The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE:

Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil.

METHODS:

A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively.

RESULTS:

Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence.

CONCLUSIONS:

Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.     

Multi-type maltreatment in childhood and psychological adjustment in adolescence: questionnaire study among adolescents in Western Herzegovina Canton

Aim

To determine the prevalence and intercorrelation of different forms of childhood maltreatment and psychological problems in adolescents in Western Herzegovina Canton.

Method

A questionnaire study was conducted in March 2003 on a convenient sample of 458 third-grade high-school students (39% boys) aged between 15 and 20 (median age, 17). Data were collected using a sociodemographic questionnaire, Family Adaptability and Cohesion Evaluation Scales III, Child Maltreatment Questionnaire, Youth Self-Report, and Rosenberg Self-Esteem Scale. Sociodemographic and family characteristics and exposure to maltreatment were analyzed as possible predictors of exposure to a particular type of abuse and subsequent psychological adjustment problems.

Results

Out of 458 students, 77% were emotionally abused, 52% physically abused, 30% neglected, 20% witnessed family violence, and 13% of girls and 21% of boys were sexually abused before the age of 14. Significant association between the maltreatment by a mother, father, and other adults were found for emotional and physical abuse and for neglect and witnessing family violence (r = 0.413-0.541, P<0.001 for all). Significant correlation was found between all forms of abuse (r = 0.163-0.594, P<0.05), except between sexual abuse and witnessing family violence (r = 0.048, P = 0.351). Almost two-thirds of students were exposed to multi-type maltreatment in childhood. Family characteristics and maltreatment scores significantly predicted anxiety/depression (R = 0.456, R² = 0.076), withdrawal (R = 0.389, R² = 0.049), somatic complaints (R = 0.437, R² = 0.059), social problems (R = 0.417, R² = 0.063), attention deficit and hyperactivity disorder (R = 0.368, R² = 0.045), rule-breaking behavior (R = 0.393, R² = 0.045), aggression (R = 0.437, R² = 0.078) (P<0.001 for all), as well as self-esteem (R = 0.371, R² = 0.035, P = 0.003).

Conclusion

Most third-grade high-school students in Western Herzegovina Canton were exposed to multi-type maltreatment in childhood, regardless of the war experience. Emotional and physical abuse were most frequently combined forms of maltreatment. Sociodemographic and family characteristics and exposure to some forms of abuse were significant predictors of exposure to other forms of abuse. Exposure to maltreatment in childhood predicted difficulties in psychological adjustment in adolescence.The focus of research on child maltreatment has recently shifted from sexual and physical abuse and physical neglect to different types of psychological maltreatment, including witnessing family violence in childhood (1,2). A growing body of evidence shows that childhood maltreatment takes many different forms, and a significant proportion of maltreated children are exposed not only to repetitive episodes of a single type of maltreatment, but also to multiple forms of maltreatment (3). Individuals who were sexually and physically abused in childhood have lower self-esteem, higher depression level, more psychosexual problems, more trauma symptoms, asocial/antisocial behavior, and poor mental health (3). According to research among adults who were exposed to maltreatment in childhood, multi-type maltreatment is generally associated with greater psychological and emotional impairment than single-type maltreatment (3,4). Individuals who were exposed to a combined physical and psychological maltreatment in childhood have to cope with low self-esteem, dysfunctional sexual behavior, and problems with anger or aggression in adult age (5), as well as higher levels of depression (6). Witnessing family violence is a unique predictor of trauma symptoms and low self-esteem, because it often leads, together with multi-type maltreatment, to anxiety, depression, dissociation, sleeping problems, and sexual dysfunction (3).The role of dysfunctional family background as a cause of adjustment issues in adolescence or adulthood is another increasingly investigated problem. Poor family functioning has been reported as a risk factor for child maltreatment (particularly sexual abuse). The study by Higgins and McCabe (7) showed that family factors in childhood, either independently or in combination with child maltreatment, were associated with adjustment difficulties in adulthood and that family violence during childhood was likely to have negative effects on psychological adjustment in early adulthood. Besides family cohesion, adaptability, and interpersonal relationships, some other family variables have also been found to increase the risk of family maltreatment (7). These include low social status, parental conflicts, parental divorce, living with only one parent, living with a stepfather, long-term absence of one parent before the age of sixteen, parental alcoholism or drug abuse, chronic illness of a parent or other family members, and low parental education (7).The fact that different types of maltreatment often overlap must be taken into account when the adjustment problems associated with one particular type of maltreatment are considered. The same applies to family dysfunction. Furthermore, the impact of child maltreatment, including neglect, should be assessed within the context of the overall family environment. The aims of our study were to determine the prevalence and intercorrelation of different forms of maltreatment in childhood; establish the frequency of maltreatment by the mother, the father, or other adults; and evaluate possible predictors of maltreatment in childhood and consequent psychological adjustment problems in adolescence. The study was performed in Western Herzegovina Canton of Bosnia and Herzegovina because there is no knowledge about the prevalence and type of childhood maltreatment or its psychological consequences in adolescents in this area.     

