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1.
JAMA Psychiatry ; 78(4): 380-386, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33502436

RESUMO

Importance: To date, the association of psychiatric diagnoses with mortality in patients infected with coronavirus disease 2019 (COVID-19) has not been evaluated. Objective: To assess whether a diagnosis of a schizophrenia spectrum disorder, mood disorder, or anxiety disorder is associated with mortality in patients with COVID-19. Design, Setting, and Participants: This retrospective cohort study assessed 7348 consecutive adult patients for 45 days following laboratory-confirmed COVID-19 between March 3 and May 31, 2020, in a large academic medical system in New York. The final date of follow-up was July 15, 2020. Patients without available medical records before testing were excluded. Exposures: Patients were categorized based on the following International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnoses before their testing date: (1) schizophrenia spectrum disorders, (2) mood disorders, and (3) anxiety disorders. Patients with these diagnoses were compared with a reference group without psychiatric disorders. Main Outcomes and Measures: Mortality, defined as death or discharge to hospice within 45 days following a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result. Results: Of the 26 540 patients tested, 7348 tested positive for SARS-CoV-2 (mean [SD] age, 54 [18.6] years; 3891 [53.0%] women). Of eligible patients with positive test results, 75 patients (1.0%) had a history of a schizophrenia spectrum illness, 564 (7.7%) had a history of a mood disorder, and 360 (4.9%) had a history of an anxiety disorder. After adjusting for demographic and medical risk factors, a premorbid diagnosis of a schizophrenia spectrum disorder was significantly associated with mortality (odds ratio [OR], 2.67; 95% CI, 1.48-4.80). Diagnoses of mood disorders (OR, 1.14; 95% CI, 0.87-1.49) and anxiety disorders (OR, 0.96; 95% CI, 0.65-1.41) were not associated with mortality after adjustment. In comparison with other risk factors, a diagnosis of schizophrenia ranked behind only age in strength of an association with mortality. Conclusions and Relevance: In this cohort study of adults with SARS-CoV-2-positive test results in a large New York medical system, adults with a schizophrenia spectrum disorder diagnosis were associated with an increased risk for mortality, but those with mood and anxiety disorders were not associated with a risk of mortality. These results suggest that schizophrenia spectrum disorders may be a risk factor for mortality in patients with COVID-19.


Assuntos
Transtornos de Ansiedade , Transtornos do Humor , Esquizofrenia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , /terapia , Comorbidade , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Mortalidade , New York/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia
2.
PLoS One ; 16(1): e0244679, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33439860

RESUMO

Law enforcement officers frequently encounter people with health conditions. We sought to estimate the rates, diagnoses, and characteristics of emergency department (ED) visits among patients transported directly by law enforcement. We analyzed statewide North Carolina Emergency Department data for adults, aged 18+ years, from 2009 to 2016. We estimated transport rates using census data; categorized primary ED diagnoses into 13 major and 8 substituent categories; compared county transport rates by rurality; and examined patient characteristics. There were 136,240 patients transported by law enforcement; annual rates increased from 186.9 (per 100,000 adult residents) in 2009 to 279.2 in 2016. Among visits, 67.7% were among men, the median age was 37 years, and 20.4% resulted in a hospital admission. Most common primary diagnoses were Mental Health Diagnoses (43.1%)-including Schizophrenia and other Psychotic Disorders (7.6%), Mood Disorders (9.7%), and Alcohol and Substance Use (10.7%)-followed by Injury and Poisoning (12.4%) and Circulatory conditions (4.1%). Involuntary commitments constituted 22% of all visits. The median transport rate in rural counties, 291.1, was 2 times that of large metro counties, 145.1. The visit rate increased by nearly 50% during the study period, with the highest rates in rural counties. Many transports were for Mental Illness and involuntary commitments. The relatively common occurrence of law enforcement transports suggests the need for greater research to understand factors influencing law enforcement transport decisions, the impact of these transports on patient health and safety, and the repercussions on patient care of a growing officer presence in EDs.


