Stability and treatment outcome of distinct classes of mania

BACKGROUND: Psychopathological heterogeneity in manic syndromes may in part reflect underlying latent classes with characteristic outcome patterns. Differential treatment course and outcome after 12 weeks of treatment were examined for three distinct classes of patients with acute mania in bipolar disorder. SUBJECTS AND METHODS: Three thousand four hundred and twenty-five patients with acute mania were divided into three distinct mania classes: 'Typical', 'Psychotic' and 'Dual' (i.e. comorbid substance use) mania. Persistence of class differences and social outcomes were examined, using multilevel regression analyses and odds ratios. RESULTS: The three classes showed substantial stability post-baseline in the pattern of associations with class-characteristic variables. Psychotic and Dual mania predicted poorer outcome in terms of psychosis comorbidity and overall bipolar and mania severity, while Dual mania additionally predicted poorer outcome of alcohol and substance abuse. Worse social outcomes were observed for both Dual and Psychotic mania. CONCLUSION: The identified distinct classes are stable and associated with differential treatment outcome. Overall, Dual and Psychotic mania show less favourable outcomes compared to Typical mania. These findings additionally give rise to concern on the generalisability of randomized clinical trials RCTs.     

Subjective neuroleptic response and treatment outcome under open and double-blind conditions — A preliminary report

Pi Edmond, John Sramek, Tram Johnson, John Herrera, Chris Heh, Jerome Costa, Neal Cutler and Jambur Ananth: Subjective Neuroleptic Response and Treatment Outcome Under Open and Double-Blind Conditions: A Preliminary Report. Prog. Neuro-Psychopharmacol. & Biol. Psychiat. 1990, : 921–928.

1. 1. A patient's early subjective response to a neuroleptic was recorded in 17 schizophrenic patients following a fixed dose of neuroleptic under both open and double-blind placebo-controlled conditions.

2. 2. High correlations were found between a patient's subjective response at 2.5, 24 and 48 hours after the initial dose, suggesting that the timing of the initial subjective response rating is not critical.

3. 3. The relationship between the psychiatric improvement and subjective response was not significant under double-blind conditions (r = 0.004), while the relationship under the open condition showed a trend towards significance comparable to earlier reports (r = 0.32).

4. 4. The findings question the usefulness of applying early subjective response to a neuroleptic to predict clinical improvement.

How to improve clinical practice on involuntary hospital admissions of psychiatric patients: Suggestions from the EUNOMIA study

Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients’ rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.     

Early subjective reactions predicting the outcome of hospital treatment in depressive patients

Early statements by 41 depressive inpatients about a subjective change in their condition and about their attitude to proposed treatment were examined. These statements, made on the day after admission, were found to correlate with the outcome of the treatment. It was found that early subjective reactions can indicate to some extent, not only the result of hospital treatment for depressive symptoms, but also the outcome measured by objective and subjective criteria, after a 3 to 4 month follow-up.     

Effect of COMT Val158Met polymorphism on personality traits and educational attainment in a longitudinal population representative study

The COMT Val158Met polymorphism has been associated with anxiety and affective disorders, but its effect on anxiety-related personality traits varies between studies. Our purpose was to investigate the effect of COMT Val158Met on personality traits from adolescence to young adulthood in a population representative Caucasian birth cohort. Also its association with educational attainment and anxiety and mood disorders by the age 25 were examined. This analysis is based on the older cohort of the Estonian Children Personality Behavior and Health Study (original number of subjects 593). The personality traits were assessed when the participants were 15, 18 and 25 years old. COMT Val158Met had an effect on Neuroticism in females by age 25 (p = 0.001, Bonferroni-corrected for five traits), whereas female Val homozygotes scored the highest. In addition, the Conscientiousness scores of subjects with Val/Val genotype were decreasing in time, being the lowest by the age 25 (p = 0.006, Bonferroni-corrected for five traits). By the age 25, males with the Val/Met genotype had mainly secondary or vocational education, whereas female heterozygotes mostly had obtained or were obtaining university education. COMT Val158Met was not associated with anxiety or mood disorders in either gender. These results suggest that genes affecting dopamine system are involved in the development of personality traits and contribute to educational attainment.     

School-related social support and subjective well-being in school among adolescents: The role of self-system factors

This 6-week longitudinal study aimed to examine a moderated mediation model that may explain the link between school-related social support (i.e., teacher support and classmate support) and optimal subjective well-being in school among adolescents (n = 1316). Analyses confirmed the hypothesized model that scholastic competence partially mediated the relations between school-related social support and subjective well-being in school, and social acceptance moderated the mediation process in the school-related social support--> subjective well-being in school path and in the scholastic competence--> subjective well-being in school path. The findings suggested that both social contextual factors (e.g., school-related social support) and self-system factors (e.g., scholastic competence and social acceptance) are crucial for adolescents' optimal subjective well-being in school. Limitations and practical applications of the study were discussed.     

