Are neurocognitive factors associated with repetition of self-harm? A systematic review

BackgroundPrediction of self-harm is limited clinically. Early identification of individuals likely to repeat self-harm could improve outcomes and reduce suicide risk. Various neurocognitive deficits have been found in people who self-harm, but the ability of these to predict repetition has yet to be establishedAimsIdentify neurocognitive factors that may predict repetition of self-harm.MethodsSystematic narrative review of English language publications assessing neurocognitive functioning and self-harm repetition, searching multiple databases from inception to March 2015. Quality of studies was appraised. A narrative synthesis was performed.Results7026 unique records were identified, and 169 full-texts assessed. 15 unique studies provided data. No imaging studies could be included. Most studies assessed cognitive control or problem solving, but neither factor was consistently associated with repetition. However, specific tasks may show promise. Two studies in adolescents suggest that value-based decision-making impairments could be predictive of repetition. There were too few results for memory to draw specific conclusions.ConclusionsSelected studies suggest promise for particular neurocognitive factors and specific cognitive tasks in terms of repetition of self-harm.     

Factors associated with hospitalisation among people with Parkinson's disease – A systematic review and meta-analysis

IntroductionParkinson's disease (PD) is associated with an increased risk of admission to hospital; however data on the main reasons for admission are lacking. Our objective was to determine the pooled prevalence of the most common factors leading to admission among people with Parkinson's disease.MethodologyA systematic literature search was conducted in 11 electronic databases. We included all studies providing reasons for admissions among PD patients without restrictions to diagnostic criteria of PD, language or year of study. In the included studies, methodological quality, publication bias and heterogeneity were assessed. Meta-analysis was performed using random-effects models to calculate the pooled estimates of the identified top factors that lead to admission among people with PD.ResultsA total of 7283 studies were identified of which nine studies including 7162 people with PD were included in this review. There was a high degree of heterogeneity between studies regarding reasons for hospitalisation. The pooled prevalence of the topmost reasons for hospitalisation among people with PD was 22% (95%CI 16.0%–30.0%) for infections (mainly urinary tract infections and pneumonia); 19% (95%CI 13.0%–27.0%) for worsening motor manifestations of PD; 18% (95%CI 14.0%–21.0%) for falls/fractures; 13% (95%CI 9.0%–18%) for cardiovascular co-morbidities; 8% (95%CI 4.0%–13.0%) for neuropsychiatric and 7% (95%CI 4.0%–11.0%) for gastrointestinal complications.ConclusionThe main reasons for hospitalisation among people with PD are infections, worsening motor features, falls/fractures, cardiovascular co-morbidities, neuropsychiatric and gastrointestinal complications. Further research is needed on targeting and implementing preventative strategies.     

Are serum vitamin D,calcium and phosphorous associated with restless leg syndrome? A systematic review and meta-analysis

BackgroundIt is hypothesized that vitamin D deficiency, and calcium/phosphate imbalance could be involved in the pathophysiology of restless leg syndrome (RLS). This systematic review and meta-analysis of observational studies were carried out to reach a firm conclusion regarding the possible association between vitamin D, calcium and phosphorous levels with RLS in end-stage renal disease (ESRD) patients, other comorbidities and healthy population.MethodsPubMed, Scopus, ISI Web of Science, and Cochrane's library were systematically searched up to June 2020. Quality assessment of the included observational studies was performed using Newcastle–Ottawa Quality Assessment Scale. Statistical analyses were done using STATA 11.2. A P-value <0.05 were considered statistically significant.ResultsA total of 36 studies involving 9590 participants were included in this systematic review and meta-analysis. We found that serum vitamin D level is significantly lower (WMD −3.39 ng/mL; 95% CI, −5.96 to −0.81; P = 0.010; I² = 86.2%) and phosphorous (SMD 0.19; 95% CI, 0.04–0.34; P = 0.011; I² = 83.6%) is significantly higher in RLS individuals compared to the non-RLS individuals. However, the mean difference of serum calcium was not significant in comparison between RLS and control groups (SMD −0.01; 95% CI, −0.19 to 0.18; P = 0.957; I² = 89.2%).ConclusionResults revealed a significant association between serum vitamin D and phosphorous with RLS. However, further prospective cohort studies and clinical trials are needed for better understanding of the relationship between these variables.     

