Lymphocyte-related ratios, systemic immune-inflammatory and systemic inflammatory response index in alcohol use disorder.

Addictive disorders are associated with systemic and central nervous system inflammation, which may be important for the onset and development of these diseases. Although lymphocyte-related parameters have recently been studied in alcohol use disorder (AUD), systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) haven't. Lymphocyte-related ratios, SII and SIRI levels were evaluated between AUD and healthy controls (HC) in this study. It was a retrospective and cross-sectional study. This study included 72 patients with AUD and 184 individuals in the HC group. Lymphocyte related ratios such as neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR), SII and SIRI values were compared. Compared to HC group, NLR (p < 0.001), MLR (p < 0.001), and SIRI (p < 0.001) levels were significantly higher in AUD group. There was also a significant relationship between NLR and AST/ALT ratio in the AUD group (p = 0.022). The results of this study support that AUD is a chronic inflammatory psychiatric disorder. In addition, it may be useful to evaluate these markers in relation to liver enzymes in patients with AUD, as alcohol consumption causes liver damage. These markers may also be used in future studies to assess treatment response and disease severity.

Effects of Sexual Myths and Intimate Partner Violence on Women's Sexual Self-Schemas.

Sexual self-schemas (SSSs) are cognitive generalizations about one's sexual aspects. The aim of this study was to explore the possible effects of intimate partner violence (IPV) and the sexual myths about sexual behavior or roles on women's sexual self-schemas. The research had a cross-sectional and observational design. Fifty women from a psychiatry outpatient clinic between the ages of 18-50 were given the Sexual Self-Schema Scale, sexual myths questionnaire, Beck Depression Inventory, Beck Anxiety Inventory, Golombok-Rust Inventory of Sexual Satisfaction, and Domestic Violence Against Women Scale. A significant relationship was found between the duration of marriage (years) and "Direct/Outspoken" schema (p = .020, r = 0.29). This schema was also correlated with emotional (p = .037, r = - 0.29), total violence score (p = .028, r = - 0.27), and sexual myth score (p = .033, r = 0.26). After the regression analysis, it was observed that the effect of emotional violence and sexual myth score on the "Direct/Outspoken" schema remained significant. Correcting sexual myths through sexual education can make women's SSSs into positive way. In addition, interventions can be made to increase SSSs positively in women exposed to IPV. It is recommended that clinicians take a holistic approach by questioning the sexual functions and schemas of women in addition to IPV in women who experience it and have depression or anxiety disorders. As a policy implication, education about women's rights and sexuality should also be given. Adequate psychological support should be provided to reduce the impact of IPV on SSS.

Response Inhibition and Interference Control in Adult Attention Deficit Hyperactivity Disorder.

Introduction: Among the executive functions affected in attention deficit hyperactivity disorder (ADHD), inhibitory control is one of the primary areas of impairment, characterized by components that include response inhibition and interference control. Determining the impaired inhibitory control components will be useful in the differential diagnosis and treatment of ADHD. The present study aimed to investigate response inhibition and interference control abilities of adults with ADHD. Methods: The study included 42 adults diagnosed with ADHD and 43 healthy controls. The stop-signal task (SST) and Stroop test were used for assessing the response inhibition and interference control, respectively. Multivariate analysis of covariance was used for comparing the ADHD and healthy control groups in terms of their SST and Stroop test scores, wherein the age and education level of the participants were taken as covariables. The relationship between SST and Stroop Test and Barratt Impulsiveness Scale-11 (BIS-11) was tested by Pearson correlation analysis. Mann-Whitney U test was used for comparing the test scores between those who were administered with psychostimulants among the adults with ADHD and those who were not. Results: Response inhibition was observed to be impaired in adults with ADHD compared with the healthy controls, whereas no difference regarding interference control was observed. As per the Barratt Impulsiveness Scale-11 (BIS-11), a weak and moderately negative relationship was found between the stop signal delay and the attentional, motor, non-planning scores, and total scores and a weak positive relationship was found between the stop-signal reaction time and the attentional, motor, non-planning scores, and total scores. A significant improvement was observed in the response inhibition skills of the adults with ADHD who had received methylphenidate treatment compared to those who had not, and the former also showed lower impulsivity levels as measured by the BIS-11. Conclusions: It should be noted that response inhibition and interference control, which are considered under the umbrella of inhibitory control, may exhibit different characteristics in adult individuals diagnosed with ADHD and this is important for differential diagnosis. An improvement was observed in the response inhibition of adults with ADHD caused by psychostimulant treatment, which was associated with positive outcomes that were also noticeable by the patients. Understanding the underlying neurophysiological mechanisms of the condition would further facilitate the development of appropriate treatments.

