Associations between childhood adversity, psychiatric symptoms, and self-esteem outcomes in adolescents and young adults: An experience sampling study.

OBJECTIVES: Self-esteem and self-esteem stability are important factors during adolescence and young adulthood that can be negatively impacted by childhood adversity and psychiatric symptoms. We examined whether childhood adversity and psychiatric symptoms are associated with decreased global self-esteem as well as increased self-esteem instability as measured with experience sampling method. In addition, we examined if childhood adversity moderates the association between psychiatric symptoms and self-esteem outcomes. METHODS: Our study consisted of 788 adolescents and young adults who were part of a twin pair. The twin structure was not of interest to the current study. Mean age was 16.8 (SD = 2.38, range: 14-25), 42% was male. We used a multilevel modeling approach to examine our hypotheses to account for the presence of twins in the data set. RESULTS: Childhood adversity and psychiatric symptoms were negatively associated with global self-esteem (respectively standardized ß = -.18, SE = 0.04, p < .0001 and standardized ß = -.45, SE = 0.04, p < .0001), with a larger effect for psychiatric symptoms. Similarly, both were associated with increased self-esteem instability (respectively standardized ß = .076, SE = 0.025, p = .002 and standardized ß = .11, SE = 0.021, p < .0001). In addition, interactions between childhood adversity and psychiatric symptoms on both global self-esteem (standardized ß = .06, SE = 0.01, p < .0001) and self-esteem instability (standardized ß = -.002, SE = 0.0006, p = .001) were found, showing that the negative association of psychiatric symptoms with self-esteem outcomes is less pronounced in young people with higher levels of childhood adversity, or formulated differently, is more pronounced in young people with little or no exposure to childhood adversity. CONCLUSION: Global self-esteem and self-esteem instability in young people are influenced by both current psychiatric symptomatology and exposure to childhood adversity. Those with more psychiatric symptoms show worse self-esteem and higher self-esteem instability, which is moderated by childhood adversity. For young people with high childhood adversity levels lower self-esteem and higher self-esteem instability are less influenced by reductions in psychiatric symptoms.

Gender differences in the associations between childhood adversity and psychopathology in the general population.

PURPOSE: To explore gender differences of the associations between childhood adversity (CA) subtypes and psychiatric symptoms in the general population. METHODS: Data of 791 participants were retrieved from a general population twin cohort. The Symptom Checklist-90 Revised (SCL-90) and the Childhood Trauma Questionnaire were used to assess overall psychopathology with nine symptom domains scores and total CA with exposure to five CA subtypes, respectively. The associations between CA and psychopathology were analyzed in men and women separately and were subsequently compared. RESULTS: Total CA was associated with total SCL-90 and all symptom domains without significant gender differences. However, the analyses of CA subtypes showed that the association between emotional abuse and total SCL-90 was stronger in women compared to men [χ2(1) = 4.10, P = 0.043]. Sexual abuse was significantly associated with total SCL-90 in women, but emotional neglect and physical neglect were associated with total SCL-90 in men. Exploratory analyses of CA subtypes and SCL-90 subdomains confirmed the pattern of gender-specific associations. In women, emotional abuse was associated with all symptom domains, and sexual abuse was associated with all except phobic anxiety and interpersonal sensitivity. In men, emotional neglect was associated with depression, and physical neglect was associated with phobic anxiety, anxiety, interpersonal sensitivity, obsessive-compulsive, paranoid ideation, and hostility subdomains. CONCLUSION: CA is a trans-syndromal risk factor regardless of gender. However, differential associations between CA subtypes and symptom manifestation might exist. Abuse might be particularly associated with psychopathology in women, whereas neglect might be associated with psychopathology in men.

Coping and sleep quality in youth: An Experience Sampling study.

