Depression, anxiety and PTSD symptoms before and during the COVID-19 pandemic in the UK.

BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors. METHOD: Online questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change. RESULTS: Prospective symptom analyses showed small decreases in depression (PHQ-9: -0.43 points) and anxiety [generalised anxiety disorder scale - 7 items (GAD)-7: -0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status. CONCLUSIONS: We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.

Loneliness in the workplace: a mixed-method systematic review and meta-analysis.

BACKGROUND: Loneliness is a risk factor for a range of mental and physical health problems and has gained increasing interest from policy-makers and researchers in recent years. However, little attention has been paid to loneliness at work and its implications for workers and employers. AIMS: Identify workplace, health and personal factors associated with workplace loneliness. METHODS: We searched five databases (PubMed, MEDLINE, EMBASE, PsycINFO and EBSCO Business Source Complete) for relevant articles published from 1 January 2000 to 23 February 2023. Quantitative data were synthesized using narrative synthesis and random-effects meta-analysis of correlation coefficients. Qualitative data were synthesized using thematic synthesis. Evidence quality was appraised using the Mixed-Methods Appraisal Tool. RESULTS: We identified 49 articles meeting the inclusion criteria. Pooled results indicate that workplace loneliness was associated with lower job performance (r = -0.35, 95% CI -0.49, -0.21), reduced job satisfaction (r = -0.34, 95% CI -0.44, -0.24), worse worker-manager relationship (r = -0.31, 95% CI -0.38, -0.24) and elevated burnout (r = 0.39, 95% CI 0.25, 0.51). Qualitative results suggest links between loneliness and inadequate workplace social interactions and mental health problems. As most studies used cross-sectional data and few adjusted for potential confounders, the direction and robustness of the associations remain untested. CONCLUSIONS: Our results indicate that loneliness is associated with poor occupational functioning and well-being among workers. Results also show that loneliness is associated with modifiable aspects of the work environment, suggesting that the workplace may offer a fruitful avenue for interventions targeting loneliness.

HPA axis functioning associated with transition to psychosis: combined DEX/CRH test.

We investigated functioning of the hypothalamic-pituitary-adrenal (HPA) axis in 12 young people at ultra high risk for developing psychosis, using the combined dexamethasone corticotrophin releasing hormone (DEX/CRH) test. Over a two year period, three of the 12 participants developed an acute psychosis. Descriptive analysis of the data indicated that contrary to expectations, participants who did not make the transition to psychosis had on average higher cortisol levels at the latter stages of the test, as well as a greater severity of depression and anxiety symptoms, than participants who subsequently developed psychosis. These preliminary results suggest that dysregulated HPA-axis functioning in individuals at high risk for psychosis may be associated more with comorbid depression symptoms than factors specifically related to the process of emerging psychosis illness.

Stress and HPA-axis functioning in young people at ultra high risk for psychosis.

It is thought that hypothalamic-pituitary-adrenal (HPA) axis functioning mediates between the experience of stress and development of psychotic symptoms. This study aimed to evaluate this model in a cohort of young people at ultra high risk (UHR) of psychosis. Information about the experience of psychological symptoms and recent stressful experiences was obtained from 23 young people who met UHR criteria. Plasma samples were taken to assess cortisol and glucocorticoid receptor numbers, and an MRI scan was also performed. Plasma cortisol levels were significantly and positively correlated with the experience of 'hassles' but not with the experience of stressful life events. Significant positive associations were also found between plasma cortisol levels and level of depression and anxiety. No significant relationships were found between plasma cortisol level and global psychopathology, psychotic symptomatology, functioning or pituitary and hippocampal volumes. These results suggest that the number of hassles experienced by young people at UHR of psychosis could be an important factor in raising their cortisol levels, which might, in turn, affect the severity of depressive and anxiety symptoms. No other relationships were found between plasma cortisol levels and the experience of psychotic symptoms, functioning or hippocampal and pituitary volumes. These results indicate possible impairment in HPA-axis functioning in the early stages of psychotic illness, but further investigation of the relationships between these parameters is required.

