Sleep disturbances in schizophrenia spectrum and bipolar disorders – a transdiagnostic perspective

BackgroundSleep disturbances are prevalent in severe mental disorders but their type and frequency across diagnostic categories has not been investigated in large scale studies.MethodsParticipants with Schizophrenia spectrum disorders (SCZ, (N = 617)), Bipolar disorders (BD, (N = 440)), and Healthy Controls (HC, (N = 173)) were included in the study. Sleep disturbances (insomnia, hypersomnia and delayed sleep phase) were identified based on items from the Inventory of Depressive Symptoms – Clinician rated scale. Clinical symptoms were assessed with the Positive and Negative Syndrome scale and level of functioning with the Global assessment of Functioning scale.ResultsThe rate of any sleep disturbance was 78% in SZ, 69% in BD and 39% in HC. Insomnia was the most frequently reported sleep disturbance across all groups. Both diagnostic groups reported significantly more of any sleep disturbances than HC (P < 0.001). Having a sleep disturbance was associated with more severe negative and depressive symptoms and with lower functioning across diagnostic groups (P < 0.001, η² = 0.0071). Hypersomnia was the only sleep disturbance associated with previous treatment history.ConclusionSleep disturbances, including insomnia, hypersomnia and delayed sleep phase, are frequent in SCZ and BD, and associated with more severe clinical symptomatology across diagnostic groups. This suggests that sleep disturbance is a clinically relevant transdiagnostic phenomenon.     

Language proficiency and mental disorders among migrants: A systematic review

BackgroundIn this review, we aimed to evaluate the association between language proficiency (LP) and the prevalence and severity of mental disorders in migrants. Secondarily, we aimed to consider whether sociodemographic and migration-related factors may affect the correlation between LP and mental disorders.MethodsMEDLINE, PsycArticles, EMBASE, and PsycInfo were systematically searched in April 2020 to identify original studies reporting prevalence of psychiatric symptoms or disorders among migrants and taking into account linguistic factors.ResultsThe search of electronic databases initially yielded 1,944 citations. Of the 197 full texts assessed for eligibility, 41 studies were selected for inclusion in the systematic review. Thirty-five of the papers included reported a significant negative association between low LP and prevalence and/or severity of psychiatric symptoms or disorders, whereas only two records found the opposite relationship and four papers reported no association between them. Inadequate LP was consistently associated with several mental disorders in migrants, including psychotic, mood, anxiety, and post-traumatic stress disorders. Notably, all the four longitudinal studies that met inclusion criteria for this review reported a positive effect of LP acquisition over time on prevalence or symptom severity of mental disorders.ConclusionsEven though larger prospective studies are needed to better evaluate the relationship between LP and psychiatric disorders among migrants, we believe that the present findings could be inspiring for authorities to provide support and courses to improve migrants’ language proficiency upon arrival.     

Turning the UPPS down: Urgency predicts treatment outcome in a partial hospitalization program

BackgroundImpulsivity in response to negative mood (negative urgency) and positive mood (positive urgency) is common in psychiatric disorders. The aims of this study were to test if urgency predicts treatment response during partial hospitalization in a transdiagnostic sample, and if urgency is malleable over the course of brief treatment.MethodParticipants (N = 348, 55% female, M age = 32.9) were patients presenting to a CBT-based partial hospitalization program. Urgency and a range of symptoms were assessed with self-report measures during treatment.ResultsHigher negative urgency scores predicted worse outcome for depression and anxiety symptoms. Negative urgency (p < .001, Cohen's d_z = 0.61) and positive urgency (p < .001, Cohen's d_z = 0.39) significantly decreased during treatment.DiscussionFindings suggest that participants report decreases in urgency during brief partial hospitalization treatment. Higher negative urgency predicted poorer treatment response for symptoms of depression and anxiety, demonstrating the need for novel treatments for urgency.     