Sleep Problems and Disorders among Adolescents with Persistent and Subthreshold Attention-deficit/Hyperactivity Disorders

Study Objectives:

To investigate the sleep schedules, problems, and disorders among adolescents with persistent attention-deficit/hyperactivity disorder (ADHD) and those with partially remitted ADHD symptoms.

Design:

A case-control study.

Setting:

National Taiwan University and schools in Taipei

Patients or Participants:

The sample included 281 adolescents (male, 85.4%; 145 with persistent ADHD, 136 with subthreshold ADHD), aged 11 to 17, who were diagnosed with ADHD, according to DSM-IV criteria, at the mean age of 6.7 years (SD = 3.0) and 185 unaffected control subjects.

Interventions:

N/A.

Measurements and Results:

We conducted psychiatric interviews of participants and their mothers using the Chinese Kiddie-Schedule for Affective Disorders and Schizophrenia-Epidemiology version for making the diagnoses of ADHD, other psychiatric disorders, and sleep problems or disorders. We also collected the medication treatment data and parent and teacher reports of ADHD-related symptoms. Our results showed that adolescents with a childhood diagnosis of ADHD according to DSM-IV criteria, regardless of persistent ADHD, were more likely to have current and lifetime sleep problems and sleep disorders according to DSM-IV (insomnia, sleep terrors, nightmares, bruxism, and snoring). The presence of at least 1 psychiatric comorbid condition increased the risks for insomnia and nightmares. The use of methylphenidate was not associated with further increased risk of sleep problems, except bruxism.

Conclusions:

Our findings support a relationship between ADHD and sleep problems, which can be partially explained by the psychiatric comorbidities, but did not support a disturbed sleep schedule. Our study suggests that mental health professionals should screen for sleep problems and psychiatric comorbidities among adolescents with a childhood diagnosis of ADHD regardless of the severity of current ADHD symptoms.

Citation:

Gau SSF; Chiang HL. Sleep problems and disorders among adolescents with persistent and subthreshold attention-deficit/hyperactivity disorders. SLEEP 2009;32(5):671-679.     

Development and evaluation of a brief self-completed family history screening tool for common chronic disease prevention in primary care

Background

Family history is an important risk factor for many common chronic diseases, but it remains underutilised for diagnostic assessment and disease prevention in routine primary care.

Aim

To develop and validate a brief self-completed family history questionnaire (FHQ) for systematic primary care assessment for family history of diabetes, ischaemic heart disease, breast cancer, and colorectal cancer.

Design and setting

Two-stage diagnostic validation study in 10 general practices in eastern England.

Method

Participants aged 18–50 years were identified via random sampling from electronic searches of general practice records. Participants completed a FHQ then had a three-generational ‘gold standard’ pedigree taken, to determine disease risk category. In stage 1, the FHQ comprised 12 items; in stage 2 the shorter 6-item FHQ was validated against the same ‘gold standard’.

Results

There were 1147 participants (stage 1: 618; stage 2: 529). Overall, 32% were at increased risk of one or more marker conditions (diabetes 18.9%, ischaemic heart disease 13.3%, breast cancer 6.2%, colorectal cancer 2.2%). The shorter 6-item FHQ performed very well for all four conditions: pooled data from both stages show diabetes, sensitivity = 98%, specificity = 94%; ischaemic heart disease, sensitivity = 93%, specificity = 81%; breast cancer, sensitivity = 81%, specificity = 83%; colorectal cancer, sensitivity = 96%, specificity = 88%, with an area under the receiver operating characteristic curve of 0.90 for males and 0.89 for females.

Conclusion

This brief self-completed FHQ shows good diagnostic accuracy for identifying people at higher risk of four common chronic diseases. It could be used in routine primary care to identify patients who would be most likely to benefit from a more detailed pedigree and risk assessment, and consequent management strategies.     

Arch height and maximum rearfoot eversion during jogging in 2 static neutral positions

Context:

Clinically, lowering of the medial longitudinal arch is believed to be closely related to rearfoot eversion. However, the relationship between arch height and rearfoot eversion during gait is unclear.

