Executive functions and insight in OCD: a comparative study.

BACKGROUND: Around 25 to 30% of patients with obsessive-compulsive disorder (OCD) do not respond to treatment. These patients have the longest duration of disease and the worst prognosis. Following years of research on this topic, insight has emerged as a potential explanation for this therapeutic resistance. Therefore, it has become important to characterize OCD patients with poor insight. Few studies have focused on the neuropsychological and cognitive characteristics of these patients. METHODS: To help fill this gap, we divided 57 patients into two groups, one with good insight and the other with poor insight, assessed their neuropsychological functions-through a Rey's figure test, a California verbal learning test, a Toulouse-Piéron test and a Wisconsin Card Sorting Test (WCST)-and compared the results with those of a paired control group. RESULTS: The statistical analysis, with a significance level of 95%, revealed differences in the executive function tests, and particularly in the WCST (p ≤ 0.001) and trail-making-test (TMT A/B) (p = 0.002). CONCLUSIONS: These differences suggest that the neuropsychological profile of poor-insight patients is different from their good-insight counterparts, emphasize the role played by the executive functions in insight and highlights the need for more accurate neurocognitive research and treatment.

The safety of agomelatine in standard medical practice in depressed patients: A 26-week international multicentre cohort study.

OBJECTIVE: The present observational cohort study documented the safety of agomelatine in current medical practice in out-patients suffering from major depressive disorder. METHOD: The 6-month evolution of agomelatine-treated patients was assessed with a focus on safety (emergent adverse events, liver acceptability), severity of depression using the Clinical Global Impression Severity (CGI-S) score, and functioning measured by the Sheehan Disability Scale (SDS). RESULTS: A total of 8453 depressed patients from 761 centres in 6 countries were analysed (female: 67.7%; mean age: 49.1 ± 14.8 years). Adverse events reported were in accordance with the known safety profile of agomelatine. Cutaneous events were reported in 1.7% of the patients and increased hepatic transaminases values were reported in 0.9 % of the patients. The incidence of events related to suicide/self-injury was 1.0%. Two completed suicides, not related to the study drug, were reported. CGI-S total scores and SDS sub-scores improved and numbers of days lost or underproductive decreased over the treatment period. CONCLUSIONS: In standard medical practice, agomelatine treatment was associated with a low incidence of side effects. No unexpected events were reported. A decrease in the severity of the depressive episode and improved functioning were observed. TRIAL REGISTRATION NAME: Observational cohort study to evaluate the safety of agomelatine in standard medical practice in depressed patients. A prospective, observational (non-interventional), international, multicentre cohort study. TRIAL REGISTRATION NUMBER: ISRCTN53570733.

Suicidal behaviour after first-episode psychosis: results from a 1-year longitudinal study in Portugal.

BACKGROUND: Suicide is one of the main causes of excess of premature death in psychotic patients. Published studies found that suicide risk begins in ultra-high risk of psychosis and continues in early years of the disease. Previous studies identifying predictive and risk factors associated with suicidality in first-episode psychosis (FEP) are highly inconsistent. Also, there are relatively few longitudinal studies on suicidal behaviour in FEP. The aim of this study was to examine prevalence, evolution and predictors of suicidal behaviour at baseline and the 12-month follow-up in patients presenting with FEP. METHODS: One hundred and eighteen patients presenting with FEP were recruited from two early psychosis units in Portugal. A comprehensive assessment examining socio-demographic and clinical characteristics was administered at baseline and the 12-month follow-up. Odds ratio were calculated using logistic regression analyses. McNemar test was used to evaluate the evolution of suicidal behaviour and depression prevalence from baseline to 12 months of follow-up. RESULTS: Follow-up data were available for 60 participants from the 118 recruited. Approximately 25.4% of the patients had suicidal behaviour at the baseline evaluation, with a significant reduction during the follow-up period to 13.3% (p = 0.035). A multivariate binary logistic regression showed that a history of suicidal behaviour and depression at baseline independently predicted suicidal behaviour at baseline, and a history of suicidal behaviour and low levels of total cholesterol predicted suicidal behaviour at the 12-month follow-up. A significant proportion of patients also had depression at the baseline evaluation (43.3%), with the last month of suicidal behaviour at baseline independently predicting depression at this time. CONCLUSIONS: The findings of our study indicate that suicidal behaviour was prevalent on the year after FEP. Patients with a history of suicidal behaviour, depression at baseline and low levels of cholesterol should undergo close evaluation, monitoring and possible intervention in order to reduce suicide risk in the early phases of psychosis.