Predicting outcome of neuroleptic treatment on the basis of subjective response and early clinical improvement

The predictive value of the subjective response after 4 hours to an oral test dose of haloperidol and the predictive value of early clinical improvement during a 28-day, fixed-dose regimen with haloperidol were tested in 33 newly admitted schizophrenic patients. A significant (p less than .01) correlation was found between subjective response and therapeutic outcome on Day 28. Five of the 7 patients with dysphoric responses to the test dose had poor therapeutic outcomes. Powerful relationships were found between therapeutic outcome on Day 28 and clinical improvement observed from Day 2 on and between the outcome at discharge and improvement measured on Days 5 and 6.     

Characteristics and post-hospital perceptions of patients refusing inpatient treatment in a South African general hospital psychiatric unit

This paper explores characteristics and post-hospital perceptions of patients who refused general hospital psychiatric inpatient treatment in a relatively young unit. It was found that after an initial significant increase of up to 9.6% per year in these patients, the average for the 6-year period studied was 6.2% of all admissions. Most of the patients were single or divorced, not gainfully employed, refused hospital inpatient treatment within the first day after admission and were significantly younger than the controls. Substance use, adjustment and personality disorders predominated, and most of the patients were dissatisfied with some aspect of their treatment. Less than half the patients had a positive attitude towards at least one staff member. Results are discussed within the context of understanding the decision of such patients, in an attempt to deal with the problem and with reference to a consultation-liaison approach.     

Dimensions of adolescent subjective social status within the school community: Description and correlates

School pupils strive to meet both school-defined and social goals, and the structure of adolescent self-concept is multidimensional, including both academic and non-academic self-perceptions. However, subjective social status within the school community has been represented as a single dimension. Scottish 15-year olds participating in a school-based survey (N = 3194) rated their own status, compared to their school year-group, via images of seven 10-rung ladders. These generated a very high response rate, and factor analysis distinguished three dimensions: (1) ladders representing “popular”, “powerful”, “respected”, “attractive or stylish” and “trouble-maker”; (2) “doing well at school” and “[not] a trouble-maker”; and (3) “sporty”. Unique relationships with variables representing more objective and/or self-report behavioural measures suggest these dimensions are markers of “peer”, “scholastic” and “sports” status. These analyses suggest multiple dimensions of adolescent social hierarchy can be very simply measured and contribute towards the development of more robust instruments within this area.     

The school behaviors of children in three psychiatric treatment settings: An outpatient clinic,a day hospital,and an inpatient hospital

Compares teachers' ratings of the school behaviors of children entering an outpatient clinic, a day psychiatric program, and an inpatient psychiatric hospital. Many of the ratings did not discriminate among the three groups. Children starting outpatient versus day treatment were rated as higher in aggression, anxiety, and hostile withdrawal, and children beginning outpatient and day treatment versus inpatient treatment, were reported as more skilled socially.     

Attachment characteristics and treatment outcome following inpatient psychotherapy: Results of a multisite study

Abstract

Existential suffering may contribute to treatment-resistant depression. The “VITA” treatment model was designed for such patients with long-standing depression accompanied by existential and/or religious concerns. This naturalistic effectiveness study compared the VITA model (n = 50) with a “treatment as usual” comparison group (TAU; n = 50) of patients with treatment-resistant depression and Cluster C comorbidity. The TAU patients were matched on several characteristics with the VITA patients. The VITA model included existential, dynamic, narrative and affect-focused components. The VITA group had significantly greater improvement on symptom distress and relational problems during treatment and from pre-treatment to 1-year follow-up. Patients in the VITA, at follow-up, were more likely to be employed and less likely be using psychotropic medications.     

Reduction of subjective distress in CBT for childhood OCD: Nature of change,predictors, and relation to treatment outcome

Little research has investigated changes in subjective distress during cognitive-behavioral therapy (CBT) for anxiety disorders in youth. In the current study, 40 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age = 11.9 years, 60% male, 80% Caucasian) and 36 parent informants completed separate weekly ratings of child distress for each OC symptom during a 12-session course of CBT. Between-session changes in distress were calculated at the start of, on average throughout, and at the end of treatment. On average throughout treatment, child- and parent-reported decreases in child distress were significant. Baseline OCD severity, functional impairment, and internalizing symptoms predicted degree of change in child distress. Additionally, greater decreases in child distress were predictive of more improved clinical outcomes. Findings advance our understanding of the strengths and limitations of this clinical tool. Future studies should examine youth distress change between and within CBT sessions across both subjective and psychophysiological levels of analysis.     