Objectives:

(1) To examine the influence of 2 reference positions (weight-bearing neutral position [WBNP] and subtalar neutral position [STNP]) on maximum rearfoot eversion, tibial internal rotation, knee flexion, knee internal rotation, and dorsiflexion-plantar flexion of ankle joint measures during jogging and (2) to compare the relationships among static arch height, navicular drop, and the 2 maximum rearfoot eversion measures.

Design:

Crossover study.

Setting:

Gait laboratory.

Patients or Other Participants:

Thirty-three volunteers between 18 and 40 years of age.

Intervention(s):

Each participant stood on the treadmill in 2 static positions: WBNP and STNP. Kinematic data were obtained using a 10-camera motion analysis system (120 Hz) when participants jogged at 2.65 m/s on the treadmill in bare feet.

Main Outcome Measure(s):

Rearfoot and shank angular kinematics, navicular drop, and static arch height.

Results:

Maximum rearfoot eversion was greater (WBNP: 4.03° ± 2.58°, STNP: 10.91° ± 5.34°) when STNP was the static reference (P < .001). A strong correlation was seen between maximum STNP eversion and navicular drop (r = 0.842) but not between WBNP and navicular drop (r = 0.216). Differences were noted in dorsiflexion and knee kinematics during gait between the static references; however, the effect sizes were low, and the mean differences were smaller than 2°, which was less than 5% of total excursion during gait.

Conclusions:

Using STNP rather than WBNP as the reference position affects estimates of frontal-plane rearfoot movement but not other ankle or knee motions in jogging.     

Assessments of the associations of thrombus localization with accompanying disorders,risk factors,D-dimer levels,and the red cell distribution width in pulmonary embolism

OBJECTIVE:

Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism.

MATERIAL AND METHODS:

In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841.

RESULTS:

The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches.

CONCLUSION:

Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed.     

Does your childhood define how you sleep and love?

Background

Adverse childhood experiences (ACEs) can lead to worse sleep quality (SQ) and have an impact on relationships. This study examines the role of sleep on the link between ACEs and romantic relationship quality (RRQ). Additionally, the association between ACEs and romantic relationship patterns and nightmares is investigated.

Methods

In a self-assessment questionnaire survey, ACEs as well as romantic relationship (quality, history, orientation) and sleep patterns (quality, nightmares) were assessed in 300 women aged 18–52 years using the Adverse Childhood Experiences Questionnaire, Pittsburgh Sleep Quality Index, Nightmare Effects Questionnaire, Relationship Orientation Questionnaire, and the Relationship Assessment Scale. Demographic data and number of previous romantic relationships were also assessed.

Results

SQ was found to be a significant mediator of the relationship between childhood maltreatment (CM) and RRQ. The prediction of RRQ through ACE becomes smaller and non-significant when impaired SQ is accounted for. Neither a general history of ACEs nor single types of ACEs predict short-term romantic relationship orientation (preference for short- over long-term romantic relationships). However, overall CM, history of sexual abuse, separation of parents, violence against the mother, substance abuse of a household member, and mental disorder of a household member significantly predict more romantic relationships. Heightened nightmare frequency is predicted by emotional neglect and substance abuse of a household member. More daytime effects of nightmares were also predicted by overall CM.

Conclusion

As sleep was found to moderate the link between ACEs and RRQ, therapeutic treatments for CM individuals should target sleep improvement as an important goal. This might not only improve SQ, but also quality of life or romantic relationships.

     

Sociodemographic and substance use correlates of repeated relapse among patients presenting for relapse treatment at an addiction treatment center in Kolkata,India

Background

In India, substance abuse has infiltrated all socio-cultural and economic strata causing loss of productivity. Prevention of relapse is crucial for its control.

Objectives

To find out the pattern of substance use, relapse rate, its association with various socio-demographic factors and treatment related issues.

Methods

An observational study with cross-sectional design during April 2009-March 2010 at a de addiction centre was conducted among consecutive 284 clients admitted with relapse. They were detoxified earlier in the same centre. Data were collected by interviewing clients with schedule and clinical examination.

Results

Brown sugar (an adulterated form of Heroin) was primary drug of abuse in urban area contrary to alcohol in rural area. Commonest age of initiation was between 15–20 years. Polydrug abusers (59.1%) were common. Only 31.3% of the relapse cases took regular follow up. Common psychiatric illnesses were anxiety (44.7%) and depression (30.6%). Peer pressure (77.8%) was commonest cause of relapse. Significantly higher relapse episodes were present with increasing age, Muslim religion, ever marriage, poor literacy, current unemployment, living in nuclear rather than joint family, early age of initiation, longer duration of abuse and no follow up.