May the right-side epileptogenic zone be a predictor of psychiatric comorbidity in people with refractory epilepsy?

The aim of this study was to determine the rate and types of lifetime psychiatric disorders, as well as their predictors, in a sample of people with refractory epilepsy. Demographic, neurological, psychiatric and neuropsychological data, from people with refractory epilepsy, were registered at the pre-surgical interview. Linear regression was used to determine predictors. One hundred and ninety-one participants were included. Forty-six percent of our sample had at least one previous psychiatric diagnosis, most frequently depressive (64%), anxiety (10%), substance use (10%) and psychotic disorders (6%). Patients with a right-side epileptogenic zone had an increased risk for these disorders (OR 2.36; CI 1.22-4.56; p = 0.01). Specific epilepsy-related factors may raise the risk of developing a psychiatric disorder. Our study adds evidence to support a bidirectional relationship between epilepsy and mental health.

Predicting de novo psychopathology after epilepsy surgery: A 3-year cohort study.

OBJECTIVE: The aim of this study was to determine the potential risk factors for de novo psychiatric syndromes after epilepsy surgery. METHODS: Refractory epilepsy surgery candidates were recruited from our Refractory Epilepsy Reference Centre. Psychiatric evaluations were made before surgery and every year, during a 3-year follow-up period. Demographic, psychiatric, and neurological data were recorded. The types of surgeries considered were resective surgery (resection of the epileptogenic zone) and palliative surgery (deep brain stimulation of the anterior nuclei of the thalamus (ANT-DBS)). A survival analysis model was used to determine pre- and postsurgical predictors of de novo psychiatric events after surgery. RESULTS: One hundred and six people with refractory epilepsy submitted to epilepsy surgery were included. Sixteen people (15%) developed psychiatric disorders that were never identified before surgery. Multilobar epileptogenic zone (p = 0.001) and DBS of the ANT-DBS (p = 0.003) were found to be significant predictors of these events. CONCLUSION: People with more generalized epileptogenic activity and those who undergo ANT-DBS seem to present an increased susceptibility for the development of mental disorders, after neurosurgical interventions, for the treatment of refractory epilepsy. People considered to be at higher risk should be submitted to more frequent routine psychiatric assessments.

Clinical determinants of psychopathological outcomes after epilepsy surgery.

OBJECTIVES: People with refractory epilepsy submitted to surgery may improve or deteriorate their cognitive and emotional functions. The aim of this study was to determine the predictors of longitudinal changes in psychopathological symptomatology, one year after epilepsy surgery, considering clinical and demographic characteristics. METHODS: People with refractory epilepsy referred to epilepsy surgery were included in this ambispective study. Psychiatric evaluations were made before surgery and one year after the procedure. Demographic, psychiatric, and neurological data were recorded. Linear regression was used to analyze longitudinal data regarding the Global Severity Index and 9 symptom dimensions of Symptom Checklist-90 (SCL-90). RESULTS: Seventy-six people were included. Bilateral epileptogenic zone, lack of remission of disabling seizures, and deep brain stimulation, targeting the anterior nucleus of the thalamus (ANT-DBS), were the most important predictors of an increase in SCL-90 scores, after surgery. CONCLUSION: Some individual factors may have an impact on the development or worsening of the previous psychopathology. This study identifies clinical aspects associated with greater psychological distress, after surgery. These patients may benefit from more frequent psychiatric routine assessments for early detection.

Psychiatric disorders as predictors of epilepsy surgery outcome.

OBJECTIVES: Our aim was to determine if a history of a mental disorder predicts a worst neurological outcome for patients undergoing epilepsy surgery. METHODS: We conducted an ambispective observational study including people with refractory epilepsy who underwent resective surgery. Demographic, psychiatric, and neurological data were collected, before and one year after surgery. Presurgical interviews included a psychiatric evaluation and the determination of prevalent and lifetime psychiatric diagnosis. The one-year postsurgical outcome was classified according to the Engel Outcome Scale. Predictors of postsurgical Engel class were determined using an ordered logistic regression model. RESULTS: A lifetime history of any mental disorder was a significant predictor of a higher Engel Class (p = 0.017). CONCLUSION: This study shows that psychiatric lifetime diagnoses are associated with worse surgical outcome and highlighted the importance of the inclusion of these diagnoses in the evaluation of the potential success of the surgery.