Assuntos
Serviço Hospitalar de Emergência , Saúde Mental , Transporte de Pacientes , Adolescente , Adulto , Feminino , Humanos , Aplicação da Lei , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , North Carolina , Transtornos Psicóticos/diagnóstico , População Rural , Esquizofrenia/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , População Urbana , Adulto Jovem
3.
Neurosci Lett ; 744: 135600, 2021 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-33421489

RESUMO

BACKGORUND: Increasing experimental data confirm the crucial role of the endocannabinoid (eCB) system in the regulation of stress response and emotional processes. Despite of the fact, that genetically determined vulnerability for stress is a widely accepted concept in the pathomechanism of affective disorders, replicable human genetic results with interaction analyses of early life trauma and eCB genes are rare. The aim of this study is to test the associations between genetic variants of the eCB pathway, childhood trauma and affective phenotypes. METHODS: We selected 18,897 SNPs in the eCB pathway of a GWAS dataset in two general population cohorts (BP sample N = 837; MN sample N = 988). Association analyses were performed on the anxious and depressive subscales of the Brief Symptom Inventory (BSI-ANX and BSI-DEP, respectively). Childhood trauma was assessed by the Childhood Adversity Questionnaire (CAQ). Association analyses were performed in the R 2.0. statistical program using the SNPassoc package. REULTS: Genetic effect was more robust in the BP sample than in the MN sample. The most comprehensive results showed that SNPs in the CACNA1C gene associated with depressive phenotype in interaction with CAQ in both BP (p = 1.2 × 10-4) and MN samples (p = 1.6 × 10-4). Direct association analyses (without interaction) provided significant associations between SNPs in different genesets of the two study populations. SNPs in KCNJ3 and GNB5 genes on the BSI-DEP (p = 6.1 × 10-5; p = 7.1 × 10-4) and GNG12 gene on the BSI-ANX (p = 7.4 × 10-6) in the BP sample, while GABAergic, ADCY1 and HTR2A gene variants can be outlined from results of MN sample with less strong p-values. CONCLUSION: Our results confirmed the prominent role of CACNA1C gene in the pathogenic effect of early life stress in the development of affective vulnerability in two different study populations using GxE interaction analysis. CACNA1C gene, as it encodes for L-type voltage-gated calcium channel, contributes to neuronal excitability, plasticity and neurogenesis being a crucial effector of both eCB signaling and the BDNF-CREB pathway as well. Our findings suggest that childhood trauma related depression may have more robust genetically determined basis than without early life stress.


Assuntos
Canais de Cálcio Tipo L/genética , Endocanabinoides/genética , Testes Genéticos/métodos , Variação Genética/genética , Estudo de Associação Genômica Ampla/métodos , Transtornos do Humor/genética , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Fenótipo , Transdução de Sinais/genética , Adulto Jovem
4.
J Am Acad Child Adolesc Psychiatry ; 60(2): 216-218, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33359030

RESUMO

Disruptive mood dysregulation disorder (DMDD) is a novel diagnosis emerging from a continuing discourse on the best diagnostic home for children with severe, chronic irritability. DMDD emerged from a research diagnosis that was developed to test the hypothesis that severe, chronic irritability is a developmental phenotype of pediatric bipolar disorder.1 That is, such irritability is a phenomenon that emerges prior to a hypo/manic episode that defines bipolar disorder. For many, such irritability in conjunction with attention-deficit/hyperactivity disorder (ADHD) symptoms had been treated as a prodrome of bipolar disorder. Although this line of research did not establish a deterministic association between the DMDD syndrome and later bipolar disorder, it did provide guidance for assessing the risk of irritability for later bipolar disorder.2 Among the outcomes was the introduction of DMDD as a new diagnosis in DSM-5. It is defined by 2 core symptoms-temper outbursts and irritable/angry mood-the 2 major features of irritability. However, what qualifies as DMDD-level irritable mood and temper outbursts is unclear, and, unlike other mood disorders, no ancillary symptom criteria are available to establish a diagnosis of DMDD. Through the example of the relationship between DMDD and ODD, we will illustrate the clinical impact of this lack of clarity and describe the current efforts to establish a developmentally sensitive clinical nosology for irritability.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno Bipolar , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/diagnóstico , Transtorno Bipolar/diagnóstico , Criança , Humanos , Humor Irritável , Transtornos do Humor/diagnóstico
6.
Bipolar Disord ; 22(8): 788-804, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33320412