Are we addressing the 'right stuff' to enhance adherence in schizophrenia? Understanding the role of insight and attitudes towards medication

Background

Despite the fact that medication adherence is among the most important health related behaviors in relapse prevention and recovery in schizophrenia, it is often not sufficiently endorsed by patients. Poor insight and negative attitudes towards medication are risk factors for non-adherence. Their relationship and the influence of more general attitudes towards pharmacotherapy besides attitudes towards antipsychotics have not been fully understood. The present study investigated whether these factors independently influence adherence or whether they mediate one another.

Methods

A cross-sectional sample of 150 outpatients completed the Beliefs about Medication Questionnaire. It assesses patients' beliefs about antipsychotic medication in terms of necessity and concerns and more general beliefs about pharmacotherapy in terms of distrust. Additionally, the patients' global awareness of illness (Scale to assess Unawareness of Mental Disorder), and medication adherence (Brief Adherence Rating Scale, Service Engagement Scale) were assessed.

Results

Using structural equation modeling, the study found evidence for a mediational model. Awareness of illness contributed to medication adherence via patients' perceived necessity of antipsychotics. The model further revealed a direct negative relationship between concerns regarding antipsychotics and adherence and an indirect negative effect of a general distrust regarding pharmacotherapy and adherence via antipsychotic specific attitudes.

Conclusion

Interventions to enhance medication adherence may be more effective if they focus on treatment related attitudes rather than on global insight into illness. Clinicians may not only enhance the patients' perceived necessity of antipsychotic treatment but also explore and address concerns and the patients' distrust in pharmacotherapy in a more personalized way.     

Are personality traits associated with cognitive disturbance in psychosis?

OBJECTIVE: Personality and cognition are often considered as disparate constructs, both in normal individuals and in those with a psychosis. The goal of the present study was to analyze the relationship between dimensions of personality and cognitive performance in individuals with psychosis. METHODS: Sixty-one consecutively admitted patients with an acute psychotic episode were recruited for this study. Personality was assessed through a semistructured interview with a close relative using the Personality Assessment Schedule. A wide neuropsychological battery was applied, including attentional, executive, memory tasks and global cognition. Assessments took place when symptomatology was in remission. RESULTS: Higher scores on a passive-dependent dimension were significantly associated with poorer memory performance. Similarly, higher levels for a schizoid dimension were significantly associated with poorer executive performance. The results remained significant after partialling out the effect of gender, psychopathological dimensions and drug status. CONCLUSION: It is hypothesized that personality traits and cognitive performance are interrelated domains in psychosis.     

Does giving up substance use work for patients with psychosis? A systematic meta-analysis

Objective: To assess the extent to which ceasing the use of cannabis or other substances reduces the symptoms and social disability associated with psychotic illness. Methods: The electronic databases CINAHL, EMBASE, MEDLINE and PsycINFO were searched for peer-reviewed publications in English that report data about the characteristics of current and former substance-using patients diagnosed with psychotic illnesses. The searches yielded 328 articles, of which 23 studies met the inclusion criteria. Four key outcome variables; positive symptoms, negative symptoms, ratings of depression and global function, and five other measures of outcome that were reported in five or more studies were examined using meta-analysis. Results: Current substance-using patients were significantly younger than former substance-using patients (standardised mean difference (SMD) = -0.38), but did not differ in age at onset of psychosis, sex, level of education or marital status. Current substance users had higher scores on rating scales of positive symptoms (SMD = 0.29) and depression (SMD = 0.36), and lower scores on global function (SMD = -0.26) when compared with former substance users. There was a significant improvement in the ratings of positive symptoms, mood and global function among patients who stopped using substances during the first episode of psychosis, while improvements in the symptoms of patients with a more established psychotic illness did not reach statistical significance. Conclusion: The results suggest that substance use contributes to both the symptoms and the burden of disability experienced by patients with psychosis. Patients in the early stages of psychotic illness should be informed about the benefits of giving up substances earlier, rather than later in the illness. Psychiatric services should regard the treatment of substance use as an integral part of the treatment of psychotic disorders.     

