Symptom overreporting obscures the dose–response relationship between trauma severity and symptoms

We investigated whether symptom overreporting affects the dose–response relationship between self-reported abuse severity and psychiatric symptoms in two samples. The first sample (N=599) consisted of adults who had previously reported to a public commission that they had been witnesses to or victims of childhood sexual abuse by Roman Catholic Church representatives. The second sample (N=1756) consisted of general population respondents who indicated that they had been victims of non-familial childhood sexual abuse. Using a web-based data collection procedure, both samples completed the Brief Symptom Inventory (BSI-18), items addressing abuse severity, and items flagging symptom overreporting. Adjusting for overreporting reduced the proportion of participants with clinically raised BSI-18 scores from 60% to 47% in sample 1 and from 26% to 22% in sample 2. Also, in both samples, normal range reporting participants exhibited the typical dose–response relationship between trauma severity and BSI-18 scores, whereas this pattern was largely non-significant in overreporting participants. Our findings show that symptom overreporting has a psychometric impact that may obscure relationships between clinically relevant variables and should therefore preferably be monitored in surveys.     

Are there bi-directional associations between depressive symptoms and C-reactive protein in mid-life women?

ObjectiveTo test whether depressive symptoms are related to subsequent C-reactive protein (CRP) levels and/or whether CRP levels are related to subsequent depressive symptoms in mid-life women.MethodsWomen enrolled in the Study of Women’s Health Across the Nation (SWAN) were followed for 7 years and had measures of CES-Depression scores and CRP seven times during the follow-up period. Women were pre- or early peri-menopausal at study entry and were of Caucasian, African American, Hispanic, Japanese, or Chinese race/ethnicity. Analyses were restricted to initially healthy women.ResultsLongitudinal mixed linear regression models adjusting for age, race, site, time between exams, and outcome variable at year X showed that higher CES-D scores predicted higher subsequent CRP levels and vice versa over a 7-year period. Full multivariate models adjusting for body mass index, physical activity, medications, health conditions, and other covariates showed that higher CRP levels at year X predicted higher CES-D scores at year X + 1, p = 0.03. Higher depressive symptoms predicted higher subsequent CRP levels at marginally significant levels, p = 0.10.ConclusionsHigher CRP levels led to higher subsequent depressive symptoms, albeit the effect was small. The study demonstrates the importance of considering bi-directional relationships for depression and other psychosocial factors and risk for heart disease.     

Monomeric C-reactive protein:a link between chronic inflammation and neurodegeneration?

<正>Pre-diabetic insulin resistance is associated with sub-clinical inflammation and concomitant increase in systemic C-reactive protein(CRP) levels.Type 2 diabetes mellitus(T2DM) patients register even higher chronic levels of inflammation,with excess circulating CRP originating from both typical hepatic synthesis,and also visceral white adipose tissue.     

Apolipoprotein E (APOE) ε4 moderates the relationship between c-reactive protein,cognitive functioning,and white matter integrity

Elevated serum C-reactive protein (CRP) and possessing an APOE ε4 allele are two of the most prominent risk factors for cognitive and neurological dysfunction in older adults, but little is known about the unique or cumulative effects of these risk factors in young-to-middle-aged adults. To further characterize these potential relationships, measures of cognition and microstructural white matter integrity were examined using data from a sample of 329 post-9/11 war veterans that was collected as part of a comprehensive evaluation that included assessment of neuropsychological functioning, MRI scanning, psychiatric diagnoses, health screening, markers of inflammation, and APOE genotypes. Hierarchical linear regression analyses revealed the CRP and APOE ε4 interaction was associated with global cognition (β = -0.633), executive functioning (β = -0.566), and global fractional anisotropy (β = -0.470), such that elevated CRP was associated with worse cognition and white matter integrity in APOE ε4 carriers. Diffusion tensor imaging (DTI) was used to determine if CRP × APOE ε4 presence was associated with regionally specific fractional anisotropy in white matter tracts. Tract-based spatial statistics revealed CRP × APOE ε4 presence was associated with fractional anisotropy in the corpus callosum, right superior longitudinal fasciculus, right posterior corona radiata, as well as the bilateral anterior and superior corona radiatas. This suggests that APOE ε4 carriers may be uniquely vulnerable to the potentially negative impact of elevated systematic inflammation to cognition and microstructural white matter integrity.     