RESUMO

OBJECTIVES: To provide a succinct, clinically useful summary of the management of major depression, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2020 ). METHODS: To develop the MDcpg2020 , the mood disorders committee conducted an extensive review of the available literature to develop evidence-based recommendations (EBR) based on National Health and Medical Research Council (NHMRC) guidelines. In the MDcpg2020 , these recommendations sit alongside consensus-based recommendations (CBR) that were derived from extensive deliberations of the mood disorders committee, drawing on their expertise and clinical experience. This guideline summary is an abridged version that focuses on major depression. In collaboration with international experts in the field, it synthesises the key recommendations made in relation to the diagnosis and management of major depression. RESULTS: The depression summary provides a systematic approach to diagnosis, and a logical clinical framework for management. The latter begins with Actions, which include important strategies that should be implemented from the outset. These include lifestyle changes, psychoeducation and psychological interventions. The summary advocates the use of antidepressants in the management of depression as Choices and nominates seven medications that can be trialled as clinically indicated before moving to Alternatives for managing depression. Subsequent strategies regarding Medication include Increasing Dose, Augmenting and Switching (MIDAS). The summary also recommends the use of electroconvulsive therapy (ECT), and discusses how to approach non-response. CONCLUSIONS: The major depression summary provides up to date guidance regarding the management of major depressive disorder, as set out in the MDcpg2020 . The recommendations are informed by research evidence in conjunction with clinical expertise and experience. The summary is intended for use by psychiatrists, psychologists and primary care physicians, but will be of interest to all clinicians and carers involved in the management of patients with depressive disorders.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/métodos , Transtornos do Humor/terapia , Guias de Prática Clínica como Assunto , Psiquiatria , Austrália , Consenso , Transtorno Depressivo Maior/diagnóstico , Humanos , Transtornos do Humor/diagnóstico , Nova Zelândia , Sociedades Médicas
7.
Artigo em Russo | MEDLINE | ID: mdl-33244959

RESUMO

OBJECTIVE: To identify characteristics of and possible differences in clinical and electroencephalographic parameters in patients with alcohol dependence with- and without comorbid affective disorders. MATERIALS AND METHODS: Ninety-five patients, including 74 with an established diagnosis of alcohol dependence and 21 with alcohol dependence and affective disorders, were examined. Duration of alcohol dependence and affective disorder (years), number of hospitalizations and suicidal attempts were analyzed as anamnestic data. Hamilton's anxiety and depression scale (HDRS), the Alcohol Use Disorders Identification Test (AUDIT), the General clinical impression scale (CGI-s) were used as psychometric tools. The study of bioelectric activity of the brain was carried out using a 16-channel encephalograph. The background electroencephalogram was recorded, the values of absolute spectral power and coherence of theta, alpha and beta rhythms were analyzed. RESULTS AND CONCLUSION: Patients with comorbidity of alcohol dependence and affective disorders have a significantly higher risk of suicidal behavior, a greater frequency of hospitalizations, higher levels of anxiety compared with patients without affective disorders. Electrophysiological data have shown that patients with comorbidity of alcohol dependence and affective disorders have higher values of spectral power of alpha-rhythm in all parts of the cerebral cortex (except for temporal lobes) and beta-rhythm in the occipital cortex, as well as an increase in interhemispheric coherence in all frequency ranges.