A comparative meta-analysis of peripheral 8-hydroxy-2'-deoxyguanosine (8-OHdG) or 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxo-dG) levels across mood episodes in bipolar disorder.

OBJECTIVE: Oxidative DNA damage has been associated with the pathophysiology of bipolar disorder (BD) as one of the common pathways between increased medical comorbidity and premature aging in BD. Previous evidence shows increased levels of oxidatively induced DNA damage markers, 8-hydroxy-2'-deoxyguanosine (8-OHdG) or its tautomer 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxo-dG), in patients with BD in comparison to healthy individuals. With the current research, we aim to analyze data on peripheral (blood or urine) 8-OHdG/8-oxo-dG levels across mood states of BD using a meta-analytical approach. METHOD: A literature search was conducted using the databases PubMed, Scopus, and Web of Science to identify eligible studies (January 1989 to July 2022). Relevant studies were systematically reviewed; a random-effects meta-analysis and a meta-regression analysis were conducted. RESULTS: The current meta-analysis included 12 studies consisting of 808 BD patients (390 in euthymia, 156 in mania, 137 in depression, 16 in mixed episode, 109 not specified) and 563 healthy controls. BD patients that were currently depressed had significantly higher levels of 8-OHdG/8-oxo-dG than healthy controls, while euthymic or manic patients did not differ from healthy controls. A meta-regression analysis showed sex distribution (being female) and older age to be significantly related to increased 8-OHdG/8-oxo-dG levels. CONCLUSION: Our findings suggest that 8-OHdG/8-oxo-dG may be a state-related marker of depression in BD and may be affected by older age and female gender.

Double-Edged Sword: A Case with Withdrawal-Emergent Dyskinesia. / Iki Ucu Keskin Biçak: Nöroleptik Kesilmesiyle Gelisen Diskinezi Olgusu.

Tardive dyskinesia is defined as involuntary athetoid or choreiform movements that develop due to the use of neuroleptic drugs for at least a few months. Tongue, lower face, jaw, upper and lower extremities are the most affected parts of the body in tardive dyskinesia. Quality of life is negatively affected because of the low remission rates. Besides tardive dyskinesia, involuntary movements may appear after discontinuation, change or a reduction in the dose of antipsychotic medications, which is called withdrawal-emergent dyskinesia (WED). Unlike tardive dyskinesia, the involuntary movements involve mainly the neck, trunk, and limbs and regress in shorter period of time in WED. A consensus has not yet been reached for the treatment of WED. Restarting the previous antipsychotic agent with slow titration or switching to an atypical antipsychotic with low affinity for dopamine D2 receptors are among the primary options for treatment. As WED is one of the predictors of tardive dyskinesia development, early detection and treatment is believed to have positive effect on the quality of life. In this report, the case of a patient followed up for bipolar disorder type I (BD-I) and started on clozapine for WED after discontinuation of haloperidol on account of adverse effects is discussed. It is necessary for clinicians to consider these types of complications when discontinuing or changing treatment. Further research is needed in order to reach a common approach for the treatment of WED.

Associations of Attachment and Coping Styles With Social Functioning in Patients With Bipolar Disorder I.

ABSTRACT: The aim of this study was to investigate the relationship of attachment and coping mechanisms with social functioning in patients with bipolar disorder (BD). Sixty-three patients with BD type I and 63 healthy controls were evaluated. Structured Clinical Interview for DSM-IV Axis I Disorders, Hamilton Depression Rating Scale, Young Mania Rating Scale, Experiences in Close Relationships Questionnaire II, Coping Orientation to Problems Experienced (COPE) inventory, and Social Functioning Scale were used. In the BD group, adaptive coping style scores and attachment avoidance scores were significantly lower than the control group, but mean scores of maladaptive coping styles were higher than the control group. Regression analysis showed that positive reinterpretation and growth, active coping, use of emotional social support, planning, religious activities, and mental disengagement subscales of COPE were significantly associated with social functioning. Psychosocial interventions to strengthen adaptive coping mechanisms may help improve the social functioning in patients with BD.

Antipsychotic Exposure in Pregnancy and the Risk of Gestational Diabetes: A Systematic Review and Meta-analysis.

