Concussion May Result in New-Onset Bipolar Disorder: A Case Report.

Emotional dysregulation following a concussion is well established. New onset of major psychiatric diseases such as bipolar disorder (BPD) post-concussion has not been investigated. BPD typically presents with an initial depressive episode followed by mania and concurrent depressive and manic states. Multiple theories explaining the etiology of BPD exist, including the diathesis-stress model (DiSM), though an accepted theory is not established. In this case study, medical records of a 50-year-old ambidextrous male with co-morbid attention deficit hyperactivity disorder (ADHD) inattentive type, obsessive-compulsive disorder (OCD), and a family history of BPD suffered a motor vehicle collision (MVC) resulting in a grade II concussion. New onset BPD was diagnosed one-year after a concussion following an involuntary admission and led to the patient self-terminating his medications and suffering a hypertensive crisis and aortic dissection, and stroke. One year later, the patient was again involuntarily admitted for a suicide attempt. Bipolar disorder persisted unchanged indefinitely. This case study may serve as a real-world example of the DiSM in the etiology of BPD post-concussion. We aim to highlight the importance of early identification of risk factors for progression to psychiatric conditions following concussion.

Childhood Family Stress and Women's Health: Parasympathetic Activity as a Risk and Resiliency Factor.

Childhood family stress (CFS) exacerbates risk for physical health problems across the lifespan. Health risks associated with CFS are particularly relevant for women who tend to endorse more CFS than men. Importantly, some evidence suggests that individuals may vary in their susceptibility to CFS. Parasympathetic activity, which helps to regulate automatic bodily activity (e.g., breathing, digestion), has been proposed to represent a marker of plasticity to environmental exposure. However, no research to date has tested whether parasympathetic activity may modulate the impact of early adversity on health. We examined whether parasympathetic activity would moderate the link between CFS and health complaints in a sample of 68 undergraduate women (Mean age = 19.44). Participants self-reported CFS and health complaints. Parasympathetic activity was indexed using high-frequency heart rate variability (HF-HRV) and was evaluated by measuring changes in HF-HRV in response to and following a laboratory-based stress induction. Multiple regression analyses indicated that CFS was significantly associated with more health complaints. Further, HF-HRV in response to stress and during recovery relative to baseline significantly moderated relationship between CFS and health complaints. Specifically, more CFS was significantly associated with more health complaints among women who showed mean or greater decreases in HF-HRV in response to stress. Additionally, lower levels of CFS were associated with fewer health complaints among women who showed mean or greater HF-HRV during recovery relative to baseline. Findings highlight the importance of parasympathetic activity in modulating stress-health links.

Adjuvant Treatment with Celecoxib after Collagenase Injection for Dupuytren Contracture: A Double-Blind Randomised Controlled Trial.

Background: In patients with a high recurrence risk after treatment for Dupuytren contracture (DC) by Collagenase Clostridium histolyticum (CCH), adjuvant medical therapy may improve the outcome. Non-steroidal anti-inflammatory drugs have been used in the treatment of similar fibroproliferative processes. The aim of this study was to investigate if adjuvant anti-inflammatory medication could improve the outcome of CCH treatment for DC. Methods: In a prospective double blinded randomised trial, the effect of adjuvant peroral celecoxib on the outcome of DC treated with CCH was investigated in 32 patients with a high fibrosis diathesis. Primary outcome was the increase in Total Passive Extension Deficit (TPED)/ray. Secondary outcomes were the TPED of the individual finger joints, Tubiana index, Disability of Arm, Shoulder and Hand score (DASH) and visual analogue scale (VAS) for pain and satisfaction. Results: A significantly greater improvement in the celecoxib group for TPED and metacarpophalangeal contracture was found. For the proximal interphalangeal joint, the effect was much less pronounced. The VAS for pain and satisfaction were better at 6 and 12 weeks in the celecoxib group. The other outcome parameters did not significantly differ between both groups. Conclusions: Adjuvant peroral administration of celecoxib might improve the gain in TPED after treatment with CCH in patients with DC and a high fibrosis diathesis, with a beneficial effect up to 24 months. Level of Evidence: Level II (Therapeutic).