INTRODUCTION: Sleep quality is closely linked with mental health. Two factors that influence sleep are coping style and locus of control, yet these have not been investigated in daily life. In this study, we examined associations between coping styles and sleep quality in daily life and the potential mediating effect of daily locus of control in a sample of youth, a group particularly vulnerable to developing psychopathology. METHODS: Three hundred and seventy-nine youths from the TwinssCan study participated in an Experience Sampling study, assessing sleep quality as well as state locus of control over the most negative event from the previous day. Participants also completed the Utrecht Coping List, which assessed engagement, disengagement, and emotion-focused coping. RESULTS: Disengagement, "passive reaction," and emotion-focused coping were associated with lower daily sleep quality. State locus of control did not mediate any effects of coping styles on quality of sleep. CONCLUSIONS: Disengagement, "passive reaction," and emotion-focused coping were associated with decreased sleep quality during several consecutive days, which may put youths at risk for developing future insomnia, and strain their mental well-being over time. Thus, there may be value in asking about coping when a young individual presents with sleep problems; however, impaired coping when sleeping poorly should also be considered.

Major depressive disorder: a possible typisation according to serotonin, inflammation, and metabolic syndrome.

OBJECTIVE: Major depressive disorder (MDD) is closely related to obesity, inflammation, and insulin resistance, all together being etiologically linked to metabolic syndrome (MetS) development. The depressive disorder has a neuroendocrinological component, co-influencing the MetS, while MetS is characterised by increased cytokine levels, which are known to cause a depressed mood. This study aimed to establish biological subtypes of the depressive disorder based on researched clinical, laboratory, and anthropometric variables. METHODS: We performed a cross-sectional study on a sample of 293 subjects (145 suffering from a depressive disorder and 148 healthy controls). Results were analysed with multivariate statistical methods as well as with cluster and discriminant analysis. In order to classify depressive disorder on the grounds of laboratory, anthropometric, and clinical parameters, we performed cluster analysis, which resulted in three clusters. RESULTS: The first cluster is characterised by low platelet serotonin, high cortisol levels, high blood glucose levels, high triglycerides levels, high Hamilton Depression Rating Scale score, high waist circumference, high C-Reactive Protein values, and a high number of previous depressive episodes, was named Combined (Metabolic) depression. The inflammatory depression cluster is defined with average platelet serotonin values, normal cortisol, and all other parameter levels, except for increased IL-6 levels. The serotoninergic depression cluster is characterised by markedly low platelet serotonin, and all other parameters are within the normal range. CONCLUSIONS: From a biological point of view, depressive disorder is not uniform, and as such, these findings suggest potential clinically useful and generalisable biological subtypes of depressive disorder.

Measuring resilience prospectively as the speed of affect recovery in daily life: a complex systems perspective on mental health.

INTRODUCTION: There is growing evidence that mental disorders behave like complex dynamic systems. Complex dynamic systems theory states that a slower recovery from small perturbations indicates a loss of resilience of a system. This study is the first to test whether the speed of recovery of affect states from small daily life perturbations predicts changes in psychopathological symptoms over 1 year in a group of adolescents at increased risk for mental disorders. METHODS: We used data from 157 adolescents from the TWINSSCAN study. Course of psychopathology was operationalized as the 1-year change in the Symptom Checklist-90 sum score. Two groups were defined: one with stable and one with increasing symptom levels. Time-series data on momentary daily affect and daily unpleasant events were collected 10 times a day for 6 days at baseline. We modeled the time-lagged effect of daily unpleasant events on negative and positive affect after each unpleasant event experienced, to examine at which time point the impact of the events is no longer detectable. RESULTS: There was a significant difference between groups in the effect of unpleasant events on negative affect 90 min after the events were reported. Stratified by group, in the Increase group, the effect of unpleasant events on both negative (B = 0.05, p < 0.01) and positive affect (B = - 0. 08, p < 0.01) was still detectable 90 min after the events, whereas in the Stable group this was not the case. CONCLUSION: Findings cautiously suggest that adolescents who develop more symptoms in the following year may display a slower affect recovery from daily perturbations at baseline. This supports the notion that mental health may behave according to the laws of a complex dynamic system. Future research needs to examine whether these dynamic indicators of system resilience may prove valuable for personalized risk assessment in this field.

