Evaluating the Interrater Reliability of the Icelandic Version of K-SADS-PL DSM-5.

The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) is a valuable tool for diagnosing mental disorders in children and adolescents. Previous studies have examined its interrater reliability, but there is limited information on individual disorders, on the updated DSM-5 version. This study aims to analyse the interrater reliability of the Icelandic translation of K-SADS-PL, DSM-5 version. K-SADS-PL was administered to a clinical sample of outpatients from the Icelandic Anxiety Centre for Children, Adolescents, and Young Adults, and The Department of Child and Adolescent Psychiatry at Landspítali, the National University Hospital in Reykjavík, Iceland. In total, 135 patients aged 6-18 were included in this study. We assessed the interrater reliability using Cohen's κ, with results ranging from poor to excellent (0.3-1.0), though most disorders showed excellent reliability (κ > 0.75). The Icelandic translation of the DSM-5 K-SADS-PL is generally reliable when used by properly trained post-graduate students, which supports its use in clinical settings.

Appraisals of Social Trauma and Their Role in the Development of Post-Traumatic Stress Disorder and Social Anxiety Disorder.

Cognitive theories of post-traumatic stress disorder (PTSD) feature appraisal of trauma as a critical factor in the development and maintenance of the disorder. Here we explored appraisals of social trauma (severe rejection or humiliation). Participants were outpatients with social anxiety disorder (SAD) and clinically significant PTSD symptoms (PTSS) after social trauma (n = 15); two clinical control groups of either SAD (n = 32) or obsessive-compulsive disorder (OCD; n = 13); and a control group with no diagnoses (n = 38). Measures included a clinical interview to assess social trauma and related open-ended appraisals and the Posttraumatic Cognitions Inventory (PTCI). Raters blind to group assignment performed content analyses of appraisals. Results showed that the PTSS group scored significantly higher than either clinical group on the PTCI SELF subscale. Only the SELF subscale predicted a diagnosis of both PTSS and SAD. All but one PTSS participant reported primarily negative beliefs about their social trauma, and the most common categories were flawed self and others are critical or cruel. Post-traumatic appraisals implicated in the course of PTSD are significant in how individuals respond to social trauma, with negative self-cognitions linked to both PTSS and SAD.

The half-painted picture: Reviewing the mental health impacts of cancer screening.

Cancer screening is recommended for select cancers worldwide. Cancer screening has become increasingly effective and accessible and often increases overall survival. However, the mental health effects of cancer screening, such as its impact on depression, anxiety, and post-traumatic stress disorder, are largely unknown. Conflicting available literature indicates the negative, neutral, and positive mental health effects of cancer screening across cancer types. There are a limited number of randomized controlled trials measuring the mental health effects of cancer screening. Overall, the more negative and life-threatening the screening results, the greater the mental health effects. Screening for cancer without a known precursor, for example, due to family history, can have positive impacts such as decreased worry and increased quality of life. However, receiving a cancer diagnosis often has negative mental effects that increase with the life-threatening potential of malignancy. In this study, we review the existing literature and provide recommendations for future research to determine if and when cancer screening is the best practice.

The first wave of COVID-19 and concurrent social restrictions were not associated with a negative impact on mental health and psychiatric well-being.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and efforts to contain it have substantially affected the daily lives of most of the world's population. OBJECTIVE: We describe the impact of the first COVID-19 wave and associated social restrictions on the mental health of a large adult population. METHODS: We performed a cohort study nested in a prospective randomized clinical trial, comparing responses during the first COVID-19 wave to previous responses. We calculated the odds ratio (OR) of the population moving up one severity category on validated instruments used to measure stress (PSS-10), anxiety (GAD-7), depression (PHQ-9), and Satisfaction With Life Scale (SWLS). Responses were linked to inpatient and outpatient ICD-10 codes from registries. Models were adjusted for age, sex, comorbidities, and pre-existing diagnoses of mental illness. RESULTS: Of 63,848 invited participants, 42,253 (66%) responded. The median age was 60 (inter-quartile range 53-68) and 19,032 (45%) were male. Responses during the first wave of COVID-19 did not suggest increased stress (OR 0.97; 95% confidence interval [CI], 0.93-1.01; p = 0.28) or anxiety (OR 1.01; 95% CI, 0.96 to 1.05; p = 0.61), but were associated with decreased depression (OR 0.89; 95% CI, 0.85-0.93, p < 0.0001) and increased satisfaction with life (OR 1.12; 95% CI, 1.08-1.16, p < 0.0001). A secondary analysis of repeated measures data showed similar results. CONCLUSIONS: Social restrictions were sufficient to contain the pandemic but did not negatively impact validated measures of mental illness or psychiatric well-being. However, responses to individual questions showed signs of fear and stress. This may represent a normal, rather than pathological, population response to a stressful situation.

