Is age at symptom onset associated with severity of memory impairment in adults with obsessive-compulsive disorder?

OBJECTIVE: Age at onset is a potentially important marker for neurobiological features of obsessive-compulsive disorder (OCD). This study examined the relationship between age at symptom onset and memory impairment in adults with OCD. METHOD: The authors used the Rey-Osterrieth Complex Figure Test and the California Verbal Learning Test to compare memory functioning of 37 adult OCD patients with self-reported childhood onset of symptoms (onset at less than 18 years of age) with that of 31 patients with adult-onset symptoms. RESULTS: No differences were found between the two groups on any of the verbal and nonverbal memory measures. CONCLUSIONS: Self-reported age at symptom onset is not associated with memory performance in adult patients with OCD according to tests previously found to be sensitive to frontal-striatal system dysfunction and impairment in OCD. Such dysfunction appears to be a consistent feature of OCD in adults, regardless of age at initial symptom onset.     

Is serum bilirubin associated with the severity of Guillain–Barré syndrome?

Objective: Our aim was to assess the correlation between serum bilirubin levels and Guillain–Barré syndrome (GBS).

Patients and methods: One hundred and one newly diagnosed patients with Guillain–Barré syndrome and 111 healthy age- and sex-matched individuals in the First Affiliated Hospital of Guangxi Medical University (Guangxi, China) from June 2012 to May 2017 were included in this study. Clinical characteristics and laboratory parameters of Guillain–Barré syndrome patients and healthy controls were retrospectively analysed.

Results: Serum bilirubin levels in Guillain–Barré syndrome patients were significantly lower as compared with those in healthy controls (p < 0.001); besides, log C-reactive protein and erythrocyte sedimentation rate were significantly higher. We found that there was a negative correlation between GBS disability scale scores and total bilirubin, direct bilirubin, indirect bilirubin (r = ?0.541, P < 0.001; r = ?0.403, P < 0.001; r = ?0.526, P < 0.001), respectively. Among patients with GBS, serum total bilirubin, direct bilirubin, and indirect bilirubin levels were independently associated with Guillain–Barré syndrome disability scale scores in multiple linear regression analysis, respectively.

Conclusions: We observed that serum bilirubin levels were lower in patients with Guillain–Barré syndrome, and suggested total bilirubin, direct bilirubin, and indirect bilirubin were independently and inversely associated with Guillain–Barré syndrome severity.     

Is bipolar disorder specifically associated with aggression?

Ballester J, Goldstein T, Goldstein B, Obreja M, Axelson D, Monk K, Hickey MB, Iyengar S, Farchione T, Kupfer DJ, Brent D, Birmaher B. Is bipolar disorder specifically associated with aggression? Bipolar Disord 2012: 14: 283–290. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective: Several studies have suggested that bipolar disorder (BP) in adults is associated with aggressive behaviors. However, most studies have included only inpatients and have not taken into consideration possible confounding factors. The goal of the present study was to compare the prevalence of aggression in subjects with BP compared to subjects with other, non‐BP psychopathology and healthy controls. Methods: Subjects with bipolar I disorder (BP‐I) and bipolar II disorder (BP‐II) (n = 255), non‐BP psychopathology (n = 85), and healthy controls (n = 84) were recruited. Aggression was measured using the Aggression Questionnaire (AQ). Group comparisons were adjusted for demographic and clinical differences (e.g., comorbid disorders) and multiple comparisons. The effects of the subtype of BP, current versus past episode, polarity of current episode, psychosis, the presence of irritable mania/hypomania only, and pharmacological treatment were examined. Results: Subjects with BP showed significantly higher total and subscale AQ scores (raw and T‐scores) when compared to subjects with non‐BP psychopathology and healthy controls. Exclusion of subjects with current mood episodes and those with common comorbid disorders yielded similar results. There were no effects of BP subtype, polarity of the current episode, irritable manic/hypomanic episodes only, or current use of pharmacological treatments. Independent of the severity of BP and polarity of the episode, those in a current mood episode showed significantly higher AQ scores than those not in a current mood episode. Subjects with current psychosis showed significantly higher total AQ score, hostility, and anger than those without current psychosis. Conclusions: Subjects with BP display greater rates of anger and aggressive behaviors, especially during acute and psychotic episodes. Early identification and management of these behaviors is warranted.     