Early warning signals in psychopathology: what do they tell?

BACKGROUND: Despite the increasing understanding of factors that might underlie psychiatric disorders, prospectively detecting shifts from a healthy towards a symptomatic state has remained unattainable. A complex systems perspective on psychopathology implies that such symptom shifts may be foreseen by generic indicators of instability, or early warning signals (EWS). EWS include, for instance, increasing variability, covariance, and autocorrelation in momentary affective states-of which the latter was studied. The present study investigated if EWS predict (i) future worsening of symptoms as well as (ii) the type of symptoms that will develop, meaning that the association between EWS and future symptom shifts would be most pronounced for congruent affective states and psychopathological domains (e.g., feeling down and depression). METHODS: A registered general population cohort of adolescents (mean age 18 years, 36% male) provided ten daily ratings of their affective states for 6 consecutive days. The resulting time series were used to compute EWS in feeling down, listless, anxious, not relaxed, insecure, suspicious, and unwell. At baseline and 1-year follow-up, symptom severity was assessed by the Symptom Checklist-90 (SCL-90). We selected four subsamples of participants who reported an increase in one of the following SCL-90 domains: depression (N = 180), anxiety (N = 192), interpersonal sensitivity (N = 184), or somatic complaints (N = 166). RESULTS: Multilevel models showed that EWS in feeling suspicious anticipated increases in interpersonal sensitivity, as hypothesized. EWS were absent for other domains. While the association between EWS and symptom increases was restricted to the interpersonal sensitivity domain, post hoc analyses showed that symptom severity at baseline was related to heightened autocorrelations in congruent affective states for interpersonal sensitivity, depression, and anxiety. This pattern replicated in a second, independent dataset. CONCLUSIONS: The presence of EWS prior to symptom shifts may depend on the dynamics of the psychopathological domain under consideration: for depression, EWS may manifest only several weeks prior to a shift, while for interpersonal sensitivity, EWS may already occur 1 year in advance. Intensive longitudinal designs where EWS and symptoms are assessed in real-time are required in order to determine at what timescale and for what type of domain EWS are most informative of future psychopathology.

TwinssCan - Gene-Environment Interaction in Psychotic and Depressive Intermediate Phenotypes: Risk and Protective Factors in a General Population Twin Sample.

Meta-analyses suggest that clinical psychopathology is preceded by dimensional behavioral and cognitive phenotypes such as psychotic experiences, executive functioning, working memory and affective dysregulation that are determined by the interplay between genetic and nongenetic factors contributing to the severity of psychopathology. The liability to mental ill health can be psychometrically measured using experimental paradigms that assess neurocognitive processes such as salience attribution, sensitivity to social defeat and reward sensitivity. Here, we describe the TwinssCan, a longitudinal general population twin cohort, which comprises 1202 individuals (796 adolescent/young adult twins, 43 siblings and 363 parents) at baseline. The TwinssCan is part of the European Network of National Networks studying Gene-Environment Interactions in Schizophrenia project and recruited from the East Flanders Prospective Twin Survey. The main objective of this project is to understand psychopathology by evaluating the contribution of genetic and nongenetic factors on subclinical expressions of dimensional phenotypes at a young age before the onset of disorder and their association with neurocognitive processes, such as salience attribution, sensitivity to social defeat and reward sensitivity.

Evidence for interaction between genetic liability and childhood trauma in the development of psychotic symptoms.

