Sex differences in the clinical presentation of early psychosis in a primary care setting.

Primary care is an important part of the help-seeking pathway for young people experiencing early psychosis, but sex differences in clinical presentation in these settings are unexplored. We aimed to identify sex differences in clinical presentation to primary care services in the 1-year period prior to a first diagnosis of psychotic disorder. We identified first-onset cases of non-affective psychotic disorder over a 10-year period (2005-2015) using health administrative data linked with electronic medical records (EMRs) from primary care (n = 465). Detailed information on encounters in the year prior to first diagnosis was abstracted, including psychiatric symptoms, other relevant behaviours, and diagnoses recorded by the family physician (FP). We used modified Poisson regression models to examine sex differences in the signs, symptoms, and diagnoses recorded by the FP, adjusting for various clinical and sociodemographic factors. Positive symptoms (PR = 0.76, 95%CI: 0.58, 0.98) and substance use (PR = 0.54, 95%CI: 0.40, 0.72) were less prevalent in the medical records of women. Visits by women were more likely to be assigned a diagnosis of depression or anxiety (PR = 1.18, 95%CI: 1.00, 1.38), personality disorder (PR = 5.49, 95%CI: 1.22, 24.62), psychological distress (PR = 11.29, 95%CI: 1.23, 103.91), and other mental or behavioral disorders (PR = 3.49, 95%CI: 1.14, 10.66) and less likely to be assigned a diagnosis of addiction (PR = 0.33, 95%CI: 0.13, 0.87). We identified evidence of sex differences in the clinical presentation of early psychosis and recorded diagnoses in the primary care EMR. Further research is needed to better understand sex differences in clinical presentation in the primary care context, which can facilitate better understanding, detection, and intervention for first-episode psychotic disorders.

Patient and Physician Factors Associated with First Diagnosis of Non-affective Psychotic Disorder in Primary Care.

Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first diagnosis of psychotic disorder. We used modified Poisson regression models to examine patient and physician factors associated with a first diagnosis of psychosis in primary care. Among people with early psychosis (n = 39,449), 63% had help-seeking contacts in primary care within six months prior to first diagnosis. Of those patients, 47% were diagnosed in primary care and 53% in secondary/tertiary care. Patients factors associated with lower likelihood of diagnosis in primary care included male sex, younger age, immigrant status, and comorbid psychosocial conditions. Physician factors associated with lower likelihood of diagnosis in primary care included solo practice model, urban practice setting, international medical education, and longer time since graduation. Our findings indicate that primary care is an important contact for help-seeking and diagnosis for a large proportion of people with early psychosis. For physicians less likely to diagnose psychosis in primary care, targeted resources and interventions could be provided to support them in caring for patients with early psychosis.

Review: System transformation to enhance transitional age youth mental health - a scoping review.

BACKGROUND: Youth mental health challenges are an emerging and persistent global public health issue despite efforts for improvement. As part of a broader social innovation study to transform youth mental health systems, this scoping review assesses interventions that aim for systems-level changes to improve the mental well-being of transitional age youth (TAY) (15-25 years) in high-income countries. METHODS: The scoping review method of Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) was used. Seven health and social service databases were utilized with study inclusion criteria applied. Titles and abstracts were screened by two independent reviewers, and four members of the research team were involved in the review and thematic analysis of selected studies. RESULTS: A total of 5652 peer-reviewed articles were screened at the title and abstract level, of which 65 were assessed in full for eligibility, and 29 were included for final analysis. The peer-reviewed articles and gray literature were based in seven different high-income countries and published between 2008 and 2019. Four major themes to support youth mental health were identified in the literature: (a) improving transitions from youth to adult mental healthcare services; (b) moving care from institutions to the community; (c) general empowerment of youth in society; and (d) youth voice within the system. Inconsistent or limited systems-level approaches to TAY mental health care were noted. CONCLUSIONS: There remains a need for innovative, evidence-based approaches to improve TAY mental health care.

Patterns of Primary Care Use Prior to a First Diagnosis of Nonaffective Psychotic Disorder in Ontario, Canada: Modèles d'utilisation des soins de première ligne avant un premier diagnostic de trouble psychotique non affectif en Ontario, Canada.