Is bipolar disorder specifically associated with panic disorder in youths?

OBJECTIVE: To replicate previous findings of high rates of bipolar disorder (BPD) in patients with panic disorder (PD) and determine if youths with both PD and BPD have more severe illness. METHOD: 2025 youths aged 5 to 19 years seen at a mood and anxiety specialty clinic were assessed using the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present Episode, 4th Revision. Diagnoses were made using DSM-III and DSM-III-R criteria and then updated to conform to DSM-IV criteria. Patients were grouped into those with PD (N = 42), those with non-PD anxiety disorders (N = 407), and psychiatric controls with no anxiety diagnosis (N = 1576). RESULTS: Youths with PD were more likely to exhibit comorbid BPD (N = 8, 19.0%) than youths with either non-PD anxiety disorders (N = 22, 5.4%) or other nonanxious psychiatric disorders (N = 112, 7.1%). The symptoms of PD and mania were not affected by the comorbidity between PD and BPD. Youths with both PD and BPD had more psychotic symptoms and suicidal ideation than patients with PD and other non-bipolar psychiatric disorders and BPD patients with other nonanxious comorbid disorders. CONCLUSION: The presence of either PD or BPD in youths made the co-occurrence of the other condition more likely, as has been noted in adults. Patients with both PD and BPD are more likely to have psychotic symptoms and suicidal ideation. In treating youths with PD, clinicians must be vigilant for possible comorbid BPD or risk of pharmacologic triggering of a manic or hypomanic episode. Prospective studies are needed to learn if PD predicts the onset of BPD in children and adolescents.     

Screening for conduct problems: does the predictive accuracy of conduct disorder symptoms improve with age?

OBJECTIVES: To investigate the influence of age on the predictive accuracy of conduct disorder (CD) symptoms for future CD and to evaluate the usefulness of CD symptoms as a screening tool in normal populations. METHOD: Two cohorts were derived from the Canadian National Longitudinal Survey of Children and Youth based on age at baseline (cohort 1: ages 5-6, n = 881; cohort 2: ages 8-9, n = 859). CD symptoms were assessed with behavior symptom checklists at baseline and the 2-year follow-up assessment. Predictive accuracy (PA) was evaluated with logistic regression and receiver operating characteristic curves. RESULTS: The PA of teacher-identified CD symptoms, alone or in combination with other risk factors (gender, socioeconomic status, familial factors), was higher in the older cohort. PA increased when CD symptoms were combined with other risk factors. However, none of the predictors evaluated achieved minimum criteria for sensitivity and positive predictive value of at least 50%. CONCLUSIONS: The PA of CD symptoms improves with age. However, the results show that the PA of CD symptoms assessed at a single point in time in children in normal populations is insufficient. Screening initiatives that use this approach to detect risk for CD should be abandoned.     

Is panic disorder associated with coronary artery disease? A critical review of the literature

OBJECTIVE: To critically review existing literature examining the relationship between panic disorder (PD) and coronary artery disease (CAD). We specifically sought answers to the following questions: (1) What is the prevalence of PD in CAD patients? (2) What is the directionality of the relationship between PD and CAD? (3) What mechanisms may mediate the link between PD and CAD? METHODS: Medline and Psychlit searches were conducted using the following search titles: "panic disorder and coronary artery disease", "panic disorder and coronary heart disease", and "panic disorder and cardiovascular disease" for the years 1980-1998. The above search was also repeated replacing "panic disorder" with "panic attacks" for the same period. RESULTS: The prevalence of PD in both cardiology out-patients and patients with documented CAD ranges from 10% to 50%. The association between PD and CAD appeared strongest in patients with atypical chest pain or symptoms that could not be fully explained by coronary status. There is some evidence linking phobic anxiety but not PD per se to CAD risk, but little evidence linking CAD to PD risk. Studies of the mechanisms linking PD to CAD are still in their infancy, but there is preliminary evidence linking PD to reduced heart rate variability (HRV) and myocardial ischemia, two pathophysiological mechanisms related to CAD. CONCLUSION: PD is prevalent in CAD patients, but it is unclear the extent to which PD confers risk for and/or exacerbates CAD. Prospective research is needed to more firmly establish PD as a distinct risk factor for the development and progression of CAD. However, because many of the symptoms of PD mimic those of CAD, differentiating these disorders and learning how they may influence each other is imperative for clinical practice.     