Conclusion

Regular follow up with family, peer and social support are essential along with vocational rehabilitation to prevent relapse.     

Carotid stenosis: what is the high-risk population?

OBJECTIVE:

Prevention is the best treatment for cerebrovascular disease, which is why early diagnosis and the immediate treatment of carotid stenosis contribute significantly to reducing the incidence of stroke. Given its silent nature, 80% of stroke cases occur in asymptomatic individuals, emphasizing the importance of screening individuals with carotid stenosis and identifying high-risk groups for the disease. The aim of this study was to determine the prevalence and the most frequent risk factors for carotid stenosis.

METHODS:

A transversal study was conducted in the form of a stroke prevention campaign held on three non-consecutive Saturdays. During the sessions, carotid stenosis diagnostic procedures were performed for 500 individuals aged 60 years or older who had systemic arterial hypertension and/or diabetes mellitus and/or coronary heart disease and/or a family history of stroke.

RESULTS:

The prevalence of carotid stenosis in the population studied was 7.4%, and the most frequent risk factors identified were mean age of 70 years, carotid bruit, peripheral obstructive arterial disease, coronary insufficiency and smoking. Independent predictive factors of carotid stenosis include the presence of carotid bruit or peripheral obstructive arterial disease and/or coronary insufficiency.

CONCLUSIONS:

The population with peripheral obstructive arterial disease and/or coronary insufficiency and carotid bruit should undergo routine screening for carotid stenosis.     

Compensatory sweating after restricting or lowering the level of sympathectomy: a systematic review and meta-analysis

OBJECTIVE:

To compare compensatory sweating after lowering or restricting the level of sympathectomy.

METHOD:

A systematic review and meta-analysis were conducted of all randomized controlled trials published in English that compared compensatory sweating after lowering or restricting the level of sympathectomy. The Cochrane collaboration tool was used to assess the risk of bias, and the Mantel-Haenszel odds ratio method was used for the meta-analysis.

RESULTS:

A total of 11 randomized controlled trials were included, including a total of 1079 patients. Five of the randomized controlled trials studied restricting the level of sympathectomy, and the remaining six studied lowering the level of sympathectomy.

CONCLUSIONS:

The compiled randomized controlled trial results published so far in the literature do not support the claims that lowering or restricting the level of sympathetic ablation results in less compensatory sweating.     

Lifetime psychopathology among the offspring of Bipolar I parents

BACKGROUND:

Recent studies have demonstrated high rates of psychopathology in the offspring of parents with bipolar disorder. The aim of this study was to identify psychiatric diagnoses in a sample of children of bipolar parents.

METHOD:

This case series comprised 35 children and adolescents aged 6 to 17 years, with a mean age of 12.5±2.9 years (20 males and 15 females), who had at least one parent with bipolar disorder type I. The subjects were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime version (K-SADS-PL). Family psychiatric history and demographics were also evaluated.

RESULTS:

Of the offspring studied, 71.4% had a lifetime diagnosis of at least one psychiatric disorder (28.6% with a mood disorder, 40% with a disruptive behavior disorder and 20% with an anxiety disorder). Pure mood disorders (11.4%) occurred less frequently than mood disorders comorbid with attention deficit hyperactivity disorder (17.1%). Psychopathology was commonly reported in second-degree relatives of the offspring of parents with bipolar disorder (71.4%).

CONCLUSIONS:

Our results support previous findings of an increased risk for developing psychopathology, predominantly mood and disruptive disorders, in the offspring of bipolar individuals. Prospective studies with larger samples are needed to confirm and expand these results.     

Multi-type childhood abuse, strategies of coping, and psychological adaptations in young adults

Aim

To retrospectively analyze the rate of multi-type abuse in childhood and the effects of childhood abuse and type of coping strategies on the psychological adaptation of young adults in a sample form the student population of the University of Mostar.

Methods

The study was conducted on a convenience sample of 233 students from the University of Mostar (196 female and 37 male), with a median age of 20 (interquartile range, 2). Exposure to abuse was determined using the Child Maltreatment Scales for Adults, which assesses emotional, physical, and sexual abuse, neglect, and witnessing family violence. Psychological adaptation was explored by the Trauma Symptom Checklist, which assesses anxiety/depression, sexual problems, trauma symptoms, and somatic symptoms. Strategies of coping with stress were explored by the Coping Inventory for Stressful Situations.