BACKGROUND: Many people experience early signs and symptoms before the onset of psychotic disorder, suggesting that there may be help-seeking prior to first diagnosis. The family physician has been found to play a key role in pathways to care. This study examined patterns of primary care use preceding a first diagnosis of psychotic disorder. METHODS: We used health administrative data from Ontario (Canada) to construct a population-based retrospective cohort. We investigated patterns of primary care use, including frequency and timing of contacts, in the 6 years prior to a first diagnosis of psychosis, relative to a general population comparison group matched on age, sex, geographic area, and index date. We used latent class growth modeling to identify distinct trajectories of primary care service use, and associated factors, preceding the first diagnosis. RESULTS: People with early psychosis contacted primary care over twice as frequently in the 6 years preceding first diagnosis (RR = 2.22; 95% CI, = 2.19 to 2.25), relative to the general population, with a sharp increase in contacts 10 months prior to diagnosis. They had higher contact frequency across nearly all diagnostic codes, including mental health, physical health, and preventative health. We identified 3 distinct service use trajectories: low-, medium-, and high-increasing usage. DISCUSSION: We found elevated patterns of primary care service use prior to first diagnosis of psychotic disorder, suggesting that initiatives to support family physicians in their role on the pathway to care are warranted. Earlier intervention has implications for improved social, educational, and professional development in young people with first-episode psychosis.

Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services.

BACKGROUND: Discrepancies between population-based estimates of the incidence of psychotic disorder and the treated incidence reported by early psychosis intervention (EPI) programs suggest additional cases may be receiving services elsewhere in the health system. Our objective was to estimate the incidence of non-affective psychotic disorder in the catchment area of an EPI program, and compare this to EPI-treated incidence estimates. METHODS: We constructed a retrospective cohort (1997-2015) of incident cases of non-affective psychosis aged 16-50 years in an EPI program catchment using population-based linked health administrative data. Cases were identified by either one hospitalization or two outpatient physician billings within a 12-month period with a diagnosis of non-affective psychosis. We estimated the cumulative incidence and EPI-treated incidence of non-affective psychosis using denominator data from the census. We also estimated the incidence of first-episode psychosis (people who would meet the case definition for an EPI program) using a novel approach. RESULTS: Our case definition identified 3245 cases of incident non-affective psychosis over the 17-year period. We estimate that the incidence of first-episode non-affective psychosis in the program catchment area is 33.3 per 100 000 per year (95% CI 31.4-35.1), which is more than twice as high as the EPI-treated incidence of 18.8 per 100 000 per year (95% CI 17.4-20.3). CONCLUSIONS: Case ascertainment strategies limited to specialized psychiatric services may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates. Accurate information on the epidemiology of first-episode psychosis will enable us to more effectively resource EPI services and evaluate their coverage.

Access and Health System Impact of an Early Intervention Treatment Program for Emerging Adults with Mood and Anxiety Disorders.

OBJECTIVES: Early intervention programs are effective for improving outcomes in first-episode psychosis; however, less is known about their effectiveness for mood and anxiety disorders. We sought to evaluate the impact of an early intervention program for emerging adults with mood and anxiety disorders in the larger health system context, relative to standard care. METHODS: Using health administrative data, we constructed a retrospective cohort of cases of mood and anxiety disorders among emerging adults aged 16 to 25 years in the catchment of the First Episode Mood and Anxiety Program (FEMAP) in London, Ontario, between 2009 and 2014. This cohort was linked to primary data from FEMAP to identify service users. We used proportional hazards models to compare indicators of service use between FEMAP users and a propensity score-matched group of nonusers receiving care elsewhere in the health system. RESULTS: FEMAP users (n = 490) had more rapid access to a psychiatrist relative to nonusers (hazard ratio [HR], 2.82; 95% confidence interval, 2.45 to 3.26; median time, 16 vs. 71 days). In the year following admission, FEMAP users also had lower rates of emergency department use for mental health reasons (HR, 0.73; 95% CI, 0.53 to 0.99). We did not observe differences in psychiatric hospitalization rates. CONCLUSIONS: An early intervention model of care for mood and anxiety disorders is associated with better access to psychiatric care and lower use of the emergency department. Our findings suggest that early intervention services for mood and anxiety disorders may be beneficial from a health systems perspective, and further research on the effectiveness of this model of care is warranted.