Is executive function associated with symptom severity in schizophrenia?

This paper reports on a study that was designed to investigate the relationship between psychopathology and executive functions in schizophrenia. Correlations were sparse and mostly weak. The most robust finding was the association between letter fluency and negative symptoms; however, most other applied tasks were not associated with symptom level. Our results support previous findings of differential relationships between impaired executive functions and symptom level.     

Is there an association between the level of grandiose narcissism severity of psychopathology?

Background: Narcissism is a personality trait associated with both psychological health and resilience as well as with aggression and interpersonal problems. Aim: This study compares levels of total narcissism and subscale scores in inpatients, outpatients and a community sample. Methods: Inpatients (N = 186) were recruited from consecutively admitted patients to two closed units, and the outpatient group (N = 144) consisted of patients attending a psychiatric outpatient clinic. The patients and a normative community sample (N = 437) all filled in the Narcissistic Personality Inventory questionnaire (NPI-29). Results: The NPI total and subscales scores showed considerable gender differences. Among men only the Uniqueness/Entitlement subscale showed significant group differences, with inpatients showing higher mean score than the two other groups. Among women three factors, Leadership/Power, Superiority/Arrogance, and Uniqueness/ Entitlement, showed significant differences between the different levels of psychopathology. The outpatient female group regularly had the lowest group mean scores. The NPI-29 scores of the normative group showed weak internal consistencies. Conclusion: Our hypothesis of a significant association between mean levels of total narcissism and subscale scores and severity of psychopathology was not supported.     

Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults?

To investigate associations between social anxiety and smoking behaviour in order to explore whether social anxiety predicts the first onset of cigarette smoking, regular smoking and the development of nicotine dependence. Baseline and four-year follow-up data from the Early Developmental Stages of Psychopathology Study (EDSP), a prospective-longitudinal community study of 3,021 adolescents and young adults, are used. Smoking behaviour and psychopathology were assessed with the M-CIDI and its DSM-IV algorithms. At baseline, 35.7% of the sample were regular smokers, and 18.7% fulfilled criteria for DSM-IV nicotine dependence. Twenty-seven point two percent reported at least one social fear, and 7.2% met criteria for DSM-IV social phobia, most of whom reported first onset of social fear problems clearly prior to smoking initiation. Cross-sectional retrospective baseline analyses based on retrospective reports revealed that social fears and DSM-IV social phobia were both significantly associated with higher rates of nicotine dependence. Prospective-longitudinal analyses that were conducted in an attempt to confirm cross-sectional retrospective results showed that baseline non-users with social fears (OR = 3.85) and baseline non-dependent users with social fears (OR = 1.5) had an increased risk of onset of nicotine dependence during the follow-up period of four years. These findings remained significant even when controlling for co-morbid depressive disorders. Social anxiety was found to be significantly associated with nicotine dependence in both cross-sectional retrospective and prospective-longitudinal analyses. It is suggested that social fears could lead to heavy tobacco use as smoking is a socially acceptable behaviour that relieves anxiety in social situations. Possible differential effects of social anxiety on the early stages of smoking behaviour compared to effects on nicotine dependence are discussed. These findings should stimulate a continued search into potentially causal links between social fear symptoms and the development of tobacco consumption and nicotine dependence in adolescence.     

Is the prevalence of psychiatric disorders associated with urbanization?