Results

Multi-type abuse in childhood was experienced by 172 participants (74%) and all types of abuse by 11 (5%) participants. Emotional and physical maltreatment were the most frequent types of abuse and mostly occurred together with other types of abuse. Significant association was found between all types of abuse (r = 0.436-0.778, P < 0.050). Exposure to sexual abuse in childhood and coping strategies were significant predictors of anxiety/depression (R² = 0.3553), traumatic symptoms (R² = 0.2299), somatic symptoms (R² = 0.2173), and sexual problems (R² = 0.1550, P < 0.001).

Conclusion

Exposure to multi-type abuse in childhood is a traumatic experience with long-term negative effects. Problem-oriented coping strategies ensure a better psychosocial adaptation than emotion-oriented strategies.There is a high degree of overlap between adults’ reports of sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence (1-4). These problems tend to occur together. Children who are ridiculed or subjected to verbal attacks are also likely to be physically punished or harmed, have their physical or emotional needs neglected, and witness violence toward other members of the family. Multi-type abuse can be defined as the concurrent exposure of a child or adult to more types of maltreatment, including sexual abuse, physical abuse, psychological (emotional) abuse, neglect, and witnessing family violence (5).Researchers who study the consequences of multi-type abuse believe that more types of stress experienced by children exposed to various types of abuse and neglect actually accumulate and interact in different ways, thus producing more serious and less reversible consequences than in cases of single-type abuse (2,6-9). Posttraumatic stress disorder is one of the most common immediate consequences of abuse and neglect of children (10). Arata et al (11) have found that persons exposed to multi-type abuse were more depressed and suicidal, and expressed more feelings of helplessness than non-abused persons. Experiencing physical and mental abuse in childhood is associated with low self-esteem (12,13), deviant sexual behavior, difficulties in coping with anger/aggression, and psychosocial malfunctioning in adult age (14). When they reach adult age, victims of childhood sexual or physical abuse have more pronounced psychosocial disorders, chronic somatic symptoms, respiratory and gastrointestinal illnesses, increased risk of developing anxiety and depressive disorder, dissociative and trauma symptoms, as well as antisocial and asocial behavior (1,15,16). Edwards et al (17) have found a relationship between the number of different types of abuse and the consequences on mental health, ie, the more types of abuse a victim had experienced, the more serious were the consequences.Although the concept of coping with stress has been variously defined by different authors, coping can generally be conceived as a response to a stressful situation with the goal of psychosocial adaptation (18). Coping can involve problem-oriented strategies and emotion-oriented strategies. The former refer to attempts by a person to change the stressor, and specific strategies to achieve this are confrontation and planned problem-solving. In contrast, emotion-oriented coping refers to attempts to regulate negative emotional responses to a stressor, with self-control and distancing as specific strategies (19).Stressful life events are the most extensively studied environmental risk factors for the development of psychopathology in children and adolescents. These events can be everyday situations that pose irritating and frustrating demands on the child, events that are expected and desired by the child but that never take place, and intense stressful events such as traumas that are horrifying and very disturbing for the child. Stressful life events can precede various disorders, increase the risk of their occurrence, as well as appear as consequences of such disorders (20).Research on mechanisms that play a mediating role between the stressful events and occurrence of symptoms has yielded equivocal results. A number of variables such as age, sex, type of stressful event, reactions of parents and family, and coping strategies should all be taken into account when trying to answer why some individuals in certain situations react by developing symptoms of psychopathology, while others do not. Despite the complexity of this problem, one thing seems certain: how a child interprets and judges a certain event, and what strategies he or she uses to cope with stressful events, plays a decisive role in predicting future psychopathology (20).Research has still not established a reliable method for differentiating effective and non-effective coping strategies. Some studies indicate that emotion-oriented coping is associated with emotional and behavioral difficulties in children (21,22). At the same time, other researchers have failed to show that problem-oriented and active strategies contribute to the success of psychological adaptation (23,24). Indeed, the effectiveness of coping strategies depends on the specifics of the stressful situation. Strategies effective for one type of stress are not necessarily effective for other types (25).It has been shown that exposure to multi-type abuse in childhood is associated with more serious difficulties in psychological adaptation than exposure to single-type abuse (10-16). The question remains whether various protective factors, such as strategies of coping with stress (26-29), can mediate the psychological adjustment of people who were abused in childhood.The aim of this study was to perform a retrospective study on a sample of students of the University of Mostar, Bosnia and Herzegovina, in order to explore the rate of multi-type abuse in childhood and the effects of the type of childhood abuse and choice of coping strategy on the students’ psychological adaptation.     

