Cardiovascular events in hospitalised patients with schizophrenia: a survival analysis

Objective: To evaluate the occurrence of cardiovascular (CV), cerebrovascular events and mortality rates, and compare the predictive ability of two scores, Framingham Risk Score (FRS) and Atherosclerotic Cardiovascular Disease (ASCVD), of detecting a cardiovascular event in a cohort of schizophrenic patients.

Methods: A cohort of 329 hospitalised schizophrenic patients is being monitored since 1 January 2013. Patients’ file review was performed to detect the CV events of interest.

Results: Out of the 329 patients with schizophrenia, with a mean study follow-up of 41.07?±?12.55?months, 29 cardiovascular events were recorded; of those events, we recorded 4 myocardial infarction, 1 stroke, 6 heart failure and 18 cardiovascular deaths. The major composite outcome of cardiovascular events rate was equal to 9.0 per 100 patient-years. The secondary composite outcome of cardiovascular events rate was equal to 7.2 per 100 patient-years (0.072 events per patient). The association between survival curve of patients with high and low CVR according to FRS score tended to significance (RR?=?1.90, p?=?.078). Patients classified as high cardiovascular risk according to ASCVD presented a reduced cardiovascular survival (RR?=?3.35, p?=?.005).

Conclusion: The ASCVD items should be included in the medical assessment in any patient with severe mental illness.

• Key points

• The major composite outcome of cardiovascular events rate was equal to 9.0 per 100 patient-years.

• The secondary composite outcome of cardiovascular events rate was equal to 7.2 per 100 patient-years (0.072 events per patient).

• The association between survival curve of patients with high and low CVR according to FRS score tended to significance.

• Patients classified as high cardiovascular risk according to ASCVD presented a reduced cardiovascular survival.

• The ASCVD items should be included in the medical assessment in any patient with severe mental illness.

     

‘I am dead’: Cotard syndrome and dementia

Background: Cotard syndrome is a rare condition whose main feature is a nihilistic delusion ranging from the denial of body parts to that of the existence of one’s own life or even the entire universe.

Objectives: The aim of this article is to review the nosological significance of Cotard syndrome and to explore the disorder among patients with dementia.

Methods: Medline and Google Scholar searches were conducted for relevant articles, chapters and books published before 2018. Search terms used included Cotard delusion, Cotard syndrome and dementia, nihilistic delusion. Publications found through this indexed search were reviewed for further relevant references.

Results and conclusion: In this narrative review we emphasise the fact that cases of Cotard syndrome involving patients with dementia are reported quite infrequently. Published studies are limited to very short series or isolated cases. Clinicians are obliged to treat the disorder. They should be alert to the potential high risk inherent in this condition.

• Keypoints

• Cotard syndrome is a rare condition characterised by nihilistic delusions that may range from negation of existence of parts of the body to delusion of being dead.

• The prevalence and incidence of this rare syndrome are not known.

• Since Cotard’s syndrome is conceptualised as part of an underlying disorder, several psychiatric and somatic diseases have been associated with the syndrome.

• The syndrome may occur in patients suffering from dementia.

     

Towards the recovery of a sense of self: An interpretative phenomenological analysis of patients’ experience of body-oriented psychotherapy for schizophrenia

Objective: Increasing evidence supports the efficacy of body-oriented psychotherapy (BPT) for schizophrenia. Yet, so far no research has investigated outcome in relation to therapy process: Why and how BPT is effective. In this study, we qualitatively explore participants’ experience of a manualized BPT for schizophrenia to shed light on the process of therapeutic change. Method: We conducted in-depth interviews with 6 participants who completed a 10-week BPT group intervention. Interviews explored participants’ experience of change and helpful aspects of therapy and were analysed using interpretative phenomenological analysis. Findings: We identified six master themes across the interviews: (i) Being a whole: body-mind connection; (ii) Being agentic and being able; (iii) Being unique and worthy: Being accepted for who one is; (iv) Changing interactions: Engaging in authentic interpersonal contact; (v) Being part of a group: Feeling integrated; and (vi) Hope and investing in the future. Conclusion: We discuss the clinical implications for each theme and bring the findings together by describing therapeutic change in schizophrenia as a recovery of sense of self at different but interlocked levels. Moreover, we put forward recommendations for both specific and common factors for schizophrenia therapy.