The variation of the stress–mental health relationship by ethnicity and gender

Population-based studies have consistently shown a higher frequency of stress and mental health problems (MHPs) among women than among men, and among immigrants than among the ethnic majority. However, little is known about ethnic variation and gender differences among immigrants. This study aimed to explore the variation of the stress–mental health relationship by gender and ethnicity. Logistic regression analyses were conducted on data from 2349 participants including Danes, and Lebanese, Pakistani and Turks – first generation of immigrants in Denmark. The results showed similarities and differences between women and men and between ethnic groups. The risk of developing MHPs was higher among women than among men and the gender difference was significant in all immigrants groups but not in Danes. Although the stress exposure is higher among women and immigrants, gender and ethnic differences in mental health are better explained by cultural dimensions and circumstances in peoples' life.     

Socially naïve self-appraisal moderates the relationship between cognitive insight and positive symptoms in schizophrenia

Cognitive insight refers to awareness of one's own thinking. Research has found deficits in cognitive insight in schizophrenia but studies of its links with positive symptoms and delusions have been equivocal. One possibility is that the association of cognitive insight with positive symptoms and delusions is moderated by other factors. To explore this issue this study examined whether level of socially naive self-appraisal moderated the relationship of two forms of cognitive insight, self-reflectivity and self-certainty with delusions and positive symptoms. Participants were 92 adults, with diagnoses of schizophrenia or schizoaffective disorder, who were administered the Positive and Negative Syndrome Scale, self-deceptive subscale from the Marlowe–Crowne Social Desirability Scale and the Beck Cognitive Insight Scale. Stepwise multiple regressions with the interaction term of the predictive and moderator variables suggested that social naiveté moderates the relationship between self-reflectivity and self-certainty with positive symptoms in general. Moreover, association between self-certainty and delusions was also moderated by social naiveté self-appraisal. All models were significant after controlling for willful impression management as well as a measure of executive function. Results suggest that higher levels of self-certainty are a risk factor for having greater positive symptoms including more severe levels of delusions, when one has a view of oneself that is not tempered by the perceptions of others. Concerning lower levels of self-reflectivity it may be that this combined with a socially naïve view of oneself leaves persons less inhibited when they are tempted to accept unusual thoughts and perceptions as accurate. Implications for treatment are discussed.     

Do humor styles mediate or moderate the relationship between self-criticism and neediness and depressive symptoms?

This study examined whether, in a community sample of Israeli adults (N = 335), benign (i.e., affiliative and self-enhancing) and injurious (i.e., aggressive and self-defeating) humor styles mediated or moderated the relationship between self-criticism and neediness, two traits that confer vulnerability to depression, on the one hand, and levels of depressive symptoms, on the other. There was no evidence of any moderating effect of humor styles on the relationship between self-criticism and neediness and depressive symptoms. However, results indicated that the use of injurious styles of humor mediated the relationship between self-criticism and depressive symptoms as well as the relationship between neediness and depressive symptoms. Moreover, the relationship between neediness and depressive symptoms was also mediated by low levels of benign humor. These findings may have important implications for theories concerning vulnerability to depressive symptoms and intervention strategies.     