Objectives In many countries, the total rate of psychiatric disorders tends to be higher in urban areas than in rural areas. The relevance of this phenomenon is that it may help in identifying environmental factors that are important in the pathogenesis of mental disorders. Moreover, urban preponderance suggests that the allocation of funds and services should take urbanization levels into account. Method The Netherlands Mental Health Survey and Incidence Study (NEMESIS) used the Composite International Diagnostic Interview (CIDI) to determine the prevalence of DSM-III-R disorders in a sample of 7,076 people aged 18–64. The sample was representative of the population as a whole. The study population was assigned to five urbanization categories defined at the level of municipalities. The association between urbanization and 12-month prevalence rates of psychiatric disorders was studied using logistic regression taking several confounders into account. Results The prevalence of psychiatric disorders gradually increased over five levels of urbanization. This pattern remained after adjustment for a range of confounders. Comorbidity rates also increased with level of urbanization. Conclusion This study confirms that psychiatric disorders are more common and more complex in more urbanized areas. This should be reflected in service allocation and may help in identifying environmental factors of importance for the aetiology of mental disorders.     

Thyroid hormone level is associated with the frequency and severity of Guillain–Barré syndrome

Objective: Guillain–Barré syndrome (GBS) is a neurodegenerative and inflammatory demyelination disorder, and oxidative stress is concerned with the pathogenesis of the disease. Also, we found that thyroid hormone level is correlated to the oxidative and antioxidant status in previous studies. Our study was aimed to find the possible relationship between the frequency and severity of GBS and thyroid hormone levels. Materials and methods: We measured serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT₄) and free triiodothyronine (FT₃) in 238 individuals, including 90 GBS, 44 multiple sclerosis and 104 healthy controls. Results: Our findings demonstrate that the patients with GBS had lower TSH and higher FT_4, FT₄/FT₃ than healthy controls in the normal range. Furthermore, it was also shown in our study that TSH levels in patients with GBS were correlated with disease severity measured by the Hughes Functional Grading Scale. Conclusion: Lower TSH, higher FT₄ and FT₄/FT₃ stand for the oxidative status and are associated with the incidence and severity of GBS.     

Is the level of C-reactive protein correlated with the extent of carotid atherosclerosis?

BACKGROUND: Increased intima-media thickness (IMT) of the common carotid arteries (CCA) and elevated levels of highly sensitive C-reactive protein (hsCRP) are both shown to be associated with the occurrence of stroke. We investigated whether elevated hsCRP level is a risk factor for the increased IMT of the CCA independent of other proven risk factors for the ischemic stroke and studied the interaction between hsCRP level and the extent of carotid atherosclerosis. METHODS AND RESULTS: We studied 104 patients aged between 30 to 92 years who were admitted to our neurology department with acute ischemic stroke. All patients underwent a clinical evaluation, laboratory investigations, and neuroultrasonographic examination. In 24 patients with normal ultrasonographic examination, mean hsCRP levels was 8.6 + 6.7 mg/L. Mean hsCRP level was 18.0 + 25.6 mg/L in patients having increased intima to media thickness (> 1.2 mm); 32.7 + 49.1 mg/L in patients who had atheromatous plaques without significant narrowing; and 23.9 + 27.3 mg/L in patients with internal carotid artery stenosis more than 50%. hsCRP levels and the extent of the atherosclerosis showed a significant relationship (p = 0.040). In multiple regression analyses, this relationship was found to be independent of other proven risk factors. The only variable that showed a significant relation with the level of hsCRP was the HDL level. A negative correlation was found between hsCRP and HDL levels. CONCLUSIONS: We conclude that elevated hsCRP level is an indirect risk factor for the ischemic stroke through its relation with the extent of the carotid atherosclerosis, and this relation is independent of other known risk factors.     

Is ADHD severity in adults associated with the lifetime prevalence of comorbid depressive episodes and anxiety disorders?