PURPOSE: Whilst childhood trauma (CT) is a known risk factor across the spectrum of psychosis expression, little is known about possible interplay with genetic liability. METHODS: The TwinssCan Study collected data in general population twins, focussing on expression of psychosis at the level of subthreshold psychotic experiences. A multilevel mixed-effects linear regression analysis was performed including 745 subjects to assess the interaction between genetic liability and CT. The Symptom Checklist-90 (SCL-90-R) score of the co-twin was used as an indirect measure of genetic liability to psychopathology, while the Childhood Trauma Questionnaire Short-Form (CTQ-SF) was used to assess CT in the domains of physical, emotional and sexual abuse, as well as physical and emotional neglect. The Community Assessment of Psychic Experience (CAPE) questionnaire was used to phenotypically characterize psychosis expression. RESULTS: In the model using the CAPE total score, the interaction between CT and genetic liability was close to statistical significance (χ2 = 5.6, df = 2, p = 0.06). Analyses of CAPE subscales revealed a significant interaction between CT and genetic liability (χ2 = 8.8, df = 2, p = 0.012) for the CAPE-negative symptoms subscale, but not for the other two subscales (i.e. positive and depressive). CONCLUSION: The results suggest that the impact of CT on subthreshold expression of psychosis, particularly in the negative subdomain, may be larger in the co-presence of significant genetic liability for psychopathology.

Self-Reported Cognitive Biases Are Equally Present in Patients Diagnosed With Psychotic Versus Nonpsychotic Disorders.

We investigated the relation between subjective cognitive biases measured with the Dutch Davos Assessment of Cognitive Biases (DACOBS-NL) and (1) the presence of a psychotic versus nonpsychotic psychiatric disorder, (2) the current dose of antipsychotic medication and current psychotic symptoms, and (3) the Personality Inventory for the DSM-5 (PID-5) Psychoticism personality trait. Results showed that DACOBS-NL subjective cognitive biases (1) were equally present in patients diagnosed with nonpsychotic disorders compared with patients with a psychotic disorder, (2) could not be explained by the current dose of antipsychotic medication, nor by current psychotic symptoms, and (3) significantly correlated with all PID-5 Personality domains. Moreover, in predicting membership of the psychotic versus nonpsychotic psychiatric disorder group, the addition of the PID-5 domains in step 2 rendered the contribution of the DACOBS-NL subjective cognitive biases in step 1 nonsignificant. Further research is needed to clarify the interplay between cognitive biases and aberrant salience in the prediction of psychotic disorders.

Sensitivity to Peer Evaluation and Its Genetic and Environmental Determinants: Findings from a Population-Based Twin Study.

Adolescents and young adults are highly focused on peer evaluation, but little is known about sources of their differential sensitivity. We examined to what extent sensitivity to peer evaluation is influenced by interacting environmental and genetic factors. A sample of 354 healthy adolescent twin pairs (n = 708) took part in a structured, laboratory task in which they were exposed to peer evaluation. The proportion of the variance in sensitivity to peer evaluation due to genetic and environmental factors was estimated, as was the association with specific a priori environmental risk factors. Differences in sensitivity to peer evaluation between adolescents were explained mainly by non-shared environmental influences. The results on shared environmental influences were not conclusive. No impact of latent genetic factors or gene-environment interactions was found. Adolescents with lower self-rated positions on the social ladder or who reported to have been bullied more severely showed significantly stronger responses to peer evaluation. Not genes, but subjective social status and past experience of being bullied seem to impact sensitivity to peer evaluation. This suggests that altered response to peer evaluation is the outcome of cumulative sensitization to social interactions.

Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries.