Association between morningness–eveningness and the severity of compulsive Internet use: the moderating role of gender and parenting style

BackgroundEveningness and Internet addiction are major concerns in adolescence and young adulthood. We investigated the relationship between morningness–eveningness and compulsive Internet use in young adults and explored the moderating effects of perceived parenting styles and family support on such relationships.MethodsThe participants consisted of 2731 incoming college students (men, 52.4%; mean age, 19.4 ± 3.6 years) from a National University in Taiwan. Each participant completed the questionnaires, which included the Morningness–Eveningness Scale (MES), the Yale-Brown Obsessive Compulsive Scale modified for Internet use (YBOCS-IU), the Parental Bonding Instrument for parenting style, the Family Adaptation, Partnership, Growth, Affection, and Resolve questionnaire (APGAR) for perceived family support, and the Adult Self-Report Inventory-4 (ASRI-4) for psychopathology. The morning (n = 459), intermediate (n = 1878), and evening (n = 394) groups were operationally defined by the MES t scores.ResultsThe results showed that eveningness was associated with greater weekend sleep compensation, increased compulsive Internet use, more anxiety, poorer parenting styles, and less family support; additionally, the most associated variables for increased compulsive Internet use were the tendency of eveningness, male gender, more anxiety symptoms, less maternal affection/care, and a lower level of perceived family support. The negative association between the morning type and compulsive Internet use severity escalated with increased maternal affection/care and decreased with increased perceived family support. The positive association between the evening type and compulsive Internet use severity declined with increased maternal protection. However, the father’s parenting style did not influence the relationship between morningness–eveningness and compulsive Internet use severity.ConclusionsOur findings imply that sleep schedule and the parental and family process should be part of specific measures for prevention and intervention of compulsive Internet use.     

SHORT REPORT The relationship between the severity of post‐stroke aphasia and state self‐esteem

Background: The study of self‐esteem after stroke may provide valuable prognostic information of the potential for functional recovery and may also inform the approach to treatment. Hitherto, research into the effect of post‐stroke aphasia on self‐esteem has received little attention. The purpose of the present study is to examine the relationship between aphasia and self‐esteem and to establish whether the severity of aphasia correlates significantly with the level of self‐esteem. Methods & Procedures: Self‐esteem was measured with the Visual Analogue Self‐Esteem Scale (VASES) and aphasia was assessed with the Western Aphasia Battery (WAB). Assessments were made as soon as practicable after the stroke onset and 3 and 6 months after the first evaluation. Outcomes & Results: Of 51 eligible patients, 40 completed the study. The mean (SD) VASES scores at baseline, 3 and 6 months post‐entry were 36.8 (7.6), 37.6 (7.2), and 38.5 (7.7), respectively. WAB scores were 71.3 (22.9) at 3 months and 72.0 (21.1) at 6 months. This compares to a baseline score of 45.5 (26.2). The changes in WAB scores from baseline to the 3 and 6 months post‐entry assessments were statistically significant. However, the correlation between the severity of aphasia and self‐esteem did not reach statistical significance either at baseline, or at the subsequent assessments. Conclusions: The severity of aphasia does not appear to correlate significantly with the level of self‐esteem in the first 6 months after stroke.     

Psychological distress and C-reactive protein: do health behaviours and pathophysiological factors modify the association?

The objective of this study is to examine the association of psychological distress to high-sensitivity C-reactive protein (hsCRP) levels and to examine the potential mediating role of health behaviours and pathophysiological factors. A total of 883 (393 men and 490 women) subjects, aged 36–56 years, participated in a population-based, cross-sectional study from 1997 to 1998 in Pieksämäki, Finland. Various clinical, biochemical and behavioural factors were measured, including hsCRP concentration. Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12). Subjects with low psychological distress (0 points in GHQ-12) were younger and more physically active, and their mean hsCRP level was lower when compared to subjects with medium (1–3 points) or high (4–12 points) psychological distress (1.26 ± 1.36, 1.53 ± 1.75 and 1.70 ± 1.68 mg/l, respectively, P for linearity = 0.003). Psychological distress was also associated with high relative cardiovascular risk (hsCRP >3.00 mg/l). After adjusting for gender, age, BMI, smoking, use of alcohol and leisure time physical activity, odds ratios for hsCRP >3.00 mg/l in the groups that had medium and high psychological distress were 1.32 (95% CI: 0.81–2.16) and 1.79 (95% CI: 1.05–3.04), respectively, compared with the low distress group (P for linearity 0.032). Psychological distress was associated with elevated hsCRP levels representing high relative cardiovascular risk. This association remained after adjusting for health behaviours and pathophysiological factors, supporting a direct, physiological link between psychological distress and inflammation. CRP could be an important pathophysiological mechanism through which psychological factors are associated with cardiovascular disease.     