Clinical or methodological significance of this article: The clinical significance of this study is twofold. On the one hand, the findings of this analysis might inform the theory and practice of BPT and might directly feedback into a further development of the manual guidelines. On the other hand, common helpful factors have been identified thatmight also be relevant for the more general clinical practice concerning patients with schizophrenia.

Here, we summarize our key messages for the clinical practitioner emerging from the findings:

1. The inclusion of bodily aspects and a focus on pre-reflective experience in psychotherapy can help persons with schizophrenia recover the sense of being a body-mind unity.

2. Empowering persons with schizophrenia, instead of instructing them, seems to foster a sense of agency and self-confidence, which are crucial to the recovery process.

3. A twofold therapeutic stance characterized by openness towards the other and authenticity was experienced by patients as facilitating the rapport building. This might help persons with schizophrenia engage in the relation.

4. Social inclusion might enhance therapeutic change and recovery in schizophrenia. Group therapy might be helpful for fostering a feeling of social belonging, but the inclusion in the wider social and community context remains a critical issue.

5. The experience of joyful moments in psychotherapy might positively contribute to therapeutic change in that it fosters a sense of hope for the future.

Overall our paper contributes to the literature aiming at expanding the range of therapeutic modalities, focussing on the creation and use of mixed models of therapy within and beyond talking practices.     

New neuromodulation techniques for treatment resistant depression

Abstract

In the treatment of depression, when pharmacotherapy, psychotherapy and the oldest brain stimulation techniques are deadlocked, the emergence of new therapies is a necessary development. The field of neuromodulation is very broad and controversial. This article provides an overview of current progress in the technological advances in neuromodulation and neurostimulation treatments for treatment-resistant depression: magnetic seizure therapy; focal electrically administered seizure therapy; low field magnetic stimulation; transcranial pulsed electromagnetic fields; transcranial direct current stimulation; epidural cortical stimulation; trigeminal nerve stimulation; transcutaneous vagus nerve stimulation; transcranial focussed ultrasound; near infra-red transcranial radiation; closed loop stimulation. The role of new interventions is expanding, probably with more efficacy. Nowadays, still under experimentation, neuromodulation will probably revolutionise the field of neuroscience. At present, major efforts are still necessary before that these therapies are likely to become widespread.

• Key points

• There is a critical need for new therapies for treatment resistant depression.

• Newer therapies are expanding. In the future, these therapies, as an evidence-based adjunctive treatments, could offer a good therapeutic choice for the patients with a TRD.

• The current trend in the new neuromodulation therapies is to apply a personalised treatment.

• These news therapies can be complementary.

• That treatment approaches can provide clinically significant benefits.

     

Evaluation of plasma agmatine level and its metabolic pathway in patients with bipolar disorder during manic episode and remission period

Objectives: Agmatine is a cationic amine resulting from the decarboxylation of l-arginine. Agmatine has neuroprotective, anti-inflammatory, anti-stress, and anti-depressant properties. In this study, plasma agmatine, arginine decarboxylase, and agmatinase levels were measured during manic episode and remission period in patients with bipolar disorder.

Methods: Thirty healthy volunteers and 30 patients who meet Bipolar Disorder Manic Episode diagnostic criteria were included in the study. Additionally, the changes in the patient group between manic episode and remission period were examined. We evaluated the relationship between levels of l-arginine and arginine decarboxylase in the agmatine synthesis pathway, and level of agmatinase that degrades agmatine.