Psychometric properties of the Repetitive Thinking Questionnaire in a clinical sample

Repetitive negative thinking (RNT) is thought to contribute to the maintenance of many emotional disorders. Although several measures of RNT are available, the items of most of these instruments index RNT that is specific to particular diagnostic groups (e.g., RNT about depression symptoms). This has limited our ability to examine the relevance of RNT across diagnostic groups and advance our understanding of RNT as a transdiagnostic process. This study evaluated the psychometric properties of the Repetitive Thinking Questionnaire (RTQ), a transdiagnostic measure of RNT. In a clinical sample of individuals with anxiety and depressive disorders (N = 186), the RTQ demonstrated good internal consistency, convergent, and divergent validity. Supporting the transdiagnostic nature of the measure, the Repetitive Negative Thinking subscale of the RTQ was associated with a variety of negative emotions and metacognitive beliefs, and significantly predicted symptoms of multiple disorders when controlling for neuroticism. Our findings support the use of the RTQ as a transdiagnostic, trans-emotional measure of maladaptive repetitive thought following distressing events, with scope to increase efficiency and reduce burden on patients by assessing RNT in clinical settings with one short measure. Experimental and longitudinal research identifying mechanisms driving RNT using the RTQ would be informative for theory and treatment developments.     

Gambling problem severity and psychiatric disorders among Hispanic and white adults: findings from a nationally representative sample

Objective

To examine differences in the associations of gambling problem severity and psychiatric disorders among a nationally representative sample of Hispanic and white adults.

Method

Chi-square tests and multinomial logistic regression analyses were performed on data obtained from the National Epidemiologic Survey on Alcohol and Related Conditions from 31,830 adult respondents (13% Hispanic; 87% white), who were categorized according to three levels of gambling problem severity (i.e., no gambling or low-frequency gambling [NG], low-risk or at-risk gambling [LRG], problem or pathological gambling [PPG]).

Results

Hispanic respondents in comparison to white respondents were more likely to exhibit PPG. Problem gambling severity was associated with past-year Axis I and lifetime Axis II psychiatric disorders in both Hispanic and white respondents, with the largest odds typically observed in association with the most severe gambling pathology. A stronger relationship between subsyndromal gambling and a broad range of Axis I disorders (mood, anxiety and substance use disorders) and Axis II disorders (particularly cluster B) was observed in Hispanic respondents as compared to white ones.

Conclusions

Levels of problem gambling severity are associated with the prevalence of Axis I and Axis II psychiatric disorders in both Hispanics and whites. Differences in the patterns of co-occurring disorders between subsyndromal levels of gambling in Hispanic and white respondents indicate the importance of considering ethnicity/race-related factors related to subthreshold levels of gambling in developing improved mental health prevention and treatment strategies.     

Three-year follow-up of older schizophrenics: extrapyramidal syndromes, psychiatric symptoms, and ventricular brain ratio.

Longitudinal evaluation of psychiatric patients often yields information that cross-sectional study does not. We previously examined 31 older (age greater than 55) chronic schizophrenics for prevalence of extrapyramidal side effects, severity of psychiatric symptoms, and ventricular brain ratio (VBR). We reexamined 22 of these patients after 2-4 years. Tardive dyskinesia (TD) and drug-induced parkinsonism (DIP) were common (mean prevalences were 52% and 62%, respectively) and often occurred together (38%). The overall prevalences of the disorders did not change significantly with time, although there was some individual fluctuation in diagnosis. Severity of TD was constant, but severity of DIP decreased, probably because neuroleptic doses were significantly decreased. Magnitude of DIP was positively correlated with VBR and severity of negative symptoms of schizophrenia. The correlation of DIP and negative symptoms occurred primarily because of the similarity between masked facies and blunted affect. VBR did not change over the follow-up period. Negative symptoms of schizophrenia were prevalent, moderately severe, and quite stable over time in this cohort. Positive symptoms were less severe but highly variable between examinations.     

Psychopathological Syndromes Across Affective and Psychotic Disorders Correlate With Gray Matter Volumes