Disparities in Access to Early Psychosis Intervention Services: Comparison of Service Users and Nonusers in Health Administrative Data.

OBJECTIVE: There is a dearth of information on people with first-episode psychosis who do not access specialized early psychosis intervention (EPI) services. We sought to estimate the proportion of incident cases of nonaffective psychosis that do not access these services and to examine factors associated with EPI admission. METHODS: Using health administrative data, we constructed a retrospective cohort of incident cases of nonaffective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario, between 1997 and 2013. This cohort was linked to primary data from PEPP to identify EPI users. We used multivariate logistic regression to model sociodemographic and service factors associated with EPI admission. RESULTS: Over 50% of suspected cases of nonaffective psychosis did not have contact with EPI services for screening or admission. EPI users were significantly younger, more likely to be male (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.24 to 2.01), and less likely to live in areas of socioeconomic deprivation (OR 0.51; 95% CI 0.36 to 0.73). EPI users also had higher odds of psychiatrist involvement at the index diagnosis (OR 7.35; 95% CI 5.43 to 10.00), had lower odds of receiving the index diagnosis in an outpatient setting (OR 0.50; 95% CI 0.38 to 0.65), and had lower odds of prior alcohol-related (OR 0.42; 95% CI 0.28 to 0.63) and substance-related (OR 0.68; 95% CI 0.50 to 0.93) disorders. CONCLUSIONS: We need a greater consideration of patients with first-episode psychosis who are not accessing EPI services. Our findings suggest that this group is sizable, and there may be sociodemographic and clinical disparities in access. Nonpsychiatric health professionals could be targeted with interventions aimed at increasing detection and referral rates.

Depression and Global Mental Health in the Global South: A Critical Analysis of Policy and Discourse.

Over the past two decades, depression has become a prominent global public health concern, especially in low- and middle-income countries (LMICs). The World Health Organization (WHO) and the Movement for Global Mental Health have developed international guidelines to improve mental health services globally, prioritizing LMICs. These efforts hold promise for advancing care and treatment for depression and other mental, neurological, and substance abuse disorders in LMICs. The intervention guides, such as the WHO's mhGAP-Intervention Guides, are evidence-based tools and guidelines to help detect, diagnose, and manage the most common mental disorders. Using the Global South as an empirical site, this article draws on Foucauldian critical discourse and document analysis methods to explore how these international intervention guides operate as part of knowledge-power processes that inscribe and materialize in the world in some forms rather than others. It is proposed that these international guidelines shape the global discourse about depression through their (re)production of biopolitical assumptions and impacts, governmentality, and "conditions of possibility." The article uses empirical data to show nuance, complexity, and multi-dimensionality where binary thinking sometimes dominates, and to make links across arguments for and against global mental health. The article concludes by identifying several resistive discourses and suggesting reconceptualizing the treatment gap for common mental disorders.

Effectiveness of a mindfulness-based intervention for persons with early psychosis: A multi-site randomized controlled trial.

BACKGROUND: The Mindfulness Ambassador Program (MAP) is a group-based, facilitated mindfulness-based intervention (MBI). We sought to determine the effectiveness of MAP on reducing negative psychotic symptoms and enhancing mindfulness skills among persons experiencing early psychosis. METHODS: We conducted a pragmatic randomized controlled trial (RCT) at three early psychosis intervention (EPI) programs in Ontario, Canada. Participants (N = 59) were randomly assigned to receive MAP (n = 29) for 1-hour weekly sessions over 3 months, or to treatment as usual (TAU, n = 30). Assessments were conducted at baseline, 3 months, and 6 months using the Self-Evaluation of Negative Symptoms (SNS) and Kentucky Inventory of Mindfulness Skills (KIMS). Linear mixed methods were used to assess the joint effects of group and time. RESULTS: At 3 months, participants who received MAP (n = 17) demonstrated greater reductions on the SNS relative to TAU (n = 15), which were clinically and statistically significant (-4.1; 95%CI -7.5, -0.7; p = 0.019). At 6 months, the difference between MAP (n = 10) and TAU (n = 13) was no longer statistically significant (-1.2; 95%CI -5.2,2.7; p = 0.54). On the KIMS, no significant effects were found at 3 months (+0.3; 95%CI -2.0,2.5; p = 0.82) or 6 months (+0.4; 95%CI -2.2,2.9; p = 0.79). CONCLUSIONS: We conducted one of the first multi-site RCTs of a MBI for early psychosis. Our findings indicated that MAP was more effective in reducing negative symptoms compared to TAU in the short term. Earlier reductions in negative psychotic symptoms may help facilitate recovery in the long term.

