Fluvoxamine may prevent onset of psychosis: a case report of a patient at ultra-high risk of psychotic disorder

Background

There is emerging evidence that antidepressants may be effective in preventing patients with non-specific and psychotic-like prodromal symptoms, defined as patients at ultra-high risk (UHR) of psychotic disorder, from transitioning to psychosis. However, the mechanism of such an effect is still unknown.

Methods

We report the case of a 19-year-old Japanese man determined to be at UHR of psychotic disorder in whom fluvoxamine (one of the antidepressants with sigma-1 receptor agonism) showed preventive effects on psychotic-like prodromal symptoms.

Results

Our patient's depressive symptoms were reduced and maintained below remission as a result of treatment with 100 mg/day of fluvoxamine. In addition, it is likely that an additional dose of fluvoxamine (50 mg/day) improved his psychotic-like prodromal symptoms directly, independent of its antidepressive effects.

Conclusion

Fluvoxamine, a sigma-1 receptor agonist, may be effective in preventing patients at UHR of psychotic disorder from onset of psychosis via its neuroprotective/neurotropic actions, independent of its antidepressive effects.     

Psychopathological symptoms in two generations of the same family: a cross-cultural comparison

Purpose

The main aims of the present study were to compare the frequency and correlates of psychopathological symptoms in two generations of the same family in Japan and in England.

Methods

The sample included 689 adolescents and one of their parents/guardians. All participants completed a set of questionnaires to measure psychopathological symptoms, self-construals, and perceived social support.

Results

In both parent and adolescent data, the Japanese sample reported significantly lower psychopathological symptoms than the English sample. The relationship between parental and adolescent psychopathology was significant in England, but not in Japan. In both countries, perceived social support and independent self-construal were generally associated with less psychopathological symptoms, and interdependent self-construal was associated with more symptoms. Additionally, in England, a significant interaction effect was found between social support and the self-construals. Participants with low independent and high interdependent self-construal had elevated levels of psychopathological symptoms when perceived social support was low.

Conclusions

The present study illustrates the importance of culture in the transmission of psychopathological symptoms across different generations in the same family.     

Who Benefits from Diabetes Self-Management Interventions? The Influence of Depression in the Latinos en Control Trial

Background

Depressive symptoms are common among adults with diabetes. Depression and social support may influence diabetes self-management.

Purpose

This study aimed to examine change in depressive symptoms and the role of depression and support on clinical and dietary outcomes among Latinos with type 2 diabetes participating in a diabetes self-management intervention.

Methods

Participants (N?=?252) were randomized to the intervention or usual care. Mixed effects models were used to examine interaction effects between intervention status and depressive symptoms (Centers for Epidemiologic Studies Depression (CES-D) score) and support for diabetes self-management behaviors at baseline. Outcomes were measured at baseline and 4 and 12 months and included dietary quality, physical activity, depressive symptoms, and hemoglobin A1c levels.

Results

Intervention participants had lower CES-D scores at follow-up than control participants. An interaction effect between intervention status and CES-D scores predicted diet quality.

Conclusion

Latinos with depressive symptoms may derive the greatest benefits from diabetes self-management interventions. Additional research on support during diabetes self-management interventions is warranted.     

Moderating factors for the effectiveness of group art therapy for schizophrenia: secondary analysis of data from the MATISSE randomised controlled trial

Purpose

Although some studies suggest that art therapy may be useful in the treatment of negative symptoms of schizophrenia, a recent large trial of group art therapy found no clinical advantage over standard care, but the study population was heterogeneous and uptake of the intervention was poor. This study aimed to investigate whether art therapy was more effective for specific subgroups of patients.

Methods

Secondary analysis of data from a randomised controlled trial of group art therapy as an adjunctive treatment for schizophrenia (n = 140) versus standard care alone (n = 137). Positive and Negative Syndrome Scale scores at 12 months were compared between trial arms. Interaction between intervention effect and different subgroups, including those with more severe negative symptoms of schizophrenia, and those who expressed a preference for art therapy prior to randomisation, was tested using a linear mixed model.