Iceland screens, treats, or prevents multiple myeloma (iStopMM): a population-based screening study for monoclonal gammopathy of undetermined significance and randomized controlled trial of follow-up strategies.

Monoclonal gammopathy of undetermined significance (MGUS) precedes multiple myeloma (MM). Population-based screening for MGUS could identify candidates for early treatment in MM. Here we describe the Iceland Screens, Treats, or Prevents Multiple Myeloma study (iStopMM), the first population-based screening study for MGUS including a randomized trial of follow-up strategies. Icelandic residents born before 1976 were offered participation. Blood samples are collected alongside blood sampling in the Icelandic healthcare system. Participants with MGUS are randomized to three study arms. Arm 1 is not contacted, arm 2 follows current guidelines, and arm 3 follows a more intensive strategy. Participants who progress are offered early treatment. Samples are collected longitudinally from arms 2 and 3 for the study biobank. All participants repeatedly answer questionnaires on various exposures and outcomes including quality of life and psychiatric health. National registries on health are cross-linked to all participants. Of the 148,704 individuals in the target population, 80 759 (54.3%) provided informed consent for participation. With a very high participation rate, the data from the iStopMM study will answer important questions on MGUS, including potentials harms and benefits of screening. The study can lead to a paradigm shift in MM therapy towards screening and early therapy.

Age-related differences in borderline personality disorder symptom networks in a transdiagnostic sample.

BACKGROUND: Naturalistic longitudinal studies of Borderline Personality Disorder (BPD) indicate that symptoms improve over time. In the present study, we applied network theory to the question of how BPD symptom networks may differ as a function of age. METHODS: In a transdiagnostic sample of 5,212 patients presenting for acute psychiatric treatment, we administered a measure of BPD symptoms and then used a novel machine learning technique to test the hypothesis that symptom networks would significantly differ across the age of participants. RESULTS: Results supported two significant differences in the BPD symptom network that emerged at age 46. In older participants, the relationships among symptoms of non-suicidal self-injury/suicide and emptiness was weaker, yet the relationship between anger and relationship problems was stronger. No differences emerged for relationships between all other symptoms. LIMITATIONS: Given the cross-sectional nature of this study, the potential influence of cohort effects cannot be ruled out. CONCLUSIONS: These findings support the utility of network theory for elucidating potential pathways by which the relationships between symptoms of BPD may differ as a function of age in treatment-seeking individuals. In parallel, results of this study support the highly central role of strong emotions in BPD regardless of age.

Social trauma and its association with posttraumatic stress disorder and social anxiety disorder.

The key characteristic of a traumatic event as defined by the Diagnostic and Mental Manual of Mental Disorders (DSM) seems to be a threat to life. However, evidence suggests that other types of threats may play a role in the development of PTSD and other disorders such as social anxiety disorder (SAD). One such threat is social trauma, which involves humiliation and rejection in social situations. In this study, we explored whether there were differences in the frequency, type and severity of social trauma endured by individuals with a primary diagnosis of SAD (n = 60) compared to a clinical control group of individuals with a primary diagnosis of obsessive compulsive disorder (OCD, n = 19) and a control group of individuals with no psychiatric disorders (n = 60). The results showed that most participants in this study had experienced social trauma. There were no clear differences in the types of experiences between the groups. However, one third of participants in the SAD group (but none in the other groups) met criteria for PTSD or suffered from clinically significant PTSD symptoms in response to their most significant social trauma. This group of SAD patients described more severe social trauma than other participants. This line of research could have implications for theoretical models of both PTSD and SAD, and for the treatment of individuals with SAD suffering from PTSD after social trauma.