高师贫困生自尊、自我效能感与主观幸福感的关系研究

目的探讨高师贫困生自尊、自我效能感与主观幸福感的关系,为高师院校心理健康教育提供依据。方法采用自尊量表、一般自我效能感量表、生活满意度量表、快乐感量表对218名贫困生和216名非贫困生进行测查。结果（1）高师贫困生的自尊、生活满意度、正性情感显著低于非贫困生,自我效能感、负性情感差异不显著。（2）自尊、自我效能感与主观幸福感显著相关。（3）不同自尊、不同自我效能感的高师贫困生主观幸福感的差异显著。（4）自尊、自我效能感对生活满意度、正性情感具有一定的预测力,自尊对负性情感具有预测作用。结论贫困生自尊、主观幸福感相对较低,自尊、自我效能感能显著预测主观幸福感。     

Effects of group art therapy combined with breath meditation on the subjective well-being of depressed and anxious adolescents

The purpose of this study is to investigate the effects of group art therapy, including breath meditation, on the subjective well-being of depressed and anxious youngsters. The subjects were 24 first-grade students at high school in a urban city (Daegu) of South Korea. The art therapy program was implemented in 13, 80-min sessions, held once or twice a week from September 28, 2010 to February 2011. The study tool was the subjective well-being scale of Han (1997), which was adapted from the subjective well-being scale of Campbell, Converse, and Rodgers (1976). The data were analyzed using SPSS WIN 18.0. To determine the homogeneity of the pre-test results, one-way analysis of variance (ANOVA) was performed. To analyze effect of subjective well-being, two-way repeated measures ANOVA was performed. Scores were significantly higher in experimental group 1 (who experienced art therapy combined with breath meditation) and 2 (who experienced only art therapy), than in the control group (who received no therapy). Scores were significantly higher in group 1 than in group 2. The results were the same in the follow-up test, which indicated the durability of the effects.     

The physiological response to Trier Social Stress Test relates to subjective measures of stress during but not before or after the test

The Trier Social Stress Test (TSST) is an effective psychosocial laboratory protocol for inducing stress in humans and has been used in numerous research studies. The stressor leads to a physiological response of the hypothalamus-pituitary-adrenal axis (HPAA) and the autonomous nervous system (ANS). Common biomarkers are cortisol levels and heart rate. In addition to the physiological stress response, the TSST also triggers a psychological response such as an increase in perceived stress, anxiety and emotional insecurity. Whereas HPA and ANS measures can easily be obtained for the TSST period itself, psychological measures are usually determined prior to (baseline) and after the TSST. This may exclude information of the stressful event itself. In the present study, we assessed perceived stress, anxiety and emotional insecurity before, during and after the TSST using visual analogue scales. In addition, cortisol levels and heart rates were assessed. Data of 260 healthy non-smoking males aged 16-60 yrs were used for analyses. Our results show that stress perception, anxiety and emotional insecurity were significantly higher during the TSST as compared to post-TSST ratings. Furthermore, our results suggest a covariance of the psychological stress response during the TSST and the physiological stress responses (cortisol and heart rate) for stress perception though the explained variance was small. This observation was not found for pre- and post-TSST ratings suggesting that assessing psychological stress measures during the stressor itself present a more informative measure of the stress response.     

The cortisol awakening response in relation to objective and subjective measures of waking in the morning

Studies of the salivary cortisol awakening response (CAR) may be confounded by delays between waking in the morning and obtaining the 'waking' salivary sample. We used wrist actigraphy to provide objective information about waking time, and studied the influence of delays in taking the waking sample on the CAR. Eighty-three men and women (mean age 61.30 years) who were referred to hospital with suspected coronary artery disease were studied. Saliva samples were obtained on waking and 15 and 30 min later. The mean interval between waking defined by actigraphy and reported waking time was 6.12+/-(S.D.) 14.8 min, with 55.4% having no delay. The waking saliva sample was obtained an average 5.78+/-15.0 min after self-reported waking, and 12.24+/-20.3 min after objective waking. The waking cortisol value was significantly higher in participants who had a delay between waking and sampling >15 min (mean 14.46+/-6.34 nmol/l) than in those with zero (mean 10.45+/-6.41 nmol/l) or 1-15 min delays (mean 11.51+/-5.99 nmol/l, p=0.043). Cortisol did not increase between 15 and 30 min after waking in those who delayed >15 min. There were no differences in CAR between participants with zero and 1-15 min delays from objectively defined waking to reported sample times. A small proportion (14.7%) of participants who did not delay saliva sampling showed no increase in cortisol over the 30 min after waking. These CAR nonresponders did not differ from the remainder on sleep patterns, waking time, clinical or medication characteristics, but were more likely to be of higher socioeconomic status (p=0.009). We conclude that long delays between waking and obtaining 'waking' cortisol samples will lead to misleading CAR results, but that delays up to 15 min may not be problematic. A small minority of individuals do not show a positive CAR despite not delaying saliva sampling after waking.