A new framework for understanding stress and disease: the developmental model of stress as applied to multiple sclerosis.

This paper proposes a new model of stress that integrates earlier models and adds insights from developmental psychology. Previous models describe the behavioral and physical effects of stress events, but have not explained the translation of experiences into stress itself. The Developmental Model of Stress shows how psychosocial developmental challenges in childhood create persistent negative beliefs and behaviors that increase threat perception and maladaptive stress responses. These developmental challenges produce early psychological and physiological predispositions for increased stress responses over time. Ongoing stress leads to dysregulation of physical stress-response systems (allostatic load), which is associated with multiple diseases. High allostatic load provides the necessary preconditions for the diathesis-stress model, which says the addition of an acute stressor to a weakened or predisposed system can lead to disease development. The paper also documents the evolving measurement of stress to better understand the stress-disease relationship, helping to resolve conflicting results between studies. The Developmental Model of Stress was combined with clinician insight and patient reports to build an integrative framework for understanding the role of stress in the development and progression of multiple sclerosis (MS). It includes the first mapping of maladaptive beliefs and behaviors arising from developmental challenges that are common to people with MS. An initial comparison shows these may be distinct from those of people with other chronic diseases. These beliefs and behaviors form the predisposing factors and contribute to the triggering factors, which are the acute stressors triggering disease onset. These often took two forms, a prolonged incident experienced as feeling trapped or stuck, and threat of a breach in a relationship. The reinforcing factors add the stress of a chronic disease with a poor prognosis and seemingly random symptom fluctuation, still managed with the same beliefs and behaviors developed in childhood, increasing physiological dysregulation and symptom severity. A pilot study is described in which these three categories of stress factors in MS were explicitly addressed. This study noted clinically important improvements in physical and mental well-being, providing preliminary support for the Developmental Model. Future research might expand on the pilot using a more robust sample and design.

Polygene by environment interactions predicting depressive outcomes.

Depression is a major public health problem with a continued need to uncover its etiology. Current models of depression contend that gene-by-environment (G × E) interactions influence depression risk, and further, that depression is polygenic. Thus, recent models have emphasized two polygenic approaches: a hypothesis-driven multilocus genetic profile score (MGPS; "MGPS × E") and a polygenic risk score (PRS; "PRS × E") derived from genome-wide association studies (GWAS). This review for the first time synthesizes current knowledge on polygene by environment "P × E" interaction research predicting primarily depression-related outcomes, and in brief, neurobiological outcomes. The "environment" of focus in this project is stressful life events. It further discusses findings in the context of differential susceptibility and diathesis-stress theories-two major theories guiding G × E work. This synthesis indicates that, within the MGPS literature, polygenic scores based on the serotonin system, the HPA axis, or across multiple systems, interact with environmental stress exposure to predict outcomes at multiple levels of analyses and most consistently align with differential susceptibility theory. Depressive outcomes are the most studied, but neuroendocrine, and neuroimaging findings are observed as well. By contrast, vast methodological differences between GWAS-based PRS studies contribute to mixed findings that yield inconclusive results.

Netherton Syndrome in Thai Children: A Report of Two Cases With a Literature Review.

Netherton syndrome (NS) is a severe autosomal recessive disorder characterized by the triad of congenital ichthyosiform erythroderma, trichorrhexis invaginata, and atopic diathesis. We report two cases that experienced severe congenital exfoliative dermatitis, recurrent infections, and allergic conditions. Examinations of hair under the light microscope revealed trichorrhexis invaginata. Whole exome sequencing identified homologous pathogenic mutations of SPINK5. Optimal skincare and proper nutritional support could improve patients' quality of life.

Characteristic Skin Eruptions with a Distinct Histological Pattern Allow Early Diagnosis of Vitamin C Deficiency.

