Prevalence and Correlates of the Concurrence of Autism Spectrum Disorder and Obsessive Compulsive Disorder in Children and Adolescents: A Systematic Review and Meta-Analysis.

BACKGROUND: Autism spectrum disorder (ASD) and obsessive compulsive disorder (OCD) are two common and impairing neurodevelopmental conditions with partial symptomatic overlap. The aim of this study is to systematically and meta-analytically examine the following: (i) the prevalence of an OCD diagnosis among young people with ASD, (ii) the prevalence of an ASD diagnosis among young people with OCD, and (iii) the clinical and therapeutic implications of such comorbidity. METHOD: A multistep literature search was performed from database inception until 17 November 2023. This PRISMA/MOOSE-compliant systematic review, registered in PROSPERO (CRD42023480543), identified studies reporting on the prevalence, sociodemographic, psychopathologic, prognostic, and therapeutic correlates of OCD and ASD concurrence in children and adolescents. A quantitative meta-analysis with random effects was conducted to analyse the pooled prevalence of OCD among samples with a mean age of < 18 years old with ASD and the prevalence of ASD among individuals under 18 with OCD. Sensitivity analyses were performed to investigate the effect of diagnostic criteria and different continents. Meta-regression analyses were conducted to examine the effect of gender, age, IQ, and OCD severity scores. A narrative review of the clinical and therapeutical implications of the comorbidity was provided. RESULTS: 42 studies were selected for the systematic review (SR), and 31 of them were also included in one of the meta-analyses. The pooled prevalence of OCD among ASD youth samples (n = 8916, mean age = 10.6 ± 1.6; 16.4% female) was 11.6% (95% confidence intervals [CI] = 6.9%; 18.8%), and the pooled prevalence of ASD among OCD children and adolescent samples (n = 6209, mean age = 14.1 ± 1.4; 45.7% female) was 9.5% (95% CI = 6.0%; 14.7%). Meta-regressions found a statistically higher prevalence of ASD among samples with a lower prevalence of females (ß = -4.7; 95%CI = -8.6; -0.8). Children with both OCD and ASD present higher rates of functional impairment, psychopathology, and other comorbidities, compared to youth with either of the disorders alone. CONCLUSIONS: OCD and ASD are highly concurrent conditions in youth, with symptomatic, prognostic, severity, and therapeutic implications. Future research should focus on conducting longitudinal cohort studies prospectively to determine development trajectories, along with randomized controlled trials to assess the efficacy of specific therapeutic interventions.

The magnitude and variability of neurocognitive performance in first-episode psychosis: a systematic review and meta-analysis of longitudinal studies.

Neurocognitive deficits are a core feature of psychotic disorders, but it is unclear whether they affect all individuals uniformly. The aim of this systematic review and meta-analysis was to synthesize the evidence on the magnitude, progression, and variability of neurocognitive functioning in individuals with first-episode psychosis (FEP). A multistep literature search was conducted in several databases up to November 1, 2022. Original studies reporting on neurocognitive functioning in FEP were included. The researchers extracted the data and clustered the neurocognitive tasks according to the seven Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) domains and six additional domains. Random-effect model meta-analyses, assessment of publication biases and study quality, and meta-regressions were conducted. The primary effect size reported was Hedges g of (1) neurocognitive functioning in individuals at FEP measuring differences with healthy control (HC) individuals or (2) evolution of neurocognitive impairment across study follow-up intervals. Of 30,384 studies screened, 54 were included, comprising 3,925 FEP individuals and 1,285 HC individuals. Variability analyses indicated greater variability in FEP compared to HC at baseline and follow-up. We found better neurocognitive performance in the HC group at baseline and follow-up but no differences in longitudinal neurocognitive changes between groups. Across the 13 domains, individuals with FEP showed improvement from baseline in all studied domains, except for visual memory. Metaregressions showed some differences in several of the studied domains. The findings suggest that individuals with FEP have marked cognitive impairment, but there is greater variability in cognitive functioning in patients than in HC. This suggests that subgroups of individuals suffer severe disease-related cognitive impairments, whereas others may be much less affected. While these impairments seem stable in the medium term, certain indicators may suggest potential further decline in the long term for a specific subgroup of individuals, although more research is needed to clarify this. Overall, this study highlights the need for tailored neurocognitive interventions for individuals with FEP based on their specific deficits and progression.