Tight junctions and IBS ‐ the link between epithelial permeability,low‐grade inflammation,and symptom generation?

In this issue of Neurogastroenterology and Motility, Dr Ewa Wilcz‐Villega and colleagues report low expression of E‐cadherin, a tight junction protein involved in the regulation of paracellular permeability, in the colonic mucosa of patients with the irritable bowel syndrome (IBS) with predominance of diarrhea (IBS‐D) or alternating symptoms (IBS‐A). These findings constitute an improvement in our knowledge of epithelial barrier disruption associated with IBS. There is mounting evidence to indicate that a compromised epithelial barrier is associated with low‐grade immune activation and intestinal dysfunction in at least a proportion of IBS patients. During the last 10 years of research, much interest has focused on the increase in the number of different types of immune cells in the gut mucosa of IBS patients including: mast cells, T lymphocytes, and other local cells such as enteroendocrine cells. The inflammatory mediators released by these cells or other luminal factors could be at the origin of altered epithelial barrier functions and enteric nervous system signaling, which lead to gut hypersensitivity. A current conceptual framework states that clinical symptoms of IBS could be associated with structural and functional abnormalities of the mucosal barrier, highlighting the crucial importance of elucidating the contributory role of epithelial barrier defects in the pathogenesis of IBS. More importantly, disruption of the epithelial barrier could also participate in the generation of persistent abdominal pain and discomfort mimicking IBS in patients with inflammatory bowel diseases considered in remission. This mini review gives a brief summary of clinical and experimental evidence concerning the mechanisms underlying epithelial barrier defects in IBS.     

Evidence of sex differences in the relationship between current tobacco use and past-year serious psychological distress: 2005–2008 National Survey on Drug Use and Health

Purpose

Cigarette use is highly prevalent in psychiatric populations. Studies suggest that smokeless tobacco use is not significantly associated with past-year psychiatric morbidity, with evidence that tobacco use differ among sexes. The relationships between current tobacco use and past-year serious psychological distress, major depressive episode and anxiety disorder were therefore examined. Sex differences in the aforementioned relationship were also examined.

Methods

A total of 133,221 adults from four successive independent samples of the 2005–2008 National Survey on Drug Use and Health were included. Prevalence odds ratios and 95 % confidence intervals were calculated using multivariable logistic regression adjusting for demographic factors, survey year, pregnancy (women only), past-year medical morbidity, past-year psychiatric comorbidity, and past-year substance use disorders.

Results

No associations were demonstrated among smokeless tobacco users. Statistically significant sex differences were found for current tobacco use and serious psychological distress (p < 0.001). Both male and female smokers were significantly more likely to have serious psychological distress and anxiety disorder compared to never users, while only female smokers were more likely to have major depressive episode. The strongest associations were found for anxiety disorder among all adults as well as both sexes.

Conclusions

The null associations for both sexes for smokeless tobacco may support a reduced risk profile. Female cigarette smokers may be more vulnerable to subclinical distress and depression than males. Studies using other nationally representative samples are needed to confirm these data.     

