The Overall Anxiety Severity and Impairment Scale as an Outcome Measure in Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders: Observational Study.

BACKGROUND: Internet-delivered cognitive behavioral therapy (iCBT) is effective in the treatment of anxiety disorders. iCBT clinical trials use relatively long and time-consuming disorder-specific rather than transdiagnostic anxiety measurements. Overall Anxiety Severity and Impairment Scale (OASIS) is a brief self-report scale that could offer a universal, easy-to-use anxiety measurement option in disorder-specific and transdiagnostic iCBT programs. OBJECTIVE: We aimed to investigate relationships between OASIS and disorder-specific instruments in iCBT. We expected these relationships to be positive. METHODS: We investigated patients in original nationwide iCBT programs for generalized anxiety disorder (GAD), obsessive-compulsive disorder, panic disorder, and social anxiety disorder, which were administered by Helsinki University Hospital, Finland. In each program, anxiety symptoms were measured using both disorder-specific scales (the 7-item Generalized Anxiety Disorder scale, Penn State Worry Questionnaire, revised Obsessive-Compulsive Inventory, Panic Disorder Severity Scale, and Social Phobia Inventory) and by OASIS. A general linear model for repeated measures (mixed models) and interaction analysis were used for investigating the changes and relationships in the mean scores of OASIS and disorder-specific scales from the first session to the last one. RESULTS: The main effect of linear mixed models indicated a distinct positive association between OASIS and disorder-specific scale scores. Interaction analysis demonstrated relatively stable associations between OASIS and the revised Obsessive-Compulsive Inventory (F822.9=0.09; 95% CI 0.090-0.277; P=.32), and OASIS and the Panic Disorder Severity Scale (F596.6=-0.02; 95% CI -0.108 to -0.065; P=.63) from first the session to the last one, while the 7-item Generalized Anxiety Disorder scale (F4345.8=-0.06; 95% CI -0.109 to -0.017; P=.007), Penn State Worry Questionnaire (F4270.8=-0.52; 95% CI -0.620 to -0.437; P<.001), and Social Phobia Inventory (F862.1=-0.39; 95% CI -0.596 to -0.187; P<.001) interrelated with OASIS more strongly at the last session than at the first one. CONCLUSIONS: OASIS demonstrates clear and relatively stable associations with disorder-specific symptom measures. Thus, OASIS might serve as an outcome measurement instrument for disorder-specific and plausibly transdiagnostic iCBT programs for anxiety disorders in regular clinical practice.

Cognitive functioning and cannabis use in first-episode psychosis.

AIM: Cannabis use is common in people with psychotic disorders. However, the effect of cannabis on cognition in psychosis remains unclear. Our study investigates relationships between the history of cannabis use and cognitive performance in patients with first-episode psychosis (FEP) during a one-year follow-up. METHODS: The present study included FEP (N = 91) and control (N = 61) groups. Cannabis use was evaluated with a self-report questionnaire, clinical assessment, and medical records during a lifetime and 12 months prior to the treatment onset (recent). Symptoms of psychosis and anxiety were evaluated on the brief psychiatric rating scale. Negative symptoms were assessed using the scale for the assessment of negative symptoms. Cognitive tests were used to evaluate neurocognition (summarized in the g factor) and social cognition. Crude regression analyses for the g factor included variables of cannabis use as independent variables. Full regression models were controlled for gender, education, and clinical symptoms. RESULTS: In the FEP group, men used cannabis more frequently than women. In the crude regression model for FEP patients, never having used cannabis was associated with a better neurocognitive profile at 12 months. In the full model, more severe anxiety symptoms were associated with better neurocognition at two months, and less severe negative symptoms were associated with better neurocognition at 12 months. Cannabis use was not associated with social cognition. No associations between cognitive performance and cannabis use emerged in the controls. CONCLUSION: Negative and affective symptom severity in FEP was associated with cognitive performance to a greater degree than a lifetime history of cannabis use.

Self-reported treatment adherence among psychiatric in- and outpatients.