BACKGROUND: We have limited knowledge about the effects of antipsychotic exposure on the development of gestational diabetes mellitus (GDM). Aim of this study is to perform a systematic review and meta-analysis to assess GDM risk associated with antipsychotic exposure in pregnancy. METHODS: Systematic literature search was performed using PubMed, Science Direct, Scopus, and Web of Science databases up to August 22, 2018. No restrictions to language or date were applied. Randomized, controlled trials, case-control, or cohort studies reporting GDM risk in antipsychotic-exposed, healthy controls or antipsychotic-ceased patients were included in the meta-analysis. The primary outcomes were study defined GDM, including number of events, odds ratios, and/or risk ratios (RR) with confidence intervals (CI). RESULTS: Ten studies were included in the meta-analysis. The total number of subjects was 6213 for the antipsychotic-exposed group, 6836 for antipsychotic-ceased control group, and 1 677 087 for the healthy control group. Compared with the healthy controls, the unadjusted cumulative RR for GDM associated with antipsychotic use was 1.63 (95% CI = 1.20-2.22). Adjusted risk for GDM was significantly higher in antipsychotic exposure group than in healthy controls (RR = 1.30, 95% CI = 1.023-1.660). The adjusted RR for GDM was similar between the antipsychotic-exposed group and the antipsychotic-ceased group (RR = 0.78, 95% CI = 0.281-2.164). No significant association was found between study quality, smoking, alcohol use, gestational age, and cumulative GDM risk. DISCUSSION: Our results indicate an increased risk of GDM with antipsychotic exposure in pregnant women, who may benefit from close pregnancy monitoring, early testing for GDM, targeting modifiable risk factors, and lifestyle modifications.

Glucose metabolism dysregulation at the onset of mental illness is not limited to first episode psychosis: A systematic review and meta-analysis.

AIM: To compare the differences of glucose metabolism outcomes between treatment-naïve, patients with first episode psychosis (FEP) and mood disorders. METHODS: We conducted a systematic review and meta-analysis of glucose intolerance in treatment-naïve, first episode patients with severe mental illnesses (SMIs). RESULTS: We identified 31 eligible studies. Compared to healthy controls, FEP group have higher insulin and insulin resistance levels, and both groups have higher glucose tolerance test results. No significant differences were found in glucose metabolism outcomes between FEP and mood disorder groups. CONCLUSIONS: Our results highlight impaired glucose metabolism at the onset of SMIs, suggesting both patients with psychosis and mood disorders are high-risk groups for diabetes development.

An Economic Evaluation of Coordinated Specialty Care (CSC) Services for First-Episode Psychosis in the U.S. Public Sector.

BACKGROUND: Schizophrenia spectrum disorders exert a large and disproportionate economic impact. Early intervention services may be able to alleviate the burden of schizophrenia spectrum disorders on diagnosed individuals, caregivers, and society at large. Economic analyses of observational studies have supported investments in specialized team-based care for early psychosis; however, questions remain regarding the economic viability of first-episode services in the fragmented U.S. healthcare system. The clinic for Specialized Treatment Early in Psychosis (STEP) was established in 2006, to explicitly model a nationally-relevant U.S. public-sector early intervention service. The purpose of this study was to conduct an economic evaluation of STEP, a Coordinated Specialty Care service (CSC) based in a U.S. State-funded community mental health center, relative to usual treatment (UT). METHODS: Eligible patients were within 5 years of psychosis onset and had no more than 12 weeks of lifetime antipsychotic exposure. Participants were randomized to STEP or UT. The annual per-patient cost of the STEP intervention per se was estimated assuming a steady-state caseload of 30 patients. A cost-offset analysis was conducted to estimate the net value of STEP from a third-party payer perspective. Participant healthcare service utilization was evaluated at 6 months and over the entire 12 months post randomization. Generalized linear model multivariable regressions were used to estimate the effect of STEP on healthcare costs over time, and generate predicted mean costs, which were combined with the per-patient cost of STEP. RESULTS: The annual per-patient cost of STEP was $1,984. STEP participants were significantly less likely to have any inpatient or ED visits; among individuals who did use such services in a given period, the associated costs were significantly lower for STEP participants at month 12. We did not observe a similar effect with regard to other healthcare services. The predicted average total costs were lower for STEP than UT, indicating a net benefit for STEP of $1,029 at month 6 and $2,991 at month 12; however, the differences were not statistically significant. CONCLUSIONS: Our findings are promising with regard to the value of STEP to third-party payers.

How accurate are self-reported height and weight in the seriously mentally ill?

