Psychological impact of the COVID-19 pandemic and lockdown in a Spanish sample with anxiety disorder: sex differences.

The early psychological impact of the COVID-19 pandemic and lockdown is greater in people with mental disorders. This study explored the differences in the psychological impact on people with an anxiety disorder by sex in Spain.

Early Impact of the COVID-19 Outbreak on Sleep in a Large Spanish Sample.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) forced Spain to implement unprecedented lockdown restriction. In this context, different factors could worsen sleep quality, but the impact of the pandemic and lockdown on sleep is still mostly unknown. In this cross-sectional study, we describe self-reported sleep disturbances in people without mental health disorders from a large Spanish sample (n = 15,070). METHODS: During the early phase of the lockdown (19-26 March), an online survey was launched using a snowball sampling method and included sociodemographic and clinical data along with the Depression, Anxiety, and Stress Scale (DASS-21) and the Impact of Event Scale (IES). Two items of the IES were employed to assess sleep characteristics. Descriptive and bivariate analysis and logistic regression models were performed. RESULTS: Difficulty initiating or maintaining sleep were reported by 23.9% of the sample and was associated in the regression model with age (OR = 1.008, p = .003), female sex (OR = 1.344, p < .001), an income reduction >50% (OR = 1.248, p = .037), having one (OR = 1.208, p = .029) and two or more (OR = 1.299, p = .035) elderly dependents, drinking alcohol (OR = 1.129, p = .024), and a higher score on DASS-21 depression (OR = 1.148, p < .001), anxiety (OR = 1.218, p < .001), or stress (OR = 1.302, p < .001) subscales, whereas being able to enjoy free time (OR = 0.604, p < .001) and painting or listening to music (OR = 0.853, p = .012) were protective factors. Dreams related to COVID-19 were reported by 12.9% of the sample and were associated in the regression model with female sex (OR = 1.617, p < .001), being married (OR = 1.190, p = .015), self-employed (OR = 1.373, p = .032), or a civil servant (OR = 1.412, p = .010), having been tested for COVID-19 (OR = 1.583, p = .012), having infected family or friends (OR = 1.233, p = .001), reading news about coronavirus (OR = 1.139, p = .023), drinking alcohol (OR = 1.251, p < .001), and higher scores on DASS-21 depression (OR = 1.102, p < .001), anxiety (OR = 1.222, p < .001), or stress (OR = 1.213, p < .001) subscales, while protective factors were older age (OR = 0.983, p < .001) and being retired (OR = 0.625, p = .045). CONCLUSIONS: These findings could help clinicians and public health systems design and deliver tailored interventions, such as internet-delivered campaigns, to promote sleep quality in the general population.

Are older adults also at higher psychological risk from COVID-19?

OBJECTIVE: Given the lack of information on the psychological impact of COVID-19 on people aged ≥60, we aimed to describe their psychological responses to this pandemic and lockdown situation and compare them with those under 60 years of age. METHODS: Secondary analysis of a larger online cross-sectional study designed to determine the psychological impact of the COVID-19 pandemic and lockdown across Spain. We analyzed a total of 1690 respondents aged ≥60 years and compared them with 13,363 respondents under 60 years of age. We employed the Depression, Anxiety, and Stress Scale and the Impact of Event Scale to evaluate psychological responses. RESULTS: In all, 52.6% of women and 34.3% of men were found to be probable cases of any emotional distress (p < 0.001). In both sexes, the most common psychological response was avoidance behavior (34.7% and 23.8%, respectively), followed by depression (28.5 and 14.2%). Older women and men were considered probable cases of any emotional distress less often than younger ones (women: 52.6% vs. 72.3%, p < 0.001; men: 34.3% vs. 50.6%, p < 0.001). Finally, the results of the binary logistic regression showed that only depressive and stress responses are psychological factors associated with age group [age ≥ 60 years, O.R. = 0.617 (95% CI = 0.501 - 0.759) and 0.437 (95% CI = 0.334 - 0.573), respectively]. CONCLUSION: Contrary to our hypothesis and despite the high percentage of emotional distress we found in older adults, especially women, they are actually at lower risk of developing depressive and stress consequences from COVID-19 and lockdown than those under 60 years of age. That said, we believe our results highlight the need for expert guidance in this age group, especially older women living alone.

