Do Low- and Middle-Income Countries Learn from the Experience of High-Income Countries?

An editorial posited that low- and middle-income countries (LMICs) take longer to access schizophrenia treatment innovations, but this lag may be an advantage in that that it allows them to have better evidence to inform clinical and policy decisions. We sought to determine whether LMIC policymakers do in fact use the best available evidence to make decisions regarding access to atypical antipsychotics, the latest innovation in schizophrenia therapeutics. Since there were no relevant policy analyses, we approached the issue by assessing the quality of the scientific evidence available to policymakers and examining in detail the experience of Chile, a middle-income country. We found that there is minimal LMIC-specific scientific evidence to inform policy analyses. Moreover, the modest body of cost-effectiveness evidence is undermined by the source of its effectiveness estimates. Only two of the four cost-effectiveness studies accounted for antipsychotics' side-effects, and only one included the long-term effects of metabolically active antipsychotics. LMICs that are able to manufacture or import cheaper generic atypical drugs have readily embraced them. Chile's experience indicates that an LMIC that implemented policies when evidence from higher-income countries strongly favored atypical drugs responded to new evidence to the contrary, but not forcefully enough to counter pressure from advocates or market forces. It appears, then, that most LMIC policymakers were not aware that the modest body of LMIC-relevant cost-effectiveness evidence did not favor atypicals, or if they were aware, their decisions were not influenced by this evidence. We conclude with a discussion of the implications of this finding.     

Can Autism Spectrum Disorders and Social Anxiety Disorders be Differentiated by the Social Responsiveness Scale in Children and Adolescents?

Autism spectrum disorder (ASD) as well as social phobia (SP), and selective mutism (SM) are characterised by impaired social interaction. We assessed the validity of the Social Responsiveness Scale (SRS) to differentiate between ASD, and SP/SM. Raw scores were compared in 6–18 year old individuals with ASD (N = 60), SP (N = 38), SM (N = 43), and typically developed (N = 42). Sensitivity and specificity were examined. The three disorders showed overlapping SRS scores. Especially in boys with SM (ROC–AUC = .81), presence of ASD was overestimated by the SRS. A combination of three disorder specific questionnaires resulted in marginally improved diagnostic accuracy. For the clinically very relevant differential diagnosis of SP/SM, SRS results must be interpreted with caution.     

Peer-Victimization and Mental Health Problems in Adolescents: Are Parental and School Support Protective?

The aim of this study was to investigate the frequency and effects of peer-victimization on mental health problems among adolescents. Parental and school support were assumed as protective factors that might interact with one another in acting as buffers for adolescents against the risk of peer-victimization. Besides these protective factors, age and gender were additionally considered as moderating factors. The Social and Health Assessment survey was conducted among 986 students aged 11–18 years in order to assess peer-victimization, risk and protective factors and mental health problems. For mental health problems, the Strengths and Difficulties Questionnaire (SDQ) was used. Effects of peer-victimization on mental health problems were additionally compared with normative SDQ data in order to obtain information about clinically relevant psychopathology in our study sample. Results of this study show that peer-victimization carries a serious risk for mental health problems in adolescents. School support is effective in both male and female adolescents by acting as a buffer against the effect of victimization, and school support gains increasing importance in more senior students. Parental support seems to be protective against maladjustment, especially in peer-victimized girls entering secondary school. Since the effect of peer-victimization can be reduced by parental and school support, educational interventions are of great importance in cases of peer-victimization.     

The Relationship Between Perceived Family Support and Depressive Symptoms in Adolescence: What is the Moderating Role of Coping Strategies and Gender?

This study examined the moderating role of gender and coping strategies in the relationship between perceived family support, self-esteem and depressive symptoms. Data were used from the My World Survey Second Level (MWS-SL), a national survey of mental health among 6062 young people aged 12–19 years. Conditional process analyses indicated that planned coping moderated the relationship between perceived family support and depressive symptoms for those engaging in low-moderate levels but not high levels of planned coping, and this moderating role was stronger for females than males. Avoidance coping was a moderator for those engaging in moderate-high but not low levels of avoidance coping, and gender also moderated this relationship. Support-focused coping only moderated the perceived family support/depressive symptoms relationship for females. Findings suggest that the strength of the relationship between perceived family support and depressive symptoms depends on level of engagement with a particular coping strategy, and this engagement is a consistently stronger moderator for females.     

