gathering information on momentary negative affect (especially feeling upset) and stress to help inform strategies that intervene to prevent application disengagement at optimal moments and to feed into strategies to mitigate bias due to non-random non-response in EMA studies.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, undergraduate students were exposed to symptoms of psychological suffering during remote classes. Therefore, it is important to investigate the factors that may be generated and be related to such outcomes. Objective: To investigate the association between fear of COVID-19, depression, anxiety, and related factors in undergraduate students during remote classes. Methods: This cross-sectional study included 218 undergraduate students (60.6% women and 39.4% men). Students answered a self-administered online questionnaire designed to gather personal information, pandemic exposure, physical activity level, fear of COVID-19 using the ‘Fear of COVID-19 Scale’, symptoms of depression using the Patient Health Questionnaire-9, and anxiety using General Anxiety Disorder-7. Results: Undergraduate students had a high prevalence of depression and anxiety (83.0% and 76.1%, respectively) but a low prevalence of fear of COVID-19 (28.9%) during remote classes. Multivariate analysis revealed that women who reported health status as neither good nor bad and who had lost a family member from COVID-19 had the highest levels of fear. For depression and anxiety, the main related factors found were female gender, bad health status, insufficiently active, and complete adherence to the restriction measures. Conclusion: These findings may be used to develop actions to manage symptoms of anxiety and depression among students, with interventions through physical activity programmes to improve mental health.

Background Heroin-assisted treatment (HAT) is effective for individuals with severe opioid use disorder (OUD) who do not respond sufficiently to other opioid agonist treatments. It is mostly offered with injectable diacetylmorphine (DAM) or DAM tablets creating a barrier for individuals who need the rapid onset of action but are either unable or unwilling to inject, or primarily snort opioids. To explore another route of administration, we evaluated the safety and feasibility of intranasal (IN) DAM. Methods This is a multicentre observational cohort study among patients in Swiss HAT. All patients planning to receive IN DAM within the treatment centres were eligible to participate. Participants were either completely switched to IN DAM or received IN DAM in addition to other DAM formulations or opioid agonists. Patients were followed up for four weeks. Sociodemographic characteristics, current HAT regimen, reasons for starting IN DAM, IN DAM doses, number of injection events in the sample, IN DAM continuation rate, and appearance of adverse events and nose-related problems were evaluated. Results Participants (n = 52) reported vein damage, preference for nasal route of administration, and desire of a stronger effect or for a less harmful route of administration as primary reasons for switching to IN DAM. After four weeks, 90.4% of participants (n = 47) still received IN DAM. Weekly average realised injection events decreased by 44.4% from the month before IN DAM initiation to the month following. No severe adverse events were reported. Conclusions After four weeks, IN DAM was a feasible and safe alternative to other routes of administration for patients with severe OUD in HAT. It addressed the needs of individuals with OUD and reduced injection behaviour. More long-term research efforts are needed to systematically assess efficacy of and patient satisfaction with IN DAM.

The objective of this study is to understand the long-term mental sequelae for families over the course of the COVID-19 pandemic by longitudinally investigating the well-being of children with and without complex medical histories and their parents. Well-being of 200 children (between 7 and 18 years of age; 73 typically developing, 46 born very preterm, 73 with complex congenital heart disease) and 175 of their parents was assessed prior to and during the first (April–May 2020), second (October–November 2020), third (April–May 2021), and fourth wave (October–November 2021) of the pandemic with standardized questionnaires. Linear mixed models were used to investigate longitudinal changes in child and parent well-being compared to before the pandemic. Social and COVID-19-specific determinants were investigated as predictors of impaired well-being. To illustrate clinical relevance, the proportion of children and parents scoring > 1 SD below normative mean/median was reported. Compared to before the pandemic, child proxy-reported well-being was lower during the first but not the second, third, and fourth waves. Child self-reported well-being was not lower during the pandemic compared to before. Parent well-being dropped during the first wave and remained low throughout the subsequent waves. Proxy-reported child and self-reported parent well-being was lower in families with sparse social support and poor family functioning. Parents of typically developing children reported lower well-being than parents of children born very preterm or with a complex congenital heart disease. In November 2021, 20% of children (both self- and proxy-report) and 24% of parents scored below the normal range compared to 11% (child self-report), 10% (child proxy-report), and 16% (parent self-report), respectively, before the pandemic. The pandemic continues to impact the well-being of parents of school-aged children with and without complex medical histories more than 1 year after its outbreak. Children’s well-being was specifically affected during the first wave of the pandemic and has recovered thereafter. Families with sparse social support and poor family functioning are particularly at risk for compromised well-being and support should be provided to them.