IntroductionMore than a century of research on the neurobiological underpinnings of major psychiatric disorders (major depressive disorder [MDD], bipolar disorder [BD], schizophrenia [SZ], and schizoaffective disorder [SZA]) has been unable to identify diagnostic markers. An alternative approach is to study dimensional psychopathological syndromes that cut across categorical diagnoses. The aim of the current study was to identify gray matter volume (GMV) correlates of transdiagnostic symptom dimensions. MethodsWe tested the association of 5 psychopathological factors with GMV using multiple regression models in a sample of N = 1069 patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for MDD (n = 818), BD (n = 132), and SZ/SZA (n = 119). T1-weighted brain images were acquired with 3-Tesla magnetic resonance imaging and preprocessed with CAT12. Interactions analyses (diagnosis × psychopathological factor) were performed to test whether local GMV associations were driven by DSM-IV diagnosis. We further tested syndrome specific regions of interest (ROIs). ResultsWhole brain analysis showed a significant negative association of the positive formal thought disorder factor with GMV in the right middle frontal gyrus, the paranoid-hallucinatory syndrome in the right fusiform, and the left middle frontal gyri. ROI analyses further showed additional negative associations, including the negative syndrome with bilateral frontal opercula, positive formal thought disorder with the left amygdala-hippocampus complex, and the paranoid-hallucinatory syndrome with the left angular gyrus. None of the GMV associations interacted with DSM-IV diagnosis. ConclusionsWe found associations between psychopathological syndromes and regional GMV independent of diagnosis. Our findings open a new avenue for neurobiological research across disorders, using syndrome-based approaches rather than categorical diagnoses.     

Emotional distress tolerance across anxiety disorders

Emotional distress tolerance (EDT) has increasingly been recognized as a transdiagnostic vulnerability factor. However, research assessing EDT in anxiety disorder populations is lacking. The current study addressed this gap in the literature by examining EDT in a sample of outpatients with panic, social anxiety, generalized anxiety, or obsessive compulsive disorders (n = 674), and by assessing its relationship to symptom severity and impairment. Results showed that poor EDT was common across diagnostic groups. However, correlation and regression analyses suggested that although EDT was associated with symptom severity and impairment, it did not account for unique variance in scores beyond the effect of negative affect, stress, intolerance of uncertainty (IU) and anxiety sensitivity (AS). IU and AS had a stronger relationship with overall symptom severity and impairment in the regression models. Together, findings suggest that although EDT may be transdiagnostic, IU and AS are more relevant to our understanding of anxiety disorders.     

Self-esteem in adults with Tourette syndrome and chronic tic disorders: The roles of tic severity,treatment, and comorbidity

BackgroundTourette syndrome (TS) and chronic tic disorders (CTD) are stigmatizing disorders that may significantly impact self-esteem. Alternatively, comorbid psychiatric illnesses may affect self-esteem more than tics themselves. Extant research on self-esteem in TS/CTD is limited, has inconsistently examined the effect of comorbidities on self-esteem, and yields mixed findings.MethodThis study aimed to clarify the roles of tics versus comorbid diagnoses on self-esteem in a large, carefully diagnosed sample of adults with TS/CTD (N = 122) receiving 10 weeks of Comprehensive Behavioral Intervention for Tics (CBIT) or Psychoeducation and Supportive Therapy (PST).ResultsBaseline self-esteem did not differ between adults with TS/CTD only and normative means, whereas self-esteem was significantly lower among adults with TS/CTD with a comorbid psychiatric illness. In a multiple regression testing the baseline association between tic severity, presence of comorbid psychiatric illness, and depression severity with self-esteem, comorbidity and depression severity were significantly associated with self-esteem, whereas tic severity was not. Finally, using a generalized linear model, we tested the effects of treatment assignment, comorbidity, and their interaction on changes in self-esteem across treatment, controlling for baseline depression severity. Results showed that for those with a comorbid illness, self-esteem improved significantly more with CBIT than with PST.ConclusionsComorbid illnesses appear to affect self-esteem more so than tics among adults with TS/CTD. Therapeutic attention should be paid to treating comorbid diagnoses alongside tics when treating TS/CTD.     