Impact of the coronavirus outbreak on mental health in the different Spanish regions.

COVID-19 is an infectious disease that has affected millions of people worldwide, Spain being one of the countries most affected by the pandemic. It is key to study its impact on the mental health of the Spanish population during the lockdown situation.

Early Psychological Correlates Associated With COVID-19 in A Spanish Older Adult Sample.

OBJECTIVE: Main aims of the study are to examine the early psychological correlates associated with the COVID-19 pandemic and lockdown on the mental health of a Spanish older adult sample and to analyze the influence of past mental disorder (PMD) and current mental disorder (CMD) on those correlates. METHODS: Cross-sectional study based on an online snowball recruiting questionnaire. Psychological correlates assessed with the Depression, Anxiety, and Stress Scale (DASS-21) and Impact of Event Scale (IES). Binary and multinomial logistic regression models were used to identify risk and protective factors. RESULTS: Final sample included 2,194 individuals aged 60 years or more (mean age [SD]: 65.62 [5.05]; females: 1,198 [54.6%]). There were 342 (15.6%) individuals who reported a PMD and 162 (7.4%) who reported a CMD. Avoidant (32.1%) and depressive (25.6%) styles were the most prevalent, regardless of mental health status. Main risk factors for negative affectivity were female gender and history CMD or PMD. However, job stability and the ability to enjoy free time were generally associated with better outcomes. No differences were found in psychological correlates between those with no lifetime history of mental disorder versus PMD on the DASS-21 or IES. However, CMD was associated with higher anxiety scores on the DASS-21 (odds ratio: 1.838, p < .001). CONCLUSION: Regardless of mental status, avoidant and depressive styles were the most prevalent in this older adult sample. Main protective factor in all subgroups was the ability to enjoy free time, whereas the main risk factors were being female and current or past history of mental disorder.

Early Intervention in Psychosis Treatment Components Utilization in Patients Aged Over 35.

Early Intervention in Psychosis (EIP) services have been youth-focused since their inception. In England, recent National Institute for Health and Care Excellence (NICE) guidelines and new National Health Service (NHS) Standards for EIP recommend the expansion of the age acceptability criterion from 14-35 to 14-65. In the Cambridgeshire and Peterborough EIP service (CAMEO), we ran a service evaluation to assess the initial impact of this policy change. It aimed to elicit EIP treatment components utilization by patients with first-episode psychosis (FEP) aged over 35, in comparison with those under 35. We found that the over-35s required more contacts from EIP healthcare professionals, especially from care coordinators (coefficient = .239; Robust SE = .102; Z = 6.42; p = 0.019) and social workers (coefficient = 18.462; Robust SE = .692; Z = .016; p < 0.001). These findings indicate that FEP patients aged over 35 may present with more complex and sustained clinical/social needs. This may have implications for EIP service development and commissioning.

Detection of synthetic cannabinoid intoxication in the Emergency Department: when routine toxicological tests are not enough. / Detección de la intoxicación por cannabinoides sintéticos en Urgencias: cuando las pruebas toxicológicas rutinarias no bastan.

Letter to the editor.

Carta al Editor.

Factors associated with tobacco consumption in patients with depression. / Factores asociados con consumo de tabaco en pacientes con depresión.