Assuntos
Alcoolismo , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Comorbidade , Humanos , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Tentativa de Suicídio
8.
Rev. med. cine ; 16(3): 165-174, sept. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-197479

RESUMO

La trama del Joker nos muestra el surgimiento del antihéroe a partir de Arthur, un individuo con un trastorno llamado afectación pseudobulbar, con antecedentes de abandono y abuso físico severo y maltrato con probable traumatismo encefálico, que vive sin vínculos sociales, carente de afecto, como cuidador primario de una familiar dependiente enteramente de él; el protagonista se mueve en un ambiente adverso, hostil en el que la sociedad que espera que él se comporte como si no tuviera ningún trastorno. un comportamiento normal”. Sin recursos y rechazado por su medio, resulta colateralmente afectado por la reducción de presupuesto para terapia y medicamentos. En un momento decisivo, convergen los diferentes detonantes de sus manifestaciones psicopatológicas que dan paso a la transformación del joker y paradójicamente lo llevarán a ser aceptado socialmente. Joker nos invita a reflexionar sobre la importancia de a los programas de salud mental, los valores humanos, la cultura de la Paz y el buen trato como pilares fundamentales para promover la salud mental en la sociedad. El presente artículo tiene por objetivo el revisitar la fisiopatología de la afección pseudobulbar y establecer los aspectos clínicos, familiares, ambientales y socioculturales potencialmente asociados a la conducta destructiva de Joker


The plot of the Joker shows us the emergence of the antihero from Arthur, an individual with a pseudobulbar disorder, a history of abandonment and severe physical abuse and abuse with probable brain trauma, living without social ties, lacking affection, as a primary caregiver of a relative dependent entirely on him; the protagonist moves in an adverse, hostile environment in which the society that expects him to behave as if he had no disorder. normal behavior. «Without resources and rejected by its means, it is collaterally affected by the reduction of budget for therapy and medications. At a decisive moment, the different triggers of his psychopathological manifestations converge that give way to the transformation of the joker and paradoxically lead him to be socially accepted. Joker invites us to reflect on the importance of mental health programs, human values, the culture of Peace and good treatment as fundamental pillars to promote mental health in society. This article aims to revisit the pathophysiology of the pseudobulbar condition and establish the clinical, family, environmental and sociocultural aspects potentially associated with Joker’s destructive behavior


Assuntos
Humanos , Medicina nas Artes , Filmes Cinematográficos , Transtornos do Humor/fisiopatologia , Sintomas Afetivos/fisiopatologia , Agressão/psicologia , Transtornos do Humor/diagnóstico , Sintomas Afetivos/diagnóstico , Estresse Psicológico/fisiopatologia , Saúde Mental , Síndrome , Psicopatologia , Riso/psicologia
9.
J Stroke Cerebrovasc Dis ; 29(8): 104923, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689613

RESUMO

OBJECTIVE: In this prospective study, we aimed to investigate the presence and evolution of cerebellar cognitive affective syndrome in a cohort of isolated cerebellar stroke with no known cognitive or psychiatric impairment. We tried to distinguish the unconfounded effect of cerebellar lesions on neuropsychological processing. METHODS: After a meticulous exclusion procedure based on possible confounders, we recruited 14 patients and 13 age-matched healthy controls to the study, prospectively. All of the patients had a detailed initial neuropsychological assessment at the first week and a follow-up assessment at the 4th month after stroke. RESULTS: The prevalence of cognitive or behavioral-affective abnormalities in our cohort were 86% and 64% respectively. The patients exhibited mild and transient affective-behavioral abnormalities except for depressive symptoms that persisted in the subacute stage. They scored lower in general cognitive performance as revealed by mini mental test (p=0.001). Memory, executive functions, attention and working memory, central processing speed, and linguistic abilities were impaired (p<0.001; p=0.001; p=0.007; p=0.05; p<0.001 respectively). Improvement was evident only in memory domain of the cognitive functions in the subacute stage. Cognitive impairment was more likely with a medial or posterolateral infarct (p=0.014). Behavioral-affective abnormalities were not associated with a specific location in our cohort. Age seemed to negatively correlate with the recovery in general cognitive performance on the follow-up. CONCLUSIONS: These findings show that acute denervation of cerebellocortical projections leads to mild affective-behavioral abnormalities, and full-blown cerebellar cognitive affective syndrome is rare. However, cognition was significantly affected after an acute cerebellar infarct even in a previously healthy, non-demented pure population.