Icelandic translation and reliability data on the DSM-5 version of the schedule for affective disorders and schizophrenia for school-aged children - present and lifetime version (K-SADS-PL).

BACKGROUND: The Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) is a semi-structured interview based on the Diagnostic and Statistical Manual of Mental Disorders (DSM), and assesses past and present symptoms in children aged 6-18 years old. It has been translated into more than 20 languages and is widely used in clinical work. The K-SADS-PL has recently been revised by adopting new DSM-5 disorders and modifying probes accordingly. However, research on this revision is critically limited. The objective of this study was to examine the inter-rater reliability of the DSM-5 K-SADS-PL when administered by postgraduate students after receiving thorough training and supervision. METHOD: The DSM-5 K-SADS-PL was applied in a clinical sample of two outpatient units: The outpatient unit of the Department of Child and Adolescent Psychiatry at the Landspítali University Hospital in Reykjavík, Iceland and The Icelandic Anxiety Centre for Children, Adolescents and Young Adults. RESULTS: Fourty-one (80%) consecutive patients aged 6-18 years consented and were included. Cohen's κ was calculated to estimate inter-rater reliability, with estimates ranging from fair to excellent (κ = 0.57-0.90), with most diagnoses in the excellent range (κ > 0.75). CONCLUSIONS: These results indicate that the Icelandic translation of the DSM-5 K-SADS-PL can be reliably administered by postgraduate students.

Prevalence and Characteristics of Body Dysmorphic Disorder Among Patients in a Partial Hospital Program.

Body dysmorphic disorder (BDD) is a common disorder that is usually associated with impaired functioning and high levels of suicidality. The current study is the first to assess prevalence of BDD among patients in a partial hospital program and compare patients with and without BDD on demographic and clinical variables. Participants were 207 patients with a variety of Axis I diagnoses. Prevalence of current BDD was 7.2%, and a diagnosis of BDD did not predict worse treatment outcome in the program. Patients with current BDD were more likely to be female and younger and have more comorbid diagnoses than patients without current BDD. No other significant differences were found at baseline between patients with and without current BDD. Results indicate that BDD is relatively common among patients in partial hospital programs and that such programs may be as beneficial to patients with BDD as to other patients.

The role of emotion regulation strategies and dissociation in non-suicidal self-injury for women with borderline personality disorder and comorbid eating disorder.

Different dysfunctional emotion regulation strategies are observed in patients with borderline personality disorder (BPD) and comorbid eating disorders (EDs) who report non-suicidal self-injury (NSSI). The objective of this study was to investigate the relationship of two well-defined emotion regulation strategies (i.e. expressive suppression and cognitive reappraisal) and dissociation with NSSI. The participants were sixty-eight women diagnosed with BPD and comorbid ED. A cross-sectional research design was used, and clinical interviews and self-report questionnaires were administered to collect data. Multiple regression was conducted to analyze the relationship of two emotion regulation strategies and dissociation with NSSI. According to the results, for low cognitive reappraisal scores, an increase in dissociation leads to an increase in NSSI; however, as cognitive reappraisal increases, higher dissociation is associated with fewer NSSI. When expressive suppression is low, an increase in cognitive reappraisal is associated with a decrease in NSSI; however, as suppression increases, a higher cognitive reappraisal has less effect on decreasing NSSI. These findings indicate that cognitive reappraisal reduces the harmful effects that dissociation has on NSSI, and that expressive suppression interferes with the beneficial effects of cognitive reappraisal on NSSI. Therefore, targeting expressive suppression before cognitive reappraisal is conducted may enhance treatment outcomes for patients with BPD and comorbid ED.