Results: Levels of agmatine and l-arginine were significantly increased than control group during manic episode (p?<?.01). All parameters were increased during manic episode compared to remission period (p?<?.05). Agmatinase was significantly decreased both during manic episode (p?<?.01) and remission period (p?<?.05) in comparison to the control group. Arginine decarboxylase levels did not show a significant difference between the groups (p?>?.05).

Conclusions: This study indicate that there may be a relationship between bipolar disorder and agmatine and its metabolic pathway. Nonetheless, we believe more comprehensive studies are needed in order to reveal the role of agmatine in etiology of bipolar disorder.

• Key points

• Agmantine, agmatinase, l-arginine and arginine decarboxylase levels in BD have not been explored before.

• Various neuro-chemical mechanisms act to increase agmatine in BD; however, agmatine could have elevated to compensate agmatine deficit prior to the manifestation of the disease as in schizophrenia.

• Elevated agmatine degradation resulting from excess expression of agmatinase which is suggested to be effective in pathogenesis of mood disorders was compensated by this way.

• Elevated agmatine may be one of the causes which play a role in mania development.

• Elevated agmatine levels are also suggested to trigger psychosis and be related with the etiology of manic episode and lead to BD.

     

The Art Therapy Working Alliance Inventory: the development of a measure

Two studies present the development and validation of the Art Therapy Working Alliance Inventory measure, based on Bordin’s [1979. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16, 252–260] conceptualisation of the therapeutic working alliance. The measure captures unique aspects of the art therapy working alliance that take into account the client’s relation to the art medium in the presence of the art therapist. The measure’s reliability and validity were examined. In Study 1, 40 art therapy students, who participated in art therapeutic simulations as clients during their training programme, rated the measure in its development phase; in Study 2, 104 art therapy students completed the final questionnaire and the Working Alliance Inventory in regard to therapeutic simulations. Exploratory factor analysis revealed three main factors: perceiving the art medium as an effective therapeutic tool (Art Task); the affective and explorative experience during art-making (Art Experience); and, acceptance of the art therapist’s interventions in the art medium (Art Therapist Acceptance). Associations were found between Art Task and Art Therapist Acceptance with each of the working alliance components, as well as between Art Experience with the Bond component. Implications for practice and research are discussed.

Plain-language summary

• In verbal psychotherapy, a strong therapeutic alliance between client and therapist is necessary to achieve therapeutic goals. In art therapy, this alliance includes a third object: the art medium, comprised of art materials, artmaking and artworks.

• In this study, we developed and tested a new questionnaire for art therapy service users which measures the client-art medium alliance formed in art therapy. The new questionnaire is based on the Working Alliance Inventory, a well-known measure used in psychotherapy (Horvath & Greenberg, 1989) and is called the Art Therapy-Working Alliance Inventory.

• In order to measure the alliance between the client and the art medium, the Art Therapy-Working Alliance Inventory asks about three main areas: the client’s perception of the art medium as a therapeutic tool (Art-Task), the client’s affective experience of his/her artwork (Art Experience), and the client’s acceptance/rejection of the art-therapist’s interventions in the art medium (Art Therapist Acceptance).

• We asked 104 art therapy students to assume the role of clients in simulated art therapy sessions and then fill out the questionnaire at the end. We found a strong association between the two alliance scores; in other words, the stronger the alliance between the client and the art therapist, the stronger the alliance between the client and the art medium.

• Thus, we concluded that the Art Therapy-Working Alliance Inventory can serve as a useful tool in the research of art therapy practice.

     

Clinical evolution of patients treated with aripiprazole long-acting injectable: a preliminary,prospective, observational study

Abstract

Objective: To evaluate the effectiveness of 6-month treatment with aripiprazole long-acting injectable (LAI) in improving psychotic symptoms, social functioning and side effects and reducing co-administered antipsychotic drugs.