Assuntos
Afeto , Infartos do Tronco Encefálico/psicologia , Doenças Cerebelares/psicologia , Cerebelo/irrigação sanguínea , Transtornos Cognitivos/psicologia , Cognição , Transtornos do Humor/fisiopatologia , Doença Aguda , Atenção , Infartos do Tronco Encefálico/diagnóstico , Infartos do Tronco Encefálico/epidemiologia , Infartos do Tronco Encefálico/fisiopatologia , Estudos de Casos e Controles , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/epidemiologia , Doenças Cerebelares/fisiopatologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/fisiopatologia , Função Executiva , Feminino , Humanos , Idioma , Masculino , Memória , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Turquia/epidemiologia
11.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32471843

RESUMO

Down syndrome disintegrative disorder (DSDD), a developmental regression in children with Down syndrome (DS), is a clinical entity that is characterized by a loss of previously acquired adaptive, cognitive, and social functioning in persons with DS usually in adolescence to early adulthood. Initially reported in 1946 as "catatonic psychosis," there has been an increasing interest among the DS community, primary care, and subspecialty providers in this clinical area over the past decade. This condition has a subacute onset and can include symptoms of mood lability, decreased participation in activities of daily living, new-onset insomnia, social withdrawal, autistic-like regression, mutism, and catatonia. The acute phase is followed by a chronic phase in which baseline functioning may not return. No strict criteria or definitive testing is currently available to diagnose DSDD, although a comprehensive psychosocial and medical evaluation is warranted for individuals presenting with such symptoms. The etiology of DSDD is unknown, but in several hypotheses for regression in this population, psychological stress, primary psychiatric disease, and autoimmunity are proposed as potential causes of DSDD. Both psychiatric therapy and immunotherapies have been described as DSDD treatments, with both revealing potential benefit in limited cohorts. In this article, we review the current data regarding clinical phenotypes, differential diagnosis, neurodiagnostic workup, and potential therapeutic options for this unique, most disturbing, and infrequently reported disorder.


Assuntos
Atividades Cotidianas/psicologia , Transtorno Autístico/epidemiologia , Transtorno Autístico/psicologia , Síndrome de Down/epidemiologia , Síndrome de Down/psicologia , Adolescente , Transtorno Autístico/diagnóstico , Catatonia/diagnóstico , Catatonia/epidemiologia , Catatonia/psicologia , Criança , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/psicologia , Síndrome de Down/diagnóstico , Feminino , Humanos , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Literatura de Revisão como Assunto
12.
Psychiatry Res ; 288: 112967, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32339805

RESUMO

The objective of the current study was to assess the association between adverse childhood experiences (ACEs) and irritable bowel syndrome (IBS) in mood disorder patients. Self-report data from the International Mood Disorders Collaborative Project were cross-sectionally analyzed to compare rates of IBS in participants with confirmed diagnoses of major depressive disorder (MDD; n = 279) or bipolar disorder (BD; n = 219). Data was sub-grouped and compared based on history of ACEs. In total, 69 of the 498 participants reported a diagnosis of IBS (13.8%). BD was associated with significantly elevated rates of IBS compared to MDD (18.5% versus 10.1% respectively). After adjusting for age and sex, history of childhood sexual abuse was associated with increased rates of IBS in mood disorder participants [adjusted odds ratio (aOR) = 1.95]. In the MDD subgroup, ACEs (all categories and individual categories) were not associated with increased rates of IBS. In the BD subgroup, history of childhood sexual abuse was associated with significantly increased rates of IBS (38% versus 14%; aOR = 3.7). In summary, BD was associated with a higher prevalence of IBS compared to MDD. Additionally, history of sexual abuse was associated with an increased prevalence of IBS in BD, but not in MDD.