Canadian Adolescents’ Internalized Symptoms in Pandemic Times: Association with Sociodemographic Characteristics,Confinement Habits,and Support

Psychiatric Quarterly - Adolescence is a time of increased risk for developing symptoms of anxiety and depression, especially for girls. The stress and social isolation experienced during...     

Can spasticity and dystonia be independently measured in cerebral palsy?

Selecting and evaluating appropriate treatments for children with cerebral palsy has been challenging. One difficulty is in the ability to quantify the presence and importance of coexisting motor signs. This study presents quantitative measures developed to assess spasticity and dystonia. Children diagnosed with extrapyramidal or spastic cerebral palsy and matched control children were studied. Spasticity was measured as the slope of the force-velocity relationship from a test where we measured the forces required to passively extend the elbow at different velocities. Dystonia was assessed by measuring "overflow" movements of arm during active movement of the other arm. Measures of dystonia and spasticity did not correlate with one another, but did correlate with their respective clinical measurement tools, the Modified Ashworth scale and the Barry-Albright Dystonia scale. Most children had a combination of both spasticity and dystonia, despite diagnosis. Our measures also related to different aspects of reaching: children with increased dystonia made more curved paths, and children with increased spasticity hit higher peak velocities. These measurements allow us to distinguish between different motor disorders and the degree to which each contributes to reaching performance. Use of quantitative measures should improve selection and evaluation of treatments for childhood motor disorders.     

Can Hostility Interfere with the Health Benefits of Giving and Receiving Social Support? The Impact of Cynical Hostility on Cardiovascular Reactivity During Social Support Interactions Among Friends

Background  Both social support and hostility have been reliably associated with important health outcomes including coronary heart disease (CHD). One potential pathway by which these variables may influence CHD is via their impact on cardiovascular reactivity (CVR). Although social support has been generally associated with beneficial effects on cardiovascular functioning, the cynicism and mistrust among hostile individuals may prevent them from benefiting from the support process during times of stress. Purpose and Method  The present study examined if level of hostility influenced CVR when discussing positive or negative personal experiences with a friend. To test this, healthy males and females and their same-sex friend were recruited (N = 216) and randomly assigned to discuss either a positive or negative (stressful) personal experience while cardiovascular measures were recorded. Results and Conclusions  Results revealed the greatest systolic blood pressure and diastolic blood pressure reactivity among individuals high in hostility when discussing a negative experience. These results suggest that hostility may interfere with the benefits from support transactions during stress. Likewise, this association between hostility and reactivity was apparent for both support recipients and support providers, suggesting that hostility could undermine the health benefits of both aspects of support transactions.

Can Consumer-Led Mental Health Services be Equally Effective? An Integrative Review of CLMH Services in High-Income Countries

This study examined the evidence from controlled studies for the effectiveness of consumer-led mental health services. Following an extensive search of material published in English from 1980, predefined inclusion criteria were systematically applied to research articles that compared a consumer-led mental health service to a traditional mental health service. A total of 29 eligible studies were appraised; all of them were conducted in high-income countries. Overall consumer-led services reported equally positive outcomes for their clients as traditional services, particularly for practical outcomes such as employment or living arrangements, and in reducing hospitalizations and thus the cost of services. Involving consumers in service delivery appears to provide employment opportunities and be beneficial overall for the consumer-staff members and the service. Despite growing evidence of effectiveness, barriers such as underfunding continue to limit the use and evaluation of consumer-led services. Future studies need to adopt more uniform definitions and prioritize the inclusion of recovery oriented outcome measures.     

Are Generalized Anxiety and Depression Symptoms Associated with Social Competence in Children with and without Autism Spectrum Disorder?

Generalized anxiety and depression symptoms may be associated with poorer social outcomes among children with Autism Spectrum Disorder (ASD) without intellectual disability. The goal of this study was to examine whether generalized anxiety and depression symptoms were associated with social competence after accounting for IQ, age, and gender in typically developing children and in children with ASD. Results indicated that for the TD group, generalized anxiety and depression accounted for 38% of the variance in social competence and for children with ASD, they accounted for 29% of the variance in social competence. However, only depression accounted for a significant amount of the variance. The findings underscore the importance of assessing the social impact of internalizing symptoms in children with ASD.     