Intolerance of uncertainty and transdiagnostic group cognitive behavioral therapy for anxiety

BackgroundRecent evidence suggests intolerance of uncertainty (IU) is a transdiagnostic variable elevated across anxiety disorders. No studies have investigated IU’s response to transdiagnostic group CBT for anxiety (TGCBT). This study evaluated IU outcomes following TGCBT across anxiety disorders.Methods151 treatment-seekers with primary diagnoses of social anxiety disorder, panic disorder, or GAD were evaluated before and after 12 weeks of TGCBT and completed self-report questionnaires at pre-, mid-, and post-treatment.ResultsIU decreased significantly following treatment. Decreases in IU predicted improvements in clinical presentation across diagnoses. IU interacted with time to predict improvement in clinical presentation irrespective of primary diagnosis. IU also interacted with time to predict improvement in clinical presentation although interactions of time with diagnosis-specific measures did not. IUS interacted with time to predict reduction in anxiety and fear symptoms, and inhibitory IU interacted with time to predicted reductions in anxiety symptoms but prospective IU did not.ConclusionIU appears to be an important transdiagnostic variable in CBT implicated in both initial presentation and treatment change. Further implications are discussed     

Objective sleep disturbances are associated with greater waking resting-state connectivity between the retrosplenial cortex/hippocampus and various nodes of the default mode network

BackgroundPsychological models highlight the bidirectional role of self-referential processing, introspection, worry and rumination in the development and maintenance of insomnia; however, little is known about the underlying neural substrates. Default mode network (DMN) functional connectivity has been previously linked to these cognitive processes.MethodsWe used fMRI to investigate waking DMN functional connectivity in a well-characterized sample of patients with primary insomnia (PI) and good sleeper controls.ResultsWe included 20 patients with PI (8 men and 12 women, mean age 42.7 ± 13.4 yr) and 20 controls (8 men and 12 women, mean age 44.1 ± 10.6 yr) in our study. While no between-group differences in waking DMN connectivity were observed, exploratory analyses across all participants suggested that greater waking connectivity between the retrosplenial cortex/hippocampus and various nodes of the DMN was associated with lower sleep efficiency, lower amounts of rapid eye movement sleep and greater sleep-onset latency.LimitationsOwing to the cross-sectional nature of the study, conclusions about causality cannot be drawn.ConclusionAs sleep disturbances represent a transdiagnostic symptom that is characteristic of nearly all psychiatric disorders, our results may hold particular relevance to previous findings of increased DMN connectivity levels in patients with psychiatric disorders.     

Brief report: Correlates of inpatient psychiatric admission in children and adolescents with eating disorders

ObjectiveTo examine the prevalence and importance of psychological, behavioural, and situational correlates of impending psychiatric inpatient admissions in children and adolescents with eating disorders.MethodThe sample consisted of 285 patients (8–17 years, M = 14.4, SD = 1.49) with DSM-5 eating disorders assessed between 2006 and 2013 from the Helping to Outline Pediatric Eating Disorders (HOPE) Project. The sample was split into two groups, those with (n = 38) and without (n = 247) impending psychiatric admission; Discriminant function analysis was used to examine correlates.ResultsThe prevalence of impending psychiatric admission was 13.3%. Suicidal ideation provided the greatest discriminating power, followed by eating pathology, depressive symptoms, anxiety, multiple methods of weight control, binge eating, and family functioning.ConclusionsEarlier recognition of comorbid symptoms in eating disorders in the community may reduce the number of young people with eating disorders who present needing critical psychiatric care.     

Dyadic analyses on the prospective association between birth experience and parent-child-bonding: The role of postpartum depression,anxiety, and childbirth-related posttraumatic stress disorder

ObjectiveNegative birth experiences are associated with postpartum mental health difficulties in parents. However, research considering the long-term impact of a negative birth experience on parent-child-bonding and the interdependence between parents is rare. This study aimed to investigate actor as well as partner effects for the association between parents’ birth experience and parent-child-bonding and whether this association is mediated by postpartum psychiatric symptoms.MethodA community sample of couples (N = 743) completed questionnaires during pregnancy, 2, and 14 months after birth.ResultsApplying Actor-Partner Interdependence Mediation Models, structural equation modeling showed that parents’ own negative birth experience predicted a poorer bond to their child 14 months postpartum. Compared to mothers, this association was twice as strong for partners and was mediated by symptoms of postpartum depression (mothers and partners), anxiety (partners), and childbirth-related posttraumatic stress disorder (mothers). Negative birth experiences of one parent were not related to the other parent’s bonding with the child.ConclusionResults underline the importance of parents’ positive birth experience for their postpartum mental health and secure bond to their child. The other parent’s birth experience or postpartum mental health does not seem to affect one’s own bond to the child in the long term.     