Personality patterns of people with medically refractory epilepsy - Does the epileptogenic zone matter?

OBJECTIVES: The aims of this study were to determine the rate of dysfunctional personality patterns before and after epilepsy surgery, their types, and the importance of the epileptogenic zone in a sample of people with refractory epilepsy. METHODS: We conducted an ambispective observational study, including refractory epilepsy surgery candidates. Demographic, psychiatric, and neurological data were recorded. Evaluation of personality was made using the Millon Clinical Multiaxial Inventory-II (MCMI-II). Presurgical predictors of personality patterns were determined using a linear regression model. The proportion of patients with dysfunctional personality patterns, before and after surgery, was compared using the Mcnemar's test. Then a generalized estimating equation model was performed to include predictors of changes in this rate. RESULTS: One hundred and ninety-nine participants were included. Seventy percent had a dysfunctional personality pattern before surgery. After surgery, this percentage dropped to 58%. The difference was statistically significant after adjusting for potential confounders (p = 0.013). The most common types were Cluster C personality patterns. Temporal epileptogenic zone was a significant predictor of higher scores of the Avoidant (Coef. 11.8; Confidence Interval (CI) -0.59 23.7; p = 0.051) and Compulsive (Coef. 9.55; CI 2.48 16.6; p = 0.008) personality patterns and lower scores of Histrionic (Coef. -11.4; CI -21.2 -1.55; p = 0.024) and Antisocial (Coef. -8.4; CI -15.6 -1.25; p = 0.022) personality patterns, compared to extratemporal epileptogenic zone. CONCLUSION: People with refractory epilepsy have high rates of dysfunctional personality patterns. These patterns differ according to the epileptogenic zone.

Facilitating the Delivery of Cognitive Remediation in First-Episode Psychosis: Pilot Study of a Home-Delivered Web-Based Intervention.

We explored the adherence to a home-delivered, computer-based, cognitive remediation protocol in a first-episode psychosis outpatient cohort. Seventeen patients underwent a cognitive training protocol for 6 months using an online platform accessible from their home under the supervision of a qualified neuropsychologist. Neuropsychological, psychopathological, and functional data were collected at baseline and postintervention, whereas qualitative appraisal of the intervention was assessed monthly. Overall, participants' evaluation of the program was positive. This was reflected in a good adherence rate with 12 (70%) of 17 patients completing 80% of the prescribed sessions. Exploratory analysis revealed significant improvements in sustained attention (p = 0.020) and verbal memory (p = 0.018). A decrease in negative symptoms and an improvement on the Clinical Global Impression were also found (p = 0.009). We believe these are encouraging results to further explore the adopted delivery approach, which could facilitate access to cognitive training earlier and to a larger group of patients.

The Uncanny of the Illness Experience: Can Phenomenology Help?

The illness experience encompasses not only several changes in bodily processes but also the very feeling of becoming ill. This seemingly non-scientific aspect of being sick is characterized by forms of uncanny body experiences and an unhomelike being-in-the-world. Both include disconcerting phenomena, feelings of fear, restlessness, and inexplicability. In this paper we discuss some contributions aiming to understand the illness experience, focusing on the concept of the uncanny. This life event brings changes in the familiarity of our world, revelation of what previously was and should have remained hidden, loss of control, and the certainty of mortality. The experience of uncanniness is here conceptualized as a psychopathological phenomenon that should be regarded as a general symptom of diseases and should be identified and approached. We discuss the impact of these considerations on medical practice, focusing on the role of physicians and ultimately on the purpose of medicine.

Self-perception of quality of life in patients with functional voice disorders: the effects of psychological and vocal acoustic variables.