Methods: Multicentre, observational, prospective study that enrolled 53 patients with diagnosis of schizophrenia spectrum disorders who initiated or switched to aripiprazole LAI. The effectiveness of aripiprazole LAI was assessed through the Positive and Negative Syndrome Scale (PANSS), the Udvalg for Kliniske Undersogelser scale for side effects, the Global Assessment of Functioning and the Clinical Global Impression-Schizophrenia (CGI-SCH).

Results: Upon treatment with aripiprazole LAI, patients significantly improved all the domains of PANSS (p?<?.05). Adverse event severity significantly improved after a 6-month aripiprazole LAI treatment (p?<?.05). Differences from baseline to month 6 in Global Assessment of Functioning score were significant (p?=?.0002). The proportion of severely ill patients decreased upon treatment with aripiprazole LAI (CGI-SCH scale). Prolactin levels were normalised after a 6-month treatment (from 43.0 to 14.7?ng/mL). Co-administered antipsychotic drugs significantly decreased after a 6-month treatment with aripiprazole LAI.

Conclusion: A 6-month treatment with aripiprazole LAI improved the clinical status of our patients without modifying their metabolic profile, and allowed the reduction of co-administered antipsychotic drugs.

• Practice implications

• Long-acting injectable antipsychotics are effective treatment options for the maintenance of patients with schizophrenia and related disorders, and to ensure treatment adherence. This study describes the evolution of patients over six months of treatment with aripiprazole long-acting injectable. The results from this study support previous data on the efficacy and safety of this atypical antipsychotic. This study may be of wide interest to the community of psychiatrists and may help clinicians optimise treatment adherence in patients with schizophrenia spectrum disorders.

• Key points

• Aripiprazole long-acting injectable is an atypical antipsychotic intended to improve treatment adherence and prevent relapses.

• This multicentre prospective study evaluated the effectiveness of aripiprazole long-acting injectable over six months of treatment on the control of a comprehensive set of clinical variables.

• Clinical rating scales showed that treatment with aripiprazole long-acting injectable improved clinical symptoms and social functioning, and reduced the severity of adverse events.

• Aripiprazole long-acting injectable contributed to the maintenance of adequate metabolic profiles and the normalisation of prolactin levels.

• Patients significantly decreased co-administered antipsychotic drugs after 6-month treatment with aripiprazole.

     

High rates of depression anxiety and suicidal ideation among inpatients in general hospital in China

Objective: To investigate the prevalence rates of depression anxiety and suicidal ideation among Chinese general hospital inpatients and to identify the potential associations with sociodemographics.

Method: A cross-sectional survey was applied in a Chinese general hospital. A questionnaire set, including sociodemographic variables, Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7), was completed by the participants. Clinically significant depression (CSD) and clinically significant anxiety (CSA) were defined as a score above 10 on the two scales. CSD and CSA are proxy measures but not specific diagnoses of mental disorders.

Results: Data from 1329 patients were included in the final analysis. 422 (31.8%) reported clinically significant depressive symptoms, 83 (6.3%) reported frequent suicidal ideation, and 204 (15.3%) reported clinically significant anxiety. Household income was negatively associated with CSD. Inpatients with lower household incomes and educational levels had higher rates of CSA. Middle-aged inpatients were more prone to suicidal ideation, and stable marital status was related to less suicidal ideation.

Conclusion: Depression, anxiety, and suicidal ideation were determined to be common psychological problems in Chinese inpatients. Chinese medical personnel must pay attention to the mental health conditions of inpatients, particularly inpatients with lower income, educational levels, and poor marital status.

• Key Points

• This is one of the first studies focusing on the prevalence of depression and anxiety in Chinese hospitalized inpatients in non-psychiatric departments of a general hospital.

• The PHQ-9 and GAD-7 were determined to be potential screening tools to aid Chinese medical workers in recognizing depression and anxiety in nonpsychiatric departments.

• The prevalence of depression, anxiety and suicidal ideation was observed to be relatively high in inpatients, which requires more attention from Chinese clinicians.