AIMS: (1) Determine the accuracy of self-reported height, weight, and body mass index (BMI) calculated from those values in a population suffering from both serious mental illness (SMI) and overweight/obesity; (2) identify any associations that may predict error in self-reported measurements. Data were collected from screening appointments for two clinical trials for adult patients with SMI and overweight/obesity (BMI > 28) who gained weight while on antipsychotic medications. Both studies were conducted at the same urban community mental health center. Differences in self-reported and measured height, weight, and BMI were calculated. Analysis included age, sex, race, psychiatric diagnosis, and level of education. BMI calculated from self-reported height and weight were significantly lower (-0.47kg/m2) than measured values. Height was significantly overestimated (1.04cm), while weight was underestimated (0.055kg). Men underestimated BMI more than women (0.55 vs. 0.41kg/m2). Increasing age correlated with lower accuracy of self-reported height and BMI. No differences due to psychiatric diagnosis, race, or education were found. BMI calculated from self-reported height and weight from patients with SMI and overweight/obesity is as accurate as the self-reported measurements collected from the general population and, while measurement is best, self-reports can be used as a tool for screening for obesity.

Antipsychotic-induced weight gain in first-episode psychosis patients: a meta-analysis of differential effects of antipsychotic medications.

AIM: The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and metabolic morbidity decades later. Antipsychotic (AP)-induced weight gain is one modifiable factor in this period. The purpose of this study is to conduct a meta-analysis of AP-induced weight and body mass index (BMI) change in FEP. METHODS: A comprehensive literature search identified 28 articles that reported data on AP-specific weight or BMI change in FEP. We conducted a meta-analysis of short- and long-term mean weight and BMI differences between placebo and AP medications. We also performed subgroup and meta-regression analysis to examine weight, BMI outcomes and their relationship with location (Asian vs. Western), sponsorship and baseline weight and BMIs. RESULTS: Compared to placebo, AP-caused mean weight gain was 3.22 kg and 1.4 points BMI in the short-term, and 5.30 kg and 1.86 points BMI in the long term. Clinically significant weight gain risk increased about twofold with AP use. Weight gain was associated with duration of AP use. AP medications were associated with more weight gain in Western samples as opposed to Asian samples. Most AP medications were associated with significant body weight gain and BMI increase in FEP patients, except for ziprasidone. Olanzapine and clozapine caused the highest weight gain compared to placebo. CONCLUSION: Except for ziprasidone, most AP medications were associated with body weight gain and BMI increase in FEP patients. Early and continuing effects of various AP medications on weight gain and BMI increase should be taken into consideration by clinicians.

Antipsychotic-Induced Weight Gain in First-Episode Psychosis Patients: A Meta-Analysis of Differential Effects of Antipsychotic Medications.

(Reprinted with permission from Early Intervention in Psychiatry 2016; 10:193-202).

Optimal management of night eating syndrome: challenges and solutions.

Night Eating Syndrome (NES) is a unique disorder characterized by a delayed pattern of food intake in which recurrent episodes of nocturnal eating and/or excessive food consumption occur after the evening meal. NES is a clinically important disorder due to its relationship to obesity, its association with other psychiatric disorders, and problems concerning sleep. However, NES often goes unrecognized by both health professionals and patients. The lack of knowledge regarding NES in clinical settings may lead to inadequate diagnoses and inappropriate treatment approaches. Therefore, the proper diagnosis of NES is the most important issue when identifying NES and providing treatment for this disorder. Clinical assessment tools such as the Night Eating Questionnaire may help health professionals working with populations vulnerable to NES. Although NES treatment studies are still in their infancy, antidepressant treatments and psychological therapies can be used for optimal management of patients with NES. Other treatment options such as melatonergic medications, light therapy, and the anticonvulsant topiramate also hold promise as future treatment options. The purpose of this review is to provide a summary of NES, including its diagnosis, comorbidities, and treatment approaches. Possible challenges addressing patients with NES and management options are also discussed.

First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial.