Introduction: Scurvy has become a rare disease in western countries with potentially high morbidity. Early diagnosis is crucial and can be challenging. Case Presentation: We present the case of a 56-year-old male patient who developed hemorrhagic diathesis after trivial impact trauma. Previously, the patient suffered from fatigue and loss of appetite. Characteristic skin eruptions and a distinct skin histology along with a decreased serum vitamin C level led to the diagnosis of scurvy. Following vitamin C supplementation, symptoms improved rapidly. Conclusion: In conclusion, vitamin C deficiency should be considered in cases with unclear hemorrhagic diathesis and a medical history of nutritional irregularities. Especially in cases of scurvy that do not yet show the full clinical spectrum of symptoms or have only moderately decreased serum vitamin C levels, thorough clinical dermatological examination and a skin biopsy are essential for early diagnosis and to prevent complications.

Gene-environment interaction between gaming addiction and perceived stress in late adolescents and young adults: A twin study.

Background and aims: The association between perceived stress (PS) and gaming addiction (GA) is well documented. However, the mechanism for explaining this association remains unclear. Using a genetically informative design, this study aims to distinguish between the diathesis-stress and bio-ecological models of gene by environment interaction (G x E) to explain the underlying mechanism of the relationship. Methods: In total, 1,468 twins (mean age = 22.6 ± 2.8 years) completed an online survey including the GA and PS scales. Twin correlations for GA and PS were computed and univariate model-fitting analysis was conducted to determine genetic and environmental influences on GA and PS. The bivariate G x E model-fitting analysis was performed to determine the best G x E interaction model. Results: Additive genetic, shared environmental, and non-shared environmental effects were 0.70 (95%CI = 0.61, 0.77), 0.00, and 0.30 (95%CI = 0.26, 0.33), and 0.38 (95%CI = 0.24, 0.55), 0.35 (95% CI = 0.18, 0.51), and 0.22 (95%CI = 0.20, 0.26) for GA and PS, respectively. Bivariate G x E model-fitting analysis supported the diathesis-stress model, where genetic influences on GA were greater in higher levels of PS, whereas environmental influences on GA were small and constant across levels of PS. Discussion and conclusions: The evidence for the diathesis-stress model for GA is consistent with the etiological process of many forms of psychopathology. The findings should be incorporated in clinical settings to improve the treatment of GA, and used in developments of intervention and prevention methods for GA.

Genetic screening reveals hotspot variants and prevalence rates of Hermansky-Pudlak syndrome in the Chinese population.

BACKGROUND: Hermansky-Pudlak Syndrome (HPS) is a rare autosomal recessive genetic disorder associated with varied clinical manifestations, including oculocutaneous albinism, bleeding tendency, and systemic complications. Early and accurate diagnosis is crucial for medical interventions and genetic counseling. We aimed to characterize the prevalence and spectrum of pathogenic variants of HPS in the Chinese population through genetic screening of newborns. METHODS: Genetic screening for HPS mutations was conducted in 29,622 Chinese newborns from 13 provinces using next-generation sequencing. Pathogenic variants were identified and classified according to ACMG guidelines. Prevalence rates were estimated, and potential hotspot variants were identified. RESULTS: Among screened newborns, 215 carriers with 103 distinct pathogenic variants were identified, including two carriers with additional missense variants. Potential hotspot variants in seven genes were identified, collectively representing over 20 % of carriers in each respective gene. Particularly, the HPS3 c.1838C>G variant was exclusively reported in the Chinese population, suggesting a potential founder effect. The estimated prevalence rate of HPS in China was 2.84/1,000,000. CONCLUSION: Our study provides valuable insights into the genetic landscape of HPS in the Chinese population, aiding in genetic counseling, early diagnosis, and management strategies. These findings contribute to enhancing the understanding and management of HPS in China.

Stress and depression among male police officers in Taiwan: Severity, determinants, and coping strategies.

BACKGROUND: Police work, known for its high stress, exhibits elevated depression rates. OBJECTIVE: This study explores stress and depression in male officers, examining personality traits, coping strategies, family, and social support. Aligned with the diathesis-stress hypothesis and job demands-resources model, it aims to illuminate these factors in policing. METHODS: Two hundred and sixty-four male police officers from Yunlin, Taiwan were enrolled in this study. Structured measurements of stress level, depression symptoms, personality traits, family functioning, and social support were made. We used multiple regression analysis to assess predictors of stress level and depression and identified coping strategies used by the police officers. RESULTS: Of the 264 male police officers, 36.4% had clinically significant depression. Occupational stress was mostly related to organizational factors. Multivariate regression analyses showed that age, personality traits, officer's rank, and period of education obtained could predict police officers' occupational stress. Personality traits, social support, occupational stress, and period of education obtained could predict depression. The most frequently used coping strategies were drinking and smoking. CONCLUSIONS: The results of our study support the diathesis-stress hypothesis and the job demands-resources model. Enhancing male police officers' mental well-being requires addressing key factors like social support and occupational stress. Strategic measures, such as mental health education, destigmatization, counseling, and community-building, are vital. Policymakers should collaborate with mental health professionals for tailored interventions, fostering a healthier work environment.