     

Problematic internet use and feelings of loneliness

Objectives: Internet addiction or problematic internet use (PIU) has been related to feelings of loneliness and social networking. Research suggests that online communication may cause loneliness. We examined if the association between PIU and loneliness is independent of lack of social support, as indicated by lack of a committed romantic relationship, poor family functioning, and lack of time to interact face-to-face due to time online.

Methods: Portuguese adolescents and young adults (N?=?548: 16–26?years) completed the Generalized Problematic Internet Use Scale-2, the UCLA Loneliness Scale, and the general functioning subscale of the McMaster Family Assessment Device. They also reported if they had a committed romantic relationship, and if being online did not leave them time to be with partner, spend with family and socialise face-to-face with friends.

Results: Social networking was reported as among the main preferences by 90.6% of the females and 88.6% of the males. Perceived loneliness was associated with PIU independently of age and indicators of social support.

Conclusions: Evolution created neurophysiological mechanisms to recognize satisfying social relationships based on sensory information and bodily feedback present in face-to-face interactions. These are greatly absent in online communication. Hence, online communication likely engenders feelings of loneliness.

• Keypoints

• Problematic internet use (PIU) has been related to loneliness and social networking.

• Online communication was shown to increase loneliness.

• Lack of romantic relationships did not explain the association of PIU with loneliness.

• Poorer family environment did not explain the association of PIU with loneliness.

• Lack of face-to-face interactions due to time online also did not explain it.

• Lack of adequate sensory cues and bodily feedback in online contacts might facilitate it.

     

Neurocognitive findings in young adults with binge eating disorder

Abstract

Objectives: Binge-eating disorder (BED) has been associated with cognitive impairment, including on measures of impulsivity, but it is not clear in prior literature whether these deficits may have been associated with obesity, rather than BED per se. Impulsivity may play a role in predisposing people towards BED as well as in the chronicity of symptoms. The aim of this study was to examine cognitive functions between BED and healthy controls matched for age, gender, and body mass indices.

Methods: Individuals with BED and healthy controls were recruited from the general community using media advertisements. After providing informed consent, study participants completed a clinical interview and computerised neuropsychological testing. Group differences were analysed.

Results: Groups did not differ significantly on age, gender, education levels, or body mass indices. The BED group (N?=?17) exhibited significantly impaired stop-signal response inhibition (Stop-Signal Task) and executive planning (Stockings of Cambridge Task) compared to healthy controls (N?=?17). Spatial working memory and set-shifting were intact.

Discussion: BED appears to be associated with motor disinhibition and impaired executive planning even controlling for obesity. Longitudinal work is needed to clarify whether motor impulsivity predisposes people to BED, and/or contributes to persistence of symptoms over time.

• Key points

• Binge-eating disorder is common, under-recognised, and associated with untoward physical and health sequelae.

• The neurobiological basis of binge-eating disorder is unclear; cognitive testing may offer insights.

• Many prior cognitive studies have not controlled for potential confounds, especially group differences in body mass indices (BMI). Obesity in itself has been linked with cognitive dysfunction.

• Here, we compared cognition between people with binge-eating disorder and controls, matched for BMI and other measures.

• Binge-eating disorder was associated with impaired response inhibition and executive planning.

• These results inform neurobiological models of binge-eating disorder and may suggest new treatment targets for this condition.

     

Psychometric properties of the Montreal Cognitive Assessment (MoCA) in healthy participants aged 18–70

Abstract

Objectives: The Montreal Cognitive Assessment (MoCA) is a cognitive screen, available in three alternate versions. Aims of the current study were to examine the effects of age, education and intelligence on MoCA performance and to determine the alternate-form equivalence and test–retest reliability of the MoCA, in a group of healthy participants.

Method: In 210 participants, two MoCA versions and an estimator for premorbid intelligence were administered at two time points.