Prevalence and Correlates of Frequent Nightmares: A Community-Based 2-Phase Study

Study Objectives:

To determine the prevalence of frequent nightmares and their correlates in a large community-based cohort of middle-aged Hong Kong Chinese.

Design:

A 2-phase design involving a cross-sectional survey of 8558 subjects (men, 47.6%) with a mean age of 40.9 years (SD 5.5, range 20-78) and subsequently followed by a detailed clinical evaluation of the psychopathology and personality profile of 252 subjects.

Setting:

Community.

Interventions:

N/A.

Measurements and Results:

The prevalence of frequent nightmares, as defined by at least once per week, was 5.1%. Female sex, low monthly family income, insomnia symptoms, sleep-disordered breathing symptoms, and sleep-related daytime consequences were significantly associated with nightmare frequency. The risk of having a psychiatric disorder was 5.74 times greater for subjects with frequent nightmares (95% confidence interval 2.03-16.26), especially mood disorders (odds ratio = 15.57, 95% confidence interval 3.77-64.37). After exclusion of concomitant psychiatric morbidities, subjects with frequent nightmares still scored significantly higher on neuroticism in the personality scale (P < 0.05).

Conclusions:

Frequent nightmares were not uncommon in the general population and were associated with a constellation of factors, including sociodemographic characteristics and comorbid sleep and psychiatric disorders. Moreover, frequent nightmares were independently related to the neuroticism personality trait, irrespective of psychiatric diagnosis. Prospective studies should be conducted to investigate various predisposing, precipitating, and perpetuating factors and the associated repercussions of nightmares.

Citation:

Li SX; Zhang B; Li AM; Wing YK. Prevalence and correlates of frequent nightmares: a community-based 2-phase study. SLEEP 2010;33(6):774-780.     

Role of psychiatric disorders and irritable bowel syndrome in asthma patients

OBJECTIVES:

The goals of the study were the following: 1) to determine the frequency of psychiatric disorders and irritable bowel syndrome in patients with asthma and 2) to compare the frequency of these disorders in patients with asthma to their frequency in healthy controls.

INTRODUCTION:

Patients with asthma have a higher frequency of irritable bowel syndrome and psychiatric disorders.

METHODS:

We evaluated 101 patients with bronchial asthma and 67 healthy subjects. All subjects completed the brief version of the Bowel Symptoms Questionnaire and a structured clinical interview for DSM-IV axis disorders (SCID-I/CV).

RESULTS:

There were 37 cases of irritable bowel syndrome in the group of 101 stable asthma patients (36.6%) and 12 cases in the group of 67 healthy subjects (17.9%) (p = 0.009). Irritable bowel syndrome comorbidity was not related to the severity of asthma (p = 0.15). Regardless of the presence of irritable bowel syndrome, psychiatric disorders in asthma patients (52/97; 53.6%) were more common than in the control group (22/63, 34.9%) (p = 0.02). Although psychiatric disorders were more common in asthma patients with irritable bowel syndrome (21/35, 60%) than in those without irritable bowel syndrome (31/62, 50%), the difference was not significant (p = 0.34). In asthma patients with irritable bowel syndrome and psychiatric disorders, the percentage of forced expiratory volume in 1 s (FEV₁) was lower than it was in those with no comorbidities (p = 0.02).

CONCLUSIONS:

Both irritable bowel syndrome and psychiatric disorders were more common in asthma patients than in healthy controls. Psychiatric disorders were more common in asthma patients with irritable bowel syndrome than in those without irritable bowel syndrome, although the differences failed to reach statistical significance. In asthma patients with IBS and psychiatric disorders, FEV₁s were significantly lower than in other asthma patients. It is important for clinicians to accurately recognize that these comorbid conditions are associated with additive functional impairment.     

Risk factors of child physical abuse by parents with mixed anxiety-depressive disorder or posttraumatic stress disorder

Aim

To determine the risk that parents with mixed anxiety and depressive disorder (MADD) or posttraumatic stress disorder (PTSD) will physically abuse their child and evaluate the specific contribution of mental health, perceived social support, experience of childhood abuse, and attributes of family relations to the risk of child physical abuse.

Method

The study conducted in 2007 included men (n = 25) and women (n = 25) with a diagnosis of MADD, men with a diagnosis of PTSD (n = 30), and a control sample of parents from the general population (n = 100, 45 men and 55 women) with children of elementary school age. General Information Questionnaire, Child Abuse Experience Inventory, Perceived Social Support Scale, and the Child Abuse Potential Inventory (CAPI) Clinical Abuse Scale were used.