Smoking and depression are related in a bidirectional way: smoking is the primary avoidable cause of illness and death in patients with depression, and depression is one of the most consistent risk factors for smoking. The main objective of this study is to investigate the relationship between smoking and depression, analyzing sociodemographic and clinical variables such as severity of symptoms, subtype of affective disorder, and its impact on suicidal behavior in the clinical population.A sample of 201 patients, over 18 years of age [mean age (SD) = 53.76 (10.36) years; women = 132 (65.7%)], with a history of depressive episode (unipolar or bipolar) or dysthymia (ICD 10 criteria) was studied.Current smoking prevalence was 43.2% and life-time prevalence 61.2%. No statistically significant differences in smoking prevalence between men and women were found (X2 = 3.896, p = 0.143). The average age of onset was 17.81 (5.60) years. There was a tendency towards a linear association between number of cigarettes/day consumed and severity of depression according to the Hamilton Depression Scale (HDRS) in current smokers (Pearson's R = 0.298, p = 0.050). Multinomial logistic regression analysis showed that current tobacco consumption was associated with higher HDRS scores, with each additional point on the HDRS increasing the likelihood of smoking by 0.062 [p = 0.032; OR (95% CI) = 1.064 (1.005-1.125)].Our results showed that depressed patients present higher prevalence of current smoking than the general population, also suggesting a relationship between severity of consumption and severity of depressive symptoms.

Tabaquismo y depresión se relacionan de forma bidireccional: el tabaquismo es la primera causa evitable de enfermedad y muerte en pacientes con depresión, y la depresión constituye uno de los factores de riesgo de tabaquismo más consistentes. El principal objetivo del presente trabajo es profundizar en la relación entre tabaquismo y depresión, analizando variables socio-demográficas y clínicas como la gravedad de los síntomas, el subtipo de trastorno afectivo, y su impacto en las conductas suicidas en población clínica.Se estudió una muestra de 201 pacientes, mayores de 18 años [edad media (SD) = 53,76 (10,36) años; mujeres = 132 (65,7%)], con historia de episodio depresivo (unipolar o bipolar) o distimia (criterios CIE 10).La prevalencia de tabaquismo actual fue 43,2% y la prevalencia vida 61,2%, no existiendo diferencias estadísticamente significativas entre hombres y mujeres (X2 = 3,896; p = 0,143). La edad media de inicio fue 17,81 (5,60) años. Se observó tendencia a asociación lineal entre número de cigarrillos/día consumidos y gravedad de la depresión según la Escala de Hamilton para la Depresión (HDRS) en los consumidores actuales de tabaco (R de Pearson = 0,298; p = 0,050). El análisis de regresión logística multinomial puso de manifiesto que el consumo actual de tabaco se asocia con puntuaciones más elevadas en la HDRS, de modo que cada incremento de un punto en dicha escala, la posibilidad de fumar aumenta en 0,062 [p = 0,032; OR (95% CI) = 1,064 (1,005-1,125)].Nuestros resultados muestran que los pacientes deprimidos presentan mayor prevalencia de consumo actual de tabaco que la población general, sugiriendo además una relación entre gravedad de consumo y gravedad de los síntomas de depresión.

Intergenerational effects of maternal childhood maltreatment on newborns' stress regulation: The role of maternal depressive symptoms.

BACKGROUND: Maternal childhood maltreatment (CM) has been repeatedly associated with negative offspring's emotional outcomes. The dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis has emerged as the main underlying physiological mechanism. OBJECTIVE: To explore the association between maternal CM and newborns' physiological and neurobehavioral stress responses, considering the role of perinatal maternal depression and bonding. PARTICIPANTS AND SETTING: 150 healthy women were followed throughout pregnancy. 79 mother-infant dyads were included in the final analyses. Maternal CM was evaluated using the Childhood Trauma Questionnaire and depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS) at each trimester. At 7 weeks postpartum, the EPDS and the Postpartum Bonding Questionnaire were administered. Newborns' behavioral responses were assessed using "States Organization" (SO) and "States Regulation" (SR) subdomains of the Neonatal Behavioral Assessment Scale (NBAS). Newborns' salivary samples were collected before and after the NBAS to study cortisol reactivity. METHODS: A cross-lagged panel model was employed. RESULTS: Infants born to mothers with higher CM presented more optimal scores on SO (ß (0.635) = 0.216, p ã€ˆ001) and SR (ß (0.273) = 0.195, p = .006), and a higher cortisol reactivity after NBAS handling (ß(0.019) = 0.217, p = .009). Moreover, newborns of mothers with higher CM and postpartum depressive symptoms exhibited a poorer performance on SR (ß (0.156 = -0.288,p = .002). Analyses revealed non-significant relationships between mother-infant bonding, newborns' cortisol reactivity and SO. CONCLUSIONS: Newborns from mothers with greater CM present higher cortisol reactivity and more optimal behavioral responses, which may reflect a prenatal HPA axis sensitization. However, those exposed to maternal postnatal depressive symptoms present poorer stress recovery.