Electromyographic activity of the long digital extensor muscle in the exercising Thoroughbred horse.

Surface electrodes were used to record electromyographic (EMG) activity of the long digital extensor muscle on the right hindlimb of 8 Thoroughbred horses for 8 s at the walk and 8 s at the trot before (unfatigued) and after (fatigued) an exercise test. The exercise test was performed on a motorised treadmill set on a 10% grade. Each test started at a speed of 6 m/s which was increased by 1 m/s each minute until the horse fatigued as indicated by its inability to keep pace with the treadmill with minimal encouragement. Observations were made on the horses prior to conditioning (untrained state) and after 8 weeks of regular exercise (trained state). The mean root-mean-square (rms) values of EMG bursts collected in each experimental trial were determined for each horse and group means were derived from the mean of independent subjects. Statistical comparisons for differences in rmsEMG were related to gait, fatigue and training. Mean rmsEMG at the trot was consistently higher than at the walk (P<0.05). At the walk, mean fatigued rmsEMG tended to be higher than the mean unfatigued rmsEMG in the untrained state and was significantly higher in the trained state (P<0.05). At the trot, mean fatigued rmsEMG was higher (P<0.05) than mean unfatigued rmsEMG in both the untrained and trained states. Training did not have an effect on mean rmsEMG of unfatigued muscles at the walk or the trot (P>0.05). However, fatigued muscles experienced higher EMG activity in the trained state at the walk (P<0.05). A similar tendency was observed at the trot. Results of this study suggest that surface EMG measurement may be useful for evaluating fatigue in exercising horses.

Determination of highest no effect dose (HNED) for local anaesthetic responses to procaine, cocaine, bupivacaine and benzocaine.

The highest no effect doses (HNEDs) for the local anaesthetic (LA) effects of procaine, cocaine, bupivacaine and benzocaine were determined using the heat lamp/hoof withdrawal model of Kamerling et al. (1985b) and the abaxial sesamoid block model of local anaesthesia. The heat lamp rapidly (4 or 5 s) increased the temperature of the superficial skin layers of the pastern to about 90 degrees C, at which point the animal sharply withdrew its hoof. Effective LA blockade precluded this response and superficial skin temperatures exceeded 120 degrees C. Thermal stimulus experiments were routinely terminated after 10 s of exposure to prevent undue tissue damage. Following abaxial sesamoid block with bupivacaine, the HNED for that drug was about 0.25 mg/site. Increasing the dose to 2 mg/site apparently produced complete and prolonged LA blockade. Analogous work showed that the HNED for procaine was about 2.5 mg/site. Similarly, the dose response curve for procaine was parallel with that of bupivacaine but was shifted 10-fold to the right. The duration of the LA response following procaine injection was less than for bupivacaine with the statistically significant response following 40 mg/site injection lasting less than 45 min. Cocaine was less potent than procaine, showing a shallower dose response curve. The HNED for cocaine was less than 5 mg/site, although at this dose the duration of action was extremely short (< 7.5 min). Benzocaine had no significant LA action when a dose of 800 mg was applied topically as a 5% preparation. These results show that the HNEDs for bupivacaine and procaine are remarkably low, that cocaine is somewhat less potent as a LA than might be expected, and that 5% topical benzocaine has no significant pharmacology. The small doses of bupivacaine and procaine producing effective local anaesthesia suggests that developing plasma thresholds for these agents is likely to be very challenging.

Skeletal growth rates of weanling and yearling thoroughbred horses.