A Bayesian approach for exploring person × environment interaction within the environmental sensitivity meta-framework.

BACKGROUND: For investigating the individual-environment interplay and individual differences in response to environmental exposures as captured by models of environmental sensitivity including Diathesis-stress, Differential Susceptibility, and Vantage Sensitivity, over the last few years, a series of statistical guidelines have been proposed. However, available solutions suffer of computational problems especially relevant when sample size is not sufficiently large, a common condition in observational and clinical studies. METHOD: In the current contribution, we propose a Bayesian solution for estimating interaction parameters via Monte Carlo Markov Chains (MCMC), adapting Widaman et al. (Psychological Methods, 17, 2012, 615) Nonlinear Least Squares (NLS) approach. RESULTS: Findings from an applied exemplification and a simulation study showed that with relatively big samples both MCMC and NLS estimates converged on the same results. Conversely, MCMC clearly outperformed NLS, resolving estimation problems and providing more accurate estimates, particularly with small samples and greater residual variance. CONCLUSIONS: As the body of research exploring the interplay between individual and environmental variables grows, enabling predictions regarding the form of interaction and the extent of effects, the Bayesian approach could emerge as a feasible and readily applicable solution to numerous computational challenges inherent in existing frequentist methods. This approach holds promise for enhancing the trustworthiness of research outcomes, thereby impacting clinical and applied understanding.

Receptive and expressive vocabulary performance in 2- to 5-year-olds in care: The role of different care types and temperament.

The detrimental role of institutionalization in children's development has prompted the introduction of alternative care types designed to offer more personalized care. The current study aimed to test whether children in alternative care types (care villages, care homes, and foster care) performed better on vocabulary than those in institutions. The role of temperament, specifically perceptual sensitivity and frustration, and the interaction between temperament and care types on vocabulary performance were also explored. The study involved 285 2- to 5-year-old children from different care types, and they were assessed through receptive and expressive vocabulary tests and temperament scales. The results of the linear mixed model revealed that children in alternative care types exhibited significantly higher vocabulary scores compared with those in institutions. Moreover, perceptual sensitivity showed a positive association with receptive and expressive vocabulary skills and seemed to act as a protective factor by mitigating the lower vocabulary scores in institutions. Frustration moderated vocabulary outcomes differently for children in institutions and foster care, aligning with the diathesis-stress model and vantage sensitivity theory, respectively. The findings emphasize the positive role of alternative care types in vocabulary performance and the importance of children's temperamental traits in this process.

Increased diameter and stiffness of elastic but not muscular arteries in men with abdominal aortic aneurysm.

It has been proposed that formation of abdominal aortic aneurysm (AAA) is part of a systemic arterial dilatative disease. However, arteries in the upper extremities are scarcely studied and it remains unclear whether both muscular and elastic arteries are affected by the proposed systemic arterial dilatation. The aim of this study was to investigate the diameter and stiffness of muscular and elastic arteries in arterial branches originating from the aortic arch. Twenty-six men with AAA (69 ± 4 yr) and 57 men without AAA (70 ± 5 yr) were included in the study. Ultrasound was used to examine the distal and proximal brachial artery, axillary artery, and common carotid artery (CCA), and measurement of diameter and diameter change was performed with wall-tracking software. Blood pressure measurements were used to calculate local arterial wall stiffness indices. The AAA cohort presented larger arterial diameters in the CCA and axillary artery after adjustment for body surface area (P = 0.002, respectively), whereas the brachial artery diameters were unchanged. Indices of increased stiffness in CCA (e.g., lower distensibility, P = 0.003) were seen in subjects with AAA after adjustments for body mass index and mean arterial blood pressure. This study supports the theory of a systemic arterial dilating diathesis in peripheral elastic, but not in muscular, arteries. Peripheral elastic arteries also exhibited increased stiffness, in analogy with findings in the aorta in AAA.NEW & NOTEWORTHY We present data partially supporting the notion of abdominal aortic aneurysm being a systemic vascular disease with focal manifestation in the abdominal aorta, from two well-defined groups recruited from a regional screening program. We show that elastic arteries distal from the aorta exhibit vascular alterations without aneurysmal formation in subjects with AAA compared with controls while muscular arteries seem unaffected.