Multisystem resiliency moderates the major depression–Telomere length association: Findings from the Heart and Soul Study

Major depressive disorder (MDD) has been associated with reduced leukocyte telomere length (LTL). It is not known, however, whether psychosocial and behavioral protective factors moderate this association. In the current study, we examine whether multisystem resiliency – defined by healthy emotion regulation, strong social connections, and health behaviors (sleep and exercise) – predicts LTL and mitigates previously demonstrated associations between depression diagnosis and LTL. LTL was measured, using a quantitative PCR assay, in 954 patients with stable cardiovascular disease in the Heart and Soul Study. In a fully adjusted model, high multisystem resiliency predicted longer LTL (b = 80.00, SE = 27.17, p = .003), whereas each individual factor did not. Multisystem resiliency significantly moderated the MDD-LTL association (p = .02). Specifically, MDD was significantly related to LTL at 1 SD below the mean of multisystem resiliency (b = −142.86, SE = 56.46, p = .01), but not at 1 SD above the mean (b = 49.07, SE = 74.51, p = .51). This study suggests that MDD associations with biological outcomes should be examined within a psychosocial–behavioral context, because this context shapes the nature of the direct relationship. Further research should explore the cognitive, neural, and other physiological pathways through which multisystem resiliency may confer biological benefit.     

Dose response relationship between plasma ACTH and cortisol after the infusion of ACTH1–24

Summary The authors examined the dose response relationship between plasma ACTH and cortisol concentrations after the administration of various doses of ACTH_1–24 (0.025 g, 0.125 g, 0.25 g, 1 g, 250 g) in dexamethasone-suppressed normal volunteers. A logarithmic dose-response relationship between the dose of ACTH administered and plasma cortisol concentration was found. Although there was considerable variability in plasma ACTH concentrations, there was, however, a definite correlation between area under the curve for ACTH and area under the curve for cortisol after the various doses of ACTH.     

High-sensitivity C-reactive protein in stroke patients – The importance in consideration of influence of multiple factors in the predictability for disease severity and death

High sensitivity C-reactive protein (hsCRP) has been evaluated as a biomarker in stroke and relevant pathological diseases. While its predictive values in several pathological phenotypes have been confirmed, controversy exists among different studies. This review summarizes reports of the predictive values of hsCRP for the diagnosis, etiology, prognosis and mortality of stroke diseases. The current literature suggests that CRP expression is influenced by multiple factors, such as polymorphisms, the genomic backgrounds and gender. However, few reported studies analyzed data based on all these multiple factors. Future studies should focus on comprehensive analysis based on multiple factors.     

The relationship between obsessive-compulsive disorder and anxiety disorders: A question of diagnostic boundaries or simply severity of symptoms?

BackgroundA growing number of studies are questioning the validity of current DSM diagnoses, either as “discrete” or distinct mental disorders and/or as phenotypically homogeneous syndromes. In this study, we investigated how symptom domains in patients with a main diagnosis of obsessive-compulsive disorder (OCD), panic disorder (PD) and social anxiety disorder (SAD) coaggregate. We predicted that symptom domains would be unrelated to DSM diagnostic categories and less likely to cluster with each other as severity increases.MethodsOne-hundred eight treatment seeking patients with a main diagnosis of OCD, SAD or PD were assessed with the Dimensional Obsessive-Compulsive Scale (DOCS), the Social Phobia Inventory (SPIN), the Panic and Agoraphobia Scale (PAS), the Anxiety Sensitivity Index-Revised (ASI-R), and the Beck Depression and Anxiety Inventories (BDI and BAI, respectively). Subscores generated by each scale (herein termed “symptom domains”) were used to categorize individuals into mild, moderate and severe subgroups through K-means clusterization and subsequently analysed by means of multiple correspondence analysis.ResultsBroadly, we observed that symptom domains of OCD, SAD or PD tend to cluster on the basis of their severities rather than their DSM diagnostic labels. In particular, symptom domains and disorders were grouped into (1) a single mild “neurotic” syndrome characterized by multiple, closely related and co-occurring mild symptom domains; (2) two moderate (complicated and uncomplicated) “neurotic” syndromes (the former associated with panic disorder); and (3) severe but dispersed “neurotic” symptom domains.ConclusionOur findings suggest that symptoms domains of treatment seeking patients with OCD and anxiety disorders tend to be better conceptualized in terms of severity rather than rigid diagnostic boundaries.