Anxiety Symptoms and Associated Psychological and Job-Related Factors Among Hospital Nurses.

OBJECTIVE: Recently, burnout and mental health issues regarding nurses are reported increasingly. This study aimed to investigate the prevalence of anxiety symptoms among hospital nurses and determine their association with psychological and job-related factors. METHODS: Data on demographics, job-related characteristics, burnout, Type A behavior patterns, self-esteem, and happiness were collected from 515 nurses working at a university hospital in Korea. Anxiety symptoms were assessed using the anxiety subscale of the Hospital Anxiety and Depression Scale, with scores of 8 or higher indicating the presence of anxiety symptoms. Demographic, job-related, and psychological factors were compared according to the presence of anxiety. Logistic regression was conducted to identify factors associated with anxiety symptoms. RESULTS: Two hundred and four (39.6%) participants had anxiety symptoms. Self-esteem and happiness were associated with a lower risk of anxiety symptoms, whereas burnout was associated with a higher risk of anxiety symptoms. Furthermore, being female, having a career of less than five years, and requiring counseling due to stress were associated with a higher risk of anxiety symptoms. Being younger, female, or a basic nurse; having a career of less than five years; partaking in shift work; experiencing job dissatisfaction; requiring counseling due to stress; being exposed to higher levels of burnout; and having lower levels of self-esteem and happiness were all found to be significantly correlated with anxiety symptoms. CONCLUSION: These findings suggest that promoting self-esteem and happiness while reducing burnout may be beneficial in preventing and managing anxiety symptoms among hospital nurses.

An app-based ecological momentary assessment of undergraduate student mental Health during the COVID-19 pandemic in Canada (Smart Healthy Campus Version 2.0): Longitudinal study.

This paper presents results from the Smart Healthy Campus 2.0 study/smartphone app, developed and used to collect mental health-related lifestyle data from 86 Canadian undergraduates January-August 2021. Objectives of the study were to 1) address the absence of longitudinal mental health overview and lifestyle-related data from Canadian undergraduate students, and 2) to identify associations between these self-reported mental health overviews (questionnaires) and lifestyle-related measures (from smartphone digital measures). This was a longitudinal repeat measures study conducted over 40 weeks. A 9-item mental health questionnaire was accessible once daily in the app. Two variants of this mental health questionnaire existed; the first was a weekly variant, available each Monday or until a participant responded during the week. The second was a daily variant available after the weekly variant. 6518 digital measure samples and 1722 questionnaire responses were collected. Mixed models were fit for responses to the two questionnaire variants and 12 phone digital measures (e.g. GPS, step counts). The daily questionnaire had positive associations with floors walked, installed apps, and campus proximity, while having negative associations with uptime, and daily calendar events. Daily depression had a positive association with uptime. Daily resilience appeared to have a slight positive association with campus proximity. The weekly questionnaire variant had positive associations with device idling and installed apps, and negative associations with floors walked, calendar events, and campus proximity. Physical activity, weekly, had a negative association with uptime, and a positive association with calendar events and device idling. These lifestyle indicators that associated with student mental health during the COVID-19 pandemic suggest directions for new mental health-related interventions (digital or otherwise) and further efforts in mental health surveillance under comparable circumstances.

Exploration of Existing Integrated Mental Health and Addictions Care Services for Indigenous Peoples in Canada.