Substance use during pregnancy and risk of postpartum depression: a systematic review and meta-analysis.

Introduction: Postpartum depression (PPD) is a prevalent mental health condition affecting women globally within the first year following childbirth. Substance use during pregnancy has been associated with an increased risk of developing PPD, but the evidence remains inconclusive. This meta-analysis aims to comprehensively assess the effects of different substances on PPD risk, exploring potential modifiers and confounding factors. Objectives: To examine the proportion of PPD among substance users during pregnancy, compared to non-users, and investigate the specific risk associated with different substances (tobacco, alcohol, and non-specified substance use/multiple substance use). Methods: A systematic literature search was conducted from inception to November 2022 using the Web of Science database (Clarivate Analytics), incorporating Web of Science Core Collection, the BIOSIS Citation Index, the KCI-Korean Journal Database, MEDLINE®, the Russian Science Citation Index, the SciELO Citation Index, and the Cochrane Central Register of Reviews, and Ovid/PsycINFO databases. Inclusion criteria comprised original studies with pregnant women, using validated depression scales and substance use reporting. Results: Among the 26 included studies, encompassing 514,441 women, the pooled prevalence of PPD among substance users during pregnancy was 29% (95% CI 25-33). Meta-analyzes revealed an overall odds ratio (OR) of 3.67 (95% CI 2.31-5.85, p < 0.01) indicating a significantly higher risk of PPD among substance users compared to non-users. Subgroup analyzes demonstrated a higher risk for women with non-specified or multiple substance use (OR 4.67, 95% CI 2.59-8.41; p < 0.01) and tobacco use (OR 4.01, 95% CI 2.23-7.20; p < 0.01). Alcohol use showed a trend toward higher risk that did not reach statistical significance (OR 1.88, 95% CI 1.00-3.55; p = 0.051). Conclusion: This meta-analysis provides evidence of an increased risk of PPD among pregnant substance users, particularly those using multiple substances or tobacco. However, caution is needed in interpreting the association with alcohol use due to its non-significant result. Systematic review registration: This study protocol was registered at PROSPERO (registration number: CCRD42022375500).

Understanding the relationship between time spent outdoors, mental well-being and health-related behaviours in a Spanish sample: A real time smartphone-based study.

INTRODUCTION: COVID-19 pandemic has affected our lifestyle and physical and mental well-being. We aimed to study the effect of being outdoors and mental well-being after the COVID-19 pandemic. MATERIAL AND METHODS: We used smartphone based ecological momentary assessments (EMA) (Urban Mind app) to study the mental well-being of the Spanish general population. We collected socio-demographic data, past and current physical and mental health, and social and physical environment. Participants were recruited during 5 months (February to June 2021). Longitudinal associations between EMA and anxiety, depression, loneliness, tiredness, and happiness during the assessments were investigated using random intercept ordinal logistic regression models. RESULTS: 274 subjects downloaded the app and completed the baseline assessment. 66 participants completed at least 50 % of the assessments. Being outdoors was related to a lower likelihood of anxiety (OR: 0.48, 95 %CI 0.34-0.66), depression (OR: 0.40, 95 %CI 0.28-0.56), tiredness (OR: 0.47, 95 %CI 0.35-0.63), and loneliness (OR: 0.59, 95 %CI 0.42-0.84), and a higher likelihood of happiness (OR: 2.14, 95 %CI 1.57-2.93). CONCLUSIONS: Being outdoors is related to better mental health in the general population independently of other factors (baseline mental well-being or socio-demographic characteristics). Public policies should include measurements to promote outdoor spaces in urban settings.

Relationship between elimination disorders and internalizing-externalizing problems in children: A systematic review and meta-analysis.