Diurnal cortisol throughout pregnancy and its association with maternal depressive symptoms and birth outcomes.

BACKGROUND: Depression during pregnancy is a common complication that can negatively affect fetal health and birth outcomes. Cortisol is believed to be a key mediator of this association. Although pregnancy entails a natural increase in cortisol levels, preclinical depression could alter its circadian rhythm, producing excessively high overall diurnal cortisol levels that might be harmful for the fetus and future offspring development. OBJECTIVES: Using a prospective longitudinal design, we aimed to study (i) trimestral cortisol circadian rhythm and its overall levels throughout pregnancy in healthy women, (ii) the extent to which maternal depressive symptoms influence both cortisol rhythmicity and overall levels, and (iii) the possible adverse consequences of elevated maternal cortisol on the offspring's weight and gestational age at birth. STUDY DESIGN: 112 healthy pregnant women from the general Spanish population were recruited before their first pregnancy. To assess cortisol circadian rhythm, participants provided four saliva samples at each trimester of pregnancy (at awakening, 30 min after awakening, before lunch and before going to bed). Overall cortisol levels were calculated with AUCg approximation. Depressive symptoms were evaluated in each trimester and defined according to EPDS cut-off values (1st trimester, EPDS ≥ 11; 2nd and 3rd trimesters, EPDS ≥ 10). At birth, the risk for low weight, prematurity and weight birth percentile was retrieved for 100 infants. Mixed models and simple effects were employed to study changes of maternal cortisol circadian rhythm and overall levels throughout pregnancy and the possible influence of maternal depressive symptoms. Finally, logistic regressions were performed to assess the associations between maternal overall cortisol levels in each trimester of pregnancy and birth anthropometrics. RESULTS: Although overall diurnal cortisol levels increase throughout pregnancy, cortisol circadian rhythm is preserved in all trimesters [1st (F(3110)= 92.565, p < .001), 2nd (F(3,85)= 46.828, p < .001) and 3rd (F(3,90)= 65.555, p < .001)]. However, women with depressive symptoms showed a flattened cortisol circadian pattern only during the second trimester, characterized by a blunted awakening peak and reduced evening decline (F(3,85)= 4.136, p = .009), but not during the first (F(3,11)= 1.676, p = .176) or the third (F(3,90)= 1.089, p = .358) trimesters. Additionally, they did not show a cortisol increase from second to third trimester (p = .636). Finally, higher maternal cortisol levels in second and third trimesters seemed to be associated with increased risk of prematurity (adjusted OR -0.371, 95% CI 0.490-0.972, p = .034) and low birth weight percentile (adjusted OR -0.612, 95% CI 0.348-0.846, p = .007) respectively. CONCLUSION: Maternal cortisol levels increased throughout pregnancy, although cortisol circadian rhythm was preserved in all trimesters of pregnancy. However, prenatal depressive symptoms were associated with flattened maternal cortisol circadian rhythm in mid-pregnancy. Therefore, it seems that women with depressive symptoms tended to increase less gradually their cortisol levels from mid to late pregnancy. Finally, higher maternal cortisol levels in mid and late-pregnancy seem to be associated with poorer birth anthropometrics Early detection of depressive symptoms in general population could help to prevent putative obstetrical and birth adverse outcomes.