PURPOSE: Functional voice disorders (FVD) are multifactorial and may have a significant impact on the patients' quality of life (QOL). The aim of this study was to explore and analyze the relationship between the VHI scores, psychological variables, and objective voice measurements, and to develop a psychological and/or vocal acoustic model for the overall self-perceived evaluation of quality of life for three different types of FVD. METHODS: After ENT examination, 83 women were classified into three groups: psychogenic voice disorder (PVD = 39), primary muscle tension voice disorder (MTVD1 = 16), and secondary muscle tension voice disorder (MTVD2 = 28). All patients were evaluated according to a multidisciplinary assessment protocol, which included the self-evaluation of quality of life (Voice Handicap Index, VHI), psychological evaluation (Hamilton Rating Scales for Depression (HAM-D) and for Anxiety (HARS), and Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto questionnaire (TEMPS-A)), and vocal acoustic analysis [mean fundamental frequency (F0, Hz), jitter (local, %), shimmer (local, %), and harmonic-to-noise ratio (HNR, dB)]. RESULTS: Our findings revealed a moderate impact on QOL, regardless of the type of FVD. There were significant correlations between VHI scores, psychological variables, and voice perturbation parameters, with the exception of the MTVD1 and MTVD2 groups. The stepwise multiple linear regression analysis suggested that QOL could be explained by: anxious temperament together with shimmer in PVD group, jitter in the MTVD1 group, and depressive temperament in the MTVD2 group. CONCLUSIONS: Affective temperaments and/or voice perturbation parameters were meaningful predictors of self-evaluation of quality of life in patients with different types of FVD.

Basic Self-Disturbances beyond Schizophrenia: Discrepancies and Affinities in Panic Disorder - An Empirical Clinical Study.

BACKGROUND: Anomalous self-experiences (ASEs), presumably involving alterations in "core" or "minimal self," have been studied as manifest in schizophrenia and its spectrum, in contrast with mood disorder and personality disorder samples. This is the first study to examine ASEs in panic disorder (PD), beginning the exploration of these disturbances of subjectivity in anxiety disorders. We aimed to clarify what might, or might not, be specific to the schizophrenia spectrum domain - which, in turn, could be useful for developing pathogenetic models for various disorders. SAMPLING AND METHODS: 47 hospital outpatients with PD and no other medical and psychiatric comorbidity and 47 healthy control (HC) subjects were assessed with the Examination of Anomalous Self Experiences (EASE) and Cambridge Depersonalization Scale (CDS). RESULTS: All our PD patients had overall ASE and EASE scores significantly higher than our HCs (mean ± SD 17.94 ± 11.88 vs. HC 1.00 ± 1.81), approaching levels found in previous schizophrenia spectrum samples. The distribution of particular EASE items and subitems in the PD sample was heterogeneous, varying from rare (<10%) or absent (termed "discrepancies" with schizophrenia spectrum: 29 items) to being present in >50% of subjects ("affinities" with schizophrenia spectrum: 7 items). EASE and CDS scores were highly correlated (r = 0.756, 95% CI 0.665-0.840). CONCLUSIONS: PD patients scored higher on items suggesting common forms of derealization and depersonalization, perhaps suggesting "secondary" and defensive psychological processes, while lacking indicators of more profound ipseity disturbance. Our study supports the basic-self-disturbance model of schizophrenia, while suggesting the possibility of transnosological "schizophrenia-like phenomena," which might require careful phenomenological exploration to be distinguished from those of true psychotic or schizophrenic conditions.

Multidimensional alcoholism typologies: could they guide clinical practice? Results from a 3-month prospective study.

OBJECTIVE: The current nosological classifications may describe a syndrome of "alcoholism" that is too heterogeneous to produce prognostic models for clinical management. Multidimensional alcoholism typologies (ATs) could represent a valuable paradigm in the search for targeted treatment. The main goal of this study was to evaluate the clinical implications of 3 empirically-validated ATs, focusing on various measures of clinical performance. METHOD: This was a 3-month naturalistic study in which drinking status, and participation in the clinical protocol and group psychotherapy were recorded and used as indicators of treatment performance. The clinical profiles of the subtypes were also compared and graphically presented. Alcohol-dependent outpatients were classified according to the Cloninger, Lesch, and NETER typologies. RESULTS: The results showed that the type II (Cloninger), type IV (Lesch), and sociopathic and addictopathic (NETER) subgroups showed a worse outcome in terms of abstinence rates and clinical healthcare resource use. CONCLUSIONS: Our findings point to the need to differentiate multidimensional alcoholism subtypes before planning the clinical management of alcohol use disorders.