Due to the persistent impacts of colonialism, Indigenous peoples of Canada face disproportionate rates of mental health and substance use disorders, which are often insufficiently addressed by Eurocentric 'mainstream' mental health and addiction services. The need to better address Indigenous mental health has led to Indigenous mental health integrated care (hereafter integrated care): programs using both Indigenous and Western practices in their care delivery. This research describes the common lessons, disjunctures, and solutions experienced by existing integrated care programs for Indigenous adults across Canada. It reveals the best practices of integrated care for programs, and contributes to the Truth and Reconciliation Commission of Canada's Calls to Action #20 and #22. This study, co-designed by an Indigenous Knowledge Keeper and Practitioner, explores the programs' relational processes through interviews with key informants. The data was analyzed in consultation with Indigenous collaborators to highlight Indigenous values and interpretations, and knowledge co-production. In highlighting the complexity of integrated care, study results show the lessons of 'Real Commitment to Communities and Community Involvement,' and tensions and disjunctures of 'Culture as Healing,' 'People-focused vs. Practitioner-focused Programs,' 'Community-oriented vs. Individual-oriented Programs,' and 'Colonial Power Dynamics in Integrated Care.' The discussion explores why tensions and disjunctures exist, and suggests how to move forward using integrated care's lessons and the concept of IND-equity. Ultimately, Indigenous-led partnerships are paramount to integrated care because they leverage Indigenous knowledge and approaches to achieve health equity within integrated care.

COVID-19-related anxiety and the role of social media among Canadian youth.

Background: Current literature indicates that safety measures, including lockdowns during the COVID-19 pandemic, severely disrupted our lifestyle, marked by increased screen time. The increased screen time is mostly associated with exacerbated physical and mental wellbeing. However, the studies that examine the relationship between specific types of screen time and COVID-19-related anxiety among youth are limited. Methods: We examined the usage of passive watching, social media, video games, and educational screen time and COVID-19-related anxiety at the 5-time points (Early-Spring 2021, Late-Spring 2021, Fall 2021, Winter 2022, and Spring 2022) among youth in Southern Ontario, Canada (N = 117, mean age = 16.82, male = 22%, non-White = 21%) and investigated the role of 4 types of screen time in COVID-19 related anxiety. COVID-related anxiety was measured using the Coronavirus Anxiety Scale (CAS). Descriptive statistics examined the binary relationships between demographic factors, screen time, and COVID-related anxiety. Also, partially adjusted and fully adjusted binary logistic regression analyses were conducted to examine the association between the types of screen time and COVID-19-related anxiety. Results: During the late Spring of 2021, when the provincial safety restrictions were most stringent, screen time was the highest among the 5 data collection time points. Further, adolescents experienced the highest COVID-19-related anxiety during this period. On the other hand, young adults experienced the highest COVID-19-related anxiety during Spring 2022. In a partially adjusted model (accounting for other types of screen time), engaging in 1-5 h per day on social media increased the likelihood of experiencing COVID-19-related anxiety compared to those who spend less than 1 h per day (OR = 3.50, 95%CI = 1.14-10.72, p < 0.05). Other types of screen time was not significantly associated with COVID-19-related anxiety. In a fully adjusted model (accounting for age, sex and ethnicity besides four types on screen time), 1-5 h per day of social media remained significantly associated with COVID-19-related anxiety (OR = 4.08, 95%CI = 1.22-13.62, p < 0.05). Conclusion: Our findings suggest that COVID-19-related anxiety is associated with youth engagement in social media during the COVID-19 pandemic. Clinicians, parents, and educators should work collaboratively to provide developmentally appropriate approaches to reduce the negative social media impact on COVID-19-related anxiety and promote/foster resiliency in our community during the recovery period.

Evaluating the feasibility and potential impacts of a recovery-oriented psychosocial rehabilitation toolkit in a health care setting in Kenya: A mixed-methods study.