In this study, we assessed the association of chronic medical conditions and multimorbidity with perceived stress among community-dwelling adults in 44 low- and middle-income countries. Data from the World Health Survey (2002-2004), including 229,293 adults, were analyzed. A perceived stress score (range, 0 (lowest stress)-100 (highest stress)) was computed on the basis of 2 questions from the Perceived Stress Scale. Eleven chronic conditions were assessed. Multivariable linear regression analyses were conducted to explore the associations. All chronic conditions were associated with significantly higher mean perceived stress scores, with the exception of edentulism. The associations were particularly strong for depression (ß = 14.71, 95% confidence interval (CI): 13.68, 15.74), visual impairment (ß = 10.66, 95% CI: 8.09, 13.23), and schizophrenia (ß = 9.98, 95% CI: 7.71, 12.24). Compared with no chronic conditions, the ß coefficients for perceived stress with the presence of 1, 2, 3, and ≥4 chronic conditions were 5.58 (95% CI: 4.94, 6.23), 9.58 (95% CI: 8.67, 10.49), 14.15 (95% CI: 12.63, 15.67), and 20.17 (95% CI: 18.29, 22.05), respectively. The associations with perceived stress were significantly stronger among the poorest individuals for arthritis, asthma, diabetes, edentulism, and ≥4 chronic conditions. Our data suggest that a range of chronic conditions and multimorbidity are associated with greatly increased perceived stress among people in low- and middle-income countries, and that the poorest persons may be a particularly vulnerable group.

Changes in metabolic parameters in patients with severe mental illness over a 10-year period: A retrospective cohort study.

BACKGROUND: Diabetes, obesity and metabolic syndrome are highly prevalent in patients with severe mental illness and can impose a major physical health burden. OBJECTIVE: To determine how anthropometric and metabolic features changed over time in a retrospective cohort of people with Severe Mental Illness living in Cheshire, UK. METHODS: In all, 1307 individuals on the severe mental illness Register were followed up between 2002 and 2012 in UK general practice. Subjects were identified through a pseudanonymised search of general practice registers. RESULTS: Baseline body mass index was 28.6 kg/m2 increasing to 31.0 at 10-year follow-up ( r2 = 0.84; p = 0.0002). There was a significant increase in fasting blood glucose from 5.72 to 6.79 mmol/L ( r2 = 0.48; p = 0.026). Correspondingly, there was a strong positive univariate relation between increase in body mass index and fasting blood glucose ( r2 = 0.54; p < 0.0001) taking into account all measurements. Fasting blood glucose also increased slightly with age ( p = 0.028). With increasing use of statins, total cholesterol fell from 4.5 to 3.9 mmol/L ( r2 = 0.88; p = 0.0001), as did low-density lipoprotein cholesterol from 3.43 to 2.35 mmol/L ( r2 = 0.94; p = 0.0001). In multivariate models, adjusting for age, gender, smoking and blood pressure, each unit increase in body mass index (odds ratio = 1.07 [1.01, 1.13]; p = 0.031) and triglycerides (odds ratio = 1.28 (1.06, 1.55); p = 0.009) was independently associated with an increased risk of having type 2 diabetes. CONCLUSION: Increasing body mass index relates to increasing rates of dysglycaemia over time. Measures to encourage weight reduction should be key strategies to reduce dysglycaemia rates in severe mental illness. Prescribing statins may have been effective in improving the lipid profile in this group.

BMI independently relates to glycaemia in patients with severe enduring mental illness (SMI).

BACKGROUND: People with severe mental illness (SMI) have higher rates of diabetes than the general population. AIMS: To assess the type-2 diabetes screening rates in primary care and the relation between body mass index (BMI) and dysglycaemia for patients on the SMI register in the Cheshire region of the United Kingdom. METHODS: The setting was 24 general practices in Central and Eastern Cheshire, United Kingdom. Subjects were identified through a semianonymized search of GP registers. RESULTS: About 451 of the 787 SMI patients were screened for dysglycaemia and dyslipidaemia. Fasting glucose was in the impaired fasting glycaemia range (6.1-6.9 mmol/l) in 6.5%, and indicative of type-2 diabetes (≥7.0 mmol/l) in 17.3%. There was a positive univariate relation between BMI and fasting glucose (normalized ß = 0.26, p < 0.001). In multivariate models, adjusting for age, gender, smoking and blood pressure, each unit increase in BMI [OR = 1.07 (1.01, 1.13); p = 0.031] and triglycerides [OR = 1.28 (1.06, 1.55); p = 0.009] were independently associated with an increased risk of having type-2 diabetes. CONCLUSION: Increasing BMI relates to dysglycaemia in patients with severe enduring mental illness (SMI). All patients with SMI whether or not receiving neuroleptic treatment should undergo routine monitoring of weight and metabolic parameters.