Results

Total results on the Clinical Abuse Scale of the CAPI indicated higher risk of child physical abuse in parents with MADD (273.3 ± 13.6) and in fathers with PTSD (333.21 ± 17.98) than in parents from the general population (79.6 ± 9.9) (F = 110.40, P < 0.001; t_PTSD,MADD = 13.73, P < 0.001). A hierarchical regression analysis showed that the greatest predictors in the multivariate model were mental health difficulties, poorer economic status, poor social support, and physical and verbal aggression in partner conflicts.

Conclusion

Parents with MADD and PTSD exhibit high risk of child abuse. Since parents with PTSD have significantly higher risk of child abuse than parents with MADD, further large-sample research is needed to clarify the relationship between PTSD intensity and the risk of child abuse.The World Health Organization lists family violence as one of the most important contemporary public health issues. It defines physical abuse of children as “any intentional use of physical action against a child that causes or is likely to cause harm to the child’s health, survival, development or dignity, including beating, kicking, shaking, biting, strangulation, scalding, burning, deliberate poisoning and suffocation, or failure to prevent physical injury (or suffering)” (1).Contemporary theoretical models explain child abuse in the family as a complex phenomenon caused by an interaction of multiple factors (2,3) at different ecological levels – individual, relational, community, and societal. In this study, the focus is on parent-related individual and relationship factors. The individual risk factors include circumstances in the parent’s personal history that can increase the risks for child abuse. Previous research has focused on the history of maltreatment in parents’ childhood, mental health problems, lack of self-control when upset or angry, misuse of alcohol or drugs, social isolation, poor parenting skills, positive attitude toward the use of physical punishment as a means for discipline, and financial difficulties. The most important relationship risk factors include mental health problems of family members, marriage or intimate relationship difficulties, partner violence in the family, lack of support network in stressful or difficult life situations, and lack of support in child rearing from family members (3).Although international research demonstrated that psychiatric disorders were an important risk factor for child maltreatment (4-8), no research focusing on this topic has been carried out in Croatia so far. International research indicated that the most frequently analyzed groups of disorders in child-abusing parents were anxiety disorders, depression, antisocial behaviors, personality disorders, and dissociative disorders. However, most of the previous studies have neglected several important methodological concerns. First, the parents who are usually included in these studies are the mothers, whereas the study of the fathers’ mental health problems associated with child abuse has received much less attention. Second, posttraumatic stress disorder (PTSD) is rarely included in research as a predictor or risk factor for abuse – it is more often studied as a consequence of exposure to family violence (9-11). Also, while there are studies on mental health difficulties of parents who have been registered for violence against children, clinical populations of parents have been much less studied.The focus of this research is the risk assessment of child abuse by parents of both sexes who have not been registered as perpetrators of violence against children, and who have a diagnosis of a psychiatric disorder – PTSD or mixed anxiety and depression disorder (MADD). Starting from ecosystem and interactive models of violence against children in the family, mental disorders of the parents were considered in interaction with their socio-demographic characteristics and personal histories (such as childhood abuse), as well as current family dynamics (such as social support and quality of partner relations). The aims of this study were:1. To compare the risk of physical child abuse, perceived social support, experience of childhood abuse, and some characteristics of family relations between parents with MADD, parents with PTSD, and parents from the general population.2. To test the contribution of mental health, perceived social support, the experience of childhood abuse, and some features of family relations to the risk of physical child abuse by parents with MADD or PTSD and by parents from the general population.     

The impact of a discrepancy between actual and preferred living arrangements on life satisfaction among the elderly in China

OBJECTIVES:

To explore the effects of a discrepancy between actual and preferred living arrangements on the relationship between living arrangements and life satisfaction among the elderly in China.

METHODS:

Secondary analysis of the 2005 dataset of the Chinese Longitudinal Healthy Longevity Survey was performed. A binary logistic regression model was used to analyze the relationship between life satisfaction and living arrangements.

RESULTS:

Among those with concordant actual and preferred living arrangements, living in a nursing home increased the likelihood of life satisfaction, whereas living alone and living with a spouse decreased the likelihood of life satisfaction compared to living with the next generation and a spouse. Among those with discordant living arrangements, there were no differences in life satisfaction between the various living arrangements, except that living with a spouse increased life satisfaction compared to living with the next generation and a spouse.