Social Cognitive Impairments and Negative Symptoms in Schizophrenia: Are There Subtypes With Distinct Functional Correlates?

Social cognitive impairments and negative symptoms are core features of schizophrenia closely associated with impaired community functioning. However, little is known about whether these are independent dimensions of illness and if so, whether individuals with schizophrenia can be meaningfully classified based on these dimensions (SANS) and potentially differentially treated. Five social cognitive measures plus Scale for the Assessment of Negative Symptoms (SANS) and Positive and Negative Syndrome Scale (PANSS) scores in a sample of 77 outpatients produced 2 distinct factors—a social cognitive factor and a negative symptom factor. Factor scores were used in a cluster analysis, which yielded 3 well-defined groupings—a high negative symptom group (HN) and 2 low negative symptom groups, 1 with higher social cognition (HSC) and 1 with low social cognition (LSC). To make these findings more practicable for research and clinical settings, a rule of thumb for categorizing using only the Mayer–Salovey–Caruso Emotional Intelligence Test and PANSS negative component was created and produced 84.4% agreement with the original cluster groups. An additional 63 subjects were added to cross validate the rule of thumb. When samples were combined (N = 140), the HSC group had significantly better quality of life and Global Assessment of Functioning (GAF) scores, higher rates of marriage and more hospitalizations. The LSC group had worse criminal and substance abuse histories. With 2 common assessment instruments, people with schizophrenia can be classified into 3 subgroups that have different barriers to community integration and could potentially benefit from different treatments.     

Can risperidone and olanzapine in elderly patients with dementia and other mental disorders be discontinued?

BACKGROUND: In March 2004, the UK Committee of Safety of Medicines (CSM) informed clinicians that risperidone and olanzapine should not be used to treat behavioural and psychological symptoms of dementia (BPSD) because of increased risk of strokes with both drugs and increased risk of mortality with olanzapine. An audit to examine the implications of the implementation of the CSM guidance was undertaken. METHODS: All patients receiving these two drugs, in one psychogeriatric service, at the time of CSM guidance were identified and reviewed. Data on clinical and demographic features, patient and carer involvement in the review and clinical outcome of the efficacy of the overall treatment package at 6 month follow-up was ascertained from the case-notes. RESULTS: The main findings were: (i) all patients receiving risperidone or olanzapine were identified and reviewed at a median interval of 8 days after the CSM guidance; (ii) most patients and carers were involved in the initial review; (iii) risperidone and olanzapine were discontinued in 22 and 12 of the patients respectively, and in 19 of these patients another neuroleptic was substituted; (iv) there was no relationship between discontinuation of these two drugs and presence of cerebrovascular and cardiovascular risk factors; and, (v) there was no relationship between the clinical outcome of efficacy at six months and discontinuation of these two drugs. CONCLUSIONS: This study illustrates that it is possible to identify, review and follow-up patients on these two drugs and involve the patient and carer in the review, and clinical outcome of efficacy of the overall treatment package is not adversely affected by continuation or discontinuation of these two drugs.     

Incarceration History and Depressive Symptoms Among Women Released from US Correctional Facilities: Does Timing,Duration, or Frequency Matter?

Research on the impact of incarceration history on the depressive symptoms of released women has yielded conflicting findings, potentially due to the use of an oversimplified dichotomized measure of incarceration history that masks the significant heterogeneity in women’s incarceration history across different studies. This study used Add Health measures that reflect the timing, duration, and frequency of incarceration to examine its association with released women’s depressive symptoms. Chi-square and t tests were conducted to characterize released women (n = 626) in comparison to women without an incarceration history (n = 7237). Simple correlation analyses and multiple linear regression were then used to determine the association between incarceration history and released women’s depressive symptoms. Findings revealed that the timing, duration, and frequency of incarceration were not significant correlates of released women’s depressive symptoms. Instead, experiences of cumulative disadvantages were significant predictors. We concluded that the effects of cumulative disadvantages on released women’s depressive symptoms might outsize the impact of incarceration history.

     

Shared Features or Co-occurrence? Evaluating Symptoms of Developmental Coordination Disorder in Children and Adolescents with Autism Spectrum Disorder

Journal of Autism and Developmental Disorders - Motor differences are common in Autism Spectrum Disorder (ASD), but rarely evaluated against diagnostic criteria for Developmental Coordination...