Cardiorespiratory fitness levels and moderators in people with HIV: A systematic review and meta-analysis.

Cardiorespiratory fitness (CRF) is a modifiable risk factor for cardiovascular disease and premature mortality. CRF levels and moderators among people living with HIV (PLWH) are unknown. The aim of the current meta-analysis was to (1) determine mean CRF in PLWH and compare levels with age- and gender-matched healthy controls (HCs), (2) explore moderators of CRF, (3) and (4) explore moderators of CRF outcomes following physical activity (PA) interventions. Major electronic databases were searched systematically for articles reporting CRF expressed as maximum or peak oxygen uptake (ml/min/kg) in PLWH. A random effects meta-analysis calculating the pooled mean CRF including subgroup- and meta-regression analyses was undertaken. Across 21 eligible studies, the CRF level was 26.4ml/kg/min (95% CI=24.6 to 28.1) (n=1010; mean age=41years). There were insufficient data to compare CRF levels with HCs. A higher body mass index (ß=-0.99, 95% CI=-1.93 to -0.06, P=0.04), older age (ß=-0.31, 95% CI=-0.58 to -0.04, P=0.02) and the presence of lipodystrophy (ß=-4.63, 95% CI=-7.88 to -1.39, P=0.005) were significant moderators of lower CRF levels. Higher CD4+ counts (ß=0.004, 95% CI=0.0007 to 0.007, P=0.016), supervised interventions (P<0.001) and interventions with a lower frequency of weekly sessions (2 or 3 versus 4 times) (P<0.001) predicted a better CRF-outcome following PA. CRF levels of PLWH are among the lowest in comparison to other vulnerable populations. More research on the most optimal physical activity intervention characteristics is needed.

The Prevalence of Metabolic Syndrome in Alcohol Use Disorders: A Systematic Review and Meta-analysis.

AIMS: People with alcohol use disorders (AUDs) have a double increased risk for cardiovascular diseases (CVD) and associated premature mortality. Metabolic syndrome (MetS) and its components are highly predictive of CVD. The primary aim of this meta-analysis was to describe pooled rates of MetS and its components in people with AUDs taking into account variations in demographic and clinical variables. METHODS: Medline, Embase and CINAHL were searched until 03/2016 for cross-sectional and baseline data of longitudinal studies in adults with AUDs. Two independent reviewers extracted data. Random effects meta-analysis with a relative risk, subgroups and meta-regression analyses were employed. RESULTS: The pooled MetS prevalence after adjusting for publication bias was 21.8% (95% CI = 19.1%-24.8%; N studies = 5; n participants = 865; age range = 34.8-51.1 years). Abdominal obesity was observed in 38.3% (N = 4, n = 389; 95%CI = 30.2%-47.0%), hyperglycemia in 14.3% (N = 4, n = 389; 95% CI = 3.7%-42.3%), hypertriglyceridemia in 43.9% (N = 4, n = 389; 95% CI = 31.7%-56.8%), low high-density lipoprotein cholesterol in 7.6% (N = 4, n = 389; 95% CI = 4.3%-13.2%) and hypertension in 46.5% (95% CI = 21.7%-73.1%). The MetS prevalence was similar across settings. A separate meta-regression analysis revealed that a higher MetS frequency was moderated by a higher percentage of psychiatric co-morbidity (coefficient = 3.651; standard error = 1.10, 95% CI = 1.50 to 5.80, z = 3.3, P < 0.001), CONCLUSIONS: Routine screening and multidisciplinary management of metabolic abnormalities in people with AUD is needed. Special attention should be given to people with AUDs with psychiatric co-morbidities. Future research should focus on how cardio-metabolic outcomes are moderated by clinical characteristics. SHORT SUMMARY: The metabolic syndrome (MetS) and its components are highly predictive of cardiovascular diseases. Our meta-analysis demonstrates that more than 1 in 5 persons with alcohol use disorder (AUDs) has the MetS. Routine screening and multidisciplinary management of metabolic abnormalities should be an integral part of the multidisciplinary treatment of AUDs.