CONCLUSIONS:

A discrepancy between actual and preferred living arrangements modifies the relationship between life satisfaction and actual living arrangement. Living in a nursing home is a good option for Chinese elder care only if the older individual emotionally accepts it. Living alone or with a spouse is not a good arrangement for elder care, even though it is often preferred by the elderly. Those with discordant living arrangements are more satisfied living with their spouses.     

Psychiatric Morbidity,Pain Perception,and Functional Status of Chronic Pain Patients in Palliative Care

Context:

Psychological factors, such as that exist when we experience pain, can profoundly alter the strength of pain perception.

Aim:

The study aims to estimate the prevalence of psychiatric disorders, and its association with perception of pain and functional status in chronic patients in palliative care.

Materials and Methods:

The sample was selected via simple randomisation and post consent were assessed using (1) a semi- structured questionnaire to elicit socio-demographic information and medical data (2) Brief Pain Inventory (3) ICD-10 Symptom Checklist (4) ICD-10-Diagnostic Criteria for Research (DCR) (5) Montgomery Asberg Depression Rating Scale (MADRS) (6) Covi Anxiety Rating Scale (7) Karnofsky Performance Status Scale. Data was analysed using independent sample t test and chi square test.

Results:

The psychiatric morbidity was 67% with depression and adjustment disorders being the major diagnosis. There was a significant association between psychiatric morbidity pain variables (P = 0.000). Psychiatric morbidity significantly impaired activity, mood, working, walk, sleep, relationship, and enjoyment. There was no association between aetiology of pain, type of cancer, treatment for primary condition and treatment for pain and psychiatric morbidity. The functional status of cancer patients was also poorer in patients with psychiatric morbidity (P = 0.008).

Conclusion:

There is a high prevalence of psychiatric illness in chronic pain patients of any aetiology. Psychiatric morbidity is associated with increased pain perception, impairment in activity and poor functional status.     

Pandemic influenza A(H1N1)pdm09: risk of infection in primary healthcare workers

Background

Healthcare workers in primary care are at risk of infection during an influenza pandemic. The 2009 influenza pandemic provided an opportunity to assess this risk.

Aim

To measure the prevalence of seropositivity to influenza A(H1N1)pdm09 among primary healthcare workers in Canterbury, New Zealand, following the 2009 influenza pandemic, and to examine associations between seropositivity and participants’ sociodemographic characteristics, professional roles, work patterns, and seasonal influenza vaccination status.

Design and setting

An observational study involving a questionnaire and testing for influenza A(H1N1)pdm09 seropositivity in all primary healthcare workers in Canterbury, New Zealand between December 2009 and February 2010.

Method

Participants completed a questionnaire that recorded sociodemographic and professional data, symptoms of influenza-like illness, history of seasonal influenza vaccination, and work patterns. Serum samples were collected and haemagglutination inhibition antibody titres to influenza A(H1N1)pdm09 measured.

Results

Questionnaires and serum samples were received from 1027 participants, from a workforce of 1476 (response rate 70%). Seropositivity was detected in 224 participants (22%). Receipt of seasonal influenza vaccine (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.2 to 3.3), recall of influenza (OR = 1.9, 95% CI = 1.3 to 2.8), and age ≤45 years (OR = 1.4, 95% CI = 1.0 to 1.9) were associated with seropositivity.

Conclusion

A total of 22% of primary care healthcare workers were seropositive. Younger participants, those who recalled having influenza, and those who had been vaccinated against seasonal influenza were more likely to be seropositive. Working in a dedicated influenza centre was not associated with an increased risk of seropositivity.     

Classification of the severity of diabetic neuropathy: a new approach taking uncertainties into account using fuzzy logic

OBJECTIVE:

This study proposes a new approach that considers uncertainty in predicting and quantifying the presence and severity of diabetic peripheral neuropathy.

METHODS:

A rule-based fuzzy expert system was designed by four experts in diabetic neuropathy. The model variables were used to classify neuropathy in diabetic patients, defining it as mild, moderate, or severe. System performance was evaluated by means of the Kappa agreement measure, comparing the results of the model with those generated by the experts in an assessment of 50 patients. Accuracy was evaluated by an ROC curve analysis obtained based on 50 other cases; the results of those clinical assessments were considered to be the gold standard.

RESULTS:

According to the Kappa analysis, the model was in moderate agreement with expert opinions. The ROC analysis (evaluation of accuracy) determined an area under the curve equal to 0.91, demonstrating very good consistency in classifying patients with diabetic neuropathy.

CONCLUSION:

The model efficiently classified diabetic patients with different degrees of neuropathy severity. In addition, the model provides a way to quantify diabetic neuropathy severity and allows a more accurate patient condition assessment.