La dépression majeure à caractéristique atypique comme facteur de risque du syndrome d’apnées obstructives du sommeil chez le jeune adulte

ObjectivesIn the literature, several studies have investigated the particular relationship between major depression and obstructive sleep apnoea syndrome (OSAS). However, most of these studies have focused primarily on middle-aged to elderly individuals (≥ 40 years) which means that this problem has been little studied in young adults (< 30 years). Nevertheless, in young adults the prevalence of major depression (particularly its atypical subtype) is not negligible, which seems to justify carrying out additional investigations in order to allow a better understanding of the potential role played by major depression in the pathophysiology of OSAS in this particular subpopulation. The aim of this study was therefore to empirically investigate the prevalence of OSAS in young adults and to study the risk of OSAS associated with major depression in this particular subpopulation.MethodsPolysomnographic and demographic data from 264 young adults were collected from the Erasme Hospital Sleep Laboratory (Brussels, Belgium) database to enable our analyses. During their two-night stay (including a first night of habituation and a night of polysomnography) at the Sleep Laboratory, these individuals underwent a complete somatic assessment (including blood test, electrocardiogram, daytime electroencephalogram and urinalysis), a systematic psychiatric assessment by a unit psychiatrist and an assessment of their complaints related to sleep. These different steps made it possible to systematically diagnose all somatic pathologies, psychiatric disorders according to the diagnostic criteria of the DSM-IV-TR and sleep pathologies according to the diagnostic criteria of the AASM. This allowed the selection of young adults included in our study based on our inclusion and exclusion criteria. Polysomnographic recordings from our Sleep Laboratory were visually scored according to AASM criteria. An obstructive sleep apnoea-hypopnoea index ≥ 5/hour was used for the diagnosis of OSAS. At the statistical level, in order to allow our analyses, we subdivided our sample of young adults into two groups: a control group without OSAS (n = 215) and a patient group with OSAS (n = 49). After checking the normal distribution of our data, normally distributed data were analysed with t-tests whereas asymmetrically or dichotomously distributed data were analysed with Wilcoxon tests or Chi² tests. Univariate regression models were used to study the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults and potential confounding factors. In multivariate regression models, the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults was adjusted only for confounding factors significantly associated with OSAS during univariate analysis. These confounding factors were introduced in a hierarchical manner in the various multivariate regression models constructed.ResultsThe prevalence of OSAS in our population of young adults was 18.6 %. During univariate analyses, atypical depression [OR 2.51 (95% CI 1.18–5.32), p-value = 0.014], male gender [OR 4.53 (95% CI 2.20–9.34), P-value < 0.001], presence of snoring [OR 2.51 (95% CI 1.33–4.75), P-value = 0.005], presence of at least one cardio-metabolic alteration [OR 2.26 (95% CI 1.19–4.28), P-value = 0.012], body mass index> 30 kg/m² [OR 4.55 (95% CI 2.07–10.03), P-value < 0.001] and ferritin ≥ 150 μg/L [OR 3.28 (95% CI 1.69–6.36), P-value < 0.001] were associated with increased risk of OSAS in our population of young adults. After adjusting for these major confounding factors associated with OSAS (gender, body mass index, cardio-metabolic alterations, ferritin level, and snoring) in the four models studied, multivariate regression analyses confirmed that unlike typical depression, atypical depression [OR 3.09 (95% CI 1.26–7.54), P-value = 0.019] was a risk factor for OSAS in young adults.ConclusionsIn our study, we demonstrated that the prevalence of OSAS was 18.6 % in young adults referred to the Erasme Hospital Sleep Laboratory. In addition, we have shown that unlike typical depression, atypical depression was associated with an increased risk of OSAS in young adults, which seems to justify more systematic research of this pathology in young adults suffering from atypical depression in order to allow the establishment of adapted therapeutic strategies and avoid the negative consequences associated with the co-occurrence of these two pathologies.     

“I want to fit in… but I don’t want to change myself fundamentally”: A qualitative exploration of the relationship between masking and mental health for autistic teenagers

BackgroundPrevious research has identified an association between masking and mental health for autistic people. However, the direction of causality and mechanisms involved in this relationship are not well understood. This qualitative study aimed to investigate autistic teenagers’ experiences of masking, mental health and how the two develop and interact.MethodsTwenty autistic teenagers took part in a semi-structured interview. The interviews were analysed using Reflexive Thematic Analysis.ResultsFrom the analysis, one theme was identified to conceptualise masking as described by participants. Five more inter-related themes were identified, each involved both in the relationship between masking and mental health and conversely in the relationship between authenticity and mental health. Participants described how masking and mental health both influence each other, and both are influenced by social and environmental factors.ConclusionsThe findings are consistent with previous research indicating that masking is associated with mental health difficulties. Our analysis presents a broader conceptualisation of masking than previously defined in the literature, placing social oppression of autistic people at the heart of the relationship between masking and mental health. The findings have implications for diagnostic services, post-diagnostic support and therapeutic interventions, highlighting the need to challenge deficit-based narratives of autism.     

The Health and Quality of Life Outcomes Among Youth and Young Adults With Cerebral Palsy

Young NL, Rochon TG, McCormick A, Law M, Wedge JH, Fehlings D. The health and quality of life outcomes among youth and young adults with cerebral palsy.

Objectives

To describe the health and quality of life (QoL) of youth and young adults who have cerebral palsy (CP), and to assess the impact of 3 key factors (severity, age, and sex) on these outcomes.