BACKGROUND: Poor adherence to psychiatric treatment is a common clinical problem, leading to unfavourable treatment outcome and increased healthcare costs. AIM: The aim of this study was to investigate the self-reported adherence and attitudes to outpatient visits and pharmacotherapy in specialized care psychiatric patients. METHODS: Within the Helsinki University Psychiatric Consortium (HUPC) pilot study, in- and outpatients with schizophrenia or schizoaffective disorder (SSA, n = 113), bipolar disorder (BD, n = 99), or depressive disorder (DD, n = 188) were surveyed about their adherence and attitudes towards outpatient visits and pharmacotherapy. Correlates of self-reported adherence to outpatient and drug treatment were investigated using regression analysis. RESULTS: The majority (78.5%) of patients reported having attended outpatient visits regularly or only partly irregularly. Most patients (79.2%) also reported regular use of pharmacotherapy. Self-reported non-adherence to preceding outpatient visits was consistently and significantly more common among inpatients than outpatients across all diagnostic groups (p < .001). Across all groups, hospital setting was the strongest independent correlate of poor adherence to outpatient visits (SSA ß = -2.418, BD ß = -3.417, DD ß = -2.766; p < .001 in all). Another independent correlate of non-adherence was substance use disorder (SSA ß = -1.555, p = .001; BD ß = -1.535, p = .006; DD ß = -2.258, p < .000). No other socio-demographic or clinical factor was significantly associated with poor adherence in multivariate regression models. CONCLUSIONS: Irrespective of diagnosis, self-reported adherence to outpatient care among patients with schizophrenia or schizoaffective disorder, bipolar disorder, and depression is associated strongly with two factors: hospital setting and substance use disorders. Thus, detection of adherence problems among former inpatients and recognition and treatment of substance misuse are important to ensure proper outpatient care.

Psychoactive substance use in specialized psychiatric care patients.

Objective Life expectancy of psychiatric patients is markedly shorter compared to the general population, likely partly due to smoking or misuse of other substances. We investigated prevalence and correlates of substance use among psychiatric patients. Methods Within the Helsinki University Psychiatric Consortium Study, data were collected on substance use (alcohol, smoking, and illicit drugs) among patients with schizophrenia or schizoaffective disorder (n = 113), bipolar (n = 99), or depressive disorder (n = 188). Clinical diagnoses of substance use were recorded, and information on smoking, hazardous alcohol use, or misuse of other substances was obtained using questionnaires. Results One-fourth (27.7%) of the patients had clinical diagnoses of substance use disorders. In addition, in the Alcohol Use Disorders Identification Test, 43.1% had hazardous alcohol use and 38.4% were daily smokers. All substance use was more common in men than in women. Bipolar patients had the highest prevalence of alcohol use disorders and hazardous use, whereas those with schizophrenia or schizoaffective disorder were more often daily smokers. In regression analyses, self-reported alcohol consumption was associated with symptoms of anxiety and borderline personality disorder and low conscientiousness. No associations emerged for smoking. Conclusions The vast majority of psychiatric care patients have a diagnosed substance use disorder, hazardous alcohol use, or smoke daily, males more often than females. Bipolar patients have the highest rates of alcohol misuse, schizophrenia or schizoaffective disorder patients of smoking. Alcohol use may associate with symptoms of anxiety, borderline personality disorder, and low conscientiousness. Preventive and treatment efforts specifically targeted at harmful substance use among psychiatric patients are necessary.

Psychotic Symptoms and Malignant Neuroleptic Syndrome in Williams Syndrome: A Case Report.