Background: Past research reports a positive relationship between experience with classic serotonergic psychedelics and nature relatedness (NR). However, these studies typically do not distinguish between different psychedelic compounds, which have a unique psychopharmacology and may be used in specific contexts and with different intentions. Likewise, it is not clear whether these findings can be attributed to substance use per se or unrelated variables that differentiate psychedelic users from nonusers. Aims: The present study was designed to determine the relative degree to which lifetime experience with different psychedelic substances is predictive of self-reported NR among psychedelic-experienced users. Methods: We conducted a combined reanalysis of five independent datasets ( N = 3817). Using standard and regularized regression analyses, we tested the relationship between degree of experience with various psychedelic substances (binary and continuous) and NR, both within a subsample of psychedelic-experienced participants as well as the complete sample including psychedelic-naïve participants. Results/Outcomes: Among people experienced with psychedelics, only past use of psilocybin (versus LSD, mescaline, Salvia divinorum, ketamine, and ibogaine) was a reliable predictor of NR and its subdimensions. Weaker, less reliable results were obtained for the pharmacologically similar N,N-dimethyltryptamine (DMT). Results replicate when including psychedelic-naïve participants. In addition, among people exclusively experience with psilocybin, use frequency positively predicted NR. Conclusions/Interpretation: Results suggest that experience with psilocybin is the only reliable (and strongest) predictor of NR. Future research should focus on psilocybin when investigating effects of psychedelic on NR and determine whether pharmacological attributes or differences in user expectations/use settings are responsible for this observation.

Character strengths are assessed in adults and adolescents using different measurements. However, a comparison of character strengths across age groups requires the equivalence of these measurements. The present study examined the comparability of the two questionnaires most frequently used in research: The VIA Inventory of Strengths (VIA-IS) for adults and the VIA Inventory of Strengths for Youth (VIA-Youth). A sample of N=170 high-school students in the age of about 18 years and up to two informants (N=164 mostly parents; N=156 mostly friends and partners) completed both character strengths questionnaires and several well-being questionnaires. The psychometric characteristics and the correlations with well-being scales were examined once exclusively on the basis of self-rating and once on the basis of combined self- and informant-ratings. Substantial differences between the questionnaires were found in each of the criteria examined (e.g., identification of signature strengths, or largest associations with well-being). The results indicate that VIA-IS and VIA-Youth measure character strengths differently, so that a comparison across age groups may lead to biased conclusions. Therefore, differences in character strengths between adults and adolescents should not be exclusively interpreted in terms of differences on the trait level as these differences may be caused by non-equivalent questionnaires.

Background and aims: Ontologies are ways of representing information that improve clarity and the ability to connect different data sources. This paper proposes an initial version of an ontology of tobacco, nicotine and vaping products with the aim of reducing ambiguity and confusion in the field. Methods: Terms related to tobacco, nicotine and vaping products were identified in the research literature and their usage characterised. Basic Formal Ontology was used as a unifying upper-level ontology to describe the domain, and classes with definitions and labels were developed linking them to this ontology. Labels, definitions and properties were reviewed and revised in an iterative manner until a coherent set of classes was agreed by the authors. Results: Overlapping but distinct classes were developed: ‘tobacco-containing product’, ‘nicotine-containing product’ and ‘vaping device’. Subclasses of tobacco-containing products are ‘combustible tobacco-containing product’, ‘heated tobacco product’ and ‘smokeless tobacco-containing product’. Subclasses of combustible tobacco-containing product include ‘cigar’, ‘cigarillo’, ‘bidi’ and ‘cigarette’ with further subclasses including ‘manufactured cigarette’. Manufactured cigarettes have properties that include ‘machine-smoked nicotine yield’ and ‘machine-smoked tar yield’. Subclasses of smokeless tobacco product include ‘nasal snuff’, ‘chewing tobacco product’, and ‘oral snuff’ with its subclass ‘snus’. Subclasses of nicotine-containing product include ‘nicotine lozenge’ and ‘nicotine transdermal patch’. Subclasses of vaping device included ‘electronic vaping device’ with a further subclass, ‘e-cigarette’. E-cigarettes have evolved with a complex range of properties including atomiser resistance, battery power, properties of consumables including e-liquid nicotine concentration and flavourings, and the ontology characterises classes of product accordingly. Conclusions: Use of an ontology of tobacco, nicotine and vaping products should help reduce ambiguity and confusion in tobacco control research and practice.