PurposeThe objective of the present study was to examine the association between ADHD severity and the lifetime prevalence of comorbid depressive episodes and anxiety disorders in adults with ADHD.Subjects/materials and methodsAnalyses were based on data of the Conner's Adult ADHD Rating Scale (CAARS) and a parent study examining the epidemiology of adult ADHD in 17 GP practices in Budapest, Hungary. Subjects between 18 and 60 years were included in the screening phase (n = 3529). Out of 279 positively screened subjects 161 participated in a clinical interview and completed the CAARS to confirm the diagnosis. We applied four diagnostic criteria: “DSM-IV”; “No-onset” (DSM-IV criteria without the specific requirement for onset); “Symptoms-only” (DSM-IV symptom criterion only); and “Reduced symptoms-only” (DSM-IV symptom criterion with a reduced threshold for symptom count). The MINI PLUS 5.0 was used to assess psychiatric comorbidity.ResultsADHD severity, as measured by the CAARS ADHD Index, showed a significant positive association with the prevalence of comorbid depressive episodes in all but the “ADHD_No-onset” group (“DSM-IV”: F[1.23] = 8.39, P = 0.0081; “No-onset”: F(1.27) = 0.97, P = 0.3346; “Symptoms-only”: F[1.55] = 30.79, P < 0.0001; “Reduced symptoms-only”: F(1.62) = 26.69, P < 0.0001).Discussion and conclusionResults indicate that ADHD symptom severity increases in association with lifetime comorbidity with depression.     

Is major depressive disorder specifically associated with mesial temporal sclerosis?

Purpose: Whether a specific lesion such as mesial temporal sclerosis (MTS) increases the risk for a mood disorder in epilepsy remains subject to debate. Despite evidence of limbic system involvement in the genesis of emotional symptoms, recent studies fail to support an association between depression and MTS. We aimed to clarify this controversial issue by overcoming prior methodologic limitations, hypothesizing that rates of major depressive disorder (MDD) would be higher in patients with MTS. Methods: Three hundred eight patients with focal epilepsy (International League Against Epilepsy [ILAE] criteria), were classified into three groups on the basis of neuroimaging findings: MTS, a lesion different from MTS, or absence of lesion. Patients were assessed using the Structured Interview for DSM‐IV axis I psychiatric disorders (SCID‐I), by a psychiatrist blinded to epilepsy subtype. The Spanish version of the Hospital Anxiety and Depression Scale (HADS) was also administered. A complete logistic regression analysis was performed to investigate the association between MTS and MDD. Key Findings: MTS increased the likelihood of a lifetime MDD by nearly 2.5. No other current or “postseizure onset” lifetime Axis I DSM‐IV psychiatric disorder was associated with MTS. Female gender, primary education, comorbid anxiety disorders, and antidepressant treatment were also associated with an increased risk of MDD. Marriage was found to be a protective factor for MDD. Significance: Our results support a specific association between MTS and lifetime “postseizure onset,” MDD. The lack of association with current depression is in line with the hypothesis that the link between MTS and depression is more of a chronic than a state‐dependent condition.     

Is initiation of smoking associated with the prodromal phase of schizophrenia?

OBJECTIVE: Although the association between smoking and schizophrenia is well known, little attention has been paid to the time between initiation of smoking and onset of schizophrenia. Our goal was to study this putative temporal relation among patients with schizophrenia. METHODS: We used data from the Northern Finland 1966 Birth Cohort (n = 11,017) linked with the National Finnish Hospital Discharge Register to study age at initiation of smoking and age at onset of schizophrenia, and we examined associations between family and environmental factors and the retrospectively determined regular smoking among patients with schizophrenia. RESULTS: Our main finding was that the initiation of regular smoking was closely related to the onset of schizophrenia. The mean difference in time between the initiation of regular smoking and the onset of schizophrenia among patients (n = 30) was 2.3 (standard deviation [SD] 6.6) years, which was statistically significantly lower than that for subjects with other psychoses (n = 18) (8.6 [SD 6.3] yr) (p < 0.001). Among patients with schizophrenia, the increased likelihood of smoking was associated only with paternal smoking in the family environment, but not with any other background factors (odds ratio 3.5, 95; confidence interval 1.9-11.3). CONCLUSION: Smoking may be a sign of the prodromal phase of schizophrenia.     