Spanish validation of the Empirically Developed Clinical Staging Model (EmDe-5) for patients with bipolar disorder.

INTRODUCTION: Bipolar disorder (BD) has been reconceptualised as a progressive disorder that develops from mild to severe presentations. An empirical staging model - the Empirically Developed Clinical Staging Model for BD (EmDe-5) - was developed in a previous study. This study aims to further validate that model using a larger and more representative Spanish sample. MATERIAL AND METHODS: 183 BD outpatients were recruited at 11 sites in Spain. Assessment included clinical characteristics of the BD (number of hospitalisations, number of suicide attempts, comorbid personality disorders), physical health (BMI, metabolic syndrome, number of physical illnesses), cognition (SCIP), functioning (permanently disabled due to BD, FAST), and quality of life (SF-36). The CGI-S, VAS-S, and psychopharmacological treatment pattern were used as external validators. RESULTS: Ten patients (51.5%) were classified as stage 1, 33 (18%) as stage 2, 93 (508%) as stage 3, 37 (202%) as stage 4, and 10 (55%) as stage 5. All profilers, other than number of suicide attempts (p=0.311) and comorbid personality disorder (p=0.061), exhibited worse scores from stage 1 to 5. As expected, VAS-S and CGI-S scores were worse in the later stages. Regarding treatment, early stages (1-2) were associated with the use of one to three drugs while late stages (4-5) were associated with four or more drugs (p=0.002). CONCLUSIONS: We confirm the EmDe-5 staging model's construct validity. The ease of obtaining the profilers, together with the operational criteria provided to quantify them, will facilitate the use of the EmDe-5 staging model in daily clinical practice.

Is it possible to stage schizophrenia? A systematic review.

INTRODUCTION: A staging model is a clinical tool used to define the development of a disease over time. In schizophrenia, authors have proposed different theoretical staging models of increasing complexity. Therefore, the aims of our study were to provide an updated and critical view of the proposed clinical staging models for schizophrenia and to review the empirical data that support them. METHODS: Systematic literature review following PRISMA guidelines. From the PubMed database and backward reference search, a total of 141 records were retrieved, but only 20 were selected according to the inclusion criteria: (a) available in English; (b) participants with schizophrenia ≥ 18 years; and (c) theoretical and empirical research studies intended to develop, validate, and/or improve staging models of schizophrenia. RESULTS: Different clinical staging models for schizophrenia were identified, information about the proposed stages was tabulated and presented in the Results section (Tables 1, 2). Most of which include neuroimaging, functioning, and psychopathology, but only two models add objective biomarkers and none include patient point of view. However, few models have been psychometrically tested or used small samples and thus have been validated only partially. In addition, five studies proposed therapeutic interventions according to the stage of the disorder from a theoretical point of view. DISCUSSION: In conclusion, it is possible to stage schizophrenia, but the models developed have several limitations. Empirical validation and inclusion of more specific biomarkers and measures of other life areas affected by schizophrenia could help in the development of more valid models.

Validation of a European Spanish adaptation of the Apathy Evaluation Scale-self-rated version (AES-S) in patients with schizophrenia.