BackgroundNightmares are a hallmark symptom of posttraumatic stress disorder (PTSD). This strong association may reflect a shared pathophysiology in the form of altered autonomic activity and increased reactivity. Using an acoustic startle paradigm, we investigated the interrelationships of psychophysiological measures during wakefulness and PTSD diagnosis, posttraumatic nightmares, and nontraumatic nightmares.MethodsA community sample of 122 trauma survivors were presented with a series of brief loud tones, while heart rate (HRR), skin conductance (SCR), and orbicularis oculi electromyogram (EMGR) responses were measured. Prior to the tone presentations, resting heart rate variability (HRV) was assessed. Nightmares were measured using nightmare logs. Three dichotomous groupings of participants were compared: (1) current PTSD diagnosis (n = 59), no PTSD diagnosis (n = 63), (2) those with (n = 26) or without (n = 96) frequent posttraumatic nightmares, and (3) those with (n = 22) or without (n = 100) frequent nontraumatic nightmares.ResultsPTSD diagnosis was associated with posttraumatic but not with nontraumatic nightmares. Both PTSD and posttraumatic nightmares were associated with a larger mean HRR to loud tones, whereas nontraumatic nightmare frequency was associated with a larger SCR. EMGR and resting HRV were not associated with PTSD diagnosis or nightmares.ConclusionsOur findings suggest a shared pathophysiology between PTSD and posttraumatic nightmares in the form of increased HR reactivity to startling tones, which might reflect reduced parasympathetic tone. This shared pathophysiology could explain why PTSD is more strongly related to posttraumatic than nontraumatic nightmares, which could have important clinical implications.

Background Depression is associated with an increased risk for cardiovascular disease (CVD). Biological cardiac risk factors are already elevated in depressed patients without existing CVD. The purpose of this exploratory trial was to examine whether treating Major Depression (MD) with cognitive behavioral therapy (CBT) is associated with improvements in cardiac risk biomarkers and whether depressive symptom severity at baseline moderates treatment effects. Methods Eighty antidepressant-free patients with MD were randomly assigned to CBT or waiting list (WL). Biological outcomes included long-term recordings (24-h, daytime, nighttime) of heart rate, heart rate variability (HRV), and blood pressure, as well as inflammatory markers such as C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α. A sample of 40 age- and sex-matched non-clinical controls was also involved to verify biological alterations in MD at study entry. Results Compared to WL, CBT was associated with a significant increase in overall HRV, as indexed by the 24-h and daytime HRV triangular index, as well as trend improvements in 24-h low-frequency HRV and daytime systolic blood pressure. Self-rated depressive symptom severity moderated (or tended to moderate) improvements in CBT for 24-h and daytime heart rate and several indices of HRV (especially daytime measures). Inflammatory treatment effects were not observed. Conclusions CBT increased overall HRV in patients with MD. Initially more depressed patients showed the most pronounced cardiovascular improvements through CBT. These exploratory findings may provide new insights into the biological effects of psychological treatment against depression and must be confirmed through future research.

Objective: Large-scale epidemiological research often uses self-reports to determine the prevalence of illicit substance use. Self-reports may suffer from inaccurate reporting but can be verified with objective measures. This study examined the following: the prevalence of illicit and non-medical substance use with self-reports and hair toxicology, the convergence of self-reported and objectively quantified substance use, and the correlates of under- and overreporting. Method: The data came from a large urban cohort study of young adults (n = 1,002, mean age = 20.6 years, 50% female). The participants provided 3 cm of hair (covering the previous 3 months) and reported their illicit and non-medical substance use and their sociodemographic, psychological, and behavioral characteristics. Hair toxicology analyses targeted cannabinoids, ketamine, opiates/opioids, stimulants including 3,4-methylenedioxymethamphetamine, and relevant metabolites. Results: Self-reports underestimated the prevalence of most substances by 30% to 60% compared to hair tests. The average detection ratio (hair test/self-report) was 1.50. Hair tests were typically more sensitive than self-reports. Underreporting was associated with a low level of that substance in hair. Self-reported delinquency and psychopathology were correlated with an increased likelihood of concordant positive self-reports and hair tests compared to underreporting. Overreporting was associated with infrequent self-reported use. Conclusion: Our study suggests that self-reports underestimate young adults’ exposure to illicit substances and non-medical use of prescription drugs. Consequently, estimates of associations between substance use and risk factors or outcomes are likely biased. Combining self-reports with hair tests may be most beneficial in study samples with occasional substance use. Researchers can use specific factors (eg, detection ratios) to adjust prevalence estimates and correlations based on self-reports., Journal of the American Academy of Child and Adolescent Psychiatry, 62 (7), ISSN:0890-8567