Clinical management and burden of bipolar disorder: results from a multinational longitudinal study (WAVE-bd).

Bipolar disorder is a mood disorder which requires complex treatment. Current treatment guidelines are based on the results of published randomized clinical trials and meta-analyses which may not accurately reflect everyday clinical practice. This multi-national, multi-centre, observational cohort study describes clinical management and clinical outcomes related to bipolar disorder in real-life settings, assesses between-country variability and identifies factors associated with clinical outcomes. Adults from 10 countries in Europe and South America who experienced at least one mood episode in the preceding 12 months were included. Overall, 2896 patients were included in the analyses and followed for at least 9 months across a retrospective and prospective study phase. Main outcome measures were the number and incidence rate of mood episodes (relapses and recurrences) and healthcare resource use including pharmacological treatments. Relapses and recurrences were reported in 18.2 and 40.5% of patients, respectively; however, the reported incidence rate of relapses was higher than that of recurrences [1.562 per person-year (95% CI 1.465-1.664) vs. 0.691 per person-year (95% CI 0.657-0.726)]. Medication use was high during all episode types and euthymia; the percentage of patients receiving no medication ranged from 11.0% in mania to 6.1% in euthymia. Antipsychotics were the most commonly prescribed drug class in all disease phases except for patients with depression, where antidepressants were more frequently prescribed. Visits to the psychiatrist were the most frequently used healthcare resource. These results provide a description of treatment patterns for bipolar disorder across different countries and indicate factors related to relapse and recurrence.

Omega-3 index as risk factor in psychiatric diseases: a narrative review.

Numerous studies have described associations between the omega-3 index (defined as the RBC percentage of EPA and DHA) and mental conditions, but no risk stratification or target value has gathered consensus so far. This narrative review aims to summarize the published data on the association between omega-3 index and mental illness and to contribute to the concept of an omega-3 index in the field of mental health. The bibliographic searches have been carried out in PubMed, Scopus and Web of Science databases to find relevant English language original research studies related to that association. The study search and selection process were registered in a PRISMA flow. Thirty-six studies were included in this review examining the links between omega-3 index and postpartum depression (3), major depression (15), major depression and bipolar disorder (1), bipolar disorder (4), schizophrenia and major depression (1), schizophrenia and other psychosis (5) and dementia (7). Thirty of these studies found either significant differences in omega-3 index between patients and controls or inverse relationships between omega-3 index and disease severity. The published evidence is compelling enough to suggest omega-3 index as a risk factor for some psychiatric diseases, specifically, major depression, postpartum depression, psychosis, and dementia. In occidental populations, we propose a risk threshold of (a) 4-5% in major depression and dementia, (b) 5% in postpartum depression, and (c) 4% for psychosis transition.

The Portuguese version of the Personal and Social Performance Scale (PSP): reliability, validity, and relationship with cognitive measures in hospitalized and community schizophrenia patients.

PURPOSE: Deficits in social functioning are a core feature of schizophrenia and are influenced by both symptomatic and neurocognitive variables. In the present study we aimed to determine the reliability and validity of the Portuguese version of the Personal and Social Performance (PSP) scale, and possible correlations with measures of cognitive functioning. METHODS: One-hundred and four community and inpatients with schizophrenia were assessed using measures of social functioning and symptom severity alongside measures of executive function, processing speed, and verbal memory. RESULTS: Convergent validity with the GAF in the four domains of the PSP varied from 0.357 to 0.899. Reliability was found to be satisfactory, with a Cronbach's alpha coefficient of 0.789. Inter-rater reliability in the four domains of the PSP varied from 0.430 to 0.954. Low-functioning patients (PSP < 70) were older, had longer duration of illness, were more symptomatic and had worse cognitive performances, as compared with high-functioning patients (PSP ≥ 70). In a regression model, deficits in social functioning were strongly predicted both by symptomatic and neurocognitive variables; these together accounted for up to 62% of the variance. CONCLUSIONS: The present study supports the reliability and validity of the Portuguese language version of the PSP and further supports the original measure. The co-administration of brief cognitive assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes in this group.

Fighting stigma of mental illness in midsize European countries.