Are negative symptoms associated with functioning deficits in both schizophrenia and nonschizophrenia patients? A 10-year longitudinal analysis

The current analyses assess the functional correlates of negative symptoms across diagnoses and across time to assess the appropriateness of a dimensional approach to the study of negative symptoms--specifically, whether negative symptoms should be studied as a single construct across diagnostic groups. Seventy-two schizophrenia/schizoaffective, 36 other psychotic, and 42 nonpsychotic depressed patients were recruited at index hospitalization and were followed up 4.5, 7.5, and 10 years later. At each followup assessment, data were collected on symptoms and adaptive and cognitive functioning. Analyses indicated that negative symptoms showed some similar functional associates in all three diagnostic groups, although results were strongest for the schizophrenia spectrum patients. Negative symptoms at the 10-year followup were associated with different patterns of social deficits prior to index hospitalization in the three diagnostic groups. The data provide some support for a dimensional approach to the study of mental illness, with negative symptoms associated with deficits across diagnosis, but also provide evidence of some diagnostic differences.     

Is violence at presentation by patients with first-episode psychosis associated with duration of untreated psychosis?

Introduction Violence in first episode psychosis poses significant challenges for mental health staff and patients’ families. Violence has been shown to be related to psychopathology. Duration of untreated psychosis (DUP) has been shown to influence psychopathology at presentation in first-episode psychosis, but little is known about the direct relationship between violence at presentation and DUP. We therefore sought to examine the relationship between these two variables. Methods Patients were all individuals aged between 16 and 65 years, with a DSM-III-R diagnosis of psychotic illness, taking part in a First Episode study. We used the Structured Clinical Interview (SCID-I), Positive and Negative Symptom Scale (PANSS), Beiser Scale and the Modified Overt Aggression Scale (MOAS) to evaluate diagnosis, psychopathology, DUP and violent behaviour respectively. Data for each case were retrospectively examined for violence, for the week prior to and week following first contact with psychiatric services, blind to diagnosis, DUP and psychopathology scores. Results We assessed 157 patients. About 46 patients (29%) were violent. Violence rates did not differ across diagnostic groups, while DUP varied significantly across diagnostic groups (P = 0.001). Violence was not associated with DUP across all psychoses (P = 0.41). In the schizophrenia subgroup (n = 94), thirty individuals (32%) were violent. In a logistic regression, logDUP was not associated with violence (P = 0.11). Violence was predicted by involuntary admission status (P = 0.04) and global positive symptoms (P = 0.03). DUP was associated weakly with negative symptoms (P = 0.01) but not associated with positive or general psychopathology. Neither pre nor post-contact violence was associated (P = 0.79 and P = 0.09 respectively) with DUP. Discussion Contrary to a recent study, we did not find an association between violence at presentation and DUP. The relationships between violence, DUP and psychopathology are complex and may be compounded by potential difficulties inherent in the PANSS. Conclusion Programs to reduce DUP may not impact on rates of violence at presentation in First Episode Psychosis (FEP).     

Interventions to improve adherence to antipsychotic medication in patients with schizophrenia–A review of the past decade

ObjectiveNonadherence to antipsychotic medication is highly prevalent in patients with schizophrenia and has a deleterious impact on the course of the illness. This review seeks to determine the interventions that were examined in the past decade to improve adherence rates.MethodThe literature between 2000 and 2009 was searched for randomized controlled trials which compared a psychosocial intervention with another intervention or with treatment as usual in patients with schizophrenia.ResultsFifteen studies were identified, with a large heterogeneity in design, adherence measures and outcome variables. Interventions that offered more sessions during a longer period of time, and especially those with a continuous focus on adherence, seem most likely to be successful, as well as pragmatic interventions that focus on attention and memory problems. The positive effects of adapted forms of Motivational Interviewing found in earlier studies, such as compliance therapy, have not been confirmed.ConclusionNonadherence remains a challenging problem in schizophrenia. The heterogeneity of factors related to nonadherence calls for individually tailored approaches to promote adherence. More evidence is required to determine the effects of specific interventions.     