Objective: This study examines the prevalence and predictors of mental health issues, specifically anxiety, depression, and stress, among Ukrainians during the military conflict with Russia. Method: A cross-sectional correlational study was conducted six months after the beginning of the conflict. Sociodemographic factors, traumatic experiences, anxiety, depression, and stress were assessed. The study included 706 participants, both men and women, from different age groups and living in various regions of Ukraine. The data were collected from August till October 2022. Results: The study found that a large portion of the Ukrainian population shows increased levels of anxiety, depression, and stress due to the war. Women were found to be more vulnerable to mental health issues than men, and younger people were found to be more resilient. Worsened financial and employment statuses predicted increased anxiety. Ukrainians who fled the conflict to other countries exhibited higher levels of anxiety, depression, and stress. Direct exposure to trauma predicted increased anxiety and depression, while war-related exposure to “other stressful events” predicted increased acute stress levels. Conclusion: The findings of this study highlight the importance of addressing the mental health needs of Ukrainians affected by the ongoing conflict. Interventions and support should be tailored to address the specific needs of different groups, particularly women, younger individuals, and those with worsened financial and employment statuses., Frontiers in Psychiatry, 14, ISSN:1664-0640

Here we review the paradigm-change from one-size-fits-all psychiatry to more personalized-psychiatry, where we distinguish between 'precision psychiatry' and 'stratified psychiatry'. Using examples in Depression and ADHD we argue that stratified psychiatry, using biomarkers to facilitate patients to best 'on-label' treatments, is a more realistic future for implementing biomarkers in clinical practice.

This study was designed to investigate the effects of collaborative, dyadic, and individual planning on moderate-to-vigorous physical activity (MVPA) in target person-partner dyads. Individual planning reflects an "I-for-me" planning of one person's behavior. Collaborative planning refers to joint planning of both dyad members' behavior ("We-for-us" planning), and dyadic planning refers to joint planning of only the target person's behavior ("We-for-me" planning).At 1-week follow-up, there were no significant Time × Condition interaction effects among target persons and partners. At 36-week follow-up, target persons and partners in the dyadic planning conditions increased their MVPA, compared to the control condition.Individuals with insufficient physical activity or with a cardiovascular disease/type II diabetes and their partners may benefit from dyadic planning, which is a promising strategy to achieve physical activity increases. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective The aim of this study was to estimate the six-month prevalence of mental illness in children with chronic physical illness (multimorbidity), examine agreement between parent and child reports of multimorbidity, and identify factors associated with child multimorbidity. Method The sample included 263 children aged 2–16 years with a physician-diagnosed chronic physical illness recruited from the outpatient clinics at a pediatric hospital. Children were categorized by physical illness according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10. Parent and child-reported six-month mental illness was based on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Results Overall, 101 (38%) of children had a parent-reported mental illness; 29 (25%) children self-reported mental illness. There were no differences in prevalence across ICD-10 classifications. Parent-child agreement on the MINI-KID was low (κ = 0.18), ranging from κ = 0.24 for specific phobia to κ = 0.03 for attention-deficit hyperactivity. From logistic regression modeling (odds ratio [OR] and 95% confidence interval), factors associated with multimorbidity were: child age (OR = 1.16 [1.04, 1.31]), male (OR = 3.76 [1.54, 9.22]), ≥$90,000 household income (OR = 2.57 [1.08, 6.22]), parental symptoms of depression (OR = 1.09 [1.03, 1.14]), and child disability (OR = 1.21 [1.13, 1.30]). Similar results were obtained when modeling number of mental illnesses. Conclusions Findings suggest that six-month multimorbidity is common and similar across different physical illnesses. Level of disability is a robust, potentially modifiable correlate of multimorbidity that can be assessed routinely by health professionals in the pediatric setting to initiate early mental health intervention to reduce the incidence of multimorbidity in children.