Results: Age, education and estimated premorbid intelligence correlated significantly with the total score (MoCA-TS) and the Memory Index Score (MoCA-MIS). Systematic differences between MoCA version 7.1 and alternate versions 7.2 and 7.3 were only found for the items animal naming, abstract reasoning and sentence repetition. Test–retest reliability of the MoCA-TS was good between 7.1 and 7.2 (ICC: 0.64) and excellent between 7.1 and 7.3 (ICC: 0.82). For the MoCA-MIS, coefficients were poor (ICC: 0.32) to fair (ICC: 0.48), respectively.

Conclusion: Adequate norms are needed that take the effects of age, education and intelligence on MoCA performance into account. All three MoCA versions are largely equivalent based on MoCA-TS and the test–retest reliabilities show that this score is suitable to monitor cognitive change over time. Comparisons of the domain-specific scores should be interpreted with caution.

• Key points

• The MoCA total score is a reliable cognitive measure.

• All three MoCA versions are largely equivalent.

• Age, education and intelligence are predictors of MoCA performance in healthy participants.

• Future studies should focus on collecting normative data for age, education and intelligence for use in clinical practice.

     

Use of the Adult Attachment Interview to measure process and change in psychotherapy

Abstract

The Adult Attachment Interview (AAI), developed and extensively tested in the domain of developmental psychology, has relevance to psychotherapy research. The authors compare and contrast the ways that social psychologists and developmental psychologists have operationalized the concept of attachment security and discuss corresponding implications for psychotherapy research. In addition, they provide an overview of the AAI and its development, reliability, and validation in developmental psychology and summarize recent work linking AAI responses with distinctive types of psychopathology. A summary of recent work showing the AAI to be a useful indicator of positive outcome in psychotherapy for adults with diverse problems, including depression, borderline personality disorder, and posttraumatic stress disorder, is provided.     

Implication of core beliefs about negative-self in neuroticism

Abstract

Objective: Core beliefs about negative-self are beliefs about self-deficiencies in basic aspects of human adaptation. Meanwhile, neuroticism is a personality trait characterised by negative emotionality, i.e., a tendency to react to stress with negative emotions. The present study tested the hypothesis that core beliefs about negative-self are implicated in neuroticism.

Methods: The subjects were 309 Japanese healthy volunteers. Core beliefs about negative-self were evaluated by the Brief Core Schema Scales, and neuroticism was evaluated by the NEO Personality Inventory-Revised.

Results: In both multiple regression analysis and structural equation modelling, higher neuroticism was strongly predicted by higher levels of core beliefs about negative-self.

Limitations: The present study cannot determine the causal relationship between core beliefs about negative-self and neuroticism, because of its cross sectional design.

Conclusions: The present study suggests that core beliefs about negative-self are deeply implicated in neuroticism.

• Key Points

• Implication of core beliefs about negative-self in neuroticism was examined.

• Neuroticism was predicted by higher levels of these core beliefs.

• These core beliefs may be involved in negative emotionality of neuroticism.

     

Construction of the Lebanese Anxiety Scale (LAS-10): a new scale to assess anxiety in adult patients

Abstract

Objective: The study objectives were (1) to create a new 10-item scale, the ‘Lebanese Anxiety Scale’ (LAS-10), inspired by the diagnostic criteria of DSM-5, and the HAM-A and STAI scales and (2) to evaluate the performance of this new scale on a sample of Lebanese individuals.

Methods: This cross-sectional study enrolled 1332 community dwelling participants between November 2017 and March 2018.

Results: In sample 1, the participants’ mean age was 28.08?years (63.9% females). The LAS items converged over a solution of two factors that had an Eigenvalue over 1, explaining a total of 51.97% of the variance (α_Cronbach=0.857). The optimal cut-off between healthy controls and anxious patients was 13.50 according to the ROC curve. The sensitivity and specificity were good at this cut-off (77.5% and 70.8%, respectively). The area under the curve was high: 0.811 [0.778–0.845]; p?<?.001. The positive predicted value of the LAS-10 score in sample 1 was 26.9%, whereas the negative predicted value was 95.2%.