Are brief febrile seizures benign? A systematic review and narrative synthesis

Febrile seizures affect 2%–5% of U.S. children and are considered benign although associated with an increased risk of epilepsy and, rarely, with sudden unexplained death. We compared rates of mortality, neurodevelopmental disorders, and neuropathology in young children with simple and complex febrile seizures to healthy controls. We systematically reviewed studies of 3- to 72-month-old children with simple or complex febrile seizures ≤30 min. We searched studies with outcome measures on mortality, neurodevelopment, or neuropathology through July 18, 2022. Bias risk was assessed per study design. Each outcome measure was stratified by study design. PROSPERO registration is CRD42022361645. Twenty-six studies met criteria reporting mortality (11), neurodevelopment (11), and neuropathology (13), including 2665 children with febrile seizures and 1206 seizure-free controls. Study designs varied: 15 cohort, 2 cross-sectional, 3 case–control, 5 series, and 1 case report. Mortality outcomes showed stark contrasts. Six cohort studies following children after febrile seizure (n = 1348) reported no deaths, whereas four child death series and 1 case report identified 24.1% (108/449) deaths associated with simple (n = 104) and complex (n = 3) febrile seizures ≤30 min. Minor hippocampal histopathological anomalies were common in sudden deaths with or without febrile seizure history. Most electroencephalography (EEG) studies were normal. Neuroimaging studies suggested increased right hippocampal volumes. When present, neurodevelopmental problems usually preexisted febrile-seizure onset. Risk bias was medium or high in 95% (18/19) of cohort and case–control studies vs medium to low across remaining study designs. Research on outcomes after simple or brief complex febrile seizures is limited. Cohort studies suffered from inadequate sample size, bias risk, and limited follow-up durations to make valid conclusions on mortality, neurodevelopment, and neuropathology. Sudden death registries, focused on a very small percentage of all cases, strongly suggest that simple febrile seizures are associated with increased mortality. Although most children with febrile seizures have favorable outcomes, longer-term prospective studies are needed.     

Is there an association between neurocognitive performance and medication adherence in first episode psychosis?

Aim: Medication adherence is a determining factor for symptomatic remission and relapse prevention following a first episode of psychosis (FEP). Neurocognitive abilities have received only scant attention so far as a risk factor for poor adherence but significant impairments with memory and/or planning abilities could play a role. We examined early medication adherence following admission to a specialized clinical programme for FEP. Method: One hundred sixty FEP participants and 35 healthy controls completed an exhaustive neurocognitive assessment. FEP participants were categorized as a function of their medication adherence at 6 months into poor (n = 34), partial (n = 27) and full (n = 99) adherence, respectively. Domain-specific and global measures of cognitive ability were examined. Results: No measure of neurocognition could significantly discriminate amongst the three medication adherence groups. Conclusion: These results suggest no strong associations between neurocognitive abilities and medication adherence in first episode of psychosis.     

Do treatment and illness beliefs influence adherence to medication in patients with bipolar affective disorder? A preliminary cross-sectional study

Adherence to medication is essential for achieving good outcomes for patients with bipolar affective disorder. This study tested whether treatment and illness beliefs are important predictors of adherence to medication. Results indicate that beliefs are predictive, and may be a suitable target for modification in efforts to change behaviour.     

Medical students’ attitudes towards people with intellectual disabilities: A literature review

The present paper provides a review of research on medical students’ attitudes to people with intellectual disabilities. The attitudes of medical students warrant empirical attention because their future work may determine people with intellectual disabilities’ access to healthcare and exposure to health inequalities. An electronic search of Embase, Ovid MEDLINE(R), PsycINFO, Scopus, and Web of Science was completed to identify papers published up to August 2013. Twenty-four studies were identified, most of which evaluated the effects of pedagogical interventions on students’ attitudes. Results suggested that medical students’ attitudes to people with intellectual disabilities were responsive to interventions. However, the evidence is restricted due to research limitations, including poor measurement, self-selection bias, and the absence of control groups when evaluating interventions. Thus, there is a dearth of high-quality research on this topic, and past findings should be interpreted with caution. Future research directions are provided.     

Can acupuncture improve objective sleep indices in patients with primary insomnia? A systematic review and meta-analysis