Design

Cross-sectional survey.

Setting

Participants were identified from 6 children's treatment centers in Ontario.

Participants

The sample of participants (N=199) included youth (n=129; age, 13-17y) and adults (n=70; age, 23-33y) with a broad range of severity: 35% mild, 19% moderate, and 47% severe.

Intervention

Not applicable.

Main Outcome Measures

Health Utilities Index (HUI₃), Assessment of Quality of Life (AQoL), and Self-Rated Health (SRH).

Results

SRH was reported to be excellent or very good by 57% of youth and 46% of adults. Mean HUI₃ scores were .30 for youth and .31 for adults. Mean AQoL scores were .28 for youth and adults. Severity of CP in childhood predicted 55% of the variance in HUI₃ scores and 45% of the variance in AQoL scores. Age and sex were not significant predictors of health or QoL.

Conclusions

The observed health and QoL scores were much lower than those previously reported in the literature. This is likely a result of the inclusion of those with severe CP. The scores for youth were similar to those for adults and suggest that health and QoL outcomes were relatively stable across the transition to adulthood. Youth and adults with CP have limited health status and will require health care support throughout their lives to help them optimize their well being. Longitudinal follow-up studies are essential to understand better the patterns of health in this population over time.     

Language functioning,mental health and alexithymia in incarcerated young offenders

Purpose: Previous studies describe high rates of language impairment in young offenders; however, important correlates such as mental health status and alexithymia have received little attention.

Method: This study describes a cross-sectional study of the language, emotion recognition and mental health of 100 young people completing custodial sentences in New South Wales (Australia). The sample comprised 70 young people from non-indigenous backgrounds (n?=?60 male) and 30 from indigenous backgrounds (n?=?25 male). The mean age of the sample was 17.1 years. It was hypothesized that, in addition to elevated rates of language impairment, alexithymia would be over-represented in this group. It was further predicted that impoverished language skills would contribute to alexithymia scores.

Result: Only a quarter of the sample overall achieved Clinical Evaluation of Language Fundamentals (CELF-4) Core Language Scores in the expected range; rates of language impairment were higher in indigenous males than in non-indigenous males and in the females. Alexithymia was present in 59% of the sample, but appeared to be associated with poor mental health, rather than with language impairment.

Conclusion: Interventions for young offenders (e.g. psychological counselling, restorative justice conferencing) should be framed around these difficulties. Validated language measures for use with young indigenous offenders are needed.     

实时剪切波弹性成像对甲状腺结节良恶性的诊断及影响因素分析

目的 探讨剪切波弹性成像(SWE)各参数对甲状腺结节良恶性鉴别诊断的临床价值。方法 应用SWE对拟接受手术或活检的221例甲状腺结节患者(265个结节)进行检查,测量结节的绝对弹性值。以病理结果为金标准,绘制ROC曲线,得到最优的诊断界点,并以此进行良恶性诊断。根据ROC曲线下面积评价各个SWE参数的诊断价值。同时,分析可能存在的影响因素。结果 265个甲状腺结节中,良性177个,恶性88个。恶性结节的杨氏模量均高于良性结节,差异有统计学意义(P均<0.05)。5个SWE参数(SWE_whole_mean、SWE_whole_min、SWE_mean、SWE_min、SWE_max)诊断结节良恶性的ROC曲线下面积分别为0.793、0.656、0.801、0.796和0.791。SWE_mean的ROC曲线下面积(AUC)面积最大,以最优的诊断界点为39.2 kPa进行良恶性诊断,诊断的敏感度和特异度分别为67.05% 和83.62%。各可能的影响因素中,结节内钙化会使测量到的杨氏模量值增加。SWE与常规超声联合应用的诊断敏感度为86.36%。结论 SWE有助于甲状腺结节良恶性的鉴别诊断。     

Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation,longitudinal processes,and key directions

Attention-deficit/hyperactivity disorder (ADHD) – and its underlying behavioral dimensions of inattention and hyperactivity–impulsivity – have been understudied in females. We first cover the conceptual issues of prevalence, diagnostic practices, diversity, comorbidity, and causal factors, plus forces limiting awareness of ADHD in females. After a narrative review of cross-sectional and longitudinal findings, we conclude the following. (a) Girls meet diagnostic criteria for ADHD at just under half the rates of boys, a ratio that becomes much closer to equal by adulthood. (b) Girls and women with ADHD show a predominance of inattention and associated internalizing problems; boys and men display greater levels of hyperactive–impulsive symptoms and associated externalizing problems. (c) Sex differences in ADHD symptoms and related outcomes depend heavily on the clinical versus nonreferred nature of the samples under investigation. (d) Females with ADHD experience, on average, serious impairments, with a particularly heightened risk for problems in close relationships and engagement in self-harm. (e) Clinicians may overlook symptoms and impairments in females because of less overt (but still impairing) symptom manifestations in girls and women and their frequent adoption of compensatory strategies. Our review of predictors and mediators of adult outcomes highlights (a) the potential for heterotypically continuous pathways in females with childhood ADHD and (b) developmental progressions to self-harm, intimate partner violence, unplanned pregnancy, and comorbid psychopathology. Focusing on ADHD in females is necessary to characterize causal and maintaining mechanisms with accuracy and to foster responsive interventions, as highlighted in our closing list of clinical implications and research priorities.