Assuntos
Experiências Adversas da Infância/tendências , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/psicologia , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Adulto , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Criança , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Delitos Sexuais/psicologia , Delitos Sexuais/tendências
13.
BMC Psychol ; 8(1): 35, 2020 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-32303262

RESUMO

BACKGROUND: Disruption of biological rhythms has been linked to the pathophysiology of mental disorders. However, little is known regarding the rhythmicity of mood symptoms due to the lack of validated clinical questionnaires. A better understanding of the rhythmicity of mood symptoms can help identifying individuals whose severity of mood symptoms follows an altered circadian rhythm. The objective of this study was to validate the English version of the Mood Rhythm Instrument (MRhI), a self-reported measure of self-perceived rhythmicity of mood symptoms and behaviours, in a sample of the general population from Canada. METHODS: After the translation process, the final English version of the Mood Rhythm Instrument (MRhI-English) was applied on participants recruited at McMaster University and St. Joseph's Healthcare Hamilton campuses. Individuals were also asked to answer the Reduced Morningness-Eveningness Questionnaire (rMEQ). RESULTS: Four hundred one individuals completed the English version of the MRhI and the rMEQ. The MRhI-English presented a Cronbach's alpha of 0.75. The factorial analysis grouped the MRhI-15 items in 3 factors (cognitive, affective and somatic), with affective items having a lower frequency of self-reported 24-h peaks. Comparison between sexes showed that women reported a higher frequency of daily peaks in irritability, anxiety, sadness and talking to friends, while men exhibited peaks more frequently in problem-solving, sexual arousal and motivation to exercise. CONCLUSIONS: Our findings suggest that the English version of the MRhI displayed good internal consistency. Future directions will include the use of the MRhI instrument in individuals with mood disorders, aiming to provide a better understanding of the relationship between daily patterns of mood variability and mental health outcomes.


Assuntos
Afeto , Ritmo Circadiano , Transtornos do Humor/diagnóstico , Testes Psicológicos , Inquéritos e Questionários , Adolescente , Adulto , Afeto/fisiologia , Ansiedade/diagnóstico , Canadá , Ritmo Circadiano/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Tradução , Adulto Jovem
14.
Medicina (Kaunas) ; 56(3)2020 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-32156038

RESUMO

The main arguments in support of researching anxiety and depression in patients with chronic somatic diseases are the prevalence of affective disorders in the population, somatic conditions as risk factors of affective disorders and the search for effective preventative and therapeutic strategies. The aim of the study was to determine the association between the functional status, selected sociodemographic characteristics and prevalence as well as severity of anxiety and depression in patients with multiple sclerosis (MS), Parkinson's disease (PD) and history of stroke (S). Material and methods: Eighty participants (44 women and 36 men) with MS (n = 22), PD (n = 31) and history of stroke (n = 27) were enrolled. All participants completed a questionnaire consisting of metrics, the Katz Index of Independence in Activities of Daily Living and the Hospital Anxiety and Depression Scale (HADS). Results: Fifty-five per cent of all participants did not present with anxiety or depression, 20% scored above the diagnostic threshold on the anxiety scale and 26% scored above the diagnostic threshold on the depression scale. Subgroup analysis revealed that anxiety and depression sufferers were 13.64% and 13.64% of MS patients, respectively; 22.58% and 35.48% of PD patients, respectively; and 22.22% and 25.93% of stroke survivors, respectively. There was a significant correlation between depression and independence level in the entire group and between depression and marital status in stroke survivors. Conclusions: Although depression and anxiety are highly prevalent in patients with neurological conditions, the disorder has a very individual nature and is not associated with the patient's age, duration of a condition or concomitant diseases. Screening for depression and anxiety as a part of comprehensive approach may increase treatment efficacy in neurological patients.