OBJECTIVES: This pilot study evaluated the feasibility and potential impacts of delivering the Psychosocial Rehabilitation (PSR) Toolkit for people with serious mental illness within a health care setting in Kenya. METHOD: This study used a convergent mixed-methods design. Participants were people with serious mental illness (n = 23), each with an accompanying family member, who were outpatients of a hospital or satellite clinic in semirural Kenya. The intervention consisted of 14 weekly group sessions of PSR cofacilitated by health care professionals and peers with mental illness. Quantitative data were collected from patients and family members using validated outcome measures before and after the intervention. Qualitative data were collected from focus groups with patients and family members, and individual interviews with facilitators, after the intervention. RESULTS: Quantitative findings indicated that patients experienced moderate improvement in illness management and, in contrast to qualitative findings, family members experienced moderate worsening in attitudes toward recovery. Qualitative findings revealed positive outcomes for both patients and family members, as reflected in greater feelings of hope and mobilization to reduce stigma. Factors that facilitated participation included: helpful and accessible learning materials; committed and involved stakeholders; and flexible solutions to promote continued involvement. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This pilot study found that delivery of the Psychosocial Rehabilitation Toolkit was feasible within a health care setting in Kenya and associated with overall positive outcomes among patients with serious mental illness. Further research on its effectiveness on a larger scale and using culturally validated measures is needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Access to a regular primary care physician among young people with early psychosis in Ontario, Canada.

AIM: Access to a primary care physician in early psychosis facilitates help-seeking and engagement with psychiatric treatment. We examined access to a regular primary care physician in people with early psychosis, compared to the general population, and explored factors associated with access. METHODS: Using linked health administrative data from Ontario (Canada), we identified people aged 14-35 years with a first diagnosis of nonaffective psychotic disorder (n = 39 449; 2005-2015). We matched cases to four randomly selected general population controls based on age, sex, neighbourhood, and index date (n = 157 796). We used modified Poisson regression to estimate prevalence ratios (PR) for access to a regular primary care physician in the year prior to first diagnosis of psychotic disorder, and the sociodemographic and clinical factors associated with access. RESULTS: A larger proportion of people with early psychosis had a regular primary care physician, relative to the general population (89% vs. 68%; PR = 1.30, 95%CI = 1.30-1.31). However, this was accounted for by a higher prevalence of comorbidities among people with psychosis, and this association was no longer present after adjustment (PR = 0.97, 95%CI = 0.97, 0.98). People with early psychosis who were older, male, refugees and those residing in lower income or high residential instability neighbourhoods were less likely to have a regular primary care physician. CONCLUSION: Approximately one in ten young people with early psychosis in Ontario lack access to a regular primary care physician. Strategies to improve primary care physician access are needed for management of physical comorbidities and to ensure continuity of care.

Heeding the Call of an Innovative Paradigm for Mental Health Interventions in Low- and Middle-income Countries.

The provision of mental health care for people living in low- and middle-income countries presents a particularly complex problem because of fractured service availability and provision, widespread stigma associated with mental illness, and the economic burden inherent in conventional mental health service delivery. People with serious mental illness in these settings are among the most marginalized in their societies and are at risk of becoming increasingly powerless in the face of top-down, service-oriented systems. Innovative intersectoral approaches that are based on asset development and entrepreneurism and that embrace the power of peer-driven networks hold promise to effect transformative and meaningful change.

A pilot study of participatory video in early psychosis: Qualitative findings.

For people with psychotic disorders, developing a personal narrative about one's experiences with psychosis can help promote recovery. This pilot study examined participants' reactions to and experiences of participatory video as an intervention to help facilitate recovery-oriented narrative development in early psychosis. Outpatients of an early psychosis intervention program were recruited to participate in workshops producing short documentary-style videos of their collective and individual experiences. Six male participants completed the program and took part in a focus group upon completion and in an individual semistructured interview three months later. Themes were identified from the focus group and interviews and then summarized for descriptive purposes. Prominent themes included impacts of the videos on the participants and perceived impacts on others, fulfilment from sharing experiences and expressing oneself, value of collaboration and cohesion in a group, acquiring interpersonal and technological skills, and recommendations for future implementation. Findings of this study suggest that participatory video is an engaging means of self-definition and self-expression among young people in recovery from early psychosis.

Episodic simulation of future events is impaired in patients with major depressive disorder.