The double jeopardy of low family income and negative emotionality: The family stress model revisited.

The family stress model has, for decades, guided empirical work linking poverty with increased risk of child social-emotional dysfunction. The present study extends this line of work by examining whether child negative emotionality moderates associations between family income, family stress (maternal distress, parental locus of control, and relationship dissatisfaction), and later externalizing and internalizing behavior problems. In a longitudinal population-based sample (n ~ 80,000) of Norwegian children followed from birth through age five (The Norwegian Mother, Father, and Child Cohort Study; MoBa), we examined whether high (vs. moderate or low) negative emotionality families would display: (a) compounding stress (i.e., particularly strong associations between low family income and family stress), (b) diathesis-stress (i.e., particularly strong associations between family stress and behavior problems), or (c) double jeopardy (i.e., both compounding stress and diathesis-stress moderating effects). Negative emotionality significantly moderated the association between family income and behavior problems in a manner most consistent with double jeopardy. As a result, compared with children with moderate/low negative emotionality, the family income-behavior problems association was two to three times larger for those with higher negative emotionality. These findings underscore the active role children may play in family processes that link low family income with behavior problems.

A longitudinal investigation of caregiving and adolescent post-traumatic stress symptoms during COVID-19: evidence for high resting RSA as a susceptibility factor.

BACKGROUND: Post-traumatic stress symptoms (PTSS) were the most frequently reported mental health concern for youth during COVID-19, yet variations in youth's PTSS responses warrant empirical consideration. Features of the caregiving environment influence youth's responses to environmental stressors, and youth's parasympathetic nervous system regulation may qualify the magnitude and/or direction of these effects. This prospective investigation evaluated diathesis stress and differential susceptibility models of caregiving and parasympathetic influences on youth's PTSS responses to COVID-19. METHOD: Participants were 225 caregiver-youth dyads (youth 49.8% female at birth; 88.4% non-white) followed from childhood through adolescence and COVID-19. Youth's resting respiratory sinus arrhythmia (RSA; Mage = 6.11, s.d. = 0.21), caregiving features (i.e. attachment security [youth Mage = 12.24, s.d. = 0.35] and caregiver internalizing psychopathology [caregiver Mage = 39.29, s.d. = 6.78]) were assessed pre-pandemic. Youth's PTSS was assessed one year prior to the US COVID-19 pandemic (Mage = 14.24, s.d. = 0.50) and during the spring of 2020 at the height of the pandemic (Mage = 15.23, s.d. = 0.57). RESULTS: Youth's PTSS increased during COVID-19. Youth with relatively high resting RSA evidenced the lowest PTSS when their caregiving environment featured high attachment security or low caregiver internalizing problems, but the highest PTSS when their caregiving environment featured low attachment security or high caregiver internalizing problems. In contrast, PTSS levels of youth with relatively low or average resting RSA did not differ significantly depending on attachment security or caregiver internalizing. CONCLUSIONS: Results are consistent with a differential susceptibility hypothesis, wherein relatively high resting RSA conferred heightened sensitivity to caregiving environments in a for-better-and-for-worse manner during COVID-19.

Pre-COVID respiratory sinus arrhythmia moderates associations between COVID-19 stress and child externalizing behaviors: Testing neurobiological stress theories.