This study was conducted to determine normal rates of growth of different skeletal segments in the thoroughbred horse. Growth of body weight and eight skeletal segments (wither height, hip height, body length, knee to pastern length, hock to pastern length, shoulder to pastern length, width of chest, depth of girth) were monitored in 106 horses (60 colts, 46 fillies) during the period from 14 to 588 d of age. Body weight gains were slightly higher (30 to 40 kg) than previously reported values. Growth in wither height and hip height were similar to previous reports. During the period measured in this study hip height was consistently 2 or 3 cm larger than wither height. Growth patterns for wither height, body length, and shoulder to pastern lengths were similar to one another. Growth of the knee to pastern and hock to pastern segments reached a plateau at approximately 140 d of age, which coincided with the cessation of longitudinal bone growth. These data define skeletal growth patterns in the thoroughbred horse and are useful in determining the relationship between growth and the occurrence of orthopedic diseases in horses.

The influence of supplemental feed on growth and bone development of nursing foals.

Thirty foals of mixed breeding, from two consecutive years, were used in two 120-d experiments to evaluate the effects of supplemental feeding (creep feed) on growth in nursing foals. At 10 d postpartum, foals were randomly assigned either to a creep-fed group (CF) or an unsupplemented group (NCF). Initial measurements of body weight (BW), height at the withers (WH), third metatarsal length (MtIII) and third metacarpal length (McIII) were made at 10 d of age and at 30-d intervals thereafter. Medial and lateral cortical peak values for radiographic bone density, cortical width and cortical area at the midpoint of the third metacarpal were used to assess bone quality. Creep feed containing National Research Council (NRC, 1978) recommended levels for all nutrients was offered at 1.5% of BW per day. When compared with unsupplemented foals, supplemented foals had greater gains in BW (P less than .05), in WH (P less than .10) and in MtIII (P less than .05). Mean gains during the trial in BW, WH, MtIII and McIII for the CF foals were 133.3 kg, 22.8 cm, 2.1 cm and 1.9 cm and for the NCF foals were 117.6 kg, 21.2 cm, 1.5 cm and 1.9 cm, respectively. The mean value for the lateral cortical peak was slightly lower (P less than .10) for the CF foals. No differences (P greater than .10) were observed for the medial cortical peak, cortical width or cortical area of the third metacarpal. The results of this study indicate that a creep feeding program that supplies NRC-recommended nutrient levels can increase the rate of skeletal growth with little decrease in quality of bone.

The influence of high planes of nutrition on skeletal growth and development of weanling horses.

Effects of high dietary levels of energy, protein and Ca and deficient levels of Ca on skeletal growth and development in the equine were studied in two experiments. The weanlings were fed grain-based diets. In Exp. 1, Group 1 (Ctl) received all nutrients at NRC recommended levels for growth; Group 2 (HE) received 150% of their digestible energy (DE) requirement; Group 3 (LC) received 150% of DE and 35% of Ca requirements. In Exp. 2, Group 1 (Ctl) again received all nutrients at NRC recommended levels for growth; Group 2 (HEP) received 150% of DE and 275% of CP requirements; Group 3 (HEPC) received 150% of DE, 275% of CP and 500% of Ca requirements. In addition, all groups had access to pasture. The HE treatment resulted in greater (P less than .10) increases in BW and total cortical width. However, LC weanlings had lower (P less than .10) gains in third metacarpal length and radiographic bone density. Cumulative increases in BW and wither height were greater (P less than .10) for the HEP and HEPC weanlings than for the Ctl weanlings. Increases in third metatarsal length also were greater (P less than .10) for HEP weanlings than for Ctl weanlings. Higher planes of nutrition increased body weight gains and growth rate of several long bones. However, skeletal development (e.g., cortical area) may be compromised by a high rate of growth.

The influence of betaine on untrained and trained horses exercising to fatigue.