OBJECTIVE: This study sought to determine the effectiveness of a comprehensive first-episode service, the clinic for Specialized Treatment Early in Psychosis (STEP), in an urban U.S. community mental health center by comparing it with usual treatment. METHODS: This pragmatic randomized controlled trial enrolled 120 patients with first-episode psychosis within five years of illness onset and 12 weeks of antipsychotic exposure. Referrals were mostly from inpatient psychiatric units, and enrollees were randomly allocated to STEP or usual treatment. Main outcomes included hospital utilization (primary); the ability to work or attend age-appropriate schooling-or to actively seek these opportunities (vocational engagement); and general functioning. Analysis was by modified intent to treat (excluding only three who withdrew consent) for hospitalization; for other outcomes, only data for completers were analyzed. RESULTS: After one year, STEP participants had less inpatient utilization compared with those in usual treatment: no psychiatric hospitalizations, 77% versus 56% (risk ratio [RR]=1.38, 95% confidence interval [CI]=1.08-1.58); mean hospitalizations, .33±.70 versus .68±.92 (p=.02); and mean bed-days, 5.34±13.53 versus 11.51±15.04 (p=.05). For every five patients allocated to STEP versus usual treatment, one additional patient avoided hospitalization over the first year (number needed to treat=5; CI=2.7-26.5). STEP participants also demonstrated better vocational engagement (91.7% versus 66.7%; RR=1.40, CI=1.18-1.48) and showed salutary trends in global functioning measures. CONCLUSIONS: This trial demonstrated the feasibility and effectiveness of a U.S. public-sector model of early intervention for psychotic illnesses. Such services can also support translational research and are a relevant model for other serious mental illnesses.

Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study.

BACKGROUND: Early intervention services for psychotic disorders optimally interlock strategies to deliver: (i) Early Detection (ED) to shorten the time between onset of psychotic symptoms and effective treatment (i.e. Duration of Untreated Psychosis, DUP); and (ii) comprehensive intervention during the subsequent 2 to 5 years. In the latter category, are teams ('First-episode Services' or FES) that integrate several empirically supported treatments and adapt their delivery to younger patients and caregivers. There is an urgent need to hasten access to established FES in the U.S. Despite improved outcomes for those in treatment, these FES routinely engage patients a year or more after psychosis onset. The Scandinavian TIPS study was able to effectively reduce DUP in a defined geographic catchment. The guiding questions for this study are: can a U.S. adaptation of the TIPS approach to ED substantially reduce DUP and improve outcomes beyond existing FES? METHODS/DESIGN: The primary aim is to determine whether ED can reduce DUP in the US, as compared to usual detection. ED will be implemented by one FES (STEP) based in southern Connecticut, and usual detection efforts will continue at a comparable FES (PREP(R)) serving the greater Boston metropolitan area. The secondary aim is to determine whether DUP reduction can improve presentation, engagement and early outcomes in FES care. A quasi-experimental design will compare the impact of ED on DUP at STEP compared to PREP(R) over 3 successive campaign years. The campaign will deploy 3 components that seek to transform pathways to care in 8 towns surrounding STEP. Social marketing approaches will inform a public education campaign to enable rapid and effective help-seeking behavior. Professional outreach and detailing to a wide variety of care providers, including those in the healthcare, educational and judicial sectors, will facilitate rapid redirection of appropriate patients to STEP. Finally, performance improvement measures within STEP will hasten engagement upon referral. DISCUSSION: STEP-ED will test an ED campaign adapted to heterogeneous U.S. pathways to care while also improving our understanding of these pathways and their impact on early outcomes. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02069925 . Registered 20 February 2014.

Childhood trauma and dissociation in tertiary care patients with migraine and tension type headache: a controlled study.

OBJECTIVE: The aims of this study were: i) to compare the severity of somatoform and psychoform dissociation and childhood trauma among migraine patients, tension-type headache patients (TTH), and healthy controls; and, ii) to identify any relationships between headache characteristics and dissociative symptoms and traumatic childhood experiences among tertiary care patients with headache. METHODS: The study sample consisted of 79 patients with migraine, 49 patients with TTH and 40 healthy controls. They completed the socio-demographic form, Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), and the Somatoform Dissociation Questionnaire (SDQ). RESULTS: The average score for childhood emotional abuse was significantly higher in the TTH and migraine patients than in healthy controls; mean scores for emotional neglect and physical abuse were higher in TTH patients than healthy controls; and the total CTQ score was higher in TTH patients than in either migraine patients or healthy controls. Average DES scores were significantly higher in TTH patients versus migraine patients and controls; and SDQ scores were higher in both headache groups than in controls. Headache duration and severity were found to be significantly related to childhood abuse scores among migraine but not TTH patients. CONCLUSION: Our findings support the evidence of a relationship between childhood trauma and migraines, and suggest that childhood traumatic events are common and deleteriously effect migraine characteristics. Also our study suggests that childhood trauma may have a role in TTH. Significant differences in the DES and SDQ scores between groups may be explained by the differences in childhood trauma experiences.