Results

The clinical effectiveness of group art therapy did not significantly differ between participants with more or less severe negative symptoms [interaction for difference in PANSS = 1.7, 95 % CI (?8.6 to 12.1), P = 0.741], or between those who did and did not express a preference for art therapy [interaction = 3.9, 95 % CI (?6.7 to 14.5), P = 0.473]. None of the other exploratory subgroups suggested differences in intervention effect.

Conclusions

There was no evidence of greater improvement in clinical symptoms of schizophrenia for those with more severe negative symptoms or those with a preference for art therapy. Identification of patients with schizophrenia who may benefit most from group art therapy remains elusive.     

Efficacy and Feasibility of a Tele-health Intervention for Acute Coronary Syndrome Patients with Depression: Results of the “MoodCare” Randomized Controlled Trial

Background

Depression is common after a cardiac event, yet there remain few approaches to management that are both effective and scalable.

Purpose

We aimed to evaluate the 6-month efficacy and feasibility of a tele-health program (MoodCare) that integrates depression management into a cardiovascular disease risk reduction program for acute coronary syndrome patients with low mood.

Methods

A two-arm, parallel, randomized design was used comprising 121 patients admitted to one of six hospitals for acute coronary syndrome.

Results

Significant treatment effects were observed for Patient Health Questionnaire 9 (PHQ9) depression (mean difference [change]?=??1.8; p?=?0.025; effect size: d?=?0.36) for the overall sample, when compared with usual medical care. Results were more pronounced effects for those with a history of depression (mean difference [change]?=??2.7; p?=?0.043; effect size: d?=?0.65).

Conclusions

MoodCare was effective for improving depression in acute coronary syndrome patients, producing effect sizes exceeding those of some face-to-face psychotherapeutic interventions and pharmacotherapy. (Trial Registration Number: ACTRN1260900038623.)     

Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review

Background

Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved.

Purpose

The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth.

Methods

This research performs a narrative synthesis of the results from included studies.

Results

Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified.

Conclusions

Research reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth.     

Which Behaviour Change Techniques Are Most Effective at Increasing Older Adults’ Self-Efficacy and Physical Activity Behaviour? A Systematic Review

Background

Increasing self-efficacy is an effective mechanism for increasing physical activity, especially for older people.

Purpose

The aim of this review was to identify behaviour change techniques (BCTs) that increase self-efficacy and physical activity behaviour in non-clinical community-dwelling adults 60 years or over.

Methods

A systematic search identified 24 eligible studies reporting change in self-efficacy for physical activity following an intervention. Moderator analyses examined whether the inclusion of specific BCTs (as defined by CALO-RE taxonomy) was associated with changes in self-efficacy and physical activity behaviour.

Results

Overall, interventions increased self-efficacy (d?=?0.37) and physical activity (d?=?0.14). Self-regulatory techniques such as setting behavioural goals, prompting self-monitoring of behaviour, planning for relapses, providing normative information and providing feedback on performance were associated with lower levels of both self-efficacy and physical activity.

Conclusions

Many commonly used self-regulation intervention techniques that are effective for younger adults may not be effective for older adults.     

The impact of immigration and visible minority status on psychosis symptom profile

Purpose

Immigrants have heightened risks of psychotic disorders, and it is proposed that migration influences symptom profiles. The purpose of this study was to investigate if either migration experience and/or visible minority status affected symptom profiles, using a cross-culturally validated five-factor model of the Positive and Negative Syndrome Scale (PANSS), in patients with broadly defined psychotic disorders.

Methods

PANSS was assessed in a large catchment area based sample of patients with psychotic disorders verified with the Structured Clinical Interview for DSM-IV (n = 1,081). Symptom profiles based on Wallwork et al. five-factor model were compared for Norwegians (73 %), white immigrants (10.5 %), and visible minority groups (16.5 %).

Results

Visible minorities were significantly younger, had less education, more often a schizophrenia diagnosis and higher PANSS positive, negative and disorganized/concrete factor scores than Norwegians and white immigrants. After controlling for confounders only the items “Delusions” and “Difficulty in abstract thinking” differed between groups. Multivariate analyses indicated that these items were not associated with immigration per se, but rather belonging to a visible minority.