The Functional Exercise Capacity Is Associated With Global Functioning in People With Bipolar Disorder.

The aim of the current study was to determine whether the Global Assessment of Functioning (GAF) score is associated with the functional exercise capacity among in- and outpatients with bipolar disorder. Sixty-five (36♀) persons with bipolar disorder performed a 6-minute walk test (6MWT) and were assessed with the GAF, Quick Inventory of Depressive Symptomatology Self Report (QIDS), and the International Physical Activity Questionnaire (IPAQ). The mean GAF-score was 55.0 ± 15.0, whereas the mean distance achieved on the 6MWT was 615.6 ± 118.6 m. There was a positive association between the GAF score and 6MWT score (r = 0.60, p < 0.001). A backward regression analysis demonstrated that an inpatient status, illness duration (16.1 ± 10.7 years), and the QIDS score (7.7 ± 5.7) explained 72.4% of the GAF-score variance. The GAF, QIDS score, and age explained 74.1% of the 6MWT-score variance. Our results indicate that a bidirectional relationship is evident between the exercise capacity and global functioning among people with bipolar disorder.

Depressive symptoms and muscular fitness contribute independently to the ability to perform daily life activities in people with bipolar disorder.

BACKGROUND: Compared with healthy controls, people with bipolar disorder experience muscle weakness. The extent to which muscle weakness influences the performance of daily life activities such as walking in people with bipolar disorder requiring hospitalization is unclear. AIMS: The primary aim of the current study was to explore whether depressive symptoms and muscular fitness independently contribute to the walking capacity in people with bipolar disorder. A secondary aim was to identify variables that could explain the variability in muscular fitness. METHODS: Forty-two inpatients with bipolar disorder performed a standing broad jump test (SBJ), a measure of muscular performance, and the six minute walk test (6MWT) in addition to the International Physical Activity Questionnaire (IPAQ), the Depressive Symptomatology Self Report (QIDS) and a full-fasting metabolic screening. RESULTS: The correlation between the 6MWT (595.0 ± 127.3m) and SBJ (126.2 ± 48.6m) was high (r = 0.72, p < 0.001). In backward regression analyzes, 82.3% of the variance in 6MWT was explained by SJB, QIDS (7.6 ± 5.1) and the presence of metabolic syndrome (n = 16; 38%), while 83.0% of the variance in SBJ-score was explained by age, and the QIDS and IPAQ (1435.3 ± 1179.8 MET-min/week) scores. CONCLUSIONS: Depressive symptoms and muscular fitness contribute independently to daily life functioning in people with bipolar disorder. Thus, muscular rehabilitation strategies might offer a strategy for improving performance of daily life activities in this group.

Knowledge of Psychiatric Nurses About the Potentially Lethal Side-Effects of Clozapine.