Effects of a transdiagnostic group treatment for anxiety on secondary depression

Researchers have recently explored transdiagnostic anxiety treatments based on models of anxiety emphasizing a single common pathway across diagnostic categories. Results from a previous study [Norton and Hope, in press] indicated that a transdiagnostic approach was effective for both targeted and untargeted anxiety disorders. Consistent with the tripartite model, the transdiagnostic treatment should also influence symptoms of a broader pathology such as negative affectivity. This follow-up to Norton and Hope found significant decreases in depressed mood for clients undergoing transdiagnostic treatment for anxiety when compared to wait-list control participants. Although not statistically established, severity of depressive diagnoses seemed to generally decrease across treatment, whereas no change in severity occurred for those not receiving treatment.     

Implementation of transdiagnostic treatment for emotional disorders in residential eating disorder programs: A preliminary pre-post evaluation

Abstract

Objective: Data are lacking from empirically supported therapies implemented in residential programs for eating disorders (EDs). Common elements treatments may be well-suited to address the complex implementation and treatment challenges that characterize these settings. This study assessed the preliminary effect of implementing a common elements therapy on clinician treatment delivery and patient (N?=?616) symptom outcomes in two residential ED programs. Method: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders was adapted to address ED and co-occurring psychopathology and implemented across sites. Therapists’ treatment fidelity was rated independently to assess implementation success. Additionally, longitudinal (pre-post) design compared treatment outcomes among patients treated before and after implementation. Patient outcomes included ED and depressive symptoms, experiential avoidance, anxiety sensitivity, and mindfulness. Results: Following training and implementation, clinicians demonstrated adequate to good fidelity. Relative to pre-implementation, post-implementation patients showed significantly greater improvements in experiential avoidance, anxiety sensitivity, and mindfulness at discharge (ps?≤?.04) Relative to patients who were treated during the pre-implementation phase, patients in the post-implementation phase experienced more favorable outcomes on ED symptom severity, depression, mindfulness, and anxiety sensitivity at 6-month-follow-up (ps ≤ .001). A similar result was observed for experiential avoidance, yet this interaction effect was no longer statistically significant (p = .10) when the time x length of stay effect/covariate was added to the model. Conclusions: Preliminary pilot data support the feasibility of implementing transdiagnostic common elements therapy in residential ED treatment, and suggest that implementation may benefit transdiagnostic outcomes for patients.

Clinical or methodological significance of this article: Limited data are available to guide evidence-based residential treatment for eating disorders. This study represents a unique effort to adapt, implement, and test an evidence-based therapy protocol across a large private network of intensive eating disorder treatment programs.     

Psychiatric symptoms in myoclonus-dystonia syndrome are just concomitant features regardless of the SGCE gene mutation

IntroductionAmong myoclonus-dystonia syndrome (MD) patients, psychiatric disorders including depression, anxiety, alcohol dependence, obsessive-compulsive disorder (OCD) and panic disorder have been frequently reported to be related with the epsilon-sarcoglycan gene (SGCE) mutation. However, the rate of psychiatric disorders has not been compared between MD patients with the SGCE mutation (SGCE (+)) and without the SGCE mutation (SGCE (−)). We analyzed the psychiatric data in both SGCE (+) and SGCE (−) MD patients to determine the association of the SGCE mutation with psychiatric disorders in MD.MethodsTwenty-six MD patients who fulfilled the Grunewald's criteria and underwent a SGCE gene study were enrolled. Patients were divided into two groups according to their SGCE status (SGCE (+) and SGCE (−) group). They were systematically assessed using a standardized protocol including motor severity scales and psychiatric questionnaires for depression, anxiety, alcohol dependence, OCD and panic disorder.ResultsFifteen SGCE (+) and eleven SGCE (−) patients were enrolled. Mean age at onset, disease duration, family history, alcohol responsiveness and motor severity were not different between the SGCE (+) and SGCE (−) group. Although more than half (53.8%) of all the MD patients had psychiatric symptoms, there were no significant differences between the SGCE (+) and SGCE (−) group in terms of their psychiatric questionnaire scores and rate of psychiatric disorders.ConclusionsPsychiatric features are not likely to be related with the SGCE mutation itself but just bespeak disability in clinical MD syndrome regardless of the SGCE mutation.     