Conclusion

We found mostly similarities in psychotic symptoms between immigrants and Norwegians when using a cross-culturally validated five-factor model of the PANSS. Immigration did not directly influence psychotic symptom profiles but visible minority groups had higher levels of “Delusions” and “Difficulty in abstract thinking”, both symptoms that are partially context dependent.     

Testing Negative Means I’m Lucky,Making Good Choices,or Immune: Diverse Reactions to HIV Test Results are Associated with Risk Behaviors

Background

HIV testing may lead to behavioral changes among some individuals, but no scale has been developed to assess potential mechanisms.

Purpose

We aimed to develop and evaluate the psychometric properties of a scale to measure psychological reactions to the receipt of a negative HIV test and explore the scale’s associations with unprotected anal intercourse (UAI).

Methods

Two focus groups were conducted to develop the Inventory of Reactions to Testing HIV Negative, which was subsequently tested on 725 men who have sex with men in the New York City area.

Results

Factor analyses confirmed the presence of three subscales—Reinforced Safety, Invulnerability, and Luck. Regression analyses demonstrated that the subscales interacted with HIV testing behavior to influence UAI.

Conclusions

These findings support the notion that there is heterogeneity in how individuals respond to a negative HIV test, with some individuals subsequently being influenced towards increased engagement in HIV risk behaviors.     

Administering the MADRS by telephone or face-to-face: a validity study

Background

The Montgomery Åsberg Depression Rating Scale (MADRS) is a frequently used observer-rated depression scale. In the present study, a telephonic rating was compared with a face-to-face rating in 66 primary care patients with minor or mild-major depression. The aim of the present study was to assess the validity of the administration by telephone. Additional objective was to study the validity of the first item, 'apparent sadness', the only item purely based on observation.

Methods

The present study was a validity study. During an in-person interview at the patient's home a trained interviewer administered the MADRS. A few days later the MADRS was administered again, but now by telephone and by a different interviewer. The validity of the telephone rating was calculated through the appropriate intraclass correlation coefficient (ICC).

Results

Mean total score on the in-person administration was 24.0 (SD = 11.1), and on the telephone administration 23.5 (SD = 10.4). The ICC for the full scale was 0.65. Homogeneity analysis showed that the observation item 'apparent sadness' fitted well into the scale.

Conclusion

The full MADRS, including the observation item 'apparent sadness', can be administered reliably by telephone.     

Prevalence and trajectory of psychopathology among child and adolescent survivors of disasters: a systematic review of epidemiological studies across 1987–2011

Aims

The goal of this paper was to systematically review evidence on (1) the potential magnitude of the psychopathological impacts of community-wide disasters on child and adolescent survivors, and (2) the long-term course or trajectory of disaster-induced psychopathology among children and adolescents.

Methods

The PubMed/MEDLINE and PsycINFO databases were searched from their respective inception through December 2011. All of the resulting epidemiological studies of child and adolescent survivors following community-wide disasters were examined.

Results

Sixty cross-sectional studies and 25 longitudinal or long-term follow-up studies were identified. The estimated rates of posttraumatic stress disorder (PTSD) and depression among child and adolescent survivors varied greatly across the included studies, ranging from 1.0 to 95 % and 1.6 to 81 %, respectively, while the reported rates of diagnosable PTSD according to the DSM-IV criteria and diagnosable depression ranged from 1.0 to 60 % and 1.6 to 33 %, respectively. The long-term courses of psychopathology among youthful survivors were summarized. Methodological issues with those studies were discussed.

Conclusions

The empirical findings summarized in this review highlight the importance of psychosocial intervention at early postdisaster stages for child and adolescent survivors. The methodological flaws revealed by this review indicate the need for continued attempts to better understand the epidemiology and trajectory of psychopathological problems among youthful survivors.     

Gamma Knife radiosurgery for arteriovenous malformations in pediatric patients

Objective

The authors present the results of Gamma Knife stereotactic radiosurgery performed in a series of children with arteriovenous malformations (AVMs).