Exploring the clinical utility of the DSM-5 conduct disorder specifier of ‘with limited prosocial emotions’ in an adolescent inpatient sample

BackgroundWith the recent addition of a callous-unemotional (CU) specifier to the diagnosis of conduct disorder (CD) in the DSM-5, studies are needed to evaluate the clinical utility of this specifier and the best ways to identify youth meeting criteria for this specifier in clinical samples.MethodsTo this end, the current study examined cross-sectional correlates and treatment response across four groups of inpatient adolescents (N = 382, ages 12–17): those with CD without the specifier, with CD and the CU specifier, CU alone, and a group of psychiatric controls. We used two different measures to identify adolescents with high levels of CU traits: the Antisocial Process Screening Device (APSD) [1] and the Inventory of Callous-Unemotional Traits (ICU) [2]. Questionnaires and structured interviews were used to evaluate a range of outcomes including presence of baseline levels and treatment outcomes of both externalizing and internalizing problems.FindingsResults indicated that the ICU, but not the APSD differentiated between conduct disordered youth with and without the specifier on externalizing behaviors in both cross-sectional relations and treatment response.ConclusionsThe results of the current study caution the use of the most frequently used measure to identify the CU specifier, and make suggestions about alternatives.     

Is parental report of upper respiratory infection at the onset of obsessive-compulsive disorder suggestive of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection?

The diagnosis of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) requires a prospectively determined association between group A beta-hemolytic streptococcal (GABHS) infection and obsessive-compulsive disorder (OCD) or tic disorder. Screening for GABHS infection imposes a significant burden on both patient and clinician. To heighten the index of suspicion for PANDAS, it would be useful to know if parent-reported upper respiratory infection (URI) is associated with PANDAS symptoms or associated characteristics. Eighty-three consecutive, clinically referred patients aged 6 to 17 years with a primary diagnosis of OCD and their primary caregivers were asked about URI signs and symptoms at the time of OCD onset, PANDAS symptoms, OCD and tic symptoms, comorbidity, and putative PANDAS risk factors. Specific inquiry regarding URI symptoms proved more informative than general inquiry. In the URI present versus URI absent group, more patients experienced a sudden rather than insidious onset of symptoms. Additionally, more patients with a URI plus sudden onset exhibited a comorbid tic disorder. Until validated biomarkers permit retrospective diagnosis, a history that OCD began around the time of a URI should clue the clinician to look prospectively for PANDAS. Additional research is required to define the boundaries of PANDAS and to develop psychometrically reliable and valid diagnostic strategies.     

Is polarity of recurrence related to serum lithium level in patients with bipolar disorder?

BACKGROUND: Recently published data might indicate that the polarity of recurrence is related to lithium serum levels. To systematically test this hypothesis all published maintenance trials in bipolar disorders were examined with regard to this issue. METHOD: Maintenance studies were subdivided in trials with low (i. e. below 0.6 mEq/l),medium (i. e. 0.6 to 0.8 mEq/l) and high (i. e. above 0.8 mEq/l) lithium serum levels. Percentage of depressive vs. (hypo-)manic or mixed recurrences were compared for these three groups. RESULTS: The percentage of depressive recurrences in the groups with low, medium and high lithium levels differed in a clinically and statistically significant manner (12% vs. 38% vs. 64%, p < 0.0001). CONCLUSION: The results might indicate that low lithium levels are effective in preventing depression whereas higher blood levels are needed to prevent (hypo-)manic or mixed states.     

Is usage of hypnotics associated with mortality?

ObjectiveTo investigate the influence of hypnotic usage on all-cause and cause-specific mortality in a middle-aged population.MethodsA cohort of 1750 men and 1773 women aged 30–65 years who responded to a postal questionnaire in 1983. The questionnaire included questions about hypnotic usage, sleep duration, sleep complaints, medical conditions, depression, demographic and life style variables. Mortality data for the period 1983–2003 were collected.ResultsRegular hypnotic usage was reported by 1.7% of men and 2.2% of women, and was associated with short sleep, sleeping difficulties, several health problems and depression. During the 20-year follow-up period 379 men (21.5%) and 278 women (15.5%) died. After adjustment for potential risk factors in multivariate analyses regular hypnotic usage was associated with significantly increased risk of all-cause mortality in men (Hazard ratios [HR], 4.54; 95% confidence interval [CI], 2.47–8.37) and in women 2.03 (95% CI, 1.07–3.86). With regard to cause-specific mortality, regular hypnotic usage in men was a risk factor for coronary artery disease death, cancer death, suicide and death from “all remaining causes.” In women it was a risk factor for suicide.ConclusionsOur results show an increased risk of all-cause mortality and cause-specific mortality in regular users of hypnotics.