Symptômes négatifs de la schizophrénie : une revue des instruments d’évaluation

IntroductionNegative symptoms are a fundamental dimension of schizophrenia despite their limited role in the international diagnostic classification. Although a consensual definition seems to be attempted regarding the main negative dimensions (anhedonia, alogia, social withdrawal, blunted affect, avolition), several standardized assessment scales have been created.ObjectivesThe objective of this study was to identify a set of unidimensional instruments which allows an assessment of negative symptoms in schizophrenia and also to identify their general characteristics and the items included.MethodsInclusion criteria were: (a) the unidimensional assessment scales of negative symptoms of schizophrenia; (b) instruments in English (with French versions if possible); (c) all assessment instruments, the oldest and the most recent. The investigation ended in February 2013.ResultsTwelve unidimensional instruments were identified with only one of them based on a self-administered survey (MAP-SR). The number of items included is from 6 (SDS) to 25 (SANS). The fastest instrument is the HEN (5–10 min) and the longest is the SANS (30 min). The MASS needs an evaluation by another person (family or care-giver). Most instruments need to be handled and take place during a semi-structured or structured psychiatric interview. The SANS allows an assessment of the most important number of negative domains (11 domains). On the other side, we have the MAP-SR (3 domains). The most frequently evaluated domains are emotional blunting, alogia, social withdrawal, anhedonia and avolition. On the other side, we have mood and thought disorders. Only SDS allows to distinguish the primary and secondary negative symptoms.DiscussionThe oldest instruments (SANS, NSA-16, SDS) are more complicated to handle and to use. The SANS is the most complete instrument but there are more recent instruments which are easier to use and handle (BNSS, CAINS). Using a self-evaluation survey, MAP-SR is judicious as this type of evaluation is reliable. However, in this case, the assessment covers only a limited part of the negative symptoms.ConclusionDespite some progress in the definition, assessment and treatment of negative symptoms and despite new scales further instruments which are easy to use in clinical practice and integrating the patient's self-report are needed.     

Autism spectrum symptoms in children with cerebral palsy: Prevalence and co-occurring conditions

PurposeTo explore autism spectrum symptoms in children with cerebral palsy (CP), and the association between autism spectrum symptoms and medical and psychiatric co-morbidity.MethodologyParents of children with CP in a Norwegian population were interviewed with a child psychiatric diagnostic instrument, and completed the Autism Spectrum Screening Questionnaire (ASSQ). Medical and socio-demographic data were obtained. ASSQ mean scores were compared to the Bergen Child Study (BCS), both to healthy controls and to subgroups of children with chronic illness in general, and neurological disorders specifically.ResultsInterviews and data collection were completed for 47 children, of whom 30 were boys, most had spastic CP, and were less severely affected by CP. Large effect sizes were found when comparing ASSQ mean scores in children with CP to children with chronic illnesses and normal controls. One in five children was ASSQ high scorers defined as a score above the 98th percentile of normal controls. A high rate of co-occurring psychiatric disorders, mainly AD/HD, was found in ASSQ high scorers.ConclusionsMore attention should be given to autism spectrum symptoms in the regular follow-up of children with CP in an attempt to enhance social functioning.     

Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders

This study aimed to replicate and extend a hierarchical model of vulnerability to worry, with neuroticism and extraversion as higher-order factors and negative metacognitions and intolerance of uncertainty as second-order factors. The model also included a transdiagnostic measure of repetitive negative thinking (RNT) and depression symptoms as outcome variables to determine whether relationships would extend beyond worry, which has traditionally been studied within the context of generalized anxiety disorder (GAD). Participants (N = 99) were referrals to a specialist anxiety disorders clinic with a principal anxiety disorder who completed a battery of self-report questionnaires assessing neuroticism, extraversion, metacognitions, intolerance of uncertainty, worry, RNT, and depression symptoms. Mediational analyses using bootstrapping provided support for transdiagnostic and diagnosis-specific mediation effects. Negative metacognitions fully mediated the relationship between neuroticism and RNT for the whole sample and for subsamples with and without GAD. Intolerance of uncertainty mediated the relationship between neuroticism and worry (for the whole sample and for those with GAD) and between neuroticism and RNT (for those with GAD). Implications for theory, treatment, and nosology are discussed.