Assuntos
Transtornos do Humor/diagnóstico , Esclerose Múltipla/complicações , Doença de Parkinson/complicações , Idoso , Análise de Variância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/fisiopatologia , Doença de Parkinson/epidemiologia , Doença de Parkinson/fisiopatologia , Polônia/epidemiologia , Escalas de Graduação Psiquiátrica , Fatores de Risco , Estatísticas não Paramétricas , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Inquéritos e Questionários
15.
Behav Ther ; 51(2): 268-282, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32138937

RESUMO

Irritability refers to a proneness for anger, and is a symptom of internalizing and externalizing psychopathology. Since irritability is associated with significant cross-sectional and longitudinal impairments, research on the behavioral and neural correlates of pediatric irritability in populations at risk for significant irritability is of paramount importance. Irritability can be assessed in the laboratory using behavioral paradigms that elicit frustration. Few behavioral frustration paradigms have been designed to measure the effects of frustration on cognitive control. Therefore, the goal of the present study was to validate a behavioral frustration paradigm for use in school-age children which addressed some of the limitations of prior research. Participants included children, ages 8-12 years, who were either typically developing (TD; n = 38) or diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 67), which provided a sample of children with a range of baseline irritability. All participants completed the Frustration Go/No-Go (GNG) task, and self-reported irritability was assessed using the Affective Reactivity Index. Results showed that across participants, self-reported frustration, commission error rate, and tau all increased with the addition of frustration, with similar effect sizes in ADHD and TD groups. Further, self-reported irritability, moreso than ADHD symptoms, predicted changes in self-reported frustration during the task. Together, these results support the construct validity of the Frustration GNG task as a means of assessing the effect of frustration on cognitive control. Clinical applications and future directions are discussed.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Frustração , Humor Irritável , Transtornos do Humor/diagnóstico , Testes Psicológicos/normas , Ira , Criança , Cognição , Estudos Transversais , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Autorrelato
16.
Behav Ther ; 51(2): 283-293, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32138938

RESUMO

Irritability is impairing in youth and is the core feature of disruptive mood dysregulation disorder (DMDD). Currently, there are no established clinician-rated instruments to assess irritability in pediatric research and clinical settings. Clinician-rated measures ensure consistency of assessment across patients and are important specifically for treatment research. Here, we present data on the psychometric properties of the Clinician Affective Reactivity Index (CL-ARI), the first semistructured interview focused on pediatric irritability. The CL-ARI was administered to a transdiagnostic sample of 98 youth (M age = 12.66, SD = 2.47; 41% female). With respect to convergent validity, CL-ARI scores were (a) significantly higher for youth with DMDD than for any other diagnostic group, and (b) showed uniquely strong associations with other clinician-, parent-, and youth-report measures of irritability compared to measures of related constructs, such as anxiety. The three subscales of the CL-ARI (temper outbursts, irritable mood, impairment) showed excellent internal consistency. Test-retest reliability of the CL-ARI was adequate. These data support that irritability can be feasibly, validly, and reliably assessed by clinicians using the CL-ARI. A validated, gold-standard assessment of pediatric irritability is critical in advancing research and treatment efforts.


Assuntos
Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Transtornos do Comportamento Infantil/diagnóstico , Entrevista Psicológica/normas , Humor Irritável , Transtornos do Humor/diagnóstico , Adolescente , Ansiedade/psicologia , Criança , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes
17.
Behav Ther ; 51(2): 350-364, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32138943

RESUMO

In recent years, irritability has received increasing attention among mental health professionals given its transdiagnostic associations with diverse forms of psychopathology. In contrast to other emotional states and traits, however, literature addressing associations between irritability and related temperament and personality constructs is limited. In addition, those who study irritability have diverse perspectives on its neurobiological substrates. In this comment, we situate irritability in the literatures on child temperament and adult personality, and describe a model in which irritability derives from low tonic dopamine (DA) levels and low phasic DA reactivity in subcortical neural structures implicated in appetitive responding. We note that different findings often emerge in neuroimaging studies when irritability is assessed in circumscribed diagnostic groups versus representative samples. We conclude with directions for future research, and propose that more authors use hierarchical Bayesian modeling, which captures functional dependencies between irritability and other dispositional traits (e.g., trait anxiety) that standard regression models are insensitive too. Treatment implications are also considered.