BackgroundThe efficacy of acupuncture for treating primary insomnia (PI) has been explored in several meta-analyses where the outcomes measures were based on subjective self-reported sleep rating scales. Sleep state misperception is common in PI and self-reports underestimate sleep duration and quality. No systematic reviews or meta-analyses have investigated the efficacy of acupuncture in improving objective sleep measures in PI.ObjectiveTo perform a systematic review to determine whether objective sleep parameters are improved by acupuncture in patients with PI.MethodsRandomized controlled trials treating PI via verum-acupuncture versus sham-/placebo-acupuncture or waitlist control were searched for in English [MEDLINE (via PubMed), Sciverse ScienceDirect, Cochrane Central Register of Controlled Trials (CENTRAL), AMED, Springer, EMBASE (Elsevier), Ebsco Medline, and PsycINFO (ProQuest)] and Chinese (SinoMed, CNKI, Wanfang and CQVIP) databases, from the dates of the databases' inception to January 2020. The parameters of polysomnography (PSG), actigraphy, or micromovement sensitive mattress/pillow sleep monitoring systems were considered as the primary outcome measures. Revman 5.3 and Stata 16.0 software were used to conduct the meta-analysis. Heterogeneity was examined by using I² statistics and publication bias was assessed via Egger's test.ResultsEleven studies involving 775 patients met the inclusion criteria. The results of meta-analysis suggested that acupuncture can increase total sleep time [MD = 55.29, 95%CI (29.16, 81.42), p < 0.01], increase sleep efficiency [MD = 8.96, 95%CI (3.97, 13.95), p < 0.01], decrease wake after sleep onset [MD = −49.54, 95%CI (−82.98, −16.09), p < 0.01], and reduce number of awakening times [MD = −6.29, 95%CI (−10.75, −1.82), p < 0.01] compared with either sham-/placebo-acupuncture or waitlist control. Subsequent analysis indicated a superior effect for verum-acupuncture in comparison with sham-/placebo-acupuncture or waitlist-control when the recommended lowest threshold dosage (12 sessions) was met. Despite positive outcomes, most studies reviewed were heterogeneous and at risk of bias due to methodological issues.ConclusionsDespite limited evidence, acupuncture was significantly associated with improvements in several objective sleep parameters (increases in total sleep time and sleep efficiency, and reductions in wake after sleep onset and number of awakening times) as well as subjective sleep quantity and quality in patients with PI. A minimum therapeutic threshold dosage (≥12 sessions) is recommended. Well-designed RCTs using PSG are required to clarify the influence of acupuncture on sleep architecture/structure and to promote better application of acupuncture as a treatment for PI.     

Are children and adolescents with psychiatric illness at risk for increased future body weight? A systematic review

The aim of this paper was to review the longitudinal relationship between early‐onset depression and disruptive behaviour and adult body weight. A systematic review of prospective longitudinal studies was conducted of articles in which (1) initial assessment occurred during childhood or adolescence (<18y); and (2) the primary outcome reported as body mass index (BMI), overweight (BMI>25–<30kg/m²), obesity (BMI≥30kg/m²), or depression; and (3) validated assessment measures for assessment of depressive symptoms or disruptive behaviour problems were employed. A total number of 16 articles were identified for review. Obese adolescent females are more likely to develop depressive illness in adulthood than their non‐obese peers. Conversely, depressed adolescent females, and possibly males, are more likely to become overweight adults than non‐depressed adolescents. There are insufficient data addressing future depression risk among overweight, non‐obese, adolescents to evaluate the potentially interactive nature of this relationship. Studies to date are consistent in reporting that children with behaviour problems are at increased risk of future overweight, though whether this risk is conferred by conduct symptoms, ADHD symptoms, or both, is less clear. Care providers of children with disruptive behaviour problems and depressed adolescents should monitor weight gain. Among obese adolescent females, mood should be followed.     

Does type-D personality predict outcomes among patients with cardiovascular disease? A meta-analytic review

Objective

Research generally indicates that psychological variables are stronger predictors of cardiovascular outcomes in healthy populations than in those with preexisting illness. Studies of Type-D personality, however, suggest that it may also be predictive of negative health outcomes in cardiovascular patient populations. To date, no independent, comprehensive meta-analysis centered specifically on Type-D has integrated this literature and provided quantitative estimates of these relationships. The present meta-analysis investigated the associations between Type-D personality and (a) major adverse cardiac events (MACE), (b) health-related quality of life (HRQOL) and (c) biochemical markers of cardiovascular disease among cardiovascular patients.

Method

Two independent reviewers abstracted data from 15 separate studies. A random effects meta-analytic model was utilized to calculate omnibus effect sizes for each set of related studies, i.e., for the MACE (N of patients=2903), HRQOL (N of patients=1263) and biochemical marker (N of patients=305) measures.

Results

A positive association was found between Type-D personality and MACE, whereas a negative association was observed between Type-D personality and HRQOL. There was a trend toward significance in the association between Type-D personality and cardiovascular disease biomarkers.

Conclusion

Type-D personality is a promising construct for understanding psychological relationships with important outcomes among cardiovascular patients. Subsequent investigations undertaken by a more diverse group of unaffiliated scientists are important for further development in this line of research.