Background: Elimination disorders are highly prevalent in childhood and often associated with clinically relevant comorbid psychological disorders. The aim of this study is to determine if, and to what extent, children with elimination disorders show higher internalizing and externalizing problems than their healthy peers. Methods: A multistep literature search was performed from database inception until May 1st, 2022. PRISMA/MOOSE-compliant systematic review (PROSPERO: CRD42022303555) were used to identify studies reporting on internalizing and/or externalizing symptoms in children with an elimination disorder and a healthy control (HC) group. First, a systematic review was provided. Second, where data allowed for it, a quantitative meta-analysis with random effects model was conducted to analyze the differences between the elimination disorder and the HC groups for internalizing and externalizing symptoms. Effect size was standardized mean difference. Meta-regression analyses were conducted to examine the effect of sex, age, and study quality. Funnel plots were used to detect a publication bias. Where found, the trim and fill method was used to correct it. Results: 36 articles were included, 32 of them reporting on enuresis (n = 3244; mean age = 9.4; SD = 3.4; 43.84% female) and 7 of them on encopresis (n = 214; mean age = 8.6; SD = 2.3; 36.24% female). Children with an elimination disorder presented significantly lower self-concept (ES:0.42; 95%CI [0.08; 9.76]; p = 0.017) and higher symptom scores for thought problems (ES:-0.26; 95%CI: -0.43;-0.09]; p = 0.003), externalizing symptoms (ES: -0.20; 95%CI [-0.37;-0.03]; p = 0.020), attention problems (ES:-0.37; 95%CI [-0.51;-0.22]; p = 0.0001), aggressive behavior (ES:-0.33; 95%CI [-0.62;-0.04]; p = 0.025) and social problems (ES:-0.39; 95%CI [-0.58;-0.21]; p = 0.0001). Significant publication biases were found across several of the studied domains. No significant effect of sex, age or quality of the study score was found. Conclusions: Children with an elimination disorder may have significant internalizing and externalizing problems, as well as impaired self-concept. It is recommendable to screen for them in children with enuresis or encopresis and provide appropriate interventions.

Longitudinal change in neurocognitive functioning in children and adolescents at clinical high risk for psychosis: a systematic review.

Clinical high risk of psychosis (CHR-P) population has become an attractive area of interest in preventing transitions to psychosis. The consequences of developing a psychotic disorder may be worse in cases of early onset. Thus, childhood and adolescence represent a critical developmental window, where opportunities to gain social and adaptive abilities depend on the individuals' neurocognitive performance. There have been previous syntheses of the evidence regarding neurocognitive functioning in CHR-P individuals and its longitudinal changes. However, there has been less focus on children and adolescents at CHR-P. A multistep literature search was performed from database inception until July 15th, 2022. PRIMSA/MOOSE compliant systematic review and PROSPERO protocol were used to identify studies reporting on longitudinal changes in neurocognitive functioning in children and adolescents (mean age of sample ≤ 18 years) at CHR-P and matched healthy control (HC) group. A systematic review of identified studies was then undertaken. Three articles were included, resulting in a total sample size of 151 CHR-P patients [mean (SD) age, 16.48 (2.41) years; 32.45% female] and 64 HC individuals [mean (SD) age, 16.79 (2.38) years; 42.18% female]. CHR-P individuals had worse outcomes in verbal learning, sustained attention and executive functioning domains compared to HC. Individuals taking antidepressants had better outcomes in verbal learning in contrast with those taking antipsychotics. In children and adolescents, neurocognition may be already impaired before the psychosis onset, and remains stable during the transition to psychosis. Further study should be performed to obtain more robust evidence.

Prolactin and morning cortisol concentrations in antipsychotic naïve first episode psychosis: A systematic review and meta-analysis.

IMPORTANCE: Alterations in prolactin and cortisol levels have been reported in antipsychotic naïve patients with first episode psychosis (FEP). However, it has been studied in very small samples, and inter-group variability has never been studied before. OBJECTIVE: To provide estimates of standardized mean differences (SMD) and inter-group variability for prolactin, cortisol awakening response (CAR) and morning cortisol concentrations in antipsychotic naïve FEP (AN-FEP) patients and healthy controls (HC). DATA SOURCES: BIOSIS, KCI, MEDLINE, Russian Science Citation Index, SciELO, Cochrane, PsycINFO, Web of Science were searched from inception to February 28, 2022. STUDY SELECTION: Peer-reviewed cohort studies that reported on prolactin or cortisol blood concentrations in AN- FEP patients and HC were included. DATA EXTRACTION AND SYNTHESIS: Study characteristics, means and standard deviations (SD) were extracted from each article. Inter group differences in magnitude of effect were estimated using Hedges g. Inter-group variability was estimated with the coefficient of variation ratio (CVR). In both cases estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression. PRISMA guideline was followed (No. CRD42022303555). MAIN OUTCOMES AND MEASURES: Prolactin, CAR and morning cortisol blood concentrations in AN-FEP group in relation to HC group. RESULTS: Fourteen studies for prolactin (N = 761 for AN-FEP group, N = 687 for HC group) and twelve studies for morning cortisol (N = 434 for AN-FEP group, N = 528 for HC group) were included. No studies were found in CAR in AN-FEP patients. Mean SMD for prolactin blood concentration was 0.88 (95% CI 0.57, 1.20) for male and 0.56 (95% CI 0.26, 0.87) for female. As a group, AN-FEP presented greater inter-group variability for prolactin levels than HC (CVR=1.28, 95% CI 1.02, 1.62). SMD for morning cortisol concentrations was non-significant: 0.34 (95% CI -0.01, 0.69) and no inter-group variability significant differences were detected: CVR= 1.05 (95% CI 0.91, 1.20). Meta-regression analyses for age and quality were non-significant. Funnel plots did not suggest a publication bias. CONCLUSIONS AND RELEVANCE: Increased prolactin levels were found in AN-FEP patients. A greater inter-group variability in the AN-FEP group suggests the existence of patient subgroups with different prolactin levels. No significant abnormalities were found in morning cortisol levels. Further research is needed to clarify whether prolactin concentrations could be used as an illness biomarker.