Exposure to stress related to the COVID-19 pandemic contributes to psychopathology risk, yet not all children are negatively impacted. The current study examined a parasympathetic biomarker of stress sensitivity, respiratory sinus arrhythmia (RSA), as a moderator of the effects of exposure to pandemic stress on child internalizing and externalizing behaviors in a sample of children experiencing economic marginalization. Three to five years pre-pandemic, when children were preschool-aged, RSA during baseline and a challenging parent-child interaction were collected. Mid-pandemic, between November 2020 and March 2021, children's exposure to pandemic stress and internalizing and externalizing behaviors were collected. Results demonstrated that children who, pre-pandemic, demonstrated blunted parasympathetic reactivity (i.e., no change in RSA relative to baseline) during the dyadic challenge exhibited elevated risk for externalizing behaviors mid-pandemic. Further, this risk was greatest for children exposed to high and moderate levels of pandemic stress. Consistent with diathesis stress and polyvagal frameworks, these conditional effects suggest that blunted parasympathetic reactivity in response to stress in early childhood may escalate the development of externalizing behaviors following stress exposure at school age.

Prognosis and risk of suicide after cancer diagnosis.

INTRODUCTION: Suicide rates are elevated after cancer diagnosis. Existential distress caused by awareness of one's impending death is well-described in patients with cancer. The authors hypothesized that suicide risk is associated with cancer prognosis, and the impact of prognosis on suicide risk is greatest for populations with higher baseline suicide risk. METHODS: The authors identified patients (≥16 years old) with newly diagnosed cancers from 2000 to 2019 in the Surveillance, Epidemiology, and End Results database, representing 27% of US cancers. Multiple primary-standardized mortality ratios (SMR) were used to estimate the relative risk of suicide within 6 months of diagnosis compared to the general US population, adjusted for age, sex, race, and year of follow-up. Suicide rates by 20 most common cancer sites were compared with respective 2-year overall survival rates (i.e., prognosis) using a weighted linear regression model. RESULTS: Among 6,754,704 persons diagnosed with cancer, there were 1610 suicide deaths within 6 months of diagnosis, three times higher than the general population (SMR = 3.1; 95% confidence interval, 3.0-3.3). Suicide risk by cancer site was closely associated with overall prognosis (9.5%/percent survival deficit, R2  = 0.88, p < .0001). The association of prognosis with suicide risk became attenuated over time. For men, the risk of suicide increased by 2.8 suicide deaths per 100,000 person-years (p < .0001) versus 0.3 in women (p < .0001). The risk was also higher for persons ≥60 old and for the White (vs. Black) race. CONCLUSIONS: Poorer prognosis was closely associated with suicide risk early after cancer diagnosis and had a greater effect on populations with higher baseline risks of suicide. This model highlights the need for enhanced psychiatric surveillance and continued research in this patient population.

The Role of Attachment, Insecurity, and Stress in Partner Maltreatment: A Meta-Analysis.

Negative, destructive, and abusive behaviors in romantic relationships can vary from explicit kinds of abuse and aggression to more subtle and seemingly innocuous slights against or ways of treating a partner. However, regardless of the severity or explicit nature, these behaviors all, to one extent or another, reflect acts of invalidation, disrespect, aggression, or neglect toward a partner, and could be considered maltreatment of a partner. The current paper proposes the term partner maltreatment as a broad overarching concept, which was used to facilitate a meta-analytic synthesis of the literature to examine the associations between attachment insecurity (i.e., attachment anxiety, attachment avoidance) and perpetration of partner maltreatment. Additionally, this paper situated partner maltreatment within an attachment-based diathesis-stress perspective to explore the moderating role of stress. Five databases were systematically searched for published and unpublished studies that examined the direct association between perpetrator's adult attachment orientation and perpetration of partner maltreatment behaviors. We synthesized effect sizes from 139 studies (N = 38,472) and found the effect between attachment insecurity and acts of partner maltreatment varied between r = .11 to .21. Our findings provide meta-analytic evidence to suggest that attachment insecurity is a significant individual vulnerability factor (diathesis) associated with partner maltreatment; and that when individuals with an insecure attachment orientation experience stress, the tendency to perpetrate partner maltreatment is typically heightened. The findings of this meta-analysis provide empirical evidence for the importance of considering and addressing contextual factors, especially stress, for those individuals and couples seeking therapy for partner maltreatment.