We examined future episodic simulation in patients with major depressive disorder (MDD) using a method that distinguishes between episodic and non-episodic details of events. Patients were impaired at generating specific episodic details concerning future events; non-episodic details were not affected. In addition, all participants generated more episodic details for positive than for negative stimulus words. These results suggest a deficit in autonoetic awareness among patients with MDD. Difficulties imagining future events may impact upon the success of therapeutic interventions aimed at altering biases in the prediction of positive and negative future happenings.

Patients with bipolar disorder show a selective deficit in the episodic simulation of future events.

A substantial body of evidence suggests that autobiographical recollection and simulation of future happenings activate a shared neural network. Many of the neural regions implicated in this network are affected in patients with bipolar disorder (BD), showing altered metabolic functioning and/or structural volume abnormalities. Studies of autobiographical recall in BD reveal overgeneralization, where autobiographical memory comprises primarily factual or repeated information as opposed to details specific in time and in place and definitive of re-experiencing. To date, no study has examined whether these deficits extend to future event simulation. We examined the ability of patients with BD and controls to imagine positive, negative and neutral future events using a modified version of the Autobiographical Interview (Levine, Svoboda, Hay, Winocur, & Moscovitch, 2002) that allowed for separation of episodic and non-episodic details. Patients were selectively impaired in imagining future positive, negative, and neutral episodic details; simulation of non-episodic details was equivalent across groups.

A mindfulness group intervention in newly diagnosed persons with multiple sclerosis: A pilot study.

BACKGROUND: Relapsing MS (RMS) is a lifelong disease without a cure, usually diagnosed between 20-40 years of age. Being newly diagnosed with RMS is a highly stressful event due to the unpredictable disease course after diagnosis. Thus, it is imperative that persons with MS have the skills and support to cope with the negative physical and emotional effects of the disease. The objective of this study was to assess whether a mindfulness-based intervention (MBI) would improve coping skills and thus lessen the negative consequences of stress due to being newly diagnosed with RMS. METHODS: This was a single-blind (assessor), randomized, prospective study of a 10-week MBI vs. usual standard of care in persons newly diagnosed (within 1 year) with RMS, recruited from one tertiary care MS clinic in London (ON), Canada. The MBI was administered in group format with a trained MBI facilitator. Primary outcomes included the Brief COPE measure and the Hospital Anxiety and Depression Scale (HADS) subscales. Secondary outcomes included measures of perceived stress, cognitive function, fatigue, and quality of life. Exploratory (tertiary) outcomes included serum markers of inflammation and stress. Subjects were assessed at baseline, post intervention (or equivalent) and 6 months later. A repeated measures multivariate analysis of covariance (MANCOVA) was used, with baseline scores employed as covariates and the test scores, to compare longitudinal changes, immediately after the MBI sessions and 6 months later. RESULTS: Twenty-five subjects were recruited (16 MBI, 9 controls) for two (Fall and Spring) MBI interventions over 1.5 years. All controls completed the study, while 4 MBI participants did not, leaving 21 subjects in the analysis. Most were women (17, 81%), with a mean age of 37.1 ± 9.4 years. Two thirds had already started a DMT at the time of consent; the median EDSS was 2.0 (0.0-4.0). The groups were well matched on baseline characteristics, with the exception of months since diagnosis (MBI 6.4 ± 6.5 vs. control 3.6 ± 2.8, p=0.023). All controls completed the study, while 4 MBI participants did not. The MBI group improved significantly on the COPE measure when compared to the control group (p=0.024) pre and post intervention; the MBI group also improved significantly on the HADS depression subscale (p=0.007). There was no significant difference over time on the HADS anxiety subscale (p=0.179). The effect size on COPE was 0.56 and 0.40 on HADS-D. On the secondary outcomes, there was a significant improvement on the Perceived Stress Scale (p=0.015). The exploratory outcomes were not significantly different. None of the outcomes were significant at the six-month follow-up. CONCLUSION: This pilot study demonstrates that an MBI may improve coping, depression and perceived stress in newly diagnosed (within one year) persons with RMS in the short term. Future research to confirm these results, as well as further investigate measures to extend the benefit beyond the immediate intervention.