Using a multimethod, multiinformant longitudinal design, we examined associations between specific forms of positive and negative emotional reactivity at age 5, children’s effortful control (EC), emotion regulation, and social skills at age 7, and adolescent functioning across psychological, academic, and physical health domains at ages 15/16 (N = 383). We examined how distinct components of childhood emotional reactivity directly and indirectly predict domain-specific forms of adolescent adjustment, thereby identifying developmental pathways between specific types of emotional reactivity and adjustment above and beyond the propensity to express other forms of emotional reactivity. Age 5 high-intensity positivity was associated with lower age 7 EC and more adolescent risk-taking; age 5 low-intensity positivity was associated with better age 7 EC and adolescent cardiovascular health, providing evidence for the heterogeneity of positive emotional reactivity. Indirect effects indicated that children’s age 7 social skills partially explain several associations between age 5 fear and anger reactivity and adolescent adjustment. Moreover, age 5 anger reactivity, low-, and high-intensity positivity were associated with adolescent adjustment via age 7 EC. The findings from this interdisciplinary, long-term longitudinal study have significant implications for prevention and intervention work aiming to understand the role of emotional reactivity in the etiology of adjustment and psychopathology.

Warning labels are an important source of health information. This study examined awareness of health warnings on cannabis packages over time in Canada-where large rotating messages are mandated-versus US states with legal adult-use cannabis, which have less comprehensive regulations.Repeat cross-sectional data were collected from the International Cannabis Policy Study online surveys among past 12-month cannabis consumers in Canada and the US (Free recall of ≥1 warning increased to a greater extent in Canada from 2018 (5%; pre-legalization) to 2019 (13%; post-legalization) compared to US "legal" (AOR = 1.93,Cannabis legalization is associated with greater recall of health warning messages. Awareness of specific warning messages was higher in jurisdictions where the associated warning was mandated on packages, suggesting that warning labels may improve knowledge of cannabis-related health risks.Supplemental data for this article is available online at.

Im internationalen Raum ersetzte am 01.01.2022 das von der Weltgesundheitsorganisation WHO herausgegebene ICD-11-Diagnosesystem das bisherige ICD-10. Als eine der vielen Neuerungen wurde eine Kategorie für trauma- und belastungsbezogenen Diagnosen eingeführt, welche die klassische und komplexe posttraumatische Belastungsstörung, die anhaltende Trauerstörung sowie die Anpassungsstörung beinhaltet. Zusätzlich wurden die reaktive Bindungsstörung und die Bindungsstörung mit sozialer Enthemmung als Dia­gnosen des Kindesalters in diese Störungsgruppe aufgenommen. Im Vergleich zum ICD-10 konnte die klinische Nützlichkeit und Anwendbarkeit der neuen ICD-11-Dia­gnosen erhöht werden, indem bestehende Störungen auf der Symptomebene vereinfacht oder neue Störungen eingeführt wurden. Erste Studien zeigen aber auch Unterschiede in der Häufigkeit der Diagnosevergabe im Vergleich zu ICD-10 und DSM-5, was durch verbleibende Unschärfen von Dia­gnosesystemen und den theoretischen Neuerungen er­klärt werden kann. Die Einführung der ICD-11 bringt insge­samt eine Reihe von Impulsen mit sich und erleichtert die Arbeit von Fachpersonen in der klinischen Praxis und Forschung.

Patients’ expectations are among the most frequently studied psychological prognostic factors in total knee and hip arthroplasty (TKA/THA). So far, however, evidence on the effect of patients’ preoperative expectations on surgery outcome is inconclusive. Heterogeneity of expectation constructs and the use of psychometrically not evaluated measurement instruments have constituted major obstacles for the integration of the current literature. Using a theory-based model of expectation constructs (Laferton, Kube, Salzmann, Auer, & Shedden-Mora, 2017), this meta-analysis set out to disentangle the conflicting results in the current literature. Systematic literature searches yielded k = 46 studies (N = 10,465) that reported associations of preoperative expectations with postoperative pain, functioning and disability, and satisfaction. Random effects meta-analysis revealed a robust small association (r = .16; 95% CI .13, .19) between patients’ positive preoperative expectations and better postoperative outcomes. This effect did not differ between THA and TKA, different outcome categories and different follow-up periods. Studies using psychometrically evaluated expectation measures reported significantly higher effects (r = .19; 95% CI .16, .22). Whether this effect varies among different expectation constructs remains unclear. High-quality studies using validated, multidimensional expectation measures are needed to further understand the role of different expectation constructs in THA and TKA surgery.