INTRODUCTION: Apathy is a negative symptom of schizophrenia and is associated with poor real world functioning. Therefore, it is important to have validated psychometric instruments to assess this symptom. This is the first study to validate the Spanish adaptation of the self-rated version of the Apathy Assessment Scale (AES-S) in patients with schizophrenia. MATERIALS AND METHODS: Naturalistic, cross-sectional, validation study in 104 patients with schizophrenia evaluated using the following scales: Clinical Global Impression-Severity (CGI-S), Personal and Social Performance (PSP), Clinical Assessment Interview for Negative Symptoms (CAINS), Self-report of Negative Symptoms (SNS), Motivation and Pleasure Scale-Self-Report (MAP-SR), Calgary Depression Scale for Schizophrenia (CDSS), and Apathy Evaluation Scale-self-rated version (AES-S). RESULTS: Reliability: Internal consistency (Cronbach's alpha) was 0.908. Convergent validity: The Pearson correlation coefficient between AES-S and CAINS-MAP total scores was -0.483 (p<0.001). For SNS, total and avolition subscale scores were -0.803 and -0.639 (p<0.001), respectively. With the MAP-SR, the correlation coefficient was -0.727 (p<0.001). Divergent validity: The Pearson correlation coefficient between AES-S and PSP total scores was 0.504 (p<0.001). Furthermore, with the CDSS, the correlation coefficient was -0.431 (p<0.001). Discriminant validity: The AES-S discriminated between different levels of illness severity according to CGI-S scores. Factor analysis: A three-component solution explained 57.32% of the variance. Pearson correlations between coefficients were 1-2=0.265, 1-3=0.464, and 2-3=0.060. CONCLUSION: The Spanish AES-S is a reliable and valid instrument for assessing apathy in Spanish patients with schizophrenia. It seems to be appropriate for use in everyday clinical practice as a means of monitoring apathy in these patients.

Validation of a European Spanish-version of the Self-Evaluation of Negative Symptoms (SNS) in patients with schizophrenia.

INTRODUCTION: Negative symptoms can be grouped into five domains: apathy/avolition, anhedonia, asociality, alogia, and affective flattening. There are few validate self-rated measures that assess these five dimensions. Therefore, this study aimed to validate the Self-Evaluation of Negative Symptoms (SNS) in Spanish patients with schizophrenia. MATERIAL AND METHODS: Cross-sectional, validation study in 104 outpatients with schizophrenia evaluated using the Spanish version of the following scales: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale - Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) and the Self-Evaluation of Negative Symptoms (SNS). RESULTS RELIABILITY: Internal consistency (Cronbach's alpha) was 0.915. Convergent validity: The Pearson correlation coefficient between MAP-SR and SNS Total scores was 0.660 (p<0.001). For PANSS-N, the correlation was 0.437 (p<0.005) and with the CAINS-Total was 0.478 (p<0.005). Divergent validity: The Pearson correlation coefficient between SNS and PSP was r=-0.372 (p≤0.001), and with SF-36 Physical and Mental Summary Component scores were r=-0.213 (p=0.066) and r=-0.144 (p=0.219), respectively. Discriminant validity: SNS Total scores were significantly statistically different according to the severity of the negative symptomatology rated by the CGI-SCH negative scale (p<0.001). CONCLUSION: The SNS is a reliable and valid instrument to self-rate the five domains of negative symptoms in patients with schizophrenia and seems to be appropriate for use in everyday clinical practice as a complementary measure to the evaluation performed by the clinician.

Factors associated with alcohol and tobacco consumption as a coping strategy to deal with the coronavirus disease (COVID-19) pandemic and lockdown in Spain.

AIM: To provide a population-based characterization of sociodemographic and clinical risk and protective factors associated with consumption of alcohol, tobacco, or both as a coping strategy in a sample of the Spanish general population during the early phase of the COVID-19 pandemic. METHODS: Cross-sectional study based on an online snowball recruiting questionnaire. The survey consisted of an ad hoc questionnaire comprising clinical and sociodemographic information and the Spanish versions of the Depression, Anxiety, and Stress Scale (DASS-21) and the Impact of Event Scale (IES). RESULTS: The final sample included 21,207 individuals [mean age (SD) = 39.7 (14.0); females: 14,768 (69.6%)]. Up to 2867 (13.5%) of participants reported using alcohol, 2545 (12%) tobacco and 1384 (6.5%) both substances as a strategy to cope with the pandemic. Sex-related factors were associated with alcohol consumption as a coping strategy [female, OR = 0.600, p < 0.001]. However, education level, work status, and income played different roles depending on the substance used to cope. Having a current mental disorder was associated only with tobacco consumption as a coping strategy [OR = 1.391, p < 0.001]. Finally, sex differences were also identified. CONCLUSIONS: Sociodemographic, clinical, and psychological factors were associated with consumption of alcohol, tobacco, or both as a coping method for the COVID-19 pandemic and lockdown. Our findings may help develop specific intervention programs reflecting sex differences, which could minimize negative long-term outcomes of substance use after this pandemic.