Assuntos
Humor Irritável/fisiologia , Transtornos do Humor/fisiopatologia , Personalidade/fisiologia , Adulto , Ansiedade/fisiopatologia , Ansiedade/psicologia , Teorema de Bayes , Criança , Feminino , Humanos , Masculino , Transtornos do Humor/diagnóstico , Temperamento/fisiologia
18.
Nord J Psychiatry ; 74(6): 444-452, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32134345

RESUMO

Background: Mood disorders commonly co-occur in patients with substance use disorders (SUD). This combination may increase the risk of pathological effects and impair cognitive functioning.Aim: The aim of the study was to examine the effects of mood and substance use disorders on specific neuropsychological measures.Methods: The participants comprised 164 hospitalised patients, 88 with (SUD + MD) and 76 (SUD-MD) without mood disorders, ranging in age from 19 to 65 years. Their diagnostic assessment was based on a psychiatric interview (ICD-10). Neuropsychological tests were carried out after a minimum of one month of abstinence.Results: Processing speed (p = 0.029), and perceptual reasoning (p = 0.039) were more impaired in the SUD + MD group than in the SUD-MD group. An Analysis of covariance (ANCOVA) controlled for age, education level, learning difficulties and polysubstance use revealed that the groups were most powerfully separated by the Digit Symbol test and the Block Design test.Conclusions: Patients with substance abuse and mood disorders seem to have more deficits in speed processing and perceptual reasoning than substance abuse patients without mood disorders. These processing speed difficulties and perceptual problems may impact prognosis and treatment. The Digit Symbol test and the Block Design test are a fast and sensitive ways to examine treatment effectiveness and monitor treatment progress.


Assuntos
Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Testes Neuropsicológicos/normas , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Afeto/fisiologia , Idoso , Cognição/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Estudos Prospectivos , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
19.
Nord J Psychiatry ; 74(6): 423-428, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32134350

RESUMO

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.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Idioma , Transtornos do Humor/diagnóstico , Esquizofrenia/diagnóstico , Traduções , Adolescente , Criança , Feminino , Humanos , Islândia/epidemiologia , Masculino , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Escalas de Graduação Psiquiátrica/normas , Reprodutibilidade dos Testes , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico
20.
Soc Psychiatry Psychiatr Epidemiol ; 55(11): 1469-1478, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32055896

RESUMO

OBJECTIVES: To quantify the strength of association between passive and active forms of screen time and adolescent major depressive episode and anxiety disorders. METHODS: Data from the 2014 Ontario Child Health Study, a representative sample of 2,320 adolescents aged 12-17 years in Ontario (mean age = 14.58, male = 50.7%) were used. Screen time was measured using adolescent self-report on time spent on screen-based activities. Past 6-month occurrence of DSM-IV-TR defined major depressive episode, social phobia, generalized anxiety disorder, and specific phobia which were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents. RESULT: Adolescents reporting 4 or more hours of passive screen time per day, compared to those reporting less than 2 h, were three times more likely to meet the DSM-IV-TR criteria for major depressive episode [OR = 3.28(95% CI = 1.71-6.28)], social phobia [OR = 3.15 (95% CI = 1.57-6.30)] and generalized anxiety disorder [OR = 2.92 (95% CI = 1.64-5.20)]. Passive screen time continued to be significantly associated with increased odds of disorders, after adjusting for age, sex, low income, active screen time use, sleep and physical activity. A small-to-moderate attenuation of the estimated ORs was observed in the fully adjusted model. In contrast, associations between active screen time use and depression and anxiety disorders were smaller in magnitude and failed to reach statistical significance. CONCLUSIONS: Passive screen time use was associated with mood and anxiety disorders, whereas active screen time was not. Further research is needed to better understand the underlying processes contributing to differential risk associated with passive versus active screen time use and adolescent mood and anxiety disorders.


Assuntos
Transtorno Depressivo Maior , Tempo de Tela , Adolescente , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Criança , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Ontário/epidemiologia
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