Background: Somatic and mental comorbidities are characteristic of individuals with Williams syndrome. The psychiatric profile of these patients mainly comprises affective disorders, while psychotic symptoms are rare. Methods: We present a case report of psychosis and malignant neuroleptic syndrome in a patient with Williams syndrome. We also conduct a review of recent works on the topic. Case Presentation: A 38-year-old Caucasian male with Williams syndrome presented with somatic delusions, previously experiencing severe anxiety and concerns about a headache. The patient was prescribed olanzapine, which did not, however, have any effect on the delusions. After switching to lurasidone, the patient presented with malignant neuroleptic syndrome (muscle rigidity, tremor, urinary retention, fluctuating level of consciousness). He was hospitalized and the antipsychotic medication was discontinued. After somatic recovery, the patient did not experience severe anxiety and the somatic delusions diminished notably. The patient was discharged from the hospital in a stable physical condition, albeit still with transient worries about his health condition. Conclusions: We present a case of the coincidence of Williams syndrome and psychosis. We hypothesize on the possible pathological relationships between the onset of the psychosis and severe anxiety in an individual with Williams syndrome. This case report duly contributes to the limited literature on psychiatric comorbidity in Williams syndrome.

Simulation of the Kinematic Condition of Radial Shear Rolling and Estimation of Its Influence on a Titanium Billet Microstructure.

The finite element method (FEM) computer simulation of the three-high radial shear rolling of Ti-6Al-4V alloy round billets was conducted using QForm software. The simulation was performed for the MISIS-100T rolling mill's three passes according to the following rolling route: 76 mm (the initial billet diameter) →65 mm→55 mm→48 mm (the final billet diameter). The change in the total velocity values for the points on the radius of the 48 mm diameter billet was estimated while passing the rolls' draft. The relative increase in the accumulated strain was estimated for the same points. Then, experimental shear rolling was performed. Grain sizes of the α- and ß-phases were estimated in the cross section of the final billet at the stationary stage of rolling. The grain size distribution histograms for different phases were plotted. An area was found in the billet's cross section in which the trend of change in the total velocity of the points changed. This area represented a neutral layer between the slowing peripheral segments of the billet and the accelerating central segments of the billet. Inside this neutral layer, the limits of the cylindrical surface radius value were estimated. Experimental radial shear rolling was performed to compare the experimental rolling results (the billet microstructure investigation) with the computer simulation results. The computer simulation obtained two estimations of the radius limits: 8-16 mm (based on the analysis of the total velocity change) and 12-16 mm (based on the accumulated strain's relative increment change). The experimental rolling obtained two more estimations of the radius limits: 8.4-19.5 mm and 11.3-19.7 mm-based on the results of the microstructure investigation. It was confirmed that varying the kinematic and deformation parameters of radial shear rolling allows regulation of the thickness of the peripheral fine-grain layer and the diameter of the central coarse-grain layer of the rolled billets.

Anxiety symptoms in first-episode psychosis.

AIM: Anxiety disorders and symptoms are common in people with psychotic disorders, having a negative impact on clinical status, function level and overall prognosis. However, research on the significance of anxiety in predicting remission and long-term functioning in first-episode psychosis (FEP) is still scarce. This study investigated the effects of anxiety and obsessive-compulsive symptoms (OCS) on clinical and functional improvement in individuals with FEP. METHODS: FEP patients (N = 97) aged 18-40 years were recruited from the University Hospital District of Helsinki and the City of Helsinki. Psychotic and anxiety symptoms were measured using the Brief Psychiatric Rating Scale. Obsessive-compulsive symptoms were assessed using the Obsessive-Compulsive Inventory (OCI-R), and functioning was evaluated using the Social and Occupational Functioning Assessment Scale (SOFAS). Follow-up measurements were performed at 2 and 12 months. We specifically studied whether anxiety and obsessive-compulsive symptoms at the 2-month follow-up assessment, at a time when the initial treatment response had been achieved, would predict outcomes at 12 months. RESULTS: Symptoms of anxiety and OCS correlated moderately with each other and psychotic symptoms, but at the 12-month follow-up, OCS no longer correlated significantly with psychotic and anxiety symptoms. When the level of psychotic symptoms was adjusted for, more severe OCS at the 2-month follow-up was associated with a lower rate of remission at 12 months, whereas a higher level of anxiety symptoms at 2 months was associated with better functioning at 12 months. CONCLUSIONS: OCS may be predictive of poorer clinical outcomes, whereas anxiety symptoms may predict better functional outcomes.

Forming Features and Properties of Titanium Alloy Billets After Radial-Shear Rolling.