Spanish Validation of the MAP-SR: Two Heads Better Than One for the Assessment of Negative Symptoms of Schizophrenia.

BACKGROUND: There is little research on self-reported negative symptomatology measures in schizophrenia. The aims of this study were to validate the Spanish version of the Motivation and Pleasure Scale-Self-Report (MAP-SR) and determine the concordance between patient-reported outcome measures for reflecting the severity of negative symptoms of schizophrenia and clinician-rated outcome measures. METHOD: A sample of 174 subjects who completed the MAP-SR and 104 who completed the Self-Evaluation of Negative Symptoms (SNS) were analyzed. The clinician-reported outcome measures (CROMs) were the Spanish versions of the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Positive and Negative Syndrome Scale (PANSS), while the patient-reported outcome measures (PROMs) were MAP-SR and SNS. Cronbach's a, bivariate analyses and Lin's concordance correlation coefficient (CCC) were calculated. RESULTS: The Spanish version of the MAP-SR demonstrated excellent reliability (Cronbach's α=.923). Its correlation coefficients were higher with CAINS [CAINS-Total: r=.608, p<.005; CAINS-Motivation and Pleasure subscale(CAINS-MAP): r=.662, p<.005] than with PANSS negative scales [PANSS-Negative scale(PANSS-N): r=.393, p<.005; PANSS-Marder Negative Factor(PANSS-MNF): r=.478, p<.005]. Finally, concordance between clinician and patient ratings was low in all cases, varying from a CCC of 0.661 to .392. CONCLUSIONS: We found poor concordance between patient and clinician ratings, hence we believe that the two evaluations are not mutually exclusive but complementary.

A clinical staging model for bipolar disorder: longitudinal approach.

Bipolar disorder (BD) has been identified as a life-course illness with different clinical manifestations from an at-risk to a late stage, supporting the assumption that it would benefit from a staging model. In a previous study, we used a clustering approach to stratify 224 patients with a diagnosis of BD into five clusters based on clinical characteristics, functioning, cognition, general health, and health-related quality of life. This study was design to test the construct validity of our previously developed k-means clustering model and to confirm its longitudinal validity over a span of 3 years. Of the 224 patients included at baseline who were used to develop our model, 129 (57.6%) reached the 3-year follow-up. All life domains except mental health-related quality of life (QoL) showed significant worsening in stages (p < 0.001), suggesting construct validity. Furthermore, as patients progressed through stages, functional decline (p < 0.001) and more complex treatment patterns (p = 0.002) were observed. As expected, at 3 years, the majority of patients remained at the same stage (49.6%), or progressed (20.9%) or regressed (23.3%) one stage. Furthermore, 85% of patients who stayed euthymic during that period remained at the same stage or regressed to previous stages, supporting its longitudinal validity. For that reason, this study provides evidence of the construct and longitudinal validity of an empirically developed, comprehensive staging model for patients with BD. Thus, it may help clinicians and researchers to better understand the disorder and, at the same time, to design more accurate and personalized treatment plans.

COVID-19 lockdown in people with severe mental disorders in Spain: Do they have a specific psychological reaction compared with other mental disorders and healthy controls?