Clozapine is an antipsychotic with superior efficacy in treatment refractory patients, and has unique anti-suicidal properties and a low propensity to cause extrapyramidal side-effects. Despite these advantages, clozapine utilization is low. This can in part be explained by a number of potentially lethal side effects of clozapine. Next to psychiatrists nurses play a crucial role in the long-term management of patients with schizophrenia. It is therefore important that nurses know, inform and monitor patients about the specific side-effects of clozapine. A recent study of psychiatrists published in 2011 has shown that there was a gap in the knowledge about side-effects of clozapine. The knowledge about side-effects of clozapine in nurses has never been studied. This cross-sectional study evaluated the knowledge base regarding the safety of clozapine, and its potential mediators, of psychiatric nurses in 3 psychiatric hospitals in Belgium with a specifically developed questionnaire based on the literature and expert opinion (3 clozapine experts). A total of 85 nurses completed the questionnaire. The mean total score was 6.1 of a potential maximum score of 18. Only 3 of the 18 multiple choice knowledge questions were answered correctly by more than 50% of nurses. Only 24.9% of participants passed the test (>50% correct answers). Nurses working on psychosis units were more likely to pass the test (xx.y% vs yy.z%, p=0.0124). There was a trend that nurses with a lower nursing diploma were more likely to fail the test (p=0.0561). Our study clearly identifies a large gap in the basic knowledge of psychiatric nurses about clozapine and its side-effects. Knowledge could be increased by more emphasis on the topic in nurse's training curricula as well as targeted onsite training. Only 23.5% of participants indicate that there was sufficient information in their basic nursing training.

Antipsychotic treatment, prolactin, and breast tumorigenesis.

BACKGROUND: Over the last decades prolactin (PRL) has gained attention for its possible role in breast tumorigenesis. As all antipsychotics (although differences with respect to PRL elevation are large) have the propensity to induce hyperprolactinemia (HPRL), questions have arisen concerning the influence of PRL-elevating antipsychotic medications on breast cancer risk. SUBJECTS AND METHODS: A literature search (until January 2016), using the MEDLINE database, was conducted for English-language published clinical studies to identify and synthesize data of the current state of knowledge concerning the relationship between HPRL, breast cancer risk (factors) and antipsychotic medication. RESULTS: Results of human prospective studies evaluating the relationship between pre-diagnostic circulating PRL levels and breast cancer risk are limited, equivocal and only correlational. Associations between higher circulating PRL levels and other breast cancer risk factors than nulliparity and hormone therapies mostly have been negative for both pre-and postmenopausal women. Until today, no causal link between (chronic) administration of antipsychotics and breast tumorigenesis in humans has been demonstrated. Finally, several reports describe mechanisms of cancer protection with the PRL hormone as well as with antipsychotic medication. CONCLUSION: The role of PRL in breast carcinogenesis therefore remains unclear, unconfirmed, yet controversial. Antipsychotics should not be withhold for breast cancer prevention reasons to patients in need of this sometimes life-saving medication, even if classical breast cancer risk factors are present.

Test-retest study of the six-minute walk test in people with bipolar disorder.

BACKGROUND: The multidisciplinary care for bipolar disorder is highly fragmented with limited opportunities for prevention and treatment of medical co-morbidities. We examined the reliability of the 6-minute walk test (6MWT). Secondary aims were to assess minimal detectable changes (MDC(95)), practice effects and the impact of clinical conditions. SUBJECTS AND METHODS: Two 6MWTs were administered within 3 days to 46 (23♂) inpatients with a DSM-V diagnosis of bipolar disorder. Physical complaints before and after the 6MWT were recorded. Patients completed the Quick Inventory of Depressive Symptomatology Self Report (QIDS-SR) and Hypomania Check List-32. RESULTS: Patients walked 594.7±121.3 meters and 600.0±122.9 meters at the first and second test. The intraclass correlation coefficient was 0.98 (95% confidence interval 0.97-0.99). The MDC(95) was 37.8 meters for men and 52.9 meters for women. No practice effect was detected. Longer illness duration, higher QIDS-SR scores and the presence of feet or ankle static problems or pain were independently related to shorter 6MWT distance accounting for 59.8% of the variance. CONCLUSION: The 6MWT is a clinically feasible tool for evaluating the functional exercise capacity in patients with bipolar disorder. Health care professionals should consider depression and physical pain when developing rehabilitation programmes.