Radial-shear rolling (RSR) of titanium alloy billets was realized in a three-high rolling mill. Experimental rolling was simulated using DEFORM software. The purpose was to reveal how stress-strain state parameters, grain structure and hardness vary along the billet's radius in the stationary stage of the RSR process. It was also the goal to establish a relation between stress state parameters, hardness and grain structure. Changes in the accumulated strain and the stress triaxiality were established by computer simulation. Hardness and grain size changes were obtained after experimental rolling. The novelty aspect is that both computer simulation and experimental rolling showed that there is a ring-shape area with lowered strength in the billet's cross-section. The radius of the ring-shape area was predicted as a result of the research.

Relationships between self-reported childhood traumatic experiences, attachment style, neuroticism and features of borderline personality disorders in patients with mood disorders.

BACKGROUND: Co-occurring borderline personality disorder (BPD) features have a marked impact on treatment of patients with mood disorders. Overall, high neuroticism, childhood traumatic experiences (TEs) and insecure attachment are plausible aetiological factors for BPD. However, their relationship with BPD features specifically among patients with mood disorders remains unclear. We investigated these relationships among unipolar and bipolar mood disorder patients. METHODS: As part of the Helsinki University Psychiatric Consortium study, the McLean Screening Instrument (MSI), the Experiences in Close Relationships-Revised (ECR-R), the Short Five (S5) and the Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n=282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, and multivariate regression (MRA) and mediation analyses were conducted. RESULTS: Spearman's correlations were strong (rho=0.58; p<0.001) between total scores of MSI and S5 Neuroticism and moderate (rho=0.42; p<0.001) between MSI and TADS as well as between MSI and ECR-R Attachment Anxiety. In MRA, young age, S5 Neuroticism and TADS predicted scores of MSI (p<0.001). ECR-R Attachment Anxiety mediated 33% (CI=17-53%) of the relationships between TADS and MSI. LIMITATIONS: Cross-sectional questionnaire study. CONCLUSIONS: We found moderately strong correlations between self-reported BPD features and concurrent high neuroticism, reported childhood traumatic experiences and Attachment Anxiety also among patients with mood disorders. Independent predictors for BPD features include young age, frequency of childhood traumatic experiences and high neuroticism. Insecure attachment may partially mediate the relationship between childhood traumatic experiences and borderline features among mood disorder patients.

Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders.

BACKGROUND: Substantial literature exists on risk factors for suicidal behaviour. However, their comparative strength, independence and specificity for either suicidal ideation or suicide attempt(s) remain unclear. METHODS: The Helsinki University Psychiatric Consortium (HUPC) Study surveyed 287 psychiatric care patients with ICD-10-DCR depressive or bipolar disorders about lifetime suicidal behaviour, developmental history and attachment style, personality and psychological traits, current and lifetime symptom profiles, and life events. Psychiatric records were used to confirm diagnosis and complement information on suicide attempts. Multinomial regression models predicting lifetime suicidal ideation and single or repeated suicide attempts were generated. RESULTS: Overall, 21.6% patients had no lifetime suicidal behaviour, 33.8% had lifetime suicide ideation without attempts, and 17.1% had a single and 27.5% repeated suicide attempts. In univariate analyses, lifetime suicidal behaviour was associated with numerous factors. In multivariate models, suicidal ideation was independently predicted by younger age, severe depressive disorder, bipolar disorder type II/nos, hopelessness, and childhood physical abuse. Repeated suicide attempts were independently predicted by younger age, female sex, severe depressive disorder with or without psychotic symptoms, bipolar disorder type II/nos, alcohol use disorder, borderline personality disorder traits, and childhood physical abuse. LIMITATIONS: Cross-sectional and retrospective study design, utilization of clinical diagnoses, and relatively low response rate. CONCLUSIONS: Risk factors for suicidal ideation and attempts may diverge both qualitatively and in terms of dose response. When effects of risk factors from multiple domains are concurrently examined, proximal clinical characteristics remain the most robust. All risk factors cluster into the group of repeated attempters.