Because exercise fatigue has been associated with the accumulation of lactic acid, factors that influence lactate metabolism during exercise can potentially enhance performance. The objective of this study was to examine the effects of supplemental betaine on eight mature Thoroughbred horses before and after 8 wk of conditioning. The effects of betaine were tested in two cross-over design experiments, allowing each horse to receive both the control and betaine treatments at each fitness level. Ingestion of 80 mg of betaine/kg of BW for 14 d before exercise testing did not alter plasma lactate, glucose, free fatty acids (FFA), or triglyceride concentrations during exercise in the untrained or trained horses. A time x treatment interaction (P < .05) was observed for plasma lactate in untrained horses during recovery from exercise, and plasma lactate concentrations were lower (P < .05) at 60 min after exercise when untrained horses received betaine. Plasma FFA concentrations were lower (P < .05) before exercise and at 720 min after exercise when untrained horses received betaine. These data indicate that betaine may influence lactate metabolism following exercise in untrained horses; however, betaine does not seem beneficial for trained horses.

Dietary control of exertional rhabdomyolysis in horses.

OBJECTIVE: To determine whether feeding a low-carbohydrate, high-fat diet would decrease severity of exercise-induced muscle injury in horses with exertional rhabdomyolysis. ANIMALS: 19 horses with a history of exertional rhabdomyolysis. DESIGN: Case series. PROCEDURE: Specimens of the semitendinosus or semimembranosus muscle were obtained for histologic examination, and serum creatine kinase (CK) and aspartate transaminase (AST) activities 4 hours after exercise were determined. Horses were then fed a low-carbohydrate, high-fat diet, and serum CK and AST activities 4 hours after exercise were reevaluated at approximately monthly intervals for 3 to 6 months. RESULTS: Serum CK and AST activities 4 hours after exercise were high before any change in diet. All 19 horses had evidence of chronic myopathic change and abnormal glycogen accumulation in muscle biopsy specimens; 11 horses also had evidence of complex polysaccharide accumulation. Adaptation to diet change required approximately 3 to 6 months. Sixteen horses did not have any episodes of exertional rhabdomyolysis after 3 to 6 months of diet change, and 3 horses had mild episodes of exertional rhabdomyolysis following either a reduction in dietary fat intake or restriction in exercise. Postexercise serum CK and AST activities 3 to 6 months after the change in diet were significantly less than initial values. CLINICAL IMPLICATIONS: Results indicated that exertional rhabdomyolysis may be a result of abnormal carbohydrate metabolism in some horses. Feeding a diet with low carbohydrate and high fat content may reduce severity of exercise-induced injury in some horses with exertional rhabdomyolysis.

Extrapyramidal symptoms and oestrogen.

OBJECTIVE: The present study aimed to investigate neuroleptic side-effect severity in women with psychosis, and to investigate their putative association with variations in sex steroids over the menstrual cycle. Based on the oestrogen hypothesis, which postulates a synergistic relationship between oestrogen and neuroleptics, it was hypothesized that oestrogen would exacerbate extrapyramidal symptoms. METHOD: Twenty-five psychotic women were assessed using the ESRS and blood hormone analysis. Testing was conducted twice, 2 weeks apart, in a randomized cross-over design. RESULTS: Contrary to expectation the results indicated that high levels of oestrogen reduce hyperkinetic symptoms in women with psychosis, and this effect appears to be further potentiated when both oestrogen and progesterone are high. CONCLUSION: On the basis of these findings, and receptor studies in animals, it was concluded that oestrogen has different effects on dopamine dynamics in the mesolimbic and mesostriatal pathways.

Reduced awareness of illness in first-episode psychosis.

We sought to investigate whether first-episode and multiple-episode patients differ in their awareness of their illness. A total of 312 multiple-episode and 144 first-episode patients participated, the majority of whom had a schizophrenia spectrum disorder (schizophrenia or schizophreniform disorder). Insight was measured using the Scale for the Assessment of Unawareness of Mental Disorder (SUMD). First-episode patients with a schizophrenia spectrum disorder were less aware of having a mental illness than multiple-episode patients. Our findings suggest that in the time following the first episode of psychosis, patients may become less defensive, and possibly more skilled in using medical terms to describe their illness. We suggest a need for skilled psychoeducation that addresses awareness in patients with psychosis, particularly those who are unaware of their illness.