The relationship between physical activity, BMI, circadian rhythm, and sleep with cognition in bipolar disorder.

BACKGROUND: Cognitive deficits affect a significant proportion of patients with bipolar disorder (BD). Problems with sustained attention have been found independent of mood state and the causes are unclear. We aimed to investigate whether physical parameters such as activity levels, sleep, and body mass index (BMI) may be contributing factors. METHODS: Forty-six patients with BD and 42 controls completed a battery of neuropsychological tests and wore a triaxial accelerometer for 21 days which collected information on physical activity, sleep, and circadian rhythm. Ex-Gaussian analyses were used to characterise reaction time distributions. We used hierarchical regression analyses to examine whether physical activity, BMI, circadian rhythm, and sleep predicted variance in the performance of cognitive tasks. RESULTS: Neither physical activity, BMI, nor circadian rhythm predicted significant variance on any of the cognitive tasks. However, the presence of a sleep abnormality significantly predicted a higher intra-individual variability of the reaction time distributions on the Attention Network Task. CONCLUSIONS: This study suggests that there is an association between sleep abnormalities and cognition in BD, with little or no relationship with physical activity, BMI, and circadian rhythm.

Commentary: Bringing together lived experience, clinical and research expertise - a commentary on the May 2022 debate (should CAMH professionals be diagnosing personality disorder in adolescence?).

BACKGROUND: There is a wealth of evidence to suggest that the Borderline Personality Disorder (BPD, or similar Emotionally Unstable Personality Disorder, EUPD) construct is harmful. We provide a commentary on the ideas expressed in the May Debate issue, highlighting both concerns and alternatives. METHOD: We bring together lived experience, clinical and research expertise. This commentary was written collaboratively drawing on all these sources of evidence. RESULTS: We outline evidence that the BPD construct is invalid, harmful, not necessary for effective treatment and a potential block to the development and evaluation of alternatives. CONCLUSIONS: We ask readers to consider these concerns, perspectives and ideas.

Risk of late-preterm stillbirth and neonatal morbidity for monochorionic and dichorionic twins.

OBJECTIVE: The purpose of this study was to determine the prospective risk of intrauterine fetal death (IUFD) at ≥34 weeks' gestation for monochorionic and dichorionic twins receiving intensive antenatal fetal surveillance. The secondary objective was to calculate the incidence of prematurity-related neonatal morbidity/mortality rates that have been stratified by gestational week and chorionicity. STUDY DESIGN: A retrospective cohort study of all twins at ≥34 weeks' gestation who were delivered at the Medical University of South Carolina (1987-2010) was performed. Twins were cared for in a longstanding Twin Clinic with standardized treatment and surveillance protocols and supervised by a consistent Maternal-Fetal Medicine specialist. Gestational age-specific fetal/neonatal mortality rates and composite neonatal morbidity rates were compared by chorionicity. A generalized linear mixed model was used to identify variables that were associated with increased composite neonatal morbidity. RESULTS: Among 768 twin gestations (601 dichorionic and 167 monochorionic), only 1 dichorionic IUFD occurred. The prospective risk of IUFD at ≥34 weeks' gestation was 0.17% for dichorionic twins and 0% for monochorionic twins. Composite neonatal morbidity decreased with each gestational week (P < .0001). Morbidity was increased by white race, gestational diabetes mellitus, and elective indication for delivery. The nadir of composite neonatal morbidity occurred at 36/0-36/6 weeks' gestation for monochorionic twins and 37/0-37/6 weeks' gestation for dichorionic twins. CONCLUSION: Our data do not support concern for an increased risk of stillbirth in uncomplicated intensively monitored monochorionic twins at ≥34 weeks' gestation. However, our data do show significantly increased rates of neonatal morbidity in late preterm monochorionic twins that cannot be justified by a corresponding reduction in the risk of stillbirth. We believe that our data support delivery of uncomplicated monochorionic twins at 37 weeks' gestation.

Retrospective cohort follow-up study of individuals detained under Section 136.

BACKGROUND: An original cohort study found that over half of the individuals detained under Section 136 (S136) of the Mental Health Act 1983 were discharged home after assessment, and nearly half were intoxicated. AIMS: To investigate whether the cohort was followed up by psychiatric services, characterise those repeatedly detained and assess whether substance use was related to these outcomes. METHOD: Data were retrospectively collected from the notes of 242 individuals, who presented after S136 detention to a place of safety over a 6-month period, and were followed up for 1 year. RESULTS: After 1 year, 48% were in secondary care. Those with psychosis were the most likely to be admitted. Diagnoses of personality disorder or substance use were associated with multiple detentions; however, few were in contact with secondary services. CONCLUSIONS: Crisis and long-term care pathways for these groups need to be developed to reduce repeated and unnecessary police detention. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Modifying cognitive errors promotes cognitive well being: a new approach to bias modification.

BACKGROUND: Cognitive Bias Modification (CBM) procedures have been used to train individuals to interpret ambiguous information in a negative or benign direction and have provided evidence that negative biases causally contribute to emotional vulnerability. METHOD: Here we present the development and validation of a new form of CBM designed to manipulate the cognitive errors known to characterize both depression and anxiety. Our manipulation was designed to modify the biased cognitions identified by Beck's cognitive error categories (e.g. arbitrary inference, overgeneralisation) and typically targeted during therapy. RESULTS: In a later test of spontaneous inferences, unselected (Experiment 1) and vulnerable participants (Experiment 2) who had generated positive alternatives rather than errors perceived novel hypothetical events, their causes and outcomes in a non-distorted manner. These groups were also less vulnerable to two different types of emotional stressor (video clips; and an imagined social situation). Furthermore participants' interpretation of their own performance on a problem-solving task was improved by the manipulation, despite actual performance showing no significant change. CONCLUSIONS: These findings demonstrate that Cognitive Error Modification can promote positive inferences, reduce vulnerability to stress and improve self-perceptions of performance.