Methods

Between June 2005 and January 2014, 75 patients 18 years old or younger received Gamma Knife radiosurgery for AVMs. Of these, 58 patients were eligible for further analysis. The median age of the population was 12 years; 41 % presented with hemorrhage, 34 % with neurological insult, and 24 % patients were diagnosed incidentally. The median AVM volume was 3.5 cm³. The median radiosurgery-based AVM score (RSBAVMS) was 0.86. The median follow-up period was 32 months.

Results

Single session Gamma Knife radiosurgery resulted in complete AVM obliteration in 40 (68.9 %) patients. There were 35 (60.3 %) excellent outcome (complete obliteration with no new deficits) in this series. During the follow-up period, nine (15.51 %) patients experienced new deficits and three (5.1 %) patients experienced intracranial hemorrhage. The annual rate of developing new deficits and hemorrhage was calculated as 5.45 and 1.8 %, respectively. Volume, gender, RSBAVMS, and nidus type factor were factors associated with excellent outcome.

Conclusions

Radiosurgery was successful in majority of patients with minimal morbidity. Gamma Knife radiosurgery for AVMs can be a safe and successful method in pediatric patients.     

The Psychosocial Context Impacts Medication Adherence After Acute Coronary Syndrome

Background

Depression is associated with poor adherence to medications and worse prognosis in patients with acute coronary syndrome (ACS).

Purpose

To determine whether cognitive, behavioral, and/or psychosocial vulnerabilities for depression explain the association between depression and medication adherence among ACS patients.

Methods

One hundred sixty-nine ACS patients who agreed to have their aspirin adherence measured using an electronic pill bottle for 3 months were enrolled within 1 week of hospitalization. Linear regression was used to determine whether depression vulnerabilities predicted aspirin adherence after adjustment for depressive symptoms, demographics, and comorbidity.

Results

Of the depression vulnerabilities, only role transitions (beta?=??3.32; P?=?0.02) and interpersonal conflict (beta -3.78; P?=?0.03) predicted poor adherence. Depression vulnerabilities did not mediate the association between depressive symptoms and medication adherence.

Conclusions

Key elements of the psychosocial context preceding the ACS including major role transitions and conflict with close contacts place ACS patients at increased risk for poor medication adherence independent of depressive symptoms.     

Suicidal ideation and attempts among men who inject drugs in Delhi,India: psychological and social risk factors

Objective

Suicide is major public health problem in India. The objective of the analyses presented in this paper is to examine depressive and anxiety symptoms and socio-demographic indicators as correlates of suicidal ideation and attempts among people who inject drugs (PWID), a high-risk group for suicide.

Method

We analysed data collected in April–May of 2012 from a community-based sample of 420 PWID in Delhi using time location sampling. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts within the past 12 months.

Results

Depressive and anxiety symptoms were associated with suicidal ideation, as were a range of social stressors including poor physical health, length of injecting drug use, housing insecurity, and experiences of violence and sexual abuse. However, depressive and anxiety symptoms were not associated with suicide attempts. Factors associated with suicide attempts among ideators were housing insecurity and relational dynamics including a poor relationship with family and, interestingly, being married.

Conclusion

Suicide prevention interventions among this population should address not only individual mental health and addiction support needs but also the overwhelmingly poor psychosocial circumstances of this group.     

CSF diversion in refractory idiopathic intracranial hypertension: single-centre experience and review of efficacy

Purpose

The current surgical management strategies for refractory cases of idiopathic intracranial hypertension (IIH) remain unresolved. We evaluated the outcome of our paediatric patients who were offered a CSF diversion procedure in order to control their symptoms.

Methods

We retrospectively reviewed the medical notes of the patients under 16 years of age, who presented in our centre from 2005 to 2010, with a confirmed diagnosis of IIH, and ultimately had a lumboperitoneal shunt (LPS). We describe their immediate postoperative course, shunt-related complications and recent outcome.

Results

Seven patients presented at a mean age of 8.7 years. Two presented with significant visual loss and had a shunt acutely; the remaining five presented with headaches and were shunted within 2 years. In the immediate postoperative period two patients experienced low-pressure symptoms. All patients required shunt revisions; in total 15 revisions took place, mainly secondary to symptomatic overdrainage or obstruction. After a mean follow-up of 26 months, two patients have diminished visual acuity at least on one side; only one patient became headache-free, despite resolution of the CSF pressure post diversion in four out of the six remaining patients.