Psychological impact of COVID-19 lockdown on a population with serious mental illness. A prospective cohort study.

Introduction: COVID-19 has spread worldwide since its appearance at the end of 2019. In Spain, 99-day long home confinement was set from March 15th 2020. Previous studies about events requiring situations of isolation suggested that mental health problems may occur among the general population and, more specifically, vulnerable groups such as individuals with serious mental illness (SMI). This study aims to assess the psychological effect of confinement in patients with mental illness admitted to an inpatient psychiatric unit. Method: In this longitudinal study, IDER (State-Trait Depression Inventory) and STAI (State-Trait Anxiety Inventory) questionnaires were used at two different times (at the beginning and after the lockdown) of the pandemic to evaluate the depression and anxiety symptoms, respectively, in a population of patients who had been previously admitted to the Psychiatry Unit of the Basurto University Hospital. Results: 95 participants completed the IDER questionnaire in the first measurement, with a mean score of 24.56 (SD = 8.18) for state and 23.57 (SD = 8.14) for trait. In the case of STAI, the mean score was 27.86 (SD = 15.19) for the state and 30.49 (SD = 14.71) for the trait. No differences between the first and the second time were found in anxiety and depression levels. People with personality disorders presented high levels of anxiety. Conclusions: Individuals with a personality disorder showed the highest scores in anxiety and depression. Nevertheless, strict confinement did not affect this population, despite the literature that evidences that the pandemic has worsened people's mental health with SMI.

Introducción: El COVID-19 se ha extendido ampliamente desde su aparición a finales del año 2019. En España se estableció un confinamiento domiciliario que comenzó el 15 de marzo de 2020 y tuvo una duración de 99 días. Estudios previos sobre situaciones que implican aislamiento indican un empeoramiento en la salud mental de la población general, y específicamente en personas con un trastorno mental grave. El objetivo de este estudio es evaluar el efecto psicológico del confinamiento en pacientes con trastorno mental grave. Método: Se emplearon los cuestionarios IDER (State-Trait Depression Inventory) y STAI (State-Trait Anxiety Inventory) al inicio del confinamiento y después del mismo, para evaluar síntomas de depresión y ansiedad, respectivamente, en una población de pacientes que habían precisado previamente un ingreso hospitalario en la unidad de hospitalización psiquiátrica en el Hospital universitario de Basurto. Resultados: En la primera evaluación, 95 participantes completaron el cuestionario IDER, obteniendo una puntuación media de 24,56 (DE = 8,18) para el estado y 23,57 (DE = 8,14) para el rasgo. En el cuestionario STAI se obtuvo una puntuación media de 27,86 (DE = 15,19) para el estado y de 30,49 (DE = 14,71) para el rasgo. No se hallaron diferencias entre los niveles de ansiedad y depresión de las 2 evaluaciones. Los individuos con trastorno de la personalidad presentaron altos niveles de ansiedad. Conclusiones: Los individuos con trastorno de la personalidad obtuvieron los resultados más altos en ansiedad y depresión. El confinamiento estricto no afectó a esta población, a pesar de la evidencia existente sobre un empeoramiento en la salud mental en pacientes con trastorno mental grave durante la pandemia.