PURPOSE: Stigma is the most powerful obstacle to the development of mental health care. Numerous activities aiming to reduce the stigma of mental illness and the consequent negative discrimination of the mentally ill and their families have been conducted in Europe. Descriptions of many of these activities are not easily available, either because there are no publications that describe them, or because descriptions exist only in local languages. This supplement aims to help in overcoming this imbalance by providing a description of anti-stigma activities in 14 countries in Europe regardless of the language in which they were published and regardless whether they were previously published. METHODS: The review was undertaken by experts who were invited to describe anti-stigma activities in the countries in which they reside. It was suggested that they use all the available evidence and that they consult others in their country to obtain a description of anti-stigma activities that is as complete as possible. RESULTS: The anti-stigma activities undertaken in the countries involved are presented in a tabular form. The texts contributed by the authors focus on their perception of the stigma of mental illness and of activities undertaken to combat it in their country. CONCLUSIONS: Although much has been done against the stigmatization and discrimination of the mentally ill, fighting stigma remains an essential task for mental health programs and for society. The descriptions summarized in this volume might serve as an inspiration for anti-stigma work and as an indication of potential collaborators in anti-stigma programs.

A study of suicidal thoughts in acute stroke patients.

BACKGROUND: In previous studies, suicidal thoughts in stroke patients were related to depression and recurrent stroke. The aim of this study was to describe the presence and correlates of suicidal thoughts in acute stroke patients. METHODS: We assessed the presence of suicidal thoughts in a sample of 177 consecutive acute stroke patients (≤ 4 days), using the item "suicidal thoughts" of the Montgomery and Asberg Depression Rating Scale. RESULTS: Fifteen percent of acute stroke patients had suicidal thoughts, 22% of them with explicit plans to complete suicide. Suicidal thoughts were more frequent in patients with a lower educational level (Chi-square 4.69; P = .05), previous mood disorder (Chi-square 12.80; P = .001), diabetes (Chi-square 5.48; P = .04), and acute depression (Chi-square 16.59; P = .001). In logistic regression, a lower educational level (odds ratio [OR] 5.13; 95% confidence interval [CI] 0.80-33.29), diabetes (OR 3.15; 95% CI 0.81-12.28), a previous mood disorder (OR 4.22; 95% CI 1.12-15.86), and depression (OR 7.82; 95% CI 1.58-38.71) were independent factors predicting suicidal thoughts (R(2) = 0.39%). The 23 depressed acute stroke patients with suicidal thoughts were similar in demographic, clinical, and lesion variables, and were similar in profile of depression to the 63 patients with depression but without suicidal thoughts, except for a higher frequency of a previous mood disorder in the former group (Chi-square 7.87; P = .01). CONCLUSIONS: Suicidal thoughts may develop shortly after the onset of acute stroke, especially in patients with a lower educational level, a previous mood disorder, and those who developed depressive symptoms in the acute phase of stroke. The high frequency of suicidal thoughts makes the assessment of suicidal behavior in patients with acute stroke an important clinical issue.

Metabolic syndrome following a first episode of psychosis: results of a 1-year longitudinal study conducted in metropolitan Lisbon, Portugal.

OBJECTIVE: We aimed to assess the prevalence and course of metabolic syndrome (MetS) and the associated metabolic parameters during the year following a first episode pf psychosis (FEP). METHODS: We performed a 1-year longitudinal observation of 60 patients who experienced FEP. MetS was defined using the modified definition of the National Cholesterol Education Program Adult Treatment Panel III. We assessed the metabolic parameters and socio-demographic and psychopathological data for the participants. RESULTS: The mean age of the participants was 27.1 years, and 33.3% of them were women. There was an increase in the prevalence of MetS from 6.7% to 11.7% during the year following the baseline assessment during the year following the baseline assessment (p = 0.250). There were also significant increases in the prevalences of abnormal triglyceride concentration, waist circumference, and high-density lipoprotein (HDL)-cholesterol concentration during this period. In addition, there was a considerable worsening of the metabolic profile of the participants. No baseline parameters were identified to be predictors of MetS over the 1-year follow-up period. CONCLUSIONS: We can conclude that metabolic abnormalities are common in patients with FEP and that these rapidly worsen during the first year following the diagnosis of FEP. Studies on interventions are needed to reduce metabolic risk to cardiovascular diseases following the FEP.