Conclusion: The results of the present study show that the LAS-10 is a tool that can be used in clinical practice and research to screen for anxiety.

• KEY POINTS

• The positive predicted value of the LAS-10 score was 26.9%.

• Its negative predicted value was 95.2%.

• People with scores above 13.5 be referred to a health care professional for further assessment.

• The LAS-10 is a tool can be used in clinical practice and research to screen for anxiety.

• Future studies are needed to validate the LAS-10 in other countries.

     

Alexithymia,suicide ideation,affective temperaments and homocysteine levels in drug naïve patients with post-traumatic stress disorder: an exploratory study in the everyday ‘real world’ clinical practice

Objective: The present exploratory study aimed to investigate relationships between alexithymia, suicide ideation, affective temperaments and homocysteine levels among drug-naïve adult outpatients with Post-Traumatic Stress Disorder (PTSD) in an everyday ‘real world’ clinical setting.

Method: Sixty-four adult outpatients with PTSD were evaluated using the Davidson Trauma Scale (DTS), the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation (SSI), the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego-Autoquestionnaire. As well, homocysteine levels were measured.

Results: Alexithymic subjects showed higher values on all scales but not homocysteine levels. Partial correlations showed that almost all studied variables were correlated with each other, except homocysteine levels. Regression analysis showed that higher disorder severity as measured by DTS and TAS-20 ‘Difficulty in Identifying Feelings’ dimension was associated with higher SSI scores.

Conclusions: In conclusion, alexithymic PTSD outpatients may be characterised by higher disorder severity and difficulty in identifying feelings that may be linked to increased suicide ideation, regardless of affective temperaments or homocysteine levels. Homocysteine levels were not related to any studied variable. However, study limitations are discussed and must be considered.

• Keypoints

• Patients with alexithymia showed increased PTSD severity, a higher score on TEMPS-A subscales, and more severe suicide ideation.

• The Difficulty in Identifying Feelings (DIF) dimension of TAS-20 was associated with suicide ideation in patients with PTSD.

• Homocysteine did not correlate with any studied variables.

• This study was exploratory and cross-sectional: further larger and prospective studies are needed.

     

Serum testosterone levels in bipolar and unipolar depressed female patients and the role of medication status

Abstract

Objective: to compare testosterone levels between female depressed patients and female bipolar patients.

Methods: Sixty-one female patients with major depressive disorder (MDD) (n?=?23) or bipolar disorder (BD) (n?=?38) between 18 and 45?years old were included in the study. Participants were evaluated during a depressive or manic episode with the Hamilton depression rating scale (HDRS) or Young mania rating scale (YMRS), respectively. No patients in the MDD group were taken valproate while in the BD group 14 (36.84%) were taken valproate. Total testosterone (TT) and free testosterone (FT) levels were quantified during the early follicular phase of the cycle, with radioimmunoassay or solid phase enzyme-linked immunoassay. Data were collected from May 2016 to February 2017.

Results: Mean TT serum levels were significantly higher in BD patients in comparison to MDD patients. Although age and diagnosis were related to TT levels, however when we added valproate use in the analysis, only the relation between TT and valproate use remained significant.

Conclusions: In this sample, TT levels were related to valproate use in patients with BD. More studies regarding the role of testosterone in affective symptoms should be conducted to clarify the relation between testosterone, affective disorders, and medication.

• Keypoints

• We observed that testosterone levels were significant higher in bipolar women compared to women with MDD.

• The use of valproate could be associated with the testosterone levels in female patients with BD.

• Evaluation of women suffering BD should include a testosterone levels determination, particularly when they are taking valproate.

     

Is sustained attention deficit related to subclinical obsessive thoughts in children and adolescents with ADHD?