The COVID-19 pandemic and the lockdown restrictions could have adverse consequences for patients with severe mental disorders (SMD). Here, we aim to compare the early psychological impact (depression, anxiety, and stress responses, intrusive and avoidant thoughts, and coping strategies) on people with SMD (n = 125) compared with two control groups: common mental disorders (CMD, n = 250) and healthy controls (HC, n = 250). An anonymous online questionnaire using a snowball sampling method was conducted from March 19-26, 2020 and included sociodemographic and clinical data along with the DASS-21 and IES scales. We performed descriptive and bivariate analyses and multinomial and linear regression models. People with SMD had higher anxiety, stress, and depression responses than HC, but lower scores than CMD in all domains. Most people with SMD (87.2%) were able to enjoy free time, although control groups had higher percentages. After controlling for confounding factors, anxiety was the only significant psychological domain with lower scores in HC than people with SMD (OR = 0.721; 95% CI: 0.579-0.898). In the SMD group, higher anxiety was associated with being single (beta = 0.144), having COVID-19 symptoms (beta = 0.146), and a higher score on the stress subscale of DASS-21 (beta = 0.538); whereas being able to enjoy free time was a protective factor (beta = -0.244). Our results showed that patients with SMD reacted to the pandemic and the lockdown restrictions with higher anxiety levels than the general public, and suggesting this domain could be a criterion for early intervention strategies and closer follow-up.

Cognitive impairment and C-reactive protein in clinically stable schizophrenia outpatients: a focus on sex differences.

Although previous findings identified an association between C-reactive protein (CRP) levels, and impaired cognitive functions in patients with schizophrenia (SZ), little is currently known about the relationship between inflammation, cognition, and sex in SZ. The current study aimed to explore the association between peripheral inflammation and cognitive impairment in SZ as a function of sex. The sample included 132 clinically stable patients with SZ, of whom 82 were males (62.1%) and 50 females (37.9%). Sociodemographic data were collected, an accurate assessment was performed using the Positive and Negative Syndrome (PANSS), Clinical Assessment Interview for Negative Symptoms (CAINS), and Calgary Depression (CDS) scales, and the MATRICS Consensus Cognitive Battery (MCCB), and CRP levels were tested. A Pearson correlation and multiple regression analyses, including potential confounding factors, were performed. We found an inverse association between CRP levels and performance on visual learning (r = - 0.386, p = 0.006) domain in female patients only, whereas no correlations were found in males. The regression model for women retained age (ß = - 0.319, p = 0.017), the CAINS-MAP score (ß = - 0.247, p = 0.070), and the CRP (ß = - 0.321, p = 0.013) as predictors of visual learning. Our results suggest the possible existence of sex-specific modulation of the association between systemic inflammation and the cognitive features of the illness.

Sex differences in bipolar disorder: Impact of lifetime cannabis use on clinical course, functioning, and quality of life in bipolar disorder.

BACKGROUND: Cannabis use is markedly prevalent among patients with bipolar disorder (BD). However, to date, there have been no studies on this issue with a sex-based approach. This study examines if lifetime cannabis use (LCU) is differently associated with clinical course, functioning, and quality of life (QoL) in patients with BD by sex. METHODS: Secondary analysis of a cross-sectional, naturalistic, multicentre study. LCU was defined as having had at least one day of use per month for at least 12 consecutive months in a patient's life. RESULTS: A total of 224 patients with BD were included (65.2% women). Patients with LCU were younger (p = 0.001) and had their first hospitalization earlier (p<0.005) than those without LCU, regardless of sex. Among women, LCU was associated with being single (p = 0.006), worse sexual functioning (p = 0.006), financial functioning (p = 0.009), QoL [bodily pain (p = 0.009), vitality (p = 0.027), social functioning (p = 0.037), emotional role (p = 0.038), mental health (p = 0.001), and mental summary component (p = 0.012)]. After controlling for confounders, among women, LCU was associated with worse QoL, specifically on bodily pain (p = 0.049) and mental health (p = 0.016) subscales. Among males, no statistically significant differences were found between LCU and no LCU (NLCU) in any of the variables of the study. LIMITATIONS: This study was a secondary analysis not powered specifically to analyze cannabis use. CONCLUSIONS: LCU was associated with a younger age at first hospitalization in both women and men, while only women reported worse QoL on bodily pain and mental health subscales. Clinicians and public health providers should be aware of this and inform their patients and the general population of these detrimental effects.