Conclusions

All patients required shunt revisions and 6/7 (85.7 %) had persisting headaches at their last follow-up. It is apparent that once functional, the LPS seems adequate to lower the CSF pressure but not effective in eliminating symptoms.     

The Use of Transcranial Doppler Ultrasound in Confirming Brain Death in the Setting of Skull Defects and Extraventricular Drains

Background

Transcranial Doppler ultrasound (TCD) has been used as a confirmatory test for the diagnosis of brain death (BD), but may be inaccurate in patients with a skull defect or extraventricular drain (EVD).

Methods and Results

We report three cases of patients with a skull defect or EVD in whom TCD supported a diagnosis of BD but in which the clinical examination later refuted the diagnosis.

Conclusion

We caution against the use of TCD to confirm the diagnosis of BD in the presence of a skull defect or EVD.     

A systematic review of the comorbidity between PTSD and alcohol misuse

Purpose

This systematic review aimed to assess (1) the level of comorbidity of post-traumatic stress disorder (PTSD) and alcohol misuse reported in research studies since 2007 and (2) any associations found between specific PTSD symptom clusters and alcohol misuse.

Methods

A literature search was carried out to capture any papers published from 2007 to the end of July 2012. Six hundred and twenty abstracts were identified and reviewed, and 42 papers were included in the final review after applying inclusion and exclusion criteria.

Results

The prevalence of comorbid alcohol misuse in those with PTSD ranged from 9.8 to 61.3 %. The prevalence of comorbid PTSD in those with alcohol misuse ranged from 2.0 to 63.0 %, and the majority of prevalence rates were over 10.0 %. Almost all of the odds ratios representing the strength of association between the conditions across a variety of populations were significant, and those ranged from 1.1 to 4.87. Of the different PTSD symptom clusters, this review found most evidence for associations between alcohol misuse and both avoidance/numbing symptoms and hyperarousal symptoms.

Conclusions

Given that comorbidity appears to be common, the evidence from this systematic review supports the use of routine screening for comorbidity in populations who are known to have PTSD or alcohol misuse.     

Spouse Confidence in Self-Efficacy for Arthritis Management Predicts Improved Patient Health

Background

In addition to patient self-efficacy, spouse confidence in patient efficacy may also independently predict patient health outcomes. However, the potential influence of spouse confidence has received little research attention.

Purpose

The current study examined the influence of patient and spouse efficacy beliefs for arthritis management on patient health.

Methods

Patient health (i.e., arthritis severity, perceived health, depressive symptoms, lower extremity function), patient self-efficacy, and spouse confidence in patients’ efficacy were assessed in a sample of knee osteoarthritis patients (N?=?152) and their spouses at three time points across an 18-month period. Data were analyzed using structural equation models.

Results

Consistent with predictions, spouse confidence in patient efficacy for arthritis management predicted improvements in patient depressive symptoms, perceived health, and lower extremity function over 6 months and in arthritis severity over 1 year.

Conclusions

Our findings add to a growing literature that highlights the important role of spouse perceptions in patients’ long-term health.     

Preoperative Sleep Complaints Are Associated with Poor Physical Recovery in the Months Following Cardiac Surgery

Background

Sleep disturbance is associated with poorer outcomes in cardiac patients, but little is known about the independent role of sleep quality in coronary artery bypass graft (CABG) patients.

Purpose

This study aims to examine the relationship between preoperative sleep complaints and post-operative emotional and physical recovery in CABG surgery patients, independently of demographic, clinical and mood factors.

Methods

Two hundred thirty CABG patients (aged 67.81?±?9.07 years) completed measures of self-reported sleep complaints before surgery and health-related quality of life (HRQoL), physical symptoms and pain 2 months after surgery.

Results

Greater sleep complaints prior to surgery were associated with greater physical symptoms, poorer physical HRQoL and greater sensory pain after surgery (p?<?0.05), but not with affective pain or mental HRQoL. Preoperative mood was not able to explain these associations.

Conclusions

Sleep complaints may be implicated in physical recovery from CABG surgery but further work is needed to understand the role of causal pathways.