Abstract

Background: Thought content and its impact on sustained attention in individuals with attention deficit hyperactivity disorder (ADHD) are topics of growing interest in literature.

Objective: We hypothesised that subclinical obsessive thoughts may be correlated with attention lapses in individuals with ADHD.

Method: Thirty children diagnosed with ADHD participated in the study and their level of subclinical obsessive thoughts, attention, and executive function were measured using Children Yale-Brown Obsessive Scale and Conners’ Continuous Performance Test II.

Results: No significant correlation between sustained attention impairment and the level of obsessive thoughts in patients with ADHD was found. Nevertheless, patients with ADHD with subclinical obsessive thoughts showed more commission errors than those without (W?=?51.5; p?=?0.02).

Conclusion: The nature of thought content in individuals with ADHD should be linked to executive dysfunction rather than attentional impairment. This could be of importance in the therapeutic strategy choice, addressing the importance of executive function remediation in the specific context of subclinical obsessive thoughts.

• Key points

• ?Patients with ADHD, without OCD or ASD comorbidity, still present subclinical obsessive thoughts (36% of our sample). ??Subclinical obsessive thoughts could be a part of thought content in patients with ADHD.

• ???Subclinical obsessive thoughts as measured by the CPT-II are not correlated with attention function in patients with ADHD.

• ???ADHD patients with subclinical obsessive symptoms present more impairment in response inhibition than the ones without.

• ???Results on subclinical obsessive thoughts are similar to those on another type of thought content called ‘mind wandering’.

• ???A clinical improvement strategy for patients with ADHD could be using executive function remediation rather than classical attention function remediation, according to both to our and previous results.

     

Dynamic changes in miR-124 levels in patients with acute cerebral infarction

Objective: To investigate the changes in serum miR-124 levels in patients with acute cerebral infarction (ACI) and elucidate the underlying mechanism by a dynamic monitor.

Methods: Fifty-four patients with ACI and 51 healthy controls were included in our study. Baseline characteristics and blood samples were collected for further analysis. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure the serum miR-124 levels. The dual-luciferase reporter assay was used to evaluate the effect of miR-124 on iASPP, a protein that inhibits apoptosis stimulating proteins in the p53 family.

Results: Compared with normal controls, the miR-124 levels in the ACI group rapidly decreased at phase 1 (within 24?h after ischemia) (p?<?0.001) and then gradually increased at phase 2 (48?～?72?h after ischemia) (p?<?0.001) and phase 3 (the 7th day after ischemia) (p?<?0.001). The dual-luciferase reporter assay showed that miR-124 down-regulates iASPP expression in 293T cells.

Conclusion: The miR-124 levels are down-regulated in ACI patients. The dynamic changes of miR-124 might provide a possible method for the detection of ischemic stroke.

• Highlights

• The difference in miR-124 expression levels between ACI patients and normal controls.

• Dynamic changes of miR-124 expression levels in ACI patients.

• The down-regulation of miR-124 upon iASPP expression.

     

Depression and sleep quality in psoriatic patients: impact of psoriasis severity

Abstract

Background: Psoriatic patients often display depression and sleep disturbances. In previous research, we found high rates of depression and poor sleep quality among psoriatic patients, unrelated to psoriasis severity. However, these results referred to a sample mainly composed of patients under remission.

Aim: To compared the prevalence of depression and sleep disturbances in patients suffering from mild versus moderate-tosevere plaque psoriasis, also investigating the association between psoriasis severity and psychopathological variables.

• Keypoints

• Psoriasis affects the patients’ psychophysical health.

• Depressive symptoms and/or sleep disturbances are frequent among psoriatic patients.

• This study investigates these issues comparing the sub-populations of mild and moderate-to-severe psoriatic patients, with special attention to the association between sleep and pruritus.

• In clinical practice, the link between psychopathological disturbances and psoriasis should not be underestimated.